Prevalence Of Alcoholic Liver Disease Research Articles

Racial and ethnic disparities in post–liver transplant survival among patients with hepatocellular carcinoma in the United States.

178 Background: Liver transplantation (LT) is a potentially curative treatment option for some patients with early-stage hepatocellular carcinoma (HCC). Racial and ethnic disparities in diagnosis and overall outcomes for HCC are well known. However, real-world data on disparities in post-LT survival among patients with HCC are lacking. Methods: We used TriNetX, a national database comprising approximately 74 million patients across 54 health care organizations in the United States, to retrospectively identify patients who had an ICD-10 diagnosis of HCC (ICD-10 C22.0, C22.8) and underwent LT (CPT codes 47135, 47140, 47140, 47141, 47142) from 2012-2022. We retrieved data on baseline characteristics and compared them across racial and ethnic subgroups; Caucasians, African Americans (AA) and other minorities (Hispanics/Asians). We studied post-LT outcomes using survival at 1 year, 3 years and 5 years. Results: A total of 2,901 patients with HCC underwent LT over the study period, out of which, majority were Caucasians (2403/2901, 84.8%), followed by AA (267/2901, 9.2%) Hispanic/Asian (231/2901, 7.9%). At baseline, AA patients had higher prevalence of viral hepatitis B (10.1% vs 5.7%, p=0.004), hepatitis C (72.7% vs 47.1%, p<0.001) and lower prevalence of alcoholic liver disease (36.3% vs 45.5%, p=0.004) as compared to Caucasian patients. Hispanic/Asian patients had lower prevalence of alcoholic liver disease (37.7% vs 45.5%, p=0.02), nicotine dependence (13.4% vs 21.3%, p=0.004) and higher prevalence of viral hepatitis B (24.7% vs 5.7%, p<0.001) as compared to Caucasian patients. We found no differences post-LT survival at 1 year (92.9% vs 91.6%, p=0.60), 3 years (77.6% vs 80.5%, p=0.48) and 5 years (71.0% vs 72.3%, p=0.46) between AA and Caucasian patients. While post-LT survival at 1 year was lower among Hispanic/Asian patients (88.5% vs 94.3%, p=0.04), we found no difference in post-LT survival at 3 years (82.5% vs 85.4%, p=0.27) and 5 years (75.8% vs 75.7%, p=0.55) when compared to Caucasians. Conclusions: We present real-world data demonstrating the under-representation of racial minorities in the cohort of patients with HCC receiving LT in the US. We found no differences in post-LT survival (except higher early mortality among Hispanic/Asian patients), across racial/ethnic groups. These results show that stringent implementation of policies aimed at ensuring equitable access to LT may contribute to bridging disparities in overall outcomes in HCC.

MICROBIOLOGICAL PROFILE OF SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH CIRRHOSIS OF LIVER IN SOUTHERN ASSAM.

Liver cirrhosis is a common disorder which can have a wide range of aetiologies. Anatomically, it is characterised as a widespread process of nodule formation and fibrosis in the liver. Without any obvious intra-abdominal source of infection, spontaneous bacterial peritonitis (SBP) is characterised by infection of the previously sterile ascitic fluid (AF). SBP is a primary cause of death in decompensated liver disease and requires quick identification and care. In recent years, Assam has seen an increase in the prevalence of alcoholic liver disease and associated complications. Aims and Objectives: This study was undertaken with an idea to evaluate the significance of AF analysis with AF culture and sensitivity to determine microbiological profile and prognosis in cirrhotic patients with SBP in this region. Materials and Methods: Patients admitted with liver cirrhosis with ascites were studied during the period from June 2021 to May 2022. All patients included in the study were confirmed liver cirrhosis by ultrasound. Basic demographics, symptoms and clinical signs of patients were recorded. Patients with the history of antibiotic use within last 3 days or any intraabdominal source of infection were excluded. Diagnostic paracentesis was done for ascitic fluid detailed report and culture. Out of 100 SBP patients, 60 (60%) had culture negative neutrocytic ascites and 40 (40%) had Results: bacterascites. Fever, abdominal tenderness and constipation were common in SBP patients. Ascitic fluid culture was positive in 26 (52%) patients. E. coli (28%) was the predominant pathogen followed by Klebsiella species (8%), Staphylococcus aureus (2%) and acetinobacter (2%). 33 (82.5%) cases showed sensitivity to cefotaxim. In rest 17.5% cases, organism is mildly sensitive or resistant to 3rd generation cephalosporins

Metabolic signature of HepaRG cells exposed to ethanol and tumor necrosis factor alpha to study alcoholic steatohepatitis by LC-MS-based untargeted metabolomics.

Despite the high prevalence of alcoholic liver disease, its identification and characterization remain poor, especially in early stages such as alcoholic fatty liver disease and alcoholic steatohepatitis. This latter implies diagnostic difficulties, few therapeutic options and unclear mechanisms of action. To elucidate the metabolic alterations and pinpoint affected biochemical pathways, alcoholic steatohepatitis was simulated in vitro by exposing HepaRG cells to ethanol (IC10, 368mM) and tumor necrosis factor alpha (TNF-α, 50ng/mL) for 24h. This combined exposure was compared to solely ethanol-exposed as well as -nonexposed cells. Four different metabolomics platforms were used combining liquid chromatography, high-resolution mass spectrometry and drift tube ion mobility to elucidate both intracellular and extracellular metabolic alterations. Some of the key findings include the influence of TNF-α in the upregulation of hepatic triglycerides and the downregulation of hepatic phosphatidylethanolamines and phosphatidylcholines. S-Adenosylmethionine showed to play a central role in the progression of alcoholic steatohepatitis. In addition, fatty acyl esters of hydroxy fatty acid (FAHFA)-containing triglycerides were detected for the first time in human hepatocytes and their alterations showed a potentially important role during the progression of alcoholic steatohepatitis. Ethoxylated phosphorylcholine was identified as a potential new biomarker of ethanol exposure.

Development and Validation of a nomogram for forecasting survival of alcohol related hepatocellular carcinoma patients.

With the increasing incidence and prevalence of alcoholic liver disease, alcohol-related hepatocellular carcinoma has become a serious public health problem worthy of attention in China. However, there is currently no prognostic prediction model for alcohol-related hepatocellular carcinoma. The retrospective analysis research of alcohol related hepatocellular carcinoma patients was conducted from January 2010 to December 2014. Independent prognostic factors of alcohol related hepatocellular carcinoma were identified by Lasso regression and multivariate COX proportional model analysis, and the nomogram model was constructed. The reliability and accuracy of the model were assessed using the concordance index(C-Index), receiver operating characteristic (ROC) curve and calibration curve. Evaluate the clinical benefit and application value of the model through clinical decision curve analysis (DCA). The prognosis was assessed by the Kaplan-Meier (KM) survival curve. In sum, 383 patients were included in our study. Patients were stochastically assigned to training cohort (n=271) and validation cohort (n=112) according to 7:3 ratio. The predictors included in the nomogram were splenectomy, platelet count (PLT), creatinine (CRE), Prealbumin (PA), mean erythrocyte hemoglobin concentration (MCHC), red blood cell distribution width (RDW) and TNM. Our nomogram demonstrated excellent discriminatory power (C-index) and good calibration at 1-year, 3-year and 5- year overall survival (OS). Compared to TNM and Child-Pugh model, the nomogram had better discriminative ability and higher accuracy. DCA showed high clinical benefit and application value of the model. The nomogram model we established can precisely forcasting the prognosis of alcohol related hepatocellular carcinoma patients, which would be helpful for the early warning of alcohol related hepatocellular carcinoma and predict prognosis in patients with alcoholic hepatocellular carcinoma.

Association of anxiety and depression with chronic liver diseases in patients with noncardiac chest pain: A cross-sectional study.

Causes of chest pain can vary from benign to life-threatening conditions, and in many cases not necessary of cardiac origin. A possible reason for noncardiac chest pain could be anxiety or depression caused by chronic liver diseases. The aim of this study was to investigate the association of anxiety and depression with chronic liver disease in patients with noncardiac pain.Patients with chest tightness or pain referred for treadmill exercise testing were recruited from a regional hospital in southern Taiwan. Medical records of the patients were used to define the presence and type of chronic liver disease. Multiple logistic regression analyses were conducted to assess the association of anxiety and depression with chronic liver disease.A total of 2537 patients with liver function test results and abdominal sonography data were analyzed, and 1965 patients showed a negative treadmill exercise testing. The mean age of these 1965 patients was 51.9 years and 54.2% were male. The prevalence of alcoholic liver disease, hepatitis B, hepatitis C, and fatty liver disease was 10.6%, 10.9%, 3.7%, and 27.0%, respectively. Results from multiple logistic regression analyses showed that the risk of anxiety (adjusted odds ratio [aOR] = 1.83, P < .001) and depression (aOR = 1.85, P < .001) was significantly higher in patients with alcoholic liver disease. Anxiety was significantly higher in patients with fatty liver disease (aOR = 1.30, P = .031), and the risk of depression was significantly higher in patients with chronic hepatitis C (aOR = 2.18, P = .005).In conclusion, in patients with noncardiac chest pain, alcoholic liver disease was significantly associated with anxiety and depression, while those with fatty liver and chronic hepatitis C were associated with anxiety and depression, respectively. Clinicians should be vigilant to these correlations in their practice.

Deconvolution of Bulk RNAseq Data from Human Liver Samples Reveals a Metabolic Switch in Periportal Hepatocytes in Alcoholic Hepatitis

The prevalence of alcoholic liver disease (ALD) is rapidly increasing, however, few if any therapies are successful in the treatment of this disease as the development of such therapies is hampered by the lack of animal models. In this work, we aim to identify points of metabolic divergence driving the progression of ALD, which may provide therapeutic potential in the treatment of the disease. To determine the differences in metabolic landscapes across these progressing stages of ALD, bulk RNA‐seq was performed on alcoholic hepatitis (AH), progressing ALD, non‐alcoholic liver disease (NALD), and healthy control human liver samples. Hierarchical clustering of metabolic genes revealed N‐glycan metabolism, nucleotide metabolism and protein modification associated with AH samples, while oxidative phosphorylation, drug metabolism and retinol metabolism associated with healthy control and NALD samples. To further investigate which hepatic cell types may be involved in this shift in metabolic activity, we performed deconvolution of the bulk RNA‐seq data using a previously published single‐cell RNA‐seq dataset from healthy human liver tissue. Two imputed populations of hepatocytes, the periportal Hep 4 population and the mid‐lobular Hep 6 population, showed a decrease in cell proportions with increasing disease severity from healthy control to AH. Oppositely, there was an increase in cholangiocyte and hepatic stellate cell (HSCs) proportions with AH progression. Hierarchical clustering of metabolic genes from each cell type showed similar clustering to the bulk data, with groups of genes partitioned into (1) those upregulated with AH and (2) those upregulated in healthy control and NALD. Clusters of upregulated metabolic genes within the AH states from the Hep 4, cholangiocyte, and HSC populations all showed overrepresentation of metabolic pathways common to those upregulated in the bulk data, which differed from the Hep 6 population, whose enriched processes were downregulated in the bulk data. However, both hepatocyte populations displayed overrepresented metabolic pathways similar to the bulk data when analyzing the cluster of upregulated metabolic genes in the NALD and healthy states. These results indicate that the Hep 4, HSC and cholangiocyte populations act synergistically to upregulate specific metabolic genes in the AH state, while only the hepatocyte populations are responsible for the upregulation of metabolic genes in the healthy control and NALD states. It is crucial to further analyze the Hep 4 cluster of cells as they seem to be driving the metabolic switch activity separating the AH states from the NALD and healthy control disease states.

Alcoholic Liver Disease among Patients Admitted to the Department of Internal Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Alcoholic liver diseases comprise a spectrum of liver diseases including fatty liver, alcoholic hepatitis, and cirrhosis. Diagnosis at advanced stages is frequent for this condition and data regarding the prevalence of such patients at early stages are limited. The aim of this study is to find out the prevalence of alcoholic liver disease among patients admitted to the Department of Internal Medicine of a tertiary care centre. A descriptive cross-sectional study was conducted among 538 patients admitted to the Department of Internal Medicine of a tertiary care centre in Nepal between 3rd November, 2021 and 22nd February, 2022 after receiving ethical approval from the Institutional Review Committee of the hospital (Reference number: 006-078/079). Convenience sampling was done. Data were collected and entered in Microsoft Excel and analysed using Statistical Package for the Social Sciences version 24.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data along with mean and standard deviation for continuous data. Among 538 patients, alcoholic liver disease was seen in 42 (7.80%) (5.53-10.07 at 95% Confidence Interval). The mean age of the patients was 53.85±10.88 years. Among these patients 25 (59.52%) were males and 17 (40.47%) of them were females. Our study showed that the prevalence of alcoholic liver disease was lower as compared to similarly reported literature. alcoholic liver diseases; jaundice; liver function test; Nepal.

Statins in Alcoholic and Non-Alcoholic Fatty Liver Disease and Chronically Elevated Liver Enzymes

The prevalence of alcoholic liver disease and non-alcoholic liver disease patients has nearly doubled over the past decades worldwide. Alcoholic liver disease among patients with chronic liver disease has increased with arisen due to alcohol consumption and obesity. The diagnosis plays a crucial role in treating such conditions based on the stages of liver functioning. The elevated liver enzymes are the key characterizing of identifying the alcoholic liver disease (ALD) and NAFLD. Later on, there is a progression of the disease conditions by developing fibrosis and cirrhosis, leading to liver carcinoma. The other state, steatohepatitis, is associated with an increase in liver-related and can lead to mortality. Risk factors for both diseases are growing, leading to various complications in health. There is no specific treatment up to date for these conditions, but statins play a crucial role in managing several liver disease conditions. The commonly used drug is hydroxymethylglutaryl coenzyme A (HMG Co-A) reductase inhibitors. It is also known as statins, which help normalize liver enzymes in patients with elevated plasma aminotransferases. As a result, external liver damage is considered safe for the liver as the Statin medication at low to moderate dose usage. OBJECTIVES: The main scope of this review is to study the various factors like pharmacological actions, adverse events, and biochemical and liver cell imaging results in patients with ALD and NAFLD. The different types of statins used in alcoholic and non-alcoholic patients’ clinical data for the safety of the statin therapy were concluded in this review. Fatty liver changes of both liver disease conditions were studied using different drugs. The other liver enzymes like Alanine transaminase (ALT), Aspartate transaminase (AST), Gamma-glutamyl Transferase (GGT), and the effectiveness of Statin therapy are considered vital concepts in this review.

Exogenous and endogenous mortality parameters as indicators of the sanitary and epidemiological status of the population of the region

Introduction. The concepts of the epidemiological transition and types of population health are applied to analyzing and evaluating the sanitary and epidemiological status of the population. Materials and methods. For many years of mortality, the dynamics of the male population of the Irkutsk region standardized indicators were used (European age standard). For identifying trends of changing mortality rates, an analytical alignment of the time series was used. It was a linear model by EXCEL’s standard tools (Microsoft Office 2007). The significance of the trend equation was calculated using F-test in IBM SPSS Statistics 23 (p &lt; 0,05). Results. It has been established that the formation of various types of pathology and caused by this pathology mortality occurred under the influence of factors of different nature in the process of changes in social, environmental, epidemiological situations in the region. In the 1990 th and the first half of the 2000 th, high mortality rates in the class of diseases of the circulatory system and the class of external causes of morbidity and mortality were determined mainly by psychosocial disadvantage factors. By the class of Diseases of the respiratory system, there was noted a steady decrease in mortality rate from chronic diseases of the lower respiratory tract and pneumonia. It was probably due to an increase in the level and quality of medical care. A steady tendency to increase intensive and extensive mortality rates by class of Certain infectious and parasitic diseases was seen. That was caused by negative changes in infectious and epidemic processes under the influence of man-made pollution was noted. During 2005 - 2015 the digestive system’s share of the class of Diseases in the mortality structure increased. That is due to the prevalence of alcoholic liver disease, chronic alcoholic pancreatitis, complications of the ulcer of the stomach and duodenum. Conclusion. The combination of the identified patterns of the formation of intensive and extensive mortality rates determined by exogenous and endogenous factors made it possible to characterize the situation in the Irkutsk region as a relative sanitary and epidemiological disadvantage of the population.

Prevalence of Alcoholic Liver Disease in Port Harcourt, Rivers State

Alcoholic liver disease is a severe liver disease that affects substantial number of people in different parts of the world. However, there is low level of awareness regarding the disease and poor knowledge of the risk factors. The present study aimed to determine the prevalence of alcoholic liver disease among the residents of Port Harcourt, Rivers State, Nigeria, as this will both provide a clear picture of the incidence, as well as, aiding the diagnosis and management of the disease and distinguish it from other forms of liver impairment. This cross-sectional, descriptive study was conducted in the University of Port Harcourt Teaching Hospital; a tertiary health facility serving treatment, teaching, health research and referral purposes for primary and secondary health care facilities within Rivers State and its adjoining states. The relationship between gender and age to the assayed parameters were investigated, shows that age (0.793) and sex (0.591) were not statistically significant for the circulating level of aspartate, with age (0.000) significant and sex (0.217) non-significant for alanine amino transaminase, while age (0.830) and sex (1.52) were not statistically significant for gamma T. the prevalence of liver disease is low (8.1%) in the population and this may be attributed to factors such as poor healthcare-seeking attitude among the residents and effective diagnostic tools to detect the anomaly in the liver, especially, at the earliest stages of the disease condition.

Comprehensive Analysis of the Expression Profiles of Hepatic lncRNAs in the Mouse Model of Alcoholic Liver Disease.

Background and Aim: The worldwide prevalence of alcoholic liver disease (ALD) due to escalating alcohol consumption has presented an unprecedented pressure on human health. A few studies have determined long non-coding RNAs (lncRNAs) involved in the pathogenesis of liver diseases. However, the roles of lncRNAs in ALD development is still poorly understood.Methods: An ALD mouse model was established and confirmed. Expression profiles of lncRNAs were obtained by whole transcriptome sequencing. The altered lncRNAs in ALD mice were further verified by qRT-PCR. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were used to enrich the functions of these lncRNAs. In combination with miRNA and mRNA profiles, we constructed concise endogenous RNA (ceRNA) networks. The function of the most up/downregulated lnRNA was further verified and investigated in both ALD model and AML-12 cells.Results: Totally, five downregulated lncRNAs were obtained and verified in ALD mice. The GO term and KEGG pathway analyses revealed that the identified lncRNAs were associated with alcohol-induced hepatic oxidative damage, cellular inflammation, and lipid metabolism. Combination the differentially modulated miRNAs and mRNAs with ceRNA network analysis, we constructed five ceRNA networks and obtained 30 miRNAs and 25 mRNAs that may participate in ALD. Further, we verified and investigate the function of the most downregulated lnc_1700023H06Rik. Depletion lnc_1700023H06Rik reduced genes encoding for lipid metabolism, especially mRNA Acat2 (ENSMUST00000159697) and Pgrmc2 (ENSMUST00000058578) both in vivo and in vitro. Knocking down lnc_1700023H06Rik induced triglyceride accumulation and lactate dehydrogenase leakage in AML12 cells, consisting with that in alcohol-treated cells.Conclusion: The five remarkably downregulated lncRNAs in ALD mouse model were identified as novel biomarkers, highlighting the key role of lncRNAs in the development of ALD. The effect of lnc_1700023H06Rik plays a pivotal role in lipid deposition and its pathological pathway in ALD needs further investigation.

The Association Between Alcoholic Liver Disease and Alcohol Tax.

The incidence of alcoholic liver disease (ALD) has increased, causing it to become a primary indication for liver transplantation in the United States. We hypothesized an association between alcohol taxation and prevalence of ALD. We conducted a retrospective study of united network for organ sharing (UNOS) waitlist additions for liver transplantation between January 2007 and December 2016. We also analyzed the average excise tax (2007-2016) for beer, wine, and spirits in listing states of liver transplant waitlist additions (LTWA). There were 104 805 adult UNOS LTWA with assigned diagnoses, an annual increase from 22% to 28%. There were 24 316 LTWA with ALD diagnosis. The mean value for beer tax was significantly lower for ALD patients than for non-ALD patients across all age groups (P < .001). The analysis demonstrated significantly more ALD in waitlisted patients 35-54 years of age (30%), compared with 18-34 years (10%) and ≥55 years (20%), P < .001. The data confirmed significantly more ALD Medicaid patients in the 35-54 year age group (28%) compared with other age groups, P < .001. Our research demonstrated an association between lower beer tax and higher ALD prevalence across all age groups. We found a larger percentage of middle-aged (35-54 years) Medicaid patients listed with ALD. These findings raise the need for further investigation of a potential public health concern for an association between ALD and beer tax, especially for middle-aged patients of lower socioeconomic status.

Both Alcoholic and Nonalcoholic Steatohepatitis Is an Emerging Indication for Liver Transplantation in the United States

Abstract Background Nonalcoholic steatohepatitis (NASH) and alcoholic liver disease (ALD) are now the most common indications for liver transplantation (LT) in the United States. A subset of patients have both alcoholic and nonalcoholic steatohepatitis (BASH). This study characterizes patients with BASH requiring LT and assesses changes in the prevalence of BASH as an indication for LT. Methods The United Network for Organ Sharing database was analyzed for all patients ≥ 18 years of age who received their first deceased donor LT from 2002 to 2016 for ALD, NASH, or BASH. Baseline demographics, clinical parameters, and LT outcomes were compared between groups. Results Since 2002, 85,448 patients underwent LT:15,327 had ALD, 9,971 had NASH, and 2,779 had BASH. The prevalence of BASH as an indication for LT increased from 0.5% in 2002 to 5% in 2016. Compared with patients with NASH, those with BASH were significantly more likely to be male (85.6 vs. 57%), younger (mean 56.4 vs. 58.6 years), and Hispanic (22.2 vs. 13.6%) (p &lt; 0.001 for all). While indication for transplant was not significantly associated with transplant outcomes on multivariable analysis, patient and graft survival curves do differ significantly by indication for transplant, with worse outcomes for patients with BASH (patient survival at 5 years: NASH 78.1%, ALD 77.2%, BASH 73.5%, p = 0.013; graft survival at 5 years: NASH 75.3%, ALD 74.0%, BASH 70.8%, p = 0.046). Conclusions BASH is a rising indication for LT, especially for Hispanic males, due to the increasing prevalence of ALD and NASH in the United States.

Burden of Alcoholic Liver Disease in a Tertiary Care Center: A Descriptive Cross-sectional Study

Alcoholic liver disease is a serious health problem related to an unhealthy lifestyle. The three most widely recognized forms of alcoholic liver disease are alcoholic fatty liver, acute alcoholic hepatitis, and alcoholic cirrhosis. The main aim of our study is to find out the prevalence of alcoholic liver disease in tertiary care center. A descriptive cross-sectional study was conducted among inpatient cases admitted in the medicine department of tertiary care center from 1st June 2018 to 31st May 2019. Ethical approval was taken for the study. Convenience sampling method was used. All the biochemical parameters were expressed as mean±standard deviation for each group and point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Prevalence of alcoholic liver disease is 50 (50%) at a 95% Confidence Interval (40.2%-59.8%) and non-alcoholic fatty liver disease is also the same. The mean age of alcoholic liver disease was 59±12 years where as the mean age for non-alcoholic fatty liver disease was 46±18 years. Out of fifty patients of alcoholic liver disease, majority 48 (96%) of the cases were males which suggests that the prevalence of alcoholic liver disease is very common in males. Similarly, for non-alcoholic fatty liver disease, prevalence was 34 (68%) showing higher prevalence than that of females. Prevalence of alcoholic liver disease is low compared to previous studies done in the similar settings. Monitoring these biochemical parameters in alcoholic liver disease at early stage could guide in planning the protocol for the initial treatment.

Changing Trends in Etiology-Based Annual Mortality From Chronic Liver Disease, From 2007 Through 2016

Although treatment of hepatitis C virus (HCV) infection has improved, the prevalence of alcoholic liver disease (ALD) has been increasing, so we need an updated estimate of the burden and etiology-specific mortality of chronic liver diseases. We studied trends in age-standardized mortality of chronic liver diseases in adults at least 20 years old in the United States from 2007 through2016. We collected data from the US Census and National Center for Health Statistics mortality records and identified individuals with HCV infection, ALD, nonalcoholic fatty liver disease, or hepatitis B virus infection using ICD-10 codes. We obtained temporal mortality rate patterns using joinpoint trend analysis with estimates of annual percentage change (APC). Age-standardized HCV-related mortality increased from 7.17 per 100,000 persons in 2007 to 8.14 per 100,000 persons in 2013, followed by a marked decrease in the time period at whichpatients began receiving treatment with direct-acting antiviral agents (from 8.09 per 100,000 persons in 2014 to7.15 per 100,000 persons in 2016). The APC in HCV mortality increased 2.0%/year from 2007 through 2014 but decreased 6.4%/year from 2014 through 2016. In contrast, age-standardized mortality increased for ALD (APC 2.3% from 2007 through 2013 and APC 5.5% from 2013 through 2016) and nonalcoholic fatty liver disease (APC 6.1% from 2007 through 2013 and APC 11.3% from 2013 through 2016). Mortality related to hepatitis B virus decreased steadily from 2007 through 2016, with an average APC of-2.1% (95% CI-3.0 to-1.2). Etiology-based mortality in minority populations was higher. HCV-related mortality (per 100,000 persons) was highest in non-Hispanic blacks (10.28) and whites (6.92), followed by Hispanics (5.94), and lowest in non-Hispanic Asians (2.33). Non-Hispanic Asians had higher mortality for hepatitis B virus infection (2.82 per 100,000 vs 1.02 for non-Hispanic blacks and 0.47 for non-Hispanic whites). In our population-based analysis ofchronic liver disease mortality in the United States, the decrease in HCV-related mortality coincided with the introduction of direct-acting antiviral therapies, whereas mortality from ALD and nonalcoholic fatty liver disease increased during the same period. Minorities in the United States have disproportionately higher mortality related to chronic liver disease.

Alcoholic Liver Disease from the Clinical Point of View

Liver disease is responsible for more than 55% of deaths resulting from alcohol abuse, while the prevalence of alcoholic liver disease (ALD) is closely correlated with per capita alcohol consumption. ALD represents a wide range of histological changes ranging from simple steatosis to heavier forms of liver injury including alcoholic hepatitis, cirrhosis and/or concurrent development of hepatocellular carcinoma. These alterations of the hepatic parenchyma do not necessarily reflect distinct stages of liver disease progression, but rather a continuum relating to histological changes that may be observed simultaneously in the same patient. The fact that only 35% of patients with heavy alcohol abuse develop advanced stages of liver disease, suggests that in the pathogenesis of ALD a number of other factors are involved that include gender, obesity, drinking patterns, dietary factors, non-sex-linked genetic factors and smoking. Also, long-term drinking can affect synergistically with hepatitis B or C and/or the human immunodeficiency virus, the non-alcoholic fatty liver disease and hepatic disorders such as hemochromatosis. The diagnosis of ALD is based on a combination of findings, including the history of significant alcohol consumption, the clinical evidence of the concomitant liver injury supported by the resultant histological, imaging and laboratory findings. A beneficial effect of alcoholic hepatitis treatment with corticosteroids is observed in patients with encephalopathy or with poor prognosis based on the various grading and prognostic systems of gravity, while the harmful effect is prominent in patients with milder disease, as they manifest an increased risk of infections compared with those not receiving corticosteroids. In patients with alcoholic hepatitis that cannot take corticosteroids for various reasons and in those with the onset of functional renal failure (“hepatorenal syndrome”), use of pentoxifylline is recommended.

Increasing Burden of Chronic Liver Disease Among Adolescents and Young Adults in the USA: A Silent Epidemic.

Chronic liver disease (CLD) starts or becomes established in the adolescent and young adult (AYA) age group. This study aimed to estimate trends in CLD prevalence among US AYAs and to assess factors associated with CLD. Cross-sectional data from 14,547 AYAs (population-weighted N=68,274,386) aged 15-39years enrolled in the National Health and Nutrition Examination Survey from 1988 to 2012 were used. Nonalcoholic fatty liver disease (NAFLD) was defined as elevated alanine aminotransferase (>19 U/L for females and >30 U/L for males) in subjects with BMI≥25kg/m2; alcoholic liver disease (ALD) as excessive alcohol use (≥3 drinks/day for men and ≥2 drinks/day for women) and elevated aminotransferases after excluding alternative etiologies. Participants were considered hepatitis C virus (HCV) positive if antibody to HCV and HCV-RNA was positive. There was a sharp increase in the prevalence of CLD from 12.9% in 1988-1994 to 28.5% in 1999-2004 that remained stable after that (27.7%). NAFLD was the most common etiology accounting for 22% of all CLD in the later period. The prevalence of ALD has been steadily increasing throughout the years, while HCV has been decreasing. On multivariate analysis, being overweight/obese, Mexican-American ethnicity, later study period, older age, and male gender, were associated with higher odds of having CLD. More than one quarter of US AYAs might be affected by CLD. CLD prevalence in this age group has more than doubled over the past three decades mainly due to rise in NAFLD prevalence.

Changes in Etiologies of Hospitalized Patients with Liver Cirrhosis in Beijing 302 Hospital from 2002 to 2013.

Background Over the last 20 years, the prevalence of hepatitis B virus (HBV) infection in China has decreased gradually due to the application of a national HBV vaccination program. In contrast, the prevalence of alcoholic liver disease (ALD), nonalcoholic fatty liver disease, autoimmune liver disease, and drug-induced liver injury has markedly increased. Methods We conducted a retrospective review of 82,562 hospitalized patients diagnosed with liver cirrhosis in Beijing 302 Hospital from 2002 to 2013. Results The top four etiologies of cirrhosis were HBV, HCV, ALD, and autoimmune liver disease. The percentage of HBV cirrhosis decreased from 81.53% in 2002 to 66.0% in 2013, whereas the frequency of alcoholic cirrhosis increased from 3.34% in 2002 to 8.40% in 2013. Females (84.34%) accounted for the majority of cirrhotic patients with autoimmune liver diseases. Males accounted for 80.16% of HBV cirrhosis patients and 98.02% of alcoholic cirrhosis patients. Conclusion In Beijing 302 Hospital, the top four etiologies of cirrhosis were HBV, HCV, ALD, and autoimmune liver disease. Over the last 12 years, the prevalence of HBV cirrhosis has decreased gradually, whereas that of alcoholic cirrhosis has increased significantly.

Non-Selective Beta-Blockers in Liver Cirrhosis: Friends or Foes? A Review of the Literature

Cirrhosis has become a leading cause of death in the United States and worldwide owing the increased prevalence of alcoholic liver disease, hepatitis C, and more recently, non-alcoholic steatohepatitis and non-alcoholic fatty liver disease. Beta-blockers have been proven to be efficacious in primary, as long as secondary prophylaxis of variceal bleeding, more than 35 years ago. Nonetheless, recent data has cautioned the use of beta-blockers in patients with end-stage cirrhosis and refractory ascites suggesting increased mortality from beta-blockers in this group of patients. In this article, we will discuss this topic in details, and review the conflicting studies about beta-blockers in cirrhosis, and try to provide logical suggestions concerning the use of this class of medication in patients with cirrhosis.

Alcoholic Liver Disease: A Clinical Review

Liver disease is responsible for more than 55% of deaths resulting from alcohol abuse, and the prevalence of alcoholic liver disease (ALD) is closely correlated with per capita alcohol consumption. ALD represents a broad range of histological changes ranging from simple steatosis to heavier forms of liver injury, including alcoholic hepatitis (AH), cirrhosis, or the parallel development of hepatocellular carcinoma (HCC). These alterations of the hepatic parenchyma are not necessary to reflect distinct stages of the liver disease progression but rather a continuum relating histological changes that may be observed simultaneously in the same patient. The fact that only 35% of patients with substantial alcohol abuse develop advanced stages of liver disease suggests that the pathogenesis of ALD involves many other factors that include gender, obesity, drinking patterns, dietary factors, non-sex-linked genetic factors, and smoking. Also, long-term drinking can affect synergistically with hepatitis B or C or the human immunodeficiency virus, the non-alcoholic fatty liver disease, and hepatic disorders such as hemochromatosis. The diagnosis of ALD is based on a combination of findings, including the history of significant alcohol consumption, the clinical evidence of the concomitant liver injury, and the support of the clinical case from the resultant histological, imaging, and laboratory findings. The beneficial effect of treating AH with corticosteroids occurs in patients with encephalopathy or with poor prognosis, based on the various grading and prognostic systems of gravity, while its harmful effect is evident in patients with milder disease as they manifest an increased risk of infections compared with those not receiving corticosteroids. In patients with alcoholic hepatitis, who cannot take corticosteroids for various reasons and in those with the onset of functional renal failure (hepatorenal syndrome), the use of pentoxifylline is recommended.