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1.
Hepatol Int ; 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33534084

RESUMO

BACKGROUND/PURPOSE: The relationship between liver injury and mortality remains unclear in patients with COVID-19. We aimed to evaluate the prognostic value of aminotransferases levels at hospital admission to predict mortality in patients with COVID-19. METHODS AND RESULTS: This prospective study included 406 patients [57% male, aged 56 years] with COVID-19 hospitalized in 26 centers in Brazil. Overall, 36.7% (95% CI 32.1-41.5) presented at admission with severe disease requiring respiratory support. The prevalence of elevated ALT and AST levels at admission [> 2 × ULN] was 14.0% (95% CI 11.0-17.8) and 12.9% (95% CI 10.0-16.6), respectively. Sixty-two patients [15.3% (95% CI 12.1-19.1)] died during hospitalization and the overall mortality rate was 13.4 (10.5-17.2) deaths per 1000 persons-years. The 15-day-overall survival (95% CI) was significantly lower in patients with ALT levels ≥ 2 × ULN compared to those with ALT < 2 × ULN [67.1% (48.4-80.2) vs 83.4% (76.1-88.6), p = 0.001] and in those with AST levels ≥ 2 × ULN compared to those with AST < 2 × ULN [61.5% (44.7-74.6) vs 84.2% (76.5-89.5), p < 0.001]. The presence of elevated aminotransferases levels at hospital admission significantly increased the risk of in-hospital all-cause mortality adjusted for age-and-sex. Those findings were present in the subgroup of critically ill patients already admitted in need of respiratory support (n = 149), but not in patients without that requirement at admission (n = 257). CONCLUSIONS: Elevated aminotransferases at hospital admission predicted in-hospital all-cause mortality in patients with COVID-19, especially in those with severe disease. Measurement of transaminases levels at hospital admission should be integrated to the care of patients with COVID-19 as an auxiliary strategy to identify patients at higher death risk.

2.
Int J Sports Med ; 40(2): 139-146, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30557886

RESUMO

The purpose of this study was to analyze and compare heart rate (HR), heart rate variability (HRV), and blood pressure (BP) responses during and after circuit resistance training with 1 min. (CIR1) vs. 2 min. (CIR2) rest intervals between exercises in liver cirrhosis patients. 10 patients (7 women, 3 men) participated in 2 experimental sessions (CIR1 and CIR2) in random order. Each experimental session consisted of 6 exercises performed for 3 sets of 10 repetitions with 70% of the 10-RM load. The only difference between experimental sessions was taking either 1 min. (CIR1) or 2 min. (CIR2) of rest between exercises. Prior and during each session, BP, HR and HRV (beat-to-beat intervals) were assessed. Training efficiency were significant higher for CIR1 when compared to CIR2, since same total training volume was performed in less time. Both protocols elicited significant changes in HR, SBP, and SampEn. Based on the ∆HR and ∆IRR between protocols, higher cardiovascular stress was observed for CIR1 vs. CIR2. However, the patients presented a similar recovery pattern between experimental sessions, and did not present significant alterations in the HRV at 60 min post-workout. In summary, the fast adjustment of autonomic modulation in HRV and BP suggests that circuit resistance training with 1-min or 2-min rest intervals between exercises elicits typical cardiovascular responses in liver cirrhosis patients.


Assuntos
Pressão Sanguínea , Exercícios em Circuitos , Frequência Cardíaca , Cirrose Hepática/fisiopatologia , Idoso , Sistema Cardiovascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
3.
Clinics (Sao Paulo) ; 72(6): 378-385, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28658438

RESUMO

OBJECTIVE:: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS:: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS:: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%, p<0.001) and a higher incidence of serious adverse events (50.7% vs. 34.8%, p<0.001). Multivariate analysis revealed that sustained viral response was associated with the absence of cirrhosis, viral recurrence after previous treatment, pretreatment platelet count greater than 100,000/mm3, and achievement of a rapid viral response. Female gender, age>65 years, diagnosis of cirrhosis, and abnormal hemoglobin levels/platelet counts prior to treatment were associated with serious adverse events. CONCLUSION:: Although serious adverse events rates were higher in this infected population, sustained viral response rates were similar to those reported for other patient cohorts.


Assuntos
Antivirais/administração & dosagem , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Inibidores de Proteases/administração & dosagem , Idoso , Brasil , Estudos Transversais , Feminino , Genótipo , Hepatite C Crônica/virologia , Humanos , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Masculino , Pessoa de Meia-Idade , Oligopeptídeos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Prolina/administração & dosagem , Prolina/análogos & derivados , RNA Viral/genética , Proteínas Recombinantes/administração & dosagem , Resultado do Tratamento
4.
Clinics ; 72(6): 378-385, June 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-840088

RESUMO

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%, p<0.001) and a higher incidence of serious adverse events (50.7% vs. 34.8%, p<0.001). Multivariate analysis revealed that sustained viral response was associated with the absence of cirrhosis, viral recurrence after previous treatment, pretreatment platelet count greater than 100,000/mm3, and achievement of a rapid viral response. Female gender, age>65 years, diagnosis of cirrhosis, and abnormal hemoglobin levels/platelet counts prior to treatment were associated with serious adverse events. CONCLUSION: Although serious adverse events rates were higher in this infected population, sustained viral response rates were similar to those reported for other patient cohorts.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Antivirais/administração & dosagem , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Inibidores de Proteases/administração & dosagem , Brasil , Estudos Transversais , Genótipo , Hepatite C Crônica/virologia , Interferon-alfa/administração & dosagem , Oligopeptídeos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Prolina/administração & dosagem , Prolina/análogos & derivados , Proteínas Recombinantes/administração & dosagem , RNA Viral/genética , Resultado do Tratamento
5.
World J Hepatol ; 9(6): 310-317, 2017 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-28293380

RESUMO

AIM: To evaluate the performance of FibroMeterVirus3G combined to the first generation tests aspartate aminotransferase-to-platelet ratio index (APRI) or Forns index to assess significant fibrosis in chronic hepatitis C (CHC). METHODS: First generation tests APRI or Forns were initially applied in a derivation population from Rio de Janeiro in Brazil considering cut-offs previously reported in the literature to evaluate significant fibrosis. FibroMeterVirus3G was sequentially applied to unclassified cases from APRI or Forns. Accuracy of non-invasive combination of tests, APRI plus FibroMeterVirus3G and Forns plus FibroMeterVirus3G was evaluated in the Brazilian derivation population. APRI plus FibroMeterVirus3G combination was validated in a population of CHC patients from Angers in France. All patients were submitted to liver biopsy staged according to METAVIR score by experienced hepatopathologists. Significant fibrosis was considered as METAVIR F ≥ 2. The fibrosis stage classification was used as the reference for accuracy evaluation of non-invasive combination of tests. Blood samples for the calculation of serum tests were collected on the same day of biopsy procedure or within a maximum 3 mo interval and stored at -70 °C. RESULTS: Seven hundred and sixty CHC patients were included (222 in the derivation population and 538 in the validation group). In the derivation population, the FibroMeterVirus3G AUROC was similar to APRI AUROC (0.855 vs 0.815, P = 0.06) but higher than Forns AUROC (0.769, P < 0.001). The best FibroMeterVirus3G cut-off to discriminate significant fibrosis was 0.61 (80% diagnostic accuracy; 75% in the validation population, P = 0.134). The sequential combination of APRI or Forns with FibroMeterVirus3G in derivation population presented similar performance compared to FibroMeterVirus3G used alone (79% vs 78% vs 80%, respectively, P = 0.791). Unclassified cases of significant fibrosis after applying APRI and Forns corresponded to 49% and 54%, respectively, of the total sample. However, the combination of APRI or Forns with FibroMeterVirus3G allowed 73% and 77%, respectively, of these unclassified cases to be correctly evaluated. Moreover, this combination resulted in a reduction of FibroMeterVirus3G requirement in approximately 50% of the entire sample. The stepwise combination of APRI and FibroMeterVirus3G applied to the validation population correctly identified 74% of patients with severe fibrosis (F ≥ 3). CONCLUSION: The stepwise combination of APRI or Forns with FibroMeterVirus3G may represent an accurate lower cost alternative when evaluating significant fibrosis, with no need for liver biopsy.

6.
Hepat Med ; 7: 71-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26586969

RESUMO

BACKGROUND: The host immune response is an important indicator of the outcome of hepatitis C virus (HCV) infection and disease progression. The aim of this study was to explore cytokine gene polymorphisms as a candidate for susceptibility to persistent HCV infection or HCV spontaneous clearance in a population from Rio de Janeiro, Brazil. METHODS: Genetic polymorphisms in the cytokines, tumor necrosis factor-alpha (-308), transforming growth factor-beta 1 (codons 10 and 25), interleukin-10 (IL-10; -1082 and -592), IL-6 (-174), and interferon-gamma (+874) were analyzed by polymerase chain reaction sequence-specific primers in 245 patients with chronic hepatitis C (CHC), 41 spontaneous recovery (SR) patients, and 189 healthy volunteers. Further, polymorphisms in IL-28B (rs12979860, rs12980275, and rs8099917) were assessed by real-time polymerase chain reaction in all groups. RESULTS: The IL-28B rs12979860 CC and rs12980275 AA genotypes were significantly associated with SR of HCV infection and response to therapy, whereas the C allele of IL-6 (-174) was associated with protection to CHC. A multivariate analysis showed that the male sex and IL-28B rs12979860 CT and TT and transforming growth factor-beta 1 (codon 10) TC genotypes were factors associated with CHC. Additionally, IL-6 (-174) C allele was increased in SR patients compared with patients with CHC. CONCLUSION: IL-28B polymorphisms are associated with spontaneous clearance of HCV and response to therapy in a Brazilian population. Also, IL-6 (-174) C allele is involved in SR and decreased inflammation scores.

7.
Ann Hepatol ; 14(3): 317-24, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25864211

RESUMO

BACKGROUND: HBV/HCV coinfection is a common finding among hemodialysis patients. However, there is scarce information concerning the impact of HBV coinfection on the response to treatment of HCV-infected patients on hemodialysis. AIM: We aimed to compare the rate of sustained virologic response (SVR) to treatment with interferon-alfa (IFN) between hemodialysis patients with HBV/HCV coinfection and those with HCV-monoinfection. MATERIAL AND METHODS: HCV-infected patients on hemodialysis treated with IFN were included. Patients coinfected by HBV/HCV were compared to HCV-monoinfected patients, regarding clinical and biochemical features and rates of SVR. RESULTS: One hundred and eleven patients were treated. HBV/HCV coinfection was observed in 18/111 patients (16%). Coinfected patients were younger (p = 002), had more time on dialysis (p = 0.05) and showed a tendency to present a higher prevalence of septal fibrosis (p = 0.06). The analysis by intention to treat showed SVR of 56% among coinfected patients and 18% in HCV-monoinfected patients (p = 0.004). CONCLUSION: In conclusion, end-stage renal disease patients with HBV/HCV coinfection exhibit higher rate of SVR to HCV treatment than HCV-monoinfected patients. It is possible that factors related to the host immune response and viral interaction could explain the better response observed among coinfected patients.


Assuntos
Antivirais/uso terapêutico , Coinfecção , Hepatite B Crônica/complicações , Hepatite C Crônica/complicações , Falência Renal Crônica/terapia , Diálise Renal , Feminino , Seguimentos , Hepatite B Crônica/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
PLoS One ; 9(11): e112574, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25426708

RESUMO

OBJECTIVE: To investigate if magnetic resonance spectroscopy (MRS) is the best Magnetic Resonance (MR)-based method when compared to gradient-echo magnetic resonance imaging (MRI) for the detection and quantification of liver steatosis in diabetic patients in the clinical practice using liver biopsy as the reference standard, and to assess the influence of steatohepatitis and fibrosis on liver fat quantification. METHODS: Institutional approval and patient consent were obtained for this prospective study. Seventy-three patients with type 2 diabetes (60 women and 13 men; mean age, 54 ± 9 years) underwent MRI and MRS at 3.0 T. The liver fat fraction was calculated from triple- and multi-echo gradient-echo sequences, and MRS data. Liver specimens were obtained in all patients. The accuracy for liver fat detection was estimated by receiver operator characteristic (ROC) analysis, and the correlation between fat quantification by imaging and histolopathology was analyzed by Spearman's correlation coefficients. RESULTS: The prevalence of hepatic steatosis was 92%. All gradient-echo MRI and MRS findings strongly correlated with biopsy findings (triple-echo, rho = 0.819; multi-echo, rho = 0.773; MRS, rho = 0.767). Areas under the ROC curves to detect mild, moderate, and severe steatosis were: triple-echo sequences, 0.961, 0.975, and 0.962; multi-echo sequences, 0.878, 0.979, and 0.961; and MRS, 0.981, 0.980, and 0.954. The thresholds for mild, moderate, and severe steatosis were: triple-echo sequences, 4.09, 9.34, and 12.34, multi-echo sequences, 7.53, 11.75, and 15.08, and MRS, 1.71, 11.69, and 14.91. Quantification was not significantly influenced by steatohepatitis or fibrosis. CONCLUSIONS: Liver fat quantification by MR methods strongly correlates with histopathology. Due to the wide availability and easier post-processing, gradient-echo sequences may represent the best imaging method for the detection and quantification of liver fat fraction in diabetic patients in the clinical practice.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Fígado Gorduroso/diagnóstico , Fígado/patologia , Biópsia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Fígado Gorduroso/complicações , Fígado Gorduroso/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Índice de Gravidade de Doença
10.
Int J Infect Dis ; 17(1): e50-3, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23041364

RESUMO

OBJECTIVE: The aim of the present study was to determine whether hepatitis C virus (HCV) RNA present at week 12 is a good predictor of the response to interferon (IFN) monotherapy in hemodialysis patients with hepatitis C. METHODS: Hemodialysis patients with hepatitis C who were treated between 1997 and 2008 with IFN monotherapy for 48 weeks without dose reduction were included. The predictive value of HCV RNA at week 12 for achieving a sustained virological response (SVR) was determined. RESULTS: Forty patients (mean age 47±9 years; 75% males and 80% with genotype 1) were included. Septal fibrosis or cirrhosis was observed in 38% of these patients. Twelve (30%) of the 40 patients achieved SVR. HCV RNA was undetectable at week 12 in 68%. The positive predictive value of HCV RNA at week 12 was 45% and the negative predictive value was 100%. CONCLUSIONS: The presence of HCV RNA at week 12 had a high negative predictive value for SVR in hemodialysis patients with chronic hepatitis C treated with IFN for 48 weeks. Therefore, if HCV RNA is detected at week 12, treatment should be discontinued due to the low probability of a sustained response.


Assuntos
Antivirais/uso terapêutico , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/virologia , Interferons/uso terapêutico , Cirrose Hepática/etiologia , Diálise Renal , Carga Viral , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , RNA Viral/sangue , Fatores de Tempo , Resultado do Tratamento
11.
J Clin Gastroenterol ; 46(3): e21-6, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21934526

RESUMO

BACKGROUND: Acute kidney injury (AKI) is frequent in cirrhotic patients but its best definition is unclear. Recently, the Acute Kidney Injury Network (AKIN) proposed criteria to define AKI. The aims of this study were to apply AKIN criteria to cirrhotic patients with ascites and to evaluate its association to hospital mortality. STUDY: In this retrospective study, cirrhotic patients with ascites admitted to a university hospital in Brazil between November 2003 and December 2007 were included. AKIN criteria were applied in the first 48 hours of hospitalization, considering 2 values of creatinine in this period. Association of AKI at admission and hospital mortality was analyzed. RESULTS: Of the 198 patients in the study, 91 (46%) presented AKI at hospital admission. Overall hospital mortality was 40.4%. Patients without AKI had a hospital mortality rate of 29.9%, whereas the same rate for patients with this complication was 52.7% (odds ratio=2.6; 95% confidence interval, 1.5-4.7; P=0.001). In a logistic regression analysis, 4 variables were independently associated to hospital mortality: infection, hepatic encephalopathy, Child score, and AKI. A receiver operating characteristic curve analysis revealed that the variation in creatinine proposed by AKIN had the best combination of sensitivity and specificity in relation to hospital mortality. CONCLUSIONS: In cirrhotic patients with ascites, prevalence of AKI at hospital admission is high. Patients with renal dysfunction defined by AKIN have significant higher hospital mortality. AKIN criteria are useful in cirrhotic patients with ascites, as it identifies earlier patients with worse prognosis.


Assuntos
Lesão Renal Aguda/classificação , Mortalidade Hospitalar/tendências , Cirrose Hepática/mortalidade , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Idoso , Ascite , Brasil/epidemiologia , Creatinina/sangue , Feminino , Hospitais Universitários , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Insuficiência Renal , Estudos Retrospectivos , Índice de Gravidade de Doença
12.
Dig Dis Sci ; 55(5): 1485-9, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-19533355

RESUMO

PURPOSE: To evaluate the success and complication rates of early precut papillotomy in difficult biliary cannulations performed by an average endoscopist skilled in ERCP. METHODS: We studied 146 consecutive ERCPs during a 27-month period. Precutting was instituted if cannulation failed after 10-15 min. Standard papillotomy was performed in the rest. The analysis was divided into initial period (1st year) and subsequent period (following 15 months). RESULTS: The success rate of cannulation was 95% (139/146). Standard papillotomy was performed in 103/146 (71%) patients. In the remainder, cannulation was successful after precutting in 36/43 (84%) patients. The complication rate was 10% (8/103 in the standard vs. 7/43 in the precut group, P = 0.14). All complications of the standard group were mild. In the precut group, there were three moderate to severe complications. There were no differences between the two periods. CONCLUSIONS: Precut papillotomy can be an effective and relatively safe procedure when performed by an average endoscopist skilled in ERCP. Although the complication rate of precutting tended to be higher than standard papilotomy, this was reasonable since it increased the success of selective biliary cannulation in 25% of cases. Complication rates did not improve with experience.


Assuntos
Cateterismo/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Competência Clínica , Esfinterotomia Endoscópica/métodos , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Reoperação , Estatísticas não Paramétricas , Resultado do Tratamento
13.
J Gastroenterol Hepatol ; 20(2): 209-16, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15683423

RESUMO

BACKGROUND AND AIMS: Malnutrition is common in liver cirrhosis patients. However, it is under-diagnosed because liver disease affects the traditional nutritional assessment. An understanding of changes in body composition and the establishment of the tissue-loss pattern in liver cirrhosis patients could help practitioners to better manage malnutrition in this setting. The aims of this study were: to quantify body composition changes, to determine tissue loss pattern, and to assess the relation of these to the severity of hepatic dysfunction. METHODS: Seventy-nine patients and 17 controls were studied. Total body water and extracellular water were measured using dilution techniques. Intracellular water and body cell mass were calculated from these parameters. Total body fat was obtained using absorptiometry. RESULTS: Extracellular water was increased and intracellular water was decreased in patients. The two major compartments (body cell mass and body fat) were significantly reduced, mainly in patients with moderate and severe disease. However, significant losses occurred even in Child-Pugh class A patients. We established a tissue-loss pattern. In Child-Pugh class A patients body fat loss predominated. Child-Pugh class B patients had losses in at least one of the two compartments. Most Child-Pugh class C patients had simultaneous depletion in both compartments. CONCLUSIONS: Liver cirrhosis was characterized by a significant reduction in body cell mass and body fat and by a redistribution of body water. Significant losses occurred even in patients with mild disease. There was a more pronounced loss of fat in the initial stages, followed by an accelerated loss of body cell mass in the advanced stages of liver cirrhosis.


Assuntos
Composição Corporal , Cirrose Hepática/complicações , Desnutrição/complicações , Absorciometria de Fóton , Antropometria , Água Corporal , Estudos de Casos e Controles , Feminino , Humanos , Cirrose Hepática/sangue , Testes de Função Hepática , Masculino , Desnutrição/sangue , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Índice de Gravidade de Doença
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