Estudio descriptivo de pacientes con cirrosis hepática de etiología viral, en la provincia de Matanzas / Descriptive study of patients with viral-etiology liver cirrhosis in the province of Matanzas

RESUMEN Introducción: la cirrosis hepática de etiología viral representa un impactante problema de salud a nivel mundial, no solo por su elevada tasa de prevalencia, sino por los costos generados en la atención médica. Objetivos: determinar el comportamiento de los pacientes cirróticos, de etiología viral, en la provincia de Matanzas. Materiales y métodos: se realizó un estudio descriptivo-retrospectivo en 47 pacientes con cirrosis hepática de etiología viral, atendidos en el Servicio de Gastroenterología del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, de enero de 2016 a enero de 2018. Los resultados de las variables analizadas se expusieron en tablas de doble entrada. Resultados: el 68,1 % de los pacientes correspondió a cirrosis por virus C. Predominaron los mayores de 50 años, con carga viral entre 4-6,9 log10, y atendidos en régimen ambulatorio. En el 57,4 % se detectaron signos endoscópicos de hipertensión portal, que se corroboraron en el doppler hepático. La ascitis asociada a diferentes sepsis fueron las complicaciones más registradas. El 55,4 % fue clasificado como Child-Pugh A, y el 76,6 % en etapa clínica compensada. Conclusiones: el diagnóstico y seguimiento de la cirrosis hepática viral sigue siendo un verdadero reto para la comunidad médica. De ahí los esfuerzos que han de realizarse para su control desde las fases compensadas, para retardar la aparición de complicaciones (AU).

ABSTRACT Introduction: viral etiology liver cirrhosis is an impacting health problem around the world, not only because of its high prevalence rate but also because of the costs generated by its medical care. Objective: to determine the behavior of the patients with viral etiology liver cirrhosis in the province of Matanzas. Materials and methods: a descriptive-retrospective study was carried out in 47 patients with viral etiology liver cirrhosis treated in the service of Gastroenterology of the Hospital "Comandante Faustino Perez" of Matanzas, from January 2016 to January 2018. The results of the analyzed variables were shown in double-entry tables. Results: 68.1% of the patients presented cirrhosis caused by C virus, Patients elder 50 years old predominated, with 4-6.9 log10, treated in ambulatory regimen. Endoscopic signs of portal hypertension were found in 57.4%. It was corroborated with liver Doppler. Ascites associated to different sepsis were the most frequently registered complications. 55.4% were classified as Child-Pugh A, and 76.6% were in compensated clinical stage. Conclusions: viral liver cirrhosis diagnosis and follow-up is still a true challenge for the medical community, and hence the efforts that should be made to control it from the compensated stages to delay the appearance of complications (AU).

Avaliação de pacientes com hepatite autoimune atendidos em ambulatório de referência do sul do Brasil / Evaluation of patients with autoimmune hepatitis in a specialized outpatient clinic in southern brazil

ABSTRACT BACKGROUND: Autoimmune hepatitis (AIH) is a chronic liver disease, characterized by necroinflammation and autoimmune etiology. Studies evaluating the characteristics of patients with AIH are scarce in Brazil. OBJECTIVE: Our objective was to evaluate the profile of patients with AIH in a specialized center in Southern Brazil and to verify factors related to treatment response. METHODS: this was a retrospective cohort study, which analyzed demographic, epidemiological, clinical, laboratory, and histologic data. Patients with AIH diagnosed according to the criteria of the International Autoimmune Hepatitis Group (IAIHG) were included. In liver biopsies, the degree of fibrosis, histological activity, presence of hepatocyte rosettes, plasma cell infiltrates, and confluent necrosis were evaluated. In the statistical analysis, the significance level was 5%. RESULTS: Forty adults patients diagnosed with AIH were included. The evaluated population predominantly consisted of women (75.0%) and the average age at diagnosis was 44.2 years. The association with extrahepatic autoimmune diseases occurred in 20.0% of cases. Clinically, 35.0% of patients presented with acute onset hepatitis, 37.5% with cirrhosis, and 27.5% with other forms of presentation. The most common clinical manifestation was jaundice (47.5%). Thirty-five patients were treated, and of these, 97.1% used prednisone combined with azathioprine. The average treatment time was 2.7 years. Response to treatment was complete or partial in 30 (85.7%) and absent in 5 (14.3%) patients. There was no statistically significant difference when evaluating response to treatment in relation to forms of presentation, histological findings, and the presence of autoantibodies. Regarding fibrosis, regression was observed in 18.75% of the cases. CONCLUSION: Most patients with AIH were young at presentation and of female sex. The association with extrahepatic autoimmune diseases and cirrhosis at presentation was seen in a considerable proportion of patients. Treatment was effective, but there were no clinical, histological or serological parameters capable of predicting treatment response.

RESUMO CONTEXTO: A hepatite autoimune (HAI) é uma doença hepática crônica, de caráter necroinflamatório e etiologia autoimune. Os estudos que avaliam as características de pacientes com HAI são escassos no Brasil. OBJETIVO: Nosso objetivo foi avaliar o perfil dos pacientes com HAI atendidos em um centro de referência do sul do Brasil e verificar fatores relacionados à resposta ao tratamento. MÉTODOS: Este foi um estudo de coorte retrospectivo, que analisou dados demográficos, epidemiológicos e clínicos. Nas biópsias hepáticas, foram avaliados o grau de fibrose, a atividade histológica, a presença de rosetas, de infiltrado plasmocitário e de necrose confluente. Na análise estatística, o nível de significância foi de 5%. RESULTADOS: Foram incluídos 40 pacientes adultos com diagnóstico de HAI. Houve predomínio do sexo feminino (75,0%), e a média de idade no diagnóstico foi de 44,2 anos. A associação com doenças autoimunes extra-hepáticas ocorreu em 20,0% dos casos. Clinicamente, 35,0% dos pacientes se apresentaram sob forma de hepatite aguda, 37,5% com cirrose e 27,5% com outras formas de apresentação. A manifestação clínica mais comum na apresentação foi a icterícia (47,5%). Trinta e cinco pacientes foram tratados, sendo que destes, 97,1% utilizaram prednisona associada com azatioprina. A média do tempo de tratamento foi 2,7 anos. A resposta ao tratamento foi completa ou parcial em 30 (85,7%) e ausente em 5 (14,3%) pacientes. Não houve diferença estatisticamente significativa quando avaliada a resposta ao tratamento em relação à forma de apresentação, aos achados histológicos e à presença de autoanticorpos. Em relação à fibrose, foi observada regressão em 18,75% dos casos. CONCLUSÃO: A maioria dos pacientes era jovem no momento do diagnóstico e do sexo feminino. A associação com doenças autoimunes extra-hepáticas e com cirrose na apresentação foi vista em uma parcela considerável dos casos. O tratamento foi eficaz, mas não houve parâmetros clínicos, histológicos ou sorológicos capazes de prever a resposta ao tratamento.

Manifestaciones clínico-endoscópicas del paciente cirrótico / Clinical-endoscopic manifestations of the cirrhotic patient

RESUMEN Introducción: la cirrosis es un proceso dinámico y actualmente se conoce que cuando se elimina el agente primario de agresión que ha producido la cirrosis, se puede llegar a remitir la fibrosis. En Cuba la enfermedad representa la décima causa de muerte, con una tendencia ascendente en los últimos 20 años y una tasa de 13,4 por 100 000 habitantes. Objetivo: caracterizar clínica y endoscópicamente a pacientes con diagnóstico de cirrosis hepática. Material y método: se realizó un estudio descriptivo transversal, en el período comprendido entre los años 2017 - 19, donde el universo y la muestra quedaron constituidos por todos los pacientes mayores de 18 años ingresados con diagnóstico de cirrosis hepática. Resultados: predominó el sexo masculino en la sexta década de la vida, siento la principal causa el alcoholismo, caracterizado por manifestaciones generales, que en muchos casos debutan por complicaciones, apareciendo várices esofágicas en el 75 % de los casos, aunque gados I y II de Paquet, dependiente a un diagnóstico precoz de la enfermedad. Conclusiones: el alcoholismo crónico es la causa más frecuente de cirrosis hepática, debuta de forma frecuente por sus complicaciones, aunque el diagnóstico se hace en etapas precoces, con varices esofágicas incipientes (AU).

Summary Introduction: liver cirrhosis is a dynamic process and currently it is known that, when the primary agent of aggression that has produced the cirrhosis is eliminated, the fibrosis could remit. In Cuba, this diseases is the tenth cause of death, with an increasing tendency in the last twenty years and a rate of 13.4 per 100 000 inhabitants. Objective: to characterize, clinically and endoscopically, patients with hepatic cirrhosis diagnosis. Material and methods: a cross-sectional descriptive study was carried out, in the period 2017 - 2019, where the universe and the sample were formed by all the patients aged more than 18 years who entered the hospital with diagnosis of liver cirrhosis. Results: in this paper, male patients in their sixties predominated, being alcoholism the main cause of disease, characterized by general manifestations; patients debuted due to complications, appearing esophageal varices in 75 % of the cases, although Paquet I and II grades, in dependence to a disease precocious diagnosis. Conclusions: the authors concluded that chronic alcoholism is the most frequent cause in hepatic cirrhosis, almost always debuting by its complications, though the diagnosis is made in precocious stages, with emerging esophageal varices (AU).

Acercamiento al tratamiento del paciente cirrótico / An approach to the treatment of the cirrhotic patient

RESUMEN La cirrosis es un estado reversible de fibrosis hepática, que se ha convertido en la 8a causa de muerte en los Estados Unidos y la 9 a causa de muerte en Cuba. Este artículo repasa el tratamiento práctico de la cirrosis basado en la revisión de ensayos clínicos obtenidos de buscadores como MEDLINE, HINARI y Scielo, durante los últimos años. Las principales causas de cirrosis hepática incluyen las hepatitis crónicas por virus B, C, alcoholismo, y la esteatohepatitis no alcohólica. La desnutrición ocurre en 20 a 60 % de los pacientes con cirrosis, por lo cual las dietas hipo proteicas están bajo revisión, se recomienda el control estricto de la sal, el uso de medicamentos debe ser valorado estrictamente, y hacer un uso juicioso de los hipotensores cuando la tensión arterial media sea inferior a 82 mm de Hg, los beta bloqueadores no selectivos tienen su indicación en varices esofágicas desarrolladas, por otro lado se recomienda la cautela en analgésicos y los inhibidores de la bomba de protones, no restringiéndose el uso de estatinas. Con respecto a los procederes invasivos, el uso de métodos quirúrgicos deben ser evaluados en situaciones extremas, donde el índice MELD puede ayudar en cuanto al pronóstico y mortalidad esperada. La paracentesis en las ascitis refractaria debe ser masiva apoyada con el uso de albúmina, y se debe realizar lo más rápido posible en la sospecha de peritonitis bacteriana espontanea. Por lo que se puede concluir que el uso adecuado de la nutrición, el control de las complicaciones y los factores de riesgo puede llevar a la reversibilidad de la cirrosis hepática (AU).

SUMMARY Cirrhosis is a reversible status of the liver fibrosis, being the 8th cause of death in the United States and the 9th cause of death in Cuba. This article reviews the practical treatment of cirrhosis based on the review of clinical research published in MEDLINE, HINARI and Scielo, during the last years. The main causes of hepatic cirrhosis include the chronic hepatitis caused by B and C viruses, alcoholism, and the non-alcoholic steato-hepatitis. Malnutrition occurs in 20-60 % of the patients with cirrhosis, therefore low protein diets are under revision; it is recommended a strict use of salt; the use of drugs should be strictly evaluated. Hypotensive drugs should be cautiously used when the average arterial tension is lower than 82 Hg mm. Non-selective beta-blockers are indicated in developed esophageal varices. It is also recommended to be cautious with analgesics and proton pump inhibitors while the statins use is not restricted. Regarding the invasive procedures, surgery should be evaluated very carefully, and the MELD index can help with respect to prognosis and expected mortality. In refractory ascites, paracentesis should be massive relayed on albumin use, and should be carried out as soon as possible in the suspicion of spontaneous bacterial peritonitis. In conclusion, the adequate nutrition use, the control of complications and risk factors, could lead to reversibility of hepatic cirrhosis (AU).

Arritmias e alterações cardíacas no paciente cirrótico / Arrhythmias and cardiac alterations in the cirrhotic patient

No Brasil, a cirrose é um problema de saúde pública, que afeta aproximadamente 2 milhões de pessoas. As causas mais comuns são a doença hepática alcoólica, as hepatites virais e a doença hepática não alcoólica. A relação entre desordens cardíacas e hepatopatias é descrita na literatura, e a mais importante delas é o prolongamento do intervalo QT. A cirrose, independente de sua causa, é uma patologia frequentemente encontrada na população brasileira. Por este motivo, elucidar dados referentes às arritmias cardíacas em pacientes cirróticos é de grande importância dentro do estudo desta subpopulação. O objetivo deste artigo é fazer uma revisão de literatura com as informações referentes a epidemiologia, fisiopatologia, fatores de risco e prognóstico para as arritmias cardíacas em portadores de cirrose. (AU)

In Brazil, cirrhosis is a public health problem affecting approximately 2 million people. The most common causes are alcoholic liver disease, viral hepatitis, and non-alcoholic liver disease. The relationship between cardiac disorders and liver diseases is described in the literature, and the most important one is the QT interval prolongation. Cirrhosis, regardless of its causes, is a pathology that is frequently found in the Brazilian population. For this reason, elucidating data regarding cardiac arrhythmias in cirrhotic patients is of great importance within the study of this subpopulation. The aim of this article is to review the literature with information on the epidemiology, pathophysiology, risk factors, and prognosis for cardiac arrhythmias in patients with cirrhosis. (AU)

Previous hepatitis E virus infection, cirrhosis and insulin resistance in patients with chronic hepatitis C

ABSTRACT Background: Hepatitis E virus (HEV) infection in patients with pre-existing liver disease has shown high morbidity and lethality. The consequences of HEV superinfection in patients with chronic hepatitis C virus (HCV) infection are not fully understood. This study aimed to evaluate the association between the presence of anti-HEV antibodies, liver cirrhosis, and insulin resistance. Methods: A total of 618 patients chronically infected with HCV were included from three reference centers for viral hepatitis in São Paulo, Brazil. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI HEV-IgG ELISA). Results: The seroprevalence of anti-HEV in patients with cirrhosis was significantly higher than in patients without cirrhosis (13.2% vs 8%, OR = 1.74, p = 0.04). Seropositivity for anti-HEV, adjusted for sex, age, and HCV genotype showed an association trend with hepatic cirrhosis (aOR = 1.75, p = 0.059). Presence of HEV antibodies, adjusted for age, body mass index and cirrhosis, was shown to be independently associated with insulin resistance (aOR: 4.39; p = 0.045). Conclusion: Patients with chronic hepatitis C are under risk of hepatitis E virus superinfection in Brazil. The trend toward association between cirrhosis and previous HEV infection suggests that it may accelerate liver fibrosis in patients with chronic hepatitis C. In addition, previous infection by HEV is independently associated with insulin resistance in the studied population, which may be an extra-hepatic manifestation of hepatitis E that persists after resolution of the active infection, and may contribute to fibrosis progression.

Cirrhose hépatique dans le service de médecine interne du CNHU de Cotonou (2011-2014) : aspects épidémiologiques, cliniques et évolutifs

L'épidémiologie de la cirrhose est en pleine évolution dans le monde. Le but de la présente étude était de rapporter les aspects sociodémographiques cliniques, étiologiques et évolutifs chez les porteurs de cirrhose. PATIENTS ET METHODES. Cette étude rétrospective portant sur des dossiers de patients hospitalisés était menée dans le service de médecine interne du Centre National Hospitalier et Universitaire de Cotonou de 2011 à 2014. RESULTATS. Sur 305 dossiers exploitables, une cirrhose était trouvée chez 68 patients (22.2% ; sex ratio 2.09 ; âge moyen 55 ±14 ans, niveau socioéconomique défavorisé 32cas ; 47%). La cirrhose était décompensée dans 100% des cas. Le mode de présentation était la décompensation sous forme d'ascite (58cas ;85.3%) l'ictère (36 ; 52.9%) le carcinome hépatocellulaire (29 ; 42.6%) et l'hémorragie digestive (17 cas ; 25%). Les principales étiologies étaient l'hépatite virale B (26 cas ; 38.2%) ou C (10cas ;14.7%), la consommation chronique d'alcool (23 cas ;33.8%) ou les causes indéterminées (14 cas ; 20.5%). L'hépatite B et l'alcool prédominaient chez les hommes de la cinquantaine tandis que l'HVC était préférentiellement trouvée chez les femmes de plus de 60 ans (8 cas /10). Sur le plan évolutif, un décès hospitalier était noté dans 14 cas (20.6%). CONCLUSION : Les cirrhoses post virales encore fréquentes sont appelées à décroitre avec la vaccination contre l'hépatite B et le traitement curatif des hépatites B et C. Cependant la lutte contre les causes toxiques(alcool), iatrogènes (médicaments, phytothérapie) et le syndrome métabolique demeure capitale pour diminuer la prévalence de la cirrhose au Bénin

Supervivencia del paciente cirrótico con gastropatía portal hipertensiva / Survival of the Cirrhotic Patient with Hypertensive Portal Gastropathy

Introducción: la gastropatía portal hipertensiva constituye una complicación de la hipertensión portal que ocurre en pacientes cirróticos. Objetivo: determinar la probabilidad de supervivencia en un grupo de pacientes cirróticos con gastropatía portal hipertensiva. Métodos: seguimiento longitudinal, prospectivo, para estudiar la supervivencia de 34 pacientes con cirrosis hepática atendidos en el servicio de Gastroenterología del Hospital Militar Central Dr. Luis Díaz Soto desde octubre de 2012 hasta octubre del 2015. Se construyeron las curvas de sobrevida total y por estratos, según clasificación de Child-Pugh-Turcotte, etiología de la cirrosis, gravedad de la gastropatía y ocurrencia de sangrado agudo durante el período de observación. Se utilizó para ello el método de Kaplan-Meier y la comparación de las curvas por el logaritmo de rangos. Resultados: se apreció una probabilidad de supervivencia global de 94,1 por ciento a los dos meses y 61,7 por ciento a los 30 meses. La media de la supervivencia para pacientes con gastropatía leve y grave fue de 29,1 y 29,7 meses, respectivamente; esta fue de 28,3 meses para casos con cirrosis por virus C y de 30,1 meses para los de otras etiologías. Hubo predominio de casos en estadios de Child A (41,2 percent) y B (47,1 percent), con una media de supervivencia de 33,5 y 30,1 meses; para los del Child C (12 por ciento) fue de 12 meses; (p= 0,05). De los pacientes, el 35,3 por ciento de los casos sangraron, con una media de supervivencia de 25,5 meses inferior respecto a los que no sangraron (p= 0,35). Conclusiones: la presencia de gastropatía portal hipertensiva se relaciona con una mayor probabilidad de fallecer cuando hay un mayor deterioro de la función hepática o ha ocurrido un sangrado agudo, a partir de los 30 meses de haberse realizado su diagnóstico(AU)

Introduction: Hypertensive portal gastropathy is a complication of portal hypertension that occurs in cirrhotic patients. Objective: Determine the probability of survival in a group of cirrhotic patients with hypertensive portal gastropathy. Methods: a longitudinal, prospective follow-up was conducted to study the survival of thirty four (34) patients with liver cirrhosis and they were treated at the Gastroenterology Service of Dr. Luis Díaz Soto Central Military Hospital from October 2012 to October 2015. Full-length and strata survival curves were constructed, according to Child-Pugh-Turcotte classification, as well as etiology of cirrhosis, severity of gastropathy, and occurrence of acute bleeding during the observation period. Kaplan-Meier method was used and the comparison of the curves by the logarithm of ranges. Results: A global survival probability of 94.1 was observed at two months and 61.7 percent at 30 months. The mean survival for patients with mild and severe gastropathy was 29.1 and 29.7 months, respectively; this was 28.3 months for cases with C virus cirrhosis and 30.1 months for those of other etiologies. There were predominant cases in Child A (41.2 percent) and B (47.1 percent), with an average survival of 33.5 and 30.1 months; For Child C (12 percent) was 12 months; (P = 0.05). 35.3 percent of the cases bled, with an average survival of 25.5 months lower than those who did not bleed (p = 0.35). Conclusions: The presence of hypertensive portal gastropathy is associated with a greater probability of dying when there is a greater deterioration of the liver function or acute bleeding has occurred, as of 30 months after having been diagnosed(AU)

Epidemiología de las infecciones bacterianas en pacientes con cirrosis hepática, experiencia de un centro español de atención terciaria / Epidemiology of bacterial infections in patients with liver cirrhosis. Experience in a Spanish tertiary health center

Introducción. Las infecciones bacterianas representan una complicación grave de la cirrosis. En los últimos años se han observado cambios en el espectro microbiológico de estas infecciones, fundamentalmente, el aumento de infecciones por gérmenes multirresistentes. Objetivo. Establecer la proporción de infecciones por microorganismos multirresistentes en pacientes cirróticos ingresados en un centro de atención de Madrid, y analizar su epidemiología, factores de riesgo e impacto clínico. Materiales y métodos. Se hizo un estudio retrospectivo en el cual se evaluaron 294 pacientes hospitalizados por infección bacteriana en el Hospital General Universitario Gregorio Marañón de Madrid, entre junio de 2011 y junio de 2013. Resultados. Se aislaron 310 microorganismos de 223 pacientes; 109 (35,2 %) eran Gram positivos, 167 (53,9 %), Gram negativos, y 34 (11 %), hongos. El agente etiológico más frecuente fue Escherichia coli (98 aislamientos). Las infecciones se habían adquirido en la comunidad en 22,9 % de los casos, se asociaron con la atención de salud en 38,1 % y se adquirieron durante la estancia hospitalaria en 39 %. Los pacientes con aislamientos multirresistentes desarrollaron con más frecuencia choque séptico (p=0,05), y presentaron peor función hepática y alta mortalidad durante la estancia hospitalaria (p=0,017). El ingreso previo, el uso de antibióticos en los 60 días anteriores, la adquisición de la infección en el hospital o asociada a un ingreso reciente y el aislamiento de bacterias en los cultivos de control, se determinaron como posibles factores de riesgo para el desarrollo de la infección multirresistente. Discusión. Los resultados del estudio confirmaron que el espectro microbiológico de las infecciones bacterianas en pacientes con cirrosis ha sufrido importantes cambios. Las infecciones por gérmenes multirresistentes causan infecciones con gran morbimortalidad y el fracaso del tratamiento antibiótico habitual. Para controlarlas de forma eficaz, es imprescindible detectar precozmente a aquellos pacientes con factores de riesgo.

Introduction: Bacterial infections represent a serious complication of liver cirrhosis. Traditionally, Gram negative bacteria have been described as the microorganisms responsible for the majority of the infections. However, in the past few years, changes in the microbiological spectrum have been described, and multiresistant bacteria are observed more frequently. Objective: To assess the proportion of patients with infections caused by multiresistant bacteria admitted to our hospital, and to obtain information about their epidemiology, risk factors and clinical impact. Materials and methods: We performed a retrospective evaluation of 294 cirrhotic patients admitted to our unit due to infection between June, 2011, and June, 2013. Results: We isolated 310 microorganisms from 294 patients; 109 (35.2%) were Gram positive, 167 (53.9%), Gram negative, and 34, fungi (11%). As for the microbiological agents, the most frequent was Escherichia coli (98 isolations). The infection was community-acquired in 22.9% of cases, healthcare-associated in 38.1% and nosocomial in 39%. Worse liver infections and septic shock were more frequent among patients with multiresistant isolates (p=0.05); and intrahospital mortality was also higher among them (p=0.017). Previous hospital admission, antibiotic treatment 60 days before, nosocomial or healthcare-associated acquisition and bacterial isolation in control cultures were identified as possible risk factors for the development of multiresistant infection. Discussion: The results of our study confirm that important changes have ocurred in the microbiological spectrum of bacterial infections in patients with liver cirrhosis. Multiresistant bacteria are associated with high morbidity and mortality, as well as failure of traditional antibiotic treatment. Successfull control of the infection requires an early identification of patients at risk.

Non-alcoholic steatohepatitis-related liver cirrhosis is increasing in China: A ten-year retrospective study

OBJECTIVE: Little is known about metabolic factors in cirrhotic patients in China. Therefore, we aimed to quantify the prevalence of both metabolic factors and non-alcoholic steatohepatitis-related liver cirrhosis in China. METHODS: The medical records of 1,582 patients diagnosed with liver cirrhosis from June 2003 to July 2013 at Daping Hospital (Chongqing, China) were retrospectively reviewed through a computer-generated search. RESULTS: Serum hepatitis B virus surface antigen was present in 1,083 (68.5%) patients, and hepatitis B was found to be the only etiological factor in 938 (59.3%) of all patients. Obesity, diabetes mellitus, and arterial hypertension were observed in 229 (14.5%), 159 (10.1%), and 129 (8.2%) patients, respectively. From 2012-2013, the proportion of non-alcoholic steatohepatitis-related liver cirrhosis increased to 3.2%, whereas the average proportion of non-alcoholic steatohepatitis-related liver cirrhosis in the previous ten years was 1.9%. The incidence of hepatocellular carcinoma was much higher in males than in females (6.3% vs. 3.7%, respectively, p=0.036). Obesity and diabetes mellitus did not significantly increase the incidence of hepatocellular carcinoma in the whole cirrhotic group. The presence of hepatitis B virus was the only risk factor for hepatocellular carcinoma in cirrhotic patients (p<0.001). CONCLUSIONS: Although hepatitis B virus remains the main etiology of liver cirrhosis in China, steatohepatitis-related liver cirrhosis is increasing in frequency. Hepatitis B virus was the sole significant risk factor for hepatocellular carcinoma in the whole cirrhotic group in the present study, in contrast to obesity and diabetes mellitus, for which only a trend of increased hepatocellular carcinoma was found. .

Disease burden of chronic hepatitis C in Brazil

Background: Hepatitis C virus infection is a major cause of cirrhosis; hepatocellular carcinoma; and liver transplantation. The aim of this study was to estimate hepatitis C virus disease progression and the burden of disease from a nationwide perspective.Methods: Using a model developed to forecast hepatitis C virus disease progression and the number of cases at each stage of liver disease; hepatitis C virus-infected population and associated disease progression in Brazil were quantified. The impact of two different strategies was compared: higher sustained virological response and treatment eligibility rates (1) or higher diagnosis and treatment rates associated with increased sustained virological response rates (2).Results: The number of infected individuals is estimated to decline by 35% by 2030 (1,255,000 individuals); while the number of cases of compensated (n= 325,900) and decompen- sated (n= 45,000) cirrhosis; hepatocellular carcinoma (n= 19,100); and liver-related deaths (n= 16,700) is supposed to peak between 2028 and 2032. In strategy 2; treated cases increased over tenfold in 2020 (118,800 treated) as compared to 2013 (11,740 treated); with sustained virological response increased to 90% and treatment eligibility to 95%. Under this strategy; the number of infected individuals decreased by 90% between 2013 and 2030. Compared to the base case; liver-related deaths decreased by 70% by 2030; while hepatitis C virus-related liver cancer and decompensated cirrhosis decreased by 75 and 80%; respectively.Conclusions: While the incidence and prevalence of hepatitis C virus in Brazil are decreasing; cases of advanced liver disease continue to rise. Besides higher sustained virological response rates; new strategies focused on increasing the proportion of diagnosed patients and eligibility to treatment should be adopted in order to reduce the burden of hepatitis C virus infection in Brazil.

Disease Progression in Chronic Hepatitis B Patients under Long-Term Antiviral Therapy

BACKGROUND/AIMS: We investigated factors associated with the disease progression and development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients during long-term oral nucleos(t)ide analog (NA) therapy. METHODS: This retrospective study included 524 naive CHB patients who received oral NA therapy for more than 48 weeks between January 2003 and December 2007. The primary outcome was 5-year cumulative probability of disease progression and HCC development. Disease progression was defined as cirrhosis development, cirrhotic complications, HCC or liver-related mortality. RESULTS: For the 524 patients, the cumulative probabilities of disease progression and HCC development at 1, 2, 3, 4 and 5 years were 1.1%, 6.3%, 9.0%, 11.6%, and 16.2% and 0.2%, 1.8%, 3.6%, 5.8%, and 9.3%, respectively. In multivariate analysis, age >50 years (hazard ratio [HR], 1.05) and cirrhosis (HR, 2.95) were significant factors for disease progression. Similarly, age >50 years (HR, 1.05), family history of HCC (HR, 5.48), and cirrhosis (HR, 17.16) were significant factors for HCC development. Importantly, longer duration (>12 months) of maintained virological response (<20 IU/mL) reduced the risks of disease progression (HR, 0.19) and HCC development (HR, 0.09). CONCLUSIONS: Longer duration of maintained virological response significantly reduces the risk of disease progression or HCC development in CHB patients undergoing long-term oral NA therapy.

AROS Is a Significant Biomarker for Tumor Aggressiveness in Non-cirrhotic Hepatocellular Carcinoma

Despite a low risk of liver failure and preserved liver function, non-cirrhotic hepatocellular carcinoma (HCC) has a poor prognosis. In the current study, we evaluated an active regulator of SIRT1 (AROS) as a prognostic biomarker in non-cirrhotic HCC. mRNA levels of AROS were measured in tumor and non-tumor tissues obtained from 283 non-cirrhotic HCC patients. AROS expression was exclusively up-regulated in recurrent tissues from the non-cirrhotic HCC patients (P=0.015) and also in tumor tissues irrespective of tumor stage (P<0.001) or BCLC stage (P<0.001). High mRNA levels of AROS were statistically significantly associated with tumor stage (P<0.001), BCLC stage (P=0.007), alpha fetoprotein (AFP) level (P=0.013), microvascular invasion (P=0.001), tumor size (P=0.036), and portal vein invasion (P=0.005). Kaplan-Meir curve analysis demonstrated that HCC patients with higher AROS levels had shorter disease-free survival (DFS) in both the short-term (P<0.001) and long-term (P=0.005) compared to those with low AROS. Cox regression analysis demonstrated that AROS is a significant predictor for DFS along with large tumor size, tumor multiplicity, vascular invasion, and poor tumor differentiation, which are the known prognostic factors. In conclusion, AROS is a significant biomarker for tumor aggressiveness in non-cirrhotic hepatocellular carcinoma.

Método para estimação de prevalência de hepatites B e C crônicas e cirrose hepática - Brasil, 2008 / Method for estimating the prevalence of chronic hepatitis B and C and cirrhosis of the liver in Brazil, 2008 / Método para estimación de prevalencia de hepatitis B y C crónicas y cirrosis hepática - Brasil, 2008

Objetivo: estimar as prevalências nacionais de hepatites virais crônicas e cirrose hepática no Brasil em 2008. Métodos: as estimativas das hepatites B e C basearam-se em inquérito nacional, considerando-se casos crônicos todos os HBsAg (antígeno de superfície de hepatite B) positivos e 70 por cento dos anti-HCV (marcador sorológico para hepatite C) positivos; sobre dados do inquérito, estimou-se a prevalência de cirrose viral; complementarmente, calculou-se a prevalência da cirrose por álcool. Resultados: as prevalências nacionais de hepatites B e C crônicas foram de 370/100 mil e 959/100 mil habitantes, respectivamente; a cirrose apresentou prevalência de 0,35 por cento no país, com 151/100 mil hab. para hepatite C, 17/100 mil hab. para hepatite B e 182/100 mil hab. para álcool e outras causas. Conclusão: tais prevalências, embora compatíveis com baixa endemicidade, destacam as hepatites virais e a cirrose como relevantes problemas de saúde no país; estudos de base populacional contribuiriam no refinamento das estimativas apresentadas...

Objective: to estimate chronic viral hepatitis and liver cirrhosis prevalence in Brazil, 2008. Methods: hepatitis B and C prevalence estimates were calculated based on a national survey, considering chronic cases to be all positive HBsAg and 70 per cent of positive anti-HCV. Hepatitis prevalence was used to estimate viral cirrhosis and cirrhosis due to alcohol and other causes were considered complementary to the former. Results: national chronic hepatitis B and C prevalence estimates were 370/100,000 and 959/100,000 inhabitants, respectively. Liver cirrhosis prevalence was 0.35 per cent overall, with the following distribution by causes: 151/100,000 for hepatitis C; 17/100,000 for hepatitis B and 182/100,000 for alcohol and other causes. Conclusion: prevalence estimates, although compatible with low endemicity, highlight viral hepatitis and cirrhosis as relevant health problems in the country. Further population-based studies are required in order to obtain better prevalence estimates...

OBJETIVO: estimar las prevalencias nacionales de hepatitis virales crónicas y cirrosis hepática en Brasil en 2008.MÉTODOS: las estimaciones de las hepatitis B y C se basaron en encuesta nacional, considerando casos crónicos todos los HBsAg (antígeno de superficie de hepatitis B) positivos y 70% de los anti-HCV (marcador serológico para hepatitis C) positivos; sobre datos de la encuesta, se estimó la prevalencia de cirrosis viral; complementariamente, se calculó la prevalencia de la cirrosis por alcohol.RESULTADOS: las prevalencias nacionales de hepatitis B y C crónicas fueron de 370/100 mil y 959/100 mil habitantes, respectivamente; la cirrosis presentó prevalencia de 0,35% en el país, con 151/100 mil hab. para hepatitis C, 17/100 mil hab. para hepatitis B y 182/100 mil hab. para alcohol y otras causas.CONCLUSIÓN: tales prevalencias, aunque compatibles con baja endemicidad, destacan las hepatitis virales y la cirrosis como relevantes problemas de salud en el país; estudios de base poblacional contribuirían a refinar las estimaciones presentadas...

Relationship of Liver Stiffness and Controlled Attenuation Parameter Measured by Transient Elastography with Diabetes Mellitus in Patients with Chronic Liver Disease

High prevalence of diabetes mellitus in patients with liver cirrhosis has been reported in many studies. The aim of our study was to evaluate the relationship of hepatic fibrosis and steatosis assessed by transient elastography with diabetes in patients with chronic liver disease. The study population consisted of 979 chronic liver disease patients. Liver fibrosis and steatosis were assessed by liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) on transient elastography. Diabetes was diagnosed in 165 (16.9%) of 979 patients. The prevalence of diabetes had significant difference among the etiologies of chronic liver disease. Higher degrees of liver fibrosis and steatosis, assessed by LSM and CAP score, showed higher prevalence of diabetes (F0/1 [14%], F2/3 [18%], F4 [31%], P50 yr (OR, 1.52; P=0.046). The degree of hepatic fibrosis but not steatosis assessed by transient elastography has significant relationship with the prevalence of diabetes in patients with chronic liver disease.

Relationship of Liver Stiffness and Controlled Attenuation Parameter Measured by Transient Elastography with Diabetes Mellitus in Patients with Chronic Liver Disease

High prevalence of diabetes mellitus in patients with liver cirrhosis has been reported in many studies. The aim of our study was to evaluate the relationship of hepatic fibrosis and steatosis assessed by transient elastography with diabetes in patients with chronic liver disease. The study population consisted of 979 chronic liver disease patients. Liver fibrosis and steatosis were assessed by liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) on transient elastography. Diabetes was diagnosed in 165 (16.9%) of 979 patients. The prevalence of diabetes had significant difference among the etiologies of chronic liver disease. Higher degrees of liver fibrosis and steatosis, assessed by LSM and CAP score, showed higher prevalence of diabetes (F0/1 [14%], F2/3 [18%], F4 [31%], P50 yr (OR, 1.52; P=0.046). The degree of hepatic fibrosis but not steatosis assessed by transient elastography has significant relationship with the prevalence of diabetes in patients with chronic liver disease.

Cirrhotic patients; incidence, of UGI bleeding factors and esophageal varices

To determine the frequency of upper GI bleeding and its predicting factors and esophageal varices in the patients with liver cirrhosis disease admitted at medicine ward of Isra university hospital. Prospective and observational study. Isra university hospital. March 2012 to August 2012 [six months]. Containing 100 patients, mean age was 45.8, and all the patients with cirrhosis disease were included in this study with liver cirrhosis disease. All patients were under went endoscopy and Frequency of upper GI bleeding and varices presentation and classification according to grade were noted. All the 100 patients were selected on the basis of presenting liver cirrhosis disease. Male were more found than the female with the mean age 45.8. Mostly cirrhotic patients were found with HCV positive and upper GI bleeding were noted in [40%] of the cases. With the endoscopic finding mostly patients were noted in II - III grad of esophageal varices and according to child pug classification majority of patients was noted in class "C" In addition, thrombocytopenia and red wale markings along with the presence of large sized varices were associated with the presence of esophageal varices. In the conclusion of this study we found majority of the cirrhotic patients with HCV, Esophageal varices and thrombocytopenia are the important factors of upper GI bleeding. Knowledge and etiology of this manuscript may helpful in the prevention of oesophageal varices and upper GI bleeding

Principales causas y factores asociados a cirrosis hepática en los pacientes del Hospital General de Zona 2 de Chiapas, México / Main causes and factors associated with liver cirrhosis in patients in the General Hospital of Zone 2 of Chiapas, Mexico

Antecedentes: la cirrosis hepática es un problema de salud pública mundial cuya característica principal es la pobre expectativa de vida. En México ocupa el segundo lugar como causa de mortalidad en el grupo de edad de mayor productividad. Métodos: estudio observacional, retrospectivo descriptivo y transversal. Se recolectaron datos de edad, sexo, ocupación, procedencia, factores de riesgo para daño hepático y probable causa etiológica de los pacientes enviados con diagnóstico de cirrosis en un periodo de 2 años. Resultados: predominó el sexo femenino sobre el masculino 57,2/42,7 por ciento; el promedio de edad fue 55,27, el 55,02 por ciento residentes de Tuxtla Gutiérrez. Factores de riesgo: consumo de alcohol en 74,67 por ciento, la diabetes mellitus 56,33 por ciento, obesidad 41,92 por ciento, medicina alternativa 19,22 por ciento, consumo frecuente de fármacos 12,66 por ciento, transfusiones 9,17 por ciento. Las amas de casa fueron las más afectadas 50,21 por ciento[95 por ciento C.I. 43,6-56,9]. El alcoholismo se reconoció como factor desencadenante 47,59 por ciento, sin causa aparente o criptogénica 41,92 por ciento y hepatitis viral crónica 5,24 por ciento. Datos de hipertensión portal se detectaron en 89,5 por ciento: várices esofágicas en 59,8 por ciento, ascitis 37,11 por ciento, encefalopatía hepática crónica 2,62 por ciento, VP >11mm en 18,7 por ciento. La prevalencia durante el periodo de estudio fue 9,85 por ciento. Conclusiones: las diferencias observadas de casos de cirrosis hepática en este estudio, tanto de género como de origen de la cirrosis, son significativas. Esto despierta el interés de investigar en un futuro las condiciones en las que viven las mujeres de la ciudad de Tuxtla Gutiérrez. Habría que investigar si son factores de tipo idiosincrático o cultural los que condicionan la mayor prevalencia de la cirrosis en este grupo de la población del sureste de México.

Background: Liver cirrhosis is a worldwide public health problem. Its main characteristic is low life expectancy. In Mexico, it is the second leading cause of death in the age group with the highest work productivity. Methods: The study is observational, retrospective, descriptive and cross-sectional. Data were collected on age, sex, occupation, origin, risk factors for liver damage and probable etiology of patients referred with a diagnosis of cirrhosis in a period of 2 years. Purpose: To determine the causes and factors associated with liver cirrhosis in our population. Results: Females prevailed over males by 57.2 percent over 42.7 percent. Average age was 55.27 and 55.02 percent were Tuxtla Gutierrez residents. The following risk factors were found: alcohol consumption (74.67 percent), diabetes mellitus (56.33 percent), obesity (41.92 percent), use of alternative medicines (19.22 percent), frequent use of drugs (12.66 percent), and transfusion (9.17 percent). Housewives were most affected (50.21 percent) [95 percent CI 43.6-56.9]. Alcoholism in 47.59 percent was found to be a triggering factor; in 41.92 percent the cause was unexplained or cryptogenic; and in 5.24 percent the cause was chronic viral hepatitis. Portal hypertension data were found in 89.5 percent: 59.8 percent had esophageal varices, 37.11 percent had ascites, and 2.62 percent had chronic hepatic encephalopathy. VP > 11 mm in 18.7 percent. The prevalence during the study period was 9.85 percent Conclusions: There are significant differences observed in gender and cause of cirrhosis in this study. In the future more research should be done to look into the conditions under which women live in the city of Tuxtla Gutierrez, as well as whether other idiosyncratic factors or cultural conditions are leading to a higher prevalence of cirrhosis in this population group in the Southeast of Mexico.

Type and cause of liver disease in Korea: single-center experience, 2005-2010

BACKGROUND/AIMS: The aim of this study was to describe the types and causes of liver disease in patients from a single community hospital in Korea between April 2005 and May 2010. METHODS: A cohort of patients who visited the liver clinic of the hospital during the aforementioned time period were consecutively enrolled (n=6,307). Consistent diagnostic criteria for each liver disease were set by a single, experienced hepatologist, and the diagnosis of all of the enrolled patients was confirmed by retrospective review of their medical records. RESULTS: Among the 6,307 patients, 528 (8.4%) were classified as acute hepatitis, 3,957 (62.7%) as chronic hepatitis, 767 (12.2%) as liver cirrhosis, 509 (8.1%) as primary liver cancer, and 546 (8.7%) as a benign liver mass or other diseases. The etiologies in the acute hepatitis group in decreasing order of prevalence were hepatitis A (44.3%), toxic hepatitis (32.4%), other hepatitis viruses (13.8%), and cryptogenic hepatitis (9.1%). In the chronic hepatitis group, 51.2% of cases were attributed to viral hepatitis, 33.3% to nonalcoholic fatty liver disease, and 13.0% to alcoholic liver disease (ALD). Of the cirrhoses, 73.4% were attributable to viral causes and 18.1% to alcohol. Of the hepatocellular carcinoma cases, 86.6% were attributed to viral hepatitis and 11.6% to ALD. Among the benign tumors, hemangioma comprised 52.2% and cystic liver disease comprised 33.7%. CONCLUSIONS: Knowledge of the current status of the type and cause of liver disease in Korea may be valuable as a basis for evaluating changing trends in liver disease in that country.

Status Quo of Chronic Liver Diseases, Including Hepatocellular Carcinoma, in Mongolia

Because Mongolia has much higher liver disease burden than any other regions of the world, it is necessary to provide information on real-time situation of chronic liver disease in Mongolia. In this article, we reviewed studies performed in Mongolia from 2000 to 2011 on seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) among healthy individuals and patients with chronic liver diseases, and on the practice patterns for the management of liver cirrhosis and hepatocellular carcinoma (HCC). According to previous reports, the seroprevalence of HBV and HCV in general population in Mongolia is very high (11.8% and 15% for HBV and HCV, respectively). Liver cirrhosis is also highly prevalent, and mortality from liver cirrhosis remained high for the past decade (about 30 deaths per 100,000 populations per year). Among patients with cirrhosis, 40% and 39% are positive for HBsAg and anti-HCV, respectively, and 20% are positive for both. The seroprevalence is similar for HCC and more than 90% of HCC patients are positive for either HBV or HCV. The incidence of HCC in Mongolia is currently among the highest in the world. The mortality from HCC is also very high (52.2 deaths per 100,000 persons per year in 2010). Partly due to the lack of established surveillance systems, most cases of HCC are diagnosed at an advanced stage. The mortality from liver cirrhosis and HCC in Mongolia may be reduced by implementation of antiviral therapy program and control of alcohol consumption.