الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hepatorenal syndrome (HRS) and acute kidney injury (AKI) are
common and devastating complications of portal hypertension and endstage
liver disease. HRS is caused by splanchnic vasodilation, which
subsequently leads to decreased effective circulating volume, systemic
vasoconstriction, and, ultimately, renal hypoperfusion. Therefore, there is a
pressing need to explore mechanisms related to inflammation and vascular
function that may contribute to HRS and AKI in cirrhosis.
The Angiopoietin/Tie2 signaling axis is an important regulator of
vascular integrity. Tie2 receptors are diffusely expressed on endothelial
cells. Angiopoietin-2 (Ang-2) is a context-specific antagonist of the Tie2
receptor that potentiates permeability and vascular inflammation by
weakening adherens junctions, recruiting inflammatory cells, and
promoting dysregulated thrombosis in the microvasculature.
Predictive result according to the previous researches showed that no
difference across s.Ang-2 tertiles by the etiology of cirrhosis although
patients with cirrhosis and AKI had higher MELD scores.
Angiopoietin - 2 levels were comparable between those with cirrhosis
and AKI and those with cirrhosis and no AKI showed higher s.Ang-2 was
associated with higher AKI stage, s.Ang-2 was higher with presence of
infection.
This study aimed to evaluate the role of serum Angiopoietin-2 levels
alone and in combination with MELD score in early detection of acute
kidney injury and all-cause mortality in patients with decompensated
cirrhosis.
To elucidate our aim, this was a cross-sectional study was conducted
on 90 patients attending to the Tropical Medicine Department, Faculty of
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Medicine, Menoufia University Hospital during the period from October
2019 to August 2021.
All subjects included in this study were divided into 3 groups as
follow: group I included 30 compensated cirrhotic patients, group II
included 30 decompensated cirrhotic patients without AKI and group III
included 30 decompensated cirrhotic patients with AKI.
All the studied subjects included in this study were selected
according inclusion and exclusion criteria as follow:
Inclusion criteria were Patients more than 18 years, decompensated
cirrhotic patients (diagnosed by history, clinical examination, by
ultrasonography and laboratory tests) and acute kidney injury. Exclusion
criteria were Patients less than 18 years, pregnant, nursing, or had a prior
kidney transplant patient.
All included patients in this study were subjected to the following:
Full history taking, Clinical examination, Laboratory investigations,
Hepatitis Markers, Radiological Investigations, Stool analysis and
Quantitative determination of serum angiopoietin-2 (Ang-2) by ELISA
kite.
MELD score was calculated for all patients on time of enrollment and
samples collection. Enrolled patients were followed up for 90 –day. We
were assessed the sensitivity and specificity of s.Ang-2 alone and in
combination with MELD score in early detection of AKI and all-cause
mortality in patients with decompensated cirrhosis.
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Results of the current study could be summarized as follows:
Range of age and BMI of the studied patients were 22-71 years, 22-35
kg/m2, respectively with the mean (54.30±11.50 years, 27.03±2.99
kg/m2), respectively. Most of the studied patients 53.3 % were males
and 56.7% of them hadn’t smoking history and index.
The mean HB, TLC, Platelet, Total Bilirubin, Direct Bilirubin, Albumin,
INR, Creatinine, BUN, ALT and AST of the studied patients were
(11.50±2.20, 7.49±4.50, 131.61±68.97, 3.15±6.28, 1.21±2.46,
3.18±0.79, 1.34±0.40, 1.98±2.41, 42.56±50.99, 44.14±41.53,
82.14±58.43), respectively.
Age, CTPC and MELD and nephrotoxic drugs history were significantly
increased among decompensated with AKI than other groups,
respectively. While, BMI was significantly increased among
compensated than other groups.
S.Ang-2 levels was significantly increased among decompensated
cirrhotic patients with AKI in compare to decompensated cirrhotic
patients without AKI and compensated cirrhotic patients with mean
(2530.67±151.14, 1586.83±219.09) with p value<0.001.
No significant correlation between Ang-2 with sex, smoking (history and
index), HCV and HBV among the studied patients.
There were positive significant correlations between Ang-2 with anemia
type, urine analysis and DM among the studied patients.
Serum Ang-2 level can early detect of mortality with sensitivity and
specificity 95% &90% respectively at cutoff point >2325, with p<0.001,
while MELD score can predict mortality with sensitivity and specificity
79% &80% respectively with AUC 0.838 (P<0.001). But the
combination of both serum Ang-2 and MELD score had more
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specificity in early detection of mortality 92% which is better than each
of them individually.
Ang-2 level is independent predictors of mortality among the studied
patients (P value < 0.008).