1
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Marti-Aguado D, Arnouk J, Liang JX, Lara-Romero C, Behari J, Furlan A, Jimenez-Pastor A, Ten-Esteve A, Alfaro-Cervello C, Bauza M, Gallen-Peris A, Gimeno-Torres M, Merino-Murgui V, Perez-Girbes A, Benlloch S, Pérez-Rojas J, Puglia V, Ferrández-Izquierdo A, Aguilera V, Giesteira B, França M, Monton C, Escudero-García D, Alberich-Bayarri Á, Serra MA, Bataller R, Romero-Gomez M, Marti-Bonmati L. Development and validation of an image biomarker to identify metabolic dysfunction associated steatohepatitis: MR-MASH score. Liver Int 2024; 44:202-213. [PMID: 37904633 DOI: 10.1111/liv.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 10/08/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND AND AIMS Diagnosis of metabolic dysfunction-associated steatohepatitis (MASH) requires histology. In this study, a magnetic resonance imaging (MRI) score was developed and validated to identify MASH in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Secondarily, a screening strategy for MASH diagnosis was investigated. METHODS This prospective multicentre study included 317 patients with biopsy-proven MASLD and contemporaneous MRI. The discovery cohort (Spain, Portugal) included 194 patients. NAFLD activity score (NAS) and fibrosis were assessed with the NASH-CRN histologic system. MASH was defined by the presence of steatosis, lobular inflammation, and ballooning, with NAS ≥4 with or without fibrosis. An MRI-based composite biomarker of Proton Density Fat Fraction and waist circumference (MR-MASH score) was developed. Findings were afterwards validated in an independent cohort (United States, Spain) with different MRI protocols. RESULTS In the derivation cohort, 51% (n = 99) had MASH. The MR-MASH score identified MASH with an AUC = .88 (95% CI .83-.93) and strongly correlated with NAS (r = .69). The MRI score lower cut-off corresponded to 88% sensitivity with 86% NPV, while the upper cut-off corresponded to 92% specificity with 87% PPV. MR-MASH was validated with an AUC = .86 (95% CI .77-.92), 91% sensitivity (lower cut-off) and 87% specificity (upper cut-off). A two-step screening strategy with sequential MR-MASH examination performed in patients with indeterminate-high FIB-4 or transient elastography showed an 83-84% PPV to identify MASH. The AUC of MR-MASH was significantly higher than that of the FAST score (p < .001). CONCLUSIONS The MR-MASH score has clinical utility in the identification and management of patients with MASH at risk of progression.
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Affiliation(s)
- David Marti-Aguado
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, and Imaging La Fe node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), Valencia, Spain
| | - Joud Arnouk
- Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jia-Xu Liang
- Digestive Diseases Department, CIBERehd, Virgen del Rocio University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (HUVR/CSIC/US), Department of Medicine, University of Seville, Seville, Spain
| | - Carmen Lara-Romero
- Digestive Diseases Department, CIBERehd, Virgen del Rocio University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (HUVR/CSIC/US), Department of Medicine, University of Seville, Seville, Spain
| | - Jaideep Behari
- Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alessandro Furlan
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ana Jimenez-Pastor
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, and Imaging La Fe node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), Valencia, Spain
- Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Valencia, Spain
| | - Amadeo Ten-Esteve
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, and Imaging La Fe node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), Valencia, Spain
| | - Clara Alfaro-Cervello
- Pathology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
- Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Mónica Bauza
- Pathology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ana Gallen-Peris
- Digestive Disease Department, Hospital Arnau de Vilanova, Valencia, Spain
| | - Marta Gimeno-Torres
- Digestive Disease Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Víctor Merino-Murgui
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Alexandre Perez-Girbes
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, and Imaging La Fe node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), Valencia, Spain
- Radiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Salvador Benlloch
- Digestive Disease Department, Hospital Arnau de Vilanova, Valencia, Spain
- CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Judith Pérez-Rojas
- Pathology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Víctor Puglia
- Pathology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | - Antonio Ferrández-Izquierdo
- Pathology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
- Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Victoria Aguilera
- CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
- Hepatology and Liver Transplantation Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Bruno Giesteira
- Radiology Department, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas de Abel Salazar, University of Porto, Porto, Portugal
| | - Manuela França
- Radiology Department, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas de Abel Salazar, University of Porto, Porto, Portugal
| | - Cristina Monton
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Desamparados Escudero-García
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
- Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Ángel Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, and Imaging La Fe node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), Valencia, Spain
- Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Valencia, Spain
| | - Miguel A Serra
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
- Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Ramon Bataller
- Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Manuel Romero-Gomez
- Digestive Diseases Department, CIBERehd, Virgen del Rocio University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (HUVR/CSIC/US), Department of Medicine, University of Seville, Seville, Spain
- University of Seville, Seville, Spain
| | - Luis Marti-Bonmati
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, and Imaging La Fe node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), Valencia, Spain
- Radiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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2
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Cabezas J, Crespo J, Aguilera A, Albillos A, Buti M, Calleja JL, Calvo Montes J, Casado Martín M, Diago Madrid M, Fernández Rodríguez C, Fernández Vázquez I, Forns X, García F, García-Samaniego J, Hernández-Guerra Aguilar M, Jorquera Plaza F, Lazarus JV, Lens S, Martró E, Molero García JM, Pena López MJ, Pineda JA, Rodríguez M, Romero Gómez M, Sanchez-Antolin G, A Serra M, Turnes J. Oportunistic diagnosis based on age and hepatitis C virus clearance: an essential step to improve the overall health of the liver. Rev Esp Enferm Dig 2023; 115:128-132. [PMID: 36514974 DOI: 10.17235/reed.2022.9325/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Back in January 2022, an EASL-Lancet Commission on the impact of liver disorders in the European region commissioned by the WHO demonstrated that this condition is, actually, the second leading cause of loss of labor years in Europe after ischemic heart disease (1). This is a very relevant piece of information since this is something that is going to impact the new generations of Europeans unless a significant change is made in public health policies. Despite the advances made over the last few years in hepatitis C virus clearance-understood as a significant reduction of morbidity and mortality associated with Hepatitis B and C viruses-there are still challenges ahead to improve liver health due to the high use of alcohol, and the inseparable triad obesity / diabetes mellitus / metabolic associated fatty liver disease. Also, access to healthcare for several population groups at risk of presenting higher rates of liver disease has become a problem.
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Affiliation(s)
- Joaquín Cabezas
- Aparato Digestivo/Unidad de Hepatología, Hospital Universitario Marqués de Valdecilla, España
| | - Javier Crespo
- Gastroenterología y Hepatología, Hospital Universitario Marqués de Valdecilla
| | - Antonio Aguilera
- Servicio de Microbiología, CHU de Santiago; Instituto de Investigación Sanitaria de Santiago(IDIS);Dep Microb Univers Santiago, España
| | - Agustín Albillos
- Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, España
| | - Maria Buti
- Liver Unit. Internal Medicine Department, Hospital Universitari Vall d´Hebron
| | - José Luís Calleja
- Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, España
| | - Jorge Calvo Montes
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, España
| | - Marta Casado Martín
- Aparato digestivo, Sección Hepatología, Hospital Universitario Torrecárdenas
| | | | | | | | - Xavier Forns
- Servicio de Hepatología, Hospital Clínic Barcelona
| | - Federico García
- Servicio de Microbiología, Hospital Universitario Clínico San Cecilio
| | | | | | | | | | - Sabela Lens
- Servicio de Hepatología, Hospital Clinic Barcelona
| | - Elisa Martró
- Servicio de Microbiología, Hospital Universitario Germans Trias i Pujol
| | | | | | - Juan Antonio Pineda
- Unidad Clínica de Enfermedades Infecciosas y Micro, Hospital Universitario de Valme
| | - Manuel Rodríguez
- Sección de Hepatología. Servicio Aparato Digestivo, Hospital Universitario Central de Asturias
| | | | | | | | - Juan Turnes
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Pontevedra
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Calleja JL, Rivera‐Esteban J, Aller R, Hernández‐Conde M, Abad J, Pericàs JM, Benito HG, Serra MA, Escudero A, Ampuero J, Lucena A, Sánchez Y, Arias‐Loste MT, Iruzubieta P, Romero‐Gómez M, Augustin S, Crespo J. Prevalence estimation of significant fibrosis because of NASH in Spain combining transient elastography and histology. Liver Int 2022; 42:1783-1792. [PMID: 35643936 PMCID: PMC9541569 DOI: 10.1111/liv.15323] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/11/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) has become a major public health problem, but the prevalence of fibrosis associated with non-alcoholic steatohepatitis (NASH) is largely unknown in the general population. This study aimed to provide an updated estimation of the prevalence of NASH fibrosis in Spain. METHODS This was an observational, retrospective, cross-sectional, population-based study with merged data from two Spanish datasets: a large (N = 12 246) population-based cohort (ETHON), including transient elastography (TE) data, and a contemporary multi-centric biopsy-proven NASH cohort with paired TE data from tertiary centres (N = 501). Prevalence for each NASH fibrosis stage was estimated by crossing TE data from ETHON dataset with histology data from the biopsy-proven cohort. RESULTS From the patients with valid TE in ETHON dataset (N = 11 440), 5.61% (95% confidence interval [95% CI]: 2.53-11.97) had a liver stiffness measurement (LSM) ≥ 8 kPa. The proportion attributable to NAFLD (using clinical variables and Controlled Attenuation Parameter) was 57.3% and thus, the estimated prevalence of population with LSM ≥ 8 kPa because of NAFLD was 3.21% (95% CI 1.13-8.75). In the biopsy-proven NASH cohort, 389 patients had LSM ≥ 8 kPa. Among these, 37% did not have significant fibrosis (F2-4). The estimated prevalence of NASH F2-3 and cirrhosis in Spain's adult population were 1.33% (95% CI 0.29-5.98) and 0.70% (95% CI 0.10-4.95) respectively. CONCLUSIONS These estimations provide an accurate picture of the current prevalence of NASH-related fibrosis in Spain and can serve as reference point for dimensioning the therapeutic efforts that will be required as NASH therapies become available.
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Affiliation(s)
- José L. Calleja
- Department of Gastroenterology and HepatologyHospital Universitario Puerta de Hierro, School of Medicine, Universidad Autónoma Madrid, IDIPHIMMajadahondaSpain
| | - Jesús Rivera‐Esteban
- Liver UnitVall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital CampusBarcelonaSpain,Universitat Autònoma de BarcelonaBellaterraSpain
| | - Rocío Aller
- Department of GastroenterologyClinic University Hospital, Medical School, Group of Biomedical Research in Critical Care Medicine (BioCritic), University of ValladolidValladolidSpain,Research UnitClinic University Hospital, Medical School, Institute of Health Sciences of Castille and Leon (IECSCYL), Group of Biomedical Research in Critical Care Medicine (BioCritic)ValladolidSpain
| | - Marta Hernández‐Conde
- Department of Gastroenterology and HepatologyHospital Universitario Puerta de Hierro, School of Medicine, Universidad Autónoma Madrid, IDIPHIMMajadahondaSpain
| | - Javier Abad
- Department of Gastroenterology and HepatologyHospital Universitario Puerta de Hierro, School of Medicine, Universidad Autónoma Madrid, IDIPHIMMajadahondaSpain
| | - Juan M. Pericàs
- Liver UnitVall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Hugo G. Benito
- Research UnitClinic University Hospital, Medical School, Institute of Health Sciences of Castille and Leon (IECSCYL), Group of Biomedical Research in Critical Care Medicine (BioCritic)ValladolidSpain
| | - Miguel A. Serra
- Digestive Medicine ServiceClinic University Hospital, University of ValenciaValenciaSpain
| | - Amparo Escudero
- Digestive Medicine ServiceClinic University Hospital, University of ValenciaValenciaSpain
| | - Javier Ampuero
- Digestive Diseases Department and CIBERehdVirgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of SevilleSevilleSpain
| | - Ana Lucena
- Digestive Diseases Department and CIBERehdVirgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of SevilleSevilleSpain
| | - Yolanda Sánchez
- Digestive Diseases Department and CIBERehdVirgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of SevilleSevilleSpain
| | - María T. Arias‐Loste
- Gastroenterology and Hepatology DepartmentMarqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, IDIVALSantanderSpain
| | - Paula Iruzubieta
- Gastroenterology and Hepatology DepartmentMarqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, IDIVALSantanderSpain
| | - Manuel Romero‐Gómez
- Digestive Diseases Department and CIBERehdVirgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of SevilleSevilleSpain
| | - Salvador Augustin
- Liver UnitVall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital CampusBarcelonaSpain,Universitat Autònoma de BarcelonaBellaterraSpain,Therapeutic Area Cardio‐Metabolism and Respiratory MedicineBoehringer Ingelheim International GmbHIngelheim am RheinGermany
| | - Javier Crespo
- Gastroenterology and Hepatology DepartmentMarqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, IDIVALSantanderSpain
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4
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Lopes H, Baptista-Leite R, Franco D, Serra MA, Escudero A, Martín-Moreno JM. Let's End HepC: Modelling Public Health Epidemiological Policies Applied to Hepatitis C in Spain. Front Public Health 2022; 9:735572. [PMID: 35071151 PMCID: PMC8777247 DOI: 10.3389/fpubh.2021.735572] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The WHO has defined international targets toward the elimination of hepatitis C by 2030. Most countries cannot be on track to achieve this goal unless many challenges are surpassed. The Let's End HepC (LEHC) tool aims to contribute to the control of hepatitis C. The innovation of this tool combines the modelling of public health policies (PHP) focused on hepatitis C with epidemiological modelling of the disease, obtaining a unique result that allows to forecast the impact of policy outcomes. The model was applied to several countries, including Spain. Methods: To address the stated objective, we applied the “Adaptive Conjoint Analysis” for PHP decision-making and Markov Chains in the LEHC modelling tool. The tool also aims to be used as an element of health literacy for patient advocacy through gamification mechanisms and country comparability. The LEHC project has been conducted in several countries, including Spain. The population segments comprised in the project are: People Who Inject Drugs (PWID), prisoners, blood products, remnant population. Results: A total of 24 PHP related to hepatitis C were included in the LEHC project. It was identified that Spain had fully implemented 14 of those policies to control hepatitis C. According to LEHC's model forecast, the WHO's Hepatitis C elimination goal on reducing the number of patients living with Hepatitis C to 10% can be achieved in Spain by 2026 if current policies are maintained. The model estimates that the total population in Spain, by 2026, is expected to comprise 26,367 individuals living with hepatitis C. Moreover, if the 24 PHP considered for this study are fully implemented in Spain, the elimination goal may be achieved in 2024, with 29,615 individuals living with hepatitis C by that year. Conclusion: The findings corroborate the view that Spain has set great efforts in directing PHP toward Hepatitis C Virus (HCV) elimination by 2030. However, there is still room for improvement, namely in further implementing 10 of the 24 PHP considered for the LEHC project. By maintaining the 14 PHP in force, the LEHC model estimates the HCV elimination in the country by 2026, and by 2024 if further measures are employed to control the disease.
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Affiliation(s)
- Henrique Lopes
- Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal
| | - Ricardo Baptista-Leite
- Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal.,Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, Netherlands
| | - Diogo Franco
- Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal
| | - Miguel A Serra
- Digestive Medicine Service, University of Valencia, Valencia, Spain
| | - Amparo Escudero
- Department of Medicine, University of Valencia, Valencia, Spain
| | - José M Martín-Moreno
- Department of Preventive Medicine and Public Health and INCLIVA, University of Valencia, Valencia, Spain
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5
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Marti-Aguado D, Fernández-Patón M, Alfaro-Cervello C, Mestre-Alagarda C, Bauza M, Gallen-Peris A, Merino V, Benlloch S, Pérez-Rojas J, Ferrández A, Puglia V, Gimeno-Torres M, Aguilera V, Monton C, Escudero-García D, Alberich-Bayarri Á, Serra MA, Marti-Bonmati L. Digital Pathology Enables Automated and Quantitative Assessment of Inflammatory Activity in Patients with Chronic Liver Disease. Biomolecules 2021; 11:biom11121808. [PMID: 34944452 PMCID: PMC8699191 DOI: 10.3390/biom11121808] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
Traditional histological evaluation for grading liver disease severity is based on subjective and semi-quantitative scores. We examined the relationship between digital pathology analysis and corresponding scoring systems for the assessment of hepatic necroinflammatory activity. A prospective, multicenter study including 156 patients with chronic liver disease (74% nonalcoholic fatty liver disease-NAFLD, 26% chronic hepatitis-CH etiologies) was performed. Inflammation was graded according to the Nonalcoholic Steatohepatitis (NASH) Clinical Research Network system and METAVIR score. Whole-slide digital image analysis based on quantitative (I-score: inflammation ratio) and morphometric (C-score: proportionate area of staining intensities clusters) measurements were independently performed. Our data show that I-scores and C-scores increase with inflammation grades (p < 0.001). High correlation was seen for CH (ρ = 0.85–0.88), but only moderate for NAFLD (ρ = 0.5–0.53). I-score (p = 0.008) and C-score (p = 0.002) were higher for CH than NAFLD. Our MATLAB algorithm performed better than QuPath software for the diagnosis of low-moderate inflammation (p < 0.05). C-score AUC for classifying NASH was 0.75 (95%CI, 0.65–0.84) and for moderate/severe CH was 0.99 (95%CI, 0.97–1.00). Digital pathology measurements increased with fibrosis stages (p < 0.001). In conclusion, quantitative and morphometric metrics of inflammatory burden obtained by digital pathology correlate well with pathologists’ scores, showing a higher accuracy for the evaluation of CH than NAFLD.
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Affiliation(s)
- David Marti-Aguado
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, 46010 Valencia, Spain; (V.M.); (C.M.); (D.E.-G.)
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, 46026 Valencia, Spain; (M.F.-P.); (Á.A.-B.); (L.M.-B.)
- Correspondence:
| | - Matías Fernández-Patón
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, 46026 Valencia, Spain; (M.F.-P.); (Á.A.-B.); (L.M.-B.)
| | - Clara Alfaro-Cervello
- Pathology Department, Clinic University Hospital, INCLIVA Health Research Institute, 46010 Valencia, Spain; (C.A.-C.); (C.M.-A.); (A.F.)
- Faculty of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Claudia Mestre-Alagarda
- Pathology Department, Clinic University Hospital, INCLIVA Health Research Institute, 46010 Valencia, Spain; (C.A.-C.); (C.M.-A.); (A.F.)
| | - Mónica Bauza
- Pathology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (M.B.); (J.P.-R.)
| | - Ana Gallen-Peris
- Digestive Disease Department, Hospital Arnau de Vilanova, 46015 Valencia, Spain; (A.G.-P.); (S.B.)
| | - Víctor Merino
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, 46010 Valencia, Spain; (V.M.); (C.M.); (D.E.-G.)
| | - Salvador Benlloch
- Digestive Disease Department, Hospital Arnau de Vilanova, 46015 Valencia, Spain; (A.G.-P.); (S.B.)
- CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Judith Pérez-Rojas
- Pathology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (M.B.); (J.P.-R.)
| | - Antonio Ferrández
- Pathology Department, Clinic University Hospital, INCLIVA Health Research Institute, 46010 Valencia, Spain; (C.A.-C.); (C.M.-A.); (A.F.)
- Faculty of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Víctor Puglia
- Pathology Department, Hospital Arnau de Vilanova, 46015 Valencia, Spain;
| | - Marta Gimeno-Torres
- Hepatology and Liver Transplantation Unit, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain;
| | - Victoria Aguilera
- CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Hepatology and Liver Transplantation Unit, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain;
| | - Cristina Monton
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, 46010 Valencia, Spain; (V.M.); (C.M.); (D.E.-G.)
| | - Desamparados Escudero-García
- Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, 46010 Valencia, Spain; (V.M.); (C.M.); (D.E.-G.)
- Faculty of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Ángel Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, 46026 Valencia, Spain; (M.F.-P.); (Á.A.-B.); (L.M.-B.)
- Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, 46021 Valencia, Spain
| | - Miguel A. Serra
- Faculty of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Luis Marti-Bonmati
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, 46026 Valencia, Spain; (M.F.-P.); (Á.A.-B.); (L.M.-B.)
- Radiology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain
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6
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Martí-Aguado D, Jiménez-Pastor A, Alberich-Bayarri Á, Rodríguez-Ortega A, Alfaro-Cervello C, Mestre-Alagarda C, Bauza M, Gallén-Peris A, Valero-Pérez E, Ballester MP, Gimeno-Torres M, Pérez-Girbés A, Benlloch S, Pérez-Rojas J, Puglia V, Ferrández A, Aguilera V, Escudero-García D, Serra MA, Martí-Bonmatí L. Automated Whole-Liver MRI Segmentation to Assess Steatosis and Iron Quantification in Chronic Liver Disease. Radiology 2021; 302:345-354. [PMID: 34783592 DOI: 10.1148/radiol.2021211027] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Standardized manual region of interest (ROI) sampling strategies for hepatic MRI steatosis and iron quantification are time consuming, with variable results. Purpose To evaluate the performance of automatic MRI whole-liver segmentation (WLS) for proton density fat fraction (PDFF) and iron estimation (transverse relaxometry [R2*]) versus manual ROI, with liver biopsy as the reference standard. Materials and Methods This prospective, cross-sectional, multicenter study recruited participants with chronic liver disease who underwent liver biopsy and chemical shift-encoded 3.0-T MRI between January 2017 and January 2021. Biopsy evaluation included histologic grading and digital pathology. MRI liver sampling strategies included manual ROI (two observers) and automatic whole-liver (deep learning algorithm) segmentation for PDFF- and R2*-derived measurements. Agreements between segmentation methods were measured using intraclass correlation coefficients (ICCs), and biases were evaluated using Bland-Altman analyses. Linear regression analyses were performed to determine the correlation between measurements and digital pathology. Results A total of 165 participants were included (mean age ± standard deviation, 55 years ± 12; 96 women; 101 of 165 participants [61%] with nonalcoholic fatty liver disease). Agreements between mean measurements were excellent, with ICCs of 0.98 for both PDFF and R2*. The median bias was 0.5% (interquartile range, -0.4% to 1.2%) for PDFF and 2.7 sec-1 (interquartile range, 0.2-5.3 sec-1) for R2* (P < .001 for both). Margins of error were lower for WLS than ROI-derived parameters (-0.03% for PDFF and -0.3 sec-1 for R2*). ROI and WLS showed similar performance for steatosis (ROI AUC, 0.96; WLS AUC, 0.97; P = .53) and iron overload (ROI AUC, 0.85; WLS AUC, 0.83; P = .09). Correlations with digital pathology were high (P < .001) between the fat ratio and PDFF (ROI r = 0.89; WLS r = 0.90) and moderate (P < .001) between the iron ratio and R2* (ROI r = 0.65; WLS r = 0.64). Conclusion Proton density fat fraction and transverse relaxometry measurements derived from MRI automatic whole-liver segmentation (WLS) were accurate for steatosis and iron grading in chronic liver disease and correlated with digital pathology. Automated WLS estimations were higher, with a lower margin of error than manual region of interest estimations. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Moura Cunha and Fowler in this issue.
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Affiliation(s)
- David Martí-Aguado
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Ana Jiménez-Pastor
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Ángel Alberich-Bayarri
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Alejandro Rodríguez-Ortega
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Clara Alfaro-Cervello
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Claudia Mestre-Alagarda
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Mónica Bauza
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Ana Gallén-Peris
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Elena Valero-Pérez
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - María Pilar Ballester
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Marta Gimeno-Torres
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Alexandre Pérez-Girbés
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Salvador Benlloch
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Judith Pérez-Rojas
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Víctor Puglia
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Antonio Ferrández
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Victoria Aguilera
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Desamparados Escudero-García
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Miguel A Serra
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
| | - Luis Martí-Bonmatí
- From the Departments of Digestive Diseases (D.M.A., M.P.B., D.E.G.), Pathology (C.A.C., C.M.A., A.F.), and Gastroenterology and Hepatology (D.M.A.), Clinic University Hospital, INCLIVA Health Research Institute, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2), La Fe Health Research Institute, Valencia, Spain (D.M.A., A.R.O., L.M.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (A.J.P., Á.A.B.); University of Valencia, Faculty of Medicine, Valencia, Spain (C.A.C., A.F., D.E.G., M.A.S.); Departments of Pathology (M.B., J.P.R.), Digestive Diseases (E.V.P., M.G.T.), and Radiology (A.P.G., L.M.B.) and the Hepatology and Liver Transplantation Unit (V.A.), La Fe University and Polytechnic Hospital, Valencia, Spain; Departments of Digestive Diseases (A.G.P., S.B.) and Pathology (V.P.), Hospital Arnau de Vilanova, Valencia, Spain; CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas), Instituto de Salud Carlos III, Madrid, Spain (S.B., V.A.); and Río Hortega, Instituto Salud Carlos III, Madrid, Spain (D.M.A.)
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7
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Cuadrado A, Perelló C, Cabezas J, Llerena S, Llop E, Escudero MD, Hernandez-Conde M, Puchades L, Redondo C, Fortea JI, Gil de Miguel A, Serra MA, Calleja JL, Crespo J. Update on epidemiology of hepatitis B in a low-endemic European country: There is still much to do. J Viral Hepat 2020; 27:1261-1265. [PMID: 32558971 DOI: 10.1111/jvh.13350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/05/2020] [Accepted: 06/08/2020] [Indexed: 01/21/2023]
Abstract
The latest epidemiological data in Spain were obtained a decade ago and revealed a prevalence of hepatitis B surface antigen (HBsAg) of 0.7%; hence, updated epidemiological data are necessary. Our aim was to determine the prevalence of hepatitis B virus (HBV) infection, and to analyse associated factors and characterize chronic infection. A population-based, cross-sectional study was performed in Spain between July 2015 and April 2017. Participants from three regions were selected using two-stage conglomerate sampling and stratified by age. Anthropometric and demographic data were collected, and blood samples were taken to detect serological markers of HBV infection and to quantify HBV-DNA. The characterization of chronic HBV infection was based on ALT (alanine aminotransferase) values, HBV-DNA levels, and results of transient elastography. The overall prevalence rates of HBsAg and antibody to hepatitis B core antigen (anti-HBc) among 12 246 participants aged 20-74 years (58.4% females) were 0.6% (95% CI [0.4-0.7]) and 8.2% (7.7-8.7), respectively. The risk factors for HBV infection identified in the multivariate analysis were age, nosocomial risk, and non-Spanish nationality. Moreover, most patients HBsAg positive (76.6%) presented as hepatitis B e antigen (HBeAg)-negative chronic infection (formerly 'inactive carriers') and only 6 (9.4%) HBsAg carriers fulfilled current criteria for treatment. The current HBV burden in Spain remains low but virtually unchanged over the past 15 years. Increased efforts are still needed to reach the goal set forth by the World Health Organization (WHO) for HBV elimination by 2030.
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Affiliation(s)
- Antonio Cuadrado
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), Cantabria, Spain
| | - Christie Perelló
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Joaquin Cabezas
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), Cantabria, Spain
| | - Susana Llerena
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), Cantabria, Spain
| | - Elba Llop
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - María Desamparados Escudero
- Gastroenterology and Hepatology, Servicio Medicina Digestiva del Hospital Clinico Universitario de Valencia (HUCV), Valencia, Spain
| | - Marta Hernandez-Conde
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Laura Puchades
- Gastroenterology and Hepatology, Servicio Medicina Digestiva del Hospital Clinico Universitario de Valencia (HUCV), Valencia, Spain
| | - Carlos Redondo
- Marqués de Valdecilla Research Institute (IDIVAL), Cantabria, Spain
| | - José Ignacio Fortea
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), Cantabria, Spain
| | - Angel Gil de Miguel
- Department of Epidemiology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Miguel A Serra
- Gastroenterology and Hepatology, Servicio Medicina Digestiva del Hospital Clinico Universitario de Valencia (HUCV), Valencia, Spain
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Javier Crespo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), Cantabria, Spain
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8
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Crespo J, Cuadrado A, Perelló C, Cabezas J, Llerena S, Llorca J, Cedillo S, Llop E, Escudero MD, Hernández Conde M, Puchades L, Redondo C, Fortea JI, Gil de Miguel A, Serra MA, Lazarus JV, Calleja JL. Epidemiology of hepatitis C virus infection in a country with universal access to direct-acting antiviral agents: Data for designing a cost-effective elimination policy in Spain. J Viral Hepat 2020; 27:360-370. [PMID: 31755634 DOI: 10.1111/jvh.13238] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 12/29/2022]
Abstract
Accurate HCV prevalence estimates are necessary for guiding elimination policies. Our aim was to determine the HCV prevalence and assess the cost-effectiveness of a screen-and-treat strategy in the Spanish population. A population-based, cross-sectional study (PREVHEP-ETHON Cohort, Epidemiological sTudy of Hepatic infectiONs; NCT02749864) was performed from July 2015-April 2017. Participants from three Spanish regions were selected using two-stage conglomerate sampling, and stratified by age, with randomized subject selection. Anthropometric and demographic data were collected, and blood samples were taken to detect anti-HCV antibodies/quantify HCV RNA. The cost-effectiveness of the screening strategies and treatment were analysed using a Markov model. Among 12 246 participants aged 20-74 (58.4% females), the overall anti-HCV prevalence was 1.2% (95% CI 1.0-1.4), whereas the detectable HCV-RNA prevalence was 0.3% (0.2-0.4). Infection rates were highest in subjects aged 50-74 years [anti-HCV 1.6% (1.3-1.9), HCV RNA 0.4% (0.3-0.6]. Among the 147 anti-HCV + subjects, 38 (25.9%) had active infections while 109 (74.1%) had been cleared of infection; 44 (40.4%) had cleared after antiviral treatment, whereas 65 (59.6%) had cleared spontaneously. Overall, 59.8% of the anti-HCV + participants were aware of their serological status. Considering a cost of treatment of €7000/patient, implementing screening programmes is cost-effective across all age cohorts, particularly in patients aged 50-54 (negative incremental cost-effectiveness ratio which indicates a cost-saving strategy). The current HCV burden is lower than previously estimated, with approximately 25% of anti-HCV + individuals having an active infection. A strategy of screening and treatment at current treatment prices in Spain is cost-effective across all age cohorts.
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Affiliation(s)
- Javier Crespo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Santander, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | - Antonio Cuadrado
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Santander, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | - Christie Perelló
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Majadahonda, Spain
| | - Joaquin Cabezas
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Santander, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | - Susana Llerena
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Santander, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, Santander, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, s/n, Santander, Spain
| | - Sergio Cedillo
- Outcomes Research Department, Chiltern International/MSD, Tres Cantos, Spain
| | - Elba Llop
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Majadahonda, Spain
| | - María Desamparados Escudero
- Gastroenterology and Hepatology, Servicio Medicina Digestiva del Hospital Clinico Universitario de Valencia (HUCV) Av. de Blasco Ibáñez, Valencia, Spain
| | - Marta Hernández Conde
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Majadahonda, Spain
| | - Laura Puchades
- Gastroenterology and Hepatology, Servicio Medicina Digestiva del Hospital Clinico Universitario de Valencia (HUCV) Av. de Blasco Ibáñez, Valencia, Spain
| | - Carlos Redondo
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | - José I Fortea
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Santander, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | | | - Miguel A Serra
- Gastroenterology and Hepatology, Servicio Medicina Digestiva del Hospital Clinico Universitario de Valencia (HUCV) Av. de Blasco Ibáñez, Valencia, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Majadahonda, Spain
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9
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Urios A, Mangas-Losada A, Gimenez-Garzó C, González-López O, Giner-Durán R, Serra MA, Noe E, Felipo V, Montoliu C. Altered postural control and stability in cirrhotic patients with minimal hepatic encephalopathy correlate with cognitive deficits. Liver Int 2017; 37:1013-1022. [PMID: 27988985 DOI: 10.1111/liv.13345] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 06/21/2016] [Accepted: 12/07/2016] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Cognitive dysfunction in cirrhotic patients with minimal hepatic encephalopathy (MHE) is associated with falls. Alterations in postural control and stability could contribute to increase falls risk in these patients. We aimed to assess whether postural control and direction-specific limits of stability are altered in cirrhotic patients with MHE compared to patients without MHE and controls. We also assessed if alterations in postural control correlate with neurological impairment and/or blood biomarkers. METHODS Posturography analysis, attention Stroop test and bimanual and visuo-motor coordination tests were performed in 18 controls, 19 patients with cirrhosis without MHE and 17 with MHE, diagnosed by PHES. Posturography was assessed by NedSVE® /IBV system under four sensory conditions. Limits of stability and rhythmic weight-shifting tests were also performed. Blood ammonia and serum interleukins were also measured. Falls were assessed after 12-24 months follow-up. RESULTS MHE patients show impaired balance, mainly on unstable surface with eyes open, with longer reaction and confinement times and lower success in Limits of Stability test compared to patients without MHE. Performance in attention and motor coordination tests correlated with most posturography parameters alterations. Logistic regression analysis shows that posturography parameters and bimanual coordination test are good predictors of falls. CONCLUSION Balance patterns and limits of stability in MHE patients are impaired compared to patients without MHE and controls. This seems to contribute to a higher falls risk. Attention and motor coordination deficits could contribute to balance impairment in patients with MHE.
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Affiliation(s)
- Amparo Urios
- Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain.,Laboratory of Neurobiology, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
| | | | - Carla Gimenez-Garzó
- Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain.,Laboratory of Neurobiology, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
| | | | | | - Miguel A Serra
- Unidad de Digestivo, Hospital Clínico de Valencia, Departamento Medicina, Universidad de Valencia, Valencia, Spain
| | - Enrique Noe
- Servicio de Daño, Cerebral del Hospital Valencia al Mar, Valencia, Spain
| | - Vicente Felipo
- Laboratory of Neurobiology, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
| | - Carmina Montoliu
- Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain.,Departamento de Patología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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10
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Calleja JL, Crespo J, Rincón D, Ruiz-Antorán B, Fernandez I, Perelló C, Gea F, Lens S, García-Samaniego J, Sacristán B, García-Eliz M, Llerena S, Pascasio JM, Turnes J, Torras X, Morillas RM, Llaneras J, Serra MA, Diago M, Rodriguez CF, Ampuero J, Jorquera F, Simon MA, Arenas J, Navascues CA, Bañares R, Muñoz R, Albillos A, Mariño Z. Effectiveness, safety and clinical outcomes of direct-acting antiviral therapy in HCV genotype 1 infection: Results from a Spanish real-world cohort. J Hepatol 2017; 66:1138-1148. [PMID: 28189751 DOI: 10.1016/j.jhep.2017.01.028] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [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: 07/14/2016] [Revised: 01/25/2017] [Accepted: 01/29/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Clinical trials evaluating second-generation direct-acting antiviral agents (DAAs) have shown excellent rates of sustained virologic response (SVR) and good safety profiles in patients with chronic hepatitis C virus (HCV) genotype 1 infection. We aimed to investigate the effectiveness and safety of two oral DAA combination regimens, ombitasvir/paritaprevir/ritonavir plus dasabuvir (OMV/PTV/r+DSV) and ledipasvir/sofosbuvir (LDV/SOF), in a real-world clinical practice. METHODS Data from HCV genotype 1 patients treated with either OMV/PTV/r+DSV±ribavirin (RBV) (n=1567) or LDV/SOF±RBV (n=1758) in 35 centers across Spain between April 1, 2015 and February 28, 2016 were recorded in a large national database. Demographic, clinical and virological data were analyzed. Details of serious adverse events (SAEs) were recorded. RESULTS The two cohorts were not matched with respect to baseline characteristics and could not be compared directly. The SVR12 rate was 96.8% with OMV/PTVr/DSV±RBV and 95.8% with LDV/SOF±RBV. No significant differences were observed in SVR according to HCV subgenotype (p=0.321 [OMV/PTV/r+DSV±RBV] and p=0.174 [LDV/SOF]) or degree of fibrosis (c0.548 [OMV/PTV/r/DSV±RBV] and p=0.085 [LDV/SOF]). Only baseline albumin level was significantly associated with failure to achieve SVR (p<0.05) on multivariate analysis. Rates of SAEs and SAE-associated treatment discontinuation were 5.4% and 1.7%, in the OMV/PTV/r+DSV subcohort and 5.5% and 1.5% in the LDV/SOF subcohort, respectively. Hepatocellular carcinoma (HCC) recurred in 30% of patients with a complete response to therapy for previous HCC. Incident HCC was reported in 0.93%. CONCLUSIONS In this large cohort of patients managed in the real-world setting in Spain, OMV/PTV/r+DSV and LDV/SOF achieved high rates of SVR12, comparable to those observed in randomized controlled trials, with similarly good safety profiles. LAY SUMMARY In clinical trials, second-generation direct-acting antiviral agents (DAAs) have been shown to cure over 90% of patients chronically infected with the genotype 1 hepatitis C virus and have been better tolerated than previous treatment regimens. However, patients enrolled in clinical trials do not reflect the real patient population encountered in routine practice. The current study, which includes almost 4,000 patients, demonstrates comparable rates of cure with two increasingly used DAA combinations as those observed in the clinical trial environment, confirming that clinical trial findings with DAAs translate into the real-world setting, where patient populations are more diverse and complex.
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Affiliation(s)
- Jose Luis Calleja
- Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid and CIBERehd, Madrid, Spain.
| | - Javier Crespo
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander and Facultad de Medicina, Universidad de Cantabria, Spain
| | - Diego Rincón
- Hospital General Universitario Gregorio Marañón, Facultad de Medicina de la Universidad Complutense and CIBERehd, Madrid, Spain
| | | | | | | | | | - Sabela Lens
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | | | | | - Susana Llerena
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | | | - Juan Turnes
- Complejo Hospitalario Universitario de Pontevedra and IISGS, Spain
| | - Xavier Torras
- Hospital Santa Creu i Sant Pau and CIBERehd, Barcelona, Spain
| | | | | | | | - Moises Diago
- Hospital Universitario General de Valencia, Valencia, Spain
| | | | - Javier Ampuero
- Hospital Universitario Virgen del Rocío, IBIS and CIBERehd, Spain
| | - Francisco Jorquera
- Complejo Asistencial Universitario León, León, IBIOMED and CIBERehd, Spain
| | - Miguel A Simon
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Juan Arenas
- Hospital Universitario Donostia, San Sebastian, Spain
| | | | - Rafael Bañares
- Hospital General Universitario Gregorio Marañón, Facultad de Medicina de la Universidad Complutense and CIBERehd, Madrid, Spain
| | - Raquel Muñoz
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Zoe Mariño
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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11
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Ballester-Ferré MP, Martínez F, Garcia-Gimeno N, Mora F, Serra MA. Miliary tuberculosis infection during hepatitis C treatment with sofosbuvir and ledipasvir plus ribavirin. World J Hepatol 2017; 9:161-166. [PMID: 28217253 PMCID: PMC5295150 DOI: 10.4254/wjh.v9.i3.161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/03/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. In the last 5 years, treatment for HCV infection has experienced a marked development. In 2014, the use of ledipasvir/sofosbuvir with or without concomitant weight-based ribavirin was approved with a very significant increase in the sustained virological response. However, new side effects have been associated. We report the first case of an HCV infected patient treated for 12 wk with the combination of sofosbuvir/ledipasvir plus ribavirin who developed a miliary tuberculosis (TB) infection while on therapy. The patient was a 65-year-old woman, who referred malaise, asthenia, hyporexia, 7 kg weight loss, productive cough, evening fever and night sweats, right after finishing the treatment. The chest computed tomography-scan revealed a superior mediastinal widening secondary to numerous lymphadenopathies with extensive necrosis and bilateral diffuse lung miliary pattern with little subsequent bilateral pleural effusion, highly suggestive of lymph node tuberculosis with lung miliary spread. A bronchoscopy was performed and bronchial suction showed more than 50 acid-alcohol resistant bacillus per line. A Mycobacterium tuberculosis DNA was detected in blood by polymerase chain reaction, which confirmed the diagnosis of miliary tuberculosis. Some cases of TB infection have been identified with α-interferon-based therapy and with the triple therapy of pegylated interferon, ribavirin and boceprevir or telaprevir. However, significant infection has not been reported with sofosbuvir/ledipasvir plus ribavirin. We believe that the case is relevant to increase awareness of opportunistic infections and particularly TB infection. Although the international guidelines offer no recommendation regarding TB screening, we wonder whether it would be advisable to screen for opportunistic infections prior to the introduction of HCV therapy.
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12
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Lluch P, Mauricio MD, Vila JM, Segarra G, Medina P, Del Olmo JA, Rodrigo JM, Serra MA. Accumulation of Symmetric Dimethylarginine in Hepatorenal Syndrome. Exp Biol Med (Maywood) 2016; 231:70-5. [PMID: 16380646 DOI: 10.1177/153537020623100108] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [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: 11/17/2022] Open
Abstract
In patients with cirrhosis, nitric oxide (NO), asymmetric dimethylarginine (ADMA), and possibly symmetric dimethylarginine (SDMA) have been linked to the severity of the disease. We investigated whether plasma levels of dimethylarginines and NO are elevated in patients with hepatorenal syndrome (HRS), compared with patients with cirrhosis without renal failure (no-HRS). Plasma levels of NO, ADMA, SDMA, and l-arginine were measured in 11 patients with HRS, seven patients with no-HRS, and six healthy volunteers. SDMA concentration in HRS was higher than in no-HRS and healthy subjects (1.47 ± 0.25 vs. 0.38 ± 0.06 and 0.29 ± 0.04 μM, respectively; P < 0.05). ADMA and NOx concentrations were higher in HRS and no-HRS patients than in healthy subjects (ADMA, 1.20 ± 0.26, 1.11 ± 0.1, and 0.53 ± 0.06 μM, respectively; P < 0.05; NOx, 94 ± 9.1, 95.5 ± 9.54, and 37.67 ± 4.62 μM, respectively; P < 0.05). In patients with HRS there was a positive correlation between serum creatinine and plasma SDMA (r2 = 0.765, P < 0.001) but not between serum creatinine and ADMA or NOx. The results suggest that renal dysfunction is a main determinant of elevated SDMA concentration in HRS. Accumulation of ADMA as a result of impaired hepatic removal may be the causative factor initiating renal vasoconstriction and SDMA retention in the kidney.
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Affiliation(s)
- Paloma Lluch
- Servicio de Hepatología, Hospital Clínico Universitario, Departamento de Medicina, Universidad de Valencia, Valencia, Spain
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13
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Buti M, Gros B, Oyagüez I, Andrade RJ, Serra MA, Turnes J, Casado MA. [Cost-utility analysis of triple therapy with telaprevir in treatment-naïve hepatitis C patients]. Farm Hosp 2014; 38:418-429. [PMID: 25344136 DOI: 10.7399/fh.2014.38.5.7640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION The prevalence of Hepatitis C (HCV) in Spain is 2,5%, with a high morbimortality rate. Triple therapy based on telaprevir plus peginterferon/ribavirin ([T/PR]) has demonstrated to be an effective approach in treatment-naïve G1-HCV patients. This analysis evaluated, through a Markov model, the incremental cost-effectiveness ratio of triple therapy compared to peginterferon/ ribavirin ([PR]) alone in naïve patients depending on fibrosis stage, from the Spanish Healthcare Authorities perspective. METHODS Efficacy results and adverse events incidence were based on the combined results of ADVANCE and OPTIMIZE studies. Adverse events and disease-related costs (€, 2014) were built up from panel expert opinion except from transplant and post-transplant costs, taken from published data. Drug costs were obtained from national databases and adjusted for the mandatory deduction. Outcomes and costs were both discounted at 3%/year. RESULTS The analysis shows higher costs and improved outcomes associated with [TR/PR] relative to [PR] alone, resulting in an incremental cost-effectiveness ratio (ICER) of €18,288/ QALY for all the cohort, €14,152QALY for moderate fibrosis, €11,364QALY for bridging fibrosis, €15,929/QALY for cirrhosis. Over a lifetime period, the use of [T/PR] could avoid 12 cirrhosis and 4 liver transplants per 1,000 patients compared to [PR] alone. The probabilistic analysis, following 10,000 Montecarlo simulations, demonstrated the probability of an ICER below a €30,000/QALY gained threshold of 69%. At a willingness- to-pay of €30,000/QALY, [T/PR] could be considered as an efficient option compared with [PR] alone for treatment-naïve genotype 1 HCV patients, over a lifetime horizon.
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Affiliation(s)
- María Buti
- Pharmacoeconomics & Outcomes Research Iberia, Madrid..
| | | | | | | | - Miguel A Serra
- Hospital Clínico de Valencia, Valencia. Universidad de Valencia, Valencia..
| | - Juan Turnes
- Complejo Hospitalario Universitario de Pontevedra, Pontevedra. España..
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Felipo V, Urios A, Giménez-Garzó C, Cauli O, Andrés-Costa MJ, González O, Serra MA, Sánchez-González J, Aliaga R, Giner-Durán R, Belloch V, Montoliu C. Non invasive blood flow measurement in cerebellum detects minimal hepatic encephalopathy earlier than psychometric tests. World J Gastroenterol 2014; 20:11815-11825. [PMID: 25206287 PMCID: PMC4155373 DOI: 10.3748/wjg.v20.i33.11815] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/23/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess whether non invasive blood flow measurement by arterial spin labeling in several brain regions detects minimal hepatic encephalopathy.
METHODS: Blood flow (BF) was analyzed by arterial spin labeling (ASL) in different brain areas of 14 controls, 24 cirrhotic patients without and 16 cirrhotic patients with minimal hepatic encephalopathy (MHE). Images were collected using a 3 Tesla MR scanner (Achieva 3T-TX, Philips, Netherlands). Pulsed ASL was performed. Patients showing MHE were detected using the battery Psychometric Hepatic Encephalopathy Score (PHES) consisting of five tests. Different cognitive and motor functions were also assessed: alterations in selective attention were evaluated using the Stroop test. Patients and controls also performed visuo-motor and bimanual coordination tests. Several biochemical parameters were measured: serum pro-inflammatory interleukins (IL-6 and IL-18), 3-nitrotyrosine, cGMP and nitrates+nitrites in plasma, and blood ammonia. Bivariate correlations were evaluated.
RESULTS: In patients with MHE, BF was increased in cerebellar hemisphere (P = 0.03) and vermis (P = 0.012) and reduced in occipital lobe (P = 0.017). BF in cerebellar hemisphere was also increased in patients without MHE (P = 0.02). Bimanual coordination was impaired in patients without MHE (P = 0.05) and much more in patients with MHE (P < 0.0001). Visuo-motor coordination was impaired only in patients with MHE (P < 0.0001). Attention was slightly affected in patients without MHE and more strongly in patients with MHE (P < 0.0001). BF in cerebellar hemisphere and vermis correlated with performance in most tests of PHES [(number connection tests A (NCT-A), B (NCT-B)and line tracing test] and in the congruent task of Stroop test. BF in frontal lobe correlated with NCT-A. Performance in bimanual and visuomotor coordination tests correlated only with BF in cerebellar hemisphere. BF in occipital lobe correlates with performance in the PHES battery and with CFF. BF in cerebellar hemisphere correlates with plasma cGMP and nitric oxide (NO) metabolites. BF in vermis cerebellar also correlates with NO metabolites and with 3-nitrotyrosine. IL-18 in plasma correlates with BF in thalamus and occipital lobe.
CONCLUSION: Non invasive BF determination in cerebellum using ASL may detect MHE earlier than the PHES. Altered NO-cGMP pathway seems to be associated to altered BF in cerebellum.
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15
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Montoliu C, Urios A, Forn C, García-Panach J, Avila C, Gimenez-Garzó C, Wassel A, Serra MA, Giner-Durán R, Gonzalez O, Aliaga R, Belloch V, Felipo V. Reduced white matter microstructural integrity correlates with cognitive deficits in minimal hepatic encephalopathy. Gut 2014; 63:1028-30. [PMID: 24218171 DOI: 10.1136/gutjnl-2013-306175] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Carmina Montoliu
- Instituto de Investigación Sanitaria -INCLIVA, , Valencia, Spain
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16
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Felipo V, Urios A, Valero P, Sánchez M, Serra MA, Pareja I, Rodríguez F, Gimenez-Garzó C, Sanmartín J, Montoliu C. Serum nitrotyrosine and psychometric tests as indicators of impaired fitness to drive in cirrhotic patients with minimal hepatic encephalopathy. Liver Int 2013; 33:1478-89. [PMID: 23714168 DOI: 10.1111/liv.12206] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 11/07/2012] [Accepted: 05/05/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND & AIMS Cirrhotic patients with minimal hepatic encephalopathy (MHE) show impaired driving ability and increased vehicle accidents. The neurological deficits contributing to impair driving and the underlying mechanisms are poorly understood. Early detection of driving impairment would help to reduce traffic accidents in MHE patients. It would be therefore useful to have psychometric or biochemical parameters reflecting driving impairment. The aims of this work were as follows: (i) to shed light on the neurological deficits contributing to impair driving; (ii) to assess whether some psychometric test or biochemical parameter is a good indicator of driving impairment. METHODS We assessed in 22 controls, 36 cirrhotic patients without and 15 with MHE, driving performance using a driving simulator (SIMUVEG) and Driver Test. MHE was diagnosed using the psychometric hepatic encephalopathy score (PHES). Psychometric tests assessing different neurological functions (mental processing speed, attention, visuo-spatial and bimanual coordination) were performed. Blood ammonia and parameters related with nitric oxide-cGMP metabolism, IL-6, IL-18 and 3-nitrotyrosine were measured. RESULTS Patients with MHE showed impaired driving ability correlating with MHE grade, with impaired vehicle lateral control in spite of reduced driving speed. Patients with MHE show psychomotor slowing, longer reaction times, impaired bimanual and visuo-spatial coordination and concentrated attention and slowed speed of anticipation and increased blood ammonia, cGMP, IL-6, IL-18 and 3-nitrotyrosine. CONCLUSIONS Impaired mental processing speed, attention and alterations in visuo-spatial and motor coordination seem main contributors to impaired driving ability in patients with MHE. Increased serum 3-nitrotyrosine is associated with impaired driving ability.
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Affiliation(s)
- Vicente Felipo
- Laboratory of Neurobiology, Centro de Investigación Principe Felipe, Valencia, Spain
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17
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Montoliu C, Gonzalez-Escamilla G, Atienza M, Urios A, Gonzalez O, Wassel A, Aliaga R, Giner-Duran R, Serra MA, Rodrigo JM, Belloch V, Felipo V, Cantero JL. Focal cortical damage parallels cognitive impairment in minimal hepatic encephalopathy. Neuroimage 2012; 61:1165-75. [PMID: 22465844 DOI: 10.1016/j.neuroimage.2012.03.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 03/11/2012] [Accepted: 03/13/2012] [Indexed: 01/12/2023] Open
Abstract
Little attention has been paid to cortical integrity in patients with minimal hepatic encephalopathy (MHE), although cognitive functions affected in early stages of liver disease are mainly allocated in different neocortical structures. Here we used cortical surface-based analysis techniques to investigate if patterns of cortical thinning accompany the mildest form of HE. To aim this goal, cortical thickness obtained from high-resolution 3T magnetic resonance imaging (MRI) was measured in patients with no MHE (NMHE), MHE, and healthy controls. Further correlation analyses were performed to examine whether scores in the critical flicker frequency (CFF) test, and blood ammonia levels accounted for the loss of cortical integrity in different stages of liver disease. Finally, we assessed group differences in volume of different subcortical regions and their potential relationships with CFF scores/blood ammonia levels. Results showed a focal thinning of the superior temporal cortex and precuneus in MHE patients when compared with NMHE and controls. Relationships between blood ammonia levels and cortical thickness of the calcarine sulcus accounted for impaired visual judgment in patients with MHE when compared to NMHE. Regression analyses between cortical thickness and CFF predicted differences between controls and the two groups of HE patients, but failed to discriminate between patients with NMHE and MHE. Taking together, these findings provide the first report of cortical thinning in MHE patients, and they yield novel insights into the neurobiological basis of cognitive impairment associated with early stages of liver diseases.
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Affiliation(s)
- Carmina Montoliu
- Fundación Investigación Hospital Clínico Universitario de Valencia-INCLIVA, Spain
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18
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Felipo V, Urios A, Montesinos E, Molina I, Garcia-Torres ML, Civera M, Olmo JAD, Ortega J, Martinez-Valls J, Serra MA, Cassinello N, Wassel A, Jordá E, Montoliu C. Contribution of hyperammonemia and inflammatory factors to cognitive impairment in minimal hepatic encephalopathy. Metab Brain Dis 2012; 27:51-8. [PMID: 22072427 DOI: 10.1007/s11011-011-9269-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [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: 07/05/2011] [Accepted: 10/25/2011] [Indexed: 12/15/2022]
Abstract
To assess the contribution of hyperammonemia and inflammation to induction of mild cognitive impairment (or MHE). We analyzed the presence of mild cognitive impairment (CI) by using the PHES battery of psychometric tests and measured the levels of ammonia and of the inflammatory cytokines IL-6 and IL-18 in blood of patients with different types of liver or dermatological diseases resulting in different grades of hyperammonemia and/or inflammation. The study included patients with 1) liver cirrhosis, showing hyperammonemia and inflammation; 2) non-alcoholic fatty liver disease (NAFLD) showing inflammation but not hyperammonemia; 3) non-alcoholic steatohepatitis (NASH) showing inflammation and very mild hyperammonemia; 4) psoriasis, showing inflammation but not hyperammonemia; 5) keloids, showing both inflammation and hyperammonemia and 6) controls without inflammation or hyperammonemia. The data reported show that in patients with liver diseases, cognitive impairment may appear before progression to cirrhosis if hyperammonemia and inflammation are high enough. Five out of 11 patients with NASH, without liver cirrhosis, showed cognitive impairment associated with hyperammonemia and inflammation. Patients with keloids showed cognitive impairment associated with hyperammonemia and inflammation, in the absence of liver disease. Hyperammonemia or inflammation alone did not induce CI but the combination of certain levels of hyperammonemia and inflammation is enough to induce CI, even without liver disease.
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Affiliation(s)
- Vicente Felipo
- Laboratory of Neurobiology. Centro de Investigación Príncipe Felipe, Valencia, Spain
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19
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Felipo V, Ordoño JF, Urios A, El Mlili N, Giménez-Garzó C, Aguado C, González-Lopez O, Giner-Duran R, Serra MA, Wassel A, Rodrigo JM, Salazar J, Montoliu C. Patients with minimal hepatic encephalopathy show impaired mismatch negativity correlating with reduced performance in attention tests. Hepatology 2012; 55:530-9. [PMID: 21953369 DOI: 10.1002/hep.24704] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED Attention deficit is an early event in the cognitive impairment of patients with minimal hepatic encephalopathy (MHE). The underlying mechanisms remain unclear. Mismatch negativity (MMN) is an auditory event-related potential that reflects an attentional trigger. Patients with schizophrenia show impaired attention and cognitive function, which are reflected in altered MMN. We hypothesized that patients with MHE, similarly to those with schizophrenia, should show MMN alterations related with attention deficits. The aims of this work were to assess whether (1) MMN is altered in cirrhotic patients with MHE, compared to those without MHE, (2) MMN changes in parallel with performance in attention tests and/or MHE in a longitudinal study, and (3) MMN predicts performance in attention tests and/or in the Psychometric Hepatic Encephalopathy Score (PHES). We performed MMN analysis as well as attention and coordination tests in 34 control subjects and in 37 patients with liver cirrhosis without MHE and 23 with MHE. Patients with MHE show reduced performance in selective and sustained attention tests and in visuomotor and bimanual coordination tests. The MMN wave area was reduced in patients with MHE, but not in those without MHE. In the longitudinal study, MMN area improved in parallel with performance in attention tests and PHES in 4 patients and worsened in parallel in another 4. Logistic regression analyses showed that MMN area predicts performance in attention tests and in PHES, but not in other tests or critical flicker frequency. Receiver operating characteristic curve analyses showed that MMN area predicts attention deficits in the number connection tests A and B, Stroop tasks, and MHE, with sensitivities of 75%-90% and specificities of 76%-83%. CONCLUSION MMN area is useful to diagnose attention deficits and MHE in patients with liver cirrhosis.
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Affiliation(s)
- Vicente Felipo
- Laboratory of Neurobiology, Centro Investigación Príncipe Felipe, Valencia, Spain
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20
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Montoliu C, Cauli O, Urios A, ElMlili N, Serra MA, Giner-Duran R, González-Lopez O, Del Olmo JA, Wassel A, Rodrigo JM, Felipo V. 3-nitro-tyrosine as a peripheral biomarker of minimal hepatic encephalopathy in patients with liver cirrhosis. Am J Gastroenterol 2011; 106:1629-37. [PMID: 21483460 DOI: 10.1038/ajg.2011.123] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Between 30 and 50% of the cirrhotic patients who do not show symptoms of clinical hepatic encephalopathy (HE) present minimal hepatic encephalopathy (MHE), with mild cognitive impairment. MHE impairs the quality of life, increases the risk of suffering accidents, predicts the appearance of clinical HE, and is associated with shortened lifespan. Early detection of MHE would be very useful. The "gold standard" for MHE diagnosis is the psychometric hepatic encephalopathy score (PHES). However, it is time consuming and needs adjusting for age and educational level. It would be very useful to have some blood biomarker reflecting the presence of MHE in cirrhotic patients. The aim of this work was to identify serum molecules useful as biomarkers for MHE. METHODS We measured in 63 controls, 43 cirrhotic patients without MHE, and 44 patients with MHE, from Hospital Clinico de Valencia, serum levels of different amino acids, cyclic guanosine monophosphate (cGMP), nitrites+nitrates, and 3-nitrotyrosine. We analyzed for each parameter its diagnostic accuracy as an indicator of MHE, as assessed using the PHES. RESULTS These studies supported that 3-nitro-tyrosine is a good marker for MHE. To validate its utility as a biomarker for MHE, we analyzed in a second cohort of 44 cirrhotic patients without MHE and 18 patients with MHE, from Hospital Arnau de Vilanova, serum levels of 3-nitro-tyrosine, methionine, and citrulline. Citrulline (173±17%), methionine (173±16%), and 3-nitro-tyrosine (857±92%) were increased in sera from patients with MHE when compared with those without MHE. The receiver operating characteristic (ROC) curve analysis of 3-nitro-tyrosine for the diagnosis of MHE in the first cohort showed an area under the curve (AUC) value of 0.96 (95% confidence interval 0.93-0.99). At the cutoff of 14 nM, the specificity was 93%, sensitivity 89%, and positive and negative predictive values were both 91%. When the same cutoff was applied to the second cohort, the specificity was 83% and sensitivity was 94%. The positive and negative predictive values were 70 and 97%, respectively. CONCLUSIONS This pilot study, to be validated in a larger cohort, shows that determination of 3-nitro-tyrosine in serum, which is easy and not time consuming, is useful to identify patients with MHE, with good sensitivity, specificity, and positive and negative predictive values.
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Affiliation(s)
- Carmina Montoliu
- Fundación Investigación Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
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21
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Urios A, Garcia-Torres ML, Gimenez-Garzó C, Aguado C, del Olmo JA, Marin C, Civera M, Cassinello FN, Ortega J, Ferrandez A, Martinez-Valls J, Serra MA, Rodrigo JM, Felipo V, Montoliu C. Metabolism of cyclic GMP in non-alcoholic fatty liver disease in morbid obesity. BMC Pharmacol 2011. [PMCID: PMC3363271 DOI: 10.1186/1471-2210-11-s1-p73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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22
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Jiménez B, Montoliu C, MacIntyre DA, Serra MA, Wassel A, Jover M, Romero-Gomez M, Rodrigo JM, Pineda-Lucena A, Felipo V. Serum metabolic signature of minimal hepatic encephalopathy by (1)H-nuclear magnetic resonance. J Proteome Res 2010; 9:5180-7. [PMID: 20690770 DOI: 10.1021/pr100486e] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Minimal hepatic encephalopathy (MHE) reduces quality of life of cirrhotic patients, predicts overt hepatic encephalopathy, and is associated with poor prognosis. We hypothesized that MHE arises once metabolic alterations derived from the liver reach a particular threshold. Our aim was to assess whether metabolic profiling of serum samples by high-field (1)H-nuclear magnetic resonance spectroscopy ((1)H NMR) and subsequent multivariate analyses would be useful to characterize metabolic perturbations associated with MHE and to identify potential metabolic biomarkers. Metabolic serum profiles from controls (n = 69) and cirrhotic patients without MHE (n = 62) and with MHE (n = 39) were acquired using high field NMR. Supervised modeling of the data provided perfect discrimination between healthy controls and cirrhotic patients and allowed the generation of a predictive model displaying strong discrimination between patients with and without MHE (R(2)Y = 0.68, Q(2)Y = 0.63). MHE patients displayed increased serum concentrations of glucose, lactate, methionine, TMAO, and glycerol, as well as decreased levels of choline, branch amino acids, alanine, glycine, acetoacetate, NAC, and lipid moieties. Serum metabonomics by (1)H NMR offers a useful approach for characterizing underlying metabolic differences between patients with and without MHE. This procedure shows great potential as a diagnostic tool of MHE as it objectively reflects measurable biochemical differences between the patient groups and may facilitate monitoring of both disease progression and effects of therapeutic treatments.
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Affiliation(s)
- Beatriz Jiménez
- Structural Biochemistry Laboratory, Centro de Investigación Príncipe Felipe, Valencia, Spain
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23
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Lluch P, Cortina B, Vila JM, Segarra G, Mauricio MD, del Olmo JA, Serra MA, Lluch S, Rodrigo JM. Unchanged plasma levels of dimethylarginines and nitric oxide in chronic hepatitis C. Scand J Gastroenterol 2009; 44:224-8. [PMID: 18951278 DOI: 10.1080/00365520802400917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Previous studies have shown that asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and nitric oxide (NO) play a prominent role in liver dysfunction. The objective of this study was to determine whether plasma levels of ADMA, SDMA and NO are altered in patients with chronic hepatitis C. MATERIAL AND METHODS Plasma levels of ADMA, SDMA and NO (nitrite plus nitrate) were measured in 22 patients with chronic hepatitis C and 24 patients with sustained virologic response after treatment with peginterferon plus ribavirin. Seven healthy volunteers served as controls. RESULTS Plasma levels of ADMA, SDMA and NO were not significantly different between groups: chronic hepatitis C, ADMA 0.55+/-0.06, SDMA 0.22+/-0.03, NO 36.3+/-5.9 micromol/l; treated patients, ADMA 0.60+/-0.15, SDMA 0.31+/-0.05, NO 36.1+/-5.5 micromol/l; controls, ADMA 0.65+/-0.08, SDMA 0.28+/-0.05, NO 40.7+/-8.9 micromol/l). CONCLUSIONS Our results show that plasma NO, ADMA and SDMA concentrations are not changed in patients with chronic hepatitis C without superimposed signs of acute inflammatory activity. Furthermore, no significant differences in plasma values of NO and dimethylarginines were observed between the group of untreated patients and the group of patients treated with interferon plus ribavirin.
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Affiliation(s)
- Paloma Lluch
- Servicio de Hepatologia, Hospital Clinico Universitario, Valencia, Spain
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24
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Zapater P, Francés R, González-Navajas JM, de la Hoz MA, Moreu R, Pascual S, Monfort D, Montoliu S, Vila C, Escudero A, Torras X, Cirera I, Llanos L, Guarner-Argente C, Palazón JM, Carnicer F, Bellot P, Guarner C, Planas R, Solá R, Serra MA, Muñoz C, Pérez-Mateo M, Such J. Serum and ascitic fluid bacterial DNA: a new independent prognostic factor in noninfected patients with cirrhosis. Hepatology 2008; 48:1924-31. [PMID: 19003911 DOI: 10.1002/hep.22564] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED We tested the hypothesis that the presence of bacterial DNA (bactDNA) in ascitic fluid and serum is associated with decreased survival in patients with cirrhosis. In a prospective, multicenter study, we analyzed the clinical evolution of 156 patients with cirrhosis and ascites (first or recurrence) with lower than 250 polymorphonuclear cells (PMN)/muL, negative ascites bacteriological culture, and absence of other bacterial infections being admitted for evaluation of large-volume paracentesis, according to the presence of bactDNA at admission. Survival, causes of death, and successive hospital admissions were determined during a 12-month follow-up period. BactDNA was detected in 48 patients. The most prevalent identified bactDNA corresponded to Escherichia coli (n = 32/48 patients, 66.6%). Patients were followed for 12 months after inclusion and in this period 34 patients died: 16 of 108 (15%) bactDNA negative versus 18 of 48 (38%) bactDNA positive (P = 0.003). The most frequent cause of death was acute-on-chronic liver failure in both groups (7/16 and 9/18 in patients without or with bactDNA, respectively), although more prevalent in the first month of follow-up in patients with presence of bactDNA (0 versus 4/7). When considering patients with model for end-stage liver disease (MELD) score less than 15, mortality was significantly higher in those with presence of bactDNA. Spontaneous bacterial peritonitis developed similarly in patients with or without bactDNA at admission. CONCLUSION The presence of bactDNA in a patient with cirrhosis during an ascitic episode is an indicator of poor prognosis. This fact may be related to the development of acute-on-chronic liver failure at short term and does not predict the development of spontaneous bacterial peritonitis.
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Affiliation(s)
- Pedro Zapater
- Unidad Hepática, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Spain
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25
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Serra MA. [The time factor in the management of chronic hepatitis C]. Rev Esp Enferm Dig 2008; 100:230-5. [PMID: 18563981 DOI: 10.4321/s1130-01082008000400007] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M A Serra
- Servicio de Hepatología, Hospital Clínico Universitario de Valencia, Universitat de Valencia.
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Escudero A, Rodríguez F, Serra MA, Del Olmo JA, Montes F, Rodrigo JM. Pegylated alpha-interferon-2a plus ribavirin compared with pegylated alpha-interferon-2b plus ribavirin for initial treatment of chronic hepatitis C virus: prospective, non-randomized study. J Gastroenterol Hepatol 2008; 23:861-6. [PMID: 18422960 DOI: 10.1111/j.1440-1746.2008.05397.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM We assessed whether the two regimens of pegylated alpha-interferon-2b (PEG-IFN-alpha2b) plus ribavirin and pegylated alpha-interferon-2a (PEG-IFN-alpha2a) plus ribavirin showed differences in terms of sustained virological response, withdrawal due to side-effects and dose adjustment requirements in the treatment of naive chronic hepatitis C virus (HCV) patients. METHODS A prospective non-randomized, open-label comparison was made of naive HCV-infected patients undergoing standard 24- or 48-week treatment with two PEG-IFN combined with weight-based dosing regimen of ribavirin (PEG-IFN-alpha2a/ribavirin, n = 91; PEG-IFN-alpha2b/ribavirin, n = 92). RESULTS Sustained virological response was similar in PEG-IFN-alpha2a and PEG-IFN-alpha2b (65.9% vs 62%, P = 0.64), without differences according to genotype. In 117 patients with HCV genotype 1, the corresponding rates were 50.8% versus 46.6% (P = 0.713). Rapid virological response at 4 weeks, early virological response at 12 weeks and transient virological response were also similar. In the multivariate analysis, HCV genotype (odds ratio [OR] = 0.076, 95% confidence interval [CI] 0.029-0.198, P = 0.000) and presence of steatosis in the liver biopsy (OR = 2.799, 95% CI 1.362-5.755, P = 0.005) were significantly associated with response to antiviral therapy. The rate of withdrawals due to treatment-related adverse events was 13.2% in the group of PEG-IFN-alpha2a and 10.9% in the group of PEG-IFN-alpha2b. Dose modification of PEG-IFN was necessary in eight patients given PEG-IFN-alpha2a and in seven given PEG-IFN-alpha2b. CONCLUSION The two PEG-IFN plus ribavirin have comparable anti-HCV activity as shown by similar percentages of patients with sustained virological response.
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Affiliation(s)
- Amparo Escudero
- Service of Hepatology, University Hospital Clinic, Department of Medicine, University of Valencia, Valencia, Spain.
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Felipo V, Piedrafita B, Urios A, Serra MA, del Olmo A, Rodrigo JM, Montoliu C. Activation of soluble guanylate cyclase by nitric oxide in lymphocytes correlates with minimal hepatic encephalopathy in cirrhotic patients. BMC Pharmacol 2007. [DOI: 10.1186/1471-2210-7-s1-p18] [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: 11/10/2022] Open
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Montoliu C, Piedrafita B, Serra MA, del Olmo JA, Ferrandez A, Rodrigo JM, Felipo V. Activation of soluble guanylate cyclase by nitric oxide in lymphocytes correlates with minimal hepatic encephalopathy in cirrhotic patients. J Mol Med (Berl) 2007; 85:237-45. [PMID: 17216205 DOI: 10.1007/s00109-006-0149-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 10/17/2006] [Accepted: 11/17/2006] [Indexed: 12/24/2022]
Abstract
Patients with liver cirrhosis with normal neurological and mental status examination may present minimal forms of hepatic encephalopathy, showing intellectual function impairment that cannot be detected through general clinical examination but can be unveiled using specific neuropsychological or neurophysiological examination. Evaluation of minimal hepatic encephalopathy (MHE) in cirrhotic patients would have prognostic value. The psychometric hepatic encephalopathy score (PHES) has been recommended as the "gold standard" in the diagnosis of MHE. Altered modulation of cyclic GMP (cGMP) levels in the brain seems to be responsible for the impairment of some types of cognitive function in liver disease. In animal models of liver disease, some of the alterations in modulation of cGMP levels in the brain are reproduced in lymphocytes. The aim of the present work was to assess whether there is a correlation between the alterations in different parameters involved in modulation of cGMP levels and the presence of MHE in patients with liver disease. We studied in 46 patients with liver cirrhosis and 26 controls the performance in the PHES battery of psychometric tests and the critical flicker frequency (CFF), the concentration of cGMP in plasma and lymphocytes, activation of guanylate cyclase by nitric oxide (NO) in lymphocytes, and several parameters likely involved in altered cGMP homeostasis in liver disease such as ammonia, NO metabolites, and atrial natriuretic peptide (ANP). Activation of guanylate cyclase by NO in lymphocytes and cGMP in plasma were higher and CFF lower in patients with MHE than in patients without MHE. Ammonia, ANP, and metabolites of NO were higher in patients than in controls but were no different in patients with or without MHE. Alteration in activation of guanylate cyclase by NO in lymphocytes correlates with PHES performance, CFF, and ammonia levels. This suggests that altered modulation of guanylate cyclase by NO in lymphocytes would reflect a parallel alteration in the brain occurring in patients with MHE that would be involved in their cognitive impairment.
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Affiliation(s)
- Carmina Montoliu
- Servicio de Hepatología, Departamento de Medicina, Hospital Clínico Universitario, Universidad de Valencia, Valencia, Spain
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Montoliu C, Piedrafita B, Serra MA, del Olmo JA, Rodrigo JM, Felipo V. A single transient episode of hyperammonemia induces long-lasting alterations in protein kinase A. Am J Physiol Gastrointest Liver Physiol 2007; 292:G305-14. [PMID: 17215436 DOI: 10.1152/ajpgi.00100.2006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Indexed: 01/31/2023]
Abstract
Hepatic encephalopathy in patients with liver disease is associated with poor prognosis. This could be due to the induction by the transient episode of hepatic encephalopathy of long-lasting alterations making patients more susceptible. We show that a single transient episode of hyperammonemia induces long-lasting alterations in signal transduction. The content of the regulatory subunit of the protein kinase dependent on cAMP (PKA-RI) is increased in erythrocytes from cirrhotic patients. This increase is reproduced in rats with portacaval anastomosis and in rats with hyperammonemia without liver failure, suggesting that hyperammonemia is responsible for increased PKA-RI in patients. We analyzed whether there is a correlation between ammonia levels and PKA-RI content in patients. All cirrhotic patients had increased content of PKA-RI. Some of them showed normal ammonia levels but had suffered previous hyperammonemia episodes. This suggested that a single transient episode of hyperammonemia could induce the long-lasting increase in PKA-RI. To assess this, we injected normal rats with ammonia and blood was taken at different times. Ammonia returned to basal levels at 2 h. However, PKA-RI was significantly increased in blood cells from rats injected with ammonia 3 wk after injection. In conclusion, it is shown that a single transient episode of hyperammonemia induces long-lasting alterations in signal transduction both in blood and brain. These alterations may contribute to the poor prognosis of patients suffering hepatic encephalopathy.
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Affiliation(s)
- Carmina Montoliu
- Servicio de Hepatología, Hospital Clínico Universitario, Departamento de Medicina, Universidad de Valencia, Valencia, Spain
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del Olmo JA, Ornia E, Serra MA, Garcia-Torres ML, Escudero A, Rodriguez F, Rodrigo JM. Changing prevalence, clinical features, and outcome of acute hepatitis in Spain (1982-2003). J Gastroenterol Hepatol 2006; 21:982-7. [PMID: 16724982 DOI: 10.1111/j.1440-1746.2006.04256.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diagnostic and preventive measures have contributed to a change in the epidemiology of acute hepatitis. The purpose of the present paper was to assess the changing prevalence of acute hepatitis from 1982 to 2003. METHODS Trends in the epidemiology, clinical findings, and outcome of acute viral hepatitis from 1982 to 2003 were examined. A total of 548 episodes of acute hepatitis diagnosed between 1982 and 2003, the clinical course of which was monitored up to the year 2003, were included. Annual changes as well as for the intervals 1982-1992 and 1993-2003 were compared. RESULTS Severe infections occurred in 1.3% of cases, with a mortality of 0.6%, with progression into chronicity in 25.1%. The annual incidences of acute hepatitis and the comparative intervals 1982-1992 and 1993-2003 showed a decline of parenterally -B, delta and C virus- transmitted infections, unchanged number of cases of acute hepatitis A, an increase in the number of cases of drug-induced hepatitis, increase in median ages, and a decrease in the proportion of hepatitis in injecting drug users. Ages of patients with hepatitis A tended to increase. CONCLUSIONS A decline of parenterally transmitted acute hepatitis was documented throughout a 22-year period, while the number of cases of hepatitis A was unchanged and that of drug-induced hepatitis increased. Evaluation of the current targeted hepatitis A vaccination approach and adequate pharmacovigilance measures are required in the near future.
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Affiliation(s)
- Juan A del Olmo
- Service of Hepatology, University Clinic Hospital, Department of Medicine, University of Valencia, Avda. Blasco Ibáñez 17, E-46010 Valencia, Spain.
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Montoliu C, Kosenko E, Del Olmo JA, Serra MA, Rodrigo JM, Felipo V. Correlation of nitric oxide and atrial natriuretic peptide changes with altered cGMP homeostasis in liver cirrhosis. Liver Int 2005; 25:787-95. [PMID: 15998430 DOI: 10.1111/j.1478-3231.2005.01066.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cyclic GMP (cGMP) concentration is increased in plasma of patients with liver cirrhosis. Three possible mechanisms may contribute: increased cGMP synthesis by soluble (activated by nitric oxide), or particulate (activated by atrial natriuretic peptide (ANP)) guanylate cyclase or increased release from cells. AIM The aim of this work was to analyze the possible contributors to increased plasma cGMP and to assess whether changes in the parameters of the system vary with the degree of liver disease (Child Pugh score) or by the presence of ascites. METHODS We measured cGMP in plasma and lymphocytes, soluble guanylate cyclase activation by nitric oxide in lymphocytes, nitrates and nitrites and ANPs (activator of particulate guanylate cyclase) in plasma. We analyzed the correlation between changes in different parameters to discern which parameters contribute to increased plasma cGMP. RESULTS The plasma content of nitrates+nitrites, ANP and cGMP are increased. Activation of soluble guanylate cyclase by nitric oxide is increased in patients while basal cGMP in lymphocytes is decreased. CONCLUSIONS Both increased ANP and increased activation of soluble guanylate cyclase by nitric oxide contribute to increased plasma cGMP in patients. The concentrations of ANP and cGMP in plasma increase with the degree of disease and are higher in patients with ascites.
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Affiliation(s)
- Carmina Montoliu
- Servicio de Hepatología, Hospital Clínico Universitario, Departamento de Medicina, Universidad de Valencia, Valencia, Spain
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Martí L, Del Olmo JA, Tosca J, Ornia E, García-Torres ML, Serra MA, Rodríguez F, Lluch P, Escudero A, Rodrigo JM. Clinical evaluation of drug-induced hepatitis. Rev esp enferm dig 2005; 97:258-65. [PMID: 15982181 DOI: 10.4321/s1130-01082005000400006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To ascertain the epidemiological characteristics, clinical symptoms, and evolution of drug-induced hepatitis over the last 22 years. EXPERIMENTAL DESIGN AND SUBJECTS: An observational, retrospective study between 1982 and 1993, and prospective study between 1994 and 2003. All patients in our department diagnosed with having drug-induced hepatitis were studied analyzing epidemiological (age, sex, cases per year, hospitalization) and clinical features (previous liver disease, hepatic symptoms, laboratory results), and follow-up (complete recovery or chronicity). RESULTS A total of 61 patients were diagnosed as having drug-induced hepatitis, 26 men and 35 women (57%), mean age 52.4 years +/- 17 years, of which 72.2% were older than 40 years. A total of 43% were admitted to hospital. In 87% of cases, two or more drugs were involved, the most frequent being antituberculosis (19 cases), psychotropic (26 cases), and non-steroidal anti-inflammatory drugs (45 cases). Evolution showed that 94% of patients recovered after the withdrawal of suspected causal drugs. CONCLUSIONS The incidence of drug-induced hepatitis is higher in patients over 40 years of age, it being more common in females. Non-steroidal anti-inflammatory, psychotropic, and anti-tuberculosis agents were the main drugs involved. Most patients made a complete recovery after withdrawal of the suspected causal drug.
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Affiliation(s)
- L Martí
- Service of Hepatology, Hospital Clínico Universiratio, Department of Medicine, Valencia, Spain
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Serra MA, Puchades MJ, Rodríguez F, Escudero A, del Olmo JA, Wassel AH, Rodrigo JM. Clinical value of increased serum creatinine concentration as predictor of short-term outcome in decompensated cirrhosis. Scand J Gastroenterol 2004; 39:1149-53. [PMID: 15545175 DOI: 10.1080/00365520410008024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to assess whether serum creatinine concentration alone or associated with other biological parameters was an independent predictor of short-term mortality in patients with decompensated cirrhosis. METHODS A total of 212 consecutive episodes of decompensated cirrhosis in patients admitted to the hospital between January 1999 and December 2001 were reviewed retrospectively. Depending on a serum creatinine concentration equal to or greater than 1.5 mg/dL at the time of admission, patients were divided into decompensated cirrhosis with renal failure (101 episodes in 59 patients, aged 69.8 +/- 10 years) and without renal failure (111 episodes in 61 patients, aged 64.5 +/- 13 years). Outcome (alive, death) during the episode of decompensation of liver disease and outcome at 90 days after admission were assessed. RESULTS Differences in the frequency of variables according to outcome in the overall episodes of decompensated cirrhosis with and without renal failure showed significant differences between patients who died and those who were alive both at hospital discharge and at 90 days in serum bilirubin, Child-Pugh score, MELD (model for end-stage liver disease) score, and serum creatinine levels. In the multivariate analysis, serum creatinine was not an independent predictor of outcome. The prediction accuracy according to the area under the ROC (receiver operating characteristic) curve was greater for the MELD scale than for serum creatinine. CONCLUSIONS Serum creatinine concentration is a parameter that should be included in the prognostic assessment of patients with decompensated cirrhosis, but should be combined with other specific parameters of liver function, such as bilirubin, albumin, and the international normalized ratio (INR) for prothrombin time.
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Affiliation(s)
- M A Serra
- Service of Hepatology, Hospital Clínico Universitario, University of Valencia, ES-46010 Valencia, Spain.
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Rodrigo R, Montoliu C, Chatauret N, Butterworth R, Behrends S, Del Olmo JA, Serra MA, Rodrigo JM, Erceg S, Felipo V. Alterations in soluble guanylate cyclase content and modulation by nitric oxide in liver disease. Neurochem Int 2004; 45:947-53. [PMID: 15312989 DOI: 10.1016/j.neuint.2004.03.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 01/30/2004] [Accepted: 02/11/2004] [Indexed: 11/17/2022]
Abstract
Hyperammonemia is the main responsible for the neurological alterations in hepatic encephalopathy in patients with liver failure. We studied the function of the glutamate-nitric oxide (NO)-cGMP pathway in brain in animal models of hyperammonemia and liver failure and in patients died with liver cirrhosis. Activation of glutamate receptors increases intracellular calcium that binds to calmodulin and activates neuronal nitric oxide synthase, increasing nitric oxide, which activates soluble guanylate cyclase (sGC), increasing cGMP. This glutamate-NO-cGMP pathway modulates cerebral processes such as circadian rhythms, the sleep-waking cycle, and some forms of learning and memory. These processes are impaired in patients with hepatic encephalopathy. Activation of sGC by NO is significantly increased in cerebral cortex and significantly reduced in cerebellum from cirrhotic patients died in hepatic coma. Portacaval anastomosis in rats, an animal model of liver failure, reproduces the effects of liver failure on modulation of sGC by NO both in cerebral cortex and cerebellum. In vivo brain microdialisis studies showed that sGC activation by NO is also reduced in vivo in cerebellum in hyperammonemic rats with or without liver failure. The content of alpha but not beta subunits of sGC are increased both in frontal cortex and cerebellum from patients died due to liver disease and from rats with portacaval anastomosis. We assessed whether determination of activation of sGC by NO-generating agent SNAP in lymphocytes could serve as a peripheral marker for the impairment of sGC activation by NO in brain. Chronic hyperammonemia and liver failure also alter sGC activation by NO in lymphocytes from rats or patients. These findings show that the content and modulation by NO of sGC are strongly altered in brain of patients with liver disease. These alterations could be responsible for some of the neurological alterations in hepatic encephalopathy such as sleep disturbances and cognitive impairment.
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Affiliation(s)
- Regina Rodrigo
- Laboratory of Neurobiology, Fundación Valenciana de Investigaciones Biomédicas, Amadeo de Saboya 4, 46010 Valencia, Spain.
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Lluch P, Torondel B, Medina P, Segarra G, Del Olmo JA, Serra MA, Rodrigo JM. Plasma concentrations of nitric oxide and asymmetric dimethylarginine in human alcoholic cirrhosis. J Hepatol 2004; 41:55-9. [PMID: 15246208 DOI: 10.1016/j.jhep.2004.03.016] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2003] [Revised: 02/19/2004] [Accepted: 03/31/2004] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS The liver plays a prominent role in the metabolism of asymmetric dimethyl-l-arginine (ADMA), an endogenous inhibitor of nitric oxide (NO) synthase. This study was designed to determine whether plasma levels of ADMA and NO production are altered in patients with compensated and decompensated alcoholic cirrhosis. METHODS Plasma levels of l-arginine, ADMA, symmetric dimethylarginine (SDMA) and NO (nitrite plus nitrate, NOx) were measured in nine patients with compensated alcoholic cirrhosis (Child-Pugh A) and 11 patients with advanced cirrhosis (Child-Pugh B-C). Seven healthy volunteers served as controls. RESULTS ADMA and NOx concentrations in decompensated cirrhosis were higher than in the compensated group and control group (ADMA: 1.12+/-0.08 vs. 0.58+/-0.05 and 0.58+/-0.07micromol/l, respectively; P<0.05; NOx 97.90+/-10.27 vs. 37.42+/-3.91 and 40.43+/-5.30micromol/l, respectively; P<0.05). There was a positive correlation between the clinical score of the patients and concentrations of ADMA (r(2)=0.547, P<0.01) and NOx (r(2)=0.689, P<0.01). SDMA and l-arginine levels were not significantly different between the three groups. CONCLUSIONS The results suggest that hepatocellular damage is a main determinant of elevated ADMA concentration in advanced alcoholic cirrhosis. By inhibiting NO release from vascular endothelium, ADMA might oppose the peripheral vasodilation caused by excessive NO production in severe cirrhosis.
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Affiliation(s)
- Paloma Lluch
- Servicio de Hepatología, Hospital Clínico Universitario, Departamento de Medicina, Universidad de Valencia, Blasco Ibañez 17, 46010 Valencia, Spain.
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Montoliu C, Kosenko E, Calvete JJ, Nies AT, Del Olmo JA, Serra MA, Rodrigo JM, Felipo V. Increased protein kinase A regulatory subunit content and cGMP binding in erythrocyte membranes in liver cirrhosis. J Hepatol 2004; 40:766-73. [PMID: 15094223 DOI: 10.1016/j.jhep.2004.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 09/05/2003] [Revised: 01/19/2004] [Accepted: 01/28/2004] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS Patients with liver disease show increased plasma cGMP and decreased intracellular cGMP in lymphocytes. The initial aim of this work was to assess whether decreased intracellular cGMP and increased plasma cGMP may be due to increased ATP-dependent release of cGMP from cells. The results obtained led to a new aim: to identify and quantify a protein responsible for the increased cGMP binding found in erythrocyte membranes from patients with liver disease. METHODS ATP-dependent cGMP transport was determined in inside-out vesicles from erythrocyte membranes. cGMP-binding proteins were isolated from the membranes and identified by MALDI-TOF peptide mass fingerprint. Protein kinase A was quantified by immunoblotting. RESULTS ATP-independent cGMP binding is increased in erythrocyte membranes from patients. There is a significant increase in the membrane content of a cGMP-binding protein with Mr 48,000, which was identified as the regulatory subunit of protein kinase A. CONCLUSIONS The content of the regulatory subunit of protein kinase A is significantly increased (twice) in erythrocyte membranes from patients with liver cirrhosis. This protein binds cGMP strongly and may be responsible for the decrease in intracellular cGMP in liver disease.
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Affiliation(s)
- Carmina Montoliu
- Servicio de Hepatología, Hospital Clínico Universitario, Departamento de Medicina, Universidad de Valencia, Valencia, Spain
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Bayo M, Serra MA, Clerici LA. In vitro detection of neuronal stress induced by mercury compounds in cerebellar granule cells from hsp70/hGH transgenic mice. Bull Environ Contam Toxicol 2004; 72:62-69. [PMID: 15058655 DOI: 10.1007/s00128-003-0241-8] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- M Bayo
- Physical and Chemical Exposure, Institute for Health and Consumer Protection, DG Joint Research Centre, Ispra, Varese, Italy
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del Olmo JA, Flor-Lorente B, Flor-Civera B, Rodriguez F, Serra MA, Escudero A, Lledó S, Rodrigo JM. Risk factors for nonhepatic surgery in patients with cirrhosis. World J Surg 2003; 27:647-52. [PMID: 12732995 DOI: 10.1007/s00268-003-6794-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [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: 12/13/2022]
Abstract
Cirrhosis of the liver appears to have an unfavorable prognosis in the surgical patient. The aim of this study was to determine risk factors for morbidity and mortality in patients with cirrhosis undergoing nonhepatic surgery. We studied 135 patients with liver cirrhosis undergoing nonhepatic procedures and 86 controls matched by age, sex, and preoperative diagnosis. Preoperative, intraoperative, and postoperative variables associated with 30-day mortality and morbidity were assessed by univariate and multivariate analyses. Patients with cirrhosis showed higher blood transfusion requirements, longer length of hospital stay, and a higher number of complications than controls. The mortality rate was 16.3% in cirrhotics and 3.5% in controls. By univariate analysis, the need for transfusions, prothrombin time, and Child-Pugh score were significantly associated with postoperative liver decompensation, whereas duration of surgery, prothrombin time, Child-Pugh score, cirrhosis-related complications, and general complications were significantly associated with mortality. In the multivariate analysis, Child-Pugh score (odds ratio [OR] 24.4; 95% confidence interval [CI] 5.5 to 106); duration of surgery (OR 5; 95% CI 1.2 to 15.6), and postoperative general complications (OR 3.7; 95% CI 3.4 to 6.4) were independent predictors of mortality. Patients with cirrhosis undergoing nonhepatic operations are at significant risk of perioperative complications leading to death. Independent variables associated with perioperative mortality include preoperative Child-Pugh score, the duration of surgery, and the presence of postoperative general complications.
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Affiliation(s)
- Juan A del Olmo
- Service of Hepatology, Hospital Clinico Universitario, Avenida Blasco Ibáñez 17, E-46010 Valencia, Spain.
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Abstract
The objective of this study was to assess the influence of age and date of acquisition of hepatitis C virus (HCV) infection on the distribution of genotypes and the progression of fibrosis in HCV-infected patients who were born in Spain and had their habitual place of residence in this country. Genotypic analysis was performed in 375 patients in whom it was possible to establish the year of HCV infection because the mode of transmission was known (transfusion, injection drug use, blood donor, or epidemic outbreak). In 298 patients with liver biopsy, fibrosis stage was related to age at infection, duration of infection, alcohol consumption, and HCV genotype. HCV subtype 1b was almost exclusively detected among transfusion recipients, but the onset of intravenous drug addiction was associated with the introduction of HCV genotypes other than 1b among injecting users with subsequent spread to other exposure risk groups. Fibrosis progression was influenced by alcohol consumption, increased duration of infection, and older age at infection. In summary, spread of intravenous drug use determined HCV infection by genotypes other than 1b. The risk of fibrosis progression was influenced more by age at viral acquisition and alcohol consumption than by the infecting genotype.
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Affiliation(s)
- M A Serra
- Service of Hepatology, Hospital Clínico Universitario, Facultad de Medicina, Avda. Blasco Ibáñez 15, E-46010 Valencia, Spain.
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Serra MA, Escudero A, Rodríguez F, del Olmo JA, Rodrigo JM. Effect of hepatitis C virus infection and abstinence from alcohol on survival in patients with alcoholic cirrhosis. J Clin Gastroenterol 2003; 36:170-4. [PMID: 12544203 DOI: 10.1097/00004836-200302000-00016] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [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] [Indexed: 12/18/2022]
Abstract
GOALS We assessed the effect of HCV infection and abstinence from alcohol on survival in a cohort of patients with alcoholic cirrhosis. BACKGROUND Hepatitis C virus (HCV) infection may be an important cofactor for liver disease in chronic alcoholics. STUDY The study population consisted of 213 patients with the diagnosis of alcoholic cirrhosis, 72 of these patients were infected by HCV. Complete alcohol abstinence after diagnosis of alcoholic cirrhosis was recorded in 86 patients. The reference group consisted of 89 patients with anti-HCV positivity who had never consumed alcohol. Survival was analyzed by the Kaplan and Meier method and predictors of survival by the Cox's multiple regression model. RESULTS HCV infection was not a determinant factor for survival in alcoholic cirrhosis. Age and Child-Pugh grade at the time of diagnosis of cirrhosis and persistence of alcohol consumption after diagnosis were independent predictors of poor outcome. The cumulative survival curve in abstinent alcoholics was significantly different from that of alcoholics who maintained the same pattern of alcohol consumption (log-rank = 4.30, p = 0.0381). Moreover, the cumulative survival in patients with anti-HCV-positive cirrhosis who stopped drinking after diagnosis was similar to that in patients with HCV-positive cirrhosis who had never consumed alcohol (log-rank 0.26, p = 0.61). CONCLUSIONS Cumulative survival in alcoholic cirrhosis does not seem to be influenced by the presence or absence of markers of HCV infection. Once liver cirrhosis has been diagnosed in the alcoholic patient, complete alcohol abstinence should be strongly recommended.
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Affiliation(s)
- Miguel A Serra
- Service of Hepatology, Hospital Clínico Universitario, Faculty of Medicine, Valencia, Spain.
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Corbalán R, Montoliu C, Miñana MD, Del Olmo JA, Serra MA, Aparisi L, Rodrigo JM, Felipo V. Altered modulation of soluble guanylate cyclase by nitric oxide in patients with liver disease. Metab Brain Dis 2002; 17:295-301. [PMID: 12602506 DOI: 10.1023/a:1021953717331] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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] [Indexed: 01/09/2023]
Abstract
The glutamate-nitric oxide-cGMP pathway is impaired in brain in vivo in animal models of chronic moderate hyperammonemia either with or without liver failure. The impairment occurs at the level of activation of soluble guanylate cyclase by nitric oxide (NO). It has been suggested that the impairment of this pathway may be responsible for some of the neurological alterations found in hyperammonemia and hepatic encephalopathy. Soluble guanylate cyclase is also present in lymphocytes. Activation of guanylate cyclase by NO is also altered in lymphocytes from hyperammonemic rats or from rats with portacaval anastomosis. We assessed whether soluble guanylate cyclase activation was also altered in human patients with liver disease. We studied activation of soluble guanylate cyclase in lymphocytes from 77 patients with liver disease and 17 controls. The basal content of cGMP in lymphocytes was decreased both in patients with liver cirrhosis and in patients with chronic hepatitis. In contrast, cGMP concentration was increased in plasma from patients with liver disease. Activation of guanylate cyclase by NO was also altered in liver disease and was higher in lymphocytes from patients with cirrhosis or hepatitis than that in lymphocytes from controls. Successful treatment with interferon of patients with hepatitis C reversed all the above alterations. Altered modulation of soluble guanylate cyclase by NO in liver disease may play a role in the neurological and hemodynamic alterations in these patients.
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Affiliation(s)
- R Corbalán
- Laboratory of Neurobiology, Instituto de Investigaciones Citológicas, FVIB, Valencia, Spain
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Corbalán R, Miñana MD, Del Olmo JA, Serra MA, Rodrigo JM, Felipo V. Altered modulation of soluble guanylate cyclase in lymphocytes from patients with liver disease. J Mol Med (Berl) 2002; 80:117-23. [PMID: 11907648 DOI: 10.1007/s00109-001-0286-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2001] [Accepted: 07/25/2001] [Indexed: 10/27/2022]
Abstract
Studies of animal models suggest that the activation of soluble guanylate cyclase by nitric oxide is altered in liver disease. We studied 77 patients with liver disease and 17 controls, to investigate whether the activation of soluble guanylate cyclase is altered in lymphocytes from patients with liver disease. The basal content of guanosine 3',5'-cyclic monophosphate (cGMP) in lymphocytes was decreased both in patients with liver cirrhosis (by 52%) and in patients with chronic hepatitis (by 62%). Activation of soluble guanylate cyclase by nitric oxide was higher in lymphocytes from patients with cirrhosis (3100+/-1000% of basal) or with hepatitis (5200+/-2500% of basal) than in lymphocytes from controls (1200+/-500% of basal). cGMP in plasma was increased in patients with liver disease. Successful (but not unsuccessful) treatment with interferon of patients with hepatitis due to virus C reversed all the above alterations. Altered modulation of soluble guanylate cyclase by nitric oxide in liver disease may play a role in the hemodynamic alterations found in these patients.
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Affiliation(s)
- Regina Corbalán
- Laboratory of Neurobiology, Instituto de Investigaciones Citologicas, Fundación Valenciana de Investigaciones Biomedicas, Amadeo de Saboya, 4, 46010 Valencia, Spain
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Souza I, Serra MA, Mattos P, Franco VA. [Comorbidity in children and adolescents with attention-deficit disorder: preliminary results]. Arq Neuropsiquiatr 2001; 59:401-6. [PMID: 11460187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Thirty-four children and adolescents with ages from 6 to 16 years having a diagnosis of attention-deficit hyperactivity disorder (ADHD)according to DSM-IV criteria were examined. Psychiatric comorbidity was evaluated through a standard questionnaire given to parents. There was a significant comorbidity (85,7%) in the sample, oppositional-defiant disorder (20,6%) and conduct disorder (39,2%) being the most common comorbid diagnosis. At least two diagnosis other than ADHD could be found in 57% of the sample. Major depression was seen in four cases and anxiety states (generalized anxiety disorder, separation anxiety and phobias) were seen in 34.3% of the sample. Comorbidity modifies prognosis in a significant way and may suggest specific therapeutic interventions according to each case. Frequent comorbidity may suggest the need for diagnostic interviews that covers other psychiatric disorders.
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Affiliation(s)
- I Souza
- Grupo de Estudos do Déficit de Atenção, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Ermolli M, Menné C, Pozzi G, Serra MA, Clerici LA. Nickel, cobalt and chromium-induced cytotoxicity and intracellular accumulation in human hacat keratinocytes. Toxicology 2001; 159:23-31. [PMID: 11250052 DOI: 10.1016/s0300-483x(00)00373-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [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: 01/19/2023]
Abstract
Nickel, cobalt and chromium can induce allergic contact dermatitis (ACD) and may provoke irritant reactions in the skin. This study aimed at investigating cytotoxicity and cell viability along with intracellular metal accumulation in HaCaT human keratinocytes exposed to soluble forms of nickel, cobalt or chromium. The EC50 (24 h) values as detected by MTT test were 30 microM for sodium chromate (Na2CrO4), 475 microM for cobalt chloride (CoCl2) and 600 microM for nickel chloride (NiCl2). Chromium chloride (CrCl3) was not toxic up to 1 mM. No clear effects were observed after 4 h, but 24-h treatments with 1 mM CoCl2 or 10 microM Na2CrO(4) were found to almost completely abolish the ability of the cells to form colonies, whilst 1 mM NiCl2 reduced cellular survival to only 70% of control cultures. Intracellular accumulation of metals was evaluated by the use of radioisotopes at the EC50 value and at 1/10-1/5 of this concentration. Accumulation of Na2(51)CrO4 was linear with increasing dose. This was not the case for 63NiCl2 and 58CoCl2. All the metals were accumulated preferentially in the cytosols; 96% or more for 63NiCl2, approximately 90% for 58CoCl2 and 60-70% for Na2(51)CrO4. Finally, it was observed that HaCaT human keratinocytes can concentrate the metals present in the media up to 3.9 and 12.5 times for NiCl2 and CoCl2, respectively, and up to 167 for Na2CrO4. These striking metal intracellular accumulation patterns, which have not been earlier described in keratinocytes, highlight the relevance of searching for specific biomarkers of early cellular toxic effects, such as cytosolic proteins that bind the metals.
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Affiliation(s)
- M Ermolli
- Environmental Impact Unit, TP 460, Environment Institute, DG Joint Research Center, I-21020 VA, Ispra, Italy
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Abstract
It has been established in previous in vitro experiments with human HaCaT keratinocytes that nickel becomes cytotoxic at concentrations higher than 100 microM and that it is accumulated mainly in the cytosolic fraction (Ermolli et al., 2000). The aim of this work was to search possible biomarkers of metal insult, i.e. nickel-binding proteins or proteins differentially expressed in the cytosolic fraction of nickel-exposed cells (up to 1 mM nickel) as compared to controls. Cytosolic proteins were studied by isoelectric focusing (IEF) and two-dimensional gel electrophoresis (2-DE). Separation by IEF revealed nickel-induced changes in the abundance of cytosolic proteins as visualised with nickel-nitrilo-triacetic-alkaline phosphatase (Ni-NTA-AP) in blots. The cytosolic fraction of cells incubated with nickel, at concentrations over 100 microM, showed nickel binding components which were absent or present in significantly lower amounts in control cells. These proteins had isoelectric points (pIs) 6.9, 7.7 and 8.5. After 2-DE silver- and protein staining significantly increased abundance of four proteins was observed. Their pI values corresponded to those of the nickel binding ones seen after IEF. A protein with pI 6.9 had a molecular weight estimated to 38 kDa, two proteins with pI around 7.7 showed molecular weights of 57 and 22 kDa, respectively and another protein with pI of 8.5 had a molecular weight of 33 kDa. The increased abundance of these components, both in IEF experiments and in 2-DE, correlated with the nickel concentration in the culture media. N-terminal amino acid sequencing and database search allowed identification of one a protein as phosphoglycerate kinase and another one as annexin II. The involvement of these proteins in cellular functions and their possible implications in the mechanism of nickel toxicity in keratinocytes are discussed. Some of these proteins may be biomarker candidates for effects of nickel exposure in human keratinocytes.
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Affiliation(s)
- F Acevedo
- National Institute for Working Life, S-17184, Solna, Sweden.
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del Olmo JA, Pascual I, Bagán JV, Serra MA, Escudero A, Rodriguez F, Rodrigo JM. Prevalence of hepatitis C virus in patients with lichen planus of the oral cavity and chronic liver disease. Eur J Oral Sci 2000; 108:378-82. [PMID: 11037753 DOI: 10.1034/j.1600-0722.2000.108005378.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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: 01/23/2023]
Abstract
Lichen planus (LP) may represent a mucosal reaction to a variety of factors including hepatitis C virus (HCV) infection. We compared the prevalence of HCV infection in patients with LP of the oral mucosa and chronic liver disease (LP-CLD) with those suffering exclusively from LP or from chronic liver disease (CLD). A total of 267 outpatients participated in a prospective study. There were 41 patients in the LP-CLD group, 128 in the LP group, and 98 in the CLD group. The diagnosis of LP was based on typical macroscopic and histopathologic features and the diagnosis of liver disease on liver histology. Serum samples were screened for anti-HCV antibodies. In 89 patients, serum HCV RNA was also measured. The overall prevalence of anti-HCV antibodies was 29.2% (78/267 patients). Serum HCV RNA levels were positive in 96.2% of anti-HCV-positive patients and in none of anti-HCV-negative subjects. Anti-HCV-positivity was more frequent in the groups of LP-CLD (78%) and CLD (42.8%) than in the LP group (3.1%). It is concluded that HCV infection plays an etiopathogenetic role in CLD associated with oral LP, whereas according to the present findings, the majority of patients suffering exclusively from oral LP are not infected by the HCV.
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Affiliation(s)
- J A del Olmo
- Service of Hepatology, Hospital Clínico Universitario, Valencia, Spain.
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del Olmo JA, Peña A, Serra MA, Wassel AH, Benages A, Rodrigo JM. Predictors of morbidity and mortality after the first episode of upper gastrointestinal bleeding in liver cirrhosis. J Hepatol 2000; 32:19-24. [PMID: 10673062 DOI: 10.1016/s0168-8278(01)68827-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Upper gastrointestinal (GI) bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. The aim of this study was to determine the independent predictors of morbidity, mortality, and survival after the first episode of GI bleeding in patients with liver cirrhosis. METHODS In a retrospective study of 403 cirrhotic patients who were admitted in the period January 1982 to December 1994 because of a first episode of GI hemorrhage, epidemiological factors, bleeding-related variables and cirrhosis-related variables that may be associated with hepatic and extrahepatic complications, mortality at 48 h and 6 weeks, and survival up to 30 June 1996 were assessed. RESULTS Forty-five percent of patients developed hepatic and/or extrahepatic complications, with a mortality rate of 7.4% at 48 h and 24% at 6 weeks. Renal failure, rebleeding, hepatocellular carcinoma, and hepatic encephalopathy were independent predictors of mortality. The Kaplan-Meier method showed a median survival of 30.9+/-4.5 months (95% confidence interval 22 to 39.7 months). The cumulative percentage of survivors was 60.2% at 1 year, 33.6% at 5 years, and 14% at 10 years. In a Cox's multiple regression analysis, age, hepatic encephalopathy, hepatocellular carcinoma, Child-Pugh grade, and renal failure were independently associated with long-term survival. CONCLUSIONS The first episode of GI bleeding in patients with liver cirrhosis is associated with high morbidity and mortality. Renal failure, rebleeding, hepatocellular carcinoma, and hepatic encephalopathy were independent risk factors for early death.
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Affiliation(s)
- J A del Olmo
- Service of Hepatology, Hospital Clínico Universitario, Valencia, Spain
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Abstract
The effect of 44 different metal ions (Ag+, Al3+, As(O-)2, Au3+, Ba2+, Be2+, Bi3+, Cd2+, Ce3+, CO2+, Cr(O2-)4, Cr3+, Cs+, Cu2+, Fe3+, Fe2+, Ga3+, Ge4+, Hg2+, Ir4+, La3+, Li+, Mn2+, MO6+, Ni2+, OS4+, Pb2+, Pt4+, Rb+, Rh3+, Sb5+, Se(O2-)4, Se(O2-)3, Sn2+, Sr2+, Th4+, T1+, U(O2+)2, V(O-)3, VO2+, W(O2-)4, Y3+, Zn2+, and Zr4+) on the activity of the reverse transcriptase (RT) of the human immunodeficiency virus (HIV-1) was investigated in vitro. For this study, the RT activity assay was carried out by means of an enzyme-linked immunosorbent assay (ELISA) kit, using the template/primer hybrid poly(A) oligo(dT)15, which required some modifications: (1) possible interfering metal chelators (such as EDTA) in the original lysis buffer were avoided, and a new buffer (50 mM Tris-NO3, pH 7.8) was used throughout; (2) an amount of 2 ng of RT per well was considered to be optimal after checking the linearity of the reaction with increasing amounts of enzyme; (3) an incubation temperature of 37 degrees C and an incubation time of 1 h were chosen after preliminary studies in a wide range of temperature and time. At an incubation temperature > or = 40 degrees C, there was a dramatic loss of enzymatic activity. In addition, when RT alone was preincubated for 1 h at 5 degrees C, 25 degrees C, and 37 degrees C, there was a large (83%) loss of activity at 37 C as compared to that at 5 degrees C. These results are indicative of enzyme thermolability, which is higher in the absence of substrates. The effect of metal ions on RT activity was tested using two different metal salt concentrations (10(-4) M and 10(-5) M). Under such experimental conditions, the presence of five metal ions (Pt4+, Ag+, Rh3+, Zn2+, and Hg2+) decreased the RT activity in a dose-response fashion. The observed order of effectiveness with respect to inhibition was Pt4+ > Ag+ > Rh3+ > Zn2+ = Hg2+. Estimated mean inhibitory concentrations (IC50) were 7.8 microM for (NH4)2PtCl6, 14.1 microM for AgNO3, 46.8 microM for RhCl3, 53.7 microM for Zn(SO)4, and 56.2 microM for Hg(NO3)2. Because these data are of the same order of magnitude as the corresponding values related to other RT inhibitors used in anti-AIDS therapy, metal compounds or their derivatives could give an interesting contribution in the development of new RT inhibitors for clinical use.
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Affiliation(s)
- E Sabbioni
- European Commission, Joint Research Centre-Ispra Site, Environment Institute, Varese, Italy
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Romero MJ, Bosch-Morell F, Romero B, Rodrigo JM, Serra MA, Romero FJ. Serum malondialdehyde: possible use for the clinical management of chronic hepatitis C patients. Free Radic Biol Med 1998; 25:993-7. [PMID: 9870551 DOI: 10.1016/s0891-5849(98)00118-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [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] [Indexed: 12/19/2022]
Abstract
Serum lipid peroxidation products are increased in inflammatory liver disease and, as we previously reported, also in chronic hepatitis C. We have performed a specific assay of malondialdehyde, the reported most abundant product of lipid peroxidation, in serum of twenty four chronic hepatitis C patients, before, during, and after interferon treatment. Liver biopsies were performed in each patient before and after interferon treatment. The results show higher serum malondialdehyde values in chronic hepatitis C patients than healthy subjects (n = 68) before interferon treatment (p < .001). Mean value of serum malondialdehyde levels after interferon treatment was significantly lower than before it (p < .002). Associating the histopathological findings in each of the 48 biopsies performed, with serum malondialdehyde and alanine aminotransferase activity levels, of the sample obtained the same day of biopsy, a much better correspondence with the histopathological severity was observed for malondialdehyde concentration than for alanine aminotransferase activity. These levels decreased significantly after interferon treatment. However, when the patients were grouped in responding (group I; n = 9) and non-responding (group II; n = 15) to interferon treatment, according to the histopathological findings before and after interferon, the values of group I before interferon treatment were significantly higher than group II (p < .03). Thus, a potential predictive value could be ascribed to the serum malondialdehyde levels before interferon treatment in these patients. We propose the utility of the specific assay of malondialdehyde for the clinical management of chronic hepatitis C patients.
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Affiliation(s)
- M J Romero
- Department of Physiology, School of Medicine & Dentistry, University of Valencia, Spain
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del Olmo JA, Serra MA, Rodríguez F, Escudero A, Gilabert S, Rodrigo JM. Incidence and risk factors for hepatocellular carcinoma in 967 patients with cirrhosis. J Cancer Res Clin Oncol 1998; 124:560-4. [PMID: 9829860 DOI: 10.1007/s004320050215] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [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: 11/29/2022]
Abstract
PURPOSE To determine the incidence of hepatocellular carcinoma in cirrhosis and to examine the influence of age and sex, and the contribution of etiological factors. METHODS 967 patients with liver cirrhosis and free of hepatocellular carcinoma were enrolled in this longitudinal, retrospective and observational study. Monitoring for hepatocellular carcinoma was scheduled at 3- to 6-month intervals. The mean (+/-SD) length of follow-up was 60.3+/-51.7 months (range 6 258). RESULTS During the observation period, hepatocellular carcinoma developed in 64 patients. The calculated annual incidence was 2.1%. The probability of being free of liver cancer was 92% at 5 years, 80% at 10 years, and 69% at 15 years. Age was the only independent risk factor for the development of malignancy in the multivariate analysis. There were no differences according to male sex, alcohol abuse, and chronic hepatitis B and C virus infection. CONCLUSIONS The annual incidence of hepatocellular carcinoma was 2.1%. These results, although confirming that age is a risk factor for hepatocellular carcinoma in cirrhosis, indicate that alcohol abuse, male sex, and concurrent hepatitis B and C virus infection do not involve a higher risk of developing liver cancer.
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Affiliation(s)
- J A del Olmo
- Service of Hepatology, Hospital Clínico Universitario, Valencia, Spain
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