Binge drinking and nitric oxide metabolites in chronic liver disease.

AIMS: The effect of binge drinking in the production of nitric oxide metabolites has not been studied in patients with chronic viral liver disease. METHODS: We therefore studied serum levels of nitrites and nitrates (NOx) in 13 patients with chronic viral hepatitis and nine patients with compensated viral cirrhosis, after administration of 80 g alcohol. 15 patients with compensated alcoholic cirrhosis and seven healthy individuals were used as controls. Serum NOx levels were measured by a modification of the Griess reaction before and at 2, 12 and 24 h after alcohol consumption. RESULTS: An increase of serum NOx levels, that was statistically significant at 12 h, was found in healthy controls (P < 0.05). A similar pattern of NOx levels was observed in patients with chronic hepatitis. By contrast, in patients with cirrhosis, either viral or alcoholic, no significant increase was found after alcohol administration. However, basal levels in cirrhotics were significantly elevated (82.2 +/- 13.8 vs. 43.1 +/- 7.2 micro mol/l, P < 0.01) compared to healthy controls. CONCLUSIONS: Binge drinking causes a significant increase of serum NOx evident after 12 h with a return after 24 h at pre-drinking levels in healthy controls and patients with chronic viral hepatitis. In cirrhosis, such an increase is not observed serum levels being constantly elevated throughout the study period.

A comparison of Child-Pugh, APACHE II and APACHE III scoring systems in predicting hospital mortality of patients with liver cirrhosis.

BACKGROUND: The aim of this study was to assess the prognostic accuracy of Child-Pugh and APACHE II and III scoring systems in predicting short-term, hospital mortality of patients with liver cirrhosis. METHODS: 200 admissions of 147 cirrhotic patients (44% viral-associated liver cirrhosis, 33% alcoholic, 18.5% cryptogenic, 4.5% both viral and alcoholic) were studied prospectively. Clinical and laboratory data conforming to the Child-Pugh, APACHE II and III scores were recorded on day 1 for all patients. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under a ROC curve (AUC). Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Overall mortality was 11.5%. The mean Child-Pugh, APACHE II and III scores for survivors were found to be significantly lower than those of nonsurvivors. Discrimination was excellent for Child-Pugh (ROC AUC: 0.859) and APACHE III (ROC AUC: 0.816) scores, and acceptable for APACHE II score (ROC AUC: 0.759). Although the Hosmer-Lemeshow statistic revealed adequate goodness-of-fit for Child-Pugh score (P = 0.192), this was not the case for APACHE II and III scores (P = 0.004 and 0.003 respectively) CONCLUSION: Our results indicate that, of the three models, Child-Pugh score had the least statistically significant discrepancy between predicted and observed mortality across the strata of increasing predicting mortality. This supports the hypothesis that APACHE scores do not work accurately outside ICU settings.

Comparison of Ranson, APACHE II and APACHE III scoring systems in acute pancreatitis.

INTRODUCTION: Acute pancreatitis runs an unpredictable course. The early prediction of the severity of an acute attack has important implications for management and timely intervention. AIM: To assess the prognostic accuracy of Ranson and APACHE II and III scoring systems in predicting the severity of acute pancreatitis. METHODS: One hundred fifty-three patients with acute pancreatitis (67.3% gallstone-related, 9.2% alcoholic, 17% idiopathic, and 6.5% of miscellaneous causes) were studied prospectively. Data conforming to the scoring systems were recorded 24 (the APACHE scores) and 48 hours (the Ranson score) after admission. Analysis was performed by using receiver operating characteristic curves (ROC), area under a curve (AUC), and by comparing likelihood ratios of positive test (LRPT). RESULTS: One hundred nineteen cases of pancreatitis were classified as mild, and 34 were classified as severe. The mortality rate was 3.2%. All three scores correlated with length of stay and disease severity. AUC for Ranson was found to be significantly larger than AUC for APACHE II and APACHE III score (0.817, cut-off > or =3; 0.618, cut-off, > or =10; and 0,676, cut-off > or =42 respectively). The Ranson score achieved the highest sensitivity and the lowest false-negative rate, but the positive and negative predictive values and LRPT were of similar extent for all three scores. CONCLUSION: The APACHE III offers little, if any, advantage over the APACHE II score. Ranson criteria proved to be as powerful a prognostic model as the more complicated APACHE II and III scoring systems, but with the disadvantage of a 24-hour delay.