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ObjectiveTo investigate the level of vascular endothelial growth factor (VEGF) in the peripheral blood of patients with liver cirrhosis and portal vein thrombosis (PVT) and its clinical significance in the diagnosis of liver cirrhosis with PVT. MethodsA total of 60 patients with liver cirrhosis and PVT who were followed up or hospitalized in the outpatient service of The First Affiliated Hospital of Soochow University from January 2017 to December 2019 were enrolled as PVT group, and 161 patients with liver cirrhosis and portal hypertension who had no thrombi were enrolled as LC group. Related clinical data were collected, including sex, age, white blood cell count, platelet count, total bilirubin, alanine aminotransferase, albumin, prothrombin time, international normalized ratio, and antithrombin Ⅲ. Double-antibody sandwich ELISA was used to measure the serum level of VEGF. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Pearson correlation test was used for correlation analysis, and a binary logistic regression analysis was used to investigate the risk factors for PVT in patients with liver cirrhosis. ResultsThe comparison of baseline indices showed that there was a significant difference in serum VEGF between the PVT group and the LC group (P＜0.05). The comparison of the patients with Child-Pugh class A, B or C disease showed that there was a significant difference in serum VEGF between the two groups (Z=3.749， 5.469， all P＜0.05). The stepwise logistic regression analysis showed that only serum VEGF (odds ratio=1004, 95% confidence interval: 1.003-1.006, P＜0.001) was an independent risk factor for liver cirrhosis with PVT. ConclusionPatients with liver cirrhosis and PVT tend to have a high level of VEGF in peripheral blood, which provides guidance for clinical diagnosis.

ObjectiveTo investigate the risk factors for hepatic encephalopathy (HE) after emergency transjugular intrahepatic portosystemic shunt (TIPS) for patients with acute esophagogastric variceal bleeding (EVB) based on an analysis of clinical outcomes. MethodsA retrospective analysis was performed for the clinical data of 93 patients with decompensated liver cirrhosis and acute EVB who failed endoscopy or medication and then underwent TIPS with a covered stent within 72 hours in The First Affiliated Hospital of Soochow University from January 2013 to December 2018. According to the presence or absence of HE after surgery, they were divided into HE group with 36 patients and non-HE group with 57 patients. Preoperative clinical data were collected, including sex, age, etiology, comorbidities, and blood biochemical parameters ［white blood cell count (WBC), platelet count (PLT), hematocrit (Hct), total bilirubin (TBil), aspartate aminotransferase (AST), albumin (Alb), serum creatinine (SCr), and prothrombin time (PT)］, and the measured values were used to calculate Model for End-Stage Liver Disease (MELD) score. Wedged hepatic venous pressure (WHVP) and free hepatic venous pressure (FHVP) were measured and recorded before TIPS stent implantation, and hepatic venous pressure gradient (HVPG) was the difference between WHVP and FHVP. The t-test or the Mann-Whitney U test was used for comparison between two groups, and the chi-square test was used for comparison of categorical data between two groups. A binary logistic regression analysis was used to identify the risk factors for the prognosis of patients after TIPS. ResultsThe incidence rate of postoperative HE was 38.710%. There were significant differences between the two groups in preoperative MELD score (13.000±3.189 vs 11.684±2.068, t=2.068, P=0043) and HVPG (24.908±5317 mm Hg vs 22.597±4.928 mm Hg, t=2.100, P=0.039). Based on the results of HE grading, 17 patients (47222%) had grade 0-1 HE, 9 (25.000%) had grade 2 HE, 6 (16.667%) had grade 3 HE, and 4 (11.111%) had grade 4 HE. The stepwise logistic regression analysis showed that MELD score (odds ratio ［OR］=0.803, 95% confidence interval ［CI］: 0.679-0948, P=0.010) and HVPG (OR=0896, 95%CI: 0.816-0.984, P=0.022) were independent risk factors for HE after TIPS. ConclusionThere is a high incidence rate of HE after emergency TIPS for acute EVB, and preoperative MELD score and HVPG can predict the risk of HE after TIPS.

ObjectiveTo investigate the effect of plasma exchange (PE) combined with continuous renal replacement therapy (CRRT) on the prognosis of patients with HBV-related acute-on-chronic liver failure (ACLF) and acute kidney injury (AKI). MethodsA retrospective analysis was performed for the clinical data of 198 HBV-ACLF-AKI patients who were admitted to The First Affiliated Hospital of Soochow University from August 1, 2013 to August 1, 2017. According to the technique of blood purification, they were divided into pharmacotherapy group (group A with 68 patients), PE group (group B with 56 patients), and PE+CRRT group (group C with 74 patients). Related clinical data on admission were collected, including sex, age, biochemical parameters after blood purification (total bilirubin, albumin, serum sodium, international normalized ratio, white blood cell count, platelet count, and hematocrit), common complications, and blood purification method. Creatinine clearance rate (CCR), estimated glomerular filtration rate (eGFR), and MELD combined with serum sodium concentration (MELD-Na) were calculated before and after treatment. A one-way analysis of variance was used for comparison of normally distributed continuous data between three groups; the paired t-test was used for comparison within one group before and after treatment, and the two samples t-test was used for comparison between groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between three groups; the paired samples Wilcoxon signed rank test was used for comparison within one group before and after treatment, and the Mann-Whitney U test was used for comparison between groups. The chi-square test was used for comparison of categorical data between three groups. The Cox proportional-hazards regression model was used to investigate the influencing factors for survival time and outcome. ResultsBefore treatment, there were significant differences between the three groups in sex, age, blood biochemical parameters, eGFR, CCR, complications, and MELD-Na (all P＞0.05). Groups B and C had significant increases in eGFR and CCR and a significant reduction in MELD-Na after treatment (group B: Z=-2.81, Z=-3.67, t=6.07, all P＜0.05; group C: Z=-5.81, Z=-4.05, t=-6.90, all P＜0.05), and there were no significant differences in eGFR, CCR, and MELD-Na between groups B and C after treatment (all P＞0.05). The regression analysis showed that eGFR, CCR, and MELD-Na after blood purification were influencing factors for the survival indices of ACLF-AKI patients (all P＜0.05). The risk of death and cumulative risk gradually increased over the time of hospitalization. ConclusionPE alone or in combination with CRRT can significantly improve the renal function of ACLF-AKI patients, but the combination treatment has no obvious advantages. The improvement in renal function after blood purification directly affects the prognosis of ACLF-AKI patients, and the risk of death and cumulative risk gradually increase over the time of hospitalization.

ObjectiveTo investigate the value of Child-Turcotte-Pugh (CTP) score, Model for End-Stage Liver Disease (MELD) score, chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score, and APASL-ACLF Research Consortium (AARC) score in evaluating the prognosis of cirrhotic patients with infection. MethodsA retrospective analysis was performed for the clinical data of cirrhotic patients with infection who were admitted to The First Hospital Affiliated to Soochow University from January 2014 to December 2017, and according to their prognosis during hospitalization, they were divided into group A (patients with a stable disease after comprehensive internal medicine treatment) and group B (patients who died during hospitalization, who left the hospital and gave up treatment, or who underwent liver transplantation due to no response to internal medicine treatment). The two groups were compared in terms of general information, the worst values of clinic indices during hospitalization, CTP score, MELD score, CLIF-SOFA score, AARC score, and organ replacement therapy (including mechanical ventilation, artificial liver support system, and renal replacement therapy). The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was performed for the variables with statistical significance in the univariate analysis, and the receiver operating characteristic (ROC) curve was used to assess the efficiency of these four scoring systems in predicting prognosis. ResultsA total of 522 cirrhotic patients with infection were enrolled, among whom 381 survived and 141 died, resulting in a mortality rate of 27.01%. The univariate analysis showed that there were significant differences between the two groups in platelet count, total bilirubin, arterial blood lactate, international normalized ratio, CTP score, MELD score, CLIF-SOFA score, and AARC score (all P＜005), and the multivariate logistic regression analysis showed that all these four scoring systems had a strong predictive value and CTP score (odds ratio ［OR］=2.308, 95% confidence interval ［CI］: 0.640-0.796, P = 0.016), MELD score (OR=0.632, 95%CI: 0.638-0.814, P=0.007), CLIF-SOFA score (OR=1.920, 95%CI: 0.788-0.908, P=0.017), and AARC score (OR=0.713, 95%CI: 0.751-0.882, P=0.005) were independent factors for the prognosis of cirrhotic patients with infection. The ROC curve analysis showed that all these four scoring systems could predict the prognosis of cirrhotic patients with infection, and the CLIF-SOFA score had the strongest predictive efficiency, with a sensitivity of 0.854, a specificity of 0.690, and an area under the ROC curve of 0.848. ConclusionCTP score, MELD score, CLIF-SOFA score, and AARC score can predict the prognosis of cirrhotic patients with infection and provide guidance to anti-infective therapy. Among them, CLIF-SOFA score has a high predictive value and can be widely used in clinical practice.