Valentina Da Prat
@sanmatteo.org
Medical Doctor, Nutrition and Dietetics Unit
Fondazione IRCCS Policlinico San Matteo
RESEARCH, TEACHING, or OTHER INTERESTS
Nutrition and Dietetics, Internal Medicine, Oncology, Gastroenterology
Scopus Publications
Scopus Publications
Valentina Da Prat, Lucia Aretano, Marco Moschini, Arianna Bettiga, Silvia Crotti, Francesca De Simeis, Emanuele Cereda, Amanda Casirati, Andrea Pontara, Federica Invernizzi,et al.
MDPI AG
Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for patients with limited-stage muscle-invasive bladder cancer. RC is associated with a complication rate of approximately 50–88%. Immunonutrition (IMN) refers to the administration of substrates, such as omega-3 fatty acids, arginine, glutamine, and nucleotides, that modulate the immune response. IMN has been associated with improved outcomes following surgery for esophagogastric, colorectal and pancreatic cancer. In this paper, we describe a study protocol for a multicentre, randomised, open-label clinical trial to evaluate the effect of IMN in patients undergoing RC for bladder cancer. A 7-day preoperative course of IMN is compared with a standard high-calorie high-protein oral nutritional supplement. The primary outcome of this study is the rate of complications (infectious, wound-related, gastrointestinal, and urinary complications) in the first 30 days after RC. Secondary outcomes include time to recovery of bowel function and postoperative mobilisation, changes in muscle strength and body weight, biochemical modifications, need for blood transfusion, length of stay, readmission rate, and mortality. The results of this study may provide new insights into the impact of IMN on postoperative outcomes after RC and may help improve IMN prescribing based on patient nutritional status parameters.
Moreno TRESOLDI, Alberto ZANGRILLO, Alessandro BELLETTI, Giuseppe A. RAMIREZ, Enrica BOZZOLO, Francesca GUZZO, Alessandro MARINOSCI, Evgeny V. FOMINSKIY, Valentina DA PRAT, Marilena MARMIERE,et al.
Edizioni Minerva Medica
BACKGROUND
COVID-19 patients frequently develop respiratory failure requiring mechanical ventilation. Data on long-term survival of patients who had severe COVID-19 are insufficient. We assessed and compared two-year survival, CT imaging, quality of life, and functional recovery of COVID-19 ARDS patients requiring respiratory support with invasive (IMV) versus noninvasive ventilation (NIV).
METHODS
Patients with COVID-19 pneumonia admitted up to May 28th, 2020, who required IMV or NIV, and survived to hospital discharge were enrolled. Patients were contacted two years after discharge to assess vital status, functional, psychological, and cognitive outcomes using validated scales. Patients with persistent respiratory symptoms or high burden of residual lung damage at previous CT scan received a two-year chest CT scan.
RESULTS
Out of 61 IMV survivors, 98% were alive at two-year follow-up, and 52 completed the questionnaire. Out of 82 survivors receiving NIV only, 94% were alive at two years, and 47 completed the questionnaire. We found no major differences between invasively and noninvasively ventilated patients, with overall acceptable functional recovery. Among the 99 patients completing the questionnaire, 23 have more than moderate exertional dyspnea. Chest CT scans showed that 4 patients (all received IMV) had fibrotic-like changes.
CONCLUSIONS
Patients who received mechanical ventilation due to COVID-19 and were discharged from hospital had a 96% survival rate at the two-year follow-up. There was no difference in overall recovery and quality of life between patients who did and did not require IMV, although respiratory morbidity remains high.
Cristina Bosetti, Amanda Casirati, Valentina Da Prat, Sara Masi, Silvia Crotti, Alessandra Ferrari, Lorenzo Perrone, Francesco Serra, Claudia Santucci, Emanuele Cereda,et al.
BMJ
BackgroundMalnutrition is a frequent problem in oncology and is associated with reduced response to cancer treatments, increased drug-related toxicity, higher rates of clinical complications, reduced quality of life (QoL) and worse prognosis. Guidelines on clinical nutrition in oncology emphasise the usefulness of early assessment of nutritional status for a prompt identification of malnutrition and the implementation of effective interventions, but no real-world clinical data are available on the adequate management of nutritional support in patients with cancer in Italy.Methods and analysisThis is an observational, longitudinal, multicentre registry of patients with a new diagnosis of cancer or metastatic disease, candidates for active treatment. They will be identified in at least 15 Italian oncological centres, members of the Alliance Against Cancer Working Group ‘Survivorship Care and Nutritional Support’. At least 1500 patients with cancer are expected to be enrolled each year. Detailed clinical and nutritional data will be collected by oncologists and clinical nutritionists during the visits foreseen in the clinical practice, through an ad hoc developed digital platform (e-Nutracare). The effects of malnutrition and nutritional support—at diagnosis and during follow-up—on overall survival and progression-free survival, as well as on patients’ symptoms and QoL, will be investigated.Ethics and disseminationThe study protocol was approved by the Ethics Committee of the Fondazione IRCCS Policlinico San Matteo, Pavia, Italy and from the Ethics Committees of all other participating centres. An informed consent will be obtained from each patient enrolled in the study. Study findings will be disseminated through peer-reviewed journals, conferences and patients with cancer or professional associations. The registry will allow a better monitoring of the nutritional status of patients with cancer, promoting adequate and sustainable nutritional support, with the ultimate goal of improving the care and prognosis of these patients.
Amanda Casirati, Valentina Da Prat, Arianna Bettiga, Lucia Aretano, Francesco Trevisani, Emanuele Cereda, Alberto Briganti, Elisa Colombo, Giorgia Preziati, Francesca De Simeis,et al.
MDPI AG
Preoperative nutritional status is a pivotal aspect to consider in patients with cancer undergoing radical cystectomy (RC), as those at risk of malnutrition or already malnourished are more prone to post-surgical complications. The loss of muscle mass is a major consequence of cancer-related malnutrition. It is associated with increased risk of hospital readmission, longer hospitalization, and higher mortality. Nowadays, the close relationship between nutritional and immunological aspects under stressful conditions, such as surgery, represents an emerging scientific and clinical issue. Indeed, the synergistic action of reduced food intake and systemic inflammation generates metabolic derangements with tissue catabolism, including skeletal muscle breakdown, which is, in turn, associated with immune system dysfunction. In order to offer an additional immune-nutritional boost to the post-surgical phase, particularly in malnourished patients, nutritional support may include oral nutritional supplements and/or enteral formulas enriched with specific nutrients such as omega-3 fatty acids, arginine, glutamine, and nucleotides, with acknowledged immune-modulating effects. In the present narrative review, we addressed the state of the art of the available scientific literature on the benefit of immunonutrition in patients undergoing RC for cancer and suggest possible future perspectives to be explored. Although the role of immunonutrition was found to be little explored in the context of urologic oncology, the preliminary available data on radical cystectomy, summarized in the present paper, are promising and suggest that it may improve postoperative outcomes through immunomodulation, regardless of nutritional status before surgery.
A. Casirati, V. Da Prat, E. Cereda, F. Sebastiani, I. Trestini, L. Perrone, F. Serra, M. Cintoni, P. Pedrazzoli, and R. Caccialanza
Elsevier BV
Valentina Da Prat, Laura Galli, Paola Cichero, Barbara Castiglioni, Chiara Oltolini, Chiara Tassan Din, Andrea Andolina, Elena Bruzzesi, Andrea Poli, Matteo Moro,et al.
Informa UK Limited
Abstract Background We investigated the role of infectious disease consultation (IDC) on therapeutic appropriateness in Gram-negative bloodstream infections (GNBSIs) in a setting with a high proportion of antibiotic resistance. Secondary outcomes were in-hospital mortality and the impact of rapid diagnostic tests (RDTs). Methods Retrospective study on hospitalised patients with GNBSIs. Therapy was deemed appropriate if it had the narrowest spectrum considering infection and patients’ characteristics. Interventional-IDC (I-IDC) group included patients with IDC-advised first appropriate or last non-appropriate therapy. Time to first appropriate therapy and survival were evaluated by Kaplan-Meier curves. Factors associated with therapy appropriateness were assessed by multivariate Cox proportional-hazard models. Results 471 patients were included. High antibiotic resistance rates were detected: quinolones 45.5%, third-generation cephalosporins 37.4%, carbapenems 7.9%. I-IDC was performed in 31.6% of patients (149/471), RDTs in 70.7% (333/471). The 7-day probability of appropriate treatment was 91.9% (95% confidence interval [95%CI]: 86.4–95.8%) vs. 75.8% (95%CI: 70.9–80.4%) with and without I-IDC, respectively (p-value = 0.0495); 85.5% (95%CI: 81.3–89.1%) vs. 69.4% (95%CI: 61.3–77.2%) with and without RDTs, respectively (p-value = 0.0023). Compared to RDTs alone, the combination with I-IDC was associated with a higher proportion of appropriate therapies at day 7: 81.9% (95%CI: 76.4–86.7%) vs. 92.6% (95%CI: 86.3–96.7%). At multivariate analysis, I-IDC and RDTs were associated with time to first appropriate therapy [adjusted hazard-ratio 1.292 (95%CI: 1.014–1.647) and 1.383 (95%CI: 1.080–1.771), respectively], with no impact on mortality. Conclusions In a setting with a high proportion of antibiotic resistance, IDC and RDTs were associated with earlier prescription of appropriate therapy in GNBSIs, without impact on mortality.
Amanda Casirati, Valentina Da Prat, Emanuele Cereda, Francesco Serra, Lorenzo Perrone, Salvatore Corallo, Francesco De Lorenzo, Paolo Pedrazzoli, and Riccardo Caccialanza
MDPI AG
Malnutrition is a common condition in cancer patients [...]
Giuseppe A. RAMIREZ, Enrica P. BOZZOLO, Agnese GOBBI, Elena CASTELLI, Clarissa CENTURIONI, Mattia DI MEO, Emanuel DELLA TORRE, Flavia DI SCALA, Anna MORGILLO, Alessandro MARINOSCI,et al.
Edizioni Minerva Medica
Sarah Damanti, Giulia Cristel, Giuseppe Alvise Ramirez, Enrica Paola Bozzolo, Valentina Da Prat, Agnese Gobbi, Clarissa Centurioni, Ettore Di Gaeta, Andrea Del Prete, Maria Grazia Calabrò,et al.
Elsevier BV
Marco Ripa, Laura Galli, Armando D’Angelo, Luca Apruzzi, Diego Palumbo, Corrado Campochiaro, Chiara Tassan Din, Anna Danise, Valentina Da Prat, Giordano Vitali,et al.
Oxford University Press (OUP)
AbstractBackgroundThis study’s primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications.MethodsThis was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray's method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections.ResultsOverall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8–11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7–21.0) and 9.3 (95% CI, 7.9–11.0) per 1000-PDFU, respectively (P = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018–3.140; P = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications.ConclusionsIn patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections.
Giuseppe A. RAMIREZ, Stefania L. CALVISI, Rebecca DE LORENZO, Valentina DA PRAT, Giorgia BORIO, Gabriele GALLINA, Federica FAROLFI, Ludovica CAVALLO, Maria PASCALI, Jacopo CASTELLANI,et al.
Edizioni Minerva Medica
Sarah Damanti, Giuseppe Alvise Ramirez, Enrica Paola Bozzolo, Valentina Da Prat, Giuseppe Di Lucca, Gaetano Di Terlizzi, Alessandro Marinosci, Raffaella Scotti, Silvia Strada, Paolo Scarpellini,et al.
Springer Science and Business Media LLC
Sarah Damanti, Giuseppe Alvise Ramirez, Valentina Da Prat, Ambra Bertola, Emanuela Manzo, Stefania Vadruccio, Moreno Tresoldi, Philipe de Souto Barreto, and Yves Rolland
Elsevier BV
Simone Gulletta, Paolo Della Bella, Luigi Pannone, Giulio Falasconi, Lorenzo Cianfanelli, Savino Altizio, Elena Cinel, Valentina Da Prat, Antonio Napolano, Giuseppe D’Angelo,et al.
Springer Science and Business Media LLC
V. Spagnuolo, M. Guffanti, L. Galli, A. Poli, P. Rovere Querini, M. Ripa, M. Clementi, P. Scarpellini, A. Lazzarin, M. Tresoldi,et al.
Springer Science and Business Media LLC
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Stefania L. Calvisi, Giuseppe A. Ramirez, Marina Scavini, Valentina Da Prat, Giuseppe Di Lucca, Andrea Laurenzi, Gabriele Gallina, Ludovica Cavallo, Giorgia Borio, Federica Farolfi,et al.
Elsevier BV
Giacomo Monti, Carlo Leggieri, Evgeny Fominskiy, Anna Mara Scandroglio, Sergio Colombo, Margherita Tozzi, Elena Moizo, Milena Mucci, Martina Crivellari, Marina Pieri,et al.
Wiley
BackgroundCOVID‐19 disease can lead to severe functional impairments after discharge. We assessed the quality of life of invasively ventilated COVID‐19 ARDS survivors.MethodsWe carried out a prospective follow‐up study of the patients admitted to the Intensive Care Units (ICUs) of a teaching hospital. Patients affected by COVID‐19 ARDS who required invasive ventilation and were successfully discharged home were assessed through the telephone administration of validated tests. We explored survival, functional outcomes, return to work, quality of life, cognitive and psychological sequelae. The main variables of interest were the following: demographics, severity scores, laboratory values, comorbidities, schooling, working status, treatments received during ICU stay, complications, and psychological, cognitive, functional outcomes.ResultsOut of 116 consecutive invasively ventilated patients, overall survival was 65/116 (56%) with no death occurring after hospital discharge. Forty‐two patients were already discharged home with a median follow‐up time of 61 (51‐71) days after ICU discharge and 39 of them accepted to be interviewed. Only one patient (1/39) experienced cognitive decline. The vast majority of patients reported no difficulty in walking (32/35:82%), self‐care (33/39:85%), and usual activities (30/39:78%). All patients were either malnourished (15/39:38%) or at risk for malnutrition (24/39:62%). Exertional dyspnea was present in 20/39 (51%) patients. 19/39 (49%) reported alterations in senses of smell and/or taste either before or after hospitalization.ConclusionsInvasively ventilated COVID‐19 ARDS survivors have an overall good recovery at a 2‐months follow‐up which is better than what was previously reported in non‐COVID‐19 ARDS patients.
Marco Ripa, Laura Galli, Andrea Poli, Chiara Oltolini, Vincenzo Spagnuolo, Andrea Mastrangelo, Camilla Muccini, Giacomo Monti, Giacomo De Luca, Giovanni Landoni,et al.
Elsevier BV
V. Spagnuolo, M. Guffanti, L. Galli, A. Poli, P. Rovere Querini, M. Ripa, M. Clementi, P. Scarpellini, A. Lazzarin, M. Tresoldi,et al.
Springer Science and Business Media LLC
AbstractThe aim of this study was to evaluate the impact of early treatment with corticosteroids on SARS-CoV-2 clearance in hospitalized COVID-19 patients. Retrospective analysis on patients admitted to the San Raffaele Hospital (Milan, Italy) with moderate/severe COVID-19 and availability of at least two nasopharyngeal swabs. The primary outcome was the time to nasopharyngeal swab negativization. A multivariable Cox model was fitted to determine factors associated with nasopharyngeal swab negativization. Of 280 patients included, 59 (21.1%) patients were treated with steroids. Differences observed between steroid users and non-users included the proportion of patients with a baseline PaO2/FiO2 ≤ 200 mmHg (45.8% vs 34.4% in steroids and non-steroids users, respectively; p = 0.023) or ≤ 100 mmHg (16.9% vs 12.7%; p = 0.027), and length of hospitalization (20 vs 14 days; p < 0.001). Time to negativization of nasopharyngeal swabs was similar in steroid and non-steroid users (p = 0.985). According to multivariate analysis, SARS-CoV-2 clearance was associated with age ≤ 70 years, a shorter duration of symptoms at admission, a baseline PaO2/FiO2 > 200 mmHg, and a lymphocyte count at admission > 1.0 × 109/L. SARS-CoV-2 clearance was not associated with corticosteroid use. Our study shows that delayed SARS-CoV-2 clearance in moderate/severe COVID-19 is associated with older age and a more severe disease, but not with an early use of corticosteroids.
Emanuel Della-Torre, Corrado Campochiaro, Giulio Cavalli, Giacomo De Luca, Angela Napolitano, Salvatore La Marca, Nicola Boffini, Valentina Da Prat, Gaetano Di Terlizzi, Marco Lanzillotta,et al.
BMJ
ObjectivesTo assess the safety and efficacy of interleukin (IL)−6 blockade with sarilumab in patients with severe COVID-19 pneumonia and systemic hyperinflammation.MethodsWe conducted an open-label study of sarilumab in severe COVID-19 pneumonia (PaO2/FiO2 <300 mm Hg) with hyperinflammation (elevated inflammatory markers and serum IL-6 levels). Sarilumab 400 mg was administered intravenously in addition to standard of care and results were compared with contemporary matched patients treated with standard of care alone. Clinical improvement, mortality, safety and predictors of response were assessed at 28 days.ResultsTwenty-eight patients were treated with sarilumab and 28 contemporary patients receiving standard of care alone were used as controls. At day 28 of follow-up, 61% of patients treated with sarilumab experienced clinical improvement and 7% died. These findings were not significantly different from the comparison group (clinical improvement 64%, mortality 18%; p=NS). Baseline PaO2/FiO2 ratio >100 mm Hg and lung consolidation <17% at CT scan predicted clinical improvement in patients treated with sarilumab. Median time to clinical improvement in patients with lung consolidation <17% was shorter after sarilumab (10 days) than after standard treatment (24 days; p=0.01). The rate of infection and pulmonary thrombosis was similar between the two groups.ConclusionsAt day 28, overall clinical improvement and mortality in patients with severe COVID-19 were not significantly different between sarilumab and standard of care. Sarilumab was associated with faster recovery in a subset of patients showing minor lung consolidation at baseline.
Filippo Pietrantonio, Armando Orlandi, Alessandro Inno, Valentina Da Prat, Daniele Spada, Alessandro Iaculli, Maria Di Bartolomeo, Carlo Morosi, and Filippo de Braud
Elsevier BV