Position statement on the use of albumin in liver cirrhosis.

Cirrhosis is characterised by a prolonged asymptomatic period in which the inflammation persists, increasing as the disease progresses. Characteristic of this is the increase in pro-inflammatory cytokines and pro-oxidant molecules which are determining factors in the development of multiple organ dysfunction. In the early development of cirrhosis, splanchnic arterial vasodilation, activation of vasoconstrictor systems (renin-angiotensin-aldosterone) and the sympathetic nervous system (noradrenaline) bring about bacterial translocation and systemic dissemination via portal circulation of bacterial products, and molecular patterns associated with damage, which exacerbate the systemic inflammation present in the patient with cirrhosis. Albumin is a molecule that undergoes structural and functional changes as liver damage progresses, affecting its antioxidant, immunomodulatory, oncotic and endothelial stabilising properties. Our knowledge of the properties of albumin reveals a molecule with multiple treatment options in patients with cirrhosis, from the compensated then decompensated phases to multiple organ dysfunction. Its recognised uses in spontaneous bacterial peritonitis, post-paracentesis circulatory dysfunction, acute kidney injury and hepatorenal syndrome are fully validated, and a treatment option has opened up in decompensated cirrhosis and in acute-on-chronic liver disease.

The product of triglycerides and glucose as biomarker for screening simple steatosis and NASH in asymptomatic women.

UNLABELLED:  Introduction and aim. Given that early identification of non-alcoholic fatty liver disease (NAFLD) is an important issue for primary prevention of hepatic disease, the objectives of this study were to evaluate the efficacy of the product of triglyceride and glucose levels (TyG) for screening simple steatosis and non-alcoholic steatohepatitis (NASH) in asymptomatic women, and to compare its efficacy vs. other biomarkers for recognizing NAFLD. MATERIAL AND METHODS: Asymptomatic women aged 20 to 65 years were enrolled into a cross-sectional study. The optimal values of TyG, for screening simple steatosis and NASH were established on a Receiver Operating Characteristic scatter plot; the sensitivity, specificity, and likelihood ratios of TyG index were estimated versus liver biopsy. According sensitivity and specificity, the efficacy of TyG was compared versus the well-known clinical biomarkers for recognizing NAFLD. RESULTS: A total of 50 asymptomatic women were enrolled. The best cutoff point of TyG for screening simple steatosis was 4.58 (sensitivity 0.94, specificity 0.69); in addition, the best cutoff point of TyG index for screening NASH was 4.59 (sensitivity 0.87, specificity 0.69). The positive and negative likelihood ratios were 3.03 and 0.08 for simple steatosis, and 2.80 and 0.18 for NASH. As compared versus SteatoTest, NashTest, Fatty liver index, and Algorithm, the TyG showed to be the best test for screening. CONCLUSIONS: TyG has high sensitivity and low negative likelihood ratio; as compared with other clinical biomarkers, the TyG showed to be the best test for screening simple steatosis and NASH.

The triglycerides and glucose index is highly associated with non-alcoholic fatty liver disease in overweight and obese women.

BACKGROUND: Although some previous studies have indicated that the triglycerides and glucose (TyG) index is associated with an increased risk of non-alcoholic fatty liver disease (NAFLD), there are still few studies in this field. AIMS: The goal of this study was to assess whether the TyG index is associated with the presence of non-alcoholic fatty liver disease NAFLD in overweight and obese women. METHODS: Overweight and obese women aged 20 to 65 years were enrolled in a cross-sectional study and allocated into the groups with and without NAFLD. Alcohol consumption, pregnancy, normal-weight, positive markers of viral or autoimmune hepatitis, acute or chronic liver disease, renal disease, cardiovascular disease, neoplasia, and intake of hepatotoxic drugs were exclusion criteria. The diagnosis of NAFLD was established by liver ultrasound and the TyG index was calculated as the Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2. RESULTS: A total of 420 participants were enrolled and allocated into the groups with (n = 212) and without (n = 208) NAFLD. In the overall population, the frequency of NAFLD was 50.4%. The logistic regression analysis adjusted by body mass index, waist circumference, and total body fat showed that total cholesterol (OR = 1.004; 95% CI: 1.000-1.007), triglycerides (OR = 1.002; 95% CI: 1.000-1.004), AST (OR = 1.19; 95% CI: 1.15-1.23), ALT (OR = 1.20; 95% CI: 1.15-1.25), and TyG index (OR = 3.15; 95% CI: 1.64-6.06) are significantly associated with NAFLD. CONCLUSIONS: The results show that the TyG index is highly associated with the presence of NAFLD in women with overweight and obesity.

Decrease of aminotransferase levels in obese women is related to body weight reduction, irrespective of type of diet.

OBJECTIVE: To evaluate the efficacy of low carbohydrate diet (LCD) as compared with low fat diet (LFD) to decrease aminotransferase levels in obese women with nonalcoholic fatty liver disease. MATERIAL AND METHODS: A total of 59 women were randomly enrolled in a non-controlled clinical intervention study to receive either LCD or LFD during six months. Apparently healthy non-pregnant obese women aged 20 to 65 years were eligible to participate. Previous diagnosis of hepatic disease, serum creatinine level ≥ 1.5 mg/dL, severe life-limiting medical illness, pregnancy, active participation in other dietary program, use of weight loss drugs, or alcohol consumption ≥ 30 g per day were exclusion criteria. RESULTS: A total of 31 obese women who received LCD were compared with 28 women allocated in the LFD group. There were 3 (LCD group) and 2 (LFD group) women with lost of follow-up. No differences in the proportion of type 2 diabetes, hypertension and hyperlipidemia were noted between women in the LCD and LFD groups. At end of follow-up, there were not significant statistical differences in the anthropometric and biochemical characteristics between women in both groups. The weight loss was 5.7 and 5.5% for women in the LCD LFD groups. Although the decrease of AST (31.7 and 22.4%) and ALT (41 and 33.3%) levels was more elevated in the women of LCD group, as compared with the LFD group, there were not significant statistical differences. CONCLUSIONS: Our results show that weight loss, irrespective of the type of diet, reduces aminotransferase levels in obese women with NAFLD.

Nonalcoholic fatty liver disease in asymptomatic obese women.

OBJECTIVE: To determine the clinical characteristics of NAFLD in asymptomatic obese women. METHODS: A total of 457 asymptomatic obese women were enrolled in a cross-sectional study and allocated into groups with and without NAFLD. Irrespective of ALT levels, diagnosis of NAFLD was established by ultrasonographic findings; irrespective of fibrosis, NASH was defined by hepatic histological changes. RESULTS: One hundred ninety five (42.7%) women had elevated ALT levels. Diagnosis of NAFLD was established in 228 (49.9%) women; among women with NAFLD, 34 (14.9%) have ALT levels within the normal range. On the other hand, based on the healthy range for ALT levels (19 UI/L), 336 (73.5%) women had elevated ALT, but only 2 (0.9%) women with NAFLD exhibited ALT levels within normal healthy values. Furthermore, 93 (41%) women who had AST/ALT levels (3) 1 underwent liver biopsy; of these, 90 (96.8%) had diagnosis of NASH and 3 (3.2%) of hepatic cirrhosis. Women with NAFLD were more obese and have higher fasting plasma glucose, triglycerides, ALT, and AST levels than obese women without NAFLD. Seventy six (16.6%) women had diagnosis of diabetes; of these 47 (61.8) in the NAFLD group. CONCLUSIONS: Results of this study support the statement that women with NAFLD have an adverse metabolic profile. Furthermore, our results show that hyperglycemia, hypertriglyceridemia and markers of liver injury such as AST/ALT > or = 1 may be useful for early recognition of NAFLD.

Dyslipidemia as a risk factor for liver fibrosis progression in a multicentric population with non-alcoholic steatohepatitis.

Background: Nonalcoholic fatty liver disease (NAFLD) is a serious worldwide health problem, with an estimated global prevalence of 24%; it has a notable relationship with other metabolic disorders, like obesity and type 2 diabetes mellitus (T2DM). Nonalcoholic steatohepatitis (NASH) is one of the most important clinical entities of NAFLD, which is associated with an increased risk of progression to liver cirrhosis and hepatocellular carcinoma (HCC). Mexico is one of the countries with the highest prevalence of metabolic diseases; therefore, we sought to investigate the impact that these clinical entities have in the progression to advanced fibrosis in Mexican patients with NASH. Methods: We performed a multicenter retrospective cross-sectional study, from January 2012 to December 2017. A total of 215 patients with biopsy-proven NASH and fibrosis were enrolled. NASH was diagnosed according NAS score and liver fibrosis was staged by the Kleiner scoring system. For comparing the risk of liver fibrosis progression, we divided our sample into two groups. Those patients with stage F0-F2 liver fibrosis were included in the group with non-significant liver fibrosis (n=178) and those individuals with F3-F4 fibrosis were included in the significant fibrosis group (n=37). We carried out a multivariate analysis to find risk factors associated with liver fibrosis progression. Results: From the 215 patients included, 37 had significant liver fibrosis (F3-4). After logistic regression analysis T2DM (p=0.044), systemic arterial hypertension (p=0.014), cholesterol (p=0.041) and triglycerides (p=0.015) were the main predictor of advanced liver fibrosis. Conclusions: In a Mexican population, dyslipidemia was the most important risk factor associated with advanced liver fibrosis and cirrhosis.

Adding cognitive behavioural treatment to either low-carbohydrate or low-fat diets: differential short-term effects.

To evaluate the efficacy of adding cognitive behavioural treatment (CBT) to either a low-carbohydrate (LC) diet or a low-fat (LF) diet in the treatment of weight loss of obese women, a randomised clinical intervention study was performed. A total of 105 healthy non-pregnant obese women (average age and BMI of 45.4 (sd 10.4) years and 36 (sd 4.3) kg/m2) were randomly allocated to the CBT or control (C) groups; within each group, women were randomly selected to receive either the LC or LF diet during 6 months. The pre-planned primary trial end-point was the weight loss. Differences between the groups were assessed using one-way ANOVA. There were three women (2.8 %) who dropped out, all of them in the CBT group. No differences in the anthropometric and laboratory characteristics at baseline were noted between women in the CBT (n 52) and control groups (n 50). Intention-to-treat analysis showed that weight loss in the CBT-LC (90 (sd 12.3) to 82.1 (sd 12.1) kg) and C-LC (89.4 (sd 10.0) to 85.8 (sd 9.8) kg) groups reached 8.7 and 4.0 %, respectively (P < 0.0001), and in the CBT-LF (87.9 (sd 11.4) to 79.4 (sd 11.8) kg) and C-LF (88.8 (sd 14.5) to 85.3 (sd 14.3) kg) groups it was 9.7 and 3.9 %, respectively (P < 0.05). Weight loss was higher in the CBT-LF group than in the CBT-LC groups (P = 0.049). The present results showed that adding CBT to either the LF or LC diet produced significantly greater short-term weight loss in obese women compared with diet alone. These finding support the efficacy of CBT in breaking previous dietary patterns and in developing healthier attitudes that reinforce a healthier lifestyle.

[Risk factors associated with upper gastrointestinal bleeding and with mortality]. / Factores de riesgo asociados a hemorragia del tubo digestivo alto y su mortalidad.

OBJECTIVE: to determine the associated risk factors with upper gastrointestinal bleeding (UGIB) and mortality in subjects with peptic ulcer. METHODS: a total of 345 subjects with peptic ulcer, < 60 years of age, were enrolled in a cross-sectional study. Subjects were allocated into one of two groups in accordance with the presence of UGIB. A logistic regression model, adjusted by age and sex, was used to compute the relationship between the risk factors and both UGIB and mortality. RESULTS: smoking (OR = 2.6, CI 95 % = 1.2-8.7), alcohol consumption (OR = 4.8, CI 95 % = 1.4-10.5), and previous history of UGIB (OR = 1.8, CI 95 % = 1.1-9.7) were strongly and independently associated with UGIB; chronic obstructive pulmonary disease (OR = 1.9, CI 95 % = 1.2-11.4), and high blood pressure (OR = 1.4, CI 95 % = 1.1- 7.5) were associated with mortality in UGIB. CONCLUSIONS: the associated risk factors with UGIB in patients with peptic ulcer were: age lower than 60 years; smoking; history of UGIB; and alcohol consumption. The chronic obstructive pulmonary disease and high blood pressure were associated with mortality in UGIB.

Risk factors associated with nonalcoholic fatty liver disease and its relationship with the hepatic histological changes.

OBJECTIVE: The objective of this study is to determine the association between risk factors and nonalcoholic fatty liver disease (NAFLD), and to establish the relationship between risk factors and hepatic histological changes in obese women. METHODS: A case-control design study. Women with NAFLD (cases) were compared with a control group of obese women without NAFLD matched by age, body mass index, waist circumference, and body fat. Irrespective of serum aminotransferases levels, diagnosis of NAFLD was established by the presence of type II diabetes, hypertriglyceridemia, and ultrasonographic changes of hepatic steatosis. Diagnosis of nonalcoholic steatohepatitis was performed by a liver biopsy. Women with an aspartate aminotransferase/alanine aminotransferase (ALT) ratio of at least 1 underwent liver biopsy. Alcohol consumption, hepatitis, and drugs that promote cholestasis or liver injury were the exclusion criteria. Multiple regression analysis was used to compute the association between the risk factors and NAFLD, and Spearman's analysis was used to examine its relationship with histological hepatic changes. RESULTS: A total of 108 obese women were enrolled. The frequency of high blood pressure, hypertriglyceridemia, and diabetes was similar between the groups. ALT (54.4+/-33.3 and 39.8+/-29.8, P=0.03) but not aspartate aminotransferase (45.4+/-23.1 and 36.7+/-21.2, P=0.06) was significantly higher in the women with NAFLD. The multivariate regression analysis showed a significant association of ALT (odds ratio 2.7; 95% confidence interval, 1.3-10.4), but not other variables with NAFLD. Type II diabetes was strongly correlated with ballooning and inflammation, and ALT with inflammation and fibrosis. CONCLUSION: Obese women with similar metabolic alterations exhibit different hepatic outcomes. Elevation of ALT, but not other risk factors, was associated with NAFLD. Diabetes and ALT correlate with histological hepatic changes.

Current trends of liver cirrhosis in Mexico: Similitudes and differences with other world regions.

AIM: To investigate the main current etiologies of cirrhosis in Mexico. METHODS: We performed a cross-sectional retrospective multicenter study that included eight hospitals in different areas of Mexico. These hospitals provide health care to people of diverse social classes. The inclusion criteria were a histological, clinical, biochemical, endoscopic, or imaging diagnosis of liver cirrhosis. Data were obtained during a 5-year period (January 2012-December 2017). RESULTS: A total of 1210 patients were included. The mean age was 62.5 years (SD = 12.1), and the percentages of men and women were similar (52.0% vs 48.0%). The most frequent causes of liver cirrhosis were hepatitis C virus (HCV) (36.2%), alcoholic liver disease (ALD) (31.2%), and nonalcoholic steatohepatitis (23.2%), and the least frequent were hepatitis B virus (1.1%), autoimmune disorders (7.3%), and other conditions (1.0%). CONCLUSION: HCV and ALD are the most frequent causes of cirrhosis in Mexico. However, we note that non-alcoholic fatty liver disease (NAFLD) as an etiology of cirrhosis increased by 100% compared with the rate noted previously. We conclude that NAFLD will soon become one of the most frequent etiologies of liver cirrhosis in Mexico.

Insulin resistance is associated with elevated transaminases and low aspartate aminotransferase/alanine aminotransferase ratio in young adults with normal weight.

OBJECTIVE: The aim of this study is to determine whether insulin resistance is associated with elevation of transaminases levels and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio in normal-weight healthy young adults. PARTICIPANTS AND METHODS: Apparently healthy nonpregnant women and men, aged 18-23 years, were enrolled in a cross-sectional study. According to the homeostasis model assessment of insulin resistance, the participants were allocated into groups of patients with (>2.5) and without (≤2.5) insulin resistance. Normal weight was defined by BMI of at least 18.5 and less than 25.0 kg/m. A multiple logistic regression analysis was carried out to determine the association between insulin resistance and elevated transaminases and AST/ALT ratio of 1 or less. RESULTS: A total of 1732 young adults were enrolled and allocated into groups with (n=287) and without (n=1445) insulin resistance. The prevalence of insulin resistance was 16.6% in the overall population. The multivariate logistic regression analysis adjusted by age, sex, waist circumference, and BMI indicated that the odds ratio (OR) between insulin resistance and elevated ALT concentrations is 1.65 [95% confidence interval (CI): 1.04-2.62, P=0.03], for AST/ALT ratio lower than 1 OR is 1.69 (95% CI: 1.27-2.26, P<0.001), and for elevated AST levels OR is 1.31 (95% CI: 0.71-2.43, P=0.377). CONCLUSION: The results of the present study suggest that insulin resistance is significantly associated with elevated ALT levels and AST/ALT ratio of lower than 1, but not with elevated AST levels.

Hypomagnesemia, insulin resistance, and non-alcoholic steatohepatitis in obese subjects.

BACKGROUND: Epidemiological evidence shows a strong relationship between decreased serum magnesium levels (DSML) and insulin resistance. As nonalcoholic steatohepatitis (NASH) seems to be related to insulin resistance, the aim of this study was to determine the potential relationship between DSML and NASH in obese subjects. METHODS: We compared obese individuals with the diagnosis of diabetes, insulin-resistance, and non-insulin resistance to a control group of non-obese, non-insulin-resistant subjects. Participants were required to have negative viral markers and negligible alcohol intake. Other liver diseases and well-known causes for decreasing of magnesium were exclusion criteria. A liver biopsy was performed in subjects with aspartate aminotransferase (AST) and alanine aminotransferease (ALT) levels > or =40 IU/mL. RESULTS: Of the 60 obese subjects, 20 were non-insulin resistant, 20 were insulin resistant, and 20 were type 2 diabetics. Twenty subjects were in the control group. Eleven (33.3%) diabetics, 14 (42.4%) insulin-resistant subjects, and 8 (24.2%) non-insulin-resistant subjects underwent liver biopsies. Diagnosis of NASH was established in 29 (36.2%) individuals. Subjects with the diagnosis of NASH exhibited lower serum magnesium levels of 1.7 +/- 0.2 mg/dL (0.70 +/- 0.08 mmol/L), and those with fibrosis showed the lowest serum magnesium concentration at 1.5 +/- 0.3 mg/dL (0.62 +/- 0.12 mmol/L). Multiple regression analysis adjusted by age showed that low serum magnesium concentration was independently related to a high HOMA-IR index (OR 7.6, CI 95% 2.1-11.2; p <0.0001) and that a high HOMA-IR index was related to NASH (OR 6.5, CI 95% 1.5-8.8; p <0.01). After adjusting for age and a high HOMA-IR index, hypomagnesemia remained independently related to NASH (OR 1.4, CI 95% 1.1-5.4; p <0.05). CONCLUSIONS: The results of this study demonstrate an independent relationship between DSML and NASH.

[Epidemiologic and situational panorama of hepatitis C in Mexico]. / Panorama epidemiológico y situacional de la hepatitis C en México.

OBJECTIVE: To determine the epidemiological situation of Chronic Hepatitis C (CHC) in our country. BACKGROUND DATA: Chronic Hepatitis C affects 170 million people worldwide, and about 0.7% of Mexican population. There is no enough epidemiological information about CHC in our country, and it is very probable that some cases are not even detected. METHODS: An investigation poll was performed. Age, gender, birthday, weight, race, residence and birth place, routes of transmission, ALT levels, histological, serological and molecular diagnosis, evidence of complications and previous treatments were recorded. A data recollection sheet was dispatched to different country provinces; they had 6 months to answer it, in order to recollect all information. RESULTS: 831 patients were analized (58.6% female and 41.4% male) with the following distribution in our country provinces: Aguascalientes 15, Chihuahua 12, Distrito Federal 495, Durango 10, Jalisco 89, Guanajuato 78, Yucatán 8, Querétaro 11, Sonora 40, Tabasco 15, Baja California 5, Veracruz 13, Tamaulipas 2 and 38 patients of Nuevo León. The highest incidence of CHC was found at fifth and sixth decade of life (28.5% y 26.7% respectively. The weight distribution was 36.2% < 65kg, 34.6% 65-75 kg and 29.2% > 75 kg. 86.5% had chronic hepatitis and 13.2% cirrhosis. The risk factors for HCV infection analysis showed that the main route of transmission was via contaminated blood (64.2%); when we excluded the patients that were exposed before 1995, the incidence was lowered to 4.5%. The higher incidence was showed between 1970 and 1990 (68%). The intravenous drug users were predominantly male and on those patients in the provinces near the north border line of our country. The predominant genotype was gen- 1 no matter the province (72.2%), in the intravenous drug users genotype 3 was found in 25%. The viral load was similar in all the provinces. 75% of the patients had have treatment and 22.5% had have two cycles, 50% of cirrhotic patients had have treatment whereas only 28% of the patients with late complications had have it. The most common treatment was pegylated alpha-2a interferon plus ribavirine. CONCLUSIONS: 1. The main route of transmission was blood transfusion. There is a marked decrease in the incidence of post-transfusional hepatitis since the introduction of anti-VHC antibody screening of blood donors (4.5%). 2. The time between the infection and diagnosis was 23 years for chronic hepatitis and 26 years for cirrhosis. 3. Intravenous drugs use was an important route of transmission in the north of our country. 4. The predominant genotype was gen-1. 5. Almost all the patients with chronic hepatitis received treatment, the most common used was pegylated interferon alpha-2a and ribavirin. 6.50% of the patients with CHC have late complications.

Etiology of liver cirrhosis in Mexico.

BACKGROUND: In the last decades it has been suggested that the main cause of liver cirrhosis in Mexico is alcohol. Currently in Western countries hepatitis C virus stage liver disease and liver transplantation. In Mexico, we have no data relative to the etiology of liver cirrhosis. The aim of this study was to investigate the main causes of liver cirrhosis in Mexico. METHODS: Eight hospitals located in different areas of the country were invited to participate in this study. Those hospitals provide health care to different social classes of the country. The inclusion criteria were the presence of either an histological or a clinical and biochemical diagnosis of liver cirrhosis. RESULTS: A total 1,486 cases were included in this study. The etiology of liver cirrhosis was alcohol in 587 (39.5%), HCV 544 (36.6%), cryptogenic 154 (10.4%), PBC 84 (5.7%), HBV 75 (5.0%) and other 42 (2.8%). There was no statistical difference between alcohol and HCV. CONCLUSIONS: We conclude that the main causes of liver cirrhosis in Mexico are alcohol and HCV.

[Gastropathy caused by non-steroidal anti-inflammatory agents and its association with Helicobacter pylori]. / Gastropatía por antiinflamatorios no esteroideos y su asociación con Helicobacter pylori.

BACKGROUND: Upper gastrointestinal bleeding that is related with older patients and NSAIDs use. The frequency of peptic ulcer bleeding varies of 15% to 30% of cases. OBJECTIVE: To determine the gastropathy features of patients who receive nonsteroidal anti-inflammatory drug, and its relation with Helicobacter pylori (Hp). METHODS: Men and women with GU or DU with or without haemorrhage, were included into two groups, NSAIDs users and non users. We determined the incidence rate of peptic ulcer and the frequencies of risk factors as tobacco use, previous peptic ulcer or haemorrhage, concomitant disease presence and its association with Hp infection. RESULTS: We included 434 (67.5%) patients that used NSAIDs and 209 (32.5%) non NSAIDs users control subjects. The average was 62.5 +/- 17.2 years and 49.5 +/- 19.4 years respectively. The annual incidence rate of peptic ulcer in NSAIDs users was 17.5%. Gastrointestinal bleeding was more frequent in NSAIDs users and its relations with Hp infection (23.5%) was smaller than patients without NSAIDs user (47.7%) (OR 0.39 p = 0.0000). CONCLUSIONS: The GU was highly frequent in the older people who using NSAIDs. The Hp infection shows lower incidence of gastrointestinal bleeding NSAIDs users.

[Analysis of liver biopsy experience in a regional hospital]. / Análisis de la experiencia en biopsia hepática en un hospital regional.

UNLABELLED: Hepatic biopsy is a safe procedure. Its findings contribute to precise diagnoses and in selecting or modifying the treatment of some patients with liver diseases. AIM: To analyze indications, findings and complications of hepatic biopsy. MATERIAL AND METHODS: Retrospective study of patients with hepatic disease in which a hepatic biopsy was obtained. Information pertaining to clinical characteristics, biopsy indications and its results were collected. All tissue samples were stained with hematoxylin-eosin, Masson and Perl. The analysis was performed by descriptive statistics, chi 2 test and the Fisher exact test. RESULTS: There were 54.6% were women and 45.4% were men. In 361 patients the major diagnoses were: Hepatic cirrhosis 19.1%, hepatic metastases 16.3%, chronic hepatitis 11.6%, alcoholic hepatitis 11.1% and nonalcoholic steatohepatitis 9.7%. In 66.2% of the biopsies were preformed meanwhile patients were in the Hospital. The procedure was ultrasound-assisted in 76%. There were major complications in 1.4%. CONCLUSION: The hepatic disease is more common in the woman and the pathologic results show that the etiology of liver diseases in our hospital are similar to reports of third level hospitals in Mexico, its major complications were fewer.

[Survival in patients with liver cirrhosis at the Durango, IMSS Regional General Hospital]. / Supervivencia de pacientes con cirrosis hepática en el Hospital General Regional del IMSS, Durango.

INTRODUCTION: In Mexico, hepatic cirrhosis mortality exhibits important regional differences. AIM: To analyze global survival of cirrhotic patients, according to etiology and functional status. MATERIAL AND METHODS: Between March 1990 to August 1998, newly diagnosed patients with hepatic cirrhosis were included in a follow-up study. Subjects were analyzed monthly. Information on clinical evolution, complications, and dates of events (death) and complications were registered. Survival was estimated using Kaplan-Meier method. RESULTS: Ninety nine subjects were included in the survival analysis, 66 with alcoholic and 33 with viral cirrhosis (HCV and HBV in 24 and nine patients, respectively). Ninety seven percent of patients were decompensated at diagnosis, and 81% had ascites. Probabilities for survival in the entire series were 69.7, 37.6 and 23.6% at 24, 48, and 60 months, respectively. There were no significant differences in the survival of patients grouped according to etiology. When survival was analyzed by Child-Pugh score, it was slightly higher in the alcoholic cirrhosis group. CONCLUSIONS: In this study survival probability of patients with viral cirrhosis was lower than in patients with alcohol cirrhosis.