Kronik karaciğer parankim hastalarında minimal hepatik ensefalopati ve karaciğer kırılganlık indeksinin yaşam kalitesine etkisi
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Dosyalar
Tarih
2022
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Sirozun yaşam kalitesini ciddi şekilde etkileyen komplikasyonlarından biri de hepatik ensefalopatidir. En hafif formunda bile, hepatik ensefalopati sag?lıkla ilişkili yaşam kalitesini du?şu?ru?r ve aşikâr hepatik ensefalopati için bir risk fakto?ru?du?r. Kırılganlık yaşlanma ile birlikte vu?cuttaki organların ve sistemlerin mevcut go?revlerini tam olarak yerine getirememesi nedeniyle yetersiz kalması, gu?nlu?k rutin aktiviteler ve stres kaynaklarına karşı vermeleri gereken yanıtta ve tepkilerde noksanlık sonucu fizyolojik kabul edilmeyen sonuçların ortaya çıkmasına yatkınlık olarak deg?erlendirilen bir sendromdur. Bu araştırmada kronik karacig?er parankim hastalarında minimal hepatik ensefalopati varlıg?ının ve Karacig?er Kırılganlık I?ndeksi’nin yaşam kalitesine etkisini ortaya koymaya çalıştık Çalışmamıza Trakya Üniversitesi Tıp Faku?ltesi Gastroenteroloji Bilim Dalı Poliklinig?i’nde takip edilen, karacig?er sirozu tanılı 76 hasta dahil edildi. Karacig?er sirozu tanısı klinik, radyolojik, laboratuvar ve/veya histopatolojik kriterlerle konuldu. Hastaların kırılganlık testi deg?erlendirmesi için Karacig?er Kırılganlık I?ndeksi kullanıldı. Aşikâr hepatik ensefalopati klinik olarak ekarte edilen hastalara minimal hepatik ensefalopati deg?erlendirmesi amacıyla I?z Su?rme Testi Form-A ve Form-B uygulandı. Hastaların yaşam kalitesinin deg?erlendirilmesinde ‘‘Karacig?er Hastalıg?ı Yaşam Kalitesi Ölçeg?i 1.0’’ kullanıldı. I?statistiksel analizde gruplar arasında su?rekli deg?işkenlerin karşılaştırılmasında Student t testi, ANOVA, Mann Whitney U testi, Kruskal wallis testi, kategorik deg?işkenlerin karşılaştırılmasında Chi Square testi, Fischer Exact testi uygulandı. Sag?kalım analizleri için Kaplan Meier sag?kalım analizi yo?ntemi kullanıldı. Çalışmamızda Minimal hepatik ensefalopati saptanan hastalarda yaşam kalitesi %67,19, saptanmayan hastalar da ise %81 saptandı. Minimal hepatik ensefalopati varlıg?ının hastaların yaşam kalitesini azalttıg?ı go?ru?ldu?. Yaşam kalitesi sag?lam hastalarda %81,91, hafifkırılgan hastalarda %75,84, kırılgan hastalarda %61,37 saptandı. Kırılganlık du?zeyinin artmasının hastaların yaşam kalitesini azalttıg?ı go?ru?ldu?. Minimal hepatik ensefalopati varlıg?ının siroz hastalarında kırılganlıg?ı arttırdıg?ı go?ru?ldu?. Yaşam kalitesi yu?ksek olan hastaların ortalama sag?kalım du?zeyi 76,43±2,37 hafta, du?şu?k olan hastaların 60,26±4,8 hafta saptandı. Yaşam kalitesi du?şu?k olan hastalarda mortalitenin daha fazla oldug?u go?sterildi. Karacig?er kırılganlık indeksine go?re sag?lam hastalarda sag?kalım %100, hafif-kırılgan hastalarda %76,1, kırılgan hastalarda ise %56,3 saptandı. Kırılganlık du?zeyindeki artışın mortaliteyi arttırdıg?ı go?ru?ldu?. Minimal hepatik ensefalopati varlıg?ının mortaliteyi arttırdıg?ı go?sterildi. Sonuç olarak; minimal hepatik ensefalopati ve kırılganlık kronik karacig?er parankim hastalarında yaşam kalitesini du?şu?rmektedir.
One of the complications of cirrhosis that seriously affects the quality of life is hepatic encephalopathy. Even in its mildest form, hepatic encephalopathy reduces health-related quality of life and is a risk factor for overt hepatic encephalopathy. Frailty is a syndrome that is evaluated as a predisposition to the emergence of non-physiological results as a result of the insufficiency of organs and systems in the body due to their inability to fully fulfill their current duties, and the lack of response and reactions to daily routine activities and stress sources. In this study, we tried to reveal the effect of minimal hepatic encephalopathy and Liver Frailty Index on quality of life in patients with chronic liver disease. Our study included 76 patients diagnosed with liver cirrhosis, who were followed up in Trakya University Faculty of Medicine, Department of Gastroenterology Outpatient Clinic. The diagnosis of liver cirrhosis was made by clinical, radiological, laboratory and/or histopathological criteria. Liver Frailty Index was used for the evaluation of patients' frailty test. Trail Making Test Form-A and Form-B were performed for the evaluation of minimal hepatic encephalopathy in patients whose overt hepatic encephalopathy was clinically excluded. " The Liver Disease Quality of Life instrument 1.0" was used to evaluate the quality of life of the patients. In statistical analysis, Student's t test, ANOVA, Mann Whitney U test, Kruskal wallis test were used to compare continuous variables between groups, Chi Square test and Fischer Exact test were used to compare categorical variables. Kaplan Meier survival analysis method was used for survival analysis. In our study, the quality of life was 67.19% in patients with minimal hepatic encephalopathy, and 81% in patients who were not. It was observed that the presence of minimal hepatic encephalopathy decreased the quality of life of the patients. Quality of life was 81.91% in robust patients, 75.84% in pre-frail patients, and 61.37% in frail patients. It was observed that the increase in the frailty level decreased the quality of life of the patients. It was observed that the presence of minimal hepatic encephalopathy increased frailty in patients with cirrhosis. The mean survival level of patients with high quality of life was 76.43±2.37 weeks, and 60.26±4.8 weeks for patients with low quality of life. It has been shown that mortality is higher in patients with low quality of life. According to the liver fragility index, survival was 100% in robust patients, 76.1% in pre-frail patients, and 56.3% in frail patients. It was observed that the increase in the frailty level increased the mortality. The presence of minimal hepatic encephalopathy was shown to increase mortality. As a result; minimal hepatic encephalopathy and fragility reduce the quality of life in patients with chronic liver disease.
One of the complications of cirrhosis that seriously affects the quality of life is hepatic encephalopathy. Even in its mildest form, hepatic encephalopathy reduces health-related quality of life and is a risk factor for overt hepatic encephalopathy. Frailty is a syndrome that is evaluated as a predisposition to the emergence of non-physiological results as a result of the insufficiency of organs and systems in the body due to their inability to fully fulfill their current duties, and the lack of response and reactions to daily routine activities and stress sources. In this study, we tried to reveal the effect of minimal hepatic encephalopathy and Liver Frailty Index on quality of life in patients with chronic liver disease. Our study included 76 patients diagnosed with liver cirrhosis, who were followed up in Trakya University Faculty of Medicine, Department of Gastroenterology Outpatient Clinic. The diagnosis of liver cirrhosis was made by clinical, radiological, laboratory and/or histopathological criteria. Liver Frailty Index was used for the evaluation of patients' frailty test. Trail Making Test Form-A and Form-B were performed for the evaluation of minimal hepatic encephalopathy in patients whose overt hepatic encephalopathy was clinically excluded. " The Liver Disease Quality of Life instrument 1.0" was used to evaluate the quality of life of the patients. In statistical analysis, Student's t test, ANOVA, Mann Whitney U test, Kruskal wallis test were used to compare continuous variables between groups, Chi Square test and Fischer Exact test were used to compare categorical variables. Kaplan Meier survival analysis method was used for survival analysis. In our study, the quality of life was 67.19% in patients with minimal hepatic encephalopathy, and 81% in patients who were not. It was observed that the presence of minimal hepatic encephalopathy decreased the quality of life of the patients. Quality of life was 81.91% in robust patients, 75.84% in pre-frail patients, and 61.37% in frail patients. It was observed that the increase in the frailty level decreased the quality of life of the patients. It was observed that the presence of minimal hepatic encephalopathy increased frailty in patients with cirrhosis. The mean survival level of patients with high quality of life was 76.43±2.37 weeks, and 60.26±4.8 weeks for patients with low quality of life. It has been shown that mortality is higher in patients with low quality of life. According to the liver fragility index, survival was 100% in robust patients, 76.1% in pre-frail patients, and 56.3% in frail patients. It was observed that the increase in the frailty level increased the mortality. The presence of minimal hepatic encephalopathy was shown to increase mortality. As a result; minimal hepatic encephalopathy and fragility reduce the quality of life in patients with chronic liver disease.
Açıklama
Anahtar Kelimeler
Minimal hepatik ensefalopati, Kırılganlık, Yaşam kalitesi, Minimal hepatic encephalopathy, Frailty, Quality of life
