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1. Opportunistic population screening as a hepatitis elimination strategy: the CRIVALVIR-FOCUS program

Author

Enrique Ortega González, María Dolores Ocete Mochón, Concepción Gimeno Cardona, María Martínez-Roma, Moisés Diago Madrid, Neus Gómez Muñoz, Alba Carrodeguas, José Luis González-Sánchez, and Miguel García-Deltoro

Subjects
Hepatitis, HBV, HCV, Opportunistic, Population, Screening, Infectious and parasitic diseases, RC109-216
Abstract

Objectives: Hepatitis B (HBV) and hepatitis C (HCV) viruses are significant causes of primary liver cancer, responsible for over a million deaths annually. We aimed to develop a screening strategy for viral hepatitis elimination in Spain, aligned with WHO's 2030 objectives. Design: The CRIVALVIR-FOCUS program, conducted at the Consortium General University Hospital of Valencia, aimed to identify individuals with active blood-borne viral infections through opportunistic population screening. The hospital's Health Department serves more than 280,000 adults. Results: Of the 31,995 adults screened (52% women; 15% immigrants), HBV prevalence was 0.44%, with higher rates in men (0.57%) than women (0.32%), and notably higher in migrants (1.27%) compared to Spanish nationals (0.30%). The 45-64 age group had the highest HBV prevalence (0.65%). HCV prevalence was 0.35%, again higher in men than women (0.51% vs 0.20%) and in migrants compared to Spanish nationals (0.58% vs 0.31%), with the 45-64 age group showing the highest HCV prevalence (0.76%). From the positive tests, 78.0% (110/141) of HBV cases and 71.4% (80/112) of HCV cases were patients previously unaware of their infections. Conclusion: Opportunistic screening effectively identifies early cases, potentially enhancing prevention of new infections. Our study highlights the need for targeted interventions for individuals aged 45-64 and migrants. Designing specific screening programs, in collaboration with social workers and cultural mediators, is critical to improve access to care. Training and involving primary care professionals are vital actions for the program's success.

Published
2024
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2. P-36 RESULTS OF AN AUTOMATIC ALERT SYSTEM FROM MICROBIOLOGY TO LINK DIAGNOSIS TO TREATMENT IN PATIENTS WITH CHRONIC HEPATITIS C

Author

Carlos Alventosa Mateu, María Dolores Ocete Mochón, Juan José Urquijo Ponce, Mercedes Latorre Sánchez, Inmaculada Castelló Miralles, Miguel García Deltoro, Enrique Ortega González, María José Bonet Igual, Concepción Gimeno Cardona, and Moisés Diago Madrid

Subjects
Specialties of internal medicine, RC581-951
Abstract

Introduction and Objectives: Strategies to simplify the care circuit for patients with the hepatitis C virus (HCV) are vital to achieving its eradication. To achieve this aim, we introduced an electronic system of HCV serology detection to link diagnosis with specialized assistance in order to minimize the loss of patients. Materials and Methods: A retrospective single-center study of HCV patients developed by Microbiology Department from February 15th, 2020, to December 15th, 2021. In the event of a positive HCV antibody, the anti-HCV core was directly measured by the electronic system. If positive, an encrypted e-mail with the patient data was automatically sent to HCV specialized physicians, who, after evaluating the benefits of antiviral therapy in each patient, contacted them by phone for an appointment. In the first face-to-face consultation FibroScan®, HCV genotype and viral load measurement were performed, and antiviral therapy was prescribed. Patient diagnosis origin and public health characteristics were recorded. We analyzed the association between antiviral therapy prescription and these variables. Statistical significance was set at p˂0.005. Results: Of 171 patients identified, with a mean age of 59.6 ± 15.9, 61.5 % of males and 81.2% of Spanish nationals. HCV origin from out-of-hospital settings predominated (50.9%, 87/171), particularly primary care (28.7%), penitentiary (11.6%) and addiction units (8.2%). In all, 43.3% (74/171) were aware of their diagnosis, but 64.9% (48/74) hadn't previously received antiviral therapy. Genotype 1 predominated. We recorded 19.4% (20/103) of patients F3 fibrosis and 27.2% (26/103) F4.Finally, 58.5% (100/171) attended a physician consultation. They were all treated with pangenotypic interferon-free therapy. A 100% rate of sustained viral response was achieved. The main reasons for not being treated were high comorbidity (43.7%,31/71), not located (23.9%, 17/71), patient refusal to treatment (23.9%,17/71) and death (8.5%,6/71). The sole association found between antiviral therapy and patient variables was that of comorbidities with being untreated (OR=7.14, p˂0.001). Conclusions: Our alert system is simple and easily reproducible. It allows for minimizing the loss of HCV patients, even considering it was performed during the COVID-19 pandemic.

Published
2023
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3. One-step diagnosis strategy together with multidisciplinary telematics referral perform an effective approach for identifying and treating patients with active Hepatitis C infection

Author

Miriam Torrecillas, Neus Gómez-Muñoz, María Dolores Ocete, Purificación Rubio Cuevas, Moisés Diago Madrid, Enrique Ortega González, Concepción Gimeno Cardona, and Miguel García-Deltoro

Subjects
Hepatitis C virus, HCV-cAg, One-step, Two-step, Viremia, Telematics referral, Specialties of internal medicine, RC581-951
Abstract

Introduction and objectives: Implementation of a one-step strategy for diagnosis of active Hepatitis C virus (HCV) infection would encourage the early diagnosis and reduce the time to access antiviral treatments. The aim of this study was to evaluate the impact of a HCV one-step diagnosis compared to the traditional two-step protocol in terms of the time required for patients to be seen by specialists and the time taken to start antiviral treatment. Material and methods: A comparative study was carried out to assess two diagnostic algorithms (one-step and two-step) for active HCV infection. Serological markers were quantified using the same serum sample to determine both anti-HCV antibodies (HCV-Ab) and HCV core antigen (HCV-cAg) by Architect i2000 SR kit. In this period, a multidisciplinary procedure was started for telematics referral of viremic patients. Results: One-step approach reduced the time required for patient HCV diagnosis, referral to a specialist, access to treatment, and eliminated the loss of patients to follow-up. Significant differences were observed between one-step and two-step diagnosis methods in the time required for patients to be seen by a specialist (18 days [Interquartile range (IQR) = 14–42] versus 107 days [IQR = 62–148]) and for the initiation of treatment (54 days [IQR = 43–75] versus 200 days [IQR = 116–388]), mainly for patients with advanced fibrosis (35 days [IQR = 116–388] versus 126 days [IQR = 152–366]). Conclusions: Use of HCV-cAg has proven to be a useful tool for screening patients with active hepatitis C. The development of a multidisciplinary protocol for the communication of results improved the efficiency of the care process.

Published
2022
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4. No association between IFNL3 (IL28B) genotype and response to peginterferon alfa-2a in HBeAg-positive or -negative chronic hepatitis B.

Author

Lai Wei, Heiner Wedemeyer, Yun-Fan Liaw, Henry Lik-Yuen Chan, Teerha Piratvisuth, Patrick Marcellin, Jidong Jia, Deming Tan, Wan-Cheng Chow, Maurizia R Brunetto, Moisés Diago, Selim Gurel, Viacheslav Morozov, Hua He, Yonghong Zhu, Cynthia Wat, Bernadette Surujbally, and Alexander J Thompson

Subjects
Medicine, Science
Abstract

BACKGROUND & AIMS:It has yet to be firmly established whether host IFNL3 (IL28B) genotype influences interferon responsiveness in patients with chronic hepatitis B. We investigated associations between single-nucleotide polymorphisms (SNPs) in the IFNL3 region and response to peginterferon alfa-2a in 701 patients enrolled in three large, randomized, international studies. METHODS:Responses were defined as hepatitis B surface antigen (HBsAg) loss and/or hepatitis B e antigen (HBeAg) seroconversion plus hepatitis B virus (HBV) DNA

Published
2018
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5. High efficacy and safety of triple therapy in HCV genotype 1 and moderate fibrosis: a multicenter study of clinical practice in Spain

Author

Javier Crespo, MD, Ph.D., Moisés Diago, Joaquín Cabezas, Marina Berenguer, Teresa Broquetas, Miguel Ángel Serra, Rosa Morillas, Javier García-Samaniego, José Luis Calleja, Juan José Sánchez, Sabela Lens, Susana Soto-Fernández, Begoña Sacristán, Inmaculada Fernández, Carmen López-Núñez, María Buti, Manuel Romero-Gómez, Federico Sáez-Royuela, Conrado Fernández, Francisco Jorquera, Gloria Sánchez-Antolín, Juan Manuel Pascasio, Antonio Cuadrado, and Manuel Hernández-Guerra

Subjects
Hepatitis C genotype 1, Moderate fibrosis, Telaprevir triple therapy, Safety and efficacy, Specialties of internal medicine, RC581-951
Abstract

Background and rational. Telaprevir-based therapy (TBT) has been extensively evaluated in clinical trials. So we designed a study to compare the efficacy and safety of TBT between patients with moderate fibrosis and those suffering from advanced fibrosis in clinical practice. A multicenter observational and ambispective study was conducted. It included 582 patients with chronic hepatitis C genotype 1, 214 with fibrosis F2, and 368 with F3/F4 (F3: 148; F4: 220).Results. The mean patient age was 55 years, 67% male. Type of prior response was 22% naïve, 57% relapsers, and 21% partial/null responders, 69% had high viral load (> 800,000 IU/mL). HCV genotypes were 1a (19%), 1b (69%), and 1 (12%), respectively. Sixty-five percent were non-CC IL28B genotype. Week-12 sustained virologic response (SVR12) was significantly higher among F2-naïve patients (78%) compared with F3/F4-naïve patients (60%; p = 0.039) and among F2 non-responders (67%) compared with F3/F4 non-responders (42%; p = 0.014). SVR12 among relapsers was remarkably high in both groups (F2:89% vs. F3/F4:78%). Severe anemia and thrombocytopenia were more frequent among patients with F3/F4 than those with F2 (p < 0.01). Overall, 132 patients (22%) discontinued treatment: 58 due to adverse effects, 42 due to the stopping-rule, and 32 due to breakthrough. Premature discontinuation was more frequent among patients with F3/F4 (p = 0.028), especially due to breakthrough (p < 0.001). Conclusions. This multicenter study demonstrates high efficacy and an acceptable safety profile with regard to TBT in F2-patients in clinical practice.

Published
2015
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6. PNPLA3 rs738409 causes steatosis according to viral & IL28B genotypes in hepatitis C

Author

Javier Ampuero, José A. Del Campo, Lourdes Rojas, José R. García-Lozano, Ricard Solá, Raúl Andrade, José A. Pons, José M. Navarro, José L. Calleja, María Buti, María F. González-Escribano, Xavier Forns, Moisés Diago, Javier García-Samaniego, and Manuel Romero-Gómez, M.D., Ph.D.

Subjects
Single nucleotide polymorphism, Viral replication, Huh7.5 cells, Liver biopsy, Dyslipidemia, Specialties of internal medicine, RC581-951
Abstract

Background. Hepatitis C virus (HCV) is associated with a higher prevalence of steatosis compared to the general population. Aim. Our aim was to assess the impact of PNPLA3 rs738409 G-allele on steatosis in HCV patients.Material and methods. We included 474 HCV patients treated with peginterferon plus ribavirin. PNPLA3 rs738409 was genotyped and patients were classified according to alleles and genotypes. Steatosis was detected in 46.4% (220/474). Fibrosis was assessed by Scheuer score. Gene expression was analyzed in Huh7.5 and Huh7 cells using Real Time-PCR.Results. PNPLA3 allele-G was associated with steatosis [54.1% (126/233) vs. 39% (94/241)] (p = 0.0001). In HCV-1, allele-G was related to steatosis [50.6% (82/162) vs. 32.3% (53/164)] (p = 0.001), but did not in HCV-3 [61.9% (26/42) vs. 62% (31/50)] (p = 0.993). PNPLA3 allele-G was associated with steatosis in patients with IL28B-CT/TT [57.7% (82/142) vs. 37.1% (56/151)] (p = 0.0001), but did not in IL28B-CC [47.8% (43/90) vs. 42% (37/88)] (p = 0.442). Independent variables associated with steatosis were: PNPLA3 G-allele [O.R. 1.84 (CI95%: 1.06-3.21); p = 0.007], age [O.R. 1.04 (CI95%: 1.01-1.07); p = 0.017], HCV-genotype 3 [O.R. 2.46 (CI95%: 1.30-4.65); p = 0.006], HOMA > 4 [O.R. 2.72 (CI95%: 1.27-5.82); p = 0.010]. Since PNPLA3 RNA could not be detected on PBMC from HCV patients, an in vitro analysis was performed. Huh7.5 cells infected with JFH1 had a decreased PNPLA3 gene expression (fold inhibition = 3.2 ± 0.2), while Huh7 cells presented increased PNPLA3 gene expression (fold induction = 1.5 ± 0.2).Conclusion. PNPLA3 allele-G modulated the development of steatosis, particularly in patients with HCV-1 and IL28B-CT/TT genotype, but was not associated with SVR. Metabolic but not viral steatosis seems to be PNPLA3 regulated. Gene interaction may result in differential PNPLA3 gene expression levels in HCV infection.

Published
2014
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7. Polycystic liver in the adult (PLA) in Spain: analysis of a structured survey analysing the experience and attitude of gastroenterologists in Spain

Author

Javier Ampuero, Jesús M. Bañales, Germán Soriano, Javier Crespo, José Luis Olcoz, Moisés Diago, José Luis Calleja, and Manuel Romero-Gómez

Subjects
Poliquistosis hepática, Enfermedad poliquística renal, Enfermedad poliquística hepática, Análogos somatostatina, Inhibidores mTOR, Trasplante hepático, Fenestración laparotómica o laparoscópica, Enfermedad poliquística hepática autosómica dominante (PCLD), Enfermedad poliquística renal autosómica dominante (PCKD), Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background: Polycystic liver in the adult (PLA) is a rare disease characterized by chronic liver enlargement. Objective: To analyse gastroenterologists' involvement in, experience with, and attitude toward diagnosing, monitoring, and treating patients with PLA in Spain. Methods: Each of seven study coordinators contacted 15 specialists in their geographic area about participating in the study via an online structured survey. Results: Of the 105 clinics contacted, 88 completed the questionnaire, with a mean of 3 patients being followed per practice, although 6 clinics were following more than 20 patients with PLA. Patients were being followed mainly by the Department of Hepatology (81 %) and/or the Department of Gastroenterology (33 %). The majority of patients were diagnosed (98 %) and monitored (97 %) using liver ultrasound. When diagnosed, 76 % of patients were under 50 years of age, females predominating. The primary treatment objective for the patients was symptomatic management. Pharmacotherapy was prescribed by 28 % of physicians: Somatostatin analogues, primarily, followed by mTOR inhibitors. One-third of the clinics indicated that they had patients who had undergone liver transplant and/or surgery. Conclusions: Ultrasound is the diagnosing and monitoring method of choice. Among the clinics using pharmacotherapy for symptomatic management, somatostatin analogues were the drugs of choice. These clinics' infrequent use of invasive procedures suggests that they perceive the various invasive techniques as not very effective.

Published
2014

9. Safety and efficacy of treatment with pegylated interferon alpha-2a with ribavirin in chronic hepatitis C genotype 4

Author

Juan José Urquijo, Moisés Diago, M.D., Jaume Boadas, Ramón Planas, Ricard Solá, Juan Angel del Olmo, Javier Crespo, José Carlos Erdozaín, María Dolores Antón, Carlos Arocena, Dolores Suarez, Josep Giné, Josep M Barrera, Javier Gracia-Samaniego, Ricardo Perez, Blai Dalmau, and Miguel Montoro

Subjects
Peginterferon, Ribavirin, Sustained viral response, Specialties of internal medicine, RC581-951
Abstract

The hepatitis C virus (HCV) genotype is an important predictive outcome parameter for pegylated interferon plus ribavirin therapy. Most published therapeutic trials to date have enrolled mainly patients with HCV genotypes 1, 2 and 3. Limited studies have focused on genotype 4 patients, who have had a poor representation in pivotal trials. Our aim was to evaluate the efficacy and safety of treatment with standard dose pegylated interferon alfa-2a in combination with weight-based ribavirin in patients with chronic hepatitis C genotype 4. In this prospective observational study, 198 patients with HCV-4 were included in this study from February 2004 to August 2005,188 patients who received at least 1 dose of drugs were included in the ITT analysis and they were treated with pegylated interferon alfa-2a and ribavirin for 48 weeks. Baseline and demographic characteristics, response to treatment at weeks 12, 48 and 72, and the nature and frequency of adverse effects were analyzed. Virological response at week 12 was achieved in 144 patients (76.6%). Virological response at the end of treatment was present in 110 patients (58.5%). At week 72, 99 patients presented SVR (52.7%). The reported adverse events were similar to those found in the literature for treatments of similar dose and duration. In conclusion, combined treatment with pegylated interferon alfa-2a and ribavirin was well tolerated and effective in chronic hepatitis C genotype 4, yielding response rates between those reported for genotype 1 and those of genotypes 2-3.

Published
2013
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13. Glomerulonefritis Fibrilar Extrarrenal Como Nueva Etiología De Enfermedad Hepática Avanzada

Author

Mateu, Carlos Alventosa, primary, Gimeno, Ana Vilar, additional, Álvarez, Irene Pérez, additional, Zamorano, Javier Carbonell, additional, Miralles, Inmaculada Castelló, additional, Sánchez, Mercedes Latorre, additional, Ponce, Juan José Urquijo, additional, Leandro, Encarnación Martínez, additional, Mas, Liria Terrádez, additional, and Madrid, Moisés Diago, additional

Published
2023
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14. Tenofovir Disoproxil Fumarate Reduces the Severity of COVID-19 in Patients with Chronic Hepatitis B

Author

Beatriz Mateos-Muñoz, María Buti, Inmaculada Fernández Vázquez, Marta Hernández Conde, Vanesa Bernal-Monterde, Fernando Díaz-Fontenla, Rosa María Morillas, Luisa García-Buey, Ester Badía, Mireia Miquel, Alberto Amador-Navarrete, Sergio Rodríguez-Tajes, Lucía Ramos-Merino, Antonio Madejón, Montserrat García-Retortillo, Juan Ignacio Arenas, Joaquín Cabezas, Jesús Manuel González Santiago, Conrado Fernández-Rodríguez, Patricia Cordero, Moisés Diago, Antonio Mancebo, Alberto Pardo, Manuel Rodríguez, Elena Hoyas, Jose Javier Moreno, Juan Turnes, Miguel Ángel Simón, Cristina Marcos-Fosch, Jose Luis Calleja, Rafael Bañares, Sabela Lens, Javier Garcia-Samaniego, Javier Crespo, Manuel Romero-Gomez, Francisco Gea, Enrique Rodríguez de Santiago, Santiago Moreno, Agustin Albillos, Institut Català de la Salut, [Mateos-Muñoz B] Hospital Universitario Ramón y Cajal, CIBEREHD, IRYCIS, Universidad de Alcalá, Madrid, Spain. [Buti M, Marcos-Fosch C] Servei d’Hepatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. CIBEREHD, Barcelona, Spain. [Fernández Vázquez I] Gastroenterology Department, Hospital Universitario, 12 de Octubre, Madrid, Spain. [Hernández Conde M] Gastroenterology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain. [Bernal-Monterde V] Gastroenterology Department, Hospital Miguel Servet, Zaragoza, Spain. [Díaz-Fontenla F] Gastroenterology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Otros calificadores::/uso terapéutico [Otros calificadores], Physiology, Gastroenterology, Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores], Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES], Other subheadings::Other subheadings::/drug therapy [Other subheadings], virosis::infecciones por virus ADN::infecciones por Hepadnaviridae::hepatitis B::hepatitis B crónica [ENFERMEDADES], Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antiviral Agents [CHEMICALS AND DRUGS], COVID-19 (Malaltia) - Tractament, acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antivíricos [COMPUESTOS QUÍMICOS Y DROGAS], virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES], Medicaments antivírics - Ús terapèutic, Other subheadings::/therapeutic use [Other subheadings], Hepatitis B - Tractament, Virus Diseases::DNA Virus Infections::Hepadnaviridae Infections::Hepatitis B::Hepatitis B, Chronic [DISEASES]
Abstract

COVID-19; Hepatitis B; Tenofovir COVID-19; Hepatitis B; Tenofovir COVID-19; Hepatitis B; Tenofovir Background and Aims HIV-positive patients on tenofovir hydroxyl fumarate (TDF)/emtricitabine have a lower risk of COVID-19 and hospitalization than those given other treatments. Our aim was to analyze the severity of COVID-19 in patients with chronic hepatitis B (CHB) on TDF or entecavir (ETV). Methods Spanish hospital databases (n = 28) including information regarding adult CHB patients on TDF or ETV for the period February 1st to November 30th 2020 were searched for COVID-19, defined as a positive SARS-CoV-2 polymerase chain reaction, and for severe COVID-19. Results Of 4736 patients, 117 had COVID-19 (2.5%), 67 on TDF and 50 on ETV. Compared to patients on TDF, those on ETV showed (p

Published
2023

15. P-36 RESULTS OF AN AUTOMATIC ALERT SYSTEM FROM MICROBIOLOGY TO LINK DIAGNOSIS TO TREATMENT IN PATIENTS WITH CHRONIC HEPATITIS C

Author

Mateu, Carlos Alventosa, primary, Mochón, María Dolores Ocete, additional, Ponce, Juan José Urquijo, additional, Sánchez, Mercedes Latorre, additional, Miralles, Inmaculada Castelló, additional, Deltoro, Miguel García, additional, González, Enrique Ortega, additional, Igual, María José Bonet, additional, Cardona, Concepción Gimeno, additional, and Madrid, Moisés Diago, additional

Published
2023
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16. HEPATITIS B VIRUS REACTIVATION AFTER IBRUTINIB TREATMENT

Author

Carlos Alventosa Mateu, Juan José Urquijo Ponce, Armando Mena Durán, Mercedes Latorre Sánchez, Inmaculada Castelló Miralles, Mariano Linares García, and Moisés Diago

Subjects
Gastroenterology, General Medicine
Published
2023

17. OUTCOMES OF AN AUTOMATED ALERT SYSTEM FROM MICROBIOLOGY TO LINK DIAGNOSIS TO TREATMENT IN PATIENTS WITH HEPATITIS C VIRUS

Author

Carlos, Alventosa Mateu, María Dolores, Ocete Mochón, Juan José, Urquijo Ponce, Mercedes, Latorre Sánchez, Inmaculada, Castelló Miralles, Miguel, García Deltoro, Enrique, Ortega González, María José, Bonet Igual, Concepción, Gimeno Cardona, and Moisés, Diago Madrid

Subjects
Gastroenterology, General Medicine
Abstract

Simplification strategies for the care circuit of patients with hepatitis C virus (HCV) are key to achieve eradication. We set up an electronic identification system for HCV serology to link diagnosis to specialist management aiming at reducing patient loss.A restrospective, single-center study in patients with HCV identified from 15/3/2020 to 15/12/2021 using an alert system from Microbiology that notified specialists of positive cases. The patient was contacted and appointed for a Fibroscan® and viral load measurement, with antiviral therapy being prescribed on the same day. We recorded origin, public health data, patient location rate, and antiviral therapy prescription.Of 174 patients identified, 171 had positive viremia, with a mean age of 59.6 ± 15.9 years, 61.5 % of males, and 81.2 % of Spanish nationals. Origin in the outpatient setting predominated (57.9 %, 99/171), particularly primary care (51/171), penitentiaries (21/171), and addiction units (14/171). In all, 43.3 % (74/171) were aware of their diagnosis. We recorded 19.4 % (20/103) of patients with F3 fibrosis and 25.2 % (26/103) with F4 fibrosis. We deemed 78.4 % (134/171) were candidates for treatment. Of these, 74.6 % (100/134) were located and initiated treatment, and all those who completed their treatment achieved a sustained viral response (96/96). We managed with this system 58.5 % (100/171) of the patients identified. The sole association found between antiviral therapy and patient variables was that of comorbidities with being untreated (OR, 7.14; p ˂ 0.001).This alert system allows to minimize loss of patients in the care circuit, and provides high rates of treated patients.

Published
2022

18. Oportunistic diagnosis based on age and hepatitis C virus clearance: an essential step to improve the overall health of the liver

Author

Joaquín Cabezas, Javier Crespo, Antonio Aguilera, Agustín Albillos, Maria Buti, José Luís Calleja, Jorge Calvo Montes, Marta Casado Martín, Moisés Diago Madrid, Conrado Fernández Rodríguez, Inmaculada Fernández Vázquez, Xavier Forns, Federico García, Javier García-Samaniego, Manuel Hernández-Guerra Aguilar, Francisco Jorquera Plaza, Jeffrey V. Lazarus, Sabela Lens, Elisa Martró, José María Molero García, Maria José Pena López, Juan Antonio Pineda, Manuel Rodríguez, Manuel Romero Gómez, Gloria Sanchez-Antolin, Miguel A. Serra, and Juan Turnes

Subjects
Gastroenterology, General Medicine
Abstract

Back in January 2022, an EASL-Lancet Commission on the impact of liver disorders in the European region commissioned by the WHO demonstrated that this condition is, actually, the second leading cause of loss of labor years in Europe after ischemic heart disease (1). This is a very relevant piece of information since this is something that is going to impact the new generations of Europeans unless a significant change is made in public health policies. Despite the advances made over the last few years in hepatitis C virus clearance-understood as a significant reduction of morbidity and mortality associated with Hepatitis B and C viruses-there are still challenges ahead to improve liver health due to the high use of alcohol, and the inseparable triad obesity / diabetes mellitus / metabolic associated fatty liver disease. Also, access to healthcare for several population groups at risk of presenting higher rates of liver disease has become a problem.

Published
2022

19. Global multi-stakeholder endorsement of the MAFLD definition

Author

Nahum Méndez-Sánchez, Elisabetta Bugianesi, Robert G Gish, Frank Lammert, Herbert Tilg, Mindie H Nguyen, Shiv K Sarin, Núria Fabrellas, Shira Zelber-Sagi, Jian-Gao Fan, Gamal Shiha, Giovanni Targher, Ming-Hua Zheng, Wah-Kheong Chan, Shlomo Vinker, Takumi Kawaguchi, Laurent Castera, Yusuf Yilmaz, Marko Korenjak, C Wendy Spearman, Mehmet Ungan, Melissa Palmer, Mortada El-Shabrawi, Hans-Juergen Gruss, Jean-François Dufour, Anil Dhawan, Heiner Wedemeyer, Jacob George, Luca Valenti, Yasser Fouad, Manuel Romero‐Gomez, Mohammed Eslam, Maria Lorena Abate, Bahaa Abbas, Ahmed Amr Abbassy, Waleed Abd El Ghany, Amira Abd Elkhalek, Emad Abd ElMajeed, Mohammad Abdalgaber, Mohamed AbdAllah, Marwa Abdallah, Nourhan Abdallah, Shereen Abdelaleem, Yasser Abdelghani, Wael Abdelghany, Safaa Mohamed Abdelhalim, Wafaa Abdelhamid, Nehal Abdelhamid, Nadia A. Abdelkader, Elsayed Abdelkreem, Aly Mohamed Abdelmohsen, Awny Ali Abdelrahman, Sherief M Abd-elsalam, Doaa Abdeltawab, Abdulbaset Abduh, Nada Abdulhakam, Maheeba Abdulla, Navid Abedpoor, Ludovico Abenavoli, Fredrik Åberg, Omala Ablack, Mostafa Abo elftouh, Yousry Esam-Eldin Abo-Amer, Ashraf Aboubkr, Alaa Aboud, Amr M. Abouelnaga, Galal A. Aboufarrag, Ashraf Aboutaleb, Leticia Abundis, Gupse Adalı, Enrique Adames, Leon Adams, Danjuma Adda, Noor Adel, Nada Adel, Muhammad Adel Sayed, Taiba Jibril Afaa, Nawal Afredj, Gulnara Aghayeva, Alessio Aghemo, Carlos A. Aguilar-Salinas, Golo Ahlenstiel, Walid Ahmady, Wafaa Ahmed, Amira Ahmed, Samah Nasser Ahmed, Heba Mostafa Ahmed, Rasha Ahmed, Elmar Aigner, Mesut Akarsu, Maisam Akroush, Umit Akyuz, Mamun Al Mahtab, Tahani Al Qadiri, Yusriya Al Rawahi, Razzaq AL rubaee, Muna Al Saffar, Shahinul Alam, Zaid Al-Ani, Agustín Albillos, Mohamed Alboraie, Said Al-Busafi, Mohamed Al-Emam, Jawaher Alharthi, Kareem Ali, Basma Abdelmoez Ali, Mohammad Ali, Raja Affendi Raja Ali, Anna Alisi, Ali Raad AL-Khafaji, Maryam Alkhatry, Rocio Aller, Yahya Almansoury, Khalid Al-Naamani, Alaa Alnakeeb, Anna Alonso, Saleh A. Alqahtani, Leina Alrabadi, Khalid Alswat, Mahir Altaher, Turki Altamimi, Jose Altamirano, Mario R. Alvares-da-Silva, Elsragy Adel M. Aly, Amgad Alzahaby, Ahmed Alzamzamy, Keisuke Amano, Maysa A. Amer, Mona A. Amin, Sayed A. Amin, Ashraf A. 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Cabral-Prodigalidad, Guillermo Cabrera-Alvarez, Wei Cai, Francesca Cainelli, Ali Riza Caliskan, Ali Canbay, Ana Cano-Contreras, Hai-Xia Cao, Zhujun Cao, Andres Carrion, Francesca Carubbi, Teresa Casanovas, Marlen Ivón Castellanos Fernández, Jin Chai, Siew Pheng Chan, Phunchai Charatcharoenwitthaya, Norberto Chavez-Tapia, Kazuaki Chayama, Jinjun Chen, Lin Chen, Zhong-Wei Chen, Huiting Chen, Sui-Dan Chen, Qiang Chen, Yaxi Chen, Gang Chen, En-Quang Chen, Fei Chen, Pei-Jer Chen, Robert Cheng, Wendy Cheng, Jack Tan Wei Chieh, Imad Chokr, Evangelos Cholongitas, Ashok Choudhury, Abhijit Chowdhury, Evaristus Sunday Chukwudike, Stefano Ciardullo, Michelle Clayton, Karine Clement, Marie Michelle Cloa, Cecilia Coccia, Cristina Collazos, Massimo Colombo, Arif Mansur Cosar, Helma Pinchemel Cotrim, Joris Couillerot, Alioune Coulibaly, Gonzalo Crespo, Javier Crespo, Maria Cruells, Ian Homer Y. Cua, Hesham K. 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A, Derbala, M, Desalegn, H, Desbois-Mouthon, C, Desoky, M, Dev, A, Di Ciaula, A, Diago, M, Diallo, I, Diaz, L, Dirchwolf, M, Dongiovanni, P, Dorofeyev, A, Dou, X, Douglas, M, Doulberis, M, Dovia, C, Doyle, A, Dragojevic, I, Drenth, J, Duan, X, Dulskas, A, Dumitrascu, D, Duncan, O, Dusabejambo, V, Dwawhi, R, Eiketsu, S, El Amrousy, D, El Deeb, A, El Deriny, G, El Din, H, El Kamshishy, S, El Kassas, M, El Raziky, M, Elagamy, O, Elakel, W, Elalfy, D, Elaraby, H, Elawady, H, Elbadawy, R, Eldash, H, Eldefrawy, M, Elecharri, C, Elfaramawy, A, Elfatih, M, Elfiky, M, Elgamsy, M, Elgendy, M, El-Guindi, M, Elhussieny, N, Eliwa, A, Elkabbany, Z, El-Khayat, H, El-Koofy, N, Elmetwalli, A, Elrabat, A, El-Raey, F, Elrashdy, F, Elsahhar, M, Elsaid, E, Elsayed, S, Elsayed, H, Elsayed, A, El-Serafy, M, Elsharkawy, A, Elsheemy, R, Elshemy, E, Elsherbini, S, Eltoukhy, N, Elwakil, R, Emad, O, Emad, S, Embabi, M, Ergenc, I, Ermolova, T, Esmat, G, Esmat, D, Estupinan, E, Ettair, S, Eugen, T, Ezz-Eldin, M, Falcon, L, Fan, Y, Fandari, S, Farag, M, Farahat, T, Fares, E, Fares, M, Fassio, E, Fathy, H, Fathy, D, Fathy, W, Fayed, S, Feng, D, Feng, G, Fernandez-Bermejo, M, Ferreira, C, Ferrer, J, Forbes, A, Fouad, R, Fouad, H, Frisch, T, Fujii, H, Fukunaga, S, Fukunishi, S, Fulya, H, Furuhashi, M, Gaber, Y, Galang, A, Gallardo, J, Galloso, R, Gamal, M, Gamal, R, Gamal, H, Gan, J, Ganbold, A, Gao, X, Garas, G, Garba, T, Garcia-Cortes, M, Garcia-Monzon, C, Garcia-Samaniego, J, Gastaldelli, A, Gatica, M, Gatley, E, Gegeshidze, T, Geng, B, Ghazinyan, H, Ghoneem, S, Giacomelli, L, Giannelli, G, Giannini, E, Giefer, M, Gines, P, Girala, M, Giraudi, P, Goh, G, Gomaa, A, Gong, B, Gonzales, D, Gonzalez, H, Gonzalez-Huezo, M, Graupera, I, Grgurevic, I, Gronbaek, H, Gu, X, Guan, L, Gueye, I, Guingane, A, Gul, O, Gul, C, Guo, Q, Gupta, P, Gurakar, A, Gutierrez, J, Habib, G, Hafez, A, Hagman, E, Halawa, E, Hamdy, O, Hamed, A, Hamed, D, Hamid, S, Hamoudi, W, Han, Y, Haridy, J, Haridy, H, Harris, D, Hart, M, Hasan, F, Hashim, A, Hassan, I, Hassan, A, Hassan, E, Hassan, M, Hassanin, F, Hassnine, A, Haukeland, J, Hawal, A, He, J, He, Q, He, Y, He, F, Hegazy, M, Hegazy, A, Henegil, O, Hernandez, N, Hernandez-Guerra, M, Higuera-de-la-Tijera, F, Hindy, I, Hirota, K, Ho, L, Hodge, A, Hosny, M, Hou, X, Huang, J, Huang, Y, Huang, Z, Huang, A, Huang, X, Hui-ping, S, Hunyady, B, Hussein, M, Hussein, O, Hussien, S, Ibanez-Samaniego, L, Ibdah, J, Ibrahim, L, Ibrahim, M, Ibrahim, I, Icaza-Chavez, M, Idelbi, S, Idilman, R, Ikeda, M, Indolfi, G, Invernizzi, F, Irshad, I, Isa, H, Iskandar, N, Ismaiel, A, Ismail, M, Ismail, Z, Ismail, F, Iwamoto, H, Jack, K, Jacob, R, Jafarov, F, Jafri, W, Jahshan, H, Jalal, P, Jancoriene, L, Janicko, M, Jayasena, H, Jefferies, M, Jha, V, Ji, F, Ji, Y, Jia, J, Jiang, C, Jiang, N, Jiang, Z, Jin, X, Jin, Y, Jing, X, Jingyu, Q, Jinjolava, M, Jong, F, Jucov, A, Julius, I, Kaddah, M, Kamada, Y, Kamal, A, Kamal, E, Kamel, A, Kao, J, Karin, M, Karlas, T, Kashwaa, M, Katsidzira, L, Kaya, E, Kayasseh, M, Keenan, B, Keklikkiran, C, Keml, W, Khalaf, D, Khalefa, R, Khamis, S, Khater, D, Khattab, H, Khavkin, A, Khlynova, O, Khmis, N, Kobyliak, N, Koffas, A, Koike, K, Kok, K, Koller, T, Komas, N, Korochanskaya, N, Koulla, Y, Koya, S, Kraft, C, Kraja, B, Krawczyk, M, Kuchay, M, Kulkarni, A, Kumar, A, Kumar, M, Lakoh, S, Lam, P, Lan, L, Lange, N, Lankarani, K, Lanthier, N, Lapshyna, K, Lashen, S, Laure, K, Lazebnik, L, Lebrec, D, Lee, S, Lee, W, Lee, Y, Leeming, D, Leite, N, Leon, R, Lesmana, C, Li, J, Li, Q, Li, Y, Li, L, Li, M, Liang, H, Lijuan, T, Lim, S, Lim, L, Lin, S, Lin, H, Lin, R, Lithy, R, Liu, Y, Liu, X, Liu, W, Liu, S, Liu, K, Liu, T, Lonardo, A, Lopez, M, Lopez-Benages, E, Lopez-Jaramillo, P, Lu, H, Lu, L, Lu, Y, Lubel, J, Lui, R, Lupasco, I, Luzina, E, Lv, X, Lynch, K, Ma, H, Machado, M, Maduka, N, Madzharova, K, Magdaong, R, Mahadeva, S, Mahfouz, A, Mahmood, N, Mahmoud, E, Mahrous, M, Maiwall, R, Majeed, A, Majumdar, A, Mak, L, Maklouf, M, Malekzadeh, R, Mandato, C, Mangia, A, Mann, J, Mansour, H, Mansouri, A, Mantovani, A, Mao, J, Maramag, F, Marchesini, G, Marcus, C, Marinho, R, Martinez-Chantar, M, Martins, A, Marwan, R, Mason, K, Masoud, G, Massoud, M, Matamoros, M, Mateos, R, Mawed, A, Mbanya, J, Mbendi, C, Mccolaugh, L, Mcleod, D, Medina, J, Megahed, A, Mehrez, M, Memon, I, Merat, S, Mercado, R, Mesbah, A, Meskini, T, Metwally, M, Metwaly, R, Miao, L, Micah, E, Miele, L, Milivojevic, V, Milovanovic, T, Mina, Y, Mishkovik, M, Mishriki, A, Mitchell, T, Mohamed, A, Mohamed, M, Mohamed, S, Mohammed, S, Mohammed, A, Mohan, V, Mohie, S, Mokhtar, A, Moniem, R, Montilla, M, Morales, J, Morata, M, Moreno-Planas, J, Morise, S, Mosaad, S, Moselhy, M, Mostafa, A, Mostafa, E, Mouane, N, Mousa, N, Moustafa, H, Msherif, A, Muller, K, Munoz, C, Munoz-Urribarri, A, Murillo, O, Mustapha, F, Muzurovic, E, Nabil, Y, Nafady, S, Nagamatsu, A, Nakajima, A, Nakano, D, Nan, Y, Nascimbeni, F, Naseef, M, Nashat, N, Natalia, T, Negro, F, Nersesov, A, Neuman, M, Ng'Wanasayi, M, Ni, Y, Nicoll, A, Niizeki, T, Nikolova, D, Ningning, W, Niriella, M, Nogoibaeva, K, Nordien, R, O Sullivan, C, O'Beirne, J, Obekpa, S, Ocama, P, Ochwoto, M, Ogolodom, M, Ojo, O, Okrostsvaridze, N, Oliveira, C, Omana, R, Omar, O, Omar, H, Omar, M, Omran, S, Omran, R, Osman, M, Owise, N, Owusu-Ansah, T, Padilla- Machaca, P, Palle, S, Pan, Z, Pan, X, Pan, Q, Papaefthymiou, A, Paquissi, F, Par, G, Parkash, A, Payawal, D, Peltekian, K, Peng, X, Peng, L, Peng, Y, Pengoria, R, Perez, M, Perez, J, Perez, N, Persico, M, Pessoa, M, Petta, S, Philip, M, Plaz Torres, M, Polavarapu, N, Poniachik, J, Portincasa, P, Pu, C, Purnak, T, Purwanto, E, Qi, X, Qian, Z, Qiang, Z, Qiao, Z, Qiao, L, Queiroz, A, Rabiee, A, Radwan, M, Rahetilahy, A, Ramadan, Y, Ramadan, D, Ramli, A, Ramm, G, Ran, A, Rankovic, I, Rao, H, Raouf, S, Ray, S, Reau, N, Refaat, A, Reiberger, T, Remes-Troche, J, Reyes, E, Richardson, B, Ridruejo, E, Riestra Jimenez, S, Rizk, I, Roberts, S, Roblero, J, Robles, J, Rockey, D, Rodriguez, M, Rodriguez Hernandez, H, Roman, E, Romeiro, F, Romeo, S, Rosales-Zabal, J, Roshdi, G, Rosso, N, Ruf, A, Ruiz, P, Runes, N, Ruzzenente, A, Ryan, M, Saad, A, Sabbagh, E, Sabbah, M, Saber, S, Sabrey, R, Sabry, R, Saeed, M, Said, D, Said, E, Sakr, M, Salah, Y, Salama, R, Salama, A, Saleh, H, Saleh, A, Salem, A, Salifou, A, Salih, A, Salman, A, Samouda, H, Sanai, F, Sanchez-Avila, J, Sanker, L, Sano, T, Sanz, M, Saparbu, T, Sawhney, R, Sayed, F, Sayed, S, Sayed, A, Sayed, M, Sebastiani, G, Secadas, L, Sediqi, K, Seif, S, Semida, N, Senates, E, Serban, E, Serfaty, L, Seto, W, Sghaier, I, Sha, M, Shabaan, H, Shalaby, L, Shaltout, I, Sharara, A, Sharma, V, Shawa, I, Shawkat, A, Shawky, N, Shehata, O, Sheils, S, Shewaye, A, Shi, G, Shi, J, Shimose, S, Shirono, T, Shou, L, Shrestha, A, Shui, G, Sievert, W, Sigurdardottir, S, Sira, M, Siradj, R, Sison, C, Smyth, L, Soliman, R, Sollano, J, Sombie, R, Sonderup, M, Sood, S, Soriano, G, Stedman, C, Stefanyuk, O, Stimac, D, Strasser, S, Strnad, P, Stuart, K, Su, W, Su, M, Sumida, Y, Sumie, S, Sun, D, Sun, J, Suzuki, H, Svegliati-Baroni, G, Swar, M, Taharboucht, S, Taher, Z, Takamura, S, Tan, L, Tan, S, Tanwandee, T, Tarek, S, Tatiana, G, Tavaglione, F, Tecson, G, Tee, H, Teschke, R, Tharwat, M, Thong, V, Thursz, M, Tine, T, Tiribelli, C, Tolmane, I, Tong, J, Tongo, M, Torkie, M, Torre, A, Torres, E, Trajkovska, M, Treeprasertsuk, S, Tsutsumi, T, Tu, T, Tur, J, Turan, D, Turcan, S, Turkina, S, Tutar, E, Tzeuton, C, Ugiagbe, R, Uygun, A, Vacca, M, Vajro, P, Van der Poorten, D, Van Kleef, L, Vashakidze, E, Velazquez, C, Velazquez, M, Vento, S, Verhoeven, V, Vespasiani-Gentilucci, U, Vethakkan, S, Vilaseca, J, Vitek, L, Volkanovska, A, Wallace, M, Wan, W, Wang, Y, Wang, X, Wang, C, Wang, M, Wangchuk, P, Weltman, M, White, M, Wiegand, J, Wifi, M, Wigg, A, Wilhelmi, M, William, R, Wittenburg, H, Wu, S, Wubeneh, A, Xia, H, Xiao, J, Xiao, X, Xiaofeng, W, Xiong, W, Xu, L, Xu, J, Xu, W, Xu, K, Xu, Y, Xu, S, Xu, M, Xu, A, Xu, C, Yan, H, Yang, J, Yang, R, Yang, Y, Yang, Q, Yang, N, Yao, J, Yara, J, Yaras, S, Yilmaz, N, Younes, R, Younes, H, Young, S, Youssef, F, Yu, Y, Yu, M, Yuan, J, Yue, Z, Yuen, M, Yun, W, Yurukova, N, Zakaria, S, Zaky, S, Zaldastanishvili, M, Zapata, R, Zare, N, Zerem, E, Zeriban, N, Zeshuai, X, Zhang, H, Zhang, X, Zhang, Y, Zhang, W, Zhang, Z, Zhao, J, Zhao, R, Zhao, H, Zheng, C, Zheng, Y, Zheng, R, Zheng, T, Zheng, K, Zhou, X, Zhou, Y, Zhou, H, Zhou, L, Zhu, L, Zhu, Y, Zhu, P, Ziada, E, Ziring, D, Ziyi, L, Zou, S, Zou, Z, Zou, H, Zuart Ruiz, R, and Global Multi-Stakeholder Consensus on the Redefinition of Fatty Liver Disease

Subjects
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Hepatology, Non-alcoholic Fatty Liver Disease, NAFLD, consensu, Gastroenterology, MAFLD, definition, Humans, MAFLD, NAFLD, Human medicine
Abstract

Contains fulltext : 252162.pdf (Publisher’s version ) (Closed access)

Published
2022

20. Enfermedad hepática por alcohol. Guías de práctica clínica. Documento de consenso auspiciado por la AEEH

Author

Moisés Diago, Manuel Hernández-Guerra, Agustín Albillos, Rafael Bañares, Esther Molina, María Teresa Arias-Loste, Pere Ginès, Manuel Romero-Gómez, María Jesús Pareja, Joaquín Cabezas, Anna Lligoña, Santiago Tomé, Rocío Gallego, Javier Abad, Joan Genescà, Ramon Bataller, Juan Caballería, Ramon Planas, Rocío Aller, Javier Salmerón, F. Jorquera, José A. Carrión, José Altamirano, Carmelo García-Monzón, Meritxell Ventura-Cots, Miren García-Cortés, Conrado M Fernández Rodríguez, and Llorenç Caballería

Subjects
medicine.medical_specialty, Cirrhosis, Hepatology, business.industry, Gastroenterology, Alcoholic hepatitis, Disease, medicine.disease, Chronic liver disease, Liver disease, Internal medicine, medicine, Prednisolone, Steatohepatitis, Intensive care medicine, business, medicine.drug
Abstract

Alcohol-related liver disease (ARLD) is the most prevalent cause of advanced liver disease and liver cirrhosis in Europe, including Spain. According to the World Health Organization the fraction of liver cirrhosis attributable to alcohol use in Spain is 73.8% among men and 56.3% among women. ARLD includes various stages such as steatohepatitis, cirrhosis and hepatocellular cancer. In addition, patients with underlying ARLD and heavy alcohol intake may develop alcoholic hepatitis, which is associated with high mortality. To date, the only effective treatment to treat ARLD is prolonged withdrawal. There are no specific treatments, and the only treatment that increases life expectancy in alcoholic hepatitis is prednisolone. For patients with alcoholic hepatitis who do not respond to treatment, some centres offer the possibility of an early transplant. These clinical practice guidelines aim to propose recommendations on ARLD taking into account their relevance as a cause of advanced chronic liver disease and liver cirrhosis in our setting. This paper aims to answer the key questions for the clinical practice of Gastroenterology, Hepatology, as well as Internal Medicine and Primary Health Centres, making the most up-to-date information regarding the management and treatment of ARLD available to health professionals. These guidelines provide evidence-based recommendations for the clinical management of this disease.

Published
2019

22. Can secukinumab improve liver fibrosis? A pilot prospective study of 10 psoriatic patients

Author

Cristina López-Martí, Amparo Pérez-Ferriols, Moisés Diago-Madrid, Pablo Hernández-Bel, J.M. Ortiz-Salvador, Jorge Magdaleno-Tapial, Juan José Tamarit-García, and José Luis Sánchez-Carazo

Subjects
Liver Cirrhosis, medicine.medical_specialty, business.industry, Liver fibrosis, Arthritis, Psoriatic, MEDLINE, Dermatology, General Medicine, Antibodies, Monoclonal, Humanized, Internal medicine, medicine, Humans, Secukinumab, Prospective Studies, business, Prospective cohort study
Published
2021

23. Abnormal liver chemistry constitutes an independent prognostic factor of less favorable clinical course in patients with COVID-19

Author

Carlos Alventosa Mateu, Salvador Benlloch Pérez, Miguel García Deltoro, Mercedes Latorre Sánchez, Francisco Sanz Herrero, Juan José Urquijo Ponce, Moisés Diago Madrid, Concepción Gimeno Cardona, María Dolores Ocete Mochón, and Francesc Puchades Gimeno

Subjects
Coronavirus disease 2019 (COVID-19), medicine.drug_class, Bilirubin, Low molecular weight heparin, Logistic regression, law.invention, chemistry.chemical_compound, law, Medicine, Humans, Risk factor, Retrospective Studies, business.industry, SARS-CoV-2, Gastroenterology, Clinical course, COVID-19, General Medicine, Prognosis, Intensive care unit, Hospitalization, Biochemistry, chemistry, Liver, Abnormal liver, business
Abstract

INTRODUCTION: Abnormal liver biochemistry (ALB) is correlated with increased clinical involvement or severity in COVID-19, but its prognostic implications have not been studied extensively. Our aim is to determine whether ALB is a risk factor for an unfavorable clinical outcome and involvement. MATERIALS AND METHODS: Retrospective, single-center study of confirmed COVID-19 cases. Patients with pharmacological hepatotoxicity or liver diseases were excluded. ALB was defined as the elevation of total bilirubin, AST, ALT, alkaline phosphatase and/or GGT above the upper limit of normal. An assessment was first made of the correlation between ALB and the need for hospitalization. This was followed by an assessment of the correlation of hospitalized patients with demographic variables, comorbidities and treatment for COVID-19 and with clinical involvement and outcome. Statistical analysis was performed using age-adjusted multiple logistic regression with a p-value of

Published
2021

24. One-step diagnosis strategy together with multidisciplinary telematics referral perform an effective approach for identifying and treating patients with active Hepatitis C infection.

Author

Torrecillas, Miriam, primary, Gómez-Muñoz, Neus, additional, Ocete, María Dolores, additional, Cuevas, Purificación Rubio, additional, Madrid, Moisés Diago, additional, González, Enrique Ortega, additional, Cardona, Concepción Gimeno, additional, and García-Deltoro, Miguel, additional

Published
2021
Full Text
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25. Hepatitis B surface antigen loss after discontinuing nucleos(t)ide analogue for treatment of chronic hepatitis B patients is persistent in White patients

Author

Rosa Maria Morillas, Juan Arenas Ruiz Tapiador, Javier Crespo, Rafael Gómez-Rodríguez, Manuel Rodríguez, José Manuel Zozaya, Marta Casado, Juan Manuel Pascasio-Acevedo, Miguel Angel Simón, J. Fuentes, Martín Prieto, Blanca Figueruela, Jose Luis Calleja, Maria Buti, Moisés Diago, T. Casanovas, E. Suárez, and Esther Molina

Subjects
Male, HBsAg, Time Factors, Cirrhosis, Hepatocellular carcinoma, medicine.medical_treatment, Liver transplantation, medicine.disease_cause, Chronic hepatitis B, Gastroenterology, Nucleos(t)ide analogue treatment, 0302 clinical medicine, Recurrence, Risk Factors, Hepatitis B virus reactivation, Nucleotides, Remission Induction, Nucleosides, Middle Aged, Hepatitis B, Treatment Outcome, Hepatitis B surface antigen, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Adult, Hepatitis B virus, medicine.medical_specialty, Antiviral Agents, Drug Administration Schedule, White People, 03 medical and health sciences, Hepatitis B, Chronic, Internal medicine, medicine, Humans, Retrospective Studies, Hepatitis B Surface Antigens, Hepatology, business.industry, medicine.disease, digestive system diseases, Discontinuation, Spain, Elevated transaminases, business, Biomarkers
Abstract

OBJECTIVE: The objective of this study was to determine the long-term clinical outcome and persistence of hepatitis B surface antigen (HBsAg) loss after discontinuation of treatment. BACKGROUND: The prognosis of patients with chronic hepatitis B (CHB) treated with nucleos(t)ide analogues (NAs) who discontinue treatment after loss of HBsAg remains largely unknown, particularly in White patients. PATIENTS AND METHODS: We analysed a cohort of patients with CHB who discontinued NA treatment after loss of HBsAg. A total of 69 patients with hepatitis-B-e antigen-positive or hepatitis-B-e antigen-negative CHB with undetectable HBsAg during NA treatment were included after discontinuation of treatment, and followed up for a median period of 37.8 months (interquartile range: 23.8-54.6 months). RESULTS: At the end of follow-up, none of the patients showed spontaneous reappearance of HBsAg and only one patient had detectable hepatitis B virus DNA (22IU/ml). Another patient negative for HBsAg and anti-HBs developed hepatitis B virus reactivation without elevated transaminases after treatment with corticosteroids and vincristine for dendritic cell neoplasm, 38 months after withdrawal of the antiviral treatment. Regarding clinical outcome, a patient with cirrhosis developed hepatocellular carcinoma, 6.6 years after discontinuing treatment. None of the patients had hepatic decompensation or underwent liver transplantation. CONCLUSION: HBsAg clearance after discontinuing NAs in patients with CHB is persistent and associated with good prognosis. The risk for developing hepatocellular carcinoma persists among patients with cirrhosis.

Published
2019

26. Eight weeks of Paritaprevir/r/Ombitasvir + Dasabuvir in HCV genotype 1b with mild-moderate fibrosis: Results from a real-world cohort

Author

José A. Carrión, Juan Turnes, J.M. Moreno, Esther Molina, M. Puigvehí, José María Moreno, Joaquín Cabezas, Juan de la Vega, Jose Luis Castro, Rosa Maria Morillas, Jose Luis Calleja, Sabela Lens, Beatriz de Cuenca, Javier Salmerón, J.J. Sanchez-Ruano, Ester Badia, M. D. Anton, Silvia Montoliu, P. Cordero, Moisés Diago, Xavier Torras, Juan Manuel Pascasio, Antonio Olveira, F. Gea, Ana Viu, Ministerio de Economía y Competitividad (España), Instituto de Salud Carlos III, and European Commission

Subjects
Cyclopropanes, Liver Cirrhosis, Male, Sustained Virologic Response, Paritaprevir, Hepacivirus, Gastroenterology, chemistry.chemical_compound, 0302 clinical medicine, 2-Naphthylamine, Medicine, Anilides, Prospective Studies, Aged, 80 and over, Sulfonamides, Dasabuvir, Valine, Middle Aged, Viral Load, Sustained virological response, 030220 oncology & carcinogenesis, Cohort, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, Viral load, medicine.drug, Adult, medicine.medical_specialty, Macrocyclic Compounds, Genotype, Proline, Lactams, Macrocyclic, Antiviral Agents, Young Adult, 03 medical and health sciences, Internal medicine, Humans, Uracil, Aged, Hepatology, business.industry, Hepatitis C, Chronic, Ombitasvir, Discontinuation, Regimen, chemistry, Spain, Ritonavir, Carbamates, business
Abstract

[Background & Aims] The interferon‐free regimen paritaprevir/ritonavir, ombitasvir + dasabuvir (PTV /r/OBV /DSV ) has shown high efficacy in patients with hepatitis C virus (HCV ) genotype 1b infection when administered for 8 or 12 weeks, but data regarding the 8‐week treatment are scarce. The aim of our study was to assess the efficacy and safety of the 8‐week administration of PTV /r/OBV /DSV in a real‐world cohort., [Methods] We performed a multicentre observational study from Spanish Hepa‐C database including patients receiving 8 weeks of PTV /r/OBV /DSV (October 2016‐November 2017). Those with advanced fibrosis, with non‐genotype 1b or who were treatment‐experienced were excluded., [Results] A total of 211 patients were registered from 23 Spanish centres; eleven were excluded. At baseline, 42.5% (n = 85) were male, median (range) age was 57 (23‐86), ALT was 45 (11‐494) IU/mL, viral load was 6.1 (3.3‐8.2) log10 IU/mL, and 74.5% had mild liver fibrosis (F0‐F1) and 25.5% moderate fibrosis (F2). At the end of treatment (EOT ), HCV viral load was undetectable in 100% (200/200). Seven patients relapsed after treatment discontinuation. Sustained virological response (SVR 12) rates by intention‐to‐treat analysis were 96% (192/200). Regarding treatment safety, 2 patients developed ALT elevation >5x ULN, but there were no treatment discontinuations. One patient died 7 weeks after EOT., [Conclusion] Treatment with PTV/r/OBV/DSV in genotype 1b‐infected treatment‐naive patients with mild‐moderate fibrosis shows excellent efficacy and safety in real life, similarly to clinical trials. Clinicaltrials.gov, number: NCT 03122132., JAC has received a grant from Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (PI14/00540), co‐funded by Fondo Europeo de Desarrollo Regional (FEDER), Unión Europea, Una manera de hacer Europa.

Published
2018

27. One-step diagnosis strategy together with multidisciplinary telematics referral perform an effective approach for identifying and treating patients with active Hepatitis C infection

Author

Enrique Ortega González, Purificación Rubio Cuevas, Miguel García-Deltoro, Neus Gómez-Muñoz, Moisés Diago Madrid, Miriam Torrecillas, María Dolores Ocete, and Concepción Gimeno Cardona

Subjects
Male, Care process, medicine.medical_specialty, Referral, Hepatitis C virus, Specialties of internal medicine, Viremia, Hepacivirus, medicine.disease_cause, Antiviral Agents, Serology, Multidisciplinary approach, Interquartile range, Internal medicine, HCV-cAg, medicine, Telematics referral, Humans, One-step, Active hepatitis, Hepatology, business.industry, Two-step, General Medicine, Hepatitis C Antibodies, medicine.disease, Hepatitis C, Telemedicine, RC581-951, Female, Hepatitis C Antigens, business
Abstract

Introduction and objectives Implementation of a one-step strategy for diagnosis of active Hepatitis C virus (HCV) infection would encourage the early diagnosis and reduce the time to access antiviral treatments. The aim of this study was to evaluate the impact of a HCV one-step diagnosis compared to the traditional two-step protocol in terms of the time required for patients to be seen by specialists and the time taken to start antiviral treatment. Material and methods A comparative study was carried out to assess two diagnostic algorithms (one-step and two-step) for active HCV infection. Serological markers were quantified using the same serum sample to determine both anti-HCV antibodies (HCV-Ab) and HCV core antigen (HCV-cAg) by Architect i2000 SR kit. In this period, a multidisciplinary procedure was started for telematics referral of viremic patients. Results One-step approach reduced the time required for patient HCV diagnosis, referral to a specialist, access to treatment, and eliminated the loss of patients to follow-up. Significant differences were observed between one-step and two-step diagnosis methods in the time required for patients to be seen by a specialist (18 days [Interquartile range (IQR) = 14–42] versus 107 days [IQR = 62–148]) and for the initiation of treatment (54 days [IQR = 43–75] versus 200 days [IQR = 116–388]), mainly for patients with advanced fibrosis (35 days [IQR = 116–388] versus 126 days [IQR = 152–366]). Conclusions Use of HCV-cAg has proven to be a useful tool for screening patients with active hepatitis C. The development of a multidisciplinary protocol for the communication of results improved the efficiency of the care process.

Published
2021

28. The impact of stigma on quality of life and liver disease burden among patients with nonalcoholic fatty liver disease

Author

Zobair M. Younossi, Saleh A. AlQahtani, Jesús Funuyet-Salas, Manuel Romero-Gómez, Yusuf Yilmaz, Caglayan Keklikkiran, Khalid Alswat, Ming-Lung Yu, Chun-Jen Liu, Jian-Gao Fan, Ming-Hua Zheng, Patrizia Burra, Sven M. Francque, Laurent Castera, Jörn M. Schattenberg, Philip N. Newsome, Alina M. Allen, Mohamed El-Kassas, Sombat Treeprasertsuk, Saeed Hameed, Vincent Wai-Sun Wong, Shira Zelber-Sagi, Hirokazu Takahashi, Takumi Kawaguchi, Marlen I. Castellanos Fernández, Ajay Duseja, Marco Arrese, Mary Rinella, Ashwani K. Singal, Stuart C. Gordon, Michael Fuchs, Wayne Eskridge, Naim Alkhouri, Kenneth Cusi, Rohit Loomba, Jane Ranagan, Achim Kautz, Janus P. Ong, Marcelo Kugelmas, Yuichiro Eguchi, Moises Diago, Lynn Gerber, Brian Lam, Lisa Fornaresio, Fatema Nader, C. Wendy Spearman, Stuart K. Roberts, Wah-Kheong Chan, Marcelo Silva, Andrei Racila, Pegah Golabi, Prooksa Ananchuensook, Linda Henry, Maria Stepanova, Patrizia Carrieri, and Jeffrey V. Lazarus

Subjects
patient-reported outcomes, metabolic liver disease, NASH, MASLD, MASH, SLD, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background & Aims: Patients with nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) face a multifaceted disease burden which includes impaired health-related quality of life (HRQL) and potential stigmatization. We aimed to assess the burden of liver disease in patients with NAFLD and the relationship between experience of stigma and HRQL. Methods: Members of the Global NASH Council created a survey about disease burden in NAFLD. Participants completed a 35-item questionnaire to assess liver disease burden (LDB) (seven domains), the 36-item CLDQ-NASH (six domains) survey to assess HRQL and reported their experience with stigmatization and discrimination. Results: A total of 2,117 patients with NAFLD from 24 countries completed the LDB survey (48% Middle East and North Africa, 18% Europe, 16% USA, 18% Asia) and 778 competed CLDQ-NASH. Of the study group, 9% reported stigma due to NAFLD and 26% due to obesity. Participants who reported stigmatization due to NAFLD had substantially lower CLDQ-NASH scores (all p

Published
2024
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30. Assessment of liver damage in patients with COVID-19 is sub-optimal: results of a survey of medical practitioners

Author

Salvador Benlloch Pérez, Moisés Diago Madrid, and Carlos Alventosa Mateu

Subjects
Hepatitis B virus, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Gastroenterology, MEDLINE, COVID-19, General Medicine, Hepatitis B, medicine.disease_cause, Antiviral Agents, Immunomodulating Agents, Hepatitis B, Chronic, Liver, Internal medicine, medicine, Humans, In patient, Liver damage, business, Systematic search
Abstract

Liver damage, defined by an increase in liver biochemical parameters, is related to a more unfavorable severity and prognosis in patients with COVID-19. These patients are also treated with immunomodulatory drugs capable of reactivating the hepatitis B virus (HBV), with indication for prophylaxis in specific situations. Due to its importance in this pathology, we wondered whether physicians should perform a systematic search for liver damage and HBV.

Published
2021

31. Definite and indeterminate nonalcoholic steatohepatitis share similar clinical features and prognosis : A longitudinal study of 1893 biopsy-proven nonalcoholic fatty liver disease subjects

Author

Javier Salmerón, Rosa Martin-Mateos, Salvador Augustin, Conrado M. Fernández-Rodríguez, Javier Crespo, José Miguel Rosales, Desam Escudero, Judith Gómez-Camarero, Joan Caballería, María Jesús Pareja‐Megia, HEPAmet Registry, Rosa Maria Morillas, Juan Turnes, Jesus M. Banales, Javier Abad, Patricia Aspichueta, Rocío Gallego-Durán, Raquel Latorre, Luis Ibañez, Manuel Romero-Gómez, Javier García-Samaniego, Moisés Diago, Manuel Hernández-Guerra, Salvador Benlloch, Germán Soriano, Águeda González-Rodríguez, Javier Ampuero, Raúl J. Andrade, Oreste Lo Iacono, Rocío Aller, Rubén Francés, Pamela Estévez, Francisco Jorquera, Junta de Andalucía, Ministerio de Economía y Competitividad (España), Instituto de Salud Carlos III, and Universidad de Sevilla. Departamento de Medicina

Subjects
Liver Cirrhosis, medicine.medical_specialty, Cirrhosis, Steatosis, Biopsy, Gastroenterology, digestive system, Ballooning, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, Fatty liver disease, Internal medicine, Nonalcoholic fatty liver disease, medicine, associated fatty liver disease, Metabolic-associated fatty liver disease, Humans, metabolic&#8208, Longitudinal Studies, First episode, Inflammation, Hepatology, medicine.diagnostic_test, ballooning, fatty liver disease, inflammation, metabolic-associated fatty liver disease, natural coursesteatohepatitis, steatosis, business.industry, Fatty liver, Natural coursesteatohepatitis, medicine.disease, digestive system diseases, Liver, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Steatohepatitis, business
Abstract

[Background and Aim] Histological score systems may not fully capture the essential nonalcoholic steatohepatitis (NASH) features, which is one of the leading causes of screening failure in clinical trials. We assessed the NASH distribution and its components across the fibrosis stages and their impact on the prognosis and their relationship with the concept of metabolic-associated fatty liver disease (MAFLD)., [Methods] Spanish multicenter study including 1893 biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients from HEPAmet registry. NASH was diagnosed by NAS score ≥4 (including steatosis, ballooning and lobular inflammation) and fibrosis by Kleiner score. The presence of MAFLD was determined. Progression to cirrhosis, first episode of decompensated cirrhosis and death were collected during the follow-up (4.7 ± 3.8 years)., [Results] Fibrosis was F0 34.3% (649/1893), F1 27% (511/1893), F2 16.5% (312/1893), F3 15% (284/1893) and F4 7.2% (137/1893). NASH diagnosis 51.9% (982/1893), and its individual components (severe steatosis, ballooning and lobular inflammation), increased from F0 (33.6%) to F2 (68.6%), and decreased significantly in F4 patients (51.8%) (P = .0001). More than 70% of non-NASH patients showed some inflammatory activity (ballooning or lobular inflammation), showing a similar MAFLD rate than NASH (96.2% [945/982] vs. 95.2% [535/562]) and significantly higher than nonalcoholic fatty liver (NAFL) subjects (89.1% [311/349]) (P < .0001). Progression to cirrhosis was similar between NASH (9.5% [51/539]) and indeterminate NASH (7.9% [25/316]), and higher than steatosis (5% [14/263]) (logRank 8.417; P = .015). Death and decompensated cirrhosis were similar between these., [Conclusions] The prevalence of steatohepatitis decreased in advanced liver disease. However, most of these patients showed some inflammatory activity histologically and had metabolic disturbances. These findings should be considered in clinical trials whose main aim is to prevent cirrhosis progression and complications, liver transplant and death., This project has been partially funded by the ‘Consejería de Salud de la Junta de Andalucía’ (PI-0075-2014) and the ‘Spanish Ministry of Economy, Innovation and Competition, Instituto de Salud Carlos III’ (PI19/01404, PI16/01842, PI17/00535 and GLD19/00100).

Published
2021

32. Obeticholic Acid and Fibrates in Primary Biliary Cholangitis: Comparative Effects in a Multicentric Observational Study

Author

Diana Horta, Mercedes Vergara, Jesús M. González-Santiago, Ana Arencibia, Raúl J. Andrade, Carmen Álvarez-Navascués, Pamela Estévez, Elena Gómez-Domínguez, Carlos Ferre-Aracil, Margarita Sala, Marina Berenguer, Rosa Maria Morillas, Esther Molina, Manuel Hernández-Guerra, Emilio Fábrega, Eva Fernández-Bonilla, Judith Gómez-Camarero, Anna Reig, Albert Parés, Moisés Diago, Victor Vargas, Lander Hijona, Adolfo Gallego-Moya, Nadia Chahri, Francisco Suárez, Agustín Albillos, Conrado M. Fernández-Rodríguez, Indhira M Pérez-Medrano, Manuel Romero-Gómez, Marta Casado, and Gema De la Cruz

Subjects
Male, medicine.medical_specialty, PROGNOSIS, Chenodeoxycholic Acid, PLACEBO-CONTROLLED TRIAL, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Fenofibrate, Internal medicine, medicine, Humans, BIOCHEMICAL RESPONSE, Adverse effect, CIRRHOSIS, Retrospective Studies, Bezafibrate, Hepatology, business.industry, Liver Cirrhosis, Biliary, Obeticholic acid, Middle Aged, BEZAFIBRATE, Ursodeoxycholic acid, eye diseases, Discontinuation, URSODEOXYCHOLIC ACID, Clinical trial, Treatment Outcome, chemistry, 030220 oncology & carcinogenesis, Alkaline phosphatase, 030211 gastroenterology & hepatology, Female, business, medicine.drug
Abstract

INTRODUCTION: Obeticholic acid (OCA) and fibrates therapy results in biochemical improvement in placebo-controlled trials in patients with primary biliary cholangitis and insufficient response to ursodeoxycholic acid. There is scarce information outside of clinical trials. Therefore, we have assessed the effectiveness and adverse events of these treatments. METHODS: Data from patients included in the ColHai registry treated with OCA, fibrates, or both were recorded during a year, as well as adverse events and treatment discontinuation. RESULTS: Eighty-six patients were treated with OCA, 250 with fibrates (81% bezafibrate; 19% fenofibrate), and 15 with OCA plus fibrates. OCA group had baseline significantly higher alkaline phosphatase (ALP) (P = 0.01) and lower platelets (P = 0.03) than fibrates. Both treatments significantly decreased ALP, gamma-glutamyl transferase (GGT), and transaminases and improved Globe score. Albumin and immunoglobulin type M improved in the fibrates group. ALP decrease was higher under fibrates, whereas alanine aminotransferase decline was higher under OCA. Although baseline transaminases and GGT were higher in patients with OCA plus fibrates, significant ALP, GGT, alanine aminotransferase, and Globe score improvement were observed during triple therapy. Adverse events were reported in 14.7% of patients (21.3% OCA; 17.6% fenofibrate; 10.7% bezafibrate), mainly pruritus (10.1% with OCA). Discontinuation was more frequent in fenofibrate treatment mainly because of intolerance or adverse events. DISCUSSION: Second-line therapy with OCA or fibrates improves hepatic biochemistry and the GLOBE score in primary biliary cholangitis patients with suboptimal response to ursodeoxycholic acid. Simultaneous treatment with OCA and fibrates improved ALP as well.

Published
2021

33. Deep-sequencing reveals broad subtype-specific HCV resistance mutations associated with treatment failure

Author

Javier Fernández-Fernández, Concepción Gimeno, Maria Saumoy, María Eugenia Soria, Pau Gilabert, Gasshan Mereish, Helena Masnou-Ridaura, Federico Sáez-Royuela, Javier Salmerón, Raúl Rodríguez, Imma Ocaña, Juan Buenestado, José Francisco Macías-Sánchez, Xavier Forns, Elisabet Deig, Silvia Montoliu, José Castellote, Maria Isabel Costafreda, Ramiro Macenlle, Ildefonso Quiñones, David Tabernero, Jordi Niubó, Silvia Fábregas, Xavier Pamplona, Qian Chen, Maria Carlota Londoño, Juan Turnes, Mercè Barenys, Javier García-Samaniego, Agustín Albillos, Javier Crespo, Juan Manuel Pascasio, Joana Villaverde, B. Sacristan, Silvia Sauleda, Mar Riveiro-Barciela, Judit Carbonell, Silvia Salord, Oscar del Río, Leticia González-Moreno, Doroteo Acero-Fernández, Martín Prieto, A. Estebanez, Manolo Romero-Gómez, Arkaitz Imaz, Xavier Torras, María José López-de-Goicoechea, Jordi Navarro, Manuel Delgado-Blanco, Rosa Maria Morillas, Yolanda Real, Gemma Olivé, Rosa M Lopez, Salvador Augustin, Joan Carles Quer, Angels García-Flores, Nuria Margall, Leonardo Nieto-Aponte, Ángeles Castro-Iglesias, Ariadna Rando-Segura, Verónica Saludes, Rosa Durández, Elena Vargas-Accarino, Mireia Cairó, María Luisa García-Buey, Carme Mora-Moruny, Álvaro Mena-de-Cea, Paloma Sanz-Cameno, Lluis Castells, Miguel Miralbés, Francisco Suárez, Rosa Roca, Joaquín Cabezas, Carlos González-Portela, Albert Bernet, Pilar Castillo-Grau, Juan García-Costa, Mercedes Guerrero-Murillo, R. Quiles, Martin Bonacci, Juan Arenas, Juan Ignacio Esteban, Xavier Xiol, Silvia Viroles, Antonio Madejón, Sabela Lens, Maria Buti, María Silvan di Yacovo, Francisco Rodriguez-Frias, Manuel Rodríguez, Damir Garcia-Cehic, Esteban Domingo, Alejandra Otero, Elisa Martró, Manuel Hernández-Guerra, Inmaculada Fernández, Alba Cachero, Pilar Vázquez-Rodríguez, Carmen García-Martin, José A. Carrión, Miguel Angel Simón, Soledad López-Calvo, Gloria Sánchez-Antolín, Fernando Lázaro, J. Llaneras, Montserrat Forné, Meritxell Llorens-Revull, Maria Juana Gomez-Alonso, Francisco José Martínez-Cerezo, Isabel Conde, Maria Francesca Cortese, Silvia Blanch, Blau Camps, David Vieito, Sofía P. Ruzo, Moisés Diago, Marta Vila, Matilde Trigo-Daporta, Mercè Rosinach, Irati Fernandez-Alonso, Carme López-Núñez, María José Ferri, Georg von Massow, Jose Luis Calleja, Rafael Esteban, Sofía Pérez-del-Pulgar, Rafael Medina, Carme Baliellas, Ángeles Vázquez, Josep Quer, Mercè Roget, Angel Rubín, Celia Perales, Jose Antonio delCampo, María Dolores Ocete, T. Casanovas, J.J. Sanchez-Ruano, Lluís Force, A Martín-Cardona, R.J. Andrade, Angelina Cañizares, Víctor Vargas-Blasco, Marta Bes, Zoe Mariño, Josep Gregori, and Raquel Baluja-Pino

Subjects
0301 basic medicine, Genotype, Hepatitis C virus, 030106 microbiology, Failure, Hepacivirus, medicine.disease_cause, Direct-acting antivirals, Antiviral Agents, Deep sequencing, Antiviral treatment, Direct-acting antivirals, Failure, HCV, NGS, RAS, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, Drug Resistance, Multiple, Viral, Interferon, Virology, Medicine, Humans, Treatment Failure, NS5A, NS5B, Pharmacology, business.industry, Ribavirin, High-Throughput Nucleotide Sequencing, Hepatitis C, Subtyping, 030104 developmental biology, chemistry, Antiviral treatment, Spain, NGS, HCV, Mutation, Drug Therapy, Combination, business, medicine.drug, RAS
Abstract

[Abstract] A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) α-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of “extra-target” RAS suggests the need for RAS screening in all three DAA target regions. Ministerio de Economía y Empresa; IDI-20151125 Ministerio de Ciencia, Innovación y Universidades; SAF SAF 2017-87846-R

Published
2020

34. Erratum to: 'Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH (J Hepatol 2020; 73: 17-25)

Author

Agustín Albillos, Juan Turnes, Joan Caballería, Germán Soriano, Javier García-Samaniego, Salvador Augustin, HEPAmet Registry, Jesus M. Banales, Manuel Romero-Gómez, Rocío Gallego-Durán, Rosa Maria Morillas, Francisco Jorquera, Patricia Aspichueta, Pamela Estévez, Luis Ibañez, José Miguel Rosales, Moisés Diago, Javier Salmerón, Raquel Latorre, Rocío Aller, Jose Luis Calleja, Salvador Benlloch, Raúl J. Andrade, Manuel Hernández-Guerra, Javier Ampuero, Oreste Lo Iacono, Conrado M. Fernández-Rodríguez, Desamparados Escudero, Carmelo García-Monzón, Judith Gómez-Camarero, Javier Crespo, and Rubén Francés

Subjects
Pediatrics, medicine.medical_specialty, Hepatology, New onset diabetes, business.industry, Published Erratum, medicine, MEDLINE, Mistake, In patient, business, Publication process, Significant fibrosis
Abstract

It has come to our attention that there was a mistake in Fig. 2 in the published version of our manuscript. The mistake occurred during the publication process and has resulted in the lines being absent from the Kaplan-Meier plots in Fig. 2A,B. The y-axis was also incorrectly labelled in Fig. 2B. Please see the corrected figure below. We apologize for any inconvenience caused. This has been corrected in the online version. [Figure presented]

Published
2020

35. Economic impact of health resource optimisation in the approach to patients with hepatitis C

Author

Juan, Turnes, Federico, García, Moisés, Diago, Raúl J, Andrade, Pilar, Díaz, Darío, Rubio-Rodríguez, and Carlos, Rubio-Terrés

Subjects
Health Services Needs and Demand, Delphi Technique, Cost Savings, Spain, Practice Guidelines as Topic, Health Resources, Humans, Health Care Costs, Hepatitis C, Chronic, Antiviral Agents
Abstract

TThe incorporation of direct-acting antiviral agents to the treatment of chronic hepatitis C infection has simplified diagnosis and follow-up, allowing optimisation of health resources (consultations and tests) dedicated to the management of the disease. The aim of this study was to estimate the economic impact of this simplification. Health resource optimisation was estimated through the Delphi method, based on a panel of 36 experts, consisting of Spanish clinicians, and on clinical practice guidelines. The unit costs (€ in 2017) of the health resources included were obtained from Spanish sources. Simplification of the process, as well as liaison between the medical specialist, nurses and the pharmacy service, would generate savings of €591.17 per patient. Likewise, the mean length of consultations would be shorter with regimens of only 1 tablet daily compared with regimens of more than 1 tablet daily. Supplement information: This article is part of a supplement entitled "The value of simplicity in hepatitis C treatment", which is sponsored by Gilead. © 2019 Elsevier España, S.L.U. All rights reserved.

Published
2020

36. Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH

Author

Francisco Jorquera, Luis Ibañez, Javier Crespo, Carmelo García-Monzón, Manuel Hernández Guerra, Patricia Aspichueta, Javier García-Samaniego, Raquel Latorre, Pamela Estévez, Salvador Augustin, HEPAmet Registry, Javier Ampuero, Conrado M. Fernández-Rodríguez, Judith Gómez-Camarero, Salvador Benlloch, Desamparados Escudero, Raúl J. Andrade, Joan Caballería, Agustín Albillos, José Miguel Rosales, Manuel Romero Gómez, Moisés Diago, Rubén Francés, Rosa Maria Morillas, Rocío Aller, Oreste Lo Iacono, Juan Turnes, Germán Soriano, Rocío Gallego-Durán, Jose Luis Calleja, Jesus M. Banales, Javier Salmerón, Junta de Andalucía, Ministerio de Economía y Competitividad (España), Instituto de Salud Carlos III, and Gilead Sciences

Subjects
0301 basic medicine, Arterial hypertension, medicine.medical_specialty, Gastroenterology, digestive system, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Fibrosis, Internal medicine, NAFLD, Biopsy, medicine, Hepatology, medicine.diagnostic_test, business.industry, Fatty liver, Hypertriglyceridemia, Type 2 Diabetes Mellitus, nutritional and metabolic diseases, medicine.disease, Hepamet score, digestive system diseases, 030104 developmental biology, Liver biopsy, 030211 gastroenterology & hepatology, business, Dyslipidemia
Abstract

[Background & Aims] Non-alcoholic fatty liver disease (NAFLD) could play a catalytic role in the development of metabolic comorbidities, although the magnitude of this effect in metabolically healthy patients with NAFLD remains unclear. We assessed the role of biopsy-proven NAFLD on the risk of developing type 2 diabetes mellitus (T2DM) and other metabolic comorbidities (arterial hypertension [AHT], and dyslipidemia) in metabolically healthy patients., [Methods] We included 178 metabolically healthy—defined by the absence of baseline T2DM, AHT, dyslipidemia—patients with biopsy-proven NAFLD from the HEPAmet Registry (N = 1,030). Hepamet fibrosis score (HFS), NAFLD fibrosis score, and Fibrosis-4 were calculated. Follow-up was computed from biopsy to the diagnosis of T2DM, AHT, or dyslipidemia., [Results] During a follow-up of 5.6 ± 4.4 years, T2DM occurred in 9% (16/178), AHT in 8.4% (15/178), low HDL in 9.6% (17/178), and hypertriglyceridemia in 23.6% (42/178) of patients. In multivariate analysis, significant fibrosis predicted T2DM and AHT. Independent variables related to T2DM appearance were significant fibrosis (HR 2.95; 95% CI 1.19–7.31; p = 0.019), glucose levels (p = 0.008), age (p = 0.007) and BMI (p = 0.039). AHT was independently linked to significant fibrosis (HR 2.39; 95% CI 1.14–5.10; p = 0.028), age (p = 0.0001), BMI (p = 0.006), glucose (p = 0.021) and platelets (p = 0.050). The annual incidence rate of T2DM was higher in patients with significant fibrosis (4.4 vs. 1.2 cases per 100 person-years), and increased in the presence of obesity, similar to AHT (4.6 vs. 1.1 cases per 100 person-years). HFS >0.12 predicted the risk of T2DM (25% [4/16] vs. HFS, [Conclusion] Metabolically healthy patients with NAFLD-related significant fibrosis were at greater risk of developing T2DM and AHT. HFS >0.12, but not NAFLD fibrosis score or Fibrosis-4, predicted the occurrence of T2DM., [Lay summary] Patients with biopsy-proven non-alcoholic fatty liver disease and significant fibrosis were at risk of developing type 2 diabetes mellitus and arterial hypertension. The risk of metabolic outcomes in patients with significant fibrosis was increased in the presence of obesity. In addition to liver biopsy, patients at intermediate-to-high risk of significant fibrosis by Hepamet fibrosis score were at risk of type 2 diabetes mellitus., This project has been partially funded by the “Consejería de Salud de la Junta de Andalucía” (PI-0075-2014), the “Spanish Ministry of Economy, Innovation and Competition, Instituto de Salud Carlos III” (PI19/01404, PI16/01842 and PI17/00535) and “Gilead” (GLD19/00100).

Published
2020

37. Prevalence of non-alcoholic fatty liver and liver fibrosis in patients with moderate-severe psoriasis: A cross-sectional cohort study

Author

Cristian Valenzuela-Oñate, Moisés Diago-Madrid, J.M. Ortiz-Salvador, Marta García-Legaz-Martínez, José Luis Sánchez-Carazo, Juan José Tamarit-García, Miriam Alonso‐Carpio, Amparo Pérez-Ferriols, Álvaro Martínez-Doménech, and Jorge Magdaleno-Tapial

Subjects
Adult, Male, medicine.medical_specialty, Dermatology, Gastroenterology, Cohort Studies, 030207 dermatology & venereal diseases, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, Internal medicine, Psoriasis, medicine, Humans, Metabolic Syndrome, business.industry, Fatty liver, Middle Aged, medicine.disease, Cross-Sectional Studies, 030220 oncology & carcinogenesis, Cohort, Elasticity Imaging Techniques, Female, Metabolic syndrome, Steatosis, business, Dyslipidemia, Cohort study
Abstract

Background/objectives Several studies have reported that non-alcoholic fatty liver disease (NAFLD) is more frequent in patients with psoriasis, but few have reviewed the presence of liver fibrosis in those patients. Methods Cross-sectional cohort, single-centre study, continuously selecting all patients with moderate-severe psoriasis seen at the Psoriasis Unit of a Tertiary Hospital. The grade of liver steatosis was assessed using liver ultrasound, and the quantity of liver fibrosis was graded using a transitional vibration-controlled elastography (Fibroscan®). Results A total of 71 patients (66.2% male) were included, with an average age of 46.6 years old. The maximum historical PASI average was 14.4 while the baseline PASI average at the time of the study was 2. A third (36%) of patients met the criteria for metabolic syndrome 52% of patients had steatosis; being male, having metabolic syndrome comorbidities, elevated AST/ALT enzymes, dyslipidemia and high initial PASI were significantly related. 14% of patients had moderate liver fibrosis (≥7.6 KPa). In 30% of them, no ultrasound liver steatosis was observed. Conclusions Elastography may be a useful tool along with ultrasound to evaluate liver disease in patients with psoriasis.

Published
2019

38. Documento de consenso. Manejo de la enfermedad hepática grasa no alcohólica (EHGNA). Guía de práctica clínica

Author

Javier Abad, Jordi Muntané, Joan Caballería, Javier Crespo, Elsa Solà, Conrado M. Fernández-Rodríguez, Manuel Hernández-Guerra, Agustín Albillos, Javier Salmerón, Francisco Jorquera, Manuel Romero-Gómez, María Jesús Pareja, Maria Reig, Rafael Bañares, Llorenç Caballería, María Teresa Arias-Loste, José López Miranda, Joan Genescà, Oreste Lo Iacono, E. Vilar-Gomez, Manuel Rodríguez-Perálvarez, Rocío Aller, J.M. Navarro, Rocío Gallego, Marina Berenguer, José A. Carrión, Carmelo García-Monzón, Miguel Ángel Rojo, Miren García-Cortés, Ramon Bataller, Esther Molina, and Moisés Diago

Subjects
medicine.medical_specialty, Hepatology, Mediterranean diet, business.industry, medicine.medical_treatment, Fatty liver, Gastroenterology, nutritional and metabolic diseases, Type 2 diabetes, Disease, Liver transplantation, medicine.disease, digestive system, Obesity, digestive system diseases, 03 medical and health sciences, 0302 clinical medicine, Weight loss, 030220 oncology & carcinogenesis, Internal medicine, medicine, 030211 gastroenterology & hepatology, Steatosis, medicine.symptom, business
Abstract

Non-alcoholic fatty liver disease (NAFLD) is the main cause of liver diseases in Spain and the incidence is raising due to the outbreak of type 2 diabetes and obesity. This CPG suggests recommendation about diagnosis, mainly non-invasive biomarkers, and clinical management of this entity. Life-style modifications to achieve weight loss is the main target in the management of NAFLD. Low caloric Mediterranean diet and 200 minutes/week of aerobic exercise are encouraged. In non-responders patients with morbid obesity, bariatric surgery or metabolic endoscopy could be indicated. Pharmacological therapy is indicated in patients with NASH and fibrosis and non-responders to weight loss measures. NAFLD could influence liver transplantation, as a growing indication, the impact of steatosis in the graft viability, de novo NAFLD rate after OLT and a raised cardiovascular risk that modify the management of this entity. The current CPG was the result of the First Spanish NAFLD meeting in Seville.

Published
2018

39. Impact of comorbidities on patient outcomes after interferon-free therapy-induced viral eradication in hepatitis C

Author

Martin Bonacci, Aida Ortega-Alonso, Jose Luis Calleja, Manuel de la Mata, Raúl J. Andrade, Maria Buti, Guillermo Ontanilla, Juan José Urquijo, Javier Crespo, Juan Manuel Pascasio, Carlota Jimeno, José María Moreno-Planas, José Miguel Rosales, Nieves Palomo, Xavier Forns, Isabel Carmona, Marta Hernández, Blanca Figueruela, Francisco Javier Serrano, Manuel Romero-Gómez, M. Maraver, Javier Salmerón, Ángela Rojas, Javier Ampuero, R. Quiles, Susana Llerena, P. Cordero, J.M. Navarro, and Moisés Diago

Subjects
Male, medicine.medical_specialty, Cirrhosis, Survival, Sustained Virologic Response, Bilirubin, Charlson index, Comorbidity, Antiviral Agents, Models, Biological, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, Liver disease, 0302 clinical medicine, Internal medicine, Outcome Assessment, Health Care, medicine, Humans, Prospective Studies, Stage (cooking), Aged, Proportional Hazards Models, Hepatology, business.industry, Hazard ratio, Viral eradication, Hepatitis C, Middle Aged, Prognosis, medicine.disease, chemistry, Spain, 030220 oncology & carcinogenesis, Multivariate Analysis, Female, 030211 gastroenterology & hepatology, Liver function, business, Algorithms
Abstract

Background & Aims: Patients with advanced liver fibrosis remain at risk of cirrhosis-related outcomes and those with severe comorbidities may not benefit from hepatitis C (HCV) eradication. We aimed to collect data on all-cause mortality and relevant clinical events within the first two years of directacting antiviral therapy, whilst determining the prognostic capability of a comorbidity-based model. Methods: This was a prospective non-interventional study, from the beginning of direct-acting antiviral therapy to the event of interest (mortality) or up to two years of follow-up, including 14 Spanish University Hospitals. Patients with HCV infection, irrespective of liver fibrosis stage, who received direct-acting antiviral therapy were used to build an estimation and a validation cohort. Comorbidity was assessed according to Charlson comorbidity and CirCom indexes. Results: A total of 3.4% (65/1,891) of individuals died within the first year, while 5.4% (102/1,891) died during the study. After adjusting for cirrhosis, platelet count, alanine aminotransferase and sex, the following factors were independently associated with one-year mortality: Charlson index (hazard ratio [HR] 1.55; 95% CI 1.29-1.86; p = 0.0001), bilirubin (HR 1.39; 95% CI 1.11-1.75; p = 0.004), age (HR 1.06 95% CI 1.02-1.11; p = 0.005), international normalized ratio (HR 3.49; 95% CI 1.36-8.97; p = 0.010), and albumin (HR 0.18; 95% CI 0.09-0.37; p = 0.0001). HepCom score showed a good calibration and discrimination (C-statistics 0.90), and was superior to the other prognostic scores (model for end-stage liver disease 0.81, ChildPugh 0.72, CirCom 0.68) regarding one-and two-year mortality. HepCom score identified low- (= 25 points: 56%-59%) mortality groups, both in the estimation and validation cohorts. The distribution of clinical events was similar between groups. Conclusions: The HepCom score, a combination of Charlson comorbidity index, age, and liver function (international normalized ratio, albumin, and bilirubin) enables detection of a group at high risk of one-and two-year mortality, and relevant clinical events, after starting direct-acting antiviral therapy. (C) 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Published
2018

40. Sa349 A GLOBAL SURVEY OF PHYSICIANS KNOWLEDGE ABOUT NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)

Author

Janus Ong, Marco Arrese, Saleh A. Alqahtani, Zobair M. Younossi, Moisés Diago, Brian Lam, Manuel Romero-Gómez, Marcelo Kugelmas, Wah-Kheong Chan, Linda Henry, Issah Younossi, Andrei Racila, Jacob George, Laurent Castera, Ming-Hua Zheng, Patrizia Burra, Vincent Wai-Sun Wong, Saeed Hamid, Mohammed El Kassas, Elisabetta Bugianesi, Maria Buti, Khalid Alswat, Nahum Méndez-Sánchez, Yusuf Yilmaz, Ajay Duseja, Yuichiro Eguchi, Hirokazu Takahashi, Jian-Gao Fan, Mariam Ziayee, Maria Stepanova, and George V. Papatheodoridis

Subjects
medicine.medical_specialty, Hepatology, business.industry, Internal medicine, Fatty liver, Gastroenterology, medicine, Non alcoholic, Disease, medicine.disease, business
Published
2021

41. Interferon-Free Therapy in Elderly Patients With Advanced Liver Disease

Author

José Ramón Fernández, Jose Luis Calleja, J. Llaneras, V. Hontangas, J. Fuentes, J.J. Sanchez-Ruano, José María Moreno, Xavier Forns, Rosa Maria Morillas, Lucia Bonet, Juan de la Vega, Carmen Baliellas, Moisés Diago, Susana Llerena, Esther Molina, Maria Cuaresma, M.A. Simón, Mercè Roget, Sergio Rodríguez-Tajes, Alicia Hernandez-Albujar, B. Sacristan, Xavier Torras, Conrado M. Fernández-Rodríguez, Pilar Sánchez Pobre, José A. Carrión, Oreste Lo lacono, Mercedes Vergara, Federico Sáez-Royuela, Mari Carmen Navascués, Sabela Lens, Carmen Lopez, Inmaculada Fernández, Jose Ramon Salcines, Raúl J. Andrade, Montserrat Forné, Miguel Fernández Bermejo, Silvia Montoliu, and Gloria Sánchez Antolín

Subjects
Male, medicine.medical_specialty, Cirrhosis, DACLATASVIR PLUS ASUNAPREVIR, COMPENSATED CIRRHOSIS, Health Services for the Aged, Population, Hepacivirus, VIRUS-INFECTION, Antiviral Agents, Severity of Illness Index, 03 medical and health sciences, chemistry.chemical_compound, Liver disease, 0302 clinical medicine, Surveys and Questionnaires, Internal medicine, medicine, Humans, GENOTYPE 1B, 030212 general & internal medicine, education, Adverse effect, Aged, Retrospective Studies, Aged, 80 and over, AGED 65 YEARS, education.field_of_study, Hepatology, business.industry, Ribavirin, HCV INFECTION, Gastroenterology, Hepatitis C, Hepatitis C, Chronic, Viral Load, EFFICACY, medicine.disease, chemistry, Tolerability, Spain, SAFETY, Concomitant, Female, 030211 gastroenterology & hepatology, Interferons, RIBAVIRIN, business, CHRONIC HEPATITIS-C
Abstract

OBJECTIVES: Interferon-free therapies have an improved safety and efficacy profile. However, data in elderly patients, who have frequently advanced liver disease, associated comorbidities, and use concomitant medications are scarce. The im of this study was to assess the effectiveness and tolerability of all-oral regimens in elderly patients in real-life clinical practice. METHODS: Retrospective analysis of hepatitis C virus (HCV) patients aged >= 65 years receiving interferon-free regimens within the Spanish National Registry (Hepa-C). RESULTS: Data of 1,252 patients were recorded. Of these, 955 (76%) were aged 65-74 years, 211 (17%) were aged 75-79 years, and 86 (7%) were aged >= 80 years at the start of antiviral therapy. HCV genotype-1b was predominant (88%) and 48% were previous non-responders. A significant proportion of patients had cirrhosis (922; 74%), of whom 11% presented decompensated liver disease. The most used regimens were SOF/LDV (33%), 3D (28%), and SOF/SMV (26%). Ribavirin was added in 49% of patients. Overall, the sustained virological response (SVR12) rate was 94% without differences among the three age categories. Albumin = 75 years (2.59 (1.16-5.83); P = 0.02) and albumin = 75 years) or those with advanced liver disease (albumin

Published
2017

42. Serum biomarkers can predict a change in liver fibrosis 1 year after lifestyle intervention for biopsy-proven NASH

Author

Moisés Diago, Leon A. Adams, Sacha Lazo-del Vallin, Eduardo Vilar-Gomez, Luis Calzadilla-Bertot, Scott L. Friedman, Licet Gonzalez-Fabian, and Bienvenido Gra-Oramas

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Pathology, Liver fibrosis, Gastroenterology, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, Fibrosis, Serum biomarkers, Internal medicine, Positive predicative value, Lifestyle intervention, Biopsy, medicine, Humans, Platelet, Hepatology, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Liver, 030220 oncology & carcinogenesis, Disease Progression, Female, 030211 gastroenterology & hepatology, sense organs, Hepatic fibrosis, business, Risk Reduction Behavior, Biomarkers
Abstract

Background & Aims The dynamic response of serum fibrosis biomarkers to histological changes within the liver following lifestyle intervention (LI) is unknown. We explored relationships between changes in serum biomarkers and liver fibrosis in NASH patients undergoing LI. Methods Paired liver biopsies were performed in 261 NASH patients to assess fibrosis change after 1 year of LI. We explored the utility of serum fibrosis markers to predict changes in hepatic fibrosis and developed and internally validated a model for predicting fibrosis improvement in patients with baseline fibrosis. Results Regression, stabilization and worsening of fibrosis occurred in 51 (20%), 165 (63%) and 45 (17%) patients, respectively. By multivariable analysis, change in HbA1c (OR, 0.39, P

Published
2017

43. Effectiveness, safety and clinical outcomes of direct-acting antiviral therapy in HCV genotype 1 infection: Results from a Spanish real-world cohort

Author

B. Sacristan, Inmaculada Fernández, Miguel Angel Simón, Xavier Torras, Rosa Maria Morillas, J. Llaneras, Diego Rincón, María García-Eliz, Zoe Mariño, F. Gea, Belén Ruiz-Antorán, Jose Luis Calleja, Carmen A. Navascués, Javier Crespo, Javier García-Samaniego, Francisco Jorquera, Miguel A. Serra, Sabela Lens, Juan Manuel Pascasio, Moisés Diago, R. Muñoz, Conrado M Fernández Rodríguez, Juan Arenas, Susana Llerena, Juan Turnes, Rafael Bañares, Christie Perelló, Javier Ampuero, and Agustín Albillos

Subjects
Cyclopropanes, Male, Sustained Virologic Response, Sofosbuvir, Paritaprevir, Hepacivirus, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, 2-Naphthylamine, Anilides, 030212 general & internal medicine, Chronic, Aged, 80 and over, Sulfonamides, Sustained virologic response, Dasabuvir, Liver Neoplasms, Valine, Middle Aged, Hepatitis C, Genotype 1, Treatment Outcome, Randomized controlled trials, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, Uridine Monophosphate, Ledipasvir, Glomerular Filtration Rate, medicine.drug, Adult, medicine.medical_specialty, Carcinoma, Hepatocellular, Macrocyclic Compounds, Genotype, Proline, Lactams, Macrocyclic, Antiviral Agents, Young Adult, 03 medical and health sciences, Internal medicine, Ribavirin, medicine, Humans, Uracil, Aged, Retrospective Studies, Fluorenes, Ritonavir, Hepatology, business.industry, Hepatitis C, Chronic, Ombitasvir, Surgery, Clinical trial, Antiviral agents, Real-world, chemistry, Spain, Benzimidazoles, Carbamates, Neoplasm Recurrence, Local, business
Abstract

Background & Aims: Clinical trials evaluating second-generation direct-acting antiviral agents (DAAs) have shown excellent rates of sustained virologic response (SVR) and good safety profiles in patients with chronic hepatitis C virus (HCV) genotype 1 infection. We aimed to investigate the effectiveness and safety of two oral DAA combination regimens, ombitasvir/paritaprevir/rito navir plus dasabuvir (OMV/PTV/r + DSV) and ledipasvir/sofosbuvir (LDV/SOF), in a real-world clinical practice. Methods: Data from HCV genotype 1 patients treated with either OMV/PTV/r + DSV +/- ribavirin (RBV) (n = 1567) or LDV/SOF +/- RBV (n = 1758) in 35 centers across Spain between April 1, 2015 and February 28, 2016 were recorded in a large national database. Demographic, clinical and virological data were analyzed. Details of serious adverse events (SAEs) were recorded. Results: The two cohorts were not matched with respect to baseline characteristics and could not be compared directly. The SVR12 rate was 96.8% with OMV/PTVr/DSV +/- RBV and 95.8% with LDV/SOF +/- RBV. No significant differences were observed in SVR according to HCV subgenotype (p = 0.321 [OMV/PTV/r + DSV +/- RBV] and p = 0.174 [LDV/SOF]) or degree of fibrosis (c0.548 [OMV/PTV/r/DSV +/- RBV] and p = 0.085 [LDV/SOF]). Only baseline albumin level was significantly associated with failure to achieve SVR (p < 0.05) on multivariate analysis. Rates of SAEs and SAE-associated treatment discontinuation were 5.4% and 1.7%, in the OMV/PTV/r + DSV subcohort and 5.5% and 1.5% in the LDV/SOF subcohort, respectively. Hepatocellular carcinoma (HCC) recurred in 30% of patients with a complete response to therapy for previous HCC. Incident HCC was reported in 0.93%. Conclusions: In this large cohort of patients managed in the real-world setting in Spain, OMV/PTV/r + DSV and LDV/SOF achieved high rates of SVR12, comparable to those observed in randomized controlled trials, with similarly good safety profiles. Lay summary: In clinical trials, second-generation direct-acting antiviral agents (DAAs) have been shown to cure over 90% of patients chronically infected with the genotype 1 hepatitis C virus and have been better tolerated than previous treatment regimens. However, patients enrolled in clinical trials do not reflect the real patient population encountered in routine practice. The current study, which includes almost 4,000 patients, demonstrates comparable rates of cure with two increasingly used DAA combinations as those observed in the clinical trial environment, confirming that clinical trial findings with DAAs translate into the real-world setting, where patient populations are more diverse and complex. (c) 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Published
2017

44. Simeprevir and daclatasvir for 12 or 24 weeks in treatment-naïve patients with hepatitis C virus genotype 1b and advanced liver disease

Author

Ashley Brown, Piero Luigi Almasio, Lawrence Serfaty, Suzanne Bourgeois, Giovanni Battista Gaeta, Peter Buggisch, Moisés Diago, Ramon Planas, Stefan Zeuzem, Ferenc Szalay, Edmund Omoruyi, I. Lonjon-Domanec, Christophe Hézode, M. Schlag, Y. Horsmans, Ralph DeMasi, Hã©zode, Christophe, Almasio, Piero L., Bourgeois, Stefan, Buggisch, Peter, Brown, Ashley, Diago, Moise, Horsmans, Yve, Serfaty, Lawrence, Szalay, Ferenc, Gaeta, Giovanni B., Planas, Ramon, Schlag, Michael, Lonjon-Domanec, Isabelle, Omoruyi, Edmund, Demasi, Ralph, Zeuzem, Stefan, Hezode C., Almasio P.L., Bourgeois S., Buggisch P., Brown A., Diago M., Horsmans Y., Serfaty L., Szalay F., Gaeta G.B., Planas R., Schlag M., Lonjon-Domanec I., Omoruyi E., DeMasi R., and Zeuzem S.

Subjects
Liver Cirrhosis, Male, 0301 basic medicine, Simeprevir, Pyrrolidines, Cirrhosis, Sustained Virologic Response, Hepacivirus, medicine.disease_cause, Gastroenterology, Liver disease, 0302 clinical medicine, Recurrence, hepatitis C viru, Multivariate Analysi, Aged, 80 and over, Imidazoles, Valine, Middle Aged, RNA, Viral, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, Human, medicine.drug, Adult, medicine.medical_specialty, Daclatasvir, Genotype, Logistic Model, Liver Cirrhosi, Hepatitis C virus, simeprevir, Antiviral Agents, Viral Relapse, Young Adult, 03 medical and health sciences, Internal medicine, medicine, Humans, daclatasvir, Adverse effect, Imidazole, Aged, Antiviral Agent, resistance-associated substitution, Hepaciviru, Hepatology, business.industry, Hepatitis C, Chronic, genotype 1b, medicine.disease, Virology, Regimen, Logistic Models, 030104 developmental biology, Multivariate Analysis, Carbamates, business
Abstract

Background & Aims: We investigated the efficacy and safety of simeprevir plus daclatasvir in treatment-naïve patients with chronic, genotype 1b hepatitis C virus infection and advanced liver disease, excluding patients with pre-defined NS5A resistance-associated substitutions. Methods: This phase II, open-label, single-arm, multicentre study included patients aged≥18years with advanced fibrosis or compensated cirrhosis (METAVIR F3/4). Patients with NS5A-Y93H or L31M/V resistance-associated substitutions at screening were excluded. Simeprevir (150mg)+daclatasvir (60mg) once daily was administered for 12 or 24weeks; treatment could be extended to 24 weeks prior to or at the Week 12 visit. Primary efficacy endpoint was sustained virological response 12weeks after the end of treatment. Results: A total of 106 patients were treated; 27% patients were aged >65years, 39% had cirrhosis, 53% had estimated glomerular filtration rate 30-89mL/min, 14% had diabetes, and 38% had arterial hypertension. Overall, 42/106 received 12weeks of treatment and 64/106 received 24weeks of treatment. Ninety-seven (92%) patients achieved a sustained virological response 12 weeks after the end of treatment. The reasons for failure were viral breakthrough (n=7) at weeks 4-16, early treatment discontinuation (n=1) and viral relapse (n=1). Seventy-four (70%) patients had ≥1 adverse event during treatment, including six (6%) patients with ≥1 serious adverse event. Three (3%) patients discontinued treatment owing to adverse events. Conclusions: Simeprevir+daclatasvir demonstrated strong antiviral activity and was well-tolerated in patients with hepatitis C virus genotype 1b infection, advanced liver disease and a high prevalence of comorbidities. However, viral breakthrough occurred in seven patients, making this regimen unsatisfactory.

Published
2017

45. Hepatic encephalopathy due to a congenital portosystemic shunt: a disease with a changeable presentation

Author

Moisés Diago Madrid, Juan José Urquijo Ponce, and Carlos Alventosa Mateu

Subjects
Pediatrics, medicine.medical_specialty, Percutaneous, Adult patients, Portal Vein, Vascular Malformations, business.industry, Gastroenterology, General Medicine, Disease, medicine.disease, Hepatic Encephalopathy, Neurological syndrome, Humans, Medicine, Portasystemic Shunt, Transjugular Intrahepatic, Portosystemic shunt, business, Hepatic encephalopathy, Shunt (electrical)
Abstract

The presence of congenital portosystemic shunts in adult patients is an uncommon entity that can manifests itself with hepatic encephalopathy symptoms. However, its clinical presentation can be very diverse and varied, hence it is essential to bear it in mind to be able to diagnose it. In this manuscript we exemplify this variability by presenting a patient with complex long-standing neurological syndrome of uncertain origin, that was finally diagnosed of portosystemic shunt. To perform a percutaneous shunt closure is recommended to achieve resolution of the clinical manifestations, as happened in our patient.

Published
2020

46. Development and Validation of Hepamet Fibrosis Scoring System-A Simple, Noninvasive Test to Identify Patients With Nonalcoholic Fatty Liver Disease With Advanced Fibrosis

Author

Salvador Benlloch, Javier Crespo, Ming-Hua Zheng, Manuel Romero-Gómez, Judith Gómez-Camarero, Juan Turnes, Jesus M. Banales, Miguel Fernández-Bermejo, Rubén Francés, Vlad Ratziu, Patricia Aspichueta, Javier García-Samaniego, Carmelo García-Monzón, Rocío Gallego-Durán, Aurora Giannetti, Javier Salmerón, Conrado M. Fernández-Rodríguez, Jérôme Boursier, Desamparados Escudero, Moisés Diago, Joan Caballería, Eduardo Vilar, Agustín Albillos, Raluca Pais, Germán Soriano, Jose Luis Calleja, Elvira del Pozo Maroto, Javier Ampuero, José Miguel Rosales, M.T.A. Loste, Rocío Aller, Francisco Jorquera, Raúl J. Andrade, Salvatore Petta, Oreste Lo Iacono, Salvador Agustin, Rebeca Sigüenza, Pamela Estévez, Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Universidad de Cantabria [Santander], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Ampuero, Javier, Pais, Raluca, Aller, Rocío, Gallego-Durán, Rocío, Crespo, Javier, García-Monzón, Carmelo, Boursier, Jerome, Vilar, Eduardo, Petta, Salvatore, Ming-Hua, Zheng, Escudero, Desamparado, Calleja, Jose Lui, Aspichueta, Patricia, Diago, Moisé, Rosales, Jose Miguel, Caballería, Joan, Gómez-Camarero, Judith, Lo Iacono, Oreste, Benlloch, Salvador, Albillos, Agustín, Turnes, Juan, Banales, Jesus M., Ratziu, Vlad, and Romero-Gómez, Manuel

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Steatosis, [SDV]Life Sciences [q-bio], Biopsy, Likelihood ratios in diagnostic testing, Gastroenterology, Severity of Illness Index, Decision Support Techniques, 03 medical and health sciences, 0302 clinical medicine, Fibrosis, Non-alcoholic Fatty Liver Disease, Positive predicative value, Internal medicine, Nonalcoholic fatty liver disease, HOMA, Medicine, Humans, ComputingMilieux_MISCELLANEOUS, Aged, 2. Zero hunger, NASH, FIBROSIS, Hepatology, medicine.diagnostic_test, Receiver operating characteristic, business.industry, Prognostic Factor, Odds ratio, Middle Aged, medicine.disease, Prognosis, 3. Good health, Cross-Sectional Studies, Diagnostic Tool, Cirrhosis, Liver, 030220 oncology & carcinogenesis, Liver biopsy, Diagnostic odds ratio, 030211 gastroenterology & hepatology, Female, business
Abstract

HEPAmet Registry., [Background & Aims] Fibrosis affects prognoses for patients with nonalcoholic fatty liver disease (NAFLD). Several non-invasive scoring systems have aimed to identify patients at risk for advanced fibrosis, but inconclusive results and variations in features of patients (diabetes, obesity and older age) reduce their diagnostic accuracy. We sought to develop a scoring system based on serum markers to identify patients with NAFLD at risk for advanced fibrosis., [Methods] We collected data from 2452 patients with NAFLD at medical centers in Italy, France, Cuba, and China. We developed the Hepamet fibrosis scoring system using demographic, anthropometric, and laboratory test data, collected at time of liver biopsy, from a training cohort of patients from Spain (n = 768) and validated the system using patients from Cuba (n = 344), Italy (n = 288), France (n = 830), and China (n = 232). Hepamet fibrosis score (HFS) were compared with those of previously developed fibrosis scoring systems (the NAFLD fibrosis score [NFS] and FIB-4). The diagnostic accuracy of the Hepamet fibrosis scoring system was assessed based on area under the receiver operating characteristic (AUROC) curve, sensitivity, specificity, diagnostic odds ratio, and positive and negative predictive values and likelihood ratios., [Results] Variables used to determine HFS were patient sex, age, homeostatic model assessment score, presence of diabetes, levels of aspartate aminotransferase, and albumin, and platelet counts; these were independently associated with advanced fibrosis. HFS discriminated between patients with and without advanced fibrosis with an AUROC curve value of 0.85 whereas NFS or FIB-4 did so with AUROC values of 0.80 (P = .0001). In the validation set, cut-off HFS of 0.12 and 0.47 identified patients with and without advanced fibrosis with 97.2% specificity, 74% sensitivity, a 92% negative predictive value, a 76.3% positive predictive value, a 13.22 positive likelihood ratio, and a 0.31 negative likelihood ratio. HFS were not affected by patient age, body mass index, hypertransaminasemia, or diabetes. The Hepamet fibrosis scoring system had the greatest net benefit in identifying patients who should undergo liver biopsy analysis and led to significant improvements in reclassification, reducing the number of patients with undetermined results to 20% from 30% for the FIB-4 and NFS systems (P < .05)., [Conclusions] Using clinical and laboratory data from patients with NAFLD, we developed and validated the Hepamet fibrosis scoring system, which identified patients with advanced fibrosis with greater accuracy than the FIB-4 and NFS systems. the Hepamet system provides a greater net benefit for the decision-making process to identify patients who should undergo liver biopsy analysis.

Published
2019

47. Effectiveness and safety of elbasvir/grazoprevir therapy in patients with chronic HCV infection: Results from the Spanish HEPA-C real-world cohort

Author

Conrado M. Fernández-Rodríguez, Fernando Menéndez, Rosa Maria Morillas, Javier García-Samaniego, Juan de la Vega, Ester Badia, Belén Piqueras Alcol, Marta Hernández-Conde, Adolfo Gallego, Inmaculada Fernández, Isabel Carmona, José Luis Castro Urda, Nuria Domínguez García, M. D. Anton, Luisa García Buey, Miguel Fernández-Bermejo, Jose Luis Calleja, José Javier Moreno-Palomares, Francisco J Salmerón, José María Moreno-Planas, Martin Bonacci, Raquel Souto-Rodríguez, Esther Molina, Moisés Diago, José A. Carrión, Jose M Rosales-Zabal, Manuel Romero-Gómez, Silvia Montoliu, Juan Jose Sanchez Ruano, Juan Manuel Pascasio, Blanca Figueruela, Christie Perelló, F. Gea, Susana Llerena, José Castellote, Gilead Sciences, AbbVie Pharmaceuticals, Merck & Co, MSD, BMS College of Engineering, and Janssen Biotech

Subjects
Male, real-world, Sustained Virologic Response, Chronic hepatitis C, law.invention, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, Randomized controlled trial, law, Medicine, 030212 general & internal medicine, Prospective Studies, Registries, Aged, 80 and over, Imidazoles, Middle Aged, Drug Combinations, Infectious Diseases, Treatment Outcome, Grazoprevir, Cohort, 030211 gastroenterology & hepatology, Drug Therapy, Combination, Female, Adult, Elbasvir, medicine.medical_specialty, Genotype, Antiviral Agents, 03 medical and health sciences, elbasvir/grazoprevir, Virology, Internal medicine, Quinoxalines, Ribavirin, Elbasvir, Grazoprevir, Humans, chronic hepatitis C, Adverse effect, Real‐world, Aged, Benzofurans, Retrospective Studies, Spain, chronic hepatitis C, elbasvir/grazoprevir, real-world, Hepatology, business.industry, Hepatitis C, Chronic, Discontinuation, chemistry, Elbasvir/grazoprevir, Spain, business
Abstract

In randomized controlled trials of patients with chronic HCV infection, elbasvir/grazoprevir (EBR/GZR) demonstrated high cure rates and a good safety profile. This study assessed the effectiveness and safety of EBR/GZR, with and without ribavirin, in a real‐world HCV patient cohort. HEPA‐C is a collaborative, monitored national registry of HCV patients directed by the Spanish Association for the Study of the Liver and the Networked Biomedical Research Centre for Hepatic and Digestive Diseases. Patients entered into HEPA‐C between December 2016 and May 2017, and treated with EBR/GZR with at least end‐of‐treatment response data, were included. Demographic, clinical and virologic data were analysed, and adverse events (AEs) recorded. A total of 804 patients were included in the study. The majority were male (57.9%), with a mean age of 60 (range, 19‐92) years. Genotype (GT) distribution was GT 1, 86.8% (1a, 14.3%; 1b, 72.5%); GT 4, 13.2% and 176 patients (21.9%) were cirrhotic. Overall, among 588 patients with available data, 570 (96.9%) achieved sustained virologic response at 12 weeks post‐treatment (SVR12). SVR12 rates by genotype were GT 1a, 97.7%; GT 1b, 98.6%; and GT 4, 98.1%. No significant differences in SVR12 according to fibrosis stage were observed. Eighty patients experienced an AE, resulting in treatment discontinuation in three. In this large cohort of patients with chronic HCV managed in a real‐world setting in Spain, EBR/GZR achieved high rates of SVR12, comparable to those observed in randomized controlled trials, with a similarly good safety profile.

Published
2019

48. Effectiveness and safety of sofosbuvir/velpatasvir/voxilaprevir in patients with chronic hepatitis C previously treated with DAAs

Author

Inmaculada Fernández, Maria Buti, Javier García-Samaniego, Zoe Mariño, Manuel Hernández-Guerra, Juan Arenas, Manuel Delgado, Vanesa Bernal, Xavier Torras, Conrado M. Fernández-Rodríguez, Jose Luis Calleja, J. Llaneras, Rafael Esteban, Sabela Lens, José A. Carrión, Moisés Diago, Alba Cachero, Juan Turnes, Ana Arencibia, Mar Riveiro-Barciela, Juan Manuel Pascasio, Miguel Fernández-Bermejo, Rosa Maria Morillas, Silvia Montoliu, Blanca Figueruela, Susana Llerena, F. Gea, Isabel Carmona, Isabel Conde, Ester Badia, Jesús M. González-Santiago, José Miguel Rosales, and Mercedes Iñarrairaegui

Subjects
Cyclopropanes, Liver Cirrhosis, Male, Aminoisobutyric Acids, Sofosbuvir, Sustained Virologic Response, HCV genotype 3, Hepacivirus, Gastroenterology, chemistry.chemical_compound, Velpatasvir, Sulfonamides, Dasabuvir, Hepatitis C, Middle Aged, Drug Combinations, Treatment Outcome, Tolerability, Female, Drug Monitoring, medicine.drug, Adult, medicine.medical_specialty, Macrocyclic Compounds, Proline, Voxilaprevir, Lactams, Macrocyclic, Treatment failures, Antiviral Agents, Heterocyclic Compounds, 4 or More Rings, Leucine, Internal medicine, Quinoxalines, Drug Resistance, Viral, medicine, Humans, Hepatology, business.industry, Hepatitis C, Chronic, medicine.disease, Ombitasvir, Regimen, chemistry, Paritaprevir, Spain, Carbamates, business
Abstract

Background & Aims: Around 5% of patients with chronic hepatitis C virus (HCV) infection treated with direct-acting antiviral (DAA) agents do not achieve sustained virological response (SVR). The currently approved retreatment regimen for prior DAA failure is a combination of sofosbuvir, velpatasvir, and voxilaprevir (SOF/VEL/VOX), although there is little data on its use in clinical practice. The aim of this study was to analyse the effectiveness and safety of SOF/VEL/VOX in the real-world setting. Methods: This was a prospective multicentre study assessing the efficacy of retreatment with SOF/VEL/VOX in patients who had experienced a prior DAA treatment failure. The primary endpoint was SVR 12 weeks after the completion of treatment (SVR12). Data on safety and tolerability were also recorded. Results: A total of 137 patients were included: 75% men, 35% with liver cirrhosis. Most were infected with HCV genotype (GT) 1 or 3. The most common prior DAA combinations were sofosbuvir plus an NS5A inhibitor or ombitasvir/paritaprevirtr +dasabuvir. A total of 136 (99%) patients achieved undetectable HCV RNA at the end of treatment. Overall SVR12 was 95% in the 135 patients reaching this point. SVR12 was lower in patients with cirrhosis (89%, p = 0.05) and those with GT3 infection (80%, p

Published
2019

49. Development and validation of a noninvasive prediction model for nonalcoholic steatohepatitis resolution after lifestyle intervention

Author

Eduardo Vilar-Gomez, Licet Gonzalez-Fabian, Bienvenido Gra-Oramas, Yadina Martinez-Perez, Ana Torres-Gonzalez, Scott L. Friedman, Manuel Romero-Gómez, Luis Calzadilla-Bertot, Moisés Diago, Ali Yasells-Garcia, and Oscar Villa-Jimenez

Subjects
Adult, Male, 0301 basic medicine, medicine.medical_specialty, Type 2 diabetes, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, Internal medicine, medicine, Humans, Prospective cohort study, Life Style, Hepatology, medicine.diagnostic_test, Receiver operating characteristic, business.industry, Fatty liver, Odds ratio, Middle Aged, Models, Theoretical, medicine.disease, Confidence interval, Surgery, 030104 developmental biology, Liver biopsy, Multivariate Analysis, Female, 030211 gastroenterology & hepatology, business, Forecasting
Abstract

UNLABELLED Liver biopsy is the gold standard method to assess nonalcoholic steatohepatitis (NASH) resolution after therapeutic interventions. We developed and validated a simple and noninvasive scoring system to predict NASH resolution without fibrosis worsening after 1 year of lifestyle intervention. This was a prospective cohort study conducted in 261 patients with histologically proven NASH who were treated with lifestyle changes for 52 weeks and underwent a second liver biopsy to confirm NASH resolution. We divided the data into development (140 subjects) and validation (121 individuals) sets. NASH resolution occurred in 28% (derivation group) and 27% (validation group). At the multivariable analysis, weight loss (odds ratio [OR] = 2.75, 95% confidence interval [CI] 1.65-4.58; P < 0.01), type 2 diabetes (OR = 0.04, 95% CI 0.005-0.49; P = 0.01), normal levels of alanine aminotransferase at the end of intervention (OR = 9.84, 95% CI 2.21-44.1; P < 0.01), age (OR = 0.89, 95% CI 0.83-0.97; P = 0.01), and a nonalcoholic fatty liver activity score ≥5 (OR = 0.08, 95% CI 0.01-0.43; P < 0.01) were independent predictors of NASH resolution. The area under the receiver operating characteristic curve of the selected model was 0.956 and 0.945 in the derivation and validation cohorts, respectively. Using a score threshold of ≤46.15, negative predictive values were 92% in the derivation and validation groups, respectively. By applying a cutoff ≥69.72, positive predictive values were 92% and 89% in the derivation and validation groups, respectively. Using both cutoffs, a liver biopsy would have been avoided in 229 (88%) of 261 patients, with a correct prediction in 209 (91%) CONCLUSIONS A noninvasive prediction model including weight loss, type 2 diabetes, alanine aminotransferase normalization, age, and a nonalcoholic fatty liver activity score ≥5 may be useful to identify NASH resolution in patients under lifestyle intervention. (Hepatology 2016;63:1875-1887).

Published
2016

50. Difficult management of triple therapy for chronic hepatitis C in a patient on haemodialysis

Author

Moisés Diago, Laura Peño, Juan José Urquijo, and Lydia Plana

Subjects
0301 basic medicine, medicine.medical_specialty, business.industry, Ribavirin, medicine.medical_treatment, Alpha interferon, Glomerulonephritis, Immunosuppression, medicine.disease, Staphylococcal infections, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 030104 developmental biology, 0302 clinical medicine, chemistry, Bacteremia, Blood Component Transfusion, Internal medicine, medicine, 030211 gastroenterology & hepatology, business, Kidney transplantation
Published
2017

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