A Multivariable Model of Clinical Variables Predicts Advanced Fibrosis in Chronic Hepatitis C

Alsatie, Mazen; Kwo, Paul Y.; Gingerich, Joel Roger; Qi, Rong; Eckert, George J.; Cummings, Oscar W.; Imperiale, Thomas F.

doi:10.1097/01.mcg.0000225593.93577.64

Cited by 15 publications

(11 citation statements)

References 29 publications

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“…Combining both race groups together, the investigators observed a trend toward increased odds of fibrosis (OR 1.08; 95 % CI 1.00-1.17; p = 0.05) [12]. However, a subsequent study by Alsatie et al [13] that evaluated BMI C 36 kg/m 2 found no significant association with advanced fibrosis after adjustments in a multivariate model. …”

Section: Obesity and Body Mass Indexmentioning

confidence: 89%

“…In particular, the effects of diabetes mellitus (DM), metabolic syndrome, and concurrent nonalcoholic fatty liver disease (NAFLD) have been implicated in the progression of hepatic fibrosis and cirrhosis [2]. However, the impact of the aforementioned factors on progression of disease among chronic HCV patients is complicated by conflicting results of existing studies [3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Furthermore, the lack of consistency in defining certain risk factors (e.g., obesity, DM, insulin resistance) among published studies additionally complicates the ability to truly ascertain the impact of these comorbidities on HCV progression.…”

Section: Introductionmentioning

confidence: 98%

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Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review

et al. 2015

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Section: Obesity and Body Mass Indexmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 98%

Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review

et al. 2015

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“…There is also circumstantial evidence to suggest that steroid boluses result in active viral replication and more aggressive recurrence including fibrosing cholestatic hepatitis. Furthermore, the development of diabetes and hyperlipidemia associated with steroids may increase the risk of steatosis, which has been implicated in worsening the outcome with HCV 4, 5…”

mentioning

confidence: 99%

Steroid avoidance in liver transplantation: Meta-analysis and meta-regression of randomized trials

et al. 2008

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Steroid use after liver transplantation (LT) has been associated with diabetes, hypertension, hyperlipidemia, obesity, and hepatitis C (HCV) recurrence. We performed meta-analysis and meta-regression of 30 publications representing 19 randomized trials that compared steroid-free with steroid-based immunosuppression (IS). There were no differences in death, graft loss, and infection. Steroid-free recipients demonstrated a trend toward reduced hypertension [relative risk (RR) 0.84, P ϭ 0.08], and statistically significant decreases in cholesterol (standard mean difference Ϫ0.41, P Ͻ 0.001) and cytomegalovirus (RR 0.52, P ϭ 0.001). In studies where steroids were replaced by another IS agent, the risks of diabetes (RR 0.29, P Ͻ 0.001), rejection (RR 0.68, P ϭ 0.03), and severe rejection (RR 0.37, P ϭ 0.001) were markedly lower in steroid-free arms. In studies in which steroids were not replaced, rejection rates were higher in steroid-free arms (RR 1.31, P ϭ 0.02) and reduction of diabetes was attenuated (RR 0.74, P ϭ 0.2). HCV recurrence was lower with steroid avoidance and, although no individual trial reached statistical significance, meta-analysis demonstrated this important effect (RR 0.90, P ϭ 0.03). However, we emphasize the heterogeneity of trials performed to date and, as such, do not recommend basing clinical guidelines on our conclusions. We believe that a large, multicenter trial will better define the role of steroid-free regimens in LT. Liver Transpl 14:512-525, 2008. © 2008 AASLD. The use of corticosteroids has historically been the mainstay of decreasing rejection risk following liver transplantation (LT). Steroids, however, are associated with a multitude of side effects, including diabetes, hypertension, altered lipid metabolism, decreased wound healing, decreased immune defense against infection, osteoporosis, fractures, and obesity.Another potential side effect of steroid use in LT is recurrence of hepatitis C virus (HCV). In the past decade, there has been a dramatic shift in the indications for LT, and HCV has emerged as the single most important cause of end-stage liver disease leading to LT. Although only 16% of transplants were performed for HCV-related cirrhosis in 1991, this increased to over 50% by 2001. 1 Immunosuppression (IS) in HCV patients is a fine balance between adequate IS to prevent rejection and avoidance of over-IS to prevent severe HCV recurrence. 2,3 There is also circumstantial evidence to suggest that steroid boluses result in active viral replication and more aggressive recurrence including fibrosing cholestatic hepatitis. Furthermore, the development of diabetes and hyperlipidemia associated with steroids may increase the risk of steatosis, which has been implicated in worsening the outcome with HCV. 4,5 With significantly improved short-term outcomes over the last 2 decades, 6 the current challenges in LT

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“…Mildly elevated bilirubin and/or bile acids could theoretically also have a protective role in advanced liver disease. However, in these patients hyperbilirubinemia is present in a much longer timeframe than observed during critical illness and the severity appears to reflect the extent of the underlying pathogenesis [76].…”

Section: Critical Illness Induced Cld: Beneficial or Maladaptive?mentioning

confidence: 99%

Cholestatic liver (dys)function during sepsis and other critical illnesses

et al. 2015

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Abstract:Objective: In ICU patients, abnormal liver tests are common. Markers of cholestasis are associated with adverse outcome. Research has focused on the possibility that mild hyperbilirubinemia, instead of indicating inadvertent cholestasis, may be adaptive and beneficial. These new insights are reviewed and integrated in the state-of-the-art knowledge on hepato-biliary alterations during sepsis and other critical illnesses.Data Sources: Relevant publications were searched in Medline with search terms bile, bile acids, cholestasis, critical illness, intensive care, sepsis, alone or in combination.

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A Multivariable Model of Clinical Variables Predicts Advanced Fibrosis in Chronic Hepatitis C

Abstract: A model for estimating AHF risk in CHC performed well in this population. BMI had no effect on the risk of AHF. If this model can be validated in other patient cohorts, it could preclude the need for liver biopsy in patients with scores of 0 or > or =4.

Cited by 15 publications

References 29 publications

Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review

Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review

Steroid avoidance in liver transplantation: Meta-analysis and meta-regression of randomized trials

Cholestatic liver (dys)function during sepsis and other critical illnesses

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