A Comparison of Prognostic Scores (Mayo, UK-PBC, and GLOBE) in Primary Biliary Cholangitis.

INTRODUCTION: Comparative data on scores that predict outcome in primary biliary cholangitis (PBC) are scarce. We aimed to assess and compare the prognostic value of the Mayo Risk Score (MRS, 1989 and 1994), UK-PBC score, and GLOBE score in a large international cohort of patients with PBC. METHODS: Ursodeoxycholic acid-treated patients from 7 centers participating in the GLOBAL PBC Study Group were included. The discriminatory performance of the scores was assessed with concordance statistics at yearly intervals up to 5 years. Model for End-stage Liver Disease was included for comparison. Prediction accuracy was assessed by comparing predicted survival and actual survival in Kaplan-Meier analyses. RESULTS: A total of 1,100 ursodeoxycholic acid-treated patients with PBC were included, with a mean (SD) age of 53.6 (12.0) years, of whom 1,003 (91%) were female. During a median follow-up of 7.6 (interquartile range 4.1-11.7) years, 42 patients underwent liver transplantation, and 127 patients died. At 1 year, the concordance statistic for Model for End-stage Liver Disease was 0.68 (95% confidence interval [CI] 0.64-0.72), 0.74 (95% CI 0.67-0.80) for the UK-PBC score, 0.76 (95% CI 0.72-0.81) for the MRS (1989 and 1994), and 0.80 (95% CI 0.76-0.84) for the GLOBE score. The GLOBE score showed superior discriminatory performance, but differences were not statistically different. For all scores, discriminatory performance increased in those with bilirubin >0.6 × ULN and advanced fibrosis estimated with Fibrosis-4. The predicted (median) minus observed 5-year transplant-free survival was +0.4% and +2.5% for the MRS (1989) and GLOBE score, respectively. DISCUSSION: All prognostic scores developed for PBC (GLOBE, UK-PBC, and MRS) demonstrated comparable discriminating performance for liver transplantation or death as well as good prediction accuracy.

[Yoghurt-induced Lactobacillus bacteremia in a patient with Crohn's disease on therapy with ustekinumab and concomitant HIV-Infection]. / Naturjoghurtinduzierte Lactobacillus-Bakteriämie bei einem mit Ustekinumab behandelten Patienten mit Morbus Crohn und begleitender HIV-Infektion.

Probiotics are live microorganisms that are often used as adjunctive therapy in patients with inflammatory bowel disease. Although there is a lack of evidence for their benefit, the use of probiotics is encouraged by the perceived lack of adverse events. However, in rare instances, probiotics can cause systemic infections through bacteremia. We report about a patient with Crohn's disease and HIV-infection, who developed a septicemia. A Lactobacillus-bacteremia was diagnosed, the causative agents could be traced back to the consumption of self-made yoghurt. The utility of probiotics in IBD patients with underlying immune-compromising diseases is a risk which is difficult to predict, therefore their use in these patients should be discouraged.

A study on the correlation of gastrointestinal bleeding and meteorological factors - is there a weather condition for GI bleeding?

AIM: We tried to identify a possible correlation between meteorological factors and the frequency of gastrointestinal bleeding (GIB). METHODS: We analyzed all endoscopic examinations performed because of suspected GIB from 2013 to 2016 at Jena University Hospital, Germany. Confirmed bleeding events were correlated with local meteorological data and meteorological season using multivariate analysis. RESULTS: Among a total of 35 522 examinations, we identified 5310 endoscopies performed for suspected GIB (61.5 % upper, 38.5 % lower endoscopies). In 35.5 %, GIB could be ascertained, gastroduodenal ulcers being the most frequent bleeding source. Of bleedings, 46.7 % merited an endoscopic intervention. Multivariate analysis did not show a correlation between meteorological factors and the total number of bleeding events. In subgroup analysis, lower ambient temperatures as well as pronounced changes in daily temperature were significantly associated with a higher rate of variceal hemorrhage (incidence rate ratio [IRR]: 0.961 for higher minimum temperature, p = 0.019; IRR: 1.119 per degree temperature change, p = 0.021), whereas ulcerative bleeding was associated with changes in air pressure (IRR: 1.031 per hPa, p = 0.010). CONCLUSIONS: Our study does not support the correlation of meteorological conditions with the frequency of GIB per se. However, we found a statistically significant increase of variceal bleeding episodes along with lower ambient temperatures and pronounced changes in daily temperature. Patients at risk for variceal hemorrhage should be advised to avoid exposure to low temperatures, whenever possible. Ulcerative bleeding was significantly associated with changes in air pressure.

Sleeping with the enemy: Clostridium difficile infection in the intensive care unit.

Over the last years, there was an increase in the number and severity of Clostridium difficile infections (CDI) in all medical settings, including the intensive care unit (ICU). The current prevalence of CDI among ICU patients is estimated at 0.4-4% and has severe impact on morbidity and mortality. An estimated 10-20% of patients are colonized with C. difficile without showing signs of infection and spores can be found throughout ICUs. It is not yet possible to predict whether and when colonization will become infection. Figuratively speaking, our patients are sleeping with the enemy and we do not know when this enemy awakens.Most patients developing CDI in the ICU show a mild to moderate disease course. Nevertheless, difficult-to-treat severe and complicated cases also occur. Treatment failure is particularly frequent in ICU patients due to comorbidities and the necessity of continued antibiotic treatment. This review will give an overview of current diagnostic, therapeutic, and prophylactic challenges and options with a special focus on the ICU patient.First, we focus on diagnosis and prognosis of disease severity. This includes inconsistencies in the definition of disease severity as well as diagnostic problems. Proceeding from there, we discuss that while at first glance the choice of first-line treatment for CDI in the ICU is a simple matter guided by international guidelines, there are a number of specific problems and inconsistencies. We cover treatment in severe CDI, the problem of early recognition of treatment failure, and possible concepts of intensifying treatment. In conclusion, we mention methods for CDI prevention in the ICU.

Frequency of a tau genotype in amyotrophic lateral sclerosis.

We investigated the susceptibility of the dinucleotide polymorphism A0 in the tau gene to amyotrophic lateral sclerosis (ALS). In 416 unrelated patients with ALS and 242 control subjects the A0/A0 genotype was not associated with the pooled sample of ALS cases. Subgroup analysis revealed that in sporadic ALS the A0 polymorphism was significantly overrepresented. There was no association of the A0/A0 genotype with the age and site of disease onset or the presence of dementia. The studied tau genotype may contribute to the multifactorial genetic background of ALS.