Liver cirrhosis: a risk factor for gallstone disease in chronic hepatitis C patients in China

Morphine prophylaxis alleviates pain in transjugular intrahepatic portosystemic shunt procedure: A randomized clinical trial

BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) is an accepted minimal invasive procedure for the management of complications of portal hypertension.

OBJECTIVE

This study aims to investigate the value of the preemptive administration of morphine, when compared with on-demand morphine, during TIPS.

METHODS

The present study was a randomized control trial. A total of 49 patients were selected to receive 10 mg of morphine either before the TIPS procedure (group B, n= 26), or on demand when needed during the TIPS procedure (group A, n= 23). The patient's pain was scored using the visual analog scale (VAS) during the procedure. VAS, pain performance, HR, systolic pressure, diastolic pressure and SPO2 were recorded at four-time points: before the operation (T0), during the trans-hepatic puncture of the portal vein (T1), during the intrahepatic channel expansion (T2), and when the operation was finished (T3). The duration of the operation was also recorded.

RESULTS

In group A, the proportion of severe pain at T1 was 4.3% (one case), two cases were combined with vagus reflex, and the proportion of severe pain at T2 was 65.2% (15 cases). No severe pain occurred in group B. The VAS score significantly decreased at T1, T2 and T3 in group B, when compared to group A (P< 0.05). HR, systolic pressure and diastolic pressure significantly decreased at T2 and T3 in group B, when compared to group A (P< 0.05). There was no significant difference between the two groups in terms of SPO2 (P> 0.05).

CONCLUSION

Preemptive analgesia can effectively relieve severe pain during TIPS, improve patient comfort and compliance, ensure a routine procedure, and offer excellent safety, and is simple and effective.

Cholecystectomy reduces the risk of cholangiocarcinoma in patients with complicated gallstones, but has negligible effect on hepatocellular carcinoma

BACKGROUND AND AIM

Gallstones have been reported to be positively associated with hepatobiliary cancers. However, risks of these cancers by cholecystectomy or in patients with complicated gallstones are controversial. We studied the effect of cholecystectomy on the risk of cholangiocarcinoma (CCA) or hepatocellular carcinoma (HCC) in patients with gallstones and subgroup of complicated gallstones.

METHODS

Patients with gallstone disease (n = 958 677) and age-matched and sex-matched controls (n = 9 586 770) were identified using the Korean National Health Insurance database. Complicated gallstones were defined as gallstones associated with acute cholecystitis or acute cholangitis. Adjusted hazard ratios (adjusted hazard ratios, 95% confidence interval) of CCA and HCC incidences were evaluated in patients with gallstones who received cholecystectomy compared to the controls. We also analyzed these effects in patients with complicated gallstones.

RESULTS

Patients with gallstones showed increased risks of CCA (1.80, 1.67-1.93) and HCC (1.03, 1.00-1.07) compared with controls. Cholecystectomy had minimal effects on the risks of CCA (1.94, 1.76-2.14) and HCC (0.93, 0.87-0.99) compared with those without cholecystectomy. However, patients with complicated gallstones showed highly increased CCA risk (5.62, 4.89-6.46) and a 30% risk reduction after cholecystectomy (3.91, 3.43-4.46). Risk reduction by cholecystectomy was greater for extrahepatic CCA than for intrahepatic CCA or ampulla of Vater cancer. However, the risk of HCC was not different in patients with complicated gallstones and those who underwent cholecystectomy compared to controls.

CONCLUSION

The risk of CCA was markedly increased in patients with complicated gallstones and was partially reduced by cholecystectomy. The risk change of HCC was minimal with gallstones or cholecystectomy.

Clinical outcomes of acute pancreatitis in patients with cirrhosis

BACKGROUND

AP outcomes in cirrhotic patients have not yet been studied. We aim to investigate the outcomes of cirrhotics patients with acute pancreatitis.

METHODS

The National Inpatient Sample (NIS) database (2003-2013) was queried for patients with a discharge diagnosis of AP and liver cirrhosis. Cirrhosis was further classified as compensated and decompensated using the validated Baveno IV criteria. Primary outcome was inpatient mortality. The analysis was adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics.

RESULTS

Over 2.8 million patients with acute pancreatitis were analyzed. Cirrhosis prevalence was 2.8% (80,093). Both compensated and decompensated cirrhosis subjects had significantly higher mortality. Highest odds ratios (OR) were: inpatient mortality (OR 3.4, P < 0.001), Shock (OR 1.5, P = 0.02), Ileus (OR: 1.3, p = 0.02, ARDS (OR 1.2, p = 0.03), upper endoscopy performed (OR 2.0, p < 0.001), blood transfusions (OR 3.1, p < 0.001), gastrointestinal bleed (OR 5.5, p < 0.001), sepsis (OR 1.3, p = 0.005), portal vein thrombosis (PVT) (OR 7.2, p < 0.001), acute cholecystitis (OR 1.3, p < 0.001). Interestingly, cirrhosis patients had lower hospital length of stay, (OR 0.16, p < 0.001), AKI (OR 0.93, p = 0.06), myocardial infarction (OR 0.31, p < 0.001), SIRS (OR 0.62, p < 0.001), parenteral nutrition requirement (OR 0.84, p = 0.002). Decompensated cirrhosis had higher inflation-adjusted hospital charges (+$3896.60; p < 0.001).

CONCLUSION

AP patients with cirrhosis have higher inpatient mortality, but it is unlikely to be due to AP severity as patients had lower incidence of SIRS and AKI. Higher mortality is possibly related to complications of cirrhosis and portal hypertension itself such as GI bleed, shock, PVT, AC and sepsis.

Diabetes mellitus is a significant risk factor for the development of liver cirrhosis in chronic hepatitis C patients

We explored the association between diabetes mellitus (DM) and the risk of hepatitis C virus (HCV)-related liver cirrhosis in Chinese patients with chronic hepatitis C (CHC). To examine the link between DM and liver cirrhosis, we conducted a case-control study of 210 Chinese CHC patients diagnosed with liver cirrhosis, comparing them to an age- and sex-matched control group of 431 CHC patients without liver cirrhosis. We conducted logistic regression analyses adjusting for demographic features and liver cirrhosis risk factors, and found that DM increased the risk of developing liver cirrhosis 2-fold [adjusted odds ratio (AOR), 2.132; 95% confidence interval (CI), 1.344–3.382]. Furthermore, the proportion of liver cirrhosis patients and CHC-only patients with elevated serum triglycerides (>1.8 mmol/L) were 5.2% and 17.4%, respectively, yielding an AOR of 0.264 (95% CI, 0.135–0.517). Multivariate analyses that stratified the risk of developing HCV-related liver cirrhosis in DM patients by gender revealed that the estimated AOR (95% CI) for males was 0.415 (0.178–0.969). In conclusion, DM was associated with an increased risk of developing liver cirrhosis in CHC patients in China. Furthermore, among patients diagnosed with both CHC and DM, females had an increased risk of liver cirrhosis development.