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Zhou X, Miu Y, Guo X, Wang J, Su T, Du H, Wang S, Zhang Y, Qiu Y, Zhao W. Observation on the Effect of Sequentially Combined Multi-modal Artificial Liver Treatment on HBV-related Acute-on-chronic Liver Failure. Curr Mol Med 2024; 24:1152-1158. [PMID: 37807648 DOI: 10.2174/0115665240253035230920041207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/31/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To observe the short-term effect of sequentially combined multimodal artificial liver treatment (SCMALT) on HBV-related acute-on-chronic liver failure (HBV-ACLF). METHODS HBV-ACLF patients 155 cases undergoing artificial liver treatment were analyzed, and they were sorted into the SCMALT group and the conventional-modal artificial liver treatment (CALT) group. The clinical data of all patients were recorded and the serum levels of interleukin-8 (IL-8), chemokine interferon-inducible protein-10 (IP-10), and interleukin-6 (IL-6) were detected. The changes in the 30-day survival rate, cytokine level, model for end-stage liver disease (MELD) score, and complications of artificial liver treatment were analyzed. RESULTS After being followed up for 30 days, 104 patients survived and 51 died. At the end of the whole-course treatment, the decreases in IL-6, IP-10, and IL-8 levels and MELD scores in the SCMALT group were greater than in the CALT group. Cox regression suggested WBC (OR=1.066, 95% CI 1.012-1.123, P=0.017), AT-III activity (OR=0.935, 95% CI 0.907-0.964, p=0.000) at baseline, artificial liver treatment mode (OR=0.362, 95% CI 0.164-0.800, p=0.012), number of artificial liver treatments (OR=0.656.95% CI 0.436-0.986, p=0.043), spontaneous peritonitis (OR=0.337, 95% CI 0.165-0.689, p=0.003), and hepatic encephalopathy (OR=0.104, 95% CI 0.028-0.388, p=0.001) were independent influencing factors of 30-day survival rate. SCMALT can significantly prolong the survival period of the patient. No obvious difference was shown in the proportions of bleeding and circulation instability between the two groups (p>0.05). CONCLUSION Compared with the CALT, SCMALT can more effectively remove inflammatory mediators and reduce the MELD score in HBV-ACLF patients, which can obviously ameliorate the prognosis, with less effect on the platelet count.
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Affiliation(s)
- Xueshi Zhou
- Department of Infectious Disease, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, China
- Department of Infectious Disease ICU, Wuxi Fifth People's Hospital, Wuxi, Jiangsu, 214000, China
| | - Youhan Miu
- Department of Infectious Disease, Nantong Third People's Hospital, Nantong University, Nantong, Jiangsu, 226000, China
| | - Xiaoye Guo
- Department of Infectious Disease ICU, Wuxi Fifth People's Hospital, Wuxi, Jiangsu, 214000, China
| | - Jun Wang
- Department of Infectious Disease ICU, Wuxi Fifth People's Hospital, Wuxi, Jiangsu, 214000, China
| | - Tingting Su
- Department of Infectious Disease ICU, Wuxi Fifth People's Hospital, Wuxi, Jiangsu, 214000, China
| | - Hejuan Du
- Department of Infectious Disease ICU, Wuxi Fifth People's Hospital, Wuxi, Jiangsu, 214000, China
| | - Sen Wang
- National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200000, China
| | - Ying Zhang
- Department of Infectious Disease ICU, Wuxi Fifth People's Hospital, Wuxi, Jiangsu, 214000, China
| | - Yuanwang Qiu
- Department of Infectious Disease ICU, Wuxi Fifth People's Hospital, Wuxi, Jiangsu, 214000, China
| | - Weifeng Zhao
- Department of Infectious Disease, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, China
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Wang XH, Peng BB, Zhang L, Zhao J, Zhang L, Ren H, Hu P, Li H, Zhong S. Mixed mode of artificial liver support in patients with acute-on-chronic liver failure: a retrospective cohort study. Hepatol Int 2023; 17:1241-1250. [PMID: 37550499 DOI: 10.1007/s12072-023-10573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND AND AIMS Different modes of artificial liver support (ALS) therapy can improve the survival of patients with acute-on-chronic liver failure (ACLF). This study aimed to compare the effects of mixed using different modes of ALS (MALS) and single using one mode of ALS (SALS) on 28- and 90-day survival rates of ACLF. METHODS Clinical data and survival times of patients with ACLF treated for ALS between January 1, 2018 and December 30, 2021 were retrospectively collected. Cox regression analysis was performed to identify risk factors of 28- and 90-day mortalities. RESULTS Of the 462 eligible ACLF patients, 388 belonged to the SALS group (76.3% male, 74.2% cirrhosis) and 74 to the MALS group (86.5% male, 71.6% cirrhosis). Comparison of 28-day and 90-day crude mortality between the SALS and MALS groups showed no significant differences (28-day: 20.4% vs. 14.9%, p = 0.27; 90-day: 44.6% vs. 52.7%, p = 0.20). After adjusting for confounders, the 28-day mortality (adjusted hazard ratio [aHR]: 0.32, 95% confidence interval [CI] 0.16-0.65) and 90-day mortality (aHR: 0.65, 95% CI 0.44-0.95) in the MALS group were significantly lower than those in the SALS group. These associations were consistently observed across pre-specified subgroups according to age, sex, etiology, and Child-Pugh grade. However, positive interactions between MALS and 90-day mortality were found between MALS and 90-day mortality in those with MELD score ≥ 22 and international normalized ratio ≥ 1.9 (p for interaction < 0.05). CONCLUSION MALS therapy significantly decreased 28- and 90-day mortalities of ACLF than SALS did, especially in advanced stages.
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Affiliation(s)
- Xiao-Hao Wang
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 401336, China
| | - Bin-Bin Peng
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 401336, China
| | - Lu Zhang
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 401336, China
| | - Jing Zhao
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 401336, China
| | - Li Zhang
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 401336, China
| | - Hong Ren
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 401336, China
| | - Peng Hu
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 401336, China
| | - Hu Li
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 401336, China.
| | - Shan Zhong
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 401336, China.
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Williamson C, Nana M, Poon L, Kupcinskas L, Painter R, Taliani G, Heneghan M, Marschall HU, Beuers U. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. J Hepatol 2023; 79:768-828. [PMID: 37394016 DOI: 10.1016/j.jhep.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 07/04/2023]
Abstract
Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether related to pregnancy or pre-existing, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver Disease invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, specialists in training and other healthcare professionals who provide care for this patient population.
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Sinha S, Yadav J, Pradhan T. A Case Report on Acute Fatty Liver of Pregnancy: A Difficult Differential Diagnosis of Liver Disorder. Cureus 2023; 15:e42733. [PMID: 37654930 PMCID: PMC10467326 DOI: 10.7759/cureus.42733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 09/02/2023] Open
Abstract
Acute fatty liver of pregnancy is a rare but potentially dangerous pregnancy condition with significant maternal and fetal fatality rates. The disorder is driven by a complex pathophysiology and clinically manifests as a rapid worsening in health conditions, increasing the rate of mortality and necessitating expert diagnosis and management. The condition progresses from spontaneous resolution to post-operative complications, resulting in negative consequences. We offer a case report of a young primigravida patient diagnosed with acute fatty liver of pregnancy at term. The report describes the clinical course and its effect. The perinatal result, however, could not be improved due to the late diagnosis. Over the last 40 years, death rates have been dramatically lowered because of competence and a multidisciplinary approach, increasing maternal-fetal outcomes. In this scenario, time management is crucial to success.
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Affiliation(s)
- Shivangni Sinha
- Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Patna, IND
- Obstetrics and Gynecology, BP Koirala Institute of Medical Sciences, Dharan, NPL
| | - Jyotsna Yadav
- Obstetrics and Gynecology, BP Koirala Institute of Medical Sciences, Dharan, NPL
| | - Tarun Pradhan
- Obstetrics and Gynecology, Birat Medical College and Teaching Hospital, Dharan, NPL
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Morrison MA, Chung Y, Heneghan MA. Managing hepatic complications of pregnancy: practical strategies for clinicians. BMJ Open Gastroenterol 2022; 9:e000624. [PMID: 35292523 PMCID: PMC8928321 DOI: 10.1136/bmjgast-2021-000624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022] Open
Abstract
Liver disorders specific to pregnancy are rare but can have potentially serious consequences for mother and fetus. Pregnancy-related liver disorders are the most common cause of liver disease in otherwise healthy pregnant women and pose a challenge to physicians because of the need to take into account both maternal and fetal health. A good knowledge of these disorders is necessary as prompt diagnosis and appropriate management results in improved maternal and fetal outcomes. This review will focus on pregnancy-specific disorders and will aim to serve as a guide for physicians in their diagnosis, management and subsequent monitoring.
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Affiliation(s)
| | - Yooyun Chung
- Institute of Liver Studies, King's College Hospital, London, UK
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Abstract
Acute fatty liver of pregnancy is a rare, but potentially fatal obstetric disorder characterized principally by varying degrees of hepatic failure with an onset typically in late pregnancy. This review outlines the etiopathogenesis and describes the multiorgan involvement that often results in a number of clinical and laboratory aberrations. These laboratory derangements provide distinct features to differentiate from other obstetric complications, such as hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Once recognized, central to the management of acute fatty liver of pregnancy is delivery planning and meticulous supportive care. One particularly dangerous complication is profound coagulopathy. After delivery, the coagulation defect resolves over 1-2 days, and hepatic and renal function are restored soon thereafter. This report offers anticipated recovery and management strategies for commonly associated complications. Application of these factors has served to decrease mortality from as high as 80% down to 10%; however, given the seriousness of this condition, severe maternal morbidities are frequently associated with this obstetric emergency.
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Ye R, Mai Z, Pan X, Cai S, Deng L. Acute fatty liver of pregnancy causes severe acute pancreatitis and stillborn fetus: A case report. Medicine (Baltimore) 2021; 100:e25524. [PMID: 33879692 PMCID: PMC8078285 DOI: 10.1097/md.0000000000025524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Acutefatty liver of pregnancy (AFLP) is a potentially fatal obstetric emergency characterized by acute hepatic failure secondary to fatty infiltration. The resultant effects include coagulopathy, electrolyte abnormalities, and multisystem organ dysfunction. Pancreatitis typically develops after the onset of renal and hepatic dysfunction. Pancreatitis has been suggested as a poor prognostic indicator because it is associated with more adverse outcomes. PATIENT CONCERNS A 29-year-old Chinese woman at 34.7 weeks pregnancy was admitted to hospital due to paroxysmal hypogastric pain and massive colporrhagia for 1 day. DIAGNOSIS Laboratory tests revealed hepatic and renal impairment, coagulopathy. Thoracoabdominal computed tomography (CT) scanning showed pleural and peritoneal effusion, fatty liver, and pancreatitis. She was diagnosed with AFLP, severe acute pancreatitis (SAP), multiple organ dysfunction syndrome (MODS), and intrauterine fetal death. INTERVENTIONS The patient was treated with blood component transfusions, plasma exchange combined with renal replacement therapy, antibiotic de-escalation, gastric and pancreatic secretion inhibitor, and enteral nutrition. OUTCOMES After successful management, the patient was discharged without any complications on day 35 of admission. At 10 months follow-up, thoracoabdominal enhanced CT revealed was normal and laboratory tests revealed normal liver and kidney function. LESSONS Once AFLP is highly suspected or confirmed, the pregnancy should be terminated in time and active symptomatic management should be given.
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Two Fatty Liver Conditions Masquerading as Autoimmune Hepatitis. Case Reports Hepatol 2021; 2021:8820350. [PMID: 33763269 PMCID: PMC7964110 DOI: 10.1155/2021/8820350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/28/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Acute fatty liver of pregnancy (AFLP) is a rare obstetric condition that classically presents in the third trimester or early postpartum period and can lead to liver failure and death. Only six second trimester AFLP cases have been reported in the English literature. We present the earliest case of AFLP at 15 weeks of gestation confounded by a high titer anti-nuclear antibody (ANA >1 : 1280) and concern for autoimmune hepatitis. Our patient had intrauterine fetal demise with prompt dilation and evacuation. Sepsis and multisystem organ failure ensued, and she was transferred to a liver transplant center where she expired without further intervention.
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Aabdi M, Mellagui Y, Ouachaou J, Ounci E, Bkiyar H, Housni B. Plasma exchange as treatment for acute fatty liver disease of pregnancy. Clin Case Rep 2021; 9:1594-1597. [PMID: 33768896 PMCID: PMC7981603 DOI: 10.1002/ccr3.3845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 11/11/2022] Open
Abstract
Acute fatty liver disease of pregnancy AFLP is an obstetrical emergency, with severe complications that may include death. Management of AFLP is challenging and include plasma exchange which helps to improve the prognosis for both mother and fetus and delay liver transplantation.
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Affiliation(s)
- Mohammed Aabdi
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
| | - Yassine Mellagui
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
| | - Jamal Ouachaou
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
| | - Essad Ounci
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
| | - Houssam Bkiyar
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
| | - Brahim Housni
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
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Acute Fatty Liver of Pregnancy: Pathophysiology, Anesthetic Implications, and Obstetrical Management. Anesthesiology 2020; 130:446-461. [PMID: 30707120 DOI: 10.1097/aln.0000000000002597] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A narrative review of the pathophysiology, diagnosis, management, delivery implications, obstetric anesthesia care, and potential critical care needs in patients presenting with acute fatty liver of pregnancy.
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12
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Zhang Y, Li L. State of the art—Artificial liver in China. Artif Organs 2019; 43:336-341. [DOI: 10.1111/aor.13448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/21/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Yimin Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases the First Affiliated Hospital, College of Medicine, Zhejiang University Hangzhou China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases the First Affiliated Hospital, College of Medicine, Zhejiang University Hangzhou China
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Yao J, Li S, Zhou L, Luo L, Yuan L, Duan Z, Xu J, Chen Y. Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure. J Clin Apher 2019; 34:392-398. [PMID: 30758886 PMCID: PMC6767528 DOI: 10.1002/jca.21690] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/07/2019] [Accepted: 01/17/2019] [Indexed: 12/15/2022]
Abstract
Objective The artificial liver support system (ALSS) is used frequently as a first‐line treatment for hepatitis B virus‐associated acute‐on‐chronic liver failure (HBV‐ACLF). This study aims to compare the therapeutic efficacy of double plasma molecular adsorption system (DPMAS) with sequential half‐dose plasma exchange (PE) (DPMAS+PE) and full‐dose PE in patients with HBV‐ACLF. Methods A total of 131 hospitalized patients who were diagnosed with HBV‐ACLF and underwent DPMAS+PE or PE were retrospectively analyzed. According to the treatment methods used, they were divided into PE group (n = 77) and DPMAS+PE group (n = 54). The main evaluation indexes included the change of liver function and the 28‐days liver transplant‐free survival rates after the different treatments. Results There were no significant differences on severity of illness between PE group and DPMAS+PE group (P > 0.05). The total bilirubin (TBIL) levels immediately after treatment, and at 24 and 72 hours after treatment were markedly decreased in DPMAS+PE group than that in PE group (52.3 ± 9.4% vs 42.3 ± 7.2%, P < 0.05; 24.2 ± 10.0% vs 13.5 ± 13.0%, P < 0.05; 24.8 ± 13.1% vs 14.9 ± 14.9%, P < 0.05; respectively). The 28‐days survival rates was 62.3% and 72.2% in PE and DPMAS+PE groups (P = 0.146). Furthermore, the 28‐days survival rates were significantly higher in DPMAS+PE group than that in PE group (57.4% vs 41.7%, P = 0.043) in the intermediate‐advanced stage patients. Conclusion Compared with PE alone, DPMAS+PE might more effectively improve temporary TBIL in ACLF patients, and improve the 28‐days survival rates in HBV‐ACLF patients with intermediate‐advanced stage. Therefore, DPMAS+PE may be an available ALSS treatment for HBV‐ACLF patients.
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Affiliation(s)
- Jia Yao
- Gastroenterology Department,General Surgery Department, Shanxi Dayi Hospital, Taiyuan, China
| | - Shuang Li
- Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Li Zhou
- Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Lei Luo
- The First Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Lili Yuan
- Gastroenterology Department,General Surgery Department, Shanxi Dayi Hospital, Taiyuan, China
| | - Zhongping Duan
- Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Jun Xu
- Gastroenterology Department,General Surgery Department, Shanxi Dayi Hospital, Taiyuan, China
| | - Yu Chen
- Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
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Rebahi H, Still ME, El Adib AR. A successful use of therapeutic plasma exchange in a fulminant form of acute fatty liver of pregnancy. J Gynecol Obstet Hum Reprod 2018; 48:133-137. [PMID: 30315885 DOI: 10.1016/j.jogoh.2018.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 12/17/2022]
Abstract
Acute fatty liver of pregnancy (AFLP) continues to raise special concerns since its first post-mortem description by Sheehan in 1940. While early diagnosis and expedite delivery are the cornerstone of management, this condition remains fatal for both mother and fetus. Acute fulminant liver failure is the most serious and life-threatening AFLP-related complication and can require liver transplant despite aggressive supportive management. In lieu of transplant, therapeutic plasma exchange (PE) has emerged as a life-saving alternative and has, in few reports, demonstrated efficacy for the reversal of this dangerous condition. Here we present a case report of a patient diagnosed with fulminant liver failure complicating an AFLP and progressed to severe hepatic encephalopathy who was successfully treated with five rounds of plasma exchange.
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Affiliation(s)
- Houssam Rebahi
- Department of Anesthesia & Intensive Care Medicine, Medical School of Marrakech (Cadi Ayyad University), Mother & Child Hospital, Mohammed VI Teaching Hospital, Marrakech, Morocco.
| | - Megan Elizabeth Still
- Department of Anesthesia & Intensive Care Medicine, Medical School of Marrakech (Cadi Ayyad University), Mother & Child Hospital, Mohammed VI Teaching Hospital, Marrakech, Morocco; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ahmed Rhassane El Adib
- Department of Anesthesia & Intensive Care Medicine, Medical School of Marrakech (Cadi Ayyad University), Mother & Child Hospital, Mohammed VI Teaching Hospital, Marrakech, Morocco
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Wu Z, Huang P, Gong Y, Wan J, Zou W. Treating acute fatty liver of pregnancy with artificial liver support therapy: Systematic review. Medicine (Baltimore) 2018; 97:e12473. [PMID: 30235743 PMCID: PMC6160087 DOI: 10.1097/md.0000000000012473] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acute fatty liver of pregnancy (AFLP) is a serious disease with high mortality. Recent data suggest that postpartum application of artificial liver support therapy (ALST) in AFLP management improves disease outcome. In current study, we tend to further evaluate whether the type, the timing, and the number of postpartum ALST sessions and other clinical factors including complications and liver and renal function will influence disease outcome in ALST era. METHODS Medical records of 15 AFLP patients having postpartum ALST in our hospital from 2010 to 2016 were first retrospectively reviewed. A systematic review and statistical analysis was then conducted with our cases and those having postpartum ALST reported in PubMed, Embase, Cochrane, and ClinicalTrials.gov till the end of June 2016. RESULTS Nine relevant studies were identified in the public databases. A total of 104 cases were enrolled for analysis including 15 cases from our hospital and 89 cases from the identified 9 studies. Univariate analysis revealed that 2 complications, postpartum hemorrhage and multiple organ dysfunctions (MODS), were associated with the outcome of AFLP patients undergoing postpartum ALST. Binary logistic regression analysis further indicated that MODS was the only independent factor affecting disease outcome. Surprisingly, factors including pre-ALST serum levels of total bilirubin and creatinine, the type and number of postpartum ALST sessions, time interval between delivery and ALST were unrelated to disease outcome. CONCLUSION Current data suggest that postpartum ALST improves the outcome of AFLP patients but more properly designed experiments are needed to confirm this point. Our study further indicates that occurrence of MODS carries a bad prognosis even in ALST era. Our study provides valuable information on guiding the clinical application of postpartum ALST in AFLP management.
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Affiliation(s)
- Zhenping Wu
- Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University
| | - Peng Huang
- Department of Epidemiology, School of Public Health, Nanchang University
| | - Yi Gong
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Junhui Wan
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Wei Zou
- Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University
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Mikolasevic I, Filipec-Kanizaj T, Jakopcic I, Majurec I, Brncic-Fischer A, Sobocan N, Hrstic I, Stimac T, Stimac D, Milic S. Liver Disease During Pregnancy: A Challenging Clinical Issue. Med Sci Monit 2018; 24:4080-4090. [PMID: 29905165 PMCID: PMC6034557 DOI: 10.12659/msm.907723] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
One of the least studied topics in the field of obstetrics is liver disease during pregnancy, which creates a challenge for both gynecologists and hepatologists. Approximately 3% of pregnant women are affected by some form of liver disease during pregnancy. Some of these conditions can be fatal for both the mother and child. In addition, 3 types of liver disease need to be differentiated during pregnancy. One type is liver disease directly related to pregnancy, which can occur at a specific time during pregnancy. Another type is liver disease not related to pregnancy, which can occur at any time, such as viral- or drug-induced hepatitis. Furthermore, pregnancy can occur in women with pre-existing liver disease. It is essential that the clinicians are familiar with this disorder so they can respond promptly and appropriately in all of these situations, especially when emergency delivery is needed and must not be postponed.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Gastroenterology, University Hospital Center (UHC) Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tajana Filipec-Kanizaj
- Department of Gastroenterology, University Hospital Merkur, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Jakopcic
- Department of Gastroenterology, University Hospital Center (UHC) Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Iva Majurec
- Department of Anesthesiology and Intensive Care Unit, University Hospital Merkur, Zagreb, Croatia
| | - Alemka Brncic-Fischer
- Department of Obstetrics and Gynecology, University Hospital Center (UHC) Rijeka, Rijeka, Croatia
| | - Nikola Sobocan
- Department of Gastroenterology, University Hospital Merkur, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Irena Hrstic
- Department of Internal Medicine, General Hospital Pula, Pula, Croatia
| | - Tea Stimac
- Department of Obstetrics and Gynecology, University Hospital Center (UHC) Rijeka, Rijeka, Croatia
| | - Davor Stimac
- Department of Gastroenterology, University Hospital Center (UHC) Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Sandra Milic
- Department of Gastroenterology, University Hospital Center (UHC) Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia
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Wang S, Li SL, Cao YX, Li YP, Meng JL, Wang XT. Noninvasive Swansea criteria are valuable alternatives for diagnosing acute fatty liver of pregnancy in a Chinese population. J Matern Fetal Neonatal Med 2017; 30:2951-2955. [PMID: 27923319 DOI: 10.1080/14767058.2016.1269316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study aims to assess the diagnostic and prognostic value of Swansea criteria in diagnosing acute fatty liver of pregnancy (AFLP) in a Chinese population. METHODS A retrospective study was conducted on 52 Chinese women diagnosed with AFLP. All selected cases were reassessed using the Swansea criteria with special focus on the noninvasive criteria, since performing a liver biopsy for this indication is rare in a Chinese population. RESULTS Ninety point four percent of patients fulfilled five or more of the Swansea criteria. Thirty-one cases were positive for six or more Swansea criteria, but there were no significance differences between patients when using a cutoff criteria <6 or >6. When patients were positive for less than seven criteria, frequency of stillbirth, continuous blood purification (CBP) treatment, hysterectomy, and postpartum hemorrhage were not increased. However, patients who were positive for seven or more criteria had a significantly higher risk of stillbirth and a higher rate of CBP treatment (p < 0.05). Areas under the receiver operating characteristic (ROC) curve of postpartum hemorrhage was 0.670, which reached a statistical significance (p = 0.040). We observed a significantly elevated postpartum hemorrhage along with positivity of the Swansea criteria (p = 0.040). CONCLUSIONS Swansea criteria without liver biopsy are good screening tools for AFLP diagnosis, and may be useful for assessing disease severity.
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Affiliation(s)
- Shan Wang
- a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Shan-Ling Li
- b Department of Obstetrics and Gynecology , Shandong Provincial Maternity and Childcare Hospital , Jinan , China
| | - Yan-Xia Cao
- a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Yan-Ping Li
- a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Jin-Lai Meng
- a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Xie-Tong Wang
- a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
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Meng J, Wang S, Gu Y, Lv H, Jiang J, Wang X. Prenatal predictors in postpartum recovery for acute fatty liver of pregnancy: experiences at a tertiary referral center. Arch Gynecol Obstet 2015; 293:1185-91. [DOI: 10.1007/s00404-015-3941-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 10/23/2015] [Indexed: 12/19/2022]
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20
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de Oliveira CV, Moreira A, Baima JP, Franzoni LDC, Lima TB, Yamashiro FDS, Coelho KYR, Sassaki LY, Caramori CA, Romeiro FG, Silva GF. Acute fatty liver of pregnancy associated with severe acute pancreatitis: A case report. World J Hepatol 2014; 6:527-531. [PMID: 25068005 PMCID: PMC4110545 DOI: 10.4254/wjh.v6.i7.527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/20/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Acute fatty liver of pregnancy is a rare disease that affects women in the third trimester of pregnancy. Although infrequent, the disease can cause maternal mortality. The diagnosis is not always clear until the pregnancy is terminated, and significant complications, such as acute pancreatitis, can occur. Pancreatic involvement typically only occurs in severe cases after the development of hepatic and renal impairment. To date, little knowledge is available regarding how the disease causes pancreatitis. Treatment involves supportive measures and pregnancy interruption. In this report, we describe a case of a previously healthy 26-year-old woman at a gestational age of 27 wk and 6 d who was admitted with severe abdominal pain and vomiting. This case illustrates the clinical and laboratory overlap between acute fatty liver of pregnancy and pancreatitis, highlighting the difficulties in differentiating each disease. Furthermore, the hypothesis for this overlapping is presented, and the therapeutic options are discussed.
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