ABSTRACT
BACKGROUND AND GOALS: Liver fibrosis influences treatment and surveillance strategies in chronic hepatitis B (CHB). This multicenter study aimed to examine the accuracy of serum fibrosis models in CHB patients including those with low alanine aminotransferase (ALT) levels and serially in those undergoing treatment. METHOD: We examined noninvasive fibrosis models [Hepascore, Fibrotest, APRI, hepatitis e antigen (HBeAg)-positive and -negative models] in 179 CHB patients who underwent liver biopsy and fibrosis assessment by METAVIR and image morphometry. Serial Hepascore measurements were assessed in 40 subjects for up to 8.7 years. RESULTS: Hepascore was more accurate than Fibrotest [area under the curve (AUC) 0.83 vs. 0.72, P = 0.05] and HBeAg-positive model (AUC 0.83 vs. 72, P = 0.03) for significant fibrosis but was not significantly different to APRI or HBeAg-negative scores. Fibrosis area assessed by morphometry was correlated with Hepascore (r = 0.603, P < 0.001), Fibrotest (r = 0.392, P = 0.03), and HBeAg-positive (r = 0.492, P = 0.001) scores only. Among 73 patients with an ALT <60 IU/L, noninvasive models were useful to predict fibrosis (PPV 80-90%) or exclude significant fibrosis (NPV 79-100%). Hepascore increased significantly among patients monitored without treatment and reduced among patients undergoing therapy (0.05/year ± 0.03 vs. -0.04/year ± 0.02, P = 0.007). CONCLUSIONS: Serum fibrosis models are predictive of fibrosis in CHB and assist in identifying subjects with low-normal ALT levels for treatment.
Subject(s)
Gastric Mucosa/pathology , Polyps/diagnosis , Stomach Diseases/diagnosis , Biopsy , Electrocoagulation , Female , Gastric Mucosa/surgery , Gastroscopy , Humans , Hyperplasia , Middle Aged , Polyps/pathology , Polyps/surgery , Reoperation , Stomach Diseases/pathology , Stomach Diseases/surgery , Treatment OutcomeSubject(s)
Anus Neoplasms/diagnosis , Carcinoma, Squamous Cell/diagnosis , Diagnostic Errors , Fissure in Ano/diagnosis , Intestinal Polyps/diagnosis , Pain/etiology , Rectal Diseases/diagnosis , Aged, 80 and over , Anus Neoplasms/complications , Biopsy , Carcinoma, Squamous Cell/complications , Fissure in Ano/complications , Fissure in Ano/surgery , Humans , Intestinal Polyps/complications , Intestinal Polyps/surgery , Male , Predictive Value of Tests , Rectal Diseases/complications , Rectal Diseases/surgery , SigmoidoscopyABSTRACT
Levosimendan is a novel inotropic agent indicated for patients with decompensated heart failure. It has well recognised mechanisms of action. Its use however, has not been described in patients with end-stage renal failure. This report describes the use of levosimendan in a post-operative coronary artery bypass graft patient with decompensated heart failure and end-stage renal failure previously receiving dialysis six days per week. Levosimendan proved to be a safe and useful agent when used as a continuous intravenous infusion initially at 0.05 microg/kg/min then increasing up to 0.2 microg/kg/min for a total of 42 hours.
