3 research outputs found
Impact of COVID-19 on liver transplant recipients during the first pandemic wave, in a tertiary hospital, in Northeastern Brazil
Worldwide, transplant programs have suffered a setback during the coronavirus disease 2019 (COVID-19) pandemic and most have temporarily suspended their transplant activities. . We identified 36 liver transplant patients who tested positive for COVID-19. The cases were confirmed by the nucleic acid test (RT-PCR). Epidemiological, demographic, clinical, laboratory, management and outcome data were obtained from the patients’ medical records. Fourteen patients (38.9%) required admission to the Intensive Care Unit and/or invasive ventilatory support (severe cases). The mean age of these severe cases was 63.8 years. Regarding the time since the transplant, 71.4% (10/14 patients) had undergone the procedure less than one year before. The immunosuppressive therapy was reduced in patients who required Intensive Care Unit. A total of 12 cases (12/14, 85.7%) required invasive ventilatory support. Eight cases (8/14, 57.1%) required renal replacement therapy. In this group of patients, nine died (64.3 %). In turn, 22 patients had mild to moderate symptoms of COVID-19, not requiring invasive ventilatory support or admission to the Intensive Care Unit. The mean age in these patients was 56.5 years and comorbidities were present in 15 (68.2%) of the cases. In this group, only five patients (5/22, 22.7%) required hospitalization due to complications and there were no deaths This report describes the results of COVID-19 infection in a very specific population, suggesting that liver transplant patients have a significant higher risk of progressing to severeCOVID-19 , with a mortality rate among critically-ill patients above that of the general population
Laennec staging and its relationship with clinical outcomes of cirrhosis by the hepatitis C virus
Introdução. Com base na espessura do septo fibroso e no tamanho dos nódulos, a classificação histológica de Laennec subdivide a cirrose em três grupos (4A, 4B e 4C). Alguns estudos transversais demonstraram relação desse sistema com o estádio clínico e com o grau de hipertensão portal. Entretanto, os dados, são escassos no que diz respeito à correspondência entre essa classificação e o prognóstico do paciente com cirrose. Objetivos. Principal correlacionar os graus histológicos de fibrose hepática (3, 4A, 4B e 4C da classificação de Laennec) com a gravidade da doença, a fim de predizer risco de eventos clínicos relacionados à cirrose por hepatite C. Secundário relacionar outros achados histológicos da biópsia hepática (quantidade de vasos nos septos, espessura da parede vascular, diâmetros dos vasos e dilatação sinusoidal) com a ocorrência de complicações da cirrose; elaboração de um escore clínico-laboratorial capaz de predizer pacientes com estádios mais avançados na classificação Laennec e com risco aumentado para desenvolver cirrose descompensada. Métodos. Foram incluídos 80 pacientes consecutivos com diagnóstico histológico de fibrose avançada em portadores de hepatite C (F3 n=31; F4 n=49). Os critérios de inclusão foram: a) idade maior ou igual a 18 anos, b) diagnóstico de hepatite C prévia ou atual documentada por via de reação de cadeia polimerase (PCR), e c) ter biópsia hepática demonstrando estadiamento de fibrose maior ou igual a F3. Os critérios de exclusão foram: a) outras etiologias de cirrose, ainda que em associação com positividade do RNA do vírus da hepatite C ou associação com o vírus da imunodeficiência humana (HIV); b) biópsias com fragmentos excessivamente pequenos que, assim, não permitiram a subclassificação da cirrose, ou indisponíveis para revisão; c) tempo de seguimento clínico menor ou igual a três anos da época da biópsia até o primeiro tratamento medicamentoso direcionado ao vírus da hepatite C; d) tratamento medicamentoso para hepatite C, durante o segmento clínico, após realização da biópsia hepática; e) ausência, dos prontuários pesquisados, de dados clínicos. O desenho do estudo foi retrospectivo, longitudinal, unicêntrico. Os procedimentos previstos no estudo foram a) consulta nos prontuários dos pacientes, b) consulta de exames laboratoriais, c) consulta de endoscopia digestiva alta e ultrassonografia abdominal, e d) revisão de lâmina de biópsia hepática. Os desfechos clínicos foram ascite, peritonite bacteriana espontânea, sangramento digestivo, encefalopatia hepática, carcinoma hepatocelular, síndrome hepatorrenal, síndrome hepatopulmonar e hipertensão portopulmonar. Na análise estatística, foi realizada uma exploração descritiva, resultando em tabelas de frequência para variáveis qualitativas, que contaram, ainda, com a inclusão do intervalo de confiança para a proporção (IC95%). Estatísticas descritivas, incluindo média, desvio padrão, mediana, mínimos e máximos, foram calculadas para resumir as variáveis quantitativas contínuas e discretas. Um escore clínico-laboratorial foi proposto para predizer a classificação Laennec com as variáveis: varizes de esôfago (V1), veia porta de calibre aumentado (V2), ascite (V3), esplenomegalia (V4), plaquetas (V5), INR (V6) e GGT (V7). Resultados. Foi verificada a homogeneidade na distribuição da amostra quanto ao gênero (58.8% do sexo masculino) e ao grau de fibrose pela classificação Laennec (Laennec 3 17.5%, Laennec 4A 27,5%, Laennec 4B 27,5% e Laennec 4C 26,3%) . Houve mais varizes de esôfago, esplenomegalia e veia porta de calibre aumentado nas categorias Laennec 4B e 4C (com p valor de 0,003, 0,04 e 0,02, respectivamente). Em relação ao MELD, CHILDPUGH e óbitos, não se registrou qualquer associação com a subclassificação de fibrose. Ao avaliar as outras características da biópsia hepática, houve significância estatística para três parâmetros, atividade de interface mais frequente em Laennec 4A, em relação a 4B e 4C (p 0,012), a vasculatura total do septo de moderada a acentuada e binucleação hepatocítica foram mais frequentes em Laennec 4B e 4C, com p valor de 0,04 e 0,002, respectivamente. O escore clínico-laboratorial criado teve acurácia de 81,2% em classificar os pacientes em Laennec 4C e de 77,6% em predizer casos com cirrose descompensada. Conclusão. Este estudo mostrou boa associação da classificação Laennec com sinais de hipertensão portal (calibre aumentado da veia porta, varizes de esôfago, esplenomegalia). A hepatite de interface, a vasculatura do septo e binucleação hepatocítica são possíveis parâmetros histológicos adicionais a serem utilizados em associação com a classificação, sendo imprescindível maior validação. O escore clínico-laboratorial criado mostrou boa aplicação como ferramenta não invasiva em predizer Laennec 4C e cirrose descompensada, necessitando de mais estudos que comprovem estes achadosIntroduction. Based on the thickness of the fibrous septum and the size of the nodules, the Laennec histological classification subdivides cirrhosis into three groups (4A, 4B and 4C). Some cross-sectional studies have shown a relationship between this system and the clinical stage and degree of portal hypertension. However, data are scarce regarding the correspondence between this classification and the prognosis of the patient with cirrhosis. Goals. Main to correlate the histological grades of liver fibrosis (3, 4A, 4B and 4C of the Laennec classification) with the severity of the disease, in order to predict the risk of clinical events related to cirrhosis due to hepatitis C. Secondary to list other histological findings of liver biopsy (number of vessels in the septa, vascular wall thickness, vessel diameters and sinusoidal dilatation) with the occurrence of complications from cirrhosis; elaboration of a clinical-laboratory score capable of predicting patients with more advanced stages in the Laennec classification and with an increased risk of developing decompensated cirrhosis. Methods. Eighty consecutive patients with histological diagnosis of advanced fibrosis in patients with hepatitis C (F3 n=31; F4 n=49) were included. Inclusion criteria were: a) age 18 years or older, b) diagnosis of previous or current hepatitis C documented via polymerase chain reaction (PCR), and c) having a liver biopsy demonstrating fibrosis staging greater than or equal to F3. Exclusion criteria were: a) other etiologies of cirrhosis, even in association with hepatitis C virus RNA positivity or association with the human immunodeficiency virus (HIV); b) biopsies with excessively small fragments that, therefore, did not allow the subclassification of cirrhosis, or unavailable for review; c) period of clinical follow-up less than or equal to three years from the time of biopsy until the first drug treatment directed at the hepatitis C virus; d) drug treatment for hepatitis C, during the clinical segment, after liver biopsy; e) absence of clinical data from the medical records surveyed. The study design was retrospective, longitudinal, single-center. The procedures foreseen in the study were a) consultation of patients\' medical records, b) consultation of laboratory tests, c) consultation of upper digestive endoscopy and abdominal ultrasound, and d) review of liver biopsy slides. Clinical outcomes were ascites, spontaneous bacterial peritonitis, digestive bleeding, hepatic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome, hepatopulmonary syndrome, and portopulmonary hypertension. In the statistical analysis, a descriptive exploration was performed, resulting in frequency tables for qualitative variables, which also included the confidence interval for the proportion (95%CI). Descriptive statistics, including mean, standard deviation, median, minimum and maximum, were calculated to summarize continuous and discrete quantitative variables. A clinical-laboratory score was proposed to predict the Laennec classification with the variables: esophageal varices (V1), increased caliber portal vein (V2), ascites (V3), splenomegaly (V4), platelets (V5), INR (V6 ) and GGT (V7). Results. Homogeneity in the distribution of the sample regarding gender (58.8% males) and degree of fibrosis was verified by the Abstract Laennec classification (Laennec 3 17.5%, Laennec 4A 27.5%, Laennec 4B 27.5% and Laennec 4C 26,3%). There were more esophageal varices, splenomegaly and increased-caliber portal vein in Laennec 4B and 4C categories (with p values of 0.003, 0.04 and 0.02, respectively). Regarding MELD, CHILD-PUGH and deaths, there was no association with the subclassification of fibrosis. When evaluating the other characteristics of the liver biopsy, there was statistical significance for three parameters, more frequent interface activity in Laennec 4A, compared to 4B and 4C (p 0.012), moderate to severe total septal vasculature and hepatocytic binucleation were more frequent in Laennec 4B and 4C, with p value of 0.04 and 0.002, respectively. The clinical-laboratory score created was 81.2% accurate in classifying patients in Laennec 4C and 77.6% in predicting cases with decompensated cirrhosis. Conclusion. This study showed a good association of the Laennec classification with signs of portal hypertension (increased caliber of the portal vein, esophageal varices, splenomegaly). Interface hepatitis, septal vasculature and hepatocytic binucleation are possible additional histological parameters to be used in association with the classification, and further validation is essential. The clinical-laboratory score created showed good application as a non-invasive tool in predicting Laennec 4C and decompensated cirrhosis, requiring further studies to prove these finding