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Costa EG, Venturini S, Colussi GL, Pratesi C, Villalta D, Sabena A, Grembiale A, Pontoni E, Bramuzzo I, Barbato G, Balbi M, Doretto P, Avolio M, Basaglia G, Crapis M, Tonizzo M, Fagiuoli S, Grazioli S. Diagnostic role of CD64 expression on neutrophils as biomarker for blood stream infection in liver cirrhosis: some preliminary findings. LE INFEZIONI IN MEDICINA 2024; 32:363-368. [PMID: 39282535 PMCID: PMC11392555 DOI: 10.53854/liim-3203-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/17/2024] [Indexed: 09/19/2024]
Abstract
Background The expression of CD64 on neutrophils (nCD64), measured using flow cytometry, has been proposed as a biomarker for bloodstream infections (BSI). However, data regarding its use in the setting of liver cirrhosis are lacking. Methods We compared nCD64 levels in 15 cirrhotic patients with BSI to those in 19 controls, including outpatients with stable decompensated cirrhosis without infection. Additionally, we compared nCD64 with C-reactive protein (CRP) and procalcitonin (PCT) in infected hospitalized cirrhotic patients. Results Cirrhotic patients with infection had higher levels of nCD64 compared to controls (6.0 [5.4-7.1] vs. 2.0 [1.5-2.2]; p<0.001). Among infected patients, a correlation between nCD64 (AUC=0.934 [0.875-0.982 95% CI]), CRP (AUC=0.972 [0.942-0.993 95% CI]), and PCT (AUC=0.859 [0.739-0.953 95% CI]) was observed. However, in our sample of cirrhotic individuals, nCD64 values were not significantly different between patients with worse prognosis and those with positive outcomes (p=0.448), and its expression was not influenced by Gram stain. Conclusions In our cohort, nCD64 appears to be a promising new biomarker for BSI. Additional prospective studies are needed to confirm its role and limitations in conjunction with other biomarkers and rapid microbiology in the diagnostic multidisciplinary pathway for septic cirrhotic patients.
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Affiliation(s)
- Elena Garlatti Costa
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Sergio Venturini
- Department of Infectious Diseases, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Gian Luca Colussi
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Chiara Pratesi
- Department of Laboratory Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Danilo Villalta
- Department of Immunology and Allergology, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Anna Sabena
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Alessandro Grembiale
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Elisa Pontoni
- Department of Emergency Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Igor Bramuzzo
- Department of Infectious Diseases, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Giuseppe Barbato
- Department of Emergency Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Massimiliano Balbi
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of San Vito al Tagliamento, Italy
| | - Paolo Doretto
- Department of Laboratory Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Manuela Avolio
- Department of Microbiology and Virology, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Giancarlo Basaglia
- Department of Microbiology and Virology, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Hospital of Bergamo, Italy
| | - Silvia Grazioli
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
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Thuluvath PJ, Amjad W, Russe-Russe J, Li F. The Lower Survival in Patients With Alcoholism and Hepatitis C Continues in the DAA Era. Transplantation 2024; 108:1584-1592. [PMID: 38389127 DOI: 10.1097/tp.0000000000004953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Alcohol liver disease (ALD) may coexist with hepatitis C (HCV) in many transplant recipients (alcoholic cirrhosis with hepatitis C [AHC]). Our objective was to determine whether there were differences in postliver transplantation outcomes of patients with AHC when compared with those with alcoholic cirrhosis (AC) and/or alcoholic hepatitis (AH). METHODS Using UNOS explant data sets (2016-2020), the survival probabilities of AC, AH, and AHC were compared by Kaplan-Meier survival analysis. Cox proportional-hazard regression analysis was used to determine outcomes after adjusting for disease confounders. The outcomes were also compared with predirect antiviral agent (DAA) period. RESULTS During study period, 8369 biopsy-proven ALD liver transplant recipients were identified. Of those, 647 had AHC (HCV + alcohol), 353 had AH, and 7369 had AC. MELD-Na score (28.7 ± 9.5 versus 23.8 ± 10.7; P < 0.001) and presence of ACLF-3 (19% versus 11%; P < 0.001) were higher in AC + AH as compared with AHC. AHC and AC+AH has similar adjusted mortality at 1-y, but 3-y (hazard ratios, 1.76; 95% confidence intervals, 1.32-2.35; P < 0.0001) and 5-y (hazard ratios, 1.64; 95% confidence intervals, 1.24-2.15; P = 0.0004) mortality rates were higher in AHC. Survival improved in the DAA era (2016-2020) compared with 2009 to 2013 in AHC, but remained worse in AHC group versus AC and/or AH. Malignancy-related mortality was higher in AHC (15% versus 9.3% in AC) in the DAA era. CONCLUSIONS AHC was associated with lower 3- and 5-y post-LT survival as compared with ALD without HCV and the worse outcomes in AHC group continued in the DAA era.
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Affiliation(s)
- Paul J Thuluvath
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Waseem Amjad
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD
| | - Jose Russe-Russe
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD
| | - Feng Li
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD
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Corona A, Dominguez M, Eti S. Palliative Care in Kidney and Liver Diseases. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:387-395. [PMID: 37657885 DOI: 10.1053/j.akdh.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 09/03/2023]
Abstract
The role of palliative care is to recognize patients with advanced illnesses who are at risk for poor outcomes and to alleviate their pain and suffering. Patients with both kidney and liver disease are a very vulnerable population due to the unique pathophysiologic relationship these two organs share, which often leads to an abbreviated life expectancy and a significant symptom burden. These patients face many challenges in their care. This article discusses the importance of prognostication for early palliative care referrals as well as the management of the two most common complaints patients with kidney and liver disease face: pain and ascites.
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Affiliation(s)
- Antonio Corona
- Albert Einstein College of Medicine at Montefiore Medical Center.
| | - Mary Dominguez
- Albert Einstein College of Medicine at Montefiore Medical Center
| | - Serife Eti
- Albert Einstein College of Medicine at Montefiore Medical Center
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