Navegando por Palavras-chave "FIB-4"

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    Avaliação da evolução da Fibrose Hepática em pacientes cirróticos com resposta virológica sustentada após tratamento de Hepatite C crônica
    (Universidade Federal de São Paulo (UNIFESP), 2019-09-11) Campos, Antonio Guelfer Saraiva [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background The advent of chronic hepatitis C therapy with direct acting antiviral agents (DAAs) without interferon made possible a cure rate in more than 90% of the infected patients and allowed the evaluation, through noninvasive measures, of changes in the stage disease and the development or resolution of hepatic complications. The objective of this study was to evaluate the evolution of hepatic fibrosis in cirrhotic patients with sustained virological response (SVR) after treatment of chronic hepatitis C with DAAs and to correlate the evolution pattern of hepatic fibrosis with clinical, laboratory and histological variables. Casuistic and Method: A total of 113 cirrhotic patients from the Hepatitis Division of the Federal University of Sao Paulo, treated between January 2016 and December 2017, were included. Non-invasive methods, APRI, FIB-4 and hepatic stiffness were measured using transient elastography (TE) before and after treatment. Results: The APRI and FIB-4 values showed a significant decrease in the comparison before and after treatment. APRI ranged from 2.52 (0.52 - 20.7) to 0.74 (0.24 - 3.82) post-treatment, (P <0.001). Likewise, FIB-4 showed improvement in the indexes, with FIB-4 from 5.71 (1.17 - 23.36) to 3.94 (0.83 - 16.46) post-treatment (P <0.001). In 52 /113 patients, TE was performed before and after treatment. The results showed a median pre-treatment of 21.65 kPa (8.3-48.8) with a significant reduction to 17.6 (5.3-88.0) after SVR (P<0.001). The laboratory parameters ALT, AST albumin and platelets also significatively improved after SVR. The stage of fibrosis assessed by hepatic elastography after a mean period of 14.6 ± 4.4 months, was maintained in 33/52 (63.5%) patients and there was improvement of the stage in 19/52 (36.5%). The absence of improvement in the stage of fibrosis was associated with the presence of portal hypertension (esophageal varices, splenomegaly and platelet count).Conclusions: In patients with hepatic cirrhosis due to hepatitis C, non-invasive fibrosis scores, APRI, FIB-4 and transient elastography obtained significant improvement after sustained virological response with direct-acting antiviral therapy. Improvement of these scores is probably a combination of resolution of hepatic inflammation as well as regression of liver fibrosis. In the presence of portal hypertension, the improvement in the stage of fibrosis in improbable.
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    Predictive value of FIB-4 and APRI versus METAVIR on sustained virologic response in genotype 1 hepatitis C patients
    (Springer, 2014-01-01) Ferenci, Peter; Aires, Rodrigo; Beavers, Kimberly L.; Curescu, Manuela; Abrao Ferreira, Paulo R. [UNIFESP]; Gschwantler, Michael; Ion, Stefan; Larrey, Dominique; Maticic, Mojca; Puoti, Massimo; Schuller, Janos; Tornai, Istvan; Tusnadi, Anna; Messinger, Diethelm; Tatsch, Fernando; Horban, Andrzej; Med Univ Vienna; Goias Fed Univ Clin Hosp; Asheville Gastroenterol Associates; Univ Med & Farm Timisoara; Universidade Federal de São Paulo (UNIFESP); Wilhelminenspital Stadt Wien; Cent Mil Hosp; St Eloi Hosp; Univ Med Ctr; SC Malattie Infett AO Osped Niguarda Ca Granda; Szent Laszlo Hosp; Univ Debrecen; Hetenyi Geza Hosp; IST GmbH; F Hoffmann La Roche Ltd; Med Univ Warsaw; Hosp Infect Dis
    Advanced liver fibrosis is a negative predictor of virologic response in genotype 1 chronic hepatitis C (CHC) patients. Biopsy, however, is invasive, costly, and carries some risk of complications.Using data from the prospective, international cohort study PROPHESYS, we assessed two alternative noninvasive measures of fibrosis, the FIB-4 and AST-to-platelet ratio index (APRI), to predict virologic response in CHC patients.CHC genotype 1, monoinfected, treatment-naive patients prescribed peginterferon alfa-2a (40 KD)/ribavirin in accordance with country-specific legal and regulatory requirements and who had baseline METAVIR, FIB-4, and APRI scores (N = 1,592) were included in this analysis. Patients were stratified according to the baseline METAVIR, FIB-4, or APRI score to assess virologic response [hepatitis C virus (HCV) RNA < 50 IU/mL] by week 4 of treatment (rapid virologic response) and 24 weeks after untreated follow-up ]sustained virologic response (SVR)]. Baseline predictors of SVR were explored by multiple logistic regression, and the strength of the association between each fibrosis measure and SVR was evaluated. Both FIB-4 and APRI scores increased with increasing levels of biopsy-assessed fibrosis. the association between FIB-4 and SVR (p < 0.1 x 10(-30)) was stronger than that between METAVIR (p = 3.86 x 10(-13)) or APRI (p = 5.48 x 10(-6)) and SVR. Baseline factors significantly associated with SVR included male gender, lower HCV RNA, lower FIB-4 score, no steatosis, and higher alanine aminotransferase ratio.The FIB-4 index provides a valuable, noninvasive measure of fibrosis and can be used to predict virologic response in patients treated with peginterferon alfa-2a (40 KD)/ribavirin.