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Iavarone M, D'Ambrosio R, Soria A, Triolo M, Pugliese N, Del Poggio P, Perricone G, Massironi S, Spinetti A, Buscarini E, Viganò M, Carriero C, Fagiuoli S, Aghemo A, Belli LS, Lucà M, Pedaci M, Rimondi A, Rumi MG, Invernizzi P, Bonfanti P, Lampertico P. High rates of 30-day mortality in patients with cirrhosis and COVID-19. J Hepatol 2020; 73:1063-1071. [PMID: 32526252 PMCID: PMC7280108 DOI: 10.1016/j.jhep.2020.06.001] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities, but its impact on patients with cirrhosis is currently unknown. Herein, we aimed to evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis. METHODS In this multicentre retrospective study, patients with cirrhosis and a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. Clinical and biochemical data at diagnosis of COVID-19 and at the last outpatient visit were obtained through review of medical records. RESULTS Fifty patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virus-related, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/polypnea, 22% encephalopathy, 96% needed hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with a model for end-stage liver disease (MELD) score ≥15 increased from 13% to 26% (p = 0.037), acute-on-chronic liver failure and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. The severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections. CONCLUSION COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis. LAY SUMMARY Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities. Herein, we assessed its impact on patients with cirrhosis. Infection with COVID-19 was associated with liver function deterioration and elevated mortality in patients with cirrhosis.
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Affiliation(s)
- Massimo Iavarone
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy.
| | - Roberta D'Ambrosio
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Alessandro Soria
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano - Bicocca School of Medicine, Monza, Italy
| | - Michela Triolo
- Gastroenterology 1 - Hepatology & Transplantology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Paolo Del Poggio
- UO Gastroenterologia. Policlinico S. Marco, Zingonia-Bergamo, Italy
| | | | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Angiola Spinetti
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Elisabetta Buscarini
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Ospedale Maggiore, Crema, Italy
| | - Mauro Viganò
- Division of Hepatology, Ospedale San Giuseppe, Italy
| | - Canio Carriero
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Stefano Fagiuoli
- Gastroenterology 1 - Hepatology & Transplantology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Luca S Belli
- Hepatology and Gastroenterology Unit, Niguarda Hospital, Milan, Italy
| | - Martina Lucà
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marianna Pedaci
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Ospedale Maggiore, Crema, Italy; University of Milan, Milan, Italy
| | - Alessandro Rimondi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; University of Milan, Milan, Italy
| | - Maria Grazia Rumi
- Division of Hepatology, Ospedale San Giuseppe, Italy; University of Milan, Milan, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Paolo Bonfanti
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano - Bicocca School of Medicine, Monza, Italy
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Caballol B, Reverter E, Cid J, Hernández-Tejero M, Triolo M, Lozano M, Fernández J. Fulminant hepatitis A complicated by Takotsubo syndrome successfully treated with standard volume plasma exchange. JHEP Rep 2019; 1:445-448. [PMID: 32039396 PMCID: PMC7005653 DOI: 10.1016/j.jhepr.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/13/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Fulminant hepatic failure is an unusual complication of hepatitis A virus infection which, without liver transplantation, is associated with a poor prognosis. We report a case of fulminant hepatitis A complicated by severe cardiac dysfunction, related to Takotsubo syndrome, that was considered a contraindication for transplantation and was successfully managed with standard volume plasma exchange.
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Affiliation(s)
- Berta Caballol
- Liver ICU, Liver Unit, IMDiM, Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Enric Reverter
- Liver ICU, Liver Unit, IMDiM, Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Michela Triolo
- Liver ICU, Liver Unit, IMDiM, Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Javier Fernández
- Liver ICU, Liver Unit, IMDiM, Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain.,EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
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Hernández-Tejero M, Triolo M, Fernández J. Reply to: "Another clinical unmet need in liver patients: Multidrug-resistant bacteria in decompensated cirrhosis". J Hepatol 2019; 71:845-846. [PMID: 31351768 DOI: 10.1016/j.jhep.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/03/2019] [Indexed: 12/04/2022]
Affiliation(s)
- M Hernández-Tejero
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - M Triolo
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J Fernández
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain; European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain.
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Sangiovanni A, Triolo M, Iavarone M, Forzenigo LV, Nicolini A, Rossi G, La Mura V, Colombo M, Lampertico P. Multimodality treatment of hepatocellular carcinoma: How field practice complies with international recommendations. Liver Int 2018; 38:1624-1634. [PMID: 29791968 DOI: 10.1111/liv.13888] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 10/06/2017] [Accepted: 05/12/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND Management of hepatocellular carcinoma (HCC) is framed within standardized protocols released by Scientific Societies, whose applicability and efficacy in field practice need refining. AIM We evaluated the applicability and effectiveness of guidelines for the treatment of HCC of the American Association for the Study of the Liver (AASLD). METHODS 370 consecutive cirrhotic patients with de novo HCC in different stages, 253 BCLC A, 66 BCLC B, 51 BCLC C received treatment through a multidisciplinary team (MDT) decision and were followed until death or end of follow-up. RESULTS Treatment was adherent to AASLD recommendations in 205 (81%) BCLC A patients, 36 (54%) BCLC B, and 27 (53%) BCLC C. Radiological complete response was achieved in 165 (45%) patients after the first-line treatment, in 22 (19%) after a second-line and in 9 (23%) after a third-line treatment. Adherence to AASLD recommendation allowed a lower yearly mean mortality rate in BCLC A patients compared with other treatment (5.0% vs 10.4% P = .004), whereas upward treatment stage migration compared with the standard of care was associated with reduced yearly mortality in BCLC B (8.6% vs 20.7%, P = .029) and BCLC C (42.6% vs 59.0%, P = .04) patients. CONCLUSIONS HCC multimodality treatment including other than first-line therapy is common in clinical practice and impact on the achievement of complete response. Personalized treatment was able to provide survival benefits to patients whose profile is not accounted for by international recommendations, which need to be amended.
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Affiliation(s)
- Angelo Sangiovanni
- Division of Gastroenterology and Hepatology, CRC "A.M. and A. Migliavacca" Center for the study of Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Michela Triolo
- Division of Internal Medicine, Policlinico S. Donato, University of Milan, San Donato Milanese, Italy
| | - Massimo Iavarone
- Division of Gastroenterology and Hepatology, CRC "A.M. and A. Migliavacca" Center for the study of Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Laura V Forzenigo
- Division of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Nicolini
- Division of Interventional Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Rossi
- Division of Surgery and Liver Transplant, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Vincenzo La Mura
- Internal Medicine Hemostasis and Thrombosis Division, Biomedical Sciences for Health Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Massimo Colombo
- Department of Medicine and Hepatology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, CRC "A.M. and A. Migliavacca" Center for the study of Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Simón-Talero M, Roccarina D, Martínez J, Lampichler K, Baiges A, Low G, Llop E, Praktiknjo M, Maurer MH, Zipprich A, Triolo M, Vangrinsven G, Garcia-Martinez R, Dam A, Majumdar A, Picón C, Toth D, Darnell A, Abraldes JG, Lopez M, Kukuk G, Krag A, Bañares R, Laleman W, La Mura V, Ripoll C, Berzigotti A, Trebicka J, Calleja JL, Tandon P, Hernandez-Gea V, Reiberger T, Albillos A, Tsochatzis EA, Augustin S, Genescà J, Yu D, Téllez L, Mandorfer M, Garcia-Pagan JC, Berbel C, Ferrusquia J, Ble M, Garcia-Criado MA, Belmonte E, Ney M, Margini C, Casu S, Murgia G, Ludwig C, Rönsch M, Stoevesandt D, Carrion L, Botella ER. Association Between Portosystemic Shunts and Increased Complications and Mortality in Patients With Cirrhosis. Gastroenterology 2018; 154:1694-1705.e4. [PMID: 29360462 DOI: 10.1053/j.gastro.2018.01.028] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/28/2017] [Accepted: 01/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Spontaneous portosystemic shunts (SPSS) have been associated with hepatic encephalopathy (HE). Little is known about their prevalence among patients with cirrhosis or clinical effects. We investigated the prevalence and characteristics of SPSS in patients with cirrhosis and their outcomes. METHODS We performed a retrospective study of 1729 patients with cirrhosis who underwent abdominal computed tomography or magnetic resonance imaging analysis from 2010 through 2015 at 14 centers in Canada and Europe. We collected data on demographic features, etiology of liver disease, comorbidities, complications, treatments, laboratory and clinical parameters, Model for End-Stage Liver Disease (MELD) score, and endoscopy findings. Abdominal images were reviewed by a radiologist (or a hepatologist trained by a radiologist) and searched for the presence of SPSS, defined as spontaneous communications between the portal venous system or splanchnic veins and the systemic venous system, excluding gastroesophageal varices. Patients were assigned to groups with large SPSS (L-SPSS, ≥8 mm), small SPSS (S-SPSS, <8 mm), or without SPSS (W-SPSS). The main outcomes were the incidence of complications of cirrhosis and mortality according to the presence of SPSS. Secondary measurements were the prevalence of SPSS in patients with cirrhosis and their radiologic features. RESULTS L-SPSS were identified in 488 (28%) patients, S-SPSS in 548 (32%) patients, and no shunt (W-SPSS) in 693 (40%) patients. The most common L-SPSS was splenorenal (46% of L-SPSS). The presence and size of SPSS increased with liver dysfunction: among patients with MELD scores of 6-9, 14% had L-SPSS and 28% had S-SPSS; among patients with MELD scores of 10-13, 30% had L-SPSS and 34% had S-SPSS; among patients with MELD scores of 14 or higher, 40% had L-SPSS and 32% had S-SPSS (P < .001 for multiple comparison among MELD groups). HE was reported in 48% of patients with L-SPSS, 34% of patients with S-SPSS, and 20% of patients W-SPSS (P < .001 for multiple comparison among SPSS groups). Recurrent or persistent HE was reported in 52% of patients with L-SPSS, 44% of patients with S-SPSS, and 37% of patients W-SPSS (P = .007 for multiple comparison among SPSS groups). Patients with SPSS also had a larger number of portal hypertension-related complications (bleeding or ascites) than those W-SPSS. Quality of life and transplantation-free survival were lower in patients with SPSS vs without. SPSS were an independent factor associated with death or liver transplantation (hazard ratio, 1.26; 95% confidence interval, 1.06-1.49) (P = .008) in multivariate analysis. When patients were stratified by MELD score, SPSS were associated with HE independently of liver function: among patients with MELD scores of 6-9, HE was reported in 23% with L-SPSS, 12% with S-SPSS, and 5% with W-SPSS (P < .001 for multiple comparison among SPSS groups); among those with MELD scores of 10-13, HE was reported in 48% with L-SPSS, 33% with S-SPSS, and 23% with W-SPSS (P < .001 for multiple comparison among SPSS groups); among patients with MELD scores of 14 or more, HE was reported in 59% with L-SPSS, 57% with S-SPSS, and 48% with W-SPSS (P = .043 for multiple comparison among SPSS groups). Patients with SPSS and MELD scores of 6-9 were at higher risk for ascites (40.5% vs 23%; P < .001) and bleeding (15% vs 9%; P = .038) than patients W-SPSS and had lower odds of transplant-free survival (hazard ratio 1.71; 95% confidence interval, 1.16-2.51) (P = .006). CONCLUSIONS In a retrospective analysis of almost 2000 patients, we found 60% to have SPSS; prevalence increases with deterioration of liver function. SPSS increase risk for HE and with a chronic course. In patients with preserved liver function, SPSS increase risk for complications and death. ClinicalTrials.gov ID NCT02692430.
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Affiliation(s)
- Macarena Simón-Talero
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Davide Roccarina
- Sheila Sherlock Liver Unit and University College London Institute for Liver and Digestive Health, Royal Free Hospital and University College London, London, UK
| | - Javier Martínez
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Katharina Lampichler
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anna Baiges
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Gavin Low
- Department of Radiology, University of Alberta, Edmonton, Alberta, Canada
| | - Elba Llop
- Liver Unit, Hospital U. Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Martin H Maurer
- Department of Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Alexander Zipprich
- First Department of Internal Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Michela Triolo
- Internal Medicine, IRCCS San Donato, Department of Biomedical Sciences for Health, University of Milan, San Donato Milanese, Milan, Italy
| | - Guillaume Vangrinsven
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Rita Garcia-Martinez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain; Instituto de Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - Annette Dam
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Avik Majumdar
- Sheila Sherlock Liver Unit and University College London Institute for Liver and Digestive Health, Royal Free Hospital and University College London, London, UK
| | - Carmen Picón
- Department of Radiology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Spain
| | - Daniel Toth
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anna Darnell
- Department of Radiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Juan G Abraldes
- Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), Centre of Excellence for Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, Canada
| | - Marta Lopez
- Liver Unit, Hospital U. Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Guido Kukuk
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Rafael Bañares
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Vincenzo La Mura
- Internal Medicine, IRCCS San Donato, Department of Biomedical Sciences for Health, University of Milan, San Donato Milanese, Milan, Italy; Centro di Ricerca Coordinata "A. M. e A. Migliavacca per lo Studio e la Cura delle Malattie del Fegato," Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Cristina Ripoll
- First Department of Internal Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Jonel Trebicka
- Department of Internal Medicine I, University of Bonn, Bonn, Germany; European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
| | - Jose Luis Calleja
- Liver Unit, Hospital U. Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Puneeta Tandon
- Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), Centre of Excellence for Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, Canada
| | - Virginia Hernandez-Gea
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
| | - Agustín Albillos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Emmanuel A Tsochatzis
- Sheila Sherlock Liver Unit and University College London Institute for Liver and Digestive Health, Royal Free Hospital and University College London, London, UK
| | - Salvador Augustin
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.
| | - Joan Genescà
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.
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Della Corte C, Triolo M, Iavarone M, Sangiovanni A. Early diagnosis of liver cancer: an appraisal of international recommendations and future perspectives. Liver Int 2016; 36:166-76. [PMID: 26386254 DOI: 10.1111/liv.12965] [Citation(s) in RCA: 17] [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: 08/07/2015] [Accepted: 09/10/2015] [Indexed: 12/17/2022]
Abstract
All Societies, AASLD, EASL, APASL and JSH, identify patients with cirrhosis as a target population for surveillance, with minor differences for additional categories of patients, such as chronic hepatitis B and hepatitis C patients with advanced fibrosis. According to AASLD, liver disease related to metabolic diseases including diabetes and obesity is a recognized target of screening, since those conditions have been causally related to HCC. All societies endorse radiological non-invasive techniques as the mainstay for early diagnosis of HCC, but discrepancies exist between Societies on the utilization of contrast-enhanced ultrasound and utilization of serum markers for surveillance and diagnosis of HCC. The diagnostic algorithm of the international societies differ substantially in the anatomic paradigm of EASL and APASL which identify 1 cm size as the starting point for radiological diagnosis of HCC compared to APASL algorithm based on the dynamic pattern of contrast imaging, independently on tumour size. While strengthening prediction in individual patients is expected to improve cost-effectiveness ratios of screening, the benefits of pre-treatment patient stratification by clinical, histological and genetic scores remain uncertain and exclusion of patients with severe co-morbidities and advanced age is still debated.
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Affiliation(s)
- Cristina Della Corte
- A.M. & A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Policlinico Hospital, University of Milan, Milan, Italy
| | - Michela Triolo
- A.M. & A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Policlinico Hospital, University of Milan, Milan, Italy
| | - Massimo Iavarone
- A.M. & A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Policlinico Hospital, University of Milan, Milan, Italy
| | - Angelo Sangiovanni
- A.M. & A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Policlinico Hospital, University of Milan, Milan, Italy
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Iavarone M, Della Corte C, Pelucchi C, Marconi M, Trotti R, Triolo M, Manini MA, La Vecchia C. Risk of hepatocellular carcinoma in relation to ABO blood type. Dig Liver Dis 2016; 48:94-6. [PMID: 26611335 DOI: 10.1016/j.dld.2015.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 06/10/2015] [Revised: 10/05/2015] [Accepted: 10/11/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mortality and incidence rates of hepatocellular carcinoma (HCC) parallel the geographical distribution of hepatitis B and C viruses among the general population, however genetic factors modulate individual cancer risk. AIMS ABO blood type, as a genetic marker, has previously been associated with the risk of several malignancies; we aimed to evaluate whether an association exists with HCC. METHODS This is a retrospective case-control study based on ABO distribution in 194 patients with HCC, compared with 215 decompensated cirrhotics without HCC listed for liver transplantation, and 90,322 healthy blood donors. RESULTS In patients with HCC, prevalence of blood type O was 35%, vs. 44% in cirrhotics (OR: 0.67, 95% CI 0.45-0.99; p=0.046) and 45% in blood donors (OR: 0.65, 95% CI 0.48-0.88; p=0.004). CONCLUSIONS ABO blood type non-O is associated with higher risk of hepatocellular carcinoma, compared to cirrhotics without HCC and healthy subjects.
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Affiliation(s)
- Massimo Iavarone
- A.M. & A. Migliavacca Center for Liver Disease, 1st Division of Gastroenterology, Fondazione IRCCS Ca' Granda Policlinico Hospital, University of Milan, Italy.
| | - Cristina Della Corte
- A.M. & A. Migliavacca Center for Liver Disease, 1st Division of Gastroenterology, Fondazione IRCCS Ca' Granda Policlinico Hospital, University of Milan, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Department of Epidemiology, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Maurizio Marconi
- Centro Trasfusionale, Fondazione IRCCS Ca' Granda Policlinico Hospital, Milan, Italy
| | - Roberta Trotti
- Centro Trasfusionale, Fondazione IRCCS Ca' Granda Policlinico Hospital, Milan, Italy
| | - Michela Triolo
- A.M. & A. Migliavacca Center for Liver Disease, 1st Division of Gastroenterology, Fondazione IRCCS Ca' Granda Policlinico Hospital, University of Milan, Italy
| | - Matteo Angelo Manini
- A.M. & A. Migliavacca Center for Liver Disease, 1st Division of Gastroenterology, Fondazione IRCCS Ca' Granda Policlinico Hospital, University of Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Dullaart R, Triolo M, de Boer J, Annema W, Tietge U. Simvastatin and bezafibrate differentially impact on various hdl functionality metrics in type 2 diabetes mellitus. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.529] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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Abstract
Hepatocellular carcinoma (HCC) is a frequent, long term complication of chronic infection with hepatitis B virus (HBV) with an annual incidence ranging from 2 to 5%, often independent from the histological stage of underlying liver disease and serological status. Nevertheless, HCC is more often seen in older patients in whom HBV has been asserting its pro-oncogenic properties through both indirect and direct mechanisms. In Europe, HBV-related HCC is associated with cirrhosis in most patients, whereas this is not true in Asia and Africa where the tumour is also common among carriers with mild hepatic fibrosis, probably because of the coexistence of environmental co-carcinogens (aflatoxin) and long standing infection that is often acquired perinatally. Since hepatitis B-related carcinogenesis develops independently of the onset of cirrhosis, antiviral treatments such as nucleo(t)side analogues (NAs) that may result in the regression of fibrosis, prevent clinical decompensation and variceal bleeding, often fail to prevent HCC. Studies enrolling patients treated with lamivudine or rescued with adefovir, i.e. regimens characterized by limited potency and a low to moderate genetic barrier, have clearly been shown to help prevent HCC in patients with chronic hepatitis but not in those with cirrhosis, and in general not in patients that cannot achieve a sustained virological response. More potent anti-HBV drugs, such as entecavir and tenofovir, have been shown to improve the prevention of HCC in responders with cirrhosis, although HCC may still occur even in low risk patients. To attenuate HCC related outcomes, HBV replication must permanently be suppressed and HCC surveillance by abdominal ultrasound should be maintained even in responder patients.
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Affiliation(s)
- Michela Triolo
- 1st Division of Gastroenterology, Department of Liver, Kidney, Lung and Bone Marrow Units and Organ Transplant, A.M. & A. Migliavacca Center for Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
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10
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Triolo M, Annema W, de Boer JF, Tietge UJF, Dullaart RPF. Simvastatin and bezafibrate increase cholesterol efflux in men with type 2 diabetes. Eur J Clin Invest 2014; 44:240-8. [PMID: 24325778 DOI: 10.1111/eci.12226] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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] [Received: 08/19/2013] [Accepted: 12/07/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The importance of functional properties of high-density lipoproteins (HDL) for atheroprotection is increasingly recognized. We determined the impact of lipid-lowering therapy on 3 key HDL functionalities in Type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS A placebo-controlled, randomized cross-over study (three 8-week treatment periods with simvastatin (40 mg daily), bezafibrate (400 mg daily), alone and in combination) was carried out in 14 men with T2DM. Cholesterol efflux was determined using human THP-1 monocyte-derived macrophages, HDL antioxidative capacity was measured as inhibition of low-density lipoprotein oxidation in vitro, and HDL anti-inflammatory capacity was assessed as suppression of thrombin-induced monocyte chemotactic protein 1 expression in human umbilical vein endothelial cells. Pre-β-HDL was assayed using crossed immunoelectrophoresis. RESULTS While cholesterol efflux increased in response to simvastatin, bezafibrate and combination treatment (+12 to +23%; anova, P = 0.001), HDL antioxidative capacity (P = 0.23) and HDL anti-inflammatory capacity (P = 0.15) did not change significantly. Averaged changes in cellular cholesterol efflux during active treatment were correlated positively with changes in HDL cholesterol, apoA-I and pre-β-HDL (P < 0.05 to P < 0.001). There were no inter-relationships between changes in the three HDL functionalities during treatment (P > 0.10). Changes in HDL antioxidative capacity and anti-inflammatory capacity were also unrelated to changes in HDL cholesterol and apoA-I, while changes in HDL antioxidative capacity were related inversely to pre-β-HDL (P < 0.05). CONCLUSION Simvastatin and bezafibrate increase cholesterol efflux, parallel to HDL cholesterol and apoA-I responses. The antioxidative and anti-inflammatory properties of HDL are not to an important extent affected by these therapeutic interventions.
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Affiliation(s)
- Michela Triolo
- Department of Endocrinology, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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11
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Triolo M, de Boer JF, Annema W, Kwakernaak AJ, Tietge UJF, Dullaart RPF. Low normal free T4 confers decreased high-density lipoprotein antioxidative functionality in the context of hyperglycaemia. Clin Endocrinol (Oxf) 2013; 79:416-23. [PMID: 23278171 DOI: 10.1111/cen.12138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 12/06/2012] [Accepted: 12/21/2012] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Low normal thyroid function may promote the development of atherosclerotic cardiovascular disease by thus far poorly defined mechanisms. We tested the impact of thyroid function on HDL antioxidative capacity, a metric of its antiatherogenic functionality, in euthyroid subjects with varying degrees of glucose tolerance. DESIGN AND SUBJECTS Seventy subjects with Type 2 diabetes mellitus (T2DM), 37 subjects with impaired fasting glucose (IFG) and 31 subjects with normal fasting glucose (NFG) (revised NCEP-ATPIII criteria) participated in a cross-sectional study. MEASUREMENTS HDL antioxidative capacity (standardized for HDL cholesterol) was measured as the percentage inhibition of low-density lipoprotein oxidation in vitro. RESULTS TSH, free T4 and HDL antioxidative capacity were not different among NFG, IFG and T2DM subjects (P > 0·25 for each). HDL antioxidative capacity was correlated positively with free T4 (r = 0·320, P = 0·007), and negatively with plasma glucose (r = -0·394, P < 0·001) in T2DM only. Taking account of age and sex, the relationship of HDL antioxidative functionality with free T4 was modified by glucose tolerance status (P = 0·040 and P = 0·008 for interactions of IFG and T2DM with free T4 respectively). Prevailing plasma glucose also interacted positively with free T4 on HDL antioxidative capacity (P = 0·054). CONCLUSIONS In the context of chronic hyperglycaemia, low free T4 within the euthyroid range confers diminished HDL antioxidative capacity, a pathophysiologically relevant metric of HDL functionality.
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Affiliation(s)
- Michela Triolo
- Department of Endocrinology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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12
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Triolo M, Annema W, Dullaart RPF, Tietge UJF. Assessing the functional properties of high-density lipoproteins: an emerging concept in cardiovascular research. Biomark Med 2013; 7:457-72. [DOI: 10.2217/bmm.13.35] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Although plasma concentrations of high-density lipoprotein (HDL) cholesterol correlate inversely with the incidence of atherosclerotic cardiovascular disease, results from recent epidemiological, genetic and pharmacological intervention studies resulted in a shift of concept. Rather than HDL cholesterol mass levels, the functionality of HDL particles is increasingly regarded as potentially clinically important. This review provides an overview of four key functional properties of HDL, namely cholesterol efflux and reverse cholesterol transport; antioxidative activities; anti-inflammatory activities; and the ability of HDL to increase vascular nitric oxide production resulting in vasorelaxation. Currently available assays are put into context with different HDL isolation procedures yielding compositional heterogeneity of the particle. Gathered knowledge on the impact of different disease states on HDL function is discussed together with potential underlying causative factors modulating HDL functionalities. In addition, a perspective is provided regarding how a better understanding of the determinants of (dys)functional HDL might impact clinical practice and the future design of rational and specific therapeutic approaches targeting atherosclerotic cardiovascular disease.
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Affiliation(s)
- Michela Triolo
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Wijtske Annema
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Top Institute Food & Nutrition, Wageningen, The Netherlands
| | - Robin PF Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Uwe JF Tietge
- Top Institute Food & Nutrition, Wageningen, The Netherlands
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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Abstract
Statins represent a major advance in the treatment of hypercholesterolemia, a significant risk factor for atherosclerosis. There is, however, notable interindividual variation in the cholesterolemic response to statins, and the origin of this variability is poorly understood; pharmacogenetics has attempted to determine the role of genetic factors. Myopathy, further, has been reported in a considerable percentage of patients, but the mechanisms underlying muscle injury have yet to be fully characterized. Most statins are the substrates of several cytochrome P450s (CYP). CYP polymorphisms may be responsible for variations in hypolipidemic activity; inhibitors of CYPs, e.g. of CYP3A4, can significantly raise plasma concentrations of several statins, but consequences in terms of clinical efficacy are not uniform. Pravastatin and rosuvastatin are not susceptible to CYP inhibition but are substrates of the organic anion-transporting polypeptide (OATP) 1B1, encoded by the SLCO1B1 gene. Essentially all statins are, in fact, substrates of membrane transporters: SLCO1B1 polymorphisms can decrease the liver uptake, as well as the therapeutic potential of these agents, and may be linked to their muscular side-effects. A better understanding of the mechanisms of statin handling will help to minimize adverse effects and interactions, as well as to improve their lipid-lowering efficiency.
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Sirtori CR, Triolo M, Bosisio R, Bondioli A, Calabresi L, De Vergori V, Gomaraschi M, Mombelli G, Pazzucconi F, Zacherl C, Arnoldi A. Hypocholesterolaemic effects of lupin protein and pea protein/fibre combinations in moderately hypercholesterolaemic individuals. Br J Nutr 2012; 107:1176-83. [PMID: 22032303 DOI: 10.1017/s0007114511004120] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The present study was aimed to evaluate the effect of plant proteins (lupin protein or pea protein) and their combinations with soluble fibres (oat fibre or apple pectin) on plasma total and LDL-cholesterol levels. A randomised, double-blind, parallel group design was followed: after a 4-week run-in period, participants were randomised into seven treatment groups, each consisting of twenty-five participants. Each group consumed two bars containing specific protein/fibre combinations: the reference group consumed casein+cellulose; the second and third groups consumed bars containing lupin or pea proteins+cellulose; the fourth and fifth groups consumed bars containing casein and oat fibre or apple pectin; the sixth group and seventh group received bars containing combinations of pea protein and oat fibre or apple pectin, respectively. Bars containing lupin protein+cellulose ( - 116 mg/l, - 4·2%), casein+apple pectin ( - 152 mg/l, - 5·3%), pea protein+oat fibre ( - 135 mg/l, - 4·7%) or pea protein+apple pectin ( - 168 mg/l, - 6·4%) resulted in significant reductions of total cholesterol levels (P<0·05), whereas no cholesterol changes were observed in the subjects consuming the bars containing casein+cellulose, casein+oat fibre or pea protein+cellulose. The present study shows the hypocholesterolaemic activity and potential clinical benefits of consuming lupin protein or combinations of pea protein and a soluble fibre, such as oat fibre or apple pectin.
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Affiliation(s)
- Cesare R Sirtori
- Department of Pharmacological Sciences, Center E. Grossi Paoletti, Università degli Studi di Milano, Milano, Italy
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Mombelli G, Fabbri N, Frasson S, Baldo C, De Vergori V, Triolo M, Sirtori C. MS392 MORE UNIFORM CHOLESTEROLEMIC RESPONSE OF WOMEN VS MEN WHEN USING A DIVERSIFIED DRUG APPROACH TO HYPOLIPIDEMIC THERAPY. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70893-x] [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: 11/28/2022]
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Mombelli G, Fabbri N, Frasson S, Baldo C, De Vergori V, Triolo M, Sirtori C. P286 DIFFERENTIAL LIPID/LIPOPROTEIN RESPONSE IN WOMEN VS MEN IN PRIMARY AND SECONDARY PREVENTION TREATED WITH STATINS. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70353-6] [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: 10/19/2022]
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Triolo M, Ogbe D, Lawal A. Considerations for Water Disposal and Management in the Development of Coalbed Methane Resources in Rural Alaska. ACTA ACUST UNITED AC 2000. [DOI: 10.2118/00-09-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
The objective of this study is to evaluate the alternatives for water disposal and management during coalbed methane production in remote arctic conditions. In this paper, we evaluate five methods of water disposal in the arctic environment. These methods are (1) direct discharge onto the surface, (2) controlled discharge into streams, (3) underground injection using wells, (4) concentration of produced saline water in a multiple effect evaporator, and (5) conversion of wastewater into clean water by reverse osmosis, a submerged combustion evaporator, and a pulse combustion dryer. The methods were ranked based on a set of criteria including logistics and engineering challenges of water treatment and processing in the arctic, environmental regulations, costs of installation, operations and maintenance. We conclude that surface discharge by use of ground sprinklers is not acceptable in the arctic; use of injection wells and the freeze thaw/evaporation processes hold promise for dewatering coalbed methane wells in rural Alaska.
Introduction
Coalbed methane has become an important source of natural gas production in the Lower 48 States and other places around the world. One current estimate shows that coal basins in the State of Alaska contain over 28 to 43 trillion standard cubic metres (1,000 to 1,500 trillion standard cubic feet) of coalbed methane. Although the actual extent and magnitude of producible gas from Alaska's remote coal basins are unknown, the Alaska Department of Natural Resources postulates that if only 10% on the estimated 28 trillion cubic metres of methane gas is recoverable, this coalbed methane resource would triple the State's current proven conventional gas reserves(1). Exploratory drilling is the key to delineating the potential of the coalbed gas resources of Alaska.
Coalbeds are naturally fractured, low pressure, water saturated gas reservoirs. In a coalbed methane reservoir, even though some free gas may exist in the coal deposits, the majority of the gas is adsorbed on the surface of the coal matrix. Proper dewatering of the coal seams is a critical factor associated with gas production from coalbed methane reservoirs. The saline water that is trapped within the deeply buried coal seams must be removed in order to reduce the pressure of the system, and allow the gas to desorbs from the coals and flow into the wellbore. Large amounts of water production can be anticipated during exploration drilling and early life of the producing field.
There are three different mechanisms by which water can be stored in coal seams. First, adherent moisture or bulk moisture refers to the free water contained in the cleat system that has a normal vapor pressure(2,3). This is the volume of water that must be removed during the dewatering phase in the coalbed methane production operations. Second, inherent moisture or absorbed moisture is the water in the microspore system that decreases the adsorptive capacity of the coal for methane(3). Although this type of water storage is inconsequential when considering water disposal, it is extremely detrimental to the gas concentration of the coal. The other forms of water found in coal seams include chemically bound water and water of hydration.
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