This multi-center study was designed as a trial to explore the frequency of silent hepatitis B infection among hepatitis C patients and to determine the prevalent genotype of hepatitis C virus (HCV) in these patients. The study comprised 45 patients with post-hepatitic liver cirrhosis. All patients gave blood samples for estimation of liver function tests and ELISA estimation of serum levels of hepatitis B surface antigen (HBsAg) and anti-HCV antibodies; patients with HBsAg positive were excluded off the study. Qualitative detection of HCV RNA and HBV DNA by PCR (home-made PCR) and quantitative PCR for estimation of HCV viremia and HCV genotyping by RFLP technique were performed. The HCV-Ab was detected in all samples irrespective of its clinical severity class with a mean viremia level of 792336.7±400074.8; range: 134985-1957632 viral copy/ml as determined by quantitative PCR with a non-significant difference between clinical severity classes as regards viremia level. The HBV DNA was detected using qualitative PCR in 20 samples (44.4%); 4 class A, 7 class B and 9 class C samples with a significant increase of the frequency of silent HB in patients with class B (X 2 =5.446, p<0.01) and C (X 2 =8.154, p<0.001) in comparison to class A patients. Genotyping of HCV reported 41 samples (91.1%) with genotype-4 and 4 samples ( 8.9%) with genotype-1 with a prevalence rate of HCV genotype-4 was 91.1%. There was positive nonsignificant correlation between both HCV genotype and the presence of silent hepatitis B infection and clinical severity, however, using the receiver operating characteristic (ROC) curve analysis judged by the area under the curve (AUC) to evaluate the sensitivity and specificity of detection of silent hepatitis B infection and identification of HCV genotype as predictors of severe hepatitis showed a nonspecific role for genotyping for prediction of severity with AUC=0.467, while the detection of HBV DNA using PCR in patients with HCV infection is a specific predictor of severity with AUC=0.617. It could be concluded that HCV genotype-4 is the most prevalent type in Egyptian Hepatitis C cirrhotic patients with an incidence of silent hepatitis B of 44.4% and its detection is a specific predictor of severe cirrhosis.
This study aimed to assess the utility of estimation of plasma Procalcitonin (PCT) and serum interleukin-6 (IL-6) and C-reactive protein (CRP), as early (within 24 h after surgery) predictors of postoperative septic complications in patients who underwent elective colonic resection for malignant disease. The study included 40 patients and 10 healthy subjects as controls for the preoperative values. Patients were observed at ICU for their first 5 postoperative days for the development of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis or septic shock that were defined according to Bone's criteria. Patients were allocated into 3 groups on the basis of signs of sepsis: Group A (No SIRS/Sepsis), Group B (SIRS) and Group C (Sepsis) group. Blood samples were obtained the day before surgery (Day-0) and at the morning of the first postoperative day (Day-1) for estimation of serum CRP and IL-6 and plasma PCT. Eight patients developed SIRS and 9 patients progressed to sepsis with a total morbidity rate of 42.5%. One patient developed septic shock and died with a mortality rate of 2.5%. Day-0 serum CRP and plasma PCT showed nonsignificant difference, while Day-0 serum IL-6 was significantly higher compared to control levels. However, Day-1 levels of the three parameters were significantly higher compared to their Day-0 levels. Day-1 serum levels of CRP showed nonsignificant difference between the three study groups; however, Day-1 serum IL-6 was non-significantly higher in group B but was significantly higher in group C compared to its levels in group A with a non-significant increase in group C compared to group B. Day-1 plasma levels of PCT were significantly higher in groups B and C compared to its levels in group A with a significant increase in group C compared to group B. There was a positive significant correlation between the frequency of occurrence of SIRS and/or septic complication with levels of serum IL-6 and of plasma PCT, while the correlation was positive non-significant with serum CRP levels and ROC curve analysis showed that plasma PCT levels were highly specific (AUC=0.928), followed by serum levels of IL-6 (AUC=0.763) and serum CRP was the least specific parameter (AUC=0.498). It could be concluded that PCT can be used as a reliable diagnostic parameter to detect and to monitor infectious complications in the postoperative period after colonic surgery and can be detected before the occurrence of clinical infection, especially in patients suspected to be at higher risk for development of SIRS or septic complications.
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