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Dondossola D, Lonati C, Pini A, Bignamini D, Zanella A, Lombardi R, Scaravilli V, La Mura V, Forzenigo L, Biondetti P, Grasselli G, Fracanzani A, Paleari C, Cespiati A, Todaro S, Cattaneo E, Di Feliciantonio M, Sigon G, Valsecchi C, Guzzardella A, Battistin M, Iuculano F. Portal hypertension-like pattern in coronavirus disease 2019 acute respiratory distress syndrome. J Crit Care 2024; 82:154759. [PMID: 38461659 DOI: 10.1016/j.jcrc.2024.154759] [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: 10/04/2023] [Revised: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES Although respiratory failure is the most common feature in coronavirus disease 2019 (COVID-19), abdominal organ involvement is likewise frequently observed. To investigate visceral and thoracic circulation and abdominal organ damage in COVID-19 patients. MATERIALS AND METHODS A monocentric observational study was carried on. In COVID-19 patients affected by acute respiratory distress syndrome (ARDS) (n = 31) or mild pneumonia (n = 60) thoracoabdominal circulation was evaluated using Doppler-ultrasound and computed tomography. The study also included non-COVID-19 patients affected by ARDS (n = 10) or portal hypertension (n = 10) for comparison of the main circulatory changes. RESULTS Patients affected by COVID-19 ARDS showed hyperdynamic visceral flow and increased portal velocity, hepatic artery resistance-index, and spleen diameter relative to those with mild-pneumonia (p = 0.001). Splanchnic circulatory parameters significantly correlated with the main respiratory indexes (p < 0.001) and pulmonary artery diameter (p = 0.02). The chest and abdominal vascular remodeling pattern of COVID-19 ARDS patients resembled the picture observed in the PH group, while differed from that of the non-COVID ARDS group. A more severe COVID-19 presentation was associated with worse liver dysfunction and enhanced inflammatory activation; these parameters both correlated with abdominal (p = 0.04) and chest imaging measures (p = 0.03). CONCLUSION In COVID-19 ARDS patients there are abdominal and lung vascular modifications that depict a portal hypertension-like pattern. The correlation between visceral vascular remodeling, pulmonary artery enlargement, and organ damage in these critically ill patients is consistent with a portal hyperlfow-like syndrome that could contribute to the peculiar characteristics of respiratory failure in these patients. CLINICAL RELEVANCE STATEMENT our data suggest that the severity of COVID-19 lung involvement is directly related to the development of a portal hyperflow-like syndrome. These observations should help in defining the need for a closer monitoring, but also to develop dedicated therapeutic strategies.
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Affiliation(s)
- Daniele Dondossola
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20019 Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi of Milan, 20019 Milan, Italy.
| | - Caterina Lonati
- Center for Preclinical Research, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20019 Milan, Italy
| | - Alessia Pini
- Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Daniela Bignamini
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20019 Milan, Italy
| | - Alberto Zanella
- Department of Pathophysiology and Transplantation, Università degli Studi of Milan, 20019 Milan, Italy; Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Rosa Lombardi
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20019 Milan, Italy
| | - Vittorio Scaravilli
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Vincenzo La Mura
- Internal Medicine, Hemostasis and Thrombosis Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy; Department of Biomedical Science for Health, Università degli Studi of Milan, 20019 Milan, Italy
| | - Laura Forzenigo
- Division of Radiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Pierpaolo Biondetti
- Division of Radiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, Università degli Studi of Milan, 20019 Milan, Italy; Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Anna Fracanzani
- Department of Pathophysiology and Transplantation, Università degli Studi of Milan, 20019 Milan, Italy; Medicine and Metabolic Disease Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20019 Milan, Italy
| | - Chiara Paleari
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Annalisa Cespiati
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20019 Milan, Italy
| | - Serena Todaro
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Emanuele Cattaneo
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Marianna Di Feliciantonio
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Giordano Sigon
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20019 Milan, Italy
| | - Carlo Valsecchi
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Amedeo Guzzardella
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20019, Italy
| | - Michele Battistin
- Center for Preclinical Research, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20019 Milan, Italy
| | - Federica Iuculano
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20019 Milan, Italy
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Forlano R, Sigon G. A two-sample Mendelian randomization study to identity microbiome signatures in patients with Non-alcoholic fatty liver disease. Dig Liver Dis 2023; 55:1462-1463. [PMID: 37537013 DOI: 10.1016/j.dld.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Roberta Forlano
- Liver and anti-viral unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial college London, London, United Kingdom.
| | - Giordano Sigon
- Liver and anti-viral unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial college London, London, United Kingdom; University of Milan, Milan, Italy
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3
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Huang J, Sigon G, Mullish BH, Wang D, Sharma R, Manousou P, Forlano R. Applying Lipidomics to Non-Alcoholic Fatty Liver Disease: A Clinical Perspective. Nutrients 2023; 15:nu15081992. [PMID: 37111211 PMCID: PMC10143024 DOI: 10.3390/nu15081992] [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: 03/07/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
The prevalence of Non-alcoholic fatty liver disease (NAFLD) and associated complications, such as hepatocellular carcinoma (HCC), is growing worldwide, due to the epidemics of metabolic risk factors, such as obesity and type II diabetes. Among other factors, an aberrant lipid metabolism represents a crucial step in the pathogenesis of NAFLD and the development of HCC in this population. In this review, we summarize the evidence supporting the application of translational lipidomics in NAFLD patients and NAFLD associated HCC in clinical practice.
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Affiliation(s)
- Jian Huang
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
| | - Giordano Sigon
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
| | - Benjamin H Mullish
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
| | - Dan Wang
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
| | - Rohini Sharma
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W21NY, UK
| | - Pinelopi Manousou
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
| | - Roberta Forlano
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
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4
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Forlano R, Sigon G, Mullish BH, Yee M, Manousou P. Screening for NAFLD-Current Knowledge and Challenges. Metabolites 2023; 13:metabo13040536. [PMID: 37110194 PMCID: PMC10144613 DOI: 10.3390/metabo13040536] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of abnormal liver function tests worldwide, with an estimated prevalence ranging between 19-46% in the general population. Of note, NAFLD is also expected to become a leading cause of end-stage liver disease in the next decades. Given the high prevalence and severity of NAFLD, especially in high-risk populations (i.e., patients with type-2 diabetes mellitus and/or obesity), there is a major interest in early detection of the disease in primary care. Nevertheless, substantial uncertainties still surround the development of a screening policy for NAFLD, such as limitations in currently used non-invasive markers of fibrosis, cost-effectiveness and the absence of a licensed treatment. In this review, we summarise current knowledge and try to identify the limitations surrounding the screening policy for NAFLD in primary care.
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Affiliation(s)
- Roberta Forlano
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
| | - Giordano Sigon
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
| | - Benjamin H Mullish
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
| | - Michael Yee
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
| | - Pinelopi Manousou
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W21NY, UK
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Lombardi R, Mura VL, Cespiati A, Iuculano F, Sigon G, Pallini G, Proietti M, Motta I, Montinaro B, Fiorelli E, Cesari M, Bandera A, Valenti L, Peyvandi F, Montano N, Baldini M, Fracanzani AL. Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity. Intern Emerg Med 2022; 17:1739-1749. [PMID: 35754075 PMCID: PMC9244481 DOI: 10.1007/s11739-022-03000-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/06/2022] [Indexed: 01/08/2023]
Abstract
Despite vaccination programs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains a public health problem. Identifying key prognostic determinants of severity of the disease may help better focus health resources. The negative prognostic role for metabolic and hepatic alterations is established; however, the interplay among different metabolic comorbidities and their interconnections with the liver have never been explored.The objective of this study is to evaluate the impact of liver alterations in addition to metabolic comorbidities as a predictor of SARS-CoV-2 severity. 382 SARS-CoV-2 patients were enrolled. Severe SARS-CoV-2 was diagnosed according to international consensus. Transaminases > 2 times the upper limit of normality (2ULN), hepatic steatosis (by ultrasound and/or computed tomography in 133 patients), and FIB-4 defined liver alterations. All data were collected on admission. The results are severe SARS-CoV-2 infection in 156 (41%) patients (mean age 65 ± 17; 60%males). Prevalence of obesity was 25%; diabetes, 17%; hypertension, 44%; dyslipidaemia, 29%; with 13% of the cohort with ≥ 3 metabolic alterations. Seventy patients (18%) had transaminases > 2ULN, 82 (62%) steatosis; 199 (54%) had FIB-4 < 1.45 and 45 (12%) > 3.25. At multivariable analysis, ≥ 3 metabolic comorbidities (OR 4.1, CI 95% 1.8-9.1) and transaminases > 2ULN (OR 2.6, CI 95% 1.3-6.7) were independently associated with severe SARS-CoV-2. FIB-4 < 1.45 was a protective factor (OR 0.42, CI 95% 0.23-0.76). Hepatic steatosis had no impact on disease course. The presence of metabolic alterations is associated with severe SARS-CoV-2 infection, and the higher the number of coexisting comorbidities, the higher the risk of severe disease. Normal FIB-4 values are inversely associated with advanced SARS-CoV-2 regardless of metabolic comorbidities, speculating on use of these values to stratify the risk of severe infection.
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Affiliation(s)
- Rosa Lombardi
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy.
| | - Vincenzo La Mura
- Unit of Internal Medicine Hemostasis and Thrombosis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Annalisa Cespiati
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Federica Iuculano
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Giordano Sigon
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Giada Pallini
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Marco Proietti
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Irene Motta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Montinaro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Fiorelli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
- Unit of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
- Department of Transfusion Medicine and Hematology, Università degli Studi di Milano, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
- Unit of Internal Medicine Hemostasis and Thrombosis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marina Baldini
- Unit of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Ludovica Fracanzani
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
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Lombardi R, La Mura V, Cespiati A, Iuculano F, Sigon G, Pallini G, Proietti M, Motta I, Montinaro B, Fiorelli E, Cesari M, Bandera A, Valenti L, Peyvandi F, Montano N, Baldini M, Fracanzani AL. Correction to: Usefulness of Fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity. Intern Emerg Med 2022; 17:1751. [PMID: 35864374 PMCID: PMC9302863 DOI: 10.1007/s11739-022-03056-z] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rosa Lombardi
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy.
| | - Vincenzo La Mura
- Unit of Internal Medicine Hemostasis and Thrombosis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Annalisa Cespiati
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Federica Iuculano
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Giordano Sigon
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Giada Pallini
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
| | - Marco Proietti
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Irene Motta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Montinaro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Fiorelli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
- Unit of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
- Department of Transfusion Medicine and Hematology, Università degli Studi di Milano, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
- Unit of Internal Medicine Hemostasis and Thrombosis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Internal Medicine and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marina Baldini
- Unit of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Ludovica Fracanzani
- Unit of Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Via F. SFORZA 35, 20122, Milan, Italy
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7
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Cinque F, Cespiati A, Lombardi R, Costantino A, Maffi G, Alletto F, Colavolpe L, Francione P, Oberti G, Fatta E, Bertelli C, Sigon G, Dongiovanni P, Vecchi M, Fargion S, Fracanzani AL. Interaction between Lifestyle Changes and PNPLA3 Genotype in NAFLD Patients during the COVID-19 Lockdown. Nutrients 2022; 14:nu14030556. [PMID: 35276911 PMCID: PMC8838646 DOI: 10.3390/nu14030556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 12/11/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) lockdown dramatically changed people’s lifestyles. Diet, physical activity, and the PNPLA3 gene are known risk factors for non-alcoholic fatty liver disease (NAFLD). Aim: To evaluate changes in metabolic and hepatic disease in NAFLD patients after the COVID-19 lockdown. Three hundred and fifty seven NAFLD patients were enrolled, all previously instructed to follow a Mediterranean diet (MD). Anthropometric, metabolic, and laboratory data were collected before the COVID-19 lockdown in Italy and 6 months apart, along with ultrasound (US) steatosis grading and information about adherence to MD and physical activity (PA). In 188 patients, PNPLA3 genotyping was performed. After the lockdown, 48% of patients gained weight, while 16% had a worsened steatosis grade. Weight gain was associated with poor adherence to MD (p = 0.005), reduced PA (p = 0.03), and increased prevalence of PNPLA3 GG (p = 0.04). At multivariate analysis (corrected for age, sex, MD, PA, and PNPLA3 GG), only PNPLA3 remained independently associated with weight gain (p = 0.04), which was also associated with worsened glycemia (p = 0.002) and transaminases (p = 0.02). During lockdown, due to a dramatic change in lifestyles, half of our cohort of NAFLD patients gained weight, with a worsening of metabolic and hepatologic features. Interestingly, the PNPLA3 GG genotype nullified the effect of lifestyle and emerged as an independent risk factor for weight gain, opening new perspectives in NAFLD patient care.
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Affiliation(s)
- Felice Cinque
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
| | - Annalisa Cespiati
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
| | - Rosa Lombardi
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
- Correspondence: ; Tel.: +39-025-503-3784
| | - Andrea Costantino
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
- Unit of Gastroenterology and Endoscopy, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gabriele Maffi
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
| | - Francesca Alletto
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
| | - Lucia Colavolpe
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
| | - Paolo Francione
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
| | - Giovanna Oberti
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
| | - Erika Fatta
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
| | - Cristina Bertelli
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
| | - Giordano Sigon
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
| | - Paola Dongiovanni
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
- Unit of Gastroenterology and Endoscopy, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Silvia Fargion
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
| | - Anna Ludovica Fracanzani
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.C.); (A.C.); (G.M.); (F.A.); (L.C.); (P.F.); (G.O.); (E.F.); (C.B.); (G.S.); (P.D.); (S.F.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (A.C.); (M.V.)
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Cespiati A, Petta S, Lombardi R, Di Marco V, Calvaruso V, Bertelli C, Pisano G, Fatta E, Sigon G, Iuculano F, Crapanzano L, Gibilaro G, Francione P, Craxì A, Fargion S, Fracanzani AL. Metabolic comorbidities and male sex influence steatosis in chronic hepatitis C after viral eradication by direct-acting antiviral therapy (DAAs): Evaluation by the controlled attenuation parameter (CAP). Dig Liver Dis 2021; 53:1301-1307. [PMID: 33214063 DOI: 10.1016/j.dld.2020.11.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic hepatitis C (CHC) is associated with hepatic steatosis, related to both a direct viral action and metabolic features. Vice-versa data on hepatic steatosis after viral eradication by direct-acting antiviral agents (DAA) are undefined although the presence of metabolic alterations could strongly influence the occurrence of steatosis as in NAFLD. The controlled attenuation parameter (CAP) (FibroscanⓇ) allows the qualitative and quantitative evaluation of fatty liver. AIM to evaluate in patients with CHC whether hepatic steatosis diagnosed by CAP modifies after DAAs-induced sustained virologic response (SVR). METHODS Data were collected the day of DAAs therapy starting and six months after SVR. CAP ≥ 248 dB/m defined the presence of steatosis. RESULTS 794 CHC SVR patients referring to 2 Italian Units were enrolled. Mean age was 64 ± 16 ys, 50% males, BMI 25.4 ± 4 kg/m2, genotype type-1 in 73%, type-3 in 8%. Prevalence of hepatic steatosis at baseline was 32% by US and 46% by CAP. De novo steatosis developed in 125 (29%), resolution in 122 (30%). At multivariate analysis de novo steatosis was independently associated with male sex (OR 1.7, CI 95% 1.09-2.67; p = 0.02) and baseline BMI (for unit increase OR 1.19, CI 95%1.11-1.29; p < 0.001). Baseline BMI (for unit increase OR 0.47, CI 95% 0.25-0.89; p = 0.02) and triglycerides (for unit increase OR 0.93, CI 95% 0.87-0.99; p = 0.03) prevented steatosis resolution after therapy. CONCLUSIONS after SVR de novo steatosis and resolution of baseline steatosis are closely related to the presence of metabolic comorbidities.
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Affiliation(s)
- Annalisa Cespiati
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Rosa Lombardi
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy.
| | - Vito Di Marco
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Vincenza Calvaruso
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Cristina Bertelli
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy
| | - Giuseppina Pisano
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy
| | - Erika Fatta
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy
| | - Giordano Sigon
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Federica Iuculano
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Luciano Crapanzano
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Gerlando Gibilaro
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Paolo Francione
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Antonio Craxì
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Italy
| | - Silvia Fargion
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Anna Ludovica Fracanzani
- Unit of Internal Medicine and Metabolic Disease, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
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9
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De Vincentis A, Vespasiani-Gentilucci U, Costanzo L, Novella A, Cortesi L, Nobili A, Mannucci PM, Incalzi RA, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Mattioli I, Biolo G, Zanetti M, Bartelloni G, Vanoli M, Grignani G, Pulixi EA, Lupattelli G, Bianconi V, Alcidi R, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Beneduce V, Cacioppo F, Corrao S, Natoli G, Mularo S, Raspanti M, Zoli M, Matacena ML, Orio G, Magnolfi E, Serafini G, Simili A, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Fabio G, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Leoni S, Di Mauro AD, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Pontremoli R, Beccati V, Nobili G, Leoncini G, Anastasio L, Carbone M, Cipollone F, Guagnano MT, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Giorgi A, Gracin C, Zuccalà G, D'Aurizio G, Romanelli G, Marengoni A, Volpini A, Lucente D, Picardi A, Gentilucci UV, Bellelli G, Corsi M, Antonucci C, Sidoli C, Principato G, Arturi F, Succurro E, Tassone B, Giofrè F, Serra MG, Bleve MA, Brucato A, De Falco T, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Prandini T, Manfredini R, Fabbian F, Boari B, De Giorgi A, Tiseo R, Paolisso G, Rizzo MR, Catalano C, Borghi C, Strocchi E, Ianniello E, Soldati M, Schiavone S, Bragagni A, Sabbà C, Vella FS, Suppressa P, De Vincenzo GM, Comitangelo A, Amoruso E, Custodero C, Fenoglio L, Falcetta A, Fracanzani AL, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Colombo G, Agosti P, Monzani V, Savojardo V, Ceriani G, Salerno F, Pallini G, Montecucco F, Ottonello L, Caserza L, Vischi G, Liberato NL, Tognin T, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Pisciotta MS, Bellucci FB, Buffelli S, Montrucchio G, Peasso P, Favale E, Poletto C, Margaria C, Sanino M, Violi F, Perri L, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Diprizio RD, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Galassi M, Grassi Y, Greco A, Sciacqua A, Perticone M, Battaglia R, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Pipita ME, Castellino P, Zanoli L, Gennaro A, Gaudio A, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Vigorito C, Cittadini A, Moreo G, Prolo S, Pina G, Ballestrero A, Ferrando F, Gonella R, Cerminara D, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Sechi L, Catena C, Colussi G, Cavarape A, Da Porto A, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Grossi M, Del Giacco S, Firinu D, Costanzo G, Argiolas G, Montalto G, Licata A, Montalto FA, Corica F, Basile G, Catalano A, Bellone F, Principato C, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, Malfa LL, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Imperiale GN, Pirisi M, Fra GP, Sola D, Bellan M, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Napoli F, Aiello I, Landolfi R, Montalto M, Mirijello A, Purrello F, Di Pino A, del Primario NEC, Ghidoni S, Salvatore T, Monaco L, Ricozzi C, Pilotto A, Indiano I, Gandolfo F. The multifaceted spectrum of liver cirrhosis in older hospitalised patients: analysis of the REPOSI registry. Age Ageing 2021; 50:498-504. [PMID: 32926127 DOI: 10.1093/ageing/afaa150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. OBJECTIVES To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. METHODS A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. RESULTS LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. CONCLUSIONS LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features.
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Affiliation(s)
| | | | - Luisa Costanzo
- Unit of Geriatrics, University Campus Bio-Medico, Rome, Italy
| | - Alessio Novella
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Laura Cortesi
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Sigon G, D'Ambrosio R, Clerici M, Pisano G, Chantarangkul V, Sollazzi R, Lombardi R, Peyvandi F, Lampertico P, Fargion S, Tripodi A, Fracanzani AL. Procoagulant imbalance influences cardiovascular and liver damage in chronic hepatitis C independently of steatosis. Liver Int 2019; 39:2309-2316. [PMID: 31419372 DOI: 10.1111/liv.14213] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/22/2019] [Accepted: 08/09/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Patients with chronic HCV infection besides hepatitis often present cardiovascular damage, the pathogenesis of which is not defined. In chronic liver diseases, including NAFLD and cirrhosis, a procoagulant imbalance, potentially responsible for atherosclerosis has been reported. We aimed at evaluating whether a procoagulant imbalance is present also in non-cirrhotic patients with HCV infection and whether the procoagulant imbalance correlates with cardiovascular damage. The correlation between the procoagulant imbalance, coexisting steatosis, and liver fibrosis was analysed. METHODS From 2014 to 2018, 393 subjects (205 patients with chronic HCV infection from two liver units and 188 controls) were enrolled. Metabolic, cardiovascular, liver assessment and coagulation parameters-procoagulants (FII and FVIII) and anticoagulants (antithrombin and protein C [PC]), endogenous thrombin potential (ETP), peak-thrombin and their ratios (with/without thrombomodulin)-were determined. RESULTS The procoagulant imbalance (defined as high FVIII, FVIII/PC ratio, ETP-ratio and peak-thrombin-ratio (with/without thrombomodulin)) was significantly higher in patients with chronic HCV than controls. Steatosis was detected in 87 patients (42%). No difference in coagulation imbalance, carotid and cardiac parameters and severity of liver fibrosis was observed in patients with or without steatosis, despite the latter had less severe metabolic alterations. The FVIII/PC ratio was independently associated with carotid intima-media thickness (coefficient 0.04, 95% CI 0.002-0.07, P = .04) and liver fibrosis (coefficient 0.64, 95% CI 0.37-0.92, P < .0001). CONCLUSION Patients with HCV infection, even in the absence of cirrhosis have a procoagulant-imbalance that possibly plays a role in increasing the risk of cardiovascular disease and progression of fibrosis.
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Affiliation(s)
- Giordano Sigon
- Unit of Medicine and Metabolic Diseases, Pathophysiology and Transplantation Department, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Roberta D'Ambrosio
- Pathophysiology and Transplantation Department, Gastroenterology and Hepatology, CRC AM e A Migliavacca Center for Liver Diseases, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mariagrazia Clerici
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Giuseppina Pisano
- Unit of Medicine and Metabolic Diseases, Pathophysiology and Transplantation Department, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Veena Chantarangkul
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Roberta Sollazzi
- Unit of Medicine and Metabolic Diseases, Pathophysiology and Transplantation Department, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Rosa Lombardi
- Unit of Medicine and Metabolic Diseases, Pathophysiology and Transplantation Department, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy
| | - Pietro Lampertico
- Pathophysiology and Transplantation Department, Gastroenterology and Hepatology, CRC AM e A Migliavacca Center for Liver Diseases, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Silvia Fargion
- Unit of Medicine and Metabolic Diseases, Pathophysiology and Transplantation Department, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Armando Tripodi
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Anna Ludovica Fracanzani
- Unit of Medicine and Metabolic Diseases, Pathophysiology and Transplantation Department, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Carlotta F, Raffaella R, Ilaria A, Alessandro N, Mannuccio MP, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Caterina C, Biolo G, Zanetti M, Guadagni M, Zaccari M, Chiuch M, Zaccari M, Vanoli M, Grignani G, Pulixi EA, Bernardi M, Bassi SL, Santi L, Zaccherini G, Lupattelli G, Mannarino E, Bianconi V, Paciullo F, Alcidi R, Nuti R, Valenti R, Ruvio M, Cappelli S, Palazzuoli A, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Cocita F, Beneduce V, Plances L, Corrao S, Natoli G, Mularo S, Raspanti M, Cavallaro F, Zoli M, Lazzari I, Brunori M, Fabbri E, Magalotti D, Arnò R, Pasini FL, Capecchi PL, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Maira D, Di Stefano V, Fabio G, Seghezzi S, Mancarella M, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Conti F, Bonini G, Ottolini BB, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Murialdo G, Marra A, Cattaneo F, Pontremoli R, Beccati V, Nobili G, Secchi MB, Ghelfi D, Anastasio L, Sofia L, Carbone M, Cipollone F, Guagnano MT, Valeriani E, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Pes C, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Zuccalà G, D’Aurizio G, Romanelli G, Marengoni A, Zucchelli A, Manzoni F, Volpini A, Picardi A, Gentilucci UV, Gallo P, Dell’Unto C, Annoni G, Corsi M, Bellelli G, Zazzetta S, Mazzola P, Szabo H, Bonfanti A, Arturi F, Succurro E, Rubino M, Tassone B, Sesti G, Interna M, Serra MG, Bleve MA, Gasbarrone L, Sajeva MR, Brucato A, Ghidoni S, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Cosi E, Scarinzi P, Amabile A, Omenetto E, Prandini T, Manfredini R, Fabbian F, Boari B, Giorgi AD, Tiseo R, De Giorgio R, Paolisso G, Rizzo MR, Borghi C, Strocchi E, Ianniello E, Soldati M, Sabbà C, Vella FS, Suppressa P, Schilardi A, Loparco F, De Vincenzo GM, Comitangelo A, Amoruso E, Fenoglio L, Falcetta A, Bracco C, Fracanzani AL, Fargion S, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Ferrari B, Colombo G, Agosti P, Monzani V, Savojardo V, Folli C, Ceriani G, Salerno F, Pallini G, Dallegri F, Ottonello L, Liberale L, Caserza L, Salam K, Liberato NL, Tognin T, Bianchi GB, Giaquinto S, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Spazzini E, Ferrandina C, Montrucchio G, Petitti P, Peasso P, Favale E, Poletto C, Salmi R, Gaudenzi P, Violi F, Perri L, Landolfi R, Montalto M, Mirijello A, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Dondi G, Pellegrini E, Carulli L, Galassi M, Grassi Y, Perticone F, Perticone M, Battaglia R, FIlice M, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Gabrielli A, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Marigliano B, Pipita ME, Castellino P, Zanoli L, Pignataro S, Gennaro A, Blanco J, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Cittadini A, Vigorito C, Arcopinto M, Salzano A, Bobbio E, Marra AM, Sirico D, Moreo G, Gasparini F, Prolo S, Pina G, Ballestrero A, Ferrando F, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Scattolin G, Martinelli S, Turrin M, Sechi L, Catena C, Colussi G, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Del Giacco S, Firinu D, Losa F, Paoletti G, Costanzo G, Montalto G, Licata A, Malerba V, Montalto FA, Lasco A, Basile G, Catalano A, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, La Malfa L, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Lauretani F, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Pirisi M, Fra GP, Sola D, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Tedeschi A, Trotta L, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Cattaneo M, Napoli F. Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients. Eur J Intern Med 2019; 68:e7-e11. [PMID: 31405773 DOI: 10.1016/j.ejim.2019.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
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