Gustavo Henrique Santos Pereira
@ufrj.br
Adjunct Professor – Faculdade de Medicina / Programa de Pós-Graduação em Clínica Médica (UFRJ)
Universidade Federal do Rio de Janeiro (UFRJ)
I am a gastroenterologist and hepatologist with a career that integrates clinical practice, teaching, and research. I graduated in Medicine from the Federal University of Rio de Janeiro (UFRJ) and completed a residency in Gastroenterology at UERJ. My international training includes a Master in Research in Liver Disease and a PhD in Medicine from the University of Barcelona, along with advanced training in Liver Transplantation at the University of Miami and certifications in Internal Medicine Ultrasound and Elastography.
I serve as Adjunct Professor at Universidade Estácio de Sá (UNESA) and collaborating faculty member of the Graduate Program in Clinical Medicine at UFRJ. Clinically, I work at the Gastroenterology and Hepatology Service of the Federal Hospital of Bonsucesso, where I previously held the positions of service chief and residency program coordinator. My main research interests include cirrhosis, acute-on-chronic liver failure, portal hypertension, MASLD, viral hepatitis, c
EDUCATION
MD, Universidade Federal do Rio de Janeiro (UFRJ); Residency in Gastroenterology, UERJ; MSc in Liver Disease, University of Barcelona; PhD in Medicine, University of Barcelona; Advanced Training in Liver Transplantation, University of Miami.
RESEARCH, TEACHING, or OTHER INTERESTS
Hepatology, Gastroenterology, Nephrology, Oncology
FUTURE PROJECTS
Clinical outcomes of patients with cholestatic liver diseases in a tertiary hepatology network
Prospective and retrospective evaluation of adult patients with cholestatic liver diseases, focusing on epidemiology, diagnosis, treatment outcomes, and prognostic markers.
Applications Invited
Medical students, residents, fellows, data analysts.
Predictors of acute-on-chronic liver failure in cirrhosis: a real-world Brazilian cohort
Identification of clinical, laboratory, and imaging predictors of ACLF development in patients with cirrhosis followed in tertiary hepatology centers.
Applications Invited
Clinical researchers, statisticians, postgraduate students.
Non-invasive markers of portal hypertension in MASLD
Study evaluating elastography parameters and serum biomarkers as predictors of portal hypertension in metabolic liver disease.
Applications Invited
Medical students, ultrasound researchers, data science collaborators.
Scopus Publications
Scopus Publications
Jasmohan S. Bajaj, Scott Silvey, Aidan Mullan, Ashok Choudhury, Florence Wong, Jacob George, Ramazan Idilman, Mark Topazian, Wai-Kay Seto, Aldo Torre,et al.
Elsevier BV
Paula G F da Silva, Juliana B P Barrocas, Hugo Perazzo, Livia Villela-Nogueira, Helena R Peixoto, Gustavo H S Pereira, Lailiane N P Braga, Miriam Chinzon, Joyce R L de Silva, Flávia F Fernandes,et al.
Baishideng Publishing Group Inc.
BACKGROUND People with compensated advanced chronic liver disease (cACLD) remain at high risk of hepatocellular carcinoma (HCC) even after hepatitis C virus (HCV) sustained virological response (HCV-SVR). AIM To evaluate transient elastography and fibrosis-4 (FIB-4) index as prognostic markers for HCC after HCV-SVR. METHODS This retrospective cohort study analyzed data from people with cALCD and HCV-SVR. cALCD was defined as baseline liver stiffness measurement (LSM) ≥ 10 kPa. The primary outcome was the occurrence of HCC. Data collected at baseline (pre-treatment) and 1 year after the end of treatment (1-year-EOT) of LSM, FIB-4 index, and laboratory results were analyzed. LSM and FIB-4 index were evaluated as independent predictors of HCC by a Cox regression analysis. Receiver operator characteristic curves, Kaplan-Meier curves, and Cox regression analysis were performed. RESULTS Total of 425 patients (65.2% female; mean age = 62 ± 10 years) were included. The median pre-treatment and 1-year-EOT LSM were respectively 15.0 kPa (interquartile range: 11.8-23.2) and 12 kPa (interquartile range: 7.9-19.9) (P < 0.001), with a 27% (interquartile range: 2.7%-43%) reduction after SVR. The median pre-treatment FIB-4 index was 2.94 (interquartile range: 1.89-4.85) and 1-year-EOT FIB-4 1.99 (interquartile range: 1.29-3.13) (P < 0.001). Neither LSM nor FIB-4 deltas were associated with HCC. A total of 26 participants (6%) developed HCC during a follow-up of 48 ± 23 months with an incidence of 15.3/1000 person-years. Age [hazard ratio (HR) = 1.06, 95% confidence interval (CI): 1.01-1.11; P = 0.02], baseline (HR = 1.05, 95%CI: 1.02-1.07) and 1-year-EOT LSM ≥ 20 kPa (HR = 4.49, 95%CI: 2.19-9.19; P < 0.001) and baseline (HR = 7.79, 95%CI: 2.31-26.32; P < 0.001) and 1-year-EOT FIB-4 index score ≥ 3.25 (HR = 3.14, 95%CI: 1.65-6.00; P < 0.001) were associated with incident HCC. CONCLUSION In cACLD-HCV SVR patients, pre-treatment or 1-year-EOT LSM ≥ 20 kPa and FIB-4 ≥ 3.25 but not their delta was associated with HCC. A single measure of LSM ≥ 20 kPa or FIB-4 ≥ 3.25, either pre-treatment or 1-year-EOT, would be necessary to predict the incidence of HCC in people with HCV-SVR.
Ângelo Z. Mattos, Caroline Machado Rotta Dornelles, Leonardo de Lucca Schiavon, Liliana Sampaio Costa Mendes, Roberto José de Carvalho Filho, Liana Codes, Alberto Queiroz Farias, Mário Reis Álvares-da-Silva, Carlos Terra, Gustavo Pereira,et al.
Springer Science and Business Media LLC
Jonel Trebicka, Ferran Aguilar, Alberto Queiroz Farias, Juan-José Lozano, Cristina Sánchez-Garrido, Eva Usón-Raposo, Carlos de la Peña-Ramirez, Julia Sidorova, Anna Curto-Vilalta, Patricia Sierra-Casas,et al.
BMJ
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.
Kavish R Patidar, Ann T Ma, Adrià Juanola, Anna Barone, Simone Incicco, Anand V Kulkarni, José Luis Pérez Hernández, Brian Wentworth, Sumeet K Asrani, Carlo Alessandria,et al.
Elsevier BV
Camila Marques de Alcântara Barreto, Eliane Almeida do Valle, Jessica Pronestino de Lima Moreira, Katia Farias e Silva, Siane Lopes Bittencourt Rosas, Patrícia Teixeira Santana, Ana Maria Pittella, Gustavo Pereira, Flavia Ferreira Fernandes, Renata de Mello Perez,et al.
Elsevier BV
Zhujun Cao, Florence Wong, Ashok K Choudhury, Patrick S Kamath, Mark Topazian, Aldo Torre, Peter C Hayes, Jacob George, Ramazan Idilman, Wai-Kay Seto,et al.
Elsevier BV
Maria Lucia Gomes Ferraz, Antonio Ricardo Cardia Ferraz de Andrade, Gustavo Henrique Santos Pereira, Liana Codes, and Paulo Lisboa Bittencourt
Springer Science and Business Media LLC
AbstractBackgroundSeveral HCV patients in Brazil were lost to follow-up (LTFU) in the last two decades before achievement of sustained virological response (SVR). Strategies to recall those diagnosed but untreated patients have been used elsewhere with different success rates.AimTo identify and retrieve LTFU patients in order to offer them the treatment with the current highly effective direct acting antiviral agents (DAAs).MethodsRegistries ofall HCV patients from three large reference centers in Brazil were retrospectively reviewed to identify those with no registry of SVR. Reasons for non-achievement of SVR were elicited in HCV-RNA + patients. All patients who were not treated or cured were contacted to offer the therapy with DAAs.Results10,289 HCV patients (50% males, mean age 52 ± 11 years) were identified. Only 4,293 (41.7%) had been successfully treated previously. From the remaining 5,996 most were LTFU (59%), were not treated for other reasons (14.7%) or were non-responders (26.3%). After revision of the charts 3,559 were considered eligible to be retrieved. The callback success of phone calls was 18%, 13% to cellphone messages (SMS or WhatsApp) and 7% to regular mail. Five-hundred sixty patients had been already treatedor were on treatment and 234 were reported to be dead or transplanted. Finally, 201 had made an appointment and initiated antiviral treatment.ConclusionEven considering the low callback rate, retrieval of LTFU patients was shown to be an important strategy forhepatitis C micro-elimination in Brazil.
Lívia Guimarães, Juliana Piedade, Tamires Rocha, Caroline Baldin, Lívia Victor, and Gustavo Pereira
Elsevier BV
Nicolas M. Intagliata, Robert S. Rahimi, Fatima Higuera-de-la-Tijera, Douglas A. Simonetto, Alberto Queiroz Farias, Daniel F. Mazo, Justin R. Boike, Jonathan G. Stine, Marina Serper, Gustavo Pereira,et al.
Elsevier BV
Alberto Queiroz Farias, Anna Curto Vilalta, Patricia Momoyo Zitelli, Gustavo Pereira, Luciana L. Goncalves, Aldo Torre, Juan Manuel Diaz, Adrian C. Gadano, Angelo Z. Mattos, Liliana S.C. Mendes,et al.
Elsevier BV
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.
Lívia Guimarães, Juliana Piedade, Joana Duarte, Caroline Baldin, Lívia Victor, Barbara Costa, Zulane Veiga, Camila Alcântara, Flávia Fernandes, and Gustavo Pereira
Elsevier BV
Élio C. Castro Filho, Flávia F. Fernandes, Cristiane Villela-Nogueira, Eduardo Madeira, Fernando Barros, Rodrigo Luz, Gustavo Henrique Pereira, and Hugo Perazzo
Ovid Technologies (Wolters Kluwer Health)
Introduction and objectives Liver stiffness measurement (LSM) by transient elastography has been validated to predict high-risk varices (HRV). We aimed to evaluate the accuracy of shear-wave elastography (SWE) and platelet count (Baveno VI criteria) to rule out HRV in patients with compensated advanced chronic liver disease (c-ACLD). Methods This retrospective study analyzed data of patients with c-ACLD (transient elastography ≥ 10 kPa) submitted to two-dimensional SWE (2D-SWE) (GE-LOGIQ-S8) and/or point SWE (p-SWE) (ElastPQ) who had a gastrointestinal endoscopy within 24 months. HRV definition was a large size and presence of red wale marks or sequelae from previous treatment. Optimal thresholds of SWE systems for HRV were identified. The proportion of spared gastrointestinal endoscopies and missing HRV considering a favorable SWE Baveno VI criteria were assessed. Results Eighty patients [36% male, median age = 63 (interquartile range, 57–69) years] were included. The prevalence of HRV was 34% (n = 27/80). The optimal thresholds to predict HRV were 10 kPa and 12 kPa for 2D-SWE and p-SWE, respectively. A favorable 2D-SWE Baveno VI criteria (LSM < 10 kPa and platelets count > 150 × 109/mm3) avoided 19% of gastrointestinal endoscopies without missing HRVs. A favorable p-SWE Baveno VI criteria (LSM < 12 kPa and platelets count > 150 × 109/mm3) spared 20% of gastrointestinal endoscopy without missing HRVs. Using a lower threshold of platelet count (<110 × 109/mm3, expanded Baveno VI), 2D-SWE (<10 kPa) avoided 33% of gastrointestinal endoscopy with 8% of missing HRVs, while p-SWE (<12 kPa) avoided 36% of gastrointestinal endoscopy with 5% of missing HRVs. Conclusion LSM by p-SWE or 2D-SWE combined with platelet count (Baveno VI criteria) can spare a considerable number of gastrointestinal endoscopies missing a negligible proportion of HRV.
Mariana Coelho, Flavia Fernandes, Sandra W. Cardoso, Juliana Piedade, Marcos Vinícius Torres da Silva, Ricardo Santos, Valdilea G. Veloso, Beatriz Grinsztejn, Gustavo Henrique Pereira, and Hugo Perazzo
Ovid Technologies (Wolters Kluwer Health)
Objectives Evaluate the accuracy and agreement of two-dimensional shear-wave elastography (2D-SWE) LOGIQ-S8 with transient elastography in patients from Rio de Janeiro, Brazil. Method This retrospective study compared liver stiffness measurements (LSMs) using transient elastography (M and XL probes) and 2D-SWE GE-LOGIQ-S8 performed by a single experienced operator on the same day in 348 consecutive individuals with viral hepatitis or HIV infection. Suggestive and highly suggestive compensated-advanced chronic liver disease (c-ACLD) were defined by transient elastography-LSM ≥10 kPa and ≥15 kPa, respectively. Agreement between techniques and accuracy of 2D-SWE using transient elastography-M probe as the reference was assessed. Optimal cut-offs for 2D-SWE were identified using the maximal Youden index. Results Three hundred five patients [61.3% male, median age = 51 [interquartile range (IQR), 42–62] years, 24% with hepatitis C virus (HCV) ± HIV; 17% with hepatitis B virus (HBV) ± HIV; 31% were HIV mono-infected and 28% had HCV ± HIV post-sustained virological response] were included. The overall correlation (Spearman’s ρ) was moderate between 2D-SWE and transient elastography-M (ρ = 0.639) and weak between 2D-SWE and transient elastography-XL (ρ = 0.566). Agreements were strong (ρ > 0.800) in people with HCV or HBV mono-infection, and poor in HIV mono-infected (ρ > 0.400). Accuracy of 2D-SWE for transient elastography-M ≥ 10 kPa [area under the receiver operating characteristic (AUROC) = 0.91 (95% confidence interval [CI], 0.86–0.96); optimal cut-off = 6.4 kPa, sensitivity = 84% (95% CI, 72–92), specificity = 89% (95% CI, 84–92)] and for transient elastography-M ≥ 15 kPa [AUROC = 0.93 (95% CI, 0.88–0.98); optimal cut-off = 7.1 kPa; sensitivity = 91% (95% CI, 75–98), specificity = 89% (95% CI, 85–93)] were excellent. Conclusion 2D-SWE LOGIQ-S8 system had a good agreement with transient elastography and an excellent accuracy to identify individuals at high risk for c-ACLD.
Zulane S. T. Veiga, Flávia F. Fernandes, Lívia Guimarães, Juliana Piedade, and Gustavo Henrique S. Pereira
Background: Hepatosplenic schistosomiasis (HSS) is a peculiar form of non-cirrhotic portal hypertension (NCPH). Although HSS patients present normal hepatic function, some evolve signs of hepatocellular failure and features of decompensated cirrhosis. The natural history of HSS-NCPH is unknown. Methods: A retrospective study was conducted that evaluated patients who fulfilled clinical-laboratorial criteria for HSS. Results: A total of 105 patients were included. Eleven patients already presented with decompensated disease and had lower transplant-free survival at 5 years than those without (61% vs. 95%, p = 0.015). Among 94 patients without prior decompensation, the median follow-up was 62 months and 44% of them had varicose bleeding (two or more episodes in 27%). Twenty-one patients presented at least one episode of decompensation (10-year probability 38%). Upon multivariate analysis, varicose bleeding and higher bilirubin levels were associated with decompensation. The 10-year probability of survival was 87%. Development of decompensation and age were predictive of mortality. Conclusion: HSS is characterized by multiple episodes of GI bleeding, a high probability of decompensation and reduced survival at the end of the first decade. Decompensation is more common in patients with varicose esophageal bleeding and is associated with lower survival.
Lívia Victor, Renata Perez, Flávia Fernandes, Juliana Piedade, Cristiane A. Villela-Nogueira, and Gustavo Pereira
Ovid Technologies (Wolters Kluwer Health)
Real-life data on the HCV treatment with direct-acting agents in patients with decompensated cirrhosis are scarce. Study to investigate the effectiveness and safety of sofosbuvir-containing regimens in a prospective cohort of patients with HCV decompensated cirrhosis. A total of 150 patients were enrolled (64% male, 84% genotype 1 with a mean age of 61 ± 9 years). The median MELD was 12, and 79% were Child-PughB. Most patients were treated with sofosbuvir and daclatasvir (98%) with ribavirin in 27%. The overall intention to treat SVR12 was 91% (137/150). The most frequent adverse event was anemia (17%), 73% associated with ribavirin. Twenty-one (14%) patients experienced renal dysfunction, 81% AKI I, and 1 discontinued treatment. Thirty-five (23%) patients presented at least 1 infectious episode, mainly respiratory tract infection (29%). Thirty-three patients (22%) had at least 1 episode of cirrhosis decompensation throughout treatment, particularly worsening of previous ascites in 19%. Nine patients died, and among those, 7 patients died from sepsis. The probability of decompensation in 28, 90 and 180 days was 4%, 19% and 25%. During treatment, infection (OR 2.24; 95 CI 1.09–4.61; P = .03) was a predictor of cirrhosis decompensation, and baseline MELD and CHILD ≥ B8 were both associated with infection. In decompensated cirrhosis, the overall virological response was high with mild adverse events. However, this population had a high frequency of liver-associated decompensation and infections.
Gustavo H. Pereira, Helena R. Peixoto, Mariana L. Giusti, Mariana L. Souza, Livia B. Victor, Flávia Fernandes, Renata M. Perez, and Cristiane A. Villela-Nogueira
Elsevier BV
Flavia Fernandes, Juliana Piedade, Gabriela Freitas, Philippe Area, Ricardo Santos, Beatriz Grinsztejn, Valdilea Veloso, Gustavo Pereira, and Hugo Perazzo
Ovid Technologies (Wolters Kluwer Health)
Objective We aimed to evaluate the agreement/accuracy of point shear-wave elastography (p-SWE) and 2D-shear-wave elastography (2D-SWE) for liver fibrosis staging using transient elastography (TE) as the reference. Methods This retrospective study analyzed data from people with chronic liver diseases submitted to TE, p-SWE, and 2D-SWE. Liver fibrosis stages were defined using the TE’s ‘rule of five’: normal (<5 kPa); suggestive of compensated-advanced chronic liver disease (cACLD) (10–15 kPa); highly suggestive of cACLD (15–20 kPa); suggestive of clinically significant portal hypertension (>20 kPa). Agreement and accuracy of p-SWE and 2D-SWE were assessed. Optimal cutoffs for p-SWE and 2D-SWE were identified using the point nearest to the upper left corner of the ROC curves. Results A total of 289 participants were included. The correlation between TE and 2D-SWE (rho = 0.59; P < 0.001) or p-SWE (rho = 0.69; P < 0.001) was satisfactory. The AUROCs (95% CI) of 2D-SWE and p-SWE for TE ≥ 5 kPa; TE ≥ 10 kPa; TE ≥ 15 kPa and TE ≥ 20 kPa were 0.757 (0.685–0.829) and 0.741 (0.676–0.806); 0.819 (0.770–0.868) and 0.870 (0.825–0.915); 0.848 (0.803–0.893) and 0.952 (0.927–0.978); 0.851 (0.806–0.896) and 0.951 (0.920–0.982), respectively. AUROCs of 2D-SWE were significantly lower compared with p-SWE for detecting cACLD. Optimal thresholds of 2D-SWE and p-SWE for TE ≥ 15 kPa were 8.82 kPa (sensitivity = 86% and specificity = 79%) and 8.86 kPa (sensitivity = 90% and specificity = 92%), respectively. Conclusion LSM by p-SWE and 2D-SWE techniques were correlated with TE. LSM by p-SWE seems to be more accurate than 2D-SWE to identify patients with more advanced fibrosis.
Maria Lúcia Gomes Ferraz, Leonora de Zorzi Piccoli, Rosamar Rezende, Luiz Augusto Borba, Alcindo Pissaia Junior, Hugo Cheinquer, Giovanni Faria Silva, Paulo Roberto Abrão Ferreira, Cristiane Alves Villela-Nogueira, Daniel Ferraz Mazo,et al.
Brazilian Journal of Infectious Diseases Elsevier BV
Raphael Braz Levigard, Henrique Salas, Henrique Serrão, Felipe Diniz, Cristiane Alves Villela Nogueira, Alicia Araújo de Oliveira, Nathalie Carvalho Leite, Marcia Ladeira, Maria Chiara Chindamo, and Gustavo Pereira
Springer Science and Business Media LLC
Mateus Jorge Nardelli, Zulane da Silva Tavares Veiga, Luciana Costa Faria, Gustavo Henrique Santos Pereira, Catherine Ferreira da Silva, Fernanda Aziz Barbosa, Flávia Ferreira Fernandes, Renata de Mello Perez, Cristiane Alves Villela-Nogueira, and Claudia Alves Couto
Elsevier BV
Caroline Baldin, Juliana Piedade, Lívia Guimarães, Lívia Victor, Joana Duarte, Zulane Veiga, Camila Alcântara, Flávia Fernandes, João Luiz Pereira, and Gustavo Pereira
Springer Science and Business Media LLC
Juliana Piedade, Gustavo Pereira, Lívia Guimarães, Joana Duarte, Lívia Victor, Caroline Baldin, Cintia Inacio, Ricardo Santos, Úrsula Chaves, Estevão P. Nunes,et al.
Springer Science and Business Media LLC
AbstractThe role of liver stiffness measurement (LSM) after sustained virological response (SVR) in HCV patients treated by direct-acting antivirals (DAAs) remains unclear. We aimed to evaluate LSM regression value after SVR and to identify risk factors associated with liver related complications (LRC) or death. This retrospective study analyzed patients with LSM ≥ 10 kPa with LSM by transient elastography pre-DAAs and post-SVR. Patients with previous hepatic decompensation were excluded. Medical records were reviewed to identify primary outcomes. Kaplan–Meier curves and time-to-event Cox proportional-hazard models were performed. 456 patients [65% female, 62 years (IQR 57–68)] were included. During a follow-up of 2.3 years (IQR 1.6–2.7), 28 patients developed 37 outcomes [rate = 29.0 (95% CI 20.0–42.0) per 1000 person-years]. The cumulative incidence of outcomes was significantly lower in patients who regressed LSM ≥ 20% [3.4% (95% CI 1.8–7.0) vs. 9.0% (5.5–14.5), p = 0.028]. In a multivariate Cox-model [HR(95% CI)], male gender [HR = 3.00 (1.30–6.95), p = 0.010], baseline albumin < 3.5 mg/dL [HR = 4.49 (1.95–10.34), p < 0.001] and baseline unfavorable Baveno-VI [HR = 4.72 (1.32–16.83), p = 0.017] were independently associated and LSM regression ≥ 20% after SVR had a trend to reduce the risk of LRC or death [HR = 0.45 (0.21–1.02), p = 0.058]. The use of simple parameters before DAAs and repetition of LSM post-SVR can identify patients with different risks for severe outcome after HCV eradication.
Juliana Piedade and Gustavo Pereira
Elsevier BV
Sergio Muñoz-Martínez, Victor Sapena, Alejandro Forner, Jean-Charles Nault, Gonzalo Sapisochin, Lorenza Rimassa, Bruno Sangro, Jordi Bruix, Marco Sanduzzi-Zamparelli, Wacław Hołówko,et al.
JHEP Reports Elsevier BV
BACKGROUND
The coronavirus 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). This project has evaluated if the schedule of LC screening or procedures has been interrupted /delayed because of the COVID-19 pandemic.
MATERIAL AND METHODS
An international survey evaluated the impact of COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave.
RESULTS
Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia and Africa (73.7%, 17.1%, 5.3%, 2.6% and 1.3% per continent, respectively). Eighty-seven per cent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening program, 50% cancelled curative and/or palliative treatments for LC, and 44.0% cancelled the liver transplantation program. Forty-five out 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service prior to COVID-19 pandemic (n=19/37).
CONCLUSION
The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with LC. Modifications in screening, diagnostic and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision making.
RECENT SCHOLAR PUBLICATIONS
GRANT DETAILS
Supervisor and principal mentor of FAPERJ-funded Scientific Initiation fellows, coordinating competitive undergraduate research projects in hepatology. Responsibilities include project conception, methodological supervision, manuscript preparation, and academic development of early-career researchers.
CONSULTANCY
Consulting and advisory roles in hepatology, cirrhosis management, and liver transplantation.
Industry, Institute, or Organisation Collaboration
Clinical and research collaboration with hepatology units, gastroenterology networks, and academic institutions in Brazil and abroad.
INDUSTRY EXPERIENCE
Medical consultant and speaker in hepatology and gastroenterology for educational and scientific activities.
SOCIAL, ECONOMIC, or ACADEMIC BENEFITS
Improvement of clinical pathways and diagnostic accuracy in liver diseases in public and private health systems; training of medical students and residents in hepatology.