[Valuation of APRI and Forns models for non-invasive diagnosis of fibrosis in patients with hepatitis C in coinfected and non-coinfected with HIV]. / Valoración de los modelos APRI y Forns para el diagnóstico no invasivo de fibrosis en pacientes con hepatitis C coinfectados y no coinfectados por VIH.

BACKGROUND: APRI and Forns (IF) index are noninvasive models consisting of routine laboratory data for the prediction of liver fibrosis in patients with chronic hepatitis C. The aim of our study was to confirm the value of these models to predict significant fibrosis in these patients and if they may decrease the need for performing liver biopsy specimens in coinfected and HIVnon-coinfected. PATIENTS AND METHOD: We included 60 patients with chronic hepatitis C and histologic data, 33 were coinfected with HIV. Mild fibrosis (F0-F1) was found in 73% patients, severe fibrosis (F3-F4) in 23% and cirrhosis in 18.3%. We calculated and compared APRI and IF with the stage of liver fibrosis. RESULTS: The APRI score < 0.5 or > 1.5 and IF < 4.2 or > 6.9, as predictors of mild or severe fibrosis, were only available in 53% and 49%. Neither laboratory nor APRI and IF were associated with liver fibrosis in non-coinfected patients. We only found association in HIV coinfected patients: severe fibrosis (F3-4) whit higher gammaglobulins [24.5% vs. 30% (p < 0.05)] and Gamma-GT levels [77 (46.5) vs. 32 (48.5) (p < 0.05)], and lower prothrombin time [72% vs. 91% (p < 0.05) ] and platelets.109 count [129 (40) vs. 170 (78) (p < 0.05)]; APRI was lower than 0.5 in 41.6% patients with mild fibrosis (F0-1) against none with severe (F3-4) (p < 0.05); specifity (E) of APRI < 0.5 for predicting mild fibrosis was 100%, but sensivity (S) was very low (41%), with a positive preditive value (VPP) of 100%, but a negative predictive value (VPN) also very low ( 36.3%). CONCLUSIONS: Our study showed that these models don t avoid the need for liver biopsies. More than a half of patients are not appropriately classified according to findings on liver biopsy and S and VPN are very low. The combination of these index with gammaglobulins, Gamma-GT, AST, ALT and platelet levels and protrombine time, only may be an approach to degree of fibrosis or inflammation liver in HIV co-infected patients.

Valoración de los modelos APRI y Forns para el diagnóstico no invasivo de fibrosis en pacientes con hepatitis C coinfectados y no coinfectados por VIH / Valuation of APRI and Forns model of non-invasive diagnosis of fibrosis in patients with hepatitis C in coinfected and non-coinfected with HIV

Introducción: Los índices APRI y de Forns (IF), son modelos no invasivos a partir de datos rutinarios de laboratorio para la predicción de fibrosis hepática en pacientes con hepatitis crónica C. El propósito de nuestro estudio es confirmar el valor de estos modelos para predecir fibrosis significativa en estos pacientes y si pueden disminuir la necesidad de la biopsia hepática en coinfectados y no coinfectados por el VIH. Pacientes y métodos: Incluimos 60 pacientes con hepatitis crónica y datos histológicos, 33 coinfectados por VIH. El 73% tenía fibrosis leve (F0-F1), el 23% grave (F3-F4) y el 18,3% cirrosis histológica. Calculamos y comparamos los índices APRI e IF con el grado de fibrosis hepática. Resultados: Los valores de APRI 1,5 e IF 6,9, indicativos de fibrosis leve o severa, sólo han podido aplicarse en el 53% y 49% de los casos respectivamente. Ningún parámetro bioquímico, ni el APRI o el IF se asociaron con el grado de fibrosis en los pacientes no coinfectados con el VIH. Sólo observamos asociaciones en los pacientes VIH(+): la fibrosis severa (F3-4) con un mayor nivel de gammaglobulinas [24,5% vs. 30% (p < 0,05)] y de GGT [77 (46,5) vs. 32 (48,5) (p < 0,05)], y una menor tasa de protrombina [72 vs. 91% (p < 0,05)] y de plaquetas 109 [129 (40) vs. 170 (78) (p < 0,05)]; se observó un mayor porcentaje de APRI < 0,5 (41,6%) con fibrosis leve (F0-1) frente al observado (0) en la grave (F3-4) (p < 0,05); la especificidad (E) del APRI < 0,5 para establecer fibrosis leve o inexistente fue del 100%, pero la sensibilidad (S) era excesivamente baja (41%), con un valor predictivo positivo (VPP) de 100%, pero un valor predictivo negativo (VPN) muy bajo (36,3%). Conclusiones: Nuestro estudio mostró que estos modelos no evitan la necesidad de biopsias hepáticas. Más de la mitad de los pacientes no pueden ser clasificados apropiadamente y la S y VPN son muy bajos. La combinación de estos índices con los niveles de gammaglobulinas, Gamma- GT, GOT, GPT, plaquetas y tiempo de protrombina, sólo han podido servir de orientación sobre el grado de fibrosis o inflamación hepáticas, y de forma limitada a los pacientes coinfectados con el VIH

Background: APRI and Forns (IF) index are noninvasive models consisting of routine laboratory data for the prediction of liver fibrosis in patients with chronic hepatitis C. The aim of our study was to confirm the value of these models to predict significant fibrosis in these patients and if they may decrease the need for performing liver biopsy specimens in coinfected and HIVnon-coinfected. Patients and method: We included 60 patients with chronic hepatitis C and histologic data, 33 were coinfected with HIV. Mild fibrosis (F0- F1) was found in 73% patients, severe fibrosis (F3-F4) in 23% and cirrhosis in 18.3%. We calculated and compared APRI and IF with the stage of liver fibrosis. Results: The APRI score 1.5 and IF 6.9, as predictors of mild or severe fibrosis, were only available in 53% and 49%. Neither laboratory nor APRI and IF were associated with liver fibrosis in non-coinfected patients. We only found association in HIV coinfected patients: severe fibrosis (F3-4) whit higher gammaglobulins [24.5% vs. 30% (p < 0.05)] and Gamma-GT levels [77 (46.5) vs. 32 (48.5) (p < 0.05)], and lower prothrombin time [72% vs. 91% (p < 0.05) ] and platelets.109 count [129 (40) vs. 170 (78) (p < 0.05)]; APRI was lower than 0.5 in 41.6% patients with mild fibrosis (F0-1) against none with severe (F3-4) (p < 0.05); specifity (E) of APRI < 0.5 for predicting mild fibrosis was 100%, but sensivity (S) was very low (41%), with a positive preditive value (VPP) of 100%, but a negative predictive value (VPN) also very low ( 36.3%). Conclusions: Our study showed that these models don’t avoid the need for liver biopsies. More than a half of patients are not appropriately classified according to findings on liver biopsy and S and VPN are very low. The combination of these index with gammaglobulins, Gamma-GT, AST, ALT and platelet levels and protrombine time, only may be an approach to degree of fibrosis or inflammation liver in HIV co-infected patients

Evaluación de la utilización de heparinas de bajo peso molecularcomo profilaxis de tromboembolismo venoso en pacientes demedicina interna / No disponible

Introducción: Existe suficiente evidencia para recomendarla tromboprofilaxis rutinaria en pacientes médicos con factores de riesgo, siendo las heparinas de bajo peso molecular (HBPM) la opción más adecuada para realizarla. El objetivo es conocer el grado de riesgo de tromboembolismo venoso (TEV) en pacientes de medicina interna tratados con HBPM en profilaxis, los hábitos de prescripción y su adecuación al protocolo del hospital, así como detectar la prevalencia de pacientes no tratados con riesgo. Material y método: Estudio descriptivo y prospectivo de 2 meses de duración sobre los pacientes ingresados en medicina interna. Se reclutaron aquellos con prescripción profiláctica de HBPM y se determinó su grado de riesgo de TEV y la dosis de HBPM adecuada, según el “Protocolo de prevención de enfermedad tromboembólica” de nuestro hospital. Paralelamente se analizaron los pacientes no tratados para estimar si eran subsidiarios de profilaxis con HBPM. Resultados: Al 30% de los ingresados se le prescribió una HBPM profiláctica, de los que el 43,5% recibió una prescripción ajustada a su grado de riesgo. Sus factores de riesgo más destacados fueron: edad, encamamiento, HTA, cardiopatía de riesgo, diabetes mellitus, dislipemias y EPOC. El test c20,05 entre grado de riesgo y HBPM instaurada reveló que no existía asociación. Del grupo de pacientes no tratados, el 72% presentaron un nivel de riesgo moderado o alto. Conclusiones:1. Una gran proporción de los pacientes estudiados presentan nivel considerable de riesgo de TEV. 2. No se observa relación entre nivel de riesgo y profilaxis pautada (AU)

Background: Sufficient evidence exists to recommend routine thromboembolic disease prophylaxis for medical inpatients with risk factors -with low-molecular-weight- heparins being(LMWH) the most suitable treatment option. The objective is to determine the thromboembolic risk level of Internal Medicine patients with LMWH prophylaxis, prescription habits and the iradequacy to hospital’s standards, as well as prevalence of non treated patients at risk. Material and methods: Descriptive and prospective study of internal medicine patients for 2 months. Patients with prophylactic LMWH prescription were chosen, and their thrombo embolicrisk level and suitable LMWH dose was determined according to the hospital’s “thromboembolic disease prevention standards”.On the other hand, patients with no LMWH prophylaxis were analysed in order to judge their candidacy. Results: 30% of patients had a prophylactical LMWH prescription, with 43.5% of these prescriptions being adequate to the risk level. The main risk factors were: age, bed-stay, hypertension,cardiopathy with risk factors, diabetes mellitus, dislipemias and COPD. c20.05 test between risk level and prescribed LMWH revealed no association. 72% of patients without LMWH prescription had a moderate or high risk level. Conclusions:1. A high proportion of the patients studied have a considerable thromboembolic risk level.2. There is not a statistical relationship between thromboembolic risk level and LMWH prescription.3. There is a high percentage of patients with no LMWH prophylaxis which could be eligible for it.4. A pharmaceutical intervention would be useful to approachpharmacological prophylaxis to each patient’s risk (AU)