Non-organ-specific autoantibodies and thyroid autoantibodieshave been frequently found in chroniccarriers of hepatitis C virus （HCV）. With respect toendomysial antibodies and tissue ...transglutaminase,it is controversial whether the prevalence of glutenrelatedseromarkers is higher in patients with HCV. Insuch cases, in addition to acknowledging any currentlyexisting autoimmune disease, recognizing the risk ofthe patient developing an autoimmune disease duringinterferon （IFN）-based treatment must be a principleconcern. From a clinical point-of-view, the presence ofautoantibodies arouses suspicion that an autoimmunedisease may be present or may be precipitated by IFNbasedHCV treatment. In this paper, we review theprevalence of autoantibodies in individuals with hepatitisC, the clinical significance of these autoantibodies, andthe approach recommended for such situations.
AbstractInfection by multidrug resistant bacteria is arousing as a relevant issue among hospitalized subjects and is of particular interest in patients with cirrhosis given the frequent use of broad ...spectrum antibiotics and their altered immune response. We report the first case report of spontaneous bacterial peritonitis (SBP) caused by Enterococcus casseliflavus and the sixth case of SBP caused by Enterococcus gallinarum.
Recent guidelines recommended grouping grade 1 and minimal HE under the term “covert HE.” However, minimal HE is not usually investigated in hospitalized patients and there are very little data about ...the impact of grade 1 HE in patients admitted for complications of cirrhosis. This study aimed to investigate factors associated with the presence of grade 1 HE and its prognostic impact in patients hospitalized for complications of cirrhosis
prospective cohort study that included 238 patients either without HE or with grade 1 HE on the first day of hospitalization. All examiners were fourth-year fellows with at least one year of experience in clinical hepatology and trained by the senior investigators specifically for the use of West-Haven criteria. Minimal hepatic was not evaluated.
The mean age was 54.2 ± 11.6 years, mean MELD was 16.4 ± 6.7. Grade 1 HE was observed in 62 patients (26.1%) and was associated with ascites, Child-Pugh C, ACLF, higher total bilirubin, INR, MELD, and CLIF-SOFA. Progression to grades 2/3/4 HE (overt HE) up to day 3 of hospitalization occurred in 7.1% of the patients and was independently associated with bacterial infection (OR = 4.934, IC 95% 1.415-17.199, P=0.012) and grade 1 HE (OR = 3.937, IC 95% 1.261-12.298, P=0.018). The progression rate to overt HE was four times higher among subjects with grade 1 HE as compared to those without HE (16.1% vs. 4.0%, P = 0.003). The 90-day Kaplan-Meier survival probability was significantly lower among patients with grade 1 (71.0% vs. 84.1%, P = 0.018) (figure 1).
When compared to individuals without HE at admission, grade 1 HE was associated with parameters of more advanced liver disease and more severe acute decompensation. Patients with grade 1 HE exhibited worse evolution of mental state and higher mortality, reinforcing the practical importance of more subtle clinical findings.
Assessment of liver fibrosis in chronic hepatitis C virus(HCV)infection is considered a relevant part of patient care and key for decision making.Although liver biopsy has been considered the gold ...standard for staging liver fibrosis,it is an invasive technique and subject to sampling errors and significant intra-and inter-observer variability.Over the last decade,several noninvasive markers were proposed for liver fibrosis diagnosis in chronic HCV infection,with variable performance.Besides the clear advantage of being noninvasive,a more objective interpretation of test results may overcome the mentioned intra-and inter-observer variability of liver biopsy.In addition,these tests can theoretically offer a more accurate view of fibrogenic events occurring in the entire liver with the advantage of providing frequent fibrosis evaluation without additional risk.However,in general,these tests show low accuracy in discriminating between intermediate stages of fibrosis and may be influenced by several hepatic and extrahepatic conditions.These methods are either serum markers(usually combined in a mathematical model)or imaging modalities that can be used separately or combined in algorithms to improve accuracy.In this review we will discuss the different noninvasive methods that are currently available for the evaluation of liver fibrosis in chronic hepatitis C,their advantages,limitations and application in clinical practice.
Celiac disease(CD) is a systemic immune-mediated disorder triggered by dietary gluten in genetically predisposed individuals. The typical symptoms are anemia, diarrhea, fatigue, weight loss, and ...abdominal pain. CD has been reported in patients with primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis, aminotransferase elevations, nonalcoholic fatty liver disease, hepatitis B, hepatitis C, portal hypertension and liver cirrhosis. We evaluate recommendations for active screening for CD in patients with liver diseases, and the effect of a gluten-free diet in these different settings. Active screening for CD is recommended in patients with liver diseases, particularly in those with autoimmune disorders, steatosis in the absence of metabolic syndrome, noncirrhotic intrahepatic portal hypertension, cryptogenic cirrhosis, and in the context of liver transplantation. In hepatitis C, diagnosis of CD can be important as a relative contraindication to interferon use. Gluten-free diet ameliorates the symptoms associated with CD; however, the associated liver disease may improve, remain the same, or progress.
Although it is standard procedure in the evaluation of liver diseases, biopsy is an invasive method subject to sampling error and intra or inter-observer variability. Thus, surrogate markers of liver ...fibrosis have been proposed, with variable availability and accuracy.
Validate and compare the performance of APRI and FIB-4 as predictors of liver fibrosis in HCV patients.
Cross-sectional study including patients with HCV-RNA (+) who underwent liver biopsy. Significant fibrosis was defined as METAVIR stage ≥ 2. The diagnostic performance of the models in predicting significant fibrosis were evaluated and compared by ROC curves.
The study included 119 patients, mean age 43.7 ± 10.6 years and 62% males. Significant fibrosis was identified in 41 patients. The AUROCs observed were: APRI = 0.793 ± 0.047, FIB-4 = 0.811 ± 0.045 and AST/ALT = 0.661 ± 0.055 (P = 0.054 for APRI vs. AST/ALT, and P = 0.014 for FIB-4 vs. AST/ALT). Considering classic cutoffs, the PPV and NPV for APRI and FIB-4 were, respectively, 77% and 92% and 83% and 81%. Thirteen (19%) patients were misdiagnosed by APRI and 16 (18%) by FIB-4. By restricting the indication of liver biopsy to patients with intermediate values, it could have been correctly avoided in 47% and 63% of the patients with APRI and FIB-4, respectively.
The models APRI and FIB-4 were superior to AST/ALT ratio in the diagnosis of significant fibrosis in chronic HCV infection. Even though the overall performance of APRI and FIB-4 was similar, a higher proportion of patients may be correctly classified by FIB-4.
Introduction. Bacterial infection is a frequent complication in patients with decompensated liver cirrhosis and is related to high mortality rates during follow-up of these individuals. We sought to ...evaluate the diagnostic value of C-reactive protein (CRP) and procalcitonin (PCT) in diagnosing infection and to investigate the relationship between these biomarkers and mortality after hospital admission.Material and methods. Prospective study that included cirrhotic patients admitted to the hospital due to complications of the disease. The diagnostic accuracy of CRP and PCT for the diagnosis of infection was evaluated by estimating the sensitivity and specificity and by measuring the area under the receiver operating characteristics curve (AUROC).Results. A total of 64 patients and 81 hospitalizations were analyzed during the study. The mean age was 54.31 ± 11.87 years with male predominance (68.8%). Significantly higher median CRP and PCT levels were observed among infected patients (P < 0.001). The AUROC of CRP and PCT for the diagnosis of infection were 0.835 ± 0.052 and 0.860 ± 0.047, respectively (P = 0.273). CRP levels > 29.5 exhibited sensitivity of 82% and specificity of 81% for the diagnosis of bacterial infection. Similarly, PCT levels > 1.10 showed sensitivity of 67% and specificity of 90%. Significantly higher levels of CRP (P = 0.026) and PCT (P = 0.001) were observed among those who died within three months after admission.Conclusion. CRP and PCT were reliable markers of bacterial infection in subjects admitted due to complications of liver cirrhosis and higher levels of these tests are related to short-term mortality in those patients.
Acute decompensation (AD) of cirrhosis is associated with systemic inflammation and increased circulating cytokines. The use of inflammatory markers, such as calprotectin, could provide information ...on the role of the immune response in the prognosis of cirrhosis.
To evaluate serum calprotectin levels in patients hospitalized complications of cirrhosis.
This prospective cohort study included 200 adult subjects hospitalized for complications of cirrhosis who were followed for up to 30 days after admission. Twenty healthy subjects and 20 patients with stable cirrhosis were evaluated as controls. Serum calprotectin was measured by the ELISA.
Serum calprotectin levels were higher among the two groups of cirrhosis patients when compared to healthy controls. Greater median values of calprotectin were observed among patients with Child-Pugh C, ACLF, infection, ascites and hepatic encephalopathy. Concentrations of calprotectin were not related to the presence of ACLF, infection or to 30-days survival. However, when considered only patients with AD without ACLF (n = 144), higher values of calprotectin and CLIF-C ADs were associated with the lower survival in the univariate and multivariate Cox analyzes. The Kaplan-Meier survival probability was 98.7% in subjects with none of the factors (CLIF-C ADs <60 and calprotectin < 580 ng/mL), 83.6% in subjects with one of the factor (CLIF-C ADs ≥ 60 and calprotectin < 580 ng/mL or CLIF-C ADs < 60 and calprotectin ≥ 580 ng/mL) and 27.3% in subjects with both factors (CLIF-C ADs ≥ 60 and calprotectin ≥ 580 ng/mL), in which p = 0.002 between the first and second groups, and p < 0.001 between the first and third, and between the second and third groups (Figure).
The combination of the serum calprotectin and CLIF-C ADs may be useful in clinical practice to identifying patients with acute decompensation of cirrhosis and a very low 30-day survival rate.
Autoantibody profile in individuals with chronic hepatitis C Marconcini, Maíra Luciana; Fayad, Leonardo; Shiozawa, Maria Beatriz Cacese ...
Revista da Sociedade Brasileira de Medicina Tropical,
03/2013, Letnik:
46, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Autoantibodies are often produced during infection with chronic hepatitis C virus (HCV), but it remains controversial whether they influence the biochemical profile and histological features of this ...disease. Therefore, this current study sought to describe these autoantibodies and evaluate their impact on the clinical and histological presentation of hepatitis C.
This cross-sectional analytical study assessed patients with HCV (RNA+) from October 2011 to July 2012.
This study included 66 patients, with a mean age of 53.2±10.5 years. Of these patients, 60.6% were male, and 54.3% presented with genotype 1. Non-organ-specific autoantibodies (NOSA) were detected in 24% of the patients; of these, 7.6% were anti-mitochondrial antibodies (AMA+), 26.7% were anti-smooth muscle antibodies (SMA+) and 6.8% were liver kidney microsomal type 1 antibodies (LKM1+). With respect to the thyroid autoantibodies, 7.4% were anti-peroxidase (ATPO+) antibodies, and none were anti-thyroglobulin (ATG+) antibodies. Regarding celiac disease autoantibodies, 5.8% were endomysial antibodies (EMA+), and no transglutaminase (TTG+) antibodies were detected. Cryoglobulins were found in 2.1% of patients. When NOSA+ individuals were compared to patients without the presence of NOSAs, they exhibited higher median alkaline phosphatase (0.7 vs. 0.6 xULN; p=0.041), lower median platelet counts (141,500.0 vs. 180,500.0/mm 3 ; p=0.036), lower mean prothrombin activity (72.6±11.5% vs. 82.2±16.0%; p=0.012) and an increased prevalence of significant fibrosis (E≥2) (45.5% vs. 18.2%; p=0.012). There was also a tendency for a greater proportion of NOSA+ cases to have marked periportal activity (APP≥3) (44.5% vs. 15.6%; p=0.087).
In addition to the high prevalence of autoantibodies associated with HCV infection, it was observed that NOSA positivity was associated with a more severe histological and biochemical profile of hepatitis C infection.
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