Differences in Inflammatory Parameters of Child-Pugh B and Child-Pugh C Scores of Liver Cirrhosis with Hepatorenal Syndrome

Background: Child-Pugh score is used to predict the poor prognosis of liver cirrhosis patients. The study objectives analyzed differences in inflammatory parameters of Child-Pugh B and Child-Pugh C of liver cirrhosis with hepatorenal syndrome. Method: Desain's study is cross-sectional in liver cirrhosis patients with hepatorenal syndrome. This research was approved by the Health Research Ethics Commission FK USU / RSUP H. Adam Malik Medan and meets the criteria of inclusion or exclusion. Diagnosis of Liver cirrhosis Child-Pugh B and Child-Pugh C score is done by clinical examination, laboratory, and ultrasound, CT scan, MRI. The hepatorenal syndrome was diagnosed using Criteria International Ascites Club, 2007. Results: The sample number of this study was 26 liver cirrhosis with hepatorenal syndrome patients consisting of Child-Pugh B patients 9 patients and Child-Pugh C patients 17 patients. The comparison between Child-Pugh B and Child-Pugh C has significant differences in leukocyte, Na, Cl, SGOT, and CTP. There is a significant correlation between CTP and leukocytes, platelets, Cl, creatinine, GFR, albumin, total bilirubin, and glued bilirubin. Conclusion: There is no clear difference in the inflammatory parameters of the Child-Pug B and Child-Pug C scores in liver cirrhosis with hepatorenal syndrome.

Antithrombotic Drugs in Cirrhosis

In patients with liver cirrhosis treated for portal vein thrombosis, there was no increase in the risk of bleeding, but there was a decrease in the incidence of liver decompensation and an increase in the survival of treated patients when compared to the untreated ones(1). Current guidelines(2) do not provide specific recommendations for the prophylaxis or treatment of thromboembolic diseases in patients with liver cirrhosis(3). In order to determine the influence of anti-thrombotic treatment on the prognosis of liver cirrhosis, 85 patients with liver cirrhosis were followed clinically, by laboratory and ultrasound parameters, for 6 months. Microsoft Excel and IBM SPSS Statistics 20 were used to analyse the data of patients, divided into two groups according to the presence or absence of anti-thrombotic treatment initiated for cardiovascular pathology. The obtained results showed that the mortality rate between the two groups was similar: 11.54% untreated, 12.12% treated, the decompensation rate of untreated patients was higher than that of the treated ones (36.54% vs. 24.24%) with antithrombotic drugs and that no patient among those treated with antithrombotic drugs showed upper digestive haemorrhage (p =0.038). The conclusions drawn from this study were that patients with liver cirrhosis in antithrombotic treatment have a better prognosis than untreated ones, in the absence of major bleeding complications, but for a change in guidelines and current practice, studies are needed on a larger number of patients in order to validate these observations.

Haemorrhagic versus non haemorrhagic ascites in cirrhosis: Their relationship and impact on prognosis of liver cirrhosis

Objectives: To evaluate the impact of haemorrhagic ascites on prognosis of patients with advance cirrhosis, this study was further aimed to assess the relationship between haemorrhagic ascites and advance cirrhosis and its effect on prognosis. Methods: Eight hundred and thirty-eight patients having liver cirrhosis with ascites were analyzed retrospectively (over three years) while segregated into two groups haemorrhagic and non haemorrhagic ascites. Patient outcome variables were identified among both groups and independent predictors for survival were analyzed. Kaplan-Meier survival estimates determined survival rate comparison between groups. Results: Haemorrhagic ascites was detected in (26.6%) patients. Spontaneous haemorrhagic ascites (79%) was the main cause of haemorrhagic ascites followed by hepatocellular carcinoma (14%) and iatrogenic (7.6%). Spontaneous bacterial peritonitis and acute kidney injury were statistically significant (p= 0.0001, 0.0001) among groups. Overall mortality at year three was higher (83%) in haemorrhagic ascites group. Survival among both groups (haemorrhagic versus non haemorrhagic) at one month, one year and three year was found to be significant (p= 0.000, 0.000 and 0.000). Conclusion: Haemorrhagic ascites impact overall survival with more mortality in comparison to non haemorrhagic ascites. Haemorrhagic ascites was an independent predictor of survival. Haemorrhagic ascites is possibly considered another predictor of survival among advance cirrhosis. doi: https://doi.org/10.12669/pjms.36.4.2075 How to cite this:Naqvi IH, Mahmood K, Talib A. Haemorrhagic versus non haemorrhagic ascites in cirrhosis: Their relationship and impact on prognosis of liver cirrhosis. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.2075 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis

Liver cirrhosis is the terminal stage of most chronic liver conditions, with a high risk of mortality. Careful evaluation of the prognosis of cirrhotic patients and providing precise management are crucial to reduce the risk of mortality. Although the liver biopsy and hepatic venous pressure gradient (HVPG) can efficiently evaluate the prognosis of cirrhotic patients, their application is limited due to the invasion procedures. Child-Pugh score and the model for end-stage liver disease (MELD) score had been widely used in the assessment of cirrhotic prognosis, but the defects of subjective variable application in Child-Pugh score and unsuitability to all phases of liver cirrhosis in MELD score limit their prognostic values. In recent years, continuous efforts have been made to investigate the prognostic value of body fluid biomarkers for cirrhotic patients, and promising results have been reported. Since the collection of fluid specimens is easy, noninvasive, and repeatable, fluid biomarkers can be ideal indicators to predict the prognosis of cirrhosis. Here, we reviewed noninvasive fluid biomarkers in different prognostic functions, including the prediction of survival and complication development.

THE RELATIONSHIP OF APRI SCORE (ASPARTATE AMINOTRANS FERASE-TO-PLATELET RATIO INDEX) AND PUGH CHILD SCORE

Liver cirrhosis is the last stage of chronic liver disease that is in the path of the disease can cause damage of liver function and/or portal hypertension. The prognosis of liver cirrhosis can be assessed by manifestations of liver function disorders with Child Pugh score that include the presence or absence of ascites, encephalopathy, bilirubin serum, albumin serum, and prothrombin time or INR, while portal hypertension also occurs in patient of cirrhosis can lead the formation of esophageal varices. APRI score has platelet count and AST serum as its variable is suspected to be related to the Child Pugh score in assessing prognosis of cirrhosis patients. This study purposed to find the relation between APRI score (Aspartate Aminotransferase-to-Platelet Ratio Index) and Child Pugh score. Purpose of this research is to find the relation between APRI score (Aspartate Aminotransferase-to-Platelet Ratio Index) and Child Pugh score and degree of esophageal varices in patients with cirrhosis. Method used is a retrospective analytic study with cross sectional approach. The data source is secondary source. The sample in this study were patients with liver cirrhosis who were diagnosed by a doctor and had complied the inclusion criteria. The data obtained was analyzed using ANOVA. The result of this study is include 48 cirrhosis patients, male 81,3%, with a mean age 49,98 years. The most common cause of cirrhosis is hepatitis B obtained from reactive HBsAg examination in 33 patients (68,8%). The APRI score was found to have a weak correlation (r = 0.044) and not significant (p = 0.868) with the Child Pugh score. The APRI score do not able to assess the prognosis in advanced cirrhotic patients.

Isotopic analysis of Cu in blood serum by multi-collector ICP-mass spectrometry: a new approach for the diagnosis and prognosis of liver cirrhosis?

The isotopic composition of blood serum Cu has been investigated as a potential parameter for the diagnosis and prognosis of liver cirrhosis.