Viral hepatitis and anti-phospholipid antibodies positivity: A systematic review and meta-analysis

Ambrosino, Pasquale; Lupoli, Roberta; Tarantino, Paolo; Minno, Alessandro Di; Tarantino, L.; Minno, Matteo Nicola Dario Di

doi:10.1016/j.dld.2015.03.006

Cited by 25 publications

(13 citation statements)

References 53 publications

(150 reference statements)

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“…Further extending these data, we have recently reported an increased prevalence of antiphospholipid antibodies (aPL) in viral hepatitis (50) and in autoimmune liver disorders (51). aPL may easily alter this unstable balance, thus leading to thrombotic complications, as documented in hepatitis B and C patients with aPL positivity (50). In a recent meta-analysis, we have also documented an increased thrombotic risk in HCV patients, regardless the severity of liver dysfunction (52).…”

Section: Discussionmentioning

confidence: 64%

“…There is now compelling evidence for the presence of hypercoagulable features in cirrhotic patients, which include enhanced thrombin generation (43)(44)(45)(46), procoagulant changes in fibrin structure (47), and platelet hyperreactivity (48,49). Further extending these data, we have recently reported an increased prevalence of antiphospholipid antibodies (aPL) in viral hepatitis (50) and in autoimmune liver disorders (51). aPL may easily alter this unstable balance, thus leading to thrombotic complications, as documented in hepatitis B and C patients with aPL positivity (50).…”

Section: Discussionmentioning

confidence: 76%

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The risk of venous thromboembolism in patients with cirrhosis

Ambrosino¹,

Tarantino²,

Minno³

et al. 2017

Thromb Haemost

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156

130

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Some studies suggest that patients with cirrhosis have an increased risk of deep venous thrombosis (DVT) and pulmonary embolism (PE). Unfortunately, available data on this association are contrasting. It was the objective of this study to perform a systematic review and meta-analysis of literature to evaluate the risk of venous thromboembolism (VTE) associated with cirrhosis. Studies reporting on VTE risk associated with cirrhosis were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. Eleven studies (15 data-sets) showed a significantly increased VTE risk in 695,012 cirrhotic patients as compared with 1,494,660 non-cirrhotic controls (OR: 1.703; 95 %CI: 1.333, 2.175; P<0.0001). These results were confirmed when specifically considering the risk of DVT (7 studies, OR: 2.038; 95 %CI: 1.817, 2.285; P<0.0001) and the risk of PE (5 studies, OR: 1.655; 95 %CI: 1.042, 2.630; p=0.033). The increased VTE risk associated with cirrhosis was consistently confirmed when analysing nine studies reporting adjusted risk estimates (OR: 1.493; 95 %CI: 1.266, 1.762; p<0.0001), and after excluding studies specifically enrolling populations exposed to transient risk factors for VTE (OR: 1.689; 95 %CI: 1.321, 2.160; p<0.0001). Meta-regression models suggested that male gender may significantly impact on the risk of VTE associated with cirrhosis. Results of our meta-analysis suggest that cirrhotic subjects may exhibit an increased risk of VTE. This should be considered to plan specific prevention strategies in this clinical setting.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 76%

The risk of venous thromboembolism in patients with cirrhosis

Ambrosino¹,

Tarantino²,

Minno³

et al. 2017

Thromb Haemost

Self Cite

156

130

View full text Add to dashboard Cite

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“…Advances in HCV detection technology create new opportunities for enhancing screening, referral, and treatment. Previous systematic reviews on HCV infection have focused on treatment response [ 8 , 9 ], clinical complications [ 10 ], and epidemiology [ 11 , 12 ]. Two previous systematic reviews on hepatitis C testing have focused on evaluating point-of-care tests compared to EIAs and other reference tests [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of tests to detect Hepatitis C antibody: a meta-analysis and review of the literature

et al. 2017

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Background: Although direct-acting antivirals can achieve sustained virological response rates greater than 90% in Hepatitis C Virus (HCV) infected persons, at present the majority of HCV-infected individuals remain undiagnosed and therefore untreated. While there are a wide range of HCV serological tests available, there is a lack of formal assessment of their diagnostic performance. We undertook a systematic review and meta-analysis to evaluate he diagnostic accuracy of available rapid diagnostic tests (RDT) and laboratory based EIA assays in detecting antibodies to HCV. Methods: We used the PRISMA checklist and Cochrane guidance to develop our search protocol. The search strategy was registered in PROSPERO (CRD42015023567). The search focused on hepatitis C, diagnostic tests, and diagnostic accuracy within eight databases (MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, SCOPUS, Literatura Latino-Americana e do Caribe em Ciências da Saúde and WHO Global Index Medicus. Studies were included if they evaluated an assay to determine the sensitivity and specificity of HCV antibody (HCV Ab) in humans. Two reviewers independently extracted data and performed a quality assessment of the studies using the QUADAS tool. We pooled test estimates using the DerSimonian-Laird method, by using the software R and RevMan. 5.3. Results: A total of 52 studies were identified that included 52,673 unique test measurements. Based on five studies, the pooled sensitivity and specificity of HCV Ab rapid diagnostic tests (RDTs) were 98% (95% CI 98-100%) and 100% (95% CI 100-100%) compared to an enzyme immunoassay (EIA) reference standard. High HCV Ab RDTs sensitivity and specificity were observed across screening populations (general population, high risk populations, and hospital patients) using different reference standards (EIA, nucleic acid testing, immunoblot). There were insufficient studies to undertake subanalyses based on HIV co-infection. Oral HCV Ab RDTs also had excellent sensitivity and specificity compared to blood reference tests, respectively at 94% (95% CI 93-96%) and 100% (95% CI 100-100%). Among studies that assessed individual oral RDTs, the eight studies revealed that OraQuick ADVANCE® had a slightly higher sensitivity (98%, 95% CI 97-98%) compared to the other oral brands (pooled sensitivity: 88%, 95% CI 84-92%). Conclusions: RDTs, including oral tests, have excellent sensitivity and specificity compared to laboratory-based methods for HCV antibody detection across a wide range of settings. Oral HCV Ab RDTs had good sensitivity and specificity compared to blood reference standards.

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“…26 The observation that the prevalence of LA was higher in cases from rural Hai region may be explained by a higher infectious burden in this area, whereas traditional stroke risk factors may be more important in urban Dar-es-Salaam. A systematic screening for infections, including tuberculosis and viral hepatitis, was beyond the scope of this study.…”

Section: Discussionmentioning

confidence: 95%

Antiphospholipid Antibodies and the Risk of Stroke in Urban and Rural Tanzania

Mast

Molhoek

Ven

et al. 2016

Stroke

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Background and Purpose-The burden of stroke is high in sub-Saharan Africa, and improved knowledge of risk factors is needed. Antiphospholipid antibodies are a common acquired stroke risk factor in young individuals. Antiphospholipid antibodies may be induced by infectious diseases. Sub-Saharan Africa has a high infectious burden, and we analyzed the contribution of antiphospholipid antibodies to the risk of stroke in an incident population from rural and urban Tanzania. Methods-Stroke cases and age-and sex-matched community-acquired controls from the rural Hai district and urban Dares-Salaam areas of Tanzania were recruited in a wider study of stroke incidence between June 2003 and June 2006. Lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein I, and antiphosphatidylserine/prothrombin antibodies were determined in stored plasma, as well as IgG antibodies against Treponema pallidum. Results-Data from 158 stroke cases and 369 controls were analyzed. Thirty cases (19%) and 4 controls (1%) had a lupus anticoagulant (odds ratio, 20.8; 95% confidence interval, 7.2-60.5). Anticardiolipin IgG was the only other antiphospholipid antibody subtype associated with increased stroke risk (odds ratio, 2.1; 95% confidence interval, 1.0-4.3), but this association disappeared when corrected for IgG antibodies against Treponema pallidum results. The prevalence of anti-β2-glycoprotein I IgG antibodies in the Tanzanian healthy population was high when Dutch cutoff values were applied (67%), whereas presence of anti-β2-glycoprotein I IgM was associated with a reduced stroke risk (odds ratio 0.3; 95% confidence interval, 0.1-1.1). Conclusions-The presence of lupus anticoagulant is a strong, and to date unrecognized, risk factor for stroke in Tanzania, especially in young and middle-aged individuals.

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Viral hepatitis and anti-phospholipid antibodies positivity: A systematic review and meta-analysis

Cited by 25 publications

References 53 publications

The risk of venous thromboembolism in patients with cirrhosis

The risk of venous thromboembolism in patients with cirrhosis

Diagnostic accuracy of tests to detect Hepatitis C antibody: a meta-analysis and review of the literature

Antiphospholipid Antibodies and the Risk of Stroke in Urban and Rural Tanzania

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