Risk assessment of gallstone among indoor patients of chronic liver diseases secondary to Hepatitis C.

Abstract

Introduction: Gallstones (GS) are widely reported as the major cause of mortality and morbidity globally.1 The frequency of GS in patients with chronic liver disease (CLD) is considerably higher than in the general population.1-7 Moreover, prevailing risk of gallstone is associated with disease frequency and severity in advance stages of CLD.1,3 The predictable local incidence of gallstones in CLD patients is approximately 24-31%.6-7 HCV is presumed to be the major cause of CLD in the local settings6-7. Despite high prevalence of GS and HCV CLD in our population, the occurrence of GS in HCV CLD cases has not been assessed so far. Objective: To assess gallstone disease in indoor patients of chronic liver diseases secondary to Hepatitis-C.Methodology: This cross-sectional study was carried out at Department of Gastroenterology, Liaquat National Hospital (LNH), Institute for postgraduate medical studies and health sciences, Karachi from January 2013 to July 2013. Totalof145 patients of chronic liver disease (CLD) secondary to Hepatitis C Virus (HCV) of either gender, regardless of duration of disease, having age more than 30 years were selected purposively. Structured questionnaire used for data collection. Ultrasonography was done to diagnose gallstones. The routine investigations such as platelet count, anti HCV antibodies, and prothrombin time (PT) were performed. SPSS version 20 was used to analyze data. Variables like gallstone was presented through percentages and frequencies, age as mean and SD. After stratification of age, gender and severity of liver disease, chi-square test was applied and p-value less than 0.05 was considered statistically significant.Results: The mean age of patients (n=145) was 54.8±9.4 years, whereas mean of males was 53.9±9.3 years and females were 56.2±9.5years. Among total cases86(59.3%) were males and59(40.7%) were females. The gallstones in male patients (n= 30, 58.8%) was higher than female patients (n=21, 41.2%). However, this difference with regards to gender, was not statistically significant (p-value=0.9). The Child-Pugh score with gallstones patients was (10.0±2.1) slightly higher than patients without gallstone (10.7±2.1). In patients with gallstone, Child’sPughclass-Cwasfoundin51(54.3%) patients, class-Bin37(39.4, %) and class-A in 6 (6.3%) patients.
 Conclusion: HCV infection is independent risk factor for gallstones in cirrhotic patients. Laparoscopic cholecystectomy in Child-Pugh A and B patients with symptomatic gallstone disease is a safe procedure.
 Keywords: Gallstones, HCVCLD, Child-Turcotte-Pugh, Cholecystectomy