Author
Michael Praktiknjo
Other affiliations: University of Bonn
Bio: Michael Praktiknjo is an academic researcher from University Hospital Bonn. The author has contributed to research in topics: Cirrhosis & Portal hypertension. The author has an hindex of 19, co-authored 87 publications receiving 1143 citations. Previous affiliations of Michael Praktiknjo include University of Bonn.
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Goethe University Frankfurt1, University of Debrecen2, University of Bologna3, Katholieke Universiteit Leuven4, University of Padua5, University of Turin6, Autonomous University of Barcelona7, Royal Free Hospital8, Université libre de Bruxelles9, University of Alcalá10, Hospital General Universitario Gregorio Marañón11, University of Pavol Jozef Šafárik12, Ludwig Maximilian University of Munich13, Medical University of Vienna14, University of Cambridge15, Wittenberg University16, Leipzig University17, RWTH Aachen University18, Leiden University Medical Center19, Medical University of Graz20, Innsbruck Medical University21, University of Lugano22, Aarhus University Hospital23, Université Paris-Saclay24, Marmara University25, Nottingham University Hospitals NHS Trust26, University of Paris27, Ghent University Hospital28, Hannover Medical School29, University Hospital Bonn30, University of Münster31, University of Basel32, University of Birmingham33, Derriford Hospital34, University of Copenhagen35
TL;DR: Acute decompensation without ACLF is a heterogeneous condition with three different clinical courses and two major pathophysiological mechanisms: systemic inflammation and portal hypertension.
228 citations
Autonomous University of Barcelona1, University College London2, Carlos III Health Institute3, University of Alcalá4, Medical University of Vienna5, University of Barcelona6, University of Alberta7, Autonomous University of Madrid8, University of Bonn9, University of Bern10, Martin Luther University of Halle-Wittenberg11, University of Milan12, Katholieke Universiteit Leuven13, Hospital General Universitario Gregorio Marañón14, Odense University Hospital15, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico16, Royal Free Hospital17
TL;DR: The main outcomes were the incidence of complications of cirrhosis and mortality according to the presence of SPSS, and quality of life and transplantation-free survival were lower in patients with S PSS vs without.
147 citations
Goethe University Frankfurt1, University of Barcelona2, University of Debrecen3, University of Bologna4, Katholieke Universiteit Leuven5, University of Padua6, University Hospital Bonn7, Autonomous University of Barcelona8, Royal Free Hospital9, University of Alcalá10, Hospital General Universitario Gregorio Marañón11, University of Pavol Jozef Šafárik12, Ludwig Maximilian University of Munich13, Medical University of Vienna14, University of Cambridge15, Wittenberg University16, Leipzig University17, RWTH Aachen University18, University of Copenhagen19, Leiden University Medical Center20, Medical University of Graz21, Innsbruck Medical University22, University of Lugano23, Aarhus University Hospital24, Université Paris-Saclay25, Marmara University26, Nottingham University Hospitals NHS Trust27, University of Paris28, French Institute of Health and Medical Research29, Ghent University Hospital30, Hannover Medical School31, University of Münster32, University of Basel33, University of Birmingham34
TL;DR: This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD and specific preventive and therapeutic strategies targeting these events may improve outcome in decompensated cirrhosis.
125 citations
TL;DR: The circulating microbiome in portal vein is characterised as the link between gut and liver and 65 genera belonging to four phyla (predominantly Proteobacteria) in this cohort are identified.
Abstract: We read with interest the recent review by Tilg et al ,1 which summarised the role of microbiota in liver diseases and pointed out that a causal link with systemic inflammation has still not been established. This letter fills in this gap and provides an analysis of the circulating microbiota in portal vein as the link between gut and liver. The access to portal circulation is possible during the implantation of a transjugular intrahepatic portosystemic shunt (TIPS). Therefore, we characterised the circulating microbiome in portal vein (first venous outflow in gut–liver axis), liver outflow, central venous blood and peripheral venous blood from seven patients with decompensated liver cirrhosis receiving TIPS for either variceal bleeding (n=3) or refractory ascites (n=4) (mean Model for End-stage Liver Disease (MELD) 8.4 (range 6–13), Child-Pugh-Score (CHILD) A: n=4, CHILD B: n=3) (figure 1A). We performed 16S ribosomal RNA (rRNA) gene sequencing of buffy coat samples and identified 65 genera belonging to four phyla (predominantly Proteobacteria) in this cohort (online supplementary figure 1 and figure 1B). Blood microbiome phylum compositions identified in our …
111 citations
TL;DR: While TIPS might improve sarc Openia and thereby survival, persistence of sarcopenia after TIPS is associated with a reduced response to TIPS and a higher risk of acute‐on‐chronic liver failure development and mortality.
109 citations
Cited by
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Zhengzhou University1, The Royal Marsden NHS Foundation Trust2, University of Bern3, Policlinico Umberto I4, University of Paris5, University of Pavia6, Goethe University Frankfurt7, University of Bergen8, University of Erlangen-Nuremberg9, Erasmus University Rotterdam10, University of Bologna11, University of Medicine and Pharmacy of Craiova12, King's College London13, University of Southern Denmark14
TL;DR: The first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography is presented, focused on the assessment of diffuse liver disease.
Abstract: We present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography with a focus on the assessment of diffuse liver disease. The short version provides clinical information about the practical use of elastography equipment and interpretation of results in the assessment of diffuse liver disease and analyzes the main findings based on published studies, stressing the evidence from meta-analyses. The role of elastography in different etiologies of liver disease and in several clinical scenarios is also discussed. All of the recommendations are judged with regard to their evidence-based strength according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both beginners and advanced clinical users.
740 citations
TL;DR: The identification of the elements of the gut-liver axis primarily damaged in each chronic liver disease offers possibilities to intervention.
709 citations
Journal Article•
TL;DR: More rapid completion of a 3‐hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completed of an initial bolus of intravenous fluids, were associated with lower risk‐adjusted in‐hospital mortality.
Abstract: BACKGROUND In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. METHODS We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3‐hour bundle of care for patients with sepsis (i.e., blood cultures, broad‐spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3‐hour bundle and risk‐adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. RESULTS Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3‐hour bundle completed within 3 hours. The median time to completion of the 3‐hour bundle was 1.30 hours (interquartile range, 0.65 to 2.35), the median time to the administration of antibiotics was 0.95 hours (interquartile range, 0.35 to 1.95), and the median time to completion of the fluid bolus was 2.56 hours (interquartile range, 1.33 to 4.20). Among patients who had the 3‐hour bundle completed within 12 hours, a longer time to the completion of the bundle was associated with higher risk‐adjusted in‐hospital mortality (odds ratio, 1.04 per hour; 95% confidence interval [CI], 1.02 to 1.05; P<0.001), as was a longer time to the administration of antibiotics (odds ratio, 1.04 per hour; 95% CI, 1.03 to 1.06; P<0.001) but not a longer time to the completion of a bolus of intravenous fluids (odds ratio, 1.01 per hour; 95% CI, 0.99 to 1.02; P=0.21). CONCLUSIONS More rapid completion of a 3‐hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk‐adjusted in‐hospital mortality. (Funded by the National Institutes of Health and others.)
662 citations
Journal Article•
TL;DR: In a small randomized controlled trial, a 12-month course of enoxaparin was safe and effective in preventing PVT in patients with cirrhosis and a Child-Pugh score of 7-10 and to improve survival.
518 citations
TL;DR: The authors describe how metabolic disorders, such as type 2 diabetes and nonalcoholic fatty liver disease, are driven by alterations in the composition of the intestinal microbiota and its metabolites, which translocate from the gut across a disrupted intestinal barrier and contribute to metabolic inflammation.
Abstract: Low-grade inflammation is the hallmark of metabolic disorders such as obesity, type 2 diabetes and nonalcoholic fatty liver disease. Emerging evidence indicates that these disorders are characterized by alterations in the intestinal microbiota composition and its metabolites, which translocate from the gut across a disrupted intestinal barrier to affect various metabolic organs, such as the liver and adipose tissue, thereby contributing to metabolic inflammation. Here, we discuss some of the recently identified mechanisms that showcase the role of the intestinal microbiota and barrier dysfunction in metabolic inflammation. We propose a concept by which the gut microbiota fuels metabolic inflammation and dysregulation. Here, the authors describe how metabolic disorders, such as type 2 diabetes and nonalcoholic fatty liver disease, are driven by alterations in the composition of the intestinal microbiota and its metabolites, which translocate from the gut across a disrupted intestinal barrier and contribute to metabolic inflammation.
502 citations