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  • 1
    In: Health and Quality of Life Outcomes, Springer Science and Business Media LLC, Vol. 18, No. 1 ( 2020-12)
    Kurzfassung: Patients with liver cirrhosis often suffer from complications such as ascites, gastrointestinal bleeding, and infections, resulting in impaired quality of life. Frequently, the close relatives of patients also suffer from a lower quality of life in chronic diseases. In recent years, acute-to-chronic liver failure has been defined as a separate entity with high mortality. Often several organs are affected which makes intensive care therapy necessary. Little is known about the influence of acute-on-chronic-liver failure (ACLF) on the quality of life of patients and the psychosocial burden on close relatives. Aim The purpose of this prospective study is to investigate the influence of decompensated liver cirrhosis and the onset of ACLF of the patient’s’ quality of life and the psychosocial burden of close relatives. Method In this non – randomized prospective cohort study a total of 63 patients with acute decompensation of liver cirrhosis and hospital admission were enrolled in the study. To assess the quality of life of patients, the disease specific CLDQ questionnaire was assessed. In addition. Quality of life and psychosocial burden of first degree relatives was measured using the generic SF-36 questionnaire as well as the Zarit Burden Score. Results 21 of the 63 patients suffered from ACLF. Patients with ACLF showed a lower quality of life in terms of worries compared to patients with only decompensated liver cirrhosis (3,57 ± 1,17 vs. 4,48 ± 1,27; p value: 0,008) and increased systemic symptoms (3,29 ± 1,19 vs. 4,48 ± 1,58; p value: 0,004). The univariate analysis confirmed the link between the existence of an ACLF and the concerns of patients. ( p value: 0,001). The organ failure score was significantly associated with overall CLDQ scores, especially with worries and systemic symptoms of patients. Interestingly the psychosocial burden and quality of life of close relative correlates with patient’s quality of life and was influenced by the onset of an acute-on-chronic liver failure. Conclusion Patients with decompensated liver cirrhosis suffer from impaired quality of life. In particular, patients with ACLF have a significantly reduced quality of life. The extent of the psychosocial burden on close relative correlates with poor quality of life in patients with decompensated liver disease and is influenced by the existence of ACLF.
    Materialart: Online-Ressource
    ISSN: 1477-7525
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2020
    ZDB Id: 2098765-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    In: Journal of Cachexia, Sarcopenia and Muscle, Wiley, Vol. 13, No. 1 ( 2022-02), p. 169-179
    Kurzfassung: Assessment of muscle quantity by sonographic muscle indices could help identify patients at risk for fatal outcome during coronavirus disease‐2019 (COVID‐19). The aim of this study was to explore sonographic muscle indices as predictors of COVID‐19 outcome and to test the feasibility of sonographic muscle measurement in an isolation context. Methods Muscle indices, derived from the psoas muscle or thigh muscles, were quantified by sonography in a cohort of patients without COVID‐19 to obtain reference values for low muscle quantity. Gender‐specific median of different muscle indices were defined as threshold value for low muscle quantity. The prognostic relevance of low muscle quantity, was prospectively explored in two cohorts of hospitalized COVID‐19 patients. Optimal muscle index cutoff values predictive for 30 day mortality during COVID‐19 were determined by receiver operating characteristic‐area under the curve and Youden index calculation. Muscle quantity and known prognostic factors of COVID‐19 were analysed by multivariable log‐regression. Results Compared with other muscle indices, the psoas muscle area index (PMAI) showed the most favourable characteristics to predict outcome of COVID‐19 disease. Sonographic morphometry of patients without COVID‐19 ( n  = 136) revealed a gender‐specific median for PMAI (male: 291.1 mm 2 /m 2 , female 260.6 mm 2 /m 2 ) as threshold value of low muscle quantity. Subsequently, COVID‐19 patients (Cohort I: n  = 58; Cohort II: n  = 55) were prospectively assessed by bedside sonography. The studied COVID‐19 patients developed a critical course of disease in 22.4% (Cohort I: n  = 13/58) and 34.5% (Cohort II: n  = 20/55). Mortality rate reached 12.1% (Cohort I: n  = 7/58) and 20.0% (Cohort I: n  = 11/55) within 30 days of follow up. COVID‐19 patients with a PMAI below the gender‐specific median showed a higher 30 day mortality in both COVID‐19 cohorts (log rank, P   〈  0.05). The optimal PMAI cutoff value (206 mm 2 /m 2 ) predicted 30 day mortality of hospitalized COVID‐19 patients with a sensitivity of 72% and specificity of 78.5% (receiver operating characteristic‐area under the curve: 0.793, 95% confidence interval 0.671–0.914, P  = 0.008). Multivariable log‐regression analysis of PMAI, age, gender, BMI and comorbidities confirmed an independent association of low PMAI with 30 day mortality of COVID‐19 patients ( P  = 0.018). Conclusions Sonographic morphometry provides reliable muscle quantification under hygienic precautions and allows risk stratification of patients with COVID‐19.
    Materialart: Online-Ressource
    ISSN: 2190-5991 , 2190-6009
    URL: Issue
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2022
    ZDB Id: 2586864-0
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    In: BMC Cancer, Springer Science and Business Media LLC, Vol. 18, No. 1 ( 2018-12)
    Materialart: Online-Ressource
    ISSN: 1471-2407
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2018
    ZDB Id: 2041352-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
    In: European Journal of Gastroenterology & Hepatology, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 10 ( 2022-10), p. 1053-1059
    Kurzfassung: The liver is of critical importance for the homeostasis of metabolic and immunomodulatory properties as well as the storage of vitamins, especially vitamin A. In this prospective analysis, the incidence of serological vitamin A deficiency and the association with disease severity as well as clinical complications in patients with liver cirrhosis were investigated. Method From May 2017 to May 2018, 159 patients with primarily alcohol-associated and non-alcoholic steatohepatitis (NASH)-associated preexisting liver cirrhosis were prospectively enrolled and vitamin A status was collected. Clinical complications and infections were followed and recorded over a period of 1-year follow-up. Selected findings were validated in an independent cohort of 44 patients. Results At study inclusion, 77% of patients showed decreased serological vitamin A. Suppressed vitamin A was more common in alcoholic (52 vs. 8%) and NASH-associated liver cirrhosis (16 vs. 9%) than in viral-associated liver cirrhosis. MELD score as well as Child-Pugh score were significantly associated with suppressed vitamin A ( P   〈  0.001). The association between the degree of vitamin A suppression and liver function was confirmed in univariate and multivariate regression analysis. After 1 year of follow-up, 57 patients died and 21 patients received a liver transplant. In addition, low vitamin A levels were more commonly observed in patients with severe ascites ( P  = 0.001), hepatic encephalopathy ( P  = 0.002) and hepatorenal syndromes ( P  = 0.008). In addition, patients with reduced vitamin A showed an increased incidence of infections ( P  = 0.02), especially respiratory infections ( P  = 0.04). Conclusion: Suppressed serological Vitamin A is common in patients with liver cirrhosis and is associated with liver function. Clinical complications and infections are more frequent in patients with liver cirrhosis and vitamin A suppression.
    Materialart: Online-Ressource
    ISSN: 0954-691X
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2030291-5
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
    Online-Ressource
    Online-Ressource
    Deutscher Arzte-Verlag GmbH ; 2020
    In:  Deutsches Ärzteblatt international ( 2020-10-23)
    In: Deutsches Ärzteblatt international, Deutscher Arzte-Verlag GmbH, ( 2020-10-23)
    Materialart: Online-Ressource
    ISSN: 1866-0452
    Sprache: Deutsch
    Verlag: Deutscher Arzte-Verlag GmbH
    Publikationsdatum: 2020
    ZDB Id: 2406159-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    In: Alimentary Pharmacology & Therapeutics, Wiley, Vol. 52, No. 3 ( 2020-08), p. 527-536
    Kurzfassung: Diabetes mellitus may lead to increased serum ammonia and systemic inflammation thereby promoting hepatic encephalopathy (HE). Aim To investigate the potential association between diabetes mellitus/glycaemic control and the presence of covert HE as well as the development of overt HE in a prospective setting. Methods A total of 240 patients with liver cirrhosis were included into this prospective cohort study and followed for a median of 17 months. Covert HE was diagnosed by pathological results in the Portosystemic Hepatic Encephalopathy Score. Predictors for the presence of covert HE or the development of overt HE were analysed using logistic regression or Cox‐regression models. Results At study inclusion, 65 patients (27.1%) presented with diabetes mellitus and covert HE was detected in 33.3%. Patients with diabetes mellitus had a more preserved liver function as compared to patients without diabetes mellitus (MELD 9 vs 10; P  = 0.043). In regression analyses after adjustment for confounders, diabetes mellitus was independently associated with the presence of covert HE at study inclusion and the development of overt HE during follow‐up. These associations were confirmed in separate propensity‐score‐weighted regression models. In subgroup analyses, patients with worse glycaemic control (HbA1c 〉 = 6.5%) had a pronounced risk for covert HE (OR 2.264, 95% CI 1.002‐5.118) and overt HE (HR 4.116, 95% CI 1.791‐9.459). Conclusions Diabetes mellitus may associate with higher risk for the presence of covert HE and the development of overt HE in patients with liver cirrhosis. Adequate glycaemic control may be a potential target to attenuate this important complication.
    Materialart: Online-Ressource
    ISSN: 0269-2813 , 1365-2036
    URL: Issue
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2020
    ZDB Id: 2003094-0
    SSG: 15,3
    Standort Signatur Einschränkungen Verfügbarkeit
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