Background: Cardiovascular-related mortality is a major concern in NAFLD. Advanced fibrosis was known to be associated with cardiovascular diseases. NAFLD Fibrosis Score (NFS) is used to identify the development of liver fibrosis in NAFLD patients. Left ventricular mass index (LVMI) is a sign of subclinical cardiovascular complications in NAFLD. The correlation between NAFLD fibrosis score with LVMI in NAFLD patients is not fully established.Objective: To analyze the correlation between NAFLD fibrosis score with LVMI in NAFLD patients.Methods: A cross-sectional study of NAFLD patients in Kariadi Hospital Indonesia. NFS was done using a formula based on clinical and biochemical parameters. LVMI was measured with echocardiography. Pearson’s, Mann-Whitney, and logistic regression were used for analysis.Results: A total of 64 patients with primary NAFLD were enrolled, 54.7% males and 45.3% females. Mean age was 52,8 ± 10,5 years (30-77 years). Based on NFS criteria, high probability group was the highest (50%), followed by intermediate probability group (34,4%) and low probability group (15,6%). Highest increase in LVMI was obtained in the high probability group (93,8%), followed by intermediate probability (59,1%), and low probability group (10%) respectively. There was significant correlation between NFS and LVMI (P 0,002). Logistic regression showed that NFS has a more significant correlation with LVMI compared to gender (P=0,002).Conclusion: NFS is a non‐invasive liver fibrosis scores which independently corelated with Left ventricular mass index (LVMI), a marker of cardiovascular abnormality.
Latar belakang Sindroma evan (Evans syndrome) merupakan penyakit yang sangat jarang, dimana terjadi suatu keadaan anemia hemolitik otoimun yang bersamaan dengan immune thrombocytopenia (ITP). Penyakit ini diperkenalkan pertama kali pada tahun 1951 oleh Evan dkk Kasus Seorang laki-laki pegawai toko 23 tahun datang dengan keluhan cepat lelah dan perdarahan gusi hilang timbul selama 4 bulan terakhir.Laboratorium hemoglobin 4,8 gr%, trombosit 11.900 /mm, leukosit 11.090/mmk, retikulosit yaitu 12,4 %. Pada pemeriksaan gambaran darah tepi ditemukan sferosit pada eritrosit dan giant trombosit. Ureum, kreatinin, natrium, kalium, kalsium normal . Protein total 8,4 gr/dl albumin 3,2 gr/dl. Didapatkan hiperbilirubinemia (4,48 mg/dl) dengan dominasi bilirubin indirek (2,20 mg/dl). Didapatkan peningkatan dari kadar ANA sebesar 79 U, tetapi anti Ds-DNA tidak meningkat (201,9 U). Pemeriksaan coomb pada penderita ini menunjukkan hasil yang positif baik direk (+3) maupun indirek (+2).Selanjutnya pasien diberikan injeksi intravena metilprednisolon 125 mg/12 jam dan siklosporin oral 50 mg/12 jam selama 5 hari dilanjutkan pemberian metilprednisolon dan siklosporin oral sampai pasien pulang dan selama dirumah. Kesimpulan Anemia hemolitik otoimun dan immune thrombocytopenia yang terjadi bersamaan (sindroma Evan) merupakan kelainan yang jarang dijumpai. Penegakan diagnosis disertai dengan menyingkirkan penyebab anemia dan trombositopenia imun sekunder yang lain. Pemberian steroid dan imunosupresan pada sebagian besar pasien masih menunjukkan hasil yang cukup baik dalam mencapai keadaan remisi.
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