Implementation of a re-linkage to care strategy in patients with chronic hepatitis C who were lost to follow-up in Latin America

To achieve WHO's goal of eliminating hepatitis C virus (HCV), innovative strategies must be designed to diagnose and treat more patients. Therefore, we aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to HCV care. We conducted an implementation study utilizing a strategy to contact patients with HCV who were not under regular follow-up in 13 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or equivalent. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined by anti-HCV+ and detectable HCV-RNA. Identified patients who were not under follow-up by a liver specialist were contacted by telephone or email, and offered a medical reevaluation. A total of 10,364 patients were classified to have HCV. After reviewing their medical charts, 1349 (13%) had undetectable HCV-RNA or were wrongly coded. Overall, 9015 (86.9%) individuals were identified with chronic HCV infection. A total of 5096 (56.5%) patients were under routine HCV care and 3919 (43.5%) had been LTFU. We were able to contact 1617 (41.3%) of the 3919 patients who were LTFU at the primary medical institution, of which 427 (26.4%) were cured at a different institutions or were dead. Of the remaining patients, 906 (76.1%) were candidates for retrieval. In our cohort, about one out of four patients with chronic HCV who were LTFU were candidates to receive treatment. This strategy has the potential to be effective, accessible and significantly impacts on the HCV care cascade.

Comparison of different prognostic scores for patients with cirrhosis hospitalized with SARS-CoV-2 infection

INTRODUCTION AND OBJECTIVES

Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality.

PATIENTS

We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves.

RESULTS

Overall, 4.6% (CI 3.7-5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P < .0001). Cirrhosis was independently associated with death [OR 3.1 (CI 1.9-4.8); P < .0001], adjusted by age, gender, and body mass index >30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < .0001).

CONCLUSIONS

SARS-CoV-2 infection is associated with elevated mortality in patients with cirrhosis. CLIF-C had better performance in predicting mortality than NACSELD, CTP and MELD-Na in patients with cirrhosis and SARS-CoV-2 infection. Clinicaltrials.gov:NCT04358380.

[Predictors of infection and mortality in patients with liver cirrhosis in the high complexity hospital Virgen de la Puerta from Trujillo, Peru]

INTRODUCTION

Liver cirrhosis decompensated due to bacterial infections is one of the main diagnoses of admission to hospitalization, taking into account that the risk per se in it is higher than in non-cirrhotic patients, leading to high mortality rates.

OBJECTIVE

The present study sought to determine the predictors of infection and mortality in patients with liver cirrhosis, as well as the epidemiological-clinical characteristics of patients with cirrhosis.

MATERIAL AND METHODS

Prospective data were collected from hospitalized cirrhotic patients in the Gastroenterology and Internal Medicine Service of the Hospital High Complexity "Virgen de la Puerta", from 2015 to June 2018.

RESULTS

The study included 66 patients. The infection frequency was of 37.88%, being more frequent the spontaneous bacterial peritonitis (21.2%) and the total mortality was of 12.12%. When performing binary logistic regression and ROC curve, the MELD value> 13.5 (p=0.003), TP >18.26 (p=0.003) and the Child Pugh C stage were obtained as predictors of mortality (p=0.02, IC 95% EXP(B) 0.13-0.365). The variables that predict absence of mortality were a platelet value ≥74 500 /mm3 (p=0.01) and sodium ≥133 (p=0.019). The predictors of infection, MELD value ≤14.5 (p=0.0004) and sodium level ≥134.5 (AUC 0.696, p=0.028), to predict absence of infection.

CONCLUSIONS

High MELD is a predictor of both mortality and infection. Child Pugh C and high values of Prothrombin time are predictors of mortality. The normal sodium level is a predictor of absence of mortality and infection, as well as platelet values discreetly low are predictors of absence of mortality.

Organochlorine compound residues in the eggs of broad-snouted caimans (Caiman latirostris) and correlation with measures of reproductive performance

Organochlorine compounds (OCCs), like pesticides (OCPs) and polychlorinated biphenyls (PCBs), are persistent lipophilic chemicals classified as endocrine-disruptors. Caiman latirostris inhabits wetlands throughout north-eastern Argentina and may accumulate OCCs. The aims of this study were to determine OCC residues in the eggs of C. latirostris and to correlate OCC burden with clutch size, hatching success and hatchling survival as measures of reproductive performance. Fourteen caiman clutches were harvested from sites with different degrees of anthropogenic intervention on wetlands surrounding Paraná River tributaries. Two to four eggs by clutch were used to quantify OCCs. OCP residues were found in all clutches. The principal contributors to the OCPs burden were the DDT family (range BDL-153.0 ng g(-1) lipid) and oxychlordane (range BDL-34.3 ng g(-1) lipid). PCBs were present in 92.9% of the clutches (range BDL-136.6 ng g(-1) lipid). Both higher concentrations and higher diversity of pesticides, including endosulfan sulfate, were found in the nests harvested close to croplands. A negative correlation was found between clutch size and ∑OCCs (p=0.02, Pearson r=-0.53, r(2)=0.28), mainly due to the ∑OCPs (p=0.04, Pearson r=-0.54, r(2)=0.30). Since egg OCCs concentrations predict maternal burden, present findings suggest that higher OCCs exposure could lead to smaller clutches. Although, other factors like mother age could influence clutch size. Additionally, as caimans are a long-lived and non-migratory species, the maternal OCCs burden reflects the environmental status throughout their home range; thus, caiman eggs could be useful as a biomonitor of local contamination.