Peculiarities of Hepatic Encephalopathy in Patients with Alcohol Liver Cirrhosis Against the Background of Chronic Bronchitis Exacerbation
Objective. To evaluate the clinical manifestations of hepatic encephalopathy (HE) in patients with alcohol liver cirrhosis (ALC) in exacerbation of chronic bronchitis (CB).
Materials and methods. 100 patients with ALC class B and C according to Child-Pugh, 82.00% of men and 18.00% of women aged (47.2±3.9) years, were examined: 48 patients without combination with CB (group I); 52 patients on the background of CB exacerbation (group II). Clinical-laboratory and instrumental examination was performed. The West-Haven criteria were used to assess the HE.
Results. In 54.17% of patients in group І, the I degree of HE was determined, in 35.42% – the ІІ degree, in 10.42% – the ІІІ degree. In patients of group ІІ the HE of the І degree was found in 17.31%, the ІІ degree – in 50.0%, the ІІІ degree – in 32.69% (p<0.05). In patients with ALC and ALC in combination with CB, respectively, clinically HE was manifested by drowsiness in the daytime and the inversion of sleep (58.33%; 75.00%), lengthening the duration of the TMT-time test (61.59±2.38 sec; 72.84±3.03 sec), mood disorders (20.83%; 28.85%), appearance of asterixis (54.17%; 76.92%), constructive apraxia (41.67%; 55.77%).
Conclusions. 1. Exacerbation of CB in patients with ALC contributes to the increase in the degree of HE, worsening the prognosis. 2. The relationship between the hyponatremia and the degree of HE is revealed.
Alcoholic liver disease. Adapted clinical guideline based on evidence, [Electronic resource]; 2014; Resource access mode: http://moz.gov.ua/docfiles/dod_akn_dn_20140616_1.pdf.
Babak OYa, Sytnik KA, Kurinnaya EG. Diagnostics and treatment of minimal hepatic encephalopathy. Ukrainian therapeutic journal. 2013; 3: 81-86.
Bondar MV. Modern aspects of intensive therapy of hepatic encephalopathy from the standpoint of evidence-based medicine. Intensive Therapy. 2012; 6: 11-16.
Vorozhbyt OB, Gerasun OB, Gritsko RYu et al. Modern aspects of diagnostics and treatment of liver encephalopathy in patients with chronic liver diseases. Hepatology Scientific and Practical Medical Journal. 2011; 30: 15-35.
Demographic Yearbook "Population of Ukraine" for 2016; Kyiv, State Statistics Service of Ukraine, 2017; 150.
Kolesnyk MO, Dudar IO. Clinical protocol for the diagnostics and treatment of hyponatremia. Ukrainian Journal of Nephrology and Dialysis. 2115; 1 (45).
Pylypko IV. Portal hypertension syndrome and mechanisms of its development in hepatic pathology. Bulletin of scientific research. 2015; 4: 7-10.
Taran OI. Symposium № 179 “Hepatorenal Syndrome”. Pochki. 2014; 3 (9): 64-68.
Tkachenko TV, Pentiuk LO, Pentyuk NO. Bacterial infections in patients with liver cirrhosis. Bukovynsky Medychny Visnyk. 2015; 19 (3 (75)): 245-253.
Futko KhV, Sirchak YeS, Archi EY et al. Markers of hepatorenal syndrome in patients with liver cirrhosis. Naukovy Visnyk Uzhhorodskoho Universytetu. 2011; 2 (41): 259-262.
Chuklin SM, Chuklin SS. Hyponatriemia in patients with liver cirrhosis. Hepatology. 2015; 3: 6-17.
Shved MI, Boyko TV, Lychatskaya HV et al. Dynamics of clinical-biochemical parameters in patients with liver cirrhosis under the influence of complex therapy with the use of ursodeoxycholic acid. Gastroenterology. 2013; 4 (50): 57-60.
European Association for the Study of the Liver: EASL Clinical Practical Guidelines: Management of Alcoholic Liver Disease. 2012. Journal of Hepatology. 2012; 57: 399-420. http://www.spg.pt/wp-content/uploads/2015/11/2012-ALD.pdf. DOI: https://doi.org/10.1016/j.jhep.2012.04.004 [PMid:22633836]
Cárdenas A, Solà E, Rodríguez E, et al. Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study. Critical Care. 2014; 18: 700. DOI: https://doi.org/10.1186/s13054-014-0700-0
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