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Martín-Sánchez E, Garcés JJ, Maia C, Inogés S, López-Díaz de Cerio A, Carmona-Torre F, Marin-Oto M, Alegre F, Molano E, Fernandez-Alonso M, Perez C, Botta C, Zabaleta A, Alcaide AB, Landecho MF, Rua M, Pérez-Warnisher T, Blanco L, Sarvide S, Vilas-Zornoza A, Alignani D, Moreno C, Pineda I, Sogbe M, Argemi J, Paiva B, Yuste JR. Immunological Biomarkers of Fatal COVID-19: A Study of 868 Patients. Front Immunol 2021; 12:659018. [PMID: 34012444 PMCID: PMC8126711 DOI: 10.3389/fimmu.2021.659018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/09/2021] [Indexed: 01/08/2023] Open
Abstract
Information on the immunopathobiology of coronavirus disease 2019 (COVID-19) is rapidly increasing; however, there remains a need to identify immune features predictive of fatal outcome. This large-scale study characterized immune responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection using multidimensional flow cytometry, with the aim of identifying high-risk immune biomarkers. Holistic and unbiased analyses of 17 immune cell-types were conducted on 1,075 peripheral blood samples obtained from 868 COVID-19 patients and on samples from 24 patients presenting with non-SARS-CoV-2 infections and 36 healthy donors. Immune profiles of COVID-19 patients were significantly different from those of age-matched healthy donors but generally similar to those of patients with non-SARS-CoV-2 infections. Unsupervised clustering analysis revealed three immunotypes during SARS-CoV-2 infection; immunotype 1 (14% of patients) was characterized by significantly lower percentages of all immune cell-types except neutrophils and circulating plasma cells, and was significantly associated with severe disease. Reduced B-cell percentage was most strongly associated with risk of death. On multivariate analysis incorporating age and comorbidities, B-cell and non-classical monocyte percentages were independent prognostic factors for survival in training (n=513) and validation (n=355) cohorts. Therefore, reduced percentages of B-cells and non-classical monocytes are high-risk immune biomarkers for risk-stratification of COVID-19 patients.
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Affiliation(s)
- Esperanza Martín-Sánchez
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain.,Hemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain.,Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - Juan José Garcés
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain.,Hemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain.,Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - Catarina Maia
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain.,Hemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain.,Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - Susana Inogés
- Centro de Investigación Biomédica en Red, Pamplona, Spain.,Immunology and Immunotherapy Department, Clínica Universidad de Navarra, Pamplona, Spain.,Hematology Service and Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ascensión López-Díaz de Cerio
- Centro de Investigación Biomédica en Red, Pamplona, Spain.,Immunology and Immunotherapy Department, Clínica Universidad de Navarra, Pamplona, Spain.,Hematology Service and Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
| | - Francisco Carmona-Torre
- Internal Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain.,Division of Infectious Diseases, Clínica Universidad de Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Marta Marin-Oto
- Neumology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Félix Alegre
- Internal Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Elvira Molano
- Internal Medicine Department, Clínica Universidad de Navarra, Madrid, Spain
| | - Mirian Fernandez-Alonso
- Immune and Infectious Inflammatory Diseases Research, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Cristina Perez
- Hemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain.,Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - Cirino Botta
- Hematology Department, Hospital "Annunziata", Cosenza, Italy
| | - Aintzane Zabaleta
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain.,Hemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain.,Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - Ana Belen Alcaide
- Neumology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Manuel F Landecho
- Internal Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marta Rua
- Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Laura Blanco
- Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - Sarai Sarvide
- Hemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain.,Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - Amaia Vilas-Zornoza
- Hemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain.,Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - Diego Alignani
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain.,Hemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain.,Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - Cristina Moreno
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain.,Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - Iñigo Pineda
- Internal Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Miguel Sogbe
- Internal Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Josepmaria Argemi
- Internal Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Bruno Paiva
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain.,Hemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain.,Hemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red, Pamplona, Spain
| | - José Ramón Yuste
- Internal Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain.,Division of Infectious Diseases, Clínica Universidad de Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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Maia C, Martín-Sánchez E, Garcés JJ, De Cerio ALD, Inogés S, Landecho MF, Gil-Alzugaray B, Perez C, Botta C, Zabaleta A, Alegre F, Rincón C, Blanco L, Sarvide S, Vilas-Zornoza A, Alignani D, Moreno C, Paiva A, Martinho A, Alves R, Colado E, Quirós C, Olid M, Blanco A, Argemi J, Paiva B, Yuste JR. Immunologic characterization of COVID-19 patients with hematological cancer. Haematologica 2020; 106:1457-1460. [PMID: 33327714 PMCID: PMC8094106 DOI: 10.3324/haematol.2020.269878] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Catarina Maia
- Clinica Universidad de Navarra, Pamplona, Spain; Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00369, Pamplona
| | - Esperanza Martín-Sánchez
- Clinica Universidad de Navarra, Pamplona, Spain; Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00369, Pamplona
| | - Juan José Garcés
- Clinica Universidad de Navarra, Pamplona, Spain; Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00369, Pamplona
| | - Ascensión López-Díaz De Cerio
- Clinica Universidad de Navarra, Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00489, Pamplona
| | - Susana Inogés
- Clinica Universidad de Navarra, Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00489, Pamplona
| | | | | | - Cristina Perez
- Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00369, Pamplona
| | | | - Aintzane Zabaleta
- Clinica Universidad de Navarra, Pamplona, Spain; Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00369, Pamplona
| | | | | | - Laura Blanco
- Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00369, Pamplona
| | - Sarai Sarvide
- Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00369, Pamplona
| | - Amaia Vilas-Zornoza
- Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00489, Pamplona
| | - Diego Alignani
- Clinica Universidad de Navarra, Pamplona, Spain; Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00369, Pamplona
| | - Cristina Moreno
- Clinica Universidad de Navarra, Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00369, Pamplona
| | - Artur Paiva
- Centro Hospitalar e Universitário de Coimbra, Coimbra
| | - António Martinho
- Centro de Sangue e Transplantação de Coimbra, Instituto Português do Sangue e da Transplantação, Coimbra
| | - Rui Alves
- Centro Hospitalar e Universitário de Coimbra, Coimbra
| | | | | | | | | | - Josepmaria Argemi
- Clinica Universidad de Navarra, Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona
| | - Bruno Paiva
- Clinica Universidad de Navarra, Pamplona, Spain; Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER-ONC number CB16/12/00369, Pamplona
| | - José Ramón Yuste
- Clinica Universidad de Navarra, Pamplona, Spain; Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona.
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Sanoja-Flores L, Flores-Montero J, Garcés JJ, Paiva B, Puig N, García-Mateo A, García-Sánchez O, Corral-Mateos A, Burgos L, Blanco E, Hernández-Martín J, Pontes R, Díez-Campelo M, Millacoy P, Rodríguez-Otero P, Prosper F, Merino J, Vidriales MB, García-Sanz R, Romero A, Palomera L, Ríos-Tamayo R, Pérez-Andrés M, Blanco JF, González M, van Dongen JJM, Durie B, Mateos MV, San-Miguel J, Orfao A. Next generation flow for minimally-invasive blood characterization of MGUS and multiple myeloma at diagnosis based on circulating tumor plasma cells (CTPC). Blood Cancer J 2018; 8:117. [PMID: 30455467 PMCID: PMC6242818 DOI: 10.1038/s41408-018-0153-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [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: 09/10/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 12/26/2022] Open
Abstract
Here, we investigated for the first time the frequency and number of circulating tumor plasma cells (CTPC) in peripheral blood (PB) of newly diagnosed patients with localized and systemic plasma cell neoplasms (PCN) using next-generation flow cytometry (NGF) and correlated our findings with the distinct diagnostic and prognostic categories of the disease. Overall, 508 samples from 264 newly diagnosed PCN patients, were studied. CTPC were detected in PB of all active multiple myeloma (MM; 100%), and smoldering MM (SMM) patients (100%), and in more than half (59%) monoclonal gammopathy of undetermined significance (MGUS) cases (p <0.0001); in contrast, CTPC were present in a small fraction of solitary plasmacytoma patients (18%). Higher numbers of CTPC in PB were associated with higher levels of BM infiltration and more adverse prognostic features, together with shorter time to progression from MGUS to MM (p <0.0001) and a shorter survival in MM patients with active disease requiring treatment (p ≤ 0.03). In summary, the presence of CTPC in PB as assessed by NGF at diagnosis, emerges as a hallmark of disseminated PCN, higher numbers of PB CTPC being strongly associated with a malignant disease behavior and a poorer outcome of both MGUS and MM.
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Affiliation(s)
- L Sanoja-Flores
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J Flores-Montero
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J J Garcés
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - B Paiva
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - N Puig
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A García-Mateo
- Department of Hematology, Health Care Center of Segovia (CAS), Segovia, Spain
| | - O García-Sánchez
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A Corral-Mateos
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - L Burgos
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - E Blanco
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J Hernández-Martín
- Department of Hematology, Health Care Center of Segovia (CAS), Segovia, Spain
| | - R Pontes
- Faculty of Medicine, Federal University of Rio de Janeiro and Institute of Pediatrics and Childhood Care, Rio de Janeiro, Brazil
| | - M Díez-Campelo
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - P Millacoy
- Department of Hematology, Hospital Center of Navarra (CHN), Pamplona, Spain
| | - P Rodríguez-Otero
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - F Prosper
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - J Merino
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - M B Vidriales
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - R García-Sanz
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A Romero
- Primary Care Center Miguel Armijo, Sanidad de Castilla y León (SACYL), Salamanca, Spain
| | - L Palomera
- Department of Hematology, University Hospital Lozano Blesa (HULB), Zaragoza, Spain
| | - R Ríos-Tamayo
- Department of Hematology, Virgen de las Nieves Hospital (HVN), Granada, Spain
| | - M Pérez-Andrés
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J F Blanco
- Department of Orthopedics, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain
| | - M González
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - J J M van Dongen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - B Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA, USA
| | - M V Mateos
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - J San-Miguel
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - A Orfao
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain.
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain.
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Giménez-Garzó C, Garcés JJ, Urios A, Mangas-Losada A, García-García R, González-López O, Giner-Durán R, Escudero-García D, Serra MA, Soria E, Felipo V, Montoliu C. The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients. PLoS One 2017; 12:e0171211. [PMID: 28146589 PMCID: PMC5287470 DOI: 10.1371/journal.pone.0171211] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/18/2017] [Indexed: 12/17/2022] Open
Abstract
Background and aims The psychometric hepatic encephalopathy score (PHES) is the “gold standard” for minimal hepatic encephalopathy (MHE) diagnosis. Some reports suggest that some cirrhotic patients “without” MHE according to PHES show neurological deficits and other reports that neurological alterations are not homogeneous in all cirrhotic patients. This work aimed to assess whether: 1) a relevant proportion of cirrhotic patients show neurological deficits not detected by PHES; 2) cirrhotic patients with mild neurological deficits are a homogeneous population or may be classified in sub-groups according to specific deficits. Methods Cirrhotic patients “without” (n = 56) or “with” MHE (n = 41) according to PHES and controls (n = 52) performed psychometric tests assessing attention, concentration, mental processing speed, working memory and bimanual and visuomotor coordination. Heterogeneity of neurological alterations was analysed using Hierarchical Clustering Analysis. Results PHES classified as “with” MHE 42% of patients. Around 40% of patients “without” MHE according to PHES fail two psychometric tests. Oral SDMT, d2, bimanual and visuo-motor coordination tests are failed by 54, 51, 51 and 43% of patients, respectively. The earliest neurological alterations are different for different patients. Hierarchical clustering analysis shows that patients “without” MHE according to PHES may be classified in clusters according to the tests failed. In some patients coordination impairment appear before cognitive impairment while in others concentration and attention deficits appear before. Conclusions PHES is not sensitive enough to detect early neurological alterations in a relevant proportion of cirrhotic patients. Oral SDMT, d2 and bimanual and visuo-motor coordination tests are more sensitive. The earliest neurological alterations are different in different cirrhotic patients. These data also have relevant clinical implications. Patients classified as “without MHE” by PHES belonging to clusters 3 and 4 in our study have a high risk of suffering clinical complications, including overt HE and must be diagnosed and clinically followed.
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Affiliation(s)
- Carla Giménez-Garzó
- Laboratorio de Neurobiología, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
| | - Juan José Garcés
- IDAL, Intelligent Data Analysis Laboratory, Escuela Técnica Superior de Ingeniería, Valencia, Spain
| | - Amparo Urios
- Laboratorio de Neurobiología, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
- Fundación Investigación Hospital Clínico de Valencia. Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain
| | - Alba Mangas-Losada
- Fundación Investigación Hospital Clínico de Valencia. Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain
| | - Raquel García-García
- Laboratorio de Neurobiología, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
| | | | | | - Desamparados Escudero-García
- Unidad de Digestivo, Hospital Clínico de Valencia, Departamento de Medicina, Universidad de Valencia, Valencia, Spain
| | - Miguel Angel Serra
- Unidad de Digestivo, Hospital Clínico de Valencia, Departamento de Medicina, Universidad de Valencia, Valencia, Spain
| | - Emilio Soria
- IDAL, Intelligent Data Analysis Laboratory, Escuela Técnica Superior de Ingeniería, Valencia, Spain
| | - Vicente Felipo
- Laboratorio de Neurobiología, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
- * E-mail:
| | - Carmina Montoliu
- Fundación Investigación Hospital Clínico de Valencia. Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain
- Departamento de Patología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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