19 results on '"Domenicali, M."'
Search Results
2. Asymptomatic and symptomatic deep venous thrombosis in hospitalized acutely ill medical patients. risk factors and therapeutic implications
- Author
-
Loffredo L., Vidili G., Sciacqua A., Cogliati C., Di Giulio R., Bernardini S., Ciacci P., Pietrangelo A., Orlando F., Paraninfi A., Boddi M., Di Minno G., Falsetti L., Lodigiani C., Santoliquido A., Ettorre E., Pignatelli P., Arezzo M. F., Gutu E., Harenberg J., Violi F., Casciaro M. A., Morelli S., Accapezzato D., Rossi E., Palumbo I. M., Pannunzio A., Fallarino A., Maggio E., Bocchini V. P., Gioia C., Izzo R., Luongo R., Cosenza M., Bisciglia M. F., Battaglia S., Pirillo L. S., Capozza A., Summa M. L., Armentaro G., Volpentesta M., Rullo R., Baldinia L., Arienti V., Meloni P. L., Sauchella A., Melis S., Berria M., Solinas B., Vilardi L., Sarobba P., Pisanu M., Mangatia P., Cringoli M., Blanca D., Casella F., Vegetti A., Crociani A., Donnarumma E., Pacciani G., Rovereto R., Lunardi S., Tufano A., Pacetti V., Domenicali M., Leopoldo P., Ceci F., Loffredo, L., Vidili, G., Sciacqua, A., Cogliati, C., Di Giulio, R., Bernardini, S., Ciacci, P., Pietrangelo, A., Orlando, F., Paraninfi, A., Boddi, M., Di Minno, G., Falsetti, L., Lodigiani, C., Santoliquido, A., Ettorre, E., Pignatelli, P., Arezzo, M. F., Gutu, E., Harenberg, J., Violi, F., Casciaro, M. A., Morelli, S., Accapezzato, D., Rossi, E., Palumbo, I. M., Pannunzio, A., Fallarino, A., Maggio, E., Bocchini, V. P., Gioia, C., Izzo, R., Luongo, R., Cosenza, M., Bisciglia, M. F., Battaglia, S., Pirillo, L. S., Capozza, A., Summa, M. L., Armentaro, G., Volpentesta, M., Rullo, R., Baldinia, L., Arienti, V., Meloni, P. L., Sauchella, A., Melis, S., Berria, M., Solinas, B., Vilardi, L., Sarobba, P., Pisanu, M., Mangatia, P., Cringoli, M., Blanca, D., Casella, F., Vegetti, A., Crociani, A., Donnarumma, E., Pacciani, G., Rovereto, R., Lunardi, S., Tufano, A., Pacetti, V., Domenicali, M., Leopoldo, P., and Ceci, F.
- Subjects
anticoagulants ,asymptomatic deep venous thrombosis ,compression ultrasound ,Anticoagulant ,medical patient ,Hematology ,Asymptomatic deep venous thrombosi ,Deep venous thrombosi ,deep venous thrombosis - Abstract
Background Acutely ill medical patients experience deep venous thrombosis (DVT) during the hospitalization, however the time course of DVT is still unclear. Objectives To evaluate risk factors in acutely ill hospitalized medical patients for proximal asymptomatic DVT (ADVT) and symptomatic DVT (SDVT) at admission and discharge. Patients/Methods In this prospective observational study, consecutive acutely ill medical patients (hospitalized mainly for acute medical disease as infections, neoplasm, anemia, heart failure) underwent compression ultrasonography (CUS) of proximal lower limb veins within 48 h from admission and at discharge to diagnose ADVT and SDVT. Covid-19 patients, anticoagulant therapy, surgical procedures, acute SDVT, and acute pulmonary embolism, were exclusion criteria. Biographical characteristics at hospitalization, D-Dimer (assessed by ELISA)) and DD-improve score. Results Of 2,100 patients (1002 females, 998 males, age 71 ± 16 years) 58 (2.7%) had proximal ADVT at admission. Logistic regression analysis showed that age, and active cancer were independently associated with ADVT at admission. The median length of hospitalization was 10 days [interquartile range: 6–15]. During the hospital stay, 6 patients (0.3%) with a negative CUS at admission experienced DVT (2 SDVT and 4 ADVT). In the subgroup of patients (n = 1118), in whom D-dimer was measured at admission, D-Dimer and IMPROVE-DD score were associated with ADVT at admission (n = 37) and with all DVT (n = 42) at discharge. ROC curve defined an IMPROVE-DD score of 2.5 as the optimal cut-off for discriminating patients with and without thrombotic events. Conclusions We provide evidence of early development of ADVT in unselected acutely ill medical patients suggesting the need of investigating patients by CUS immediately after hospital admission (within 48 h). Advanced age, active cancer, known thrombophilia and increased IMPROVE-DD score may identify patients at risk. The benefit of anticoagulation needs to be investigated in patients with these specific risk factors and negative CUS at admission. Trial registration NCT03157843.
- Published
- 2022
3. Mortality risk in a population of patients treated for gambling disorders: results of a follow-up study
- Author
-
Pavarin, R. M., Domenicali, M., Marani, S., Turino, E., Caputo, F., Pavarin R.M., Domenicali M., Marani S., Turino E., and Caputo F.
- Subjects
Male ,Gambling disorders ,Mental Disorders ,Cancer, Gambling disorders, suicide, mortality risk ,Gambling disorder ,NO ,Cohort Studies ,Suicide ,Cause of Death ,Gambling ,Humans ,Female ,Mortality risk ,Cancer ,Aged ,Follow-Up Studies - Abstract
Aims. To examine mortality risk and causes of death in a cohort of a population of patients treated for gambling disorders in northern Italy from 1992 to 2019. Methods. Cohort study. Results. Half of the patients were diagnosed with psychiatric disorders, substance use disorder or alcohol dependence. The excess mortality compared to the general population (SMR) was 1.16 (0.85-1.58), more elevated among females aged 40 to 59 and males aged 20 to 29. Females had higher SMRs for all cancers and suicide; males for malignant neoplasm of liver, of lung, of prostate, and of bladder. Conclusions. Despite patients increasing, subjects who most turn to the services are the most serious ones, in older age, with comorbid mental disorders and with a compromised health status. This is reflected in the high risk of death for all cancers.
- Published
- 2021
4. Characteristics and survival of patients with primary biliary cholangitis and hepatocellular carcinoma
- Author
-
Edoardo G. Giannini, Giulia Pieri, Sara Labanca, Maria Corina Plaz Torres, Antonio Gasbarrini, Elisabetta Biasini, Claudia Campani, Nora Cazzagon, Francesco Giuseppe Foschi, Andrea Mega, Alberto Masotto, Giovanni Raimondo, Gian Ludovico Rapaccini, Rodolfo Sacco, Eugenio Caturelli, Maria Guarino, Francesco Tovoli, Gianpaolo Vidili, Maurizia Rossana Brunetto, Gerardo Nardone, Gianluca Svegliati-Baroni, Donatella Magalotti, Francesco Azzaroli, Giuseppe Cabibbo, Maria Di Marco, Angelo Sangiovanni, Franco Trevisani, Maurizio Biselli, Paolo Caraceni, Annagiulia Gramenzi, Francesca Benevento, Alessandro Granito, Luca Muratori, Fabio Piscaglia, Federica Bertellini, Fabio Farinati, Giorgio Palano, Filippo Pelizzaro, Barbara Penzo, Elisa Pinto, Gloria Allegrini, Calogero Cammà, Ciro Celsa, Paolo Giuffrida, Caterina Stornello, Mauro Grova, Carmelo Marco Giacchetto, Gabriele Rancatore, Maria Vittoria Grassini, Valentina Adotti, Stefano Gitto, Fabio Marra, Martina Rosi, Vittoria Bevilacqua, Alberto Borghi, Andrea Casadei Gardini, Fabio Conti, Lucia Napoli, Marco Domenicali, Maria Teresa Migliano, Nicoletta de Matthaeis, Francesca Romana Ponziani, Andrea Olivani, Gabriele Missale, Valentina Cossiga, Mario Capasso, Filomena Morisco, Ester Marina Cela, Antonio Facciorusso, Valentina Lauria, Giorgia Ghittoni, Giorgio Pelecca, Fabrizio Chegai, Fabio Coratella, Mariano Ortenzi, Serena Dell'Isola, Maria Stella Franzè, Carlo Saitta, Assunta Sauchella, Elton Dajti, Federico Ravaioli, Filippo Oliveri, Gabriele Ricco, Veronica Romagnoli, Alessandro Inno, Fabiana Marchetti, Pietro Coccoli, Antonio Malerba, Alberta Cappelli, Rita Golfieri, Cristina Mosconi, Matteo Renzulli, Giannini, Edoardo G, Pieri, Giulia, Labanca, Sara, Plaz Torres, Maria Corina, Gasbarrini, Antonio, Biasini, Elisabetta, Campani, Claudia, Cazzagon, Nora, Foschi, Francesco Giuseppe, Mega, Andrea, Masotto, Alberto, Raimondo, Giovanni, Rapaccini, Gian Ludovico, Sacco, Rodolfo, Caturelli, Eugenio, Guarino, Maria, Tovoli, Francesco, Vidili, Gianpaolo, Brunetto, Maurizia Rossana, Nardone, Gerardo, Svegliati-Baroni, Gianluca, Magalotti, Donatella, Azzaroli, Francesco, Cabibbo, Giuseppe, Di Marco, Maria, Sangiovanni, Angelo, Trevisani, Franco, Giannini, E. G., Pieri, G., Labanca, S., Plaz Torres, M. C., Gasbarrini, A., Biasini, E., Campani, C., Cazzagon, N., Foschi, F. G., Mega, A., Masotto, A., Raimondo, G., Rapaccini, G. L., Sacco, R., Caturelli, E., Guarino, M., Tovoli, F., Vidili, G., Brunetto, M. R., Nardone, G., Svegliati-Baroni, G., Magalotti, D., Azzaroli, F., Cabibbo, G., Di Marco, M., Sangiovanni, A., Trevisani, F., Biselli, M., Caraceni, P., Gramenzi, A., Benevento, F., Granito, A., Muratori, L., Piscaglia, F., Bertellini, F., Farinati, F., Palano, G., Pelizzaro, F., Penzo, B., Pinto, E., Allegrini, G., Camma, C., Celsa, C., Giuffrida, P., Stornello, C., Grova, M., Giacchetto, C. M., Rancatore, G., Grassini, M. V., Adotti, V., Gitto, S., Marra, F., Rosi, M., Bevilacqua, V., Borghi, A., Gardini, A. C., Conti, F., Napoli, L., Domenicali, M., Migliano, M. T., de Matthaeis, N., Ponziani, F. R., Olivani, A., Missale, G., Cossiga, V., Capasso, M., Morisco, F., Cela, E. M., Facciorusso, A., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Dell'Isola, S., Franze, M. S., Saitta, C., Sauchella, A., Dajti, E., Ravaioli, F., Oliveri, F., Ricco, G., Romagnoli, V., Inno, A., Marchetti, F., Coccoli, P., Malerba, A., Cappelli, A., Golfieri, R., Mosconi, C., and Renzulli, M.
- Subjects
Male ,Carcinoma, Hepatocellular ,Cholestatic liver disease ,Outcome ,Surveillance ,Survival ,Treatment ,Hepatology ,Prognosi ,Liver Cirrhosis, Biliary ,Risk Factor ,Settore MED/12 - GASTROENTEROLOGIA ,Liver Neoplasms ,Gastroenterology ,Prognosis ,Risk Factors ,Humans ,Female ,Human ,Aged - Abstract
Background: Comprehensive and contemporary data pertaining large populations of patients with Primary Biliary Cholangitis (PBC) and hepatocellular carcinoma (HCC) are missing. Aim: To describe main characteristics and outcome of PBC patients with HCC diagnosed in the new millennium. Methods: Analysing the Italian Liver Cancer registry we identified 80 PBC patients with HCC diagnosed after the year 2000, and described their clinical characteristics, access to treatment and survival. Results: Median age of patients was 71 years and 50.0% were males. Cirrhosis was present in 86.3% of patients, being well-compensated in 58.0%. Median HCC diameter was smaller in patients under surveillance (2.6vs 4.0cm, P=0.007). Curative treatment, feasible in 50.0% of patients, was associated with improved survival compared to palliative and supportive care (42vs 33vs 6 months, P
- Published
- 2022
5. Strategies and Tools for Supporting the Appropriateness of Drug Use in Older People
- Author
-
Carlotta Lunghi, Caterina Trevisan, Michele Fusaroli, Valentina Giunchi, Emanuel Raschi, Elisa Sangiorgi, Marco Domenicali, Stefano Volpato, Fabrizio De Ponti, Elisabetta Poluzzi, Lunghi C., Trevisan C., Fusaroli M., Giunchi V., Raschi E., Sangiorgi E., Domenicali M., Volpato S., De Ponti F., and Poluzzi E.
- Subjects
older adult ,adverse drug reaction ,medication adherence ,Drug Discovery ,digital health ,appropriatene ,Pharmaceutical Science ,Molecular Medicine ,polypharmacy - Abstract
Through this structured review of the published literature, we aimed to provide an up-to-date description of strategies (human-related) and tools (mainly from the digital field) facilitating the appropriateness of drug use in older adults. The evidence of each strategy and tool’s effectiveness and sustainability largely derives from local and heterogeneous experiences, with contrasting results. As a general framework, three main steps should be considered in implementing measures to improve appropriateness: prescription, acceptance by the patient, and continuous monitoring of adherence and risk-benefit profile. Each step needs efforts from specific actors (physicians, patients, caregivers, healthcare professionals) and dedicated supporting tools. Moreover, how to support the appropriateness also strictly depends on the particular setting of care (hospital, ambulatory or primary care, nursing home, long-term care) and available economic resources. Therefore, it is urgent assigning to each approach proposed in the literature the following characteristics: level of effectiveness, strength of evidence, setting of implementation, needed resources, and issues for its sustainability.
- Published
- 2022
6. Adopting STOPP/START Criteria Version 3 in Clinical Practice: A Q&A Guide for Healthcare Professionals.
- Author
-
Lunghi C, Domenicali M, Vertullo S, Raschi E, De Ponti F, Onder G, and Poluzzi E
- Abstract
The growing complexity of geriatric pharmacotherapy necessitates effective tools for mitigating the risks associated with polypharmacy. The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) criteria have been instrumental in optimizing medication management among older adults. Despite their large adoption for improving the reduction of potentially inappropriate medications (PIM) and patient outcomes, the implementation of STOPP/START criteria faces notable challenges. The extensive number of criteria in the latest version and time constraints in primary care pose practical difficulties, particularly in settings with a high number of older patients. This paper critically evaluates the challenges and evolving implications of applying the third version of the STOPP/START criteria across various clinical settings, focusing on the European healthcare context. Utilizing a "Questions & Answers" format, it examines the criteria's implementation and discusses relevant suitability and potential adaptations to address the diverse needs of different clinical environments. By emphasizing these aspects, this paper aims to contribute to the ongoing discourse on enhancing medication safety and efficacy in the geriatric population, and to promote more person-centred care in an aging society., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
7. Development and internal validation of a multivariable model for the prediction of the probability of 1-year readmission to the emergency department for acute alcohol intoxication.
- Author
-
Palmese F, Bonavita ME, Pompili E, Reggidori N, Migliano MT, Di Stefano C, Grieco M, Colazzo S, Baldassarre M, Caraceni P, Foschi FG, Giostra F, Farina G, Del Toro R, Bedogni G, and Domenicali M
- Subjects
- Humans, Male, Female, Adult, Middle Aged, Retrospective Studies, Italy, Logistic Models, Probability, Patient Readmission statistics & numerical data, Emergency Service, Hospital statistics & numerical data, Emergency Service, Hospital organization & administration, Alcoholic Intoxication
- Abstract
To develop and internally validate a multivariable logistic regression model (LRM) for the prediction of the probability of 1-year readmission to the emergency department (ED) in patients with acute alcohol intoxication (AAI). We developed and internally validated the LRM on a previously analyzed retrospective cohort of 3304 patients with AAI admitted to the ED of the Sant'Orsola-Malpighi Hospital (Bologna, Italy). The benchmark LRM employed readmission to the same ED for AAI within 1 year as the binary outcome, age as a continuous predictor, and sex, alcohol use disorder, substance use disorder, at least one previous admission for trauma, mental or behavioral disease, and homelessness as the binary predictors. Optimism correction was performed using the bootstrap on 1000 samples without replacement. The benchmark LRM was gradually simplified to get the most parsimonious LRM with similar optimism-corrected overall fit, discrimination and calibration. The 1-year readmission rate was 15.7% (95% CI 14.4-16.9%). A reduced LRM based on sex, age, at least one previous admission for trauma, mental or behavioral disease, and homelessness, performed nearly as well as the benchmark LRM. The reduced LRM had the following optimism-corrected metrics: scaled Brier score 17.0%, C-statistic 0.799 (95% CI 0.778 to 0.821), calibration in the large 0.000 (95% CI - 0.099 to 0.099), calibration slope 0.985 (95% CI 0.893 to 1.088), and an acceptably accurate calibration plot. An LRM based on sex, age, at least one previous admission for trauma, mental or behavioral disease, and homelessness can be used to estimate the probability of 1-year readmission to ED for AAI. To begin proving its clinical utility, this LRM should be validated in external cohorts., (© 2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)
- Published
- 2024
- Full Text
- View/download PDF
8. Physical Prehabilitation in Patients who Underwent Major Abdominal Surgery: A Comprehensive Systematic Review and Component Network Meta-Analysis Using GRADE and CINeMA Approach.
- Author
-
Ricci C, Alberici L, Serbassi F, Caraceni P, Domenicali M, Ingaldi C, Grego DG, Mazzucchelli C, and Casadei R
- Subjects
- Humans, Network Meta-Analysis, Length of Stay, Postoperative Complications prevention & control, Prognosis, Preoperative Care, Exercise, Preoperative Exercise, Abdomen surgery
- Abstract
Background: Physical prehabilitation is recommended before major abdominal surgery to ameliorate short-term outcomes., Methods: A frequentist, random-effects network meta-analysis (NMA) was performed to clarify which type of preoperative physical activity among aerobic exercise (AE), inspiratory muscle training (IMT), and resistance training produces benefits in patients who underwent major abdominal surgery. The surface under the P-score, odds ratio (OR), or mean difference (MD) with a 95% confidence interval (CI) were reported. The results were adjusted by using the component network approach. The critical endpoints were overall and major morbidity rate and mortality rate. The important but not critical endpoints were the length of stay (LOS) and pneumonia., Results: The meta-analysis included 25 studies. The best approaches for overall morbidity rate were AE and AE + IMT (OR = 0.61, p-score = 0.76, and OR = 0.66, p-score = 0.68). The best approaches for pneumonia were AE + IMT and AE (OR = 0.21, p-score = 0.91, and OR = 0.52, p-score = 0.68). The component analysis confirmed that the best incremental OR (0.30; 95% CI 0.12-0.74) could be obtained using AE + IMT. The best approach for LOS was AE alone (MD - 1.63 days; 95% CI - 3.43 to 0.18). The best combination of components was AE + IMT (MD - 1.70; 95% CI - 2.06 to - 1.27)., Conclusions: Physical prehabilitation reduces the overall morbidity rate, pneumonia, and length of stay. The most relevant effect of prehabilitation requires the simultaneous use of AE and IMT., (© 2023. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
9. Education and Training in Alcohology in Italy.
- Author
-
Agabio R, Domenicali M, Zavan V, and Addolorato G
- Published
- 2024
- Full Text
- View/download PDF
10. Predictors of clinical trajectories of patients with acutely decompensated cirrhosis. An external validation of the PREDICT study.
- Author
-
Pompili E, Baldassarre M, Bedogni G, Zaccherini G, Iannone G, De Venuto C, Pratelli D, Palmese F, Domenicali M, and Caraceni P
- Subjects
- Humans, C-Reactive Protein, Inflammation, Prognosis, Prospective Studies, Acute-On-Chronic Liver Failure complications, Hepatic Encephalopathy complications, Liver Cirrhosis
- Abstract
Background and Aims: The PREDICT study recently showed that acutely decompensated (AD) patients with cirrhosis can present three different clinical phenotypes in the 90 days after admission: (1) pre-ACLF, developing acute-on-chronic liver failure (ACLF); (2) unstable decompensated cirrhosis (UDC), being re-admitted for AD without ACLF and (3) stable decompensated cirrhosis (SDC), not presenting readmission or ACLF. This study aimed to externally validate the existence of these three distinct trajectories and to identify predictors for the occurrence of each trajectory., Methods: Baseline data, 3-month ACLF and readmission incidence and 1-year survival were analysed in a prospective cohort of patients admitted for AD. A multinomial multivariable model was used to evaluate the association between baseline features and clinical trajectories., Results: Of the 311 patients enrolled, 55% met the criteria for SDC, 18% for UDC and 27% for pre-ACLF, presenting a significantly different 1-year mortality: pre-ACLF 65%, UDC 46%, SDC 21% (p < .001). The presence of hepatic encephalopathy (HE) was associated with UDC (p = .043), while the absence of ascites to SDC (p = .017). Among laboratory parameters, an increase in MELD-Na (p = .001) and C-reactive protein (p = .009) and a decrease in haemoglobin (p = .004) and albumin (p = .008) levels were associated with pre-ACLF., Conclusion: The present study confirms that AD patients have three different clinical trajectories with different mortality rates. Besides the severity of cirrhosis, the association with C-reactive protein supports the predominant role of systemic inflammation in ACLF pathophysiology. Finally, HE is associated with the UDC phenotype highlighting the need for better management of this complication after discharge., (© 2023 The Authors. Liver International published by John Wiley & Sons Ltd.)
- Published
- 2024
- Full Text
- View/download PDF
11. Sympathetic nervous activation, mitochondrial dysfunction and outcome in acutely decompensated cirrhosis: the metabolomic prognostic models (CLIF-C MET).
- Author
-
Weiss E, de la Peña-Ramirez C, Aguilar F, Lozano JJ, Sánchez-Garrido C, Sierra P, Martin PI, Diaz JM, Fenaille F, Castelli FA, Gustot T, Laleman W, Albillos A, Alessandria C, Domenicali M, Caraceni P, Piano S, Saliba F, Zeuzem S, Gerbes AL, Wendon JA, Jansen C, Gu W, Papp M, Mookerjee R, Gambino CG, Jiménez C, Giovo I, Zaccherini G, Merli M, Putignano A, Uschner FE, Berg T, Bruns T, Trautwein C, Zipprich A, Bañares R, Presa J, Genesca J, Vargas V, Fernández J, Bernardi M, Angeli P, Jalan R, Claria J, Junot C, Moreau R, Trebicka J, and Arroyo V
- Subjects
- Humans, Prognosis, Prospective Studies, Liver Cirrhosis complications, Inflammation complications, Metabolomics, Mitochondria, Methoxyhydroxyphenylglycol, Acute-On-Chronic Liver Failure
- Abstract
Background and Aims: Current prognostic scores of patients with acutely decompensated cirrhosis (AD), particularly those with acute-on-chronic liver failure (ACLF), underestimate the risk of mortality. This is probably because systemic inflammation (SI), the major driver of AD/ACLF, is not reflected in the scores. SI induces metabolic changes, which impair delivery of the necessary energy for the immune reaction. This investigation aimed to identify metabolites associated with short-term (28-day) death and to design metabolomic prognostic models., Methods: Two prospective multicentre large cohorts from Europe for investigating ACLF and development of ACLF, CANONIC (discovery, n=831) and PREDICT (validation, n=851), were explored by untargeted serum metabolomics to identify and validate metabolites which could allow improved prognostic modelling., Results: Three prognostic metabolites strongly associated with death were selected to build the models. 4-Hydroxy-3-methoxyphenylglycol sulfate is a norepinephrine derivative, which may be derived from the brainstem response to SI. Additionally, galacturonic acid and hexanoylcarnitine are associated with mitochondrial dysfunction. Model 1 included only these three prognostic metabolites and age. Model 2 was built around 4-hydroxy-3-methoxyphenylglycol sulfate, hexanoylcarnitine, bilirubin, international normalised ratio (INR) and age. In the discovery cohort, both models were more accurate in predicting death within 7, 14 and 28 days after admission compared with MELDNa score (C-index: 0.9267, 0.9002 and 0.8424, and 0.9369, 0.9206 and 0.8529, with model 1 and model 2, respectively). Similar results were found in the validation cohort (C-index: 0.940, 0.834 and 0.791, and 0.947, 0.857 and 0.810, with model 1 and model 2, respectively). Also, in ACLF, model 1 and model 2 outperformed MELDNa 7, 14 and 28 days after admission for prediction of mortality., Conclusions: Models including metabolites (CLIF-C MET) reflecting SI, mitochondrial dysfunction and sympathetic system activation are better predictors of short-term mortality than scores based only on organ dysfunction (eg, MELDNa), especially in patients with ACLF., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
- Full Text
- View/download PDF
12. Relationship between Muscle Mass, Bone Density and Vascular Calcifications in Elderly People with SARS-CoV-2 Pneumonia.
- Author
-
Del Toro R, Palmese F, Feletti F, Zani G, Minguzzi MT, Maddaloni E, Napoli N, Bedogni G, and Domenicali M
- Abstract
Background: Little is known about the changes in organs and tissues that may make elder patients more vulnerable to acute stressors such as SARS-CoV-2 infection., Methods: In 80 consecutive elderly patients with SARS-CoV-2 infection, we evaluated the association between the descending thoracic aorta calcium score, L1 bone density and T12 skeletal muscle density measured on the same scan by high-resolution computed tomography., Results: At median regression, the ln-transformed DTA calcium score was inversely associated with L1 bone density (-0.02, 95%CI -0.04 to -0.01 ln-Agatston units for an increase of 1 HU) and with T12 muscle density (-0.03, -0.06 to -0.001 ln-Agatston units for an increase of 1 HU). At penalized logistic regression, an increase of 1 ln-Agatston unit of DTA calcium score was associated with an OR of death of 1.480 (1.022 to 2.145), one of 1 HU of bone density with an OR of 0.981 (0.966 to 0.996) and one of 1 HU of muscle density with an OR of 0.973 (0.948 to 0.999). These relationships disappeared after correction for age and age was the stronger predictor of body composition and death., Conclusions: Age has a big effect on the relationship between vascular calcifications, L1 bone density and T12 muscle density and on their relationship with the odds of dying.
- Published
- 2023
- Full Text
- View/download PDF
13. Low haemoglobin level predicts early hospital readmission in patients with cirrhosis and acute decompensation.
- Author
-
Pompili E, Baldassarre M, Zaccherini G, Tufoni M, Iannone G, Pratelli D, Palmese F, Vizioli L, Faggiano C, Bedogni G, Domenicali M, and Caraceni P
- Abstract
Background & Aims: Patients with decompensated cirrhosis present frequent hospitalisations with a relevant clinical and socio-economic impact. This study aims to characterise unscheduled readmissions up to 1-year follow-up and identify predictors of 30-day readmission after an index hospitalisation for acute decompensation (AD)., Methods: We performed a secondary analysis of a prospectively collected cohort of patients admitted for AD. Laboratory and clinical data at admission and at discharge were collected. Timing and causes of unscheduled readmissions and mortality were recorded up to 1 year., Results: A total of 329 patients with AD were included in the analysis. Acute-on-chronic liver failure was diagnosed in 19% of patients at admission or developed in an additional 9% of patients during the index hospitalisation. During the 1-year follow-up, 182 patients (55%) were rehospitalised and 98 (30%) more than once. The most frequent causes of readmission were hepatic encephalopathy (36%), ascites (22%), and infection (21%). Cumulative incidence of readmission was 20% at 30 days, 39% at 90 days, and 63% at 1 year. Fifty-four patients were readmitted for emergent liver-related causes within 30 days. Early readmission was associated with a higher 1-year mortality (47 vs. 32%, p = 0.037). Multivariable Cox regression analysis showed that haemoglobin (Hb) ≤8.7 g/dl (hazard ratio 2.63 [95% CI 1.38-5.02], p = 0.003) and model for end-stage liver disease-sodium score (MELD-Na) >16 at discharge (hazard ratio 2.23 [95% CI 1.27-3.93], p = 0.005), were independent predictors of early readmission. In patients with MELD-Na >16 at discharge, the presence of Hb ≤8.7 g/dl doubles the risk of early rehospitalisation (44% vs. 22%, p = 0.02)., Conclusion: Besides MELD-Na, a low Hb level (Hb ≤8.7 g/dl) at discharge emerged as a new risk factor for early readmission, contributing to identification of patients who require closer surveillance after discharge., Impact and Implications: Patients with decompensated cirrhosis face frequent hospitalisations. In the present study, type and causes of readmissions were analysed during 1-year follow-up in patients discharged after the index hospitalisation for an acute decompensation of the disease. Early (30-day) liver-related readmission was associated with higher 1-year mortality. The model for end-stage liver disease-sodium score and low haemoglobin at discharge were identified as independent risk factors for early readmissions. Haemoglobin emerged as a new easy-to-use parameter associated with early readmission warranting further investigation., Competing Interests: All authors declare no conflicts of interest that are relevant to the content of this article. Please refer to the accompanying ICMJE disclosure forms for further details., (© 2023 The Authors.)
- Published
- 2023
- Full Text
- View/download PDF
14. COVID-19-Related Death in Patients with Alcohol or Substance Use Disorders.
- Author
-
Pavarin RM, Consonni D, Lucchi F, Pandolfi P, Marani S, Palmese F, and Domenicali M
- Subjects
- Humans, Follow-Up Studies, Italy epidemiology, Alcoholism epidemiology, COVID-19, Substance-Related Disorders epidemiology
- Abstract
Background: People with substance or alcohol use disorders (SUDs/AUDs) are likely to be more vulnerable to COVID-19 infection than the general population, but the evidence of COVID-19-related mortality in these patients is unclear., Objectives: The aim of the study was to verify whether patients with AUD and SUD have a higher mortality rate for COVID-19-related mortality compared to the general population., Method: We performed a follow-up study to assess mortality in 2020 in a cohort of patients diagnosed for the first time with AUDs or SUDs at the Public Health Services in the metropolitan area of Bologna (Northern Italy) from 2009 to 2019., Results: SUDs/AUDs patients present an excess mortality with respect to the general population for all causes of death and for COVID-19-related mortality., Conclusions: Our data support the need for prevention strategies in SUDs/AUDs patients such as vaccinations., (© 2022 S. Karger AG, Basel.)
- Published
- 2023
- Full Text
- View/download PDF
15. Mortality and its association with chronic alcohol-related diseases in patients admitted to the emergency department for acute alcoholic intoxication: retrospective cohort study.
- Author
-
Palmese F, Bonavita ME, Pompili E, Migliano MT, Reggidori N, Di Stefano C, Grieco M, Colazzo S, Tufoni M, Baldassarre M, Caraceni P, Foschi FG, Giostra F, Farina G, Del Toro R, Bedogni G, and Domenicali M
- Subjects
- Humans, Retrospective Studies, Emergency Service, Hospital, Alcoholism complications, Alcoholism epidemiology, Alcoholic Intoxication complications, Alcoholic Intoxication epidemiology, Alcohol-Related Disorders epidemiology, Substance-Related Disorders epidemiology
- Abstract
We assessed long-term mortality and its association with chronic alcohol-related diseases in patients admitted to the emergency department (ED) because of acute alcoholic intoxication (AAI). A retrospective cohort study was performed at the ED of Sant'Orsola-Malpighi Hospital, Bologna, Italy. 3304 patients, corresponding to 6415 admissions for AAI, who accessed the ED from January 1, 2005, to December 31, 2017, were studied. The ED electronic registry system was used to assess living status on 08 May 2020 and to obtain the prespecified potential predictors, i.e., age at first admission, sex, alcohol use disorder (AUD), substance use disorder (SUD), more than 1 admission to ED for trauma, mental and behavioral disorders, neurological disorders, and cardiovascular disease. The median follow-up time was 9.3 years and the time on risk was 30,053 person years (PY) with a death rate corresponding to 4.42 (95% CI 3.74-5.26) per 1000 PY (n = 133 deaths). The death rate was higher in patients with AUD (17.30) than in those without AUD (1.98) and in those with SUD (13.58) than in those without SUD (3.80). Lastly, there was a clearly higher death rate among AUD+ SUD+ (20.89) compared to AUD-SUD-patients (1.74). At multivariable Cox regression, AUD, SUD, and liver cirrhosis were strong and independent predictors of time-to-death. Using standardized mortality ratios, a clear excess of mortality was evident for all the age bands from (40-45] to (60-65] years. Mortality is higher in AAI than in the general population and chronic alcohol-related diseases are strongly associated with it., (© 2022. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
16. Correction and Prevention of Hyponatremia in Patients With Cirrhosis and Ascites: Post Hoc Analysis of the ANSWER Study Database.
- Author
-
Zaccherini G, Baldassarre M, Tufoni M, Nardelli S, Piano S, Alessandria C, Neri S, Foschi FG, Levantesi F, Bedogni G, Domenicali M, Bernardi M, and Caraceni P
- Subjects
- Humans, Albumins administration & dosage, Ascites complications, Hyponatremia etiology, Hyponatremia prevention & control, Hyponatremia therapy, Liver Cirrhosis complications
- Abstract
Introduction: We assessed the impact of long-term albumin administration to hyponatremic patients with ascites enrolled in the ANSWER trial., Methods: The normalization rate of baseline hyponatremia and the 18-month incidence rate of at least moderate hyponatremia were evaluated., Results: The hyponatremia normalization rate was higher with albumin than with standard medical treatment (45% vs 28%, P = 0.042 at 1 month). Long-term albumin ensured a lower incidence of at least moderate hyponatremia than standard medical treatment (incidence rate ratio: 0.245 [CI 0.167-0.359], P < 0.001)., Discussion: Long-term albumin administration improves hyponatremia and reduces episodes of at least moderate hyponatremia in outpatients with cirrhosis and ascites., (Copyright © 2022 by The American College of Gastroenterology.)
- Published
- 2023
- Full Text
- View/download PDF
17. Strategies and Tools for Supporting the Appropriateness of Drug Use in Older People.
- Author
-
Lunghi C, Trevisan C, Fusaroli M, Giunchi V, Raschi E, Sangiorgi E, Domenicali M, Volpato S, De Ponti F, and Poluzzi E
- Abstract
Through this structured review of the published literature, we aimed to provide an up-to-date description of strategies (human-related) and tools (mainly from the digital field) facilitating the appropriateness of drug use in older adults. The evidence of each strategy and tool's effectiveness and sustainability largely derives from local and heterogeneous experiences, with contrasting results. As a general framework, three main steps should be considered in implementing measures to improve appropriateness: prescription, acceptance by the patient, and continuous monitoring of adherence and risk-benefit profile. Each step needs efforts from specific actors (physicians, patients, caregivers, healthcare professionals) and dedicated supporting tools. Moreover, how to support the appropriateness also strictly depends on the particular setting of care (hospital, ambulatory or primary care, nursing home, long-term care) and available economic resources. Therefore, it is urgent assigning to each approach proposed in the literature the following characteristics: level of effectiveness, strength of evidence, setting of implementation, needed resources, and issues for its sustainability.
- Published
- 2022
- Full Text
- View/download PDF
18. Lumbar spinal canal stenosis: An early sign of amyloid transthyretin related amyloidosis.
- Author
-
Graziani A, Cenni P, Lisi M, Domenicali M, and Graziani L
- Subjects
- Constriction, Pathologic, Humans, Prealbumin genetics, Spinal Canal, Amyloidosis complications, Amyloidosis diagnosis, Spinal Stenosis diagnostic imaging, Spinal Stenosis etiology
- Published
- 2022
- Full Text
- View/download PDF
19. Determination of Effective Albumin in Patients With Decompensated Cirrhosis: Clinical and Prognostic Implications.
- Author
-
Baldassarre M, Naldi M, Zaccherini G, Bartoletti M, Antognoli A, Laggetta M, Gagliardi M, Tufoni M, Domenicali M, Waterstradt K, Paterini P, Baldan A, Leoni S, Bartolini M, Viale P, Trevisani F, Bernardi M, and Caraceni P
- Subjects
- Biomarkers analysis, Biomarkers blood, Chromatography, Liquid methods, Female, Humans, Italy epidemiology, Kaplan-Meier Estimate, Male, Middle Aged, Protein Binding, Protein Degradation End Products, Protein Structural Elements, Reproducibility of Results, Severity of Illness Index, Spectrometry, Mass, Electrospray Ionization methods, Acute-On-Chronic Liver Failure blood, Acute-On-Chronic Liver Failure diagnosis, Acute-On-Chronic Liver Failure mortality, Liver Cirrhosis blood, Liver Cirrhosis etiology, Liver Cirrhosis physiopathology, Prognosis, Serum Albumin, Human analysis
- Abstract
Background and Aims: Circulating albumin in cirrhosis can be dysfunctional because of accumulating structural damages, leading to the concept of effective albumin concentration (eAlb), referring to the albumin portion presenting structural and functional integrity. We aimed to estimate eAlb in patients with decompensated cirrhosis and analyze its relationships with albumin function and clinical outcomes as compared to total albumin concentration (tAlb)., Approach and Results: We evaluated 319 patients with cirrhosis hospitalized for acute decompensation (AD) with and without acute-on-chronic liver failure (ACLF) and 18 age- and sex-comparable outpatients with compensated cirrhosis. tAlb was quantified by standard assay, whereas eAlb was estimated combining liquid chromatography/electrospray ionization/mass spectrometry and standard methods. Albumin binding and detoxification efficiency were evaluated by electron paramagnetic resonance analysis. Circulating albumin in patients with decompensated cirrhosis displayed multiple structural abnormalities, with reversible oxidation and glycation being the most frequent. As a result, eAlb progressively declined with the worsening of cirrhosis and was superior to tAlb in stratifying patients between compensated cirrhosis, AD, and ACLF, as well as patients with and without complications. Moreover, eAlb, but not tAlb, was closely associated with binding capacities in ACLF. Finally, eAlb at admission predicted the occurrence of ACLF within 30 days and mortality at 90 days better than tAlb., Conclusions: This large, observational study provides the evidence in patients with decompensated cirrhosis that eAlb can be quantified and differentiated from tAlb routinely measured in clinical practice. As compared to tAlb, eAlb is more closely associated with disease severity and albumin dysfunction and carries a greater prognostic power. These results prompt future research assessing eAlb as a biomarker for predicting prognosis and treatment response., (© 2021 The Authors. Hepatology published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.)
- Published
- 2021
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.