Clinical and Epidemiological Profile of Cirrhotic Patients at a Reference Center in Belém-PA , Analysis of 10 years

Conclusions: The profile was predominantly of male patients, aged between 51 and 60 years, coming from the capital Belem, whose main etiologies of cirrhosis were C hepatitis and alcohol. Ascites was the most frequent clinical manifestation and Child-Pugh score A was the most prevalent. Clinical and Epidemiological Profile of Cirrhotic Patients at a Reference Center in Belém-PA, Analysis of 10 years ORIGINAL


Introduction
The liver plays a central role in the control of the human body [1].The main histopathological characteristic of liver injury is the deposition of extensive fibrosis with reduced liver function.Cirrhosis is the end result of fibrosis and, once present, the process is irreversible and predisposes to a high risk of mortality [2].
The severity of liver disease is directly related to the extent of fibrosis, which determines the degree of stiffness of the liver.This degree varies according to the etiology of the disease, being the main ones: alcoholic, post-viral hepatitis, secondary to steatohepatitis [3].
Viral ethyologies are caused by hepatitis B, C and D virus infection.Alcoholic liver disease and hepatitis C are the most frequent causes of cirrhosis in developed countries of the West.In Asia and Africa, virus B is the main etiology of the disease.In addition, studies show that up to almost half of patients with cirrhosis are asymptomatic, making it difficult to diagnose early and determine the exact prevalence of the disease.In these, cirrhosis may be discovered during routine exams or at necropsy.However, once the symptoms manifest themselves, the prognosis is severe and the economic costs are high [4].
Hepatic cirrhosis accounts for a high morbidity and mortality rate, both in Brazil and worldwide [5].According to the World Health Organization, the disease is among the top 10 causes of death in adult individuals worldwide [6].It is important to emphasize the early diagnosis of chronic liver diseases, so that immediate and appropriate treatment is adopted, reducing the risk of progression to cirrhosis and later, for hepatocellular carcinoma, besides contributing to the reduction of the continuous transmission of infection in the liver.cases of viral hepatitis [7].
The aim of this study was to analyze the demographic, ethyological and clinical aspects of patients with liver cirrhosis treated in the Chronic Liver Disease Center.

Methods
The sample was composed by patients attended at Chronic Liver Disease Center, in Belem (Brazil), from both genders, whose complementary exams (laboratory, endoscopic, and/or ultrasonographic) were suggestive of cirrhosis, in the presence or absence of signs and symptoms of hepatic insufficiency or portal hypertension or histopathological examination of cirrhosis.The clinical diagnosis of cirrhosis was based on signs of portal hypertension (clinical or ultrasonographic) or hepatic insufficiency.A descriptive, cross-sectional and retrospective study included data collected from patients diagnosed with cirrhosis attended in the center between January 2004 and August 2014.Medical records of 580 patients were evaluated.The selected patients signed a Informed Consent Term and were submitted to clinical, epidemiological and histopathological evaluation with specific protocol.

Results
The search results are distributed in the following eight tables.

Discussion
In this research, 62% of the patients were male, which is justified by a greater exposure of men to most risk factors [8,9] and also because men attend less health services, thus, the evolution of undiagnosed fibrosis favors liver cirrhosis [10].
Age over 40 years old is a risk factor for fibrosis evolution [11].In this study, 33% of the patients were between 51-60 years old.The advanced age in cirrhotic patients is justified by the slow progression of the disease in viral hepatitis, especially by hepatitis C virus (HCV) [12].
More than 70% of the patients come from urban areas.This suggests the possibility of under-reporting of liver disease in rural areas, due to the lack of medical care in the country.In addition, this disease        has a urban pattern of infection, where there is a greater exposure to risk factors [12].The most commom ethyology was alcoholic, followed by C hepatitis, as observed in other studies [13,14].The ingestion of alcohol accelerates the frequency of hepatic decompensation, doubles the risk of mortality in cirrhotic patients, and there is a worsening of prognosis when there is an association with other ethyologies 1 .Meanwhile the natural history of hepatitis C virus includes long asymptomatic periods, which contributes a large number of patients to ignore this problem [15].
There were cases of co-infection between HIV and viral hepatitis.This association is a frequent event, due to the common risk factors in the transmission of these diseases.Viral hepatitis is the leading cause of morbidity and mortality among HIV-infected patients.The progression rate of hepatic fibrosis in co-infected patients is about twice as fast as in patients infected only with B or D virus [16].
The most frequent clinical manifestations were ascites, edema and abdominal pain.Researches have shown that ascites is the main clinical manifestation of cirrhosis decompensation and approximately half of cirrhotic patients will develop ascites within 10 years of follow-up [17].Ascites occurs due to alterations in the functioning of hepatocytes resulting in decreased albumin synthesis, which reduces plasma oncotic pressure and contributes to the formation of edema [18].
Another important finding was the presence of esophageal varices identified in the vast majority of patients by upper digestive endoscopy.In cirrhosis, portal hypertension leads to the development of esophageal varices, which is a very commom clinical manifestation found in studies with this group of patients [19].
The most frequent Child-Pugh score was A, followed by B and C.This result disagrees with other researches in hepatopathy specialized services, which C is the most commom score [14].The authors believe that due to the successful treatment and follow-up in this center, patients have lower scores.

Conclusion
The importance of cirrhosis in public health scenario, due to its high morbidity, mortality and scarcity of regional information makes this research a way to contribute to a better understanding of regional aspects of this disease.Thus, it is emphasized the need for new studies that allow a deep analysis of this theme and optimize the quality of care to the population, particularly highlightning aspects related to treatment and prevention.

Table 1 .
Gender of cirrhotic patients attended at Chronic Liver Disease Center between 2004 e 2014.

Table 5 .
Clinical manifestations of cirrhotic patients attended at Chronic Liver Disease Center between 2004 e 2014.
Source: research protocol.

Table 4 .
Ethyology related to cirrhotic patients attended at Chronic Liver Disease Center between 2004 e 2014.

Table 3 .
Hometown region in state of Pará (Brazil) of cirrhotic patients attended at Chronic Liver Disease Center between 2004 e 2014.
Source: research protocol.

Table 2 .
Age of cirrhotic patients attended at Chronic Liver Disease Center between 2004 e 2014.

Table 6 .
Upper digestive endoscopy of cirrhotic patients attended at Chronic Liver Disease Center between 2004 e 2014.

Table 7 .
Anti-HIVof cirrhotic patients attended at Chronic Liver Disease Center between 2004 e 2014.

Table 8 .
Child-Pugh score of cirrhotic patients attended at Chronic Liver Disease Center between 2004 e 2014.