الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Liver cirrhosis is an irreversible process resulting from various disorders that damage liver cells over time. This damage becomes so extensive that the normal structure of the liver is distorted and its function is impaired and associated with increased morbidity, development of life threatening complications, and decreased quality of life.
Cirrhosis is a pathological diagnosis characterized by diffuse fibrosis, severe disruption of the intrahepatic arterial and venous flow, portal hypertension and, ultimately, liver failure.
Acute-on-chronic liver failure (ACLF) is an increasingly recog¬nized distinct disease entity includes an acute deterioration of liver function in patients with chronic liver disease. It results in significantly higher short-term mortality than expected with decompensated liver cirrhosis and the occurrence of organ failure(s) in patients with cirrhosis indicates a poor prognosis with high mortality.
Copeptin is a stable fragment of AVP that has emerged as a reliable prognostic marker in a wide variety of diseases. It was proved to be increased in the events of systemic inflammation and can be considered a stress hormone, acting to maintain homeostasis and the principal effects of circulating AVP are vasoconstriction through its receptors.
Vitamin D is known for its function in calcium homeostasis and bone mineralization. However, it has numerous additional roles such as regulation of proliferation, apoptosis, differentiation and inflammation. Recently, an increased incidence of 25(OH)D3 deficiency has been found in individuals suffering from liver diseases and the severity of 25(OH)D3 deficiency in the patients correlated with the severity of liver dysfunction.
CRP is one of several proteins that are often referred as acute phase reactants and is used to monitor changes in inflammation associated with many infectious and autoimmune diseases. SIRS is common in patients with severe cirrhosis. It is the consequence of overt or occult bacterial infections and bacterial translocation which is the consequence of bacterial overgrowth, structural and functional changes (exudative enteropathy) of the mucosa, and a deficiency of mucosal T lymphocytes and immunoglobulin A.
The aim of this work is to study the serum levels of copeptin, Vit D and CRP in patients with ACLF. Also, to correlate their level with the severity of liver dysfunction using CP and MELD-Na scores, the grade of ACLF and the severity of ACLF using CLIF- SOFA and CLIF-C ACLF scores.