CLINICAL AND EPIDEMIOLOGICAL ASPECTS OF LIVER CIRRHOSIS AMONG THE YOUNG AND MIDDLE-AGED PATIENTS

FIRST AUTHOR: DOLGHII XENIA

COAUTHOR(S) : BORDIANU ALEXANDRA, VULEA DIANA-

MONICA

COORDINATOR(S):DR. MELANIA MACARIE

Faculty of Medicine, UMPh Tîrgu MureșDepartment of Gastroenterology I, Faculty of Medicine, UMPh Tîrgu Mureș

Introduction

Liver cirrhosis represents a major problem of an actual society, being frequently diagnosed among the young population. The number of young patients suffering from cirrhosis has increased progressively in the past several decades.

Histologically, cirrhosis is defined as a diffuse hepatic fibrosis and the process of a conversion from a normal liver architecture into structurally pathological nodules that goes in time to a complete and irreversible damage of liver structure.

The most common causes of liver cirrhosis are alcohol abuse and Hepatitis Viruses B and C.

Cirrhosis - Alcohol

Also known as Laennec’s cirrhosis. Histology - megamitochondria, Mallory bodies, inflammation,

fibrosis, necrosis. Key mediator is acetaldehyde (ADH), the product of alcohol

metabolism by alcohol dehydrogenase. ADH directly activates stellate cells, inhibits DNA repair =>

FIBROSIS.

Healthy Liver vs Cirrhotic Liver ( Macroscopic Aspect)

Healthy Liver vs Cirrhotic Liver ( Microscopic Aspect)

Mallory bodies

Ethanol Metabolism

Objective

The aim of this study is to define the main clinical and epidemiological features of liver cirrhosis among the young population.

Material and Method

A retrospective study was performed which included patients diagnosed with liver cirrhosis, admitted in Gastroenterology department of Târgu Mureș Emergency County Hospital between 01.01.2013-31.12.2014.

According to age category, the patients were stratified into two groups : patients under 50 years old and the patients aged over 50 years old.

The patients were separated by sex categories and living areas.

All the readmissions were excluded from the study.

Data were collected with Microsoft Excel program and analyzed with GraphPad InStat program. Categorical data analysis was conducted with Fisher Exact Test.

Results

During the studied period 627 patients suffering from cirrhosis were admitted in Gastroenterology department of Târgu Mureș Emergency County Hospital.

Distribution by Age Category

<50 >50

77,83%

22,16%

There were included in the study 397 patients being separated by age category into two groups with an underlined ratio of >50/<50 of 3,5/1.

Distribution by Gender

Male prevalence of young and middle-aged cirrhotic patients (<50 years old): ( M/F ratio of 3/1).

Male Female0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00% 76.10%

23.80%

Distribution by Geographical Area

Prevalence of young and middle-aged cirrhotic patients(<50 years old) in the rural living area(50 rural vs 38 urban) with a ratio of R/U of 1,3/1.

Rural Urban0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

56.80%43.10%

Distribution by Etiology

Prevalence of toxic etiology in 71,59%(n=63)of cases, followed by HCV in 10,22%(n=9)of cases,HBV in3,4%(n=3) of cases, 2,2%( n=2)cases of autoimmune cirrhosis, 1,13%(n=1)cases of cirrhosis suffering from Wilson’s disease, 11,36% (n=10) cases of mixed etiology among the “<50 years old” cirrhotic patients.

Toxic Etiology + (Hep B,C/Wilson's)

Wilson's disease

Autoimmune

HBV

HCV

Toxic Etiology

0.00% 10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%

11.36%

1.13%

2.27%

3.40%

10.22%

71.59%

Other Clinical Data(I)

Cirrhosis

UGI V.B. <50 y.o

Endoscopic Band

Ligation

34,09% (n=30 cases)

83,3% (n=25 cases)

22,16% ( n=88 cases)

The relation between UGI Variceal Bleeding and an Endoscopic Band Ligation among the young and middle-aged ( <50 y.o) vs elder (>50 y.o) cirrhotic patients.

Cirrhosis

UGI V.B. >50 y.o

Endoscopic Band Ligation

77,83% (n=309 cases)

22% (n=68 cases)

82,35% (n=56 cases)

p˂0.05

1st grade of Esophageal Varices

Other Clinical Data (II)

81% (n=72 cases) of patients <50 years old have presented at admission esophageal varices of different grades.

E. Varices gr 1 E. Varices gr 2 E. Varices gr 3 E. Varices gr 40%

5%

10%

15%

20%

25%

30%

35%

40%36%

28% 29%

7%

Other Clinical Data (III)

Prevalence of Hepatocellular Carcinoma among cirrhotic patients in <50 years old vs >50 years old samples:

>50 y.o <50 y.o0

50100150200250300

HCC (+)

HCC(-)

28 0

281

88

HCC (+) HCC(-)

p˂0.05

Conclusions:

. Liver cirrhosis is a highly alarming disease which being untreated leads to a progressive loss of liver function.

Liver cirrhosis frequently leads to its complications which can be fatal if they are not diagnosed and treated on time.

Cirrhosis affects an increasingly big percent of young population as a result of a high level of ethanol consumption.

Prevalently, liver cirrhosis is diagnosed among the patients from a rural living areas, affecting more often male population.

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