Christian Labenz

Impact of Individual Components of the Metabolic Syndrome on the Outcome of Patients with Advanced Hepatocellular Carcinoma Treated with Sorafenib

Background/Aim: Individual components of the metabolic syndrome (MS) such as obesity or diabetes mellitus impair the prognosis of patients with hepatocellular carcinoma (HCC) following curative treatment approaches or transarterial therapies. The aim of this retrospective study was to assess the impact of these factors on the overall survival (OS) of patients with advanced HCC treated with sorafenib. Methods: Univariate and multivariate analyses were performed to assess the impact of individual components of the MS on the OS of 152 consecutive patients with advanced HCC treated with sorafenib. Results: The presence of overweight/obesity, type 2 diabetes mellitus, hypertension, dyslipidemia, and of the MS itself did not impair the median OS. Multivariate analysis showed that Eastern Cooperative Oncology Group Performance Status ≥1 (hazards ratio [HR] 2.03), presence of macrovascular invasion (HR 1.71), Child-Pugh score B/C (HR 2.19), tumor grading G3 (HR 2.17), no prior HCC treatment (HR 2.34), and the presence of 2 or more out of 5 individual components of the MS (HR 0.65) were independent prognostic factors regarding the median OS. Conclusions: Our investigations do not confirm a negative prognostic role of individual components of the MS or the MS itself for patients with advanced HCC treated with sorafenib.

Prospective evaluation of the impact of covert hepatic encephalopathy on quality of life and sleep in cirrhotic patients

Minimal hepatic encephalopathy (HE) and HE grade 1 (HE1) according to the West Haven criteria have recently been grouped as one entity named—covert HE‐ (CHE). Data regarding the impact of CHE on health‐related quality of life (HRQoL) and sleep quality are controversial.

Epidemiology of hepatic encephalopathy in german hospitals – the EpHE study

Background Hepatic encephalopathy (HE) is a serious complication of liver cirrhosis. The proportion of patients with liver cirrhosis attending German hospitals suffering from HE is unknown. Methods In the first part of the study, data of 14 community hospitals and 5 university hospitals covering the years 2010 and 2011 were analyzed retrospectively for the DRG codes of liver cirrhosis and hepatic encephalopathy. In the second prospective part of the multicenter observational study, all patients with liver cirrhosis attending the departments of gastroenterology of 16 participating community hospitals within a study period of 3 months were included and screened for HE clinically according to the West Haven criteria (grades 1 - 4). Results A diagnosis of liver cirrhosis has been coded in 6366 cases in 2010 and in 7279 cases in 2011. In the vast majority of hospitals, less than 20 % of these cases had an additional DRG code for HE. Two hundred seventy-eight patients with liver cirrhosis were included into the prospective study. A clinically detectable HE was present in 36 % of the patients (n = 99). The majority was classified as West Haven 1 (n = 59, 59.6 %). Of the patients without clinical sings of HE, 48 % (n = 134) showed a pathological NCT. Conclusion Our data suggest that HE is underdiagnosed in German hospitals. Since treatment of HE may improve the prognosis of the patients as well as their quality of life, hospitalized patients with liver cirrhosis should be routinely screened for HE.

Diagnostik und konservative Therapie der Divertikelblutung

Blutungen aus dem Verdauungstrakt gehoren zu den haufigsten Notfallen in der klinischen Routine. Das Spektrum reicht von geringen Blutbeimengungen zum Stuhl bis hin zu Massenblutungen. Leitsymptome konnen die sichtbaren Blutverluste, aber auch die Folgen des Blutverlustes mit allgemeiner Schwache, Schock und Versagen wichtiger Organfunktionen sein. Es ist von immenser Bedeutung, dass in einer solchen Notfallsituation rasch und umsichtig gehandelt wird, um die Ursache der Blutung zu eruieren, die Blutung wenn notwendig zu stillen und die Folgen des Blutverlustes zu kompensieren bzw. zu beheben.

Validation of the simplified Animal Naming Test as primary screening tool for the diagnosis of covert hepatic encephalopathy

BACKGROUND Diagnosis of covert hepatic encephalopathy (CHE) is time consuming in clinical practice. Recently, a new diagnostic tool - the simplified Animal Naming Test (S-ANT1) - was presented with promising results in an Italian cohort. The aim of the present study was to validate S-ANT1 in a cohort of cirrhotic patients from a German tertiary referral centre. METHODS 143 cirrhotic patients and 37 healthy controls were enrolled. Hepatic encephalopathy (HE) grade 1 (HE1) was clinically diagnosed according to the West-Haven Criteria. Critical flicker frequency and Psychometric Hepatic Encephalopathy Score were used to detect minimal HE (MHE). All participants were additionally examined by S-ANT1. RESULTS 58 (40.6%) patients presented with CHE (40 MHE, 18 HE1). S-ANT1 was lowest in patients with HE1, followed by patients with MHE, patients without CHE, and healthy controls, respectively (each p < 0.05). Naming <20 animals discriminated best between patients with and without CHE in ROC analysis (with Youdens index). With a cut-off value of ≥23 mentioned animal names further testing for CHE could be avoided in 38.5% of patients with a negative predictive value of 84%. CONCLUSIONS S-ANT1 may become an important first screening tool for the assessment of CHE in clinical practice.

Predictors of advanced fibrosis in non-cirrhotic non-alcoholic fatty liver disease in Germany

Advanced fibrosis has been established as the most important predictor of overall mortality in patients with non‐alcoholic fatty liver disease (NAFLD). In contrast to cirrhosis, advanced, non‐cirrhotic NAFLD is difficult to identify and data from Germany are lacking.

Chronischer Oberbauchschmerz: Diese organische Erkrankungen können die Ursache sein

Chronische oder wiederkehrende Oberbauchschmerzen sind haufig. Das Ursachenspektrum reicht von harmlosen Funktionsstorungen bis hin zu lebensbedrohlichen Erkrankungen. Durch sorgfaltige Anamnese und korperliche Untersuchung sollte im ersten Schritt die Differentialdiagnose eingegrenzt und somatische von viszeralen Schmerzen unterschieden werden. Chronische Bauchwandschmerzen werden haufig nicht als solche erkannt mit der Konsequenz uberflussiger Diagnostik und ineffektiver Therapie. Viszerale Schmerzen werden oft entsprechend der embryonalen Entwicklung in bestimmte Segmente der Mittellinie des Abdomens projiziert. Die Differentialdiagnose ist oft breit. Neben organpathologischen Erkrankungen sind funktionelle Storungen, Nebenwirkungen von Medikamenten und auch psychosomatische Ursachen zu berucksichtigen. Die Diagnostik sollte von den Symptomen und Begleitsymptomen geleitet werden. Als Basisdiagnostik empfehlen sich eine Laboruntersuchung, eine Sonografie der Abdominalorgane sowie eine Osophago-Gastro-Duodenoskopie mit Entnahme von Gewebeproben. Bei persistierender Symptomatik und unergiebiger Basisdiagnostik ist eine systematische Abklarung angezeigt.