Предиктивен потенцијал на MELD и Child-Turcotte-Pugh II скорот за СБП кај пациенти со црнодробна цироза и асцит

It is very important for patients with spontaneous bacterial peritonitis (SBP) to assess the length of survival and the risk of death, primarily because of the wide range of potential complications that can lead to multisystem organ failure and fatal outcome. The aim of this study was to determine the predictive potential of MELD and Child-Turcotte-Pugh II score for SBP in patients with cirrhosis and ascites. Material and methods: The study was designed as a prospective-analytical-observational and was conducted at the University Clinic for Gastroenterohepatology in Skopje for a period of one year. The study population included 70 hospitalized patients with established liver cirrhosis, regardless of etiology, divided into two groups, 35 patients with SBP and 35 non-SBP. Prognostic scores in patients with liver cirrhosis and ascites: MELD score, according to the formula: MELD = [(0.957 x Ln Creatinin) + (0.378 x Ln Bilirubin) + (1.12 x Ln INR) + (0.643) x 10]. The Child-Turcotte-Pugh II score includes 6 parameters: serum albumin and bilirubin, amount of ascites, degree of encephalopathy ( HE), prothrombin time (PT) and serum creatinine, and assessment of the degree of hepatic encephalopathy according to the West Haven criteria. Results: The average value of the MELD score in patients with SBP was 22.6 ± 8.27 and in non-SBP the average value was lower - 17.83±5.87. According to the Mann-Whitney U test, the difference between the mean values ​​was statistically significant for p <0.05 (z = 2.41; p = 0.015). A score of 30 to 39 was registered in 25.7% of patients with SBP, and only in 2.9% in non-SBP; the percentage difference was statistically significant for p <0.05 (Difference test, p = 0.0064 ). Patients with SBP had an average Child-Pugh score of 13.09 ± 2.48 or 100.0% C-class points. In patients with non-SBP, an average child-Pugh score of 9.63 ± 1.62 was recorded, or class B in 65.7% and class C in 34.3%. The percentage difference was statistically significant for p <0.05 (Difference test, p = 0.000000). According to the Mann-Whitney U test, the difference between the mean values ​​was statistically significant for p <0.05 (z = -5.44; p = 0.00001). ROC analysis indicated that the Child-Turcotte-Pugh II score contributed to the diagnosis of SBP - 90.7% (p = 0.000) (excellent predictor), closer to the ideal value of 1.0 and above the worst value of 0.5. ROC analysis indicated that the MELD score did not contribute to the diagnosis of SBP - 66.7% (p = 0.017) (weak predictor), closer to the worst value of 0.5. Conclusion:Our research confirmed that SBP occurs in patients with severe hepatic dysfunction calculated according to the CTP II score and MELD score. Mean value of the MELD score in patients with SBP was higher then in patients with non-SBP. On the other hand all patients with SBP had an average CTP II score, C-class points,  while the largest percentage of patients with non-SBP were class B-class points. MELD score is a weak predictor of SBP.  The best predictor for predicting SBP is the CTP II score (rank C).Поради широкиот спектар на потенцијални компликации кои може да доведат до  мултисистемско органско попуштање и смрт,  многу е важно кај пациентите со спонтан бактериски перитонитис (СБП) да се направи проценка на должината на преживување и ризикот од смртен исход. Целта на трудот беше да се одреди предиктивниот потенцијал на MELD и Child-Turcotte-Pugh II скорот (CTP II) за  СБП кај пациентите со црнодробна цироза и асцит. Материјал и методи: Студијата беше дизајнирана како проспективно-аналитичко-опсервациска и се спроведе на Универзитетската  клиника за гастроентерохепатологија во Скопје во период од една година. Студиска популација беа хоспитализирани пациенти со етаблирана црнодробна цироза, без оглед на етиологијата, вкупно 70 пациенти, поделени во две групи, 35 пациенти со СБП и 35 без СБП.  Прогностички скорови кај пациенти со црнодробна цироза и асцит:   MELD скор, според формулата: MELD = [(0,957 х Ln Creatinin) + (0,378 х Ln Bilirubin) + (1,12 х Ln INR) + (0,643) х 10]. СТП II скор вклучува 6 параметри: албумин и билирубин во серум, количина на асцит, степен на енцефалопатија, протромбинско време (ПВ) и креатинин во серум, а проценка на степенот на хепатална енцефалопатија(HE) со West-Haven-овите критериуми. Резултати: Просечната вредност на MELD скорот кај пациентите со СБП изнесуваше 22,6±8,27 а кај  оние без СБП просечната вредност беше пониска и изнесуваше 17,83±5,87. Според Mann-Whitney U тестот, разликата помеѓу просечните вредности беше статистички сигнификантна за p<0,05 (z =2,41; p=0,015). Вредност на скорот од 30 до 39 беше регистрирана кај  25,7% од пациентите со СБП, а само кај 2,9% од оние без СБП; процентуалната разлика беше статистички сигнификантна за p<0,05 (Difference тест, p=0,0064).Кај пациентите со СБП беше регистрирана просечна вредност на CTP II скорот од 13,09±2,48 или во поени 100,0%, класа C. Кај пациентите без СБП беше регистрирана просечна вредност на  CTP II скорот од 9,63±1,62 или класа B  кај 65,7%  и  класа C кај 34,3%. Процентуалната разлика беше статистички сигнификантна за p<0,05 (Difference тест, p=0,000000). Според Mann-Whitney U тестот, разликата помеѓу просечните вредности беше статистички сигнификантна за p<0,05 (z =-5,44; p=0,00001).ROC-анализата покажа дека CTP II скорот придонесува за дијагностицирање на СБП - 90,7% (p = 0,000) (одличен предиктор), поблизу до идеалната вредност од 1,0 и над најлошата вредност од 0,5.ROC-анализата покажа дека MELD скорот не придонесува за дијагностицирање на СБП  со 66,7% (p = 0,017) (слаб предиктор), поблизу e до најлошата вредност од 0,5. Заклучок:Нашето истражување потврди дека СБП се јавува кај пациенти со тешка хепатална дисфункција пресметана според CTP II и MELD скорот. Средната вредност на MELD скорот кај пациенти со СБП беше поголема отколку кај пациенти со не-СБП. Од друга страна, сите пациенти со СБП имаа просечна вредност на CTP II, C-класа, додека најголем процент од пациентите со не-СБП беа B-класа. MELD скорот е слаб предиктор за СБП. Најдобар предиктор за предвидување на СБП е CTP II (ранг C) скор

Kвантитативно одредување на калпротектин во асцит кај пациенти со спонтан бактериски перитонитис

Spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis is a newly developed, spontaneous bacterial infection of sterile ascites fluid, in the absence of intraabdominal sources of infection or malignancy. The most sensitive indicator of diagnosis is when the polymorphonuclear cell count (PMNC) is ≥250 in 1 ml ascites fluid (manual microscopic or automated counting) and/or when a bacterial strain is isolated in microbiological culture. The objectives of our pilot study were to determine the concentration of calprotectin in ascites in patients with SBP and non-SBP with BíœHLMANN Quantum Blue®Reader, whether there was a significant difference between the average values "‹"‹of Turcotte-Pugh II and MELD score and to determine average values for CRP serum and ascites in the studied groups. Materials and methods. This prospective analytical observational pilot study included 30 patients with liver cirrhosis and ascites, divided into two groups, SBP and non-SBP. The quantitative measurement of calprotectin in ascites was performed with the Quantum Blue Calprotectin Ascites (LF-ASC25) test. The test is designed to selectively measure calprotectin antigen (MRP8/14) with direct sandwich immunoassay. The ascites samples were diluted with Chase Buffer 1:5 and after 12 minutes incubation at room temperature, the test line signal intensity and the control line were quantitated with BíœHLMANN Quantum Blue®Reader. The collected data were processed using the SPSS 23 statistical software for Windows. Results. In our study the average value of calprotectin in patients with SBP was 1.4 µg/mL. The lowest value of calprotectin in the study group was recorded in one patient at 0.61 µg/mL, while the highest value was 1.81 µg/mL in four patients. The results showed higher values "‹"‹of calprotectin in ascites in patients with alcoholic liver disease compared to other etiologies. Refractive ascites was reported in 60.0% of the subjects and only one patient (6.7%)was reported with Klepsiella pneumoniae in the microbiological analysis of ascites. According to the Child-Turcotte-PughII classification, all patients in the study group were class C, while the mean MELD score was 29.8±6.14. The difference between the average values of CRP in serum and ascites in patients with SBP was statistically significant compared to non-SBP. Conclusion. The quantitative determination of calprotectin in ascites by the Quantum Blue Calprotectin Ascites (LF-ASC25) assay can be used as an alternative to the determination of PMNC in ascites. SBP occurs in patients with severe hepatic dysfunction calculated according to the Child-Pugh II score and the MELD score. Serum and ascites C-reactive protein values were not significantly elevated in patients with SBP, but were significantly different from non-SBP patients.Спонтаниот бактериски перитонитис (СБП) кај пациентите со црнодробна цироза е новонастаната, спонтана бактериска инфекција на стерилна асцитна течност, во отсуство на интраабдоминални извори на инфекција или малигнитет. Најсензитивен показател за поставување на дијагнозата е бројот на полиморфонуклеарни клетки (ПМНК) ≥250 во 1 мл асцитна течност (рачно микроскопско или автоматизирано пребројување) и/или кога во микробиолошката култура биде изолиран еден бактериски вид. Цел на трудот е да се одреди концентрацијата на калпротектин во асцит кај пациентите со СБП и не-СБП, да се споредат просечните вредности на Turcotte-Pugh II и MELD скорот кај пациентите со СБП и не-СБП  и просечните вредности на C-реактивниот протеин во серум и во асцит во испитуваните групи. Материјали и методи. Во оваа проспективно-аналитичко-опсервациска пилот студија беа вклучени 30 пациенти со црнодробна цироза и асцит, поделени во две групи, СБП и не-СБП. Квантитативното мерење на калпротектин во асцит се вршеше  со тестот Quantum Blue Calprotectin Ascites (LF-ASC25). Тестот е дизајниран за селективно мерење на антигенот на калпротектинот (MRP8/14) со директен сендвич имуноесеј. Примероците од асцитот се разредуваа со  Chase Buffer во однос 1:5 и по 12 минути инкубација на собна температура,  интензитетот на сигналот на линијата за тестирање и контролната линија се мереа квантитативно со BÜHLMANN Quantum Blue®Reader. Собраните податоци се обработија со помош на статистичкиот програм SPSS 23 за Windows. Резултати. Во нашата студија просечната вредност на калпротектин кај пациентите со СБП изнесуваше 1,4 μg/mL. Најниската вредност на калпротектин во испитуваната група беше регистрирана кај еден пациент со вредност од 0,61 μg/mL,  додека највисока вредност од 1,81μg/mL кај четири пациенти. Резултатите покажаа повисоки вредности на калпротектин во асцит кај пациентите со алкохолна болест на црниот дроб во споредба со останатите етиологии. Рефракторен асцит се регистрира кај 60,0% од испитаниците, а само кај еден пациент (6,7%) се регистрира Klepsiella pneumoniae во  микробиолошката анализа на асцитот. Според Child-Turcotte-PughII класификација сите пациенти од испитуваната група беа класа C, додека просечната вредност на MELD скорот изнесуваше 29,8±6,14. Разликата помеѓу просечните вредности наC-реактивниот протеин во серум и во асцит кај пациентите со СБП  беше статистички сигнификантна во споредба со не-СБП.  Заклучок. Kвантитативното одредување на калпротектинот во асцит со тестот Quantum Blue Calprotectin Ascites(LF-ASC25) може да се користи како алтернатива наполиморфонуклеарните клетки (ПМНК) во асцит. СБП се јавува кај пациенти со сериозна црнодробна дисфункција пресметана според Child-Pugh II скорот и MELD скорот. Вредноста на C-реaктивниот протеин во серум и во асцит кај пациентите со СБП немаше високи вредности ,но сепак беше утврдена сигнификантна разлика во споредба со пациентите со не-СБП

Atorvastatin in Combination with Pegylated Interferon and Ribavirin Provided High Rate of Sustained Virological Response in Patients with Genotype 3 Hepatitis C Virus

BACKGROUND: Chronic hepatitis C virus infection represents a more frequent cause of liver cirrhosis and hepatocellular carcinoma. Statins, inhibit HCV replication in vitro, enhance the antiviral effect of the already known antiviral drugs and reduce their resistance. AIM: To determine the impact of additional therapy (treatment with Atorvastatin 20 mg) to the standard antiviral therapy (pegylated interferon alpha-peg-IFN α and ribavirin) on achieving sustained virological response (SVR). MATERIAL AND METHODS: In the study which is comparative, open-label, prospective-retrospective, 70 patients diagnosed with chronic hepatitis C virus infection who met criteria for treatment with standard antiviral therapy combined with anti-lipemic therapy (Atorvastatin 20 mg) were included. Patients in the study were divided into two groups: one group of 35 patients receiving combination therapy (Atorvastatin + peg-IFN α + Ribavirin) and another group of 35 patients received only standard antiviral therapy. Those parameters were followed in all patients: genotyping, quantification of the virus, histological assessment of liver inflammation and fibrosis degree (before starting treatment), the presence of steatosis, laboratory analysis: hematology, liver, lipid and carbohydrate status, insulin blood level (the calculation of HOMA-IR) and body mass index (BMI) calculation. The overall treatment of the patients depends from the virus genotype, thus, patients with genotype 1 and 4 received 48 weeks standard antiviral therapy, but patients with genotypes 2 and 3 received 24 weeks of antiviral therapy. SVR was considered an undetectable level of HCV RNA levels 24 weeks after completion of antiviral therapy. The results were statistically analysed, and all results for p < 0.05 were considered statistically significant. RESULTS: Combination therapy leads to a slightly higher percentage of SVR (85.71%) in patients with chronic hepatitis C versus standard therapy (74.29%), but in a group of patients with genotype 3 this rate of SVR amounting to 95.83%. Combination therapy leads to significant improvement of lipid and glucose status after treatment, and in terms of side effects, there was no appearance of serious adverse events that would be a reason for discontinuation of the therapy. CONCLUSION: Combination therapy Atorvastatin + pegylated interferon alpha + Ribavirin leads to high rate of SVR of 95.83% in patients with chronic hepatitis C, genotype 3. Statins can be used safely in patients with chronic hepatitis C

Post COVID-19 irritable bowel syndrome

Objectives: The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. Design: GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. Results: The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. Conclusion: Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls. Trial registration number: NCT04691895

Correlation of serum leptin with anthropometric parameters and abdominal fat depots determined by ultrasonography in overweight and obese women

Leptin is an adipocytokine that has an important role in energy homeostasis and therefore in the pathophysiology of obesity. Leptin levels are influenced by many factors such as gender, race, energy intake, fat mass, etc. The aim of our study is to investigate the relationship of circulating leptin levels to anthropometric parameters and to the subcutaneous and visceral fat tissue determined by ultrasonography in healthy overweight and obese women. The study included 50 healthy women, with body mass index (BMI) above 25 kg/m2. Measurements of anthropometric parameters were performed with a standardized technique. The subcutaneous and visceral fat tissue was measured with ultrasound 1 cm above the umbilicus. Leptin was determined by radioimmunoassay. The serum leptin levels presented a positive correlation between the levels of leptin and BMI (r-0.73, p < 0.05) waist circumference (r-0.73, p < 0.05) hip circumference (r-0.74, p < 0.05), thigh circumference (r-0.56, p < 0.05) and abdominal subcutaneous fat tissue (r- 0.46, p < 0.05). There was no correlation between leptin and visceral fat tissue, waist to hip and waist to thigh ratio. The results of our study confirmed the correlation between leptin and BMI. The correlation between leptin and all measured circumferences cannot be attributed to a particular fat depot, but rather reflect the correlation between this adipocytokine and the total body fat. The subcutaneous fat depot determined by ultrasound showed a correlation with leptin, while this kind of connection was not established for the visceral fat tissue. Key words: Leptin, abdominal subcutaneous fat, abdominal visceral fat

Insulin, insulin resistance and anthropometric parameters in overweight and obese women

Insulin resistance together with obesity, hypertension and dyslipidemia is part of the cluster that represents the metabolic syndrome. The impaired insulin sensitivity has been reported to be linked with obesity; however the importance of the fat distribution has also been emphasized in the development of this disorder. The aim of our study was to determine to association of serum insulin and insulin resistance assessed by HOMA with anthropometric parameters in obese and overweight women. Also the correlation of insulin and insulin resistance (HOMA-IR) with the subcutaneous and visceral abdominal fat was evaluated. The study included 41 overweight and obese women, aged 20- 60 years. The anthropometric parameters like body mass index (BMI), waist, hip and thigh circumference were measured with standard methods. Abdominal subcutaneous fat tissue (SFT) and visceral fat tissue (VFT) were determined by ultrasonography. Insulin values were measured with radioimmunoassay and the insulin resistance was assessed by the HOMA2 method. The results of our study showed strong correlation of insulin and HOMA-IR with BMI (r 0.36, p<0.01). The median and mean values of these parameters were much higher in subjects with obesity grade 2 and 3. The insulin concentrations and HOMA-IR also showed good correlation with waist and hip circumference and with the subcutaneous fat tissue (p<0.05). The results of our study point to the fact that in addition to the total body fat accumulation, the role of the subcutaneous fat tissue in the development of insulin resistance in overweight and obese Macedonian women should not be underestimated. Key words: insulin resistance, subcutaneous fat, visceral fa

PORTAL VEIN THROMBOSIS-ULTRASOUND IMAGING

Portal venous system, apart from the main portal vein, includes its tributaries: superior and inferior mesenteric vein, as well as splenic vein, so the term portal venous thrombosis encompasses a broad spectrum of pathological conditions. Usually, one or more causative factors can be recognized, either local endothelial/ flow disturbances, or systemic inherited /acquired conditions. Portal vein thrombosis can be associated with benign or malignant disorders. Weather we are speaking about acute or chronic thrombosis, the clinical presentation is different. Acute thrombosis can be presented in a wide range, from mild abdominal discomfort to a state of intestinal ischemia and life-threatening infarction. Chronic thrombosis is usually recognized when variceal bleeding or other symptoms of portal hypertension express. Fast and accurate diagnosis sometimes is a life-saving procedure, especially in acute vascular alterations. Recently, due to the improvement of imaging procedures the number of patients with diagnosed portal vein thrombosis is increasingly growing. With a negative predictive value of 98% color Doppler ultrasound is considered as imaging modality of choice in detecting portal vein thrombosis. Based on large studies it is presumed that overall risk of getting portal vein thrombosis during lifetime is 1% in general population, but much bigger 5%-15% in cirrhotic patients. Existence of specific ultrasound criteria, if fulfilled, has ensured that diagnosis of portal vein thrombosis is fast and non-invasive. Procedure is convenient for the patient and healthcare providers, and above all, allows prompt treatment preventing further deterioration

Aсоцијација на плазма Д-димерите со стадиумите на црнодробна цироза и нејзините компликации

Aim of the study: To investigate plasma D-dimer levels in correlation with Child-Pugh-Turcotte (CTP) and Model for End-Stage Liver Disease (MELD) scores in patients with liver cirrhosis (LC) of different severity, as well as the correlation with LC-associated clinical, biochemical parameters and complications. Material and methods: Fifty patients with LC were divided in three groups according to LC severity using the CTP Score (CTP-A, CTP-B, CTP-C).  The levels of D-dimer were measured in sodium-citrate plasma on Siemens, BCS XP Blood Coagulometer. Kruskal-Wallis test was used to compare D-dimer levels between the groups. Mann-Whitney U test was used to evaluate the difference of D-dimer levels in groups with different MELD score, and to evaluate the difference in D-dimer levels in patients with presence or absence of ascites and the difference of D-dimer levels in patients with or without spontaneous bacterial peritonitis (SBP). Pearson’s coefficient of correlation was used to evaluate the correlation between D-dimer levels with MELD score and the correlation between D-dimer levels and the concentration of LC-associated biochemical, clinical parameters and complications. Results: D-dimer levels increased with severity of the disease as assessed with CTP and MELD scores, with a statistically significant difference between the groups (p=.0000 and p=.0001, respectively). Group CTP-C demonstrated the highest D-dimer levels, followed by groups B and A. Patients with SBP had significantly higher levels of D-dimers than patients without SBP (p=.0006). A significant positive correlation between D-dimers and CTP and MELD score was detected (r= 0.74 and r=0.44, respectively; p&lt;.001). A correlation between D-dimer levels and several biochemical parameters characterizing progressive liver dysfunction was observed. From all investigated biochemical parameters, the highest significant correlation was detected between D-dimer levels and the concentration of serum albumin (r= -0.65, p&lt;.001). Conclusions: Plasma D-dimer levels are tightly correlated with the degree of liver dysfunction and LC-associated complications. Therefore, D-dimer levels could be utilized as a prognostic stratification marker and adjunctive diagnostic marker in LC-associated complications. Цел на студијата: Да се испита нивото на Д-димери во плазма во корелација со клиничките скорови: Child-Pugh-Turcotte (CTP) и Model for End-Stage Liver Disease (MELD) кај пациенти со црнодробна цироза со различна тежина, како и нивна корелација со клинички, биохемиски параметри и компликации поврзани со црнодробна цироза. Материјали и методи:  Вкупно 50 пациенти со цироза на црн дроб беа поделени во три групи според тежината на цироза на црниот дроб врз основа на CTP Score (CTP-A, CTP-Б, CTP-C). Концентрацијата на Д-димерите беше одредена во плазма со натриум цитрат користејќи го Siemens, BCSXP крвниот коагулометар. Kruskal-Wallis тестот беше користен за да се споредат нивоата на Д-димери помеѓу CTP групите. Mann-Whitney U тестот беше направен за да се одреди разликата во нивоата на Д-димерите помеѓу групите со различен MELD скор, и за да се оцени разликата во нивоата на Д-димерите кај пациенти со присуство или отсуство на асцит и разликата во нивоата на Д-димерите кај пациенти со или без спонтан бактериски перитонитис (SBP). Pearson-овиот коефициент на корелација беше користен за да се оцени корелацијата помеѓу нивоата на Д-димери со MELD скорот и корелацијата помеѓу нивоата на Д-димери и концентрацијата на биохемиски, клинички параметри и компликации поврзани со црнодробна цироза. Резултати: Концентрацијата на Д-димерите се зголеми со тежината на болеста проценета со CTP и MELDскорот со статистички значајна разлика помеѓу групите (p=,0000 и p=,0001, соодветно). Групата CTP-C покажа највисока концентрација на Д-димери, по што следуваа групите Б и А. Пациентите со SBP имаа значително повисока концентрација на Д-димери во споредба со пациентите без SBP (p= ,0006). Беше утврдена значителна позитивна корелација помеѓу Д-димерите и CTP и MELD скорот (коефициент на корелација r= 0,74 и r= 0,44, соодветно; p&lt; ,001). Дополнително, резултатите покажаа дека постои поврзаност меѓу плазма концентрацијата на Д-димерите со клиничките и биохемиски параметри кои карактеризираат прогресивна дисфункција на црниотдроб. Од сите испитувани биохемиски параметри, највисока статистички значителна корелација беше утврдена меѓу нивоата на Д-димерите и концентрацијата на серумските албумини (r = - 0,65, p&lt; 0,001). Заклучок: Плазматската концентрација на Д-димерите е тесно поврзана со степенот на дисфункција на црниотдроб и компликациите поврзани со цироза на црн дроб. Затоа, нивоата на Д-димерите може да се користат како прогностички маркер за стратификација и дополнителен дијагностички маркер во компликациите поврзани со цироза на црн дроб

Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study

INTRODUCTION: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month. METHODS: The GI-COVID-19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire. RESULTS: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID+ and 296 COVID-) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P < 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels. DISCUSSION: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection

Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study

INTRODUCTION: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month. METHODS: TheGI-COVID-19 is a prospective,multicenter, controlled study. Patientswith and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire. RESULTS: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID1and 296 COVID2) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P &lt; 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels. DISCUSSION: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection