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1. Risk of infections in patients with NAFLD and Type 2 Diabetes under treatment with SGLT2 inhibitors and relationship with liver outcomes: A retrospective case-control study

Author

Juan Bañares, Ramiro Manzano-Nuñez, Alba Prió, Jesús Rivera-Esteban, Laura Camps-Relats, Ana Villarejo, Lourdes Ruiz-Ortega, Mònica Pons, Andreea Ciudin, María Teresa Salcedo, Víctor Vargas, Joan Genescà, Juan M. Pericàs, Institut Català de la Salut, [Bañares J, Manzano-Nuñez R, Prió A, Camps-Relats L, Villarejo A, Ruiz-Ortega L] Unitat Hepàtica, Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. [Rivera-Esteban J] Unitat Hepàtica, Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Pons M, Pericàs JM] Unitat Hepàtica, Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Centro de Investigación Biomédica en Red de enfermedades digestivas y hepáticas (CIBERehd), Madrid, Instituto de Salud Carlos III, Madrid, Spain. [Ciudin A] Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. Servei d’Endocrinologia i Nutrició, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDem), Instituto de Salud Carlos III, Madrid, Spain. [Salcedo MT] Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. Servei d’Anatomia Patològica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Vargas V, Genescà J] Unitat Hepàtica, Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. Centro de Investigación Biomédica en Red de enfermedades digestivas y hepáticas (CIBERehd), Madrid, Instituto de Salud Carlos III, Madrid, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
enfermedades del sistema digestivo::enfermedades hepáticas::hígado graso::esteatosis hepática no alcohólica [ENFERMEDADES], Endocrinology, Diabetes and Metabolism, Digestive System Diseases::Liver Diseases::Fatty Liver::Non-alcoholic Fatty Liver Disease [DISEASES], Esteatosi hepàtica - Complicacions, Infections, Antidiabètics - Ús terapèutic, Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Hypoglycemic Agents [CHEMICALS AND DRUGS], enfermedades del sistema endocrino::diabetes mellitus::diabetes mellitus tipo II [ENFERMEDADES], Diabetis - Tractament, Otros calificadores::Otros calificadores::/complicaciones [Otros calificadores], Diabetes Mellitus, Type 2, Non-alcoholic Fatty Liver Disease, acciones y usos químicos::acciones farmacológicas::efectos fisiológicos de los fármacos::hipoglicemiantes [COMPUESTOS QUÍMICOS Y DROGAS], Case-Control Studies, NAFLD, Type 2 diabetes mellitus, Humans, Endocrine System Diseases::Diabetes Mellitus::Diabetes Mellitus, Type 2 [DISEASES], Hepatic outcomes, Sodium-Glucose Transporter 2 Inhibitors, Sodium-glucose co-transporter-2 inhibitors, Retrospective Studies, Other subheadings::Other subheadings::/complications [Other subheadings]
Abstract

Hepatic outcomes; Infections; Sodium-glucose co-transporter-2 inhibitors Resultados hepáticos; Infecciones; Inhibidores del cotransportador de sodio-glucosa-2 Resultats hepàtics; Infeccions; Inhibidors del cotransportador de sodi-glucosa-2 Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in developed countries, with its incidence growing parallel to the epidemics of obesity and type 2 diabetes mellitus (T2DM). Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are becoming a cornerstone in the management of cardiovascular health and some studies suggest the potential role in NAFLD. However, patients under treatment with SGLT2i are at risk of developing genitourinary fungal infections (GFIs). Moreover, both NAFLD and SGLT2i have a strong influence on the immune system, and therefore the risk of infections other than GFIs could be increased in NAFLD patients treated with SGLT2i. We aimed to examine the possible association of SGLT2i with infections and hepatic outcomes in NAFLD patients. Methods: We conducted a case-control study including NAFLD patients with T2DM visited at the Liver Unit outpatient clinic from 2016 to 2021 with a minimum follow-up of 6 months by selecting 65 patients receiving SGLT2i and 130 matched patients with other types of antidiabetic treatment. Results: During follow-up, GFIs were significantly higher in the SGLT2i group (15.4% vs. 3.8%; p=0.008), whereas there were no differences in the occurrence of overall infections (41.5% vs. 30%; p=0.1) nor in other types of specific infections. In the multivariable analysis, treatment with SGLT2i was not independently associated with higher odds of overall infection. On the other hand, SGLT2i patients showed a significantly lower incidence of hepatic events (1.5% vs. 10.7%; p=0.02). There were no significant different in all-cause mortality between cases and controls. Conclusions: NAFLD patients with T2DM receiving SGLT2i more frequently presented GFIs, whereas the incidence of other types of infections was not found to be higher than in other patients with NAFLD and T2DM treated with other drugs. Moreover, SGLT2i-treated patients had a lower occurrence of hepatic events. Further studies are warranted to validate our data. Funds from European Commission/EFPIA IMI2 853966-2, IMI2 777377, H2020 847989, and ISCIII PI19/01898.

Published
2022
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2. The role of liver steatosis as measured with transient elastography and transaminases on hard clinical outcomes in patients with COVID-19

Author

Campos Varela, Isabel, Villagrasa, Ares, Simon-Talero, Macarena, Riveiro Barciela, Mar, Ventura-Cots, Meritxell, Aguilera-Castro, Lara, Álvarez-López, Patricia, Nordahl, Emilie A., Anton, Adrian, Bañares, Juan, Barber, Claudia, Barreira-Diaz, Ana, Biagetti, Betina, Camps-Relats, Laura, Ciudin, Andreea, Cocera, Raul, Dopazo, Cristina, Fernandez, Andrea, Jiménez, Cesar, Jiménez, María M., Jofra, Mariona, Gil, Clara, Gómez Gavara, Concepción, Guanozzi, Danila, Guevara, Jorge A., Lobo, Beatriz, Malagelada Prats, Carolina, Martinez-Camprecios, Joan, Mayorga, Luis, Miret Alomar, Enric, Pando, Elizabeth, Pérez-Lopez, Ana, Pigrau Pastor, Marc, Prio, Alba, Rivera-Esteban, Jesus M., Romero, Alba, Tasayco, Staphanie, Vidal-Gonzalez, Judit, Vidal, Laura, Minguez, Beatriz, Augustin Recio, Salvador, Genescà, J., Universitat Autònoma de Barcelona, Institut Català de la Salut, [Campos-Varela I, Augustin S] Unitat del Fetge, Servei de Medicina Interna, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Villagrasa A, Alvarez-Lopez P, Anton A, Bañares J, Barreira-Diaz A, Camps-Relats L, Jimenez C, Gil C, Martinez-Camprecios J, Prio A, Rivera-Esteban JM, Romero A, Vidal-Gonzalez J] Unitat del Fetge, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Simon-Talero M, Riveiro-Barciela M, Ventura-Cots M, Minguez B, Genesca J] Unitat del Fetge, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain. [Aguilera-Castro L, Barber C, Guanozzi D, Lobo B, Malagelada C, Mayorga L, Tasayco S] Servei de l’Aparell Digestiu, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Nordahl EA] Servei de Farmacologia Clínica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Biagetti B, Ciudin A] Servei d’Endocrinologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Cocera R, Miret E] Servei d’Urologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Dopazo C, Fernandez A, Jofra M, Gomez-Gavara C, Pando E, Vidal L] Servei de Cirurgia Hepatobiliopancreàtica i Trasplantaments, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Jimenez MM, Pérez-Lopez A] Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Gomez-Gavara C, Pigrau M] Servei d’Endoscòpia, Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), ALT, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), RC799-869, Liver injury, Gastroenterology, Otros calificadores::Otros calificadores::/complicaciones [Otros calificadores], Liver disease, Liver steatosis, Internal medicine, virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES], Medicine, In patient, AST, Other subheadings::Other subheadings::/diagnostic imaging [Other subheadings], COVID-19 (Malaltia) - Complicacions, Original Research, business.industry, Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES], Otros calificadores::Otros calificadores::/diagnóstico por imagen [Otros calificadores], Diseases of the digestive system. Gastroenterology, medicine.disease, CAP, controlled attenuation parameter, enfermedades del sistema digestivo::enfermedades hepáticas [ENFERMEDADES], Fetge - Malalties - Imatgeria, Digestive System Diseases::Liver Diseases [DISEASES], Controlled attenuation parameter, business, Transient elastography, Other subheadings::Other subheadings::/complications [Other subheadings], liver injury
Abstract

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Paràmetre d'atenuació controlat; Lesió hepàtica Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Parámetro de atenuación controlado; Daño hepático Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Controlled attenuation parameter; Liver injury Liver injury has been widely described in patients with Coronavirus disease 2019 (COVID-19). We aimed to study the effect of liver biochemistry alterations, previous liver disease, and the value of liver elastography on hard clinical outcomes in COVID-19 patients. We conducted a single-center prospective observational study in 370 consecutive patients admitted for polymerase chain reaction (PCR)-confirmed COVID-19 pneumonia. Clinical and laboratory data were collected at baseline and liver parameters and clinical events recorded during follow-up. Transient elastography [with Controlled Attenuation Parameter (CAP) measurements] was performed at admission in 98 patients. All patients were followed up until day 28 or death. The two main outcomes of the study were 28-day mortality and the occurrence of the composite endpoint intensive care unit (ICU) admission and/or death. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated at admission in 130 patients (35%) and 167 (45%) patients, respectively. Overall, 14.6% of patients presented the composite endpoint ICU and/or death. Neither ALT elevations, prior liver disease, liver stiffness nor liver steatosis (assessed with CAP) had any effect on outcomes. However, patients with abnormal baseline AST had a higher occurrence of the composite ICU/death (21% versus 9.5%, p = 0.002). Patients ⩾65 years and with an AST level > 50 U/ml at admission had a significantly higher risk of ICU and/or death than those with AST ⩽ 50 U/ml (50% versus 13.3%, p

Published
2021

3. Simple predictive models identify patients with COVID-19 pneumonia and poor prognosis.

Author

Riveiro-Barciela M, Labrador-Horrillo M, Camps-Relats L, González-Sans D, Ventura-Cots M, Terrones-Peinador M, Nuñez-Conde A, Martínez-Gallo M, Hernández M, Antón A, González A, Pujol-Borrell R, and Martínez-Valle F

Subjects
Female, Hospitalization, Humans, Male, Middle Aged, Prognosis, Proportional Hazards Models, Retrospective Studies, SARS-CoV-2 pathogenicity, Severity of Illness Index, COVID-19 diagnosis, COVID-19 pathology, Pneumonia diagnosis, Pneumonia pathology
Abstract

Background and Aims: Identification of SARS-CoV-2-infected patients at high-risk of poor prognosis is crucial. We aimed to establish predictive models for COVID-19 pneumonia severity in hospitalized patients., Methods: Retrospective study of 430 patients admitted in Vall d'Hebron Hospital (Barcelona) between 03-12-2020 and 04-28-2020 due to COVID-19 pneumonia. Two models to identify the patients who required high-flow-oxygen-support were generated, one using baseline data and another with also follow-up analytical results. Calibration was performed by a 1000-bootstrap replication model., Results: 249 were male, mean age 57.9 years. Overall, 135 (31.4%) required high-flow-oxygen-support. The baseline predictive model showed a ROC of 0.800 based on: SpO2/FiO2 (adjusted Hazard Ratio-aHR = 8), chest x-ray (aHR = 4), prior immunosuppressive therapy (aHR = 4), obesity (aHR = 2), IL-6 (aHR = 2), platelets (aHR = 0.5). The cut-off of 11 presented a specificity of 94.8%. The second model included changes on the analytical parameters: ferritin (aHR = 7.5 if ≥200ng/mL) and IL-6 (aHR = 18 if ≥64pg/mL) plus chest x-ray (aHR = 2) showing a ROC of 0.877. The cut-off of 12 exhibited a negative predictive value of 92%., Conclusions: SpO2/FiO2 and chest x-ray on admission or changes on inflammatory parameters as IL-6 and ferritin allow us early identification of COVID-19 patients at risk of high-flow-oxygen-support that may benefit from a more intensive disease management., Competing Interests: No authors have competing interests.

Published
2020
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