Predictors of residual hepatic reserve and hepatic decompensation in cirrhotic patients after ablated hepatocellular carcinoma treated by DDAs or systemic therapy

Autor:	Hesham Atia, Sameh Saber, Mohamed Abu Taleb, Amr Shaaban Hanafy, Tarek M. Ibrahim, Mohamed Sorour Mohamed, H. M. Mohammed
Jazyk:	angličtina
Rok vydání:	2021
Předmět:	Sorafenib medicine.medical_specialty Cirrhosis Sofosbuvir RD1-811 RC799-869 Gastroenterology Liver disease Internal medicine medicine General Environmental Science medicine.diagnostic_test business.industry Complete blood count Hepatology Diseases of the digestive system. Gastroenterology medicine.disease Thrombocytopenia digestive system diseases Endoscopy Liver volume Hepatocellular carcinoma HCV General Earth and Planetary Sciences Hepatic reserve Surgery business Liver stiffness Hepatic decompensation medicine.drug
Zdroj:	Egyptian Liver Journal, Vol 11, Iss 1, Pp 1-11 (2021)
ISSN:	2090-6226
Popis:	Background Therapeutic interventions for hepatocellular carcinoma (HCC) particularly in patients with advanced liver disease may lead to more aggravation of clinical and biochemical parameters of liver functions. We aimed to assess the utilization of easily applied variables which evaluate residual hepatic reserve to predict liability for complications and hepatic decompensation in cirrhotic patients with ablated HCC particularly when these patients were exposed to specific medical treatment such as DAAs and systemic therapy for HCC such as sorafenib. This study included 3 groups with HCC. Group 1: patients with ablated HCC and Child-Turcotte-Pugh (CTP) class A, who received Sofosbuvir (SOF)-based treatment (n = 250), group 2: HCC patients CTP (A), managed with sorafenib after transarterial chemoembolization (TACE) (n = 250) and group 3 as a control group of non-cirrhotic patients (n = 176). Evaluation for all patients was done by routine laboratory investigations including liver and kidney functions, complete blood count, platelet indices and plasma ammonia, upper gastrointestinal (GI) endoscopy and estimation of liver volume by ultrasound and liver stiffness (LS) by Fibroscan. Results Unfavorable outcome and increased incidence of complications during DAAs were independently associated with severity of thrombocytopenia (p = 0.001) at a cut-off 78,000/μl, LS > 20 kPa (p = 0.001), liver volume < 500 ml (p = 0.002), and gamma globulin levels > 4 gm/dl (p = 0.004). In the sorafenib group, unfavorable outcome and complications were independently associated with PDW/MPV ratio > 2.74 (p = 0.001), level of ammonia > 87 μg/dl (p = 0.001), LS > 25 kPa (p = 0.001), and liver volume < 490 ml (p = 0.001). Conclusion Non-invasive parameters of residual hepatic reserve are promising tools to guide therapy and avoid further complications in patients with liver cirrhosis and ablated HCC.
Databáze:	OpenAIRE
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