الفهرس | Only 14 pages are availabe for public view |
Abstract Hepatorenal syndrome (HRS) and acute kidney injury (AKI) are common and devastating complications of portal hypertension and endstage liver disease. HRS is caused by splanchnic vasodilation, which subsequently leads to decreased effective circulating volume, systemic vasoconstriction, and, ultimately, renal hypoperfusion. Therefore, there is a pressing need to explore mechanisms related to inflammation and vascular function that may contribute to HRS and AKI in cirrhosis. The Angiopoietin/Tie2 signaling axis is an important regulator of vascular integrity. Tie2 receptors are diffusely expressed on endothelial cells. Angiopoietin-2 (Ang-2) is a context-specific antagonist of the Tie2 receptor that potentiates permeability and vascular inflammation by weakening adherens junctions, recruiting inflammatory cells, and promoting dysregulated thrombosis in the microvasculature. Predictive result according to the previous researches showed that no difference across s.Ang-2 tertiles by the etiology of cirrhosis although patients with cirrhosis and AKI had higher MELD scores. Angiopoietin - 2 levels were comparable between those with cirrhosis and AKI and those with cirrhosis and no AKI showed higher s.Ang-2 was associated with higher AKI stage, s.Ang-2 was higher with presence of infection. This study aimed to evaluate the role of serum Angiopoietin-2 levels alone and in combination with MELD score in early detection of acute kidney injury and all-cause mortality in patients with decompensated cirrhosis. To elucidate our aim, this was a cross-sectional study was conducted on 90 patients attending to the Tropical Medicine Department, Faculty of Summary 103 Medicine, Menoufia University Hospital during the period from October 2019 to August 2021. All subjects included in this study were divided into 3 groups as follow: group I included 30 compensated cirrhotic patients, group II included 30 decompensated cirrhotic patients without AKI and group III included 30 decompensated cirrhotic patients with AKI. All the studied subjects included in this study were selected according inclusion and exclusion criteria as follow: Inclusion criteria were Patients more than 18 years, decompensated cirrhotic patients (diagnosed by history, clinical examination, by ultrasonography and laboratory tests) and acute kidney injury. Exclusion criteria were Patients less than 18 years, pregnant, nursing, or had a prior kidney transplant patient. All included patients in this study were subjected to the following: Full history taking, Clinical examination, Laboratory investigations, Hepatitis Markers, Radiological Investigations, Stool analysis and Quantitative determination of serum angiopoietin-2 (Ang-2) by ELISA kite. MELD score was calculated for all patients on time of enrollment and samples collection. Enrolled patients were followed up for 90 –day. We were assessed the sensitivity and specificity of s.Ang-2 alone and in combination with MELD score in early detection of AKI and all-cause mortality in patients with decompensated cirrhosis. Summary 104 Results of the current study could be summarized as follows: Range of age and BMI of the studied patients were 22-71 years, 22-35 kg/m2, respectively with the mean (54.30±11.50 years, 27.03±2.99 kg/m2), respectively. Most of the studied patients 53.3 % were males and 56.7% of them hadn’t smoking history and index. The mean HB, TLC, Platelet, Total Bilirubin, Direct Bilirubin, Albumin, INR, Creatinine, BUN, ALT and AST of the studied patients were (11.50±2.20, 7.49±4.50, 131.61±68.97, 3.15±6.28, 1.21±2.46, 3.18±0.79, 1.34±0.40, 1.98±2.41, 42.56±50.99, 44.14±41.53, 82.14±58.43), respectively. Age, CTPC and MELD and nephrotoxic drugs history were significantly increased among decompensated with AKI than other groups, respectively. While, BMI was significantly increased among compensated than other groups. S.Ang-2 levels was significantly increased among decompensated cirrhotic patients with AKI in compare to decompensated cirrhotic patients without AKI and compensated cirrhotic patients with mean (2530.67±151.14, 1586.83±219.09) with p value<0.001. No significant correlation between Ang-2 with sex, smoking (history and index), HCV and HBV among the studied patients. There were positive significant correlations between Ang-2 with anemia type, urine analysis and DM among the studied patients. Serum Ang-2 level can early detect of mortality with sensitivity and specificity 95% &90% respectively at cutoff point >2325, with p<0.001, while MELD score can predict mortality with sensitivity and specificity 79% &80% respectively with AUC 0.838 (P<0.001). But the combination of both serum Ang-2 and MELD score had more Summary 105 specificity in early detection of mortality 92% which is better than each of them individually. Ang-2 level is independent predictors of mortality among the studied patients (P value < 0.008). |