Independent prognostic factors in patients with liver cirrhosis.

BACKGROUND/AIMS: Evaluation of the urgency of the liver transplantation in individual patients may help to prioritize patients at risk of death. Consequently we undertook the search for independent prognostic factors in patients with liver cirrhosis. METHODOLOGY: The study group was composed of 219 patients with liver cirrhosis, treated in our Department, from 1996 to 2005. Patients' files were examined for details of physical findings, results of laboratory examinations, and patients' survival. Prognostic significance of 15 variables was analyzed. All prognostic factors which turned out to be statistically significant in univariate analysis were included in the Cox proportional hazard model. RESULTS: Child-Turcotte-Pugh (CTP) score B (p<0.001; hazard ratio (HR): 13.33), CTP score C (p<0.001; HR=7.45), presence of hepato-renal syndrome (p<0.001; HR=3.54), history of esophageal bleeding (p=0.048; HR=1.63) and presence of peripheral edema (p=0.034; HR=1.61) were found to be independently associated with survival. Model of End-stage Liver Disease score, etiology of cirrhosis, sex, ascites, bacterial spontaneous peritonitis, encephalopathy, serum creatinine concentration, INR and serum bilirubin concentration were shown to be significantly associated with patients' prognosis, however not independently. CONCLUSIONS: Analysis of presence of common clinical symptoms is crucial for evaluation of patients' prognosis.

[Etiology and results of treatment of adults with bacterial encephalomeningitis]. / Ocena etiologii i wyników leczenia ropnych zapalen opon mózgowo-rdzeniowych i mózgu u doroslych.

UNLABELLED: Results of treatment and outcomes of 89 adults with purulent encephalomeningitis, treated in years 1996-2002 in the Department of Infectious Diseases and Hepatology, Medical University of Lodz, were analyzed. Eighty nine patients were retrospectively included into the study. Results of treatment were evaluated at the last day of patient's hospitalization, and classified as: cure, disability or death. Results of treatment were analyzed in relation to etiology of purulent encephalomeningitis, age and gender of patients, course of the disease, and time from the onset of symptoms to admission to the Department. No statistically significant correlations between age, gender and prognosis were found. Thirty seven out of 89 patients were cured (41.6%); 29 of 89 patients died (32.6%); in 18 patients (19/89; 20.2) disability was diagnosed. In remaining 5 cases (5.6%), the result of treatment remained unknown. These patients were transferred to Intensive Care Units, outside our Hospital. In the studied group, etiologic factor was identified in 40 out of 89 cases (44.9%). In 40 patients, positive results of bacterial examination of cerebrospinal fluid were achieved. In 22 out of these 40 cases (55.0%), Streptococcus pneumoniae was identified as the etiologic factor. Higher percentage of patients died in subgroup with known etiology than in in subgroup of unknown etiology (p = 0.02). Higher percentage of cases with unconsciousness and higher percentage of cases with respiratory insufficiency were diagnosed in patients who died, than in patients who were cured (p = 0.00001). CONCLUSION: 1. Purulent meningoencephalitis in adults, despite progress in antibiotic treatment, is still a serious condition, with poor prognosis. 2. Diagnostics and treatment modalities of purulent meningo-encephalitis should be urgently extended in order to achieve better outcomes in these group of patients.

[Brain abscess: analysis of prevalence and clinical course]. / Bakteryjne ropnie mózgu jako problem oddzialu zakaznego.

The aim of the study was the analysis of the patients with bacterial meningitis and brain abscess who were treated in the Department of Infection Disease and Hepatology of Medical University in Lodz in years 1996-2005. We reviewed their clinical presentation, bacteriology treatment and outcome retrospectively. Among 135 patients who were confirmed cases of bacterial meningitis 16 identified as having brain abscesses. The prevalence rate of brain abscesses significantly increased in years: 2004-2005. The common predisposing factors were otic and teeth infections, sinusitis, penetrating head trauma, and bacterial endocarditis. Solitary abscess was found in 56% of the cases while in 44% of the cases multiple abscess were found. The most common presentation: headache, fever and neurological deficit were present in 37% of the cases. 75% of patients were disqualified from early neurosurgical intervention and antibiotic therapy were recommended. The antibiotic therapy was effective only in 1 patient. The mortality rate was 38% and 56% of the survivors had late neurological defects. The prevalence rate of brain abscesses significantly increased in years 2004-2005. Over all mortality was very high and antibiotic therapy hasn't been effective treatment in brain abscess at the late stage of its evolution. The early neurosurgical intervention is recommended. Late neurosurgical intervention strongly influences poor outcome in patients with brain abscess.

[Assessment of etiological diagnostics in adults with aseptic encephalomeningitis--own material]. / Ocena diagnozowania etiologii limfocytowych zapalen opon mózgowych i mózgu u doroslych w materiale wlasnym.

OBJECTIVE: Epidemiologic, etiologic and clinical assessment of patients with aseptic encephalomeningitis (AE); evaluation of efficacy of diagnostic process. METHODS: From January 1996 to August 2002, in seventy seven patients AE was diagnosed on the basis of lymphocytic predominance in cerebrospinal fluid (CSF) and negative culture of CSF. Analysis comprised: etiology, course of the disease and spectrum of used diagnostic tests. RESULTS: In 48/77 patients (62.3%) etiology was not identified. In 8/77 patients (10.3%) herpes simplex encephalitis was diagnosed, in 7/77 (9.1%) neuroborreliosis, in 6/77 (7.8%) tuberculosis encephalitis, in 3/77 (3.9%) listerial meningitis, in 3/77 (3.9%) mumps meningitis, and in remaining 2/77 (2.6%) tick-borne encephalitis. The incidence of AE was higher in summer (42.9%) than in any other season. In 14/77 patients (18.2%) the episode of unconsciousness occurred in the course of the disease. In 6 of these 14 patient etiology was unknown, in 4 tuberculosis AE, in 2 herpes simplex encephalitis and in 2 neuroborreliosis was diagnosed. In 7 of 77 patients (9.0%) et least one episode of convulsions occurred. CONCLUSIONS: In 62.3% of patients etiology remained unknown due to clinical and economic reasons. Aseptic encephalomeningitis in adults not always mean the viral etiology and mild course of the disease.