Browsing by Author "Arnold, Jorge"

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    Comparison Between Dynamic Models for Predicting Response to Corticosteroids in Alcohol-Associated Hepatitis: A Global Cohort Study
    (WILEY, 2025) Idalsoaga Ferrer, Francisco Javier; Díaz Piga, Luis Antonio; Guizzetti, Leonardo; Dunn, Winston; Mehta, Heer; Arnold, Jorge; Ayares Campos, Gustavo Ignacio; Mortuza, Rokhsana; Mahli, Gurpreet; Islam, Alvi H.; Sarin, Shiv K.; Maiwall, Rakhi; Zhang, Wei; Qian, Steve; Simonetto, Douglas; Singal, Ashwani K.; Elfeki, Mohamed A.; Ramirez-Cadiz, Carolina; Cabezas, Joaquin; Echavarria, Victor; Cots, Meritxell Ventura; La Tijera, Maria Fatima Higuera-De; Abraldes, Juan G.; Al-Karaghouli, Mustafa; Jalal, Prasun K.; Ali Ibrahim, Mohamad; Garcia-Tsao, Guadalupe; Goyes, Daniela; Skladany, Lubomir; Havaj, Daniel J.; Sulejova, Karolina; Selcanova, Svetlana Adamcova; Rincon, Diego; Shah, Vijay H.; Kamath, Patrick S.; Arrese, Marco; Bataller, Ramon; Arab, Juan Pablo
    Several dynamic models predict mortality and corticosteroid response in alcohol-associated hepatitis (AH), yet no consensus exists on the most effective model. This study aimed to assess predictive models for corticosteroid response and short-term mortality in severe AH within a global cohort. We conducted a multi-national study of patients with severe AH treated with corticosteroids for at least 7 days, enrolled between 2009 and 2019. Dynamic models-Lille-4, Lille-7, trajectory of serum bilirubin (TSB), and neutrophil-to-lymphocyte ratio (NLR)-were used to estimate 30- and 90-day mortality. Lille-7 demonstrated the highest accuracy for both 30- and 90-day mortality.
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    Development and validation of nonalcoholic fatty liver disease test: a simple sensitive and specific marker for early diagnosis of nonalcoholic fatty liver disease
    (2023) Omran, Mohamed; Omr, Mona; Mohamed, Amal A.; Abdelghafour, Reem A.; Muharram, Nashwa M.; Hassan, Mohamed B.; Fangry, Abobakrelsedik; Emran, Tarek; Arab, Juan P.; Arnold, Jorge; Diaz, Luis Antonio; Zheng, Ming-Hua; El-Kassas, Mohamed
    AimThis study aimed to develop a noninvasive test for identifying patients with nonalcoholic fatty liver disease (NAFLD) based on clinical and routine laboratory data. MethodsThe developed model 'NAFLD test' was compared to the most commonly used NAFLD scores and then validated in three groups of NAFLD patients from five centers in Egypt, China, and Chile. Patients were divided into the discovery cohort (n = 212) and the validation study (n = 859). The ROC curve and stepwise multivariate discriminant analysis were used to develop and validate the NAFLD test and evaluate its diagnostic performance, which was then compared to other NAFLD scores. ResultsElevated C-reactive protein (CRP), cholesterol, BMI, and alanine aminotransferase (ALT) levels were significantly associated with NAFLD (P < 0.0001). NAFLD test is depicted as (-0.695 + 0.031 x BMI + 0.003 x cholesterol + 0.014 x ALT + 0.025 x CRP) to discriminate patients with NAFLD from healthy individuals. The area under the ROC curve (AUC) of the NAFLD test was 0.92 [95% confidence interval (CI): 0.88-0.96]. The NAFLD test was the most accurate diagnostic indicator of NAFLD when compared to widely used NAFLD indices. Upon validating the NAFLD test, its AUC (95% CI) for distinguishing patients with NAFLD from healthy individuals was 0.95 (0.94-0.97), 0.90 (0.87-0.93), and 0.94 (0.91-0.97) in Egyptian, Chinese, and Chilean patients with NAFLD respectively. ConclusionThe NAFLD test is a new validated diagnostic biomarker that can be utilized for the early diagnosis of NAFLD with high diagnostic performance.
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    Effect of acute on chronic liver failure over post-transplant survival
    (2023) Benitez, Carlos; Arnold, Jorge; Cambindo, Veronica; Schoenfeldt, Fernanda; Cancino, Alejandra; Ibanez, Samuel; Grandy, Catalina; Hunfan, Paola; Gonzalez, Jorge; Guerra, Catalina; Godoy, Esteban; Araneda, Veronica; Mollo, Constanza; Poniachik, Jaime; Urzua, Alvaro; Cattaneo, Maximo; Roblero, Juan Pablo; Oppenheimer, Ilan; Pizarro, Vicente
    Introduction and Objectives: Acute-on-chronic liver failure (ACLF) is associated with reduced short-term sur-vival, and liver transplantation is frequently the only therapeutic option. Nonetheless, the post-transplanta-tion prognosis seems to be worse in ACLF patients.Materials and Methods: The databases of two university centers were retrospectively evaluated, and adult patients with cirrhosis who underwent transplantation between 2013 and 2020 were included. One-year survival of patients with ACLF was compared to that of patients without ACLF. Variables associated with mor-tality were identified.Results: A total of 428 patients were evaluated, and 303 met the inclusion criteria; 57.1% were male, the mean age was 57.1 +/- 10.2 years, 75 patients had ACLF, and 228 did not. The main etiologies of ACLF were NASH (36.6%), alcoholic liver disease (13.9%), primary biliary cholangitis (8.6%) and autoimmune hepatitis (7.9%). Mechanical ventilation, renal replacement therapy, the use of vasopressors and the requirement of blood product transfusion during liver transplantation were significantly more frequent in ACLF patients. Among those recipients without and with ACLF, survival at 1, 3 and 5 years was 91.2% vs. 74.7%, 89.1% vs. 72.6% and 88.3% vs. 72.6%, respectively (p=0.001). Among pre-transplantation variables, only the presence of ACLF was independently associated with survival (HR 3.2, 95% CI: 1.46-7.11). Post-transplantation variables indepen-dently associated with survival were renal replacement therapy (HR 2.8, 95% CI: 1.1-6.8) and fungal infec-tions (HR 3.26, 95% CI: 1.07-9.9).Conclusions: ACLF is an independent predictor of one-year post-transplantation survival. Importantly, trans-plant recipients with ACLF require the use of more resources than patients without ACLF. (c) 2023 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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    Identification of Optimal Therapeutic window for steroid use in severe alcohol associated Hepatitis: a worldwide study
    (2021) Arab, Juan Pablo; Díaz, Luis Antonio; Baeza, Natalia; Idalsoaga, Francisco; Fuentes-López, Eduardo; Arnold, Jorge; Ramírez, Carolina A.; Morales-Arraez, Dalia; Ventura-Cots, Meritxell; Alvarado-Tapias, Edilmar; Wei Zhang; Clark, Virginia; Simonetto, Douglas; Ahn, Joseph C.; Buryska, Seth; Mehta, Tej I.; Stefanescu, Horia; Horhat, Adelina; Bumbu, Andreea; Dunn, Winston
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    Metabolic subtypes of patients with NAFLD exhibit distinctive cardiovascular risk profiles
    (2022) Martinez-Arranz, Ibon; Bruzzone, Chiara; Noureddin, Mazen; Gil-Redondo, Ruben; Minchole, Itziar; Bizkarguenaga, Maider; Arretxe, Enara; Iruarrizaga-Lejarreta, Marta; Fernandez-Ramos, David; Lopitz-Otsoa, Fernando; Mayo, Rebeca; Embade, Nieves; Newberry, Elizabeth; Mittendorf, Bettina; Izquierdo-Sanchez, Laura; Smid, Vaclav; Arnold, Jorge; Iruzubieta, Paula; Perez Castano, Ylenia; Krawczyk, Marcin; Marigorta, Urko M.; Morrison, Martine C.; Kleemann, Robert; Martin-Duce, Antonio; Hayardeny, Liat; Vitek, Libor; Bruha, Radan; Aller de la Fuente, Rocio; Crespo, Javier; Romero-Gomez, Manuel; Banales, Jesus M.; Arrese, Marco; Cusi, Kenneth; Bugianesi, Elisabetta; Klein, Samuel; Lu, Shelly C.; Anstee, Quentin M.; Millet, Oscar; Davidson, Nicholas O.; Alonso, Cristina; Mato, Jose M.
    Background and Aims We previously identified subsets of patients with NAFLD with different metabolic phenotypes. Here we align metabolomic signatures with cardiovascular disease (CVD) and genetic risk factors. Approach and Results We analyzed serum metabolome from 1154 individuals with biopsy-proven NAFLD, and from four mouse models of NAFLD with impaired VLDL-triglyceride (TG) secretion, and one with normal VLDL-TG secretion. We identified three metabolic subtypes: A (47%), B (27%), and C (26%). Subtype A phenocopied the metabolome of mice with impaired VLDL-TG secretion; subtype C phenocopied the metabolome of mice with normal VLDL-TG; and subtype B showed an intermediate signature. The percent of patients with NASH and fibrosis was comparable among subtypes, although subtypes B and C exhibited higher liver enzymes. Serum VLDL-TG levels and secretion rate were lower among subtype A compared with subtypes B and C. Subtype A VLDL-TG and VLDL-apolipoprotein B concentrations were independent of steatosis, whereas subtypes B and C showed an association with these parameters. Serum TG, cholesterol, VLDL, small dense LDL5,6, and remnant lipoprotein cholesterol were lower among subtype A compared with subtypes B and C. The 10-year high risk of CVD, measured with the Framingham risk score, and the frequency of patatin-like phospholipase domain-containing protein 3 NAFLD risk allele were lower in subtype A. Conclusions Metabolomic signatures identify three NAFLD subgroups, independent of histological disease severity. These signatures align with known CVD and genetic risk factors, with subtype A exhibiting a lower CVD risk profile. This may account for the variation in hepatic versus cardiovascular outcomes, offering clinically relevant risk stratification.
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    Moderate alcohol-associated hepatitis: A real-world multicenter study
    (2025) Idalsoaga Ferrer, Francisco Javier; Diaz, Luis Antonio; Dunn, Winston; Mehta, Heer; Munoz, Karen; Caldentey, Vicente; Arnold, Jorge; Ayares, Gustavo; Mortuza, Rokhsana; Sarin, Shiv K.; Maiwall, Rakhi; Zhang, Wei; Qian, Steve; Simonetto, Douglas; Singal, Ashwani K.; Elfeki, Mohamed A.; Ramirez-Cadiz, Carolina; Malhi, Gurpreet; Ahmed, Adan; Homsi, Hoomam; Abid, Zinia; Cabezas, Joaquin; Echavarria, Victor; Poca, Maria; Soriano, German; Cuyas, Berta; Cots, Meritxell Ventura; Higuera-De La Tijera, Maria Fatima; Ayala-Valverde, Maria; Perez, Diego; Gomez, Jaime; Abraldes, Juan G.; Al-Karaghouli, Mustafa; Jalal, Prasun K.; Ibrahim, Mohamad A.; Garcia-Tsao, Guadalupe; Goyes, Daniela; Skladany, Lubomir; Havaj, Daniel J.; Sulejova, Karolina; Selcanova, Svetlana Adamcova; Rincon, Diego; Chacko, Kristina R.; Restrepo, Juan C.; Yaquich, Pamela; Toro, Luis G.; Shah, Vijay; Arrese Jiménez, Marco Antonio; Kamath, Patrick S.; Bataller, Ramon; Arab Verdugo, Juan Pablo
    Background: Severe alcohol-associated hepatitis (sAH) is a well-characterized disease with high short-term mortality. However, there is limited research on those with a "less severe condition" (moderate AH). This study aims to characterize in-depth patients with moderate AH (mAH), including the performance of mortality scoring systems, key prognostic factors, and survival over time. Methods:A multicenter retrospective cohort study (2009-2019) included patients with mAH (MELD score <= 20 at admission). Cox regression and receiver operating characteristic curves with AUC were used for analysis. Results:We included 1845 patients with AH (20 centers, 8 countries) between 2009 and 2019. mAH was defined as a MELD score <= 20 at admission. Twenty-four percent met the criteria for an mAH episode. Patients with mAH tend to be older and have a higher proportion of females, with a median MELD of 17 (15-19), Maddrey discriminant function (mDF) of 33 (22-40), the trajectory of serum bilirubin of 0.83 (0.60-1.21), and neutrophil-to-lymphocyte ratio (NLR) of 5 (2.96-8.60). The primary causes of death in mAH included multiple organ failure (34.1%) and infections (16.6%). The cumulative survival rates at 30, 90, and 180 days were 94.3%, 90.4%, and 88.2%, respectively. In multivariable analysis, age was the only significant predictor of 30-day mortality (HR 1.49, 95% CI: 1.27-1.76, p<0.001). Mortality prediction models showed poor performance, with AUC for MELD (0.671), mDF (0.726), trajectory of serum bilirubin (0.733), and NLR (0.697). Conclusions:Patients with moderate AH exhibited a mortality of 11.8% at 6 months, primarily driven by multiple organ failure and infections. These patients also exhibit a different clinical profile compared to those with sAH. Tailored models and therapeutic strategies are needed to improve long-term outcomes in mAH.
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    Moderate alcohol-associated hepatitis: A real-world multicenter study
    (Springer, 2025) Idalsoaga Ferrer, Francisco Javier; Diaz, Luis Antonio; Dunn, Winston; Mehta, Heer; Munoz, Karen; Caldentey, Vicente; Arnold, Jorge; Ayares, Gustavo; Mortuza, Rokhsana; Sarin, Shiv K.; Maiwall, Rakhi; Zhang, Wei; Qian, Steve; Simonetto, Douglas; Singal, Ashwani K.; Elfeki, Mohamed A.; Ramirez-Cadiz, Carolina; Malhi, Gurpreet; Ahmed, Adan; Homsi, Hoomam; Abid, Zinia; Cabezas, Joaquin; Echavarria, Victor; Poca, Maria; Soriano, German; Cuyas, Berta; Cots, Meritxell Ventura; Higuera-De La Tijera, Maria Fatima; Ayala-Valverde, Maria; Perez, Diego; Gomez, Jaime; Abraldes, Juan G.; Al-Karaghouli, Mustafa; Jalal, Prasun K.; Ibrahim, Mohamad A.; Garcia-Tsao, Guadalupe; Goyes, Daniela; Skladany, Lubomir; Havaj, Daniel J.; Sulejova, Karolina; Selcanova, Svetlana Adamcova; Rincon, Diego; Chacko, Kristina R.; Restrepo, Juan C.; Yaquich, Pamela; Toro, Luis G.; Shah, Vijay; Arrese Jiménez, Marco Antonio; Kamath, Patrick S.; Bataller, Ramon; Arab Verdugo, Juan Pablo
    Background: Severe alcohol-associated hepatitis (sAH) is a well-characterized disease with high short-term mortality. However, there is limited research on those with a "less severe condition" (moderate AH). This study aims to characterize in-depth patients with moderate AH (mAH), including the performance of mortality scoring systems, key prognostic factors, and survival over time. Methods:A multicenter retrospective cohort study (2009-2019) included patients with mAH (MELD score <= 20 at admission). Cox regression and receiver operating characteristic curves with AUC were used for analysis. Results:We included 1845 patients with AH (20 centers, 8 countries) between 2009 and 2019. mAH was defined as a MELD score <= 20 at admission. Twenty-four percent met the criteria for an mAH episode. Patients with mAH tend to be older and have a higher proportion of females, with a median MELD of 17 (15-19), Maddrey discriminant function (mDF) of 33 (22-40), the trajectory of serum bilirubin of 0.83 (0.60-1.21), and neutrophil-to-lymphocyte ratio (NLR) of 5 (2.96-8.60). The primary causes of death in mAH included multiple organ failure (34.1%) and infections (16.6%). The cumulative survival rates at 30, 90, and 180 days were 94.3%, 90.4%, and 88.2%, respectively. In multivariable analysis, age was the only significant predictor of 30-day mortality (HR 1.49, 95% CI: 1.27-1.76, p<0.001). Mortality prediction models showed poor performance, with AUC for MELD (0.671), mDF (0.726), trajectory of serum bilirubin (0.733), and NLR (0.697). Conclusions:Patients with moderate AH exhibited a mortality of 11.8% at 6 months, primarily driven by multiple organ failure and infections. These patients also exhibit a different clinical profile compared to those with sAH. Tailored models and therapeutic strategies are needed to improve long-term outcomes in mAH.
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    Prevalence of Helicobacter pylori Antimicrobial Resistance Among Chilean Patients
    (2021) Gonzalez-Hormazabal, Patricio; Arenas, Alex; Serrano, Carolina; Pizarro, Margarita; Fuentes-Lopez, Eduardo; Arnold, Jorge; Berger, Zoltan; Musleh, Maher; Valladares, Hector; Lanzarini, Enrique; Jara, Lilian; Castro, V. Gonzalo; Camargo, M. Constanza; Riquelme, Arnoldo
    Background. Treatments for Helicobacter pylori (H. pylori) eradication include the use of antibiotics and a proton-pump inhibitor. Antibiotic resistance is a major concern for two drugs: levofloxacin and clarithromycin. The aim was to determine the prevalence of levofloxacin resistance (LevoR) and clarithromycin resistance (ClaR) in an urban population in Santiago, Chile.
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    The Mortality Index for Alcohol-Associated Hepatitis: A Novel Prognostic Score
    (2022) Kezer, Camille A.; Buryska, Seth M.; Ahn, Joseph C.; Harmsen, William S.; Dunn, Winston; Singal, Ashwani K.; Arab, Juan P.; Diaz, Luis A.; Arnold, Jorge; Kamath, Patrick S.; Shah, Vijay H.; Simonetto, Douglas A.
    Objective: To develop a new scoring system that more accurately predicts 30-day mortality in patients with alcohol-associated hepatitis (AH).