380 results on '"Drolz, A."'
Search Results
2. MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis
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Horvatits, Thomas, Mahmud, Nadim, Serper, Marina, Seiz, Oliver, Reher, Dominik, Drolz, Andreas, Sarnast, Naveed, Gu, Wenyi, Erasmus, Hans Peter, Allo, Gabriel, Ferstl, Phillip, Wittmann, Sebastian, Piecha, Felix, Groth, Stefan, Zeuzem, Stefan, Schramm, Christoph, Huber, Samuel, Rösch, Thomas, Lohse, Ansgar W., Trebicka, Jonel, Ogola, Gerald, Asrani, Sumeet K., and Kluwe, Johannes
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- 2023
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3. Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation
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Waldschmidt, Lara, Drolz, Andreas, Heimburg, Paula, Goßling, Alina, Ludwig, Sebastian, Voigtländer, Lisa, Linder, Matthias, Schofer, Niklas, Reichenspurner, Hermann, Blankenberg, Stefan, Westermann, Dirk, Conradi, Lenard, Kluwe, Johannes, and Seiffert, Moritz
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- 2021
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4. Performance of non-invasive fibrosis scores in non-alcoholic fatty liver disease with and without morbid obesity
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Drolz, Andreas, Wolter, Stefan, Wehmeyer, Malte H., Piecha, Felix, Horvatits, Thomas, Schulze zur Wiesch, Julian, Lohse, Ansgar W., Mann, Oliver, and Kluwe, Johannes
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- 2021
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5. Klinisches Bild der Blutung bei kritisch kranken Patienten auf der Intensivstation: Organsysteme und klinische Implikationen
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Drolz, Andreas and Fuhrmann, Valentin
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- 2021
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6. Severe liver dysfunction complicating course of COVID-19 in the critically ill: multifactorial cause or direct viral effect?
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Kevin Roedl, Dominik Jarczak, Andreas Drolz, Dominic Wichmann, Olaf Boenisch, Geraldine de Heer, Christoph Burdelski, Daniel Frings, Barbara Sensen, Axel Nierhaus, Marc Lütgehetmann, Stefan Kluge, and Valentin Fuhrmann
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COVID-19 ,Hypoxic liver injury ,Jaundice ,Cholestatic liver disease ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background SARS-CoV-2 caused a pandemic and global threat for human health. Presence of liver injury was commonly reported in patients with coronavirus disease 2019 (COVID-19). However, reports on severe liver dysfunction (SLD) in critically ill with COVID-19 are lacking. We evaluated the occurrence, clinical characteristics and outcome of SLD in critically ill patients with COVID-19. Methods Clinical course and laboratory was analyzed from all patients with confirmed COVID-19 admitted to ICU of the university hospital. SLD was defined as: bilirubin ≥ 2 mg/dl or elevation of aminotransferase levels (> 20-fold ULN). Results 72 critically ill patients were identified, 22 (31%) patients developed SLD. Presenting characteristics including age, gender, comorbidities as well as clinical presentation regarding COVID-19 overlapped substantially in both groups. Patients with SLD had more severe respiratory failure (paO2/FiO2: 82 (58–114) vs. 117 (83–155); p
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- 2021
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7. Severe liver dysfunction complicating course of COVID-19 in the critically ill: multifactorial cause or direct viral effect?
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Roedl, Kevin, Jarczak, Dominik, Drolz, Andreas, Wichmann, Dominic, Boenisch, Olaf, de Heer, Geraldine, Burdelski, Christoph, Frings, Daniel, Sensen, Barbara, Nierhaus, Axel, Lütgehetmann, Marc, Kluge, Stefan, and Fuhrmann, Valentin
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- 2021
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8. Initial therapy affects duration of diarrhoea in critically ill patients with Clostridioides difficile infection (CDI)
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Carolin F. Manthey, Darja Dranova, Martin Christner, Andreas Drolz, Stefan Kluge, Ansgar W. Lohse, and Valentin Fuhrmann
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Clostridioides difficile infection (CDI) ,Intensive care unit (ICU) ,28-day mortality ,Sepsis ,Immunosuppression ,Metronidazole ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Critically ill patients in the intensive care unit (ICU) are at high risk for developing Clostridioides difficile infections (CDI). Risk factors predicting their mortality or standardized treatment recommendations have not been defined for this cohort. Our goal is to determine outcome and mortality associated risk factors for patients at the ICU with CDI by evaluating clinical characteristics and therapy regimens. Methods A retrospective single-centre cohort study. One hundred forty-four patients (0.4%) with CDI-associated diarrhoea were included (total 36.477 patients admitted to 12 ICUs from January 2010 to September 2015). Eight patients without specific antibiotic therapy were excluded, so 132 patients were analysed regarding mortality, associated risk factors and therapy regimens using univariate and multivariate regression. Results Twenty-eight-day mortality was high in patients diagnosed with CDI (27.3%) compared to non-infected ICU patients (9%). Patients with non CDI-related sepsis (n = 40/132; 30.3%) showed further increase in 28-day mortality (45%; p = 0.003). Initially, most patients were treated with a single CDI-specific agent (n = 120/132; 90.9%), either metronidazole (orally, 35.6%; or IV, 37.1%) or vancomycin (18.2%), or with a combination of antibiotics (n = 12/132; 9.1%). Patients treated with metronidazole IV showed significantly longer duration of diarrhoea > 5 days (p = 0.006). In a multivariate regression model, metronidazole IV as initial therapy was an independent risk factor for delayed clinical cure. Immunosuppressants (p = 0.007) during ICU stay lead to increased 28-day mortality. Conclusion Treatment of CDI with solely metronidazole IV leads to a prolonged disease course in critically ill patients.
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- 2019
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9. Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival
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Piecha, Felix, Radunski, Ulf K., Ozga, Ann-Kathrin, Steins, David, Drolz, Andreas, Horvatits, Thomas, Spink, Clemens, Ittrich, Harald, Benten, Daniel, Lohse, Ansgar W., Sinning, Christoph, and Kluwe, Johannes
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- 2019
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10. Hypoxic liver injury after in- and out-of-hospital cardiac arrest: Risk factors and neurological outcome
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Roedl, Kevin, Spiel, Alexander O., Nürnberger, Alexander, Horvatits, Thomas, Drolz, Andreas, Hubner, Pia, Warenits, Alexandra-Maria, Sterz, Fritz, Herkner, Harald, and Fuhrmann, Valentin
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- 2019
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11. Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival
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Felix Piecha, Ulf K. Radunski, Ann-Kathrin Ozga, David Steins, Andreas Drolz, Thomas Horvatits, Clemens Spink, Harald Ittrich, Daniel Benten, Ansgar W. Lohse, Christoph Sinning, and Johannes Kluwe
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Refractory ascites is the main reason for the implantation of a transjugular intrahepatic portosystemic shunt (TIPS) in liver cirrhosis, but ascites control by TIPS fails in a relevant proportion of cases. Here, we investigated whether routine parameters pre-TIPS can predict persistent ascites after TIPS implantation and whether persistent ascites predicts long-term clinical outcome. Methods: A detailed retrospective analysis of 128 patients receiving expanded polytetrafluoroethylene-covered stents for the treatment of refractory ascites was performed. Persistent ascites post-TIPS was defined as the prolonged need for paracentesis >3 months after TIPS. The influence of demographics, laboratory results, pre-TIPS heart and liver ultrasound results, and invasive hemodynamic parameters on persistent ascites was evaluated by univariable and multivariable logistic regression. Predictors of the composite endpoint liver transplantation/death were analyzed using a multivariable Cox regression. Results: Ascites control post-TIPS was achieved in 95/128 patients (74%), whereas ascites remained persistent in 33/128 cases (26%). On multivariable analysis, a lower paracentesis frequency pre-TIPS (odds ratio 1.672; 95% CI 1.253–2.355) and lower baseline creatinine levels (odds ratio 2.640; CI 1.201–6.607) were associated with ascites control. Patients with persistent ascites post-TIPS had and impaired transplant-free survival (median 10.0 vs. 25.8 months), for which persistent ascites was the only independent predictor (hazard ratio 5.654; CI 3.019–10.59). Conclusion: TIPS-placement in patients with lower paracentesis frequency and creatinine levels is associated with superior ascites control. Thus, TIPS implantation should be considered in moderate decompensation and not as a last resort. Persistent ascites post-TIPS seems to be the only predictor of liver transplantation and death. Lay summary: The insertion of a transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites should be considered in patients with moderate decompensation and not as a last resort, as lower paracentesis frequency and creatinine levels pre-TIPS are associated with superior ascites control. In turn, failure to control ascites seems to be the only predictor of liver transplantation and death. Key words: liver cirrhosis, hepatic venous pressure gradient, portal hypertension, refractory ascites, MELD score, transplant, decompensation, stents
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- 2019
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12. Akutes Leberversagen: Zeitgerechte Diagnose und Therapie ist entscheidend für die Prognose
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Rutter, Karoline, Horvatits, Thomas, Drolz, Andreas, Roedl, Kevin, Siedler, Stephanie, Kluge, Stefan, and Fuhrmann, Valentin
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- 2019
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13. Characterization of the immune cell landscape of patients with NAFLD.
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Tom Diedrich, Silke Kummer, Antonio Galante, Andreas Drolz, Veronika Schlicker, Ansgar W Lohse, Johannes Kluwe, Johanna Maria Eberhard, and Julian Schulze Zur Wiesch
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Medicine ,Science - Abstract
Multiple factors are involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD), but the exact immunological mechanisms that cause inflammation and fibrosis of the liver remain enigmatic. In this current study, cellular samples of a cohort of NAFLD patients (peripheral blood mononuclear cells (PBMC): n = 27, liver samples: n = 15) and healthy individuals (PBMC: n = 26, liver samples: n = 3) were analyzed using 16-color flow cytometry, and the frequency and phenotype of 23 immune cell subtypes was assessed. PBMC of NAFLD patients showed decreased frequencies of total CD3+, CD8+ T cells, CD56dim NK cells and MAIT cells, but elevated frequencies of CD4+ T cells and Th2 cells compared to healthy controls. Intrahepatic lymphocytes (IHL) of NAFLD patients showed decreased frequencies of total T cells, total CD8+ T cells, Vd2+γδ T cells, and CD56bright NK cells, but elevated frequencies of Vδ2-γδ T cells and CD56dim NK cells compared to healthy controls. The activating receptor NKG2D was significantly less frequently expressed among iNKT cells, total NK cells and CD56dim NK cells of PBMC of NAFLD patients compared to healthy controls. More strikingly, hepatic fibrosis as measured by fibroscan elastography negatively correlated with the intrahepatic frequency of total NK cells (r2 = 0,3737, p = 0,02). Hepatic steatosis as measured by controlled attenuation parameter (CAP) value negatively correlated with the frequency of circulating NKG2D+ iNKT cells (r2 = 0,3365, p = 0,0047). Our data provide an overview of the circulating and intrahepatic immune cell composition of NAFLD patients, and point towards a potential role of NK cells and iNKT cells for the regulation of hepatic fibrosis and steatosis in NAFLD.
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- 2020
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14. Acid–base status and its clinical implications in critically ill patients with cirrhosis, acute-on-chronic liver failure and without liver disease
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Andreas Drolz, Thomas Horvatits, Kevin Roedl, Karoline Rutter, Richard Brunner, Christian Zauner, Peter Schellongowski, Gottfried Heinz, Georg-Christian Funk, Michael Trauner, Bruno Schneeweiss, and Valentin Fuhrmann
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Acid–base ,Cirrhosis ,Acute-on-chronic liver failure ,Mortality ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Acid–base disturbances are frequently observed in critically ill patients at the intensive care unit. To our knowledge, the acid–base profile of patients with acute-on-chronic liver failure (ACLF) has not been evaluated and compared to critically ill patients without acute or chronic liver disease. Results One hundred and seventy-eight critically ill patients with liver cirrhosis were compared to 178 matched controls in this post hoc analysis of prospectively collected data. Patients with and without liver cirrhosis showed hyperchloremic acidosis and coexisting hypoalbuminemic alkalosis. Cirrhotic patients, especially those with ACLF, showed a marked net metabolic acidosis owing to increased lactate and unmeasured anions. This metabolic acidosis was partly antagonized by associated respiratory alkalosis, yet with progression to ACLF resulted in acidemia, which was present in 62% of patients with ACLF grade III compared to 19% in cirrhosis patients without ACLF. Acidemia and metabolic acidosis were associated with 28-day mortality in cirrhosis. Patients with pH values
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- 2018
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15. Reduzierte zelluläre Immunantwort auf SARS-CoV2 Impfung bei Patienten mit Child C Zirrhose
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von der Schulenburg, P., additional, Herting, A., additional, Lütgehetmann, M., additional, Pischke, S., additional, Wehmeyer, M., additional, Piecha, F., additional, Drolz, A., additional, Jörg, V., additional, Hübener, P., additional, Addo, M. M., additional, Fischer, L., additional, Lohse, A. W., additional, zur Wiesch, J. Schulze, additional, and Sterneck, M., additional
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- 2023
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16. High vaccination coverage and infection rate result in a robust SARS‐CoV‐2‐specific immunity in the majority of liver cirrhosis and transplant patients: A single‐center cross‐sectional study
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Schulenburg, P., Herting, A., Harberts, A., Lütgehetmann, M., Jahnke‐Triankowski, J., Pischke, S., Piecha, F., Drolz, A., Jörg, V., Hübener, P., Wehmeyer, M., Addo, M. M., Fischer, L., Lohse, A. W., Schulze Zur Wiesch, J., and Sterneck, M.
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In the third year of the SARS‐CoV‐2 pandemic, little is known about the vaccine‐ and infection‐induced immune response in liver transplant recipients (LTR) and liver cirrhosis patients (LCP). This cross‐sectional study assessed the vaccination coverage, infection rate, and the resulting humoral and cellular SARS‐CoV‐2‐specific immune responses in a cohort of LTR and LCP at the University Medical Center Hamburg‐Eppendorf, Germany between March and May 2023. Clinical and laboratory data from 244 consecutive patients (160 LTR and 84 LCP) were collected via chart review and a patient survey. Immune responses were determined via standard spike(S)‐ and nucleocapsid‐protein serology and a spike‐specific Interferon‐gamma release assay (IGRA). On average, LTR and LCP were vaccinated 3.7 and 3.3 times, respectively and 59.4% of patients received ≥4 vaccinations. Altogether, 68.1% (109/160) of LTR and 70.2% (59/84) of LCP experienced a SARS‐CoV‐2 infection. Most infections occurred during the Omicron wave in 2022 after an average of 3.0 vaccinations. Overall, the hospitalization rate was low (<6%) in both groups. An average of 4.3 antigen contacts by vaccination and/or infection resulted in a seroconversion rate of 98.4%. However, 17.5% (28/160) of LTR and 8.3% (7/84) of LCP demonstrated only low anti‐S titers (<1000 AU/ml), and 24.6% (16/65) of LTR and 20.4% (10/59) of LCP had negative or low IGRA responses. Patients with hybrid immunity (vaccination plus infection) elicited significantly higher anti‐S titers compared with uninfected patients with the same number of spike antigen contacts. A total of 22.2% of patients refused additional booster vaccinations. By spring 2023, high vaccination coverage and infection rate have resulted in a robust, mostly hybrid, humoral and cellular immune response in most LTR and LCP. However, booster vaccinations with vaccines covering new variants seem advisable, especially in patients with low immune responses and risk factors for severe disease.
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- 2024
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17. Initial therapy affects duration of diarrhoea in critically ill patients with Clostridioides difficile infection (CDI)
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Manthey, Carolin F., Dranova, Darja, Christner, Martin, Drolz, Andreas, Kluge, Stefan, Lohse, Ansgar W., and Fuhrmann, Valentin
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- 2019
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18. MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis
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Thomas Horvatits, Nadim Mahmud, Marina Serper, Oliver Seiz, Dominik Reher, Andreas Drolz, Naveed Sarnast, Wenyi Gu, Hans Peter Erasmus, Gabriel Allo, Phillip Ferstl, Sebastian Wittmann, Felix Piecha, Stefan Groth, Stefan Zeuzem, Christoph Schramm, Samuel Huber, Thomas Rösch, Ansgar W. Lohse, Jonel Trebicka, Gerald Ogola, Sumeet K. Asrani, and Johannes Kluwe
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Physiology ,Gastroenterology - Abstract
Predictors of poor outcome associated with variceal bleeding remain suboptimal. In patients with cirrhosis, serum lactate combined with Model for End-Stage Liver Disease (MELD-LA) improved prediction across heterogeneous populations. However, prognostic properties have not yet been assessed in the context of variceal bleeding.We aimed to evaluate the predictive performance of MELD-LA compared to MELD, lactate, and nadir hemoglobin in cirrhosis patients with variceal bleeding.In this multicenter study, we identified 472 patients with variceal bleeding from a German primary cohort (University Hospitals Hamburg/Frankfurt/Cologne), and two independent external validation cohorts [Veterans Affairs (VA), Baylor University]. Discrimination for 30-day mortality was analyzed and scores were compared. MELD-LA was evaluated separately in validation cohorts to ensure consistency of findings.In contrast to nadir hemoglobin, MELD and peak-lactate at time of bleeding were significantly higher in 30-day non-survivors in the primary cohort (p = 0.708; p 0.001). MELD-LA had excellent discrimination for 30-day mortality (AUROC 0.82, 95% CI 0.76-0.88), better than MELD and peak-lactate (AUROC 0.78, 95% CI 0.71-0.84; AUROC 0.73, 95% CI 0.66-0.81). MELD-LA predicted 30-day mortality independently of age, sex, severity of liver disease and vasopressor support (HR 1.29 per 1-point-increase of MELD-LA; 95% CI 1.19-1.41; p 0.001). Similarly, MELD-LA demonstrated excellent discrimination for 30-day mortality in the VA (AUROC = 0.86, 95% CI 0.79-0.93) and Baylor cohort (AUROC = 0.85, 95% CI 0.74-0.95).MELD-LA significantly improves discrimination of short-term mortality associated with variceal bleeding, compared to MELD, peak-lactate and nadir hemoglobin. Thus, MELD-LA might represent a useful and objective marker for risk assessment and therapeutic intervention in patients with variceal bleeding.
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- 2022
19. Akutes Leberversagen
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Rutter, K., Horvatits, T., Drolz, A., Roedl, K., Siedler, S., Kluge, S., and Fuhrmann, V.
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- 2018
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20. Different enteral nutrition formulas have no effect on glucose homeostasis but on diet-induced thermogenesis in critically ill medical patients: a randomized controlled trial
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Wewalka, Marlene, Drolz, Andreas, Seeland, Berit, Schneeweiss, Mathias, Schmid, Monika, Schneeweiss, Bruno, and Zauner, Christian
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- 2018
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21. Outcome of in- and out-of-hospital cardiac arrest survivors with liver cirrhosis
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Kevin Roedl, Christian Wallmüller, Andreas Drolz, Thomas Horvatits, Karoline Rutter, Alexander Spiel, Julia Ortbauer, Peter Stratil, Pia Hubner, Christoph Weiser, Jasmin Katrin Motaabbed, Dominik Jarczak, Harald Herkner, Fritz Sterz, and Valentin Fuhrmann
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Cardiac arrest ,Cirrhosis ,Acute-on-chronic liver failure ,Multiple organ failure ,Intensive care unit ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Organ failure increases mortality in patients with liver cirrhosis. Data about resuscitated cardiac arrest patients with liver cirrhosis are missing. This study aims to assess aetiology, survival and functional outcome in patients after successful cardiopulmonary resuscitation (CPR) with and without liver cirrhosis. Methods Analysis of prospectively collected cardiac arrest registry data of consecutively hospital-admitted patients following successful CPR was performed. Patient’s characteristics, admission diagnosis, severity of disease, course of disease, short- and long-term mortality as well as functional outcome were assessed and compared between patients with and without cirrhosis. Results Out of 1068 patients with successful CPR, 47 (4%) had liver cirrhosis. Acute-on-chronic liver failure (ACLF) was present in 33 (70%) of these patients on admission, and four patients developed ACLF during follow-up. Mortality at 1 year was more than threefold increased in patients with liver cirrhosis (OR 3.25; 95% CI 1.33–7.96). Liver cirrhosis was associated with impaired neurological outcome (OR for a favourable cerebral performance category: 0.13; 95% CI 0.04–0.36). None of the patients with Child–Turcotte–Pugh (CTP) C cirrhosis survived 28 days with good neurological outcome. Overall nine (19%) patients with cirrhosis survived 28 days with good neurological outcome. All patients with ACLF grade 3 died within 28 days. Conclusion Cardiac arrest survivors with cirrhosis have worse outcome than those without. Although one quarter of patients with liver cirrhosis survived longer than 28 days after successful CPR, patients with CTP C as well as advanced ACLF did not survive 28 days with good neurological outcome.
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- 2017
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22. Circulating bile acids predict outcome in critically ill patients
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Thomas Horvatits, Andreas Drolz, Karoline Rutter, Kevin Roedl, Lies Langouche, Greet Van den Berghe, Günter Fauler, Brigitte Meyer, Martin Hülsmann, Gottfried Heinz, Michael Trauner, and Valentin Fuhrmann
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Bile acids ,Cholestasis ,Cardiogenic shock ,Septic shock ,Critically ill patients ,ICU ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Jaundice and cholestatic hepatic dysfunction are frequent findings in critically ill patients associated with increased mortality. Cholestasis in critically ill patients is closely associated with stimulation of pro-inflammatory cytokines resulting in impaired bile secretion and subsequent accumulation of bile acids. Aim of this study was to evaluate the clinical role of circulating bile acids in critically ill patients. Methods Total and individual serum bile acids were assessed via high-performance liquid chromatography in 320 critically ill patients and 19 controls. Results Total serum bile acids were threefold higher in septic than cardiogenic shock patients and sixfold higher than in post-surgical patients or controls (p
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- 2017
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23. Circulating bile acids predict outcome in critically ill patients
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Horvatits, Thomas, Drolz, Andreas, Rutter, Karoline, Roedl, Kevin, Langouche, Lies, Van den Berghe, Greet, Fauler, Günter, Meyer, Brigitte, Hülsmann, Martin, Heinz, Gottfried, Trauner, Michael, and Fuhrmann, Valentin
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- 2017
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24. ESICM LIVES 2016: part two: Milan, Italy. 1–5 October 2016
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Sivakumar, S., Taccone, F. S., Desai, K. A., Lazaridis, C., Skarzynski, M., Sekhon, M., Henderson, W., Griesdale, D., Chapple, L., Deane, A., Williams, L., Strickland, R., Lange, K., Heyland, D., Chapman, M., Rowland, M. J., Garry, P., Westbrook, J., Corkill, R., Antoniades, C. A., Pattinson, K. T., Fatania, G., Strong, A. J., Myers, R. B., Lazaridis, C., Jermaine, C. M., Robertson, C. S., Rusin, C. G., Hofmeijer, J., Sondag, L., Tjepkema-Cloostermans, M. C., Beishuizen, A., Bosch, F. H., van Putten, M. J. A. M., Carteron, L., Patet, C., Solari, D., Oddo, M., Ali, M. A., Dias, C., Almeida, R., Vaz-Ferreira, A., Silva, J., Monteiro, E., Cerejo, A., Rocha, A. P., Elsayed, A. A., Abougabal, A. M., Beshey, B. N., Alzahaby, K. M., Pozzebon, S., Ortiz, A. Blandino, Cristallini, S., Lheureux, O., Brasseur, A., Vincent, J. L., Creteur, J., Taccone, F. S., Hravnak, M., Yousef, K., Chang, Y., Crago, E., Friedlander, R. M., Abdelmonem, S. A., Tahon, S. A., Helmy, T. A., Meligy, H. S., Puig, F., Dunn-Siegrist, I., Pugin, J., Gupta, S., Govil, D., Srinivasan, S., Patel, S. J., N, J. K., Gupta, A., Tomar, D. S., Shafi, M., Harne, R., Arora, D. P., Talwar, N., Mazumdar, S., Papakrivou, E. E., Makris, D., Manoulakas, E., Tsolaki, B., Karadodas, B., Zakynthinos, E., Garcia, I. Palacios, Martin, A. Diaz, Encinares, V. Sanchez, Ibañez, M. Pachón, Montero, J. Garnacho, Labrador, G., Cangueiro, T. Cebrero, Poulose, V., Koh, J., Kam, J. W., Yeter, H., Kara, A., Aktepe, O., Topeli, A., Tsolakoglou, I., Intas, G., Stergiannis, P., Kolaros, A. A., Chalari, E., Athanasiadou, E., Martika, A., Fildisis, G., Faivre, V., Mengelle, C., Favier, B., Payen, D., Poppe, A., Winkler, M. S., Mudersbach, E., Schreiber, J., Wruck, M. L., Schwedhelm, E., Kluge, S., Zöllner, C., Tavladaki, T., Spanaki, A. M., Dimitriou, H., Kondili, E., Choulaki, C., Meleti, E., Kafetzopoulos, D., Georgopoulos, D., Briassoulis, G., la Torre, A. García-de, de la Torre-Prados, M. V., Tsvetanova-Spasova, T., Nuevo-Ortega, P., Rueda-Molina, C., Fernández-Porcel, A., Camara-Sola, E., Salido-Díaz, L., García-Alcántara, A., Tavladaki, T., Spanaki, A. M., Dimitriou, H., Kondili, E., Choulaki, C., Meleti, D. E., Kafetzopoulos, D., Georgopoulos, D., Briassoulis, G., Suberviola, B., Riera, J., Rellan, L., Sanchez, M., Robles, J. C., Lopez, E., Vicente, R., Miñambres, E., Santibañez, M., Le Guen, M., Moore, J., Mason, N., Windpassinger, M., Plattner, O., Mascha, E., Sessler, D. I., Research, Outcomes, Melia, U., Fontanet, J., van den Berg, J. P., Struys, M. M. R. F., Vereecke, H. E. M., Jensen, E. W., Rood, P. J. T., van de Schoor, F., van Tertholen, K., Pickkers, P., van den Boogaard, M., Beardow, Z. J., Redhead, H., Paramasivam, K., Numan, T., van den Boogaard, M., Kamper, A. M., Rood, P., Peelen, L. M., Zeman, P. M., Slooter, A. J., van Ewijk, C. E., Jacobs, G. E., Girbes, A. R. J., Myatra, S. N., Harish, M. M., Prabu, N. R., Siddiqui, S., Kulkarni, A. P., Divatia, J. V., Murbach, L. D., Leite, M. A., Osaku, E. F., Costa, C. R. L. M., Pelenz, M., Neitzke, N. M., Moraes, M. M., Jaskowiak, J. L., Silva, M. M. M., Zaponi, R. S., Abentroth, L. R. L., Ogasawara, S. M., Jorge, A. C., Duarte, P. A. D., Hernández-Sánchez, N., Sánchez-Hurtado, L. A., García-Guillen, F. J., Ñamendys-Silva, S. A., Maghsoudi, B., Emami, M., Khosravi, M. B., Zand, F., Tabatabaie, H. R., Masjedi, M., Sabetiyan, G., Mokri, A., Troubleyn, J., Diltoer, M., Jacobs, R., Nguyen, D. N., De Waele, E., De Regt, J., Honoré, P. M., Van Gorp, V., Spapen, H. D., Contreras, R. S., Toapanta, N. D., Moreno, G., Sabater, J., Torrado, H., Gonzalez, M., Marin, M., Farigola, E., Gonzalez, A., Fernandez, J., Vera, A., Gisbert, X., Juliá, C., Uya, J., Corral, L., Elias-Jones, I., Gemmell, L., MacKay, A., Randall, D., Adwaney, A., Blunden, M., Prowle, J. R., Kirwan, C. 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H., Besch, G., Perrotti, A., Puyraveau, M., Carteron, L., Baltres, M., Samain, E., Chocron, S., Pili-Floury, S., Plata-Menchaca, E. P., Sabater-Riera, J., Estruch, M., Boza, E., Sbraga, F., Toscana-Fernández, J., Bruguera-Pellicer, E., Ordoñez-Llanos, J., Pérez-Fernández, X. L., Cavaleiro, P., Tralhão, A., Arrigo, M., Lopes, J.-P., Lebrun, M., Cholley, B., PerezVela, J. L., MarinMateos, H., Rivera, J. J. Jimenez, Llorente, M. A. Alcala, De Marcos, B. Gonzalez, Fernandez, F. J. Gonzalez, Laborda, C. Garcia, Zamora, D. Fernandez, Delgado, J. C. Lopez, Imperiali, C., Berbel-Franco, D., Dastis, M., Moreno-Gonzalez, G., Perez-Sanchez, J., Romera-Peregrina, I., Abellan-Lencina, R., Martinez-Pascual, A., Fuentes-Mila, V., Gonzalez-Romero, M., Górka, J., Górka, K., Iwaniec, T., Frołow, M., Polok, K., Fronczek, J., Kózka, M., Musiał, J., Szczeklik, W., Pérez, A. González, Ordoñez, P. Florez, Giribet, A., Cuervo, M. A. Alonso, Cuervo, R. Alonso, Esteban, M. A. Rodriguez, Fraile, L. Iglesias, Mittelbrum, C. Ponte, Albaiceta, G. Muñiz, Ampatzidou, F., Sileli, M., Kehagioglou, G., Madesis, A., Karaiskos, T., Moursia, C., Maleoglou, H., Leleki, K., Drossos, G., Uz, Z., Ince, Y., Papatella, R., Bulent, E., Guerci, P., Ince, C., De Mol, B., Vicka, V., Gineityte, D., Ringaitiene, D., Norkiene, I., Sipylaite, J., Möller, C., Fleischmann, C., Thomas-Rueddel, D. O., Vlasakov, V., Rochwerg, B., Theurer, P., Gattinoni, L., Reinhart, K., Hartog, C. S., Pérez, A. González, Al Sibai, J. Zanabili, Camblor, P. Martinez, Fernandez, P. Alvarez, Gala, J. M. García, Guisasola, J. Silba, Albaiceta, G. Muñiz, Tamura, T., Yatabe, T., Miyajima, I., Yamashita, K., Yokoyama, M., Ampatzidou, F., Kehagioglou, G., Dalampini, E., Nastou, M., Baddour, A., Ignatiadis, A., Asteri, T., Drossos, G., Hathorn, K. E., Purtle, S. W., Horkan, C. M., Gibbons, F. K., Christopher, K. B., Viana, M. V., Tonietto, T. A., Gross, L. A., Costa, V. L., Tavares, A. L. J., Lisboa, B. O., Moraes, R. B., Vieira, S. R., Viana, L. V., Azevedo, M. J., Ceniccola, G. D., Pequeno, R. S. F., Holanda, T. P., Mendonça, V. S., Araújo, W. M. C., Carvalho, L. S. F., Segaran, E., Vickers, L., Brinchmann, K., Wignall, I., Rubulotta, F., De Brito-Ashurst, I., del Olmo, R., Esteban, M. J., Vaquerizo, C., Carreño, R., Gálvez, V., Kaminsky, G., Nieto, B., Fuentes, M., De la Torre, M. A., Torres, E., Alonso, A., Velayos, C., Saldaña, T., Escribá, A., GRIP, J., Kölegård, R., Sundblad, P., Rooyackers, O., Naser, Ben, Jaziri, F., Jazia, A. Ben, Barghouth, M., Hentati, O., Skouri, W., El Euch, M., Mahfoudhi, M., Turki, S., Abdelghni, K. Ben, Abdallah, Ben, Maha, B. N. M., Cánovas, J., Sotos, F., López, A., Lorente, M., Burruezo, A., Torres, D., Polok, K., Włudarczyk, A., Górka, J., Hałek, A., Musiał, J., Szczeklik, W., Jazia, A. Ben, Jaziri, F., Bargouth, M., Bennasr, M., Turki, S., Abdelghani, K. Ben, Abdallah, T. Ben, de Grooth, H. J., Geenen, I. L., Parienti, J. J., Straaten, H. M. Oudemans-van, Shum, H. P., King, H. S., Chan, K. C., Yan, W. W., Londoño, J. Gonzalez, Cardenas, C. Lorencio, Pedrosa, M. Morales, Gubianas, C. Murcia, Bertolin, C. Fuster, Batllori, N. Vila, Sirvent, J. M., Wykes, K., Jack, J., Morgan, P., Mukhopadhyay, A., Chan, H. Y., Kowitlawakul, Y., Remani, D., Leong, C. S. F., Henry, C. J., Puthucheary, Z. A., Mendsaikhan, N., Begzjav, T., Lundeg, G., Dünser, M., Espinoza, E. D. Valenzuela, Welsh, S. P., Motta, M. F., Guerra, E., Zerpa, M. C. l., Zechner, F., Furche, M., Berdaguer, F., Birri, P. N. Rubatto, Risso-Vazquez, A., Dubin, A., Masevicius, F. D., Greaney, D., Magee, A., Fitzpatrick, G., Lugo-Cob, R. G., Sánchez-Hurtado, L. A., Arvizu-Tachiquín, P. C., Tejeda-Huezo, B. C., Cano-Oviedo, A. A., Baltazar-Torres, J. A., Aydogan, M. S., Togal, T., Taha, A., Chai, H. Z., Kam, C., Razali, S. S. Yang, Sivasamy, V., Kuan, L. Y., Poulose, V., Morales, M. A. Lopez, Castro, S., Pires, T., Melão, L., Krystopchuk, A., Pereira, I., Granja, C., Taniguchi, L. U., Pires, E. M. C., Vieira, Jr, J. M., Azevedo, L. C. P., Nurses of the Central and General ICUs of Shiraz Namazi Hospital, Sedation an Delirium Group Hospital Universitari de Bellvitge, SPACeR group (Surrey Peri-operative, Anaesthesia and Critical Care Collaborative Research Group), for the PRoVENT investigators and the PROVE Network, SEMICYUC/GETGAG Working Group, TAVeM study group, POPC-CB investigators, DESIRE (DExmedetomidine for Sepsis in ICU Randomized Evaluation) Trial Investigators, GEMINI, Bioethics work group of SEMICYUC, The FINNAKI Study Group, Queen Square Neuroanaesthesia and Neurocritical Care Resreach Group, Renal Transplantation HUVR, GEMINI, EDISVAL Group, EDISVAL Group, PLUG Working group, TAVeM study Group, The FINNAKI Study Group, on behalf of Department of Professional Development, ESICM, Critical Care Research Group, SIRAKI group, and Grupo ESBAGA
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- 2016
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25. Hepatokardiale Wechselwirkungen: Interaktionen zweier Organsysteme
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Horvatits, Thomas, Drolz, Andreas, Rutter, Karoline, Roedl, Kevin, Kluge, Stefan, and Fuhrmann, Valentin
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- 2017
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26. MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis
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Horvatits, Thomas, primary, Mahmud, Nadim, additional, Serper, Marina, additional, Seiz, Oliver, additional, Reher, Dominik, additional, Drolz, Andreas, additional, Sarnast, Naveed, additional, Gu, Wenyi, additional, Erasmus, Hans Peter, additional, Allo, Gabriel, additional, Ferstl, Phillip, additional, Wittmann, Sebastian, additional, Piecha, Felix, additional, Groth, Stefan, additional, Zeuzem, Stefan, additional, Schramm, Christoph, additional, Huber, Samuel, additional, Rösch, Thomas, additional, Lohse, Ansgar W., additional, Trebicka, Jonel, additional, Ogola, Gerald, additional, Asrani, Sumeet K., additional, and Kluwe, Johannes, additional
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- 2022
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27. Predictors for Post Transplant Survival in Patients with Acute-on-Chronic Liver Failure
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Sterneck, Martina, Huebener, Peter, Bangert, Katrin, Drolz, Andreas, Kluge, Stefan, Lohse, Ansgar, Fischer, Lutz, and Fuhrmann, Valentin
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- 2018
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28. Klinisches Bild der Blutung bei kritisch kranken Patienten auf der Intensivstation
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Andreas Drolz and Valentin Fuhrmann
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Gynecology ,medicine.medical_specialty ,Erythrocyte transfusion ,business.industry ,Intracranial Hemorrhages ,Peptic ulcer ,Emergency Medicine ,Internal Medicine ,Medicine ,Emergency Nursing ,Critical Care and Intensive Care Medicine ,business ,medicine.disease - Abstract
Blutungsereignisse sind gefurchtete Komplikationen bei kritisch kranken Patienten auf der Intensivstation. Je nach Lokalisation und Schweregrad der Blutungen sind diese haufig mit erhohter Morbiditat und Mortalitat vergesellschaftet. Die klinische Bedeutung der unterschiedlichen Blutungskomplikationen ergeben sich einerseits aus der Blutungslokalisation (z. B. intrazerebrale Blutung), der Blutungsintensitat (z. B. fulminante Osophagusvarizenblutung), andererseits aber auch aus der Haufigkeit (z. B. gastrointestinale Blutung). In jedem Fall besteht die Therapie aus der Stabilisierung des Patienten, dem Stoppen der Blutung und der Verhinderung von Folge- und Begleitkomplikationen. In der aktuellen Ubersicht sollen wichtige Ursachen und Aspekte im Hinblick auf Blutungen bei kritisch kranken Patienten erortert werden.
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- 2021
29. Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation
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Johannes Kluwe, Stefan Blankenberg, Lisa Voigtländer, Moritz Seiffert, M. Linder, Hermann Reichenspurner, Lenard Conradi, Sebastian Ludwig, Niklas Schofer, Dirk Westermann, Alina Goßling, Andreas Drolz, Lara Waldschmidt, and Paula Heimburg
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Male ,Gastrointestinal bleeding ,medicine.medical_specialty ,Transcatheter aortic ,030204 cardiovascular system & hematology ,Angiodysplasia ,TAVI ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Germany ,Prevalence ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Heyde syndrome ,Aged, 80 and over ,Original Paper ,business.industry ,General Medicine ,Aortic Valve Stenosis ,Syndrome ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,Paravalvular leakage ,Aortic Valve ,Fluoroscopy ,Cardiology ,Recurrent bleeding ,Female ,Cardiology and Cardiovascular Medicine ,business ,Index hospitalization ,Gastrointestinal Hemorrhage ,Follow-Up Studies - Abstract
Background Heyde syndrome (HS) is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. Data on the prevalence of HS and results after TAVI remain scarce. Methods 2548 consecutive patients who underwent TAVI for the treatment of AS from 2008 to 2017 were evaluated for a history of GIB and the presence of HS. The diagnosis of HS was defined as a clinical triad of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. These patients (Heyde) were followed to investigate clinical outcomes, bleeding complications and the recurrence of GIB and were compared to patients with GIB unrelated to HS (Non-Heyde). Results A history of GIB prior to TAVI was detected in 190 patients (7.5%). Among them, 47 patients were diagnosed with HS (1.8%). Heyde patients required blood transfusions more frequently compared to Non-Heyde patients during index hospitalization (50.0% vs. 31.9%, p = 0.03). Recurrent GIB was detected in 39.8% of Heyde compared to 21.2% of Non-Heyde patients one year after TAVI (p = 0.03). In patients diagnosed with HS and recurrent GIB after TAVI, the rate of residual ≥ mild paravalvular leakage (PVL) was higher compared to those without recurrent bleeding (73.3% vs. 38.1%, p = 0.05). Conclusion A relevant number of patients undergoing TAVI were diagnosed with HS. Recurrent GIB was detected in a significant number of Heyde patients during follow-up. A possible association with residual PVL requires further investigation to improve treatment options and outcomes in patients with HS. Graphic abstract
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- 2021
30. Acid–base status and its clinical implications in critically ill patients with cirrhosis, acute-on-chronic liver failure and without liver disease
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Drolz, Andreas, Horvatits, Thomas, Roedl, Kevin, Rutter, Karoline, Brunner, Richard, Zauner, Christian, Schellongowski, Peter, Heinz, Gottfried, Funk, Georg-Christian, Trauner, Michael, Schneeweiss, Bruno, and Fuhrmann, Valentin
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- 2018
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31. Hepatokardiale Wechselwirkungen: Interaktionen zweier Organsysteme
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Horvatits, T., Drolz, A., Rutter, K., Roedl, K., Kluge, S., and Fuhrmann, V.
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- 2016
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32. Prognostic impact of ICG-PDR in patients with hypoxic hepatitis
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Horvatits, Thomas, Kneidinger, Nikolaus, Drolz, Andreas, Roedl, Kevin, Rutter, Karoline, Kluge, Stefan, Trauner, Michael, and Fuhrmann, Valentin
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- 2015
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33. Pulmonary impairment independently determines mortality in critically ill patients with acute‐on‐chronic liver failure
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Schulz, Martin S., primary, Mengers, Jan, additional, Gu, Wenyi, additional, Drolz, Andreas, additional, Ferstl, Philip G., additional, Amoros, Alex, additional, Uschner, Frank E., additional, Ackermann, Nora, additional, Guttenberg, Georg, additional, Queck, Alexander, additional, Brol, Maximilian J., additional, Graf, Christiana, additional, Stoffers, Philipp, additional, de la Vera, Anna‐Lena Laguna, additional, Cremonese, Carla, additional, Erasmus, Hans‐Peter, additional, Welker, Martin W., additional, Grünewaldt, Achim, additional, Arroyo, Vincente, additional, Bojunga, Jörg, additional, Fernandez, Javier, additional, Zeuzem, Stefan, additional, Kluwe, Johannes, additional, Peiffer, Kai‐Hendrik, additional, Welsch, Christoph, additional, Fuhrmann, Valentin, additional, Rohde, Gernot, additional, and Trebicka, Jonel, additional
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- 2022
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34. Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure
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Martin S. Schulz, Jan Mengers, Wenyi Gu, Andreas Drolz, Philip G. Ferstl, Alex Amoros, Frank E. Uschner, Nora Ackermann, Georg Guttenberg, Alexander Queck, Maximilian J. Brol, Christiana Graf, Philipp Stoffers, Anna‐Lena Laguna de la Vera, Carla Cremonese, Hans‐Peter Erasmus, Martin W. Welker, Achim Grünewaldt, Vincente Arroyo, Jörg Bojunga, Javier Fernandez, Stefan Zeuzem, Johannes Kluwe, Kai‐Hendrik Peiffer, Christoph Welsch, Valentin Fuhrmann, Gernot Rohde, and Jonel Trebicka
- Subjects
Hepatology - Abstract
In ACLF patients, an adequate risk stratification is essential, especially for liver transplant allocation, since ACLF is associated with high short-term mortality. The CLIF-C ACLF score is the best prognostic model to predict outcome in ACLF patients. While lung failure is generally regarded as signum malum in ICU care, this study aims to evaluate and quantify the role of pulmonary impairment on outcome in ACLF patients.In this retrospective study, 498 patients with liver cirrhosis and admission to IMC/ICU were included. ACLF was defined according to EASL-CLIF criteria. Pulmonary impairment was classified into three groups: unimpaired ventilation, need for mechanical ventilation and defined pulmonary failure. These factors were analysed in different cohorts, including a propensity score-matched ACLF cohort.Mechanical ventilation and pulmonary failure were identified as independent risk factors for increased short-term mortality. In matched ACLF patients, the presence of pulmonary failure showed the highest 28-day mortality (83.7%), whereas mortality rates in ACLF with mechanical ventilation (67.3%) and ACLF without pulmonary impairment (38.8%) were considerably lower (p .001). Especially in patients with pulmonary impairment, the CLIF-C ACLF score showed poor predictive accuracy. Adjusting the CLIF-C ACLF score for the grade of pulmonary impairment improved the prediction significantly.This study highlights that not only pulmonary failure but also mechanical ventilation is associated with worse prognosis in ACLF patients. The grade of pulmonary impairment should be considered in the risk assessment in ACLF patients. The new score may be useful in the selection of patients for liver transplantation.
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- 2022
35. Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure
- Author
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Schulz, Martin S., Mengers, Jan, Gu, Wenyi, Drolz, Andreas, Ferstl, Philip, Amoros, Alex, Uschner, Frank Erhard, Ackermann, Nora, Guttenberg, Georg, Queck, Alexander David Roger, Brol, Maximilian, Graf, Christiana, Stoffers, Philipp Clemens, Laguna de la Vera, Anna-Lena, Cremonese, Carla-Luisa Elsa, Erasmus, Hans-Peter, Welker, Martin-Walter, Grünewaldt, Achim Bernd, Arroyo, Vicente, Bojunga, Jörg, Fernandez, Javier, Zeuzem, Stefan, Kluwe, Johannes, Peiffer, Kai-Henrik, Welsch, Christoph, Fuhrmann, Valentin, Rohde, Gernot Gerhard Ulrich, Trebicka, Jonel, Schulz, Martin S., Mengers, Jan, Gu, Wenyi, Drolz, Andreas, Ferstl, Philip, Amoros, Alex, Uschner, Frank Erhard, Ackermann, Nora, Guttenberg, Georg, Queck, Alexander David Roger, Brol, Maximilian, Graf, Christiana, Stoffers, Philipp Clemens, Laguna de la Vera, Anna-Lena, Cremonese, Carla-Luisa Elsa, Erasmus, Hans-Peter, Welker, Martin-Walter, Grünewaldt, Achim Bernd, Arroyo, Vicente, Bojunga, Jörg, Fernandez, Javier, Zeuzem, Stefan, Kluwe, Johannes, Peiffer, Kai-Henrik, Welsch, Christoph, Fuhrmann, Valentin, Rohde, Gernot Gerhard Ulrich, and Trebicka, Jonel
- Abstract
Background & Aims: In ACLF patients, an adequate risk stratification is essential, especially for liver transplant allocation, since ACLF is associated with high short-term mortality. The CLIF-C ACLF score is the best prognostic model to predict outcome in ACLF patients. While lung failure is generally regarded as signum malum in ICU care, this study aims to evaluate and quantify the role of pulmonary impairment on outcome in ACLF patients. Methods: In this retrospective study, 498 patients with liver cirrhosis and admission to IMC/ICU were included. ACLF was defined according to EASL-CLIF criteria. Pulmonary impairment was classified into three groups: unimpaired ventilation, need for mechanical ventilation and defined pulmonary failure. These factors were analysed in different cohorts, including a propensity score-matched ACLF cohort. Results: Mechanical ventilation and pulmonary failure were identified as independent risk factors for increased short-term mortality. In matched ACLF patients, the presence of pulmonary failure showed the highest 28-day mortality (83.7%), whereas mortality rates in ACLF with mechanical ventilation (67.3%) and ACLF without pulmonary impairment (38.8%) were considerably lower (p < .001). Especially in patients with pulmonary impairment, the CLIF-C ACLF score showed poor predictive accuracy. Adjusting the CLIF-C ACLF score for the grade of pulmonary impairment improved the prediction significantly. Conclusions: This study highlights that not only pulmonary failure but also mechanical ventilation is associated with worse prognosis in ACLF patients. The grade of pulmonary impairment should be considered in the risk assessment in ACLF patients. The new score may be useful in the selection of patients for liver transplantation.
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- 2022
36. Reply
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Drolz, Andreas and Fuhrmann, Valentin
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- 2017
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37. Serum bile acids as marker for acute decompensation and acute‐on‐chronic liver failure in patients with non‐cholestatic cirrhosis
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Horvatits, Thomas, Drolz, Andreas, Roedl, Kevin, Rutter, Karoline, Ferlitsch, Arnulf, Fauler, Günter, Trauner, Michael, and Fuhrmann, Valentin
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- 2017
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38. Correction: Different enteral nutrition formulas have no effect on glucose homeostasis but on diet-induced thermogenesis in critically ill medical patients: a randomized controlled trial
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Wewalka, Marlene, Drolz, Andreas, Seeland, Berit, Schneeweiss, Mathias, Schmid, Monika, Schneeweiss, Bruno, and Zauner, Christian
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- 2019
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39. Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis
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Christoph Schramm, Andreas Drolz, Oliver Seiz, Stefan Groth, Eik Vettorazzi, Thomas Horvatits, Malte H. Wehmeyer, Tobias Goeser, Thomas Roesch, Ansgar W. Lohse, and Johannes Kluwe
- Subjects
Liver Cirrhosis ,0301 basic medicine ,medicine.medical_specialty ,Cirrhosis ,Bilirubin ,Esophageal and Gastric Varices ,Gastroenterology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Coagulopathy ,Humans ,Ligation ,Retrospective Studies ,Univariate analysis ,business.industry ,Hazard ratio ,medicine.disease ,Confidence interval ,030104 developmental biology ,chemistry ,030211 gastroenterology & hepatology ,Upper gastrointestinal bleeding ,Gastrointestinal Hemorrhage ,Varices ,business - Abstract
Background Prophylactic endoscopic variceal band ligation (EVL) is frequently performed in patients with liver cirrhosis. The aim of our study was to identify factors associated with early upper gastrointestinal bleeding (UGIB) in cirrhosis patients after prophylactic EVL. Methods 787 nonemergency EVLs performed in 444 patients in two German University medical centers were analyzed retrospectively. Results Within 30 days after EVL, 38 UGIBs were observed (4.8 % of all procedures). Bilirubin levels (hazard ratio [HR] 1.5, 95 % confidence interval [CI] 1.2–2.0 for a 2-fold increase) and presence of varices grade III/IV according to Paquet (HR 2.6, 95 %CI 1.3–5.0 compared with absence or smaller sized varices) were independently associated with UGIB following EVL. International normalized ratio (INR) was associated with bleeding events in the univariate analysis but did not reach statistical significance after adjustment for bilirubin and presence of varices grade III/IV (HR 1.2, 95 %CI 0.9–1.6 for an increase by 0.25). There was no statistically significant association between platelet count or fibrinogen levels and UGIB. Substitution of coagulation products did not affect incidence of bleeding after EVL, which also applied to patients with “coagulopathy” (INR > 1.5 and/or platelet count Conclusions EVL is a safe procedure and immediate bleeding complications are rare. Serum bilirubin levels and size of varices, rather than coagulation indices, are associated with UGIB after EVL. Our data do not support the preventive substitution of blood or coagulation products.
- Published
- 2020
40. Leberdysfunktion bei kritisch kranken mit COVID-19: Vorkommen und Outcome
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Daniel Frings, Barbara Sensen, Dominic Wichmann, Olaf Boenisch, Kevin Roedl, V Fuhrmann, Dominik Jarczak, Stefan Kluge, Christoph Burdelski, G de Heer, Andreas Drolz, M Lütgehetmann, and Axel Nierhaus
- Published
- 2021
41. Gender-specific differences in energy metabolism during the initial phase of critical illness
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Drolz, A., Wewalka, M., Horvatits, T., Fuhrmann, V., Schneeweiss, B., Trauner, M., and Zauner, C.
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Medical research ,Medicine, Experimental ,Bioenergetics -- Research ,Energy metabolism -- Research ,Food/cooking/nutrition ,Health - Abstract
BACKGROUND/OBJECTIVES: Women and men differ in substrate and energy metabolism. Such differences may affect energy requirements during the acute phase of critical illness. SUBJECTS/METHODS: Data of 155 critically ill medical patients were reviewed for this study. Indirect calorimetry in each patient was performed within the first 72 h following admission to the medical intensive care unit after an overnight fast. RESULTS: In overweight (body mass index (BMI) [greater than or equal to] 25 kg/[m.sup.2]) but not in normal-weight patients, resting energy expenditure (REE) adjusted for body weight ([REE.sub.aBW]) differed significantly between women and men (17.2 (interquartile range (IQR) 15.2-20.7) vs 20.9 (IQR 17.9-23.4) kcal/kg/day, P CONCLUSIONS: [REE.sub.aBW] decreases with increasing body mass in both sexes. This relationship differs between women and men. Overweight critically ill women show significantly lower [REE.sub.aBW] and [REE.sub.a!BW], respectively, compared with men. These findings could affect the current practice of nutritional support during the early phase of critical illness. European Journal of Clinical Nutrition (2014) 68, 707-711; doi:10.1038/ejcn.2013.287; published online 15 January 2014 Keywords: energy metabolism; gender; indirect calorimetry; body weight; body mass index, INTRODUCTION Women and men differ not only in anatomy, but also in substrate and energy metabolism. (1-4) Energy metabolism is of key relevance for clinical nutritional practice, as the balance [...]
- Published
- 2014
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42. Schockleber und Cholestase beim kritisch Kranken
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Drolz, A., Horvatits, T., Roedl, K., and Fuhrmann, V.
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- 2014
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43. Pulmonale Komplikationen bei Lebererkrankungen
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Horvatits, T., Drolz, A., Rutter, K., Kluge, S., and Fuhrmann, V.
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- 2014
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44. Extrakorporale Therapien bei Patienten mit Lebererkrankungen auf der Intensivstation
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Fuhrmann, V., Horvatits, T., Drolz, A., and Rutter, K.
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- 2014
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45. Pulmonary impairment independently determines mortality in critically ill patients with acute‐on‐chronic liver failure.
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Schulz, Martin S., Mengers, Jan, Gu, Wenyi, Drolz, Andreas, Ferstl, Philip G., Amoros, Alex, Uschner, Frank E., Ackermann, Nora, Guttenberg, Georg, Queck, Alexander, Brol, Maximilian J., Graf, Christiana, Stoffers, Philipp, de la Vera, Anna‐Lena Laguna, Cremonese, Carla, Erasmus, Hans‐Peter, Welker, Martin W., Grünewaldt, Achim, Arroyo, Vincente, and Bojunga, Jörg
- Subjects
LIVER failure ,PATIENT selection ,CRITICALLY ill ,ALLOCATION of organs, tissues, etc. ,ARTIFICIAL respiration - Abstract
Background & Aims: In ACLF patients, an adequate risk stratification is essential, especially for liver transplant allocation, since ACLF is associated with high short‐term mortality. The CLIF‐C ACLF score is the best prognostic model to predict outcome in ACLF patients. While lung failure is generally regarded as signum malum in ICU care, this study aims to evaluate and quantify the role of pulmonary impairment on outcome in ACLF patients. Methods: In this retrospective study, 498 patients with liver cirrhosis and admission to IMC/ICU were included. ACLF was defined according to EASL‐CLIF criteria. Pulmonary impairment was classified into three groups: unimpaired ventilation, need for mechanical ventilation and defined pulmonary failure. These factors were analysed in different cohorts, including a propensity score‐matched ACLF cohort. Results: Mechanical ventilation and pulmonary failure were identified as independent risk factors for increased short‐term mortality. In matched ACLF patients, the presence of pulmonary failure showed the highest 28‐day mortality (83.7%), whereas mortality rates in ACLF with mechanical ventilation (67.3%) and ACLF without pulmonary impairment (38.8%) were considerably lower (p <.001). Especially in patients with pulmonary impairment, the CLIF‐C ACLF score showed poor predictive accuracy. Adjusting the CLIF‐C ACLF score for the grade of pulmonary impairment improved the prediction significantly. Conclusions: This study highlights that not only pulmonary failure but also mechanical ventilation is associated with worse prognosis in ACLF patients. The grade of pulmonary impairment should be considered in the risk assessment in ACLF patients. The new score may be useful in the selection of patients for liver transplantation. [ABSTRACT FROM AUTHOR]
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- 2023
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- View/download PDF
46. [Clinical presentation of bleeding in critically ill patients in the intensive care unit : Organ systems and clinical implications]
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Andreas, Drolz and Valentin, Fuhrmann
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Intensive Care Units ,Critical Illness ,Incidence ,Humans ,Esophageal and Gastric Varices ,Gastrointestinal Hemorrhage - Abstract
Bleedings are frequent and clinically important complications in critically ill patients in the intensive care unit, and-depending on location and intensity-are associated with high morbidity and mortality. The clinical impact of different bleeding entities is affected by the location (e.g. intracerebral bleedings), the severity (e.g. fulminant variceal bleeding) and the incidence (e.g. gastrointestinal bleeding) of the respective bleeding type. Therapy varies among bleeding entities, but consists of stabilization of the patient, control of the bleeding, and prevention of complications. This review describes relevant therapeutic aspects of selected bleeding complications in critically ill patients.Blutungsereignisse sind gefürchtete Komplikationen bei kritisch kranken Patienten auf der Intensivstation. Je nach Lokalisation und Schweregrad der Blutungen sind diese häufig mit erhöhter Morbidität und Mortalität vergesellschaftet. Die klinische Bedeutung der unterschiedlichen Blutungskomplikationen ergeben sich einerseits aus der Blutungslokalisation (z. B. intrazerebrale Blutung), der Blutungsintensität (z. B. fulminante Ösophagusvarizenblutung), andererseits aber auch aus der Häufigkeit (z. B. gastrointestinale Blutung). In jedem Fall besteht die Therapie aus der Stabilisierung des Patienten, dem Stoppen der Blutung und der Verhinderung von Folge- und Begleitkomplikationen. In der aktuellen Übersicht sollen wichtige Ursachen und Aspekte im Hinblick auf Blutungen bei kritisch kranken Patienten erörtert werden.
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- 2021
47. Leberdysfunktion bei kritisch kranken mit COVID-19: Vorkommen und Outcome
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Roedl, K, additional, Jarczak, D, additional, Drolz, A, additional, Wichmann, D, additional, Boenisch, O, additional, de Heer, G, additional, Burdelski, C, additional, Frings, D, additional, Sensen, B, additional, Nierhaus, A, additional, Lütgehetmann, M, additional, Kluge, S, additional, and Fuhrmann, V, additional
- Published
- 2021
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48. Einsatz von Protonenpumpenhemmern bei Patienten mit Leberzirrhose – eine Umfrage unter Hepatologen in Deutschland
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Jonel Trebicka, Johannes Kluwe, Thomas Horvatits, Ansgar W. Lohse, Christian J. Steib, Malte H. Wehmeyer, and Andreas Drolz
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Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Practice patterns ,business.industry ,Gastroenterology ,Medicine ,030211 gastroenterology & hepatology ,030212 general & internal medicine ,business - Abstract
Zusammenfassung Einleitung Protonenpumpeninhibitoren (PPIs) gehören zu den weltweit am häufigsten verordneten Medikamenten. Vor allem bei Patienten mit Leberzirrhose wurden Verschreiberaten von bis zu 78 % berichtet. PPIs scheinen mit relevanten Nebenwirkungen, wie erhöhtem Risiko für nosokomiale Infektionen, spontan bakterieller Peritonitis oder dem Auftreten einer hepatischen Enzephalopathie assoziiert zu sein. Aus diesem Grund war es Ziel dieser Umfrage, die Verschreibungspraxis von PPIs bei Patienten mit Leberzirrhose in Deutschland zu erheben. Methoden Die Daten wurden mittels Web-basierter Befragung erhoben. Hierfür wurde eine Einladung über die Newsletter der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), des Berufsverbandes Gastroenterologie Deutschland (BVGD) und der Arbeitsgemeinschaft universitärer Gastroenterologen (AUG) versandt. Ergebnisse 61 Personen haben an der Umfrage teilgenommen. Insgesamt wurden sehr hohe PPI-Verschreiberaten von 58 % im stationären, sowie 44 % im ambulanten Bereich berichtet. Beinahe die Hälfte der Befragten gab an, PPIs bei medizinisch fraglicher Indikation einzusetzen (z. B. unspezifische abdominelle Beschwerden). Bei einem Drittel der Patienten könnte die bestehende PPI-Therapie nach kritischer Evaluation wieder beendet werden. 55 % der Befragten gaben an, dass PPIs ihrer Einschätzung zufolge mit relevanten Nebenwirkungen assoziiert sind. Blutungskomplikationen nach Absetzen einer PPI-Therapie wurden durch die Befragten selten beobachtet. Schlussfolgerung PPIs werden bei Patienten mit Leberzirrhose in Deutschland sehr häufig verordnet. Ein Problembewusstsein bezüglich eines insgesamt unklaren Risiko-Nutzen-Verhältnisses scheint vorhanden zu sein. Prospektive Untersuchungen sind dringend nötig, um die Evidenzlage hinsichtlich Indikation und Dauer einer PPI-Therapie bei Patienten mit Leberzirrhose zu erhärten.
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- 2019
49. Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival
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Ann-Kathrin Ozga, Daniel Benten, David Steins, Clemens Spink, Ulf K Radunski, Thomas Horvatits, Ansgar W. Lohse, Christoph Sinning, Harald Ittrich, Johannes Kluwe, Andreas Drolz, and Felix Piecha
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medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Portal venous pressure ,liver cirrhosis ,Liver transplantation ,Gastroenterology ,Internal medicine ,Ascites ,Internal Medicine ,Paracentesis ,Immunology and Allergy ,Medicine ,Decompensation ,transplant ,lcsh:RC799-869 ,refractory ascites ,Hepatology ,medicine.diagnostic_test ,decompensation ,business.industry ,portal hypertension ,MELD score ,medicine.disease ,hepatic venous pressure gradient ,stents ,Portal hypertension ,lcsh:Diseases of the digestive system. Gastroenterology ,medicine.symptom ,business ,Transjugular intrahepatic portosystemic shunt ,Research Article - Abstract
Background & Aims Refractory ascites is the main reason for the implantation of a transjugular intrahepatic portosystemic shunt (TIPS) in liver cirrhosis, but ascites control by TIPS fails in a relevant proportion of cases. Here, we investigated whether routine parameters pre-TIPS can predict persistent ascites after TIPS implantation and whether persistent ascites predicts long-term clinical outcome. Methods A detailed retrospective analysis of 128 patients receiving expanded polytetrafluoroethylene-covered stents for the treatment of refractory ascites was performed. Persistent ascites post-TIPS was defined as the prolonged need for paracentesis >3 months after TIPS. The influence of demographics, laboratory results, pre-TIPS heart and liver ultrasound results, and invasive hemodynamic parameters on persistent ascites was evaluated by univariable and multivariable logistic regression. Predictors of the composite endpoint liver transplantation/death were analyzed using a multivariable Cox regression. Results Ascites control post-TIPS was achieved in 95/128 patients (74%), whereas ascites remained persistent in 33/128 cases (26%). On multivariable analysis, a lower paracentesis frequency pre-TIPS (odds ratio 1.672; 95% CI 1.253–2.355) and lower baseline creatinine levels (odds ratio 2.640; CI 1.201–6.607) were associated with ascites control. Patients with persistent ascites post-TIPS had and impaired transplant-free survival (median 10.0 vs. 25.8 months), for which persistent ascites was the only independent predictor (hazard ratio 5.654; CI 3.019–10.59). Conclusion TIPS-placement in patients with lower paracentesis frequency and creatinine levels is associated with superior ascites control. Thus, TIPS implantation should be considered in moderate decompensation and not as a last resort. Persistent ascites post-TIPS seems to be the only predictor of liver transplantation and death. Lay summary The insertion of a transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites should be considered in patients with moderate decompensation and not as a last resort, as lower paracentesis frequency and creatinine levels pre-TIPS are associated with superior ascites control. In turn, failure to control ascites seems to be the only predictor of liver transplantation and death., Graphical abstract Unlabelled Image, Highlights • Ascites control post-TIPS is superior if the TIPS is placed at lower paracentesis frequency and creatinine levels. • Transplant-free survival is decreased in patients with a failed ascites control post-TIPS. • TIPS-placement should be considered “early” in ascitic decompensation. • Close monitoring and prioritized organ allocation should be considered in patients with failed ascites control post-TIPS.
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- 2019
50. Hypoxic liver injury after in- and out-of-hospital cardiac arrest: Risk factors and neurological outcome
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Kevin Roedl, Thomas Horvatits, Fritz Sterz, Alexandra-Maria Warenits, Andreas Drolz, Harald Herkner, Pia Hubner, Alexander O. Spiel, Valentin Fuhrmann, and Alexander Nürnberger
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Male ,medicine.medical_specialty ,Organ Dysfunction Scores ,030204 cardiovascular system & hematology ,Emergency Nursing ,Return of spontaneous circulation ,medicine.disease_cause ,Out of hospital cardiac arrest ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Ischemic hepatitis ,Risk Factors ,law ,medicine ,Humans ,Registries ,Hypoxia ,Aged ,Liver injury ,Brain Diseases ,business.industry ,Incidence (epidemiology) ,030208 emergency & critical care medicine ,Emergency department ,Middle Aged ,Prognosis ,medicine.disease ,Intensive care unit ,Cardiopulmonary Resuscitation ,Liver ,Austria ,Emergency medicine ,Emergency Medicine ,Female ,Emergency Service, Hospital ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Out-of-Hospital Cardiac Arrest - Abstract
Hypoxic liver injury (HLI) is a frequent and life-threatening complication in critically ill patients that occurs in up to ten percent of critically ill patients. However, there is a lack of data on HLI following cardiac arrest and its clinical implications on outcome. Aim of this study was to investigate incidence, outcome and functional outcome of patients with HLI after in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA).We conducted an analysis of a cardiac arrest registry data over a 7-year period. All patients with non-traumatic OHCA and IHCA with return of spontaneous circulation (ROSC) treated at the emergency department of a tertiary care hospital were included in the study. HLI was defined according to established criteria. Predictors of HLI, occurrence, clinical and neurological outcome were assessed using multivariable regression.Out of 1068 patients after IHCA and OHCA with ROSC, 219 (21%) patients developed HLI. Rate of HLI did not differ significantly in IHCA and OHCA patients. Multivariate regression analysis identified time-to-ROSC [OR 1.18, 95% CI (1.01-1.38); p 0.05], presence of cardiac failure [OR 2.57, 95% CI (1.65-4.01); p 0.001] and Charlson comorbidity index [OR 0.83, 95% CI (0.72-0.95); p 0.01] as independent predictors for occurrence of HLI. Good functional outcome was significantly lower in patients suffering from HLI after 28-days (35% vs. 48%, p 0.001) and 1-year (34% vs. 44%, p 0.001). Occurrence of HLI was associated with unfavourable neurological outcome [OR 1.74, 95% CI (1.16-2.61); p 0.01] in multivariate regression analysis.New onset of HLI is a frequent finding after IHCA and OHCA. HLI is associated with increased mortality, unfavourable neurological and overall outcome.
- Published
- 2019
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