Factores pronósticos de mortalidad en la cirrosis hepática tras un primer episodio de peritonitis bacteriana espontánea. Estudio multicéntrico / Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study

Introducción: la peritonitis bacteriana espontánea es una complicación infecciosa con impacto negativo sobre la supervivencia de los pacientes con cirrosis. Objetivo: analizar la supervivencia a corto y largo plazo después de un primer episodio de peritonitis bacteriana espontánea y los factores pronósticos asociados. Material y métodos: estudio multicéntrico retrospectivo que incluyó a los pacientes ingresados por peritonitis bacteriana espontánea entre 2008 y 2013. Las variables independientes relacionadas con la mortalidad se analizaron mediante regresión logística. Se analizó el poder pronóstico de los índices Child Pugh, MELD y Charlson mediante curva de ROC. Resultados: fueron incluidos 159 pacientes. El 72% fueron hombres con una edad media de 63,5 años y con una puntuación MELD de 19 (DE ± 9,5). La mortalidad a los 30 días, 90 días, al año y a los dos años fue del 21%, 31%, 55% y 69%, respectivamente. La encefalopatía hepática (p = 0,008; OR 3,5; IC 95% 1,4-8,8) y la función renal (p = 0,026; OR 2,7; IC 95% 1,13-16,7) fueron factores independientes de mortalidad a corto y largo plazo. El MELD fue un buen indicador de supervivencia a corto y largo plazo (área bajo la curva [AUC] 0,7: IC 95% 1,02-1,4). El índice de Charlson se relacionó con la mortalidad a largo plazo (AUC 0,68: IC 95% 0,6-0,77). Conclusiones: en la peritonitis bacteriana espontánea la mortalidad a corto y largo plazo sigue siendo elevada. Los principales factores pronósticos de mortalidad son el deterioro de la función hepática y renal. El MELD y el índice de Charlson son unos buenos indicadores de supervivencia (AU)

Introduction: Spontaneous bacterial peritonitis is an infectious complication with a negative impact on survival of patients with cirrhosis. Objective: To analyze the short- and long-term survival after a first episode of bacterial peritonitis and the associated prognostic factors. Patients and methods: This was a retrospective, multicenter study of patients admitted to hospital for spontaneous bacterial peritonitis between 2008 and 2013. Independent variables related to mortality were analyzed by logistic regression. The prognostic power of the Child Pugh Score, the Model for End-Stage Liver Disease (MELD) and the Charlson index was analyzed by ROC curve. Results: A total of 159 patients were enrolled, 72% were males with a mean age of 63.5 years and a mean MELD score of 19 (SD ± 9.5). Mortality at 30 and 90 days and one and two years was 21%, 31%, 55% and 69%, respectively. Hepatic encephalopathy (p = 0.008, OR 3.5, 95% CI 1.4-8.8) and kidney function (p = 0.026, OR 2.7, 95% CI 1.13-16.7) were independent factors for short- and long-term mortality. MELD was a good marker of short- and long-term survival (area under the curve [AUC] 0.7: 95% CI 1.02-1.4). The Charlson index was related to long-term mortality (AUC 0.68: 95% CI 0.6-0.77). Conclusions: Short- and long-term mortality of spontaneous bacterial peritonitis is still high. The main prognostic factors for mortality are impairment of liver and kidney function. MELD and the Charlson index are good markers of survival (AU)

Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study.

INTRODUCTION: Spontaneous bacterial peritonitis is an infectious complication with a negative impact on survival of patients with cirrhosis. OBJECTIVE: To analyze the short- and long-term survival after a first episode of bacterial peritonitis and the associated prognostic factors. PATIENTS AND METHODS: This was a retrospective, multicenter study of patients admitted to hospital for spontaneous bacterial peritonitis between 2008 and 2013. Independent variables related to mortality were analyzed by logistic regression. The prognostic power of the Child Pugh Score, the Model for End-Stage Liver Disease (MELD) and the Charlson index was analyzed by ROC curve. RESULTS: A total of 159 patients were enrolled, 72% were males with a mean age of 63.5 years and a mean MELD score of 19 (SD ± 9.5). Mortality at 30 and 90 days and one and two years was 21%, 31%, 55% and 69%, respectively. Hepatic encephalopathy (p = 0.008, OR 3.5, 95% CI 1.4-8.8) and kidney function (p = 0.026, OR 2.7, 95% CI 1.13-16.7) were independent factors for short- and long-term mortality. MELD was a good marker of short- and long-term survival (area under the curve [AUC] 0.7: 95% CI 1.02-1.4). The Charlson index was related to long-term mortality (AUC 0.68: 95% CI 0.6-0.77). CONCLUSIONS: Short- and long-term mortality of spontaneous bacterial peritonitis is still high. The main prognostic factors for mortality are impairment of liver and kidney function. MELD and the Charlson index are good markers of survival.

Impact of anticoagulation on upper-gastrointestinal bleeding in cirrhosis. A retrospective multicenter study.

UNLABELLED: Recent studies have shown that liver cirrhosis (LC) behaves as an acquired hypercoagulable state with increased thrombotic risk. This is why anticoagulation therapy (AT) is now frequently used in these patients. Variceal bleeding is a severe complication of LC. It is unknown whether AT may impact the outcome of bleeding in these patients. Fifty-two patients on AT with upper gastrointestinal bleeding (UGIB) were evaluated. Portal vein thrombosis (PVT) and different cardiovascular disorders (CVDs) were the indication for AT in 14 and 38 patients, respectively. Overall, 104 patients with LC and UGIB not under AT matched for severity of LC, age, sex, source of bleeding, and Sequential Organ Failure Assessment (SOFA) score served as controls. UGIB was attributed to portal hypertension (PH) in 99 (63%) patients and peptic/vascular lesions in 57 (37%). Twenty-six (17%) patients experienced 5-day failure; SOFA, source of UGIB, and PVT, but not AT, were independent predictors of 5-day failure. In addition, independent predictors of 6-week mortality, which was observed in 26 (11%) patients, were SOFA, Charlson Comorbidity index, and use of AT for a CVD. There were no differences between patients with/without AT in needs for rescue therapies, intensive care unit admission, transfusions, and hospital stay. CONCLUSIONS: Factors that impact the outcome of UGIB in patients under AT are degree of multiorgan failure and comorbidity, but not AT itself.

Factors related to survival in hepatocellular carcinoma in the geographic area of Sabadell (Catalonia, Spain).

BACKGROUND: hepatocellular carcinoma (HCC) is a very frequent tumor. Screening for the disease is effective, but the prognostic factors are difficult to evaluate. OBJECTIVES: 1. To determine epidemiological data and the clinical course of HCC in our setting. 2. To compare patient survival according to whether screening is performed or not. 3. To evaluate survival prognostic factors. PATIENTS AND METHODS: data on the epidemiology and clinical course of patients diagnosed with HCC were collected on a prospective basis (January 2004-December 2006). Two groups were considered according to whether screening had been performed (group A) or not (group B). RESULTS: a total of 110 patients were diagnosed with HCC (70% males). The most common etiology of cirrhosis was hepatitis C (56.1%), and 69% presented mild liver failure (Child-Pugh grade A). The median follow-up was 1.8 years. Fifty-one percent had been subjected to screening. The diagnosis of HCC was established by imaging techniques in 48.2% of the cases, and by histological criteria in 51.8%. The median tumor size was 23 mm in group A and 28 mm in group B (p = 0.005). Treatment with curative intent was provided in 72% of the cases in group A and in 48% in group B (p = 0.011). The median overall survival was 1.99 years -2.67 years in group A and 1.75 years in group B (p = 0.05). The multivariate analysis of overall survival showed the type of treatment (OR = 2.82 95%CI: 1.3-6.12, p = 0.009) and liver function (OR = 1.71 95%CI: 1.1-2.68, p = 0.020) to be independent predictors of survival. CONCLUSIONS: screening allows the diagnosis of smaller lesions and a higher percentage of curative treatments. The degree of liver function and the provision of curative treatment are independent predictors of survival.

Factores relacionados con la supervivencia en el carcinoma hepatocelular en el área geográfica de Sabadell / No disponible

Introducción: el carcinoma hepatocelular (CHC) es un tumor muy prevalente. Su cribado es eficaz, pero los factores pronósticos son difíciles de evaluar. Objetivos: 1. Conocer datos epidemiológicos y evolución clínica en nuestra área. 2. Comparar la supervivencia de los pacientes según si seguían cribado o no. 3. Evaluar los factores pronósticos de supervivencia. Pacientes y métodos: se recogieron prospectivamente (enero 2004-diciembre 2006) datos epidemiológicos y evolución clínica de pacientes diagnosticados de CHC. Se estudiaron dos grupos en función del cribado (grupo A = cribado, grupo B = sin cribado). Resultados: 110 pacientes fueron diagnosticados de CHC (70% hombres). La etiología más frecuente de la cirrosis fue por virus C en 56,1%, eran Child A el 69%. El seguimiento mediano fue de 1,8 años. El 51% estaban en programa de cribado. El diagnóstico de CHC fue mediante pruebas de imagen en el 48,2% y 51,8% por criterios histológicos. El tamaño tumoral mediano fue 23 mm en el grupo A y de 28 mm en el B (p = 0,005). El tratamiento con intención curativa fue del 72% en el A y del 48% en el B (p = 0,011). La supervivencia global mediana fue de 1,99 años: grupo A. 2,67 años y grupo B 1,75 años (p = 0,05). El análisis multivariado de la supervivencia global evidenció que el tipo de tratamiento -OR = 2,82 (IC 95%: 1,3-6,12) (p = 0,009)- y la funcionalidad hepática -OR = 1,71 (IC 95%: 1,1-2,68) (p= 0,020)- predicen independientemente la supervivencia. Conclusiones: el cribado permite el diagnóstico de lesiones de menor tamaño y mayor porcentaje de tratamientos curativos. De forma independiente el grado de función hepática y la realización de un tratamiento curativo predicen la supervivencia(AU)

Background: hepatocellular carcinoma (HCC) is a very frequent tumor. Screening for the disease is effective, but the prognostic factors are difficult to evaluate. Objectives: 1. To determine epidemiological data and the clinical course of HCC in our setting. 2. To compare patient survival according to whether screening is performed or not. 3. To evaluate survival prognostic factors. Patients and methods: data on the epidemiology and clinical course of patients diagnosed with HCC were collected on a prospective basis (January 2004-December 2006). Two groups were considered according to whether screening had been performed (group A) or not (group B). Results: a total of 110 patients were diagnosed with HCC (70% males). The most common etiology of cirrhosis was hepatitis C (56.1%), and 69% presented mild liver failure (Child-Pugh grade A). The median follow-up was 1.8 years. Fifty-one percent had been subjected to screening. The diagnosis of HCC was established by imaging techniques in 48.2% of the cases, and by histological criteria in 51.8%. The median tumor size was 23 mm in group A and 28 mm in group B (p = 0.005). Treatment with curative intent was provided in 72% of the cases in group A and in 48% in group B (p = 0.011). The median overall survival was 1.99 years-2.67 years in group A and 1.75 years in group B (p = 0.05). The multivariate analysis of overall survival showed the type of treatment (OR = 2.82 95%CI: 1.3-6.12, p = 0.009) and liver function (OR = 1.71 95%CI: 1.1-2.68, p = 0.020) to be independent predictors of survival. Conclusions: screening allows the diagnosis of smaller lesions and a higher percentage of curative treatments. The degree of liver function and the provision of curative treatment are independent predictors of survival(AU)