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Matrix Biol 2021 Jun 9. Epub 2021 Jun 9.

Institute of Pharmacology and Toxicology, Goethe University, Frankfurt, Germany. Electronic address:

Soluble biglycan, a small leucine-rich proteoglycan, plays a significant role in several pathologies as it has emerged as an extracellular matrix-derived danger-associated molecular pattern. Biglycan is released from the extracellular matrix in response to tissue injury and, as a canonical danger signal, interacts with innate immune receptor, Toll-like receptors 2 and 4, thereby triggering a sustained inflammatory response. Recent evidence indicates that biglycan acts as a molecular switch between inflammation and autophagy by a specific interaction with the Toll-like co-receptor CD14 and CD44, respectively. Read More

J Clin Pharm Ther 2021 Jun 7. Epub 2021 Jun 7.

Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.

What Is Known And Objective: The purpose of this paper was to discuss the limitations of the studies serving as the evidence for recommendations in clinical practice guidelines concerning albumin use for cirrhosis-related complications, review relevant studies published since the guidelines and suggest directions for future investigations.

Comment: There are no recent comprehensive clinical practice guidelines concerning albumin. Instead, more recent albumin guidelines reflect areas of specialty practice such as those by American and European associations for the study of the liver and liver disease. Read More

Hepatology 2021 Jun 7. Epub 2021 Jun 7.

Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Italy.

We appreciate the interest of Jindal et al. in our article recently published in Hepatology on response to terlipressin and albumin and post-transplant outcomes in patients with hepatorenal syndrome (AKI-HRS). They raised four important points. Read More

World J Gastroenterol 2021 May;27(20):2615-2629

State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.

Background: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with high mortality, which necessitates accurate clinical decision. However, studies on prognostic factors and scoring systems to predict overall survival of HRS are not enough. Meanwhile, a multicenter cohort study with a long span of time could be more convincing. Read More

Hepatology 2021 Jun 6. Epub 2021 Jun 6.

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi- 110070, India.

We read with interest the article by Piano et al. suggesting improved liver transplant (LT) outcomes in cirrhosis patients with hepatorenal syndrome (AKI-HRS) showing response to terlipressin and albumin . Few important issues need to be addressed. Read More

Clin Case Rep 2021 May 24;9(5):e04037. Epub 2021 Mar 24.

Toxoplasmosis Research Center Communicable Diseases Institute Iranian National Registry Center for Lophomoniasis and Toxoplasmosis Mazandaran University of Medical Sciences Sari Iran.

HRS is a rare and poor prognosis complication of chronic acetaminophen toxicity, which presents by progressive decline in renal function secondary to liver failure. Read More

Hepat Med 2021 25;13:45-57. Epub 2021 May 25.

Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA.

According to the Centers for Disease Control and Prevention, chronic liver disease and cirrhosis is the 11th leading cause of death in the United States. Common causes of chronic liver disease include alcohol, viral hepatitis, and non-alcoholic steatohepatitis (NASH). Inflammation is a critical driver in the progression of liver disease to liver fibrosis and ultimately cirrhosis. Read More

Medicines (Basel) 2021 May 12;8(5). Epub 2021 May 12.

Department of Medicine, Mayo Clinic, Division of Nephrology and Hypertension, Rochester, MN 55905, USA.

This study aimed to determine the rates of inpatient palliative care service use and assess the impact of palliative care service use on in-hospital treatments and resource utilization in hospital admissions for hepatorenal syndrome. Using the National Inpatient Sample, hospital admissions with a primary diagnosis of hepatorenal syndrome were identified from 2003 through 2014. The primary outcome of interest was the temporal trend and predictors of inpatient palliative care service use. Read More

Can J Gastroenterol Hepatol 2021 17;2021:9915055. Epub 2021 May 17.

Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.

A low serum bicarbonate (SB) level is predictive of adverse outcomes in kidney injury, infection, and aging. Because the liver plays an important role in acid-base homeostasis and lactic acid metabolism, we speculated that such a relationship would exist for patients with cirrhosis. To assess the prognostic value of admission SB on adverse hospital outcomes, clinical characteristics were extracted and analyzed from a large electronic health record system. Read More

Eur J Gastroenterol Hepatol 2021 May 21. Epub 2021 May 21.

Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India.

Background: Acute kidney injury (AKI) in a patient with cirrhosis has high short-term mortality. Midodrine has shown promising results in the treatment of AKI-hepatorenal syndrome (HRS-AKI).

Aims: To compare midodrine and albumin versus albumin alone for the secondary prophylaxis of HRS-AKI. Read More

J Clin Gastroenterol 2021 May 24. Epub 2021 May 24.

Department of Medicine Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH.

Acute on chronic liver failure (ACLF) is a unique syndrome that afflicts patients with chronic liver disease and results in high short-term mortality, in the setting of organ system failures. Given this prognosis, there is an urgent need to understand risk factors for this condition, for appropriate medical management of organ failures, and for selection criteria for patients who may benefit from liver transplantation (LT). Although several definitions exist to identify ACLF, all of them are designed to identify patients with uniquely high mortality. Read More

Liver Transpl 2021 May 24. Epub 2021 May 24.

Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA.

Hepatorenal syndrome (HRS) is a devastating complication of advanced liver disease associated with high mortality. Despite having been described as a clinical syndrome more than 60 years ago, options for the treatment of HRS remain very limited. Medical management of patients with HRS, either those waiting for definitive treatment with liver transplantation or those for whom transplantation is not an option, typically includes administration of albumin in combination with vasoconstrictor therapy. Read More

Pituitary 2021 May 21. Epub 2021 May 21.

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthpuram, Kerala, India.

Leptospirosis is a common tropical febrile illness which may manifest with the hepatorenal syndrome and systemic hemorrhagic manifestations. Pituitary apoplexy is a rare but life-threatening condition characterized by a hemorrhage within the pituitary gland or a pituitary adenoma. Apoplexy is very rarely associated with some inducing events such as infectious diseases such as dengue hemorrhagic fever, Hantaan virus, Puumala virus have also been reported to cause pituitary apoplexy. Read More

ACG Case Rep J 2021 May 12;8(5):e00587. Epub 2021 May 12.

New York University Grossman School of Medicine, New York, NY.

A 65-year-old man with chronic hepatitis C virus and hepatocellular carcinoma, after surgical resection and chemotherapy, was started on a regimen of glecaprevir and pibrentasavir for treatment of his hepatitis C virus. Ten days later, he developed hepatotoxicity with subsequent progression to hepatorenal syndrome (HRS). On discontinuation of glecaprevir/pibrentasavir and initiation of HRS treatment, he had improvement in his renal and hepatic function. Read More

J Clin Exp Hepatol 2021 May-Jun;11(3):354-386. Epub 2020 Oct 9.

Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, 110060, Delhi, India.

Renal dysfunction is very common among patients with chronic liver disease, and concomitant liver disease can occur among patients with chronic kidney disease. The spectrum of clinical presentation and underlying etiology is wide when concomitant kidney and liver disease occur in the same patient. Management of these patients with dual onslaught is challenging and requires a team approach of hepatologists and nephrologists. Read More

J Clin Exp Hepatol 2021 May-Jun;11(3):343-353. Epub 2020 Aug 25.

Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029, India.

Aims And Background: There is limited information on comparison of clinical outcomes with carvedilol for secondary prophylaxis following acute variceal bleed (AVB) when compared with propranolol. We report long-term clinical and safety outcomes of a randomised controlled trial comparing carvedilol with propranolol with respect to reduction in hepatic venous pressure gradient (HVPG) in patients after AVB.

Methods: We conducted a post-hoc analysis of patients recruited in an open-label randomized controlled trial comparing carvedilol and propranolol following AVB, and estimated long-term rates of rebleed, survival, additional decompensation events and safety outcomes. Read More

Clin Transl Gastroenterol 2021 May 11;12(5):e00359. Epub 2021 May 11.

Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

Introduction: Urinary neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in differentiating acute tubular necrosis (ATN) from other types of acute kidney injuries (AKIs) in cirrhosis, particularly hepatorenal syndrome (HRS). However, NGAL is not currently available in clinical practice in North America.

Methods: Urinary NGAL was measured in a prospective cohort of 213 US hospitalized patients with decompensated cirrhosis (161 with AKI and 52 reference patients without AKI). Read More

Clin Liver Dis 2021 Feb 17;25(1):103-120. Epub 2020 Oct 17.

Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, 1120 Northwest 14th #1115, Miami, FL 33136, USA.

Complications of portal hypertension such as gastroesophageal variceal hemorrhage, ascites, and spontaneous bacterial peritonitis, as well as pulmonary complications, are often responsible for diminished quality of life, excess morbidity and mortality, increased health care resource use and expenditure, and dropout from the liver transplant (LT) waiting list. Therefore, the care of LT candidates on the waiting list must be centered on anticipation and prompt intervention for these complications. Read More

World J Hepatol 2021 Apr;13(4):421-432

Department ofGastroenterology and Hepatology, Changi General Hospital, Singapore 529889, Singapore.

Decompensated cirrhosis is characterized by chronic inflammation and severe portal hypertension leading to systemic circulatory dysfunction. Albumin infusion has been widely used in decompensated cirrhosis in patients with spontaneous bacterial peritonitis, large-volume paracentesis and hepatorenal syndrome. Emerging data suggest long-term albumin infusion has both oncotic and non-oncotic properties which may improve the clinical outcomes in decompensated cirrhosis patients. Read More

J Am Coll Radiol 2021 May;18(5S):S153-S173

Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, Chair, FMLH credentials committee, Division chief of IR at Medical College of Wisconsin.

Cirrhosis is a heterogeneous disease that cannot be studied as a single entity and is classified in two main prognostic stages: compensated and decompensated cirrhosis. Portal hypertension, characterized by a pathological increase of the portal pressure and by the formation of portal-systemic collaterals that bypass the liver, is the initial and main consequence of cirrhosis and is responsible for the majority of its complications. A myriad of treatment options exists for appropriately managing the most common complications of portal hypertension, including acute variceal bleeding and refractory ascites. Read More

Hepatology 2021 May 3. Epub 2021 May 3.

Stanford University, Division of Gastroenterology and Hepatology, Palo Alto, California, USA.

This is a comprehensive guidance on the diagnosis, evaluation, and management of ascites and hepatorenal syndrome in patients with chronic liver disease from the American Association for the Study of Liver Diseases (AASLD). It replaces the prior AASLD guideline on the same topic published in 2012 (1). Read More

Zhonghua Gan Zang Bing Za Zhi 2021 Mar;29(3):193-195

Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.

Liver cirrhosis can lead to a variety of complications. Ascites, hepatic encephalopathy, esophageal variceal bleeding, and hepatorenal syndrome have been well recognized. However, there are still some complications that have a high incidence, but are overlooked by clinicians. Read More

Am J Gastroenterol 2021 Apr 21. Epub 2021 Apr 21.

Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Introduction: A model that can predict short-term mortality in patients with the Budd-Chiari syndrome (BCS) with a high degree of accuracy is currently lacking. The primary objective of our study was to develop an easy-to-use in-hospital mortality prediction model in patients with BCS using easily available clinical variables.

Methods: Data were extracted from the National Inpatient Sample to identify all adult patients with a listed diagnosis of BCS from 2008 to 2017 using ICD-9 or ICD-10 codes. Read More

Eur J Gastroenterol Hepatol 2021 Apr 16. Epub 2021 Apr 16.

Division of Gastroenterology Cardiology Unit Interventional Radiology Unit, San Giovanni Battista Hospital, Turin, Italy.

Background And Aims: Left ventricular diastolic dysfunction (LVDD) in cirrhotics are associated with circulatory dysfunction, hepatorenal syndrome (HRS) and heart failure in stressful conditions. Transjugular intrahepatic portosystemic shunt (TIPS) exacerbates the hyperdynamic circulation and challenges cardiac function. We evaluated the incidence and the impact of LVDD in cirrhotic candidates to TIPS for refractory ascites. Read More

Hepatol Commun 2021 Apr 5;5(4):608-617. Epub 2021 Jan 5.

Division of Gastroenterology Department of Medicine Duke University Hospital Durham NC USA.

Identifying patients at higher risk for poor outcomes from nonalcoholic fatty liver disease (NAFLD) remains challenging. Metabolomics, the comprehensive measurement of small molecules in biological samples, has the potential to reveal novel noninvasive biomarkers. The aim of this study was to determine if serum metabolite profiles in patients with NAFLD associate with future liver-related events. Read More

Rev Med Suisse 2021 04;17(734):758

Groupement hospitalier de l'Ouest lémanique (GHOL), Nyon.

Liver Transpl 2021 Apr 13. Epub 2021 Apr 13.

Department of Internal Medicine and Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

Acute kidney injury in the setting of cirrhosis (hepatorenal syndrome-acute kidney injury [HRS-AKI]) is a severe and often fatal complication of end-stage liver disease. The goals of treatment are to reverse renal failure and prolong survival in critically ill patients. However, interventions have limited efficacy, and mortality rates remain high. Read More

Indian J Nephrol 2020 Nov-Dec;30(6):391-397. Epub 2019 Nov 11.

Department of Biochemistry, JIPMER, Pondicherry, India.

Background And Aims: Renal failure occurring in the setting of cirrhosis increases mortality by more than threefold. Serum creatinine, the conventional marker for renal dysfunction has inherent limitations in identifying and categorizing renal dysfunction in patients with chronic liver disease (CLD). Neutrophil gelatinase associated lipocalin (NGAL) is a novel biomarker which gets upregulated as early as 2-6 hours following the insult to renal tubules. Read More

Clin Liver Dis 2021 May 11;25(2):441-460. Epub 2021 Mar 11.

Liver Unit, Hospital Clínic de Barcelona, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.

Acute kidney injury (AKI) is a frequent complication in patients with cirrhosis. Patients with cirrhosis can develop AKI due to different causes. Hepatorenal syndrome (HRS) is a unique cause of AKI occurring in patients with advanced cirrhosis and is associated with high short-term mortality. Read More

Liver Transpl 2021 Apr 10. Epub 2021 Apr 10.

Stanford University, Division of Nephrology.

Background & Aims: Vasoconstrictors are the treatment of choice for hepatorenal syndrome (HRS), a potentially lethal complication of end-stage liver disease. We evaluate the real-life effectiveness of a sequential vasoconstrictor regimen of midodrine-octreotide followed by norepinephrine in a non-ICU setting in the United States, where terlipressin is not available.

Approach & Results: Adult patients diagnosed with HRS were treated with oral midodrine and subcutaneous octreotide in conjunction with albumin. Read More