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1.
Am Surg ; 85(10): 1129-1133, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657308

RESUMO

Best management for acute appendicitis (AA) in adults with liver cirrhosis is controversial and needs more investigation. We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was queried to identify AA patients with no cirrhosis, compensated cirrhosis (CC), and decompensated cirrhosis (DC). Each cohort was further stratified according to the treatment type: nonoperative management, open appendectomy, and laparoscopic appendectomy (LA). Chi-square, ANOVA, and binary regression analyses were used to determine differences between groups and risk factors for mortality and complications, with P < 0.05 considered statistically significant. A total of 108,289 AA patients were analyzed; of those, 304 with CC and 134 with DC were identified. Compared with CC and no cirrhosis, DC patients had significantly higher mortality, higher cost, and longer hospital length of stay. LA is accompanied by higher survival, lower cost, shorter duration of hospitalization, and lower incidence of complications across all groups. We conclude that LA is the best management strategy for AA in cirrhotic patients. Even in decompensated cirrhotics, which are associated with worse clinical outcomes, LA is still a favorable option over open appendectomy and nonoperative management.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia , Cirrose Hepática/complicações , Doença Aguda , Adulto , Análise de Variância , Apendicectomia/efeitos adversos , Apendicectomia/economia , Apendicectomia/mortalidade , Apendicite/complicações , Apendicite/mortalidade , Distribuição de Qui-Quadrado , Conversão para Cirurgia Aberta/estatística & dados numéricos , Custos e Análise de Custo , Feminino , Preços Hospitalares , Mortalidade Hospitalar , Humanos , Incidência , Laparoscopia/economia , Laparoscopia/mortalidade , Tempo de Internação/economia , Cirrose Hepática/classificação , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Análise de Regressão , Fatores de Risco , Resultado do Tratamento
2.
Semin Liver Dis ; 39(1): 96-103, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30634187

RESUMO

The Child-Pugh classification is one of the commonest and oldest bedside tools utilized in estimating prognosis in patients with cirrhosis. However, its usage as a risk prediction tool or indeed a decision-making tool should be revisited. In this review, we discuss some inherent issues with the Child-Pugh classification and present a few contexts in which the current usage of Child-Pugh warrants reassessment, elaborating on its utility in acute variceal bleeding, specifically its role in decision-making on early transjugular intrahepatic portosystemic shunt, as well as its use in the context of hepatocellular carcinoma and drug development and dose adjustment.


Assuntos
Técnicas de Apoio para a Decisão , Cirrose Hepática/classificação , Índice de Gravidade de Doença , Carcinoma Hepatocelular/classificação , Carcinoma Hepatocelular/mortalidade , Humanos , Cirrose Hepática/mortalidade , Medição de Risco
3.
Am J Cardiol ; 123(3): 466-473, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502049

RESUMO

The purpose of this study was to determine the relation between liver histology, exercise tolerance, and diastolic function in patients with nonalcoholic fatty liver disease (NAFLD). Myocardial remodeling and diastolic dysfunction have been associated with NAFLD. However, its physiological impact and relationship to the histological severity of NAFLD is not known. Cardiopulmonary exercise testing and stress echocardiography was performed in subjects with biopsy-confirmed NAFLD. Maximal aerobic exercise capacity (peak oxygen consumption [VO2]) was related to diastolic function (mitral annulus Doppler velocity e' and ratio of early diastolic filling pressure [E] to e' [E/e']) at rest and peak exercise. Autonomic dysfunction was determined from heart rate recovery after exercise. Independent predictors of cardiac function and exercise capacity were identified by multivariable regression. Thirty-six subjects (nonalcoholic fatty liver [NAFL  =  15], nonalcoholic steatohepatitis [NASH  =  21]) were enrolled. NASH was associated with impaired exercise capacity compared with NAFL (median peak VO2 17.0 [15.4, 18.9] vs 19.9 [17.4, 26.0], p  =  001); pVO2 declined with increasing fibrosis (F0  =  22.5, F1  =  19.9, F2  =  19.0, F3  =  16.6 ml·kg-1·min-1; p  =  0.01). Similarly, E/e' during exercise increased progressively with increasing fibrosis (F0  =  5.6, F1  =  6.5, F2  =  8.7, F3  =  9.8; P  =  0.02). Finally, heart rate recovery, a marker of autonomic function, was blunted in those with higher fibrosis stages (F0  =  25 [20, 30], F1  =  23 [17.5, 27.0], F2  =  17 [11.8, 21.5], F3  =  11 [8.5, 18.0] beats per minute; p <0.01). Fibrosis was an independent predictor of these functional outcomes. In conclusion, NASH is associated with impaired exercise capacity and diastolic dysfunction compared with NAFL. The severity of impairment is directly related to the severity of fibrosis stage in precirrhotic stages of NAFLD.


Assuntos
Diástole/fisiologia , Tolerância ao Exercício/fisiologia , Cirrose Hepática/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Velocidade do Fluxo Sanguíneo/fisiologia , Ecocardiografia Doppler , Ecocardiografia sob Estresse , Feminino , Frequência Cardíaca/fisiologia , Humanos , Cirrose Hepática/classificação , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/classificação , Consumo de Oxigênio/fisiologia , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
5.
Infection ; 47(3): 409-415, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30519966

RESUMO

PURPOSE: We aimed to assess the diagnostic reliability of two indirect biomarkers, APRI and FIB-4, for the staging of liver fibrosis using transient elastography (TE) as reference standard, among HIV/HCV co-infected and HCV mono-infected patients. METHODS: This is an observational, retrospective study on subjects who had access to the RESIST HCV from October 2013 to December 2016, a regional network encompassing 22 hospitals and academic centers throughout Sicily. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) < 9.5 kPa (significant fibrosis) and LSM ≥ 12.5 kPa (cirrhosis) were determined by receiver operator characteristics (ROC) curves. RESULTS: 238 HIV/HCV co-infected and 1937 HCV mono-infected patients were included. Performances of FIB-4 and APRI for the detection of significant fibrosis and cirrhosis proved to be unsatisfactory, with very high false negative and false positive rates among both cohorts. No significant differences were found after stratification of HIV/HCV co-infected patients for BMI < or ≥ 25, ALT < or ≥ 40 IU/L, ALT < or ≥ 80 IU/L, and presence/absence of a bright liver echo pattern on ultrasonography. CONCLUSIONS: Differently from other studies, we detected the unreliability of APRI and FIB-4 for the assessment of liver fibrosis in both HCV mono-infected and HIV/HCV co-infected patients.


Assuntos
Coinfecção/complicações , Técnicas de Imagem por Elasticidade/métodos , Infecções por HIV/complicações , Hepatite C/complicações , Cirrose Hepática/diagnóstico , Adulto , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Feminino , HIV/fisiologia , Hepacivirus/fisiologia , Humanos , Cirrose Hepática/classificação , Cirrose Hepática/etiologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sicília
7.
PLoS One ; 13(8): e0202226, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30161179

RESUMO

OBJECTIVE: The race for finding effective treatments for nonalcoholic fatty liver disease (NAFLD) has been slowed down by the high screen-failure rate for including patients in trials due to the lack of a noninvasive biomarker that can identify patients with significant disease. Recently, Wisteria floribunda agglutinin-positive Mac-2-binding protein (WFA+ -M2BP) has shown promise in predicting liver fibrosis. The aims of this study were to evaluate the utility of WFA+ -M2BP as a biomarker to sub-classify patients with NAFLD according to their disease severity and to assess its correlation with histologic features of NAFLD. METHODS: Patients undergoing biopsy for clinical suspicion of NAFLD and healthy controls were included. Patients with NAFLD were classified into: NAFL, early NASH (F0-F1), fibrotic NASH (F2-F3), and NASH cirrhosis (F4). Levels of WFA+ -M2BP in sera was measured by a HISCL™ M2BPGi™ assay kit using an automated immunoanalyzer (HISCL™-800; Sysmex, Kobe, Japan). Analysis of covariance was used to assess difference in WFA+ -M2BP between the groups and Spearman's correlation coefficients were used to assess correlation with histological features. RESULTS: Our cohort consisted of 20 healthy controls and 198 patients with biopsy-proven NAFLD divided as follows: 52 with NAFL, 62 with early NASH, 52 with fibrotic NASH, and 32 with NASH cirrhosis. WFA+ -M2BP level was found to be significantly increased in the fibrotic NASH and NASH cirrhosis groups compared to healthy controls and those with early NAFLD after adjusting for age, gender and BMI. Furthermore, patients with NASH cirrhosis had significantly higher WFA+ -M2BP levels (2.4[1.5, 4.2] C.O.I (Cut-off Index)) than those with fibrotic NASH (1.2[0.79, 1.9]), p < 0.001. WFA+ -M2BP level had moderate correlation with inflammation, ballooning and NAFLD activity score and strong correlation with fibrosis stage. Additionally, ROC curve analysis demonstrated that WFA+ -M2BP accurately differentiated F2-4 from F0-F1. CONCLUSION: In a large cohort of patients with the full spectrum of NAFLD, WFA+ -M2BP levels predicted the presence of advanced disease and correlated strongly with fibrosis stage.


Assuntos
Antígenos de Neoplasias/sangue , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Glicoproteínas de Membrana/sangue , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Lectinas de Plantas/sangue , Receptores de N-Acetilglucosamina/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Cirrose Hepática/classificação , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/classificação
8.
BMJ Open ; 8(8): e021787, 2018 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-30139901

RESUMO

OBJECTIVE: This study aimed to assess the accuracy of staging liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) usingpoint shear wave elastography (pSWE) and transient elastography (TE). SETTING: Relevant records on NAFLD were retrieved from PubMed, Embase, Web of Science and the China National Knowledge Infrastructure databases up to 20 December 2017. A bivariate mixed-effects model was conducted to combine sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and area under the summary receiver operating characteristic curve (AUC) between pSWE and TE. A sensitivity analysis was implemented to explore the source of heterogeneity. PARTICIPANTS: Patients with NAFLD who had a liver stiffness measurement using pSWE and TE before liver biopsy were enrolled according to the following criteria: 2×2 contingency tables can be calculated via the reported number of cases; sensitivity and specificity were excluded according to the following criteria: history of other hepatic damage, such as chronic hepatitis C, concurrent active hepatitis B infection, autoimmune hepatitis, suspicious drug usage and alcohol abuse. RESULTS: Nine pSWE studies comprising a total of 982 patients and 11 TE studies comprising a total of 1753 patients were included. For detection of significant fibrosis, advanced fibrosis and cirrhosis, the summary AUC was 0.86 (95% CI 0.83 to 0.89), 0.94 (95% CI 0.91 to 0.95) and 0.95 (95% CI 0.93 to 0.97) for pSWE, and the summary AUC was 0.85 (95% CI 0.82 to 0.88), 0.92 (95% CI 0.89 to 0.94) and 0.94 (95% CI 0.93 to 0.97) for TE, respectively. The proportion of failure measurement was over tenfold as common with TE using an M probe compared with pSWE. CONCLUSION: pSWE and TE, providing precise non-invasive staging of liver fibrosis in NAFLD, are promising techniques, particularly for advanced fibrosis and cirrhosis.


Assuntos
Técnicas de Imagem por Elasticidade , Cirrose Hepática/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/complicações , Humanos , Cirrose Hepática/classificação , Índice de Gravidade de Doença
9.
BMC Gastroenterol ; 18(1): 112, 2018 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-29996772

RESUMO

BACKGROUND: Previous studies have indicated that bile acid is associated with progression of liver cirrhosis. However, the particular role of specific bile acid in the development of liver cirrhosis is not definite. The present study aims to identify the specific bile acid and explore its possible mechanisms in promoting liver cirrhosis. METHODS: Thirty two cirrhotic patients and 27 healthy volunteers were enrolled. Age, gender, Child-Pugh classification and serum of patients and volunteers were collected. Liquid chromatography tandem mass spectrometry (LC-MS) was utilized to determine concentrations of 12 bile acids in serum. Principal component analysis, fold change analysis and heatmap analysis were used to identify the most changed bile acid. And pathway analysis was used to identify the most affected pathway in bile acid metabolism. Spearman rank correlation analysis was employed to assess correlation between concentrations of bile acids and Child-Pugh classification. Hepatic stellate cells (LX-2) were cultured in DMEM. LX-2 cells were also co-cultured with HepG2 cells in the transwell chambers. LX-2 cells were treated with Na+/taurocholate in different concentrations. Western blot was used to evaluate the expression of alpha smooth muscle actin (α-SMA), type I collagen, and Toll-like receptor 4 (TLR4) in LX-2 cells. RESULTS: Concentrations of 12 bile acids in serum of patients and healthy volunteers were determined with LC-MS successively. Principal component analysis, fold change analysis and heatmap analysis identified taurocholic acid (TCA) to be the most changed bile acid. Pathway analysis showed that TCA biosynthesis increased significantly. Spearman rank correlation analysis showed that concentration of TCA in serum of cirrhotic patients was positively associated with Child-Pugh classification. TCA increased the expression of α-SMA, type I collagen, and TLR4 in LX-2 cells. Moreover, the above effect was strengthened when LX-2 cells were co-cultured with HepG2 cells. CONCLUSIONS: Increased TCA concentration in serum of liver cirrhotic patients is mainly due to increased bile acid biosynthesis. TCA is an active promoter of the progression of liver cirrhosis. TCA promoting liver cirrhosis is likely through activating hepatic stellate cells via upregulating TLR4 expression. TCA is a potential therapeutic target for the prevention and treatment of liver cirrhosis.


Assuntos
Cirrose Hepática/sangue , Metabolômica , Ácido Taurocólico/sangue , Actinas/metabolismo , Idoso , Ácidos e Sais Biliares/biossíntese , Ácidos e Sais Biliares/sangue , Biomarcadores/sangue , Linhagem Celular , Proliferação de Células , Técnicas de Cocultura , Colágeno Tipo I/metabolismo , Progressão da Doença , Feminino , Células Hep G2 , Células Estreladas do Fígado/metabolismo , Humanos , Cirrose Hepática/classificação , Masculino , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Ácido Taurocólico/biossíntese , Receptor 4 Toll-Like/metabolismo
10.
Indian J Pathol Microbiol ; 61(3): 345-349, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30004052

RESUMO

Background and Aims: Liver biopsy may be considered in patients with hepatitis C virus (HCV) infection to assess the severity of liver injury and stage of fibrosis, thereby guiding therapeutic decisions. In addition, advanced stage also necessitates surveillance for hepatocellular carcinoma. The aim of this study was to assess whether transaminase (alanine transaminase [ALT]) levels and RNA titers correlate with the histological activity index (HAI) and fibrosis (F) stage in asymptomatic patients with incidentally detected HCV (IDHCV). Patients and Methods: Retrospective evaluation of liver biopsies was done in 113 patients with IDHCV, diagnosed during routine screening. Decision of liver biopsy was made on the basis of age, genotype, acceptable clinical, hematological, and biochemical profiles, and willingness of the patients to undergo treatment. Serum ALT levels, HCV RNA titers, and genotypes were correlated with HAI and F stage. Results: Genotyping was done in 77 of the 113 patients, of which genotype 3 was seen in 43 and genotype 1 in 25 patients. A higher fibrosis stage (Ishak's >F2) was noted in 23.8% of the biopsies. Serum ALT showed a significant correlation with the HAI score on liver biopsy (P = 0.01) but not with the stage of fibrosis (P = 0.52). HCV RNA titers did not reveal any correlation with HAI score or fibrosis stage. Conclusion: Serum transaminases and HCV RNA titers are poor predictors of disease severity and fibrosis. Since HCV shows a slow disease progression, higher stage may predict a worse prognosis irrespective of the low viral RNA load. Liver biopsy may help guide therapeutic decisions in IDHCV infection.


Assuntos
Gerenciamento Clínico , Hepatite C Crônica/diagnóstico , Hepatite C/diagnóstico , Cirrose Hepática/patologia , Fígado/patologia , Adolescente , Adulto , Idoso , Alanina Transaminase/sangue , Infecções Assintomáticas/epidemiologia , Biópsia , Feminino , Genótipo , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/classificação , Hepatite C/patologia , Hepatite C/virologia , Humanos , Achados Incidentais , Fígado/virologia , Cirrose Hepática/classificação , Cirrose Hepática/diagnóstico , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , Estudos Retrospectivos , Carga Viral , Adulto Jovem
11.
Mod Pathol ; 31(8): 1191-1200, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29700417

RESUMO

In this new era of successful long term suppression of hepatitis B viral replication and consistent eradication of hepatitis C virus the necessity for routine pre-treatment biopsies has often been eliminated. Thus, whether there is utility to perform liver biopsy in chronic viral hepatitis is undergoing re-examination. In response to these changing needs, we have developed a new staging system, the Beijing Classification, for assessment of biopsy specimens from patients with chronic viral hepatitis. The most important novelty of the Beijing Classification is that it includes not only extent (stage) of fibrosis, but the quality of fibrosis, namely if the specimen shows predominantly regressive vs. progressive features (or is indeterminantly balanced between the two), the P-I-R score. This histologic distinction between regressive and progressive fibrosis, while invoked in this particular setting of chronic viral hepatitis, may have applicability to all forms of chronic liver disease. Thus, the review contains a description of the concepts of regression and progression with the aim of empowering pathologists to apply them in histopathologic-clinical correlation research as well as in the specific clinical setting for which it was developed. Also, in light of changing clinical needs, grading of necroinflammatory activity and staging of fibrosis are simplified into three point scales. These simplifications should aid the general diagnostic pathologist in being comfortable and confident in assessing biopsy specimens as the criteria for their distinction are far more precise, with significantly reduced "gray zones" of prior grading/staging systems.


Assuntos
Hepatite B Crônica/patologia , Hepatite C Crônica/patologia , Cirrose Hepática/classificação , Cirrose Hepática/patologia , Progressão da Doença , Humanos , Cirrose Hepática/virologia
12.
J Hepatol ; 68(5): 949-958, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29331339

RESUMO

BACKGROUND & AIMS: The main stages of cirrhosis (compensated and decompensated) have been sub-staged based on clinical, endoscopic, and portal pressure (determined by the hepatic venous pressure gradient [HVPG]) features. Vasodilation leading to a hyperdynamic circulatory state is central in the development of a late decompensated stage, with inflammation currently considered a key driver. We aimed to assess hepatic/systemic hemodynamics and inflammation (by C-reactive protein [CRP]) among the different sub-stages of cirrhosis and to investigate their interrelationship and prognostic relevance. METHODS: A single center, prospective cohort of patients with cirrhosis undergoing per protocol hepatic and right-heart catheterization and CRP measurement, were classified into recently defined prognostic stages (PS) of compensated (PS1: HVPG ≥6 mmHg but <10 mmHg; PS2: HVPG ≥10 mmHg without gastroesophageal varices; PS3: patients with gastroesophageal varices) and decompensated (PS4: diuretic-responsive ascites; PS5: refractory ascites) disease. Cardiodynamic states based on cardiac index (L/min/m2) were created: relatively hypodynamic (<3.2), normodynamic (3.2-4.2) and hyperdynamic (>4.2). RESULTS: Of 238 patients, 151 were compensated (PS1 = 25; PS2 = 36; PS3 = 90) and 87 were decompensated (PS4 = 48; PS5 = 39). Mean arterial pressure decreased progressively from PS1 to PS5, cardiac index increased progressively from PS1-to-PS4 but decreased in PS5. HVPG, model for end-stage liver disease (MELD), and CRP increased progressively from PS1-to-PS5. Among compensated patients, age, HVPG, relatively hypodynamic/hyperdynamic state and CRP were predictive of decompensation. Among patients with ascites, MELD, relatively hypodynamic/hyperdynamic state, post-capillary pulmonary hypertension, and CRP were independent predictors of death/liver transplant. CONCLUSIONS: Our study demonstrates that, in addition to known parameters, cardiopulmonary hemodynamics and CRP are predictive of relevant outcomes, both in patients with compensated and decompensated cirrhosis. LAY SUMMARY: There are two main stages in cirrhosis, compensated and decompensated, each with a main relevant outcome. In compensated cirrhosis the main relevant outcome is the development of ascites, while in decompensated cirrhosis it is death. Major roles of cardiac dysfunction and systemic inflammation have been hypothesized in the evolution of the disease in decompensated patients. In this study, we have shown that these factors were also involved in the progression from compensated to decompensated stage.


Assuntos
Proteína C-Reativa/metabolismo , Hemodinâmica , Cirrose Hepática/fisiopatologia , Idoso , Estudos de Coortes , Circulação Coronária , Feminino , Humanos , Mediadores da Inflamação/sangue , Circulação Hepática , Cirrose Hepática/sangue , Cirrose Hepática/classificação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pressão na Veia Porta , Prognóstico , Estudos Prospectivos , Circulação Pulmonar , Vasodilatação
13.
Microsc Res Tech ; 81(3): 338-347, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29318713

RESUMO

Chronic liver diseases' hallmark is the fibrosis that results in liver function failure in advanced stages. One of the serious parasitic diseases affecting the liver tissues is schistosomiasis. Immunologic reactions to Schistosoma eggs leads to accumulation of collagen in the hepatic parenchyma causing fibrosis. Thus, monitoring and reporting the staging of the histopathological information related to liver fibrosis are essential for accurate diagnosis and therapy of the chronic liver diseases. Automated assessment of the microscopic liver tissue images is an essential process. For accurate and timeless assessment, an automated image analysis and classification of different stages of fibrosis can be employed as an efficient procedure. In this work, granuloma stages, namely cellular, fibrocellular, and fibrotic granulomas along with normal liver samples were classified after features extraction. In this work, a new hybrid combination of statistical features with empirical mode decomposition (EMD) is proposed. These combined features are further classified using the back-propagation neural network (BPNN). A comparative study of the used classifier with the support vector machine is also conducted. The comparative results established that the BPNN achieved superior accuracy of 98.3% compared to the linear SVM, quadratic SVM, and cubic SVM that provided 85%, 84%, and 80%; respectively. In conclusion, this work is of special value that provides promising results for early prediction of the liver fibrosis in schistosomiais and other fibrotic liver diseases in no time with expected better prognosis after treatment.


Assuntos
Processamento de Imagem Assistida por Computador , Cirrose Hepática/classificação , Cirrose Hepática/diagnóstico por imagem , Esquistossomose/diagnóstico por imagem , Colágeno , Humanos , Fígado/parasitologia , Fígado/patologia , Cirrose Hepática/parasitologia , Máquina de Vetores de Suporte
14.
Hepatol Int ; 12(Suppl 1): 34-43, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28681347

RESUMO

The clinical course of cirrhosis has been typically described by a compensated and a decompensated state based on the absence or, respectively, the presence of any of bleeding, ascites, encephalopathy or jaundice. More recently, it has been recognized that increasing portal hypertension and several major clinical events are followed by a marked worsening in prognosis, and disease states have been proposed accordingly in a multistate model. The development of multistate models implies the assessment of the probabilities of more than one possible outcome from each disease state. This requires the use of competing risks analysis which investigates the risk of several competing outcomes. In such a situation, the Kaplan-Meier risk estimates and the Cox regression may be not appropriate. Clinical states of cirrhosis presently considered as suitable for a comprehensive multistate model include: in compensated cirrhosis, early (mild) portal hypertension with hepatic venous pressure gradient (HVPG) >5 and <10 mmHg, clinically significant portal hypertension (HVPG ≥ 10 mmHg) without gastro-esophageal varices (GEV), and GEV; in decompensated cirrhosis, a first variceal bleeding without other decompensating events, any first non-bleeding decompensation and any second decompensating event; and in a late decompensation state, refractory ascites, sepsis, renal failure, recurrent encephalopathy, profound jaundice, acute on chronic liver failure, all predicting a very short survival. In this review, we illustrate how competing risks analysis and multistate models may be applied to cirrhosis.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/complicações , Encefalopatia Hepática/complicações , Hipertensão Portal/complicações , Cirrose Hepática/classificação , Cirrose Hepática/complicações , Ascite/complicações , Ascite/epidemiologia , Ascite/mortalidade , Ascite/fisiopatologia , Progressão da Doença , Varizes Esofágicas e Gástricas/epidemiologia , Varizes Esofágicas e Gástricas/mortalidade , Varizes Esofágicas e Gástricas/fisiopatologia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/fisiopatologia , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/mortalidade , Encefalopatia Hepática/fisiopatologia , Humanos , Hipertensão Portal/epidemiologia , Hipertensão Portal/mortalidade , Hipertensão Portal/fisiopatologia , Icterícia/complicações , Icterícia/epidemiologia , Icterícia/mortalidade , Icterícia/fisiopatologia , Cirrose Hepática/epidemiologia , Cirrose Hepática/fisiopatologia , Modelos Teóricos , Pressão na Veia Porta/fisiologia , Valor Preditivo dos Testes , Prognóstico , Recidiva , Insuficiência Renal/complicações , Insuficiência Renal/epidemiologia , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Medição de Risco , Sepse/complicações , Sepse/epidemiologia , Sepse/mortalidade , Sepse/fisiopatologia , Índice de Gravidade de Doença
15.
Acta Med Indones ; 49(2): 128-135, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28790227

RESUMO

BACKGROUND: acoustic radiation force impulse (ARFI) is a new proposed noninvasive method for liver fibrosis staging. Integrated with B-mode ultrasonography, ARFI can be used to assess liver tissue condition. However its diagnostic accuracy is still being continuously evaluated. Also, there is lack of data regarding the utilization of ARFI in our population. This study aimed to evaluate the diagnostic value of ARFI as an alternative noninvasive modality for fibrosis staging in chronic hepatitis B and hepatitis C patients in our population. METHODS: we conducted cross-sectional comparison of ARFI imaging and transient elastography on patients who underwent liver biopsy at Cipto Mangunkusumo Hospital. Fibrosis staging using METAVIR scoring system presented as standard reference. A total of 43 patients underwent liver biopsy was evaluated by ARFI imaging and transient elastography. Cut-off values were determined using receiver-operating characteristic (ROC). RESULTS: both liver stiffness determined by ARFI and transient elastography (TE) were moderately correlated with METAVIR score with value of 0.581 and 0.613, respectively (both P<0.01). Diagnostic accuracy of ARFI predicted significant fibrosis (F≥2) with area under receiver operating characteristic curve (AUROC) of 0.773 (95% CI 0.616-0.930) and even better for cirrhosis (F4 fibrosis), expressed as AUROC of 0.856 (95% CI 0.736-0.975). Transient elastography was better for significant fibrosis with AUROC of 0.761 (95% CI 0.601-0.920) and was best for prediction of cirrhosis, expressed as AUROC of 0.845 (95% CI 0.722-0.968). CONCLUSION: ARFI is provided with more convenient evaluation of liver tissue condition, and its diagnostic accuracy is not significantly different from TE for staging liver fibrosis.


Assuntos
Técnicas de Imagem por Elasticidade , Cirrose Hepática/classificação , Cirrose Hepática/diagnóstico por imagem , Estudos Transversais , Feminino , Hepatite B Crônica/complicações , Hepatite C Crônica/complicações , Humanos , Masculino , Pessoa de Meia-Idade
16.
Kyobu Geka ; 70(8): 596-600, 2017 07.
Artigo em Japonês | MEDLINE | ID: mdl-28790273

RESUMO

Liver cirrhosis has emerged as a serious risk factor for cardiac surgery due to the higher mortality and morbidity that these patients display compared with the non-cirrhotic cardiac surgery population. Child-Pugh classification and model for end-stage liver disease score( MELD) score are useful to assess perioperative risk in patients with cirrhosis. According to recent research, cardiac surgery could be offered to patients with Child-Pugh A and a low MELD score with only mild increase in the risk of mortality. However, for patients with more advanced cirrhosis, risk of mortality is extremely high. To decrease mortality, careful patient selection, meticulous consideration of surgical strategy and perioperative treatment are vital for the recovery of cirrhotic patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cirrose Hepática/complicações , Procedimentos Cirúrgicos Cardíacos/mortalidade , Humanos , Cirrose Hepática/classificação , Cirrose Hepática/mortalidade , Seleção de Pacientes , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
17.
BMJ Open ; 7(7): e013752, 2017 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-28710203

RESUMO

OBJECTIVES: Mortality due to liver disease (of which cirrhosis is the end stage) is increasing more than any other chronic condition in the UK. This study aims to demonstrate that (1) exclusive reliance on mortality rates may not reveal the true burden of liver cirrhosis, and (2) diverse use of diagnostic coding may produce misleading estimates. DESIGN: Observational study. SETTING: The Office for National Statistics death registry was interrogated to investigate liver cirrhosis mortality trends in England and Wales from 1968 to 2011. MAIN OUTCOME: Standardised mortality trends according to three different definitions of liver cirrhosis based on the specificity of diagnostic codes were calculated: 1 (chronic liver diseases), 2 (alcoholic and unspecified cirrhosis only) and 3 (cirrhosis as end-stage liver disease). The mortality trends were compared with incidence rates established in a previous population-based study (based on definition 3), from 1998 to 2009, to investigate discrepancies between these two measures. RESULTS: Over the study period, the overall standardised liver cirrhosis mortality rates were 8.8, 5,1 and 5.4 per 100 000 person-years for definitions 1, 2 and 3, respectively. The mortality rates for definition 3 in 1998 and 2009 were 6.2 and 5.9 per 100 000 person-years, respectively; while the equivalent incidence rates were at least threefold and sixfold higher: 23.4 and 35.9 per 100 000 person-years, respectively. This discrepancy between incidence and mortality rates was also at least threefold in men and women separately and across age groups. CONCLUSION: Mortality rates underestimated the incidence of liver cirrhosis by at least threefold between 1998 and 2009 and varied with differing definitions of disease. Mortality data should not be used exclusively as an indicator for the occurrence of liver cirrhosis in the population. Routinely collected healthcare data are available to measure occurrence of this disease. Careful consideration should be taken when selecting diagnostic codes for cirrhosis.


Assuntos
Cirrose Hepática/classificação , Cirrose Hepática/mortalidade , Adulto , Distribuição por Idade , Idoso , Bases de Dados Factuais , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Distribuição por Sexo , País de Gales/epidemiologia
18.
Lancet Oncol ; 18(2): e101-e112, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28214411

RESUMO

Underlying liver cirrhosis is present in most patients with hepatocellular carcinoma, and liver transplantation is the only treatment strategy to cure both diseases. All other hepatocellular carcinoma treatment strategies have to take into account residual liver function that concurs with the patient's prognosis and might limit their feasibility. In patients with hepatocellular carcinoma and Child-Pugh-Turcotte class B (CPT-B), owing to borderline liver function, any intervention might be offset by liver function deterioration. In this setting, the decision for hepatocellular carcinoma treatment requires a comprehensive assessment of liver function, not restricted to the CPT classification, in addition to a careful evaluation of the prognostic effect of hepatocellular carcinoma compared with cirrhosis. In this Review, we provide an overview of the literature regarding the benefits and harms of non-transplant therapies in patients with hepatocellular carcinoma and CPT-B cirrhosis.


Assuntos
Carcinoma Hepatocelular/terapia , Cirrose Hepática/terapia , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/patologia , Humanos , Cirrose Hepática/classificação , Cirrose Hepática/patologia , Neoplasias Hepáticas/patologia , Transplante de Fígado , Índice de Gravidade de Doença
19.
Dig Dis ; 34(6): 632-639, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27750230

RESUMO

BACKGROUND: An interferon-free regimen including sofosbuvir and ribavirin (RBV) for patients with hepatitis C virus (HCV) genotype 2 (G2) infection leads to a drastic improvement of sustained virological response (SVR). However, the safety, tolerability, and efficacy in patients aged 75 or older have not been completely understood. SUMMARY: Fifty-six patients with HCV G2 infection who were treated with sofosbuvir and weight-based dose of RBV were enrolled. Thirty-seven patients aged ≥75 and 19 patients aged ≤74 were classified as the aged and non-aged groups, respectively. The aged group was characterized by significantly more number of women, history of hepatocellular carcinoma, low serum albumin (ALB) level, low hemoglobin (Hb) concentration, low estimated glomerular filtration rate (eGFR), and high fibrosis-4 index (p = 0.0029). Forty-one patients were evaluated for SVR at 12 weeks after the end of therapy (SVR12); of them, all but one completed the treatment scheduled for 12 weeks. The aged group showed lower SVR12 rate than the non-aged group (81.3% for aged and 96.0% for non-aged groups). Although the Hb concentration and eGFR are significantly lower in the aged group throughout the clinical course, all patients in the aged group completed the 12-week treatment with a gradual increase of serum ALB level. Key Messages: The combination of sofosbuvir plus RBV is tolerable and beneficial in patients aged >75. However, intensive management of anemia by dose reduction of RBV is necessary, which could lead to a low SVR12 rate compared to that observed in patients younger than 75 years.


Assuntos
Antivirais/administração & dosagem , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Ribavirina/administração & dosagem , Sofosbuvir/administração & dosagem , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/patologia , Estudos de Coortes , Feminino , Genótipo , Taxa de Filtração Glomerular/efeitos dos fármacos , Hemoglobinas/análise , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/virologia , Humanos , Interferons/uso terapêutico , Cirrose Hepática/classificação , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Segurança , Albumina Sérica/análise , Fatores Sexuais , Resultado do Tratamento , Uridina Monofosfato/uso terapêutico
20.
Med Clin North Am ; 100(3): 449-64, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27095638
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