ABSTRACT
INTRODUCTION AND OBJECTIVES: Frailty is characterized by a poor restoration of homeostasis after a stressor event. Although it is not usually diagnosed, it has been associated with decreased survival in cirrhotic patients. We aimed to evaluate the impact of frailty and decreased gait speed over survival in cirrhotic patients at long-term follow-up. MATERIALS AND METHODS: We included stable cirrhotic patients Child-Pugh B-C or MELD ≥12, ≥50 years old. We performed a clinical evaluation, anthropometry, and laboratory tests. Frailty was diagnosed using Fried Frailty Index. We evaluated survival at a 4-year follow-up. RESULTS: We included 126 patients; mean age 64±8.3 years, median MELD-Na 15[12-17], median follow-up was 881 [349-1277] days. The main etiology was MAFLD (31.4%). Frailty was diagnosed in 65.1% of patients. There were no significant differences in baseline characteristics per frailty condition. Mortality was higher in frail patients than non-frail patients (68.2% versus 20.6% at 48 months, respectively; p-value <0.001). The mean gait speed in frail and non-frail patients was 0.86±0.3m/s and 1.16±0.2m/s, respectively (p-value <0.001). Interestingly, 26.9% of patients presented a reduced gait speed (≤0.8m/s). Patients with decreased gait speed also had higher mortality than patients with normal gait speed (79.9% versus 40.8%, respectively; p-value <0.001). A multivariate-adjusted model showed that decreased gait speed (HR=3.27, 95%CI:1.74-6.14; p<0.001) and frailty (HR=4.24, 95%CI:1.89-9.51; p<0.001) were associated with mortality. CONCLUSIONS: Frailty is independently associated with decreased survival at long-term follow-up. Reduced gait speed is strongly associated with mortality and could be a surrogate marker of frailty in clinical practice.
Subject(s)
Frailty/complications , Liver Cirrhosis/etiology , Liver Cirrhosis/mortality , Walking Speed , Aged , Female , Follow-Up Studies , Geriatric Assessment , Humans , Liver Cirrhosis/diagnosis , Male , Middle Aged , Prospective Studies , Risk Factors , Survival Rate , Time FactorsSubject(s)
Antineoplastic Agents , Gastrointestinal Stromal Tumors , Liver Neoplasms , Liver Transplantation , Antineoplastic Agents/therapeutic use , Gastrointestinal Stromal Tumors/drug therapy , Gastrointestinal Stromal Tumors/surgery , Humans , Imatinib Mesylate/therapeutic use , Liver Neoplasms/drug therapy , Liver Neoplasms/surgery , Living DonorsABSTRACT
Abstrac: Before the advent of highly active antiretroviral therapy (HAART), patients infected with human immunodeficiency virus (HIV) were considered as having an absolute contraindication for liver transplantation (LT). Considering the increased life expectancy in HIV positive patients under HAART and the improvements in the management of graft recipients, these patients are now suitable for carrying out transplants in selected cases. We report a 26 years old HIV positive male who developed acute liver failure possibly caused by drug induced liver injury who underwent a successful liver transplantation.
Subject(s)
Humans , Male , Adult , Acquired Immunodeficiency Syndrome/drug therapy , Liver Transplantation/methods , Antiretroviral Therapy, Highly Active/adverse effects , Chemical and Drug Induced Liver Injury/surgery , Treatment Outcome , Chemical and Drug Induced Liver Injury/pathology , ImmunocompetenceABSTRACT
A hepatitis A outbreak has occurred in Chile since November 2016. Men are predominantly affected, with a large proportion of men who have sex with men (MSM). We describe 12 consecutive unrelated confirmed cases who presented at our healthcare institution in Santiago Metropolitan Area. Nine were men, all reporting having had sex with men. Ten viral sequences, genotyped as IA, clustered with the V16-25801 strain causing outbreaks mostly in MSM in Europe since mid-2016.
Subject(s)
Disease Outbreaks , Hepatitis A virus/genetics , Hepatitis A virus/isolation & purification , Hepatitis A/epidemiology , Homosexuality, Male , Sequence Analysis, DNA , Adult , Chile/epidemiology , Europe/epidemiology , Genotype , Hepatitis A/diagnosis , Hepatitis A/virology , Hepatitis A virus/classification , Humans , Male , Middle Aged , Polymerase Chain Reaction , RNA, Viral/blood , RNA, Viral/genetics , Young AdultABSTRACT
Abstrac: Before the advent of highly active antiretroviral therapy (HAART), patients infected with human immunodeficiency virus (HIV) were considered as having an absolute contraindication for liver transplantation (LT). Considering the increased life expectancy in HIV positive patients under HAART and the improvements in the management of graft recipients, these patients are now suitable for carrying out transplants in selected cases. We report a 26 years old HIV positive male who developed acute liver failure possibly caused by drug induced liver injury who underwent a successful liver transplantation.
