1
|
Zhang Z, Zhang J, Cai M, Huang X, Guo X, Zhu D, Guo T, Yu Y. The fibrosis-4 index is a prognostic factor for cholangiocarcinoma patients who received immunotherapy. Front Immunol 2024; 15:1376590. [PMID: 38799431 PMCID: PMC11116781 DOI: 10.3389/fimmu.2024.1376590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background Research of immunotherapy for cholangiocarcinoma has yielded some results, but more clinical data are needed to prove its efficacy and safety. Moreover, there is a need to identify accessible indexes for selecting patients who may benefit from such treatments. Methods The medical records of 66 cholangiocarcinoma patients who underwent immunotherapy were retrospectively collected. The effectiveness of immunotherapy was assessed by tumor response, progression-free survival (PFS), and overall survival (OS), while safety was evaluated by adverse events during treatment. Univariate and multivariate Cox regression analyses were performed to identify prognostic risk factors for PFS and OS, and Kaplan-Meier curves of potential prognostic factors were drawn. Results Overall, in this study, immunotherapy achieved an objective response rate of 24.2% and a disease control rate of 89.4% for the included patients. The median PFS was 445 days, and the median OS was 772.5 days. Of the 66 patients, 65 experienced adverse events during treatment, but none had severe consequences. Multivariate Cox analysis indicated that tumor number is a prognostic risk factor for disease progression following immunotherapy in cholangiocarcinoma patients, while tumor differentiation and the fibrosis-4 (FIB-4) index are independent risk factors for OS. Conclusion In general, immunotherapy for cholangiocarcinoma is safe, with adverse events remaining within manageable limits, and it can effectively control disease progression in most patients. The FIB-4 index may reflect the potential benefit of immunotherapy for patients with cholangiocarcinoma.
Collapse
Affiliation(s)
- Zhiwei Zhang
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, Hubei, China
| | - Jingzhao Zhang
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, Hubei, China
| | - Ming Cai
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, Hubei, China
| | - Xiaorui Huang
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, Hubei, China
| | - Xinyi Guo
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, Hubei, China
| | - Dengsheng Zhu
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, Hubei, China
| | - Tong Guo
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, Hubei, China
| | - Yahong Yu
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, Hubei, China
| |
Collapse
|
2
|
Bucci T, Galardo G, Gandini O, Vicario T, Paganelli C, Cerretti S, Bucci C, Pugliese F, Pastori D. Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department. Intern Emerg Med 2022; 17:1777-1784. [PMID: 35624344 PMCID: PMC9140323 DOI: 10.1007/s11739-022-02997-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/20/2022] [Indexed: 12/30/2022]
Abstract
Liver damage worsens the prognosis of coronavirus 19 disease (COVID-19). However, the best strategy to stratify mortality risk according to liver damage has not been established. The aim of this study is to test the predictive value of the validated Fibrosis-4 (FIB-4) Index and compared it to liver transaminases and to the AST-to-Platelet ratio index (APRI). Multicenter cohort study including 992 consecutive COVID-19 patients admitted to the Emergency Department. FIB-4 > 3.25 and APRI > 0.7 were used to define liver damage. Multivariable Cox regression and ROC curve analysis for mortality were performed. Secondary endpoints were (1) need for high-flow oxygen and (2) mechanical ventilation. 240 (24.2%) patients had a FIB-4 > 3.25. FIB-4 > 3.25 associated with an increased mortality (n = 119, log-rank test p < 0.001 and adjusted hazard ratio (HR) 1.72 (95% confidence interval [95%CI] 1.14-2.59, p = 0.010). ROC analysis for mortality showed that FIB-4 (AUC 0.734, 95% CI 0.705-0.761) had a higher predictive value than AST (p = 0.0018) and ALT (p < 0.0001). FIB-4 > 3.25 was also superior to APRI > 0.7 (AUC 0.58, 95% CI 0.553-0.615, p = 0.0008). Using an optimized cut-off > 2.76 (AUC 0.689, 95% CI 0.659-0.718, p < 0.0001), FIB-4 was superior to FIB-4 > 3.25 (p = 0.0302), APRI > 0.7 (p < 0.0001), AST > 51 (p = 0.0119) and ALT > 42 (p < 0.0001). FIB-4 was also associated with high-flow oxygen use (n = 255, HR 1.69, 95% CI 1.25-2.28, p = 0.001) and mechanical ventilation (n = 39, HR 2.07, 95% CI 1.03-4.19, p = 0.043). FIB-4 score predicts mortality better than liver transaminases and APRI score. FIB-4 score may be an easy tool to identify COVID-19 patients at worse prognosis in the emergency department.
Collapse
Affiliation(s)
- Tommaso Bucci
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Gioacchino Galardo
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Orietta Gandini
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Tommasa Vicario
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
- Emergency Department, Policlinico Tor Vergata Hospital, Rome, Italy
| | - Carla Paganelli
- Emergency Department, Policlinico Tor Vergata Hospital, Rome, Italy
| | - Sara Cerretti
- Emergency Medicine Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Chiara Bucci
- Emergency Medicine Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Emergency Medicine Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- Emergency Medicine Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
| |
Collapse
|
4
|
Zein AFMZ, Raffaello WM. Dipeptidyl peptidase-4 (DPP-IV) inhibitor was associated with mortality reduction in COVID-19 - A systematic review and meta-analysis. Prim Care Diabetes 2022; 16:162-167. [PMID: 34952805 PMCID: PMC8666291 DOI: 10.1016/j.pcd.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This systematic review and meta-analysis aimed to synthesize the latest evidence on the effect of dipeptidyl peptidase-4 (DPP-IV) inhibitor in patients with COVID-19. METHODS We performed a systematic literature search from the PubMed, Scopus, Embase, and Clinicaltrials.gov up until 15 July 2021. Studies that met the following criteria were included: prospective or retrospective observational studies or case series or randomized controlled trials (RCTs) reporting DPP-IV inhibitor use in patients with COVID-19 and mortality. The intervention group was patients receiving DPP-IV inhibitor. The control group was patients that did not receive DPP-IV inhibitor. The outcome was mortality reported as odds ratio (OR). RESULTS There were 11 studies consisting of 5950 patients in this meta-analysis. DPP-IV inhibitor use was associated with reduced mortality (OR 0.75 [0.56, 0.99], p = 0.043, I2: 42.9, p = 0.064) compared to those that did not receive DPP-IV inhibitor. Sensitivity analysis using the fixed-effect model (OR 0.75 [0.63, 0.88], p < 0.001, I2: 42.9, p = 0.064) also showed mortality benefit. The association between DPP-IV inhibitor and mortality was not significantly affected by age (p = 0.540), sex (p = 0.054), hypertension (p = 0.320), location (continent; p = 0.532), and retrospective/prospective nature of the study (p = 0.840). However, the association was affected by metformin (OR 1.03 [95% CI 1.01, 1.06], p = 0.010) and ACEI/ARB use (OR 1.06 [95% CI 1.02, 1.10], p = 0.004). CONCLUSION This meta-analysis showed that DPP-IV inhibitor was associated with reduced mortality in patients with COVID-19.
Collapse
Affiliation(s)
- Ahmad Fariz Malvi Zamzam Zein
- Department of Internal Medicine, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Indonesia; Department of Internal Medicine, Waled General Hospital, Cirebon, Indonesia.
| | | |
Collapse
|
5
|
Crisan D, Avram L, Grapa C, Dragan A, Radulescu D, Crisan S, Grosu A, Militaru V, Buzdugan E, Stoicescu L, Radulescu L, Ciovicescu F, Jivanescu DB, Mocan O, Micu B, Donca V, Marinescu L, Macarie A, Rosu M, Nemes A, Craciun R. Liver Injury and Elevated FIB-4 Define a High-Risk Group in Patients with COVID-19. J Clin Med 2021; 11:153. [PMID: 35011894 PMCID: PMC8745798 DOI: 10.3390/jcm11010153] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Liver involvement in Coronavirus Disease 2019 (COVID-19) has been widely documented. However, data regarding liver-related prognosis are scarce and heterogeneous. The current study aims to evaluate the role of abnormal liver tests and incidental elevations of non-invasive fibrosis estimators on the prognosis of hospitalized COVID-19 patients. We conducted a retrospective cohort study to investigate the impact of elevated liver tests, non-invasive fibrosis estimators (the Fibrosis-4 (FIB-4), Forns, APRI scores, and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio), and the presence of computed tomography (CT)-documented liver steatosis on mortality in patients with moderate and severe COVID-19, with no prior liver disease history. A total of 370 consecutive patients were included, of which 289 patients (72.9%) had abnormal liver biochemistry on admission. Non-survivors had significantly higher FIB-4, Forns, APRI scores, and a higher AST/ALT ratio. On multivariate analysis, severe FIB-4 (exceeding 3.25) and elevated AST were independently associated with mortality. Severe FIB-4 had an area under the receiver operating characteristic (AUROC) of 0.73 for predicting survival. The presence of steatosis was not associated with a worse outcome. Patients with abnormal liver biochemistry on arrival might be susceptible to a worse disease outcome. An FIB-4 score above the threshold of 3.25, suggestive of the presence of fibrosis, is associated with higher mortality in hospitalized COVID-19 patients.
Collapse
Affiliation(s)
- Dana Crisan
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Lucretia Avram
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Cristiana Grapa
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
| | - Alexandra Dragan
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
| | - Dan Radulescu
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Sorin Crisan
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Alin Grosu
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Valentin Militaru
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Elena Buzdugan
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Laurentiu Stoicescu
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Liliana Radulescu
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Felix Ciovicescu
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Delia Bunea Jivanescu
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Oana Mocan
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Bogdan Micu
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of General Surgery, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Valer Donca
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Luminita Marinescu
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Antonia Macarie
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Marina Rosu
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
- Department of Internal Medicine, Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Andrada Nemes
- Intensive Care Unit I, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania;
| | - Rares Craciun
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.); (A.D.); (D.R.); (S.C.); (A.G.); (V.M.); (E.B.); (L.S.); (L.R.); (F.C.); (D.B.J.); (O.M.); (B.M.); (V.D.); (L.M.); (A.M.); (M.R.); (R.C.)
| |
Collapse
|