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Piñero F, Anders M, Bermudez C, Demirdjian E, Varón A, Palazzo A, Rodriguez J, Beltrán O, da Fonseca LG, Ridruejo E, Caballini P, Tamagnone N, Reggiardo V, Cheinquer H, Araujo A, Arufe D, Marín JI, Ratusnu N, Manero E, Perez D, Villa M, Orozco F, Murga D, Marciano S, Bessone F, Silva M, Mendizabal M. Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC. Ann Hepatol 2023; 28:101110. [PMID: 37100385 DOI: 10.1016/j.aohep.2023.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES With the advent of new therapeutic options for patients with hepatocellular carcinoma (HCC) for intermediate or advanced stages of the Barcelona Clinic Liver Cancer (BCLC), regional real-world data regarding prognostic survival factors are of significant importance. PATIENTS AND METHODS A multicenter prospective cohort study was conducted in Latin America including BCLC B or C patients since 15th May 2018. We report here the second interim analysis focusing on prognostic variables and causes of treatment discontinuation. Cox proportional hazard survival analysis was performed, estimating hazard ratios (HR) and 95% confidence intervals (95% CI). RESULTS Overall, 390 patients were included, 55.1% and 44.9% were BCLC B and C at the time of study enrollment. Cirrhosis was present in 89.5% of the cohort. Among the BCLC-B group, 42.3% were treated with TACE with a median survival since the first session of 41.9 months. Liver decompensation before TACE was independently associated with increased mortality [HR 3.22 (CI 1.64;6.33); P<.001]. Systemic treatment was initiated in 48.2% of the cohort (n=188), with a median survival of 15.7 months. Of these, 48.9% presented first-line treatment discontinuation (44.4% tumor progression, 29.3% liver decompensation, 18.5% symptomatic deterioration, and 7.8% intolerance), and only 28.7% received second-line systemic treatments. Liver decompensation [HR 2.9 (1.64;5.29); P<.0001], and symptomatic progression [HR 3.9 (1.53;9.78); P=0.004] were independently associated with mortality after first-line systemic treatment discontinuation. CONCLUSIONS The complexity of these patients, with one-third presenting liver decompensation after systemic therapies, underlines the need for multidisciplinary team management and the central role of hepatologists.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ezequiel Ridruejo
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Argentina
| | | | | | | | - Hugo Cheinquer
- Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul. Brazil
| | - Alexandre Araujo
- Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul. Brazil
| | | | | | | | - Estela Manero
- Hospital Pablo Soria, San Salvador de Jujuy, Argentina
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Lupo S, Tamagnone N, Rodriguez M, Co A, Blanch MV, Curi BF, Crema J, Pompei C, Rogani P, Dulcich S, Sagardoy L, Osca M, Dell’elce C, Borra E, Eleonori M. Case series of Community Acquired Methicillin Resistant Staphylococcus Aureus. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Brance ML, Miljevic JN, Tizziani R, Taberna ME, Grossi GP, Toni P, Valentini E, Trepat A, Zaccardi J, Moro J, Finuci Curi B, Tamagnone N, Ramirez M, Severini J, Chiarotti P, Consiglio F, Piñeski R, Ghelfi A, Kilstein J, Street E, Moretti D, Oliveto V, Mariño M, Manera J, Brun LR. Serum 25-hydroxyvitamin D levels in hospitalized adults with community-acquired pneumonia. Clin Respir J 2018; 12:2220-2227. [PMID: 29570946 DOI: 10.1111/crj.12792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/11/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is the infectious disease with the highest number of deaths worldwide. Several studies have shown an association between vitamin D deficiency and increases susceptibility to respiratory tract infections. OBJECTIVE The aim of this study was to evaluate the serum 25-hydroxyvitamin D (25OHD) levels in hospitalized adults in general room with CAP. MATERIALS AND METHODS An observational study was carried out in 207 hospitalized adults of both sex with CAP (>18 years) from Rosario city, Argentina (32° 52' 18″S) between July 2015 and June 2016. RESULTS In total, 167 patients were included in the data analysis [59% women (57.4 ± 19.6 years), body mass index 27.2 ± 7.8 kg/m2 ]. In brief, 63% showed unilobar infiltrate and 37% were multilobar. The CURB-65 index was 66.5% low risk, 16.0% intermediate risk and 17.5% high risk. According to Charlson comorbidity index (CCI) 53.5% had not comorbidity (CCI = 0) and 46.5% showed CCI ≥ 1. The 25OHD level was: 11.92 ± 7.6 ng/mL (51.5%: <10 ng/mL, 33.5%: 10-20 ng/mL, 13.2%: 20-30 ng/mL and 1.8%: >30 ng/mL). Higher 25OHD were found in male (female: 10.8 ± 6.7 ng/mL, male: 13.5 ± 8.5 ng/mL, P = .02) and 25OHD correlated with age (r = -.17; P = .02). 25-Hydroxyvitamin D was also correlated with CURB65 index (r = -.13; P = .049), CCI (r = -.20, P = .007) and with the 10 years of life expectative (%) (r = .19; P = .008). In addition, higher 25OHD were found with lower CCI (CCI 0 = 13.0 ± 8.2 ng/mL, CCI ≥ 1= 10.5 ± 6.7 ng/mL; P = .0093). CONCLUSIONS Hospitalized adults with CAP have lower 25OHD levels and would be associated with the severity of CAP.
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Affiliation(s)
- María L Brance
- Bone Biology Laboratory, School of Medicine, Rosario National University, Rosario, Argentina.,National Council of Scientific and Technical Research (CONICET), Rosario, Argentina
| | - Julio N Miljevic
- Internal Medicine Department, Hospital Juan Bautista Alberdi, Rosario, Argentina
| | - Raquel Tizziani
- Internal Medicine Department, Hospital Roque Saenz Peña, Rosario, Argentina
| | - María E Taberna
- Internal Medicine Department, Hospital Roque Saenz Peña, Rosario, Argentina
| | - Georgina P Grossi
- Internal Medicine Department, Hospital de Emergencias Clemente Alvarez, Rosario, Argentina
| | - Pablo Toni
- Internal Medicine Department, Hospital de Emergencias Clemente Alvarez, Rosario, Argentina
| | - Elina Valentini
- Internal Medicine Department, Sanatorio de la Mujer, Rosario, Argentina
| | - Andrea Trepat
- Internal Medicine Department, Sanatorio de la Mujer, Rosario, Argentina
| | - Julia Zaccardi
- Internal Medicine Department, Hospital Español, Rosario, Argentina
| | - Juan Moro
- Internal Medicine Department, Hospital Español, Rosario, Argentina
| | | | | | - Mariano Ramirez
- Internal Medicine Department, Sanatorio Plaza, Rosario, Argentina
| | - Javier Severini
- Internal Medicine Department, Hospital Juan Bautista Alberdi, Rosario, Argentina
| | - Pablo Chiarotti
- Internal Medicine Department, Hospital Juan Bautista Alberdi, Rosario, Argentina
| | | | - Raúl Piñeski
- Internal Medicine Department, Sanatorio Laprida, Rosario, Argentina
| | - Albertina Ghelfi
- Internal Medicine Department, Hospital Escuela Eva Perón, Granadero Baigorria, Argentina
| | - Jorge Kilstein
- Internal Medicine Department, Hospital Escuela Eva Perón, Granadero Baigorria, Argentina
| | - Eduardo Street
- Internal Medicine Department, Sanatorio Rosendo García, Rosario, Argentina
| | - Dino Moretti
- Internal Medicine Department, Sanatorio Delta, Rosario, Argentina
| | - Viviana Oliveto
- Internal Medicine Department, Sanatorio IPAM, Rosario, Argentina
| | - Marcelo Mariño
- Internal Medicine Department, Sanatorio Británico, Rosario, Argentina
| | - Jorge Manera
- Internal Medicine Department, Sanatorio Británico, Rosario, Argentina
| | - Lucas R Brun
- Bone Biology Laboratory, School of Medicine, Rosario National University, Rosario, Argentina.,National Council of Scientific and Technical Research (CONICET), Rosario, Argentina
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