S D Janaki Rama Raju

Associate Professor, Department of General Medicine, Rangaraya Medical College, Kakinada, Andhra Pradesh, INDIA.

Email: jampanas.8@gmail.com  

Table 1: Child Pugh criteria for severity of Liver cirrhosis

Table 2: Allotment of points for Child Pugh criteria

RESULTS

Out of total of 100 patients, most of the patients were between 45-55 years of age. Average age of the patients was 54.5+8.5 years. Among the 100 patients 76 were male and 24 were female. Based on the Clinical findings, Ultrasonography of abdomen (USG) findings and biochemical studies the patients were classified in to three classes of Child Pugh (Table 3). Biochemical parameters were presented in Table 4 and Lipid profile of all the patients was presented in Table 5.

Table 3: Distribution of Child Pugh class in the sample studied

Table 4: Biochemical Parameters among the patients

Table 5: Lipid profile among the patients of liver cirrhosis

Patients among the ‘Class C’ of Child Pugh score, the mean total cholesterol value was 98.0 mg/dl, which was lowest when compared to other classes with statistical significance (p <0.001). Patients among “Child Pugh Class A” had a mean cholesterol value of 122.31 mg/dl, whereas in “Child Pugh Class B” the mean triglyceride level was 107.42mg/d1 and in patients with “Child Class C”, the mean triglyceride level was 83.51 mg/dl. The result was statistically significant with the ‘p value’ <0.001. In cirrhotic patients in “Child Pugh Class A”, the mean LDL level was 129.50 mg/dl when compared to the patients in “Child Class B” had 108.81 mg/dl and those in “Child class C” had a level of 20.38 mg/dl. The result was significant with a p value of <0.001. In the sample studied, patients in Child Pugh class C has least mean HDL level of 20.02 mg/dl, and patients in Child Pugh Class B has slightly higher mean HDL level of 26.45 mg/dl. Patients in the “Child Pugh Class A” had highest mean value of 41.25 mg/dl. The results were significant with a p value <0.001.

DISCUSSION

In a similar study conducted by Suman et al.,¹³ a total of 150 patients with cirrhosis were included Majority of the patients were in the age group between 41 to 50 years (31.3%). The youngest patient studied in the group was 36 years old and the oldest was 85 years old. Average age of the study population was 55.8±10.1 years and the age ranged from 36 to 85 years. The median age in the study group was 55 years. In a study conducted by Mohammad et al.,¹⁴ the most affected age group was 41 to 50 years of age. Phukan et al., ¹⁵ also found in their study that the most common affected age group was 41-50 years (41%). Among the patients studied, 76% were males and 24% were females. Majority of the patients with cirrhosis were males with male to female ratio of 3.1:1. Mandal et al., ¹⁶ had conducted studies in total 120 cirrhotic patients as cases from which 80 were male and 40 female patients. In another study conducted Nangliya et al., ¹⁷ had observed in their study that of 150 clinically diagnosed patients of cirrhosis (cases) 66% were males and 34% were females. which is also in concordance with our study. The incidence of liver cirrhosis is more common in men probably because they are more prone to high risk activities, substance abuse and alcohol abuse. In a study conducted by Maskey et al., ¹⁸ the most common presenting complaint of the cirrhotic patients was abdominal distension. On clinical examination of the studied samples, 52% had ascites, 41.3% had pallor, 41% had pedal edema, 36% had jaundice, 27.3 had caput medusa, 24.7% had flapping tremor, 22.7% had gynecomastia, 22% had splenomegaly, 19.3% had hepatomegaly 16.7% had parotid swelling, 15.3% had glossitis, 14% had spider naevi, 12% patients had palmar erythema and 10% had clubbing,. Ascites (52%) was the most common clinical sign found in patients with cirrhosis in the present study followed by pallor and pedal edema. According to study conducted by Makey et al., ²⁰ the most common presenting signs were ascites (100% in young cirrhotics versus 84.4% in adult cirrhotics) and icterus (93.3% in young cirrhotics vs. 84.4% in adult cirrhotics), followed by loss of body hair (73.3% vs. 71.1% in young and adult cirrhotics respectively) and spider naevi (46.7% vs. 61.1% in young and adult cirrhotics respectively). In both the studies, ascites is the most common clinical finding. Our findings were in contrast to the results observed in the study conducted by Makey et al., ²⁰ where jaundice was the second most common clinical finding; pallor was the second most common clinical sign in the present study. This can be attributed to the fact that many of the patients in the present study had hematemesis (36%) and malena (31.3%). A study conducted by Jatav et al., ¹⁹ shown a similar lipid profile findings in patients with cirrhosis when comparedto the group of non-cirrhotic individuals. This study also observed a significant decrease in serum total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, and serum triglyceride levels in liver cirrhosis patients when compared to the control group. A study done by Kumar et al.., ²⁰ shown that the reduction in the LDL cholesterol level was proportionate to the severity of liver damage in cirrhosis as detected by the Child Pugh scoring system. Ghadir et al.., ²¹ observed in their study that according to Child-Pugh classification criteria, 11 patients had score "A," 14 score "B," and 25 had score "C" from total 50 patients. It was observed that there was a significant (P < 0.05) negative correlation between liver damage according to Child Pugh criteria and serum total, HDL, and LDL cholesterol level. HDL levels were considered predictors of severity as observed in the study done by Habib et al. ²²

CONCLUSION

In our study all the parameters in lipid profiles were found to be significantly decreased in patients with liver cirrhosis. It was also observed that all the parameters of lipid profiles were significantly lower in patients belonging to “Child Pugh Class C” when compared to “class B and A” thus concluding that lipid profile progressively decreases with increase in severity of cirrhosis.

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