Browsing by Author "Farias, Alberto Queiroz"

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    Genetic Ancestry, Race, and Severity of Acutely Decompensated Cirrhosis in Latin America
    (2023) Farias, Alberto Queiroz; Vilalta, Anna Curto; Zitelli, Patricia Momoyo; Pereira, Gustavo; Goncalves, Luciana L.; Torre, Aldo; Diaz, Juan Manuel; Gadano, Adrian C.; Mattos, Angelo Z.; Mendes, Liliana S. C.; Alvares-da-Silva, Mario R.; Bittencourt, Paulo L.; Benitez, Carlos; Couto, Claudia Alves; Mendizabal, Manuel; Toledo, Claudio L.; Mazo, Daniel F. C.; Barradas, Mauricio Castillo; Raposo, Eva M. Uson; Padilla-Machaca, P. Martin; Miranda, Adelina Zarela Lozano; Male-Velazquez, Rene; Lyra, Andre Castro; Davalos-Moscol, Milagros B.; Hernandez, Jose L. Perez; Ximenes, Rafael O.; Silva, Giovanni Faria; Beltran-Galvis, Oscar A.; Huezo, Maria S. Gonzalez; Bessone, Fernando; Rocha, Tarciso D. S.; Fassio, Eduardo; Terra, Carlos; Marin, Juan I.; Casas, Patricia Sierra; de la Pena-Ramirez, Carlos; Parera, Ferran Aguilar; Fernandes, Flavia; Zago-Gomes, Maria da Penha; Mendez-Guerrero, Osvely; Marciano, Sebastian; Mattos, Angelo A.; Oliveira, Joao C.; Guerreiro, Gabriel T. S.; Codes, Liana; Arrese, Marco; Nardelli, Mateus J.; Silva, Marcelo O.; Palma-Fernandez, Renato; Alcantara, Camila; Garrido, Cristina Sanchez; Trebicka, Jonel; Gustot, Thierry; Fernandez, Javier; Claria, Joan; Jalan, Rajiv; Angeli, Paolo; Arroyo, Vicente; Moreau, Richard; ACLARA Study Collaborators
    BACKGROUND & AIMS: Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (eg, 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 who were nonelectively admitted to 44 hospitals from 7 Latin American countries. RESULTS: Three hundred ninety-five patients (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had a 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 ACLF. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native American and a lower percentage of patients with ACLF than patients without ACLF were European American or African American. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% 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 acutely decompensated cirrhosis, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment.
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    Procedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study
    (2023) Intagliata, Nicolas M.; Rahimi, Robert S.; Higuera-de-la-Tijera, Fatima; Simonetto, Douglas A.; Farias, Alberto Queiroz; Mazo, Daniel F.; Boike, Justin R.; Stine, Jonathan G.; Serper, Marina; Pereira, Gustavo; Mattos, Angelo Z.; Marciano, Sebastian; Davis, Jessica P. E.; Benitez, Carlos; Chadha, Ryan; Mendez-Sanchez, Nahum; deLemos, Andrew S.; Mohanty, Arpan; Dirchwolf, Melisa; Fortune, Brett E.; Northup, Patrick G.; Patrie, James T.; Caldwell, Stephen H.
    BACKGROUND & AIMS: Hospitalized patients with cirrhosis frequently undergo multiple procedures. The risk of procedural-related bleeding remains unclear, and management is not standardized. We conducted an international, prospective, multicenter study of hospitalized patients with cirrhosis undergoing nonsurgical procedures to establish the incidence of procedural-related bleeding and to identify bleeding risk factors. METHODS: Hospitalized patients were prospectively enrolled and monitored until surgery, transplantation, death, or 28 days from admission. The study enrolled 1187 patients undergoing 3006 nonsurgical procedures from 20 centers. RESULTS: A total of 93 procedural-related bleeding events were identified. Bleeding was reported in 6.9% of patient admissions and in 3.0% of the procedures. Major bleeding was reported in 2.3% of patient admissions and in 0.9% of the procedures. Patients with bleeding were more likely to have nonalcoholic steatohepatitis (43.9% vs 30%) and higher body mass index (BMI; 31.2 vs 29.5). Patients with bleeding had a higher Model for End-Stage Liver Disease score at admission (24.5 vs 18.5). A multivariable analysis controlling for center variation found that high-risk procedures (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.44-8.84), Model for End Stage Liver Disease score (OR, 2.37; 95% CI, 1.46-3.86), and higher BMI (OR, 1.40; 95% CI, 1.10-1.80) independently predicted bleeding. Preprocedure international normalized ratio, platelet level, and antithrombotic use were not predictive of bleeding. Bleeding prophylaxis was used more routinely in patients with bleeding (19.4% vs 7.4%). Patients with bleeding had a significantly higher 28-day risk of death (hazard ratio, 6.91; 95% CI, 4.22-11.31). CONCLUSIONS: Procedural-related bleeding occurs rarely in hospitalized patients with cirrhosis. Patients with elevated BMI and decompensated liver disease who undergo high-risk procedures may be at risk to bleed. Bleeding is not associated with conventional hemostasis tests, preprocedure prophylaxis, or recent antithrombotic therapy.