Systemic inflammatory response syndrome in patients with liver cirrhosis

Patients with liver cirrhosis present an increased susceptibility to the systemic inflammatory response syndrome [SIRS], which is considered the cause of hospital admission in about 10% of patients and is present in about 40% of those admitted for ongoing complications. We tried to assess the prevalence of the SIRS with the possible effects on the course of the disease during hospital stay. Two hundred and three patients with liver cirrhosis were examined and investigated with close monitoring during hospital stay. The main clinical endpoints were death and the development of portal hypertension-related complications. Eighty-one patients met the criteria of SIRS [39.9%]. We found significant correlations between SIRS and jaundice [p = 0.005], bacterial infection [p = 0.008], white blood cell count [p < 0.001], low haemoglobin concentration [p = 0.004], high serum creatinine levels [p < 0.001], high alanine aminotransferase levels [p < 0.001], serum bilirubin levels [p < 0.001], international normalised ratio [p < 0.001], serum albumin levels [p = 0.033], high Child-Pugh score [p < 0.001]. During the follow-up period, 26 patients died [12.8%], 15 developed portal hypertension-related bleeding [7.3%], 30 developed hepatic encephalopathy [14.7%], and 9 developed hepatorenal syndrome type-1 [4.4%]. SIRS showed significant correlations both to death [p < 0.001] and to portal hypertension-related complications [p < 0.001]. The systemic inflammatory response syndrome occurs in patients with advanced cirrhosis and is associated with a bad prognosis

Assessment of serum hyaluronic acid and N-acetylglucosamine levels in chronic hepatitis C patients

Knowledge of the stage of liver fibrosis is essential for prognosis and decisions on antiviral treatment. Liver biopsy is currently the gold standard in assessing the liver histology. There is an increasing desire for non-invasive tests to assess the stage of liver fibrosis or cirrhosis. Serum hyaluronic acid [SHA] and N-acetylglucosamine [NAG] could be a hope for clinicians to diagnose or exclude fibrosis and cirrhosis. Therefore, the present study was done to assess SHA and NAG levels in chronic hepatitis C [CHC] patients and to determine the cut off values of these markers to predict fibrosis or cirrhosis. The present study was conducted on 89 subjects [20 controls and 69 CHC patients]. The HCV infection was diagnosed based on positive HCV antibodies and positive HCV-RNA. Percutaneous-ultrasoundassisted liver biopsies were done for all patients and assessed by the METAVIR scoring system. According to the results of the liver biopsy, the patients were classified into 3 groups. Group I included 15 patients without fibrosis [F0]. Group II included 35 patients with significant fibrosis [F1-F3]. Group III included 19 patients with cirrhosis [F4]. SHA levels were determined using enzyme-linked binding protein assay Kits and NAG levels were assayed by reverse phase-high performance liquid chromatography [RP-HPLC]. There were highly significant elevations of SHA and NAG in patient group when compared to the control group. Moreover levels of SHA and NAG increase with the extent of fibrosis. SHA with cut off value of less than 25 ng/ml was used to exclude fibrosis or cirrhosis with a sensitivity of 68% and specificity of 58%. SHA with cut off value of more than 200 ng/ml was used to detect significant fibrosis with sensitivity of 93% and specificity of 95%. SHA with cut off value of more than 350 ng/ml was used to detect cirrhosis with sensitivity of 92% and specificity of 100%. NAG with cut off value of less than 25 ng/ml was used to exclude fibrosis or cirrhosis with sensitivity of 60%, specificity of 55%. NAG with cut off value of more than 40 ng/ml was used to detect significant fibrosis with sensitivity of 90% and specificity of 92%. NAG with cut off value of more than 55 ng/ml was used to detect cirrhosis with sensitivity of 90% and specificity of 86%. SHA and NAG were correlated negatively with serum albumin, prothrombin concentrations and platelet count and positively with the degree of fibrosis. Serum hyaluronic acid and N-acetylglucosamine are highly valuable and informative in detection of significant fibrosis and cirrhosis while they are of limited value in exclusion of minimal fibrosis

Serum leptin in end-stage renal disease patients on hemodialysis: its value as a malnutrition marker

Leptin is a protein hormone secreted by adipocytes in proportion to the amount of body fat and exerts sustained inhibitory effects on food intake while increasing energy expenditure. It has been reported that serum leptin levels are high in patients with chronic renal failure and may have a potential impact on the development of uremic cachexia. The present study aimed to evaluate serum leptin level and its relation to markers of malnutrition in non diabetic patients with end-stage renal disease [ESRD] treated with hemodialysis. Serum leptin level was measured in 48 ESRD patients [30 males and 18 females] on regular hemodialysis, and in 20 healthy control subjects. The nutritional status was checked by anthropometric measurements [body mass index [BMI] and triceps skin fold thickness [TSFT]] and laboratory data [hemoglobin, hematocrite, serum albumin, pre-albumin, total protein, and blood urea nitrogen]. Patients were included if they were on hemodialysis for more than one year, anuric, had normal C reactive protein values and had no history of diabetes mellitus, liver disease or chronic pulmonary disorders. The mean serum leptin level was higher in ESRD patients [28.5 +/- 15.3ng/ml] compared to the control [5.2 +/- 3.8ng/ml; P<0.001]. The indices of hematological and protein-energy malnutrition were evident in hemodialysed patients compared to controls. The mean serum leptin was significantly higher in male patients compared to the male control group [11.5 +/- 4.7 vs 3.2 +/- 2.1ng/ml, P<0.01]. Also, serum leptin was significantly higher in the female patients compared to the female control group [35.8 +/- 12.1 vs 12.7 +/- 4.5ng/ml, P<0.001]. The mean BMI for female patients was significantly higher than male patients [24.4 +/- 4.1 vs 21.1 +/- 5.6kg/m2, P<0.04]. The mean TSFT for female patients was significantly higher than male patients [13.8 +/- 3.2 vs 10.7 +/- 2.2mm, P<0.05]. A positive correlation was found between the TSFT and leptin, both in male [r=0.44, P<0.03] and female patients [r=0.71, P<0.01]. Also, there was a positive correlation between the BMI and leptin both in male [r=0.41, P<0.02] and female patients [r=0.67, P<0.01]. No correlation was observed between serum leptin with the length of time on dialysis, total protein, serum albumin, pre-albumin, hemoglobin, hematocrite, creatinine and blood urea levels. Serum leptin is markedly elevated in patients with ESRD on hemodialysis. It is significantly correlated with the BMI and TSFT and could be utilized as a potential indicator of malnutrition in these patients. Further studies may provide a therapeutical approach aiming to neutralize serum leptin levels or blocking its effect on the hypothalamus to prevent uremia-associated malnutrition