European Journal of Cardiovascular Medicine

A patient with cirrhosis may be seen in both the asymptomatic and symptomatic phases, with the latter exhibiting liver disease consequences. The terms "compensated" and "decompensated" are used to describe the presentation above.[1]
Cirrhosis patients who exhibit jaundice, ascites, hepatic encephalopathy, or bleeding varices are said to be in decompensation. In addition, hypernatremia, spontaneous bacterial peritonitis, and hepatorenal syndrome may manifest.
The terms listed above are crucial for determining therapy and prognosis. In compensated cardiac patients, the 10-year survival rate is 50%, but in decompensated patients, the 18-month survival rate is 50%. Among patients with compensated liver disease, the rate of decompensation is 10%.In [2] Usually, liver transplantation is necessary for decompensated individuals.

Many prognostic models were developed to forecast future occurrences, which assisted in the patient list for transplantation. In medicine, mathematical models are utilized for diagnosis, prognosis prediction, and therapy planning. Prognostic, simulation, and diagnostic models are examples of mathematical models. One such statistical model, called the Model for End Stage Liver Disease (MELD), was created to predict patient outcomes during TIPS.[3] It was discovered that this was a reliable indicator of death in cases with advanced liver illness.[4] Models of prognosis have to have statistical validity. The best statistical technique for the study is either Cox Regression analysis or proportional hazards. Two key components of a valid model are accuracy and precision.[5] While precision is the capacity to replicate the anticipated event, accuracy is the capacity to anticipate an occurrence that corresponds with the actual event.[5]

While there are other reliable and helpful prognostic models, MELD is one of the most accurate and exact ones. Although it was not created using statistical analysis, the Child-Turcott-Pugh (CTP) score is the conventional paradigm for determining prognosis in advanced liver disease.[6] While CTP score is favored in everyday practice, MELD is typically recommended for organ allocation preferences.[7] These models assist in prioritizing individuals for liver transplantation, as it is the only treatment that can cure patients with advanced liver disease. In patients with a variety of liver disorders, including those receiving liver transplantation, serum ferritin and transferrin are readily available markers that are known to predict survival. Ferritin is thought to leak from injured hepatocytes, despite the fact that the exact mechanism of release is not well known. As an acute-phase protein, ferritin is linked to increased blood levels in a variety of clinical diseases, such as diabetes mellitus, chronic renal disease, inflammation, and cancer. Numerous variations of these characteristics are frequently observed in patients with liver disease. An increasing number of studies have assessed the potential for albumin and salt levels to improve the prediction power of the MELD score. Still, no research has looked at the possibility of increasing the MELD score's prediction by increasing serum levels of ferritin or transferrin. Moreover, the MELD score has to be computed and is dependent on several criteria, which may restrict its widespread application as a screening tool in clinical settings. The purpose of this research was to determine how well serum ferritin and transferrin might forecast future events in individuals with advanced liver disease.

INCLUSION CRITERIA:

1. Age more than or equals to 18 years.
2. Patients with decompensated cirrhosis, regardless of etiology.
3. Patients with acute on chronic hepatic failure, whatever may be the etiology.

EXCLUSION CRITERIA:

1. Age < 18 years
2. Age > 70 years
3. Pregnant woman
4. Patients with hepatocellular carcinoma
5. Patients with any other malignancy
6. Patients with HIV
7. Patients with HEMOCHROMATOSIS

METHOD OF DATA COLLECTION:

Data collection was started after obtaining clearance from the institutional ethics committee and after taking written informed consent from the patient. A detailed history and clinical. examination and noted as per the predesigned proforma. The investigations were done under the following headings:

1. Recording the presenting complains/ symptoms along with demographic profile.
2. Detailed Clinical examination.
3. Routine investigations: Complete blood count (CBC), Liver function test (LFT), Renal function test (RFT), fasting blood sugar (FBS), Postprandial blood sugar (PPBS), Total Protein and Albumin, Serum electrolytes (sodium, potassium, calcium).

In all, 140 people signed up for the research. The mean age of the patients who were enrolled in them was 43.7 years. Every participant's completed age was further divided into age groups. A little over 57 (40.3%) were between the ages of 41 and 50, while the next group (25.0%) were between the ages of 31 and 40. There were fewer patients in this age category than in any other, with only 2 (1.4%) being between the ages of 10 and 20. Approximately 122 (87.1%) of the total participants were male, with the remaining patients being female.

TABLE-1 : MEAN AGE OF STUDY COHORT

TABLE-2 : AGE WISE DISTRIBUTION OF STUDY COHORT

 TABLE-3 : GENDER WISE DISTRIBUTION OF STUDY COHORT

TABLE-4 : JAUNDICE AMONG THE STUDY COHORT

TABLE-5 : ASCITES AMONG THE STUDY COHORT

TABLE-6 : GRADES OF ENCEPHALOPATHY AMONG THE STUDY COHORT

The predictive efficacy of serum ferritin and transferrin to predict death in individuals with end-stage liver disease was evaluated in this study. According to this study, the majority of the registered individuals were between the ages of 41 and 50, with an average age of 43.7 years. Similar results from many research were found through database searches. In 2018, Sreenath Sreenivasan et al. reported that the ratio of male to female was 4.1:1This study likewise revealed a similar finding: the frequency of male patients was much greater than that of female patients. In my research, the majority of patients with liver disease had substantial ascites, and the majority of them also had upper gastrointestinal hemorrhage and grade II encephalopathy. Comparable The outcomes were also noted in other studies that were published.

According to a review paper by Johannes Weigand et al. (2013), hepatitis B infection was the second most prevalent cause of liver illness after alcohol consumption. In Germany, 8619 fatalities are related to alcohol use. In this investigation, similar results were also seen. An paper by Sonal Singh et al. examined the relationship between anemia and the severity of liver cirrhosis. They included 181 patients with liver cirrhosis, and based on their MELD scores and the degree of their anemia, they were further divided into two groups. In addition, their hemoglobin levels were evaluated using the Child-Pugh classification. This large-scale prospective experiment found that when liver disease severity increased, hemoglobin levels declined as well. Anaemia frequency rose in this research in a similar manner as illness severity increased. Given that all patients with end-stage liver disease were at risk of contracting secondary bacterial infections, Consequently, it was shown that MELD sodium >27 patients had higher total leukocyte counts.

In order to predict mortality, additional scoring factors, such as the DF score, CTP score, and CLIF-C AD score, were computed for each individual in addition to the standard Child-pugh and MELD scores. Numerous studies that were listed in the database looked at these scores as a predictor of death for individuals suffering from either acute or chronic liver failure. In a fairly recent trial, 66 patients with decompensated cirrhosis were enrolled by C. Baldin et al. They noticed that patients with a high CLIF-C AD score > 60 had a lower chance of surviving and a higher frequency of problems, which were then followed by cirrhosis. They came to the conclusion that as the patients were experiencing acute decompensation, the score strongly predicted death.

To forecast the course of patients with decompensated liver disease, we employed a range of scoring patterns and indicators in our clinical practice. Serum ferritin levels were the most significant predictor of death in these individuals among all the indicators. The database contains a number of studies that assess the blood ferritin level's predictive significance in patients with end-stage liver disease. 191 patients were assessed by Walker et al. in a 2010 publication. Ferritin levels >200 at baseline were found to be an independent predictor of death in a 6- to 12-month period, and it was noted that all of those patients had died. These results might be skewed because, despite including patients with stable, decompensated liver cirrhosis who had no problems, individuals with infections were not excluded. In a different study, Maiwall et al. included 318 hospitalized patients with decompensated liver cirrhosis and found that blood ferritin was a significant predictor of liver-related death. There were patients with and without decompensated liver cirrhosis in the short-term evaluation group, which lasted one month.

When end-stage liver disease patients are diagnosed, serum ferritin and transferrin levels are significant and reliable prognostic indicators that may be used to estimate their death early. Serum ferritin levels were found to be higher than 400 and transferrin levels lower than 150 in all dead patients, in addition to these indicators' capacity to predict mortality after 90 days. This study was successful since the factors it used to predict mortality in individuals with end-stage liver disease performed comparably to previous score computations.

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