Navegando por Palavras-chave "liver fibrosis"
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- ItemSomente MetadadadosClinical and histological impact of previous hepatitis B virus infection in patients with chronic hepatitis C(Wiley-Blackwell, 2009-01-01) Carvalho-Filho, Roberto J. [UNIFESP]; Lucca Schiavon, Leonardo de [UNIFESP]; Narciso-Schiavon, Jana-na L. [UNIFESP]; Sampaio, Juliana P. [UNIFESP]; Lanzoni, Valeria P. [UNIFESP]; Gomes Ferraz, Maria L. [UNIFESP]; Benedito Silva, Antonio E. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)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.We sought to assess the prevalence and impact of previous HBV infection in patients with HCV chronic infection.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.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).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.
- ItemSomente MetadadadosDirect comparison of diagnostic performance of transient elastography in patients with chronic hepatitis B and chronic hepatitis C(Wiley-Blackwell, 2012-04-01) Cardoso, Ana-Carolina; Carvalho-Filho, Roberto J. [UNIFESP]; Stern, Christiane; Dipumpo, Alexandrine; Giuily, Nathalie; Ripault, Marie-Pierre; Asselah, Tarik; Boyer, Nathalie; Lada, Olivier; Castelnau, Corinne; Martinot-Peignoux, Michelle; Valla, Dominique-Charles; Bedossa, Pierre; Marcellin, Patrick; Univ Paris 07; Universidade Federal de São Paulo (UNIFESP)Background/ Aims: Accuracy of transient elastography (TE) in hepatitis B virus (HBV) infection has not been well established. We aimed to compare the performances of TE for the assessment of liver fibrosis in patients with chronic HBV or hepatitis C virus (HCV) infection. A secondary analysis was performed to assess whether or not alanine aminotransferase (ALT) levels would impact on the accuracy of TE. Methods: This cross-sectional study, carried out in a single centre, included treatment-naive patients with compensated chronic HBV or HCV infection, consecutively admitted between 2006 and 2008 for a liver biopsy and TE measurement on the same day. Results: A total of 202 HBV patients and 363 HCV subjects were evaluated. Overall diagnostic accuracy of TE in the HBV group was comparable to that observed in HCV patients [area under the receiver-operating characteristics (AUROCs) 0.867 +/-0.026 vs. 0.868 +/-0.019 for predicting F +/-2, P = 0.975; 0.902 +/-0.029 vs. 0.894 +/-0.020 for F +/-3, P = 0.820; and 0.935 +/-0.024 vs. 0.947 +/-0.027 for F4, P = 0.740 respectively]. TE exhibited comparable accuracies, sensitivities, specificities, predictive values and likelihood ratios in HBV and HCV groups. AUROC analysis showed no influence of ALT levels on the performance of TE in HBV individuals. ALT-specific cut-off values did not exhibit significantly higher diagnostic performances for predicting fibrosis in HBV patients with elevated ALT. Conclusions: in HBV patients, TE measurement accurately predicts the absence or presence of significant fibrosis, advanced fibrosis or cirrhosis and shows similar performances as compared to HCV patients. the use of TE cut-off values adjusted to ALT level did not improve performances for estimating liver fibrosis in HBV patients.
- ItemAcesso aberto (Open Access)Effect of host-related factors on the intensity of liver fibrosis in patients with chronic hepatitis C virus infection(Brazilian Society of Infectious Diseases, 2002-10-01) Costa, Luciano Bello [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Perez, Renata de Mello [UNIFESP]; Ferreira, Adalgisa de Souza Paiva [UNIFESP]; Matos, Carla Adriana Loureiro de [UNIFESP]; Lanzoni, Valeria Pereira [UNIFESP]; Silva, Antonio Eduardo Benedito [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)There is increasing interest in the identification of factors associated with liver disease progression in patients infected with hepatitis C virus (HCV). We assessed host-related factors associated with a histologically advanced stage of this disease and determined the rate of liver fibrosis progression in HCV-infected patients. We included patients submitted to liver biopsy, who were anti-HCV and HCV RNA positive, who showed a parenteral risk factor (blood transfusion or intravenous drug use), and who gave information about alcohol consumption.Patients were divided into two groups for analysis: group 1 - grades 0 to 2; group 2 - grades 3 to 4. The groups were compared in terms of sex, age at the time of infection, estimated duration of infection and alcoholism. The rate of fibrosis progression (index of fibrosis) was determined based on the relationship between disease stage and duration of infection (years). Logistic regression analysis revealed that age at the time of infection (P<0.01; 95% CI 1.06-1.22) and the duration of infection (P<0.01; 95% CI 1.06-1.32) were independently associated with a more advanced stage of hepatitis C. The median index of fibrosis was 0.14 for the group as a whole. A significant difference in the index of fibrosis was observed between patients aged < 40 years at infection (median = 0.11) and patients aged> or =40 years (median = 0.47). The main factors associated with a more rapid fibrosis progression were age at the time of infection and the estimated duration of infection. Patients who acquired HCV after 40 years of age showed a higher rate of fibrosis progression.
- ItemSomente MetadadadosEnhanced Liver Fibrosis Panel as a Predictor of Liver Fibrosis in Chronic Hepatitis C Patients(Lippincott Williams & Wilkins, 2015-03-01) Fernandes, Flavia F.; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Dellavance, Alessandra [UNIFESP]; Terra, Carlos; Pereira, Gustavo; Pereira, Joao L.; Campos, Frederico; Figueiredo, Fatima; Perez, Renata de Mello [UNIFESP]; Universidade do Estado do Rio de Janeiro (UERJ); Bonsucesso Fed Hosp; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de São Paulo (UNIFESP); Fleury GrpBackground: Evaluation of fibrosis is crucial in the assessment of chronic hepatitis C (CHC). The enhanced liver fibrosis (ELF) is a serological panel including hyaluronic acid (HA), tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), and amino-terminal propeptide of type III procollagen (PIIINP) that has shown good results in predicting liver fibrosis in distinct scenarios of chronic liver diseases.Aims: We aimed to assess the performance of ELF on the detection of fibrosis and cirrhosis in a CHC patient cohort and to compare the results of ELF and transient elastography (TE-Fibroscan) using liver biopsy as reference.Patients and Methods: One hundred twenty patients were prospectively evaluated by TE and ELF using an ADVIA Centaur automated system. The ELF score was calculated using the manufacturer's algorithm. Biopsies were classified according to the METAVIR score. Receiver operator characteristic curve analyses were performed to evaluate the accuracy of ELF and TE.Results: The area under the receiver operator characteristic curve (AUROC) of ELF for the diagnosis of significant fibrosis was 0.81 [95% confidence interval (CI), 0.73-0.87], for advanced fibrosis was 0.82 (95% CI, 0.74-0.88), and for cirrhosis was 0.78 (95% CI, 0.70-0.85). Using the proposed cutoffs, ELF overestimated fibrosis in 66% (81/120) of cases and underestimated in 3% (3/120). We found no statistically significant difference when comparing the AUROC of ELF and TE for diagnosing fibrosis or cirrhosis.Conclusions: ELF panel is a good noninvasive fibrosis marker and showed similar results to TE in CHC patients. However, new cutoff points need to be established to improve its performance on patients with CHC.
- ItemSomente MetadadadosLiver Morphologic Analysis in Perinatal Autopsies with Intrauterine Stress Liver Morphology in Perinatal Autopsies(Informa Healthcare, 2012-01-01) Oliveira, Livia Ferreira; Fernandes da Silva Monteiro, Ana Paula [UNIFESP]; Espindula, Ana Paula; Morais Pereira, Livia Helena; Rocha, Laura Penna; Oliveira Guimaraes, Camila Souza de; Cavellani, Camila Lourencini; Cunha Castro, Eumenia Costa da; Miranda Correa, Rosana Rosa; Univ Fed Triangulo Mineiro; Universidade Federal de São Paulo (UNIFESP)Quantify steatosis, fibrosis, and focuses of extramedullary erythropoiesis (ER) in the liver and report it to the causes of death in the perinatal. Morphologic analysis of steatosis', percentage of fibrosis, and ER of 467 perinatal autopsies. Cases with hypoxia/perinatal anoxia and ascending infection showed higher percentage of fibrosis. the number of ER was significantly higher among premature infants and in cases with infection. Our results contribute to a better quality of perinatal care through clinical demonstration of which injuries are associated with them, what may help in early diagnosis of these alterations in children who survive.
- ItemSomente MetadadadosNoninvasive serum markers in the diagnosis of structural liver damage in chronic hepatitis C virus infection(Blackwell Publishing, 2006-11-01) Parise, Edison R.; Oliveira, Ana C.; Figueiredo-Mendes, Claudio; Lanzoni, Valeria; Martins, Joao; Nader, Helena; Ferraz, Maria L.; Universidade Federal de São Paulo (UNIFESP)Aim: Several noninvasive markers are being used to assess the structural liver damage in patients with chronic hepatitis C (CHC). We evaluated the capacity of serum hyaluronic acid (HA), aspartate aminotransferase (AST)/ALT ratio, the AST to platelet ratio index (APRI) and gamma-glutamyltransferase (GGT) levels to predict the intensity of hepatic fibrosis in patients with CHC.Patients and methods: in a total of 206 hepatitis C virus RNA-positive biopsied patients, AST, ALT, GGT levels, platelet count and serum HA concentration were determined. the APRI was calculated as the ratio of AST to platelets.Results: HA levels were best correlated with disease stage (r=-0.694; P < 0.001). in the diagnosis of significant fibrosis (F2-F4), HA levels [AUC=0.879, 95% CI (0.832-0.927)] and APRI [AUC=0.824 (0.772-0.903)] were the markers with the best diagnostic accuracy. These parameters also best identified the presence of cirrhosis (F4), with an AUC of 0.908 (0.868-0.949) for HA and of 0.837 (0.772-0.903) for APRI.Conclusions: Serum HA was the parameter that alone presented the best diagnostic accuracy in the assessment of hepatic fibrosis in CHC. the APRI showed a better diagnostic sensitivity than GGT levels or the AST/ALT ratio. Its simple determination and low cost make this index a valid alternative for the noninvasive staging of CHC.
- ItemSomente MetadadadosOptimized 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(Blackwell Publishing, 2008-04-01) Carvalho-Filho, Roberto J. [UNIFESP]; Schiavon, Leonardo L. [UNIFESP]; Narciso-Schiavon, Janaina L. [UNIFESP]; Sampaio, Juliana P. [UNIFESP]; Lanzoni, Valeria P. [UNIFESP]; Ferraz, Maria Lucia G. [UNIFESP]; Silva, Antonio Eduardo B. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)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. 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 >= 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 (>= 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.
- ItemSomente MetadadadosPrediction of significant liver fibrosis in kidney transplant patients with chronic hepatitis C virus infection: the TX-3 index(Wiley-Blackwell, 2010-06-01) Schiavon, L. L. [UNIFESP]; Carvalho-Filho, R. J. [UNIFESP]; Narciso-Schiavon, J. L. [UNIFESP]; Pinheiro, S. R. [UNIFESP]; Barbosa, D. V. [UNIFESP]; Lanzoni, V. P. [UNIFESP]; Ferraz, M. L. G. [UNIFESP]; Silva, A. E. B. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)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 >= 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 < 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.
- ItemSomente MetadadadosRebiopsy in patients with untreated hepatitis C: A useful procedure(Lippincott Williams & Wilkins, 2006-04-01) Khouri, Sandra Tuma [UNIFESP]; Perez, R. M.; Oliveira, P. M. de; Figueiredo, V. M.; Barbosa, D. V.; Lanzoni, V. P.; Silva, AEB; Ferraz, M. L.; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ)Background: the progression of fibrosis in the early stages of chronic hepatitis C virus is variable, and the ideal interval to perform a new biopsy in untreated patients is still unknown.Aims: We evaluated the histologic progression of patients with untreated hepatitis C virus with two liver biopsies and correlated disease progression with demographic, epidemiologic, biochemical, and histologic variables.Patients and Methods: Untreated hepatitis C virus-infected patients with two liver biopsies at a minimum interval of 1 year were studied. Gender, age, parenteral risk factors, duration of infection, alcohol intake, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, and histologic findings were analyzed.Results: Fifty-five patients were included. the first biopsy showed low grades of fibrosis and periportal necroinflammatory activity in 93%. A second biopsy was performed after 39 +/- 14 months; 40% of patients showed a progression of fibrosis and/or periportal necroinflammation. Comparison between groups with and without histologic worsening revealed no differences in demographic, epidemiologic, biochemical, or histologic data.Conclusions: Histologic worsening occurred in 40% of untreated patients after 3.2 years. No factor could be established at the first biopsy to predict which patients are at risk of progression. Thus, histologic reassessment between 3 and 5 years seems to be the only approach to document disease progression and establish treatment indication.
- ItemSomente MetadadadosSerum hyaluronic acid as a comprehensive marker to assess severity of liver disease in schistosomiasis(Elsevier B.V., 2002-11-01) Aguiar, Luciane Aparecida Köpke de [UNIFESP]; Martins, JRM; Passerotti, C. C.; Toledo, C. F.; Nader, H. B.; Borges, D. R.; Universidade Federal de São Paulo (UNIFESP)Schistosomiasis mansoni is a non-cirrhotic fibrogenic disease model. the mild form shows normal liver function with slight or no liver fibrosis whereas in the periportal fibrosis form the manifestations of portal hypertension prevail over hepatocellular failure. We assessed serum hyaluronic acid as a marker of the course of the disease. We studied 24 patients presenting with pure chronic forms of schistosomiasis and seven with cirrhosis. in order to measure serum hyaluronic acid we developed a sandwich fluorescent ELISA-like assay. alpha(2)-Macroglobulin, prothrombin index, gamma-glutamyltransferase, platelets and ultrasound parameters were also assessed. the 20 mug/l (ROC plot) hyaluronic acid level differentiated patients with the mild form (with no portal hypertension) from those with the severe form of schistosomiasis with 78% diagnostic efficacy. the 80 mug/l cut-off value differentiated patients with the severe form of schistosomiasis from the cirrhotic group with similar diagnostic efficacy. alpha2-Macroglobulin provided no distinction between the groups studied. the hyaluronic acid serum concentration correlated positively with the splenic vein diameter (P = 0.004) and marginally with alpha2-macroglobulin (P = 0.059). Serum hyaluronic acid is a good marker for the initial phase of hepatic fibrosis and it was able to assess severity of liver disease in schistosomiasis. (C) 2002 Elsevier Science B.V. All rights reserved.