98 research outputs found
BLOOD-BRAIN BARRIER DYSFUNCTION ASSESSED BY PROTEIN S-100 BETA LEVELS IN CIRRHOTIC PATIENTS IN ICU
Multicenter prospective validation of the Baveno IV and Baveno II/III criteria in cirrhosis patients with variceal bleeding
UNLABELLED: The criteria for defining failure to control bleeding in cirrhosis patients were introduced at the Baveno II/III meetings and were widely used as endpoints in clinical trials. Because they lacked specificity, the Baveno IV criteria were proposed in 2005 and slightly modified in 2010 (Baveno V). These criteria included a new index for patients undergoing transfusion, called adjusted-blood-requirement-index (ABRI=number of blood units/(final-initial hematocrit+0.01)), with a cutoff value of 0.75. In this multicenter prospective study, we sought to 1) validate the Baveno IV/V criteria; 2) compare them to the Baveno II/III criteria; 3) assess ABRI performance using a standardized calculation. The key inclusion criteria were: 1) variceal bleeding; 2) cirrhosis; 3) no need to modify the transfusion policy. The patients were classified according to the Baveno IV, V, and II/III criteria. The gold standard for failure during a 5-day period was the clinical judgment of three independent experts, blinded to the Baveno assessments. A total of 249 patients were included. The experts\u27 agreement in clinical judgment of the failure was 80%. Failure occurred in 20.5% of patients; the c-statistics were 0.72 versus 0.64 and 0.65 for Baveno IV versus Baveno II/III and Baveno V criteria (P=0.001 for both). ABRI did not improve the diagnostic performance of the Baveno IV criteria. The Baveno IV, but not Baveno II/III, criteria independently predicted survival.
CONCLUSION: The Baveno IV criteria demonstrated a higher accuracy than the Baveno II/III and Baveno V criteria for assessing failure to control bleeding and predicted survival independently. Together, our results show that ABRI is not a useful metric, and the Baveno IV criteria should replace the Baveno II/III criteria
Intravenous non-high-dose pantoprazole is equally effective as high-dose pantoprazole in preventing rebleeding among low risk patients with a bleeding peptic ulcer after initial endoscopic hemostasis
Diagnostic performance of FibroTest, SteatoTest and ActiTest in patients with NAFLD using the SAF score as histological reference
BACKGROUND: Blood tests of liver injury are less well validated in nonâalcoholic fatty liver disease (NAFLD) than in patients with chronic viral hepatitis. AIMS: To improve the validation of three blood tests used in NAFLD patients, FibroTest for fibrosis staging, SteatoTest for steatosis grading and ActiTest for inflammation activity grading. METHODS: We preâincluded new NAFLD patients with biopsy and blood tests from a singleâcentre cohort (FibroFrance) and from the multicentre FLIP consortium. Contemporaneous biopsies were blindly assessed using the new steatosis, activity and fibrosis (SAF) score, which provides a reliable and reproducible diagnosis and grading/staging of the three elementary features of NAFLD (steatosis, inflammatory activity) and fibrosis with reduced interobserver variability. We used nonbinaryâROC (NonBinAUROC) as the main endpoint to prevent spectrum effect and multiple testing. RESULTS: A total of 600 patients with reliable tests and biopsies were included. The mean NonBinAUROCs (95% CI) of tests were all significant (P < 0.0001): 0.878 (0.864â0.892) for FibroTest and fibrosis stages, 0.846 (0.830â0.862) for ActiTest and activity grades, and 0.822 (0.804â0.840) for SteatoTest and steatosis grades. FibroTest had a higher NonBinAUROC than BARD (0.836; 0.820â0.852; P = 0.0001), FIB4 (0.845; 0.829â0.861; P = 0.007) but not significantly different than the NAFLD score (0.866; 0.850â0.882; P = 0.26). FibroTest had a significant difference in median values between adjacent stage F2 and stage F1 contrarily to BARD, FIB4 and NAFLD scores (Bonferroni test P < 0.05). CONCLUSIONS: In patients with NAFLD, SteatoTest, ActiTest and FibroTest are nonâinvasive tests that offer an alternative to biopsy, and they correlate with the simple grading/staging of the SAF scoring system across the three elementary features of NAFLD: steatosis, inflammatory activity and fibrosis
Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension
VARICEAL BLEEDING: UPDATE OF RECOMMENDATIONS FROM THE BRAZILIAN ASSOCIATION OF HEPATOLOGY
Predicting risk factors for rebleeding, infections, mortality following peptic ulcer bleeding in patients with cirrhosis and the impact of antibiotics prophylaxis at different clinical stages of the disease
Authors' reply to Rozin and Quinn et al
Rheumatoid arthritis (RA) is the most common chronic inflammatory disease affecting about 1% of the white population, particularly female patients, and has considerable physical, psychological, and social repercussions.1 In a paper published previously in the Annals, Dadoniene et al described and compared two cohorts of patients with RA from Vilnius (Lithuania) and Oslo (Norway).2 There were no significant differences in sex, age, extra-articular manifestations, education, or family history of RA between the groups. None the less, there were important differences in disease activity, disability, pain, emotional, mental and general health, with patients in the Vilnius group having the worst scores. The number of patients who had never used a disease modifying antirheumatic drug (DMARD) was similar in both groups. Vilnius patients had more commonly used azathioprine, sulfasalazine, and antimalarial drugs, whereas Oslo patients had used methotrexate, gold salts, cyclosporin, and D-penicillamine. Surgery was more common in the Oslo patients. That study was developed to compare the evolution and outcomes of two different populations with RA and was the first to include health related quality of life. The authors attributed the differences between these groups to differences in economic status, medical care, drugs used and, to a lesser extent, genetic differences
Encéphalopathies métaboliques
International audienceMetabolic encephalopathies (ME) are a common cause of admission to emergency rooms, to hospitalization wards or to intensive care units. They could account for 10 to 20% of causes of comatose states in ICU and could be associated to a poor outcome especially in older patients. Nevertheless, they are often reversible and are associated with a favorable outcome when diagnosed and rapidly treated. They correspond to an altered brain functioning secondary to the deficiency of a substance that is mandatory for the normal brain functioning or to the accumulation of a substance that can be either endogenous or exogenous. It preferably occurs in co-morbid patients, complicating its diagnosis and its management. Altered brain functioning, going from mild neuropsychological impairment to coma, movement disorders especially myoclonus and the absence of any obvious differential diagnosis are highly suggestive of the diagnosis. Whereas some biological samplings and brain MRI are essential to rule out differential diagnosis, some others, such as electroencephalogram, may be able to propose important clues in favor of the diagnosis. Once simple symptomatic measures are introduced, the treatment consists mainly in the correction of the cause. Specific treatment options are only seldom available for ME; this is the case for hepatic encephalopathy and some drug-induced encephalopathies. We will successively describe in this review the main pathophysiological mechanisms, the main causes, favoring circumstances of ME, the differential diagnosis to rule out and the etiological work-up for the diagnosis. Finally, a diagnostic and therapeutic strategy for the care of patients with ME will be proposed.Les encĂ©phalopathies mĂ©taboliques (EMtb) sont des causes frĂ©quentes de recours au systĂšme de soins, via les urgences, l'hospitalisation et mĂȘme la rĂ©animation. Elles pourraient reprĂ©senter jusqu'Ă 10 Ă 20 % des causes de coma en rĂ©animation et compromettre le pronostic vital, notamment chez le sujet ĂągĂ©. L'EMtb correspond Ă une altĂ©ration du fonctionnement cĂ©rĂ©bral due Ă un dĂ©ficit en une substance indispensable au mĂ©tabolisme normal ou Ă l'accumulation d'une substance toxique que celle-ci soit endogĂšne ou exogĂšne. Elle survient prĂ©fĂ©rentiellement chez des patients prĂ©sentant des comorbiditĂ©s, complexifiant ainsi son diagnostic et sa prise en charge. Son diagnostic clinique repose sur la survenue subaiguĂ« de troubles des fonctions supĂ©rieures et de mouvements anormaux, myoclonies principalement, en l'absence de signe de localisation neurologique. Indispensables pour Ă©liminer les diagnostics diffĂ©rentiels, certains examens complĂ©mentaires sont parfois en mesure d'apporter des arguments positifs en faveur du diagnostic. C'est le cas pour certains dosages biologiques, et l'Ă©lectroencĂ©phalogramme. Une fois les mesures symptomatiques simples mises en oeuvre Ă l'Ă©vocation du diagnostic, le traitement repose souvent sur le traitement de la cause. Seules certaines encĂ©phalopathies mĂ©taboliques dont l'encĂ©phalopathie hĂ©patique bĂ©nĂ©ficient de prises en charge spĂ©cifiques. Nous dĂ©crirons successivement les principaux mĂ©canismes physiopathologiques et les Ă©tiologies les plus frĂ©quentes d'EMtb, les circonstances favorisantes, la prĂ©sentation clinique, les diagnostics diffĂ©rentiels Ă Ă©liminer, et les examens complĂ©mentaires utiles au diagnostic. Nous proposerons enfin une stratĂ©gie de prise en charge de l'EMtb
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