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D'Ambrosio R, Piccinelli S, Beccalli B, Spinetti A, Puoti M, Fagiuoli S, Magni CF, Vavassori A, Sacchi P, Castaldi S, Bombardieri G, Farina C, Buoro S, Amorosi A, Corradin M, Cereda D, Lampertico P. A territory-wide opportunistic, hospital-based HCV screening in the general population from northern Italy: The 1969-1989 birth-cohort. Liver Int 2023; 43:2645-2656. [PMID: 37715524 DOI: 10.1111/liv.15727] [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: 05/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND AND AIM The World Health Organization (WHO) goal of Hepatitis C Virus (HCV) elimination by 2030 rose awareness about the need of screening plans, worldwide. In Italy, graduated screening starting from people born in 1969-1989 might be the most-effective strategy. We performed an opportunistic HCV screening study in the general population attending health facilities in Lombardy region, Northern Italy. METHODS This is a prospective, multicenter, territory-wide, opportunistic study supported by the Regional Government of Lombardy, Italy. Between June 2022 and December 2022, all subjects born in 1969-1989, hospitalized or accessing blood collection centres were offered anti-HCV and HCV-RNA tests. Patients with known anti-HCV positivity and/or previous anti-HCV treatment were excluded. Demographic features were uploaded into a regional web-based platform. RESULTS In total, 120 193 individuals were screened in 75 centres. Mean age was 44 (±6) years, 65.2% were females, 83.7% were tested at blood collection centres. Anti-HCV tested positive in 604 (0.50%) subjects: mean age 47 (±5), 51.1% females. HCV seroprevalence was higher in males (p < 0.00001), elderly (p < 0.00001) and in- vs. outpatients (p = 0.0009). HCV-RNA was detectable in 125 out of 441 (28.3%) anti-HCV positive subjects. Actively infected patients were 46 (±6) years old, mainly males (56.8%). The overall prevalence of active HCV infection was 0.10%, higher in elderly (p = 0.0003) and in in-patients (p = 0.0007). Among 93 HCV-RNA positive patients, the median age was 48 years, 58% males, 62% Italian born, median HCV-RNA levels were 6,1 log IU/mL, liver stiffness measurement (LSM) values 5.5 (3.1-29.9) kPa and ALT levels 48 U/L. CONCLUSIONS The prevalence of active HCV infection in the 1969-1989 population attending health facilities in Lombardy was low. Most viremic patients were Italian-born, with mild liver disease but high-HCV-RNA levels. Due to the higher prevalence in the elderly, the extension of such opportunistic screening programs to lower birth cohorts would be warranted.
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Affiliation(s)
- Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Piccinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Angiola Spinetti
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, AAST Spedali Civili, Brescia, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, ASST GOM Niguarda, Milan, Italy
- Department of Medicine, University of Milan Bicocca, Milan, Italy
| | - Stefano Fagiuoli
- Department of Medicine, University of Milan Bicocca, Milan, Italy
- Division of Gastroenterology, Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Paolo Sacchi
- Division of Infectious Diseases, IRCCS San Matteo di Pavia, Pavia, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Quality Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Bombardieri
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | | | | | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Centre for Liver Disease, University of Milan, Milan, Italy
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Camagni S, Amaduzzi A, Grazioli L, Ghitti D, Pasulo L, Pinelli D, Fagiuoli S, Colledan M. Extended criteria liver donation after circulatory death with prolonged warm ischemia: a pilot experience of normothermic regional perfusion and no subsequent ex-situ machine perfusion. HPB (Oxford) 2023; 25:1494-1501. [PMID: 37659903 DOI: 10.1016/j.hpb.2023.07.902] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Livers from controlled donation after circulatory death (cDCD) with very prolonged warm ischemic time (WIT) are regularly transplanted after abdominal normothermic regional perfusion (aNRP) plus ex-situ machine perfusion (MP). Considering aNRP as in-situ MP, we investigated whether the results of a pilot experience of extended criteria cDCD liver transplantation (LT) with prolonged WIT, with aNRP alone, were comparable to the best possible outcomes in low-risk cDCD LT. METHODS Prospectively collected data on 24 cDCD LT, with aNRP alone, were analyzed. RESULTS The median total and asystolic WIT were 51 and 25 min. Measures within benchmark cut-offs were: median duration of surgery (5.9 h); median intraoperative transfusions (3 units of red blood cells); need for renal replacement therapy (2/24 patients); median intensive care stay (3 days); key complications; overall morbidity, graft loss, and retransplantation up to 12 months; 12-month mortality (2/21 patients). The median hospital stay (33 days, due to logistics) and mortality up to 6 months (2/24 patients, due to graft-unrelated causes) exceeded benchmark thresholds. CONCLUSIONS This pilot experience suggests that livers from cDCD with very prolonged WIT that appear viable during adequate quality aNRP may be safely transplanted, with no need for ex-situ MP, with considerable resource savings.
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Affiliation(s)
- Stefania Camagni
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy.
| | - Annalisa Amaduzzi
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Lorenzo Grazioli
- Department of Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Davide Ghitti
- Department of Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy; Università degli Studi di Milano-Bicocca, Piazza dell'Ateneo Nuovo, 20126 Milano, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy; Università degli Studi di Milano-Bicocca, Piazza dell'Ateneo Nuovo, 20126 Milano, Italy
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3
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Marra P, Muglia R, Capodaglio CA, Dulcetta L, Carbone FS, Sansotta N, Pinelli D, Celestino A, Muscogiuri G, Bonanomi E, Fagiuoli S, D'Antiga L, Colledan M, Sironi S. Current Endovascular Management of Arterial Complications After Pediatric Liver Transplantation in a Tertiary Center. Cardiovasc Intervent Radiol 2023; 46:1610-1620. [PMID: 37831217 PMCID: PMC10616219 DOI: 10.1007/s00270-023-03557-0] [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: 04/27/2023] [Accepted: 09/02/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Pediatric liver transplant surgery is burdened by arterial complications whose endovascular treatment is not standardized. We report the outcomes of a cohort of pediatric recipients with hepatic artery complications treated by endoluminal procedures. MATERIALS AND METHODS From December 2019 to December 2022, consecutive transplanted pediatric patients who underwent endovascular treatment of hepatic artery complications were reviewed. The analysis included: type of complication (occlusion, stenosis, pseudoaneurysm); onset (acute = < 15 days, subacute = 15-90 days, late = > 90 days); endovascular technique (angioplasty, stenting); complications and outcomes. Technical success was defined as the opacification of the hepatic artery at the final angiogram with < 50% residual stenosis and no pseudoaneurysms. Clinical success was defined by graft's and patient's survival. RESULTS Seventeen patients (8 males; median age 33 months, IQR 9-103) underwent 21 hepatic arteriography procedures for predominantly acute or subacute occlusions (n = 7) or stenosis (n = 11) with concurrent pseudoaneurysms (n = 4). Primary and secondary technical success was achieved in 13/18 and 3/3 procedures, respectively, with overall technical success of 76%. Angioplasty alone was successful in 5/21 procedures; stent-retriever thrombectomy was performed in one occlusion with thrombosis; stenting was required in 9/17 (53%) patients. Clinical success was obtained in 14/17 (82%) patients with hepatic artery patency after a median of 367 days (IQR 114.5-500). Clinical failure occurred in 3 permanent occlusions, with 2 deaths and 1 re-transplantation. Procedure-related complications included minor events in 3/17 (18%) patients and 1/17 (6%) death. CONCLUSION In liver transplanted children with hepatic artery complications, endovascular treatment may provide clinical success, with stenting often required in acute and subacute conditions. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Paolo Marra
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy.
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.
| | - Riccardo Muglia
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Carlo Alberto Capodaglio
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Ludovico Dulcetta
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Francesco Saverio Carbone
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Naire Sansotta
- Department of Pediatric Hepatology, Gastroenterology, Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Antonio Celestino
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Ezio Bonanomi
- Pediatric Intensive Care Unit, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Stefano Fagiuoli
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Gastroenterology, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Lorenzo D'Antiga
- Department of Pediatric Hepatology, Gastroenterology, Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Michele Colledan
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
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Viganò M, Beretta M, Lepore M, Abete R, Benatti SV, Grassini MV, Camagni S, Chiodini G, Vargiu S, Vittori C, Iachini M, Terzi A, Neri F, Pinelli D, Casotti V, Di Marco F, Ruggenenti P, Rizzi M, Colledan M, Fagiuoli S. Vaccination Recommendations in Solid Organ Transplant Adult Candidates and Recipients. Vaccines (Basel) 2023; 11:1611. [PMID: 37897013 PMCID: PMC10611006 DOI: 10.3390/vaccines11101611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Prevention of infections is crucial in solid organ transplant (SOT) candidates and recipients. These patients are exposed to an increased infectious risk due to previous organ insufficiency and to pharmacologic immunosuppression. Besides infectious-related morbidity and mortality, this vulnerable group of patients is also exposed to the risk of acute decompensation and organ rejection or failure in the pre- and post-transplant period, respectively, since antimicrobial treatments are less effective than in the immunocompetent patients. Vaccination represents a major preventive measure against specific infectious risks in this population but as responses to vaccines are reduced, especially in the early post-transplant period or after treatment for rejection, an optimal vaccination status should be obtained prior to transplantation whenever possible. This review reports the currently available data on the indications and protocols of vaccination in SOT adult candidates and recipients.
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Affiliation(s)
- Mauro Viganò
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy (S.F.)
| | - Marta Beretta
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.B.); (F.D.M.)
| | - Marta Lepore
- Unit of Nephrology and Dialysis, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.L.); (P.R.)
| | - Raffaele Abete
- Cardiology Division, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy (C.V.)
| | - Simone Vasilij Benatti
- Infectious Diseases Unit, ASST Papa Giovanni XXII, 24127 Bergamo, Italy; (S.V.B.); (M.R.)
| | - Maria Vittoria Grassini
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy (S.F.)
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90128 Palermo, Italy
| | - Stefania Camagni
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (F.N.); (D.P.); (M.C.)
| | - Greta Chiodini
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.B.); (F.D.M.)
| | - Simone Vargiu
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.B.); (F.D.M.)
| | - Claudia Vittori
- Cardiology Division, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy (C.V.)
| | - Marco Iachini
- Unit of Nephrology and Dialysis, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.L.); (P.R.)
| | - Amedeo Terzi
- Cardiothoracic Department, ASST Papa Giovanni XXII, 24127 Bergamo, Italy;
| | - Flavia Neri
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (F.N.); (D.P.); (M.C.)
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (F.N.); (D.P.); (M.C.)
| | - Valeria Casotti
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXII, 24127 Bergamo, Italy;
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.B.); (F.D.M.)
- Department of Health Sciences, University of Milan, 20158 Milan, Italy
| | - Piero Ruggenenti
- Unit of Nephrology and Dialysis, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.L.); (P.R.)
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases “Aldo e Cele Daccò”, Institute of Pharmacologic Research “Mario Negri IRCCS”, Ranica, 24020 Bergamo, Italy
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXII, 24127 Bergamo, Italy; (S.V.B.); (M.R.)
| | - Michele Colledan
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (F.N.); (D.P.); (M.C.)
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy (S.F.)
- Department of Medicine, University of Milan Bicocca, 20126 Milan, Italy
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5
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Rendina M, Barone M, Lillo C, Trapani S, Masiero L, Trerotoli P, Puoti F, Lupo LG, Tandoi F, Agnes S, Grieco A, Andorno E, Marenco S, Giannini EG, Baccarani U, Toniutto P, Carraro A, Colecchia A, Cescon M, Morelli MC, Cillo U, Burra P, Angeli P, Colledan M, Fagiuoli S, De Carlis L, Belli L, De Simone P, Carrai P, Di Benedetto F, De Maria N, Ettorre GM, Giannelli V, Gruttadauria S, Volpes R, Corsale S, Mazzaferro V, Bhoori S, Romagnoli R, Martini S, Rossi G, Caccamo L, Donato MF, Rossi M, Ginanni Corradini S, Spada M, Maggiore G, Tisone G, Lenci I, Vennarecci G, Tortora R, Vivarelli M, Svegliati Baroni G, Zamboni F, Mameli L, Tafuri S, Simone S, Gesualdo L, Cardillo M, Di Leo A. The Italian data on SARS-CoV-2 infection in transplanted patients support an organ specific immune response in liver recipients. Front Immunol 2023; 14:1203854. [PMID: 37469512 PMCID: PMC10352984 DOI: 10.3389/fimmu.2023.1203854] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/18/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction The study of immune response to SARSCoV-2 infection in different solid organ transplant settings represents an opportunity for clarifying the interplay between SARS-CoV-2 and the immune system. In our nationwide registry study from Italy, we specifically evaluated, during the first wave pandemic, i.e., in non-vaccinated patients, COVID-19 prevalence of infection, mortality, and lethality in liver transplant recipients (LTRs), using non-liver solid transplant recipients (NL-SOTRs) and the Italian general population (GP) as comparators. Methods Case collection started from February 21 to June 22, 2020, using the data from the National Institute of Health and National Transplant Center, whereas the data analysis was performed on September 30, 2020.To compare the sex- and age-adjusted distribution of infection, mortality, and lethality in LTRs, NL-SOTRs, and Italian GP we applied an indirect standardization method to determine the standardized rate. Results Among the 43,983 Italian SOTRs with a functioning graft, LTRs accounted for 14,168 patients, of whom 89 were SARS-CoV-2 infected. In the 29,815 NL-SOTRs, 361 cases of SARS-CoV-2 infection were observed. The geographical distribution of the disease was highly variable across the different Italian regions. The standardized rate of infection, mortality, and lethality rates in LTRs resulted lower compared to NL-SOTRs [1.02 (95%CI 0.81-1.23) vs. 2.01 (95%CI 1.8-2.2); 1.0 (95%CI 0.5-1.5) vs. 4.5 (95%CI 3.6-5.3); 1.6 (95%CI 0.7-2.4) vs. 2.8 (95%CI 2.2-3.3), respectively] and comparable to the Italian GP. Discussion According to the most recent studies on SOTRs and SARS-CoV-2 infection, our data strongly suggest that, in contrast to what was observed in NL-SOTRs receiving a similar immunosuppressive therapy, LTRs have the same risk of SARS-CoV-2 infection, mortality, and lethality observed in the general population. These results suggest an immune response to SARS-CoV-2 infection in LTRS that is different from NL-SOTRs, probably related to the ability of the grafted liver to induce immunotolerance.
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Affiliation(s)
- Maria Rendina
- Gastroenterology Unit, University Hospital Policlinico of Bari, Bari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Chiara Lillo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Silvia Trapani
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Lucia Masiero
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Paolo Trerotoli
- Section of Statistics, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesca Puoti
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Luigi Giovanni Lupo
- General Surgery and Liver Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari, Bari, Italy
| | - Francesco Tandoi
- General Surgery and Liver Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari, Bari, Italy
| | - Salvatore Agnes
- U.O.C. Chirurgia Generale e Trapianti di Organo, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Grieco
- U.O.C. Medicina Interna e del Trapianto di Fegato, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Enzo Andorno
- Chirurgia dei Trapianti di Fegato, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Simona Marenco
- Gastroenterology Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Umberto Baccarani
- Centro Trapianto di Fegato, A.O.U.I. Udine, Università degli Studi di Udine, Udine, Italy
| | - Pierluigi Toniutto
- U.S.D. Epatologia e Trapianto di Fegato, A.O.U.I. Udine, Università degli Studi di Udine, Udine, Italy
| | | | - Antonio Colecchia
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, Modena, Italy
| | - Matteo Cescon
- Chirurgia Epatobiliare e dei Trapianti, IRCCS, A.O.U. di Bologna, University of Bologna, Bologna, Italy
| | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS, A.O.U. di Bologna, Bologna, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation, University-Teaching Hospital of Padova, Padova, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, University-Teaching Hospital of Padova, Padova, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), University-Teaching Hospital of Padova, Padova, Italy
| | - Michele Colledan
- U.O.C. Chirurgia Generale III, Centro Trapianti Fegato, A.S.S.T. Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, A.S.S.T. Ospedale Papa Giovanni XXIII, Bergamo, Italy
- Gastroenterologia, Department of Medicine University of Milan Bicocca, Milano, Italy
| | - Luciano De Carlis
- Chirurgia Generale dei Trapianti, Azienda Ospedaliera Niguarda Ca’Granda, University of Milano-Bicocca, Milano, Italy
| | - Luca Belli
- U.O.C. Epatologia e Gastroenterologia, Azienda Ospedaliera Niguarda Ca’Granda, Milano, Italy
| | - Paolo De Simone
- U.O.C. Chirurgia Epatica e Trapianti di Fegato, A.O.U. Pisana, University of Pisa, Pisa, Italy
| | - Paola Carrai
- U.O. Chirurgia Epatica e del Trapianto di Fegato, A.O.U. Pisana, Pisa, Italy
| | - Fabrizio Di Benedetto
- U.O.C. di Chirurgia Oncologica Epatobiliopancreatica e Chirurgia dei Trapianti di Fegato, Azienda Ospedaliera Policlinico, Università di Modena, Modena, Italy
| | - Nicola De Maria
- U.O.C. Chirurgia Generale e Trapianti, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | | | - Valerio Giannelli
- Hepatology Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | | | - Riccardo Volpes
- Unità di Gastroenterologia ed Epatologia, IRCCS-ISMETT-UPMCI, Palermo, Italy
| | - Sveva Corsale
- Unità di Gastroenterologia ed Epatologia, IRCCS-ISMETT-UPMCI, Palermo, Italy
| | - Vincenzo Mazzaferro
- Hepato-pancreatic-biliary surgery and Liver transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Department of Oncology, University of Milan, Milan, Italy
| | - Sherrie Bhoori
- Hepato-pancreatic-biliary surgery and Liver transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Renato Romagnoli
- Chirurgia Generale 2, Centro Trapianto Fegato A.O.U Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Silvia Martini
- Gastroenteroly Unit, A.O.U Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Giorgio Rossi
- Division of General and Liver Transplant Surgery, Ospedale Maggiore Policlinico, Milano, Italy
| | - Lucio Caccamo
- Division of General and Liver Transplant Surgery, Ospedale Maggiore Policlinico, Milano, Italy
| | - Maria Francesca Donato
- Division of Gastroenterology and Hepatology, Ospedale Maggiore Policlinico, Milano, Italy
| | - Massimo Rossi
- U.O.C. di Chirurgia Generale e Trapianti di Organo, Policlinico Umberto I, Sapienza Università di Roma, Rome, Italy
| | | | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giuseppe Maggiore
- Hepatogastroenterology, Digestive Endoscopy, Nutrition and Liver Transplantation Unit, Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giuseppe Tisone
- Liver Transplant Unit, A.O.U. Policlinico Tor Vergata, University of Tor Vergata Rome, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, A.O.U. Policlinico Tor Vergata, University of Tor Vergata Rome, Rome, Italy
| | - Giovanni Vennarecci
- Hepatobiliary and Liver Tranplantation Surgery, A.O.R.N. “A. CARDARELLI”, Naples, Italy
| | | | - Marco Vivarelli
- Chirurgia Epatobiliare, Pancreatica e dei Trapianti, A.O.U., Ospedali Riuniti, Ancona, Italy
| | | | - Fausto Zamboni
- General and Hepatic Transplantation Surgery Unit, AO.B. G. Brotzu, Cagliari, Italy
| | - Laura Mameli
- General and Hepatic Transplantation Surgery Unit, AO.B. G. Brotzu, Cagliari, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Simona Simone
- Dialysis and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Loreto Gesualdo
- Dialysis and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
| | - Massimo Cardillo
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy
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6
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Novelli L, Raimondi F, Carioli G, Carobbio A, Pappacena S, Biza R, Trapasso R, Anelli M, Amoroso M, Allegri C, Malandrino L, Imeri G, Conti C, Beretta M, Gori M, D'Elia E, Senni M, Lorini FL, Rizzi M, Cosentini R, Rambaldi A, Masciulli A, Gavazzi A, Solidoro P, Sironi S, Fagiuoli S, Barbui T, Marco FD. One-year mortality in COVID-19 is associated with patients' comorbidities rather than pneumonia severity. Respir Med Res 2023; 83:100976. [PMID: 36473331 PMCID: PMC9691276 DOI: 10.1016/j.resmer.2022.100976] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/15/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In patients with pneumonia or acute respiratory distress syndrome who survived hospitalization, one-year mortality can affect up to one third of discharged patients. Therefore, significant long-term mortality after COVID-19 respiratory failure could be expected. The primary outcome of the present study was one-year all-cause mortality in hospitalized COVID-19 patients. METHODS Observational study of COVID-19 patients hospitalized at Papa Giovanni XXIII Hospital (Bergamo, Italy), during the first pandemic wave. RESULTS A total of 1326 COVID-19 patients were hospitalized. Overall one-year mortality was 33.6% (N 446/1326), with the majority of deaths occurring during hospitalization (N=412, 92.4%). Thirty-four patients amongst the 914 discharged (3.7%) subsequentely died within one year. A third of these patients died for advanced cancer, while death without a cause other than COVID-19 was uncommon (8.8% of the overall post-discharge mortality). In-hospital late mortality (i.e. after 28 days of admission) interested a population with a lower age, and fewer comorbidities, more frequentely admitted in ICU. Independent predictors of post-discharge mortality were age over 65 years (HR 3.19; 95% CI 1.28-7.96, p-value=0.013), presence of chronic obstructive pulmonary disease (COPD) (HR 2.52; 95% CI 1.09-5.83, p-value=0.031) or proxy of cardiovascular disease (HR 4.93; 95% CI 1.45-16.75, p-value=0.010), and presence of active cancer (HR 3.64; 95% CI 1.50-8.84, p-value=0.004), but not pneumonia severity. CONCLUSIONS One-year post-discharge mortality depends on underlying patients' comorbidities rather than COVID-19 pneumonia severity per se. Awareness among physicians of predictors of post-discharge mortality might be helpful in structuring a follow-up program for discharged patients.
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Affiliation(s)
- Luca Novelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Raimondi
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy,Corresponding author at: Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1 - 24127 Bergamo, Italy
| | - Greta Carioli
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Alessandra Carobbio
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Simone Pappacena
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Biza
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Trapasso
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Marisa Anelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Mariangela Amoroso
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Chiara Allegri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Malandrino
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianluca Imeri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Caterina Conti
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marta Beretta
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Gori
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Emilia D'Elia
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ferdinando Luca Lorini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Intensive Critical Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alessandro Rambaldi
- Department of Health Sciences, University of Milan, Milan, Italy,Hematology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Arianna Masciulli
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Antonello Gavazzi
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Paolo Solidoro
- Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Italy
| | - Sandro Sironi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Gastroenterlogy 1, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Tiziano Barbui
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
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7
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Riggio O, Celsa C, Calvaruso V, Merli M, Caraceni P, Montagnese S, Mora V, Milana M, Saracco GM, Raimondo G, Benedetti A, Burra P, Sacco R, Persico M, Schepis F, Villa E, Colecchia A, Fagiuoli S, Pirisi M, Barone M, Azzaroli F, Soardo G, Russello M, Morisco F, Labanca S, Fracanzani AL, Pietrangelo A, Di Maria G, Nardelli S, Ridola L, Gasbarrini A, Cammà C. Hepatic encephalopathy increases the risk for mortality and hospital readmission in decompensated cirrhotic patients: a prospective multicenter study. Front Med (Lausanne) 2023; 10:1184860. [PMID: 37305121 PMCID: PMC10248517 DOI: 10.3389/fmed.2023.1184860] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Hepatic encephalopathy (HE) affects the survival and quality of life of patients with cirrhosis. However, longitudinal data on the clinical course after hospitalization for HE are lacking. The aim was to estimate mortality and risk for hospital readmission of cirrhotic patients hospitalized for HE. Methods We prospectively enrolled 112 consecutive cirrhotic patients hospitalized for HE (HE group) at 25 Italian referral centers. A cohort of 256 patients hospitalized for decompensated cirrhosis without HE served as controls (no HE group). After hospitalization for HE, patients were followed-up for 12 months until death or liver transplant (LT). Results During follow-up, 34 patients (30.4%) died and 15 patients (13.4%) underwent LT in the HE group, while 60 patients (23.4%) died and 50 patients (19.5%) underwent LT in the no HE group. In the whole cohort, age (HR 1.03, 95% CI 1.01-1.06), HE (HR 1.67, 95% CI 1.08-2.56), ascites (HR 2.56, 95% CI 1.55-4.23), and sodium levels (HR 0.94, 95% CI 0.90-0.99) were significant risk factors for mortality. In the HE group, ascites (HR 5.07, 95% CI 1.39-18.49) and BMI (HR 0.86, 95% CI 0.75-0.98) were risk factors for mortality, and HE recurrence was the first cause of hospital readmission. Conclusion In patients hospitalized for decompensated cirrhosis, HE is an independent risk factor for mortality and the most common cause of hospital readmission compared with other decompensation events. Patients hospitalized for HE should be evaluated as candidates for LT.
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Affiliation(s)
- Oliviero Riggio
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Department of Gastroenterology, “Santa Maria Goretti” Hospital, “Sapienza” Polo Pontino, Latina, Italy
| | - Ciro Celsa
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Vincenza Calvaruso
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Caraceni
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Center for Biomedical Applied Research, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Vincenzina Mora
- Medicina Interna e Gastroenterologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Martina Milana
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
| | - Giorgio Maria Saracco
- Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Raimondo
- Division of Medicine and Hepatology, University Hospital of Messina, Messina, Italy
| | - Antonio Benedetti
- Department of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ancona, Italy
| | - Patrizia Burra
- Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Rodolfo Sacco
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Marcello Persico
- Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Filippo Schepis
- Gastroenterology Unit, Department of Medical Specialities, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Villa
- Gastroenterology Unit, Department of Medical Specialities, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, Department of Medical Specialities, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Gastroenterology, Borgo Trento University Hospital, Verona, Italy
| | - Stefano Fagiuoli
- Gastroentyerology, University of Milan Bicocca, Milan, Italy
- Gastroenterology, Hepatology and Transplantation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy
- Internal Medicine Unit, Azienda Ospedaliera Universitaria (AOU) Maggiore della Carità Hospital, Novara, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Department of Surgical and Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giorgio Soardo
- Clinic of Internal Medicine-Liver Unit, Department of Medical Area (DAME), University of Udine, Udine, Italy
- Italian Liver Foundation, Area Science Park, Trieste, Italy
| | - Maurizio Russello
- Liver Unit, Azienda di Rilievo Nazionale ed Alta Specializzazione (ARNAS) Garibaldi-Nesima, Catania, Italy
| | - Filomena Morisco
- Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Sara Labanca
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Anna Ludovica Fracanzani
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- General Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonello Pietrangelo
- Department of Internal and Emergency Medicine, University Hospital of Modena, Modena, Italy
| | - Gabriele Di Maria
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Silvia Nardelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Ridola
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Calogero Cammà
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
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8
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Pelusi S, Bianco C, Colombo M, Cologni G, Del Poggio P, Pugliese N, Prati D, Pigozzi MG, D'Ambrosio R, Lampertico P, Fagiuoli S, Valenti L. Metabolic dysfunction outperforms ultrasonographic steatosis to stratify hepatocellular carcinoma risk in patients with advanced hepatitis C cured with direct-acting antivirals. Liver Int 2023. [PMID: 37035867 DOI: 10.1111/liv.15577] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/18/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND AND AIMS Metabolic dysfunction (MD)-associated fatty liver disease has been proposed to identify individuals at risk of liver events irrespectively of the contemporary presence of other liver diseases. The aim of this study was to examine the impact of MD in patients cured of chronic hepatis C (CHC). PATIENTS AND METHODS We analysed data from a real-life cohort of 2611 Italian patients cured of CHC with direct antiviral agents and advanced liver fibrosis, without HBV/HIV, transplantation and negative for hepatocellular carcinoma (HCC) history (age 61.4 ± 11.8 years, 63.9% males, median follow-up 34, 24-40 months). Information about ultrasonographic steatosis (US) after sustained virological response was available in 1978. RESULTS MD affected 58% of patients, diagnosed due to the presence of diabetes (MD-diabetes, 19%), overweight without diabetes (MD-overweight, 37%) or multiple metabolic abnormalities without overweight and diabetes (MD-metabolic, 2%). MD was more frequent than and not coincident with US (32% MD-only, 23% MD-US and 13% US-only). MD was associated with higher liver stiffness (p < 0.05), particularly in patients with MD-diabetes and MD-only subgroups, comprising older individuals with more advanced metabolic and liver disease (p < 0.05). At Cox proportional hazard multivariable analysis, MD was associated with increased risk of HCC (HR 1.97, 95% CI 1.27-3.04; p = 0.0023). Further classification according to diagnostic criteria improved risk stratification (p < 0.0001), with the highest risk observed in patients with MD-diabetes. Patients with MD-only appeared at highest risk since the sustained virological response achievement (p = 0.008), with a later catch-up of those with combined MD-US, whereas US-only was not associated with HCC. CONCLUSIONS MD is more prevalent than US in patients cured of CHC with advanced fibrosis and identifies more accurately individuals at risk of developing HCC.
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Affiliation(s)
- Serena Pelusi
- Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristiana Bianco
- Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giuliana Cologni
- Department of Internal Medicine, Papa Giovanni Hospital, Bergamo, Italy
| | - Paolo Del Poggio
- Department of Gastroenterology and Hepatology, Papa Giovanni Hospital, Zingonia, Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Daniele Prati
- Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Roberta D'Ambrosio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology, Milan, Italy
| | - Pietro Lampertico
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC 'A. M. and A. Migliavacca' Center for Liver Disease, University of Milan, Milan, Italy
| | - Stefano Fagiuoli
- Gastroenterology, Hepatology and Transplantation Unit, Department of Specialty and Transplant Medicine, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luca Valenti
- Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Precision Medicine Lab, Biological Resource Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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9
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Brancaccio G, Coco B, Nardi A, Quaranta MG, Tosti ME, Ferrigno L, Cacciola I, Messina V, Chessa L, Morisco F, Milella M, Barbaro F, Ciancio A, Russo FP, Coppola N, Blanc P, Claar E, Verucchi G, Puoti M, Zignego AL, Chemello L, Madonia S, Fagiuoli S, Marzano A, Ferrari C, Lampertico P, Di Marco V, Craxì A, Santantonio TA, Raimondo G, Brunetto MR, Gaeta GB, Kondili LA. Trends in chronic hepatitis B virus infection in Italy over a 10-year period: Clues from the nationwide PITER and MASTER cohorts toward elimination. Int J Infect Dis 2023; 129:266-273. [PMID: 36791877 DOI: 10.1016/j.ijid.2023.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVES The study measures trends in the profile of patients with chronic hepatitis B virus linked to care in Italy. METHODS A cross-sectional, multicenter, observational cohort (PITER cohort) of consecutive patients with hepatitis B surface antigen (HBsAg) over the period 2019-2021 from 46 centers was evaluated. The reference was the MASTER cohort collected over the years 2012-2015. Standard statistical methods were used. RESULTS The PITER cohort enrolled 4583 patients, of whom 21.8% were non-Italian natives. Compared with those in MASTER, the patients were older and more often female. The prevalence of hepatitis B e antigen (HBeAg) declined (7.2% vs 12.3; P <0.0001) and that of anti-hepatitis D virus (HDV) remained stable (9.3% vs 8.3%). In both cohorts, about 25% of the patients had cirrhosis, and those in the PITER cohort were older. HBeAg-positive was 5.0% vs 12.6% (P <0.0001) and anti-HDV positive 24.8% vs 17.5% (P <0.0017). In the logistic model, the variables associated with cirrhosis were anti-HDV-positive (odds ratio = 10.08; confidence interval 7.63-13.43), age, sex, and body mass index; the likelihood of cirrhosis was reduced by 40% in the PITER cohort. Among non-Italians, 12.3% were HBeAg-positive (vs 23.4% in the MASTER cohort; P <0.0001), and 12.3% were anti-HDV-positive (vs 11.1%). Overall, the adherence to the European Association for the Study of the Liver recommendations for antiviral treatment increased over time. CONCLUSION Chronic hepatitis B virus infection appears to be in the process of becoming under control in Italy; however, HDV infection is still a health concern in patients with cirrhosis and in migrants.
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Affiliation(s)
- Giuseppina Brancaccio
- Department of Molecular Medicine, Infectious Diseases Unit, University of Padua, Padua, Italy
| | - Barbara Coco
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Alessandra Nardi
- Department of Mathematics, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Luigina Ferrigno
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Irene Cacciola
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
| | - Vincenzo Messina
- Department of Infectious Diseases, Sant'Anna Hospital, Caserta, Italy
| | - Luchino Chessa
- Liver Unit, University Hospital, Monserrato, Cagliari, Italy
| | - Filomena Morisco
- Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples, Federico II, Naples, Italy
| | - Michele Milella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Francesco Barbaro
- Department of Medicine, Infectious Diseases Unit, University Hospital of Padua, Padua, Italy
| | - Alessia Ciancio
- Gastroenterology Unit, Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, Padua, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pierluigi Blanc
- Infectious Disease Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Gabriella Verucchi
- Clinic of Infectious Diseases and Microbiology Unit, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Massimo Puoti
- Infectious Disease Unit, Niguarda Hospital, Milan, Italy
| | - Anna Linda Zignego
- Center for Systemic Manifestations of Hepatitis Viruses, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Liliana Chemello
- Department of Medicine, Unit of Internal Medicine & Hepatology, University of Padua, Padua, Italy
| | - Salvatore Madonia
- Department of Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Stefano Fagiuoli
- Gastroenterology, Department of Medicine, University of Milan Bicocca, Milan, Italy; Gastroenterology Hepatology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Carlo Ferrari
- Department of Medicine and Surgery, University of Parma, Unit of Hematology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Vito Di Marco
- Unit of Gastroenterology and Hepatology, Biomedical Department of Internal and Specialistic Medicine, University of Palermo, Palermo, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
| | | | - Giovanni Raimondo
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
| | - Maurizia R Brunetto
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | | | - Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
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10
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Viganò M, La Milia M, Grassini MV, Pugliese N, De Giorgio M, Fagiuoli S. Hepatotoxicity of Small Molecule Protein Kinase Inhibitors for Cancer. Cancers (Basel) 2023; 15:cancers15061766. [PMID: 36980652 PMCID: PMC10046041 DOI: 10.3390/cancers15061766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
Small molecule protein kinase inhibitors (PKIs) have become an effective strategy for cancer patients. However, hepatotoxicity is a major safety concern of these drugs, since the majority are reported to increase transaminases, and few of them (Idelalisib, Lapatinib, Pazopanib, Pexidartinib, Ponatinib, Regorafenib, Sunitinib) have a boxed label warning. The exact rate of PKI-induced hepatoxicity is not well defined due to the fact that the majority of data arise from pre-registration or registration trials on fairly selected patients, and the post-marketing data are often based only on the most severe described cases, whereas most real practice studies do not include drug-related hepatotoxicity as an end point. Although these side effects are usually reversible by dose adjustment or therapy suspension, or by switching to an alternative PKI, and fatality is uncommon, all patients undergoing PKIs should be carefully pre-evaluated and monitored. The management of this complication requires an individually tailored reappraisal of the risk/benefit ratio, especially in patients who are responding to therapy. This review reports the currently available data on the risk and management of hepatotoxicity of all the approved PKIs.
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Affiliation(s)
- Mauro Viganò
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
- Correspondence: ; Tel.: +39-035-2674259; Fax: +39-035-2674964
| | - Marta La Milia
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Maria Vittoria Grassini
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Nicola Pugliese
- Department of Gastroenterology, Division of Internal Medicine and Hepatology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Massimo De Giorgio
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
- Gastroenterology, Department of Medicine, University of Milan Bicocca, 20126 Milan, Italy
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11
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Cristoferi L, Porta M, Bernasconi DP, Leonardi F, Gerussi A, Mulinacci G, Palermo A, Gallo C, Scaravaglio M, Stucchi E, Maino C, Ippolito D, D'Amato D, Ferreira C, Nardi A, Banerjee R, Valsecchi MG, Antolini L, Corso R, Sironi S, Fagiuoli S, Invernizzi P, Carbone M. A quantitative MRCP-derived score for medium-term outcome prediction in primary sclerosing cholangitis. Dig Liver Dis 2023; 55:373-380. [PMID: 36357293 DOI: 10.1016/j.dld.2022.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is the gold standard for diagnosis of patients with primary sclerosing cholangitis (PSC). The semi-quantitative MRCP-derived Anali scores proposed for risk stratification, have poor-to-moderate inter-reader agreement. AIMS To evaluate the prognostic performance of quantitative MRCP metrics in PSC. METHODS This is a retrospective study of PSC patients undergoing MRCP. Images were processed using MRCP+ software (Perspectum Ltd, Oxford) that provides quantitative biliary features, semi-automatically extracted by artificial intelligence-driven analysis of MRCP-3D images. The prognostic value of biliary features has been assessed for all hepato-biliary complications. RESULTS 87 PSC patients have been included in the analysis. Median follow-up from MRCP to event/censoring of 30.9 months (Q1-Q3=13.6-46.6). An adverse outcome occurred in 27 (31.0%) patients. The number of biliary strictures (HR=1.05 per unit, 95%CI 1.02-1.08, p < 0.0001), spleen length (HR=1.16 per cm, 95%CI 1.01-1.34, p = 0.039), adjusted for height, age at MRCP, and time from diagnosis to MRCP predicted higher risk of hepatobiliary complications. These were incorporated into a the quantitative MRCP-derived PSC (qMRCP-PSC) score (C-statistic=0.80). After 3-fold cross-validation, qMRCP-PSC outperformed the Anali score in our cohort (C-statistic of 0.78 vs 0.64) and enabled the discrimination of survival of PSC patients (log-rank p < 0.0001). CONCLUSIONS The qMRCP-PSC score identified patients at higher risk of hepatobiliary complications and outperformed the available radiological scores. It represents a novel quantitative biomarker for disease monitoring and a potential surrogate endpoint for clinical trials.
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Affiliation(s)
- Laura Cristoferi
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, MB 20900, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Via Gian Battista Pergolesi 33, Monza 20900, Italy; Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB 20900, Italy
| | - Marco Porta
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, Monza, MB 20900, Italy
| | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB 20900, Italy
| | - Filippo Leonardi
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, piazza OMS, 1, Bergamo, BG 24127, Italy
| | - Alessio Gerussi
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, MB 20900, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Via Gian Battista Pergolesi 33, Monza 20900, Italy
| | - Giacomo Mulinacci
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, MB 20900, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Via Gian Battista Pergolesi 33, Monza 20900, Italy
| | - Andrea Palermo
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, MB 20900, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Via Gian Battista Pergolesi 33, Monza 20900, Italy
| | - Camilla Gallo
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, MB 20900, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Via Gian Battista Pergolesi 33, Monza 20900, Italy
| | - Miki Scaravaglio
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, MB 20900, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Via Gian Battista Pergolesi 33, Monza 20900, Italy
| | - Eliana Stucchi
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, MB 20900, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Via Gian Battista Pergolesi 33, Monza 20900, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, Monza, MB 20900, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, Monza, MB 20900, Italy; School of Medicine, University of Milano-Bicocca, via Cadore 48, Monza, MB 20900, Italy
| | - Daphne D'Amato
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, MB 20900, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Via Gian Battista Pergolesi 33, Monza 20900, Italy
| | - Carlos Ferreira
- Perspectum Ltd, Gemini One, 5520 John Smith Dr, Oxford OX4 2LL, United Kingdom
| | - Alessandra Nardi
- Department of Mathematics, University of Rome Tor Vergata, Via della Ricerca Scientifica, 1, Roma, RM 00133, Italy
| | - Rajarshi Banerjee
- Perspectum Ltd, Gemini One, 5520 John Smith Dr, Oxford OX4 2LL, United Kingdom
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB 20900, Italy
| | - Laura Antolini
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB 20900, Italy
| | - Rocco Corso
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, Monza, MB 20900, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, piazza OMS, 1, Bergamo, BG 24127, Italy; School of Medicine, University of Milano-Bicocca, via Cadore 48, Monza, MB 20900, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, piazza OMS, 1, Bergamo, BG 24127, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, MB 20900, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Via Gian Battista Pergolesi 33, Monza 20900, Italy
| | - Marco Carbone
- Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, MB 20900, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Via Gian Battista Pergolesi 33, Monza 20900, Italy.
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12
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Fagiuoli S, Toniutto P, Coppola N, Ancona DD, Andretta M, Bartolini F, Ferrante F, Lupi A, Palcic S, Rizzi FV, Re D, Alvarez Nieto G, Hernandez C, Frigerio F, Perrone V, Degli Esposti L, Mangia A. Italian Real-World Analysis of the Impact of Polypharmacy and Aging on the Risk of Multiple Drug-Drug Interactions (DDIs) in HCV Patients Treated with Pangenotypic Direct-Acting Antivirals (pDAA). Ther Clin Risk Manag 2023; 19:57-65. [PMID: 36699017 PMCID: PMC9868280 DOI: 10.2147/tcrm.s394467] [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: 11/01/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Purpose The study aims at investigating the impact of polymedication and aging in the prevalence of multiple drug-drug interactions (DDIs) on HCV patients treated with sofosbuvir/velpatasvir (SOF/VEL) or glecaprevir/pibrentasvir (GLE/PIB). Patients and Methods This is a retrospective analysis based on administrative data covering around 6.9 million individuals. Patients treated with SOF/VEL or GLE/PIB over November 2017-March 2020 were included. Index date corresponded to SOF/VEL or GLE/PIB first prescription during such period; patients were followed up for treatment duration. Analyses were then focused on patients with ≥2 comedications at risk of multiple DDIs. The severity and the effect of multiple DDI were identified using the Liverpool University tool. Results A total of 2057 patients with SOF/VEL and 2128 with GLE/PIB were selected. Mean age of SOF/VEL patients was 58.5 years, higher than GLE/PIB ones (52.5 years) (p < 0.001), and patients >50 years were more present in SOF/VEL vs GLE/PIB cohorts: 72% vs 58%, (p < 0.001). Most prescribed co-medications were cardiovascular, alimentary and nervous system drugs. Proportion of patients with ≥2 comedications was higher in SOF/VEL compared to GLE/PIB cohort (56.5% vs 32.3%, p < 0.001). Those at high-risk of multiple DDIs accounted for 11.6% (N = 135) of SOF/VEL and 19.6% (N = 135) of GLE/PIB (p < 0.001) patients with ≥2 comedications. Among them, the potential effect of DDI was a decrease of DAA serum levels (11% of SOF/VEL and GLE/PIB patients) and an increased concentration of comedication serum levels (14% of SOF/VEL and 42% of GLE/PIB patients). Conclusion This real-world analysis provided a thorough characterization on the burden of polymedication regimens in HCV patients treated with SOF/VEL or GLE/PIB that expose such patients to an increased risk of DDIs. In our sample population, SOF/VEL regimen was more frequently detected on elderly patients and on those with ≥2 comedications at risk of multi-DDI, ie, among patients characterized by higher rates of comorbidities and polypharmacy.
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Affiliation(s)
- Stefano Fagiuoli
- Department of Medicine and Surgery, University of Milan Bicocca & Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Azienda Ospedaliero Universitaria, Udine, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, University of Campania L. Vanvitelli, Naples, Italy
| | | | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda Ulss 8 Berica, Vicenza, Italy
| | | | - Fulvio Ferrante
- Dipartimento Diagnostica Ed Assistenza Farmaceutica – ASL Frosinone, Frosinone, Italy
| | | | - Stefano Palcic
- Farmaceutica Territoriale- Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
| | | | - Davide Re
- Servizio Farmaceutico Territoriale ASL Teramo, Teramo, Italy
| | | | | | | | - Valentina Perrone
- Clicon S.r.l., Health Economics and Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- Clicon S.r.l., Health Economics and Outcomes Research, Bologna, Italy,Correspondence: Luca Degli Esposti, CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 9, Bologna, 40137, Italy, Tel +390544 38393, Email
| | - Alessandra Mangia
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, 24127, Italy
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13
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Efe C, Kulkarni AV, Terziroli Beretta-Piccoli B, Magro B, Stättermayer A, Cengiz M, Clayton-Chubb D, Lammert C, Bernsmeier C, Gül Ö, la Tijera FHD, Anders M, Lytvyak E, Akın M, Purnak T, Liberal R, Peralta M, Ebik B, Duman S, Demir N, Balaban Y, Urzua Á, Contreras F, Venturelli MG, Bilgiç Y, Medina A, Girala M, Günşar F, Londoño MC, Androutsakos T, Kisch A, Yurci A, Güzelbulut F, Çağın YF, Avcı E, Akyıldız M, Dindar-Demiray EK, Harputluoğlu M, Kumar R, Satapathy SK, Mendizabal M, Silva M, Fagiuoli S, Roberts SK, Soylu NK, Idilman R, Yoshida EM, Montano-Loza AJ, Dalekos GN, Ridruejo E, Schiano TD, Wahlin S. Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome. Hepatology 2022; 76:1576-1586. [PMID: 35567545 PMCID: PMC9348326 DOI: 10.1002/hep.32572] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS A few case reports of autoimmune hepatitis-like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series. APPROACH AND RESULTS We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18-79) years at presentation. Liver injury was diagnosed a median 15 (range: 3-65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3-4 liver injury than for grade 1-2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up. CONCLUSIONS SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.
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Affiliation(s)
- Cumali Efe
- Department of GastroenterologyHarran University HospitalŞanlıurfaTurkey
| | - Anand V Kulkarni
- Department of Hepatology and Liver TransplantationAsian Institute of Gastroenterology HospitalsHyderabadIndia
| | | | - Bianca Magro
- Gastroenterology Hepatology and TransplantationASST Papa Giovanni XXIII-BergamoBergamoItaly
| | - Albert Stättermayer
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Mustafa Cengiz
- Department of GastroenterologyGülhane Training and Research HospitalAnkaraTurkey
| | | | - Craig Lammert
- Department of Medicine IndianaUniversity School of MedicineIndianapolisIndianaUSA
| | - Christine Bernsmeier
- Department of BiomedicineUniversity of BaselBaselSwitzerland.,University Centre for Gastrointestinal and Liver DiseasesBaselSwitzerland
| | - Özlem Gül
- Department of GastroenterologyKırıkkale UniversityKırıkkaleTurkey
| | | | - Margarita Anders
- Hepatology and Liver Transplant UnitHospital AlemánCiudad Autónoma de Buenos AiresArgentina
| | - Ellina Lytvyak
- Division of Gastroenterology and Liver UnitUniversity of AlbertaEdmontonAlbertaCanada
| | - Mete Akın
- Department of GastroenterologyAkdeniz University Faculty of MedicineAntalyaTurkey
| | - Tugrul Purnak
- Division of GastroenterologyHepatology and NutritionMcGovern Medical SchoolHoustonTexasUSA
| | - Rodrigo Liberal
- Gastroenterology and Hepatology DepartmentCentro Hospitalar e Universitário de São JoãoPortoPortugal.,World Gastroenterology Organization (WGO) Porto Training CenterPortoPortugal
| | - Mirta Peralta
- Hepatology SectionHospital Francisco J MuñizCiudad Autónoma de Buenos AiresArgentina.,Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina
| | - Berat Ebik
- Department of GastroenterologyGazi Yaşargil Education and Research HospitalDiyarbakirTurkey
| | - Serkan Duman
- Department of GastroenterologyAnkara University Medical FacultyAnkaraTurkey
| | - Nurhan Demir
- Department of GastroenterologyHaseki Training and Research HospitalIstanbulTurkey
| | - Yasemin Balaban
- Department of GastroenterologyFaculty of MedicineHacettepe UniversityAnkaraTurkey
| | - Álvaro Urzua
- Gastroenterology and Hepatology UnitHospital Clínico Universidad de ChileSantiago de ChileChile
| | | | | | - Yılmaz Bilgiç
- Department of GastroenterologyInönü University School of MedicineMalatyaTurkey
| | - Adriana Medina
- Gastroenterology and Hepatology UnitHospital de Clínicas, Universidad Nacional de AsunciónSan LorenzoParaguay
| | - Marcos Girala
- Gastroenterology and Hepatology UnitHospital de Clínicas, Universidad Nacional de AsunciónSan LorenzoParaguay
| | - Fulya Günşar
- Department of GastroenterologyEge University School of MedicineİzmirTurkey
| | | | - Theodoros Androutsakos
- Department of PathophysiologyNational and Kapodistrian University of AthensMedical SchoolAthensGreece
| | - Ayelen Kisch
- Hepatology SectionHospital Bonorino UdaondoCiudad Autónoma de Buenos AiresArgentina
| | - Alper Yurci
- Department of GastroenterologyErciyes University School of MedicineKayseriTurkey
| | - Fatih Güzelbulut
- Department of GastroenterologyHaydarpaşa Numune Education and Research HospitalİstanbulTurkey
| | - Yasir Furkan Çağın
- Department of GastroenterologyInönü University School of MedicineMalatyaTurkey
| | - Enver Avcı
- Department of GastroenterologyKTO Karatay University Medical School Affiliated Konya Medicana HospitalKonyaTurkey
| | - Murat Akyıldız
- Department of GastroenterologyKoc University School of MedicineIstanbulTurkey
| | | | - Murat Harputluoğlu
- Department of GastroenterologyInönü University School of MedicineMalatyaTurkey
| | - Rahul Kumar
- Department of Gastroenterology and HepatologyChangi General HospitalMedicine Academic Clinical ProgrammeSing Health Duke-NUS Academic Medical CentreSingapore
| | - Sanjaya K Satapathy
- Department of Internal MedicineDonald and Barbara Zucker School of MedicineNorthwell HealthManhassetNew YorkUSA
| | - Manuel Mendizabal
- Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina.,Hepatology and Liver Transplant UnitHospital Universitario AustralPilarArgentina
| | - Marcelo Silva
- Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina.,Hepatology and Liver Transplant UnitHospital Universitario AustralPilarArgentina
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and TransplantationASST Papa Giovanni XXIII-BergamoBergamoItaly
| | - Stuart K Roberts
- Department of GastroenterologyAlfred HealthMelbourneVictoriaAustralia.,Central Clinical SchoolDepartment of MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Neşe Karadağ Soylu
- Department of PathologyInönü University Faculty of MedicineMalatyaTurkey
| | - Ramazan Idilman
- Department of GastroenterologyAnkara University Medical FacultyAnkaraTurkey
| | - Eric M Yoshida
- Division of GastroenterologyUniversity of British Columbia and Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Liver UnitUniversity of AlbertaEdmontonAlbertaCanada
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal MedicineNational Expertise Center of Greece in Autoimmune Liver DiseasesGeneral University Hospital of LarissaLarissaGreece.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)General University Hospital of LarissaLarissaGreece
| | - Ezequiel Ridruejo
- Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina.,Hepatology and Liver Transplant UnitHospital Universitario AustralPilarArgentina.,Hepatology SectionDepartment of MedicineCentro de Educación Médica e Investigaciones Clínicas, CEMICCiudad Autónoma de Buenos AiresArgentina
| | - Thomas D Schiano
- Division of Liver Diseasesthe Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Staffan Wahlin
- Hepatology Division, Department of Upper GI DiseasesKarolinska Institutet and Karolinska University HospitalStockholmSweden
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14
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Giampreti A, Lucà M, Gallo M, Baldan A, Eleftheriou G, Schranz M, Contessa G, Faraoni L, Butera R, Fagiuoli S, Bacis G. Dexrazoxane for rapid extended livedo reticularis-like skin reaction due to systemic epirubicin diffusion during transcatheter arterial chemoembolization procedure for hepatocellular carcinoma. J Cancer Res Ther 2022; 18:S501-S506. [PMID: 36511016 DOI: 10.4103/jcrt.jcrt_574_20] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Skin reactions after transarterial chemoembolization (TACE) with anthracyclines are rare and mostly limited to small areas. We describe a 56-year-old male with hepatocellular carcinoma treated with epirubicin chemoembolization. Immediately the procedure, pain on the right side and an extended livedo reticularis-like skin reaction appeared. Since dexrazoxane, a topoisomerase-II catalytic-cycle inhibitor, has been shown to be effective in preventing or reducing skin necrosis and ulceration following anthracycline extravasation, the drug was administered 8 h after TACE and repeated in the following 2 days. Due to marked extrahepatic diffusion of epirubicin as evidenced by computed tomography imaging, the patient showed signs of systemic organ involvement. The critically ill patient required close follow-up and intensified treatment including blood supply and pulmonary drainage of a pleural effusion. The patient presented a significant clinical improvement of the skin lesions and resolution of organ involvement with normalization of laboratory parameters after dexrazoxane. In conclusion, adverse extended skin reactions and severe systemic effects related to anthracyclines diffusion could be properly treated with dexrazoxane infusion.
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Affiliation(s)
- Andrea Giampreti
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Lucà
- Department of Gastroenterology and Transplantation Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mariapina Gallo
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Anna Baldan
- Department of Gastroenterology and Transplantation Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Melanie Schranz
- Department of Gastroenterology and Transplantation Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gioia Contessa
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorella Faraoni
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Raffaella Butera
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Gastroenterology and Transplantation Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giuseppe Bacis
- Bergamo Poison Control Center, Papa Giovanni XXIII Hospital, Bergamo, Italy
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15
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Marra P, Dulcetta L, Carbone FS, Muglia R, Muscogiuri G, Cheli M, D’Antiga L, Colledan M, Fagiuoli S, Sironi S. The Role of Imaging in Portal Vein Thrombosis: From the Diagnosis to the Interventional Radiological Management. Diagnostics (Basel) 2022; 12:2628. [PMID: 36359472 PMCID: PMC9689990 DOI: 10.3390/diagnostics12112628] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 08/30/2023] Open
Abstract
PURPOSE To illustrate diagnostic and interventional imaging for the characterization and treatment of portal vein thrombosis (PVT). INTRODUCTION The broad spectrum of congenital and acquired PVT manifestations is illustrated, with a focus on the pediatric population; diagnostic and interventional imaging techniques are described. DESCRIPTION PVT frequently presents as an incidental finding at imaging in the screening for liver diseases or for other unrelated reasons. PVT can be classified based on: extension (intrahepatic, extrahepatic, involving the spleno-mesenteric tract, etc.); degree (partial or complete); onset (acute or chronic); and with or without cavernomatous transformation. This comprehensive review relies on the experience gained from a large series of congenital and acquired PVT in a referral center for pediatric and adult liver transplantation. Diagnostic and interventional imaging techniques are described, including: color-Doppler and contrast-enhanced Ultrasound; CT and MR angiography; retrograde portography; percutaneous transhepatic, transplenic, and transmesenteric portography; transjugular intrahepatic portosystemic shunt creation. Pre- and post-operative imaging assessment of the surgical meso-rex bypass is discussed. The description is enriched with an original series of pictorial imaging findings. CONCLUSION PVT is a clinical condition associated with significant morbidity and mortality. Diagnostic and interventional imaging plays a crucial role in both conservative and operative management.
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Affiliation(s)
- Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Maurizio Cheli
- Department of Pediatric Surgery, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Lorenzo D’Antiga
- Department of Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Michele Colledan
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Stefano Fagiuoli
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Gastroenterology, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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16
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Zacchetti L, Longhi L, Bianchi I, Di Matteo M, Russo F, Gandini L, Manesso L, Monti M, Cosentini R, Di Marco F, Fagiuoli S, Grazioli L, Gritti P, Previdi F, Senni M, Ranieri M, Lorini L. Characterization of compliance phenotypes in COVID-19 acute respiratory distress syndrome. BMC Pulm Med 2022; 22:296. [PMID: 35915487 PMCID: PMC9341412 DOI: 10.1186/s12890-022-02087-8] [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: 01/16/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) seems to differ from the "classic ARDS", showing initial significant hypoxemia in the face of relatively preserved compliance and evolving later in a scenario of poorly compliant lungs. We tested the hypothesis that in patients with COVID-19 ARDS, the initial value of static compliance of respiratory system (Crs) (1) depends on the previous duration of the disease (i.e., the fewer days of illness, the higher the Crs and vice versa) and (2) identifies different lung patterns of time evolution and response to prone positioning. METHODS This was a single-center prospective observational study. We enrolled consecutive mechanically ventilated patients with a diagnosis of COVID-19 who met ARDS criteria, admitted to intensive care unit (ICU). Patients were divided in four groups based on quartiles of initial Crs. Relationship between Crs and the previous duration of the disease was evaluated. Respiratory parameters collected once a day and during prone positioning were compared between groups. RESULTS We evaluated 110 mechanically ventilated patients with a diagnosis of COVID-19 who met ARDS criteria admitted to our ICUs. Patients were divided in groups based on quartiles of initial Crs. The median initial Crs was 41 (32-47) ml/cmH2O. No association was found between the previous duration of the disease and the initial Crs. The Crs did not change significantly over time within each quartile. Positive end-expiratory pressure (PEEP) and driving pressure were respectively lower and greater in patients with lower Crs. Prone positioning significantly improved PaO2/FiO2 in the 4 groups, however it increased the Crs significantly only in patients in lower quartile of Crs. CONCLUSIONS In our cohort, the initial Crs is not dependent on the previous duration of COVID-19 disease. Prone positioning improves oxygenation irrespective to initial Crs, but it ameliorates respiratory mechanics only in patients with lower Crs.
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Affiliation(s)
- Lucia Zacchetti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.
| | - Luca Longhi
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Isabella Bianchi
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Maria Di Matteo
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Filippo Russo
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Lucia Gandini
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Leonardo Manesso
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Martina Monti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.,Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Roberto Cosentini
- Emergency Medicine Department, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Milan, Italy.,Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.,Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Lorenzo Grazioli
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Paolo Gritti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Fabio Previdi
- Department of Bioengineering, University of Bergamo, Bergamo, Italy
| | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Ranieri
- Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Lorini
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.,Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
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17
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Marchetti M, Gomez-Rosas P, Russo L, Gamba S, Sanga E, Verzeroli C, Ambaglio C, Schieppati F, Restuccia F, Bonanomi E, Rizzi M, Fagiuoli S, D’Alessio A, Gerotziafas GT, Lorini L, Falanga A. Fibrinolytic Proteins and Factor XIII as Predictors of Thrombotic and Hemorrhagic Complications in Hospitalized COVID-19 Patients. Front Cardiovasc Med 2022; 9:896362. [PMID: 35757331 PMCID: PMC9226333 DOI: 10.3389/fcvm.2022.896362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction In a prospective cohort of hospitalized COVID-19 patients, an extensive characterization of hemostatic alterations by both global and specific assays was performed to clarify mechanisms underlying the coagulopathy and identify predictive factors for thrombotic and hemorrhagic events during hospitalization. Materials and Methods Intensive care unit (ICU; n = 46) and non-ICU (n = 55) patients were enrolled, and the occurrence of thrombotic and hemorrhagic events was prospectively monitored. At study inclusion, thromboelastometry together with the measurement of specific coagulation proteins and hypercoagulation markers was performed. Results Patients (median age 67 years) showed significantly shorter clot formation time together with greater maximum clot firmness by thromboelastometry, increased levels of F1 + 2 and D-dimer, as biomarkers of hypercoagulability, and of procoagulant factors V, VIII, IX, XI, and fibrinogen, while FXIII was significantly reduced. The concentration of fibrinolytic proteins, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) were elevated in the overall cohort of patients. Many of these hemostatic alterations were significantly greater in ICU compared to non-ICU subjects and, furthermore, they were associated with inflammatory biomarker elevation [i.e., interleukin 6 (IL-6), C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), and procalcitonin]. After enrollment, 7 thrombosis and 14 major bleedings occurred. Analysis of clinical and biological data identified increased t-PA, PAI-1, and NLR values as independent predictive factors for thrombosis, while lower FXIII levels were associated with bleeding. Conclusion This study demonstrates alterations in all different hemostatic compartments analyzed, particularly in severe COVID-19 conditions, that strongly correlated with the inflammatory status. A potential role of fibrinolytic proteins together with NLR and of FXIII as predictors of thrombotic and hemorrhagic complications, respectively, is highlighted.
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Affiliation(s)
- Marina Marchetti
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
- *Correspondence: Marina Marchetti,
| | - Patricia Gomez-Rosas
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
- Hematology Service, Hospital General Regional Tecamac Instituto Mexicano del Seguro Social (IMSS), Mexico, Mexico
| | - Laura Russo
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Gamba
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Eleonora Sanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Cristina Verzeroli
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Ambaglio
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Schieppati
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Restuccia
- Department of Anesthesiology and Critical Care Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Ezio Bonanomi
- Department of Anesthesiology and Critical Care Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Unit of Infectious Diseases, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Internal Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea D’Alessio
- Medical Oncology and Internal Medicine, Policlinico San Marco – Gruppo San Donato, Bergamo, Italy
| | - Grigorios T. Gerotziafas
- Sorbonne Université, INSERM UMR_S938, Research Group “Cancer-Hemostasis-Angiogenesis”, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Paris, France
| | - Luca Lorini
- Department of Anesthesiology and Critical Care Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
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18
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D’Ambrosio R, Rizzardini G, Puoti M, Fagiuoli S, Anolli MP, Gabiati C, D’Amico F, Pasulo L, Restelli U, Colombo M, Lampertico P. Implementation of HCV screening in the 1969-1989 birth-cohort undergoing COVID-19 vaccination. Liver Int 2022; 42:1012-1016. [PMID: 35220667 PMCID: PMC9115160 DOI: 10.1111/liv.15216] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/09/2021] [Accepted: 01/26/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM The World Health Organization (WHO) goal of hepatitis C virus (HCV) elimination by 2030 relies on the scaling-up of both identification and linkage to care of the infected population, worldwide. In Italy, the estimated burden of HCV carriers who are unaware of their infection amounts to 200 000 persons, a projection that reinforces the need for broadening population access to effective screening programmes. METHODS A pivotal screening programme targeting subjects born between 1969 and 1989 has been conducted in Lombardy, Northern Italy, where point-of-care (POC) testing was offered for free concomitantly to COVID-19 vaccination. RESULTS Amongst 7219 subjects born between 1969 and 1989 who underwent HCV screening through POC, 7 (0.10%) subjects tested anti-HCV positive: 5 (0.07%) had confirmed anti-HCV positivity (Table 1) and 4 of them (0.05%) were HCV-RNA positive by standard confirmation tests. CONCLUSIONS This pivotal study demonstrated the feasibility of a POC-based anti-HCV screening programme in young adults undergoing COVID-19 vaccination. The prevalence of HCV infection in subjects born in the 1969-1989 cohort in Italy seems to be lower than previously estimated. Whether the extension of this programme to subjects born before 1969 could lead to improved screening effectiveness should be a matter of debate.
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Affiliation(s)
- Roberta D’Ambrosio
- Division of Gastroenterology and HepatologyFoundation IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Giuliano Rizzardini
- ASST Fatebenefratelli‐Sacco, First Division of Infectious DiseasesMilanItaly
| | - Massimo Puoti
- ASST Grande Ospedale Metropolitano Niguarda, Division of Infectious DiseasesMilanItaly
| | - Stefano Fagiuoli
- AAST Papa Giovanni XXIII, Gastroenterology, Hepatology and TransplantationBergamoItaly
| | - Maria Paola Anolli
- Division of Gastroenterology and HepatologyFoundation IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Claudia Gabiati
- ASST Fatebenefratelli‐Sacco, Division of Internal MedicineMilanItaly
| | - Federico D’Amico
- ASST Grande Ospedale Metropolitano Niguarda, Division of Infectious DiseasesMilanItaly
| | - Luisa Pasulo
- AAST Papa Giovanni XXIII, Gastroenterology, Hepatology and TransplantationBergamoItaly
| | - Umberto Restelli
- LIUC Cattaneo UniversityCastellanza (VA)Italy
- Faculty of Health SciencesSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Pietro Lampertico
- Division of Gastroenterology and HepatologyFoundation IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- CRC “A. M. and A. Migliavacca” Center for Liver Diseases, Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
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19
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Sciarrone SS, Ferrarese A, Bizzaro D, Volpato S, Donato FM, Invernizzi F, Trespidi L, Ramezzana IG, Avolio AW, Nure E, Pascale MM, Fagiuoli S, Pasulo L, Merli M, Lapenna L, Toniutto P, Lenci I, Di Donato R, De Maria N, Villa E, Galeota Lanza A, Marenco S, Bhoori S, Mameli L, Cillo U, Boccagni P, Russo FP, Bo P, Cosmi E, Burra P. Safe pregnancy after liver transplantation: Evidence from a multicenter Italian collaborative study. Dig Liver Dis 2022; 54:669-675. [PMID: 34497039 DOI: 10.1016/j.dld.2021.08.013] [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: 06/22/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women who have undergone liver transplantation (LT) enjoy better health, and possibility of childbearing. However, maternal and graft risks, optimal immunosuppression, and fetal outcome is still to clarify. AIM Aim of the study was to assess outcomes of pregnancy after LT at national level. METHODS In 2019, under the auspices of the Permanent Transplant Committee of the Italian Association for the Study of the Liver, a multicenter survey including 14 Italian LT-centers was conducted aiming at evaluating the outcomes of recipients and newborns, and graft injury/function parameters during pregnancy in LT-recipients. RESULTS Sixty-two pregnancies occurred in 60 LT-recipients between 1990 and 2018. Median age at the time of pregnancy was 31-years and median time from transplantation to conception was 8-years. During pregnancy, 4 recipients experienced maternal complications with hospital admission. Live-birth-rate was 100%. Prematurity occurred in 25/62 newborns, and 8/62 newborns had low-birth-weight. Cyclosporine was used in 16 and Tacrolimus in 37 pregnancies, with no different maternal or newborn outcomes. Low-birth-weight was correlated to high values of AST, ALT and GGT. CONCLUSION Pregnancy after LT has good outcome; however, maternal complications and prematurity may occur. Compliance with the immunosuppression is fundamental to ensure the stability of graft function and prevent graft-deterioration.
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Affiliation(s)
- Salvatore Stefano Sciarrone
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Debora Bizzaro
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Sofia Volpato
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, University of Padua, Via Giustianini 3, Padua 35128, Italy
| | - Francesca Maria Donato
- Division of Gastroenterology, Maggiore Hospital and IRCCS Foundation, Via Francesco Sforza 35, Milan 20122, Italy
| | - Federica Invernizzi
- Division of Gastroenterology, Maggiore Hospital and IRCCS Foundation, Via Francesco Sforza 35, Milan 20122, Italy
| | - Laura Trespidi
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, Fondazione Ospedale Maggiore, Via Francesco Sforza 35, Milan 20122, Italy
| | - Ilaria Giuditta Ramezzana
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, Fondazione Ospedale Maggiore, Via Francesco Sforza 35, Milan 20122, Italy
| | - Alfonso Wolfango Avolio
- Liver Unit, Department of Surgery, Agostino Gemelli Hospital, Catholic University, Largo Agostino Gemelli 8, Rome 00168, Italy
| | - Erida Nure
- Liver Unit, Department of Surgery, Agostino Gemelli Hospital, Catholic University, Largo Agostino Gemelli 8, Rome 00168, Italy
| | - Marco Maria Pascale
- Liver Unit, Department of Surgery, Agostino Gemelli Hospital, Catholic University, Largo Agostino Gemelli 8, Rome 00168, Italy
| | - Stefano Fagiuoli
- Gastroenterology, Hepatology and Liver Transplantation Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Luisa Pasulo
- Gastroenterology, Hepatology and Liver Transplantation Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Manuela Merli
- Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Via di Grottarossa 1015, Rome 00189, Italy
| | - Lucia Lapenna
- Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Via di Grottarossa 1015, Rome 00189, Italy
| | - Pierluigi Toniutto
- Internal Medicine, Department of Medical Area, University of Udine, via Palladio 8, Udine 33100, Italy
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, Department of Medicine, Policlinico Tor Vergata, Viale Oxford 81, Rome 00133, Italy
| | - Roberto Di Donato
- Department of Digestive Disease and Internal Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico S.Orsola-Malpighi, Via Giuseppe Massarenti 11, Bologna 40138, Italy
| | - Nicola De Maria
- Department of Internal Medicine, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Largo del Pozzo 71, Modena 41124, Italy
| | - Erica Villa
- Department of Internal Medicine, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Largo del Pozzo 71, Modena 41124, Italy
| | | | - Simona Marenco
- Department of Internal Medicine, Gastroenterolgy Unit, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genova 16132, Italy
| | - Sherrie Bhoori
- Department of Surgery and Oncology, Istituto Nazionale Tumori IRCCS, Via Giacomo Venezian, 1, Milan 20133, Italy
| | - Laura Mameli
- Liver and Pancreas Transplant Center, Azienda Ospedaliera Brotzu Piazzale Ricchi 1, Cagliari 09134, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, Padua 35128, Italy
| | - Patrizia Boccagni
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, Padua 35128, Italy
| | - Francesco Paolo Russo
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Patrizio Bo
- Gynaecology and Obstetrics Unit, Cittadella Hospital, Via Riva dell'Ospedale, Cittadella 35013, Italy
| | - Erich Cosmi
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, University of Padua, Via Giustianini 3, Padua 35128, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy.
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20
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Pinelli D, Neri F, Tornese S, Amaduzzi A, Camagni S, D'Antiga L, Fagiuoli S, Colledan M. Physiological reno-portal bypass in liver transplantation with non-tumorous portal vein thrombosis. Updates Surg 2022; 74:1617-1626. [PMID: 35441945 DOI: 10.1007/s13304-022-01280-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/11/2022] [Indexed: 11/25/2022]
Abstract
Reno-portal anastomosis (RPA) in presence of spleno-renal shunts (SRS) is a physiological option to restore blood flow in liver transplantation with portal vein thrombosis (PVT). Diffuse splanchnic venous system thrombosis (complex PVT) is its main indication but RPA proved to be useful in selected cases of less extensive thrombosis (non-complex PVT). Up until now only two monocentric and one multicentric case series has been published on this topic in addition to few anecdotal reports. After 2014, we introduced RPA in our institution to manage some cases of complex PVT in presence of SRS. Here, we present the evolution of indication to RPA. From 2014 to 2020, we performed ten RPA: nine patients presented non-complex and one complex PVT. Overall early and late complication rates were 66.6% and 50%, respectively. Two patients developed RPA stenosis, treated by interventional radiology. Self-resolving acute kidney injury (AKI) was observed in three cases. No re-transplantation was necessary. RPA was patent in all patients, with a mean follow-up of 41.9 months. The overall patient survival was 70% at 1 year and 60% at 3 and 5 years. Four patients died at 1, 2, 3 and 20 months from LT. Causes of deaths were, respectively, stroke, cerebral infection, sepsis (MOF) and sudden variceal bleeding in sinusoidal obstruction syndrome. The relative simplicity and effectiveness of RPA in presence of SRS allowed us to rely more and more often on this technique in liver transplantation with challenging non-complex PVT.
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Affiliation(s)
- Domenico Pinelli
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy.
| | - Flavia Neri
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Stefania Tornese
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Annalisa Amaduzzi
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Stefania Camagni
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Lorenzo D'Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Michele Colledan
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
- Università di Milano - Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milano, MI, Italy
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21
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Gori M, Berzuini C, D’Elia E, Ghirardi A, Bernardinelli L, Gavazzi A, Balestrieri G, Giammarresi A, Trevisan R, Di Marco F, Bellasi A, Amoroso M, Raimondi F, Novelli L, Magro B, Mangia G, Lorini FL, Guagliumi G, Fagiuoli S, Parati G, Senni M. Antecedent use of renin-angiotensin system inhibitors is associated with reduced mortality in elderly hypertensive Covid-19 patients. J Hypertens 2022; 40:666-674. [PMID: 34889863 PMCID: PMC9904437 DOI: 10.1097/hjh.0000000000003059] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The effect of renin-angiotensin system inhibitors (RASIs) on mortality in patients with coronavirus disease (Covid-19) is debated. From a cohort of 1352 consecutive patients admitted with Covid-19 to Papa Giovanni XXIII Hospital in Bergamo, Italy, between February and April 2020, we selected and studied hypertensive patients to assess whether antecedent (prior to hospitalization) use of RASIs might affect mortality from Covid-19 according to age. METHODS AND RESULTS Arterial hypertension was present in 688 patients. Overall mortality (in-hospital or shortly after discharge) was 35% (N = 240). After adjusting for 26 medical history variables via propensity score matching, antecedent use of RASIs (N = 459, 67%) was associated with a lower mortality in older hypertensive patients (age above the median of 68 years in the whole series), whereas no evidence of a significant effect was found in the younger group of the same population (P interaction = 0.001). In an analysis of the subgroup of 432 hypertensive patients older than 68 years, we considered two RASI drug subclasses, angiotensin-converting enzyme inhibitors (ACEIs, N = 156) and angiotensin receptor blockers (ARBs, N = 140), and assessed their respective effects by taking no-antecedent-use of RASIs as reference. This analysis showed that both antecedent use of ACEIs and antecedent use of ARBs were associated with a lower Covid-19 mortality (odds ratioACEI = 0.57, 95% confidence interval 0.36--0.91, P = 0.018) (odds ratioARB = 0.49, 95% confidence interval 0.29--0.82, P = 0.006). CONCLUSION In the population of over-68 hypertensive Covid-19 patients, antecedent use of ACEIs or ARBs was associated with a lower all-cause mortality, whether in-hospital or shortly after discharge, compared with no-antecedent-use of RASIs.
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Affiliation(s)
- Mauro Gori
- Cardiovascular Department, Bergamo, Italy
| | - Carlo Berzuini
- ASST Papa Giovanni XXIII, Bergamo, Italy
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, UK
| | | | | | - Luisa Bernardinelli
- The Department of Brain and Behavioural Sciences, The University of Pavia, Pavia, Italy
| | | | | | | | | | - Fabiano Di Marco
- The Unit of Pulmonary Medicine, Bergamo, Italy
- University of Milan
| | - Antonio Bellasi
- The Department of Research, Innovation, Brand Reputation, Bergamo, Italy
| | | | | | | | - Bianca Magro
- The Gastroenterology Hepatology and Transplantation Unit, Bergamo, Italy
| | - Gianpaolo Mangia
- The Gastroenterology Hepatology and Transplantation Unit, Bergamo, Italy
| | | | | | - Stefano Fagiuoli
- The Gastroenterology Hepatology and Transplantation Unit, Bergamo, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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22
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Rigamonti C, Coco B, Brunetto M, Labanca S, Giannini E, Magro B, Fagiuoli S, Baroni GS, Sgamato C, Miele L, Grieco A, Giuli L, Manfredi G, Pirisi M. Clinical features of patients with new onset of autoimmune hepatitis following SARS-CoV-2 vaccination. Dig Liver Dis 2022. [PMCID: PMC8935163 DOI: 10.1016/j.dld.2022.01.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- C. Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale and Division of Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - B. Coco
- Hepatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - M. Brunetto
- Hepatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - S. Labanca
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - E.G. Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - B. Magro
- Gastroenterology, Hepatology and Liver Transplantation, Department of Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - S. Fagiuoli
- Gastroenterology, Hepatology and Liver Transplantation, Department of Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - G. Svegliati Baroni
- SOSD Danno Epatico e Trapianti, Università Politecnica delle Marche, Ancona, Italy
| | - C. Sgamato
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples ``Federico II'', Naples, Italy
| | - L. Miele
- Unità di Medicina Interna e del Trapianto di Fegato, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma, Italy
| | - A. Grieco
- Unità di Medicina Interna e del Trapianto di Fegato, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma, Italy
| | - L. Giuli
- Unità di Medicina Interna e del Trapianto di Fegato, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma, Italy
| | - G.F. Manfredi
- Department of Translational Medicine, Università del Piemonte Orientale and Division of Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - M. Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale and Division of Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
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23
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Efe C, Lammert C, Taşçılar K, Dhanasekaran R, Ebik B, Higuera-de la Tijera F, Calışkan AR, Peralta M, Gerussi A, Massoumi H, Catana AM, Purnak T, Rigamonti C, Aldana AJG, Khakoo N, Nazal L, Frager S, Demir N, Irak K, Melekoğlu-Ellik Z, Kacmaz H, Balaban Y, Atay K, Eren F, Alvares-da-Silva MR, Cristoferi L, Urzua Á, Eşkazan T, Magro B, Snijders R, Barutçu S, Lytvyak E, Zazueta GM, Demirezer-Bolat A, Aydın M, Heurgue-Berlot A, De Martin E, Ekin N, Yıldırım S, Yavuz A, Bıyık M, Narro GC, Kıyıcı M, Akyıldız M, Kahramanoğlu-Aksoy E, Vincent M, Carr RM, Günşar F, Reyes EC, Harputluoğlu M, Aloman C, Gatselis NK, Üstündağ Y, Brahm J, Vargas NCE, Güzelbulut F, Garcia SR, Aguirre J, Anders M, Ratusnu N, Hatemi I, Mendizabal M, Floreani A, Fagiuoli S, Silva M, Idilman R, Satapathy SK, Silveira M, Drenth JPH, Dalekos GN, N Assis D, Björnsson E, Boyer JL, Yoshida EM, Invernizzi P, Levy C, Montano-Loza AJ, Schiano TD, Ridruejo E, Wahlin S. Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis. Liver Int 2022; 42:607-614. [PMID: 34846800 DOI: 10.1111/liv.15121] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 09/02/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). PATIENTS AND METHODS Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. RESULTS We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. CONCLUSION Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.
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Affiliation(s)
- Cumali Efe
- Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Turkey
| | - Craig Lammert
- Department of Medicine Indiana, University School of Medicine Indianapolis, Indianapolis, Indiana, USA
| | - Koray Taşçılar
- Department of Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Renumathy Dhanasekaran
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Berat Ebik
- Department of Gastroenterology, Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey
| | | | - Ali R Calışkan
- Department of Gastroenterology, Adıyaman University, Adıyaman, Turkey
| | - Mirta Peralta
- Hepatology Section, Hospital Francisco J Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Alessio Gerussi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Hatef Massoumi
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Andreea M Catana
- Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tugrul Purnak
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, Houston, Texas, USA
| | - Cristina Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Division of Internal Medicine, "AOU Maggiore della Carità", Novara, Italy
| | - Andres J G Aldana
- Gastroenterology and Hepatology Unit, Fundación Santa Fe de Bogotá y universidad de Los Andes, Bogotá, Colombia
| | - Nidah Khakoo
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Leyla Nazal
- Gastroenterology and Hepatology Unit, Clínica Las Condes, Santiago de Chile, Chile
| | - Shalom Frager
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Nurhan Demir
- Department of Gastroenterology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Kader Irak
- Department of Gastroenterology, SBU Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | | | - Hüseyin Kacmaz
- Department of Gastroenterology, Adıyaman University, Adıyaman, Turkey
| | - Yasemin Balaban
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kadri Atay
- Departmant of Gastroenterology, Mardin State Hospital, Mardin, Turkey
| | - Fatih Eren
- Departmant of Gastroenterology, Ordu State Hospital, Ordu, Turkey
| | - Mario R Alvares-da-Silva
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Cristoferi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Álvaro Urzua
- Gastroenterology and Hepatology Unit. Hospital Clínico, Universidad de Chile, Santiago de Chile, Chile
| | - Tuğçe Eşkazan
- Department of Gastroenterology, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Bianca Magro
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII-Bergamo, Bergamo, Italy
| | - Romee Snijders
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Nijmegen, The Netherlands
| | - Sezgin Barutçu
- Department of Gastroenterology, University of Gaziantep Medical Faculty, Gaziantep, Turkey
| | - Ellina Lytvyak
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Godolfino M Zazueta
- Gastroenterology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | | | - Mesut Aydın
- School of Medicine, Department of Gastroenterology, Van Yuzuncu Yil University, Van, Turkey
| | | | - Eleonora De Martin
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, FHU Hepatinov, INSERM Unit UMR 1193, Univ Paris-Saclay, Gif-sur-Yvette, France
| | - Nazım Ekin
- Department of Gastroenterology, Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Sümeyra Yıldırım
- Department of Gastroenterology, Erciyes Hospital, Kayseri, Turkey
| | - Ahmet Yavuz
- Division of Gastroenterology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Murat Bıyık
- Division of Gastroenterology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Graciela C Narro
- Gastroenterology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | - Murat Kıyıcı
- Department of Gastroenterology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Murat Akyıldız
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey
| | | | - Maria Vincent
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine, Northwell Health, Manhasset, NY, USA
| | - Rotonya M Carr
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fulya Günşar
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Eira C Reyes
- Hepatology Unit. Hospital Militar Central de México, Ciudad de México, México
| | - Murat Harputluoğlu
- Department of Gastroenterology, Inönü University School of Medicine, Malatya, Turkey
| | - Costica Aloman
- Section of Hepatology, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Yücel Üstündağ
- Department of Gastroenterology, Bulent Ecevit University of Medicine, Zonguldak, Turkey
| | - Javier Brahm
- Gastroenterology Unit, Clínica Las Condes, Santiago, Chile
| | - Nataly C E Vargas
- Hepatology Unit Hospital Nacional Almanzor Aguinaga Asenjo, Chiclayo, Perú
| | - Fatih Güzelbulut
- Department of Gastroenterology, Haydarpaşa Numune Education and Research Hospital, İstanbul, Turkey
| | - Sandro R Garcia
- Gastroenterology Unit, Hospital Víctor Lazarte Echegaray, Trujillo, Perú
| | - Jonathan Aguirre
- Hepatology Unit, Hospital Ángeles Pedregal, Ciudad de México, México
| | - Margarita Anders
- Hepatology and Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Natalia Ratusnu
- Hepatology Unit, Hospital Regional de Ushuaia, Ushuaia, Argentina
| | - Ibrahim Hatemi
- Department of Gastroenterology, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Manuel Mendizabal
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Annarosa Floreani
- Scientific Consultant IRCCS Negrar, Verona, Italy.,Senior Scholar, University of Padova, Padova, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII-Bergamo, Bergamo, Italy
| | - Marcelo Silva
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Sanjaya K Satapathy
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine, Northwell Health, Manhasset, NY, USA
| | - Marina Silveira
- Department of Medicine, Section of Digestive Diseases Yale School of Medicine, New Haven, Connecticut, USA
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Nijmegen, The Netherlands
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - David N Assis
- Department of Medicine, Section of Digestive Diseases Yale School of Medicine, New Haven, Connecticut, USA
| | - Einar Björnsson
- Department of Internal Medicine, Section of Gastroenterology, Landspitali University Hospital, Reykjavik, Iceland
| | - James L Boyer
- Department of Medicine, Section of Digestive Diseases Yale School of Medicine, New Haven, Connecticut, USA
| | - Eric M Yoshida
- Division of Gastroenterology, University of British Columbia and Vancouver General Hospital, Vancouver, Canada
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Cynthia Levy
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas D Schiano
- Division of Liver Diseases, The Mount Sinai Medical Center, New York, New York, USA
| | - Ezequiel Ridruejo
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina.,Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas, CEMIC, Ciudad Autónoma de Buenos Aires, Argentina
| | - Staffan Wahlin
- Hepatology Division, Department of Upper GI Diseases, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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24
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Novelli L, Raimondi F, Ghirardi A, Galimberti C, Biza R, Trapasso R, Anelli M, Amoroso M, Allegri C, Imeri G, Conti C, Tarantini F, Beretta M, Gori M, D'Elia E, Senni M, Solidoro P, Lorini FL, Rizzi M, Tebaldi A, Barbui T, Taurino D, Cosentini R, Masciulli A, Gavazzi A, Sironi S, Fagiuoli S, DI Marco F. Frequency, characteristics, and outcome of patients with COVID-19 pneumonia and "silent hypoxemia" at admission: a severity-matched analysis. Panminerva Med 2022; 64:442-451. [PMID: 35191633 DOI: 10.23736/s0031-0808.22.04609-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND An aspect of COVID-19 baffling physicians is the presentation of patients with acute respiratory failure, but normal mental faculties and no perception of dyspnea (i.e. "silent hypoxemia"). The aim of this study was to investigate the frequency, characteristics, and outcome of COVID-19 patients with silent hypoxemic status and comparing them with a symptomatic severity-matched group. METHODS This is a retrospective monocentric observational study involving all patients with PCR confirmed SARS-CoV-2 pneumonia, admitted at Papa Giovanni XXIII Hospital, Bergamo (Italy) from Emergency Department due to acute respiratory failure, during the first Italian pandemic peak (February-April 2020). RESULTS Overall 28-day mortality in 1,316 patients was 26.9%. Patients who did not report dyspnea at admission (N 469, 35.6%) had a lower 28-day mortality (22.6 vs. 29.3%, p=0.009). The severity matching analysis (i.e. PaO2/FiO2 and imaging) led to the identification of two groups of 254 patients that did not differ for sex prevalence, age, BMI, smoking history, comorbidities, and PaCO2 at admission. The use of CPAP during the first 24 hours, such as the need of endotracheal intubation (ETI) during the overall admission were significantly lower in matched patients with silent hypoxemia, whereas 28-day mortality resulted similar (p=0.21). CONCLUSIONS Lack of dyspnea is common in patients suffering from severe COVID-19 pneumonia leading to respiratory failure, since up to a third of them could be asymptomatic on admission. Dyspnea per se correlates with pneumonia severity, and prognosis. However, dyspnea loses its predictive relevance once other findings to evaluate pneumonia severity are available such as PaO2/FiO2 and imaging. Silent hypoxemic patients are less likely to receive CPAP during the first 24 hours and ETI during the hospitalization, in spite of a comparable mortality to the dyspneic ones.
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Affiliation(s)
- Luca Novelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Raimondi
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy - .,Department of Health Sciences, University of Milan, Milan, Italy
| | - Arianna Ghirardi
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | | | - Roberta Biza
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Trapasso
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Marisa Anelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Mariangela Amoroso
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Chiara Allegri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianluca Imeri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Caterina Conti
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Marta Beretta
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Gori
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Emilia D'Elia
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Solidoro
- Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ferdinando L Lorini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Intensive Critical Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Tiziano Barbui
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | | | | | - Arianna Masciulli
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Antonello Gavazzi
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Sandro Sironi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Gastroenterlogy 1, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano DI Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
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Costentin C, Piñero F, Degroote H, Notarpaolo A, Boin IF, Boudjema K, Baccaro C, Podestá LG, Bachellier P, Ettorre GM, Poniachik J, Muscari F, Dibenedetto F, Hoyos Duque S, Salame E, Cillo U, Marciano S, Vanlemmens C, Fagiuoli S, Burra P, Van Vlierberghe H, Cherqui D, Lai Q, Silva M, Rubinstein F, Duvoux C, Boudjema K, Bachellier P, Conti F, Scatton O, Muscari F, Salame E, Bernard PH, Francoz C, Durand F, Dharancy S, Woehl ML, Vanlemmens C, Laurent A, Radenne S, Dumortier J, Abergel A, Cherqui D, Barbier L, Houssel-Debry P, Pageaux GP, Chiche L, Deledinghen V, Hardwigsen J, Gugenheim J, altieri M, Hilleret MN, Decaens T, Duvoux C, Piñero F, Chagas A, Costa P, Cristina de Ataide E, Quiñones E, Duque SH, Marciano S, Anders M, Varón A, Zerega A, Poniachik J, Soza A, Machaca MP, Arufe D, Menéndez J, Zapata R, Vilatoba M, Muñoz L, Menéndez RC, Maraschio M, Podestá LG, McCormack L, Mattera J, Gadano A, Fatima Boin ISF, Parente García JH, Carrilho F, Silva M, Notarpaolo A, Magini G, Miglioresi L, Gambato M, Benedetto FD, D’Ambrosio C, Ettorre GM, Vitale A, Burra P, Fagiuoli S, Cillo U, Colledan M, Pinelli D, Magistri P, Vennarecci G, Colasanti M, Giannelli V, Pellicelli A, Baccaro C, Lai Q, Degroote H, Vlierberghe HV, Eduard C, Samuele I, Jeroen D, Jonas S, Jacques P, Chris V, Dirk Y, Peter M, Valerio L, Christophe M, Olivier D, Jean D, Roberto T, Paul LJ. R3-AFP score is a new composite tool to refine prediction of hepatocellular carcinoma recurrence after liver transplantation. JHEP Rep 2022; 4:100445. [PMID: 35360522 PMCID: PMC8961219 DOI: 10.1016/j.jhepr.2022.100445] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/13/2022] Open
Abstract
Background & Aims Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging ± alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are frequent. Our aim was to design an explant-based recurrence risk reassessment score to refine prediction of recurrence after LT and provide a framework to guide post-LT management. Methods Adult patients who underwent transplantation between 2000 and 2018 for HCC in 47 centres were included. A prediction model for recurrence was developed using competing-risk regression analysis in a European training cohort (TC; n = 1,359) and tested in a Latin American validation cohort (VC; n=1,085). Results In the TC, 76.4% of patients with HCC met the Milan criteria, and 89.9% had an AFP score of ≤2 points. The recurrence risk reassessment (R3)-AFP model was designed based on variables independently associated with recurrence in the TC (with associated weights): ≥4 nodules (sub-distribution of hazard ratio [SHR] = 1.88, 1 point), size of largest nodule (3–6 cm: SHR = 1.83, 1 point; >6 cm: SHR = 5.82, 5 points), presence of microvascular invasion (MVI; SHR = 2.69, 2 points), nuclear grade >II (SHR = 1.20, 1 point), and last pre-LT AFP value (101–1,000 ng/ml: SHR = 1.57, 1 point; >1,000 ng/ml: SHR = 2.83, 2 points). Wolber’s c-index was 0.76 (95% CI 0.72–0.80), significantly superior to an R3 model without AFP (0.75; 95% CI 0.72–0.79; p = 0.01). Four 5-year recurrence risk categories were identified: very low (score = 0; 5.5%), low (1–2 points; 15.1%), high (3–6 points; 39.1%), and very high (>6 points; 73.9%). The R3-AFP score performed well in the VC (Wolber’s c-index of 0.78; 95% CI 0.73–0.83). Conclusions The R3 score including the last pre-LT AFP value (R3-AFP score) provides a user-friendly, standardised framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials for HCC not limited to the Milan criteria. Clinical Trials Registration NCT03775863. Lay summary Considering discrepancies between pre-LT tumour assessment and explant are frequent, reassessing the risk of recurrence after LT is critical to further refine the management of patients with HCC. In a large and international cohort of patients who underwent transplantation for HCC, we designed and validated the R3-AFP model based on variables independently associated with recurrence post-LT (number of nodules, size of largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value). The R3-AFP model including last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a robust framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials, irrespective of criteria used to select patients with HCC for LT. Discrepancies between pretransplant tumour assessment and liver explant are frequent. The R3-AFP predictive model of recurrence was designed and validated in a large and international cohort of patients transplanted for HCC. The components of the final model are the following: number of nodules, size of the largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value. The R3-AFP model including the last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a standardised framework to refine post-LT management of patients, irrespective of criteria used to select patients with HCC for LT.
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Andreoni M, Coppola N, Craxì A, Fagiuoli S, Gardini I, Mangia A, Nava FA, Pasqualetti P. Meet-Test-Treat for HCV management: patients' and clinicians' preferences in hospital and drug addiction services in Italy. BMC Infect Dis 2022; 22:3. [PMID: 34983405 PMCID: PMC8725306 DOI: 10.1186/s12879-021-06983-y] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/09/2021] [Indexed: 02/08/2023] Open
Abstract
Background It has been estimated that the incidence of chronic hepatitis C virus (HCV) will not decline over the next 10 years despite the improved efficacy of antiviral therapy because most patients remain undiagnosed and/or untreated. This study aimed to investigate the opinion of relevant target populations on the practicability, effectiveness and best modalities of the test-and-treat approach in the fight against HCV in Italy. Methods A survey was delivered to patients with HCV from the general population, patients from drug addiction services, hospital physicians and healthcare providers for drug addiction services. Results For both hospital clinicians and SerD HCPs, tolerability is shown as the most important feature of a suitable treatment. Time to treatment (the time from first contact to initiation of treatment) is deemed important to the success of the strategy by all actors. While a tolerable treatment was the main characteristic in a preferred care pathway for general patients, subjects from drug addiction services indicated that a complete Meet–Test–Treat pathway is delivered within the habitual care center as a main preference. This is also important for SerD HCPs who are a strong reference for their patients; hospital clinicians were less aware of the importance of the patient-HCP relationship in this process. Conclusion The health system is bound to implement suitable pathways to facilitate HCV eradication. A Meet–Test–Treat program within the drug addiction services may provide good compliance from subjects mainly concerned with virus transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06983-y.
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Affiliation(s)
- Massimo Andreoni
- Infectious Diseases, Polyclinic of Rome Tor Vergata, Rome, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Craxì
- Department of Gastroenterology, University of Palermo, Palermo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ivan Gardini
- EpaC Onlus, Italian Liver Patient Association, Monza (MB), Italy
| | - Alessandra Mangia
- Liver Unit, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Felice Alfonso Nava
- Penitentiary Medicine and Drug Abuse Unit, Public Health Service, Padua, Italy
| | - Patrizio Pasqualetti
- Section of Medical Statistics, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
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Magro B, Pinelli D, De Giorgio M, Lucà MG, Ghirardi A, Carrobio A, Baronio G, Del Prete L, Nounamo F, Gianatti A, Colledan M, Fagiuoli S. Pre-Transplant Alpha-Fetoprotein > 25.5 and Its Dynamic on Waitlist Are Predictors of HCC Recurrence after Liver Transplantation for Patients Meeting Milan Criteria. Cancers (Basel) 2021; 13:5976. [PMID: 34885087 PMCID: PMC8656660 DOI: 10.3390/cancers13235976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/30/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND AIM Hepatocellular carcinoma (HCC) recurrence rates after liver transplantation (LT) range between 8 and 20%. Alpha-fetoprotein (AFP) levels at transplant can predict HCC recurrence, however a defined cut-off value is needed to better stratify patients. The aim of this study was to evaluate the rate of HCC recurrence at our centre and to identify predictors, focusing on AFP. METHODS We retrospectively analysed 236 consecutive patients that were waitlisted for HCC who all met the Milan criteria from January 2001 to December 2017 at our liver transplant centre. A total of twenty-nine patients dropped out while they were waitlisted, and 207 patients were included in the final analysis. All survival analyses included the competing-risk model. RESULTS The mean age was 56.8 ± 6.8 years. A total of 14% were female (n = 29/207). The median MELD (model for end-stage liver disease) at LT was 12 (9-16). The median time on the waitlist was 92 (41-170) days. The HCC recurrence rate was 16.4% (n = 34/208). The mean time to recurrence was 3.3 ± 2.8 years. The median AFP levels at transplant were higher in patients with HCC recurrence (p < 0.001). At multivariate analysis, the AFP value at transplant that was greater than 25.5 ng/mL (AUC 0.69) was a strong predictor of HCC recurrence after LT [sHR 3.3 (1.6-6.81); p = 0.001]. The HCC cumulative incidence function (CIF) of recurrence at 10 years from LT was significantly higher in patients with AFP > 25.5 ng/mL [34.3% vs. 11.5% (p = 0.001)]. Moreover, an increase in AFP > 20.8%, was significantly associated with HCC recurrence (p = 0.034). CONCLUSIONS In conclusion, in our retrospective study, the AFP level at transplant > 25.5 ng/mL and its increase greater than 20.8% on the waitlist were strong predictors of HCC recurrence after LT in a cohort of patients that were waitlisted within the Milan criteria. However further studies are needed to validate these data.
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Affiliation(s)
- Bianca Magro
- Gastroenterology, Hepatology and Liver Transplantation, Department of Medicine-Papa Giovanni, XXIII Hospital, 24122 Bergamo, Italy; (M.D.G.); (M.G.L.); (S.F.)
| | - Domenico Pinelli
- Unit of Hepato-Biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, 24122 Bergamo, Italy; (D.P.); (G.B.); (L.D.P.); (F.N.); (M.C.)
| | - Massimo De Giorgio
- Gastroenterology, Hepatology and Liver Transplantation, Department of Medicine-Papa Giovanni, XXIII Hospital, 24122 Bergamo, Italy; (M.D.G.); (M.G.L.); (S.F.)
| | - Maria Grazia Lucà
- Gastroenterology, Hepatology and Liver Transplantation, Department of Medicine-Papa Giovanni, XXIII Hospital, 24122 Bergamo, Italy; (M.D.G.); (M.G.L.); (S.F.)
| | - Arianna Ghirardi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, 24122 Bergamo, Italy; (A.G.); (A.C.)
| | - Alessandra Carrobio
- FROM Research Foundation, Papa Giovanni XXIII Hospital, 24122 Bergamo, Italy; (A.G.); (A.C.)
| | - Giuseppe Baronio
- Unit of Hepato-Biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, 24122 Bergamo, Italy; (D.P.); (G.B.); (L.D.P.); (F.N.); (M.C.)
| | - Luca Del Prete
- Unit of Hepato-Biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, 24122 Bergamo, Italy; (D.P.); (G.B.); (L.D.P.); (F.N.); (M.C.)
| | - Franck Nounamo
- Unit of Hepato-Biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, 24122 Bergamo, Italy; (D.P.); (G.B.); (L.D.P.); (F.N.); (M.C.)
| | - Andrea Gianatti
- Pathology Unit, ASST Papa Giovanni XXIII, 24122 Bergamo, Italy;
| | - Michele Colledan
- Unit of Hepato-Biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, 24122 Bergamo, Italy; (D.P.); (G.B.); (L.D.P.); (F.N.); (M.C.)
| | - Stefano Fagiuoli
- Gastroenterology, Hepatology and Liver Transplantation, Department of Medicine-Papa Giovanni, XXIII Hospital, 24122 Bergamo, Italy; (M.D.G.); (M.G.L.); (S.F.)
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Valenti L, Pelusi S, Aghemo A, Gritti S, Pasulo L, Bianco C, Iegri C, Cologni G, Degasperi E, D'Ambrosio R, Del Poggio P, Soria A, Puoti M, Carderi I, Pigozzi MG, Carriero C, Spinetti A, Zuccaro V, Memoli M, Giorgini A, Viganò M, Rumi MG, Re T, Spinelli O, Colombo MC, Quirino T, Menzaghi B, Lorini G, Pan A, D'Arminio Monforte A, Buscarini E, Autolitano A, Bonfanti P, Terreni N, Aimo G, Mendeni M, Prati D, Lampertico P, Colombo M, Fagiuoli S. Dysmetabolism, Diabetes and Clinical Outcomes in Patients Cured of Chronic Hepatitis C: A Real-Life Cohort Study. Hepatol Commun 2021; 6:867-877. [PMID: 34811949 PMCID: PMC8948549 DOI: 10.1002/hep4.1851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to examine the impact of features of dysmetabolism on liver disease severity, evolution, and clinical outcomes in a real‐life cohort of patients treated with direct acting antivirals for chronic hepatitis C virus (HCV) infection. To this end, we considered 7,007 patients treated between 2014 and 2018, 65.3% with advanced fibrosis, of whom 97.7% achieved viral eradication (NAVIGATORE‐Lombardia registry). In a subset (n = 748), liver stiffness measurement (LSM) was available at baseline and follow‐up. Higher body mass index (BMI; odds ratio [OR] 1.06 per kg/m2, 1.03‐1.09) and diabetes (OR 2.01 [1.65‐2.46]) were independently associated with advanced fibrosis at baseline, whereas statin use was protective (OR 0.46 [0.35‐0.60]; P < 0.0001 for all). The impact of BMI was greater in those without diabetes (P = 0.003). Diabetes was independently associated with less pronounced LSM improvement after viral eradication (P = 0.001) and in patients with advanced fibrosis was an independent predictor of the most frequent clinical events, namely de novo hepatocellular carcinoma (HCC; hazard ratio [HR] 2.09 [1.20‐3.63]; P = 0.009) and cardiovascular events (HR 2.73 [1.16‐6.43]; P = 0.021). Metformin showed a protective association against HCC (HR 0.32 [0.11‐0.96]; P = 0.043), which was confirmed after adjustment for propensity score (P = 0.038). Diabetes diagnosis further refined HCC prediction in patients with compensated advanced chronic liver disease at high baseline risk (P = 0.024). Conclusion: Metabolic comorbidities were associated with advanced liver fibrosis at baseline, whereas statins were protective. In patients with advanced fibrosis, diabetes increased the risk of de novo HCC and of cardiovascular events. Optimization of metabolic comorbidities treatment by a multi‐disciplinary management approach may improve cardiovascular and possibly liver‐related outcomes.
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Affiliation(s)
- Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.,Precision Medicine Lab, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Serena Pelusi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.,Precision Medicine Lab, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Alessio Aghemo
- Department of Internal Medicine and Hepatology, Humanitas University and Research Hospital, Rozzano, Italy
| | - Sara Gritti
- Fondazione Ricerca Ospedale di Bergamo, Papa Giovanni Hospital, Bergamo, Italy
| | - Luisa Pasulo
- Department of Gastroenterology and Hepatology, Papa Giovanni Hospital, Bergamo, Italy
| | - Cristiana Bianco
- Precision Medicine Lab, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Claudia Iegri
- Department of Gastroenterology and Hepatology, Papa Giovanni Hospital, Bergamo, Italy
| | - Giuliana Cologni
- Department of Internal Medicine, Papa Giovanni Hospital, Bergamo, Italy
| | - Elisabetta Degasperi
- Division of Gastroenterology & Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Roberta D'Ambrosio
- Division of Gastroenterology & Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Paolo Del Poggio
- Department of Gastroenterology and Hepatology, Papa Giovanni Hospital, Bergamo, Zingonia, Italy
| | - Alessandro Soria
- Division of Infectious Diseases, San Gerardo Hospital-ASST Monza, Monza, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, Hepatitis Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | - Canio Carriero
- Department of Infectious Diseases, Spedali Civili Hospital-ASST Brescia, Brescia, Italy
| | - Angiola Spinetti
- Department of Infectious Diseases, Spedali Civili Hospital-ASST Brescia, Brescia, Italy
| | - Valentina Zuccaro
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy
| | - Massimo Memoli
- Liver Center, San Raffaele Scientific Institute IRCCS, Milano, Italy
| | - Alessia Giorgini
- Department of Gastroenterology and Hepatology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mauro Viganò
- Department of Gastroenterology and Hepatology, San Giuseppe Hospital, Milan, Italy
| | - Maria Grazia Rumi
- Department of Gastroenterology and Hepatology, San Giuseppe Hospital, Milan, Italy
| | - Tiziana Re
- Department of Gastroenterology and Hepatology, Legnano Hospital-ASST Milano Ovest, Milan, Italy
| | - Ombretta Spinelli
- Department of Gastroenterology and Hepatology, Lariana Como Hospital, Milan, Italy
| | - Maria Chiara Colombo
- Department of Gastroenterology and Hepatology, Lariana Como Hospital, Milan, Italy
| | - Tiziana Quirino
- Department of Gastroenterology and Hepatology, Busto Arsizio Hospital ASST Valle Olona, Milan, Italy
| | - Barbara Menzaghi
- Department of Gastroenterology and Hepatology, Busto Arsizio Hospital ASST Valle Olona, Milan, Italy
| | - Gianpaolo Lorini
- Department of Gastroenterology and Hepatology, ASST Franciacorta, Milan, Italy
| | - Angelo Pan
- Department of Internal Medicine, Ospedale di Cremona, Cremona, Italy
| | | | | | | | - Paolo Bonfanti
- Division of Infectious Diseases, ASST Lecco, Lecco, Italy
| | | | | | | | - Daniele Prati
- Precision Medicine Lab, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Pietro Lampertico
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.,Division of Gastroenterology & Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy.,CRC "AM. and A. Migliavacca" Center for Liver Disease, Università degli Studi di Milano, Milano, Italy
| | - Massimo Colombo
- Liver Center, San Raffaele Scientific Institute IRCCS, Milano, Italy
| | - Stefano Fagiuoli
- Department of Gastroenterology and Hepatology, Papa Giovanni Hospital, Bergamo, Italy
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Pinelli D, Camagni S, Amaduzzi A, Frosio F, Fontanella L, Carioli G, Guizzetti M, Zambelli MF, Giovanelli M, Fagiuoli S, Colledan M. Liver transplantation in patients with non-neoplastic portal vein thrombosis: 20 years of experience in a single center. Clin Transplant 2021; 36:e14501. [PMID: 34633110 DOI: 10.1111/ctr.14501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/14/2021] [Accepted: 09/25/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Yerdel classification is widely used for describing the severity of portal vein thrombosis (PVT) in liver transplant (LT) candidates, but might not accurately predict transplant outcome. METHODS We retrospectively analyzed data regarding 97 adult patients with PVT who underwent LT, investigating whether the complexity of portal reconstruction could better correlate with transplant outcome than the site and extent of the thrombosis. RESULTS 79/97 (80%) patients underwent thrombectomy and anatomical anastomosis (TAA), 18/97 (20%) patients underwent non-anatomical physiological reconstructions (non-TAA). PVT Yerdel grade was 1-2 in 72/97 (74%) patients, and 3-4 in 25/97 (26%) patients. Univariate analysis revealed higher 30-day mortality, 90-day mortality, 1-year mortality, and a higher rate of severe early complications in the non-TAA group than in the TAA group (p = .018, .001, .014, .009, respectively). In the model adjusted for PVT Yerdel grade, non-TAA remained independently associated with higher 30-day, 90-day, and 1-year mortality (p = .021, .007, and .015, respectively). The portal vein re-thrombosis and overall patient and graft survival rates were similar. DISCUSSION In our experience, the complexity of portal reconstruction better correlated with transplant outcome than the Yerdel classification, which did not even appear to be a reliable predictor of the surgical complexity and technique.
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Affiliation(s)
- Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefania Camagni
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Annalisa Amaduzzi
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabio Frosio
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Fontanella
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Greta Carioli
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Guizzetti
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mara Giovanelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
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30
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Belli LS, Duvoux C, Cortesi PA, Facchetti R, Iacob S, Perricone G, Radenne S, Conti S, Patrono D, Berlakovich G, Hann A, Pasulo L, Castells L, Faitot F, Detry O, Invernizzi F, Magini G, De Simone P, Kounis I, Morelli MC, Díaz Fontenla F, Ericzon BG, Loinaz C, Johnston C, Gheorghe L, Lesurtel M, Romagnoli R, Kollmann D, Perera MTP, Fagiuoli S, Mirza D, Coilly A, Toso C, Zieniewicz K, Elkrief L, Karam V, Adam R, den Hoed C, Merli M, Puoti M, De Carlis L, Oniscu GC, Piano S, Angeli P, Fondevila C, Polak WG. COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study. Gut 2021; 70:1914-1924. [PMID: 34281984 PMCID: PMC8300535 DOI: 10.1136/gutjnl-2021-324879] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. DESIGN Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. RESULTS From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170). CONCLUSIONS Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).
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Affiliation(s)
- Luca Saverio Belli
- Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), Universita degli Studi di Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy
| | - Rita Facchetti
- Research Centre on Public Health (CESP), Universita degli Studi di Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy
| | - Speranta Iacob
- Digestive Diseases and Liver Transplantation Center, Institutul Clinic Fundeni, Bucharest, Romania
| | - Giovanni Perricone
- Epatologia e Gastroenterologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Sylvie Radenne
- Service Hépatologie et Gastro-Entérologie, Hospital Croix-Rousse, Lyon, France
| | - Sara Conti
- Research Centre on Public Health (CESP), Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Damiano Patrono
- Liver Transplantation Unit, Ospedale Molinette, Torino, Italy
| | - Gabriela Berlakovich
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Angus Hann
- Department of Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Lluis Castells
- Liver Transplant Unit, HPB Surgery and Transplants, Hospital Vall d'Hebron, Barcelona, Spain
| | - Francois Faitot
- Service de Chirurgie Hepatobiliare and Transplantation, Hôpital de Hautepierre, Strasbourg, France
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Liege, Belgium
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, Policlinico di Milano, Milan, Italy
| | - Giulia Magini
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Paolo De Simone
- Trapiantologia Epatica Universitaria, Ospedale Cisanello, Pisa, Italy
| | - Ilias Kounis
- Centre Hépatobiliaire, Hospital Paul Brousse, Villejuif, France
| | - Maria Cristina Morelli
- Department of Organ Failures and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fernando Díaz Fontenla
- Liver Transplantation Unit, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Bo-Göran Ericzon
- Transplantation Surgery, Karolinska Institute, Stockholm, Sweden
| | - Carmelo Loinaz
- HBP and Transplant Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Chris Johnston
- Liver Transplantation Unit, Edinburgh Royal Infirmary, Edinburgh, Edinburgh, UK
| | - Liliana Gheorghe
- Digestive Diseases and Liver Transplantation Center, Clinical Institute Fundeni, Bucuresti, Romania
| | - Mickael Lesurtel
- Department of Surgery and Transplanattion, Hospital Croix-Rousse, Lyon, Rhône-Alpes, France
| | | | - Dagmar Kollmann
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Stefano Fagiuoli
- Department of Gastroenterology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Darius Mirza
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, Birmingham, UK
| | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, Île-de-France, France
- UMR-S1193, INSERM, Villejuif, Île-de-France, France
| | - Christian Toso
- Department of Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Faculty of Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Laure Elkrief
- Hepatogastroenterology Unit, Hopital Trousseau, Chambray-les-Tours, France
| | - Vincent Karam
- Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France
| | - Rene Adam
- Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France
| | | | - Marco Merli
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Massimo Puoti
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Luciano De Carlis
- Chirurgia Generale e dei Trapianti, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Gabriel C Oniscu
- Transplantation Surgery, Karolinska Institute, Stockholm, Sweden
| | - Salvatore Piano
- Department of Medicine, Faculty of Medicine and Surgery, University of Padua, Padova, Italy
| | - Paolo Angeli
- Department of Medicine, Faculty of Medicine and Surgery, University of Padua, Padova, Italy
| | | | - Wojciech G Polak
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Gori M, Ghirardi A, D'Elia E, Imeri G, Di Marco F, Gavazzi A, Carobbio A, Balestrieri G, Giammarresi A, Trevisan R, Amoroso M, Raimondi F, Novelli L, Magro B, Mangia G, Lorini FL, Fagiuoli S, Barbui T, Rizzi M, Cosentini R, Sironi S, Senni M. Association between inhibitors of the renin-angiotensin system and lung function in elderly patients recovered from severe COVID-19. Eur J Prev Cardiol 2021; 29:e196-e199. [PMID: 34535993 DOI: 10.1093/eurjpc/zwab143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Mauro Gori
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Arianna Ghirardi
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Emilia D'Elia
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gianluca Imeri
- The Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- The Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Milan, Milan, Italy
| | | | - Alessandra Carobbio
- The Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Roberto Trevisan
- The Endocrinology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mariangela Amoroso
- The Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Milan, Milan, Italy
| | - Federico Raimondi
- The Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Milan, Milan, Italy
| | - Luca Novelli
- The Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Bianca Magro
- The Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gianpaolo Mangia
- The Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Stefano Fagiuoli
- The Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Tiziano Barbui
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- The Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Sandro Sironi
- The Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
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32
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Degroote H, Piñero F, Costentin C, Notarpaolo A, Boin IF, Boudjema K, Baccaro C, Chagas AL, Bachellier P, Ettorre GM, Poniachik J, Muscari F, Di Benedetto F, Duque SH, Salame E, Cillo U, Gadano A, Vanlemmens C, Fagiuoli S, Rubinstein F, Burra P, Cherqui D, Silva M, Van Vlierberghe H, Duvoux C. International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria. JHEP Rep 2021; 3:100331. [PMID: 34485882 PMCID: PMC8405981 DOI: 10.1016/j.jhepr.2021.100331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/28/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
Background & Aims Good outcomes after liver transplantation (LT) have been reported after successfully downstaging to Milan criteria in more advanced hepatocellular carcinoma (HCC). We aimed to compare post-LT outcomes in patients receiving locoregional therapies (LRT) before LT according to Milan criteria and University of California San Francisco downstaging (UCSF-DS) protocol and 'all-comers'. Methods This multicentre cohort study included patients who received any LRT before LT from Europe and Latin America (2000-2018). We excluded patients with alpha-foetoprotein (AFP) above 1,000 ng/ml. Competing risk regression analysis for HCC recurrence was conducted, estimating subdistribution hazard ratios (SHRs) and corresponding 95% CIs. Results From 2,441 LT patients, 70.1% received LRT before LT (n = 1,711). Of these, 80.6% were within Milan, 12.0% within UCSF-DS, and 7.4% all-comers. Successful downstaging was achieved in 45.2% (CI 34.8-55.8) and 38.2% (CI 25.4-52.3) of the UCSF-DS group and all-comers, respectively. The risk of recurrence was higher for all-comers (SHR 6.01 [p <0.0001]) and not significantly higher for the UCSF-DS group (SHR 1.60 [p = 0.32]), compared with patients remaining within Milan. The all-comers presented more frequent features of aggressive HCC and higher tumour burden at explant. Among the UCSF-DS group, an AFP value of ≤20 ng/ml at listing was associated with lower recurrence (SHR 2.01 [p = 0.006]) and better survival. However, recurrence was still significantly high irrespective of AFP ≤20 ng/ml in all-comers. Conclusions Patients within the UCSF-DS protocol at listing have similar post-transplant outcomes compared with those within Milan when successfully downstaged. Meanwhile, all-comers have a higher recurrence and inferior survival irrespective of response to LRT. Additionally, in the UCSF-DS group, an ALP of ≤20 ng/ml might be a novel tool to optimise selection of candidates for LT. Clinical trial number This study was registered as part of an open public registry (NCT03775863). Lay summary Patients with more extended HCC (within the UCSF-DS protocol) successfully downstaged to the conventional Milan criteria do not have a higher recurrence rate after LT compared with the group remaining in the Milan criteria from listing to transplantation. Moreover, in the UCSF-DS patient group, an ALP value equal to or below 20 ng/ml at listing might be a novel tool to further optimise selection of candidates for LT.
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Key Words
- AC, all-comers
- AFP, alpha-foetoprotein
- All-comers
- Alpha-foetoprotein
- DS, downstaging
- Downstaging
- EASL, European Association for the Study of the Liver
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hepatocellular carcinoma
- ITT, intention to treat
- LR, liver resection
- LRT, locoregional therapies
- LT, liver transplantation
- MC, Milan criteria
- MVI, microvascular invasion
- PEI, percutaneous ethanol ablation
- RFA, radiofrequency ablation
- SHR, subdistribution hazard ratio
- TACE, transarterial chemoembolisation
- UCSF downstaging protocol
- UCSF-DS, University of California San Francisco downstaging
- UNOS, United Network for Organ Sharing
- WL, waiting list
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Affiliation(s)
- Helena Degroote
- Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Federico Piñero
- Hospital Universitario Austral, School of Medicine, Austral University, Argentina.,Argentina and Latin American Liver Research Educational and Awareness Network (LALREAN)
| | - Charlotte Costentin
- Grenoble Alpes University; Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309; Gastroenterology, Hepatology and GI Oncology Department, Digidune, Grenoble Alpes University Hospital; 38700 La Tronche, France
| | | | - Ilka F Boin
- Hospital das Clinicas UNICAMP Campiñas, Campiñas, Brazil
| | - Karim Boudjema
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital Rennes 1 University, Rennes, France
| | | | - Aline Lopes Chagas
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Philippe Bachellier
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplant, Hôpital de Hautepierre, CHU de Strasbourg, France
| | | | - Jaime Poniachik
- Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Fabrice Muscari
- Digestive Surgery and Transplant Unit, Hôpital Rangueil, Toulouse, France
| | - Fabrio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Department of General Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Sergio Hoyos Duque
- Hospital Pablo Tobón Uribe y Grupo de Gastrohepatología de la Universidad de Antioquía, Medellín, Colombia
| | | | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplant Unit, Padova University Hospital, Padua, Italy
| | - Adrián Gadano
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Stefano Fagiuoli
- Gastroenterology, Hepatology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fernando Rubinstein
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padua, Italy
| | - Daniel Cherqui
- Paul Brousse Hospital, APHP - University Paris Saclay, Villejuif, France
| | - Marcelo Silva
- Hospital Universitario Austral, School of Medicine, Austral University, Argentina.,Argentina and Latin American Liver Research Educational and Awareness Network (LALREAN)
| | - Hans Van Vlierberghe
- Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Christophe Duvoux
- Liver and Medical Liver Transplant Unit, Hospital Henri Mondor, University of Paris-Est, Creteil, France
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33
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Casiraghi F, Perico N, Podestà MA, Todeschini M, Zambelli M, Colledan M, Camagni S, Fagiuoli S, Pinna AD, Cescon M, Bertuzzo V, Maroni L, Introna M, Capelli C, Golay JT, Buzzi M, Mister M, Ordonez PYR, Breno M, Mele C, Villa A, Remuzzi G. Third-party bone marrow-derived mesenchymal stromal cell infusion before liver transplantation: A randomized controlled trial. Am J Transplant 2021; 21:2795-2809. [PMID: 33370477 DOI: 10.1111/ajt.16468] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/24/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023]
Abstract
Mesenchymal stromal cells (MSC) have emerged as a promising therapy to minimize the immunosuppressive regimen or induce tolerance in solid organ transplantation. In this randomized open-label phase Ib/IIa clinical trial, 20 liver transplant patients were randomly allocated (1:1) to receive a single pretransplant intravenous infusion of third-party bone marrow-derived MSC or standard of care alone. The primary endpoint was the safety profile of MSC administration during the 1-year follow-up. In all, 19 patients completed the study, and none of those who received MSC experienced infusion-related complications. The incidence of serious and non-serious adverse events was similar in the two groups. Circulating Treg/memory Treg and tolerant NK subset of CD56bright NK cells increased slightly over baseline, albeit not to a statistically significant extent, in MSC-treated patients but not in the control group. Graft function and survival, as well as histologic parameters and intragraft expression of tolerance-associated transcripts in 1-year protocol biopsies were similar in the two groups. In conclusion, pretransplant MSC infusion in liver transplant recipients was safe and induced mild positive changes in immunoregulatory T and NK cells in the peripheral blood. This study opens the way for a trial on possible tolerogenic efficacy of MSC in liver transplantation. ClinicalTrials.gov identifier: NCT02260375.
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Affiliation(s)
- Federica Casiraghi
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Norberto Perico
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Manuel A Podestà
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Marta Todeschini
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Marco Zambelli
- Department of Organ Failure and Transplantation, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefania Camagni
- Department of Organ Failure and Transplantation, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology, Hepatology and Transplantation, Department of Medicine, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio D Pinna
- General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria-Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Matteo Cescon
- General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria-Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Valentina Bertuzzo
- General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria-Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Lorenzo Maroni
- General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria-Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Martino Introna
- G. Lanzani Laboratory of Cell Therapy, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Capelli
- G. Lanzani Laboratory of Cell Therapy, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Josee T Golay
- G. Lanzani Laboratory of Cell Therapy, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Marina Buzzi
- Emilia Romagna Cord Blood Bank, Immunohematology and Transfusion Medicine, Azienda Ospedaliero-Universitaria-Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Marilena Mister
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Pamela Y R Ordonez
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Matteo Breno
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Caterina Mele
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Alessandro Villa
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giuseppe Remuzzi
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
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Marchetti M, Gomez-Rosas P, Sanga E, Gamba S, Verzeroli C, Russo L, Restuccia F, Schieppati F, Bonanomi E, Rizzi M, Fagiuoli S, D'Alessio A, Lorini L, Falanga A. Endothelium Activation Markers in Severe Hospitalized COVID-19 Patients: Role in Mortality Risk Prediction. ACTA ACUST UNITED AC 2021; 5:e253-e263. [PMID: 34235394 PMCID: PMC8255108 DOI: 10.1055/s-0041-1731711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/22/2021] [Indexed: 02/08/2023]
Abstract
Introduction
Endothelial damage and hypercoagulability are major players behind the hemostatic derangement of SARS-CoV-2 infection.
Aim
In this prospective study we assessed endothelial and inflammatory biomarkers in a cohort of COVID-19 patients, aiming to identify predictive factors of in-hospital mortality.
Methods
COVID-19 patients hospitalized in intensive care (ICU) and non-ICU units at 2 Bergamo (Italy) hospitals from March 23 to May 30, 2020, were enrolled. Markers of endothelium activation including von-Willebrand factor (vWF), soluble thrombomodulin (sTM), and fibrinolytic proteins (t-PA and PAI-1) were measured. Additionally, D-dimer, Fibrinogen, FVIII, nucleosomes, C reactive protein (CRP) and procalcitonin were assessed.
Results
Sixty-three (45 ICU, and 18 non-ICU) patients, with a median age of 62 years were analyzed. Increased plasma levels of D-dimer, FVIII, fibrinogen, nucleosomes, CRP, and procalcitonin were observed in the whole cohort. Extremely elevated vWF levels characterized all patients (highest values in ICU-subjects). After a median time of 30 days, death occurred in 13 (21%) patients. By multivariable analysis, vWF-activity, neutrophil-count and PaO2/FiO2 were significantly associated with death. Using these variables, a linear score with 3-risk groups was generated that provided a cumulative incidence of death of 0% in the low-, 32% in the intermediate-, and 78% in the high-risk group.
Conclusions
COVID-19-induced hemostatic abnormalities are exacerbated by the severity of the disease and strongly correlate with the inflammatory status, underlying the link between coagulation, endothelial activation, and inflammation. Our study provides evidence for a role of vWF, together with neutrophils and PaO2/FiO2, as a significant predictor of in-hospital mortality by SARSCoV-2 infection.
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Affiliation(s)
- Marina Marchetti
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Patricia Gomez-Rosas
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy.,Hematology Service, Hospital General Regional Tecamac IMSS, Mexico, Mexico
| | - Eleonora Sanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Gamba
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Cristina Verzeroli
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Russo
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Restuccia
- Department of Anesthesiology and Critical Care Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Schieppati
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Ezio Bonanomi
- Department of Anesthesiology and Critical Care Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Unit of Infectious Diseases, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Internal Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea D'Alessio
- Department of Medical Oncology and Internal Medicine, Policlinico San Marco, Zingonia, Bergamo, Italy
| | - Luca Lorini
- Department of Anesthesiology and Critical Care Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy.,School of Medicine, University of Milano Bicocca, Milano, Italy
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35
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Mangia A, Scaglione F, Toniutto P, Pirisi M, Coppola N, Di Perri G, Alvarez Nieto G, Calabrese S, Hernandez C, Perrone V, Degli Esposti L, Fagiuoli S. Drug-Drug Interactions in Italian Patients with Chronic Hepatitis C Treated with Pangenotypic Direct Acting Agents: Insights from a Real-World Study. Int J Environ Res Public Health 2021; 18:7144. [PMID: 34281080 PMCID: PMC8296917 DOI: 10.3390/ijerph18137144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 12/22/2022]
Abstract
This Italian observational real-world study aims to assess in chronic hepatitis C virus (HCV) patients treated with pangenotypic direct acting agents (pDAAs) glecaprevir/pibrentasvir (GLE/PIB) or sofosbuvir/velpatasvir (SOF/VEL) the potential drug-drug interactions (DDIs) with concomitant medications prescribed, with a focus on cardiovascular and system nervous (CNS) co-medications. Data were collected from administrative databases covering 6.9 million health-assisted individuals. All patients prescribed SOF/VEL or GLE/PIB between 11/2017 and 12/2018 were included. Patients were analyzed while on DAA. DDIs were identified according to the Liverpool University tool. Overall, 3181 HCV patients were included: 1619 in the GLE/PIB cohort and 1562 in the SOF/VEL cohort. SOF/VEL patients were generally older than GLE/PIB ones (mean age 58.4 vs. 53.1, p < 0.001) and had more cardiovascular and CNS comorbidities (58% vs. 42%, p < 0.001 and 33% vs. 28%, p = 0.002, respectively). Contraindications due to DDIs in the GLE/PIB cohort affected 9.3% and 3.2% of patients before and on DAA, respectively, while the percentages in the SOF/VEL cohort were 3.2% before and 0.4% after pDAAs initiation. Among GLE/PIB patients, 2.7% had cardiovascular drugs (all statins) contraindicated while on DAA. The potential DDIs between cardiovascular drugs and SOF/VEL were mainly with statins (5%). SOF/VEL was prescribed in patients with older age and with more cardiovascular and CNS comorbidities. Despite this, a proportion of contraindicated drugs lower than that of GLE/PIB was registered.
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Affiliation(s)
- Alessandra Mangia
- Liver Unit, Fondazione “Casa Sollievo Della Sofferenza” IRCCS, 71013 San Giovanni Rotondo, Italy;
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, 20122 Milan, Italy;
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Azienda Ospedaliero Universitaria, 33100 Udine, Italy;
| | - Mario Pirisi
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Nicola Coppola
- Department of Mental Health and Public Medicine–Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy;
| | - Giovanni Di Perri
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
| | - Gema Alvarez Nieto
- Gilead Sciences, Medical Affairs Italy, 202124 Milan, Italy; (G.A.N.); (S.C.)
| | - Stefano Calabrese
- Gilead Sciences, Medical Affairs Italy, 202124 Milan, Italy; (G.A.N.); (S.C.)
| | - Candido Hernandez
- Gilead Sciences, Global Medical Affairs, Stockley Park, London UB11 1BD, UK;
| | - Valentina Perrone
- CliCon S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy;
| | - Luca Degli Esposti
- CliCon S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy;
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy;
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36
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Gritti G, Raimondi F, Bottazzi B, Ripamonti D, Riva I, Landi F, Alborghetti L, Frigeni M, Damiani M, Micò C, Fagiuoli S, Lorini FL, Gandini L, Novelli L, Morgan JP, Owens BMJ, Kanhai KJK, Reljanovic GT, Rizzi M, Di Marco F, Mantovani A, Rambaldi A. Siltuximab downregulates interleukin-8 and pentraxin 3 to improve ventilatory status and survival in severe COVID-19. Leukemia 2021; 35:2710-2714. [PMID: 34031531 PMCID: PMC8142063 DOI: 10.1038/s41375-021-01299-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 04/01/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Giuseppe Gritti
- Hematology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.
| | - Federico Raimondi
- Pneumology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Postgraduate School of Respiratory Medicine, University of Milan, Milan, Italy
| | | | - Diego Ripamonti
- Infectious Diseases Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Ivano Riva
- Intensive Care Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Landi
- Hematology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Postgraduate School of Hematology, University of Milan, Milan, Italy
| | - Leonardo Alborghetti
- Infectious Diseases Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Frigeni
- Hematology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Marianna Damiani
- Intensive Care Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Postgraduate School of Anesthesiology and Intensive Care, University of Milan, Milan, Italy
| | - Caterina Micò
- Hematology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Ferdinando Luca Lorini
- Intensive Care Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Lucia Gandini
- Intensive Care Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Postgraduate School of Anesthesiology and Intensive Care, University of Milan, Milan, Italy
| | - Luca Novelli
- Pneumology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | | | | | - Marco Rizzi
- Infectious Diseases Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- Pneumology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Mantovani
- Postgraduate School of Respiratory Medicine, University of Milan, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy.,The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Alessandro Rambaldi
- Hematology Unit, Azienda Socio Sanitario Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Department of Oncology-Hematology, University of Milan, Milan, Italy
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Raimondi F, Novelli L, Ghirardi A, Russo FM, Pellegrini D, Biza R, Trapasso R, Giuliani L, Anelli M, Amoroso M, Allegri C, Imeri G, Sanfilippo C, Comandini S, Hila E, Manesso L, Gandini L, Mandelli P, Monti M, Gori M, Senni M, Lorini FL, Rizzi M, Barbui T, Paris L, Rambaldi A, Cosentini R, Guagliumi G, Cesa S, Colledan M, Sessa M, Masciulli A, Gavazzi A, Buoro S, Remuzzi G, Ruggenenti P, Callegaro A, Gianatti A, Farina C, Bellasi A, Sironi S, Fagiuoli S, Di Marco F. Covid-19 and gender: lower rate but same mortality of severe disease in women-an observational study. BMC Pulm Med 2021; 21:96. [PMID: 33743654 PMCID: PMC7980742 DOI: 10.1186/s12890-021-01455-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients. METHODS Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization. RESULTS 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO2/FiO2 was similar between men and women (228 [IQR, 134-273] vs 238 mmHg [150-281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan-Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687). CONCLUSION Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.
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Affiliation(s)
- Federico Raimondi
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Luca Novelli
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | | | - Filippo Maria Russo
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Dario Pellegrini
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberta Biza
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Roberta Trapasso
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Lisa Giuliani
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Marisa Anelli
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Mariangela Amoroso
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Chiara Allegri
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Gianluca Imeri
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Claudia Sanfilippo
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Sofia Comandini
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - England Hila
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Leonardo Manesso
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lucia Gandini
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Pietro Mandelli
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Martina Monti
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Gori
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Laura Paris
- Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Rambaldi
- Università degli Studi di Milano, Milan, Italy
- Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giulio Guagliumi
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Simonetta Cesa
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Colledan
- Department of Health and Social Care Professions, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Sessa
- Neurology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Sabrina Buoro
- Quality Management, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Mario Negri Institute for Pharmacological Research IRCCS, Anna Maria Astori Centre, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | | | | | | | - Claudio Farina
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio Bellasi
- Department of Research, Innovation, Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Sandro Sironi
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy.
- Università degli Studi di Milano, Milan, Italy.
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Fabbiani M, Lombardi A, Colaneri M, Del Poggio P, Perini P, D'Ambrosio R, Degasperi E, Dibenedetto C, Giorgini A, Pasulo L, Maggiolo F, Castelli F, Brambilla P, Spinelli O, Re T, Lleo A, Rumi M, Uberti-Foppa C, Soria A, Aghemo A, Lampertico P, Baiguera C, Schiavini M, Fagiuoli S, Bruno R. High rates of sustained virological response despite premature discontinuation of directly acting antivirals in HCV-infected patients treated in a real-life setting. J Viral Hepat 2021; 28:558-568. [PMID: 33306247 DOI: 10.1111/jvh.13454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/21/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
In routine clinical practice, hepatitis C virus-infected patients can prematurely discontinue the prescribed regimen for several reasons. The aim of our study was to investigate sustained virological response (SVR12) rates in patients who prematurely discontinued directly acting antiviral (DAA) regimens and to assess the shortest effective duration of DAA able to lead to SVR12. We retrospectively collected the SVR rates of patients, registered in the NAVIGATORE-Lombardia Network database from January 2015, who discontinued DAAs before the predefined end of treatment. Overall, we included 365 patients, males were the majority (213, 58.4%), mean age was 60.5 years, and 53 (14.5%) patients were HIV-co-infected. Liver cirrhosis was observed in 251 (68.8%) subjects, and the most represented genotypes were 1b (n = 168, 46%) and 3 (n = 59, 16.2%). DAA was discontinued a median of 1 (IQR 1-4) weeks before the predefined EOT, with 164 (44.9%) patients stopping DAAs at least 2 weeks before the planned schedule. In patients with F0-F3 liver fibrosis, lower rates of SVR12 were observed in patients treated for <4 weeks: 50% (n = 2/4) vs. 99.1% (n = 109/110) for ≥4 weeks, p = 0.003. In patients with liver cirrhosis, lower rates of SVR12 were observed in patients treated <8 weeks: 83.3% (n = 25/30) vs. 94.6% (n = 209/221) for ≥8 weeks, p = 0.038. Despite premature discontinuation of DAA, high SVR12 rates were observed in a real-life setting for treatment lasting at least 4 weeks in patients with liver fibrosis F0-F3 and 8 weeks in those with liver cirrhosis. On this basis, feasibility of reducing DAA treatment duration should be explored in randomized clinical trials.
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Affiliation(s)
- Massimiliano Fabbiani
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Andrea Lombardi
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Colaneri
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Paolo Perini
- Divisione di Medicina, Policlinico San Pietro, Bergamo, Italy
| | - Roberta D'Ambrosio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Gastroenterologia ed Epatologia, CRC 'AM e A Migliavacca' per lo studio e la cura delle malattie del fegato, Milan, Italy
| | - Elisabetta Degasperi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Gastroenterologia ed Epatologia, CRC 'AM e A Migliavacca' per lo studio e la cura delle malattie del fegato, Milan, Italy
| | - Clara Dibenedetto
- Unità di Epatologia e Gastroenterologia, Ospedale San Paolo, Milan, Italy
| | - Alessia Giorgini
- Unità di Epatologia e Gastroenterologia, Ospedale San Paolo, Milan, Italy
| | - Luisa Pasulo
- Unità di Gastroenterologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Franco Maggiolo
- U.O. Malattie Infettive, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Paola Brambilla
- U.O. Malattie Infettive, Istituti Ospitalieri, Cremona, Italy
| | | | - Tiziana Re
- U.O. Malattie Infettive, ASST Ovest Milanese, Legnano, Italy
| | - Ana Lleo
- Medicina Interna ed Epatologia, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Mariagrazia Rumi
- U.O. Epatologia, Ospedale San Giuseppe Multimedica, Università degli Studi di Milano, Milan, Italy
| | - Caterina Uberti-Foppa
- Division of Infectious Diseases, Vita-Salute San Raffaele University Milan, Milan, Italy.,Division of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Soria
- UO Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Alessio Aghemo
- Medicina Interna ed Epatologia, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Pietro Lampertico
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Gastroenterologia ed Epatologia, CRC 'AM e A Migliavacca' per lo studio e la cura delle malattie del fegato, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Chiara Baiguera
- UO Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Monica Schiavini
- Dipartimento di Malattie Infettive, Ospedale Luigi Sacco, Milan, Italy
| | - Stefano Fagiuoli
- Unità di Gastroenterologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Raffaele Bruno
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Perico N, Fagiuoli S, Di Marco F, Laghi A, Cosentini R, Rizzi M, Gianatti A, Rambaldi A, Ruggenenti P, La Vecchia C, Bertolini G, Paglia S, Lorini FL, Remuzzi G. Bergamo and Covid-19: How the Dark Can Turn to Light. Front Med (Lausanne) 2021; 8:609440. [PMID: 33681246 PMCID: PMC7933506 DOI: 10.3389/fmed.2021.609440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/23/2020] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
The novel coronavirus, SARS-CoV-2, continues to spread rapidly. Here we discuss the dramatic situation created by COVID-19 in Italy, particularly in the province of Bergamo (the most severely affected in the first wave), as an example of how, in the face of an unprecedented tragedy, acting (albeit belatedly)-including imposing a very strict lockdown-can largely resolve the situation within approximately 2 months. The measures taken here ensured that Bergamo hospital, which was confronted with rapidly rising numbers of severely ill COVID-19 patients requiring hospitalization, was able to meet the initial challenges of the pandemic. We also report that local organization and, more important, the large natural immunity against SARS-CoV-2 of the Bergamo population developed during the first wave of the epidemic, can explain the limited number of new COVID-19 cases during the more recent second wave compared to the numbers in other areas of Lombardy. Furthermore, we highlight the importance of coordinating the easing of containment measures to avoid what is currently observed in other countries, especially in the United States, Latin American and India, where this approach has not been adopted, and a dramatic resurgence of COVID-19 cases and an increase in the number of hospitalisations and deaths have been reported.
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Affiliation(s)
- Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, Department of Medicine, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Unità di Pneumologia, Department of Medicine ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Laghi
- Dipartimento di Scienze Medico Chirurgiche e Medicina Traslazionale, Sapienza Università di Roma, AOU Sant'Andrea, Rome, Italy
| | | | - Marco Rizzi
- Infectious Diseases Department, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alessandro Rambaldi
- Hematology Unit, ASST-Papa Giovanni XXIII, Bergamo, Italy
- Department of Oncology and Oncohematology, Università degli Studi di Milano, Milan, Italy
| | - Piero Ruggenenti
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Guido Bertolini
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
| | | | | | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
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40
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Caraceni P, Tufoni M, Zaccherini G, Riggio O, Angeli P, Alessandria C, Neri S, Foschi FG, Levantesi F, Airoldi A, Simone L, Svegliati-Baroni G, Fagiuoli S, Laffi G, Cozzolongo R, Di Marco V, Sangiovanni V, Morisco F, Toniutto P, Gasbarrini A, De Marco R, Piano S, Nardelli S, Elia C, Roncadori A, Baldassarre M, Bernardi M. On-treatment serum albumin level can guide long-term treatment in patients with cirrhosis and uncomplicated ascites. J Hepatol 2021; 74:340-349. [PMID: 32853747 DOI: 10.1016/j.jhep.2020.08.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/10/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS The ANSWER study reported that long-term albumin administration in patients with cirrhosis and uncomplicated ascites improves survival. During treatment, serum albumin increased within a month and remained stable thereafter. In this post hoc analysis, we aimed to determine whether on-treatment serum albumin levels could guide therapy. METHODS Logistic regression was used to assess the association between baseline serum albumin and mortality, as well as to determine on-treatment factors associated with mortality and to predict the achievement of a given on-treatment serum albumin level. Survival was assessed by Kaplan-Meier estimates and second-order polynomial regression. Patients whose on-treatment serum albumin remained below normal were compared with a subset of patients from the control arm matched by principal score. RESULTS Baseline serum albumin was closely associated with 18-month mortality in untreated patients; albumin treatment almost effaced this relationship. On-treatment serum albumin and MELD-Na at month 1 were the sole independent variables associated with mortality. Second-order polynomial regression revealed that survival improved in parallel with increased 1-month on-treatment serum albumin. Kaplan-Meier estimations showed that any value of 1-month on-treatment serum albumin (0.1 g/dl intervals) in the range 2.5-4.5 g/dl discriminated patient survival. In the normal range of serum albumin, the best discriminant value was 4.0 g/dl. Compared to untreated patients, survival even improved in patients whose on-treatment serum albumin remained below normal. CONCLUSION Baseline serum albumin per se should not guide the decision to start albumin therapy. Conversely, 1-month on-treatment serum albumin levels are strongly associated with outcomes and could guide the use of albumin - 4.0 g/dl being the target threshold. However, even patients whose serum albumin remains below normal benefit from long-term albumin administration. LAY SUMMARY The ANSWER study has shown that long-term albumin administration improves survival and prevents the occurrence of major complications in patients with cirrhosis and ascites. This study shows that the achievement of these beneficial effects is related to a significant increase in serum albumin concentration. Even though the best results follow the achievement of a serum albumin concentration of 4 g/dl, a survival benefit is also achieved in patients who fail to normalise serum albumin.
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Affiliation(s)
- Paolo Caraceni
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Bologna University Hospital Authority St. Orsola-Malpighi Polyclinic, Italy
| | - Manuel Tufoni
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Bologna University Hospital Authority St. Orsola-Malpighi Polyclinic, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Bologna University Hospital Authority St. Orsola-Malpighi Polyclinic, Italy
| | - Oliviero Riggio
- Department of Clinical Medicine, "Sapienza" University of Rome, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padua, Italy
| | - Carlo Alessandria
- Division of Gastroenterology and Hepatology, "Città della Salute e della Scienza" Hospital, University of Turin, Italy
| | - Sergio Neri
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | | | - Fabio Levantesi
- Internal Medicine, Hospital of Bentivoglio, A.U.S.L. of Bologna, Italy
| | - Aldo Airoldi
- Liver Unit, Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | | | | | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giacomo Laffi
- Careggi University Hospital, University of Florence, Italy
| | - Raffaele Cozzolongo
- Division of Gastroenterology, National Institute of Gastroenterology "S. De Bellis", Castellana Grotte (Bari), Italy
| | - Vito Di Marco
- Unit of Gastroenterology and Hepatology, Biomedical Department of Internal and Specialistic Medicine, University of Palermo, Italy
| | | | - Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Department of Medical Area, University of Udine, Italy
| | | | | | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padua, Italy
| | - Silvia Nardelli
- Department of Clinical Medicine, "Sapienza" University of Rome, Italy
| | - Chiara Elia
- Division of Gastroenterology and Hepatology, "Città della Salute e della Scienza" Hospital, University of Turin, Italy
| | | | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Center for Applied Biomedical Research (CRBA), University of Bologna, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Italy.
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41
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Novelli L, Raimondi F, Ghirardi A, Pellegrini D, Capodanno D, Sotgiu G, Guagliumi G, Senni M, Russo FM, Lorini FL, Rizzi M, Barbui T, Rambaldi A, Cosentini R, Grazioli LS, Marchesi G, Sferrazza Papa GF, Cesa S, Colledan M, Civiletti R, Conti C, Casati M, Ferri F, Camagni S, Sessa M, Masciulli A, Gavazzi A, Falanga A, DA Pozzo LF, Buoro S, Remuzzi G, Ruggenenti P, Callegaro A, D'Antiga L, Pasulo L, Pezzoli F, Gianatti A, Parigi P, Farina C, Bellasi A, Solidoro P, Sironi S, DI Marco F, Fagiuoli S. At the peak of COVID-19 age and disease severity but not comorbidities are predictors of mortality: COVID-19 burden in Bergamo, Italy. Panminerva Med 2020; 63:51-61. [PMID: 33244949 DOI: 10.23736/s0031-0808.20.04063-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Findings from February 2020, indicate that the clinical spectrum of COVID-19 can be heterogeneous, probably due to the infectious dose and viral load of SARS-CoV-2 within the first weeks of the outbreak. The aim of this study was to investigate predictors of overall 28-day mortality at the peak of the Italian outbreak. METHODS Retrospective observational study of all COVID-19 patients admitted to the main hospital of Bergamo, from February 23 to March 14, 2020. RESULTS Five hundred and eight patients were hospitalized, predominantly male (72.4%), mean age of 66±15 years; 49.2% were older than 70 years. Most of patients presented with severe respiratory failure (median value [IQR] of PaO<inf>2</inf>/FiO<inf>2</inf>: 233 [149-281]). Mortality rate at 28 days resulted of 33.7% (N.=171). Thirty-nine percent of patients were treated with continuous positive airway pressure (CPAP), 9.5% with noninvasive ventilation (NIV) and 13.6% with endotracheal intubation. 9.5% were admitted to Semi-Intensive Respiratory Care Unit, and 18.9% to Intensive Care Unit. Risk factors independently associated with 28-day mortality were advanced age (≥78 years: odds ratio [OR], 95% confidence interval [CI]: 38.91 [10.67-141.93], P<0.001; 70-77 years: 17.30 [5.40-55.38], P<0.001; 60-69 years: 3.20 [1.00-10.20], P=0.049), PaO<inf>2</inf>/FiO<inf>2</inf><200 at presentation (3.50 [1.70-7.20], P=0.001), need for CPAP/NIV in the first 24 hours (8.38 [3.63-19.35], P<0.001), and blood urea value at admission (1.01 [1.00-1.02], P=0.015). CONCLUSIONS At the peak of the outbreak, with a probable high infectious dose and viral load, older age, the severity of respiratory failure and renal impairment at presentation, but not comorbidities, are predictors of 28-day mortality in COVID-19.
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Affiliation(s)
- Luca Novelli
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Raimondi
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Milan, Milan, Italy
| | | | - Dario Pellegrini
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Capodanno
- Unit of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | | | - Filippo M Russo
- University of Milan, Milan, Italy.,Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ferdinando L Lorini
- Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Unit of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alessandro Rambaldi
- University of Milan, Milan, Italy.,Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Lorenzo S Grazioli
- Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gianmariano Marchesi
- Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe F Sferrazza Papa
- University of Milan, Milan, Italy.,Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Simonetta Cesa
- Department of Health and Social Care Professions, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Colledan
- Unit of General Surgery 3, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberta Civiletti
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.,Federico II University, Naples, Italy
| | - Caterina Conti
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Casati
- Department of Health and Social Care Professions, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Ferri
- Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefania Camagni
- Unit of General Surgery 3, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Sessa
- Unit of Neurology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Anna Falanga
- Unit of Immunohematology and Transfusion, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Milano-Bicocca, Milan, Italy
| | - Luigi F DA Pozzo
- University of Milano-Bicocca, Milan, Italy.,Unit of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Sabrina Buoro
- Unit of Quality Management, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Mario Negri Institute for Pharmacological Research IRCCS, Anna Maria Astori Centet, Kilometro Rosso Science and Technology Park, Bergamo, Italy
| | - Piero Ruggenenti
- Unit of Nephrology and Dialysis, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Lorenzo D'Antiga
- Unit of Pediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luisa Pasulo
- Unit of Gastroenterology 1, Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabio Pezzoli
- Medical Direction, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Gianatti
- Unit of Pathology, Department of Laboratory Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Piercarlo Parigi
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Claudio Farina
- Department of Laboratory Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio Bellasi
- Department of Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Solidoro
- Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sandro Sironi
- University of Milano-Bicocca, Milan, Italy.,Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano DI Marco
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy - .,University of Milan, Milan, Italy
| | - Stefano Fagiuoli
- Unit of Gastroenterology 1, Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
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Cortesi PA, Conti S, Scalone L, Jaffe A, Ciaccio A, Okolicsanyi S, Rota M, Fabris L, Colledan M, Fagiuoli S, Belli LS, Cesana G, Strazzabosco M, Mantovani LG. Health related quality of life in chronic liver diseases. Liver Int 2020; 40:2630-2642. [PMID: 32851764 DOI: 10.1111/liv.14647] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/13/2020] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The impact of chronic liver diseases (CLDs) on health-related quality of life (HRQoL) is relevant to understand the burden of these conditions and inform decision-making processes related to their care. Studies simultaneously comparing the HRQoL of patients affected by the major CLDs to that of the general population are still lacking and are the subject of this study. METHODS Using the EQ-5D-3L questionnaire, we analysed and compared HRQoL data from 2962 Italian patients affected by CLDs and forming a representative sample of the general Italian population (6800 individuals). Exploratory analyses were conducted to investigate the effects of each CLD on HRQoL, using the general population as reference and adjusting for possible confounders. RESULTS Patients with CLDs (HBV, HCV, PSC, PBC, AIH, NAFLD/NASH) in the chronic hepatitis stage and with compensated cirrhosis (CC) showed HRQoL similar to the general population. However, AIH were more likely to report problems in self-care and lower EQ-5D VAS score, while NAFLD/NASH and HCV showed an increased risk of anxiety/depression. On the other hand, with progression to more advanced stages of liver disease (DC or HCC), HRQoL decreased significantly with higher risk of reporting problems in the physical domains, and significant reductions in the VAS and utility index scores. CONCLUSIONS Different subtypes of CLD affected different QoL domains. This study therefore provides a real estimate of the impact of CLDs on patients' HRQoL, and represents a much needed tool to inform decision-making while assessing the effectiveness and cost-effectiveness of the care of these patients.
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Affiliation(s)
- Paolo A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Luciana Scalone
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Ariel Jaffe
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Antonio Ciaccio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Stefano Okolicsanyi
- Department of Surgical Disciplines, Gastroenterology and Digestive Endoscopy, Umberto Parini Hospital, Aosta, Italy
| | - Matteo Rota
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.,Department of Molecular and Traslational Medicine, University of Brescia, Brescia, Italy
| | - Luca Fabris
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Molecular Medicine, University of Padua School of Medicine, Padua, Italy
| | - Michele Colledan
- Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Gastroenterology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca S Belli
- Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milan, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Mario Strazzabosco
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Lorenzo G Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.,IRCCS Multimedica, Sesto San Giovanni, Italy
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43
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Iavarone M, D'Ambrosio R, Soria A, Triolo M, Pugliese N, Del Poggio P, Perricone G, Massironi S, Spinetti A, Buscarini E, Viganò M, Carriero C, Fagiuoli S, Aghemo A, Belli LS, Lucà M, Pedaci M, Rimondi A, Rumi MG, Invernizzi P, Bonfanti P, Lampertico P. High rates of 30-day mortality in patients with cirrhosis and COVID-19. J Hepatol 2020; 73:1063-1071. [PMID: 32526252 PMCID: PMC7280108 DOI: 10.1016/j.jhep.2020.06.001] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities, but its impact on patients with cirrhosis is currently unknown. Herein, we aimed to evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis. METHODS In this multicentre retrospective study, patients with cirrhosis and a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. Clinical and biochemical data at diagnosis of COVID-19 and at the last outpatient visit were obtained through review of medical records. RESULTS Fifty patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virus-related, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/polypnea, 22% encephalopathy, 96% needed hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with a model for end-stage liver disease (MELD) score ≥15 increased from 13% to 26% (p = 0.037), acute-on-chronic liver failure and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. The severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections. CONCLUSION COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis. LAY SUMMARY Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities. Herein, we assessed its impact on patients with cirrhosis. Infection with COVID-19 was associated with liver function deterioration and elevated mortality in patients with cirrhosis.
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Affiliation(s)
- Massimo Iavarone
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy.
| | - Roberta D'Ambrosio
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Alessandro Soria
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano - Bicocca School of Medicine, Monza, Italy
| | - Michela Triolo
- Gastroenterology 1 - Hepatology & Transplantology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Paolo Del Poggio
- UO Gastroenterologia. Policlinico S. Marco, Zingonia-Bergamo, Italy
| | | | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Angiola Spinetti
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Elisabetta Buscarini
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Ospedale Maggiore, Crema, Italy
| | - Mauro Viganò
- Division of Hepatology, Ospedale San Giuseppe, Italy
| | - Canio Carriero
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Stefano Fagiuoli
- Gastroenterology 1 - Hepatology & Transplantology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Luca S Belli
- Hepatology and Gastroenterology Unit, Niguarda Hospital, Milan, Italy
| | - Martina Lucà
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marianna Pedaci
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Ospedale Maggiore, Crema, Italy; University of Milan, Milan, Italy
| | - Alessandro Rimondi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; University of Milan, Milan, Italy
| | - Maria Grazia Rumi
- Division of Hepatology, Ospedale San Giuseppe, Italy; University of Milan, Milan, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Paolo Bonfanti
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano - Bicocca School of Medicine, Monza, Italy
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Merli M, Pasulo L, Perricone G, Travi G, Rossotti R, Colombo VG, De Carlis R, Chiappetta S, Moioli MC, Minetti E, Frigerio M, De Carlis LG, Belli L, Fagiuoli S, Puoti M. Impact of immunosuppressive therapy on the severity of COVID-19 in solid organ transplant recipients. J Infect 2020; 82:414-451. [PMID: 33127455 PMCID: PMC7590634 DOI: 10.1016/j.jinf.2020.10.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Marco Merli
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Luisa Pasulo
- Division of Gastroenterology, Hepatology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giovanna Travi
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | | | - Stefania Chiappetta
- Division of Gastroenterology, Hepatology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Enrico Minetti
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Maria Frigerio
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Luca Belli
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Massimo Puoti
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Gerussi A, Rigamonti C, Elia C, Cazzagon N, Floreani A, Pozzi R, Pozzoni P, Claar E, Pasulo L, Fagiuoli S, Cristoferi L, Carbone M, Invernizzi P. Coronavirus Disease 2019 in Autoimmune Hepatitis: A Lesson From Immunosuppressed Patients. Hepatol Commun 2020; 4:1257-1262. [PMID: 32838102 PMCID: PMC7300554 DOI: 10.1002/hep4.1557] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic immunosuppression is associated with increased and more severe viral infections. However, little is known about the association between immunosuppression and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Our aim was to describe the clinical course of patients with immunosuppressed autoimmune hepatitis (AIH) during coronavirus disease 2019 (COVID-19) infection in Italy. Our study is a case series of patients with AIH treated with immunosuppression, who tested positive for SARS-CoV-2 in March 2020 during the outbreak of COVID-19. Ten patients from seven different hospitals in Italy were diagnosed with COVID-19 during the outbreak of SARS-CoV-2 in March 2020. Seven subjects were female (70%), and age ranged from 27 to 73 years. Before the onset of SARS-CoV-2 infection, all patients were taking immunosuppressive therapy for AIH, and eight of them were on biochemical remission. Two other patients had recent acute onset of their AIH, and consequently started high-dose steroids, as per induction protocol. All patients had a respiratory syndrome and a positive nasal swab for SARS-CoV-2. Five patients developed a computed tomography-confirmed COVID-19 pneumonia. Six subjects received a combination of antiretroviral and antimalarial drugs. In seven patients, the dosage of immunosuppressive medication was changed. Liver enzymes were repeated during SARS-CoV-2 infection in all hospitalized cases; they remained within the normal range in all cases, and improved in the two acute cases treated with high-dose steroids. The clinical outcome was comparable to the reported cases occurring in non-immunosuppressed subjects. Conclusion: Patients under immunosuppressive therapy for AIH developing COVID-19 show a disease course presumptively similar to that reported in the non-immunosuppressed population. These data might aid in medical decisions when dealing with SARS-CoV-2 infection in immunocompromised patients.
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Affiliation(s)
- Alessio Gerussi
- Division of Gastroenterology and Center for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- European Reference Network on Hepatological DiseasesSan Gerardo HospitalMonzaItaly
| | - Cristina Rigamonti
- Department of Translational MedicineUniversità del Piemonte Orientale UPONovaraItaly
- Division of Internal MedicineAOU Maggiore della CaritàNovaraItaly
| | - Chiara Elia
- Gastroenterology UnitCardinal Massaia HospitalAstiItaly
| | - Nora Cazzagon
- Department of Surgery, Oncology and GastroenterologyUniversity of PadovaPadovaItaly
- European Reference Network on Hepatological Diseases, Gastroenterology UnitAzienda Ospedaliera Universitaria PadovaPadovaItaly
| | - Annarosa Floreani
- Department of Surgery, Oncology and GastroenterologyUniversity of PadovaPadovaItaly
- IRCCS NegrarVeronaItaly
| | | | | | | | - Luisa Pasulo
- Gastroenterology, Hepatology and Liver Transplantation UnitDepartment of MedicineASST Papa Giovanni XXIIIBergamoItaly
| | - Stefano Fagiuoli
- Gastroenterology, Hepatology and Liver Transplantation UnitDepartment of MedicineASST Papa Giovanni XXIIIBergamoItaly
| | - Laura Cristoferi
- Division of Gastroenterology and Center for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- European Reference Network on Hepatological DiseasesSan Gerardo HospitalMonzaItaly
| | - Marco Carbone
- Division of Gastroenterology and Center for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- European Reference Network on Hepatological DiseasesSan Gerardo HospitalMonzaItaly
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- European Reference Network on Hepatological DiseasesSan Gerardo HospitalMonzaItaly
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Rambaldi A, Gritti G, Micò MC, Frigeni M, Borleri G, Salvi A, Landi F, Pavoni C, Sonzogni A, Gianatti A, Binda F, Fagiuoli S, Di Marco F, Lorini L, Remuzzi G, Whitaker S, Demopulos G. Endothelial injury and thrombotic microangiopathy in COVID-19: Treatment with the lectin-pathway inhibitor narsoplimab. Immunobiology 2020; 225:152001. [PMID: 32943233 PMCID: PMC7415163 DOI: 10.1016/j.imbio.2020.152001] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [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: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/30/2022]
Abstract
In COVID-19, acute respiratory distress syndrome (ARDS) and thrombotic events are frequent, life-threatening complications. Autopsies commonly show arterial thrombosis and severe endothelial damage. Endothelial damage, which can play an early and central pathogenic role in ARDS and thrombosis, activates the lectin pathway of complement. Mannan-binding lectin-associated serine protease-2 (MASP-2), the lectin pathway’s effector enzyme, binds the nucleocapsid protein of severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2), resulting in complement activation and lung injury. Narsoplimab, a fully human immunoglobulin gamma 4 (IgG4) monoclonal antibody against MASP-2, inhibits lectin pathway activation and has anticoagulant effects. In this study, the first time a lectin-pathway inhibitor was used to treat COVID-19, six COVID-19 patients with ARDS requiring continuous positive airway pressure (CPAP) or intubation received narsoplimab under compassionate use. At baseline and during treatment, circulating endothelial cell (CEC) counts and serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8), C-reactive protein (CRP) and lactate dehydrogenase (LDH) were assessed. Narsoplimab treatment was associated with rapid and sustained reduction of CEC and concurrent reduction of serum IL-6, IL-8, CRP and LDH. Narsoplimab was well tolerated; no adverse drug reactions were reported. Two control groups were used for retrospective comparison, both showing significantly higher mortality than the narsoplimab-treated group. All narsoplimab-treated patients recovered and survived. Narsoplimab may be an effective treatment for COVID-19 by reducing COVID-19-related endothelial cell damage and the resultant inflammation and thrombotic risk.
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Affiliation(s)
- Alessandro Rambaldi
- Department of Oncology-Hematology University of Milan, Milan, Italy; Unit of Hematology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.
| | - Giuseppe Gritti
- Unit of Hematology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Caterina Micò
- Unit of Hematology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Frigeni
- Unit of Hematology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Gianmaria Borleri
- Unit of Hematology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Salvi
- Unit of Hematology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Landi
- Unit of Hematology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Pavoni
- Unit of Hematology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Aurelio Sonzogni
- Unit of Pathology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Gianatti
- Unit of Pathology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Binda
- Unit of Infectious Diseases, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Unit of Gastroenterology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- Unit of Pneumology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy; Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Lorini
- Unit of Intensive Care, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
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Mangia A, Milligan S, Khalili M, Fagiuoli S, Shafran SD, Carrat F, Ouzan D, Papatheodoridis G, Ramji A, Borgia SM, Wedemeyer H, Losappio R, Pérez‐Hernandez F, Wick N, Brown RS, Lampertico P, Doucette K, Ntalla I, Ramroth H, Mertens M, Vanstraelen K, Turnes J. Global real-world evidence of sofosbuvir/velpatasvir as simple, effective HCV treatment: Analysis of 5552 patients from 12 cohorts. Liver Int 2020; 40:1841-1852. [PMID: 32449966 PMCID: PMC7496473 DOI: 10.1111/liv.14537] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 02/21/2020] [Revised: 04/24/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Achieving sustained virological response (SVR; cure) in hepatitis C patients using a simple regimen is key to making elimination by 2030 possible. In the largest real-world analysis to date, the effectiveness of pangenotypic, panfibrotic, single-tablet, sofosbuvir/velpatasvir (SOF/VEL) once-daily for 12 weeks was assessed in 12 clinical real-world cohorts from various geographical areas, settings and treatment practices. Factors affecting risk of not achieving SVR were assessed. METHODS Adults treated with SOF/VEL 400/100 mg, without ribavirin, were included. All HCV patients reaching Week 12 or 24 post-treatment were assessed for SVR12/24. Factors associated with not achieving SVR12/24 for virological reasons were evaluated using logistic regression analysis. RESULTS Overall, 5552 patients were included: 13.3% treatment-experienced; 20.7% compensated cirrhotic; 30.2% genotype 1; 29.5% genotype 2; 32.9% genotype 3; 4.7% genotype 4; 3.7% HIV coinfection; 13.4% current/former intravenous drug use. Of the 5196 patients evaluated for effectiveness, 98.9% achieved SVR12/24. High SVR12/24 rates occurred in all genotypes including genotype 3 (98.3%; 1649/1677) and in those with compensated cirrhosis (97.9; 1055/1078). Only 55 patients did not achieve SVR12/24 due to a virological reason; the only factor statistically significantly associated with an increased risk of not achieving SVR12/24 was compensated cirrhosis (P = .002). Overall, 6% (332/5552) of patients did not achieve SVR12/24 for non-virological reasons (67% lost to follow-up; 26.5% early treatment discontinuation). CONCLUSIONS In this large cohort, representative of clinical practice, a simple 12-week regimen of SOF/VEL without ribavirin resulted in high SVR12/24 rates in diverse patient populations, even among those with compensated cirrhosis.
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Affiliation(s)
| | | | | | | | | | - Fabrice Carrat
- Sorbonne UniversitéINSERMInstitut Pierre Louis Epidémiologie et Santé PubliqueAPHP.Sorbonne UniversitéParisFrance
| | - Denis Ouzan
- Institut Arnault TzanckSaint‐Laurent‐du‐VarFrance
| | | | | | | | | | | | | | | | - Robert S. Brown
- Weill Cornell MedicineDepartment of MedicineNew York CityUSA
| | - Pietro Lampertico
- Fondazione IRCCS Ca’ GrandaOspedale Maggiore PoliclinicoUniversity of MilanMilanItaly
| | | | - Ioanna Ntalla
- Gilead Sciences Europe LtdStockley ParkUnited Kingdom
| | | | | | | | - Juan Turnes
- Department of Gastroenterology and HepatologyC.H.U. Pontevedra and IIS Galicia SurPontevedraSpain
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48
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Mazzaferro V, Citterio D, Bhoori S, Bongini M, Miceli R, De Carlis L, Colledan M, Salizzoni M, Romagnoli R, Antonelli B, Vivarelli M, Tisone G, Rossi M, Gruttadauria S, Di Sandro S, De Carlis R, Lucà MG, De Giorgio M, Mirabella S, Belli L, Fagiuoli S, Martini S, Iavarone M, Svegliati Baroni G, Angelico M, Ginanni Corradini S, Volpes R, Mariani L, Regalia E, Flores M, Droz Dit Busset M, Sposito C. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial. Lancet Oncol 2020; 21:947-956. [PMID: 32615109 DOI: 10.1016/s1470-2045(20)30224-2] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Indications for liver transplantation for hepatocellular carcinoma are evolving and so-called expanded criteria remain debated. Locoregional therapies are able to downstage hepatocellular carcinoma from beyond to within the Milan criteria. We aimed to investigate the efficacy of liver transplantation after successful hepatocellular carcinoma downstaging. METHODS We did an open-label, multicentre, randomised, controlled trial designed in two phases, 2b and 3, at nine Italian tertiary care and transplantation centres. Patients aged 18-65 years with hepatocellular carcinoma beyond the Milan criteria, absence of macrovascular invasion or extrahepatic spread, 5-year estimated post-transplantation survival of at least 50%, and good liver function (Child-Pugh A-B7) were recruited and underwent tumour downstaging with locoregional, surgical, or systemic therapies according to multidisciplinary decision. After an observation period of 3 months, during which sorafenib was allowed, patients with partial or complete responses according to modified Response Evaluation Criteria in Solid Tumors were randomly assigned (1:1) by an interactive web-response system to liver transplantation or non-transplantation therapies (control group). A block randomisation (block size of 2), stratified by centre and compliance to sorafenib treatment, was applied. Liver transplantation was done with whole or split organs procured from brain-dead donors. The control group received sequences of locoregional and systemic treatment at the time of demonstrated tumour progression. The primary outcomes were 5-year tumour event-free survival for phase 2b and overall survival for phase 3. Analyses were by intention to treat. Organ allocation policy changed during the course of the study and restricted patient accrual to 4 years. This trial is registered with ClinicalTrials.gov, NCT01387503. FINDINGS Between March 1, 2011, and March 31, 2015, 74 patients were enrolled. Median duration of downstaging was 6 months (IQR 4-11). 29 patients dropped out before randomisation and 45 were randomly assigned: 23 to the transplantation group versus 22 to the control group. At data cutoff on July 31, 2019, median follow-up was 71 months (IQR 60-85). 5-year tumour event-free survival was 76·8% (95% CI 60·8-96·9) in the transplantation group versus 18·3% (7·1-47·0) in the control group (hazard ratio [HR] 0·20, 95% CI 0·07-0·57; p=0·003). 5-year overall survival was 77·5% (95% CI 61·9-97·1) in the transplantation group versus 31·2% (16·6-58·5) in the control group (HR 0·32, 95% CI 0·11-0·92; p=0·035). The most common registered grade 3-4 serious adverse events were hepatitis C virus recurrence (three [13%] of 23 patients) and acute transplant rejection (two [9%]) in the transplantation group, and post-embolisation syndrome (two [9%] of 22 patients) in the control group. Treatment-related deaths occurred in four patients: two (8%) of 23 patients in the transplantation group (myocardial infarction and multi-organ failure) versus two (9%) of 22 patients in the control group (liver decompensation). INTERPRETATION Although results must be interpreted with caution owing to the early closing of the trial, after effective and sustained downstaging of eligible hepatocellular carcinomas beyond the Milan criteria, liver transplantation improved tumour event-free survival and overall survival compared with non-transplantation therapies Post-downstaging tumour response could contribute to the expansion of hepatocellular carcinoma transplantation criteria. FUNDING Italian Ministry of Health.
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Affiliation(s)
- Vincenzo Mazzaferro
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy.
| | - Davide Citterio
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Sherrie Bhoori
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Marco Bongini
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Rosalba Miceli
- Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Luciano De Carlis
- General Surgery and Abdominal Transplantation Unit, Hepatology, University of Milano-Bicocca andNiguarda-CàGranda Hospital, Milan, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, Gastroenterology, Hepatology and Liver Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Salizzoni
- General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Cittàdella Salute e della Scienza di Torino, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Cittàdella Salute e della Scienza di Torino, Turin, Italy
| | - Barbara Antonelli
- General and Liver Transplant Surgery Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Hepatology, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Giuseppe Tisone
- Department of Surgical Sciences and Medical Sciences University of Rome-Tor Vergata, Rome, Italy
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Sapienza University, Rome, Italy
| | - Salvatore Gruttadauria
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, ISMETT, Palermo, Italy
| | - Stefano Di Sandro
- General Surgery and Abdominal Transplantation Unit, Hepatology, University of Milano-Bicocca andNiguarda-CàGranda Hospital, Milan, Italy
| | - Riccardo De Carlis
- General Surgery and Abdominal Transplantation Unit, Hepatology, University of Milano-Bicocca andNiguarda-CàGranda Hospital, Milan, Italy
| | - Maria Grazia Lucà
- Department of Organ Failure and Transplantation, Gastroenterology, Hepatology and Liver Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo De Giorgio
- Department of Organ Failure and Transplantation, Gastroenterology, Hepatology and Liver Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Mirabella
- General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Cittàdella Salute e della Scienza di Torino, Turin, Italy
| | - Luca Belli
- General Surgery and Abdominal Transplantation Unit, Hepatology, University of Milano-Bicocca andNiguarda-CàGranda Hospital, Milan, Italy
| | - Stefano Fagiuoli
- Department of Organ Failure and Transplantation, Gastroenterology, Hepatology and Liver Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Martini
- General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Cittàdella Salute e della Scienza di Torino, Turin, Italy
| | - Massimo Iavarone
- Division of Gastroenterology and Hepatology, CRC A M and A Migliavacca Center for Liver Disease, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Svegliati Baroni
- Hepatobiliary and Abdominal Transplantation Surgery, Hepatology, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Mario Angelico
- Department of Surgical Sciences and Medical Sciences University of Rome-Tor Vergata, Rome, Italy
| | | | - Riccardo Volpes
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, ISMETT, Palermo, Italy
| | - Luigi Mariani
- Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Enrico Regalia
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Maria Flores
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Michele Droz Dit Busset
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Carlo Sposito
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
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Duca A, Memaj I, Zanardi F, Preti C, Alesi A, Della Bella L, Ghezzi E, Di Marco F, Lorini FL, Venturelli S, Fagiuoli S, Cosentini R. Severity of respiratory failure and outcome of patients needing a ventilatory support in the Emergency Department during Italian novel coronavirus SARS-CoV2 outbreak: Preliminary data on the role of Helmet CPAP and Non-Invasive Positive Pressure Ventilation. EClinicalMedicine 2020; 24:100419. [PMID: 32766538 PMCID: PMC7301102 DOI: 10.1016/j.eclinm.2020.100419] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Novel Coronavirus SARS-CoV-2 pandemic is spreading around the world. At the end of February, the outburst of the pandemic has hit hard on northern Italian's hospitals. As of today, no data have been published regarding the severity of respiratory failure of patients presenting to the Emergency Departments. Moreover, the outcome the patients forced to undergo Continuous Positive Airway Pressure (CPAP) or Non-Invasive Positive Pressure Ventilation (NIPPV) due to lack of Intensive Care resources is unknown. "Papa Giovanni XXIII" hospital (HPG23) of Bergamo is one of the largest hospitals in the Country, with an Emergency Department (ED) managing over 100,000 patients per year. METHODS This is a retrospective observational study based on chart review of patients presenting to the Emergency Department of HPG23 from 29/02/2020 to 10/03/2020 with a clinical condition highly suspicious for COVID-19 infection. Registration of admission rates, severity of respiratory failure (ARDS classification), need of respiratory support, SARS-CoV-2 PCR test and outcome of patients treated with a ventilatory support were registered on 10th of May 2020. FINDINGS From 29/02 to 10/03 611 patients with a suspected diagnosis of COVID-19 infection were evaluated in our ED; 320 (52%) met the criteria for hospital admission and 99 (31%) needed to be immediately started on ventilatory support (81% CPAP, 7% NIPPV, 12% Invasive Mechanical Ventilation). Eighty-five (86%) of the 99 patients needing a ventilatory support eventually had SARS-CoV-2 infection confirmed by PCR test on nasal-pharyngeal swab. Their median PO2/FiO2 ratio was 128 (IQR 85-168), with 23 patients (29.5%) classified as severe ARDS. Mortality rate as of 10th of May was 76.5%, ranging from 44.4% within patients <60 years old to 85% within those older than 60 years (p = 0.001). NIPPV/CPAP failure occurred in 91.5% of patients. INTERPRETATION The population of patients suspected for COVID-19 infection presenting at our ED showed a very high rate of severe respiratory failure, with urgent need of a large amount of intensive care resources. Mortality rates of critically ill patients with confirmed COVID-19 (76.5%) are similar to previously reported studies with similar population. CPAP/NIPPV could be a valid strategy to treat severely hypoxic patients that cannot be intubated in the ED due to lack of intensive care resources. FUNDING No funds were received for this research project.
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Affiliation(s)
- Andrea Duca
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy
- Corresponding author.
| | - Irdi Memaj
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Carlo Preti
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Alesi
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Elena Ghezzi
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | | | - Stefano Fagiuoli
- Internal Medicine Department, ASST Papa Giovanni XXIII, Bergamo, Italy
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50
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Manini MA, Bruce M, Whitehouse G, Mazzarelli C, Considine A, Agarwal K, Suddle A, Fagiuoli S, Heaton N, Heneghan M. A Very Short Course of HBIg+NA Followed by Entecavir or Tenofovir Monotherapy Prevents HBV Recurrence in Low-Risk Liver Transplant Recipients. Transplant Proc 2020; 53:207-214. [PMID: 32605776 DOI: 10.1016/j.transproceed.2020.04.1822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/20/2020] [Accepted: 04/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Monoprophylaxis with third-generation nucleos(t)ide analogues (NAs) can be safely adopted in hepatitis B virus (HBV)-positive, liver transplantation (LT) patients after at least 6 months of HBV immunoglobulin (HBIg)+NA. We investigated the efficacy of earlier initiation of post-LT entecavir (ETV) or tenofovir (TDF) monoprophylaxis. METHODS Between September 2011 and January 2017, all consecutive hepatitis B surface antigen (HBsAg)-positive transplanted patients were scheduled to receive HBIg with ETV or TDF for a period related to the risk for HBV reinfection: 1. low-risk patients (HBeAg-negative and HBV DNA < 12 IU/mL before LT) were due to withdraw from HBIg once HBsAg had become negative after a minimum of 7 days of HBIg+NA; 2. high-risk patients were due to receive HBIg for at least 6 months, after which they continued with third-generation NA monotherapy, only. RESULTS Twenty patients with a median interquartile range (IQR) follow-up of 46 (64-39) months were enrolled in the study (40% receiving ETV, 60% receiving TDF). Two low-risk patients refused early HBIg withdrawal and were therefore treated and analyzed along with the high-risk group. Eventually, there were 2 groups: group A, which included 12 low-risk patients, and group B, which included 8 patients (six high-risk, 2 low-risk). After transplantation, group A and B patients received HBIg+NA for a median (IQR) time of 7 (9-7) days and 9 (13-5) months, respectively. All 20 recipients demonstrated HBV DNA < 12 IU/mL and stable graft function during follow-up. Two patients (10%), 1 from each group, had HBsAg relapse. Notably, both patients who relapsed had hepatocellular carcinoma (HCC) diagnosed before LT and showed very low levels (< 0.25 IU/mL) of HBsAg after recurrence. CONCLUSION In low-risk HBsAg-positive recipients, HBIg may be safely discontinued within 2 weeks of LT and replaced by ETV or TDF monotherapy.
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Affiliation(s)
- Matteo A Manini
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; Gastroenterology, Hepatology, and Transplant Unit, Department of Specialty and Transplant Medicine, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy.
| | - Matthew Bruce
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Gavin Whitehouse
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Chiara Mazzarelli
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; Gastroenterology and Hepatology, ASST Ospedale Metropolitano Niguarda, Milano, Italy
| | - Aisling Considine
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Abid Suddle
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Stefano Fagiuoli
- Gastroenterology, Hepatology, and Transplant Unit, Department of Specialty and Transplant Medicine, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Michael Heneghan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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