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García-Pajares F, Peñas-Herrero I, Sánchez-Ocaña R, Torrres-Yuste R, Cimavilla-Román M, Carbajo-López A, Almohalla-Alvarez C, Pérez-Saborido B, Muñoz-Conejero E, Gonzalez-Sagrado M, Caro-Patón A, Sánchez-Antolín G. Metabolic Syndrome After Liver Transplantation: Five-Year Prevalence and Risk Factors. Transplant Proc 2017; 48:3010-3012. [PMID: 27932133 DOI: 10.1016/j.transproceed.2016.07.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022]
Abstract
Survival after orthotopic liver transplantation (OLT) has increased over the last decades, focusing on the metabolic complications that contribute to patient morbidity and mortality. The aim of our study was to describe the prevalence of metabolic syndrome (MS), its components, and its associated factors in patients who underwent OLT in a hospital in Spain. From November 2001 to January 2014, we performed 415 transplantations in 386 patients. We analyzed 204 patients with a minimum follow-up of 1 year (77.6% were male and the mean age was 54.2+/-9.5 years). The most frequent etiology was alcohol (41%), followed by hepatitis C virus (29.1%). The indication was decompensated cirrhosis in 51.8% and hepatocellular carcinoma in 34%. According to modified National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATP III) criteria, 5 years post-transplantation MS was diagnosed in 38.2% of patients. Significant independent predictors of post-transplantation MS on logistic regression analysis were as follows: pretransplantation obesity (odds ratio [OR], 3.09; P = .056), 1-year post-transplantation obesity (OR, 3.95; P = .009), pretransplantation diabetes (OR, 4.63; P = .001), 1-year post-transplantation diabetes (OR, 3.01; P = .015), 1-year post-transplantation hypertension (OR, 1.85; P = .176), and hypertriglyceridemia at the first year after transplantation (OR, 2.32; P = .063). In our center the prevalence of MS at 5 years after OLT is slightly lower than published. The most important risk factors were obesity and diabetes (both pretransplantation and the first year post-transplantation).
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Affiliation(s)
- F García-Pajares
- Gastroenterology Service, Liver Transplantation Unit, Valladolid, Spain.
| | - I Peñas-Herrero
- Gastroenterology Service, Liver Transplantation Unit, Valladolid, Spain
| | - R Sánchez-Ocaña
- Gastroenterology Service, Liver Transplantation Unit, Valladolid, Spain
| | - R Torrres-Yuste
- Gastroenterology Service, Liver Transplantation Unit, Valladolid, Spain
| | - M Cimavilla-Román
- Gastroenterology Service, Liver Transplantation Unit, Valladolid, Spain
| | - A Carbajo-López
- Gastroenterology Service, Liver Transplantation Unit, Valladolid, Spain
| | | | - B Pérez-Saborido
- Gastroenterology Service, Liver Transplantation Unit, Valladolid, Spain; Surgery Service, Liver Transplantation Unit, Valladolid, Spain
| | - E Muñoz-Conejero
- Gastroenterology Service, Liver Transplantation Unit, Valladolid, Spain
| | - M Gonzalez-Sagrado
- Investigation Unit, Hospital Universitario Río Hortega, Valladolid, Spain
| | - A Caro-Patón
- Gastroenterology Service, Liver Transplantation Unit, Valladolid, Spain
| | - G Sánchez-Antolín
- Gastroenterology Service, Liver Transplantation Unit, Valladolid, Spain
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Ceccato A, Torres A, Cilloniz C, Amaro R, Gabarrus A, Polverino E, Prina E, Garcia-Vidal C, Muñoz-Conejero E, Mendez C, Cifuentes I, Puig de la Bella Casa J, Menendez R, Niederman MS. Invasive Disease vs Urinary Antigen-Confirmed Pneumococcal Community-Acquired Pneumonia. Chest 2017; 151:1311-1319. [PMID: 28093269 DOI: 10.1016/j.chest.2017.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/08/2016] [Accepted: 01/02/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The burden of pneumococcal disease is measured only through patients with invasive pneumococcal disease. The urinary antigen test (UAT) for pneumococcus has exhibited high sensitivity and specificity. We aimed to compare the pneumococcal pneumonias diagnosed as invasive disease with pneumococcal pneumonias defined by UAT results. METHODS A prospective observational study of consecutive nonimmunosuppressed patients with community-acquired pneumonia was performed from January 2000 to December 2014. Patients were stratified into two groups: invasive pneumococcal pneumonia (IPP) defined as a positive blood culture or pleural fluid culture result and noninvasive pneumococcal pneumonia (NIPP) defined as a positive UAT result with negative blood or pleural fluid culture result. RESULTS We analyzed 779 patients (15%) of 5,132, where 361 (46%) had IPP and 418 (54%) had NIPP. Compared with the patients with IPP, those with NIPP presented more frequent chronic pulmonary disease and received previous antibiotics more frequently. Patients with IPP presented more severe community-acquired pneumonia, higher levels of inflammatory markers, and worse oxygenation at admission; more pulmonary complications; greater extrapulmonary complications; longer time to clinical stability; and longer length of hospital stay compared with the NIPP group. Age, chronic liver disease, mechanical ventilation, and acute renal failure were independent risk factors for 30-day crude mortality. Neither IPP nor NIPP was an independent risk factor for 30-day mortality. CONCLUSIONS A high percentage of confirmed pneumococcal pneumonia is diagnosed by UAT. Despite differences in clinical characteristics and outcomes, IPP is not an independent risk factor for 30-day mortality compared with NIPP, reinforcing the importance of NIPP for pneumococcal pneumonia.
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Affiliation(s)
- Adrian Ceccato
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Sección Neumología, Hospital Nacional Alejandro Posadas, El Palomar, Argentina
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Catia Cilloniz
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Rosanel Amaro
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Albert Gabarrus
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Eva Polverino
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Elena Prina
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | | | | | - Rosario Menendez
- Department of Pneumology, IIS/Hospital Universitario y Politécnico La Fe, CIBERES, Valencia, Spain
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York Presbyterian/Weill Cornell Medical Center, New York, NY
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Sanchez-Antolín G, Almohalla-Alvarez C, Bueno P, Almansa R, Iglesias V, Rico L, Ortega A, Muñoz-Conejero E, García-Pajares F, Bermejo-Martin JF. Evidence of Active Pro-Fibrotic Response in Blood of Patients with Cirrhosis. PLoS One 2015; 10:e0137128. [PMID: 26317806 PMCID: PMC4552880 DOI: 10.1371/journal.pone.0137128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/12/2015] [Indexed: 01/08/2023] Open
Abstract
The role of systemic immunity in the pathogenesis of cirrhosis is not fully understood. Analysis of transcriptomic profiles in blood is an easy approach to obtain a wide picture of immune response at the systemic level. We studied gene expression profiles in blood from thirty cirrhotic patients and compared them against those of eight healthy volunteers. Most of our patients were male [n = 21, 70%] in their middle ages [57.4 ± 6.8 yr]. Alcohol abuse was the most frequent cause of cirrhosis (n = 22, 73%). Eleven patients had hepatocellular carcinoma (36.7%). Eight patients suffered from hepatitis C virus infection (26.7%). We found a signature constituted by 3402 genes which were differentially expressed in patients compared to controls (2802 over-expressed and 600 under-expressed). Evaluation of this signature evidenced the existence of an active pro-fibrotic transcriptomic program in the cirrhotic patients, involving the [extra-cellular matrix (ECM)-receptor interaction] & [TGF-beta signaling] pathways along with the [Cell adhesion molecules] pathway. This program coexists with alterations in pathways participating in [Glycine, serine and threonine metabolism], [Phenylalanine metabolism], [Tyrosine metabolism], [ABC transporters], [Purine metabolism], [Arachidonic acid metabolism]. In consequence, our results evidence the co-existence in blood of a genomic program mediating pro-fibrotic mechanisms and metabolic alterations in advanced cirrhosis. Monitoring expression levels of the genes involved in these programs could be of interest for predicting / monitoring cirrhosis evolution. These genes could constitute therapeutic targets in this disease.
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Affiliation(s)
- Gloria Sanchez-Antolín
- Unidad de Hepatología, Unidad de Trasplante Hepático. Hospital Universitario Río Hortega, Valladolid, Spain
- * E-mail:
| | - Carolina Almohalla-Alvarez
- Unidad de Hepatología, Unidad de Trasplante Hepático. Hospital Universitario Río Hortega, Valladolid, Spain
| | - Pilar Bueno
- Servicio de Análisis Clínicos, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Raquel Almansa
- Investigación Médica en Infección e Inmunidad (IMI), Hospital Clínico Universitario de Valladolid-IECSCYL, Valladolid, Spain
| | - Verónica Iglesias
- Investigación Médica en Infección e Inmunidad (IMI), Hospital Clínico Universitario de Valladolid-IECSCYL, Valladolid, Spain
| | - Lucia Rico
- Investigación Médica en Infección e Inmunidad (IMI), Hospital Clínico Universitario de Valladolid-IECSCYL, Valladolid, Spain
| | - Alicia Ortega
- Investigación Médica en Infección e Inmunidad (IMI), Hospital Clínico Universitario de Valladolid-IECSCYL, Valladolid, Spain
| | | | - Felix García-Pajares
- Unidad de Hepatología, Unidad de Trasplante Hepático. Hospital Universitario Río Hortega, Valladolid, Spain
| | - Jesus F. Bermejo-Martin
- Investigación Médica en Infección e Inmunidad (IMI), Hospital Clínico Universitario de Valladolid-IECSCYL, Valladolid, Spain
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