RESUMO
With the increasing rate of infections caused by multidrug-resistant organisms (MDRO), selecting appropriate empiric antibiotics has become challenging. We aimed to develop and externally validate a model for predicting the risk of MDRO infections in patients with cirrhosis. METHODS: We included patients with cirrhosis and bacterial infections from two prospective studies: a transcontinental study was used for model development and internal validation (n = 1302), and a study from Argentina and Uruguay was used for external validation (n = 472). All predictors were measured at the time of infection. Both culture-positive and culture-negative infections were included. The model was developed using logistic regression with backward stepwise predictor selection. We externally validated the optimism-adjusted model using calibration and discrimination statistics and evaluated its clinical utility. RESULTS: The prevalence of MDRO infections was 19% and 22% in the development and external validation datasets, respectively. The model's predictors were sex, prior antibiotic use, type and site of infection, MELD-Na, use of vasopressors, acute-on-chronic liver failure, and interaction terms. Upon external validation, the calibration slope was 77 (95% CI .48-1.05), and the area under the ROC curve was .68 (95% CI .61-.73). The application of the model significantly changed the post-test probability of having an MDRO infection, identifying patients with nosocomial infection at very low risk (8%) and patients with community-acquired infections at significant risk (36%). CONCLUSION: This model achieved adequate performance and could be used to improve the selection of empiric antibiotics, aligning with other antibiotic stewardship program strategies.
RESUMO
INTRODUCTION: Bacterial infection is present in up to 30% of hospitalized cirrhotic patients. It can lead, even after its resolution, to organ dysfunction and even acute-on-chronic liver failure (ACLF). It is the precipitating factor of ACLF in one third of the cases and is the main cause of mortality in patients with liver cirrhosis. OBJECTIVES: The aim of this study was to evaluate the prevalence and identify early risk factors for severe ACLF and death in hospitalized patients with liver cirrhosis with bacterial infection. PATIENTS AND METHODS: This was a prospective observational study. Hospitalized patients with liver cirrhosis and bacterial infection were included. Clinical and laboratory data and their evolution to organ dysfunction and death were assessed. A statistical analysis were carried out to identify predictors of severe ACLF and in-hospital mortality. RESULTS: This study included 88 patients. ACLF was observed in 62 (70%) patients, with 48 (55%) grade 2 or higher. Of the 27 deaths (31% of all patients), 26 had severe ACLF (54% mortality) (P<0.0001). The independent risk factors for ACLF of at least 2 and death were baseline serum sodium [odds ratio (OR): 0.874; P=0.01, and OR: 0.9, P=0.04], initial MELD (OR: 1.255, P=0.0001, and OR: 1.162, P=0.005), and a recent invasive procedure (OR: 3.169, P=0.01, and OR: 6.648, P=0.003). CONCLUSION: Lower serum sodium values, higher MELD scores at diagnosis of infection, and a recent history of invasive procedures were independent risk factors for severe ACLF and death in patients with cirrhosis and bacterial infection.
Assuntos
Insuficiência Hepática Crônica Agudizada/diagnóstico , Infecções Bacterianas/diagnóstico , Técnicas de Apoio para a Decisão , Hiponatremia/diagnóstico , Cirrose Hepática/diagnóstico , Admissão do Paciente , Sódio/sangue , Insuficiência Hepática Crônica Agudizada/sangue , Insuficiência Hepática Crônica Agudizada/microbiologia , Insuficiência Hepática Crônica Agudizada/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/sangue , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Biomarcadores/sangue , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Progressão da Doença , Feminino , Mortalidade Hospitalar , Humanos , Hiponatremia/sangue , Hiponatremia/mortalidade , Pacientes Internados , Cirrose Hepática/sangue , Cirrose Hepática/microbiologia , Cirrose Hepática/mortalidade , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Adulto JovemRESUMO
Background: Tolerance and response to antiviral HCV treatment is poor in advanced fibrosis. The aim of this study was to assess SVR rate and its predictive factors in HCV advanced fibrosis patients treated in real life with full dose PEG-IFN plus RBV and to evaluate the adverse events related to treatment. Methods: A multicentric, retrospective study was conducted at six university hospitals. METAVIR F3 and F4 HCV monoinfected patients who were treated with PEG-IFN and RBV had their data analyzed. A stepwise logistic regression analysis was performed to identify the variables independently related to SVR. Adverse events were recorded during treatment. Results: 308 patients were included, 75% genotype 1 and 23% genotype 3. METAVIR F3 was present in 39% and F4 in 61% of patients. The median Child Pugh score for F4 patients was 5 (5–9). The global SVR rate was 34%, 11% were relapsers and 55% were nonresponders. SVR rates were similar between patients treated with PEG-IFN alfa 2a or alfa 2b (p = 0.24). SVR rates according to Child–Pugh score were 26% (Child A) and 18% (Child B). The independent factors related to SVR in F4 patients were genotype 3, RVR and fewer Child Pugh score points. Treatment interruption occurred in 31% patients and death occurred in 1.9%, all with liver cirrhosis. Conclusion: Treatment of HCV in patients with advanced fibrosis should not be postponed. However, a very careful evaluation of cirrhotic patients must be performed before treatment is indicated and careful monitoring is required during treatment. .
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antivirais/administração & dosagem , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/administração & dosagem , Cirrose Hepática/etiologia , Polietilenoglicóis/administração & dosagem , Ribavirina/administração & dosagem , Antivirais/efeitos adversos , Quimioterapia Combinada/métodos , Genótipo , Hepacivirus/genética , Hepatite C Crônica/complicações , Hepatite C Crônica/virologia , Interferon-alfa/efeitos adversos , Valor Preditivo dos Testes , Polietilenoglicóis/efeitos adversos , Estudos Retrospectivos , RNA Viral/genética , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Ribavirina/efeitos adversos , Índice de Gravidade de Doença , Carga ViralRESUMO
BACKGROUND: Tolerance and response to antiviral HCV treatment is poor in advanced fibrosis. The aim of this study was to assess SVR rate and its predictive factors in HCV advanced fibrosis patients treated in real life with full dose PEG-IFN plus RBV and to evaluate the adverse events related to treatment. METHODS: A multicentric, retrospective study was conducted at six university hospitals. METAVIR F3 and F4 HCV monoinfected patients who were treated with PEG-IFN and RBV had their data analyzed. A stepwise logistic regression analysis was performed to identify the variables independently related to SVR. Adverse events were recorded during treatment. RESULTS: 308 patients were included, 75% genotype 1 and 23% genotype 3. METAVIR F3 was present in 39% and F4 in 61% of patients. The median Child Pugh score for F4 patients was 5 (5-9). The global SVR rate was 34%, 11% were relapsers and 55% were nonresponders. SVR rates were similar between patients treated with PEG-IFN alfa 2a or alfa 2b (p=0.24). SVR rates according to Child-Pugh score were 26% (Child A) and 18% (Child B). The independent factors related to SVR in F4 patients were genotype 3, RVR and fewer Child Pugh score points. Treatment interruption occurred in 31% patients and death occurred in 1.9%, all with liver cirrhosis. CONCLUSION: Treatment of HCV in patients with advanced fibrosis should not be postponed. However, a very careful evaluation of cirrhotic patients must be performed before treatment is indicated and careful monitoring is required during treatment.
Assuntos
Antivirais/administração & dosagem , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/administração & dosagem , Cirrose Hepática/etiologia , Polietilenoglicóis/administração & dosagem , Ribavirina/administração & dosagem , Antivirais/efeitos adversos , Quimioterapia Combinada/métodos , Feminino , Genótipo , Hepacivirus/genética , Hepatite C Crônica/complicações , Hepatite C Crônica/virologia , Humanos , Interferon-alfa/efeitos adversos , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/efeitos adversos , Valor Preditivo dos Testes , RNA Viral/genética , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Estudos Retrospectivos , Ribavirina/efeitos adversos , Índice de Gravidade de Doença , Carga ViralRESUMO
OBJECTIVE: Infection with hepatitis C virus (HCV) is a serious public health problem worldwide. In clinical studies, weight loss has been reported in 11% to 29% of patients treated with pegylated interferon-α-2a/2b. Few reports have tried to explain such a weight loss. The aim of this study was to evaluate nutritional status, body composition, and resting energy expenditure (REE) in patients with chronic hepatitis C before and during treatment with pegylated interferon and ribavirin. METHODS: This was a prospective study with the evaluation of patients with hepatitis C virus before and after 12 wk of treatment with pegylated interferon and ribavirin. The evaluation consisted of anthropometry (weight, height, body mass index, and waist circumference), and body composition was determined by bioelectrical impedance analysis. The REE of each individual was obtained by indirect calorimetry. To compare the two phases of treatment, the Wilcoxon test was used. The significance level was 5%. RESULTS: Subjects had significant weight loss during treatment with a consequent decrease in body mass index. This weight decrease was accompanied by a significant decrease in body fat and no decrease in fat-free mass. There was a significant decrease in energy intake as assessed by 24-h recall. However, there was no change in REE and in REE corrected for fat-free mass. CONCLUSION: Our study of patients with hepatitis C treatment showed that these patients had significant weight loss and this was not associated with changes in energy expenditure. However, we observed a significant decrease in energy intake, pointing to a possible need for intervention measures to decrease the damage.
Assuntos
Tecido Adiposo/efeitos dos fármacos , Metabolismo Basal/efeitos dos fármacos , Índice de Massa Corporal , Ingestão de Energia/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/efeitos adversos , Polietilenoglicóis/efeitos adversos , Redução de Peso/efeitos dos fármacos , Tecido Adiposo/metabolismo , Adulto , Antivirais/efeitos adversos , Antivirais/uso terapêutico , Compartimentos de Líquidos Corporais/efeitos dos fármacos , Registros de Dieta , Feminino , Hepatite C Crônica/metabolismo , Humanos , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/uso terapêutico , Estudos Prospectivos , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Ribavirina/uso terapêutico , Padrão de Cuidado , Estatísticas não ParamétricasRESUMO
A encefalopatia hepática (EH) é um distúrbio funcional do sistema nervoso central (SNC) associado à insufi ciência hepática, de fisiopatologia multifatorial e complexa. Devido aos avanços no conhecimento sobre o manejo da EH na cirrose e na insuficiência hepática aguda (IHA), a diretoria da Sociedade Brasileira de Hepatologia (SBH) promoveu uma reunião monotemática acerca da fi siopatologia, diagnóstico e tratamento da EH, abordando aspectos controversos relacionados ao tema. Com a utilização de sistemática da medicina baseada em evidências, foram abordados o manejo da EH e da hipertensão intracraniana na IHA, o manejo da EH episódica na cirrose, as controvérsias no manejo da EH e a abordagem da EH mínima. O objetivo desta revisão é resumir os principais tópicos discutidos na reunião monotemática e apresentar recomendações sobre o manejo da síndrome votadas pelo painel de expertos da SBH.
Hepatic encephalopathy (HE) is a functional disorder of the central nervous system (CNS) associated with liver failure, either end-stage chronic liver disease or fulminant hepatic failure. Its pathogenesis remains complex and poorly understood. In view of recent advances in the management of HE, the Brazilian Society of Hepatology endorsed a monothematic meetingregarding HE in order to gather experts in the to discuss related data and to draw evidence-based recommendations concerning: management of HE and intracranial hypertension in FHF, treatment of episodic HE in cirrhosis, controversies in the management of EH including difficult to treat cases and diagnostic and treatment challenges for minimal HE. The purpose of this review is to summarize the lectures and recommendations made by the panel of experts of the Brazilian Society of Hepatology.
Assuntos
Humanos , Encefalopatia Hepática , Fibrose , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/fisiopatologia , Transplante de Fígado , Falência Hepática Aguda , Hipertensão Intracraniana/prevenção & controle , Amônia , Hipertensão PortalRESUMO
Osteodistrofia hepática é distúrbio de mineralização óssea associada à doença hepática crônica, sendo a osteoporose, e mais raramente a osteomalácia, sua forma de apresentação clínica. Apesar de pouco diagnosticada e com prevalência de grande variação na literatura, na maioria das vezes, apresenta-se de forma assintomática e, quando não identificada, aumenta consideravelmente o risco de fratura e sequelas permanentes. Seu diagnóstico, portanto, requer alta suspeição e faz-se, na prática clínica, por meio da avaliação da densitometria óssea. De fisiopatogenia multifatorial, envolve fatores genético, ambiental e do próprio estado clínico-nutricional do paciente. Uma atenção maior deve ser despendida a hepatopatas desnutridos, com cirrose hepática avançada, doença colestática crônica e transplantados pelo maior risco de desmineralização óssea. Nesta revisão, será discorrido sobre o metabolismo fisiológico da síntese óssea e a fisiopatologia do distúrbio de mineralização óssea, desde mecanismos fisiopatogênicos na doença hepática crônica, seu diagnóstico e revisão da terapêutica atual empregada.
Hepatic osteodystrophy is a disorder of bone mineralization associated to liver disease, clinically manifested by osteoporosis and more rarely osteomalacia. Although seldomly diagnosed and varying greatly in literature, most of the time, it presents asymptomatically and, when it is not recognized, it enhances considerably the risk of fracture and permanent sequelae. Indeed it requires a high grade of suspicion and it is confirmed by means of bone densitometry evaluation in clinical practice. Presenting with a multifactorial physiopathology, it involves factors, such as genetical, environmental, and patient clinical-nutritional status. A greater attention must be spent on patients with liver disease, especially those malnourished, with advanced cirrhosis, chronic cholestatic disease, and transplanted, because of a higher risk of bone demineralization. In this data, it will be reviewed the bone synthesis metabolism and the physiopathology of bone mineralization disorder ? since fisiopatogenic mechanisms in chronic liver disease, diagnosis and recent therapeutic review employed.
Assuntos
Humanos , Osteoporose , Desmineralização Patológica Óssea , Osteomalacia , Calcificação Fisiológica , Hepatite Autoimune , Doença Hepática Crônica Induzida por Substâncias e DrogasRESUMO
Osteodistrofia hepática é distúrbio de mineralização óssea associada à doença hepática crônica, sendo a osteoporose, e mais raramente, a osteomalácia, sua forma de apresentação clínica. Apesar de pouco diagnosticada e prevalência com grande variação na literatura, na maioria das vezes, apresenta-se de forma assintomática e, quando não identificada, aumenta consideravelmente o risco de fratura e sequelas permanentes. Seu diagnóstico, portanto, requer alta suspeição e faz-se, na prática clínica, por meio da avaliação da densitometria óssea. De fisiopatogenia multifatorial, envolve fatores genético, ambiental e do próprio estado clínico-nutricional do paciente. Uma atenção maior deve ser despendida a hepatopatas desnutridos, com cirrose hepática avançada, doença colestática crônica e transplantados pelo maior risco de desmineralização óssea. Nesta revisão, será discorrido sobre o metabolismo fisiológico da síntese óssea e a fisiopatologia do distúrbio de mineralização óssea, desde mecanismos fisiopatogênicos na doença hepática crônica, seu diagnóstico e revisão da terapêutica atual empregada.
Hepatic osteodystrophy is a disorder of bone mineralization associated to liver disease, clinically manifested by osteoporosis and more rarely osteomalacia. Although seldomly diagnosed and varying greatly in literature, most of the time, it presents asymptomatically and, when it is not recognized, it enhances considerably the risk of fracture and permanent sequelae. Indeed it requires a high grade of suspicion and it is confirmed by means of bone densitometry evaluation in clinical practice. Presenting with a multifactorial physiopathology, it involves factors, such as genetical, environmental, and patient clinical-nutritional status. A greater attention must be spent on patients with liver disease, especially those malnourished, with advanced cirrhosis, chronic cholestatic disease, and transplanted, because of a higher risk of bone demineralization. In this data, it will be reviewed the bone synthesis metabolism and the physiopathology of bone mineralization disorder - since fisiopatogenic mechanisms in chronic liver disease, diagnosis and recent therapeutic review employed.
Assuntos
Humanos , Masculino , Feminino , Deficiência de Vitamina D , Calcificação Fisiológica , Distúrbios do Metabolismo do Cálcio , Hepatopatias , Hepatopatias/complicações , Osteomalacia , Osteoporose , Colestase , Transplante de Fígado , Hepatite AutoimuneRESUMO
A case of enalapril-induced acute hepatotoxicity with an unusual morphology is described. This morphology was characterized by macro- and microvesicular steatosis associated with neutrophil infiltration and Mallory bodies, occasionally with satellitosis. These alterations were most abundant in zone 1 of the periportal region, less common in zone 2 and rare in zone 3. There was also confluent periportal necrosis with sinusoidal fibrin deposits associated with intense ductal metaplasia and an infiltrate of inflammatory cells that included plasmocytes and a few eosinophils, as well as focal biliary damage. This morphology, that may be referred as "predominantly periportal steatohepatitis", was distinct from that associated with non-alcohol and alcohol-induced steatohepatitis, both initiated in acinar zone 3 and subsequently extended to other zones.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Enalapril/efeitos adversos , Fígado Gorduroso/induzido quimicamente , Fígado/efeitos dos fármacos , Doença Aguda , Adulto , Biópsia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Fígado Gorduroso/patologia , Humanos , Fígado/patologia , Masculino , Necrose , Infiltração de Neutrófilos/efeitos dos fármacosRESUMO
BACKGROUND: The combination of endoscopic band ligation (EBL) with either endoscopic injection sclerotherapy (EIS) or thermal therapy has been shown to reduce recurrence of esophageal varices compared to EBL alone. The aim of this prospective trial was twofold: 1) to evaluate the safety and efficacy of EBL used in association with microwave coagulation (MC), a thermal endoscopic therapy method, for treating esophageal varices and preventing recurrence; and 2) to compare these results to the joint application of EBL and EIS. METHODS: Seventy cirrhotic patients with bleeding esophageal varices were treated with EBL until only thin vessels remained. Thirty-six randomly selected patients received EIS (group A) and 34 received MC (group B) until complete eradication had been achieved. Endoscopic follow-up was performed to detect recurrence. The effectiveness of the treatment was measured using variceal recurrence, rebleeding, intervention complications, and recurrence factors. RESULTS: During follow-up evaluations averaging 34.9 +/- 11.4 months, no significant differences were found between groups A and B in variceal recurrence (27.7 vs. 17.6%, P = 0.31) or rebleeding (8.3 vs. 0%, P = 0.23). Complications were rare, with no difference detected between groups. The presence of gastric varices influenced recurrence with an odds ratio of 3.9 (95% CI 1.14-13.1, P = 0.029). CONCLUSIONS: Application of MC to esophageal varices after band ligation is safe. The post-MC recurrence rate may be comparable to that observed following the combined treatment of EBL and EIS. The presence of gastric varices increases the risk of esophageal variceal recurrence.
Assuntos
Eletrocoagulação/métodos , Varizes Esofágicas e Gástricas/terapia , Micro-Ondas/uso terapêutico , Escleroterapia/métodos , Adulto , Idoso , Terapia Combinada , Eletrocoagulação/efeitos adversos , Endoscopia/métodos , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Seguimentos , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Cirrose Hepática/complicações , Masculino , Micro-Ondas/efeitos adversos , Pessoa de Meia-Idade , Estudos Prospectivos , Escleroterapia/efeitos adversos , Prevenção Secundária , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND: The presence of autonomic dysfunction in nonalcoholic cirrhosis and its influence on intestinal transit and disease outcome still need clarification. GOALS: To investigate the function of the autonomic nervous system in patients with nonalcoholic cirrhosis and the possible associations among autonomic dysfunction, severity of liver disease, disturbed intestinal transit, and the development of complications during follow-up. STUDY: Measurements of heart rate variability obtained by analysis of 24-hour ambulatory electrocardiographic recordings to assess autonomic function and lactulose breath hydrogen test to determine orocecal transit time were performed in 32 patients with nonalcoholic cirrhosis divided into Child A and B. RESULTS: Child B patients showed significantly lower values (P<0.05) of those parameters reflecting parasympathetic (high frequency, log-transformed high frequency, pNN50) and sympathetic function (low frequency, log-transformed low frequency) in comparison with controls and Child A patients. Orocecal transit time values were significantly (P=0.02) higher in Child B patients than in controls, but no relationship was found between delayed orocecal transit time and autonomic dysfunction. During follow-up, 42% of Child B patients developed encephalopathy. This complication was significantly associated with autonomic dysfunction. In addition, in the 4 patients who died the parameters reflecting parasympathetic function were significantly reduced in comparison with those of survivors. CONCLUSIONS: Autonomic dysfunction and delayed intestinal transit are related to the severity of disease in nonalcoholic cirrhosis. Autonomic dysfunction seems to predispose cirrhotic patients to the development of encephalopathy and may be associated with a poor prognosis of these patients.
Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Trânsito Gastrointestinal , Cirrose Hepática/fisiopatologia , Adulto , Testes Respiratórios , Progressão da Doença , Eletrocardiografia Ambulatorial , Feminino , Frequência Cardíaca , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/fisiopatologia , Humanos , Lactulose , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Percutaneous ethanol injection (PEI) is an option for hepatocellular carcinoma (HCC) treatment that is most effective for solitary lesions Assuntos
Carcinoma Hepatocelular/secundário
, Etanol/administração & dosagem
, Injeções Intralesionais/efeitos adversos
, Neoplasias Hepáticas/diagnóstico por imagem
, Inoculação de Neoplasia
, Neoplasias Lipomatosas/secundário
, Ultrassonografia Doppler em Cores/métodos
, Anti-Infecciosos Locais/administração & dosagem
, Anti-Infecciosos Locais/efeitos adversos
, Carcinoma Hepatocelular/diagnóstico por imagem
, Carcinoma Hepatocelular/tratamento farmacológico
, Diagnóstico Diferencial
, Etanol/efeitos adversos
, Seguimentos
, Humanos
, Neoplasias Hepáticas/tratamento farmacológico
, Neoplasias Hepáticas/patologia
, Pessoa de Meia-Idade
, Neoplasias Lipomatosas/diagnóstico por imagem
Assuntos
Duodeno/irrigação sanguínea , Hemorragia Gastrointestinal/terapia , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Derivação Portossistêmica Transjugular Intra-Hepática , Varizes/terapia , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Varizes/etiologiaRESUMO
The role of the spleen in the process of liver fibrosis in schistosomiasis still needs clarification. The aim of this study was to assess the effect of splenectomy on serum levels of two markers of fibrosis, type IV collagen and TIMP-1, in patients with schistosomiasis mansoni. Twenty-four patients with hepatosplenic schistosomiasis mansoni participated in the study. Type IV collagen and TIMP-1 serum levels were measured preoperatively, and after 2 (POD-1) and 60 days (POD-2) of spleen removal. Before splenectomy, both type IV collagen and TIMP-1 serum levels were elevated in the majority of patients. After splenectomy, the levels of type IV collagen showed a significant decrease in relation to the preoperative values both in POD-1 (median pre-splenectomy: 143.7 ng/ml versus 77.01 ng/ml; p=0.04) and POD-2 (103.3 ng/ml; p=0.015). Serum levels of TIMP-1 also showed a significant decrease in relation to the preoperative values both in POD-1 (pre-splenectomy: 585.9 ng/ml versus 196.4 ng/ml; p=0.008) and POD-2 (97.4 ng/ml; p<0.001). There was no difference between POD-1 and POD-2 values for each serum marker. In conclusion, splenectomy in schistosomotic patients was associated with a decrease in serum markers of fibrosis levels, which persisted for at least 60 days. These results suggest that the spleen may play a role in the extra cellular matrix production, and therefore may contribute to liver fibrosis in schistosomiasis mansoni.
Assuntos
Colágeno Tipo IV/sangue , Esquistossomose mansoni/sangue , Esplenectomia , Inibidor Tecidual de Metaloproteinase-1/sangue , Adulto , Biomarcadores , Feminino , Humanos , Cirrose Hepática/sangue , Masculino , Pessoa de Meia-IdadeRESUMO
RACIONAL: A fibrose hepática é caracterizada por um aumento progressivo na quantidade do tecido conjuntivo hepático, que é formado pelo aumento na deposição de componentes da matriz extracelular, tendo sido encontrada grande quantidade desses componentes no fígado de pacientes com esquistossomose mansoni. A laminina e o colágeno tipo IV têm sido investigados em várias doenças hepáticas, mas seu papel na esquistossomose ainda não está esclarecido. OBJETIVOS: Avaliar a fibrose hepática na esquistossomose mansoni através da determinação sérica de laminina e colágeno tipo IV, considerados marcadores séricos de fibrose hepática. PACIENTES E MÉTODOS: Foram incluídos 82 indivíduos, sendo 18 indivíduos normais, como controle e 64 pacientes com esquistossomose mansoni, em suas diferentes formas clínicas: intestinal (grupo I), hepatointestinal (grupo II), hepatoesplênica compensada (grupo III) e hepatoesplênica descompensada (grupo IV). Os níveis séricos de laminina e colágeno tipo IV foram determinados por método imunoenzimático sanduíche. RESULTADOS: Os valores médios de colágeno tipo IV e laminina estiveram significativamente aumentados em pacientes com esquistossomose, quando comparados com os controles. Em relação às formas clínicas, os níveis séricos de colágeno tipo IV estiveram significativamente aumentados nos grupos II e IV, em relação aos controles e entre as formas hepatoesplênica descompensada e intestinal. Os níveis séricos de laminina estiveram significativamente aumentados nos grupos II, III e IV e entre o grupo IV e II. Não foi encontrada correlação entre os valores médios de colágeno tipo IV e laminina com o grau de espessamento periportal, detectado por ultra-sonografia. Foi encontrada correlação positiva entre colágeno tipo IV e laminina nos grupos II e IV. CONCLUSÕES: Os resultados mostram que existe aumento de produção de colágeno tipo IV e laminina na esquistossomose mansoni, surgindo altos níveis desde as fases iniciais do envolvimento hepático da doença, até as formas mais avançadas, sugerindo ser um útil fator para detecção de progressão da doença.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colágeno Tipo IV/sangue , Laminina/sangue , Cirrose Hepática/diagnóstico , Esquistossomose mansoni/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Progressão da Doença , Cirrose Hepática/sangue , Cirrose Hepática/etiologia , Esquistossomose mansoni/complicaçõesRESUMO
Progression of chronic hepatitis C is known to be associated with some factors, but influence of HCV genotypes is still controversial. Association between HCV genotypes and other risk factors was examined to determine which factors are associated with progression of infection. One hundred consecutive anti-HCV positive volunteer blood donors were evaluated for several risk factors, examined for HCV genotypes, and submitted to hepatic biopsy and biochemical exams.HCV genotyping were carried out in 89 patients and hepatic biopsy in 78. Transmission routes were found to be illicit intravenous drug use (26%), Gluconergan use in a non-safe manner (48%) and blood transfusion (15%). HCV genotype was 1 in 45%, 3 in 40%, and it was not associated with the stage of fibrosis or with inflammatory activity. There was no significant association of factors related to infection, chronic alcohol use, or duration of illness, with progression of the lesion. There was a significant association of aminotransferase levels and the fibrosis stage. Univariate analysis showed that the age at contamination, patient's age, GT-gamma, and aminotransferase levels over three times the upper normal limits, were associated with fibrosis stages 2 to 4. Multivariate analysis detected age (odds ratio=1.19), and GT-gamma (odds ratio=2.02) as independent factors.
Assuntos
Doadores de Sangue , Hepacivirus/genética , Hepatite C Crônica/virologia , Cirrose Hepática/patologia , RNA Viral/análise , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Brasil/epidemiologia , Progressão da Doença , Feminino , Genótipo , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores de RiscoRESUMO
Progression of chronic hepatitis C is known to be associated with some factors, but influence of HCV genotypes is still controversial. Association between HCV genotypes and other risk factors was examined to determine which factors are associated with progression of infection. One hundred consecutive anti-HCV positive volunteer blood donors were evaluated for several risk factors, examined for HCV genotypes, and submitted to hepatic biopsy and biochemical exams.HCV genotyping were carried out in 89 patients and hepatic biopsy in 78. Transmission routes were found to be illicit intravenous drug use (26 percent), Gluconergan® use in a non-safe manner (48 percent) and blood transfusion (15 percent). HCV genotype was 1 in 45 percent, 3 in 40 percent, and it was not associated with the stage of fibrosis or with inflammatory activity. There was no significant association of factors related to infection, chronic alcohol use, or duration of illness, with progression of the lesion. There was a significant association of aminotransferase levels and the fibrosis stage. Univariate analysis showed that the age at contamination, patient's age, GT-gamma, and aminotransferase levels over three times the upper normal limits, were associated with fibrosis stages 2 to 4. Multivariate analysis detected age (odds ratio=1.19), and GT-gamma (odds ratio=2.02) as independent factors.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doadores de Sangue , Hepacivirus/genética , Hepatite C Crônica/virologia , Cirrose Hepática/patologia , RNA Viral/análise , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Brasil/epidemiologia , Progressão da Doença , Genótipo , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/patologia , Análise de Regressão , Fatores de RiscoRESUMO
BACKGROUND: Fibrosis is the process of excessive deposition of collagen and other extra cellular matrix components and large amounts of these components have been shown in periovular schistosomal granulomas, especially in the liver. Laminin and type IV collagen have been investigated in various hepatic disorders but their accuracy in fibrosis detection and in the evaluation of its progression in schistosomiasis have not been fully explained. AIM: To measure the serum levels of two markers of fibrosis, laminin and type IV collagen in schistosomiasis. PATIENTS AND METHODS: Sixty-four patients with different clinical forms of schistosomiasis mansoni: intestinal (group I), hepatointestinal (group II), compensated (group III) and decompensated hepatosplenic (group IV) and 18 healthy volunteers were included. RESULTS: Serum type IV collagen and laminin levels were significantly increased in patients compared to controls. At about clinical forms, serum type IV collagen was increased in groups II and IV, compared to controls and was significantly higher in group IV than in group I. Serum laminin was significantly increased in groups II, III and IV and was significantly higher in group IV than in group II. Serum type IV collagen was closely correlated with serum laminin in groups II and IV. CONCLUSIONS: Connective tissue marker levels did not correlate with periportal thickness. In schistosomiasis mansoni there is an increase of type IV collagen and laminin levels at the initial stage of the disease, as well as in advanced forms. We also suggest that these markers may be a useful predictor of disease progression.
Assuntos
Colágeno Tipo IV/sangue , Laminina/sangue , Cirrose Hepática/diagnóstico , Esquistossomose mansoni/sangue , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Esquistossomose mansoni/complicaçõesRESUMO
BACKGROUND/AIMS: Chronic hepatitis by HCV is progressive towards cirrhosis, with variable rate. We evaluated the rate of fibrosis progression (RFP), risk factors associated with advanced fibrosis (F3 and F4), and estimated the evolution time to cirrhosis. METHODS: We transversely selected 142 blood donors infected only with HCV, with a known route of infection, submitted to liver biopsy at admission. RFP= ratio between stage of fibrosis (METAVIR)/estimated duration of infection in years. Non-parametric tests and logistic regression analysis, with significance level of 5% were used. RESULTS: Median RFP was 0.086 U/year (0.05-0.142). Ten patients had F4 and 25 had F3. Median RFP values were significantly different (p=0.001) from one age group at contamination to the others and ALT and AST levels. There were no differences in the expected evolution to cirrhosis between intermediate fibrosers (F2) and the rapid fibrosers (F3 and F4). The independent variables associated with advanced fibrosis were ALT (OR 7.2) and GGT (OR 6.4) and age at inclusion (OR 1.12). CONCLUSION: This study suggests that RFP is extremely variable, it is exponential with age, and mainly influenced by host characteristics, especially age at contamination and possibly ethnical group. These asymptomatic patients had high percentage of fibrosis F2, F3 and F4.
Assuntos
Hepatite C Crônica/patologia , Cirrose Hepática/patologia , Adulto , Doadores de Sangue/estatística & dados numéricos , Progressão da Doença , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Estatísticas não ParamétricasRESUMO
BACKGROUND: The prevalence of anti-hepatitis C virus (HCV) positive test is higher among patients in dialysis and in kidney recipients than in general population. Hepatitis C virus infection is the main cause of chronic liver disease in renal transplant patients. Liver biopsy and virological analysis were performed to clarify the grade of liver damage in kidney recipients. METHODS: Renal recipients patients with at least 5 yr under immunosuppression were submitted to clinical and laboratory analysis. Patients who tested anti-HCV positive were candidates to liver biopsy with no regard to transaminase levels. RESULTS: Forty-five patients tested anti-HCV positive and 42 anti-HCV negative. Twenty-six anti-HCV and RNA-HCV positive patients were submitted to liver biopsy. Seventy-three percentage of these patients presented chronic active hepatitis, from these only one patient presented cirrhosis. Only 29% of the anti-HCV positive group presented elevated alanine aminotransferase levels. Anti-HCV positive patients presented longer previous time on dialysis and less rejection episodes than the group anti-HCV negative (p < 0.05). All anti-HCV positive patients but one tested RNA-HCV positive by polymerase chain reaction (PCR). CONCLUSIONS: In this series the prevalence of anti-HCV positive is 51.7%. Most of the patients presented liver damage in histology caused by HCV. However, we found only mild or minimal fibrosis and inflammatory activity grade, despite 10 yr of HCV infection and 5 yr of immunosuppressive treatment. Only one patient presented cirrhosis (4%). Performing serial liver biopsies in a long-term follow-up is needed to clarify the impact of HCV infection in renal transplant patients.