Tammo Lambert Tergast

Medizinische Hochschule Hannover

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Benjamin Maasoumy

Medizinische Hochschule Hannover

Markus Cornberg

Medizinische Hochschule Hannover

Heiner Wedemeyer

Medizinische Hochschule Hannover

Michael P. Manns

Medizinische Hochschule Hannover

Marie Griemsmann

Medizinische Hochschule Hannover

Jim Benjamin Mauz

Medizinische Hochschule Hannover

Bernhard Meyer

Klinikum rechts der Isar

Jan B. Hinrichs

Medizinische Hochschule Hannover

Lena Stockhoff

Medizinische Hochschule Hannover

Marie Schultalbers

Medizinische Hochschule Hannover

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Center for Disease Analysis

145

Medizinische Hochschule Hannover

European Foundation for the Study of Chronic Liver Failure

German Center for Infection Research

Medical University of Vienna

Heidelberg University

German Cancer Research Center

University College London

Inserm

Goethe University Frankfurt

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Givosiran als neue therapeutische Option

Gastro-News (2021)

Heiner Wedemeyer Katja Deterding Tammo Lambert Tergast

10.1007/s15036-020-2280-y

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Frequency, characteristics and impact of multiple consecutive nosocomial infections in patients with decompensated liver cirrhosis and ascites

United European Gastroenterology Journal (2020)

Marie Schultalbers Tammo Lambert Tergast N. Simon Abdul‐Rahman Kabbani Markus Kimmann

Background Nosocomial infections are a particular threat for patients with liver cirrhosis. It is not uncommon that individuals develop even several consecutive infections during a single hospital stay. We aimed to investigate the impact and characteristics of multiple, consecutive nosocomial infections. Methods A total of 514 consecutive patients with liver cirrhosis and ascites were included and followed up for 28 days for nosocomial infection, death or liver transplantation (LTx). Laboratory values were assessed at the time of hospitalization as well as at the onset of each new infectious episode. Results 58% ( n = 298) of the patients developed at least one nosocomial infection and in 23% ( n = 119) even multiple infections were documented during a single hospital stay. Consecutive infections usually occurred shortly after the previous episode. Spontaneous bacterial peritonitis (SBP) was the most common infection. However, the proportion of SBP declined from 43% at the first to only 31% at the third nosocomial infection ( p = 0.096). In contrast, the likelihood for other, less common types of infection such as blood stream infections increased. Third nosocomial infections were also more likely to be linked to the detection of fungal pathogens (21% vs. 52%; p = 0.001). Each additional infectious episode had a dramatic detrimental impact on LTx‐free survival that was independent from the stage of liver disease (adjusted‐HR: 6.76, p = 0.002 for first nosocomial infection; adjusted‐HR: 14.69, p <0.001 for second nosocomial infection; adjusted‐HR: 24.95, p <0.001 for third nosocomial infection). Conclusion In patients with decompensated liver cirrhosis LTx‐free survival significantly decreases with every consecutive infectious episode. Development of prevention strategies is urgently required.

Spontaneous bacterial peritonitis

Liver disease

10.1177/2050640620913732

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The impact of proton pump inhibitors on the intestinal microbiota in chronic hepatitis C patients

Scandinavian Journal of Gastroenterology (2019)

Freya Wellhöner Nico Döscher Tammo Lambert Tergast Marius Vital Iris Plumeier

Objectives: Proton pump inhibitors (PPI), a class of drugs commonly used, are known to be associated with changes in the intestinal microbiota. Published studies were done in heterogeneous cohorts which could hamper conclusions drawn as effects of diseases were not taken into consideration. We aimed to elucidate differences in the intestinal microbiota being associated to the use of PPI in a cohort study of patients with chronic hepatitis C.Material and Methods: The 16S rDNA gene was analyzed in stool samples of patients with and without PPI use. Patients with concomitant medication influencing the microbiota were excluded. Results were compared with the clinical course of hepatitis C patients with decompensated liver cirrhosis.Results: No differences in alpha diversity could be observed, while the microbial community structure differed significantly, especially in patients with liver cirrhosis. The relative abundance of Streptococcus spp., Enterobacter spp. and Haemophilus spp. was significantly increased in patients with PPI use irrespectively of the stage of liver disease. Finally, in patients with decompensated liver cirrhosis due to chronic HCV infection only in these using PPI bacterial phylotypes were isolated.Conclusions: PPI use was associated with significant alterations in the microbial community in patients with chronic hepatitis C, which were even pronounced in patients with liver cirrhosis. In patients with decompensated liver cirrhosis due to chronic HCV infection, the use of PPI may promote infections either directly or indirectly through changes in the microbial community structure. Future studies should further investigate long-term impact on the microbiota and the clinical outcome.

Spontaneous bacterial peritonitis

Chronic liver disease

Liver disease

Veillonella

10.1080/00365521.2019.1647280

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Application of CT-contrast media is not associated with a higher risk for acute kidney injury in patients with decompensated liver cirrhosis

Journal of Hepatology (2022)

Tammo Lambert Tergast Marie Griemsmann Benjamin Schulte Denise Menti Neslihan Deveci

10.1016/s0168-8278(22)02075-x

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Updated epidemiology of hepatitis C virus infections and implications for hepatitis C virus elimination in Germany

Journal of Viral Hepatitis (2022)

Tammo Lambert Tergast Sarah Blach Frank Tacke Thomas Berg Markus Cornberg

Abstract In 2014, an analysis was conducted to evaluate the hepatitis C virus (HCV) epidemiology and disease burden in Germany. Since then, there have been considerable developments in HCV management such as the implementation of direct acting antivirals. The aim of this analysis was to assess the recent data available for Germany, establish an updated 2020 HCV prevalence and cascade of care and evaluate the impact of what‐if scenarios on the future burden of disease using modelling analysis. A dynamic Markov model was used to forecast the HCV disease burden in Germany. Model inputs were retrieved through literature review, unpublished sources and expert input. Next, three “what‐if” scenarios were developed to evaluate the status quo, COVID‐19 pandemic, and steps needed to achieve the WHO targets for elimination. At the beginning of 2020, there were 189,000 (95% UI: 76,700–295,000) viremic infections in Germany, a decline of more than 85,000 viremic infections since 2012. Annual treatment starts went down since 2015. Compared with 2019, the COVID‐19 pandemic resulted in a further 11% decline in 2020. If this continues for two years, it could result in 110 excess HCC cases and 200 excess liver related deaths by 2030. To achieve the WHO targets, 81,200 people need to be diagnosed, with 118,600 initiated on treatment by 2030. This could also avert 1,020 deaths and 720 HCC cases between 2021 and 2030. Germany has made strides towards HCV elimination, but more efforts are needed to achieve the WHO targets by 2030.

Hepatitis virus

10.1111/jvh.13680

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SAT-112-Each additional infection significantly increases mortality in patients with decompensated liver cirrhosis

Journal of Hepatology (2019)

Marie Schultalbers Tammo Lambert Tergast Abdul‐Rahman Kabbani Markus Kimmann H. Laser

10.1016/s0618-8278(19)31351-9

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Limited stability of Hepatitis B virus RNA in plasma and serum

Zeitschrift für Gastroenterologie (2024)

Valerie Ohlendorf Birgit Bremer Lisa Sandmann Carola Mix Tammo Lambert Tergast

Background & Aims Pregenomic hepatitis B virus (HBV) RNA (pgRNA) is intensively investigated as a biomarker in the management of HBV infected patients. However, prior to the use in routine clinical practice potential confounders of test results need to be identified. This study investigates the stability of HBV pgRNA under various storage conditions.

10.1055/s-0043-1777655

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Effects of renin–angiotensin inhibitors on renal function and the clinical course in patients with decompensated cirrhosis

Scientific Reports (2023)

Tammo Lambert Tergast Marie Griemsmann Heiner Wedemeyer Markus Cornberg Benjamin Maasoumy

Patients with decompensated cirrhosis are at risk of developing acute kidney injury (AKI). Studies have suggested that inhibition of the Renin-Angiotensin System (RAS) has certain nephro- and hepatoprotective effects in patients with compensated liver disease. This study aimed to investigate the clinical impact of RAS-Inhibitors in individuals with decompensated liver cirrhosis. Overall, 1181 consecutive hospitalized patients with ascites that underwent paracentesis were considered for this retrospective study. In total, 667 patients with decompensated cirrhosis fulfilled the inclusion criteria and were finally analyzed. RAS-Inhibitor intake was documented in 41 patients (7%). First, 28-day incidences of AKI and grade III AKI of all patients with RAS-Inhibitors were compared to those without intake. Afterwards, propensity score matching was conducted in a 3:1 manner. Here, incidence of further renal endpoints such as need of hemodialysis were analyzed in detail. In the unmatched setting, intake of RAS-Inhibitors was not associated with an increased 28 day-incidence of AKI (P = 0.76) or LTx-free survival (P = 0.60). However, 28 day-incidence of grade III AKI was significantly lower in patients with RAS-Inhibitor intake (P < 0.001). In the matched setting, 28 day-incidence of AKI did not differ (P = 0.81), while grade III AKI was significantly less frequent in the RAS-Inhibitor group (P < 0.001). Need for hemodialysis was also significantly lower in patients with RAS-Inhibitors (P = 0.03) and LTx-free survival was comparable between both groups (P = 0.52). Thus, this study suggests that intake of RAS-Inhibitors is associated with decreased incidences of grade III AKI and need of hemodialysis in patients with decompensated liver disease.

10.1038/s41598-023-44299-w

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Validation of Baveno VII criteria and other non-invasive diagnostic algorithms for clinically significant portal hypertension in hepatitis delta

Journal of Hepatology (2024)

Mathias Jachs Lisa Sandmann Lukas Hartl Tammo Lambert Tergast Michael Schwarz

Background and AimsNon-invasive tests (NIT) for clinically significant portal hypertension (CSPH) in compensated advanced chronic liver disease (cACLD) lack validation in patients infected with hepatitis D virus (HDV).MethodsHDV-cACLD patients (LSM ≥10 kPa or histological METAVIR F3/F4 fibrosis) who underwent paired HVPG and NIT assessment at Medical University of Vienna or Hannover Medical School between 2013 and 2023 were retrospectively included.Liver stiffness measurement (LSM), von Willebrand factor to platelet count ratio (VITRO), and spleen stiffness measurement (SSM) were assessed. Individual CSPH risk was calculated according to previously published models (ANTICIPATE, 3P/5P).The diagnostic performance of Baveno-VII criteria and refined algorithms (Baveno-VII-VITRO, Baveno-VII-SSM) was evaluated. The prognostic utility of NIT was investigated in the main and an independent, multicenter validation cohort.ResultsFifty-one patients (HVPG ≥10 mmHg/CSPH prevalence: 62.7%, varices: 42.2%) were included. LSM (25.8 [17.2-31.0] vs. 14.0 [10.5-19.8] kPa; p<0.001), VITRO (n=31, 3.5 [2.7-4.5] vs. 1.3 [0.6-2.0] %/[G/L]; p<0.001), and SSM (n=20, 53.8 [41.7-75.5] vs. 24.0 [17.0-33.9] kPa; p<0.001) were significantly higher in CSPH patients. Composite CSPH risk models yielded excellent AUROC (ANTICIPATE: 0.885, 3P: 0.903, 5P: 0.912). Baveno-VII criteria ruled out CSPH with 100% sensitivity and ruled in CSPH with 84.2% specificity. The Baveno-VII 'grey zone' (41.1%) was significantly reduced by Baveno-VII-VITRO or Baveno-VII-SSM, while maintaining diagnostic accuracy. Hepatic decompensation within two years occurred only in patients who had CSPH or met Baveno-VII rule-in criteria. The prognostic value of NIT was confirmed in the validation cohort comprising 92 patients.ConclusionsStandalone and composite NIT/ diagnostic algorithms are useful for CSPH diagnosis in HDV-cACLD patients. Thus, NIT may be applied to identify and prioritize patients with CSPH for novel antiviral treatments against CHD.Impact and implicationsNon-invasive tests (NIT) for clinically significant portal hypertension (CSPH) have been developed to identify compensated advanced chronic liver disease (cACLD) patients at risk for decompensation, but conflicting data has been published regarding the accuracy of liver stiffness measurement (LSM) for the staging of fibrosis in patients infected with hepatitis D virus (HDV). In our study including 51 HDV-cACLD patients, NIT, i.e., most importantly, the ANTICIPATE model based on LSM and platelet count, but also lab-based approaches, i.e., 3P/5P model and the von Willebrand factor to platelet count ratio (VITRO), and spleen stiffness measurement (SSM) yielded high AUROC for CSPH. Moreover, only patients with CSPH or high non-invasively assessed CSPH-risk were at risk for decompensation within two years, and the prognostic value of NIT was confirmed in a validation cohort. Thus, NIT should be applied and updated in yearly intervals in clinical routine to identify HDV-cACLD patients at short-term risk and may guide prioritization for novel antiviral treatment options.

10.1016/j.jhep.2024.03.005

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FRI-107-YI Folic acid prescription is associated with a lower mortality and hospital readmission in patients with decompensated alcohol-related liver cirrhosis

Journal of Hepatology (2024)

Laura Buttler Anja Tiede Marie Griemsmann Hannah Schneider Jim Benjamin Mauz

10.1016/s0168-8278(24)00886-9

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