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Article ; Online: Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients.

Galli, Flavia / Bindo, Francesco / Motos, Anna / Fernández-Barat, Laia / Barbeta, Enric / Gabarrús, Albert / Ceccato, Adrián / Bermejo-Martin, Jesús F / Ferrer, Ricard / Riera, Jordi / Peñuelas, Oscar / Lorente, José Ángel / de Gonzalo-Calvo, David / Menéndez, Rosario / Gonzalez, Jessica / Misuraca, Sofia / Palomeque, Andrea / Amaya-Villar, Rosario / Añón, José Manuel /

Balan Mariño, Ana / Barberà, Carme / Barberán, José / Blandino Ortiz, Aaron / Bustamante-Munguira, Elena / Caballero, Jesús / Cantón-Bulnes, María Luisa / Carbajales Pérez, Cristina / Carbonell, Nieves / Catalán-González, Mercedes / de Frutos, Raul / Franco, Nieves / Galbán, Cristóbal / Lopez Lago, Ana / Gumucio-Sanguino, Víctor D / de la Torre, Maria Del Carmen / Díaz, Emilio / Estella, Ángel / Gallego Curto, Elena / García-Garmendia, José Luis / Gómez, José Manuel / Huerta, Arturo / Jorge García, Ruth Noemí / Loza-Vázquez, Ana / Marin-Corral, Judith / Martin Delgado, María Cruz / Martínez de la Gándara, Amalia / Martínez Varela, Ignacio / Lopez Messa, Juan / M Albaiceta, Guillermo / Nieto, María Teresa / Novo, Mariana Andrea / Peñasco, Yhivian / Pérez-García, Felipe / Pozo-Laderas, Juan Carlos / Ricart, Pilar / Sagredo, Victor / Sánchez-Miralles, Angel / Sancho Chinesta, Susana / Roche-Campo, Ferran / Socias, Lorenzo / Solé-Violan, Jordi / Suarez-Sipmann, Fernando / Tamayo Lomas, Luis / Trenado, José / Úbeda, Alejandro / Valdivia, Luis Jorge / Vidal, Pablo / Boado, Maria Victoria / Rodríguez, Alejandro / Antonelli, Massimo / Blasi, Francesco / Barbé, Ferran / Torres, Antoni

Intensive care medicine

2023 Volume 49, Issue 8, Page(s) 934–945

Abstract: ... or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial ...

Abstract	Purpose: Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia. Methods: We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations. Results: Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality. Conclusion: Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.
MeSH term(s)	Humans ; Procalcitonin ; C-Reactive Protein/metabolism ; Calcitonin ; Coinfection/epidemiology ; Critical Illness ; COVID-19/complications ; Biomarkers ; ROC Curve ; Retrospective Studies
Chemical Substances	Procalcitonin ; C-Reactive Protein (9007-41-4) ; Calcitonin (9007-12-9) ; Biomarkers
Language	English
Publishing date	2023-07-28
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-023-07161-1
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Article: Updated Evidence on the Epidemiology of Hepatitis C Virus in Hemodialysis.

Fabrizi, Fabrizio / Cerutti, Roberta / Messa, Piergiorgio

Pathogens (Basel, Switzerland)

2021 Volume 10, Issue 9

Abstract: Prevalence rates of HCV infection are decreasing in hemodialysis units of most developed countries; however, nosocomial transmission of HCV continues to occur in the hemodialysis setting, not only in the emerging world. According to the Dialysis Outcomes ...

Abstract	Prevalence rates of HCV infection are decreasing in hemodialysis units of most developed countries; however, nosocomial transmission of HCV continues to occur in the hemodialysis setting, not only in the emerging world. According to the Dialysis Outcomes and Practice Patterns Study (DOPPS, 2012-2015), the prevalence of HCV among patients on regular hemodialysis was 9.9%; in incident patients, the frequency of HCV was approximately 5%. Outbreaks of HCV have been investigated by epidemiologic and phylogenetic data obtained by sequencing of the HCV genome; no single factor was retrieved as being associated with nosocomial transmission of HCV within hemodialysis units. Transmission of HCV within HD units can be prevented successfully by full compliance with infection control practices; also, antiviral treatment and serologic screening for anti-HCV can be useful in achieving this aim. Infection control practices in hemodialysis units include barrier precautions to prevent exposure to blood-borne pathogens and other procedures specific to the hemodialysis environment. Isolating HCV-infected hemodialysis patients or using dedicated dialysis machines for HCV-infected patients are not currently recommended; reuse of dialyzers of HCV-infected patients should be made, according to recent guidelines. Randomized controlled trials regarding the impact of isolation on the risk of transmission of HCV to hemodialysis patients have not been published to date. At least two studies showed complete elimination of de novo HCV within HD units by implementation of strict infection control practices without isolation practices. De novo HCV within hemodialysis units has been independently associated with facility HCV prevalence, dialysis vintage, and low staff-to-patient ratio. Antiviral treatment of HCV-infected patients on hemodialysis should not replace the implementation of barrier precautions and other routine hemodialysis unit procedures.
Language	English
Publishing date	2021-09-07
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens10091149
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Article: An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease.

Fabrizi, Fabrizio / Cerutti, Roberta / Messa, Piergiorgio

Pathogens (Basel, Switzerland)

2021 Volume 10, Issue 11

Abstract: Background: Hepatitis C virus infection remains common in patients with chronic kidney disease ... including those on maintenance dialysis. The relationship between hepatitis C virus infection and ...

Abstract	Background: Hepatitis C virus infection remains common in patients with chronic kidney disease, including those on maintenance dialysis. The relationship between hepatitis C virus infection and chronic kidney disease is bi-directional; in fact, HCV is both a cause and consequence of chronic kidney disease. According to a systematic review with meta-analysis of observational studies ( Aim: The goal of this narrative review is to report the available treatment options for HCV in advanced chronic kidney disease. Methods: We have made an extensive review of the medical literature and various research engines have been adopted. Results: Some combinations of DAAs are currently recommended for HCV in advanced CKD (including patients on maintenance dialysis): elbasvir/grazoprevir; glecaprevir/pibrentasvir; and sofosbuvir-based regimens. Solid evidence, based on registration and "real life" studies supports their efficacy (SVR rates > 90%) and safety even in patients with advanced CKD. No dosage adjustment is necessary and treatment duration is 8-12 weeks. However, recent data highlight that many patients with advanced CKD remain untreated, and numerous barriers to antiviral treatment of HCV still exist. Whether successful antiviral therapy with DAAs will translate into improved survival in the advanced CKD population is another point of future research.
Language	English
Publishing date	2021-10-26
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens10111381
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Article ; Online: Updated Evidence on the Epidemiology of Hepatitis C Virus in Hemodialysis

Fabrizio Fabrizi / Roberta Cerutti / Piergiorgio Messa

Pathogens, Vol 10, Iss 1149, p

2021 Volume 1149

Abstract	Prevalence rates of HCV infection are decreasing in hemodialysis units of most developed countries; however, nosocomial transmission of HCV continues to occur in the hemodialysis setting, not only in the emerging world. According to the Dialysis Outcomes and Practice Patterns Study (DOPPS, 2012–2015), the prevalence of HCV among patients on regular hemodialysis was 9.9%; in incident patients, the frequency of HCV was approximately 5%. Outbreaks of HCV have been investigated by epidemiologic and phylogenetic data obtained by sequencing of the HCV genome; no single factor was retrieved as being associated with nosocomial transmission of HCV within hemodialysis units. Transmission of HCV within HD units can be prevented successfully by full compliance with infection control practices; also, antiviral treatment and serologic screening for anti-HCV can be useful in achieving this aim. Infection control practices in hemodialysis units include barrier precautions to prevent exposure to blood-borne pathogens and other procedures specific to the hemodialysis environment. Isolating HCV-infected hemodialysis patients or using dedicated dialysis machines for HCV-infected patients are not currently recommended; reuse of dialyzers of HCV-infected patients should be made, according to recent guidelines. Randomized controlled trials regarding the impact of isolation on the risk of transmission of HCV to hemodialysis patients have not been published to date. At least two studies showed complete elimination of de novo HCV within HD units by implementation of strict infection control practices without isolation practices. De novo HCV within hemodialysis units has been independently associated with facility HCV prevalence, dialysis vintage, and low staff-to-patient ratio. Antiviral treatment of HCV-infected patients on hemodialysis should not replace the implementation of barrier precautions and other routine hemodialysis unit procedures.
Keywords	hepatitis C virus ; hemodialysis ; incidence ; infection control practices ; prevalence ; transmission ; Medicine ; R
Subject code	360
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Treatment Choices for Hepatitis C in Patients with Kidney Disease.

Fabrizi, Fabrizio / Messa, Piergiorgio

Clinical journal of the American Society of Nephrology : CJASN

2018 Volume 13, Issue 5, Page(s) 793–795

MeSH term(s)	Antiviral Agents/adverse effects ; Antiviral Agents/therapeutic use ; Drug Therapy, Combination ; Hepatitis C/complications ; Hepatitis C/drug therapy ; Hepatitis C/virology ; Humans ; Renal Insufficiency, Chronic/drug therapy ; Renal Insufficiency, Chronic/etiology ; Sustained Virologic Response
Chemical Substances	Antiviral Agents
Language	English
Publishing date	2018-03-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.12621117
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Zs.A 6584: Show issues

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Article: Updated Evidence on the Epidemiology of Hepatitis C Virus in Hemodialysis

Fabrizi, Fabrizio / Cerutti, Roberta / Messa, Piergiorgio

Pathogens. 2021 Sept. 07, v. 10, no. 9

2021

Abstract	Prevalence rates of HCV infection are decreasing in hemodialysis units of most developed countries; however, nosocomial transmission of HCV continues to occur in the hemodialysis setting, not only in the emerging world. According to the Dialysis Outcomes and Practice Patterns Study (DOPPS, 2012–2015), the prevalence of HCV among patients on regular hemodialysis was 9.9%; in incident patients, the frequency of HCV was approximately 5%. Outbreaks of HCV have been investigated by epidemiologic and phylogenetic data obtained by sequencing of the HCV genome; no single factor was retrieved as being associated with nosocomial transmission of HCV within hemodialysis units. Transmission of HCV within HD units can be prevented successfully by full compliance with infection control practices; also, antiviral treatment and serologic screening for anti-HCV can be useful in achieving this aim. Infection control practices in hemodialysis units include barrier precautions to prevent exposure to blood-borne pathogens and other procedures specific to the hemodialysis environment. Isolating HCV-infected hemodialysis patients or using dedicated dialysis machines for HCV-infected patients are not currently recommended; reuse of dialyzers of HCV-infected patients should be made, according to recent guidelines. Randomized controlled trials regarding the impact of isolation on the risk of transmission of HCV to hemodialysis patients have not been published to date. At least two studies showed complete elimination of de novo HCV within HD units by implementation of strict infection control practices without isolation practices. De novo HCV within hemodialysis units has been independently associated with facility HCV prevalence, dialysis vintage, and low staff-to-patient ratio. Antiviral treatment of HCV-infected patients on hemodialysis should not replace the implementation of barrier precautions and other routine hemodialysis unit procedures.
Keywords	Hepatitis C virus ; compliance ; cross infection ; dialysis ; disease control ; epidemiology ; genome ; hemodialysis ; phylogeny ; risk
Language	English
Dates of publication	2021-0907
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens10091149
Database	NAL-Catalogue (AGRICOLA)

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Article: Ribavirin as a beneficial treatment option for hepatitis C virusassociated glomerular disease.

Fabrizi, Fabrizio / Cresseri, Donata / Moroni, Gabriella / Passerini, Patrizia / Pallotti, Francesco / Donato, Francesca Maria / Lampertico, Pietro / Messa, Piergiorgio

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia

2020 Volume 31, Issue 1, Page(s) 109–117

Abstract: The management of hepatitis C virus (HCV)-induced glomerular disease remains unsatisfactory despite ...

Abstract	The management of hepatitis C virus (HCV)-induced glomerular disease remains unsatisfactory despite novel advances in antiviral and immunosuppressive therapy. Recent evidence highlighted the role of ribavirin, a drug provided with immunomodulatory properties, in the treatment of glomerular diseases associated with chronic HCV. We administered low-dose ribavirin (200 mg/day or 200 mg twice a week or 200 mg thrice weekly) in a prospective fashion to a group of patients with HCV-associated glomerular disease (n = 7). Ribavirin monotherapy was given in most (n = 6) patients and was accompanied by erythropoietin therapy in all. The primary endpoint was reduction of 24-h proteinuria after treatment ended; the secondary end-points were decrease in serum creatinine and amelioration of urinary abnormalities. We collected data on on-treatment adverse events (AEs), serious AEs, and laboratory abnormalities. Many patients (n = 6) had inactive HCV infection as they had shown HCV RNA clearance from serum after antiviral therapy with direct-acting antivirals. Some patients (n = 4) had membranoproliferative glomerulo- nephritis, the diagnosis being confirmed by kidney histology in three cases; others (n = 2) received diagnosis of diabetic glomerulosclerosis, confirmed in one by kidney biopsy. We observed consistent reduction of 24-h proteinuria in two individuals after ribavirin therapy; another patient reported disappearance of microscopic hematuria. We found severe AE (hemolytic anemia) in three patients which required discontinuation of ribavirin treatment in two patients, one required hospitalization. Other AEs were cutaneous rash (n = 1), dyspepsia (n = 1), and fatigue (n = 1). Low-dose ribavirin was able to give consistent reduction of 24-h proteinuria in two patients; tolerance to ribavirin was unsatisfactory. We need further studies aimed to expand our knowledge on ribavirin therapy of HCV-associated glomerular disease. The low incidence of the disease hampers the conduction of clinical trials on this aim.
MeSH term(s)	Aged ; Antiviral Agents/adverse effects ; Antiviral Agents/therapeutic use ; Female ; Hepatitis C, Chronic/complications ; Hepatitis C, Chronic/drug therapy ; Humans ; Kidney Diseases/drug therapy ; Kidney Diseases/virology ; Male ; Middle Aged ; Prospective Studies ; Ribavirin/adverse effects ; Ribavirin/therapeutic use ; Treatment Outcome
Chemical Substances	Antiviral Agents ; Ribavirin (49717AWG6K)
Language	English
Publishing date	2020-03-04
Publishing country	Saudi Arabia
Document type	Journal Article
ZDB-ID	1379955-1
ISSN	1319-2442
ISSN	1319-2442
DOI	10.4103/1319-2442.279930
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Zs.A 4735: Show issues

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Article ; Online: An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease

Fabrizio Fabrizi / Roberta Cerutti / Piergiorgio Messa

Pathogens, Vol 10, Iss 1381, p

2021 Volume 1381

Abstract	Background: Hepatitis C virus infection remains common in patients with chronic kidney disease, including those on maintenance dialysis. The relationship between hepatitis C virus infection and chronic kidney disease is bi-directional; in fact, HCV is both a cause and consequence of chronic kidney disease. According to a systematic review with meta-analysis of observational studies ( n = 23 studies) ( n = 574,081 patients on long-term dialysis), anti-HCV positive serologic status was an independent and significant risk factor for death in patients with advanced chronic kidney disease on long-term dialysis. The overall estimate for adjusted mortality (all-cause death risk) with HCV was 1.26 (95% CI, 1.18; 1.34) ( p < 0.0001). Interferon-based therapies are biased by low efficacy/safety in chronic kidney disease, but the advent of direct-acting antiviral drugs has made a paradigm shift in the treatment of HCV-infection. These medications give interruption of viral replication because they target specific non-structural viral proteins; four classes of DAAs exist-NS3/4A protease inhibitors, NS5A inhibitors, NS5B nucleoside and non-nucleoside polymerase inhibitors. All-oral, interferon-free, ribavirin-free combinations of DAAs are now available. Aim: The goal of this narrative review is to report the available treatment options for HCV in advanced chronic kidney disease. Methods: We have made an extensive review of the medical literature and various research engines have been adopted. Results: Some combinations of DAAs are currently recommended for HCV in advanced CKD (including patients on maintenance dialysis): elbasvir/grazoprevir; glecaprevir/pibrentasvir; and sofosbuvir-based regimens. Solid evidence, based on registration and “real life” studies supports their efficacy (SVR rates > 90%) and safety even in patients with advanced CKD. No dosage adjustment is necessary and treatment duration is 8–12 weeks. However, recent data highlight that many patients with advanced CKD remain untreated, and numerous ...
Keywords	dialysis ; direct-acting antiviral agents ; Hepatitis C virus ; sustained viral response ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Update to hepatitis C review.

Fabrizi, Fabrizio / Messa, Piergiorgio / Martin, Paul

Kidney international

2014 Volume 85, Issue 5, Page(s) 1238–1239

MeSH term(s)	Antiviral Agents/therapeutic use ; Hepatitis C/drug therapy ; Humans ; Renal Dialysis ; Renal Insufficiency, Chronic/therapy
Chemical Substances	Antiviral Agents
Language	English
Publishing date	2014-05
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1038/ki.2014.50
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Zs.A 797: Show issues

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Article ; Online: Managing hepatitis C therapy failures and chronic kidney disease.

Fabrizi, Fabrizio / Messa, Piergiorgio

Expert review of clinical pharmacology

2018 Volume 11, Issue 11, Page(s) 1135–1142

Abstract: Introduction: Hepatitis C virus (HCV) infection leads to important morbidity and mortality ... have shown great efficacy, according to two multicenter phase-3 trials (C-SURFER and EXPEDITION-4 ...

Abstract	Introduction: Hepatitis C virus (HCV) infection leads to important morbidity and mortality through liver disease and extra-hepatic manifestations. Recent evidence suggests the role of HCV in developing chronic kidney disease (CKD); also, HCV adversely affects cardiovascular (CV) disease both in the general population and in patients with CKD. Areas covered: All-oral, interferon-free direct-acting antiviral agents (DAAs) are currently available; anti-HCV regimens based on DAAs are provided with high efficacy and safety and short treatment duration. However, some difficult-to-treat populations still exist including patients with CKD and those who failed previous DAA regimen. Expert commentary: Two DAAs regimens (elbasvir/grazoprevir and glecaprevir/pibrentasvir) are now recommended for the treatment of HCV in patients with advanced CKD, these combinations have shown great efficacy, according to two multicenter phase-3 trials (C-SURFER and EXPEDITION-4). These trials reported a minimal impact of baseline resistance-associated substitutions (RASs) on treatment outcomes. The sofosbuvir/velpatasvir/voxaliprevir combination has been recommended as the first-line option for DAAs failures, on the basis of the results given by two randomized clinical trials involving patients who had been previously received DAA-containing regimens (POLARIS 1-4 studies). It has been suggested that clinicians should consider RASs upon the introduction of DAA-based antiviral therapy.
MeSH term(s)	Antiviral Agents/administration & dosage ; Antiviral Agents/adverse effects ; Antiviral Agents/pharmacology ; Benzimidazoles/administration & dosage ; Benzofurans/administration & dosage ; Cardiovascular Diseases/physiopathology ; Drug Combinations ; Hepatitis C, Chronic/complications ; Hepatitis C, Chronic/drug therapy ; Humans ; Imidazoles/administration & dosage ; Quinoxalines/administration & dosage ; Randomized Controlled Trials as Topic ; Renal Insufficiency, Chronic/etiology ; Renal Insufficiency, Chronic/physiopathology ; Sulfonamides/administration & dosage ; Treatment Failure
Chemical Substances	Antiviral Agents ; Benzimidazoles ; Benzofurans ; Drug Combinations ; Imidazoles ; Quinoxalines ; Sulfonamides ; elbasvir-grazoprevir drug combination ; pibrentasvir (2WU922TK3L) ; glecaprevir (K6BUU8J72P)
Language	English
Publishing date	2018-10-15
Publishing country	England
Document type	Journal Article ; Review
ISSN	1751-2441
ISSN (online)	1751-2441
DOI	10.1080/17512433.2018.1534202
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