7 recent reports on cirrhosis outcomes, risk factors

Cirrhotic liver damage is a significant concern in hepatology as treatment is limited to a focus on the underlying cause. However, recent studies have highlighted how to improve fibrosis screening and risk factors that may act as a warning sign for progression to cirrhosis.

The following reports detail new research data on cirrhosis outcomes, related risk factors, and potential treatment through a plasma transfer system.

Acute-on-chronic liver failure ICU outcomes similar to other patients

Patients with acute-on-chronic liver failure admitted to the ICU had clinical outcomes comparable to patients in the ICU without chronic liver disease and similar baseline severity of illness characteristics, according to a recently published study.

“These findings suggest that ICU care in patients with cirrhosis and organ failure is not universally futile and warrants the same ICU treatment considered in non-cirrhotic patients with end organ failure,” Philippe Meersseman, MD, from the University Hospitals Leuven in Belgium, and colleagues wrote. “In addition, ACLF patients should be evaluated for liver transplantation early on during their ICU stay.” Read more

Community-based primary care fibrosis screening feasible for chronic HCV

Researchers using liver stiffness measurement found significant and comparable prevalence of advanced fibrosis between patients with chronic hepatitis C recruited from primary care practices and those recruited from a hospital cohort, according to a recently published study.

“In order to reach the WHO goal of [chronic HCV (CHC)] elimination, the engagement of nonspecialist physicians in CHC treatment and management is paramount,” Stephen Bloom, PhD, from Eastern Health in Victoria, Australia, and colleagues wrote. “Our study suggests a comprehensive community-based CHC screening program is feasible and may identify those at risk of liver-related events and [hepatocellular carcinoma (HCC)].” Read more

Low subcutaneous adiposity linked to mortality risk in women with cirrhosis

A lower subcutaneous adipose tissue index correlated with higher mortality in women with cirrhosis, while lower skeletal muscle predicted mortality in men with cirrhosis, according to a recently published study.

“Besides body composition, sex differences exist regarding other clinical features of liver disease,” Maryam Ebadi, PhD, from the University of Alberta Hospital, Canada, and colleagues wrote. “The findings of our study emphasize the importance of differentiating between muscle, subcutaneous and visceral adipose tissue using cross sectional imaging in patients with liver cirrhosis.” Read more

Alcoholic cirrhosis increases risk for hip fracture

Patients with alcoholic cirrhosis had a significantly higher risk for hip fracture and post-hip fracture mortality compared with the general population, according to recently published data.

“Using data from two national cohorts, we have shown an increased rate of hip fracture for people with alcoholic cirrhosis of between 5-fold to nearly 10-fold compared with the general population,” Harmony Otete, PhD, from the University of Nottingham, United Kingdom, and colleagues wrote. “Our study therefore indicates that interventions to prevent hip fracture in this population could have a significant benefit.” Read more

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Morbid obesity increases risk for acute-on-chronic liver failure

Patients with class III obesity have an increased risk for acute-on-chronic liver failure and a higher prevalence of renal failure as a component of ACLF, according to a recently published study.

“We propose that the link between class III obesity and increased risk of ACLF is due to an obesity-related chronic inflammatory state,” Vinay Sundaram, MD, from the Cedars-Sinai Medical Center, California, and colleagues wrote. “Given the high mortality and health care burden associated with obesity, along with its rising prevalence among patients with cirrhosis, we suggest an even greater emphasis on weight reduction among cirrhotic patients with class III obesity.” Read more

ELAD shows promise in alcoholic hepatitis biomechanical response

In a disease that has no current treatment, a plasma transfer system may offer hope to patients with alcoholic liver disease, according to a poster at the International Liver Congress 2018.

“It is unfortunate that patients with acute alcohol-induced decompensated liver disease are not able to be treated optimally,” Nikolaos T. Pyrsopoulos, MD, PhD, MBA, FACP, AGAF, FAASLD, FRCP, of Rutgers New Jersey Medical School, told Healio Gastroenterology and Liver Disease. “What we would consider our golden bullet — this means steroid-containing therapy — turned out to be not very optimal. In an attempt to against this fierce fight, the extracorporeal liver device might offer a very good result for a very highly specialized segment of this population.” Watch here

Health care costs increase by over 90% after compensated cirrhosis diagnosis

All-cause hospitalizations, rate of emergency department visits and inpatient costs increased by more than 90% following compensated cirrhosis diagnosis among patients with nonalcoholic fatty liver disease or nonalcoholic steatohepatitis, according to a presentation at the International Liver Congress 2018.

“As we all know, NAFLD and NASH are a common cause of compensated cirrhosis in the Western world,” Ali Canbay, MD, from the University of Magdeburg Medical in Germany, said in his presentation. “These patients often develop liver-related complications and can progress to end-stage liver diseases ... which in many cases lead to death.” Read more