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Ira S. Goldman, MD; John L. Gollan, MD, PhD; Kris V. Kowdley, MD; Paul Martin, MD;
Marion G. Peters, MD |
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HEPATOLOGY WATCH® |
MAY 2003
NATURAL HISTORY OF CHRONIC LIVER DISEASE
Fibrosis progression rate in miscellaneous chronic liver
diseases. Thierry
Poynard and colleagues from The PANFIBROSIS Group retrospectively studied 4,852
patients with chronic liver diseases (chronic hepatitis C [n = 2,313], chronic
hepatitis B [n = 777], alcoholic liver disease [n = 701], PBC [n = 406],
genetic hemochromatosis [n = 383], HIV-HCV coinfection [n = 180], autoimmune
hepatitis [n = 57], and delta hepatitis [n = 35]). Patients with HIV-HCV coinfection had the
most rapid fibrosis progression rate (50% cirrhosis percentile at 52 years of
age), while PBC patients had the slowest rate (50% cirrhosis percentile at 81
years of age). In addition, the fibrosis
progression rate increased with aging and was generally slower in women
compared to men. These findings
demonstrated that rates of fibrosis progression varied according to the cause
of chronic liver disease, age, and gender.
In an accompanying editorial, William Rosenberg emphasized that the concept
of fibrosis progression rate has considerable value for the evaluation of
prognostic factors, timing of therapeutic interventions, and risk modifications
for patients with chronic liver disease.
(Poynard T, et al. J Hepatol
2003;38:257-265 and Rosenberg WMC. J
Hepatol 2003;38:357-360)
Natural HCV disease progression rate. Jean-Pierre Zarski et al examined
fibrosis change measured by METAVIR scoring of serial liver biopsies from 180
patients with chronic HCV infection. They found that an increase in fibrosis
stage occurred more frequently after at least 4 years of follow-up. Multivariate analysis identified age >40
years at first biopsy and alcohol consumption as independent predictors of
severe fibrosis. These results indicate
that an interval of 4-5 years between serial liver biopsies is required to
detect a measurable change in fibrosis stage in HCV patients. (Zarski J-P, et al. J Hepatol 2003;38:307-314)
Small esophageal varices (EV) in cirrhotic patients. Manuela Merli and associates
prospectively studied 206 cirrhotic patients at risk for EV. At baseline, 93 of these patients had small
EV and no prior gastrointestinal bleeding.
Endoscopy was performed every 12 months, and the rate of EV progression
was observed to be 12% at 1 year and 31% at 3 years. The 2-year risk for bleeding was greater for
those patients with, versus without, EV at baseline (12% vs. 2%; p
<0.01). Predictors for EV progression
were cirrhosis due to alcoholic liver disease, Child-Pugh class of B or C, and
the finding of red wale marks at the first endoscopy. These findings can be used to plan endoscopy
surveillance for cirrhotic patients.
(Merli M, et al. J Hepatol
2003;38:266-272)
Risk factors for hepatocellular carcinoma (HCC). Rosario Velazquez et al.
prospectively followed 463 patients with Child-Pugh class A or B cirrhosis in a
surveillance program for HCC.
Thirty-eight patients developed HCC, and multivariate analysis
identified the following factors to be predictive for the development of HCC:
age ³ 55 years;
presence of anti-HCV; prothrombin activity £75%; and platelet count <75,000/mm3. The authors then constructed a model with a
score ranging from 0 to 4.71 points awarded according to the contribution of
each of the risk factors. In this model
the patients were divided into low-risk (n = 270; score £ 2.33
points) and high-risk (n = 193; score >2.33 points) groups with cumulative
incidences of HCC at 4 years of 2.3% and 30.1%, respectively. This model may be useful in identifying
cirrhotic patients that will benefit from participating in a HCC surveillance
program. (Velazquez RP, et al. Hepatology 2003;37:520-527)
HYPOGLYCEMIC AGENTS AND LIVER TOXICITY
Cohort study of acute liver injury. In order to more precisely
estimate the incidence of serious liver injury in diabetic patients treated
with insulin or hypoglycemic drugs, K. Arnold Chan and colleagues conducted a
retrospective cohort study of 171,264 patients in 5 geographically diverse
health maintenance organizations.
Thirty-five cases of acute liver failure or injury not clearly
attributable to known causes other than the use of hypoglycemic agents were
identified. The age- and
sex-standardized incidences per 1,000 person-years were 0.15, 0.12, 0.10, and
0.08 for patients receiving insulin, metformin, troglitazone, and sulfonylurea,
respectively. Thus, the incidence of
serious acute liver injury not due to other known causes in diabetic patients
treated with hypoglycemic agents is approximately 1 per 10,000 person-years. (Chan KA, et al. Arch Intern Med 2003;163:728-734)
TRANSPLANTATION
Liver transplantation in HIV patients. Guy Neff and others reported their
experience with liver transplantation for end-stage liver disease in 16 HIV
patients receiving highly active antiretroviral therapy (HAART). This preliminary study suggests that overall
and graft survival times achieved in selected HAART-treated HIV patients are
similar to those obtained historically in non-HIV patients who have undergone
liver transplantation for end-stage liver disease. (Neff GW, et al. Liver Transpl 2003;9:239-247)
URSODEOXYCHOLIC ACID (UDCA)
Chemopreventive agent for colorectal dysplasia or
cancer. UDCA has
shown effectiveness as a colon cancer chemopreventive agent in preclinical
studies. In addition, a recent report suggests UDCA may also decrease the risk
for developing colorectal dysplasia in patients with ulcerative colitis (UC)
and primary sclerosing cholangitis (PSC). Darrell Pardi and coworkers at the
Mayo Clinic (
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