RESUMO
INTRODUCTION: Bacterial infection is present in up to 30% of hospitalized cirrhotic patients. It can lead, even after its resolution, to organ dysfunction and even acute-on-chronic liver failure (ACLF). It is the precipitating factor of ACLF in one third of the cases and is the main cause of mortality in patients with liver cirrhosis. OBJECTIVES: The aim of this study was to evaluate the prevalence and identify early risk factors for severe ACLF and death in hospitalized patients with liver cirrhosis with bacterial infection. PATIENTS AND METHODS: This was a prospective observational study. Hospitalized patients with liver cirrhosis and bacterial infection were included. Clinical and laboratory data and their evolution to organ dysfunction and death were assessed. A statistical analysis were carried out to identify predictors of severe ACLF and in-hospital mortality. RESULTS: This study included 88 patients. ACLF was observed in 62 (70%) patients, with 48 (55%) grade 2 or higher. Of the 27 deaths (31% of all patients), 26 had severe ACLF (54% mortality) (P<0.0001). The independent risk factors for ACLF of at least 2 and death were baseline serum sodium [odds ratio (OR): 0.874; P=0.01, and OR: 0.9, P=0.04], initial MELD (OR: 1.255, P=0.0001, and OR: 1.162, P=0.005), and a recent invasive procedure (OR: 3.169, P=0.01, and OR: 6.648, P=0.003). CONCLUSION: Lower serum sodium values, higher MELD scores at diagnosis of infection, and a recent history of invasive procedures were independent risk factors for severe ACLF and death in patients with cirrhosis and bacterial infection.
Assuntos
Insuficiência Hepática Crônica Agudizada/diagnóstico , Infecções Bacterianas/diagnóstico , Técnicas de Apoio para a Decisão , Hiponatremia/diagnóstico , Cirrose Hepática/diagnóstico , Admissão do Paciente , Sódio/sangue , Insuficiência Hepática Crônica Agudizada/sangue , Insuficiência Hepática Crônica Agudizada/microbiologia , Insuficiência Hepática Crônica Agudizada/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/sangue , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Biomarcadores/sangue , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Progressão da Doença , Feminino , Mortalidade Hospitalar , Humanos , Hiponatremia/sangue , Hiponatremia/mortalidade , Pacientes Internados , Cirrose Hepática/sangue , Cirrose Hepática/microbiologia , Cirrose Hepática/mortalidade , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Adulto JovemAssuntos
Duodeno/irrigação sanguínea , Hemorragia Gastrointestinal/terapia , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Derivação Portossistêmica Transjugular Intra-Hepática , Varizes/terapia , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Varizes/etiologiaRESUMO
BACKGROUND: The prevalence of anti-hepatitis C virus (HCV) positive test is higher among patients in dialysis and in kidney recipients than in general population. Hepatitis C virus infection is the main cause of chronic liver disease in renal transplant patients. Liver biopsy and virological analysis were performed to clarify the grade of liver damage in kidney recipients. METHODS: Renal recipients patients with at least 5 yr under immunosuppression were submitted to clinical and laboratory analysis. Patients who tested anti-HCV positive were candidates to liver biopsy with no regard to transaminase levels. RESULTS: Forty-five patients tested anti-HCV positive and 42 anti-HCV negative. Twenty-six anti-HCV and RNA-HCV positive patients were submitted to liver biopsy. Seventy-three percentage of these patients presented chronic active hepatitis, from these only one patient presented cirrhosis. Only 29% of the anti-HCV positive group presented elevated alanine aminotransferase levels. Anti-HCV positive patients presented longer previous time on dialysis and less rejection episodes than the group anti-HCV negative (p < 0.05). All anti-HCV positive patients but one tested RNA-HCV positive by polymerase chain reaction (PCR). CONCLUSIONS: In this series the prevalence of anti-HCV positive is 51.7%. Most of the patients presented liver damage in histology caused by HCV. However, we found only mild or minimal fibrosis and inflammatory activity grade, despite 10 yr of HCV infection and 5 yr of immunosuppressive treatment. Only one patient presented cirrhosis (4%). Performing serial liver biopsies in a long-term follow-up is needed to clarify the impact of HCV infection in renal transplant patients.
Assuntos
Anticorpos Anti-Hepatite C/análise , Hepatite C Crônica/etiologia , Transplante de Rim , Fígado/patologia , Adulto , Alanina Transaminase/sangue , Biópsia , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Hepatite C Crônica/patologia , Humanos , Terapia de Imunossupressão , Masculino , Reação em Cadeia da Polimerase , Fatores de TempoRESUMO
Foi feito levantamento sobre a prevalencia da infeccao por Strongyloides stercoralis em tres areas do Brasil, atraves do desenvolvimento de metodo de cultura de fezes (cultura em placa de agar). A infeccao por Strongyloides foi confirmada em 11,3 por cento de 432 pacientes examinados. A eficacia do diagnostico pela cultura em placa de agar foi de 93,9 por cento comparado com apenas 28,5 por cento e 26,5 por cento pelo metodo de Harada-Mori de cultura em papel de filtro e metodo de concentracao de fezes, quando amostras de fezes foram examinadas simultaneamente por estes tres metodos. Entre as 49 amostras positivas, aproximadamente 60 por cento foram confirmadas como positivas somente pela cultura em placa de agar. Estes resultados indicam que a cultura em placa de agar e um novo metodo sensivel para o diagnostico correto da infeccao cronica pelo Strongyloides
