Gene score to quantify systemic inflammation in patients with acutely decompensated cirrhosis Jonel Trebicka, Ferran Aguilar, Alberto Queiroz Farias, Juan-José Lozano, Cristina Sánchez-Garrido, et al. Gut, 2025 Background and aimsQuantifying systemic inflammation (SI) in acutely decompensated cirrhosis (ADC) is of major importance because SI is a driver of the most severe forms of ADC, including acute-on-chronic liver failure (ACLF). Blood biomarkers of SI already evaluated in ADC failed to appropriately assess SI in ADC. We aimed to investigate whether gene expression related to circulating immune cells could quantify SI in ADC.MethodsStandard biomarkers (white cell count, C reactive protein, cytokines) and genome-wide RNA expression (RNA-sequencing) were obtained in blood from 700 patients with ADC at the time of their hospital admission. A composite score based on standard biomarkers of SI (Chronic Liver Failure-Standard Biomarkers Composite (CLIF-SBC) score) and a gene score (CLIF-Systemic Inflammation Gene (SIG) score) composed of the 28 top differentially expressed immune cell-related genes in the comparison between high-severity and low-severity clinical phenotypes were computed. Among the 700 patients, the CLIF-SIG score was repeated once during follow-up in 375 patients, and 3 times or more in 46 patients.ResultsThe CLIF-SIG score was more accurate in reflecting clinical severity induced by SI than the CLIF-SBC score (area under the curve 0.803 vs 0.658). A CLIF-SIG score of 0.386 (Youden Index) was the best cut-off level discriminating patients with poor outcomes from the others, in all clinical scenarios. Sequential measurement of the CLIF-SIG score showed that 78% of patients were admitted at the peak or descending part of the SI-wave. ACLF developed during hospitalisation in 80% of patients with a CLIF-SIG score >0.386 on admission.ConclusionsIn patients with ADC, the CLIF-SIG score is an accurate estimator of SI, clinical course severity and prognosis.
Variceal gastrointestinal bleeding: epidemiology, pathogenesis, management and prophylaxis Revista De Gastroenterologia Del Peru Organo Oficial De La Sociedad De Gastroenterologia Del Peru, 2025
A New Routine Immunity Score (RIS2020) to Predict Severe Infection in Solid-Organ Transplant Recipients E. Sarmiento, I. Ezzahouri, Maricela Jimenez-Lopez, Kristofer M. Limay Carré, Rocio Alonso, et al. Annals of Transplantation, 2025 Background Infection is a cause of morbidity and mortality in solid-organ transplantation (SOT). We evaluated a new score that is applied during the first month after transplantation. The score comprises biomarkers of innate and acquired immunity to predict infections in SOT. Material/Methods Prospectively collected blood samples from 377 heart, liver, or kidney recipients were analyzed at 2 centers in Madrid (Spain) and Lima (Peru). Biomarkers were tested before transplantation and at days 7 and 30 after transplantation. During the first 6 months after transplantation, 183 (48.5%) patients developed severe infections (bacterial infections and/or CMV disease). Risk for severe infection was assessed using logistic regression analysis. We designed a score, the routine immunity score (RIS2020), which is based on the sum of the hazard ratios (HRs) of each biomarker. Results The risk factors for severe infection were as follows: Moderate IgG hypogammaglobulinemia (IgG <600 mg/dL at days 7 or 30, HR 2.07, 95% CI 1.37–3.12, p=0.0005, 2 points), CD4 <400 cells/uL at day 30 (HR 1.76, 95% CI 1.03–3.04, p=0.039, 2 points), C3 <80 mg/dL at day 30 (HR 2.18, 95% CI 1.16–4.06, p=0.014, 2 points), and CRP >3 mg/dL at day 30 (HR 2.11, 95% CI 1.12–3.97, p=0.02, 2 points). In patients with ≥4 points, the HR for infection was 5.18 (95% CI 3.06–8.75; p<0.001). RIS2020 was an independent predictor of severe infection in multivariate models. Conclusions An immunological score combining moderate IgG hypogammaglobulinemia and other parameters of innate and acquired immunity could better identify the risk for severe infection in SOT.
A global action agenda for turning the tide on fatty liver disease Jeffrey V. Lazarus, Henry E. Mark, Alina M. Allen, Juan Pablo Arab, Patrizia Carrieri, et al. Hepatology, 2024 Background and Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach and Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of “agree” responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% “agree”). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. Conclusions: This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce fatty liver disease prevalence and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.
Genetic Ancestry, Race, and Severity of Acutely Decompensated Cirrhosis in Latin America Alberto Queiroz Farias, Anna Curto Vilalta, Patricia Momoyo Zitelli, Gustavo Pereira, Luciana L. Goncalves, et al. Gastroenterology, 2023 BACKGROUND & AIMS Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (e.g., Covid-19). This study aimed to investigate the association of genetic ancestry and race with acute-on-chronic liver failure (ACLF), which is characterized by acute systemic inflammation, multi-organ failure and high risk of short-term death. METHODS This prospective cohort study analyzed a comprehensive set of data including genetic ancestry and race, among several others, in 1274 patients with acutely decompensated cirrhosis (ADC) who were nonelectively admitted to 44 hospitals from 7 Latin American countries. RESULTS 395 (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had higher median percentage of Native American genetic ancestry and lower median percentage of European ancestry than patients without ACLF (22.6% vs 12.9% and 53.4% vs 59.6%, respectively). The median percentage of African genetic ancestry was low among patients with ACLF and among those without. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native Americans and a lower percentage of patients with ACLF than patients without were European Americans or African Americans. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% confidence interval [CI], 1.03-1.13) with Native American genetic ancestry and 2.57 (95% CI, 1.84-3.58) for Native American race vs. European American race. CONCLUSIONS In a large cohort of Latin American patients with ADC, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment.
Impact of COVID-19 on liver disease and the public health in Peru Revista De Gastroenterologia Del Peru Organo Oficial De La Sociedad De Gastroenterologia Del Peru, 2020
Portal vein thrombosis in patients undergoing to liver transplantation Revista De Gastroenterologia Del Peru Organo Oficial De La Sociedad De Gastroenterologia Del Peru, 2019
Peruvian experience in the treatment of chronic hepatites C with the new direct acting antiviral drugs Revista De Gastroenterologia Del Peru Organo Oficial De La Sociedad De Gastroenterologia Del Peru, 2019
