Utilidad de las medidas de atrofia cerebral en el diagnóstico y seguimiento de la esclerosis múltiple

La esclerosis múltiple (EM) es una enfermedad inflamatoria desmielinizante del sistema nervioso central. Su evolución es muy variable entre individuos, como también lo es la respuesta de éstos al tratamiento. Las medidas clínicas de actividad son solo parcialmente útiles para predecir los cambios en la evolución de la enfermedad. Además, la resonancia magnética (RM), aunque altamente sensible para detectar lesiones, presenta solo una moderada correlación con la evolución de la discapacidad. El daño neuroaxonal sobre las lesiones como en el tejido cerebral aparentemente normal es probablemente la causa subyacente de discapacidad permanente. Las medidas de atrofia cerebral mediante RM reflejan la pérdida tisular y es posible obtenerlas actualmente mediante programas informáticos de procesamiento de imagen. No obstante, el papel de la atrofia como biomarcador pronóstico en EM es poco conocido, por lo que se planteó investigar su valor en situaciones de práctica clínica habitual, como son la predicción del riesgo de conversión a EM clínicamente definida (EMCD) tras un síndrome clínico aislado (SCA) y la predicción de progresión de la discapacidad a pesar de iniciar terapia modificadora de la evolución de la enfermedad (TME). Para ello, se analizaron los exámenes de RM de dos cohortes prospectivas: 1)cohorte SCA, compuesta de 176 pacientes con un SCA, en los que se realizó un examen de RM convencional a los 3 meses del inicio de los síntomas y al año y que fueron seguidos un mínimo de 2 años; 2)cohorte TME, compuesta de 105 pacientes con EMCD que iniciaron TME con interferón β (IFNβ), en los que se realizó un examen de RM convencional previamente al inicio de IFNβ y al año, y que fueron seguidos ≥2 años y hasta completar 4 años. Los análisis volumétricos se realizaron mediante los programas SIENA (Structural Imaging Evaluation, using Normalization, of Atrophy) para el cálculo del porcentaje de cambio del volumen cerebral (PCVC) y SPM (Statistical Parametric Mapping) para el cálculo de los porcentajes de cambio del volumen de sustancia gris (%cVSG) y blanca (%cVSB). Se investigó la relación entre las variables de volumetría cerebral y el curso clínico, y se encontraron valores de corte en los cambios de volumen cerebral de predicción de un peor pronóstico clínico. En la cohorte SCA se determinó la relación con la conversión a EMCD, y en la cohorte TME la relación con la progresión de la discapacidad, mediante análisis de supervivencia de Kaplan-Meier, y mediante análisis multivariante de regresión de Cox, ajustando por variables demográficas, clínicas y de RM. En términos generales, en ambas cohortes, un mayor grado de atrofia cerebral global medida con PCVC se relacionó con un peor pronóstico clínico. Los pacientes con SCA que desarrollaron EMCD tuvieron mayores descensos del PCVC (-0,65% frente a +0,059%; p 0.001). Además, los descensos del PCVC mayores a -0,817% predijeron de forma independiente una conversión a EMCD más precoz. Los cambios observados en los pacientes con SCA que desarrollaron EMCD se debieron a cambios en la sustancia gris, pero no en la sustancia blanca. Los pacientes con EM tratados con IFNβ que desarrollaron progresión clínica tras 4 años de seguimiento tuvieron mayores descensos en PCVC y en el %cVSB. Los descensos superiores a -0,86% de PCVC o descensos superiores a -2,49% de %cVSB se relacionaron con una probabilidad de ≃4 veces más de desarrollar progresión clínica tras el inicio de IFNβ. En resumen, los resultados indican que los cambios del volumen cerebral a tan corto plazo como un año son predictores de la evolución clínica posterior, tanto en pacientes al inicio de la enfermedad como en aquellos que acaban de iniciar terapia con IFNβ.Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Its evolution varies widely among individuals, and so is their response to treatment. Measures of MS clinical activity are only partially useful to predict changes in the evolution of the disease. On the other hand, magnetic resonance imaging (MRI), although highly sensitive to detect lesions, only has a moderate correlation with the evolution of disability. The axonal damage in both lesions and normal-appearing white matter is probably the underlying cause of permanent disability. The measures of brain atrophy by MRI reflect tissue loss and it is possible to obtain them nowadays, using softwares for image processing. However, there is little information on the clinical relevance of atrophy as a prognostic biomarker in MS, so we set out to investigate whether the measurement of brain atrophy can be useful in routine clinical practice situations, such as predicting the risk of conversion to clinically definite MS (CDMS) after a clinically isolated syndrome (CIS) and the prediction of disability progression after starting disease-modifying drugs (DMD). For this purpose, the images from the MRI scans of two prospectively followed cohorts of patients were analyzed: 1) CIS cohort, composed of 176 patients with CIS, in which conventional MRI scans were performed at 3 months of the onset of symptoms and one year after, and that were followed up at least 2 years; 2) DMD cohort, composed of 105 CDMS patients who started their first immunomodulatory therapy with interferon β (IFNβ), in which conventional MRI scans were performed prior to starting IFNβ therapy and one year after, and that were followed up a minimum of 2 years and up to 4 years. Volumetric analyses were performed using SIENA (Structural Imaging Evaluation, using Normalization, of Atrophy) software for determining the percentage brain volume change (PBVC), and SPM (Statistical Parametric Mapping) software for calculating the percentages of grey and white matter volume changes. The relationship between brain volume variables and the disease clinical course was investigated and appropriate methodologies were used to find cutoff values in brain volume changes for the identification of patients at higher or lower risks of worse clinical outcomes. In particular, in the CIS cohort the relation of brain volume change with the development of CDMS, and in the DMD cohort the relation with the progression of disability were determined by Kaplan-Meier survival curves analyses, and by Cox proportional hazards multivariate regression analyses, adjusting for demographic, clinical and MRI parameters. Overall, in both cohorts a greater degree of cerebral atrophy as measured with PBVC was associated to a worse prognosis. CIS patients who developed a second relapse had greater declines in PBVC (-0.65% vs. +0.059%; p 0.001). Moreover, declines of PBVC greater than -0.817% were independent predictors of an earlier conversion to CDMS. The volume decreases observed in CIS patients who developed MS were due to changes in the grey matter, whereas no significant changes were detected in the white matter. MS patients treated with IFNβ who developed clinical progression after 4 years of follow-up had greater decreases in PBVC and in the percentage of white matter change (PWMC). Declines beyond -0.86% in PBVC or beyond -2.49% in PWMC increased up to 4 times the risk of developing clinical progression after the beginning of IFNβ therapy. In summary, these results indicate that changes in brain volume in such a short period as one year are predictive of the posterior clinical course, not only at disease onset, but also in patients starting treatment with IFNβ

Characteristics of patients with type 2 diabetes mellitus newly treated with GLP-1 receptor agonists (CHADIG Study): a cross-sectional multicentre study in Spain

Objective: Several glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1Ra) have been made recently available in Spain for type 2 diabetes mellitus (DM2) treatment. There are no published data on the clinical and sociodemographic profile of patients initiating treatment with GLP-1Ra in Spain. Our objective was to understand these patients' characteristics in a real-world clinical practice setting. Design: Cross-sectional observational study. Setting: Spanish specialist outpatient clinics. Participants: 403 adults with DM2 initiating GLP-1Ra treatment were included. Primary and secondary outcome measures: Sociodemographic and DM2-related clinical data, including treatment at and after GLP-1Ra initiation and comorbidities, were collected. Results: Evaluable patients (n=403; 50.9% female) were included ( July 2013 to March 2014) at 24 centres by 53 specialists (47 endocrinology, 6 internal medicine), with the following profile (value±SD): age (58.3±10.4 years), diabetes duration (9.9±7 years), body mass index (BMI; 36.2±5.5) and glycated haemoglobin (HbA1c; 8.4±1.4%); 14% had HbA1c≤7%. Previous antidiabetic treatment: 53.8% only oral antidiabetic drugs (OADs), 5.2% insulin and 40% insulin and OAD; of those receiving OAD, 35% single drug, 38.2% 2 drugs and 24% 3 drugs. Concomitant to GLP-1Ra, 55.3% were only on OAD, 36.2% on insulin and OAD, and 7.2% only on insulin. Of those receiving OAD, the GLP-1Ra was mainly associated with 1 drug (65%) or 2 drugs (31.8%). GLP-1Ra are frequently added to existing antidiabetic drugs, with dipeptidyl peptidase-4 inhibitors being the OAD most frequently switched (45% receiving 1 before starting GLP-1Ra, only 2.7% receiving it concomitantly). Conclusions: In Spain, GLP-1Ra therapy is usually started in combination with OADs or OADs and insulin. These drugs are used in relatively young patients often not reaching therapeutic goals with other treatment combinations, roughly a decade after diagnosis and with a relatively high BMI. The latter could be explaine

SARS-CoV-2 Infection in Multiple Sclerosis

To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal diseas

Downstream Services for Rice Crop Monitoring in Europe: From Regional to Local Scale

The ERMES agromonitoring system for rice cultivations integrates EO data at different resolutions, crop models, and user-provided in situ data in a unified system, which drives two operational downstream services for rice monitoring. The first is aimed at providing information concerning the behavior of the current season at regional/rice district scale, while the second is dedicated to provide farmers with field-scale data useful to support more efficient and environmentally friendly crop practices. In this contribution, we describe the main characteristics of the system, in terms of overall architecture, technological solutions adopted, characteristics of the developed products, and functionalities provided to end users. Peculiarities of the system reside in its ability to cope with the needs of different stakeholders within a common platform, and in a tight integration between EO data processing and information retrieval, crop modeling, in situ data collection, and information dissemination. The ERMES system has been operationally tested in three European rice-producing countries (Italy, Spain, and Greece) during growing seasons 2015 and 2016, providing a great amount of near-real-time information concerning rice crops. Highlights of significant results are provided, with particular focus on real-world applications of ERMES products and services. Although developed with focus on European rice cultivations, solutions implemented in the ERMES system can be, and are already being, adapted to other crops and/or areas of the world, thus making it a valuable testing bed for the development of advanced, integrated agricultural monitoring systems

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

Diverse Large HIV-1 Non-subtype B Clusters Are Spreading Among Men Who Have Sex With Men in Spain

In Western Europe, the HIV-1 epidemic among men who have sex with men (MSM) is dominated by subtype B. However, recently, other genetic forms have been reported to circulate in this population, as evidenced by their grouping in clusters predominantly comprising European individuals. Here we describe four large HIV-1 non-subtype B clusters spreading among MSM in Spain. Samples were collected in 9 regions. A pol fragment was amplified from plasma RNA or blood-extracted DNA. Phylogenetic analyses were performed via maximum likelihood, including database sequences of the same genetic forms as the identified clusters. Times and locations of the most recent common ancestors (MRCA) of clusters were estimated with a Bayesian method. Five large non-subtype B clusters associated with MSM were identified. The largest one, of F1 subtype, was reported previously. The other four were of CRF02_AG (CRF02_1; n = 115) and subtypes A1 (A1_1; n = 66), F1 (F1_3; n = 36), and C (C_7; n = 17). Most individuals belonging to them had been diagnosed of HIV-1 infection in the last 10 years. Each cluster comprised viruses from 3 to 8 Spanish regions and also comprised or was related to viruses from other countries: CRF02_1 comprised a Japanese subcluster and viruses from 8 other countries from Western Europe, Asia, and South America; A1_1 comprised viruses from Portugal, United Kingom, and United States, and was related to the A1 strain circulating in Greece, Albania and Cyprus; F1_3 was related to viruses from Romania; and C_7 comprised viruses from Portugal and was related to a virus from Mozambique. A subcluster within CRF02_1 was associated with heterosexual transmission. Near full-length genomes of each cluster were of uniform genetic form. Times of MRCAs of CRF02_1, A1_1, F1_3, and C_7 were estimated around 1986, 1989, 2013, and 1983, respectively. MRCA locations for CRF02_1 and A1_1 were uncertain (however initial expansions in Spain in Madrid and Vigo, respectively, were estimated) and were most probable in Bilbao, Spain, for F1_3 and Portugal for C_7. These results show that the HIV-1 epidemic among MSM in Spain is becoming increasingly diverse through the expansion of diverse non-subtype B clusters, comprising or related to viruses circulating in other countries

Utilidad de las medidas de atrofia cerebral en el diagnóstico y seguimiento de la esclerosis múltiple

La esclerosis múltiple (EM) es una enfermedad inflamatoria desmielinizante del sistema nervioso central. Su evolución es muy variable entre individuos, como también lo es la respuesta de éstos al tratamiento. Las medidas clínicas de actividad son solo parcialmente útiles para predecir los cambios en la evolución de la enfermedad. Además, la resonancia magnética (RM), aunque altamente sensible para detectar lesiones, presenta solo una moderada correlación con la evolución de la discapacidad. El daño neuroaxonal sobre las lesiones como en el tejido cerebral aparentemente normal es probablemente la causa subyacente de discapacidad permanente. Las medidas de atrofia cerebral mediante RM reflejan la pérdida tisular y es posible obtenerlas actualmente mediante programas informáticos de procesamiento de imagen. No obstante, el papel de la atrofia como biomarcador pronóstico en EM es poco conocido, por lo que se planteó investigar su valor en situaciones de práctica clínica habitual, como son la predicción del riesgo de conversión a EM clínicamente definida (EMCD) tras un síndrome clínico aislado (SCA) y la predicción de progresión de la discapacidad a pesar de iniciar terapia modificadora de la evolución de la enfermedad (TME). Para ello, se analizaron los exámenes de RM de dos cohortes prospectivas: 1) cohorte SCA, compuesta de 176 pacientes con un SCA, en los que se realizó un examen de RM convencional a los 3 meses del inicio de los síntomas y al año y que fueron seguidos un mínimo de 2 años; 2) cohorte TME, compuesta de 105 pacientes con EMCD que iniciaron TME con interferón β (IFNβ), en los que se realizó un examen de RM convencional previamente al inicio de IFNβ y al año, y que fueron seguidos ≥2 años y hasta completar 4 años. Los análisis volumétricos se realizaron mediante los programas SIENA (Structural Imaging Evaluation, using Normalization, of Atrophy) para el cálculo del porcentaje de cambio del volumen cerebral (PCVC) y SPM (Statistical Parametric Mapping) para el cálculo de los porcentajes de cambio del volumen de sustancia gris (%cVSG) y blanca (%cVSB). Se investigó la relación entre las variables de volumetría cerebral y el curso clínico, y se encontraron valores de corte en los cambios de volumen cerebral de predicción de un peor pronóstico clínico. En la cohorte SCA se determinó la relación con la conversión a EMCD, y en la cohorte TME la relación con la progresión de la discapacidad, mediante análisis de supervivencia de Kaplan-Meier, y mediante análisis multivariante de regresión de Cox, ajustando por variables demográficas, clínicas y de RM. En términos generales, en ambas cohortes, un mayor grado de atrofia cerebral global medida con PCVC se relacionó con un peor pronóstico clínico. Los pacientes con SCA que desarrollaron EMCD tuvieron mayores descensos del PCVC (–0,65% frente a +0,059%; p<0.001). Además, los descensos del PCVC mayores a –0,817% predijeron de forma independiente una conversión a EMCD más precoz. Los cambios observados en los pacientes con SCA que desarrollaron EMCD se debieron a cambios en la sustancia gris, pero no en la sustancia blanca. Los pacientes con EM tratados con IFNβ que desarrollaron progresión clínica tras 4 años de seguimiento tuvieron mayores descensos en PCVC y en el %cVSB. Los descensos superiores a –0,86% de PCVC o descensos superiores a –2,49% de %cVSB se relacionaron con una probabilidad de ≃4 veces más de desarrollar progresión clínica tras el inicio de IFNβ. En resumen, los resultados indican que los cambios del volumen cerebral a tan corto plazo como un año son predictores de la evolución clínica posterior, tanto en pacientes al inicio de la enfermedad como en aquellos que acaban de iniciar terapia con IFNβ.Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Its evolution varies widely among individuals, and so is their response to treatment. Measures of MS clinical activity are only partially useful to predict changes in the evolution of the disease. On the other hand, magnetic resonance imaging (MRI), although highly sensitive to detect lesions, only has a moderate correlation with the evolution of disability. The axonal damage in both lesions and normal-appearing white matter is probably the underlying cause of permanent disability. The measures of brain atrophy by MRI reflect tissue loss and it is possible to obtain them nowadays, using softwares for image processing. However, there is little information on the clinical relevance of atrophy as a prognostic biomarker in MS, so we set out to investigate whether the measurement of brain atrophy can be useful in routine clinical practice situations, such as predicting the risk of conversion to clinically definite MS (CDMS) after a clinically isolated syndrome (CIS) and the prediction of disability progression after starting disease-modifying drugs (DMD). For this purpose, the images from the MRI scans of two prospectively followed cohorts of patients were analyzed: 1) CIS cohort, composed of 176 patients with CIS, in which conventional MRI scans were performed at 3 months of the onset of symptoms and one year after, and that were followed up at least 2 years; 2) DMD cohort, composed of 105 CDMS patients who started their first immunomodulatory therapy with interferon β (IFNβ), in which conventional MRI scans were performed prior to starting IFNβ therapy and one year after, and that were followed up a minimum of 2 years and up to 4 years. Volumetric analyses were performed using SIENA (Structural Imaging Evaluation, using Normalization, of Atrophy) software for determining the percentage brain volume change (PBVC), and SPM (Statistical Parametric Mapping) software for calculating the percentages of grey and white matter volume changes. The relationship between brain volume variables and the disease clinical course was investigated and appropriate methodologies were used to find cutoff values in brain volume changes for the identification of patients at higher or lower risks of worse clinical outcomes. In particular, in the CIS cohort the relation of brain volume change with the development of CDMS, and in the DMD cohort the relation with the progression of disability were determined by Kaplan-Meier survival curves analyses, and by Cox proportional hazards multivariate regression analyses, adjusting for demographic, clinical and MRI parameters. Overall, in both cohorts a greater degree of cerebral atrophy as measured with PBVC was associated to a worse prognosis. CIS patients who developed a second relapse had greater declines in PBVC (–0.65% vs. +0.059%; p < 0.001). Moreover, declines of PBVC greater than –0.817% were independent predictors of an earlier conversion to CDMS. The volume decreases observed in CIS patients who developed MS were due to changes in the grey matter, whereas no significant changes were detected in the white matter. MS patients treated with IFNβ who developed clinical progression after 4 years of follow-up had greater decreases in PBVC and in the percentage of white matter change (PWMC). Declines beyond –0.86% in PBVC or beyond –2.49% in PWMC increased up to 4 times the risk of developing clinical progression after the beginning of IFNβ therapy. In summary, these results indicate that changes in brain volume in such a short period as one year are predictive of the posterior clinical course, not only at disease onset, but also in patients starting treatment with IFNβ

Prognostic value of liver stiffness in HIV/HCV-Coinfected patients with decompensated cirrhosis

Abstract Background Little is known about the utility of transient elastography (TE) for assessing the prognosis of patients with decompensated cirrhosis (DC). Methods We analyzed HIV/HCV-coinfected patients with DC who underwent TE as part of their routine follow-up between 2006 and 2015. We also calculated the liver stiffness spleen diameter-to-platelet score (LSPS), FIB-4 index, albumin, MELD score, and Child-Pugh score. The primary outcome was death. Results The study population comprised 65 patients. After a median follow-up of 32 months after the first TE, 17 patients had received anti-HCV therapy and 31 patients had died. The highest area under the receiver operating characteristic curve (AUROC) value for prediction of death was observed with albumin (0.695), followed by Child-Pugh score (0.648), both with P values .05. In the univariate Cox regression analysis, albumin, FIB-4, Child-Pugh score, and MELD score, but not TE, were associated with death. In the multivariate analysis, albumin and Child-Pugh score were the only baseline variables associated with death. Conclusions Our results suggest that TE is not useful for assessing the prognosis of HIV-infected patients with decompensated HCV-related cirrhosis. Albumin concentration and Child-Pugh scores were the most consistent predictors of death in this population group