Hepatic encephalopathy (HE) affects the survival and quality of life of patients with cirrhosis. However, longitudinal data on the clinical course after hospitalization for HE are lacking. The aim ...was to estimate mortality and risk for hospital readmission of cirrhotic patients hospitalized for HE.
We prospectively enrolled 112 consecutive cirrhotic patients hospitalized for HE (HE group) at 25 Italian referral centers. A cohort of 256 patients hospitalized for decompensated cirrhosis without HE served as controls (no HE group). After hospitalization for HE, patients were followed-up for 12 months until death or liver transplant (LT).
During follow-up, 34 patients (30.4%) died and 15 patients (13.4%) underwent LT in the HE group, while 60 patients (23.4%) died and 50 patients (19.5%) underwent LT in the no HE group. In the whole cohort, age (HR 1.03, 95% CI 1.01-1.06), HE (HR 1.67, 95% CI 1.08-2.56), ascites (HR 2.56, 95% CI 1.55-4.23), and sodium levels (HR 0.94, 95% CI 0.90-0.99) were significant risk factors for mortality. In the HE group, ascites (HR 5.07, 95% CI 1.39-18.49) and BMI (HR 0.86, 95% CI 0.75-0.98) were risk factors for mortality, and HE recurrence was the first cause of hospital readmission.
In patients hospitalized for decompensated cirrhosis, HE is an independent risk factor for mortality and the most common cause of hospital readmission compared with other decompensation events. Patients hospitalized for HE should be evaluated as candidates for LT.
We aimed to evaluate the impact of oesophageal varices (OV) and their evolution on the risk of complications of compensated advanced chronic liver disease (cACLD) caused by non-alcoholic fatty liver ...disease (NAFLD). We also assessed the accuracy of non-invasive scores for predicting the development of complications and for identifying patients at low risk of high-risk OV.
We performed a retrospective assessment of 629 patients with NAFLD-related cACLD who had baseline and follow-up oesophagogastroduodenoscopy and clinical follow-up to record decompensation, portal vein thrombosis (PVT), and hepatocellular carcinoma.
Small and large OV were observed at baseline in 30 and 15.9% of patients, respectively. The 4-year incidence of OV from absence at baseline, and that of progression from small to large OV were 16.3 and 22.4%, respectively. Diabetes and a ≥5% increase in BMI were associated with OV progression. Multivariate Cox regression revealed that small (hazard ratio HR 2.24, 95% CI 1.47–3.41) and large (HR 3.86, 95% CI 2.34–6.39) OV were independently associated with decompensation. When considering OV status and trajectories, small (HR 2.65, 95% CI 1.39–5.05) and large (HR 4.90, 95% CI 2.49–9.63) OV at baseline and/or follow-up were independently associated with decompensation compared with the absence of OV at baseline and/or follow-up. The presence of either small (HR 2.8, 95% CI 1.16–6.74) or large (HR 5.29, 95% CI 1.96–14.2) OV was also independently associated with incident PVT.
In NAFLD-related cACLD, the presence, severity, and evolution of OV stratify the risk of developing decompensation and PVT.
Portal hypertension is the main driver of liver decompensation in chronic liver diseases, and its non-invasive markers can help risk prediction. The presence, severity, and progression of oesophageal varices stratify the risk of complications of non-alcoholic fatty liver disease. Easily obtainable laboratory values and liver stiffness measurement can identify patients at low risk for whom endoscopy may be withheld, and can also stratify the risk of liver-related complications.
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•The presence, severity, and progression of oesophageal varices stratify complication risk in patients with non-alcoholic fatty liver disease-related compensated advanced chronic liver disease.•Changes in oesophageal varices status during follow-up improved the risk stratification of portal hypertension-related complications.•Non-invasive surrogates of portal hypertension also significantly predicted a higher risk of liver decompensation.
Durum wheat varieties are important sources of nutrients and provide remarkable amounts of phytochemicals. Especially, phenolics, which are mostly located in external layers of grains, have recently ...gained increased interest due to their high antioxidant power. This study aimed to evaluate the differences in the quality traits and phenolic compounds' concentration (e.g., phenolic acids) of different durum wheat genotypes, namely four Italian durum wheat cultivars and a USA elite variety, in relation to their yield potential and year of release. Phenolic acids were extracted both from wholemeal flour and semolina and analysed through HPLC-DAD analysis. Ferulic acid was the most represented phenolic acid, both in the wholemeal flour (438.3 µg g
dry matter) and in semolina (57.6 µg g
dry matter) across all cultivars, followed by
-coumaric acid, sinapic acid, vanillin, vanillic acid, syringic acid, and
-hydroxybenzoic acid. Among the cultivars, Cappelli showed the highest phenolic acid content, whilst Kronos had the lowest one. Negative correlations occurred between some phenolic acids and morphological and yield-related traits, especially for Nadif and Sfinge varieties. On the contrary, durum wheat genotypes with low yield potential such as Cappelli accumulated higher concentrations of phenolic acids under the same growing conditions, thereby significantly contributing to the health-promoting purposes.
The gut flora carries out important functions for human health, although most of them are still unknown, and an alteration of any of them, due to a condition of dysbiosis, can lead to relevant ...pathological implications. Commensal bacteria in the gut are essential for the preservation of the integrity of the mucosal barrier function and an alteration in the anatomic functional integrity of this barrier has been implicated in the pathophysiologic process of different diseases. The gut microflora plays a role in modulating the intestinal immune system; in fact, it is essential for the maturation of gut-associated lymphatic tissue, the secretion of IgA and the production of antimicrobial peptides. The enteric flora represents a potent bioreactor which controls several metabolic functions, even if most of them are still unknown. The main metabolic functions are represented by the fermentation of indigestible food substances into simple sugars, absorbable nutrients, and short-chain fatty acids. Furthermore, the gut microbiota exerts important trophic and developmental functions on the intestinal mucosa. This overview focuses briefly on the physiological role of the gut microbiota in maintaining a healthy state and the potential role played by disturbances of both the function and composition of the gut microbiota in determining important pathological conditions, such as irritable bowel syndrome, inflammatory bowel disease, metabolic syndrome, obesity, and cancer.
The study investigated the nutritional profile and nutraceutical composition of the seeds (whole and defatted) of two monoecious hemp cultivars (Carmaleonte, Codimono) and one dioecious cultivar (CS) ...grown during the 2018 and 2019 crop seasons. The phenolic acid profiles, both free and bound, antioxidant activity (AA), protein content (PC), total phenolic content (TPC), β-carotene, lutein content, and condensed tannins (CT) were studied, and the effects of genotype (G), year (Y), and GxY interaction were also measured. The results indicated the stronger involvement of the year in the nutritional and antioxidant properties of the whole seeds than in those of the defatted seeds, as indicated by the analysis of the variance. The PC, TPC, AA, sum of phenolics free (SPF), and sum of phenolics bound (SPB) were significantly affected by year, while the lutein and some phenolic acids, free and bound (ferulic and p-coumaric acids and N-trans-caffeoyltyramine), showed significant effects of the genotype. In this respect, the Carmaleonte revealed the highest content of ferulic and p-coumaric acids, as well as CS of N-trans-caffeoyltyramine. A prevalence of Y effect over G was measured in the free and bound fraction of the phenolics of the whole seeds, in contrast to the defatted seeds, in which significant effects of GxY were also measured. Moreover, the Pearson’s correlation coefficients indicated a strict involvement of precipitations in the variation of the phenolics accumulation, above all with bound p-hydroxybenzoic acid (r = 0.71 **), bound syringic acid (r = 0.69 *), bound N-trans-caffeoyltyramine (r = 0.64 *), and SPB (r = 0.60 *). As phenolics bound fractions have strong biological activities, (including antioxidant and anti-inflammatory activities) the high concentrations of N-trans-Caffeoyltyramine B in the CS defatted seeds suggest that it is valuable ingredient for functional foods.
A simple combined score with liver stiffness, controlled attenuation parameter and serum aspartate aminotransferase (AST), the FibroScan-AST (FAST) score, has been proposed to non-invasively identify ...patients with fibrotic non-alcoholic steatohepatitis (NASH). We performed a systematic review and meta-analysis of published studies to evaluate the overall diagnostic accuracy of the FAST score in identifying patients with fibrotic NASH.
We systematically searched MEDLINE, Ovid Embase, Scopus and Cochrane Library electronic databases for full-text published articles in any language between 3 February 2020 and 30 April 2022. We included original articles that reported data for the calculation of sensitivity and specificity of the FAST score for identifying adult patients with fibrotic NASH adults, according to previously described rule-out (≤0.35) and rule-in (≥0.67) cut-offs.
We included 12 observational studies for a total of 5835 participants with biopsy-confirmed non-alcoholic fatty liver disease. The pooled prevalence of fibrotic NASH was 28% (95% CI 21% to 34%). The FAST score's pooled sensitivity was 89% (95% CI 82% to 93%), and the pooled specificity was 89% (95% CI 83% to 94%) according to the aforementioned rule-in/rule-out cut-offs. The negative predictive value and positive predictive value of the FAST score were 92% (95% CI 91% to 95%) and 65% (95% CI 53% to 68%), respectively. Subgroup analyses and influential bias analyses did not alter these findings.
The results of our meta-analysis show that the FAST score has a good performance for non-invasive diagnosis of fibrotic NASH. Therefore, this score can be used to efficiently identify patients who should be referred for a conclusive liver biopsy and/or consideration for treatment with emerging pharmacotherapies.
CRD42022350945.
•Liver stiffness measurement (LSM) by transient elastography is a promising technique for early diagnosis of veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) in adults undergoing ...hematopoietic stem cell transplantation (HSCT).•LSM anticipates the VOD/SOS diagnosis with a gain at 2 to 12 days before clinical diagnosis.•LSM decreases after VOD/SOS-specific treatments.•LSM can discriminate between VOD/SOS and other post-HSCT complications.
Veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), is a life-threatening complication affecting patients undergoing hematopoietic stem cell transplantation (HSCT). The survival rate is higher when specific therapy is initiated early; thus, improving early, noninvasive diagnosis of VOD/SOS is an important need. In an adult population undergoing HSCT, we aimed to assess the role of liver stiffness measurement (LSM), evaluated by transient elastography (TE), for diagnosing VOD/SOS. Between April 2016 and March 2018, 78 consecutive adult patients with indications for allogeneic HSCT were prospectively included. LSM was performed before HSCT and at days +9/10, +15/17, and +22/24 post-HSCT. New European Society for Blood and Marrow Transplantation criteria were used to establish VOD/SOS diagnosis. Four patients developed VOD/SOS (5.1%) during the study period, with a median time of +17 days post-HSCT. A sudden increase in LSM compared with previously assessed values and pre-HSCT values, was seen in all patients who developed VOD/SOS. LSM increases occurred from 2 to 12 days before clinical SOS/VOD appearance. The VOD/SOS diagnostic performance of increased LSM over pre-HSCT assessment showed an area under the receiver operating characteristic curve of 0.997 (sensitivity 75%; specificity 98.7%). LSM gradually decreased following successful VOD/SOS-specific treatment. Interestingly, LSM values did not increase significantly in patients experiencing hepatobiliary complications (according to the Common Terminology Criteria) other than VOD/SOS. LSM by TE can be considered a promising method to perform an early, preclinical diagnosis and follow-up of VOD/SOS.
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