European Journal of Cardiovascular Medicine

Introduction: Hyponatremia is serum sodium less than 135 meq/lit. Hyponatremia is the most common electrolyte disorder in hospitalised patients. In advanced cirrhosis a disturbance of body water homeostasis is a common feature. Hence there is higher rate of renal retention of water in relation to sodium due to a reduction in solute-free water clearance. Pathologic features consist of the development of fibrosis to the point that there is architectural distortion with the formation of regenerative nodules. This results in a decrease in hepatocellular mass, and thus function, and an alteration of blood flow. The induction of fibrosis occurs with activation of hepatic stellate cells, resulting in the formation of increased amounts of collagen and other components of the extracellular matrix.Material And Methods: This is cross-sectional study conducted in the Department of General Medicine at Mahalakshmi Multispeciality Hospital, Ambattur, Chennai from June 2021 to May 2023. Patients were selected based on clinical examination, biochemical tests and ultrasound abdomen. Informed consent was obtained from all patients enrolled for the study. The data of the patients like relevant clinical history, examination findings, laboratory investigations were recorded in a proforma sheet. All the patients enrolled in the study were examined at the time of admission in the hospital and their serum sodium levels were checked and the patients were followed during their stay in the hospital. The severity of cirrhosis was assessed according to Child-Pugh score. MELD score and MELD-Na score were also calculated at the time of admission. Results: The mean age of the patients was 48.15±13.79 and consisted of 85 (94.4%) men and 05 (5.6%) women. Causative factors for liver cirrhosis included alcoholism in 90% of patients, hepatitis B in 5.6% of patients and hepatitis C in 4.4% of the patients. Alcohol was the most common etiology in present study, seen in 94.4% patients.In the present study, alcohol is found to be cause of cirrhosis in 24 patients out of 25 (96%) in the group with serum sodium levels ≤ 130 meq/L, in 23 patients out of 28 (82%) in patients with serum sodium levels between 131-135 meq/L, in 33 out of 37 patients (89.2%) in the group with serum sodium levels ≥136 meq/L. In the present study, there is no significant statistical differencebetween the three groups with respect to alcohol as the cause of cirrhosis (p value 0.25). Conclusions: Dilutional hyponatremia is frequent in cirrhotic patients and low serum sodium levels are associated with severe complications of liver cirrhosis like hepatic encephalopathy, hepatorenal syndrome. Hyponatremia is also associated with high morbidity and mortality in cirrhotic patients. Hence hyponatremia is a valuable marker that can be used to assess the prognosis in patients with cirrhosis of liver. Incorporation of sodium levels in MELD score is much more useful than MELD score alone to assess the prognosis and to refer the patient for liver transplantation.

Background: Zinc deficiency in Chronic liver disease is associated with decreased albumin levels, reduced absorption, increased levels of IL-6 which may interfere with the zinc transporters, and increased excretion in the urine which also may be related to the use of diuretics in cirrhosis. Despite the fact that zinc deficiency and CLD are closely linked, the routine testing of serum zinc levels in Cirrhotic patients is lacking. Furthermore, the impact of the Child- Pugh scoring system on the prognosis of  Hepatic Cirrhosis patients and serum Zn levels is less known. Thus the present study was planned to solidify the correlation between serum zinc level and severity of cirrhosis by studying the prevalence of zinc deficiency in patients with cirrhosis and by assessing its association with parameters such as alcohol intake, albumin, prothrombin time, bilirubin, ascites, and occurrence of hepatic encephalopathy. Research Question: Is decreased serum zinc levels have an association with child-pughs score towards the development of complications in patients with hepatic cirrhosis in our setup? The setting of the study was at Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Pondichery.  A one-year observational study was conducted during the period from October 2022 to September 2023 on about 44 Hepatic Cirrhosis patients admitted during the above period in the department of General Medicine by studying their socio-demographic profiles, Serum Zinc levels and their association & correlation with Child-Plugh score to assess severity and with other various biochemical & epidemiological risk factor parameters, etc. Results: Among the total study subjects 88.6% were male and 11.36% were female. It was observed that the burden of the disease was more between 41-60 years of age (66%) and the Mean age was 52 years. Also, it was noticed that the severity was higher among males when compared to females significantly. In addition to this significantly Patients with high Child-Pugh scores were associated with low serum zinc levels. About 16% of the study subjects were developed Hepatic encephalopathy with low serum zinc levels and also Albumin levels were directly proportional to low serum zinc levels significantly and further about 75% of the cases were developed ascites while having significant association with low serum zinc levels. Regarding alcohol consumption nearly 72% of the patients had positive history. It was observed that there was a significant correlation between serum zinc levels and total bilirubin, Prothrombin time, and Sodium levels in the blood.

Background: Patients with hepatocellular carcinoma (HCC) face a number of challenges for surgical resection or liver transplant including poor liver status, significant postoperative morbidity, a slight mortality risk and high costs. Radio-Frequency ablation (RFA) is an established effective and minimally invasive treatment method for the treatment of HCC. Aims and objectives: The aim of this study was to determine the relationship between preprocedural tumor morphology, or the size of the lesion on contrast imaging, the Child-Pugh score, and technical parameters, and the outcome of RFA whether successful ablation or local tumor progression. Materials and methods: Inclusion criteria were single nodular HCC ≤5cm in maximum diameter, 3 lesions, each ≤3 cm in diameter and Child-Pugh class A or B liver cirrhosis. Radio-frequency ablation was performed on patients under sedation. A repeat ablation session was carried out if persistent tumor was detected on the follow-up CT scan. The patients underwent imaging one month after the procedure. After then, an MRI or CT scan was done every three months. The mean follow-up period was 13 months. Results: A statistically significant association was observed in the size of the lesion with the outcome. Technical parameters and the patient's Child Pugh score did not statistically correlate with the outcome. The 1-year survival rate for Child-Pugh A and B patients was 61% and 50% respectively. Conclusion: Our study found out that size of the lesion has an impact on the outcome of RFA, with small HCC < 3cm in size showed higher rates of successful ablation than larger ones. Since the Child Pugh score of patients and technical parameters did not show any statistical association, further studies consisting of a larger number of patients and longer follow-up are necessary, as regular long-term surveillance is essential for early detection and eradication of local tumor progression and intrahepatic distant recurrence.

Introduction: Liver cirrhosis is often associated with altered thyroid function, which may reflect the severity of liver dysfunction. Understanding this relationship can help in predicting disease progression and prognosis in cirrhotic patients. The aim of this study was to demonstrate the relationship between thyroid function tests and the severity of liver function in cirrhosis of the liver. Method: A total of 73 patients diagnosed with cirrhosis of liver based on clinical, biochemical, and radiological findings were included. Results: Majority of the patients belonged to the age group of 41-59 years (63%) with male predominance (79.4%). Alcoholism (84.9%) emerged as the leading cause of liver cirrhosis. Fatigue (73.9%), body ache (57.5%), and dysphagia (54.7%) were the most common clinical symptoms linked to thyroid dysfunction. Using the Child-Pugh classification system, 15 patients were categorized as Child A, 37 as Child B, and 21 as Child C. Hypothyroidism (65.7%) was more prevalent than hyperthyroidism among the patients. Significant correlations were found between T3, FT3, and TSH levels and the severity of liver dysfunction, as classified by the Child-Pugh score (p<0.05). Hepatic encephalopathy (42.85%) was the main complication causing mortality, and all fatal cases (7) had abnormal thyroid profiles. Conclusion: In conclusion, altered T3, FT3, and TSH levels were associated with disease progression in cirrhosis and can serve as valuable indicators for prognosis. These findings suggest that thyroid function tests should be considered in evaluating the severity of liver disease progression and outcome of cirrhosis in affected patients.

Introduction: Portopulmonary hypertension (PoPH) is a severe complication of chronic liver disease (CLD) caused by pulmonary vascular remodeling due to portal hypertension. Early detection is essential, particularly in liver transplant candidates. This study assesses the prevalence, clinical characteristics, and risk factors for PoPH in CLD patients. Material and Methods: A prospective observational study at Dr. N Y Tasgaonkar Institute of Medical Science (January 2023–January 2025) enrolled 100 CLD patients. Clinical, biochemical, imaging, and hemodynamic assessments were performed, including transthoracic echocardiography (TTE), right heart catheterization (RHC), pulmonary function tests (PFT), and six-minute walk test (6MWT). PoPH was diagnosed per ESC/ERS guidelines. Statistical analysis included chi-square tests, t-tests/Mann-Whitney U tests, and multivariate logistic regression. Results: PoPH prevalence was 29% (54% mild, 8% moderate, no severe cases). Mean age was 53.42 ± 9.13 years, with 75% male. Alcoholic liver disease (46%) and NAFLD (28%) were the most common etiologies. Higher BMI (p = 0.002), male sex (p = 0.041), smoking (p = 0.032), and comorbidities (p = 0.023) were significantly associated with PoPH. Pulmonary function impairment (FEV1 < 70%, p = 0.028) and reduced exercise tolerance (6MWT < 350m, p = 0.008) were significant. Liver disease severity (Child-Pugh, p = 0.015; MELD, p = 0.041) was strongly linked to PoPH. Conclusion: PoPH is prevalent in 29% of CLD patients, with BMI, male sex, smoking, comorbidities, and liver disease severity as major risk factors. Pulmonary function impairment and reduced exercise capacity underscore the need for early screening and cardiopulmonary assessment. Routine echocardiography and pulmonary function testing should be prioritized for early detection and management.

Background: Liver cirrhosis is a chronic, progressive disease marked by systemic complications including autonomic nervous system (ANS) dysfunction, which has been increasingly recognized as a contributor to morbidity and mortality. Despite its prognostic significance, autonomic dysfunction in cirrhosis remains under-assessed. Aim: To evaluate the presence, pattern, and severity of autonomic dysfunction in patients with hepatic cirrhosis and correlate findings with the Child-Pugh classification. Methods: This hospital-based case-control study was involved 30 cirrhotic patients and 30 age- and sex-matched healthy controls. Cirrhotic patients were categorized into Child-Pugh Classes A, B, and C. Parasympathetic and sympathetic functions were evaluated using standardized tests including E/I ratio, Valsalva ratio, Lying/Standing ratio, postural fall in SBP, cold pressor response, and hand grip test. Mean values were calculated from three consecutive recordings. Statistical significance was set at p<0.05. Results: Autonomic dysfunction was found in 73.3% of cirrhotic patients. Parasympathetic tests showed early and more frequent abnormalities, with E/I ratio abnormal in 60% of cases. Sympathetic dysfunction became prominent in advanced stages (Child Class C), where 73.3% exhibited combined impairment. All parameters worsened significantly with increasing Child-Pugh class (p<0.001). Conclusion: Autonomic dysfunction, particularly of parasympathetic origin, is prevalent in hepatic cirrhosis and correlates with disease severity. Given its prognostic implications and potential reversibility, routine autonomic assessment should be integrated into cirrhosis management protocols.

Background: Decompensated chronic liver disease (DCLD) is linked to an imbalance in water regulation, resulting in abnormalities in sodium levels, known as dysnatremias. Hyponatremia occurs when water and sodium are imbalanced, with an excess of water relative to sodium. It is the predominant electrolyte abnormality observed in individuals who are hospitalized, particularly those with DCLD. Hypernatremia is a rare condition in individuals with DCLD, often caused by the use of osmotic diuretic medications and upper gastrointestinal (UGI) hemorrhage, which is associated with higher mortality rates. Research Question: What is the distribution and association of serum sodium levels among decompensated chronic liver disease patients in relation to clinico-sociodemographic factors in our setup?  Methods: An observational study was conducted from Jane 2025 to July 2025 on approximately 100 DCLD patients admitted to the Department of General Medicine at Government Medical College/Government Teaching General Hospital, Rajamahendravaram. The study analyzed socio-demographic profiles, serum sodium levels, and their association with Child-Pugh score, MELD score, alcohol consumption, HBV infection, clinical features, complications and mortality. Results: The study found that: The disease burden was higher among  individuals aged 50-70 years (53%), with a mean age of 56 years.- Morbidity was significantly higher among males (98%) compared to females (2%).- Approximately 40% of study subjects had serum sodium levels between 131-135 mEq/L, 32% had levels ≥136 mEq/L, and 28% had levels ≤130 mEq/L.- Patients with high MELD scores were significantly associated with low serum sodium levels.- Complications such as ascites and portal hypertension were significantly associated with hyponatremia compared to hypernatremia.- A mortality rate of 15% was observed among study subjects who developed hyponatremia.

Background: Ascites refers to the abnormal accumulation of fluid within the peritoneal cavity, often seen in patients with cirrhosis of the liver. SBP (Spontaneous Bacterial Peritonitis) is a serious infection of ascitic fluid without an identifiable intra-abdominal, surgically treatable cause. SBP develops in approximately 10 to 30% of cirrhotic patients with ascites and is associated with high mortality. Early detection of SBP is crucial to improve patient outcomes. Methods: This cross-sectional observational study was conducted at the Department of Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. A total of 152 subjects were included, divided into two groups: SBP (n=45) and non-SBP (n=107). Diagnostic paracentesis was performed to obtain ascitic fluid, which was sent for cytological, biochemical, and microbiological analysis, including culture sensitivity testing. Results: The median (IQR) ascitic fluid LDH level in SBP patients was 308 U/L (233-641), significantly higher than in non-SBP patients, who had a median (IQR) value of 102 U/L (83-124) (p < 0.01). Furthermore, the ratio of ascitic fluid LDH to serum LDH was 1.2 (0.74-1.96) in the SBP group, compared to 0.35 (0.27-0.46) in the non-SBP group (p < 0.01). Conclusion: The findings of this study suggest that elevated ascitic fluid LDH levels, along with the ascitic fluid LDH to serum LDH ratio, can serve as useful diagnostic markers for SBP in patients with cirrhosis and ascites.