Long-Term Outcomes of Patients with Coronavirus Disease 2019 at One Year after Hospital Discharge.

BACKGROUND: The long-term effects of COVID-19 remain largely unclear. This study aims to investigate post-acute health consequences and mortality one year after hospital discharge. METHODS: All surviving adult patients who were discharged after hospital admission due to acute COVID-19 in the first wave of the pandemic underwent a comprehensive interview. Functional assessment was performed in patients aged over 65. Clinical and hospital records were reviewed and mortality causes assessed. RESULTS: A total of 587 patients with COVID-19 were discharged from hospital, including 266 after hospital admission and 321 from the emergency room. Mortality within the following year occurred in 34/266 (12.8%) and 10/321 (3.1%), respectively, due to causes directly or possibly related to COVID-19 in 20.5% and 25% of patients. Post-COVID-19 syndrome was assessed in 543 patients at one year from discharge. Any clinical complaint was reported by 90.1% of patients who needed hospitalization and 80.4% of those discharged from the emergency room (p = 0.002), with breathlessness (41.6%), tiredness (35.4%), ageusia (30.2%), and anosmia (26.3%) being the most common complaints. Ongoing symptoms attributed to COVID-19 were reported by 66.8% and 49.5% of patients, respectively (p < 0.001). Newly developed COPD, asthma, diabetes, heart failure, and arthritis-as well as worsening of preexisting comorbidities-were found. CONCLUSIONS: One-year mortality among survivors of acute COVID-19 was 7.5%. A significant proportion of COVID-19 patients experienced ongoing symptoms at 1 year from onset of the disease.

Association between nutritional screening via the Controlling Nutritional Status index and bone mineral density in chronic liver disease of various etiologies.

AIM: Bone density disorders are prevalent in patients with chronic liver disease (CLD), who commonly present with hepatic osteodystrophy. However, the relationship between nutritional status and bone mineral density (BMD) has been scarcely studied in CLD. METHODS: This single-center, cross-sectional study included outpatients consecutively diagnosed with CLD during a 1.5-year period. The nutritional status was assessed with the Controlling Nutritional Status (CONUT) index; dual-energy X-ray absorptiometry scans and parameters of bone mineral metabolism were carried out. Bone fracture risk was estimated with the World Health Organization FRAX tool. RESULTS: Among the 126 patients recruited (58.7% male), osteopenia and osteoporosis were present in 31.1% and 10.7%, respectively. The 10-year fracture risk was significantly higher among women. Malnutrition estimated with the CONUT index was present in 29.9% of patients and was significantly more frequent in cirrhotic patients, 63.4% of whom were malnourished. Malnutrition stage directly correlated with hepatic function as expressed by the Model for End-Stage Liver Disease index. A non-significant relationship between CONUT-assessed nutritional status and BMD was documented. 25-Hydroxyvitamin-D3 (25[OH]-D3) and fracture risk correlated positively with the CONUT stage, and total cholesterol had an inverse relationship with BMD. CONCLUSION: Malnutrition assessed by the CONUT was very frequent in patients with liver cirrhosis. The CONUT score inversely correlated with liver function, while malnutrition stage directly correlated with BMD, fracture risk and 25(OH)-D3. Total cholesterol showed a negative association with BMD in this population.

Enfermedad hepática alcohólica y alteraciones de la densidad mineral ósea / Alcoholic liver disease and changes in bone mineral density

La osteoporosis y la osteopenia son alteraciones de la densidad mineral ósea (DMO) que se desarrollan frecuentemente en la enfermedad hepática crónica (EHC). Dichas alteraciones han sido estudiadas predominantemente en la enfermedad colestásica crónica y en la cirrosis hepática. El consumo de alcohol es un factor de riesgo independiente para la aparición de osteoporosis, cuya prevalencia estimada en pacientes con enfermedad hepática por alcohol (EHA) varía entre un 5 % y un 40 %. La pérdida de DMO en la EHA se produce por un disbalance entre formación y resorción ósea. Su etiopatogenia es multifactorial y comprende la toxicidad del alcohol sobre el hueso, las alteraciones endocrinológicas y nutricionales secundarias al alcoholismo y el déficit de osteocalcina, vitamina D e IGF-1, entre otras. El diagnóstico de las alteraciones de la DMO en la EHA se basa en su medición mediante densitometría ósea. El tratamiento incluye el abandono del alcohol y medidas generales de tipo nutricional, abandono del tabaco y ejercicio físico. La suplementación con calcio y vitamina D se recomienda en todos los pacientes con EHA y osteoporosis. Los bisfosfonatos son los principales fármacos para el tratamiento específico de esta entidad. Otras alternativas son el raloxifeno, el tratamiento hormonal sustitutivo y la calcitonina. La presente revisión abordará los aspectos más relevantes para el manejo clínico de las alteraciones de la DMO en el contexto de la EHA, incluyendo su prevalencia, etiopatogenia y diagnóstico. Por otra parte, se efectuará una revisión del tratamiento de la osteoporosis en la EHC en general, incidiendo en los aspectos específicos relacionados con la pérdida de masa ósea en la EHA (AU)

Osteoporosis and osteopenia are alterations in bone mineral density (BMD) that frequently occur in the context of chronic liver disease (CLD). These alterations have been studied predominantly in chronic cholestatic disease and cirrhosis of the liver. Alcohol consumption is an independent risk factor for the onset of osteoporosis, whose estimated prevalence in patients with alcoholic liver disease (ALD) ranges between 5 % and 40 %. The loss of BMD in ALD is the result of an imbalance between bone formation and resorption. Its pathogenesis is multifactorial and includes the toxic effects of alcohol on bone and endocrine and nutritional disorders secondary to alcoholism and a deficiency of osteocalcin, vitamin D and insulin growth factor-1. The diagnosis of BMD alterations in ALD is based on its measurement using bone densitometry. Treatment includes smoking and alcohol cessation and general measures such as changes in nutrition and exercise. Calcium and vitamin D supplements are recommended in all patients with ALD and osteoporosis. Bisphosphonates are the most commonly prescribed drugs for the specific treatment of this condition. Alternatives include raloxifene, hormone replacement therapy and calcitonin. This review will address the most important aspects involved in the clinical management of abnormal BMD in the context of ALD, including its prevalence, pathogenesis and diagnosis. We will also review the treatment of osteoporosis in CLD in general, focusing on specific aspects related to bone loss in ALD (AU)

Alcoholic liver disease and changes in bone mineral density.

Osteoporosis and osteopenia are alterations in bone mineral density (BMD) that frequently occur in the context of chronic liver disease (CLD). These alterations have been studied predominantly in chronic cholestatic disease and cirrhosis of the liver. Alcohol consumption is an independent risk factor for the onset of osteoporosis, whose estimated prevalence in patients with alcoholic liver disease (ALD) ranges between 5 % and 40 %. The loss of BMD in ALD is the result of an imbalance between bone formation and resorption. Its pathogenesis is multifactorial and includes the toxic effects of alcohol on bone and endocrine and nutritional disorders secondary to alcoholism and a deficiency of osteocalcin, vitamin D and insulin growth factor-1. The diagnosis of BMD alterations in ALD is based on its measurement using bone densitometry. Treatment includes smoking and alcohol cessation and general measures such as changes in nutrition and exercise. Calcium and vitamin D supplements are recommended in all patients with ALD and osteoporosis. Bisphosphonates are the most commonly prescribed drugs for the specific treatment of this condition. Alternatives include raloxifene, hormone replacement therapy and calcitonin.This review will address the most important aspects involved in the clinical management of abnormal BMD in the context of ALD, including its prevalence, pathogenesis and diagnosis. We will also review the treatment of osteoporosis in CLD in general, focusing on specific aspects related to bone loss in ALD.

Hepatic osteodystrophy: An important matter for consideration in chronic liver disease.

Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral metabolism found in patients with chronic liver disease. This paper is a global review of HO and its main pathophysiological, epidemiological and therapeutic aspects. Studies examining the most relevant information concerning the prevalence, etiological factors, diagnostic and therapeutic aspects involved in HO were identified by a systematic literature search of the PubMed database. HO generically defines overall alterations in bone mineral density (BMD) (osteoporosis or osteopenia) which appear as a possible complication of chronic liver disease. The origin of HO is multifactorial and its etiology and severity vary in accordance with the underlying liver disease. Its exact prevalence is unknown, but different studies estimate that it could affect from 20% to 50% of patients. The reported mean prevalence of osteoporosis ranges from 13%-60% in chronic cholestasis to 20% in chronic viral hepatitis and 55% in viral cirrhosis. Alcoholic liver disease is not always related to osteopenia. HO has been commonly studied in chronic cholestatic disease (primary biliary cirrhosis and primary sclerosing cholangitis). Several risk factors and pathogenic mechanisms have been associated with the loss of BMD in patients with chronic liver disease. However, little information has been discovered in relationship to most of these mechanisms. Screening for osteopenia and osteoporosis is recommended in advanced chronic liver disease. There is a lack of randomized studies assessing specific management for HO.