[A prospective prognostic study of liver cirrhosis]. / Prospektivní prognostická studie jaterní cirhózy.

The authors conducted a prospective, longitudinal, multicentre study in patients with liver cirrhosis; a total of 192 patients were on follow-up, of this number 125 died during the study. Mean age, 56 years, was markedly more advanced in the dead; men prevailed among the patients. Duration of complaints and the interval since the diagnosis had been established was shorter in the dead than in those alive; a positive HBs antigen was likewise more often present in the former. Clinical and laboratory parameters in this group were assessed with a view to the differences between the dead and those alive and with a view to the time course of changes in these differences. Multifactorial discriminative analysis of these data for various intervals before death was also performed. The most pronounced differences were noted in clinical manifestations and laboratory signs of hepatic insufficiency, especially in the presence and degree of ascites, jaundice, encephalopathy, and in the values of bilirubin, Quick' test and blood albumin levels; thus the degree of liver insufficiency appears to be the most important prognostic marker in patients with liver cirrhosis. Moreover, a significant increase in urea and leucocyte levels was found in the terminal stages of the disease. Ascites, encephalopathy and a progressive increase in serum bilirubin levels seem to be the best markers for discriminative analysis of prognosis for the last six months of life. Results of this study, while confirming some findings by other authors, offer also new insights into the whole issue.

The plasma concentration and renal elimination of phenols in patients with chronic renal insufficiency.

The plasma concentration and renal elimination of phenols was studied in 32 individuals with various renal insufficiency (CRI) and in 30 healthy subjects. In patients with chronic renal insufficiency the increase in P phenols values correlated directly with Per and P urea. Daily urinary excretion of phenols in patients with CRI is only mildly decreased compared with that in healthy controls. Renal clearance (C phenols), 8.52 (+/- 2.69) ml/min on an average, decreases significantly in patients with CRI. While fraction excretion of phenols (FE phenols) was 9.53 (+/- 4.14) % on an average in healthy persons, patients with CRI displayed a significant increase. A significant linear correlation in the values of FE phenols and FEH2O and those of FE phenols and FE urea was documented. Our findings support the assumption that phenols are excreted by the kidney by a mechanism similar to that of urea excretion. Filtration of phenols in the glomeruli is followed, in healthy volunteers, by their significant reabsorption which is a flow-dependent process. In the residual nephrons of patients with CRI, the tubular reabsorption of phenols is decreased, a mechanism largely compensating the effect of decreased filtration of phenols on their total urinary excretion.