الفهرس 
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Abstract
Liver cirrhosis has a high morbidity and mortality due to its related complications. Ascites is the most common complication and the main cause of hospitalization in decompensated cirrhotic patient. Cirrhotic patients are at high risk for bacterial infections due to changes in the gut-liver axis that result in pathologic bacterial translocation and endotoxin release into the systemic circulation. SBP is a serious common form of infection in cirrhotic ascitic patients. Its prevalence among the hospitalized group of those patients varies from 25%-30%. The disease burden of SBP in liver cirrhosis patients greatly affect and increase morbidity and mortality amongst this group. Early detection and prober management of SBP help decrease mortality. Hepatorenal syndrome is one of various potential causes of acute kidney injury in patients with decompensated liver disease and an important complication of SBP. Adequate and early treatment of SBP proved to prevent hepatorenal syndrome in patients with SBP Patients. Therefore, there is a need for new and effective predictor of SBP infection and its possible complications for better patient’s outcome. vWF is a marker of endothelial dysfunction in patients with cirrhosis which is closely linked to liver fibrogenesis that leads to portal hypertension and liver disease progression. Endotoxemia due to pathological bacterial translocation has been also closely linked to vWF-Ag level independently of HVPG. So, in this study; we aimed to evaluate the clinical utility of vWF-Ag level as a marker to early predict SBP infection and HRS as an important complication. We estimated vWF-Ag level together with full clinical assessment, laboratory tests for 90 cirrhotic ascitic patients. They were selected from Tropical Medicine Department, Tanta University Hospital. They were divided to 3 groups; (group A: 30 cirrhotic ascitic patients without Spontaneous bacterial peritonitis), (group B: 30 cirrhotic ascitic patients with Spontaneous bacterial peritonitis) and (group C: 30 cirrhotic ascitic patients with Spontaneous bacterial peritonitis and complicated with HRS). Our results demonstrated that: vWF is not only a marker of portal hypertension but also strongly and independently predictive of SBP At cut off >196.5 with sensitivity of 95%, specificity of 80%, PPV of 89.1% and NPV of 88.5%. Also can predict HRS in patients with SBP At cut off >244 with sensitivity of 93.33%, specificity of 63.33%, PPV of 56% and NPV of 95%. VITRO score can predict SBP At cut off >2.26 with sensitivity of 75%, specificity of 60%, PPV of 78.9% and NPV of 54.5%. Also can predict HRS in patients with SBP At cut off >2.6 with sensitivity of 70%, specificity of 60%, PPV of 46.7%and NPV of 80%. vWF and VITRO score have been considerably correlated to CHILD score and MELD score in all study groups (p=<0.001, p=0.035). And accurately predict hepatic decompensation. The mean value of CHILD score was significantly lower in non SBP group compared to SBP groups. The mean value of MELD score was significantly higher in group C compared to groups A and B and was significantly higher in group B compared to group A. There is a positive significant correlation between vWF-Ag level and PV diameter (r=0.566, P=0.001). That supports the value of vWF-Ag level in the prediction of CSPH and oesophageal varices and variceal bleeding. Ascites degree, PV diameter and splenic vein diameter are significantly higher in SBP groups compared to non SBP group. TLC and Neutrophil count in ascitic fluid analysis were significantly higher in group C compared to groups A and B. Ascitic protein and ascitic glucose were significantly higher in group B&C compared to groups A . Hb, Lymphocytes, Monocytes and Platelet were insignificantly different among the studied groups. WBCs count was significantly higher in group B compared to group A while it was significantly higher in group C compared to group A and group B. Neutrophil count was significantly different among the studied groups Albumin, AST, INR, total bilirubin and direct bilirubin were insignificantly different among the studied groups. ALT was significantly different among the studied groups, it was significantly higher in group C compared to groups A and B .However it was insignificantly different between group A and group B. Creatinine and Urea were significantly higher in group C compared to groups A and B .While eGFR was significantly lower in group C compared to groups A and B. Serum Na was significantly lower in group C compared to groups A and B. whereas serum K was significantly higher in group C compared to groups A and B.