Andrea Mancuso

Review article: the aetiology of primary Budd–Chiari syndrome – differences between the West and China

China may have the largest number of Budd–Chiari syndrome (BCS) cases in the world (at least 1914 original papers were published, and at least 20 191 BCS patients were reported). Considering the discrepancy in the clinical profiles and preferred treatment selection of primary BCS between the West and China, understanding its aetiology in these two different regions is very important.

Transient portal vein thrombosis in liver cirrhosis

In real-world clinical practice, the acceptance of anticoagulation therapy in the management of portal vein thrombosis (PVT) in patients with cirrhosis is limited by the fear of an increased bleeding risk. Additionally, accumulating evidence indicates that spontaneous recanalization of PVT may occur in the absence of antithrombotic treatment. Therefore, risk stratification based on outcomes in such patients is crucial for determining a therapeutic strategy. In this paper, we draw attention to the distinct clinical entity, “transient PVT” by introducing two cases with PVT that spontaneously recanalized in the absence of antithrombotic treatment. We reviewed the available data regarding the probability of and predictors for spontaneous recanalization of PVT. Available data suggest singling out transient thrombosis in the natural history of PVT in patients with cirrhosis because of its prognostic and management implications.

Albumin-to-bilirubin score for assessing the in-hospital death in cirrhosis

BackgroundnTo evaluate the ability of albumin-to-bilirubin (ALBI) score for assessing the in-hospital death in cirrhotic patients.nnnMethodsnOverall, 1,067 cirrhotic patients admitted between January 2009 and December 2014 were retrospectively enrolled. We calculated the Child-Pugh, model for end-stage liver disease (MELD), and ALBI scores. We performed receiver operating characteristic curve (ROC) analyses to assess the in-hospital death. We calculated the area under the ROC curve (AUC).nnnResultsnIn the overall analysis, all of the three scores can significantly assess the in-hospital death (Child-Pugh score AUC =0.750, 95% CI: 0.713-0.784, P<0.0001; MELD score AUC =0.728, 95% CI: 0.689-0.765, P<0.0001; ALBI score AUC =0.698, 95% CI: 0.667-0.727, P<0.0001). In the subgroup analysis of hepatitis B virus, Child-Pugh and ALBI scores were suitable to assess in-hospital death (Child-Pugh score AUC =0.752, 95% CI: 0.679-0.816, P<0.0001; ALBI score AUC =0.803, 95% CI: 0.751-0.849, P=0.0002) and both were superior to the MELD score (AUC=0.564, 95% CI: 0.483-0.643, P=0.5357). In the subgroup analysis of alcohol abuse, Child-Pugh and MELD scores properly assessed in-hospital death (Child-Pugh score AUC =0.791, 95% CI: 0.727-0.846, P<0.0001; MELD score AUC =0.720, 95% CI: 0.647-0.786, P=0.0023), rather than ALBI score (AUC =0.646, 95% CI: 0.588-0.702, P=0.1360).nnnConclusionsnALBI score might be an alternative index for assessing the in-hospital death in patients with liver cirrhosis.

Xuebijing Injection Combined with Antibiotics for the Treatment of Spontaneous Bacterial Peritonitis in Liver Cirrhosis: A Meta-Analysis

Background and Aim Spontaneous bacterial peritonitis (SBP) is one of the most common complications of liver cirrhosis. Antibiotics are the main treatment regimen of SBP. Traditional Chinese medicine Xuebijing injection has been used in such patients. Our study aimed to overview the efficacy of Xuebijing injection combined with antibiotics for the treatment of SBP. Method We searched the PubMed, Embase, China National Knowledge Infrastructure, VIP, and Wanfang databases. The search items included “Xuebijing”, “peritonitis”, “liver cirrhosis”, and “random” to identify all relevant randomized controlled trials (RCTs). The Cochrane risk of bias tool was used to assess the study quality. The odd ratios (ORs) with 95% confidence intervals (CIs) were calculated by using a random-effect model. Heterogeneity was also calculated. Results A total of 9 RCTs were included. The study quality was unsatisfied. The overall (OR = 2.95, 95% CI = 1.97–4.42, p < 0.00001) and complete (OR = 2.18, 95% CI = 1.57–3.04, p < 0.00001) responses were significantly higher in the Xuebijing injection combined with antibiotics group than the antibiotics alone group. The incidence of cirrhosis related complications, including hepatic encephalopathy and hepatorenal syndrome, was lower in the Xuebijing injection combined with antibiotics group than the antibiotics alone group. No significant heterogeneity was observed among studies. Conclusion Additional use of Xuebijing injection may improve the efficacy of antibiotics for the treatment of SBP in liver cirrhosis. However, due to a low level of current evidence, we did not establish any recommendation regarding the use of Xuebijing injection for the treatment of SBP.

Diabetes mellitus and liver disease

Nonalcoholic fatty liver disease (NAFLD) is characterized by accumulation of fat in hepatocytes with or without evidence of significant necro-inflammation or fibrosis.

Prognostic Assessment and Management of Liver Cirrhosis

1Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China 2Worthing Hospital, Western Sussex NHS Foundation Trust, West Sussex, UK 3Department of Gastroenterology, General Hospital of Chengdu Military Area, Chengdu, China 4Medicina Interna 1, ARNAS Civico-Di Cristina-Benfratelli, Piazzale Liotti 4, Palermo, Italy 5Epatologia e Gastroenterologia, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy 6Faculdade de Medicina de Botucatu, UNESP, Campus de Botucatu, s/n, Botucatu, SP, Brazil

Association of hepatitis B e antigen and DNA viral load with severity of liver dysfunction and in-hospital outcomes in hepatitis B-related liver cirrhosis

Background: Hepatitis B virus (HBV) infection is a common cause of liver cirrhosis. Our study aimed to evaluate the clinical relevance of hepatitis B e antigen (HBeAg) and HBV DNA viral load in HBV-related liver cirrhosis. n Methods: All HBV-related cirrhosis patients consecutively admitted to our hospital between January 2012 and June 2014 were retrospectively reviewed. Clinical profiles were collected. HBV DNA viral load would be detectable, if HBV DNA viral load was >200 IU/mL. n Results: Overall, 428 patients were included. The prevalence of positive HBeAg was 11.9% (40/335). HBeAg-positive patients had significantly higher proportions of moderate-large ascites and Child-Pugh class B/C than HBeAg-negative patients. The in-hospital mortality was not significantly different between them. The prevalence of detectable HBV DNA viral load was 38.25% (109/285). Patients with detectable HBV DNA viral load had a significantly higher proportion of moderate-large ascites and higher Child-Pugh and model for end-stage liver disease (MELD) scores than patients with undetectable HBV DNA viral load. The in-hospital mortality was not significantly different between them. The prevalence of HBV DNA viral load >2,000 IU/mL was 31.9% (91/285). Patients with HBV DNA viral load >2,000 IU/mL had significantly higher proportions of moderate-large ascites and in-hospital death and higher Child-Pugh and MELD scores than patients with HBV DNA viral load 2,000 IU/mL was not significantly associated with in-hospital death (odds ratio =2.154, P=0.272). n Conclusions: In HBV-related cirrhosis, HBeAg and HBV DNA viral load were significantly associated with the severity of liver dysfunction, but not independently associated with in-hospital death.

Neutrophil to lymphocyte ratio and albumin-bilirubin score for predicting the in-hospital mortality of hepatocellular carcinoma with acute upper gastrointestinal bleeding

Background: Acute upper gastrointestinal bleeding (AUGIB) represents a major risk factor for mortality in patients with hepatocellular carcinoma (HCC) and liver cirrhosis. This retrospective observational study aimed to evaluate the prognostic performance of neutrophil to lymphocyte ratio (NLR) and albumin-bilirubin (ALBI) score for the assessment of in-hospital outcomes of cirrhotic patients with HCC and AUGIB. Methods: All consecutive HCC patients with AUGIB were included in our study. The areas under the receiving operator characteristics curves (AUCs) of NLR, platelet to lymphocyte ratio (PLR), ALBI score, Child-Pugh score, and model of end-stage liver disease (MELD) score for predicting the in-hospital mortality were calculated. Results: Overall, 191 HCC patients with AUGIB were included. In the overall analysis, the AUCs of NLR, PLR, ALBI score, Child-Pugh score, and MELD score were 0.74 (P=0.0007), 0.486 (P=0.8681), 0.78 (P Conclusions: Patients with HCC and AUGIB have a high risk of in-hospital mortality, and NLR and ALBI score appear as promising predictors of adverse outcome. Future studies should prospectively evaluate these scores, potentially in conjunction with other bio-markers, to improve prognostication in clinical practice.

Prevalence and in-hospital outcomes of diabetes mellitus in elderly patients with liver cirrhosis

Background: A retrospective, single-center, observational study aimed to evaluate the prevalence and in-hospital outcomes of diabetes mellitus (DM) in elderly patients with liver cirrhosis. n Methods: All electronic records of consecutive patients diagnosed with liver cirrhosis without malignancy at our hospital from January 2012 to June 2014 were retrospectively collected. Patient cohorts were subdivided according to age (elderly: above 60 years), presence of DM and glycemic control of DM patients (HbA1c 7%), patient characteristics, liver cirrhosis complications and in-hospital mortality were assessed. n Results: Overall, 36.9% (452/1,225) of cirrhotic patients were elderly, and 20.6% (252/1,225) of them had DM. Elderly patients had a significantly higher percentage of DM than non-elderly patients [25.9% (117/452) versus 17.5% (135/773), P=0.001]. Elderly patients with DM had a significantly higher in-hospital mortality than those without DM [8.5% (10/117) versus 1.8% (6/335), P=0.002], but Child-Pugh and MELD scores were similar between them. Additionally, good diabetic control was significantly associated with a lower Child-Pugh score, but not in-hospital mortality. n Conclusion: DM is more common in elderly patients with liver cirrhosis. DM may increase the in-hospital mortality in such patients, independent from the stage of cirrhosis.