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Liver Cirrhosis: Advances in Clinical Management
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Liver Cirrhosis: Advances in Clinical Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (15 April 2023) | Viewed by 10055

Special Issue Editor

Dr. Laura Turco

E-Mail Website
Guest Editor
Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
Interests: cirrhosis; portal hypertension; ascites; variceal bleeding; hepatic encephalopathy; non-selective beta-blockers; transjugular intrahepatic portosystemic shunt; liver transplantation.

Special Issue Information

Dear Colleagues,

Cirrhosis is the end stage of any chronic liver disease and it can cause various complications, leading to a high mortality rate.

It consists of two main clinical stages, compensated and decompensated disease, which have entirely different outcomes. Decompensation consists of the development of ascites, variceal bleeding and/or hepatic encephalopathy. In the early phase of cirrhosis, when the patient is compensated, etiological treatment is vital as it can lead to regression of the disease. When portal hypertension develops, drugs that lower the portal pressure, such as non-selective beta-blockers, can be useful in decreasing the risk of decompensation. However, when decompensation occurs, other interventions, such TIPS placement or liver transplantation, should be considered. 

The clinical management of liver cirrhosis, both compensated and decompensated, has rapidly evolved over recent years. For this Special Issue, we encourage submissions that discuss the current state of the diagnosis, treatment, and prognosis of cirrhosis, as well as the treatment of its complications. 

We hope that this Special Issue can provide new insights into the clinical management of cirrhosis.

Dr. Laura Turco
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • portal hypertension
  • ascites
  • variceal bleeding
  • hepatic encephalopathy
  • non-selective beta-blockers
  • transjugular intrahepatic portosystemic shunt
  • liver transplantation
 
 

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Published Papers (3 papers)

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Research

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10 pages, 694 KiB  
Article
Outcome of Intermittent Thoracentesis versus Pigtail Catheter Drainage for Hepatic Hydrothorax
by Seul-Ki Han, Seong-Hee Kang, Moon-Young Kim, Seong-Kyun Na, Taehyung Kim, Minjong Lee, Baek-Gyu Jun, Tae-Suk Kim, Dae-Hee Choi, Ki-Tae Suk, Young-Don Kim, Gab-Jin Cheon, Hyung-Joon Yim, Dong-Joon Kim and Soon-Koo Baik
J. Clin. Med. 2022, 11(23), 7221; https://doi.org/10.3390/jcm11237221 - 5 Dec 2022
Cited by 2 | Viewed by 1998
Abstract
Background/Aims: The management of hepatic hydrothorax (HH) remains a challenging clinical scenario with suboptimal options. We investigated the effect and safety of pigtail catheter drainage compared to intermittent thoracentesis. Methods: This multicenter, retrospective study included 164 cirrhotic patients with recurrent pleural effusion from [...] Read more.
Background/Aims: The management of hepatic hydrothorax (HH) remains a challenging clinical scenario with suboptimal options. We investigated the effect and safety of pigtail catheter drainage compared to intermittent thoracentesis. Methods: This multicenter, retrospective study included 164 cirrhotic patients with recurrent pleural effusion from March 2012 to June 2017. Patients with neoplasms, cardiopulmonary disease, and infectious conditions were excluded. We compared the clinical outcomes of pigtail catheter drainage versus thoracentesis for variables including complications related to procedures, overall survival, and re-admission rates. Results: A total of 164 patients were divided into pigtail catheter (n = 115) and thoracentesis (n = 49) groups. During the follow-up period of 6.93 months after discharge, 98 patients died (pigtail; n = 47 vs. thoracentesis; n = 51). The overall survival (p = 0.61) and 30-day mortality (p = 0.77) rates were similar between the pigtail catheter and thoracentesis groups. Only MELD scores were associated with overall survival (adjusted HR, 1.08; p < 0.01) in patients with HH. Spontaneous pleurodesis occurred in 59 patients (51.3%) in the pigtail catheter group. Re-admission rates did not differ between the pigtail catheter and thoracentesis groups (13.2% vs 19.6% p = 0.7). A total of five complications occurred, including four total cases of bleeding (one patient in the pigtail catheter group and three in the thoracentesis group) and one case of empyema in the pigtail catheter group. Conclusions: Pigtail catheter drainage is not inferior to that of intermittent thoracentesis for the management of HH, proving it may be an effective and safe clinical option. Full article
(This article belongs to the Special Issue Liver Cirrhosis: Advances in Clinical Management)
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14 pages, 2249 KiB  
Article
Use of Human Albumin Administration for the Prevention and Treatment of Hyponatremia in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis
by Zhaohui Bai, Le Wang, Hanyang Lin, Frank Tacke, Gang Cheng and Xingshun Qi
J. Clin. Med. 2022, 11(19), 5928; https://doi.org/10.3390/jcm11195928 - 8 Oct 2022
Cited by 7 | Viewed by 5231
Abstract
Background. Hyponatremia is a common complication of liver cirrhosis and aggravates patients’ outcomes. It may be corrected by human albumin (HA) infusion. Herein, we have conducted a systematic review and meta-analysis to evaluate the efficacy of intravenous HA administration for the prevention and [...] Read more.
Background. Hyponatremia is a common complication of liver cirrhosis and aggravates patients’ outcomes. It may be corrected by human albumin (HA) infusion. Herein, we have conducted a systematic review and meta-analysis to evaluate the efficacy of intravenous HA administration for the prevention and treatment of hyponatremia in liver cirrhosis. Methods. Literature was searched in the PubMed, EMBASE, and Cochrane Library databases. If possible, a meta-analysis would be conducted. Incidence of hyponatremia, rate of resolution of hyponatremia, and serum sodium level were compared between cirrhotic patients who received and did not receive HA infusion. Odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. The quality of evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results. Initially, 3231 papers were identified. Among them, 30 studies, including 25 randomized controlled trials (RCTs) and 5 cohort studies, were eligible. Among cirrhotic patients without hyponatremia, the HA infusion group had significantly lower incidence of hyponatremia (OR = 0.55, 95%CI = 0.38–0.80, p = 0.001) and higher serum sodium level (MD = 0.95, 95%CI = 0.47–1.43, p = 0.0001) as compared to the control group. Among cirrhotic patients with hyponatremia, the HA infusion group had a significantly higher rate of resolution of hyponatremia (OR = 1.50, 95%CI = 1.17–1.92, p = 0.001) as compared to the control group. Generally, the quality of available evidence is low. Conclusions. Based on the current evidence, HA may be considered for preventing the development of hyponatremia in liver cirrhosis, especially in those undergoing LVP, and treating hyponatremia. Well-designed studies are required to clarify the effects of HA infusion on hyponatremia in liver cirrhosis. Full article
(This article belongs to the Special Issue Liver Cirrhosis: Advances in Clinical Management)
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Review

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10 pages, 1184 KiB  
Review
Current Therapy and Liver Transplantation for Portopulmonary Hypertension in Japan
by Katsutoshi Tokushige, Tomomi Kogiso and Hiroto Egawa
J. Clin. Med. 2023, 12(2), 562; https://doi.org/10.3390/jcm12020562 - 10 Jan 2023
Cited by 5 | Viewed by 2270
Abstract
Portopulmonary hypertension (PoPH) and hepatopulmonary syndrome are severe pulmonary complications associated with liver cirrhosis (LC) and portal hypertension. Three key pathways, involving endothelin, nitric oxide, and prostacyclin, have been identified in the development and progression of pulmonary arterial hypertension (PAH). To obtain a [...] Read more.
Portopulmonary hypertension (PoPH) and hepatopulmonary syndrome are severe pulmonary complications associated with liver cirrhosis (LC) and portal hypertension. Three key pathways, involving endothelin, nitric oxide, and prostacyclin, have been identified in the development and progression of pulmonary arterial hypertension (PAH). To obtain a good effect with PAH-specific drugs in PoPH patients, it is important to diagnose PoPH at an early stage and promptly initiate therapy. The majority of therapeutic drugs are contraindicated for Child-Pugh grade C LC, and their effects decrease in the severe PAH stage. Among many LC patients, the measurement of serum brain natriuretic peptide levels might be useful for detecting PoPH. Previously, liver transplantation (LT) for PoPH was contraindicated; however, the indications for LT are changing and now take into account how well the PoPH is controlled by therapeutic drugs. In Japan, new registration criteria for deceased-donor LT have been established for PoPH patients. PoPH patients with a mean pulmonary arterial pressure <35 mmHg and pulmonary vascular resistance <400 dyn/s/cm−5 are indicated for LT, regardless of whether they are using therapeutic drugs. Combined with PAH-specific drugs, LT may lead to excellent long-term outcomes in PoPH patients. We aimed to review current therapies for PoPH, including LT. Full article
(This article belongs to the Special Issue Liver Cirrhosis: Advances in Clinical Management)
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