CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 AFRICA 177 On the free wall side of the RV pulmonary annulus, a sample volume with a fixed length of 5.0 mm was established.23 If the RVOT long-axis view was insufficient, PAMVUT was performed using a modified parasternal long-axis view. We then added PAMVUT values to St values for obtaining CSV. A sample of the measurements of PAMVUT and St velocities is shown in Fig. 1. Statistical analysis Data were collected, tabulated and statistically analysed. Before statistical analysis, the distributional properties of the data were evaluated using the Shapiro–Wilk test. For normally distributed data, continuous variables are expressed as mean ± standard deviation. Group comparison was performed using the one-way ANOVA, and the Tukey test was employed as a post hoc test. Non-normally distributed data are expressed as median (min–max), and group comparison was performed using the Kruskall–Wallis and Dunn’s tests used as post hoc tests. Categorical variables are presented as frequency and percentage, and the χ2 test was used for bivariate comparison. The outcome was considered significant when the p-value was less than 0.05. The statistical software package GraphPad Prism 9 was used. Results The study comprised 74 patients with cirrhosis. Table 1 shows the clinical characteristics of all patients. Seven patients had an increased alveolar–arterial oxygen gradient and were therefore diagnosed with hepatopulmonary syndrome (HPS). Six of these patients had mild (pO2 ≥ 80 mmHg) and one had moderate HPS (pO2 = 60–79 mmHg). There were no severe or very severe HPS patients in our study. When the patients were examined based on their Child–Pugh scores, 49 patients were classified as Child– Pugh class A (66.2%), 21 as Child–Pugh class B (28.3%) and four patients as Child–Pugh class C (5.4%). Table 2 shows the demographic and laboratory data for the patients depending on their Child–Pugh classes. There was no significant difference between the two groups regarding clinical characteristics. Prothrombin time, platelet cell counts, and albumin, sodium and potassium levels were typically distributed. ANOVA results showed statistical significance for prothrombin time, and albumin, sodium and potassium levels. Tukey’s post hoc test showed that class A was significantly lower than class B and C for prothrombin time; class A was significantly higher than class B and C for albumin level; class A was significantly higher than class B for sodium level; and class C was significantly lower than class A and B for potassium level. Bilirubin, ALT, AST, alkaline phosphatase (ALP), gammaglutamyl transferase (GGT), alpha-foetoprotein (AFP), blood urea nitrogen and creatinine showed non-normal distribution, and the Kruskal–Wallis results showed statistical significance for bilirubin, AST and ALP. Dunn’s post hoc test showed that class A was significantly lower than class B and C for bilirubin; class A was significantly lower than class B for AST; and class A was significantly lower than class C for ALP. The other laboratory results for each group were comparable. Table 1. Clinical characteristics of all patients with cirrhosis (n = 74) Characteristics Number (%) Cause of liver cirrhosis Hepatitis B 28 (37.8) Hepatitis C 16 (21.6) Alchol 5 (6.7) Wilson’s 4 (5.4) Autoimmune liver disease 2 (2.7) Primary biliary cirrhosis 3 (4.1) Cryptogenic 7 (9.4) Hepatic steatosis 2 (2.7) Haemochromatosis 2 (2.7) Budd Chiari syndrome 1 (1.3) Portal vein thrombosis 1 (1.3) Other 3 (4.1) Complications of cirrhosis Ascites 28 (37.8) Splenomegaly 56 (75.6) Varices 51 (68.9) Variceal bleeding 17 (22.9) Hepatopulmonary syndrome 7 (9.4) Mild (PaO2 ≥ 80 mmHg) 6 (8.1) Moderate (PaO2 < 80 and ≥ 60 mmHg) 1 (1.3) Severe (PaO2 < 60 and ≥ 50 mmHg) 0 Very severe (PaO2 < 50 mmHg) 0 Liver cancer 4 (5.4) MELD-Na Score 11.18 ± 4.17 Child–Pugh class A 49 (66.2) B 21 (28.3) C 4 (5.4) Table 2. Clinic charcteristics and laboratory findings of patients Child–Pugh class A (n = 49) Child–Pugh class B (n = 21) Child–Pugh class C (n = 4) p-value Maleα, n (%) 29 ( 59.1) 9 (42.8) 2 (50.0) 0.45 Ageβ, years 54.16 ± 14.26 58.47 ± 13.00 45.25 ± 13.67 0.19 Hypertensionα n (%) 12 (24.4) 9 (42.8) 1 (25.0) 0.30 Diabetesα n (%) 19 (38.7) 11 (52.3) 1 (25.0) 0.45 CKDα n (%) 2 (4.1) 2 (9.5) 0 (0) 0.58 Bilirubinγ, mg/dl 0.93 (0.31–2.45)a 1.62 (0.48–17.38 )b 6.05 (3.06–9.31)b 0.001 Prothrombin timeβ, INR 1.24 ± 0.26a 1,50 ± 0.66b 1,64 ± 0.40ab 0.02 Platelet count cellsβ, µl 130.12 ± 79.90 113.25 ± 43.45 119.32 ± 40.34 0.65 Albuminβ, g/l 4.16 ± 0.51a 3.17 ± 0.81b 2.75 ± 0.77b 0.001 ALTγ, U/l 24.5 (6–148) 29.5 (9–71) 33.5 (15–72) 0.25 ASTγ, U/l 27 (12–187)a 46 (17–107)b 84 (23–241)ab 0.002 ALPγ 85 (32–268)a 113 (51–290)ab 154 (109–286)b 0.006 GGTγ 28.5 (9–294) 70 (12–185) 62.5 (57–308) 0.20 AFPγ 2.74 (0.73–134.5) 3.25 (1.27–322) 4.46 (2.35–1534) 0.44 Blood urea nitrogenγ, mg/dl 28 ( 13–92) 39 (16–152) 31 (24–58) 0.07 Creatinineγ, mg/dl 0.78 (0.45–2.63) 0.85 (0.58–1.73) 0.805 0.56–1.02) 0.52 Sodiumβ, mmol/l 138.85 ± 2.87a 136.66 ± 4.54b 138.08 ± 1.82ab 0.03 Potassiumβ, mmol/l 4.29 ± 0.33a 4.43 ± 0.33a 3.85 ± 0.44b 0.008 CKD : chronic kidney disease, INR: international normalised ratio, ALT: alanine aminotransferase, AST: aspartate aminotransferase, ALP: alkaline phosphatase, GGT: gamma-glutamyl transferase, AFP: alpha-foetoprotein. α Catagorical variables; p-values were determined via chi-squared test. β Values are means ± SD; p-values were determined via one-way ANOVA test. Values within each row sharing a common superscript are significantly different (p < 0.05), as determined by Tukey’s test. γ Values are median (min–max); p-values were determined via the Kruskal–Wallis test. Values within each row sharing a common superscript are significantly different (p < 0.05), as determined by Dunn’s test.
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