RESUMO
INTRODUCTION AND OBJECTIVES: Patients with Fontan circulation (FC) have a high incidence of clinical complications. However, no biomarker is able to accurately stratify risk. The aim of this study was to analyze the relationship between biomarkers and clinical complications, including carbohydrate antigen 125 (CA125) for the first time, and to propose a risk estimation based on a combination of biomarkers. METHODS: Cross-sectional study of patients with FC. The clinical endpoint was the combination of heart failure, atrial arrhythmias, veno-venous fistulae, protein-losing enteropathy, or plastic bronchitis. Demographic, clinical, and laboratory variables were analyzed, including CA125, NT-proBNP, renal and liver function, and red cell distribution width (RDW). We performed univariate and multivariate analyses of the relationship between these variables and the composite endpoint. Cutoff values were calculated by ROC curves. RESULTS: We included 56 patients (27.4±7.8 years). A total of 34% showed the composite endpoint, with significantly higher CA125 levels (30.1 IU/mL vs 12.6 IU/mL; P=.001). In the multivariate model, the biomarkers related to the endpoint were LnCA125 (OR, 5.1; 95%CI, 1.2-22), RDW (OR, 1.8; 95%CI, 1.1-3.1), and FIB4 (OR, 38, 95%CI, 1.7-855). The cutoff points were CA125 ≥ 20 U/mL, FIB4 ≥ 0.75, and RDW ≥ 14.5%, and the probability of the occurrence of the endpoint was 81% if ≥ 2 biomarkers were elevated. CONCLUSIONS: CA125 elevation is associated with a higher prevalence of complications in patients with Fontan-type circulation. CA125 levels ≥ 20U/mL, FIB4 ≥ 0.75 and RDW ≥ 14.5% identify with a high probability the clinical failure of FC.
Assuntos
Técnica de Fontan , Cardiopatias Congênitas , Insuficiência Cardíaca , Humanos , Técnica de Fontan/efeitos adversos , Estudos Transversais , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Análise Multivariada , Antígeno Ca-125 , Cardiopatias Congênitas/cirurgiaRESUMO
A 64-year-old male with a history of HBV Child A MELD 9 cirrhosis on treatment with oral entecavir 0.5 mg/day. Diagnosed with 2 cm hepatocarcinoma in segment 6 treated by radiofrequency in April 2016 with complete response until June 2021, when an increase in the size of the solid component of the treated lesion (28 x 20 mm in diameter) was detected with early enhancement after the administration of paramagnetic contrast, suggestive of local tumor recurrence. Microwave ablation is a percutaneous thermal treatment that creates an electromagnetic field around a monopolar electrode, inducing homogeneous heating and coagulative tissue necrosis. It allows treating several lesions simultaneously and in less time than radiofrequency ablation with low morbidity and mortality. The incidence of adverse events ranges between 2.6% and 7.5%. The most frequent complications are bleeding and hematoma. Ablation tract fistulization is an infrequent complication, with a higher risk of appearing in subcapsular or peripheral hepatic lesions, as was the case in our patient.
Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Neoplasias Hepáticas , Ablação por Radiofrequência , Carcinoma Hepatocelular/patologia , Ablação por Cateter/efeitos adversos , Humanos , Neoplasias Hepáticas/patologia , Masculino , Micro-Ondas/efeitos adversos , Pessoa de Meia-Idade , Necrose , Resultado do TratamentoRESUMO
Chronic hepatitis C virus infection may be associated with extrahepatic manifestations. Thyroid disease related to chronic hepatitis C virus infection has been associated with interferon-alpha treatment. We present the case of a 40-year-old woman with chronic hepatitis C virus infection, who developed subacute thyroiditis during treatment with pegylated interferon-alpha plus ribavirin.
Assuntos
Antivirais/efeitos adversos , Hepatite C Crônica/complicações , Interferon-alfa/efeitos adversos , Polietilenoglicóis/efeitos adversos , Ribavirina/uso terapêutico , Tireoidite Subaguda/etiologia , Adulto , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Feminino , Genótipo , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/virologia , Humanos , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Interferon-alfa/uso terapêutico , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/uso terapêutico , Proteínas Recombinantes , Ribavirina/administração & dosagem , Ribavirina/efeitos adversos , Tireoidite Autoimune/induzido quimicamente , Tireoidite Subaguda/induzido quimicamente , Carga ViralRESUMO
La infección crónica por el virus de la hepatitis C puede acompañarse de manifestaciones extrahepáticas. En especial se ha relacionado la enfermedad tiroidea con el tratamiento con interferón alfa. Se presenta el caso de una mujer de 40 años con infección por el virus de la hepatitis C, que desarrolló un cuadro de tiroiditis subaguda durante el tratamiento con interferón alfa pegilado y ribavirina (AU)
Chronic hepatitis C virus infection may be associated with extrahepatic manifestations. Thyroid disease related to chronic hepatitis C virus infection has been associated with interferon-alpha treatment. We present the case of a 40-year-old woman with chronic hepatitis C virus infection, who developed subacute thyroiditis during treatment with pegylated interferon-alpha plus ribavirin (AU)
