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Zhao L, Zhang X, Coday M, Garcia DO, Li X, Mossavar-Rahmani Y, Naughton MJ, Lopez-Pentecost M, Saquib N, Shadyab AH, Simon MS, Snetselaar LG, Tabung FK, Tobias DK, VoPham T, McGlynn KA, Sesso HD, Giovannucci E, Manson JE, Hu FB, Tinker LF, Zhang X. Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality. JAMA 2023; 330:537-546. [PMID: 37552302 PMCID: PMC10410478 DOI: 10.1001/jama.2023.12618] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/21/2023] [Indexed: 08/09/2023]
Abstract
Importance Approximately 65% of adults in the US consume sugar-sweetened beverages daily. Objective To study the associations between intake of sugar-sweetened beverages, artificially sweetened beverages, and incidence of liver cancer and chronic liver disease mortality. Design, Setting, and Participants A prospective cohort with 98 786 postmenopausal women aged 50 to 79 years enrolled in the Women's Health Initiative from 1993 to 1998 at 40 clinical centers in the US and were followed up to March 1, 2020. Exposures Sugar-sweetened beverage intake was assessed based on a food frequency questionnaire administered at baseline and defined as the sum of regular soft drinks and fruit drinks (not including fruit juice); artificially sweetened beverage intake was measured at 3-year follow-up. Main Outcomes and Measures The primary outcomes were (1) liver cancer incidence, and (2) mortality due to chronic liver disease, defined as death from nonalcoholic fatty liver disease, liver fibrosis, cirrhosis, alcoholic liver diseases, and chronic hepatitis. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% CIs for liver cancer incidence and for chronic liver disease mortality, adjusting for potential confounders including demographics and lifestyle factors. Results During a median follow-up of 20.9 years, 207 women developed liver cancer and 148 died from chronic liver disease. At baseline, 6.8% of women consumed 1 or more sugar-sweetened beverage servings per day, and 13.1% consumed 1 or more artificially sweetened beverage servings per day at 3-year follow-up. Compared with intake of 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more servings per day had a significantly higher risk of liver cancer (18.0 vs 10.3 per 100 000 person-years [P value for trend = .02]; adjusted HR, 1.85 [95% CI, 1.16-2.96]; P = .01) and chronic liver disease mortality (17.7 vs 7.1 per 100 000 person-years [P value for trend <.001]; adjusted HR, 1.68 [95% CI, 1.03-2.75]; P = .04). Compared with intake of 3 or fewer artificially sweetened beverages per month, individuals who consumed 1 or more artificially sweetened beverages per day did not have significantly increased incidence of liver cancer (11.8 vs 10.2 per 100 000 person-years [P value for trend = .70]; adjusted HR, 1.17 [95% CI, 0.70-1.94]; P = .55) or chronic liver disease mortality (7.1 vs 5.3 per 100 000 person-years [P value for trend = .32]; adjusted HR, 0.95 [95% CI, 0.49-1.84]; P = .88). Conclusions and Relevance In postmenopausal women, compared with consuming 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more sugar-sweetened beverages per day had a higher incidence of liver cancer and death from chronic liver disease. Future studies should confirm these findings and identify the biological pathways of these associations.
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Affiliation(s)
- Longgang Zhao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Xinyuan Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - David O. Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
| | - Xinyi Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Michelle J. Naughton
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus
| | | | - Nazmus Saquib
- College of Medicine, Sulaiman Alrajhi University, Bukariyah, Qassim, Saudi Arabia
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Michael S. Simon
- Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Linda G. Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Fred K. Tabung
- Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center-James Cancer Hospital, Solove Research Institute, The Ohio State University, Columbus
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Deirdre K. Tobias
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Trang VoPham
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Howard D. Sesso
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - JoAnn E. Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Frank B. Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lesley F. Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Sjöland W, Wahlström A, Makki K, Schöler M, Molinaro A, Olsson L, Greiner T, Caesar R, de Boer JF, Kuipers F, Bäckhed F, Marschall HU. Absence of gut microbiota reduces neonatal survival and exacerbates liver disease in Cyp2c70-deficient mice with a human-like bile acid composition. Clin Sci (Lond) 2023; 137:995-1011. [PMID: 37384590 PMCID: PMC10346113 DOI: 10.1042/cs20230413] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/11/2023] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 07/01/2023]
Abstract
Mice with deletion of Cyp2c70 have a human-like bile acid composition, display age- and sex-dependent signs of hepatobiliary disease and can be used as a model to study interactions between bile acids and the gut microbiota in cholestatic liver disease. In the present study, we rederived Cyp2c70-/- mice as germ-free (GF) and colonized them with a human or a mouse microbiota to investigate whether the presence of a microbiota can be protective in cholangiopathic liver disease associated with Cyp2c70-deficiency. GF Cyp2c70-/- mice showed reduced neonatal survival, liver fibrosis, and distinct cholangiocyte proliferation. Colonization of germ-free breeding pairs with a human or a mouse microbiota normalized neonatal survival of the offspring, and particularly colonization with mouse microbiota from a conventionally raised mouse improved the liver phenotype at 6-10 weeks of age. The improved liver phenotype in conventionalized (CD) Cyp2c70-/- mice was associated with increased levels of tauro-ursodeoxycholic acid (TUDCA) and UDCA, resulting in a more hydrophilic bile acid profile compared with GF and humanized Cyp2c70-/- mice. The hydrophobicity index of biliary bile acids of CD Cyp2c70-/- mice was associated with changes in gut microbiota, liver weight, liver transaminases, and liver fibrosis. Hence, our results indicate that neonatal survival of Cyp2c70-/- mice seems to depend on the establishment of a gut microbiota at birth, and the improved liver phenotype in CD Cyp2c70-/- mice may be mediated by a larger proportion of TUDCA/UDCA in the circulating bile acid pool and/or by the presence of specific bacteria.
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Affiliation(s)
- Wilhelm Sjöland
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden
| | - Annika Wahlström
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden
| | - Kassem Makki
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden
| | - Marc Schöler
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden
| | - Antonio Molinaro
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine, Gothenburg, Sweden
| | - Lisa Olsson
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden
| | - Thomas Uwe Greiner
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden
| | - Robert Caesar
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden
| | - Jan Freark de Boer
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, The Netherlands
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Folkert Kuipers
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, The Netherlands
- European Research Institute for the Biology of Ageing (ERIBA), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Fredrik Bäckhed
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Physiology, Gothenburg, Sweden
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, DK-2200, Denmark
| | - Hanns-Ulrich Marschall
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Physiology, Gothenburg, Sweden
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3
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Soufi M, Flick KF, Ceppa DP, Blackwell MM, Mararu R, Nguyen TK, Schmidt CM, Nakeeb A, Zyromski N, House MG, Moszczynski Z, Ceppa EP. Investigating the incidence, impact, and severity of pulmonary complications after hepatectomy: A single institution experience. Surgery 2022; 171:643-649. [PMID: 35074169 DOI: 10.1016/j.surg.2021.12.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Postoperative pulmonary complications are a common cause of postoperative morbidity in patients undergoing hepatectomy. This study aimed to identify risk factors, define severity, and evaluate the impact of postoperative pulmonary complications on postoperative morbidity after hepatectomy. METHOD We used a prospective database in identifying all hepatectomies from 2013 to 2018. The database was then augmented using extensive review of medical records. The Strasburg system was used in categorizing resections per complexity: major hepatic resection and minor hepatic resection, whereas the Clavien-Dindo system was used in defining postoperative pulmonary complications per severity. Potential confounders were controlled for on multiple regression models. RESULTS A total of 702 cases were identified: major hepatic resection 413 (60%) and minor hepatic resection 289 (40%). Patients demonstrated comparable characteristics, but the postoperative pulmonary complications group was more likely to have chronic obstructive pulmonary disease (10% vs 5%; P = .02). Severe postoperative pulmonary complications among major hepatectomy was observed in 38 patients (13%). Predictors for severe postoperative pulmonary complications requiring intervention included postoperative liver failure (odds ratio = 2.8; P = .002) and biliary fistula (odds ratio = 3.5; P = .001). In addition, the occurrence of severe postoperative pulmonary complications markedly hindered recovery, increasing length of stay by 4.4-fold and readmission rates by 3-fold (P < .001). On multivariable analysis, postoperative pulmonary complications significantly increase postoperative length of stay (8 vs 5 days; P < .001) and readmission (odds ratio = 3.2; P = .001). Mortality was similar (1% vs 4%; P = .066). CONCLUSION Postoperative pulmonary complications are a major cause of delayed recovery and worse outcomes after hepatectomy. Further, postoperative liver failure and biliary fistula can predict the occurrence of severe postoperative pulmonary complications among major hepatic resection and the associated need for readmission with these complications.
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Affiliation(s)
- Mazhar Soufi
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Katelyn F Flick
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Duykhanh P Ceppa
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Madeline M Blackwell
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Rodica Mararu
- Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Trang K Nguyen
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - C Max Schmidt
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Attila Nakeeb
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Nicholas Zyromski
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Michael G House
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | | | - Eugene P Ceppa
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
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4
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Karlsen TH, Sheron N, Zelber-Sagi S, Carrieri P, Dusheiko G, Bugianesi E, Pryke R, Hutchinson SJ, Sangro B, Martin NK, Cecchini M, Dirac MA, Belloni A, Serra-Burriel M, Ponsioen CY, Sheena B, Lerouge A, Devaux M, Scott N, Hellard M, Verkade HJ, Sturm E, Marchesini G, Yki-Järvinen H, Byrne CD, Targher G, Tur-Sinai A, Barrett D, Ninburg M, Reic T, Taylor A, Rhodes T, Treloar C, Petersen C, Schramm C, Flisiak R, Simonova MY, Pares A, Johnson P, Cucchetti A, Graupera I, Lionis C, Pose E, Fabrellas N, Ma AT, Mendive JM, Mazzaferro V, Rutter H, Cortez-Pinto H, Kelly D, Burton R, Lazarus JV, Ginès P, Buti M, Newsome PN, Burra P, Manns MP. The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet 2022; 399:61-116. [PMID: 34863359 DOI: 10.1016/s0140-6736(21)01701-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Tom H Karlsen
- Department of Transplantation Medicine and Research Institute for Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway.
| | - Nick Sheron
- Institute of Hepatology, Foundation for Liver Research, Kings College London, London, UK
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Patrizia Carrieri
- Aix-Marseille University, Inserm, Institut de recherche pour le développement, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), ISSPAM, Marseille, France
| | - Geoffrey Dusheiko
- School of Medicine, University College London, London, UK; Kings College Hospital, London, UK
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, UK
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra-IDISNA and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Mae Ashworth Dirac
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Annalisa Belloni
- Health Economics and Modelling Division, Public Health England, London, UK
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Brittney Sheena
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alienor Lerouge
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Marion Devaux
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Henkjan J Verkade
- Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, University of Groningen, Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ekkehard Sturm
- Division of Paediatric Gastroenterology and Hepatology, University Children's Hospital Tübingen, Tübingen, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | | | | | - Chris D Byrne
- Department of Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton and Southampton General Hospital, Southampton, UK
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Damon Barrett
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tatjana Reic
- European Liver Patients Organization, Brussels, Belgium; Croatian Society for Liver Diseases-Hepatos, Split, Croatia
| | | | - Tim Rhodes
- London School of Hygiene & Tropical Medicine, London, UK
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Claus Petersen
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Schramm
- Martin Zeitz Center for Rare Diseases, Hamburg Center for Translational Immunology (HCTI), and First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Poland
| | - Marieta Y Simonova
- Department of Gastroenterology, HPB Surgery and Transplantation, Clinic of Gastroentrology, Military Medical Academy, Sofia, Bulgaria
| | - Albert Pares
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Isabel Graupera
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Christos Lionis
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Elisa Pose
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Ann T Ma
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan M Mendive
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Madrid, Spain; La Mina Health Centre, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS Foundation (INT), Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia and Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Deirdre Kelly
- Liver Unit, Birmingham Women's and Children's Hospital and University of Birmingham, UK
| | - Robyn Burton
- Alcohol, Drugs, Tobacco and Justice Division, Public Health England, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, Barcelona, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Maria Buti
- CIBEREHD del Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario Valle Hebron, Barcelona, Spain
| | - Philip N Newsome
- National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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García-Herola A, Domínguez-Hernández R, Casado MÁ. Clinical and economic impact of an alert system in primary care for the detection of patients with chronic hepatitis C. PLoS One 2021; 16:e0260608. [PMID: 34928962 PMCID: PMC8687533 DOI: 10.1371/journal.pone.0260608] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/13/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Prevalence of chronic hepatitis C (CHC) is higher in patients born between 1955-1975. The aim was to perform an economic evaluation of an age-based electronic health record (EHR) alert in primary care to detect patients with undiagnosed CHC and its treatment in comparison with non-use of the alert system, in Valencian Community, Spain. MATERIALS AND METHODS Decision trees and Markov model were used to evaluate the diagnosis and progression of the disease, respectively. CHC was diagnosed by serology and viral load in seropositive subjects. Epidemiological data and diagnostic costs were extracted from public sources of the Valencian Community. Probabilities, utilities and costs of model states were obtained from the literature. The impact on mortality and hepatic complications avoided by the implementation of the alert were estimated, and efficiency was measured as an incremental cost-utility ratio (ICUR) based on quality-adjusted life years (QALYs) and the costs of both alternatives. RESULTS The EHR alert detected 269,548 patients, of whom 1,331 had CHC (vs. 23 patients with non-alert). Over the patients' lifetime, the alert would prevent 93% of decompensated cirrhosis cases, 87% of hepatocellular carcinomas, 90% of liver transplants, and 89% of liver related deaths compared to non-use of the alert system. In addition, it would obtain an additional 3.3 QALY per patient, with an incremental cost of €10,880 and an ICUR of €3,321. CONCLUSIONS The implementation of an age-based EHR alert in primary care to detect patients with CHC reduces hepatic complications and mortality and is an efficient strategy.
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Affiliation(s)
- Antonio García-Herola
- Digestive Medicine Section, Hospital Marina Baixa de la Vila Joiosa (Alicante), Marina Baixa de la Vila Hospital, Joiosa, Alicante, Spain
- * E-mail:
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6
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Kedia SK, Ali B, Jiang Y, Arshad H, Satapathy SK, Gonzalez HC. Post-liver transplant outcomes in patients with major psychiatric diagnosis in the United States. Ann Hepatol 2021; 22:100311. [PMID: 33482365 DOI: 10.1016/j.aohep.2021.100311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/20/2020] [Revised: 12/01/2020] [Accepted: 12/11/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Higher rates of psychiatric disorders are reported among cirrhotic patients. This study examines the demographic and clinical outcomes post-liver transplant (LT) among cirrhotic patients with a major psychiatric diagnosis (cases) compared to those without psychiatric diagnosis (controls). MATERIALS AND METHODS Retrospective case control design was used among 189 cirrhotic patients who had undergone LT at Methodist University Hospital Transplant Institute, Memphis, TN between January 2006 and December 2014. Multivariable regression and Cox proportional hazard regression were conducted to compare allograft loss and all-cause mortality. RESULTS The study sample consisted of a matched cohort of 95 cases and 94 controls with LT. Females and those with Hepatic Encephalopathy (HE) were more likely to have psychiatric diagnosis. Patients with hepatocellular carcinoma (HCC) were twice as likely to have allograft loss. Psychiatric patients with HCC had two and a half times (HR 2.54; 95% CI: 1.20-5.37; p = 0.015) likelihood of all-cause mortality. Data censored at 1-year post-LT revealed that patients with psychiatric diagnosis have a three to four times higher hazard for allograft loss and all-cause mortality compared to controls after adjusting for covariates, whereas when the data is censored at 5 year, allograft loss and all-cause mortality have two times higher hazard ratio. CONCLUSIONS The Cox proportional hazard regression analysis of censored data at 1 and 5 year indicate higher allograft loss and all-cause mortality among LT patients with psychiatric diagnosis. Patients with well-controlled psychiatric disorders who undergo LT need close monitoring and medication adherence.
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Affiliation(s)
- Satish K Kedia
- School of Public Health, University of Memphis, Memphis, TN, United States.
| | - Bilal Ali
- James D Eason Transplant Institute, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, TN, United States.
| | - Yu Jiang
- School of Public Health, University of Memphis, Memphis, TN, United States.
| | - Hassan Arshad
- School of Public Health, University of Memphis, Memphis, TN, United States.
| | - Sanjaya K Satapathy
- Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases & Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, United States.
| | - Humberto C Gonzalez
- Department of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI, United States; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, United States.
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Zhu Z, Yin J, Dawsey SM, Liu B, Freedman ND, Yin L, Taylor PR, Cui J, Fan J, Liu Y, Chen W, Qiao Y, Abnet CC. Association between serum ferritin, incident primary liver cancer, and chronic liver disease mortality in the Linxian Nutrition Intervention Trials: A nested case-control study. J Gastroenterol Hepatol 2021; 36:3410-3417. [PMID: 34106490 PMCID: PMC8655023 DOI: 10.1111/jgh.15571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/04/2020] [Revised: 05/09/2021] [Accepted: 06/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Previous studies suggest that serum ferritin may be associated with higher risk of liver cancer. However, additional studies of the association are needed. It is also not clear whether serum ferritin is associated with mortality from chronic liver disease (CLD). METHODS We performed a nested case-control study in the Linxian Nutrition Intervention Trials. Baseline serum ferritin was measured for 226 incident primary liver cancer cases, 281 CLD mortalities diagnosed, and 1061 age-matched, gender-matched, and trial-matched controls. We used multivariable logistic regression models to calculate odds ratios and 95% confidence intervals. Subgroup analysis and interaction tests were performed by age, gender, alcohol drinking, hepatitis B virus seropositivity (HBV+)/hepatitis C virus seropositivity (HCV+), and trial. RESULTS Participants with serum ferritin in the highest quartile, as compared with those in the lowest quartile, had an increased risk of CLD mortality (odds ratio = 1.72, 95% confidence interval = 1.12, 2.64, P-trend < 0.01). Moreover, the association with higher serum ferritin was stronger among alcohol drinkers and those who were HCV+ (P-interaction < 0.05). For incident liver cancer, risk estimates were above one but were not statistically significant. CONCLUSION In this study, higher levels of serum ferritin at baseline were associated with subsequent mortality from CLD, particularly if combined with alcohol drinking or viral hepatitis. Further work is warranted to confirm our findings.
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Affiliation(s)
- Zhikai Zhu
- Department of Cancer Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
- School of Health Policy and Management, School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jian Yin
- Department of Cancer Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Sanford M. Dawsey
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Bin Liu
- Department of Cancer Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Neal D. Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Liangyu Yin
- Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Department of Clinical Nutrition, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing 400042, China
| | - Philip R. Taylor
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Jianfeng Cui
- Department of Cancer Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Jinhu Fan
- Department of Cancer Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yuanli Liu
- School of Health Policy and Management, School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen Chen
- Department of Cancer Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Youlin Qiao
- Department of Cancer Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Christian C. Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
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8
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The Lancet Gastroenterology Hepatology. The lottery of primary care for liver disease. Lancet Gastroenterol Hepatol 2021; 6:771. [PMID: 34509188 DOI: 10.1016/S2468-1253(21)00315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Oye-Somefun A, Kuk JL, Ardern CI. Associations between elevated kidney and liver biomarker ratios, metabolic syndrome and all-cause and coronary heart disease (CHD) mortality: analysis of the U.S. National Health and Nutrition Examination Survey (NHANES). BMC Cardiovasc Disord 2021; 21:352. [PMID: 34311708 PMCID: PMC8311936 DOI: 10.1186/s12872-021-02160-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/21/2021] [Accepted: 07/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We examined the relationship between ratios of select biomarkers of kidney and liver function on all-cause and coronary heart disease (CHD) mortality, both in isolation, and in combination with metabolic syndrome (MetS), among adults (20 + years, n = 10,604). METHODS Data was derived from the U.S. National Health and Nutrition Examination Survey (1999-2016) including public-use linked mortality follow-up files through December 31, 2015. RESULTS Select biomarker ratios of kidney (UACR or albuminuria and BUN-CR) and liver (AST-ALT and GGT-ALP) function in isolation and in combination with MetS were associated with all-cause and CHD mortality. Compared to individuals with neither elevated biomarker ratios nor MetS (HR = 1.00, referent), increased risk of all-cause mortality was observed in the following groups: MetS with elevated UACR (HR, 95% CI = 2.57, 1.99-3.33), MetS with elevated AST-ALT (HR = 2.22, 1.61-3.07), elevated UACR without MetS (HR = 2.12, 1.65-2.72), and elevated AST-ALT without MetS (HR = 1.71, 1.35-2.18); no other biomarker ratios were associated with all-cause mortality. For cause-specific deaths, elevated risk of CHD mortality was associated with MetS with elevated UACR (HR = 1.67, 1.05-2.67), MetS with elevated AST-ALT (HR = 2.80, 1.62-4.86), and elevated BUN-CR without MetS (HR = 2.12, 1.12-4.04); no other biomarker ratios were associated with CHD mortality. CONCLUSION Future longitudinal studies are necessary to examine the utility of these biomarker ratios in risk stratification for chronic disease management.
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Affiliation(s)
- Akinkunle Oye-Somefun
- School of Kinesiology and Health Science, 222A Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada.
| | - Jennifer L Kuk
- School of Kinesiology and Health Science, 222A Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada
| | - Chris I Ardern
- School of Kinesiology and Health Science, 222A Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada
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10
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Zhang Y, Li L, Jia L, Chong W, Hai Y, Lunsford LD, You C, Cheng Y, Fang F. Association of Chronic Liver Disease and Mortality in Patients With Aneurysmal Subarachnoid Hemorrhage. Stroke 2021; 52:e614-e617. [PMID: 34281381 DOI: 10.1161/strokeaha.121.034136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Chronic liver disease (CLD) is a risk factor for increased morbidity and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between CLD and mortality remains unknown. METHODS In this retrospective cohort study, we analyzed consecutive aSAH patients admitted to the West China Hospital between 2009 and 2019. The primary outcome was in-hospital all-cause mortality. RESULTS This study included 6228 cases of aSAH, 489 (7.9%) of whom also had CLD. In a propensity-matched analysis, CLD was associated with increased mortality in patients with aSAH compared with non-CLD (odds ratio, 2.04 [95% CI, 1.43-2.92]). In aSAH patients with CLD, a high Model for End-Stage Liver Disease score was still associated with an increased odds of mortality. CONCLUSIONS Among aSAH patients, CLD was associated with increased mortality compared with non-CLD. Among aSAH patients with CLD, a higher Model for End-Stage Liver Disease score was associated with an increased odds of mortality.
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Affiliation(s)
- Yu Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
| | - Linjie Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
| | - Lu Jia
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
| | - Weelic Chong
- Thomas Jefferson University, Philadelphia, PA (W.C., Y.H.)
| | - Yang Hai
- Thomas Jefferson University, Philadelphia, PA (W.C., Y.H.)
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, PA (L.D.L.)
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
| | - Yongzhong Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (Y.Z., L.L., L.J., C.Y., Y.C., F.F.)
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Abstract
BACKGROUND A safety net policy was implemented in August 2017 giving liver transplant alone (LTA) recipients with significant renal dysfunction posttransplant priority for subsequent kidney transplantation (KT). This study was undertaken to evaluate early outcomes under this policy. METHODS Adults undergoing LTA after implementation of the safety net policy and were subsequently listed for KT between 60 and 365 days after liver transplantation contained in United Network for Organ Sharing data were examined. Outcomes of interest were receipt of a kidney transplant and postliver transplant survival. Safety net patients were compared with LTA recipients not subsequently listed for KT as well as to patients listed for simultaneous liver-kidney (SLK) transplant yet underwent LTA and were not subsequently listed for KT. RESULTS There were 100 patients listed for safety net KT versus 9458 patients undergoing LTA without subsequent KT listing. The cumulative incidence of KT following listing was 32.5% at 180 days. The safety net patients had similar 1-year unadjusted patient survival (96.4% versus 93.4%; P = 0.234) but superior adjusted survival (hazard ratio0.133, 0.3570.960; P = 0.041) versus LTA recipients not subsequently listed for KT. Safety net patients had superior 1-year unadjusted (96.4% versus 75.0%; P < 0.001) and adjusted (hazard ratio0.039, 0.1260.406; P < 0.001) survival versus SLK listed patients undergoing LTA without subsequent KT listing. CONCLUSIONS The safety net appears to provide rapid access to KT with good early survival for those able to take advantage of it. Survival of patients unable to qualify for KT listing after LTA needs to be better understood before further limitation of SLK, however.
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Affiliation(s)
- Robert M Cannon
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - David S Goldberg
- Division of Hepatology, Department of Medicine, University of Miami, Coral Gables, FL
| | - Devin E Eckhoff
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Douglas J Anderson
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Babak J Orandi
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jayme E Locke
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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12
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Katz M, Gillespie S, Stevens JP, Hall L, Kolachala V, Ford R, Levin K, Gupta NA. African American Pediatric Liver Transplant Recipients Have an Increased Risk of Death After Transferring to Adult Healthcare. J Pediatr 2021; 233:119-125.e1. [PMID: 33667506 DOI: 10.1016/j.jpeds.2021.02.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/24/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To analyze the long-term outcomes in pediatric liver transplant recipients after they have transferred to an adult provider and assess for racial disparities in health outcomes. STUDY DESIGN This is a single-center, retrospective review of pediatric patients who underwent liver transplantation between July 1990 and August 2015 at a tertiary healthcare system with a large transplant center. Patient mortality and retransplantation were assessed after transfer to adult care. RESULTS There were 120 patients who were transferred, of whom 19 did not meet the inclusion criteria. Of the remaining 101 patients, 64 (63%) transferred care to a nearby affiliated tertiary adult facility, 29 (29%) were followed by other healthcare systems, and 8 (8%) were lost to follow-up. Of the patients followed at our affiliated adult center, 18 of the 64 (28%) died. Of those 18 deaths, 4 (22%) occurred within the first 2 years after transfer, and 10 (55%) within 5 years of transfer. Four patients were retransplanted by an adult provider, of whom 2 eventually received a third transplant. African Americans had higher rates of death after transfer than patients of other races (44% mortality vs 16%, representing 67% of all cases of death; P = .032), with nearly 50% mortality at 20 years from time of transplantation. CONCLUSIONS Death is common in pediatric liver transplant recipients after transfer to adult care, with African Americans having disproportionately higher mortality. This period of transition of care is a vulnerable time, and measures must be taken to ensure the safe transfer of young adults with chronic health care needs.
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Affiliation(s)
- Mikaela Katz
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Scott Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - James P Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Transplant services, Children's Healthcare of Atlanta, Atlanta, GA
| | - Lori Hall
- Transplant services, Children's Healthcare of Atlanta, Atlanta, GA
| | - Vasantha Kolachala
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Ryan Ford
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Keri Levin
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Nitika A Gupta
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Transplant services, Children's Healthcare of Atlanta, Atlanta, GA.
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Bernardo S, Crespo R, Saraiva S, Barata R, Gonçalves S, Nogueira P, Cortez-Pinto H, Machado MV. Outcomes of excessive alcohol drinkers without baseline evidence of chronic liver disease after 15 years follow-up: Heavy burden of cancer and liver disease mortality. PLoS One 2021; 16:e0252218. [PMID: 34033642 PMCID: PMC8148371 DOI: 10.1371/journal.pone.0252218] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background Most long-term heavy drinkers do not have clinically evident chronic liver disease (CLD). However, at any time-point, their risk of developing CLD remains unknown. We aimed to evaluate the long-term outcomes of a group of heavy drinkers, without evidence of CLD at baseline. Methods A cohort of 123 long-term heavy drinkers without CLD were prospectively recruited in 2002 and retrospectively followed until 2018. Results At baseline (2002), median alcohol consumption was 271±203g/day during 21.5±20 years, 65% being abstinent during the previous 1.75±5 months. Patients were followed for 14±3 years. During follow-up, 53% reported any alcohol intake. Alcohol consumption during follow-up associated weakly with either 1- or 6-months previous abstinence at baseline. Until 2018, progression to CLD occurred in 6%, associating with years of alcohol intake during follow-up (OR 1.15 [1.01–1.31]) and baseline alkaline-phosphatase (OR 1.05 [1.01–1.10]). During follow-up, being abstinent for at least 1 year positively associated with CLD-free survival. 27% died (55% of cancer–mostly oropharyngeal cancer, 27% of cardiovascular disease, and 9% of liver disease), with a mean age of 71 years [69–74] (10 years less than the expected in the Portuguese population). Achieving abstinence for at least 1 year positively associated with overall survival, while smoking, and hepatic steatosis at baseline associated negatively. Conclusion Long-term heavy drinkers seemed to have a decreased life expectancy compared with the overall Portuguese population. Cancer was the main cause of death. Our results suggest that progression to CLD depends mostly on continued alcohol intake. Alcohol abstinence, even if temporary, seems to decrease the risks of CLD and mortality.
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Affiliation(s)
- Sónia Bernardo
- Gastroenterology and Hepatology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Ricardo Crespo
- Gastroenterology and Hepatology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Sofia Saraiva
- Nephrology Department, Hospital de Curry Cabral, CHULC, Lisbon, Portugal
| | - Rui Barata
- Gastroenterology Department, Portuguese Oncology Institute, Lisbon, Portugal
| | - Sara Gonçalves
- Nephrology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Paulo Nogueira
- Biostatistics’ Department, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Helena Cortez-Pinto
- Gastroenterology and Hepatology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mariana Verdelho Machado
- Gastroenterology and Hepatology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- * E-mail:
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Zhang SS, Dong L, Wang GM, Tian Y, Ye XF, Zhao Y, Liu ZY, Zhai JY, Zhao ZL, Wang JH, Zhang HM, Li XL, Wu CX, Yang CT, Yang LJ, Du HX, Wang H, Ge QG, Xiu DR, Shen N. Progressive liver injury and increased mortality risk in COVID-19 patients: A retrospective cohort study in China. World J Gastroenterol 2021; 27:835-853. [PMID: 33727773 PMCID: PMC7941865 DOI: 10.3748/wjg.v27.i9.835] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/09/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver injury is common and also can be fatal, particularly in severe or critical patients with coronavirus disease 2019 (COVID-19).
AIM To conduct an in-depth investigation into the risk factors for liver injury and into the effective measures to prevent subsequent mortality risk.
METHODS A retrospective cohort study was performed on 440 consecutive patients with relatively severe COVID-19 between January 28 and March 9, 2020 at Tongji Hospital, Wuhan, China. Data on clinical features, laboratory parameters, medications, and prognosis were collected.
RESULTS COVID-19-associated liver injury more frequently occurred in patients aged ≥ 65 years, female patients, or those with other comorbidities, decreased lymphocyte count, or elevated D-dimer or serum ferritin (P < 0.05). The disease severity of COVID-19 was an independent risk factor for liver injury (severe patients: Odds ratio [OR] = 2.86, 95% confidence interval [CI]: 1.78-4.59; critical patients: OR = 13.44, 95%CI: 7.21-25.97). The elevated levels of on-admission aspartate aminotransferase and total bilirubin indicated an increased mortality risk (P < 0.001). Using intravenous nutrition or antibiotics increased the risk of COVID-19-associated liver injury. Hepatoprotective drugs tended to be of assistance to treat the liver injury and improve the prognosis of patients with COVID-19-associated liver injury.
CONCLUSION More intensive monitoring of aspartate aminotransferase or total bilirubin is recommended for COVID-19 patients, especially patients aged ≥ 65 years, female patients, or those with other comorbidities. Drug hepatotoxicity of antibiotics and intravenous nutrition should be alert for COVID-19 patients.
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Affiliation(s)
- Shui-Sheng Zhang
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Li Dong
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
| | - Gao-Ming Wang
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Yuan Tian
- Department of Radiotherapy Oncology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Xiao-Fang Ye
- Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yue Zhao
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Zheng-Yin Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100005, China
| | - Jia-Yu Zhai
- Department of Rheumatology, Peking University Third Hospital, Beijing 100191, China
| | - Zhi-Ling Zhao
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Jun-Hong Wang
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Hui-Min Zhang
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Xiao-Long Li
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Chang-Xin Wu
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
| | - Cai-Ting Yang
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
| | - Li-Juan Yang
- Department of Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Hai-Xia Du
- Department of Rehabilitation, Peking University Third Hospital, Beijing 100191, China
| | - Hui Wang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Qing-Gang Ge
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Dian-Rong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Ning Shen
- Department of Respiratory and Critical Medicine, Peking University Third Hospital, Beijing 100191, China
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Shehab M, Alrashed F, Shuaibi S, Alajmi D, Barkun A. Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis. BMJ Open Gastroenterol 2021; 8:e000571. [PMID: 33664052 PMCID: PMC7934201 DOI: 10.1136/bmjgast-2020-000571] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/01/2021] [Accepted: 02/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Patients infected with the SARS-CoV-2 usually report fever and respiratory symptoms. However, multiple gastrointestinal (GI) manifestations such as diarrhoea and abdominal pain have been described. The aim of this study was to evaluate the prevalence of GI symptoms, elevated liver enzymes and mortality of patients with COVID-19. METHODS A systematic review and meta-analysis of published studies that included a cohort of patients infected with SARS-CoV-2 were performed from 1 December 2019 to 15 December 2020. Data were collected by conducting a literature search using PubMed, Embase, Scopus, and Cochrane according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We analysed pooled data on the prevalence of individual GI symptoms and elevated liver enzymes and performed subanalyses to investigate the relationship between GI symptoms/elevated liver enzymes, geographical location, mortality, and intensive care unit (ICU) admission. RESULTS The available data of 78 798 patients positive for SARS-CoV-2 from 158 studies were included in our analysis. The most frequent manifestations were diarrhoea (16.5%, 95% CI 14.2% to 18.4%), nausea (9.7%, 95% CI 9.0% to 13.2%) and elevated liver enzymes (5.6%, 95% CI 4.2% to 9.1%). The overall mortality and GI mortality were 23.5% (95% CI 21.2% to 26.1%) and 3.5% (95% CI 3.1% to 6.2%), respectively. Subgroup analysis showed non-statistically significant associations between GI symptoms/elevated liver enzymes and ICU admissions (OR=1.01, 95% CI 0.55 to 1.83). The GI mortality was 0.9% (95% CI 0.5% to 2.2%) in China and 10.8% (95% CI 7.8% to 11.3%) in the USA. CONCLUSION GI symptoms/elevated liver enzymes are common in patients with COVID-19. Our subanalyses showed that the presence of GI symptoms/elevated liver enzymes does not appear to affect mortality or ICU admission rate. Furthermore, the proportion of GI mortality among patients infected with SARS-CoV-2 varied based on geographical location.
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Affiliation(s)
- Mohammad Shehab
- Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabreyah, Kuwait
| | - Fatema Alrashed
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
- Department of Pharmacy Practice, Kuwait University, Jabreyah, Kuwait
| | - Sameera Shuaibi
- Department of Internal Medicine, Mubark Al-Kabeer Hospital, Jabreyah, Kuwait
| | - Dhuha Alajmi
- Department of Internal Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Alan Barkun
- Department of Internal Medicine, McGill University, Montreal, Québec, Canada
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16
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic has brought challenges to clinicians caring for patients with chronic liver disease. In the past 6 months, COVID-19 has led to over 150,000 deaths in the United States and over 660,000 deaths around the world. Mounting evidence suggests that chronic liver diseases can have an adverse effect on the clinical outcomes of patients with COVID-19. We present a comprehensive review of the latest literature on preexisting liver diseases and its interrelationship with COVID-19 infection in cirrhosis, hepatocellular carcinoma, nonalcoholic fatty liver disease, autoimmune hepatitis, and viral hepatitis B. As social distancing and telemedicine gain new footing, we synthesize recommendations from 3 major hepatology societies [American Association for the Study of Liver Disease (AASLD), the European Association for the Study of Liver (EASL), and the Asian Pacific Association for the Study of Liver (APASL)] to present the best approaches for caring for patients with liver diseases as well as those requiring liver transplantation.
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Affiliation(s)
- Abdul Mohammed
- Department of Hospital Medicine, Cleveland Clinic Foundation
| | - Neethi Paranji
- Division of Gastroenterology and Hepatology, Case Western Reserve University School of Medicine, The MetroHealth System, Cleveland, OH
| | - Po-Hung Chen
- Johns Hopkins School of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Bolin Niu
- Division of Gastroenterology and Hepatology, Case Western Reserve University School of Medicine, The MetroHealth System, Cleveland, OH
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17
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Shao J, Liang Y, Li Y, Ding R, Zhu M, You W, Wang Z, Huang B, Wu M, Zhang T, Li K, Wu W, Wu L, Wang Q, Xia X, Wang S, Lu L. Implications of liver injury in risk-stratification and management of patients with COVID-19. Hepatol Int 2021; 15:202-212. [PMID: 33548030 PMCID: PMC7865118 DOI: 10.1007/s12072-020-10123-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infection with SARS-CoV-2 has been associated with liver dysfunction, aggravation of liver burden, and liver injury. This study aimed to assess the effects of liver injuries on the clinical outcomes of patients with COVID-19. METHODS A total of 1520 patients with severe or critical COVID-19 from Huoshenshan Hospital, Wuhan, were enrolled. Chronic liver disease (CLD) was confirmed by consensus diagnostic criteria. Laboratory test results were compared between different groups. scRNA-seq data and bulk gene expression profiles were used to identify cell types associated with liver injury. RESULTS A total of 10.98% of patients with severe or critical COVID-19 developed liver injury after admission that was associated with significantly higher rates of mortality (21.74%, p < 0.001) and intensive care unit admission (26.71%, p < 0.001). Pre-existing CLDs were not associated with a higher risk. However, fatty liver disease and cirrhosis were associated with higher risks, supported by evidences from single cell and bulk transcriptome analysis that showed more TMPRSS2+ cells in these tissues. By generating a model, we were able to predict the risk and severity of liver injury during hospitalization. CONCLUSION We demonstrate that liver injury occurring during therapy as well as pre-existing CLDs like fatty liver disease and cirrhosis in patients with COVID-19 is significantly associated with the severity of disease and mortality, but the presence of other CLD is not associated. We provide a risk-score model that can predict whether patients with COVID-19 will develop liver injury or proceed to higher-risk stages during subsequent hospitalizations.
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Affiliation(s)
- Jiaofang Shao
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Yuan Liang
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- The Affiliated Cancer Hospital and Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
- Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Yan Li
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Rong Ding
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Mengyan Zhu
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Wenhua You
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- The Affiliated Cancer Hospital and Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
- Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Ziyu Wang
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Bin Huang
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Min Wu
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Tingting Zhang
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Kening Li
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Wei Wu
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Lingxiang Wu
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Qianghu Wang
- Research Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166 Jiangsu China
- Department of Bioinformatics, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166 Jiangsu China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, 211166 Jiangsu China
| | - Xinyi Xia
- COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing Clinical College of Southern Medical University, Nanjing, 210002 Jiangsu China
- Joint Expert Group for COVID-19, Department of Laboratory Medicine and Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan, 430100 Hubei China
| | - Shukui Wang
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- Department of Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006 Jiangsu China
| | - Ling Lu
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
- The Affiliated Cancer Hospital and Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
- Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
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18
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Namusamba M, Li Z, Zhang Q, Wang C, Wang T, Wang B. Biological roles of the B cell receptor-associated protein 31: Functional Implication in Cancer. Mol Biol Rep 2021; 48:773-786. [PMID: 33439410 DOI: 10.1007/s11033-020-06123-w] [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: 02/25/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BAP31 is a ubiquitously expressed integral membrane protein of the endoplasmic reticulum. BAP31 is involved in various biological and molecular processes, including protein transport, viral processing, apoptosis signaling, MHC 1 antigen processing and presentation, mitochondria and ER calcium regulation, and proteasomal protein degradation. We employed a BAP31 interaction search using STRING and inBioMap™ protein-protein interaction networks, and the Metabolic Atlas, which revealed molecular and metabolic interactors involved in various pathways essential for cell growth, cell survival, and disease development. BAP31, as a chaperone and resident protein of the ER, was reported in the development of some central nervous system disorders and metabolic diseases about AD, ALS, and Liver disease. In addition, BAP31 is overexpressed in many cancers. Furthermore, research around BAP31 involvement in cancer has taken up a shape, focusing on its roles in cancer cell survival, disease prognosis, and targeted treatment. Here, we address published data on the Biological roles of BAP31 in both health and disease. We present an analytical description of BAP31 expression and functional implication in some human cancers and the impact of its expression and regulation while it models as a potential target in cancer therapy. Besides, a profound understanding of BAP31 is insightful of the gap between cancer development and neurodegeneration, thus generating novel ideas surrounding the link between the two different cell phenomena.
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Affiliation(s)
- Mwichie Namusamba
- College of Life Science and Health, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, Liaoning Province, 110819, People's Republic of China
| | - Zhi Li
- College of Life Science and Health, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, Liaoning Province, 110819, People's Republic of China
| | - Qi Zhang
- College of Life Science and Health, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, Liaoning Province, 110819, People's Republic of China
| | - Changli Wang
- College of Life Science and Health, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, Liaoning Province, 110819, People's Republic of China
| | - Tianyi Wang
- College of Life Science and Health, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, Liaoning Province, 110819, People's Republic of China.
| | - Bing Wang
- College of Life Science and Health, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, Liaoning Province, 110819, People's Republic of China.
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Galiero R, Pafundi PC, Simeon V, Rinaldi L, Perrella A, Vetrano E, Caturano A, Alfano M, Beccia D, Nevola R, Marfella R, Sardu C, Coppola C, Scarano F, Maggi P, De Lucia Sposito P, Vocciante L, Rescigno C, Sbreglia C, Fraganza F, Parrella R, Romano A, Calabria G, Polverino B, Pagano A, Bologna C, Amitrano M, Esposito V, Coppola N, Maturo N, Adinolfi LE, Chiodini P, Sasso FC. Impact of chronic liver disease upon admission on COVID-19 in-hospital mortality: Findings from COVOCA study. PLoS One 2020; 15:e0243700. [PMID: 33301529 PMCID: PMC7728173 DOI: 10.1371/journal.pone.0243700] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Italy has been the first Western country to be heavily affected by the spread of SARS-COV-2 infection and among the pioneers of the clinical management of pandemic. To improve the outcome, identification of patients at the highest risk seems mandatory. OBJECTIVES Aim of this study is to identify comorbidities and clinical conditions upon admission associated with in-hospital mortality in several COVID Centers in Campania Region (Italy). METHODS COVOCA is a multicentre retrospective observational cohort study, which involved 18 COVID Centers throughout Campania Region, Italy. Data were collected from patients who completed their hospitalization between March-June 2020. The endpoint was in-hospital mortality, assessed either from data at discharge or death certificate, whilst all exposure variables were collected at hospital admission. RESULTS Among 618 COVID-19 hospitalized patients included in the study, 143 in-hospital mortality events were recorded, with a cumulative incidence of about 23%. At multivariable logistic analysis, male sex (OR 2.63, 95%CI 1.42-4.90; p = 0.001), Chronic Liver Disease (OR 5.88, 95%CI 2.39-14.46; p<0.001) and malignancies (OR 2.62, 95%CI 1.21-5.68; p = 0.015) disclosed an independent association with a poor prognosis, Glasgow Coma Scale (GCS) and Respiratory Severity Scale allowed to identify at higher mortality risk. Sensitivity analysis further enhanced these findings. CONCLUSION Mortality of patients hospitalized for COVID-19 appears strongly affected by both clinical conditions on admission and comorbidities. Originally, we observed a very poor outcome in subjects with a chronic liver disease, alongside with an increase of hepatic damage.
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Affiliation(s)
- Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, Department of Physical and Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria Alfano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Domenico Beccia
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Riccardo Nevola
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Internal Medicine, Sant’Ottone Frangipane Hospital, Ariano Irpino, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carmine Coppola
- COVID Center "S. Anna e SS. Madonna della Neve" Hospital, Boscotrecase, Italy
| | - Ferdinando Scarano
- COVID Center "S. Anna e SS. Madonna della Neve" Hospital, Boscotrecase, Italy
| | - Paolo Maggi
- U.O.C. Infectious and Tropical Diseases, S. Anna e S. Sebastiano Hospital, Caserta, Italy
| | | | | | - Carolina Rescigno
- U.O.C. Infectious Diseases and Neurology, Cotugno Hospital, Naples, Italy
| | - Costanza Sbreglia
- U.O.C. Infectious Diseases of the Elderly, Cotugno Hospital, Naples, Italy
| | | | - Roberto Parrella
- U.O.C. Respiratory Infectious Diseases, Cotugno Hospital, Naples, Italy
| | | | - Giosuele Calabria
- IX Division of Infectious Diseases and Interventional Ultrasound, Cotugno Hospital, Naples, Italy
| | | | - Antonio Pagano
- Emergency and Acceptance Unit, "Santa Maria delle Grazie" Hospital, Pozzuoli, Italy
| | | | - Maria Amitrano
- U.O.C. Internal Medicine—Moscati Hospital, Avellino, Italy
| | - Vincenzo Esposito
- IV Division of Immunodeficiency and Gender Infectious Diseases, Cotugno Hospital, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Centro COVID A.O.U. Vanvitelli, Naples, Italy
| | - Nicola Maturo
- U.O.S.D. Infectious Diseases Emergency and Acceptance, Cotugno Hospital, Naples, Italy
| | - Luigi Elio Adinolfi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, Department of Physical and Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Abstract
HCV-HIV coinfected patients exhibit rapid progression of liver damage relative to HCV monoinfected patients. The availability of new directly acting antiviral agents has dramatically improved outcomes for coinfected patients as sustained virologic response rates now exceed 95% and fibrosis-related parameters are improved. Nevertheless, coinfected patients still have a higher mortality risk and more severe hepatocellular carcinoma compared to HCV monoinfected patients, implying the existence of pathways unique to people living with HIV that continue to promote accelerated liver disease. In this article, we review the pathobiology of liver disease in HCV-HIV coinfected patients in the directly acting antiviral era and explore the mechanisms through which HIV itself induces liver damage. Since liver disease is one of the leading causes of non-AIDS-related mortality in HIV-positive patients, enhancing our understanding of HIV-associated fibrotic pathways will remain important for new diagnostic and therapeutic strategies to slow or reverse liver disease progression, even after HCV cure.
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Affiliation(s)
- Andre J Jeyarajan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raymond T Chung
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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21
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Visaria A, Pai S, Fayngersh A, Kothari N. Association between alanine aminotransferase within the normal range and all-cause and cause-specific mortality: A nationwide cohort study. PLoS One 2020; 15:e0242431. [PMID: 33216778 PMCID: PMC7678955 DOI: 10.1371/journal.pone.0242431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/23/2020] [Indexed: 01/04/2023] Open
Abstract
Background and aim We sought to determine the association between alanine aminotransferase (ALT) in the normal range and mortality in the absence of liver dysfunction to better understand ALT’s clinical significance beyond liver injury and inflammation. Methods A cohort of 2,708 male and 3,461 female adults aged 20–75 years without liver dysfunction (ALT<30 in males & <19 in females, negative viral serologies, negative ultrasound-based steatosis, no excess alcohol consumption) from the National Health and Nutrition Examination Survey (NHANES)-III (1988–1994) were linked to the National Death Index through December 31, 2015. Serum ALT levels were categorized into sex-specific quartiles (Females: <9, 9–11, 11–14, ≥14 IU/L, Male: <12, 12–15, 15–20, ≥20 U/L). The primary outcome was all-cause mortality. Hazard ratios (HRs) were estimated, adjusting for covariates and accounting for the complex survey design. Results Relative to males in the lowest quartile (Q1), males in the highest quartile (Q4) had 44% decreased risk of all-cause mortality (aHR [95% CI]: 0.56 [0.42, 0.74]). Females in Q4 had 45% decreased risk of all-cause mortality (aHR [95% CI]: 0.55 [0.40, 0.77]). Males with BMI <25 kg/m2 in Q4 had significantly lower risk of all-cause mortality than Q1; however, this association did not exist in males with BMI ≥25 (BMI<25: 0.36 [0.20, 0.64], BMI≥25: 0.77 [0.49, 1.22]). Risk of all-cause mortality was lower in males ≥50 years than in males<50 (age≥50: 0.55 [0.39, 0.77], age<50: 0.81 [0.39, 1.69]). These age- and BMI-related differences were not seen in females. Conclusion ALT within the normal range was inversely associated with all-cause mortality in U.S. adults.
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Affiliation(s)
- Aayush Visaria
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
- * E-mail:
| | - Suraj Pai
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Alla Fayngersh
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Neil Kothari
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
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Medetalibeyoglu A, Catma Y, Senkal N, Ormeci A, Cavus B, Kose M, Bayramlar OF, Yildiz G, Akyuz F, Kaymakoglu S, Tukek T. The effect of liver test abnormalities on the prognosis of COVID-19. Ann Hepatol 2020; 19:614-621. [PMID: 32920162 PMCID: PMC7481800 DOI: 10.1016/j.aohep.2020.08.068] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION COVID-19 caused by the SARS-CoV-2 continues to spread rapidly across the world. In our study, we aim to investigate the relationship between the liver enzymes on admission (AST, ALT, ALP, GGT) and severity of COVID-19. We evaluated course of disease, hospital stay, liver damage and mortality. MATERIALS AND METHODS Our study included 614 patients who were hospitalized with the diagnosis of COVID-19 between 03.16.20 and 05.12.20. Patients with liver disease, hematological and solid organ malignancy with liver metastases were excluded, resulting in 554 patients who met our inclusion criteria. We retrospectively evaluated liver transaminase levels, AST/ALT ratio, cholestatic enzyme levels and R ratio during hospital admission and these were compared in terms of morbidity, mortality and clinical course. RESULTS Mean age of 554 subjects were 66.21±15.45 years, 328 (59.2%) were men. The mean values of liver enzymes on admission were AST (36.2±33.6U/L), ALT (34.01±49.34U/L), ALP (78.8±46.86U/L), GGT (46.25±60.05U/L). Mortality rate and need for intensive care unit were statistically significant in subjects that had high ALT-AST levels during their admission to the hospital (p=0.001). According to the ROC analysis AST/ALT ratio was a good marker of mortality risk (AUC=0.713: p=0.001) and expected probability of intensive care unit admission (AUC=0.636: p=0.001). R ratio, which was used to evaluate prognosis, showed a poor prognosis rate of 26.5% in the cholestatic injury group, 36.1% in the mixed pattern group and 30% in the hepato-cellular injury group (p 0.001). CONCLUSIONS ALT-AST elevation and AST/ALT ratio >1 was associated with more severe course and increased mortality in COVID-19.
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Affiliation(s)
- Alpay Medetalibeyoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Yunus Catma
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Naci Senkal
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Asli Ormeci
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul, Turkey
| | - Bilger Cavus
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul, Turkey
| | - Murat Kose
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Osman Faruk Bayramlar
- Istanbul University, Istanbul Faculty of Medicine, Department of Public Health, Istanbul, Turkey
| | - Gulcan Yildiz
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Filiz Akyuz
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul, Turkey
| | - Sabahattin Kaymakoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul, Turkey
| | - Tufan Tukek
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey.
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Imam A, Abukhalaf SA, Merhav H, Abu-Gazala S, Cohen-Arazi O, Pikarsky AJ, Safadi R, Khalaileh A. Prognosis and Treatment of Liver Transplant Recipients in the COVID-19 Era: A Literature Review. Ann Transplant 2020; 25:e926196. [PMID: 33106469 PMCID: PMC7602367 DOI: 10.12659/aot.926196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/21/2020] [Accepted: 07/15/2020] [Indexed: 01/08/2023] Open
Abstract
Liver transplantation during the COVID-19 pandemic is challenging. Both donor and recipient issues can be influenced by the risks attributed to the pandemic. Allocation policy may need to be modified and criteria may be influenced by local infection rates and availability of medical facilities. Modifying immunosuppression (IS) protocols is controversial and is not evidence-based. In this study, we review the published literature on liver transplant recipients who were infected with COVID-19. A literature review was performed using PubMed, ScienceDirect, and WHO databases to identify relevant English-language articles published up to May 20, 2020. Fifteen articles reported 120 liver transplant recipients who were infected with COVID-19. Only 10 papers with 22 patients reported full encounter characteristics. Four papers reported 23, 17, 13, and 6 patients, respectively, but with minimal data. One paper reported the authors' own 39 patients' characteristics and demographics. The mean age was 58.2 years with 66% males. The most commonly reported presentations in descending order were fever (91%), cough (36.7%), shortness of breath (SOB) (31.8%), and diarrhea (31.8%). Liver transplant patients infected with COVID-19 were maintained on Tac (79%), mycophenolate (MMF) (48.4%), and Prednisone (29.6%) and were managed by reducing MMF in 14.3% of patients and reducing Tac in 14.3% of patients; 28.6% of patients needed ICU admission, 13.6% of patients had died, and the reported general population COVID-19 mortality rate was 3.4%. The clinical presentation of COVID-19 in liver transplant recipients may be different from the general population, with higher rates of severe disease, complications, and mortality.
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Affiliation(s)
- Ashraf Imam
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sadi A. Abukhalaf
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hadar Merhav
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Samir Abu-Gazala
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Oded Cohen-Arazi
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alon Josef Pikarsky
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Rifaat Safadi
- Department of Gastroenterology and Liver Disease, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Abed Khalaileh
- Transplantation Unit, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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24
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Choi C, Barajas-Ochoa A, Uppuluri A, Ro G, Hashemipour R, Jiang Y, Nasir U, Ahlawat S. The impact of bariatric surgery on in-patient clinical outcomes among patients with autoimmune hepatitis. Medicine (Baltimore) 2020; 99:e22446. [PMID: 33080679 PMCID: PMC7572015 DOI: 10.1097/md.0000000000022446] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Autoimmune hepatitis (AIH) is a form of liver inflammation in which immune cells target hepatocytes, inducing chronic inflammatory states. Bariatric surgery (BS) was shown to reduce inflammation in severely obese patients. We hypothesize that obese patients with AIH and BS have lower prevalence of liver-related complications and in-patient mortality compared to those without BS.The National Inpatient Sample from 2007 to 2013 was queried for hospitalizations of adults over 18 years of age with a diagnosis of AIH. Of those, hospitalizations with BS were selected as cases and those with morbid obesity as controls. Case-control 1:2 matching was done based on sex, age, race, and comorbidities. Primary outcomes were prevalence of liver-related complications and in-patient mortality. Independent risk factors of in-patient clinical outcomes were identified using multivariate regression analysis.From 137,834 hospitalizations with a diagnosis of AIH, 688 with BS were selected as cases, and 1295 were matched as controls. The prevalence of ascites was higher in the BS group compared to the control (odds ratio 1.73, 95% confidence interval (CI) 1.27-2.36). The prevalence of cirrhosis (36.8% vs 33.2%), portal hypertension (7.4% vs 10.0%), hepatic encephalopathy (10.6% vs 8.7%), and varices and variceal bleeding (3.9% vs 5.5%) was not statistically different from case controls, (P > .05).BS was an independent risk factor for ascites (adjusted odds ratio (aOR) 1.87; 95% CI 1.36-2.56) and hepatic encephalopathy (aOR 1.42; 95% CI 1.03-1.97) but was an independent protective factor against in-patient mortality (aOR 0.21, 95% CI 0.08-0.55) once adjusted for age, sex, race, and comorbidities.
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Affiliation(s)
| | | | | | - Grace Ro
- Rutgers New Jersey Medical School
| | - Reza Hashemipour
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Yi Jiang
- Internal Medicine, Rutgers New Jersey Medical School
| | - Umair Nasir
- Internal Medicine, Rutgers New Jersey Medical School
| | - Sushil Ahlawat
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ, USA
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25
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Becchetti C, Zambelli MF, Pasulo L, Donato MF, Invernizzi F, Detry O, Dahlqvist G, Ciccarelli O, Morelli MC, Fraga M, Svegliati-Baroni G, van Vlierberghe H, Coenraad MJ, Romero MC, de Gottardi A, Toniutto P, Del Prete L, Abbati C, Samuel D, Pirenne J, Nevens F, Dufour JF. COVID-19 in an international European liver transplant recipient cohort. Gut 2020; 69:1832-1840. [PMID: 32571972 PMCID: PMC7335697 DOI: 10.1136/gutjnl-2020-321923] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Knowledge on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant recipients is lacking, particularly in terms of severity of the disease. The aim of this study was to describe the demographic, baseline clinical characteristics and early outcomes of a European cohort of liver transplant recipients with SARS-CoV-2 infection. DESIGN We conducted an international prospective study across Europe on liver transplant recipients with SARS-CoV-2 infection confirmed by microbiological assay during the first outbreak of COVID-19 pandemic. Baseline characteristics, clinical presentation, management of immunosuppressive therapy and outcomes were collected. RESULTS 57 patients were included (70% male, median (IQR) age at diagnosis 65 (57-70) years). 21 (37%), 32 (56%) and 21 (37%) patients had one cardiovascular disease, arterial hypertension and diabetes mellitus, respectively. The most common symptoms were fever (79%), cough (55%), dyspnoea (46%), fatigue or myalgia (56%) and GI symptoms (33%). Immunosuppression was reduced in 22 recipients (37%) and discontinued in 4 (7%). With this regard, no impact on outcome was observed. Forty-one (72%) subjects were hospitalised and 11 (19%) developed acute respiratory distress syndrome. Overall, we estimated a case fatality rate of 12% (95% CI 5% to 24%), which increased to 17% (95% CI 7% to 32%) among hospitalised patients. Five out of the seven patients who died had a history of cancer. CONCLUSION In this European multicentre prospective study of liver transplant recipients, COVID-19 was associated with an overall and in-hospital fatality rate of 12% (95% CI 5% to 24%) and 17% (95% CI 7% to 32%), respectively. A history of cancer was more frequent in patients with poorer outcome.
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Affiliation(s)
- Chiara Becchetti
- University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Marco Fabrizio Zambelli
- Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Bergamo, Bergamo, Lombardia, Italy
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology, "Papa Giovanni XXIII" Hospital, Bergamo, Bergamo, Lombardia, Italy
| | - Maria Francesca Donato
- Transplant Hepatology Unit, Division of Gastroenterology and Hepatology, IRCSS Foundation Ca' Granda, Maggiore Hospital Policlinico, CRC "A.M. and A. Migliavacca" Center of Liver Disease, Milan, Italy
| | - Federica Invernizzi
- Transplant Hepatology Unit, Division of Gastroenterology and Hepatology, IRCSS Foundation Ca' Granda, Maggiore Hospital Policlinico, CRC "A.M. and A. Migliavacca" Center of Liver Disease, Milan, Italy
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, Central University Hospital of Liege, Liege, Belgium
| | - Géraldine Dahlqvist
- Hepatogastroenterology Unit, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Olga Ciccarelli
- Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Maria Cristina Morelli
- Department of Organ Failures and Transplantation, Universita degli Studi di Bologna Azienda Ospedaliera di Bologna Policlinico Sant'Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
| | - Montserrat Fraga
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Gianluca Svegliati-Baroni
- Liver Injury and Transplant Unit, AOU Ospedali Riuniti di Ancona, Ancona, Marche, Italy
- Department of Clinical and Molecular Sciences and Obesity Center, Polytechnic University of Marche, Ancona, Marche, Italy
| | | | - Minneke J Coenraad
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Andrea de Gottardi
- Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pierluigi Toniutto
- Hepatology and Liver Transplant Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Friuli-Venezia Giulia, Italy
| | - Luca Del Prete
- Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Bergamo, Bergamo, Lombardia, Italy
| | - Claudia Abbati
- Department of Surgery, General Surgery and Abdominal Transplant Unit, "Papa Giovanni XXIII" Hospital, Bergamo, Bergamo, Lombardia, Italy
| | - Didier Samuel
- Centre Hépato-Biliaire, Paris-Saclay University, Inserm research unit, Hôpital Paul Brousse, Villejuif, France
| | - Jacques Pirenne
- Abdominal Transplant Surgery, KU Leuven Hospital, Leuven, Flanders, Belgium
| | | | - Jean-François Dufour
- University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
- Hepatology, Depertment of Biomedical Research, University of Bern, Bern, Switzerland
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Lee YR, Kang MK, Song JE, Kim HJ, Kweon YO, Tak WY, Jang SY, Park JG, Lee C, Hwang JS, Jang BK, Suh JI, Chung WJ, Kim BS, Park SY. Clinical outcomes of coronavirus disease 2019 in patients with pre-existing liver diseases: A multicenter study in South Korea. Clin Mol Hepatol 2020; 26:562-576. [PMID: 33053932 PMCID: PMC7641571 DOI: 10.3350/cmh.2020.0126] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS Although coronavirus disease 2019 (COVID-19) has spread rapidly worldwide, the implication of pre-existing liver disease on the outcome of COVID-19 remains unresolved. . METHODS A total of 1,005 patients who were admitted to five tertiary hospitals in South Korea with laboratory-confirmed COVID-19 were included in this study. Clinical outcomes in COVID-19 patients with coexisting liver disease as well as the predictors of disease severity and mortality of COVID-19 were assessed. . RESULTS Of the 47 patients (4.7%) who had liver-related comorbidities, 14 patients (1.4%) had liver cirrhosis. Liver cirrhosis was more common in COVID-19 patients with severe pneumonia than in those with non-severe pneumonia (4.5% vs. 0.9%, P=0.006). Compared to patients without liver cirrhosis, a higher proportion of patients with liver cirrhosis required oxygen therapy; were admitted to the intensive care unit; had septic shock, acute respiratory distress syndrome, or acute kidney injury; and died (P<0.05). The overall survival rate was significantly lower in patients with liver cirrhosis than in those without liver cirrhosis (log-rank test, P=0.003). Along with old age and diabetes, the presence of liver cirrhosis was found to be an independent predictor of severe disease (odds ratio, 4.52; 95% confidence interval [CI], 1.20-17.02;P=0.026) and death (hazard ratio, 2.86; 95% CI, 1.04-9.30; P=0.042) in COVID-19 patients. . CONCLUSION This study suggests liver cirrhosis is a significant risk factor for COVID-19. Stronger personal protection and more intensive treatment for COVID-19 are recommended in these patients.
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Affiliation(s)
- Yu Rim Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Daegu-Gyeongbuk Liver Study Group
| | - Min Kyu Kang
- Daegu-Gyeongbuk Liver Study Group
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong Eun Song
- Daegu-Gyeongbuk Liver Study Group
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hyun Jung Kim
- Daegu-Gyeongbuk Liver Study Group
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Young Oh Kweon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Daegu-Gyeongbuk Liver Study Group
| | - Won Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Daegu-Gyeongbuk Liver Study Group
| | - Se Young Jang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Daegu-Gyeongbuk Liver Study Group
| | - Jung Gil Park
- Daegu-Gyeongbuk Liver Study Group
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Changhyeong Lee
- Daegu-Gyeongbuk Liver Study Group
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jae Seok Hwang
- Daegu-Gyeongbuk Liver Study Group
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Byoung Kuk Jang
- Daegu-Gyeongbuk Liver Study Group
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong Ill Suh
- Daegu-Gyeongbuk Liver Study Group
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Woo Jin Chung
- Daegu-Gyeongbuk Liver Study Group
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Byung Seok Kim
- Daegu-Gyeongbuk Liver Study Group
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Daegu-Gyeongbuk Liver Study Group
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27
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Kusnik A, Teufel A. [Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality]. Z Gastroenterol 2020; 58:1003-1005. [PMID: 33036053 DOI: 10.1055/a-1162-1200] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Alexander Kusnik
- Sektion Hepatologie, II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg
| | - Andreas Teufel
- Sektion Hepatologie, II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg
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Chen C, Ke R, Yang F, Cai Q, Liu J, Huang X, Chen J, Xu F, Jiang Y. Risk factors for recurrent autoimmune liver diseases after liver transplantation: A meta-analysis. Medicine (Baltimore) 2020; 99:e20205. [PMID: 32443344 PMCID: PMC7253929 DOI: 10.1097/md.0000000000020205] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/04/2020] [Accepted: 04/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Autoimmune liver disease (ALD) is a chronic liver disease caused by immune dysfunction in the body. However, no causative or curative medical treatment with proven efficacy exists to cure ALDs, and liver transplantation (LT) remains the only effective treatment available. However, the problem of recurrence of ALDs (rALDs) still remains after LT, which seriously affects the survival rate of the patients. Therefore, clinicians need to be aware of the risk factors affecting rALDs after LT. Therefore, this meta-analysis aims to define the risk factors for rALDs, which include the recurrence of primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. METHODS A systematic search in Pubmed, Embase, Cochrane library and Web of Science databases was performed from 1980 to 2019. The inclusion criteria were risk factors for developing rALDs after LT. However, case series, case reports, reviews, meta-analysis and studies only including human immunodeficiency virus cases, children, and pregnant patients were excluded. RESULTS The electronic database search yielded 1728 results. Sixty-three retrospective cohort studies met the inclusion criteria and 13 were included in the meta-analysis. The final cohort included 5077 patients, and among them, 21.96% developed rALDs. Colectomy before LT, HR 0.59 (95% confidence interval [CI]: 0.37-0.96), cholangiocarcinoma, HR 3.42 (95% CI: 1.88-6.21), multiple episodes of acute cellular rejection, HR 2.07 (95% CI: 1.27-3.37), model for end-stage liver disease score, HR 1.05 (95% CI: 1.02-1.08), use of mycophenolate mofetil, HR 1.46 (95% CI: 1.00-2.12) and the use of cyclosporin A, HR 0.69 (95% CI: 0.49-0.97) were associated with the risk of rprimary sclerosing cholangitis. In addition, the use of tacrolimus, HR 1.73 (95% CI: 1.00-2.99) and cyclosporin A, HR 0.59 (95% CI: 0.39-0.88) were associated with the risk of rALD. CONCLUSIONS Multiple risk factors for rALDs were identified, such as colectomy before LT, cholangiocacinoma, multiple episodes of acute cellular rejection, model for end-stage liver disease score, and especially the use of mycophenolate mofetil, cyclosporin A and tacrolimus.
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Affiliation(s)
- Chongfa Chen
- Department of Hepatobiliary Surgery, Dongfang Hospital, Xiamen University
| | - Ruisheng Ke
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xiamen University
| | - Fang Yang
- Department of Hepatobiliary Surgery, 900 Hospital of the Joint Logistics Team, China
| | - Qiucheng Cai
- Department of Hepatobiliary Surgery, 900 Hospital of the Joint Logistics Team, China
| | - Jianyong Liu
- Department of Hepatobiliary Surgery, 900 Hospital of the Joint Logistics Team, China
| | - Xinghua Huang
- Department of Hepatobiliary Surgery, 900 Hospital of the Joint Logistics Team, China
| | - Jianwei Chen
- Department of Hepatobiliary Surgery, 900 Hospital of the Joint Logistics Team, China
| | - Fengfeng Xu
- Department of Hepatobiliary Surgery, Dongfang Hospital, Xiamen University
| | - Yi Jiang
- Department of Hepatobiliary Surgery, Dongfang Hospital, Xiamen University
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Abstract
Importance One factor associated with the rapidly increasing clinical and economic burden of chronic liver disease (CLD) is inpatient health care utilization. Objective To understand trends in the hospitalization burden of CLD in the US. Design, Setting, and Participants This cross-sectional study of hospitalized adults in the US used data from the National Inpatient Sample from 2012 to 2016 on adult CLD-related hospitalizations. Data were analyzed from June to October 2019. Main Outcomes and Measures Hospitalizations identified using a comprehensive review of CLD-specific International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Survey-weighted annual trends in national estimates of CLD-related hospitalizations, in-hospital mortality, and hospitalization costs, stratified by demographic and clinical characteristics. Results This study included 1 016 743 CLD-related hospitalizations (mean [SD] patient age, 57.4 [14.4] years; 582 197 [57.3%] male; 633 082 [62.3%] white). From 2012 to 2016, the rate of CLD-related hospitalizations per 100 000 hospitalizations increased from 3056 (95% CI, 3042-3069) to 3757 (95% CI, 3742-3772), and total inpatient hospitalization costs increased from $14.9 billion (95% CI, $13.9 billion to $15.9 billion) to $18.8 billion (95% CI, $17.6 billion to $20.0 billion). Mean (SD) patient age increased (56.8 [14.2] years in 2012 to 57.8 [14.6] years in 2016) and, subsequently, the proportion with Medicare also increased (41.7% [95% CI, 41.1%-42.2%] to 43.6% [95% CI, 43.1%-44.1%]) (P for trend < .001 for both). The proportion of hospitalizations of patients with hepatitis C virus was similar throughout the period of study (31.6% [95% CI, 31.3%-31.9%]), and the proportion with alcoholic cirrhosis and nonalcoholic fatty liver disease showed increases. The mortality rate was higher among hospitalizations with alcoholic cirrhosis (11.9% [95% CI, 11.7%-12.0%]) compared with other etiologies. Presence of hepatocellular carcinoma was also associated with a high mortality rate (9.8% [95% CI, 9.5%-10.1%]). Cost burden increased across all etiologies, with a higher total cost burden among hospitalizations with alcoholic cirrhosis ($22.7 billion [95% CI, $22.1 billion to $23.2 billion]) or hepatitis C virus ($22.6 billion [95% CI, $22.1 billion to $23.2 billion]). Presence of cirrhosis, complications of cirrhosis, and comorbidities added to the CLD burden. Conclusions and Relevance Over the study period, the total estimated national hospitalization costs in patients with CLD reached $81.1 billion. The inpatient CLD burden in the US is likely increasing because of an aging CLD population with increases in concomitant comorbid conditions.
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Affiliation(s)
- Grishma Hirode
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, California
| | - Sammy Saab
- David Geffen School of Medicine, Department of Medicine, University of California at Los Angeles
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, California
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Loftfield E, Rothwell JA, Sinha R, Keski-Rahkonen P, Robinot N, Albanes D, Weinstein SJ, Derkach A, Sampson J, Scalbert A, Freedman ND. Prospective Investigation of Serum Metabolites, Coffee Drinking, Liver Cancer Incidence, and Liver Disease Mortality. J Natl Cancer Inst 2020; 112:286-294. [PMID: 31168595 PMCID: PMC7073908 DOI: 10.1093/jnci/djz122] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/06/2019] [Accepted: 05/31/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Coffee has been consistently associated with lower risk of liver cancer and chronic liver disease, suggesting that coffee affects mechanisms underlying disease development. METHODS We measured serum metabolites using untargeted metabolomics in 1:1 matched nested case-control studies of liver cancer (n = 221 cases) and fatal liver disease (n = 242 cases) in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention cohort (n = 29 133). Associations between baseline coffee drinking and metabolites were identified using linear regression; conditional logistic regression models were used to identify associations with subsequent outcomes. RESULTS Overall, 21 metabolites were associated with coffee drinking and also each subsequent endpoint; nine metabolites and trigonelline, a known coffee biomarker, were identified. Tyrosine and two bile acids, glycochenodeoxycholic acid (GCDCA) and glycocholic acid (GCA), were inversely associated with coffee but positively associated with both outcomes; odds ratios (ORs) comparing the 90th to 10th percentile (modeled on a continuous basis) ranged from 3.93 (95% confidence interval [CI] = 2.00 to 7.74) for tyrosine to 4.95 (95% CI = 2.64 to 9.29) for GCA and from 4.00 (95% CI = 2.42 to 6.62) for GCA to 6.77 (95% CI = 3.62 to 12.65) for GCDCA for liver cancer and fatal liver disease, respectively. The remaining six metabolites and trigonelline were positively associated with coffee drinking but inversely associated with both outcomes; odds ratio ranged from 0.16 to 0.37. Associations persisted following diet adjustment and for outcomes occurring greater than 10 years after blood collection. CONCLUSIONS A broad range of compounds were associated with coffee drinking, incident liver cancer, and liver disease death over 27 years of follow-up. These associations provide novel insight into chronic liver disease and liver cancer etiology and support a possible hepatoprotective effect of coffee.
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Affiliation(s)
- Erikka Loftfield
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Joseph A Rothwell
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
- Nutrition and Metabolism Section, Biomarkers Group, International Agency for Research on Cancer, Lyon, France
| | - Rashmi Sinha
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Pekka Keski-Rahkonen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
- Nutrition and Metabolism Section, Biomarkers Group, International Agency for Research on Cancer, Lyon, France
| | - Nivonirina Robinot
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
- Nutrition and Metabolism Section, Biomarkers Group, International Agency for Research on Cancer, Lyon, France
| | - Demetrius Albanes
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Stephanie J Weinstein
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Andriy Derkach
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Joshua Sampson
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Augustin Scalbert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
- Nutrition and Metabolism Section, Biomarkers Group, International Agency for Research on Cancer, Lyon, France
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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Chan KH, Bennett DA, Kurmi OP, Yang L, Chen Y, Lv J, Guo Y, Bian Z, Yu C, Chen X, Dong C, Li L, Chen Z, Lam KBH. Solid fuels for cooking and tobacco use and risk of major chronic liver disease mortality: a prospective cohort study of 0.5 million Chinese adults. Int J Epidemiol 2020; 49:45-55. [PMID: 31650183 PMCID: PMC7124491 DOI: 10.1093/ije/dyz216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/26/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Harmful substances in solid fuel and tobacco smoke are believed to enter the bloodstream via inhalation and to be metabolized in the liver, leading to chronic liver damage. However, little is known about the independent and joint effects of solid fuel use and smoking on risks of chronic liver disease (CLD) mortality. METHODS During 2004-08, ∼0.5 million adults aged 30-79 years were recruited from 10 areas across China. During a 10-year median follow-up, 2461 CLD deaths were recorded. Multivariable Cox regression yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the individual associations of self-reported long-term cooking fuel and tobacco use with major CLD death. RESULTS Overall, 49% reported solid fuel use and 26% smoked regularly. Long-term solid fuel use for cooking and current smoking were associated with higher risks of CLD deaths, with adjusted HRs of 1.26 (95% CI, 1.02-1.56) and 1.28 (1.13-1.44), respectively. Compared with never-smoking clean fuel users, the HRs were 1.41 (1.10-1.82) in never-smoking solid fuel users, 1.55 (1.17-2.06) in regular-smoking clean fuel users and 1.71 (1.32-2.20) in regular-smoking solid fuels users. Individuals who had switched from solid to clean fuels (1.07, 0.90-1.29; for median 14 years) and ex-regular smokers who stopped for non-medical reasons (1.16, 0.95-1.43; for median 10 years) had no evidence of excess risk of CLD deaths compared with clean fuel users and never-regular smokers, respectively. CONCLUSIONS Among Chinese adults, long-term solid fuel use for cooking and smoking were each independently associated with higher risks of CLD deaths. Individuals who had stopped using solid fuels or smoking had lower risks.
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Affiliation(s)
- Ka Hung Chan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Om P Kurmi
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xiaofang Chen
- NCDs Prevention and Control Department, Pengzhou Center for Disease Control and Prevention, Sichuan, China
| | - Caixia Dong
- NCDs Prevention and Control Department, Gansu Center for Disease Control and Prevention, Gansu, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Siddiqui NA, Jawed M, Pirzada A, Ahmed M, Khan RN. Non-operative treatment of hepatic trauma: A changing paradigm. A Six year review of liver trauma patient in a single institute. J PAK MED ASSOC 2020; 70(Suppl 1):S27-S32. [PMID: 31981332] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To review the managing strategies of adult patients with liver trauma in a tertiary care hospital during a six years period. METHODS The medical records of all patients admitted with a diagnosis of liver trauma from January 2012 to December 2017 in the Aga Khan University Hospital were retrospectively reviewed. The details of demographic, clinical, and outcome variables including morbidity and mortality rates were noted. RESULTS A total of 182 patients were admitted at AKUH with liver trauma between January 2012 and December 2017. Twenty-two patients were excluded according to our study criteria. Of 160 patients, 139 were male and 21 were female. One hundred twenty seven (79.4%) patients were less than 45 years of age. Most patients (89.4%) had no comorbids and 48 (44%) arrived at the hospital within 4 hours of injury. Majority, 101 (63.1%) of the patients had blunt trauma and 142 (89%) met with road accidents. A total of 109 (68.1%) patients were stable at arrival and 77 (48.1%) had abdominal signs present on examination. FAST ultrasound was done on 75 (46.9%) patients and CT scan abdomen on 145 (90.6 %) patients. Liver injuries were associated with other abdominal or systemic injuries in 139 (86.6%) patients. Low grade (Grade I & II) liver injuries were found in only 41 (25.6%) patients, with the remainder being high grade (Grade III- 41 patients, Grade IV-42 patients and Grade V-2 patients). Conservative treatment was offered to 68 (41.9%) patients, of which 57 (85.1%) remained stable and were eventually discharged. Of these, 2 expired and 3 required intervention. There were a total of 92 (57.2%) interventions done of which 60 patients were cured, 14 expired and 18 readmitted. Interventions included perihepatic packing (n=18), hepatorraphy (n=3), angioembolization (n=12) and hepatectomy (n=1). There were 16(10%) deaths in which liver haemorrhage and sepsis were the most common cause of mortality. Mean hospital stay in our study population was 8.9 days. Second admission was observed in 28 (17.5%) patients (n=28). Morbidity rate in our patients was 17.5% (n=28). The most common complication noted was that of a liver abscess, developing in 2 (1.3%) patients. Other significant problems were intra-abdominal collections (n=2) and biliary complications (n=3). Unstable haemodynamic status at arrival and prolonged stay in high dependency unit were noted to be independent risk factors for mortality. CONCLUSIONS Conservative treatment was found successful in most of our patients with an intervention rate of 57.5% and overall mortality rate of 10%. So, NOMLI can be safely offered to liver trauma patients, even in high grade injuries.
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Affiliation(s)
| | - Misaal Jawed
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Mobeen Ahmed
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Sun Y, Chang J, Liu X, Liu C. Mortality trends of liver diseases in mainland China over three decades: an age-period-cohort analysis. BMJ Open 2019; 9:e029793. [PMID: 31712333 PMCID: PMC6858130 DOI: 10.1136/bmjopen-2019-029793] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/04/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To analyse mortality trends of liver diseases in China over the past 30 years. DESIGN Age-period-cohort analyses were applied to liver diseases data obtained from the Chinese Health Statistics Annual Report (1987-2001) and the Chinese Health Statistics Yearbook (2003-2017). SETTING General population in mainland China. OUTCOMES Mortality rates and age, period and cohort effects on three categories of liver diseases: primary liver cancer (PLC), chronic liver disease and cirrhosis (CLD), and viral hepatitis (VH). RESULTS A total of 13.54 million deaths were attributable to liver diseases over the period between 1987 and 2016, resulting in an average of 36.15 deaths per 100 000 population per year. The risk of PLC mortality increased by 32.69% over the period after controlling for the effects of age and birth cohort. By contrast, the risk of CLD mortality decreased by 56.64% over the same period. The risk of VH mortality decreased first, followed by a resurgence after the period of 2002-2006. Similar mortality risk trends by age (increasing) and birth cohort (decreasing) were observed for PLC and CLD. The year 1952 represented a turning point for VH, with people born after 1950 experiencing a declining risk of VH mortality. CONCLUSIONS China has achieved great success in reducing the mortality of VH and CLD. However, significant challenges lie ahead in the efforts to prevent and control PLC and the resurgence of VH.
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Affiliation(s)
- Yang Sun
- Department of Public Affairs Management, School of Political Science and Public Administration, Wuhan University, Wuhan, China
- Center for Health Governance Research, Wuhan University, Wuhan, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
| | - Xin Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Chaojie Liu
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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Lewer D, Tweed EJ, Aldridge RW, Morley KI. Causes of hospital admission and mortality among 6683 people who use heroin: A cohort study comparing relative and absolute risks. Drug Alcohol Depend 2019; 204:107525. [PMID: 31581023 PMCID: PMC6891224 DOI: 10.1016/j.drugalcdep.2019.06.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mortality in high-risk groups such as people who use illicit drugs is often expressed in relative terms such as standardised ratios. These measures are highest for diseases that are rare in the general population, such as hepatitis C, and may understate the importance of common long-term conditions. POPULATION 6683 people in community-based treatment for heroin dependence between 2006 and 2017 in London, England, linked to national hospital and mortality databases with 55,683 years of follow-up. METHOD Age- and sex-specific mortality and hospital admission rates in the general population of London were used to calculate the number of expected events. We compared standardised ratios (relative risk) to excess deaths and admissions (absolute risk) across ICD-10 chapters and subcategories. RESULTS Drug-related diseases had the highest relative risks, with a standardised mortality ratio (SMR) of 48 (95% CI 42-54) and standardised admission ratio (SAR) of 293 (95% CI 282-304). By contrast, other diseases had an SMR of 4.4 (95% CI 4.0-4.9) and an SAR of 3.15 (95% CI 3.11-3.19). However, the majority of the 621 excess deaths (95% CI 569-676) were not drug-related (361; 58%). The largest groups were liver disease (75 excess deaths) and COPD (45). Similarly, 80% (11,790) of the 14,668 excess admissions (95% CI 14,382-14,957) were not drug-related. The largest groups were skin infections (1073 excess admissions), alcohol (1060), COPD (812) and head injury (612). CONCLUSIONS Although relative risks of drug-related diseases are very high, most excess morbidity and mortality in this cohort was caused by common long-term conditions.
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Affiliation(s)
- Dan Lewer
- Collaborative Centre for Inclusion Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; National Addictions Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, UK; Institute of Health Informatics, University College London, 222 Euston Road London, NW1 2DA, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK.
| | - Emily J Tweed
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow, G2 3AX, UK
| | - Robert W Aldridge
- Collaborative Centre for Inclusion Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; Institute of Health Informatics, University College London, 222 Euston Road London, NW1 2DA, UK
| | - Katherine I Morley
- National Addictions Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK; RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, UK
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Abstract
OBJECTIVES Patients with liver disease frequently require hospitalisation with infection often the trigger. Influenza vaccination is an effective infection prevention strategy in healthy and elderly but is often perceived less beneficial in patients with liver disease. We investigated whether influenza vaccination triggered serological response and prevented hospitalisation and death in liver disease. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, PubMed and CENTRAL up to January 2019. ELIGIBILITY CRITERIA Randomised or observational studies of the effects of influenza vaccine in adults with liver disease. DATA EXTRACTION AND SYNTHESIS Two reviewers screened studies, extracted data and assessed risk of bias and quality of evidence. Primary outcomes were all-cause hospitalisation and mortality. Secondary outcomes were cause-specific hospitalisation and mortality, and serological vaccine response. Random-effects meta-analysis was used to estimate pooled effects of vaccination. RESULTS We found 10 041 unique records, 286 were eligible for full-text review and 12 were included. Most patients had viral liver disease. All studies were of very low quality. Liver patients both with and without cirrhosis mounted an antibody response to influenza vaccination, and vaccination was associated with a reduction in risk of hospital admission from 205/1000 to 149/1000 (risk difference -0.06, 95% CI -0.07 to 0.04) in patients with viral liver disease. Vaccinated patients were 27% less likely to be admitted to hospital compared with unvaccinated patients (risk ratio 0.73, 95% CI 0.66 to 0.80). No effect against all-cause or cause-specific mortality or cause-specific hospitalisation was found. CONCLUSIONS The low quantity and quality of the evidence means that the protective vaccine effect may be uncertain. Considering the high risk of serious health outcomes from influenza infection in patients with liver disease and the safety and low cost of vaccination, overall, the potential benefits of seasonal vaccination both to patients and the healthcare systems are likely to outweigh the costs and risks associated with vaccination. PROSPERO REGISTRATION NUMBER CRD42017067277.
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Affiliation(s)
- Suvi Härmälä
- Institute of Health Informatics, University College London, London, UK
| | | | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | | | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
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Terefe Tesfaye B, Gudina EK, Bosho DD, Mega TA. Short-term clinical outcomes of patients admitted with chronic liver disease to selected teaching hospitals in Ethiopia. PLoS One 2019; 14:e0221806. [PMID: 31469861 PMCID: PMC6716656 DOI: 10.1371/journal.pone.0221806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/16/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic liver disease (CLD) is a progressive destruction of liver tissue with subsequent necrosis that persists for at least 6 months. In Ethiopia, despite the high burden report, data on CLD is limited. The objective of this study was to assess short-term clinical outcomes in patients admitted with chronic liver disease to three tertiary teaching hospitals in Ethiopia and to identify predictors of mortality. METHODS A cohort of 109 patients admitted with CLD to three tertiary teaching hospitals in Ethiopia, were prospectively followed from the time of admission to 30-days of hospital discharge. The study was conducted from April 1, 2018, to October 5, 2018. Kaplan-Maier curve was used to estimate survival and cox-regression analysis to identify predictors of mortality. RESULT A total of 109 patients (80% male) diagnosed with CLD were included. Median age of the participants was 38(IQR, 30-48). The overall median length of hospital stay was 7(IQR, 4-11) days. Of the total, 39(35.8%) patients were HBsAg positive, and 12(11%) patients were anti-HCV positive. The 30-day mortality was 38(34.9%), and most of the deaths, 31(81.6%) occurred before hospital discharge. Hepatic encephalopathy at admission; being with unidentified risk factor/etiologies of CLD and total bilirubin level were independent predictors of in-hospital mortality. Patients with hepatic encephalopathy at admission had approximately 11 times increased risk of death as compared to patients without hepatic encephalopathy at admission. Similarly, the hazard of mortality was 5.8 times higher in those patients with unidentified risk factor/etiology as compared to others. The risk of dying had also increased with an increase in bilirubin (1.188[95% CI, 1.0719-1.316]) level. CONCLUSION Approximately one-quarter of patients with CLD died during their hospital stay, and the risk of death continued after hospital discharge. Hepatic encephalopathy at admission, unidentified risk factor/etiology and increased level of total bilirubin are poor prognostic factors. Given that more than one third the patients had HBV-infection, access to antiviral drugs could help improve the prognosis of patients with end-stage liver disease in Ethiopia, as well as prevent the progression of the disease if initiated earlier.
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Affiliation(s)
| | - Esayas Kebede Gudina
- School of Medicine, Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Dula Dessalegn Bosho
- School of Pharmacy, Department of Clinical Pharmacy, Jimma University, Jimma, Ethiopia
| | - Teshale Ayele Mega
- School of Pharmacy, Department of Clinical Pharmacy, Jimma University, Jimma, Ethiopia
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Fabrizi F, Dixit V, Messa P. Hepatitis C virus and mortality among patients on dialysis: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2019; 43:244-254. [PMID: 30910601 DOI: 10.1016/j.clinre.2018.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 07/25/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND RATIONALE The role of hepatitis C virus (HCV) as an independent risk factor for death in dialysis population is unclear. DESIGN A systematic review of the published medical literature was performed to evaluate the impact of positive anti-HCV serologic status on all-cause and disease-specific mortality in patients on regular dialysis. The risk of all-cause, cardiovascular and liver disease-related mortality was regarded as the most reliable outcome end-point. Study-specific relative risks were weighted by the inverse of their variance to obtain fixed- and random-effects pooled estimates for mortality with HCV across the published studies. RESULTS Twenty-three observational studies (n = 574,081 patients on long-term dialysis) were identified. Pooling of study results demonstrated that HCV positive status was an independent and significant risk factor for death in patients on maintenance dialysis. The summary estimate for adjusted death risk (all-cause mortality) with HCV was 1.26 (95% CI: 1.18; 1.34) (P < 0.0001). Between-study heterogeneity was found (Q value 52.8, P = 0.001). The overall estimate for adjusted death risk (liver disease-related mortality) was 5.05 (95% CI: 2.53; 10.0) (P < 0.0001); heterogeneity statistics, Q value 8.2, P = 0.04. The overall estimate for adjusted death risk (cardiovascular mortality) was 1.18 (95% CI: 1.085; 1.29) (P < 0.0001) (no heterogeneity). Meta-regression showed that the effect of HCV on all-cause mortality was more evident in those studies provided with a greater size (P = 0.0001), a higher prevalence of diabetics (P = 0.0005) and HCV-infected individuals (P = 0.001). CONCLUSIONS An association between HCV positive serologic status and increased risk of either liver or cardiovascular disease-related mortality exists among dialysis patients.
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Affiliation(s)
- Fabrizio Fabrizi
- Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milano, Italy.
| | - Vivek Dixit
- Division of Gastroenterology, UCLA School of Medicine, Los Angeles, CA, USA
| | - Piergiorgio Messa
- Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milano, Italy; University School of Medicine, Milano, Italy
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Jindai K, Crawford C, Thomas AR. Short-Term Incidence of Sequelae of HCV Infection Among Medicaid Beneficiaries in Oregon. Public Health Rep 2018; 134:81-88. [PMID: 30508493 PMCID: PMC6304724 DOI: 10.1177/0033354918813552] [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] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES Given the known high morbidity and mortality of hepatitis C virus (HCV) infection in Oregon, we sought to develop a practical method of estimating the severe sequelae of HCV infection among Medicaid beneficiaries in Oregon. METHODS We assembled a retrospective cohort that identified all Oregon Medicaid beneficiaries with HCV infection enrolled for at least 1 year during 2009-2013. We linked this cohort to 3 data sets to identify HCV-related deaths, cases of hepatocellular carcinoma (HCC), and first hospitalizations for advanced liver disease (ALD). We calculated incidence density rates and used multivariable Cox regression modeling to calculate adjusted hazard ratios (aHRs) to evaluate the association between demographic characteristics (birth year, sex, race, ethnicity) and these 3 outcomes. RESULTS Of 11 790 Oregon Medicaid beneficiaries with HCV infection, 474 (4.0%) had an HCV-related death, 156 (1.3%) had HCC, and 596 (5.1%) had a first hospitalization for ALD. Adjusted hazard ratios for deaths were 2.2 (95% confidence interval [CI], 1.6-2.8) among persons born in 1945 through 1965 (vs persons born after 1965), 2.1 (95% CI, 1.7-2.5) among males (vs females), and 1.9 (95% CI, 1.2-2.9) among Asian/Pacific Islanders and 2.2 (95% CI, 1.5-3.2) among American Indian/Alaska Natives (vs white persons). The same risk groups had significant aHRs for first hospitalizations for ALD. Persons born before 1945 (aHR = 17.0; 95% CI, 5.2-55.8) and in 1945 through 1965 (aHR = 12.8; 95% CI, 4.1-40.3) vs born after 1965, males (aHR = 3.3; 95% CI, 2.3-4.8) vs females, and Asian/Pacific Islanders (aHR = 3.9; 95% CI, 2.3-6.7) vs white persons had higher risks for HCC. CONCLUSIONS Continued assessments using the methods piloted in this study will allow Oregon to monitor trends in severe sequelae of HCV infection over time.
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Affiliation(s)
- Kazuaki Jindai
- Oregon Public Health Division, Acute and Communicable Disease Prevention,
Oregon Health Authority, Portland, OR, USA
- Veterans Affairs Portland Healthcare System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University, Portland,
OR, USA
| | - Courtney Crawford
- Oregon Public Health Division, Acute and Communicable Disease Prevention,
Oregon Health Authority, Portland, OR, USA
| | - Ann R. Thomas
- Oregon Public Health Division, Acute and Communicable Disease Prevention,
Oregon Health Authority, Portland, OR, USA
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Williams R, Alexander G, Aspinall R, Batterham R, Bhala N, Bosanquet N, Severi K, Burton A, Burton R, Cramp ME, Day N, Dhawan A, Dillon J, Drummond C, Dyson J, Ferguson J, Foster GR, Gilmore I, Greenberg J, Henn C, Hudson M, Jarvis H, Kelly D, Mann J, McDougall N, McKee M, Moriarty K, Morling J, Newsome P, O'Grady J, Rolfe L, Rice P, Rutter H, Sheron N, Thorburn D, Verne J, Vohra J, Wass J, Yeoman A. Gathering momentum for the way ahead: fifth report of the Lancet Standing Commission on Liver Disease in the UK. Lancet 2018; 392:2398-2412. [PMID: 30473364 DOI: 10.1016/s0140-6736(18)32561-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/04/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023]
Abstract
This report presents further evidence on the escalating alcohol consumption in the UK and the burden of liver disease associated with this major risk factor, as well as the effects on hospital and primary care. We reiterate the need for fiscal regulation by the UK Government if overall alcohol consumption is to be reduced sufficiently to improve health outcomes. We also draw attention to the effects of drastic cuts in public services for alcohol treatment, the repeated failures of voluntary agreements with the drinks industry, and the influence of the industry through its lobbying activities. We continue to press for reintroduction of the alcohol duty escalator, which was highly effective during the 5 years it was in place, and the introduction of minimum unit pricing in England, targeted at the heaviest drinkers. Results from the introduction of minimum unit pricing in Scotland, with results from Wales to follow, are likely to seriously expose the weakness of England's position. The increasing prevalence of obesity-related liver disease, the rising number of people diagnosed with type 2 diabetes and its complications, and increasing number of cases of end-stage liver disease and primary liver cancers from non-alcoholic fatty liver disease make apparent the need for an obesity strategy for adults. We also discuss the important effects of obesity and alcohol on disease progression, and the increased risk of the ten most common cancers (including breast and colon cancers). A new in-depth analysis of the UK National Health Service (NHS) and total societal costs shows the extraordinarily large expenditures that could be saved or redeployed elsewhere in the NHS. Excellent results have been reported for new antiviral drugs for hepatitis C virus infection, making elimination of chronic infection a real possibility ahead of the WHO 2030 target. However, the extent of unidentified cases remains a problem, and will also apply when new curative drugs for hepatitis B virus become available. We also describe efforts to improve standards of hospital care for liver disease with better understanding of current service deficiencies and a new accreditation process for hospitals providing liver services. New commissioning arrangements for primary and community care represent progress, in terms of effective screening of high-risk subjects and the early detection of liver disease.
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Affiliation(s)
| | | | | | - Rachel Batterham
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Neeraj Bhala
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, Birmingham, UK
| | - Nick Bosanquet
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Anya Burton
- Hepatocellular Carcinoma UK and National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | | | - Matthew E Cramp
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | | | - John Dillon
- Medical Research Institute, University of Dundee, Dundee, UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology & Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | | | - James Ferguson
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Graham R Foster
- Barts Liver Centre, Queen Mary University of London, London, UK
| | | | | | | | | | - Helen Jarvis
- Institute of Health and Society, Newcastle University, Newcastle, UK; The Royal College of General Practitioners, London, UK
| | - Deirdre Kelly
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Jake Mann
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | | | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Joanne Morling
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Philip Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | | | | | - Peter Rice
- Scottish Health Action on Alcohol Problems (SHAAP), Bath, UK
| | | | - Nick Sheron
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | | | | | - Jyotsna Vohra
- Cancer Policy Research Centre, Cancer Research UK, London
| | - John Wass
- Department of Endocrinology, Churchill Hospital, Oxford, UK
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Gong Y, Long X, Xu H, Yang X, Guo Q. The changes and prognostic value of liver function in young adults with severe burn: A retrospective observational study. Medicine (Baltimore) 2018; 97:e13721. [PMID: 30572508 PMCID: PMC6320172 DOI: 10.1097/md.0000000000013721] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 11/21/2018] [Indexed: 11/25/2022] Open
Abstract
To analyze the changes in liver functions and the relationship between alterations in liver function and mortality risk in young adults with third-degree burn wounds on over 90% of the total body surface area (TBSA).A total of 23 fatally burned factory workers in an inflammable dust explosion and fire were enrolled from 2 intensive care units. Clinical data, particularly the laboratory tests for liver function, were retrospectively analyzed and compared between the survivor and non-survivor groups.Compared to survivors, non-survivors had significantly higher total bilirubin (TBIL), glutamate-pyruvate transaminase (GPT), glutamic-oxaloacetic transaminase, alkaline phosphatase, prothrombin time, and activated partial thromboplastin time (APTT) at the terminal point of this study (P <.05). In addition, the peak values of TBIL, GPT, and longer APTT were higher in non-survivors than in survivors during hospital course, and the peak values of TBIL was one of major prognostic factors for mortality risk. Furthermore, at the first 2 weeks, the cumulative survival rates were significantly lower in patients with liver dysfunction than those without liver dysfunction (P <.01).Our findings show that the great changes in liver function occurred in first 2 weeks after severe burns. Liver dysfunction may have an effect on clinical outcomes of post-burn. Measures to protect liver function and prevent from deterioration could be beneficial in improvement survival rate, especially during the first 2 weeks.
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Affiliation(s)
- Yan Gong
- Department of Rehabilitation medicine, The Affiliated Suzhou Hospital of Nanjing Medical University
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Soochow University
| | - Xianming Long
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hua Xu
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Soochow University
| | - Xinjing Yang
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Soochow University
| | - Qiang Guo
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Soochow University
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Barba R, Gonzalvez-Gasch A, Joya Seijo D, Marco J, Canora J, Plaza S, Angelina García M, Zapatero A. Venous thromboembolism in patients with liver diseases. J Thromb Haemost 2018; 16:2003-2007. [PMID: 30066476 DOI: 10.1111/jth.14255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/27/2018] [Indexed: 11/30/2022]
Abstract
Essentials Emerging evidence shows that patients with liver disease are not protected from thrombotic events. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease. The presence of VTE resulted in an increase in mortality for patients with liver disease. Hospitalized patients with moderate-severe liver disease had low risk of VTE during admission. SUMMARY Background and Aims Patients with liver disease were traditionally believed to be protected against development of blood clots, but some studies have shown a potential increased risk of venous thrombotic complications. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease. Methods Data in discharge reports of patients with liver disease and control patients without liver disease were analyzed from the national inpatient sample. Incidence of VTE was compared in patients with mild, moderate-severe or no liver disease, and the impact on in-hospital mortality and length of stay was calculated. Results The overall incidence of VTE for patients with no liver disease, mild liver disease and moderate-severe liver disease was 2.7, 2.4 and 0.9 per 100 patient discharges, respectively. In the presence of VTE, in-hospital mortality was 10.8%, 5.8%, and 21.7% for the no liver disease, mild disease and moderate-severe liver disease, respectively. The presence of VTE resulted in an increase in mortality for patients with no liver disease (OR, 1.16; 95% CI, 1.14-1.18) and moderate-severe liver disease (OR, 1.63; CI 95%, 1.42-1.88). Conclusions Patients with moderate-severe liver disease have a lower risk of VTE than those without liver disease. Development of thrombosis during admission increased the risk of in-hospital mortality.
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Affiliation(s)
- R Barba
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | | | - D Joya Seijo
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - J Marco
- Department of Internal Medicine, Hospital Clínico de San Carlos, San Carlos, Madrid, Spain
| | - J Canora
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - S Plaza
- Department of Internal Medicine, Hospital Severo Ochoa, Leganés, Madrid, Spain
| | - M Angelina García
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - A Zapatero
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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Imperatore N, Micheletto G, Manes G, Redaelli DG, Reitano E, de Nucci G. Systematic review: Features, diagnosis, management and prognosis of hepatic hematoma, a rare complication of ERCP. Dig Liver Dis 2018; 50:997-1003. [PMID: 30097261 DOI: 10.1016/j.dld.2018.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 04/27/2018] [Revised: 06/08/2018] [Accepted: 07/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatic hematoma (HH) is a rare but severe adverse event following endoscopic retrograde cholangiopancreatography (ERCP). AIMS To perform a systematic literature review and describe two additional cases, one of which presenting multiple subcapsular/intrahepatic hematomas after ERCP. METHODS The literature review was performed in PubMed/MEDLINE, EMBASE, and SCOPUS to identify all cases reporting on HH after ERCP. RESULTS A total of 48 cases (females 63%, mean age 58.2 ± 20.6 years) were included. The mean symptoms onset time was 46.8 h after ERCP, and the most common symptoms were abdominal pain (91.7%), anaemia (43.8%), hypotension (29.2%) and fever (20.8%). All cases were diagnosed by computed tomography (CT). HH was found mostly in the right hepatic lobe (95.1%) and the mean size was 116 × 93 mm. A conservative management was adopted in 38.3% of cases, while percutaneous drainage, embolization and surgery were needed in 31.9%, 14.9% and 25%. Mortality rate was about 9%. Anaemia (OR 6.9; p = 0.02) and surgery (OR 10.5; p < 0.01) were the only independent factors for unfavorable outcome (death), while abdominal pain (OR 0.1; p = 0.03) and antibiotics administration (OR 0.06; p < 0.001) were associated with better outcome. CONCLUSIONS HH is a rare but severe complication following ERCP which needs a multidisciplinary approach. Antibiotics administration is the only treatment able to reduce the risk of death.
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Affiliation(s)
- Nicola Imperatore
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy; Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense Garbagnate Milanese, Milan, Italy.
| | - Giancarlo Micheletto
- Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy; Department of General Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Gianpiero Manes
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense Garbagnate Milanese, Milan, Italy
| | | | - Elisa Reitano
- Department of General Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Germana de Nucci
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense Garbagnate Milanese, Milan, Italy
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Manns MP, Burra P, Sargent J, Horton R, Karlsen TH. The Lancet-EASL Commission on liver diseases in Europe: overcoming unmet needs, stigma, and inequities. Lancet 2018; 392:621-622. [PMID: 30060999 DOI: 10.1016/s0140-6736(18)31734-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School and German Center for Infection Research (DZIF), Hannover-Braunschweig partner site, D-30625 Hannover, Germany.
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | | | | | - Tom H Karlsen
- European Association for the Study of the Liver, Geneva, Switzerland
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Desai AP, Mohan P, Roubal AM, Bettencourt R, Loomba R. Geographic Variability in Liver Disease-Related Mortality Rates in the United States. Am J Med 2018; 131:728-734. [PMID: 29496501 PMCID: PMC6090542 DOI: 10.1016/j.amjmed.2018.01.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 01/01/2018] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Liver disease is an important cause of morbidity and mortality in the United States. Geographic variations in the burden of chronic liver disease may have significant impact on public health policies but have not been explored at the national level. The objective of this study is to examine interstate variability in liver disease mortality in the United States. METHODS We compared liver disease mortality from the 2010 National Vital Statistics Report on a state level. States in each quartile of liver disease mortality were compared with regard to viral hepatitis death rates, alcohol consumption, obesity, ethnic and racial composition, and household income. Race, ethnicity, and median household income data were derived from the 2010 US Census. Alcohol consumption and obesity data were obtained from the 2010 Behavioral Risk Factor Surveillance System Survey. RESULTS AND CONCLUSION We found significant interstate variability in liver disease mortality, ranging from 6.4 to 17.0 per 100,000. The South and the West carry some of the highest rates of liver disease mortality. In addition to viral hepatitis death rates, there is a strong correlation between higher percentage of Hispanic population and a state's liver disease mortality rate (r = 0.538, P < .001). Lower household income (r = 0.405, P = .003) was also associated with the higher liver disease mortality. While there was a trend between higher obesity rates and higher liver disease mortality, the correlation was not strong and there was no clear association between alcohol consumption and liver disease mortality rates.
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Affiliation(s)
- Archita P Desai
- Division of Gastroenterology and Hepatology, Liver Research Institute
| | | | - Anne M Roubal
- Center for Population Science and Discovery, University of Arizona, Tucson
| | - Ricki Bettencourt
- NAFLD Translational Research Unit, Department of Medicine and Division of Epidemiology, Department of Family and Preventive Medicine
| | - Rohit Loomba
- NAFLD Translational Research Unit, Division of Gastroenterology and Epidemiology, University of California at San Diego, La Jolla.
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Lima JG, Nobrega LHC, Lima NN, dos Santos MCF, Silva PHD, Baracho MDFP, Lima DN, de Melo Campos JTA, Ferreira LC, Freire Neto FP, Mendes-Aguiar CDO, Jeronimo SMB. Causes of death in patients with Berardinelli-Seip congenital generalized lipodystrophy. PLoS One 2018; 13:e0199052. [PMID: 29883474 PMCID: PMC5993255 DOI: 10.1371/journal.pone.0199052] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/30/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Berardinelli-Seip Congenital Lipodystrophy (BSCL) is a rare autosomal recessive disease that affects the development of adipocytes and leads to an inability to store fat in adipocytes. This study aimed to evaluate the life expectancy and the causes of death of patients with BSCL. METHOD We analyzed death certificates, and medical records of BSCL patients who died between 1997 and 2017. If the death certificate was incomplete or unavailable, we reviewed the medical records, and if they were not available too, we collected information from the patient's relatives to understand how the death happened. We calculated the potential years of life lost as a result of premature death. RESULTS Twenty patients (12 female and 8 male) died between 1997 and 2017. The mean age at the time of death was 27.1±12.4 years (women 25.2±12.5 vs. men 29.9±12.6 years, p = 0.41). Life expectancy for the study population was 62.9±4.8 years. The potential number of years of life lost was 35.6±16.6 years. The causes of deaths were divided into three major groups: infections (7 patients, 35%), liver disease (7 patients, 35%), and other causes (acute pancreatitis, one patient; renal failure, three patients; sudden death/myocardial infarction, two patients). Three patients had pulmonary fibrosis. CONCLUSION BSCL led to premature death, cutting the patients' lifespan by 30 or more years. The majority of these young patients died of liver disease or infection. Other studies are needed to understand better the mechanisms that predispose to infections, as well as to assess whether new therapies can alter the natural history of this disease.
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Affiliation(s)
- Josivan Gomes Lima
- Departamento de Medicina Clínica, Hospital Universitário Onofre Lopes (HUOL/UFRN), Natal, RN, Brazil
- * E-mail:
| | - Lucia Helena C. Nobrega
- Departamento de Medicina Clínica, Hospital Universitário Onofre Lopes (HUOL/UFRN), Natal, RN, Brazil
| | - Natalia Nobrega Lima
- Departamento de Medicina Clínica, Hospital Universitário Onofre Lopes (HUOL/UFRN), Natal, RN, Brazil
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Lai GY, Wang JB, Weinstein SJ, Parisi D, Horst RL, McGlynn KA, Männistö S, Albanes D, Freedman ND. Association of 25-Hydroxyvitamin D with Liver Cancer Incidence and Chronic Liver Disease Mortality in Finnish Male Smokers of the ATBC Study. Cancer Epidemiol Biomarkers Prev 2018; 27:1075-1082. [PMID: 29720370 DOI: 10.1158/1055-9965.epi-17-0877] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/19/2017] [Accepted: 04/27/2018] [Indexed: 01/23/2023] Open
Abstract
Background: Although circulating 25-hydroxyvitamin D [25(OH)D] concentrations were linked to liver cancer and chronic liver disease (CLD) in laboratory studies, few epidemiologic studies have addressed the associations.Methods: Within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, we measured 25(OH)D in baseline serum of 202 incident liver cancer cases and 225 CLD deaths that occurred during nearly 25 years of follow-up, and 427 controls. ORs and 95% confidence intervals (CIs) were estimated using unconditional logistic regression. We examined predetermined clinically defined cut-points, and season-specific and season-standardized quartiles.Results: Low serum 25(OH)D concentrations were associated with higher risk of liver cancer (<25 nmol/L vs. ≥50 nmol/L: 1.98; 95% CI, 1.22-3.20; Ptrend across categories = 0.003) and CLD mortality (1.93; 95% CI, 1.23-3.03; Ptrend = 0.006) in models adjusted for age and date of blood draw. After additional adjustment for body mass index, diabetes, smoking, and other potential confounders, the association remained statistically significant for liver cancer (1.91; 95% CI, 1.16-3.15; Ptrend = 0.008), but was somewhat attenuated for CLD mortality (1.67; 95% CI, 1.02-2.75; Ptrend = 0.05). Associations were similar for analyses using season-specific and season-standardized quartiles, and after excluding participants with diabetes, or hepatitis B or C.Conclusions: Our results suggest a possible preventive role for vitamin D against liver cancer and CLD, although the importance of the liver for vitamin D metabolism and the lack of information about underlying liver disease makes reverse causality a concern.Impact: Future studies are needed to evaluate associations of vitamin D with liver cancer and liver disease in other populations, particularly those with a different constellation of risk factors. Cancer Epidemiol Biomarkers Prev; 27(9); 1075-82. ©2018 AACR.
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Affiliation(s)
- Gabriel Y Lai
- Environmental Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
| | - Jian-Bing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Stephanie J Weinstein
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | | | | | - Katherine A McGlynn
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Satu Männistö
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Demetrius Albanes
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Madhavan S, Shelat VG, Soong SL, Woon WWL, Huey T, Chan YH, Junnarkar SP. Predicting morbidity of liver resection. Langenbecks Arch Surg 2018; 403:359-369. [PMID: 29417211 DOI: 10.1007/s00423-018-1656-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 07/27/2017] [Accepted: 01/25/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Multiple models have attempted to predict morbidity of liver resection (LR). This study aims to determine the efficacy of American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator and the Physiological and Operative Severity Score in the enUmeration of Mortality and Morbidity (POSSUM) in predicting post-operative morbidity in patients who underwent LR. METHODS A retrospective analysis was conducted on patients who underwent elective LR. Morbidity risk was calculated with the ACS-NSQIP surgical risk calculator and POSSUM equation. Two models were then constructed for both ACS-NSQIP and POSSUM-(1) the original risk probabilities from each scoring system and (2) a model derived from logistic regression of variables. Discrimination, calibration, and overall performance for ACS-NSQIP and POSSUM were compared. Sub-group analysis was performed for both primary and secondary liver malignancies. RESULTS Two hundred forty-five patients underwent LR. Two hundred twenty-three (91%) had malignant liver pathologies. The post-operative morbidity, 90-day mortality, and 30-day mortality rate were 38.3%, 3.7%, and 2.4% respectively. ACS-NSQIP showed superior discriminative ability, calibration, and performance to POSSUM (p = 0.03). Hosmer-Lemeshow plot demonstrated better fit of the ACS-NSQIP model than POSSUM in predicting morbidity. CONCLUSION In patients undergoing LR, the ACS-NSQIP surgical risk calculator was superior to POSSUM in predicting morbidity risk.
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Affiliation(s)
- Sudharsan Madhavan
- Ministry of Health Holdings, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Republic of Singapore
| | - Vishal G Shelat
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Su-Lin Soong
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Winston W L Woon
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Terence Huey
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Yiong H Chan
- Biostatistics Unit, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore
| | - Sameer P Junnarkar
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore.
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Park H, Jeong D, Nguyen P, Henry L, Hoang J, Kim Y, Sheen E, Nguyen MH. Economic and clinical burden of viral hepatitis in California: A population-based study with longitudinal analysis. PLoS One 2018; 13:e0196452. [PMID: 29708985 PMCID: PMC5927421 DOI: 10.1371/journal.pone.0196452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/15/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Economic burden of HBV and HCV infection are trending upwards. AIMS Compare hepatitis B virus (HBV) and hepatitis C virus (HCV) related hospital admission rates, charges, mortality rates, causes of death in a US population-based study. METHODS Retrospective cohort analysis of HBV and HCV patients from the California Office of Statewide Health Planning and Development (2006-2013) database. RESULTS A total of 23,891 HBV and 148,229 HCV patients were identified. Across the 8-year period, the mean increase for all-cause ($1,863 vs $1,388) and liver-related hospitalization charges ($1,175 vs $675) were significantly higher for the HBV cohort compared to the HCV cohort. HBV patients had significantly higher liver-related hospital charges per person per year than HCV patients after controlling for covariates ($123,239 vs $111,837; p = 0.002). Compared to HCV patients, adjusted mortality hazard ratio was slightly lower in HBV patients (relative risk = 0.96; 95% CI 0.94-0.99). The major causes and places of death were different. The three major causes of death for HBV were: other malignant neoplasms (35%), cardiovascular disease/other circulatory disorders (17%), and liver-related disease (15%) whereas for HCV patients were: liver-related disease (22%), other malignant neoplasms (20%), and cardiovascular disease (16%). Regarding the place of death, 53% of HBV patients and 44% of HCV patients died in hospital inpatient, respectively. CONCLUSIONS HBV patients incurred higher liver-related hospital charges and higher mean increase for all-cause and liver-related hospitalization charges over the 8-year period compared to HCV patients. HBV patients had slightly lower mortality rate and their major causes and places of death were noticeably different from HCV patients.
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Affiliation(s)
- Haesuk Park
- University of Florida College of Pharmacy, Pharmaceutical Outcomes & Policy, Gainesville, FL, United States of America
| | - Donghak Jeong
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, United States of America
| | - Pauline Nguyen
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, United States of America
| | - Linda Henry
- University of Florida College of Pharmacy, Pharmaceutical Outcomes & Policy, Gainesville, FL, United States of America
| | - Joseph Hoang
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, United States of America
| | - Yoona Kim
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, United States of America
| | - Edward Sheen
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, United States of America
| | - Mindie H. Nguyen
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, United States of America
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Abstract
OBJECTIVE Current chronic liver disease (CLD) mortality surveillance methods may not adequately capture data on all causes of CLD mortality. The objective of this study was to calculate and compare CLD death rates in New Mexico and the United States by using both an expanded definition of CLD and estimates of the fractional impact of alcohol on CLD deaths. METHODS We defined CLD mortality as deaths due to alcoholic liver disease, cirrhosis, viral hepatitis, and other liver conditions. We estimated alcohol-attributable CLD deaths by using national and state alcohol-attributable fractions from the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact application. We classified causes of CLD death as being alcohol-attributable, non-alcohol-attributable, or hepatitis C. We calculated average annual age-adjusted CLD death rates during five 3-year periods from 1999 through 2013, and we stratified those rates by sex, age, and race/ethnicity. RESULTS By cause of death, CLD death rates were highest for alcohol-attributable CLD. By sex and race/ethnicity, CLD death rates per 100 000 population increased from 1999-2001 to 2011-2013 among American Indian men in New Mexico (67.4-90.6) and the United States (38.9-49.4), American Indian women in New Mexico (48.4-63.0) and the United States (27.5-39.5), Hispanic men in New Mexico (48.6-52.0), Hispanic women in New Mexico (16.9-24.0) and the United States (12.8-13.1), non-Hispanic white men in New Mexico (17.4-21.3) and the United States (15.9-18.4), and non-Hispanic white women in New Mexico (9.7-11.6) and the United States (7.6-9.7). CLD death rates decreased among Hispanic men in the United States (30.5-27.4). CONCLUSIONS An expanded CLD definition and alcohol-attributable fractions can be used to create comprehensive data on CLD mortality. When stratified by CLD cause and demographic characteristics, these data may help states and jurisdictions improve CLD prevention programs.
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Affiliation(s)
- Laura E. Tomedi
- Epidemiology and Response Division, New Mexico Department of Health, Santa Fe, NM, USA
| | - Jim Roeber
- Epidemiology and Response Division, New Mexico Department of Health, Santa Fe, NM, USA
| | - Michael Landen
- Epidemiology and Response Division, New Mexico Department of Health, Santa Fe, NM, USA
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