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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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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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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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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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7
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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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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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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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10
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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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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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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, 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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da Graça Ferronato M, Staub LJ, Teixeira Pinto Viana RC, da Rosa L, Cacese Shiozawa MB, Narciso-Schiavon JL, Dantas-Correa EB, de Lucca Schiavon L. Cholestasis as the initial presentation of relapsing polychondritis. Ann Hepatol 2011; 10:565-7. [PMID: 21911901] [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
Relapsing polychondritis is an immune-mediated disease associated with inflammation in cartilaginous structures and other tissues throughout the body, particularly the ears, nose, eyes, joints, and respiratory tract. Although association with other conditions is seen in about one-third of the cases, liver involvement is not usually observed in those patients. We described a case of liver involvement in relapsing polychondritis, presenting with a predominantly cholestatic pattern. Other conditions associated with abnormal liver tests were excluded and the patient showed a prompt response to steroid therapy. We discuss the spectrum of the liver involvement in relapsing and review the literature.
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da Graça Ferronato M, Staub LJ, Teixeira Pinto Viana RC, da Rosa L, Cacese Shiozawa MB, Narciso-Schiavon JL, Dantas-Correa EB, de Lucca Schiavon L. Cholestasis as the initial presentation of relapsing polychondritis. Ann Hepatol 2011. [PMID: 21911901 DOI: 10.1016/s1665-2681(19)31528-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Relapsing polychondritis is an immune-mediated disease associated with inflammation in cartilaginous structures and other tissues throughout the body, particularly the ears, nose, eyes, joints, and respiratory tract. Although association with other conditions is seen in about one-third of the cases, liver involvement is not usually observed in those patients. We described a case of liver involvement in relapsing polychondritis, presenting with a predominantly cholestatic pattern. Other conditions associated with abnormal liver tests were excluded and the patient showed a prompt response to steroid therapy. We discuss the spectrum of the liver involvement in relapsing and review the literature.
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Schiavon LL, Narciso-Schiavon JL, Carvalho-Filho RJ, Sampaio JP, El Batah PN, Silva GA, Carvente CT, Silva AEB, Ferraz MLG. Evidence of a significant role for Fas-mediated apoptosis in HCV clearance during pegylated interferon plus ribavirin combination therapy. Antivir Ther 2011; 16:291-8. [PMID: 21555811 DOI: 10.3851/imp1768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The role of apoptosis in treatment-induced HCV clearance is controversial. We sought to assess the kinetics of serum apoptosis-related cytokines during pegylated interferon-α2a or -α2b plus weight-based ribavirin therapy for genotype 1 chronic HCV infection. METHODS Serum levels of soluble Fas (sFas), soluble Fas ligand (sFasL) and soluble tumour necrosis factor receptor I (sTNF-RI) were measured at baseline, week 12 and 24 weeks after the end of therapy. RESULTS Sustained virological response (SVR) was achieved in 46% of the 164 included patients, 29% had a non-response (NR) and 25% had relapse (RR). NR patients presented with higher levels of sFasL at baseline and lower levels of sTNF-RI at week 12 as compared to RR and SVR patients. Lower concentrations of sFas were observed in SVR patients 24 weeks after treatment as compared to RR and NR patients. An increase in sFas at week 12 followed by a significant drop 24 weeks after therapy was observed among SVR patients. An increase in sFasL during and after treatment was observed in RR and SVR patients. NR patients exhibited an earlier drop in sTNF-RI levels as compared to RR and SVR patients. CONCLUSIONS Virological response during HCV therapy was associated with an increase of sFas and sFasL, and maintenance of increased concentrations of sTNF-RI.
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Affiliation(s)
- Leonardo L Schiavon
- Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Brazil.
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Schiavon LL, Narciso-Schiavon JL, Carvalho-Filho RJ, Ferraz MLG, Silva AEB. Impact of CD4+ T-cell count on the performance of non-invasive fibrosis markers in HIV-HCV patients. Aliment Pharmacol Ther 2011; 33:1173-4; author reply 1174-5. [PMID: 21488916 DOI: 10.1111/j.1365-2036.2011.04613.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Schiavon LL, Carvalho-Filho RJ, Narciso-Schiavon JL, Pinheiro SR, Barbosa DV, Lanzoni VP, Ferraz MLG, Silva AEB. Prediction of significant liver fibrosis in kidney transplant patients with chronic hepatitis C virus infection: the TX-3 index. J Viral Hepat 2010; 17:391-9. [PMID: 19758273 DOI: 10.1111/j.1365-2893.2009.01190.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 12/17/2022]
Abstract
HCV infection is highly prevalent among kidney transplant (KT) recipients. The natural history and management of these patients are controversial. We sought to assess the diagnostic value of noninvasive markers of liver fibrosis in KT HCV-infected patients. This cross-sectional study included 102 KT individuals with positive HCV-RNA. Bivariate and multivariate analyses were used to identify variables associated with significant fibrosis (METAVIR > or = F2). Significant fibrosis was observed in 20 patients (20%). Time after transplantation, AST level, and platelet count were identified as independent predictors of significant fibrosis. Based on the regression model, a simplified index was devised. The AUROC for the TX-3 model was 0.867 +/- 0.081 (0.909, when adjusted by DANA). Values < or =4.0 of TX-3 showed a NPV of 97% and scores >9.6 exhibited a PPV of 71%. If biopsy indication was restricted to scores in the intermediate range of TX-3, this could have been correctly avoided in 68% of cases. The APRI score provided a correct diagnosis in only 47 individuals (46%) and exhibited lower diagnostic indices for both cutoffs, as compared to the TX-3 index. Comparison of AUROCs showed a trend towards superior diagnostic accuracy for TX-3 over APRI, although the difference between AUROCs did not reach statistical significance (0.867 +/- 0.053 vs 0.762 +/- 0.066, respectively, P = 0.064). In conclusion, significant liver fibrosis can be reliably predicted in KT HCV-infected subjects by simple and widely available parameters. If additional studies confirm our results, this model might obviate the requirement for a liver biopsy in a significant proportion of those patients.
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Affiliation(s)
- L L Schiavon
- Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil.
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Schiavon LL, Carvalho-Filho RJ, Narciso-Schiavon JL, Medina-Pestana JO, Lanzoni VP, Ferraz MLG, Silva AEB. YKL-40 and hyaluronic acid (HA) as noninvasive markers of liver fibrosis in kidney transplant patients with HCV chronic infection. Scand J Gastroenterol 2010; 45:615-22. [PMID: 20163287 DOI: 10.3109/00365521003637203] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 02/04/2023]
Abstract
OBJECTIVE Hepatitis C is highly prevalent among kidney transplant (KT) recipients. In this population, the natural history of hepatitis C virus (HCV) infection and its proper management remains controversial. The invasiveness of the procedure and the interpretation variability of liver biopsy limit its use in these patients. We sought to evaluate the performance of YKL-40 and HA as markers of liver fibrosis in KT patients with HCV infection. MATERIAL AND METHODS This cross-sectional study included HCV infected KT individuals. Univariate analysis was used to identify variables associated with significant fibrosis (METAVIR >or= F2). The diagnostic values of the YKL-40 and HA were compared using receiver operating characteristic (ROC) curves. RESULTS Eighty-five patients were included (60% males, mean age 44.9 +/- 9.4 years). Significant fibrosis was observed in 14 patients (17%). When compared to F0/F1 individuals, patients with significant fibrosis were older, showed a higher time since transplantation, and higher prevalence of diabetes. No difference was observed in YKL-40 levels between the groups. Significantly higher levels of HA were noted in METAVIR >or= F2 subjects (108 vs. 37 ng/ml, p = 0.002). The AUROCs of YKL-40 and HA for predicting significant fibrosis were 0.615 and 0.765, respectively (p = 0.144). Levels of YKL-40 <or= 105 ng/ml and of HA <or= 27 ng/ml showed a NPV of 36% and 96%, respectively. YKL-40 >or= 418 ng/ml and HA >or= 120 ng/ml exhibited a PPV of 31% and 39%, respectively. CONCLUSIONS Increased serum levels of HA but not of YKL-40 were associated with more advanced stages of liver fibrosis in KT HCV-infected patients.
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Affiliation(s)
- Leonardo L Schiavon
- Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
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Narciso-Schiavon JL, Freire FCF, Suarez MM, Ferrari MVO, Scanhola GQ, Schiavon LDL, de Carvalho Filho RJ, Ferraz MLG, Silva AEB. Antinuclear antibody positivity in patients with chronic hepatitis C: clinically relevant or an epiphenomenon? Eur J Gastroenterol Hepatol 2009; 21:440-6. [PMID: 19382301] [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: 12/10/2022]
Abstract
BACKGROUND Serum autoantibodies such as antinuclear antibody (ANA) are frequently detected in patients with chronic hepatitis C virus (HCV) infection, but its relevance is a matter of discussion. AIM To assess the association of ANA positivity with clinical and histological features, and with the outcome of antiviral therapy in patients with HCV infection. METHODS Baseline samples from patients with hepatitis C treated with interferon and ribavirin were tested for ANA positivity by indirect immunofluorescence. RESULTS The mean age was 48.3+/-11.1 years and 56% were men. Among 234 included patients, 22 patients (9.4%) were positive for ANA. These patients showed significantly higher median alanine aminotransferase level (3.52 vs. 2.39 x upper limit of normal, P=0.009) when compared with ANA-negative patients. Fibrosis stage and necroinflammatory grading were not influenced by ANA positivity. Sustained virological response (SVR) rates were similar between ANA-positive and ANA-negative patients (27 vs. 29%, P=0.882). Alanine aminotransferase flares (> or =1.5-fold the baseline) during treatment were observed in 28 patients (12%), irrespective of the presence of ANA and without any clinical significance. CONCLUSION Among HCV patients, ANA positivity seems to represent an immunological epiphenomenon. It neither influences clinical, biochemical, and histological features of chronic hepatitis C nor predicts response to antiviral treatment.
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Carvalho-Filho RJ, de Lucca Schiavon L, Narciso-Schiavon JL, Sampaio JP, Lanzoni VP, Gomes Ferraz ML, Benedito Silva AE. Clinical and histological impact of previous hepatitis B virus infection in patients with chronic hepatitis C. Liver Int 2009; 29:133-40. [PMID: 18507759 DOI: 10.1111/j.1478-3231.2008.01786.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 02/13/2023]
Abstract
BACKGROUND Recent reports suggest that hepatitis C virus (HCV) carriers with serological markers of prior hepatitis B virus (HBV) infection have more advanced liver fibrosis, irrespective of HBV-DNA detection. AIMS We sought to assess the prevalence and impact of previous HBV infection in patients with HCV chronic infection. METHODS This cross-sectional study included hepatitis B surface antigen- and human immunodeficiency virus-negative subjects with positive HCV-RNA. All patients had prior parenteral exposure as the probable source of HCV infection. Serum samples were tested for HBV-DNA using a commercial assay. The METAVIR system was used for histological analysis. RESULTS One-hundred and eleven patients were evaluated. Thirty-one out of 111 patients (28%) tested positive for antihepatitis B core antigen (anti-HBc). HBV-DNA was not detected in any sample. Anti-HBc-positive patients showed higher histological grading, staging and a higher fibrosis progression rate. By multivariate analysis, anti-HBc-positivity was predictive of moderate to severe activity [odds ratio (OR)=3.532; P=0.032] and significant hepatic fibrosis (OR=3.364; P=0.017). After approximately 20 years of infection, advanced liver fibrosis (F3/F4) can be expected in 13% of anti-HBc-negative subjects who acquired HCV before the age of 30 and in 57% of those anti-HBc-positive patients who were infected by HCV after 30 years of age (P<0.001). CONCLUSION Previous HBV infection is common among HCV carriers and may exert a negative impact on the natural history of HCV infection, independently of the presence of significant HBV replication.
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Affiliation(s)
- Roberto J Carvalho-Filho
- Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil.
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Schiavon LL, Narciso-Schiavon JL, Carvalho Filho RJ, Sampaio JP, Medina-Pestana JO, Lanzoni VP, Silva AEB, Ferraz MLG. Serum levels of YKL-40 and hyaluronic acid as noninvasive markers of liver fibrosis in haemodialysis patients with chronic hepatitis C virus infection. J Viral Hepat 2008; 15:666-74. [PMID: 18482283 DOI: 10.1111/j.1365-2893.2008.00992.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [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: 12/20/2022]
Abstract
Hepatitis C virus (HCV) infection is highly prevalent among end-stage renal disease (ESRD) patients undergoing haemodialysis and it is an important cause of morbidity and mortality in this population. The aim of this study was to evaluate the diagnostic value of YKL-40 and hyaluronic acid (HA) as noninvasive markers of liver fibrosis in 185 ESRD HCV-infected patients. Significant liver fibrosis was defined as METAVIR F2, F3 or F4 stages. Significant fibrosis was observed in 45 patients (24%). By univariate analysis, higher levels of YKL-40, HA, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) as well as reduced platelet count were associated with fibrosis. However, by multivariate analysis, only AST (P = 0.001), platelet count (P = 0.004) and HA (P = 0.042) were independently associated with significant fibrosis. For the prediction of significant fibrosis, the areas under receiver operating characterictic curve (AUROC) of the regression model (0.798) was significantly higher than the AUROC of YKL-40 (0.607) and HA (0.650). No difference was noted between the AUROC of the regression model and AST to platelet ratio index (APRI) (0.787). Values <8.38 of the regression model showed a negative predictive value of 94% and scores >or=9.6 exhibited a positive predictive value of 65%. If biopsy indication was restricted to scores in the intermediate range of the regression model, it could have been correctly avoided in 61% of the cases. In conclusion, APRI and a model based on AST, platelet count and HA showed better accuracy than YKL-40 and HA (when used solely) for the prediction of significant fibrosis in ESRD HCV-infected patients.
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Affiliation(s)
- L L Schiavon
- Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
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Narciso-Schiavon JL, Schiavon LL, Carvalho-Filho RJ, Freire FCF, Cardoso JR, Bordin JO, Silva AEB, Ferraz MLG. Anti-hepatitis C virus-positive blood donors: are women any different? Transfus Med 2008; 18:175-83. [PMID: 18598280 DOI: 10.1111/j.1365-3148.2008.00859.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We sought to assess clinical, epidemiological, biochemical, serological and histological characteristics of anti-hepatitis C virus (HCV)-positive female blood donors and compare them with men. As women are frequently the minority among blood donors, studies evaluating this population usually reflect characteristics of male gender. This retrospective study included 380 blood donors with confirmed positive anti-HCV. The mean age was 36.9 +/- 11.3 years and 33.2% were women. Compared with men, female donors showed higher prevalence of prior transfusion of blood products (P = 0.031) and lower prevalence of intravenous drug use (P = 0.001) and alcohol abuse (P < 0.001). Women exhibited lower medians of alanine aminotransferase (P < 0.001) and gamma-glutamyltransferase (P < 0.001). They also showed higher platelet count (P < 0.001) and prothrombin activity (P = 0.049), and a lower frequency of antibody against core antigen of hepatitis B virus (anti-HBc) positivity (P = 0.032). A higher proportion of spontaneous viral clearance (P = 0.001) and a lower frequency of viraemia (P < 0.001) were observed among women. On liver biopsy, women had lower prevalence of fibrosis stage > or = 2. Multivariate analysis identified age (OR = 1.050, 95% CI: 1.019-1.081, P = 0.001) and anti-HBc positivity (OR = 2.184, 95% CI: 1.010-4.722, P = 0.047) as independent predictors of significant fibrosis. Female blood donors presented higher prevalence of spontaneous viral clearance as well as biochemical and histological evidence of less advanced liver disease. These findings could be because of intrinsic characteristics of female gender or secondary to associated factors such as younger age or anti-HBc positivity.
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Affiliation(s)
- J L Narciso-Schiavon
- Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil.
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Schiavon LL, Carvalho-Filho RJ, Narciso-Schiavon JL, Barbosa DV, Lanzoni VP, Ferraz MLG, Silva AEB. Impact of cyclosporine-based immunosuppressive therapy on liver histology of hepatitis C virus-infected renal transplant patients. Hepatology 2008; 48:348-9. [PMID: 18521870 DOI: 10.1002/hep.22331] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Carvalho-Filho RJ, Schiavon LL, Narciso-Schiavon JL, Sampaio JP, Lanzoni VP, Ferraz MLG, Silva AEB. Optimized cutoffs improve performance of the aspartate aminotransferase to platelet ratio index for predicting significant liver fibrosis in human immunodeficiency virus/hepatitis C virus co-infection. Liver Int 2008; 28:486-93. [PMID: 18339075 DOI: 10.1111/j.1478-3231.2008.01675.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [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: 12/31/2022]
Abstract
AIM To assess the diagnostic value of modified cutoffs for aspartate aminotransferase to platelet ratio index (APRI) to predict significant liver fibrosis in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) patients. PATIENTS AND METHODS This retrospective cross-sectional study included consecutive patients with HIV/HCV co-infection who underwent percutaneous liver biopsy. The accuracy of APRI for the diagnosis of significant fibrosis (F2/F3/F4 METAVIR) was evaluated by estimating the positive and negative predictive values (PPV and NPV respectively) and by measuring the area under the receiver operating characteristics curve (AUROC). RESULTS One hundred and eleven patients were included (73% men, mean age 40.2+/-7.8 years). Significant fibrosis was observed in 45 patients (41%). To discriminate these subjects, the AUROC of APRI was 0.774+/-0.045. An APRI > or = 1.8 showed a PPV of 75% for the presence of significant fibrosis, and an index < 0.6 excluded significant fibrosis with an NPV of 87%. If biopsy indication was based only on APRI and restricted to scores in the intermediate range (> or = 0.6 and < 1.8), 46% of liver biopsies could have been avoided as compared with 40% using the classical cutoffs. CONCLUSION APRI with adjusted cutoffs can predict significant liver fibrosis in patients with HIV/HCV co-infection and might obviate the need to perform a biopsy in a considerable percentage of those subjects.
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Affiliation(s)
- Roberto J Carvalho-Filho
- Division of Gastroenterology-Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil.
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