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1. Prevalence and influence of diabetes mellitus on clinical outcomes in patients hospitalized for acutely decompensated cirrhosis.

Author

Bonomo, M., Calleri, A., Tizzani, M., Lisi, C., Pecorella, G., Robone, M.L., Botta, M., Frigo, F., Campion, D., Ottobrelli, A., Marzano, A., Bugianesi, E., Saracco, G.M., and Alessandria, C.

Abstract

Diabetes mellitus (DM) is common in patients with chronic liver disease and significantly increases the risk of liver-related complications. However, its impact on decompensated hospitalized patients remains poorly addressed. Patients with cirrhosis hospitalized for acute decompensation (AD) between July 2022 and October 2024 were prospectively evaluated and followed-up until liver transplantation (LT) or death. 304 patients were included. One-third had DM (101/304, 33%). Compared to non-DM patients, DM patients were older (66 vs 57 years, p<0.001) and with higher rates of arterial hypertension (45% vs 26%, p=0.002); the prevalence of chronic kidney disease was similar (24% vs 19%, p=0.36). The predominant etiology was metabolic dysfunction-associated steatotic liver disease (MASLD) in DM patients (30% vs. 8%, p<0.001) and alcohol-related liver disease in non-DM patients (26% vs 54%, p<0.001). The most common reason for hospitalization in each group was ascites (63% and 58%, respectively). Both groups had a median MELD-Na score of 20. Acute kidney injury (AKI) occurred in 36% in both groups during index hospitalization (p=0.89). AKI stage≥2 was more frequent in DM patients, although not significantly (47% vs 30%, p=0.09). Among patients discharged from the index hospitalization (278), 33/93 (35%) of DM patients and 71/185 (38%) of non-DM patients experienced further hospitalizations (p=0.69). The 3-month cumulative probability of rehospitalization was similar (25% vs 29%, log-rank p=0.84). After a median follow-up of 5.7 (IQR 1.7-13.2) months, a comparable number of patients with- and without DM died (27% vs 26%, p=0.89) or underwent LT (27% vs 30%, p=0.69). The 6-month LT-free survival was 78.8% and 79.1%, respectively (log-rank p=0.99). Diabetes mellitus is frequently observed in patients with cirrhosis hospitalized for AD, particularly among older individuals and those with MASLD. It does not appear to significantly impact short- or medium-term outcomes, as evidenced by similar AKI rates, rehospitalization risk and 6-month LT-free survival. [ABSTRACT FROM AUTHOR]

Published
2025
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2. Prognostic implications of minimal serum creatinine fluctuations in acutely decompensated cirrhosis.

Author

Botta, M., Tizzani, M., Calleri, A., Lisi, C., Pecorella, G., Robone, M.L., Bonomo, M., Bertoldi, E., Frigo, F., Campion, D., Ottobrelli, A., Marzano, A., Bugianesi, E., Saracco, G.M., and Alessandria, C.

Abstract

Renal dysfunction is common in cirrhosis, affecting prognosis. If subtle increases in serum creatinine (sCr) significantly impact on outcomes in patients hospitalized for acute decompensation (AD) remains unclear. Patients with cirrhosis hospitalized for AD from July 2022 to October 2024 were prospectively evaluated. Stable renal function (SRF) was defined as sCr level at or below patients baseline value defined as per International Club of Ascites (ICA); minimal renal dysfunction (MRD) was defined as any sCr level exceeding the baseline without fulfilling acute kidney injury (AKI) or acute kidney disease criteria as per ICA definitions. Follow-up ended at liver transplantation (LT) or death. 304 patients were enrolled. Median age was 60 years. The most frequent cause of hospitalization was ascites (60%). Alcohol-related liver disease was the most prevalent etiology (45%). Patients were classified as follows: 13% SRF, 39% MRD, 28% AKI, 12% chronic kidney disease (CKD) and 8% acute-on-chronic kidney disease. Median follow-up was 5.7 months (1.7-13.2). Overall, 87 (29%) patients underwent LT and 69 (23%) died. Among the 105 patients with follow-up ≥ 3 months, 14 (13%) developed new-onset CKD. The incidence was 0/31 for SRF, 7/47 (15%) for MRD and 7/27 (26%) for AKI (MRD vs SRF, p=0.038; MRD vs AKI, p=0.36). 104/278 (37%) patients discharged from index hospitalization were re-hospitalized. The 3-month cumulative incidence of rehospitalization was comparable across groups (42%, 32%, and 39%; log-rank p=0.73). The 6- and 12-month LT-free survival were respectively 97% and 94% in SRF, 88% and 78% in MRD, 64% and 52% in AKI (MRD vs SRF, p=0.028; MRD vs AKI, p<0.001). MRD is very common among patients hospitalized for decompensated cirrhosis. Our preliminary results suggest that MRD may be clinically meaningful as it entails intermediate prognosis between SRF and AKI. These patients may then need careful monitoring to prevent negative outcomes. [ABSTRACT FROM AUTHOR]

Published
2025
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3. Real-world practice patterns on the use of terlipressin in patients with cirrhosis and acute kidney injury - results from the ICA-GLOBAL AKI study.

Author

Incicco, S., MA, A.T., Juanola, A., Patidar, K., Barone, A., Kulkarni, A., Pérez-Hernández, J.L., Wentworth, B., Asrani, S., Alessandria, C., Abdelkader, N. Abdelaaty, Wong, Y.J., Xie, Q., Pyrsopoulos, N.T., Kim, S.E., Fouad, Y., Torre, A., Reyes, E. Cerda, Diaz-Ferrer, J., and Maiwall, R.

Abstract

Terlipressin is indicated for the treatment of HRS-AKI. However, real-world practice patterns on the use of terlipressin in AKI in general as well as outcomes in non HRS-AKI remain largely unknown. International prospective study including patients hospitalized for decompensated cirrhosis from July 2022 to May 2023. This was a subgroup analysis of patients who received terlipressin for AKI treatment. Primary outcome was absence of AKI resolution (return of serum creatinine to a value within 0.3 mg/dl of the baseline). Secondary outcomes were incidence of respiratory failure, and 28-day mortality. Among 1,456 patients with cirrhosis and AKI, 243 (17%) received terlipressin for AKI treatment. Terlipressin was predominantly administered in continuous infusion (75%) at a median maximum daily dose of 3 mg [IQR=2-4] and median duration of 5 days [IQR=3-8]. The AKI phenotype was HRS-AKI in 50%, ATN in 17%, hypovolemia-induced in 25%. Complete AKI resolution occurred in 49% of patients. Lack of AKI resolution was highest in ATN (71%), followed by HRS-AKI (49%). On multivariable analysis ATN was independently associated with lack of AKI resolution (OR 2.77; p=0.016) compared to HRS-AKI, along with AKI stage 3 and ACLF stages 2-3. De novo respiratory failure occurred in 20% of patients treated with terlipressin. No significant differences were found in albumin and terlipressin doses in patients who did and did not developed respiratory failure. Pneumonia (OR=8.29; p<0.001) and lack of volume loss/hypovolemia before AKI (OR=2.70; p=0.029) were independent predictors of respiratory failure. On multivariable analysis, age, ATN, hospital-acquired AKI and MELD score were independent predictors of 28-day mortality. Terlipressin is often used for treatment of AKI outside its primary indication of HRS-AKI. Since AKI response and clinical outcomes are very poor in ATN, terlipressin should be used with caution in this setting as its risks may outweigh benefits. [ABSTRACT FROM AUTHOR]

Published
2025
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7. Orchestration of Tryptophan-Kynurenine Pathway, Acute Decompensation, and Acute-on-Chronic Liver Failure in Cirrhosis

Author

Claria, J., Moreau, R., Fenaille, F., Amoros, A., Junot, C., Gronbaek, H., Coenraad, M.J., Pruvost, A., Ghettas, A., Chu-Van, E., Lopez-Vicario, C., Oettl, K., Caraceni, P., Alessandria, C., Trebicka, J., Pavesi, M., Deulofeu, C., Albillos, A., Gustot, T., Welzel, T.M., Fernandez, J., Stauber, R.E., Saliba, F., Butin, N., Colsch, B., Moreno, C., Durand, F., Nevens, F., Banares, R., Benten, D., Gines, P., Gerbes, A., Jalan, R., Angeli, P., Bernardi, M., Arroyo, V., EASL Clif Consortium, Grifols Chair European Fdn Study C, Clària, Joan, Moreau, Richard, Fenaille, Françoi, Amorós, Alex, Junot, Christophe, Gronbaek, Henning, Coenraad, Minneke J, Pruvost, Alain, Ghettas, Aurélie, Chu-Van, Emeline, López-Vicario, Cristina, Oettl, Karl, Caraceni, Paolo, Alessandria, Carlo, Trebicka, Jonel, Pavesi, Marco, Deulofeu, Carme, Albillos, Agustin, Gustot, Thierry, Welzel, Tania M, Fernández, Javier, Stauber, Rudolf E, Saliba, Faouzi, Butin, Noémie, Colsch, Benoit, Moreno, Christophe, Durand, Françoi, Nevens, Frederik, Bañares, Rafael, Benten, Daniel, Ginès, Pere, Gerbes, Alexander, Jalan, Rajiv, Angeli, Paolo, Bernardi, Mauro, Arroyo, Vicente, Grifols Chair, Partenaires INRAE, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Université Paris Diderot - Paris 7 (UPD7), Service de Pharmacologie et d'Immunoanalyse (SPI), Institut National de la Recherche Agronomique (INRA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Université Paris Saclay (COmUE), Aarhus University Hospital, Department of Gastroenterology and Hepatology, Leiden University Medical Center (LUMC), Institut National de la Recherche Agronomique (INRA), Medical University Graz, Department of Medical and Surgical Sciences, Universita degli Studi di Padova, San Giovanni Battista Hosp, Div Gastroenterol & Hepatol, Turin, Italy, Rheinische Friedrich-Wilhelms-Universität Bonn, Hospital Universitario, Université libre de Bruxelles (ULB), Goethe-Universität Frankfurt am Main, Hôpital Paul Brousse, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse, Université Catholique de Louvain = Catholic University of Louvain (UCL), Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Univ Hosp LMU Munich, Liver Ctr Munich, Dept Med 2, Munich, Germany, University College of London [London] (UCL), Universita di Padova, ICREA Academia Award, Service de Pharmacologie et Immunoanalyse (SPI), Médicaments et Technologies pour la Santé (MTS), Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Universiteit Leiden-Universiteit Leiden, and Università degli Studi di Padova = University of Padua (Unipd)

Subjects
Liver Cirrhosis, Male, 0301 basic medicine, Cirrhosis, Kynurenine pathway, [SDV]Life Sciences [q-bio], medicine.medical_treatment, severity, Decompensated cirrhosis, Systemic inflammation, Gastroenterology, Tryptophan -- blood, chemistry.chemical_compound, 0302 clinical medicine, hepatic-encephalopathy, Prospective Studies, Renal Insufficiency, Indoleamine 2,3-dioxygenase, Hepatic encephalopathy, Kynurenine, Liver Cirrhosis -- blood -- complications -- mortality -- physiopathology, systemic inflammation, Europe -- epidemiology, Kynurenine -- blood, Hepatic Encephalopathy -- blood -- complications, Tryptophan, Bacterial Infections -- blood -- complications, Immunosuppression, Bacterial Infections, Sciences bio-médicales et agricoles, Middle Aged, Acute-On-Chronic Liver Failure -- blood -- etiology, metabolomics, 3. Good health, Europe, chromatography, Female, 030211 gastroenterology & hepatology, medicine.symptom, metabolomic, medicine.medical_specialty, indoleamine 2,3-dioxygenase, Decompensated cirrhosi, 03 medical and health sciences, Internal medicine, medicine, Humans, organ failure, Decompensation, plasma, Aged, Inflammation, Inflammation -- blood -- complications, Renal Insufficiency -- blood -- complications, Hepatology, business.industry, Acute-On-Chronic Liver Failure, blockade, medicine.disease, mortality, kynurenine, 030104 developmental biology, chemistry, Case-Control Studies, Hepatic Encephalopathy, business, metabolism
Abstract

Systemic inflammation (SI) is involved in the pathogenesis of acute decompensation (AD) and acute-on-chronic liver failure (ACLF) in cirrhosis. In other diseases, SI activates tryptophan (Trp) degradation through the kynurenine pathway (KP), giving rise to metabolites that contribute to multiorgan/system damage and immunosuppression. In the current study, we aimed to characterize the KP in patients with cirrhosis, in whom this pathway is poorly known. The serum levels of Trp, key KP metabolites (kynurenine and kynurenic and quinolinic acids), and cytokines (SI markers) were measured at enrollment in 40 healthy subjects, 39 patients with compensated cirrhosis, 342 with AD (no ACLF) and 180 with ACLF, and repeated in 258 patients during the 28-day follow-up. Urine KP metabolites were measured in 50 patients with ACLF. Serum KP activity was normal in compensated cirrhosis, increased in AD and further increased in ACLF, in parallel with SI; it was remarkably higher in ACLF with kidney failure than in ACLF without kidney failure in the absence of differences in urine KP activity and fractional excretion of KP metabolites. The short-term course of AD and ACLF (worsening, improvement, stable) correlated closely with follow-up changes in serum KP activity. Among patients with AD at enrollment, those with the highest baseline KP activity developed ACLF during follow-up. Among patients who had ACLF at enrollment, those with immune suppression and the highest KP activity, both at baseline, developed nosocomial infections during follow-up. Finally, higher baseline KP activity independently predicted mortality in patients with AD and ACLF. Conclusion: Features of KP activation appear in patients with AD, culminate in patients with ACLF, and may be involved in the pathogenesis of ACLF, clinical course, and mortality., info:eu-repo/semantics/published

Published
2019
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8. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure

Author

Jalan R, Saliba F, Pavesi M, Amoros A, Moreau R, Ginès P, Levesque E, Durand F, Angeli P, Hopf C, Alessandria C, Rodriguez E, Solis Muñoz P, Laleman W, Trebicka J, Zeuzem S. Albillos A, Gustot T, Mookerjee R, Elkrief L, Benten D, Montero JL, Catalina MV, Concepción M, Cordoba J, McCormick A, Stauber R, Vogel W, De Gottardi A, Peck Radosavljevic M, Van Vlierberghe H, Sperl J, Groenbaek H, Mortensen C, Coenraad MJ, Morando F, Gerbes AL, Risso A, Garcia E, Deulofeu C, Samuel D, Arroyo V., ZACCHERINI, GIACOMO, CARACENI, PAOLO, BERNARDI, MAURO, Jalan R, Saliba F, Pavesi M, Amoros A, Moreau R, Ginès P, Levesque E, Durand F, Angeli P, Caraceni P, Hopf C, Alessandria C, Rodriguez E, Solis-Muñoz P, Laleman W, Trebicka J, Zeuzem S. Albillos A, Gustot T, Mookerjee R, Elkrief L, Benten D, Montero JL, Catalina MV, Concepción M, Cordoba J, McCormick A, Stauber R, Vogel W, De Gottardi A, Peck-Radosavljevic M, Van Vlierberghe H, Sperl J, Groenbaek H, Mortensen C, Coenraad MJ, Morando F, Gerbes AL, Risso A, Garcia E, Deulofeu C, Samuel D, Bernardi M, and Arroyo V.

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Cirrhosis, Time Factors, Databases, Factual, Multi-organ failure, Severity of Illness Index, Cohort Studies, Databases, Internal medicine, Intensive care, Sepsis, Severity of illness, medicine, Risk of mortality, Humans, Decompensation, Intensive care medicine, Hepatic encephalopathy, Factual, Aged, Hepatology, business.industry, Acute-on chronic liver failure, Acute-On-Chronic Liver Failure, Middle Aged, medicine.disease, Prognosis, body regions, Europe, Acute-on-chronic liver failure, Cohort, Female, business, Cohort study
Abstract

Background & Aims: Acute-on-chronic liver failure (ACLF) is a frequent syndrome (30% prevalence), characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality. This study develops and validates a specific prognostic score for ACLF patients. Methods: Data from 1349 patients included in the CANONIC study were used. First, a simplified organ function scoring system (CLIF Consortium Organ Failure score, CLIF-C OFs) was developed to diagnose ACLF using data from all patients. Subsequently, in 275 patients with ACLF, CLIP-C OFs and two other independent predictors of mortality (age and white blood cell count) were combined to develop a specific prognostic score for ACLF (CLIF Consortium ACLF score [CLIF-C ACLFs]). A concordance index (C-index) was used to compare the discrimination abilities of CLIF-C ACLF, MELD, MELD-sodium (MELD-Na), and Child-Pugh (CPs) scores. The CLIF-C ACLFs was validated in an external cohort and assessed for sequential use. Results: The CLIF-C ACLFs showed a significantly higher predictive accuracy than MELDs, MELD-Nas, and CPs, reducing (19-28%) the corresponding prediction error rates at all main time points after ACLF diagnosis (28, 90, 180, and 365 days) in both the CANONIC and the external validation cohort. CLIF-C ACLFs computed at 48 h, 3-7 days, and 8-15 days after ACLF diagnosis predicted the 28-day mortality significantly better than at diagnosis. Conclusions: The CLIF-C ACLFs at ACLF diagnosis is superior to the MELDs and MELD-Nas in predicting mortality. The CLIP-C ACLFs is a clinically relevant, validated scoring system that can be used sequentially to stratify the risk of mortality in ACLF patients. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Published
2014

13. Long-term albumin administration in patients with cirrhosis and uncomplicated ascites: the use of serum albumin concentration for personalizing treatment.

Author

Zaccherini, G., Riggio, O., Angeli, P., Alessandria, C., Neri, S., Foschi, F.G., Levantesi, F., Airoldi, A., Simone, L., Svegliati-Baroni, G., Fagiuoli, S., Romanelli, R.G., Cozzolongo, R., Di Marco, V., Sangiovanni, V., Morisco, F., Toniutto, P., Tortora, A., De Marco, R., and Nardelli, S.

Published
2019
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24. Clinical features and evolution of bacterial infection-related acute-on-chronic liver failure

Author

Carlo Alessandria, Carmine Gambino, Javier Fernández, Hans Van Vlierberghe, Sophie Restellini, Marcos Girala, Luis Colombato, Tae Hee Lee, Nikolaos Pyrsopoulos, Eduardo Fassio, Sang Gyune Kim, Gisela Pinero, Paolo Caraceni, Shivaram Prasad Singh, Do Seon Song, Ji Won Park, Julio Vorobioff, Dong Joon Kim, C. Toledo, Aleksander Krag, Liane Rabinowich, Preetam Nath, Robert A. de Man, Elza Cotrim Soares, Xavier Verhelst, Tiago Sevá Pereira, Gustavo Romero, Macarena Simón-Talero, Sung Eun Kim, Michele Bartoletti, Alexander L. Gerbes, Sebastián Marciano, Tony Bruns, Hyoung Su Kim, Ki Tae Suk, Nicolas M. Intagliata, Annette Dam Fialla, Adrià Juanola, Manuela Merli, Rita de Cassia Ribeiro Barea, Laure Elkrief, Rakhi Maiwall, Laurentius A Lesmana, Pere Ginès, Vikas Gautam, E.L. Yoon, M. Marino, Paolo Angeli, Kalyan Ram Bhamidimarri, Victor Vargas, Virendra Singh, Juan Pablo Roblero, François Durand, Cosmas A. Rinaldi Lesmana, M. V. Maevskaya, Gustavo Navarro, Adrian Gadano, Florence Wong, Pramod Kumar, Tae Hun Kim, Daniela Campion, Salvatore Piano, Giacomo Zaccherini, Barbara Lattanz, Jae Seok Hwang, Sun Young Yim, Thomas D. Boyer, Jeong Han Kim, Carlos Brodersen, Wong F., Piano S., Singh V., Bartoletti M., Maiwall R., Alessandria C., Fernandez J., Soares E.C., Kim D.J., Kim S.E., Marino M., Vorobioff J., Barea R.D.C.R., Merli M., Elkrief L., Vargas V., Krag A., Singh S.P., Lesmana L.A., Toledo C., Marciano S., Verhelst X., Intagliata N., Rabinowich L., Colombato L., Kim S.G., Gerbes A., Durand F., Roblero J.P., Bruns T., Yoon E.L., Girala M., Pyrsopoulos N.T., Kim T.H., Yim S.Y., Juanola A., Gadano A., Angeli P., Bhamidimarri K., Boyer T.D., Brodersen C., Campion D., Caraceni P., de Man R.A., Fassio E., Fialla A.D., Gambino C., Gautam V., Gines P., Hwang J.S., Kim H.S., Kim J.H., Kumar P., Lattanz B., Lee T.H., Rinaldi Lesmana C.A., Maevskaya M., Nath P., Navarro G., Park J.-W., Pinero G., Restellini S., Romero G., Seva -Pereira T., Simon-Talero M., Song D.S., Suk K.T., Van Vlierberghe H., and Zaccherini G.

Subjects
Male, 0301 basic medicine, Cirrhosis, Organ Dysfunction Scores, Antibiotic resistance, medicine.medical_treatment, Liver transplantation, Severity of Illness Index, 0302 clinical medicine, ACLF, MDR, Epidemiology, Cross Infection, Mortality rate, Age Factors, Bacterial Infections, Middle Aged, Prognosis, Community-Acquired Infections, Europe, Hospitalization, Female, 030211 gastroenterology & hepatology, Alcohol-Related Disorders, medicine.medical_specialty, Sepsi, India, Risk Assessment, Sepsis, 03 medical and health sciences, Sex Factors, Spontaneous bacterial peritonitis, Internal medicine, medicine, Humans, XDR, Cirrhosi, Hepatology, business.industry, Acute-On-Chronic Liver Failure, medicine.disease, Pneumonia, 030104 developmental biology, antibiotic resistance, liver transplantation, sepsis, business
Abstract

Background & Aims: Bacterial infections can trigger the development of organ failure(s) and acute-on-chronic liver failure (ACLF). Geographic variations in bacteriology and clinical practice could lead to worldwide differences in ACLF epidemiology, phenotypes and associated outcomes. Herein, we aimed to evaluate regional differences in bacterial infection-related ACLF in patients with cirrhosis admitted to hospital. Methods: This post hoc analysis included 1,175 patients with decompensated cirrhosis (with bacterial infection on admission or nosocomial infection) from 6 geographic regions worldwide. Clinical, laboratory and microbiological data were collected from the diagnosis of infection. Patients were followed-up for organ failure(s) and ACLF development according to the EASL-CLIF criteria from enrolment to discharge/death. Results: A total of 333 patients (28%) had ACLF at diagnosis of infection, while 230 patients developed ACLF after diagnosis of infection, resulting in an overall rate of bacterial infection related-ACLF of 48%, with rates differing amongst different geographic regions (38% in Southern Europe vs. 75% in the Indian subcontinent). Bacterial infection related-ACLF more frequently developed in younger patients (55 ± 13 vs. 58 ± 14 years), males (73% vs. 62%), patients with alcohol-related cirrhosis (59% vs. 45%) and those with a higher baseline MELD score (25 ± 11 vs. 16 ± 5) (all p

Published
2021
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25. Nursing Care of Patients With Cirrhosis: The LiverHope Nursing Project

Author

Fabrellas, Núria, Carol, Marta, Palacio, Ester, Aban, Marites, Lanzillotti, Tommaso, Nicolao, Gea, Chiappa, Maria Teresa, Esnault, Vanessa, Graf‐Dirmeier, Sabine, Helder, Jeltje, Gossard, Andrea, Lopez, Mireia, Cervera, Marta, Dols, Lacey L., Solà, Elsa, Pose, Elisa, Caraceni, Paolo, Vargas, Victor, Alessandria, Carlo, Beuers, Ulrich, Trebicka, Jonel, Durand, François, Mookerjee, Rajeshwar, Angeli, Paolo, Korenjak, Marko, Abraldes, Juan G, Watson, Hugh, Kamath, Patrick S, Ginès, Pere, Fabrellas N., Carol M., Palacio E., Aban M., Lanzillotti T., Nicolao G., Chiappa M.T., Esnault V., Graf-Dirmeier S., Helder J., Gossard A., Lopez M., Cervera M., Dols L.L., Sola E., Pose E., Caraceni P., Vargas V., Alessandria C., Beuers U., Trebicka J., Durand F., Mookerjee R., Angeli P., Korenjak M., Abraldes J.G., Watson H., Kamath P.S., and Gines P.

Subjects
0301 basic medicine, Liver Cirrhosis, medicine.medical_specialty, Cirrhosis, Cirrosi hepàtica, Liver Cirrhosi, MEDLINE, Reviews, Context (language use), Disease, Review, Bacterial Infection, Nurse's Role, 03 medical and health sciences, Nursing care, 0302 clinical medicine, Quality of life (healthcare), Patient Education as Topic, Multidisciplinary approach, Mortalitat, Medicine, Humans, Edema, Mortality, Intensive care medicine, Liver diseases, Patient Care Team, Hepatology, business.industry, Malalties del fetge, Ascites, Bacterial Infections, Acute Kidney Injury, medicine.disease, Primary care, 3. Good health, 030104 developmental biology, Atenció primària, Hepatic cirrhosis, Hepatic Encephalopathy, Ascite, Quality of Life, 030211 gastroenterology & hepatology, business, Gastrointestinal Hemorrhage, Patient education, Human
Abstract

Cirrhosis is a complex disease that is associated with disturbances in different organs besides the liver, including kidneys, heart, arterial circulation, lungs, gut, and brain. As a consequence, patients develop a number of complications that result in frequent hospital admissions and high morbidity and mortality. Patients with cirrhosis require constant and rigorous monitoring both in and outside the hospital. In this context, the role of nurses in the care of patients with cirrhosis has not been sufficiently emphasized and there is very limited information about nursing care of patients with cirrhosis compared with other chronic diseases. The current article provides a review of nursing care for the different complications of patients with cirrhosis. Nurses with specific knowledge on liver diseases should be incorporated into multidisciplinary teams managing patients with cirrhosis, both inpatient and outpatient. Conclusion: Nurses play an important role in the management and prevention of complications of the disease and improvement in patients' quality of life and bridge the gap between clinicians and families, between primary care and hospital care, and provide medical education to patients and caregivers.

Published
2020

26. Radioisotope guided surgery with imaging probe, a hand-held high-resolution gamma camera

Author

Soluri, A., Trotta, C., Scopinaro, F., Tofani, A., D’Alessandria, C., Pasta, V., Stella, S., and Massari, R.

Subjects
*CANCER patients, *TUMORS, *ENGINEERING instruments, *IONIZING radiation
Abstract

Abstract: Since 1997, our group of Physics together with Nuclear Physicians studies imaging probes (IP), hand-held, high-resolution gamma cameras for radio-guided surgery (RGS). Present work is aimed to verify the usefulness of two updated IP in different surgical operations. Forty patients scheduled for breast cancer sentinel node (SN) biopsy, five patients with nodal recurrence of thyroid cancer, seven patients with parathyroid adenomas, five patients with neuroendocrine tumours (NET), were operated under the guide of IP. We used two different IP with field of view of 1 and 4in.2, respectively and intrinsic spatial resolution of about 2mm. Radioisotopes were 99mTc, 123I and 111In. The 1in.2 IP detected SN in all the 40 patients and more than one node in 24, whereas anger camera (AC) failed locating SN in four patients and detected true positive second nodes in only nine patients. The 4in.2 IP was used for RGS of thyroid, parathyroid and NETs. It detected eight latero-cervical nodes. In the same patients, AC detected five invaded nodes. Parathyroid adenomas detected by IP were 10 in 7 patients, NET five in five patients. One and 4in.2 IPs showed usefulness in all operations. Initial studies on SN biopsy were carried out on small series of patients to validate IP and to demonstrate the effectiveness and usefulness of IP alone or against conventional probes. We propose the use of the IP as control method for legal documentation and surgeon strategy guide before and after lesion(s) removal. [Copyright &y& Elsevier]

Published
2007
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27. MELD score and clinical type predict prognosis in hepatorenal syndrome: Relevance to liver transplantation

Author

C. Alessandria, Pere Ginès, Mónica Guevara, T. Restuccia, Juan Rodés, Wladimiro Jiménez, Vicente Arroyo, O. Ozdogan, and Alessandria C., Ozdogan O. C., Guevara M., Restuccia T., Jimenez W., Arroyo V., Rodes J., Gines P.

Subjects
Internal Diseases, Male, Cirrhosis, medicine.medical_treatment, Liver transplantation, Sağlık Bilimleri, Severity of Illness Index, Gastroenterology, İç Hastalıkları, Clinical Medicine (MED), Liver disease, Hepatorenal syndrome, Health Status Indicators, Klinik Tıp (MED), Prospective Studies, Prospective cohort study, Klinik Tıp, Middle Aged, Prognosis, GASTROENTEROLOJİ VE HEPATOLOJİ, Tıp, Hepatoloji, Predictive value of tests, Medicine, Female, medicine.medical_specialty, Hepatorenal Syndrome, Gastroenterology and Hepatology, Decision Support Techniques, Gastroenteroloji-(Hepatoloji), Predictive Value of Tests, Internal medicine, Health Sciences, medicine, Humans, Survival analysis, Internal Medicine Sciences, Hepatology, business.industry, GASTROENTEROLOGY & HEPATOLOGY, Dahili Tıp Bilimleri, CLINICAL MEDICINE, medicine.disease, Survival Analysis, Liver Transplantation, Surgery, Gastroenteroloji, business, Kidney disease
Abstract

Important progress has been made recently regarding the pathogenesis and treatment of hepatorenal syndrome (HRS). However, scant information exists about factors predicting outcome in patients with cirrhosis and HRS. Moreover, the prognostic value of the model of end-stage liver disease (MELD) score has not been validated in the setting of HRS. The current study was designed to assess the prognostic factors and outcome of patients with cirrhosis and HRS. The study included 105 consecutive patients with HRS. Forty-one patients had type 1 HRS, while 64 patients had type 2 HRS. Patients with type 1 HRS not only had more severe liver and renal failure than type 2 patients, they also had greater impairment of circulatory function, as indicated by lower arterial pressure and higher activation of vasoconstrictor factors. In the whole series, the median survival was 3.3 months. In a multivariate analysis of survival, only HRS type and MELD score were associated with an independent prognostic value. All patients with type 1 HRS had a high MELD score (> or =20) and showed an extremely poor outcome (median survival: 1 mo). By contrast, the survival of patients with type 2 HRS was longer and dependent on MELD score (> or =20, median survival 3 mo

Published
2005
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28. Effects of treatment of hepatorenal syndrome before transplantation on posttransplantation outcome. A case-control study

Author

Pere Ginès, Antoni Rimola, Juan Rodés, O. Ozdogan, Miquel Navasa, Juan Carlos García-Valdecasas, Rolando Ortega, Vicente Arroyo, Mónica Guevara, C. Alessandria, T. Restuccia, and Restuccia T., Ortega R., Guevara M., Gines P., Alessandria C., Ozdogan O. C., Navasa M., Rimola A., Garcia-Valdecasas J., Arroyo V., et al.

Subjects
Male, Internal Diseases, medicine.medical_treatment, Lypressin, Ornipressin, Liver transplantation, Kidney, Sağlık Bilimleri, THERAPY, Gastroenterology, İç Hastalıkları, Clinical Medicine (MED), law.invention, Postoperative Complications, Hepatorenal syndrome, law, Vasoconstrictor Agents, Klinik Tıp (MED), Postoperative Period, hepatorenal syndrome, CIRRHOSIS, Klinik Tıp, liver transplantation, Immunosuppression, Middle Aged, Prognosis, LIVER-TRANSPLANTATION, Intensive care unit, GASTROENTEROLOJİ VE HEPATOLOJİ, Tıp, Hepatoloji, PROGNOSTIC VALUE, posttransplantation, Treatment Outcome, TERLIPRESSIN, SURVIVAL, Medicine, Female, medicine.drug, medicine.medical_specialty, Vasopressins, Renal function, Gastroenterology and Hepatology, ALBUMIN, Gastroenteroloji-(Hepatoloji), Internal medicine, Health Sciences, medicine, Humans, TYPE-1, Survival analysis, Internal Medicine Sciences, Hepatology, business.industry, GASTROENTEROLOGY & HEPATOLOGY, Dahili Tıp Bilimleri, PRETRANSPLANT RENAL-FUNCTION, CLINICAL MEDICINE, medicine.disease, Survival Analysis, Surgery, Gastroenteroloji, MODEL, Transplantation, Case-Control Studies, Terlipressin, business, Liver Failure
Abstract

Background : Pretransplant renal function is the major determinant of survival after liver transplantation (LTx). Patients with hepatorenal syndrome (HRS) have a poor outcome after LTx compared with patients transplanted without HRS. Aim : To analyze the impact of treatment of HRS before LTx on outcome after transplantation. Methods : The outcome of patients with HRS ( n =9) treated with vasopressin analogues before LTx was compared with that of a contemporary control group of patients without HRS ( n =27) matched by age, severity of liver failure, and type of immunosuppression. Results : Cases and controls were similar with respect to pretransplantation characteristics. Three-year survival probability was similar between the two groups (HRS-treated: 100% vs control: 83%, P =0.15). No significant differences were found between the two groups with respect to the incidence of impairment of renal function after LTx (HRS-treated: 22% vs control: 30%), severe infections (22 vs 33%), acute rejection (33 vs 41%), days in Intensive Care Unit (6±1 vs 8±1), days in hospital (27±4 vs 31±4), and transfusion requirements (11±3 vs 10±2 units). Conclusions : Patients with HRS treated with vasopressin analogues before LTx have a posttransplantion outcome similar to that of patients transplanted with normal renal function. These results suggest that HRS should be treated before LTx.

Published
2004
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29. GS-001 - Epidemiology, predictors and outcomes of multi drug resistant bacterial infections in patients with cirrhosis across the world. Final results of the “Global study”.

Author

Piano, S., Singh, V., Caraceni, P., Maiwall, R., Alessandria, C., Fernandez, J., Soares, E., Kim, D.J., Kim, S.E., Marino, M., Vorobioff, J., de Cassia Ribeiro Barea, R., Merli, M., Elkrief, L., Blasco, V.M.V., Krag, A., Singh, S., Lesmana, L.A., Toledo, C., and Marciano, S.

Published
2018
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31. 769 Initial clinical experience with 177Lu-PSMA I&T radionuclide therapy in patients with metastatic castration-resistant prostate cancer.

Author

Heck, M.M., Retz, M., Rauscher, I., Scheidhauer, K., Maurer, T., Storz, E., Janssen, F., D'Alessandria, C., Wester, H.-J., Gschwend, J.E., Schwaiger, M., Tauber, R., and Eiber, M.

Subjects
*RADIOISOTOPES in urology, *PROSTATE cancer, *PROSTATE-specific antigen, *CANCER invasiveness, *RADIONUCLIDE imaging of cancer, *ADVERSE health care events
Published
2016
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32. P0185 : Acute-on-Chronic Liver Failure not associated with bacterial infections. Characteristics, prognosis and importance of systemic inflammatory response.

Author

Solè, C., Sola, E., Fernandez, J., Pavesi, M., Amoros, A., Moreau, R., Angeli, P., Jalan, R., Durand, F., Gustot, T., Saliba, F., Domenicali, M., Gerbes, A., Wendon, J., Alessandria, C., Laleman, W., Zeuzem, S., Trebicka, J., Bernardi, M., and Arroyo, V.

Subjects
*BACTERIAL diseases, *INFLAMMATION, *HEPATOLOGY, *LIVER failure, *PROGNOSIS, *THERAPEUTICS
Published
2015
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33. P508 VALIDATION OF THE CLIF-CONSORTIUM (CLIF-C) SCORE TO PREDICT MORTALITY OF PATIENTS WITH ACUTE-ON-CHRONIC LIVER FAILURE (ACLF) IN AN EXTERNAL COHORT AND FOR SEQUENTIAL MEASUREMENTS.

Author

Jalan, R., Pavesi, M., Saliba, F., Amoros, A., Levesque, E., Moreau, R., Gines, P., Durand, F., Angeli, P., Agarwal, B., Alessandria, C., Laleman, W., Trebicka, J., Samuel, D., Zeuzem, S., Gustot, T., Cordoba, J., Domenicali, M., Gerbes, A., and Wendon, J.

Subjects
*LIVER failure, *MORTALITY, *INTENSIVE care units, *THERAPEUTICS
Published
2014
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34. P476 SHORT-TERM (28-DAY) CLINICAL COURSE AND TRANSPLANT-FREE MORTALITY IN ACUTE ON CHRONIC LIVER FAILURE (ACLF); EVIDENCE FOR REVERSIBILITY OF ACLF (A STUDY FROM THE CANONIC DATABASE).

Author

Gustot, T., Fernandez, J., Garcia, E., Ginès, P., Moreau, R., Jalan, R., Pavesi, M., Durand, F., Angeli, P., Caraceni, P., Markwardt, D., Alessandria, C., Solis Muñoz, P., Laleman, W., Trebicka, J., Saliba, F., Zeuzem, S., Albillos, A., Elkrief, L., and Benten, D.

Subjects
*LIVER transplantation, *LIVER failure, *CIRRHOSIS of the liver, *CRITICALLY ill, *HEPATOLOGY
Published
2014
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35. P937 EARLY TREATMENT WITH TERLIPRESSIN AND ALBUMIN IS EFFECTIVE FOR TYPE-1 HEPATORENAL SYNDROME ASSOCIATED WITH SEPSIS.

Author

Rodriguez, E., Elia, C., Sola, E., Barreto, R., Graupera, I., Andrealli, A., Pereira, G.H., Ariza, X., Poca, M., Sanchez, J., Guevara, M., Soriano, G., Alessandria, C., Fernandez, J., Arroyo, V., and Gines, P.

Subjects
*HEPATORENAL syndrome, *EARLY medical intervention, *ALBUMINS, *SEPSIS, *PHARMACODYNAMICS, *CLINICAL trials, *THERAPEUTICS
Published
2014
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