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1. Clinical characteristics and outcome of cirrhotic patients with high protein concentrations in ascites: a prospective study.

Author

Guillaume M, Robic MA, Péron JM, Selves J, Otal P, Sirach E, Vinel JP, and Bureau C

Subjects
Adult, Biopsy, Female, Humans, Liver pathology, Liver Cirrhosis metabolism, Liver Cirrhosis pathology, Liver Cirrhosis surgery, Liver Transplantation, Longitudinal Studies, Male, Middle Aged, Portasystemic Shunt, Transjugular Intrahepatic, Prognosis, Prospective Studies, Ascites etiology, Ascites metabolism, Liver Cirrhosis complications, Proteins analysis
Abstract

Background: The protein concentration in ascites is usually low in cirrhosis because capillarization and defenestration of the sinusoids limit diffusion of large proteins from plasma to the space of Disse. However, some cirrhotic patients have high-protein ascites (HPA)., Aim: The aim of this study was to describe and compare the characteristics and prognosis between cirrhotic patients with HPA (>20 g/l) and patients with low-protein ascites (LPA)., Patients and Methods: In this longitudinal observational prospective cohort study, all consecutive cirrhotic patients with ascites hospitalized in our tertiary liver center were included and followed for up to 2 years, provided that they had no other cause of HPA. HPA was defined as protein concentrations of more than 20 g/l., Results: Among 107 patients included, 19 (17.8%) had HPA. HPA patients had more refractory ascites (63 vs. 34%), better liver functions, and a higher 1-year transplant-free survival rate compared with LPA patients (P<0.05). Portal hypertension parameters were not different. During follow-up, 47% of HPA patients were treated by transjugular intrahepatic portosystemic shunts versus 18% of LPA patients, whereas 15 LPA patients required liver transplantation for end-stage liver disease versus only one HPA patient. We observed higher protein filtration and less pericellular, centrilobular, and sinusoidal fibrosis in cirrhotic HPA livers compared with LPA livers., Conclusion: Almost 20% of cirrhotic patients with ascites have HPA (>20 g/l). These patients have better liver functions and a higher 1-year survival than those with LPA, even though ascites are more often refractory.

Published
2016
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2. Preemptive-TIPS Improves Outcome in High-Risk Variceal Bleeding: An Observational Study

Author

Hernandez-Gea, V, Procopet, B, Giraldez, A, Amitrano, L, Villanueva, C, Thabut, D, Ibanez-Samaniego, L, Silva-Junior, G, Martinez, J, Genesca, J, Bureau, C, Trebicka, J, Llop, E, Laleman, W, Palazon, JM, Castellote, J, Rodrigues, S, Gluud, LL, Ferreira, CN, Barcelo, R, Canete, N, Rodriguez, M, Ferlitsch, A, Mundi, JL, Gronbaek, H, Hernandez-Guerra, M, Sassatelli, R, Dell'Era, A, Senzolo, M, Abraldes, JG, Romero-Gomez, M, Zipprich, A, Casas, M, Masnou, H, Primignani, M, Krag, A, Nevens, F, Calleja, JL, Jansen, C, Robic, MA, Conejo, I, Catalina, MV, Albillos, A, Rudler, M, Alvarado, E, Guardascione, MA, Tantau, M, Bosch, J, Torres, F, Garcia-Pagan, JC, Fischer, P, Stefanescu, H, Pop, A, Laursen, SB, Turon, F, Baiges, A, Berbel, C, Cerda, E, Tellez, L, Allegretti, G, Macedo, G, Haldrup, D, Santos, P, Moura, M, Reis, D, Meireles, L, Sousa, P, Alexandrino, P, Navascues, C, Augustin, S, La Mura, V, Banares, R, Diaz, R, Gomez, ML, and Ripoll, C

Subjects
Adult, Male, medicine.medical_specialty, Variceal bleeding, 610 Medicine & health, Esophageal and Gastric Varices, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Internal medicine, Ascites, Secondary Prevention, medicine, Humans, Prospective Studies, Treatment Failure, Prospective cohort study, Hepatic encephalopathy, Hepatology, medicine.diagnostic_test, business.industry, Mortality rate, Middle Aged, medicine.disease, 3. Good health, Endoscopy, Treatment Outcome, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Observational study, Portasystemic Shunt, Transjugular Intrahepatic, medicine.symptom, Gastrointestinal Hemorrhage, Risk assessment, business, International Variceal Bleeding Observational Study Group and Baveno Cooperation
Abstract

Patients admitted with acute variceal bleeding (AVB) and Child-Pugh C score (CP-C) or Child-Pugh B plus active bleeding at endoscopy (CP-B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high-risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p-TIPS was based on individual center policy. p-TIPS in the setting of AVB is associated with a lower mortality in CP-C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; P = 0.002). Mortality rate in CP-B+AB patients was low, and p-TIPS did not improve it. In CP-C and CP-B+AB patients, p-TIPS reduced treatment failure and rebleeding (1-year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p-TIPS must be the treatment of choice in CP-C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients. ispartof: HEPATOLOGY vol:69 issue:1 pages:282-293 ispartof: location:United States status: published

Published
2019
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