The presence of infection in patients with chronic liver disease is long known to be an unfavorable prognostic sign. The same holds true for hepatic encephalopathy. In this study the group of Strauss revises a large series of patients with encephalopathy observed over a period of 15 years and provides clinically relevant information on the prevalence and clinical significance of infection in these patients. Over 10 years the incidence of infections (mainly spontaneous bacterial peritonitis) halved, most probably due to effective treatment. Also relevant was the observation that this reduction was associated with a significant reduction (about 50%) of mortality. Most important was the observation that early mortality during hospitalization doubled in infected patients. The study confirms and stresses the need for a careful screening of infection in each patient and appropriate treatment in case of positivity.
2. Castano, et al. A randomized study on Losartan…Losartan, an angiotensin II receptor antagonist, has been used since more than a decade to counteract the increased activity of the rennin-angiotensin-aldosterone found in chronic liver disease, cirrhosis in particular. In this study the effect of losartan in reducing portal hypertension was assessed and compared with the golden standard drug, propanonol, in a limited number of cirrhotic patients. After 3 months treatment. losartan was apparently more effective that propranolol in reducing portal hypertension (assessed as HVPG), particularly in the more severe cases. This effect was not associated with reduction in cardiac index, cardiac output and heart rate as occurred in the propranolol group. The real question is whether losartan is better than propranolol. Unfortunately, due to the limited number of cases, the study cannot provide this importanmt answer indicating the need for a larger, prospective, double-blind trial. The cost of losartan as compared to propranolol should be also considered.
