Pilot study on the assessment of unrecognized alcoholic liver disease in patients with metabolic dysfunction-associated steatotic liver disease using the ANI score.

This pilot study evaluates the presence of potential unrecognized steatotic liver disease with moderate alcohol consumption (MetALD) in patients diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD) using the ALD/NAFLD index (ANI) score. A retrospective single-center study was conducted on 85 patients attending Digestive Diseases consultations in May and June 2024. MASLD was defined by hepatic steatosis with limited alcohol intake (<20 g/day for women and <30 g/day for men) and at least one cardiovascular risk factor. The ANI score identified 21.2% of patients as having a potential probability of MetALD, with higher alcohol consumption (10-30 g/day) and increased liver fibrosis observed in this group, though the latter did not reach statistical significance. Even though the ANI score is not validated to distinguish MetALD from MASLD, our findings highlight its potential utility in improving diagnostic accuracy by addressing underreported alcohol consumption.

Outcomes of an automated alert system from Microbiology to link diagnosis to treatment in patients with hepatitis C virus.

INTRODUCTION: simplification strategies for the care circuit of patients with hepatitis C virus (HCV) are key to achieve eradication. An electronic identification system was set up for HCV serology to link diagnosis to specialist management, aimed to reduce patient loss. MATERIAL AND METHODS: a retrospective, single-center study was performed 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 a Fibroscan® and viral load measurement, with antiviral therapy prescribed on the same day. Origin, public health data, patient location rate and antiviral therapy prescription were recorded. RESULTS: of 174 patients identified, 171 had positive viremia, with a mean age of 59.6 ± 15.9 years, 61.5 % were males and 81.2 % were 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). Overall, 43.3 % (74/171) were aware of their diagnosis; 19.4 % (20/103) of patients had F3 fibrosis and 25.2 % (26/103) had F4 fibrosis. Also, 78.4 % (134/171) were deemed candidates for treatment. Of these, 74.6 % (100/134) were located and treatment was initiated, and all those who completed their treatment achieved a sustained viral response (96/96). This system managed 58.5 % (100/171) of the patients identified. The only association found between antiviral therapy and patient variables was comorbidities with being untreated (OR, 7.14; p ˂ 0.001). CONCLUSIONS: this alert system allows to minimize patient loss in the care circuit and provides high rates of treated patients.

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

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.

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

Liver damage, defined by an increase in liver chemistry parameters, is related to more unfavorable severity and prognosis in patients with COVID-19. These patients are also treated with immunomodulatory drugs capable of reactivating hepatitis B virus (HBV), with an 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.

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

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. The aim of this study was to determine whether ALB is a risk factor for unfavorable clinical outcome and involvement. MATERIALS AND METHODS: a retrospective, single-center study in confirmed COVID-19 cases. Patients with pharmacological hepatotoxicity or liver diseases were excluded. ALB was defined as any elevation of total bilirubin, AST, ALT, alkaline phosphatase, and/or GGT above the upper limit of normal. First, an assessment was made of the correlation between ALB and need for hospitalization. This was followed by an assessment of the correlation of ALB in hospitalized patients with demographic variables, comorbidities, and treatment for COVID-19, and with clinical involvement and outcome. The statistical analysis was performed using an age-adjusted multiple logistic regression with a p-value < 0.05. RESULTS: of 1,277 confirmed cases, 346 required hospitalization and 302 were included. The prevalence of ALB was higher in hospitalized patients compared to non-hospitalized patients (60.9 % vs. 10.3 %, p ˂ 0.001). Among hospitalized patients, there was no correlation between ALB and demographic variables, comorbidities, or treatment for COVID-19, except for low molecular weight heparin. There was a significant correlation between ALB and moderate/severe COVID-19 involvement and between unfavorable clinical outcomes and elevated total bilirubin. The period of greatest clinical worsening and deterioration of liver biochemistry parameters occurred during the first seven days. There was a significant correlation of ALB with longer hospital stay and admission to the intensive care unit, but this did not imply increased mortality. CONCLUSIONS: ALB correlates with greater clinical involvement and worse clinical outcomes in hospitalized patients with COVID-19.

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

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.

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

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.

An outbreak of acute hepatitis due to the hepatitis A virus in 2017: are we witnessing a change in contagion risk factors?

There has been an increase in the incidence rates in recent years of sexually transmitted diseases within the cohort of males who have sex with other men (MSM). An outbreak of acute hepatitis due to the hepatitis A virus was reported in 2017, both nationally and internationally. The sexual practices of this cohort are strongly implicated as a mechanism of infection. This situation was assessed in our health district and the incidence rate of this disease in 2017 was higher than usual. MSM practices are the potential cause of transmission in 52% of the cases (12/23). This situation triggers a change in the contagion risk factors for this disease. Therefore, we believe that we must provide health education and act within the MSM group to avoid new outbreaks in the future.

[Gastrointestinal bleeding and acute hepatic failure by leptospirosis: an entity that should not be forgotten]. / Hemorragia digestiva e insuficiencia hepática aguda por leptospirosis: una entidad que no debemos olvidar.

Leptospirosis disease is caused by the spirochete Leptospira. It is a worldwide distribution zoonosis, with predominance in the tropics. In Spain, it is not frequent but some cases have been noticed especially in humid areas surrounded by rivers, lakes or ponds, such as Catalonia, Andalucia or the Valencian Community. It is transmitted by a variety of animals such as cows or rats, that are infected either by direct contact with these animals or their urine, or indirectly by consuming or being in contact with water contaminated by their urine. The clinical manifestations are very variable, being asymptomatic or not very symptomatic in most of the patients. Unusually, leptospirosis presents with a first phase with fever, myalgias, liver injury or different organs hemorrhage, followed by a second phase with the presence of jaundice due to hepatic failure. Weil's disease is a kind of severe leptospirosis characterized by hepatic failure with jaundice and acute renal failure, associated with high mortality rates.The diagnosis is based on serological techniques and DNA detection by PCR. The treatment consists of life support measures and antibiotic therapy. A patient with Weil's disease and leptospirosis digestive bleeding is presented, with a fulminant clinical course. In order to achieve an early diagnosis, the need to keep this entity in mind must be emphasized, especially in favorable epidemiological environments as the one of this patient.

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

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.

An outbreak of acute hepatitis due to the hepatitis A virus in 2017: are we witnessing a change in contagion risk factors? / Brote de hepatitis aguda por virus hepatitis A en 2017. ¿Estamos asistiendo a un cambio en los factores de riesgo de contagio?

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Diagnóstico oportunista basado en la edad y eliminación de la hepatitis C: un paso imprescindible para mejorar la salud hepática global / Opportunistic diagnosis based on age and elimination of hepatitis C: an essential step to improve global liver health

En enero de este 2022 una Comisión de EASL-Lancet sobre el impacto de las enfermedades hepáticas en la región europea de la OMS mostró que esta patología es actualmente la segunda causa de pérdida de años de vida laboral en Europa, después de la cardiopatía isquémica. Esto es un dato muy relevante ya que va a impactar en las nuevas generaciones europeas si no existe un cambio importante en las políticas de salud pública. A pesar de los avances de los últimos años en la eliminación de las hepatitis virales entendidas como una disminución importante en la morbimortalidad de la hepatitis B y C, aún quedan retos para mejorar la salud hepática debido al elevado consumo de alcohol, la inseparable tripleta de obesidad / diabetes mellitus / esteatosis hepática metabólica y las dificultades en el acceso a la salud de amplios colectivos de nuestra población, que característicamente están en riesgo de presentar tasas más elevadas de enfermedad hepática (AU)

Resultados de un sistema de alertas automático desde Microbiología para ligar diagnóstico y tratamiento en pacientes con virus de la hepatitis C / Outcomes of an automated alert system from Microbiology to link diagnosis to treatment in patients with hepatitis C virus

Introducción: las estrategias de simplificación del circuitoasistencial para pacientes con virus de la hepatitis C (VHC)son fundamentales para lograr su erradicación. Para ello,introdujimos un sistema electrónico de detección de serología VHC con el objetivo de ligar diagnóstico y asistenciaespecializada para disminuir la pérdida de pacientes.Material y métodos: estudio retrospectivo unicéntrico depacientes VHC detectados del 15/3/2020 al 15/12/2021 mediante un sistema de alertas desde Microbiología que notificaba los casos positivos a facultativos especialistas. Se contactaba con el paciente concertando una cita donderealizaban Fibroscan® y determinación de carga viral y sepautaba tratamiento antiviral el mismo día. Registramosprocedencia, datos sociosanitarios, tasa de localización delpaciente y prescripción de tratamiento antiviral.Resultados: de 174 pacientes detectados, 171 presentaronviremia positiva, con edad media de 59,6 ± 15,9 años, un61,5 % varones y el 81,2 % españoles. Predominó la procedencia del ámbito extrahospitalario (57,9 %, 99/171), destacando Atención Primaria (51/171), centro penitenciario(21/171) y unidades de adicción (14/171). El 43,3 % (74/171)conocía el diagnóstico. Registramos un 19,4 % (20/103) depacientes con fibrosis F3 y un 25,2 % (26/103) con F4. Consideramos candidatos a tratamiento al 78,4 % (134/171). Deestos, fueron localizados e iniciaron tratamiento el 74,6 %(100/134) y lograron respuesta viral sostenida todos los quelo completaron (96/96). Con este sistema hemos tratado al58,5 % (100/171) de los pacientes detectados. La única asociación detectada entre tratamiento antiviral y variablesdel paciente fue que presentar comorbilidades se asociócon no ser tratado (OR 7,14, p < 0,001).Conclusiones: este sistema de alerta permite minimizar lapérdida de pacientes en el circuito asistencial y presentatasas elevadas de pacientes tratados. (AU)

Hemorragia digestiva e insuficiencia hepática aguda por leptospirosis: una entidad que no debemos olvidar / Gastrointestinal bleeding and acute hepatic failure by leptospirosis: an entity that should not be forgotten

La leptospirosis es una enfermedad causada por la espiroqueta Leptospira. Se trata de una zoonosis de distribución mundial, con predominio en los trópicos. En España no es frecuente pero sí se observan casos en zonas más húmedas o con presencia de ríos, lagos o estanques, como son Cataluña, Andalucía o la Comunidad Valenciana, donde se relaciona con los arrozales. Los transmisores son múltiples animales como vacas o ratas, contagiándose el ser humano mediante contacto directo con estos animales o su orina, o bien de forma indirecta al consumir o estar en contacto con agua contaminada por la orina de éstos. Las manifestaciones clínicas son muy variables, siendo asintomática o poco sintomática en la mayoría de los pacientes. Aunque no ocurre siempre, la leptospirosis cursa con una primera fase con fiebre, mialgias, afectación renal o hemorragia de distintos órganos, seguida de una segunda fase con presencia de ictericia por afectación hepática. La enfermedad de Weil es una forma de leptospirosis grave caracterizada por afectación hepática con ictericia e insuficiencia renal aguda, asociada a una considerable mortalidad. El diagnóstico se basa en técnicas serológicas y detección de DNA mediante PCR. El tratamiento consta de medidas de soporte y antibioticoterapia. Presentamos un paciente con enfermedad de Weil y hemorragia digestiva por leptospirosis, con una evolución clínica fulminante, y hacemos hincapié en la necesidad de tener presente esta entidad, especialmente en ambientes epidemiológicos favorables como el de este paciente, con el fin de lograr un diagnóstico precoz.

Leptospirosis disease is caused by the spirochete Leptospira. It is a worldwide distribution zoonosis, with predominance in the tropics. In Spain, it is not frequent but some cases have been noticed especially in humid areas surrounded by rivers, lakes or ponds, such as Catalonia, Andalucia or the Valencian Community. It is transmitted by a variety of animals such as cows or rats, that are infected either by direct contact with these animals or their urine, or indirectly by consuming or being in contact with water contaminated by their urine. The clinical manifestations are very variable, being asymptomatic or not very symptomatic in most of the patients. Unusually, leptospirosis presents with a first phase with fever, myalgias, liver injury or different organs hemorrhage, followed by a second phase with the presence of jaundice due to hepatic failure. Weil's disease is a kind of severe leptospirosis characterized by hepatic failure with jaundice and acute renal failure, associated with high mortality rates. The diagnosis is based on serological techniques and DNA detection by PCR. The treatment consists of life support measures and antibiotic therapy. A patient with Weil's disease and leptospirosis digestive bleeding is presented, with a fulminant clinical course. In order to achieve an early diagnosis, the need to keep this entity in mind must be emphasized, especially in favorable epidemiological environments as the one of this patient.

Encefalopatía hepática por shunt porto-sistémico congénito: una entidad de presentación variable / No disponible

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Hepatitis C

Guía de actuación clínica que contiene los siguientes apartados : introducción, epidemiología, clínica e historia natural, diagnóstico, recomendaciones generales, tratamiento, algoritmo de actuación frente al hallazgo de anti-VHC positivo y puntos clave.