Browsing by Author "Marciano, Sebastian"

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    A changing etiologic scenario in liver transplantation for hepatocellular carcinoma in a multicenter cohort study from Latin America
    (2018) Piñero, Federico; Costa, Paulo; Boteon, Yuri Longatto; Hoyos Duque, Sergio; Marciano, Sebastian; Anders, Margarita; Varon, Adriana; Zerega, Alina; Poniachik, Jaime; Soza, Alejandro; Padilla Machaca, Martin; Menendez, Josemaria; Zapata, Rodrigo; Vilatoba, Mario; Munoz, Linda; Maraschio, Martin; Podesta, Luis G.; McCormack, Lucas; Gadano, Adrian; Fatima Boin, Ilka S. F.; Garcia, Parente; Silva, Marcelo
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    An artificial intelligence-generated model predicts 90-day survival in alcohol-associated hepatitis: A global cohort study
    (2024) Dunn, Winston; Li, Yanming; Singal, Ashwani K.; Simonetto, Douglas A.; Díaz Piga, Luis Antonio; Idalsoaga Ferrer, Francisco Javier; Ayares, Gustavo; Arnold Alvaréz, Jorge Ignacio; Ayala-Valverde, Maria; Perez, Diego; Gomez, Jaime; Escarate, Rodrigo; Fuentes López, Eduardo; Ramirez-Cadiz, Carolina; Morales-Arraez, Dalia; Zhang, Wei; Qian, Steve; Ahn, Joseph C.; Buryska, Seth; Mehta, Heer; Dunn, Nicholas; Waleed, Muhammad; Stefanescu, Horia; Bumbu, Andreea; Horhat, Adelina; Attar, Bashar; Agrawal, Rohit; Cabezas, Joaquin; Echavaria, Victor; Cuyas, Berta; Poca, Maria; Soriano, German; Sarin, Shiv K.; Maiwall, Rakhi; Jalal, Prasun K.; Higuera-de-la-Tijera, Fatima; Kulkarni, Anand V.; Rao, P. Nagaraja; Guerra-Salazar, Patricia; Skladany, Lubomir; Kubanek, Natalia; Prado, Veronica; Clemente-Sanchez, Ana; Rincon, Diego; Haider, Tehseen; Chacko, Kristina R.; Romero, Gustavo A.; Pollarsky, Florencia D.; Restrepo, Juan C.; Toro, Luis G.; Yaquich, Pamela; Mendizabal, Manuel; Garrido, Maria L.; Marciano, Sebastian; Dirchwolf, Melisa; Vargas, Victor; Jimenez, Cesar; Hudson, David; Garcia-Tsao, Guadalupe; Ortiz, Guillermo; Abraldes, Juan G.; Kamath, Patrick S.; Arrese, Marco; Shah, Vijay H.; Bataller, Ramon; Arab, Juan P.
    Background and Aims: Alcohol-associated hepatitis (AH) poses significant short-term mortality. Existing prognostic models lack precision for 90-day mortality. Utilizing artificial intelligence in a global cohort, we sought to derive and validate an enhanced prognostic model. Approach and Results: The Global AlcHep initiative, a retrospective study across 23 centers in 12 countries, enrolled patients with AH per National Institute for Alcohol Abuse and Alcoholism criteria. Centers were partitioned into derivation (11 centers, 860 patients) and validation cohorts (12 centers, 859 patients). Focusing on 30 and 90-day postadmission mortality, 3 artificial intelligence algorithms (Random Forest, Gradient Boosting Machines, and eXtreme Gradient Boosting) informed an ensemble model, subsequently refined through Bayesian updating, integrating the derivation cohort's average 90-day mortality with each center's approximate mortality rate to produce posttest probabilities. The ALCoholic Hepatitis Artificial INtelligence Ensemble score integrated age, gender, cirrhosis, and 9 laboratory values, with center-specific mortality rates. Mortality was 18.7% (30 d) and 27.9% (90 d) in the derivation cohort versus 21.7% and 32.5% in the validation cohort. Validation cohort 30 and 90-day AUCs were 0.811 (0.779-0.844) and 0.799 (0.769-0.830), significantly surpassing legacy models like Maddrey's Discriminant Function, Model for End-Stage Liver Disease variations, age-serum bilirubin-international normalized ratio-serum Creatinine score, Glasgow, and modified Glasgow Scores (p < 0.001). ALCoholic Hepatitis Artificial INtelligence Ensemble score also showcased superior calibration against MELD and its variants. Steroid use improved 30-day survival for those with an ALCoholic Hepatitis Artificial INtelligence Ensemble score > 0.20 in both derivation and validation cohorts. Conclusions: Harnessing artificial intelligence within a global consortium, we pioneered a scoring system excelling over traditional models for 30 and 90-day AH mortality predictions. Beneficial for clinical trials, steroid therapy, and transplant indications, it's accessible at: https://aihepatology.shinyapps.io/ALCHAIN/.
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    Diagnostic performance of three non-invasive fibrosis scores (Hepamet, FIB-4, NAFLD fibrosis score) in NAFLD patients from a mixed Latin American population
    (2020) Zambrano-Huailla, Rommel; Guedes, Laura; Stefano, Jose Tadeu; de Souza, Arthur A. Arrais; Marciano, Sebastian; Yvamoto, Erika; Michalczuk, Matheus Truccolo; Vanni, Denise Siqueira; Rodriguez, Hernan; Carrilho, Flair Jose; Alvares-da-Silva, Mario Reis; Gadano, Adrian; Arrese, Marco; Miranda, Adelina Lozano; Oliveira, Claudia P.
    Introduction and aims: Several non-invasive scoring systems have been developed and validated worldwide to predict the risk of liver fibrosis in nonalcoholic fatty liver disease (NAFLD). However, information about the performance of these systems in Latin American populations is scarce. Our aim was to evaluate the performance of the Hepamet Fibrosis Score, Fibrosis-4 (FIB-4) and the NAFLD Fibrosis Score (NFS) in a mixed Latin American group of NAFLD patients.
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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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    Implementation of a re-linkage to care strategy in patients with chronic hepatitis C who were lost to follow-up in Latin America
    (2023) Mendizabal, Manuel; Thompson, Marcos; Gonzalez-Ballerga, Esteban; Anders, Margarita; Castro-Narro, Graciela E.; Pessoa, Mario G.; Cheinquer, Hugo; Mezzano, Gabriel; Palazzo, Ana; Ridruejo, Ezequiel; Descalzi, Valeria; Velarde-Ruiz Velasco, Jose A.; Marciano, Sebastian; Munoz, Linda; Schinoni, Maria, I; Poniachik, Jaime; Perazzo, Rosalia; Cerda, Eira; Fuster, Francisco; Varon, Adriana; Ruiz Garcia, Sandro; Soza, Alejandro; Cabrera, Cecilia; Gomez-Aldana, Andres J.; de Maria Beltran, Flor; Gerona, Solange; Cocozzella, Daniel; Bessone, Fernando; Hernandez, Nelia; Alonso, Cristina; Ferreiro, Melina; Antinucci, Florencia; Torre, Aldo; Moutinho, Bruna D.; Coelho Borges, Silvia; Gomez, Fernando; Dolores Murga, Maria; Pinero, Federico; Sotera, Gisela F.; Ocampo, Jhonier A.; Cortes Mollinedo, Valeria A.; Simian, Daniela; Silva, Marcelo O.
    To achieve WHO's goal of eliminating hepatitis C virus (HCV), innovative strategies must be designed to diagnose and treat more patients. Therefore, we aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to HCV care. We conducted an implementation study utilizing a strategy to contact patients with HCV who were not under regular follow-up in 13 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or equivalent. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined by anti-HCV+ and detectable HCV-RNA. Identified patients who were not under follow-up by a liver specialist were contacted by telephone or email, and offered a medical reevaluation. A total of 10,364 patients were classified to have HCV. After reviewing their medical charts, 1349 (13%) had undetectable HCV-RNA or were wrongly coded. Overall, 9015 (86.9%) individuals were identified with chronic HCV infection. A total of 5096 (56.5%) patients were under routine HCV care and 3919 (43.5%) had been LTFU. We were able to contact 1617 (41.3%) of the 3919 patients who were LTFU at the primary medical institution, of which 427 (26.4%) were cured at a different institutions or were dead. Of the remaining patients, 906 (76.1%) were candidates for retrieval. In our cohort, about one out of four patients with chronic HCV who were LTFU were candidates to receive treatment. This strategy has the potential to be effective, accessible and significantly impacts on the HCV care cascade.
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    Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease
    (2020) Pablo Arab, Juan; Dirchwolf, Melisa; Alvares-da-Silva, Mario Reis; Barrera, Francisco; Benitez, Carlos; Castellanos-Fernandez, Marlene; Castro-Narro, Graciela; Chavez-Tapia, Norberto; Chiodi, Daniela; Cotrim, Helma; Cusi, Kenneth; Marques Souza de Oliveira, Claudia Pinto; Diaz, Javier; Fassio, Eduardo; Gerona, Solange; Girala, Marcos; Hernandez, Nelia; Marciano, Sebastian; Masson, Walter; Mendez-Sanchez, Nahum; Leite, Nathalie; Lozano, Adelina; Padilla, Martin; Panduro, Arturo; Parana, Raymundo; Parise, Edison; Perez, Marlene; Poniachik, Jaime; Carlos Restrepo, Juan; Ruf, Andres; Silva, Marcelo; Tagle, Martin; Tapias, Monica; Torres, Kenia; Vilar-Gomez, Eduardo; Costa Gil, Jose Eduardo; Gadano, Adrian; Arrese, Marco
    Non-alcoholic fatty liver disease (NAFLD) currently represents an epidemic worldwide. NAFLD is the most frequently diagnosed chronic liver disease, affecting 20-30% of the general population. Furthermore, its prevalence is predicted to increase exponentially in the next decades, concomitantly with the global epidemic of obesity, type 2 diabetes mellitus (T2DM), and sedentary lifestyle. NAFLD is a clinical syndrome that encompasses a wide spectrum of associated diseases and hepatic complications such as hepatocellular carcinoma (HCC). Moreover, this disease is believed to become the main indication for liver transplantation in the near future. Since NAFLD management represents a growing challenge for primary care physicians, the Asociacion Latinoamericana para el Estudio del Higado (ALEH) has decided to organize this Practice Guidance for the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease, written by Latin-American specialists in different clinical areas, and destined to general practitioners, internal medicine specialists, endocrinologists, diabetologists, gastroenterologists, and hepatologists. The main purpose of this document is to improve patient care and awareness of NAFLD. The information provided in this guidance may also be useful in assisting stakeholders in the decision-making process related to NAFLD. Since new evidence is constantly emerging on different aspects of the disease, updates to this guideline will be required in future. (C) 2020 Published by Elsevier Espana, S.L.U. on behalf of Fundacion Cilnica Medica Sur, A.C.
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    Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region
    (2021) Pinero, Federico; Anders, Margarita; Boin, Ilka F.; Chagas, Aline; Quinonez, Emilio; Marciano, Sebastian; Vilatoba, Mario; Santos, Luisa; Hoyos Duque, Sergio; Lima, Agnaldo Soares; Menendez, Josemaria; Padilla, Martin; Poniachik, Jaime; Zapata, Rodrigo; Soza, Alejandro; Maraschio, Martin; Chong Menendez, Ricardo; Munoz, Linda; Arufe, Diego; Figueroa, Rodrigo; de Ataide, Elaine Cristina; Maccali, Claudia; Vergara Sandoval, Rodrigo; Bermudez, Carla; Podesta, Luis G.; McCormack, Lucas; Varon, Adriana; Gadano, Adrian; Mattera, Juan; Villamil, Federico; Rubinstein, Fernando; Carrilho, Flair; Silva, Marcelo
    This study aimed to compare liver transplantation (LT) outcomes and evaluate the potential rise in numbers of LT candidates with hepatocellular carcinoma (HCC) of different allocation policies in a high waitlist mortality region. Three policies were applied in two Latin American cohorts (1085 HCC transplanted patients and 917 listed patients for HCC): (i) Milan criteria with expansion according to UCSF downstaging (UCSF-DS), (ii) the AFP score, and (iii) restrictive policy or Double Eligibility Criteria (DEC; within Milan + AFP score <= 2). Increase in HCC patient numbers was evaluated in an Argentinian prospective validation set (INCUCAI; NCT03775863). Expansion criteria in policy A showed that UCSF-DS [28.4% (CI 12.8-56.2)] or "all-comers" [32.9% (CI 11.9-71.3)] had higher 5-year recurrence rates compared to Milan, with 10.9% increase in HCC patients for LT. The policy B showed lower recurrence rates for AFP scores <= 2 points, even expanding beyond Milan criteria, with a 3.3% increase. Patients within DEC had lower 5-year recurrence rates compared with those beyond DEC [13.3% (CI 10.1-17.3) vs 24.2% (CI 17.4-33.1; P = 0.0006], without significant HCC expansion. In conclusion, although the application of a stricter policy may optimize the selection process, this restrictive policy may lead to ethical concerns in organ allocation (NCT03775863).
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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.
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    Results of liver transplantation for hepatocellular carcinoma in a multicenter latin American cohort study
    (2018) Pinero, Federico; Costa, Paulo; Boteon, Yuri L.; Hoyos Duque, Sergio; Marciano, Sebastian; Anders, Margarita; Varón, Adriana; Zerega, Alina; Poniachik, Jaime; Soza, Alejandro; Padilla Machaca, Martín; Menéndez, Josemaría; Zapata, Rodrigo; Vilatoba, Mario; Muñoz, Linda; Maraschio, Martín; Fauda, Martín; McCormack, Lucas; Gadano, Adrian; Boin, Ilka SF; Parente García, Jose H.; Silva, Marcelo