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Dive into the research topics where X. Torras is active.

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Featured researches published by X. Torras.


Hepatology | 2008

Serum and ascitic fluid bacterial DNA: A new independent prognostic factor in noninfected patients with cirrhosis

Pedro Zapater; Rubén Francés; José M. González-Navajas; Maria A. de la Hoz; Rocío Moreu; Sonia Pascual; David Monfort; Silvia Montoliu; Carmen Vila; Amparo Escudero; X. Torras; Isabel Cirera; Lucía Llanos; Carlos Guarner-Argente; Palazón Jm; Fernando Carnicer; Pablo Bellot; Carlos Guarner; Ramón Planas; R. Solà; Miguel A. Serra; Carlos Muñoz; Miguel Pérez-Mateo; José Such

We tested the hypothesis that the presence of bacterial DNA (bactDNA) in ascitic fluid and serum is associated with decreased survival in patients with cirrhosis. In a prospective, multicenter study, we analyzed the clinical evolution of 156 patients with cirrhosis and ascites (first or recurrence) with lower than 250 polymorphonuclear cells (PMN)/μL, negative ascites bacteriological culture, and absence of other bacterial infections being admitted for evaluation of large‐volume paracentesis, according to the presence of bactDNA at admission. Survival, causes of death, and successive hospital admissions were determined during a 12‐month follow‐up period. BactDNA was detected in 48 patients. The most prevalent identified bactDNA corresponded to Escherichia coli (n = 32/48 patients, 66.6%). Patients were followed for 12 months after inclusion and in this period 34 patients died: 16 of 108 (15%) bactDNA negative versus 18 of 48 (38%) bactDNA positive (P = 0.003). The most frequent cause of death was acute‐on‐chronic liver failure in both groups (7/16 and 9/18 in patients without or with bactDNA, respectively), although more prevalent in the first month of follow‐up in patients with presence of bactDNA (0 versus 4/7). When considering patients with model for end‐stage liver disease (MELD) score less than 15, mortality was significantly higher in those with presence of bactDNA. Spontaneous bacterial peritonitis developed similarly in patients with or without bactDNA at admission. Conclusion: The presence of bactDNA in a patient with cirrhosis during an ascitic episode is an indicator of poor prognosis. This fact may be related to the development of acute‐on‐chronic liver failure at short term and does not predict the development of spontaneous bacterial peritonitis. (HEPATOLOGY 2008;48:1924‐1931.)


Journal of Hepatology | 2017

Effectiveness, safety and clinical outcomes of direct-acting antiviral therapy in HCV genotype 1 infection: results from a Spanish real world cohort.

Jose Luis Calleja; Javier Crespo; Diego Rincón; Belén Ruiz-Antorán; Inmaculada Fernández; C. Perelló; F. Gea; Sabela Lens; J. García-Samaniego; B. Sacristan; María García-Eliz; S. Llerena; J.M. Pascasio; Juan Turnes; X. Torras; Rosa Maria Morillas; Jordi Llaneras; Miguel A. Serra; M. Diago; Conrado Fernández Rodriguez; Javier Ampuero; F. Jorquera; Miguel A. Simón; Juan Arenas; C.A. Navascués; Rafael Bañares; Raquel Muñoz; Agustín Albillos; Zoe Mariño

BACKGROUND & AIMS Clinical trials evaluating second-generation direct-acting antiviral agents (DAAs) have shown excellent rates of sustained virologic response (SVR) and good safety profiles in patients with chronic hepatitis C virus (HCV) genotype 1 infection. We aimed to investigate the effectiveness and safety of two oral DAA combination regimens, ombitasvir/paritaprevir/ritonavir plus dasabuvir (OMV/PTV/r+DSV) and ledipasvir/sofosbuvir (LDV/SOF), in a real-world clinical practice. METHODS Data from HCV genotype 1 patients treated with either OMV/PTV/r+DSV±ribavirin (RBV) (n=1567) or LDV/SOF±RBV (n=1758) in 35 centers across Spain between April 1, 2015 and February 28, 2016 were recorded in a large national database. Demographic, clinical and virological data were analyzed. Details of serious adverse events (SAEs) were recorded. RESULTS The two cohorts were not matched with respect to baseline characteristics and could not be compared directly. The SVR12 rate was 96.8% with OMV/PTVr/DSV±RBV and 95.8% with LDV/SOF±RBV. No significant differences were observed in SVR according to HCV subgenotype (p=0.321 [OMV/PTV/r+DSV±RBV] and p=0.174 [LDV/SOF]) or degree of fibrosis (c0.548 [OMV/PTV/r/DSV±RBV] and p=0.085 [LDV/SOF]). Only baseline albumin level was significantly associated with failure to achieve SVR (p<0.05) on multivariate analysis. Rates of SAEs and SAE-associated treatment discontinuation were 5.4% and 1.7%, in the OMV/PTV/r+DSV subcohort and 5.5% and 1.5% in the LDV/SOF subcohort, respectively. Hepatocellular carcinoma (HCC) recurred in 30% of patients with a complete response to therapy for previous HCC. Incident HCC was reported in 0.93%. CONCLUSIONS In this large cohort of patients managed in the real-world setting in Spain, OMV/PTV/r+DSV and LDV/SOF achieved high rates of SVR12, comparable to those observed in randomized controlled trials, with similarly good safety profiles. LAY SUMMARY In clinical trials, second-generation direct-acting antiviral agents (DAAs) have been shown to cure over 90% of patients chronically infected with the genotype 1 hepatitis C virus and have been better tolerated than previous treatment regimens. However, patients enrolled in clinical trials do not reflect the real patient population encountered in routine practice. The current study, which includes almost 4,000 patients, demonstrates comparable rates of cure with two increasingly used DAA combinations as those observed in the clinical trial environment, confirming that clinical trial findings with DAAs translate into the real-world setting, where patient populations are more diverse and complex.


Archive | 2010

CLINICAL STUDY: BACTERIAL DNA IN DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS

Germán Soriano; Oscar Esparzia; Michel Montemayor; Carlos Guarner-Argente; Roser Pericas; X. Torras; Nuria Calvo; E. Román; Ferran Navarro; Carlos Guarner; Pere Coll

Aliment Pharmacol Ther 2011; 33: 275–284


European Journal of Gastroenterology & Hepatology | 2006

Pharmacologic treatment of portal hypertension in the prevention of community-acquired spontaneous bacterial peritonitis.

Bego a Gonzalez-Suarez; Carlos Guarner; Càndid Villanueva; Josep Miñana; Germán Soriano; Adolfo Gallego; Sergio Sainz; X. Torras; Xavier Cussó; Joaquim Balanzó

Introduction Given that &bgr;-blockers reduce the incidence of bacterial translocation in cirrhotic rats, the aim of this study was to compare the long-term incidence of spontaneous bacterial peritonitis in cirrhotic patients submitted to pharmacologic versus endoscopic treatment to prevent variceal rebleeding. Patients and methods Two hundred and thirty patients with variceal hemorrhage were included in two previous randomized trials performed to compare the efficacy of medication (nadolol plus isosorbide mononitrate, n=115) versus endoscopic treatment (n=115) with sclerotherapy or ligation for the prevention of rebleeding. Results The mean follow-up was 23±1.4 months. The characteristics of the patients and the number of patients on long-term prophylaxis with norfloxacin were similar in both groups. The incidence of spontaneous bacterial peritonitis was lower in the medication group (9 versus 14.7%, P=NS). The probability of spontaneous bacterial peritonitis was also lower in the medication group (6 versus 12% at 1 year, 22 versus 36% at 5 years; P=0.08), due to a significantly lower probability of community-acquired spontaneous bacterial peritonitis in this group (1 versus 10% at 1 year, 18 versus 32% at 5 years; P=0.02). Patients with no hemodynamic response to therapy had a significantly higher probability to develop community-acquired spontaneous bacterial peritonitis during follow-up than hemodynamic responders (P<0.03). Long-term probability of developing community-acquired spontaneous bacterial peritonitis is lower in patients submitted to pharmacologic treatment for preventing variceal rebleeding than in those submitted to endoscopic treatment. Conclusion Long-term pharmacologic prophylaxis of variceal rebleeding contributes to the prevention of community-acquired spontaneous bacterial peritonitis.


World Journal of Gastroenterology | 2014

Cytokine production in patients with cirrhosis and TLR4 polymorphisms.

Juan C. Nieto; Elisabet Sánchez; Eva Román; Silvia M. Vidal; Laia Oliva; Carlos Guarner-Argente; Maria A. Poca; X. Torras; Candido Juarez; Carlos Guarner; Germán Soriano

AIM To analyze the cytokine production by peripheral blood cells from cirrhotic patients with and without TLR4 D299G and/or T399I polymorphisms. METHODS The study included nine patients with cirrhosis and TLR4 D299G and/or T399I polymorphisms, and 10 wild-type patients matched for age, sex and degree of liver failure. TLR4 polymorphisms were determined by sequence-based genotyping. Cytokine production by peripheral blood cells was assessed spontaneously and also after lipopolysaccharide (LPS) and lipoteichoic acid (LTA) stimulation. RESULTS Patients with TLR4 polymorphisms had a higher incidence of previous hepatic encephalopathy than wild-type patients (78% vs 20%, P = 0.02). Spontaneous production of interleukin (IL)-6 and IL-10 was lower in patients with TLR4 polymorphisms than in wild-type patients [IL-6: 888.7 (172.0-2119.3) pg/mL vs 5540.4 (1159.2-26053.9) pg/mL, P < 0.001; IL-10: 28.7 (6.5-177.1) pg/mL vs 117.8 (6.5-318.1) pg/mL, P = 0.02]. However, the production of tumor necrosis factor-α, IL-6 and IL-10 after LPS and LTA stimulation was similar in the two groups. CONCLUSION TLR4 polymorphisms were associated with a distinctive pattern of cytokine production in cirrhotic patients, suggesting that they play a role in the development of cirrhosis complications.


Journal of Hepatology | 2000

Pre-treatment with prednisolone does not improve the efficacy of subsequent alpha interferon therapy in chronic hepatitis C

Magda Guilera; Xavier Forns; X. Torras; Jaime Enríquez; Susana Coll; R. Solà; Rosa Maria Morillas; Ramon Planas; Sergi Ampurdanés; Marta Soler; Josep Costa; J.C. Sáiz; José M. Sánchez-Tapias; Juan Rodés

BACKGROUND/AIMS Alpha interferon administration is quite disappointing as a single therapy in chronic hepatitis C. A brief course of corticosteroid therapy might increase the effectiveness of subsequent alpha interferon administration, but data on this issue are controversial. METHODS One hundred and fifty-six consecutive patients with chronic hepatitis C were randomly assigned to be treated blind with tapering doses of oral prednisolone or placebo for 4 weeks. Two weeks after cessation of therapy, patients received alpha interferon (3 MU t.i.w.) for 48 weeks and were followed for 24 additional weeks. Response was defined by the presence of normal alanine aminotransferase (ALT) and negative HCV-RNA in serum. RESULTS ALT activity decreased during prednisolone administration and rebounded upon withdrawal in 38% of the patients treated with this drug. Significant changes in serum bilirubin were not observed. HCV-RNA serum concentration tended to increase during prednisolone administration and to decrease upon withdrawal. ALT and HCV-RNA did not change during administration of placebo. At the end of interferon administration, 33% of patients treated with prednisolone and 25% of those treated with placebo presented biochemical and virological response. At the end of post-treatment follow-up, response was maintained in 12% and 13% of patients treated with prednisolone or placebo respectively. Response was not related to ALT or HCV-RNA changes observed during the pre-interferon phase of the study. No adverse events related to prednisolone administration were observed. CONCLUSIONS Prednisolone administration and withdrawal induced a rebound in ALT activity and a decrease in HCV-RNA serum concentration in about one third of the patients with chronic hepatitis C. However, these changes did not enhance the effectiveness of subsequent alpha interferon therapy.


Liver International | 2017

High efficacy of Sofosbuvir plus Simeprevir in a large cohort of Spanish cirrhotic patients infected with genotypes 1 and 4.

Zoe Mariño; Juan Manuel Pascasio-Acevedo; Adolfo Gallego; M. Diago; Carme Baliellas; Rosa Maria Morillas; Martín Prieto; J.M Moreno; G. Sánchez-Antolín; Mercedes Vergara; Montserrat Forné; Inmaculada Fernández; Maria Ángeles Castro; Sonia Pascual; Alexandra Gómez; Lluis Castells; J.L. Montero; Javier Crespo; Jose Luis Calleja; J. García-Samaniego; J.A. Carrión; Ana del Carmen Arencibia; Alejandro Blasco; Carmen López-Núñez; J.J. Sanchez-Ruano; Francisco Gea-Rodríguez; Álvaro Giráldez; J. Cabezas; V. Hontangas; X. Torras

Hepatitis C (HCV) therapy with Sofosbuvir (SOF)/Simeprevir (SMV) in clinical trials and real‐world clinical practice, showed high rates of sustained virological response (SVR) in non‐cirrhotic genotype (GT)‐1 and GT‐4 patients. These results were slightly lower in cirrhotic patients. We investigated real‐life effectiveness and safety of SOF/SMV with or without ribavirin (RBV) in a large cohort of cirrhotic patients.


Scientific Reports | 2016

Alteration of the serum microbiome composition in cirrhotic patients with ascites

Alba Santiago; Marta Pozuelo; Maria A. Poca; Cristina Gely; Juan C. Nieto; X. Torras; Eva Román; David Campos; Guillaume Sarrabayrouse; Silvia M. Vidal; Edilmar Alvarado-Tapias; Francisco Guarner; Germán Soriano; Chaysavanh Manichanh; Carlos Guarner

The progression of cirrhosis is associated with alterations in the composition of the gut microbiome. To assess microbial translocation, we compared the serum microbial composition of patients with and without ascites and characterized the ascitic fluid microbiome using 16S rDNA high-throughput sequencing data. A complex and specific microbial community was detected in the serum and ascitic fluid of patients with cirrhosis but barely detectable in the serum of healthy controls. The serum microbiome of patients with ascites presented higher levels of lipopolysaccharide binding protein, a marker of microbial translocation, associated with higher diversity and relative abundance of Clostridiales and an unknown genus belonging to the Cyanobacteria phylum compared to patients without ascites. The composition of the fecal microbiome was also more altered in patients with than without ascites, confirming previous studies on fecal microbiome. We propose that alteration of the serum and fecal microbiome composition be considered indicators of cirrhosis progression.


The American Journal of Gastroenterology | 2017

Interferon-Free Therapy in Elderly Patients With Advanced Liver Disease

Sabela Lens; Inmaculada Fernández; Sergio Rodríguez-Tajes; V. Hontangas; Mercedes Vergara; Montserrat Forné; Jose Luis Calleja; M. Diago; Jordi Llaneras; S. Llerena; X. Torras; Begoña Sacristán; Mercè Roget; Conrado M. Fernández-Rodríguez; Mari Carmen Navascués; J. Fuentes; J.J. Sanchez-Ruano; Miguel-Ángel Simón; Federico Sáez-Royuela; C. Baliellas; Rosa Maria Morillas; Xavier Forns; Juan de la Vega; R.J. Andrade; L. Bonet; Esther Molina; José Ramón Fernández; Gloria Sanchez Antolin; J.R. Salcines; J.M Moreno

Objectives:Interferon-free therapies have an improved safety and efficacy profile. However, data in elderly patients, who have frequently advanced liver disease, associated comorbidities, and use concomitant medications are scarce. The im of this study was to assess the effectiveness and tolerability of all-oral regimens in elderly patients in real-life clinical practice.Methods:Retrospective analysis of hepatitis C virus (HCV) patients aged ≥65 years receiving interferon-free regimens within the Spanish National Registry (Hepa-C).Results:Data of 1,252 patients were recorded. Of these, 955 (76%) were aged 65–74 years, 211 (17%) were aged 75–79 years, and 86 (7%) were aged ≥80 years at the start of antiviral therapy. HCV genotype-1b was predominant (88%) and 48% were previous non-responders. A significant proportion of patients had cirrhosis (922; 74%), of whom 11% presented decompensated liver disease. The most used regimens were SOF/LDV (33%), 3D (28%), and SOF/SMV (26%). Ribavirin was added in 49% of patients. Overall, the sustained virological response (SVR12) rate was 94% without differences among the three age categories. Albumin ≤3.5 g/dl was the only independent negative predictor of response (0.25 (0.15–0.41); P<0.01). Regarding tolerability, the rate of severe adverse events increased with age category (8.8, 13, and 14%; P=0.04). In addition, the main predictors of mortality (2.3%) were age ≥75 years (2.59 (1.16–5.83); P =0.02) and albumin ≤3.5 (17 (6.3–47); P <0.01).Conclusions:SVR rates with interferon-free regimens in elderly patients are high and comparable to the general population. Baseline low albumin levels (≤3.5 g/dl) was the only predictor of treatment failure. Importantly, the rate of severe adverse events and death increased with age. Elderly patients (≥75 years) or those with advanced liver disease (albumin ≤3.5) presented higher mortality. Thus a careful selection of patients for antiviral treatment is recommended.


Gastrointestinal Endoscopy | 2000

3388 Endoscopic treatment with argon plasma coagulation for portal hypertensive gastropathy.

Begoña González; Càndid Villanueva; Montserrat Planella; Jose M. Lopez-Balaguer; Jose M. Dedeu; Cristina Gómez; X. Torras; J. Balanzó

Portal hypertensive gastropathy (PHG) is a rare but relevant cause of gastrointestinal bleeding for which few options of medical therapy are available. Argon plasma coagulation (APC) is an endoscopic method of non-contact electrocoagulation which can be delivered by tangential application and has only limited deep of penetration. Subsequently, APC appeal for treating widespread vascular disorders such as PHG. The aim of this study was to assess the efficacy of APC for the treatment of chronic bleeding from PHG which did not respond to the pharmacological therapy of portal hypertension. METHODS: 9 patients with cirrhosis (Pugh class A/B in 3/6 and posthepatitic etiology in 6) were included. All had PHG with recurrent bleeding despite iron therapy plus isosorbide mononitrate alone (in 4 cases with intolerance to β-blockers) or combined with nadolol (3 cases) while 2 patients had no previous treatment. APC was delivered by multiple and brief pulses applied over wide areas of visible angioectasias. Sessions were performed every 2 to 3 weeks. PHG was diffuse in 4 cases and mainly antral in 5. RESULTS: a median of 6 sessions of APC were performed (range 4 to 12) during a mean period of 6±4 months. The mean follow-up was of 28±12 months. Hemoglobin value significantly improved after APC (from 76±13 to 106±19 G/L, P= 0.006) although iron therapy could be discontinued only in 1 case. Transfusional requirements decreased from a median of 4 (range 2 to 13) Units of Red Cells in the 12 months before APC to 0 (0 to 4) during the 12 months after starting APC (P=0.001). The endoscopic severity of PHG (graded from 1 for mild, to 3 for severe) also improved (from 2.9±0.3 to 2±0.5, P=0.002). There were no serious complications due to APC (3 patients complained of transient pain). Only 1 patient died 18 months after APC due to liver failure. CONCLUSIONS: endoscopic therapy with APC is a safe and effective treatment for PHG which do not respond to the pharmacological therapy of portal hypertension. In these patients APC should be considered before more aggressive approaches

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Rosa Maria Morillas

Autonomous University of Barcelona

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Càndid Villanueva

Autonomous University of Barcelona

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Germán Soriano

Instituto de Salud Carlos III

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J.A. Carrión

Autonomous University of Barcelona

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M. Diago

University of Valencia

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S. Lens

University of Barcelona

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Carlos Guarner

University of Louisville

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R. Solà

Autonomous University of Barcelona

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Zoe Mariño

University of Barcelona

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J. Balanzó

Autonomous University of Barcelona

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