cirrhosis

Introduction

Disability-adjusted life years (DALY) is a multidimensional measure used to quantify specific tasks of the disease. Chronic liver disease attributed to hepatitis Delta virus (HDV) is one of the major causes that contribute to morbidity and mortality in our country. The DALY estimate in HDV-induced liver disease has the potential to highlight both fatal and nonfatal outcomes of the disease and thus, help in policy making and allocation of health resources.

Material and methods

This was an analytical prognostic study conducted in the 2021–2024 period, with the enrollment of 104 patients with HDV-induced liver disease. YLL was predictively rated using Child-Pugh's estimate of the remaining years of life. The chronic liver disease questionnaire was used to evaluate patients' disabilities along with the disability weights of the Global Burden of Disease study, calculating YLD. The impact of DALY was interpreted according to the patient's safety indicators.
Results. 104 patients with HDV, originating in different areas of the country, were evaluated, with an average age of 56 ±4.5 years. Substantial YLD losses caused by HDV were mainly reported in working class. The greatest losses of YLD and DALY were caused by cirrhosis of the liver, followed by hepatocellular carcinoma. A great rate of mortality attributed to HDV was seen in the 45-59 and 60-74 age group. A total of 739.1 YLL in male gender and 719.5 in females were recorded for cirrhosis. Overall, men attest a DALY value of 1358.44 total/29.53 per person, and women registered – 1477.3total /25.47 per person.

Conclusions

Chronic liver disease attributed to HDV is a medical challenge in Republic of Moldova. Loading the national medical system with serious and overwhelmed patients, make the DALY calculation approach a priority setting.

Introduction

Bacterial infections in cirrhotic patients represent a major clinical problem, occuring 4-5 times more frequently compared to the general population and increasing mortality by leading to acute on chronic liver failure, subsequent decompensation, and multiorgan failure. The study’s purpose is to determine the possibilities of laparoscopy in the treatment of spontaneous bacterial peritonitis with decompensated liver cirrhosis.

Materials and methods

A retrospective descriptive study was conducted on 82 patients diagnosed with liver cirrhosis and spontaneous bacterial peritonitis, who were admitted to the Constantin Tibirna Surgery department No2, Holy Trinity Municipal Clinical Hospital and the Scientific Research Laboratory of Hepatic Surgery, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, between January 2012 and December 2021. Patients who underwent surgical drainage of the abdominal cavity by laparoscopy with postoperative peritoneal lavage with antibiotics were selected. All patients received standard treatment for the correction of liver function and complications of portal hypertension. The data were extracted from the medical records of the hospital archive, and the patient database was compiled. Data analysis was performed using simple statistical calculations.

Results

Positive ascitic fluid bacterial culture was in 29.2% (24 patients), while 70.7% (58 patients) had culture-negative ascites and peritonitis. The most frequent bacterial species was E. coli, present in 54.1% (13 patients). Mortality was 8.5% (7 patients) due to progressive liver failure. Recurrence of ascites and peritonitis at 1 month was 6.0% (5 patients).

Conclusions

The laparoscopic approach in spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis allows for better sanitation of the abdominal cavity, improves peritoneal absorption, and deserves establishment as clinical practice for patients with ascites and peritonitis and cirrhosis.