New index for the diagnosis of liver fibrosis in Schistosomiasis mansoni

Barreto, Ana Virgínia Matos Sá; Alecrim, Vinícius Martins; Medeiros, Tibério Batista de; Domingues, Ana Lúcia Coutinho; Lopes, Edmundo Pessoa; Martins, João Roberto Maciel; Nader, Helena B.; Diniz, George Tadeu Nunes; Montenegro, Sílvia Maria Lucena; Morais, Clarice Neuenschwander Lins de

doi:10.1590/s0004-2803.2017v54n1-10

Cited by 16 publications

(11 citation statements)

References 32 publications

(34 reference statements)

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“…Nonetheless, a wide range of liver damage has been described in both human and animal infections. These include impaired protein synthesis 4 , reduced lipoprotein concentrations [5][6][7][8] , decreased erythrocyte counts and blood indexes, neutropenia, lymphopenia and eosinophilia 9 , increased circulating liver enzymes levels 10,11 , and hemostatic abnormalities 12,13 . Despite the variability in clinical signs, it remains unclear whether infected individuals without clinical complaints or symptoms present a detectable degree of liver dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Alterations in the lipid profiles and circulating liver enzymes in individuals infected by Schistosoma mansoni

Silva¹,

Del-Rei

Fraga

et al. 2018

Rev. Soc. Bras. Med. Trop.

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Introduction: Portal hypertension and periportal fibrosis commonly occur in severe Schistosoma mansoni infection. Changes in lipid profile and elevated levels of circulating liver enzymes have also been described in infected individuals. The present study sought to assess the alterations in laboratory parameters associated with liver disorder in individuals infected by S. mansoni who visited a private routine laboratory service. Levels of circulating liver enzymes (gamma-glutamyl transferase [γ-GT], aspartate transaminase [AST], alanine transaminase [ALT], and alkaline phosphatase [ALP]) and a lipid panel (total cholesterol [COL], high-density lipoprotein [HDL], low-density lipoprotein [LDL], very low-density lipoprotein [VLDL], and triglycerides [TRI]) were evaluated in both infected and non-infected individuals and relative risk was used to measure associations. Methods: Data were collected for analysis from a total of 1,078 cases identified in 379,600 individuals who submitted samples to the Datalab Laboratory (Salvador, Bahia) between 2004 and 2008. Results: S. mansoni infection led to increased circulating levels of γ-GT in both women and men, AST (women), and ALP (men). S. mansoni infection was a protective factor against increased levels of TRI, CHO, and VLDL for individuals aged 19 years or older. The results of our analysis indicate that alterations in lipid metabolism and circulating liver enzymes in asymptomatic S. mansoni-infected individuals might be attributed to eggs lodged in the hepatic sinusoids. Conclusions: Parasitological testing for S. mansoni should be indicated in endemic areas when this pattern of alterations is detected.

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Section: Introductionmentioning

confidence: 99%

Alterations in the lipid profiles and circulating liver enzymes in individuals infected by Schistosoma mansoni

Silva¹,

Del-Rei

Fraga

et al. 2018

Rev. Soc. Bras. Med. Trop.

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“…Our study discovered that ALP was positively associated with interstitial fibrosis in patients with DN. Accumulating studies have shown that serum ALP is a fibrosis marker in chronic interstitial disorders [48][49][50]. The underlying mechanisms of ALP-induced fibrosis might be via the Wntdependent pathway by secreted Frizzled-related protein 2 (sFRP2) [51].…”

Section: Kidney Diseasementioning

confidence: 99%

Association between serum alkaline phosphatase and renal outcome in patients with type 2 diabetes mellitus

Zhao

Ren

et al. 2020

Renal Failure

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This retrospective study included 299 patients with type 2 diabetes mellitus and biopsy-confirmed diabetic nephropathy (DN) to investigate the prognostic value of alkaline phosphatase (ALP) for renal outcome. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for the serum ALP level on renal outcome, which was defined as end-stage renal disease (ESRD) or a 50% decline in estimated glomerular filtration rate (eGFR) from baseline. The median baseline ALP was 80 IU/L with an interquartile range of 64-97 IU/L. Serum ALP was negatively associated with eGFR but positively associated with proteinuria and renal interstitial fibrosis. During a median follow-up period of 23 months, ESRD or a 50% declined in the eGFR occurred in 156 (52.2%) patients. The highest quartile of ALP was significantly associated with poor renal outcome, as defined above (HR 2.38, 95% confidence interval [CI] 1.09-5.17), when adjusted for sociodemographics, baseline eGFR, proteinuria, liver function parameters, parathyroid hormone levels, and renal pathological findings. Each standard deviation higher in the natural log-transformed ALP was associated with a 25% increased risk for poor renal outcome. Additionally, there was a graded increase in the risk for poor renal outcome with higher ALP in patients with nephrotic-range proteinuria. However, no significant associations were observed between serum ALP levels and renal outcome in patients with non-nephrotic-range proteinuria. In conclusion, an elevated ALP level was independently associated with poor renal outcome in patients with type 2 diabetes mellitus and nephrotic-range proteinuria after multivariate adjustment.

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“…Out of these tests that are used in daily clinical practice some non-invasive tools have been developed including Alanine aminotransferase (AST) to platelet count (PTC) ratio index (APRI) and Platelet to splenic diameter ration (PSDR) levels. The APRI levels have been used to assess the severity of fibrosis in patients with PPF with excellent sonographic and histological correlation [16,17], however, there is still a paucity of studies describing the utility APRI levels in the prediction of varices in patients with periportal fibrosis. The data on the use of PSDR levels in discriminating presence of portal varices among patients with periportal fibrosis is also still scarce as compared to patients with liver cirrhosis [12,13,18].…”

Section: Introductionmentioning

confidence: 99%

“…The median age was 41(IQR: 33-51) years and most of them, 215 (86.0; 95%CI: 81.1-90.1) were married. In total, 222 (88.8%; IQR: 84.2-92.4) participants had a positive test for S. mansoni and 44 (17.6%; IQR: 13.1-22.9) tested positive for hepatitis B. Ascites was found in 155 (62.0%; 95%CI: 55.7-68.0) participants, and both dilated portal veins and splenomegalywere common with median measurements centimeters of 1.5 (IQR: 1.4-1.9) and 17 (IQR:[15][16][17][18] respectively (Table 1).…”

mentioning

confidence: 99%

Schistosoma mansoni -related periportal fibrosis; are APRI and PSDR levels of any potential utility in a well-timed selection of patients for targeted endoscopy in a resource-limited setting?: a case-control clinic-based study

Gunda

Mtui

Manyiri

et al. 2020

Preprint

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Background Schistosoma mansoni related hepatic fibrosis is usually associated with hemodynamic alteration with increased mortality due to bleeding varices. The diagnosis of varices before bleeding imposes a big challenge in resource-limited countries using endoscopy. Published evidence on the utility of non-invasive clinical tools in predicting the presence of varices among patients with S. mansoni related periportal fibrosis is still inadequate including APRI and PSDR levels. This study describes the determinants of portal varices and assesses the potential utility of the APRI and PSDR level in the discrimination of portal varices among patients with S. mansoni related periportal fibrosis. Methods All patients with periportal fibrosis were cross-sectionally assessed for the presence of esophageal varices at Bugando medical centre, in Mwanza Tanzania. Socio-demographic, laboratory and ultrasound data were collected for analysis using STATA 13. The prevalence of varices and associated factors were determined, and the sensitivity and specificity of independent factors were assessed to determine their utility in discriminating presence of varices in patients with PPF. Results In total, 250 patients were included in this study, 109 (43.6%; 95%CI: 37.3-.49.9) of them had varices. On multivariate analysis the odds of having varices were independently increased among patients with higher median APRI levels, (1.51; vs. 0.9; AOR: 5.6; 95%CI: 3.1-10.1; p=<0.001) and PSDR levels that were lower than 5700 (AOR: 3.9; 95%CI: 2.0-7.6; p<0.001. Both APRI and PSDR levels had significantly high sensitivity and specificity in predicting the presence of esophageal varices. Conclusions This study indicates that varices are a common encounter among patients with S. mansoni related periportal fibrosis and it is independently associated with higher median APRI and lower PSDR levels suggesting that these tools are potential discriminators of varices in this subgroup of patients. The reproducibility of these results should further be assessed longitudinally as potential non-invasive tools in selecting patients at high risk of having esophageal varices who could benefit from the targeted endoscopic intervention in a resource-limited setting like ours.

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New index for the diagnosis of liver fibrosis in Schistosomiasis mansoni

Cited by 16 publications

References 32 publications

Alterations in the lipid profiles and circulating liver enzymes in individuals infected by Schistosoma mansoni

Alterations in the lipid profiles and circulating liver enzymes in individuals infected by Schistosoma mansoni

Association between serum alkaline phosphatase and renal outcome in patients with type 2 diabetes mellitus

Schistosoma mansoni -related periportal fibrosis; are APRI and PSDR levels of any potential utility in a well-timed selection of patients for targeted endoscopy in a resource-limited setting?: a case-control clinic-based study

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