Gastroenterology ( IF 25.7 ) Pub Date : 2023-05-30 , DOI: 10.1053/j.gastro.2023.05.033 Alberto Queiroz Farias 1 , Anna Curto Vilalta 2 , Patricia Momoyo Zitelli 1 , Gustavo Pereira 3 , Luciana L Goncalves 4 , Aldo Torre 5 , Juan Manuel Diaz 6 , Adrian C Gadano 7 , Angelo Z Mattos 8 , Liliana S C Mendes 9 , Mario R Alvares-da-Silva 10 , Paulo L Bittencourt 11 , Carlos Benitez 12 , Claudia Alves Couto 13 , Manuel Mendizabal 14 , Claudio L Toledo 15 , Daniel F C Mazo 16 , Mauricio Castillo Barradas 17 , Eva M Uson Raposo 2 , P Martín Padilla-Machaca 18 , Adelina Zarela Lozano Miranda 19 , René Malé-Velázquez 20 , André Castro Lyra 21 , Milagros B Dávalos-Moscol 22 , José L Pérez Hernández 23 , Rafael O Ximenes 24 , Giovanni Faria Silva 25 , Oscar A Beltrán-Galvis 26 , María S González Huezo 27 , Fernando Bessone 28 , Tarciso D S Rocha 29 , Eduardo Fassio 30 , Carlos Terra 31 , Juan I Marín 32 , Patricia Sierra Casas 2 , Carlos de la Peña-Ramirez 2 , Ferran Aguilar Parera 2 , Flavia Fernandes 33 , Maria da Penha Zago-Gomes 4 , Osvely Méndez-Guerrero 5 , Sebastián Marciano 7 , Angelo A Mattos 8 , Joao C Oliveira 9 , Gabriel T S Guerreiro 10 , Liana Codes 11 , Marco Arrese 34 , Mateus J Nardelli 35 , Marcelo O Silva 14 , Renato Palma-Fernandez 15 , Camila Alcantara 33 , Cristina Sánchez Garrido 2 , Jonel Trebicka 36 , Thierry Gustot 37 , Javier Fernández 38 , Joan Clària 39 , Rajiv Jalan 40 , Paolo Angeli 41 , Vicente Arroyo 2 , Richard Moreau 42 , Flair J Carrilho 1 ,
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Background & Aims
Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (eg, COVID-19). This study aimed to investigate the association of genetic ancestry and race with acute-on-chronic liver failure (ACLF), which is characterized by acute systemic inflammation, multi-organ failure, and high risk of short-term death.
Methods
This prospective cohort study analyzed a comprehensive set of data, including genetic ancestry and race among several others, in 1274 patients with acutely decompensated cirrhosis who were nonelectively admitted to 44 hospitals from 7 Latin American countries.
Results
Three hundred ninety-five patients (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had a higher median percentage of Native American genetic ancestry and lower median percentage of European ancestry than patients without ACLF (22.6% vs 12.9% and 53.4% vs 59.6%, respectively). The median percentage of African genetic ancestry was low among patients with ACLF and among those without ACLF. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native American and a lower percentage of patients with ACLF than patients without ACLF were European American or African American. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% CI, 1.03–1.13) with Native American genetic ancestry and 2.57 (95% CI, 1.84–3.58) for Native American race vs European American race
Conclusions
In a large cohort of Latin American patients with acutely decompensated cirrhosis, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment.
中文翻译：
拉丁美洲急性失代偿性肝硬化的遗传祖先、种族和严重程度
背景与目标
与全身炎症相关的疾病（例如，COVID-19）存在健康结果的遗传血统或种族差异。本研究旨在探讨遗传血统和种族与慢性肝衰竭（ACLF）的关联，其特点是急性全身炎症、多器官衰竭和短期死亡高风险。
方法
这项前瞻性队列研究分析了来自 7 个拉丁美洲国家 44 家医院的 1274 名急性失代偿性肝硬化患者的一组全面数据，包括遗传血统和种族等。
结果
395 名患者 (31.0%) 在入组时患有任何级别的 ACLF。与无 ACLF 的患者相比，患有 ACLF 的患者具有较高的美洲原住民遗传血统中位数百分比和较低的欧洲血统中位数百分比（分别为 22.6% vs 12.9% 和 53.4% vs 59.6%）。在 ACLF 患者和非 ACLF 患者中，非洲遗传血统的中位百分比较低。就种族而言，患有 ACLF 的患者中美洲原住民的比例高于未患 ACLF 的患者，而患有 ACLF 的患者中欧洲裔美国人或非裔美国人的比例低于未患 ACLF 的患者。在根据社会人口统计学和临床特征差异进行调整的多变量分析中，美国原住民遗传血统的入组时 ACLF 的优势比为 1.08（95% CI，1.03–1.13），美国原住民的优势比为 2.57（95% CI，1.84–3.58）种族 vs 欧美种族
结论
在一大群患有急性失代偿性肝硬化的拉丁美洲患者中，美国原住民血统和美国原住民种族比例的增加是入组时与 ACLF 独立相关的因素。
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