scholarly journals CONUT Score Predicts Early Morbidity After Liver Transplantation: A Collaborative Study

2022 ◽  
Vol 8 ◽  
Author(s):  
Gabriele Spoletini ◽  
Flaminia Ferri ◽  
Alberto Mauro ◽  
Gianluca Mennini ◽  
Giuseppe Bianco ◽  
...  

Introduction: Liver transplantation (LT) is burdened by the risk of post-operative morbidity. Identifying patients at higher risk of developing complications can help allocate resources in the perioperative phase. Controlling Nutritional Status (CONUT) score, based on lymphocyte count, serum albumin, and cholesterol levels, has been applied to various surgical specialties, proving reliable in predicting complications and prognosis. Our study aims to investigate the role of the CONUT score in predicting the development of early complications (within 90 days) after LT.Methods: This is a retrospective analysis of 209 patients with a calculable CONUT score within 2 months before LT. The ability of the CONUT score to predict severe complications, defined as a Comprehensive Complication Index (CCI) ≥42.1, was examined. Inverse Probability Treatment Weighting was used to balance the study population against potential confounders.Results: Patients with a CCI ≥42.1 had higher CONUT score values (median: 7 vs. 5, P-value < 0.0001). The CONUT score showed a good diagnostic ability regarding post-LT morbidity, with an AUC = 0.72 (95.0%CI = 0.64–0.79; P-value < 0.0001). The CONUT score was the only independent risk factor identified for a complicated post-LT course, with an odds ratio = 1.39 (P-value < 0.0001). The 90-day survival rate was 98.8% and 87.5% for patients with a CONUT score <8 and ≥8, respectively.Conclusions: Pre-operative CONUT score is a helpful tool to identify patients at increased post-LT morbidity risk. Further refinements in the score composition, specific to the LT population, could be obtained with prospective studies.

Author(s):  
Quirino Lai ◽  
Fabio Melandro ◽  
Greg Nowak ◽  
Daniele Nicolini ◽  
Samuele Iesari ◽  
...  

Author(s):  
Lijian Chen ◽  
Yuming Peng ◽  
Chunyi Ji ◽  
Miaoxian Yuan ◽  
Qiang Yin

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2398
Author(s):  
Matteo Serenari ◽  
Enrico Prosperi ◽  
Marc-Antoine Allard ◽  
Michele Paterno ◽  
Nicolas Golse ◽  
...  

Hepatic resection (HR) for hepatocellular carcinoma (HCC) may require secondary liver transplantation (SLT). However, a previous HR is supposed to worsen post-SLT outcomes. Data of patients treated by SLT between 2000 and 2018 at two tertiary referral centers were analyzed. The primary outcome of the study was to analyze the impact of HR on post-LT complications. A Comprehensive Complication Index ≥ 29.6 was chosen as cutoff. The secondary outcome was HCC-related death by means of competing-risk regression analysis. In the study period, 140 patients were included. Patients were transplanted in a median of 23 months after HR (IQR 14–41). Among all the features analyzed regarding the prior HR, only time interval between HR and SLT (time HR-SLT) was an independent predictor of severe complications after LT (OR = 0.98, p < 0.001). According to fractional polynomial regression, the probability of severe complications increased up to 15 months after HR (43%), then slowly decreased over time (OR = 0.88, p < 0.001). There was no significant association between HCC-related death and time HR-SLT at the multivariable competing risks regression model (SHR, 1.06; 95% CI: 0.69–1.62, p = 0.796). This study showed that time HR-SLT was key in predicting complications after LT, without affecting HCC-related death.


2017 ◽  
Vol 37 (8) ◽  
pp. 1239-1248 ◽  
Author(s):  
Kuang-Cheng Chan ◽  
Jia-Rong Yeh ◽  
Wei-Zen Sun

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Vijay R. Varma ◽  
H. Büşra Lüleci ◽  
Anup M. Oommen ◽  
Sudhir Varma ◽  
Chad T. Blackshear ◽  
...  

AbstractThe role of brain cholesterol metabolism in Alzheimer’s disease (AD) remains unclear. Peripheral and brain cholesterol levels are largely independent due to the impermeability of the blood brain barrier (BBB), highlighting the importance of studying the role of brain cholesterol homeostasis in AD. We first tested whether metabolite markers of brain cholesterol biosynthesis and catabolism were altered in AD and associated with AD pathology using linear mixed-effects models in two brain autopsy samples from the Baltimore Longitudinal Study of Aging (BLSA) and the Religious Orders Study (ROS). We next tested whether genetic regulators of brain cholesterol biosynthesis and catabolism were altered in AD using the ANOVA test in publicly available brain tissue transcriptomic datasets. Finally, using regional brain transcriptomic data, we performed genome-scale metabolic network modeling to assess alterations in cholesterol biosynthesis and catabolism reactions in AD. We show that AD is associated with pervasive abnormalities in cholesterol biosynthesis and catabolism. Using transcriptomic data from Parkinson’s disease (PD) brain tissue samples, we found that gene expression alterations identified in AD were not observed in PD, suggesting that these changes may be specific to AD. Our results suggest that reduced de novo cholesterol biosynthesis may occur in response to impaired enzymatic cholesterol catabolism and efflux to maintain brain cholesterol levels in AD. This is accompanied by the accumulation of nonenzymatically generated cytotoxic oxysterols. Our results set the stage for experimental studies to address whether abnormalities in cholesterol metabolism are plausible therapeutic targets in AD.


2021 ◽  
pp. 152692482110028
Author(s):  
Alberto Ferrarese ◽  
Patrizia Burra

Liver transplantation is considered an effective therapeutic option for Wilson’s disease (WD) patients with hepatic phenotype, since it removes the inherited defects of copper metabolism, and is associated with excellent graft and patient outcomes. The role of liver transplantation in WD patients with mixed hepatic and neuropsychiatric phenotype has remained controversial over time, mainly because of high post-operative complications, reduced survival and a variable, unpredictable rate of neurological improvement. This article critically discusses the recently published data in this field, focussing in more detail on isolated neuropsychiatric phenotype as a potential indication for liver transplantation in WD patients.


Proceedings ◽  
2021 ◽  
Vol 77 (1) ◽  
pp. 15
Author(s):  
Hernan Mondani ◽  
Amir Rostami ◽  
Tina Askanius ◽  
Jerzy Sarnecki ◽  
Christofer Edling

This presentation summarizes a register-based study on women who have been identified as belonging to three violent extremist milieus in Sweden: violent Islamic, violent far-right, and violent far-left extremism. We studied the women in these milieus along a number of analytical dimensions, ranging from demographic and educational to criminal background and network relationships, and compared them to three reference groups: (i) non-extremist biological sisters to female extremists in the study population; (ii) men in the respective extremist milieus; and (iii) female members of other antagonistic milieus such as organized crime. Our results showed that there are both similarities and differences between groups. In some cases, like age and region of birth, there are commonalities between violent far-right and violent far-left women. Regarding region of birth and migration background, women affiliated to violent far-right and violent far-left extremism are predominantly born in Sweden. Women affiliated to violent Islamic extremism tend to be born in Sweden to a greater extent than men in the same milieu, but to a much lesser degree than women in the violent far-right and violent far-left. When it comes to education, women in the violent Islamic milieu are closer to women in violent far-right extremism. Women in violent far-left extremism perform best at school, with consistently higher grades. The average score of women in violent far-left extremism is identical to that of their sisters, and women in violent far-left extremism perform on average substantially better than men in the same milieu. Women in violent Islamic extremism, in contrast, perform on average similarly to men in violent far-left extremism, and they perform better than their biological sisters. Regarding labor market attachment, violent Islamic extremists have the weakest attachment and the highest dependency upon financial assistance as well as a low employment share (36 percent in 2016), but also a relatively high share of individuals with a high number of unemployment days, suggesting that women in violent Islamic extremism experience higher social exclusion. We find the highest employment share among women in violent far-left extremism, where 89 percent are gainfully employed in 2016 (80 percent for at least three of the last five years) and about a 20 percent unemployment share. Men in violent far-left extremism have an employment share around 10 percent below that of the women in far-left extremism for 2016. The highest fractions of individuals that have not been in contact with the health system due to mental disorders are among violent Islamic extremism, with the women’s fraction at 84 percent, compared to their non-extremist sisters and men in the same milieu that are just above 79 percent. Women in violent far-left extremism have the highest share of in-patient major mental disorders among the extremist milieus (3 percent), higher than men in the same milieu (less than 1 percent) as well as than women and their sisters in the other categories. During the period 2007–2016, 68 percent of individuals in the extremist milieus are covered by the register of suspected individuals. The coverage is substantially higher for men, 72 percent than for women, 43 percent. Compared to their sisters, women in all three milieus are criminally active to a much higher extent. However, women in all three milieus are less criminally active than women in other antagonistic milieus, among whom 67 percent have been suspected at least once. In all three milieus, the share of men with a criminal record is about twice as large as that of women. As far as the gender aspect is concerned, we know that extremist milieus generally have a conservative view of the role of women in society. In our results, this is reflected in the low rates of crime in women compared to men, and relatively marginal positions in the co-offending networks. The fact that women in violent far-left extremism have stronger positions in their networks than the other women in the study population is expected, given that the ideology of this milieu allows for greater equality. This means that women in violent far-left extremism participate more often than, e.g., women in violent far-right extremism, in political actions where violence is common. This pattern of gender roles and criminal involvement also holds concerning women in violent Islamic extremism. This milieu has a more traditional view of the role of women than views among even violent far-right extremists. Women in violent Islamic extremism are less involved in crime and, in particular, violent crime.


2021 ◽  
Vol 11 (6) ◽  
pp. 499
Author(s):  
Michele Finotti ◽  
Maurizio Romano ◽  
Pasquale Auricchio ◽  
Michele Scopelliti ◽  
Marco Brizzolari ◽  
...  

Non-alcoholic fatty liver disease represents an increasing cause of chronic hepatic disease in recent years. This condition usually arises in patients with multiple comorbidities, the so-called metabolic syndrome. The therapeutic options are multiple, ranging from lifestyle modifications, pharmacological options, to liver transplantation in selected cases. The choice of the most beneficial one and their interactions can be challenging. It is mandatory to stratify the patients according to the severity of their disease to tailor the available treatments. In our contribution, we review the most recent pharmacological target therapies, the role of bariatric surgery, and the impact of liver transplantation on the NAFLD outcome.


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