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1. Long-term albumin improves the outcomes of patients with decompensated cirrhosis and diabetes mellitus: Post hoc analysis of the ANSWER trial

Author

Pompili, E, Baldassarre, M, Iannone, G, Tedesco, G, Nardelli, S, Piano, S, Alessandria, C, Neri, S, Foschi, F, Levantesi, F, Caraceni, P, Bernardi, M, Zaccherini, G, Domenicali, M, Giannone, F, Antognoli, A, Riggio, O, Merli, M, Pasquale, C, Gioia, S, Angeli, P, Fasolato, S, Sticca, A, Cavallin, M, Campion, D, Risso, A, Andrealli, A, Saracco, G, Prestianni, L, Fidone, F, Maiorca, D, Rizzotto, A, Cappa, F, Lanzi, A, Neri, E, Visani, A, Mastroianni, A, Airoldi, A, Perricone, G, Alberti, A, Cesarini, L, Mazzarelli, C, Vangeli, M, Vigano, R, Svegliati-Baroni, G, Marzioni, M, Capretti, F, Kostandini, A, Fagiuoli, S, Magini, G, Colpani, M, Laffi, G, Gabbani, T, Marsico, M, Cozzolongo, R, Zappimbulso, M, Petruzzi, J, Di Marco, V, Calvaruso, V, Sangiovanni, V, Parrella, G, Caporaso, N, Morisco, F, Auriemma, F, Guarino, M, Toniutto, P, Pugliese, F, Gasbarrini, A, Tortora, A, Leo, P, De Marco, R, Angelico, M, De Leonardis, F, Pecchioli, A, Rossi, P, Raimondo, G, Cacciola, I, Elia, G, Negri, E, Dallio, M, Loguercio, C, Federico, A, Conte, D, Massironi, S, Ballardini, G, Celli, N, Rendina, M, Bringiotti, R, Castellaneta, N, Salerno, F, Boccia, S, Simone, L, Guarisco, R, Galioto, A, Pompili E., Baldassarre M., Iannone G., Tedesco G., Nardelli S., Piano S., Alessandria C., Neri S., Foschi F. G., Levantesi F., Caraceni P., Bernardi M., Zaccherini G., Domenicali M., Giannone F. A., Antognoli A., Riggio O., Merli M., Pasquale C., Gioia S., Angeli P., Fasolato S., Sticca A., Cavallin M., Campion D., Risso A., Andrealli A., Saracco G. M., Prestianni L., Fidone F., Maiorca D., Rizzotto A., Cappa F. M., Lanzi A., Neri E., Visani A., Mastroianni A., Airoldi A., Perricone G., Alberti A. B., Cesarini L., Mazzarelli C., Vangeli M., Vigano R., Svegliati-Baroni G., Marzioni M., Capretti F., Kostandini A., Fagiuoli S., Magini G., Colpani M., Laffi G., Gabbani T., Marsico M., Cozzolongo R., Zappimbulso M., Petruzzi J., Di Marco V., Calvaruso V., Sangiovanni V., Parrella G., Caporaso N., Morisco F., Auriemma F., Guarino M., Toniutto P., Pugliese F., Gasbarrini A., Tortora A., Leo P., De Marco R., Angelico M., De Leonardis F., Pecchioli A., Rossi P., Raimondo G., Cacciola I., Elia G., Negri E., Dallio M., Loguercio C., Federico A., Conte D., Massironi S., Ballardini G., Celli N., Rendina M., Bringiotti R., Castellaneta N. M., Salerno F., Boccia S., Simone L., Guarisco R., Galioto A., Pompili, E, Baldassarre, M, Iannone, G, Tedesco, G, Nardelli, S, Piano, S, Alessandria, C, Neri, S, Foschi, F, Levantesi, F, Caraceni, P, Bernardi, M, Zaccherini, G, Domenicali, M, Giannone, F, Antognoli, A, Riggio, O, Merli, M, Pasquale, C, Gioia, S, Angeli, P, Fasolato, S, Sticca, A, Cavallin, M, Campion, D, Risso, A, Andrealli, A, Saracco, G, Prestianni, L, Fidone, F, Maiorca, D, Rizzotto, A, Cappa, F, Lanzi, A, Neri, E, Visani, A, Mastroianni, A, Airoldi, A, Perricone, G, Alberti, A, Cesarini, L, Mazzarelli, C, Vangeli, M, Vigano, R, Svegliati-Baroni, G, Marzioni, M, Capretti, F, Kostandini, A, Fagiuoli, S, Magini, G, Colpani, M, Laffi, G, Gabbani, T, Marsico, M, Cozzolongo, R, Zappimbulso, M, Petruzzi, J, Di Marco, V, Calvaruso, V, Sangiovanni, V, Parrella, G, Caporaso, N, Morisco, F, Auriemma, F, Guarino, M, Toniutto, P, Pugliese, F, Gasbarrini, A, Tortora, A, Leo, P, De Marco, R, Angelico, M, De Leonardis, F, Pecchioli, A, Rossi, P, Raimondo, G, Cacciola, I, Elia, G, Negri, E, Dallio, M, Loguercio, C, Federico, A, Conte, D, Massironi, S, Ballardini, G, Celli, N, Rendina, M, Bringiotti, R, Castellaneta, N, Salerno, F, Boccia, S, Simone, L, Guarisco, R, Galioto, A, Pompili E., Baldassarre M., Iannone G., Tedesco G., Nardelli S., Piano S., Alessandria C., Neri S., Foschi F. G., Levantesi F., Caraceni P., Bernardi M., Zaccherini G., Domenicali M., Giannone F. A., Antognoli A., Riggio O., Merli M., Pasquale C., Gioia S., Angeli P., Fasolato S., Sticca A., Cavallin M., Campion D., Risso A., Andrealli A., Saracco G. M., Prestianni L., Fidone F., Maiorca D., Rizzotto A., Cappa F. M., Lanzi A., Neri E., Visani A., Mastroianni A., Airoldi A., Perricone G., Alberti A. B., Cesarini L., Mazzarelli C., Vangeli M., Vigano R., Svegliati-Baroni G., Marzioni M., Capretti F., Kostandini A., Fagiuoli S., Magini G., Colpani M., Laffi G., Gabbani T., Marsico M., Cozzolongo R., Zappimbulso M., Petruzzi J., Di Marco V., Calvaruso V., Sangiovanni V., Parrella G., Caporaso N., Morisco F., Auriemma F., Guarino M., Toniutto P., Pugliese F., Gasbarrini A., Tortora A., Leo P., De Marco R., Angelico M., De Leonardis F., Pecchioli A., Rossi P., Raimondo G., Cacciola I., Elia G., Negri E., Dallio M., Loguercio C., Federico A., Conte D., Massironi S., Ballardini G., Celli N., Rendina M., Bringiotti R., Castellaneta N. M., Salerno F., Boccia S., Simone L., Guarisco R., and Galioto A.

Abstract

Type-2 diabetes mellitus is a frequent comorbidity of cirrhosis independently associated with cirrhosis-related complications and mortality. This post hoc analysis of the ANSWER trial database assessed the effects of long-term human albumin (HA) administration on top of the standard medical treatment (SMT) on the clinical outcomes of a subgroup of 85 outpatients with liver cirrhosis, uncomplicated ascites and insulin-treated diabetes mellitus type 2 (ITDM). Compared to patients in the SMT arm, the SMT + HA group showed a better overall survival (86% vs. 57%, p =.016) and lower incidence rates of paracenteses, overt hepatic encephalopathy, bacterial infections, renal dysfunction and electrolyte disorders. Hospital admissions did not differ between the two arms, but the number of days spent in hospital was lower in the SMT + HA group. In conclusion, in a subgroup of ITDM outpatients with decompensated cirrhosis and ascites, long-term HA administration was associated with better survival and a lower incidence of cirrhosis-related complications.

Published
2024

3. Safety and efficacy of 177Lu-PSMA-I&T Radioligand Therapy in Octogenarians with metastatic castration-resistant prostate cancer: Report on eighty patients over age eighty

Author

Grigorascu, S., additional, Tauber, R., additional, Knorr, K., additional, Retz, M., additional, Rauscher, I., additional, Hansen, K., additional, D’Alessandria, C., additional, Wester, H. J., additional, Gschwend, J., additional, Weber, W. A., additional, Eiber, M., additional, and Langbein, T., additional

Published
2023
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4. 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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5. 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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6. 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. On-treatment serum albumin level can guide long-term treatment in patients with cirrhosis and uncomplicated ascites

Author

Caraceni, P, Tufoni, M, Zaccherini, G, Riggio, O, Angeli, P, Alessandria, C, Neri, S, Foschi, F, Levantesi, F, Airoldi, A, Simone, L, Svegliati-Baroni, G, Fagiuoli, S, Laffi, G, Cozzolongo, R, Di Marco, V, Sangiovanni, V, Morisco, F, Toniutto, P, Gasbarrini, A, De Marco, R, Piano, S, Nardelli, S, Elia, C, Roncadori, A, Baldassarre, M, Bernardi, M, Domenicali, M, Giannone, F, Antognoli, A, Merli, M, Pasquale, C, Gioia, S, Fasolato, S, Sticca, A, Campion, D, Risso, A, Saracco, G, Prestianni, L, Fidone, F, Maiorca, D, Rizzotto, A, Cappa, F, Lanzi, A, Neri, E, Visani, A, Mastroianni, A, Perricone, G, Alberti, A, Cesarini, L, Mazzarelli, C, Vangeli, M, Vigano, R, Marzioni, M, Capretti, F, Kostandini, A, Magini, G, Colpani, M, Gabbani, T, Marsico, M, Zappimbulso, M, Petruzzi, J, Calvaruso, V, Parrella, G, Caporaso, N, Auriemma, F, Guarino, M, Pugliese, F, Tortora, A, Leo, P, Angelico, M, De Leonardis, F, Pecchioli, A, Rossi, P, Raimondo, G, Cacciola, I, Elia, G, Negri, E, Dallio, M, Loguercio, C, Federico, A, Conte, D, Massironi, S, Natascia Celli, G, Rendina, M, Bringiotti, R, Castellaneta, N, Salerno, F, Boccia, S, Guarisco, R, Galioto, A, Cavallin, M, Andrealli, A, Caraceni P., Tufoni M., Zaccherini G., Riggio O., Angeli P., Alessandria C., Neri S., Foschi F. G., Levantesi F., Airoldi A., Simone L., Svegliati-Baroni G., Fagiuoli S., Laffi G., Cozzolongo R., Di Marco V., Sangiovanni V., Morisco F., Toniutto P., Gasbarrini A., De Marco R., Piano S., Nardelli S., Elia C., Roncadori A., Baldassarre M., Bernardi M., Domenicali M., Giannone F. A., Antognoli A., Merli M., Pasquale C., Gioia S., Fasolato S., Sticca A., Campion D., Risso A., Saracco G. M., Prestianni L., Fidone F., Maiorca D., Rizzotto A., Cappa F. M., Lanzi A., Neri E., Visani A., Mastroianni A., Perricone G., Alberti A. B., Cesarini L., Mazzarelli C., Vangeli M., Vigano R., Marzioni M., Capretti F., Kostandini A., Magini G., Colpani M., Gabbani T., Marsico M., Zappimbulso M., Petruzzi J., Calvaruso V., Parrella G., Caporaso N., Auriemma F., Guarino M., Pugliese F., Tortora A., Leo P., Angelico M., De Leonardis F., Pecchioli A., Rossi P., Raimondo G., Cacciola I., Elia G., Negri E., Dallio M., Loguercio C., Federico A., Conte D., Massironi S., Natascia Celli G. B., Rendina M., Bringiotti R., Castellaneta N. M., Salerno F., Boccia S., Guarisco R., Galioto A., Cavallin M., Andrealli A., Caraceni, P, Tufoni, M, Zaccherini, G, Riggio, O, Angeli, P, Alessandria, C, Neri, S, Foschi, F, Levantesi, F, Airoldi, A, Simone, L, Svegliati-Baroni, G, Fagiuoli, S, Laffi, G, Cozzolongo, R, Di Marco, V, Sangiovanni, V, Morisco, F, Toniutto, P, Gasbarrini, A, De Marco, R, Piano, S, Nardelli, S, Elia, C, Roncadori, A, Baldassarre, M, Bernardi, M, Domenicali, M, Giannone, F, Antognoli, A, Merli, M, Pasquale, C, Gioia, S, Fasolato, S, Sticca, A, Campion, D, Risso, A, Saracco, G, Prestianni, L, Fidone, F, Maiorca, D, Rizzotto, A, Cappa, F, Lanzi, A, Neri, E, Visani, A, Mastroianni, A, Perricone, G, Alberti, A, Cesarini, L, Mazzarelli, C, Vangeli, M, Vigano, R, Marzioni, M, Capretti, F, Kostandini, A, Magini, G, Colpani, M, Gabbani, T, Marsico, M, Zappimbulso, M, Petruzzi, J, Calvaruso, V, Parrella, G, Caporaso, N, Auriemma, F, Guarino, M, Pugliese, F, Tortora, A, Leo, P, Angelico, M, De Leonardis, F, Pecchioli, A, Rossi, P, Raimondo, G, Cacciola, I, Elia, G, Negri, E, Dallio, M, Loguercio, C, Federico, A, Conte, D, Massironi, S, Natascia Celli, G, Rendina, M, Bringiotti, R, Castellaneta, N, Salerno, F, Boccia, S, Guarisco, R, Galioto, A, Cavallin, M, Andrealli, A, Caraceni P., Tufoni M., Zaccherini G., Riggio O., Angeli P., Alessandria C., Neri S., Foschi F. G., Levantesi F., Airoldi A., Simone L., Svegliati-Baroni G., Fagiuoli S., Laffi G., Cozzolongo R., Di Marco V., Sangiovanni V., Morisco F., Toniutto P., Gasbarrini A., De Marco R., Piano S., Nardelli S., Elia C., Roncadori A., Baldassarre M., Bernardi M., Domenicali M., Giannone F. A., Antognoli A., Merli M., Pasquale C., Gioia S., Fasolato S., Sticca A., Campion D., Risso A., Saracco G. M., Prestianni L., Fidone F., Maiorca D., Rizzotto A., Cappa F. M., Lanzi A., Neri E., Visani A., Mastroianni A., Perricone G., Alberti A. B., Cesarini L., Mazzarelli C., Vangeli M., Vigano R., Marzioni M., Capretti F., Kostandini A., Magini G., Colpani M., Gabbani T., Marsico M., Zappimbulso M., Petruzzi J., Calvaruso V., Parrella G., Caporaso N., Auriemma F., Guarino M., Pugliese F., Tortora A., Leo P., Angelico M., De Leonardis F., Pecchioli A., Rossi P., Raimondo G., Cacciola I., Elia G., Negri E., Dallio M., Loguercio C., Federico A., Conte D., Massironi S., Natascia Celli G. B., Rendina M., Bringiotti R., Castellaneta N. M., Salerno F., Boccia S., Guarisco R., Galioto A., Cavallin M., and Andrealli A.

Abstract

Background & Aims: The ANSWER study reported that long-term albumin administration in patients with cirrhosis and uncomplicated ascites improves survival. During treatment, serum albumin increased within a month and remained stable thereafter. In this post hoc analysis, we aimed to determine whether on-treatment serum albumin levels could guide therapy. Methods: Logistic regression was used to assess the association between baseline serum albumin and mortality, as well as to determine on-treatment factors associated with mortality and to predict the achievement of a given on-treatment serum albumin level. Survival was assessed by Kaplan-Meier estimates and second-order polynomial regression. Patients whose on-treatment serum albumin remained below normal were compared with a subset of patients from the control arm matched by principal score. Results: Baseline serum albumin was closely associated with 18-month mortality in untreated patients; albumin treatment almost effaced this relationship. On-treatment serum albumin and MELD-Na at month 1 were the sole independent variables associated with mortality. Second-order polynomial regression revealed that survival improved in parallel with increased 1-month on-treatment serum albumin. Kaplan-Meier estimations showed that any value of 1-month on-treatment serum albumin (0.1 g/dl intervals) in the range 2.5–4.5 g/dl discriminated patient survival. In the normal range of serum albumin, the best discriminant value was 4.0 g/dl. Compared to untreated patients, survival even improved in patients whose on-treatment serum albumin remained below normal. Conclusion: Baseline serum albumin per se should not guide the decision to start albumin therapy. Conversely, 1-month on-treatment serum albumin levels are strongly associated with outcomes and could guide the use of albumin – 4.0 g/dl being the target threshold. However, even patients whose serum albumin remains below normal benefit from long-term albumin administration. Lay

Published
2021

10. Long-term albumin administration eases the management of hyponatremia in outpatients with decompensated cirrhosis: data from the ANSWER Trial

Author

Zaccherini, G., primary, Baldassarre, M., additional, Tufoni, M., additional, Riggio, O., additional, Angeli, P., additional, Alessandria, C., additional, Neri, S., additional, Foschi, F.G., additional, Levantesi, F., additional, Airoldi, A., additional, Simone, L., additional, Svegliati-Baroni, G., additional, Fagiuoli, S., additional, Laffi, G., additional, Cozzolongo, R., additional, Di Marco, V., additional, Sangiovanni, V., additional, Morisco, F., additional, Toniutto, P., additional, Tortora, A., additional, De Marco, R., additional, Nardelli, S., additional, Piano, S., additional, Elia, C., additional, Bernardi, M., additional, and Caraceni, P., additional

Published
2022
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11. Long-term albumin administration improves survival in outpatients with decompensated cirrhosis and diabetes: post-hoc analysis of the ANSWER Trial

Author

Zaccherini, G., De Venuto, C., Baldassarre, M., Pompili, E., Iannone, G., Riggio, O., Angeli, P., Alessandria, C., Neri, S., Foschi, F.G., Levantesi, F., Airoldi, A., Simone, L., Svegliati-Baroni, G., Fagiuoli, S., Laffi, G., Cozzolongo, R., Di Marco, V., Sangiovanni, V., Morisco, F., Toniutto, P., Tortora, A., De Marco, R., Nardelli, S., Piano, S., Elia, C., Caraceni, P., and Bernardi, M.

Published
2024
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15. Blood metabolomics uncovers inflammation-associated mitochondrial dysfunction as a potential mechanism underlying ACLF (vol 72, pg 688, 2020)

Author

Moreau, R, Claria, J, Aguilar, F, Fenaille, F, Lozano, JJ, Junot, C, Colsch, B, Caraceni, P, Trebicka, J, Pavesi, M, Alessandria, C, Nevens, F, Saliba, F, Welzel, TM, Albillos, A, Gustot, T, Fernandez, J, Moreno, C, Baldassarre, M, Zaccherini, G, Piano, S, Montagnese, S, Vargas, V, Genesca, J, Sola, E, Bernal, W, Butin, N, Hautbergue, T, Cholet, S, Castelli, F, Jansen, C, Steib, C, Campion, D, Mookerjee, R, Rodriguez-Gandia, M, Soriano, G, Durand, F, Benten, D, Banares, R, Stauber, RE, Gronbaek, H, Coenraad, MJ, Gines, P, Gerbes, A, Jalan, R, Bernardi, M, Arroyo, V, Angeli, P, CANONIC Study, and Grifols Chair European

Published
2020
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16. Nomograms to predict outcomes after 177Lu-PSMA therapy in men with metastatic castration-resistant prostate cancer: an international, multicentre, retrospective study

Author

Gafita, A, Calais, J, Grogan, TR, Hadaschik, B, Wang, H, Weber, M, Sandhu, S, Kratochwil, C, Esfandiari, R, Tauber, R, Zeldin, A, Rathke, H, Armstrong, WR, Robertson, A, Thin, P, D'Alessandria, C, Rettig, MB, Delpassand, ES, Haberkorn, U, Elashoff, D, Herrmann, K, Czernin, J, Hofman, MS, Fendler, WP, Eiber, M, Gafita, A, Calais, J, Grogan, TR, Hadaschik, B, Wang, H, Weber, M, Sandhu, S, Kratochwil, C, Esfandiari, R, Tauber, R, Zeldin, A, Rathke, H, Armstrong, WR, Robertson, A, Thin, P, D'Alessandria, C, Rettig, MB, Delpassand, ES, Haberkorn, U, Elashoff, D, Herrmann, K, Czernin, J, Hofman, MS, Fendler, WP, and Eiber, M

Abstract

BACKGROUND: Lutetium-177 (177Lu) prostate-specific membrane antigen (177Lu-PSMA) is a novel targeted treatment for patients with metastatic castration-resistant prostate cancer (mCRPC). Predictors of outcomes after 177Lu-PSMA to enhance its clinical implementation are yet to be identified. We aimed to develop nomograms to predict outcomes after 177Lu-PSMA in patients with mCRPC. METHODS: In this multicentre, retrospective study, we screened patients with mCRPC who had received 177Lu-PSMA between Dec 10, 2014, and July 19, 2019, as part of the previous phase 2 trials (NCT03042312, ACTRN12615000912583) or compassionate access programmes at six hospitals and academic centres in Germany, the USA, and Australia. Eligible patients had received intravenous 6·0-8·5 GBq 177Lu-PSMA once every 6-8 weeks, for a maximum of four to six cycles, and had available baseline [68Ga]Ga-PSMA-11 PET/CT scan, clinical data, and survival outcomes. Putative predictors included 18 pretherapeutic clinicopathological and [68Ga]Ga-PSMA-11 PET/CT variables. Data were collected locally and centralised. Primary outcomes for the nomograms were overall survival and prostate-specific antigen (PSA)-progression-free survival. Nomograms for each outcome were computed from Cox regression models with LASSO penalty for variable selection. Model performance was measured by examining discrimination (Harrell's C-index), calibration (calibration plots), and utility (patient stratification into low-risk vs high-risk groups). Models were validated internally using bootstrapping and externally by calculating their performance on a validation cohort. FINDINGS: Between April 23, 2019, and Jan 13, 2020, 414 patients were screened; 270 (65%) of whom were eligible and were divided into development (n=196) and validation (n=74) cohorts. The median duration of follow-up was 21·5 months (IQR 13·3-30·7). Predictors included in the nomograms were time since initial diagnosis of prostate cancer, chemotherapy status, baseline

Published
2021

19. Nephrotoxicity after PSMA-RLT using Lu-177-PSMA I&T

Author

Cala, L, additional, Steinhelfer, L, additional, Langbein, T, additional, Pfob, C, additional, Lapa, C, additional, Buck, A, additional, Wester, HJ, additional, Tauber, R, additional, Weber, W, additional, D’Alessandria, C, additional, and Eiber, M, additional

Published
2021
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20. Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial

Author

Caraceni, P, Riggio, O, Angeli, P, Alessandria, C, Neri, S, Foschi, F, Levantesi, F, Airoldi, A, Boccia, S, Svegliati-Baroni, G, Fagiuoli, S, Romanelli, R, Cozzolongo, R, Di Marco, V, Sangiovanni, V, Morisco, F, Toniutto, P, Tortora, A, De Marco, R, Angelico, M, Cacciola, I, Elia, G, Federico, A, Massironi, S, Guarisco, R, Galioto, A, Ballardini, G, Rendina, M, Nardelli, S, Piano, S, Elia, C, Prestianni, L, Cappa, F, Cesarini, L, Simone, L, Pasquale, C, Cavallin, M, Andrealli, A, Fidone, F, Ruggeri, M, Roncadori, A, Baldassarre, M, Tufoni, M, Zaccherini, G, Bernardi, M, Domenicali, M, Giannone, F, Merli, M, Gioia, S, Fasolato, S, Sticca, A, Campion, D, Risso, A, Saracco, G, Maiorca, D, Rizzotto, A, Lanzi, A, Neri, E, Visani, A, Mastroianni, A, Alberti, A, Mazzarelli, C, Vangeli, M, Marzioni, M, Capretti, F, Kostandini, A, Magini, G, Colpani, M, Laffi, G, Gabbani, T, Marsico, M, Zappimbulso, M, Petruzzi, J, Calvaruso, V, Parrella, G, Caporaso, N, Auriemma, F, Guarino, M, Pugliese, F, Gasbarrini, A, Leo, P, De Leonardis, F, Pecchioli, A, Rossi, P, Raimondo, G, Negri, E, Dallio, M, Loguercio, C, Conte, D, Celli, N, Bringiotti, R, Castellaneta, N, Salerno, F, Caraceni P., Riggio O., Angeli P., Alessandria C., Neri S., Foschi F. G., Levantesi F., Airoldi A., Boccia S., Svegliati-Baroni G., Fagiuoli S., Romanelli R. G., Cozzolongo R., Di Marco V., Sangiovanni V., Morisco F., Toniutto P., Tortora A., De Marco R., Angelico M., Cacciola I., Elia G., Federico A., Massironi S., Guarisco R., Galioto A., Ballardini G., Rendina M., Nardelli S., Piano S., Elia C., Prestianni L., Cappa F. M., Cesarini L., Simone L., Pasquale C., Cavallin M., Andrealli A., Fidone F., Ruggeri M., Roncadori A., Baldassarre M., Tufoni M., Zaccherini G., Bernardi M., Domenicali M., Giannone F. A., Merli M., Gioia S., Fasolato S., Sticca A., Campion D., Risso A., Saracco G. M., Maiorca D., Rizzotto A., Lanzi A., Neri E., Visani A., Mastroianni A., Alberti A. B., Mazzarelli C., Vangeli M., Marzioni M., Capretti F., Kostandini A., Magini G., Colpani M., Laffi G., Gabbani T., Marsico M., Zappimbulso M., Petruzzi J., Calvaruso V., Parrella G., Caporaso N., Auriemma F., Guarino M., Pugliese F., Gasbarrini A., Leo P., De Leonardis F., Pecchioli A., Rossi P., Raimondo G., Negri E., Dallio M., Loguercio C., Conte D., Celli N., Bringiotti R., Castellaneta N. M., Salerno F., Caraceni, P, Riggio, O, Angeli, P, Alessandria, C, Neri, S, Foschi, F, Levantesi, F, Airoldi, A, Boccia, S, Svegliati-Baroni, G, Fagiuoli, S, Romanelli, R, Cozzolongo, R, Di Marco, V, Sangiovanni, V, Morisco, F, Toniutto, P, Tortora, A, De Marco, R, Angelico, M, Cacciola, I, Elia, G, Federico, A, Massironi, S, Guarisco, R, Galioto, A, Ballardini, G, Rendina, M, Nardelli, S, Piano, S, Elia, C, Prestianni, L, Cappa, F, Cesarini, L, Simone, L, Pasquale, C, Cavallin, M, Andrealli, A, Fidone, F, Ruggeri, M, Roncadori, A, Baldassarre, M, Tufoni, M, Zaccherini, G, Bernardi, M, Domenicali, M, Giannone, F, Merli, M, Gioia, S, Fasolato, S, Sticca, A, Campion, D, Risso, A, Saracco, G, Maiorca, D, Rizzotto, A, Lanzi, A, Neri, E, Visani, A, Mastroianni, A, Alberti, A, Mazzarelli, C, Vangeli, M, Marzioni, M, Capretti, F, Kostandini, A, Magini, G, Colpani, M, Laffi, G, Gabbani, T, Marsico, M, Zappimbulso, M, Petruzzi, J, Calvaruso, V, Parrella, G, Caporaso, N, Auriemma, F, Guarino, M, Pugliese, F, Gasbarrini, A, Leo, P, De Leonardis, F, Pecchioli, A, Rossi, P, Raimondo, G, Negri, E, Dallio, M, Loguercio, C, Conte, D, Celli, N, Bringiotti, R, Castellaneta, N, Salerno, F, Caraceni P., Riggio O., Angeli P., Alessandria C., Neri S., Foschi F. G., Levantesi F., Airoldi A., Boccia S., Svegliati-Baroni G., Fagiuoli S., Romanelli R. G., Cozzolongo R., Di Marco V., Sangiovanni V., Morisco F., Toniutto P., Tortora A., De Marco R., Angelico M., Cacciola I., Elia G., Federico A., Massironi S., Guarisco R., Galioto A., Ballardini G., Rendina M., Nardelli S., Piano S., Elia C., Prestianni L., Cappa F. M., Cesarini L., Simone L., Pasquale C., Cavallin M., Andrealli A., Fidone F., Ruggeri M., Roncadori A., Baldassarre M., Tufoni M., Zaccherini G., Bernardi M., Domenicali M., Giannone F. A., Merli M., Gioia S., Fasolato S., Sticca A., Campion D., Risso A., Saracco G. M., Maiorca D., Rizzotto A., Lanzi A., Neri E., Visani A., Mastroianni A., Alberti A. B., Mazzarelli C., Vangeli M., Marzioni M., Capretti F., Kostandini A., Magini G., Colpani M., Laffi G., Gabbani T., Marsico M., Zappimbulso M., Petruzzi J., Calvaruso V., Parrella G., Caporaso N., Auriemma F., Guarino M., Pugliese F., Gasbarrini A., Leo P., De Leonardis F., Pecchioli A., Rossi P., Raimondo G., Negri E., Dallio M., Loguercio C., Conte D., Celli N., Bringiotti R., Castellaneta N. M., and Salerno F.

Abstract

Background: Evidence is scarce on the efficacy of long-term human albumin (HA) administration in patients with decompensated cirrhosis. The human Albumin for the treatmeNt of aScites in patients With hEpatic ciRrhosis (ANSWER) study was designed to clarify this issue. Methods: We did an investigator-initiated multicentre randomised, parallel, open-label, pragmatic trial in 33 academic and non-academic Italian hospitals. We randomly assigned patients with cirrhosis and uncomplicated ascites who were treated with anti-aldosteronic drugs (≥200 mg/day) and furosemide (≥25 mg/day) to receive either standard medical treatment (SMT) or SMT plus HA (40 g twice weekly for 2 weeks, and then 40 g weekly) for up to 18 months. The primary endpoint was 18-month mortality, evaluated as difference of events and analysis of survival time in patients included in the modified intention-to-treat and per-protocol populations. This study is registered with EudraCT, number 2008–000625–19, and ClinicalTrials.gov, number NCT01288794. Findings: From April 2, 2011, to May 27, 2015, 440 patients were randomly assigned and 431 were included in the modified intention-to-treat analysis. 38 of 218 patients died in the SMT plus HA group and 46 of 213 in the SMT group. Overall 18-month survival was significantly higher in the SMT plus HA than in the SMT group (Kaplan-Meier estimates 77% vs 66%; p=0·028), resulting in a 38% reduction in the mortality hazard ratio (0·62 [95% CI 0·40–0·95]). 46 (22%) patients in the SMT group and 49 (22%) in the SMT plus HA group had grade 3–4 non-liver related adverse events. Interpretation: In this trial, long-term HA administration prolongs overall survival and might act as a disease modifying treatment in patients with decompensated cirrhosis. Funding: Italian Medicine Agency.

Published
2018

25. 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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26. Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe

Author

Fernandez, J., Prado, V., Trebicka, J., Amoros, A., Gustot, T., Wiest, R., Deulofeu, C., Garcia, E., Acevedo, J., Fuhrmann, V., Durand, F., Sanchez, C., Papp, M., Caraceni, P., Vargas, V., Banares, R., Piano, S., Janicko, M., Albillos, A., Alessandria, C., Soriano, G., Welzel, T.M., Laleman, W., Gerbes, A., Gottardi, A. de, Merli, M., Coenraad, M., Saliba, F., Pavesi, M., Jalan, R., Gines, P., Angeli, P., Arroyo, V., European Fdn Study Chronic Liver, Fernández, Javier, Prado, Verónica, Trebicka, Jonel, Amoros, Alex, Gustot, Thierry, Wiest, Reiner, Deulofeu, Carme, Garcia, Elisabet, Acevedo, Juan, Fuhrmann, Valentin, Durand, Françoi, Sánchez, Cristina, Papp, Maria, Caraceni, Paolo, Vargas, Victor, Bañares, Rafael, Piano, Salvatore, Janicko, Martin, Albillos, Agustin, Alessandria, Carlo, Soriano, German, Welzel, Tania M., Laleman, Wim, Gerbes, Alexander, De Gottardi, Andrea, Merli, Manuela, Coenraad, Minneke, Saliba, Faouzi, Pavesi, Marco, Jalan, Rajiv, Ginès, Pere, Angeli, Paolo, and Arroyo, Vicente

Subjects
0301 basic medicine, Liver Cirrhosis, Male, Cirrhosis, antibiotic resistance, Epidemiology, Antibiotic resistance, Antibiotics, antibiotic strategies, Antibiotic strategies, 0302 clinical medicine, Risk Factors, Drug Resistance, Multiple, Bacterial, Outcome Assessment, Health Care, Prevalence, Gastro-entérologie, Prospective Studies, 610 Medicine & health, Prognosis, Hepatology, Cross Infection, Bacterial Infections, Middle Aged, Anti-Bacterial Agents, Europe, Hospitalization, Disease Progression, 030211 gastroenterology & hepatology, Female, epidemiology, medicine.medical_specialty, medicine.drug_class, Prognosi, prevalence, 03 medical and health sciences, Spontaneous bacterial peritonitis, Pharmacotherapy, Internal medicine, medicine, Humans, Bacteria, business.industry, Bacterial pneumonia, Acute-On-Chronic Liver Failure, medicine.disease, Pneumonia, 030104 developmental biology, prognosis, business, Antibiotic strategie
Abstract

Background & Aims: Antibiotic resistance has been increasingly reported in patients with decompensated cirrhosis in single-center studies. Prospective investigations reporting broad epidemiological data are scarce. We aimed to analyze epidemiological changes in bacterial infections in patients with decompensated cirrhosis. Methods: This was a prospective evaluation of 2 series of patients hospitalized with decompensated cirrhosis. The Canonic series included 1,146 patients from Northern, Southern and Western Europe in 2011. Data on epidemiology, clinical characteristics of bacterial infections, microbiology and empirical antibiotic schedules were assessed. A second series of 883 patients from Eastern, Southern and Western Europe was investigated between 2017–2018. Results: A total of 455 patients developed 520 infections (39.7%) in the first series, with spontaneous bacterial peritonitis, urinary tract infections and pneumonia the most frequent infections. Nosocomial episodes predominated in this series. Nearly half of the infections were culture-positive, of which 29.2% were caused by multidrug-resistant organisms (MDROs). MDR strains were more frequently isolated in Northern and Western Europe. Extended-spectrum beta-lactamase-producing Enterobacteriaceae were the most frequent MDROs isolated in this series, although prevalence and type differed markedly among countries and centers. Antibiotic resistance was associated with poor prognosis and failure of antibiotic strategies, based on third-generation cephalosporins or quinolones. Nosocomial infection (odds ratio [OR] 2.74; p < 0.001), intensive care unit admission (OR 2.09; p = 0.02), and recent hospitalization (OR 1.93; p = 0.04) were identified as independent predictors of MDR infection. The prevalence of MDROs in the second series (392 infections/284 patients) was 23%; 38% in culture-positive infections. A mild increase in the rate of carbapenem-resistant Enterobacteriaceae was observed in this series. Conclusions: MDR bacterial infections constitute a prevalent, growing and complex healthcare problem in patients with decompensated cirrhosis and acute-on-chronic liver failure across Europe, negatively impacting on prognosis. Strategies aimed at preventing the spread of antibiotic resistance in cirrhosis should be urgently evaluated. Lay summary: Infections caused by bacteria resistant to the main antibiotic families are prevalent in patients with cirrhosis. This study demonstrates that this healthcare problem is increasing and extends through all European regions. Infections caused by these difficult to treat bacteria resolve less frequently and often cause the death of the patient. The type of resistant bacteria varies markedly among different hospitals., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2019
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28. Long-term albumin therapy is not futile in patients with cirrhosis and uncomplicated ascites not normalizing on-treatment serum albumin concentration

Author

Tufoni, M., primary, Caraceni, P., additional, Zaccherini, G., additional, Riggio, O., additional, Angeli, P., additional, Alessandria, C., additional, Neri, S., additional, Foschi, F.G., additional, Levantesi, F., additional, Airoldi, A., additional, Simone, L., additional, Svegliati-Baroni, G., additional, Fagiuoli, S., additional, Laffi, G., additional, Cozzolongo, R., additional, Di Marco, V., additional, Sangiovanni, V., additional, Morisco, F., additional, Toniutto, P., additional, Tortora, A., additional, De Marco, R., additional, Nardelli, S., additional, Piano, S., additional, Elia, C., additional, Roncadori, A., additional, Baldassarre, M., additional, and Bernardi, M., additional

Published
2020
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29. Terlipressin vs noradrenaline for the treatment of hepatorenal syndrome in patients with acute-on-chronic liver failure: a 5-year retrospective analysis

Author

Giovo, I., primary, Rizzo, M., additional, Ponzo, P., additional, Campion, D., additional, Roma, M., additional, Rizzi, F., additional, Risso, A., additional, Caviglia, G.P., additional, Balzola, F., additional, Martini, S., additional, Cerenzia, M. Torrani, additional, Saracco, G.M., additional, and Alessandria, C., additional

Published
2020
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30. Risk of contrast-induced acute kidney injury in cirrhotic patients undergoing computed tomography: myth or reality?

Author

Campion, D., primary, Rizzo, M., additional, Ponzo, P., additional, Risso, A., additional, Giovo, I., additional, Rizzi, F., additional, Roma, M., additional, Caropreso, P., additional, Caviglia, G.P., additional, Colla, L., additional, Biancone, L., additional, Manca, A., additional, Mengozzi, G., additional, Saracco, G.M., additional, and Alessandria, C., additional

Published
2020
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35. Adherence to EASL antibiotic treatment recommendations improves the outcomes of patients with cirrhosis and bacterial infections. Results from the ICA 'Global Study'

Author

Piano, S., Singh, V., Caraceni, P., Maiwall, R., Alessandria, C., Fernandez, J., Soares, E. C., Kim, D. J., Kim, S. E., Marino, M., Vorobioff, J., Barea, R. Ribeiro, Merli, M., Elkrief, L., Vargas, V., Krag, A., Singh, S. P., Lesmana, L. A., Toledo, C., Marciano, S., Verhelst, X., Wong, F., Intagliata, N., Rabinowich, L., Colombato, L. A., Kim, S. G., Gerbes, A., Durand, F., Roblero, J. P., Bhamidimarri, K. R., Boyer, T. D., Maevskaya, M., Fassio, E., Kim, H. S., Hwang, J. S., Gadano, A., Sarin, S. K., Angeli, P., and Grp, Int Club Ascites Global Study

Subjects
medicine.medical_specialty, Cirrhosis, Hepatology, medicine.drug_class, business.industry, Internal medicine, Antibiotics, Gastroenterology, medicine, medicine.disease, business
Published
2018
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36. Abstracts of the 33rd International Austrian Winter Symposium : Zell am See, Austria. 24-27 January 2018

Author

Binzel, K, Adelaja, A, Wright, CL, Scharre, D, Zhang, J, Knopp, MV, Teoh, EJ, Bottomley, D, Scarsbrook, A, Payne, H, Afaq, A, Bomanji, J, van As, N, Chua, S, Hoskin, P, Chambers, A, Cook, GJ, Warbey, VS, Chau, A, Ward, P, Miller, MP, Stevens, DJ, Wilson, L, Gleeson, FV, Scheidhauer, K, Seidl, C, Autenrieth, M, Bruchertseifer, F, Apostolidis, C, Kurtz, F, Horn, T, Pfob, C, Schwaiger, M, Gschwend, J, D'Alessandria, C, Morgenstern, A, Uprimny, C, Kroiss, A, Decristoforo, C, von Guggenberg, E, Nilica, B, Horninger, W, Virgolini, I, Rasul, S, Poetsch, N, Woehrer, A, Preusser, M, Mitterhauser, M, Wadsak, W, Widhalm, G, Mischkulnig, M, Hacker, M, Traub-Weidinger, T, Wuthrick, EJ, Miller, ED, Maniawski, P, Rep, S, Hocevar, M, Vaupotic, J, Zdesar, U, Zaletel, K, Lezaic, L, Mairinger, S, Filip, T, Sauberer, M, Flunkert, S, Wanek, T, Stanek, J, Okamura, N, Langer, O, Kuntner, C, Fornito, MC, Balzano, R, Di Martino, V, Cacciaguerra, S, Russo, G, Seifert, D, Kleinova, M, Cepa, A, Ralis, J, Hanc, P, Lebeda, O, Mosa, M, Vandenberghe, S, Mikhaylova, E, Borys, D, Viswanath, V, Stockhoff, M, Efthimiou, N, Caribe, P, Van Holen, R, Karp, JS, Haller, PM, Farhan, C, Piackova, E, Jäger, B, Knoll, P, Kiss, A, Podesser, BK, Wojta, J, Huber, K, Mirzaei, S, Traxl, A, Komposch, K, Glitzner, E, Sibilia, M, Russello, M, Sorko, S, Gallowitsch, HJ, Kohlfuerst, S, Matschnig, S, Rieser, M, Sorschag, M, Lind, P, Ležaič, L, Žibert, J, Frelih, N, Šuštar, S, Baum, RP, Langbein, T, Singh, A, Shahinfar, M, Schuchardt, C, Volk, GF, Kulkarni, HR, Di Martino, GV, Thomson, WH, Kudlacek, M, Karik, M, Rieger, H, Pokieser, W, Glaser, K, Petz, V, Tugendsam, C, Buchinger, W, Schmoll-Hauer, B, Schenk, IP, Rudolph, K, Krebs, M, Zettinig, G, Zoufal, V, Krohn, M, Pahnke, J, Weitzer, F, Pernthaler, B, Salamon, S, Aigner, R, Koranda, P, Henzlová, L, Kamínek, M, Váchalová, M, Bachleda, P, Summer, D, Garousi, J, Oroujeni, M, Mitran, B, Andersson, KG, Vorobyeva, A, Löfblom, JN, Orlova, A, Tolmachev, V, Kaeopookum, P, Orasch, T, Lechner, B, Petrik, M, Novy, Z, Rangger, C, and Haas, H

Published
2018

37. Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis

Author

Gustot T, Fernandez J, Garcia E, Morando F, CARACENI, PAOLO, Alessandria C, Laleman W, Trebicka J, Elkrief L, Hopf C, Solís Munoz P, Saliba F, Zeuzem S, Albillos A, Benten D, Montero Alvarez JL, Chivas MT, Concepción M, Córdoba J, McCormick A, Stauber R, Vogel W, de Gottardi A, Welzel TM, DOMENICALI, MARCO, Risso A, Wendon J, Deulofeu C, Angeli P, Durand F, Pavesi M, Gerbes A, Jalan J, Moreau R, Ginés P, BERNARDI, MAURO, Arroyo V, for the CANONIC Study Investigators of the EASL CLIF Consortium, ZACCHERINI, GIACOMO, Gustot T, Fernandez J, Garcia E, Morando F, Caraceni P, Alessandria C, Laleman W, Trebicka J, Elkrief L, Hopf C, Solís-Munoz P, Saliba F, Zeuzem S, Albillos A, Benten D, Montero-Alvarez JL, Chivas MT, Concepción M, Córdoba J, McCormick A, Stauber R, Vogel W, de Gottardi A, Welzel TM, Domenicali M, Risso A, Wendon J, Deulofeu C, Angeli P, Durand F, Pavesi M, Gerbes A, Jalan J, Moreau R, Ginés P, Bernardi M, Arroyo V, and for the CANONIC Study Investigators of the EASL-CLIF Consortium.

Subjects
Adult, medicine.medical_specialty, Cirrhosis, Bilirubin, medicine.medical_treatment, clinical course, Disease, Liver transplantation, survival, chemistry.chemical_compound, Internal medicine, Intensive care, medicine, Humans, Decompensation, Aged, Hepatology, business.industry, cirrhosis, Acute-On-Chronic Liver Failure, Middle Aged, medicine.disease, Prognosis, Surgery, Discontinuation, Liver Transplantation, Europe, chemistry, business, prognosi
Abstract

Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation (AD) of cirrhosis, organ failure(s), and high 28-day mortality. We investigated whether assessments of patients at specific time points predicted their need for liver transplantation (LT) or the potential futility of their care. We assessed clinical courses of 388 patients who had ACLF at enrollment, from February through September 2011, or during early (28-day) follow-up of the prospective multicenter European Chronic Liver Failure (CLIF) ACLF in Cirrhosis study. We assessed ACLF grades at different time points to define disease resolution, improvement, worsening, or steady or fluctuating course. ACLF resolved or improved in 49.2%, had a steady or fluctuating course in 30.4%, and worsened in 20.4%. The 28-day transplant-free mortality was low-to-moderate (6%-18%) in patients with nonsevere early course (final no ACLF or ACLF-1) and high-to-very high (42%-92%) in those with severe early course (final ACLF-2 or -3) independently of initial grades. Independent predictors of course severity were CLIF Consortium ACLF score (CLIF-C ACLFs) and presence of liver failure (total bilirubin ≥12 mg/dL) at ACLF diagnosis. Eighty-one percent had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade at 3-7 days. Among patients that underwent early LT, 75% survived for at least 1 year. Among patients with ≥4 organ failures, or CLIF-C ACLFs >64 at days 3-7 days, and did not undergo LT, mortality was 100% by 28 days. Conclusions: Assessment of ACLF patients at 3-7 days of the syndrome provides a tool to define the emergency of LT and a rational basis for intensive care discontinuation owing to futility. (Hepatology 2015;62:243-252)

Published
2015
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38. Long-term albumin administration in patients with cirrhosis and uncomplicated ascites: the use of serum albumin concentration for personalizing treatment

Author

Zaccherini, G., primary, Riggio, O., additional, Angeli, P., additional, Alessandria, C., additional, Neri, S., additional, Foschi, F.G., additional, Levantesi, F., additional, Airoldi, A., additional, Simone, L., additional, Svegliati-Baroni, G., additional, Fagiuoli, S., additional, Romanelli, R.G., additional, Cozzolongo, R., additional, Di Marco, V., additional, Sangiovanni, V., additional, Morisco, F., additional, Toniutto, P., additional, Tortora, A., additional, De Marco, R., additional, Nardelli, S., additional, Piano, S., additional, Elia, C., additional, Roncadori, A., additional, Baldassarre, M., additional, Tufoni, M., additional, Caraceni, P., additional, and Bernardi, M., additional

Published
2019
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39. Response to treatment and mortality in patients with acute-on-chronic liver failure according to the new definition of hepatorenal syndrome: a single center 3-year retrospective analysis

Author

Giovo, I., primary, Campion, D., additional, Ponzo, P., additional, Rizzo, M., additional, Caviglia, G.P., additional, Balzola, F., additional, Martini, S., additional, Cerenzia, M. Torrani, additional, Saracco, G.M., additional, and Alessandria, C., additional

Published
2019
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41. Clinical experience with 100 consecutive patients treated with Lu-177-labeled PSMA-I&T radioligand therapy for metastatic castration-resistant prostate cancer: Final analysis

Author

Tauber, R.L., primary, Knorr, K., additional, Schwaiger, S., additional, Retz, M., additional, Maurer, T., additional, D'Alessandria, C., additional, Wester, H.-J., additional, Gschwend, J., additional, Weber, W., additional, Schwaiger, M., additional, Heck, M.M., additional, and Eiber, M., additional

Published
2018
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43. Regional variations in the development of acute-on-chronic liver failure (ACLF) in patients with cirrhosis and bacterial infections

Author

Wong, F., primary, Singh, V., additional, Caraceni, P., additional, Maiwall, R., additional, Piano, S., additional, Marciano, S., additional, Fernandez, J., additional, Alessandria, C., additional, Soares, E., additional, Kim, D.J., additional, Kim, S.E., additional, Marino, M., additional, Vorobioff, J., additional, de Cassia Ribeiro Barea, R., additional, Merli, M., additional, Elkrief, L., additional, Manuel, V., additional, Blasco, V., additional, Krag, A., additional, Singh, S., additional, Lesmana, L.A., additional, Toledo, C., additional, Xavier, V., additional, Intagliata, N., additional, Rabinowich, L., additional, Bruns, T., additional, Yoon, E.L., additional, Girala, M., additional, Pyrsopoulos, N.T., additional, Kim, T.H., additional, Yim, S.Y., additional, Durand, F., additional, Gadano, A., additional, and Angeli, P., additional

Published
2018
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44. 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., primary, Singh, V., additional, Caraceni, P., additional, Maiwall, R., additional, Alessandria, C., additional, Fernandez, J., additional, Soares, E., additional, Kim, D.J., additional, Kim, S.E., additional, Marino, M., additional, Vorobioff, J., additional, de Cassia Ribeiro Barea, R., additional, Merli, M., additional, Elkrief, L., additional, Blasco, V.M.V., additional, Krag, A., additional, Singh, S., additional, Lesmana, L.A., additional, Toledo, C., additional, Marciano, S., additional, Xavier, V., additional, Wong, F., additional, Intagliata, N., additional, Rabinowich, L., additional, Colombato, L.A., additional, Kim, S.G., additional, Gerbes, A., additional, Durand, F., additional, Roblero, J.P., additional, Bhamidimarri, K., additional, Boyer, T.D., additional, Maevskaya, M., additional, Fassio, E.L., additional, Kim, H.S., additional, Hwang, J.-S., additional, Gadano, A., additional, Sarin, S.K., additional, and Angeli, P., additional

Published
2018
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45. Determinants of clinical efficacy of empirical antibiotic treatment in patients with cirrhosis and bacterial infections: Results from the ICA global study

Author

Maiwall, R., primary, Piano, S., additional, Singh, V., additional, Caraceni, P., additional, Alessandria, C., additional, Fernandez, J., additional, Soares, E., additional, Kim, D.J., additional, Kim, S.E., additional, Marino, M., additional, Vorobioff, J., additional, de Cassia Ribeiro Barea, R., additional, Merli, M., additional, Elkrief, L., additional, Blasco, V.M.V., additional, Krag, A., additional, Singh, S., additional, Lesmana, L.A., additional, Toledo, C., additional, Marciano, S., additional, Xavier, V., additional, Wong, F., additional, Intagliata, N., additional, Rabinowich, L., additional, Colombato, L.A., additional, Kim, S.G., additional, Gerbes, A., additional, Durand, F., additional, Roblero, J.P., additional, Kim, J.H., additional, Man, R.D., additional, Song, D.S., additional, Brodersen, C.E., additional, Gadano, A., additional, Sarin, S.K., additional, and Angeli, P., additional

Published
2018
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46. Albumin administration in the prevention of hepatorenal syndrome (HRS) and death in patients with advanced cirrhosis and non-SBP infections

Author

Fernandez, J., primary, Angeli, P., additional, Trebicka, J., additional, Merli, M., additional, Gustot, T., additional, Alessandria, C., additional, Aagaard, N.K., additional, De Gottardi, A., additional, Zeuzem, S., additional, Gerbes, A., additional, Soriano, G., additional, Vargas, V., additional, Albillos, A., additional, Salerno, F., additional, Durand, F., additional, Bañares, R., additional, Stauber, R.E., additional, Prado, V., additional, Arteaga, M., additional, Morando, F., additional, Jansen, C., additional, Lattanzi, B., additional, Moreno, C., additional, Risso, A., additional, Grønbæk, H., additional, Garcia, R., additional, Pavesi, M., additional, and Arroyo, V., additional

Published
2018
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47. Adherence to EASL antibiotic treatment recommendations improves the outcomes of patients with cirrhosis and bacterial infections. Results from the ICA Global Study

Author

Piano, S., primary, Singh, V., additional, Caraceni, P., additional, Maiwall, R., additional, Alessandria, C., additional, Fernandez, J., additional, Soares, E., additional, Kim, D.J., additional, Kim, S.E., additional, Marino, M., additional, Vorobioff, J., additional, de Cassia Ribeiro Barea, R., additional, Merli, M., additional, Elkrief, L., additional, Blasco, V.M.V., additional, Krag, A., additional, Singh, S., additional, Lesmana, L.A., additional, Toledo, C., additional, Marciano, S., additional, Xavier, V., additional, Wong, F., additional, Intagliata, N., additional, Rabinowich, L., additional, Colombato, L.A., additional, Kim, S.G., additional, Gerbes, A., additional, Durand, F., additional, Roblero, J.P., additional, Bhamidimarri, K., additional, Boyer, T.D., additional, Maevskaya, M., additional, Fassio, E.L., additional, Kim, H.S., additional, Hwang, J.-S., additional, Gadano, A., additional, Sarin, S.K., additional, and Angeli, P., additional

Published
2018
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48. The kynurenine pathway in cirrhosis. Relationship with the development of acute decompensation and acute-on-chronic liver failure, clinical course and mortality

Author

Clària, J., primary, Moreau, R., additional, Fenaille, F., additional, Amoros, A., additional, Junot, C., additional, Gronbaek, H., additional, Coenraad, M., additional, Oettl, K., additional, Caraceni, P., additional, Alessandria, C., additional, Trebicka, J., additional, Pavesi, M., additional, Gomez, C.D., additional, Albillos, A., additional, Gustot, T., additional, Welzel, T., additional, Fernandez, J., additional, Stauber, R.E., additional, Saliba, F., additional, Butin, N., additional, Colsch, B., additional, Moreno, C., additional, Durand, F., additional, Nevens, F., additional, Bañares, R., additional, Benten, D., additional, Ginès, P., additional, Gerbes, A., additional, Jalan, R., additional, Angeli, P., additional, Bernardi, M., additional, and Arroyo, V., additional

Published
2018
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49. Radioligand therapy with Lutetium 177-labeled PSMA-I&T for metastatic castration-resistant prostate cancer: Clinical experience with 100 consecutive patients

Author

Heck, M., primary, Schwaiger, S., additional, Knorr, K., additional, Retz, M., additional, Maurer, T., additional, Janssen, F., additional, D`Alessandria, C., additional, Wester, H.-J., additional, Gschwend, J., additional, Schwaiger, M., additional, Tauber, R., additional, and Eiber, M., additional

Published
2018
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50. Long-term use of human albumin for the treatment of ascites in patients with hepatic cirrhosis: the interim analysis of the ANSWER study

Author

Bernardi M, Riggio O, Angeli P, Alessandria C, Neri S, Foschi FG, Levantesi F, Boccia S, Airoldi A, Fagiuoli S, Svegliati Baroni G, Laffi G, Cozzolongo R, Butera G, Sangiovanni V, Toniutto P, Zocco MA, De Marco R, Morisco F, De Leonardis F, Cacciola I, Elia G, Massironi S, Guarisco R, Marin A, Piano V, Elia C, Nardelli S, Maiorca V, Neri V, Mastroianni A, Tufoni M, Simone L, Cesarini L., Magini G, Marzioni M, Romanelli R. G, Zappimbulso M, Macaluso F, Parrella G, Pugliese F, Tortora A, Cavallin M, Andrealli A, Pasquale C, Fidone F, Lanzi A, Alberti A, Salerno F, Roncadori A, Zaccherini G, Caraceni P, the ANSWER Study Group, FEDERICO, Alessandro, Bernardi, M, Riggio, O, Angeli, P, Alessandria, C, Neri, S, Foschi, Fg, Levantesi, F, Boccia, S, Airoldi, A, Fagiuoli, S, Svegliati Baroni, G, Laffi, G, Cozzolongo, R, Butera, G, Sangiovanni, V, Toniutto, P, Zocco, Ma, De Marco, R, Morisco, F, De Leonardis, F, Cacciola, I, Elia, G, Federico, Alessandro, Massironi, S, Guarisco, R, Marin, A, Piano, V, Elia, C, Nardelli, S, Maiorca, V, Neri, V, Mastroianni, A, Tufoni, M, Simone, L, Cesarini, L., Magini, G, Marzioni, M, Romanelli, R. G., Zappimbulso, M, Macaluso, F, Parrella, G, Pugliese, F, Tortora, A, Cavallin, M, Andrealli, A, Pasquale, C, Fidone, F, Lanzi, A, Alberti, A, Salerno, F, Roncadori, A, Zaccherini, G, Caraceni, P, and the ANSWER Study, Group

Published
2015

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