Cases Of Cirrhosis Research Articles

HBV elimination in sub-Saharan Africa: Rwanda's approach to health system integration

Liver cirrhosis and liver cancer are major causes of morbidity and mortality in the sub-Saharan African region. This region has the highest age-standardised death rate due to cirrhosis, and more than half of all cases of cirrhosis are attributable to hepatitis B virus (HBV) or hepatitis C virus (HCV) across all sub-regions. The attributable fraction due to HBV is particularly concerning, given the higher oncogenic potential of HBV genotypes that predominate in the region, as well as the higher risk of hepatocellular carcinoma associated with vertical HBV transmission.

Acquired Thrombophilic Hypercoagulable States Seen in Patients with Liver Cirrhosis: A Single Center Study

Among the common hemostatic issues of the patients of liver cirrhosis, deep venous thrombosis, pulmonary embolism, and intrahepatic thrombus development are more often ignored. With an estimated frequency ranging from 0.6 to 26 percent, portal venous thrombosis is another potentially dangerous consequence of liver cirrhosis. Objectives: To determine the frequency of various acquired thrombophilic / hypercoagulable states seen in patients with liver cirrhosis. Study design: Descriptive, cross sectional. Settings: Department of Medicine, Allied Hospital, Faisalabad Study duration: 30th June 2019 to 29th December 2019 Materials & Methods: Cirrhosis cases ranging in age from 25 to 75 years old and of both genders were included in the study. Patients with HCC, heritable thrombophilias such as the Factor V leiden mutation, congenital budd chiari, and cholestatic liver disorders such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis were also eliminated. To assess for hepatic decompensation, ultrasonography, LFTs, and other baseline procedures were performed. Doppler USG was performed in each case with the assistance of the Radiology Department of Allied Hospital Faisalabad to assess for DVT, Budd-Chiari syndrome, and Portal venous thrombosis. Results: Mean age of the patients enrolled was 52.08 ± 10.47 years. Among these 840 patients, 461 (54.88%) were male and 379 (45.12%) were females (ratio 1.2 : 1). Mean AST levels were 77.49 ± 8.93 units/liter. Mean ALT levels were 88.51 ± 9.17 units/liter. Mean total bilirubin levels were 8.33 ± 1.65 mg/dl. Frequency of various acquired thrombophilic / hypercoagulable states seen in patients with liver cirrhosis were as follows; portal vein thrombosis in 136 (16.19%) patients, budd chiari syndrome in 102 (12.14%), deep vein thrombosis in 96 (11.43%) and pulmonary embolism in 108 (12.86%) patients. Conclusion: This study concluded that frequency of various acquired thrombophilic / hypercoagulable states seen in patients with liver cirrhosis is quite high. Keywords: liver cirrhosis, hypercoagulable states, portal vein thrombosis.

Correlation of Ultrasonographically Measured Splenic Size with Endoscopic Grading of Esophageal Varices in Cirrhosis of Liver

Background: Cirrhosis is the end stage of chronic liver disease, resulting in formation of fibrous tissue, derangement of liver architecture and ultimately results in portal hypertension and its complication. Objective: To find out the correlation between splenic size and endoscopic grading of esophageal varices in diagnosed cases of cirrhosis of liver. Methods: This prospective observational cross-sectional study was carried out in the Department of Radiology and Imaging in collaboration with GHPD, BIRDEM, Dhaka. 110 liver cirrhosis patients with or without esophageal varices diagnosed by endoscopy of UGIT referred to the department of Radiology and Imaging were included in this study on the basis of selection criteria. Result: The following observations and results were obtained in this study the mean age was 44.81 (±14.42) years, minimum age was 18 years and maximum age was 65 years. Majority 69% were male and 31% were female. Esophageal variceal grading of the study population majority 47(42.73%) were grade I, 24(21.82%) were grade II, 16(14.55%) were grade III, 12(10.91%) were grade IV and 11(10%) were no varices. Splenic size by ultrasonography, majority 66(60%) were 12-14.9 cm, 37(33.64%) were ≥15 cm and 07(6.36%) were < 12 cm. In splenic size ≤ 15 cm, grading of esophageal varices, 15.07% had no varices, 60.27% had grade I, 20.55% had grade II, 2.74% had grade III and 1.37% had grade IV. In splenic size ≥ 15 cm grading of esophageal varices, 8.11% had grade I, 24.32% had grade II, 37.84% had grade III and 29.73% had grade IV. That means there is a positive correlation between ultrasonographically measured splenic size and endoscopic grading of esophageal varices in liver cirrhosis patients. Conclusion: Positive correlation was found between ultrasonographically measured splenic size with endoscopic grading of esophageal varices. Bangladesh Crit Care J March 2022; 10 (1): 57-61

GWO BASED OPTIMISTIC FEATURE SELECTION FOR PREDICTION OF ADVANCED LIVER FIBROSIS

The present populace of India is 1,362,255,678 as of January, 2019, in view of the most recent United Nations estimates [1]. Worldwide examinations calculate that there are 8.7 million individuals living with chronic Hepatitis in India. Chronic Hepatitis disease represents 12-32 per cent of liver malignant growth and 10-20 per cent of cirrhosis cases in India. The vast majority with constant Hepatitis B or C are ignorant of diseases and are at genuine danger of creating cirrhosis or liver malignant growth.Machine learning fits a few procedures superior to other traditional methods like Biopsy. This paper evaluate various machine learning methods to predict advanced liver fibrosis by using patient’s blood report to build up the optimization and classification models. The METAVIR score is a device used to assess the seriousness of fibrosis seen on a liver biopsy test from a human who has chronic hepatitis. Based on the METAVIR score [2,3,4] chronic hepatitis divided into three parts, first one is classified as mild stage, second one is moderate stage and third one is advanced stage of fibrosis. Grey Wolf Optimization, Random Forest Classifier and Decision tree procedure models forpropelled fibrosis chance expectation were produced. ROC curve and confusion matrix was evaluated to compare the accuracy of proposed methods.

Cost-Effectiveness of Hepatitis B Testing and Vaccination of Adults Seeking Care for Sexually Transmitted Infections.

The estimated number of people living with hepatitis B virus (HBV) infection acquired through sexual transmission was 103,000 in 2018, with an estimated incidence of 8300 new cases per year. Although hepatitis B (HepB) vaccination is recommended by the Advisory Committee for Immunization Practices for persons seeking evaluation and treatment for sexually transmitted infections (STIs), prevaccination testing is not yet recommended. Screening may link persons with chronic hepatitis B to care and reduce unnecessary vaccination. We used a Markov model to calculate the health impact and cost-effectiveness of 1-time HBV testing combined with the first dose of the HepB vaccine for adults seeking care for STI. We ran a lifetime, societal perspective analysis for a hypothetical population of 100,000 aged 18 to 69 years. The disease progression estimates were taken from recent cohort studies and meta-analyses. In the United States, an intervention that costs less than $100,000 per quality-adjusted life-year (QALY) is generally considered cost-effective. The strategies that were compared were as follows: (1) vaccination without HBV screening, (2) vaccination and hepatitis B surface antigen (HBsAg) screening, (3) vaccination and screening with HBsAg and anti-HBs, and (4) vaccination and screening with HBsAg, anti-HBs, and anti-HBc. Data were obtained from Centers for Medicare & Medicaid services reimbursement, the Centers for Disease Control and Prevention vaccine price list, and additional cost-effectiveness literature. Compared with current recommendations, the addition of 1-time HBV testing is cost-saving and would prevent an additional 138 cases of cirrhosis, 47 cases of decompensated cirrhosis, 90 cases of hepatocellular carcinoma, 33 liver transplants, and 163 HBV-related deaths, and gain 2185 QALYs, per 100,000 adults screened. Screening with the 3-test panel would save $41.6 to $42.7 million per 100,000 adults tested compared with $41.5 to $42.5 million for the 2-test panel and $40.2 to $40.3 million for HBsAg alone. One-time HBV prevaccination testing in addition to HepB vaccination for unvaccinated adults seeking care for STI would save lives and prevent new infections and unnecessary vaccination, and is cost-saving.

Chronic liver diseases must be reduced worldwide: it is time to act

There were an estimated 1·5 billion cases of chronic liver disease worldwide in 2017,1 including 10·6 million cases of decompensated cirrhosis and 112 million cases of compensated cirrhosis.2 Cirrhosis accounted for an estimated 1·32 million deaths in the same year.2 This burden, which is probably underestimated,2 is highly concerning.

Type 2 Diabetes, PNPLA3 rs738409 Polymorphism, and the Risk of Liver Cirrhosis: Analysis of Taiwan Biobank.

Type 2 diabetes (T2D) and liver cirrhosis remain significant public health threats in Taiwan. These conditions are reported to be associated with the rs738409 polymorphism of the patatin-like phospholipase domain-containing protein three gene (PNPLA3) in European populations. We assessed the effect of T2D and PNPLA3 rs738409 polymorphism on liver cirrhosis among Taiwan Biobank (TWB) participants. In total, 17,985 participants in TWB had their health records linked to the National Health Insurance Research Database (NHIRD). Participants included those who visited the assessment centers between 2008 and 2015, with an age range between 30 and 70 years of age. We performed logistic regression analysis to investigate the odds ratios (OR) for liver cirrhosis among participants based on the T2D status and rs738409 genotypes. Genotyping was performed using the Axiom Genome-Wide TWB Array Plate. In our analysis, 150 of the 17,619 eligible participants were identified as cirrhosis cases. Based on the univariate analysis, liver cirrhosis was positively associated with T2D (OR, 1.83; 95% CI 1.23–2.70) whereas, the variant rs738409 was not (regardless of the genetic model). The variant and T2D, however, showed significant interactions in the additive, genotype, and dominant models (p values of 0.0302, 0.0395, and 0.0455, respectively). We observed a statistically significant association between T2D and liver cirrhosis and variant rs738409 with an OR of 1.71 (95% CI, 1.03–2.84) for individuals carrying a G allele compared to those with a C allele and 2.92 (95% CI 1.07–7.99) for GG compared to CC individuals. According to our study, Taiwanese adults with T2D and the rs738409 GG genotype are more likely to develop liver cirrhosis.

Universal Hepatitis B Antibody Screening and Vaccination in Pregnancy: A Cost-Effectiveness Analysis.

To evaluate the cost effectiveness of universal screening for hepatitis B immunity and vaccination among pregnant women in the United States. We designed a decision-analytic model to evaluate the outcomes, costs, and cost effectiveness associated with universal hepatitis B virus (HBV) immunity screening in pregnancy with vaccination of susceptible individuals compared with no screening. A theoretical cohort of 3.6 million women, the approximate number of annual live births in the United States, was used. Outcomes included cases of HBV, hepatocellular carcinoma, decompensated cirrhosis, liver transplant and death, in addition to cost and quality-adjusted life-years (QALYs). Model inputs were derived from the literature, and the willingness-to-pay threshold was $50,000 per QALY. Univariate sensitivity analyses and Monte Carlo simulation models were performed to evaluate the robustness of the results. In a theoretical cohort of 3.6 million women, universal HBV immunity screening and vaccination resulted in 1,702 fewer cases of HBV, seven fewer cases of decompensated cirrhosis, four fewer liver transplants, and 11 fewer deaths over the life expectancy of a woman after pregnancy. Universal screening and vaccination were found to be cost effective, with an incremental cost-effectiveness ratio of $1,890 per QALY. Sensitivity analyses demonstrated the model was robust even when the prevalence of HBV immunity was high and the annual risk of HBV acquisition low. Among pregnant women in the United States, universal HBV immunity screening and vaccination of susceptible persons is cost effective compared with not routinely screening and vaccinating.

Expression and Clinical Values of Serum miR-155 and miR-224 in Chinese Patients with HCV Infection.

BackgroundTo investigate the expression of serum miR-155 and miR-224 among patients with hepatitis C virus (HCV) infection and analyze their clinical values.MethodsA total of 116 patients suffering from HCV infection admitted to our hospital and 70 healthy subjects were selected. According to the diagnostic results, patients with HCV infection were divided into 48 cases of chronic hepatitis C (CHC), 43 cases of liver cirrhosis and 25 cases of hepatocellular carcinoma (HCC). The expression signature for miR-155 and miR-224 was detected in serum samples. ROC curve and Pearson correlation test were conducted to investigate their diagnostic value and correlation.ResultsThe expression extent for serum miR-155 and miR-224 increased along with the increase of malignancy (all P < 0.05). According to ROC curve, the area under the curve (0.918, 95% CI: 0.856–0.974) of miR-155 and miR-224 combined in the diagnosis of HCC was the largest, and its sensitivity and specificity were 93.0% and 86.2%. There is a positive relationship for expression level between miR-155 and miR-224 in CHC and HCC group (all P < 0.001).ConclusionmiR-155 and miR-224 are remarkably increased in patients suffering from HCV infection. The combination of miR-155 and miR-224 has a good diagnostic value for HCC caused by HCV infection.

Direct acting antiviral治療後に原発不明癌を発症し急激な転機を辿ったC型肝硬変の1例

Direct acting antiviral治療後に原発不明癌を発症し急激な転機を辿ったC型肝硬変の1例

Epidemiology and disease burden of non-alcoholic steatohepatitis in greater China: a systematic review.

Non-alcoholic steatohepatitis (NASH) is a progression of non-alcoholic fatty liver disease. The increasing burden of NASH has become a major concern of public health in greater China. This study aimed to characterize the epidemiology, disease burden, and treatment of NASH in greater China to better inform national disease management and delivery of health services. We conducted a systematic review searching four English databases (Web of Science, PubMed, Medline, and Cochrane Central) and three Chinese databases (CNKI, Wanfang, and VIP). We identified articles published from database inception to October 10, 2020 which reported NASH epidemiology, disease burden, and/or intervention in Chinese adults. Of 44,115 articles retrieved, 33 were eligible for inclusion. Overall prevalence of NASH ranged from 2.4 to 6.1% in greater China, with a more substantial burden among males, the aged, and those in Hong Kong and Taiwan. Most NASH patients suffered from several comorbidities, including obesity, diabetes, and cardiovascular conditions. PNPLA3 rs738409 G allele and haptoglobin 2-2 genotype drove the fibrosis progression in NASH. Increasingly prevalent cases of cirrhosis and hepatocellular carcinoma caused a higher NASH-related mortality. Compared with normal population, NASH patients experienced markedly poorer quality of life and heavier costs. This is the first comprehensive overview of NASH among Chinese population that revealed an overwhelming impact of social and healthcare burden associated with the condition. Further high-quality studies are needed to improve the understanding and management of NASH in greater China.

Effect of increased alcohol consumption during COVID-19 pandemic on alcohol-associated liver disease: A modeling study.

Background and AimsAlcohol consumption increased during the COVID‐19 pandemic in 2020 in the United States. We projected the effect of increased alcohol consumption on alcohol‐associated liver disease (ALD) and mortality.Approach and ResultsWe extended a previously validated microsimulation model that estimated the short‐ and long‐term effect of increased drinking during the COVID‐19 pandemic in individuals in the United States born between 1920 and 2012. We modeled short‐ and long‐term outcomes of current drinking patterns during COVID‐19 (status quo) using survey data of changes in alcohol consumption in a nationally representative sample between February and November 2020. We compared these outcomes with a counterfactual scenario wherein no COVID‐19 occurs and drinking patterns do not change.One‐year increase in alcohol consumption during the COVID‐19 pandemic is estimated to result in 8000 (95% uncertainty interval [UI], 7500–8600) additional ALD‐related deaths, 18,700 (95% UI, 17,600–19,900) cases of decompensated cirrhosis, and 1000 (95% UI, 1000–1100) cases of HCC, and 8.9 million disability‐adjusted life years between 2020 and 2040. Between 2020 and 2023, alcohol consumption changes due to COVID‐19 will lead to 100 (100–200) additional deaths and 2800 (2700–2900) additional decompensated cirrhosis cases. A sustained increase in alcohol consumption for more than 1 year could result in additional morbidity and mortality.ConclusionsA short‐term increase in alcohol consumption during the COVID‐19 pandemic can substantially increase long‐term ALD‐related morbidity and mortality. Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high‐risk alcohol drinking in the United States.

Assessment of Plasma Vitronectin as Diagnostic and Prognostic Marker of Hepatocellular Carcinoma in Patients with Hepatitis C Virus Cirrhosis

Background: hepatitis C is an inflammatory liver disease caused by the hepatitis C infection (HCV), and without treatment, almost 50% will progress to liver cirrhosis. Hepatocellular carcinoma (HCC) is the most frequent type of primary liver cancer and the fourth leading cause of cancer-related mortality. Aim of the study: the objective of this study was to evaluate the serum level of vitronectin (VTN) compared to AFP and determine their role as diagnostic and prognostic markers of HCV-related liver diseases. Subject and Methods: this study involved 52 HCV patients from which 26 patients were cirrhotic, and 26 patients had HCC (on top of hepatitis C virus-related cirrhosis) plus 10 healthy people as a control group. It was carried out in Gastroenterology and Hepatology Unit, Internal Medicine Department, Zagazig University Hospitals, Egypt. All individuals in this study were subjected to physical examination, full history taking, liver function tests, assessment of serum levels of Vitronectin (VTN) and alpha-fetoprotein (AFP) before and after the intervention within three months. Results: serum level of vitronectin increased significantly in cirrhosis patients and HCC patients than controls (p = 0.0041), (p &lt; 0.001), respectively, and in HCC than cirrhosis patients (p &lt; 0.001). Significant positive correlations were observed between levels of serum VTN and AFP in all HCV patients as well as cirrhotic patients (p &lt; 0.001, p = 0.011, respectively). On the contrary, VTN and AFP didn’t show a significant correlation in HCC patients’ group. Moreover, the median serum level of VTN decreased significantly after treatment in patients with HCC (p &lt; 0.001). At cut-off 38.5 ng/mL for AFP it shows sensitivity 80.8%, specificity 76.9% to differentiate HCC from cirrhosis cases. While VTN shows 84.6% sensitivity, 96.2% specificity at cut-off 26.5 μg/mL. Regarding clinicopathological characteristics and VTN levels, half of patients were stage B, 63.9% had tumor size &gt;3 cm, 84.6% had more than one focal lesion. Conclusions: these results may allow one to speculate a potential role of Vitronectin in diagnosis and prognosis of HCC on top of cirrhosis related to HCV infection in addition to AFP and US and CT.

The Value of Serum MidKine as a Marker of Hepatocellular Carcinoma on Top of Hepatitis C Virus Related Cirrhosis

Background: Hepatocellular carcinoma (HCC) is characterized by the deficiency of specific symptoms in the early stages of the disease and a poor prognosis. Biomarkers that have the diagnostic ability to distinguish between inflammation, cirrhosis, and HCC are needed for early case detection. MidKine (MK) is overexpressed in many malignancies, including hepatocellular carcinoma, gastric carcinoma, colon carcinoma, lung carcinoma, urinary bladder carcinoma and prostate carcinoma. Objective: The objective is to evaluate serum MidKine as a marker of HCC in HCV-related liver cirrhosis. Patients and Methods: This study included 50 patients with HCC (on top of hepatitis C virus-related cirrhosis), 20 cirrhotic patients due to chronic HCV infection, and 10 normal subjects as a control group. History, examination, and laboratory investigations were performed on all subjects in the three groups including MK and Alpha fetoprotein (AFP) serum levels. Results: Serum levels of AFP and MK were higher in the HCC group than in the other study groups (P < 0.001). AFP was positive in 35 (70%) and negative in 15 (30%) whereas MK was positive in all HCC cases. There was a statistically significant correlation between MK serum levels and AFP serum levels, tumor size, and tumor stage. Conclusion: MidKine is a novel sensitive biomarker that could be used for early detection of HCC and has a high significance in differentiation between cirrhosis and HCC cases. MidKine levels are correlated with HCC stages and sizes.

Study of common precipitating factors and clinical outcome of hepatic encephalopathy in known case of cirrhosis of liver

Background and Aim: Earlier studies for evaluation of cause and outcome of hepatic encephalopathy (HE) in cirrhosis of the liver have shown varying results. Patients with HE can have varying outcomes. We undertook this study to assess the clinical spectrum of HE, precipitating factors in addition to the outcome.

LIVER CIRRHOSIS WITH CRYPTOGENIC GENESES. CLINICAL CASE

The article presents clinical observation of a patient with cryptogenic cirrhosis of the liver, a chronic diffuse progressive liver disease, which is manifested by structural rearrange¬ment of its parenchyma. Cryptogenic cirrhosis is cirrhosis of uncertain etiology that lacks definitive clinical and histological criteria for a specific disease. Cryptogenic cirrhosis accounts for nearly 5% to 30% of cases of cirrhosis and nearly 10% of liver transplants. The problem of cirrhosis of the liver is extremely relevant, because this pathology is observed mainly in young and able-bodied people. In addition, it takes the first place among the causes of mortality from diseases of the digestive system. To clarify the diagnosis, laboratory and instrumental diagnostic methods of investigation were performed. Due to severe thrombocytopenia and minor leukopenia, myelodysplastic syndrome was suspected. Metabolic disorders that can be considered as probable in the occurrence of the above-mentioned changes in the liver parenchyma had been ruled out.

Inical Characteristics, Evaluation, Treatment, and Prognosis of Cryptogenic Cirrhosis

The term cryptogenic cirrhosis (CC) implies that the underlying etiology is uncertain and devoid of definitive clinical, serological, and histological criteria for a specific type of cirrhosis. CC denotes a spectrum of underlying causes, among whom, the majority of evidence implicates non-alcoholic steatohepatitis (NASH) led progression as the most frequent route. CC is held accountable for around 5% of cirrhosis cases today. Cirrhosis complications like liver failure and hepatocellular carcinoma appear as the first presenting feature of the disease, as in other hepatic diseases. The hepatocarcinogenic risk of CC is substantial, with hepatocellular carcinoma’s reported annual cumulative incidence ranging between 2.6% to 3.5%. The diagnosis of CC relies on the exclusion of distinctly recognizable diseases and involves a careful clinical assessment including risk history and family history, followed by laboratory testing including serology, autoantibodies, immunoglobulin concentrations, biomarkers for Wilson’s disease and Celiac disease, and lastly histological assessment for the prominent type and inflammation distribution, and typical presenting features of cirrhotic tissues. The definitive treatment of CC involves transplantation. In cases suspected to be linked with NASH, medical management until transplantation can be beneficial to the patient. The management of CC involves collaboration of primary care with gastroenterology, hepatology, and transplant consultation, and nutritional counseling. Data regarding survival post-transplantation is limited and has shown conflicting results.

Spleen stiffness measurement based on shear-wave elastography for noninvasive assessment of esophageal varices in liver cirrhosis cases

Background and aim Several laboratory tests and procedures have been considered as noninvasive prediction of esophageal varices (OV). This study assessed the usefulness of shear-wave elastography in splenic stiffness measurement (SSM) as a noninvasive assessment for OV prediction. Patients and methods This study was performed on 100 cases in Sohag Cardiology and Gastroenterology 1Center who were categorized into three groups: group A: (n=40) included liver cirrhosis of any cause proved clinically, laboratory, and by ultrasound; group B: (n=30) included chronic hepatitis of any cause; and group C: (n=30) included nonhepatic cases attending the hospital with gastrointestinal tract complaints. All cases have been subjected to full history taking and clinical examination before classification, complete blood count, alanine aminotransferase, aspartate transaminase, serum albumin, coagulation profile and serum bilirubin, hepatitis C virus antibody (HCV Ab) and hepatitis B surface antigen (HB Ag), abdominal ultrasonography, SSM by shear-wave elastography, and upper endoscopy for diagnosing of OV. Results As regards to abdominal ultrasound and upper endoscopy, significant differences were noted between three groups regarding spleen, spleen diameter, SSM, ascites, and OV (as 27.5 and 65% cases in group I had ascites and OV versus no cases in groups II and III as P&lt;0.001). As regards to spleen diameter and SSM, significant increase was noted in group A than B and C, but insignificant differences were noted among groups B and C. As regards to OV grades in group A, there were five cases with grade I, nine cases with grade II, five cases with grade III, and seven cases with grade IV. Considerable positive correlations were noted among OV grades and acoustic radiation force impulse elastography (r=0.904, P &lt;0.001). Conclusion SSM by shear-wave elastography is a useful noninvasive parameter for detection of OV presence and grading in cases of liver cirrhosis.

Frequency of Vitamin D Deficiency in Patients with Liver Cirrhosis

Objective: To determine the frequency of vitamin D deficiency among liver cirrhosis patients and presented at Isra university hospital Hyderabad Study design: Cross-sectional Study setting: Gastroenterology department of Isra university Hospital, Hyderabad Sind Pakistan Study duration: January 2018 to July 2018 All patients with age between 30 and 60 years, both genders and having evidence of cirrhosis of liver were selected in the study. Disease severity was evaluated by the Child–Pugh’s classification. For the assessment of vitamin D levels, the blood samples from all patients were sent to the diagnostic laboratory. During the hospital stay and subsequent follow-up visits, the patients were monitored. All the data were collected via study proforma for the purpose of analysis. Results: A total of 120 cases of liver cirrhosis were studied, their average age was 50.58+5.15 years. Males were commonest 55.0% compared to females 45.0%. Hepatitis C was the most common etiological factor 65.8%. Child–Pugh grade C was most common 57.5%. Mean of the vitamin D level was 19.16+ 6.74 ng/ml. Almost all patients were with vitamin D deficiency as 90.0%. Vitamin D deficiency was significantly associated to the old age, HCV, alcoholic and fatty liver disease (p-&lt;0.05), while statistically insignificant according to gender (p-0.142). Conclusion: It was concluded that the deficiency of vitamin D was highly prevalent 90.0%. It was significantly linked to the HCV, age and alcoholic hepatic disease. Key words: Liver cirrhosis, vitamin D

Clinical and economic impact of an alert system in primary care for the detection of patients with chronic hepatitis C

IntroductionPrevalence of chronic hepatitis C (CHC) is higher in patients born between 1955–1975. The aim was to perform an economic evaluation of an age-based electronic health record (EHR) alert in primary care to detect patients with undiagnosed CHC and its treatment in comparison with non-use of the alert system, in Valencian Community, Spain.Materials and methodsDecision trees and Markov model were used to evaluate the diagnosis and progression of the disease, respectively. CHC was diagnosed by serology and viral load in seropositive subjects. Epidemiological data and diagnostic costs were extracted from public sources of the Valencian Community. Probabilities, utilities and costs of model states were obtained from the literature. The impact on mortality and hepatic complications avoided by the implementation of the alert were estimated, and efficiency was measured as an incremental cost-utility ratio (ICUR) based on quality-adjusted life years (QALYs) and the costs of both alternatives.ResultsThe EHR alert detected 269,548 patients, of whom 1,331 had CHC (vs. 23 patients with non-alert). Over the patients’ lifetime, the alert would prevent 93% of decompensated cirrhosis cases, 87% of hepatocellular carcinomas, 90% of liver transplants, and 89% of liver related deaths compared to non-use of the alert system. In addition, it would obtain an additional 3.3 QALY per patient, with an incremental cost of €10,880 and an ICUR of €3,321.ConclusionsThe implementation of an age-based EHR alert in primary care to detect patients with CHC reduces hepatic complications and mortality and is an efficient strategy.