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Abstract
Hypoxic hepatitis is a common cause of abnormal liver biochemistries in hospitalized patients. It is important clinicians maintain a high index of suspicion for diagnosis so that appropriate supportive therapies may be implemented in a timely manner. We present a rare case of takotsubo cardiomyopathy-induced hypoxic hepatitis and resultant acute liver failure in a patient after an intentional drug overdose. Once competing etiologies of acute liver failure were excluded and the diagnosis of hypoxic hepatitis was established, therapy was focused on the patient's cardiomyopathy in an effort to simultaneously improve her liver function.
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Abstract
Drug-induced liver injury (DILI) is the most common cause of acute liver failure (ALF) in Western countries. Without liver transplantation, the mortality rate for ALF approaches greater than 80%. Acetaminophen-related ALF may be associated with a rapid progression but fortunately has a high chance for spontaneous survival compared with idiosyncratic DILI-related ALF. Several prognostic scoring systems for severe DILI have been developed to aid clinicians in selecting patients who require urgent liver transplantation. Patients who undergo liver transplantation for ALF are at risk for early graft loss and death and should be closely followed.
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Affiliation(s)
- Maneerat Chayanupatkul
- Department of Physiology, Chulalongkorn University, Pattayapat Building, 10th Floor, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand; Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Pattayapat Building, 10th Floor, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand.
| | - Thomas D Schiano
- Division of Liver Diseases, Department of Medicine, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, Icahn Building, 3rd Floor, 1425 Madison Avenue, New York, NY 10029, USA
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Büttner A. Hepatopathien und Drogenkonsum. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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De Silvestro G, Marson P, Brandolese R, Pittoni G, Ongaro G. A Single Institution's Experience (1982–1999) with Plasma-Exchange Therapy in Patients with Fulminant Hepatic Failure. Int J Artif Organs 2018. [DOI: 10.1177/039139880002300708] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fulminant hepatic failure is a rare, but often fatal complication of acute viral hepatitis. This condition, in absence of orthotopic liver transplantation (OLTx) surgery, is associated with a high mortality rate, despite the improvement of general intensive care. Plasma-exchange (PEx) therapy has been long used to treat FHF, in particular by removing toxic substances and correcting the severe coagulopathy. In this study we describe our experience with PEx treatment of FHF, beginning in 1982. Seventy patients affected with FHF due to various causes (HBV=40; cryptogenic/non-A, non-E=15; Amanita phalloides=8; other=7) were treated with PEx (altogether 348 sessions). Overall survival rate, comprising patients undergoing OLTx, was 51%, a little higher than what we observed in patients (N=49) treated solely by PEx, i.e., 41%. The best outcome predictor was FHF aetiology, owing to the good survival rate in patients with Amanita phalloides intoxication and the very poor prognosis of patients suffering from cryptogenic/non-A, non-E FHF. Moreover, the marked increase in prothrombin time and alpha-fetoprotein levels after 48 hours from admission was associated with a good prognosis, whereas the patient's age and coma grade were not clearly predictive of survival. Additionally, lymphocyte subpopulation, resulting in a CD4/CD8 ratio lower than 1.0 along with CD8 activation with HLA-DR strong expression, were associated with a high rate of mortality and morbidity. Our data indicate that PEx therapy can improve survival in patients with sufficient residual capacity of liver regeneration. Moreover, the identification of certain prognostic factors may be useful for the rational planning of therapeutic strategy in FHF.
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Affiliation(s)
- G. De Silvestro
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padova, Padova - Italy
| | - P. Marson
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padova, Padova - Italy
| | - R. Brandolese
- Service of Anaesthesia and Intensive Care, University Hospital of Padova, Padova - Italy
| | - G. Pittoni
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padova, Padova - Italy
| | - G. Ongaro
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padova, Padova - Italy
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Carrier P, Debette-Gratien M, Girard M, Jacques J, Nubukpo P, Loustaud-Ratti V. Liver Illness and Psychiatric Patients. HEPATITIS MONTHLY 2016; 16:e41564. [PMID: 28123443 PMCID: PMC5237472 DOI: 10.5812/hepatmon.41564] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/30/2016] [Accepted: 11/14/2016] [Indexed: 12/11/2022]
Abstract
Patients with psychiatric disorders are usually more exposed to multiple somatic illnesses, including liver diseases. Specific links are established between psychiatric disorders and alcohol hepatitis, hepatitis B, and hepatitis C in the population as a whole, and specifically in drug abusers. Metabolic syndrome criteria, and associated steatosis or non-alcoholic steato-hepatitis (NASH) are frequent in patients with chronic psychiatric disorders under psychotropic drugs, and should be screened. Some psychiatric medications, such as neuroleptics, mood stabilizers, and a few antidepressants, are often associated with drug-induced liver injury (DILI). In patients with advanced chronic liver diseases, the prescription of some specific psychiatric treatments should be avoided. Psychiatric disorders can be a limiting factor in the decision-making and following up for liver transplantation.
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Affiliation(s)
- Paul Carrier
- Service D’hépato-Gastroentérologie, CHU Limoges, 87042 Limoges Cédex, France
- INSERM, U850, F-87000 Limoges, Univ Limoges, France
- Corresponding Author: Paul Carrier, Service D’hépato-Gastroentérologie, CHU Limoges, 87042 Limoges Cédex, France. Tel: +33-555056687, Fax: +33-555056767, E-mail: ;
| | - Marilyne Debette-Gratien
- Service D’hépato-Gastroentérologie, CHU Limoges, 87042 Limoges Cédex, France
- INSERM, U850, F-87000 Limoges, Univ Limoges, France
| | - Murielle Girard
- Unité D’investigation Clinique, Centre Hospitalier Spécialisé Esquirol, 87042 Limoges, France
| | - Jérémie Jacques
- Service D’hépato-Gastroentérologie, CHU Limoges, 87042 Limoges Cédex, France
| | - Philippe Nubukpo
- Pôle D’addictologie, Centre Hospitalier Spécialisé Esquirol, 87042 Limoges, France
| | - Véronique Loustaud-Ratti
- Service D’hépato-Gastroentérologie, CHU Limoges, 87042 Limoges Cédex, France
- INSERM, U850, F-87000 Limoges, Univ Limoges, France
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Hser YI, Gelberg L, Hoffman V, Grella CE, McCarthy W, Anglin MD. Health conditions among aging narcotics addicts: medical examination results. J Behav Med 2005; 27:607-22. [PMID: 15669446 DOI: 10.1007/s10865-004-0005-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The study examined health conditions among an aging cohort of male narcotics addicts. This prospective cohort study (1964-1998) included interviews and medical testing for 108 surviving subjects who had been admitted to the California Civil Addict Program during the years 1962 through 1964. Medical testing results were: 51.9% had high blood pressure, 22.4% showed hyperlipidemia, 13.3% had elevated levels of blood glucose, 33.6% had abnormal pulmonary function, half of the sample had abnormal liver function, and 94.2% tested positive for hepatitis C, 85.6% for hepatitis B, 3.8% for syphilis, and 27.3% for TB. The study empirically demonstrated poor health conditions and high morbidity among surviving narcotics addicts.
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Affiliation(s)
- Yih-Ing Hser
- University of California, Los Angeles, California 90025, USA.
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Abstract
In recent years, considerable progress has been made in developing specific and supportive medical measures that have improved prognosis in FHF. Although new techniques for cell culture and perfusion have also resulted in a number of promising devices for the provision of temporary liver support, their clinical efficacy is as yet uncertain. Controlled multicenter trials in well-defined patient groups and with standardized outcome measures will be essential to evaluate the clinical value of these devices properly. The same considerations must also apply in assessing the efficacy of hepatocyte transplantation in FHF. A better understanding of mechanisms responsible for liver cell death and multiorgan failure, and the development of strategies to enhance liver regeneration may, in the future, allow a more targeted approach to therapy.
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Affiliation(s)
- S M Riordan
- Institute of Hepatology, University College London, United Kingdom
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Riordan SM, Williams R. Cause and prognosis in acute liver failure. LIVER TRANSPLANTATION AND SURGERY : OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES AND THE INTERNATIONAL LIVER TRANSPLANTATION SOCIETY 1999; 5:86-9. [PMID: 9873098 DOI: 10.1002/lt.500050107] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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