Liver international : official journal of the International Association for the Study of the Liver
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Randomized Controlled Trial
Ombitasvir/paritaprevir/r, dasabuvir and ribavirin for cirrhotic HCV patients with thrombocytopaenia and hypoalbuminaemia.
Thrombocytopaenia and hypoalbuminaemia are surrogate markers for portal hypertension and hepatic synthetic dysfunction respectively. Patients infected with hepatitis C virus (HCV) with these surrogates have reduced likelihood of sustained virologic response and increased risk for hepatic decompensation or death when treated with peginterferon/ribavirin plus either telaprevir or boceprevir. ⋯ The findings of these analyses support the use of ombitasvir/paritaprevir/ritonavir and dasabuvir with ribavirin in these subpopulations with cirrhosis. Genotype 1a-infected patients with indicators of portal hypertension may benefit from a 24-week treatment duration.
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To assess the correlation between liver stiffness measurement (LSM) by real-time shear wave elastography (SWE) and hepatic venous pressure gradient (HVPG) and to investigate the diagnostic performance of SWE for predicting clinically significant and severe portal hypertension (CSPH and SPH). ⋯ In cirrhotic patients, LSM by SWE is highly correlated with HVPG value regardless of ascites. SWE is a new reliable non-invasive diagnostic tool to predict CSPH and SPH, even in cirrhotic patients with ascites.
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Ischaemia-modified albumin: a marker of bacterial infection in hospitalized patients with cirrhosis.
Patients with cirrhosis present structural changes of human serum albumin (HSA) affecting non-oncotic functions. Ischaemia-modified albumin (IMA), which reflects the capacity to bind cobalt, has been associated to patient mortality during acute-on-chronic liver failure. This study aimed to assess whether circulating IMA is elevated in advanced cirrhosis and its relationship with severity of cirrhosis and specific complications. ⋯ IMA is elevated in patients with advanced cirrhosis. The IMA level does not correlate with disease severity scores, but it is specifically associated to bacterial infection, showing a discriminating performance similar to CRP. Further investigations to assess IMA as a novel diagnostic test for bacterial infection are advocated.