RESUMO
Virtually unknown to the greater public before November 2022, ChatGPT was made available in open access in Autumn 2022, driving the perspective of artificial intelligence integration to the forefront of daily life. The field of medicine hasn't been left aside, and sparks as much interest as it does questions. Although this tool has considerable potential for use in clinical practice, it, like others, has limitations that need to be clearly understood to avoid misuse. In addition, the legal framework and issues of data confidentiality are currently poorly defined, and clinicians will need to keep a close eye on legislative developments in this area.
Quasiment inconnu avant novembre 2022, la mise à disposition en libre accès de ChatGPT (Chat Generative Pre-trained Transformer) en automne 2022 a permis au grand public d'être exposé pour la première fois à une forme d'intelligence artificielle (IA). La médecine n'a pas échappé à cette révolution technologique qui suscite autant d'intérêt que de questionnements. Bien que doté d'importantes capacités avec de nombreuses perspectives pour une utilisation en pratique clinique, cet outil, comme d'autres, présente des limites qu'il convient de bien comprendre pour éviter un mésusage. Par ailleurs, le cadre légal et les enjeux de confidentialité des données sont pour l'heure mal définis, et le clinicien devra suivre de manière attentive l'évolution de la législation en ce sens.
Assuntos
Inteligência Artificial , Medicina , Humanos , Estações do AnoRESUMO
The advent of direct antiviral agents (DAAs) has radically changed the natural history of hepatitis C virus (HCV) chronic liver disease. Even patients with cirrhosis may display improvements in liver function or features of portal hypertension following viral eradication. The aim of this study was to assess whether a HCV cure would lead to improvements in cirrhotic patients using simple, readily available tools in clinical practice, together with liver stiffness (LS) measurement. This is a retrospective study of cirrhotic patients with cured HCV infection, with or without previous decompensation. Clinical and biochemical parameters as well as LS measurements were collected before antiviral treatment with DAAs and after 6 months following sustained virological response. Hepatic synthesis was assessed by serum albumin levels. Portal hypertension was indirectly assessed by platelet count. Liver function was determined by the CHILD score. A total of 373 cirrhotic patients with successful HCV eradication were retrospectively included. After 6 months of follow-up, a significantly higher proportion of patients showed improved liver function, shifting from the CHILD B/C to CHILD A group, (71.4%, p < 0.001). Similarly, LS improved from a median of 19.3 kPa (14.7−27) at the baseline vs. a median of 11.6 (7.7−16.8 kPa) at follow-up (p < 0.001). The proportion of patients who showed improved hepatic synthesis was 66.0%, which was statistically different when compared to that of patients who had a worsened condition (0.3%) (p < 0.001). Moreover, when classifying the cohort according to the RESIST-HCV score, we found that a significant proportion of patients shifted into the "low risk" group following DAA treatment (52% baseline vs. 45.6% at follow-up, p = 0.004). Even in the decompensated patients, LS improved from 1.6 to 2-fold from the baseline. Antiviral treatment is effective in improving indirect signs of hepatic synthesis and portal hypertension. Similarly, the LS values displayed significant improvements, even in decompensated patients.
RESUMO
Despite the availability of an effective vaccination, chronic hepatitis B virus (HBV) infection is still a major health concern worldwide. Chronic HBV infection can lead to fibrosis accumulation and overtime to cirrhosis, the principal risk factor for liver failure and hepatocellular carcinoma development. Liver biopsy is still considered the gold standard for fibrosis assessment, even though it is invasive and not exempt of complications. Overtime, several non-invasive methods for the detection of liver fibrosis have been developed and gradually introduced into clinical practice. However, their main limitation is the poor performance for the detection of intermediate stages of fibrosis. Finally, novel serological biomarkers, polygenic risk scores and imaging methods have been proposed in last years as novel promising tools to correctly identify the degree of liver fibrosis and to monitor liver disease progression. In this narrative review, we provide an overview on the novel non-invasive approaches for the evaluation of liver fibrosis and risk stratification of patients with chronic hepatitis B.