الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
The aim of this prospective case control study was to evaluate
serum levels of GDF 15 and EPO in patients with liver cirrhosis
according to their grading in relation to anemia.
In this study, there was significant difference among all studied
groups (P<0.001) as regard ALT, AST &HCV- RNA load with
highest level in class B as compared to class A, class C and controls
group.
Also, there was significant difference among the studied groups
(P<0.001) as regard albumin, total bilirubin, direct bilirubin &
Hemoglobin with lowest level in class C as compared to class A, class
B and controls group.
In the current study, GDF15 was significantly different among
the 4 studied groups (P<0.001) with highest level in class C as
compared to class A, class B and controls group. Our data in HCV
related anaemic patients showed GDF 15 to have a negative
correlation with HB level and a positive correlation with both viral
load & Child-Pugh score.
As regard EPO, there was significant difference among the 4
studied groups (P<0.001) with highest level in class B as compared to
class A, class C and controls group. One explanation would be that
EPO exerts cytoprotective & regenerative effect on hepatocytes in
early cirrhosis due to modulation of nitric oxide (NO) which lead to
improve the hemodynamic insufficiency
In conclusion, we showed that higher GDF-15 levels were seen
in patients with ALC of all stages compared to controls. GDF-15 was
produced in those patients as a cytoprotective mechanism & there is a strong evidence supporting the role of GDF-15 in anemia of chronic
disease. ALC patients with a more severe disease exhibited lower
EPO levels than patients with better hepatic function and were free of
serious complications. This finding implies that EPO response to
anaemia was affected by mechanisms strictly related to cirrhosis &
changing with the evolution of disease.