Search

INTRODUCTION: Liver enzyme elevation has been reported for SARS-CoV-2 disease (COVID-19) in heterogeneous cohorts, mainly from China. Comprehensive reports from other countries are needed. We dissect the pattern, evolution and predictive value of such abnormalities in a cohort from Madrid, Spain. METHODS: Retrospective study with prospective 14-day follow-up of 373 patients with confirmed COVID-19 in five Madrid hospitals, including 50 outpatients. COVID-19 severe course was defined as need of mechanical ventilation. RESULTS: A total of 33.1% hospitalised patients showed baseline AST elevation and 28.5% showed ALT elevation, contrasting with 12% and 8% of outpatients (P≤0.001). Baseline AST, ALT and GGT levels correlated with LDH and C-reactive protein levels (CRP) (r≤0.598, P

Introduction: The prevalence of portal vein thrombosis (PVT) in patients that have undergone liver transplantation (LT) is 9.7% (SD 4.5). The aim of our study was to determine the prevalence, assess the factors that are associated with PVT and clarify their association with prognosis in patients with liver cirrhosis (LC) and LT. Aims and methods: From 2005 to 2014, laboratory, radiological and surgical data were collected from patients with LC in our center who had undergone LT for the first time. Results: One hundred and ninety-one patients were included. The mean age was 55 (SD 9), 75.4% of patients were male and 48.7% had HCV. The Child-Pugh scores were A/B/C 41.9%/35.9%/25.5% and the MELD score was 15 (SD 6). Previous decompensations were: ascites (61.4%), hepatic encephalopathy (34.4%), variceal bleeding (25.4%), hepatocellular carcinoma (48.9%) and spontaneous bacterial peritonitis (SPB) (14.3%). The mean post-transplant follow-up was 42 months (0-113). PVT was diagnosed at LT in 18 patients (9.4%). Six patients were previously diagnosed using imaging tests (33.3%): 2 patients (11.1%) by DU and 4 patients (22.2%) by CT scan. All patients with PVT had DU in a mean time of 6 months before LT (0-44) and 90 patients (47.1%) had a CT scan in a median time of 6 months before LT (0-45). PVT was significantly related to the presence of SBP (33.3% vs 12.6%; p = 0.02) and lower levels of albumin (3.1g/dl vs 3.4g/ dl; p = 0.05). MELD was higher in patients with PVT (16.6 vs 14.9; p = 0.3). There were no significant differences with regard to the need for transfusion of blood components. Moreover, the surgery time was similar in both groups. PVT correlated with a higher mortality in the first 30 days (8.8% vs 16.7%; p = 0.2). Conclusion: Prior history of SBP and lower levels of albumin were identified as factors associated with PVT. The pre-transplant diagnosis rate is very low and the presence of PVT may have implications for short-term mortality

espanolIntroduccion: entre los efectos adversos hepaticos secundarios al tratamiento tiopurinico en pacientes con enfermedad inflamatoria intestinal (EII), se ha descrito la posibilidad de desarrollar hipertension portal idiopatica. Esta patologia de etiologia y prevalencia real inciertas puede comprometer el pronostico de estos pacientes, por lo que se debe tener un alto grado de sospecha para su diagnostico precoz. Material y metodos: se ha llevado a cabo un estudio transversal en una cohorte de pacientes con EII en seguimiento en nuestra unidad para determinar la prevalencia del diagnostico de HTP idiopatica (HTPI) y su relacion con el tratamiento tiopurinico. Resultados: en nuestro centro, en el momento del analisis habia 1.419 pacientes en seguimiento por enfermedad inflamatoria intestinal. De estos, 927 pacientes se encuentran bajo tratamiento con farmacos tiopurinicos (o lo han estado durante la evolucion de su enfermedad), lo que supone el 65,3% de la poblacion: 689 pacientes con azatioprina (74,3%) y 238 con 6-mercaptopurina (25,7%). En total, se identificaron 4 pacientes con EII tipo enfermedad de Crohn con hipertension portal idiopatica en probable relacion con el tratamiento tiopurinico, lo que supuso un 4,3% del total, es decir, una incidencia de 4,3 casos por cada 1.000 pacientes con EII tratados con tiopurinicos. Las caracteristicas basales de los pacientes se describen en la tabla I. El 75% de los pacientes debuto con signos o sintomas de hipertension portal: 1 paciente con encefalopatia hepatica y 2 pacientes con hemorragia digestiva por varices esofagicas. Solo un paciente se encontraba asintomatico, pero se sospecho el diagnostico de HTP por trombopenia aislada. No obstante, cabe destacar que todos los pacientes presentaban trombopenia previamente aunque no se habia sospechado el diagnostico de HTP a pesar de un exhaustivo estudio. A todos los se realizo ecografia abdominal con fibroscan, cateterismo de venas suprahepaticas, asi como biopsia hepatica como parte del estudio etiologico de hipertension portal. En la ecografia abdominal se objetivaron datos indirectos de HTP en todos los pacientes (como esplenomegalia), descartandose asimismo cirrosis hepatica. El fibroscan mostraba datos de fibrosis hepatica significativa (F2-F3). Ademas, a todos los pacientes se les realizo una angiorresonancia en la que se descarto trombosis del eje esplenoportal como causa de HTP. Por ultimo, la anatomia patologica de la biopsia hepatica descarto la presencia de cirrosis hepatica, apoyando el diagnostico de HTP idiopatica (Tabla II). Conclusiones: la hipertension portal idiopatica secundaria a tratamiento tiopurinico en pacientes con enfermedad inflamatoria intestinal es un fenomeno poco frecuente, pero ha de ser tenido en cuenta en el diagnostico diferencial para un diagnostico precoz, principalmente en pacientes con tratamiento tiopurinico de larga evolucion. La presencia de trombopenia es a menudo el unico factor predictor de su desarrollo en fases preclinicas. EnglishIntroduction: The possibility of developing idiopathic portal hypertension has been described with thiopurine treatment despite compromises the prognosis of these patients, the fact its true prevalence is unknown. Material and methods: A cross-sectional study was conducted in a cohort of inflammatory bowel disease (IBD) patients followed at our unit, to determine the prevalence of diagnosis of idiopathic portal hypertension (IPH) and its relationship with thiopurine treatment. Results: At the time of the analysis, 927/1,419 patients were under treatment with thiopurine drugs (65%). A total of 4 patients with IBD type Crohn’s disease with idiopathic portal hypertension probably related to the thiopurine treatment were identified (incidence of 4.3 cases per 1,000). Seventy-five percent of patients started with signs or symptoms of portal hypertension. Only one patient was asymptomatic but the diagnosis of IPH because of isolated thrombocytopenia is suspected. However, note that all patients had thrombocytopenia previously. Abdominal ultrasound with fibroscan, hepatic vein catheterization and liver biopsy were performed on all of them as part of the etiology of portal hypertension. In the abdominal ultrasound, indirect portal hypertension data were observed in all patients (as splenomegaly) cirrhosis was also ruled out. The fibroscan data showed significant liver fibrosis (F2-F3). Conclusion: Idiopathic portal hypertension following thiopurine treatment in IBD patients is a rare occurrence, but it must be borne in mind in the differential diagnosis for early diagnosis, especially in patients undergoing thiopurine treatment over a long period. The presence of thrombocytopenia is often the only predictor of its development in the preclinical stage.