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Pembroke TPI, John G, Puyk B, Howkins K, Clarke R, Yousuf F, Czajkowski M, Godkin A, Salmon J, Yeoman A. Rising incidence, progression and changing patterns of liver disease in Wales 1999-2019. World J Hepatol 2023; 15:89-106. [PMID: 36744166 PMCID: PMC9896508 DOI: 10.4254/wjh.v15.i1.89] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/17/2022] [Accepted: 01/01/2023] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Liver disease incidence and hence demand on hepatology services is increasing.
AIM To describe trends in incidence and natural history of liver diseases in Wales to inform effective provision of hepatology services.
METHODS The registry is populated by International Classification of Diseases-10 (ICD-10) code diagnoses for residents derived from mortality data and inpatient/day case activity between 1999-2019. Pseudo-anonymised linkage of: (1) Causative diagnoses; (2) Cirrhosis; (3) Portal hypertension; (4) Decompensation; and (5) Liver cancer diagnoses enabled tracking liver disease progression.
RESULTS The population of Wales in 2019 was 3.1 million. Between 1999 and 2019 73054 individuals were diagnosed with a hepatic disorder, including 18633 diagnosed with cirrhosis, 10965 with liver decompensation and 2316 with hepatocellular carcinoma (HCC). Over 21 years the incidence of liver diseases increased 3.6 fold, predominantly driven by a 10 fold increase in non-alcoholic fatty liver disease (NAFLD); the leading cause of liver disease from 2014. The incidence of cirrhosis, decompensation, HCC, and all-cause mortality tripled. Liver-related mortality doubled. Alcohol-related liver disease (ArLD), autoimmune liver disease and congestive hepatopathy were associated with the highest rates of decompensation and all-cause mortality.
CONCLUSION A 10 fold increase in NAFLD incidence is driving a 3.6 fold increase in liver disease in Wales over 21 years. Liver-related morbidity and mortality rose more slowly reflecting the lower progression rate in NAFLD. Incidence of ArLD remained stable but was associated with the highest rates of liver-related and all-cause mortality.
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Affiliation(s)
- Thomas Peter Ignatius Pembroke
- Department of Gastroenterology and Hepatology, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom
- Division of Infection and Immunity, Cardiff University, Cardiff CF14 4XW, United Kingdom
| | - Gareth John
- Digital Health and Care Wales, NHS Wales, Cardiff CF11 9AD, United Kingdom
| | - Berry Puyk
- Digital Health and Care Wales, NHS Wales, Cardiff CF11 9AD, United Kingdom
| | - Keith Howkins
- Digital Health and Care Wales, NHS Wales, Cardiff CF11 9AD, United Kingdom
| | - Ruth Clarke
- Digital Health and Care Wales, NHS Wales, Cardiff CF11 9AD, United Kingdom
| | - Fidan Yousuf
- Gwent Liver Unit, Royal Gwent Hospital, Newport NP20 2UB, United Kingdom
| | - Marek Czajkowski
- Gwent Liver Unit, Royal Gwent Hospital, Newport NP20 2UB, United Kingdom
| | - Andrew Godkin
- Department of Gastroenterology and Hepatology, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom
- Division of Infection and Immunity, Cardiff University, Cardiff CF14 4XW, United Kingdom
| | - Jane Salmon
- Public Health Wales, NHS Wales, Cardiff CF10 4BZ, United Kingdom
| | - Andrew Yeoman
- Gwent Liver Unit, Royal Gwent Hospital, Newport NP20 2UB, United Kingdom
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Yeoman A, Maggs DR, Gardezi SAA, Haboubi HN, Yahya MI, Yousuf F, Czajkowski MA. Incidence, pattern and severity of abnormal liver blood tests among hospitalised patients with SARS-COV2 (COVID-19) in South Wales. Frontline Gastroenterol 2020; 12:89-94. [PMID: 33617606 PMCID: PMC7873537 DOI: 10.1136/flgastro-2020-101532] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/26/2020] [Accepted: 07/12/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION SARS-CoV-2 (COVID-19) is a novel coronavirus that emerged in Wuhan, China in late 2019 and since become a global pandemic. As such, its clinical behaviour is a subject of much interest. Initial reports suggested a significant proportion of patients have abnormal liver blood tests. Gwent has experienced one of the highest incidences of COVID-19 infection in the UK, which itself has among the highest COVID-19 impacts worldwide. METHOD We set out to report the incidence, clinical pattern and severity of liver blood test abnormalities in hospitalised patients with confirmed COVID-19 in our institution over a 3-week period. Data on clinical outcomes such as admission to intensive therapy unit (ITU), hospital discharge and mortality were recorded. RESULTS 318 hospitalised COVID-19 positive had liver blood tests available for analysis. Ninety-seven patients (31%) had one or more abnormal liver blood tests and were abnormal admission in 64%. Liver tests were predominantly cholestatic (72%) in contrast to other studies to date. Male gender and abnormal liver blood tests were associated with ITU admission. CONCLUSIONS Almost one-third of admissions with COVID-19 have abnormal LBTs which are typically mild and are associated with male gender. Importantly, we have identified that cholestatic patterns dominate but were not clearly associated with ITU admission or death.
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Affiliation(s)
- Andrew Yeoman
- Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, UK
| | - Daniel Raun Maggs
- Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, UK
| | - Syed A A Gardezi
- Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, UK
| | | | | | - Fidan Yousuf
- Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, UK
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Shinohara RT, Oh J, Nair G, Calabresi PA, Davatzikos C, Doshi J, Henry RG, Kim G, Linn KA, Papinutto N, Pelletier D, Pham DL, Reich DS, Rooney W, Roy S, Stern W, Tummala S, Yousuf F, Zhu A, Sicotte NL, Bakshi R. Volumetric Analysis from a Harmonized Multisite Brain MRI Study of a Single Subject with Multiple Sclerosis. AJNR Am J Neuroradiol 2017; 38:1501-1509. [PMID: 28642263 PMCID: PMC5557658 DOI: 10.3174/ajnr.a5254] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging can be used to measure structural changes in the brains of individuals with multiple sclerosis and is essential for diagnosis, longitudinal monitoring, and therapy evaluation. The North American Imaging in Multiple Sclerosis Cooperative steering committee developed a uniform high-resolution 3T MR imaging protocol relevant to the quantification of cerebral lesions and atrophy and implemented it at 7 sites across the United States. To assess intersite variability in scan data, we imaged a volunteer with relapsing-remitting MS with a scan-rescan at each site. MATERIALS AND METHODS All imaging was acquired on Siemens scanners (4 Skyra, 2 Tim Trio, and 1 Verio). Expert segmentations were manually obtained for T1-hypointense and T2 (FLAIR) hyperintense lesions. Several automated lesion-detection and whole-brain, cortical, and deep gray matter volumetric pipelines were applied. Statistical analyses were conducted to assess variability across sites, as well as systematic biases in the volumetric measurements that were site-related. RESULTS Systematic biases due to site differences in expert-traced lesion measurements were significant (P < .01 for both T1 and T2 lesion volumes), with site explaining >90% of the variation (range, 13.0-16.4 mL in T1 and 15.9-20.1 mL in T2) in lesion volumes. Site also explained >80% of the variation in most automated volumetric measurements. Output measures clustered according to scanner models, with similar results from the Skyra versus the other 2 units. CONCLUSIONS Even in multicenter studies with consistent scanner field strength and manufacturer after protocol harmonization, systematic differences can lead to severe biases in volumetric analyses.
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Affiliation(s)
- R T Shinohara
- From the Departments of Biostatistics and Epidemiology (R.T.S., K.A.L.)
| | - J Oh
- Department of Neurology (J.O., P.A.C., D.S.R.), Johns Hopkins University School of Medicine, Baltimore, Maryland.,St. Michael's Hospital (J.O.), University of Toronto, Toronto, Ontario, Canada
| | - G Nair
- Translational Neuroradiology Section (G.N., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - P A Calabresi
- Department of Neurology (J.O., P.A.C., D.S.R.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C Davatzikos
- Radiology (C.D., J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Doshi
- Radiology (C.D., J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - R G Henry
- Department of Neurology (R.G.H., N.P., W.S., A.Z.), University of California, San Francisco, San Francisco, California
| | - G Kim
- Laboratory for Neuroimaging Research (G.K., S.T., F.Y., R.B.), Partners Multiple Sclerosis Center
| | - K A Linn
- From the Departments of Biostatistics and Epidemiology (R.T.S., K.A.L.)
| | - N Papinutto
- Department of Neurology (R.G.H., N.P., W.S., A.Z.), University of California, San Francisco, San Francisco, California
| | - D Pelletier
- Department of Neurology (D.P.), Yale Medical School, New Haven, Connecticut
| | - D L Pham
- Henry M. Jackson Foundation for the Advancement of Military Medicine (D.L.P., S.R.), Bethesda, Maryland
| | - D S Reich
- Department of Neurology (J.O., P.A.C., D.S.R.), Johns Hopkins University School of Medicine, Baltimore, Maryland.,Translational Neuroradiology Section (G.N., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - W Rooney
- Advanced Imaging Research Center, Oregon Health & Science University (W.R.), Portland, Oregon
| | - S Roy
- Henry M. Jackson Foundation for the Advancement of Military Medicine (D.L.P., S.R.), Bethesda, Maryland
| | - W Stern
- Department of Neurology (R.G.H., N.P., W.S., A.Z.), University of California, San Francisco, San Francisco, California
| | - S Tummala
- Laboratory for Neuroimaging Research (G.K., S.T., F.Y., R.B.), Partners Multiple Sclerosis Center
| | - F Yousuf
- Laboratory for Neuroimaging Research (G.K., S.T., F.Y., R.B.), Partners Multiple Sclerosis Center
| | - A Zhu
- Department of Neurology (R.G.H., N.P., W.S., A.Z.), University of California, San Francisco, San Francisco, California
| | - N L Sicotte
- Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, California
| | - R Bakshi
- Laboratory for Neuroimaging Research (G.K., S.T., F.Y., R.B.), Partners Multiple Sclerosis Center.,Departments of Neurology and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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