الفهرس 
Liver Cirrhosis and associated renal dysfunctionOnly 14 pages are availabe for public view
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Abstract
C
irrhosis is the end stage in the spectrum of chronic liver disease, characterized by advanced fibrosis and formation of regenerative nodules with distortion of underlying normal hepatic architecture (Heidlbaugh et al., 2006).
Cirrhosis of the liver is more common than previously thought, affecting more than 633,000 adults yearly worldwide, according to a study published in (The Journal of Clinical Gastroenterology, 2015). There are multiple prognostic scores that predict the mortality from chronic liver disease, of which the Child-Pugh score and MELD score are the most commonly used. MELD is a validated scoring system used to predict mortality and is a composite of the patient’s laboratory values for serum bilirubin and serum creatinine, and the international normalized ratio (INR) for prothrombin time (Younossi et al., 2014).
The MELD score has been shown to be at least equivalent to the Child-Pugh score (Shaikh et al., 2010) in predicting survival of patients with cirrhosis. Hyponatremia is a common laboratory finding in patients with decompensated liver disease. It has been noted in several studies that inclusion of the serum sodium level, especially in hyponatremic patients, increases the predictive accuracy of MELD in chronic liver disease (Biselli et al., 2010). Hyponatremia mirrors the underlying primary changes in hemodynamic parameters, such as vasodilation with decreased systemic vascular resistance (SVR) and subsequent compensatory neurohumoral adaptations (Ginès and Guevara, 2008). It has been postulated that the marked reduction in SVR results from inability of the liver to metabolize circulating vasodilators such as nitric oxide, eicosanoids, bile salts, adenosine, and tachykinins (Ginès and Schrier, 2009).
The aim of this study is to identify the prognostic value of Systemic Vascular Resistance as a single entity, according to its correlation with prospectively validated scoring systems such as Model of End stage Liver Disease (MELD) & its modification (MELD-NA) as predictors of severity in cirrhosis and also their correlation with renal impairment.
This study is Retrospective cohort study for 75 patients, which was conducted on patients presented in the Gastroenterology & Hepatology unit, department of Internal Medicine Ain Shams University Hospital from February-July 2017.
According to the Child Pugh score and the renal profile, the included patients were divided into three Groups:
group 1: 15 patients with compensated Cirrhosis as control.
group 2: 30 Patients with Decompensated Cirrhosis without renal impairment. a)15 Normonatremic Patients. b)15 Hyponatremic Patients.
group 3: 30 Patients with Decompensated Cirrhosis with renal impairment. a) 15 Normonatremic Patients. b) 15 Hyponatremic Patients.
All patients were subjected to history taking, clinical examination, abdominal ultrasonography, echocardiography and laboratory investigations.
Patients excluded in cases of pre-existing kidney disease and those with other possible causes of hyperdynamic circulation, including sepsis and thyrotoxicosis, were excluded, as well as patients who had undergone any portosystemic or arteriovenous shunting procedure, patients with known D.M, Hypertention and preexisting cardiac patients.
The study revealed that patients with decompensated liver cirrhosis have low systemic vascular resistance and also identified the prognostic value of SVR as a single entity, according to its correlation with prospectively validated scoring systems such as MELD and its modification MELD-Na.
The study also observed a statistically significant inverse correlation between SVR and the validated liver disease severity models MELD and MELD-Na in patients with low serum sodium levels.
The results pointed to a mean cut off value of 591 for SVR, 20 for MELD score and 23 for MELD-Na score for renal impairment.