ABSTRACT
BACKGROUND & AIMS: Complications of cirrhosis are the main cause of hospital admissions in liver units. In areas where HCV is prevalent, most of these admissions are attributable to HCV-related cirrhosis (HCV-cirrhosis). This study assessed the impact of direct-acting antivirals (DAA) in the profile of patients with liver disease admitted to a referral liver unit from a university hospital. METHODS: We registered hospital admissions resulting from cirrhosis to the Liver Unit of the Hospital Clinic of Barcelona, from 2011 to 2014 (pre-DAA period) and from 2015 to 2019 (post-DAA period). RESULTS: From a total of 14,865 hospital admissions, 10,053 resulted from cirrhosis (corresponding to 6,272 patients). The number and proportion of hospital admissions because of HCV-cirrhosis remained stable during the period 2011-2014 (525 per year, 48.8% of the total), but decreased progressively after 2015 (p <0.001), reaching <300 (27.1%) admissions in 2019. Similarly, HCV-cirrhosis accounted for 3,885 inpatient days per year (44.9%) during the pre-DAA period and decreased steadily after 2015 (p >0.001), reaching only 1,909 inpatient days (22%) in 2019. The figures for intensive care unit admissions followed a similar pattern. By means of a slope analysis (binomial regression model), we predicted that HCV-cirrhosis hospital admissions will be residual by 2025 (2.3%, 95% CI 0-10.9%). By contrast, we observed a significant increase in hospital admissions because of metabolic-associated fatty liver disease (5-fold) and autoimmune hepatitis (4-fold) during the study period. CONCLUSIONS: In summary, our data showed a profound reduction in HCV-cirrhosis hospitalisation burden since 2015, coincident with the wide use of DAAs in Spain. Our predictions suggest that, by 2025, HCV-cirrhosis will be a marginal cause of hospital admissions for patients with liver disease. LAY SUMMARY: Over the past few years, the wide use of antiviral drugs that cure HCV has had a significant effect on patients being admitted to hospital. Most patients with HCV and cirrhosis are treated (and often cured) in the community and, thus, the number of hospital admissions because of severe forms of HCV has decreased drastically. HCV is no longer the first cause of admission into liver units and, in only a few years from now, it is likely to be only a residual cause of hospitalisation.
Subject(s)
Antiviral Agents , Hepatitis C, Chronic , Hospitalization/statistics & numerical data , Liver Cirrhosis , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use , Disease Progression , Female , Hepacivirus/drug effects , Hepacivirus/isolation & purification , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Hepatitis C, Chronic/physiopathology , Humans , Liver Cirrhosis/epidemiology , Liver Cirrhosis/etiology , Liver Cirrhosis/therapy , Liver Cirrhosis/virology , Male , Middle Aged , Patient Admission/trends , Retrospective Studies , Spain/epidemiologyABSTRACT
INTRODUCCIÓN: La hipotermia es el tratamiento estándar en la encefalopatía hipóxico isquémica (EHI) a pesar de que todavía no se conocen todos sus efectos y complicaciones. La bradicardia sinusal está ampliamente descrita en la literatura como consecuencia de dicho enfriamiento pero se ha estudiado poco la actividad eléctrica cardiaca en este grupo de pacientes. OBJETIVO: Determinar si existe un alargamiento del intervalo QT corregido (QTc) durante la hipotermia en neonatos con EHI moderada-grave y su evolución durante el tratamiento. MATERIAL Y MÉTODOS: Se reclutó a pacientes con EHI tratados con hipotermia entre noviembre del 2012 y octubre del 2013. Se realizaron electrocardiogramas (ECG) durante la hipotermia (uno cada 24 h durante el tratamiento) y durante el recalentamiento (a 34,5, 35,5 y 36,5°C). Se realizó un séptimo ECG a la semana de vida. RESULTADOS: Se incluyó a un total de 19 pacientes. Se observó un alargamiento del QTc en todos los pacientes durante la hipotermia. En 84% de los pacientes (n=16), el alargamiento se apreció en todos los ECG durante la hipotermia. Tras el recalentamiento, todos los pacientes presentaron una normalización del mismo. No se encontraron diferencias estadísticamente significativas al evaluar la prolongación del QTc según el grado de EHI (p = 0,192) y según el uso de soporte inotrópico o no (p = 0,669). Ningún paciente presentó arritmias potencialmente graves. CONCLUSIONES: La hipotermia moderada aplicada a los recién nacidos con EHI moderada-grave parece inducir una prolongación en el intervalo QTc temporal que se resuelve con el recalentamiento del paciente hasta temperatura fisiológica
INTRODUCTION: Therapeutic hypothermia is the standard treatment for hypoxic ischaemic encephalopathy (HIE), despite not knowing all its effects and complications. Sinus bradycardia is one of the consequences of cooling that has been previously documented in the literature, but little is known about the cardiac electrical activity in these patients. OBJECTIVE: To determine the corrected QT (QTc) interval in newborns treated with therapeutic hypothermia for HIE. MATERIAL AND METHODS: A prospective observational study was conducted in all patients treated with hypothermia for HIE that were admitted to our Unit between November 2012 and October 2013. ECGs were performed during hypothermia (every 24h), during the re-warming period (at 34.5°C, 35.5°C, 36.5°C), and on the 7th day of life. RESULTS: A total of 19 patients were included. A prolonged QTc was observed in all patients during hypothermia, and 84% (n=16) had prolonged QTc in all the ECGs during treatment. In 3 patients, one of the ECGs did not have a prolonged QTc. After re-warming, the QTc interval returned to normal in all patients. No statistically significant differences were seen when the degree of HIE (P=.192) or the use of inotropic support (P=.669) were considered. CONCLUSIONS: Therapeutic hypothermia applied to asphyxiated newborns with HIE seems to induce a QTc prolongation that resolves when the patient regains physiological temperature
Subject(s)
Humans , Male , Female , Romano-Ward Syndrome , Hypothermia/therapy , Hypoxia-Ischemia, Brain/complications , Hypoxia-Ischemia, Brain , Hypothermia, Induced/methods , Hypothermia, Induced/statistics & numerical data , Hypothermia, Induced/standards , Electrocardiography/methods , Electrocardiography , Prospective Studies , Bradycardia/epidemiologyABSTRACT
INTRODUCTION: Therapeutic hypothermia is the standard treatment for hypoxic ischaemic encephalopathy (HIE), despite not knowing all its effects and complications. Sinus bradycardia is one of the consequences of cooling that has been previously documented in the literature, but little is known about the cardiac electrical activity in these patients. OBJECTIVE: To determine the corrected QT (QTc) interval in newborns treated with therapeutic hypothermia for HIE. MATERIAL AND METHODS: A prospective observational study was conducted in all patients treated with hypothermia for HIE that were admitted to our Unit between November 2012 and October 2013. ECGs were performed during hypothermia (every 24h), during the re-warming period (at 34.5°C, 35.5°C, 36.5°C), and on the 7th day of life. RESULTS: A total of 19 patients were included. A prolonged QTc was observed in all patients during hypothermia, and 84% (n=16) had prolonged QTc in all the ECGs during treatment. In 3 patients, one of the ECGs did not have a prolonged QTc. After re-warming, the QTc interval returned to normal in all patients. No statistically significant differences were seen when the degree of HIE (P=.192) or the use of inotropic support (P=.669) were considered. CONCLUSIONS: Therapeutic hypothermia applied to asphyxiated newborns with HIE seems to induce a QTc prolongation that resolves when the patient regains physiological temperature.
Subject(s)
Arrhythmias, Cardiac/etiology , Hypothermia, Induced/adverse effects , Hypoxia-Ischemia, Brain/complications , Hypoxia-Ischemia, Brain/therapy , Electrocardiography , Female , Humans , Hypoxia-Ischemia, Brain/physiopathology , Infant, Newborn , Male , Prospective StudiesSubject(s)
Humans , Male , Female , Child , Adolescent , Chest Pain/diagnosis , Chest Pain/etiology , Chest Pain/therapy , Myocarditis/complications , Myocarditis/diagnosis , Myocarditis/drug therapy , Heart Failure, Diastolic/complications , Diagnosis, Differential , Myocarditis/physiopathology , Myocarditis , Electrocardiography/methods , Electrocardiography , Magnetic Resonance Spectroscopy/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Infant , Child , Substance Withdrawal Syndrome/epidemiology , Substance Withdrawal Syndrome/prevention & control , Heart Transplantation/methods , Dexmedetomidine/metabolism , Dexmedetomidine/therapeutic use , Myocarditis/prevention & control , Myocarditis/surgery , Critical Care/methods , Critical Care/standards , Critical Care , Cardiomyopathies/complications , Cardiomyopathies/drug therapy , Cardiomyopathies/surgeryABSTRACT
No disponible
