Severe Cirrhosis Research Articles

Impact of unique hemodynamic characteristics and paradoxical ventricular function on clinical outcome of portopulmonary hypertension

Abstract Background Limited data are available on hemodynamic characteristics, outcomes, and liver transplantation candidacy for portopulmonary hypertension (PoPH). This study aimed to evaluate the hemodynamic characteristics, natural course, and outcomes following liver transplantation in PoPH patients. Methods Patients diagnosed with PoPH by right heart catheterization at two referral centers were retrospectively analyzed. PoPH was defined as Group 1 pulmonary arterial hypertension with clinical evidence of portal hypertension. Results We included 43 patients with PoPH (median age: 52 years; 19 men). Advanced liver cirrhosis was associated with higher cardiac index and tricuspid annular plane systolic excursion (TAPSE). Mean pulmonary arterial pressure (PAP) and right atrial pressure increased with increasing pulmonary vascular resistance (PVR), while the cardiac index declined but was mostly preserved within normal limits. Of the 34 patients without liver transplantation, 13 (38%) died during a median follow-up of 2.2 years. Severity of liver cirrhosis and an increased TAPSE were significant predictors of mortality (per 1 mm increase, adjusted hazard ratio 1.17, 95% confidence interval 1.01-1.35, p=0.042). Among the nine patients who underwent liver transplantation, six had a mean PAP of 35–45 mmHg and PVR >3 Wood units; of these, one died after liver transplantation, from reasons unrelated to pulmonary hypertension. Conclusion In PoPH patients, a higher cardiac index with right ventricular hypercontraction was prominent in advanced stages of liver cirrhosis. Higher TAPSE was identified as a risk factor for mortality in patients without liver transplantation. Establishing optimal PoPH candidates for liver transplantation is essential for improving patient survival.

Lactulose use among patients with alcohol-related liver cirrhosis as a surrogate marker of hepatic encephalopathy: prevalence and association with mortality - a Danish nationwide cohort study

Background & aims: Hepatic encephalopathy (HE), one of the most serious prognostic factors for mortality in alcohol-related cirrhosis (ALD cirrhosis), is not recorded in Danish healthcare registries. However, treatment of HE with lactulose, the universal first-line treatment, can be identified through data on filled prescriptions. This study aimed to investigate if lactulose can be used as a surrogate marker of HE. Methods: We used Danish healthcare registries to establish a cohort of patients with ALD cirrhosis diagnosed in 2000–2018. Lactulose users were identified using data on filled prescriptions. We computed the prevalence and cumulative incidence of lactulose use, and then matched lactulose users with cohort members who were not using lactulose. This matched dataset was used to identify predictors of lactulose initiation, and to examine the association between lactulose use and all-cause mortality. Results: We included 23,089 patients, among whom we identified 4,789 first-time lactulose users. The prevalence of lactulose usage rose to 11% within the first 6 months after ALD diagnosis and reached 19% 5 years after inclusion. The 1-year cumulative incidence of lactulose use was 31%, and predictors of initiating lactulose use were history of severe liver disease (ascites, portal hypertension, spontaneous bacterial peritonitis or gastrointestinal bleeding) or hepatocellular carcinoma. Lactulose use was associated with higher mortality (adjusted hazard ratio 1.61 [95% confidence interval 1.53; 1.69]). Conclusions: Lactulose is used by 10–20% of patients with ALD cirrhosis, primarily those with severe cirrhosis, and lactulose users have a markedly higher mortality than nonusers. We conclude that lactulose use can be used to estimate the prevalence of HE and to reduce confounding from HE, but it should not be used as a surrogate for HE in studies with HE as an outcome.

Risk of Post-Polypectomy Bleeding After Colorectal Endoscopic Mucosal Resection in Patients with Cirrhosis: A Propensity-Matched Analysis of the US Collaborative Network

Introduction: Data on the risk of post-polypectomy bleeding after endoscopic mucosal resection (EMR) in patients with cirrhosis is limited. Methods: This retrospective cohort study utilized the U.S. Collaborative Network to assess post-polypectomy bleeding risk after colorectal EMR in patients with cirrhosis compared to controls. Using one-to-one propensity score matching (PSM), the primary outcome measured was bleeding within 30 days post-EMR. The bleeding risk was further stratified by cirrhosis severity (compensated and decompensated). Results: After PSM, each cohort included 2,381 patients. Patients with cirrhosis had a higher risk of post-polypectomy bleeding (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.05-1.82, p=0.02). However, endoscopic reinterventions for hemostasis were similar between cirrhosis and control cohorts (OR 1.20, 95% CI 0.71-2.05, p=0.50). The post-polypectomy bleeding risk was significantly higher in patients with decompensated cirrhosis (OR 1.65, 95% CI 1.12-2.42, p=0.01), while those with compensated cirrhosis showed no increased risk of post-polypectomy bleeding (OR 1.15, 95% CI 0.85-1.54, p=0.37). Conclusions: The post-polypectomy bleeding risk was higher in patients with decompensated cirrhosis, while the bleeding risk was not increased in those with compensated disease. Optimizing patients with cirrhosis, especially with decompensated disease, before colorectal EMR and monitoring for post-procedure bleeding remains important. A conservative, supportive approach to managing bleeding in patients with cirrhosis may be as effective as in those without cirrhosis.

Primary prophylaxis of acute variceal bleeding in patients with severe cirrhosis: Time for combination therapy?

Primary prophylaxis of acute variceal bleeding in patients with severe cirrhosis: Time for combination therapy?

Association between Clot Waveform Analysis Parameters and the Severity of Liver Cirrhosis.

Clot waveform analysis (CWA) provides a global assessment of hemostasis and may be useful for patients with cirrhosis with complex hemostatic abnormalities. This study aimed to assess the association between prothrombin time (PT-) and activated partial thromboplastin time (aPTT-) based CWA parameters and cirrhosis severity and prospectively evaluate the role of CWA in predicting mortality and acute decompensation (AD) over 1 year. This prospective study included adult patients with cirrhosis between June 2021 and December 2023 at Chulalongkorn University Hospital. The PT- and aPTT-based CWA parameters were obtained using an automated coagulation analyzer. A total of 560 patients with cirrhosis were included; 165 (29.5%) and 47 (11.5%) had Child-Turcotte-Pugh (CTP) B and C cirrhosis, respectively. The PT- and aPTT-based CWA parameters, including maximum velocity (min1), maximum acceleration (min2), and maximum deceleration (max2), were significantly lower (p ≤ 0.05) in patients with decompensated cirrhosis than in those with compensated cirrhosis. Additionally, CWA values were significantly higher in patients with higher CTP and Model for End-Stage Liver Disease (MELD) scores. Multivariable analysis revealed that liver stiffness (LS) and max2 of PT-based CWA assay were independently associated with CTP B/C. In addition, min2 and max2 of PT-based CWA assay were independently associated with 1-year mortality. No significant differences in CWA parameters were observed between patients with and without portal vein thrombosis. CWA parameters were not related to AD during the 1-year follow-up. A hypocoagulable profile based on CWA parameters is associated with advanced-stage cirrhosis. CWA may be a useful objective marker for assessing cirrhosis severity and predicting 1-year mortality.

DECODING THE RISK PROFILE OF NON-ALCOHOLIC FATTY LIVER DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: This is a systematic review and meta-analysis that aims to evaluate the prevalence of non-alcoholic fatty liver disease (NAFLD) and the risk factors such as type 2 diabetes mellitus (T2DM), hypertension, obesity, PCOS, and sleep apnea associated with it. NAFLD is one of the most prevalent diseases that affect approximately 40% of diabetic, hypertensive, dyslipidemic obese individuals. Its asymptomatic nature often leads to under diagnosis and progress to severe liver cirrhosis and hepatocellular carcinoma. Methods: A total of 1819 studies from database from 2019 to 2024 were identified, finally 10 studies were selected, the Statistical Package for the Social Sciences software was used for data analysis. Results: The analyses across different geographic regions with 620,3969 patients with NAFLD, T2DM prevalence came out to be 15% among males, whereas 22.2% in females. A prevalence of 52.55% was noted in the obese population and 26.74% in lean individuals, with PCOS 43%, metabolic syndrome 75.3%, and sleep apnea 40% and various risk factors were also identified. Conclusion: This review throws light on the nature of NAFLD, focusing on the need for increased awareness and screening among people at risk, strategies could help avert liver disease progression.

HYPONATREMIA IN LIVER CIRRHOSIS: A RETROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL

Objective: This study’s main objective was to ascertain the frequency of hyponatremia in patients with liver cirrhosis and to assess its relationship with the severity of liver cirrhosis and the duration of liver cirrhosis. Materials and Methods: This retrospective study was carried out in Gastroenterology unit at Hayatabad Medical Complex Peshawar after approval from the hospital's ethical committee. A total of 175 patients with liver cirrhosis who fulfilled the inclusion criteria were included. Patients were categorized according to the Child-Pugh score into three classes. Serum sodium level was determined in the hospital laboratory. Patients were labeled to have hyponatremia if their blood sodium level was less than 135 mmol/L. The Statistical Package for the Social Sciences (SPSS) version 25 was used for data analysis. Results: The participants in our study were from 18 to 60 years. The mean age was 46.68 ± 10.24 years. This study has more male participants than females. 48% of the participants in this study had hyponatremia. The mean serum sodium level was 131.36 ± 6.51 mmol/L. Disease duration and Child-Pugh class are significantly associated with hyponatremia (p <0.001). Age, gender, and BMI had no significant association with hyponatremia. Conclusion: Hyponatremia is a common electrolyte abnormality in liver cirrhosis. Prolonged duration of liver cirrhosis and patients with advanced liver disease (Child-Pugh class C) are more likely to have hyponatremia.

The Impact of Hepatic Hydrothorax on the Outcome of Liver Cirrhosis: A Comparative Study.

Introduction: Hepatic hydrothorax (HH) is a severe cirrhosis complication requiring early diagnosis and appropriate management. This study aimed to assess the impact of HH on the disease severity and mortality of cirrhotic patients and compare their clinical and biological profiles with those of patients without HH. Materials and Methods: This retrospective study involved 155 patients diagnosed with cirrhosis, of whom 31 had HH. The diagnosis of HH was based on imaging techniques such as X-ray, ultrasound, and thoracic CT scans. The severity of cirrhosis was evaluated using the Child-Pugh, MELD, MELD-Na, and MELD 3.0 scoring systems. Results: Of the included patients, 83.87% (n = 26) were men, with a 20% incidence of HH. The main etiology was chronic alcohol use. The pleural fluid localization revealed similar numbers of patients with bilateral and right pleural distribution. Patients with HH were predominantly classified in Child-Pugh-Turcotte class C. The MELD, MELD-Na, and MELD 3.0 scores had higher median values in the group of patients with hepatic hydrothorax. Still, death occurred at lower MELD scores when compared with cirrhotic patients without HH (MELD score > 22.5 for patients with HH vs. MELD > 32.5 for patients without HH). (The cirrhotic patients with HH presented lower serum albumin, cholesterol, and triglyceride levels and higher bilirubin, INR, and creatinine values. The mortality rate was higher in the group with HH-58,06% versus 20.97% in the control group (cirrhotics without HH). Conclusions: Hepatic hydrothorax is a serious complication of cirrhosis that requires early recognition and proper management, supported by using biomarkers and scoring systems.

The Utility of Psoas Muscle Index for the Detection of Sarcopenia and its Association with Severity of Alcoholic Liver Cirrhosis: Western India Perspective.

Alcoholic liver cirrhosis (LC) is a severe condition that can lead to malnutrition and negatively impact a person's quality of life. Malnutrition can also increase the risk of functional impairment, mortality, and poor response to stressors like infections and surgeries. Addressing malnutrition in these patients is essential for improving their health outcomes and overall well-being. Current prognostic scoring systems do not consider malnutrition, and sarcopenia is a refractory complication associated with alcoholic LC. The study aimed to quantify sarcopenia using the psoas muscle index (PMI) determined by computed tomography-guided imaging of the abdomen and associate it with the severity of cirrhosis and correlate it with the Child-Pugh score. The study included 50 alcoholic patients with the clinical-radiological diagnosis of cirrhosis and was stratified based on the Child-Pugh score. Computed tomography (CT) scans were used to calculate the PMI at the level of the third lumbar vertebra with cutoff values of <3.64 cm2/m2 in females and <4.25 cm2/m2 in males. Male patients were recruited due to cultural differences in alcohol consumption in Western India. The prevalence of sarcopenia in the study was 50%, with the maximum number of patients falling in Child-Pugh score C (43/50 patients). The study found a strong negative correlation (r = -0.63) between high Child-Pugh class and lower PMI (p < 0.001, CI = 95%), while low PMI values were moderately associated with the occurrence of hepatic encephalopathy (r = -0.48; p < 0.001, CI: 95%). The study inferred that poor outcomes in alcoholic LC and its fatal neurological complications were attributed to loss of muscle mass (sarcopenia) and higher Child-Pugh scores. In conclusion, malnutrition is a serious complication associated with alcoholic LC, and addressing it is critical for improving patients' morbidity and prognosis. The study quantified sarcopenia using the PMI and associated it with the severity of cirrhosis (Child-Pugh score) and its complication (hepatic encephalopathy). The study found a negative correlation between high Child-Pugh class and lower PMI and inferred poor outcomes in alcoholic LC attributed to sarcopenia and higher Child-Pugh scores.

Impact of Sodium, Potassium, and Calcium on the Child-Pugh and MELD Scores in Assessing the Severity of Liver Cirrhosis: A Two-Year Cross-Sectional Study.

Background and aim Patients with chronic liver disease are prone to experiencing electrolyte imbalances as a result of physiological changes caused by cirrhosis. These imbalances have a detrimental effect on prognosis, morbidity, and mortality. This study aimed to assess the serum concentrations of sodium, calcium, and potassium in patients with liver cirrhosis and determine their correlation with disease severity and prognosis. Methods A cross-sectional study was conducted on 110 patients with liver cirrhosis at the Department of Medicine, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Higher Education and Research (DMIHER) (DU), Wardha, Maharashtra, India, between December 2020 and November 2022. All patients diagnosed with liver cirrhosis, aged 18 years or older, were categorized into three groups: Child-Pugh class A (n = 5), class B (n = 39), and class C (n = 66). Results Our investigation found a notable significant disparity in serum sodium levels across groups A, B, and C, with the Child-Pugh class A group exhibiting the highest median serum sodium levels. The serum sodium < 137 mg/dL group had the highest median model for end-stage liver disease (MELD) score, and there was a statistically significant difference in the MELD score among the three groups. The distribution of serum potassium levels and results exhibited substantial variation across the groups. Conclusion The integration of sodium, potassium, and calcium levels into predictive models is imperative for accurately forecasting in-hospital mortality among patients with cirrhosis. These electrolytes play vital roles in physiological processes, and their inclusion enhances the predictive power of models, providing clinicians with more precise risk assessments. By incorporating these key variables, healthcare professionals can better tailor interventions and optimize patient care strategies, ultimately improving the outcomes for individuals with cirrhosis.

Decompensated Cirrhosis with Hepatopulmonary Syndrome in a Patient with Interrupted Treatment for Hypopituitarism: A Case Report

A 32-year-old man presented with cirrhosis. At 8 years of age, he underwent resection of a craniopharyngioma, which resulted in panhypopituitarism. He underwent self-interrupted hormone replacement therapy at 20 years of age. Computed tomography revealed severe fatty liver and cirrhosis. An endocrinological evaluation revealed panhypopituitarism. Further assessment revealed a diagnosis of hepatopulmonary syndrome. Home oxygen therapy and hormone replacement therapy were initiated. Despite these efforts, poorly controlled hypothalamic obesity led to liver failure, and the patient is currently awaiting liver transplantation. Liver cirrhosis associated with long-term panhypopituitarism may have a poor prognosis even with hormone replacement therapy.

MicroRNA-122 protects against interferon-α-induced hepatic inflammatory response via the Janus kinase–signal transducer and activator of transcription pathway

Significant overlap in the epidemiology and coinfection of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) has been identified, which accelerates the development of severe liver cirrhosis and hepatocellular carcinoma worldwide. Interferon-α (IFN-α), a cytokine with antiviral properties, exerts profound physiological effects on innate immunity by regulating interferon-stimulated genes (ISGs) within cells. However, the underlying mechanism of IFN-α in hepatic inflammation remains to be fully elucidated. Here, we utilized LO2 cells treated with the recombinant IFN-α protein and conducted microRNA (miR) sequencing. MiR-122-3p and miR-122-5p_R+1 were the most enriched miRNAs involved in the pathogenesis of IFN-α-induced inflammatory responses and were significantly downregulated by IFN-α treatment. Furthermore, we identified interferon induced protein with tetratricopeptide repeats 1 (IFIT1) as a potential target gene of miR-122. IFN-α markedly increased the expression of proinflammatory cytokines and fibrogenic genes but decreased the mRNA expression of ISGs. Additionally, IFN-α significantly activated the NF-κB p-p65, MAPK p-p38, and Jak/STAT pathways to trigger inflammation. Importantly, supplementation with a miR-122 mimic significantly alleviated IFN-α-induced inflammation and induced IFIT1 expression in LO2 cells. Conversely, the suppression of miR-122 markedly exacerbated the inflammatory response triggered by IFN-α. Furthermore, silencing IFIT1 via an siRNA elicited an inflammatory response, whereas IFIT1 overexpression ameliorated hepatic inflammation and fibrosis in a manner comparable to that induced by IFN-α treatment. Taken together, our findings suggest that miR-122 and its target, IFIT1, reciprocally regulate the inflammatory response associated with IFN through the Jak/STAT pathway.

Relationship between Quality Practice Metrics and Treatment Outcomes in Hospitalized Cirrhotic Patients.

Variations in cirrhosis management practices and care quality affect patient prognoses and outcomes. We aimed to evaluate the number of successful cirrhosis care processes and the relationship between the quality statement implementation and clinical outcomes in patients with cirrhosis. This retrospective cohort study included hospitalized patients with cirrhosis. Eighteen process-based methods were independently assessed. Measurement indices for each participant were selected per cirrhosis severity. Service quality was determined using standard settings for each process-based gap scale. The optimal care group comprised participants who adhered to all instruction quality indices. Kaplan-Meier survival analysis assessed the 90-day readmission and mortality rates relating to the optimal quality care. Of the 205 patients (73.2% male; mean age, 62.7±11.8 years), the median Model for End-stage Liver Disease score was 15.35 (9.37-21.37), and the majority were Child-Pugh B/C. Previously set performance gaps were observed for 13/18 quality processes, and 5/13 clinical processes attained the final goal. Paracentesis in ascites patients, antibiotic administration within 12 hours of spontaneous bacterial peritonitis diagnosis, and precipitating factors identification with lactulose therapy were the top three quality index (QI) accomplishments. Out of 205 patients, 84 attained optimal care. Concerning optimal care, although the readmission rate remained same, patients with decompensated Child-Pugh C who received excellent complete QI care had significantly increased both 1-month (100% vs. 43.5%; p=0.022) and 3-month (100% vs. 26.1%; p=0.022) survival in comparison to those receiving incomplete QI care. Using quality metrics for the appropriate stage of individual cirrhosis treatment is advocated as best practice. Adherence to standard practices improves clinical outcomes.

Survey on the Hepatocellular Carcinoma and Severe Cirrhosis Treatment Research Promotion Project in Hyogo Prefecture

Survey on the Hepatocellular Carcinoma and Severe Cirrhosis Treatment Research Promotion Project in Hyogo Prefecture

Fontan-associated liver disease: the importance of multidisciplinary teamwork in its management.

The Fontan operation, which directly connects the superior and inferior vena cava to the pulmonary artery, is a palliative surgery for children with a functional or anatomic single ventricle. This procedure leads to hemodynamic changes (Fontan circulation) in patients, who tend to develop congestive hepatic fibrosis characterized by sinusoidal fibrosis and dilatation beginning approximately 10 years after the procedure. In addition, in the context of severe fibrosis and cirrhosis, hepato-gastrointestinal complications including hepatocellular carcinoma, focal nodular hyperplasia, and portal hypertension can arise. Fontan-associated liver disease (FALD) encompasses the broad spectrum of liver alterations secondary to postoperative hemodynamic changes, and the effective management of FALD requires contributions from specialists in hepatology, gastroenterology, surgery, radiology, histopathology, and pediatric and adult cardiology. In this article, we outline the pathogenesis of FALD and discuss the importance of a multidisciplinary collaborative approach to its management.

Sex differences in patient-reported outcomes and perception of ascites burden amongst outpatients with decompensated cirrhosis and ascites.: Sex Differences in Ascites Burden Perception.

Perception of the ascites burden and its effects on quality of life may be different between sexes. This study assessed sex differences in perception of ascites burden and its impact on health related QoL (HRQoL) in patients with recurrent or refractory ascites. The North American Consortium for the Study of End-stage Liver Disease prospectively enrolled outpatients with cirrhosis and large ascites requiring repeat large volume paracenteses. Demographics, laboratory results, co-morbidities, medications, frailty measurements, self-reported questionnaires related to functional status, physical activities, and HRQoL (generic = SF36 & ascites specific = ascites Q) were compared between sexes. 392 men (59.6±10.7yrs) and 184 women (59.5±11.1yrs) with predominantly alcohol related liver disease 51% and 43% respectively), median MELD-Na: 13, were enrolled. Both groups had similar co-morbidities and cirrhosis complications, ascites duration and severity, and frailty scores (p=0.94). Women had more symptoms related to their ascites (Ascites Q score =66±21 vs. 60±21 in men, p=0.001) (higher value = feeling worse). 35% of women felt depressed versus 22% of men (p=0.0009), with lower mental but not physical functioning components of SF36 (p=0.019). Women continued to conduct their daily activities as adequately as men as indicated by Duke Status Activity index (p=0.27) and Godin Leisure Activity Index (p=0.47). Women with cirrhosis and ascites experienced worse emotional HRQoL than men without difference in daily function. Our analyses underscore the differences in the lived experience of women versus men with cirrhosis and highlight the need for patient-reported metrics to provide patient-centered care.

Testicular enzyme activity alterations in rats with liver cirrhosis induced by alcohol and acetaminophen

Alcohol-induced acetaminophen (APAP) toxicity is one of the numerous factors that might result in liver cirrhosis (LC). The hepatotoxicity of APAP appears to increase in chronic drinkers, according to a number of investigations. These people not only have a greater risk of experiencing acute overdose-related severe and deadly liver damage but are also at risk of experiencing similar substantial liver damage from therapeutic APAP use. The male reproductive system consists of both testes and a few other auxiliary sexual organs. Smaller and lighter testicles are indicative of severe cirrhosis causing testicular atrophy. In the case of severe LC, low testosterone results from hypogonadotropic hypogonadism. Sexual dysfunction is a prevalent condition that is frequently overlooked in individuals suffering from cirrhosis and chronic liver disease. Eighteen rats were randomly divided into three groups. Rats of normal control group received water and normal diet ad libitum; alcohol control and LC group received 4.5% alcohol and a combination of 4.5% alcohol and APAP (300 mg/kg bw) through drinking water, respectively, for 7 days. Several glycolytic and antioxidant enzymes were assessed for their effects through non-denaturing polyacrylamide gel electrophoresis analysis and enzyme activity. The results indicated that long-term alcohol consumption and APAP medication altered the levels of antioxidant and glycolytic enzymes. To the best of our knowledge, this is the first study demonstrating that chronic alcoholism and APAP induce hepatotoxicity, and LC further affects the antioxidant and glycolytic enzyme activities of the testes.

Current status of treatment for acute variceal bleeding in liver cirrhosis

Acute variceal bleeding (AVB) continues to be a fatal complications of cirrhotic portal hypertension. Although the hospitalization rate of patients with acute variceal bleeding has significantly decreased with the advancement of medical technology, and the mortality rate has dropped from 50% three decades before to 15%～20% now, the in-hospital mortality rate is still high and is closely related to the severity of cirrhosis, ranging from 0 in Child A grade to 32% in Child C grade. Therefore, it is a good choice to risk stratify these patients and individualize the treatment method according to the expected risk, as the risk of death in patients with acute variceal bleeding is highly heterogeneous. This article mainly reviews the current status of risk stratification and treatment of acute variceal bleeding in cirrhosis.

Evaluation of Thyroid Activity in Patients with Liver Cirrhosis

Abstract Background: Liver cirrhosis is increasingly becoming a public health problem. The aim of study is to evaluate the relationship levels thyroid stimulating hormone (TSH), triiodothyronine (T3), free thyroxine (fT4) and and liver cirrhosis(LC) severity, measured by Child-Pugh (CP) and MELD scores. Methods: 419 patients diagnosed with liver cirrhosis were included in the study. Biological tests for TSH, T3, fT4 on admission and discharge were used. All analysis was performed using, One-Sample Wilcoxon test and Kruskal-Wallis test. Results: The mean values for TSH were statistically significant higher compared to normal values only at admission (p&lt;.05), and the mean values for T3 were statistically significant lower both on admission (p&lt;.001) and on discharge (p&lt;.001). No effect was observed for fT4. TSH on the admission and discharge moments were statistically significant differences (p&lt;.001), T3 (p&lt;.001) and fT4 (p&lt;.004). The CP also influenced the hormone's values for TSH at admission (p&lt;.01 and discharge (p&lt;.001), and T3 at admission (p&lt;.001) and discharge (p&lt;.001) but not for fT4. For MELD score, a low power positive associations were observed only with TSH, on admission and discharge and negative associations with F3, in both situations. Conclusions: Elevated TSH levels at admission, coupled with their negative correlation with the CP score and differences between TSH-CP group C and groups A and B, highlighting the necessity for vigilant endocrine monitoring in hepatic patients. Also, admission T3 levels are lower than normal and negatively correlate with cirrhosis severity and MELD scores underscore potential clinical utility of monitoring thyroid function in assessing disease progression and improving patient survival outcomes.

Child-Pugh Score and Vitamin D: Exploring a New Frontier in Liver Cirrhosis Assessment.

This study investigates the relationship between vitamin D levels and liver cirrhosis severity, a leading cause of global morbidity and mortality. Chronic liver diseases, stemming from conditions such as hepatitis, alcohol use, non-alcoholic fatty liver disease, autoimmune diseases, and cryptogenic disorders, disrupt vitamin D metabolism, as the liver converts dietary and skin-derived vitamin D into 25-hydroxyvitamin D (25[OH]D), the primary circulating form. The cross-sectional study conducted at the Department of General Medicine of BLDE (DU) Shri. B. M. Patil Medical College Hospital and Research Centre, Vijayapura, from August 2022 to May 2024, involved 89 patients. Based on the Child-Pugh scoring system, these patients were classified into three classes: class A (good hepatic function), class B (moderate dysfunction), and class C (advanced dysfunction). The study found a significant negative correlation (Pearson r=-0.462, p<0.0001) between vitamin D levels and Child-Pugh scores, indicating that as cirrhosis severity worsens, vitamin D levels decrease. The findings highlight vitamin D deficiency as a marker of disease severity, linking it to increased morbidity and mortality and underscoring its potential as a prognostic tool in managing liver cirrhosis.