Development of a novel score for the diagnosis of bacterial infection in patients with acute-on-chronic liver failure

Definitions, Etiologies, and Outcomes of Acute on Chronic Liver Failure: A Systematic Review and Meta-analysis

BACKGROUND & AIMS

Acute-on-chronic liver failure (ACLF) is a major public health concern. We aimed to assess the definitions, etiologic spectrum, organ failure (OF), and outcomes of ACLF globally.

METHODS

Three databases were searched for studies on ACLF from 1990 until September 2022. Information regarding definitions, acute precipitants, underlying chronic liver disease (CLD), OF, and mortality were extracted. Meta-analyses were performed for pooled prevalence rates (95% confidence interval [CI]) using random-effects model for each definition of ACLF.

RESULTS

Of the 11,451 studies identified, 114 articles (142 cohorts encompassing 210,239 patients) met the eligibility criteria. Most studies (53.2%) used the European Association for the Study of the Liver (EASL) definition, followed by Asia-Pacific Association for the Study of the Liver (APASL) (33.3%). Systemic infection was the major acute precipitant, and alcohol use was the major cause of CLD in EASL-defined studies, whereas alcohol was both the major acute precipitant and cause of CLD in APASL-defined studies. Liver failure was the major OF in APASL-based studies, whereas renal failure was predominant in EASL-based studies. Thirty-day mortality varied across definitions: APASL: 38.9%, 95% CI, 31.2%-46.9%; EASL: 47.9%, 95% CI, 42.2%-53.5%; and NACSELD: 52.2%, 95% CI, 51.9%-52.5%. Diagnostic overlap between definitions ranged from 7.7% to 80.2%. Meta-regression suggested that the World Health Organization region influenced 30-day mortality in studies using EASL definition.

CONCLUSIONS

Heterogeneity in the definition of ACLF proposed by different expert societies and regional preferences in its use result in differences in clinical phenotype and outcomes. A uniform definition would enhance the comparability and interpretation of global data.

Network Pharmacology Combined with an Experimental Validation Study to Reveal the Effect and Mechanism of Eucommia ulmoides Leaf Polysaccharide against Immunomodulation

In the present study, the immuno-enhancing effect of Eucommia ulmoides leaf polysaccharide (ELP) was investigated in immunosuppressed mice induced by cyclophosphamide (CTX). To evaluate the immune enhancement mechanism of ELP, the immunoregulation effect of ELP was evaluated in vitro and in vivo. ELP is primarily composed of arabinose (26.61%), galacturonic acid (25.1%), galactose (19.35%), rhamnose (16.13%), and a small amount of glucose (12.9%). At 1000~5000 μg·mL^-1, ELP could significantly enhance the proliferation and the phagocytosis of macrophages in vitro. Additionally, ELP could protect immune organs, reduce pathological damage, and reverse the decrease in the hematological indices. Moreover, ELP significantly increased the phagocytic index, enhanced the ear swelling response, augmented the production of inflammatory cytokines, and markedly up-regulated the expression of IL-1β, IL-6, and TNF-α mRNA levels. Furthermore, ELP improved phosphorylated p38, ERK1/2, and JNK levels, suggesting that MAPKs might be involved in immunomodulatory effects. The results provide a theoretical foundation for exploring the immune modulation function of ELP as a functional food.

To Investigate the Effect of Magnetic Resonance Imaging (MRI) and Diffusion Tensor Imaging (DTI) in the Diagnosis of Mild Craniocerebral Injury

In order to assess the value of magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) in microscopic brain scans. Diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRI) changes over time in patients with traumatic brain injury (TBI) show a relationship between recovery from coma and overall Glasgow prognostic parameters. The value of DTI combined with MRI in evaluating TBI has been investigated. 10 patients with TBI received 10 evaluations of magnetic resonance imaging, DTI and MRI scans. Thalamic plate nucleus, reticular nucleus, and retinal developmental activity were measured in normal controls and TBI coma (2-3 weeks) and mild (>4 weeks) patients. Anisotropy, mean diffusion coefficient, axial diffusion coefficient, and radial diffusion coefficient were measured using MRI together with acetylaspartic acid, choline, creatinine, and lactic acid. Independent control t-tests were conducted between controls and TBI patients, and 1-test paired between moderate and severe injuries, and regression and correlation were evaluated. Evaluated for all measures and treatments. DTI and MRI scores in TBI patients differed from normal controls. DTI and MRI can predict the prognosis of TBI patients better. The limitations of the thalamus-retinal activation system are gradually restored. axial diffusion coefficient and radial diffusion coefficient can be used to evaluate the reliability of comatose patients with TBI. DTI and MRI scans of the patient's brain can predict recovery and guide treatment in TBI coma patients.

Diagnostic Accuracy of Procalcitonin for Bacterial Infection in Liver Failure: A Meta-Analysis

The purpose of our studies was to systematically assess the accuracy and clinical value of plasma calcitonin in patients with liver failure complicated with bacterial infection. In this study, we included prospective observational studies or randomized controlled trials on PCT. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC), and metaregression analysis were performed using Stata16.0 software. Consequently, the studies revealed substantial heterogeneity (I 2 = 96, 95% confidence interval (95% CI) = 94-99). The results of meta-analysis using random effect models suggested that the combined DOR was 10.67 (95% CI = 3.73-30.53). In addition, the threshold effect analysis showed that the threshold effect was 0.23 and the correlation coefficient was -0.48, indicating that there was no threshold effect. In the forest map, the DOR of each study and the combined DOR are not distributed along the same line, and Q = 2.2 × 1014, P ≤ 0.001. Furthermore, the metaregression analysis of PCT study design, bacterial infection site, and mean age displayed that the P values were >0.05. The combined sensitivity was 0.77 (95% CI = 0.54-0.90), the combined specificity was 0.76 (95% CI = 0.70-0.82), the combined positive likelihood ratio was 3.25 (95% CI = 2.33-4.52), the combined negative likelihood ratio was 0.30 (95% CI = 0.14-0.67), and the combined AUC was 0.80 (95% CI = 0.76-0.83). In conclusion, PCT has moderate diagnostic value for adult liver failure complicated with bacterial infection, and it is a better auxiliary diagnostic index for liver failure with bacterial infection. However, the results of procalcitonin must be carefully interpreted combined with medical history, physical examination, and microbiological assessment.