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Schwarz M, Schwarz C, Burghart L, Pfisterer N, Bauer D, Hübl W, Mandorfer M, Gschwantler M, Reiberger T. Late-stage presentation with decompensated cirrhosis is alarmingly common but successful etiologic therapy allows for favorable clinical outcomes. PLoS One 2023; 18:e0290352. [PMID: 37616205 PMCID: PMC10449133 DOI: 10.1371/journal.pone.0290352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Liver cirrhosis accounts for considerable morbidity and mortality worldwide and late presentation limits therapeutic options. We aimed to assess characteristics of patients with liver cirrhosis at the time of first presentation and during their clinical course. METHODS Patients with cirrhosis as evident by presence of varices at endoscopy, liver stiffness ≥15kPa at elastography, or ascites requiring paracentesis between Q1/2015-Q2/2020 were retrospectively included. Clinical, laboratory, and imaging data were collected from medical records at presentation and last follow-up. RESULTS 476 patients were included (alcohol-related liver disease, ALD: 211, 44.3%; viral hepatitis: 163, 34.2%). Of these, 106 patients (22.3%) and 160 patients (33.6%) presented already with Child-Pugh C and MELD >15, respectively, and decompensation events were registered in 50% (238 patients) at baseline, and even in 75.4% of ALD patients. During a median follow-up of 11.0 (IQR 4-24) months, 116 patients died. Two-year survival was worse for patients with ALD than for viral hepatitis (71.1% vs. 90.2%, log rank p<0.001). We observed the highest percentage of portal-vein thrombosis (30.0%), hepatocellular carcinoma (15.0%), and death (45.0%) in the MAFLD group (n = 20). Patients cured from hepatitis C showed significant improvements in platelet count (147 to 169 G/L, p<0.001) and liver stiffness (26.2 to 17.7 kPa, p<0.001), while ALD patients improved in Child-Pugh score (8.6 to 7.6, p<0.001) during follow-up. With increasing Child Pugh score and MELD, we found increasing serum concentrations of CRP (p<0.001) and an inverse correlation with serum HDL (Spearman's ρ = -0.573 and -0.529, respectively, p<0.001). CONCLUSION Half of the patients with cirrhosis had decompensated cirrhosis at presentation. This calls for increased awareness and strategies for earlier diagnosis of chronic liver disease and cirrhosis.
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Affiliation(s)
- Michael Schwarz
- Department of Internal Medicine IV, Department for Gastroenterology and Hepatology, Klinik Ottakring, Vienna, Austria
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Caroline Schwarz
- Department of Internal Medicine IV, Department for Gastroenterology and Hepatology, Klinik Ottakring, Vienna, Austria
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Lukas Burghart
- Department of Internal Medicine IV, Department for Gastroenterology and Hepatology, Klinik Ottakring, Vienna, Austria
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Pfisterer
- Department for Gastroenterology and Hepatology, Department of Internal Medicine IV, Klinik Landstraße, Vienna, Austria
| | - David Bauer
- Department of Internal Medicine IV, Department for Gastroenterology and Hepatology, Klinik Ottakring, Vienna, Austria
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Hübl
- Klinik Ottakring, Institute for Laboratory Medicine, Vienna, Austria
| | - Mattias Mandorfer
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Michael Gschwantler
- Department of Internal Medicine IV, Department for Gastroenterology and Hepatology, Klinik Ottakring, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
| | - Thomas Reiberger
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
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Shi C, Shi H, Chen C, Liu Y, Lv Y, Zhang H, Liang P. Trends of hospitalisation for patients with liver cirrhosis in Ningxia, China: a cross-sectional study. BMJ Open 2023; 13:e068655. [PMID: 37607786 PMCID: PMC10445391 DOI: 10.1136/bmjopen-2022-068655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/08/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To evaluate the changing trends of hospitalisation for patients with liver cirrhosis between 2015 and 2019 by using hospitalisation summary records in Ningxia Hui Autonomous Region (NHAR), China. DESIGN A cross-sectional study. SETTING Hospitalisation summary records between 1 January 2015 and 31 December 2019 from 28 top-ranking hospitals in NHAR were extracted and rigorously analysed. PARTICIPANTS During the study period, hospitalisation records referring to liver cirrhosis were included. Records with missing data were excluded. A total of 16 566 patients with liver cirrhosis were included in this study. OUTCOME MEASURES International Classification of Diseases codes, tenth version (ICD-10) and text-diagnoses were used to identify hospitalisation records referring to liver cirrhosis. RESULTS Between 2015 and 2019, hospitalisation rates for liver cirrhosis declined from 8.38% to 5.57%. Chronic viral hepatitis accounted for almost 70% of all liver cirrhosis admissions; the remaining 30% of patients were admitted due to non-viral hepatitis cirrhosis (28.06%) and alcoholic cirrhosis (2.05%). The male-to-female hospitalisation rate ratio for liver cirrhosis was 2.57. The hospitalisation rate for workers with hepatitis cirrhosis was significantly higher than farmers (hospitalisation rate ratio (RR)=1.06, 95% CI 1.01 to 1.15, p<0.001); this was also the case for alcoholic cirrhosis (RR=5.23, 95% CI 3.34 to 8.20). However, the hospitalisation rate for workers with non-viral hepatitis cirrhosis was significantly lower than for farmers (RR=5.23, 95% CI 3.34 to 8.20, p<0.001). The hospitalisation rate increased in patients over the age of 30 years and reached a peak at the age of 45-50 years. CONCLUSIONS The hospitalisation rate for liver cirrhosis has declined over recent years and chronic viral hepatitis remains the major cause of liver cirrhosis in NHAR. Hospitalisation summary records can efficiently reflect the local changing trends of hospitalisation for liver cirrhosis and represent an efficient strategy for the surveillance of chronic disease.
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Affiliation(s)
- Chao Shi
- Central Laboratory, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Central Laboratory, Ningxia Medical University Affiliated People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Hongjuan Shi
- School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Chen Chen
- Central Laboratory, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Central Laboratory, Ningxia Medical University Affiliated People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Yining Liu
- Central Laboratory, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Central Laboratory, Ningxia Medical University Affiliated People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Yongtao Lv
- Central Laboratory, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Central Laboratory, Ningxia Medical University Affiliated People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Hua Zhang
- Central Laboratory, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Central Laboratory, Ningxia Medical University Affiliated People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Peifeng Liang
- Central Laboratory, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Central Laboratory, Ningxia Medical University Affiliated People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
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Zayadeen AR, Hijazeen S, Smadi M, Fayyad L, Halasa M, AlQusous S, AlRabadi O, Hijazeen R, Ajlouni Y, Tulenko K, Malik P. Comparing shear wave elastography with liver biopsy in the assessment of liver fibrosis at King Hussein Medical Center. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00186-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background and study aims
The aim of this prospective study is to compare the sensitivity and specificity of the liver shear wave elastography to the golden standard liver biopsy in staging liver fibrosis.
Patients and methods
Ninety-five patients were included in this study. These patients were sent for liver biopsy as a possible living liver donor or because of different pathologies including viral and autoimmune hepatitis and congenital liver diseases. A shear wave elastography and US-guided liver biopsy were done at the same setting by one experienced radiologist. One experienced histopathologist, blinded to SWE results, read the specimens.
Results
We included 95 patients in the study with a mean age of 30 years (range 3–65 years). We had 15/95 (16%) patients with hepatitis B/C, 61/95 (64%) patients with another liver disease, and 19/95 (20%) were donors. The mean of liver stiffness measured by elastography in patients was 6.5±0.19 kPa. The mean liver stiffness measured by elastography in patients with F0–F1 fibrosis was 5.39 ± 0.62 kPa, F2 was 7.32 ± 0.41, at stage F3 was 8.46 ± 0.33, and in the F4 stage, it was 11.42 ± 2.8 kPa. We found a significant difference in the mean level of liver stiffness in different degrees of fibrosis (p = 0.0001).
Conclusion
The shear wave elastography could be used to assess liver fibrosis regardless of the cause.
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Flemming JA, Djerboua M, Groome PA, Booth CM, Terrault NA. NAFLD and Alcohol-Associated Liver Disease Will Be Responsible for Almost All New Diagnoses of Cirrhosis in Canada by 2040. Hepatology 2021; 74:3330-3344. [PMID: 34174003 DOI: 10.1002/hep.32032] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Mortality secondary to cirrhosis in North America is increasing. We describe the incidence of cirrhosis stratified by birth cohort and cirrhosis etiology and project disease burden to 2040. APPROACH AND RESULTS This is a retrospective cohort study in Ontario, Canada, using population-based administrative health care data. Individuals with incident cirrhosis (2000-2017) were identified, and etiology was defined as HCV, HBV, NAFLD, alcohol-associated liver disease (ALD), or autoimmune liver disease/other using validated case definitions. Annual age/sex-adjusted cirrhosis incidence rate per 100,000 person-years was calculated with incidence projection to 2040 using age-period-cohort modeling along with average annual percent change (AAPC) in cirrhosis incidence stratified by birth cohort and etiology. In total, 159,549 incident cases of cirrhosis were identified. Incidence increased by 26% with an AAPC of 2%/year (95% CI, 1.6-2.4; P < 0.001). The largest increases were for HCV (AAPC, 4.1%/year; 95% CI, 2.6-5.7; P < 0.001) and NAFLD (AAPC, 3.3%/year; 95% CI, 2.6-4.1%; P < 0.001). ALD and HCV cirrhosis in those born >1980 increased by 11.6%/year (95% CI, 9.3-13.9; P < 0.001) and 9.5%/year (95% CI, 6.2-13.0; P < 0.001), respectively. However, by 2040, cirrhosis incidence is projected to continue to increase, driven mostly by NAFLD, especially in postmenopausal women, and ALD in individuals born >1980. CONCLUSIONS Cirrhosis incidence will continue to increase over the next two decades secondary to NAFLD with a worrisome rapid rise in ALD cirrhosis among young adults. Public education, policy, and intervention targeting NAFLD risk factors and alcohol use in young adults are urgently needed.
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Affiliation(s)
- Jennifer A Flemming
- Department of Medicine, Queen's University, Kingston, ON, Canada.,ICES, Queen's University, Kingston, ON, Canada.,Public Health Sciences, Queen's University, Kingston, ON, Canada.,Cancer Care and Epidemiology, Queen's University, Kingston, ON, Canada
| | | | - Patti A Groome
- ICES, Queen's University, Kingston, ON, Canada.,Public Health Sciences, Queen's University, Kingston, ON, Canada.,Cancer Care and Epidemiology, Queen's University, Kingston, ON, Canada
| | - Christopher M Booth
- ICES, Queen's University, Kingston, ON, Canada.,Public Health Sciences, Queen's University, Kingston, ON, Canada.,Cancer Care and Epidemiology, Queen's University, Kingston, ON, Canada
| | - Norah A Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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Ballard DH, Ludwig DR, Fraum TJ, Salter A, Narra VR, Shetty AS. Quality Control of Magnetic Resonance Elastography Using Percent Measurable Liver Volume Estimation. J Magn Reson Imaging 2021; 55:1890-1899. [PMID: 34704644 DOI: 10.1002/jmri.27976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although studies have described factors associated with failed magnetic resonance elastography (MRE), little is known about what factors influence usable elastography data. PURPOSE To identify factors that have a negative impact on percent measurable liver volume (pMLV), defined as the proportion of usable liver elastography data relative to the volume of imaged liver in patients undergoing MRE. STUDY TYPE Retrospective. SUBJECTS A total of 264 patients (n = 132 males, n = 132 females; mean age = 57 years) with suspected or known chronic liver disease underwent MRE paired with a liver protocol MRI. FIELD STRENGTH/SEQUENCE MRE was performed on a single 1.5 T scanner using a two-dimensional gradient-recalled echo phase-contrast sequence with a passive acoustic driver overlying the right hemiliver. ASSESSMENT Stiffness maps (usable data at 95% confidence) and liver contours on magnitude images of the MRE acquisition were manually traced and used to assess mean stiffness and pMLV. Hepatic fat fraction and R2 * values were also calculated. The distance from the acoustic wave generator on the skin surface to the liver edge was measured. Two radiologists performed the MR analyses with 50 overlapping cases for inter-reader analysis. STATISTICAL TESTS Linear regression was performed to identify factors significantly associated with pMLV. Intraclass correlation was performed for inter-reader reliability. RESULTS pMLV was 31% ± 20% (range 0%-86%). Complete MRE failure (i.e. pMLV = 0%) occurred in 10 patients (4%). Multivariate linear regression identified higher hepatic fat fraction, R2 *, BMI, and driver-to-liver surface distance; male sex; and lower mean liver stiffness was significantly independently associated with lower pMLV. Intraclass correlation for pMLV was 0.96, suggestive of excellent reliability. DATA CONCLUSION Higher fat fraction, R2 *, BMI, driver-to-liver surface distance, male sex, and lower mean liver stiffness were associated with lower pMLV. Optimization of image acquisition parameters and driver placement may improve MRE quality, and pMLV likely serves as a diagnostic utility quality control metric. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Vamsi R Narra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Ijioma SC, Pontinha VM, Holdford DA, Carroll NV. Cost-effectiveness of syringe service programs, medications for opioid use disorder, and combination programs in hepatitis C harm reduction among opioid injection drug users: a public payer perspective using a decision tree. J Manag Care Spec Pharm 2021; 27:137-146. [PMID: 33506729 PMCID: PMC10391166 DOI: 10.18553/jmcp.2021.27.2.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: The hepatitis C virus (HCV) prevalence rate among injection drug users (IDUs) in North America is 55.2%, with 1.41 million individuals estimated to be HCV-antibody positive. Studies have shown the effectiveness of syringe service programs (SSPs) alone, medications for opioid use disorder (MOUD) alone, or SSP+MOUD combination in reducing HCV transmission among opioid IDUs. OBJECTIVE: To evaluate the cost-effectiveness of SSP alone, MOUD alone, and SSP + MOUD combination in preventing HCV cases among opioid IDUs in the United States. METHODS: We used a decision tree analysis model based on published literature and publicly available data. Effectiveness was presented as the number of HCV cases avoided per 100 opioid IDUs. A micro-costing approach was undertaken and included both direct medical and nonmedical costs. Cost-effectiveness was assessed from a public payer perspective over a 1-year time horizon. It was expressed as an incremental cost-effectiveness ratio (ICER) and an incremental cost savings per HCV case avoided per 100 opioid IDUs compared with cost savings with "no intervention." Costs were standardized to 2019 U.S. dollars. RESULTS: The incremental cost savings per HCV case avoided per 100 opioid IDUs compared with no intervention were as follows: SSP + MOUD combination = $347,573; SSP alone = $363,821; MOUD alone = $317,428. The ICER for the combined strategy was $4,699 compared with the ICER for the SSP group. Sensitivity analysis showed that the results of the base-case cost-effectiveness analysis were sensitive to variations in the probabilities of injection-risk behavior for the SSP and SSP + MOUD combination groups, probability of no HCV with no intervention, and costs of MOUD and HCV antiviral medications. CONCLUSIONS: The SSP + MOUD combination and SSP alone strategies dominate MOUD alone and no intervention strategies. SSP had the largest incremental cost savings per HCV case avoided per 100 opioid IDUs compared with the no intervention strategy. Public payers adopting the SSP + MOUD combination harm-reduction strategy instead of SSP alone would have to pay an additional $4,699 to avoid an additional HCV case among opioid IDUs. Although these harm-reduction programs will provide benefits in a 1-year time frame, the largest benefit may become evident in the years ahead. DISCLOSURES: This research had no external funding. The authors declare no financial interests in this article. Ijioma is a Health Economics and Outcomes Research (HEOR) postdoctoral Fellow with Virginia Commonwealth University and Indivior. Indivior is a pharmaceutical manufacturer of opioid addiction treatment drugs but was not involved in the design, analysis, or write-up of the manuscript.
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Affiliation(s)
- Stephen C Ijioma
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Vasco M Pontinha
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - David A Holdford
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Norman V Carroll
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
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Liver Cirrhosis, Etiology and Clinical Characteristics Disparities Among Minority Population. J Immigr Minor Health 2021; 24:1122-1128. [PMID: 34453643 DOI: 10.1007/s10903-021-01263-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
Liver cirrhosis (LC) is a common disease with varied primary causes and ethnic disparities. Clinical characteristics and outcomes of Arab Bedouin (AB) and Jewish patients with LC were retrospective collected and compared. We included 1048 patients, 95 (9%) Arab Bedouin and 953 (91%) Jewish patients. The incidence of cirrhosis was much lower among AB. Age at diagnosis was 47 ± 18 years among Bedouins compared to 61 ± 13 years (p < 0.001) among Jews. The most frequent causes of cirrhosis among Bedouin patients were fatty liver 21.1%, cryptogenic 20%, hepatitis B 17.9% and autoimmune hepatitis 15.8%, while hepatitis C (39.2%), fatty liver (17.2%) and alcoholic liver disease (14.4%) were most common among Jewish patients. An all-cause mortality of 48.4% was observed in AB patients compared to 66.4% in Jewish patients (p < 0.001). Significant disparities regarding incidence, clinical characteristics and outcomes of cirrhosis among Arab Bedouin compared with Jewish population were found.
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Yoon SH, Kim BR, Lee SY, Beom J, Choi JH, Lim JY. Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: a retrospective cohort study. BMC Geriatr 2021; 21:283. [PMID: 33910513 PMCID: PMC8082882 DOI: 10.1186/s12877-021-02227-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/15/2021] [Indexed: 01/01/2023] Open
Abstract
Background The incidence and number of fragility hip fractures are gradually increasing, resulting in a wide consumption of medical resources. Various factors affecting functional recovery in patients with fragility hip fractures are known, and comorbid diseases are one of them. The purpose of this study is to determine the effect of comorbidities on functional outcomes in patients surgically treated for fragility hip fractures, thereby contributing to the efficient distribution of medical resources. Methods This was a retrospective cohort study performed in the three tertiary rehabilitation facilities. A total of 211 patients (50 men and 161 women; average age 81.6 ± 6.7 years) who had undergone surgery for fragility hip fractures were followed up from immediately after transfer to the Department of Rehabilitation Medicine to 6 months postoperatively. Comorbidities referred to a summary of the following conditions: hypertension, diabetes mellitus, chronic liver disease, dementia, cerebrovascular accident, and osteoporosis. Functional outcomes included Koval’s grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM)-locomotion, Modified Rivermead Mobility Index, Berg Balance Scale (BBS), 4-Meter Walking speed Test (4MWT), the Korean version of the Mini-Mental State Examination(K-MMSE), Geriatric Depression Scale (GDS), EuroQol Five-Dimension (EQ-5D) questionnaire, the Korean version of the Modified Barthel Index (K-MBI), the Korean version of the Instrumental Activities of Daily Living (K-IADL), and Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale (K-FRAIL). For all tests, each patient was assessed immediately after transfer and 6 months post-surgery. Results Multivariate linear regression analyses adjusted for age, sex, the initial variable of the functional outcomes, and comorbidities revealed that dementia had a significant negative impact on Koval’s grade and K-FRAIL 6 months postoperatively. Diabetes mellitus had a significant negative impact on the FAC, GDS, EQ-5D, K-IADL, and K-FRAIL 6 months postoperatively. Patients with osteoporosis showed a significant negative outcome of FIM-locomotion 6 months postoperatively. A cerebrovascular accident revealed a significant negative impact on the BBS 6 months postoperatively. In addition, hypertension led to significantly less favorable outcomes of the K-FRAIL 6 months postoperatively. Conclusions This study confirmed that comorbidities, particularly dementia and diabetes mellitus, significantly influence functional outcomes 6 months after fragility hip fracture surgeries.
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Affiliation(s)
- Soo Hoon Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jun Hwan Choi
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
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Welch N, Attaway A, Bellar A, Alkhafaji H, Vural A, Dasarathy S. Compound Sarcopenia in Hospitalized Patients with Cirrhosis Worsens Outcomes with Increasing Age. Nutrients 2021; 13:nu13020659. [PMID: 33670535 PMCID: PMC7923160 DOI: 10.3390/nu13020659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023] Open
Abstract
Background: There are limited data on outcomes of older patients with chronic diseases. Skeletal muscle loss of aging (primary sarcopenia) has been extensively studied but the impact of secondary sarcopenia of chronic disease is not as well evaluated. Older patients with chronic diseases have both primary and secondary sarcopenia that we term compound sarcopenia. We evaluated the clinical impact of compound sarcopenia in hospitalized patients with cirrhosis given the increasing number of patients and high prevalence of sarcopenia in these patients. Design: The Nationwide Inpatients Sample (NIS) database (years 2010–2014) was analyzed to study older patients with cirrhosis. Since there is no universal hospital diagnosis code for “muscle loss”, we used a comprehensive array of codes for “muscle loss phenotype” in the international classification of diseases-9 (ICD-9). A randomly selected 2% sample of hospitalized general medical population (GMP) and inpatients with cirrhosis were stratified into 3 age groups based on age-related changes in muscle mass. In-hospital mortality, length of stay (LoS), cost of hospitalization (CoH), comorbidities and discharge disposition were analyzed. Results. Of 517,605 hospitalizations for GMP and 106,835 hospitalizations for treatment of cirrhosis or a cirrhosis-related complication, 207,266 (40.4%) GMP and 29,018 (27.7%) patients with cirrhosis were >65 years old, respectively. Muscle loss phenotype in both GMP and inpatients with cirrhosis 51–65 years old and >65 years old was significantly (p < 0.001 for all) associated with higher mortality, LoS, and CoH compared to those ≤50 years old. Patients >65 years old with cirrhosis and muscle loss phenotype had higher mortality (adjusted OR: 1.06, 95% CI [1.04, 1.08] and CoH (adjusted odds ratio (OR): 1.10, 95% confidence interval (CI) [1.04, 1.08])) when compared to >65 years old GMP with muscle loss phenotype. Muscle loss in younger patients with cirrhosis (≤50 years old) was associated with worse outcomes compared to GMP >65 years old. Non-home discharges (nursing, skilled, long-term care) were more frequent with increasing age to a greater extent in patients with cirrhosis with muscle loss phenotype for each age stratum. Conclusion: Muscle loss is more frequent in older patients with cirrhosis than younger patients with cirrhosis and older GMP. Younger patients with cirrhosis had clinical outcomes similar to those of older GMP, suggesting an accelerated senescence in cirrhosis. Compound sarcopenia in older patients with cirrhosis is associated with higher inpatient mortality, increased LoS, and CoH compared to GMP with sarcopenia.
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Affiliation(s)
- Nicole Welch
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, USA;
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH 44195, USA; (A.B.); (H.A.); (A.V.)
| | - Amy Attaway
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Annette Bellar
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH 44195, USA; (A.B.); (H.A.); (A.V.)
| | - Hayder Alkhafaji
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH 44195, USA; (A.B.); (H.A.); (A.V.)
| | - Adil Vural
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH 44195, USA; (A.B.); (H.A.); (A.V.)
| | - Srinivasan Dasarathy
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, USA;
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH 44195, USA; (A.B.); (H.A.); (A.V.)
- Correspondence:
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Luntsi G, Muhammad MA, Shirama YB, Lawal Mohammed M, Suleiman A, Ochie K. Sonographic evaluation of the portal vein diameter in patients with chronic liver disease in northeastern Nigeria. ULTRASOUND (LEEDS, ENGLAND) 2021; 29:36-43. [PMID: 33552226 PMCID: PMC7844466 DOI: 10.1177/1742271x20944981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/27/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Chronic liver disease is a public health burden worldwide. Portal hypertension is a major portosystemic abnormality in chronic liver disease. This study aimed to determine the main, right, and the left portal vein diameter in patients with chronic liver disease. MATERIALS AND METHODS A cross-sectional study was carried out at the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, northeastern Nigeria from December 2018 to September 2019. Ethical clearance was obtained from the institutional review board. A total of 200 subjects were recruited comprising 100 patients with chronic liver disease and 100 age-matched controls, aged 18 years and above. A transabdominal ultrasound scan was carried out measuring the main, right, and left portal vein diameter while lying supine and/or in the right anterior oblique position after overnight fasting, or 6 hours before the scan. Data analysis was done using SPSS version 22.0. Descriptive statistics (mean, standard deviation) and Pearson's correlation were used. RESULTS There were 106(53%) males and 94(47%) females, aged between 18 and 73 years with a mean age of 46.79 ± 15.43. The main, right, and left portal vein diameter in patients with chronic liver disease was 14.51 ± 0.78 mm, 6.83 ± 0.81 mm, and 6.26 ± 0.74 mm, which were higher than those of their control. The portal vein diameter positively correlated (weak) with age and respiratory phases among participants (P < 0.05). CONCLUSION This study found the main, right, and left portal vein diameter among patients with chronic liver disease to be larger than those of the controls. Ultrasonography is a reliable diagnostic tool in evaluating portosystemic pathologies.
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Affiliation(s)
- Geofery Luntsi
- Department of Medical Radiography, College of Medical Sciences,
University of Maiduguri, Borno State, Nigeria
| | - Musa Abubakar Muhammad
- Department of Medical Radiography, College of Medical Sciences,
University of Maiduguri, Borno State, Nigeria
| | - Yakubu Bababa Shirama
- Department of Radiology, Tafawa Balewa University Teaching
Hospital, Bauchi, Bauchi State, Nigeria
| | - Mohammed Lawal Mohammed
- Department of Radiology, University of Maiduguri Teaching
Hospital, Maiduguri, Borno State, Nigeria
| | - Aliyu Suleiman
- Department of Radiology, 465 Nigerian Air Force Hospitals, Kano,
Kano State, Nigeria
| | - Kalu Ochie
- Department of Radiography and Radiological Sciences, Faculty of
Health Sciences, University of Nigeria Enugu Campus, Nigeria
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11
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Asghar MS, Ahsan MN, Rasheed U, Hassan M, Jawed R, Abbas MB, Yaseen R, Ali Naqvi SA, Rizvi H, Syed M. Severity of Non-B and Non-C Hepatitis Versus Hepatitis B and C Associated Chronic Liver Disease: A Retrospective, Observational, Comparative Study. Cureus 2020; 12:e12294. [PMID: 33520498 PMCID: PMC7834553 DOI: 10.7759/cureus.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and objectives Chronic liver disease (CLD) encompasses a variety of etiologies, and the infectious causes are mainly hepatitis B and hepatitis C virus. Chronic alcohol abuse and non-alcoholic fatty liver disease also have a major contribution to CLD. The Child-Pugh scoring system indicates the probable prognosis and mortality risk of a patient with cirrhosis. The primary objective of this research is to observe the mortality risks of CLD caused by a variety of etiologies mentioned above. The secondary objective is to determine the biochemical markers that are correlating with the severity of the study groups. Another aim was to determine the Model for End-Stage Liver Disease (MELD) scoring of each study group predicting the severity of disease among the Child-Pugh classification. Materials and methods We broadly classified the etiologies into two study groups: (1) hepatitis B, C associated CLD (hepatitis B, C-CLD) and (2) non-hepatitis B, C associated CLD (non-hepatitis B, C-CLD). This study was conducted as a descriptive, retrospective study involving patients admitted to the Gastroenterology Department at Dow University Hospital between July 2019 and December 2019. All patients who met the inclusion criteria were included in the study in order to document their levels of severity markers of CLD. A total of 167 individuals met the inclusion criteria, and the sampling was done through non-probability consecutive methods. All continuous variables were described as mean and standard deviations, which were then compared using an independent sample t-test. The comparison of categorical data was done either using the chi-square test or Fisher’s exact test accordingly. A p-value of <0.05 was considered statistically significant (two-tailed). Results The mean age of the study population was 51.83 ± 13.67, with no difference in gender and type of CLD. The frequent co-morbidities (other than CLD) found in the study population were diabetes, hypertension, ischemic heart disease, and chronic kidney disease, with most of them having significant association with non-hepatitis B, C-CLD. Both types of CLD had equal gender proportion (p=0.708). Among the study groups, 56.28% (n=94) had hepatitis B, C-CLD, out of which 18 (19%) belonged to Child-Pugh class A, 36 (38%) to Child-Pugh class B, and 40 (43%) to Child-Pugh class C, whereas 43.72% (n=71) had non-hepatitis B, C-CLD, comprising of 13% (n=10) of Child-Pugh class A patients, 42% (n=31) of Child-Pugh class B patients, and 44% (n=32) of Child-Pugh class C patients (p=0.631). Bilirubin levels (p=0.055), serum creatinine (p=0.201), and International normalized ratio (INR) are found higher in non-hepatitis B, C-CLD (p=0.312), whereas thrombocytopenia was more likely to be associated with hepatitis B, C-CLD (p=0.205). Hyponatremia was slightly associated with non-hepatitis B, C-CLD (p=0.281). The mean MELD score was comparable among the two study groups in both Child-Pugh classes A and B, but in Child-Pugh class C it was significantly higher in non-hepatitis B, C-CLD patients as compared to hepatitis B, C-CLD (p=0.006). Conclusion Non-hepatitis B, C-CLD was proved to be milder in Child-Pugh class A as compared to hepatitis B, C-CLD, but its mortality risk increases with severity, as mean MELD score was found significantly higher in Child-Pugh class C. Our research was able to identify severe biochemical markers in both types of CLD.
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Affiliation(s)
| | | | - Uzma Rasheed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Maira Hassan
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Rumael Jawed
- Internal Medicine , Liaquat National Hospital, Karachi, PAK
| | - Marium B Abbas
- Internal Medicine, Dow International Medical College, Karachi, PAK
| | - Rabail Yaseen
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Hera Rizvi
- General Surgery, Dow International Medical College, Karachi, PAK
| | - Mashaal Syed
- Gastroenterology and Hepatology, Dow International Medical College, Karachi, PAK
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12
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Ly KN, Miniño AM, Liu SJ, Roberts H, Hughes EM, Ward JW, Jiles RB. Deaths Associated With Hepatitis C Virus Infection Among Residents in 50 States and the District of Columbia, 2016-2017. Clin Infect Dis 2020; 71:1149-1160. [PMID: 31586173 PMCID: PMC11089524 DOI: 10.1093/cid/ciz976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mortality associated with hepatitis C virus (HCV) has been well-documented nationally, but an examination across regions and jurisdictions may inform health-care planning. METHODS To document HCV-associated deaths sub-nationally, we calculated age-adjusted, HCV-associated death rates and compared death rate ratios (DRRs) for 10 US regions, 50 states, and Washington, D.C., using the national rate and described rate changes between 2016 and 2017 to determine variability. We examined the mean age at HCV-associated death, and rates and proportions by sex, race/ethnicity, and birth year. RESULTS In 2017, there were 17 253 HCV-associated deaths, representing 4.13 (95% confidence interval [CI], 4.07-4.20) deaths/100 000 standard population, in a significant, 6.56% rate decline from 4.42 in 2016. Age-adjusted death rates significantly surpassed the US rate for the following jurisdictions: Oklahoma; Washington, D.C.; Oregon; New Mexico; Louisiana; Texas; Colorado; California; Kentucky; Tennessee; Arizona; and Washington (DRRs, 2.87, 2.77, 2.24, 1.62, 1.57, 1.46, 1.36, 1.35, 1.35, 1.35, 1.32, and 1.32, respectively; P < .05). Death rates ranged from a low of 1.60 (95% CI, 1.07-2.29) in Maine to a high of 11.84 (95% CI, 10.82-12.85) in Oklahoma. Death rates were highest among non-Hispanic (non-H) American Indians/Alaska Natives and non-H Blacks, both nationally and regionally. The mean age at death was 61.4 years (range, 56.6 years in West Virginia to 64.1 years in Washington, D.C.), and 78.6% of those who died were born during 1945-1965. CONCLUSIONS In 2016-2017, the national HCV-associated mortality declined but rates remained high in the Western and Southern regions and Washington, D.C., and among non-H American Indians/Alaska Natives, non-H Blacks, and Baby Boomers. These data can inform local prevention and control programs to reduce the HCV mortality burden.
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Affiliation(s)
- Kathleen N Ly
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Arialdi M Miniño
- Division of Vital Statistics, National Center for Health Statistics, US Centers for Disease Control and Prevention, Hyattsville, Maryland, USA, Pittsburg, Pennsylvania, USA
| | - Stephen J Liu
- Graduate School of Public Health, University of Pittsburg, Pittsburg, Pennsylvania, USA
| | - Henry Roberts
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth M Hughes
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - Ruth B Jiles
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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13
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Sahara K, Paredes AZ, Tsilimigras DI, Hyer JM, Merath K, Wu L, Mehta R, Beal EW, White S, Endo I, Pawlik TM. Impact of Liver Cirrhosis on Perioperative Outcomes Among Elderly Patients Undergoing Hepatectomy: the Effect of Minimally Invasive Surgery. J Gastrointest Surg 2019; 23:2346-2353. [PMID: 30719676 DOI: 10.1007/s11605-019-04117-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/09/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The impact of cirrhosis on perioperative outcomes for elderly patients undergoing hepatectomy remains not well defined. We sought to determine the influence of underlying cirrhosis and minimally invasive surgery (MIS) on postoperative outcomes among elderly patients who underwent a hepatectomy. METHODS Patients who underwent hepatectomy between 2013 and 2015 were identified using the Center for Medicare Services (CMS) 100% Limited Data Set (LDS) Standard Analytic Files (SAFs). Short-term outcomes after hepatectomy, stratified by the presence of cirrhosis and MIS, were examined. RESULTS Among 7452 patients who underwent a hepatectomy, a minority had cirrhosis (n = 481, 6.5%) whereas the vast majority did not (n = 6971, 93.5%). Overall, median patient age was 72 years (IQR 68-76) and preoperative Charlson comorbidity score was 6 (IQR 2-8). Patients with cirrhosis were more likely to be younger (median age 71 [67-76] vs 72 [IQR 68-76] years), male (64.4% vs 50%), African American (8.1% vs 6.4%) and have a malignant diagnosis (87.1% vs 78.7%) compared to non-cirrhotic patients (all p < 0.001). There was no difference among patients with and without cirrhosis regarding type of hepatectomy or surgical approach (open vs MIS) (both p > 0.05). Patients with versus without cirrhosis had similar complication rates (24.1% vs 22.3%, p = 0.36), as well as 30-day (6.2% vs 5%, p = 0.25) and 90-day (10.4% vs 8.5%, p = 0.15) mortality. MIS reduced the length-of-stay in non-cirrhotic patients (OR 0.79, 95% CI 0.62-0.99, p < 0.05), yet was not associated with morbidity or mortality (both p > 0.05). CONCLUSION The presence of cirrhosis did not generally impact outcomes in elderly patients undergoing hepatectomy for benign and malignant diseases. MIS hepatectomy in the elderly Medicare beneficiary population reduced LOS among patients without cirrhosis, yet was not associated with differences in morbidity or mortality.
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Affiliation(s)
- Kota Sahara
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.,Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Anghela Z Paredes
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Katiuscha Merath
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lu Wu
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Rittal Mehta
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Eliza W Beal
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Susan White
- Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Itaru Endo
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. .,Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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14
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Chung M, Baird GL, Weiss KE, Beland MD. 2D shear wave elastography: measurement acquisition and reliability criteria in noninvasive assessment of liver fibrosis. Abdom Radiol (NY) 2019; 44:3285-3294. [PMID: 31435762 DOI: 10.1007/s00261-019-02183-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The objective was to evaluate the accuracy of 2D shear wave elastography (SWE) in predicting stages of liver fibrosis using five individual versus grouped measurements and different reliability criteria. MATERIALS AND METHODS This is a prospective study of 109 patients who underwent hepatic 2D SWE (Canon Aplio 500) prior to liver biopsy for varied indications. Liver fibrosis was staged using the METAVIR scoring system (F = 0-4). Propagation mapping was used to guide ten SWE measurements from the liver parenchyma: five individual measurements and five grouped measurements. IQR/median, SD/median, and SD/mean were examined as quality criteria for patient inclusion at various thresholds (IQR/median ≤ 0.15, 0.2, 0.3, 0.4, 0.5; SD/median ≤ 0.15, 0.2, 0.3; SD/mean ≤ 0.2, 0.3, 0.5). Threshold for clinically significant fibrosis (F ≥ 2) was determined with receiver operating characteristic (ROC) analysis. RESULTS There was high agreement between individual and grouped measurements without statistically significant differences (intraclass correlation coefficient = 0.82; p = 0.26-0.96). When no quality criterion was used (n = 103), the optimal threshold was 11.3 kPa [AUROC 0.78, 95% CI (0.69, 0.88)] with sensitivity and specificity of 80% and 66%, respectively. All quality criteria were associated with equal or higher AUROC ranging from 0.78 to 0.87. IQR/median ≤ 0.5 (n = 88) achieved the highest sensitivity of 85% and only excluded a small subset of patients. The AUROC and specificity were 0.83 [95% CI (0.74, 0.92)] and 72%, respectively. SIGNIFICANCE Quality criterion IQR/median ≤ 0.5 increases sensitivity and specificity in prediction of clinically significant liver fibrosis while excluding only a small subset of patients. Grouped measurements are comparable to individual measurements and may help increase procedural efficiency.
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Affiliation(s)
- Maggie Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., Room M391, Box 0628, San Francisco, CA, 94143, USA.
| | - Grayson L Baird
- Lifespan Biostatistics Core, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA
| | - Krista E Weiss
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA
| | - Michael D Beland
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA
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15
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Lu C, White SJ, Ye IB, Mikhail CM, Cheung ZB, Cho SK. The Effects of Liver Disease on Surgical Outcomes Following Adult Spinal Deformity Surgery. World Neurosurg 2019; 130:e498-e504. [PMID: 31254688 DOI: 10.1016/j.wneu.2019.06.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND As the prevalence of chronic liver disease continues to rise in the United States, understanding the effects of liver dysfunction on surgical outcomes has become increasingly important. The objective of this study was to assess the effects of chronic liver disease on 30-day complications following adult spinal deformity (ASD) surgery. METHODS We performed a retrospective cohort study of 2337 patients in the 2008-2015 American College of Surgeons National Surgical Quality Improvement Program database who underwent corrective ASD surgery. Patients with liver disease were identified based on a Model for End-Stage Liver Disease-Na score ≥10. A univariate analysis was performed to compare 30-day postoperative complications between patients with and without liver disease. A multivariate regression analysis adjusting for differences in baseline patient characteristics was performed to identify complications that were associated with liver disease. RESULTS Patients with liver disease had a significantly greater incidence of postoperative pulmonary complications (6.3% vs. 2.9%; P < 0.001), blood transfusion (34.6% vs. 24.0%; P < 0.001), sepsis (2.2% vs. 0.9%; P = 0.011), prolonged hospitalization (19.0% vs. 8.0%; P < 0.001), as well as any 30-day complication (45.4% vs. 29.4%; P < 0.001). The multivariate regression analysis identified liver disease as a risk factor for prolonged hospitalization (odds ratio [OR] 2.16; 95% confidence interval [CI] 1.64-2.84; P < 0.001), pulmonary complications (OR 1.78; 95% CI 1.16-2.74; P = 0.009), blood transfusion (OR 1.67; 95% CI 1.36-2.05; P < 0.001), and any 30-day complication (OR 1.43; 95% CI 1.15-1.77; P = 0.001). CONCLUSIONS The multisystem pathophysiology of liver dysfunction predisposes patients to postoperative complications following ASD surgery. A multidisciplinary approach in surgical planning and preoperative optimization is needed to minimize liver disease-related complications and improve patient outcomes.
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Affiliation(s)
- Charles Lu
- The New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York, USA
| | - Samuel J White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ivan B Ye
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher M Mikhail
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zoe B Cheung
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samuel K Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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16
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Chen S, Jin H, Dai Z, Wei M, Xiao H, Su T, Li B, Liu X, Wang Y, Li J, Shen S, Zhou Q, Peng B, Peng Z, Peng S. Liver resection versus transarterial chemoembolization for the treatment of intermediate-stage hepatocellular carcinoma. Cancer Med 2019; 8:1530-1539. [PMID: 30864247 PMCID: PMC6488138 DOI: 10.1002/cam4.2038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/18/2019] [Accepted: 01/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of transarterial chemoembolization (TACE) as the standard treatment for intermediate-stage hepatocellular carcinoma (HCC) is being challenged by increasing studies supporting liver resection (LR); but evidence of survival benefits of LR is lacking. We aimed to compare the overall survival (OS) of LR with that of TACE for the treatment of intermediate-stage HCC in cirrhotic patients. METHODS A Markov model, comparing LR with TACE over 15 years, was developed based on the data from 31 literatures. Additionally, external validation of the model was performed using a data set (n = 1735; LR: 701; TACE: 1034) from a tertiary center with propensity score matching method. We conducted one-way and two-way sensitivity analyses, in addition to a Monte Carlo analysis with 10 000 patients allocated into each arm. RESULTS The mean expected survival times and survival rates at 5 years were 77.8 months and 47.1% in LR group, and 48.6 months and 25.7% in TACE group, respectively. Sensitivity analyses found that initial LR was the most favorable treatment. The 95% CI for the difference in OS was 2.42-2.46 years between the two groups (P < 0.001). In the validation set, the 5-year survival rates after LR were significantly better than those after TACE before (40.2% vs. 25.9%, P < 0.001) and after matching (43.2% vs 30.9%, P < 0.001), which was comparable to the model results. CONCLUSIONS For cirrhotic patients with resectable intermediate-stage HCC, LR may provide survival benefit over TACE, but large-scale studies are required to further stratify patients at this stage for different optimal treatments.
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Affiliation(s)
- Shuling Chen
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huilin Jin
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zihao Dai
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mengchao Wei
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Han Xiao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tianhong Su
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xin Liu
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu Wang
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shunli Shen
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qi Zhou
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Baogang Peng
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhenwei Peng
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sui Peng
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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17
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Decreased health‐related quality of life in children and adolescents with autoimmune hepatitis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Bozzini AB, Neder L, Silva CA, Porta G. Decreased health-related quality of life in children and adolescents with autoimmune hepatitis. J Pediatr (Rio J) 2019; 95:87-93. [PMID: 29331407 DOI: 10.1016/j.jped.2017.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/16/2017] [Accepted: 10/30/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the health-related quality of life in children and adolescents with autoimmune hepatitis. METHODS A cross-sectional assessment with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) was completed for 80 patients with autoimmune hepatitis and 45 healthy controls. Demographic data, prednisone dose, disease remission state, disease severity, and abdominal pain were also evaluated. RESULTS Based on the child self-reports, physical, emotional, school, and total scores were significantly lower in autoimmune hepatitis patients when compared with controls (p<0.05). Based on the parental reports, only the physical and total scores were significantly lower in autoimmune hepatitis patients versus controls (p<0.05). Further analysis in autoimmune hepatitis patients with abdominal pain in the last month revealed significantly lower physical, social, and total median scores (p<0.05). No differences were observed based on disease remission state or disease severity (p>0.05). Autoimmune hepatitis patients who received a prednisone dose below 0.16mg/kg/day at the time of the interview showed significantly higher physical scores than those who received a dose similar to or above 0.16mg/kg/day (87.5 [50-100] vs. 75 [15.63-100], p=0.006). CONCLUSIONS Reduced scores in the physical, emotional, and school domains were observed in pediatric autoimmune hepatitis patients compared to control patients. Abdominal pain and corticosteroid dose negatively influenced the health-related quality of life in children and adolescents with autoimmune hepatitis.
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Affiliation(s)
- Ana Beatriz Bozzini
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil.
| | - Luciana Neder
- Universidade Federal do Mato Grosso (UFMT), Departamento de Clínicas, Cuiabá, MT, Brazil
| | - Clovis A Silva
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil
| | - Gilda Porta
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Programa de Pós-graduação Pediátrica, São Paulo, SP, Brazil
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Golabi P, Fazel S, Otgonsuren M, Escheik C, Sayiner M, Younossi ZM. Association of Parity in Patients with Chronic Liver Disease. Ann Hepatol 2018; 17:1035-1041. [PMID: 30600295 DOI: 10.5604/01.3001.0012.7204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND AIM The impact of type of liver disease on parity rates hasn't been described. Our aim was to assess the parity rates among women with CLD. MATERIAL AND METHODS The National Health and Nutrition Examination Survey-III (1988-1994) data were used to identify adult female participants with a diagnosis of CLD. Participants were asked about their reproductive health status. Parity was defined as having at least one live birth. Hepatic ultrasound, serologic, medical examination and clinical data were available to determine the presence and type of CLD. Body mass index (kg/m2) was divided into 3 categories (< 30; 30-35; 36+). RESULTS A total of 3,502 (865 NAFLD, 737 other CLD, 1,901 control) subjects were included. Patients with NAFLD were more likely to have at least one live birth than patients with other CLD and controls (77% in NAFLD vs. 72% in controls). Multivariate analysis revealed that presence of CLD other than NAFLD (OR: 0.46 [95% CI, 0.34-0.63]) and having a college or higher degree (OR: 0.48 [95% CI, 0.34-0.68]) were negatively associated while having low income (OR: 11.06 [95% CI, 6.86-17.82]) and being African American (OR: 3.93 [95% CI, 2.59-5.98]) were positively associated with having at least one live birth. CONCLUSIONS This study revealed that patients with CLD other than NAFLD were less likely to have at least one live birth. NAFLD and obesity were associated with higher rates of live births which can potentially be explained by weight gain post live birth leading to obesity and its associated-NAFLD.
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Affiliation(s)
- Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Sofie Fazel
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Munkhzul Otgonsuren
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Carey Escheik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Mehmet Sayiner
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
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20
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Chao CT, Wang J, Huang JW, Chien KL. Acarbose Use and Liver Injury in Diabetic Patients With Severe Renal Insufficiency and Hepatic Diseases: A Propensity Score-Matched Cohort Study. Front Pharmacol 2018; 9:860. [PMID: 30131698 PMCID: PMC6090209 DOI: 10.3389/fphar.2018.00860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/16/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Acarbose has been deemed contraindicated in diabetic patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD), but such use is not uncommon. We tested whether this concept hold true in this population with different background hepatic diseases. Methods: All incident diabetic patients (n = 2,036,531) with stage 5 CKD/ESRD were enrolled from Taiwan between 2017 and 2013 and divided into those without chronic liver disease (CLD), with CLD but without cirrhosis, and those with cirrhosis. Among each group, acarbose users, defined as cumulative use >30 days within the preceding year, were propensity-score matched 1:2 to non-users. Our main outcome was the development of liver injury events during follow-up. Results: Acarbose users did not exhibit an increased incidence of liver injury during follow-up compared to non-users (hazard ratio and 95% confidence interval, 1.04 [0.88–1.25], 0.97 [0.61–1.56], and 0.71 [0.33–1.54] among those without CLD, with CLD but without cirrhosis, and those with cirrhosis, respectively), after adjusting for demographic profiles, comorbidities, potentially hepatotoxic medication use, and diabetic severity. Conclusions: The incidence of liver injury did not increase significantly among diabetic acarbose users with severe renal insufficiency than non-users, regardless of the presence or absence of chronic liver disease. Our findings support the renaissance of acarbose as a useful adjunct in diabetic patients with stage 5 and 5D chronic kidney disease.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Jui Wang
- College of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Jenq-Wen Huang
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Liong Chien
- College of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
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21
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Obmann VC, Mertineit N, Berzigotti A, Marx C, Ebner L, Kreis R, Vermathen P, Heverhagen JT, Christe A, Huber AT. CT predicts liver fibrosis: Prospective evaluation of morphology- and attenuation-based quantitative scores in routine portal venous abdominal scans. PLoS One 2018; 13:e0199611. [PMID: 29990333 PMCID: PMC6038998 DOI: 10.1371/journal.pone.0199611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives Our aim was to prospectively determine whether quantitative computed tomography (CT) scores, consisting of simplified indices for liver remodeling and attenuation, may predict liver fibrosis in abdominal CT scans. Materials and methods This cross-sectional, prospective study was approved by the local IRB (Kantonale Ethikkommission Bern). Written informed consent was given from all patients undergoing study-MR exams. Between 02/16 and 05/17, four different liver fibrosis scores (CRL-R = caudate-right-lobe ratio, LIMV-, LIMA- and LIMVA-fibrosis score, with “LIM” for liver imaging morphology, “V” for liver vein diameter and “A” for attenuation) were calculated in 1534 consecutive abdominal CT scans, excluding patients with prior liver surgery and liver metastasis. Patients were invited to undergo magnetic resonance (MR) elastography as the non-invasive gold standard to evaluate liver fibrosis. MR elastography shear modulus ≥2.8 kPa was defined as beginning liver fibrosis, while ≥3.5 kPa was defined as significant liver fibrosis (which would correspond to fibrosis stage F2 or higher in histology). Cutoff values, sensitivities and specificities obtained from the receiver operating characteristics (ROC) analysis were then calculated in 141 patients who followed the invitation for MR elastography. To mitigate selection bias, prevalence was estimated in the screened total population (n = 1534) by applying the cutoff values with sensitivities and specificities calculated in the MR elastography sub-group. Positive predictive values (PPV) and negative predictive values (NPV) were then calculated. Results Fibrosis scores including liver vein attenuation LIMA-FS and LIMVA-FS showed higher areas under the ROC curves (0.96–0.97) than CRL-R (0.82) to detect significant liver fibrosis, while LIMV-FS showed good performance as well (0.92). The prevalence-corrected PPV were 29% for CRL-R, 70% for LIMV-FS, 76% for LIMA-FS and 82% for LIMVA-FS. Conclusion CT fibrosis scores, notably LIMA-FS and LIMVA-FS, may predict significant liver fibrosis on routine abdominal CT scans.
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Affiliation(s)
- Verena C. Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nando Mertineit
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Hepatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christina Marx
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Kreis
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research, Unit for Magnetic Resonance Spectroscopy and Methodology, University of Bern, Bern, Switzerland
| | - Peter Vermathen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research, Unit for Magnetic Resonance Spectroscopy and Methodology, University of Bern, Bern, Switzerland
| | - Johannes T. Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
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22
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Flamm SL. Complications of Cirrhosis in Primary Care: Recognition and Management of Hepatic Encephalopathy. Am J Med Sci 2018; 356:296-303. [PMID: 30286824 DOI: 10.1016/j.amjms.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/24/2018] [Accepted: 06/08/2018] [Indexed: 12/13/2022]
Abstract
Approximately 3.7% of patients in primary care settings have chronic liver disease, and 18% with chronic liver disease in the specialty care setting have cirrhosis. For cirrhotic patients without complications, prognosis is generally favorable; increased morbidity and mortality are observed when complications (i.e., hepatic encephalopathy [HE]) occur. HE occurs in up to 70% of patients with cirrhosis. Neurologic signs in HE span a wide spectrum, from those not easily apparent (covert) to more clinically obvious signs (overt). Providers should consider overt HE in patients with cirrhosis and signs of impaired cognition, confusion, consciousness and/or personality changes, and/or impaired memory. Overt HE treatment includes identifying and treating precipitating factors and reducing bacterial-derived toxin loads. For acute overt HE, lactulose is first-line treatment. To prevent HE recurrence, lactulose plus rifaximin is recommended. Patients with cirrhosis and HE often present in primary care; recognizing and properly managing HE are important in this setting.
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Affiliation(s)
- Steven L Flamm
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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23
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Fumeaux L, Scarpelli MP, Tettamanti C, Palmiere C. Usefulness of liver function tests in postmortem samples. J Forensic Leg Med 2018. [DOI: 10.1016/j.jflm.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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24
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Chen S, Peng Z, Wei M, Liu W, Dai Z, Wang H, Mei J, Cheong M, Zhang H, Kuang M. Sorafenib versus Transarterial chemoembolization for advanced-stage hepatocellular carcinoma: a cost-effectiveness analysis. BMC Cancer 2018; 18:392. [PMID: 29621988 PMCID: PMC5887167 DOI: 10.1186/s12885-018-4308-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 03/26/2018] [Indexed: 12/14/2022] Open
Abstract
Background Sorafenib and transarterial chemoembolization (TACE) might both provide survival benefit for advanced hepatocellular carcinoma (HCC). Adopting either as a first-line therapy carries major cost and resource implications. We aimed to estimate the cost-effectiveness of sorafenib and TACE in advanced HCC. Methods A Markov model was constructed in a hypothetical cohort of patients aged 60 years with advanced HCC and Child-Pugh A/B cirrhosis over a 2-year time frame. Three strategies (full or dose-adjusted sorafenib and TACE) were compared in two cost settings: China and the USA. Transition probabilities, utility and costs were extracted from systematic review of 27 articles. Sensitivity analysis and Monte Carlo analysis were conducted. Results Full and dose-adjusted sorafenib respectively produced 0.435 and 0.482 quality-adjusted life years (QALYs) while TACE produced 0.375 QALYs. The incremental cost-effectiveness ratio (ICER) of full-dose sorafenib versus TACE was $101,028.83/QALY in China whereas full-dose sorafenib is a dominant strategy (ICER of -$1,014,507.20/ QALY) compared with TACE in the USA. Compared to full-dose sorafenib, dose-adjusted sorafenib was the dominant strategy with the negative ICERs in both China (−$132,238.94/QALY) and the USA (−$230,058.09/QALY). However, dose-adjusted sorafenib is not available currently, so full-dose sorafenib should be compared with TACE. As the acceptability curves shown, full-dose sorafenib was the optimal strategy at the accepted thresholds of WTP in these two countries. Specifically, full-dose sorafenib was the cost-effective treatment compared with TACE if a WTP was set above $21,670 in the USA, whereas in China, TACE could be more favorable than full-dose sorafenib if a WTP was set below $10,473. Conclusions Dose-adjusted sorafenib may be cost-effective compared to full-dose sorafenib or TACE for advanced HCC patients. However, when confining the comparisons between full-dose sorafenib and TACE, full-dose sorafenib was cost-effective for these patients, under the accepted thresholds of WTP. Electronic supplementary material The online version of this article (10.1186/s12885-018-4308-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuling Chen
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhenwei Peng
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,Clinical Research Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Mengchao Wei
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Weifeng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Zihao Dai
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Haibo Wang
- Clinical Research Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jie Mei
- Clinical Research Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Mingfong Cheong
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Hanmei Zhang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ming Kuang
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China. .,Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
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25
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Kistler CE, Zimmerman S, Ward KT, Reed D, Golin C, Lewis CL. Health of Older Adults in Assisted Living and Implications for Preventive Care. THE GERONTOLOGIST 2017; 57:949-954. [PMID: 27053505 DOI: 10.1093/geront/gnw053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/20/2016] [Indexed: 12/18/2022] Open
Abstract
Purpose of the Study Older adults in residential care and assisted living (RC/AL) are less healthy than the general elderly population, and some have needs similar to those in nursing homes, making this an important group in which to assess potential overuse or underuse of preventive services. We determined the health status of RC/AL residents and distinguished characteristics between those who may and may not benefit from preventive services requiring a life expectancy ≥5 years. Design and Methods Cross-sectional survey of a nationally representative sample of RC/AL residents using 2010 data from the National Survey of Residential Care Facilities. The primary outcome was the weighted frequency distribution of health states using three predictive mortality indices: Charlson Comorbidity Index, 4-year mortality index, and 9-year mortality index. Results A total of 666,700 of 733,300 (weighted) residents met criteria for inclusion. Based on the three indices, 10%-15% were in good health, 11%-70% in intermediate health, and 20%-76% in poor health. Implications Using triangulation between 3 well-validated mortality indices, 10%-15% of RC/AL residents are in good health and highly likely to benefit from preventive services that require ≥5 year life expectancy. In addition, many residents have uncertain benefit and would benefit from shared decision making.
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Affiliation(s)
- Christine E Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,School of Social Work, University of North Carolina at Chapel Hill
| | - Kimberly T Ward
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - David Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Carol Golin
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Carmen L Lewis
- Department of Medicine, School of Medicine, University of Colorado, Denver
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26
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Samukawa Y, Sata M, Furihata K, Ito T, Ueda N, Ochiai H, Sakai S, Kumagai Y. Luseogliflozin, an SGLT2 Inhibitor, in Japanese Patients With Mild/Moderate Hepatic Impairment: A Pharmacokinetic Study. Clin Pharmacol Drug Dev 2017; 6:439-447. [DOI: 10.1002/cpdd.364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/05/2017] [Indexed: 11/09/2022]
Affiliation(s)
| | - Michio Sata
- Kurume University School of Medicine; Fukuoka Japan
| | | | - Toshifumi Ito
- Japan Community Healthcare Organization Osaka Hospital; Osaka Japan
| | - Naohiko Ueda
- Medical Corporation Kyosoukai AMC Nishi Umeda Clinic; Osaka Japan
| | | | | | - Yuji Kumagai
- Kitasato University School of Medicine; Kanagawa Japan
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27
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Ioannou GN. Transplant-related survival benefit should influence prioritization for liver transplantation especially in patients with hepatocellular carcinoma. Liver Transpl 2017; 23:652-662. [PMID: 28006870 DOI: 10.1002/lt.24690] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/26/2016] [Indexed: 02/07/2023]
Abstract
Transplant-related survival benefit is calculated as the difference between life expectancy with transplantation and life expectancy without transplantation. Determining eligibility and prioritization for liver transplantation based on the highest survival benefit is a superior strategy to prioritization based on the highest urgency (ie, the highest wait-list mortality) or the highest utility (ie, the highest posttransplant survival) because prioritization based on the highest survival benefit maximizes the overall life expectancy of all patients in need of liver transplantation. Although the Model for End-Stage Liver Disease (MELD)-based prioritization system was designed as an urgency-based system, in practice it functions to a large extent as a survival benefit-based system, when the natural MELD score is used without exceptions. Survival benefit considerations should be used to determine the consequences of deviating from prioritization based on the natural MELD score, such as when exception points are awarded to patients with hepatocellular carcinoma (HCC) that are independent of MELD score or tumor burden, or the appropriateness of expanding eligibility for transplantation. The most promising application of survival benefit-based prioritization would be to replace the current system of prioritization of patients with HCC by one that uses their natural MELD score and tumor characteristics such as HCC tumor burden, serum alpha fetoprotein level, and response to locoregional therapies to predict the impact on survival benefit caused by the presence of HCC and adjust the natural MELD score for prioritization accordingly. Liver Transplantation 23 652-662, 2017 AASLD.
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Affiliation(s)
- George N Ioannou
- Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA
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28
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Defining a Patient Population With Cirrhosis: An Automated Algorithm With Natural Language Processing. J Clin Gastroenterol 2016; 50:889-894. [PMID: 27348317 DOI: 10.1097/mcg.0000000000000583] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objective of this study was to use natural language processing (NLP) as a supplement to International Classification of Diseases, Ninth Revision (ICD-9) and laboratory values in an automated algorithm to better define and risk-stratify patients with cirrhosis. BACKGROUND Identification of patients with cirrhosis by manual data collection is time-intensive and laborious, whereas using ICD-9 codes can be inaccurate. NLP, a novel computerized approach to analyzing electronic free text, has been used to automatically identify patient cohorts with gastrointestinal pathologies such as inflammatory bowel disease. This methodology has not yet been used in cirrhosis. STUDY DESIGN This retrospective cohort study was conducted at the University of California, Los Angeles Health, an academic medical center. A total of 5343 University of California, Los Angeles primary care patients with ICD-9 codes for chronic liver disease were identified during March 2013 to January 2015. An algorithm incorporating NLP of radiology reports, ICD-9 codes, and laboratory data determined whether these patients had cirrhosis. Of the 5343 patients, 168 patient charts were manually reviewed at random as a gold standard comparison. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of the algorithm and each of its steps were calculated. RESULTS The algorithm's PPV, NPV, sensitivity, and specificity were 91.78%, 96.84%, 95.71%, and 93.88%, respectively. The NLP portion was the most important component of the algorithm with PPV, NPV, sensitivity, and specificity of 98.44%, 93.27%, 90.00%, and 98.98%, respectively. CONCLUSIONS NLP is a powerful tool that can be combined with administrative and laboratory data to identify patients with cirrhosis within a population.
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29
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Saracco GM, Evangelista A, Fagoonee S, Ciccone G, Bugianesi E, Caviglia GP, Abate ML, Rizzetto M, Pellicano R, Smedile A. Etiology of chronic liver diseases in the Northwest of Italy, 1998 through 2014. World J Gastroenterol 2016; 22:8187-8193. [PMID: 27688660 PMCID: PMC5037087 DOI: 10.3748/wjg.v22.i36.8187] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/08/2016] [Accepted: 08/30/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the etiology of chronic liver diseases (CLD) from 1998 to 2014 at the outpatient clinic of Gastroenterology of the main hospital in Northwest of Italy among those dedicated to hepatology.
METHODS A random sample of charts of patients referred to for increased liver enzymes between January 1998 and December 2006, and between January 2012 and December 2014 were reviewed. Etiology search included testing for hepatitis B virus (HBV), hepatitis C virus (HCV), autoimmune hepatitis, primary biliary cirrhosis, Wilson’s disease and hereditary hemocromatosis. A risky alcohol consumption was also considered. Non-alcoholic fatty liver disease (NAFLD) was diagnosed in patients with histological and/or ultrasound evidence of steatosis/steatohepatitis, and without other causes of CLD.
RESULTS The number of patients included was 1163. Of them, 528 (45%) had positivity for HCV and 85 (7%) for HBV. Among the virus-free patients, 417 (36%) had metabolic disorders whereas the remaining had history of alcohol abuse, less prevalent causes of CLD or concomitant conditions. In comparison to 1998-2000 (41%), a reduction of HCV alone-related cases was detected during the periods 2001-2003 (35%, OR = 0.75, 95%CI: 0.53-1.06), 2004-2006 (33%, OR = 0.70, 95%CI: 0.50-0.97) and 2012-2014 (31%, OR = 0.64, 95%CI: 0.46-0.91). On the contrary, in comparison to 1998-2000 (31%), metabolic-alone disorders increased in the period 2004-2006 (39%, OR = 1.37, 95%CI: 0.99-1.91) and 2012-2014 (41%, OR = 1.53, 95%CI: 1.09-2.16). The other etiologies remained stable. The increase of incidence of metabolic-alone etiology during the period 2004-2006 and 2012-2014 tended to be higher in older patients (≥ 50 years) compared to younger (P = 0.058).
CONCLUSION In the Northwest of Italy, during this study period, the prevalence of HCV infection decreased notably whereas that of NAFLD increased.
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30
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Guimaraes AR, Siqueira L, Uppal R, Alford J, Fuchs BC, Yamada S, Tanabe K, Chung RT, Lauwers G, Chew ML, Boland GW, Sahani DV, Vangel M, Hahn PF, Caravan P. T2 relaxation time is related to liver fibrosis severity. Quant Imaging Med Surg 2016; 6:103-14. [PMID: 27190762 DOI: 10.21037/qims.2016.03.02] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The grading of liver fibrosis relies on liver biopsy. Imaging techniques, including elastography and relaxometric, techniques have had varying success in diagnosing moderate fibrosis. The goal of this study was to determine if there is a relationship between the T2-relaxation time of hepatic parenchyma and the histologic grade of liver fibrosis in patients with hepatitis C undergoing both routine, liver MRI and liver biopsy, and to validate our methodology with phantoms and in a rat model of liver fibrosis. METHODS This study is composed of three parts: (I) 123 patients who underwent both routine, clinical liver MRI and biopsy within a 6-month period, between July 1999 and January 2010 were enrolled in a retrospective study. MR imaging was performed at 1.5 T using dual-echo turbo-spin echo equivalent pulse sequence. T2 relaxation time of liver parenchyma in patients was calculated by mono-exponential fit of a region of interest (ROI) within the right lobe correlating to histopathologic grading (Ishak 0-6) and routine serum liver inflammation [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)]. Statistical comparison was performed using ordinary logistic and ordinal logistic regression and ANOVA comparing T2 to Ishak fibrosis without and using AST and ALT as covariates; (II) a phantom was prepared using serial dilutions of dextran coated magnetic iron oxide nanoparticles. T2 weighed imaging was performed by comparing a dual echo fast spin echo sequence to a Carr-Purcell-Meigboom-Gill (CPMG) multi-echo sequence at 1.5 T. Statistical comparison was performed using a paired t-test; (III) male Wistar rats receiving weekly intraperitoneal injections of phosphate buffer solution (PBS) control (n=4 rats); diethylnitrosamine (DEN) for either 5 (n=5 rats) or 8 weeks (n=4 rats) were MR imaged on a Bruker Pharmascan 4.7 T magnet with a home-built bird-cage coil. T2 was quantified by using a mono-exponential fitting algorithm on multi-slice multi echo T2 weighted data. Statistical comparison was performed using ANOVA. RESULTS (I) Histopathologic evaluation of both rat and human livers demonstrated no evidence of steatosis or hemochromatosis There was a monotonic increase in mean T2 value with increasing degree of fibrosis (control 65.4±2.9 ms, n=6 patients); mild (Ishak 1-2) 66.7±1.9 ms (n=30); moderate (Ishak 3-4) 71.6±1.7 ms (n=26); severe (Ishak 5-6) 72.4±1.4 ms (n=61); with relatively low standard error (~2.9 ms). There was a statistically significant difference between degrees of mild (Ishak <4) vs. moderate to severe fibrosis (Ishak >4) (P=0.03) based on logistic regression of T2 and Ishak, which became insignificant (P=0.07) when using inflammatory markers as covariates. Expanding on this model using ordinal logistic regression, there was significance amongst all 4 groups comparing T2 to Ishak (P=0.01), with significance using inflammation as a covariate (P=0.03) and approaching statistical significance amongst all groups by ANOVA (P=0.07); (II) there was a monotonic increase in T2 and statistical significance (ANOVA P<0.0001) between each rat subgroup [phosphate buffer solution (PBS) 25.2±0.8, DEN 5-week (31.1±1.5), and DEN 9-week (49.4±0.4) ms]; (III) the phantoms that had T2 values within the relevant range for the human liver (e.g., 20-100 ms), demonstrated no statistical difference between two point fits on turbo spin echo (TSE) data and multi-echo CPMG data (P=0.9). CONCLUSIONS The finding of increased T2 with liver fibrosis may relate to inflammation that may be an alternative or adjunct to other noninvasive MR imaging based approaches for assessing liver fibrosis.
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Affiliation(s)
- Alexander R Guimaraes
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Luiz Siqueira
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ritika Uppal
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jamu Alford
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bryan C Fuchs
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Suguru Yamada
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kenneth Tanabe
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Raymond T Chung
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gregory Lauwers
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Michael L Chew
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Giles W Boland
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Duhyant V Sahani
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Mark Vangel
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Peter F Hahn
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Peter Caravan
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is prevalent in the general population and a growing indication for liver transplant. Longer wait times and challenges with pretransplant survivorship are expected, underscoring the need for improved management of attendant comorbidities. Recognition with potential modification of obesity, sarcopenia, chronic kidney disease, and cardiovascular disease in patients with NAFLD may have important implications in the pretransplant and posttransplant periods. Although patients with NAFLD have generally favorable postoperative outcomes, they are at risk for developing recurrent disease in their allograft, driving the need for pharmacotherapies and dietary innovations appropriate for use in the posttransplant period.
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Affiliation(s)
- Tuan Pham
- Division of Gastroenterology and Hepatology, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Travis B Dick
- Department of Pharmacy, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84107-5701, USA
| | - Michael R Charlton
- Hepatology and Liver Transplantation, Intermountain Transplant Center, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84107-5701, USA.
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Kumar PA, Subramanian K. The Role of Ischemia Modified Albumin as a Biomarker in Patients with Chronic Liver Disease. J Clin Diagn Res 2016; 10:BC09-12. [PMID: 27134856 DOI: 10.7860/jcdr/2016/17168.7399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/14/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Chronic Liver Disease (CLD) is characterised by gradual destruction of liver tissue over time. Ischemia Modified Albumin (IMA) is an upcoming biomarker shown to be elevated in conditions associated with ischemia and oxidative stress. Albumin levels are greatly reduced in patients with CLD and studying its alterations will provide essential information regarding the molecular changes occurring to it. AIM The study aims to estimate IMA and IMA/Albumin ratio in patients with CLD and to correlate it with parameters assessing liver function and the Model for End Stage Liver Disease (MELD) score. MATERIALS AND METHODS The study consisted of 43 CLD patients as test subjects and 28 apparently healthy individuals as controls. Multiple parameters assessing liver function like albumin, bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), Gamma Glutamyl Transpeptidase (GGT), alkaline phosphatase (ALP), Prothrombin Time (PT) INR and creatinine were estimated and the MELD score calculated. Serum IMA expressed as Absorbance Units (ABSU) was estimated using the Albumin Cobalt Binding test (ABT). Student's t-test and correlation coefficient was used for statistical analysis. RESULTS Serum IMA was significantly higher in CLD patients (0.5320 ± 0.1677) as compared to the control group (0.3203 ± 0.1257) with a p-value of <0.0001. The IMA/Albumin ratio was also significantly higher (0.2035 ± 0.0970) in patients with CLD compared to control group (0.0714 ± 0.0283) with a p-value of <0.0001. IMA has a negative correlation with albumin. The IMA/Albumin ratio shows positive correlation with MELD score, bilirubin and ALP. There was no correlation with ALT, AST, GGT and PT INR. CONCLUSION Decreased serum albumin correlates with increase in IMA in CLD could indicate a qualitative change and not merely a quantitative reduction of albumin. IMA can serve as a biomarker to assess the disease severity and prognosis of CLD patients.
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Affiliation(s)
- Prashanth Ashok Kumar
- Intern, Department of Biochemistry, PSG Institute of Medical Sciences and Research , Peelamedu, Coimbatore, India
| | - Kavitha Subramanian
- Assistant Professor, Department of Biochemistry, PSG Institute of Medical Sciences and Research , Peelamedu, Coimbatore, India
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Types and predictors of interferon/ribavirin induced cardiac complications in the Egyptian patients with chronic hepatitis C virus. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jicc.2016.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Advanced liver disease is becoming more prevalent in the United States. This increase has been attributed largely to the growing epidemic of nonalcoholic fatty liver disease and an aging population infected with hepatitis C. Complications of cirrhosis are a major cause of hospital admissions and readmissions. It is important to target efforts for preventing rehospitalization toward patients with cirrhosis who are at the highest risk for readmission, such as those who have high Model for End-Stage Liver Disease scores, are at risk for fluid/electrolyte abnormalities or overt hepatic encephalopathy recurrence, and those who have comorbid conditions (e.g. diabetes). The heart failure management paradigm may provide valuable insights for managing patients with cirrhosis, given the extensive research on preventing hospital readmission and improving health care utilization in this subpopulation. As quality measures related to hospital readmissions for cirrhosis and its complications are adopted by the Centers for Medicare & Medicaid Services and private payers in the future, understanding drivers of hospital readmissions and health care utilization in this vulnerable population are key to improving quality measure performance.
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Affiliation(s)
- Archita P Desai
- a Liver Research Institute, Department of Medicine , University of Arizona , Tucson , AZ , USA
| | - Nancy Reau
- b Section of Hepatology , Rush University , Chicago , IL , USA
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Beste LA, Leipertz SL, Green PK, Dominitz JA, Ross D, Ioannou GN. Trends in burden of cirrhosis and hepatocellular carcinoma by underlying liver disease in US veterans, 2001-2013. Gastroenterology 2015; 149:1471-1482.e5; quiz e17-8. [PMID: 26255044 DOI: 10.1053/j.gastro.2015.07.056] [Citation(s) in RCA: 331] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/24/2015] [Accepted: 07/18/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Cirrhosis and hepatocellular carcinoma (HCC) are predicted to increase in the United States but the accuracy of prior forecasts and the contributions from various liver disease etiologies remain unclear. We aimed to determine the burden of cirrhosis and HCC according to underlying cause from 2001 to 2013. METHODS We developed a national retrospective cohort of Veterans Affairs (VA) patients with the diagnosis of cirrhosis (n = 129,998) or HCC (n = 21,326) from 2001 to 2013. We used laboratory results, International Classification of Diseases, ninth edition (ICD-9) codes, and body mass index to identify underlying etiologies. RESULTS In 2013, VA provided care to 5,720,614 individuals, of whom 60,553 (1.06%) had cirrhosis and 7,670 (0.13%) had HCC. Hepatitis C virus (HCV) was present in an increasing proportion of cirrhosis and HCC between 2001 and 2013, reaching 48% of cirrhosis cases and deaths and 67% of HCC cases and deaths by 2013. Cirrhosis prevalence nearly doubled from 2001 to 2013 (664 to 1058 per 100,000 enrollees), driven by HCV and nonalcoholic fatty liver disease (NAFLD). Cirrhosis incidence ranged from 159 to 193 per 100,000 patient-years. Deaths in patients with cirrhosis increased from 83 to 126 per 100,000 patient-years, largely driven by HCV. HCC incidence was 2.5-fold increased from 17 to 45 per 100,000 patient-years. HCC mortality tripled from 13 to 37 per 100,000 patient-years, driven overwhelmingly by HCV, with much smaller contributions from NAFLD and alcoholic liver disease. CONCLUSIONS Cirrhosis prevalence and mortality and HCC incidence and mortality increased from 2001 to 2013, driven by HCV, with a smaller contribution from NAFLD. If current trends continue, cirrhosis prevalence will peak in 2021. Health care systems will need to accommodate rising numbers of patients with cirrhosis and HCC.
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Affiliation(s)
- Lauren A Beste
- Primary Care Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Division of General Internal Medicine, University of Washington, Seattle, Washington
| | - Steven L Leipertz
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Pamela K Green
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Jason A Dominitz
- Primary Care Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Division of Gastroenterology, University of Washington, Seattle, Washington
| | - David Ross
- HIV, HCV, and Public Health Pathogens Programs, Office of Public Health/Clinical Public Health, US Department of Veterans Affairs, Washington, DC
| | - George N Ioannou
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Division of Gastroenterology, University of Washington, Seattle, Washington; Division of Gastroenterology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
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Beste LA, Harp BK, Blais RK, Evans GA, Zickmund SL. Primary Care Providers Report Challenges to Cirrhosis Management and Specialty Care Coordination. Dig Dis Sci 2015; 60:2628-35. [PMID: 25732712 DOI: 10.1007/s10620-015-3592-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/17/2015] [Indexed: 12/09/2022]
Abstract
BACKGROUND Two-thirds of patients with cirrhosis do not receive guideline-concordant liver care. Cirrhosis patients are less likely to receive recommended care when followed exclusively by primary care providers (PCPs), as opposed to specialty co-management. Little is known about how to optimize cirrhosis care delivered by PCPs. AIMS We conducted a qualitative analysis to explore PCPs' attitudes and self-reported roles in caring for patients with cirrhosis. METHODS We recruited PCPs from seven Veterans Affairs facilities in the Pacific Northwest via in-service trainings and direct email from March to October 2012 (n = 24). Trained staff administered structured telephone interviews covering: (1) general attitudes; (2) roles and practices; and (3) barriers and facilitators to cirrhosis management. Two trained, independent coders reviewed each interview transcript and thematically coded responses. RESULTS Three overarching themes emerged in PCPs' perceptions of cirrhosis patients: the often overwhelming complexity of comorbid medical, psychiatric, and substance issues; the importance of patient self-management; and challenges surrounding specialty care involvement and co-management of cirrhosis. While PCPs felt they brought important skills to bear, such as empathy and care coordination, they strongly preferred to defer major cirrhosis management decisions to specialists. The most commonly reported barriers to care included patient behaviors, access issues, and conflicts with specialists. CONCLUSIONS PCPs perceive Veterans with cirrhosis as having significant medical and psychosocial challenges. PCPs tend not to see their role as directing cirrhosis-related management decisions. Educational efforts directed at PCPs must foster PCP empowerment and improve comfort with managing cirrhosis.
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Affiliation(s)
- Lauren A Beste
- Primary Care Service, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA,
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Ly KN, Speers S, Klevens RM, Barry V, Vogt TM. Measuring chronic liver disease mortality using an expanded cause of death definition and medical records in Connecticut, 2004. Hepatol Res 2015; 45:960-968. [PMID: 25319958 PMCID: PMC11005817 DOI: 10.1111/hepr.12437] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/08/2014] [Accepted: 10/12/2014] [Indexed: 02/08/2023]
Abstract
AIM Chronic liver disease (CLD) is a leading cause of death and is defined based on a specific set of underlying cause-of-death codes on death certificates. This conventional approach to measuring CLD mortality underestimates the true mortality burden because it does not consider certain CLD conditions like viral hepatitis and hepatocellular carcinoma. We measured how much the conventional CLD mortality case definition will underestimate CLD mortality and described the distribution of CLD etiologies in Connecticut. METHODS We used 2004 Connecticut death certificates to estimate CLD mortality two ways. One way used the conventional definition and the other used an expanded definition that included more conditions suggestive of CLD. We compared the number of deaths identified using this expanded definition with the number identified using the conventional definition. Medical records were reviewed to confirm CLD deaths. RESULTS Connecticut had 29 314 registered deaths in 2004. Of these, 282 (1.0%) were CLD deaths identified by the conventional CLD definition while 616 (2.1%) were CLD deaths defined by the expanded definition. Medical record review confirmed that most deaths identified by the expanded definition were CLD-related (550/616); this suggested a 15.8 deaths/100 000 population mortality rate. Among deaths for which hepatitis B, hepatitis C and alcoholic liver disease were identified during medical record review, only 8.6%, 45.4% and 36.5%, respectively, had that specific cause-of-death code cited on the death certificate. CONCLUSION An expanded CLD mortality case definition that incorporates multiple causes of death and additional CLD-related conditions will better estimate CLD mortality.
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Affiliation(s)
- Kathleen N. Ly
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Suzanne Speers
- Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - R. Monina Klevens
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vaughn Barry
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara M. Vogt
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Pontoriero AC, Trinks J, Hulaniuk ML, Caputo M, Fortuny L, Pratx LB, Frías A, Torres O, Nuñez F, Gadano A, Argibay P, Corach D, Flichman D. Influence of ethnicity on the distribution of genetic polymorphisms associated with risk of chronic liver disease in South American populations. BMC Genet 2015. [PMID: 26219465 PMCID: PMC4518515 DOI: 10.1186/s12863-015-0255-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The global burden of chronic liver disease is rising. Besides environmental, behavioral, viral and metabolic factors, genetic polymorphisms in patatin-like phospholipase-3 (PNPLA3) and vitamin D receptor (VDR) genes have been related to the development of chronic liver disease and progression towards liver cancer. Although their prevalence differs remarkably among ethnic groups, the frequency of these polymorphisms in South American populations -whose genetic background is highly admixed- has been poorly studied. Hence, the aim of this study was to characterize polymorphisms related to chronic liver disease and their association with the genetic ancestry of South American populations. RESULTS DNA samples from 258 healthy unrelated male volunteers were analyzed. The frequencies of G and C alleles of rs738409 polymorphism (PNPLA3 gene) were 74 % and 26 %, respectively; whereas the bAt (CCA) haplotype (VDR gene) was observed in 32.5 % of the samples. The GG genotype of PNPLA3 rs738409 and the bAt (CCA) haplotype -associated with an increased risk of chronic liver disease and progression towards liver cancer- were significantly more frequent among samples exhibiting maternal and paternal Native American haplogroups (63.7 % and 64.6 %), intermediate among admixed samples (45.1 % and 44.9 %; p = 0.03) and the lowest for Non-native American ancestry (30.1 % and 29.6 %; p = 0.001 and p = 0.0008). CONCLUSIONS These results suggest that individuals with Native American ancestry might have a high risk of chronic liver disorders and cancer. Furthermore, these data not only support the molecular evaluation of ancestry in multi-ethnic population studies, but also suggest that the characterization of these variants in South American populations may be useful for establishing public health policies aimed at high risk ethnic communities.
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Affiliation(s)
- Ana Cecilia Pontoriero
- Instituto de Ciencias Básicas y Medicina Experimental (ICBME), Hospital Italiano de Buenos Aires, Potosí 4240, C1199ACL, Buenos Aires, Argentina.
| | - Julieta Trinks
- Instituto de Ciencias Básicas y Medicina Experimental (ICBME), Hospital Italiano de Buenos Aires, Potosí 4240, C1199ACL, Buenos Aires, Argentina. .,National Scientific and Technical Research Council (CONICET), Av. Rivadavia 1917, C1033AAJ, Buenos Aires, Argentina.
| | - María Laura Hulaniuk
- Instituto de Ciencias Básicas y Medicina Experimental (ICBME), Hospital Italiano de Buenos Aires, Potosí 4240, C1199ACL, Buenos Aires, Argentina.
| | - Mariela Caputo
- National Scientific and Technical Research Council (CONICET), Av. Rivadavia 1917, C1033AAJ, Buenos Aires, Argentina. .,Servicio de Huellas Digitales Genéticas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junín 954, C1113AAD, Buenos Aires, Argentina.
| | - Lisandro Fortuny
- Servicio de Medicina Transfusional, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - Leandro Burgos Pratx
- Servicio de Medicina Transfusional, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - Analía Frías
- Servicio de Medicina Transfusional, Hospital Materno Infantil "Ramón Sardá", Esteban de Luca 2151, C1246ABQ, Buenos Aires, Argentina.
| | - Oscar Torres
- Servicio de Medicina Transfusional, Hospital Materno Infantil "Ramón Sardá", Esteban de Luca 2151, C1246ABQ, Buenos Aires, Argentina.
| | - Félix Nuñez
- Servicio de Medicina Transfusional, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - Adrián Gadano
- Servicio de Hepatología, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - Pablo Argibay
- Instituto de Ciencias Básicas y Medicina Experimental (ICBME), Hospital Italiano de Buenos Aires, Potosí 4240, C1199ACL, Buenos Aires, Argentina. .,National Scientific and Technical Research Council (CONICET), Av. Rivadavia 1917, C1033AAJ, Buenos Aires, Argentina.
| | - Daniel Corach
- National Scientific and Technical Research Council (CONICET), Av. Rivadavia 1917, C1033AAJ, Buenos Aires, Argentina. .,Servicio de Huellas Digitales Genéticas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junín 954, C1113AAD, Buenos Aires, Argentina.
| | - Diego Flichman
- National Scientific and Technical Research Council (CONICET), Av. Rivadavia 1917, C1033AAJ, Buenos Aires, Argentina. .,Cátedra de Virología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junín 954, C1113AAD, Buenos Aires, Argentina.
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Menzies V, Jallo N, Kinser P, Robins JLW, An K, Driscoll C, Starkweather A, Bajaj JS, Lyon DE. Shared symptoms and putative biological mechanisms in chronic liver disease: implications for biobehavioral research. Biol Res Nurs 2015; 17:222-9. [PMID: 25037448 PMCID: PMC5818716 DOI: 10.1177/1099800414541541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Liver disease affects over 25 million people in the United States and, despite advances in medical management resulting in increased survival, a majority of these individuals report multiple co-occurring symptoms that severely impair functioning and quality of life. The purpose of this review is to (1) propose defining these co-occurring symptoms as a symptom cluster of chronic liver disease (CLD), (2) discuss putative underlying biological mechanisms related to CLD, including the liver-gut-brain axis and influence of the microbiome, and (3) discuss the implications for biobehavioral research in this patient population. Biobehavioral research focusing on the interrelated, and possibly synergistic, mechanisms of these symptoms may lead to the development and testing of targeted symptom management interventions for improving function and quality of life in this growing patient population.
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Affiliation(s)
- Victoria Menzies
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Nancy Jallo
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Patricia Kinser
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Jo Lynne W Robins
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Kyungeh An
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Carolyn Driscoll
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jasmohan S Bajaj
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Debra E Lyon
- College of Nursing, University of Florida, Gainesville, FL
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Rana A, Riaz IB, Gruessner AC, Gruessner RW. Geographic inequity results in disparate mortality: a multivariate intent-to-treat analysis of liver transplant data. Clin Transplant 2015; 29:484-91. [PMID: 25530463 DOI: 10.1111/ctr.12499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 12/19/2022]
Abstract
CONTEXT The distribution of livers to listed transplant candidates shows substantial geographic inequity. OBJECTIVE To compare mortality between the 11 UNOS (United Network of Organ Sharing) regions from the time of listing and to show that the geographic region impacts survival. DESIGN, SETTING, AND PATIENTS We studied the data of 1930 adults listed with a Model for End-Stage Liver Disease (MELD) score of 18 for a liver transplant from March 1, 2002 through December 31, 2007. We calculated one- and three-yr survival rates and performed multivariate Cox regression analysis to determine significant risk factors for mortality. MAIN OUTCOME MEASURES Patient survival from the time of listing for transplantation. RESULTS Actual one-yr mortality rate from the time of listing ranged from 30.5% (Region 2) to 12.9% (Region 4). The three-yr mortality rate ranged from 42.0% (Region 2) to 21.6% (Region 4). Multivariate analysis showed a significant increase in mortality in Region 2 (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.21 to 1.83) and a significant decrease in mortality in Region 3 (OR, 0.74; 95% CI, 0.59 to 0.93). CONCLUSIONS We found significant differences in one- and three-yr mortality rates among UNOS regions. Regional disparities significantly affect patient survival and result in national inequality.
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Affiliation(s)
- Abbas Rana
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Irbaz Bin Riaz
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Rainer W Gruessner
- Division of Abdominal Transplantation, University of Arizona, Tucson, AZ, USA
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Shapshak P, Sinnott JT, Somboonwit C, Kuhn JH. Surveillance for Hepatitis C. GLOBAL VIROLOGY I - IDENTIFYING AND INVESTIGATING VIRAL DISEASES 2015. [PMCID: PMC7120481 DOI: 10.1007/978-1-4939-2410-3_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hepatitis C is a global public health problem. Globally, an estimated 170 million persons (3 % of the world’s population) have been infected with the hepatitis C virus, and an estimated 350,000 persons die annually from complications of chronic hepatitis C. Furthermore, an increasing trend in hepatitis C mortality in the USA was observed over the last decade; in 2007, mortality associated with hepatitis C surpassed mortality associated with HIV. As the hepatitis C epidemic continues, it is increasingly important to accurately measure hepatitis C-related morbidity and mortality in order to inform public health programs and policies and prioritize and evaluate prevention efforts. This chapter provides an overview of hepatitis C surveillance and methods used in the USA with some examples from other countries.
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Affiliation(s)
- Paul Shapshak
- Division of Infectious Diseases and International Medicine, USF Morsani College of Medicine, Tampa, Florida USA
| | - John T. Sinnott
- Infectious Diseases and International He, USF Morsani College of Medicine, Tampa, Florida USA
| | - Charurut Somboonwit
- Division of Infectious Diseases and Inte, USF Morsani College of Medicine, Tampa, Florida USA
| | - Jens H. Kuhn
- C.W. Bill Young Center for Biodefense & Emerging Infectious Diseases, NIH-NIAID Div. Clinical Research, Frederick, Maryland USA
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Samir AE, Dhyani M, Vij A, Bhan AK, Halpern EF, Méndez-Navarro J, Corey KE, Chung RT. Shear-wave elastography for the estimation of liver fibrosis in chronic liver disease: determining accuracy and ideal site for measurement. Radiology 2014; 274:888-96. [PMID: 25393946 DOI: 10.1148/radiol.14140839] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the accuracy of shear-wave elastography (SWE) for staging liver fibrosis in patients with diffuse liver disease (including patients with hepatitis C virus [HCV]) and to determine the relative accuracy of SWE measurements obtained from different hepatic acquisition sites for staging liver fibrosis. MATERIALS AND METHODS The institutional review board approved this single-institution prospective study, which was performed between January 2010 and March 2013 in 136 consecutive patients who underwent SWE before their scheduled liver biopsy (age range, 18-76 years; mean age, 49 years; 70 men, 66 women). Informed consent was obtained from all patients. SWE measurements were obtained at four sites in the liver. Biopsy specimens were reviewed in a blinded manner by a pathologist using METAVIR criteria. SWE measurements and biopsy results were compared by using the Spearman correlation and receiver operating characteristic (ROC) curve analysis. RESULTS SWE values obtained at the upper right lobe showed the highest correlation with estimation of fibrosis (r = 0.41, P < .001). Inflammation and steatosis did not show any correlation with SWE values except for values from the left lobe, which showed correlation with steatosis (r = 0.24, P = .004). The area under the ROC curve (AUC) in the differentiation of stage F2 fibrosis or greater, stage F3 fibrosis or greater, and stage F4 fibrosis was 0.77 (95% confidence interval [CI]: 0.68, 0.86), 0.82 (95% CI: 0.75, 0.91), and 0.82 (95% CI: 0.70, 0.95), respectively, for all subjects who underwent liver biopsy. The corresponding AUCs for the subset of patients with HCV were 0.80 (95% CI: 0.67, 0.92), 0.82 (95% CI: 0.70, 0.95), and 0.89 (95% CI: 0.73, 1.00). The adjusted AUCs for differentiating stage F2 or greater fibrosis in patients with chronic liver disease and those with HCV were 0.84 and 0.87, respectively. CONCLUSION SWE estimates of liver stiffness obtained from the right upper lobe showed the best correlation with liver fibrosis severity and can potentially be used as a noninvasive test to differentiate intermediate degrees of liver fibrosis in patients with liver disease.
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Affiliation(s)
- Anthony E Samir
- From the Department of Radiology (A.E.S., M.D.), Department of Pathology (A.K.B.), Institute for Technology Assessment (E.F.H.), and Department of Hepatology, Liver and GI Division, Department of Medicine (K.E.C., R.T.C.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (A.V.); and Department of Gastroenterology, National Medical Center, Hospital de Especialidades, CMN Siglo XXI, IMSS, Mexico City, Mexico (J.M.N.)
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Wang X, Lin SX, Tao J, Wei XQ, Liu YT, Chen YM, Wu B. Study of liver cirrhosis over ten consecutive years in Southern China. World J Gastroenterol 2014; 20:13546-13555. [PMID: 25309085 PMCID: PMC4188906 DOI: 10.3748/wjg.v20.i37.13546] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/21/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the etiology and complications of liver cirrhosis (LC) in Southern China.
METHODS: In this retrospective, cross-sectional study, we identified cases of liver cirrhosis admitted between January 2001 to December 2010 and reviewed the medical records. Patient demographics, etiologies and complications were collected, and etiological changes were illustrated by consecutive years and within two time periods (2001-2005 and 2006-2010). All results were expressed as the mean ± SD or as a percentage. The χ2 test or Student’s t-test was used to analyze the differences in age, gender, and etiological distribution, and one-way analysis of variance was applied to estimate the trends in etiological changes. We analyzed the relationship between the etiologies and complications using unconditioned logistic regression, and the risk of upper gastrointestinal bleeding (UGIB) and hepatocellular carcinoma (HCC) in the major etiological groups was evaluated as ORs. A P value less than 0.05 was considered significant. Statistical computation was performed using SPSS 17.0 software.
RESULTS: In this study, we identified 6719 (83.16%) male patients and 1361 (16.84%) female patients. The average age of all of the patients was 50.5 years at the time of diagnosis. The distribution of etiological agents was as follows: viral hepatitis, 80.62% [hepatitis B virus (HBV) 77.22%, hepatitis C virus (HCV) 2.80%, (HBV + HCV) 0.58%]; alcohol, 5.68%; mixed etiology, 4.95%; cryptogenic, 2.93%; and autoimmune hepatitis, 2.03%; whereas the other included etiologies accounted for less than 4% of the total. Infantile hepatitis syndrome LC patients were the youngest (2.5 years of age), followed by the metabolic LC group (27.2 years of age). Viral hepatitis, alcohol, and mixed etiology were more prevalent in the male group, whereas autoimmune diseases, cryptogenic cirrhosis, and metabolic diseases were more prevalent in the female group. When comparing the etiological distribution in 2001-2005 with that in 2006-2010, the proportion of viral hepatitis decreased from 84.7% to 78.3% (P < 0.001), and the proportion of HBV-induced LC also decreased from 81.9% to 74.6% (P < 0.001). The incidence of mixed etiology, cryptogenic cirrhosis, and autoimmune diseases increased by 3.1% (P < 0.001), 0.5% (P = 0.158), and 1.3% (P < 0.001), respectively. Alcohol-induced LC remained relatively steady over the 10-year period. The ORs of the development of UGIB between HBV and other major etiologies were as follows: HCV, 1.07; alcohol, 1.89; autoimmune, 0.90; mixed etiology, 0.83; and cryptogenic, 1.76. The ORs of the occurrence of HCC between HBV and other major etiologies were as follows: HCV, 0.54; alcohol, 0.16; autoimmune, 0.05; mixed etiology, 0.58; and cryptogenic, 0.60.
CONCLUSION: The major etiology of liver cirrhosis in Southern China is viral hepatitis. However, the proportions of viral hepatitis and HBV are gradually decreasing. Alcoholic LC patients exhibit a greater risk of experiencing UGIB, and HBV LC patients may have a greater risk of HCC.
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Abstract
BACKGROUND Cirrhosis is diagnosed in patients of all ages and is the end result of many different diseases. The aim of this study was to characterize clinical and ethnic features of adult patients who were admitted to the hospital at different (young/old) ages and examine associations between age and ethnicity within these groups. METHODS In this retrospective analysis of a diverse cohort of 2017 patients with a clinical diagnosis of cirrhosis between January 2001 and December 2011, we focused on age, ethnicity, and outcome of patients with cirrhosis. RESULTS We identified 219 patients younger than the age of 40 years, including 87 (11%) of 802 white, 31 (6%) of 550 African American, and 89 (16%) of 550 Hispanic patients (P < 0.001). Ethnicity and causes of cirrhosis were found to have a significant correlation with age. Overall, Hispanic and white patients together were more than twice as likely to be diagnosed with cirrhosis at an age younger than 40 years compared with African American patients (P < 0.001). Autoimmune hepatitis caused cirrhosis at a younger age regardless of ethnicity (P < 0.001), whereas cryptogenic/nonalcoholic fatty liver disease/nonalcoholic steatohepatitis was more likely identified at an older age (P = 0.008). African American patients with cirrhosis due to either alcohol or hepatitis C virus were older than Hispanic (P < 0.001 and P = 0.003, respectively) and white patients (P < 0.001 and P < 0.001, respectively) at presentation. Finally, younger patients admitted with cirrhosis had a higher in-hospital mortality rate (P < 0.001). CONCLUSIONS The data suggest an association between ethnicity and age of cirrhosis diagnosis, both overall and in patients with certain cirrhosis etiologies. This work raises the possibility of an ethnic and/or genetic basis for cirrhosis.
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Affiliation(s)
- Krishna C. Sajja
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center and Parkland Memorial Hospital, Dallas, TX, USA
| | - Desh P. Mohan
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center and Parkland Memorial Hospital, Dallas, TX, USA
| | - Don C. Rockey
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA
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Kim Y, Ejaz A, Tayal A, Spolverato G, Bridges JFP, Anders RA, Pawlik TM. Temporal trends in population-based death rates associated with chronic liver disease and liver cancer in the United States over the last 30 years. Cancer 2014; 120:3058-65. [PMID: 24917245 PMCID: PMC4316688 DOI: 10.1002/cncr.28843] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/28/2014] [Accepted: 05/07/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND The health and economic burden from liver disease in the United States is substantial and rising. The objective of this study was to characterize temporal trends in mortality from chronic liver disease and liver cancer and the incidence of associated risk factors using population-based data over the past 30 years. METHODS Population-based mortality data were obtained from the National Vital Statistics System, and population estimates were derived from the national census for US adults (aged >45 years). Crude death rates (CDRs), age-adjusted death rates (ADRs), and average annual percentage change (AAPC) statistics were calculated. RESULTS In total, 690,414 deaths (1.1%) were attributable to chronic liver disease, whereas 331,393 deaths (0.5%) were attributable to liver cancer between 1981 and 2010. The incidence of liver cancer was estimated at 7.1 cases per 100,000 population. Mortality rates from chronic liver disease and liver cancer increased substantially over the past 3 decades, with ADRs of 23.7 and 16.6 per 100,000 population in 2010, respectively. The AAPC from 2006 to 2010 demonstrated an increased ADR for chronic liver disease (AAPC, 1.5%; 95% confidence interval, 0.3%-2.8%) and liver cancer (AAPC, 2.6%; 95% confidence interval, 2.4%-2.7%). CONCLUSIONS A comprehensive approach that involves primary and secondary prevention, increased access to treatment, and more funding for liver-related research is needed to address the high death rates associated with chronic liver disease and liver cancer in the United States.
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Affiliation(s)
- Yuhree Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aslam Ejaz
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Surgery, University of Illinois Hospital and Health Sciences Center, Chicago, Illinois
| | - Amit Tayal
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gaya Spolverato
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John F. P. Bridges
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert A. Anders
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy M. Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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K-t GRAPPA-accelerated 4D flow MRI of liver hemodynamics: influence of different acceleration factors on qualitative and quantitative assessment of blood flow. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2014; 28:149-59. [PMID: 25099493 DOI: 10.1007/s10334-014-0456-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/08/2014] [Accepted: 07/18/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We sought to evaluate the feasibility of k-t parallel imaging for accelerated 4D flow MRI in the hepatic vascular system by investigating the impact of different acceleration factors. MATERIALS AND METHODS k-t GRAPPA accelerated 4D flow MRI of the liver vasculature was evaluated in 16 healthy volunteers at 3T with acceleration factors R = 3, R = 5, and R = 8 (2.0 × 2.5 × 2.4 mm(3), TR = 82 ms), and R = 5 (TR = 41 ms); GRAPPA R = 2 was used as the reference standard. Qualitative flow analysis included grading of 3D streamlines and time-resolved particle traces. Quantitative evaluation assessed velocities, net flow, and wall shear stress (WSS). RESULTS Significant scan time savings were realized for all acceleration factors compared to standard GRAPPA R = 2 (21-71 %) (p < 0.001). Quantification of velocities and net flow offered similar results between k-t GRAPPA R = 3 and R = 5 compared to standard GRAPPA R = 2. Significantly increased leakage artifacts and noise were seen between standard GRAPPA R = 2 and k-t GRAPPA R = 8 (p < 0.001) with significant underestimation of peak velocities and WSS of up to 31 % in the hepatic arterial system (p <0.05). WSS was significantly underestimated up to 13 % in all vessels of the portal venous system for k-t GRAPPA R = 5, while significantly higher values were observed for the same acceleration with higher temporal resolution in two veins (p < 0.05). CONCLUSION k-t acceleration of 4D flow MRI is feasible for liver hemodynamic assessment with acceleration factors R = 3 and R = 5 resulting in a scan time reduction of at least 40 % with similar quantitation of liver hemodynamics compared with GRAPPA R = 2.
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Roberts HW, Utuama OA, Klevens M, Teshale E, Hughes E, Jiles R. The contribution of viral hepatitis to the burden of chronic liver disease in the United States. Am J Gastroenterol 2014; 109:387-93; quiz 386, 394. [PMID: 24445570 DOI: 10.1038/ajg.2013.477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 12/07/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Chronic liver disease (CLD) is increasingly recognized as a major public health problem. However, in the United States, there are few nationally representative data on the contribution of viral hepatitis as an etiology of CLD. METHODS We applied a previously used International Classification of Diseases, Ninth Revision, Clinical Modification-based definition of CLD cases to the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey databases for 2006-2010. We estimated the mean number of CLD visits per year, prevalence ratio of visits by patient characteristics, and the percentage of CLD visits attributed to viral hepatitis and other selected etiologies. RESULTS An estimated 6.0 billion ambulatory care visits occurred in the United States from 2006 to 2010, of which an estimated 25.8 million (0.43%) were CLD-related. Among adults aged 45-64 years, Medicaid and Medicare recipients were 3.9 (prevalence ratio (PR)=3.9, 95% confidence limit (CL; 2.8, 5.4)) and 2.3 (PR=2.3, 95% CL (1.6, 3.4)) times more likely to have a CLD-related ambulatory visit than those with private insurance, respectively. In the United States, from 2006 to 2010, an estimated 49.6% of all CLD-related ambulatory visits were attributed solely to viral hepatitis B and C diagnoses. CONCLUSIONS In this unique application of health-care utilization data, we confirm that viral hepatitis is an important etiology of CLD in the United States, with hepatitis B and C contributing approximately one-half of the CLD burden. CLD ambulatory visits in the United States disproportionately occur among adults, aged 45-64 years, who are primarily minorities, men, and Medicare or Medicaid recipients.
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Affiliation(s)
- Henry W Roberts
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, Georgia, USA
| | - Ovie A Utuama
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, Georgia, USA
| | - Monina Klevens
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, Georgia, USA
| | - Eyasu Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, Georgia, USA
| | - Elizabeth Hughes
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, Georgia, USA
| | - Ruth Jiles
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, Georgia, USA
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Ly KN, Xing J, Klevens RM, Jiles RB, Holmberg SD. Causes of death and characteristics of decedents with viral hepatitis, United States, 2010. Clin Infect Dis 2014; 58:40-9. [PMID: 24065331 PMCID: PMC11005812 DOI: 10.1093/cid/cit642] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Previous research indicates that the mortality burden from viral hepatitis is growing, particularly among middle-aged persons. To monitor progress toward prevention goals, it is important to continue to document characteristics and comortalities of these deaths. This study sought to examine demographic characteristics and the most frequent causes of death among decedents with a viral hepatitis-related death. METHODS A cross-sectional study was performed on approximately 2.4 million death records from 2010. We calculated mortality rates for decedents with and without hepatitis A, B, and C virus (HAV, HBV, and HCV) and relative risks for the most frequently cited conditions in decedents with and without HBV and HCV. RESULTS In 2010, there were 18 473 (0.7%) deaths with HAV, HBV, and HCV listed among causes of death, disproportionately in those aged 45-64 years. Among the 10 frequent causes of death, decedents listing HBV or HCV died, on average, 22-23 years earlier than decedents not listing these infections. HBV- and HCV-infected decedents aged 45-64 years had an increased risk of having the following conditions reported than decedents without these infections: cancer of liver and intrahepatic bile duct; fibrosis, cirrhosis, and other liver diseases; alcohol-related liver disease; gastrointestinal hemorrhage; human immunodeficiency infection; acute and unspecified renal failure; and septicemia (HCV only). CONCLUSIONS Decedents with other causes of death that include HBV or HCV died 22-23 years earlier than decedents not listing these infections. These data suggest and support the need for prevention, early identification, and treatment of HBV and HCV.
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Affiliation(s)
- Kathleen N Ly
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
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Using Transient Elastography to Detect Chronic Liver Diseases in a Primary Care Nurse Consultancy. Nurs Res 2013; 62:450-4. [DOI: 10.1097/nnr.0000000000000001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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