RESUMO
Almost a 3[rd] of patients with liver cirrhosis and ascites may develop spontaneous bacterial peritonitis [SBP]. SBP carries a high morbidity and mortality. Hence identifying predisposing factors that may cause a patient with ascites to develop SBP are of great interest. The Model for End-Stage Liver Disease [MELD] score is a measure of mortality risk in patients with end-stage liver disease7. Development of ascites and encephalopathy, two complications of end-stage liver disease that are not used in the MELD score calculation, have generally correlated with higher MELD scores
Aims and methods: The aim of this study was to determine the frequency of higher MELD score in patients of SBP with liver cirrhosis. Eighty-five patients fulfilling the inclusion criteria were selected. An informed consent was taken from all patients. Demographic data including age, sex etc. was obtained. All patients had MELD scoring on the basis of serum creatinine, serum bilirubin and INR. MELD scores were calculated according to the method used by the United Network of Organ Sharing [UNOS]
Results: A total of 85 patients were included in the study. It included 52 [61%] male patients and 33 [39%] female patients. Mean age was 48.88 years [SD +/-8.82], Serology for viral markers showed that 68[80 %] patients were positive for hepatitis C antibodies and 8[9.4%] patients were positive for hepatitis B while 3 [3.5%] patients were positive for both hepatitis B and C. In the remaining 6 patients, 2 [2.35%] patients had alcoholic cirrhosis and in 4 [4.7%] patients, etiology of liver disease could not be ascertained. MELD scores in these patients ranged from 9 to 36. Eight patients [9.41%] with SBP had a MELD score of below 15 while 15 [17.64%] patients had scores between 16 and 20. 32 [37.64%] patients had MELD scores between 21 and 25. 20 [23.52%] patients had scores between 26 and 30 while 10 [11.76%] patients had a MELD score higher than 30. Conclusion: A high MELD score [>16] is noted in a significant number of patients with spontaneous bacterial peritonitis [over 90%]
RESUMO
Hepatic encephalopathy [HE] is one of the common complications of liver cirrhosis. Lactulose is conventionally used for the treatment of hepatic encephalopathy
Aims and methods: The aim of this study was to evaluate the combined efficacy of lactulose plus rifaximin versus lactulose alone in the management of hepatic encephalopathy. 80 patients with HE were given lactulose alone and another 80 were given a combination of lactulose and rifaximin. They were monitored for 7 days for response i.e., reversal of HE
Results: Initially 160 patients with HE, who met inclusion and exclusion criteria, were enrolled in this study [out of 183 screened]. 80 patients were randomized in lactulose plus rifaximin group [group A] while the other 80 were placed in lactulose alone group [group B]
Patients were given respective treatment and were monitored for improvement of HE by using West Haven [WH] criteria. Patients were assessed daily. Patients were monitored till recovery or death for 7 days, whichever occurred first. 62 [77.5%] patients in the rifaximin plus lactulose group showed reversal while 43[53.75%] patients in lactulose only group showed reversal of HE. Mortality was also less in the rifaximin plus lactulose group compared to lactulose alone group 17[21.25%] vs. 33 [41.25%] respectively [P<0.05]
Conclusion: Rifaximin and lactulose have different mechanisms of action and act synergistically in combination and show better response in treating HE. This can result in significant decrease in morbidity and mortality