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Clayton-Chubb D, Kemp WW, Majeed A, Woods RL, Ryan J, Murray AM, Chong TTJ, Lubel JS, Tran C, Hodge AD, Schneider HG, McNeil JJ, Roberts SK. Late-Life Metabolic Dysfunction-Associated Steatotic Liver Disease and its Association With Physical Disability and Dementia. J Gerontol A Biol Sci Med Sci 2024; 79:glae011. [PMID: 38227760 PMCID: PMC10923210 DOI: 10.1093/gerona/glae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The burden of metabolic dysfunction-associated steatotic liver disease (MASLD) is growing rapidly, including among older adults. The number of older adults is also rising with concomitantly increasing rates of age-related physical and cognitive dysfunction. However, data on whether MASLD affects physical and cognitive function in older adults is limited. As such, we aimed to identify whether prevalent MASLD influences the risk of incident physical disability or dementia in initially healthy older adults. METHODS A post-hoc analysis of participants from the ASPREE-XT cohort study, which recruited community-dwelling older adults without a history of cardiovascular disease, dementia, or independence-limiting functional impairment. The Fatty Liver Index (to identify MASLD) was calculated in those with complete data. Cox proportional-hazards models were used to investigate the outcomes of dementia and persistent physical disability in participants with MASLD vs those without. RESULTS Of the 9 097 individuals included (mean age 75.1 ± 4.2 years; 45.0% men), 341 (3.7%) developed persistent physical disability and 370 (4.1%) developed dementia over a median follow-up of 6.4 years (IQR 5.3-7.5 years). When adjusting for known contributors including age, gender, education, comorbidity, and functional measures, MASLD was associated with an increased risk of persistent physical disability (HR 1.41 [95% CI: 1.07-1.87]) and reduced risk of incident dementia (HR 0.63 [95% CI: 0.48-0.83]). CONCLUSIONS Prevalent MASLD is associated with reduced rates of incident dementia but increased risk of persistent physical disability in initially relatively healthy older adults. Understanding the mechanisms underlying these divergent results to allow appropriate risk stratification and counseling is important.
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Affiliation(s)
- Daniel Clayton-Chubb
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - William W Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research and Department of Medicine, Geriatrics Division, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Trevor T J Chong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alexander D Hodge
- Department of Medicine, Eastern Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, Victoria, Australia
| | - Hans G Schneider
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Clinical Biochemistry Unit, Alfred Pathology Service, Alfred Health, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Vaz K, Kemp WW, Majeed A, Lubel J, Magliano D, Glenister K, Bourke L, Simmons D, Roberts SK. Steatotic liver disease in rural and regional Victoria, according to the NAFLD and newer diagnostic criteria: retrospective cohort analyses of 2001-03 and 2016-18 data. Med J Aust 2024; 220:97-99. [PMID: 38113294 DOI: 10.5694/mja2.52189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/22/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Karl Vaz
- Alfred Health, Melbourne, VIC
- Central Clinical School, Monash University, Melbourne, VIC
| | - William W Kemp
- Alfred Health, Melbourne, VIC
- Central Clinical School, Monash University, Melbourne, VIC
| | - Ammar Majeed
- Alfred Health, Melbourne, VIC
- Central Clinical School, Monash University, Melbourne, VIC
| | - John Lubel
- Alfred Health, Melbourne, VIC
- Central Clinical School, Monash University, Melbourne, VIC
| | | | | | - Lisa Bourke
- The University of Melbourne, Shepparton, VIC
| | - David Simmons
- The University of Melbourne, Shepparton, VIC
- Macarthur Clinical School, Western Sydney University, Sydney, NSW
| | - Stuart K Roberts
- Alfred Health, Melbourne, VIC
- Central Clinical School, Monash University, Melbourne, VIC
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Clayton-Chubb D, Kemp WW, Majeed A, Lubel JS, Woods RL, Tran C, Ryan J, Hodge A, Schneider HG, McNeil JJ, Roberts SK. Metabolic dysfunction-associated steatotic liver disease in older adults is associated with frailty and social disadvantage. Liver Int 2024; 44:39-51. [PMID: 37698034 DOI: 10.1111/liv.15725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND & AIMS The burden of metabolic dysfunction-associated steatotic liver disease (MASLD) is growing rapidly, as is the number of older adults globally. However, relatively few studies have been performed evaluating the prevalence and risk factors for MASLD in older adults. As such, we aimed to identify the prevalence of MASLD in older adults, as well as sociodemographic, clinical, functional and biochemical associations. METHODS The study population included older adults without a history of cardiovascular disease, dementia or independence-limiting functional impairment who had participated in the ASPirin in Reducing Events in the Elderly (ASPREE) randomised trial. MASLD was defined using the Fatty Liver Index (FLI). Associations were identified using Poisson regression with robust variance for FLI ≥ 60 vs FLI < 30. RESULTS 9097 Australian participants aged ≥70 years had complete biochemical and anthropometric data to identify MASLD. The study population had a mean age of 75.1 ± 4.3 years and was 45.0% male. Almost one-third (33.0%) had prevalent MASLD, and the prevalence decreased with increasing age (adjusted RR [aRR] 0.96, 95% CI: 0.96-0.97). MASLD was also negatively associated with social advantage (aRR 0.94, 95% CI: 0.90-0.99) and exercise tolerance and was positively associated with diabetes mellitus (aRR: 1.22, 95% CI: 1.16-1.29), hypertension (aRR: 1.31, 95% CI: 1.22-1.41), male sex (aRR: 1.66, 95% CI: 1.57-1.74), pre-frailty (aRR: 1.99, 95% CI: 1.82-2.12) and frailty (aRR: 2.36, 95% CI: 2.16-2.56). MASLD and nonalcoholic fatty liver disease (NAFLD) results were 100% concordant. CONCLUSION This study in a large cohort of relatively healthy community-dwelling older adults shows that MASLD is common, decreases with age and is associated with poorer metabolic health, social disadvantage and frailty.
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Affiliation(s)
- Daniel Clayton-Chubb
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
- Department of Gastroenterology, Eastern Health, Melbourne, Australia
| | - William W Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
- Department of Gastroenterology, Northern Health, Melbourne, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alexander Hodge
- Department of Gastroenterology, Eastern Health, Melbourne, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, Australia
- Department of Medicine, Eastern Clinical School, Monash University, Melbourne, Australia
| | - Hans G Schneider
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Pathology, Alfred Health, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
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Abdelmalak J, Strasser SI, Ngu N, Dennis C, Sinclair M, Majumdar A, Collins K, Bateman K, Dev A, Abasszade JH, Valaydon Z, Saitta D, Gazelakis K, Byers S, Holmes J, Thompson AJ, Pandiaraja D, Bollipo S, Sharma S, Joseph M, Nicoll A, Batt N, Sawhney R, Tang MJ, Lubel J, Riordan S, Hannah N, Haridy J, Sood S, Lam E, Greenhill E, Majeed A, Kemp W, Zalcberg J, Roberts SK. Improved Survival Outcomes with Surgical Resection Compared to Ablative Therapy in Early-Stage HCC: A Large, Real-World, Propensity-Matched, Multi-Centre, Australian Cohort Study. Cancers (Basel) 2023; 15:5741. [PMID: 38136287 PMCID: PMC10742146 DOI: 10.3390/cancers15245741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
The optimal treatment approach in very-early and early-stage hepatocellular carcinoma (HCC) is not precisely defined, and there is ambiguity in the literature around the comparative efficacy of surgical resection versus ablation as curative therapies for limited disease. We performed this real-world propensity-matched, multi-centre cohort study to assess for differences in survival outcomes between those undergoing resection and those receiving ablation. Patients with Barcelona Clinic Liver Cancer (BCLC) 0/A HCC first diagnosed between 1 January 2016 and 31 December 2020 who received ablation or resection as initial treatment were included in the study. A total of 450 patients were included in the study from 10 major liver centres including two transplant centres. Following propensity score matching using key covariates, 156 patients were available for analysis with 78 in each group. Patients who underwent resection had significantly improved overall survival (log-rank test p = 0.023) and local recurrence-free survival (log rank test p = 0.027) compared to those who received ablation. Based on real-world data, our study supports the use of surgical resection in preference to ablation as first-line curative therapy in appropriately selected BCLC 0/A HCC patients.
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Affiliation(s)
- Jonathan Abdelmalak
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - Simone I. Strasser
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Natalie Ngu
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Claude Dennis
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Marie Sinclair
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Avik Majumdar
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Kate Collins
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Katherine Bateman
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Anouk Dev
- Department of Gastroenterology, Monash Health, Clayton, VIC 3168, Australia; (A.D.); (J.H.A.)
| | - Joshua H. Abasszade
- Department of Gastroenterology, Monash Health, Clayton, VIC 3168, Australia; (A.D.); (J.H.A.)
| | - Zina Valaydon
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Daniel Saitta
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Kathryn Gazelakis
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Susan Byers
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Jacinta Holmes
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Parkville, VIC 3052, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Parkville, VIC 3052, Australia
| | - Dhivya Pandiaraja
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Suresh Sharma
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Merlyn Joseph
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Amanda Nicoll
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
- Department of Medicine, Eastern Health Clinical School, Box Hill, VIC 3128, Australia
| | - Nicholas Batt
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
- Department of Medicine, Eastern Health Clinical School, Box Hill, VIC 3128, Australia
| | - Myo J. Tang
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
| | - John Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
| | - Stephen Riordan
- Department of Gastroenterology, Prince of Wales Hospital, Randwick, NSW 2031, Australia;
| | - Nicholas Hannah
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - James Haridy
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - Siddharth Sood
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - Eileen Lam
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Elysia Greenhill
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Stuart K. Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
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Commins I, Clayton-Chubb D, Melton S, Majeed A, Kemp W, Roberts SK. Initial outcomes of a dedicated multidisciplinary non-alcoholic fatty liver disease clinic: a retrospective cohort study. Intern Med J 2023; 53:2065-2072. [PMID: 36880362 DOI: 10.1111/imj.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/12/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a major healthcare burden. Real-world outcomes in dedicated tertiary care settings in Australia remain unknown. AIM To evaluate the initial outcomes of patients referred to a dedicated multidisciplinary tertiary care NAFLD clinic. METHODS Retrospective review of all adult patients with NAFLD who attended a dedicated tertiary care NAFLD clinic between January 2018 and February 2020 and who had two clinic visits and FibroScans at least 12 months apart. Demographic and health-related clinical and laboratory data were extracted from electronic medical records. Key outcome measures were serum liver chemistries, liver stiffness measurement (LSM) and weight control at 12 months. RESULTS A total of 137 patients with NAFLD were included. Median (interquartile range (IQR)) follow-up time was 392 days (343-497 days). One hundred and eleven patients (81%) achieved weight control (i.e. weight loss or stability). Markers of liver disease activity were significantly improved, including median (IQR) serum alanine aminotransferase (48 (33-76) vs 41 (26-60) U/L, P = 0.009) and aspartate aminotransferase (35 (26-54) vs 32 (25-53) U/L, P = 0.020). Median (IQR) LSM across the whole cohort was significantly improved (8.4 (5.3-11.8) vs 7.0 (4.9-10.1) kPa, P = 0.001). No significant reduction was observed in mean body weight or the frequency of metabolic risk factors. CONCLUSIONS This study highlights a new model of care for patients with NAFLD and demonstrates promising initial outcomes in relation to significant reductions in markers of liver disease severity. Although most patients achieved weight control, further refinements are needed to achieve significant weight reduction including more frequent and structured dietetic and/or pharmacotherapeutic interventions.
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Affiliation(s)
- Isabella Commins
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Sarah Melton
- Department of Nutrition and Dietetics, Alfred Health, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
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Tan N, Lubel J, Kemp W, Roberts S, Majeed A. Current Therapeutics in Primary Sclerosing Cholangitis. J Clin Transl Hepatol 2023; 11:1267-1281. [PMID: 37577219 PMCID: PMC10412694 DOI: 10.14218/jcth.2022.00068s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/01/2023] [Accepted: 01/20/2023] [Indexed: 07/03/2023] Open
Abstract
Primary sclerosing cholangitis (PSC) is an orphan, cholestatic liver disease that is characterized by inflammatory biliary strictures with variable progression to end-stage liver disease. Its pathophysiology is poorly understood. Chronic biliary inflammation is likely driven by immune dysregulation, gut dysbiosis, and environmental exposures resulting in gut-liver crosstalk and bile acid metabolism disturbances. There is no proven medical therapy that alters disease progression in PSC, with the commonly prescribed ursodeoxycholic acid being shown to improve liver biochemistry at low-moderate doses (15-23 mg/kg/day) but not alter transplant-free survival or liver-related outcomes. Liver transplantation is the only option for patients who develop end-stage liver disease or refractory complications of PSC. Immunosuppressive and antifibrotic agents have not proven to be effective, but there is promise for manipulation of the gut microbiome with fecal microbiota transplantation and antibiotics. Bile acid manipulation via alternate synthetic bile acids such as norursodeoxycholic acid, or interaction at a transcriptional level via nuclear receptor agonists and fibrates have shown potential in phase II trials in PSC with several leading to larger phase III trials. In view of the enhanced malignancy risk, statins, and aspirin show potential for reducing the risk of colorectal cancer and cholangiocarcinoma in PSC patients. For patients who develop clinically relevant strictures with cholestatic symptoms and worsening liver function, balloon dilatation is safer compared with biliary stent insertion with equivalent clinical efficacy.
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Affiliation(s)
- Natassia Tan
- Department of Gastroenterology and Hepatology, Alfred Health; Central Clinical School, Monash University, Melbourne, Australia
| | - John Lubel
- Department of Gastroenterology and Hepatology, Alfred Health; Central Clinical School, Monash University, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology and Hepatology, Alfred Health; Central Clinical School, Monash University, Melbourne, Australia
| | - Stuart Roberts
- Department of Gastroenterology and Hepatology, Alfred Health; Central Clinical School, Monash University, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology and Hepatology, Alfred Health; Central Clinical School, Monash University, Melbourne, Australia
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Vaz K, Clayton-Chubb D, Majeed A, Lubel J, Simmons D, Kemp W, Roberts SK. Current understanding and future perspectives on the impact of changing NAFLD to MAFLD on global epidemiology and clinical outcomes. Hepatol Int 2023; 17:1082-1097. [PMID: 37556065 PMCID: PMC10522780 DOI: 10.1007/s12072-023-10568-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/27/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION For the first time in nearly half a century, fatty liver disease has undergone a change in name and definition, from the exclusive term, non-alcoholic fatty liver disease (NAFLD), to the inclusion-based, metabolic-associated fatty liver disease (MAFLD). This has led investigators across the globe to evaluate the impact the nomenclature change has had on the epidemiology and natural history of the disease. METHODS This systematic review provides a comprehensive overview on how the shift in name and diagnostic criteria has influenced point prevalence in different geographic regions, as well as morbidity and mortality risk, whilst highlighting gaps in the literature that need to be addressed. CONCLUSIONS MAFLD prevalence is higher than NAFLD prevalence, carries a higher risk of overall mortality, with greater granularity in risk-stratification amongst MAFLD subtypes.
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Affiliation(s)
- Karl Vaz
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
- Central Clinical School, Monash University, Melbourne, Australia.
| | - Daniel Clayton-Chubb
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - John Lubel
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - David Simmons
- Macarthur Clinical School, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - William Kemp
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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Vaz K, Kemp W, Majeed A, Lubel J, Magliano DJ, Glenister KM, Bourke L, Simmons D, Roberts SK. Non-alcoholic fatty liver disease prevalence in Australia has risen over 15 years in conjunction with increased prevalence of obesity and reduction in healthy lifestyle. J Gastroenterol Hepatol 2023; 38:1823-1831. [PMID: 37571988 PMCID: PMC10946623 DOI: 10.1111/jgh.16314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND AND AIM Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver condition globally. The aim of this study was to evaluate the change in age- and sex-standardized prevalence of NAFLD in regional Victoria over a 15-year period and explore the underlying factors associated with differences over time. METHODS Repeated comparative cross-sectional studies in four towns in regional Victoria, Australia. Individuals randomly selected from households from residential address lists from local government organizations in 2001-2003 (CrossRoads I [CR1]) and 2016-2018 (CrossRoads II [CR2]) with 1040 (99%) and 704 (94%) participants from CR1 and CR2 having complete data for analysis. Primary outcome was change in prevalence estimates of NAFLD (defined by a fatty liver index ≥ 60 in the absence of excess alcohol and viral hepatitis) between 2003 and 2018. RESULTS Crude prevalence of NAFLD increased from 32.7% to 38.8% (P < 0.01), while age-standardized/sex-standardized prevalence increased from 32.4% to 35.4% (P < 0.01). Concurrently, prevalence of obesity defined by BMI and elevated waist circumference increased 28% and 25%, respectively. Women had a greater increase in the prevalence of NAFLD than men, in parallel with increasing prevalence of obesity. Proportion of participants consuming takeaway food greater than once weekly increased significantly over time. Up to 60% of NAFLD patients require additional tests for assessment of significant fibrosis. CONCLUSIONS Crude and age-standardized/sex-standardized prevalence of NAFLD have both increased significantly over the last 15 years, particularly among women, in association with a parallel rise in the prevalence of obesity.
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Affiliation(s)
- Karl Vaz
- Department of Gastroenterology and HepatologyAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - William Kemp
- Department of Gastroenterology and HepatologyAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Ammar Majeed
- Department of Gastroenterology and HepatologyAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - John Lubel
- Department of Gastroenterology and HepatologyAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Dianna J Magliano
- Diabetes and Population HealthBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | | | - Lisa Bourke
- Department of Rural HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - David Simmons
- Department of Rural HealthUniversity of MelbourneMelbourneVictoriaAustralia
- School of Medicine, Macarthur Clinical SchoolWestern Sydney UniversityMelbourneVictoriaAustralia
| | - Stuart K Roberts
- Department of Gastroenterology and HepatologyAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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9
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Janko N, Majeed A, Kemp W, Hogan C, Nandurkar H, Roberts SK. Rotational ThromboElastometry-guided blood component administration versus standard of care in patients with Cirrhosis and coagulopathy undergoing Invasive ProcEdures (RECIPE): study protocol for a randomised controlled trial. Trials 2023; 24:516. [PMID: 37568228 PMCID: PMC10422802 DOI: 10.1186/s13063-023-07552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Patients with cirrhosis often undergo invasive procedures both for management of complications of their advanced liver disease, including treatment for hepatocellular carcinoma, as well as underlying comorbidities. Despite a current understanding that most patients with cirrhosis are in a rebalanced haemostatic state (despite abnormalities in conventional coagulation tests, namely INR and platelet count), patients with cirrhosis are still often given prophylactic blood components based on these conventional parameters, in an effort to reduce procedure-related bleeding. Viscoelastic tests such as Rotational Thromboelastometry (ROTEM) provide a global measurement of haemostasis and have been shown to predict bleeding risk more accurately than conventional coagulation tests, and better guide blood product transfusion in a number of surgical and trauma-related settings. The aim of this study is to assess the utility of a ROTEM-based algorithm to guide prophylactic blood component delivery in patients with cirrhosis undergoing invasive procedures. We hypothesise that ROTEM-based decision-making will lead to a reduction in pre-procedural blood component usage, particularly fresh frozen plasma (FFP), compared with standard of care, whilst maintaining optimal clinical outcomes. METHODS This is a multi-centre randomised controlled trial comparing ROTEM-guided prophylactic blood component administration to standard of care in patients with cirrhosis and coagulopathy undergoing invasive procedures. The primary efficacy outcome of the trial is the proportion of procedures requiring prophylactic transfusion, with the primary safety outcome being procedure-related bleeding complications. Secondary outcomes include the amount of blood products (FFP, platelets, cryoprecipitate) transfused, transfusion-related side effects, procedure-related complications other than bleeding, hospital length of stay and survival. DISCUSSION We anticipate that this project will lead to improved prognostication of patients with cirrhosis, in terms of their peri-procedural bleeding risk. We hope to show that a significant proportion of cirrhotic patients, deemed coagulopathic on the basis of standard coagulation tests such as INR and platelet count, are actually in a haemostatic balance and thus do not require prophylactic blood product, leading to decreased and more efficient blood component use. TRIAL REGISTRATION RECIPE has been prospectively registered with the Australia and New Zealand Clinical Trials Registry on the 30th April 2019 ( ACTRN12619000644167 ).
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Affiliation(s)
- Natasha Janko
- Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia.
- Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Chris Hogan
- Department of Laboratory Haematology, Austin Health, Melbourne, VIC, Australia
| | - Harshal Nandurkar
- Department of Haematology, Alfred Health, Melbourne, VIC, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
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10
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Abdelmalak J, Tan N, Con D, Eslick G, Majeed A, Kemp W, Roberts SK. The Effect of Aspirin Use on Incident Hepatocellular Carcinoma-An Updated Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:3518. [PMID: 37444628 DOI: 10.3390/cancers15133518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
An increasing number of observational studies have described an association between aspirin use and a reduced risk of incident hepatocellular carcinoma. We performed this meta-analysis to provide a comprehensive and updated aggregate assessment of the effect of aspirin on HCC incidence. Two independent authors performed a systematic search of the literature, utilising the Medline, Embase, Scopus, and PubMed databases. A total of 16 studies (12 cohort studies, and 4 case-control studies) were selected for inclusion, with a large number of studies excluded, due to an overlapping study population. The pooled analysis of cohort studies involving a total population of approximately 2.5 million subjects, 822,680 aspirin users, and 20,626 HCC cases demonstrated a 30% reduced risk of HCC associated with aspirin use (adjusted HR 0.70, 95%CI 0.60-0.81). There was a similar but non-significant association observed across the case-control studies (adjusted OR 0.60, 95%CI 0.32-1.15, p = 0.13), which involved a total of 1961 HCC cases. In a subgroup meta-analysis of patients with cirrhosis, the relationship between aspirin use and incident HCC diminished to non-significance (adjusted HR 0.96, 95%CI 0.84-1.09). Aspirin use was associated with a statistically significant increase in bleeding events when all relevant studies were pooled together (adjusted HR 1.11, 95%CI 1.02-1.22). Prospectively collected data should be sought, to define the optimal patient group in which aspirin is safe and effective for the chemoprophylaxis of HCC.
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Affiliation(s)
- Jonathan Abdelmalak
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3145, Australia
| | - Natassia Tan
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3145, Australia
| | - Danny Con
- Department of Gastroenterology, Austin Health, Heidelberg, VIC 3084, Australia
| | - Guy Eslick
- Clinical Links Using Evidence-Based Data (CLUED) Pty. Ltd., Sydney, NSW 2060, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3145, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3145, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3145, Australia
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11
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Clayton-Chubb D, Kemp W, Majeed A, Lubel JS, Hodge A, Roberts SK. Reply to Abenavoli et al. Comment on "Clayton-Chubb et al. Understanding NAFLD: From Case Identification to Interventions, Outcomes, and Future Perspectives. Nutrients 2023, 15, 687". Nutrients 2023; 15:2908. [PMID: 37447237 DOI: 10.3390/nu15132908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Thank you for your interesting comment [...].
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Affiliation(s)
- Daniel Clayton-Chubb
- Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC 3004, Australia
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC 3004, Australia
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC 3004, Australia
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - John S Lubel
- Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC 3004, Australia
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Alex Hodge
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC 3004, Australia
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
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12
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Mishra G, Majeed A, Dev A, Eslick GD, Pinato DJ, Izumoto H, Hiraoka A, Huo TI, Liu PH, Johnson PJ, Roberts SK. Clinical Utility of Albumin Bilirubin Grade as a Prognostic Marker in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: a Systematic Review and Meta-analysis. J Gastrointest Cancer 2023; 54:420-432. [PMID: 35635637 DOI: 10.1007/s12029-022-00832-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Hepatic function is a key prognostic marker in patients with hepatocellular cancer (HCC) and central to patient selection for transarterial chemoembolization (TACE). We investigated the clinical utility of the Albumin-Bilirubin (ALBI) grade, an emerging prognostic model, in this heterogenous cohort via a meta-analysis of published studies. METHODS Publications including full text articles and abstracts regarding ALBI grade were sourced by two independent researchers from databases including PubMed, Embase, Medline and Cochrane Library. Studies analysing patients with HCC undergoing TACE treatment were systematically screened utilising the PRISMA tool for data extraction and synthesis, after exclusion of duplicates, irrelevant studies and overlapping cohorts. The primary outcome was overall survival (OS), as determined by ALBI grade and assessed by hazard ratio (HRs) with 95% confidence intervals (CIs), with analysis of collated data using comprehensive meta-analysis, version 3.0 software. RESULTS Eight studies were included, with a pooled population of 6538 patients with HCC that underwent TACE treatment. Higher pre-treatment grade was associated with poor OS, with median OS of 12.0 months (P < 0.001) in ALBI grade 3, compared to 33.5 months in ALBI grade 1 (P < 0.001). Significant heterogeneity within each ALBI grade was associated with age and tumour size (P < 0.001) in ALBI grades 1 and 2. In contrast, age and alcohol-related liver disease were significant in the ALBI grade 3 group (P < 0.001). CONCLUSIONS High pre-treatment ALBI grade is associated with poorer prognosis in patients with HCC undergoing TACE therapy. The ALBI grade demonstrates clinical utility for clinical prognostication and patient selection for TACE.
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Affiliation(s)
- Gauri Mishra
- Gastroenterology Department, Monash Medical Centre, Melbourne, Australia.
- School of Clinical Sciences, Monash University, Melbourne, Australia.
| | - Ammar Majeed
- School of Clinical Sciences, Monash University, Melbourne, Australia
- Gastroenterology Department, Alfred Health, Melbourne, Australia
| | - Anouk Dev
- Gastroenterology Department, Monash Medical Centre, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Sydney, Australia
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Atsushi Hiraoka
- Gastroenterology Centre, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Teh-Ia Huo
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Po-Hong Liu
- Internal Medicine, University of Texas Southwestern Medical Centre, Dallas, Texas, USA
| | - Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Stuart K Roberts
- School of Clinical Sciences, Monash University, Melbourne, Australia
- Gastroenterology Department, Alfred Health, Melbourne, Australia
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13
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Toumpakari Z, Valerino-Perea S, Willis K, Adams J, White M, Vasiljevic M, Ternent L, Brown J, Kelly MP, Bonell C, Cummins S, Majeed A, Anderson S, Robinson T, Araujo-Soares V, Watson J, Soulsby I, Green D, Sniehotta FF, Jago R. Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study. Int J Behav Nutr Phys Act 2023; 20:64. [PMID: 37259093 DOI: 10.1186/s12966-023-01465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies. METHODS We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding. RESULTS We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication. CONCLUSIONS Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability.
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Affiliation(s)
- Z Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.
| | - S Valerino-Perea
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - K Willis
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - J Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - M White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - M Vasiljevic
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Department of Psychology, Durham University, Durham, UK
| | - L Ternent
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - J Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - M P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - C Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - S Cummins
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - S Anderson
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Department of Psychology, Durham University, Durham, UK
| | - T Robinson
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- The National Institute for Health Research, Applied Research Collaboration Northeast and North Cumbria (NIHR ARC NENC), St Nicholas' Hospital, Newcastle Upon Tyne, Jubilee Road, Gosforth, NE3 3XT, UK
| | - V Araujo-Soares
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Faculty of Behavioural, Management and Social Sciences, Department of Health Technology and Services Research, University of Twente, Twente, The Netherlands
| | - J Watson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
- South Gloucestershire Council, Badminton Road, Yate, Bristol, BS37 5AF, UK
| | - I Soulsby
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
| | - D Green
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - F F Sniehotta
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- Department for Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - R Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Applied Research Collaboration West (NIHR ARC West), The National Institute for Health Research, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, BS1 2NT, UK
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Janko N, Majeed A, Clements W, Fink MA, Lubel J, Goodwin M, Nicoll A, Strasser SI, Sood S, Bollipo S, Bate J, Bowers KA, George J, Kemp W, Roberts SK. Wide variation in pre-procedural blood product transfusion practices in cirrhosis: a national multidisciplinary survey. Hepatol Commun 2023; 7:02009842-202305010-00014. [PMID: 37102761 PMCID: PMC10146548 DOI: 10.1097/hc9.0000000000000147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/16/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND AND AIMS Recent guidelines recognize the limitations of standard coagulation tests in predicting bleeding and guiding pre-procedural blood component prophylaxis in cirrhosis. It is unclear whether these recommendations are reflected in clinical practice. We performed a nationwide survey to investigate pre-procedural transfusion practices and opinions of key health care stakeholders involved in managing cirrhosis. METHODS We designed a 36-item multiple-choice questionnaire to investigate the international normalized ratio and platelet cutoffs utilized to guide pre-procedural transfusion of fresh frozen plasma and platelets in patients with cirrhosis undergoing a range of low and high-risk invasive procedures. Eighty medical colleagues from all mainland States involved in managing patients with cirrhosis were invited by email to participate. RESULTS Overall, 48 specialists across Australia completed the questionnaire: 21 gastroenterologists, 22 radiologists, and 5 hepatobiliary surgeons. 50% of respondents reported that their main workplace did not have written guidelines relating to pre-procedural blood component prophylaxis in patients with cirrhosis. There was marked variation in routine prophylactic transfusion practices across institutions for the different procedures and international normalized ratio and platelet cutoffs. This variation was present both within and between specialty groups and held for both low and high-risk procedures. For scenarios where the platelet count was ≤ 50 × 109/L, 61% of respondents stated that prophylactic platelet transfusions would be given before low-risk and 62% before high-risk procedures at their center. For scenarios where the international normalized ratio was ≥2, 46% of respondents stated that prophylactic fresh frozen plasma would be routinely given before low-risk procedures and 74% before high-risk procedures. CONCLUSION Our survey reveals significant heterogeneity of pre-procedural prophylactic transfusion practices in patients with cirrhosis and discrepancies between guidelines and clinical practice.
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Affiliation(s)
- Natasha Janko
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Warren Clements
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Michael A Fink
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Australia
| | - John Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mark Goodwin
- Department of Radiology, Interventional Radiology Service, Austin Hospital, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Amanda Nicoll
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Center, Royal Prince Alfred Hospital and University of Sydney, NSW, Australia
| | - Siddharth Sood
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia
- School of Medicine & Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - John Bate
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, South Australia, Australia
| | - Kaye A Bowers
- Department of Hepatobiliary Surgery, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, University of Sydney, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Vaz K, Little R, Majeed A, Roberts S, Kemp W. Letter to the Editor: Predicting mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis-Does novelty supplant the standard? Hepatology 2023; 77:E74-E75. [PMID: 36169940 DOI: 10.1002/hep.32811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/08/2022]
Affiliation(s)
- Karl Vaz
- Department of Gastroenterology and Hepatology , Alfred Health , Melbourne , Victoria , Australia
- Central Clinical School , Monash University , Melbourne , Victoria , Australia
| | - Robert Little
- Department of Gastroenterology and Hepatology , Alfred Health , Melbourne , Victoria , Australia
- Central Clinical School , Monash University , Melbourne , Victoria , Australia
| | - Ammar Majeed
- Department of Gastroenterology and Hepatology , Alfred Health , Melbourne , Victoria , Australia
- Central Clinical School , Monash University , Melbourne , Victoria , Australia
| | - Stuart Roberts
- Department of Gastroenterology and Hepatology , Alfred Health , Melbourne , Victoria , Australia
- Central Clinical School , Monash University , Melbourne , Victoria , Australia
| | - William Kemp
- Department of Gastroenterology and Hepatology , Alfred Health , Melbourne , Victoria , Australia
- Central Clinical School , Monash University , Melbourne , Victoria , Australia
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Braude M, Roberts S, Majeed A, Lubel J, Prompen J, Dev A, Sievert W, Bloom S, Gow P, Kemp W. Liver stiffness (Fibroscan®) is a predictor of all-cause mortality in people with non-alcoholic fatty liver disease. Liver Int 2023; 43:90-99. [PMID: 36050821 PMCID: PMC10086842 DOI: 10.1111/liv.15415] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/03/2022] [Accepted: 08/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Progressive liver fibrosis related to non-alcoholic fatty liver disease (NAFLD) is associated with all-cause and liver-related mortality. We assessed vibration-controlled transient elastography (VCTE) as a predictor of mortality. METHOD Data from patients who underwent VCTE for NAFLD at four large health services in Victoria, Australia between the years 2008 and 2019 were linked to state-wide data registries. Cause of death (COD) and predictors of all-cause mortality were subsequently analysed using descriptive statistics and Cox-proportional regression analysis. RESULTS Of 7079 VCTE records submitted for data linkage, 6341 were matched via data registry linkage. There were 217 deaths over a 22 653 person-year follow-up. COD included malignancies other than hepatocellular carcinoma (HCC) (18.0%, n = 39), sepsis (16.1%, n = 35), decompensated liver disease (15.2%, n = 33), cardiac disease (15.2%, n = 33) and HCC 6.0% (n = 13). Controlled attenuation parameter (CAP) was not associated with mortality in univariable analysis (HR = 1.00, CI 1.0-1.0, p = .488). Increased liver stiffness measurement (LSM) (HR 1.02 per kiloPascal, CI 1.01-1.03, p < .001), Charlson comorbidity index (CCI) (HR 1.32 for each point, CI 1.27-1.38, p < .001) and age (HR 1.05 per annum, CI 1.03-1.07, p < .001) were each associated with higher rates of all-cause mortality in multivariable analysis. LSM ≥10 kPa suggestive of compensated advanced chronic liver disease (cACLD) was associated with mortality in multivariable analysis (HR 2.31, CI 1.73-3.09, p < .001). CONCLUSION VCTE LSM, in addition to age and CCI, is independently associated with increased all-cause mortality in a large cohort with NAFLD.
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Affiliation(s)
- Michael Braude
- Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Stuart Roberts
- Gastroenterology and Hepatology, Alfred Health, Melbourne, Victoria, Australia.,Monash Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Ammar Majeed
- Gastroenterology and Hepatology, Alfred Health, Melbourne, Victoria, Australia.,Monash Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - John Lubel
- Gastroenterology and Hepatology, Alfred Health, Melbourne, Victoria, Australia.,Monash Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Jirayut Prompen
- Gastroenterology and Hepatology, Alfred Health, Melbourne, Victoria, Australia
| | - Anouk Dev
- Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - William Sievert
- Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Stephen Bloom
- Monash Central Clinical School, Monash University, Clayton, Victoria, Australia.,Gastroenterology and Hepatology, Eastern Health, Box Hill, Victoria, Australia
| | - Paul Gow
- Gastroenterology, Austin Health, Heidelberg, Victoria, Australia.,Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - William Kemp
- Gastroenterology and Hepatology, Alfred Health, Melbourne, Victoria, Australia.,Monash Central Clinical School, Monash University, Clayton, Victoria, Australia
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17
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Majeed A, Bailey M, Kemp W, Majumdar A, Bellomo R, Pilcher D, Roberts SK. Improved survival of cirrhotic patients with infections in Australian and New Zealand ICUs between 2005 and 2017. Liver Int 2023; 43:49-59. [PMID: 35532544 DOI: 10.1111/liv.15285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 03/22/2022] [Accepted: 04/23/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Changes in outcomes of cirrhotic patients admitted to intensive care units (ICUs) with infections are poorly understood. We aimed to describe changes over time in outcomes for such patients and to compare them to other ICU admissions. METHODS Analysis of consecutive admissions to 188 ICUs between 2005 and 2017 as recorded in the Australian and New Zealand Intensive Care Society Centre for Outcome and Research Evaluation Adult Patient Database. RESULTS Admissions for cirrhotic patients with infections accounted for 4645 (0.6%) of 813 189 non-elective ICU admissions. Hospital mortality rate (35.5%) was significantly higher compared with other cirrhotic patients' admissions (28.5%), and other ICU admissions for infection (17.1%, p < .0001), and increased to 52.2% in the presence of acute-on-chronic liver failure (ACLF). Hospital mortality in cirrhotic patients' ICU admissions for infection decreased significantly over time (annual decline odds ratio, 0.97; 95% CI, 0.95-0.99, p = .002). There was a comparable reduction in-hospital mortality rates over time in other ICU admissions for infections and other cirrhotic patients' ICU admissions. However, mortality rates did not change over time in the ACLF subgroup. Median hospital and ICU length of stays for cirrhotic patients' ICU admissions for infections were 12.1 and 3.5 days, respectively, and decreased significantly by 1 day every 4 years in-hospital survivors(p < .0001). CONCLUSION Hospital mortality in ICU admissions for cirrhotic patients with infection is double that of non-cirrhotic patients with infection but has declined significantly over time. Outcomes in the subgroup with ACLF remained poor without significant improvement over the study period.
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Affiliation(s)
- Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Australia.,ANZICS Centre for Outcome and Resource Evaluation (CORE), Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, The University of Sydney, Sydney, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Australia.,ANZICS Centre for Outcome and Resource Evaluation (CORE), Melbourne, Australia.,Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
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18
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Razzaq H, Rao A, Sathananthan S, Majeed A, Dworkin M. Screening tool to improve patient referral to acute surgical care from accident and emergency. Ann R Coll Surg Engl 2023; 105:14-19. [PMID: 35133208 PMCID: PMC9773239 DOI: 10.1308/rcsann.2021.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION This study aimed, first, to audit the appropriateness of surgical referrals to an acute surgical unit for urgent assessment and, second, to devise a screening tool for use in the emergency department to categorise patients into those who need an urgent surgical review and those who can be seen in an ambulatory setting within the next few days. METHODS The first phase of the study was an audit of surgical referrals between 1 and 18 February 2020 to check the appropriateness of the surgical referral. In the second phase, a tool was designed to screen patients who did not require urgent surgical review and could be seen in the ambulatory clinic. A prospective questionnaire study was conducted from 1 February to 24 March 2020 with patients who were admitted to an acute surgical ward. Based on responses to the screening tool, patients were given the outcome of whether they can be discharged and seen in an ambulatory clinic. The accuracy of the screening tool outcome was assessed and compared with actual patient discharge outcomes by the surgical team evaluating patients' electronic medical records. RESULTS In the first audit of referrals to the acute surgical ward, 206 patients were referred to the acute surgical unit and seen by the senior surgeon. Of these, 142 (68.9%) were discharged on the same day with or without follow-up in the ambulatory surgical clinic. In the prospective questionnaire phase of the study, 98 patients completed the questionnaire. The most common presentation was abdominal pain (n=60) followed by urological symptoms (n=11), symptoms of hernia complication (n=10), abscess (n=7), testicular pain (n=2) and trauma (n=2). Of the patients discharged on the same day, 50% were given ambulatory care appointments and 50% were discharged with no further follow-up. The sensitivity and specificity of the screening tool were 100% and 60.7%, respectively; the overall accuracy was 88.4%. CONCLUSION A large proportion of patients who are referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool used for acute surgical referral had reasonable sensitivity and high specificity to screen patients who can be seen in ambulatory clinics. At the same time, it identified patients who were unwell and required urgent surgical admission.
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Affiliation(s)
- H Razzaq
- Mid and South Essex NHS Foundation Trust, UK
| | - A Rao
- Mid and South Essex NHS Foundation Trust, UK
| | | | | | - M Dworkin
- Mid and South Essex NHS Foundation Trust, UK
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19
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Foley KA, Maile EJ, Bottle A, Neale FK, Viner RM, Kenny SE, Majeed A, Hargreaves DS, Saxena S. How did the covid-19 pandemic affect lower respiratory tract infections in young children in England? Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Social distancing policies to reduce transmission of covid-19 also reduced children's exposures to endemic respiratory viruses. We aimed to examine the impact of the covid-19 pandemic on lower respiratory tract infections in under 5s presenting to primary care in England.
Methods
Longitudinal trends analysis using electronic health records from a nationally representative primary care database. Our target population was children aged <5 years registered with a primary care practice from January 2015 to March 2021.
Our main outcome was total weekly contacts with primary care for a lower respiratory tract infection (LRTI). We defined three pandemic phases from March 2020 - March 2021: i) first national lockdown (late March to early June 2020), ii) childcare settings reopened and second national lockdown with schools open (mid-June to mid-December 2020) and iii) third national lockdown with schools closed (late December 2020 to end of March 2021). We compared outcomes during each of the three phases with corresponding calendar weeks during pre-pandemic years 2015 to 2019.
Results
Our study population included 843 020 children <5 years who had 1 076 181 contacts with primary care for LRTIs. During the first phase (first lockdown) there were falls of 79.3% (95% CI: 73.6 to 84.5) from an average of 28 547 primary care contacts for LRTI in 2015 - 2019 to 5915 in 2020; there was a 78.9% (95% CI: 73.7 to 83.9) fall in phase two (childcare settings reopened and second lockdown) from 107 873 to 22 792 contacts; and a 77.7% (95% CI: 73.5 to 81.4) fall in phase three (third lockdown) from 57 200 to 12 764 contacts.
Conclusions
Children under 5 in England had fewer contacts with primary care for LRTIs during the covid-19 pandemic. This change likely reflects lower prevalence of respiratory illness due to fewer social contacts. This may impact on future health service use as these children have had less exposure, and therefore may have less immunity, to respiratory diseases.
Key messages
• Children under 5 had fewer contacts with primary care for lower respiratory tract infections during the covid-19 pandemic in England likely due to the restrictions in place to reduce social contacts.
• The falls in lower respiratory tract infections during the covid-19 pandemic in under 5s may mean they have less immunity to respiratory viruses which may impact upon their future health service use.
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Affiliation(s)
- KA Foley
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - EJ Maile
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - A Bottle
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - FK Neale
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - RM Viner
- Population, Policy & Practice Department, UCL Great Ormand Street Institute of Child Health , London, UK
| | - SE Kenny
- Department of Women’s and Children’s Health, Alder Hey Children’s NHS Foundation Trust , Liverpool, UK
- NHS England and NHS Improvement, NHS , London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - DS Hargreaves
- Mohn Centre for Children’s Health, Imperial College London , London, UK
| | - S Saxena
- Department of Primary Care and Public Health, Imperial College London , London, UK
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20
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Hargreaves S, Carter J, Mehrotra A, Knights F, Deal A, Crawshaw AF, Wurie F, Ciftci Y, Majeed A. Exploring barriers to vaccine delivery in adult migrants: a qualitative study in primary care. Eur J Public Health 2022. [PMCID: PMC9593771 DOI: 10.1093/eurpub/ckac130.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 pandemic has highlighted shortfalls in the delivery of vaccine programmes to older migrant groups. Guidelines exist, however, little is known around care pathways and engagement of these older cohorts in routine vaccinations in primary care, including catch-up programmes. We explored the views of primary care professionals around barriers and facilitators to catch-up vaccination in adult migrants (defined as foreign born; 18+ years) with incomplete or uncertain vaccination status. Methods We did a qualitative interview study with purposive sampling and thematic analysis in UK primary care (50 practices included nationally; 1 hour qualitative interviews) with 64 primary care professionals (PCPs): 48 clinical staff including GPs, Practice Nurses and healthcare assistants (HCAs); 16 administrative staff including practice managers and receptionists (mean age 45 years; 84.4% female; a range of ethnicities). Results Participants highlighted direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters, and not be aligned with the UK's vaccine schedule, from both a personal and service-delivery level, with themes including: lack of training and knowledge of guidance around catch-up vaccination among staff; unclear or incomplete vaccine records; and lack of incentivization (including financial reimbursement) and dedicated time and care pathways. Adult migrants were reported as being excluded from many vaccination initiatives, most of which focus exclusively on children. PCPs noted that migrants expressed to them a range of views around vaccines, from positivity to uncertainty, to refusal. Conclusions Vaccine uptake in adult migrants could be improved through implementing new financial incentives, strengthening care pathways and training, and working directly with local community groups to improve understanding around the benefits of vaccination at all ages. Key messages
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - J Carter
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - A Mehrotra
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - F Knights
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - AF Crawshaw
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - F Wurie
- Office for Improvements and Disparities, UK Health Security Agency London , London, UK
| | - Y Ciftci
- Doctors of the World UK , London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London , London, UK
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21
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Palladino R, Alfano R, Moccia M, Barone-Adesi F, Majeed A, Triassi M, Millett C. Association between institutional affiliations of academic editors and authors in medical journals. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Most of the literature on conflict of interest (COI) has not focused on the role of academic editors and their possible COIs, although academic editors often hold senior faculty positions at universities, which might be considered a COI if this influences towards a more favourable processing to articles submitted by institutional colleagues. The current study aims to assess whether academic editor affiliation, a potential COI, can influence academic institution ranking as top contributor in the biomedical field.
Methods
We conducted a cross-sectional analysis extracting publicly available data from the 2019 Clarivate InCites Journal Citation Reports for journals in the “Medicine, General & Internal” category and from each journal website. We constructed the following study outcomes: i) being a top 5 academic contributor for the peer-review journal of interest (yes/no), ii) being a top 10 academic contributor for the peer-review journal of interest (yes/no), and iii) ranking position as top 50 academic contributor for the peer-review journal of interest. Mixed-effect linear and logistic regression models were employed, as appropriate.
Results
We included 114 journals in our analysis, 49% were open-access only. Sharing same affiliation of any of the editorial board members was associated with a 6.7 and 5.6 greater likelihood of being top 5 and top 10 contributors, respectively (95%CI 5.07-8.73 and 4.34-7.22). Similarly, sharing same affiliation was associated with being 12.1 places higher as top contributor (95%CI 10.35-13.81). When considering the editor in chief affiliation solely, association was even stronger.
Conclusions
We found that academic editors sharing the same institutional affiliation with authors was strongly associated with the likelihood of that institution of being a top contributor. Shared institutional affiliations between editors and authors should be clearly stated as part of an open and transparent peer-review process.
Key messages
• Editors sharing same affiliation with authors was strongly associated with the likelihood for the institution the editor was affiliated with of being top contributor for academic medical journals.
• Shared institutional affiliations between editors and authors should be clearly stated as part of an open and transparent peer-review process.
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Affiliation(s)
- R Palladino
- Public Health Policy Evaluation Unit, Imperial College , London, UK
- Department of Public Health, University , Naples, Italy
- CIRMIS, University , Naples, Italy
| | - R Alfano
- Centre for Environmental Sciences, Hasselt University , Diepenbeek, Belgium
| | - M Moccia
- MS Clinical Care and Research Centre, Department of Neuroscience , Naples, Italy
| | - F Barone-Adesi
- Department of Translational Medicine, Università del Piemonte Orientale , Novara, Italy
- Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale , Novara, Italy
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College of London , London, UK
| | - M Triassi
- Department of Public Health, University , Naples, Italy
- CIRMIS, University , Naples, Italy
| | - C Millett
- Public Health Policy Evaluation Unit, Imperial College , London, UK
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22
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Tang MJ, Eslick GD, Lubel JS, Majeed A, Majumdar A, Kemp W, Roberts SK. Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma: A systematic review and meta-analysis. World J Meta-Anal 2022; 10:220-237. [DOI: 10.13105/wjma.v10.i4.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies to date comparing outcomes of microwave ablation (MWA) with radiofrequency ablation (RFA) on patients with hepatocellular carcinoma have yielded conflicting results, with no clear superiority of one technique over the other. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of MWA with RFA.
AIM To perform a systematic review and meta-analysis comparing the efficacy and safety of MWA with RFA.
METHODS A systematic literature search was performed using Ovid Medline, Embase, PubMed, Reference Citation Analysis, Cochrane Central and Cochrane Systematic Review databases, and Web of Science. Abstracts and full manuscripts were screened for inclusion utilising predefined inclusion and exclusion criteria comparing outcomes of MWA and RFA. A random-effects model was used for each outcome. Meta-regression analysis was performed to adjust for the difference in follow-up period between the studies. Primary outcome measures included complete ablation (CA) rate, local recurrence rate (LRR), survival [local recurrence-free survival (LRFS), overall survival (OS)] and adverse events.
RESULTS A total of 42 published studies [34 cohort and 8 randomised controlled trials (RCT)] with 6719 patients fulfilled the selection criteria. There was no significant difference in tumour size between the treatment groups. CA rates between MWA and RFA groups were similar in prospective cohort studies [odds ratio (OR) 0.95, 95% confidence interval (CI) 0.28–3.23] and RCTs (OR 1.18, 95%CI 0.64–2.18). However, retrospective studies reported higher rates with MWA (OR 1.29, 95%CI 1.06–1.57). Retrospective cohort studies reported higher OS (OR 1.54, 95%CI 1.15–2.05 and lower LRR (OR 0.67, 95%CI 0.51–0.87). No difference in terms of LRFS or 30-d mortality was observed between both arms. MWA had an increased rate of adverse respiratory events when compared to RFA (OR 1.99, 95%CI 1.07–3.71, P = 0.03).
CONCLUSION MWA achieves similar CA rates and as good or better longer-term outcomes in relation to LRR and OS compared to RFA. Apart from an increased rate of respiratory events post procedure, MWA is as safe as RFA.
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Affiliation(s)
- Myo Jin Tang
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Monash Medical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Guy D Eslick
- Department of Statistics, Clued Pty Ltd, Sydney 2006, New South Wales, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Avik Majumdar
- Department of Gastroenterology, Austin Hospital, Heidelberg 3084, Victoria, Australia
- Department of Medicine, Austin Campus, University of Medicine, Melbourne 3084, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
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23
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Tilney M, Vallejo-Vaz A, Majeed A. Identification of familial hypercholesterolaemia (FH) in Malta: An update of the FH registry and cascade screening programme in Malta. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Vaz K, Little R, Majeed A, Kemp W, Roberts SK. Determinants of Short- and Long-Term Outcomes of an Australian Cohort of Patients Admitted with Alcoholic Hepatitis. Dig Dis Sci 2022; 67:3356-3365. [PMID: 34231100 DOI: 10.1007/s10620-021-07140-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Alcoholic hepatitis is a common condition with high mortality. This study aimed to firstly describe the presentation, treatment, and short- and long-term outcomes of an Australian cohort of patients admitted to hospital with alcoholic hepatitis and secondly to validate existing prognostic models. METHODS This is a retrospective study of consecutive patients admitted with alcoholic hepatitis to a major academic liver center in Melbourne, Australia, between January 1, 2010, and December 31, 2019. Cases were identified through appropriate International Classification of Diseases version 10 coding as well as review of non-coded patients with compatible biochemistry. Baseline demographic data, alcohol consumption, laboratory values, treatment, and outcomes at 30 days, 90 days, and 12 months post-diagnosis were collected from electronic medical records. Mortality data were extracted from an independent state government death registry. RESULTS In total, 126 patients (72 males [57%], median age 51 years) were included in the final analysis. Ninety-five (75%) were cirrhotic at diagnosis, 81 (64%) met criteria for severe alcoholic hepatitis, and 41 (33%) had an infection during their index admission. 54% of eligible patients were treated with corticosteroids. 30-day and 12-month mortality rates were 8.7% and 27.1%, respectively, with hepatic encephalopathy (hazard ratio 5.45) and neutrophil-to-lymphocyte ratio (hazard ratio 1.09) independent markers for 12-month mortality on Cox regression analysis. Glasgow alcoholic hepatitis score outperformed other major prognostic models for short-term mortality. CONCLUSIONS The 12-month mortality rate of 27% following alcoholic hepatitis is lower than previously reported studies, with hepatic encephalopathy and neutrophil-to-lymphocyte ratio predictive of long-term outcome.
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Affiliation(s)
- Karl Vaz
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Australia.
- Department of Gastroenterology and Hepatology, Austin Health, 145 Studley Rd, Heidelberg, VIC, 3084, Australia.
| | - Robert Little
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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25
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Smith RL, Taylor KM, Friedman AB, Majeed A, Perera N, Gibson PR. Nonspecific ileitis: Impact of histopathology and gastrointestinal ultrasound in achieving the diagnosis of Crohn's disease. JGH Open 2022; 6:388-394. [PMID: 35774353 PMCID: PMC9218532 DOI: 10.1002/jgh3.12740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/10/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
Background and Aim Nonspecific ileitis is inflammation of the ileum without specific diagnostic features. A minority may go on to develop Crohn's disease, but optimal pathways of further investigation have not been established. This study aimed to identify a cohort of patients with nonspecific ileitis and to determine the value of ileal histology and gastrointestinal ultrasound in identifying/excluding Crohn's disease. Patients and Methods In a retrospective analysis, all patients having nonspecific ileitis at colonoscopy from January 2010 to August 2021 were identified. Clinical associations with those subsequently diagnosed with Crohn's disease were examined with specific reference to ileal histology and gastrointestinal ultrasound. Results Of 29 638 procedures, 147 patients (0.5%) had nonspecific ileitis. Crohn's disease was subsequently diagnosed in 8 patients (5.4%) at a median of 148 (range 27–603) days after colonoscopy. The presence of chronic inflammation on ileal biopsies was more common in those subsequently diagnosed with Crohn's disease (63% vs 20%; P = 0.0145). On gastrointestinal ultrasound, none of the 26 patients with normal bowel wall thickness (<3 mm) were subsequently diagnosed with Crohn's disease, and repeat ultrasound in 15 patients 1 year later showed no change. Of the nine patients with abnormal sonographic findings, three were diagnostic for Crohn's disease. Repeat ultrasound revealed Crohn's disease in two, while four had resolution of the abnormal findings. Conclusion Although ileal histology was of limited value in identifying patients with nonspecific ileitis who were subsequently diagnosed with Crohn's disease, gastrointestinal ultrasound was highly informative. Prospective studies are needed to confirm the value of gastrointestinal ultrasound as a diagnostic and monitoring tool in this setting.
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Affiliation(s)
- Rebecca L Smith
- Department of Gastroenterology Alfred Hospital Melbourne Victoria Australia
- Department of Gastroenterology, Central Clinical School Monash University Melbourne Victoria Australia
| | - Kirstin M Taylor
- Department of Gastroenterology Alfred Hospital Melbourne Victoria Australia
- Department of Gastroenterology, Central Clinical School Monash University Melbourne Victoria Australia
| | - Antony B Friedman
- Department of Gastroenterology Alfred Hospital Melbourne Victoria Australia
- Department of Gastroenterology, Central Clinical School Monash University Melbourne Victoria Australia
| | - Ammar Majeed
- Department of Gastroenterology Alfred Hospital Melbourne Victoria Australia
- Department of Gastroenterology, Central Clinical School Monash University Melbourne Victoria Australia
| | - Natalie Perera
- Department of Gastroenterology Alfred Hospital Melbourne Victoria Australia
| | - Peter R Gibson
- Department of Gastroenterology Alfred Hospital Melbourne Victoria Australia
- Department of Gastroenterology, Central Clinical School Monash University Melbourne Victoria Australia
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Sekhon Inderjit Singh HK, Lal N, Majeed A, Pawa N. A systematic review of ethnic disparities in the uptake of colorectal cancer screening. Perspect Public Health 2022; 143:105-120. [PMID: 35506652 DOI: 10.1177/17579139221093153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Colorectal cancer (CRC) screening reduces mortality, but variation exists in uptake. Ethnicity is suggested to play a role; however, there is no high-level evidence to support this. We aim to clarify the impact of Ethnicity on CRC screening uptake and our barriers to its understanding. METHODS A systematic review to identify studies reporting on the participation of ethnic minorities in CRC screening worldwide was performed. MEDLINE, Embase, Scopus and Google Scholar databases up until 31 May 2019 were searched. Compliance with screening according to ethnic groups and screening modality was evaluated compared to the 'White' control group. RESULTS Twenty-two studies were included in the review reporting on 2,084,213 patients. Substantial variation in categorisation of ethnicities (40 sub-categories), screening modality studied and confounding factors accounted for was observed. 8/15 studies for 'Blacks', 10/13 for 'Hispanics', 2/2 for 'Asians' and 1/1 for 'South East Asians' suggest a less likely or significantly decreased compliance with screening for all screening modalities (p < .05) compared to 'Whites'. Interestingly 'Japanese', 'Vietnamese' and 'Filipino' groups consistently show no difference in the uptake of CRC screening compared to the 'White' majority. CONCLUSION This is the only systematic review on this topic. It highlights the inconsistency in screening uptake behaviour in different ethnic minority groups and identifies barriers like variation in ethnicity categorisation, screening modality and study design utilised to understanding the intricacies of this relationship. Further collaboration and action needs to be undertaken internationally to clarify and improve inequity in the uptake of screening.
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Affiliation(s)
- H K Sekhon Inderjit Singh
- Colorectal Surgical Department, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
| | - N Lal
- Department of Surgery, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - N Pawa
- Consultant General and Colorectal Surgeon, Colorectal Surgical Department, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Twickenham Road, Isleworth TW7 6AF, UK.,* HK Sekhon Inderjit Singh is now affiliated with Royal London Hospital, Barts Health NHS Trust. London, UK
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27
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Majeed A, Chiah Y, Latif N, Tahir A, Mahmood A. Simultaneous malignant hyperthermia reactions in two siblings during living donor liver transplantation. Anaesth Rep 2022; 10:ANR312145. [PMID: 35146429 PMCID: PMC8810940 DOI: 10.1002/anr3.12145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
We report a case of simultaneous malignant hyperthermia reactions occurring in two siblings during living donor liver transplantation. This report highlights the conflicting goals in the clinical management of liver transplantation and malignant hyperthermia, including the use of total intravenous anaesthesia and dantrolene in the face of the potential for drug-induced hepatotoxicity in the remnant liver or transplanted liver graft, as well as cautious fluid management needed for liver transplantation balanced against the liberal fluid therapy required to prevent acute kidney injury associated with malignant hyperthermia. The logistical challenges of managing this emergency in two closely related patients are discussed, including rapid preparation of two vapour-free anaesthesia machines, the need for availability of additional dantrolene and the requirement for additional personnel. Prompt recognition, immediate removal of the triggering agents and conversion to total intravenous anaesthesia helped to curtail the malignant hyperthermic reactions in our patients, both of whom made a full recovery.
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Affiliation(s)
- A. Majeed
- Department of AnaesthesiaKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Y. Chiah
- School of MedicineAlfaisal UniversityRiyadhSaudi Arabia
| | - N. Latif
- Department of AnaesthesiaPakistan Kidney and Liver Institute and Research CentreLahorePakistan
| | - A. Tahir
- Department of AnaesthesiaPrince Muhammad Bin Abdulaziz HospitalMadinahSaudi Arabia
| | - A. Mahmood
- Department of AnaesthesiaKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
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Kemp W, Clayton-Chubb D, Majeed A, Glenister KM, Magliano DJ, Lubel J, Bourke L, Simmons D, Roberts SK. Impact of renaming NAFLD to MAFLD in an Australian regional cohort: Results from a prospective population-based study. J Gastroenterol Hepatol 2022; 37:395-403. [PMID: 34693553 DOI: 10.1111/jgh.15723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Clinical and public health implications of the recent redefining of non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD) remain unclear. We sought to determine the prevalence and compare MAFLD with NAFLD in a well-defined cohort. METHODS A cross-sectional study was conducted in regional Victoria with participants from randomly selected households. Demographic and health-related clinical and laboratory data were obtained. Fatty liver was defined as a fatty liver index ≥ 60 with MAFLD defined according to recent international expert consensus. RESULTS A total of 722 participants were included. Mean age was 59.3 ± 16 years, and 55.3% were women with a median body mass index of 27.8 kg/m2 . Most (75.2%) participants were overweight or obese. MAFLD was present in 341 participants giving an unadjusted prevalence of 47.2% compared with a NAFLD prevalence of 38.7%. Fifty-nine (17.5%) participants met the criteria of MAFLD but not NAFLD. The increased prevalence of MAFLD in this cohort was primarily driven by dual etiology of fatty liver. All participants classified as NAFLD met the new definition of MAFLD. Compared with NAFLD subjects, participants with MAFLD had higher ALT (26.0 [14.0] U/L vs 30.0 [23] U/L, P = 0.024), but there were no differences in non-invasive markers for steatosis or fibrosis. CONCLUSION Metabolic-associated fatty liver disease is a highly prevalent condition within this large community cohort. Application of the MAFLD definition increased prevalence of fatty liver disease by including people with dual etiologies of liver disease.
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Affiliation(s)
- William Kemp
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kristen M Glenister
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dianna J Magliano
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - John Lubel
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lisa Bourke
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David Simmons
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia.,Macarthur Clinical School, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Zheng B, Su B, Udeh-Momoh C, Price G, Tzoulaki I, Vamos EP, Majeed A, Riboli E, Ahmadi-Abhari S, Middleton LT. Associations of Cardiovascular and Non-Cardiovascular Comorbidities with Dementia Risk in Patients with Diabetes: Results from a Large UK Cohort Study. J Prev Alzheimers Dis 2022; 9:86-91. [PMID: 35098977 DOI: 10.14283/jpad.2022.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is an established risk factor for dementia. However, it remains unclear whether the presence of comorbidities could further increase dementia risk in diabetes patients. OBJECTIVES To examine the associations between cardiovascular and non-cardiovascular comorbidities and dementia risk in T2D patients. DESIGN Population-based cohort study. SETTING The UK Clinical Practice Research Datalink (CPRD). PARTICIPANTS 489,205 T2D patients aged over 50 years in the UK CPRD. MEASUREMENTS Major cardiovascular and non-cardiovascular comorbidities were extracted as time-varying exposure variables. The outcome event was dementia incidence based on dementia diagnosis or dementia-specific drug prescription. RESULTS During a median of six years follow-up, 33,773 (6.9%) incident dementia cases were observed. Time-varying Cox regressions showed T2D patients with stroke, peripheral vascular disease, atrial fibrillation, heart failure or hypertension were at higher risk of dementia compared to those without such comorbidities (HR [95% CI] = 1.64 [1.59-1.68], 1.37 [1.34-1.41], 1.26 [1.22-1.30], 1.15 [1.11-1.20] or 1.10 [1.03-1.18], respectively). Presence of chronic obstructive pulmonary disease or chronic kidney disease was also associated with increased dementia risk (HR [95% CI] = 1.05 [1.01-1.10] or 1.11 [1.07-1.14]). CONCLUSIONS A range of cardiovascular and non-cardiovascular comorbidities were associated with further increases of dementia risk in T2D patients. Prevention and effective management of these comorbidities may play a significant role in maintaining cognitive health in T2D patients.
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Affiliation(s)
- B Zheng
- Prof. Lefkos Middleton, Ageing Epidemiology Research Unit, School of Public Health, Faculty of Medicine, Imperial College London, London W6 8RP, UK. E-mail: ; Tel: +44 20 3311 0216; Fax: +44 20 3311 0216
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30
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Kemp W, Majeed A, Mitchell J, Majumdar A, Tse E, Skoien R, Croagh D, Dev A, Gao H, Weltman M, Craig P, Stuart K, Cheng W, Edmunds S, Lee E, Sood S, Metz A, Thompson A, Sinclair M, Beswick L, Nicoll A, Riordan S, Braund A, Muller K, MacQuillan G, Sandanayake N, Shackel N, Roberts SK. Management, outcomes and survival of an Australian IgG4-SC cohort: The MOSAIC study. Liver Int 2021; 41:2934-2943. [PMID: 34392596 DOI: 10.1111/liv.15036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/21/2021] [Accepted: 08/06/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS IgG4 sclerosing cholangitis (IgG4-SC) is the biliary component of the multisystem IgG4-related disease. We aimed to investigate the clinical features, demographics, treatment response and outcomes of IgG4-SC in a large Australian cohort. METHODS We conducted nationwide retrospective cohort via the Australian Liver Association Clinical Trials Network (ALA-CRN). 39 sites were invited to participate. IgG4-SC was defined by the clinical diagnostic criteria established by the Japanese Biliary Association in 2012. Data were collected on patient demographic, clinical and laboratory information, presenting features, response to therapy and clinical outcomes. RESULTS 67 patients meet inclusion criteria from 22 sites. 76% were male with mean age of 63.3 ± 14.5 years and a median IgG4 level of 3.6 g/L [0.09-67.1]. The most frequent presenting symptom was jaundice (62%) and abdominal pain (42%) and Type 1 biliary stricturing (52%) at the distal common bile duct was the most frequent biliary tract finding. Prednisolone was used as a primary treatment in 61 (91%) and partial or complete response occurred in 95% of subjects. Relapse was common (42%) in those who ceased medical therapy. After a median follow up of 3.9 years there was one hepatocellular carcinoma and no cholangiocarcinomas. CONCLUSIONS Our study confirms the preponderance of IgG4-SC in males and highlights the steroid response nature of this condition although relapse is common after steroid cessation. Progression to malignancy was uncommon.
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Affiliation(s)
- William Kemp
- Alfred Hospital, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - Ammar Majeed
- Alfred Hospital, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | | | - Avik Majumdar
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Edmund Tse
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Richard Skoien
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | | | - Anouk Dev
- Monash Medical Centre, Melbourne, VIC, Australia
| | - Hugh Gao
- Monash Medical Centre, Melbourne, VIC, Australia
| | | | | | | | | | | | - Eric Lee
- Westmead Hospital, Sydney, NSW, Australia
| | | | - Andrew Metz
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | | | - Alicia Braund
- Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Kate Muller
- Flinders Medical Centre, Adelaide, SA, Australia
| | | | | | | | - Stuart Keith Roberts
- Alfred Hospital, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
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Abstract
INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming the major cause of liver disease worldwide. Bile acids play a central part in the pathogenesis of NAFLD with agents that target bile acid synthesis and metabolism in development as potential therapies. AREAS COVERED The paper presents an overview of NAFLD and its pathogenesis, with focus on bile acid metabolism and regulation through fibroblast growth factor 19 (FGF-19), and the development of aldafermin as a non-tumorigenic FGF-19 analogue. We explore results from preclinical studies on the efficacy and safety of aldafermin. EXPERT OPINION Bile acid regulation is a promising therapeutic target in the management of NAFLD. FGF-19 plays key role in this mechanistic pathway, but also exhibits hepatocarcinogenic effect. Aldafermin is an FGF-19 analogue that has shown promising results in nonalcoholic steatohepatitis animal models, with preclinical data supporting its safety profile, specifically, the lack of a tumorigenic effect. The preclinical data presented in this paper support the clinical development of aldafermin, and indeed early data from several phase II clinical trials report promising results in relation to the ability of aldafermin to improve the histological features of NASH particularly in relation to a reduction in liver fat content.
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Affiliation(s)
- Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Australia
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32
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Vaz K, Goodwin T, Kemp W, Roberts S, Majeed A. Artificial Intelligence in Hepatology: A Narrative Review. Semin Liver Dis 2021; 41:551-556. [PMID: 34327698 DOI: 10.1055/s-0041-1731706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
There has been a tremendous growth in data collection in hepatology over the last decade. This wealth of "big data" lends itself to the application of artificial intelligence in the development of predictive and diagnostic models with potentially greater accuracy than standard biostatistics. As processing power of computing systems has improved and data are made more accessible through the large databases and electronic health record, these more contemporary techniques for analyzing and interpreting data have garnered much interest in the field of medicine. This review highlights the current evidence base for the use of artificial intelligence in hepatology, focusing particularly on the areas of diagnosis and prognosis of advanced chronic liver disease and hepatic neoplasia.
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Affiliation(s)
- Karl Vaz
- Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Australia
| | - Thomas Goodwin
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Stuart Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
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Abstract
Hepatitis B is the leading cause of hepatocellular cancer (HCC) worldwide. Untreated, annual HCC incidence rates in chronic hepatitis B subjects are 0.4% in noncirrhotics and 2% to 3% in cirrhotics. Surveillance with ultrasound with/without α-fetoprotein at 6-month intervals is recommended in at-risk persons including children. Antiviral therapy in chronic hepatitis B with entecavir or tenofovir significantly lowers the risk of HCC across all stages of liver disease, and lowers the risk of HCC recurrence following curative therapy. There are insufficient data to recommend use of tenofovir over entecavir in the prevention of de novo or recurrent HCC postcurative therapy.
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Affiliation(s)
- Stuart K Roberts
- The Alfred, 55 Commercial Road, Melbourne 3004, Australia; Monash University, Melbourne, Australia.
| | - Ammar Majeed
- The Alfred, 55 Commercial Road, Melbourne 3004, Australia; Monash University, Melbourne, Australia
| | - William Kemp
- The Alfred, 55 Commercial Road, Melbourne 3004, Australia; Monash University, Melbourne, Australia
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34
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Pham AD, Vaz K, Ardalan ZS, Sinclair M, Apostolov R, Gardner S, Majeed A, Mishra G, Kam NM, Patwala K, Kutaiba N, Arachchi N, Bell S, Dev AT, Lubel JS, Nicoll AJ, Sood S, Kemp W, Roberts SK, Fink M, Testro AG, Angus PW, Gow PJ. Clinical outcomes of patients with two small hepatocellular carcinomas. World J Hepatol 2021; 13:1439-1449. [PMID: 34786178 PMCID: PMC8568581 DOI: 10.4254/wjh.v13.i10.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/28/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Management of single small hepatocellular carcinoma (HCC) is straightforward with curative outcomes achieved by locoregional therapy or resection. Liver transplantation is often considered for multiple small or single large HCC. Management of two small HCC whether presenting synchronously or sequentially is less clear.
AIM To define the outcomes of patients presenting with two small HCC.
METHODS Retrospective review of HCC databases from multiple institutions of patients with either two synchronous or sequential HCC ≤ 3 cm between January 2000 and March 2018. Primary outcomes were overall survival (OS) and transplant-free survival (TFS).
RESULTS 104 patients were identified (male n = 89). Median age was 63 years (interquartile range 58-67.75) and the most common aetiology of liver disease was hepatitis C (40.4%). 59 (56.7%) had synchronous HCC and 45 (43.3%) had sequential. 36 patients died (34.6%) and 25 were transplanted (24.0%). 1, 3 and 5-year OS was 93.0%, 66.1% and 62.3% and 5-year post-transplant survival was 95.8%. 1, 3 and 5-year TFS was 82.1%, 45.85% and 37.8%. When synchronous and sequential groups were compared, OS (1,3 and 5 year synchronous 91.3%, 63.8%, 61.1%, sequential 95.3%, 69.5%, 64.6%, P = 0.41) was similar but TFS was higher in the sequential group (1,3 and 5 year synchronous 68.5%, 37.3% and 29.7%, sequential 93.2%, 56.6%, 48.5%, P = 0.02) though this difference did not remain during multivariate analysis.
CONCLUSION TFS in patients presenting with two HCC ≤ 3 cm is poor regardless of the timing of the second tumor. All patients presenting with two small HCC should be considered for transplantation.
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Affiliation(s)
- Anh Duy Pham
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Karl Vaz
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Zaid S Ardalan
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
- Department of Gastroenterology, Alfred Health, Melbourne 3000, Victoria, Australia
| | - Marie Sinclair
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- The University of Melbourne, Parkville 3010, Victoria, Australia
| | - Ross Apostolov
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
- The University of Melbourne, Parkville 3010, Victoria, Australia
| | - Sarah Gardner
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne 3000, Victoria, Australia
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Gauri Mishra
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, Victoria, Australia
| | - Ning Mao Kam
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Kurvi Patwala
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Numan Kutaiba
- Department of Radiology, Austin Health, Heidelberg 3084, Victoria, Australia
- Department of Radiology, Eastern Health, Box Hill 3128, Victoria, Australia
| | - Niranjan Arachchi
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- Department of Gastroenterology, Western Health, Footscray 3011, Victoria, Australia
| | - Sally Bell
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- The University of Melbourne, Parkville 3010, Victoria, Australia
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, Victoria, Australia
| | - Anouk T Dev
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, Victoria, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Health, Melbourne 3000, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Amanda J Nicoll
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- Department of Gastroenterology, Eastern Health, Box Hill 3128, Victoria, Australia
| | - Siddharth Sood
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- The University of Melbourne, Parkville 3010, Victoria, Australia
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne 3000, Victoria, Australia
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne 3000, Victoria, Australia
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Michael Fink
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- The University of Melbourne, Parkville 3010, Victoria, Australia
| | - Adam G Testro
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- The University of Melbourne, Parkville 3010, Victoria, Australia
| | - Peter W Angus
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- The University of Melbourne, Parkville 3010, Victoria, Australia
| | - Paul J Gow
- The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
- The Melbourne Liver Group, Melbourne 3000, Victoria, Australia
- The University of Melbourne, Parkville 3010, Victoria, Australia
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35
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Gazelakis K, Majeed A, Kemp W, Di Muzio B, Gerstenmaier J, Cheung W, Roberts SK. Liver disease severity predicts carcinogenesis of dysplastic liver nodules in cirrhosis. Sci Rep 2021; 11:20954. [PMID: 34697374 PMCID: PMC8545953 DOI: 10.1038/s41598-021-00474-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/11/2021] [Indexed: 02/07/2023] Open
Abstract
While dysplastic liver nodules in cirrhosis are pre-malignant, little is known about the predictors of hepatocarcinogenesis of these lesions. This was a retrospective observational study of subjects with cirrhosis who had at least one hypervascular, non-malignant intrahepatic nodule on imaging while undergoing outpatient management by a tertiary hepatology referral centre between Jan 2009 and Jan 2019. Clinical and biochemical parameters were collected. The primary endpoint was transformation to hepatocellular carcinoma (HCC) as determined by Liver Imaging Reporting and Data System. During the study period, 163 non-malignant hypervascular nodules were identified in 77 patients; 147 had at least 6 months of follow up imaging and 16 received upfront radiofrequency ablation upon detection. During a median follow up of 38.5 months (IQR 16.5-74.5), 25 (17%) of the 147 hypervascular nodules being monitored transformed to HCC. On multivariate analysis, Child-Pugh grade was found to be the only independent predictor of nodule transformation into HCC (p = 0.02). Those with Child-Pugh B and C liver disease had a 10.1 (95% CI 1.22-83.8; p = 0.03) and 32.6-fold (95% CI 2.3-467; p = 0.01) increased risk respectively for HCC transformation compared to Child-Pugh A subjects. This large, single centre study demonstrates that around 20% of dysplastic nodules in cirrhotic patients undergo hepatocarcinogenesis during follow up, and that Child Pugh grade is the only independent predictor of transformation to HCC. Additional prospective studies are warranted to better understand the risk profile of these nodules, and how best they should be managed.
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Affiliation(s)
- Kathryn Gazelakis
- Department of Gastroenterology, Alfred Health, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Bruno Di Muzio
- Department of Radiology, Alfred Health, Melbourne, Australia
| | | | - Wa Cheung
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia.
- Central Clinical School, Monash University, Melbourne, Australia.
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36
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Vaz K, McLean C, Majeed A, Little R, Kemp W, Roberts S. Letter: the diagnostic and prognostic significance of liver histology in alcoholic hepatitis. Aliment Pharmacol Ther 2021; 54:862-863. [PMID: 34425014 DOI: 10.1111/apt.16539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Karl Vaz
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, VIC, Australia.,Department of Gastroenterology and Hepatology, Austin Health, Melbourne, VIC, Australia
| | - Catriona McLean
- Department of Anatomical Pathology, Alfred Health, Melbourne, VIC, Australia
| | - Ammar Majeed
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Robert Little
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, VIC, Australia.,Department of Gastroenterology and Hepatology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - William Kemp
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Stuart Roberts
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
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Freeman E, Cheung W, Ferdousi S, Kavnoudias H, Majeed A, Kemp W, Roberts SK. Irreversible electroporation versus radiofrequency ablation for hepatocellular carcinoma: a single centre propensity-matched comparison. Scand J Gastroenterol 2021; 56:942-947. [PMID: 34057003 DOI: 10.1080/00365521.2021.1930145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Irreversible electroporation (IRE) is a relatively new non-thermal ablative method for unresectable hepatocellular carcinoma (HCC). We aimed to compare the longer-term efficacy of IRE to the standard thermal technique of radiofrequency ablation (RFA) in HCC. METHODS All patients who underwent IRE or RFA for HCC in our centre were identified and demographic and clinical data were analysed up until 1st March, 2020. Local recurrence-free survival (LRFS) was compared between groups after propensity score matching for age, gender, Child-Pugh grade, BCLC stage, lesion size and alpha-fetoprotein (AFP) level. RESULTS A total of 190 HCC ablations (31 IRE and 159 RFA) were identified. After propensity score matching, we compared 25 IRE procedures (76% males, median age 62.4 years, median tumour size 20 mm) to 96 RFA procedures (84.4% males, median age 64.3 years, median tumour size 18.5 mm). LRFS did not differ between groups, with a 1-, 2- and 5-year LRFS of 80.4% (95% CI 55.8-92.2), 69.1% (95% CI 43.3-84.9) and 44.9% (95% CI 18.9-68.1%), respectively for IRE and 84.8% (95% CI 75.2-90.9), 71.3% (95% CI 58.3-81.0) and 52.1% (95% CI 35.4-66.4%), respectively for RFA (p = .63). There were no major procedure-related complications or deaths in either group. CONCLUSIONS Whilst IRE remains a relatively novel therapy for HCC cases where standard thermal ablation is contraindicated, the LRFS in our centre is comparable to that of RFA. IRE should therefore be considered as a treatment option in such cases when available before stage-migration to non-curative therapies such as transarterial chemoembolization (TACE).
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Affiliation(s)
- Elliot Freeman
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia
| | - Wa Cheung
- Department of Radiology, Alfred Hospital, Melbourne, Australia
| | - Sapphire Ferdousi
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia
| | | | - Ammar Majeed
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
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Roberts SK, Majeed A, Glenister K, Magliano D, Lubel JS, Bourke L, Simmons D, Kemp WW. Prevalence of non-alcoholic fatty liver disease in regional Victoria: a prospective population-based study. Med J Aust 2021; 215:77-82. [PMID: 34028830 DOI: 10.5694/mja2.51096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) and its risk factors in regional Victoria. DESIGN Prospective cross-sectional observational study (sub-study to CrossRoads II health study in Shepparton and Mooroopna). SETTING Four towns (populations, 6300-49 800) in the Goulburn Valley of Victoria. PARTICIPANTS Randomly selected from households selected from residential address lists provided by local government organisations for participation in the CrossRoads II study. MAIN OUTCOME MEASURES Age- and sex-adjusted estimates of NAFLD prevalence, defined by a fatty liver index score of 60 or more in people without excessive alcohol intake or viral hepatitis. RESULTS A total of 705 invited adults completed all required clinical, laboratory and questionnaire evaluations of alcohol use (participation rate, 37%); 392 were women (56%), and their mean age was 59.1 years (SD, 16.1 years). Of the 705 participants, 274 met the fatty liver index criterion for NAFLD (crude prevalence, 38.9%; age- and sex-standardised prevalence, 35.7%). The mean age of participants with NAFLD (61 years; SD, 15 years) was higher than for those without NAFLD (58 years; SD, 16 years); a larger proportion of people with NAFLD were men (50% v 41%). Metabolic risk factors more frequent among participants with NAFLD included obesity (69% v 15%), hypertension (66% v 48%), diabetes (19% v 8%), and dyslipidaemia (63% v 33%). Mean serum alanine aminotransferase levels were higher (29 U/L; SD, 17 U/L v 24 U/L; SD, 14 U/L) and mean median liver stiffness greater (6.5 kPa; SD, 5.6 kPa v 5.3kPa; SD, 2.0 kPa) in participants with NAFLD. CONCLUSION The prevalence of NAFLD among adults in regional Victoria is high. Metabolic risk factors are more common among people with NAFLD, as are elevated markers of liver injury.
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Affiliation(s)
- Stuart K Roberts
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
| | - Ammar Majeed
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
| | | | | | - John S Lubel
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
| | | | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW
| | - William W Kemp
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
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Harris M, Kreindler J, El-Osta A, Esko T, Majeed A. Safe management of full-capacity live/mass events in COVID-19 will require mathematical, epidemiological and economic modelling. J R Soc Med 2021; 114:290-294. [PMID: 33870766 PMCID: PMC8212553 DOI: 10.1177/01410768211007759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- M Harris
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - J Kreindler
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - A El-Osta
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - T Esko
- Institute of Genomics, 37546University of Tartu is Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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Clements W, Kuang R, Majeed A, Joseph T. Percutaneous Transjejunal Retrograde Cholangiogram as Alternative Biliary Access in Patients with Previous Roux-en-Y Surgery. Journal of Gastrointestinal and Abdominal Radiology 2021. [DOI: 10.1055/s-0041-1722812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, VIC, Australia
- National Trauma Research Institute, Monash University, Melbourne, VIC, Australia
| | - Ronny Kuang
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia
- Department of Gastroenterology, Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
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Con D, Goodwin T, Majeed A, Roberts S, Kemp W. Comparison of 48-week efficacy of tenofovir vs entecavir for patients with chronic hepatitis B: A network meta-analysis. J Viral Hepat 2021; 28:40-50. [PMID: 32893921 DOI: 10.1111/jvh.13400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023]
Abstract
Both tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are accepted as first-line treatments for chronic hepatitis B (CHB). However, there are few randomized studies comparing their efficacy. The primary aim of this study was to compare the efficacy of TDF and ETV using a network meta-analysis of randomized trials. The secondary aim was to additionally include propensity-matched cohort studies in a conventional meta-analysis. We systematically searched PubMed, EMBASE, Cochrane Library and Web of Science for published English-language randomized and propensity-matched studies between 1/1/2000 and 4/2/2020. Outcomes included undetectable HBV DNA, ALT normalization and HBeAg seroconversion at 48 weeks. We excluded patients who had co-infection or significant prior treatment with antivirals. 13 517 participants from 16 studies (11 RCTs, n = 2675; five propensity-matched cohort studies, n = 10 842) were included. Virological response at 48 weeks was higher in patients receiving TDF compared to ETV using both the network meta-analytic approach (OR 1.69, P < .001) and the conventional meta-analysis including propensity-matched cohort studies (OR 1.40, P < .001). On subgroup analysis, this difference was only significant in HBeAg-positive patients (OR 1.81, P = .037). There was limited evidence to suggest a higher rate of ALT normalization with ETV (OR 0.74, P = .07). There was no difference in rates of HBeAg seroconversion between the two antivirals. TDF is more likely than ETV to induce virological response at 48 weeks in treatment-naïve CHB patients. Future studies should focus on elucidating associations between early and sustained virological response with adverse patient outcomes including development of HCC or cirrhosis.
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Affiliation(s)
- Danny Con
- Department of General Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Thomas Goodwin
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Stuart Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia
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Abstract
Introduction Viral hepatitis remains a significant threat to transfusion safety, although largely mitigated by donor screening. Aim Our objective was to estimate the past and present burden of transfusion transmission of all types of viral hepatitis (A to E) and to find undiagnosed infections with hepatitis C virus (HCV). Method We performed a retrospective cohort study using a database of the entire computerised transfusion experience of Sweden from 1968 to 2012 and linking it to a nationwide database of notifiable infections. We then used two independent statistical approaches. Firstly, we tracked recipients of blood from donors with confirmed viral hepatitis. Secondly, we computed a donor-specific risk score, defined as the difference between the observed and the expected number of HCV infections among all previous recipients of all donors, where thresholds were determined using simulation. Results Among 1,146,307 transfused patients, more than 5,000 were infected with HCV. Transfusion transmission only occurred before 1992 when donor screening had been completely implemented. Overall, we found 44 donors and 1,180 recipients likely to be infected with HCV who were still alive but who remained undiagnosed. Conclusion There is still a substantial number of individuals in Sweden who have probably been infected with HCV through blood transfusion and who are still unaware of their infection. We recommend that a follow-up study should be conducted to validate the method we used by approaching these individuals and offer testing. This would also serve as an opportunity to offer treatment to those who remain infected.
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Affiliation(s)
- Viktor Dahl
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Ammar Majeed
- Central Clinical School, Monash University, Melbourne, Australia.,Department of Gastroenterology, Alfred Health, Melbourne, Australia.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Wikman
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Rut Norda
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Gustaf Edgren
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden.,Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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Lindqvist C, Nordstedt P, Nowak G, Slinde F, Majeed A, Bottai M, Wahlin S. Energy expenditure early after liver transplantation: Better measured than predicted. Nutrition 2020; 79-80:110817. [DOI: 10.1016/j.nut.2020.110817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/13/2022]
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Roberts SK, Strasser SI, Nicoll AJ, Kemp W, Majeed A, Mitchell J, Stuart K, Gow P, Sood S, MacQuillan G, George J, Mitchell J, McCaughan GW. Efficacy and safety profile of calcineurin inhibitor salvage therapy in autoimmune hepatitis. Scand J Gastroenterol 2020; 55:1309-1317. [PMID: 33070650 DOI: 10.1080/00365521.2020.1821764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND As data is limited on the outcomes of calcineurin inhibitors (CNI) in autoimmune hepatitis (AIH), we evaluated the efficacy and safety of CNI in AIH patients who failed prior treatment(s). METHODS A retrospective study was performed of AIH patients who received cyclosporine A (CsA) and/or tacrolimus (TAC) after prior treatment(s) failure. Records were reviewed for baseline demographic and clinical characteristics, and treatment outcomes. The primary outcome was biochemical remission. UNLABELLED Results: Thirty-three AIH patients received CNI across seven liver centers:17 received CsA, 21 TAC and 5 TAC after CsA failure/intolerance. 82% received CNI for an insufficient response to treatment(s). Overall, 48% of CNI treated patients achieved biochemical remission including 41% in prior non-responders and 83% in treatment intolerant patients. Remission rates with CNI as second-line and third-line therapy were 63% and 29% respectively. There were no baseline predictors of response to CNI on multivariate analysis. Eighteen (55%) patients developed significant side effects and 8 (24%) discontinued due to intolerance. Three patients required liver transplantation for decompensated cirrhosis and 6 patients died including one from malignancy possibly related to CNI. CONCLUSION CNI salvage therapy is well tolerated and moderately effective achieving remission in around 50% of AIH who failed standard therapy.
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Affiliation(s)
- Stuart K Roberts
- The Alfred Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Simone I Strasser
- Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Amanda J Nicoll
- Monash University, Melbourne, Australia.,Eastern Health, Melbourne, Australia
| | - William Kemp
- The Alfred Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Ammar Majeed
- The Alfred Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
| | | | | | - Paul Gow
- Austin Hospital, Melbourne, Australia
| | | | | | - Jacob George
- University of Sydney, Sydney, Australia.,Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, Australia
| | | | - Geoffrey W McCaughan
- Royal Prince Alfred Hospital, Sydney, Australia.,Centenary Research Institute, Sydney, Australia
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45
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Freeman E, Cheung W, Kavnoudias H, Majeed A, Kemp W, Roberts SK. Irreversible Electroporation For Hepatocellular Carcinoma: Longer-Term Outcomes At A Single Centre. Cardiovasc Intervent Radiol 2020; 44:247-253. [PMID: 33051707 DOI: 10.1007/s00270-020-02666-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Irreversible electroporation (IRE) is a non-thermal ablation technique for unresectable hepatocellular carcinoma (HCC) not amenable to standard thermal ablation. The aim of this study was to report our longer-term outcomes using this treatment modality. METHOD We identified all patients at our institution who underwent IRE for HCC between December 2008 and October 2019 as recommended after multi-disciplinary team review. Demographic, clinical, tumour response and survival data up until 1 March, 2020 were analysed. The primary outcome was local recurrence-free survival (LRFS) in patients who had a complete response (CR). Secondary outcomes included CR rates, procedure-related complications and the incidence of death or liver transplantation. RESULTS A total of 23 patients (78% males, median age 65.2 years) received IRE therapy to 33 HCC lesions during the study period with the median tumour size being 2.0 cm (range 1.0-5.0 cm). Twenty-nine (87.9%) lesions were successfully ablated after one (n = 26) or two (n = 3) procedures. The median follow-up time for these lesions was 20.4 months. The median overall LRFS was 34.5 (95% CI 24.8 -) months with a 6- and 12-month LRFS of 87.9% (95% CI 75.8-100) and 83.6% (95% CI 70.2-99.7), respectively. Tumours < 2 cm had a 12-month LRFS of 100% (95% CI 100-100). CONCLUSION IRE appears to be an efficacious local ablative method for early stage HCC not amenable to standard ablative techniques, with very good CR rates and longer-term LRFS, particularly for smaller lesions. Further studies comparing this technique to more widely accepted ablative methods such as radiofrequency and microwave ablation are warranted.
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Affiliation(s)
- E Freeman
- Department of Gastroenterology, Alfred Hospital, The Alfred55 Commercial Rd, Melbourne, 3004, Australia
| | - W Cheung
- Department of Radiology, Alfred Hospital, Melbourne, Australia
| | - H Kavnoudias
- Department of Radiology, Alfred Hospital, Melbourne, Australia
| | - A Majeed
- Department of Gastroenterology, Alfred Hospital, The Alfred55 Commercial Rd, Melbourne, 3004, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - W Kemp
- Department of Gastroenterology, Alfred Hospital, The Alfred55 Commercial Rd, Melbourne, 3004, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - S K Roberts
- Department of Gastroenterology, Alfred Hospital, The Alfred55 Commercial Rd, Melbourne, 3004, Australia. .,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia.
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Abstract
OBJECTIVES To analyse the association between ABO blood group and aortic disease using data on blood donors and transfused patients from Sweden. DESIGN This was a retrospective study using data from the Swedish portion of the Scandinavian Donations and Transfusions Database. The association between ABO blood group and aortic disease was analysed using log-linear Poisson regression models and presented as incidence rate ratios (IRRs). SETTING Swedish population-based study. PARTICIPANTS The study cohort consisted of 1 164 561 Swedish blood donors and 961 637 transfused patients with a combined follow-up time of 29 390 649 person-years. PRIMARY AND SECONDARY OUTCOME MEASURES IRRs of aortic events (ie, aortic aneurysms and/or aortic dissections) in relation to patient blood group. RESULTS A total of 20 684 aortic events occurred during the study period. Non-O donors and patients had similar incidence of aortic events when compared with blood group O donors and patients with an IRR of 0.98 (95% CI, 0.93-1.04) and 1.00 (95% CI, 0.97-1.03), respectively. There were no differences between non-O and blood group O individuals when aortic dissections and aortic aneurysms were analysed separately. Blood group B conferred a lower risk of aortic aneurysms in the patient cohort when compared with blood group O (IRR, 0.90; 95% CI, 0.85-0.96). CONCLUSIONS In the present study, there were no statistically significant associations between ABO blood group and the risk of aortic disease. A possible protective effect of blood group B was observed in the patient cohort but this finding requires further investigation.
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Affiliation(s)
- Igor Zindovic
- Department of Clinical Sciences, Department of Cardiothoracic Surgery, Lund, Sweden, Lund University, Skåne University Hospital, Lund, Sweden
| | - Gustaf Edgren
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Shahab Nozohoor
- Department of Clinical Sciences, Department of Cardiothoracic Surgery, Lund, Sweden, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ammar Majeed
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, The Alfred Health, Melbourne, Victoria, Australia
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Janko N, Majeed A, Kemp W, Roberts SK. Viscoelastic Tests as Point-of-Care Tests in the Assessment and Management of Bleeding and Thrombosis in Liver Disease. Semin Thromb Hemost 2020; 46:704-715. [PMID: 32932542 DOI: 10.1055/s-0040-1715475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Viscoelastic point-of-care (VET POC) tests provide a global assessment of hemostasis and have an increasing role in the management of bleeding and blood component delivery across several clinical settings. VET POC tests have a rapid turnaround time, provide a better overall picture of hemostasis, predict bleeding more accurately than conventional coagulation tests, and reduce blood component usage and health care costs. Despite commonly having abnormal conventional coagulation tests, most patients with chronic liver disease have a "rebalanced" hemostasis. However, this hemostatic balance is delicate and these patients are predisposed to both bleeding and thromboembolic events. Over recent years, VET POC tests have been increasingly studied for their potential as better functional tests of hemostasis in liver disease patients. This review provides a background on the most common VET POC tests (thromboelastography and rotational thromboelastometry) and discusses the current evidence for these tests in the prediction and management of bleeding and thrombosis in patients with chronic liver disease, and in liver resection and transplant. With the recent publication of several randomized controlled trials, there is growing evidence that VET POC tests may be used to improve bleeding risk assessment and reduce blood product use in liver disease patients outside of the transplant setting. However, consensus is still lacking regarding the VET POC tests' thresholds that should be used to trigger blood product transfusion. VET POC tests also show promise in predicting thrombosis in patients with liver disease, but further research is needed before they can be used to guide anticoagulant therapy.
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Affiliation(s)
- Natasha Janko
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Palladino R, Majeed A, Millett C, Vamos E. The association between non-diabetic hyperglycaemia and incident vascular disease. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
It is unknown whether the associated risk of vascular disease for individuals with non-diabetic hyperglycaemia (NDH) persists following the Type 2 diabetes (T2D) diagnosis. We assessed whether NDH detection before the T2D diagnosis is associated with different risk of incident vascular disease following the T2D diagnosis.
Methods
Population-based retrospective cohort study including 159,736 individuals with newly diagnosed T2D from the CPRD database in England between 2004 and 2017. Outcomes: incident retinopathy, nephropathy, and composite macrovascular disease. We employed time-partitioned Cox regression models partitioning the 10-year follow-up period into 4 equal time segments to model differences in rates between groups with different glycaemic status in the 3 years before diagnosis of T2D.
Results
Following T2D diagnosis those with prior NDH had 86%, 58%, and 42% increased rates of retinopathy in the 30 months, between 31 and 60 months, and 61 and 90 months, respectively(0-30 months: HR 1.86,95%CI 1.69-2.04;31-60 months: HR 1.58,95%CI 1.37-1.84;61-90 months:HR 1.42,95%CI 1.10-1.83), as compared with those with prior normoglycaemia. They also had 16% and 25% increased rates of nephropathy in the period 0-30 months and 31-60 months, respectively (0-30 months: HR 1.16,95%CI 1.07-1.26;31-60 months: HR 1.25,95%CI 1.09-1.42). Individuals with prior NDH had 19% reduced rate of macrovascular disease in the first 30 months of the study period (HR 0.81,95%CI 0.71-0.93), as compared with individuals with glycaemic values within the normal range.
Conclusions
Individuals detected with NDH had increased rates of microvascular disease up to 7.5 years following the diagnosis of T2D. Timely testing and identification of NDH and specific clustering of NDH with other risk factors for T2D might prompt earlier risk factor assessment and tailored vascular risk reduction strategies during the NDH phase to reduce the burden of vascular disease following the diagnosis of T2D
Key messages
Individuals detected with NDH had increased rates of microvascular disease up to 7.5 years following the diagnosis of T2D, as compared with individuals with prior normoglycaemia. Timely detection of NDH and specific clustering with other risk factors for T2D might prompt earlier and tailored vascular risk reduction strategies to reduce the burden of vascular disease.
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Affiliation(s)
- R Palladino
- Public Health Policy Evaluation Unit, Imperial College, London, UK
- Department of Public Health, University, Naples, Italy
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - C Millett
- Public Health Policy Evaluation Unit, Imperial College, London, UK
| | - E Vamos
- Public Health Policy Evaluation Unit, Imperial College, London, UK
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Hargreaves S, Deal A, Mounier-Jack S, Campos-Matos I, Edelstein M, Hayward S, Friedland J, Carter J, Rustage K, Majeed A. Migration and outbreaks of vaccine-preventable disease in Europe: a systematic analysis (1990-2019). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Migrant populations (defined as foreign-born) in the EU/EEA may be one of several under-immunised populations yet their role in outbreaks of vaccine-preventable diseases (VPDs) has been poorly defined to date.
Methods
We did both a temporal analysis to map published reports of migrant-related outbreaks against data from the ECDC's Surveillance Atlas of Infectious Disease, and a systematic review (PROSPERO CRD42019157473; 1990-2019) adhering to PRISMA guidelines, to explore whether migrants are involved in outbreaks in Europe and which particular subpopulations may be at increased risk. Studies on VPD outbreaks (measles, mumps, rubella, diphtheria, pertussis, polio, hepatitis A, N meningitidis, and H influenzae) in migrants residing in the EU/EEA were included.
Results
46 studies were included, reporting on 50 VPD outbreaks across 13 EU/EEA countries, of which 98% (n = 49) occured since January 2000. Measles had the highest number of reports of outbreaks involving migrants (n = 21; 5043 cases), followed by varicella (n = 10; 595 cases) and hepatitis A (n = 10; 1226 cases). 21 (40%) of outbreaks were reported from shelters for asylum seekers and refugees (mainly varicella or measles). Of 27 outbreaks where the index case was defined, 20 (74.1%) were migrants, including 9 (33.3%) from Eastern Europe and 6 (22.2%) from Africa. When mapped against the ECDC timeline of measles outbreaks, migrant-related outbreaks coincide with Europe-wide peaks in measles incidence (in 2006, 2010, and 2018).
Conclusions
Migrants represent one key group involved in VPD outbreaks, with refugees/asylum seekers residing in shelters or camps particularly at risk. Measles accounted for 38% of all reported outbreaks. Improved data collection on migrant status across Europe is crucial to understanding the complex relationship between migration and occurrence of VPD outbreaks to inform policy decisions on the most effective strategies to prevent future outbreaks.
Key messages
Migrants represent one key group involved in vaccine-preventable diseases outbreaks in Europe. Refugees and asylum seekers may be particularly at risk.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | | | | | - S Hayward
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - J Friedland
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - J Carter
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - A Majeed
- Department Primary Care and Public Health, Imperial College London, London, UK
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Parnham JC, Laverty AA, Majeed A, Vamos EP. Half of children entitled to free school meals did not have access to the scheme during COVID-19 lockdown in the UK. Public Health 2020; 187:161-164. [PMID: 32980783 PMCID: PMC7447260 DOI: 10.1016/j.puhe.2020.08.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objectives of the study were to investigate access to free school meals (FSMs) among eligible children, to describe factors associated with uptake and to investigate whether receiving FSMs was associated with measures of food insecurity in the UK using the Coronavirus (COVID-19) wave of the UK Household Longitudinal Study. STUDY DESIGN The study design was cross-sectional analyses of questionnaire data collected in April 2020. METHODS Six hundred and thirty-five children who were FSM eligible with complete data were included in the analytic sample. Accessing a FSM was defined as receiving a FSM voucher or a cooked meal at school. Multivariable logistic regression was used to investigate (i) associations between characteristics and access to FSMs and (ii) associations between access to FSMs and household food insecurity measures. All analyses accounted for survey design and sample weights to ensure representativeness. RESULTS Fifty-one percent of eligible children accessed a FSM. Children in junior schools or above (aged 8+ years) (adjusted odds ratio [AOR]: 11.81; 95% confidence interval [CI]: 5.54, 25.19), who belonged to low-income families (AOR: 4.81; 95% CI: 2.10, 11.03) or still attending schools (AOR: 5.87; 95% CI: 1.70, 20.25) were more likely to receive FSMs. Children in Wales were less likely to access FSMs than those in England (AOR: 0.11; 95% CI: 0.03, 0.43). Receiving a FSM was associated with increased odds of recently using a food bank but not reporting feeling hungry. CONCLUSIONS In the month after the COVID-19 lockdown, 49% of eligible children did not receive any form of FSMs. The present analyses highlight that the voucher scheme did not adequately serve children who could not attend school during the lockdown. Moreover, more needs to be done to support families relying on income-related benefits, who still report needing to access a food bank. As the scheme may be continued in summer or in a potential second wave, large improvements will be needed to improve its reach.
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Affiliation(s)
- J C Parnham
- Public Health Policy Evaluation Unit, Imperial College London, UK.
| | - A A Laverty
- Public Health Policy Evaluation Unit, Imperial College London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London, UK
| | - E P Vamos
- Public Health Policy Evaluation Unit, Imperial College London, UK
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