Morbidity and mortality in icu patients with end stage liver disease

Acute or chronic liver failure is associated with numerous complications which may occur in combination and patients may require intensive care unit [ICU] treatment; many do not survive. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. To estimate the frequency of different morbidity changes and to evaluate risk factors responsible for mortality among patients with end stage liver disease [ESLD] admitted to the ICU. A total of 120 patients with ESLD were enrolled [102 males [85%] and 18 females [15%]. All were consecutively admitted to the ICU at the Tropical Medicine and Gastroenterology Department, Assiut University Hospital from May 1[st] to August 31[st], 2013. Full history taking, thorough clinical examination, full investigations and assessment of patients accordinglo C-hild-Turcotte-Pugh [CTP] class and Model for End-stage Liver Disease [MELD] score were done with close monitoring and follow up. The mean age of patients was [56.23 +/- 11.21] years. Regarding clinical presentation, hepatic cncephalopathy [HE] was found in 87.5%, jaundice in 60%, hematemesis in 41.7%. hepatorenal syndrome [MRS] in 35.8% and spontaneous bacterial peritonitis [SBP] in 20.8%. The majority of patients [86.7%] were CTP class C. Mortality rate was 57.5%; the main causes of death were HRS [10.8%], HE[21.7], aspiration pneumonia [10%], septic shock [2.5%] and irreversible shock in only.7%. There was a significant correlation between mortality and old age, CTP and MELD scores and a longer stay at the ICU. We found six risk factors independently affecting the outcome of ESLD patients in the ICU. Those were HE, jaundice, HRS, increased white blood cell count, increased hemoglobin and decreased prothrombin concentrations. Among ESLD patients having more risk factors, mortality rates were higher, 86.2% with 5-6 risk factors and 21.7% with 1-2 risk factors. Rates of improvement were highest with 1-2 risk factors [78.3%] and worst with 5-6 risk factors [13.8%]. The mortality rate in of ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP and MELD scores as well as HE, HRS and jaundice were significant predictors of mortality in ESLD patients in the ICU. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin and prothrombin concentrations were indepejident risk factors affecting the outcome of ESLD patients in the ICU

Risk factors and outcome in ICU patients with end-stage liver disease

Acute or chronic liver failure is associated with numerous complications that may occur in combination, and patients may require ICU treatment. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. The present study aims to estimate the frequency of mortality and evaluate morbidity from cirrhosis in patients with end-stage liver disease [ESLD] admitted to the ICU and evaluate the relationship between the demographic, clinical, and laboratory data [potential risk factors] of those patients and mortality. A total of 120 patients with ESLD were enrolled [102 [85%] male and 18 [15%] female patients]. History taking, clinical examination, and other laboratory investigations were carried out, and patients were classifi ed according to the Child-Turcotte-Pugh [CTP] and the model for endstage liver disease [MELD] scores. Regarding the clinical presentation, hepatic encephalopathy [HE] was found in 87.5% of patients, jaundice in 60%, hematemesis in 41.7%, hepatorenal syndrome [HRS] in 35.8%, and spontaneous bacterial peritonitis in 20.8% of patients. The mortality rate was 57.5%; the main causes of death were HRS [40.8%], HE [21.7%], aspiration pneumonia [10%], septic shock [2.5%], and irreversible shock [1.7%]. There was a significant relationship between mortality and old age, CTP and MELD scores, and a longer stay at the ICU. Increased white blood cell count, increased hemoglobin and decreased prothrombin concentration, and elevated creatinine were independent risk factors of mortality in ESLD patients in the ICU. Mortality rates were higher in patients with 5-6 risk factors [86.2%] than in those with 1-2 risk factors [21.7%]. Mortality rate in ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP, MELD score, HE, HRS, and jaundice were significant predictors of mortality in ESLD patients. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin, and prothrombin concentration were independent risk factors of mortality in ESLD patients

Prognostic indicators in cirrhotic patients with bleeding oesophageal varices

The aim of this study was to identify the risk factors that affect the prognosis in patients with liver cirrhosis presented with acute variceal bleeding through clinical and laboratory assessment. It included 200 cirrhotic patients presented with bleeding esophageal varices with a mean age of 48.9 +/- 11.4 years. They were enrolled in prospective study and followed up for six weeks after bleeding attack. The patients were assessed using clinical, ultrasonographic, endoscopic and laboratory examinations. It was concluded that the main factors that can independently affect the prognosis of cirrhotic patients with bleeding esophageal varices are ascites, hepatocellular carcinoma on top of liver cirrhosis and prothrombin time. Furthermore, Child Pugh grade is an important prognostic factor

Psychiatric aspects in hepatitis C infection

Psychiatric symptoms and emotional distress appear to be more common in chronic hepatitis C [CHC] patients than in the general population. The aim of this study was to assess the psychiatric disorders in hepatitis C infection in cases not receiving anti-viral therapy in a rural community of Upper Egypt [Sallam village]. In a cross- sectional study, 86 positive anti-HCV cases, aged 15-65 years old and 60 control subjects of matched age and sex participated in this study. Assessment was done using standardized questionnaires including Hamilton anxiety rating scale [HARS], Hamilton checklist of symptoms of depressive illness, symptom checklist -90 [SCL-90] and social scale assessment. In addition to clinical, physical, ultrasonographic examinations and laboratory assessment including urinalysis, blood sugar, hepatitis B surface antigen [HBsAg], HCV antibody and HCV RNA by polymerase chain reaction [PCR]. The mean age was 40.29 + 15. 75. Fifty cases [58.1%] were HCV RNA positive, whereas 36 cases [41.9%] were negative. The mean score of the nine subscales of SCL-90 were significantly higher in HCV antibody positive cases than in controls and the mean score of the nine subscales of SCL-90 were significantly higher in positive HCV-RNA cases than in controls except for those with paranoia. Moreover, the mean scores of the nine subscales were significantly higher in negative HCV-RNA cases than controls except for those with anxiety and phobia. The previous parameters were higher in HCV RNA positive than in negative cases but without significant difference. The frequencies of depressive cases [> 18 degrees] and severe cases [> 26 degrees] were significantly higher in HCV antibody cases [25 [29.1%] and 6[7%]] than in controls [3[5%] and 0%] [P < 0.001 and P < 0.05 respectively]. The frequencies of mild and moderate depressive cases were significantly higher in HCV RNA positive cases than in controls [P <0.01 and P < 0.05 respectively but only in mild cases for those with HCV RNA negative cases. However, the frequency of depressive cases [> 18 degrees] was significantly higher in both positive [16[32%]] and negative [9[25%]] HCV RNA than in controls [3[5%]] [P < 0.001 and P < 0.01 respectively]. There was a significant difference between mild anxiety cases [15-28 degree] and also anxiety cases > 15 degrees in HCV antibody positive cases [41.9%] than in controls 03.3%] [P < 0.001 and P < 0.001 respectively]. The same previous results were obtained on comparison of positive HCV RNA and negative cases versus controls [P <0.01 and P < 0.001 respectively]. Although the frequency of severe anxiety cases [> 29 degree] was higher in positive HCV RNA cases [4 [8%]] than in controls [1 [1.7%]] but without significant difference [P = 0.056]. No significant association was found between ALT levels and depressive as well as anxiety cases in HCV RNA positive cases and also, no significant correlation was found between the score of the nine SCL 90 subscales and the level of ALT in HCV RNA positive cases. Psychiatric disorders as anxiety and depression and also, the nine SCL-90 subscales were significantly higher in HCV RNA positive or negative cases than in controls. Although, the previous parameters were higher in HCV RNA positive than in negative cases but without significant difference. These results may be due to the patients concern about the potentially serious health consequence of CHC infection

Comparative study of primary and secondary prevention of bleeding oesophgeal varices

This study included 302 patients with liver cirrhosis and esophageal varices who were classified into five groups; two groups of primary prophylaxis and three groups of secondary prophylaxis. The first group was under propranolol therapy [88 patients] and the second group was the control group [62 patients] with a mean age of 49 years and the mean follow up period was 2.97 +/- 1.88 years for the former and 2.35 +/- 1.1 years for the latter. It was concluded that propranolol is an effective treatment in primary prophylaxis as it decreases the rate of bleeding while increases the need for and the amount of blood transfusion. Also, this study supported the long-term use of propranolol plus endoscopic sclerotherapy for secondary prevention of bleeding esophageal varices

Study of risk factors among acute HBV infected patients.

This study was designed to determine the various risk factors affecting the transmission of acute hepatitis B and to investigate whether the infection is essentially household or community acquired. The study showed that HbsAg-positive individuals were present more in households of HBV acutely infected patients than households of the controls. Also, anti- HBc IgG seropositivity was significantly higher in patients spouses and contacts than controls spouses and contacts. The various risk factors for transmission of HBV were the following in order of frequencies: Shared blades in barber shops, injections, sharing utensils with HbsAg-positive household member, shared machines in barber shops, shared combs or towels with HbsAg-positive household member, dental procedures, operation, sharing room with HbsAg-positive household member, vaccination, stitches, sharing bed, bedding, blades with or kissing of HbsAg-positive household member, neurological examination [pin pricking] and contact with jaundiced patient

use of three Ascarid antigens in serodiagnosis of visceral larva migrans in clinically suspected patients

The syndrome of visceral larva migrans [VLM] is a zoonotic disease caused by migration of nematode larvae especially ascarids in human tissues. In the present study serum samples of 40 clinically suspected patients of VLM with persistent unexplained eosinophilia were tested by ELISA IgG and Western-immunoblotting assays for antibodies of three ascarids [Parascaris equorum, Toxocara vitulorum and Toxascaris leonina]. Embryonated egg extract antigens of these ascarids were used for serodiagnosis. By ELISA test the percentage of positivity was 42.5 percent with P.equorum, 40 percent with T.vitulorum and 30 percent with T.leonina antigens. By Western-blot assay, the seropositivity was 42.5 percent with P.equorum and 25 percent with T.vitulorum antigens. 27.5 percent of tested sera reacted with T.leonina antigen and showed single band at 65 KDa. This band was previously proven to be specific for Toxocara canis infection only. Some cases showed seropositivity for two or three species of ascarid antigens. The relationship between the seropositivity, clinical symptoms, eosinophilia and age groups was discussed. The use of two immunological assays and three types of ascarid antigens in the present study revealed for the first time the role of P.equorum and Toxocara vitulorum as causative agents of human VLM in Upper Egypt

Hepatitis B, C and D virus infections in patients and staff in Assiut dialysis unit

Thorough history was taken from 50 HD patients and 30 staff members with special stress on the risk factors that may contribute to hepatitis virus infection in addition to clinical examination, abdominal ultrasound, serological detection of viral markers and liver transaminase estimation. The high percentage of HCV-Ab [74%] and HBs Ag may be due to exposure of uremic patients to various risk factors for virus transmission prior or during HD. The percentage of HCV-Ab [13.3%] in dialysis staff matches that in the community and the absence of HBs Ag could be explained by staff vaccination against HBV