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Narciso-Schiavon JL, Schiavon LL. Celiac disease screening in patients with cryptogenic cirrhosis. World J Gastroenterol 2023; 29:410-412. [PMID: 36687121 PMCID: PMC9846935 DOI: 10.3748/wjg.v29.i2.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/26/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
We write a letter to the editor commenting the article “Who to screen and how to screen for celiac disease”. We discuss the present literature on cirrhosis and celiac disease (CD) and recommend screening and treating CD in individuals with cryptogenic cirrhosis.
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Affiliation(s)
- Janaina Luz Narciso-Schiavon
- Gastroenterology Division, Internal Medicine Department, Federal University of Santa Catarina, Florianopolis 88040-900, SC, Brazil
| | - Leonardo Lucca Schiavon
- Gastroenterology Division, Internal Medicine Department, Federal University of Santa Catarina, Florianopolis 88040-900, SC, Brazil
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Matiollo C, Rateke ECDM, Moura EQDA, Andrigueti M, Augustinho FCD, Zocche TL, Silva TE, Gomes LO, Farias MR, Narciso-Schiavon JL, Schiavon LL. Elevated calprotectin levels are associated with mortality in patients with acute decompensation of liver cirrhosis. World J Hepatol 2022; 14:1964-1976. [PMID: 36483607 PMCID: PMC9724106 DOI: 10.4254/wjh.v14.i11.1964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute decompensation (AD) of cirrhosis is related to systemic inflammation and elevated circulating cytokines. In this context, biomarkers of inflammation, such as calprotectin, may be of prognostic value.
AIM To evaluate serum calprotectin levels in patients hospitalized for complications of cirrhosis.
METHODS This is a prospective cohort study that included 200 subjects hospitalized for complications of cirrhosis, 20 outpatients with stable cirrhosis, and 20 healthy controls. Serum calprotectin was measured by enzyme-linked immunosorbant assay.
RESULTS Calprotectin levels were higher among groups with cirrhosis when compared to healthy controls. Higher median calprotectin was related to Child-Pugh C, ascites, and hepatic encephalopathy. Higher calprotectin was related to acute-on-chronic liver failure (ACLF) and infection in the bivariate, but not in multivariate analysis. Calprotectin was not associated with survival among patients with ACLF; however, in patients with AD without ACLF, higher calprotectin was associated with a lower 30-d survival, even after adjustment for chronic liver failure-consortium (CLIF-C) AD score. A high-risk group (CLIF-C AD score ≥ 60 and calprotectin ≥ 580 ng/mL) was identified, which had a 30-d survival (27.3%) similar to that of patients with grade 3 ACLF (23.3%).
CONCLUSION Serum calprotectin is associated with prognosis in patients with AD without ACLF and may be useful in clinical practice to early identify patients with a very low short-term survival.
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Affiliation(s)
- Camila Matiollo
- Clinical Analysis Laboratory Unit, University Hospital, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil
| | | | | | - Michelle Andrigueti
- Clinical Analysis Laboratory Unit, University Hospital, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil
| | | | - Tamara Liana Zocche
- Division of Gastroenterology, University Hospital, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
| | - Telma Erotides Silva
- Division of Gastroenterology, University Hospital, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
| | - Lenyta Oliveira Gomes
- Department of Pharmaceutical Sciences Health Sciences Center, Federal University of Santa Catarina, Florianópolis 88040-370, Brazil
| | - Mareni Rocha Farias
- Department of Pharmaceutical Sciences Health Sciences Center, Federal University of Santa Catarina, Florianópolis 88040-370, Brazil
| | - Janaina Luz Narciso-Schiavon
- Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis 88040-900, SC, Brazil
| | - Leonardo Lucca Schiavon
- Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis 88040-900, SC, Brazil
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Duodenal Ulcers as Manifestation of Eosinophilic Gastroenteritis. JCRMH 2022. [DOI: 10.54289/jcrmh2200130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The most common causes of duodenal ulcer are Helicobacter pylori infection and use of non-steroidal anti-inflammatory drugs (NSAIDs). We present a case of a patient with back pain, food impaction and nail dystrophy who exhibited eosinophilic esophagitis and duodenal ulcers via upper digestive endoscopy (UDE). Helicobacter pylori was not identified after repeated investigations with UDE and serology, and there was no healing of the ulcer with the use of a proton pump inhibitor after two years and suspension of NSAIDs. The etiology of the ulcer was identified by biopsy with the presence of eosinophils characterizing eosinophilic gastroenteritis. There was complete remission of the esophageal and duodenal symptoms, resolution of UDE lesions and normalization of the nails with oral prednisone 20mg for three months.
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Morais Rateke EC, Matiollo C, de Andrade Moura EQ, Andrigueti M, Maccali C, Fonseca JS, Canova SMF, Narciso-Schiavon JL, Schiavon LL. Low sodium to potassium ratio in spot urine sample is associated with progression to acute kidney injury and mortality in hospitalized patients with cirrhosis. Dig Liver Dis 2021; 53:1159-1166. [PMID: 33446446 DOI: 10.1016/j.dld.2020.12.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/04/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND sodium to potassium ratio in spot urine sample (Na/Kur) is a surrogate marker of sodium excretion that is recommended for the management of patients with ascites due to cirrhosis. AIMS to investigate Na/Kur ratio and fractional excretion of sodium (FENa) in patients admitted with decompensated cirrhosis, evaluating its relationship with acute kidney injury (AKI) and prognosis. METHODS prospective cohort study included 225 adult subjects. Urine samples were obtained within 48 h of hospitalization. RESULTS AKI at admission was observed in 32.9% of patients and was associated with lower Na/Kur ratio, but not FENa. Among 151 subjects initially without kidney dysfunction, AKI at some point during hospitalization occurred in 26.2% and was independently associated with low Na/Kur ratio at admission. AKI was observed in 44% of the patients with Na/Kur ratio < 1 and only in 8% when values ≥ 2. Na/Kur ratio at admission was independently associated with 30-day mortality, with Kaplan-Meier survival probability of 78.8% for Na/Kur ratio < 1 and 93.6% for values ≥ 1. CONCLUSIONS low Na/Kur ratio in spot urine sample is associated with progression to AKI and lower short-term survival in patients hospitalized for decompensated cirrhosis.
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Affiliation(s)
| | - Camila Matiollo
- Unidade de Laboratório de Análises Clínicas, Hospital Universitário, Universidade Federal de Santa Catarina, Brazil
| | | | - Michelle Andrigueti
- Unidade de Laboratório de Análises Clínicas, Hospital Universitário, Universidade Federal de Santa Catarina, Brazil
| | - Claudia Maccali
- Serviço de Gastroenterologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Janaína Sant'Ana Fonseca
- Serviço de Gastroenterologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | | | - Janaína Luz Narciso-Schiavon
- Serviço de Gastroenterologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Leonardo Lucca Schiavon
- Serviço de Gastroenterologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil.
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Maccali C, Augustinho FCD, Zocche TL, Silva TE, Narciso-Schiavon JL, Schiavon LDL. NEUTROPHIL-LYMPHOCYTE RATIO PREDICTS SHORT-TERM MORTALITY IN PATIENTS HOSPITALIZED FOR ACUTE DECOMPENSATION OF CIRRHOSIS. Arq Gastroenterol 2021; 58:131-138. [PMID: 34287528 DOI: 10.1590/s0004-2803.202100000-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Individuals with cirrhosis have a chronic systemic inflammation associated with an immune dysfunction, affecting the progression of the liver disease. The neutrophil-lymphocyte ratio (NLR) was proposed as a marker of systemic inflammatory response and survival in patients with cirrhosis. OBJECTIVE Evaluate the prognostic role of NLR in cirrhotic patients and its relation with inflammatory cytokines(IL-6, IL-10 and IL-17). METHODS In this prospective study two groups were evaluated: 1) Stable cirrhotic in outpatient follow-up (n=193); 2) Hospitalized cirrhotic for acute decompensation for at least 48 hours (n=334) with admission and 48 hours tests evaluation. Circulating inflammatory cytokines were available for 130 hospitalized patients. RESULTS In outpatients with stable cirrhosis, NLR correlated with MELD score and other variables associated with severity of disease. However, after a median of 32 months of follow up NLR was not associated with mortality (HR 1.058, 95%CI 0.900-1.243; P=0.495). In hospitalized patients, NLR at 48-hour after admission was independently associated with 90-day survival (HR 1.061, 95%CI 1.020-1.103; P=0.003) in multivariate Cox-regression analysis. The 90-day Kaplan-Meier survival probability was 87% for patients with a 48-hour NLR <3.6 and 62% for NLR ≥3.6 (P<0.001). Elevation of NLR in the first 48 hours was also independently associated with mortality (HR 2.038, 95%CI 1295-3207; P=0.002). The 90-day Kaplan-Meier survival probability was 83% when NLR did not increase and 62% when NLR increased (P<0.001). IL-6, IL-10 and IL-17 at admission were positively correlated with both admission and 48-hour NLR. Lower levels of baseline IL-10 were associated with NLR increase during first 48-hour. CONCLUSION NLR evaluated at 48 hours of hospitalization and its early increase after admission were independently associated with short-term mortality in patients hospitalized for acute decompensation of cirrhosis.
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Affiliation(s)
- Claudia Maccali
- Universidade Federal de Santa Catarina, Departamento de Medicina Interna, Divisão de Gastroenterologia, Florianópolis, SC, Brasil
| | - Fernanda Cristina de Augustinho
- Universidade Federal de Santa Catarina, Departamento de Medicina Interna, Divisão de Gastroenterologia, Florianópolis, SC, Brasil
| | - Tamara Liana Zocche
- Universidade Federal de Santa Catarina, Departamento de Medicina Interna, Divisão de Gastroenterologia, Florianópolis, SC, Brasil
| | - Telma Erotides Silva
- Universidade Federal de Santa Catarina, Departamento de Medicina Interna, Divisão de Gastroenterologia, Florianópolis, SC, Brasil
| | - Janaína Luz Narciso-Schiavon
- Universidade Federal de Santa Catarina, Departamento de Medicina Interna, Divisão de Gastroenterologia, Florianópolis, SC, Brasil
| | - Leonardo de Lucca Schiavon
- Universidade Federal de Santa Catarina, Departamento de Medicina Interna, Divisão de Gastroenterologia, Florianópolis, SC, Brasil
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Borgonovo A, Baldin C, Maggi DC, Victor L, Bansho ETO, Piedade J, Wildner LM, Guimarães L, Bazzo ML, Rocha T, Dantas-Corrêa EB, Alcântara C, Fernandes F, Narciso-Schiavon JL, Pereira GHS, Schiavon LL. Systemic Inflammatory Response Syndrome in Patients Hospitalized for Acute Decompensation of Cirrhosis. Can J Gastroenterol Hepatol 2021; 2021:5581587. [PMID: 33987144 DOI: 10.1155/2021/5581587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although recently challenged, systemic inflammatory response syndrome (SIRS) criteria are still commonly used in daily practice to define sepsis. However, several factors in liver cirrhosis may negatively impact its prognostic ability. Goals. To investigate the factors associated with the presence of SIRS, the characteristics of SIRS related to infection, and its prognostic value among patients hospitalized for acute decompensation of cirrhosis. Study. In this cohort study from two tertiary hospitals, 543 patients were followed up, up to 90 days. Data collection, including the prognostic models, was within 48 hours of admission. RESULTS SIRS was present in 42.7% of the sample and was independently associated with upper gastrointestinal bleeding (UGB), ACLF, infection, and negatively related to beta-blockers. SIRS was associated with mortality in univariate analysis, but not in multiple Cox regression analysis. The Kaplan-Meier survival probability of patients without SIRS was 73.0% and for those with SIRS was 64.7%. The presence of SIRS was not significantly associated with mortality when considering patients with or without infection, separately. Infection in SIRS patients was independently associated with Child-Pugh C and inversely related to UGB. Among subjects with SIRS, mortality was independently related to the presence of infection, ACLF, and Child-Pugh C. CONCLUSIONS SIRS was common in hospitalized patients with cirrhosis and was of no prognostic value, even in the presence of infection.
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Matiollo C, Rateke ECDM, de Oliveira KG, Turnes BL, da Silva TE, Maccali C, Latini AS, Narciso-Schiavon JL, Schiavon LL. Elevated neopterin levels are associated with acute-on-chronic liver failure and mortality in patients with liver cirrhosis. Dig Liver Dis 2020; 52:753-760. [PMID: 32434738 DOI: 10.1016/j.dld.2020.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/09/2020] [Accepted: 03/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Macrophage activation plays a central role in hepatic and systemic inflammation and is involved in the pathogenesis of acute-on-chronic liver failure (ACLF). AIMS This study aimed to investigate neopterin levels in patients admitted for acute decompensation (AD) of cirrhosis, evaluating its relationship with ACLF and prognosis. METHODS This prospective cohort study included 205 adult subjects hospitalized for AD of cirrhosis. Twenty-one healthy subjects and 89 patients with stable cirrhosis were evaluated as controls. RESULTS Circulating neopterin was higher in AD as compared to stable cirrhosis and healthy controls (p<0.001). ACLF was independently associated with higher neopterin levels (OR 1.015, 95% CI 1.002-1.028, p = 0.025). In the multivariate Cox regression analysis, neopterin levels (HR = 1.002, IC 95% 1.000-1.004, p = 0.041), Child-Pugh class C, and ACLF were predictors of 30-day survival. Among patients with ACLF, the Kaplan-Meier survival probability was 71.4% in those with neopterin levels < 25 nmol/L and 31.0% if neopterin ≥ 25 nmol/L (p<0.001). CONCLUSIONS Higher circulating neopterin was associated with ACLF in patients hospitalized for AD of cirrhosis. Neopterin levels were also independently predictors of high short-term mortality, especially among patients with ACLF, and could represent a useful biomarker of macrophage activation in clinical practice.
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Affiliation(s)
- Camila Matiollo
- Laboratório de Análises Clínicas, Hospital Universitário, Universidade Federal de Santa Catarina, Brazil
| | | | - Karina Ghisoni de Oliveira
- Laboratório de Bioenergética e Estresse Oxidativo - LABOX, Universidade Federal de Santa Catarina, Brazil
| | - Bruna Lenfers Turnes
- Laboratório de Bioenergética e Estresse Oxidativo - LABOX, Universidade Federal de Santa Catarina, Brazil
| | - Telma Erotides da Silva
- Serviço de Gastroenterologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Claudia Maccali
- Serviço de Gastroenterologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Alexandra Susana Latini
- Laboratório de Bioenergética e Estresse Oxidativo - LABOX, Universidade Federal de Santa Catarina, Brazil
| | - Janaína Luz Narciso-Schiavon
- Serviço de Gastroenterologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - L L Schiavon
- Serviço de Gastroenterologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
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Maggi DC, Borgonovo A, Bansho ET, Soares-Silva PE, Silva TE, Colombo BS, Wildner LM, Bazzo ML, Dantas-Correa EB, Narciso-Schiavon JL, Schiavon LL. Serial assessment of hepatic encephalopathy in patients hospitalised for acute decompensation of cirrhosis. Ann Hepatol 2020; 18:331-337. [PMID: 31053543 DOI: 10.1016/j.aohep.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/22/2018] [Accepted: 11/23/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND AIM Hepatic encephalopathy (HE) is a frequent complication of cirrhosis, but the clinical and prognostic significance of the progression of mental status in hospitalised cirrhotics is unknown. We aimed to investigate the prognostic significance of serial evaluation of HE in patients hospitalised for acute decompensation (AD) of cirrhosis. MATERIALS AND METHODS Patients (n=293) were evaluated for HE (West-Haven criteria) at admission and at day-3 and classified in two groups: (1) Absent or improved HE: HE absent at admission and at day-3, or any improvement at day-3; (2) Unfavourable progression: Development of HE or HE present at admission and stable/worse at day-3. RESULTS Unfavourable progression of HE was observed in 31% of patients and it was independently associated with previous HE, Child-Pugh C and acute-on-chronic liver failure (ACLF). MELD score and unfavourable progression of HE were independently associated with 90-day mortality. The 90-day Kaplan-Meier survival probability was 91% in patients with MELD<18 and absent or improved HE and only 31% in subjects with both MELD≥18 and unfavourable progression of HE. Unfavourable progression of HE was also related to lower survival in patients with or without ACLF. Worsening of GCS at day-3 was observed in 11% of the sample and was related with significantly high mortality (69% vs. 27%, P<0.001). CONCLUSION Among cirrhotics hospitalised for AD, unfavourable progression of HE was associated with high short-term mortality and therefore can be used for prognostication and to individualise clinical care.
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Affiliation(s)
- Dariana C Maggi
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Ariane Borgonovo
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Emília T Bansho
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Pedro E Soares-Silva
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Telma E Silva
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Bruno S Colombo
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Letícia M Wildner
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Maria L Bazzo
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Esther B Dantas-Correa
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | | | - Leonardo L Schiavon
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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Cisilotto J, do Amaral AE, Rosolen D, Rode MP, Silva AH, Winter E, da Silva TE, Fischer J, Matiollo C, Rateke ECDM, Narciso-Schiavon JL, Schiavon LDL, Creczynski-Pasa TB. MicroRNA profiles in serum samples from Acute-On-Chronic Liver Failure patients and miR-25-3p as a potential biomarker for survival prediction. Sci Rep 2020; 10:100. [PMID: 31919459 PMCID: PMC6952390 DOI: 10.1038/s41598-019-56630-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/02/2019] [Indexed: 12/30/2022] Open
Abstract
Acute-on-chronic liver failure (ACLF) is a condition characterized by acute decompensation of cirrhosis, associated with organ failure(s), and high short-term mortality. The microRNAs or miRNAs are small non-coding RNA molecules, stable in circulating samples such as biological fluids, and the difference in expression levels may indicate the presence, absence and/or stage of the disease. We analyzed here the miRNA profiling to identify potential diagnostic or prognostic biomarkers for ACLF. The major miRNAs discovered were validated in a cohort of patients with acute decompensation of cirrhosis grouped in no ACLF or ACLF according to EASL-CLIF definition. Relationship between serum miRNAs and variables associated with liver-damage and survival outcomes were verified to identify possible prognostic markers. Our results showed twenty altered miRNAs between no ACLF and ACLF patients, and twenty-seven in patients who died in 30 days compared with who survived. In validation phase, miR-223-3p and miR-25-3p were significantly altered in ACLF patients and in those who died in 30 days. miR-223-3p and miR-25-3p expression were associated with the lowest survival in 30 days. The decrease in miR-223-3p and miR-25-3p expression was associated with the presence of ACLF and poor prognosis. Of these, miR-25-3p was independently related to ACLF and 30-day mortality.
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Affiliation(s)
- Júlia Cisilotto
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianopolis, 88040-900, SC, Brazil
| | - Alex Evangelista do Amaral
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianopolis, 88040-900, SC, Brazil
| | - Daiane Rosolen
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianopolis, 88040-900, SC, Brazil
| | - Michele Patrícia Rode
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianopolis, 88040-900, SC, Brazil
| | - Adny Henrique Silva
- Department of Biochemistry, Federal University of Santa Catarina, Florianopolis, 88040-900, SC, Brazil
| | - Evelyn Winter
- Department of Agriculture, Biodiversity and Forestry, Federal University of Santa Catarina, Curitibanos, 89520-000, SC, Brazil
| | - Telma Erotides da Silva
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
| | - Josiane Fischer
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
| | - Camila Matiollo
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
| | - Elayne Cristina de Morais Rateke
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
| | - Janaína Luz Narciso-Schiavon
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
| | - Leonardo de Lucca Schiavon
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil.
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COUTO CA, TERRABUIO DRB, CANÇADO ELR, PORTA G, LEVY C, SILVA AEB, BITTENCOURT PL, CARVALHO FILHO RJD, CHAVES DM, MIURA IK, CODES L, FARIA LC, EVANGELISTA AS, FARIAS AQ, GONÇALVES LL, HARRIZ M, LOPES EPDA, LUZ GO, OLIVEIRA PMC, OLIVEIRA EMG, SCHIAVON JLN, SEVÁ-PEREIRA T. UPDATE OF THE BRAZILIAN SOCIETY OF HEPATOLOGY RECOMMENDATIONS FOR DIAGNOSIS AND MANAGEMENT OF AUTOIMMUNE DISEASES OF THE LIVER. Arq Gastroenterol 2019; 56:232-241. [PMID: 31460591 DOI: 10.1590/s0004-2803.201900000-43] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/04/2019] [Indexed: 02/08/2023]
Abstract
ABSTRACT New data concerning the management of autoimmune liver diseases have emerged since the last single-topic meeting sponsored by the Brazilian Society of Hepatology to draw recommendations about the diagnosis and treatment of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), overlap syndromes of AIH, PBC and PSC and specific complications and topics concerning AIH and cholestatic liver diseases. This manuscript updates those previous recommendations according to the best evidence available in the literature up to now. The same panel of experts that took part in the first consensus document reviewed all recommendations, which were subsequently scrutinized by all members of the Brazilian Society of Hepatology using a web-based approach. The new recommendations are presented herein.
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Bansho ETO, Silva PES, Colombo BS, Wildner LM, Bazzo ML, Dantas-Corrêa EB, Schiavon LL, Narciso-Schiavon JL. Prognostic Significance of The New Criteria for Acute Kidney Injury in Cirrhosis. Ann Hepatol 2019; 17:461-469. [PMID: 29735786 DOI: 10.5604/01.3001.0011.7390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND New criteria for acute kidney injury (AKI) in cirrhosis have been proposed, but its prognostic significance is unclear. This study aims to evaluate the prognostic significance of the AKI criteria in cirrhotic patients hospitalized for acute decompensation. MATERIAL AND METHODS This is a prospective cohort study. AKI was defined as an increase in creatinine (Cr) levels ≥ 0.3 mg/dL in 48 h or ≥ 50% of the basal value in the last 7d. AKI was divided into stages 1 (elevation: < 2x basal), 2 (2 or 3x), and 3 (> 3x). RESULTS In this study, 227 patients aged 53.9 ± 11.5 years were included, of whom 37% had AKI (28% AKI1, 5% AKI2, and 4% AKI3). Thirty percent of the patients died or were transplanted within 90 days from causes related to the presence of ascites at hospital admission and higher values of Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) scores, but not to the presence of AKI. In a regression analysis conducted to assess the effect of the final Cr level in patients with AKI, 90-day mortality was associated with ascites, higher CLIF-SOFA score, and AKI with final Cr level ≥ 1.5 mg/dL. The patients with AKI with Cr levels ≥ 1.5 mg/dL showed lower transplant-free survival rates than those without AKI, and those with AKI1 with final Cr level < 1.5 mg/dL. CONCLUSIONS Early AKI was frequent and associated with 90-day mortality or transplantation only when the final Cr level was ≥ 1.5 mg/dL. Distinct approaches are needed for patients with AKI1 according to final Cr.
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Affiliation(s)
- Emilia T O Bansho
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Internal Medicine Department, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Pedro Eduardo S Silva
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Internal Medicine Department, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Bruno S Colombo
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Internal Medicine Department, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Letícia M Wildner
- Department of Clinical Analysis, University Hospital Polydoro Ernani de São Thiago-Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Maria Luiza Bazzo
- Department of Clinical Analysis, University Hospital Polydoro Ernani de São Thiago-Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Esther B Dantas-Corrêa
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Internal Medicine Department, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Leonardo L Schiavon
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Internal Medicine Department, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Janaína L Narciso-Schiavon
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Internal Medicine Department, Federal University of Santa Catarina, Florianopolis, SC, Brazil
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Augustinho FC, Zocche TL, Borgonovo A, Maggi DC, Rateke ECM, Matiollo C, Dantas-Correa EB, Narciso-Schiavon JL, Schiavon LL. Applicability of Sepsis-3 criteria and quick Sequential Organ Failure Assessment in patients with cirrhosis hospitalised for bacterial infections. Liver Int 2019; 39:307-315. [PMID: 30276961 DOI: 10.1111/liv.13980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/12/2018] [Accepted: 09/23/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS An algorithm including Sepsis-3 criteria and quick Sequential Organ Failure Assessment (qSOFA) was recently proposed to predict severity of infection in cirrhosis. However, its applicability among patients without a baseline SOFA available for Sepsis-3 definition is unknown. We sought to investigate the applicability and prognostic value of qSOFA and Sepsis-3 criteria in patients with cirrhosis hospitalised for bacterial infections, without pre-hospitalisation SOFA. METHODS In this cohort study, 164 patients were followed up to 30 days. Data collection, including the prognostic models, was performed at admission and at day-3. RESULTS All patients fulfilled Sepsis-3 criteria (admission SOFA ≥ 2) and, therefore, admission Sepsis-3 was not included in further analysis. Admission qSOFA was an independent predictor of survival (HR = 2.271, P = 0.015). For patients initially classified as high risk by qSOFA, Chronic Liver Failure - Sequential Organ Failure Assessment (CLIF-SOFA) was the only prognostic predictor. Among patients initially classified as low risk by qSOFA, the following parameters evaluated at day-3 were independent predictors of survival: qSOFA, acute-on-chronic liver failure, and Child-Pugh classification. Although not independently related to survival, Sepsis-3 criteria at day-3 was associated with lower 30-day survival in Kaplan-Meier analysis (66% vs 85%, P = 0.008). However, prognosis was better predicted by day-3 qSOFA, with 30-day Kaplan-Meier survival probability of 88% when qSOFA < 2 and 24% among those with qSOFA ≥ 2. CONCLUSION Sepsis-3 criteria evaluated at admission are very limited in infected patients with cirrhosis without baseline SOFA. qSOFA was independently related to survival and appears to be a valuable tool for determining severity of infection and to follow patients initially classified as low risk.
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Affiliation(s)
- Fernanda C Augustinho
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Tamara L Zocche
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Ariane Borgonovo
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Dariana C Maggi
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Elayne C M Rateke
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Camila Matiollo
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Esther B Dantas-Correa
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | | | - Leonardo L Schiavon
- Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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Neitzke I, Brito HFD, Brandão AB, Schiavon JLN, Schiavon LDL, Buzzoleti FDC. Apresentação clínica da Doença de Creutzfeldt-Jakob como Síndrome Cerebelar. Rev Neurocienc 2019. [DOI: 10.34024/rnc.2009.v17.8606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A doença de Creutzfeldt-Jakob (DCJ) constitui-se na mais comum das doenças priônicas em seres humanos. Apresentamos um caso de DCJ tipo esporádico em um homem de 48 anos, que iniciou quadro de síndrome cerebelar, cuja clínica evoluiu compatível com DCJ associado à alteração do eletroencefalograma (EEG) típica e líquor (LCR) com alteração da proteína 14-3-3. São discutidos os métodos diagnósticos, as expectativas sobre a identificação de fatores de transmissão e a terapêutica atual.
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Narciso-Schiavon JL, Delziovo HA, Santos LEB, Shiozawa MBC, Schiavon LL. Recurrent albendazole-induced acute hepatitis. Rev Colomb Gastroenterol 2018. [DOI: 10.22516/25007440.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
El albendazol es un medicamento usado para tratar infecciones por helmintos y usualmente presenta pocos o ningún efecto secundario. A pesar de que hay un incremento transitorio de enzimas hepáticas luego de su uso, existe poca evidencia en la literatura en la que se reporte lesión hepática luego de automedicación con albendazol. En este informe, el paciente se presentó con hepatitis aguda luego de automedicarse con albendazol. El paciente cuenta además con una historia de episodios similares después de haber usado el fármaco. Se evaluada la causalidad con el método de evaluación de causalidad de Roussel Uclaf del Concejo para Organizaciones Internacionales de Ciencias Médicas, cuyo resultado fue un puntaje de 10, lo que indicó una alta probabilidad de lesión hepática inducida por albendazol al cabo de realizarse una investigación rigurosa y de excluir otras posibles causas de la condición física del paciente. En conclusión, aunque es ideal agilizar el proceso para combatir a los helmintos, es necesario intensificar la necesidad de monitorizaciones de calidad para evitar reacciones adversas como la hepatitis inducida por medicamentos. Asimismo, la automedicación de cualquier medicamento debe ser siempre evitada.
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15
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Amaral AED, Rode MP, Cisilotto J, Silva TED, Fischer J, Matiollo C, Morais Rateke ECD, Narciso-Schiavon JL, Schiavon LL, Creczynski-Pasa TB. MicroRNA profiles in serum samples from patients with stable cirrhosis and miRNA-21 as a predictor of transplant-free survival. Pharmacol Res 2018; 134:179-192. [PMID: 29935272 DOI: 10.1016/j.phrs.2018.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 12/19/2022]
Abstract
MicroRNAs (miRNAs) have remarkable potential as diagnostic and prognostic markers because of their roles in disease pathogenesis. miRNAs can be released into the bloodstream, where they are sufficiently stable to be detected noninvasively. Here, we prospectively evaluated serum levels of miR-21, miR-34a, miR-122, miR-181b, and miR-885-5p in patients with stable cirrhosis. Total RNA was extracted from the sera of patients with cirrhosis and healthy individuals, and the expression levels of the target miRNAs were analyzed by reverse transcription-quantitative polymerase chain reaction. Serum miRNAs levels were correlated with liver function parameters, etiology, and complications of cirrhosis. Circulating miR-34a, miR-122, and miR-885-5p levels were higher in patients with cirrhosis than in healthy individuals. These miRNAs were positively correlated with alanine aminotransferase and aspartate aminotransferase levels, and the relative expression levels were higher in hepatitis C virus-infected patients and lower in patients with Child-Pugh C cirrhosis. miR-122 and miR-885-5p levels were also positively correlated with γ-glutamyl transpeptidase concentrations. miR-21 was associated with transplant-free survival in univariate Cox regression analysis and remained independently associated with survival after adjustment for age, Child-Pugh classification, Model for End-stage Liver Disease score, and history of previous decompensation in multivariate Cox regression analysis. These data suggested that miR-34a, miR-122, and miR-885-5p levels may be more related to the inflammatory process and ongoing hepatocyte damage in patients with cirrhosis. Moreover, miR-21 levels were independently associated with shorter transplant-free survival and may be used as a prognostic tool in outpatients with stable cirrhosis.
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Affiliation(s)
- Alex Evangelista do Amaral
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Delfino Conti Street, Florianopolis 88040-370, SC, Brazil.
| | - Michele Patrícia Rode
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Delfino Conti Street, Florianopolis 88040-370, SC, Brazil.
| | - Julia Cisilotto
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Delfino Conti Street, Florianopolis 88040-370, SC, Brazil.
| | - Telma Erotides da Silva
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Maria Flora Pausewang Street, Florianopolis 88036-800, SC, Brazil.
| | - Josiane Fischer
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Maria Flora Pausewang Street, Florianopolis 88036-800, SC, Brazil.
| | - Camila Matiollo
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Maria Flora Pausewang Street, Florianopolis 88036-800, SC, Brazil.
| | - Elayne Cristina de Morais Rateke
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Maria Flora Pausewang Street, Florianopolis 88036-800, SC, Brazil.
| | - Janaína Luz Narciso-Schiavon
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Maria Flora Pausewang Street, Florianopolis 88036-800, SC, Brazil
| | - Leonardo Lucca Schiavon
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Maria Flora Pausewang Street, Florianopolis 88036-800, SC, Brazil.
| | - Tânia Beatriz Creczynski-Pasa
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Delfino Conti Street, Florianopolis 88040-370, SC, Brazil.
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Narciso-Schiavon JL, Pereira JG, Silva TE, Bansho ETO, Morato EF, Pinheiro JT, Muraro-Wildner L, Bazzo ML, Dantas-Corrêa EB, Schiavon LL. Circulating levels of pentraxin-3 (PTX3) in patients with liver cirrhosis. Ann Hepatol 2018; 16:780-787. [PMID: 28809733 DOI: 10.5604/01.3001.0010.2789] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the circulating levels of PTX3 were related to the severity of various diseases, there are no studies investigating its role in patients with liver cirrhosis. We aimed to study PTX3 levels in patients with liver cirrhosis. MATERIAL AND METHODS A prospective cohort study included 130 patients hospitalized for acute decompensation of liver cirrhosis, 29 stable cirrhotic outpatients and 32 healthy controls evaluated in a tertiary hospital in Southern Brasil. RESULTS The median PTX3 level was significantly higher in stable cirrhotic patients compared to controls (2.6 vs. 1.1 ng/mL; p < 0.001), hospitalized cirrhotic patients compared to controls (3.8 vs. 1.1 ng/mL; p < 0.001), and hospitalized cirrhotic patients compared to stable cirrhotic patients (3.8 vs. 2.6 ng/mL; p = 0.001). A positive correlation was found between PTX3 and serum creatinine (r = 0.220; p = 0.012), Chronic Liver Failure - Sequential Organ Failure Assessment score (CLIF-SOFA) (r = 0.220; p = 0.010), MELD (r = 0.279; p = 0.001) and Child-Pugh score (r = 0.224; p = 0.010). Significantly higher levels of PTX3 were observed in patients on admission with ACLF (8.9 vs. 3.1 ng/mL; p < 0.001) and MELD score ≥ 20 (6.6 vs. 3.4 ng/mL; p = 0.002). Death within 90 days occurred in 30.8% of patients and was associated with higher levels of PTX3 (5.3 vs. 3.4 ng/mL; p = 0.009). The probability of Kaplan-Meier survival was 77.0% in patients with PTX-3 < 5.3 ng mL (upper tercile) and 53.5% in those with PTX3 ≥ 5.3 ng/mL (p = 0.002). CONCLUSION These results indicate the potential for use of PTX3 as an inflammatory biomarker for the prognosis of patients with hepatic cirrhosis.
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Affiliation(s)
- Janaína L Narciso-Schiavon
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil Núcleo de Estudos em Gastroenterologia e Hepatologia, Department of Internal Medicine
| | - Jéssica G Pereira
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil Núcleo de Estudos em Gastroenterologia e Hepatologia, Department of Internal Medicine
| | - Telma Erotides Silva
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil Núcleo de Estudos em Gastroenterologia e Hepatologia, Department of Internal Medicine
| | - Emília T O Bansho
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil Núcleo de Estudos em Gastroenterologia e Hepatologia, Department of Internal Medicine
| | - Edelton F Morato
- University Hospital Polydoro Ernani de São Thiago - Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil Postgraduate Program in Medical Sciences
| | - José T Pinheiro
- University Hospital Polydoro Ernani de São Thiago - Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil Center for Assessment of Allergic Type Reactions to Drugs
| | - Letícia Muraro-Wildner
- University Hospital Polydoro Ernani de São Thiago - Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil Clinical Analysis Laboratory
| | - Maria Luiza Bazzo
- Department of Clinical Analysis. Federal University of Santa Catarina. Brasil
| | | | - Leonardo L Schiavon
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil Núcleo de Estudos em Gastroenterologia e Hepatologia, Department of Internal Medicine
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da Silva TE, Costa-Silva M, Correa CG, Denardin G, Alencar MLA, Coelho MSPH, Muraro-Wildner L, Luiza-Bazzo M, González-Chica DA, Dantas-Correa EB, Narciso-Schiavon JL, Schiavon LDL. Clinical Significance of Serum Adiponectin and Resistin Levels in Liver Cirrhosis. Ann Hepatol 2018; 17:286-299. [PMID: 29469045 DOI: 10.5604/01.3001.0010.8659] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adiponectin and resistin levels are increased in patients with cirrhosis, but it prognostic significance is unknown. We sought to investigate the factors associated with adiponectin and resistin levels and its clinical significance in patients with cirrhosis. MATERIALS AND METHODS This was a prospective cohort study that included 122 subjects with cirrhosis who attended an outpatient clinic and were initially evaluated in 2012. Serum adiponectin and resistin levels were measured in samples collected in 2012 (adiponectin and resistin) and 2014 (adiponectin). Thirty healthy subjects served as a control group. RESULTS Higher adiponectin (21.59 μ g/mL vs. 12.52 μg/mL, P < 0.001) and resistin levels (3.83 ng/mL vs. 2.66 ng/mL, P < 0.001) were observed among patients with cirrhosis compared to controls. Patients classified as Child-Pugh B/C had higher adiponectin levels in relation to Child-Pugh A patients. At second measurement, adiponectin levels increased significantly in non-transplant patients and decreased in liver transplant recipients. Univariate Cox analysis showed that among patients with alcoholic liver disease, adiponectin levels were associated with lower transplant-free survival (HR = 1.034, 95% CI 1.006 - 1.062, P = 0.016). The transplant-free survival was significantly lower among patients with alcoholic liver disease and adiponectin ≥ 17 μg/mL (26.55 months, 95% CI 21.40-31.70) as compared to those with levels < 17 μg/mL (33.76 months, 95% CI 30.70-36.82) (P = 0.045). No relationship was found between the levels of resistin and survival. CONCLUSION Adiponectin but not resistin levels were associated with intensity of liver dysfunction and worse prognosis in patients with alcoholic liver disease, suggesting a potential as a prognostic biomarker.
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Affiliation(s)
- Telma Erotides da Silva
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Division of Gastroenterology
| | - Mariana Costa-Silva
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Division of Gastroenterology
| | - Carina G Correa
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Division of Gastroenterology
| | - Giovana Denardin
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Division of Gastroenterology
| | - Maria L Ayres Alencar
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Nutrition and Dietetic Service
| | | | - Letícia Muraro-Wildner
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Department of Clinical Analysis
| | - Maria Luiza-Bazzo
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Department of Clinical Analysis
| | - David A González-Chica
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Post-Graduate Program in Nutrition
| | | | - Janaína L Narciso-Schiavon
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Division of Gastroenterology
| | - Leonardo de Lucca Schiavon
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Division of Gastroenterology
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Affiliation(s)
- Leonardo de Lucca Schiavon
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina. Brasil
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WALTER GUSTAVOPALMEIRO, SEIDEL WILLIAM, GIUSTINA RENATADELLA, BINS-ELY JORGE, MAURICI ROSEMERI, NARCISO-SCHIAVON JANAÍNALUZ. PROGNOSTIC FACTORS IN PATIENTS WITH PRESSURE SORES IN A UNIVERSITY HOSPITAL IN SOUTHERN BRAZIL. Acta Ortop Bras 2017; 25:243-247. [PMID: 29375252 PMCID: PMC5782856 DOI: 10.1590/1413-785220172506169042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective: Despite advances in medical care, patients who are hospitalized or have spinal cord injuries often develop pressure sores. The objective of this study was to describe the epidemiological characteristics of pressure sores and evaluate factors associated with recurrence and cure. Methods: In this historical cohort study, clinical and laboratory data were collected from medical records between 1997 and 2016. Results: Sixty individuals with pressure ulcers were included; mean patient age was 38.1±16.5 (37.0) years, 83.3% were men, and 86.8% identified as white. Most patients (85.1%) had paraplegia, amputation, or trauma of the lower limbs with motor sequelae; the remainder (14.9%) were quadriplegic. Most (78.3%) underwent surgery, and the mean follow-up time was 1.8±2.5 years. The lesions were cured in 25 patients; they recurred in 25% of the patients, and recurrence was seen to be associated with the location of the lesions. Patients with recurrent lesions had more medical consultations and a longer treatment time. Individuals whose ulcers had healed had fewer lesions, higher body mass index (BMI), and a higher proportion of these patients underwent surgery. Conclusions: BMI and location and number of lesions are prognostic factors. Level of Evidence IV, Case Series.
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Thereza-Filho MA, Bansho ETO, Tonon D, I-Ching L, Dantas-Corrêa EB, Cunha VJL, Schiavon LL, Narciso-Schiavon JL. Recurrent anaemia in a patient with lymphocytic gastritis and vitamin B 12 deficiency. Arab J Gastroenterol 2017; 18:165-168. [PMID: 28943131 DOI: 10.1016/j.ajg.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 11/10/2016] [Accepted: 09/05/2017] [Indexed: 12/17/2022]
Abstract
Lymphocytic gastritis is an idiopathic disease, characterized by intraepithelial infiltration of large numbers of T lymphocytes and often described in association with coeliac disease and Helicobacter pylori infection. Although usually associated with iron deficiency anaemia, there is no description on the association between lymphocytic gastritis and secondary vitamin B12 deficiency anaemia. We describe a rare case of recurrent anaemia in a patient with lymphocytic gastritis reversed with vitamin B12 replacement.
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Affiliation(s)
| | - Emília T O Bansho
- Gastroenterology, Internal Medicine Department, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Débora Tonon
- Gastroenterology, Internal Medicine Department, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Lee I-Ching
- Service of Pathology, University Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Esther B Dantas-Corrêa
- Gastroenterology, Internal Medicine Department, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Viriato J L Cunha
- Digestive Endoscopy, University Hospital Polydoro Ernani of São Thiago, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Leonardo L Schiavon
- Gastroenterology, Internal Medicine Department, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Janaína L Narciso-Schiavon
- Gastroenterology, Internal Medicine Department, Federal University of Santa Catarina, Santa Catarina, Brazil.
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Schiavon LL, Narciso-Schiavon JL, Ferraz MLG, Silva AEB, Carvalho-Filho RJ. The γ-glutamyl transpeptidase to platelet ratio (GPR) in HBV patients: just adding up? Gut 2017; 66:1169-1170. [PMID: 27534672 DOI: 10.1136/gutjnl-2016-312658] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 07/29/2016] [Accepted: 07/30/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Leonardo L Schiavon
- Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Janaína L Narciso-Schiavon
- Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Maria Lucia G Ferraz
- Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio E B Silva
- Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Roberto J Carvalho-Filho
- Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil
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Fischer J, Silva TE, Soares e Silva PE, Colombo BS, Silva MC, Wildner LM, Bazzo ML, Rateke ECM, Frode TS, Mello SVD, Rosa JS, Dantas-correa EB, Narciso-schiavon JL, Schiavon LL. From stable disease to acute-on-chronic liver failure: Circulating cytokines are related to prognosis in different stages of cirrhosis. Cytokine 2017; 91:162-9. [PMID: 28082235 DOI: 10.1016/j.cyto.2016.12.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/24/2016] [Accepted: 12/21/2016] [Indexed: 12/19/2022]
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Seidel W, Bins-Ely J, Ongaratto Barazzetti D, Della Giustina R, Walter GP, Ferri TA, Maurici R, Narciso-Schiavon JL. Breast reconstruction after mastectomy for breast cancer: comparative analysis of early and delayed reconstruction. MINERVA CHIR 2017; 72:188-199. [PMID: 28198179 DOI: 10.23736/s0026-4733.17.07314-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Early reconstruction after mastectomy for breast cancer with definitive implants has been widely used, especially with the evolution of conservative surgical breast cancer treatments. We aimed to identify different characteristics associated with plastic surgery, based on immediate or delayed reconstruction time and evaluate quality of life in patients undergoing mastectomy for cancer. METHODS This is a cross-sectional analytical study that evaluated adult patients undergoing mastectomy for breast cancer and breast reconstruction in Plastic Surgery Service at a tertiary hospital. RESULTS Between March 2011 and November 2015, 58 patients who underwent mastectomy were included, with a mean age of 51.6±10.6 years and 98.3% of them being women. Eighty percent of the patients underwent a radical mastectomy and 20% underwent segmentectomies. Immediate and delayed surgical reconstructions occurred in 22.4% and 77.6% of the cases, respectively, including immediate reconstruction with the local flap trade (15.5%), immediate reconstruction with prosthesis (6.9%), transverse rectus abdominis myocutaneous (TRAM) flap (6.9%), delayed reconstruction with local flap (8.6%), expander and prosthesis (35.7%), and reconstruction with latissimus dorsi flap and prosthesis (22.4%). When comparing subjects undergoing reconstructive surgery based on timing of reconstruction, it was observed that patients undergoing delayed breast reconstruction surgery presented a higher proportion of radical mastectomy (90.7% vs. 41.7%; P=0.001) and the need for two or more surgical interventions (64.1% vs. 20.0%; P=0.029). There was no difference in the quality of life according to reconstruction time. CONCLUSIONS The characteristics associated with postmastectomy reconstruction timing are related to preoperative factors such as the procedure employed and the number of interventions performed and have no influence on complications or the quality of life.
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Affiliation(s)
- William Seidel
- Plastic Surgery Unit, University Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina, Florianópolis, Brazil - .,Postgraduate Program in Intensive and Palliative Care, Centre of Health Sciences, Federal University of Santa Catarina, Florianópolis, Brazil -
| | - Jorge Bins-Ely
- Plastic Surgery Unit, University Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Daniel Ongaratto Barazzetti
- Plastic Surgery Unit, University Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Renata Della Giustina
- Gastroenterology and Hepatology Unit, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Gustavo P Walter
- Plastic Surgery Unit, University Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina, Florianópolis, Brazil.,Postgraduate Program in Intensive and Palliative Care, Centre of Health Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Thiago A Ferri
- Plastic Surgery Unit, University Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina, Florianópolis, Brazil.,Postgraduate Program in Intensive and Palliative Care, Centre of Health Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Rosemeri Maurici
- Postgraduate Program in Intensive and Palliative Care, Centre of Health Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Janaína L Narciso-Schiavon
- Postgraduate Program in Intensive and Palliative Care, Centre of Health Sciences, Federal University of Santa Catarina, Florianópolis, Brazil.,Gastroenterology and Hepatology Unit, Federal University of Santa Catarina, Florianópolis, Brazil
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Narciso-Schiavon JL, Schiavon LL. To screen or not to screen? Celiac antibodies in liver diseases. World J Gastroenterol 2017; 23:776-791. [PMID: 28223722 PMCID: PMC5296194 DOI: 10.3748/wjg.v23.i5.776] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/28/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is a systemic immune-mediated disorder triggered by dietary gluten in genetically predisposed individuals. The typical symptoms are anemia, diarrhea, fatigue, weight loss, and abdominal pain. CD has been reported in patients with primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis, aminotransferase elevations, nonalcoholic fatty liver disease, hepatitis B, hepatitis C, portal hypertension and liver cirrhosis. We evaluate recommendations for active screening for CD in patients with liver diseases, and the effect of a gluten-free diet in these different settings. Active screening for CD is recommended in patients with liver diseases, particularly in those with autoimmune disorders, steatosis in the absence of metabolic syndrome, noncirrhotic intrahepatic portal hypertension, cryptogenic cirrhosis, and in the context of liver transplantation. In hepatitis C, diagnosis of CD can be important as a relative contraindication to interferon use. Gluten-free diet ameliorates the symptoms associated with CD; however, the associated liver disease may improve, remain the same, or progress.
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Schiavon LL, Silva TE, Fischer J, Narciso-Schiavon JL. Letter: proton pump inhibitors and prognosis of cirrhosis - searching for the balance point. Aliment Pharmacol Ther 2017; 45:378-379. [PMID: 27933687 DOI: 10.1111/apt.13873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- L L Schiavon
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - T E Silva
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - J Fischer
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - J L Narciso-Schiavon
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Florianopolis, SC, Brazil
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Colombo BDS, Ronsoni MF, Soares E Silva PE, Fayad L, Wildner LM, Bazzo ML, Dantas-Correa EB, Narciso-Schiavon JL, Schiavon LL. Prognostic significance of insulin-like growth factor-I serum levels in acute decompensation of cirrhosis. Biomarkers 2016; 22:127-132. [PMID: 27775431 DOI: 10.1080/1354750x.2016.1252949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT IGF-I serum levels are suppressed in cirrhosis, but its prognostic significance is unknown. OBJECTIVES To investigate the prognostic value of IGF-I in patients admitted for acute decompensation of cirrhosis. MATERIALS AND METHODS Cohort study that included 103 patients. IGF-I was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS Ninety-day mortality was 26.2% and it was independently associated with MELD, age and IGF-I. The Kaplan-Meier survival probability at 90 days was 94.3% in patients with IGF-I ≥13 ng/mL and 63.2% for patients with IGF-I <13 ng/mL (p = .001). DISCUSSION AND CONCLUSION IGF-I levels are independently associated with mortality in acute decompensation of cirrhosis.
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Affiliation(s)
| | | | | | - Leonardo Fayad
- a Division of Gastroenterology , Federal University of Santa Catarina , Florianópolis , Brazil
| | - Letícia Muraro Wildner
- b Department of Clinical Analysis , Federal University of Santa Catarina , Florianópolis , Brazil
| | - Maria Luiza Bazzo
- b Department of Clinical Analysis , Federal University of Santa Catarina , Florianópolis , Brazil
| | | | | | - Leonardo Lucca Schiavon
- a Division of Gastroenterology , Federal University of Santa Catarina , Florianópolis , Brazil
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Aiko Hatanaka S, De Oliveira e Silva N, Dantas-Corrêa EB, De Lucca Schiavon L, Narciso-Schiavon JL. El efecto de la dieta libre de gluten en la alanina- aminotransferasa (ALT) en pacientes celíacos. Rev Colomb Gastroenterol 2016. [DOI: 10.22516/25007440.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Correa CG, Colombo BDS, Ronsoni MF, Soares e Silva PE, Fayad L, Silva TE, Wildner LM, Bazzo ML, Dantas-Correa EB, Narciso-Schiavon JL, Schiavon LDL. Circulating insulin-like growth factor-binding protein 3 as prognostic biomarker in liver cirrhosis. World J Hepatol 2016; 8:739-748. [PMID: 27330683 PMCID: PMC4911508 DOI: 10.4254/wjh.v8.i17.739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/03/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prognostic significance of insulin-like growth factor-binding protein 3 (IGFBP-3) in patients with cirrhosis.
METHODS: Prospective study that included two cohorts: outpatients with stable cirrhosis (n = 138) and patients hospitalized for acute decompensation (n = 189). Development of complications, mortality or liver transplantation was assessed by periodical phone calls and during outpatient visits. The cohort of stable cirrhosis also underwent clinical and laboratory evaluation yearly (2013 and 2014) in predefined study visits. In patients with stable cirrhosis, IGFBP-3 levels were measured at baseline (2012) and at second re-evaluation (2014). In hospitalized subjects, IGFBP-3 levels were measured in serum samples collected in the first and in the third day after admission and stored at -80 °C. IGFBP-3 levels were measured by immunochemiluminescence.
RESULTS: IGFBP-3 levels were lower in hospitalized patients as compared to outpatients (0.94 mcg/mL vs 1.69 mcg/mL, P < 0.001) and increased after liver transplantation (3.81 mcg/mL vs 1.33 mcg/mL, P = 0.008). During the follow-up of the stable cohort, 17 patients died and 11 received liver transplantation. Bivariate analysis showed that death or transplant was associated with lower IGFBP-3 levels (1.44 mcg/mL vs 1.74 mcg/mL, P = 0.027). The Kaplan-Meier transplant-free survival probability was 88.6% in patients with IGFBP-3 ≥ 1.67 mcg/mL and 72.1% for those with IGFBP3 < 1.67 mcg/mL (P = 0.015). In the hospitalized cohort, 30-d mortality was 24.3% and was independently associated with creatinine, INR, SpO2/FiO2 ratio and IGFBP-3 levels in the logistic regression. The 90-d transplant-free survival probability was 80.4% in patients with IGFBP-3 ≥ 0.86 mcg/mL and 56.1% for those with IGFBP3 < 0.86 mcg/mL (P < 0.001).
CONCLUSION: Lower IGFBP-3 levels were associated with worse outcomes in patients with cirrhosis, and might represent a promising prognostic tool that can be incorporated in clinical practice.
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Soares JC, Borgonovo A, Maggi DC, Pasinato AP, Ramos FG, Dantas-Corrêa EB, Schiavon LL, Narciso-Schiavon JL. Liver dysfunction and fibrosis as predictors of biochemical response to autoimmune hepatitis treatment. MINERVA GASTROENTERO 2016; 62:138-47. [PMID: 27091035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Autoimmune hepatitis (AIH) is a disease that presents itself in various forms, ranging from aminotransferase asymptomatic alteration, acute hepatitis to decompensated cirrhosis. Few studies have evaluated the predictive criteria as a response to treatment. METHODS A cross-sectional analytical study examined patients with AIH who were visited in the hepatology clinic of a university hospital between January 2013 and July 2015. RESULTS A total of 36 patients were included (44.7 ± 14.3 years, 22.2% male, and 19.2% of patients presented with liver failure). Patients with significant fibrosis had lower mean aminotransferases and bilirubins and higher mean prothrombin activity (PA) than those with insignificant fibrosis. Most patients (94.5%) underwent treatment with azathioprine and prednisone. In a comparison between individuals who exhibited biochemical response (ALT and AST < 55 U/L in the sixth month of treatment) and those without biochemical response, it was observed that those with biochemical response presented minor proportion of patients with significant fibrosis, and these patients had a higher proportion of liver failure in initial presentation and lower mean PA. Furthermore, it was observed that the lower the PT on admission was, the lower ALT levels (r = 0.682, P = 0.020) and AST (r = 0.431, P = 0.040) in the sixth month of treatment were. CONCLUSIONS Individuals with liver dysfunction and elevated aminotransferases show insignificant fibrosis histologically. AIH patients who initially present liver failure and insignificant fibrosis are more likely to develop biochemical response to treatment.
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Narciso-Schiavon JL, Schiavon LDL, Carvalho-Filho RJD, Emori CT, Maryia FA, Bordin JO, Silva AEB, Ferraz MLG. Clinical and epidemiological profile of female blood donors with positive serology for viral hepatitis B. Rev Soc Bras Med Trop 2016; 48:524-31. [PMID: 26516960 DOI: 10.1590/0037-8682-0157-2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/14/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Since women are frequently the minority among blood donors worldwide, studies evaluating this population usually reflect male features. We assessed the features of female blood donors with positive serology for HBV and compared them with those of men.METHODS The study comprised consecutive blood donors referred to a specialized liver disease center to be evaluated due to HBsAg- and/or anti-HBc-positive tests. RESULTS The study encompassed 1,273 individuals, 219 (17.2%) of whom were referred due to positive HBsAg test and 1,054 (82.8%) due to reactive anti-HBc test. Subjects' mean age was 36.8±10.9 years, and 28.7% were women. Female blood donors referred for positive HBsAg screening tests demonstrated higher prevalence of healthcare workers (9.3% vs 2.5%) and lower prevalence of sexual risk behaviors (15.1% vs 41.1%) and alcohol abuse (1.9% vs 19.8%) compared to men. Women had lower ALT (0.6 vs 0.8×ULN), AST (0.6 vs 0.8×ULN), direct bilirubin (0.2 vs 0.3mg/dL), and alkaline phosphatase (0.5 vs 0.6×ULN) levels and higher platelet count (223,380±50,293 vs 195,020±53,060/mm3). Women also had a higher prevalence of false-positive results (29.6% vs 17.0%). No differences were observed with respect to liver biopsies. Female blood donors referenced for reactive anti-HBc screening tests presented similar clinical, epidemiological, and biochemical characteristics to those reported for positive HBsAg screening tests and similarly had a higher prevalence of false-reactive results. CONCLUSIONS Compared to men, female blood donors with positive HBsAg and/or anti-HBc screening tests demonstrated higher prevalence of professional risk and false-positive results and reduced alteration of liver chemistry.
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Affiliation(s)
- Janaína Luz Narciso-Schiavon
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Leonardo de Lucca Schiavon
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Christine Takemi Emori
- Divisão de Gastroenterologia, Setor de Hepatites, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Fernando Akio Maryia
- Divisão de Gastroenterologia, Setor de Hepatites, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - José Orlando Bordin
- Divisão de Hematologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Maria Lucia Gomes Ferraz
- Divisão de Gastroenterologia, Setor de Hepatites, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Hatanaka SA, Alcaire BP, Ronsoni MF, Schiavon Lde L, Narciso-Schiavon JL. Type 1 diabetic adults should be screened for coeliac autoimmunity. Arab J Gastroenterol 2015; 16:81-2. [PMID: 26526509 DOI: 10.1016/j.ajg.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 05/28/2015] [Accepted: 09/26/2015] [Indexed: 11/20/2022]
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Silva NDOE, Ronsoni MF, Colombo BDS, Corrêa CG, Hatanaka SA, Canalli MHBDS, Schiavon LDL, Narciso-Schiavon JL. Clinical and laboratory characteristics of patients with thyroid diseases with and without alanine aminotransferase levels above the upper tertile - Cross-sectional analytical study. Arch Endocrinol Metab 2015; 60:101-7. [PMID: 26331222 DOI: 10.1590/2359-3997000000066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/06/2015] [Indexed: 11/22/2022]
Abstract
Objective Thyroid disease affects 6.6% of the general population. The liver is fundamental in metabolizing thyroid hormones, and hepatocytes are often affected in thyroid disease. We aimed to compare clinical and laboratory parameters among thyroid disease patients with alanine aminotransferase (ALT) levels above vs. below the upper tertile. Subjects and methods A retrospective cross-sectional analytical study was conducted in the endocrinology clinic at Polydoro Ernani de São Thiago University Hospital. Patients with thyroid disease between August 2012 and January 2014 were included in the study. Clinical and laboratory parameters were collected from medical records. Results One hundred patients were included, of which 14.0% were male, with a mean age of 49.1 ± 14.4 years. ALT levels ranged from 9 to 90 U/L, and the ALT upper tertile was defined as 0,64 times the upper normal limit (xUNL). Patients with ALT levels above the upper tertile exhibited a higher proportion of systemic arterial hypertension (SAH), a higher mean abdominal circumference and a higher frequency of elevated TSH levels than did patients with ALT levels below the upper tertile. In multivariate analysis, ALT ≥ 0.64 (xUNL) was independently associated with abdominal circumference (odds ratio [OR] = 0.087, 95% confidence interval [CI] 0012-0167, P = 0.022). ALT (xUNL) correlated positively with total cholesterol (r = 0.213, P = 0.042). Conclusions In patients with thyroid diseases, it was observed that those with ALT above the upper tertile are associated with abdominal circumference and ALT levels correlate with total cholesterol.
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Affiliation(s)
- Nathanael de Oliveira E Silva
- Divisão de Gastroenterologia, Departamento de Medicina Interna, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | | | | | - Simone Aiko Hatanaka
- Divisão de Gastroenterologia, Departamento de Medicina Interna, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | - Leonardo de Lucca Schiavon
- Divisão de Gastroenterologia, Departamento de Medicina Interna, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Janaína Luz Narciso-Schiavon
- Divisão de Gastroenterologia, Departamento de Medicina Interna, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Hatanaka SA, Silva NO, Colombo BS, Correa CG, Alcaire BP, Coral MH, Schiavon LL, Narciso-Schiavon JL. Factors associated with elevated serum alanine aminotransferase in patients with type 1 diabetes mellitus. MINERVA GASTROENTERO 2015; 61:137-43. [PMID: 26161569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Metabolic syndrome and type 2 diabetes are associated with insulin resistance and hepatic steatosis, which are common causes of alanine aminotransferase (ALT) elevation. This study aims to identify variables associated with altered ALT in type 1 diabetic (DM1) subjects. METHODS A cross-sectional study conducted in the outpatient endocrinology clinic of a university hospital. Patients with DM1 were seen between December 2012 and September 2013; clinical variables were collected from medical records. RESULTS Fifty-six patients were included aged 27 ± 10.1 years; 60.7% were men. The study subjects exhibited an average ALT of 36.7 ± 10.3 U/L (median = 35 U/L) and their average Body Mass Index (BMI) was 23.8 ± 3.8 kg/m2. When comparing individuals with elevated ALT > 35 U/L (N. = 27) with those ALT ≤ 35 U/L (N. = 29), we found that individuals with ALT values > 35 U/L showed a higher proportion of men (77.8% vs. 44.8%, P = 0.012) and a higher mean age (30.2 ± 12.3 vs. 24.6 ± 6.9 years, P = 0.046). When new ALT reference values were applied (19 U/L for women and 30 U/L for men), five individuals had normal ALT values. Individuals with elevated ALT had higher BMI (24.3 vs. 20.9; P = 0.036), fasting glucose (194.8 ± 101.2 vs. 123.6 ± 42.0 mg/dL; P = 0.013) and higher HbA1c (9.9 ± 2.8 vs. 7.8 ± 0.7%; P < 0.001) levels. In Pearson correlation analysis, ALT values correlated with HbA1c (r = 0.285; P = 0.033). CONCLUSION In patients with DM1, elevated ALT values are associated with BMI, fasting glucose and HbA1c.
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Affiliation(s)
- S A Hatanaka
- Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil -
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Costa Silva M, Erotides Silva T, de Alentar MLA, Honório Coelho MSP, Wildner LM, Bazzo ML, González-Chica DA, Dantas-Corrêa EB, Narciso-Schiavon JL, Schiavon LDL. Factors associated with 25-hydroxyvitamin D levels in patients with liver cirrhosis. Ann Hepatol 2015; 14:99-107. [PMID: 25536647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Lower 25-hydroxyvitamin D [25(OH)D] levels have been observed in cirrhotic patients and have been related to disease severity. However, most previous studies included patients with very advanced disease, lacking an adequate control for other variables that could interfere with vitamin D levels. We sought to investigate the prevalence of hypovitaminosis D and the factors related to its occurrence. MATERIAL AND METHODS This cross-sectional study included 133 cirrhotic patients and 30 healthy controls. Bivariate and multivariate analyses were performed to determine factors associated with 25(OH)D levels below the lower tertile. Thirty patients who had been recently hospitalized were compared in two time points. RESULTS Mean 25(OH)D levels were 32.34 ± 11.38 in controls and 27.03 ± 6.22 ng/mL in patients (P = 0.018). 25(OH)D levels were < 30 ng/mL in 69.9% and < 20 ng/mL in 14.3% of the sample. Levels of 25(OH)D below the lower tertile (< 24 ng/mL) were independently associated with higher triceps skinfold and non-Caucasian race. Parathyroid hormone above the reference value (65 pg/mL) was found in 24.6% of patients without association with 25(OH)D or severity of liver disease. Significantly lower levels of 25(OH)D were found at the time of acute decompensation of cirrhosis. CONCLUSIONS In conclusion, hypovitaminosis D was prevalent in cirrhotics and it was associated with adiposity and non-Caucasian race in stable patients with relatively well preserved liver function. However, significantly lower levels were observed during admission for acute decompensation suggesting an impact of systemic inflammation or liver dysfunction on 25(OH)D levels.
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Affiliation(s)
| | | | | | | | | | - Maria Luiza Bazzo
- Department of Clinical Analysis, Federal University of Santa Catarina
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Giustina RD, Marconcini ML, Bansho ET, Tonon D, Pasinato AP, Dantas-Corrêa EB, Schiavon LL, Narciso-Schiavon JL. Factors associated with steatosis in liver biopsies of individuals with chronic hepatitis C infection in southern Brazil. Arab J Gastroenterol 2015; 16:59-62. [PMID: 26169501 DOI: 10.1016/j.ajg.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/04/2015] [Accepted: 06/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND STUDY AIMS Infection by the hepatitis C virus (HCV) is associated with various metabolic disorders that are collectively referred to as dysmetabolic syndrome associated with HCV. Hepatic steatosis is a common finding in chronic HCV infection and has been reported in 30-70% of patients. Here, we determine the prevalence of steatosis in patients with HCV, identify the characteristics associated with the presence of steatosis in liver biopsies and assess the association between steatosis and the severity of liver disease. PATIENTS AND METHODS This analytic cross-sectional study evaluated HCV carriers (adults) at the Gastroenterology and Hepatology Outpatient Clinic of a public university hospital between July 2013 and June 2014 using retrospective data collection. The patients were divided into two groups according to the presence or absence of steatosis in their liver biopsies. The groups were compared for the presence of risk factors for steatosis and clinical, laboratory, virological and histological characteristics. RESULTS One hundred and four patients aged 49.5±9.3 years were included in the study; 56.0% of the patients were men. Steatosis was observed in 65.4% of the liver biopsies. When comparing individuals with and without steatosis, patients with steatosis exhibited a higher proportion of non-1 genotype (43.9 vs. 20.7%; p=0.034), higher median triglyceride levels (101.0 vs. 75.0; p=0.034), ferritin levels (333.0 vs. 193.5; p=0.025) and gamma glutamyl transferase levels (2.92 xULN vs. 1.87; p=0.030). Multivariate analysis demonstrated that triglyceride levels were independently associated with the presence of steatosis (OR=1.016; 95% CI 1.002-1.031; p=0.026). CONCLUSIONS Hepatic steatosis was observed in 65.4% of individuals with HCV. We observed that elevated triglyceride levels were associated independently with the presence of hepatic steatosis; we did not demonstrate an association between hepatic steatosis and histological severity.
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Leal R, Fayad L, Vieira D, Figueiredo T, Lopes A, Carvalho R, Dantas-Corrêa E, Schiavon L, Narciso-Schiavon J. Unusual presentations of eosinophilic gastroenteritis: two case reports. Turk J Gastroenterol 2015; 25:323-9. [PMID: 25141324 DOI: 10.5152/tjg.2014.6735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Eosinophilic gastroenteritis is a rare disease that is characterized by eosinophil infiltration in one or multiple segments of the gastrointestinal tract. The etiology of this condition remains unknown. Eosinophilic gastroenteritis has heterogeneous clinical manifestations that depend upon the location and depth of infiltration in the gastrointestinal tract, and eosinophilia may or may not be present. This article reports two cases of eosinophilic gastroenteritis. The first is that of a 49-year-old woman with abdominal pain, ascites, eosinophilia, and a history of asthma. The second case is that of a 69-year-old male with a history of loss of appetite, belching, postprandial fullness, heartburn, and a 5-kilogram weight loss over a period of 9 months; ultimately, the patient was diagnosed with a gastric outlet obstruction due to pyloric stenosis. The rare character of eosinophilic gastroenteritis and its varied clinical presentations often lead to delayed diagnoses and complications. Case reports may help to disseminate knowledge about the disease, thereby increasing the likelihood of early diagnosis and intervention to prevent complications.
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Affiliation(s)
- Regina Leal
- Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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Schiavon LL, Narciso-Schiavon JL. Benefits of beta-blockers for patients with cirrhosis and infection: do not celebrate too soon! Liver Int 2015; 35:1777-8. [PMID: 25664375 DOI: 10.1111/liv.12800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Leonardo L Schiavon
- Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis, Brazil
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Narciso-Schiavon JL, Schiavon LDL. Autoantibodies in chronic hepatitis C: A clinical perspective. World J Hepatol 2015; 7:1074-1085. [PMID: 26052396 PMCID: PMC4450184 DOI: 10.4254/wjh.v7.i8.1074] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/16/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Non-organ-specific autoantibodies and thyroid autoantibodies have been frequently found in chronic carriers of hepatitis C virus (HCV). With respect to endomysial antibodies and tissue transglutaminase, it is controversial whether the prevalence of gluten-related seromarkers is higher in patients with HCV. In such cases, in addition to acknowledging any currently existing autoimmune disease, recognizing the risk of the patient developing an autoimmune disease during interferon (IFN)-based treatment must be a principle concern. From a clinical point-of-view, the presence of autoantibodies arouses suspicion that an autoimmune disease may be present or may be precipitated by IFN-based HCV treatment. In this paper, we review the prevalence of autoantibodies in individuals with hepatitis C, the clinical significance of these autoantibodies, and the approach recommended for such situations.
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Silva PESE, Fayad L, Lazzarotto C, Ronsoni MF, Bazzo ML, Colombo BS, Dantas-Correa EB, Narciso-Schiavon JL, Schiavon LL. Single-centre validation of the EASL-CLIF consortium definition of acute-on-chronic liver failure and CLIF-SOFA for prediction of mortality in cirrhosis. Liver Int 2015; 35:1516-23. [PMID: 24840673 DOI: 10.1111/liv.12597] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/13/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The idea of acute-on-chronic liver failure (ACLF) has emerged to identify those subjects with organ failure and high mortality rates. However, the absence of a precise definition has limited the clinical application and research related to the ACLF concept. We sought to validate the ACLF definition and the CLIF-SOFA Score recently proposed by the EASL-CLIF Consortium in a cohort of patients admitted for acute decompensation (AD) of cirrhosis. METHODS In this prospective cohort study, patients were followed during their hospital stay and thirty and 90-day mortality was evaluated by phone call, in case of hospital discharge. All subjects underwent laboratory evaluation at admission. RESULTS Between December 2010 and November 2013, 192 cirrhotic patients were included. At enrollment, 46 patients (24%) met the criteria for ACLF (Grades 1, 2 and 3 in 18%, 4% and 2% respectively). The 30-day mortality was 65% in ACLF group and 12% in the remaining subjects (P < 0.001). Logistic regression analysis showed that 30-day mortality was independently associated with ascites and ACLF at admission. The Kaplan-Meier survival probability at 90-day was 92% in patients without ascites or ACLF and only 22% for patients with both ascites and ACLF. The AUROC of CLIF-SOFA in predicting 30-day mortality was 0.847 ± 0.034, with sensitivity of 64%, specificity of 90% and positive likelihood ratio of 6.61 for values ≥9. CONCLUSION In our single-centre experience the CLIF-SOFA and the EASL-CLIF Consortium definition of ACLF proved to be strong predictors of short-term mortality in cirrhotic patients admitted for AD.
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Affiliation(s)
- Pedro E Soares E Silva
- Division of Gastroenterology, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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Guollo F, Narciso-Schiavon JL, Barotto AM, Zannin M, Schiavon LL. Significance of alanine aminotransferase levels in patients admitted for cocaine intoxication. J Clin Gastroenterol 2015; 49:250-5. [PMID: 24518798 DOI: 10.1097/mcg.0000000000000056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Experimental studies in animal models and case reports in humans have described the hepatotoxic potential of cocaine. However, there are few data regarding the clinical and laboratory characteristics of patients admitted for cocaine intoxication, particularly regarding the status of the liver enzymes. GOAL To investigate the significance of alanine aminotransferase (ALT) levels in individuals hospitalized for acute cocaine intoxication. METHODS Retrospective study with standardized chart review that included patients admitted between January 2003 and December 2010. Bivariate analyses were used to investigate factors associated with ALT above the upper tertile according to gender. Cases of marked ALT elevation were described in detail. RESULTS Ninety-three patients were included (79% men, mean age of 27.73±9.97 y). ALT above the upper tertile was associated with higher aspartate aminotransferase (AST), creatine phosphokinase, creatinine, and international normalized ratio. Higher levels of ALT were also related to acute renal failure and death. Five subjects had severe ALT elevation during follow-up and all had evidence of hepatocellular dysfunction (jaundice, prolonged prothrombin time with or without hepatic encephalopathy), rhabdomyolysis, and acute renal failure. AST/ALT ratio <2 was present in 2 subjects with severe ALT elevation at admission, but AST/ALT ratio >2 was observed in 3 cases with evidence of progression to acute liver injury. CONCLUSIONS In acute cocaine intoxication, higher ALT levels were associated with evidence of muscle damage, progression to acute renal failure, and death. Severe liver damage was observed in 5% of the sample and was associated with rhabdomyolysis and renal failure in all cases.
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Affiliation(s)
- Fernanda Guollo
- *Division of Gastroenterology, Federal University of Santa Catarina, Florianópolis †Center for Toxicological Information of Santa Catarina (CIT/SC), SC, Brazil
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Narciso-Schiavon JL, Borgonovo A, Marques PC, Tonon D, Bansho ETO, Maggi DC, Dantas-Corrêa EB, de Lucca Schiavon L. Enterococcus casseliflavus and Enterococcus gallinarum as causative agents of spontaneous bacterial peritonitis. Ann Hepatol 2015. [PMID: 25671838 DOI: 10.1016/s1665-2681(19)30791-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Infection by multidrug resistant bacteria is arousing as a relevant issue among hospitalized subjects and is of particular interest in patients with cirrhosis given the frequent use of broad spectrum antibiotics and their altered immune response. We report the first case report of spontaneous bacterial peritonitis (SBP) caused by Enterococcus casseliflavus and the sixth case of SBP caused by Enterococcus gallinarum.
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Affiliation(s)
- Janaína Luz Narciso-Schiavon
- Department of Internal Medicine, Gastroenterology Division, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Ariane Borgonovo
- Department of Internal Medicine, Gastroenterology Division, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Paula Couto Marques
- Department of Internal Medicine, Gastroenterology Division, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Débora Tonon
- Department of Internal Medicine, Gastroenterology Division, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Emilia Tiemi Oshiro Bansho
- Department of Internal Medicine, Gastroenterology Division, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Dariana Carla Maggi
- Department of Internal Medicine, Gastroenterology Division, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Esther Buzaglo Dantas-Corrêa
- Department of Internal Medicine, Gastroenterology Division, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Leonardo de Lucca Schiavon
- Department of Internal Medicine, Gastroenterology Division, Federal University of Santa Catarina, Florianopolis, SC, Brazil
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Costa Silva M, Erotides Silva T, de Alentar MLA, Honório Coelho MSP, Wildner LM, Bazzo ML, González-Chica DA, Dantas-Corrêa EB, Narciso-Schiavon JL, Schiavon LDL. Factors associated with 25-hydroxyvitamin D levels in patients with liver cirrhosis. Ann Hepatol 2015. [PMID: 25536647 DOI: 10.1016/s1665-2681(19)30806-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Lower 25-hydroxyvitamin D [25(OH)D] levels have been observed in cirrhotic patients and have been related to disease severity. However, most previous studies included patients with very advanced disease, lacking an adequate control for other variables that could interfere with vitamin D levels. We sought to investigate the prevalence of hypovitaminosis D and the factors related to its occurrence. MATERIAL AND METHODS This cross-sectional study included 133 cirrhotic patients and 30 healthy controls. Bivariate and multivariate analyses were performed to determine factors associated with 25(OH)D levels below the lower tertile. Thirty patients who had been recently hospitalized were compared in two time points. RESULTS Mean 25(OH)D levels were 32.34 ± 11.38 in controls and 27.03 ± 6.22 ng/mL in patients (P = 0.018). 25(OH)D levels were < 30 ng/mL in 69.9% and < 20 ng/mL in 14.3% of the sample. Levels of 25(OH)D below the lower tertile (< 24 ng/mL) were independently associated with higher triceps skinfold and non-Caucasian race. Parathyroid hormone above the reference value (65 pg/mL) was found in 24.6% of patients without association with 25(OH)D or severity of liver disease. Significantly lower levels of 25(OH)D were found at the time of acute decompensation of cirrhosis. CONCLUSIONS In conclusion, hypovitaminosis D was prevalent in cirrhotics and it was associated with adiposity and non-Caucasian race in stable patients with relatively well preserved liver function. However, significantly lower levels were observed during admission for acute decompensation suggesting an impact of systemic inflammation or liver dysfunction on 25(OH)D levels.
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Affiliation(s)
| | | | | | | | | | - Maria Luiza Bazzo
- Department of Clinical Analysis, Federal University of Santa Catarina
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Fayad L, Narciso-Schiavon JL, Lazzarotto C, Ronsoni MF, Wildner LM, Bazzo ML, Schiavon LDL, Dantas-Corrêa EB. The performance of prognostic models as predictors of mortality in patients with acute decompensation of cirrhosis. Ann Hepatol 2015. [PMID: 25536645 DOI: 10.1016/s1665-2681(19)30804-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although several prognostic models have been proposed for cirrhotic patients listed for transplantation, the performance of these scores as predictors of mortality in patients admitted for acute decompensation of cirrhosis has not been satisfactorily investigated. AIMS To study MELD, MELD-Na, MESO, iMELD, Refit-MELD and Refit MELD-Na models as prognostic predictors in cirrhotic patients admitted for acute decompensation, and to compare their performance between admission and 48 hours of hospitalization to predict in-hospital mortality. MATERIAL AND METHODS This cohort study included cirrhotic patients admitted to hospital due to complications of the disease. Individuals were evaluated on admission and after 48 h of hospitalization, and mortality was evaluated during the present admission. RESULTS One hundred and twenty-three subjects with a mean age of 54.26 ± 10.79 years were included; 76.4% were male. Mean MELD score was 16.43 ± 7.08 and 52.0% of patients were Child-Pugh C. Twenty-seven patients (22.0%) died during hospitalization. Similar areas under the curve (AUROCs) for prognosis of mortality were observed when different models were compared on admission (P > 0.05) and after 48 h of hospitalization (P > 0.05). When models executed after 48 h of hospitalization were compared to their corresponding model calculated on admission, significantly higher AUROCs were obtained for all models (P < 0.05), except for MELD-Na (P = 0.075) and iMELD (P = 0.119). CONCLUSION The studied models showed similar accuracy as predictors of in-hospital mortality in cirrhotic patients admitted for acute decompensation. However, the performance of these models was significantly better when applied 48 h after admission when compared to their calculation on admission.
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Affiliation(s)
- Leonardo Fayad
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil
| | - Janaína Luz Narciso-Schiavon
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil
| | - César Lazzarotto
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil
| | - Marcelo Fernando Ronsoni
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil
| | | | - Maria Luiza Bazzo
- Department of Clinical Analysis, Federal University of Santa Catarina (UFSC). Brazil
| | - Leonardo de Lucca Schiavon
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil
| | - Esther Buzaglo Dantas-Corrêa
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil
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Ventura A, Ronsoni MF, Shiozawa MBC, Dantas-Corrêa EB, Canalli MHBDS, Schiavon LDL, Narciso-Schiavon JL. Prevalence and clinical features of celiac disease in patients with autoimmune thyroiditis: cross-sectional study. SAO PAULO MED J 2014; 132:364-71. [PMID: 25351758 PMCID: PMC10496779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 11/28/2013] [Accepted: 12/10/2013] [Indexed: 10/18/2022] Open
Abstract
CONTEXT AND OBJECTIVE Celiac disease is an autoimmune disorder with an average prevalence of 1% in Europe and the United States. Because of strong European ancestry in southern Brazil, this study aimed to evaluate the seroprevalence of celiac disease among autoimmune thyroiditis patients. DESIGN AND SETTING Cross-sectional study in a public university hospital. METHODS This cross-sectional prevalence study included autoimmune thyroiditis patients who were tested for anti-endomysial and anti-transglutaminase antibodies between August 2010 and July 2011. RESULTS Fifty-three patients with autoimmune thyroiditis were included; 92.5% were women, with mean age of 49.0 ± 13.5 years. Five patients (9.3%) were serologically positive for celiac disease: three of them (5.6%) were reactive for anti-endomysial antibodies and two (3.7%) for anti-transglutaminase. None of them exhibited anemia and one presented diarrhea. Endoscopy was performed on two patients: one with normal histology and the other with lymphocytic infiltrate and villous atrophy. CONCLUSION The prevalence of celiac disease among patients with autoimmune thyroid disease was 9.3%; one patient complained of diarrhea and none presented anemia. Among at-risk populations, like autoimmune thyroiditis patients, the presence of diarrhea or anemia should not be used as a criterion for indicating celiac disease investigation. This must be done for all autoimmune thyroiditis patients because of its high prevalence.
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Affiliation(s)
- Aline Ventura
- Medical Student. Núcleo de Estudos em Gastroenterologia e Hepatologia (NEGH), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Marcelo Fernando Ronsoni
- MD, MSc. Volunteer Staff, Department of Internal Medicine, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Maria Beatriz Cacese Shiozawa
- MD, MSc. Professor, Department of Pathology, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Esther Buzaglo Dantas-Corrêa
- MD, PhD. Adjunct Professor, Department of Internal Medicine, Gastroenterology Division, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Maria Heloisa Busi da Silva Canalli
- MD, MSc. Attending Physician, Endocrinology Service, "Polydoro Ernani de São Thiago" University Hospital, Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, Santa Catarina, Brazil
| | - Leonardo de Lucca Schiavon
- MD, PhD. Adjunct Professor, Department of Internal Medicine, Gastroenterology Division, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Janaína Luz Narciso-Schiavon
- MD, PhD. Adjunct Professor, Department of Internal Medicine, Gastroenterology Division, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
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Ventura A, Ronsoni MF, Shiozawa MBC, Dantas-Corrêa EB, Canalli MHBDS, Schiavon LDL, Narciso-Schiavon JL. Prevalence and clinical features of celiac disease in patients with autoimmune thyroiditis: cross-sectional study. SAO PAULO MED J 2014. [PMID: 25351758 DOI: 10.1590/1516-3180.2014.1326725] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
CONTEXT AND OBJECTIVE Celiac disease is an autoimmune disorder with an average prevalence of 1% in Europe and the United States. Because of strong European ancestry in southern Brazil, this study aimed to evaluate the seroprevalence of celiac disease among autoimmune thyroiditis patients. DESIGN AND SETTING Cross-sectional study in a public university hospital. METHODS This cross-sectional prevalence study included autoimmune thyroiditis patients who were tested for anti-endomysial and anti-transglutaminase antibodies between August 2010 and July 2011. RESULTS Fifty-three patients with autoimmune thyroiditis were included; 92.5% were women, with mean age of 49.0 ± 13.5 years. Five patients (9.3%) were serologically positive for celiac disease: three of them (5.6%) were reactive for anti-endomysial antibodies and two (3.7%) for anti-transglutaminase. None of them exhibited anemia and one presented diarrhea. Endoscopy was performed on two patients: one with normal histology and the other with lymphocytic infiltrate and villous atrophy. CONCLUSION The prevalence of celiac disease among patients with autoimmune thyroid disease was 9.3%; one patient complained of diarrhea and none presented anemia. Among at-risk populations, like autoimmune thyroiditis patients, the presence of diarrhea or anemia should not be used as a criterion for indicating celiac disease investigation. This must be done for all autoimmune thyroiditis patients because of its high prevalence.
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Affiliation(s)
- Aline Ventura
- Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Marcelo Fernando Ronsoni
- Department of Internal Medicine, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | | | | | - Leonardo de Lucca Schiavon
- Department of Internal Medicine, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Arruda Leal R, Fayad L, Vieira DSC, Figueiredo TMS, Lopes A, Magalhães Carvalho RDO, Dantas-Corrêa EB, Schiavon LL, Narciso-Schiavon JL. Author's reply to the comment titled "Eosinophilic gastroenteritis: the new imitator". Turk J Gastroenterol 2014; 25:601. [PMID: 25417636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Regina Arruda Leal
- Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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Nau AL, Soares JC, Shiozawa MBC, Dantas-Corrêa EB, Schiavon LDL, Narciso-Schiavon JL. Clinical and laboratory characteristics associated with dyslipidemia and liver steatosis in chronic HBV carriers. Rev Soc Bras Med Trop 2014; 47:158-64. [PMID: 24861288 DOI: 10.1590/0037-8682-0009-2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/10/2014] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Chronic hepatitis B virus (HBV) infection and liver steatosis (LS) are the most common causes of chronic liver disease, and their coexistence is frequently observed in clinical practice. Although metabolic syndrome is the main cause of LS, it has not been associated with HBV infection. The aims of this study were to describe the lipid profile and prevalence of LS among HBV carriers and to identify the characteristics associated with LS in this group. METHODS This retrospective cross-sectional study included hepatitis B surface antigen (HBsAg)-positive patients evaluated during 2011 and 2012. RESULTS Of the 83 patients included, the mean age was 46.4±12.5 years, 53% were men, and 9.1% were hepatitis B e antigen (HBeAg) -positive. These patients exhibited the following lipid profile: total cholesterol = 175.4±38.8mg/dL, low-density lipoprotein (LDL) = 113.0±32.7mg/dL, and triglycerides = 91.1±45.2mg/dL. Their fasting glucose was 95.3±14.5g/dL, and fasting insulin was 6.1±5.9µIU/mL. Liver steatosis was observed on abdominal ultrasound in 11.3% of individuals. Factors associated with the presence of LS included higher levels of total cholesterol, prothrombin activity, fasting insulin, and body mass index (BMI) as well as lower levels of aspartate aminotransferase (AST). CONCLUSIONS These findings suggest that LS in patients with chronic HBV appears to be a consequence of metabolic alterations and insulin action rather than of viral factors.
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Affiliation(s)
- Angélica Luciana Nau
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC
| | - Júlia Cristina Soares
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC
| | | | - Esther Buzaglo Dantas-Corrêa
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC
| | - Leonardo de Lucca Schiavon
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC
| | - Janaína Luz Narciso-Schiavon
- Núcleo de Estudos em Gastroenterologia e Hepatologia, Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC
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Barcelos STA, Dantas-Corrêa EB, Alencar MLA, Schiavon LDL, Narciso-Schiavon JL. Características clínicas y de laboratorio en pacientes cirróticos asociada con desnutrición moderada o severa. Rev chil nutr 2014. [DOI: 10.4067/s0717-75182014000200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Narciso-Schiavon JL, Di Giunta G, André MH, Dimatos OC, Dantas-Corrêa EB, Nunes DH, Schiavon LL. Green sweat: an atypical finding in drug-induced liver disease. Liver Int 2014; 34:816-7. [PMID: 24373125 DOI: 10.1111/liv.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Janaína L Narciso-Schiavon
- Gastroenterology Division, Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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