EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.28906

Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases.

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.27210

Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver

Hyponatraemia, defined as a serum sodium concentration !135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association – European Dialysis and Transplant Association (ERA–EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

/pdf/clinical-practice-guideline-on-diagnosis-and-treatment-of-509w3449ob.pdf

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Chronic rheumatological manifestations similar to those of rheumatoid arthritis (RA) are described after chikungunya virus infection. We aimed to compare the relevance of joint counts and symptoms to clinical outcomes in RA and chronic chikungunya disease. Forty patients with chronic chikungunya arthralgia and 40 patients with RA were enrolled in a cross-sectional study. The association of tenderness and swelling, clinically assessed in 28 joints, and patient evaluations of pain and musculoskeletal stiffness with modified Health Assessment Questionnaire (HAQ) and quality of life (QoL) assessments were investigated. Tender and swollen joint counts, pain and stiffness scores were all associated with the HAQ disability index in RA (all r > 0.55, p ≤ 0.0002), but only stiffness was significantly associated with disability in chikungunya (r = 0.38, p = 0.02). Joint counts, pain and stiffness were also associated with most QoL domains in RA patients. In contrast, in chikungunya disease, tender joint counts were associated only with one QoL domain and swollen joints for none, while pain and stiffness were associated with several domains. Our results confirm the relevance of joint counts in RA, but suggest that in chronic chikungunya disease, joint counts have more limited value. Stiffness and pain score may be more important to quantify chikungunya arthritis impact.

/pdf/tender-and-swollen-joint-counts-are-poorly-associated-with-1z7cv6fmwp.pdf

Tender and swollen joint counts are poorly associated with disability in chikungunya arthritis compared to rheumatoid arthritis.

857 satavaptan efficacy and safety in recurrent ascites without concomitant diuretics: the spare-2 study

http://manuscript.elsevier.com/S016635422200064X/pdf/S016635422200064X.pdf

Therapeutic and prophylactic treatment with a virus-specific antibody is highly effective in rodent models of Chikungunya infection and disease.

Patients with cirrhosis are at increased risk for cardiovascular death [1]. At the same time, they have a prolonged electrocardiographic QT interval, which is a sign of delayed ventricular repolari...

QT interval corrected for heart rate is not associated with mortality in patients with cirrhosis and ascites

Ascites formation is a sign of decompensation of cirrhosis and heralds a poor prognosis. The widely used standard binary classification of ascites as diuretic‐responsive or refractory does not cover the spectrum of ascites and has limited prognostic information. We developed the Cirrhotic Ascites Severity (CIRAS) model to predict 1‐year mortality among 465 patients randomized to placebo in the satavaptan trials investigating treatment of cirrhotic ascites. We used multivariable logistic regression to derive the CIRAS model based on these variables: ascites discomfort score (≤50 or >50), plasma sodium (≥140, 133–139, 125–132, or <125 mmoL/L), and a composite of ascites accumulation and diuretic treatment. We validated the prediction model in 697 trial participants randomized to satavaptan treatment. The 1‐year all‐cause mortality was 19.6%. The area under the receiver operator curve was higher for the CIRAS model than for the standard ascites classification into refractory and diuretic‐responsive in both the development cohort (0.68 [95% confidence interval (CI): 0.62–0.75] vs. 0.62 [0.57–0.68]), and the validation cohort (0.68 [0.64–0.72] vs. 0.55 [0.51–0.60]). The CIRAS model had similar discrimination to the Child‐Pugh score and nearly as good as the Model for End‐Stage Liver Disease (MELD), MELD‐Na, and MELD 3.0. Conclusions: The CIRAS model based on simple ascites‐relevant data is an easily applicable and patient‐centered way to describe the severity and prognosis of all ascites grades. It carries more prognostic information than today's label of “refractory ascites” and forms the basis for earlier and better clinical decisions related to ascites management.

Hugh Watson

Papers

Tender and swollen joint counts are poorly associated with disability in chikungunya arthritis compared to rheumatoid arthritis.

857 satavaptan efficacy and safety in recurrent ascites without concomitant diuretics: the spare-2 study

Therapeutic and prophylactic treatment with a virus-specific antibody is highly effective in rodent models of Chikungunya infection and disease.

QT interval corrected for heart rate is not associated with mortality in patients with cirrhosis and ascites

Development and validation of the Cirrhotic Ascites Severity model—A patient‐reported outcome‐based model to predict 1‐year mortality