487. Experience with Remdesivir for Treatment of SARS-CoV-2 in Patients with Liver Cirrhosis

Abstract Background Remdesivir is a nucleotide analogue antiviral that was FDA approved for the treatment of hospitalized patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Remdesivir has been associated with elevations in serum aminotransferase levels but most cases being mild to moderate and reversible upon discontinuation. Although national COVID-19 guidelines and the American Association for the Study of Liver Diseases (AASLD) currently recommend remdesivir for use in hospitalized patients requiring supplemental oxygen, data is limited using remdesivir in patients with chronic liver disease. Here, we describe our experience with remdesivir in patients with liver cirrhosis. Methods Patients with liver cirrhosis who received remdesivir were identified either prospectively or retrospectively by primary or secondary ICD-10 codes indicating liver disease. Data collected included patient demographics, underlying cause of cirrhosis, co-morbidities, Child-Pugh score, laboratory values (serum aminotransferase levels, serum creatinine) during and following remdesivir, adverse reactions attributed to remdesivir, and mortality (in-hospital, 30-day, and 90-day). Results A total of 4 patients with underlying liver cirrhosis completed a 5-day course of remdesivir treatment. On admission, Child-Pugh class was A for 1 patient, B for 2 patients, and C for 1 patient. Causes for cirrhosis were nonalcoholic steatohepatitis (NASH), hepatic amyloidosis, and chronic hepatitis B. There were no acute elevations in aminotransferase levels or adverse events attributed to remdesivir therapy. Mortality was high with 50% in-hospital mortality. Of the 2 other patients who survived to discharge, one was discharged to home hospice and the other was readmitted within 30 days and expired during that admission. Conclusion Since there is limited data available using remdesivir in patients with advanced liver disease, we did not identify any safety concerns related to remdesivir in our cirrhotic patients. Mortality was high illustrating the poor outcomes of patients with advanced liver disease and COVID-19. Patients with cirrhosis should be offered remdesivir if clinically appropriate. Disclosures All Authors: No reported disclosures

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Patterns of dendritic cell and monocyte subsets are associated with disease severity and mortality in liver cirrhosis patients

Scientific Reports ◽

10.1038/s41598-021-85148-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chandra Chiappin Cardoso ◽

Camila Matiollo ◽

Carolina Hilgert Jacobsen Pereira ◽

Janaina Santana Fonseca ◽

Helder Emmanuel Leite Alves ◽

...

Keyword(s):

Dendritic Cells ◽

Liver Cirrhosis ◽

Liver Disease ◽

Dendritic Cell ◽

Disease Severity ◽

Advanced Liver Disease ◽

Hla Dr ◽

Acute Decompensation ◽

Cirrhotic Patients ◽

Classical Monocytes

AbstractLiver cirrhosis is often complicated by an immunological imbalance known as cirrhosis-associated immune dysfunction. This study aimed to investigate disturbances in circulating monocytes and dendritic cells in patients with acute decompensation (AD) of cirrhosis. The sample included 39 adult cirrhotic patients hospitalized for AD, 29 patients with stable cirrhosis (SC), and 30 healthy controls (CTR). Flow cytometry was used to analyze monocyte and dendritic cell subsets in whole blood and quantify cytokines in plasma samples. Cirrhotic groups showed higher frequencies of intermediate monocytes (iMo) than CTR. AD patients had lower percentages of nonclassical monocytes than CTR and SC. Cirrhotic patients had a profound reduction in absolute and relative dendritic cell numbers compared with CTR and showed higher plasmacytoid/classical dendritic cell ratios. Increased plasma levels of IL-6, IL-10, and IL-17A, elevated percentages of CD62L+ monocytes, and reduced HLA-DR expression on classical monocytes (cMo) were also observed in cirrhotic patients. Patients with more advanced liver disease showed increased cMo and reduced tissue macrophages (TiMas) frequencies. It was found that cMo percentages greater than 90.0% within the monocyte compartment and iMo and TiMas percentages lower than 5.7% and 8.6%, respectively, were associated with increased 90-day mortality. Monocytes and dendritic cells are deeply altered in cirrhotic patients, and subset profiles differ between stable and advanced liver disease. High cMo and low TiMas frequencies may be useful biomarkers of disease severity and mortality in liver cirrhosis.

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Incidence and Predictors of 30-day Readmission in Hospitalized Patients with Advanced Liver Disease

The American Journal of Gastroenterology ◽

10.14309/00000434-200910003-01133 ◽

2009 ◽

Vol 104 ◽

pp. S417

Author(s):

Sweta Tandra ◽

Kenneth Berman ◽

Raj Vuppalanchi ◽

Devonne Mullis ◽

Marco Lacerda ◽

...

Keyword(s):

Liver Disease ◽

Hospitalized Patients ◽

Advanced Liver Disease

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A pilot study of an alcoholic liver disease recurrence prevention education program in hospitalized patients with advanced liver disease

Addictive Behaviors ◽

10.1016/j.addbeh.2004.06.016 ◽

2005 ◽

Vol 30 (3) ◽

pp. 465-473 ◽

Cited By ~ 3

Author(s):

Steve Sussman ◽

Bruce A. Runyon ◽

Rosendo Hernandez ◽

Maria Magallanes ◽

Michel Mendler ◽

...

Keyword(s):

Liver Disease ◽

Pilot Study ◽

Alcoholic Liver Disease ◽

Education Program ◽

Disease Recurrence ◽

Hospitalized Patients ◽

Advanced Liver Disease ◽

Prevention Education ◽

Recurrence Prevention

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Hepatitis C virus RNA quantitation in hepatic veins and peripheral blood in patients with liver cirrhosis: evidence for low level intrahepatic hepatitis C virus replication in advanced liver disease

Digestive and Liver Disease ◽

10.1016/s1590-8658(02)80074-3 ◽

2002 ◽

Vol 34 (11) ◽

pp. 802-807 ◽

Cited By ~ 3

Author(s):

C. Puoti ◽

R. Castellacci ◽

L. Bellis ◽

F. Montagnese ◽

P. Corvisieri ◽

...

Keyword(s):

Liver Cirrhosis ◽

Hepatitis C Virus ◽

Liver Disease ◽

Hepatitis C ◽

Virus Replication ◽

Peripheral Blood ◽

Hepatic Veins ◽

Hepatitis C Virus Rna ◽

Advanced Liver Disease ◽

Virus Rna

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Changes in Etiologies of Hospitalized Patients with Liver Cirrhosis in Beijing 302 Hospital from 2002 to 2013

Mediators of Inflammation ◽

10.1155/2017/5605981 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Binxia Chang ◽

Baosen Li ◽

Ying Sun ◽

Guangju Teng ◽

Ang Huang ◽

...

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Alcoholic Cirrhosis ◽

Hospitalized Patients ◽

Autoimmune Liver Disease ◽

Drug Induced ◽

Nonalcoholic Fatty Liver ◽

Drug Induced Liver Injury ◽

Hbv Vaccination ◽

Cirrhotic Patients

Background. Over the last 20 years, the prevalence of hepatitis B virus (HBV) infection in China has decreased gradually due to the application of a national HBV vaccination program. In contrast, the prevalence of alcoholic liver disease (ALD), nonalcoholic fatty liver disease, autoimmune liver disease, and drug-induced liver injury has markedly increased. Methods. We conducted a retrospective review of 82,562 hospitalized patients diagnosed with liver cirrhosis in Beijing 302 Hospital from 2002 to 2013. Results. The top four etiologies of cirrhosis were HBV, HCV, ALD, and autoimmune liver disease. The percentage of HBV cirrhosis decreased from 81.53% in 2002 to 66.0% in 2013, whereas the frequency of alcoholic cirrhosis increased from 3.34% in 2002 to 8.40% in 2013. Females (84.34%) accounted for the majority of cirrhotic patients with autoimmune liver diseases. Males accounted for 80.16% of HBV cirrhosis patients and 98.02% of alcoholic cirrhosis patients. Conclusion. In Beijing 302 Hospital, the top four etiologies of cirrhosis were HBV, HCV, ALD, and autoimmune liver disease. Over the last 12 years, the prevalence of HBV cirrhosis has decreased gradually, whereas that of alcoholic cirrhosis has increased significantly.

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Determinants of Morbidity and Mortality Associated With Isolated Tricuspid Valve Surgery

Journal of the American Heart Association ◽

10.1161/jaha.120.018417 ◽

2021 ◽

Author(s):

Akram Kawsara ◽

Fahad Alqahtani ◽

Vuyisile T. Nkomo ◽

Mackram F. Eleid ◽

Sorin V. Pislaru ◽

...

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Liver Disease ◽

Tricuspid Valve ◽

Valve Surgery ◽

Advanced Liver Disease ◽

The Poor ◽

Tricuspid Valve Surgery ◽

Poor Outcomes ◽

Late Referral

Background Whether the poor outcomes of isolated tricuspid valve surgery are related to the operation itself or to certain patient characteristics including late referral is unknown. Methods and Results Adult patients who underwent isolated tricuspid valve surgery were identified in the Nationwide Readmissions Database (2016–2017). Patients who had redo tricuspid valve surgery, endocarditis, or congenital heart disease were excluded. Multivariable logistic regression was performed to identify contributors to postoperative mortality. A total of 1513 patients were included (mean age 55.7±16.6 years, 49.6% women). Surrogates of late referral were frequent: 41% of patients were admitted with decompensated heart failure, 44.3% had a nonelective surgery status, 16.8% had advanced liver disease, and 31% had an unplanned hospitalization in the prior 90 days. The operation was performed on day 0 to 1 of the hospitalization in only 50% of patients, and beyond day 10 in 22% of patients. In‐hospital mortality occurred in 8.7% of patients. Median length of stay was 14 days (7–35 days), and median cost was $87 223 ($43 122–$200 872). In multivariable logistic regression analysis, surrogates for late referrals (acute heart failure decompensation, nonelective surgery status, or advanced liver disease) were the strongest predictors of in‐hospital mortality (odds ratio [OR], 4.75; 95% CI, 2.74–8.25 [ P <0.001]). This was also consistent in a second model incorporating unplanned hospitalizations in the 90 days before surgery as a surrogate for late referral (OR, 5.50; 95% CI, 2.28–10.71 [ P <0.001]). Conclusions The poor outcomes of isolated tricuspid valve surgery may be largely explained by the late referral for intervention. Studies are needed to determine the role of early intervention for severe isolated tricuspid regurgitation.

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Serum Squamous Cell Carcinoma Antigen-Immunoglobulin M complex levels predict survival in patients with cirrhosis

Scientific Reports ◽

10.1038/s41598-019-56633-2 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Marco Cagnin ◽

Alessandra Biasiolo ◽

Andrea Martini ◽

Mariagrazia Ruvoletto ◽

Santina Quarta ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Squamous Cell Carcinoma ◽

Liver Cirrhosis ◽

Liver Disease ◽

Cell Carcinoma ◽

Squamous Cell ◽

Immunoglobulin M ◽

Squamous Cell Carcinoma Antigen ◽

Advanced Liver Disease

AbstractComplications of chronic liver diseases – particularly hepatocellular carcinoma (HCC) – are a major cause of mortality worldwide. Several studies have shown that high or increasing levels of serum Squamous Cell Carcinoma Antigen-Immunoglobulin M complex (SCCA-IgM) are associated with development of HCC in patients with advanced liver disease and worse survival in patients with liver cancer. The aim of the present study was to assess, in patients with advanced liver disease, differences in long-term clinical outcomes in relation to baseline levels of serum SCCA-IgM. Ninety one consecutive outpatients with liver cirrhosis of different etiologies, without hepatocellular carcinoma at presentation, were enrolled from April 2007 to October 2012 in a prospective study. For a median time of 127 months, patients were bi-annually re-evaluated. SCCA-IgM complex levels were determined with a validated enzyme-linked immunosorbent assay. The results provided evidence that serum SCCA-IgM is a predictor of overall survival. The best cut-off to discriminate both HCC-free and overall survival rates was 120 AU/mL. Patients with baseline values higher than this threshold showed a substantial increase in both HCC incidence rate and all-cause mortality rate. In conclusion, a single measurement of serum SCCA-IgM helps to identify those patients with liver cirrhosis with increased risks of HCC development and mortality.

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M1709 Low Total Cholesterol Levels At First Decompensation of Liver Cirrhosis Are Associated with Advanced Liver Disease and Predict Higher Mortality At Hospital Admission and At 1 Year

Gastroenterology ◽

10.1016/s0016-5085(09)61909-0 ◽

2009 ◽

Vol 136 (5) ◽

pp. A-415

Author(s):

Carlos Noronha Ferreira ◽

Teresa Rodrigues ◽

Helena Cortez-Pinto ◽

Fatima Serejo ◽

Fernando Ramalho ◽

...

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Hospital Admission ◽

Total Cholesterol ◽

Advanced Liver Disease ◽

Cholesterol Levels

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Liver function following hepatitis C virus eradication by direct acting antivirals in patients with liver cirrhosis: data from the PITER cohort

BMC Infectious Diseases ◽

10.1186/s12879-021-06053-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maria Giovanna Quaranta ◽

Luigina Ferrigno ◽

Xhimi Tata ◽

Franca D’Angelo ◽

Carmine Coppola ◽

...

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Liver Function ◽

Previous History ◽

Direct Acting Antivirals ◽

Advanced Liver Disease ◽

Cox Regression Analysis ◽

Viral Eradication ◽

Direct Acting

Abstract Background The development of direct-acting antivirals (DAA) for HCV has revolutionized the treatment of HCV, including its treatment in patients with HIV coinfection. The aim of this study was to compare the changes in liver function between coinfected and monoinfected patients with cirrhosis who achieved HCV eradication by DAA. Methods Patients with pre-treatment diagnosis of HCV liver cirrhosis, consecutively enrolled in the multicenter PITER cohort, who achieved a sustained virological response 12 weeks after treatment cessation (SVR12) were analysed. Changes in Child-Pugh (C-P) class and the occurrence of a decompensating event was prospectively evaluated after the end of DAA treatment. Cox regression analysis was used to evaluate factors independently associated with changes in liver function following viral eradication. Results We evaluated 1350 patients, of whom 1242 HCV monoinfected (median follow-up 24.7, range 6.8–47.5 months after viral eradication) and 108 (8%) HCV/HIV coinfected (median follow-up 27.1, range 6.0–44.6). After adjusting for age, sex, HCV-genotype, HBsAg positivity and alcohol use, HIV was independently associated with a more advanced liver disease before treatment (C-P class B/C vs A) (OR: 3.73, 95% CI:2.00–6.98). Following HCV eradication, C-P class improved in 17/20 (85%) coinfected patients (from B to A and from C to B) and in 53/82 (64.6%) monoinfected patients (from B to A) (p = 0.08). C-P class worsened in 3/56 coinfected (5.3%) (from A to B) and in 84/1024 (8.2%) monoinfected patients (p = 0.45) (from A to B or C and from B to C). Baseline factors independently associated with C-P class worsening were male sex (HR = 2.00; 95% CI = 1.18–3.36), platelet count < 100,000/μl (HR = 1.75; 95% CI 1.08–2.85) and increased INR (HR = 2.41; 95% CI 1.51–3.84). Following viral eradication, in 7 of 15 coinfected (46.6%) and in 61 of 133 (45.8%) monoinfected patients with previous history of decompensation, a new decompensating event occurred. A first decompensating event was recorded in 4 of 93 (4.3%) coinfected and in 53 of 1109 (4.8%) monoinfected patients (p = 0.83). Conclusions Improvement of liver function was observed following HCV eradication in the majority of patients with cirrhosis; however viral eradication did not always mean cure of liver disease in both monoinfected and coinfected patients with advanced liver disease.

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