Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Internal Medicine

Background:Egypt has high morbidity and mortality from chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC).Severity of liver cirrhosis can be determined by using Child Pugh and model of end stage liver disease (MELD) scores. Several studies have shown that urinary albumin to creatinine ratio (UACR)> 30 mg/g is associated with worse outcome in the general population, as well as in specific groups of patients, such as those with diabetes mellitus and arterial hypertension.Two studies had shown that proteinuria worsens the prognosis of decompensated cirrhosis.Some studies had investigated the relation of proteinuria to the cognitive functions and functional capacity in geriatric population and found a significant relation between the presence of proteinuria and dementia and decreased functional capacity in geriatrics. Objectives:The aim of this study is toevaluate the relationship between UACR and the severity of liver cirrhosis (child and MELD scores) and the relation of UACR and geriatric cognitive functions, functional capacity, depression and nutritional status. Patients and methods:A total of 94 patients [divided into two groups:the adults group (47 patients < 65 years old) and the geriatrics group(47 patients {u2265} 65 years old)] with decompensated liver cirrhosis admitted to Kasr Al-Ainyhospital for any cause were included in this study.Severity of liver disease was evaluated using the Child{u2013}Pugh score and MELD score.Random urine samples were collected to measure UACR. Geriatric patients were screened for cognitive impairment using mini mental state examination (MMSE) test, depression using 4 item geriatric depression scale, functional capacity using Barthel index (BI) and malnutrition using mini nutrition assessment scale (MNA). Results:There was a significant relation between UACR and Child score in geriatric group only and there was no significant relation between UACR and MELD score in both groups. There was no relation between UACR and the occurrence of HCC, ascites, hepatic encephalopathy or the cause of liver cirrhosis (viral vs non-viral hepatitis related cirrhosis). No significant relation had been found between UACR and cognitive, functional, mood or nutritional status of the geriatric age group

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