Pub Date : 2024-09-03DOI: 10.1016/j.dld.2024.07.030
Marc Hilmi, Ines Khati, Anthony Turpin, Antoine Andremont, Charles Burdet, Nathalie Grall, Joana Vidal, Philippe-Jean Bousquet, Benoît Rousseau, Christine Le Bihan-Benjamin
Background: The impact of antibiotics (ATBs) on the risk of colorectal cancer (CRC) recurrence after curative resection remains unknown.
Methods: Using the French nation-wide database of cancer patients, all newly diagnosed non-metastatic CRC patients resected between 01/2012 and 12/2014 were included. The perioperative ATB intake (from 6 months before surgery until 1 year after) was classified according to the class, the period of use (pre- vs post-resection), the disease stage (localized and locally advanced), and the primary tumor location (colon and rectum/junction). The primary endpoint was the 3-year disease-free survival (DFS). The impact of ATB was assessed using time-dependent multivariate Cox models.
Results: A total of 35,496 CRC patients were included. Seventy-nine percent of patients had at least one ATB intake. Outpatient ATB intake after surgery was associated with unfavorable 3-year DFS. The ATBs associated with decreased 3-year DFS were cephalosporins, streptogramins, quinolones, penicillin A with beta-lactamase inhibitors, and antifungals with differential effects according to the primary tumor location and disease stage.
Conclusion: These findings suggest that ATBs modulate the risk of recurrence after early CRC resection with a differential impact of the ATB classes depending on disease stage and tumor site.
{"title":"Association between the antibiotics use and recurrence in patients with resected colorectal cancer: EVADER-1, a nation-wide pharmaco-epidemiologic study.","authors":"Marc Hilmi, Ines Khati, Anthony Turpin, Antoine Andremont, Charles Burdet, Nathalie Grall, Joana Vidal, Philippe-Jean Bousquet, Benoît Rousseau, Christine Le Bihan-Benjamin","doi":"10.1016/j.dld.2024.07.030","DOIUrl":"https://doi.org/10.1016/j.dld.2024.07.030","url":null,"abstract":"<p><strong>Background: </strong>The impact of antibiotics (ATBs) on the risk of colorectal cancer (CRC) recurrence after curative resection remains unknown.</p><p><strong>Methods: </strong>Using the French nation-wide database of cancer patients, all newly diagnosed non-metastatic CRC patients resected between 01/2012 and 12/2014 were included. The perioperative ATB intake (from 6 months before surgery until 1 year after) was classified according to the class, the period of use (pre- vs post-resection), the disease stage (localized and locally advanced), and the primary tumor location (colon and rectum/junction). The primary endpoint was the 3-year disease-free survival (DFS). The impact of ATB was assessed using time-dependent multivariate Cox models.</p><p><strong>Results: </strong>A total of 35,496 CRC patients were included. Seventy-nine percent of patients had at least one ATB intake. Outpatient ATB intake after surgery was associated with unfavorable 3-year DFS. The ATBs associated with decreased 3-year DFS were cephalosporins, streptogramins, quinolones, penicillin A with beta-lactamase inhibitors, and antifungals with differential effects according to the primary tumor location and disease stage.</p><p><strong>Conclusion: </strong>These findings suggest that ATBs modulate the risk of recurrence after early CRC resection with a differential impact of the ATB classes depending on disease stage and tumor site.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1016/j.dld.2024.08.041
B Picard, E Weiss, V Bonny, C Vigneron, A Goury, G Kemoun, O Caliez, M Rudler, R Rhaiem, V Rebours, J Mayaux, C Fron, F Pène, J B Bachet, A Demoule, M Decavèle
Background: Gastrointestinal (GI) bleeding is a leading cause of intensive care unit (ICU) admission in pancreatic cancer patients.
Aims: To analyze causes, ICU mortality and hemostatic treatment success rates of GI bleeding in pancreatic cancer patients requiring ICU admission.
Methods: Retrospective multicenter cohort study between 2009 and 2021. Patients with a recent pancreatic resection surgery were excluded.
Results: Ninety-five patients were included (62 % males, 67 years-old). Fifty-one percent presented hemorrhagic shock, 41 % required mechanical ventilation. Main GI bleeding causes were gastroduodenal tumor invasion (32 %), gastroesophageal varices (21 %) and arterial aneurysm (12 %). Arterial aneurysms were more frequent in patients with previous pancreatic resection (36 % vs 2 %, p < 0.001). Hemostatic procedures included gastroduodenal endoscopy in 81 % patients and arterial embolization in 28 % patients. ICU mortality was 19 %. Multivariate analysis identified four variables associated with mortality: performance status >2 (OR 9.34, p = 0.026), mechanical ventilation (OR 14.14, p = 0.003), treatment success (OR 0.09, p = 0.010), hemorrhagic shock (OR 11.24, p = 0.010). Treatment success was 46 % and was associated with aneurysmal bleeding (OR 29.89, p = 0.005), ongoing chemotherapy (OR 0.22, p = 0.016), and prothrombin time ratio (OR 1.05, p = 0.001).
Conclusion: In pancreatic cancer patients with severe GI bleeding, early identification of aneurysmal bleeding (particularly in case of previous resection surgery) and coagulopathy management may increase the treatment success and reduce mortality.
{"title":"Causes, management, and prognosis of severe gastrointestinal bleedings in critically ill patients with pancreatic cancer: A retrospective multicenter study.","authors":"B Picard, E Weiss, V Bonny, C Vigneron, A Goury, G Kemoun, O Caliez, M Rudler, R Rhaiem, V Rebours, J Mayaux, C Fron, F Pène, J B Bachet, A Demoule, M Decavèle","doi":"10.1016/j.dld.2024.08.041","DOIUrl":"https://doi.org/10.1016/j.dld.2024.08.041","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal (GI) bleeding is a leading cause of intensive care unit (ICU) admission in pancreatic cancer patients.</p><p><strong>Aims: </strong>To analyze causes, ICU mortality and hemostatic treatment success rates of GI bleeding in pancreatic cancer patients requiring ICU admission.</p><p><strong>Methods: </strong>Retrospective multicenter cohort study between 2009 and 2021. Patients with a recent pancreatic resection surgery were excluded.</p><p><strong>Results: </strong>Ninety-five patients were included (62 % males, 67 years-old). Fifty-one percent presented hemorrhagic shock, 41 % required mechanical ventilation. Main GI bleeding causes were gastroduodenal tumor invasion (32 %), gastroesophageal varices (21 %) and arterial aneurysm (12 %). Arterial aneurysms were more frequent in patients with previous pancreatic resection (36 % vs 2 %, p < 0.001). Hemostatic procedures included gastroduodenal endoscopy in 81 % patients and arterial embolization in 28 % patients. ICU mortality was 19 %. Multivariate analysis identified four variables associated with mortality: performance status >2 (OR 9.34, p = 0.026), mechanical ventilation (OR 14.14, p = 0.003), treatment success (OR 0.09, p = 0.010), hemorrhagic shock (OR 11.24, p = 0.010). Treatment success was 46 % and was associated with aneurysmal bleeding (OR 29.89, p = 0.005), ongoing chemotherapy (OR 0.22, p = 0.016), and prothrombin time ratio (OR 1.05, p = 0.001).</p><p><strong>Conclusion: </strong>In pancreatic cancer patients with severe GI bleeding, early identification of aneurysmal bleeding (particularly in case of previous resection surgery) and coagulopathy management may increase the treatment success and reduce mortality.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To construct a nomogram for predicting necrotizing enterocolitis (NEC) in preterm infants.
Methods: A total of 4,724 preterm infants who were admitted into 8 hospitals between April 2019 and September 2020 were initially enrolled this retrospective multicenter cohort study. Finally, 1,092 eligible cases were divided into training set and test set based on a 7:3 ratio. A univariate logistic regression analysis was performed to compare the variables between the two groups. Stepwise backward regression, LASSO regression, and Boruta feature selection were utilized in the multivariate analysis to identify independent risk factors. Then a nomogram model was constructed based on the identified risk factors.
Results: Risk factors for NEC included gestational diabetes mellitus, gestational age, small for gestational age, patent ductus arteriosus, septicemia, red blood cell transfusion, intravenous immunoglobulin, severe feeding intolerance, and absence of breastfeeding. The nomogram model developed based on these factors showed well discriminative ability. Calibration and decision curve analysis curves confirmed the good consistency and clinical utility of the model.
Conclusions: We developed a nomogram model with strong discriminative ability, consistency, and clinical utility for predicting NEC. This model could be valuable for the early prediction of preterm infants at risk of developing NEC.
背景：构建预测早产儿坏死性小肠结肠炎（NEC）的提名图：构建预测早产儿坏死性小肠结肠炎（NEC）的提名图：这项回顾性多中心队列研究初步纳入了2019年4月至2020年9月期间8家医院收治的4724名早产儿。最后，1092 个符合条件的病例按照 7:3 的比例被分为训练集和测试集。对两组变量进行单变量逻辑回归分析比较。在多变量分析中，利用逐步回归、LASSO 回归和 Boruta 特征选择来识别独立的风险因素。然后根据确定的风险因素构建了一个提名图模型：结果：NEC的风险因素包括妊娠糖尿病、胎龄、胎龄小、动脉导管未闭、败血症、输注红细胞、静脉注射免疫球蛋白、严重喂养不耐受和未母乳喂养。根据这些因素建立的提名图模型显示出良好的分辨能力。校准和决策曲线分析曲线证实了该模型具有良好的一致性和临床实用性：我们建立的提名图模型具有很强的判别能力、一致性和临床实用性，可用于预测 NEC。结论：我们建立的提名图模型具有很强的判别能力、一致性和临床实用性，可用于早期预测有发生 NEC 风险的早产儿。
{"title":"Establishing a nomogram for predicting necrotizing enterocolitis in premature infants: A retrospective multicenter cohort study.","authors":"Baoquan Zhang, Wenlong Xiu, Enhuan Wei, Ronghua Zhong, Chunhui Wei, Qifan Wang, Jianmin Zheng, Zheng Yan, Xiaoying Wu, Changyi Yang","doi":"10.1016/j.dld.2024.08.038","DOIUrl":"https://doi.org/10.1016/j.dld.2024.08.038","url":null,"abstract":"<p><strong>Background: </strong>To construct a nomogram for predicting necrotizing enterocolitis (NEC) in preterm infants.</p><p><strong>Methods: </strong>A total of 4,724 preterm infants who were admitted into 8 hospitals between April 2019 and September 2020 were initially enrolled this retrospective multicenter cohort study. Finally, 1,092 eligible cases were divided into training set and test set based on a 7:3 ratio. A univariate logistic regression analysis was performed to compare the variables between the two groups. Stepwise backward regression, LASSO regression, and Boruta feature selection were utilized in the multivariate analysis to identify independent risk factors. Then a nomogram model was constructed based on the identified risk factors.</p><p><strong>Results: </strong>Risk factors for NEC included gestational diabetes mellitus, gestational age, small for gestational age, patent ductus arteriosus, septicemia, red blood cell transfusion, intravenous immunoglobulin, severe feeding intolerance, and absence of breastfeeding. The nomogram model developed based on these factors showed well discriminative ability. Calibration and decision curve analysis curves confirmed the good consistency and clinical utility of the model.</p><p><strong>Conclusions: </strong>We developed a nomogram model with strong discriminative ability, consistency, and clinical utility for predicting NEC. This model could be valuable for the early prediction of preterm infants at risk of developing NEC.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.dld.2024.08.019
M. Dallio, M. Romeo, F. Di Nardo, P. Vaia, C. Napolitano, C. Basile, S. Olivieri, L. Vitale, M. Niosi, A. Federico
Introduction
The platelet (PLT) count is paramount in almost all the available non-invasive tools (NITs) predicting the first hepatic decompensation (FHD) in advanced chronic liver disease (ACLD). However, a non-negligible proportion of Metabolic dysfunction-associated Steatotic Liver Disease (MASLD)-related ACLD individuals presenting clinically significant portal hypertension (CSPH) do not show splenomegaly and hypersplenism-related thrombocytopenia.
Aim
To evaluate the performance of NITs in predicting the 3-year FHD in CSPH-MASLD-cACLD, stratifying the study population according to the splenomegaly.
Materials and Methods
Between 2018 and 2021, 148 splenic and 27 asplenic (25-splenectomized; 2-agenesis) nonselective-beta-blockers-(NSBB)-naïve MASLD-cACLD patients with endoscopic CSPH were enrolled. Patients subsequently received NSBBs and the response was surrogately evaluated following the available guidelines. Ultrasound AI-supported dedicated tools automatically defined spleen diameter and spleen area (SA), discriminating “Splenomegaly +” (91) and “Splenomegaly -” (57) patients. Patients were semiannually observed and the liver-related events were recorded. Albumin-bilirubin (ALBI) score and PLT count-incorporating NITs (PINs) [FIB-4, ALBI-FIB-4, red-cell-distribution-width/PLT-ratio, Liver-Stiffness-Measurement/PLT-ratio, and ANTICIPATE±NASH] were determined at baseline and during the follow-up.
Results
FHD occurred in 18.68% of “Splenomegaly+”, 19.29% of “Splenomegaly-”, and 22.22% of “Asplenic” individuals. The multivariate competing risk analysis (adjusted for sex, age, BMI, diabetes, MELD, and NSBB-response) revealed the PINs as modest predictors of FHD, highlighting SA as the variable more significantly associated with this outcome [aSHR: 0.870 (95% C.I.: 0.833-1.108), p<0.0001] in “Splenomegaly -”, and ALBI [aSHR:1.273 (95% C.I.:1.199-1.305, p:0.002] as the only significantly predicting factors in the “Asplenic” group. Consistently, contrariwise to “Splenomegaly +”, in “Splenomegaly -” and “Asplenic” individuals, ROC and time-dependent ROC analysis evidenced the poor performance of PINs in predicting HD at baseline, 1,1.5, and 2 years, evidencing only ALBI preserved a good accuracy (baseline AUC 0.651, p:0.04 and baseline AUC:0.625, p:0.03 respectively) (Figure).
Conclusions
The spleen area dramatically affects the predictive performance of the PINs in CSPH-MASLD-cACLD patients.
{"title":"Spleen area affects the predictive performance for decompensation of the platelet count-based non-invasive tools in MASLD-related cirrhosis: a preliminary observation","authors":"M. Dallio, M. Romeo, F. Di Nardo, P. Vaia, C. Napolitano, C. Basile, S. Olivieri, L. Vitale, M. Niosi, A. Federico","doi":"10.1016/j.dld.2024.08.019","DOIUrl":"10.1016/j.dld.2024.08.019","url":null,"abstract":"<div><h3>Introduction</h3><p>The platelet (PLT) count is paramount in almost all the available non-invasive tools (NITs) predicting the first hepatic decompensation (FHD) in advanced chronic liver disease (ACLD). However, a non-negligible proportion of Metabolic dysfunction-associated Steatotic Liver Disease (MASLD)-related ACLD individuals presenting clinically significant portal hypertension (CSPH) do not show splenomegaly and hypersplenism-related thrombocytopenia.</p></div><div><h3>Aim</h3><p>To evaluate the performance of NITs in predicting the 3-year FHD in CSPH-MASLD-cACLD, stratifying the study population according to the splenomegaly.</p></div><div><h3>Materials and Methods</h3><p>Between 2018 and 2021, 148 splenic and 27 asplenic (25-splenectomized; 2-agenesis) nonselective-beta-blockers-(NSBB)-naïve MASLD-cACLD patients with endoscopic CSPH were enrolled. Patients subsequently received NSBBs and the response was surrogately evaluated following the available guidelines. Ultrasound AI-supported dedicated tools automatically defined spleen diameter and spleen area (SA), discriminating “Splenomegaly +” (91) and “Splenomegaly -” (57) patients. Patients were semiannually observed and the liver-related events were recorded. Albumin-bilirubin (ALBI) score and PLT count-incorporating NITs (PINs) [FIB-4, ALBI-FIB-4, red-cell-distribution-width/PLT-ratio, Liver-Stiffness-Measurement/PLT-ratio, and ANTICIPATE±NASH] were determined at baseline and during the follow-up.</p></div><div><h3>Results</h3><p>FHD occurred in 18.68% of “Splenomegaly+”, 19.29% of “Splenomegaly-”, and 22.22% of “Asplenic” individuals. The multivariate competing risk analysis (adjusted for sex, age, BMI, diabetes, MELD, and NSBB-response) revealed the PINs as modest predictors of FHD, highlighting SA as the variable more significantly associated with this outcome [aSHR: 0.870 (95% C.I.: 0.833-1.108), <em>p</em><0.0001] in “Splenomegaly -”, and ALBI [aSHR:1.273 (95% C.I.:1.199-1.305, <em>p</em>:0.002] as the only significantly predicting factors in the “Asplenic” group. Consistently, contrariwise to “Splenomegaly +”, in “Splenomegaly -” and “Asplenic” individuals, ROC and time-dependent ROC analysis evidenced the poor performance of PINs in predicting HD at baseline, 1,1.5, and 2 years, evidencing only ALBI preserved a good accuracy (baseline AUC 0.651, <em>p</em>:0.04 and baseline AUC:0.625, <em>p</em>:0.03 respectively) (<strong>Figure</strong>).</p></div><div><h3>Conclusions</h3><p>The spleen area dramatically affects the predictive performance of the PINs in CSPH-MASLD-cACLD patients.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"56 ","pages":"Page S323"},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.dld.2024.08.031
D. Saltini , S. Nardelli , F. Vizzutti , R. Miraglia , D. Bellafante , F. Banchelli , C. Caporali , L. Maruzzelli , G. Falcone , M. Bianchini , T. Guasconi , A. Ingravallo , F. Casari , F. Prampolini , A. Colecchia , F. Marra , C. Cammà , M. Senzolo , O. Riggio , F. Schepis
Background and Aims
Transjugular intrahepatic portosystemic shunt (TIPS) has been demonstrated to be feasible in older adult patients (age ≥70 years), yet the selection criteria remain suboptimal. Sarcopenia, highly prevalent in elderly population, may be significantly associated with post-TIPS outcome. This study aimed at evaluating the impact of baseline sarcopenia on post-TIPS survival in older adults with cirrhosis.
Method
A retrospective analysis of the prospective Italian TIPS-Registry was conducted to identify patients ≥70 years who received TIPS from June 2015 to March 2023. The availability of baseline abdominal CT scan was a mandatory inclusion criterion. Skeletal muscle index (SMI) was evaluated at the L3-L4 level. Sarcopenia was defined as SMI <50 cm2/m2 for men and <39 cm2/m2 for women. Probability of liver-related death was evaluated by competing risks analysis. A prediction model for liver-related mortality was created.
Results
One-hundred and fifteen patients were included: median age 74 years (IQR 3.1), 62% male, median dry-BMI 25.7 (IQR 4.7), 60% prevalence of sarcopenia. The main etiologies were viral (40%), alcohol-associated cirrhosis (23%), and metabolic dysfunction-associated steatohepatitis (20%). Refractory ascites (57%) was the main indications for TIPS. During a mean follow up of 20 months (IQR 20), 40 (34.8%) patients died for liver-related causes and 16 (13.9%) for extrahepatic causes. Liver-related mortality was significantly higher in patients with sarcopenia than in those without (6-months: 25.0% vs. 2.2%; 1-year: 43.0% vs. 4.8%, respectively; p value <0.001). A predictive model including INR, creatinine, and sarcopenia was developed to estimate liver-related mortality. The model achieved good predictive performances with AUCs of 0.826, 0.788, and 0.712 at 6-month, 1-year, and 2-years, respectively.
Conclusion
Due to its significant impact on survival, the evaluation of sarcopenia may improve the selection of older adults candidate to TIPS. The new predictive model for post-TIPS liver-related mortality deserves external validation.
{"title":"Assessment of sarcopenia improves the prediction of post-TIPS mortality in older adult patients with cirrhosis","authors":"D. Saltini , S. Nardelli , F. Vizzutti , R. Miraglia , D. Bellafante , F. Banchelli , C. Caporali , L. Maruzzelli , G. Falcone , M. Bianchini , T. Guasconi , A. Ingravallo , F. Casari , F. Prampolini , A. Colecchia , F. Marra , C. Cammà , M. Senzolo , O. Riggio , F. Schepis","doi":"10.1016/j.dld.2024.08.031","DOIUrl":"10.1016/j.dld.2024.08.031","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Transjugular intrahepatic portosystemic shunt (TIPS) has been demonstrated to be feasible in older adult patients (age ≥70 years), yet the selection criteria remain suboptimal. Sarcopenia, highly prevalent in elderly population, may be significantly associated with post-TIPS outcome. This study aimed at evaluating the impact of baseline sarcopenia on post-TIPS survival in older adults with cirrhosis.</p></div><div><h3>Method</h3><p>A retrospective analysis of the prospective Italian TIPS-Registry was conducted to identify patients ≥70 years who received TIPS from June 2015 to March 2023. The availability of baseline abdominal CT scan was a mandatory inclusion criterion. Skeletal muscle index (SMI) was evaluated at the L3-L4 level. Sarcopenia was defined as SMI <50 cm<sup>2</sup>/m<sup>2</sup> for men and <39 cm<sup>2</sup>/m<sup>2</sup> for women. Probability of liver-related death was evaluated by competing risks analysis. A prediction model for liver-related mortality was created.</p></div><div><h3>Results</h3><p>One-hundred and fifteen patients were included: median age 74 years (IQR 3.1), 62% male, median dry-BMI 25.7 (IQR 4.7), 60% prevalence of sarcopenia. The main etiologies were viral (40%), alcohol-associated cirrhosis (23%), and metabolic dysfunction-associated steatohepatitis (20%). Refractory ascites (57%) was the main indications for TIPS. During a mean follow up of 20 months (IQR 20), 40 (34.8%) patients died for liver-related causes and 16 (13.9%) for extrahepatic causes. Liver-related mortality was significantly higher in patients with sarcopenia than in those without (6-months: 25.0% vs. 2.2%; 1-year: 43.0% vs. 4.8%, respectively; p value <0.001). A predictive model including INR, creatinine, and sarcopenia was developed to estimate liver-related mortality. The model achieved good predictive performances with AUCs of 0.826, 0.788, and 0.712 at 6-month, 1-year, and 2-years, respectively.</p></div><div><h3>Conclusion</h3><p>Due to its significant impact on survival, the evaluation of sarcopenia may improve the selection of older adults candidate to TIPS. The new predictive model for post-TIPS liver-related mortality deserves external validation.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"56 ","pages":"Page S329"},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.dld.2024.08.010
P. Gallo , V. Flagiello , A. De Vincentis , F. Terracciani , A. Falcomata , A. Picardi , U. Vespasiani Gentilucci
<div><h3>Introduction</h3><p>Sarcopenia is a common complication in patients with liver cirrhosis. In this context, its diagnosis is typically based on operational definitions, including the estimation of low muscle mass. Recently, muscle ultrasound-based measurements have drawn attention due to their improved feasibility and accessibility. However, only a limited number of studies evaluating this approach have been reported. Finally, the role of muscle strength respect to mass in identifying patients with the worst clinical outcomes has not been clearly elucidated.</p></div><div><h3>Aim</h3><p>In a cohort of cirrhotic patients, our primary aim was to investigate the correlation and agreement between ultrasound-derived measures of muscle mass and bioimpedance analysis (BIA) as the gold standard, as well as their discriminative power. In addition, as a secondary aim, we investigated the correlation of these techniques and muscle strength with clinical outcomes.</p></div><div><h3>Materials and Methods</h3><p>The study included consecutive adult outpatients attending the Hepatology Unit of the Fondazione Policlinico Campus Bio-Medico of Rome. Muscle mass was defined as appendicular skeletal mass (ASMM) according to the Sergi equation (EWGSOP 2019). Ultrasound was performed to measure muscle mass according to previously described standardized indices (quadriceps and iliopsoas muscles). Hand grip measurement was used to define muscle strength. Pearson's correlation coefficient and Bland-Altman plots were used to assess the correlation and agreement between ASMM and ultrasound indices. Predictive performance was estimated by calculating the area under the receiver operating characteristic curve (AUROC). Finally, crude and adjusted Cox regression analyses were performed to test the possible association between the different proxies of sarcopenia and liver decompensation or mortality within 24 months.</p></div><div><h3>Results</h3><p>88 patients were included [(mean age 73 years (7.07), 78% male, mean BMI 27 kg/m2 (10)]. The most common aetiology of cirrhosis was viral (40%) and the majority of patients (80%) had well preserved liver function. Average compression index (ACI) and average feather index (AFI) showed a good correlation with ASMM, while among the psoas indices, only psoas to height ratio (PHR)- but not ileopsoas index (IPI) - showed a correlation (Figure 1). Linear regression analysis confirmed that AFI [beta 0.64 (CI95% 0.37-0.92), p<0.001], ACI [0.5 (CI95% 0.21-0.78), p<0.001] and PHR [0.38 (CI95% 0.08-0.69), p=0.01] were significantly associated with ASMM, also independently of gender. In addition, Bland-Altman analyses showed good agreement for US with ASMM. Furthermore, these indices showed adequate discriminatory power, with AUROCs of 0.71 (0.57-0.854), 0.81 (0.69-0.931) and 0.75 (0.63-0.862) for ACI, AFI and PHR, respectively. Finally, in Cox regression analyses, only low muscle strength was associated with higher rates of mortal
{"title":"Assessment of sarcopenia with ultrasound-based measurements in patients with liver cirrhosis and correlation with clinical outcomes","authors":"P. Gallo , V. Flagiello , A. De Vincentis , F. Terracciani , A. Falcomata , A. Picardi , U. Vespasiani Gentilucci","doi":"10.1016/j.dld.2024.08.010","DOIUrl":"10.1016/j.dld.2024.08.010","url":null,"abstract":"<div><h3>Introduction</h3><p>Sarcopenia is a common complication in patients with liver cirrhosis. In this context, its diagnosis is typically based on operational definitions, including the estimation of low muscle mass. Recently, muscle ultrasound-based measurements have drawn attention due to their improved feasibility and accessibility. However, only a limited number of studies evaluating this approach have been reported. Finally, the role of muscle strength respect to mass in identifying patients with the worst clinical outcomes has not been clearly elucidated.</p></div><div><h3>Aim</h3><p>In a cohort of cirrhotic patients, our primary aim was to investigate the correlation and agreement between ultrasound-derived measures of muscle mass and bioimpedance analysis (BIA) as the gold standard, as well as their discriminative power. In addition, as a secondary aim, we investigated the correlation of these techniques and muscle strength with clinical outcomes.</p></div><div><h3>Materials and Methods</h3><p>The study included consecutive adult outpatients attending the Hepatology Unit of the Fondazione Policlinico Campus Bio-Medico of Rome. Muscle mass was defined as appendicular skeletal mass (ASMM) according to the Sergi equation (EWGSOP 2019). Ultrasound was performed to measure muscle mass according to previously described standardized indices (quadriceps and iliopsoas muscles). Hand grip measurement was used to define muscle strength. Pearson's correlation coefficient and Bland-Altman plots were used to assess the correlation and agreement between ASMM and ultrasound indices. Predictive performance was estimated by calculating the area under the receiver operating characteristic curve (AUROC). Finally, crude and adjusted Cox regression analyses were performed to test the possible association between the different proxies of sarcopenia and liver decompensation or mortality within 24 months.</p></div><div><h3>Results</h3><p>88 patients were included [(mean age 73 years (7.07), 78% male, mean BMI 27 kg/m2 (10)]. The most common aetiology of cirrhosis was viral (40%) and the majority of patients (80%) had well preserved liver function. Average compression index (ACI) and average feather index (AFI) showed a good correlation with ASMM, while among the psoas indices, only psoas to height ratio (PHR)- but not ileopsoas index (IPI) - showed a correlation (Figure 1). Linear regression analysis confirmed that AFI [beta 0.64 (CI95% 0.37-0.92), p<0.001], ACI [0.5 (CI95% 0.21-0.78), p<0.001] and PHR [0.38 (CI95% 0.08-0.69), p=0.01] were significantly associated with ASMM, also independently of gender. In addition, Bland-Altman analyses showed good agreement for US with ASMM. Furthermore, these indices showed adequate discriminatory power, with AUROCs of 0.71 (0.57-0.854), 0.81 (0.69-0.931) and 0.75 (0.63-0.862) for ACI, AFI and PHR, respectively. Finally, in Cox regression analyses, only low muscle strength was associated with higher rates of mortal","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"56 ","pages":"Page S319"},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.dld.2024.08.021
E. Errigo, R. Mizzi, A. Lombardo, V. Calvaruso, G. Di Maria, F. Simone, N. Alessi, G. Cabibbo, S. Petta, C. Celsa, S. Peralta, M. Peralta, C. Cammà, V. Di Marco
Background
The epidemiology of liver cirrhosis is evolving and the etiology, complications, and comorbidities of cirrhosis are continuously changing, presenting new challenges.
Methods
We reported data from an observational, monocentric study including 1,617 patients with liver cirrhosis admitted to our liver unit from January 2014 to December 2023.
Results
The mean age of patients was 66.8 years, with a male predominance except for autoimmune etiology. During the observation period, the number of hospitalized patients with active HCV infection decreased from 47.9% in 2014 to 9.2% in 2023, while patients with HCV cirrhosis in sustained virologic response (SVR) increased from 15.6% in 2014 to 26.2% in 2023. Hospitalizations for HBV-related cirrhosis remained stable (5.5% in 2014 and 8.5% in 2023. Patients for alcohol-related cirrhosis increased from 16.6% in 2014 to 23.9% 2023 and patients with metabolic cirrhosis increased from 10.6% in 2014 to 36.8% in 2023. The rate of patients with autoimmune cirrhosis (3.0% in 2014 and 4.2% in 2023) and cryptogenic cirrhosis (6.0% in 2014 to 7.9% in 2023) remained stable over the years. Patients with alcohol-related cirrhosis (mean age 59.5 years), HBV cirrhosis (62.1 years) and autoimmune etiologies (62.2 years) were younger than patients with HCV cirrhosis (69.3 years), metabolic cirrhosis (68.3 years) and cryptogenic cirrhosis (67.6 years). The most frequent complication for hospitalization was HCC in active (47.8%) and SVR (58.2%) HCV cirrhosis, and in HBV cirrhosis (47.3%), with the ascites was more frequent in alcohol-related (45.8%) and metabolic (34.1%) cirrhosis Patients with metabolic cirrhosis had the most extrahepatic comorbidities (66.3% diabetic, 18.0% chronic kidney disease, and 20.7% heart disease).
Conclusions
Liver cirrhosis epidemiology is changing, with decreasing HCV infections but increasing alcohol-related and metabolic cases. Complications and comorbidities require tailored management strategies. Effective public health interventions and adaptive healthcare approaches are crucial to address these evolving challenges.
{"title":"Evolving trends in liver cirrhosis: etiology, complications and comorbidities","authors":"E. Errigo, R. Mizzi, A. Lombardo, V. Calvaruso, G. Di Maria, F. Simone, N. Alessi, G. Cabibbo, S. Petta, C. Celsa, S. Peralta, M. Peralta, C. Cammà, V. Di Marco","doi":"10.1016/j.dld.2024.08.021","DOIUrl":"10.1016/j.dld.2024.08.021","url":null,"abstract":"<div><h3>Background</h3><p>The epidemiology of liver cirrhosis is evolving and the etiology, complications, and comorbidities of cirrhosis are continuously changing, presenting new challenges.</p></div><div><h3>Methods</h3><p>We reported data from an observational, monocentric study including 1,617 patients with liver cirrhosis admitted to our liver unit from January 2014 to December 2023.</p></div><div><h3>Results</h3><p>The mean age of patients was 66.8 years, with a male predominance except for autoimmune etiology. During the observation period, the number of hospitalized patients with active HCV infection decreased from 47.9% in 2014 to 9.2% in 2023, while patients with HCV cirrhosis in sustained virologic response (SVR) increased from 15.6% in 2014 to 26.2% in 2023. Hospitalizations for HBV-related cirrhosis remained stable (5.5% in 2014 and 8.5% in 2023. Patients for alcohol-related cirrhosis increased from 16.6% in 2014 to 23.9% 2023 and patients with metabolic cirrhosis increased from 10.6% in 2014 to 36.8% in 2023. The rate of patients with autoimmune cirrhosis (3.0% in 2014 and 4.2% in 2023) and cryptogenic cirrhosis (6.0% in 2014 to 7.9% in 2023) remained stable over the years. Patients with alcohol-related cirrhosis (mean age 59.5 years), HBV cirrhosis (62.1 years) and autoimmune etiologies (62.2 years) were younger than patients with HCV cirrhosis (69.3 years), metabolic cirrhosis (68.3 years) and cryptogenic cirrhosis (67.6 years). The most frequent complication for hospitalization was HCC in active (47.8%) and SVR (58.2%) HCV cirrhosis, and in HBV cirrhosis (47.3%), with the ascites was more frequent in alcohol-related (45.8%) and metabolic (34.1%) cirrhosis Patients with metabolic cirrhosis had the most extrahepatic comorbidities (66.3% diabetic, 18.0% chronic kidney disease, and 20.7% heart disease).</p></div><div><h3>Conclusions</h3><p>Liver cirrhosis epidemiology is changing, with decreasing HCV infections but increasing alcohol-related and metabolic cases. Complications and comorbidities require tailored management strategies. Effective public health interventions and adaptive healthcare approaches are crucial to address these evolving challenges.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"56 ","pages":"Page S324"},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.dld.2024.08.014
B. Stefanini , D. Mandrioli , A. Vornoli , A. Salomone , D. Sgargi , F. Manservisi , F. Piscaglia , F. Tovoli
Introduction
Pollutants are increasingly being evaluated as possible contributors to the progression of liver damage in metabolic dysfunction-associated steatotic liver disease (MASLD). Recently, we published a case-control study showing that patients with MASLD-related advanced chronic liver disease (ACLD) and/or hepatocellular carcinoma (HCC) were more likely to report workplace toxicant exposure compared to those with uncomplicated MASLD. Consequently, an extension of the accrual and a transition to a multicenter study were decided.
Aim
To provide updated evidence following the first extension of the cohort from our original study, which aimed to assess the prevalence of self-reported occupational exposure to toxicants in patients with MASLD.
Methods
After the extension, this hospital-based prospective pilot study include 224 patients with MASLD. Data on workplace toxicant exposure were collected systematically using a structured questionnaire. Subsequently, patients with ACLD and/or HCC (n = 65) were compared to controls (n = 159). Logistic regression analysis and propensity score models were used to investigate the associations between self-reported occupational exposure and ACLD and/or HCC.
Results
The updated data confirmed that patients with ACLD/HCC are more likely to report exposure to metals, halogenated refrigerants, paint/resins, and fuel emissions than the controls. Durations of 21-30 years and >30 years of occupational exposure to toxicants were also more frequently associated with ACLD/HCC, with odds ratios (ORs) of 2.42 (95% confidence interval [CI]: 1.11-4.94, p = 0.020) and 4.21 (95% CI: 2.36-7.53, p < 0.001), respectively. These associations were confirmed after corrections for demographics and other confounders.
Conclusions
The extension of our cohort confirms that patients with MASLD complications are more likely to report workplace toxicant exposure than controls. A transition to a multicenter effort is underway. If confirmed, our results may help in developing prevention policies to reduce the risk of life-threatening diseases among exposed populations.
{"title":"Occupational exposure and risk of complications in MASLD patients:updates from a case:control study","authors":"B. Stefanini , D. Mandrioli , A. Vornoli , A. Salomone , D. Sgargi , F. Manservisi , F. Piscaglia , F. Tovoli","doi":"10.1016/j.dld.2024.08.014","DOIUrl":"10.1016/j.dld.2024.08.014","url":null,"abstract":"<div><h3>Introduction</h3><p>Pollutants are increasingly being evaluated as possible contributors to the progression of liver damage in metabolic dysfunction-associated steatotic liver disease (MASLD). Recently, we published a case-control study showing that patients with MASLD-related advanced chronic liver disease (ACLD) and/or hepatocellular carcinoma (HCC) were more likely to report workplace toxicant exposure compared to those with uncomplicated MASLD. Consequently, an extension of the accrual and a transition to a multicenter study were decided.</p></div><div><h3>Aim</h3><p>To provide updated evidence following the first extension of the cohort from our original study, which aimed to assess the prevalence of self-reported occupational exposure to toxicants in patients with MASLD.</p></div><div><h3>Methods</h3><p>After the extension, this hospital-based prospective pilot study include 224 patients with MASLD. Data on workplace toxicant exposure were collected systematically using a structured questionnaire. Subsequently, patients with ACLD and/or HCC (n = 65) were compared to controls (n = 159). Logistic regression analysis and propensity score models were used to investigate the associations between self-reported occupational exposure and ACLD and/or HCC.</p></div><div><h3>Results</h3><p>The updated data confirmed that patients with ACLD/HCC are more likely to report exposure to metals, halogenated refrigerants, paint/resins, and fuel emissions than the controls. Durations of 21-30 years and >30 years of occupational exposure to toxicants were also more frequently associated with ACLD/HCC, with odds ratios (ORs) of 2.42 (95% confidence interval [CI]: 1.11-4.94, p = 0.020) and 4.21 (95% CI: 2.36-7.53, p < 0.001), respectively. These associations were confirmed after corrections for demographics and other confounders.</p></div><div><h3>Conclusions</h3><p>The extension of our cohort confirms that patients with MASLD complications are more likely to report workplace toxicant exposure than controls. A transition to a multicenter effort is underway. If confirmed, our results may help in developing prevention policies to reduce the risk of life-threatening diseases among exposed populations.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"56 ","pages":"Page S321"},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.dld.2024.08.015
A. Romano , A.R. Caspanello , S.S. Piano , M. Tonon , C. Gambino , V. Calvino , A. Barone , S. Incicco , N. Zeni , R. Gagliardi , P. Angeli
Introduction
The LiverRisk score has been recently developed and validated as a predictor of liver fibrosis and liver-related outcomes in the general population. This score has never been evaluated as predictor of liver fibrosis and outcomes in secondary care, such as in patients with chronic liver diseases.
AIM
The aim of this study was to evaluate the role of the LiverRisk score as a predictor of liver fibrosis and mortality in patients with HCV-related hepatitis treated with direct acting antivirals (DAA).
Methods
patients were enrolled retrospectively, outpatients with chronic hepatitis C treated with DAA between 2015 and 2017 were included consecutively. Patients were followed-up until September 2023. The exclusion criteria were: liver transplantation before DAAs and presence of HCC. Patient characteristics and LiverRisk score were collected before starting the DAA. The data for the calculation of LiverRisk score were collected the same day the fibroscan was performed. The primary endpoint was a liver stiffness ≥10 kPa. Area under the receiver operating characteristic (AUROC) curve was evaluated for assessing the discrimination ability of Liver Risk score. Overall mortality was assessed at the end of follow-up.
Results
in this ongoing study, 136 patients of our center with chronic hepatitis C treated with DAA were enrolled. In this population, 51% were men, the mean age was 65.3±12.2 years, 65.4% were genotype 1, 59.6% had liver cirrhosis, the mean liver stiffness measurement was 15.9 KPa (3.5-48.8), sustained virological response (SVR) was 95.5% and the mean follow-up was of 59 months. Coinfection with hepatitis B virus (HBV) was present in 8.8%. Discrimination ability of the LiverRisk score in the prediction of liver stiffness ≥10KPa was very good as shown by an AUROC of 0.848 (95% confidence interval [CI] = 0.767-0.930; p=0.000). During follow up 21 patients (15.4%) died. LiverRisk score was associated with the risk of all cause of mortality (Hazard Ratio = 1.154; 95% CI = 1.01–1.318; p = 0.035).
Conclusion
the liver risk score is a good predictor of fibrosis and mortality in HCV patients treated with DAA.
{"title":"Evaluation of LiverRisk score as predictor of liver fibrosis and mortality in patients with HCV-related hepatitis treated with direct acting antivirals","authors":"A. Romano , A.R. Caspanello , S.S. Piano , M. Tonon , C. Gambino , V. Calvino , A. Barone , S. Incicco , N. Zeni , R. Gagliardi , P. Angeli","doi":"10.1016/j.dld.2024.08.015","DOIUrl":"10.1016/j.dld.2024.08.015","url":null,"abstract":"<div><h3>Introduction</h3><p>The LiverRisk score has been recently developed and validated as a predictor of liver fibrosis and liver-related outcomes in the general population. This score has never been evaluated as predictor of liver fibrosis and outcomes in secondary care, such as in patients with chronic liver diseases.</p></div><div><h3>AIM</h3><p>The aim of this study was to evaluate the role of the LiverRisk score as a predictor of liver fibrosis and mortality in patients with HCV-related hepatitis treated with direct acting antivirals (DAA).</p></div><div><h3>Methods</h3><p>patients were enrolled retrospectively, outpatients with chronic hepatitis C treated with DAA between 2015 and 2017 were included consecutively. Patients were followed-up until September 2023. The exclusion criteria were: liver transplantation before DAAs and presence of HCC. Patient characteristics and LiverRisk score were collected before starting the DAA. The data for the calculation of LiverRisk score were collected the same day the fibroscan was performed. The primary endpoint was a liver stiffness ≥10 kPa. Area under the receiver operating characteristic (AUROC) curve was evaluated for assessing the discrimination ability of Liver Risk score. Overall mortality was assessed at the end of follow-up.</p></div><div><h3>Results</h3><p>in this ongoing study, 136 patients of our center with chronic hepatitis C treated with DAA were enrolled. In this population, 51% were men, the mean age was 65.3±12.2 years, 65.4% were genotype 1, 59.6% had liver cirrhosis, the mean liver stiffness measurement was 15.9 KPa (3.5-48.8), sustained virological response (SVR) was 95.5% and the mean follow-up was of 59 months. Coinfection with hepatitis B virus (HBV) was present in 8.8%. Discrimination ability of the LiverRisk score in the prediction of liver stiffness ≥10KPa was very good as shown by an AUROC of 0.848 (95% confidence interval [CI] = 0.767-0.930; p=0.000). During follow up 21 patients (15.4%) died. LiverRisk score was associated with the risk of all cause of mortality (Hazard Ratio = 1.154; 95% CI = 1.01–1.318; p = 0.035).</p></div><div><h3>Conclusion</h3><p>the liver risk score is a good predictor of fibrosis and mortality in HCV patients treated with DAA.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"56 ","pages":"Pages S321-S322"},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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