الفهرس 
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Abstract
Liver cirrhosis is a critical stage of chronic liver disease. In Egypt, hepatitis C virus is a major and a leading cause of liver cirrhosis and hepatocellular carcinoma.
Acute kidney injury (AKI) is one of the most serious complications of end-stage liver cirrhosis. Therefore, it is important to make a definitive diagnosis in the early stage and to prescribe appropriate medications to avoid mortality and improve prognosis.
Cardiocirculatory dysfunction develops as subclinical condition during the natural course of liver disease, manifesting only in certain clinical situations. Patients with advanced liver disease have a different risk-factor profile for cardiovascular disease than the general population.
The aim of the work was to evaluate serum copeptin in patients with HCV related cirrhosis complicated by acute kidney injury and if it is possible to use it as a biomarker for early diagnosis of acute kidney inury and cardiac complications in those patients.
The mean age of group Ia patients was 52.2±5.1 years, mean age of group Ib was 49.7± 7.31 years and that of group Ic was 57.8 ± 5.6 years, the mean age of group II was 52.2 ± 5.6 years and that of group III was 48.4 ± 3.6 years.There was no significant differences in the mean age between control and patient groups with p value =0.499 (Table 6).
Serum Copeptin level:
Serum copeptin levels in group Ia (21.08+4.11 pmol/L), group Ib (13.29+2.72 pmol/L) and group Ic (10.04+2.13 pmol/L) were significantly higher compared to group II (6.46+1.68 pmol/L) with p-value <0.001 , and also this was significantly higher compared to group III (4.29 + 1.52 pmol/L) with p-value <0.001 (Table 10 ).
There was highly significant increase in serum copeptin levels in group Ia (21.08+4.11 pmol/L) compared to group Ib (13.29+2.72 pmol/L) with p-value <0.001
Copeptin showed a positive correlation with urea (p=0.003) ‚ creatinine(p=0.036) ‚ INR(p=0.003) and Child score(p=0.001) and a negative correlation with serum albumin (p=0.001) and no correlation with bilirubin (p=0.125) or MELD score(p=0.066) (Table 11).
Copeptin predicted acute kidney injury in cirrhotic patients at a cutoff value of 7 pmol/L, with different sensitivity and specificity figures according to each group. group II exhibited 78% sensitivity and 85% specificity. In group Ia, 94% sensitivity and 97% specificity were observed. group Ib exhibited 88% sensitivity and 90% specificity (table 12).
Echocardiography findings of the study groups:
By conventional echocardiography, although there was significant increased in EF by M-mode (P=0.021*) in cirrhotic group versus control group, there was insignificantly increased LV end-diastolic dimensions, LV end-diastolic volume, and EF by2D. Regarding diastolic function by conventional parameters, there were statistically higher significant values of E, A, and deceleration time in cirrhotic group versus control group with p value = 0.023*(table 13) . When patients were stratified according to the degree of liver impairment (Child-Pugh class and MELD), echocardiography parameters were similar (Table 14). Interestingly, there was no difference in echocardiographic parameters when Child A status patients were compared to Child B/C status patients. Systolic and/or diastolic dysfunction was not influenced by a more severe liver impairment.
Copeptin correlated directly with wall motion index score (WMIS) and inversely with LV ejection fraction (LVEF) at discharge (WMIS, r=0.276, P<0 .001 ; LVEF, r=-0.188, P=0.003) .In addition,there was significant correlation between Copeptin and ventricular volumes (LVEDV, r=0.076, P=0.235; LVESV, r=0.143, P = 0.025)(Table 15).
Conclusion:
Serum copeptin has the ability to differentiate between AKI types in patients with cirrhosis. This could improve risk stratification for patients admitted to the hospital with cirrhosis, perhaps leading to early ICU admission, transplant evaluation, and prompt initiation of HRS therapy and early management of AKI.