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Cadranel JFD, Zougmoré HT, Efole JRN, Hanslik B, Causse X, Rosa I, Lemaitre C, Mokhtari C, Baron A, Thevenot T, Medmoun M, Smadhi R, Fantognon G, Remy AJ, Macaigne G, Arondel Y, Arpurt JP, Bellaiche G, Bourlière M, De Kerguenec C, Heluwaert F, Verlynde J, Halfon P, Roulot D, Carrier P, Loustaud-Ratti V, Lemagoarou T. Hepatitis B Delta: assessment of the knowledge and practices of hepato-gastroenterologists practicing in non-academic settings in France. Eur J Gastroenterol Hepatol 2024; 36:735-741. [PMID: 38683191 DOI: 10.1097/meg.0000000000002707] [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] [Indexed: 05/01/2024]
Abstract
BACKGROUND Data on the management of Hepatitis B-Delta (HB-D) by hepatogastroenterologists (HGs) practicing in nonacademic hospitals or private practices are unknown in France. OBJECTIVE We aimed to evaluate the knowledge and practices of HGs practicing in nonacademic settings regarding HB-D. METHODS A Google form document was sent to those HGs from May to September 2021. RESULTS A total of 130 HGs (mean age, 45 years) have participated in this survey. Among HBsAg-positive patients, Delta infection was sought in only 89% of cases. Liver fibrosis was assessed using FibroScan in 77% of the cases and by liver biopsy in 81% of the cases. A treatment was proposed for patients with >F2 liver fibrosis in 49% of the cases regardless of transaminase levels and for all the patients by 39% of HGs. Responding HGs proposed a treatment using pegylated interferon in 50% of cases, bulevirtide in 45% of cases and a combination of pegylated interferon and bulevirtide in 40.5% of cases. Among the criteria to evaluate the treatment efficacy, a decrease or a normalization of transaminases was retained by 89% of responding HGs, a reduction of liver fibrosis score for 70% of them, an undetectable delta RNA and HBsAg for 55% of them and a 2 log 10 decline in delta viremia for 62% of the cases. CONCLUSION Hepatitis Delta screening was not systematically performed in HBsAg-positive patients despite the probable awareness and knowledge of the few responders who were able to prescribe treatments of hepatitis delta.
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Affiliation(s)
| | | | | | | | | | - Isabelle Rosa
- Department of Liver and Digestive Diseases, CHI Créteil
| | | | | | - Aurore Baron
- Department of Liver and Digestive Diseases, Corbeil
| | | | - Mourad Medmoun
- Department of Liver and Digestive Diseases, GHPSO, Creil
| | - Ryad Smadhi
- Department of Liver and Digestive Diseases, GHPSO, Creil
| | | | - André J Remy
- Department of Liver and Digestive Diseases, Perpignan
| | | | - Yves Arondel
- Department of Liver and Digestive Diseases, Haguenau
| | | | - Guy Bellaiche
- Department of Liver and Digestive Diseases, Aulnay-sous-bois
| | | | | | | | | | - Philippe Halfon
- Department of Internal Medicine and Infectious Diseases, Alphabio Laboratory Marseille, Marseille
| | | | - Paul Carrier
- Department of Liver and Digestive Diseases, Limoges
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Callum J, Skubas NJ, Bathla A, Keshavarz H, Clark EG, Rochwerg B, Fergusson D, Arbous S, Bauer SR, China L, Fung M, Jug R, Neill M, Paine C, Pavenski K, Shah PS, Robinson S, Shan H, Szczepiorkowski ZM, Thevenot T, Wu B, Stanworth S, Shehata N. Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines. Chest 2024:S0012-3692(24)00285-X. [PMID: 38447639 DOI: 10.1016/j.chest.2024.02.049] [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: 11/21/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Albumin is used commonly across a wide range of clinical settings to improve hemodynamics, to facilitate fluid removal, and to manage complications of cirrhosis. The International Collaboration for Transfusion Medicine Guidelines developed guidelines for the use of albumin in patients requiring critical care, undergoing cardiovascular surgery, undergoing kidney replacement therapy, or experiencing complications of cirrhosis. METHODS Cochairs oversaw the guideline development process and the panel included researchers, clinicians, methodologists, and a patient representative. The evidence informing this guideline arises from a systematic review of randomized clinical trials and systematic reviews, in which multiple databases were searched (inception through November 23, 2022). The panel reviewed the data and formulated the guideline recommendations using Grading of Recommendations Assessment, Development and Evaluation methodology. The guidelines were revised after public consultation. RESULTS The panel made 14 recommendations on albumin use in adult critical care (three recommendations), pediatric critical care (one recommendation), neonatal critical care (two recommendations), cardiovascular surgery (two recommendations), kidney replacement therapy (one recommendation), and complications of cirrhosis (five recommendations). Of the 14 recommendations, two recommendations had moderate certainty of evidence, five recommendations had low certainty of evidence, and seven recommendations had very low certainty of evidence. Two of the 14 recommendations suggested conditional use of albumin for patients with cirrhosis undergoing large-volume paracentesis or with spontaneous bacterial peritonitis. Twelve of 14 recommendations did not suggest albumin use in a wide variety of clinical situations where albumin commonly is transfused. CONCLUSIONS Currently, few evidence-based indications support the routine use of albumin in clinical practice to improve patient outcomes. These guidelines provide clinicians with actionable recommendations on the use of albumin.
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Affiliation(s)
- Jeannie Callum
- Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston.
| | - Nikolaos J Skubas
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland
| | | | | | - Edward G Clark
- Division of Nephrology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa
| | - Bram Rochwerg
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton
| | - Dean Fergusson
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa
| | - Sesmu Arbous
- Department of Critical Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Seth R Bauer
- Department of Pharmacy, Cleveland Clinic, Cleveland
| | - Louise China
- Department of Hepatology and ILDH, The Royal Free NHS Trust and University College London, London
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT
| | - Rachel Jug
- University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Cary Paine
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, ON
| | - Prakesh S Shah
- Institute of Health Policy, Management, and Evaluation, Mount Sinai Hospital, Toronto, ON; Department of Pediatrics, Mount Sinai Hospital, Toronto, ON
| | - Susan Robinson
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London
| | - Hua Shan
- Department of Pathology, Stanford University School of Medicine, Palo Alto
| | | | - Thierry Thevenot
- Service d'Hépatologie, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France
| | - Bovey Wu
- Department of Internal Medicine, Graduate Medical Education, Loma Linda University, Loma Linda, CA
| | - Simon Stanworth
- NHS Blood and Transplant, Oxford, England; Radcliffe Department of Medicine, University of Oxford, Oxford, England; John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Nadine Shehata
- Department of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, ON; Transfusion Medicine Laboratory, Mount Sinai Hospital, Toronto, ON
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3
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Di Martino V, Questiaux J, Lemagoarou T, Weil D, Vendeville S, Engelmann C, Hu J, Singh V, Newsome PN, Lal SB, Sarin SK, Berg T, Thevenot T. Granulocyte colony stimulating factor in decompensated cirrhosis, acute alcoholic hepatitis, and acute-on-chronic liver failure: A comprehensive meta-analysis of randomized controlled trials. Clin Res Hepatol Gastroenterol 2023; 47:102207. [PMID: 37716522 DOI: 10.1016/j.clinre.2023.102207] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/08/2023] [Accepted: 09/08/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND GCSF may improve the prognosis of severe liver disease by promoting liver regeneration and immune restoration. Our Aim was to investigate its controversial efficacy in decompensated cirrhosis, acute alcoholic hepatitis (AAH), or acute-on-chronic liver failure (ACLF) through meta-analysis. METHODS Meta-analysis of proportions (random effect model) including 19 RCTs (1287 patients from 16 Asian and 3 European studies including 487 ACLF, 231 AAH and 569 cirrhotic patients) evaluating survival at day-28, day-90, 6 months, one year, and/or occurrence of sepsis as major outcomes. RESULTS In patients with decompensated cirrhosis, G-CSF administration was associated with a reduction in the weight-adjusted risk of mortality of 9% at day-90 (OR=0.33; 95%CI: 0.18-0.58; p = 0.0002), 16% at 6 months (OR=0.31; 95%CI: 0.15-0.62; p = 0.0009), 26% at one year (OR=0.21; 95%CI:0.12-0.38, p<0.0001) and a weight-adjusted 28% risk reduction for sepsis (OR=0.28; 95%CI: 0.16-0.49; p<0.0001). Only Asian studies were positive. In AAH, G-CSF was associated with an 18% reduction in weight-adjusted mortality risk at day-28 (OR=0.31; 95%CI:0.11-0.83, p = 0.021), 32% at day-90 (OR=0.20; 95%CI:0.09-0.46, p<0.0001) and a weight-adjusted 42% risk reduction for sepsis (OR=0.17; 95%CI: 0.08-0.38; p<0.0001). Only Asian studies, in which corticosteroids were not given systematically in case of severe AAH, were positive. In patients with ACLF, the results on mortality at day-28 were heterogeneous, and GCSF had no beneficial effect on sepsis or survival at day-90. CONCLUSION G-CSF may be effective in patients with decompensated cirrhosis or AAH by reducing the occurrence of sepsis and mortality. Further meta-analyses of individual data, or new, powerful and methodologically flawless therapeutic trials, are warranted to confirm these results, which harbor wide divergences between Asian and European RCTs.
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Affiliation(s)
- Vincent Di Martino
- Service d'Hépatologie, CHU Jean Minjoz, Besançon, France; Laboratoire EPILAB EA4266, Université de Franche Comté, Besançon, France.
| | | | - Tristan Lemagoarou
- Département d'information Médicale et de Santé Publique, GHPSO CREIL, Creil, France
| | - Delphine Weil
- Service d'Hépatologie, CHU Jean Minjoz, Besançon, France; Laboratoire EPILAB EA4266, Université de Franche Comté, Besançon, France
| | | | - Cornelius Engelmann
- Department of Hepatology and Gastroenterology, Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany; Institute for Liver and Digestive Health, University College London, London, United Kingdom
| | - Jinhua Hu
- Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Virendra Singh
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Philip N Newsome
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Sadhna B Lal
- Division of Paediatric Gastroenterology and Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shiv K Sarin
- Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
| | - Thomas Berg
- Division of Hepatology Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Thierry Thevenot
- Service d'Hépatologie, CHU Jean Minjoz, Besançon, France; Laboratoire EPILAB EA4266, Université de Franche Comté, Besançon, France
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4
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Thevenot T, Desmarets M, Weil D, Di Martino V. Diameter of the shunt: the missing link in the appraisal of pTIPS in patients with cirrhosis with previous hepatic encephalopathy. Gut 2023; 72:2189-2190. [PMID: 36328411 DOI: 10.1136/gutjnl-2022-328761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon, France
| | - Maxime Desmarets
- uMETh, Centre d'investigation Clinique 1431, Hôpital Jean Minjoz, Besançon, France
- UMR1098 Right, Inserm, Établissement Français du Sang, Université Bourgogne-Franche-Comté, Besançon, France
| | - Delphine Weil
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon, France
| | - Vincent Di Martino
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon, France
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5
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Cadranel JFD, Ollivier-Hourmand I, Cadranel J, Thevenot T, Zougmore H, Nguyen-Khac E, Bureau C, Allaire M, Nousbaum JB, Loustaud-Ratti V, Causse X, Sogni P, Hanslik B, Bourliere M, Peron JM, Ganne-Carrie N, Dao T, Thabut D, Maitre B, Debzi N, Smadhi R, Sombie R, Kpossou R, Nouel O, Bissonnette J, Ruiz I, Medmoun M, Dastis SN, Deltenre P, Artru F, Raherison C, Elkrief L, Lemagoarou T. International survey among hepatologists and pulmonologists on the hepatic hydrothorax: plea for recommendations. BMC Gastroenterol 2023; 23:305. [PMID: 37697230 PMCID: PMC10496231 DOI: 10.1186/s12876-023-02931-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The Hepatic hydrothorax is a pleural effusion related to portal hypertension; its diagnosis and therapeutic management may be difficult. The aims of this article are which follows: To gather the practices of hepatogastroenterologists or pulmonologists practitioners regarding the diagnosis and management of the hepatic hydrothorax. METHODS Practitioners from 13 French- speaking countries were invited to answer an online questionnaire on the hepatic hydrothorax diagnosis and its management. RESULTS Five hundred twenty-eight practitioners (80% from France) responded to this survey. 75% were hepatogastroenterologists, 20% pulmonologists and the remaining 5% belonged to other specialities. The Hepatic hydrothorax can be located on the left lung for 64% of the responders (66% hepatogastroenterologists vs 57% pulmonologists; p = 0.25); The Hepatic hydrothorax can exist in the absence of clinical ascites for 91% of the responders (93% hepatogastroenterologists vs 88% pulmonologists; p = 0.27). An Ultrasound pleural scanning was systematically performed before a puncture for 43% of the responders (36% hepatogastroenterologists vs 70% pulmonologists; p < 0.001). A chest X-ray was performed before a puncture for 73% of the respondeurs (79% hepatogastroenterologists vs 54% pulmonologists; p < 0.001). In case of a spontaneous bacterial empyema, an albumin infusion was used by 73% hepatogastroenterologists and 20% pulmonologists (p < 0.001). A drain was used by 37% of the responders (37% hepatogastroenterologists vs 31% pulmonologists; p = 0.26).An Indwelling pleural catheter was used by 50% pulmonologists and 22% hepatogastroenterologists (p < 0.01). TIPS was recommended by 78% of the responders (85% hepatogastroenterologists vs 52% pulmonologists; p < 0.001) and a liver transplantation, by 76% of the responders (86% hepatogastroenterologists vs 44% pulmonologists; p < 0.001). CONCLUSIONS The results of this large study provide important data on practices of French speaking hepatogastroenterologists and pulmonologists; it appears that recommendations are warranted.
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Affiliation(s)
| | | | | | | | - Honoré Zougmore
- Hepatogastroenterology and Nutrition Department GHPSO Boulevard Laennec, 60100, Creil, France
| | | | | | - Manon Allaire
- Hepatogastroenterology Department, La Pitié Salpétrière, Paris, France
| | | | | | | | | | | | - Marc Bourliere
- Hepatogastroenterology department, Saint-Joseph, Marseille, France
| | | | | | - Thong Dao
- Hepatogastroenterology department, CHU Caen, Caen, France
| | - Dominique Thabut
- Hepatogastroenterology Department, La Pitié Salpétrière, Paris, France
| | | | - Nabil Debzi
- Hepatology Department CHU Mustapha, Alger, Algérie, Algeria
| | - Ryad Smadhi
- Hepatogastroenterology and Nutrition Department GHPSO Boulevard Laennec, 60100, Creil, France
- Hepatology Department CHU Mustapha, Alger, Algérie, Algeria
| | - Roger Sombie
- Gastroenterology Department, CHU Yalgado Ouedraogo Ouagadougou, Ouagadougou, Burkina Faso
| | - Raimi Kpossou
- Hepatogastroenterology Deparment, National Hospital and University Center Hubert Koutoukou Maga, Cotonou, Benin
| | - Olivier Nouel
- Hepatogastroenterology Department, St Brieuc, France
| | - Julien Bissonnette
- Department of Hepatology and Liver Transplantation, University of Montreal Hospital, Montreal, Canada
| | - Isaac Ruiz
- Department of Hepatology and Liver Transplantation, University of Montreal Hospital, Montreal, Canada
| | - Mourad Medmoun
- Hepatogastroenterology and Nutrition Department GHPSO Boulevard Laennec, 60100, Creil, France
| | | | | | - Florent Artru
- Hepatogastroenterology Department, Lausanne, Suisse, Switzerland
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6
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Bai Z, Méndez-Sánchez N, Romeiro FG, Mancuso A, Philips CA, Tacke F, Basaranoglu M, Primignani M, Ibrahim M, Wong YJ, Nery FG, Teschke R, Ferreira CN, Muñoz AE, Pinyopornpanish K, Thevenot T, Singh SP, Mohanty A, Satapathy SK, Ridola L, Maruyama H, Cholongitas E, Levi Sandri GB, Yang L, Shalimar, Yang Y, Villa E, Krag A, Wong F, Jalan R, O’Brien A, Bernardi M, Qi X. Use of albumin infusion for cirrhosis-related complications: An international position statement. JHEP Rep 2023; 5:100785. [PMID: 37456673 PMCID: PMC10339261 DOI: 10.1016/j.jhepr.2023.100785] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 02/17/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND & AIMS Numerous studies have evaluated the role of human albumin (HA) in managing various liver cirrhosis-related complications. However, their conclusions remain partially controversial, probably because HA was evaluated in different settings, including indications, patient characteristics, and dosage and duration of therapy. METHODS Thirty-three investigators from 19 countries with expertise in the management of liver cirrhosis-related complications were invited to organise an International Special Interest Group. A three-round Delphi consensus process was conducted to complete the international position statement on the use of HA for treatment of liver cirrhosis-related complications. RESULTS Twelve clinically significant position statements were proposed. Short-term infusion of HA should be recommended for the management of hepatorenal syndrome, large volume paracentesis, and spontaneous bacterial peritonitis in liver cirrhosis. Its effects on the prevention or treatment of other liver cirrhosis-related complications should be further elucidated. Long-term HA administration can be considered in specific settings. Pulmonary oedema should be closely monitored as a potential adverse effect in cirrhotic patients receiving HA infusion. CONCLUSIONS Based on the currently available evidence, the international position statement suggests the potential benefits of HA for the management of multiple liver cirrhosis-related complications and summarises its safety profile. However, its optimal timing and infusion strategy remain to be further elucidated. IMPACT AND IMPLICATIONS Thirty-three investigators from 19 countries proposed 12 position statements on the use of human albumin (HA) infusion in liver cirrhosis-related complications. Based on current evidence, short-term HA infusion should be recommended for the management of HRS, LVP, and SBP; whereas, long-term HA administration can be considered in the setting where budget and logistical issues can be resolved. However, pulmonary oedema should be closely monitored in cirrhotic patients who receive HA infusion.
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Affiliation(s)
- Zhaohui Bai
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Andrea Mancuso
- Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Cyriac Abby Philips
- Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, India
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Metin Basaranoglu
- Division of Gastroenterology, Department of Internal Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Massimo Primignani
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mostafa Ibrahim
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Yu Jun Wong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Filipe Gaio Nery
- Serviço de Cuidados Intensivos, Unidade de Cuidados Intermédios Médico-Cirúrgica, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Germany
| | - Carlos Noronha Ferreira
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria-Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Alberto E. Muñoz
- Sección Hepatología, Hospital Dr. Carlos B. Udaondo. Ciudad Autónoma de Buenos Aires, Argentina
| | - Kanokwan Pinyopornpanish
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thierry Thevenot
- Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Service d’Hépatologie et de Soins Intensifs Digestifs, Besançon, France
| | | | - Arpan Mohanty
- Section of Gastroenterology, Boston Medical Center, Boston, MA, USA
| | - Sanjaya K. Satapathy
- Department of Internal Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases & Transplantation, Donald and Barbara Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, New York, USA
| | - Lorenzo Ridola
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Li Yang
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Yongping Yang
- Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Erica Villa
- Department of Gastroenterology, University of Modena & Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Aleksander Krag
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Florence Wong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rajiv Jalan
- Liver Failure Group, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, University College London, London, UK
| | | | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China
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7
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Thabut D, Bouzbib C, Meunier L, Haas M, Weiss N, Louvet A, Imbert-Bismut F, Mochel F, Nadjar Y, Santiago A, Thevenot T, Duhalde V, Oberti F, Francoz C, Coilly A, Hilleret MN, Lebray P, Liou-Schischmanoff A, Barbier L, Duvoux C, Pageaux GP, Bismuth M, Galanaud D, Broucker TD, Cadranel JF, Leroy V, Di Martino V, Larrey D, Camus C, Scatton O, De Ledinghen V, Mallat A, Rudler M, Bureau C. Diagnosis and management of hepatic encephalopathy: The French recommendations. Liver Int 2023; 43:750-762. [PMID: 36625084 DOI: 10.1111/liv.15510] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 07/28/2022] [Revised: 11/27/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
Hepatic encephalopathy (HE) is a frequent and severe complication of liver disease with poor patient outcomes. However, it is a poorly understood complication, with no consensus for diagnosis. Therefore, HE is often underdiagnosed. Differential diagnosis may be cumbersome because of non-specific symptoms, such as confusion, cognitive disorders, the aetiological factors of cirrhosis and comorbidities, which are often observed in cirrhotic patients. Therefore, an overt or covert form of HE should be systematically investigated. Advice is provided to drive patient work-up. Effective treatments are available to prevent or treat HE bouts, but the issue of single or combination therapy has not been resolved. Transjugular intrahepatic portosystemic shunt (TIPS) placement largely improved the prognosis of cirrhotic patients, but HE occurrence of HE is often a fear, even when post-TIPS HE can be avoided by a careful selection of patients and preventive treatment. HE is an indication of liver transplantation. However, its reversibility post-transplantation and the consequences of transplantation in patients with other causes of neurological disorders remain controversial, which supports the performance of an extensive work-up in expert centres for this subset of patients. The present guidelines assist clinicians in the diagnosis of the overt or covert form of HE to implement curative and preventive treatments and clarify which patients require referral to expert centres for consideration for liver transplantation. These guidelines are very clinically oriented and address different frequent clinical issues to help physicians make bedside decisions.
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Affiliation(s)
- Dominique Thabut
- APHP-Sorbonne Université, Service d'hépato-gastroentérologie, Hôpital Pitié-Salpêtrière. INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN). Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Paris, France
| | - Charlotte Bouzbib
- APHP-Sorbonne Université, Service d'hépato-gastroentérologie, Hôpital Pitié-Salpêtrière. INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN). Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Paris, France
| | - Lucy Meunier
- Service d'hépato-gastroentérologie A et Transplantation, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France
| | - Manon Haas
- APHP-Paris Saclay, Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris-saclay, Villejuif, France
| | - Nicolas Weiss
- APHP-Sorbonne Université, Service de réanimation neurologique, Hôpital Pitié-Salpêtrière. INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN). Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Paris, France
| | - Alexandre Louvet
- Services des maladies de l'appareil digestif, CHRU de Lille, Lille, France
| | - Francois Imbert-Bismut
- APHP-Sorbonne Université, Service de biochimie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Fanny Mochel
- APHP-Sorbonne Université, Service de génétique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yann Nadjar
- APHP-Sorbonne Université, Service de neurologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Antoine Santiago
- APHP-Sorbonne Université, Service d'hépato-gastroentérologie, Hôpital Pitié-Salpêtrière. INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN). Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Paris, France
| | - Thierry Thevenot
- Service d'hépatologie, Hôpital Jean Minjoz, CHU de Besançon, Besançon, France
| | - Véronique Duhalde
- Service de pharmacie, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Frédéric Oberti
- Laboratoire HIFIH, UPRES-EA2170, Faculté de Médecine, Service d'hépato-gastroentérologie, CHU ANGERS, Angers, France
| | - Claire Francoz
- APHP-Hôpital Beaujon, Service d'hépatologie, Clichy, France
| | - Audrey Coilly
- APHP-Paris Saclay, Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris-saclay, Villejuif, France
| | | | - Pascal Lebray
- APHP-Sorbonne Université, Service d'hépato-gastroentérologie, Hôpital Pitié-Salpêtrière. INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN). Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Paris, France
| | | | - Louise Barbier
- Service de chirurgie hépatique et transplantation, CHU de Tours, Tours, France
| | | | - Georges-Philippe Pageaux
- Service d'hépato-gastroentérologie A et Transplantation, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France
| | - Michael Bismuth
- Service d'hépato-gastroentérologie B, Hôpital Saint Eloi, CHU de Montpellier, Montpellier, France
| | - Damien Galanaud
- APHP-Sorbonne Université, Service de neuro-radiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Thomas De Broucker
- Service de Neurologie Hôpital Pierre Delafontaine, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Jean-François Cadranel
- Service d'hépato-gastroentérologie de nutrition et d'Alcoologie-GHPSO site de Creil, Creil, France
| | - Vincent Leroy
- APHP Hôpital Henri-Mondor, Service d'hépatologie, Créteil, France
| | - Vincent Di Martino
- Service d'hépatologie, Hôpital Jean Minjoz, CHU de Besançon, Besançon, France
| | - Dominique Larrey
- Service d'hépato-gastroentérologie A et Transplantation, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France
| | - Christophe Camus
- Service de réanimation Médicale, Hôpital Pontchaillou, CHU de Rennes, Rennes, France
| | - Olivier Scatton
- APHP-Sorbonne Université, Service de chirurgie et transplantation hépatique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Victor De Ledinghen
- Service d'hépato-gastroentérologie, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | - Ariane Mallat
- APHP Hôpital Henri-Mondor, Service d'hépatologie, Créteil, France
| | - Marika Rudler
- APHP-Sorbonne Université, Service d'hépato-gastroentérologie, Hôpital Pitié-Salpêtrière. INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN). Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Paris, France
| | - Christophe Bureau
- Service d'hépatologie, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
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Barrault C, Alqallaf S, Lison H, Lamote-Chaouche I, Bourcier V, Laugier J, Thevenot T, Labarriere D, Ripault MP, Le Gruyer A, Costentin C, Behar V, Hagege H, Jung C, Cadranel JF. Baclofen Combined With Psychosocial Care is Useful and Safe in Alcohol-Related Cirrhosis Patients: A Real-Life Multicenter Study. Alcohol Alcohol 2023; 58:117-124. [PMID: 36527321 DOI: 10.1093/alcalc/agac065] [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: 06/09/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Alcohol-related cirrhosis is a frequent and difficult-to-treat disease. Despite the low hepatic metabolism of baclofen, data on its use in this subgroup are scarce. The French multicenter Observatory of patients treated with Baclofen for Alcohol DEpendence real-life cohort assessed: (a) prescription modalities of baclofen in liver units; (b) safety profile of baclofen; and (c) declared alcohol intake, biological markers of excessive alcohol intake and hepatic function at 12 months. METHODS All consecutive patients with cirrhosis who received baclofen to reduce alcohol consumption or maintain abstinence were prospectively included. Psychosocial management was always associated. Clinical and biological data were collected every 3 months for 1 year. RESULTS Between November 2013 and December 2016, 71 in- or outpatients were included from 10 liver units. Of the patients, 25% had ascites. After 12 months, 52 patients (73%) were still being followed, and 41 (57.7%) were still receiving baclofen at a mean dosage of 75 mg/day (r30-210). The overall declared consumption decreased from 100.2 to 14.7 g/day (P < 0.0001), and 29 patients (40.8%) reached abstinence. Significant improvement in the usual biomarkers of excessive alcohol intake (AST, GGT and MCV) and liver function (Prothrombin ratio (PTr), albumin levels) were observed. The usual side effects such as drowsiness were frequent (22%) but no serious adverse events (AEs) or overt encephalopathy related to baclofen was reported. CONCLUSION In this 1-year follow-up series, baclofen was combined with psychosocial treatment in patients with cirrhosis and was well tolerated. This treatment was associated with a significant decrease in declared alcohol consumption as well as improvement in hepatic function.
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Affiliation(s)
- Camille Barrault
- Liver, Digestive Disease and Addiction Unit, CH Intercommunal, Créteil 83056, France
| | - Shuaib Alqallaf
- Liver, Digestive Disease and Addiction Unit, CH Intercommunal, Créteil 83056, France
| | - Hortensia Lison
- Liver and Digestive Diseases Nutrition and Addiction Department, GHPSO, Creil 60100, France
| | | | - Valérie Bourcier
- Liver Unit, AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Bobigny 93143, France
| | - Joëlle Laugier
- Liver, Digestive Disease and Addiction Unit, CH Delafontaine, Saint Denis, Bobigny 93200, France
| | - Thierry Thevenot
- Liver Unit and Intensive Care Unit, Hôpital Jean Minjoz, 25030 Besançon Cedex, France
- CIC-1431 INSERM, CHU de Besançon, Besançon 25030, France
| | - Damien Labarriere
- Liver, Digestive Disease and Addiction Unit, CH Régional, Orléans 75008, France
| | | | - Antonia Le Gruyer
- Liver, Digestive Disease and Addiction Unit, CH Yves Le Foll, Saint Brieuc 22000, France
| | | | - Véronique Behar
- Liver, Digestive Disease and Addiction Unit, CH Intercommunal, Créteil 83056, France
| | - Hervé Hagege
- Liver, Digestive Disease and Addiction Unit, CH Intercommunal, Créteil 83056, France
| | | | - Jean-François Cadranel
- Liver and Digestive Diseases Nutrition and Addiction Department, GHPSO, Creil 60100, France
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9
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Thevenot T, Mouhat B, Revel L, Altieri M. The Evaluation of Cirrhotic Cardiomyopathy in Liver Transplantation Candidates: An Emerging Debate. Liver Transpl 2021; 27:1068-1069. [PMID: 33660905 DOI: 10.1002/lt.26038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/26/2021] [Indexed: 12/05/2022]
Affiliation(s)
- Thierry Thevenot
- Department of Hepatology, University Hospital Besançon, Besançon, France
| | - Basile Mouhat
- Department of Cardiology, University Hospital Besançon, Besançon, France
| | - Lucie Revel
- Department of Radiology, University Hospital Besançon, Besançon, France
| | - Mario Altieri
- Department of Hepatology, University Hospital Caen, Caen, France
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10
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Thevenot T, Mouhat B, Cervoni JP, Chopard R. The dual role of non-selective beta-blockers in cirrhotic patients: How do we know when Dr Jekyll turns into Mr Hyde? Liver Int 2021; 41:1166-1167. [PMID: 33342043 DOI: 10.1111/liv.14770] [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: 02/13/2023]
Affiliation(s)
- Thierry Thevenot
- Department of Hepatology, University Hospital Besançon, Besançon, France.,EA 4266 "Pathogens and inflammation, EPILAB", Université Bourgogne - Franche Comte, UFR SMP, Besançon, France
| | - Basile Mouhat
- Department of Cardiology, University Hospital Besançon, Besançon, France
| | - Jean-Paul Cervoni
- Department of Hepatology, University Hospital Besançon, Besançon, France
| | - Romain Chopard
- Department of Cardiology, University Hospital Besançon, Besançon, France.,EA3920, University of Burgundy Franche-Comté, Besançon, France
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11
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Tebani A, Sudrié-Arnaud B, Boudabous H, Brassier A, Anty R, Snanoudj S, Abergel A, Abi Warde MT, Bardou-Jacquet E, Belbouab R, Blanchet E, Borderon C, Bronowicki JP, Cariou B, Carette C, Dabbas M, Dranguet H, de Ledinghen V, Ferrières J, Guillaume M, Krempf M, Lacaille F, Larrey D, Leroy V, Musikas M, Nguyen-Khac E, Ouzan D, Perarnau JM, Pilon C, Ratzlu V, Thebaut A, Thevenot T, Tragin I, Triolo V, Vergès B, Vergnaud S, Bekri S. Large-scale screening of lipase acid deficiency in at risk population. Clin Chim Acta 2021; 519:64-69. [PMID: 33857477 DOI: 10.1016/j.cca.2021.04.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lysosomal acid lipase deficiency (LALD, OMIM#278000) is a rare lysosomal disorder with an autosomal recessive inheritance. The main clinical manifestations are related to a progressive accumulation of cholesteryl esters, triglycerides or both within the lysosome in different organs such as the liver, spleen, and cardiovascular system. A wide range of clinical severity is associated with LALD including a severe very rare antenatal/neonatal/infantile phenotype named Wolman disease and a late-onset form named cholesteryl ester storage disease (CESD). METHODS This study aimed to investigate a cohort of at-risk patients (4174) presenting with clinical or biological signs consistent with LALD using the assessment of LAL activity on dried blood spots. RESULTS LAL activity was lower than 0.05 nmol/punch/L (cut-off: 0.12) in 19 patients including 13 CESD and 6 Wolman. Molecular study has been conducted in 17 patients and succeeded in identifying 34 mutated alleles. Fourteen unique variants have been characterized, 7 of which are novel. CONCLUSION This study allowed to identify a series of patients and expanded the molecular spectrum knowledge of LALD. Besides, a new screening criteria grid based on the clinical/biological data from our study and the literature has been proposed in order to enhance the diagnosis rate in at risk populations.
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Affiliation(s)
- Abdellah Tebani
- Normandie Univ, UNIROUEN, INSERM U1245, CHU Rouen, Department of Metabolic Biochemistry, 76000 Rouen, France
| | - Bénédicte Sudrié-Arnaud
- Normandie Univ, UNIROUEN, INSERM U1245, CHU Rouen, Department of Metabolic Biochemistry, 76000 Rouen, France
| | - Hela Boudabous
- Pediatric Department, La Rabta Hospital, Faculty of Medecine of Tunis, University of Tunis El Manar, Jabberi, Jebal Lakhdhar, Tunis, Tunisia
| | - Anais Brassier
- Reference Center of Inherited Metabolic Diseases, Necker Enfants Malades Hospital, Imagine Institute, University Paris Descartes, AP-HP, 75015 Paris, France
| | - Rodolphe Anty
- INSERM, U1065, C3M, Team 8 "Hepatic Complications in Obesity", Nice, France
| | - Sarah Snanoudj
- Normandie Univ, UNIROUEN, INSERM U1245, CHU Rouen, Department of Metabolic Biochemistry, 76000 Rouen, France
| | - Armand Abergel
- Department of Digestive Medicine, CHU Estaing, Clermont-Ferrand, France
| | | | - Edouard Bardou-Jacquet
- Univ Rennes, INSERM, Institut Numecan, Liver Disease Unit, CHU de Rennes, F-35000 Rennes, France
| | - Reda Belbouab
- Pediatric Department, University Hospital Center Mustapha Bacha, 16000 Algiers, Algeria
| | - Eloi Blanchet
- Service Hépatologie-Gastroenterologie, Groupe Hospitalier La Rochelle-Ré-Aunis, La Rochelle, France
| | | | - Jean-Pierre Bronowicki
- Department of Hepato-Gastroenterology, Centre Hospitalo-Universitaire de Nancy, 54000 Nancy, France
| | - Bertrand Cariou
- Université de Nantes, CHU de Nantes, CNRS, INSERM, L'institut du thorax, Department of Endocrinology-Diabetology-Nutrition, F-44000 Nantes, France
| | - Claire Carette
- AP-HP, Department of Nutrition, Centre spécialisé de l'Obesité Hôpital Européen Georges Pompidou, Paris University, Paris, France
| | - Myriam Dabbas
- AP-HP, Nutrition Obesity Unit, Necker Hospital, Paris, France
| | - Hélène Dranguet
- Normandie Univ, UNIROUEN, INSERM U1245, CHU Rouen, Department of Metabolic Biochemistry, 76000 Rouen, France
| | | | - Jean Ferrières
- Department of Cardiology and UMR INSERM 1027, Toulouse University School of Medicine, Toulouse, TSA 50032 31059, France
| | - Maeva Guillaume
- Service d'Hépatologie CHU Toulouse Rangueil, Institut Cardiomet et Université Paul Sabatier, Toulouse, France
| | - Michel Krempf
- Endocrinology, Metabolic Diseases and Nutrition, ELSAN, Clinique Breteché, Nantes, France
| | - Florence Lacaille
- Gastroenterology Hepatology Nutrition Unit, Hôpital Necker-Enfants Malades, Paris, France
| | - Dominique Larrey
- Liver and Transplantation Unit, Montpellier School of Medicine and IRB-INSERM-1183, Montpellier, France
| | - Vincent Leroy
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Grenoble-Alpes, INSERM U1209, Université Grenoble-Alpes, Grenoble, France
| | - Marietta Musikas
- Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, France
| | - Eric Nguyen-Khac
- Service d'Hépato-Gastroentérologie, Amiens University Hospital, and Equipe Région INSERM 24, University of Picardy, Amiens, France
| | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Jean-Marc Perarnau
- Service d'Hépato-gastroentérologie, Centre Hospitalo-Universitaire, Tours, France
| | - Carine Pilon
- Normandie Univ, UNIROUEN, INSERM U1245, CHU Rouen, Department of Metabolic Biochemistry, 76000 Rouen, France
| | - Vlad Ratzlu
- Department of Hepatology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France; University Pierre et Marie Curie, Institut National de la Santé et de la Recherche Médicale UMR 938, Paris, France
| | - Alice Thebaut
- Pediatric Hepatology & Pediatric Liver Transplant Department, Centre de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques (AVB-CG), Filière de Santé des Maladies Rares du Foie de l'enfant et de l'adulte (FILFOIE), European Reference Network RARE-LIVER, Assistance Publique-Hôpitaux de Paris, Faculty of Medecine Paris-Saclay, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Thierry Thevenot
- Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Service d'Hépatologie et de Soins Intensifs Digestifs, Besançon, France
| | - Isabelle Tragin
- Normandie Univ, UNIROUEN, INSERM U1245, CHU Rouen, Department of Metabolic Biochemistry, 76000 Rouen, France
| | | | - Bruno Vergès
- Université de Bourgogne, Centre de Recherche INSERM LNC-UMR1231; Service de Diabétologie et Endocrinologie, CHU François Mitterand, BP 77908, Dijon cedex 21079, France
| | - Sabrina Vergnaud
- Department of Biochemistry Toxicology and Pharmacology, Grenoble University Hospital, La Tronche, France
| | - Soumeya Bekri
- Normandie Univ, UNIROUEN, INSERM U1245, CHU Rouen, Department of Metabolic Biochemistry, 76000 Rouen, France.
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12
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Thevenot T, Desmarets M. G-CSF, a ray of sunshine in the darkness for patients with alcoholic hepatitis? Clin Res Hepatol Gastroenterol 2021; 45:101585. [PMID: 33607376 DOI: 10.1016/j.clinre.2020.101585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, CHU Besançon, 25030 Besançon, France.
| | - Maxime Desmarets
- uMETh, Centre d'investigation Clinique 1431, CHU Besançon, 25030, Besançon, France; UMR1098 Right, Inserm, Établissement Français du Sang, Université Bourgogne-Franche-Comté, Besançon, France
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13
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Bernardi M, Angeli P, Claria J, Moreau R, Gines P, Jalan R, Caraceni P, Fernandez J, Gerbes AL, O'Brien AJ, Trebicka J, Thevenot T, Arroyo V. Albumin in decompensated cirrhosis: new concepts and perspectives. Gut 2020; 69:1127-1138. [PMID: 32102926 PMCID: PMC7282556 DOI: 10.1136/gutjnl-2019-318843] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 12/12/2022]
Abstract
The pathophysiological background of decompensated cirrhosis is characterised by a systemic proinflammatory and pro-oxidant milieu that plays a major role in the development of multiorgan dysfunction. Such abnormality is mainly due to the systemic spread of bacteria and/or bacterial products from the gut and danger-associated molecular patterns from the diseased liver triggering the release of proinflammatory mediators by activating immune cells. The exacerbation of these processes underlies the development of acute-on-chronic liver failure. A further mechanism promoting multiorgan dysfunction and failure likely consists with a mitochondrial oxidative phosphorylation dysfunction responsible for systemic cellular energy crisis. The systemic proinflammatory and pro-oxidant state of patients with decompensated cirrhosis is also responsible for structural and functional changes in the albumin molecule, which spoil its pleiotropic non-oncotic properties such as antioxidant, scavenging, immune-modulating and endothelium protective functions. The knowledge of these abnormalities provides novel targets for mechanistic treatments. In this respect, the oncotic and non-oncotic properties of albumin make it a potential multitarget agent. This would expand the well-established indications to the use of albumin in decompensated cirrhosis, which mainly aim at improving effective volaemia or preventing its deterioration. Evidence has been recently provided that long-term albumin administration to patients with cirrhosis and ascites improves survival, prevents complications, eases the management of ascites and reduces hospitalisations. However, variant results indicate that further investigations are needed, aiming at confirming the beneficial effects of albumin, clarifying its optimal dosage and administration schedule and identify patients who would benefit most from long-term albumin administration.
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Affiliation(s)
- Mauro Bernardi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy,EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Joan Claria
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain,Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBERehd) and Universitat de Barcelona, Barcelona, Spain
| | - Richard Moreau
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain,Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur l'Inflammation (CRI), Paris, France
| | - Pere Gines
- Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS) and Centro de Investigación Biomèdica en Red (CIBEREHD), Barcelona, Spain
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver Disease Health, University College London, Royal Free Hospital, London, UK
| | - Paolo Caraceni
- Unit of Semeiotica Medica, Policlinico S Orsola, Bologna; Department of Medical and Surgical Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Javier Fernandez
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain,Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS) and Centro de Investigación Biomèdica en Red (CIBEREHD), Barcelona, Spain
| | - Alexander L Gerbes
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU Munich, Munich, Germany
| | - Alastair J O'Brien
- Institute for Liver Disease Health, University College London, Royal Free Hospital, London, UK
| | - Jonel Trebicka
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain,Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany
| | - Thierry Thevenot
- Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Service d'Hépatologie et de Soins Intensifs Digestifs, Besançon, France
| | - Vicente Arroyo
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
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14
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Verhoeven F, Weil-Verhoeven D, Prati C, Martino VD, Thevenot T, Wendling D. Safety of TNF inhibitors in rheumatic disease in case of NAFLD and cirrhosis. Semin Arthritis Rheum 2020; 50:544-548. [PMID: 32446022 DOI: 10.1016/j.semarthrit.2020.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/15/2019] [Revised: 03/06/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Abstract
The management of inflammatory rheumatic diseases has substantially changed in recent years, as has the profile of patients. The advent of biotherapies has been a revolution in rheumatology and the impact of co-morbidities in the management of these patients is now becoming increasingly important. Metabolic syndrome (MetS) is one of the most frequent comorbidities, and hepatic complications of MetS are not uncommon. MetS is responsible for Non-alcoholic fatty liver disease (NAFLD), characterized by excessive hepatic fat accumulation. In extreme cases, progression to cirrhosis is possible. NAFLD ranks among the top three indications for liver transplantation. We review available data on the safety, especially the risk of infections, of TNF inhibitors (TNFi) in case of NAFLD and in case of liver cirrhosis, in patients with rheumatic disease. In cases of NAFLD without severe fibrosis, available data are reassuring and tend to show a beneficial effect of TNFi on hepatic tissue. In case of cirrhosis, data are conflicting. Further large, well-designed studies are needed to explore this specific issue.
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Affiliation(s)
- Frank Verhoeven
- Department of Rheumatology, CHRU Besançon - France; EA 4267 "PEPITE", FHU Increase, Université Bourgogne - Franche Comte, UFR SMP, Besançon, France.
| | - Delphine Weil-Verhoeven
- Department of Hepatology, CHRU Besançon, France; EA 4266 "Pathogens and inflammation, EPILAB", Université Bourgogne - Franche Comte, UFR SMP, Besançon, France
| | - Clément Prati
- Department of Rheumatology, CHRU Besançon - France; EA 4267 "PEPITE", FHU Increase, Université Bourgogne - Franche Comte, UFR SMP, Besançon, France
| | - Vincent Di Martino
- Department of Hepatology, CHRU Besançon, France; EA 4266 "Pathogens and inflammation, EPILAB", Université Bourgogne - Franche Comte, UFR SMP, Besançon, France
| | - Thierry Thevenot
- Department of Hepatology, CHRU Besançon, France; EA 4266 "Pathogens and inflammation, EPILAB", Université Bourgogne - Franche Comte, UFR SMP, Besançon, France
| | - Daniel Wendling
- Department of Rheumatology, CHRU Besançon - France; EA 4266 "Pathogens and inflammation, EPILAB", Université Bourgogne - Franche Comte, UFR SMP, Besançon, France
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Thevenot T, Weil D, Di Martino V. What Is the True Relationship Between Spontaneous Portosystemic Shunts and Portopulmonary Hypertension in Cirrhotic Patients? Gastroenterology 2018; 155:1647-1648. [PMID: 30118742 DOI: 10.1053/j.gastro.2018.02.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/22/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon Cedex, France
| | - Delphine Weil
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon Cedex, France
| | - Vincent Di Martino
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon Cedex, France
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Weil D, Levesque E, McPhail M, Cavallazzi R, Theocharidou E, Cholongitas E, Galbois A, Pan HC, Karvellas CJ, Sauneuf B, Robert R, Fichet J, Piton G, Thevenot T, Capellier G, Di Martino V. Prognosis of cirrhotic patients admitted to intensive care unit: a meta-analysis. Ann Intensive Care 2017; 7:33. [PMID: 28321803 PMCID: PMC5359266 DOI: 10.1186/s13613-017-0249-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [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: 11/22/2016] [Accepted: 02/18/2017] [Indexed: 02/08/2023] Open
Abstract
Background The best predictors of short- and medium-term mortality of cirrhotic patients receiving intensive care support are unknown. Methods We conducted meta-analyses from 13 studies (2523 cirrhotics) after selection of original articles and response to a standardized questionnaire by the corresponding authors. End-points were in-ICU, in-hospital, and 6-month mortality in ICU survivors. A total of 301 pooled analyses, including 95 analyses restricted to 6-month mortality among ICU survivors, were conducted considering 249 variables (including reason for admission, organ replacement therapy, and composite prognostic scores). Results In-ICU, in-hospital, and 6-month mortality was 42.7, 54.1, and 75.1%, respectively. Forty-eight patients (3.8%) underwent liver transplantation during follow-up. In-ICU mortality was lower in patients admitted for variceal bleeding (OR 0.46; 95% CI 0.36–0.59; p < 0.001) and higher in patients with SOFA > 19 at baseline (OR 8.54; 95% CI 2.09–34.91; p < 0.001; PPV = 0.93). High SOFA no longer predicted mortality at 6 months in ICU survivors. Twelve variables related to infection were predictors of in-ICU mortality, including SIRS (OR 2.44; 95% CI 1.64–3.65; p < 0.001; PPV = 0.57), pneumonia (OR 2.18; 95% CI 1.47–3.22; p < 0.001; PPV = 0.69), sepsis-associated refractory oliguria (OR 10.61; 95% CI 4.07–27.63; p < 0.001; PPV = 0.76), and fungal infection (OR 4.38; 95% CI 1.11–17.24; p < 0.001; PPV = 0.85). Among therapeutics, only dopamine (OR 5.57; 95% CI 3.02–10.27; p < 0.001; PPV = 0.68), dobutamine (OR 8.92; 95% CI 3.32–23.96; p < 0.001; PPV = 0.86), epinephrine (OR 5.03; 95% CI 2.68–9.42; p < 0.001; PPV = 0.77), and MARS (OR 2.07; 95% CI 1.22–3.53; p = 0.007; PPV = 0.58) were associated with in-ICU mortality without heterogeneity. In ICU survivors, eight markers of liver and renal failure predicted 6-month mortality, including Child–Pugh stage C (OR 2.43; 95% CI 1.44–4.10; p < 0.001; PPV = 0.57), baseline MELD > 26 (OR 3.97; 95% CI 1.92–8.22; p < 0.0001; PPV = 0.75), and hepatorenal syndrome (OR 4.67; 95% CI 1.24–17.64; p = 0.022; PPV = 0.88). Conclusions Prognosis of cirrhotic patients admitted to ICU is poor since only a minority undergo liver transplant. The prognostic performance of general ICU scores decreases over time, unlike the Child–Pugh and MELD scores, even recorded in the context of organ failure. Infection-related parameters had a short-term impact, whereas liver and renal failure had a sustained impact on mortality. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0249-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Delphine Weil
- Hepatology Department, University Hospital Jean Minjoz, 3 bld Fleming, 25030, Besançon, France
| | - Eric Levesque
- Centre Hépato-Biliaire, University Hospital Paul Brousse, Villejuif, France
| | - Marc McPhail
- Liver Intensive Care Unit and Institute of Liver Studies and Transplantation, King's College Hospital, London, UK
| | | | - Eleni Theocharidou
- Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
| | | | - Arnaud Galbois
- Intensive Care Unit, University Hospital Saint-Antoine, Paris, France
| | - Heng Chih Pan
- Nephrology Department, Chang Gung Memorial Hospital, Taipei, Taiwan
| | | | | | - René Robert
- Intensive Care Unit, University Hospital of Poitiers, Poitiers, France
| | - Jérome Fichet
- Intensive Care Unit, University Hospital of Tours, Tours, France
| | - Gaël Piton
- Intensive Care Unit, University Hospital Jean Minjoz, Besançon, France
| | - Thierry Thevenot
- Hepatology Department, University Hospital Jean Minjoz, 3 bld Fleming, 25030, Besançon, France
| | - Gilles Capellier
- Intensive Care Unit, University Hospital Jean Minjoz, Besançon, France
| | - Vincent Di Martino
- Hepatology Department, University Hospital Jean Minjoz, 3 bld Fleming, 25030, Besançon, France.
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Thevenot T, Weil D, Cervoni JP, Villamil FG, Di Martino V. Are we still searching for the fifth element of MELD? J Hepatol 2017; 66:246-247. [PMID: 27771452 DOI: 10.1016/j.jhep.2016.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/06/2016] [Indexed: 12/04/2022]
Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, 25030 Besançon cedex, France
| | - Delphine Weil
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, 25030 Besançon cedex, France
| | - Jean-Paul Cervoni
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, 25030 Besançon cedex, France.
| | - Federico G Villamil
- Liver Transplant Unit, British Hospital, Perdriel 74, CABA (AEB1280), Buenos Aires, Argentina
| | - Vincent Di Martino
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, 25030 Besançon cedex, France
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18
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Ambregna S, Koch S, Sulz MC, Grüner B, Öztürk S, Chevaux JB, Sulima M, de Gottardi A, Napoléon B, Abergel A, Bichard P, Boytchev I, Deprez P, Dumortier J, Frossard JL, Kull E, Meny B, Moradpour D, Prat F, Vanbiervliet G, Thevenot T, Vuitton DA, Bresson-Hadni S, Vuitton L. A European survey of perendoscopic treatment of biliary complications in patients with alveolar echinococcosis. Expert Rev Anti Infect Ther 2016; 15:79-88. [PMID: 27788612 DOI: 10.1080/14787210.2017.1252260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 12/13/2022]
Abstract
BACKGROUND Biliary complications represent a turning point in the course of Alveolar Echinococcosis (AE). We conducted a European survey to collect data on the current usage and results of perendoscopic interventions (PEIs) for their treatment. METHODS Patient's characteristics and follow-up until January 31st, 2015 were recorded using an online questionnaire. RESULTS From 18 centers 129 PEIs were analyzed in 38 patients; 139 plastic stents were inserted during 85 PEIs; median time between stent placements was significantly longer when 3 stents or more were placed. Initial symptoms disappeared in 95% and long-term bile duct patency was obtained in 73% of cases. Cholangitis was a more frequent complication of the PEIs (10%) than in other indications; intensive lavage of the bile ducts may prevent this complication. CONCLUSION European centers use perendoscopic biliary drainage as an efficient and safe alternative to surgery to treat AE biliary complications. Insertion of multiple plastic stents delays stent occlusion and leads to effective and prolonged bile duct patency.
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Affiliation(s)
- Sylvain Ambregna
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Stéphane Koch
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Michael C Sulz
- b Division of Gastroenterology and Hepatology , Kantonsspital , St. Gall , Switzerland
| | | | | | | | - Małgorzata Sulima
- e Institute of Maritime and Tropical Medicine in Gdynia , Medical University of Gdynia , Poland
| | | | - Bertrand Napoléon
- g Gastroenterology department, Mermoz Private Hospital , Générale de Santé , Lyon , France
| | - Armand Abergel
- h Gastroenterology and Hepatology department , University Hospital , Clermont-Ferrand , France
| | - Philippe Bichard
- i Gastroenterology and Hepatology department , University Hospital , Grenoble , France
| | - Isabelle Boytchev
- j Gastroenterology department , Kremlin-Bicêtre University Hospital , Paris , France
| | - Pierre Deprez
- k Gastroenterology department , Saint-Luc University Hospital , Brussels , Belgium
| | - Jerome Dumortier
- l Department of digestive diseases , Edouard Herriot University Hospital , Lyon , France
| | - Jean-Louis Frossard
- m Hepato-Pancreato-Biliary Centre , University Hospital , Geneva , Switzerland
| | - Eric Kull
- n Gastroenterology and Hepatology department , Regional Hospital , Metz , France
| | - Bernard Meny
- o Gastroenterology unit , Clinique Drevon , Dijon , France
| | - Darius Moradpour
- p Gastroenterology and Hepatology department , University Hospital , Lausanne , Switzerland
| | - Fréderic Prat
- q Gastroenterology department , Cochin University Hospital , Paris , France
| | | | - Thierry Thevenot
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Dominique Angèle Vuitton
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Solange Bresson-Hadni
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Lucine Vuitton
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
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Verhoeven F, Weil-Verhoeven D, Di Martino V, Prati C, Thevenot T, Wendling D. Management of acute HVE infection in a patient treated with rituximab for rheumatoid arthritis. Joint Bone Spine 2016; 83:577-8. [PMID: 27055728 DOI: 10.1016/j.jbspin.2015.11.010] [Citation(s) in RCA: 4] [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: 10/03/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Acute E hepatitis becomes more frequent in immunocompromised patients. No guidelines are available to date for the management of this infection and of the immunosuppressive treatment. METHODS We report a case of acute E hepatitis treated with ribavirine in a patient known for rheumatoid arthritis and treated with rituximab. CASE A 51-year-old woman known for rheumatoid arthritis and treated with rituximab was hospitalized for a jaundice secondary to an acute E hepatitis. She was treated with ribavirin 800mg twice a day during 2 months with a good efficacy and tolerance. Finally, 3 months after the acute E hepatitis, she benefited from 2 new 1000mg rituximab infusions because of the rheumatoid arthritis activity. The treatment was well tolerated without acute hepatitis. The follow-up of the HVE infection was realized with HVE PCR in the blood and 8 months after the last infusions, there were no chronic courses or acute hepatitis recurrence. CONCLUSION This case highlights the safety and the efficacy of the reintroduction of rituximab after 2 months of treatment with ribavirin and a negative PCR.
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Affiliation(s)
- Frank Verhoeven
- Department of rheumatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France
| | | | - Vincent Di Martino
- Department of hepatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France
| | - Clément Prati
- Department of rheumatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France
| | - Thierry Thevenot
- Department of hepatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France
| | - Daniel Wendling
- Department of rheumatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France.
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20
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Kerbert AJC, Weil D, Verspaget HW, Moréno JP, van Hoek B, Cervoni JP, Di Martino V, Coenraad MJ, Thevenot T. Copeptin is an independent prognostic factor for transplant-free survival in cirrhosis. Liver Int 2016; 36:530-7. [PMID: 26502363 DOI: 10.1111/liv.12992] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/13/2015] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Copeptin is a stable cleavage product of the arginine vasopressin (AVP) precursor and is equimolarly secreted with AVP. Copeptin is currently considered a reliable prognostic marker in a wide variety of diseases other than cirrhosis. We aimed to investigate the association between severity of cirrhosis and copeptin concentrations and to confirm whether copeptin is of prognostic significance in cirrhosis. METHODS One hundred and eighty-four cirrhotic patients hospitalized in two tertiary referral centres were studied. Serum copeptin was measured in samples obtained at hospital admission. Differences in serum copeptin between Child-Pugh classes were evaluated using the Kruskal-Wallis test. Cox proportional hazard regression and Kaplan-Meier analyses were performed to evaluate associations of copeptin and other possible prognostic factors with 6- and 12-month mortality. RESULTS Median serum copeptin (interquartile range) increased significantly through Child-Pugh classes A [5.4 (3.1-10.7) pmol/L], B [9.6 (6.0-17.3) pmol/L] and C [13.8 (5.8-34.1) pmol/L, P < 0.01]. Patients with serum copeptin >12.3 pmol/L displayed significantly higher mortality rates at 6 and 12 months as compared to those with serum copeptin ≤12.3 pmol/L (Log-rank test: P < 0.01). Serum copeptin >12.3 pmol/L was significantly associated with mortality, particularly at 6 months, independently of age, clinical parameters and Model for End stage Liver Disease (MELD), MELD-sodium and Child-Pugh score. CONCLUSIONS Serum copeptin concentration increases significantly along with the severity of cirrhosis as defined by the Child-Pugh classification. A high serum copeptin concentration predicts survival, particularly at 6 months, independently of liver-specific scoring systems in a heterogeneous population of hospitalized cirrhotic patients.
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Affiliation(s)
- Annarein J C Kerbert
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Delphine Weil
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Paul Cervoni
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - Vincent Di Martino
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thierry Thevenot
- Department of Hepatology, University Hospital of Besançon, Besançon, France
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21
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Degand T, Monnet E, Durand F, Grandclement E, Ichai P, Borot S, Qualls CR, Agin A, Louvet A, Dumortier J, Francoz C, Dumoulin G, Di Martino V, Dorin R, Thevenot T. Assessment of adrenal function in patients with acute hepatitis using serum free and total cortisol. Dig Liver Dis 2015; 47:783-9. [PMID: 26077885 DOI: 10.1016/j.dld.2015.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/02/2015] [Revised: 05/11/2015] [Accepted: 05/16/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Adrenal dysfunction is frequently reported in severe acute hepatitis using serum total cortisol. AIMS Because 90% of serum cortisol is bound to proteins that are altered during stress, we investigated the effect of decreased cortisol-binding proteins on serum total and free cortisol in severe acute hepatitis. METHODS 43 severe and 31 non-severe acute hepatitis and 29 healthy controls were enrolled consecutively and studied prospectively. Baseline (T0) and cosyntropin-stimulated (T60) serum total and free cortisol concentrations were measured. RESULTS T0 and T60 serum total cortisol did not differ significantly between severe, non-severe hepatitis and healthy controls. Conversely, serum free cortisol (T0p=0.012; T60p<0.001) concentrations increased from healthy controls to severe hepatitis, accompanied by a decrease in corticosteroid-binding globulin and albumin (all p<0.001). In acute hepatitis (n=74), patients with "low" corticosteroid-binding globulin (<28mg/L) had higher T0 serum free cortisol than others (103.1 [61.2-157] vs. 56.6 [43.6-81.9]nmol/L, p=0.0024). Analysis of covariance showed that at equal concentration of total cortisol, the free cortisol concentration was significantly higher in severe than in non-severe hepatitis (p<0.001) or healthy controls (p<0.001). CONCLUSIONS In severe hepatitis, the decrease in cortisol-binding proteins impairs correct diagnosis of adrenal dysfunction. This could be corrected by measuring or estimating free cortisol.
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Affiliation(s)
- Thibault Degand
- Hepatology and Digestive Intensive Care Unit, University Hospital of Besançon, France; EA UPRES 3186 « Agents Pathogènes et Inflammation » of Franche-Comté University, France
| | - Elisabeth Monnet
- Hepatology and Digestive Intensive Care Unit, University Hospital of Besançon, France; EA UPRES 3186 « Agents Pathogènes et Inflammation » of Franche-Comté University, France
| | | | - Emilie Grandclement
- Laboratory for Endocrinology and Metabolism, University Hospital of Besançon, France
| | - Philippe Ichai
- Hepatobiliary Unit and Liver Intensive Care, Paul Brousse University Hospital AP-HP, Villejuif cedex, France
| | - Sophie Borot
- Department of Endocrinology, University Hospital of Besançon, France
| | - Clifford R Qualls
- Clinical Translational Science Center, University of New Mexico Health Science Center, USA
| | - Arnaud Agin
- ICube, UMR 7357, University of Strasbourg and CNRS, FMTS, Strasbourg, France
| | - Alexandre Louvet
- Department of Hepatogastroenterology, University Hospital of Lille, France
| | - Jérôme Dumortier
- Department of Hepatogastroenterology, University Hospital Edouard Herriot of Lyon, France
| | | | - Gilles Dumoulin
- Laboratory for Endocrinology and Metabolism, University Hospital of Besançon, France
| | - Vincent Di Martino
- Hepatology and Digestive Intensive Care Unit, University Hospital of Besançon, France; EA UPRES 3186 « Agents Pathogènes et Inflammation » of Franche-Comté University, France
| | - Richard Dorin
- Department of Medicine, New Mexico VA Medical Center and University of New Mexico Health Science Center, USA
| | - Thierry Thevenot
- Hepatology and Digestive Intensive Care Unit, University Hospital of Besançon, France; EA UPRES 3186 « Agents Pathogènes et Inflammation » of Franche-Comté University, France.
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Thevenot T, Monnet E, di Martino V. Reply to "Albumin infusion in cirrhotic patients with non-SBP infections: End of the story?". J Hepatol 2015; 63:768-9. [PMID: 25998162 DOI: 10.1016/j.jhep.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 05/11/2015] [Indexed: 12/04/2022]
Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Universitaire Jean Minjoz, 25030 Besançon cedex, France.
| | - Elisabeth Monnet
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Universitaire Jean Minjoz, 25030 Besançon cedex, France
| | - Vincent di Martino
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Universitaire Jean Minjoz, 25030 Besançon cedex, France
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Di Martino V, Coutris C, Cervoni JP, Dritsas S, Weil D, Richou C, Vanlemmens C, Thevenot T. Prognostic value of C-reactive protein levels in patients with cirrhosis. Liver Transpl 2015; 21:753-60. [PMID: 25677965 DOI: 10.1002/lt.24088] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/29/2015] [Indexed: 02/07/2023]
Abstract
I dentifying cirrhosis with a poor short-term prognosis remains crucial for improving the allocation of liver grafts. The purpose of this study was to assess the prognostic value of a model combining the variation of C-reactive protein (CRP) levels within 15 days, the Model for End-Stage Liver Disease (MELD) score, and the presence of comorbidities in patients with decompensated cirrhosis with a Child-Pugh score > B7 and to test the relevance of this model in patients with compensated cirrhosis. We collected data for cirrhotic patients without hepatocellular carcinoma, extrahepatic malignancy, human immunodeficiency virus infection, organ transplantation, seen between January 2010 and December 2011. Multivariate analyses of predictors of 3-month mortality used Cox models adjusted with the age-adjusted Charlson comorbidity index. The prognostic performance [area under receiver operating characteristic curves (AUROCs)] of the 3-variable model was compared to that of the MELD score. The 241 patients who met the inclusion criteria included 109 patients with a Child-Pugh score > B7 who were hospitalized for decompensation. In these patients with severe cases, the 3-month mortality was independently predicted by the MELD score [hazard ratio (HR), 1.10; 95% confidence interval (CI), 1.05-1.14; P < 0.001] and a CRP level > 32 mg/L at the baseline and on day 15 (HR, 2.21; 95% CI, 1.03-4.76; P = 0.042). This model was better than MELD alone (AUROC, 0.789 versus 0.734; P = 0.043). In the whole population with cirrhosis, the 3-month mortality was also predicted by high MELD scores (HR, 1.11; 95% CI, 1.07-1.16; P < 0.001) and a CRP level > 10 mg/L at the baseline and on day 15 (HR, 2.89; 95% CI, 1.29-6.48; P < 0.001), but the AUROCs of the 3-variable model and the MELD score alone were no longer significantly different (0.89 versus 0.88, not significant). In conclusion, prognostic models incorporating variations in CRP predict 3-month mortality in patients with cirrhosis. Such models are particularly relevant for patients with decompensated cirrhosis but provide a limited increase in prediction in comparison with the MELD score in the whole population with cirrhosis.
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Affiliation(s)
- Vincent Di Martino
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Besançon, France.,Université de Franche Comté, Unité de Formation et de Recherche des Sciences Médicales et Pharmaceutiques, Besançon, France
| | - Caroline Coutris
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Besançon, France
| | - Jean-Paul Cervoni
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Besançon, France
| | - Stavros Dritsas
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Besançon, France.,Université de Franche Comté, Unité de Formation et de Recherche des Sciences Médicales et Pharmaceutiques, Besançon, France
| | - Delphine Weil
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Besançon, France
| | - Carine Richou
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Besançon, France
| | - Claire Vanlemmens
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Besançon, France
| | - Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Besançon, France.,Université de Franche Comté, Unité de Formation et de Recherche des Sciences Médicales et Pharmaceutiques, Besançon, France
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Abstract
Determining the prognosis of cirrhotic patients is not an easy task. Prognostic scores, like Child-Pugh and Model of End-stage Liver Disease scores, are commonly used by hepatologists, but do not always reflect superimposed events that may strongly influence the prognosis. Among them, bacterial intestinal translocation is a key phenomenon for the development of cirrhosis-related complications. Several biological variables (C-reactive protein, serum free cortisol, copeptin, von Willebrand factor antigen) are surrogates of "inflammatory stress" and have recently been identified as potential prognostic markers in cirrhotic patients. Most of these above mentioned markers were investigated in pilot studies with sometimes a modest sample size but allow us to catch a glimpse of the pathophysiological mechanisms leading to the worsening of cirrhosis. These new data should generate further well-designed studies to better assess the benefit for liver function of preventing intestinal bacterial translocation and microvascular thrombosis. The control of infection is vital and among all actors of immunity, vitamin D also appears to act as an anti-infective agent and therefore has probably a prognostic value.
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Affiliation(s)
- Vincent Di Martino
- Vincent Di Martino, Delphine Weil, Jean-Paul Cervoni, Thierry Thevenot, Service D'hépatologie Et De Soins Intensifs Digestifs, CHU Jean Minjoz, 25000 Besançon, France
| | - Delphine Weil
- Vincent Di Martino, Delphine Weil, Jean-Paul Cervoni, Thierry Thevenot, Service D'hépatologie Et De Soins Intensifs Digestifs, CHU Jean Minjoz, 25000 Besançon, France
| | - Jean-Paul Cervoni
- Vincent Di Martino, Delphine Weil, Jean-Paul Cervoni, Thierry Thevenot, Service D'hépatologie Et De Soins Intensifs Digestifs, CHU Jean Minjoz, 25000 Besançon, France
| | - Thierry Thevenot
- Vincent Di Martino, Delphine Weil, Jean-Paul Cervoni, Thierry Thevenot, Service D'hépatologie Et De Soins Intensifs Digestifs, CHU Jean Minjoz, 25000 Besançon, France
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Thevenot T, Weil D, Di Martino V. Surrogate markers of free cortisol in cirrhotic patients: another step has been reached. Clin Gastroenterol Hepatol 2014; 12:513-5. [PMID: 24095976 DOI: 10.1016/j.cgh.2013.09.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 09/18/2013] [Accepted: 09/18/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon Cedex, France
| | - Delphine Weil
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon Cedex, France
| | - Vincent Di Martino
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon Cedex, France
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Moreno JP, Grandclement E, Monnet E, Clerc B, Agin A, Cervoni JP, Richou C, Vanlemmens C, Dritsas S, Dumoulin G, Di Martino V, Thevenot T. Plasma copeptin, a possible prognostic marker in cirrhosis. Liver Int 2013; 33:843-51. [PMID: 23560938 DOI: 10.1111/liv.12175] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 03/16/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIM Copeptin, secreted stoichiometrically with vasopressin, demonstrated its prognostic role in various diseases other than cirrhosis. METHODS We investigated the association between severity of cirrhosis and plasma concentrations of copeptin, and the prognostic value of copeptin in 95 non-septic cirrhotic patients (34 Child-Pugh A, 29 CP-B, 32 CP-C), 30 septic patients with a Child-Pugh >8 ('group D'), and 16 healthy volunteers. Patients were followed for at least 12 months to assess the composite endpoint death/liver transplantation. RESULTS Median copeptin concentrations (interquartile range) increased through healthy volunteers group [5.95 (3.76-9.43) pmol/L] and 'group D' patients [18.81 (8.96-36.66) pmol/L; P < 0.001)]. During a median follow-up of 11.0 ± 6.1 months, 28 non-transplanted patients died and eight were transplanted. In receiver operated characteristic curves analysis, the area under the curve values were as follows: Child-Pugh score 0.80 (95% CI: 0.71-0.86), model of end-stage liver disease (MELD) score 0.80 (0.70-0.86), C-reactive protein (CRP) 0.71 (0.60-0.80) and copeptin 0.70 (0.57-0.79). By stratifying the values of these variables into tertiles, the risk of death/liver transplantation for patients belonging to the highest tertile of copeptin (>13 pmol/L) was high (Log-rank test: P = 0.0002) and 2.3-fold higher than for patients with lower concentrations after adjusting for MELD score (>21) and CRP (>24 mg/L) in a Cox model. Other potential predictors (age, total cholesterol, natraemia and serum free cortisol) did not reach a significant level. CONCLUSION In cirrhotic patients, copeptin concentrations increased along with the severity of liver disease. In our cohort, the 1-year mortality or liver transplantation was predicted by high MELD score and high concentrations of CRP and copeptin.
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Affiliation(s)
- José-Philippe Moreno
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon, France
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Thevenot T, Degand T, Grelat N, Elkrief L, Christol C, Moreau R, Henrion J, Cadranel JF, Sheppard F, Bureau C, di Martino V, Pauwels A. A French national survey on the use of antibiotic prophylaxis in cirrhotic patients. Liver Int 2013; 33:389-97. [PMID: 23302021 DOI: 10.1111/liv.12093] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 11/26/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines recommend antibiotic prophylaxis (AP) in well-selected groups of cirrhotic patients, but the impact of these recommendations has not been assessed in France. AIM To evaluate AP prescription tendencies for gastrointestinal bleeding, and primary and secondary prophylaxis of spontaneous bacterial peritonitis (SBP). METHODS Practitioners (n = 1,159) working in general hospitals (GH) or in university hospitals (UH) received a self-administered questionnaire. RESULTS Three hundred and eighty-nine (33.6%; GH 35% and UH 30.4%) practitioners responded. AP was prescribed by 97.7%, 72.3% and 94.8% of practitioners, without significant differences between UH and GH, respectively, for gastrointestinal bleeding (quinolones 48.2%, third-generation cephalosporins 27.7% and amoxicillin-clavulanic acid 22.2%), primary (quinolones 97.2%) and secondary prophylaxis of SBP (quinolones 99%). For gastrointestinal bleeding, ofloxacin (47.6%) and norfloxacin (37.4%) were the main quinolones prescribed, and ceftriaxone (77%) was the main third-generation cephalosporin prescribed. The principal reasons for prescribing AP were a decrease in bacterial infection (88.9% for gastrointestinal bleeding, 91.3% for primary and 94.3% for secondary prophylaxis of SBP), a recommendation by a consensus conference (83%, 38% and 74.4% respectively) and an improvement in survival (72.8%, 41.3% and 57.7% respectively). Only 31.7% of practitioners (39.6% for UH vs. 28.6% for GH; P = 0.038) believed that AP may reduce the risk of bleeding recurrence. Reported side effects (28%) of AP mainly concerned the risk of quinolone resistance (62% of cases). CONCLUSION Antibiotic prophylaxis is well-recognized by French practitioners, but its routine use depends on the expertise of practitioners. Quinolones remain the main antibiotic class prescribed irrespective of the type of prophylaxis.
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Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Universitaire Jean Minjoz, Besançon, France.
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Thevenot T, Monnet E, Di Martino V. Effect of albumin on survival in septic cirrhotic patients other than spontaneous bacterial peritonitis. The question remains open. J Hepatol 2013; 58:638-9. [PMID: 23220370 DOI: 10.1016/j.jhep.2012.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/10/2012] [Accepted: 10/11/2012] [Indexed: 12/04/2022]
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Thevenot T, Blasco G, Grelat N, Pili-Floury S. [Primary antibiotic prophylaxis of spontaneous bacterial peritonitis in cirrhotic patients is a matter of target!]. Presse Med 2012; 41:1168-70. [PMID: 23040951 DOI: 10.1016/j.lpm.2012.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 07/19/2012] [Indexed: 12/14/2022] Open
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Thevenot T, Dorin R, Monnet E, Qualls CR, Sapin R, Grandclement E, Borot S, Sheppard F, Weil D, Degand T, Di Martino V, Kazlauskaite R. High serum levels of free cortisol indicate severity of cirrhosis in hemodynamically stable patients. J Gastroenterol Hepatol 2012; 27:1596-601. [PMID: 22647073 DOI: 10.1111/j.1440-1746.2012.07188.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM We investigated: (i) the association between severity of cirrhosis and serum levels of free cortisol (SFC) and total cortisol (STC), measured before and 30 min after (T(30)) the low-dose 1-µg short synacthen test (LD-SST); and (ii) the prognostic value of SFC and STC. METHODS Consecutive, hemodynamically stable, cirrhotic patients (34 Child-Pugh class A, 29B, and 32C) underwent the LD-SST. Patients were followed for at least 12 months to assess non-transplant-related mortality. RESULTS Child-Pugh class C patients had significantly higher basal levels of SFC than Child-Pugh class A or B patients. Prevalence of suspected adrenal dysfunction ranged between 7.4% (T(0) STC < 138 nmol/L) and 49.4% (change in STC < 250 nmol/L) according to the threshold used. In receiver-operator curve analysis, the area-under-the-curve values were 0.67 for T(30) SFC (0.51-0.79), 0.81 for Child-Pugh score (0.70-0.88), and 0.79 for albumin level (0.63-0.88). During the follow-up period, 16 patients with high T(30) SFC (≥ 78.9 nmol/L) (26.2%) and one patient with low T(30) SFC (< 78.9 nmol/L) (3.4%) died (P = 0.027 for high vs low T(30) SFC, log-rank test). Albeit not statistically significant, the risk of death for patients with T(30) SFC ≥ 78.9 nmol/L was fivefold higher than for patients with lower levels after adjusting for cirrhosis severity and level of albumin. CONCLUSIONS One-year, non-transplant-related mortality is high among patients with T(30) levels of SFC ≥ 78.9 nmol/L (26.2%). These findings might result from latent inflammatory stress in hemodynamically stable cirrhotic patients, detected by adrenal testing.
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Affiliation(s)
- Thierry Thevenot
- Department of Hepatology, University Hospital Jean Minjoz, France.
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Cattelan J, Racadot E, Di Martino V, Thevenot T. Antiannexin V antibodies: an underestimated source of noncirrhotic portal vein thrombosis? Hepatology 2012; 56:1182. [PMID: 22371219 DOI: 10.1002/hep.25669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Piedoux S, Monnet E, Piroth L, Montange D, Royer B, Thevenot T, Kantelip JP, Di Martino V, Muret P. Relative impact of ribavirin monitoring and HIV coinfection on sustained virological response in patients with chronic hepatitis C. Antivir Ther 2012; 16:1317-26. [PMID: 22155913 DOI: 10.3851/imp1920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In chronic hepatitis C, higher ribavirin (RBV) concentrations are associated with sustained virological response (SVR); target concentration cutoffs have been proposed. As RBV displays interindividual variability, monitoring of RBV plasma levels appears relevant. The impact of RBV therapeutic drug monitoring (TDM(RBV)) on SVR has not been explored in current practice. Our study aimed to assess this impact. METHODS Three patient groups were defined as RBV cutoffs achieved at week 12 (group A1), not achieved (group A2), and one without RBV concentration assessment (group B). A predictive model assessed the group impact on SVR in multivariate analysis, while adjusting for additional predictive factors. A specific evaluation of HIV-HCV-coinfected patients was performed. RESULTS A total of 122 patients were included. In group A1 (n=30, HIV-positive =18), SVR, relapse and non-response rates were 60%, 17% and 23%, respectively; in group A2 (n=32, HIV-positive =18), 25%, 19% and 56%, respectively; and in group B (n=60, HIV-positive =3), 52%, 33% and 15%, respectively (P=0.0004). The patient group was an independent predictor of SVR (P=0.01), along with baseline viral load and HCV genotype. HIV coinfection did not impede the SVR rate. The cutoffs were achieved in 62% and 28% (P=0.008) of patients, when TDM(RBV) was performed or not, respectively. CONCLUSIONS The achievement of RBV cutoffs is a predictive factor of SVR independent of HIV coinfection. It makes it possible to reach high SVR rates, avoid relapse and obtain the same SVR rates in HIV-HCV-coinfected as in HCV-monoinfected patients. TDM(RBV) enables RBV concentration cutoffs to be reached more frequently and could thus be a useful tool to optimize hepatitis C treatment.
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Affiliation(s)
- Sarah Piedoux
- EA UPRES 3186, Laboratoire de Pharmacologie Clinique, CHU Besançon, Besançon, France.
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Cattelan J, Delabrousse E, Chatelain B, Thevenot T. A maxillofacial tumour after liver transplantation. Liver Int 2012; 32:429. [PMID: 22136360 DOI: 10.1111/j.1478-3231.2011.02692.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 10/31/2011] [Accepted: 10/31/2011] [Indexed: 02/13/2023]
Affiliation(s)
- Jessy Cattelan
- Department of Hepatology, University Hospital Jean Minjoz, Besançon Cedex, France
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Thevenot T, Cervoni JP, Di Martino V. Variceal bleeding in cirrhotic patients is associated with adrenal dysfunction: what is the evidence? Clin Gastroenterol Hepatol 2012; 10:95; author reply 95. [PMID: 21888881 DOI: 10.1016/j.cgh.2011.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 08/24/2011] [Indexed: 02/07/2023]
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Nguyen-Khac E, Thevenot T, Piquet MA, Benferhat S, Goria O, Chatelain D, Tramier B, Dewaele F, Ghrib S, Rudler M, Carbonell N, Tossou H, Bental A, Bernard-Chabert B, Dupas JL. Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis. N Engl J Med 2011; 365:1781-9. [PMID: 22070475 DOI: 10.1056/nejmoa1101214] [Citation(s) in RCA: 257] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mortality among patients with severe acute alcoholic hepatitis is high, even among those treated with glucocorticoids. We investigated whether combination therapy with glucocorticoids plus N-acetylcysteine would improve survival. METHODS We randomly assigned 174 patients to receive prednisolone plus N-acetylcysteine (85 patients) or only prednisolone (89 patients). All patients received 4 weeks of prednisolone. The prednisolone-N-acetylcysteine group received intravenous N-acetylcysteine on day 1 (at a dose of 150, 50, and 100 mg per kilogram of body weight in 250, 500, and 1000 ml of 5% glucose solution over a period of 30 minutes, 4 hours, and 16 hours, respectively) and on days 2 through 5 (100 mg per kilogram per day in 1000 ml of 5% glucose solution). The prednisolone-only group received an infusion in 1000 ml of 5% glucose solution per day on days 1 through 5. The primary outcome was 6-month survival. Secondary outcomes included survival at 1 and 3 months, hepatitis complications, adverse events related to N-acetylcysteine use, and changes in bilirubin levels on days 7 and 14. RESULTS Mortality was not significantly lower in the prednisolone-N-acetylcysteine group than in the prednisolone-only group at 6 months (27% vs. 38%, P = 0.07). Mortality was significantly lower at 1 month (8% vs. 24%, P = 0.006) but not at 3 months (22% vs. 34%, P = 0.06). Death due to the hepatorenal syndrome was less frequent in the prednisolone-N-acetylcysteine group than in the prednisolone-only group at 6 months (9% vs. 22%, P = 0.02). In a multivariate analysis, factors associated with 6-month survival were a younger age (P<0.001), a shorter prothrombin time (P<0.001), a lower level of bilirubin at baseline (P<0.001), and a decrease in bilirubin on day 14 (P<0.001). Infections were less frequent in the prednisolone-N-acetylcysteine group than in the prednisolone-only group (P = 0.001); other side effects were similar in the two groups. CONCLUSIONS Although combination therapy with prednisolone plus N-acetylcysteine increased 1-month survival among patients with severe acute alcoholic hepatitis, 6-month survival, the primary outcome, was not improved. (Funded by Programme Hospitalier de Recherche Clinique; AAH-NAC ClinicalTrials.gov number, NCT00863785 .).
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Affiliation(s)
- Eric Nguyen-Khac
- Service d'Hépato-Gastroentérologie, Amiens University Hospital, and Equipe Région INSERM 24, University of Picardy, Amiens, France.
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Thevenot T, Borot S, Remy-Martin A, Sapin R, Cervoni JP, Richou C, Vanlemmens C, Cleau D, Muel E, Minello A, Tirziu S, Penfornis A, Di Martino V, Monnet E. Assessment of adrenal function in cirrhotic patients using concentration of serum-free and salivary cortisol. Liver Int 2011; 31:425-33. [PMID: 21281437 DOI: 10.1111/j.1478-3231.2010.02431.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Because over 90% of serum cortisol is bound to albumin and corticosteroid-binding globulin (CBG), changes in these proteins can affect measures of serum total cortisol levels in cirrhotics without altering serum-free and salivary cortisol concentrations. METHODS We assessed basal (T₀) and post-synacthen (T₆₀) serum total cortisol, serum-free and salivary cortisol in 125 consecutive cirrhotics (95 non-septic and 30 septic patients with a Child>8). RESULTS Serum total cortisol levels significantly decreased from the Child A-C non-septic group, as did albumin and CBG levels, with a non-significant rise in serum-free cortisol concentrations. Non-septic patients with low albumin (≤25 g/L) or CBG levels (≤35 mg/L) had lower T₀ serum total cortisol levels than patients with near-normal albumin (303.4 vs. 382.6 nmol/L; P=0.0035) or with normal CBG levels (289.9 vs. 441.4 nmol/L; P<0.0001), respectively, despite similar serum-free cortisol or salivary cortisol concentrations. Subnormal T₆₀ serum total cortisol concentrations (<510.4 nmol/L) were measured in 7.2% of all patients (Child C: 14.5% vs. Child A and B: 0%; P=0.0013) but no patients exhibited symptoms suggesting adrenal insufficiency. Patients with or without subnormal T₆₀ total cortisol had similar T₀ salivary cortisol and serum-free cortisol concentrations. A trend was observed towards high serum-free cortisol concentrations and mortality in multivariate analysis. CONCLUSIONS Serum total cortisol levels overestimated the prevalence of adrenal dysfunction in cirrhotics with end-stage liver disease. Since serum-free cortisol cannot be measured routinely, salivary cortisol testing could represent a useful approach but needs to be standardized.
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Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon cedex, France.
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Thevenot T, Cervoni JP, Monnet E, Sheppard F, Martino VD. Is this really the end of beta-blockers in patients with cirrhosis and refractory ascites? Hepatology 2011; 53:715-6. [PMID: 20814893 DOI: 10.1002/hep.23839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Crouzet J, Grenouillet F, Delabrousse E, Blagosklonov O, Thevenot T, Di Martino V, Piarroux R, Mantion GA, Bresson-Hadni S. Personalized management of patients with inoperable alveolar echinococcosis undergoing treatment with albendazole: usefulness of positron-emission-tomography combined with serological and computed tomography follow-up. Clin Microbiol Infect 2009; 16:788-91. [PMID: 19912267 DOI: 10.1111/j.1469-0691.2009.02924.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The present study aimed to identify a sub-group of inoperable alveolar echinococcosis (AE) patients undergoing long-term treatment with benzimidazole (BZM) who presented with an evolution suggestive of a parasitocidal effect. An evolution compatible with parasite death was observed in five patients.
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Affiliation(s)
- J Crouzet
- WHO Collaborating Center for Prevention and Treatment of Human Echinococcosis, University Hospital, Besançon, France
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Thevenot T, Pastor CM, Cervoni JP, Jacquelinet C, Nguyen-Khac E, Richou C, Heyd B, Vanlemmens C, Mantion G, Di Martino V, Cadranel J. Le syndrome hépatopulmonaire. ACTA ACUST UNITED AC 2009; 33:565-79. [DOI: 10.1016/j.gcb.2009.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 08/12/2008] [Accepted: 03/12/2009] [Indexed: 12/17/2022]
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Thevenot T, Borot S, Remy-Martin A, Sapin R, Penfornis A, Di Martino V, Monnet E. Assessing adrenal function in cirrhotic patients: is there a reliable test? ACTA ACUST UNITED AC 2009; 33:584-8. [PMID: 19473798 DOI: 10.1016/j.gcb.2009.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 03/14/2009] [Accepted: 03/26/2009] [Indexed: 12/11/2022]
Affiliation(s)
- T Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean-Minjoz, 25030 Besançon cedex, France.
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Barbare JC, Bouché O, Bonnetain F, Dahan L, Lombard-Bohas C, Faroux R, Raoul JL, Cattan S, Lemoine A, Blanc JF, Bronowicki JP, Zarski JP, Cazorla S, Gargot D, Thevenot T, Diaz E, Bastie A, Aparicio T, Bedenne L. Treatment of advanced hepatocellular carcinoma with long-acting octreotide: a phase III multicentre, randomised, double blind placebo-controlled study. Eur J Cancer 2009; 45:1788-97. [PMID: 19303768 DOI: 10.1016/j.ejca.2009.02.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 02/10/2009] [Accepted: 02/13/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND A previous study reported a significant survival benefit for octreotide compared with no treatment in patients with advanced hepatocellular carcinoma (HCC). This was investigated further in this multicentre study. PATIENTS AND METHODS Two hundred and seventy two patients with HCC who were ineligible for curative treatments or had relapsed following potentially curative therapies were randomised to receive long-acting octreotide, 30 mg as an intramuscular injection once every 4 weeks for up to 2 years, or placebo. RESULTS At the time of the final analysis, median overall survival (OS) was 6.53 months (95% confidence interval [CI], 4.8-8.3) for octreotide versus 7.03 months (95% CI, 5.43-8.53) for placebo (p=0.34). Progression-free survival (p=0.26) also did not differ significantly between the two treatment groups. No objective responses were achieved in the octreotide group but 33% of patients achieved disease stabilisation for a mean time of 5.5 months (95% CI, 1.1-9.9). The median time until definitive global health score deterioration (according to QLQ-C30) was 2.3 months (95% CI, 1.4-3.7) in the octreotide and 4 months (95% CI, 2.2-5.7) in the placebo group (p=0.09). There were four objective responses in the placebo group. Octreotide was well tolerated; seven patients reported severe adverse events possibly related to octreotide and there were no cases of haematoma or cholecystitis. CONCLUSIONS In patients with advanced HCC, octreotide has a favourable safety profile but does not improve OS and could have a negative impact on quality of life.
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Affiliation(s)
- Jean-Claude Barbare
- Fédération Francophone de Cancérologie Digestive, Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux, France.
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Amouroux C, Cervoni JP, Delabrousse E, Koch S, Thevenot T, Di Martino V. [Portal vein thrombosis after cyanoacrylate injection therapy in bleeding gastric varices]. ACTA ACUST UNITED AC 2009; 33:205-7. [PMID: 19233578 DOI: 10.1016/j.gcb.2009.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 12/30/2008] [Accepted: 01/07/2009] [Indexed: 11/28/2022]
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Nguyen-Khac E, Thevenot T, Capron D, Dharancy S, Paupart T, Thabut D, Tiry C. Are ascitic electrolytes usable in cirrhotic patients? Correlation of sodium, potassium, chloride, urea, and creatinine concentrations in ascitic fluid and blood. Eur J Intern Med 2008; 19:613-8. [PMID: 19046728 DOI: 10.1016/j.ejim.2007.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 07/06/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treatment of ascitic cirrhosis requires monitoring of blood biochemistry. A direct measure of ascites could simplify the medical procedure. We aimed to assess the correlation of sodium (Na), potassium (K), chloride (Cl), urea (U), and creatinine (Creat) in ascitic fluid and venous blood. METHODS Ascitic fluid and venous blood samples were collected simultaneously from 70 cirrhotic patients. Na, K, Cl, U, and Creat were measured in all samples using a biochemical auto-analyzer. RESULTS Results are expressed as the mean and SD of 200 concomitant samples of ascitic fluid and venous blood (mmol/L for Na, K, and Cl; g/L for U; mg/L for Creat). In ascites and blood the results were, respectively: 133.1+/-6.6 and 131.8+/-6.3 for Na (p<0.0001, r=0.95), 4.1+/-0.8 and 4.3+/-0.9 for K (p<0.0001, r=0.90), 107.2+/-7.6 and 101+/-7 for Cl (p<0.0001, r=0.93), 0.54+/-0.52 and 0.53+/-0.5 for U (p<0.0001, r=0.99), and 9.8+/-7.5 and 11+/-7 for Creat (p<0.0001, r=0.99). Analysis of ascites predicted blood results for different cut-offs (Na< or =125, K< or =3.2, K> or =5.5 and Creat> or =14) with a sensitivity of 1.00, 0.89, 0.71, and 0.92, and a specificity of 1.00, 0.95, 0.98, and 0.92, respectively. CONCLUSIONS Correlations for Na, K, Cl, U, and Creat are strong between ascites and venous blood in cirrhotic patients. These parameters could, therefore, be assayed directly in ascitic fluid to monitor diuretic therapy in patients without venous access or when biochemical measurements, such as liver tests or coagulation tests, are not required, and in patients with poor venous access.
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Nguyen-Khac E, Cadranel JF, Thevenot T, Nousbaum JB. Review article: the utility of reagent strips in the diagnosis of infected ascites in cirrhotic patients. Aliment Pharmacol Ther 2008; 28:282-8. [PMID: 19086234 DOI: 10.1111/j.1365-2036.2008.03735.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spontaneous bacterial peritonitis (SBP) can be diagnosed via leucocyte esterase reagent strips, although diagnostic performances vary. AIM To perform critical review of literature on the use of reagent strips in SBP. METHODS Nineteen studies were analysed (Medline search), comparing reagent strips in cirrhotic ascites vs. cytobacteriological methods. Diagnostic grades (G) were: GO = 0 leucocytes/mm3; G1 = 15; G2 = 70; G3 = 125; G4 = 500 for Multistix, GO = 0; G1 = 25; G2 = 75; G3 = 500 for Nephur, Combur, UriScan, and GO = 0; G1 = 25; G2 = 75; G3 = 250; G4 = 500 for Aution. RESULTS Medians per study were: 75 patients (range: 31-1041), 136 ascites (47-2123), 17 SBP (5-117). For Multistix (12 studies), the sensitivities fell within the ranges 64.7-100% (G > or = 1), 45.7-83% (G > or = 2) and 45.3-89% (G > or = 3). For Nephur (n = 2), Combur (n = 6), UriScan (n = 1), sensitivities ranged 80.4-100% (G > or = 1), 63-100% (G > or = 2) and 67.7-97% (G > or = 3). For Aution (n = 3), sensitivities ranged 93-96% (G > or = 2) and 89% (G > or = 3). Nephur, Combur, UriScan displayed higher sensitivities than Multistix. However, in larger studies, sensitivities dramatically fell at 45.3% for Multistix (G > or = 3) if ascites polymorphonuclear count <1000/mm3 and 22.2% for bacterascites or 16.7-25% for asymptomatic patients. CONCLUSION Use of reagent strips for the diagnosis of SBP cannot be recommended, in view of low sensitivity and a high risk of false negatives, especially in patients with SBP and low polymorphonuclear count.
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Affiliation(s)
- E Nguyen-Khac
- Hepato-Gastroenterology, Amiens University Hospital, CHU Nord, place Victor Pauchet, France.
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Cadranel JF, Thevenot T. [Chronic transaminase elevation]. Gastroenterol Clin Biol 2008; 32:S205-S209. [PMID: 18479862 DOI: 10.1016/j.gcb.2008.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- J-F Cadranel
- Service d'hépatogastroentérologie et de nutrition, centre hospitalier Laennec, boulevard Laennec, B.P. 72, 60109 Creil cedex, France.
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Dobrin A, Thevenot T, Alby B, Di Martino V, Sailley N, Meneveau N. A case of isolated splenic infarction associated with a foramen ovale and an interatrial septal aneurysm. Gastroenterol Clin Biol 2008; 32:351-353. [PMID: 18400441 DOI: 10.1016/j.gcb.2008.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 12/13/2007] [Accepted: 01/08/2008] [Indexed: 05/26/2023]
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Thevenot T, Denis J, Jouannaud V, Monnet E, Renou C, Labadie H, Abdelli N, Nguyen-Khac E, Dumouchel P, Bresson-Hadni S, Chousterman M, DI Martino V, Cadranel JF. Coeliac disease in chronic hepatitis C: a French multicentre prospective study. Aliment Pharmacol Ther 2007; 26:1209-16. [PMID: 17944735 DOI: 10.1111/j.1365-2036.2007.03499.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND A prevalence of 1.2% of coeliac disease (CD) in patients with chronic hepatitis C was recently reported, suggesting a possible epidemiological link between these two diseases. However, other studies have not found this relationship. AIM To conduct a French multicentre prospective study to assess the prevalence of CD in hepatitis C virus (HCV)-infected patients. METHODS Between June 2003 and November 2005, 624 consecutive HCV-positive out-patients were tested for antiendomysial IgA antibodies (AEA), antigliadin IgA and IgG antibodies (AGA). Patients with positive AEA or IgA AGA and positive IgG AGA in a context of a high suspicion of CD were asked to undergo gastroscopy with duodenal biopsies. RESULTS Isolated IgA AEA, IgA AGA and IgG AGA were 0.16%, 5.7% and 4.4%, respectively. Gastroscopy was required for 39 patients, 31 were performed (eight refusals), but only 25 duodenal biopsies were performed as six patients had cirrhosis. CD was never detected. CONCLUSIONS The prevalence of CD in HCV-positive patients was 0% (95% confidence interval: 0-0.59%), but there is a low prevalence of CD in the whole French population.
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Affiliation(s)
- T Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Universitaire Jean Minjoz, Besançon, France.
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Thevenot T, Boruchowicz A, Henrion J, Nalet B, Moindrot H. Celiac disease is not associated with chronic hepatitis C. Dig Dis Sci 2007; 52:1310-2. [PMID: 17372827 DOI: 10.1007/s10620-006-9360-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 03/28/2006] [Indexed: 02/07/2023]
Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Universitaire Jean Minjoz, Boulevard Fleming, 25030, Besançon, France.
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Lerut J, Orlando G, Adam R, Sabbà C, Pfitzmann R, Klempnauer J, Belghiti J, Pirenne J, Thevenot T, Hillert C, Brown CM, Gonze D, Karam V, Boillot O. Liver transplantation for hereditary hemorrhagic telangiectasia: Report of the European liver transplant registry. Ann Surg 2007; 244:854-62; discussion 862-4. [PMID: 17122610 PMCID: PMC1856634 DOI: 10.1097/01.sla.0000247258.35406.a4] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is a rare disease characterized by the presence of arteriovenous malformations. Hepatic involvement can lead to life-threatening conditions. MATERIAL AND METHODS Forty patients, reported to the European Liver Transplant Registry, were analyzed to define the role of liver transplantation in the treatment of the hepatic disease form. Indications for transplantation were classified according to Garcia-Tsao: cardiac failure (14 patients), biliary necrosis causing hepatic failure (12 patients), severe portal hypertension (5 patients), cardiac failure and biliary necrosis (6 patients), cardiac failure and portal hypertension (2 patients), and cardiac failure associated with biliary necrosis and portal hypertension (1 patient). Eighteen (81%) of 22 patients had pulmonary artery hypertension. Twelve (30%) patients had pretransplant hepatic interventions. Follow-up was complete for all patients with a mean of 69 months (range, 0-230 months). RESULTS One-, 5- and 10-year actuarial patient and graft survival rates are 82.5%. Six of the 7 pretransplant procedures performed on the hepatic artery were severely complicated. Cardiovascular function documented in 24 patients improved in 18 patients and remained stable in 5 patients; 1 patient died perioperatively of acute heart failure. Twenty-four (60%) patients had post-transplant complications, all but one occurring within the first 4 posttransplant months. Seven (17.5%) patients died perioperatively, 6 of them due to bleeding and 1 due to cardiac failure; 1 (2.5%) patient died late due to chronic rejection. There were 2 possible recurrences. Quality of life markedly improved in all 32 surviving patients. CONCLUSION The results of the largest reported transplant series in the treatment of hepatic-based HHT are excellent. Elimination of hepatobiliary sepsis and reversal of cardiopulmonary changes dramatically improve quality of life of the recipients. LT should be proposed earlier in the course of symptomatic hepatic HHT presenting with life-threatening conditions. Palliative interventions, especially on the hepatic artery, should be avoided in view of their high (infectious) complication rate.
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Affiliation(s)
- Jan Lerut
- Liver Transplant Unit, University Hospital St. Luc, Brussels, Belgium.
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Thevenot T, Di Martino V, Lagrange A, Petrella T, Faucher JF, Fontan J, Terebus M, Miguet JP, Bresson-Hadni S. Granulomatous hepatitis and hemophagocytic syndrome after bacillus Calmette-Guerin bladder instillation. ACTA ACUST UNITED AC 2006; 30:480-2. [PMID: 16633319 DOI: 10.1016/s0399-8320(06)73208-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Intravesical instillations of bacillus Calmette-Guérin are frequently used for treating superficial bladder carcinoma which is considered a safe treatment. We describe an unusual complication with hemophagocytosis and granulomatous hepatitis. Prompt diagnosis and treatment with corticosteroids, anti-tuberculous agents and intravenous immunoglobulins led to a rapid recovery.
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Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Louis Pasteur, Dole.
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