Arterial Blood Pressure Is Closely Related to Ascites Development in Compensated HCV-Related Cirrhosis

<div><p>Background</p><p>Arterial blood pressure (BP) is a reliable marker of circulatory dysfunction in cirrhotic patients. There are no prospective studies evaluating the association between different levels of arterial BP and ascites development in compensated cirrhotic patients. Therefore, we evaluated the relationship between arterial BP and ascites development in compensated cirrhotic patients.</p><p>Materials and Methods</p><p>A total of 402 patients with compensated HCV-related cirrhosis were prospectively followed during 6 years to identify ascites development. At baseline, patients underwent systolic, diastolic and mean arterial pressure (MAP) measurements. Any history of arterial hypertension was also recorded. The occurrence of events such as bleeding, hepatocellular carcinoma, death and liver transplantation prior to ascites development were considered as competing risk events.</p><p>Results</p><p>Over a median of 156 weeks, ascites occurred in 54 patients (13%). At baseline, MAP was significantly lower in patients with ascites development (75.9 mm/Hg [95%CI, 70.3–84.3]) than those without ascites (93.6 mm/Hg [95% CI: 86.6–102.3]). After adjusting for covariates, the 6-year cumulative incidence of ascites was 40% (95%CI, 34%–48%) for patients with MAP<83.32 mm/Hg. In contrast, cumulative incidences of ascites were almost similar among patients with MAP values between 83.32 mm/Hg and 93.32 mm/Hg (7% [95% CI: 4%–12%]), between 93.32 mm/Hg and 100.31 mm/Hg (5% [95% CI: 4%–11%]) or higher than 100.31 mm/Hg (3% [95% CI: 1%–6%]). The MAP was an independent predictor of ascites development.</p><p>Conclusions</p><p>The MAP is closely related to the development of ascites in compensated HCV-related cirrhosis. The risk of ascites development increases in 4.4 fold for subjects with MAP values <83.32 mm/Hg.</p></div

Baseline characteristics according to ascites development during the follow-up.

<p>Abbreviations: MELD, Model for End-Stage Liver Disease; ALT, alanine aminotransferase; AST, aspartate aminotransferase; INR, international normalized ratio.</p><p>* Arterial hypertension included patients with current history of hypertension and antihypertensive medication or high blood pressure (systolic ≥140 mm/Hg and/or diastolic ≥90 mm/Hg on at least 3 occasions) without antihypertensive drugs.</p>†<p>Nonselective beta-blockers as primary prophylaxis for variceal bleeding.</p><p>For all laboratory measures and for continuous demographics: Wilcoxon signed-ranks tests.</p><p>Proportions: percentage, P value chi-square.</p><p>Quantitative data were expressed as median (25%–75% quantiles).</p><p>The Child-Pugh and MELD scores are measures of the severity of liver disease.</p

Variables found as significant predictors of ascites development.

<p>Results based on competing risk regression models.</p><p>Abbreviations: CI, confidence interval; sHR, subHazard ratios; INR, international normalized ratio.</p><p>*Overall MAP and their quartiles were analyzed separately in different multivariable models.</p>†<p>Non selective beta-blockers as primary prophylaxis for variceal bleeding.</p

Flow of patients through the study.

<p>Flow of patients through the study.</p

Antioxidant and immunomodulatory effects of Viusid in patients with chronic hepatitis C

AIM: To investigate the efficacy of Viusid, a nutritional supplement, as an antioxidant and an immunomodulator in patients with chronic hepatitis C

Development and validation of a noninvasive prediction model for nonalcoholic steatohepatitis resolution after lifestyle intervention.

Liver biopsy is the gold standard method to assess nonalcoholic steatohepatitis (NASH) resolution after therapeutic interventions. We developed and validated a simple and noninvasive scoring system to predict NASH resolution without fibrosis worsening after 1 year of lifestyle intervention. This was a prospective cohort study conducted in 261 patients with histologically proven NASH who were treated with lifestyle changes for 52 weeks and underwent a second liver biopsy to confirm NASH resolution. We divided the data into development (140 subjects) and validation (121 individuals) sets. NASH resolution occurred in 28% (derivation group) and 27% (validation group). At the multivariable analysis, weight loss (odds ratio [OR] = 2.75, 95% confidence interval [CI] 1.65-4.58; P A noninvasive prediction model including weight loss, type 2 diabetes, alanine aminotransferase normalization, age, and a nonalcoholic fatty liver activity score ≥5 may be useful to identify NASH resolution in patients under lifestyle intervention. (Hepatology 2016;63:1875-1887)