ALBERTO QUEIROZ FARIAS

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Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 9 Citação(ões) na Scopus
    Procedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study
    (2023) INTAGLIATA, Nicolas M.; RAHIMI, Robert S.; HIGUERA-DE-LA-TIJERA, Fatima; SIMONETTO, Douglas A.; FARIAS, Alberto Queiroz; MAZO, Daniel F.; BOIKE, Justin R.; STINE, Jonathan G.; SERPER, Marina; PEREIRA, Gustavo; MATTOS, Angelo Z.; MARCIANO, Sebastian; DAVIS, Jessica P. E.; BENITEZ, Carlos; CHADHA, Ryan; MENDEZ-SANCHEZ, Nahum; DELEMOS, Andrew S.; MOHANTY, Arpan; DIRCHWOLF, Melisa; FORTUNE, Brett E.; NORTHUP, Patrick G.; PATRIE, James T.; CALDWELL, Stephen H.
    BACKGROUND & AIMS: Hospitalized patients with cirrhosis frequently undergo multiple procedures. The risk of procedural-related bleeding remains unclear, and management is not standardized. We conducted an international, prospective, multicenter study of hospitalized patients with cirrhosis undergoing nonsurgical procedures to establish the incidence of procedural-related bleeding and to identify bleeding risk factors. METHODS: Hospitalized patients were prospectively enrolled and monitored until surgery, transplantation, death, or 28 days from admission. The study enrolled 1187 patients undergoing 3006 nonsurgical procedures from 20 centers. RESULTS: A total of 93 procedural-related bleeding events were identified. Bleeding was reported in 6.9% of patient admissions and in 3.0% of the procedures. Major bleeding was reported in 2.3% of patient admissions and in 0.9% of the procedures. Patients with bleeding were more likely to have nonalcoholic steatohepatitis (43.9% vs 30%) and higher body mass index (BMI; 31.2 vs 29.5). Patients with bleeding had a higher Model for End-Stage Liver Disease score at admission (24.5 vs 18.5). A multivariable analysis controlling for center variation found that high-risk procedures (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.44-8.84), Model for End Stage Liver Disease score (OR, 2.37; 95% CI, 1.46-3.86), and higher BMI (OR, 1.40; 95% CI, 1.10-1.80) independently predicted bleeding. Preprocedure international normalized ratio, platelet level, and antithrombotic use were not predictive of bleeding. Bleeding prophylaxis was used more routinely in patients with bleeding (19.4% vs 7.4%). Patients with bleeding had a significantly higher 28-day risk of death (hazard ratio, 6.91; 95% CI, 4.22-11.31). CONCLUSIONS: Procedural-related bleeding occurs rarely in hospitalized patients with cirrhosis. Patients with elevated BMI and decompensated liver disease who undergo high-risk procedures may be at risk to bleed. Bleeding is not associated with conventional hemostasis tests, preprocedure prophylaxis, or recent antithrombotic therapy.
  • article 44 Citação(ões) na Scopus
    Epidemiology of HCC in Brazil: incidence and risk factors in a ten-year cohort
    (2014) PARANAGUA-VEZOZZO, Denise C.; ONO, Suzane K.; ALVARADO-MORA, Monica V.; FARIAS, Alberto Q.; CUNHA-SILVA, Marlone; FRANCA, Joao I. D.; ALVES, Venancio A. F.; SHERMAN, Morris; CARRILHO, Flair Jose
    Background and aim. The lack of information about hepatocellular carcinoma (HCC) in Brazil weakens health policy in preventing deaths from the illness. The aim of this study was to establish the cumulative incidence and the risk factors for hepatocellular carcinoma development in patients under a surveillance program. Material and methods. 884 patients with compensated cirrhosis were prospectively followed up for at least five years, from August 1998 until August 2008, with at least one annual ultrasonography liver examination and serum alpha fetoprotein (AFP) measurement. Results. Among 884 patients, 72 (8.1%) developed a tumor with a median follow up of 21.4 months. In the hepatocellular carcinoma group, hepatitis C virus infection was the major etiological factor (65.3%), 56.9% (41/72) were male and the mean average age was 57 +/- 10 years. The annual incidence of hepatocellular carcinoma was 2.9%. 79.2% (57/72) of HCCs were detected within Milan Criteria, and the mean survival time was 52.3 months, significantly higher than for those outside Milan, with a mean time of 40.6 months (p = 0.0003). Conclusion. The annual incidence of HCC among this large series of Brazilian cirrhotic patients was around 2.9% with a detection rate of 8.1%, or a cumulative incidence rate over five years of 14.3%. The three variables related to HCC risk were low serum albumin [HR: 0.518 (0.46-0.78)], high AFP > 20 ng/mL [HR: 3.16 (1.86-5.38)], and ethnicity (Brazilian-East Asian descendants vs. other mixed Brazilian ethnicities) [HR: 2.86 (1.48-5.53)].
  • article 9 Citação(ões) na Scopus
    Selectins and Platelet-Derived Growth Factor (PDGF) in Schistosomiasis-Associated Pulmonary Hypertension
    (2014) LAPA, Monica; ACENCIO, Milena M. P.; FARIAS, Alberto Q.; TEIXEIRA, Lisete R.; FERNANDES, Caio J. C.; JARDIM, Carlos P.; TERRA-FILHO, Mario
    The aim of this study was to evaluate the expression profiles of the relevant selectins and PDGF in schistosomiasis-associated pulmonary hypertension. Patients with three distinct clinical profiles were enrolled in the study: IPAH(n = 11), schistosomiasis-associated PH (Sch-PH))(n = 13), and schistosomiasis without PH (Sch) (n = 13). Healthy volunteers, were recruited as a control group(n = 13). Echocardiography was performed in all groups, and the PH patients underwent right heart catheterization. Plasma soluble adhesion molecules E- and P-Selectin, PDGF-AB, PDGF-BB were determined by ELISA. E-selectin was significantly increased in the IPAH group compared with the other groups [the control, Sch + PH and Sch groups) (p < 0.001) (Fig. 2)]. P-selectin was lower in Sch (20.2 + 8.9 x 103 pg/mL) as compared to the control, (43 16.8 x 103 pg/mL), IPAH (35.8 7.8 x 103 pg/mL), and Sch + PH (36.8 +/- A 15.7 x 103 pg/mL) (p = 0.005) groups. Serum PDGF-BB levels were higher in the control group (8.9 +/- A 4.8 x 103 pg/mL) compared with the IPAH (3.7 +/- A 2.17 x 103 pg/mL), Sch + PH (5.2 +/- A 3.7 x 103 pg/mL) and Sch (2.4 +/- A 1.7 x 103 pg/mL) groups (p < 0.05). PDGF-AB levels were also higher in the control group (25.6 +/- A 8.6 x 103 pg/mL), compared with the other three groups, being the Sch group the one with lower serum levels of this marker (11.4 +/- A 8.6 x 103 pg/mL) (p = 0.006). In conclusion, vascular inflammation in schistosomiasis, with or without PH, is different from IPAH suggesting distinct pathophysiological mechanisms associated with the development of pulmonary hypertension.
  • article 2 Citação(ões) na Scopus
    m-RECIST at 1 month and Child A are survival predictors after percutaneous ethanol injection of hepatocellular carcinoma
    (2014) SILVA, Mauricio F.; CARRILHO, Flair J.; PARANAGUA-VEZOZZO, Denise C.; CAMPOS, Luciana T.; NACIF, Lucas S.; DINIZ, Marcio A.; FARIAS, Alberto Q.; ALVES, Venancio A. F.; D'ALBURQUERQUE, Luis A. C.; ONO, Suzane K.
    Background and aims. Percutaneous ethanol injection (PEI) is a well-established therapeutic option in patients with cirrhosis and hepatocellular carcinoma (HCC). The modified-Response Evaluation Criteria in Solid Tumors (m-RECIST) are an important tool for the assessment of HCC response to therapy. The aim was to evaluate whether HCC response according to the m-RECIST criteria could be an effective predictor of Long-term survival in Barcelona Clinic Liver Cancer (BCLC) stage 0 and A HCC patients undergoing PEI. Material and methods. 79 patients were followed-up for median time of 26.8 months. HCC diagnosis was based on the,current guidelines of the American Association for Study of the Liver Diseases (AASLD) and European Association for Study of the Liver (EASL). Patient survival was calculated from the first PEI session to the end of the follow-up. Results. The 1-, 3-, and 5-year overall survival rates were 79, 48 and 37%, respectively. In the multivariate analysis, Child-Pugh-Turcotte (CPT) (p = 0.022) and the response to m-RECIST criteria (p = 0.016) were associated with patient survival. CPT A patients who achieved Complete Response (CR) 1 month after PEI presented a 5-year survival rate of 55%. By contrast, the worst scenario, the group with CPT B but without CR had a 5-year survival rate of 9%, while the group with either CPT A or CR as a survival predictor had a 5-year survival rate of 31%. In conclusion, in BCLC stage 0 and A HCC-patients, m-RECIST at 1 month and Child A may predict survival rates after PEI.
  • article 2 Citação(ões) na Scopus
    Preservation of thrombin generation in cirrhosis despite abnormal results of international normalized ratio: implications for invasive procedures
    (2021) FERREIRA, Caroline M.; ROCHA, Tania R. F.; SOUZA, Evandro O.; CARRILHO, Flair J.; D'AMICO, Elbio A.; FARIAS, Alberto Q.
    Thrombin generation is normal or elevated in patients with cirrhosis when tested in the presence of thrombomodulin, the activator of the main natural anticoagulant protein C. However, the relationship between thrombin generation with bleeding has been little explored in literature. 97 Consecutive patients with cirrhosis were prospectively included (58 men; 54 +/- 10 years) and divided into two groups international normalized ratio (INR) less than 1.5 (n = 72) or INR at least 1.5 (n = 25). 46 Healthy individuals were tested as controls. Endogenous thrombin potential (ETP) was measured without and with the addition of thrombomodulin. ETP measured without thrombomodulin was reduced in patients with cirrhosis when compared with controls, but no significant difference was found between the INR less than 1.5 and INR at least 1.5 groups (1250 +/- 315.7 versus 1186 +/- 238 nmol/l x min; P = 0.3572). After the addition of thrombomodulin, both groups generated thrombin comparable with controls (INR >= 1.5: 965.9 +/- 232.3; INR < 1.5: 893.0 +/- 368.6; controls: 915.0 +/- 458 nmol/l x min). 80% of patients had high ETP without/with thrombomodulin ratio, demonstrating the resistance to the anticoagulant action of thrombomodulin for both groups. This was more marked in the INR at least 1.5 group (0.81 +/- 0.1 versus 0.69 +/- 0.2; P = 0.0042). Postligation of esophageal varices bleeding occurred in 5.2% of patients (INR < 1.5, n = 3; INR >= 1.5, n = 2), all of them with ETP without/with thrombomodulin ratio ranging from 0.72 to 0.90 (controls 0.57 +/- 0.21). This study confirms that thrombin generation in the presence of thrombomodulin was normal in most patients with cirrhosis, including those with high INR value, but did not correlate with postligation of esophageal varices bleeding.
  • article 86 Citação(ões) na Scopus
    Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide
    (2019) SHAH, Neil D.; VENTURA-COTS, Meritxell; ABRALDES, Juan G.; ALBORAIE, Mohamed; ALFADHLI, Ahmad; ARGEMI, Josepmaria; BADIA-ARANDA, Ester; ARUS-SOLER, Enrique; BARRITT, A. Sidney; BESSONE, Fernando; BIRYUKOVA, Marina; CARRILHO, Flair J.; FERNANDEZ, Marlen Castellanos; GUIRIDI, Zaily Dorta; KASSAS, Mohamed El; ENG-KIONG, Teo; FARIAS, Alberto Queiroz; GEORGE, Jacob; GUI, Wenfang; THURAIRAJAH, Prem H.; HSIANG, John Chen; HUSIC-SELIMOVIC, Azra; ISAKOV, Vasily; KARONEY, Mercy; KIM, Won; KLUWE, Johannes; KOCHHAR, Rakesh; DHAKA, Narendra; COSTA, Pedro Marques; PHARM, Mariana A. Nabeshima; ONO, Suzane K.; REIS, Daniela; RODIL, Agustina; DOMECH, Caridad Ruenes; SAEZ-ROYUELA, Federico; SCHEURICH, Christoph; SIOW, Way; SIVAC-BURINA, Nadja; TRAQUINO, Edna Solange dos Santos; SOME, Fatma; SPRECKIC, Sanjin; TAN, Shiyun; VOROBIOFF, Julio; WANDERA, Andrew; WU, Pengbo; YACOUB, Mohamed; YANG, Ling; YU, Yuanjie; ZAHIRAGIC, Nerma; ZHANG, Chaoqun; CORTEZ-PINTO, Helena; BATALLER, Ramon
    BACKGROUND & AIMS: Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly owing to the large burden of advanced alcohol-related liver disease (ALD). We investigated whether patients with ALD are initially seen at later stages of disease development than patients with hepatitis C virus (HCV) infection or other etiologies. METHODS: We performed a cross-sectional study of 3453 consecutive patients with either early or advanced liver disease (1699 patients with early and 1754 with advanced liver disease) seen at 17 tertiary care liver or gastrointestinal units worldwide, from August 2015 through March 2017. We collected anthropometric, etiology, and clinical information, as well as and model for end-stage liver disease scores. We used unconditional logistic regression to estimate the odds ratios for evaluation at late stages of the disease progression. RESULTS: Of the patients analyzed, 81% had 1 etiology of liver disease and 17% had 2 etiologies of liver disease. Of patients seen at early stages for a single etiology, 31% had HCV infection, 21% had hepatitis B virus infection, and 17% had nonalcoholic fatty liver disease, whereas only 3.8% had ALD. In contrast, 29% of patients seen for advanced disease had ALD. Patients with ALD were more likely to be seen at specialized centers, with advanced-stage disease, compared with patients with HCV-associated liver disease (odds ratio, 14.1; 95% CI, 10.5-18.9; P < .001). Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. These patients had significantly more visits to health care providers, with more advanced disease, compared with patients without excess alcohol use. The mean model for end-stage liver disease score for patients with advanced ALD (score, 16) was higher than for patients with advanced liver disease not associated with excess alcohol use (score, 13) (P < .01). CONCLUSIONS: In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-stage disease than patients with HCV-associated liver disease. Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. Early detection and referral programs are needed for patients with ALD worldwide.
  • article 23 Citação(ões) na Scopus
    beta-Blocker therapy for cirrhotic cardiomyopathy: a randomized-controlled trial
    (2018) SILVESTRE, Odilson M.; FARIAS, Alberto Q.; RAMOS, Danusa S.; FURTADO, Meive S.; RODRIGUES, Ana C.; XIMENES, Rafael O.; MAZO, Daniel F. de Campos; ZITELLI, Patricia M. Yoshimura; DINIZ, Marcio A.; ANDRADE, Jose L.; STRUNZ, Celia; FRIEDMANN, Antonio A.; LEE, Samuel S.; CARRILHO, Flair J.; D'ALBUQUERQUE, Luiz A. C.; BACAL, Fernando
    Background Cirrhotic cardiomyopathy is characterized by an attenuated contractile response to stress. Long-term exposure of beta-adrenergic receptors to persistently high levels of catecholamines has been implicated in its pathogenesis. We hypothesized that beta-blockade with metoprolol could reverse the changes in heart function and morphology in cirrhotic cardiomyopathy. Patients and methods In this prospective randomized trial, we included 78 patients aged between 18 and 60 years with abnormal cardiac output response under dobutamine stress echocardiography, without primary cardiac disease or a history of alcohol intake. Patients were assigned randomly to receive metoprolol or placebo for 6 months. The primary endpoint was the improvement in cardiac output response to stress, measured by an increase in the left ventricle stroke volume more than 30%. Results Three (7.3%) patients in the metoprolol group and nine (24.3%) patients in the placebo group showed improved stroke volume (P=0.057). Diastolic dysfunction was found in two (4.8%) patients before and in five (15.6%) patients after therapy in the metoprolol group, and in 10 (27%) patients before and nine (31%) patients after therapy in the placebo group (P=0.67). After treatment, no echocardiography parameter of morphology was significantly different between metoprolol or placebo groups. No significant differences were observed in noradrenaline, plasma renin activity, and troponin levels between groups. Cirrhosis-related clinical events, including hospitalizations and mortality, were not significantly different between the two groups. Six months of therapy with beta-blocker did not ameliorate heart function and morphology in patients with cirrhotic cardiomyopathy.
  • article 107 Citação(ões) na Scopus
    Terlipressin versus Norepinephrine in the Treatment of Hepatorenal Syndrome: A Systematic Review and Meta-Analysis
    (2014) NASSAR JUNIOR, Antonio Paulo; FARIAS, Alberto Queiroz; ALBUQUERQUE, Luiz Augusto Carneiro d'; CARRILHO, Flair Jose; MALBOUISSON, Luiz Marcelo Sa
    Background: Hepatorenal syndrome (HRS) is a severe and progressive functional renal failure occurring in patients with cirrhosis and ascites. Terlipressin is recognized as an effective treatment of HRS, but it is expensive and not widely available. Norepinephrine could be an effective alternative. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of norepinephrine compared to terlipressin in the management of HRS. Methods: We searched the Medline, Embase, Scopus, CENTRAL, Lilacs and Scielo databases for randomized trials of norepinephrine and terlipressin in the treatment of HRS up to January 2014. Two reviewers collected data and assessed the outcomes and risk of bias. The primary outcome was the reversal of HRS. Secondary outcomes were mortality, recurrence of HRS and adverse events. Results: Four studies comprising 154 patients were included. All trials were considered to be at overall high risk of bias. There was no difference in the reversal of HRS (RR = 0.97, 95% CI = 0.76 to 1.23), mortality at 30 days (RR = 0.89, 95% CI = 0.68 to 1.17) and recurrence of HRS (RR = 0.72; 95% CI = 0.36 to 1.45) between norepinephrine and terlipressin. Adverse events were less common with norepinephrine (RR = 0.36, 95% CI = 0.15 to 0.83). Conclusions: Norepinephrine seems to be an attractive alternative to terlipressin in the treatment of HRS and is associated with less adverse events. However, these findings are based on data extracted from only four small studies.
  • article 32 Citação(ões) na Scopus
    Serum B-Type Natriuretic Peptide in the Initial Workup of Patients With New Onset Ascites: A Diagnostic Accuracy Study
    (2014) FARIAS, Alberto Q.; SILVESTRE, Odilson M.; GARCIA-TSAO, Guadalupe; SEGURO, Luis F. B. da Costa; MAZO, Daniel F. de Campos; BACAL, Fernando; ANDRADE, Jose L.; GONCALVES, Luciana L.; STRUNZ, Celia; RAMOS, Danusa S.; POLLI, Demerson; PUGLIESE, Vincenzo; RODRIGUES, Ana C. T.; FURTADO, Meive S.; CARRILHO, Flair J.; D'ALBUQUERQUE, Luiz A. C.
    Heart failure (HF) is, after cirrhosis, the second-most common cause of ascites. Serum B-type natriuretic peptide (BNP) plays an important role in the diagnosis of HF. Therefore, we hypothesized that BNP would be useful in the differential diagnosis of ascites. Consecutive patients with new onset ascites were prospectively enrolled in this cross-sectional study. All patients had measurements of serum-ascites albumin gradient (SAAG), total protein concentration in ascitic fluid, serum, and ascites BNP. We enrolled 218 consecutive patients with ascites resulting from HF (n = 44), cirrhosis (n = 162), peritoneal disease (n = 10), and constrictive pericarditis (n = 2). Compared to SAAG and/or total protein concentration in ascites, the test that best discriminated HF-related ascites from other causes of ascites was serum BNP. A cutoff of >364 pg/mL (sensitivity 98%, specificity 99%, and diagnostic accuracy 99%) had the highest positive likelihood ratio (168.1); that is, it was the best to rule in HF-related ascites. Conversely, a cutoff 182 pg/mL had the lowest negative likelihood ratio (0.0) and was the best to rule out HF-related ascites. These findings were confirmed in a 60-patient validation cohort. Conclusions: Serum BNP is more accurate than ascites analyses in the diagnosis of HF-related ascites. The workup of patients with new onset ascites could be streamlined by obtaining serum BNP as an initial test and could forego the need for diagnostic paracentesis, particularly in cases where the cause of ascites is uncertain and/or could be the result of HF. (Hepatology 2014;59:1043-1051)
  • article 0 Citação(ões) na Scopus
    Lysosomal Acid Lipase Deficiency in the Etiological Investigation of Cryptogenic Liver Disease in Adults: A Multicenter Brazilian Study
    (2023) CANDOLO, Aline Coelho Rocha; CANCADO, Guilherme Grossi Lopes; ZITELLI, Patricia Momoyo; MAZO, Daniel Ferraz de Campos; OLIVEIRA, Claudia Pinto Marques; CUNHA-SILVA, Marlone; GRECA, Raquel Dias; ARAUJO, Roberta Chaves; ALUSTAU, Amanda Sacha Paulino Tolentino; COUTO, Claudia Alves; NARDELLI, Mateus Jorge; LIMA, Roque Gabriel Rezende de; FARIAS, Alberto Queiroz; CARRILHO, Flair Jose; PESSOA, Mario Guimaraes
    Background: Lysosomal acid lipase deficiency (LAL-D) is a rare genetic disease associated with the deregulation of lipid metabolism, leading to atherosclerosis, dyslipidemia, and hepatic steatosis, with potential progression to cirrhosis. Our study aims to assess the role of LAL-D in the setting of cryptogenic liver disease. Methods: A large multicenter cross-sectional study was conducted, which included 135 patients with cryptogenic liver disease from four liver centers in Brazil. All patients were submitted to the investigation of LAL enzyme activity on dried blood spots. Results: Three patients (two female) presented levels of LAL below the reference limit, compatible with LAL-D (2.2%). They had a mean age of 43.9 +/- 10.1 years and a mean body-mass index (BMI) of 23.1 +/- 1.7 kg/m2. The mean serum levels of glucose, HDL-cholesterol, and triglycerides were 89.7 +/- 3.2, 21.7 +/- 3.2, and 206.7 +/- 25.5 mg/dL, respectively. All patients had duodenal polyposis with xanthomatous macrophages. LAL-D investigation should be considered for individuals with chronic liver disease of an unknown etiology, especially with a normal BMI, high triglycerides, and low-HDL-cholesterol levels. The identification of LAL-D patients is extremely important since enzyme replacement therapy with Sebelipase Alfa significantly increases their survival.