Staging liver fibrosis after severe yellow fever with ultrasound elastography in Brazil: A six-month follow-up study |
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Authors: | Yuri Costa Sarno Neves Victor Augusto Camarinha de Castro-Lima Davi Jorge Fontoura Solla Vivian Simone de Medeiros Ogata Fernando Linhares Pereira Jordana Machado Araujo Ana Catharina Seixas Nastri Yeh-Li Ho Maria Cristina Chammas |
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Affiliation: | 1. Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil;2. Department and Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil;3. Department of Neurology, Division of Neurosurgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil;NIAID Integrated Research Facility, UNITED STATES |
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Abstract: | BackgroundYellow fever (YF) is a hemorrhagic disease caused by an arbovirus endemic in South America, with recent outbreaks in the last years. Severe cases exhibit fulminant hepatitis, but there are no studies regarding its late-term effects on liver parenchyma. Thus, the aim of this study was to determine the frequency and grade of liver fibrosis in patients who recovered from severe YF and to point out potential predictors of this outcome.Methodology/Principal findingsWe followed-up 18 patients who survived severe YF during a recent outbreak (January-April 2018) in Brazil using ultrasound (US) with shear-wave elastography (SWE) at 6 months after symptoms onset. No patient had previous history of liver disease.Median liver stiffness (LS) was 5.3 (4.6–6.4) kPa. 2 (11.1%) patients were classified as Metavir F2, 1 (8.3%) as F3 and 1 (8.3%) as F4; these two last patients had features of cardiogenic liver congestion on Doppler analysis. Age and cardiac failure were associated with increased LS (p = 0.036 and p = 0.024, respectively). SAPS-3 at ICU admission showed a tendency of association with significant fibrosis (≥ F2; p = 0.053). 7 patients used sofosbuvir in a research protocol, of which none showed liver fibrosis (p = 0.119).Conclusions/SignificanceWe found a low frequency of liver fibrosis in severe YF survivors. US with SWE may have a role in the follow up of patients of age and / or with comorbidities after hospital discharge in severe YF, a rare but reemergent disease. |
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