الفهرس 
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Abstract
Introduction:Cirrhosis is associated with an increased risk for the development of cardiovascular diseases. The most characteristic features and consequences of cirrhosis are decreased systemic vascular resistance, increased cardiac output and abnormal myocardial contractile function. The functional and structural changes of the myocardium have been referred as cirrhotic cardiomyopathy (CCM), a slow progression of myocardial dysfunction associated with cirrhosis CCM is defined as cardiac dysfunction with cirrhotic patients characterized by impaired contractile responsiveness to stress and/or alteration in diastolic relaxation with electrophysiological abnormalities in the lack of other known cardiac disease.The aim of work: To study if Prohormone of brain natriuretic peptide level (Pro-BNP), Troponin I and Hs-CRP are related to severity of liver disease and survival in cirrhotic patients in children. Research Plan: The design was a case control observational study, including 40 children suffering from with liver cirrhosis. The diagnosis of cirrhosis was established through a combination of biochemical, clinical, liver biopsy, and ultrasonography findings, attending hepatic clinic at Mansoura University Children’ Hospital (MUCH). And 20 control normal children of the same age& sex. They were matched prospectively for age and gender. The time period of this study was between September 2014 and September 2017. Inclusion criteria: Patients eligible for this study were be selected from those who attending hepatic clinic at MUCH& meat the following criteria Presence of cirrhosis that was diagnosed on the basis of clinical, radiological, laboratory parameters and liver biopsy. Have written informed assent. Exclusion criteria: Presence of malignancy that significantly affects survival. Presence of sever systemic illness (cardiorespiratory, active sepsis) . Refusal to give assent. Results: He CRP and Pro BNP showed significantly higher concentration in studied cases when compared to control groups. Troconcentration did not differ significantly between both groups. Pro BNP was significantly higher in Child C when compared to Child B. Otherwise, no significant differences were found in hs-CRP, troponin concentrations between studied cases according to severity of cirrhosis. Child C showed significantly lower median PELD score, 1 year waiting list survival. Pro BNP showed significantly positive correlation with troponin in all studied cases. Otherwise, no significant correlations were found between hs CRP, Pro BNP, troponin with other studied parameters in all studied cases. Only ProBNP was considered as independent risk factor for prediction of severity of LC. Conclusion: Pro BNP and Hs CRP showed significantly higher concentration in studied cases when compared to control groups. Pro BNP was correlated to severity of liver cirrhosis. Cirrhotic cardiomyopathy is an under-recognized complication of chronic liver cirrhosis. So, cirrhotic children should be examined for presence of CCMP periodically using pro-BNP and troponin-I for identification of CCM.