Papers by gennaro d'amico
Liver International, 2006
Journal of Hepatology, 1991
Journal of Hepatology, 1991
Journal of Hepatology, 1987
In order to evaluate the reliability of the endoscopic assessment of variceal features, 6 skilled... more In order to evaluate the reliability of the endoscopic assessment of variceal features, 6 skilled endoscopists separately examined 28 patients with liver cirrhosis and varices. Definitions of variceal features were set up on the basis of the classification of the Japanese Research Society for Portal Hypertension. A new item, i.e. oesophageal lumen occupancy, and a semiquantitative rating system of endoscopic findings were introduced. Beyond chance agreement (Kappa index) was poor on the assessment of the extension of blue colour (0.33) and prevalence of cherry red spots or red weal marking (0.17) whereas was fair to good (0.40-0.66; P less than 10(-5)) on the following: location, size, lumen occupancy, presence of blue colour, presence and extension of red colour sign, haematocystic spot. We conclude that the endoscopic assessment of oesophageal varices based on these features is reliable; their prognostic value as predictors of bleeding risk should be prospectively assessed.
Journal of Hepatology, 2001
Journal of Hepatology, 2010
Background & Aims: The definition of failure to control bleeding agreed upon at the Baveno IV con... more Background & Aims: The definition of failure to control bleeding agreed upon at the Baveno IV consensus meeting, included the Adjusted Blood Requirement Index [ABRI: number of blood units/(final À initial hematocrit + 0.01)]. ABRI P0.75 denotes failure. However, timing for hematocrit measurements was not defined. The aims of this study were: (1) to assess the Baveno IV criteria performance to classify treatment success or failure to control bleeding at 5 days, (2) to determine the appropriate timing for hematocrit. Methods: Two hundred and forty-two cirrhotic patients with gastrointestinal bleeding were independently classified by three clinical experts according to the Baveno IV criteria, by analysis of the database of a randomized trial. ABRI was calculated by using the closest hematocrit to the 5 day time point from the first trial product administration (ABRI-1) or after the latest transfusion within the 5-day period (ABRI-2). The gold standard for success/failure for 5-day control of bleeding was the clinical judgment of the three independent observers based on all the clinical and follow-up data. Results: Inter-observer agreement for the final outcome assessment was 0.82 and a final consensus was obtained in 236/242 patients. Inter-observer agreement on patient classification with Baveno IV criteria was 0.70 with ABRI-1 and 0.84 with ABRI-2. c-statistics for correct patients classification were 0.86 for ABRI-1, 0.84 for ABRI-2, and 0.88 for Baveno IV criteria without ABRI. ABRI-1 caused misclassification of 27 patients and ABRI-2 of 39. Conclusions: Baveno IV criteria are accurate to assess outcome of patients with variceal bleeding. There is a substantial observer variability linked to timing of hematocrits for ABRI calculation. With the current definition ABRI does not add to the performance of the other criteria.
Digestive Diseases and Sciences, 1991
ABSTRACT
Clinical Transplantation, 2006
Clinical Transplantation, 2006
Hepatology International, 2017
The clinical course of cirrhosis has been typically described by a compensated and a decompensate... more The clinical course of cirrhosis has been typically described by a compensated and a decompensated state based on the absence or, respectively, presence of any of bleeding, ascites, encephalopathy or jaundice. More recently, it has been recognized that increasing portal hypertension and several major clinical events are followed by a marked worsening in prognosis and disease states have been proposed accordingly in a multistate model. The development of multistate models implies the assessment of the probabilities of more than one possible outcome from each disease state. This requires the use of competing risks analysis which investigates the risk of several competing outcomes. In such a situation the Kaplan Meier risk estimates and the Cox regression may be not appropriate. Clinical states of cirrhosis presently considered as suitable for a comprehensive multistate model include, in compensated cirrhosis: early (mild) portal hypertension with hepatic venous pressure gradient (HVPG) >5 and <10 mmHg, clinically significant portal hypertension (HVPG ≥10 mmHg) without gastro-esophageal varices (GEV), and GEV; in decompensated cirrhosis: a first variceal bleeding without other decompensating events, any first non bleeding decompensation and any second decompensating event; in a late decompensation state, refractory ascites, sepsis, renal failure, recurrent encephalopathy, profound jaundice, acute on chronic liver failure, may occur, all predicting a very short survival. In this review we illustrate how competing risks analysis and multistate models may be applied to cirrhosis. New concepts on cirrhosis stratification Hepatology International Jan 2017 Pag. 3 di 28
Journal of Hepatology, 2018
Digestive and Liver Disease, 2017
Statement 1.7 Doppler-US follow up surveillance should not be routinely performed in properly pla... more Statement 1.7 Doppler-US follow up surveillance should not be routinely performed in properly placed ePTFE-covered stents (4, C) [35-39]. Votation 1.7: Votes in Favour: 87%. Comment: A single evaluation within the first 7 days should be performed when bare metal stents are implanted, technical difficulties occurred or in case of incomplete clinical response. The evaluation of flow direction in the intrahepatic portal vein branches is a reliable qualitative indicator of TIPS malfunction [35,36,38,39]. 1.8-11. Sedation and patient monitoring Statement 1.8 Monitored anesthesia care (MAC) should be administered by an anaesthesiologist (4, C) [40]. Votation 1.8: Votes in Favour: 100% Statement 1.9 Monitored anesthesia care (MAC) and moderate sedation should be adopted as routine procedures during TIPS (4, C) [24]. Votation 1.9: Votes in Favour: 96% Statement 1.10 Propofol and remifentanil, which enable a fast recovery after sedation in cirrhotic patients, represent the first choices for sedation or GA (2b, B) [41-44].
Variceal Hemorrhage, 2014
Journal of Hepatology, 2005
Journal of Hepatology, 2014
Hepatology, 2003
Several treatments have been proven to be effective for variceal bleeding in patients with cirrho... more Several treatments have been proven to be effective for variceal bleeding in patients with cirrhosis. The aim of this multicenter, prospective, cohort study was to assess how these treatments are used in clinical practice and what are the posttherapeutic prognosis and prognostic indicators of upper digestive bleeding in patients with cirrhosis. A training set of 291 and a test set of 174 bleeding cirrhotic patients were included. Treatment was according to the preferences of each center and the follow-up period was 6 weeks. Predictive rules for 5-day failure (uncontrolled bleeding, rebleeding, or death) and 6-week mortality were developed by the logistic model in the training set and validated in the test set. Initial treatment controlled bleeding in 90% of patients, including vasoactive drugs in 27%, endoscopic therapy in 10%, combined (endoscopic and vasoactive) in 45%, balloon tamponade alone in 1%, and none in 17%. The 5-day failure rate was 13%, 6-week rebleeding was 17%, and mortality was 20%. Corresponding findings for variceal versus nonvariceal bleeding were 15% versus 7% (P ؍ .034), 19% versus 10% (P ؍ .019), and 20% versus 15% (P ؍ .22). Active bleeding on endoscopy, hematocrit levels, aminotransferase levels, Child-Pugh class, and portal vein thrombosis were significant predictors of 5-day failure; alcohol-induced etiology, bilirubin, albumin, encephalopathy, and hepatocarcinoma were predictors of 6-week mortality. Prognostic reassessment including blood transfusions improved the predictive accuracy. All the developed prognostic models were superior to the Child-Pugh score. In conclusion, prognosis of digestive bleeding in cirrhosis has much improved over the past 2 decades. Initial treatment stops bleeding in 90% of patients. Accurate predictive rules are provided for early recognition of high-risk patients. (HEPATOLOGY 2003;38:599-612.) Patients and Methods Patients. Thirty centers uniformly distributed throughout Italy participated in the study. All the cirrhotic pa-Abbreviation: PI, prognostic index.
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Papers by gennaro d'amico