Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : OC04 - OC10 Full Version

Relationship Between Disorders of Lipid Profile and Features of Liver Cirrhosis- An Open Prospective and Comparative Analysis of Patients of Stavropol Territory in Russian Federation


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53485.16426
Temirlan Ruslanovich Dudov, Vijaya Jawahar Sarithala, Pavel Vladimirovich Koroy, Alexander Valentinovich Yagoda

1. Assistant Professor, Department of Hospital Therapy, Stavropol State Medical University, Stavropol, Russia. 2. Assistant Professor, Department of Hospital Therapy, Stavropol State Medical University, Stavropol, Russia. 3. Professor, Department of Hospital Therapy, Stavropol State Medical University, Stavropol, Russia. 4. Professor, Department of Hospital Therapy, Stavropol State Medical University, Stavropol, Russia.

Correspondence Address :
Dr. Vijaya Jawahar Sarithala,
No 12/432, First Floor, Ramachandra Lodge, Tadipatri-515411, Andhra Pradesh, India.
E-mail: jay_sv2006@yahoo.com

Abstract

Introduction: Liver plays an essential role in the metabolism, synthesis, transport and clearance of lipids and lipoproteins, therefore, changes in the lipid profile in liver pathology reflects the degree of its dysfunction. Leading role in the development of atherosclerosis belongs to lipid spectrum disorders in the form of hyperlipidaemia and dyslipidaemia, associated with an increased cardiovascular risk in liver cirrhosis.

Aim: To study the relationship between violations of lipid profile of blood with the features and the clinical picture of Liver Cirrhosis (LC).

Material and methods: The study was an open prospective and comparative analysis of patients with LC, conducted at Stavropol State Medical University (Stavropol State, Russia). Research was conducted from June 2020 till August 2020. In 108 patients with LC, blood concentration of total cholesterol, triglycerides, High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL) were studied in association with manifestations of the disease. Control group constituted of 45 healthy individuals, comparable in sex, age and ethnicity. Two sample Student’s t-test, Newman Keuls test, chi-square test with Yates’s correction and Pearson’s linear correlation coefficient (r) were calculated. Receiver Operating Characteristic (ROC) analysis was used, the Odds Ratio (OR) and its 95% Confidence Interval (CI), sensitivity, specificity, positive and negative predictive value, and accuracy were determined. Differences were considered statistically significant at p≤0.05.

Results: Regardless of gender and age of patients, decrease of serum levels of total cholesterol (p<0.05), triglycerides (p<0.05), HDL (p<0.05) and LDL (p<0.05) were marked, associated with expression of portal hypertension and severity of liver cirrhosis. Parameters of LDL more than 2.16 mmol/L {OR 6.78-95% CI (2.74-16.78)} were connected with absence of oesophageal varices. Levels of triglycerides less than 0.83 mmol/L {OR 10.85-95% CI (2.86-41.19)} were associated with presence of oesophageal varices of grade III. Generally, hyperlipidaemia was observed in 17.6% of patients, and it was associated with alcoholic etiology of liver cirrhosis (χ2=3.7; p=0.053). Hypocholesterolaemia (81.5% of cases) or hypotriglyceridemia (48.1% of cases) was more commonly observed in patients with ascites (χ2=8.8; p=0.003), and classes B, C according Child-Pugh score (χ2=4.0; p=0.045).

Conclusion: In this study it was found that, in liver cirrhosis, there is a decrease in the serum content of total cholesterol, triglycerides, HDL and LDL, regardless of gender and age of patients. The LDL values of more than 2.16 mmol/L are associated with an increased chance of absence of oesophageal varices in patients with liver cirrhosis.

Keywords

Cholesterol, Dyslipidemia, High density lipoproteins, Low density lipoproteins, Oesophageal varices, Triglycerides

Lipids and lipoproteins are important elements of the body that control cellular functions and homeostasis, including energy, and upon contact with hepatotropic viruses, they reduce the toxic effects of viruses (1). Liver plays an essential role in the metabolism, synthesis, transport and clearance of lipids and lipoproteins, therefore, changes in the lipid profile in liver pathology reflect the degree of its dysfunction (2).

Leading role in the development of atherosclerosis belongs to lipid spectrum disorders in the form of hyper- and dyslipidaemia, associated with an increased cardiovascular risk in LC. Until now, there is discussion about the relationship between liver cirrhosis and Ischaemic Heart Disease (IHD) (3). The incidence of coronary artery disease in patients with liver cirrhosis ranges from 2.5-5.1% (4) to 21.7-36.8% (5),(6) and higher (up to 77%) (7),(8). The disputable data may be based on the heterogeneity of patients, differences in the influence of etiology of the disease, risk factors, etc. (4), (6), (9). A number of factors are considered as cardioprotective in patients with LC, including a decrease in the content of lipids and lipoproteins in blood, coagulopathy, thrombocytopenia, systemic vasodilation, malnutrition and hyperketonaemia (10). Thus, with LC, dyslipidaemia was detected less frequently than in the general population (11), and the phenomenon of hypolipidemia prevailed in a large number of patients (12),(13), which may explain the low cardiovascular risk.

On the other hand, a decrease in the serum lipid content is responsible for the development of complications of LC, such as infections, trophological insufficiency, adrenal dysfunction, anaemia, etc. (14). Hypocholesterolaemia was a predictor of survival in patients with LC (14).

Despite the presence in LC, reduced serum levels of total cholesterol, Very Low-Density lipoprotein (VLDL), LDL and HDL and triglycerides (15),(16), there is a point of view about the absence of changes in the lipid spectrum (17),(18) or their shift towards dyslipidaemia (6),(19). In addition, the possible relationship of blood lipid profile with the clinical components of LC, such as the duration of the disease, activity, manifestations of portal hypertension, the severity and prognosis of the disease has not yet been fully clarified (13),(17),(20). There is no clear evidence of the existence of an association between lipid imbalance and manifestations of portal hypertension in LC. At the same time, a decrease in total cholesterol was a predictor of the development of future hepatic complications (especially oesophageal varices) in non alcoholic fatty liver disease patients with severe fibrosis or Child-Pugh class A cirrhosis (21).

The aim of the research was to study the relationship between violations of the lipid profile of the blood with the features and the clinical picture of LC.

Material and Methods

The present research was of an open prospective and comparative analysis of patients, which followed the STROBE guidelines, and was conducted from June 2020 till August 2020. The research was corresponded with the Helsinki declaration of World Medical Association on ethical principles for medical research involving human subjects. The study was approved by the Ethics Committee of the Stavropol State Medical University, Russia, Protocol No 100, from 17 June 2021. Patients and individuals in the control group had given their informed consent to participate in the study.

One hundred and eight patients with LC (52 men, 56 women, mean age 55.91±0.75 years) were examined, who were under observation and undergoing treatment at department of gastroenterology at Stavropol regional clinical hospital, Stavropol state, Russia.

Sample size calculation: Sample size was calculated using formula n=(Z2pq)/Δ2, with Standard Error (SE) 4.3%, CL 90%, N=153.

Inclusion criteria: The study included patients with alcoholic or viral LC in the age group of 18 years or older.

Exclusion criteria: Patients aged less than 18 years; LC of non-viral and non-alcoholic etiology; diabetes mellitus, chronic renal failure, malignant neoplasms, acute pancreatitis, thyroid dysfunction; gastrointestinal bleeding; intake of lipid or glucose regulating drugs; parenteral nutrition. The choice of exclusion criteria is associated with the maximum exclusion of diseases and conditions that affect lipid metabolism.

Study Procedure

The patients underwent clinical, biochemical and instrumental examination, including general blood analysis, biochemical analysis of blood, liver function tests, immunological analysis, Polymerase Chain Reaction (PCR) diagnostics, ultrasound examination of abdomen, fibroelastometry, endogastroduodenoscopy. The serum content of total cholesterol, HDL, LDL, triglycerides was studied on an automatic Siemens ADVIA 1800 analyzer (USA).

Etiology of the disease was obtained using anamnestic and PCR data for viral etiology. Activity of the disease was evaluated using the levels of Alanine Transaminase (ALT). Using the ultrasound findings presence of ascites and hypersplenism were found. By the results of endo-gastroduodenoscopy, the presence of oesophageal varices was noticed. Grading of oesophageal varices was done in accordance with Soehendra classification of oesophageal varices (22). Severity of LC was estimated using Child-Pugh score (23).

Hypocholesterolaemia was determined when total cholesterol values were less than 2.59 mmol/L (100 mg/dL) and/or LDL cholesterol was less than 1.81 mmol/L (70 mg/dL) and/or HDL cholesterol was less than 1.03 mmol/L (40 mg/dL). Hypotriglyceridaemia was diagnosed with triglyceride values less than 0.79 mmol/L (70 mg/dL) (12),(13). Hyperlipidaemia was indicated by levels of total cholesterol ≥5.17 mmol/L (200 mg/dL), LDL ≥4.14 mmol/L (160 mg/dL), or triglycerides ≥1.7 mmol/L (150 mg/dL) (4).

The control group consisted of 45 healthy individuals (control size was calculated in accordance with samples), recruited from students and staff of medical university and blood donors, matched by sex (21 men, 24 women), age (average age 52.18-2.51 years), ethnicity and having normal blood lipid profile (24).

Statistical Analysis

The data obtained were statistically processed using Microsoft Office Excel 2010, IBM Statistical Package for the Social Sciences (SPSS) Statistics 21. Quantitative values with normal distribution are presented in the form of mean±standard error of the mean. Two sample student’s t-test, Newman-Keuls test, χ2 test with Yates' correction were calculated. The relationship between the traits was identified using the Pearson linear correlation coefficient (r). To assess the predictive role of the trait, ROC analysis was used and the OR and its 95% CI were determined. The diagnostic value was characterized by Sensitivity (Se), Specificity (Sp), Positive Predictive Value (PPV) and Negative Predictive Value (NPV), Accuracy (Ac), expressed as a percentage. Differences were considered statistically significant at p≤0.05.

Results

In the present study , total 108 patients with LC were included, of which, 52 were males and 56 were females, with a mean age of 55.91±0.75 years (Table/Fig 1). Alcoholic LC was observed in 55 (50.9%) of the patients, LC of viral etiology was noticed in 53 (49.1%) of individuals Hepatitis B Virus (HBV) infection was detected in 14 (26.4%) of cases, Hepatitis C Virus (HCV) was detected in 39 (73.6%) of patients. Minimal, moderate and high activity of LC was observed in 39 (80.6%), 16 (14.8%) and 5 (4.6%) of patients, respectively. Viral and alcoholic etiology of LC was distributed equally. With viral LC, HCV was detected in most cases. Most of patients had minimal disease activity, hypersplenism, oesophageal varices, ascites, as well as compensated (39.8%) and sub compensated (45.4%) variants of the disease. The average ALT and Aspartate Aminotransferase (AST) values reached 77.62±7.75 U/L and 49.94±4.10 U/L, respectively.

Hypersplenism developed in 78 (72.2%) of patients, ascites was noticed in 63 (58.3%) of patients. Oesophageal varices were detected in 75 (69.4%) of patients: grade I – in 22 (29.3%) of cases, grade II - in 29 (38.7%) of patients, grade III – in 24 (32.0%) of patients. 43 (39.8%) of patients had LC of Child-Pugh class A, 49 (45.4%) and 16 (14.8%) of cases had Band C classes, respectively (Table/Fig 1). With LC, a decrease in the serum content of all the studied parameters of the lipid profile (Table/Fig 2), (Table/Fig 3) was observed, which was not interrelated with the gender and age of the patients (Table/Fig 4), (Table/Fig 5).

Regardless of the etiology of LC, a reduced concentration of total cholesterol, LDL, HDL in the blood was determined (Table/Fig 6). In alcoholic LC, HDL values were significantly lower than in cases of viral LC. In both HBV associated and HCV cirrhosis, decreased serum levels of total cholesterol, LDL and HDL were recorded; triglyceride levels were reduced only in cases of LC caused by HBV infection (Table/Fig 7).

The duration of the disease did not affect the reduced values of total cholesterol, LDL, HDL in the blood (Table/Fig 8). The content of triglycerides in the blood in patients of LC with duration of more than 10 years was reduced, being lower than in the group of patients with a disease duration of less than 10 years.

Reduced levels of total cholesterol, LDL, HDL were not associated with the activity of LC and triglyceride levels decreased only with minimal activity of the process. The parameters of the lipid profile did not correlate with the activity of aminotransferases.

The appearance of ascites was characterized by comparatively lower serum levels of total cholesterol, LDL, HDL than in the compensated variant of the disease (Table/Fig 9). The presence or absence of hypersplenism in patients with liver cirrhosis was not associated with a reduced concentration of total cholesterol and LDL in the blood, while HDL values were characterized by comparatively higher values in cases of hypersplenism (Table/Fig 10).

In liver cirrhosis, the content of total cholesterol, HDL and triglycerides in the blood was not associated with the presence of oesophageal varices. However, in patients with oesophageal varices, serum LDL values were statistically significantly lower than in those without port-caval anastomoses (Table/Fig 11). Threshold LDL levels of more than 2.16 mmol/L were associated with a high probability of absence of dilated oesophageal veins {OR 6.78, 95% CI (2.74-16.78)} (Table/Fig 12) and were characterized by moderate accuracy in this aspect (73.1%). Indicators of Se, Sp, PPV, NPV for the above LDL values were 69.7, 74.7, 54.8 and 84.8%, respectively (Table/Fig 13).

The authors did not investigate the relationship between reduced amounts of total cholesterol, LDL, HDL in the blood with the severity of oesophageal veins dilatation in LC. On the contrary, the decreased serum triglyceride content, noticed in patients with grade III oesophageal phlebectasias, was lower than the corresponding values in patients with lower gradations of oesophageal vein dilatation (Table/Fig 14). Triglyceride values with a cut-off point less than 0.83 mmol/L indicated an increased chance of severe oesophageal veins dilatation {OR 10.85 (95% CI (2.86-41.19)} (Table/Fig 15), although they had little accuracy (69.3%) in its prediction indicators Se, Sp, PPV, NPV were 87.5, 60.8, 51.2 and 91.2%, respectively (Table/Fig 16).

The content of total cholesterol, LDL, HDL in the blood decreased with the severity of the disease according to the Child-Pugh classification, reaching minimum values in cases of class C, triglyceride levels were reduced only in decompensated LC. In patients with class C according to Child-Pugh, all the studied parameters were significantly lower than in the compensated variant of the disease, and LDL levels additionally differed from the corresponding values in those examined with class B (Table/Fig 17).

There was a negative correlation found between the Child-Pugh scale values with total cholesterol and HDL cholesterol (r=-0.28; p<0.05; r=-0.27; p<0.05, respectively), and its relationship with triglycerides tended to be reliable (r=-0.18; p=0.059). There was a positive correlation between HDL and triglycerides with serum albumin levels (r = +0.20; p<0.05; r = +0.23; p<0.05, respectively), as well as triglycerides with values of prothrombin index (r = +0.23; p<0.05) (Table/Fig 18).

Hyperlipidaemia was observed in 17.6% (n=19) of patients with LC. In cases of alcoholic LC, hyperlipidaemia was more common than absence of hyperlipadaemia (73.7% and 46.1% respectively, χ2=3.7; p=0.053), while demographic, clinical and laboratory markers of the disease were not associated with its occurrence (Table/Fig 19).

Hypocholesterolemia observed in 81.5% (n=88) of patients with LC, hypotriglyceridemia seen in 48.1% (n=52) of cases, hypocholesterolemia and/or hypotriglyceridemia seen in 86.1% (n=93) of cases. Patients with or without hypocholesterinaemia and/or hypotriglyceridaemia did not differ in sex, age, etiology and duration of the disease, levels of AST, ALT, bilirubin, albumin, prothrombin index, Child-Pugh scale, presence of oesophageal varices and hypersplenism. In cases of hypocholesterolaemia and/or hypotriglyceridaemia, ascites was relatively more common (64.5% and 20.0%, respectively, χ2=8.8; p=0.003), Child-Pugh scale class A was less common (35.5% and 66.7%, respectively, χ2=4.0; p=0.045), and the values of the Child-Pugh scale were higher (7.39±0.19 and 6.20±0.35, respectively, p = 0.023).

Discussion

According to the presented data, in LC, there was a reduced content of total cholesterol, HDL, LDL and triglycerides in the blood, which coincides with the results of other authors (15),(16),(25). Nevertheless, the possibility of normal or elevated serum levels of triglycerides, LDL, VLDL in patients with liver cirrhosis cannot be ruled out against the background of a decrease in other indicators of the blood lipid spectrum (17),(18).

The decrease in the parameters of the blood lipid profile in patients with LC did not depend on gender and age. In an earlier study, it was found that there was no relationship between serum lipid levels and the age of patients with HCV associated liver pathology (20).

This study did not establish the relationship between the indicators of total cholesterol, LDL, triglycerides with the etiology of the disease, however, in alcoholic LC, HDL values were comparatively lower than in LC of viral etiology. It is assumed that the nature of deviations in lipid metabolism in LC depends on the etiological factor. Nevertheless, changes in the blood lipid spectrum in alcoholic LC, as a rule, did not differ from those in the viral etiology of the process (15),(16),(26), with the exception of lower HDL values (15) and higher triglycerides in alcoholic LC (26).

According to our data, the content of lipids and lipoproteins in the blood was not associated with the activity of LC, which generally corresponds to previously obtained data on the absence of a relationship between blood lipids and the degree of viremia, biochemical and histological activity, and the stage of viral liver pathology (20),(27). However, it is possible for lower triglyceride (27) or total cholesterol (28) values to be present in cases of elevated aminotransferase values in patients with HBV infection.

The parameters of the blood lipid spectrum in patients were negatively associated with manifestations of portal hypertension in the form of comparatively lower values of total cholesterol, LDL, HDL with the appearance of ascites, LDL - in cases with the formation of oesophageal varices, as well as triglycerides - against the background of the third-grade dilatation of the oesophageal veins. Threshold values of LDL of more than 2.16 mmol/L have been established, which make it possible with a high probability to exclude the presence of oesophageal varices in LC, as well as the values of triglycerides (less than 0.83 mmol/L), which characterize patients with a high risk of having oesophageal varices of the 3rd grade have been determined.

Oesophageal varices are one of the most severe manifestations of portal hypertension. The priority of early detection and assessment of the state of oesophageal phlebectasias in LC is quite obvious, allowing timely preventive measures for the development of bleeding. The diagnostic value of non invasive predictors of dilated oesophageal veins is widely discussed, taking into account the possibility of their damage during endoscopic examination. Previously, the prognostic significance of a number of parameters of haemostatic homeostasis and endothelial dysfunction in the detection of oesophageal phlebectasias was established (29),(30). It was noted that in patients with non alcoholic fatty liver disease with severe fibrosis or compensated cirrhosis, a decrease in total blood cholesterol acted as a predictor of future complications (including dilated oesophageal veins) (21). Apparently, the revealed relationship is due to the fact that the formation and/or aggravation of portal hypertension is responsible for the violation of the flow of cholesterol and fatty acids with the portal blood flow to the liver and the subsequent decrease in the content of lipids and lipoproteins in the blood.

According to our data, blood lipid profile parameters were characterized by minimal values in patients with LC with class C according to Child-Pugh, negatively correlating with the values of the Child-Pugh scale and positively with the levels of albumin and prothrombin index. The conjugation of lipid metabolism markers with the Child-Pugh and Model for End-stage Liver Disease (MELD) scales in LC was found earlier (12),(16), although not in all studies (17),(26). In patients with LC, the content of total cholesterol and LDL in the blood had a predictive ability in relation to class C, and in total cholesterol, LDL, and triglycerides - in relation to MELD values>24 (16). In our opinion, the found association may be based on a violation of the synthetic function of the liver, which plays an important role in metabolism, synthesis, transport, and clearance of lipids and lipoproteins (2).

Hyperlipidaemia, registered in 17.6% of patients, was associated with alcoholic etiology of the process, which confirms the increased risk of coronary heart disease in cases of alcoholic LC (11), (19). It is known that the alcoholic nature of hepatic pathology was a risk factor for obstructive form of IHD (11) and calcification of coronary arteries (31). In our opinion, patients with alcoholic LC with elevated levels of blood lipids constitute a risk group for the development of IHD, which requires further targeted diagnostic research in this direction.

On the contrary, the majority of patients with LC had hypocholesterolaemia and/or hypotriglyceridaemia, which coincides with the previously obtained data (12), (13). Hypolipidemia was more often observed in decompensated forms of the disease, which raises the question of optimizing the elements of nutritional support for this category of patients in order to improve the blood lipid profile.

Thus, patients with LC develop blood lipid spectrum disorders associated with an unfavourable course of the disease. Lipid metabolism markers associated with the appearance and weighting of oesophageal varices in LC can be a useful tool in the non invasive diagnosis of oesophageal varices.

The effect of virological features of the disease (presence or absence of HBeAg in HBV cases, HCV genotype, degree of viremia of HCV, HBV) on lipid profile disorders in patients with viral LC were not evaluated. It is known that HCV infection is closely associated with lipid disorders, since the virus uses the host’s lipid metabolism to maintain its life cycle (32). The HCV enters the hepatocyte through ApoE receptors, which normally binds to LDL, then the viral genome replicates, binding to VLDL, which masks HCV and makes it inaccessible to the human immune system (33). The mechanisms by which HCV virus leads to hypocholesterolaemia have not been fully elucidated. It is suggested that HCV reduces the activity and amount of microsomal triglyceride transporter protein, which impairs the production and secretion of VLDL and LDL (13).

Characteristic disorders of the lipid profile in HCV infection are due to the use of host lipoproteins by the virus (especially genotype 3) in the life cycle, which changes the final pathways of cholesterol synthesis (34),(35). It was previously noticed that lipid profile disorders in HCV infection were more pronounced in cases of genotype 3a, (36), did not depend on the level of viremia and virus genotype (20), positively correlated with the severity of hepatic steatosis and negatively correlated with the response to antiviral therapy (19),(35).

Secondly, in patients with alcoholic LC, the relationship of lipid disorders with the presence or absence of alcoholic hepatitis, the duration of alcohol abuse and the dose of ethanol taken, has not been studied. It is known that alcohol consumption is a common cause of secondary hyperlipidaemia, manifested by elevated levels of total cholesterol, triglycerides, VLDL, phospholipids in the blood and is more common in alcoholic steatosis and steatohepatitis, than in cirrhosis (37),(38),(39),(40).

Thirdly, the association of lipid spectrum abnormalities with morphological manifestations of LC has not been studied, although in general, the relationship of reduced blood lipid levels with biochemical or histological activity (20),(41),(42), stage (20) of HCV or HBV-associated liver pathology was not found.

Finally, the study of lipid metabolism markers in the course of observation of patients with LC would make it possible to establish the ability of lipid profile deviations in terms of predicting lethal outcomes and severe complications of the disease. In patients who died from acute liver failure, relatively lower levels of HDL were determined (43), and in patients with liver cirrhosis with an unfavourable 3-month and 12-month prognosis, lower values of cholesterol, triglycerides, HDL, and LDL were observed (42). The content of total cholesterol in the blood of less than 2 mmol/L had an accuracy of 75% in predicting mortality in LC (44), and values of ≤2.8 mmol/L were predictors of 3-month and 12-month mortality, which allows them to be used in predicting the mortality of patients with LC, taking into account the imperfection of the MELD scale (43). At the same time, there were no differences in the incidence of hypocholesterolaemia and/or hypotriglyceridaemia in surviving and deceased patients over a 4-year follow-up period in patients with LC (13).

Limitation(s)

The present study was limited by small sample size. There is a need of a large multicentred clinical analysis of patients for generalizing the results. A comparative analysis of virological features of the disease, presence or absence of HBeAg in HBV cases, HCV genotype, degree of viremia of HCV, HBV on lipid profile disorders, which were not studied in our current research must be analysed for clarifying the extent of lipid disorder with etiology of LC.

Conclusion

With LC, there was a decrease in the serum content of total cholesterol, triglycerides, HDL, LDL, regardless of gender and age of patients, associated with the severity of portal hypertension and the severity of the disease. Low density lipoprotein values of more than 2.16 mmol/L were associated with an increased chance of absence of oesophageal varices in patients with LC, triglyceride levels less than 0.83 mmol/L predict the presence of grade 3 oesophageal varices.

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DOI and Others

DOI: 10.7860/JCDR/2022/53485.16426

Date of Submission: Nov 29, 2021
Date of Peer Review: Jan 27, 2022
Date of Acceptance: Mar 08, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

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