Kliničko-laboratorijski pokazatelji i skoring sistemi u predikciji mortaliteta alkoholom indukovanog jetrenog oštećenja/

Abstract

Uvod: Alkoholna ciroza jetre predstavlja jedan od terminalnih stadijuma jetrene disfunkcije i rastuću globalnu pandemiju, svrstavajući se među vodeće uzroke prijevremene smrti kod odraslih. Patogeneza ove bolesti je veoma složena sa brojnim komplikacijama koje su životno ugrožavajuće ukoliko se ne liječe. Do danas, transplantacija jetre ostaje jedino dugoročno terapijsko rješenje, koje je, nažalost, mnogim pacijentima nedostižno. Cilj: Procijeniti efikasnost različitih skoring sistema u predviđanju mortaliteta i praćenja progresije bolesti kod pacijenata sa dekompenzovanom alkoholnom cirozom jetre, te identifikacija ključnih prognostičkih kliničkih i laboratorijskih parametara u predviđanju ishoda bolesti. Materijal i metode: Prospektivna, komparativna, deskriptivna i analitička studija fokusirana na procjenu pouzdanosti četiri skoring sistema (Child-Pugh, MELD, CLIF-C AD, ALCSS) u predviđanju tromjesečnog i godišnjeg mortaliteta. U istraživanje će biti uključeno 123 muška pacijenata liječena na Klinici za unutrašnje bolesti Univerzitetskog kliničkog centra Republike Srpske u Banja Luci, na Odjeljenju za gastroenterologiju, hepatologiju i toksikologiju. Sva neophodna dijagnostička obrada (laboratorijska, mikrobiološka, serološka, radiološka i endoskopska) biće učinjena u toku prve hospitalizacije. Statistička obrada podataka biće urađena koristeći program Statistical Package for the Social Sciences (SPSS), verzija 29. Rezultati: Srednja dob ispitanika bila je 59,09±9,316 godina. Većina njih imala je anemiju (91,86% snižene eritrocite i 88,62% snižen hemoglobin) i trombocitopeniju (84,55%). Povišen MCV zabilježen je kod 55,28% pacijenata. Od biohemijskih parametara, najčešće su bile povišene vrijednosti bilirubina (79,67%), AST (90,24%), GGT (88,61%), i D-dimera (89,44%), dok je albumin bio snižen kod 87,00% pacijenata. Snižen natrijum je zabilježen kod 51,21%, a povišen kalcijum kod 94,30%. Ikterus je bio najčešći spoljašnji znak (79,67%), dok je ascites bio prisutan kod 69,91% ispitanika. Smrtni ishod tokom prve dekompenzacije imalo je 25,20% pacijenata, od kojih je 54,83% preminulo u bolnici. Najčešći komorbiditeti bili su srčana slabost, dijabetes i bubrežna insuficijencija. CLIF-C AD skor bolje je predviđao tromjesečnu i godišnju smrtnost od MELD i Child-Pugh skora, dok je ALCSS pokazao najbolju prediktivnu vrijednost na oba nivoa u regresionim analizama. Zaključak: Ciroza jetre predstavlja kompleksno oboljenje praćeno brojnim sistemskim poremećajima i visokom stopom komplikacija. Pravovremena dijagnoza, adekvatno praćenje i individualizovan pristup u liječenju ključni su za poboljšanje prognoze i kvaliteta života pacijenata. Evaluacija prognostičkih skorova omogućava preciznije predviđanje ishoda i optimizaciju terapijskih strategija.

Introduction: Alcoholic liver cirrhosis represents one of the terminal stages of liver dysfunction and a growing global pandemic, ranking among the leading causes of premature death in adults. The pathogenesis of this disease is highly complex, with numerous complications that are lifethreatening if left untreated. To date, liver transplantation remains the only long-term therapeutic solution, which, unfortunately, is inaccessible to many patients. Aim: To evaluate the efficacy of different scoring systems in predicting mortality and monitoring disease progression in patients with decompensated alcoholic liver cirrhosis and to identify key prognostic clinical and laboratory parameters for predicting disease outcomes. Materials and Methods: A prospective, comparative, descriptive, and analytical study focused on assessing the reliability of four scoring systems (Child-Pugh, MELD, CLIF-C AD, ALCSS) in predicting three-month and one-year mortality. The study included 123 male patients treated at the Internal Medicine Clinic, University Clinical Centre of the Republic of Srpska in Banja Luka, in the Department of Gastroenterology, Hepatology, and Toxicology. All necessary diagnostic evaluations (laboratory, microbiological, serological, radiological, and endoscopic) were performed during the first hospitalization. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 29. Results: The average age of participants was 59.09 ± 9.316 years. Most patients had anemia (91.86% with reduced erythrocytes and 88.62% with decreased hemoglobin) and thrombocytopenia (84.55%). Elevated MCV was recorded in 55.28% of patients. Among biochemical parameters, elevated bilirubin (79.67%), AST (90.24%), GGT (88.61%), and D-dimer (89.44%) were most common, while albumin was decreased in 87.00% of patients. Hyponatremia was noted in 51.21% of patients, and hypercalcemia in 94.30%. Jaundice was the most common external sign (79.67%), while ascites was present in 69.91% of patients. During the first decompensation, 25.20% of patients experienced fatal outcomes, with 54.83% of these deaths occurring in the hospital. The most frequent comorbidities were heart failure, diabetes, and renal insufficiency. The CLIF-C AD score was superior in predicting three-month and one-year mortality compared to the MELD and Child-Pugh scores, while the ALCSS demonstrated the highest predictive value at both levels in regression analyses. Conclusion: Liver cirrhosis is a complex disease characterized by numerous systemic disturbances and a high rate of complications. Timely diagnosis, adequate monitoring, and an individualized treatment approach are crucial for improving prognosis and quality of life in patients. Evaluating prognostic scores enables more precise outcome predictions and optimization of therapeutic strategies.