No abstract

Annotation. Variceal bleeding is one of the most dangerous complications of liver cirrhosis, which is associated with relatively high lethality. At the same time, the bleeding can trigger some other complications of liver cirrhosis that further worsen the prognosis for these patients. These factors determine the necessity not only for the diagnosis of variceal bleeding in patients with liver cirrhosis but also for the prognosis of possible recurrent bleeding and lethality. The aim of this study was to evaluate the possibility of predicting survival or lethality in patients with variceal bleeding. This study is based on the results of the investigation and treatment of 121 patients with liver cirrhosis complicated by variceal bleeding. To determine the prognostic value of the clinical course, the analysis of various markers of complete blood count, biochemical blood and coagulation markers, Child-Turcotte-Pugh and MELD criteria was performed. The ROC (receiver operating characteristic) curve was applied for the evaluation and comparison of various markers. Additionally, the specificity, sensitivity, accuracy, positive (PPV) and negative prognostic value (NPV), positive (LR+) and negative (LR-) likelihood ratio were used. The J-index (index Youden) was applied for the comparison of border values. Predicting the clinical course allows for identifying patients with a possible unfavorable prognosis who require intensive therapy, as well as those with minimal risk of fatal outcome. According to the study results, the International normalized ratio (sensitivity – 95%, specificity – 97%), potassium blood level (sensitivity – 95.2%, specificity – 89%), and MELD score (sensitivity – 95.2%, specificity – 86%) are the markers, which had the highest prognostic value for the unfavorable clinical course. Whereas the sodium blood level (sensitivity – 96%, specificity – 100%) was the best marker of favorable clinical course. Other analyzed indicators had limited prognostic significance. Thus, although the number of bleedings in the anamnesis increases the risk of a fatal outcome, it has limited importance for prognostics of a favorable or unfavorable course of variceal bleeding. The sodium blood level is the best marker for the prediction of a favorable clinical course. International normalized ratio, potassium blood level, and MELD score are the markers of an unfavorable clinical course.

Annotation. The aim of the study was to evaluate the dynamics of changes in the quality of life of patients with liver cirrhosis complicated by esophageal and gastric variceal bleeding while taking L-Ornithine L-Aspartate. 67 patients with a confirmed diagnosis of liver cirrhosis complicated by esophageal and gastric variceal bleeding were included in the study. All patients were randomly divided into two groups – experimental group (34 patients, standard therapy, supplemented with L-Ornithine L-Aspartate) and comparison group (33 patients, standard therapy). To evaluate the effectiveness of the treatment, the quality of life was assessed using the Gastrointestinal Symptom Rating Scale questionnaire on days 1st–2nd, 7th and 30th. Parametric values were evaluated using Student's t-test, non-parametric values - using the Mann-Whitney test. The intensity of the studied syndromes at the beginning of the study did not differ significantly in both groups. It is explained by the homogeneity of the patient population. In patients of the experimental group, there was a tendency to a more rapid progressive decrease in the intensity of the studied parameters both during their stay in the hospital and after discharge. The improvement in the quality of life after discharge of patients of the experimental group from the hospital is associated with the continuation of the course of taking L-Ornithine L-Aspartate in the form of granules. A moderate decrease in the intensity of the studied syndromes during hospitalization in patients of the comparison group can be explained by the appointment of only standard intensive care. After the patients of the comparison group were discharged from the hospital and the intensive care was stopped, no changes in the quality of life were observed. Thus, the administration of L-Ornithine L-Aspartate to patients with liver cirrhosis complicated by esophageal and gastric variceal bleeding can significantly improve the quality of life and reduce the intensity of dyspeptic, pain, diarrheal, constipation and reflux syndromes. It is planned to evaluate the long-term results of the use of L-Ornithine L-Aspartate in this patient population.