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INTRODUCTION: Egypt has the highest prevalence of Hepatitis C Virus (HCV) in the world, estimated nationally at 14.7%. HCV treatment consumes 20% ($80 million) of Egypt's annual health budget. Outcomes of cirrhotic patients admitted to the ICU may, in fact, largely depend on differences in the state of the disease, criteria and indications for admission, resource utilization, and intensity of treatment. AIM: The aim of the present study was to evaluate the efficacy of liver specific scoring models in predicting the outcome of critically ill cirrhotic patients in the ICU as it may help in prioritization of high risk patients and preservation of ICU resources. MATERIALS AND METHODS: Over one year, a total of 777 patients with End Stage Liver Disease (ESLD) due to HCV infection were included in this retrospective non-randomized human study. All statistical analyses were performed by the statistical software SPSS version 22.0 (SPSS, Chicago, IL, USA). Child Turcotte Pugh (CTP) score, MELD score, MELD-Na, MESO, iMELD, Refit MELD and Refit MELD-Na were calculated on ICU admission. RESULTS: ICU admission was mainly due to Gastrointestinal (GI) bleeding and Hepatic Encephalopathy (HE). Overall mortality was 27%. Age and sex showed no statistical difference between survivors and non survivors. Significantly higher mean values were observed for all models among individuals who died compared to survivors. MELD-Na was the most specific compared to the other scores. MELD-Na was highly predictive of mortality at an optimized cut-off value of 20.4 (AURC=0.789±0.03-CI 95%=0.711-0.865) while original MELD was highly predictive of mortality at an optimized cut-off value of 17.4 (AURC=0.678±0.01-CI 95%=0.613-0.682) denoting the importance of adding serum sodium to the original MELD. INR, serum creatinine, bilirubin, white blood cells count and hyponatremia were significantly higher in non survivors compared to survivors, while hypoalbuminemia showed no statistical difference. The advent of Hepatorenal Syndrome (HRS) and Spontaneous Bacterial Peritonitis (SBP) carried worse prognosis. Hyponatremia and number of transfused blood bags were additional independent predictors of mortality. CONCLUSION: In cirrhosis of liver, due to HCV infection, patients who died during their ICU stay displayed significantly higher values on all prognostic scores at admission. The addition of sodium to MELD score greatly improves the predictive accuracy of mortality. MELD-Na showed the highest predictive value of all scores.
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This work studied how pollution impacts the ecosystem of Lake Manzala by determination of physicochemical parameters, studying biodiversity of aquatic plants and macroinvertebrates, and determining bioaccumulation of Pb, Cu, Cd & Zn in some major organisms, Biomphalaria alexandrina and Melanoides tuberculata snails and Oreochromis niloticus fish. The more near to Mediterranean Sea and to the industrial area, Port-Said and Damietta sites showed higher dissolved oxygen and conductivity than Dakahlia sites. Distribution percentage of Eichhornia crassipes is high among Port-Said and Dakahlia sites of 100 and 88%, respectively, while Lemna giba is the most abundant among Damietta sites of 60%. The maximum macroinvertebrate taxa richness was obtained at Gammalya, Dakahlia of 16 species while the maximum abundance was registered at Annanya, Damietta of 591 organisms. Gastropoda are the most distributed organisms in Lake Manzala followed by Hemiptera and Plecoptera then shrimps and scud. All the medically important snails, B. alexandrina, B. truncatus and L. natalensis were recorded in Dakahlia, but only B. alexandrina was in Damietta and Port-Said sites. The collected water samples from Damietta sites showed the highest significant Cu & Cd concentration while Port-Said samples showed the highest Pb concentration and Dakahlia showed the highest Zn concentration. The metals concentrations were higher in snail tissue and in fish liver, kidney and most of muscle samples as compared in surface water. The higher metal bioaccumulation was determined in snails collected from sites showed higher water metals concentrations. Fish muscle showed the least residues than liver and kidney for all the measured metals. Pb and Cd were more accumulated in kidneys, Cu was more accumulated in liver and Zn was accumulated in all examined fish parts in descending order as follows Kidney > liver > muscle.
