Stage Of Chronic Liver Disease Research Articles

Serum trace element levels of liver cirrhosis and pancreatic cancer patients

The incidence of liver cirrhosis and pancreatic cancer varies between countries and stands out as an important health problem worldwide. Liver cirrhosis is the most advanced stage of chronic liver disease and is a widespread result of chronic liver damage. The etiology of liver cirrhosis and pancreatic cancer, which are major causes of cancer fatalities in developed countries, is poorly understood. Many metabolic and physiological processes in the human body utilize trace elements. The creation and development of many diseases like cancer, cardiovascular, and diabetes mellitus occur with the disruption of trace element metabolism in the body as a result of improper nutrition, environmental, and occupational exposure, and impaired digestion and absorption. Methods and materials: In this study, copper (Cu), cadmium (Cd), iron (Fe), cobalt (Co), manganese (Mn), magnesium (Mg), nickel (Ni), zinc (Zn), and lead (Pb) concentrations were researched in the serum of liver cirrhosis and Pancreatic Cancer (PC) patients and healthy controls. Analysis of the elements was carried out by flame atomic absorption spectrophotometer. Results: Fe and Zn serum levels were considerably lower in individuals with liver cirrhosis and pancreatic cancer than in controls (p <0.001). Furthermore, mean serum levels of Cd and Mn in patients with liver cirrhosis and pancreatic Ca were considerably lower than in controls (p <0.01). In addition, when compared to pancreatic cancer, mean serum Cu and Ni levels in liver cirrhosis patients and controls were considerably lower (p <0.05). Mean serum levels of Pb in pancreatic Ca patients were significantly lower compared to liver cirrhosis patients and controls (p <0.05). When comparing all cancer patients to controls, mean serum Co and Mg levels were not substantially different. Conclusion: Deficiency in four trace elements (Cd, Mn, Fe, and Zn) was determined in patients with liver cirrhosis and pancreatic cancer. In addition, we have determined the deficiency of Cu and Ni trace elements (TEs) in pancreatic cancer patients. TE insufficiencies in cancer patients may be due to excessive consumption of foods and undernourishment. Epidemiological and physiological causes of trace element changes should be investigated further.

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

Molecular characterization of chronic liver disease dynamics: From liver fibrosis to acute-on-chronic liver failure

Background & AimsThe molecular mechanisms driving the progression from early-chronic liver disease (CLD) to cirrhosis and, finally, acute-on-chronic liver failure (ACLF) are largely unknown. Our aim was to develop a protein network-based approach to investigate molecular pathways driving progression from early-CLD to ACLF.MethodsTranscriptome analysis was performed on liver biopsies from patients at different liver disease stages, including fibrosis, compensated cirrhosis, decompensated cirrhosis and ACLF, and control healthy livers. We created 9 liver-specific disease-related protein-protein interaction networks capturing key pathophysiological processes potentially related to CLD. We used these networks as a framework and performed gene set-enrichment analysis (GSEA) to identify dynamic gene profiles of disease progression.ResultsPrincipal component analyses revealed that samples clustered according to the disease stage. GSEA of the defined processes showed an upregulation of inflammation, fibrosis and apoptosis networks throughout disease progression. Interestingly, we did not find significant gene expression differences between compensated and decompensated cirrhosis, while ACLF showed acute expression changes in all the defined liver disease-related networks. The analyses of disease progression patterns identified ascending and descending expression profiles associated with ACLF onset. Functional analyses showed that ascending profiles were associated with inflammation, fibrosis, apoptosis, senescence and carcinogenesis networks, while descending profiles were mainly related to oxidative stress and genetic factors. We confirmed by qPCR the upregulation of genes of the ascending profile and validated our findings in an independent patient cohort.ConclusionACLF is characterized by a specific hepatic gene expression pattern related to inflammation, fibrosis, apoptosis, senescence and carcinogenesis. Moreover, the observed profile is significantly different from that of compensated and decompensated cirrhosis, supporting the hypothesis that ACLF should be considered a distinct entity.Lay summaryBy using transjugular biopsies obtained from patients at different stages of chronic liver disease, we unveil the molecular pathogenic mechanisms implicated in the progression of chronic liver disease to cirrhosis and acute-on-chronic liver failure. The most relevant finding in this study is that patients with acute-on-chronic liver failure present a specific hepatic gene expression pattern distinct from that of patients at earlier disease stages. This gene expression pattern is mostly related to inflammation, fibrosis, angiogenesis, and senescence and apoptosis pathways in the liver.

The Prevalence and Association of Cognitive Impairment with Sleep Disturbances in Patients with Chronic Liver Disease.

Introduction/Aim. The aim of this study was to assess the prevalence of cognitive impairments and their association with sleep patterns in a cohort of patients diagnosed with chronic liver disease (CLD). Material and methods. The present paper is a prospective cohort study, carried out over a period of 12 months, among patients with various stages of CLD. We evaluated the cognitive function through psychometric hepatic encephalopathy score (PHES), while sleep was assessed by actigraphy and two self-reported questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Results. Seventy-four patients with CLD were considered eligible and were enrolled between December 2020–November 2021. The prevalence of minimal hepatic encephalopathy (MHE) in the entire cohort was 41.9%, and the diagnosis was considered for PHES scores ≤ −3. Patients with cirrhosis recorded significantly lower PHES scores compared to patients with other CLDs but without cirrhosis (−3.19 ± 3.89 vs. 0.19 ± 2.92, p < 0.05). Patients who exhibited MHE suffered from poor sleep, daytime somnolence, disturbed nighttime sleep, and low overall sleep efficacy. Patients diagnosed with MHE and undergoing treatment with lactulose and/or rifaximin for prevention of overt hepatic encephalopathy (HE) showed better results in terms of sleep parameters compared to patients diagnosed with MHE but without treatment. Conclusions. This research increases awareness regarding the connection between sleep features and MHE in patients with cirrhosis and other CLDs. A deeper insight into the subclinical stages of HE and associated sleep disturbances is warranted in future studies.

Statin Use in Patients With Chronic Liver Disease and Cirrhosis: Current Evidence and Future Directions.

Chronic liver disease (CLD) and its complications constitute a significant cause of mortality and morbidity worldwide. Most deaths are secondary to the decompensation of cirrhosis and evolution of portal hypertension (PHTN). Since disease progression reversal is hardly attainable after decompensated cirrhosis develops, it is essential to intervene early with a therapeutic agent or regimen that could prevent or slow disease evolution. Thus far, there has been no agreed-upon medication to help in the fight against the development of cirrhosis or its decompensation. While early data depicted statins as harmful agents for the liver, current evidence from preclinical and clinical studies suggests that they might have positive impact on CLD. Low-quality evidence supports the fact that statins reduce mortality in CLD. Moderate-quality evidence suggests that statins reduce the risk of hepatic decompensation, variceal bleeding, and mortality, especially among patients with compensated cirrhosis. Combining this data with the long track-record of safety and tolerability of statins and their potential benefits in hepatocellular carcinoma (HCC) risk reduction, hepatologists might soon rely on statins to achieve better outcomes in their CLD and cirrhotic patients without significant additional costs. This review describes the rationale behind the use of statins in patients with CLD and cirrhosis. It sheds light on the current preclinical and clinical studies that reflect beneficial effects of the use of different types and doses of statins in the treatment of patients with different types and stages of CLD and cirrhosis. It also emphasizes the need for designing and developing additional large prospective interventional randomized control trials (RCTs) to better evaluate the association between statin exposure and the risk of fibrosis progression and development of cirrhosis in patients with non-cirrhotic CLDs, the risk of progression of PHTN in patients with cirrhosis, and the mortality rates in patients with cirrhotic or non-cirrhotic CLDs.

Impact of Sarcopenia and Myosteatosis in Non-Cirrhotic Stages of Liver Diseases: Similarities and Differences across Aetiologies and Possible Therapeutic Strategies.

Sarcopenia is defined as a loss of muscle strength, mass and function and it is a predictor of mortality. Sarcopenia is not only a geriatric disease, but it is related to several chronic conditions, including liver diseases in both its early and advanced stages. Despite the increasing number of studies exploring the role of sarcopenia in the early stages of chronic liver disease (CLD), its prevalence and the relationship between these two clinical entities are still controversial. Myosteatosis is characterized by fat accumulation in the muscles and it is related to advanced liver disease, although its role in the early stages is still under researched. Therefore, in this narrative review, we firstly aimed to evaluate the prevalence and the pathogenetic mechanisms underlying sarcopenia and myosteatosis in the early stage of CLD across different aetiologies (mainly non-alcoholic fatty liver disease, alcohol-related liver disease and viral hepatitis). Secondly, due to the increasing prevalence of sarcopenia worldwide, we aimed to revise the current and the future therapeutic approaches for the management of sarcopenia in CLD.

Vitamin B12: A Non-invasive Biomarker for Monitoring Hepatocellular Carcinoma Development among Egyptian HCV-Infected Patients

Several studies have revealed an association between the high serum levels of vitamin B12 (vit B12) and the stage of chronic liver diseases. This study analyzes serum vit B12 levels among Egyptian hepatitis C virus (HCV) and hepatocellular carcinoma (HCC) patients. The serum levels of vit B12 were examined in HCV patients without cirrhosis (HCV group, n=30), with cirrhosis (HCV+cirrhosis group, n=24), HCC patients (HCC group, n=30), and healthy individuals (control group, n=16). Serum vit B12 levels increased significantly in HCV+cirrhosis and HCC groups compared with the control group. HCC patients showed a significant increase in vit B12 levels compared with HCV patients with cirrhosis. Moreover, HCV patients without cirrhosis showed no significant increase in vit B12 level than the control group. Also, patients with fibrosis scores (F) from F2 to F4 showed a significant increase in serum vit B12 levels compared with the control group. Regarding correlations with liver functions, serum vit B12 was negatively correlated with serum albumin level and positively correlated with total bilirubin level. Interestingly, serum vit B12 was also positively correlated with serum AFP level. This clinical study revealed that the level of vit B12 could be used as a non-invasive biomarker to monitor liver fibrosis and HCC development among HCV-infected patients.

Study of arterial blood gases in different stages of chronic liver diseases

BackgroundEarly detection of arterial gas abnormalities and acid–base disturbances in patients with chronic liver disease is essential to improve prognosis on the basis of pulmonary and liver diseases. The aim of the current study was to detect arterial blood gas changes, acid–base disturbances, and prevalence of hepatopulmonary syndrome (HPS) in different classes of severity of chronic hepatic disease for achieving a higher survival rate.ResultsPatients with hypoxemia represented 38 (33.6%) cases: three (15.7%) of 19 patients in group A, 16 (33.3%) of 48 patients in group B, 12 (34.2%) of 35 patients in group C, and seven (63.6%) of 11 patients with encephalopathy. Highly statistically significant decreases in arterial blood partial pressure of O2 and oxygen saturation were found with the increase in the severity of the hepatic disease and cirrhosis as assessed using the Child–Pugh score. Moreover, partial pressure of O2 was lowest in patients with encephalopathy. HPS was present in 22 (19.4%) patients with hypoxemia. A total of 12 patients were Child class C, eight patients were Child class B, and two patients were Child class A. Acid–base disturbances were observed in 82 (72.6%) patients, respiratory alkalosis in 49 (43.4%) patients, metabolic alkalosis in 10 (8.8%) patients, metabolic acidosis in seven (6.2%) patients, respiratory acidosis in eight (7.1%) patients, and mixed disturbances in eight (7.1%) patients.ConclusionsPatients with hypoxemia were found to have a higher score of Child–Pugh than patients not having hypoxemia. HPS was found in all three Child–Pugh classes but mostly in Class C, so it is recommended that every patient with chronic liver disease should be evaluated and assessed for therapeutic decision, control of symptoms, improving survival, and quality of life.

Estimation of Serum Sodium, Potassium and Calcium Levels as Prognostic Markers in Cirrhosis of Liver: A Study Protocol

Background: Cirrhosis of the liver is final stage of chronic liver disease [1], which can lead to complications associated with portal hypertension and liver failure. In a much remunerated state, the cirrhotic patient maintains close association to traditional solution and acid–base standing, however this delicate balance may be discontinuous by malady progression, infection, dietary indiscretion/deprivation, or medicine intervention. Many mineral metabolism disorders are represented in relation with hepatic diseases. This study aims to estimate the levels of Sodium, Potassium and Calcium in Cirrhosis of Liver and correlate them with severity of cirrhosis and in-hospital morbidity and mortality.&#x0D; Materials and Methods: This cross-sectional study is planned to be carried out in Medicine department, AVBRH, Wardha. Total 50 patients with liver diseases will be enrolled. The lab. investigations will include different parameters of liver function tests along with assessment of sodium, potassium and calcium level. Child-Pugh, end-stage liver disease scores model will be determined using required formulas. All such patients’ in-hospital death records will be collected. Data will be collected and analyzed. The mean and standard deviations of the measurements per cluster will be used for applied analysis (SPSS twenty-two.00 for windows; SPSS INC, Chicago, USA). For every assessment purpose, data will be statistically analyzed using factorial ANOVA. Distinction between 2 groups determined using student t-test similarly as chi sq. test (p &lt;.05).&#x0D; Expected Results: We expect significant correlation between the level of Na, K and Calcium with in-hospital morbidity and mortality in patients of cirrhosis.&#x0D; Conclusion: Serum levels of calcium, potassium and sodium should be integrated into model for predicting in-hospital mortality in patients of cirrhosis. Considering that prognostic accuracy of elements may well be comparatively modest, any studies ought to confirm clinical quality of liquid body substance sodium, potassium, and Ca concentrations.

Assessment of Sleep among Patients with Chronic Liver Disease: Association with Quality of Life.

The present study aims to assess the sleep characteristics and health-related quality of life (HRQOL) among patients with chronic liver diseases (CLDs), as well as the relationship between them. We conducted a prospective cross-sectional study, over a period of eight months, on patients with CLDs. Sleep was assessed by subjective tools (self-reported validated questionnaires), semi-objective methods (actigraphy), and HRQOL by using the 36-Item Short Form Survey (SF-36) and Chronic Liver Disease Questionnaire (CLDQ). The results indicated that 48.21% of patients with CLDs had a mean Pittsburgh Sleep Quality Index (PSQI) score higher than five, suggestive of poor sleep; 39.29% of patients had a mean Epworth Sleepiness Scale (ESS) score ≥11, indicative of daytime sleepiness. Actigraphy monitoring showed that patients with cirrhosis had significantly more delayed bedtime hours and get-up hours, more awakenings, and more reduced sleep efficacy when compared to pre-cirrhotics. The CLDQ and SF-36 questionnaire scores were significantly lower in cirrhotics compared to pre-cirrhotics within each domain. Moreover, we identified significant correlations between the variables from each questionnaire, referring to HRQOL and sleep parameters. In conclusion, sleep disturbances are commonly encountered among patients with CLDs and are associated with impaired HRQOL. This is the first study in Romania that assesses sleep by actigraphy in a cohort of patients with different stages of CLD.

NUTRITIONAL APPROACHES TOWARDS PREVENTION AND TREATMENT OF DCLD

Decompensated chronic liver disease (DCLD) is also known as decompensating cirrhosis. Cirrhosis is a chronic liver disease that is commonly resulting of hepatitis or alcohol use disorder. It is the severe scarring of liver seen at the terminal stages of chronic liver disease. The diet of patients with chronic liver disease is based on a standard diet with supplements addition as necessary. Restrictions may be harmful and should be individualized. In this study we detailed a patient having decompensated chronic liver disease and observed all require parameter in dietary management. The patient undertook a dietary counselling for 16 days and dietary modification was done according to the patient condition. The HB level was 9.1g/dl, so beetroot juice in the mid-morning and soybean and 2 egg whites were suggested to increase the protein level. Later it was seen that Hb level was increased to 9.9g/dl and protein level was increased to 6g/dl. Also, the potassium level was below normal, so coconut water suggested. what to avoid and what to include and a sample menu and a diet chat was given to the patient at the time of discharge. Malnutrition is a potentially reversible condition that, when identified and treated appropriately, can lead to improvement of the outcomes of patients with DCLD.

Update on blood-based biomarkers for chronic liver diseases prognosis: Literature review and institutional experience.

Liver cirrhosis is the final stage of chronic liver disease (CLD) and is associated with high morbidity and mortality. Various complications such as portal hypertension, ascites retention, hepatic encephalopathy, and hepatorenal syndrome deeply affect patient outcome. The most common tools to predict the outcome of a CLD patient include the following: assessing severity of portal hypertension; scoring systems such as the model of end‐stage liver disease and Child–Pugh score and blood biomarkers related to complications and/or survival rate. In this article, we summarize recent studies of noninvasive markers for predicting impending complications related to CLD and discuss the clinical value of currently available blood biomarkers based on evidence from the literature. In addition, noninvasive blood biomarker assays for different prognostic functions were validated on 113 liver cirrhosis patients at our institution using Kaplan–Meier curve analysis to confirm that these markers can satisfactorily predict CLD‐related patient death.

Fibroblast Growth Factor 21 Augments Autophagy and Reduces Apoptosis in Damaged Liver to Improve Tissue Regeneration in Zebrafish.

Regeneration of a part of the diseased liver after surgical resection is mainly achieved by the proliferation of the remaining healthy liver cells. However, in case of extreme loss of liver cells or in the final stages of chronic liver disease, most liver cells are depleted or lose their ability to proliferate. Therefore, to foster liver regeneration, it is of great clinical and scientific significance to improve the survival and proliferation ability of residual hepatocytes. In this study, we conducted experiments on a zebrafish model of targeted ablation of liver cells to clarify the role of fibroblast growth factor 21 (FGF21). We found that FGF21 increased the regeneration area of the damaged liver and improved the survival rate of damaged liver cells by inhibiting cell apoptosis and reducing oxidative stress. Our results also showed that administration of FGF21 upregulated autophagy, and the beneficial effects of FGF21 were reversed by the well-known autophagy inhibitor chloroquine (CQ), indicating that FGF21-activated autophagy played a central role in the treatment. We further showed that the enhancement of autophagy induced by FGF21 was due to the activation of the AMPK-mTOR signaling pathway. Taken together, these data provide new evidence that FGF21 is an effective autophagy regulator that can significantly improve the survival of damaged livers.

Regulatory T Cells Improved the Anti-cirrhosis Activity of Human Amniotic Mesenchymal Stem Cell in the Liver by Regulating the TGF-β-Indoleamine 2,3-Dioxygenase Signaling.

Liver fibrosis is a progression stage of chronic liver disease, while current therapies cannot cure or attune cirrhosis effectively. Human amniotic mesenchymal stromal cell (hAMSC) presented immunoregulatory and tissue repairability of multiple illnesses. Regulatory T cells (Treg) had been proved to be functional in reducing immune cell activity. We showed that co-infusion of hAMSC and Treg prevented mild liver fibrosis comparing with hAMSC or Treg alone group. In vitro study indicated that the addition of Treg or the supernatant of Treg improved the hepatocyte growth factor (HGF) secreting and cell differentiation ability of hAMSC. Reduction of TGF-β significantly decreased the HGF secreting and differentiation of hAMSC. Multiple signal neutralizers were added to the culture to understand further the mechanism, which showed that 1-MT, the suppressor of Indoleamine 2,3-dioxygenase (IDO), was involved in the effect of TGF-β in regulating hAMSC. Depletion of TGF-β or IDO signaling successfully abolished the effect of Treg in improving hAMSC’s function both in vitro and vivo. Finally, our result indicated that Treg improved the function of hAMSC by regulating the TGF-β-IDO signaling and co-infusion of hAMSC and Treg provided a promising approach for treating liver cirrhosis.

P-59 LIVER TRANSPLANTATION: SIX YEARS EXPERIENCE IN A UNIVERSITY HOSPITAL OF CHILE

Liver transplantation (LT) has improved the quality of life and survival of patients in advanced stages of chronic liver disease (CLD). In the last decade, an increase in non-alcoholic steatohepatitis (NASH) as an indication for LT has been evidenced worldwide. There is little up-to-date information regarding the characteristics of LT performed in our country. To describe the clinical characteristics of LT performed at the Hospital Clínico de la Universidad de Chile in the last 6 years. Retrospective study. LT performed between September 2013 and September 2019 were included. Clinical data, aetiology of DHC and MELD-Na were recorded at the time of transplantation. 145 LT were performed, 60.6% being men, the median age was 59 years (22-72 years). The main etiology of CLD was NASH (39.3%), followed by CLA attributed to alcohol (17.9%) and autoimmune hepatitis (7.6%). 33.1% of the patients had hepatocellular carcinoma (HCC), of which 54% were patients with NASH. The mean MELD-Na at transplantation was 22 ± 9 and the operational MELD 28 ± 5. In our center, NASH is the first indication for LT, as well as the etiology most frequently related to the presence of HCC. These data are consistent with projections estimated worldwide. This information reaffirms the need for successful strategies to prevent and reverse the progression of NASH.

The Concentration of 25-Hydroxy Vitamin D in Chronic Liver Disease and its’ Correlation with Severity

Chronic Liver Disease (CLD) is a common disease all over the world and the major biological factors are Hepatitis B virus (HBV) and Hepatitis C virus (HCV) in Bangladesh and Alcoholic liver disease in the western world. Life expectancy of CLD patient is increasing now a days by available modern treatment; but the long term complications are now evident. Hepatic osteodystrophy is one of the most common complication which is associated with vitamin D deficiency. Vitamin D undergoes hepatic 25-hydroxylation, but as the hepatic parenchyma is jeopardized so the metabolic activation of this vitamin is impaired. The aim of the study was to measure the concentration of 25-hydroxy vitamin D 25(OH) D in CLD patient in different etiology and to find out the relationship of level of 25(OH) D in different stages of the disease according to Child-Pugh classification. This cross sectional study was carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of April 2015 to March 2016. Patients attending the Gastroenterology Department with cirrhosis of liver and who fulfilled the inclusion criteria were initially enrolled for the study. Study objectives were explained and informed consent was taken from patients prior to record their clinical history, examination findings and initial investigation reports in the standard data sheet. The diagnosis of liver cirrhosis was made by combination of clinical features, blood profile and trans abdominal ultrasonography (T. USG). Endoscopy of the upper GIT was also done to see the presence of oesophageal or gastric varices which is a sign of increase portal pressure. Stages of CLD were assessed by Child-Pugh scoring system and level of 25(OH) D was measured from blood with the help of the Department of Bio-chemistry. Data was collected using a structured data sheet and analyzed by SPSS. Out of 85 patients, male-female ratio was 3:1 and mean age was 53.0 ± 10.7 year within the range of 25-70 years. Most of the patients had acites 92.9% and anorexia 90.6%; where four-fifth patients had weight loss and more than one third had Jaundice. Nearly half of the patients had abdominal pain and 42.4% had melaena. Four-fifth patients had history of blood transfusion and most of them had H/O hospitalization 94.8%, anaemia (97.6%) and Splenomegaly 92.9%. More than half (52.9%) of patients had bone pain; where jaundice 61.2% and Leukonychia 61.2% were detected in equal number of patients. Mean vitamin 25(OH) D was 16.29 ± 7.96 in 69 HBV patients and 20.14 ± 9.76 in 16 HCV patients. In this study, 28.2% patients were in child Pugh A, 36.4% in child Pugh B and 32.9% in child Pugh C stages. Mean vitamin 25(OH) D were 27.12 ± 6.11, 15.97 ± 5.40 and 9.57 ± 1.I5 in Child-pugh A, Child-pugh B and Child-pugh C stages respectively. Mean vitamin 25(OH) D was observed at decreased level as the changes of stage from lower to higher. Vitamin D deficiency was highly prevalent in patients with CLD and inversely correlated with disease severity. In the case of chronic liver diseases, vitamin D seems to modulate the innate and adaptive immune system, which explains the association. This study suggest that these parameters may improve with vitamin D supplementation. Monitoring of S. 25(OH) D is reasonable in CLD patient.&#x0D; Bangladesh Med J. 2020 Sept; 49(3) : 35-42

Nurses' Knowledge and Practice Regarding Nursing Care of Patients with Liver Cirrhosis

Background:Cirrhosis of the liver is the end stage of chronic liver disease. Nurses role very important to patient with liver cirrhosis. Aim:Assess nurses, knowledge and practice regarding nursing care of patients with liver cirrhosis. Subjects and Method:A descriptive research design was used. Setting: The study was conducted medical unit at Ismailia university hospital, Ismailia general hospital and Port-Said general hospitals (Port-Said, Port-Fouad and AL-Zehor central). Subjects: A 150 convenient nurses participated in the study Tools: Data were collected using two tools, Nurses' Knowledge questionnaire and Observational Check list for practice. Result: The result of study indicated that 78.65% and 63.09% of studied nurses had unsatisfactory knowledge and practice Conclusion: Most of the studied nurses had unsatisfactory knowledge and practice regarding care of patients with liver cirrhosis. Recommendations: There are obvious needs for conducted an educational and training programs to improve nurse's knowledge and practice regarding nursing care of patients liver cirrhosis.

Assessment of Malnutrition in Chronic Liver Disease Patients with the Child Pugh Classification at a Large Tertiary Care Center in Karachi, Pakistan

Background: Child Pugh classification is an easy-to-use method that allows Physicians to assess malnutrition in patients suffering from CLD. Objective: To determine the frequency of malnutrition at different stages of chronic liver disease in accordance with Child Pugh classification. Study Design: The type of study is a cross-sectional study. Settings: Medical Unit III Civil Hospital, Karachi Pakistan. Duration: Six months from 31st May 2016 to 30th November 2016. Methodology: All the patients between the age 30 to 60 years who are known cases of CLD secondary to hepatitis B, C or both, with active signs of CLD were included. All the patients having debilitating co-morbidities likes malignancy, TB, psychiatric, etc. were excluded. Anthropometric evaluation and lab investigation at the time of admission were performed for all the patients. Results: The average age was 48.12±8.521 years and duration of disease was 5.48±3.792 months. There were 61.54% male and 38.46% females. Hepatitis-B was observed in 19.91% (n=44) cases, Hepatitis-C was 62.44% (n=62.44) and both hepatitis B and C was observed in 17.65% (n=39) cases. According to Child Pugh score, 9.5% cases were in class A, 32.58% were in class B and 57.92% were in class C. Frequency of malnutrition in chronic liver disease patients was 62.44% (138/221). Rate of malnutrition was significantly high in class B and C (p=0.002). Rate of malnutrition was also observed to be significantly high in those cases who were positive for both hepatitis like B and C (p=0.001). Effect of duration of cirrhosis was also not statistically significant with malnutrition. Conclusion: Malnutrition was significantly common among chronic liver disease patients regardless of viral etiology. Child Pugh B &amp; C patients were found to have more significant malnourished states.

Decreased maximal cortisol secretion rate in patients with cirrhosis: Relation to disease severity

Background & AimsHepatic enzymes play a major role in the metabolic elimination of cortisol, and reduced rates of cortisol clearance have been consistently observed in patients with chronic liver disease. It is less clear whether there are concomitant abnormalities of adrenocortical function in patients with cirrhosis. In the present study, we sought to assess adrenocortical function in patients with cirrhosis using measures of free cortisol appearance and elimination rates that are independent of serum concentrations of cortisol binding proteins.MethodsPost hoc analysis used computer-assisted numerical and modelling methods with serial total and free cortisol concentration data to obtain rates of free cortisol appearance and elimination. Rate parameters were obtained in 114 patients with chronic liver disease, including Child-Pugh (CP) ≤8 (n = 53) and CP >8 (n = 61).ResultsMaximal cortisol secretion rate (CSRmax) was significantly decreased (p = 0.01) in patients with cirrhosis with CP >8 (0.28 nM/s; 95% CI 0.24–0.34) compared with those with CP ≤8 (0.39 nM/s; 95% CI 0.33–0.46), and CSRmax was negatively correlated with CP score (r = −0.19, p = 0.01). Free cortisol elimination rate was significantly (p = 0.04) decreased in the CP >8 group (0.16 ± 0.20 min−1) compared with that in the CP ≤8 group (0.21 ± 0.21 min−1), and free cortisol elimination rates were negatively correlated with CP score (r = −0.23, p = 0.01). A significant correlation between CSRmax and free cortisol elimination rate (r = 0.88, p <0.001) was observed.ConclusionsCSRmax and free cortisol elimination rates were significantly reduced according to severity of cirrhosis. In contrast to stimulated total cortisol concentrations, CSRmax estimates were independent of cortisol-binding protein concentrations. Results provide additional evidence of subnormal adrenocortical function in patients with cirrhosis.Lay summaryWe applied numerical analytic methods to characterise adrenocortical function in patients with varying stages of chronic liver disease. We found that patients with more severe cirrhosis have decreased rate of free cortisol elimination and decreased maximal cortisol secretion rate, which is a measure of adrenocortical function. In contrast to conventional measures of adrenocortical function, those obtained using numerical methods were not affected by variation in corticosteroid binding globulin and albumin concentrations. We conclude that patients with cirrhosis demonstrate measurable abnormalities of adrenocortical function, evidence of which supports aspects of the hepatoadrenal syndrome hypothesis.

Blood reelin in the progression of chronic liver disease

PurposeReelin is an extracellular matrix protein originally found to be associated with neuropsychiatric disorders. Recent findings indicate, that reelin may also play an important role in the process of liver fibrosis as well as in the development of hepatocellular carcinoma (HCC). Against this background, the aim of our study was to explore alterations in blood reelin levels in different stages of chronic liver diseases. Patients and methodsWe analyzed blood samples of patients with chronic liver disease without liver fibrosis (n ​= ​25), with liver fibrosis (n ​= ​36), with liver cirrhosis (n ​= ​74), with HCC (n ​= ​26) as well as of healthy controls (n ​= ​15). Blood reelin concentrations were determined utilizing an enzyme-linked immunosorbent assay. ResultsBlood reelin levels were significantly elevated in patients who had liver fibrosis or cirrhosis compared to patients without liver fibrosis and healthy controls (13.9 (10.2–21.1) ng/ml vs. 11.2 (8.8–16.8) ng/ml, p ​= ​0.032). Importantly, patients with HCC displayed significantly higher reelin concentrations compared to patients with liver cirrhosis alone (27.0 (17.3–35.9) ng/ml vs. 16.6 (11.0–22.7) ng/ml, p ​< ​0.001). Blood reelin was not relevantly linked to liver function, inflammation and etiology of liver disease. ConclusionsOur results demonstrate, that blood reelin levels are altered in different stages of chronic liver disease, which makes reelin a potential biomarker in this setting. This may be especially relevant with regard to its use as an additional tumor marker of HCC.