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1.
Hepatol Commun ; 6(11): 3212-3222, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36073343

RESUMO

The natural history of compensated cirrhosis due to nonalcoholic fatty liver disease (NAFLD) has not been completely characterized. The aim of the present study was to assess the incidence and risk factors of acute decompensation of cirrhosis, hepatocellular carcinoma, and extrahepatic cancers. This was a multicenter, retrospective, cohort study including 449 patients with compensated cirrhosis due to NAFLD. We calculated cumulative incidences and used competitive risk analysis to determine the risk factors associated with decompensation and cancer development. Over a median of 39 months of follow-up, 124 patients (28%) presented acute decompensation. The most frequent decompensation was ascites (21%) followed by hepatic encephalopathy (15%), variceal bleeding (9%), and spontaneous bacterial peritonitis (3%). Acute-on-chronic liver failure was diagnosed in 6% of patients during follow-up. Liver function parameters and specifically an albumin level below 40 g/L were independently associated with an increased risk of decompensation. The presence of ischemic heart disease was independently associated with acute decompensation. Seventy-eight patients (18%) developed hepatocellular carcinoma or extrahepatic cancers during follow-up (51 and 27, respectively). Conclusion: Patients with compensated cirrhosis due to NAFLD are at high risk of severe liver complications, such as the development of acute decompensation, in a relative short follow-up time. This population is at high risk of hepatic and extrahepatic cancers.


Assuntos
Carcinoma Hepatocelular , Varizes Esofágicas e Gástricas , Neoplasias Hepáticas , Hepatopatia Gordurosa não Alcoólica , Humanos , Carcinoma Hepatocelular/epidemiologia , Hepatopatia Gordurosa não Alcoólica/complicações , Varizes Esofágicas e Gástricas/epidemiologia , Estudos Retrospectivos , Estudos de Coortes , Hemorragia Gastrointestinal/epidemiologia , Cirrose Hepática/complicações , Neoplasias Hepáticas/epidemiologia , Albuminas
2.
Med. clín (Ed. impr.) ; 153(4): 169-177, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183450

RESUMO

La enfermedad por hígado graso no alcohólico (EHGNA) es una de las enfermedades hepáticas crónicas más frecuentes, con una prevalencia del 20-30% en la población general y del 60-80% en poblaciones de riesgo. En un porcentaje no despreciable de pacientes la EHGNA progresa desde la esteatosis hacia a diferentes estadios de fibrosis y cirrosis. Por su alta prevalencia, la EHGNA se ha convertido en un problema de salud relevante que requiere de acciones específicas para su detección, diagnóstico, seguimiento y tratamiento. Además, dado que la EHGNA presenta un riesgo aumentado de morbimortalidad cardiovascular requiere un enfoque multidisciplinar para su tratamiento y seguimiento. Los pacientes en estadios iniciales de la enfermedad, sin fibrosis, pueden ser evaluados y recibir tratamiento en el ámbito de Atención Primaria, mientras que aquellos con enfermedad hepática avanzada se benefician de un seguimiento especializado en el ámbito hospitalario para prevenir y tratar las complicaciones hepáticas. El presente documento de consenso, elaborado por las Sociedades Catalanas de Digestología, Atención Primaria, Endocrinología, Diabetes y Medicina Interna nace de la necesidad de diseñar estrategias que guíen los flujos de los pacientes entre el ámbito de Atención Primaria y Hospitalaria para poder ofrecer a los pacientes con EHGNA la mejor atención según el estadio de su enfermedad. En el documento de consenso se describen los métodos diagnósticos no invasivos más utilizados para el diagnóstico de los pacientes y se han diseñado dos algoritmos para el tratamiento de los pacientes tanto en ámbito de atención primaria como de atención hospitalaria


Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, with a prevalence of 20-30% in the general population and 60-80% in at-risk populations. In a not negligible percentage of patients, NAFLD progresses from steatosis to different stages of fibrosis and cirrhosis. Due to its high prevalence, NAFLD has become a significant health problem that requires specific action in detection, diagnosis, follow-up and treatment. Furthermore, given that NAFLD presents an increased risk of cardiovascular morbidity and mortality, a multidisciplinary approach is required for its treatment and follow-up. Patients with early stages of the disease, without fibrosis, can be diagnosed and receive treatment in the Primary Care setting, while those with more advanced liver disease benefit from specialised follow-up in the hospital setting to prevent and treat liver complications. This consensus document, prepared by the Catalan Societies of Digestology, Primary Care, Endocrinology, Diabetes and Internal Medicine, arises from the need to design strategies to guide patient flows between Primary and Hospital Care in order to offer patients with NAFLD the best care according to the stage of their disease. The consensus document describes the most commonly used non-invasive diagnostic methods for patient diagnosis and two algorithms have been designed for patient management in both Primary Care and Hospital Care


Assuntos
Humanos , Fígado Gorduroso/diagnóstico , Atenção Primária à Saúde , Consenso , Seguimentos , Fatores de Risco , Fígado Gorduroso/epidemiologia , Fígado Gorduroso/etiologia , Hepatopatia Gordurosa não Alcoólica/etiologia
3.
Med Clin (Barc) ; 153(4): 169-177, 2019 08 16.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31178295

RESUMO

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, with a prevalence of 20-30% in the general population and 60-80% in at-risk populations. In a not negligible percentage of patients, NAFLD progresses from steatosis to different stages of fibrosis and cirrhosis. Due to its high prevalence, NAFLD has become a significant health problem that requires specific action in detection, diagnosis, follow-up and treatment. Furthermore, given that NAFLD presents an increased risk of cardiovascular morbidity and mortality, a multidisciplinary approach is required for its treatment and follow-up. Patients with early stages of the disease, without fibrosis, can be diagnosed and receive treatment in the Primary Care setting, while those with more advanced liver disease benefit from specialised follow-up in the hospital setting to prevent and treat liver complications. This consensus document, prepared by the Catalan Societies of Digestology, Primary Care, Endocrinology, Diabetes and Internal Medicine, arises from the need to design strategies to guide patient flows between Primary and Hospital Care in order to offer patients with NAFLD the best care according to the stage of their disease. The consensus document describes the most commonly used non-invasive diagnostic methods for patient diagnosis and two algorithms have been designed for patient management in both Primary Care and Hospital Care.


Assuntos
Consenso , Continuidade da Assistência ao Paciente/normas , Hospitalização , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/terapia , Atenção Primária à Saúde/normas , Algoritmos , Diagnóstico Diferencial , Técnicas de Imagem por Elasticidade/métodos , Humanos , Hepatopatia Gordurosa não Alcoólica/complicações , Fatores de Risco , Sociedades Médicas , Espanha
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