Evaluation of Neutrophilic Functions in Patients with Post Hepatitic Liver Cirrhosis

Abstract

Liver cirrhosis which is now a major concern in the Middle East in general and specifically in Egypt is the end result of many chronic liver diseases, such as viral hepatitis, alcoholic liver disease, autoimmune hepatitis, and hemochromatosis. Knowing the major effects of such a condition, new markers, easier way to predict prognosis, effective management of the sequelae of cirrhosis, however, can decrease overall costs, reduce mortality, and maintain quality of life.

Liver disease is progressive in response to chronic liver injury. This progression results in irreversible scarring and nodularity of the liver. This change in liver parenchyma interferes with blood flow through the liver, disrupting its biochemical function.

This study aims to point at the relation between post-hepatitic cirrhosis and neutrophil dysfunction from the point of phagocytic index, also it’s relation with the rise of leukocyte alkaline phosphatase score, which is an enzyme suggested to have role in the bactericidal activity of neutrophils and is known to be elevated in some hematological conditions such as polycythemia rubra vera, and decreases in CML, and either the rise of ammonia level in blood due to liver cirrhosis is related to these outcomes.

The present study was conducted on 80 patients, 60 patients are known hepatic caused by viral hepatitis divided according to Child Pugh classification into: Group (A): 20 patients in Child A stage, Group (B): 20 patients in Child B stage, Group (C): 20 patients in Child C stage and Group (D): 20 control cases. Blood samples are withdrawn from all cases to assess the three tests of the study which are: Ammonia level, NAP score and neutrophil phagocytic index.

As the liver is the organ responsible for ammonia metabolism and detoxification therefore with the decompensation of liver as it progress in course ammonia level was found to be remarkably elevated in cirrhotic patients plasma even in the earliest stages of liver cirrhosis with it’s highest levels in Child (C) cases with the latest stage of cirrhosis, and increased ammonia level in blood is considered one of the important incriminated factors causing hepatic encephalopathy which is known as one of the most important complications of liver cirrhosis.

Neutrophil alkaline phosphatase is an enzyme that is known to be affected by several hematological conditions that was found to be affected by liver cirrhosis and it’s progress among different stages of the disease with the highest levels in Child (C) cases.which exposure

With those two tests found to increase in level with the progress of the disease a correlation was found to be strongly positive showing directly proportional relationship between both tests which may point towards a new concept wether ammonia level elevation consequently elevates the neutrophil alkaline phosphatase and affects the NAP score and whether those two tests are dependable on eachother or it was just a coincidence that both increase in level with liver cirrhosis but they are independent.

Also results showed that phagocytic index is not affected by the progress of the disease, and there was no positive correlation between ammonia level and phagocytic index, and these two results are still debatable as many studies stated the opposite that phagocytic index is affected by liver cirrhosis progress leading to hepatic patients’ immunosuppression (as one of the causes of neutrophil dysfunction), and also other studies proved the opposite, whether the case was the technique of phagocytic index assay starting from sample withdrawal area, method, analysis and type of test.

This study is considered as a step in many steps required tocomplete the started researches about this area concerning the effect of liver cirrhosis and it’s progression on patients’ immune system either directly or by inability to detoxify produced toxins during body metabolism that the diseased liver cannot handle anymore.