1
|
Giri S, Singh A, Kolhe K, Kale A, Shukla A. Reply: Portal vein thrombosis in cirrhosis: exploring the uncharted waters. J Gastroenterol Hepatol 2023; 38:2254. [PMID: 37804045 DOI: 10.1111/jgh.16378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Affiliation(s)
- S Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - A Singh
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - K Kolhe
- Department of Gastroenterology, Narayana Hospital, Nanded, India
| | - A Kale
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - A Shukla
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| |
Collapse
|
2
|
Giri S, Singh A, Kolhe K, Kale A, Shukla A. Natural history of portal vein thrombosis in cirrhosis: A systematic review with meta-analysis. J Gastroenterol Hepatol 2023; 38:1710-1717. [PMID: 37354011 DOI: 10.1111/jgh.16263] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND AND AIM Progression of liver disease in cirrhosis is associated with an increased incidence of portal vein thrombosis (PVT) in cirrhosis. However, evidence suggests that spontaneous recanalization of PVT may occur even without anti-thrombotic therapy. Thus, the present meta-analysis was conducted to study the natural history of PVT in cirrhosis, facilitating decisions regarding anticoagulation. METHODS Three electronic databases were searched from 2000 to August 2022 for studies reporting the outcome of PVT in cirrhotics without anticoagulation. The pooled proportions with their 95% confidence intervals (CIs) were calculated using a random-effect model. RESULTS A total of 26 studies (n = 1441) were included in the final analysis. Progression of PVT on follow-up was seen in 22.2% (95% CI 16.1-28.4), while 77.7% (95% CI 71.6-83.9) remained non-progressive (improved or stable). The most common outcome was a stable PVT with a pooled event rate of 44.6% (95% CI 34.4-54.7). The pooled rates of regression and complete recanalization of PVT in cirrhotics were 29.3% (95% CI 20.9-37.7) and 10.4% (95% CI 5.0-15.8), respectively. On follow-up after improvement, pooled recurrence rate of PVT was 24.0% (95% CI 14.7-33.4). MELD score, and presence of ascites had a negative association, while a longer follow-up duration had positive association with PVT regression. CONCLUSION Approximately 25% of the cases of PVT in cirrhosis are progressive, 30% cases improve, and 45% remain stable. Future studies are needed to analyze the predictors of spontaneous regression.
Collapse
Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Ankita Singh
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Kailash Kolhe
- Department of Gastroenterology, Narayana Hospital, Nanded, India
| | - Aditya Kale
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| |
Collapse
|
3
|
Giri S, Singh A, Angadi S, Kolhe K, Roy A. Prevalence of hepatic encephalopathy in patients with non-cirrhotic portal hypertension: A systematic review and meta-analysis. Indian J Gastroenterol 2023; 42:642-650. [PMID: 37589913 DOI: 10.1007/s12664-023-01412-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Hepatic encephalopathy, (HE) although commonly associated with cirrhosis, has also been reported in non-cirrhotic portal hypertension (NCPH). The importance of identifying and treating HE in NCPH lies in the fact that many patients may be wrongly diagnosed as having psychiatric or neurologic disorders. Hence, we aimed to systematically review the prevalence of HE in NCPH. METHODS A comprehensive search of three databases (Medline, Embase and Scopus) was conducted from inception to November 2022 for studies reporting on the prevalence of minimal HE (MHE) and overt HE (OHE) in patients with NCPH. Results were presented as pooled proportions with their 95% confidence intervals (CI). RESULTS Total 25 studies (n = 1487) were included after screening 551 records. The pooled prevalence of MHE in NPCH was 32.9% (95% CI: 26.7-39.0) without any difference between adult (32.9%, 95% CI: 23.5-42.3) and pediatric patients (32.6%, 95% CI: 26.1-39.1) (p = 0.941). There was no significant difference in the prevalence between patients with NCPH and compensated cirrhosis with odds ratio of 1.06 (95% CI: 0.77-1.44). The pooled event rate for prior history of OHE in NCPH was 1.2% (95% CI: 0.3-2.1). CONCLUSION Around one-third of the patients with NCPH have MHE, irrespective of age group. OHE is extremely rare in NCPH and is usually associated with a precipitating factor.
Collapse
Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, 500 082, India
| | - Ankita Singh
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, 400 012, India
| | - Sumaswi Angadi
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, 500 082, India
| | - Kailash Kolhe
- Department of Gastroenterology, Narayana Hospital, Nanded, 431 602, India
| | - Akash Roy
- Institute of Gastrosciences and Liver Transplantation, Apollo Multispecialty Hospital, Kolkata, 700 054, India.
| |
Collapse
|
4
|
Giri S, Singh A, Kolhe K, Kozyk M, Roy A. Assessment of portal system hemodynamics for the prediction of portal vein thrombosis in cirrhosis-A systematic review and meta-analysis. J Clin Ultrasound 2023; 51:1248-1258. [PMID: 37459439 DOI: 10.1002/jcu.23523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The pathogenesis of portal vein thrombosis (PVT) in cirrhosis is multifactorial, with altered hemodynamics being proposed as a possible contributor. The present systematic review was conducted to study the role of assessment of portal hemodynamics for the prediction of PVT in patients with cirrhosis. METHODS Three databases (Medline, Embase, and Scopus) were searched from inception to February 2023 for studies comparing portal venous system parameters in patients with cirrhosis developing PVT with those not. Results were presented as mean difference (MD) or odds ratio (OR) with their 95% confidence intervals (CIs). RESULTS A total of 31 studies (patients with cirrhosis: 19 studies, patients with cirrhosis undergoing splenectomy: 12 studies) were included. On pooling the data from multivariable analyses of the included studies, a larger portal vein diameter was a significant predictor of PVT in patients with cirrhosis without or with splenectomy with OR 1.74 (1.12-2.69) and OR 1.55 (1.26-1.92), respectively. On the other hand, a lower portal vein velocity (PVV) was a significant predictor of PVT in cirrhotics without or with splenectomy with OR 0.93 (0.91-0.96) and OR 0.71 (0.61-0.83), respectively. A PVV of <15 cm/s was the most commonly used cut-off for the prediction of PVT. Patients developing PVT also had a significantly higher splenic length, thickness, and splenic vein velocity. CONCLUSION The assessment of portal hemodynamic parameters at baseline evaluation in patients with cirrhosis may predict the development of PVT. Further studies are required to determine the optimal cut-offs for various parameters.
Collapse
Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology & Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Ankita Singh
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Kailash Kolhe
- Department of Gastroenterology, Narayana Hospital, Nanded, India
| | - Marko Kozyk
- Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Akash Roy
- Institute of Gastrosciences and Liver, Apollo Multispecialty Hospital, Kolkata, India
| |
Collapse
|
5
|
Giri S, Kolhe K, Sundaram S. Risk of post-ERCP pancreatitis is increased in patients with end-stage renal disease - a meta-analysis. Clin Res Hepatol Gastroenterol 2023; 47:102112. [PMID: 36918111 DOI: 10.1016/j.clinre.2023.102112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Kailash Kolhe
- Department of Gastroenterology, Narayana Hospital, Nanded, India
| | - Sridhar Sundaram
- Department of Digestive Disease and Clinical Nutrition, Tata Memorial Hospital, Mumbai 400012, India.
| |
Collapse
|
6
|
Lad SG, Kolhe K, Chauhan S, Gattani M, Sethiya P, Singh GK, Kiran B, Ingle M, Pandey V. AIH in HIV: A Very Much Possible Entity. J Clin Exp Hepatol 2022; 12:1388-1392. [PMID: 36157146 PMCID: PMC9499873 DOI: 10.1016/j.jceh.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/09/2022] [Indexed: 12/12/2022] Open
Abstract
Autoimmune Hepatitis (AIH) is a chronic liver disease Characterized by interface hepatitis, lymphoplasmacytic infiltrate, and hepatic rosettes. HIV infection is a state of immunosuppression; hence, the possibility of AIH is relatively rare, especially in patients with low CD4 counts. Therefore, we present an interesting case series of four patients with autoimmune liver disease with myriad presentations for the first time from India. We propose that despite the rarity of this presentation with immunosuppression, one should never miss such a treatable cause of liver disease leading to good clinical outcomes.
Collapse
Key Words
- ACLF, Acute on chronic liver failure
- AIH, Autoimmune Hepatitis
- AKI, Acute kidney injury
- ALT, Alanine transaminase
- ANA, Antinuclear antibody
- ART, Antiretroviral therapy
- ASMA, Anti smooth muscle antibody
- AST, Aspartate aminotransferase
- CAM, Complementary and alternative medications
- DILI, Drug-induced liver injury
- GGT, Gamma-transferase
- HAV, Hepatitis A Virus
- HEV, Hepatitis E Virus
- HIV, Human immunodeficiency Virus
- IRIS, Immune reconstitution inflammatory syndrome
- LFT, Liver function test
- PHG, portal hypertensive gastropathy
- TJLB, Transjugular liver biopsy
- autoimmune hepatitis (AIH)
- cART, Combination antiretroviral therapy
- drug-induced liver injury – AIH (DILI-AIH)
- human immunodeficiency virus (HIV)
- iAIH, Denovo Idiopathic AIH
Collapse
Affiliation(s)
- Saiprasad G. Lad
- Dept of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai- 400022, India
| | - Kailash Kolhe
- Dept of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai- 400022, India
| | - Shamshersingh Chauhan
- Dept of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai- 400022, India
| | - Mayur Gattani
- Dept of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai- 400022, India
| | - Pratik Sethiya
- Dept of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai- 400022, India
| | - Gaurav K. Singh
- Dept of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai- 400022, India
| | - B. Kiran
- Dept of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai- 400022, India
| | - Meghraj Ingle
- Dept of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai- 400022, India
| | - Vikas Pandey
- Dept of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai- 400022, India
| |
Collapse
|
7
|
Walke SS, Chauhan S, Pandey V, Jadhav R, Chaudhari V, Vishwanathan D, Kolhe K, Ingle M. When to Discharge a Patient After Endoscopy: A Narrative Review. Clin Endosc 2022; 55:8-14. [PMID: 35135177 PMCID: PMC8831418 DOI: 10.5946/ce.2021.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/08/2021] [Indexed: 11/14/2022] Open
Abstract
Video endoscopy is an important modality for the diagnosis and treatment of various gastrointestinal diseases. Most endoscopic procedures are performed as outpatient basis, sometimes requiring sedation and deeper levels of anesthesia. Moreover, advances in endoscopic techniques have allowed invasion into the third space and the performance of technically difficult procedures that require the utmost precision. Hence, formulating strategies for the discharge of patients requiring endoscopy is clinically and legally challenging. In this review, we have discussed the various criteria and scores for the discharge of patients who have undergone endoscopic procedures with and without anesthesia.
Collapse
Affiliation(s)
| | | | - Vikas Pandey
- Department of Gastroenterology, LTMMC & LTMGH, Sion, Mumbai, India
| | - Rahul Jadhav
- Department of Gastroenterology, LTMMC & LTMGH, Sion, Mumbai, India
| | - Vipul Chaudhari
- Department of Gastroenterology, LTMMC & LTMGH, Sion, Mumbai, India
| | | | - Kailash Kolhe
- Department of Gastroenterology, LTMMC & LTMGH, Sion, Mumbai, India
| | - Meghraj Ingle
- Department of Gastroenterology, LTMMC & LTMGH, Sion, Mumbai, India
- Correspondence: Meghraj Ingle Department of gastroenterology, LTMMC & LTMGH, Endoscopy room 13, College building, First Floor, Sion, Mumbai 400022, India Tel: +91-93209-79659, Fax: +91-022-240-63000, E-mail:
| |
Collapse
|
8
|
Kaur S, Hussain S, Kolhe K, Kumar G, Tripathi DM, Tomar A, Kale P, Narayanan A, Bihari C, Bajpai M, Maiwall R, Gupta E, Sarin SK. Elevated plasma ICAM1 levels predict 28-day mortality in cirrhotic patients with COVID-19 or bacterial sepsis. JHEP Rep 2021; 3:100303. [PMID: 33997748 PMCID: PMC8106200 DOI: 10.1016/j.jhepr.2021.100303] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/01/2021] [Accepted: 04/24/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS Endothelial injury and dysfunction play a detrimental role in the pathogenesis of infections. Endothelium-related molecules have been reported as potential diagnostic and/or prognostic biomarkers of infection. The prognostic value of these biomarkers in patients with cirrhosis and infections remains elusive. METHODS In this study, we investigated the performance of key soluble endothelial injury biomarkers, including intercellular adhesion molecule 1 (ICAM1), von Willebrand factor (vWF), vascular endothelial growth factor receptor 1 (VEGFR1), and angiopoietin 1 and 2 (Ang1, 2) as mortality predictors in patients with cirrhosis and severe COVID-19 or bacterial sepsis. RESULTS A total of 66 hospitalized patients (admitted to the COVID-19 ward or liver intensive care unit [ICU]) were included. Twenty-two patients had COVID-19 alone, while 20 patients had cirrhosis plus COVID-19. Twenty-four patients had cirrhosis plus bacterial sepsis. Among patients with cirrhosis, the most common aetiology of liver disease was alcohol. ICAM1 was increased (p = 0.003) while VEGFR1 (p <0.0001) and Ang1 (p <0.0001) were reduced in patients with COVID-19 and cirrhosis, compared to patients with COVID-19 alone. Endothelial biomarker levels did not differ significantly between patients with cirrhosis and severe COVID-19 or bacterial sepsis in the ICU. In these patients, ICAM1 levels significantly and independently predicted mortality (hazard ratio 3.24; 95% CI 1.19-8.86) along with model for end-stage liver disease (MELD) score, renal and coagulation failures. The AUC for ICAM1 was 0.74, MELD was 0.60 and combined ICAM1 and MELD was 0.70. ICAM1 also positively correlated with the composite organ failure scores recorded 3-5 days post ICU admission (CLIF-OF and SOFA) in this subgroup of patients. CONCLUSION The study indicates that in patients with cirrhosis, elevated plasma ICAM1 serves as an independent predictor of severe COVID-19- or sepsis-associated 28-day mortality. LAY SUMMARY Bacterial sepsis and COVID-19 lead to increased mortality in patients with cirrhosis. In this study, we demonstrate that high plasma levels of ICAM1, an endothelial injury biomarker, is one of the important factors predicting mortality in critically ill cirrhotic patients with severe COVID-19 or bacterial sepsis.
Collapse
Key Words
- ACLF, acute-on-chronic liver failure
- AST, aspartate aminotransferase
- Ang1, angiopoietin 1
- Ang2, angiopoietin 2
- Biomarkers
- CCI, Charlson comorbidity index
- COVID-19
- Endothelial Injury
- HR, hazard ratio
- ICAM1, intercellular adhesion molecule 1
- ICU, intensive care unit
- LDH, lactate dehydrogenase
- Liver Cirrhosis
- MELD, model for end-stage liver disease
- NLR, neutrophil to lymphocyte ratio
- PCT, procalcitonin
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- SOFA, sequential organ failure assessment
- Sepsis
- VEGFR1, vascular endothelial growth factor receptor 1
- vWF, von Willebrand factor
Collapse
Affiliation(s)
- Savneet Kaur
- Department of Molecular and Cellular Medicine, Institute of liver and biliary Sciences, New Delhi, India
| | - Sadam Hussain
- Department of Molecular and Cellular Medicine, Institute of liver and biliary Sciences, New Delhi, India
| | - Kailash Kolhe
- Department of Molecular and Cellular Medicine, Institute of liver and biliary Sciences, New Delhi, India
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - Guresh Kumar
- Department of Molecular and Cellular Medicine, Institute of liver and biliary Sciences, New Delhi, India
- Department of Research and Biostatistics, Institute of liver and biliary Sciences, New Delhi, India
| | - Dinesh M. Tripathi
- Department of Molecular and Cellular Medicine, Institute of liver and biliary Sciences, New Delhi, India
| | - Arvind Tomar
- Department of Pulmonary Medicine, Institute of liver and biliary Sciences, New Delhi, India
| | - Pratibha Kale
- Department of Microbiology, Institute of liver and biliary Sciences, New Delhi, India
| | - Ashad Narayanan
- Department of Emergency, Institute of liver and biliary Sciences, New Delhi, India
| | - Chaggan Bihari
- Department of Pathology, Institute of liver and biliary Sciences, New Delhi, India
| | - Meenu Bajpai
- Department of Transfusion Medicine, Institute of liver and biliary Sciences, New Delhi, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of liver and biliary Sciences, New Delhi, India
| | - Ekta Gupta
- Department of Virology, Institute of liver and biliary Sciences, New Delhi, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of liver and biliary Sciences, New Delhi, India
| |
Collapse
|
9
|
Khairnar H, Ingle M, Pandey V, Kolhe K, Chauhan S, Sawant P, Walke S, Chaudhary V. Accuracy of Leukocyte Esterase Reagent Strip (LERS) test for rapid bedside screening of spontaneous bacterial peritonitis: An observational study. J Family Med Prim Care 2021; 9:5542-5546. [PMID: 33532392 PMCID: PMC7842442 DOI: 10.4103/jfmpc.jfmpc_1207_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 12/28/2019] [Accepted: 07/08/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. SBP is generally diagnosed based on an increased number of polymorphonuclear neutrophils in the ascitic fluid (>250/mm3) and positive culture. Usually fluid analysis and culture take time and precious hours are lost in starting therapy. Leukocyte Esterase Reagent Strips (LERS) have consistently given a high negative predictive value (>95% in the majority of the studies). Aims and Objectives: Aim was to evaluate the diagnostic utility of leukocyte esterase reagent strip for rapid diagnosis of SBP in patients who underwent abdominal paracentesis and to calculate the sensitivity, specificity, positive, and negative predictive values. Methodology: The study was carried out on 64 patients with ascites. Cell count of AF as determined by colorimetric scale of Multistix 10 SG reagent strip was compared with counting chamber method (PMNL count ≥250 cells/mm3 was considered positive). Results: Of the 64 patients SBP was diagnosed in 17 patients, 47 patients were negative for SBP by manual cell count. At cut off of 2+; sensitivity to diagnose SBP was 100%; specificity of 94%; PPV being 57% and NPV of 94%. at the cut off level of 3+; sensitivity decreased down to 76%; specificity increased to 100%; PPV of 100% and NPV of 93.75%. Overall accuracy at 2 + and 3 + was respectively 94.5% and 93.75%. Conclusion: In this study we have found good sensitivity and specificity for the prompt detection of elevated polymorphonuclear neutrophil count. A negative test result excludes SBP with a high degree of certainty. Thus, it represents a convenient, inexpensive, simple bedside screening tool for SBP diagnosis.
Collapse
Affiliation(s)
- Harshad Khairnar
- Department of Gastroenterology, LTMGH and LTMMC, Sion, Mumbai, Maharashtra, India
| | - Meghraj Ingle
- Department of Gastroenterology, LTMGH and LTMMC, Sion, Mumbai, Maharashtra, India
| | - Vikas Pandey
- Department of Gastroenterology, LTMGH and LTMMC, Sion, Mumbai, Maharashtra, India
| | - Kailash Kolhe
- Department of Gastroenterology, LTMGH and LTMMC, Sion, Mumbai, Maharashtra, India
| | - Shamsher Chauhan
- Department of Gastroenterology, LTMGH and LTMMC, Sion, Mumbai, Maharashtra, India
| | - Prabha Sawant
- Department of Gastroenterology, LTMGH and LTMMC, Sion, Mumbai, Maharashtra, India
| | - Swapnil Walke
- Department of Gastroenterology, LTMGH and LTMMC, Sion, Mumbai, Maharashtra, India
| | - Vipul Chaudhary
- Department of Gastroenterology, LTMGH and LTMMC, Sion, Mumbai, Maharashtra, India
| |
Collapse
|
10
|
Kolhe K, Tripathi DM, Kaur S. Management of portopulmonary hypertension: What is more important, PAH severity or liver disease severity? J Hepatol 2021; 74:237-238. [PMID: 32950270 DOI: 10.1016/j.jhep.2020.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Kailash Kolhe
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), Vasant Kunj, New Delhi; Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai.
| | - Dinesh M Tripathi
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), Vasant Kunj, New Delhi
| | - Savneet Kaur
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), Vasant Kunj, New Delhi
| |
Collapse
|
11
|
Chauhan SG, Chaubal A, Kolhe K, Khairnar H, Lotlikar M, Walke S, Chaudhari V, Ingle M, Pandey V, Shukla A. Lactate-free AARC ACLF Score (LaFAS) - A Simple Userfriendly Score is the Best Prognostic Marker for Patients with Alcohol Induced ACLF in Western Indian Population in a Nontransplant Resource-limited Setting. J Assoc Physicians India 2020; 68:34-38. [PMID: 32610863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Acute-on-Chronic liver failure (ACLF) is a disease with a distinct spectrum of liver injury, with a rapid downhill course Here we describe three new scores - Albumin Bilirubin Index (ALBI), platelet albumin bilirubin index (PALBI) and Lactate-free AARC ACLF score(LaFAS), in predicting short-term mortality in patients with alcohol induced ACLF when compared to standard validated scores. METHODS Consecutive patients diagnosed as alcohol induced ACLF as per the APASL 2014 definition were included in the study. Standard scores - MELD, MELD-Na, Maddreys' discriminant function, CLIF-OF and CLIF-C ACLF scores, APACHE II, ALBI, PALBI and LaFAS were calculated. The endpoints of the study were to predict short term mortality in alcohol induced ACLF patients using ALBI, PALBI and LaFAS and finding the cut-offs of these new scores and comparing it with standard validated scores. RESULTS 67 patients were studied with 97% being male. Mean age was 45.78 + 8.15 years.44 patients died. The cut-offs, area under the ROC curve; sensitivity and specificity, positive and negative predictive values of the new prognostication scores were, respectively: ALBI (-0.57; 0.948; 90.9% and 82.6%; 77.69% and 93.15%),LaFAS(7; 0.968; 95.5% and 96.7%; 95.075 and 96.99%), PALBI(-0.28; 0.59; 61.4% and 52.2%; 46.13% and 66.98%). LaFAS and ALBI outnumbered the valid prognostic scores in predicting short-term mortality. PALBI underperformed when compared to all other scores. CONCLUSION Thus incorporating albumin and bilirubin in a mathematical equation (for ALBI) or combining it with creatinine and grade of hepatic encephalopathy (for LaFAS) would help in prognosticate the patients with ACLF on admission in a resource limited setting thus enabling them to be transferred to a transplant center.
Collapse
Affiliation(s)
- Shamshersingh G Chauhan
- Resident, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra
| | - Alisha Chaubal
- Assistant Professor, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra
| | - Kailash Kolhe
- Resident, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra
| | - Harshad Khairnar
- Resident, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra
| | - Mamata Lotlikar
- Resident, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra
| | - Swapnil Walke
- Resident, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra
| | - Vipul Chaudhari
- Resident, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra
| | - Meghraj Ingle
- Additional Professor, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra
| | - Vikas Pandey
- Assistant Professor, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra
| | - Akash Shukla
- Professor and Head, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra
| |
Collapse
|