Epidemiological And Clinical Features Of Patients With Cirrhosis In The Department Of Gastroenterology,General Hospital

BACKGROUND:Liver cirrhosis is a chronic disease with various etiologies,complex clinical manifestations,ferocious complications,high mortality,and in-depth basic and clinical research is essential for improving cirrhosis.At present,there are many epidemiological studies related to cirrhosis in China,but patients with cirrhosis often visit different departments due to different needs,such as gastroenterology,infection,traditional Chinese medicine,general medicine,geriatrics or hepatobiliary surgery,resulting in different clinical characteristics of cirrhosis in various departments,with different focus and different treatment purposes.There are currently few epidemiological studies of patients with cirrhosis admitted to gastroenterology.OBJECTIVE:Understand the clinical epidemiology and clinical characteristics of patients with cirrhosis in the Department of Gastroenterology of General Hospital,and provide a reference basis for gastroenterologists to diagnose and treat patients with cirrhosis.METHODS:The clinical data of 434 patients with liver cirrhosis who were hospitalized in the Department of Gastroenterology of Henan Provincial People’s Hospital from January 2020 to December 2020 were collected.Retrospective analysis of the clinical features of patients with cirrhosis,such as sex,age,etiology,past history,personal history,family history,signs,complications,staging and grading,laboratory and imaging.The clinical features of viral hepatitis cirrhosis and non-viral hepatitis cirrhosis,hepatitis B cirrhosis and hepatitis C cirrhosis were compared.Etiological changes in patients with cirrhosis from 2017 to 2020 were also analyzed.RESULTS:The proportion of males with cirrhosis is relatively high(1.8:1 for males: females),with an average age of 56.0 ± 12.5 years.There are as many as 11 causes of cirrhosis,with hepatitis B virus infection being the most,accounted for 51.6%,followed by cryptogenic cirrhosis,accounted for 24.2%(hepatitis B virus infection accounted for 59.9% in 2017,cryptogenic cirrhosis accounted for 20.6%.).The median length of hospital stay was 9(6,13)days and was positively correlated with both the Child-Pugh score and the model for end-stage liver disease(MELD)score,particularly with the Child-Pugh score.15.9% of patients with cirrhosis have a family history of the same liver disease,most commonly hepatitis B.There were 3 people with a previous history of psoriasis,and all of them were cryptogenic cirrhosis,which was statistically different from other causes of cirrhosis(P < 0.05).Signs of cirrhosis are most common in the form of liver disease face,shifting dullness,and jaundice of the skin or sclera,while liver palms,spider nevi,and abdominal wall variceal veins are rare.Complications may include ascites,pleural fluid,upper gastrointestinal bleeding,liver cancer,hepatic encephalopathy,and hepatorenal syndrome.The clinical stage of cirrhosis was the most numerous in stage 3,accounting for 52.3%,and there were no stage 5patients.Laboratory results show that abnormalities of hemoglobin,hematocrit,platelets,total protein,direct bilirubin,aspartate transaminase(AST),and gamma-glutamyl transpeptidase(GGT)are more common in patients with cirrhosis of liver.The most significant decreases in albumin,prealbumin and HDL levels were observed as compared with normal levels.Abdominal imaging findings show high consistency,with the most common findings being an unsmooth liver margin,an enlarged spleen,a thick gallbladder wall,a disproportional liver,and cholecystitis.In addition,Computed Tomography(CT)of the abdomen revealed213 cases of esophageal and gastric varices,accounting for 49.1%.Of the patients who underwent gastroscopy,91% had esophageal and gastric varices and 40.6% had portal hypertensive gastropathy.Patients with viral cirrhosis(266 cases,61.3%)were more male,with younger median age,shorter hospital stay,and more common family history,which was statistically different from those with non-viral cirrhosis(168 cases,38.7%)(P < 0.05).However,the complications of ascites and hepatic encephalopathy in patients with non-viral cirrhosis are more common than those in patients with viral hepatitis cirrhosis,cholestasis is more common than viral hepatitis cirrhosis,with statistical difference(P < 0.05).In addition,the levels of platelets,white blood cells,low density lipoprotein,AST,GGT and carbohydrate antigen 125(CA125)in patients with viral hepatitis cirrhosis are lower,but the levels of erythrocyte and alpha-fetal protein(AFP)are higher,and peribiliary effusion is more common,which is statistically different from those in patients with non-viral hepatitis cirrhosis(P < 0.05).Hepatitis B(224 cases)is more common in men,younger in age,with higher levels of hemoglobin,hematocrit,red blood cells,AST,GGT and alanine transaminase(ALT),and a high proportion of family history of the same disease,which is statistically different from hepatitis C(42 cases)cirrhosis(P <0.05).Hepatitis C is more common in women,and most of them are accompanied by esophageal and gastric varices,which is statistically different from hepatitis B cirrhosis(P <0.05).CONCLUSION:The proportion of viral hepatitis cirrhosis in the gastroenterology department may show a downward trend,while the proportion of cryptogenic liver cirrhosis increases.In addition,cryptogenic cirrhosis is often accompanied by psoriasis,so careful diagnosis should be made.Liver failure in patients with cirrhosis of the liver in gastroenterology is rare,and the length of hospital stay is positively correlated with Child-Pugh scores and model scores for end-stage liver disease.The patients with viral hepatitis cirrhosis are mainly in the mild and moderate conditions,while the patients with non-viral hepatitis cirrhosis are relatively in the severe condition and have more complications.Hepatitis B cirrhosis tends to have a family history of the same disease relative to hepatitis C cirrhosis.