The Effect of Polymorphisms and Other Biomarkers on Infliximab Exposure in Paediatric Inflammatory Bowel Disease: Development of a Population Pharmacokinetic Model.

BACKGROUND: Therapeutic drug monitoring (TDM) of infliximab has been shown to be a effective strategy for inflammatory bowel disease (IBD). Population pharmacokinetic (PopPK) modeling can predict trough concentrations for individualized dosing. OBJECTIVE: The aim of this study was to develop a PopPK model of infliximab in a paediatric population with IBD, assessing the effect of single nucleotide polymorphisms (SNPs) and other biomarkers on infliximab clearance. METHODS: This observational and ambispective single-centre study was conducted in paediatric patients with IBD treated with infliximab between July 2016 and July 2022 in the Paediatric Gastroenterology Service of the Hospital Universitari Vall d'Hebron (HUVH) (Spain). Demographic, clinical, and analytical variables were collected. Twenty SNPs potentially associated with variations in the response to infliximab plasma concentrations were analysed. infliximab serum concentrations and antibodies to infliximab (ATI) were determined by ELISA. PopPK modelling was performed using nonlinear mixed-effects analysis (NONMEM). RESULTS: Thirty patients (21 males) were included. The median age (range) at the start of infliximab treatment was 13 years (16 months to 16 years). A total of 190 samples were obtained for model development (49 [25.8%] during the induction phase). The pharmacokinetics (PK) of infliximab were described using a two-compartment model. Weight, erythrocyte sedimentation rate (ESR), faecal calprotectin (FC), and the SNP rs1048610 (ADAM17) showed statistical significance for clearance (CL), and albumin for inter-compartmental clearance (Q). Estimates of CL1 (genotype 1-AA), CL2 (genotype 2-AG), CL3 (genotype 3-GG), Q, Vc, and Vp (central and peripheral distribution volumes) were 0.0066 L/h/46.4 kg, 0.0055 L/h/46.4 kg, 0.0081 L/h/46.4 kg, 0.0029 L/h/46.4 kg, 0.6750 L/46.4 kg, and 1.19 L/46.4 kg, respectively. The interindividual variability (IIV) estimates for clearance, Vc, and Vp were 19.33, 16.42, and 36.02%, respectively. CONCLUSIONS: A popPK model utilising weight, albumin, FC, ESR, and the SNP rs1048610 accurately predicted infliximab trough concentrations in children with IBD.

Systematic review of the role of calprotectin in cirrhosis.

BACKGROUND: Calprotectin is a calcium-binding-S100-protein synthetized mainly in neutrophils which has been demonstrated to be an accurate biomarker of the presence of these cells. Gut barrier dysfunction in patients with advanced chronic liver disease (ACLD), in addition to the lack of noninvasive tools for diagnosis and prognosis of cirrhosis decompensations, has raised interest in this biomarker. AIMS: Our aim is to summarize the current evidence regarding the role of calprotectin in terms of its diagnostic and prognostic utility in ACLD. METHODS: We performed a systematic search (PROSPERO registration no. CRD42023389069) of original articles published without any restrictions on the publication date until January 2023 providing information about calprotectin for the prognosis or diagnosis of ACLD and its decompensations in adult patients. RESULTS: A total 227 articles were identified, and 26 observational studies finally met the inclusion criteria. In 14 studies, calprotectin was measured in ascitic fluid, all of which reported higher calprotectin values in spontaneous bacterial peritonitis, while cut-off points for its diagnosis were proposed in nine studies. Three studies reported higher faecal calprotectin levels in patients with hepatic encephalopathy and portal hypertension. Four studies evaluated faecal calprotectin and one plasma calprotectin as biomarkers for gut barrier integrity and bacterial translocation. CONCLUSIONS: Calprotectin is emerging as a promising biomarker in ACLD, particularly for the management of bacterial infections and alcohol-related liver disease. Further research with better study designs should help to determine the feasibility of calprotectin measurement in routine clinical practice.

Incidence, risk factors and clinical outcomes of multidrug-resistant microorganism infections among patients admitted for decompensated cirrhosis: A prospective study / Incidencia, factores de riesgo y evolución clínica de las infecciones por microorganismos multiresistentes en pacientes ingresados por descompensación de la cirrosis: estudio retrospectivo

Background: Bacterial infections remain one of the main complications in cirrhosis and worsen patients’ prognosis and quality of life. An increase in multidrug resistant microorganism (MDRM) infections among patients with cirrhosis, together with infection-related mortality rates, have been reported in recent years. Therefore, adaptation of the initial empiric antibiotic approach to different factors, particularly the local epidemiology of MDRM infections, has been recommended. We aim to describe the main features, outcomes and risk factors of MDRM infections in patients with cirrhosis. Methods: Prospective registry of all episodes of in-hospital infections occurring among cirrhotic patients admitted within a 2-year period at a single center. Clinical and microbiological data were collected at the time of infection diagnosis, and the in-hospital mortality rate of the infectious episode was registered. Results: A total of 139 infectious episodes were included. The disease-causing microorganism was identified in 90 episodes (65%), of which 31 (22%) were caused by MDRM. The only two factors independently associated with MDRM infections were rectal colonization by MDRM and a nosocomial or healthcare-associated source. The infection-related mortality rate was 18.7%. MDRM infection and a past history of hepatic encephalopathy were independently associated with in-hospital mortality. Conclusions: Almost one fourth of bacterial infections occurring in admitted cirrhotic patients were due to MDRM. Rectal colonization was the most important risk factor for MDRM infections in decompensated cirrhosis. Screening for MDRM rectal colonization in patients admitted for decompensated cirrhosis should be assessed as a tool to improve local empiric antibiotic strategies.(AU)

Antecedentes: Las infecciones bacterianas representan una de las principales complicaciones del paciente cirrótico, empeoran su pronóstico y calidad de vida. Recientemente se ha descrito un aumento de infecciones por microorganismos multiresistentes (MMR) en pacientes cirróticos, con un incremento de la mortalidad relacionada con la infección. Se recomienda adecuar el tratamiento antibiótico empírico inicial a diferentes factores, en particular a la epidemiología local. El objetivo del estudio es describir las principales características clínicas, evolución y factores de riesgo asociados a infecciones por MMR en cirrosis. Métodos: Se registraron todos los episodios de infecciones bacterianas que presentaron los pacientes hospitalizados durante un período de 2 años en un único centro. Se recogieron datos clínicos y microbiológicos en el momento de la infección y la tasa de mortalidad intrahospitalaria. Resultados: Se incluyó un total de 139 episodios de infección. Se identificó el microorganismo responsable de la infección en 90 episodios (65%), de los cuales en 31 (22%) la causa fue un MMR. Los 2 factores asociados independientemente con las infecciones MMR fueron colonización rectal por MMR y origen nosocomial o asociado al sistema sanitario de la infección. La mortalidad intrahospitalaria relacionada con la infección fue del 18,7%. La infección por MMR y tener antecedentes de encefalopatía hepática se asociaron independientemente con la mortalidad intrahospitalaria. Conclusiones: Casi una cuarta parte de las infecciones que aparecen en los pacientes cirróticos hospitalizados son producidas por MMR. La colonización rectal fue el factor de riesgo más importante para infecciones por MMR. El cribado de colonización rectal por MMR en pacientes con cirrosis descompensada debe valorarse como una herramienta para mejorar las estrategias de terapia antibiótica empírica.(AU)

Incidence, risk factors and clinical outcomes of multidrug-resistant microorganism infections among patients admitted for decompensated cirrhosis: A prospective study.

BACKGROUND: Bacterial infections remain one of the main complications in cirrhosis and worsen patients' prognosis and quality of life. An increase in multidrug resistant microorganism (MDRM) infections among patients with cirrhosis, together with infection-related mortality rates, have been reported in recent years. Therefore, adaptation of the initial empiric antibiotic approach to different factors, particularly the local epidemiology of MDRM infections, has been recommended. We aim to describe the main features, outcomes and risk factors of MDRM infections in patients with cirrhosis. METHODS: Prospective registry of all episodes of in-hospital infections occurring among cirrhotic patients admitted within a 2-year period at a single center. Clinical and microbiological data were collected at the time of infection diagnosis, and the in-hospital mortality rate of the infectious episode was registered. RESULTS: A total of 139 infectious episodes were included. The disease-causing microorganism was identified in 90 episodes (65%), of which 31 (22%) were caused by MDRM. The only two factors independently associated with MDRM infections were rectal colonization by MDRM and a nosocomial or healthcare-associated source. The infection-related mortality rate was 18.7%. MDRM infection and a past history of hepatic encephalopathy were independently associated with in-hospital mortality. CONCLUSIONS: Almost one fourth of bacterial infections occurring in admitted cirrhotic patients were due to MDRM. Rectal colonization was the most important risk factor for MDRM infections in decompensated cirrhosis. Screening for MDRM rectal colonization in patients admitted for decompensated cirrhosis should be assessed as a tool to improve local empiric antibiotic strategies.

Comparative genomics of mortal and immortal cnidarians unveils novel keys behind rejuvenation.

Turritopsis dohrnii is the only metazoan able to rejuvenate repeatedly after its medusae reproduce, hinting at biological immortality and challenging our understanding of aging. We present and compare whole-genome assemblies of T. dohrnii and the nonimmortal Turritopsis rubra using automatic and manual annotations, together with the transcriptome of life cycle reversal (LCR) process of T. dohrnii. We have identified variants and expansions of genes associated with replication, DNA repair, telomere maintenance, redox environment, stem cell population, and intercellular communication. Moreover, we have found silencing of polycomb repressive complex 2 targets and activation of pluripotency targets during LCR, which points to these transcription factors as pluripotency inducers in T. dohrnii. Accordingly, we propose these factors as key elements in the ability of T. dohrnii to undergo rejuvenation.

Patient and health practitioner perceptions about the role of hospital pharmacists along the care continuum: the Fharmaconectados Project.

OBJECTIVE: To determine the perception of patients and practitioners regarding the role of the hospital pharmacist along the care  continuum. METHOD: This was a multicenter cross-sectional observational analytical study, carried out in two phases between 15 October and 31  December 2020. In the first phase, a literature search was carried out to  identify specific questionnaires that measured the overall satisfaction of  patients in relation to the work of hospital pharmacists. Subsequently, a  specific consensus-based questionnaire was developed, structured into  three areas: care, relationships, and capacity-building and training. The  study included patients treated in the participating centers and served by  patient associations. They had to be older than 18 years, present with a  chronic condition, and be treated with medication for hospital use. In the  second phase, a qualitative study was carried out using focus group  discussions to analyze how hospital pharmacists are perceived and how  they would like to be recognized by patients. Four meetings were held in  different territories of Spain. Previously, the research team agreed on the  questions to be asked, which were grouped into four sections: healthcare,  relational, training and information. RESULTS: A total of 482 surveys were obtained. The percentage of patients  who expressed a positive view of the role of the hospital  pharmacist was 88.0% (n = 424). In the multivariate analysis, the most  positive  opinions about these professionals were expressed by women and by patients who had received previous care in the hospital, those who had  a high opinion of the coordination of these professionals with the rest of  the care team, and those who had received the greatest amount of  emotional support. Integration of the pharmacist with the healthcare team  was found to vary across different hospitals and the hospitals' public image  we seen to be related to the way they were pharmacoeconomically  managed. In the sections related to capacity-building and training and  challenges for the future, respondents emphasized the need to promote  the introduction of new patient monitoring technologies. CONCLUSIONS: Patients have a good opinion of the service provided by hospital pharmacists, although many are unaware of the significance of  their role.

Objetivo: Determinar la percepción de los pacientes y profesionales  especto al papel del farmacéutico de hospital en el proceso asistencial  sanitario.Método: Estudio multicéntrico, observacional, analítico y transversal,  realizado en dos fases entre el 15 de octubre y el 31 de  diciembre de 2020. En la primera fase se realizó una búsqueda  bibliográfica para identificar cuestionarios específicos que midieran la  satisfacción global de los pacientes en relación con la actividad asistencial  de los farmacéuticos de hospital. Al no identificarse ninguno validado y  adaptado, se elaboró un cuestionario específico. Se estructuró en tres  áreas: asistencial, relacional y de capacitación y formación. Se incluyeron  pacientes atendidos en los centros participantes y asociaciones de  pacientes colaboradoras en el proyecto, mayores de 18 años, con patología  crónica y tratamiento con medicación de uso hospitalario. En la  segunda fase se llevó a cabo un estudio cualitativo en formato focus group para analizar cómo son percibidos y cómo les gustaría ser reconocidos a  los farmacéuticos de hospital por parte de los pacientes. Se realizaron  cuatro reuniones en diferentes territorios de España. Previamente el  equipo investigador acordó el guion y las preguntas a llevar a cabo,  incluyéndose 13, agrupadas por bloques: asistencial, relacional, formación  e información. Resultados: Se obtuvieron un total de 482 encuestas. El porcentaje de  pacientes que valoraron positivamente el papel del farmacéutico de Abstract hospital fue del 88,0% (n = 424). Se identificó que tienen  mejor opinión sobre los farmacéuticos hospitalarios las mujeres, los  pacientes que habían recibido atención previa en el hospital, los que  valoraron mejor la coordinación de estos profesionales con el resto del  equipo y aquellos con mayor apoyo emocional previo recibido. En la  segunda fase se identificó que la integración del farmacéutico con el  equipo varía en función de los centros y que la imagen que se tiene es la  relacionada con la gestión farmacoeconómica. En el bloque de capacitación  y formación, así como retos de futuro, se identificó la  necesidad de fomentar la introducción de nuevas tecnologías para el  seguimiento de los pacientes.Conclusiones: Los pacientes tienen una buena opinión del servicio prestado por el farmacéutico de hospital, aunque muchos  desconocen su papel.

Percepción de pacientes y profesionales respecto al papel del farmacéutico de hospital en el proceso asistencial. Proyecto Fharmaconectados / Patient and health practitioner perceptions about the role of hospital pharmacists along the care continuum: the Fharmaconectados Project

Objetivo: Determinar la percepción de los pacientes y profesionales respecto al papel del farmacéutico de hospital en el proceso asistencial sanitario.Método: Estudio multicéntrico, observacional, analítico y transversal,realizado en dos fases entre el 15 de octubre y el 31 de diciembre de2020. En la primera fase se realizó una búsqueda bibliográfica paraidentificar cuestionarios específicos que midieran la satisfacción global delos pacientes en relación con la actividad asistencial de los farmacéuticosde hospital. Al no identificarse ninguno validado y adaptado, se elaboróun cuestionario específico. Se estructuró en tres áreas: asistencial, relacional y de capacitación y formación. Se incluyeron pacientes atendidos enlos centros participantes y asociaciones de pacientes colaboradoras en elproyecto, mayores de 18 años, con patología crónica y tratamiento conmedicación de uso hospitalario. En la segunda fase se llevó a cabo unestudio cualitativo en formato focus group para analizar cómo son percibidos y cómo les gustaría ser reconocidos a los farmacéuticos de hospitalpor parte de los pacientes. Se realizaron cuatro reuniones en diferentesterritorios de España. Previamente el equipo investigador acordó el guiony las preguntas a llevar a cabo, incluyéndose 13, agrupadas por bloques: asistencial, relacional, formación e información.Resultados: Se obtuvieron un total de 482 encuestas. El porcentajede pacientes que valoraron positivamente el papel del farmacéutico de hospital fue del 88,0% (n = 424). Se identificó que tienen mejor opinión sobre los farmacéuticos hospitalarios las mujeres, los pacientes quehabían recibido atención previa en el hospital, los que valoraron mejorla coordinación de estos profesionales con el resto del equipo y aquellos con mayor apoyo emocional previo recibido. (AU)

Objective: To determine the perception of patients and practitionersregarding the role of the hospital pharmacist along the care continuum.Method: This was a multicenter cross-sectional observational analyticalstudy, carried out in two phases between 15 October and 31 December2020. In the first phase, a literature search was carried out to identifyspecific questionnaires that measured the overall satisfaction of patientsin relation to the work of hospital pharmacists. Subsequently, a specific consensus-based questionnaire was developed, structured into threeareas: care, relationships, and capacity-building and training. The studyincluded patients treated in the participating centers and served by patientassociations. They had to be older than 18 years, present with a chroniccondition, and be treated with medication for hospital use. In the secondphase, a qualitative study was carried out using focus group discussionsto analyze how hospital pharmacists are perceived and how they wouldlike to be recognized by patients. Four meetings were held in differentterritories of Spain. Previously, the research team agreed on the questionsto be asked, which were grouped into four sections: healthcare, relational,training and information.Results: A total of 482 surveys were obtained. The percentage ofpatients who expressed a positive view of the role of the hospital pharmacist was 88.0% (n = 424). In the multivariate analysis, the most positive opinions about these professionals were expressed by women and bypatients who had received previous care in the hospital, those who had ahigh opinion of the coordination of these professionals with the rest of thecare team, and those who had received the greatest amount of emotionalsupport. (AU)

Monitorización de las superficies de trabajo de medicamentos peligrosos en los Servicios de Farmacia. Documento de consenso. Guía de práctica farmacéutica de la Sociedad Española de Farmacia Hospitalaria (SEFH) / Monitoring contamination of hazardous drug compounding surfaces at hospital pharmacy departments. A consensus Statement. Practice guidelines of the Spanish Society of Hospital Pharmacists (SEFH)

Objetivo: Establecer unas recomendaciones, en base a la evidencia disponible, para la monitorización de la contaminación de superficies en las áreasde elaboración de medicamentos peligrosos de los Servicios de Farmacia.Método: A partir de una revisión bibliográfica en las bases de datosMedline y Embase desde enero de 2009 a julio de 2019, así como de laconsulta de documentos de estándares y recomendaciones de organizaciones sanitarias, un comité de expertos de la Sociedad Española de FarmaciaHospitalaria ha definido una serie de prácticas seguras sobre manipulaciónde medicamentos peligrosos y monitorización de superficies de trabajo. Lasdecisiones de recomendación se tomaron por consenso entre el grupo deexpertos teniendo en cuenta las recomendaciones encontradas, la situaciónen nuestro entorno y los costes asociados a la monitorización.Resultados: Se han definido 10 recomendaciones estructuradas enocho secciones. Se incluyen aspectos relacionados con los medicamentos a monitorizar; localizaciones a monitorizar; momento de la toma demuestras; determinación del riesgo y plan de muestreo; técnicas analíticas;umbrales de contaminación; plan de acción según los resultados del muestreo y descontaminación. (AU)

Objective: To establish a series of recommendations based on available evidence for monitoring surface contamination in the areas devoted tocompounding hazardous drugs in pharmacy departments.Method: Based on a literature search in the Medline and Embase databases (search period: January 2009 to July 2019), as well as on a reviewof standards and recommendations issued by different healthcare organizations, a committee of experts from the Spanish Society of Hospital Pharmacists defined a series of safe practices for handling hazardous drugsand monitoring compounding work surfaces. Recommendation decisionswere adopted by consensus among the members of the expert group,considering the recommendations reviewed, the monitoring situation inSpanish hospital departments, and the associated costs.Results: Ten recommendations were formulated, structured into eight sections. They include aspects related to the drugs to be monitored; the areasto be monitored; when samples should be taken; risk determination andpreparation of a sampling protocol; analytical techniques; contaminationthresholds; and design of an action plan based on the sampling anddecontamination results obtained. (AU)

Monitoring contamination of hazardous drug compounding surfaces at hospital pharmacy departments. A consensus Statement. Practice guidelines of the Spanish Society of Hospital Pharmacists (SEFH).

OBJECTIVE: To establish a series of recommendations based on available evidence for monitoring surface contamination in the areas devoted to compounding hazardous drugs in pharmacy departments. METHOD: Based on a literature search in the Medline and Embase databases (search period: January 2009 to July 2019), as well as on a review of standards and recommendations issued by different healthcare organizations, a committee of experts from the Spanish Society of Hospital Pharmacists defined a series of safe practices for handling hazardous drugs and monitoring compounding work surfaces. Recommendation decisions were adopted by consensus among the members of the expert group, considering the recommendations reviewed, the monitoring situation in Spanish hospital departments, and the associated costs. RESULTS: Ten recommendations were formulated, structured into eight sections. They include aspects related to the drugs to be monitored; the  areas to be monitored; when samples should be taken; risk determination and preparation of a sampling protocol; analytical techniques; contamination thresholds; and design of an action plan based on the sampling and decontamination results obtained. CONCLUSIONS: Surface monitoring allows hazardous drugs detection and evaluation of the effectiveness of current protocols for the safe handling of such drugs in hospital pharmacy departments. The evaluation should include an analysis of the efficacy of engineering controls, work practices and cleaning and decontamination processes.

Objetivo: Establecer unas recomendaciones, en base a la evidencia disponible, para la monitorización de la contaminación de superficies en las áreas de elaboración de medicamentos peligrosos de los Servicios de Farmacia.Método:A partir de una revisión bibliográfica en las bases de datos Medline y Embase desde enero de 2009 a julio de 2019, así como de la consulta de documentos de estándares y recomendaciones de organizaciones sanitarias, un comité de expertos de la Sociedad Española de Farmacia Hospitalaria ha definido una serie de prácticas seguras sobre manipulación de medicamentos peligrosos y monitorización de superficies de trabajo. Las decisiones de recomendación se tomaron por consenso entre el grupo de expertos teniendo en cuenta las recomendaciones encontradas, la situación en nuestro entorno y los costes asociados a la monitorización.Resultados: Se han definido 10 recomendaciones estructuradas en ocho secciones. Se incluyen aspectos relacionados con los medicamentos a  monitorizar; localizaciones a monitorizar; momento de la toma de muestras; determinación del riesgo y plan de muestreo; técnicas analíticas; umbrales de contaminación; plan de acción según los resultados del muestreo y descontaminación.Conclusiones: La monitorización de superficies permite determinar la presencia de medicamentos peligrosos y evaluar la eficacia del programa de manejo seguro de los mismos en los Servicios de Farmacia. La  evaluación debería incluir un estudio de la eficacia de los controles de  ingeniería, de las prácticas laborales y de los procesos de limpieza y descontaminación.

Safety of tocilizumab in COVID-19 pregnant women and their newborn: A retrospective study.

WHAT IS KNOWN AND OBJECTIVE: Tocilizumab is an IL-6 receptor inhibitor agent which has been proposed as a candidate to stop the inflammatory phase of infection by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, safety data of tocilizumab in pregnant women and their newborn are scarce. We aimed to describe maternal and neonatal safety outcomes associated with tocilizumab treatment in pregnant women with severe COVID-19. METHODS: This is a retrospective study of severe COVID-19 pregnant women, treated with tocilizumab in two Spanish hospitals between 1 March and 31 April 2020. Demographics, medical history, clinical and radiologic findings, treatment information and laboratory data of mothers and their newborns were collected from electronic medical records. RESULTS AND DISCUSSION: A total of 12 pregnant women were identified to have received tocilizumab during pregnancy in the two hospitals. Median gestational age at admission was 27.7 weeks (interquartile range, 18.0-36.4). Most of them received lopinavir/ritonavir, azithromycin and hydroxychloroquine, two patients received corticosteroids and one received interferon beta 1B. All 12 pregnancies resulted in live births. Somatometric values were normal for all newborns, and evolution at 14 and 28 days was favourable for all of them. Hepatotoxicity was observed in 2 patients, which improved or resolved at discharge. Cytomegalovirus reactivation was detected in another patient who had also received corticosteroids for 15 days, causing a congenital infection in her newborn. Both hepatotoxicity and viral reactivation adverse events were classified as possibly related to tocilizumab administration according to Naranjo's causality algorithm. WHAT IS NEW AND CONCLUSIONS: It does not appear that tocilizumab has detrimental effects for the mother and newborn. Close monitoring of infections should be considered, especially if other immunosuppressive agents are used.

COVID-19 in Solid Organ Transplantation: A Matched Retrospective Cohort Study and Evaluation of Immunosuppression Management.

BACKGROUND: The epidemiological and clinical characteristics of solid organ transplant (SOT) patients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear. We conducted a matched retrospective cohort study to compare clinical outcomes among SOT recipients with the general population and to assess immunosuppression management. METHODS: Adult SOT recipients with laboratory polymerase chain reaction-confirmed SARS-CoV-2 infection admitted to a tertiary-care hospital in Barcelona, Spain, from March 11 to April 25, 2020, were matched to controls (1:4) on the basis of sex, age, and age-adjusted Charlson's Index. Patients were followed for up to 28 days from admission or until censored. Primary endpoint was mortality at 28 days. Secondary endpoints included admission to the intensive care unit and secondary complications. Drug-drug interactions (DDI) between immunosuppressants and coronavirus disease 2019 (COVID-19) management medication were collected. RESULTS: Forty-six transplant recipients and 166 control patients were included. Mean (SD) age of transplant recipients and controls was 62.7 (12.6) and 66.0 (12.7) years, 33 (71.7%) and 122 (73.5%) were male, and median (interquartile range) Charlson's Index was 5 (3-7) and 4 (2-7), respectively. Mortality was 37.0% in SOT recipients and 22.9% in controls (P = 0.51). Thirty-three (71.7%) patients underwent transitory discontinuation of immunosuppressants due to potential or confirmed DDI. CONCLUSIONS: In conclusion, hospitalized SOT recipients with COVID-19 had a trend toward higher mortality compared with controls, although it was not statistically significant, and a notable propensity for DDI.

Modificaciones en las características de los ingresos hospitalarios por cirrosis descompensada en la era de los antivirales de acción directa frente al virus de la hepatitis C / No disponible

INTRODUCCIÓN: el desarrollo de los regímenes libres de interferón, basados en antivirales de acción directa (AADs), ha supuesto una revolución en el tratamiento de la infección por el virus de la hepatitis C (VHC). OBJETIVO: conocer si han existido cambios en las características de los ingresos hospitalarios por cirrosis descompensada desde la introducción de los AADs. MÉTODOS: se recogieron de forma prospectiva todos los ingresos hospitalarios por cirrosis descompensada en dos periodos: octubre/12-octubre/14 (P-I) y julio/16-julio/18 (P-II). Se registraron variables demográficas y clínicas y se utilizaron los métodos estadísticos habituales para su análisis. RESULTADOS: se registraron 746 ingresos (347 en P-I y 399 en P-II). Los pacientes del P-I fueron más jóvenes (59 vs. 63 años; p = 0,034), mientras que la proporción de ingresos por cirrosis-VHC fue inferior en el P-II (15,8 % vs. 21,6 %; p = 0,041). No hubo diferencias significativas en la proporción de ingresos por otras etiologías de la cirrosis entre ambos periodos. Analizando los ingresos por cirrosis-VHC, los pacientes del P-II tuvieron menos frecuentemente infección viral activa (57,1 vs. 97,3 %; p = 0,001) y en ellos coexistía con mayor frecuencia un consumo excesivo de alcohol (55,5 % vs. 30,7 %; p = 0,003), mientras que la coinfección con VIH fue menos frecuente (1,6 % vs. 10,7 %; p = 0,039). CONCLUSIONES: la proporción de ingresos por cirrosis descompensada ocasionada por el VHC ha descendido en torno a un 30 % desde la introducción de los AADs. Además, las características de los pacientes que ingresan por complicaciones de la cirrosis relacionada con el VHC han cambiado desde la aplicación de los regímenes libres de interferón

No disponible

Changes in the characteristics of hospital admissions due to decompensated cirrhosis in the era of direct-acting antivirals against hepatitis C virus.

BACKGROUND: the development of interferon-free regimens, based on direct acting antivirals (DAAs) has revolutionized the treatment of hepatitis C virus (HCV) infection. AIMS: to determine if there have been changes in the characteristics of hospital admissions due to decompensated cirrhosis in a general hospital since the introduction of DAAs. PATIENTS AND METHODS: this was a prospective study of all hospital admissions due to decompensated cirrhosis during two periods: October 2012-October 2014 (P-I) and July 2016-July 2018 (P-II). Clinical and demographic variables were collected and standard statistical methods were used for the analysis. RESULTS: there were 746 hospital admissions; 347 in P-I and 399 in P-II. P-I patients were younger (59 vs 63 years; p = 0.034), while the proportion of admissions due to HCV-cirrhosis was lower in P-II (15.8 % vs 21.6 %; p = 0.041). There were no significant differences in the proportion of admissions due to other etiologies of cirrhosis between both periods. Patients in the P-II group presented an active viral infection (57.1 vs 97.3 %; p = 0.001) less frequently and had a higher rate of excessive alcohol consumption (55.5 vs 30.7 %; p = 0.003) when admitted, while HIV co-infection was less frequent (1.6 % vs 10.7 %; p = 0.039). CONCLUSION: the proportion of admissions due to decompensated HCV-related cirrhosis has decreased by almost 30 % since the introduction of the DAA. In addition, the characteristics of patients admitted have changed since the application of interferon-free regimens.

Registro de pacientes y tratamientos de medicamentos hospitalarios en Cataluña: 10 años de datos clínicos / Registry of patients and treatments of hospital medicines in Spain: 10 years of clinical data

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Sex specificity of kidney markers to assess prognosis in cirrhotic patients with TIPS.

BACKGROUND & AIMS: Renal function assessed by creatinine is a key prognostic factor in cirrhotic patients. However, creatinine is influenced by several factors, rendering interpretation difficult in some situations. This is especially important in early stages of renal dysfunction where renal impairment might not be accompanied by an increase in creatinine. Other parameters, such as cystatin C (CysC) and beta-trace protein (BTP), have been evaluated to fill this gap. However, none of these studies have considered the role of the patient's sex. The present study analysed CysC and BTP to evaluate their prognostic value and differentiate them according to sex. PATIENTS AND METHODS: CysC and BTP were measured in 173 transjugular intrahepatic portosystemic shunt (TIPS)-patients from the NEPTUN-STUDY(NCT03628807) and analysed their relationship with mortality and sex. Propensity score for age, MELD, etiology and TIPS indication was used. RESULTS: Cystatin C and BTP showed excellent correlations with creatinine values at baseline and follow-up. CysC was an independent predictor of overall mortality (HR = 1.66(1.33-2.06)) with an AUC of 0.75 and identified a cut-off of 1.55 mg/L in the whole cohort. Interestingly, CysC was significantly lower in females, also after propensity score matching. In males, the only independent predictor was the creatinine level (HR = 1.54(1.25-1.58)), while in females CysC levels independently predicted mortality (HR = 3.17(1.34-7.52)). CONCLUSION: This study demonstrates for the first time that in TIPS-patients creatinine predicts mortality in males better than in females, whereas CysC is a better predictor of mortality in females. These results may influence future clinical decisions on therapeutic options for example, allocation for liver transplantation in TIPS-patients.