Asunto(s)
Antivirales/uso terapéutico , Hepatitis C/tratamiento farmacológico , Enfermedad Aguda , Antivirales/administración & dosificación , Antivirales/clasificación , Coinfección , Quimioterapia Combinada , Genotipo , Infecciones por VIH/complicaciones , Hepacivirus/efectos de los fármacos , Hepacivirus/genética , Hepatitis C/complicaciones , Hepatitis C/cirugía , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Cirrosis Hepática/etiología , Fallo Hepático/etiología , Fallo Hepático/prevención & control , Trasplante de Hígado , Recurrencia , Insuficiencia Renal/complicaciones , Terapia Recuperativa , Proteínas no Estructurales Virales/antagonistas & inhibidoresRESUMEN
BACKGROUND: Serum-based scores (SBS) appear to be a high applicability strategy for assessment of liver fibrosis in primary care. Aim of the study was to evaluate their performance to detect ≥F2 in a general population and to design a highly-applicable strategy for screening. METHODS: prospective population-based cohort study in randomly identified subjects, aged 40-70y. Medical history, blood tests and elastography were obtained, ≥F2 was determined by using LSM cutoff ≥9.2/7.8 kPa for M/XL probe and SBS diagnostic accuracies were evaluated. RESULTS: 986 patients were analyzed. LSM prevalence estimate suggestive of ≥F2 was 1.9% and Metabolic Sindrome (MS) (OR 3.4, 1.3-9.0;p = 0.01), was the only factor independently associated with ≥F2, with increasing prevalence according to the number of criteria (0 criterion:0%,1:0.3%,2:2.8%,3:2.4%,4:6.9%,5:14.3%;p<0.001). FLI and NFS were the two best-performing tests in the cross-sectional study, with AUROCs for ≥F2 of 0.89 (95%CI,0.84- 0.95) and 0.82 (95%CI,0.74-0.90), respectively. Predefined cutoff for FLI≥60 (Sn89.5%, Sp72.1%, NPV99.9%) and NFS≥-1.455 (Sn83.3%, Sp68%, NPV99.6%) showed adequate diagnostic accuracy. Based on these findings, a 3- step algorithm strategy to detect liver fibrosis in the community setting is proposed (Sn84.2%, Sp75.2%, NVP99.6%). CONCLUSIONS: A staged risk-stratification model improves the detection of ≥F2 in the community setting, while reducing unnecessary referrals.
Asunto(s)
Diagnóstico por Imagen de Elasticidad , Hepatopatías , Médicos , Adulto , Anciano , Biopsia , Estudios de Cohortes , Estudios Transversales , Amigos , Humanos , Hígado , Cirrosis Hepática , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
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