Association of Clinically Significant Systemic Inflammation with Liver Cirrhosis Progression In the Riga East University Hospital Patient Population with Chronic Hepatitis B or C Virus Infection
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Date
2023
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Aknu cirozes patofizioloģijas pētniecībā sistēmisks iekaisums ir kļuvis par nozīmīgu mehānismu. Pētījuma mērķis bija izpētīt saistību starp sistēmisku iekaisumu un aknu cirozes progresēšanu pacientu populācijā ar hronisku hepatīta B (HBV) vai C vīrusa (HCV) infekciju, pielietojot plaši izmantotu marķieri — C reaktīvo olbaltumu (CRO).
Mēs veicām retrospektīvu šķērsgriezuma pētījumu Rīgas Austrumu klīniskās universitātes slimnīcā, izmantojot 164 stacionāra slimību vēstures laikā no 2016. līdz 2021. gadam. Iekļāvām pacientus ar SSK-10 kodu pāriem B18.2+K74 vai B18.1+K74, izslēdzot citas difūzas aknu patoloģijas. Datus analizējām ar datorprogrammām: “Microsoft® Excel v16.68” un “IBM® SPSS® Statistics v28.0.1.0”.
Mēs izveidojām loģistiskās regresijas modeli ar alfa vērtību 0,05. CRO bija neatkarīgais mainīgais, tā robežvērtība ≥10 mg/L apzīmēja klīniski nozīmīgu iekaisumu. Neatkarīgie mainīgie bija Child-Pugh klase A/B/C (CP-A/B/C) un akūta infekcija stacionēšanas brīdī. Mēs aprēķinājām koriģētās izredžu attiecības (aOR), koriģējot ar vecumu un dzimumu.
Izlases vidējais vecums bija 58,6 (95% CI [56,9–60,3]), vīrieši bija 54,9% (N=90), un hronisks HCV bija 71,3% (N=117) pacientiem, kā arī 24,4% (N=40) bija akūtas infekcijas. Pacientu sadalījums CP klasēs bija šāds: CP-A 20,1% (N=33), CP-B 54,3% (N=89), CP-C 25,0% (N=41), vienam gadījumam trūka datu. CRO mediāna bija 9,75 mg/L (IQR=22,45), grupā ar rezultātu ≥10 mg/L bija 47,6% (N=78) pacientu, <10 mg/L bija 52,1% (N=85).
Salīdzinot ar CP-A, tikai CP-C bija spēcīga nozīmīga pozitīva asociācija ar iekaisumu: aOR 5,84 (95% CI [1,88–18,12]; p=0,002). Akūtu infekciju pozitīvā asociācija izpaudās ar aOR 2,54 (95% CI [1,14–5,67]; p=0,023). HCV, salīdzinot ar HBV, uzrādīja negatīvu asociāciju: aOR 0,173 (95% CI [0,075–0,399]; p<0,001).
Mēs noteicām pozitīvu CP-C asociāciju ar CRO līmeni ≥10 mg/L, ko nevarēja pilnībā izskaidrot nedz ar akūtām infekcijām, nedz ar hronisku HCV/HBV. Klīniski nozīmīgas sistēmiska iekaisuma izredzes CP-C klasei bija 5,84 reižu augstākas nekā CP-A, norādot uz sistēmiska iekaisuma nozīmīgo lomu aknu cirozes pasliktināšanās procesā.
Systemic inflammation has garnered interest as a pathophysiologic mechanism of liver cirrhosis. The aim was to explore the relationship between systemic inflammation and cirrhosis progression in a population with chronic infection of Hepatitis B Virus (HBV) or Hepatitis C virus (HCV), using a widely available marker—C reactive protein (CRP). A retrospective cross-sectional study analysed 164 hospitalization records from Riga East University Hospital with ICD-10 code pairings B18.2+K74, or B18.1+K74, excluding other diffuse liver pathologies. Data spanning 2016–2021 were processed with Microsoft® Excel v16.68, and IBM® SPSS® Statistics v28.0.1.0. Logistic regression model was created with alpha 0.05. CRP, the dependent variable, with a cut-off value ≥10 mg/L represented clinically significant inflammation. Independent variables were Child-Pugh class A/B/C (CP-A/CP-B/CP-C); acute infections at hospitalization. Adjusted odds ratios (aOR) were calculated, controlling for age and sex. Sample mean age was 58.6, 95% CI [56.9, 60.3]; 54.9% (N=90) were males; 71.3% (N=117) had chronic HCV; 24.4% (N=40) had acute infections. Patients represented CP classes accordingly: CP-A 20.1% (N=33); CP-B 54.3% (N=89); CP-C 25.0% (N=41), with one case missing data. Median CRP was 9.75 mg/L (IQR=22.45); ≥10 mg/L group had 47.6% (N=78) patients; <10 mg/L had 52.1% (N=85). Compared to CP-A, only CP-C had a strong significant positive association with inflammation: aOR 5.84 (95% CI [1.88, 18.12], p=0.002). Acute infections had a positive association: aOR 2.54 (95% CI [1.14, 5.67], p=0.023). HCV, compared to HBV, showed a negative association: aOR 0.173 (95% CI [0.075, 0.399], p<0.001). A positive association between CP-C and CRP levels ≥10 mg/L was found, not wholly explained by acute infections or chronic HCV/HBV, having positive and negative associations, respectively. CP-C had 5.84 times greater odds than CP-A for clinically significant inflammation, signifying the role of systemic inflammation in the deterioration of liver cirrhosis.
Systemic inflammation has garnered interest as a pathophysiologic mechanism of liver cirrhosis. The aim was to explore the relationship between systemic inflammation and cirrhosis progression in a population with chronic infection of Hepatitis B Virus (HBV) or Hepatitis C virus (HCV), using a widely available marker—C reactive protein (CRP). A retrospective cross-sectional study analysed 164 hospitalization records from Riga East University Hospital with ICD-10 code pairings B18.2+K74, or B18.1+K74, excluding other diffuse liver pathologies. Data spanning 2016–2021 were processed with Microsoft® Excel v16.68, and IBM® SPSS® Statistics v28.0.1.0. Logistic regression model was created with alpha 0.05. CRP, the dependent variable, with a cut-off value ≥10 mg/L represented clinically significant inflammation. Independent variables were Child-Pugh class A/B/C (CP-A/CP-B/CP-C); acute infections at hospitalization. Adjusted odds ratios (aOR) were calculated, controlling for age and sex. Sample mean age was 58.6, 95% CI [56.9, 60.3]; 54.9% (N=90) were males; 71.3% (N=117) had chronic HCV; 24.4% (N=40) had acute infections. Patients represented CP classes accordingly: CP-A 20.1% (N=33); CP-B 54.3% (N=89); CP-C 25.0% (N=41), with one case missing data. Median CRP was 9.75 mg/L (IQR=22.45); ≥10 mg/L group had 47.6% (N=78) patients; <10 mg/L had 52.1% (N=85). Compared to CP-A, only CP-C had a strong significant positive association with inflammation: aOR 5.84 (95% CI [1.88, 18.12], p=0.002). Acute infections had a positive association: aOR 2.54 (95% CI [1.14, 5.67], p=0.023). HCV, compared to HBV, showed a negative association: aOR 0.173 (95% CI [0.075, 0.399], p<0.001). A positive association between CP-C and CRP levels ≥10 mg/L was found, not wholly explained by acute infections or chronic HCV/HBV, having positive and negative associations, respectively. CP-C had 5.84 times greater odds than CP-A for clinically significant inflammation, signifying the role of systemic inflammation in the deterioration of liver cirrhosis.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Aknu ciroze, iekaisums, B hepatīta vīruss, C hepatīta vīruss, Liver cirrhosis; Inflammation; Hepatitis B Virus; Hepatitis C virus