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AASLD - Study Suggests Hispanics Progress More Quickly Than Blacks and Whites

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  • claudine intexas
    NATAP www.natap.org ... AASLD - American Association for the Study of Liver Diseases October 27-31 2000 dallas Reported by Jules Levin Study Suggests Hispanics
    Message 1 of 1 , Oct 31, 2000
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      NATAP
      www.natap.org
      -----------------

      AASLD - American Association for the Study of Liver
      Diseases
      October 27-31 2000
      dallas
      Reported by Jules Levin

      Study Suggests Hispanics Progress More Quickly than
      Blacks & Whites

      THE HISTOPATHOLOGICAL IMPACT OF RACE IN VETERANS WITH
      HCV INFECTION:
      ALT
      predicts histologic activity; both white blood cell
      count & alkaline
      phosphatase predicted fibrosis

      This research group from the University of Miami
      compared HCV
      progression for
      whites, blacks & hispanics. They looked at 246
      veterans from the Miami
      VA
      Medical Center. But complete data was available in
      only 96 patients. Dr
      Schiff was involved in this study and is a very well
      respected
      researcher in
      this field. They looked at histologic activity and
      fibrosis stage. They
      also
      looked at ALT. They found that histlogic activity was
      statistically
      significantly higher in hispanics than blacks or
      whites (p=0.001). They
      found
      that fibrosis stage was more advanced in hispanics
      than blacks (p=0.01)
      and
      whites (p=0.08). The numbers in parenthesis mean the
      differences were
      found
      to be statistically significant which is important to
      researchers. If
      differences are not statistically significant, the
      results may not be
      reliable. The researchers also found that ALT
      predicted histologic
      activity
      and this also was statistically significant (p=0.036).
      Also important,
      researchers found alkaline phosphatase (measure of
      liver function) &
      white
      blood cell count to be statistically significant
      predictors of
      fibrosis.

      The authors concluded that alcohol intake (which is
      bad for HCV
      progression)
      and other risk factors may have cause the differences
      in progression
      seen in
      this study, but they believe that race may have an
      impact on both
      histological activity and fibrosis progression of the
      liver. But, the
      authors
      concluded that further well designed studies are
      required to more
      definitively understand the effect of race on liver
      histology or in
      other
      words if hispanics do in fact progress more quickly.
      So, they are not
      certain
      of their findings.


      (Damien B Mallat, Larry Young, Univ of Miami, Miami,
      FL; Claire
      Milikowski,
      Lennox Jeffers, Miami VA Medical Ctr, Miami, FL;
      Eugene R Schiff, Univ
      of
      Miami, Miami, FL)

      Background: The natural history and prognostic factors
      in patients with
      HCV
      are still evolving. Host factors are considered
      important determinants
      of
      fibrosis in patients infected with HCV. Aims: To study
      the correlation
      of
      ethnic background with the histopathology of the liver
      and to evaluate
      predictor variables for hepatic histological severity
      in patients with
      HCV
      infection. Setting: The Miami VA Medical Center has
      strong diversity of
      patients from different racial groups.

      Design: A retrospective analysis of 246 veterans from
      the Miami VA
      Medical
      Center who underwent liver biopsy for HCV infection
      between 1995 and
      2000
      were included. Complete data on race was available
      only in 96 patients.
      One
      single pathologist re-evaluated all coded liver
      biopsies using the
      Batts-Ludwig histologic score. Both basic descriptive
      and regression
      analysis
      were applied.

      Results: Of the 96 patients studied, all but one were
      male. Fifty-four
      patients (56%) were white, 23 patients (23%) were
      black, and 19
      patients
      (18%) were hispanic. The average age was not
      significantly different
      among
      white, black and hispanic patients (49 years, 48
      years, and 43 years
      respectively). The mean histological activity was 2.16
      among whites,
      2.04
      among blacks, and 2.63 among hispanics. Histological
      activity was
      significantly higher in hispanic patients than black
      or white patients
      (
      P=0.001). In addition, the mean fibrosis stage was
      2.10 in whites, 1.90
      in
      blacks, and 2.47 in hispanics. Fibrosis stage was more
      advanced in
      hispanics
      than blacks (P=0.01), or whites (P=0.08). White
      patients were found to
      have a
      higher stage than black patients (P=0.18), although
      statistically
      non-significant. Steatosis on liver biopsy was similar
      among all racial
      groups. Using Pearson correlation, the inter-observer
      effect of
      Batts-Ludwig
      score was approximately 0.75. Finally, univariate
      regression analysis
      showed
      ALT to be the only statistically significant predictor
      of histological
      activity (P=0.036), however both white blood cell
      count and alkaline
      phosphatase were statistically significant predictors
      of the fibrosis
      stage.

      Conclusion: In our VA patients with HCV infection,
      both the
      histological
      activity and the fibrosis stage were significantly
      higher in hispanic
      patients than white or black patients. Although
      alcohol among other
      risk
      factors may have caused this distinction, we believe
      that race may have
      an
      impact on both histological activity and progressive
      fibrosis
      progression of
      the liver. Alkaline phosphatase and WBC were fibrotic
      predictor
      parameters in
      this study. Further controlled studies are required to
      characterize
      more
      definitively the effect of race on liver histology in
      patients with
      hepatitis
      C virus infection.


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