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The Annals of Thoracic Surgery Oct 2021
Topics: Guilt; Humans; Liver Diseases
PubMed: 33571497
DOI: 10.1016/j.athoracsur.2020.11.076 -
World Journal of Gastroenterology Nov 2021Due to concomitant changes in pro- and anti-coagulant mechanisms, patients with liver dysfunction have a "rebalanced hemostasis", which can easily be tipped toward... (Review)
Review
Due to concomitant changes in pro- and anti-coagulant mechanisms, patients with liver dysfunction have a "rebalanced hemostasis", which can easily be tipped toward either a hypo- or a hypercoagulable phenotype. Clinicians are often faced with the question whether patients with chronic liver disease undergoing invasive procedures or surgery and those having active bleeding require correction of the hemostasis abnormalities. Conventional coagulation screening tests, such as the prothrombin time/international normalized ratio and the activated partial thromboplastin time have been demonstrated to have numerous limitations in these patients and do not predict the risk of bleeding prior to high-risk procedures. The introduction of global coagulation assays, such as viscoelastic testing (VET), has been an important step forward in the assessment of the overall hemostasis profile. A growing body of evidence now suggests that the use of VET might be of significant clinical utility to prevent unnecessary infusion of blood products and to improve outcomes in numerous settings. The present review discusses the advantages and caveats of both conventional and global coagulation assays to assess the risk of bleeding in patients with chronic liver disease as well as the current role of transfusion and hemostatic agents to prevent or manage bleeding.
Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Hemostasis; Humans; Liver Diseases; Thrombelastography
PubMed: 34876789
DOI: 10.3748/wjg.v27.i42.7285 -
Rheumatology International May 2019The objective was to investigate the clinical and histological features of liver dysfunction in patients with polymyositis (PM) or dermatomyositis (DM).A total of 115...
The objective was to investigate the clinical and histological features of liver dysfunction in patients with polymyositis (PM) or dermatomyositis (DM).A total of 115 patients (38 with PM and 77 with DM), who were admitted to our hospital between 2001 and 2012, were retrospectively reviewed. Liver dysfunction was defined as an alanine transaminase (ALT) level ≥ 60 U/l and a disproportionate ALT elevation relative to the creatine kinase level. The histological findings from liver biopsies were also assessed.The frequencies of liver dysfunction were 3% and 17% in the patients with PM and DM, respectively. Liver dysfunction was not observed in the patients who had malignancies. Among the patients with DM with no malignancies (n = 50), 20% had liver dysfunction, and all of the patients with liver dysfunction were positive for the anti-melanoma differentiation-associated gene 5 (MDA5) antibody. Compared with those in the patients who did not have liver dysfunction, the ALT, alkaline phosphatase, γ-glutamyl transferase, and KL-6 levels were significantly elevated in the patients who had liver dysfunction. Six patients, comprising four with DM and two with PM, underwent liver biopsies, and the common histological findings associated with DM were steatosis, hepatocyte ballooning, increases in the pigmented macrophage numbers, and glycogenated nuclei. Hemophagocytosis was detected in two of three patients with DM who underwent liver biopsies and bone marrow aspirations. In conclusion, Liver dysfunction might be an extramuscular manifestation in patients with DM who are anti-MDA5 antibody-positive. Steatosis and hepatocyte ballooning could be common histological features.
Topics: Adult; Aged; Alanine Transaminase; Alkaline Phosphatase; Autoantibodies; Creatine Kinase; Dermatomyositis; Fatty Liver; Female; Humans; Interferon-Induced Helicase, IFIH1; Liver; Liver Diseases; Male; Middle Aged; Mucin-1; Polymyositis; gamma-Glutamyltransferase
PubMed: 30790016
DOI: 10.1007/s00296-019-04255-2 -
Anaesthesia and Intensive Care May 1991Abnormal liver function commonly accompanies critical illness. Ischaemic hepatitis occurs with shock and is characterised by elevated plasma aminotransferase... (Review)
Review
Abnormal liver function commonly accompanies critical illness. Ischaemic hepatitis occurs with shock and is characterised by elevated plasma aminotransferase concentrations. 'ICU jaundice' occurs later in critical illness, especially after trauma and sepsis. The major biochemical abnormality is conjugated hyperbilirubinaemia. The clinical setting suggests that hepatic ischaemia and hepatotoxic actions of inflammatory mediators are the major aetiological factors. Massive blood transfusion, effects of nutritional support and drug toxicity may contribute. Both the presence and degree of jaundice are associated with increased mortality in several nonhepatic diseases. It is proposed that Kupffer cell phagocytic depression associated with liver dysfunction permits systemic spread of endotoxin and inflammatory mediators and thus predisposes to multiple organ failure. Immunosuppression, metabolic abnormalities, impaired drug oxidation and myocardial depression may contribute to the poor prognosis. There is no specific treatment, but prompt resuscitation, definitive treatment of sepsis and meticulous supportive care will likely reduce the incidence and severity.
Topics: Animals; Chemical and Drug Induced Liver Injury; Critical Care; Drug-Related Side Effects and Adverse Reactions; Hepatitis; Humans; Ischemia; Jaundice; Liver; Liver Diseases
PubMed: 2069235
DOI: 10.1177/0310057X9101900203 -
The Proceedings of the Nutrition Society Nov 2007Parenteral nutrition is life saving in patients with intestinal failure but liver dysfunction is commonly encountered, especially in neonates. Although abnormal liver... (Review)
Review
Parenteral nutrition is life saving in patients with intestinal failure but liver dysfunction is commonly encountered, especially in neonates. Although abnormal liver function tests associated with short-term parenteral nutrition are usually benign and transient, liver dysfunction in both children and adults receiving long-term parenteral nutrition can progress to end-stage liver disease and liver failure. The aetiology of parenteral nutrition-associated liver disease is complex and multifactorial, with a range of patient, disease and nutrition-related factors implicated. Sepsis is of particular importance, as is the lack of enteral nutrition and overfeeding with intravenous glucose and/or lipid. Deficiencies of a number of amino acids including choline and taurine have also been implicated. Management of hepatic dysfunction in parenteral nutrition should initially focus on preventing its occurrence. Sepsis should be managed appropriately, enteral nutrition should be encouraged and maximised where possible and parenteral overfeeding should be avoided. Provision of parenteral lipid should be optimised to prevent the adverse effects of both deficiency and excess, and cyclical rather than continuous parenteral feeding should be administered. There is some evidence of benefit in neonates from oral antibiotics to prevent intestinal bacterial overgrowth and from oral ursodeoxycholic acid, but less to support their use in adults. Similarly, data to support widespread use of parenteral choline or taurine supplementation are lacking at present. Ultimately, severe parenteral nutrition-associated liver disease may necessitate referral for small intestine and/or liver transplantation.
Topics: Anti-Bacterial Agents; Cholestasis; Enteral Nutrition; Humans; Liver Diseases; Parenteral Nutrition; Risk Factors; Sepsis; Ursodeoxycholic Acid
PubMed: 17961274
DOI: 10.1017/S002966510700585X -
The Veterinary Clinics of North... Jul 2011This article reviews the common pathophysiology that constitutes hepatic dysfunction, regardless of the inciting cause. The systemic consequences of liver failure and... (Review)
Review
This article reviews the common pathophysiology that constitutes hepatic dysfunction, regardless of the inciting cause. The systemic consequences of liver failure and the impact of this condition on other organ systems are highlighted. The diagnostic tests available for determining the cause and extent of liver dysfunction are outlined, treatment strategies aimed at supporting hepatic health and recovery are discussed, and prognosis is briefly covered. The article emphasizes the fact that because of the central role of the liver in maintaining normal systemic homeostasis, hepatic dysfunction cannot be effectively addressed as an isolated entity.
Topics: Animals; Central Nervous System Diseases; Critical Illness; Humans; Liver; Liver Diseases; Liver Failure, Acute; Risk Factors; Sepsis; Species Specificity; Systemic Inflammatory Response Syndrome; Water-Electrolyte Imbalance
PubMed: 21757090
DOI: 10.1016/j.cvsm.2011.04.002 -
Interactive Cardiovascular and Thoracic... Nov 2022The aim of this study was to perform a meta-analysis of studies reporting outcomes in patients with liver dysfunction addressed by the model of end-stage liver disease... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this study was to perform a meta-analysis of studies reporting outcomes in patients with liver dysfunction addressed by the model of end-stage liver disease and Child-Turcotte-Pugh scores undergoing cardiac surgery.
METHODS
A systematic literature search was conducted to identify contemporary studies reporting short- and long-term outcomes in patients with liver dysfunction compared to patients with no or mild liver dysfunction undergoing cardiac surgery (stratified in high and low score group based on the study cut-offs). Primary outcome was perioperative mortality. Secondary outcomes were perioperative neurological events, prolonged ventilation, sepsis, bleeding and/or need for transfusion, acute kidney injury and long-term mortality.
RESULTS
A total of 33 studies with 48 891 patients were included. Compared with the low score group, being in the high score group was associated with significantly higher risk of perioperative mortality [odds ratio (OR) 3.72, 95% confidence interval (CI) 2.75-5.03, P < 0.001]. High score group was also associated with a significantly higher rate of perioperative neurological events (OR 1.49, 95% CI 1.30-1.71, P < 0.001), prolonged ventilation (OR 2.45, 95% CI 1.94-3.09, P < 0.001), sepsis (OR 3.88, 95% CI 2.07-7.26, P < 0.001), bleeding and/or need for transfusion (OR 1.95, 95% CI 1.43-2.64, P < 0.001), acute kidney injury (OR 3.84, 95% CI 2.12-6.98, P < 0.001) and long-term mortality (incidence risk ratio 1.29, 95% CI 1.14-1.46, P < 0.001).
CONCLUSIONS
The analysis suggests that liver dysfunction in patients undergoing cardiac surgery is independently associated with higher risk of short and long-term mortality and also with an increased occurrence of various perioperative adverse events.
Topics: Humans; Liver Diseases; Cardiac Surgical Procedures; Hemorrhage
PubMed: 36477871
DOI: 10.1093/icvts/ivac280 -
Scientific Reports Sep 2020Immune-related adverse events (irAEs) are induced by immune checkpoint inhibitors (ICIs). Liver is one of the main target organs which irAEs occur and we investigated...
Immune-related adverse events (irAEs) are induced by immune checkpoint inhibitors (ICIs). Liver is one of the main target organs which irAEs occur and we investigated the influence of liver dysfunction on prognosis of patients after ICIs. From July 2014 to December 2018, 188 patients with diverse cancers who received ICIs (nivolumab or pembrolizumab) were enrolled. Twenty-nine patients experienced liver dysfunction of any grades after ICIs. Progression-free survival (PFS) was significantly shorter in the liver dysfunction-positive group than in the liver dysfunction-negative group, and a similar result was obtained for Overall survival (OS). Multiple logistic regression analysis revealed liver metastasis and alanine aminotransferase before ICIs were associated with a higher incidence of liver dysfunction after ICIs. Regardless of liver metastasis, PFS and OS were significantly shorter in the liver dysfunction-positive group. In conclusion, this study suggests liver dysfunction is associated with poor prognosis in patients after ICIs with diverse cancers.
Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Immune Checkpoint Inhibitors; Liver; Liver Diseases; Male; Middle Aged; Neoplasms; Nivolumab; Prognosis; Progression-Free Survival
PubMed: 32879383
DOI: 10.1038/s41598-020-71561-2 -
Current Opinion in Critical Care Apr 2013This article reviews the current literature dealing with pathophysiology, diagnostics, bleeding management, and thromboprophylaxis in patients with acute and chronic... (Review)
Review
PURPOSE OF REVIEW
This article reviews the current literature dealing with pathophysiology, diagnostics, bleeding management, and thromboprophylaxis in patients with acute and chronic liver dysfunction.
RECENT FINDINGS
Routine coagulation tests such as prothrombin time and International Normalized Ratio (INR) are not able to define whether a patient with critical liver dysfunction is hypocoagulable or hypercoagulable and are not able to predict the risk of bleeding in patients with liver dysfunction. Therefore, prophylactic transfusion of fresh frozen plasma and platelets in order to correct laboratory values is not appropriate. Notably, patients with liver dysfunction and increased INR are not 'autoanticoagulated'. In contrast, thrombin generation assays in the presence and absence of thrombomodulin or Protac, a snake venom that activates protein C in a manner similar to thrombomodulin, as well as viscoelastic tests (thrombelastography/thromboelastometry) indicate that patients with liver dysfunction are rather hypercoagulable with the inherent risk of thrombosis.
SUMMARY
Coagulopathy in patients with critical liver dysfunction is complex and can quickly decompensate to bleeding as well as to thrombosis. Both are associated with worse outcome. Hemostatic interventions should only be performed in case of clinically relevant bleeding and thromboprophylaxis should strongly be considered.
Topics: Blood Coagulation Disorders; Female; Hemorrhage; Hemostasis; Humans; International Normalized Ratio; Liver Diseases; Male; Partial Thromboplastin Time; Plasma; Risk Factors; Thrombelastography
PubMed: 23400090
DOI: 10.1097/MCC.0b013e32835ebb52 -
Neonatal Network : NN 2003The liver, the largest organ in the body, is critical to a number of key metabolic functions. Its also plays an important role in removing the waste products of... (Review)
Review
The liver, the largest organ in the body, is critical to a number of key metabolic functions. Its also plays an important role in removing the waste products of metabolism (particularly ammonia) and in detoxifying drugs and other substances such as endogenous hormones and steroid compounds. In addition, the liver plays a major role in the production of clotting factors, plasma proteins, bile salts, and bilirubin. Many neonates display signs of hepatic dysfunction such as hyperbilirubinemia, hepatomegaly, or elevated liver enzymes. These often occur secondary to systemic illness, such as sepsis or hypoxic injury, or following the use of drugs or parenteral nutrition to treat other problems. Although rare, primary liver disease does occur in neonates and must be recognized promptly, with treatment initiated in a timely manner to prevent unnecessary sequelae. This article, the third in a series on the liver, examines causes of liver dysfunction in neonates, beginning with an overview of jaundice and hepatomegaly and moving to a discussion of specific diseases.
Topics: Diagnosis, Differential; Hepatomegaly; Humans; Hyperbilirubinemia; Infant, Newborn; Jaundice, Neonatal; Liver Diseases; Liver Function Tests; Neonatal Nursing; Nurse's Role
PubMed: 12795504
DOI: 10.1891/0730-0832.22.3.5