Stage Of Chronic Liver Disease Research Articles

Hematological Indices Are Useful in Predicting Complications of Liver Cirrhosis.

Liver cirrhosis is the final stage of chronic liver disease. We aimed to evaluate non-invasive scores as predictors of complications and outcome in cirrhotic patients. A total of 150 cirrhotic patients were included. Models for end-stage liver disease (MELD), albumin-bilirubin (ALBI) score, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MoLR), and neutrophil-lymphocyte-albumin ratio (NLA) scores were tested in relation to the development of complications and mortality using receiver operating characteristic (ROC) curves. The ROC curve analysis showed (area under the curve) AUC values of NLR, NLA, ALBI, and MELD of 0.711, 0.730, 0.627, and 0.684, respectively, for short-term mortality. MELD, ALBI, and NLA scores showed a statistically significant correlation with hepatic encephalopathy (p = 0.000 vs. 0.014 vs. 0.040, respectively), and the MELD cut-off value of 16 had a sensitivity of 70% and a specificity of 52% (AUC: 0.671, 95% CI (0.577-0.765)). For the assessment of the presence of ascites, the AUC values for NLA and MoLR were 0.583 and 0.658, respectively, with cut-offs of 11.38 and 0.44. MELD, ALBI, and NLA are reliable predictors of hepatic encephalopathy. NLA and MoLR showed a significant correlation with the presence of ascites, and MELD, ALBI, NLR, and NLA have prognostic value to predict 30-day mortality in cirrhotic patients.

Malnutrition among Patients with Chronic Liver Disease Admitted to the Department of Gastroenterology and Hepatology in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Protein-calorie malnutrition is a transversal condition to all stages of chronic liver disease. It is considered an independent predictor of mortality that leads to an increased number of complications. The aim of this study was to find out the prevalence of malnutrition among patients with chronic liver disease admitted to the Department of Gastroenterology and Hepatology in a tertiary care centre. Methods: This descriptive cross-sectional study was done among patients with chronic liver disease admitted to the Department of Gastroenterology and Hepatology in a tertiary care centre between 10 January 2021 to 15 February 2022 after receiving ethical approval from the Institutional Review Committee (Reference number: 394/077/078-IRC). The nutritional status of patients was assessed by subjective global assessment. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 110 patients with chronic liver disease, malnutrition was seen in 91 (82.72%) (75.65-89.79, 95% Confidence Interval). Out of 91 patients who were malnourished, 56 (61.53%) had moderate malnutrition whereas 35 (38.46%) had severe malnutrition. Seventy-six (83.51%) suffered from alcoholic cirrhosis. Conclusions: The prevalence of malnutrition among patients with chronic liver disease was higher than in other studies done in similar settings.

Study of Propranolol in Cirrhosis Patients with Portal Hypertension: Research at Sidoarjo General Hospital

Cirrhosis is the final stage of chronic liver disease caused by fibrosis which decreases the function and changes the shape and structure of the liver. Portal hypertension is an essential pathophysiology of cirrhosis, which can lead to an increased risk of death in patients resulting in very detrimental complications originating from portal obstruction of blood flow, such as cirrhosis or blockage of blood vessels. According to the EASL guidelines, non-selective β-blocker therapy such as propranolol can reduce portal pressure by reducing the portal venous flow through two mechanisms: decreased cardiac output and decreased splanchnic blood flow. This study aimed to determine the pattern of using propranolol in patients with liver cirrhosis in Sidoarjo Hospital. This was an observational study with a retrospective approach in cirrhosis patients with portal hypertension from 1st January 2021 until 31st December 2021. The Patient Medication Records (PMR) data was obtained from 15 male patients (68%), with the most age ranging from 56 to 65 years old (37%). The pattern of using single therapy was in 22 patients (100%). The highest use of single treatment was Propranolol (3×10 mg) with 12 patients (52%), Propranolol (2x10 mg) with ten patients (43%), and Propranolol (2x40 mg) with only one patient (5%). Interm of switching therapy, only one medication which is Propranolol (2x10 mg switch toPropranolol (2x40 mg).
 Keywords: Propranolol, Portal Hypertention, Cirrhosis

Scoring system for predicting 90-day mortality of in-hospital liver cirrhosis patients at Cipto Mangunkusumo Hospital

BackgroundLiver cirrhosis is the final stage of chronic liver disease. Complications due to progression of liver disease may deteriorate the liver function and worsen prognosis. Previous studies have shown that patients with liver cirrhosis are at increased risk of death within 90-day after hospitalization. It is necessary to identify patients who are at higher risk of early mortality. This study aims to develop a scoring system to predict the 90-day mortality among hospitalized patients with liver cirrhosis that could be used for modification of treatment plan according to the scores that have been obtained. By using this scoring system, crucial care of plans can be taken to reduce the risk of mortality.MethodThis prospective cohort study was conducted on hospitalized cirrhotic patients at Cipto Mangunkusumo National General Hospital, Jakarta. Demographic, clinical, and laboratory data were recorded. Patients were monitored for up to 90-day after hospitalization to determine their condition. Cox regression analysis was performed to obtain predictor factors contributing to mortality in liver cirrhosis patients. The scoring system that resulted from this study categorized patients into low, moderate, and high-risk categories based on their predicted mortality rates. The sensitivity and specificity of the scoring system were evaluated using the AUC (area under the curve) metric.ResultThe study revealed that liver cirrhosis patients who were hospitalized had a 90-day mortality rate of 42.2%, with contributing factors including Child-Pugh, MELD, and leukocyte levels. The combination of these variables had a good discriminative value with an AUC of 0.921 (95% CI: 0.876–0.967). The scoring system resulted in three risk categories: low risk (score of 0–3) with a 4.1-18.4% probability of death, moderate risk (score of 5–6) with a 40.5-54.2% probability of death, and high risk (score of 8–11) with a 78.1-94.9% probability of death.ConclusionThe scoring system has shown great accuracy in predicting 90-day mortality in hospitalized cirrhosis patients, making it a valuable tool for identifying the necessary care and interventions needed for these patients upon admission.

Computed tomography predictors of gastroesophageal varices in cirrhotic patients: the added value of portosystemic collaterals

BackgroundDetection of ‘spontaneous’ portosystemic collateral veins (PSCV) serves as an important tool in diagnosing portal hypertension (PTHN) and predicting prognosis. Multidetector computed tomography (MDCT) imaging is noninvasive and allows accurate assessment of variceal site and size. So, this study was conducted to assess the role of MDCT in predicting, detecting and grading gastroesophageal varices in correlation with endoscopy in cirrhotic patients in relation to other portosystemic collaterals.MethodsAnalytical cross-sectional prospective study was conducted on 100 cirrhotic patients. All patients were subjected to history taking, upper gastrointestinal endoscopic assessment, and triphasic CT or contrast-enhanced CT assessment of abdomen and pelvis.ResultsPatients who had esophageal varices in MDCT show a statistically significant difference (p = 0.016) with its endoscopic grading. There was good agreement between endoscopy and MDCT in diagnosing grade of esophageal varices as k = 0.882. The presence of ascites, splenic size, and esophageal vein diameter serve as clinically significant predictors of esophageal varices. Splenic size showed a significant difference according to endoscopic grades of EV (esophageal varices) as p = 0.031 as patients with no varices had splenic size of (15.9 ± 1.4) cm, patients with grade I had a mean splenic size of (15.2 ± 8.7) cm, patients with grade II had mean splenic size of (16.9 ± 1.8) cm and patients with grade III had mean splenic size of (18 ± 4.2) cm, while other veins diameters showed increase with advanced grades of EV but with statistically insignificant differences as p > 0.05.ConclusionsMultidetector CT features of the presence of PSCVs, splenic size, and ascites are accurate predictors of PTHN in either EVs presence or absence. MDCT can be an excellent alternative for patients who are contraindicated for endoscopy. Moreover, it can be potential screening tool for early detection of esophageal varices in very early stage of chronic liver disease and in the early care of patient with varices. MDCT remains the most applicable noninvasive diagnostic tool for patients with portosystemic collaterals.

PREDICTION OF ESOPHAGEAL VARICES BASED ON SERUM-ASCITES ALBUMIN GRADIENT (SAAG) IN CIRRHOTIC PATIENTS

1.Introduction Cirrhosis is the end stage of chronic liver disease. Ascites and esophageal varices (EVs) are the most common complications of portal hypertension (PHT), with an incidence of approximately 50% [1]. Since effective preventive modalities have been established for variceal haemorrhage, early detection of EVs is critical for primary prevention of bleeding. Upper gastrointestinal endoscopy (UGE) remains the gold standard for screening [2,3]. However, many studies have been conducted to predict PHT and EV with a diverse rate of accuracy. All patients with cirrhosis should undergo UGE screening to identify those at high risk of bleeding and who may benet from primary prophylaxis, since EVs are an independent predictive factor and an early complication of cirrhosis. The test should also be repeated during the follow-up of patients with cirrhosis without EVs, who are at risk of bleeding, with or without decompensation [1]. Though UGiscopy is the gold standard to screen patients for variceal development; but has has many drawbacks such as being relatively expensive, invasive, and restrictive [4]. Such a screening test should be simple, rapid, reproducible, and inexpensive [5–7]. The serum ascites albumin gradient (SAAG) is a minimally invasive method that is precise and has been described in the classication of ascitic uid(AF) based on the presence or absence of PHT [8]. Many Studies have been performed to identify non-invasive parameters for the prediction of EVs in patients newly diagnosed with cirrhosis [5]. SAAG can be considered an indirect parameter for the detection of EVs and is useful in regions where there are limitations to perform UGE. The aim of our study was to evaluate the role of SAAG in the prediction of EVs in cirrhotic patients with ascites.

Trends of Chronic Liver Disease in a Tertiary Care Centre in the Eastern Part of India: A Retrospective Study.

To assess the relationship between the severity of liver cirrhosis and its outcomesbased on laboratory parameters, Child-Turcotte-Pugh (CTP) score, and upper gastrointestinal (UGI) endoscopy findings. Cirrhosis is the end stage of chronic liver disease (CLD)and is characterised by progressive liver fibrosis and distortion of the liver architecture. It is a major cause of morbidity and mortality all over the world. Cirrhosis is compensated in the initial stages and later progresses to the decompensated stage with various complications. The CTP scoring system predicts mortality inpatients with cirrhosis. This retrospective study was done in the Department ofMedicine and Gastroenterology of Tata Main Hospital (TMH), Jamshedpur, Jharkhand, India. It wasconducted over a period of two years between 1 January2019 and31 December 2020, on 150 confirmed cases ofcirrhosis. The most common age group was 41-60 years (86, 57.33%) and the mean age ± standard deviation (SD) for all patients was 49.82 ± 11.63 years. In a total of 150 CLD cases, males were 96 (64%). The most common cause of CLD was alcohol (76, 50.67%). Based on presenting symptoms, most CLD patients presented with generalized weakness (144, 96.00%). The most common signs were icterus (68, 45.33%) and ascites (44, 29.33%). Most patients belonged to CTP class A (77, 51.33%), followed by CTP class B (44, 29.33%) and class C (29, 19.34%). The most common UGI endoscopy findingwas portal hypertensive gastropathy (mild or severe) (135, 75%). Total deaths were 24 (16.00%), with 17 deaths (70.83%) in patients belonging to CTP class C. CLD is a common entity in eastern India with male preponderance and affects mostly people of the middle age group.Alcohol intake is a major cause of CLD,followed by non-alcoholic fatty liver disease and chronic hepatitis B and C. A significant rise inmorbidity and mortality due toalcoholic liver disease (ALD)was observed in the study and needs urgent social and medical intervention. The incidence of ALD in our study was 50.67%.

Antioxidant and anti-inflammatory agents in chronic liver diseases: Molecular mechanisms and therapy.

Chronic liver disease (CLD) is a continuous process that causes a reduction of liver function lasting more than six months. CLD includes alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), chronic viral infection, and autoimmune hepatitis, which can lead to liver fibrosis, cirrhosis, and cancer. Liver inflammation and oxidative stress are commonly associated with the development and progression of CLD. Molecular signaling pathways such as AMP-activated protein kinase (AMPK), C-Jun N-terminal kinase, and peroxisome proliferator-activated receptors (PPARs) are implicated in the pathogenesis of CLD. Therefore, antioxidant and anti-inflammatory agents from natural products are new potent therapies for ALD, NAFLD, and hepatocellular carcinoma (HCC). In this review, we summarize some powerful products that can be potential applied in all the stages of CLD, from ALD/NAFLD to HCC. The selected agents such as β-sitosterol, curcumin, genistein, and silymarin can regulate the activation of several important molecules, including AMPK, Farnesoid X receptor, nuclear factor erythroid 2-related factor-2, PPARs, phosphatidylinositol-3-kinase, and lysyl oxidase-like proteins. In addition, clinical trials are undergoing to evaluate their efficacy and safety.

Liver-Targeted Delivery of Small Interfering RNA of C-C Chemokine Receptor 2 with Tetrahedral Framework Nucleic Acid Attenuates Liver Cirrhosis.

Liver cirrhosis is the end stage of chronic liver diseases without approved clinical drugs. In this study, a new strategy that uses a C-C chemokine receptor 2 (CCR2) small interfering RNA silencing (siCcr2)-based therapy by loading multivalent siCcr2 with tetrahedron framework DNA nanostructure (tFNA) vehicle (tFNA-siCcr2) was established to attenuate liver fibrosis. tFNA-siCcr2 was successfully synthesized without changing the physiochemical properties of tFNA. Compared to the naked siCcr2 molecule, the tFNA-siCcr2 complex altered the accumulation from the kidney to the liver after the intraperitoneal injection. The tFNA-siCcr2 complex also prolonged hepatic retention and mainly colocalized within macrophages and endothelial cells. tFNA-siCcr2 efficiently silenced CCR2 and significantly ameliorated liver fibrosis in prevention and treatment interventions. Single-cell RNA sequencing followed by experimental validation suggested that tFNA-siCcr2 can restore the immune cell landscape and construct an antifibrotic niche by inhibiting profibrotic macrophage and neutrophil accumulation in the murine fibrotic liver. Molecularly, the tFNA-siCcr2 complex reduced inflammatory mediator production by inactivating the NF-κB signaling pathway. In conclusion, the tFNA-based liver-targeted tFNA-siCcr2 delivery complex efficiently ameliorated liver fibrosis by restoring the immune cell landscape and constructing an antifibrotic niche, which makes the tFNA-siCcr2 complex a potential therapeutic candidate for the clinical treatment of liver cirrhosis.

Effect of chronic liver disease continuum upon calcium homeostasis and bone mineral metabolism: An observation from Eastern India

Background: Cirrhosis, a major and life-threatening complication of liver disease, has claimed over a million lives since 2010. It has been estimated that liver disease causes 1.03 million deaths/year globally. Chronic liver disease (CLD) affects metabolism of other organs such as the bone. The prevalence rates of hepatic osteodystrophy range from 13% to 70% in Western countries. Even higher prevalence rate between 68% and 95% has been reported from India. Reports from previous studies regarding the serum concentrations of 25(OH)D and its correlation with the progression of liver diseases have been inconsistent. Some studies have found that 25(OH)D levels decline as the liver disease progresses, whereas others found no significant difference between cirrhotic patients and non-cirrhotic patients or among the Child-Pugh groups. Vitamin D estimation is also thought to bear little predictive value to assess the progression of liver disease in etiologies such as hepatitis C. There are very few studies in the Eastern part of India to show the effect of CLD on bone mineral homeostasis. Based on this background, this study has been designed to reveal the effects of CLD and its severity on various parameters of bone mineral metabolism. Aim and Objectives: The aim of the study was to evaluate the effects of different stages of CLD on bone mineral metabolism and its homeostasis. Materials and Methods: After obtaining proper permission from the Institutional Ethics Committee, the cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Medicine in a tertiary care hospital in Kolkata. The study included 90 cases with established CLD and 90 age- and sex-matched controls screened from the Department of Medicine. Serum Calcium, Inorganic phosphate, 25(OH) Vitamin D, and intact parathyroid hormone (iPTH) were estimated in the Department of Biochemistry. The Child-Pugh-Tucotte score was used to grade the severity of disease. Results: It was observed that serum calcium and serum 25(OH) D levels were significantly lower in patients with CLD (P <0.0001). Serum iPTH levels were significantly higher in patients with CLD compared to controls (P < 0.0001). Conclusion: Routine serial estimation of serum calcium, inorganic phosphate, and 25(OH)D should be mandatory in patients of CLD so that adequate replacements can be initiated as a therapeutic adjunct.

What does quantitative HBsAg level mean in chronic hepatitis D infection?

In hepatitis delta virus (HDV) infection, which is an important etiological cause of chronic liver disease, the relationship between serum quantitative HBsAg level and fibrosis and histological activity was investigated. Between 2014 and 2020, 98 patients with chronic HDV infection (53 noncirrhotic, 45 cirrhotic) participated in this prospectively designed study. Quantitative HBsAg levels of the patients were measured and their relationship with the stage of chronic liver disease was compared with histological activity index (HAI), fibrosis score and HDV RNA, model for end-stage liver disease score and other biochemical parameters. All patients were infected with genotype 1 (100%). HBeAg was positive in 8 (8.1%) of the patients. A correlation was found between quantitative HBsAg level and HDV RNA level in patients with both cirrhotic (r = 0.568; P < 0.001) and noncirrhotic (r = 0.644; P < 0.001) HDV infection. Alanine transaminase (P = 0.001; r = 0.495) and aspartate transaminase (P = 0.001; r = 0.511) levels correlated with quantitative HBsAg levels, more prominently in noncirrhotic patients. There was a correlation between quantitative HBsAg level and histological activity index (HAI) in patients with noncirrhotic HDV infection (P < 0.001; r = 0.664). In receiver operating characteristic analysis, both quantitative HBsAg (for cutoff: 1000; sensitivity 76%; specificity 17%; P = 0.335) and HDV RNA (for cutoff: 100000; sensitivity 2%; specificity 98%; P = 0.096) were not predictive markers for cirrhosis. Quantitative HBsAg level can be evaluated as an indicator of viral replication and histological activity in patients with chronic delta hepatitis without cirrhosis. We think that quantitative HBsAg level will be useful in the management of chronic HDV infection, especially in noncirrhotic patients.

Characteristic analysis of patients with type 2 diabetes mellitus combined with advanced stage chronic liver disease: a community population-based cross-sectional study in Heping District, Shenyang City (CHESS-LN 2101)

Objective: To investigate the prevalence and independent risk factors of non-alcoholic fatty liver disease (NAFLD) and advanced chronic liver disease among the type 2 diabetes mellitus (T2DM) population in the Shenyang community, so as to provide evidence for the prevention and control of T2DM combined with NAFLD. Methods: This cross-sectional study was conducted in July 2021. 644 T2DM cases from 13 communities in Heping District, Shenyang City were selected. All the surveyed subjects underwent physical examination (measurements of height, body mass index, neck circumference, waist circumference, abdominal circumference, hip circumference, and blood pressure), infection screening (excluding hepatitis B and C, AIDS, and syphilis), random fingertip blood glucose, controlled attenuation parameter (CAP), and liver stiffness measurement (LSM). The study subjects were divided into the non-advanced chronic liver disease group and the advanced chronic liver disease group according to whether the LSM value was greater than 10 kPa. Cirrhotic portal hypertension development was indicated in patients with LSM ≥ 15 kPa. The comparison of multiple mean values among the sample groups was performed by analysis of variance when the normal distribution was met. Results: In the T2DM community population, there were 401 cases (62.27%) combined with NAFLD, 63 cases (9.78%) combined with advanced chronic liver disease, and 14 cases (2.17%) combined with portal hypertension. There were 581 cases in the non-advanced chronic liver disease group and 63 cases (9.78%) in the advanced chronic liver disease group (LSM ≥10 kPa), including 49 cases (7.61%) with 10 kPa≤LSM<15 kPa, 11 cases (1.71%) with 15 kPa ≤LSM<25 kPa, and 3 cases (0.47%) with LSM ≥ 25 kPa. Age, body mass, body mass index, neck circumference, waist circumference, hip circumference, waist-to-height ratio, systolic blood pressure, and CAP were all statistically different between the non-advanced chronic liver disease group and the advanced chronic liver disease group (F=-1.983,-2.598,-4.091,-2.062,-3.909, -4.581,-4.295,-2.474, and -5.191, respectively; P<0.05). There was a statistically significant difference in terms of whether or not there was combined cerebrovascular disease (2=4.632, P=0.031); however, there were no statistically significant differences in terms of lifestyle, diabetes complications, and other complications (P>0.05). Conclusion: Patients with T2DM have a higher prevalence of NAFLD (62.27%) than those with advanced chronic liver disease (9.78%). 2.17% of T2DM cases in the community may not have had early diagnosis and early intervention, and they might have been combined with cirrhotic portal hypertension. So, the management of these patients should be strengthened.

COAGULOPATHY IN CHRONIC LIVER DISEASE. A DISTURBED COAGULATION HARMONY IN RELATION TO SEVERITY OF LIVER DISEASE.

Coagulation of blood is the most important vital function to obviate excessive bleeding. Many coagulation factors are involved in this process, among which most of them are synthesised in liver. Cirrhosis is dened as a nal stage of chronic liver disease. It is associated with disturbances in the synthetic and metabolic function of liver and can leads to abnormalities in the coagulation process. The hemostatic system is a delicate balance between prothrombotic and antithrombotic processes. Liver acts as a key organ in the synthesis of various coagulation factors and hence participate in both primary and secondary haemostasis. Identication of specic biochemical markers that can predict the severity of liver cirrhosis and the probability of bleeding tendency can help the physician in early identication of complications. This study was done to analyse the efcacy of coagulation tests like PT, APTT, brinogen and platelets in predicting the severity of liver disease and its complications, to study the relevance and signicance of coagulation tests in relation to bleeding complications in patients with CLD. We conducted a cross sectional observation study involving 100 patients diagnosed with CLD. The mean levels of PT and Results: APTT found to have positive association and a strong correlation with increasing grades of MELD and Child Pugh score, whereas the mean platelet count and serum brinogen levels showed a strong negative association. Signicant correlations between PT, APTT, and declining brinogen and platelet levels and GI bleeding were observed. Coagulation parameters like PT, APTT, brinogen and platelet levels can be used for grading the severity of CLD and also predict the propensity of a patient with CLD to bleed.

Sex-specific analysis of microRNA profiles in HBV-associated cirrhosis by small RNA-sequencing.

Liver cirrhosis represents an advanced stage of chronic liver disease and is associated with significant morbidity, mortality, and risk of cancer development. While sex disparity of liver diseases has been observed, understanding at a genetic level awaits more thorough investigation. In this study, we performed a sex-specific analysis of the microRNA (miR) profiles in hepatitis B virus (HBV)-associated cirrhosis by small RNA-sequencing using clinical tissue samples. Potential associated signaling pathways, downstream gene targets, and upstream regulators were highlighted by computational prediction analyses based on the differentially expressed miRs (DEmiRs). From our results, deregulation of miRs in cirrhosis showed a marked difference between males and females by the degree and pattern. Sixty-five (64 up-regulated, 1 down-regulated) and 12 (6 up-regulated, 6 down-regulated) DEmiRs were found in males and females, respectively, when compared with their respective control group. A number of DEmiRs were only observed in one sex but not the other. In addition, 26 DEmiRs were identified between cirrhosis female and cirrhosis male groups. Fatty acid biosynthesis pathway, extracellular matrix-receptor interaction, p53 signaling, Hippo signaling, tumor necrosis factor signaling, the forkhead box O signaling, as well as gene targets ribosomal protein S27 like, methyl CpG binding protein 2, and estrogen receptor 1, may contribute to the pathogenesis and biological behavior of cirrhosis in a sex-specific manner. Analysis of the Cancer Genome Atlas data set suggested a role of sex-specific DEmiRs in multistep hepatocarcinogenesis. Conclusion: Our findings illustrate that miR profiles in HBV-associated cirrhosis are distinct between the males and females and suggest a potential role of sex-specific biomarkers and molecular mechanisms in disease development and progression.

THE CORRELATION BETWEEN THE SEVERITY OF LIVER CIRRHOSIS WITH ESOPHAGEAL VARICES IN RSUD DR SOETOMO SURABAYA

Introduction: Liver cirrhosis is the end stage of chronic liver disease. The morbidity and mortality associated with complications of liver cirrhosis are very high. In cases of death caused by cirrhosis of the liver, it tends to increase from around 676,000 in 1980 to more than one million in 2010, globally equivalent to 2% of all mortality in the world (Mokdad et al., 2014). The mortality rate increases if there are complications such as ascites, hepatic encephalopathy, esophageal varices, and liver cancer, with success rates of 20-60%, 50%, 70-90% (D'Amico, 2014). In liver cirrhosis with esophageal varices, it is reported that patients with mild and severe liver cirrhosis risk 40% and 85% for varicose veins. So, this research is to determine the correlation between the severity of liver cirrhosis with esophageal varices in Dr. Soetomo General Hospital Surabaya. Methods: This study was an analytic observational with a cross-sectional study design. The research subjects used in this study were patients diagnosed with liver cirrhosis with esophageal varices from January 2015 - December 2016. Data were collected from medical records and analyzed using the spearman correlation test. Sampling was carried out in total sampling. Results: Of 26 subjects, most of the subjects were men (69.32%), the highest severity of liver cirrhosis from the Child B group (53.85%), and the highest esophageal varices were grade II and III (46,15%). The most results from each group based on the severity of liver cirrhosis were Child A with grade II esophageal varices (66.7%), and Child B with grade II esophageal varices (64.3%), and Child C with esophageal varices grade III esophagus (88.9%). A correlation coefficient was obtained at 0.659 (p &lt;0.005). Conclusion: This research concludes a significant correlation between the severity of liver cirrhosis and esophageal varices.

Clinical Characteristics and Etiology of Chronic Liver Disease among Egyptian Patients in Nile Delta: A Clinical Study

Background: Chronic liver disease (CLD) is an extremely common clinical condition that causes significant morbidity and mortality and was responsible for 1.3 million deaths worldwide. There had been a 46% increase in CLD mortality in the world between 1980 and 2013 and most of this increase has been reported in low-income countries in Asia and Africa including Egypt. These countries are experiencing a demographic and epidemiologic transition in disease burden and Egypt is one of the epicenters of this change. Previously, CLD in Egypt was traditionally attributed to schistosomiasis mainly in the region of the Nile Delta until the mid-1980s.&#x0D; Aims: To capture the modes of clinical presentation and at which stage CLD patients seek clinical care, as well as the dramatic change in the etiological profile of CLD in this area of the Nile Delta&#x0D; Methods: 1013 newly diagnosed CLD patients were selected and identified from the Tanta Liver Center (TLC) across the middle of the Nile Delta. After informed or written consent, all consecutive patients (18 years and above) referred to TLC with suspected or overt chronic liver disease were subjected to full history taking, clinical examination searching for stigmata of chronic liver disease, and laboratory studies including urine, blood sugar, liver biochemical tests (bilirubin, ALT, AST&amp; serum albumin), prothrombin, viral markers (HCV Ab &amp; HBS Ag) and AFP. Imaging studies including the abdominal US for all patients and triphasic CT and liver biopsy in selected patients.&#x0D; Results: About 50% of our CLD patients present at a relatively advanced stage of decompensated cirrhosis (ascites in 39.2%, bleeding in 22.8%, and HCC in 9.3%).&#x0D; CLD patients of schistosomal etiology presented mainly with manifestations of portal hypertension (splenomegaly, UGI Bleed &amp; thrombocytopenia) that was significantly higher than the other 2 groups.&#x0D; The vast majority of our CLD patients (83.5%) have viral etiology, while only 11.1% have schistosomal etiology and the remaining 5.4% have non-identified etiology.&#x0D; Conclusion: based on the results of the present study, it is evident that HCV had replaced schistosomiasis as the predominant cause of CLD in Egypt particularly in the region of the Nile Delta. The late presentation of a good percentage of our CLD patients raises the importance of screening programs for CLD in this endemic area of the Nile Delta.

Diagnostic Accuracy of Splenic Index Measued on Ultrasound for Noninvasive Diagnosis of Esophageal Varices Keeping Endoscopy as Gold Standard

Background: End stage chronic liver disease results in the growth of fibrous tissue, the disruption of hepatic architecture, and the formation of nodules, which interfere with liver function and contribute to portal hypertension. Esophageal varices might arise when blood flow through liver is impeded, most typically by scar tissue in the liver caused by liver disease. For high-risk EV diagnosis, endoscopy is the gold standard, but is not available at most health centres in our nation. In individuals at high risk of esophageal varices, performing endoscopies on a yearly or biannual basis can be difficult. We wish to conduct a noninvasive investigation to gather local evidence and to confirm the accuracy of splenic index determined by ultrasonography in detection of EVs. Objective: To find out diagnostic accuracy of splenic index measured by Ultrasound for noninvasive diagnosis of esophageal varices keeping endoscopy as gold standard.

Cirrhosis and pregnancy: a single centre experience.

Cirrhosis is a diffuse pathology characterized by fibrosis of the liver and is the last stage of chronic liver diseases. It is a serious medical condition which seriously impacts reproduction and reproductive life span. The aim of this study is to evaluate the outcomes of pregnancies complicated with liver cirrhosis. Retrospective chart review of the fetal and maternal results of 20 pregnant women with liver cirrhosis who had undergone antenatal follow-up and delivery at a tertiary center in a 12-year period was performed. Chronic hepatitis B was found to be the leading cause of liver cirrhosis in the study group, with a rate of 25% (n: 5/20). The average MELD score was calculated as 8.8 ± 3.5. Only three patients developed hepatic decompensation during pregnancy. Fetal demise was observed in 10% of the cases (n: 2/20, MELD scores 8 and 17). MELD score was significantly higher in the patients with adverse perinatal outcomes. Even though pregnancy is rarely observed in women with liver cirrhosis, many patients are able to achieve favorable maternal and fetal results without developing hepatic decompensation with appropriate management and close follow-up. The Model for End-Stage Liver Disease (MELD) score is a clinical tool utilized to estimate the severity and survival for chronic liver disease and was previously found to be associated with unfavorable outcomes in pregnant patients. Our study confirms this finding with the current experience from a tertiary care center.

Circadian Rhythms Coordinated With Gut Microbiota Partially Account for Individual Differences in Hepatitis B-Related Cirrhosis.

Cirrhosis is the end stage of chronic liver diseases like chronic hepatitis B. In China, hepatitis B accounts for around 60% of cases of cirrhosis. So far, clinical and laboratory indexes for the early diagnosis of cirrhosis are far from satisfactory. Nevertheless, there haven’t been specific drugs for cirrhosis. Thus, it is quite necessary to uncover more specific factors which play their roles in cirrhosis and figure out the possible therapeutic targets. Among emerging factors taking part in the initiation and progression of cirrhosis, gut microbiota might be a pivot of systemic factors like metabolism and immune and different organs like gut and liver. Discovery of detailed molecular mechanism in gut microbiota and gut liver axis leads to a more promising prospect of developing new drugs intervening in these pathways. Time-based medication regimen has been proofed to be helpful in hormonotherapy, especially in the use of glucocorticoid. Thus, circadian rhythms, though haven’t been strongly linked to hepatitis B and its complications, are still pivotal to various pathophysiological progresses. Gut microbiota as a potential effective factor of circadian rhythms has also received increasing attentions. Here, our work, restricting cirrhosis to the post-hepatitis B one, is aimed to summarize how circadian rhythms and hepatitis B-related cirrhosis can intersect via gut microbiota, and to throw new insights on the development of new and time-based therapies for hepatitis B-related cirrhosis and other cirrhosis.

Medikamentöse Therapie bei Patienten mit Leberzirrhose

Die Leberzirrhose ist das Endstadium chronischer Lebererkrankungen und insbesondere im fortgeschrittenen Stadium mit einer hohen Morbidität und Mortalität verbunden. Patienten mit Leberfunktionseinschränkung sind permanent von einer Vielzahl schwerwiegender Komplikationen bedroht. Ein optimales pharmakologisches Management bei Patienten mit Leberinsuffizienz kann die Progression der Grunderkrankung verlangsamen, Hospitalisationen verhindern sowie Lebensqualität und Überleben verbessern. Dieser Artikel gibt einen Überblick über den aktuellen Stand und neue Entwicklungen der Pharmakotherapie bei Patienten mit Leberzirrhose.