Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection
Autor(a) principal: | |
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Data de Publicação: | 2007 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/29880 http://dx.doi.org/10.1002/hep.21681 |
Resumo: | HCV infection is common among patients with end-stage renal disease (ESRD) on hemodialysis, and it has been considered an independent risk factor for mortality in this setting. Although liver biopsy in ESRD patients with HCV infection is useful before kidney transplantation, it carries a high risk of complications. We sought to assess the diagnostic value of noninvasive markers to stage liver fibrosis in 203 ESRD HCV-infected patients. Univariate and multivariate analysis were used to identify variables associated with significant fibrosis (METAVIR F2, F3, or F4 stages). Significant liver fibrosis was observed in 48 patients (24%). Logistic regression analysis identified AST and platelet count as independent predictors of significant fibrosis (P < 0.001 and P = 0.001, respectively). the area under the receiver operating characteristic curve of the AST to platelet ratio index (A-PRI) for predicting significant fibrosis was 0.801. An APRI < 0.40 accurately identified patients with fibrosis stage 0 or 1 in 93% of the cases (NPV = 93%), and all misclassified subjects were F2. A cutoff >= 0.95 to confirm significant fibrosis had a PPV of 66%. If biopsy indication was restricted to APRI scores in the intermediate range (>= 0.40 and < 0.95), 52% of liver biopsies could have been correctly avoided. Conclusion: Stage of liver fibrosis can be reliably predicted in ESRD HCV-infected subjects by simple and widely available blood tests such as AST levels and platelet count. These tests might obviate the requirement for a liver biopsy in a significant proportion of those patients. |
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Schiavon, Leonardo de Lucca [UNIFESP]Narciso-Schiavon, Janaína Luz [UNIFESP]Carvalho-Filho, Roberto José de [UNIFESP]Sampaio, Juliana Peghini [UNIFESP]Lanzoni, Valeria Pereira [UNIFESP]Silva, Antonio Eduardo Benedito [UNIFESP]Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]Universidade Federal de São Paulo (UNIFESP)2016-01-24T13:48:53Z2016-01-24T13:48:53Z2007-08-01Hepatology. Hoboken: John Wiley & Sons Inc, v. 46, n. 2, p. 307-314, 2007.0270-9139http://repositorio.unifesp.br/handle/11600/29880http://dx.doi.org/10.1002/hep.2168110.1002/hep.21681WOS:000248501600006HCV infection is common among patients with end-stage renal disease (ESRD) on hemodialysis, and it has been considered an independent risk factor for mortality in this setting. Although liver biopsy in ESRD patients with HCV infection is useful before kidney transplantation, it carries a high risk of complications. We sought to assess the diagnostic value of noninvasive markers to stage liver fibrosis in 203 ESRD HCV-infected patients. Univariate and multivariate analysis were used to identify variables associated with significant fibrosis (METAVIR F2, F3, or F4 stages). Significant liver fibrosis was observed in 48 patients (24%). Logistic regression analysis identified AST and platelet count as independent predictors of significant fibrosis (P < 0.001 and P = 0.001, respectively). the area under the receiver operating characteristic curve of the AST to platelet ratio index (A-PRI) for predicting significant fibrosis was 0.801. An APRI < 0.40 accurately identified patients with fibrosis stage 0 or 1 in 93% of the cases (NPV = 93%), and all misclassified subjects were F2. A cutoff >= 0.95 to confirm significant fibrosis had a PPV of 66%. If biopsy indication was restricted to APRI scores in the intermediate range (>= 0.40 and < 0.95), 52% of liver biopsies could have been correctly avoided. Conclusion: Stage of liver fibrosis can be reliably predicted in ESRD HCV-infected subjects by simple and widely available blood tests such as AST levels and platelet count. These tests might obviate the requirement for a liver biopsy in a significant proportion of those patients.Universidade Federal de São Paulo, Hepatitis Sect, Div Gastroenterol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, São Paulo, BrazilUniversidade Federal de São Paulo, Hepatitis Sect, Div Gastroenterol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, São Paulo, BrazilWeb of Science307-314engWiley-BlackwellHepatologyhttp://olabout.wiley.com/WileyCDA/Section/id-406071.htmlinfo:eu-repo/semantics/openAccessSimple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infectioninfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlereponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP11600/298802023-02-15 09:30:32.931metadata only accessoai:repositorio.unifesp.br:11600/29880Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652023-05-25T12:30:57.962639Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection |
title |
Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection |
spellingShingle |
Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection Schiavon, Leonardo de Lucca [UNIFESP] |
title_short |
Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection |
title_full |
Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection |
title_fullStr |
Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection |
title_full_unstemmed |
Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection |
title_sort |
Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection |
author |
Schiavon, Leonardo de Lucca [UNIFESP] |
author_facet |
Schiavon, Leonardo de Lucca [UNIFESP] Narciso-Schiavon, Janaína Luz [UNIFESP] Carvalho-Filho, Roberto José de [UNIFESP] Sampaio, Juliana Peghini [UNIFESP] Lanzoni, Valeria Pereira [UNIFESP] Silva, Antonio Eduardo Benedito [UNIFESP] Ferraz, Maria Lucia Cardoso Gomes [UNIFESP] |
author_role |
author |
author2 |
Narciso-Schiavon, Janaína Luz [UNIFESP] Carvalho-Filho, Roberto José de [UNIFESP] Sampaio, Juliana Peghini [UNIFESP] Lanzoni, Valeria Pereira [UNIFESP] Silva, Antonio Eduardo Benedito [UNIFESP] Ferraz, Maria Lucia Cardoso Gomes [UNIFESP] |
author2_role |
author author author author author author |
dc.contributor.institution.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.author.fl_str_mv |
Schiavon, Leonardo de Lucca [UNIFESP] Narciso-Schiavon, Janaína Luz [UNIFESP] Carvalho-Filho, Roberto José de [UNIFESP] Sampaio, Juliana Peghini [UNIFESP] Lanzoni, Valeria Pereira [UNIFESP] Silva, Antonio Eduardo Benedito [UNIFESP] Ferraz, Maria Lucia Cardoso Gomes [UNIFESP] |
description |
HCV infection is common among patients with end-stage renal disease (ESRD) on hemodialysis, and it has been considered an independent risk factor for mortality in this setting. Although liver biopsy in ESRD patients with HCV infection is useful before kidney transplantation, it carries a high risk of complications. We sought to assess the diagnostic value of noninvasive markers to stage liver fibrosis in 203 ESRD HCV-infected patients. Univariate and multivariate analysis were used to identify variables associated with significant fibrosis (METAVIR F2, F3, or F4 stages). Significant liver fibrosis was observed in 48 patients (24%). Logistic regression analysis identified AST and platelet count as independent predictors of significant fibrosis (P < 0.001 and P = 0.001, respectively). the area under the receiver operating characteristic curve of the AST to platelet ratio index (A-PRI) for predicting significant fibrosis was 0.801. An APRI < 0.40 accurately identified patients with fibrosis stage 0 or 1 in 93% of the cases (NPV = 93%), and all misclassified subjects were F2. A cutoff >= 0.95 to confirm significant fibrosis had a PPV of 66%. If biopsy indication was restricted to APRI scores in the intermediate range (>= 0.40 and < 0.95), 52% of liver biopsies could have been correctly avoided. Conclusion: Stage of liver fibrosis can be reliably predicted in ESRD HCV-infected subjects by simple and widely available blood tests such as AST levels and platelet count. These tests might obviate the requirement for a liver biopsy in a significant proportion of those patients. |
publishDate |
2007 |
dc.date.issued.fl_str_mv |
2007-08-01 |
dc.date.accessioned.fl_str_mv |
2016-01-24T13:48:53Z |
dc.date.available.fl_str_mv |
2016-01-24T13:48:53Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Hepatology. Hoboken: John Wiley & Sons Inc, v. 46, n. 2, p. 307-314, 2007. |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/29880 http://dx.doi.org/10.1002/hep.21681 |
dc.identifier.issn.none.fl_str_mv |
0270-9139 |
dc.identifier.doi.none.fl_str_mv |
10.1002/hep.21681 |
dc.identifier.wos.none.fl_str_mv |
WOS:000248501600006 |
identifier_str_mv |
Hepatology. Hoboken: John Wiley & Sons Inc, v. 46, n. 2, p. 307-314, 2007. 0270-9139 10.1002/hep.21681 WOS:000248501600006 |
url |
http://repositorio.unifesp.br/handle/11600/29880 http://dx.doi.org/10.1002/hep.21681 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
Hepatology |
dc.rights.driver.fl_str_mv |
http://olabout.wiley.com/WileyCDA/Section/id-406071.html info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
http://olabout.wiley.com/WileyCDA/Section/id-406071.html |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
307-314 |
dc.publisher.none.fl_str_mv |
Wiley-Blackwell |
publisher.none.fl_str_mv |
Wiley-Blackwell |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
|
_version_ |
1783460301418528768 |