Navegando por Palavras-chave "Cirrose"

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    Avaliação da frequência de descompensação de cirrose hepática e óbito por doença hepática terminal em pacientes coinfectados pelo HIV/HCV e em pacientes vivendo exclusivamente com HCV
    (Universidade Federal de São Paulo (UNIFESP), 2019-11-28) Santos, Damiana Montes [UNIFESP]; Ferreira, Paulo Roberto Abrao [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: People living with HIV have higher mortality rates when compared to the general population. Among the main non-AIDS-related causes of death in this population are liver diseases, which lead to cirrhotic liver failure or hepatocellular carcinoma. HIV / HCV coinfection determines a worse natural history for each virus. People living with HIV have higher levels of HCV RNA, more frequent viral persistence in primary HCV infection, faster progression to cirrhosis, higher risk of HCC, and higher mortality. For these reasons, it is important to identify factors associated with clinical outcomes in HIV / HCV co-infected compared with HCV monoinfected. In addition, it is necessary to define more appropriate behaviors for each of these populations. Objectives: To determine the mortality rate among coinfected HCV / HIV and HCV monoinfected cirrhotic patients. To determine the rate of hepatic decompensation and its characteristics by comparing these two cohorts. Methods: A retrospective, observational, non-probabilistic longitudinal study was conducted from a case series involving two centers with all patients with cirrhosis living with HIV / HCV or exclusively with HCV, until october 2012. Results: 138 patients were analyzed, 84 of them living with HCV and 54 with HIV / HCV. Coinfected patients were, on average, younger at the time of diagnosis of cirrhosis (HCV - 55 years, SD 11; HCV / HIV - 43 years, SD 8; p <0.0001). Most patients (52.1%) received treatment for HCV (peginterferon or standard interferonxviii with ribavirin) with SVR in only 23.6% of patients, mostly monoinfected (37.2%, p <0.002). SVR occurred in 16 (37.2%) monoinfected and 1 (3.2%) coinfected and this difference was statistically significant (p <0.002). We observed that the CPT score showed a higher predominance of Child A in both cohorts (HCV 71.4%, 60/84; HCV / HIV 46.3%, 25/54; p <0.005) and more cases of Child B and C among co-infected (HCV 20.2%, 17/84; HCV / HIV 44.4%, 24/54; p <0.005). Decompensations occurred in 28.3% of the patients and most of them in co-infected patients (HCV 22.6%, 19/84; HCV / HIV 38.9%, 21/54), but this difference was not significant (p <0.082). Regarding the hepatic decompensations observed in this study (ascites, esophageal variceal bleeding and encephalopathy), the predominant event was ascites (48.3%), followed by bleeding from esophageal varices (31%) and hepatic encephalopathy (20.7%). Ascites (HCV 13.1%, 11/84; HCV / HIV 31.5%, 17/54) and hepatic encephalopathy (HCV 3.6%, 3/84; HCV / HIV 16.7%, 9/54) tend to be more frequent in co-infected patients (p <0.009 and p <0.008, respectively). Regarding bleeding from esophageal varices (HCV 10.7%, 9/84; HCV / HIV 16.6%, 9/54), there were no differences between the groups (p <0.310). Most deaths occurred in co-infected patients (HCV 8.3%, 7/84; HCV / HIV 18.5%, 10/54; p <0.007). Of the 17 deaths that occurred, only two were not related to liver disease (11.8% among deaths): one death in monoinfected due to subarcanoid hemorrhage and one death in coinfected because of unknown cause. The number of weeks from diagnosis of liver cirrhosis to death was higher for co-infected patients (HCV-average / median 121.2 / 116, SD 100.6, 4 to 575; HCV / HIV-average 209.3, SD 213, 4, 1 to 974; p <0.001), contrary to what was observed for the time from diagnosis until the first hepatic decompensation (HCV- mean 70, DP 112,7, 0 a 465; HIV/HCV – mean 37,7, DP 6,1, a 270; p=0,306). Conclusions: Mortality for coinfected patients was more than twice as high as for monoinfected patients. In our study, co-infected patients were diagnosed with liver cirrhosis younger than monoinfected patients, but had worse CPT scores at the time of diagnosis of cirrhosis.
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    Avaliação dos escores MELD, Child-Turcotte-Pugh, APRI, contagem de plaquetas e testes hepáticos como indicadores da presença de varizes de esôfago com ou sem necessidade de profilaxia para sangramento
    (Universidade Federal de São Paulo (UNIFESP), 2010-10-29) Tafarel, Jean Rodrigo [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: The aim of this study was to determine whether MELD, Child-Turcotte-Pugh (CTP) class, APRI and laboratory tests could predict the presence of EV or varices which need prophylactic therapy (EV with medium or large size). Methods: Three hundred cirrhotic patients (193 men; mean age 53,1 years; majority with cirrhosis from chronic C hepatitis) were prospective analyzed. Uni and multivariate analysis were used to evaluate associations between the presence of EV (any size and medium or large EV) and patients’ characteristics (MELD, CTP class, APRI, platelets count and liver tests). Small varices were regarded as those which flatten with insufflation; medium varices those which protruded less than 1/3 of the lumen and large ones those which protruded more than 1/3. Results: One hundred seventy one patients (57%) had EV, of whom 35% (105) had varices which need prophylactic therapy. The distribution of EV according to the CTP class was as follows: A, 49%; B, 75,3% and C, 80%. Independent predictors of the presence of EV were: MELD > 8 (p = 0,02); APRI > 1,64 (p = 0,01); a platelet count < 93.000/mm3 (p < 0,01); AST > 1,34xUNL (p = 0,01) and total bilirubin > 1 mg/dl (p = 0,04). MELD > 8 had the highest discriminative value for presence of EV with sensitivity of 80,1% and specificity of 51,2%. Factors independently associated with EV which need prophylactic therapy were: thrombocytopenia (< 92.000/mm3; p < 0,01) and AST > 1,47xUNL (p = 0,03). A platelet count < 92.000/mm3 had sensitivity of 65,7% and specificity of 57,9% for the presence of varices which need prophylactic therapy. Conclusions: High values on MELD are associated with EV and thrombocytopenia (< 92.000/mm3), with varices which need prophylactic therapy. Considering their low sensitivity and specificity, it is suggested to maintain the recommendation of upper gastrointestinal endoscopy for all cirrhotic patients.
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    Estudo sobre prevalência e impacto prognóstico da sarcopenia em portadores de cirrose hepática.
    (Universidade Federal de São Paulo (UNIFESP), 2018-12-05) Souza, Gabriela Morais De [UNIFESP]; Carvalho Filho, Roberto Jose de [UNIFESP]; http://lattes.cnpq.br/4303806669248065; http://lattes.cnpq.br/1105170025844543; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Sarcopenia is a common nutritional complication common in cirrhotic patients. It adversely affects functional status, disease progression, survival, quality of life, stress response and outcomes after hepatic transplantation, being associated with poor prognosis and occurrence of complications in these patients. The diversity and complexity of the methods currently used for the diagnosis of sarcopenia is evident. Objectives: 1) to evaluate the prevalence of functional sarcopenia; 2) to identify epidemiological, clinical and nutritional factors associated with the presence of functional sarcopenia; 3) to evaluate the concordance between functional and objective sarcopenia; and 4) to assess the impact of sarcopenia on the incidence of hepatic decompensation and on the overall survival. Methodology: a crosssectional study, carried out through clinical and nutritional evaluation of outpatients with liver cirrhosis, including measurement of handgrip strength (HGS) with dynamometry and L3 skeletal muscle mass index (SMIL3) obtained by CT for the diagnosis of functional and objective sarcopenia, respectively. Results: 69 patients were evaluated, with 87% of men. The mean age was 58.8 ± 10.1 years. Alcoholic liver disease was the most prevalent cause or cirrhosis (61%), followed by chronic infection with hepatitis C or B viruses (20%). The ChildPughTurcotte (CPT) classification defined 58% of the patients as CPTA, 32% CPTB and 9% CPTC, and the mean MELD (Model for EndStage Liver Disease) score was 11.8 ± 3.8. Diabetes mellitus was present in 38% of the patients, as well as systemic arterial hypertension (SAH) in 36%, ascites in 33% and peripheral edema in 20%. Laboratory evaluation revealed serum albumin lower than 3.5 g/dL in 33% of cases and anemia in 35% of the subjects. Nutritional status through body mass index evaluation considered 45% of the patients as eutrophic, 10% malnourished and 45% overweight and through the midarm circumference (MAC) 43% were eutrophic, 49% undernourished and 8% overweight. The mean HGS was 31.9 ± 9.5 kgf and the mean SMIL3 was 50.5 ± 8.6 cm2/m2. The mean caloric intake was 21.5 ± 8.6 kcal/kg/day and the mean protein intake was 0.9 ± 0.5 g/kg/day. Of the patients evaluated, 90% did not reach the ideal goal for daily caloric intake and 71% did not reach the protein goal. By the HGS, 52% of the patients exhibited functional sarcopenia, which was associated with absence of SAH (p = 0.011), presence of ascites (p = 0.011), low serum levels of albumin (p = 0.040) and sodium (p = 0.001), and lower values of MAC (p = 0.003) and corrected arm muscle area (CAMA; p = 0.001). Through IMML3, 39% of the patients showed objective sarcopenia. There was low concordance between HGS with dynamometry and SMIL3 by CT (kappa coefficient = 0.064). There was no significant association between the presence of functional sarcopenia and the incidence of hepatic decompensation and death during followup. Conclusions: the prevalence of sarcopenia was 52% using dynamometry and 39% using CT. Factors associated with the presence of sarcopenia by HGS include absence of SAH, presence of ascites, low serum levels of albumin and sodium, and lower values of MAC and CAMA. There was low concordance between the two criteria used for the diagnosis of sarcopenia, HGS and SMIL3. Functional sarcopenia had no significant impact on the incidence of hepatic decompensation or survival.
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    Evolução de pacientes cirróticos pelo vírus da Hepatite C submetidos a transplante renal
    (Universidade Federal de São Paulo (UNIFESP), 2019-03-15) Emori, Christini Takemi [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; http://lattes.cnpq.br/1870810357457710; http://lattes.cnpq.br/4375276274242210; Universidade Federal de São Paulo (UNIFESP)
    Background: The prevalence and clinical epidemiological profile of hepatitis C virus (HCV) infection has changed over time and the renal transplant (RTx) in cirrhotic patients is still a challenge. Aim: To verify changes in renal transplant recipients comparing two different decades and to analyze evolution of cirrhotic patients after the RTx. Material and methods: RTx with HCV referred to renal transplant from 1993 to 2003 (A) and from 2004 to 2014 (B) were retrospectively studied. Demographic and clinical characteristics and outcomes of decompensation, loss of graft and hepatic cause of death were compared between groups A and B as well as between cirrhotic (C) and non-cirrhotic (NC) patients. Results: Among 11,715 RTx, the prevalence of HCV was 7%in A and 4,9%in B. In the more recent period (B) mean age was higher (46.2 vs 39.5 years), with more males(72% vs 60.7%), larger number of deceased donors (74% vs 55%), higher percentage of previous renal transplant (27% vs 13.7%), less frequent history of blood transfusion (81% vs 89.4%), lower prevalence of HBV co-infection(4.7% vs 21.4%) and higher percentage of cirrhotic patients (13% vs 5%). Patients of group B more frequently underwent HCV treatment (29% vs 9%), less frequently used azathioprine (38.6% vs 60.7%) and cyclosporine (11.8% vs 74.7%), and more frequently used tacrolimus (91% vs. 27,3%). In the outcomes, graft loss had no difference between periods; however, decompensation was more frequent (p=0.007) and patient’s survival was lower in the more recent period (p=0.032). NC (n=201) and C (n=23) were compared. C patients were older (49 vs 41.6 y), with more males(87% vs 65%), greater number of previous RTx (48% vs 18%), lower use azathioprine (26% vs 54%), less use of cyclosporine (13% vs 46.5%), more use of tacrolimus (87% vs 55%), lower count of platelets x 1000 cells/mm3 (110 vs 187) and higher pré-RTx INR (1.20 vs 1.1).The Kaplan-Meier survival curves differed C vs NC only in hepatic decompensation. Cox regression analysis identified pre-transplant cirrhosis HR6.64, p<0.001 and the use of tacrolimus HR 3.17, p=0.041 as variables that were independently associated with decompensation. Conclusions: The profile of RTx with hepatitis C has changed over the last 20 years. Despite a decrease in the prevalence of HCV, new clinical challenges have emerged, such as a more advanced age and a higher prevalence of cirrhosis. Cirrhotic exhibit higher morbidity when submitted to RTx than non-cirrhotic, with a higher risk of hepatic decompensation. However, no difference was observed in liver-related mortality, suggesting that RTx is a feasible option in cirrhotics without decompensation, even if they have portal hypertension.