- Email: [email protected]
Anemia Profile in Patients of Chronic Liver Disease from North Indian Tertiary Hospital
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
Conclusion: Albumin level < 2.5 gm/dL, and MELD score >15 are the risk factors for cellulitis in chronic liver disease. Antibiotic prophylaxis helps in preventing recurrence of cellulitis in cirrhosis.
Corresponding author: Rooby E.H. Email: [email protected]
ANEMIA PROFILE IN PATIENTS OF CHRONIC LIVER DISEASE FROM NORTH INDIAN TERTIARY HOSPITAL Abdul Rauf, Varun Gupta, Rinkesh Bansal, Vinit Shah, Noor Mohammad, Abdul Matin, Mohan Goyel, Vijendra Kirnake, Vikas Singla, Praveen Sharma, Naresh Bansal, Pankaj Tyagi, Ashish Kumar, Anil Arora Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi, India Background: Patients with chronic liver disease (CLD) are known to have malnutrition. However the data on prevalence of the type of anemia and etiology of anemia is sparse. Aim: To know the prevalence of anemia and etiology of anemia in patients with CLD
Logistic regression for risk factors of cellulitis: Multivariate analysis
B
S.E.
P valaue
OR
95% confidence interval Lower
Upper
1.012
8.458
HE
1.073
0.542
0.048
2.925
DM
0.675
0.409
0.099
1.963
0.88
4.379
MELD >15
1.085
0.383
0.005
2.958
1.395
6.27
Platelet
0.285
0.402
0.478
1.33
0.605
2.922
Hypoalbuminemia (Albumin <2.5 )
1.031
0.381
0.007
2.804
1.328
5.922
Journal of Clinical and Experimental Hepatology | March 2014 | Vol. 4 | No. S2 | S39–S54
S41
Cirrhosis and Complications
Background: Cirrhotic patients are highly prone for infections due to their underlying immunocompromised status. Cellulitis forms an important cause for sepsis in cirrhosis which may lead to decompensation, increased morbidity and mortality. Aim: To determine the risk factors of cellulitis in cirrhosis liver and whether antibiotic prophylaxis has a role in preventing recurrence of cellulitis. Materials and Methods: Consecutive cirrhotic patients admitted with cellulitis from August 2011 to July 2013 were taken as cases (n = 70). Cirrhotic patients without cellulitis or history of cellulitis from the same institution included as controls (n = 73). Exclusion criteria: Patients with history of significant trauma and known cases of filariasis. Data regarding age, sex, stage of liver disease, co morbidities and laboratory investigations of cases and controls were noted and compared. Additional data regarding whether the cases were started on antibiotics (norfloxacin or rifaximin) as primary or secondary prophylaxis for SBP or for hepatic encephalopathy, at the time of discharge were also collected. Those started with antibiotic prophylaxis was assigned as group 1 (n = 51) and those who were not started was assigned as group 2 (n = 10). Both groups were followed up and data regarding recurrence of cellulitis within six months was collected. We compared the rate of recurrence of cellulitis between group 1 and 2. Statistical analysis: Various factors among cases and controls were analyzed by univariate and multivariate analysis and OR, CI, RR and NNT for antibiotic prophylaxis were calculated. Results: Themain etiology of cirrhosis was alcohol (67%). 68% of cases belonged to Child C and 77% had ascites and 36% had SBP. Of the positive cultures, 73% showed gram negative organism. Factors which showed significance in univariate analysis were presence of diabetes, hepatic encephalopathy, platelet count, albumin level and MELD score. Logistic regression showed that presence of hepatic encephalopathy (P = 0.048), albumin level <2.5 gm/dl (P = 0.007) and MELD >15 (P = 0.005) are significantly associated with cellulitis. 17patients (20%) had recurrence of cellulitis within 6 months, 7 (14%) in group 1 and 5 (50%) in group 2. Recurrence of cellulitis was significantly low among patients on antibiotic prophylaxis (15% vs 50% P = 0.048, RR-0.27, NNT = 3)
ABSTRACTS
Methods: Consecutive patients of CLD in whom complete anemia profile were done were included in the study. Patients on hematinics or who were given packed cells infusion, were excluded from the study. All patients had detailed history, examination, relevant blood investigation and complete anemia profile. Patients were divided into two group; alcohol related CLD (ALD) and other etiology of CLD (non-ALD). Results: one hundred ten patients were included, male: female: 69%: 31%. Fifty patients were in alcoholic group. Child A: B: C: 15%: 45%: 40%. Anemia was present in 90% and 80% in ALD and non-ALD respectively. Leucopenia was present in 25% in ALD and 33% in non-ALD. Iron deficiency was seen in 58% in non-ALD were as it was 35% in ALD group. Vitamin B12 deficiency was seen in 15% in non-ALD group and 5% in ALD group. Folic acid deficiency was seen in 5% in non-ALD group and 15% in ALD group. Conclusion: Anemia is very common in CLD patients with Iron deficiency being the most common cause of the anemia. Corresponding author: Abdul Rauf. Email: [email protected]
Cirrhosis and Complications
LIPID PROFILE IN ASSESSING THE SEVERITY OF CIRRHOSIS Suman Chowdavaram, Prabhakar Boddu, K. Panduranga Rao, B. Ramesh Kumar Department of Gastroenterology, Osmania Medical College, Hyderabad, Andhra Pradesh, India Background: Liver plays an essential role in lipid metabolism, lipid synthesis and transportation. An impaired lipid metabolism is often found in patients with chronic liver diseases. Few studies are available concerning serum lipid levels in patients with liver cirrhosis. Aims: To study lipid profile in patients with cirrhosis of liver and to relate the findings to severity of cirrhosis. Methods: In an analytical cross-sectional study, 150 patients with cirrhosis (cases) and 50 age- and sex-matched healthy patients (controls) were studied. Fasting lipid profile including serum triglycerides, total cholesterol, HDL, LDL and VLDL cholesterol were measured. For assessing the severity of cirrhosis, Child Pugh score was calculated for each cirrhotic patient. Results: In patients with cirrhosis, there was a significant decrease in serum triglycerides, total cholesterol, LDL, VLDL and HDL cholesterol levels compared to the mean of general population (mean of 84 vs 125, 137 vs 182, 87 vs 121, 21 vs 28 and 26 vs 44 mg/dL, respectively; all P < 0.05). Among patients with cirrhosis, the mean values of total cholesterol, LDL, VLDL, HDL cholesterol were found to be highest in patients with Child's A cirrhosis and lowest in patients with Child's C; mean values of patients with S42
22ND ANNUAL CONFERENCE – 2014
Child's B cirrhosis were intermediate (total cholesterol : 163 vs 154 vs 121; LDL : 105 vs 89 vs 62; VLDL: 24 vs 22 vs 17; HDL: 39 vs 28 vs 21 in Child's A,B and C respectively; all P < 0.05). Thus, except for serum triglyceride level, serum lipid levels diminished progressively with increasing severity of liver cirrhosis (as assessed by Child Pugh scoring). Conclusions: Low serum lipid levels are common in liver cirrhosis. The amount of decrements in the levels of serum total cholesterol, LDL, VLDL and HDL cholesterol in patients with cirrhosis correlate with the severity of cirrhosis (as assessed by Child Pugh scoring). Thus, serum lipids may serve as a marker to assess the severity of liver cirrhosis. Corresponding author: Suman Chowdavaram. Email: [email protected]
NUTRITIONAL AND EPIDEMIOLOGICAL STATUS OF NON HOSPITALIZED PATIENTS WITH CHRONIC LIVER DISEASE Vinodkumar Dixit*, Neha Singh*, Jitendra Kumar Choudhary*, Smita Verma*, Manish Kumar Tripathi*, Arttrika Ranjan*, Surya Kumar Singhy, Ashok Kumar Jain*, Vinod Kumar Dixit* *Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, y Department of Endocrinology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India Background: Liver plays the crucial role in nutrient and fuel metabolism, protein-energy malnutrition (PEM) is common in patients with liver cirrhosis. Malnutrition in liver cirrhosis is commonly associated with increased morbidity and mortality. Malnourished liver cirrhotic patients have higher incidence of encephalopathy, infection, and variceal bleeding. Malnutrition develops in patients with liver cirrhosis due to inadequate intake, impaired absorption and hypermetabolic state. Objective: The aim of this study was to assess the nutritional and epidemiological status in non- hospitalized patients with chronic liver disease (CLD). Patients and Methods: A total of three hundred twelve patients (M/F: 155/25) with non hospitalized chronic liver disease were enrolled in this prospective study with Mean age (41.45 10.97). The disease was diagnosed on the basis of biochemical profile, clinical features and radiological imaging. Anthropometric evaluation was performed by the usual parameters: BMI, triceps skin fold (TSF) and mid arm circumference (MAC). Nutritional assessment was done by using subjective global assessment (SGA) and twenty four hour dietary recall method during follow-up period of 12 months. Parametric analysis was done using SPSS. P-value of <0.05 was considered significant. © 2014, INASL
Conclusion: Albumin level < 2.5 gm/dL, and MELD score >15 are the risk factors for cellulitis in chronic liver disease. Antibiotic prophylaxis helps in preventing recurrence of cellulitis in cirrhosis.
Corresponding author: Rooby E.H. Email: [email protected]
ANEMIA PROFILE IN PATIENTS OF CHRONIC LIVER DISEASE FROM NORTH INDIAN TERTIARY HOSPITAL Abdul Rauf, Varun Gupta, Rinkesh Bansal, Vinit Shah, Noor Mohammad, Abdul Matin, Mohan Goyel, Vijendra Kirnake, Vikas Singla, Praveen Sharma, Naresh Bansal, Pankaj Tyagi, Ashish Kumar, Anil Arora Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi, India Background: Patients with chronic liver disease (CLD) are known to have malnutrition. However the data on prevalence of the type of anemia and etiology of anemia is sparse. Aim: To know the prevalence of anemia and etiology of anemia in patients with CLD
Logistic regression for risk factors of cellulitis: Multivariate analysis
B
S.E.
P valaue
OR
95% confidence interval Lower
Upper
1.012
8.458
HE
1.073
0.542
0.048
2.925
DM
0.675
0.409
0.099
1.963
0.88
4.379
MELD >15
1.085
0.383
0.005
2.958
1.395
6.27
Platelet
0.285
0.402
0.478
1.33
0.605
2.922
Hypoalbuminemia (Albumin <2.5 )
1.031
0.381
0.007
2.804
1.328
5.922
Journal of Clinical and Experimental Hepatology | March 2014 | Vol. 4 | No. S2 | S39–S54
S41
Cirrhosis and Complications
Background: Cirrhotic patients are highly prone for infections due to their underlying immunocompromised status. Cellulitis forms an important cause for sepsis in cirrhosis which may lead to decompensation, increased morbidity and mortality. Aim: To determine the risk factors of cellulitis in cirrhosis liver and whether antibiotic prophylaxis has a role in preventing recurrence of cellulitis. Materials and Methods: Consecutive cirrhotic patients admitted with cellulitis from August 2011 to July 2013 were taken as cases (n = 70). Cirrhotic patients without cellulitis or history of cellulitis from the same institution included as controls (n = 73). Exclusion criteria: Patients with history of significant trauma and known cases of filariasis. Data regarding age, sex, stage of liver disease, co morbidities and laboratory investigations of cases and controls were noted and compared. Additional data regarding whether the cases were started on antibiotics (norfloxacin or rifaximin) as primary or secondary prophylaxis for SBP or for hepatic encephalopathy, at the time of discharge were also collected. Those started with antibiotic prophylaxis was assigned as group 1 (n = 51) and those who were not started was assigned as group 2 (n = 10). Both groups were followed up and data regarding recurrence of cellulitis within six months was collected. We compared the rate of recurrence of cellulitis between group 1 and 2. Statistical analysis: Various factors among cases and controls were analyzed by univariate and multivariate analysis and OR, CI, RR and NNT for antibiotic prophylaxis were calculated. Results: Themain etiology of cirrhosis was alcohol (67%). 68% of cases belonged to Child C and 77% had ascites and 36% had SBP. Of the positive cultures, 73% showed gram negative organism. Factors which showed significance in univariate analysis were presence of diabetes, hepatic encephalopathy, platelet count, albumin level and MELD score. Logistic regression showed that presence of hepatic encephalopathy (P = 0.048), albumin level <2.5 gm/dl (P = 0.007) and MELD >15 (P = 0.005) are significantly associated with cellulitis. 17patients (20%) had recurrence of cellulitis within 6 months, 7 (14%) in group 1 and 5 (50%) in group 2. Recurrence of cellulitis was significantly low among patients on antibiotic prophylaxis (15% vs 50% P = 0.048, RR-0.27, NNT = 3)
ABSTRACTS
Methods: Consecutive patients of CLD in whom complete anemia profile were done were included in the study. Patients on hematinics or who were given packed cells infusion, were excluded from the study. All patients had detailed history, examination, relevant blood investigation and complete anemia profile. Patients were divided into two group; alcohol related CLD (ALD) and other etiology of CLD (non-ALD). Results: one hundred ten patients were included, male: female: 69%: 31%. Fifty patients were in alcoholic group. Child A: B: C: 15%: 45%: 40%. Anemia was present in 90% and 80% in ALD and non-ALD respectively. Leucopenia was present in 25% in ALD and 33% in non-ALD. Iron deficiency was seen in 58% in non-ALD were as it was 35% in ALD group. Vitamin B12 deficiency was seen in 15% in non-ALD group and 5% in ALD group. Folic acid deficiency was seen in 5% in non-ALD group and 15% in ALD group. Conclusion: Anemia is very common in CLD patients with Iron deficiency being the most common cause of the anemia. Corresponding author: Abdul Rauf. Email: [email protected]
Cirrhosis and Complications
LIPID PROFILE IN ASSESSING THE SEVERITY OF CIRRHOSIS Suman Chowdavaram, Prabhakar Boddu, K. Panduranga Rao, B. Ramesh Kumar Department of Gastroenterology, Osmania Medical College, Hyderabad, Andhra Pradesh, India Background: Liver plays an essential role in lipid metabolism, lipid synthesis and transportation. An impaired lipid metabolism is often found in patients with chronic liver diseases. Few studies are available concerning serum lipid levels in patients with liver cirrhosis. Aims: To study lipid profile in patients with cirrhosis of liver and to relate the findings to severity of cirrhosis. Methods: In an analytical cross-sectional study, 150 patients with cirrhosis (cases) and 50 age- and sex-matched healthy patients (controls) were studied. Fasting lipid profile including serum triglycerides, total cholesterol, HDL, LDL and VLDL cholesterol were measured. For assessing the severity of cirrhosis, Child Pugh score was calculated for each cirrhotic patient. Results: In patients with cirrhosis, there was a significant decrease in serum triglycerides, total cholesterol, LDL, VLDL and HDL cholesterol levels compared to the mean of general population (mean of 84 vs 125, 137 vs 182, 87 vs 121, 21 vs 28 and 26 vs 44 mg/dL, respectively; all P < 0.05). Among patients with cirrhosis, the mean values of total cholesterol, LDL, VLDL, HDL cholesterol were found to be highest in patients with Child's A cirrhosis and lowest in patients with Child's C; mean values of patients with S42
22ND ANNUAL CONFERENCE – 2014
Child's B cirrhosis were intermediate (total cholesterol : 163 vs 154 vs 121; LDL : 105 vs 89 vs 62; VLDL: 24 vs 22 vs 17; HDL: 39 vs 28 vs 21 in Child's A,B and C respectively; all P < 0.05). Thus, except for serum triglyceride level, serum lipid levels diminished progressively with increasing severity of liver cirrhosis (as assessed by Child Pugh scoring). Conclusions: Low serum lipid levels are common in liver cirrhosis. The amount of decrements in the levels of serum total cholesterol, LDL, VLDL and HDL cholesterol in patients with cirrhosis correlate with the severity of cirrhosis (as assessed by Child Pugh scoring). Thus, serum lipids may serve as a marker to assess the severity of liver cirrhosis. Corresponding author: Suman Chowdavaram. Email: [email protected]
NUTRITIONAL AND EPIDEMIOLOGICAL STATUS OF NON HOSPITALIZED PATIENTS WITH CHRONIC LIVER DISEASE Vinodkumar Dixit*, Neha Singh*, Jitendra Kumar Choudhary*, Smita Verma*, Manish Kumar Tripathi*, Arttrika Ranjan*, Surya Kumar Singhy, Ashok Kumar Jain*, Vinod Kumar Dixit* *Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, y Department of Endocrinology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India Background: Liver plays the crucial role in nutrient and fuel metabolism, protein-energy malnutrition (PEM) is common in patients with liver cirrhosis. Malnutrition in liver cirrhosis is commonly associated with increased morbidity and mortality. Malnourished liver cirrhotic patients have higher incidence of encephalopathy, infection, and variceal bleeding. Malnutrition develops in patients with liver cirrhosis due to inadequate intake, impaired absorption and hypermetabolic state. Objective: The aim of this study was to assess the nutritional and epidemiological status in non- hospitalized patients with chronic liver disease (CLD). Patients and Methods: A total of three hundred twelve patients (M/F: 155/25) with non hospitalized chronic liver disease were enrolled in this prospective study with Mean age (41.45 10.97). The disease was diagnosed on the basis of biochemical profile, clinical features and radiological imaging. Anthropometric evaluation was performed by the usual parameters: BMI, triceps skin fold (TSF) and mid arm circumference (MAC). Nutritional assessment was done by using subjective global assessment (SGA) and twenty four hour dietary recall method during follow-up period of 12 months. Parametric analysis was done using SPSS. P-value of <0.05 was considered significant. © 2014, INASL