3 research outputs found
Transarterial embolization for the treatment of complicated liver hemangiomas: A report of two cases and review of the literature
Chronic kidney disease in patients with non-alcoholic fatty liver disease: What the Hepatologist should know?
The association of non-alcoholic fatty liver disease (NAFLD) with several other diseases has gained increased interest during the recent years. Among them, the association with chronic kidney disease (CKD) has emerged as an important one regarding both its prevalence and significance. The early recognition of this association is important for the prognosis of patients with NAFLD and CKD. Apart from early diagnosis, the accurate assessment of renal function is also crucial in the clinical practice of hepatologists. Several methods have been used in the literature for the evaluation of kidney function in patients with NAFLD up to now. In this respect, calculators (or formulas) for the estimation of Glomerular Filtration Rate (eGFR) and Albumin to Creatinine Ratio (ACR) are simple, practical and easily available methods for this purpose. The aim of this review is to report on the epidemiology and pathophysiology of the relationship between NAFLD and CKD and to describe the different methods of kidney function assessment in patients with NAFLD. The collection of all relevant data regarding this association will provide hepatologists with pertinent knowledge on this topic and allow them to use the most accurate methods for the assessment of kidney function in these patients in their clinical practice
The significance of C-reactive protein to albumin ratio in patients with decompensated cirrhosis
Background Prognostic indicators in patients with decompensated
cirrhosis are vital for the estimation of death risk. The ratio of
C-reactive protein to albumin (CAR) has been verified as a prognostic
marker in patients with hepatocellular carcinoma and decompensated
cirrhosis related to hepatitis B virus. Neutrophil-to-lymphocyte ratio
(NLR), lymphocyte-to-monocyte ratio (LMR), and gamma globulins have been
separately studied in cirrhosis. We evaluated the predictive role of CAR
and other inflammatory markers in decompensated patients.
Methods We prospectively studied 159 patients with stable decompensated
cirrhosis, calculating the following indexes: CAR, NLR, LMR,
Child-Turcotte-Pugh (CTP), and model for end-stage liver disease (MELD).
Results MELD (area under the curve [AUC] 0.814) and CTP score (AUC
0.752) were superior to the other markers above in predicting patients’
mortality (P<0.05). Patients with CAR<2.17 (median value) presented
better times of survival: 20 months (12-27) vs. 14 months (10-17) (log
rank P=0.015). NLR and LMR barely discriminated patients’ prognosis. In
multivariate analysis, only MELD and CTP scores were significant risk
factors, whether using the proposed cutoff of 1.3 (hazard ratio [HR]
1.17 [1.106-2.44], P<0.001) or the median 2.17 CAR categorical
variable (HR 1.17 [1.104-1.243], P<0.001). When patients who underwent
liver transplantation were excluded, apart from the MELD and CTP scores
CAR 2.17 was the only significant factor associated with the outcome (HR
3.61 [0.96-13.6], P=0.05) and detected different survival times: 10
(1-48) vs. 11 (2-38) months, log rank P=0.003. Patients with LMR=1.9
presented significantly better renal function, in terms of true
glomerular filtration rate (80 +/- 34 vs. 64 +/- 33 mL/min, P=0.004) and
creatinine levels: 0.84 (0.1-1.8) vs. 0.98 (0.59-3.3) mg/dL (P=0.001).
Conclusion Our findings demonstrate the significance of CAR and LMR in
the outcome and renal function of decompensated patients