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Impact Of Compensated Cirrhosis On Survival In Patients With Acute-On-Chronic Liver Failure, Kessarin Thanapirom, Tongluk Teerasarntipan, Sombat Treeprasertsuk, Ashok Choudhury, Manoj K. Sahu, Rakhi Maiwall, Viniyendra Pamecha, Richard Moreau, Saeed Hamid, Amna Subhan Butt

Section of Gastroenterology

Background and aims: Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database.
Methods: A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis.
Results: Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36-0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43-0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred.
Conclusions: The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were …

Acute-On-Chronic Liver Failure: Consensus Recommendations Of The Asian Pacific Association For The Study Of The Liver (Apasl): An Update, Shiv Kumar Sarin, Ashok Choudhury, Manoj K. Sharma, Rakhi Maiwall, Mamun Al Mahtab, Salimur Rahman, Saeed Hamid, Amna S. Butt, Wasim Jafri, Zaigham Abbas

Section of Gastroenterology

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the "APASL ACLF Research Consortium (AARC)" was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during …

Assessment Of Malnutrition In Patients With Liver Cirrhosis Using Protein Calorie Malnutrition (Pcm) Score Verses Bio-Electrical Impedance Analysis (Bia), Om Parkash, Wasim Jafri, S. M. Munir, Romaina Iqbal

Section of Gastroenterology

Objective: Malnutrition is a common problem in patients with liver cirrhosis and tools for nutritional assessment are under debate. We conducted this study to assess prevalence of malnutrition in cirrhotic patients using PCM score and BIA. Additionally we compared BIA to PCM score for detecting malnutrition in this patient population.

Results: This was a cross sectional study conducted in two tertiary care hospitals of Karachi Pakistan on adults with liver cirrhosis. Malnutrition was assessed by PCM score using anthropometric measurements and biological specimens and (ii) Body cell mass was assessed using BIA. Malnutrition as estimated by the PCM score was …

Next Big Threat For Pakistan Hepatocellular Carcinoma (Hcc), Om Parkash, Saeed Hamid

Section of Gastroenterology

In our country, world hepatitis day (28th May 2013) was observed as a liver cancer day to draw global attention on the global health menace caused by Hepatocellular carcinoma (HCC). This is the right time to write a review article to apprise the nation of this growing burden of HCC caused most commonly by viruses in our country. Pakistan is also recognized as one of the countries of the world where hepatitis C virus (HCV) is endemic. Recent large national surveys suggest an overall HCV prevalence of 4.8% and that of HBV as 2.5%. There are however communities where the …

Electrophysiological Changes In Patients With Liver Cirrhosis In A Tertiary Care Hospital In Karachi, Pakistan, Om Parkash, Ghulam Rehman Mohyuddin, Adil Ayub, Irfan Nazir, Arslan Arif Maan, Saeed Hamid

Section of Gastroenterology

Background: Electrophysiological changes in cirrhosis are well known but least investigated especially in our country hence we wanted to see electrophysiological changes especially QT interval in cirrhotic patients.

Methods: A cross-sectional study was conducted at Aga Khan University Hospital Karachi (AKUH) in which medical records (duration 2008-2010) of cirrhotic patients were reviewed.

Results: Three hundred and eighty cirrhotic patients' charts were studied, 227 (59.7 %) were male and mean age of this cohort was 52.8±12.6 years. The most common cause for CLD was Hepatitis C (CHC) in 260 (68.4%), NBNC in 56(14.7%) and HBV in 51 (13.4%). Only 225 …

Frequency Of Poor Quality Of Life And Predictors Of Health Related Quality Of Life In Cirrhosis At A Tertiary Care Hospital Pakistan, Om Parkash, Romaina Iqbal, Fatima Jafri, Iqbal Azam, Wasim Jafri

Section of Gastroenterology

Background

Cirrhosis produces variety of symptoms which eventually lead to a negative impact on Health Related Quality of Life (HRQOL). The general aim of this study was to evaluate the magnitude of poor HRQOL and to assess factors related with HRQOL in patients with CLD in Pakistan.

Findings

This was a cross sectional study conducted in gastroenterology outpatient clinics of Aga Khan University Hospital, Karachi on adult patients with cirrhosis. In this study chronic liver disease questionnaire (CLDQ) was used to assess HRQOL of these patients and CLDQ score was used as an outcome measure to determine factors related with …

Short Course Adjuvant Terlipressin In Acute Variceal Bleeding: A Randomized Double Blind Dummy Controlled Trial, Zahid Azam, Saeed Hamid, Wasim Jafri, Mohammad Salih, Zaigham Abbas, Shahab Abid, Hasnain Shah

Section of Gastroenterology

Background & Aims: Terlipressin is recommended for 3-5 days as adjuvant to endoscopic variceal band ligation (EVBL) in esophageal variceal bleeding (EVB). We assessed whether terlipressin can be administered for a shorter period of time to Patients with EVB.

Methods: All eligible EVB Patients received 24 h of open label terlipressin at presentation. After successful EVBL, Patients were randomized to receive active or dummy terlipressin for the next 48 h. We excluded Patients with failure to achieve initial hemostasis, bleeding gastric varices, known hepatoma, and/or portal vein thrombosis, advanced cirrhosis (Child-Pugh score >= 12), and Patients on a ventilator. …

Precipitating Factors And The Outcome Of Hepatic Encephalopathy In Liver Cirrhosis, Khalid Mumtaz, Umair Syed Ahmed, Shahab Abid, Noshaba Baig, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

Objective: To determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality.

Study Design: Cross-sectional, analytical study. Place and Duration of Study: The Aga Khan University Hospital, from January 2005 to December 2007.

Methodology: Consecutive patients admitted with different grades of HE were evaluated between January 2005 and December 2007. The precipitants of HE were correlated with the different grades of HE, and length of hospital stay and mortality. Chi-square test was used to compare the proportion of precipitating factors versus hospital stay and grade with significance at p < 0.05.

Results: Of the 404 patients 252 (62%) …

Model For End-Stage Liver Disease (Meld) Score As A Useful Prognostic Marker In Cirrhotic Patients With Infection, Rustam Khan, Shahab Abid, Wasim Jafri, Safia Awan, Saeed Hamid, Hasnain Shah, Shahid Pervez

Section of Gastroenterology

OBJECTIVE: To determine the association of Model for End stage liver disease (MELD) score to the outcome of cirrhotic patients with bacterial infection and to compare it with Child-Turcott-Pugh (CTP) score.

STUDY DESIGN: Descriptive study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007.

METHODOLOGY: Patients with diagnosis of liver cirrhosis and bacterial infection were included. Demographic features, laboratory data and type of infection were recorded. Multiple logistic regression assays were applied to determine the factors associated with poor outcome in cirrhotics with infection. Receiver-Operating Characteristics (ROC) were used to determine the …