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Gratacós-Ginès J, Avitabile E, Montironi C, Guillamon-Thiery A, Hernández-Évole H, Moreta MJ, Blaya D, Ariño S, Rubio AB, Pérez-Guasch M, Cervera M, Carol M, Fabrellas N, Soria A, Juanola A, Graupera I, Sancho-Bru P, Díaz A, Coll M, Bataller R, Ginès P, Pose E. Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling. Clin Gastroenterol Hepatol 2024; 22:768-777.e8. [PMID: 38065374 DOI: 10.1016/j.cgh.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/20/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND & AIMS Alcoholic foamy degeneration (AFD) is a condition with similar clinical presentation to alcohol-associated hepatitis (AH), but with a specific histologic pattern. Information regarding the prevalence and prognosis of AFD is scarce and there are no tools for a noninvasive diagnosis. METHODS A cohort of patients admitted to the Hospital Clinic of Barcelona for clinical suspicion of AH who underwent liver biopsy was included. Patients were classified as AFD, AH, or other findings, according to histology. Clinical features, histology, and genetic expression of liver biopsy specimens were analyzed. The accuracy of National Institute on Alcohol Abuse and Alcoholism criteria and laboratory parameters for differential diagnosis were investigated. RESULTS Of 230 patients with a suspicion of AH, 18 (8%) met histologic criteria for AFD, 184 (80%) had definite AH, and 28 (12%) had other findings. In patients with AFD, massive steatosis was more frequent and the fibrosis stage was lower. AFD was characterized by down-regulation of liver fibrosis and inflammation genes and up-regulation of lipid metabolism and mitochondrial function genes. Patients with AFD had markedly better long-term survival (100% vs 57% in AFD vs AH; P = .002) despite not receiving corticosteroid treatment, even in a model for end-stage liver disease-matched sensitivity analysis. Serum triglyceride levels had an area under the receiver operating characteristic of 0.886 (95% CI, 0.807-0.964) for the diagnosis of AFD, whereas the National Institute on Alcohol Abuse and Alcoholism criteria performed poorly. A 1-step algorithm using triglyceride levels of 225 mg/dL (sensitivity, 0.77; specificity, 0.90; and Youden index, 0.67) is proposed for differential diagnosis. CONCLUSIONS AFD in the setting of suspicion of AH is not uncommon. A differential diagnosis is important because prognosis and treatment differ largely. Triglyceride levels successfully identify most patients with AFD and may be helpful in decision making.
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Affiliation(s)
- Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Emma Avitabile
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain
| | - Carla Montironi
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain
| | - Alex Guillamon-Thiery
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain
| | | | - María José Moreta
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain
| | - Delia Blaya
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain
| | - Silvia Ariño
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain
| | - Ana Belén Rubio
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, Spain
| | - Martina Pérez-Guasch
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, Spain
| | - Marta Cervera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain
| | - Marta Carol
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, Spain
| | - Anna Soria
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Adrià Juanola
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Isabel Graupera
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, Spain
| | - Pau Sancho-Bru
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Alba Díaz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain; Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, Spain
| | - Mar Coll
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Ramón Bataller
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, Spain.
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2
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Gratacós-Ginès J, Ruz-Zafra P, Celada-Sendino M, Martí-Carretero A, Pujol C, Martín-Mateos R, Echavarría V, Frisancho LE, García S, Barreales M, Tejedor-Tejada J, Vázquez-Rodríguez S, Cañete N, Fernández-Carrillo C, Valenzuela M, Martí-Aguado D, Horta D, Quiñones M, Bernal-Monterde V, Acosta S, Artaza T, Pinazo J, Villar-Lucas C, Clemente-Sánchez A, Badia-Aranda E, Giráldez-Gallego Á, Rodríguez M, Sancho-Bru P, Cabezas J, Ventura-Cots M, Fernández-Rodríguez C, Aguilera V, Tomé S, Bataller R, Caballería J, Pose E. Recurrent alcohol-associated hepatitis is common and is associated with increased mortality. Hepatology 2024:01515467-990000000-00773. [PMID: 38441908 DOI: 10.1097/hep.0000000000000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/06/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND AIMS Alcohol relapse after surviving an episode of alcohol-associated hepatitis (AH) is common. However, the clinical features, risk factors, and prognostic implications of recurrent alcohol-associated hepatitis (RAH) are not well described. APPROACH AND RESULTS A registry-based study was done of patients admitted to 28 Spanish hospitals for an episode of AH between 2014 and 2021. Baseline demographics and laboratory variables were collected. Risk factors for RAH were investigated using Cox regression analysis. We analyzed the severity of the index episodes of AH and compared it to that of RAH. Long-term survival was assessed by Kaplan-Meier curves and log-rank tests. A total of 1118 patients were included in the analysis, 125 (11%) of whom developed RAH during follow-up (median: 17 [7-36] months). The incidence of RAH in patients resuming alcohol use was 22%. The median time to recurrence was 14 (8-29) months. Patients with RAH had more psychiatric comorbidities. Risk factors for developing RAH included age <50 years, alcohol use >10 U/d, and history of liver decompensation. RAH was clinically more severe compared to the first AH (higher MELD, more frequent ACLF, and HE). Moreover, alcohol abstinence during follow-up was less common after RAH (18% vs. 45%, p <0.001). Most importantly, long-term mortality was higher in patients who developed RAH (39% vs. 21%, p = 0.026), and presenting with RAH independently predicted high mortality (HR: 1.55 [1.11-2.18]). CONCLUSIONS RAH is common and has a more aggressive clinical course, including increased mortality. Patients surviving an episode of AH should undergo intense alcohol use disorder therapy to prevent RAH.
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Affiliation(s)
- Jordi Gratacós-Ginès
- Department of Liver Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- Liver, Digestive System and Metabolism Department Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
| | - Pilar Ruz-Zafra
- Department of Digestive Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Miriam Celada-Sendino
- Department of Liver Diseases, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Aina Martí-Carretero
- Department of Liver Diseases, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clàudia Pujol
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Rosa Martín-Mateos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Víctor Echavarría
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Luis E Frisancho
- Department of Liver Diseases, Hospital Parc Taulí, Sabadell, Spain
| | - Sonia García
- Department of Hepatology and Liver Transplant, Hospital Universitari i Politècnic La Fe, IISLa FE, Valencia, Spain
| | - Mónica Barreales
- Department of Liver Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Sergio Vázquez-Rodríguez
- Department of Gastroenterology. Xerencia Xestion Integrada de Vigo Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, SERGAS, Vigo, Spain
| | - Nuria Cañete
- Liver Section, Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Carlos Fernández-Carrillo
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - María Valenzuela
- Department of Gastroenterology and Hepatology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - David Martí-Aguado
- Digestive Disease Department, Clínic University Hospital, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Diana Horta
- Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Marta Quiñones
- Gastroenterology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Silvia Acosta
- Department of Digestive Diseases, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Tomás Artaza
- Department of Digestive Diseases, Hospital Universitario de Toledo, Toledo, Spain
| | - José Pinazo
- Department of Gastroenterology, Hospital Virgen de la Victoria, Málaga, Spain
| | - Carmen Villar-Lucas
- Department of Digestive Diseases, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ana Clemente-Sánchez
- Department of Liver Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ester Badia-Aranda
- Department of Digestive Diseases, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Manuel Rodríguez
- Department of Liver Diseases, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Pau Sancho-Bru
- Liver, Digestive System and Metabolism Department Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Joaquín Cabezas
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Meritxell Ventura-Cots
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
- Department of Liver Diseases, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Conrado Fernández-Rodríguez
- Gastroenterology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
- Department of Medicine, Universidad Rey Juan Carlos, Madrid, Spain
| | - Victoria Aguilera
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
- Department of Hepatology and Liver Transplant, Hospital Universitari i Politècnic La Fe, IISLa FE, Valencia, Spain
| | - Santiago Tomé
- Department of Liver Diseases, Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Ramon Bataller
- Department of Liver Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
| | - Juan Caballería
- Department of Liver Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- Liver, Digestive System and Metabolism Department Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
| | - Elisa Pose
- Department of Liver Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- Liver, Digestive System and Metabolism Department Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
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3
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Gratacós-Ginès J, López-Pelayo H, Pose E. Reply: Medications promoting abstinence in alcohol-associated cirrhosis. Hepatology 2024; 79:E100-E101. [PMID: 38193591 DOI: 10.1097/hep.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Hugo López-Pelayo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Addictions Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Catalunya, Spain
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Gratacós-Ginès J, Bruguera P, Pérez-Guasch M, López-Lazcano A, Borràs R, Hernández-Évole H, Pons-Cabrera MT, Lligoña A, Bataller R, Ginès P, López-Pelayo H, Pose E. Medications for alcohol use disorder promote abstinence in alcohol-associated cirrhosis: Results from a systematic review and meta-analysis. Hepatology 2024; 79:368-379. [PMID: 37625154 DOI: 10.1097/hep.0000000000000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND AND AIMS The role of medications for alcohol use disorder (MAUD) in patients with cirrhosis is not well established. Evidence on the efficacy and safety of these drugs in these patients is scarce. APPROACH AND RESULTS We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol guidelines on the efficacy of MAUD in patients with cirrhosis. A search was conducted in PubMed, Embase, and Scopus, including all studies until May 2022. The population was defined as patients with AUD and cirrhosis. The primary outcome was alcohol abstinence. Safety was a secondary outcome. We performed a random-effect analysis and expressed the results as relative risk of alcohol consumption. Heterogeneity was measured by I2 . Out of 4095 unique references, 8 studies on 4 different AUD treatments [baclofen (n = 6), metadoxine (n = 1), acamprosate (n = 1), and fecal microbiota transplant (n = 1)] in a total of 794 patients were included. Four were cohort studies, and 4 were RCTs. Only RCTs were included in the meta-analysis. MAUD was associated with a reduced rate of alcohol consumption [relative risk = 0.68 (CI: 0.48-0.97), P = 0.03], increasing alcohol abstinence by 32% compared to placebo or standard treatment, despite high heterogeneity ( I2 = 67%). Regarding safety, out of 165 serious adverse events in patients treated with MAUD, only 5 (3%) were possibly or probably related to study medications. CONCLUSION MAUD in patients with cirrhosis is effective in promoting alcohol abstinence and has a good safety profile. Larger studies on the effects of MAUD are needed, especially in patients with advanced liver disease.
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Affiliation(s)
- Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Pol Bruguera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Addictions Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Catalunya, Spain
| | - Martina Pérez-Guasch
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ana López-Lazcano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Clinical Health Psychology Section, Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalunya, Spain
| | - Roger Borràs
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Catalunya, Spain
| | | | - Maria T Pons-Cabrera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Addictions Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Catalunya, Spain
| | - Anna Lligoña
- Addictions Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Catalunya, Spain
| | - Ramón Bataller
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Catalunya, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Catalunya, Spain
| | - Hugo López-Pelayo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Addictions Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Catalunya, Spain
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5
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Llach J, Salces I, Guerra A, Peñas B, Rodriguez-Alcalde D, Redondo PD, Cubiella J, Murcia Ó, Escalante M, Gratacós-Ginès J, Pocurull A, Daca-Alvarez M, Luzko I, Sánchez A, Herrera-Pariente C, Ocaña T, Carballal S, Elizalde I, Castellví-Bel S, Fernández-Esparrach G, Castells A, Balaguer F, Moreira L. Endoscopic surveillance for familial intestinal gastric cancer in low-incidence areas: An effective strategy. Int J Cancer 2024; 154:124-132. [PMID: 37676082 DOI: 10.1002/ijc.34714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
While clinical practice guidelines for hereditary diffuse gastric cancer are well established, there is no consensus on the approach for familial intestinal gastric cancer (FIGC). In low-incidence gastric cancer (GC) areas such as the United States or most European countries, there are no evidence-based recommendations on endoscopic assessment in FIGC families. We aim to describe the yield of GC surveillance in these families, and to identify epidemiological risk factors for the development of GC and its precursor lesions. This is a multicenter observational study involving nine tertiary Spanish hospitals, in which all individuals fulfilling FIGC criteria who underwent endoscopic surveillance were included between 1991 and 2020. Forty-one healthy individuals of 31 families were recruited. The median number of upper gastrointestinal endoscopies per individual was 3 (interquartile range, IQR, 1-4). The median interval time between tests was 2 years (IQR 1.5-2.5), and the median follow-up was 9 years (IQR 3-14.5). In 18 (43.9%) subjects, a precursor lesion of GC was found during follow-up, and in 2 (4.9%), an early GC was identified, in which curative treatment was offered. Helicobacter pylori (Hp) infection proved to be independently associated with an increased risk of developing precursor lesions or GC, adjusted by age, gender and follow-up, with an Odds Ratio of 6.443 (1.36-30.6, P value .019). We present the first outcomes that support endoscopic surveillance with biopsies and detection of Hp in FIGC families, although the periodicity has yet to be defined.
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Affiliation(s)
- Joan Llach
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | | | - Ana Guerra
- Complejo Hospitalario de Navarra, Navarra, Spain
| | - Beatriz Peñas
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Joaquin Cubiella
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Grupo de Investigación en Oncología Digestiva-Ourense, Hospital Universitario de Ourense, Ourense, Spain
| | - Óscar Murcia
- Hospital General Universitario de Alicante, Valencia, Spain
| | | | - Jordi Gratacós-Ginès
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Anna Pocurull
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Maria Daca-Alvarez
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Irina Luzko
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ariadna Sánchez
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Cristina Herrera-Pariente
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Teresa Ocaña
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Sabela Carballal
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Ignasi Elizalde
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Sergi Castellví-Bel
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Glòria Fernández-Esparrach
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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6
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Avitabile E, Díaz A, Montironi C, Pérez-Guasch M, Gratacós-Ginès J, Hernández-Évole H, Moreira RK, Sehrawat TS, Malhi H, Olivas P, Hernández-Gea V, Bataller R, Shah VH, Kamath PS, Ginès P, Pose E. Adding Inflammatory Markers and Refining National Institute on Alcohol Abuse and Alcoholism Criteria Improve Diagnostic Accuracy for Alcohol-associated Hepatitis. Clin Gastroenterol Hepatol 2023; 21:3080-3088.e9. [PMID: 37004974 DOI: 10.1016/j.cgh.2023.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/08/2023] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND & AIMS Although histology is considered the gold standard for diagnosis of alcohol-associated hepatitis (AH), it is not required for entry into therapeutic studies if patients meet National Institute on Alcohol Abuse and Alcoholism (NIAAA) consensus criteria for probable AH. Our aim was to assess the diagnostic accuracy of NIAAA criteria against liver biopsy and to explore new criteria to enhance diagnostic accuracy for AH. METHODS A total of 268 consecutive patients with alcohol-related liver disease with liver biopsy were prospectively included: 210 and 58 in the derivation and validation cohorts, respectively. NIAAA criteria and histological diagnosis of alcoholic steatohepatitis (ASH) were independently reviewed by clinical investigators and pathologists from Hospital Clínic and Mayo Clinic. Using biopsy-proven ASH as gold standard we determined diagnostic capability of NIAAA criteria and proposed the new improved criteria. RESULTS In the derivation cohort, diagnostic accuracy of NIAAA for AH was modest (72%) due to low sensitivity (63%). Subjects who did not meet NIAAA with ASH at liver biopsy had lower 1-year survival compared with subjects without ASH (70% vs 90%; P < .001). NIAAAm-CRP criteria, created by adding C-reactive protein and modifying the variables of the original NIAAA, had higher sensitivity (70%), accuracy (78%), and specificity (83%). Accuracy was also higher in a sensitivity analysis in severe AH (74% vs 65%). In the validation cohort, NIAAAm-CRP and NIAAA criteria had a sensitivity of 56% vs 52% and an accuracy of 76% vs 69%, respectively. CONCLUSION NIAAA criteria are suboptimal for the diagnosis of AH. The proposed NIAAAm-CRP criteria may improve accuracy for noninvasive diagnosis of AH in patients with alcohol-related liver disease.
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Affiliation(s)
- Emma Avitabile
- Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacións Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alba Díaz
- Institut d'Investigacións Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Pathological Department, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Carla Montironi
- Pathological Department, Hospital Clínic, Barcelona, Spain; Molecular Biology Core, Hospital Clínic, Barcelona, Spain
| | - Martina Pérez-Guasch
- Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacións Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Gratacós-Ginès
- Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacións Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Helena Hernández-Évole
- Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacións Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Roger K Moreira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Tejasav S Sehrawat
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Harmeet Malhi
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Pol Olivas
- Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacións Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Virginia Hernández-Gea
- Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacións Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Ramón Bataller
- Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacións Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Pere Ginès
- Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacións Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacións Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
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7
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Ariño S, Aguilar-Bravo B, Coll M, Lee WY, Peiseler M, Cantallops-Vilà P, Sererols-Viñas L, Martínez-García de la Torre RA, Martínez-Sánchez C, Pedragosa J, Zanatto L, Gratacós-Ginès J, Pose E, Blaya D, Almodóvar X, Fernández-Fernández M, Ruiz-Blázquez P, Lozano JJ, Affo S, Planas AM, Ginès P, Moles A, Kubes P, Sancho-Bru P. Ductular reaction-associated neutrophils promote biliary epithelium proliferation in chronic liver disease. J Hepatol 2023; 79:1025-1036. [PMID: 37348790 PMCID: PMC10585421 DOI: 10.1016/j.jhep.2023.05.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND & AIMS Ductular reaction expansion is associated with poor prognosis in patients with advanced liver disease. However, the mechanisms promoting biliary cell proliferation are largely unknown. Here, we identify neutrophils as drivers of biliary cell proliferation and the defective wound-healing response. METHODS The intrahepatic localization of neutrophils was evaluated in patients with chronic liver disease. Neutrophil dynamics were analyzed by intravital microscopy and neutrophil-labeling assays in DDC-treated mice. Neutrophil depletion or inhibition of recruitment was achieved using a Ly6g antibody or a CXCR1/2 inhibitor, respectively. Mice deficient in PAD4 (peptidyl arginine deiminase 4) and ELANE/NE (neutrophil elastase) were used to investigate the mechanisms underlying ductular reaction expansion. RESULTS In this study we describe a population of ductular reaction-associated neutrophils (DRANs), which are in direct contact with biliary epithelial cells in chronic liver diseases and whose numbers increased in parallel with disease progression. We show that DRANs are immobilized at the site of ductular reaction for a prolonged period of time. In addition, liver neutrophils display a unique phenotypic and transcriptomic profile, showing a decreased phagocytic capacity and increased oxidative burst. Depletion of neutrophils or inhibition of their recruitment reduces DRANs and the expansion of ductular reaction, while mitigating liver fibrosis and angiogenesis. Mechanistically, neutrophils deficient in PAD4 and ELANE abrogate neutrophil-induced biliary cell proliferation, thus indicating the role of neutrophil extracellular traps and elastase release in ductular reaction expansion. CONCLUSIONS Overall, our study reveals the accumulation of DRANs as a hallmark of advanced liver disease and a potential therapeutic target to mitigate ductular reaction and the maladaptive wound-healing response. IMPACT AND IMPLICATIONS Our results indicate that neutrophils are highly plastic and can have an extended lifespan. Moreover, we identify a new role of neutrophils as triggers of expansion of the biliary epithelium. Overall, the results of this study indicate that ductular reaction-associated neutrophils (or DRANs) are new players in the maladaptive tissue-healing response in chronic liver injury and may be a potential target for therapeutic interventions to reduce ductular reaction expansion and promote tissue repair in advanced liver disease.
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Affiliation(s)
- Silvia Ariño
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Beatriz Aguilar-Bravo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mar Coll
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Medicine Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
| | - Woo-Yong Lee
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Moritz Peiseler
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Paula Cantallops-Vilà
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Sererols-Viñas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Celia Martínez-Sánchez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Jordi Pedragosa
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Neuroscience and Experimental Therapeutics, Institute of Biomedical Research of Barcelona, Spanish National Research Council (CSIC), Barcelona, Spain
| | - Laura Zanatto
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Gratacós-Ginès
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Liver Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Elisa Pose
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Medicine Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Liver Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Delia Blaya
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xènia Almodóvar
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Fernández-Fernández
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Experimental Pathology, Institute of Biomedical Research of Barcelona, Spanish National Research Council (CSIC), Barcelona, Spain
| | - Paloma Ruiz-Blázquez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Experimental Pathology, Institute of Biomedical Research of Barcelona, Spanish National Research Council (CSIC), Barcelona, Spain
| | - Juan José Lozano
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Silvia Affo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna M Planas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Neuroscience and Experimental Therapeutics, Institute of Biomedical Research of Barcelona, Spanish National Research Council (CSIC), Barcelona, Spain
| | - Pere Ginès
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Medicine Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Liver Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Anna Moles
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Experimental Pathology, Institute of Biomedical Research of Barcelona, Spanish National Research Council (CSIC), Barcelona, Spain
| | - Paul Kubes
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Pau Sancho-Bru
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Medicine Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
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8
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Gratacós-Ginès J, Pose E. Defining recompensation of alcohol-related liver disease: A step beyond decompensated cirrhosis. Liver Int 2023; 43:2060-2061. [PMID: 37718720 DOI: 10.1111/liv.15690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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9
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Serra-Burriel M, Juanola A, Serra-Burriel F, Thiele M, Graupera I, Pose E, Pera G, Grgurevic I, Caballeria L, Piano S, van Kleef L, Reichert M, Roulot D, Pericàs JM, Schattenberg JM, Tsochatztis EA, Guha IN, Garcia-Retortillo M, Hernández R, Hoyo J, Fuentes M, Expósito C, Martínez A, Such P, Madir A, Detlefsen S, Tonon M, Martini A, Ma AT, Pich J, Bonfill E, Juan M, Soria A, Carol M, Gratacós-Ginès J, Morillas RM, Toran P, Navarrete JM, Torrejón A, Fournier C, Llorca A, Arslanow A, de Koning HJ, Cucchietti F, Manns M, Newsome PN, Hernáez R, Allen A, Angeli P, de Knegt RJ, Karlsen TH, Galle P, Wong VWS, Fabrellas N, Castera L, Krag A, Lammert F, Kamath PS, Ginès P. Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study. Lancet 2023; 402:988-996. [PMID: 37572680 DOI: 10.1016/s0140-6736(23)01174-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/04/2023] [Accepted: 06/05/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Liver cirrhosis is a major cause of death worldwide. Cirrhosis develops after a long asymptomatic period of fibrosis progression, with the diagnosis frequently occurring late, when major complications or cancer develop. Few reliable tools exist for timely identification of individuals at risk of cirrhosis to allow for early intervention. We aimed to develop a novel score to identify individuals at risk for future liver-related outcomes. METHODS We derived the LiverRisk score from an international prospective cohort of individuals from six countries without known liver disease from the general population, who underwent liver fibrosis assessment by transient elastography. The score included age, sex, and six standard laboratory variables. We created four groups: minimal risk, low risk, medium risk, and high risk according to selected cutoff values of the LiverRisk score (6, 10, and 15). The model's discriminatory accuracy and calibration were externally validated in two prospective cohorts from the general population. Moreover, we ascertained the prognostic value of the score in the prediction of liver-related outcomes in participants without known liver disease with median follow-up of 12 years (UK Biobank cohort). FINDINGS We included 14 726 participants: 6357 (43·2%) in the derivation cohort, 4370 (29·7%) in the first external validation cohort, and 3999 (27·2%) in the second external validation cohort. The score accurately predicted liver stiffness in the development and external validation cohorts, and was superior to conventional serum biomarkers of fibrosis, as measured by area under the receiver-operating characteristics curve (AUC; 0·83 [95% CI [0·78-0·89]) versus the fibrosis-4 index (FIB-4; 0·68 [0·61-0·75] at 10 kPa). The score was effective in identifying individuals at risk of liver-related mortality, liver-related hospitalisation, and liver cancer, thereby allowing stratification to different risk groups for liver-related outcomes. The hazard ratio for liver-related mortality in the high-risk group was 471 (95% CI 347-641) compared with the minimal risk group, and the overall AUC of the score in predicting 10-year liver-related mortality was 0·90 (0·88-0·91) versus 0.84 (0·82-0·86) for FIB-4. INTERPRETATION The LiverRisk score, based on simple parameters, predicted liver fibrosis and future development of liver-related outcomes in the general population. The score might allow for stratification of individuals according to liver risk and thus guide preventive care. FUNDING European Commission under the H20/20 programme; Fondo de Investigación Sanitaria de Salud; Instituto de Salud Carlos III; Spanish Ministry of Economy, Industry, and Competitiveness; the European Regional Development Fund; and the German Ministry of Education and Research (BMBF).
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Affiliation(s)
- Miquel Serra-Burriel
- Epidemiology, Statistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Adrià Juanola
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | | | - Maja Thiele
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Isabel Graupera
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Elisa Pose
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Llorenç Caballeria
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Laurens van Kleef
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Mathias Reichert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Dominique Roulot
- Unité d'Hépatologie, Hôpital Avicenne, AP-HP, Université Paris 13, Bobigny, France
| | - Juan M Pericàs
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Emmanuel A Tsochatztis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College of London, London, UK
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | | | - Rosario Hernández
- Institut Catala de la Salut, BCN, Ambit d'Atencio Primaria, Barcelona, Spain
| | - Jordi Hoyo
- Institut Catala de la Salut, BCN, Ambit d'Atencio Primaria, Barcelona, Spain
| | - Matilde Fuentes
- Institut Catala de la Salut, BCN, Ambit d'Atencio Primaria, Barcelona, Spain
| | - Carmen Expósito
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Alba Martínez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Patricia Such
- Health, Safety and Emergencies of SEAT, CUPRA and the Volkswagen Group Companies in Spain, Martorell, Spain
| | - Anita Madir
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Marta Tonon
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Martini
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Ann T Ma
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Judith Pich
- Clinical Trial Unit, Hospital Clínic, Barcelona, Spain
| | - Eva Bonfill
- Clinical Trial Unit, Hospital Clínic, Barcelona, Spain
| | - Marta Juan
- Clinical Trial Unit, Hospital Clínic, Barcelona, Spain
| | - Anna Soria
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Marta Carol
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Jordi Gratacós-Ginès
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Rosa M Morillas
- Liver Unit, Hospital Germans Trias i Pujol, IGTP, Badalona, Spain
| | - Pere Toran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - J M Navarrete
- Health, Safety and Emergencies of SEAT, CUPRA and the Volkswagen Group Companies in Spain, Martorell, Spain
| | - Antoni Torrejón
- Health, Safety and Emergencies of SEAT, CUPRA and the Volkswagen Group Companies in Spain, Martorell, Spain
| | | | | | - Anita Arslanow
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | | | - Michael Manns
- Health Sciences, Hannover Medical School MHH, Hannover, Germany
| | - Phillip N Newsome
- National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Rubén Hernáez
- Division of Gastroenterology and Hepatology, Department of Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alina Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Tom H Karlsen
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Peter Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, Université de Paris, Paris, France
| | - Aleksander Krag
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany; Institute for Occupational Medicine and Public Health, Saarland University, Homburg, Germany; Hannover Medical School, Hannover, Germany
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Pere Ginès
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain.
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10
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Gratacós-Ginès J, Pose E. Review of the role of statins in cirrhosis and portal hypertension. Clin Liver Dis (Hoboken) 2023; 22:50-57. [PMID: 37663550 PMCID: PMC10473354 DOI: 10.1097/cld.0000000000000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/23/2022] [Indexed: 09/05/2023] Open
Affiliation(s)
- Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
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11
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Uchima H, Da Fieno A, Bonilla A, Melo-Borges J, Sánchez-Montes C, Cuatrecasas M, Córdova H, Elizalde I, Rakislova N, Gratacós-Ginès J, Bayarri C, Casanova G, Ginès À, Llach J, Balaguer F, Fernández-Esparrach G. Serological levels of IGF-1 and IGFBP-3 in patients with Barrett's esophagus and esophageal adenocarcinoma: Longitudinal study. Gastroenterol Hepatol 2023; 46:360-368. [PMID: 36179948 DOI: 10.1016/j.gastrohep.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Barrett's esophagus (BE) is an entity with a known histological progression to malignancy. The insulin-like growth factor (IGF) system is involved in the carcinogenesis through obesity-related mechanisms that include IGF and it has been associated with several types of cancer. OBJECTIVES To evaluate the serological levels of IGF-1 and IGFBP-3 in patients with BE and esophageal adenocarcinoma. PATIENTS AND METHODS Prospective study of patients with BE and esophageal adenocarcinoma who underwent upper endoscopy between September 2012 and December 2015. A baseline determination of IGF-1 and IGFBP-3 was performed. We included a control group of patients without BE. RESULTS One hundred sixteen patients were included: 36 controls, 62 with BE (42 without dysplasia and 20 with dysplasia) and 18 with adenocarcinoma. IGF-1 and IGF-1/IGFBP-3 molar ratio showed a progression to high levels in BE and adenocarcinoma than in controls (IGF-1: 135.55±66.07ng/ml, 148.33±81.5ng/ml, 108.19±46.69ng/ml, respectively; P=.049) (molar ratio: 0.23±0.91, 0.29±0.11, 0.19±0.06, respectively; P=.001), without differences between the histological types of BE. Fifty-four out of the 65 patients with BE were followed up (median of 58.50 months, range 12-113) and 11 of them (20.4%) presented progression to low-grade dysplasia (n=8) or high-grade dysplasia/adenocarcinoma (n=3), without differences in the IGF system compared with patients without progression. CONCLUSIONS Patients with BE and esophageal adenocarcinoma have changes in the IGF system although the serological levels of IGF-1 and IGFBP-3 do not correlate with histological progression of BE.
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Affiliation(s)
- Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Angella Da Fieno
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Araceli Bonilla
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Jordana Melo-Borges
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Cristina Sánchez-Montes
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Míriam Cuatrecasas
- Servicio de Anatomía Patológica, Hospital Clinic de Barcelona, Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España
| | - Ignasi Elizalde
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Natalia Rakislova
- Servicio de Anatomía Patológica, Hospital Clinic de Barcelona, Barcelona, España
| | - Jordi Gratacós-Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Carolina Bayarri
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Gherzon Casanova
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Àngels Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Francesc Balaguer
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Glòria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España.
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12
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Napoleone L, Solé C, Juanola A, Ma AT, Carol M, Pérez-Guasch M, Rubio AB, Cervera M, Avitabile E, Bassegoda O, Gratacós-Ginès J, Morales-Ruiz M, Fabrellas N, Graupera I, Pose E, Crespo G, Solà E, Ginès P. Patterns of kidney dysfunction in acute-on-chronic liver failure: Relationship with kidney and patients' outcome. Hepatol Commun 2022; 6:2121-2131. [PMID: 35535681 PMCID: PMC9315130 DOI: 10.1002/hep4.1963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/17/2022] [Accepted: 03/20/2022] [Indexed: 11/22/2022] Open
Abstract
Impairment of kidney function is common in acute-on-chronic liver failure (ACLF). Patterns of kidney dysfunction and their impact on kidney and patient outcomes are ill-defined. Aims of the current study were to investigate patterns of kidney dysfunction and their impact on kidney and patient outcomes in patients with acute decompensation (AD) of cirrhosis, with or without ACLF. This prospective study includes 639 admissions for AD (232 with ACLF; 407 without) in 518 patients. Data were collected at admission and during hospitalization, and patients were followed up for 3 months. Urine samples were analyzed for kidney biomarkers. Most patients with ACLF (92%) had associated acute kidney injury (AKI), in most cases without previous chronic kidney disease (CKD), whereas some had AKI-on-CKD (70% and 22%, respectively). Prevalence of AKI in patients without ACLF was 35% (p < 0.001 vs. ACLF). Frequency of CKD alone was low and similar in both groups (4% and 3%, respectively); only a few patients with ACLF (4%) had no kidney dysfunction. AKI in ACLF was associated with poor kidney and patient outcomes compared with no ACLF (AKI resolution: 54% vs. 89%; 3-month survival: 51% vs. 86%, respectively; p < 0.001 for both). Independent predictive factors of 3-month survival were Model for End-Stage Liver Disease-Sodium score, ACLF status, and urine neutrophil gelatinase-associated lipocalin (NGAL). AKI is almost universal in patients with ACLF, sometimes associated with CKD, whereas CKD alone is uncommon. Prognosis of AKI depends on ACLF status. AKI without ACLF has good prognosis. Best predictors of 3-month survival are MELD-Na, ACLF status, and urine NGAL.
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Affiliation(s)
- Laura Napoleone
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Cristina Solé
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Adrià Juanola
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Ann T Ma
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Marta Carol
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain.,School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
| | - Martina Pérez-Guasch
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain.,School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
| | - Ana-Belén Rubio
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Marta Cervera
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain.,School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
| | - Emma Avitabile
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Octavi Bassegoda
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Manuel Morales-Ruiz
- Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain.,School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain.,Biochemistry and Molecular Genetics DepartmentHospital Clínic de BarcelonaBarcelonaSpain
| | - Núria Fabrellas
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain.,School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
| | - Isabel Graupera
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain.,School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Gonzalo Crespo
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Elsa Solà
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain
| | - Pere Ginès
- Liver Unit, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain.,Institut d'Investigacions Biomèdiques August Pi i SunyerBarcelonaSpain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasMadridSpain.,School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
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13
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Llovet LP, Gratacós-Ginès J, Téllez L, Gómez-Outomuro A, Navascués CA, Riveiro-Barciela M, Vinuesa R, Gómez-Camarero J, García-Retortillo M, Díaz-Fontenla F, Salcedo M, García-Eliz M, Horta D, Guerrero M, Rodríguez-Perálvarez M, Fernández-Rodriguez C, Albillos A, G-Abraldes J, Parés A, Londoño MC. Noninvasive Prediction of Outcomes in Autoimmune Hepatitis-Related Cirrhosis. Hepatol Commun 2022; 6:1392-1402. [PMID: 34989164 PMCID: PMC9134802 DOI: 10.1002/hep4.1889] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022] Open
Abstract
The value of noninvasive tools in the diagnosis of autoimmune hepatitis (AIH)-related cirrhosis and the prediction of clinical outcomes is largely unknown. We sought to evaluate (1) the utility of liver stiffness measurement (LSM) in the diagnosis of cirrhosis and (2) the performance of the Sixth Baveno Consensus on Portal Hypertension (Baveno VI), expanded Baveno VI, and the ANTICIPATE models in predicting the absence of varices needing treatment (VNT). A multicenter cohort of 132 patients with AIH-related cirrhosis was retrospectively analyzed. LSM and endoscopies performed at the time of cirrhosis diagnosis were recorded. Most of the patients were female (66%), with a median age of 54 years. Only 33%-49% of patients had a LSM above the cutoff points described for the diagnosis of AIH-related cirrhosis (12.5, 14, and 16 kPa). Patients with portal hypertension (PHT) had significantly higher LSM than those without PHT (15.7 vs. 11.7 kPa; P = 0.001), but 39%-52% of patients with PHT still had LSM below these limits. The time since AIH diagnosis negatively correlated with LSM, with longer time being significantly associated with a lower proportion of patients with LSM above these cutoffs. VNT was present in 12 endoscopies. The use of the Baveno VI, expanded Baveno VI criteria, and the ANTICIPATE model would have saved 46%-63% of endoscopies, but the latter underpredicted the risk of VNT. Conclusions: LSM cutoff points do not have a good discriminative capacity for the diagnosis of AIH-related cirrhosis, especially long-term after treatment initiation. Noninvasive tools are helpful to triage patients for endoscopy.
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Affiliation(s)
- Laura-Patricia Llovet
- Liver UnitHospital Clínic BarcelonaIDIBAPSCIBEREHDUniversity of BarcelonaBarcelonaSpain
| | - Jordi Gratacós-Ginès
- Liver UnitHospital Clínic BarcelonaIDIBAPSCIBEREHDUniversity of BarcelonaBarcelonaSpain
| | - Luis Téllez
- Department of Gastroenterology and HepatologyHospital Universitario Ramón y CajalInstituto Ramón y Cajal de Investigación SanitariaCIBEREHDUniversidad de AlcaláMadridSpain
| | - Ana Gómez-Outomuro
- 16474Liver UnitDivision of Gastroenterology & HepatologyHospital Universitario Central de AsturiasOviedoSpain
| | - Carmen A Navascués
- 16474Liver UnitDivision of Gastroenterology & HepatologyHospital Universitario Central de AsturiasOviedoSpain
| | - Mar Riveiro-Barciela
- Liver UnitInternal Medicine DepartmentVall d'Hebron HospitalCIBEREHDBarcelonaSpain
| | - Raquel Vinuesa
- 16821Department of Hepatology and GastroenterologyHospital Universitario de BurgosBurgosSpain
| | - Judith Gómez-Camarero
- 16821Department of Hepatology and GastroenterologyHospital Universitario de BurgosBurgosSpain
| | - Montserrat García-Retortillo
- Liver SectionGastroenterology DepartmentDepartament der MedicinaHospital del MarUniversistat Autonoma de BarcelonaIMIMBarcelonaSpain
| | - Fernando Díaz-Fontenla
- Liver Unit and Digestive DepartmentHospital General Universitario Gregorio MarañónCIBEREHDMadridSpain
| | - Magdalena Salcedo
- Liver Unit and Digestive DepartmentHospital General Universitario Gregorio MarañónCIBEREHDMadridSpain
| | - María García-Eliz
- Liver Transplantation Unit and HepatologyHospital Universitario La FeCIBEREHDValenciaSpain
| | - Diana Horta
- Digestive Diseases UnitHospital Universitari Mutua TerrassaTerrassaSpain
| | - Marta Guerrero
- Department of Hepatology and Liver TransplantationIMIBICCIBEREHD, Hospital Universitario Reina SofíaCórdobaSpain
| | - Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver TransplantationIMIBICCIBEREHD, Hospital Universitario Reina SofíaCórdobaSpain
| | | | - Agustín Albillos
- Department of Gastroenterology and HepatologyHospital Universitario Ramón y CajalInstituto Ramón y Cajal de Investigación SanitariaCIBEREHDUniversidad de AlcaláMadridSpain
| | - Juan G-Abraldes
- Liver UnitDivision of GastroenterologyCEGIIRUniversity of AlbertaEdmontonABCanada
| | - Albert Parés
- Liver UnitHospital Clínic BarcelonaIDIBAPSCIBEREHDUniversity of BarcelonaBarcelonaSpain
| | - Maria-Carlota Londoño
- Liver UnitHospital Clínic BarcelonaIDIBAPSCIBEREHDUniversity of BarcelonaBarcelonaSpain
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14
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Londoño MC, Gratacós-Ginès J, Sáez-Peñataro J. Another case of autoimmune hepatitis after SARS-CoV-2 vaccination - still casualty? J Hepatol 2021; 75:1248-1249. [PMID: 34129886 PMCID: PMC8197609 DOI: 10.1016/j.jhep.2021.06.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Joaquín Sáez-Peñataro
- Clinical Pharmacology Department, Medicines Area. Technical Committee for pharmacovigilance. Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
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15
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Solé C, Ma AT, Solà E, Carol M, Fabrellas N, Juanola A, Napoleone L, Gratacós-Ginès J, Bassegoda O, Cervera M, Pérez M, Rubio AB, Avitabile E, Morales-Ruiz M, Graupera I, Pose E, Kamath PS, Ginès P. Sequential changes in urinary biomarker levels in patients with cirrhosis and severe hepatorenal syndrome. Liver Int 2021; 41:2729-2732. [PMID: 34569697 DOI: 10.1111/liv.15069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/07/2022]
Abstract
Whether tubular injury develops in patients with acute kidney injury owing to hepatorenal syndrome (AKI-HRS) is controversial. We performed repeated measurements of biomarkers of tubular injury during a 14-day period in 60 patients with cirrhosis and AKI (34 with AKI-HRS meeting the classical definition of type 1 HRS and 26 with AKI owing to acute tubular necrosis, AKI-ATN). Nineteen of 34 patients had resolution of AKI-HRS, while the remainder had persistent AKI-HRS. The persistence of AKI-HRS was associated with remarkably high short-term mortality. There were no significant differences in urinary NGAL or IL-18 between patients with resolution vs those with persistent AKI-HRS throughout the 14-day period. By contrast, biomarker levels were significantly lower in AKI-HRS, even if persistent, compared to AKI-ATN. These findings are highly suggestive of lack of significant tubular injury in AKI-HRS and could be of value in the clinical decision between combined liver-kidney or liver transplantation alone in patients with cirrhosis and AKI candidates to transplantation.
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Affiliation(s)
- Cristina Solé
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ann T Ma
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elsa Solà
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - Marta Carol
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain.,Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain.,Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
| | - Adrià Juanola
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Napoleone
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Octavi Bassegoda
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Cervera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain.,Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
| | - Martina Pérez
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
| | - Ana Belén Rubio
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
| | - Emma Avitabile
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Manuel Morales-Ruiz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain.,Biochemistry and Molecular Genetics Department. Hospital Clínic, Department of Biomedicine-Biochemistry Unit, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Isabel Graupera
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pere Ginès
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain.,Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
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16
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Ginès A, Fusaroli P, Sendino O, Seicean A, Gimeno-Garcia AZ, Gratacós-Ginès J, Araujo IK, Rodríguez-Carunchio L, Alós S, Lisotti A, Cominardi A, Montenegro A, Fernández-Esparrach G. Performance of a new flexible 19 G EUS needle in pancreatic solid lesions located in the head and uncinate process: A prospective multicenter study. Endosc Int Open 2021; 9:E1269-E1275. [PMID: 34447875 PMCID: PMC8383085 DOI: 10.1055/a-1480-0428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/22/2021] [Indexed: 12/30/2022] Open
Abstract
Background and study aims The poor flexibility of large-bore EUS needles often leads to technical failure when sampling from the duodenum. The aim of this study was to evaluate the technical and diagnostic performances of a new Menghini tip 19G nitinol EUS needle for sampling pancreatic solid lesions in the head and uncinate process. Patients and methods This was a European prospective multicenter single-arm study. A maximum of four passes were allowed. In case of failure, different needles were permitted. Results We included 75 patients (51 % males) with lesions in the head (n = 68; 91 %) and uncinate process (n = 7; 9 %) (mean size: 33 ± 12 mm; number of passes: 1.8 ± 0.9). Technical success was seen in 71 of 75 (94.7 %). Diagnostic rates were 89.3 % (67/75) and 94.4 % (67/71) in the intention-to-treat (ITT) and per-protocol (PP) analysis, respectively. In the eight cases with failure, diagnosis was obtained with another needle (n = 4), from another lesion (n = 3) or with follow-up (n = 1). A histological sample was obtained in 64 patients (ITT 85.3 % and PP 90 %) and immunohistochemistry was successfully performed in 13 of 15 lesions in which it was required. No differences between rapid on-site evaluation (ROSE) and non-ROSE groups were observed regarding diagnostic success (87.5 % vs 91 %, P = 0.582) and diagnosis at the first pass (70 % vs 81 %, P = 0.289). Number of passes was lower in the ROSE group (1.4 + 0.9 vs 2.2 + 0.7, P < 0.001). One adverse event was recorded (1.3 %) consisting in a duodenal perforation after a single session EUS-ERCP. Conclusions The new nitinol Menghini tip 19G EUS needle showed high technical diagnostic success in safely sampling solid lesions in the head and uncinate process of the pancreas.
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Affiliation(s)
- Angels Ginès
- Hospital Clinic de Barcelona – Endoscopy Unit, Barcelona. University of Barcelona, Spain,CIBEREHD Barcelona, Spain,IDIBAPS – Medicina, Barcelona, Spain
| | - Pietro Fusaroli
- Hospital of Imola – GI Unit, University of Bologna, Imola, Italy
| | - Oriol Sendino
- Hospital Clinic de Barcelona – Endoscopy Unit, Barcelona. University of Barcelona, Spain,CIBEREHD Barcelona, Spain,IDIBAPS – Medicina, Barcelona, Spain
| | - Andrada Seicean
- University of Medicine and Pharmacy – Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Antonio Z. Gimeno-Garcia
- Hospital Universitario de de Sta Cruz de Tenerife – Service of Gastroenterology, Tenerife, Spain
| | - Jordi Gratacós-Ginès
- Hospital Clinic de Barcelona – Endoscopy Unit, Barcelona. University of Barcelona, Spain
| | - Isis K. Araujo
- Hospital Clinic de Barcelona – Endoscopy Unit, Barcelona. University of Barcelona, Spain,IDIBAPS – Medicina, Barcelona, Spain
| | - Leonardo Rodríguez-Carunchio
- Hospital Clinic de Barcelona – Pathology Department, University of Vic – Central University of Catalonia (UVic-UCC), Barcelona, Spain
| | - Silvia Alós
- Hospital Clinic de Barcelona – Pathology Department, University of Vic – Central University of Catalonia (UVic-UCC), Barcelona, Spain
| | - Andrea Lisotti
- Hospital of Imola – GI Unit, University of Bologna, Imola, Italy
| | - Anna Cominardi
- Hospital of Imola – GI Unit, University of Bologna, Imola, Italy
| | - Andrea Montenegro
- Hospital Clinic de Barcelona – Endoscopy Unit, Barcelona. University of Barcelona, Spain
| | - Glòria Fernández-Esparrach
- Hospital Clinic de Barcelona – Endoscopy Unit, Barcelona. University of Barcelona, Spain,CIBEREHD Barcelona, Spain,IDIBAPS – Medicina, Barcelona, Spain
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17
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Pose E, Torrents A, Reverter E, Perez-Campuzano V, Campos-Varela I, Avitabile E, Gratacós-Ginès J, Castellote J, Castells L, Colmenero J, Tort J, Ginès P, Crespo G. A notable proportion of liver transplant candidates with alcohol-related cirrhosis can be delisted because of clinical improvement. J Hepatol 2021; 75:275-283. [PMID: 33746085 DOI: 10.1016/j.jhep.2021.02.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/03/2021] [Accepted: 02/24/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS To what extent patients with alcohol-related decompensated cirrhosis can improve until recovery from decompensation remains unclear. We aimed to investigate the probability of recovery and delisting due to improvement in patients with alcohol-related decompensated cirrhosis on the waiting list (WL) for liver transplantation (LT). METHODS We conducted a registry-based, multicenter, retrospective study including all patients admitted to the LT WL in Catalonia (Spain) with the indication of alcohol-, HCV-, cholestasis- or non-alcoholic steatohepatitis-related decompensated cirrhosis between January 2007 and December 2018. Competing-risk analysis was used to investigate variables associated with delisting due to improvement in patients with alcohol-related decompensated cirrhosis. Criteria for delisting after improvement were not predefined. Outcomes of patients after delisting were also studied. RESULTS One-thousand and one patients were included, 420 (37%) with alcohol-related decompensated cirrhosis. Thirty-six (8.6%) patients with alcohol-related decompensated cirrhosis were delisted after improvement at a median time of 29 months after WL admission. Lower model for end-stage liver disease (MELD) score, higher platelets and either female sex or lower height were independently associated with delisting due to improvement, while time of abstinence did not reach statistical significance in multivariate analysis (p = 0.055). Five years after delisting, the cumulative probability of remaining free from liver-related death or LT was 76%, similar to patients with HCV-related decompensated cirrhosis delisted after improvement. CONCLUSIONS A significant proportion of LT candidates with alcohol-related cirrhosis can be delisted due to improvement, which is predicted by low MELD score and higher platelet count at WL admission. Women also have a higher probability of being delisted after improvement, partially due to reduced early access to LT for height discrepancies. Early identification of patients with potential for improvement may avoid unnecessary transplants. LAY SUMMARY Patients with alcohol-related cirrhosis can improve until being delisted in approximately 9% of cases. Low model for end-stage liver disease score and high platelet levels at admission predict delisting after improvement, and women have higher probabilities of being delisted due to improvement. Long-term outcomes after delisting are generally favorable.
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Affiliation(s)
- Elisa Pose
- Liver Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
| | - Abiguei Torrents
- Organització Catalana de Trasplantaments (OCATT), Servei Català de la Salut, Catalonia, Spain
| | - Enric Reverter
- Liver Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Valeria Perez-Campuzano
- Liver Transplant Unit, Liver Unit, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Spain
| | - Isabel Campos-Varela
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Spain
| | - Emma Avitabile
- Liver Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jose Castellote
- Liver Transplant Unit, Liver Unit, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Spain
| | - Lluis Castells
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Spain
| | - Jordi Colmenero
- Liver Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Jaume Tort
- Organització Catalana de Trasplantaments (OCATT), Servei Català de la Salut, Catalonia, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Gonzalo Crespo
- Liver Unit, Hospital Clínic, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
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18
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Pose E, Pera G, Torán P, Gratacós-Ginès J, Avitabile E, Expósito C, Díaz A, Graupera I, Rubio AB, Ginès P, Fabrellas N, Caballeria L. Interaction between metabolic syndrome and alcohol consumption, risk factors of liver fibrosis: A population-based study. Liver Int 2021; 41:1556-1564. [PMID: 33595176 DOI: 10.1111/liv.14830] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Alcohol and metabolic syndrome (MS) coexist frequently as cofactors of liver disease. Previous studies suggest a deleterious effect of MS in advanced alcohol-related liver disease (ArLD). However, it is unknow whether MS can increase the risk of liver fibrosis in early stages of ArLD. The aim of this study was to investigate the effect of MS on liver fibrosis in subjects with alcohol consumption from a population-based cohort. METHODS The number of subjects include 1760(58%) of 3014 who were randomly selected from the community consumed alcohol and were classified as current drinkers, divided in moderate (n = 1222) or high-risk drinkers (n = 275) (>21 units/week men, >14 units/week women for high-risk drinkers), or former drinkers (n = 263). Liver fibrosis was estimated by measuring liver stiffness(LS) with transient elastography (TE). RESULTS Prevalence of significant LS using cutoff values of TE of 8 and 9.1kPa was increased in high-risk compared with moderate or former drinkers and lifetime abstainers. In subjects with alcohol consumption, LS was associated with male gender, AST, ALT, years of consumption, and MS. In high-risk drinkers, MS and intensity of consumption were the only factors associated with significant LS (OR 3.7 and 4.6 for LS ≥ 8 kPa and 3.9 and 9.2 kPa for LS ≥ 9.1 kPa, respectively). Presence of significant liver fibrosis in the liver biopsy was higher among high-risk as compared with moderate or former drinkers. CONCLUSION MS increases the risk of liver fibrosis in subjects with alcohol consumption. Among high-risk drinkers, only MS and consumption of high amount of alcohol are associated with risk of liver fibrosis.
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Affiliation(s)
- Elisa Pose
- Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Guillem Pera
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Barcelona, Spain
| | - Pere Torán
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Barcelona, Spain
| | | | - Emma Avitabile
- Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain
| | - Carmen Expósito
- Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Barcelona, Spain
| | - Alba Díaz
- Pathological Department, Hospital Clínic, Barcelona, Spain
| | - Isabel Graupera
- Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Ana B Rubio
- Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Llorenç Caballeria
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Barcelona, Spain
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19
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Blaya D, Rubio-Tomás T, Rodrigo-Torres D, Lozano J, Coll M, Argemi J, Altamirano J, Affò S, Morales-Ibanez O, Gratacós-Ginès J, Pose E, Tanguy M, Issoufaly T, Rautou PE, Bataller R, Caballería J, Sancho-Bru P. Endothelial dysfunction markers predict short-term mortality in patients with severe alcoholic hepatitis. Hepatol Int 2021; 15:1006-1017. [PMID: 33954832 PMCID: PMC10113804 DOI: 10.1007/s12072-021-10165-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/22/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Alcoholic hepatitis (AH) is a severe condition characterized by a marked inflammatory response and high short-term mortality. Endothelial dysfunction (ED) is an early event in vascular and inflammatory disorders. The aim of this study is to evaluate ED in AH patients. METHODS Prognostic value of ED biomarkers was evaluated in patients with severe AH (n = 67), compensated alcoholic cirrhosis (n = 15), heavy drinkers without liver disease (n = 15) and controls (n = 9), and in a validation cohort of 50 patients with AH. Gene expression of ED markers was analyzed in liver tissue. RESULTS Plasma levels of ED markers such as vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), E-selectin and von Willebrand factor (vWF) increased along alcohol-related liver disease (ALD) progression. Intergroup analysis showed a significant increase of these markers in AH patients. In addition, VCAM-1 showed a positive correlation with Maddrey, MELD and ABIC scores and inflammation parameters (i.e. C-reactive protein and LPS levels). Importantly, levels of VCAM-1 were higher in patients with increased mortality and were independently associated with short-term survival (90-day) when adjusted by ABIC score. These results were confirmed in an independent cohort of AH patients. In addition, severe AH patients showed altered hepatic expression of ED markers. CONCLUSIONS In this study we show that advanced ALD and particularly severe AH is associated with an increase of ED biomarkers, which correlate with patient outcomes. These results suggest that ED may be a pathogenic event in AH and highlight endothelial factors as potential biomarkers in AH.
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Affiliation(s)
- Delia Blaya
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain
| | - Teresa Rubio-Tomás
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain.,School of Medicine, University of Crete, 70013, Heraklion, Crete, Greece
| | - Daniel Rodrigo-Torres
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain
| | - JuanJosé Lozano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Mar Coll
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Josepmaria Argemi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA.,Liver Unit, Clínica Universidad de Navarra, Hepatology Program, Centro de Investigación Medica Aplicada, IdisNA, Universidad de Navarra, Pamplona, Spain
| | - José Altamirano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain
| | - Silvia Affò
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain
| | - Oriol Morales-Ibanez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain
| | - Jordi Gratacós-Ginès
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Elisa Pose
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Liver Unit, Hospital Clínic, Barcelona, Spain
| | - Marion Tanguy
- Service d'Hépatologie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France.,Centre de Référence des Maladies Vasculaires du Foie, French Network for Rare Liver Diseases, European Reference Network Rare-Liver, Centre de Recherche sur l'inflammation, Inserm, Université de Paris, Paris, France
| | - Tazime Issoufaly
- Service d'Hépatologie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France.,Centre de Référence des Maladies Vasculaires du Foie, French Network for Rare Liver Diseases, European Reference Network Rare-Liver, Centre de Recherche sur l'inflammation, Inserm, Université de Paris, Paris, France
| | - Pierre-Emmanuel Rautou
- Service d'Hépatologie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France.,Centre de Référence des Maladies Vasculaires du Foie, French Network for Rare Liver Diseases, European Reference Network Rare-Liver, Centre de Recherche sur l'inflammation, Inserm, Université de Paris, Paris, France
| | - Ramon Bataller
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joan Caballería
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain.,Liver Unit, Hospital Clínic, Barcelona, Spain
| | - Pau Sancho-Bru
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain. .,Universitat de Barcelona, Barcelona, Spain.
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20
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Bassegoda O, Huelin P, Ariza X, Solé C, Juanola A, Gratacós-Ginès J, Carol M, Graupera I, Pose E, Napoleone L, Albertos S, de Prada G, Cervera M, Fernández J, Fabrellas N, Poch E, Solà E, Ginès P. Development of chronic kidney disease after acute kidney injury in patients with cirrhosis is common and impairs clinical outcomes. J Hepatol 2020; 72:1132-1139. [PMID: 31953138 DOI: 10.1016/j.jhep.2019.12.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Acute kidney injury (AKI) is common in cirrhosis and is associated with poor prognosis. In patients who survive after AKI, it is not known whether the acute injury leads to chronic impairment of kidney function (chronic kidney disease [CKD]). The aim of the study was to determine the frequency of CKD at 3 months after an AKI episode and its effects on patient outcomes. METHODS Patients admitted for complications of cirrhosis during a 6.5-year period were evaluated using the same protocol, with assessment of kidney function at regular intervals during and after hospitalization. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2 at 3 months after AKI. RESULTS A total of 409 patients (168 with AKI and 241 without AKI) were included. After 3 months, 97 patients with AKI and 188 patients without AKI had survived. Of the 97 patients with AKI, 24 had developed CKD at 3 months compared to only 2 of the 188 patients without AKI (25% vs. 1%, odds ratio 31; p <0.0001). Risk factors independently associated with CKD were nosocomial AKI and severity of AKI (stage ≥1B). At diagnosis of CKD, all patients had stage 3A CKD and one-quarter of them progressed to stages 3B and 4 after 1 year. The transition from AKI to CKD was associated with an increased rate of 3-month hospital readmission, increased frequency of AKI, bacterial infections, ascites, and refractory ascites and a trend towards a higher need for liver transplantation. Transplant-free survival was not impaired. CONCLUSIONS CKD frequently develops in patients with cirrhosis who survive AKI and has a negative impact on relevant clinical outcomes. The transition from AKI to CKD is common and should be considered a high-risk condition in patients with cirrhosis. LAY SUMMARY Episodes of acute impairment of kidney function are common in patients with cirrhosis. This study shows that the development of chronic impairment of kidney function is frequent in patients surviving these acute episodes and that it is associated with a higher risk of developing other complications of cirrhosis and to a higher rate of 3-month hospital readmissions.
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Affiliation(s)
- Octavi Bassegoda
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Patricia Huelin
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Xavier Ariza
- Digestive Diseases Unit, Hospital Moisès Broggi, Sant Joan Despí, Catalonia, Spain
| | - Cristina Solé
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Adrià Juanola
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Marta Carol
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Isabel Graupera
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Laura Napoleone
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Sonia Albertos
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Gloria de Prada
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Marta Cervera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Javier Fernández
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Esteban Poch
- Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Nephrology Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Elsa Solà
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain.
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Gratacós-Ginès J, Jung G, Díaz A, Forns X. An uncommon presentation of alcoholic liver disease. Liver Int 2018; 38:1514. [PMID: 29714031 DOI: 10.1111/liv.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
| | - Gerhard Jung
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Alba Díaz
- Pathology Department, Hospital Clínic, Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
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