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Palmese F, Bonavita ME, Pompili E, Reggidori N, Migliano MT, Di Stefano C, Grieco M, Colazzo S, Baldassarre M, Caraceni P, Foschi FG, Giostra F, Farina G, Del Toro R, Bedogni G, Domenicali M. Development and internal validation of a multivariable model for the prediction of the probability of 1-year readmission to the emergency department for acute alcohol intoxication. Intern Emerg Med 2024; 19:823-829. [PMID: 38095747 DOI: 10.1007/s11739-023-03490-7] [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: 06/19/2023] [Accepted: 11/17/2023] [Indexed: 04/24/2024]
Abstract
To develop and internally validate a multivariable logistic regression model (LRM) for the prediction of the probability of 1-year readmission to the emergency department (ED) in patients with acute alcohol intoxication (AAI). We developed and internally validated the LRM on a previously analyzed retrospective cohort of 3304 patients with AAI admitted to the ED of the Sant'Orsola-Malpighi Hospital (Bologna, Italy). The benchmark LRM employed readmission to the same ED for AAI within 1 year as the binary outcome, age as a continuous predictor, and sex, alcohol use disorder, substance use disorder, at least one previous admission for trauma, mental or behavioral disease, and homelessness as the binary predictors. Optimism correction was performed using the bootstrap on 1000 samples without replacement. The benchmark LRM was gradually simplified to get the most parsimonious LRM with similar optimism-corrected overall fit, discrimination and calibration. The 1-year readmission rate was 15.7% (95% CI 14.4-16.9%). A reduced LRM based on sex, age, at least one previous admission for trauma, mental or behavioral disease, and homelessness, performed nearly as well as the benchmark LRM. The reduced LRM had the following optimism-corrected metrics: scaled Brier score 17.0%, C-statistic 0.799 (95% CI 0.778 to 0.821), calibration in the large 0.000 (95% CI - 0.099 to 0.099), calibration slope 0.985 (95% CI 0.893 to 1.088), and an acceptably accurate calibration plot. An LRM based on sex, age, at least one previous admission for trauma, mental or behavioral disease, and homelessness can be used to estimate the probability of 1-year readmission to ED for AAI. To begin proving its clinical utility, this LRM should be validated in external cohorts.
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Affiliation(s)
- Francesco Palmese
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy.
| | - Maria Elena Bonavita
- Department of Internal Medicine, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Enrico Pompili
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Nicola Reggidori
- Department of Internal Medicine, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Maria Teresa Migliano
- Department of Internal Medicine, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Cecilia Di Stefano
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Marta Grieco
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Stefano Colazzo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Center for Applied Biomedical Research-CRBA, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | | | - Fabrizio Giostra
- Emergency Department-Pronto Soccorso, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Gabriele Farina
- Emergency Department-Pronto Soccorso, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Rossella Del Toro
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
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Agabio R, Domenicali M, Zavan V, Addolorato G. Education and Training in Alcohology in Italy. Eur Addict Res 2024:1-4. [PMID: 38498982 DOI: 10.1159/000537799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/08/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Roberta Agabio
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria delle Croci" Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Valeria Zavan
- Addiction Unit, Local Health Agency To4, Torino, Italy
| | - Giovanni Addolorato
- Department of Medical and Surgical Sciences, Catholic University of Rome, Rome, Italy
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Ricci C, Alberici L, Serbassi F, Caraceni P, Domenicali M, Ingaldi C, Grego DG, Mazzucchelli C, Casadei R. Physical Prehabilitation in Patients who Underwent Major Abdominal Surgery: A Comprehensive Systematic Review and Component Network Meta-Analysis Using GRADE and CINeMA Approach. Ann Surg Oncol 2024; 31:1725-1738. [PMID: 38038791 PMCID: PMC10838229 DOI: 10.1245/s10434-023-14632-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Physical prehabilitation is recommended before major abdominal surgery to ameliorate short-term outcomes. METHODS A frequentist, random-effects network meta-analysis (NMA) was performed to clarify which type of preoperative physical activity among aerobic exercise (AE), inspiratory muscle training (IMT), and resistance training produces benefits in patients who underwent major abdominal surgery. The surface under the P-score, odds ratio (OR), or mean difference (MD) with a 95% confidence interval (CI) were reported. The results were adjusted by using the component network approach. The critical endpoints were overall and major morbidity rate and mortality rate. The important but not critical endpoints were the length of stay (LOS) and pneumonia. RESULTS The meta-analysis included 25 studies. The best approaches for overall morbidity rate were AE and AE + IMT (OR = 0.61, p-score = 0.76, and OR = 0.66, p-score = 0.68). The best approaches for pneumonia were AE + IMT and AE (OR = 0.21, p-score = 0.91, and OR = 0.52, p-score = 0.68). The component analysis confirmed that the best incremental OR (0.30; 95% CI 0.12-0.74) could be obtained using AE + IMT. The best approach for LOS was AE alone (MD - 1.63 days; 95% CI - 3.43 to 0.18). The best combination of components was AE + IMT (MD - 1.70; 95% CI - 2.06 to - 1.27). CONCLUSIONS Physical prehabilitation reduces the overall morbidity rate, pneumonia, and length of stay. The most relevant effect of prehabilitation requires the simultaneous use of AE and IMT.
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Affiliation(s)
- Claudio Ricci
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italy.
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Laura Alberici
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italy
| | - Francesco Serbassi
- Alma Mater Studiorum, Biology of the Health Faculty, University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Marco Domenicali
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, AUSL Romagna, "S. Maria Delle Croci" Hospital, Ravenna, Italy
| | - Carlo Ingaldi
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italy
| | - Davide Giovanni Grego
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Alma Mater Studiorum, Biology of the Health Faculty, University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, AUSL Romagna, "S. Maria Delle Croci" Hospital, Ravenna, Italy
| | - Carlo Mazzucchelli
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italy
| | - Riccardo Casadei
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Ricci C, Alberici L, Serbassi F, Caraceni P, Domenicali M, Ingaldi C, Grego DG, Mazzucchelli C, Casadei R. ASO Visual Abstract: Physical Prehabilitation in Patients Who Underwent Major Abdominal Surgery-A Comprehensive Systematic Review and Component Network Meta-analysis Using GRADE and CINeMA Approach. Ann Surg Oncol 2024; 31:1798-1799. [PMID: 38095824 DOI: 10.1245/s10434-023-14744-1] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Claudio Ricci
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Laura Alberici
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Serbassi
- Grad Student in Biology of the Health Faculty, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Marco Domenicali
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
| | - Carlo Ingaldi
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Davide Giovanni Grego
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Carlo Mazzucchelli
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Riccardo Casadei
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Pompili E, Baldassarre M, Bedogni G, Zaccherini G, Iannone G, De Venuto C, Pratelli D, Palmese F, Domenicali M, Caraceni P. Predictors of clinical trajectories of patients with acutely decompensated cirrhosis. An external validation of the PREDICT study. Liver Int 2024; 44:72-82. [PMID: 37718730 DOI: 10.1111/liv.15734] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/31/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND AND AIMS The PREDICT study recently showed that acutely decompensated (AD) patients with cirrhosis can present three different clinical phenotypes in the 90 days after admission: (1) pre-ACLF, developing acute-on-chronic liver failure (ACLF); (2) unstable decompensated cirrhosis (UDC), being re-admitted for AD without ACLF and (3) stable decompensated cirrhosis (SDC), not presenting readmission or ACLF. This study aimed to externally validate the existence of these three distinct trajectories and to identify predictors for the occurrence of each trajectory. METHODS Baseline data, 3-month ACLF and readmission incidence and 1-year survival were analysed in a prospective cohort of patients admitted for AD. A multinomial multivariable model was used to evaluate the association between baseline features and clinical trajectories. RESULTS Of the 311 patients enrolled, 55% met the criteria for SDC, 18% for UDC and 27% for pre-ACLF, presenting a significantly different 1-year mortality: pre-ACLF 65%, UDC 46%, SDC 21% (p < .001). The presence of hepatic encephalopathy (HE) was associated with UDC (p = .043), while the absence of ascites to SDC (p = .017). Among laboratory parameters, an increase in MELD-Na (p = .001) and C-reactive protein (p = .009) and a decrease in haemoglobin (p = .004) and albumin (p = .008) levels were associated with pre-ACLF. CONCLUSION The present study confirms that AD patients have three different clinical trajectories with different mortality rates. Besides the severity of cirrhosis, the association with C-reactive protein supports the predominant role of systemic inflammation in ACLF pathophysiology. Finally, HE is associated with the UDC phenotype highlighting the need for better management of this complication after discharge.
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Affiliation(s)
- Enrico Pompili
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maurizio Baldassarre
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Centre for Applied Biomedical Research (CRBA), Alma Mater Studiorum of Bologna, Bologna, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria delle Croci" Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Iannone
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Clara De Venuto
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Dario Pratelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Palmese
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria delle Croci" Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria delle Croci" Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Weiss E, de la Peña-Ramirez C, Aguilar F, Lozano JJ, Sánchez-Garrido C, Sierra P, Martin PIB, Diaz JM, Fenaille F, Castelli FA, Gustot T, Laleman W, Albillos A, Alessandria C, Domenicali M, Caraceni P, Piano S, Saliba F, Zeuzem S, Gerbes AL, Wendon JA, Jansen C, Gu W, Papp M, Mookerjee R, Gambino CG, Jiménez C, Giovo I, Zaccherini G, Merli M, Putignano A, Uschner FE, Berg T, Bruns T, Trautwein C, Zipprich A, Bañares R, Presa J, Genesca J, Vargas V, Fernández J, Bernardi M, Angeli P, Jalan R, Claria J, Junot C, Moreau R, Trebicka J, Arroyo V. Sympathetic nervous activation, mitochondrial dysfunction and outcome in acutely decompensated cirrhosis: the metabolomic prognostic models (CLIF-C MET). Gut 2023; 72:1581-1591. [PMID: 36788015 PMCID: PMC10359524 DOI: 10.1136/gutjnl-2022-328708] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND AIMS Current prognostic scores of patients with acutely decompensated cirrhosis (AD), particularly those with acute-on-chronic liver failure (ACLF), underestimate the risk of mortality. This is probably because systemic inflammation (SI), the major driver of AD/ACLF, is not reflected in the scores. SI induces metabolic changes, which impair delivery of the necessary energy for the immune reaction. This investigation aimed to identify metabolites associated with short-term (28-day) death and to design metabolomic prognostic models. METHODS Two prospective multicentre large cohorts from Europe for investigating ACLF and development of ACLF, CANONIC (discovery, n=831) and PREDICT (validation, n=851), were explored by untargeted serum metabolomics to identify and validate metabolites which could allow improved prognostic modelling. RESULTS Three prognostic metabolites strongly associated with death were selected to build the models. 4-Hydroxy-3-methoxyphenylglycol sulfate is a norepinephrine derivative, which may be derived from the brainstem response to SI. Additionally, galacturonic acid and hexanoylcarnitine are associated with mitochondrial dysfunction. Model 1 included only these three prognostic metabolites and age. Model 2 was built around 4-hydroxy-3-methoxyphenylglycol sulfate, hexanoylcarnitine, bilirubin, international normalised ratio (INR) and age. In the discovery cohort, both models were more accurate in predicting death within 7, 14 and 28 days after admission compared with MELDNa score (C-index: 0.9267, 0.9002 and 0.8424, and 0.9369, 0.9206 and 0.8529, with model 1 and model 2, respectively). Similar results were found in the validation cohort (C-index: 0.940, 0.834 and 0.791, and 0.947, 0.857 and 0.810, with model 1 and model 2, respectively). Also, in ACLF, model 1 and model 2 outperformed MELDNa 7, 14 and 28 days after admission for prediction of mortality. CONCLUSIONS Models including metabolites (CLIF-C MET) reflecting SI, mitochondrial dysfunction and sympathetic system activation are better predictors of short-term mortality than scores based only on organ dysfunction (eg, MELDNa), especially in patients with ACLF.
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Affiliation(s)
- Emmanuel Weiss
- Centre de Recherchesurl' Inflammation (CRI), Universite Paris Diderot, Paris, Île-de-France, France
- INSERM UMR_S1149, University Paris Cite, Paris, France
- Department of Anesthesiology and Critical Care, Hopital Beaujon, Clichy, France
| | | | | | | | | | | | | | | | | | | | - Thierry Gustot
- Department of Hepato Gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Bruxelles, Bruxelles, Belgium
| | - Wim Laleman
- Division of Liver and Biliopanreatic Disorders, KU Leuven, University of Leuven, Leuven, Belgium
| | - Agustín Albillos
- Department of Gastroenterology, Hospital Ramon y Cajal, Madrid, Spain
- Universidad de Alcala de Henares, Madrid, Spain
| | | | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Center for Applied Biomedical Research (CRBA), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paolo Caraceni
- IRCCS Azienda-Ospedaliera Universitaria di Bologna, Department of Medical and Surgical Science - University of Bologna, Bologna, Italy
| | - Salvatore Piano
- Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Faouzi Saliba
- Centre Hepato-Biliare, Hopital Paul Brousse, Villejuif, France
| | - Stefan Zeuzem
- Department of Gastroenterology and Hepatology, J. W. Goethe-University Hospital, Frankfurt am Main, Hessen, Germany
| | | | - Julia A Wendon
- Institute of Liver Studies, King's College Hospital, London, UK
| | | | - Wenyi Gu
- Department of Internal Medicine B, University of Münster, Munster, Nordrhein-Westfalen, Germany
| | - Maria Papp
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Raj Mookerjee
- Institute of Liver and Digestive Health, University College London Medical School, London, UK
| | - Carmine Gabriele Gambino
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padua, Padova, Veneto, Italy
| | | | - Ilaria Giovo
- Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, University of Bologna Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Manuela Merli
- II Department of Gastroenterology, "La Sapienza" University, Rome, Italy
| | - Antonella Putignano
- Division of Gastroenterology and Gastrointestinal Endoscopy. Vita-Salute San Raffaele University - Scientific Institute San Raffaele, Milan, Italy
| | | | - Thomas Berg
- Medizinische Klinik, Gastroenterologie und Hepatologie, Berlin, Germany
| | - Tony Bruns
- Department of Medicine III, University Hospital Aachen, Aachen, Germany
| | - Christian Trautwein
- Deptartment of Internal Medicine III, University Hospital Aachen Department of Gastroenterology Metabolic Disorders and Intensive Medicine, Aachen, Germany
| | - Alexander Zipprich
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Rafael Bañares
- Gastroenterology, IRYCIS, Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain
| | | | - Joan Genesca
- Internal Medicine-Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Barcelona, Spain
- Spain
| | - Victor Vargas
- Liver Unit, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | | | | | - Paolo Angeli
- Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
| | | | - Joan Claria
- Department of Biochemistry/Molecular Genetics, Hospital Clínic/University of Barcelona, Barcelona, Spain
| | | | - Richard Moreau
- Centre de Recherchesurl' Inflammation (CRI), Universite Paris Diderot, Paris, Île-de-France, France
- EF Clif, Barcelona, Catalunya, Spain
- Hepatology, Hôpital Beaujon, Clichy, France
| | - Jonel Trebicka
- EF Clif, Barcelona, Catalunya, Spain
- Translational Hepatology Department of Internal Medicine I, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
- Department of Internal Medicine B, University of Münster, Münster, Germany
| | - Vicente Arroyo
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
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Pompili E, Baldassarre M, Zaccherini G, Tufoni M, Iannone G, Pratelli D, Palmese F, Vizioli L, Faggiano C, Bedogni G, Domenicali M, Caraceni P. Low haemoglobin level predicts early hospital readmission in patients with cirrhosis and acute decompensation. JHEP Rep 2023; 5:100698. [PMID: 37025944 PMCID: PMC10070139 DOI: 10.1016/j.jhepr.2023.100698] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 04/08/2023] Open
Abstract
Background & Aims Patients with decompensated cirrhosis present frequent hospitalisations with a relevant clinical and socio-economic impact. This study aims to characterise unscheduled readmissions up to 1-year follow-up and identify predictors of 30-day readmission after an index hospitalisation for acute decompensation (AD). Methods We performed a secondary analysis of a prospectively collected cohort of patients admitted for AD. Laboratory and clinical data at admission and at discharge were collected. Timing and causes of unscheduled readmissions and mortality were recorded up to 1 year. Results A total of 329 patients with AD were included in the analysis. Acute-on-chronic liver failure was diagnosed in 19% of patients at admission or developed in an additional 9% of patients during the index hospitalisation. During the 1-year follow-up, 182 patients (55%) were rehospitalised and 98 (30%) more than once. The most frequent causes of readmission were hepatic encephalopathy (36%), ascites (22%), and infection (21%). Cumulative incidence of readmission was 20% at 30 days, 39% at 90 days, and 63% at 1 year. Fifty-four patients were readmitted for emergent liver-related causes within 30 days. Early readmission was associated with a higher 1-year mortality (47 vs. 32%, p = 0.037). Multivariable Cox regression analysis showed that haemoglobin (Hb) ≤8.7 g/dl (hazard ratio 2.63 [95% CI 1.38-5.02], p = 0.003) and model for end-stage liver disease-sodium score (MELD-Na) >16 at discharge (hazard ratio 2.23 [95% CI 1.27-3.93], p = 0.005), were independent predictors of early readmission. In patients with MELD-Na >16 at discharge, the presence of Hb ≤8.7 g/dl doubles the risk of early rehospitalisation (44% vs. 22%, p = 0.02). Conclusion Besides MELD-Na, a low Hb level (Hb ≤8.7 g/dl) at discharge emerged as a new risk factor for early readmission, contributing to identification of patients who require closer surveillance after discharge. Impact and Implications Patients with decompensated cirrhosis face frequent hospitalisations. In the present study, type and causes of readmissions were analysed during 1-year follow-up in patients discharged after the index hospitalisation for an acute decompensation of the disease. Early (30-day) liver-related readmission was associated with higher 1-year mortality. The model for end-stage liver disease-sodium score and low haemoglobin at discharge were identified as independent risk factors for early readmissions. Haemoglobin emerged as a new easy-to-use parameter associated with early readmission warranting further investigation.
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Affiliation(s)
- Enrico Pompili
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Centre for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Manuel Tufoni
- Unit of Semeiotics, Liver and Alcohol-related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Iannone
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Dario Pratelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Francesco Palmese
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit addressed to Frailty and Aging, “Santa Maria delle Croci” Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Luca Vizioli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Chiara Faggiano
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit addressed to Frailty and Aging, “Santa Maria delle Croci” Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit addressed to Frailty and Aging, “Santa Maria delle Croci” Ravenna Hospital, AUSL Romagna, Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Department of Primary Health Care, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Corresponding authors. Addresses: Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Unit of Semeiotics, Liver and Alcohol-related diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. Tel.: +39-051-214-2919; fax: +39-051-214-2930.
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Del Toro R, Palmese F, Feletti F, Zani G, Minguzzi MT, Maddaloni E, Napoli N, Bedogni G, Domenicali M. Relationship between Muscle Mass, Bone Density and Vascular Calcifications in Elderly People with SARS-CoV-2 Pneumonia. J Clin Med 2023; 12:jcm12062372. [PMID: 36983372 PMCID: PMC10059976 DOI: 10.3390/jcm12062372] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Little is known about the changes in organs and tissues that may make elder patients more vulnerable to acute stressors such as SARS-CoV-2 infection. METHODS In 80 consecutive elderly patients with SARS-CoV-2 infection, we evaluated the association between the descending thoracic aorta calcium score, L1 bone density and T12 skeletal muscle density measured on the same scan by high-resolution computed tomography. RESULTS At median regression, the ln-transformed DTA calcium score was inversely associated with L1 bone density (-0.02, 95%CI -0.04 to -0.01 ln-Agatston units for an increase of 1 HU) and with T12 muscle density (-0.03, -0.06 to -0.001 ln-Agatston units for an increase of 1 HU). At penalized logistic regression, an increase of 1 ln-Agatston unit of DTA calcium score was associated with an OR of death of 1.480 (1.022 to 2.145), one of 1 HU of bone density with an OR of 0.981 (0.966 to 0.996) and one of 1 HU of muscle density with an OR of 0.973 (0.948 to 0.999). These relationships disappeared after correction for age and age was the stronger predictor of body composition and death. CONCLUSIONS Age has a big effect on the relationship between vascular calcifications, L1 bone density and T12 muscle density and on their relationship with the odds of dying.
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Affiliation(s)
- Rossella Del Toro
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Francesco Palmese
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Francesco Feletti
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Diagnostic Imaging, Radiology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Maria Teresa Minguzzi
- Department of Diagnostic Imaging, Radiology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicola Napoli
- Department of Medicine and Surgery, Research Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Giorgio Bedogni
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Marco Domenicali
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
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Pavarin RM, Consonni D, Lucchi F, Pandolfi P, Marani S, Palmese F, Domenicali M. COVID-19-Related Death in Patients with Alcohol or Substance Use Disorders. Eur Addict Res 2023; 29:67-70. [PMID: 36450270 PMCID: PMC9892992 DOI: 10.1159/000527542] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/02/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND People with substance or alcohol use disorders (SUDs/AUDs) are likely to be more vulnerable to COVID-19 infection than the general population, but the evidence of COVID-19-related mortality in these patients is unclear. OBJECTIVES The aim of the study was to verify whether patients with AUD and SUD have a higher mortality rate for COVID-19-related mortality compared to the general population. METHOD We performed a follow-up study to assess mortality in 2020 in a cohort of patients diagnosed for the first time with AUDs or SUDs at the Public Health Services in the metropolitan area of Bologna (Northern Italy) from 2009 to 2019. RESULTS SUDs/AUDs patients present an excess mortality with respect to the general population for all causes of death and for COVID-19-related mortality. CONCLUSIONS Our data support the need for prevention strategies in SUDs/AUDs patients such as vaccinations.
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Affiliation(s)
- Raimondo Maria Pavarin
- Epidemiological Monitoring Center on Addiction, Azienda USL Bologna, Department of Mental Health and Addictions, Azienda USL Bologna, Bologna, Italy,Italian Society on Addiction (SITD), Rome, Italy,*Raimondo Maria Pavarin,
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Lucchi
- Department of Mental Health and Addictions, Azienda USL di Bologna, Bologna, Italy
| | - Paolo Pandolfi
- Public Health Department, Azienda USL Bologna, Bologna, Italy
| | - Silvia Marani
- Epidemiological Monitoring Center on Addiction, Azienda USL Bologna, Department of Mental Health and Addictions, Azienda USL Bologna, Bologna, Italy
| | - Francesco Palmese
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Palmese F, Bonavita ME, Pompili E, Migliano MT, Reggidori N, Di Stefano C, Grieco M, Colazzo S, Tufoni M, Baldassarre M, Caraceni P, Foschi FG, Giostra F, Farina G, Del Toro R, Bedogni G, Domenicali M. Mortality and its association with chronic alcohol-related diseases in patients admitted to the emergency department for acute alcoholic intoxication: retrospective cohort study. Intern Emerg Med 2023; 18:257-263. [PMID: 36199001 PMCID: PMC9883355 DOI: 10.1007/s11739-022-03114-6] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/25/2022] [Indexed: 02/01/2023]
Abstract
We assessed long-term mortality and its association with chronic alcohol-related diseases in patients admitted to the emergency department (ED) because of acute alcoholic intoxication (AAI). A retrospective cohort study was performed at the ED of Sant'Orsola-Malpighi Hospital, Bologna, Italy. 3304 patients, corresponding to 6415 admissions for AAI, who accessed the ED from January 1, 2005, to December 31, 2017, were studied. The ED electronic registry system was used to assess living status on 08 May 2020 and to obtain the prespecified potential predictors, i.e., age at first admission, sex, alcohol use disorder (AUD), substance use disorder (SUD), more than 1 admission to ED for trauma, mental and behavioral disorders, neurological disorders, and cardiovascular disease. The median follow-up time was 9.3 years and the time on risk was 30,053 person years (PY) with a death rate corresponding to 4.42 (95% CI 3.74-5.26) per 1000 PY (n = 133 deaths). The death rate was higher in patients with AUD (17.30) than in those without AUD (1.98) and in those with SUD (13.58) than in those without SUD (3.80). Lastly, there was a clearly higher death rate among AUD+ SUD+ (20.89) compared to AUD-SUD-patients (1.74). At multivariable Cox regression, AUD, SUD, and liver cirrhosis were strong and independent predictors of time-to-death. Using standardized mortality ratios, a clear excess of mortality was evident for all the age bands from (40-45] to (60-65] years. Mortality is higher in AAI than in the general population and chronic alcohol-related diseases are strongly associated with it.
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Affiliation(s)
- Francesco Palmese
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy.
| | - Maria Elena Bonavita
- Department of Internal Medicine, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Enrico Pompili
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Maria Teresa Migliano
- Department of Internal Medicine, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Nicola Reggidori
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Cecilia Di Stefano
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Marta Grieco
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Stefano Colazzo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Manuel Tufoni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Center for Applied Biomedical Research-CRBA, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | | | - Fabrizio Giostra
- Emergency Department-Pronto Soccorso, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Gabriele Farina
- Emergency Department-Pronto Soccorso, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Rossella Del Toro
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
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Graziani A, Cenni P, Lisi M, Domenicali M, Graziani L. Lumbar spinal canal stenosis: An early sign of amyloid transthyretin related amyloidosis. Kardiol Pol 2021; 80:218-219. [PMID: 34904218 DOI: 10.33963/kp.a2021.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/23/2022]
Affiliation(s)
| | - Patrizia Cenni
- Department of Radiology, Santa Maria Delle Croci, Ravenna, Italy
| | - Matteo Lisi
- Department of Cardiology, Santa Maria Delle Croci, Ravenna, Italy
| | - Marco Domenicali
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - Ludovico Graziani
- Department of Genetic Medicine, Bambino Gesù Children's Hospital, Roma, Italy
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12
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Baldassarre M, Naldi M, Zaccherini G, Bartoletti M, Antognoli A, Laggetta M, Gagliardi M, Tufoni M, Domenicali M, Waterstradt K, Paterini P, Baldan A, Leoni S, Bartolini M, Viale P, Trevisani F, Bernardi M, Caraceni P. Determination of Effective Albumin in Patients With Decompensated Cirrhosis: Clinical and Prognostic Implications. Hepatology 2021; 74:2058-2073. [PMID: 33710623 PMCID: PMC8518406 DOI: 10.1002/hep.31798] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 06/26/2020] [Revised: 01/21/2021] [Accepted: 02/11/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Circulating albumin in cirrhosis can be dysfunctional because of accumulating structural damages, leading to the concept of effective albumin concentration (eAlb), referring to the albumin portion presenting structural and functional integrity. We aimed to estimate eAlb in patients with decompensated cirrhosis and analyze its relationships with albumin function and clinical outcomes as compared to total albumin concentration (tAlb). APPROACH AND RESULTS We evaluated 319 patients with cirrhosis hospitalized for acute decompensation (AD) with and without acute-on-chronic liver failure (ACLF) and 18 age- and sex-comparable outpatients with compensated cirrhosis. tAlb was quantified by standard assay, whereas eAlb was estimated combining liquid chromatography/electrospray ionization/mass spectrometry and standard methods. Albumin binding and detoxification efficiency were evaluated by electron paramagnetic resonance analysis. Circulating albumin in patients with decompensated cirrhosis displayed multiple structural abnormalities, with reversible oxidation and glycation being the most frequent. As a result, eAlb progressively declined with the worsening of cirrhosis and was superior to tAlb in stratifying patients between compensated cirrhosis, AD, and ACLF, as well as patients with and without complications. Moreover, eAlb, but not tAlb, was closely associated with binding capacities in ACLF. Finally, eAlb at admission predicted the occurrence of ACLF within 30 days and mortality at 90 days better than tAlb. CONCLUSIONS This large, observational study provides the evidence in patients with decompensated cirrhosis that eAlb can be quantified and differentiated from tAlb routinely measured in clinical practice. As compared to tAlb, eAlb is more closely associated with disease severity and albumin dysfunction and carries a greater prognostic power. These results prompt future research assessing eAlb as a biomarker for predicting prognosis and treatment response.
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Affiliation(s)
- Maurizio Baldassarre
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Centre for Applied Biomedical Research–CRBAAlma Mater Studiorum University of BolognaSt. Orsola HospitAlbolognaItaly
| | - Marina Naldi
- Centre for Applied Biomedical Research–CRBAAlma Mater Studiorum University of BolognaSt. Orsola HospitAlbolognaItaly,Department of Pharmacy and BiotechnologyAlma Mater Studiorum University of BolognaBolognaItaly
| | - Giacomo Zaccherini
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Michele Bartoletti
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Agnese Antognoli
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Maristella Laggetta
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Martina Gagliardi
- Centre for Applied Biomedical Research–CRBAAlma Mater Studiorum University of BolognaSt. Orsola HospitAlbolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Manuel Tufoni
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly
| | - Marco Domenicali
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly,Department of Internal MedicineS. Maria delle Croci HospitalAUSL RomagnaRavennaItaly
| | | | - Paola Paterini
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Centre for Applied Biomedical Research–CRBAAlma Mater Studiorum University of BolognaSt. Orsola HospitAlbolognaItaly
| | - Anna Baldan
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly
| | - Simona Leoni
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly
| | - Manuela Bartolini
- Department of Pharmacy and BiotechnologyAlma Mater Studiorum University of BolognaBolognaItaly
| | - Pierluigi Viale
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Franco Trevisani
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Mauro Bernardi
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Paolo Caraceni
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
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Pavarin RM, Domenicali M, Marani S, Turino E, Caputo F. Mortality risk in a population of patients treated for gambling disorders: results of a follow-up study. Ann Ist Super Sanita 2021; 57:205-211. [PMID: 34554114 DOI: 10.4415/ann_21_03_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIMS To examine mortality risk and causes of death in a cohort of a population of patients treated for gambling disorders in northern Italy from 1992 to 2019. METHODS Cohort study. RESULTS Half of the patients were diagnosed with psychiatric disorders, substance use disorder or alcohol dependence. The excess mortality compared to the general population (SMR) was 1.16 (0.85-1.58), more elevated among females aged 40 to 59 and males aged 20 to 29. Females had higher SMRs for all cancers and suicide; males for malignant neoplasm of liver, of lung, of prostate, and of bladder. CONCLUSIONS Despite patients increasing, subjects who most turn to the services are the most serious ones, in older age, with comorbid mental disorders and with a compromised health status. This is reflected in the high risk of death for all cancers.
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Affiliation(s)
- Raimondo Maria Pavarin
- Osservatorio Epidemiologico Metropolitano Dipendenze Patologiche, Dipartimento Salute Mentale e Dipendenze, Azienda USL Bologna, Bologna, Italy
| | - Marco Domenicali
- Centro per lo Studio ed il Trattamento Multidisciplinare dell'Uso Inadeguato dell'Alcol "G. Fontana", Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - Silvia Marani
- Osservatorio Epidemiologico Metropolitano Dipendenze Patologiche, Dipartimento Salute Mentale e Dipendenze, Azienda USL Bologna, Bologna, Italy
| | - Elsa Turino
- Osservatorio Epidemiologico Metropolitano Dipendenze Patologiche, Dipartimento Salute Mentale e Dipendenze, Azienda USL Bologna, Bologna, Italy
| | - Fabio Caputo
- Centro per lo Studio ed il Trattamento delle Patologie Alcol-Correlate, Dipartimento di Medicina Translazionale e per la Romagna, Università degli Studi di Ferrara, Ferrara, Italy
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Foschi FG, Domenicali M, Giacomoni P, Dall'Aglio AC, Conti F, Borghi A, Bevilacqua V, Napoli L, Mirici F, Cucchetti A, Ercolani G, Gardini AC, Bellentani S, Gastaldelli A, Giuffrè M, Tiribelli C, Bedogni G. Is there an association between commonly employed biomarkers of liver fibrosis and liver stiffness in the general population? Ann Hepatol 2021; 19:380-387. [PMID: 32451205 DOI: 10.1016/j.aohep.2020.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/08/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Surrogate biomarkers of liver fibrosis developed in tertiary care are increasingly used in general populations. We evaluated the association between liver stiffness (LS) and five continuous (AST/ALT, APRI, Forns Index, FIB-4, GGT) and two discrete biomarkers (BARD, BAAT) in a general population. PATIENTS AND METHODS 636 (29%) of the 2159 citizens of the Bagnacavallo Study had LS measured by transient elastography. Using linear regression with univariate multiple imputation, we evaluated the association of LS with the above biomarkers in the total sample of 2159 citizens. RESULTS The mean change of LS between the 5th and 95th internal percentile of any continuous biomarker was ≤1kPa. The mean change of LS between scores 0 and 3 of BARD and scores 0 and ≥3 of BAAT was >1kPa but of doubtful clinical relevance. CONCLUSION We found a modest association between LS and seven biomarkers of liver fibrosis in a general population.
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Affiliation(s)
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | - Fabio Conti
- Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Italy
| | - Alberto Borghi
- Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Italy
| | | | - Lucia Napoli
- Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Italy
| | - Federica Mirici
- Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giorgio Ercolani
- Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Italy
| | - Andrea Casadei Gardini
- Department of Oncology and Hematology, Division of Oncology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Amalia Gastaldelli
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Mauro Giuffrè
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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15
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Bedogni G, Tamini S, Caroli D, Cicolini S, Domenicali M, Sartorio A. Development and Internal Validation of Fatty Liver Prediction Models in Obese Children and Adolescents. J Clin Med 2021; 10:jcm10071470. [PMID: 33918271 PMCID: PMC8038182 DOI: 10.3390/jcm10071470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/11/2021] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
To develop predictive models of fatty liver (FL), we performed a cross-sectional retrospective study of 1672 obese children with a median (interquartile range) age of 15 (13-16) years. The outcome variable was FL diagnosed by ultrasonography. The potential predictors were: (1) binary: sex; (2) continuous: age, body mass index (BMI), waist circumference (WC), alanine transaminase (ALT), aspartate transaminase, gamma-glutamyltransferase, glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), HDL-cholesterol, LDL-cholesterol, triglycerides, mean arterial pressure, uric acid, and c-reactive protein; (3) ordinal: Pubertal status. Bootstrapped multivariable logistic regression with fractional polynomials was used to develop the models. Two models were developed and internally validated, one using BMI and the other using WC as the anthropometric predictor. Both models included ALT, HOMA-IR, triglycerides, and uric acid as predictors, had similar discrimination (c-statistic = 0.81), and were similarly well calibrated as determined by calibration plots. These models should undergo external validation before being employed in clinical or research practice.
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Affiliation(s)
- Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, 34012 Basovizza, Italy
- Correspondence:
| | - Sofia Tamini
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Verbania, Italy; (S.T.); (S.C.); (D.C.); (A.S.)
| | - Diana Caroli
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Verbania, Italy; (S.T.); (S.C.); (D.C.); (A.S.)
| | - Sabrina Cicolini
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Verbania, Italy; (S.T.); (S.C.); (D.C.); (A.S.)
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
- Internal Medicine, S. Maria delle Croci Hospital, 48121 Ravenna, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Verbania, Italy; (S.T.); (S.C.); (D.C.); (A.S.)
- Istituto Auxologico Italiano, IRCCS, Division of Auxology and Metabolic Diseases, 28824 Verbania, Italy
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16
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Pavarin RM, Sanchini S, Tadonio L, Domenicali M, Caputo F, Pacetti M. Suicide mortality risk in a cohort of individuals treated for alcohol, heroin or cocaine abuse: Results of a follow-up study. Psychiatry Res 2021; 296:113639. [PMID: 33352416 DOI: 10.1016/j.psychres.2020.113639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/25/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Cohort study. This follow-up study (from 1975 to 2016) was aimed to estimate the mortality risk for suicide in a cohort of patients presenting to a public treatment centre for addiction (SERD) with Alcohol Use Disorder (AUD), Heroin Use Disorder - HUD or Cocaine Use Disorder (CUD), also relating to their access to a Mental Heath Service. Crude Mortality Rates for suicide were higher for patients with AUDs, for men and subjects 45-64 years old. Hanging was the main cause of suicide death. We highlight an increase in mortality in the period 2009-2012, which coincides with the economic recession, and in the year of first contact with a SERD. The Standardized Mortality Ratios (SMRs) were 4.9, higher among females than males. From the multivariate analysis, a higher risk for patients that were separated or divorced was observed. The results of our study provide some guidance on the features of subjects at greatest risk of death from suicide, which may be useful in reducing and preventing suicide and gaining a better clinical management of patients with SUDs.
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Affiliation(s)
- Raimondo Maria Pavarin
- Epidemiological Monitoring Center on Addiction, Azienda USL Bologna, Mental Health DSM-DP, Bologna, Italy; Italian Society on Addiction (SITD);.
| | - Samantha Sanchini
- Epidemiological Monitoring Center on Addiction, Mental Health DSM-DP, Azienda USL Romagna, Italy.
| | - Leonardo Tadonio
- Monitoring Center on Addiction, Mental Health DAISM-DP, Azienda USL Parma, Italy.
| | - Marco Domenicali
- Internal Medicine S.Maria delle Croci Hospital, Ravenna, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.
| | - Fabio Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara), Italy University of Ferrara, Italy; Italian Society on Alcohol (SIA).
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Caputo F, Pavarin RM, Lungaro L, Minarini A, Vigna-Taglianti F, Brambilla R, Sanchini S, Zoli E, Noventa A, Domenicali M, Vignoli T, Patussi V, Testino G, Scafato E, De Giorgio R, Zoli G. Identification of harmful drinking in subjects who have had their driving license suspended due to alcohol use: a retrospective Italian study. Eur Rev Med Pharmacol Sci 2020; 24:10720-10728. [PMID: 33155232 DOI: 10.26355/eurrev_202010_23432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Early identification of Harmful Drinking (HD) is difficult, and underestimated. The aim of our retrospective study was to investigate the presence of HD in a population of subjects who had their driving license suspended due to driving under the influence of alcohol. MATERIALS AND METHODS We retrospectively recruited 979 subjects. During the first appointment (T0), clinical and laboratory characteristics of patients were evaluated, and the AUDIT questionnaire was administered. Two groups were then defined: Harmful Drinking (HD) and non-HD, and all subjects underwent a brief interview for 5-10 minutes before being assigned to a group. RESULTS 95.9% of our sample were identified as non-HD, whereas 4.1% of them were HD; twenty-one (2.1%) of the HD underwent a control appointment (T1), and 17 (1.7%) of them were diagnosed with alcohol use disorder (AUD); there was a statistically significant reduction in mean daily alcohol intake (p<0.009), and in the mean values of the blood markers of HD between T0 and T1 in HD. CONCLUSIONS The present study shows that 4.1%, and 1.7% of subjects presented a diagnosis of HD and AUD, respectively, and their entry in a protocol of drinking monitoring proved beneficial in reducing alcohol intake. Thus, the implementation of strict surveillance of subjects found driving under the influence of alcohol involving a network of professional figures (from police forces to specialists in alcohol addiction treatment) may help to detect and to treat subjects with HD and AUD, and to monitor their alcohol use over time.
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Affiliation(s)
- F Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara), University of Ferrara, Ferrara, Italy.
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18
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Bartoletti M, Baldassarre M, Domenicali M, Lewis RE, Giannella M, Antognoli A, Rinaldi M, Zaccherini G, Verucchi G, Marconi L, Tamè M, Berardi S, Napoli L, Siniscalchi A, Fabbri A, Biselli M, Tufoni M, Pavarin RM, Trevisani F, Viale P, Bernardi M, Caraceni P. Prognostic Role of Bacterial and Fungal Infections in Patients With Liver Cirrhosis With and Without Acute-on-Chronic Liver Failure: A Prospective 2-Center Study. Open Forum Infect Dis 2020; 7:ofaa453. [PMID: 33209950 PMCID: PMC7652102 DOI: 10.1093/ofid/ofaa453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bacterial and fungal infections (BFIs) are frequent in patients with cirrhosis and often trigger acute-on-chronic liver failure (ACLF). This prospective observational study aims to describe the interactions between BFI and ACLF in terms of mortality and related risk factors. METHODS We performed a 2-center prospective observational study enrolling hospitalized patients with cirrhosis admitted for acute decompensation. Data were recorded at admission and during hospitalization. Survival was recorded up to 1 year. RESULTS Among the 516 patients enrolled, 108 (21%) were infected at admission, while an additional 61 patients (12%) developed an infection during hospital stay. In the absence of ACLF, the 1-year mortality rate of patients with BFI did not differ from that of patients without BFI (33% vs 31%; P = .553). In contrast, those with ACLF triggered or complicated by BFI had a significantly higher mortality rate than those who remained free from BFI (75% vs 54%; P = .011). Competing risk analysis showed that the negative impact of ACLF-related BFI on long-term prognosis was independent from Model for End-stage Liver Disease (MELD) incorporating serum sodium concentration score, comorbidity, and basal C-reactive protein level. Finally, multivariable logistic regression showed that higher MELD score (P < .001), QuickSOFA score ≥2 points (P = .007), and secondary bloodstream (P = .022) and multidrug-resistant pathogen isolation (P = .030) were independently associated with ACLF in patients with BFI. CONCLUSIONS This large prospective study indicated that the adverse impact of BFI on long-term survival in decompensated cirrhosis is not universal but is limited to those patients who also develop ACLF. Both disease severity and microbiological factors predispose infected decompensated patients to ACLF.
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Affiliation(s)
- Michele Bartoletti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
- Centre for Applied Biomedical Research (CRBA), University of Bologna, Bologna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Russell E Lewis
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Agnese Antognoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Centre for Applied Biomedical Research (CRBA), University of Bologna, Bologna, Italy
| | - Matteo Rinaldi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gabriella Verucchi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lorenzo Marconi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mariarosa Tamè
- U.O. Gastroenterology, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Sonia Berardi
- U.O. Internal Medicine and Organ Failure, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lucia Napoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- S.S.D. Intensive Care of Abdominal Transplantation and Liver Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Angela Fabbri
- U.O. Internal Medicine, Infermi Hospital of Rimini, Area Vasta Romagna (AVR) Rimini, Rimini, Italy
| | - Maurizio Biselli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Manuel Tufoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Raimondo M Pavarin
- Epidemiological Monitoring Center on Addiction, Mental Health DSM DP, Bologna, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
- Centre for Applied Biomedical Research (CRBA), University of Bologna, Bologna, Italy
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19
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Bartoletti M, Giannella M, Lewis RE, Caraceni P, Tedeschi S, Paul M, Schramm C, Bruns T, Merli M, Cobos-Trigueros N, Seminari E, Retamar P, Muñoz P, Tumbarello M, Burra P, Torrani Cerenzia M, Barsic B, Calbo E, Maraolo AE, Petrosillo N, Galan-Ladero MA, D'Offizi G, Zak-Doron Y, Rodriguez-Baño J, Baldassarre M, Verucchi G, Domenicali M, Bernardi M, Viale P. Extended Infusion of β-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study. Clin Infect Dis 2020; 69:1731-1739. [PMID: 30649218 DOI: 10.1093/cid/ciz032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/10/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We analyzed the impact of continuous/extended infusion (C/EI) vs intermittent infusion of piperacillin-tazobactam (TZP) and carbapenems on 30-day mortality of patients with liver cirrhosis and bloodstream infection (BSI). METHODS The BICRHOME study was a prospective, multicenter study that enrolled 312 cirrhotic patients with BSI. In this secondary analysis, we selected patients receiving TZP or carbapenems as adequate empirical treatment. The 30-day mortality of patients receiving C/EI or intermittent infusion of TZP or carbapenems was assessed with Kaplan-Meier curves, Cox-regression model, and estimation of the average treatment effect (ATE) using propensity score matching. RESULTS Overall, 119 patients received TZP or carbapenems as empirical treatment. Patients who received C/EI had a significantly lower mortality rate (16% vs 36%, P = .047). In a Cox-regression model, the administration of C/EI was associated with a significantly lower mortality (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.11-0.936; P = .04) when adjusted for severity of illness and an ATE of 25.6% reduction in 30-day mortality risk (95% CI, 18.9-32.3; P < .0001) estimated with propensity score matching. A significant reduction in 30-day mortality was also observed in the subgroups of patients with sepsis (HR, 0.21; 95% CI, 0.06-0.74), acute-on-chronic liver failure (HR, 0.29; 95% CI, 0.03-0.99), and a model for end-stage liver disease score ≥25 (HR, 0.26; 95% CI, 0.08-0.92). At competing risk analysis, C/EI of beta-lactams was associated with significantly higher rates of hospital discharge (subdistribution hazard [95% CI], 1.62 [1.06-2.47]). CONCLUSIONS C/EI of beta-lactams in cirrhotic patients with BSI may improve outcomes and facilitate earlier discharge.
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Affiliation(s)
- Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Russell E Lewis
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Sara Tedeschi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Mical Paul
- Unit of Infectious Diseases, Rambam Health Care Campus, HaAliya HaShniya, Israel
| | - Christoph Schramm
- Department of Gastroenterology and Hepatology, University Clinic of Cologne, Germany
| | - Tony Bruns
- Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University, Germany
| | - Manuela Merli
- Division of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Viale, Italy
| | | | - Elena Seminari
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pilar Retamar
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena-Instituto de Biomedicina de Sevilla (IBIS) and Departamento de Medicina, Universidad de Sevilla, Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mario Tumbarello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, Italy
| | - Maria Torrani Cerenzia
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Bruno Barsic
- Infectious Diseases, University Hospital for Infectious Diseases "Dr Fran Mihaljevic," Zagreb, Croatia
| | - Ester Calbo
- Infectious Disease Unit, Service of Internal Medicine, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II
| | - Nicola Petrosillo
- 2nd Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, Rome
| | | | - Gianpiero D'Offizi
- Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases L. Spallanzani, Rome
| | - Yael Zak-Doron
- Unit of Infectious Diseases, Rambam Health Care Campus, HaAliya HaShniya, Israel
| | - Jesus Rodriguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena-Instituto de Biomedicina de Sevilla (IBIS) and Departamento de Medicina, Universidad de Sevilla, Madrid, Spain
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, University of Bologna, Italy.,S.Orsola-Malpighi University Hospital, Center for Applied Biomedical Research, Bologna, Italy
| | - Gabriella Verucchi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
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Bossi MM, Tufoni M, Zaccherini G, Antognoli A, Domenicali M, Caraceni P. A web-based group treatment for patients with alcoholic liver diseases at the time of the COVID-19 pandemic. Dig Liver Dis 2020; 52:956-957. [PMID: 32513630 PMCID: PMC7200346 DOI: 10.1016/j.dld.2020.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | - Paolo Caraceni
- Coreesponding author at: U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
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Graziani A, Domenicali M, Zanframundo G, Palmese F, Caroli B, Graziani L. Pulmonary artery thrombosis in COVID-19 patients. Pulmonology 2020; 27:261-263. [PMID: 32873513 PMCID: PMC7444900 DOI: 10.1016/j.pulmoe.2020.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- A Graziani
- Medicina Interna, Ospedale Santa Maria delle Croci, Viale Randi 48121, Ravenna, Italy.
| | - M Domenicali
- Medicina Interna, Ospedale Santa Maria delle Croci, Viale Randi 48121, Ravenna, Italy; Università degli Studi di Bologna, Italy
| | - G Zanframundo
- Medicina Interna, Ospedale Santa Maria delle Croci, Viale Randi 48121, Ravenna, Italy
| | - F Palmese
- Medicina Interna, Ospedale Santa Maria delle Croci, Viale Randi 48121, Ravenna, Italy
| | - B Caroli
- Medicina Interna, Ospedale Santa Maria delle Croci, Viale Randi 48121, Ravenna, Italy
| | - L Graziani
- Università Cattolica Del Sacro Cuore, Roma, Italy
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22
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Palmese F, Caroli B, Graziani A, Zanframundo G, Del Toro R, Sagrini E, Cataleta P, Domenicali M. Daily Evaluation of COVID-19 Patients Primarily Based on Lung Ultrasound: In Times of Emergency, It's Time to Change Some Paradigms. Am J Trop Med Hyg 2020; 103:922-923. [PMID: 32534598 PMCID: PMC7410475 DOI: 10.4269/ajtmh.20-0596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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23
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Rimini M, Casadei-Gardini A, Ravaioli A, Rovesti G, Conti F, Borghi A, Dall’Aglio AC, Bedogni G, Domenicali M, Giacomoni P, Tiribelli C, Bucchi L, Falcini F, Foschi FG. Could Inflammatory Indices and Metabolic Syndrome Predict the Risk of Cancer Development? Analysis from the Bagnacavallo Population Study. J Clin Med 2020; 9:jcm9041177. [PMID: 32325965 PMCID: PMC7231063 DOI: 10.3390/jcm9041177] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Despite the robust data available on inflammatory indices (neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)) and clinical outcome in oncological patients, their utility as a predictor of cancer incidence in the general population has not been reported in literature. Methods: The Bagnacavallo study was performed between October 2005 and March 2009. All citizens of Bagnacavallo (Ravenna, Emilia-Romagna, Italy) aged 30–60 years as of January 2005 were eligible and were invited by written letter to participate to the study. All participants underwent a detailed clinical history and physical examination following the model of the Dionysos Study. All blood values included in the analysis were obtained the day of physical examination. Cancer incidence data were obtained from the population-based Romagna Cancer Registry, which operates according to standard methods. The aim of this analysis was to examine the association between metabolic syndrome and baseline SII, NLR, and PLR levels, and the diagnosis of an invasive cancer in the Bagnacavallo study cohort. Results: At univariate analysis, metabolic syndrome was not associated with an increase of cancer incidence (HR 1.30; p = 0.155). High glucose (HR 1.49; p = 0.0.16), NLR HR 1.54, p = 0.002), PLR (HR 1.58, p = 0.001), and SII (HR 1.47, p = 0.006) were associated with an increase of cancer incidence. After adjusting for clinical covariates (smoking, physical activity, education, age, and gender) SII, PLR, and NLR remained independent prognostic factors for the prediction of cancer incidence. Conclusions: Inflammatory indices are promising, easy to perform, and inexpensive tools for identifying patients with higher risk of cancer in cancer-free population.
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Affiliation(s)
- Margherita Rimini
- Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, 73828 Modena, Italy; (M.R.); (G.R.)
| | - Andrea Casadei-Gardini
- Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, 73828 Modena, Italy; (M.R.); (G.R.)
- Correspondence:
| | - Alessandra Ravaioli
- Romagna Cancer Registry-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.R.); (L.B.); (F.F.)
| | - Giulia Rovesti
- Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, 73828 Modena, Italy; (M.R.); (G.R.)
| | - Fabio Conti
- Department of Internal Medicine, Degli Infermi Hospital, 48018 Faenza, Italy; (F.C.); (A.C.D.); (F.G.F.)
| | - Alberto Borghi
- Centro di Ricerca Biomedica Applicata (CRBA), Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi e Università di Bologna, 40121 Bologna, Italy;
| | - Anna Chiara Dall’Aglio
- Department of Internal Medicine, Degli Infermi Hospital, 48018 Faenza, Italy; (F.C.); (A.C.D.); (F.G.F.)
| | - Giorgio Bedogni
- Liver Research Center, Italian Liver Foundation, Basovizza, 34121 Trieste, Italy; (G.B.); (C.T.)
| | - Marco Domenicali
- Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, 40121 Bologna, Italy;
| | - Pierluigi Giacomoni
- Department of Internal Medicine, Ospedale di Lugo, AUSL Romagna, 48022 Lugo, Italy;
| | - Claudio Tiribelli
- Liver Research Center, Italian Liver Foundation, Basovizza, 34121 Trieste, Italy; (G.B.); (C.T.)
| | - Lauro Bucchi
- Romagna Cancer Registry-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.R.); (L.B.); (F.F.)
| | - Fabio Falcini
- Romagna Cancer Registry-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.R.); (L.B.); (F.F.)
| | - Francesco Giuseppe Foschi
- Department of Internal Medicine, Degli Infermi Hospital, 48018 Faenza, Italy; (F.C.); (A.C.D.); (F.G.F.)
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Graziani A, Del Giudice E, Lisi M, Domenicali M, Graziani L. Scintigraphy showing the possible progression of transthyretin cardiac amyloidosis. Kardiol Pol 2020; 78:253-254. [DOI: 10.33963/kp.15125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Pavarin RM, Domenicali M, Marani S, Caputo F, Mazzoni M. Visits of adolescents for acute alcohol intoxication to emergency departments in Northern Italy: natives and non-natives. Journal of Substance Use 2019. [DOI: 10.1080/14659891.2019.1664665] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Raimondo Maria Pavarin
- Epidemiological Monitoring Center on Addiction, Mental Health DSM-DP, Ausl Bologna, Bologna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences G. Fontana, Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, University of Bologna, Bologna, Italy
| | - Silvia Marani
- Epidemiological Monitoring Center on Addiction, Mental Health DSM-DP, Azienda USL Bologna, Bologna, Italy
| | - Fabio Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara), Italy
| | - Monica Mazzoni
- Department of statistics, Città Metropolitana of Bologna, Italy
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Zaccherini G, Baldassarre M, Bartoletti M, Tufoni M, Berardi S, Tamè M, Napoli L, Siniscalchi A, Fabbri A, Marconi L, Antognoli A, Iannone G, Domenicali M, Viale P, Trevisani F, Bernardi M, Caraceni P. Prediction of nosocomial acute-on-chronic liver failure in patients with cirrhosis admitted to hospital with acute decompensation. JHEP Rep 2019; 1:270-277. [PMID: 32039378 PMCID: PMC7001573 DOI: 10.1016/j.jhepr.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/04/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022] Open
Abstract
Nosocomial acute-on-chronic liver failure (nACLF) develops in at least 10% of patients with cirrhosis hospitalized for acute decompensation (AD), greatly worsening their prognosis. In this prospective observational study, we aimed to identify rapidly obtainable predictors at admission, which allow for the early recognition and stratification of patients at risk of nACLF. Methods A total of 516 consecutive patients hospitalized for AD of cirrhosis were screened: those who did not present ACLF at admission (410) were enrolled and surveilled for the development of nACLF. Results Fifty-nine (14%) patients developed nALCF after a median of 7 (IQR 4-18) days. At admission, they presented a more severe disease and higher degrees of systemic inflammation and anemia than those (351; 86%) who remained free from nACLF. Competing risk multivariable regression analysis showed that baseline MELD score (sub-distribution hazard ratio [sHR] 1.15; 95% CI 1.10-1.21; p ≪0.001), hemoglobin level (sHR 0.81; 95% CI 0.68-0.96; p = 0.018), and leukocyte count (sHR 1.11; 95% CI 1.06-1.16; p ≪0.001) independently predicted nACLF. Their optimal cut-off points, determined by receiver-operating characteristic curve analysis, were: 13 points for MELD score, 9.8 g/dl for hemoglobin, and 5.6x109/L for leukocyte count. These thresholds were used to stratify patients according to the cumulative incidence of nACLF, being 0, 6, 21 and 59% in the presence of 0, 1, 2 or 3 risk factors (p ≪0.001). Nosocomial bacterial infections only increased the probability of developing nACLF in patients with at least 1 risk factor, rising from 3% to 29%, 16% to 50% and 52% to 83% in patients with 1, 2 or 3 risk factors, respectively. Conclusions Easily available laboratory parameters, related to disease severity, systemic inflammation, and anemia, can be used to identify, at admission, hospitalized patients with AD at increased risk of developing nACLF. Lay summary More than 10% of patients with cirrhosis hospitalized because of an acute decompensation develop acute-on-chronic liver failure, which is associated with high short-term mortality, during their hospital stay. We found that the combination of 3 easily obtainable variables (model for end-stage liver disease score, leukocyte count and hemoglobin level) help to identify and stratify patients according to their risk of developing nosocomial acute-on-chronic liver failure, from nil to 59%. Moreover, if a nosocomial bacterial infection occurs, such an incidence proportionally increases from nil to 83%. This simple approach helps to identify patients at risk of developing nosocomial acute-on-chronic liver failure at admission to hospital, enabling clinicians to put in place preventive measures.
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Affiliation(s)
- Giacomo Zaccherini
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences - University of Bologna, Italy.,Centre for Applied Biomedical Research (CRBA), University of Bologna, Italy
| | - Michele Bartoletti
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Manuel Tufoni
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Sonia Berardi
- U.O. Internal Medicine and Organ Failure - S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mariarosa Tamè
- U.O. Gastroenterology - S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lucia Napoli
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Antonio Siniscalchi
- S.S.D. Intensive Care of Abdominal Transplantation and Liver Surgery - S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Angela Fabbri
- U.O. Internal Medicine, Infermi Hospital of Rimini, Area Vasta Romagna (AVR) Rimini, Italy
| | - Lorenzo Marconi
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Agnese Antognoli
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Giulia Iannone
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences - University of Bologna, Italy.,Centre for Applied Biomedical Research (CRBA), University of Bologna, Italy
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Caputo F, Domenicali M, Bernardi M. Diagnosis and Treatment of Alcohol Use Disorder in Patients With End-Stage Alcoholic Liver Disease. Hepatology 2019; 70:410-417. [PMID: 30471136 DOI: 10.1002/hep.30358] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 06/29/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022]
Abstract
Between 14%-30% of the world's population is affected by alcohol use disorder (AUD), and excessive alcohol consumption represents the most common cause of liver disease in the western world. The clinical picture of alcoholic end-stage liver disease is rendered extremely complex, as manifestations such as alcohol withdrawal syndrome, craving and physical dependence, as well as extrahepatic alcohol-related diseases merge with the complications of advanced cirrhosis. This makes AUD recognition and assessment difficult and its management arduous as many drugs commonly used to treat complications such as alcohol withdrawal syndrome are often contraindicated by the presence of hepatic encephalopathy or hepatorenal syndrome. Reaching and maintaining abstinence represents the mainstay of managing patients with AUD and end-stage liver disease. Psychosocial interventions are an essential component of treatment to reach these goals. However, these interventions alone often prove insufficient in AUD patients and even more frequently in those with end-stage liver disease because of inadequate adherence due to poor functional and physical status. Pharmacological treatments need to be associated, but the available options are greatly limited in end-stage liver disease because many GABA-Ergic drugs can favor the development of hepatic encephalopathy, whereas drugs undergoing extensive liver metabolism should be avoided or used with the greatest caution. Because of these limitations, the management of end-stage AUD is extremely challenging and requires an integrated multidisciplinary approach.
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Affiliation(s)
- Fabio Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara), Italy.,"G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Marco Domenicali
- "G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Mauro Bernardi
- "G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Sciences, University of Bologna, Italy
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28
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Affiliation(s)
- Fabio Caputo
- Unit of Internal Medicine, S.S. Annunziata Hospital, Cento, Italy
| | - Marco Domenicali
- Department of Clinical Medicine, U.O. Semeiotica Medica, Bologna, Italy.,Internal Medicine, University of Bologna, Bologna, Italy
| | - Mauro Bernardi
- Internal Medicine, University of Bologna, Bologna, Italy
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Biselli M, Gramenzi A, Lenzi B, Dall'Agata M, Pierro ML, Perricone G, Tonon M, Bellettato L, D'Amico G, Angeli P, Boffelli S, Bonavita ME, Domenicali M, Caraceni P, Bernardi M, Trevisani F. Development and Validation of a Scoring System That Includes Corrected QT Interval for Risk Analysis of Patients With Cirrhosis and Gastrointestinal Bleeding. Clin Gastroenterol Hepatol 2019; 17:1388-1397.e1. [PMID: 30557740 DOI: 10.1016/j.cgh.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/08/2018] [Revised: 11/29/2018] [Accepted: 12/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The electrocardiographic QT interval frequently is prolonged in patients with cirrhosis. Acute gastrointestinal bleeding further prolongs corrected QT (QTc) in patients with cirrhosis, which has been associated with an increased risk of death within 6 weeks. We aimed to confirm these findings and develop a mortality risk index that incorporates QTc. METHODS We collected data from 274 patients with cirrhosis and acute gastrointestinal bleeding from any cause admitted to a hospital in Bologna, Italy, from January 2001 through December 2012 (training set). We used logistic regression analysis to identify patient factors associated with death within 6 weeks (6-week mortality). We validated our findings by using data from 200 patients with cirrhosis and gastrointestinal bleeding treated at 2 separate hospitals in Italy, from 2001 through 2016 and 2007 through 2012. Our primary aim was to confirm the prognostic effects of prolonged QTc in a large population of patients and develop a 6-week mortality risk score for acute gastrointestinal bleeding from any cause that incorporates the QTc interval. RESULTS In the training set, QTc greater than 456 ms, the model for end-stage liver disease-sodium (MELD-Na) score, previous bleeding, and serum albumin concentration were associated independently with 6-week mortality. We combined these parameters to create a risk scoring system that we named MELD-Na acute gastrointestinal bleeding (MELDNa-AGIB). In the validation set, the MELDNa-AGIB identified patients who died within 6 weeks with an area under the receiver operating characteristic curve (AUROC) of 0.888; this value was higher than that of the MELD score (AUROC, 0.838; P = .031), MELD score with updated calibration (AUROC, 0.837; P = .029), Child-Turcotte-Pugh score (AUROC, 0.789; P = .004), D'Amico score (AUROC, 0.761; P = .003), and Augustin score (AUROC, 0.792; P = .001), with a net reclassification improvement better than the MELD-Na score (0.266; P = .045). In calibration, the MELDNa-AGIB produced a high score in the Hosmer-Lemeshow test (P = .947), which was superior to that of MELD-Na (P = .146). In the training set, only 6.3% of patients with MELDNa-AGIB scores of 4 or less died within 6 weeks. Among patients with a scores of 9, 16, and 25 or higher, 15.5%, 41.5%, and 81% or more patients died within 6 weeks, respectively. The probability of survival progressively and significantly decreased with increasing scores in the training and validation sets. CONCLUSIONS We confirmed QTc as an independent predictor of 6-week mortality in a large population of patients with cirrhosis and acute gastrointestinal bleeding. The combination of QTc, MELD-Na, previous bleeding, and serum albumin (the MELDNa-AGIB score) accurately determines the risk of 6-week mortality, providing timely identification of patients at very high risk of death.
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Affiliation(s)
- Maurizio Biselli
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Annagiulia Gramenzi
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Barbara Lenzi
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Dall'Agata
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Monica Loreta Pierro
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giovanni Perricone
- Gastroenterology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; Gastroenterology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; Hepatology and Gastroenterology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marta Tonon
- Clinica Medica, Dipartimento di Medicina, University of Padua, Padua, Italy
| | - Luca Bellettato
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Gennaro D'Amico
- Gastroenterology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Paolo Angeli
- Clinica Medica, Dipartimento di Medicina, University of Padua, Padua, Italy
| | - Silvia Boffelli
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Maria Elena Bonavita
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Domenicali
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mauro Bernardi
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Franco Trevisani
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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Callegari E, Domenicali M, Shankaraiah RC, D'Abundo L, Guerriero P, Giannone F, Baldassarre M, Bassi C, Elamin BK, Zagatti B, Ferracin M, Fornari F, Altavilla G, Blandamura S, Silini EM, Gramantieri L, Sabbioni S, Negrini M. MicroRNA-Based Prophylaxis in a Mouse Model of Cirrhosis and Liver Cancer. Mol Ther Nucleic Acids 2019; 14:239-250. [PMID: 30641476 PMCID: PMC6330511 DOI: 10.1016/j.omtn.2018.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
Most hepatocellular carcinomas (HCCs) arise in the context of chronic liver disease and/or cirrhosis. Thus, chemoprevention in individuals at risk represents an important but yet unproven approach. In this study, we investigated the ability of microRNA (miRNA)-based molecules to prevent liver cancer development in a cirrhotic model. To this end, we developed a mouse model able to recapitulate the natural progression from fibrosis to HCC, and then we tested the prophylactic activity of an miRNA-based approach in the model. The experiments were carried out in the TG221 transgenic mouse, characterized by the overexpression of miR-221 in the liver and predisposed to the development of liver tumors. TG221 as well as wild-type mice were exposed to the hepatotoxin carbon tetrachloride (CCl4) to induce chronic liver damage. All mice developed liver cirrhosis, but only TG221 mice developed nodular lesions in 100% of cases within 6 months of age. The spectrum of lesions ranged from dysplastic foci to carcinomas. To investigate miRNA-based prophylactic approaches, anti-miR-221 oligonucleotides or miR-199a-3p mimics were administered to TG221 CCl4-treated mice. Compared to control animals, a significant reduction in number, size, and, most significantly, malignant phenotype of liver nodules was observed, thus demonstrating an important prophylactic action of miRNA-based molecules. In summary, in this article, we not only report a simple model of liver cancer in a cirrhotic background but also provide evidence for a potential miRNA-based approach to reduce the risk of HCC development.
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Affiliation(s)
- Elisa Callegari
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; Center for Applied Biomedical Research, St. Orsola-Malpighi University Hospital, 40138 Bologna, Italy
| | - Ram Charan Shankaraiah
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Lucilla D'Abundo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Paola Guerriero
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Ferdinando Giannone
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; Center for Applied Biomedical Research, St. Orsola-Malpighi University Hospital, 40138 Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; Center for Applied Biomedical Research, St. Orsola-Malpighi University Hospital, 40138 Bologna, Italy
| | - Cristian Bassi
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Bahaeldin K Elamin
- Department of Basic Sciences, College of Medicine, University of Bisha, 61922 Bisha, Saudi Arabia; Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, University of Khartoum, 11115 Khartoum, Sudan
| | - Barbara Zagatti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Manuela Ferracin
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy
| | - Francesca Fornari
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; Center for Applied Biomedical Research, St. Orsola-Malpighi University Hospital, 40138 Bologna, Italy
| | | | - Stella Blandamura
- Department of Medicine DIMED, University of Padova, 35121 Padova, Italy
| | - Enrico Maria Silini
- Section of Anatomy and Pathology, University Hospital of Parma, 43121 Parma, Italy
| | - Laura Gramantieri
- Center for Applied Biomedical Research, St. Orsola-Malpighi University Hospital, 40138 Bologna, Italy
| | - Silvia Sabbioni
- Department of Life Sciences and Biotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Massimo Negrini
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
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Foschi FG, Bedogni G, Domenicali M, Giacomoni P, Dall'Aglio AC, Dazzani F, Lanzi A, Conti F, Savini S, Saini G, Bernardi M, Andreone P, Gastaldelli A, Casadei Gardini A, Tiribelli C, Bellentani S, Stefanini GF. Prevalence of and risk factors for fatty liver in the general population of Northern Italy: the Bagnacavallo Study. BMC Gastroenterol 2018; 18:177. [PMID: 30486798 PMCID: PMC6262973 DOI: 10.1186/s12876-018-0906-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/13/2018] [Indexed: 01/02/2023] Open
Abstract
Background The estimation of the burden of disease attributable to fatty liver requires studies performed in the general population. Methods The Bagnacavallo Study was performed between October 2005 and March 2009. All the citizens of Bagnacavallo (Ravenna, Italy) aged 30 to 60 years as of January 2005 were eligible. Altered liver enzymes were defined as alanine transaminase > 40 U/l and/or aspartate transaminase > 37 U/l. Results Four thousand and thirty-three (58%) out of 6920 eligible citizens agreed to participate and 3933 (98%) had complete data. 393 (10%) of the latter had altered liver enzymes and 3540 had not. After exclusion of subjects with HBV or HCV infection, liver ultrasonography was available for 93% of subjects with altered liber enzymes and 52% of those with normal liver enzymes. The prevalence of fatty liver, non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD) was 0.74 (95%CI 0.70 to 0.79) vs. 0.35 (0.33 to 0.37), 0.46 (0.41 to 0.51) vs. 0.22 (0.21 to 0.24) and 0.28 (0.24 to 0.33) vs. 0.13 (0.11 to 0.14) in citizens with than in those without altered liver enzymes. Ethanol intake was not associated and all the components of the metabolic syndrome (MS) were associated with fatty liver. All potential risk factors were associated with a lower odds of normal liver vs. NAFLD while they were unable to discriminate AFLD from NAFLD. Conclusions Fatty liver as a whole was highly prevalent in Bagnacavallo in 2005/9 and was more common among citizens with altered liver enzymes. Electronic supplementary material The online version of this article (10.1186/s12876-018-0906-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Giorgio Bedogni
- Liver Research Center, Italian Liver Foundation, Basovizza, Trieste, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Pierluigi Giacomoni
- Department of Internal Medicine, Ospedale di Lugo, AUSL Romagna, Locarno, Italy
| | | | - Francesca Dazzani
- Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Faenza, Italy
| | - Arianna Lanzi
- Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Faenza, Italy
| | - Fabio Conti
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. .,Research Center for the Study of Hepatitis, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Sara Savini
- Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Faenza, Italy
| | - Gaia Saini
- Department of Internal Medicine, Ospedale di Faenza, AUSL Romagna, Faenza, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Pietro Andreone
- Research Center for the Study of Hepatitis, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Amalia Gastaldelli
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Andrea Casadei Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo studio e la cura dei tumori (IRST) IRCCS, Meldola, Italy
| | - Claudio Tiribelli
- Liver Research Center, Italian Liver Foundation, Basovizza, Trieste, Italy
| | - Stefano Bellentani
- Gastroenterology and Hepatology Service, Clinica Santa Chiara, Locarno, Switzerland
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Piano S, Bartoletti M, Tonon M, Baldassarre M, Chies G, Romano A, Viale P, Vettore E, Domenicali M, Stanco M, Pilutti C, Frigo AC, Brocca A, Bernardi M, Caraceni P, Angeli P. Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections. Gut 2018; 67:1892-1899. [PMID: 28860348 DOI: 10.1136/gutjnl-2017-314324] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [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: 04/12/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Patients with cirrhosis have a high risk of sepsis, which confers a poor prognosis. The systemic inflammatory response syndrome (SIRS) criteria have several limitations in cirrhosis. Recently, new criteria for sepsis (Sepsis-3) have been suggested in the general population (increase of Sequential Organ Failure Assessment (SOFA) ≥2 points from baseline). Outside the intensive care unit (ICU), the quick SOFA (qSOFA (at least two among alteration in mental status, systolic blood pressure ≤100 mm Hg or respiratory rate ≥22/min)) was suggested to screen for sepsis. These criteria have never been evaluated in patients with cirrhosis. The aim of the study was to assess the ability of Sepsis-3 criteria in predicting in-hospital mortality in patients with cirrhosis and bacterial/fungal infections. METHODS 259 consecutive patients with cirrhosis and bacterial/fungal infections were prospectively included. Demographic, laboratory and microbiological data were collected at diagnosis of infection. Baseline SOFA was assessed using preadmission data. Patients were followed up until death, liver transplantation or discharge. Findings were externally validated (197 patients). RESULTS Sepsis-3 and qSOFA had significantly greater discrimination for in-hospital mortality (area under the receiver operating characteristic (AUROC)=0.784 and 0.732, respectively) than SIRS (AUROC=0.606) (p<0.01 for both). Similar results were observed in the validation cohort. Sepsis-3 (subdistribution HR (sHR)=5.47; p=0.006), qSOFA (sHR=1.99; p=0.020), Chronic Liver Failure Consortium Acute Decompensation score (sHR=1.05; p=0.001) and C reactive protein (sHR=1.01;p=0.034) were found to be independent predictors of in-hospital mortality. Patients with Sepsis-3 had higher incidence of acute-on-chronic liver failure, septic shock and transfer to ICU than those without Sepsis-3. CONCLUSIONS Sepsis-3 criteria are more accurate than SIRS criteria in predicting the severity of infections in patients with cirrhosis. qSOFA is a useful bedside tool to assess risk for worse outcomes in these patients. Patients with Sepsis-3 and positive qSOFA deserve more intensive management and strict surveillance.
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Affiliation(s)
- Salvatore Piano
- Department of Medicine, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Michele Bartoletti
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marta Tonon
- Department of Medicine, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giada Chies
- Department of Medicine, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Antonietta Romano
- Department of Medicine, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elia Vettore
- Department of Medicine, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marialuisa Stanco
- Department of Medicine, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Chiara Pilutti
- Department of Medicine, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padova, Padova, Italy
| | - Alessandra Brocca
- Department of Medicine, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Paolo Angeli
- Department of Medicine, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
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Bartoletti M, Baldassarre M, Domenicali M, Lewis R, Giannella M, Rinaldi M, Tufoni M, Zaccherini G, Tamè M, Berardi S, Napoli L, Pavarin F, Angela F, Trevisani F, Bernardi M, Viale P, Caraceni P. Bacterial infections with and without acute-on-chronic liver failure in patients with cirrhosis and acute decompensation: Risk factors and outcome. Dig Liver Dis 2018. [DOI: 10.1016/j.dld.2018.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Baldassarre M, Caputo F, Pavarin RM, Bossi MM, Bonavita ME, Caraceni P, Grignaschi A, Balloni M, Cavazza M, Bernardi M, Domenicali M. Accesses for alcohol intoxication to the emergency department and the risk of re-hospitalization: An observational retrospective study. Addict Behav 2018; 77:1-6. [PMID: 28918344 DOI: 10.1016/j.addbeh.2017.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/13/2017] [Accepted: 08/29/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Alcohol use disorders (AUD) are a frequent cause of admission to emergency departments (EDs) for acute alcohol intoxication (AAI). Patients with AUD present a higher risk of readmission to EDs for AAI than the general population, however, the distinction between sporadic AAI and AAI in the context of AUD in the ED setting is difficult. AIMS To analyze the epidemiological characteristics of patients admitted to EDs because of AAI and to identify factors associated with repeated admissions in order to develop a risk stratification system for patients with AUD based on objective data that can be easily applied in an ED setting. METHODS An observational retrospective study was performed. All patients with diagnosis of AAI at admission in 2014 were enrolled. RESULTS Five hundred and sixty-five patients were enrolled, of which 92 (16%) were admitted more than once to the ED. At multivariate analysis, factors associated with readmission were past episodes of alcohol abuse, social discomfort, previous traumas and psychiatric disorders. Basing on this parameter, a risk-score for re-hospitalization was developed. This score has a high predictive power for the risk of readmission to the ED (AROC 0.837, 95%CI 0.808-0.866), moreover, the cumulative probability of readmission within one year, increased in parallel with score value, being highest in patients presenting 3 or more risk factors. CONCLUSION The present study demonstrates that several risk factors stratify the risk of re-hospitalization in patients admitted to EDs for AAI, allowing the identification of those presenting more severe conditions and who would likely benefit from multidisciplinary intervention.
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Baldassarre M, Naldi M, Domenicali M, Volo S, Pietra M, Dondi F, Caraceni P, Peli A. Simple and rapid LC–MS method for the determination of circulating albumin microheterogeneity in veal calves exposed to heat stress. J Pharm Biomed Anal 2017; 144:263-268. [DOI: 10.1016/j.jpba.2017.04.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/10/2017] [Accepted: 04/23/2017] [Indexed: 12/17/2022]
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Naldi M, Baldassarre M, Domenicali M, Bartolini M, Caraceni P. Structural and functional integrity of human serum albumin: Analytical approaches and clinical relevance in patients with liver cirrhosis. J Pharm Biomed Anal 2017; 144:138-153. [PMID: 28465079 DOI: 10.1016/j.jpba.2017.04.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/04/2017] [Accepted: 04/15/2017] [Indexed: 02/08/2023]
Abstract
Human serum albumin (HSA) is the most abundant circulating plasma protein. Besides a significant contribution to the osmotic pressure, it is also involved in the fine regulation of many other physiological processes, including the balance of the redox state, the inflammatory and/or immunological responses, and the pharmacokinetic and pharmacodynamics of many drugs. Growing evidence suggests that HSA undergoes structural and functional damage in diseases characterized by an enhanced systemic inflammatory response and oxidative stress, as it occurs in chronic liver disease. Based on their clinical relevance, this review provides a summary of the most common post-translational modifications affecting HSA structural integrity and functions and their clinical relevance in the field of liver disease. The review also provides a critical description of the analytical approaches employed for the investigation of conformational alterations and the identification/quantitation of specific post-translational modifications affecting HSA. Finally, the analytical methods available for the assessment of two of the most clinically relevant non-oncotic properties of HSA, namely the binding capacity and the antioxidant activity, are critically reviewed. Among the available techniques particular attention is given to those proposed for the in vitro and in vivo investigation of structurally modified albumin.
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Affiliation(s)
- Marina Naldi
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum University of Bologna, Via Belmeloro 6, 40126, Italy; Center for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Maurizio Baldassarre
- Center for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Italy
| | - Marco Domenicali
- Center for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Italy
| | - Manuela Bartolini
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum University of Bologna, Via Belmeloro 6, 40126, Italy
| | - Paolo Caraceni
- Center for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Italy.
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Conti F, Vukotic R, Foschi FG, Domenicali M, Giacomoni P, Savini S, Lanzi A, Dall'Aglio AC, Saini G, Matroroberto M, Bernardi M, Stefanini GF, Andreone P. Transient elastography in healthy subjects and factors influencing liver stiffness in non-alcoholic fatty liver disease: An Italian community-based population study. Dig Liver Dis 2016; 48:1357-1363. [PMID: 27522549 DOI: 10.1016/j.dld.2016.07.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 11/18/2015] [Revised: 05/17/2016] [Accepted: 07/20/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Few studies have been performed to explore parameters that influence liver stiffness measurement (LSM) using transient elastography in general population. AIM To explore factors influencing LSM in healthy and in subjects with non-alcoholic fatty liver disease (NAFLD). METHODS LSM was performed in a well-characterized cohort of subjects aged between 30 and 63 years. After exclusion of any causes of liver disease, the healthy cohort was defined and was compared with participants with NAFLD. The 95th percentile value of LSM in healthy was used as a cutoff suggesting relevant fibrosis. RESULTS Among 780 subjects evaluated, 331 were defined as healthy. The median value was 4.4kPa (3.7-5.2) and the 95th percentile was 6.8kPa. LSM was not influenced by gender, age, anthropometrics and biochemical parameters. Only insulin resistance was independently associated with increasing of LSM. In the cohort of 157 subjects with NAFLD, LSM was higher than in healthy (5.6±1.9 vs 4.6±1.3kPa; p<0.001). On multivariate analysis, the degree of steatosis was independently associated with increasing of LSM in NAFLD cohort (β=0.271; 95% CI=0.026-0.095; p<0.001). Participants with diabetes and/or severe steatosis had the highest probabilities of relevant fibrosis. CONCLUSIONS LSM varies between 3.7 and 5.2kPa in healthy Caucasians and is influenced only by insulin resistance. In NAFLD, severe steatosis and diabetes are factors influencing LSM.
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Affiliation(s)
- Fabio Conti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ranka Vukotic
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Pierluigi Giacomoni
- Department of Internal Medicine, Hospital of Faenza, AUSL Romagna, Faenza (RA), Italy
| | - Sara Savini
- Department of Internal Medicine, Hospital of Faenza, AUSL Romagna, Faenza (RA), Italy
| | - Arianna Lanzi
- Department of Internal Medicine, Hospital of Faenza, AUSL Romagna, Faenza (RA), Italy
| | | | - Gaia Saini
- Department of Internal Medicine, Hospital of Faenza, AUSL Romagna, Faenza (RA), Italy
| | | | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Pietro Andreone
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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Clària J, Stauber RE, Coenraad MJ, Moreau R, Jalan R, Pavesi M, Amorós À, Titos E, Alcaraz-Quiles J, Oettl K, Morales-Ruiz M, Angeli P, Domenicali M, Alessandria C, Gerbes A, Wendon J, Nevens F, Trebicka J, Laleman W, Saliba F, Welzel TM, Albillos A, Gustot T, Benten D, Durand F, Ginès P, Bernardi M, Arroyo V. Systemic inflammation in decompensated cirrhosis: Characterization and role in acute-on-chronic liver failure. Hepatology 2016; 64:1249-64. [PMID: 27483394 DOI: 10.1002/hep.28740] [Citation(s) in RCA: 472] [Impact Index Per Article: 59.0] [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: 03/15/2016] [Accepted: 07/27/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED Acute-on-chronic liver failure (ACLF) in cirrhosis is characterized by acute decompensation (AD), organ failure(s), and high short-term mortality. Recently, we have proposed (systemic inflammation [SI] hypothesis) that ACLF is the expression of an acute exacerbation of the SI already present in decompensated cirrhosis. This study was aimed at testing this hypothesis and included 522 patients with decompensated cirrhosis (237 with ACLF) and 40 healthy subjects. SI was assessed by measuring 29 cytokines and the redox state of circulating albumin (HNA2), a marker of systemic oxidative stress. Systemic circulatory dysfunction (SCD) was estimated by plasma renin (PRC) and copeptin (PCC) concentrations. Measurements were performed at enrollment (baseline) in all patients and sequentially during hospitalization in 255. The main findings of this study were: (1) Patients with AD without ACLF showed very high baseline levels of inflammatory cytokines, HNA2, PRC, and PCC. Patients with ACLF showed significantly higher levels of these markers than those without ACLF; (2) different cytokine profiles were identified according to the type of ACLF precipitating event (active alcoholism/acute alcoholic hepatitis, bacterial infection, and others); (3) severity of SI and frequency and severity of ACLF at enrollment were strongly associated. The course of SI and the course of ACLF (improvement, no change, or worsening) during hospitalization and short-term mortality were also strongly associated; and (4) the strength of association of ACLF with SI was higher than with SCD. CONCLUSION These data support SI as the primary driver of ACLF in cirrhosis. (Hepatology 2016;64:1249-1264).
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Affiliation(s)
- Joan Clària
- Department of Biochemistry and Molecular Genetics, Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Rudolf E Stauber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Richard Moreau
- Inserm, U1149, Centre de Recherche sur l'Inflammation (CRI), UMRS1149; Université Paris Diderot-Paris 7, Département Hospitalo-Universitaire (DHU) UNITY; Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Excellence Inflamex, ComUE Sorbonne Paris Cité, Paris, France
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver Disease Health, University College London, Royal Free Hospital, London, United Kingdom
| | - Marco Pavesi
- EF-CLIF and EASL-CLIF Consortium, Barcelona, Spain
| | - Àlex Amorós
- EF-CLIF and EASL-CLIF Consortium, Barcelona, Spain
| | - Esther Titos
- Department of Biochemistry and Molecular Genetics, Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - José Alcaraz-Quiles
- Department of Biochemistry and Molecular Genetics, Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Karl Oettl
- Institute of Physiological Chemistry, Medical University of Graz, Graz, Austria
| | - Manuel Morales-Ruiz
- Department of Biochemistry and Molecular Genetics, Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, DIMED, University of Padova, Padova, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo Alessandria
- Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Torino, Italy
| | - Alexander Gerbes
- Department of Medicine II, University Hospital LMU Munich, Liver Center Munich, Munich, Germany
| | | | - Frederik Nevens
- University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Jonel Trebicka
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Wim Laleman
- University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Faouzi Saliba
- Hôpital Paul Brousse, Université Paris-Sud, Villejuif, France
| | | | | | - Thierry Gustot
- Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel Benten
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - François Durand
- Inserm, U1149, Centre de Recherche sur l'Inflammation (CRI), UMRS1149; Université Paris Diderot-Paris 7, Département Hospitalo-Universitaire (DHU) UNITY; Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Excellence Inflamex, ComUE Sorbonne Paris Cité, Paris, France
| | - Pere Ginès
- Liver Unit, Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain.
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Caputo F, Maremmani AGI, Addolorato G, Domenicali M, Zoli G, D'Amore A, Maremmani I, Bernardi M. Sodium oxybate plus nalmefene for the treatment of alcohol use disorder: A case series. J Psychopharmacol 2016; 30:402-9. [PMID: 26860331 DOI: 10.1177/0269881116629126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Indexed: 11/16/2022]
Abstract
The treatment of alcohol use disorder still remains a challenge. The efficacy of the combined pharmacological treatment for alcohol use disorder has been widely investigated with controversial results. The aim of our case series was to investigate the effect of nalmefene in patients not responding to sodium oxybate therapy. We describe seven cases of consecutive patients affected by alcohol use disorder, and treated with sodium oxybate (50 mg/kg per day) who did not achieve complete alcohol abstinence after at least one month of pharmacological treatment. Then, in partial- and non-responder patients to sodium oxybate treatment, administration of nalmefene, 18 mg as needed, was commenced. Our data show that, during the first month of the combined treatment of sodium oxybate plus nalmefene, patients were able to achieve alcohol abstinence (two patients), to suppress (five cases) or reduce (two patients) episodes of heavy drinking days, and to suppress the onset of craving for sodium oxybate (one patient). Likely, nalmefene may act in modulating the excessive reward effect of sodium oxybate, which may be responsible for the persistence of alcohol intake and for the onset of craving for sodium oxybate. However, controlled clinical trials to confirm the safety and efficacy of sodium oxybate plus nalmefene in treating alcohol use disorder are warranted.
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Affiliation(s)
- Fabio Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy 'G Fontana' Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | - Angelo G I Maremmani
- Vincent P Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Giovanni Addolorato
- Alcohol Use Disorders Unit, Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | - Marco Domenicali
- 'G Fontana' Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | - Giorgio Zoli
- Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy
| | - Antonio D'Amore
- Centre for The Treatment of Alcoholism, Region of Campania, Aversa, Italy
| | - Icro Maremmani
- Vincent P Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Mauro Bernardi
- 'G Fontana' Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Clinical Medicine, University of Bologna, Bologna, Italy
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Grønbæk H, Rødgaard-Hansen S, Aagaard NK, Arroyo V, Moestrup SK, Garcia E, Solà E, Domenicali M, Piano S, Vilstrup H, Møller HJ. Macrophage activation markers predict mortality in patients with liver cirrhosis without or with acute-on-chronic liver failure (ACLF). J Hepatol 2016; 64:813-22. [PMID: 26639396 DOI: 10.1016/j.jhep.2015.11.021] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [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: 06/22/2015] [Revised: 10/21/2015] [Accepted: 11/17/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Activation of liver macrophages plays a key role in liver and systemic inflammation and may be involved in development and prognosis of acute-on-chronic liver failure (ACLF). We therefore measured the circulating macrophage activation markers soluble sCD163 and mannose receptor (sMR) and related them to the short-(1-3 months) and long-term (6 months) mortality in the cirrhosis patients of the CANONIC study. METHODS Eighty-six cirrhosis patients had no ascites and no ACLF, 580 had ascites but no ACLF; 100, 66, and 19 had ACLF-grade-I (ACLF-I), ACLF-II, and ACLF-III, respectively. The patients' clinical course was registered and their MELD, CLIF-C Acute Decompensation (AD), and CLIF-C ACLF-scores computed at inclusion. RESULTS We found a stepwise increase (p<0.001) in median sCD163 (5.68 (IQR: 3.86-9.60); 8.26 (5.02-12.34); 9.50 (5.37-17.91); 15.68 (10.12-19.42); 20.18 (15.26-32.20) mg/L) and sMR (0.60 (0.40-0.84); 0.81 (0.57-1.12); 0.81 (0.61-1.26); 1.17 (0.89-1.62); 1.41 (1.14-1.79)mg/L) with increasing grades of ACLF. Both sCD163 and sMR were independently associated with short and long-term mortality and showed equal or higher predictive accuracy than MELD, CLIF-C ACLF and CLIF-C AD scores. Addition of the macrophage markers to the clinical scores improved the prognostic efficacy: In ACLF patients sCD163 improved prediction of short-term mortality (C-index: 0.74 (0.67-0.80)) and in patients without ACLF sMR improved prediction of long-term mortality (C-index: 0.80 (0.76-0.85)). CONCLUSIONS The severity related increase in sCD163 and sMR and close association with mortality suggest a primary importance of inflammatory activation of liver macrophages in the emergence and course of ACLF. Accordingly, supplementation of the macrophage biomarkers to the platform of the clinical scores improved the prognostic performance beyond that of the original scores.
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Affiliation(s)
- Henning Grønbæk
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Niels Kristian Aagaard
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren K Moestrup
- Department of Biomedicine, Aarhus University, Aarhus & Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Elsa Solà
- Liver Unit, Hospital Clinic de Barcelona, Unviersity of Barcelona, IDIBAPS, CIBEReHD, Barcelona, Spain
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Salvatore Piano
- Unit of Hepatic Emergencies and Liver Transplantation, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Hendrik Vilstrup
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Holger Jon Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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Caputo F, Vignoli T, Tarli C, Domenicali M, Zoli G, Bernardi M, Addolorato G. A Brief Up-Date of the Use of Sodium Oxybate for the Treatment of Alcohol Use Disorder. Int J Environ Res Public Health 2016; 13:E290. [PMID: 26959045 PMCID: PMC4808953 DOI: 10.3390/ijerph13030290] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/08/2016] [Accepted: 02/23/2016] [Indexed: 01/01/2023]
Abstract
The treatment of alcohol use disorder (AUD) with sodium oxybate (SMO) or gamma-hydroxybutyric acid (GHB) was introduced in Italy and Austria more than 20 years and 15 years ago, respectively, and it is now widely employed to treat alcohol withdrawal syndrome (AWS) and to maintain alcohol abstinence. These indications derive from its similar structure to the inhibitory neurotransmitter γ-amino-butyric acid (GABA), exerting an ethanol-mimicking effect, because it binds to GABAB receptors. Craving for, and abuse of, SMO remain a controversial issue; even though these unfavorable effects are evident in poly-drug addicted patients and in those with psychiatric diagnosis of borderline personality disorder. In addition, despite cases of severe intoxication and deaths being widely documented when GHB is used as "street drug"; its clinical use remains safe. Thus, the aim of the present review is to examine the role of SMO in the treatment of AUD, its possible implications in reducing alcohol consumption, and cases of abuse, and severe intoxication due to SMO during its clinical use in the treatment of AUD.
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Affiliation(s)
- Fabio Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara 44042, Italy.
- "G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Clinical Medicine, University of Bologna, Bologna 40130, Italy.
| | - Teo Vignoli
- Unit for Addiction Treatment, Department of Mental Health, Lugo, Ravenna 48022, Italy.
| | - Claudia Tarli
- Alcohol Use Disorders Unit, Department of Internal Medicine, Catholic University of Rome, Rome 00168, Italy.
| | - Marco Domenicali
- "G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Clinical Medicine, University of Bologna, Bologna 40130, Italy.
| | - Giorgio Zoli
- Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara 44042, Italy.
| | - Mauro Bernardi
- "G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Clinical Medicine, University of Bologna, Bologna 40130, Italy.
| | - Giovanni Addolorato
- Alcohol Use Disorders Unit, Department of Internal Medicine, Catholic University of Rome, Rome 00168, Italy.
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42
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Pavarin RM, Caputo F, Zoli G, Domenicali M, Bernardi M, Gambini D. Mortality risk in a cohort of Italian alcoholic individuals treated for alcohol dependence. Drug Alcohol Rev 2015; 36:186-191. [PMID: 26643015 DOI: 10.1111/dar.12366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/21/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS The aim of this study was to investigate the mortality risk and to explore the presence of subjects more at risk of dying in a cohort of alcoholic individuals treated for alcohol dependence over a lengthy follow-up period. DESIGN AND METHODS A total of 2363 subjects attending 10 centres for addiction treatment for alcohol dependence were recruited. RESULTS During the 17 year follow-up period, 14.7% of the entire cohort died. Total standardised mortality rates (SMR) were higher in women (SMR = 5.94) as compared with men (SMR = 4.65). Higher SMRs were found for several diseases, for traumatic episodes (SMR = 6.65) and in younger patients (18-44 age group) (SMR = 8.16). Alcoholic women showed a higher survival rate as compared with men. In addition, a higher risk of death for men and unemployed subjects, with a progressive increase of risk in line with the increase of the age of admission to treatment, and with a progressive decrease of risk after 1 year from the beginning of the treatment, was also found. DISCUSSION AND CONCLUSIONS This study confirms that mortality risk in alcoholic individuals in treatment is higher in comparison with the general population. Moreover, alcoholics men, unemployed, >40 years at time of admission and during the first year of treatment are more at risk to die. Thus, much more attention to patients with these characteristics should be planned by the professional staff working in centres for addiction treatment. [ Pavarin R M, Caputo F, Zoli G, Domenicali M, Bernardi M, Gambini D. Mortality risk in a cohort of Italian alcoholic individuals treated for alcohol dependence Drug Alcohol Rev 2017;36:186-191].
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Affiliation(s)
| | - Fabio Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy.,Department of Medical and Surgical Sciences, 'G. Fontana' Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, University of Bologna, Bologna, Italy
| | - Giorgio Zoli
- Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, 'G. Fontana' Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, University of Bologna, Bologna, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, 'G. Fontana' Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, University of Bologna, Bologna, Italy
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Giannone FA, Domenicali M, Baldassarre M, Caraceni P. Response to The reduced CO(2+) -binding ability of ischaemia-modified albumin is unlikely to be because of oxidative modification of the N-terminus". Liver Int 2015; 35:2623-4. [PMID: 26053692 DOI: 10.1111/liv.12885] [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)
- Ferdinando A Giannone
- U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marco Domenicali
- U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maurizio Baldassarre
- U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paolo Caraceni
- U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi University Hospital, Bologna, Italy
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44
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Giannone FA, Domenicali M, Baldassarre M, Bartoletti M, Naldi M, Laggetta M, Bertucci C, Colecchia A, Viale P, Bernardi M, Caraceni P. Ischaemia-modified albumin: a marker of bacterial infection in hospitalized patients with cirrhosis. Liver Int 2015; 35:2425-32. [PMID: 25939693 DOI: 10.1111/liv.12860] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 02/02/2015] [Accepted: 04/26/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Patients with cirrhosis present structural changes of human serum albumin (HSA) affecting non-oncotic functions. Ischaemia-modified albumin (IMA), which reflects the capacity to bind cobalt, has been associated to patient mortality during acute-on-chronic liver failure. This study aimed to assess whether circulating IMA is elevated in advanced cirrhosis and its relationship with severity of cirrhosis and specific complications. METHODS A total of 127 cirrhotic patients hospitalized for an acute complication of the disease and 44 healthy controls were enrolled. Plasma IMA and IMA to albumin ratio (IMAr) were measured with a cobalt-binding assay. HSA isoforms carrying post-transcriptional molecular changes were assessed with HPLC-ESI-MS. The effect of endotoxemia on IMA was evaluated in rats with CCl4 -cirrhosis. RESULTS IMA/IMAr is significantly higher in cirrhotic patients than in controls, but no correlations were found with prognostic scores. IMA did not correlate with the altered HSA isoforms. Ascites, renal impairment and hepatic encephalopathy did not influence IMA/IMAr levels. In contrast, IMA/IMAr is significantly higher in infected than non-infected patients. ROC curves showed that IMA/IMAr had similar discriminating performances for bacterial infection as C-reactive protein (CRP). Moreover, CRP and IMA were independently associated with bacterial infection. Consistently, endotoxin injection significantly increased IMA in cirrhotic, but not in healthy rats. CONCLUSIONS IMA is elevated in patients with advanced cirrhosis. The IMA level does not correlate with disease severity scores, but it is specifically associated to bacterial infection, showing a discriminating performance similar to CRP. Further investigations to assess IMA as a novel diagnostic test for bacterial infection are advocated.
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Affiliation(s)
- Ferdinando A Giannone
- U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marco Domenicali
- U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maurizio Baldassarre
- U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Michele Bartoletti
- U.O. Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marina Naldi
- Center for Applied Biomedical Research (C.R.B.A.), S.Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Pharmacology and Biotechnology, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maristella Laggetta
- U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Carlo Bertucci
- Department of Pharmacology and Biotechnology, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Antonio Colecchia
- U.O. Gastroenterology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Pierluigi Viale
- U.O. Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Mauro Bernardi
- U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paolo Caraceni
- U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S.Orsola-Malpighi University Hospital, Bologna, Italy
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45
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Domenicali M, Grignaschi A, Baldassarre M, Caputo F, Bossi MM, Vignoli T, Guerrini S, Cavazza M, Bernardi M. P-28RISK OF RE-HOSPITALIZATION IN PATIENTS ATTENDING THE EMERGENCY DEPARTMENT FOR ACUTE ALCOHOL INTOXICATION: AN OBSERVATIONAL RETROSPECTIVE STUDY. Alcohol Alcohol 2015. [DOI: 10.1093/alcalc/agv080.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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46
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Naldi M, Baldassarre M, Nati M, Laggetta M, Giannone FA, Domenicali M, Bernardi M, Caraceni P, Bertucci C. Mass spectrometric characterization of human serum albumin dimer: A new potential biomarker in chronic liver diseases. J Pharm Biomed Anal 2015; 112:169-75. [DOI: 10.1016/j.jpba.2014.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/30/2014] [Accepted: 12/02/2014] [Indexed: 01/08/2023]
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Gustot T, Fernandez J, Garcia E, Morando F, Caraceni P, Alessandria C, Laleman W, Trebicka J, Elkrief L, Hopf C, Solís-Munoz P, Saliba F, Zeuzem S, Albillos A, Benten D, Montero-Alvarez JL, Chivas MT, Concepción M, Córdoba J, McCormick A, Stauber R, Vogel W, de Gottardi A, Welzel TM, Domenicali M, Risso A, Wendon J, Deulofeu C, Angeli P, Durand F, Pavesi M, Gerbes A, Jalan R, Moreau R, Ginés P, Bernardi M, Arroyo V, Bañares R, Bocci M, Catalina MV, Chin JL, Coenraad MJ, Coilly A, Dorn L, Gatta A, Gerber L, Grøenbæk H, Graupera I, Guevara M, Hausen A, Karlsen S, Lohse AW, Maggioli C, Markwardt D, Martinez J, Marzano A, de la Mata García M, Mesonero F, Mookerjee RP, Moreno C, Morrell B, Mortensen C, Nevens F, Peck‐Radosavljevic M, Rizzetto M, Romano A, Samuel D, Sauerbruch T, Simon‐Talero M, Solà E, Soriano G, Sperl J, Spindelboeck W, Steib C, Valla D, Verbeke L, Van Vlierberghe H, Wege H, Willars C, Baenas MY, Zaccherini G. Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology 2015; 62:243-52. [PMID: 25877702 DOI: 10.1002/hep.27849] [Citation(s) in RCA: 407] [Impact Index Per Article: 45.2] [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: 10/29/2014] [Accepted: 04/07/2015] [Indexed: 12/20/2022]
Abstract
UNLABELLED Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation (AD) of cirrhosis, organ failure(s), and high 28-day mortality. We investigated whether assessments of patients at specific time points predicted their need for liver transplantation (LT) or the potential futility of their care. We assessed clinical courses of 388 patients who had ACLF at enrollment, from February through September 2011, or during early (28-day) follow-up of the prospective multicenter European Chronic Liver Failure (CLIF) ACLF in Cirrhosis study. We assessed ACLF grades at different time points to define disease resolution, improvement, worsening, or steady or fluctuating course. ACLF resolved or improved in 49.2%, had a steady or fluctuating course in 30.4%, and worsened in 20.4%. The 28-day transplant-free mortality was low-to-moderate (6%-18%) in patients with nonsevere early course (final no ACLF or ACLF-1) and high-to-very high (42%-92%) in those with severe early course (final ACLF-2 or -3) independently of initial grades. Independent predictors of course severity were CLIF Consortium ACLF score (CLIF-C ACLFs) and presence of liver failure (total bilirubin ≥12 mg/dL) at ACLF diagnosis. Eighty-one percent had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade at 3-7 days. Among patients that underwent early LT, 75% survived for at least 1 year. Among patients with ≥4 organ failures, or CLIF-C ACLFs >64 at days 3-7 days, and did not undergo LT, mortality was 100% by 28 days. CONCLUSIONS Assessment of ACLF patients at 3-7 days of the syndrome provides a tool to define the emergency of LT and a rational basis for intensive care discontinuation owing to futility.
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Affiliation(s)
- Thierry Gustot
- Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Elisabet Garcia
- Data Management Center of the EASL-CLIF Consortium, CIBEReHD, Barcelona, Spain
| | | | | | | | - Wim Laleman
- University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | - Corinna Hopf
- University of Munich, Klinikum der LMU, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carme Deulofeu
- Data Management Center of the EASL-CLIF Consortium, CIBEReHD, Barcelona, Spain
| | | | | | - Marco Pavesi
- Data Management Center of the EASL-CLIF Consortium, CIBEReHD, Barcelona, Spain
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Caputo F, Mirijello A, Cibin M, Mosti A, Ceccanti M, Domenicali M, Bernardi M, Maremmani I, Addolorato G. Novel strategies to treat alcohol dependence with sodium oxybate according to clinical practice. Eur Rev Med Pharmacol Sci 2015; 19:1315-1320. [PMID: 25912595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The treatment of alcohol dependence (AD) with sodium oxybate (SMO) was introduced in Italy and Austria more than 20 years and 15 years ago respectively, and it is now widely employed. In addition to the data obtained from clinical trials, little information is available on specific clinical practices. Thus, the aim of this study was to present and discuss the results of a consensus meeting held after twenty years of using SMO in clinical practice in Italy. MATERIALS AND METHODS A validated questionnaire study was conducted to investigate the modalities of treatment of AD with SMO currently used in Italy. A group of four referees first drew up the questionnaire which was distributed to fifty experts in the field of alcohol use disorders. The questionnaire consisted of 125 items with five different modalities of response and two or three answer possibilities. RESULTS The results of this survey showed a broad consensus on some issues regarding, for example, the duration of treatment, and the dose regimen of the drug; however, some aspects of the treatment of AD with SMO still remain controversial. CONCLUSIONS This is the first consensus study investigating the use of SMO for the treatment of AD through the opinions gained in over twenty years of clinical practice provided by fifty Italian expert clinicians. A consensus on good practice for the correct administration of SMO has clearly emerged; these opinions, along with those derived from previous clinical investigations, will help physicians to use SMO in a better way. However, some issues remain controversial, and others remain unresolved.
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Affiliation(s)
- F Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy.
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Domenicali M, Baldassarre M, Giannone FA, Naldi M, Mastroroberto M, Biselli M, Laggetta M, Patrono D, Bertucci C, Bernardi M, Caraceni P. Posttranscriptional changes of serum albumin: clinical and prognostic significance in hospitalized patients with cirrhosis. Hepatology 2014; 60:1851-60. [PMID: 25048618 DOI: 10.1002/hep.27322] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [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: 12/20/2013] [Accepted: 07/13/2014] [Indexed: 12/16/2022]
Abstract
UNLABELLED Beside the regulation of fluid distribution, human serum albumin (HSA) carries other activities, such as binding, transport, and detoxification of many molecules. In patients with cirrhosis, HSA exhibits posttranscriptional alterations that likely affect its functions. This study aimed at identifying the structural HSA alterations occurring in cirrhosis and determining their relationship with specific clinical complications and patient survival. One hundred sixty-eight patients with cirrhosis, 35 with stable conditions and 133 hospitalized for acute clinical complications, and 94 healthy controls were enrolled. Posttranscriptional HSA molecular changes were identified and quantified by using a high-performance liquid chromatography/electrospray ionization mass spectrometry technique. Clinical and biochemical parameters were also recorded and hospitalized patients were followed for up to 1 year. Seven HSA isoforms carrying one or more posttranscriptional changes were identified. Altered HSA isoforms were significantly more represented in patients than in healthy controls. Conversely, the native, unchanged HSA isoform was significantly reduced in cirrhosis. Native HSA and most altered isoforms correlated with both Child-Pugh and Model for End-Stage Liver Disease scores. In hospitalized patients, oxidized and N-terminal truncated isoforms were independently associated with ascites, renal impairment, and bacterial infection. Finally, the native HSA and cysteinylated/N-terminal truncated isoforms were predictors of 1-year survival, with greater prognostic accuracy than total serum albumin concentration. CONCLUSIONS Extensive posttranscriptional changes of HSA, involving several molecular sites and increasing in parallel with disease severity, occur in patients with cirrhosis. Altered isoforms are independently associated with specific clinical complications, whereas the residual, native HSA isoform independently predicts patient survival. These findings support the concept of the "effective albumin concentration," which implies that the global HSA function is related not only to its serum concentration, but also to the preservation of its structural integrity.
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Affiliation(s)
- Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy; Center for Applied Biomedical Research (C.R.B.A.), S.Orsola-Malpighi University Hospital, Bologna, Bologna, Italy
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50
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Affiliation(s)
- Fabio Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento, Italy
| | - Marco Domenicali
- "G. Fontana" Centre for Treatment of Alcohol Addiction, University of Bologna, Bologna, Italy
| | - Mauro Bernardi
- "G. Fontana" Centre for Treatment of Alcohol Addiction, University of Bologna, Bologna, Italy
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