Todorovska, Beti
Preferred name
Todorovska, Beti
Official Name
Todorovska, Beti
Alternative Name
Beti Todorovska
B. Todorovska
Todorovska B.
Бети Тодоровска
Тодоровска Бети
Б. Тодоровска
Тодоровска Б.
Main Affiliation
Email
beti.todorovska@medf.ukim.edu.mk
todorovskabeti@gmail.com
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Item type:Publication, Diagnostic Potential of Calprotectin for Spontaneous Bacterial Peritonitis in Patients Withliver Cirrhosis and Ascites(Walter de Gruyter GmbH / Macedonian Academy of Sciences and Arts, 2021-12-30); ; ; ; The development of spontaneous bacterial peritonitis (SBP) is a serious and life-threatening condition in patients with cirrhosis and ascites. The aim of this study was to determine the diagnostic potential of calprotectin in ascites, for SBP in patients with liver cirrhosis and ascites before and after antibiotic treatment and to compare the mean values of calprotectin in ascites in patients with and without SBP. This prospective-observational study was comprised of 70 patients with cirrhosis and ascites, divided into two groups, the SBP and the non-SBP group. Quantitative measurements of calprotectin in ascites was completed with the Quantum Blue Calprotectin Ascites test (LF-ASC25), using the Quantum Blue Reader. The average value of calprotectin in the SBP group was 1.5 ± 0.40 μg / mL, and in the non-SBP group it was lower (0.4 ± 0.30). The difference between the mean values was statistically significant with p <0.05. The mean value of calprotectin in ascites before therapy among the SBP group was 1.5 ± 0.4, and after antibiotic therapy, the value decreased significantly to 1.0 ± 0.6; the difference between the mean values was statistically significant with p <0.05. ROC analysis indicated that calprotectin contributed to the diagnosis of SBP with a 94.3% sensitivity rating (to correctly identify positives), and the specificity was 62.5%, which corresponded to the value of 0.275. Our research confirmed that ascitic calprotectin was a good predictor, and is significantly associated with the occurrence of SBP in patients with liver cirrhosis. By monitoring the value of calprotectin in ascites on the 7th day of antibiotic treatment, the effectiveness of antibiotic treatment in patients with SBP can be determined. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Unrecognized Wernicke's encephalopathy during pregnancy induced by hyperemesis gravidarum(Termedia Publishing House Ltd., 2025); ; ; Hyperemesis gravidarum (HG) is the most common indication for hospitalization in the first half of pregnancy. Although 70—90% of pregnant women experience nausea and vomiting, few develop HG. Maternal complications include malnutrition and vitamin deficiencies, peripheral neuropathy, and serious neurological complications, including central pontine myelinolysis and Wernicke’s encephalopathy (WE). - Some of the metrics are blocked by yourconsent settings
Item type:Publication, PREDICTIVE POTENTIAL OF BLOOD AND ASCITIC FLUID LABORATORY PARAMETERS FOR SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH CIRRHOSIS(Georgian Association of Business Press, 2021-12); ; ; ; Patients with spontaneous bacterial peritonitis (SBP) usually have serious complications associated with deteriorating synthetic and excretory function of the liver cells, and require hospitalization and regular monitoring of biochemical parameters in blood and ascites.Aims - to determine the average values of laboratory parameters in blood and ascites in patients with SBP, to determine whether there is a difference in the average values between patients with SBP and non-SBP as well as their predictive power for the diagnosis of SBP.The study was designed as a prospective-analytical-observational and was conducted at the University Clinic for Gastroenterohepatology in Skopje for a period of one year. The study population included hospitalized patients with established liver cirrhosis, regardless of etiology; 70 patients, divided into two groups, 35 patients with SBP and 35 non-SBP. The selection of patients who were included in the study was conducted according to pre-determined inclusion and exclusion criteria. All diagnostic test specimens were immediately referred to the Central Clinical Laboratory. Five ml of a total of 10 ml of ascites were used for automatic counting of PMNC, and 5 ml for biochemical analysis of ascites (total sweat-WP). At the same time, for the needs of biochemical blood tests, a venipuncture of 10 ml of blood was performed.The univariate analysis showed that INR, albumin/s, creatinine/s, TP/ascites (p=0.039, p=0.035, p=0.013, p=0.000, p=0.030) were independent risk factors for the development of SBP. INR>1.2 significantly increased the chance of SBP by three times (Exp (B) = 3.222 (CI (1.063-9.768)). Serum albumin<35 g/L significantly increased the chance of SBP by five and a half times (Exp (B) = 5.712 (CI (1.135-28.748). Creatinine/s>115 µmol/L significantly increased the chance of SBP by four times (Exp (B) = 4.070 (CI (1.352-12.255)).TP in ascites ≤10 significantly increased the chance of SBP by five times (Exp (B) = 5.337 (CI (6.243-416.469). The multivariate logistic analysis confirmed that INR>1.2 and creatinine>115 µmol/L were statistical risk factors (predictors) that increased the chance of SBP.Low serum albumin values are independent risk factors for predicting SBP and significantly increase the risk of developing SBP by five and a half times. Patients with SBP have lower mean TP values in ascites than non-SBP. Low TP values in ascites<11g/L are independent risk factors for the development of SBP and significantly increase the risk of SBP by five times. Of course, additional and larger studies are necessary in order to confirm our conclusion in the future. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Polymorphism IL 28B and response to therapy in chronic hepatitis C(2016); ; ; ; INTRODUCTION: Chronic hepatitis C is still a majgor cause for developing cirrhosis and hepatocellular carcinoma which often results in liver failure and thus in liver transplantation. According to the World Health Organisation 180 million people are infected worldwide and 3-4 million new infections per year were estimated (1). The current standard of care (SOC) for chronic HCV infection is a combination of pegylated interferon (PegINF -2a or PegINF -2b) plus body-weighted ribavirin (RBV) for the duration of 24 weeks or 48 weeks depending on the HCV viral genotypes (2). The primary goal of the treatment is HCV eradication, which is actally sustained viral response (SVR). The SVR is defined as undetectable HCV RNA in serum, 24 weeks after the completion of the antiviral treatment (3). However, only about 40-50% genotype 1 or 4 patients treated and 80% genotype 2 or 3 patients treated could respond completely and achive sustained virological response (4,5). Moreover, side effects from the therapy such as influenza-like symptoms, psychiatric symptoms and hematological abnormalities, could result in the dose reduction or even the premature discontinuation of the treatment (6). To avoid these potential adverse events in patients who do not benefit from the treatment and to reduce the cost of therapy, it is necessary to predict an individual’s response before at the early stage of the treatment. Virus-specific characteristic (viral load, genotype, viral variants as mutations of interferon sensitivity determining region- ISDR) may be responsible for virologic response but also clinical parametars (age, gender, BMI, fibrosis stage, liver enzymes) (7,8). Investigations on genetic determinants of chronic hepatis C established that a single nucleotide polymorphism (SNP) in the interleukin (IL)-28B gene promoter region affected the spontaneous and induced clearance of hepatitis C virus (9). Among 500 000 genetic variants which were analyzed genome-wide, a few associated with virologic response were identified, and showed variable frequency and importance across human ethnic groups (10). The mechanism by which SNPs influence the outcome of HCV infection and its treatment is not clear. It is suggested that regulation of the promoter region of IL28B in antiviral activity may also affect two other genes belonging to interferon (INF)- family encoded in this region (10, 11). INF- possess antiviral activities agains hepatitis C virus (12). The genome-wide associated studies (GWAS) showed that SNPs near IL28B gene (CC for rs12979860, TT for rs8099917 and AA for rs12980275) were associated significantly with treatment outcome in patient with chronic hepatitis C. However, about 50% of patients with a sustained virological response do not carry favorable IL28B alleles (13). The factors which increase the chance of a therapeutic response in these patient are not yet known. A detailed analysis if the course of therapy of chronic hepatitis C with pegylated INF and ribavirin in the presence of a hazardous IL28B allele might better delineate the clinical characteristics of the difficult-to-treat group of patients. The aim of the study was to evaluate the effects of IL28B polymorphism on response to treatment with peginterferon and ribavirin in patients with chronic hepatitis C. MATERIAL AND METHODS: Twenty-five adult Caucasians previous assessed with chronic hepatitis C due to HCV genotupe 1 and 3 were included in the study. The study protocol was approved by the institutional ethics committee and written informed consent was obtained from each study participant. Patients were treated with standard antiviral therapy with pegylated INF alfa and ribavirin. Pegylated interferon alfa 2a 180 μg was administered subcutaneously once a week. Body-weighted ribavirin was administered daily. The treatment duration was 48 weeks for patients with HCV genotype 1 and 24 weeks for patients infected with HCV genotype 3. SVR was used for the assessment of the antiviral treatment effectiveness. SVR is defined by undetectable viral RNA 24 weeks after the end of treatment. Finaly eighteen patients were analysed, because two premature discontinuated the treatment and for five there are no available data for SVR. Sample od peripheral blood were collected from each patient enrolled in the study for HCV quatntification and IL28B polymorphism genotyping. Reverse transcriptase-polymerase chain reaction assay for HCV quantification was done with One-tube real time PCR HCV amplification with lower detection limit 70 IU/ml. Polymorphisms rs12979860 (C>T) and rs8099917 (T>G) in gene IL28B were genotyed by PCR. Each polymorphism assay contained one pair of primers and one pair of probes, and each allele of the polymorphisms was labeled. For statistical analysis mean and standard deviation were used for parametric variables. Considering the small sample difference test (percentage of structure) was used to determinate the genetic predictors of the SVR. A p<0.05 was consideded statistically significant. RESULTS: The study population included 9 genotype 1 and 9 genotype 3 HCV infected patients. Their median age was 31.4±4.4 years and 88.88% were males. SVR were achived in 83.3% patients. The distribution of the frequencies od rs12979860 genotypes in the analyzed sample was: 10 (55.55%) patients with CC genotype and 8 (44.44%) patients with CT genotype. The distribution of the frequencies od rs8099917 genotypes was: 15 (83.33%) patients with TT genotype and 3 (16.66%) patients with TG genotype. The difference test showed that difference in persentage which is registered between SVR in CC and CT is not statistically significant (p=0,6714). There is no association in achievement SVR in CC and non-CC genotypes of rs12979860. There also no significance in achieving SVR in patients with TT genotype of rs8099917 and in patients with TG genotypes (p=0.3961). Futhermore there was no association with the achivment od SVR as compared with genotype (p=0.0579). DISCUSION: In this study, no significant difference was found in the response to treatment and allele proportions of SNPs rs12979860 and rs8099917 possibly due to the small size of the sample. The study of Silva Conde et al. confirmed similar effect of IL28B polymorphism on SVR in infected HCV patients (14). In another study from Norway and Denmark involving genotype 3 HCV-infected patients, RVR was achived by a significantly greater number of patients who had CC and TT genotypes at rs 12979860 and rs8099917, respectively, but these genotypes showed no association with SVR (15). Consistent to our findings were results of the study of Sarrazin et al.which present no significant association of SNPa rs8099917 with virologic treatment response (16). Investigation of a comparable number of genotype 2/3 infected patients in study by Rauch et al. also showed no correlation between the rs8099917 genotype and virologic response to pegylated interferon/ribavirin combination therapy (17). In contrast, the GWAS identified that homozygosis for C allele of rs12979860 and homozygosis for the T allele of rs8099917 were favorable genotypes of the IL28B gene polymorphisms which predicted the SVR in patients with chronic hepatitis C treated with peginterferon and ribavirin (18,19). The distribution of frequencies of rs12979860 genotypes in our study group was : CC 55.55% and CT in 44.44% . The distribution of frequencies of rs8099917 genotypes in our study sample was TT 83.33% and TG 16.66%. Sticchi et al. reported distribution of rs8099917 genotypes TT in 55%, TG in 40% and GG in 5% of the study participants (20). Results of other studies reported bigger percentage of CT than CC for distribution of the frequencies of rs12979860 (21.22). However, about 50% of patients with a sustained virological response do not carry favorable IL28B alleles (13). The factors which increase the chance of a therapeutic response in these patient are not yet known. Other factors, such as HCV genotype, viral-load, ethnicity should be used together with IL28B genotype as predictors of response on antiviral therapy. CONCLUSION: We did not find a significant association of SNPs rs12979860 and rs8099917 with SVR thus disagreeing with studies that found an association between genotype CC (rs12979860) and SVR in individuals with genotype 1, 2 and 3 as well as between genotype TT (rs 8099917) and SVR in individuals with genotype 3. Our study is limited by its sample size. And possibly results due to this fact. Nevertheless genotyping of this polymorphism on a large HCV population will aid clinical decision making for both current standard care and potentially for the integration of other agents in future, providing an opportunity for clinicians to individualize treatment regimens for hepatitis C patients. - Some of the metrics are blocked by yourconsent settings
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Item type:Publication, Insulin resistance in patients with chronic hepatitis C(Македонско лекарско друштво = Macedonian Medical Association, 2016); ; ; ; Introduction: Insulin resistance is the most common extrahepatic manifestation associated with hepatitis C virus, which leads to developing more pronounced fibrosis and liver steatosis. The aim of the study was to assess the prevalence of insulin resistance in non-diabetic, treatment naive patients with chronic hepatitis C and to analyze the relation of insulin resistance with genotype, viral load, gender, age, laboratory parameters, inflammatory and fibrotic changes in the liver, body mass index (BMI) and the presence of steatosis. Material and methods: In this cross sectional study, 224 patients with hepatitis C viral infection were included. The patients were divided into two groups. The first group was with no insulin resistance and the second one with present insulin resistance. They were compared in terms of genotype, viral load, gender, age, inflammatory and fibrotic changes in the liver, BMI and liver steatosis. Results: Insulin resistance was present in 45.5% of patients. The following factors were associated with insulin resistance: age (p = 0.0022), inflammatory and fibrotic changes in the liver (p = 0.001, p = 0.006, respectively), steatosis (p = 0.015) and transaminase activities (for AST, p = 0,002, for ALT, p = 0.001). Conclusion: In the Republic of Macedonia, high percentage of 45.5% among non-diabetic and treatment naïve patients with chronic viral hepatitis C, had insulin resistance. Insulin resistance was more prevalent in older patients, in those with more pronounced inflammatory and fibrotic changes in the liver, in patients with steatosis and in those with higher transaminase activity. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The influence of Interferon based antiviral therapy in combination with Atorvastatin 20 mg on sustained virological response and metabolic alterations at patients with chronic hepatitis C(Slovenian Association for Gastroenterology and Hepatology, 2019-10)Introduction: Chronic hepatitis C virus infection represents more frequent cause of liver cirrhosis and hepatocellular carcinoma. The severity of the disease and its progression depends on factors related to the virus and factors associated with the host, among which metabolic abnormalities are listed, such as: changes occurring in the metabolism of fats, sugars, vitamin D, iron, the presence of fatty liver, obesity and others. Statins, inhibit HCV replication in vitro, enhances the antiviral effect of the already known antiviral drugs and reduce their resistance. Objectives of the study: Primary objective: To determine the impact of additional therapy (treatment with Atorvastatin 20 mg) to the standard antiviral therapy (pegylated interferon alpha (peg-IFN α) and ribavirin) on achieving sustained virological response (SVR). Secondary objectives: to determine the presence of metabolic alterations in patients with chronic hepatitis C, their impact on achieving SVR, to determine the impact of antiviral therapy on metabolic abnormalities, to determine the influence of genotype on the incidence of metabolic alterations and achieving SVR and to analyze the connection of metabolic alterations with the level of stetatotic, necro-inflammatory and fibrotic changes in the liver, with the gender, age and viral load, aiming to determine their mutual correlation. Material and Methods: In the study which is comparative, open label, prospective - retrospective, 70 patients diagnosed with chronic hepatitis C virus infection who met criteria for treatment with standard antiviral therapy combined with anti-lipemic therapy (Atorvastatin 20 mg) were included. Patients in the study were divided into two groups: one group of 35 patients receiving combination therapy (Atorvastatin + Pegylated alpha interferon + Ribavirin) and another group of 35 patients received only standard antiviral therapy. For the realization of secondary objectives, the patients were divided in accordance to the achieved virological response to group with SVR and group non virologic response (NVR). Those parameters were followed in all patients: genotyping, quantification of the virus, histological assessment of liver inflammation and fibrosis degree (before starting treatment), the presence of steatosis, laboratory analysis: hematology, liver, lipid and carbohydrate status, HbA1c, insulin blood level (the calculation of HOMA-IR), vitamin D3, serum iron, ferritin and body mass index (BMI) calculation. Overall treatment of the patients depends from the virus genotype, thus, patients with genotype 1 and 4 received 48 weeks standard antiviral therapy, but patients with genotypes 2 and 3 received 24 weeks of antiviral therapy. SVR was considered an undetectable levels of HCV RNA levels 24 weeks after completion of antiviral therapy. The results were statistically analyzed, and all results for p <0.05 were considered statistically significant. Results: Combination therapy leads to a slightly higher percentage of SVR (85.71%) in patients with chronic hepatitis C versus standard therapy (74.29%) and in patients with genotype 3 this rate of SVR amounting to 95.83%. Combination therapy leads to significant improvement of lipid and glucose status after treatment, and in terms of side effects, there was no appearance of serious adverse events that would be a reason for discontinuation. Presence of insulin resistance (IR> 2) in 48.6% of patients, low (insufficient) levels of vitamin D of 26.94 ± 14.7, which has not affected significantly the achieved virological response, a high percentage of steatosis (total 54.3% of which 48.6% have mild degree of steatosis and 5.7 have severe steatosis) and increased body mass (55.7% total), of which 40% were overweight and 15.7% obese, were detected in all tested group. Patients who achieved SVR had a slightly higher baseline values of TG, total cholesterol and LDL, as well as slightly lower values for HDL, and significantly lower HOMA IR at the beginning of the treatment apart from the group who did not achieve SVR (p = 0.028). Patients without virological response had significantly higher BMI than those with SVR, p = 0.014. Univariable Logistic Regression Analysis as factors that are significantly associated with achieving SVR has confirmed the following parameters: the age of patients, HCV genotype 3, BMI and HOMA-IR prior to therapy. Multivariable Logistic Regression analysis, as independent significant predictors of achieving SVR pointed only the age, HCV genotype and HOMA-IR. Antiviral therapy that led to achieved SVR, significantly affected the increasing of TG serum levels, total cholesterol and LDL 24 weeks after completion of the treatment compared from their basic level, as well as significant reduction of ferritin 24 weeks after completed treatment, compared to those who did not achieve SVR (Z = 2.06 p = 0.039). Although, the antiviral therapy slightly improved steatosis among patients who achieved SVR (p = 0.06). Early virological response, response at the end of treatment and SVR, significantly more frequently encountered in patients with genotype 3. Genotype 1 patients had significantly higher BMI, higher glucose and insignificantly higher HOMA-IR, compared to patients with genotype 3. Values of cholesterol and its fractions, LDL and HDL were lower in the group with genotype 3, with significant difference for HDL. The presence of steatosis was associated with BMI, with insulin blood level and HOMA-IR. There was a negative correlation between inflammatory changes in the liver and HDL, while Knodell score positively correlated with glucose, insulin blood level, HOMA-IR index, ferritin and serum iron. The presence of fibrotic changes and cirrhosis of the liver were correlated with higher values of LDL, glucose and ferritin. From the metabolic parameters only glucose, serum iron and ferritin values prior treatment were significantly dependent on the gender of the subjects, with significantly higher values in male patients. Positive correlations was detected between the age of the patients and the BMI, serum ferritin and iron. The level of viremia is positively correlated with the degree of steatosis and serum iron levels before the treatment. Conclusion: Combination therapy Atorvastatin + pegylated interferon alpha + Ribavirin leads to high rate of SVR of 95.83% in patients with chronic hepatitis C, genotype 3. Statins can be used safely in patients with chronic hepatitis C. Determined independent significant predictors for achieving SVR were: age (by increasing the age for 1 year, the chance of achieving SVR is reduced by 10.2%), HCV genotype (patients with HCV genotype 3 have about 8,112 times higher chance to achieve SVR, compared with patients with genotype 1) and HOMA-IR (increased HOMA-IR value for one unit before starting the therapy, reduces the chance of achieving SVR for 18.5%), confirmed by Multivariable Logistic Regression Analysis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, PREDICTIVE POTENTIAL OF THE MELD AND CHILD-TURCOTTE-PUGH II SCORES FOR SBP IN PATIENTS WITH CIRRHOSIS AND ASCITES(Institute of Public Health of Republic of North Macedonia = Институт за јавно здравје на Република Северна Македонија, 2021); ; ; ; It is very important for patients with spontaneous bacterial peritonitis (SBP) to assess the length of survival and the risk of death, primarily because of the wide range of potential complications that can lead to multisystem organ failure and fatal outcome. The aim of this study was to determine the predictive potential of MELD and Child-Turcotte-Pugh II score for SBP in patients with cirrhosis and ascites. Material and methods: The study was designed as a prospectiveanalytical-observational and was conducted at the University Clinic for Gastroenterohepatology in Skopje for a period of one year. The study population included 70 hospitalized patients with established liver cirrhosis, regardless of etiology, divided into two groups, 35 patients with SBP and 35 non-SBP. Prognostic scores in patients with liver cirrhosis and ascites: MELD score, according to the formula: MELD = [(0.957 x Ln Creatinin) + (0.378 x Ln Bilirubin) + (1.12 x Ln INR) + (0.643) x 10]. The Child-Turcotte-Pugh II score includes 6 parameters: serum albumin and bilirubin, amount of ascites, degree of encephalopathy ( HE), prothrombin time (PT) and serum creatinine, and assessment of the degree of hepatic encephalopathy according to the West Haven criteria. Results: The average value of the MELD score in patients with SBP was 22.6 ± 8.27 and in non-SBP the average value was lower - 17.83±5.87. According to the Mann-Whitney U test, the difference between the mean values was statistically significant for p <0.05 (z = 2.41; p = 0.015). A score of 30 to 39 was registered in 25.7% of patients with SBP, and only in 2.9% in non-SBP; the percentage difference was statistically significant for p <0.05 (Difference test, p = 0.0064 ). Patients with SBP had an average ChildPugh score of 13.09 ± 2.48 or 100.0% C-class points. In patients with non-SBP, an average child-Pugh score of 9.63 ± 1.62 was recorded, or class B in 65.7% and class C in 34.3%. The percentage difference was statistically significant for p <0.05 (Difference test, p = 0.000000). According to the Mann-Whitney U test, the difference between the mean values was statistically significant for p <0.05 (z = -5.44; p = 0.00001). ROC analysis indicated that the Child-Turcotte-Pugh II score contributed to the diagnosis of SBP - 90.7% (p = 0.000) (excellent predictor), closer to the ideal value of 1.0 and above the worst value of 0.5. ROC analysis indicated that the MELD score did not contribute to the diagnosis of SBP - 66.7% (p = 0.017) (weak predictor), closer to the worst value of 0.5. Conclusion:Our research confirmed that SBP occurs in patients with severe hepatic dysfunction calculated according to the CTP II score and MELD score. Mean value of the MELD score in patients with SBP was higher then in patients with non-SBP. On the other hand all patients with SBP had an average CTP II score, C-class points, while the largest percentage of patients with non-SBP were class B-class points. MELD score is a weak predictor of SBP. The best predictor for predicting SBP is the CTP II score (rank C) - Some of the metrics are blocked by yourconsent settings
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Item type:Publication, MODEL FOR END-STAGE LIVER DISEASE (MELD) IN STRATIFIACATION OF IN HOSPITAL PATIENTS WITH TERMINAL LIVER DISEASE(2012); ; ; Syardelova KINTRODUCTION: Liver cirrhosis is end stage of liver disease where liver transplantation is the only curative treatment. MELD score system is relatively newer system (the last ten years) used as assesment tool for liver disease severity as well as for creating of liver transplantation priority lists. In the contrary of already used system - Child-Turcotte-Pugh, where posibility for subjective assesment of variables as ascites and encephalopathy is existing, this system avoids such posibility. MELD includes another very important variable – renal function assesment as serious prognostic factor. Well-defined formula calculating natural logarithms of bilrubin, creatinin and international normalized ratio (INR) of prothrombin time determined MELD-'s set of points. The aim of this study is to stratify in hospital patients in Clinic of Gastroenterohepatology, Skopje with terminal liver disease using MELD scoring system and easy recognize the real need for transplantation in these patients. MATERIAL AND METHODS: This retrospective study is analyzing medical discharge summary among 192 patients hospitalized at our clinic in the period from 01.01.2011 to 31.12.2011 with diagnosis of liver cirrhosis, who have all the necessary parameters available to calculate the MELD score (patients with the same diagnosis without the necessary parameters were excluded from the study). Patients were aged between 20 and 90 years (average age 55.7 years) with predominance of males (147 males and 45 females). They were analyzed in accordance to cirrhosis etiology, indication for hospitalization, MELD score and the risk of lethal outcome. Descriptive statistics to analyze data was used. RESULTS: Total of 192 patients are analyzed, 76.6% are male, while 23.4% are women. From the etiological point of view the alcohol as cause of cirrhosis dominates in 73 patients (38%), followed by HBV infection in 49 patients (25.5%), undefined etiology has in 24 patients (12.5%), mixed etiology of ethyl and viral origin of hepatitis B in 11 patients (6%), HCV infection in 9 patients (4.7%), immunogenic etiology in 8 patients (4.1%), portal vein thrombosis in 4 patients (2.1%), secondary biliary cirrhosis in 4 patients (2.1%), alcohol and HCV infection in 3 patients (1.5%), mixed HBV and HCV infection in 2 patients (1%), primary biliary cirrhosis in 2 patients (1%), Wilson disease in 2 patients (1%) and nonalcoholic steatohepatitis as a cause of cirrhosis in 1 patient (0.5%). The most common reason for hospitalization is variceal bleeding in 51 patients (26.6%), followed by refractory ascites in 35 patients (18.2%), jaundice in 31 patients (16.1%), portal encephalopathy in 29 patients (15.1%), diagnostic differentiation (liver biopsy) in 28 patients (14.6%), and hepato-renal syndrome in 14 patients (7.3%). In accordance to the MELD score, patients are divided into 5 groups regarding to calculated percentage of three month mortality. Average MELD score for all 192 patients is 15. Under this scoring system 4 patients (2.1%) belong to the group with highest risk (71.3% is the rate of mortality within three months), 14 patients (7.3%) in group having 52.6% mortality rate within three months, 31 patients (16%) belong to a group with 19.6% mortality rate, and the remaining patients in the group with 6% mortality rate (69 patients - 36%) and the group with the lowest mortality of 1.9% (74 patients - 39.5%). The outcome of 20 from 192 patients analyzed was lethal. The reason for this outcome was hepato-renal syndrome in 11 patients (55%), variceal bleeding in 7 patients (35%) and in 2 patients (10%) hepatic coma. DISCUSSION: Liver cirrhosis as an indication for hospitalization is often seen in our daily practice. Especially common reason for hospitalization is the occurrence of complications of cirrhosis (variceal bleeding, refractory ascites, jaundice, portal encephalopathy or hepato-renal syndrome), which caused lethal outcome in some patients. According to our analysis, a significant percentage of patients (39/192 or 25.4%) with MELD score> 20, belong to the group with high short-term risk of lethal outcome (3 months mortality rate). Those patients in developed countries would find themselves on a priority list for liver transplantation. Our commitment (such as internal disease specialists and surgeons) should be to enable these patients equal access to treatment as in those patients with terminal liver failure in developed countries.