Outcome Of Liver Disease Research Articles

Survival of Patients with Hepatitis B-Related Hepatocellular Carcinoma with Concomitant Metabolic Associated Fatty Liver Disease.

Metabolic associated fatty liver disease is a novel concept defined as fatty liver associated with metabolic disorders. We investigated the effect of metabolic associated fatty liver disease on hepatocellular carcinoma patient mortality. A total of 624 patients with hepatocellular carcinoma between 2012 and 2020 were enrolled in this retrospective study. Hepatic steatosis was diagnosed using computed tomography or magnetic resonance imaging. Metabolic associated fatty liver disease was defined based on the proposed criteria in 2020. Propensity score matching was performed for patients with metabolic associated fatty liver disease and those without the condition. A Cox proportional hazards regression model was used to evaluate the association between metabolic associated fatty liver disease and hepatocellular carcinoma patient outcomes. Patients with hepatocellular carcinoma and metabolic associated fatty liver disease tended to achieve better outcomes than did those without metabolic associated fatty liver disease after matching (p<0.001). Metabolic associated fatty liver disease was significantly associated with better prognosis in patients with concurrent hepatitis B infection (p<0.001). Moreover, high levels of hepatitis B viral DNA in serum samples was associated with a significantly increased risk of death in patients without non-metabolic associated fatty liver disease (p=0.045). Additionally, the association between metabolic associated fatty liver disease and survival in hepatitis B virus-related hepatocellular carcinoma was similar in all subgroups based on metabolic traits. Metabolic associated fatty liver disease increases the survival rate of patients with hepatocellular carcinoma and hepatitis B virus infection. The potential interaction of steatosis and virus replication should be considered for future research and clinical treatment strategies.

De Novo Cost-Effectiveness Model Framework for Nonalcoholic Steatohepatitis-Modeling Approach and Validation.

Nonalcoholic steatohepatitis (NASH) is a chronic liver disease associated with hepatic morbidity and mortality and extra-hepatic comorbidities. Published NASH cost-effectiveness models (CEMs) are heterogeneous and consistently omit comorbid conditions that frequently co-exist alongside NASH. We aimed to develop a de novo CEM framework that incorporates extra-hepatic disease states and outcomes alongside hepatic components to enable future estimation of the cost-effectiveness of NASH interventions. Patient-level simulation and cohort-level Markov models were implemented in the same framework. Model inputs included fibrosis progression; late-stage liver disease outcomes; comorbidity outcomes for cardiovascular disease, type 2 diabetes, and obesity; mortality; health-related quality of life; and direct medical costs. The prototype analysis assessed the cost-effectiveness of obeticholic acid versus standard of care from a US payer perspective over a lifetime horizon with costs and effects discounted at 3% per annum. However, the CEM was designed for easy adaptation to other countries, time horizons, and other considerations. Efficacy and adverse event parameters were obtained from the 18-month interim analysis of the REGENERATE trial. Outputs include total and incremental costs, total life years, and quality-adjusted life years. In this model, total costs, total life years, and quality-adjusted life years were all higher with obeticholic acid compared with standard of care. Cross-validation of this model with the 2016 and 2020 Institute for Clinical and Economic Review models revealed marked differences, mainly driven by mortality inputs, transition probability estimates, and incorporation of the effect of treatment and comorbidities. This is the first CEM in NASH to incorporate the clinical consequences of several comorbidities. The flexible yet standardized framework permits estimation of the cost-effectiveness of NASH interventions in a variety of settings. The model currently includes several assumptions and will be further developed as more relevant data become available.

Expansion of Betatorquevirus and/or Gammatorquevirus in Patients with Severe Clinical Outcomes of the Liver Diseases.

Anellovirus (AV) is a ubiquitous virus in the human population. Individuals can be infected with multiple AV genera and species to form a heterogeneous repertoire, termed the anellome. Using advanced methods, we examined the anellomes from 12 paired serum and liver samples, as well as 2701 subjects with different clinical diagnoses. Overall, anellomes are remarkably individualized, with significant among-group differences (Kruskal-Wallis test p = 6.6 × 10-162 for richness and p = 7.48 × 10-162 for Shannon entropy). High dissimilarity scores (beta diversity) were observed between patient groups, except for paired serum and liver samples. At the population level, the relative abundance of combinational AV genus Betatorquevirus (torque teno mini viruses, TTMV), and Gammatorquevirus (torque teno midi viruses, TTMDV) exhibited an exponential distribution with a low bound point at 32%. Defined by this value, the AV TTMV/TTMDV-expanded anellome was significantly enriched among patients with acute liver failure (31.7%) and liver transplantation (40.7%), compared with other patient groups (χ2 test: p = 4.1 × 10-8-3.2 × 10-3). Therefore, anellome heterogeneity may be predictive of clinical outcomes in certain diseases, such as liver disease. The consistency of anellome between paired serum and liver samples indicates that a liquid biopsy approach would be suitable for longitudinal studies to clarify the causality of the AV TTMV/TTMDV-expanded anellome in the outcomes of liver disease.

Diagnostic Performance of Quantitative Ultrasound Parameters in Non-alcoholic Fatty Liver Disease

Marked liver steatosis, steatohepatitis, and significant fibrosis are risk factors for unfavorable outcomes in non-alcoholic fatty liver disease (NAFLD). In this study, the diagnostic performance ofattenuation coefficient(AC), liver stiffness(LS), and dispersion slope (DS) was evaluated separately and combined in the diagnosis of liver steatosis and fibrosis in NAFLD suspects using biopsy or magnetic resonance imaging (MRI) as a reference standard. Seventy-four NAFLD suspects were prospectively imaged with an Aplio i800 ultrasound scanner (Canon Medical Systems, Tustin, CA). AC, LS, and DS measurements were obtained from the right liver lobe. Thirty-four patients underwent liver biopsy, and 40 had MRI. There were 32 patients (43%) with liver steatosis and fibrosis (S+F), 22(30%) with steatosis (S), 5 (7%) with fibrosis (F), and 15 (20%) with normal liver (N). Mean ACs were significantly higher in steatotic livers (n=54) than in non-steatotic livers (n=20) (P<0.0001). LS and DS were significantly higher in patients with liver fibrosis (n=37) compared tonon-fibrotic livers (n=37) (P=0.0004 and P=0.0002, respectively). In detecting (S+F), the area under the receiver operating characteristic curve (AUROCC) was 0.87 for combined ultrasound parameters of LS and AC (negative predictive value [NPV]: 75%, positive predictive value [PPV]: 77%, P<0.0001). In detecting patients with liver steatosis and fibrosis stage ≥2, LS had an AUROCC of 0.93 (NPV: 87%, PPV: 82%, P<0.0001). In the biopsy group, 32% (11/34) were diagnosed with non-alcoholic steatohepatitis (NASH). DS values showed a significant difference among patients with (n=23) or without (n=11) hepatocellular ballooning (P=0.02). AUROCC was 0.87 for combined ultrasound parameters of AC, LS, and DS with body mass index (BMI) in detecting NASH (NPV: 80%, PPV: 87%, P=0.0006). AC and LS showed high diagnostic value in detecting liver steatosis and fibrosis, respectively. The combined AC and LS values further improved the diagnostic accuracy in detecting NAFLD and high-risk NAFLD patients.

The global burden of alcoholic liver disease: a systematic analysis of the global burden of disease study 2019.

Alcohol use is a major risk factor for the burden of mortality and morbidity. Alcoholic cirrhosis (AC) and alcoholic liver cancer (ALC) are most important and severe liver disease outcomes caused by alcohol use. The objectives of the current study were to investigate the global prevalence and burden of disease in disability-adjusted life years (DALYs) for AC and ALC, based on data from the Global Burden of Disease (GBD). Incidence, prevalence, death, and DALYs for GBDs in different locations, years, sex, and age groups were estimated using DisMod-MR 2.1 and a generic Cause of Death Ensemble Modeling approach. The correlations between the age-standardized incidence rate or age-standardized death rate and gender, sociodemographic index (SDI), and alcohol usage were conducted by Generalized Linear Models. Globally, the changes of age-standardized rates of indicators were not much significant over the 30-year period. However, the changes varied widely across regions. Central Asia and East Europe contributed the highest age-standardized incidence, prevalence, death, and DALYs and increased sharply by past 30years. Generalized Linear Models (GLMs) showed male gender as a risk factor of AC, with the relative risk of incidence of 1.521 and relative risk of death of 1.503. Globally, there were improvements in overall health with regard to GBDs over the 30years. However, the prevention of AC and ALC should be promoted in middle and middle-high SDI regions, especially Central Asia and East Europe, whereas more medical resources should be provided to improve treatment levels in low SDI region.

Dynamics in Liver Stiffness Measurements Predict Outcomes in Advanced Chronic Liver Disease

Liver stiffness measurements (LSM) provide an opportunity to non-invasively monitor liver disease progression/regression. We aimed to determine the prognostic relevance of LSM-dynamics over time for liver-related events and death in patients with chronic liver disease. Patients with chronic liver disease undergoing ≥2 reliable LSM at least 180 days apart were included in this retrospective cohort study and stratified at baseline (BL) as non-advanced chronic liver disease (nonACLD, BL-LSM<10kPa), compensated ACLD (cACLD; BL-LSM≥10kPa) and decompensated ACLD (dACLD). Data on all consecutive LSM and clinical outcomes were collected. 2508 patients with 8561 reliable LSM (3 [IQR: 2-4] per patient) were included: 1647 (65.7%) nonACLD, 757 (30.2%) cACLD, and 104 (4.1%) dACLD. 7 nonACLD (0.4%) and 83 cACLD patients (10.9%) developed hepatic decompensation (median follow-up: 71 months). 20% increase in LSM at any time was associated with a ∼50% increased risk for hepatic decompensation (hazard ratio, HR: 1.58 [95%CI: 1.41-1.79], p<0.001) and liver-related death (HR: 1.45 [95%CI: 1.28-1.68], p<0.001) in cACLD patients. LSM-dynamics yielded a high accuracy to predict hepatic decompensation in the following 12 months (AUROC: 0.933). The performance of LSM-dynamics was numerically better than dynamics in FIB-4 (0.873), MELD (0.835), and single timepoint LSM (BL-LSM: 0.846; 2nd LSM: 0.880). Any LSM-decrease to <20kPa identified cACLD patients with a substantially lower risk of hepatic decompensation (HR: 0.13 [95%CI: 0.07-0.24]). If reliable, LSM also confers prognostic information in dACLD. Repeating LSM enables an individual and updated risk assessment for decompensation and liver-related mortality in ACLD.

Correlation of Liver Elastography as a Predictor of Esophageal Varices and Its Comparison With Ultrasound Abdomen and Liver Function Tests in Patients With Chronic Liver Disease.

Variceal haemorrhage is a life-threatening complication that occurs in up to 40% of patients with chronic liver disease including cirrhosis. It is associated with a mortality rate of 20%with each episode of variceal bleeding. Esophagogastroduodenoscopy is the gold standard for the detection of esophageal varices but is an invasive procedure and not verycost-effective. Our study was designed to correlate the presence of esophageal varices on endoscopywith the liver stiffness measurement using liver elastography inpatients with chronic liver disease. We also comparedvarious non-invasive predictors like laboratory parameters and ultrasound features andcorrelated them with the presence of varices inpatients with chronic liver disease. This prospective observational study was conducted ina tertiary-care hospital in South Indiafrom November 2017 to April 2019.All patients withchronic liver disease were subjected to endoscopy, and the presence ofesophageal varicesand their grading was noted. The predictive efficacy of ultrasound elastographyusing Toshiba Aplio 500 ultrasound two-dimensional shear wave elastography (2D-SWE) in predicting esophageal varices was calculated and compared with the efficacy of predictingesophageal varices by other non-invasive parameters like laboratory investigations, abdominal ultrasound, and liver scores like Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD) score, fibrosis 4 (FIB-4) score,aspartate aminotransferase-to-platelet ratio index (APRI) score, andaspartate aminotransferase/alanine aminotransferase ratio (AAR). The study includeda total of 168 patients out ofwhich 57% (96 patients) had no varices. About 52 patients(72.2%) had F1/Grade I varices,9(12.5%) had F2/Grade II varices, and 11 (15.3%) had F3/Grade III varices. The greatest predictive value for esophageal variceswas liver stiffness with a diagnostic accuracy of 81.7%.Ultrasound features likecoarse echotexture of the liver (66.7%), splenomegaly (67%), dilated portal vein (78.6%), and presence of moderate ascites (66.7%) had asignificantstatistical association with the presence of esophageal varices. Laboratory parameters like thrombocytopeniaof less than 1.5 lakhs/cu.mm (52.8%), albumin <3 g/dL (60.4%), and reversal of albumin/globulin ratio(52.4%) weresignificant predictors of esophageal varices. The odds ratio for significant scores in predicting oesophageal varices using binary logistic regression was significant in patients whose liver elastography grade wasmore than F4, CTP score was B, MELD score was >11, and FIB-4 scoreswas >3.25 and between 1.46 and 3.25. Liver elastography is a non-invasiveprocedure that can be a useful tool in predicting esophageal varices in chronic liver disease. Other non-invasive predictorslike ultrasound abdomen and laboratory parameters canalso be considered a replacement for repeatedinvasive endoscopy, thusfacilitating early intervention and avoiding unfavourable outcomes in patients withchronic liver disease.

Epidemiology and outcomes of non-alcoholic fatty liver disease in African Americans.

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1339-P: Hepatic Steatosis and Fibrosis Are Common in Obese Patients with Type 2 Diabetes Mellitus (T2DM)

Diabetes is a strong predictor of worse outcomes in nonalcoholic fatty liver disease (NAFLD), such as cirrhosis, CVD, and overall mortality. However, its true prevalence in clinical practice, and the role of obesity contributing to fibrosis, remain unclear. To this end, we recruited 759 patients without known NAFLD (35% with T2DM; age: 56 ± 11 years; BMI: 30.8 ± 6.5 kg/m2; female 59 %; ethnicity: Caucasian 75%, AA 14%, other 11%) attending outpatient endocrine/primary care clinics. We measured: 1) Routine laboratories; 2) Liver fat (CAP score ≥ 274 dB/m) and fibrosis (liver stiffness measurement or LSM) by elastography. The prevalence of NAFLD in T2DM was 68% vs. 44% in those without T2DM (p&amp;lt;0.05). Comparing patients with vs. without T2DM, the presence of any liver fibrosis (LSM ≥7 kPa or F≥1) was 20% vs. 6%, of clinically significant fibrosis (LSM ≥8 kPa [moderate-to-severe] = F≥2) was 12% vs. 4%, and advanced fibrosis (LSM ≥ 9.7 kPa = F3/F4) was 7% vs. 1%, respectively (all p&amp;lt;0.05). Obesity in T2DM promoted a much higher prevalence of steatosis (80% vs. 47% in T2DM without obesity) and of moderate-to-severe fibrosis (17% vs. 3%, respectively, both p&amp;lt;0.05). In people without T2DM, obesity also played a major role regarding steatosis (obese: 66 % vs. non-obese: 28%) and moderate-to-severe fibrosis (F≥2: 8% vs. 1%, respectively; both p&amp;lt;0.05). Worse glycemic control in people with T2DM (A1c ≥7.0% vs. &amp;lt;7.0%) led to a higher prevalence of steatosis (75% vs. 62%) and of fibrosis (24% vs 18%; both p&amp;lt;0.05). In multiple regression analysis, with a 95% CI, obesity in T2DM was the most significant risk factor for steatosis (OR 2.8, 1.9-4.2) and fibrosis (OR 3.4, 2.1-5.3). Conclusion: People with T2DM are at a very high risk of hepatic steatosis and severe fibrosis. Obesity is a major risk factor for worse disease, even in the absence of diabetes. These findings strongly support recent ADA recommendations to screen people with T2DM and obesity and cardiometabolic risk factors for moderate-to-severe fibrosis. Disclosure E.Valdez saenz: None. D.Barb: None. A.Sharma: None. K.Cusi: Consultant; Poxel SA, Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck &amp; Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns, Research Support; Echosens, Inventiva, LabCorp, Zydus. E.Godinez leiva: None. R.Lomonaco: None. S.Kalavalapalli: None. S.A.Marangi: None. M.A.Gonzalez: None. A.Ortiz rocha: None. X.Chi: None. M.J.Gurka: None. Funding National Institutes of Health (R01120331-01A1)

THU-416 - Patatin-like phospholipase domain-containing 3 (PNPLA3) risk allele increases rate of progression to end-stage liver disease outcomes and decreases survival rate over time irrespective of degree of fibrosis

THU-416 - Patatin-like phospholipase domain-containing 3 (PNPLA3) risk allele increases rate of progression to end-stage liver disease outcomes and decreases survival rate over time irrespective of degree of fibrosis

Clinical Outcomes of Adult Fontan-Associated Liver Disease and Combined Heart-Liver Transplantation

BackgroundThe impact of Fontan-associated liver disease (FALD) on post-transplant mortality and indications for combined heart-liver transplant (CHLT) in adult Fontan patients remains unknown. ObjectivesThe purpose of this study was to assess the impact of FALD on post-transplant outcomes and compare HT vs CHLT in adult Fontan patients. MethodsWe performed a retrospective-cohort study of adult Fontan patients who underwent HT or CHLT across 15 centers. Inclusion criteria were as follows: 1) Fontan; 2) HT/CHLT referral; and 3) age ≥16 years at referral. Pretransplant FALD score was calculated using the following: 1) cirrhosis; 2) varices; 3) splenomegaly; or 4) ≥2 paracenteses. ResultsA total of 131 patients (91 HT and 40 CHLT) were included. CHLT recipients were more likely to be older (P = 0.016), have a lower hemoglobin (P = 0.025), require ≥2 diuretic agents pretransplant (P = 0.051), or be transplanted in more recent decades (P = 0.001). Postmatching, CHLT demonstrated a trend toward improved survival at 1 year (93% vs 74%; P = 0.097) and improved survival at 5 years (86% vs 52%; P = 0.041) compared with HT alone. In patients with a FALD score ≥2, CHLT was associated with improved survival (1 year: 85% vs 62%; P = 0.044; 5 years: 77% vs 42%; P = 0.019). In a model with transplant decade and FALD score, CHLT was associated with improved survival (HR: 0.33; P = 0.044) and increasing FALD score was associated with worse survival (FALD score: 2 [HR: 14.6; P = 0.015], 3 [HR: 22.2; P = 0.007], and 4 [HR: 27.8; P = 0.011]). ConclusionsHigher FALD scores were associated with post-transplant mortality. Although prospective confirmation of our findings is necessary, compared with HT alone, CHLT recipients were older with higher FALD scores, but had similar survival overall and superior survival in patients with a FALD score ≥2.

Outcomes of fatty liver disease with and without metabolic comorbidities and risk factors for mortality.

As the clinical course of metabolic-associated fatty liver disease (MAFLD) is unclear, we compared the clinical courses of MAFLD and non-alcoholic FLD (NAFLD). Asian FLD patients (n = 987) from 1991 to 2021 (biopsy-proven in 939) were enrolled. The patients were divided into NAFLD (N-alone, n = 92), both MAFLD and N (M&N, n = 785), and M-alone (n = 90) groups. Clinical features, complications, and survival rates were compared among the three groups. Risk factors of mortality were subjected to Cox regression analysis. The N-alone group patients were significantly younger (N alone, M&N, and M alone: 50, 53, and 57 years, respectively), more frequently male (54.3%, 52.6%, and 37.8%), and had a low body mass index (BMI, 23.1, 27.1, and 26.7 kg/m2) and FIB-4 index (1.20, 1.46, and 2.10). Hypopituitarism (5.4%) and hypothyroidism (7.6%) were significantly observed in the N-alone group. Hepatocellular carcinoma (HCC) developed in 0.0%, 4.2%, and 3.5% of the cases, and extrahepatic malignancies in 6.8%, 8.4%, and 4.7% of the cases, respectively, with no significant differences. The cardiovascular event rate was significantly higher in the M-alone group (1, 37, and 11 cases, P < 0.01). Survival rates were similar among the three groups. Risk factors for mortality were age and BMI in the N-alone group; age, HCC, alanine transaminase, and FIB-4 in the M&N group; and FIB-4 in the M-alone group. Different risk factors for mortality may exist among the FLD groups.

Prognostic value of non-invasive scores based on liver stiffness measurement, spleen diameter and platelets in HIV-infected patients.

People living with HIV (PLWH) are at high risk for advanced chronic liver disease and related adverse outcomes. We aimed to validate the prognostic value of non-invasive scores based on liver stiffness measurement (LSM) and on markers of portal hypertension (PH), namely platelets and spleen diameter, in PLWH. We combined data from eight international cohorts of PLWH with available non-invasive scores, including LSM and the composite biomarkers liver stiffness-spleen size-to-platelet ratio score (LSPS), LSM-to-Platelet ratio (LPR) and PH risk score. Incidence and predictors of all-cause mortality, any liver-related event and classical hepatic decompensation were determined by survival analysis, controlling for competing risks for the latter two. Non-invasive scores were assessed and compared using area under the receiver operating curve (AUROC). We included 1695 PLWH (66.8% coinfected with hepatitis C virus). During a median follow-up of 4.7 (interquartile range 2.8-7.7) years, the incidence rates of any liver-related event, all-cause mortality and hepatic decompensation were 13.7 per 1000 persons-year (PY) (95% confidence interval [CI], 11.4-16.3), 13.8 per 1000 PY (95% CI, 11.6-16.4) and 9.9 per 1000 PY (95% CI, 8.1-12.2), respectively. The AUROC of LSM was similar to that of the composite biomarkers, ranging between 0.83 and 0.86 for any liver-related event, 0.79-0.85 for all-cause mortality and 0.87-0.88 for classical hepatic decompensation. All individual non-invasive scores remained independent predictors of clinical outcomes in multivariable analysis. Non-invasive scores based on LSM, spleen diameter and platelets predict clinical outcomes in PLWH. Composite biomarkers do not achieve higher prognostic performance compared to LSM alone.

Global prevalence, incidence, and outcomes of alcohol related liver diseases: a systematic review and meta-analysis

BackgroundAlcohol related liver disease (ARLD) is one of the major chronic liver diseases worldwide. This review aimed to describe the global prevalence, incidence, and outcomes of ARLD.MethodsMedline, Embase, The Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched from inception to May 31, 2022. The language was restricted to English or Chinese. According to the criteria, articles describing the basic characteristics of the population were selected. Two reviewers extracted the data independently.ResultsA total of 372 studies were identified: 353 were used for prevalence analysis, 7 were used for incidence analysis, and 114 were used to for outcome analysis. The prevalence of ARLD worldwide was 4.8%. The prevalence in males was 2.9%, which was higher than female (0.5%). Among the ethnic groups, the percentage was highest in Caucasians (68.9%). Alcoholic liver cirrhosis comprised the highest proportion in the disease spectrum of ARLD at 32.9%. The prevalence of ascites in ARLD population was highest (25.1%). The ARLD population who drinking for > 20 years accounted for 54.8%, and the average daily alcohol intake was 146.6 g/d. About 59.5% of ARLD patients were current or former smokers, and 18.7% were complicated with hepatitis virus infection. The incidence was 0.208/1000 person-years. The overall mortality was 23.9%, and the liver-related mortality was 21.6%.ConclusionThe global prevalence of ARLD was 4.8% and was affected by sex, region, drinking years, and other factors. Therefore, removing the factors causing a high disease prevalence is an urgent requisite.Trial registrationPROSPERO Nr: CRD42021286192

The Presence of Myosteatosis Is Associated with Age, Severity of Liver Disease and Poor Outcome and May Represent a Prodromal Phase of Sarcopenia in Patients with Liver Cirrhosis.

Myosteatosis implies impaired muscle quality. The aim of the study was to investigate the association of myosteatosis with other muscle abnormalities and its role in the prognosis of liver cirrhosis (LC). Skeletal muscle index (SMI) and myosteatosis were measured by computed tomography. Myosteatosis was defined as muscle radiodensity and evaluated according to dry body mass index (BMI). Median values and interquartile range were used for continuous and count (percentage) for categorical variables. A total of 197 consecutive patients were included (age 61 (IQR 52-68); 67% male; MELD score 11 (interquartile range 7.5-16)). Myosteatosis was identified in 73.6% and sarcopenia in 44.6% of patients. Myosteatosis was positively associated with age (p = 0.024) and Child-Pugh (p = 0.017) and inversely associated with SMI (p = 0.026). Patients with myosteatosis exhibited lower 360-day survival (log-rank p = 0.001) compared to those without it. MELD (p < 0.001) and myosteatosis (p = 0.048) emerged as negative prognostic factors of survival in multivariate model. Individuals combining low muscle strength and impaired muscle quality and quantity displayed more advanced LC, impaired muscle performance, lower BMI (p < 0.001 each) and a three times higher mortality rate compared to those with low muscle quality alone. The presence of myosteatosis was associated with advanced age, low skeletal mass and more severe LC. Myosteatosis was associated with poor prognosis and may represent a prodromal phase of muscle degeneration before the development of sarcopenia.

Non-alcoholic fatty liver disease (NAFLD) and COVID-19 outcomes: A systematic review, meta-analysis, and meta-regression.

It is important to identify risk factors for poor outcomes of coronavirus disease 2019 (COVID-19) patients. Currently, the correlation between non-alcoholic fatty liver disease (NAFLD) and COVID-19 outcomes has not been established. This study was conducted to determine the association between NAFLD and in-hospital outcomes of COVID-19 patients. The systematic searches were conducted by using PubMed and the Europe PMC databases and particular keywords were used as of December 10, 2020. Further searches were conducted up to 2022. All articles that include data about COVID-19 and fatty liver disease were collected. Statistical analysis was performed by using Review Manager 5.4 and Comprehensive Meta-Analysis version 3 software. A total of 7,210 COVID-19 patients from 18 studies were included in the final analysis. Meta-analysis revealed that NAFLD increased the risk of developing poor in-hospital outcome (pooled both severe disease and death) in COVID-19 patients (RR 1.42; 95%CI: 1.17-1.73, p<0.001, I2=84%, random-effect modeling). Subgroup analysis however found that having NAFLD only increased the chance of getting severe COVID-19 (RR 1.67; 95%CI: 1.32-2.13, p<0.001, I2=86%, random-effect modeling) and not mortality (RR 1.00; 95%CI: 0.68-1.47, p=0.98, I2=80%, random-effect modeling). Meta-regression suggested that age (p=0.001) and diabetes (p=0.029) were significantly influenced the relationship between NAFLD and in-hospital outcomes of COVID-19 (pooled both severe disease and mortality). The weaker association of NAFLD and in-hospital outcomes of COVID-19 was found for studies with median age ≥45 years old (RR 1.29) when compared to studies with median age <45 years old (RR 2.96). In addition, studies with the prevalence of diabetes ≥25% (RR 1.29) had a weaker association with in-hospital outcomes when compared to studies with diabetes prevalence <25% (RR 1.85). In conclusion, NAFLD increased the risk of chance of getting severe COVID-19 and therefore it should be evaluated closely to reduce the chance of getting severe COVID-19.

Statins Are Associated With a Decreased Risk of Severe Liver Disease in Individuals With Noncirrhotic Chronic Liver Disease

Little is known about the potential impact of statins on the progression of noncirrhotic chronic liver diseases (CLDs) to severe liver disease. Using liver histopathology data in a nationwide Swedish cohort, we identified 3862 noncirrhotic individuals with CLD and statin exposure, defined as a statin prescription filled for 30 or more cumulative defined daily doses. Statin users were matched to 3862 (statin) nonusers with CLD through direct 1:1 matching followed by propensity score matching. Cox regression was used to estimate hazard ratios (HRs) for the primary outcome of incident severe liver disease (a composite of cirrhosis, hepatocellular carcinoma, and liver transplantation/liver-related mortality). A total of 45.3% of CLD patients had nonalcoholic fatty liver disease, 21.9% had alcohol-related liver disease, 17.7% had viral hepatitis, and 15.1% had autoimmune hepatitis. During follow-up evaluation, 234 (6.1%) statin users vs 276 (7.1%) nonusers developed severe liver disease. Statin use was associated with a decreased risk of developing severe liver disease (HR, 0.60; 95% CI, 0.48-0.74). Statistically significantly lower rates of severe liver disease were seen in alcohol-related liver disease (HR, 0.30; 95% CI, 0.19-0.49) and in nonalcoholic fatty liver disease (HR, 0.68; 95% CI, 0.45-1.00), but not in viral hepatitis (HR, 0.76; 95% CI, 0.51-1.14) or autoimmune hepatitis (HR, 0.88; 95% CI, 0.48-1.58). Statin use had a protective association in both prefibrosis and fibrosis stages at diagnosis. Statin use was associated with lower rates of progression to cirrhosis (HR, 0.62; 95% CI, 0.49-0.78), hepatocellular carcinoma (HR, 0.44; 95% CI, 0.27-0.71), and liver-related mortality (HR, 0.55; 95% CI, 0.36-0.82). Among individuals with noncirrhotic CLD, incident statin use was linked to lower rates of severe liver disease, suggesting a potential disease-modifying role.

Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease.

Chronic liver disease (CLD), including non-alcoholic fatty liver disease (NAFLD) and its advanced form, non-alcoholic steatohepatitis (NASH), affects a significant portion of the population worldwide. NAFLD is characterised by fat accumulation in the liver, while NASH is associated with inflammation and liver damage. Osteosarcopenia, which combines muscle and bone mass loss, is an emerging clinical problem in chronic liver disease that is often underappreciated. The reductions in muscle and bone mass share several common pathophysiological pathways; insulin resistance and chronic systemic inflammation are the most crucial predisposing factors and are related to the presence and gravity of NAFLD and to the worsening of the outcome of liver disease. This article explores the relationship between osteosarcopenia and NAFLD/MAFLD, focusing on the diagnosis, prevention and treatment of this condition in patients with CLD.

A Nationwide Study of Liver Disease Hospitalizations During the Coronavirus Pandemic in the United States.

The impact of the Coronavirus disease-2019 (COVID-19) pandemic on patients with liver disease is not well described at the population level in the United States. We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years. Using the National Inpatient Sample (2018-2020), we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality for liver-related complications including cirrhosis, alcohol-associated liver disease (ALD) and alcoholic hepatitis (AH) using regression modeling. We reported relative change (RC) in the study period. Decompensated cirrhosis hospitalizations decreased in 2020 compared to 2019 (RC: -2.7%, p <0.001) while all-cause mortality increased by 15.5% (p <0.001). Hospitalizations for ALD increased compared to pre-pandemic years (RC: 9.2%, p<0.001) with a corresponding increase in mortality in 2020 (RC 25.2%, p= 0.002). We observed an increase in liver transplant surgery mortality during the peak months of the pandemic. Importantly, mortality from COVID-19 was higher among patients with decompensated cirrhosis [adjusted odds ratio (OR) 1.72, 95% confidence interval [CI] (1.53-1.94)], Native Americans (OR 1.76, 95% CI: 1.53-2.02), and patients from lower socioeconomic groups. Cirrhosis hospitalizations decreased in 2020 compared to pre-pandemic years but were associated with higher all-cause mortality rates particularly in the peak months of the COVID-19 pandemic. In-hospital COVID-19 mortality was higher among Native Americans, patients with decompensated cirrhosis, chronic illnesses, and those from lower socioeconomic groups.

A63 TRENDS AND OUTCOMES OF LIVER DISEASE HOSPITALIZATIONS DURING THE CORONAVIRUS PANDEMIC IN THE UNITED STATES: A NATIONWIDE POPULATION-LEVEL ANALYSIS

Abstract Background The impact of the Coronavirus disease-2019 (COVID-19) pandemic on patients with liver disease is not well described at the population level in the United States. Purpose We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years. Method Using the National Inpatient Sample (2018-2020), we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality for liver-related indications including compensated cirrhosis, decompensated cirrhosis, alcohol-associated liver disease (ALD), alcohol-associated hepatitis (AH), hepatocellular carcinoma (HCC), and variceal upper gastrointestinal bleeding (VUGIB) using regression modeling. We also looked at the impact of the COVID-19 pandemic on liver transplantation rates. A p-value &amp;lt;0.05 was considered statistically significant. Result(s) Hospitalizations for both compensated and decompensated cirrhosis decreased in 2020 compared to 2019 (relative change [RC] of 1.5%, p &amp;lt;0.001, Table 1). Interestingly, hospitalizations for ALD and AH increased in 2020 compared to pre-pandemic years (ALD RC=15.5% and AH RC 17.0%; p&amp;lt;0.001). Despite the decrease in cirrhosis hospitalizations in 2020, all-cause inpatient mortality among patients with compensated cirrhosis increased from 30,135 in 2019 to 35,220 in 2020 (p&amp;lt;0.001) and from 22,850 in 2019 to 26,390 in 2020 among patients with decompensated cirrhosis (p&amp;lt;0.001). This was accompanied by a 27.8% increase in mortality for ALD (p=0.004) in comparison to pre-pandemic years. Corresponding to the peaks of the pandemic, we observed the fewest cirrhosis hospitalizations in April and December 2020 (Table 2), however, these months had the highest observed mortality rates (p-trend ≤ 0.004). Reassuringly, liver transplantation rates were not significantly impacted by the COVID-19 pandemic (p=0.51). Image Conclusion(s) Cirrhosis hospitalizations, in general, decreased in 2020 compared to pre-pandemic years but were associated with higher all-cause mortality rates particularly in the peak months of the COVID-19 pandemic (April and December 2020) possibly reflecting COVID-19 specific mortality. Alcoholic liver disease admissions also increased during the pandemic while liver transplantation rates were not significant impacted. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared