Risk factors of unfavorable prognosis of chronic hepatitis C.

AIM: To investigate risk factors of unfavorable prognosis in patients with chronic hepatitis C (CHC), including liver cirrhosis (LC), decompensated cirrhosis, hepatocellular carcinoma (HCC), cryoglobulinemic vasculitis (CryoVas) and B-cell non-Hodgkin's lymphoma. MATERIALS AND METHODS: This was a retrospective study using data of 824 patients with CHC hospitalized between 2010 and 2016 in clinic named after E.M. Tareev. We used multivariate analysis including logistic regression to calculate odds ratios (ORs) for potential risk factors/predictors associated with unfavorable outcomes in patients with CHC. RESULTS: The rate of LC, decompensated LC, HCC, serious CryoVas and B-cell lymphoma in patients with CHC was 39.1% (322/824), 14.0% (115/824), 2.8% (23/824), 5.2% (43/824) and 1.2% (10/824), respectively. After adjustment for sex and age the rate of LC, decompensated LC, HCC was 22.8, 8.0 and 1.5%, respectively. Annual rate of LC in patients with CHC was 1.5%; in cirrhotic patients annual rate of decompensated LC and HCC was 2.9 and 1%, respectively. Risk factors independently associated with development of LC were elevated body mass index (OR 1.43), immunosuppressive therapy (OR 1.67), diabetes type 2 (OR 2.03), absence of antiviral therapy (OR 2.15), alcohol abuse (OR 2.34), duration of infection ≥20 years (ОR 2.74) and an absence of sustained virological responce (SVR) (OR 2.98). Independent risk factors for decompensation in cirrhotic patients included diabetes type 2 (OR 1.47), alcohol abuse (OR 1.53), an absence of antiviral therapy (OR 2.36) and an absence of SVR (OR 1.94). An episode of decompensation was the independent predictor of HCC in cirrhotic patients (OR 3.99). Genotype 1b (OR 1.66) and an absence of antiviral therapy (OR 3.31) were independently associated with serious CryoVas. Two prognostic scales were offered for risk evaluation of LC and its complications. CONCLUSION: Multivariate analysis showed several factors independently associated with higher risk for LC, decompensation of LC, HCC, serious CryoVas in patients with CHC. The rate of unfavorable outcomes of CHC is found, including rare extrahepatic manifestations.

[Systemic manifestations of primary sclerosing cholangitis].

Primary sclerosing cholangitis (PSC) is a chronic slowly developing cholestatic diseases of liver characterized by non-purulent destructive inflammation and fibrosis of bile ducts leading to secondary biliary cirrhosis. PSC etiology remains unknown and the disease is regarded as an autoimmune pathology. In 60-80% of the patients PSC combines with other autoimmune diseases (over 40 nosological forms). This paper deals with the diversity and prevalence of systemic manifestations of PSC in a group of 93 patients admitted to Tareev Nephrology Clinic. Autoimmune diseases were diagnosed in 79.6% of the patients. PSC was most frequently associated with ulcerative colitis (49.5%), Crohn's disease (17.2%), hemorrhagic vasculitis (8.6%) and autoimmune thyroiditis (7.59%). Nervous system, kidneys, lungs and eyes were affected less frequently. 20.3% of the patients had more than one (2-5) manifestations of PSC in different combinations. It is concluded that the knowledge of extrahepatic PSC symptoms will promote its early diagnosis in patients with cholestasis of uncertain origin.

[Congenital bile duct hypoplasia (Alagille-Watson syndrome)--a rare cause of biliary cirrhosis in adults].

A case of a rare hereditary disease, Alagille-Watson syndrome, is reported. It most frequently affects liver and cardiovascular system which leads to biliary cirrhosis and cardiovascular catastrophe in young patients. Pathogenesis and clinical variants of the disease are described.

[Possibilities provided by personalized therapy of chronic hepatitis C (case conference at E.M.Tareev Clinic of Nephrology, Internal and Occupational Diseases)].

The presented clinical case gave rise to discussion of the main mechanisms and factors behind the progress of chronic hepatitis C. Special emphasis is laid on the currently available possibilities of antiviral therapy and its future prospects. The efficacy of personalized treatment and approaches to its improvement are considered based on the proper preventive measures and correction of factors responsible for poor responsiveness to the treatment, in the first place metabolic disorders (obesity, hepatic steatosis).

[Hippocratic fingers: clinical importance and differential diagnosis].

Changing of the distant finger phalanges into the form of a drumstick or fingernails into the form of a watch-glass (hippocratic fingers--HF) presents a well-known clinical phenomenon that suggests the presence of various diseases, especially those associated with hypoxia, i.e. manifested by respiratory and/or heart failure, as well as malignant tumors and subacute infective endocarditis. At the same time, the fact that this clinical phenomenon can accompany other diseases (Crohn's disease, HIV-infection) should be taken into consideration as well. HF often appear ahead of more specific symptoms. In this connection, correct interpretation of this clinical sign, augmented with laboratory tests, allows for early and valid diagnosis.

[System manifestations of primary biliary cirrhosis].

Primary biliary cirrhosis (PBC) is characterized by high frequency of systemic extrahepatic manifestations (EHM), which often precede the development of full clinical picture of PBC and play the leading part in the clinical course of the disease, sometimes determining its prognosis. The examination of 145 PBC patients (including two men) found a frequency of EHM of 72. 4%. The majority of EHM were caused by delayed-type hypersensitivity reactions, such as Sjogren syndrome, fibrosing alveolitis, autoimmune thyroiditis, tubulointerstitial nephritis, pulmonary granulomatosis/sarcoidosis, systemic scleroderma, rheumatoid arthritis, and ulcerative colitis; immunocomplex pathology including vasculites involving blood vessels of different caliber and localization and polyneuropathy was rarer. In 24.1% of PBC patients, system EHM manifestations were the first clinical signs of the disease. In 62.8% of patients with EHM their different combinations were registered. The most frequent one was a combination of Sjogren syndrome, fibrosing alveolitis, and tubulointerstitial nephritis, which was found in 16.2% of the patients. 6 7% of the patients had a combination of four EHM - Sjogren syndrome, fibrosing alveolitis, tubulointerstitial nephritis, and autoimmune thyroiditis. A long duration of PBC (more than five years from the debut), stage IV of the disease, and the presence of the rheumatoid factor in blood serum, were risk factors of the development of system PBC manifestations. In 20% of EHM patients their symptoms prevailed in the clinical picture, thus determining the severity of the condition. Three patients died of system EHM of PBC (systemic scleroderma, pulmonary granulomatosis). Thus, PBC diagnostics must be performed with taking into account system EHM found in this category of patients.