Validación de la cuantificación de la concentración hepática de hierro mediante resonancia magnética nuclear de 1-Tesla

Introducción: La medición de la concentración de hierro hepática (CHH) por RM es una técnica no invasiva de gran utilidad en el diagnóstico de los pacientes con sospecha de sobrecarga férrica en hígado. Objetivo:Validar la eficacia de la RM 1 Tesla en la determinación de la (CHH) en pacientes con sospecha de sobrecarga férrica. Validar su capacidad para diagnosticar o descartar la presencia de una CHH sugestiva de hemocromatosis. Pacientes y métodos:Estudio observacional, transversal, con inclusión prospectiva de pacientes consecutivos. De 2002 a 2010 hemos obtenido la CHH estimada mediante RM 1 Tesla (método Gandon) y de RM 1,5 Tesla (método Alústiza), y mediante BH, en 56 pacientes consecutivos (58RM:35/23). Resultados:Grupo RM 1 Tesla: de acuerdo con CHH en BH, 15 pacientes clasificados como normales (80 µmol/g)-valoró correctamente las 5-. Existió una correlación entre la determinación de la CHH por BH y RM 1 Tesla con r=0.619. Existieron diferencias estadísticamente significativas (p0.05). Conclusiones: La determinación de CHH por RM 1 Tesla (método Gandon) es útil para diagnosticar o descartar hemocromatosis y para diagnosticar CHH normal. Existe una importante tendencia a la sobreestimación en pacientes sin y con sobrecarga férrica en la CHH obtenida por RM 1 Tesla. La determinación de CHH por RM 1,5 Tesla (método Alústiza) es superior a la de RM 1 Tesla, aunque también existe una tendencia a sobreestimar. La CHH media obtenida por BH o RM 1,5 Tesla no tuvieron diferencias significativas. En cambio si existieron entre BH y RM 1 Tesla

Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry

[Background & Aims] Prospective drug-induced liver injury (DILI) registries are important sources of information on idiosyncratic DILI. We aimed to present a comprehensive analysis of 843 patients with DILI enrolled into the Spanish DILI Registry over a 20-year time period.[Methods] Cases were identified, diagnosed and followed prospectively. Clinical features, drug information and outcome data were collected.[Results] A total of 843 patients, with a mean age of 54 years (48% females), were enrolled up to 2018. Hepatocellular injury was associated with younger age (adjusted odds ratio [aOR] per year 0.983; 95% CI 0.974–0.991) and lower platelet count (aOR per unit 0.996; 95% CI 0.994–0.998). Anti-infectives were the most common causative drug class (40%). Liver-related mortality was more frequent in patients with hepatocellular damage aged ≥65 years (p = 0.0083) and in patients with underlying liver disease (p = 0.0221). Independent predictors of liver-related death/transplantation included nR-based hepatocellular injury, female sex, higher onset aspartate aminotransferase (AST) and bilirubin values. nR-based hepatocellular injury was not associated with 6-month overall mortality, for which comorbidity burden played a more important role. The prognostic capacity of Hy’s law varied between causative agents. Empirical therapy (corticosteroids, ursodeoxycholic acid and MARS) was prescribed to 20% of patients. Drug-induced autoimmune hepatitis patients (26 cases) were mainly females (62%) with hepatocellular damage (92%), who more frequently received immunosuppressive therapy (58%).[Conclusions] AST elevation at onset is a strong predictor of poor outcome and should be routinely assessed in DILI evaluation. Mortality is higher in older patients with hepatocellular damage and patients with underlying hepatic conditions. The Spanish DILI Registry is a valuable tool in the identification of causative drugs, clinical signatures and prognostic risk factors in DILI and can aid physicians in DILI characterisation and management.[Lay summary] Clinical information on drug-induced liver injury (DILI) collected from enrolled patients in the Spanish DILI Registry can guide physicians in the decision-making process. We have found that older patients with hepatocellular type liver injury and patients with additional liver conditions are at a higher risk of mortality. The type of liver injury, patient sex and analytical values of aspartate aminotransferase and total bilirubin can also help predict clinical outcomes.The present study has been supported by grants of Instituto de Salud Carlos III cofounded by Fondo Europeo de Desarrollo Regional – FEDER (contract numbers: PI19/00883, PI16/01748, PI18/00901, PI18/01804, PI-0285-2016, PI-0274-2016, PI-0310-2018, PT17/0017/0020) and Agencia Española del Medicamento. CIBERehd and Plataforma ISCIII Ensayos Clinicos are funded by Instituto de Salud Carlos III. MRD holds a Joan Rodes (JR16/00015)/Acción B clinicos investigadores (B-0002-2019) and JSC a Rio Hortega (CM17/00243) research contract from ISCIII and Consejería de Salud de Andalucía.Peer reviewe

Validación de la cuantificación de la concentración hepática de hierro mediante resonancia magnética nuclear de 1-Tesla

Introducción: La medición de la concentración de hierro hepática (CHH) por RM es una técnica no invasiva de gran utilidad en el diagnóstico de los pacientes con sospecha de sobrecarga férrica en hígado. Objetivo:Validar la eficacia de la RM 1 Tesla en la determinación de la (CHH) en pacientes con sospecha de sobrecarga férrica. Validar su capacidad para diagnosticar o descartar la presencia de una CHH sugestiva de hemocromatosis. Pacientes y métodos:Estudio observacional, transversal, con inclusión prospectiva de pacientes consecutivos. De 2002 a 2010 hemos obtenido la CHH estimada mediante RM 1 Tesla (método Gandon) y de RM 1,5 Tesla (método Alústiza), y mediante BH, en 56 pacientes consecutivos (58RM:35/23). Resultados:Grupo RM 1 Tesla: de acuerdo con CHH en BH, 15 pacientes clasificados como normales (80 µmol/g)-valoró correctamente las 5-. Existió una correlación entre la determinación de la CHH por BH y RM 1 Tesla con r=0.619. Existieron diferencias estadísticamente significativas (p0.05). Conclusiones: La determinación de CHH por RM 1 Tesla (método Gandon) es útil para diagnosticar o descartar hemocromatosis y para diagnosticar CHH normal. Existe una importante tendencia a la sobreestimación en pacientes sin y con sobrecarga férrica en la CHH obtenida por RM 1 Tesla. La determinación de CHH por RM 1,5 Tesla (método Alústiza) es superior a la de RM 1 Tesla, aunque también existe una tendencia a sobreestimar. La CHH media obtenida por BH o RM 1,5 Tesla no tuvieron diferencias significativas. En cambio si existieron entre BH y RM 1 Tesla

Drug-induced autoimmune liver disease: A diagnostic dilemma of an increasingly reported disease.

Journal Article;The aetiology of autoimmune hepatitis (AIH) is uncertain but the disease can be triggered in susceptible patients by external factors such as viruses or drugs. AIH usually develops in individuals with a genetic background mainly consisting of some risk alleles of the major histocompatibility complex (HLA). Many drugs have been linked to AIH phenotypes, which sometimes persist after drug discontinuation, suggesting that they awaken latent autoimmunity. At least three clinical scenarios have been proposed that refers to drug- induced autoimmune liver disease (DIAILD): AIH with drug-induced liver injury (DILI); drug induced-AIH (DI-AIH); and immune mediated DILI (IM-DILI). In addition, there are instances showing mixed features of DI-AIH and IM-DILI, as well as DILI cases with positive autoantibodies. Histologically distinguishing DILI from AIH remains a challenge. Even more challenging is the differentiation of AIH from DI-AIH mainly relying in histological features; however, a detailed standardised histologic evaluation of large cohorts of AIH and DI-AIH patients would probably render more subtle features that could be of help in the differential diagnosis between both entities. Growing information on the relationship of drugs and AIH is being available, being drugs like statins and biologic agents more frequently involved in cases of DIAILD. In addition, there is some evidence on the fact that patients diagnosed with DIAILD may have had a previous episode of hepatotoxicity. Further collaborative studies in DIAILD will strengthen the knowledge and understanding of this intriguing and complex disorder which might represent different phenotypes across the spectrum of disease.Ye