Lviv clinical bulletin 2016, 4(16): 42-54

https://doi.org/10.25040/lkv2016.04.042

Treatment of the Cirrhotic Patients Considering Portal Hypertension Severity Degree and Comorbid Syntropic Extrahepatic Lesions, their Complications: Modified Algorithm, its Effectiveness

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M. Ferko

Danylo Halytsky Lviv National Medical University

Intraduction. Liver cirrhosis is one of the most difficult diseases in the world to the diagnosis and treatment of which special attention is paid. The prevalence of liver cirrhosis and mortality caused by it is very different across countries and tends to increase. The incidence of liver cirrhosis increased over the past 10 years in developed countries in 10.0-15.0 %. Information on mortality due to the liver cirrhosis is ambiguous – from 8 to 80 per 100 thousand population.

It was learned that liver cirrhosis is not limited by the injury of hepatobiliary system, but also extends to other organs and systems that can be considered as cirrhotic disease of the whole organism with involvement into the pathological process of various organs and systems of the human body, interpreted as syntropic comorbid lesions, which in most of the cases cause temporary, and in the future – sustainable abnormal function, disability, often – death of the patient.

Today it is premature to assume that the problem of treatment of the cirrhotic patients is solved due to the fragmentary information, obtained using a variety of different models in experimental and clinical conditions, ignoring the severity of portal hypertension and syntropic comorbid extrahepatic lesions and their complications, does not allow to affect substantially on the treatment effectiveness of these patients, improve their quality of life. This determines the relevance, medical, social and economic significance, and also the need for the improvement of the principles and increase the efficiency of complex differential treatment of the cirrhotic patients considering the severity degree of portal hypertension and comorbid syntropic extrahepatic lesions and their complications that are still not performed.

The aim of our study was to improve the algorithm and increase the treatment effectiveness of patients with liver cirrhosis taking into account the severity degree of portal hypertension and comorbid syntropic extrahepatic lesions and their complications.

Materials and methods. After obtaining written consent in accordance with the principles of the Helsinki Declaration of Human Rights, the European Convention on Human Rights and Biomedicine and Legislation of Ukraine into the study in randomized manner with the preliminary stratification by the presence of liver cirrhosis were involved 240 patients who were hospitalized with the aim of the examination and treatment into created on the basis of the Internal Medicine Department N 1 of Lviv National Medical University and Gastroenterological Department of Lviv Regional Clinical Hospital, Lviv Regional Hepatological Center.

According to the results of an ultrasound dopplerfloumetric examination of the abdominal cavity vessels, all the patients were stratified into three groups: the first – patients with I degree portal hypertension – 122 persons [33 women (27.0 %) and 89 men (73.0 %), aged 21 to 78 years (average age 46,4 ± 1,0 years), including 78 patients (57.4 %), for whicha comprehensive differentiated treatment with the help of modified by us algorithm was conducted (experimental group) and 44 patients (42.3 %), for which there was conducted a comprehensive treatment due to the conventional method (Order of the MPH of Ukraine from 13.06.2005, N 271 – the control group), the second patients with II degree portal hypertension – 57 patients [14 women (24.6 %) and 43 men (75.4 %) aged 27 to 66 years (average age 48,2 ± 1,3 years), including 26 persons (19.1 %) – experimental group and 31 patients (29.8 %) – control group], the third group – patients with III degree portal hypertension – 61 patients [18 women (29.5 %) and 43 men (70.5 %) aged 29 to 73 years (average age 50,2 ± 1,3 years), including 32 patients (23.5 %) – experimental group and 29 patients (27.9 %) – the control group]. The criteria for evaluating the treatment results were as follows: excellent result – recovery; good result – a significant improvement, most values of the indices returned to normal; satisfactory result – a slight improvement, some values of indices have improved; bad result – no improvement and a very bad result – deterioration or transformation into cancer. For the direct assessment of the life quality of the patients with cirrhosis, we used a questionnaire MOS 36-Item Short-Form Healh Survey, created by J. E. Ware in 1992.

Results and discussion. In accordance with the aim, we have developed a comprehensive differentiated pathogenetically grounded individualized landmark treatment algorithm for the patients with liver cirrhosis taking into account the severity degree of portal hypertension, syntropic comorbid extrahepatic lesions and their complications. It was found that it is effective in 93.6% of the patients, as well as in 9.5 % (p < 0.05) for the value exceeds the conventional method (Order of the MPH of Ukraine from 13.06.2005, N 271). According to the results of our study, we can say that the improved algorithm for the treatment of patients with liver cirrhosis and a common methodology gives a positive result, but in terms of qualitative and quantitative indices, generally accepted medical complex is significantly inferior to modified by us algorithm.

Conclusions. Treatment of the patients with liver cirrhosis according to the modified by us algorithm is effective for the results of evaluation of physical parameters and quality of life. It must be comprehensive, that, except of the impact on the etiological factor, its main pathogenetic links, commits to take into account the severity of portal hypertension and the presence of syntropic comorbid extrahepatic lesions and their complications.

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