Correlation Between the Severity of Liver Cirrhosis (Chil-Pugh Score) and QTc Interval Prolongation

Background:Liver cirrhosis causes changes in cardiovascular system. Electrographic (ECG) abnormality commonly found in cirrhosis patients is QT interval prolongation. It is part of cirrhotic cardiomyopathy. QTc interval prolongation is correlated to the incidence of life-threatening arrhythmias. The objective of this study was to recognize the correlation between the severity of liver cirrhosis and QTc interval prolongation in patients with liver cirrhosis at Sardjito General Hospital, Jogjakarta.Method: The design of this study was cross-sectional. The subjects were hospitalized patients with liver cirrhosis at the Department of Internal Medicine, Sardjito Hospital, Jogjakarta between January 2011 and March 2012. ECG was performed in all patients and QTc interval was measured. The severity of liver cirrhosis was determined by Child-Pugh score. Spearman correlation analysis was used to determine the correlation between variables of QTc interval prolongation and Child-Pugh score.Results: A total of 73 patients were enrolled, including 51 (69.9%) male and 22 (31.1%) female patients with mean age of 54.05 ± 12.55 years (range 20-80). Liver cirrhosis was caused by hepatitis B virus in 36 (49.3%) patients, hepatitis C virus in 20 (27.4%) patients and other causes in 19 (26%) patients. The Child-Pugh score for liver cirrhosis was found as follows: child A in 10 (13.6%) patients, child B in 27 (36.9%) patients and child C in 36 (49.3%) patients. The correlation between the severity of liver cirrhosis and QTc interval prolongation was weak (r = 0.255; p = 0.029).Conclusion:Severity of liver cirrhosis has a weak positive correlation with QTc interval prolongation

Serum Zinc Level and Urinary Zinc Excretion in Liver Cirrhotic Patient

Background: Zinc deficiency is commonly found in liver cirrhotic patient, and it is usually caused by excessive urinary excretion that is exaggerated by diuretic agents. The objective of this study is to know the differences of zinc serum concentration according to the Child-Turcotte-Pugh (CTP) score and clinical factors that influence zinc serum level and 24-hour urinary zinc excretion. Method: The design of this study was cross-sectional. In adult patients with liver cirrhosis, blood samples were collected after patients had fasted for at least 8 hours. Zinc levels were measured by the flame atomic absorption spectrophotometry method. Correlation test was performed among numeric variables, as well as Mann-Whitney U test to measure mean differences of zinc serum concentration and of 24-hours urinary zinc excretion according to clinical factors. The level of significance was p < 0.05. Results: During the period of May 1st - September 30th 2007, there were 36 eligible patients. The mean value of zinc serum levels was 63.70 ± 24.85 µg/dL. There were 24 (66.67%) patients with hypozincemia. The mean value of 24-hour-urinary zinc excretion was 787.52 ± 570.20 µg. There were 19 (52.8%) patients with urinary zinc excretion > 550 µg/24 hour. The results of mean difference test of zinc serum concentration between CTP score B and C showed no statistical significance (p = 0.052). Urinary zinc excretion correlated to urine volume (r = 0.638, p = 0.000), and it was higher in hospitalized patients compared to outpatients. It also was higher in men compared to women. There were no statistically significant differences in zinc serum level, zinc urinary level, and urinary zinc excretion on the administration of diuretic agents. Conclusion: There were no significant differences of fasting zinc serum concentration in cirrhotic patients between the CTP scores B and C. In liver cirrhotic patients, urinary zinc excretion positively correlates to urine volume