Comparativo do perfil hepático no pré e pós-operatório de pacientes submetidos à cirurgia bariátrica: rede particular versus pública

Abstract

Introduction: Obesity is associated to several comorbidities, including nonalcoholic fatty liver disease, which implicates in isolated steatosis to steatohepatitis. The latter may progress to severe manifestations such as liver fibrosis, cirrhosis and hepatocellular carcinoma. Objective: To compare the presence of advanced liver fibrosis before and after bariatric surgery in patients of private and public health system. Methods: Patients from public and privative networks were studied before and after bariatric surgery. The presence or absence of advanced hepatic fibrosis was evaluated by NAFLD Fibrosis Score, a non-invasive method that uses age, BMI, AST / ALT ratio, albumin, platelet count and the presence or absence of hyperglycemia or diabetes. The characteristics of the two groups were compared using the chi-square (X2) for categorical variables and the t Student test for independent samples in the case of numeric variables. Analysis of variance (ANOVA) for repeated measures was used for comparisons between groups and times (preoperatively, six months and one year). The established statistical significance criterion was p <0.05. Results: We analyzed 40 patients with a mean age of 34.6 ± 9.5 years for private network and 40.6 ± 10.2 years for public. The study sample, 35% were treated at private health system and 65% in the public ones, 38% male and 62% female. Preoperatively the private network 1 (7.1%) patient had advanced iver fibrosis and developed to the absence of liver fibrosis after surgery. In the public 8 (30.8%) patients had advanced liver fibrosis preoperatively, and at 1 year after the proportion fell to 6 (23%). Conclusion: The non-alcoholic fatty liver disease in its advanced form is more prevalent in obese patients treated in the public network than in the treated at the private network and bariatric surgery may be important therapeutic option in both populations.