Correlation between Hepatic Vein Wave form Changes on Doppler Ultrasound and the Severity of Diseases in Cirrhotic Patients

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106

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Correlation of global longitudinal strain with disease severity in liver cirrhosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.155 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

Y Dimitroglou ◽

C Aggeli ◽

A Alexopoulou ◽

T Alexopoulos ◽

D Patsourakos ◽

...

Keyword(s):

Liver Cirrhosis ◽

Disease Severity ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Class A ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Class C

Abstract Funding Acknowledgements Type of funding sources: None. Introduction/purpose Cirrhotic cardiomyopathy is characterized by high cardiac output, reduced peripheral resistance and diastolic dysfunction and has been correlated with cirrhosis severity and prognosis. Global longitudinal strain (GLS) is a sensitive marker of cardiac dysfunction which is considered relatively independent of preload and afterload conditions and thus may be of high diagnostic significance in this special population. We sought to investigate alterations of GLS relating to disease severity in cirrhotic patients. Methods Echocardiographic analysis of 51 consecutive cirrhotic patients was performed. Images were acquired and analyzed off-line. GLS was calculated with a semi-automatic way using dedicated software. Clinical and biochemical examination were used to assess severity of liver disease by calculating Child-Pugh class (class C patients have more severe disease than class B and A patients) and MELD-Na score (increased score as the disease progresses). Results Mean age was 58.4 ± 8.7 years, 38 (74.5%) were males. Among patients, 22 (43.1%) were Child-Pugh class A, 17 (33.3%) Child-Pugh B and 12 (23.5%) Child-Pugh C and mean MELD-Na score was 15.3 ± 7.5. Mean left ventricular end-systolic volume (LVEDV) was 117 ± 29ml, mean stroke volume (SV) 72.5 ± 19.9ml , mean left ventricular ejection fraction (LVEF) 61.0 ± 5.0%, mean systolic blood pressure (SBP) 128 ± 13mmHg, mean ratio of peak transmitral to peak annular (septal) velocity during early diastole (E/e’ ratio) 10.4 ± 4.5, mean left atrial volume index (LAVI) 37.4 ± 11.8 ml/cm2 and mean GLS -21.6 ± 2.6%. GLS of Child-Pugh class A patients (-20.3 ± 2.4) was higher (less negative) than GLS of Child-Pugh class B (-22.2 ± 2.2) and class C (-23.0 ± 2.8) patients. Difference between groups B and C was non-significant (figure). Severity of cirrhosis as determined by higher MELD-Na score correlated with LAVI (r = 0.592, p < 0.001), SV (r = 0.554, p < 0.001), GLS (r=-0.441, p = 0.001) and LVEDV (r = 0.428, p = 0.002). GLS correlated with SV (r=-0.369, p = 0.008) but not with preload (LVEDV), or afterload (SBP). In a linear regression model, GLS was independently associated with Meld-Na score when adjusting for age, SBP, LVEDV and NASH etiology [B=-0.139 (-0.252; -0.025), p = 0.018]. Conclusions GLS is lower (more negative) in patients with liver cirrhosis as disease progresses a relation not affected by preload and afterload conditions. Further research works are required to explain the underlying pathophysiology and to assess prognostic significance of reduced GLS values in patients with advanced cirrhosis. Abstract Figure. GLS stratified by Child-Pugh score

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Cardiomyopathy in Cirrhotic Patients and Its Relationship with the Severity of Cirrhosis

10.53350/pjmhs2115102779 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2779-2782

Author(s):

Saira Khalid ◽

Nasir Shah ◽

Yasir Abbas Zaidi ◽

Muhammad Saleem Hasan ◽

Saqib Jahangir ◽

...

Keyword(s):

Liver Cirrhosis ◽

Severe Disease ◽

P Value ◽

Cirrhotic Cardiomyopathy ◽

Male Predominance ◽

Class A ◽

Class B ◽

Cirrhotic Patients ◽

The Mean ◽

Class C

Study Objectives: To determine the frequency of cirrhotic cardiomyopathy in patients with liver cirrhosis and to compare it across varying grades of cirrhosis on Child Turcotte Pugh classification. Study Design and Settings: It was a descriptive cross-sectional study carried at Department of Medicine, Lahore General Hospital Lahore over 1 year from Jan 2018 to Dec 2018. Patients and Methods: The present research involved 100 male and female patients aged between 16-70 years having liver cirrhosis diagnosed at least 6 months ago. These patients underwent echocardiographic screening of cardiomyopathy which was diagnosed by the presence of diastolic dysfunction (i.e. increased E/A ratio>1). An informed written consent was obtained from every patient. Results of the Study: There was a male predominance (M:F, 1.6:1) among cirrhotic patients with a mean age of 51.9±9.8 years. The mean BMI was 26.5±3.7 Kg/m2 while the mean duration of cirrhosis was 22.0±10.9 months. Majority (49.0%) of the patients belonged to CTP Class C followed by Class-B (39.0%) and Class-A (12.0%). Cirrhotic cardiomyopathy was observed in 41.0% patients with cirrhosis. There was statistically insignificant difference in the observed frequency of cirrhotic cardiomyopathy among various subgroups of cirrhotic patients depending upon patient’s age (p-value=0.928), gender (p-value=0.997), BMI (p-value=0.983) and duration of disease (p-value=0.782). However, it increased considerably with worsening of disease on CTP Classification; Class-A vs. Class-B vs. Class-C (8.3% vs. 35.9% vs. 53.1%; p-value=0.013). Conclusion: Cirrhotic cardiomyopathy was observed in a substantial proportion of cirrhotic patients and was more frequent in patients with more severe disease which warrants routine echocardiographic screening of cirrhotic patients so that timely recognition and anticipated treatment of this complication may improve the case outcome in future medical practice. Keywords: Cirrhosis, Cardiomyopathy, Child Turcotte Pugh Class

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Experience in the treatment of some complications of portal hypertension in alcoholic liver cirrhosis

Vojnosanitetski pregled ◽

10.2298/vsp1111917s ◽

2011 ◽

Vol 68 (11) ◽

pp. 917-922 ◽

Cited By ~ 1

Author(s):

Zeljka Savic ◽

Vladimir Vracaric ◽

Ljiljana Hadnadjev ◽

Zora Petrovic ◽

Dragomir Damjanov

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Variceal Bleeding ◽

Alcoholic Liver Cirrhosis ◽

Class A ◽

Class B ◽

Pugh Class ◽

Class C ◽

Upper Gastrointestinal ◽

General Mortality

Background/Aim. Portal hypertension (PH) is hemodynamical abnormality associated with the most serious complications of alcoholic liver cirrhosis (ALC): ascites, varices and variceal bleeding. The aim of this study was to determine characteristics of portal hypertension, especially of upper gastrointestinal bleedings in patients with alcoholic liver cirrhosis (ALC). Methods. A total of 237 patients with ALC were observed in a 3-year period. Results. A total of 161 patients (68%) were hospitalized because of PH elements: 86 (36.3%) had upper gastrointestinal bleeding, 75 (31.7%) were decompensated. Only 76 (32%) of the patients had icterus. General mortality was 85 (36%). According to the source of bleeding, 61 (71%) patients bled from varices, and 25 (29%) from other sources with existing varices but non-incriminated for bleeding in 16 (64%) of those patients. Active bleeding or stigmata of recent bleeding were found in 63 (73%) cases. Endoscopic treatment of variceal bleeding along with octreotide applied in 20 (32.78%) patients, just octreotide in 32 (52.46%), and octreotid plus balloon tamponade in 9 (14.75%). According to Child-Pugh classification, 25 (29%) of the bleeding patients were in class A, score 5.4; 43 (50%) in class B, score 7.8; and 18 (21%) in class C, score 10.9. Average hemoglobin level was 93 g/L, hematocrit 0.27, AST 71.52 U/L (normal to 37 U/L), ALT 37.74 U/L (normal to 40 U/L). Until this bleeding episode, 41 (47%) of the patients already bled. In the decompensated patients 3 (4%) were in Child Pugh class A, score 6; 42 (56%) in class B, score 8.3; and 30 (40%) in class C, score 10.6. Until this decompensation episode, 7 (9.3%) patients already bled. Conclusion. Patients with ALC need early detection of varices, primary and secondary profilaxis of variceal bleeding and adequate therapy of ascites. When bleeding occurs, patients need urgent upper endoscopy and intensive treatment.

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Correlation of Grading of Esophageal Varices with Child Turcotte Pugh Class in Patients of Liver Cirrhosis

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v16i2.24879 ◽

2018 ◽

Vol 16 (2) ◽

pp. 50-53

Author(s):

Anil Shrestha ◽

Dipendra Khadka ◽

Richa Shrestha

Keyword(s):

Liver Cirrhosis ◽

Esophageal Varices ◽

Upper Gastrointestinal Endoscopy ◽

Cross Sectional ◽

Class A ◽

Red Color ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Small Varices

Background: Majority of cirrhotic patients develop varices over their lifetime and it is anticipated that roughly one third of varices will develop bleeding. Child Turcotte Pugh (CTP) class predicts the risk of variceal bleeding and has been used as a prognostic tool inpatients of liver cirrhosis. Objective: To correlate grade of esophageal varices in Upper Gastrointestinal endoscopy with Child Turcotte Pugh class in patients of liver cirrhosis. Material and method: This is a cross sectional descriptive study conducted in thedepartment of medicine of NGMCTH, Kohalpur between December 2017 to November 2018. A total of 97 patients were included inthe study who were diagnosed as cirrhosis of liver clinically and radio logically. Patient were classified into CTP class A, B and According to CTP score. UGI endoscopy was performed and endoscopic grading of esophageal varices were correlated with CTP classand the data were recorded and analysed. Result: Mean of patients was 50 years. Among 97 patients, 30 (30.9%) were in CTP class A,30 (30.9%) in CTP class B and 37 (38.1%) were in CTP class C. 25 (25.8%) had small varices, 50 (51.5%) had large varices with red colorsign, 20 (20.6%) had large varices without red color sign and 2 (2.1%) had no varices. Most of the patients in CTP class B and C hadlarge varices with red color sign whereas CTP class A had small varices. Conclusion: The cirrhotic patients in CTP class B and C havelarge varices with red color sign and have more chances of bleeding. Hence, routine screening is indicated to determine the presenceof varices. Porphylactic therapy after identifying large varices will decrease the incidence of bleeding leading to reduction inmortality rate.

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Comparison of Doppler waveform and mean velocity of hepatic vein in cirrhotic patients with healthy subjects and their correlation with severity of cirrhosis

Community Based Medical Journal ◽

10.3329/cbmj.v3i2.53400 ◽

2014 ◽

Vol 3 (2) ◽

pp. 23-28

Author(s):

Mahzabeen Islam ◽

Akhter Uddin Ahmed ◽

AS Mohiuddin

Keyword(s):

Hepatic Vein ◽

Healthy Subjects ◽

Wave Form ◽

Case Group ◽

Mean Velocity ◽

Class A ◽

Doppler Waveform ◽

Class B ◽

Cirrhotic Patients ◽

The Mean

This descriptive study was carried out in the Department of Radiology and Imaging, BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder) Dhaka during the period of 1st June 2008 to 30th May 2009, to compare the pattern of the Doppler waveform and mean velocity of hepatic vein between healthy subjects and that in cirrhotic patients and to detect possible differences and also to assess the accuracy of the detection of changes in hepatic vein waveform and mean velocity for the diagnosis of liver cirrhosis. A total of 40 cirrhotic patients and 40 healthy subjects were enrolled in this study. Doppler waveform was done in all the patients and the healthy subjects. The mean hepatic vein velocity (MHVV) was 12.22±4.22 cm/sec and 5.17±1.19 cm/sec in case and healthy group respectively. The mean MHVV difference was significantly (p<0.001) higher in case group. 37.5% patient had wave form HV-0 and HV-1 and 25.0% had wave form HV-2 in case group, however, in healthy group all subjects had wave form HV-0 and the difference was statistically significant (p<0.05) between case and healthy. In Child's class A wave form HV-0 was found in 75.0%, HV-1 was 25.0% and HV-2 was not found in case group. In Child's class B wave form HV-0 was found in 21.4%, HV-1 was 71.5% and HV-2 was 7.1%. In Child's class C wave form HV-0 was not found, HV-1 was 10.0% and HV-2 was 90.0%. The and the difference was statistically significant (p<0.05) among the different grading level with wave form. In Child's class A the mean velocity was 9.18±1.81 cm/sec and velocity ranged from 7.5 to 14.2 cm/sec. In Child's class B the mean velocity was 11.26 ±1.81 cm/sec and velocity ranged from 7.5 to 14.2 cm/sec. In Child's class C the mean velocity was 18.44±1.91 cm/sec and velocity ranged from 15.5 to 20.9 cm/sec. The mean velocity was statistically significant (p<0.05) among Child's class A, Child's class B and Child's class C. From the above summary and previous study it is observed that there is a significant difference between Doppler waveform and mean velocity of right hepatic vein in cirrhotic patients and in normal subjects. It can be used as a new parameter in the assessment of liver cirrhosis. CBMJ 2014 July: Vol. 03 No. 02 P: 23-28

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Cardiovascular dysfunction in patients of cirrhosis of liver

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20195636 ◽

2019 ◽

Vol 7 (1) ◽

pp. 39

Author(s):

Manish Chandey ◽

Gurinder Mohan ◽

Japnit Kaur ◽

Aarti Vaid

Keyword(s):

Liver Cirrhosis ◽

Diastolic Dysfunction ◽

P Value ◽

Qtc Interval ◽

Cardiovascular Dysfunction ◽

Class A ◽

Class B ◽

Pugh Class ◽

Class C ◽

Cirrhosis Of Liver

Background: Cirrhosis of liver refers to a progressive condition that disrupts the normal architecture of the liver. It is increasingly recognized that cirrhosis per se can cause cardiac dysfunction. The aim was to assess cardiovascular dysfunction electrocardiographically and echocardiographically in patients with cirrhosis of liver and to find the correlation between cardiovascular dysfunction and severity of liver cirrhosis as per child-PUGH score.Methods: Total 90 patients of cirrhosis of liver of both sexes were included in this cross-sectional study conducted from January 2018 to August 2019 in SGRDIMSR, Sri Amritsar. The severity of liver cirrhosis was assessed as per Child Pugh Score. QTc interval was calculated by Bazett’s formula. Systolic and Diastolic dysfunction was seen on 2D-echocardiography.Results: QTc interval increased linearly with the severity of liver cirrhosis. Mean values of QTc in Child Pugh Class A=425.00(±20.97), Class B=437.35(±42.60), Class C=479.71(±29.48) with p value of 0.04 which is significant. Diastolic dysfunction was also related with the severity of liver cirrhosis. In Child Pugh Class A= 2(33%) patients had grade 1 diastolic dysfunction, Class B=23(59%) patients had grade 1 diastolic dysfunction while in Child Pugh Class C=3(7%) had grade 1 diastolic dysfunction, 33(73%) patients had grade 2 diastolic dysfunction and 1(2%) patients had grade 3 diastolic dysfunction with p value of 0.04 which is significant. Systolic function was found normal in all the patients.Conclusions: Diastolic dysfunction and QTc interval prolongation are both related with the severity of liver cirrhosis and are major criteria of cirrhotic cardiomyopathy.

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Association of thromboelastography profile with severity of liver cirrhosis and portal venous system thrombosis

BMC Gastroenterology ◽

10.1186/s12876-021-01832-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yanglan He ◽

Shanshan Yuan ◽

Xiaozhong Guo ◽

Fangfang Yi ◽

Xiangbo Xu ◽

...

Keyword(s):

Liver Cirrhosis ◽

Maximum Amplitude ◽

Cross Sectional Study ◽

Venous System ◽

High Rate ◽

Portal Venous System ◽

Cross Sectional ◽

Class A ◽

Pugh Class ◽

Cirrhotic Patients

Abstract Background and aim Hemostasis profile is often complicated in liver cirrhosis. Thromboelastography is a global viscoelastic test recommended by the current practice guideline and consensus. This cross-sectional study aimed to evaluate the association of thromboelastography profile with severity of liver cirrhosis and presence of portal venous system thrombosis (PVST). Methods Overall, 116 and 50 cirrhotic patients were included in the Shenyang and Xi’an cohorts, respectively. Thromboelastography parameters were compared between cirrhotic patients with Child–Pugh class A and B/C, those with and without decompensated events, and those with and without PVST. Hypercoagulability would be considered if at least two of the following thromboelastography parameters were met: shortened reactive time (R), shortened coagulation time (K), increased angle, and increased maximum amplitude (MA). Results In the Shenyang cohort, 16 patients had shortened R, of whom seven (43.75%) had prolonged K and 11 (68.75%) decreased MA. In the Xi’an cohort, 24 patients had shortened R, of whom seven (29.17%) had prolonged K and 15 (62.50%) decreased MA. In the Shenyang cohort, the prevalence of hypercoagulability was not significantly different between cirrhotic patients with Child–Pugh class A and B/C (3.85% vs. 6.25%, P = 0.873), those with and without decompensated events (5.49% vs. 4.00%, P = 1.000), and those with and without PVST (4.17% vs. 5.88%, P = 1.000), which were similar to the results obtained in the Xi’an cohort. Conclusion There is a high rate of discordance between R and other thromboelastography parameters. In addition, hypercoagulability may not be related to more advanced stage of liver cirrhosis or presence of PVST.

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Prevalence of Spontaneous Bacteria Peritonitis in Patients with Hypoalbuminemia and Cirrhosis

10.53350/pjmhs211592943 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2943-2947

Author(s):

Muhammad Siddique ◽

Muhammad Abdul Quddus ◽

Tahir Iqbal ◽

Hefsa Qamar ◽

Muhammad Ikram Shah ◽

...

Keyword(s):

Liver Cirrhosis ◽

Bacterial Infections ◽

Spontaneous Bacterial Peritonitis ◽

Operational Definition ◽

Cross Sectional ◽

Bacterial Peritonitis ◽

Number Of Patients ◽

Class B ◽

Pugh Class ◽

Class C

Background and Aim: Spontaneous bacterial peritonitis (SBP) is one of the most serious complications of ascites, resulting in liver cirrhosis infection, accounting for approximately 25% of all bacterial infections. Within a diagnostic year, the mortality rate for spontaneous bacterial peritonitis ranges from 30% to 90%. The current study attempted to determine the prevalence of spontaneous bacterial peritonitis in patients with hypoalbuminemia and cirrhosis. Materials and Methods: This cross-sectional study was conducted on 112 cirrhosis with hypoalbuminemia patients at Medical Unit A, Hayatabad Medical Complex Peshawar and department of Gastroenterology AK CMH / Sheikh Khalifa bin Zaid Al Nahyan Hospital, Rawalakot Azad Kashmir. The duration of the study was six months from 5th January 2021 to 5th June 2021. All patients of either gender with liver cirrhosis and hypoalbuminemia aged 20 to 60 years were included in the study. Each individual was asked to provide written informed consent. Each patient's creatinine, albumin, and sodium levels were measured in the laboratory using urine and blood sample tests. Each patient's absence or presence of SBP was recorded according to the operational definition. For data analysis, SPSS version 20 was used. Results: Of the total 112 patients, 59 (52.7%) were male and 53 (473%) were female. The overall mean age of the patients was 43.51±4.58 years whereas male and female patients had 47.36±5.62 and 39.66±3.54 years respectively. The number of patients falling in class B and Child Push class C was 50 (44.6%) and 62 (55.4%) respectively. The prevalence of spontaneous bacterial peritonitis was 48 (42.9%). Out of 48 SBP patients, 29 (60.4%) were male and 19 (39.6%) were female. The prevalence of SBP was seen in 13 (27.1%) cases of Class B and 35 (72.9%) of Class C (Child-Pugh Class) respectively. Hypertension and diabetes mellitus as comorbidities were present in 11 (9.8%) and 25 (22.3%) cases respectively. Conclusion: In the current study, the prevalence of SBP was 42.9%. Our study revealed a higher prevalence of spontaneous bacterial peritonitis in cirrhosis patients. Also, a significant association has been found between spontaneous bacterial peritonitis and child Pugh Class C and Class B whereas SBP had no substantial connotation with gender, etiology, and even age but with disease duration. Keywords: Cirrhosis; Spontaneous Bacterial Peritonitis; Hypoalbuminemia

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Treatment of hepatitis C Cirrhotic patients with directly acting antivirals: A multicenter study

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666201019122205 ◽

2020 ◽

Vol 20 ◽

Author(s):

Asem Ahmed Elfert ◽

Sherief Abd-Elsalam ◽

Lobna Abo-Ali ◽

Taher Eldemerdash ◽

Sabry AbouSaif ◽

...

Keyword(s):

Hepatitis C ◽

Treatment Response ◽

Outcome Measures ◽

Secondary Outcome ◽

Genotype 4 ◽

Class A ◽

Number Of Patients ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients

Background &Aims: With the introduction of sofosbuvir based regimens, there have been achieved high cure rates and decreased duration. Several studies showed variances in SVR rates between different genotypes, with lower rates of SVR among cirrhotic patients . The aim of our study was to assess the safety and effectiveness of sofosbuvir-based antiviral regimens for the treatment of HCV-infected Egyptian cirrhotic patients. Methods: This was a retrospective observational comparative study. Nine hundred forty six cirrhotic patients with chronic HCV genotype 4 infection who were eligible for direct acting drugs (DAAs) therapy were enrolled. The primary outcome measures were the number of patients with successful eradication of the virus evidenced by SVR at 12 Weeks After discontinuation of therapy (SVR12) and the secondary outcome measures were the incidence of adverse effects associated with the tested HCV therapy. Results: Among the 946 patients enrolled in the study; 527 patients (55.7%) were males and 419 patients (44.3 %) were females with mean age 54.00±8.88 years. 20.2 % were diabetics and 19.1% were hypertensive. Patients were classified according to Child -Pugh classifications; 818 patients (86.46%) were Child-Pugh class A cirrhosis, 28 patients (13.53 %) were Child-Pugh class B cirrhosis. SVR12 rate was 96.93% (917 /946). Treatment response in the Child-Pugh class A cirrhosis was 794 (97%) after 12 weeks while treatment response in the Child-Pugh class B cirrhosis was 123 (96%). Mild side effects were observed in 76 patients. Conclusions: Sofosbuvir based regimens were effective and safe in the treatment of cirrhotic patients with chronic hepatitis C genotype 4.

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Increased Thromboxane Metabolites Excretion in Liver Cirrhosis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615058 ◽

1998 ◽

Vol 79 (04) ◽

pp. 747-751 ◽

Cited By ~ 21

Author(s):

Domenico Ferro ◽

Stefania Basili ◽

Luigi Iuliano ◽

Caterina Camastra ◽

Carlo Giammarresi ◽

...

Keyword(s):

Liver Cirrhosis ◽

Urinary Excretion ◽

Excretion Rate ◽

Systemic Circulation ◽

Progressive Increase ◽

Class A ◽

Significant Difference ◽

Cirrhotic Patients ◽

Class C

SummaryAn augmented systemic production of thromboxane (TX) A2, as assessed by urinary excretion of the thromboxane metabolites, has been described in severe liver cirrhosis. However, the significance of this finding remains unclear since in liver cirrhosis a number of phenomena i.e. altered hepatic TXA2 metabolism, increased intrasplenic platelet destruction, may affect TXA2 entry into systemic circulation as well as its metabolism. In order to further clarify this, we measured both major enzymatic metabolites of TXB2 in the urine of 44 patients affected by liver cirrhosis, subdivided in three classes on the basis of Child-Pugh criteria. Urinary 11-dehydro-TXB2 and 2,3-dinor-TXB2 were assayed with previously validated RIA techniques.The urinary excretion rate of 11-dehydro-TXB2 was significantly (p = 0.0001) increased in the cirrhotic patients (673.5 pg/mg cr, median) in comparison with the controls (275 pg/mg cr, median) but no significant difference could be demonstrated among the excretion rates of the three patient subgroups. The excretion rate of 2,3 dinor-TXB2 was also significantly (p = 0.0001) increased in the patients (824 pg/mg cr, median) in comparison with controls (175 pg/mg cr, median), with a significant (p <0.05) increase from class A (381 pg/mg cr) to class C (1337 pg/mg cr). The sum of the two enzymatic metabolites was significantly (p = 0.0001) increased in the cirrhotic patients in comparison to controls, with a progressive increase from class A (1003 pg/mg cr, median) to class C (2240 pg/mg cr, median). The urinary excretion of 2,3 dinor-TXB2 was significantly (p = 0.008) related to plasma prothrombin fragment 1+2 (F1+2).This study provides further evidence of increased thromboxane biosynthesis in liver cirrhosis. Moreover, we demonstrate intraliver shift of thromboxane metabolic disposition, due to progressive liver decompensation, because only the fraction undergoing β-oxidation to 2,3-dinor-TXB2 was progressively increased with the degree of liver failure. We, also, find a significant correlation between urinary excretion of 2,3-dinor-TXB2 and plasma F1+2, suggesting that clotting activation could partly account for in vivo platelet activation.

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