Factors Participating in Development of Bleeding Varices in Portal Hypertension. Part
II: Possible Impact of Kidney Damage and Malnutrition, Mortality
Lata J.1, Husová L.1, Juránková J.2, Šenkyřík M.1, Dítě P.1, Dastych M. jun.1, Dastych M.3, Kroupa R.1
1Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc. 2Oddělení klinické mikrobiologie FN Brno, pracoviště Bohunice, přednosta prim. MUDr. Alena Ševčíková, CSc. 3Oddělení klinické biochemie FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Milan Dastych, CSc. |
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Summary:
An acute bleeding from oesophageal varices as a result of portal hypertension is a frequent and
serious complication of liver cirrhosis. The development of oesophageal varices and their rupture
depends on the portal pressure. However, a range of other factors can contribute to a development
of bleeding and its negative prognosis. A sample of 46 patients admitted for the acute
bleeding has been compared to 48 cirrhosis patients hospitalised for other conditions in this
work. There were significantly higher levels of nitrogenous matters in bleeding patients (urea
14.1 mmol/l vs. 7.78 mmol/l, p < 0.01, creatinine 129.8 mol/l vs. 106.04 mol/l, p = 0.09). Perhaps it
can't be said that impaired renal functions alone increase the risk of bleeding. From this point of
view they could rather be seen as definite prognostic markers of the degree of portal hypertension.
Moreover, there was a decreased level of total proteins in bleeding patients (60.7 g/l vs. 69.9 g/l,
p < 0.01) at a mild nonsignificant decrease of albumin (26.64 g/l vs. 28.51 g/l). Cirrhotic patients are
known to suffer from malnutrition and there is a possibility that malnutrition can contribute to
development of bleeding. A prognostic marker of mortality was a considerable impairment of
liver function (bilirubin 97.4 mol/l vs. 57.4 mol/l; p = 0.1 and prolonged prothrombin time 1.99
INR vs. 1.56 INR; p = 0.09) and impaired kidney function (creatinine 166.7 mol/l vs. 114.9 mol/l,
p = 0.09). Therefore a care of a good renal function must be a part of the complex care of bleeding
patients.
Key words:
Cirrhosis of liver - Portal hypertension - Bleeding oesophageal varices - Renal function
- Nutrition status
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