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Implications of anaemia and response to anaemia treatment on outcomes in patients with cirrhosis

BACKGROUND & AIMS: Anaemia is frequently observed in patients with cirrhosis and was identified as a predictor of adverse outcomes, such as increased mortality and occurrence of acute-on-chronic liver failure. To date, the possible effects of iron supplementation on these adverse outcomes are no...

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Autores principales: Rashidi-Alavijeh, Jassin, Nuruzade, Nargiz, Frey, Alexandra, Huessler, Eva-Maria, Hörster, Anne, Zeller, Amos Cornelius, Schütte, Andreas, Schmidt, Hartmut, Willuweit, Katharina, Lange, Christian Markus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10011825/
https://www.ncbi.nlm.nih.gov/pubmed/36926273
http://dx.doi.org/10.1016/j.jhepr.2023.100688
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author Rashidi-Alavijeh, Jassin
Nuruzade, Nargiz
Frey, Alexandra
Huessler, Eva-Maria
Hörster, Anne
Zeller, Amos Cornelius
Schütte, Andreas
Schmidt, Hartmut
Willuweit, Katharina
Lange, Christian Markus
author_facet Rashidi-Alavijeh, Jassin
Nuruzade, Nargiz
Frey, Alexandra
Huessler, Eva-Maria
Hörster, Anne
Zeller, Amos Cornelius
Schütte, Andreas
Schmidt, Hartmut
Willuweit, Katharina
Lange, Christian Markus
author_sort Rashidi-Alavijeh, Jassin
collection PubMed
description BACKGROUND & AIMS: Anaemia is frequently observed in patients with cirrhosis and was identified as a predictor of adverse outcomes, such as increased mortality and occurrence of acute-on-chronic liver failure. To date, the possible effects of iron supplementation on these adverse outcomes are not well described. We therefore aimed to assess the role of iron supplementation in patients with cirrhosis and its capability to improve prognosis. METHODS: Laboratory diagnostics were performed in consecutive outpatients with cirrhosis admitted between July 2018 and December 2019 to the University Hospital Essen. Associations with transplant-free survival were assessed in regression models. RESULTS: A total of 317 outpatients with cirrhosis were included, of whom 61 received a liver transplant (n = 19) or died (n = 42). In multivariate Cox regression analysis, male sex (hazard ratio [HR] = 3.33, 95% CI [1.59, 6.99], p = 0.001), model for end-stage liver disease score (HR = 1.19, 95% CI [1.11, 1.27], p <0.001) and the increase of haemoglobin levels within 6 months (ΔHb6) (HR = 0.72, 95% CI [0.63, 0.83], p <0.001) were associated with transplant-free survival. Regarding the prediction of haemoglobin increase, intake of rifaximin (beta = 0.50, SD beta = 0.19, p = 0.007) and iron supplementation (beta = 0.79, SD beta = 0.26, p = 0.003) were significant predictors in multivariate analysis. CONCLUSIONS: An increase of haemoglobin levels is associated with improvement of transplant-free survival in patients with cirrhosis. Because the prediction of haemoglobin increase significantly depends on rifaximin and iron supplementation, application of these two medications can have an important impact on the outcome of these patients. IMPACT AND IMPLICATIONS: Anaemia is very common in patients with cirrhosis and is known to be a predictor of negative outcomes, but little is known about the effect of iron substitution in these individuals. In our cohort, increase of haemoglobin levels improved transplant-free survival of patients with cirrhosis. The increase of haemoglobin levels was mainly induced by iron supplementation and was even stronger in the case of concomitant use of iron and rifaximin. CLINICAL TRIAL REGISTRATION: UME-ID-10042.
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spelling pubmed-100118252023-03-15 Implications of anaemia and response to anaemia treatment on outcomes in patients with cirrhosis Rashidi-Alavijeh, Jassin Nuruzade, Nargiz Frey, Alexandra Huessler, Eva-Maria Hörster, Anne Zeller, Amos Cornelius Schütte, Andreas Schmidt, Hartmut Willuweit, Katharina Lange, Christian Markus JHEP Rep Research Article BACKGROUND & AIMS: Anaemia is frequently observed in patients with cirrhosis and was identified as a predictor of adverse outcomes, such as increased mortality and occurrence of acute-on-chronic liver failure. To date, the possible effects of iron supplementation on these adverse outcomes are not well described. We therefore aimed to assess the role of iron supplementation in patients with cirrhosis and its capability to improve prognosis. METHODS: Laboratory diagnostics were performed in consecutive outpatients with cirrhosis admitted between July 2018 and December 2019 to the University Hospital Essen. Associations with transplant-free survival were assessed in regression models. RESULTS: A total of 317 outpatients with cirrhosis were included, of whom 61 received a liver transplant (n = 19) or died (n = 42). In multivariate Cox regression analysis, male sex (hazard ratio [HR] = 3.33, 95% CI [1.59, 6.99], p = 0.001), model for end-stage liver disease score (HR = 1.19, 95% CI [1.11, 1.27], p <0.001) and the increase of haemoglobin levels within 6 months (ΔHb6) (HR = 0.72, 95% CI [0.63, 0.83], p <0.001) were associated with transplant-free survival. Regarding the prediction of haemoglobin increase, intake of rifaximin (beta = 0.50, SD beta = 0.19, p = 0.007) and iron supplementation (beta = 0.79, SD beta = 0.26, p = 0.003) were significant predictors in multivariate analysis. CONCLUSIONS: An increase of haemoglobin levels is associated with improvement of transplant-free survival in patients with cirrhosis. Because the prediction of haemoglobin increase significantly depends on rifaximin and iron supplementation, application of these two medications can have an important impact on the outcome of these patients. IMPACT AND IMPLICATIONS: Anaemia is very common in patients with cirrhosis and is known to be a predictor of negative outcomes, but little is known about the effect of iron substitution in these individuals. In our cohort, increase of haemoglobin levels improved transplant-free survival of patients with cirrhosis. The increase of haemoglobin levels was mainly induced by iron supplementation and was even stronger in the case of concomitant use of iron and rifaximin. CLINICAL TRIAL REGISTRATION: UME-ID-10042. Elsevier 2023-01-28 /pmc/articles/PMC10011825/ /pubmed/36926273 http://dx.doi.org/10.1016/j.jhepr.2023.100688 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Article
Rashidi-Alavijeh, Jassin
Nuruzade, Nargiz
Frey, Alexandra
Huessler, Eva-Maria
Hörster, Anne
Zeller, Amos Cornelius
Schütte, Andreas
Schmidt, Hartmut
Willuweit, Katharina
Lange, Christian Markus
Implications of anaemia and response to anaemia treatment on outcomes in patients with cirrhosis
title Implications of anaemia and response to anaemia treatment on outcomes in patients with cirrhosis
title_full Implications of anaemia and response to anaemia treatment on outcomes in patients with cirrhosis
title_fullStr Implications of anaemia and response to anaemia treatment on outcomes in patients with cirrhosis
title_full_unstemmed Implications of anaemia and response to anaemia treatment on outcomes in patients with cirrhosis
title_short Implications of anaemia and response to anaemia treatment on outcomes in patients with cirrhosis
title_sort implications of anaemia and response to anaemia treatment on outcomes in patients with cirrhosis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10011825/
https://www.ncbi.nlm.nih.gov/pubmed/36926273
http://dx.doi.org/10.1016/j.jhepr.2023.100688
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