Serum ferritin - An independent prognostic marker in predicting early mortality in advanced liver disease.

Shujaath Asif, M (2014) Serum ferritin - An independent prognostic marker in predicting early mortality in advanced liver disease. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Various prognostic models were devised to predict the future events in patients with cirrhosis, thereby help in listing the patients for transplantation. Model for end stage liver disease (MELD) is one such mathematical model which was found to be accurate in predicting mortality. MELD is usually preferred for organ allocation priorities whereas CTP score is preferred in daily practice. This study was carried out to know the efficacy of serum ferritin in predicting future events in patients with advanced liver disease. PRINCIPAL AIM OF THE STUDY was to study whether serum ferritin can independently predict the 15 day mortality in patients with advanced liver disease. MATERIALS AND METHODS : This study was a prospective analytical evaluation, conducted at tertiary referral center, Department of Medical gastroenterology, Madras Medical College & Rajiv Gandhi Government General Hospital, Chennai. The evaluation period was from June 2013 to March 2014. Adult patients in age group 12 years and above with chronic liver disease were enrolled. Demographic data, medical history, co-morbid history, drug history, anthropometric measurements and physical examination were extracted from prospective database. Routine blood investigations, liver biochemistry, metabolic work up, renal function tests, serum ferritin levels, relevant imaging of abdomen and upper G.I endoscopy were recorded. All the patients enrolled were followed up. Mortality was assessed at 15th day of evaluation. Prognostic models along with serum ferritin were analysed. RESULTS : A total of 75 consecutive patients were enrolled. 5 patients were excluded as 3 patients lost to follow up and 2 had HCC. Hence the total participants were 70 patients. Among the 70 patients 65 were diagnosed to have decompensated cirrhosis and remaining 5 patients were in compensated phase of cirrhosis. None of the consecutive patients enrolled satisfied the criteria of Acute on Chronic Liver Failure. Male to female ratio was 8:1. Majority of patients (49 patients) were in 40 to 60 year age group. The clinical profile, laboratory investigations, prognostic models and outcome were looked upon. All the patients involved in the study had jaundice at the time of presentation, 66 patients (94%) had ascites. 74 % of patients had encephalopathy. Majority of them were in lower grade. Mortality was found to be increased in higher grades of encephalopathy. 60 % of the patients evaluated had experienced upper G.I bleed. Majority patients showed alcohol as the cause of liver disease, followed by HBV and NAFLD. Serum creatinine and serum sodium were found to be useful in predicting mortality. Bilirubin and transaminases were increased in all patients, but were not useful as prognostic marker. CTP score, MELD and serum ferritin were found to be useful prognostic models in predicting outcome, but serum ferritin was superior to other two models. Addition of serum ferritin to MELD was found to increase the accuracy and precision. CONCLUSION : Serum ferritin levels were highly elevated in patients with early mortality. Serum ferritin as an independent prognostic appears to be convincing but large prospective multi-center studies should be carried out before being recommended in hepatology practice.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Serum ferritin ; independent prognostic marker ; predicting early mortality ; advanced liver disease.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:13
Last Modified: 13 Jul 2017 04:13

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