Étude de la cinétique de la bilirubine avant traitement par corticostéroïdes dans l'hépatite alcoolique aigüe sévère

Étude de la cinétique de la bilirubine avant traitement par corticostéroïdes dans l'hépatite alcoolique aigüe sévère Introduction: Acute alcoholic hepatitis (AAH) are treated by corticosteroid therapy (CT) when the Maddrey DF is = 32. The decrease in total bilirubin at day 7 is a major prognostic factor and a component of the Lille model predicting survival. The aim of our study was to evaluate the impact on survival of the evolution of biological variables as bilirubin in the week before CT initiation. Patients and methods: 106 patients consecutively hospitalized from January 2007 to December 2010 for a severe acute alcoholic hepatitis and having a DF = 32 were included for a retrospective study. Clinical and laboratory data were collected at admission and during hospitalization. All received CT and were alive 7 days after CT initiation; 28 also received N-acetyl cysteine (NAC). Variables affecting survival were analyzed in a Cox model. Results: Mean age was 53 (24-74), 61% were male and 85% had cirrhosis. All patients had an active consumption of alcohol. The mean time between admission and initiation of CT was 10 days (4-31). The 3 and 6-months survivals were 69 % and 60 %. In multivariate analysis, younger patients (p=0.04), decrease in bilirubin level at 7 days CT (p <0.0002), and decrease of bilirubin before steroid (DBBS) (p< 0. 0003) had better3-months survival. DBBS was observed in 55% of patients and 88% with DBBS were still alive at 3 months vs 40% without DBBS. This later variable was related to response to CT and adding the DBBS variable to Lille Model or DF increased the AUROC. Conclusion: The present study indicates that in patients with severe acute alcoholic hepatitis, DBBS is a significantly independent predictor for both the response to CT and the 3 months survival. This could help to rapidly define the patients with a poor prognostic for whom other therapies than CT could be attempted such as transplantation or bio-artificial livers.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Acute Ulceronecrotic Gastritis With Cytomegalovirus Reactivation: Uncommon Toxicity of Immune Checkpoint Inhibitors in Microsatellite Instability–High Metastatic Colorectal Cancer

International audienceNo abstract availabl

Nivolumab‐induced celiac‐like enteropathy in patient with metastatic renal cell carcinoma: Case report and review of the literature

International audienceNivolumab may induce severe celiac-like enteropathy, that may appear very rapidly, after only two injections of nivolumab, and may be successfully treated with corticosteroids. This observation underlines the importance of histological analysis of duodenal biopsies and the necessity to rule out a real celiac disease in patients with nivolumab-induced diarrhea

Immune Alterations in Patients With Type 1 Autoimmune Hepatitis Persist Upon Standard Immunosuppressive Treatment

International audienceAutoimmune hepatitis (AIH) is a rare disease characterized by an immune attack of the liver. This study consists of a comprehensive analysis of immune alterations related to AIH at diagnosis, and during remission phase under treatment. A total of 37 major lymphocyte populations were analyzed from the peripheral blood of new-onset AIH patients (AIHn; n = 14), AIH patients with controlled disease (n = 11), and healthy subjects (n = 14). Liver biopsy analyses were performed to complete the blood phenotypic analysis. Four blood lymphocyte populations were significantly altered in AIHn patients at diagnosis compared with healthy subjects. Levels of mucosal-associated invariant T cells (MAIT), Type 1/Type 17 helper (Th1/ Th17) cells, clusters of differentiation (CD4) T cells, and invariant natural killer T cells were decreased, whereas MAIT granzyme B+ (GrB) cells were increased. A trend toward an increase of CD8+CD161+GrB+ cells was also observed. These alterations were not restored with standard immunosuppressive treatments. In the liver of AIHn patients, CD4, forkhead box P3 (Foxp3), and MAIT cell markers were enriched in the portal tract, and CD8, CD161, and GrB markers were enriched in the hepatic lobule. During remission, the hepatic lobule was clear of infiltrating T cells, but residual CD4 and MAIT cells were found in the portal tract, where Foxp3 was decreased, as previously described. In vitro, MAIT cells were functionally altered in AIH patients. Ex vivo MAIT cell activity (GrB) was linked to severe fibrosis. Conclusion: Our work proposes a global view of the lymphocyte alterations from diagnosis to remission phase in AIH patients. The absence of blood immune homeostasis restoration and the persistence of a CD4 infiltrate in the liver under standard immunosuppres-sion could form the basis of the high risk of relapse observed in AIH

Immune Alterations in Patients With Type 1 Autoimmune Hepatitis Persist Upon Standard Immunosuppressive Treatment

International audienceAutoimmune hepatitis (AIH) is a rare disease characterized by an immune attack of the liver. This study consists of a comprehensive analysis of immune alterations related to AIH at diagnosis, and during remission phase under treatment. A total of 37 major lymphocyte populations were analyzed from the peripheral blood of new-onset AIH patients (AIHn; n = 14), AIH patients with controlled disease (n = 11), and healthy subjects (n = 14). Liver biopsy analyses were performed to complete the blood phenotypic analysis. Four blood lymphocyte populations were significantly altered in AIHn patients at diagnosis compared with healthy subjects. Levels of mucosal-associated invariant T cells (MAIT), Type 1/Type 17 helper (Th1/ Th17) cells, clusters of differentiation (CD4) T cells, and invariant natural killer T cells were decreased, whereas MAIT granzyme B+ (GrB) cells were increased. A trend toward an increase of CD8+CD161+GrB+ cells was also observed. These alterations were not restored with standard immunosuppressive treatments. In the liver of AIHn patients, CD4, forkhead box P3 (Foxp3), and MAIT cell markers were enriched in the portal tract, and CD8, CD161, and GrB markers were enriched in the hepatic lobule. During remission, the hepatic lobule was clear of infiltrating T cells, but residual CD4 and MAIT cells were found in the portal tract, where Foxp3 was decreased, as previously described. In vitro, MAIT cells were functionally altered in AIH patients. Ex vivo MAIT cell activity (GrB) was linked to severe fibrosis. Conclusion: Our work proposes a global view of the lymphocyte alterations from diagnosis to remission phase in AIH patients. The absence of blood immune homeostasis restoration and the persistence of a CD4 infiltrate in the liver under standard immunosuppres-sion could form the basis of the high risk of relapse observed in AIH

PERSISTENT MODERATE ALCOHOL CONSUMPTION IMPACTS SURVIVAL IN PATIENTS WITH COMPENSATED ALCOHOL-RELATED CIRRHOSIS: ANALYSIS OF THE CIRRAL COHORT.

International audienc

PERSISTENT MODERATE ALCOHOL CONSUMPTION IMPACTS SURVIVAL IN PATIENTS WITH COMPENSATED ALCOHOL-RELATED CIRRHOSIS: ANALYSIS OF THE CIRRAL COHORT.

International audienc

PERSISTENT MODERATE ALCOHOL CONSUMPTION IMPACTS SURVIVAL IN PATIENTS WITH COMPENSATED ALCOHOL-RELATED CIRRHOSIS: ANALYSIS OF THE CIRRAL COHORT.

International audienc

PERSISTENT MODERATE ALCOHOL CONSUMPTION IMPACTS SURVIVAL IN PATIENTS WITH COMPENSATED ALCOHOL-RELATED CIRRHOSIS: ANALYSIS OF THE CIRRAL COHORT.

International audienc