Publications by authors named "Silvia Nardelli"

Article Synopsis
  • Type-2 diabetes often coexists with cirrhosis, negatively impacting complications and mortality rates among patients.
  • A study analyzing data from the ANSWER trial focused on 85 patients receiving long-term human albumin (HA) in addition to standard treatment, revealing improved survival rates (86% vs. 57%) and fewer complications.
  • The HA group experienced fewer instances of complications like infections and renal issues, although overall hospital admissions were similar between groups, with shorter hospital stays for those receiving HA.
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  • Minimal hepatic encephalopathy (MHE) is linked to a greater risk of overt hepatic encephalopathy (OHE) as measured by the portosystemic hepatic encephalopathy score (PHES).
  • A multicenter study followed patients with MHE to see if worse PHES results led to a progressively higher risk of developing OHE.
  • Findings showed that while abnormal PHES indicates a higher chance of OHE, there isn't a stepwise increase in risk as PHES scores worsen beyond a certain threshold.
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Hepatic encephalopathy (HE) is a common complication of advanced liver disease and acute liver failure. It is a condition that features several neuropsychiatric symptoms that affect mortality, morbidity and the quality of patients' and caregivers' lives. An HE diagnosis is generally an exclusion diagnosis.

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  • The study investigates the mortality rates in patients who experience overt hepatic encephalopathy (OHE) after undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement, comparing them to those who do not develop OHE.
  • Out of 614 patients analyzed over 30 months, 293 developed OHE, but the mortality rate difference between those with and without OHE was not significant, suggesting OHE may not directly impact survival outcomes.
  • Factors like age and MELD score were found to be more strongly associated with higher mortality than the occurrence of OHE itself.
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Malnutrition is a tangible complication of cirrhosis with portal hypertension with a prevalence of up to 50%. In particular, sarcopenia and myosteatosis, defined as the alteration in muscle quantity and quality, have a negative impact on the main complications of liver disease and are associated with higher mortality in patients with cirrhosis. Recently, alterations in adipose tissue have also been described in cirrhotic patients and they seem to influence the course of liver disease.

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Background And Aims: Minimal hepatic encephalopathy (MHE) is a frequent complication in patients with liver cirrhosis. Its impact on predicting the development of overt hepatic encephalopathy (OHE) and survival has not been studied in large multicenter studies.

Methods: Data from patients recruited at eight centers across Europe and the United States were analyzed.

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Background: Porto-sinusoidal vascular disorder (PSVD) is characterised by lesions involving portal veins and sinusoids in absence of cirrhosis with an unclear pathophysiology. However, its association with immunodeficiency, bowel disorders and abdominal bacterial infections supports the role of altered intestinal permeability and gut-derived endotoxins. The study aimed at assessing the association between serological markers of increased intestinal permeability, pro-aggregating/procoagulant state and liver injury in PSVD and portal hypertension.

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Background And Aim: The term porto-sinusoidal vascular disorder (PSVD) was recently proposed to replace that of idiopathic non-cirrhotic portal hypertension (INCPH) to describe patients with typical histological lesions in absence of cirrhosis, irrespective of the presence/absence of portal hypertension (PH), and new diagnostic criteria were defined. The study aimed to compare the applicability between the diagnostic criteria of PSVD and those of INCPH.

Materials And Methods: 53 patients affected by PSVD were enrolled.

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Background: Porto-sinusoidal vascular disease (PSVD) and portal vein thrombosis (PVT) are causes of portal hypertension characterized respectively by an intrahepatic and a pre-hepatic obstacle to the flow in the portal system. As PVT may be a consequence of PSVD, in PVT patients at presentation, a pre-existing PSVD should be suspected. In these patients the identification of an underlying PSVD would have relevant implication regarding follow-up and therapeutic management, but it could be challenging.

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Hepatic encephalopathy (HE) represents one of the most frequent complications of liver cirrhosis and one of the most debilitating clinical manifestations of liver disease due to the accumulation of toxic substances in the blood and central nervous system [...

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Introduction: Hepatic encephalopathy (HE) affects the survival and quality of life of patients with cirrhosis. However, longitudinal data on the clinical course after hospitalization for HE are lacking. The aim was to estimate mortality and risk for hospital readmission of cirrhotic patients hospitalized for HE.

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Introduction: The knowledge of natural history and prognostic factors of portal vein thrombosis (PVT) is still based on a limited number of studies.

Aim: To describe our single-center experience with 79 consecutive non-neoplastic non-cirrhotic patients with PVT (15 recent/64 chronic PVT).

Results: Among patients with recent PVT, 7 received anticoagulation alone, 4 systemic thrombolysis, 3 direct thrombolysis through a TIPS and 1 TIPS alone.

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Article Synopsis
  • A study aimed to determine the prevalence of minimal hepatic encephalopathy (MHE) in different patient subgroups suffering from cirrhosis, to better identify those at higher risk.
  • The research involved 1,868 patients from 10 centers in Europe and the U.S. and found that 35% had MHE, with notable variations based on liver disease severity.
  • Results showed lower prevalence in early-stage cirrhosis (CP A at 25%) compared to advanced stages (CP B at 42% and CP C at 52%), suggesting the need for personalized screening strategies based on disease stage and MELD scores.
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Introduction: Hepatic encephalopathy (HE) is a peculiar kind of brain dysfunction typical of liver cirrhosis characterized by nonspecific neurological and psychiatric manifestations. HE ranges from minimal hepatic encephalopathy (MHE) to the most severe form characterized by alteration of consciousness or coma (overt HE, OHE). Once the diagnosis of OHE is made, every effort to identify and correct the precipitating cause is essential for the resolution of symptoms.

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Hepatic encephalopathy (HE) is a common complication in patients with advanced liver disease. It is a brain dysfunction characterized by neurological and psychiatric symptoms that significantly affects quality of life, morbidity and mortality of patients. HE has various precipitants that can potentially promote its onset, alone or in combination.

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Minimal hepatic encephalopathy (MHE) is a frequent complication of hepatic encephalopathy (HE) and can affect up to 80% of patients with liver cirrhosis. It is characterized by the lack of obvious clinical signs and the presence of alterations detectable using psychometric or electrophysiological testing focused on attention, working memory, psychomotor speed and visuospatial ability. Ideally, each patient should be tested for this condition because, despite the absence of symptoms, it has severe repercussions on daily life activities.

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Transjugular intrahepatic portosystemic shunt (TIPS) has been used since more than 25 years to treat some of the complications of portal hypertension, especially variceal bleeding and ascites refractory to conventional therapy. TIPS establishes a communication between the portal and hepatic veins, inducing the blood to shift from the splanchnic circulation into the systemic vascular bed with the aim of decompressing the portal venous system, and avoids the major complications of portal hypertension. However, the shunt of the portal blood into the systemic circulation is the cause of one of the major complications of the procedure: the post-TIPS hepatic encephalopathy (HE).

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Article Synopsis
  • This study examined the effects of long-term albumin treatment on hyponatremic patients with ascites from the ANSWER trial.
  • Results showed that albumin treatment significantly improved the normalization of low sodium levels compared to standard care.
  • Additionally, patients receiving albumin had a lower incidence of moderate hyponatremia over 18 months, suggesting it is a more effective management option for these patients.
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