Correlation between Ascites and Total Lymphocyte Count with Occurrence of Hepatic Encephalopathy in Liver Cirrhosis Patients
DOI:
https://doi.org/10.21776/ub.jkb.2021.031.04.3Keywords:
Ascites, hepatic encephalopathy, total lymphocyte countAbstract
Hepatic encephalopathy (HE) is brain dysfunction manifested as a broad spectrum of neuropsychiatric abnormalities caused by hepatic insufficiency or portosystemic shunting due to portal hypertension. Portal hypertension in liver cirrhosis also causes ascites, as the most common clinical manifestation. Further, immune dysfunction, one of which is decreased total lymphocyte count (TLC), happens at liver cirrhosis, which triggers the systemic inflammatory response. This systemic inflammatory response plays a role in HE. Objective of this study is to know the correlation between ascites and TLC with occurence of HE in liver cirrhosis patient. This study was conducted by retrospective cohort design in Saiful Anwar Hospital. Determination of sample amount at this study used total sampling method. Hepatic encephalopathy diagnosis was based on West Haven Criteria. Ascites was determined by physical examination and/or abdominal ultasonography. Total lymphocyte count data was taken from medical record, with complete blood count examination used XS-800i hematology analyzer machine. Data were analyzed using a logistic regression test, with p<0.05 was considered significant and Confidence Interval (CI) 95%. Seventy-eight liver cirrhosis patients were observed using a retrospective cohort method regarding the HE occurrence, and physical examination for ascites and laboratory examination were performed. The statistical analysis result of the correlation between ascites and HE is significant with an odds ratio of 5.108 and CI of 1.36-19.25. On the other hand, TLC has no significant correlation with the occurrence of HE. Based on this analysis result, it is concluded that ascites has a correlation with HE, but TLC does not.Â
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References
Tranah TH, Paolino A, and Shawcross DL. Pathophysiological Mechanisms of Hepatic Encephalopathy. Clinical Liver Disease A Multimedia Review Journal. 20155; 5(3): 59-63.
Nurdjanah S. Sirosis Hati. In: Sudoyo AW, Setiyohadi B, Alwi I, Simadibrata KM, Setiati S (Eds). Buku Ajar Ilmu Penyakit Dalam. 6th edition. Jakarta: Internal Publishing; 2014: pp.1980-1985.
Elwir S and Rahimi RS. Hepatic Encephalopathy: An Update on the Pathophysiology and Therapeutic Options. Journal of Clinical and Translational Hepatology. 2017; 5(2): 142-151.
Montagnese S and Bajaj JS. Impact of Hepatic Encephalopathy in Cirrhosis on Quality-of-Life Issues. Drugs. 2019; 79(1): 11-16.
Michalska IC, Szczepanek M, Slowik A, and Mach T. Pathogenesis of Hepatic Encephalopathy. Gastroenterology Research and Practice. 2012; 2012: 1-7.
Ferenci P. Hepatic Encephalopathy. Gastroenterology Report. 2017; 5(2): 138-147.
Frederick, RT. Current Concepts in the Pathophysiology and Management of Hepatic Encephalopathy. Gastroenterology and Hepatology. 2011; 7(4): 222-233.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the Management of Ascites, Spontaneous Bacterial Peritonitis, and Hepatorenal Syndrome in Cirrhosis. Journal of Hepatology. 2010; 53(3): 397-401.
Mustapha SK. Cirrhotic Ascites: A Review of Pathophysiology and Management. Nigerian Journal of Gastroenterology and Hepatology. 2020; 12(1): 1-8.
Albillos A, Lario M, and Alvarez-Mon M. Cirrhosis-Associated Immune Dysfunction: Distinctive Features and Clinical Relevance. Journal of Hepatology. 2014; 61(6): 1385-1396.
Liaskou E and Hirschfield GM. Cirrhosis-Associated Immune Dysfunction: Novel Insights in Impaired Adaptive Immunity. EBioMedicine. 2019; 50: 3-4.
Bogdanos DP, Gao B, and Gershwin ME. Liver Immunology. Comprehensive Physiology. 2013; 3(2): 567-598.
Noor MT and Manoria, P. Immune Dysfunction in Cirrhosis. Journal of Clinical and Translational Hepatology. 2017; 5(1): 50-58.
Wong MCS and Huang J. The Growing Burden of Liver Cirrhosis: Implications for Preventive Measures. Hepatology International. 2018; 12(3): 201-203.
Sajja KC, Mohan DP, and Rockey DC. Age and Ethnicity in Cirrhosis. Journal of Investigative Medicine. 2014; 62(7): 920-926.
Bohra A, Worland T, Hui S, Terbah R, Farrel, A, and Robertson M. Prognostic Significance of Hepatic Encephalopathy in Patients with Cirrhosis Treated with Current Standards of Care. World Journal of Gastroenterology. 2020; 26(18): 2221-2231.
Tapper EB, Henderson JB, Parikh ND, Ioannou GN, and Lok AS. Incidence of and Risk Factors for Hepatic Encephalopathy in a Population-Based Cohort of Americans with Cirrhosis. Hepatology Communications. 2019; 3(11): 1510-1519.
Zhang H, Sun Q, Mao W, Fan J, and Ye B. Neutrophil-to-Lymphocyte Ratio Predicts Early Mortality in Patients with HBV-Related Decompensated Cirrhosis. Gastroenterology Research and Practice. 2016; 2016: 1-5.
Shawcross DL, Davies NA, Williams R, and Jalan R. Systemic Inflammatory Response Exacerbates the Neuropsychological Effects of Induced Hyperammonemia in Cirrhosis. Journal of Hepatology. 2004; 40(2): 247-254.
Odeh M, Sabo E, Srugo I, and Oliven A. Relationship between Tumor Necrosis Factor-Alpha and Ammonia in Patients with Hepatic Encephalopathy Due to Chronic Liver Failure. Annals of Medicine. 2005; 37(8): 603-612.
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