Acurácia de parâmetros não invasivos para discriminar a esquistossomose hepatoesplênica da doença hepática avançada compensada por hepatite C

Abstract

BACKGROUND: The clinical presentation of presinusoidal or sinusoidal portal hypertension liver diseases may have overlap of symptoms and challenge the clinical diagnosis. We investigate the accuracy of noninvasive methods to distinguish hepatosplenic schistosomiasis (presinusoidal) from compensated cirrhosis (sinusoidal). METHODS: A cross-sectional study compared the laboratory (biochemical and hematological) and noninvasive (ultrasonography and two-dimensional shear wave [2D-SWE] elastography) tests of participants of two groups: compensated cirrhosis related to chronic hepatitis C (HCV; n=23) or hepatosplenic schistosomiasis (HSS n=24). Parametric/nonparametric tests, receiver operating characteristic (ROC) curves and values of area under curve (AUC) were used to discriminate groups. RESULTS: The laboratory analyses (leukocytes, aminotransferases, and platelets) had AUC below 0.8 to discriminate the groups. By ultrasonography, HCV group had more heterogeneous liver and larger right lobe (p <0.001), and HSS group had larger spleen, splenic vein and periportal fibrosis (p <0.001). The median liver and splenic elastography in HCV and HSS groups were 14.0 and 7.5 kPa (p<0.001), and 22.0 and 23.2 kPa (p=0.40), respectively. The AUC of liver elastography to discriminate HCV and HSS was 0.86 (p<0.001). CONCLUSIONS: The 2D-SWE liver elastography improved accuracy to discriminate the hepatosplenic schistosomiasis from HCV compensated cirrhosis, which are valuable in endemic areas of both diseases. Number of words: 199 Keywords: Chronic Hepatitis C, Compensated Liver Cirrhosis, Hepatosplenic Schistosomiasis, Liver Elastography, Portal Hypertension