Background & Aims Hepatitis C virus (HCV), human immunodeficiency virus (HIV) and cirrhosis induce metabolic disorders. Here, we aimed to evaluate the association of plasma metabolites with Child‐Turcotte‐Pugh (CTP) score and hepatic decompensation in HIV/HCV‐coinfected and HCV‐monoinfected patients with advanced cirrhosis. Methods A cross‐sectional study was carried out in 62 HIV/HCV‐coinfected and 28 HCV‐monoinfected patients. Metabolomics analysis was performed by gas chromatography‐mass spectrometry (GC‐MS) and liquid chromatography‐mass spectrometry (LC‐MS). The statistical association analysis was performed by partial least squares discriminant analysis (PLS‐DA) and generalized linear model (GLM) with binomial distribution (to analyse HIV coinfection, high alcohol intake, treatment with statins, previous HCV therapy failure and decompensation) and ordinal logistic regression (OLR) models to analyse different stages of cirrhosis (CTP score). Results The statistical analysis identified plasma metabolites associated with HIV coinfection, high alcohol intake, CTP score and hepatic decompensation. Overall, fatty acids, bile acids, aromatic and sulphur amino acids, butyrate derivatives, oxidized phospholipids, energy‐related metabolites and bacterial fermentation‐related metabolites were increased in more advanced cirrhosis stages; while lysophosphatidylcholines and lysophosphatidylethanolamines, branched‐chain amino acids (BCAA) and metabolites of tricarboxylic acid cycle, among others, were decreased in more advanced cirrhosis. Most of the significant metabolites displayed a similar trend after stratifying for HIV/HCV‐ and HCV‐infected patients. Glycolic acid, LPC (16:0) and taurocholic acid had high accuracy for discriminating patients according to decompensated cirrhosis (CTP ≥ 7). Conclusion Altered plasma metabolomic profile was associated with advanced stages of cirrhosis in HIV/HCV‐coinfected and HCV‐monoinfected patients.
BackgroundPatients with spondyloarthritis (SpA) were classified in five subgroups: ankylosing spondylitis (AS), psoriatic arthritis, arthritis associated with inflammatory bowel disease, reactive arthritis and undifferentiated SpA (uSpA). ASAS criteria classify patients in peripheral SpA and axial SpA (axSpA), being the latest classified in two groups: classical AS and non-radiographic axSpA (nr-axSpa). Whether or not patients with nr-axSpA represent the same group of patients that used to be classified as uSpA remains unclear.ObjectivesTo evaluate the similarities and differences between patients with predominant axial disease classified currently as nr-axSpA versus those traditionally classified as uSpA.MethodsBaseline data from the ESPeranza program (a multicenter national initiative to early diagnose SpA between 2008 and 2011) was used. Inclusion criteria for this program were: age <45 years and inflammatory back pain plus ≥1 SpA features with symptoms duration between 3 and 24 months. Demographic, clinic, laboratory and image results were compared between two groups: 182 patients with nr-axSpA and 166 patients classified as uSpA. In order to get a deeper knowledge of the differences between nr-axSpA and uSpA, we also compared: i) 88 patients only classified as nr-axSpA, ii) 72 patients only classified as uSpA; iii) 94 patients fulfilling both criteria. Student-t test for continuous variables and Pearson Chi-square test for categorical variables were used.ResultsCompared to patients classified as uSpA patients with nr-axSpA were younger, had HLA-B27 positive more frequently and higher values of CRP. On the other hand, they had history of SpA less frequently and lower values for BASDAI, BASFI and ASQoL (table). No differences were observed for gender, work incapacity, dactilitis, enthesitis, Pt's and Phy's VAS, BASMI and BASRI.Table 1.Results are presented in mean ± standard deviation for continuous variables and n (%) for categorical variablesBoth,OnlyOnly undifferentiatedp value* nr-axSpA & undifferentiated SpAnr-axSpASpA N (%) = 94N (%) = 88N (%) = 72 Age (years)30.9±7.332.2±6.935.2±6.9 <0.01 Male61 (64.9)50 (56.8)34 (47.2)0.2Family history48 (51.1)21 (23.9)30 (41.7) <0.05 HLA-B2781 (86.2)65 (73.9)6 (8.3) <0.001 Enthesitis29 (30.9)18 (20.5)22 (30.6)0.1BASDAI3.7±2.33.8±2.14.7±2.3 <0.01 BASFI2.2±2.22.1±2.12.9±2.5 <0.05 ASQoL5.9±4.75.2±4.57.4±5.2 0.01 CRP (mg/L)10.7±14.39.8±16.55.1±9.1 <0.05 *p value for differences between nr-axSpA and undifferentiated SpA (Student-t test for continuous variables and Pearson Chi-square test for categorical variables).ConclusionsCompared with patients traditionally classified as uSpA, patients who are currently classified as nr-axSpA are diagnosed earlier, are more frequently HLA-B27 carriers and have higher disease activity according to objective parameters. On the other hand, they report lower values for patient reported outcomes.Disclosure of InterestNone declared
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