Mónica González

Hospital Universitario Ramón y Cajal

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Agustı́n Albillos

Hospital Universitario Ramón y Cajal

Rafael Bañares

Hospital General Universitario Gregorio Marañón

Luís Ruíz-del-Árbol

Hospital Universitario Ramón y Cajal

José Luís Calleja

Hospital Universitario Puerta de Hierro Majadahonda

Luis-Miguel Molinero

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas

Agustín Albillos

Hospital Universitario Ramón y Cajal

Cándido Villanueva

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas

Vicente Arroyo

European Foundation for the Study of Chronic Liver Failure

Juan Ramón Ayuso

Hospital Clínic de Barcelona

Cristina Ripoll

Jena University Hospital

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Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas

Centro de Investigación Biomédica en Red

Instituto de Salud Carlos III

Universitat de Barcelona

Consorci Institut D'Investigacions Biomediques August Pi I Sunyer

Universidad de Alcalá

Hospital Clínic de Barcelona

Hospital Universitario Ramón y Cajal

Hospital General Universitario Gregorio Marañón

Centre for Biomedical Network Research on Rare Diseases

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A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites

Journal of Hepatology (2005)

Agustı́n Albillos Rafael Bañares Mónica González María‐Vega Catalina Luis-Miguel Molinero

Hepatic Encephalopathy

Paracentesis

Spontaneous bacterial peritonitis

10.1016/j.jhep.2005.06.005

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Citations (160)

Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta-analysis

Hepatology (2002)

Rafael Bañares Agustı́n Albillos Diego Rincón Sonia Alonso Sáenz De Oger Mónica González

Endoscopic therapy, involving either injection sclerosis or band ligation, is considered the intervention of first choice for acute variceal bleeding (AVB). Pharmacologic agents have also been shown to be highly effective in the control of the bleeding episode. The purpose of this meta-analysis was to assess whether vasoactive drugs may improve the efficacy of endoscopic therapy (injection sclerosis or band ligation) in the control of AVB and thus increase survival rates. Computer databases and scientific meeting abstracts from 1994 to 2001 were used to search for randomized trials that compared the combined use of endoscopic and drug therapy with endoscopic therapy alone in the control of AVB. Eight trials involving 939 patients fulfilled the selection criteria and the following evaluated by standard meta-analysis methods: initial hemostasis, 5-day hemostasis, 5-day mortality, and adverse events. Combined treatment improved initial control of bleeding (relative risk [RR], 1.12; 95% confidence interval (CI), 1.02-1.23), and 5-day hemostasis (RR, 1.28; 95% CI, 1.18-1.39), with numbers of patients needed to treat (NNT) of 8 and 5, respectively. The difference in favor of combined treatment remained significant when trials that used drugs other than octreotide or that included a low proportion of alcoholic patients (<40%) or high-risk cirrhotic patients (<35%) were excluded. Mortality was not significantly decreased by combined therapy (RR, 0.73; 95% CI, 0.45-1.18). Severe adverse events were similar in both groups. In conclusion, in patients with AVB, pharmacologic agents improve the efficacy of endoscopic therapy to achieve initial control of bleeding and 5-day hemostasis, yet fail to affect mortality.

10.1053/jhep.2002.31354

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Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis

Hepatology (2003)

Luís Ruíz-del-Árbol Jesús Urmán Javier Martín Fernández Mónica González Miguel Navasa

Spontaneous bacterial peritonitis (SBP) is frequently associated with renal failure. This study assessed if systemic and hepatic hemodynamics are also affected by this condition. Standard laboratory tests, tumor necrosis factor alpha (TNF-alpha) in plasma and ascitic fluid, plasma renin activity (PRA) and norepinephrine (NE), and systemic and hepatic hemodynamics were determined in 23 patients with SBP at diagnosis and after resolution of infection. Eight patients developed renal failure during treatment. At diagnosis of infection, patients developing renal failure showed significantly higher values of TNF-alpha, blood urea nitrogen (BUN), PRA and NE, peripheral vascular resistance, and hepatic venous pressure gradient (HVPG) and lower cardiac output than patients not developing renal failure. During treatment, a significant reduction in cardiac output and arterial pressure and increase in PRA and NE, HVPG, and Child-Pugh score were observed in the first group but not in the second. Peripheral vascular resistance remained unmodified in both groups. Changes in PRA and NE correlated inversely with changes in arterial pressure and directly with changes in BUN, Child-Pugh score, and HVPG. Five patients in the renal failure group developed encephalopathy, and 6 died. In the group without renal failure, none of the patients developed encephalopathy or expired. In conclusion, patients with SBP frequently develop a rapidly progressive impairment in systemic hemodynamics, leading to severe renal and hepatic failure, aggravation of portal hypertension, encephalopathy, and death. This occurs despite rapid resolution of infection and is associated with an extremely poor prognosis.

Hepatic Encephalopathy

Spontaneous bacterial peritonitis

Hyperdynamic circulation

Mean arterial pressure

Plasma renin activity

Blood urea nitrogen

10.1053/jhep.2003.50447

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Citations (488)

Increased lipopolysaccharide binding protein in cirrhotic patients with marked immune and hemodynamic derangement

Hepatology (2003)

Agustı́n Albillos Antonio de la Hera Mónica González J.L. Moya José Luís Calleja

Intestinal bacterial overgrowth and translocation, both common in cirrhosis with ascites, may lead to the activation of monocytes and lymphocytes, increased levels of proinflammatory cytokines, and enhanced synthesis of nitric oxide present in cirrhosis. Bacterial endotoxin promotes the synthesis of lipopolysaccharide (LPS)-binding protein (LBP), and forms a LPS-LBP complex that binds to CD14. This study was designed to evaluate LBP levels and their correlation to the immune response and the hemodynamic status in cirrhotic patients. Plasma LBP, endotoxin, soluble CD14 (sCD14), cytokines, renin, nitrites, and systemic vascular resistance were determined before and 4 weeks after norfloxacin or placebo in 102 cirrhotic patients and 30 controls. LBP was elevated in 42% of ascitic cirrhotic patients (15.7 +/- 0.7 versus 6.06 +/- 0.5 microg/mL, P <.01). In 60% of high LBP patients, endotoxin was within normal range. Among ascitic patients, those with high LBP showed greater (P <.05) levels of sCD14, tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), nitrites + nitrates (NOx)/creatinine, and renin, and lower vascular resistance. In the cirrhotic patients with high LBP, norfloxacin normalized (P <.01) LBP (from 16.6 +/- 0.5 to 5.82 +/- 0.8 microg/mL) and sCD14; reduced the level of cytokines, NOx/creatinine, and renin; and increased vascular resistance; but lacked effect in patients with normal LBP. Portal pressure was unchanged after norfloxacin in another group of 18 cirrhotic patients with high and 19 with normal LBP. In conclusion, the subset of ascitic cirrhotic patients with marked immune and hemodynamic derangement is identified by increased LBP levels. Amelioration of these abnormalities by norfloxacin suggests the involvement of enteric bacteria or their products in the triggering of the process.

Lipopolysaccharide binding protein

Plasma renin activity

Proinflammatory cytokine

10.1053/jhep.2003.50038

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Citations (431)

Portal Hypertension–Related Complications After Acute Portal Vein Thrombosis: Impact of Early Anticoagulation

Clinical Gastroenterology and Hepatology (2008)

Juan Turnés Juan Carlos Garcı́a-Pagán Mónica González Carles Aracil José Luís Calleja

Portal vein thrombosis

10.1016/j.cgh.2008.07.031

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Citations (201)