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Eur J Pediatr 2021 May 12. Epub 2021 May 12.

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

The objective of the study was to evaluate the diagnostic and prognostic role of serum cystatin C, urinary neutrophil gelatinase-associated lipocalin (NGAL), and renal resistive index (RRI) in AKI among pediatric cirrhotics. The study included cirrhotic children under 18 years of age. AKI was diagnosed as per Kidney Diseases-Improving Global Outcomes (KDIGO) guidelines. 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

Lab Med 2021 May 3. Epub 2021 May 3.

Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: Spontaneous bacterial peritonitis (SBP) is considered the paradigmatic model of infection in patients with liver cirrhosis. Therefore, there is a need for an accurate and rapid method for SBP diagnosis. The aim of this study was to evaluate the validity of serum-ascites 25-hydroxyvitamin D (25-OH vitamin D) gradient (SADG) as a marker for diagnosing SBP in patients with cirrhotic ascites. Read More

Clin Res Hepatol Gastroenterol 2021 Apr 27:101714. Epub 2021 Apr 27.

The Department of Internal, Occupational Diseases and Rheumatology, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya st., Moscow, 119991, Russia; The Department of Internal Diseases, Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University, 27-1 Lomonosov prospect, Moscow, 119192, Russia.

Background: Previous short-term studies have reported on liver function improvements and delisting among liver transplantation (LT) candidates with hepatitis C virus (HCV) and decompensated liver cirrhosis after successful antiviral therapy. This study aimed to evaluate the long-term impact of HCV eradication on liver function, portal hypertension, probability of delisting, and clinical outcomes in patients awaiting LT.

Methods: Forty-five LT candidates with decompensated HCV cirrhosis were prospectively observed after HCV eradication by direct-acting antiviral therapy. Read More

Expert Opin Pharmacother 2021 Apr 21:1-12. Epub 2021 Apr 21.

Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany.

Bacterial peritonitis is an infection with high mortality if not treated immediately. In the absence of an intraabdominal source of infection, bacterial peritonitis may arise in patients with liver cirrhosis, in patients on peritoneal dialysis (PD) for end-stage renal disease or in patients with tuberculosis. In patients with cirrhosis, bacterial peritonitis may trigger acute on chronic liver failure with substantial mortality despite optimal treatment. Read More

Front Immunol 2021 2;12:661182. Epub 2021 Apr 2.

Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.

Chronic liver injury results in immune-driven progressive fibrosis, with risk of cirrhosis development and impact on morbidity and mortality. Persistent liver cell damage and death causes immune cell activation and inflammation. Patients with advanced cirrhosis additionally experience pathological bacterial translocation, exposure to microbial products and chronic engagement of the immune system. Read More

Med J Armed Forces India 2021 Apr 25;77(2):129-137. Epub 2021 Mar 25.

Head of Division, Division of Gastroenterology, Hepatology & Nutrition, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, USA.

End stage liver disease (ESLD) is an irreversible condition that is a management challenge to the paediatrician. The aetiology and natural history of ESLD in children is not only distinct from adults but also variable depending upon the age of presentation. Children are especially vulnerable to developmental delay, frailty and malnutrition. 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

Am J Case Rep 2021 Apr 13;22:e930677. Epub 2021 Apr 13.

Department of Internal Medicine, HANSUNG Union Internal Medicine Clinic and Dialysis Center, Daegu, South Korea.

BACKGROUND Pediatric patients with nephrotic syndrome have a high risk of developing spontaneous bacterial peritonitis (SBP). However, SBP in adults with nephrotic syndrome is very rare. We report a case of SBP induced by Escherichia coli in a 60-year-old male patient on immunosuppressive therapy for the treatment of minimal change disease (MCD). Read More

Rev Med Chil 2020 Nov;148(11):1674-1678

Grupo Medicina Hospitalaria, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

In patients with actively bleeding gastric varices, the treatment of choice is the endoscopic use of sclerosing agents such as cyanoacrylate. We report a 69-year-old man who, after being treated with cyanoacrylate, suffered from recurrent febrile episodes. After an extensive study and broad-spectrum antibiotic treatment, discarding other presumably infectious focus, the superinfection of the cyanoacrylate plug was suspected, and its surgical removal was decided. 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

Trop Biomed 2021 Mar;38(1):183-186

Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.

Spontaneous bacterial peritonitis caused by Vibrio cholerae non-O1/ non-O139 is a rare phenomenon. V. cholerae is known as a common aetiology of epidemic diarrheal disease and rarely causes extra-gastrointestinal infections. Read More

Case Rep Infect Dis 2021 12;2021:8865339. Epub 2021 Mar 12.

Wright State University Boonshoft School of Medicine, Department of Infectious Diseases, Weber CHE Building, 2nd Floor E Apple St. Dayton, Dayton, OH 45409-2902, USA.

We describe a case of gonococcal spontaneous bacterial peritonitis (SBP) in a 48-year-old sexually active female with alcoholic cirrhosis and chronic hepatitis B. She was admitted with fever, abdominal pain and distension without dysuria, dyspareunia, or vaginal discharge. On exam, she was icteric with features of sepsis and tense ascites. Read More

Hepatology 2021 Mar 27. Epub 2021 Mar 27.

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

Human serum albumin (HSA) is the most abundant plasma protein and it regulates diverse body functions. In advanced and decompensated cirrhosis patients, serum albumin levels are low due to reduction in hepatocyte mass and loss due to disease per se and multiple therapeutic interventions. Due to its oncotic and non-oncotic properties, administration of human albumin solutions (HAS) has been found to be beneficial in patients undergoing large volume paracentesis, hepatorenal syndrome and spontaneous bacterial peritonitis. Read More

J Clin Exp Hepatol 2021 Mar-Apr;11(2):171-180. Epub 2020 Aug 22.

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

Background And Aims: Autoimmune hepatitis presenting as acute on chronic liver failure (AIH-ACLF) is a novel entity with limited data on clinical course and management. We assessed outcomes in patients of AIH-ACLF with no extrahepatic organ dysfunction/failure when administered steroids.

Methods: In this retrospective analysis, clinical data, laboratory parameters, liver biopsy indices and prognostic scores such as model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores at baseline were computed for patients with AIH-ACLF and compared across strata of incident infections and transplant-free survival. Read More

Eur J Gastroenterol Hepatol 2021 Mar 19. Epub 2021 Mar 19.

Tropical Medicine and Gastroenterology Department, Al-Rajhi Liver Hospital, Assiut University Hospitals, Assiut, Egypt Hospital Israelita Albert Einstein, São Paulo, Brazil.

Background: Acute-on-chronic liver failure (ACLF) is a severe liver cirrhosis complication with high mortality rates. Despite that chronic liver diseases are prevalent in Egypt, there is no available data about patients with ACLF. We aimed to evaluate the pattern of ACLF in Egypt. Read More

Gut Pathog 2021 Mar 19;13(1):17. Epub 2021 Mar 19.

Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.

Background: Spontaneous bacterial peritonitis (SBP) is one of the most common infectious diseases in patients with cirrhosis and is associated with serious prognosis. A prevailing dogma posits that SBP is exacerbated by the frequent use of proton pump inhibitors (PPIs).

Aims: To re-assess the association between PPIs use and SBP incidence with larger and better-quality data. Read More

JAMA 2021 03;325(11):1118

Penn State Hershey Medical Center, Hershey, Pennsylvania.

Gut 2021 Mar 11. Epub 2021 Mar 11.

Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Bavaria, Germany

Objective: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis with a 1-year mortality of 66%. Bacterial translocation (BT) from the intestine to the mesenteric lymph nodes is crucial for the pathogenesis of SBP.

Design: Since BT presupposes a leaky intestinal epithelium, the integrity of mucus and epithelial cell junctions (E-cadherin and occludin) was examined in colonic biopsies from patients with liver cirrhosis and controls. Read More

JHEP Rep 2021 Apr 17;3(2):100221. Epub 2020 Dec 17.

Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany.

Background & Aims: Macrophage migration inhibitory factor (MIF) is an inflammatory cytokine and an important regulator of innate immune responses. We hypothesised that serum concentrations of MIF are associated with disease severity and outcome in patients with decompensated cirrhosis and acute-on-chronic liver failure (ACLF).

Methods: Circulating concentrations of MIF and its soluble receptor CD74 (sCD74) were determined in sera from 292 patients with acute decompensation of cirrhosis defined as new onset or worsening of ascites requiring hospitalisation. Read More

J Pharm Pract 2021 Mar 2:897190021997002. Epub 2021 Mar 2.

Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA.

Background: Albumin has been shown to decrease the incidence of mortality and acute kidney injury (AKI) in patients with spontaneous bacterial peritonitis (SBP). Albumin administration in SBP is recommended within 6 hours of diagnosis and for reserved use in high-risk patients with the following baseline laboratory tests: serum creatinine >1 mg/dL, blood urea nitrogen >30 mg/dL or total bilirubin >4 mg/dL.

Objective: We aimed to assess the impact of an albumin order set restricted to high-risk SBP. Read More

Transpl Immunol 2021 Apr 20;65:101378. Epub 2021 Feb 20.

Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK. Electronic address:

Blau syndrome is a rare autoinflammatory granulomatous disease caused by variants in the NOD2 gene, classically presenting in childhood. Hepatic manifestations are recognized including cholestasis and granulomatous liver disease. We describe a novel NOD2 gene variant c. Read More

J Clin Transl Hepatol 2021 Feb 22;9(1):32-39. Epub 2020 Dec 22.

Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, NJ, USA.

Background And Aims: Patients with cirrhosis are immunocompromised and at higher risk of developing infections compared to the general population. The aim of this study was to assess the incidence of infections in cirrhotic patients in a large academic liver center and investigate potential associations between infections, bacteria isolated, therapeutic regimens used, and mortality.

Methods: This was a retrospective chart review study, including 192 patients. Read More

Transpl Infect Dis 2021 Feb 14:e13583. Epub 2021 Feb 14.

Division of Gastroenterology (Gastrocentro), University of Campinas (Unicamp), Campinas, Brazil.

Cryptococcus neoformans is rarely associated with peritonitis in cirrhotic patients; nevertheless, it has a high mortality rate. Early diagnosis and prompt treatment may be the determining prognostic factors. This is a report of two patients awaiting a liver transplant who had opposite outcomes after the diagnosis of spontaneous cryptococcal peritonitis. Read More

J Gastrointestin Liver Dis 2021 Mar 12;30(1):94-102. Epub 2021 Mar 12.

Centre for Liver Disease, Buon Consiglio - Fatebenefratelli Hospital, Napoli, Italy.

Background And Aims: Patients with liver cirrhosis (LC) often have malnutrition (MN), which can be associated with decompensation, infection, and death. The aims were to determine: the prevalence of MN in patients with LC and ascites, its impact on mortality, and the relationship between MN and spontaneous bacterial peritonitis (SBP).

Methods: Nutritional status (NS) was analysed in cirrhotic patients, experiencing their first episode of ascites, who were consecutively admitted at two clinical liver centres between November 2014 and October 2016. Read More

J Family Med Prim Care 2020 Nov 30;9(11):5542-5546. Epub 2020 Nov 30.

Department of Gastroenterology, LTMGH and LTMMC, Sion, Mumbai, Maharashtra, India.

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/mm) and positive culture. Usually fluid analysis and culture take time and precious hours are lost in starting therapy. Read More

Int J Infect Dis 2021 Mar 28;104:718-724. Epub 2021 Jan 28.

Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address:

Objective: To determine serogroups, multilocus sequence typing (MLST) of Listeria monocytogenes isolates and analyze clinical characteristics of these clones focusing on non-perinatal cases.

Methods: From 2000 to 2015, we analyzed 123 human listeriosis cases at a medical center in northern Taiwan using PCR serogrouping, MLST, and clinical presentations.

Results: The annual incidence of listeriosis increased since 2005 with a peak in 2008 (0. Read More

J Transl Int Med 2020 Dec 31;8(4):220-236. Epub 2020 Dec 31.

Department of Medicine and Surgery, University of Insubria, Como/Varese, Italy.

Clinical history of liver cirrhosis is characterised by two phases: the asymptomatic phase, also termed 'compensated cirrhosis', and the phase of complications due to the development of portal hypertension and liver dysfunction, also termed 'decompensated cirrhosis', in which patients may develop ascites, the most frequent and clinically relevant complication of liver cirrhosis. Ascites can be classified into uncomplicated and complicated according to the development of refractoriness, spontaneous bacterial peritonitis (SBP) or the association with hepatorenal syndrome (HRS). In this narrative review, we will extensively discuss the optimal pharmacological and non-pharmacological management of cirrhotic ascites with the aim to offer an updated practical guide to Internal Medicine physicians. Read More