6 research outputs found
Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission
Introduction & objectives: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. Materials & methods: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. Results: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7–47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4–16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9–21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1–14.6); P 30. Conclusions: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation.Fil: Mendizabal, Manuel. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Piñero, Federico. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones MĂ©dicas e Investigaciones ClĂnicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Anders, Margarita. Hospital Aleman; ArgentinaFil: Silveyra, MarĂa Dolores. Sanatorio Anchorena; ArgentinaFil: Torre, Aldo. Centro MĂ©dico ABC; MĂ©xicoFil: Montes, Pedro. Hospital Nacional Daniel A. CarriĂłn; PerĂşFil: UrzĂşa, Alvaro. Hospital ClĂnico de la Universidad de Chile; ChileFil: Pages, Josefina. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Toro, Luis G.. Hospitales de San Vicente FundaciĂłn de MedellĂn y Rionegro; ColombiaFil: DĂaz, Javier. Hospital Nacional Edgardo Rebagliati Martins; PerĂşFil: Gonzalez Ballerga, Esteban. Universidad de Buenos Aires. Facultad de Medicina. Hospital de ClĂnicas General San MartĂn; ArgentinaFil: Miranda Zazueta, Godolfino. Instituto Nacional de Ciencias MĂ©dicas y NutriciĂłn; MĂ©xicoFil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: GutiĂ©rrez, Isabel. Centro MĂ©dico ABC; MĂ©xicoFil: Michelato, Douglas. Hospital Especializado en Enfermedades Infecciosas Instituto Couto Maia; BrasilFil: Venturelli, Maria Grazia. Hospital Nacional Guillermo Almenara Irigoyen; PerĂşFil: VarĂłn, Adriana. FundaciĂłn Cardio-Infantil; ColombiaFil: Vera Pozo, Emilia. Hospital Regional Dr. Teodoro Maldonado Carbo; EcuadorFil: Tagle, MartĂn. ClĂnica Anglo-Americana; PerĂşFil: GarcĂa, MatĂas. Centro de EducaciĂłn MĂ©dica e Investigaciones ClĂnicas "Norberto Quirno"; ArgentinaFil: Tassara, Alfredo. Hospital Aleman; ArgentinaFil: Brutti, Julia. Sanatorio Anchorena; ArgentinaFil: Ruiz GarcĂa, Sandro. Hospital de VĂctor Lazarte Echegaray; PerĂşFil: Bustios, Carla. ClĂnica Delgado; PerĂşFil: Escajadillo, Nataly. Hospital Nacional Almanzor Aguinaga Asenjo; PerĂşFil: Macias, Yuridia. No especifĂca;Fil: Higuera de la Tijera, Fátima. Hospital General de MĂ©xico “Dr. Eduardo Liceaga"; MĂ©xicoFil: GĂłmez, AndrĂ©s J.. Hospital Universitario FundaciĂłn Santa FĂ© de Bogotá; ColombiaFil: Dominguez, Alejandra. Hospital Padre Hurtado; ChileFil: Castillo Barradas, Mauricio. Hospital de Especialidades del Centro MĂ©dico Nacional La Raza; MĂ©xicoFil: Contreras, Fernando. No especifĂca;Fil: Scarpin, Aldana. Centro de EducaciĂłn MĂ©dica e Investigaciones ClĂnicas "Norberto Quirno"; ArgentinaFil: Schinoni, Maria Isabel. Hospital Alianza; BrasilFil: Toledo, Claudio. Universidad Austral de Chile; ChileFil: Girala, Marcos. Universidad Nacional de AsunciĂłn; ParaguayFil: Mainardi, Victoria. Hospital Central De las Fuerzas Armadas; UruguayFil: Sanchez, Abel. Hospital Roosevelt; GuatemalaFil: Bessone, Fernando. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; ArgentinaFil: Rubinstein, Fernando Adrian. Instituto de Efectividad ClĂnica y Sanitaria; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Silva, Marcelo Oscar. Universidad Austral. Hospital Universitario Austral; Argentin
The impact of different infectious complications on mortality of hospitalized patients with liver cirrhosis
Introduction and objectives: Bacterial infections are common complications in patients with cirrhosis and are associated with poor prognosis. There are no studies that analyze the impact of different infectious complications in the mortality of these patients, so we aimed to perform this evaluation. Materials and methods: We performed a case-control study in adult patients with cirrhosis with a follow-up period of one year. We recorded demographic data, prognostic scales, infectious complications and mortality at 30, 90 and 365 days. For the survival analysis, Kaplan–Meyer survival curve was performed and hazard ratios were calculated with 95% confidence intervals by Cox-regression in univariate and multivariate models. For the comparison between groups the Chi squared test, Fisher's exact test and Mann–Whitney U test were performed. Results: We included 500 patients. Median age was 58 years, predominant sex was woman (52%) and the most common infections were urinary tract infections (35%), pneumonia (28.2%) and spontaneous bacterial peritonitis (SBP) (18%). From the patients, 40.4% were CTP score C and median MELD score was 15. In the univariate analysis, infections in general, SBP, pneumonia and central nervous system (CNS) infections had an increased mortality at the three follow up periods, however in the multivariate analysis with the prognostic scales, only pneumonia (HR 2.03, CI 95%[1.06–3.86]) and CNS infections (HR 4.84, CI 95%[1.38–16.93]) remained with increased mortality. Conclusions: Some infectious complications, as pneumonia and CNS infections, increase mortality in hospitalized patients with cirrhosis, regardless of the severity of liver disease
SARS-CoV-2 vaccination and risk of severe COVID-19 outcomes in patients with autoimmune hepatitis
Background: Data regarding outcome of Coronavirus disease 2019 (COVID-19) in vaccinated patients with autoimmune hepatitis (AIH) are lacking. We evaluated the outcome of COVID-19 in AIH patients who received at least one dose of Pfizer- BioNTech (BNT162b2), Moderna (mRNA-1273) or AstraZeneca (ChAdOx1-S) vaccine. Patients and methods: We performed a retrospective study on AIH patients with COVID-19. The outcomes of AIH patients who had acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection after at least one dose of COVID-19 vaccine were compared to unvaccinated patients with AIH. COVID-19 outcome was classified according to clinical state during the disease course as: (i) no hospitalization, (ii) hospitalization without oxygen supplementation, (iii) hospitalization with oxygen supplementation by nasal cannula or mask, (iv) intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v) ICU admission with invasive mechanical ventilation or (vi) death, and data was analyzed using ordinal logistic regression. Results: We included 413 (258 unvaccinated and 155 vaccinated) patients (81%, female) with a median age of 52 (range: 17–85) years at COVID-19 diagnosis. The rates of hospitalization were (36.4% vs. 14.2%), need for any supplemental oxygen (29.5% vs. 9%) and mortality (7% vs. 0.6%) in unvaccinated and vaccinated AIH patients with COVID-19. Having received at least one dose of SARS-CoV-2 vaccine was associated with a significantly lower risk of worse COVID-19 severity, after adjusting for age, sex, comorbidities and presence of cirrhosis (adjusted odds ratio [aOR] 0.18, 95% confidence interval [CI], 0.10–0.31). Overall, vaccination against SARS-CoV-2 was associated with a significantly lower risk of mortality from COVID-19 (aOR 0.20, 95% CI 0.11–0.35). Conclusions: SARS-CoV-2 vaccination significantly reduced the risk of COVID-19 severity and mortality in patients with AIH.Fil: Efe, Cumali. Harran University Hospital; TurquĂaFil: Taşçılar, Koray. Universitat Erlangen-Nuremberg; AlemaniaFil: Gerussi, Alessio. San Gerardo Hospital; Italia. UniversitĂ degli Studi di Milano; ItaliaFil: Bolis, Francesca. UniversitĂ degli Studi di Milano; ItaliaFil: Lammert, Craig. University School of Medicine; Estados UnidosFil: Ebik, Berat. Gazi YaĹźargil Education and Research Hospital; TurquĂaFil: Stättermayer, Albert Friedrich. Medizinische Universität Wien; AustriaFil: Cengiz, Mustafa. GĂĽlhane Training and Research Hospital; TurquĂaFil: Gökçe, Dilara Turan. Ankara City Hospital; TurquĂaFil: Cristoferi, Laura. UniversitĂ degli Studi di Milano; Italia. San Gerardo Hospital; ItaliaFil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina. Latin American Liver Research Educational And Awareness Network; ArgentinaFil: Massoumi, Hatef. Montefiore Medical Center; Estados UnidosFil: Montes, Pedro. Hospital Nacional Daniel Alcides CarriĂłn; PerĂşFil: Cerda, Eira. Hospital Central Militar, Mexico City; MĂ©xicoFil: Rigamonti, Cristina. UniversitĂ del Piemonte Orientale UPO,; Italia. Azienda Ospedaliera Maggiore Della Carita Di Novara; ItaliaFil: Yapalı, Suna. Acıbadem University School of Medicine; TurquĂaFil: Adali, Gupse. Umraniye Education and Research Hospital; TurquĂaFil: Çalışkan, Ali Rıza. Adiyaman Ăśniversitesi; TurquĂaFil: Balaban, Yasemin. Hacettepe Ăśniversitesi; TurquĂaFil: Eren, Fatih. Uludag University; TurquĂaFil: EĹźkazan, Tuğçe. CerrahpaĹźa School of Medicine; TurquĂaFil: Barutçu, Sezgin. University of Gaziantep Medical Faculty; TurquĂaFil: Lytvyak, Ellina. University of Alberta; CanadáFil: Zazueta, Godolfino Miranda. Instituto Nacional de la NutriciĂłn Salvador Zubiran; MĂ©xicoFil: Kayhan, Meral Akdogan. GĂĽlhane Training and Research Hospital; TurquĂaFil: Heurgue Berlot, Alexandra. Chu de Reims; FranciaFil: De Martin, Eleonora. Universite Paris-Saclay;Fil: Yavuz, Ahmet. Necmettin Erbakan University; TurquĂaFil: Bıyık, Murat. Necmettin Erbakan University; TurquĂaFil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones MĂ©dicas e Investigaciones ClĂnicas "Norberto Quirno". CEMIC-CONICET; Argentina. Universidad Austral; Argentina. Latin American Liver Research Educational and Awareness Network; Argentin
Position statement on the use of albumin in liver cirrhosis
Cirrhosis is characterized by a prolonged asymptomatic period in which the inflammation persists, increasing as the disease progresses. Proinflammatory cytokines and pro-oxidant molecules are key in the development of organ dysfunction. Cirrhosis progression and worsening of portal hypertension bring about bacterial translocation and systemic dissemination via portal circulation of bacterial products, and molecular patterns associated with damage, which exacerbate the systemic Inflammation. Albumin is a molecule that undergoes structural and functional changes as liver damage progresses, affecting its antioxidant, immunomodulatory, oncotic, and endothelial stabilizing properties. Our knowledge of the properties of albumin reveals a molecule with multiple treatment options, capable of targeting several physiopathological aspects of cirrhosis. For the elaboration of the present manuscript on the uses of albumin in liver cirrhosis, several experts in the field of hepatology in Mexico were divided into 5 working groups to summarise and formulate, when appropriate, position statements: 1)pathophysiology of cirrhosis and properties of albumin; 2)proven uses of albumin [large-volume paracentesis, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS)]; 3)controversial/emerging uses of albumin (long-term use, acute decompensation, liver transplant, non-HRS kidney injury, muscle cramps, non-SBP infections, hyponatremia, encephalopathy); 4)use of albumin in acute-on-chronic liver failure, immunomodulation, and systemic Inflammation; 5)pharmacoeconomics
SARS-CoV-2 vaccination and risk of severe COVID-19 outcomes in patients with autoimmune hepatitis
Data regarding outcome of Coronavirus disease 2019 (COVID-19) in vaccinated patients with autoimmune hepatitis (AIH) are lacking. We evaluated the outcome of COVID-19 in AIH patients who received at least one dose of Pfizer- BioNTech (BNT162b2), Moderna (mRNA-1273) or AstraZeneca (ChAdOx1-S) vaccine
Consensus document on acute-on-chronic liver failure (ACLF) established by the Mexican Association of Hepatology
Acute-on chronic liver failure (ACLF) has been an intensively debated topic mainly due to the lack of a unified definition and diagnostic criteria. The growing number of publications describing the mechanisms of ACLF development, the progression of the disease, outcomes and treatment has contributed to a better understanding of the disease, however, it has also sparked the debate about this condition. As an attempt to provide medical professionals with a more uniform definition that could be applied to our population, the first Mexican consensus was performed by a panel of experts in the area of hepatology in Mexico. We used the most relevant and impactful publications along with the clinical and research experience of the consensus participants. The consensus was led by 4 coordinators who provided the most relevant bibliography by doing an exhaustive search on the topic. The entire bibliography was made available to the members of the consensus for consultation at any time during the process and six working groups were formed to develop the following sections: 1.- Generalities, definitions, and criteria, 2.- Pathophysiology of cirrhosis, 3.- Genetics in ACLF, 4.- Clinical manifestations, 5.- Liver transplantation in ACLF, 6.- Other treatments