Petrea Monson

Serum aminotransferase levels and platelet counts as predictors of degree of fibrosis in chronic hepatitis C virus infection.

OBJECTIVE:In patients with chronic hepatitis C virus (HCV) infection, liver fibrosis stage is a prognostic factor for therapy outcome. So far, a liver biopsy is necessary to determine disease stage accurately. We sought to develop a simple, noninvasive method of accurately predicting the degree of liver fibrosis in chronic HCV infection.METHODS:We retrospectively studied 211 consecutive patients with chronic HCV, who received a liver biopsy at the Liver Center of the University of California, San Diego. A total of 58 of these patients had a positive history of alcohol abuse, and we analyzed them separately in a sensitivity analysis. AST/ALT ratio and platelet counts were determined in all patients. Fibrosis was staged using the METAVIR score.RESULTS:Both AST/ALT ratio and platelet counts correlated significantly with the disease stage (r = 0.190, p = 0.006, and r = − 0.543, p < 0.00, respectively). In a sensitivity analysis, there was no correlation between AST/ALT ratio and disease stage for patients with a history of alcohol abuse. For patients without history of alcohol abuse, the correlation between disease stage, AST/ALT ratio, and platelet counts was r = 0.297, p < 0.00, and r = 0.560, p < 0.00, respectively. In these patients, AST/ALT ratio ≥1 in combination with a platelet count of <150,000/mm3 can identify patients with severe fibrosis or cirrhosis (stages 3 and 4) with a positive predictive value of 93.1%. Sensitivity, specificity, and negative predictive value were 41.2%, 99.1%, and 85.0%, respectively. In patients with ALT/AST ratio of <1 or platelet counts of >150,000/mm3, these laboratory parameters cannot predict liver fibrosis stage.CONCLUSION:AST/ALT ratio in combination with platelet counts may obviate a liver biopsy for fibrosis staging in some patients with chronic HCV infection.

Nutrition in Acute Renal Failure: A Reappraisal for the 1990s

■ Objective: To review current concepts regarding the rationale for and choice of nutritional support and nutritional assessment techniques in patients with catabolic acute renal failure (ARF). ■ Data sources: Published references, conference proceedings, and personal observations. ■ Conclusions: Providing optimal nutritional support to patients with catabolic ARF requires recognition of the nutritional requirements of patients with catabolic ARF, modification of standard nutritional assessment techniques, and familiarity with the unique characteristics of current forms of renal replacement therapies. Use of these techniques may allow for the improvement of nutritional status in this patient population and ultimately have a positive effect on outcome.

Nutritional Considerations in Continuous Renal Replacement Therapies

Continuous renal replacement therapy (CRRT) is a term used to describe a group of dialytic techniques increasingly used in the intensive care unit (ICU) for critically ill patients with catabolic acute renal failure (ARF). Use of these newer methods of dialysis offers significant advantages over traditional intermittent hemodialysis (IHD) techniques with respect to nutrition. Prior to the widespread use of CRRT, calorie, protein, electrolyte, and fluid delivery were frequently limited in critically ill patients with catabolic ARF. This practice may have increased morbidity and mortality in this patient population. Cumulative calorie deficits have been correlated with increased mortality in critically ill patients with ARF (1, 2), while cumulative protein deficits have been associated with critical losses of structural and functional proteins in surgical patients (3, 4). With the introduction of CRRT, physiologic rates of fluid and solute removal can be achieved, even in anuric patients with catabolic ARF, allowing full calorie and protein support. Familiarity with the impact specific CRRT techniques have on nutritional assessment techniques and nutrition support delivery is important for clinicians providing care for this patient population. This paper will review specific nutritional considerations unique to patients with catabolic ARF treated with CRRT by: 1) describing characteristics of CRRT which influence nutrition, 2) discussing the impact of CRRT on nutritional assessment techniques and nutritional support delivery, 3) reviewing appropriate guidelines for the delivery and monitoring of nutritional therapy for patients on CRRT, and 4) presenting a case example (Appendix A).

Combination therapy results in a significant reduction in transaminase levels in patients with normal pre-treatment transaminase levels

Combination therapy results in a significant reduction in transaminase levels in patients with normal pre-treatment transaminase levels

Factors associated with steatosis in patients with chronic hepatitis C

Purpose: Steatosis is a common feature of chronic Hepatitis C (HCV). The pathophysiology of steatosis is not clear. Multiple factors may play a role in the degree of steatosis in patients with HCV infection. We investigated the correlation between pre-treatment body mass index (BMI), serum liver injury tests, and HCV viral load (HCV-RNA), and steatosis in patients with HCV.