Clinical effectiveness of cell therapies in patients with chronic liver disease and acute-on-chronic liver failure: a systematic review protocol

This study will systematically review the evidence on clinical effectiveness of cell therapies in patients. Methods All types of study design that investigate the effectiveness of cell therapies (haematopoietic, mesenchymal and unsorted cell types) of autologous or allogeneic origin and/or the use of granulocyte colony-stimulating factor in patients with CLD including ACLF will be included (except case reports). Both autologous and allogenic cell types will be included. The primary outcomes of interest are survival, model for end-stage liver disease score, quality of life and adverse events. Secondary outcomes include liver function tests, Child-Pugh score and events of liver decompensation. A literature search will be conducted in the following databases: MEDLINE, MEDLINE in Process, EMBASE and Cochrane Library (CENTRAL, CDSR, DARE, HTA databases). Trial registers will be searched for ongoing trials, as will conference proceedings. Reference lists of relevant articles and systematic reviews will be screened. Randomised controlled trial (RCT) evidence is likely to be scant; therefore, controlled trials and concurrently controlled observational studies will be primarily analysed and uncontrolled observational studies will be analysed where primary outcomes are not reported in the control studies or where uncontrolled studies have longer follow-up. Initial screening of studies will be carried by one reviewer with a proportion checked ...
Source: Systematic Reviews - Category: Global & Universal Source Type: research

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Authors: Lee YR, Park SY, Tak WY Abstract Background/Aims: The treatment outcomes and prognostic markers of acute variceal bleeding (AVB) in hepatocellular carcinoma (HCC) patients remain unclear. Therefore, we evaluated the clinical outcomes and prognostic factors of AVB in HCC patients. Methods: Cirrhotic patients with endoscopically confirmed AVB between 2007 and 2013 were enrolled in this prospective study. Prognostic factors were identified by multivariate Cox proportional hazards regression analysis. Results: Among the 329 enrolled patients, 125 patients (38.0%) were diagnosed with HCC. The 6-week mor...
Source: Gut and Liver - Category: Gastroenterology Tags: Gut Liver Source Type: research
Authors: Soh H, Chun J, Hong SW, Park S, Lee YB, Lee HJ, Cho EJ, Lee JH, Yu SJ, Im JP, Kim YJ, Kim JS, Yoon JH Abstract Background/Aims: The risk for colonoscopic postpolypectomy bleeding (PPB) in patients with chronic liver disease (CLD) remains unclear. We determined the incidence and risk factors for colonoscopic PPB in patients with CLD, especially those with liver cirrhosis. Methods: We retrospectively reviewed the medical records of patients with CLD who underwent colonoscopic polypectomy at Seoul National University Hospital between 2011 and 2014. The study endpoints were immediate and delayed PPB. R...
Source: Gut and Liver - Category: Gastroenterology Tags: Gut Liver Source Type: research
This study was performed to find out the prevalence of RAI in decompensated cirrhotic patients presenting with hepatic encephalopathy and variceal bleeding without any evidence of infection. METHODS: The study prospectively included 75 cirrhotic patients with signs of decompensation. The short Synacthen test (SST) was performed on all patients after ruling out infection. Patients with positive blood, urine, sputum, ascitic and pleural fluid cultures or evidence of infection on chest X-ray and those with elevated procalcitonin levels (>0.05 ng/ml) were excluded. RAI in critical illness was defined by a delta cortisol...
Source: Journal of the Royal College of Physicians of Edinburgh - Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research
CONCLUSION: For cirrhotic patients with variceal bleeding, in-hospital rebleeding and mortality rates remain high. The CTP and CRS can be used clinically to predict in-hospital rebleeding. The performances of the CRS, CTP, AIMS65, MELD-Na and MELD are excellent at predicting in-hospital mortality. PMID: 31832005 [PubMed - in process]
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
An 89-year-old man with a history of alcoholic cirrhosis underwent transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC). The 52  × 50 × 42-mm HCC was widely spread throughout the right lobe without any vascular invasion (Fig.1). Incidentally, hematuria developed after the insertion of a urinary catheter for standard perioperative management. However, the hematuria got progressively worse. Subsequently, cystoscopy w as performed that revealed a small bleeding polypoid lesion located on the anterior wall of the urinary bladder (Fig.
Source: Digestive and Liver Disease - Category: Gastroenterology Authors: Tags: Image of the Month Source Type: research
Conclusion and Relevance: In patients with end-stage cirrhosis, use of NSBBs did not affect 24-month mortality. More research is needed to determine when, and if, NSBBs should be discontinued in end-stage cirrhosis. PMID: 31701773 [PubMed - as supplied by publisher]
Source: The Annals of Pharmacotherapy - Category: Drugs & Pharmacology Authors: Tags: Ann Pharmacother Source Type: research
Portal hypertension is associated with many of the known complications of cirrhosis and has an enormous impact on patients ’ prognosis. Ascites and hepatic encephalopathy represent the most common complications of cirrhosis; both are associated with a significantly worse prognosis, with 50% survival over 1–2 years. Acute variceal bleeding is a life-threatening complication, and despite significant improvements in th e management it remains a leading cause of death in patients with cirrhosis. Advances in variceal bleeding management, including empirical antibiotic use, vasoactive drugs, early endoscopy and thera...
Source: Medicine - Category: Internal Medicine Authors: Tags: Management problems in liver disease Source Type: research
The severe form of CF liver disease, multilobular biliary cirrhosis (MBC) is associated with the almost invariable development of portal hypertension (PH) and the complications of variceal bleeding [1 –4] and unusually hepatic encephalopathy [5] or liver failure requiring transplantation [6]. These features in combination with splenomegaly and laboratory evidence of hypersplenism facilitate a diagnosis of MBC/PH which can be confirmed with non-invasive ultrasonography [2,7–9] and magnetic res onance imaging.
Source: Journal of Cystic Fibrosis - Category: Respiratory Medicine Authors: Source Type: research
Patients with chronic liver disease (CLD) have complex changes in their haemostatic system. These changes often include thrombocytopenia, low levels of coagulation factors and inhibitors, low levels of fibrinolytic proteins and elevated levels of endothelium-derived haemostatic proteins, including the platelet adhesive molecule von Willebrand factor. Patients often have prolongation of conventional coagulation tests (prothrombin time and associated international normalised ratio (PT/INR) and activated partial thromboplastin time [aPTT]), interpreted as indicating an increased risk of bleeding complications, particularly fr...
Source: Journal of Hepatology - Category: Gastroenterology Authors: Tags: Editorial Source Type: research
ConclusionThe presence of complications is a major risk factor for mortality in HBV –ACLF patients. TPPM possesses high predictive ability in HBV–ACLF patients, especially in cirrhotic HBV–ACLF patients.
Source: Hepatology International - Category: Infectious Diseases Source Type: research
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