Aralik 2018
C-Reaktif protein/albümin oraninin sirotik hastalarda prognostik amaçli kullanimi
Prognostic utility of C-Reactive protein/albumin ratio in cirrhotic patients
- Ana Sayfa
- Sayılar
- Aralik 2018
- C-Reaktif protein/albümin oraninin sirotik hastalarda prognostik amaçli kullanimi...
Ankara Numune Egitim ve Arastirma Hastanesi, 2Iç Hastaliklari Klinigi, Ankara
Özet
Giris ve Amaç: Bu çalismada yeni tani siroz hastalarinda tani anindakiC-reaktif protein-albümin oraninin hepatosellüler karsinom, hepatik ensefalopati, mortalite, Child-Pugh ve MELD skorlari ile iliskisini arastirdik.Gereç ve Yöntem: Bu çalisma 2011-2017 yillari arasinda Gastroenteroloji ve Hepatoloji poliklinige basvuran yeni tani siroz hastalarinin hasta kayitlari incelenerek retrospektif olarak yapilmistir. Çalismaya alinmaaninda spontan bakteriyel peritonit, hepatik ensefalopati veya hepatosellüler karsinom tanisi olanlar ve 18 yasindan küçük olanlar çalismadan dislanmistir. Bulgular: Arastirma popülasyonu 78 erkek (%66.1)ve 40 kadin (%33.9) hasta olmak üzere 118 kisiden olustu. Hastalarinortalama yasi 50.3±11.7 yildi. Hastalarda sirozun en sik etiyolojik faktörleri hepatit B (%37.3), kriptojenik (%17.8) ve hepatit C (%11.9) idi.Hastalarin ortalama takip süresi 48 aydi. Risk faktörlerinin dahil edildigiçok degiskenli stepwise Cox regresyon modelinde; hepatik ensefalopati gelismesi (HR:4.21; p=0.001), baslangiç MELD skoru (HR:1.17; p<0.001) ve C-reaktif protein-albümin orani (HR=1.22; p <0.001) mortalite riskini öngören bagimsiz prediktörler olarak saptandi. C-reaktifprotein-albümin oraninda %1’lik artisin 1.22 kat mortalite riskini arttirdigi saptandi. Mortaliteyi öngörmede C-reaktif protein-albümin oraninaait kestirim degeri %77.1 duyarlilik ve %95.2 özgüllük ile ?2.4 olaraksaptandi. C-reaktif protein-albümin orani 2.4 ve üzeri olan hastalardaHES gelismesi (%35.5 vs %10.3; p=0.004), ortalama Child-Pugh skoru (7.4±1.9 vs 6.4±1.6; p <0.001), ortalama MELD skoru (14.2±3.7vs 11.8±4.1; p <0.001) ve ölenlerin orani (%87.1 vs %9.2; p <0.001)daha yüksek saptandi. Sonuç: C-reaktif protein-albümin orani yeni tanisirotik hastalarda mortalite ve siroz komplikasyonlarini öngörmede kullanilabilecek kolay ölçülebilen ve spesifitesi yüksek bir parametredir.
Abstract
Background and Aims: In this study, we investigated the relationshipsbetween C-reactive protein/albumin ratio and hepatocellular carcinoma,hepatic encephalopathy, mortality, Child-Pugh score and model for endstage liver disease scores in newly diagnosed cirrhotic patients. Materials and Methods: This study was performed retrospectively by examining records of newly diagnosed cirrhotic patients who applied to theGastroenterology and Hepatology Polyclinic between 2011 and 2017.Patients who were diagnosed with hepatic encephalopathy, hepatocellular carcinoma or spontaneous bacterial peritonitis at admission, andpatients younger than 18 years were excluded from the study. Results:The study population was consisted of 118 patients; 78 men (66.1%)and 40 women (33.9%). The mean age of the patients was 50.3±11.7years. The most common etiologic factors for cirrhosis were hepatitis B(37.3%), cryptogenic (17.8%) and hepatitis C (11.9%). The mean follow-up period for the patients was 48 months. Using the multivariatestepwise Cox regression model in which risk factors were included. hepatic encephalopathy development (HR=4.21; p=0.001), initial model forend-stage liver disease score (HR=1.17; p <0.001) and C-reactive protein/albumin ratio (HR=1.22; p <0.001) were found to be independent predictors of mortality risk. A 1% increase in C-reactive protein/albumin ratio was found to increase the mortality risk 1.22-fold. The cut-off value ofC-reactive protein/albumin ratio for predicting mortality was found to be?2.4 with 77.1% sensitivity and 95.2% specificity. Development of hepatic encephalopathy (35.5% vs 10.3%, p=0.004), the mean Child-Pughscore (7.4±1.9 vs 6.4±1.6, p <0.001), the mean model for end-stageliver disease score (14.2±3.7 vs 11.8±4.1; p <0.001) and the proportionof dead patients (87.1% vs 9.2%, p <0.001) were significantly higher inpatients with a C-reactive protein/albumin ratio of 2.4 or above. Conclusion: C-reactive protein/albumin ratio is an easily measured parameterwith a high specificity that can be used in the prediction of mortality andcomplications in newly diagnosed cirrhotic patients
