748 LACK OF SUSTAINED VIROLOGICAL RESPONSE TO ANTIVIRAL THERAPY IN PATIENTS WITH CHRONIC HEPATITIS C IS ASSOCIATED WITH A SIGNIFICANT RISK OF PROGRESSION TO CIRRHOSIS
2008; Elsevier BV; Volume: 48; Linguagem: Inglês
10.1016/s0168-8278(08)60750-3
ISSN1600-0641
AutoresSandra M Sancho Martínez, Nancy Tesei, Eva Martínez–Bauer, Sergi Ampurdanés, J.M. Barrera, Miquel Bruguera, J.M. Sánchez-Tapias, Xavier Forns,
Tópico(s)Hepatitis C virus research
ResumoBackground and Aims: Transient elastography (FibroScan ® , Echosens, Paris) has been used to assess liver fibrosis (LF) as a non-invasive procedure.The aim of this study was to estimate the prevalence of failure of liver stiffness measurement (LSM) as a function of biological and histological determinants in patients with chronic liver disease.Methods: A series of 215 consecutive patients with chronic liver disease were included in the study sample.Liver biopsy was performed on the same day that LSM was measured and demographical, biological and histological data were recorded prospectively.The stage of LF was evaluated with the METAVIR scoring system.Failure of LSM was present when no value was obtained after 10 measurements.Indications for liver biopsy were chronic hepatitis C (n = 74; 34.4%), abnormal serum transaminases in transplant recipients (n = 52; 24%), HIV/HCV coinfection (n = 26; 12%), chronic hepatitis B (n = 14; 6.5%), NAFLD (n = 13; 6%) and miscellaneous in the remaining.Results: 65% were male; median age was 48 years (range: 22-74).Failure was observed in 13 cases (prevalence 6.05%, 95% confidence limits 3.39-10.35).Biological characteristics were statistically different between groups (failure vs. successful LSM) for age (mean, 59 vs. 49 years; p < 0.005), BMI (30.8 vs. 25.6 kg/m 2 ; p < 0.0001); GGT (265 vs. 178 UI/L; p < 0.01); alkaline phosphatase (311 vs. 231 UI/L; p = 0.002), albumin (4 vs. 3.8 mg/dL; p = 0.02), diabetes (38.5% vs. 7%; p < 0.0001) and transplant recipients (61.5% vs. 22%; p = 0.001).Histological parameters showed statistically significant differences between the two groups for ductal injury (38.5% vs. 16.5%;p = 0.04), hepatocyte degeneration (38.5% vs. 10.5%;p = 0.003) and endothelitis (30.8% vs. 7.5%; p = 0.004).In a multivariate analysis, factors associated with failure were: BMI (OR = 1.4; 95% CI: 1.2-1.6;p = 0.0001), diabetes mellitus (OR = 11; 2.2-56; p = 0.003) and being a liver transplant recipient (OR = 4; 1-16.3;p = 0.05). Conclusion:The LSM was a feasible method to evaluate liver fibrosis in 94% of patients.Advanced age, obesity, diabetes mellitus, and being a liver transplant recipient were independent predictors of failure.
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