Diastolic versus systolic dysfunction in patients with chronic liver disease ­ a single center study in South-South, Nigeria

Objectives: The term cirrhotic cardiomyopathy (CCM) has been used to describe the constellation of cardiovascular abnormalities including diastolic and systolic dysfunctions in patients with chronic liver disease (CLD). CCM contributes to morbidity and mortality associated with CLD. The aim of the study was to evaluate the left atrial and ventricular geometry, systolic and diastolic functions in patients with CLD. Material and Methods: This was a cross-sectional analytical study that involved 80 patients with CLD seen at University of Calabar Teaching Hospital, Calabar, Nigeria, and 80 apparently healthy controls matched for age/ gender. The participants were interviewed, examined and had resting transthoracic echocardiography. The data were analyzed using IBM SPSS version 20.0. Results: A total of 160 subjects were recruited into the study with a male to female ratio of 2.8:1. There was no difference in the mean age of cases and controls (P = 0.115). Systolic function of the left ventricle was similar in the two arms. However, left ventricular diastolic dysfunction, left atrial enlargement, and increased left ventricular mass index (LVMI) were more prevalent among the patients with CLD compared to controls (P < 0.05). Conclusion: The study demonstrated increased left atrial diameter, increased LVMI associated with diastolic dysfunction, and preserved systolic function at rest among CLD patients. Keywords: Chronic liver disease, Diastolic dysfunction, Systolic dysfunction

Early prediction of acute kidney injury in patients with acute on chronic liver failure by measuring kidney injury Molecule-1 level in Urine at Zagazig University Hospitals

Background and study aim: Some of patients with decompensated cirrhosis will exhibit newly developed acute liver failure. This condition is called acute-on-chronic liver failure (ACLF). Acute kidney injury (AKI) is common with ACLF. Kidney injury Molecule-1 (KIM-1) is an ideal biomarker of AKI. The aim of this study was to evaluate role of KIM-1 in prediction of AKI in ACLF patients. Patients and Methods: Eighty four patients were included in this study. They were selected from hospitalized patients with acute decompensated cirrhosis. They were allocated into two groups; group I: patients with no acute-on-chronic liver failure (ACLF), group II: patients with ACLF. Results: KIM-1 was significantly higher in the ACLF (group II). KLM-1 median was 2.4 in group I vs 7.35 in group II with p value <0.001. We found that at cut off value of ≥0.5 KLM-1 can predict the presence of AKI with sensitivity of 85.7%, specificity 88.1%, positive predictive value 87.8%, negative predictive value 86%, accuracy 86.9% and AUC= 0.867 p <0.001. Conclusion: KLM-1 rises significantly in patients with ACLF. KLM-1 can be reliable in prediction of the presence of acute kidney injury in decompensated cirrhosis