ABSTRACT
Background: Malnutrition is commonly seen in cirrhotic patients and has been shown to adversely affect outcome. However, it remains associated with the severity of cirrhosis. Therefore, its role as an independent prognostic factor is still under debate. The aims of our study were to determine the prevalence of malnutrition in cirrhotic patients and determine whether this condition was an independent prognostic factor
Patients and methods: We prospectively analyzed the nutritional status of 104 consecutive patients with cirrhosis Subjective global nutritional assessment [SGA] and anthropometry [dry body mass index [BMI], triceps skinfold [TSF], arm muscle circumference [AMC]] were used for the evaluation of the nutritional status. Complications of cirrhosis during follow-up and patient's survival were recorded. Global survival and survival without complications was studied by Kaplan Meier method and using Log Rank test
Results: Prevalence of malnutrition ranged from 16.3 and 62.5% according to the method of nutritional assessment used. Survival without complications was reduced in malnourished patients. This difference was significant when assessing malnutrition by dry BMI [p=0.001]. In multivariate analysis, malnutrition defined by dry BMI<18.5 kg/m2 was an independent predictor of complications [p<0.001; RR 3.2] especially hepatic encephalopathy [p=0.001; RR 2.66]. In univariate analysis, global survival was worse in malnourished patients [by BMI and SGA; p=0.03 and p=0.0014 respectively], but this trend was lost in multivariate analysis
Conclusion: In our study, malnutrition was an independent predictor of complications in cirrhosis. However, it did not appear as an independent prognostic factor for global survival. These results raise again difficulties to clarify whether malnutrition influence itself the prognosis of cirrhosis or if it is only related to the severity of cirrhosis
ABSTRACT
Background: Hyponatremia is the most common electrolyte abnormality encountered in cirrhotic patients. Recent studies have shown that hyponatremia was correlated with severity of cirrhosis and associated with increased risk of complications and mortality. However this relationship is still unclear. The aims of the present study were to search predictive factors for hyponatremia in cirrhosis and to assess its prognostic value
Methods: We performed a retrospective study, including consecutive cirrhotic patients admitted to our department between January 2011 and April 2014. Patients and cirrhosis characteristics were studied. Serum sodium levels were determined at admission. The cutoff level of 130 mmol/l was chosen because it is widely accepted to define hyponatremia in patients with cirrhosis. Predictive factors of hyponatremia development and its impact on the outcome [cirrhosis complications and survival] were evaluated
Results: We included 143 cirrhotic patients: 67 females [46.9%] and 76 males [53.1%] with a mean age of 58 years. Etiology of cirrhosis was mainly viral [56.7%]. Child-Pugh stage was B in 41.2% and C in 25.9%. Mean MELD score was 15 [6-40]. The prevalence of dilutional hyponatremia as defined by a serum sodium concentration 16 [OR=6.76; p=0.001]. Survival without complications was reduced in patients with hyponatremia but was only significant if a serum sodium concentration
Conclusion: Low serum sodium level was correlated with severity of cirrhosis. Hyponatremia was a negative prognostic factor associated with increased short-term morbi-mortality
ABSTRACT
Background: Introduction: Upper gastrointestinal endoscopy [UGE] is an increasing and reliable procedure. Given the high costs and potential risks, appropriate indication of UGE may be facilitated by referring to qualifying criteria such as those devised by the European Panel [EPAGE]. This prospective study evaluates the applicability and efficacy of these criteria in clinical practice
Methods: Cross sectional study. Consecutive patients were referred to our unit endoscopy for diagnostic upper gastrointestinal endoscopy between January 2011 and June 2011. Demographic data, indication of the procedure, and endoscopic diagnosis were collected. The appropriateness of UGE was assessed based on EPAGE II criteria before the procedure
Results:EPAGE criteria were applicable in 89.1% of cases. They were 78 men [48.1%] and mean age was 49 years [14 - 91]. Indications for UGE were extremely appropriate, appropriate, inappropriate and uncertain in 21.6%, 47.4%%, 8.8% and 22.2% respectively. Among patients with clinically significant lesions detected by UGE, 70.7% had an appropriate indication. Clinically significant lesions were disclosed in 59% of the appropriate group and 54% of the inappropriate group. All cancers were observed in patients with appropriate indications. Patients with appropriate indication were older than patients belonging to the inappropriate group [53.6 years versus 39.9 years, p =0,0001]
Conclusion: In this present study, EPAGE criteria were applicable in 89.1% and indication was judged appropriate in more than two-third of cases. However, clinical significant lesions were observed in a proportion of patients with inappropriate indication, and in some relevant clinical situations EPAGE criteria were not applicable. Therefore, even if these criteria are helpful for decision-making, final decision must however rely upon practitioner. Qualifying criteria for an appropriate selection of endoscopical procedure adapted to our population are advisable
ABSTRACT
Little is known in inflammatory bowel disease [IBD] regarding risk factors for psychological distress. The aims of our work were to evaluate the frequency of anxiety and depression among patients with IBD and to determine the factors associated with these psychological disorders in Tunisian patients. From June 2012 to April 2013, 60 consecutive patients with IBD answered a questionnaire about psychological and socioeconomic factors and adherence to treatment. In this study we focused the analysis on the characteristics of IBD [type, localization, severity, treatment] and socioeconomic factors [professional, educational, and marital status]. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale [HADS]. According to the HADS, 25 patients [41.6%] were anxious while 4 [6.6%] were depressed. Three had anxiety and depression at the same time. Twelve patients had a probable anxiety, 2 patients had a probable depression and 3 patients had a probable depression and anxiety at the same time. By univariate analysis, factors associated with anxiety and depression were: female gender [p<0.03], rent [p<0.03], high school graduation [p<0.009], IBD type ulcerative colitis [p<0.05]. By multivariate analysis, independent factors associated with these emotional disorders were: female gender [p=0.005, OR 11.3], the high school graduation [p=0.004, OR 12.1]. In our cohort, risk factors for anxiety and depression were the high school graduation and IBD type ulcerative colitis. Consequently, psychological interventions would be useful when these factors are identified