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    • "All patients had previous histological confirmation of cirrhosis or a diagnosis of cirrhosis on the basis of standard clinical, biochemical parameters and imaging examinations (19). Refractory ascites is defined also based on the Korean clinical practice guideline for liver cirrhosis (19). All patients had stable hemodynamic parameters and were not active drinkers. "
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    ABSTRACT: This study aimed to assess and compare sarcopenia with other prognostic factors for predicting long-term mortality in cirrhotic patients with ascites. Clinical data of 65 among 89 patients with measurement of all parameters were consecutively collected. Sarcopenia was evaluated as right psoas muscle thickness measurement divided by height (PMTH) (mm/m). During a mean follow-up of 20 (range: 1-49) months, 19 (29.2%) of 65 patients died. The values of the area under the receiver operating characteristics curve (AUROC) of Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, MELD-Na, and PMTH for predicting 1-yr mortality were 0.777 (95% CI, 0.635-0.883), 0.769 (95% CI, 0.627-0.877), 0.800 (95% CI, 0.661-0.900), and 0.833 (95% CI, 0.699-0.924), whereas hepatic venous pressure gradient was not significant (AUROC, 0.695; 95% CI. 0.547-0.818, P=0.053). The differences between PMTH and other prognostic variables were not significant (all P>0.05). The best cut-off value of PMTH to predict long-term mortality was 14 mm/m. The mortality rates at 1-yr and 2-yr with PMTH>14 mm/m vs. PMTH≤14 mm/m were 2.6% and 15.2% vs. 41.6% and 66.8%, respectively (P<0.001). The mortality in cirrhotic patients with PMTH≤14 mm/m was higher than those with PMTH>14 mm/m (HR, 5.398; 95% CI, 2.111-13.800, P<0.001). In conclusion, sarcopenia, evaluated by PMTH, is an independent useful predictor for long-term mortality in cirrhotic patients with ascites. Graphical Abstract
    Full-text · Article · Sep 2014 · Journal of Korean Medical Science
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    • "By contrast, previous studies have suggested that both GVO and GVL can be effective at arresting bleeding in patients with GOV1 [35, 36]. This is mainly because GOV1 extends beyond the gastroesophageal junction and is always associated with esophageal varices [35, 37]. GVL seems to be more effective at arresting GOV1 bleeding than GVO, and thus we extracted data on patients with GOV1 [8, 12, 15, 16]. "
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    ABSTRACT: Background. Cyanoacrylate injection (GVO) and band ligation (GVL) are effective treatments for gastric variceal hemorrhage. However, data on the optimal treatment are still controversial. Methods. For our overall analysis, relevant studies were identified from several databases. For each outcome, data were pooled using a fixed-effect or random-effects model according to the result of a heterogeneity test. Results. Seven studies were included. Compared with GVL, GVO was associated with increased likelihood of hemostasis of active bleeding (odds ratio [OR] = 2.32; 95% confidence interval [CI] = 1.19-4.51) and a longer gastric variceal rebleeding-free period (hazard ratio = 0.37; 95% CI = 0.24-0.56). No significant differences were observed between GVL and GVO for mortality (hazard ratio = 0.66; 95% CI = 0.43-1.02), likelihood of variceal obliteration (OR = 0.89; 95% CI = 0.52-1.54), number of treatment sessions required for complete variceal eradication (weighted mean difference = -0.45; 95% CI = -1.14-0.23), or complications (OR = 1.02; 95% CI = 0.48-2.19). Conclusion. GVO may be superior to GVL for achieving hemostasis and preventing recurrence of gastric variceal rebleeding but has no advantage over GVL for mortality and complications. Additional studies are warranted to enable definitive conclusions.
    Full-text · Article · Apr 2014 · Gastroenterology Research and Practice
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    • "In patients with advanced cirrhosis, spontaneous bacterial peritonitis (SBP) is a common and life-threatening infection that requires prompt recognition and treatment. It is characterized by the presence of >250 polymorphonuclear cells (PMN)/mm3 in ascites in the absence of an intra-abdominal source of infection [1], [2]. Despite advances in the knowledge of bacterial cirrhosis pathogenesis and developments of appropriate treatment strategies, the mortality rate of SBP remains at 20% [3]–[5]. "
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    ABSTRACT: Spontaneous bacterial peritonitis (SBP) is a common and life-threatening infection in patients with advanced cirrhosis. The prognostic value of a novel marker, the delta neutrophil index (DNI), was investigated relative to mortality in patients with SBP. Seventy-five patients with SBP were studied from April 2010 to May 2012. DNI at initial diagnosis of SBP was determined and compared with 30-day mortality rates. Of the patients, 87.7% were men, and the median age of all patients was 59.0 yrs. The area under the receiver-operating characteristic (ROC) curve of DNI for 30-day mortality was 0.701 (95% confidence interval [CI], 0.553-0.849; p = 0.009), which was higher than that of C-reactive protein (0.640, 95% CI, 0.494-0.786; p = 0.076) or the model for end-stage liver disease score (0.592, 95% CI, 0.436-0.748; p = 0.235). From the ROC curve, with the sum of sensitivity and specificity, the cutoff value of DNI was determined to be 5.7%. In the high-DNI group (DNI ≥5.7%), septic shock and 30-day mortality were more prevalent compared with the low-DNI group (84.2% vs. 48.2%, p = 0.007; 57.9% vs. 14.3%, p<0.001, respectively). Patients with an elevated DNI had a higher risk of 30-day mortality compared with those with a low DNI (4.225, 95% CI, 1.631-10.949; p = 0.003). A higher DNI at the time of SBP diagnosis is an independent predictor of 30-day mortality in patients with SBP.
    Full-text · Article · Jan 2014 · PLoS ONE
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