Tuesday, 3 December 2013

Cirrhosis - The Risk Factors

Cirrhosis is defined as a condition of irreversible scarring liver as a result of liver tissue by fibrosis due to final phase of chronic liver diseases of that can lead to poor function of the liver and liver failure. According to the statistics, Number of discharges with chronic liver disease or cirrhosis as the first-listed diagnosis: 101,000 in 2009 and Deaths per 100,000 population: 10.3 in 2010(a). Hepatitis B infection cause of the disease is very prevalent in South-East Asia.
Risk factors
1. Gender
Female who are chronic alcohol drinkers are at increase to develop Cirrhosis. According to the study  in a population-based prospective cohort of 13,285 men and women aged 30-79 years, and diagnoses indicating alcoholic liver disease (n = 261) or cirrhosis (n = 124) were obtained from the Danish National Health Registers, indicated that women had a significantly higher relative risk of developing alcohol related liver disease than men for any given level of alcohol intake(8).

2. Diabetes mellitus (DM)
If you are diabetic, you are associated with increased risk of cirrhosis. According to the study by the University Hospital, Monterrey, about 30% of patients with cirrhosis have diabetes mellitus (DM). There exists in relation to: type 2 DM alone or as part of the metabolic syndrome in the development of liver disease; factors involved in the genesis of hepatogenous diabetes; the impact of DM on the clinical outcome of liver disease; the management of DM in cirrhotic patients and the role of DM as a risk factor for the occurrence and exacerbation of hepatocellular carcinoma(9). Other study indicated that Insulin resistance in liver cirrhosis was higher than the other type 2 DM, and impaired hepatic insulin degradation might be an important mechanism of hyperinsulinemia in liver cirrhosis(10).

3. Excessive alcohol drinking
People who drinks abusively, in most case died as a result of the progression of liver diseases. According to the review of Seventeen studies  alcohol consumption had a significantly larger impact on mortality of liver cirrhosis compared with morbidity. Also, the same amount of average consumption was related to a higher risk of liver cirrhosis in women than in men(11).

4. Medication induced cirrhosis
Certain medication may cause increased risk of cirrhosis to the takers. According to the study by the Seoul National University College of Medicine, anti-tuberculosis (TB) drug-induced liver injury (DILI) in patients with chronic liver disease including cirrhosis, but the drugs may be safely used in the patients with chronic liver disease including compensated cirrhosis if number of hepatotoxic drugs used is adjusted appropriately(12). In other study by University "Magna Græcia" of Catanzaro, there is a case of a male patient who developed severe drug-induced hepatotoxicity during the treatment with Cyproterone acetate (CPA). The case, presenting sub-acute hepatitis, was characterized by a rapid evolution of cirrhosis and a protracted activity during the period of a few months despite the treatment withdrawal and an apparent benefits of corticosteroids, suggesting their indication in life threatening cases(13).

5. Age
Risk of cirrhosis is increased with progression of age. According to the study by the University of Sydney, there is evidence that the sinusoidal changes in cirrhosis and aging contribute to hepatocyte hypoxia, thus providing a mechanism for the apparent differential reduction of oxygen-dependent phase I metabolic pathways in these conditions. Structural change and subsequent dysfunction of the liver sieve warrant consideration as a significant factor in the impairment of overall substrate handling and hepatic drug metabolism in cirrhosis and aging(14).

6. Obesity
Risk of cirrhosis is increased for obese people. In the study to evaluate the role of obesity, in relationship to other recognized predictors, in the development of CD in patients with compensated cirrhosis, found that obesity has a deleterious effect on the natural history of compensated cirrhosis of all etiologies, independent of portal pressure and liver function. Weight reduction may be a valuable therapeutic measure in this patient population(15).

7. Heredity
Alpha-1-anti-trypsin deficiency is the most common genetic cause of liver disease in children and liver transplantation is currently the only available treatment, according to the study by Telethon Institute of Genetics and Medicine(16).

8. Toxins
Toxins can damage the liver. according to the study by University Hospital Regensburg, Xanthohumol, the major prenylated chalcone found in hops, is known for its anti-inflammatory properties exerts a protective effects of xanthohumol in this toxic liver injury model involves direct mechanisms related to its ability to block both hepatic inflammation and the activation of hepatic stellate cells, presumable at least in part via decreasing NFκB activity(17).

9. Etc.
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(a) http://www.cdc.gov/nchs/fastats/liverdis.htm
(8) http://www.ncbi.nlm.nih.gov/pubmed/9214055
(9) http://www.ncbi.nlm.nih.gov/pubmed/19140227
(10) http://www.ncbi.nlm.nih.gov/pubmed/17237630
(11) http://www.ncbi.nlm.nih.gov/pubmed/20636661
(12) http://www.ncbi.nlm.nih.gov/pubmed/20670648
(13) http://www.ncbi.nlm.nih.gov/pubmed/23293208
(14) http://www.ncbi.nlm.nih.gov/pubmed/15656697
(15) http://www.ncbi.nlm.nih.gov/pubmed/21567436
(16) http://www.ncbi.nlm.nih.gov/pubmed/23381957
(17) http://www.ncbi.nlm.nih.gov/pubmed/22295144

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