Abd Al Monem, N., Afifi, S., Ahmed, S., Ghareeb, D., Ateya, R., Bessar, A., Rageh, F. (2021). Role of Portal Hemodynamics in Mortality and Adverse Out-come Prediction of Hyponatremic Cirrhotic Patients. Suez Canal University Medical Journal, 24(2), 118-127. doi: 10.21608/scumj.2021.192015
Nagla Abd Al Monem; Samir A Afifi; Samar S Ahmed; Dalia Ghareeb; Rehab M. M Ateya; Ahmed A Bessar; Fatma Rageh. "Role of Portal Hemodynamics in Mortality and Adverse Out-come Prediction of Hyponatremic Cirrhotic Patients". Suez Canal University Medical Journal, 24, 2, 2021, 118-127. doi: 10.21608/scumj.2021.192015
Abd Al Monem, N., Afifi, S., Ahmed, S., Ghareeb, D., Ateya, R., Bessar, A., Rageh, F. (2021). 'Role of Portal Hemodynamics in Mortality and Adverse Out-come Prediction of Hyponatremic Cirrhotic Patients', Suez Canal University Medical Journal, 24(2), pp. 118-127. doi: 10.21608/scumj.2021.192015
Abd Al Monem, N., Afifi, S., Ahmed, S., Ghareeb, D., Ateya, R., Bessar, A., Rageh, F. Role of Portal Hemodynamics in Mortality and Adverse Out-come Prediction of Hyponatremic Cirrhotic Patients. Suez Canal University Medical Journal, 2021; 24(2): 118-127. doi: 10.21608/scumj.2021.192015
Role of Portal Hemodynamics in Mortality and Adverse Out-come Prediction of Hyponatremic Cirrhotic Patients
1Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt
2Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
3Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Suez University, Egypt
4Department of Clinical Pathology, Faculty of Medicine, Suez University, Egypt
5Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
6Department of Radio-diagnosis, Faculty of Medicine, Zagazig University, Egypt
7Department of Infectious diseases, Gastroenterology and Hepatology, Faculty of Medicine, Suez University
Abstract
Background: Cirrhotic patients have variable degrees of hepatic dysfunction. Impaired portal hemodynamics and hyponatremia occurs in the setting of end-stage liver disease. Aim: to uncover the role of portal hemodynamics in mortality and adverse outcome prediction of hyponatremic cirrhotic patients. Subjects and Methods:Eighty cirrhotic patients with hyponatremia (serum Na<130mmol/L) were included. ]iagnosis of hepatic encephalopathy using West Haven criteria, laboratory investigations, modified Child-Pugh and MELD scores were calculated, abdominal ultrasonography with Doppler study of portal circulation and upper GIT endoscopy were performed and the patients were followed up during their stay in hospital. Results:Serum sodium level has high statistically significant negative correlation with modified Child-Pugh score (P <0.001) and with MELD score (P <0.001). Most of the patients developed hepatic encephalopathy, spontaneous bacterial peritonitis, hepato-renal syndrome, and bleeding recorded in some patients; meanwhile mortality in 10% of the patients. In addition, apart from Hepatic Artery resistive Index, the difference in MELD score, MELD-Na score and Portal vein congestive Index between non-survived and survived patients was statistically insignificant, although all these indices were highly significant with hepatic encephalopathy, Portal vein congestive Index is highly significant in hepatorenal syndrome and bleeding esophageal varices, and Hepatic Artery resistive Index is highly significant in hepatorenal syndrome. Analysis of the receiver operating characteristic curve revealed that Portal vein CI was the most sensitive indicator (sensitivity 78.5%) and hepatic A resistive Index was the most specific indicator for prediction of mortality in hyponatremia cirrhotic patients. Conclusion:portal vein CI and hepatic A. RI can be used in the prediction of mortality in hyponatremia cirrhotic patients.
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