Liver Function Assessment

Researchers are studying whether high-dose insulin therapy can improve liver function before major liver surgery in patients with colorectal liver metastasis. The trial aims to understand if this therapy enhances liver function pre-operatively, its effects after a liver venous deprivation LVD procedure, and the relationship between liver volume growth and function during regeneration. This study is interventional and explores these effects using specialized liver imaging techniques. Participants will receive a 6-hour infusion of insulin and dextrose to maintain a stable blood sugar level before their planned liver surgery. The study has three groups one receiving insulin therapy before surgery, one receiving insulin therapy after LVD, and one group undergoing LVD without insulin treatment. Insulin dosing is carefully controlled with blood sugar monitoring every 15 minutes during the infusion. During the study, liver function and regeneration will be assessed using 99mTc-Mebrofenin hepatobiliary scintigraphy and CT scans at specific times before and after treatment. Researchers will measure liver function improvements within 24 hours or 7 days post-treatment depending on the group. Participants may be involved in imaging, blood glucose monitoring, and clinical evaluations throughout their participation, which continues until after their liver surgery and follow-up assessments.

Hepatocellular carcinoma HCC is a common and deadly cancer worldwide, with a high rate of tumor recurrence after curative surgery, especially in China. Current postoperative treatments like transarterial chemoembolization TACE and tyrosine kinase inhibitors TKIs have limitations such as low response rates and significant side effects. This study seeks to develop a precise artificial intelligence AI model that integrates preoperative imaging, postoperative digital pathology, clinical data, and pathological reports to better predict which patients will benefit from specific postoperative therapies. The study includes a large retrospective cohort of about 10,000 HCC patients who underwent surgical resection, collecting detailed imaging, pathology, and clinical data to build and train the AI predictive model. Then, a prospective observational phase will enroll 1,000 postoperative HCC patients from multiple centers. The AI model will generate treatment predictions based on patient data but will not influence clinical decisions. Patients will be grouped by whether the actual treatments they receive match the AI predictions. Long-term follow-up will assess tumor recurrence and survival outcomes to validate the models prediction accuracy and clinical usefulness. Participants will undergo routine clinical care, including preoperative contrast-enhanced CT or MRI scans and postoperative collection of H&E-stained tissue slides for digital analysis. Researchers will collect comprehensive clinical, pathological, and follow-up data. Outcomes measured include recurrence-free survival and recurrence rates up to 3 years after surgery, with overall survival tracked for up to 5 years. No interventions are imposed by the study, and treatment decisions remain with physicians. The study aims to improve postoperative management and individualize adjuvant therapy for HCC patients through AI-based predictions.

Researchers are investigating the effects and mechanisms of the ALPPS procedure on liver regeneration in patients with hepatobiliary cancers, including hepatocellular carcinoma and cholangiocarcinoma. These cancers are aggressive and often diagnosed late. While liver resection offers a chance for cure, success depends on having enough healthy liver left after surgery. ALPPS is a newer surgical method that speeds up liver regrowth, allowing more patients to safely undergo liver removal compared to traditional approaches. The study aims to understand the cellular and genetic changes during liver regeneration caused by ALPPS and how these relate to patient outcomes over time. This observational study involves patients undergoing the ALPPS procedure at a hospital, with no changes made to their standard surgical care. ALPPS involves separating the liver and tying off part of the portal vein to stimulate rapid growth in the remaining liver. Researchers collect liver tissue and medical data during routine care and use advanced techniques like single-cell and spatial transcriptomics to analyze liver cell types and gene activity. The first stage is followed by assessment of liver volume growth before proceeding to the second surgery. Participants will have assessments of their liver volume around 7 and 14 days after the first ALPPS stage, with the main analysis using the last measurement before the second surgery. Researchers will monitor regeneration quality and relate it to short- and long-term clinical outcomes including recurrence. The study collects detailed clinical data and tissue samples without altering treatment, aiming to improve understanding of liver regrowth and inform future therapies. Participation duration depends on surgical timing and follow-up, with safety monitored through standard care.

Traumatic brain injury is a significant cause of illness and death worldwide, often leading to systemic inflammation and secondary organ problems in critically ill patients. Acute respiratory distress syndrome ARDS is a serious complication affecting 19-30% of severe traumatic brain injury patients, usually developing within the first week after injury. This study evaluates the fibrinogen-to-albumin ratio as a potential early predictor of ARDS in adults with traumatic brain injury. The study involves measuring fibrinogen and albumin levels from routine blood samples taken within 24 hours of ICU admission. The fibrinogen-to-albumin ratio FAR is calculated by dividing fibrinogen by albumin levels. Patients are categorized into groups based on whether they develop ARDS within 7 days according to Berlin criteria. The study does not involve administering treatments but focuses on diagnostic blood tests. Participants will be followed during their ICU stay, with researchers assessing the accuracy of early fibrinogen-to-albumin ratio measurements to predict ARDS development within 7 days. Secondary outcomes include ARDS incidence and severity, duration of mechanical ventilation, ICU stay length, mortality, and neurological outcomes up to 90 days after injury. Consent is obtained from authorized representatives, and follow-up is expected while participants remain hospitalized.

Researchers are studying the effects of different dialysis parameters on the functional properties of albumin in patients undergoing hemodialysis for end-stage chronic kidney disease. This condition requires hemodialysis to survive but is associated with increased cardiovascular risks due to chronic inflammation and incomplete removal of toxins. The study aims to explore how dialyzer types and dialysis modes can therapeutically improve albumin function and overall treatment quality. Participants will receive treatments involving hemodialysis, hemodiafiltration, high-flux dialyzers, and low-flux dialyzers, each for a period of three months. This proof-of-concept interventional study will assess how these different dialysis approaches affect albumins ability to bind and detoxify harmful substances. The study focuses on comparing the effects of dialysis mode and dialyzer characteristics over a total duration of nine months. Throughout the study, researchers will measure the level of irreversibly oxidized albumin HNA-2 and evaluate albumins binding and detoxification efficiency at the end of nine months. Participants will be monitored regularly during treatment to assess these outcomes. The study is sponsored by Universitt Duisburg-Essen and aims to provide insights into improving long-term hemodialysis treatment quality by modifying albumin functions.

Researchers are collecting data from patients undergoing liver surgery for benign liver tumors, primary liver cancer, or secondary liver cancer at Institut Paoli-Calmettes. This observational study aims to create a database to describe the epidemiology of these patients over a period of 5 years. The research helps improve understanding of liver surgery outcomes in different patient groups. The study involves collecting detailed information before, during, and after liver surgery. This includes pre-operative, surgical, and post-surgical data from patients treated at Institut Paoli-Calmettes. There are no experimental treatments, as the study focuses on gathering and analyzing medical data related to liver surgeries. Participants will have their medical and surgical information recorded and monitored as part of routine care. Researchers will analyze this data to describe patterns and outcomes associated with liver surgeries. The study is planned to continue until November 2030, allowing for long-term data collection and follow-up. Participation does not involve additional procedures beyond standard surgical care.

Postoperative delirium POD is a common complication in elderly patients after surgery, especially following hip fracture, vascular, or cardiac procedures. It is linked to longer hospital stays, cognitive decline, functional loss, and increased mortality within 6 to 12 months. This research evaluates whether a new measurement called the CRP-Albumin-Lymphocyte CALLY Index can predict the risk of POD in older adults undergoing hip fracture surgery. The study includes patients aged 65 and older having surgery for femoral neck or intertrochanteric fractures. Researchers will collect demographic information, medical history, and preoperative lab values to calculate the CALLY Index. Delirium presence will be assessed twice daily for three days after surgery using the DSM-5 criteria. Data on anesthesia, surgery details, postoperative complications, and hospital stay will also be recorded. Participants will be monitored for delirium starting in the post-anesthesia recovery unit and continuing during their hospital stay. Assessments include twice-daily delirium checks for three days and recording of outcomes such as intensive care unit stay length, overall hospital stay, and mortality. The main outcome measured is postoperative delirium as diagnosed by DSM-5 criteria. The study is observational and will last until the end of 2025.

Researchers are studying how the body produces carbon monoxide CO after part of the liver has been surgically removed. The study focuses on measuring CO levels in breath as a way to understand how well the liver regenerates and to predict possible liver-related complications after surgery. This research aims to better monitor liver healing and assess liver function following surgery. All participants will provide breath samples to measure carbon monoxide levels before surgery, then again 4 hours and 24 hours after liver resection. The study will track these CO levels alongside the amount and quality of liver regeneration over time. Liver volume and function will be assessed at one and three months after the surgery to correlate with the CO measurements. Participants will be monitored through breath tests and follow-up visits to measure liver regeneration and function. Researchers will collect data on CO levels in exhaled air and compare them to liver volume and function results. The main outcome is to find a link between CO levels and liver healing, which may help predict liver-related health issues after surgery. The study is expected to continue until 2039.

Researchers are studying the effects of enhanced perioperative pulmonary physiotherapy on reducing postoperative pulmonary complications PPCs after laparoscopic liver surgery. PPCs include respiratory infections, atelectasis, pleural effusion, bronchospasm, aspiration pneumonitis, pneumothorax, exacerbations of chronic lung conditions, and respiratory failure, which can cause significant health issues and costs. This multicenter, randomized controlled trial aims to evaluate whether a short, easy-to-integrate physiotherapy program can lower PPC rates compared to standard perioperative care. The study compares two groups one receiving enhanced pulmonary physiotherapy involving a preoperative session, an educational video, and daily exercises including deep breathing, coughing, pursed lip breathing, and positive expiratory pressure PEP therapy performed twice daily for 14 days 7 days before and 7 days after surgery. The control group receives standard perioperative breathing education based on Enhanced Recovery After Surgery ERAS protocols. Surgeons and researchers are blinded to group allocation to reduce bias. Participants will be assessed before surgery, at discharge, and 30 days postoperatively. Data collected include patient characteristics, surgical details, and postoperative outcomes such as PPC incidence within 14 days, length of hospital and ICU stays, antibiotic use, complications, mortality up to 90 days, and hospital costs. Compliance with the physiotherapy program will be monitored. The total participation duration covers preoperative preparation through 90 days of postoperative follow-up.

This trial focuses on patients hospitalized with acute decompensation of chronic heart failure CHF, who often experience worsening renal function WRF leading to resistance to diuretics and poor outcomes. Researchers are investigating if CHF patients with liver dysfunction, who produce less albumin, are more prone to WRF. The study evaluates whether adding intravenous human albumin to standard IV loop diuretics improves diuretic effectiveness and protects kidney function in these patients. Participants are randomly assigned to receive either a continuous slow intravenous infusion of human albumin combined with IV furosemide or IV furosemide alone. The human albumin infusion is adjusted based on urine output and starts within 30 minutes after randomization and within 2 hours of hospital admission. Both groups receive diuretics adjusted by body weight and urine output. The study treatment lasts for at least 72 hours. During the study, researchers will assess symptoms and changes in serum creatinine levels from baseline to 72 hours. Additional measures include patient-reported breathlessness, body weight changes, fluid loss, length of hospital stay, and a composite outcome of death, rehospitalization, treatment escalation, or emergency visits up to 180 days after discharge. Participants are closely monitored with laboratory and imaging tests to evaluate liver function and kidney status throughout the study period, which is expected to continue until December 2026.