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Background: Cirrhosis is the irreversible fibrosis of liver, it continues to be a common cause of morbidity and mortality. It is accompanied by inflammation and malnutrition and thus can have a negative effects on bone metabolism and promote fractures accordingly. Aim of the study: to evaluate the risk of fractures among patients with cirrhosis. Methods: A systematic review of the scientific literature following PRISMA/STROBE guidelines, Medline Cochrane Library and Embase abstracts were retrieved using an algorithm comprising relevant MeSH terms from 1980 to 2017. Publications on the association of cirrhosis/bone fracture were abstracted independently by the authors and included in both gender and gender-specific meta-analyses, following recalculations of published data as appropriate. The Newcastle-Ottawa scale was used to evaluate the quality of included studies. Results: 8 studies met the inclusion criteria enrolling 988 patients (286 of which are diagnosed with alcoholic liver disease (ALD). Overall, ALD demonstrated a relative risk (RR) of 1.825, 95%CI: 1.370-2.28, P < 0.001 for the development of bone fractures. Bone mineral density (BMD) was not significantly different between the ALD and control groups, although there was a trend toward lower BMD in patients with ALD. Sensitivity analyses showed consistent results. Conclusion: in accordance to the present meta-analysis, there is a significant correlation between bone fractures and ALD independent of BMD.

Evaluation of level of consciousness has become essential for anticipation of sepsis and septic shock. Both the Sequential Organ Failure Assessment (SOFA) score and the quick SOFA score utilize the Glasgow Coma Score (GCS) for screening of sepsis. Objectives: the aim of this review is to determine and study the role of Glasgow coma score in anticipation of sepsis and septic shock. Methods: To achieve this aim, we have searched online database, namely PubMed and Cochrane Library for studies and review articles assessing the significance of assessment of Glasgow Coma Scale (GCS) for anticipating sepsis or septic shock. Thirteen appropriately-related studies were selected for review. Results: Disturbed sensorium was found to be a sensitive early indicator for sepsis, thus GCS is used for assessment of both the Sequential Organ Failure Assessment (SOFA) and quick SOFA scores qSOFA scores. Lower GCS scores were associated with high mortality rates. Discussion: Encephalopathy is an early sign of sepsis and septic shock. Glasgow Coma score (GCS) was a good indicator of neurological dysfunction evaluated by the SOFA and qSOFA scores. The use of GCS was also a predictor of mortality in patients with sepsis. Some researchers, however, reported that GCS was not the best tool for measuring brain dysfunction in sepsis. Conclusions: Glasgow coma score can anticipate sepsis and septic shock, and predict the outcome of sepsis.