Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 9, Number 6, December 2018, pages 358-363

Cardiac Profile of Filipino Patients With Liver Cirrhosis: A 10-Year Study

**Table 1.** Child-Pugh Classification of the Severity of Cirrhosis
	Child-Pugh Classification (CPC)
Encephalopathy	None	Grades 1 - 2 (or precipitant-induced)	Grades 3 - 4 (or chronic)
Ascites	None	Mild/moderate (diuretic-responsive)	Severe (diuretic-refractory)
Bilirubin (mg/dL)	< 2	2 - 3	> 3
Albumin (g/dL)	> 3.5	2.8 - 3.5	< 2.8
PT (s)	< 4	4 - 6	> 6
INR	< 1.7	1.7 - 2.3	> 2.3

Table 1. Child-Pugh Classification of the Severity of Cirrhosis

Child-Pugh Classification (CPC)

Encephalopathy

None

Grades 1 - 2 (or precipitant-induced)

Grades 3 - 4 (or chronic)

Ascites

None

Mild/moderate (diuretic-responsive)

Severe (diuretic-refractory)

Bilirubin (mg/dL)

< 2

2 - 3

> 3

Albumin (g/dL)

> 3.5

2.8 - 3.5

< 2.8

PT (s)

< 4

4 - 6

> 6

INR

< 1.7

1.7 - 2.3

> 2.3

**Table 2.** General Characteristics of Patients Admitted With Liver Cirrhosis (2007 - 2016)
Demographics	f (%), mean ± SD
No. of patients	148
Age (years)	72.4 ± 14
Male	70 (47%)
Female	78 (53%)
Mean duration of hospitalization (days)	7.5 ± 6
Etiology of cirrhosis
Hepatitis	30 (20%)
Hepatitis B infection	24 (16%)
Hepatitis C infection	6 (4%)
Cryptogenic	29 (20%)
Non-alcoholic steatohepatitis	27 (18%)
Alcohol-related	23 (15%)
Schistosomiasis	4 (3%)
Hemosiderosis/hemochromatosis	2 (1%)
Autoimmune hepatitis	1 (0.7%)
Portal vein thrombosis	1 (0.7%)
Wilson’s disease	1 (0.7%)
Outcome
Discharged improved	122 (82%)
Expired	26 (18%)

Table 2. General Characteristics of Patients Admitted With Liver Cirrhosis (2007 - 2016)

Demographics

f (%), mean ± SD

No. of patients

148

Age (years)

72.4 ± 14

Male

70 (47%)

Female

78 (53%)

Mean duration of hospitalization (days)

7.5 ± 6

Etiology of cirrhosis

Hepatitis

30 (20%)

Hepatitis B infection

24 (16%)

Hepatitis C infection

6 (4%)

Cryptogenic

29 (20%)

Non-alcoholic steatohepatitis

27 (18%)

Alcohol-related

23 (15%)

Schistosomiasis

4 (3%)

Hemosiderosis/hemochromatosis

2 (1%)

Autoimmune hepatitis

1 (0.7%)

Portal vein thrombosis

1 (0.7%)

Wilson’s disease

1 (0.7%)

Outcome

Discharged improved

122 (82%)

Expired

26 (18%)

**Table 3.** Child Pugh Score (CPC), n = 130
CPC	No. of patients (%) N = 130	Alive, f (%) n = 106	Expired, f (%) n = 24	P value
A	31 (24%)	29 (%)	2 (%)	0.05
B	84 (64%)	67 (%)	17 (1%)
C	15 (11%)	10 (%)	5 (%)
≤ 9	16 (13%)	14 (1%)	2 (%)	0.005
10 - 12	27 (21%)	26 (%)	1 (%)
13 - 16	26 (21%)	24 (%)	2 (%)
≥ 17	57 (45%)	39 (%)	18 (%)

Table 3. Child Pugh Score (CPC), n = 130

CPC

No. of patients (%) N = 130

Alive, f (%) n = 106

Expired, f (%) n = 24

P value

31 (24%)

29 (%)

2 (%)

0.05

84 (64%)

67 (%)

17 (1%)

15 (11%)

10 (%)

5 (%)

MELD

No. of patients (%) N = 126

Alive, f (%) n = 103

Expired, f (%) n = 23

P value

≤ 9

16 (13%)

14 (1%)

2 (%)

0.005

10 - 12

27 (21%)

26 (%)

1 (%)

13 - 16

26 (21%)

24 (%)

2 (%)

≥ 17

57 (45%)

39 (%)

18 (%)

**Table 4.** Median QTc Among the Different Child-Pugh Classification (CPC) and MELD Classification (N = 84)
CPC	No. of patients (%)	Median QTc, ms (IQR)	P value
A	17 (20%)	470 (423 - 501)	470 (412 - 496)	607	0.152
B	57 (68%)	433 (410 - 453)	435 (413 - 435)	416 (402 - 443)	0.213
C	9 (11%)	447 (412 - 484)	432 (402 - 516) 0.117	465 (447 - 484) 0.256	0.462
Total	83	439
≤ 9	9 (11%)	485 (436 - 501)	488 (370 - 607)	485 (436 - 501)	0.769
10 - 12	16 (20%)	437 (411 - 470)	0	437 (411 - 470)
13 - 16	18 (22%)	438 (407 - 470)	443	435 (407 - 470)	0.772
≥ 17	39 (47%)	432 (410 - 454)	426 (410 - 453) 0.949	433 (412 - 454) 0.279	0.665
Total	82	439

Table 4. Median QTc Among the Different Child-Pugh Classification (CPC) and MELD Classification (N = 84)

CPC

No. of patients (%)

Median QTc, ms (IQR)

P value

Total

Alive

Expired

17 (20%)

470 (423 - 501)

470 (412 - 496)

607

0.152

57 (68%)

433 (410 - 453)

435 (413 - 435)

416 (402 - 443)

0.213

9 (11%)

447 (412 - 484)

432 (402 - 516)
0.117

465 (447 - 484)
0.256

0.462

Total

439

MELD

No. of patients (%)

Median QTc, ms (IQR)

P value

Total

Alive

Expired

≤ 9

9 (11%)

485 (436 - 501)

488 (370 - 607)

485 (436 - 501)

0.769

10 - 12

16 (20%)

437 (411 - 470)

13 - 16

18 (22%)

438 (407 - 470)

443

435 (407 - 470)

0.772

≥ 17

39 (47%)

432 (410 - 454)

426 (410 - 453)
0.949

433 (412 - 454)
0.279

0.665

Total

439

**Table 5.** Echocardiographic Features in Patients With Liver Cirrhosis
Parameter	Normal range	Mean ± SD (cm)	Child-Pugh Score	P value
LVEDD: left ventricular end-diastolic dimension; BSA: body surface area; LVESD: left ventricular end-systolic diameter; IVSD: interventricular septum at end diastole; IVSS: interventricular septal end-systolic thickness; PWD: posterior wall thickness at end-diastole; PWS: posterior wall thickness at end-systole; LVMI: left ventricular mass index; RWT: relative wall thickness; LA: left atrium; LAVI: left atrial volume index; LVEF: left ventricular ejection fraction; CO: cardiac output; CI: cardiac index.
LVEDD		4.28 ± 0.91	4.22 ± 1.11	4.36 ± 0.81	3.73 ± 1.15	0.445
LVEDD/BSA	F: 2.2 - 3.1 cm/m² M: 2.4 - 3.2 cm/m²	2.8 ± 0.51	2.82 ± 0.34	2.77 ± 0.60	2.67 ± 0.25	0.095
LVESD		2.5 ± 0.73	2.70 ± 1.12	2.53 ± 0.60	2.07 ± 0.68	0.055
LVESD/BSA	1.4 - 2.1 cm/m²	1.51 ± 0.44	1.65 ± 0.64	1.46 ± 0.38	1.5 ± 0.10	0.023
IVSD	F: 0.6 - 0.9 cm M: 0.6 - 1.0 cm	1.15 ± 0.23	1.25 ± 0.27	1.12 ± 0.20	1.27 ± 0.47	0.123
IVSS		1.44 ± 0.30	1.40 ± 0.32	1.45 ± 0.32	1.33 ± 0.11	0.353
PWD	F: 0.6 - 0.9 cm M: 0.6 - 1.0 cm	1.17 ± 0.29	1.23 ± 0.36	1.18 ± 0.27	1.13 ± 0.32	0.608
PWS		26.89 ± 46.74	34.26 ± 57.29	24.62 ± 44.29	41.43 ± 68.91	0.473
LVMI	F: 43 - 95 gm/m² M: 49 - 115 gm/m²	79.11 ± 50.27	86.64 ± 69.58	78.37 ± 45.48	60.51 ± 52.36	0.276
RWT	F: 0.22 - 0.42 cm M: 0.24 - 0.42 cm	1.34 ± 1.71	1.69 ± 2.11	1.31 ± 1.70	1.62 ± 2.06	0.70
LA	1.5 - 2.3 cm/m²	3.61 ± 1.00	3.60 ± 0.85	3.68 ± 0.944	3.50 ± 1.28	0.748
LA/BSA		10.47 ± 15.69	13.4 ± 20.01	9.69 ± 14.89	8.73 ± 10.5	0.426
LAVI	< 28 mL/m²	41.54 ± 16.5	44.17 ± 18.20	41.30 ± 17.11	47.33 ± 19.10	0.960
LVEF	> 55%	54.40 ± 28.63	44.56 ± 27.95	57.02 ± 28.34	50.3 ± 36.2	0.883
CO	> 4.5 L/min	6.04 ± 5.24	5.06 ± 2.31	6.61 ± 6.34	4.40 ± 1.47	0.003
CI	2.5 L/min/m²	2.92 ± 1.47	2.52 ± 1.40	3.08 ± 1.41	2.17 ± 1.33	0.993

Table 5. Echocardiographic Features in Patients With Liver Cirrhosis

Parameter

Normal range

Mean ± SD (cm)

Child-Pugh Score

P value

LVEDD: left ventricular end-diastolic dimension; BSA: body surface area; LVESD: left ventricular end-systolic diameter; IVSD: interventricular septum at end diastole; IVSS: interventricular septal end-systolic thickness; PWD: posterior wall thickness at end-diastole; PWS: posterior wall thickness at end-systole; LVMI: left ventricular mass index; RWT: relative wall thickness; LA: left atrium; LAVI: left atrial volume index; LVEF: left ventricular ejection fraction; CO: cardiac output; CI: cardiac index.

LVEDD

4.28 ± 0.91

4.22 ± 1.11

4.36 ± 0.81

3.73 ± 1.15

0.445

LVEDD/BSA

F: 2.2 - 3.1 cm/m²
M: 2.4 - 3.2 cm/m²

2.8 ± 0.51

2.82 ± 0.34

2.77 ± 0.60

2.67 ± 0.25

0.095

LVESD

2.5 ± 0.73

2.70 ± 1.12

2.53 ± 0.60

2.07 ± 0.68

0.055

LVESD/BSA

1.4 - 2.1 cm/m²

1.51 ± 0.44

1.65 ± 0.64

1.46 ± 0.38

1.5 ± 0.10

0.023

IVSD

F: 0.6 - 0.9 cm
M: 0.6 - 1.0 cm

1.15 ± 0.23

1.25 ± 0.27

1.12 ± 0.20

1.27 ± 0.47

0.123

IVSS

1.44 ± 0.30

1.40 ± 0.32

1.45 ± 0.32

1.33 ± 0.11

0.353

PWD

F: 0.6 - 0.9 cm
M: 0.6 - 1.0 cm

1.17 ± 0.29

1.23 ± 0.36

1.18 ± 0.27

1.13 ± 0.32

0.608

PWS

26.89 ± 46.74

34.26 ± 57.29

24.62 ± 44.29

41.43 ± 68.91

0.473

LVMI

F: 43 - 95 gm/m²
M: 49 - 115 gm/m²

79.11 ± 50.27

86.64 ± 69.58

78.37 ± 45.48

60.51 ± 52.36

0.276

RWT

F: 0.22 - 0.42 cm
M: 0.24 - 0.42 cm

1.34 ± 1.71

1.69 ± 2.11

1.31 ± 1.70

1.62 ± 2.06

0.70

1.5 - 2.3 cm/m²

3.61 ± 1.00

3.60 ± 0.85

3.68 ± 0.944

3.50 ± 1.28

0.748

LA/BSA

10.47 ± 15.69

13.4 ± 20.01

9.69 ± 14.89

8.73 ± 10.5

0.426

LAVI

< 28 mL/m²

41.54 ± 16.5

44.17 ± 18.20

41.30 ± 17.11

47.33 ± 19.10

0.960

LVEF

> 55%

54.40 ± 28.63

44.56 ± 27.95

57.02 ± 28.34

50.3 ± 36.2

0.883

> 4.5 L/min

6.04 ± 5.24

5.06 ± 2.31

6.61 ± 6.34

4.40 ± 1.47

0.003

2.5 L/min/m²

2.92 ± 1.47

2.52 ± 1.40

3.08 ± 1.41

2.17 ± 1.33

0.993