Prevalence Of Cirrhosis Research Articles

323 Phenobarbital Protocol for Alcohol Withdrawal Syndrome Reduces ICU Length of Stay in Trauma and Burn Patients

323 Phenobarbital Protocol for Alcohol Withdrawal Syndrome Reduces ICU Length of Stay in Trauma and Burn Patients

S1354 Diabetes as a Risk Factor of Liver Fibrosis in Patients With Non-Alcoholic Fatty Liver Disease

Introduction: Non-alcoholic liver disease (NAFLD) ranks first in the prevalence among liver diseases, affecting 20-30% of the population worldwide. Type 2 diabetes mellitus (T2DM) commonly co-exists with NAFLD and may act synergically to drive adverse outcomes. We aimed to compare the characteristics and severity of liver disease between diabetic and non-diabetic patients with NAFLD, in a tertiary referral center in Greece. Methods: Data including demographics, blood results and liver stiffness measurements (LSM) of consecutive NAFLD patients presenting to the hepatology outpatient clinic were retrospectively reviewed. LSM and FIB-4 measurements were used to non-invasively assess the severity of NAFLD. Results: Ninety-eight patients were included (54.3% females, mean 60.4±15 years, 51.8% cirrhosis) of whom 64 (65.3%) were non-diabetics and 34 (34.6%) were diabetics. When compared to the non-diabetic group, diabetic patients were more frequently females (67.2% vs 46.2%, p=0.07), older (65.8 vs 54.6 years, p=0.005) and had lower ALT levels (25.2 vs 60.2IU/l, p=0.04). Contrarily, AST levels (39.6 vs 51IU/l, p=0.26), γ-GT (99.3 vs 102.1IU/l, p=0.95) and BMI (35.6 vs 34.6 Kg/m2) were not significantly different between the two groups. Regarding to severity of NAFLD, diabetic patients exhibited more advanced fibrosis, showing higher mean LSM (21.9 vs 11.9kPa, p=0.01) and FIB-4 (4.1 vs 2.2, p=0.01) values. The prevalence of cirrhosis ( >11.5kPa by LSM) was significantly higher in diabetic compared to non-diabetic patients (75% versus 41.3%, p=0.01). By multivariate analysis, advancing age (OR=1.04, 95%CI: 1.00-1.08; p =0.03) and T2DM (OR= 6.45, 95%CI: 1.80-23.03; p=0.004) were independently associated with cirrhosis. Conclusion: Our findings underline the importance of T2DM as a predisposing factor correlating with the severity of liver fibrosis in patients with NAFLD.

S1243 Epidemiology of Hepatocellular Carcinoma (HCC) in a Canadian University Centre

Introduction: Nearly 85% of HCC cases are reported in Asia and Saharan Africa. This explains why data on risk factors often concerns Asian populations. In fact, hepatitis B and C are among the major risk factors leading to HCC in current literature. We believe our predominant Caucasian population might not be the same given the different incidence of Non-Alcoholic Steatohepatitis (NASH) or alcoholic cirrhosis compared to these countries. In this study, we evaluated the prevalence of risk factors of HCC in our Canadian population in order to prevent and identify the best treatments for our population. Since the cause leading to HCC might modify management in the future, it becomes interesting to describe the epidemiology of our population. Methods: We retrospectively reviewed 196 files of patients 18 years of age and older diagnosed with HCC by radiological or pathological criteria between 2010 and 2020 from two of our university databases (Registre Local du Cancer and Ned-Écho). The prevalence of cirrhosis, hepatitis B, hepatitis C, alcoholic cirrhosis and NASH were presented using proportion with the Wilson method using 95% confidence interval. Z tests were used to compare the prevalence of our population’s HCC risk factors with the literature values. Finally, a Cox model was used to assess the risks factors contributing most to mortality. Results: 178 patients were included in our study. 94.9% of our population was Caucasian. 83.1% were male.19.6% did not have an underlying cirrhosis. Only 59.6% had a CHILD A cirrhosis limiting accessibility to treatment. Furthermore, the prevalence of hepatitis B was 4.7% compared to 33% in current literature (p< 0.001), hepatitis C was 25.1% compared to 21% (p =0.183), alcoholism was 45.0% compared to 30% (p< 0.001), NASH was 37.8% compared to less than 16% (p=0.002). There was no statistical difference in mortality by cancer risk factor. Conclusion: New evidence suggest that HCC related to NASH may be a favourable prognostic factor in patients treated with lenvatinib. Hence, the choice of a tyrosine kinase treatment might be better for the management of a Caucasian population. Promoting good lifestyle habits might also reduce the incidence of HCC in our Canadian population given the high prevalence of HCC related to NASH and alcoholic cirrhosis. Finally, approximatively half of our population had a CHILD A cirrhosis which emphasizes how crucial it is to adequately screen for HCC before cirrhosis progression as this will have an effect on management and prognostic.

S1193 Differences in Prevalence and Treatment of Hepatitis B Virus Infection in Asian and Black Patients

Introduction: Hepatitis B virus (HBV) infection, an important cause of chronic liver disease, has a prevalence of 4.3% in the United States (US) and causes significant morbidity and mortality. Immigrants and racial/ethnic minorities are disproportionately burdened by HBV. Few studies have investigated characteristics of HBV infection and treatment by race; therefore, we sought to understand and compare risk factors, barriers to care, and treatment patterns in Blacks and Asians, the two most disproportionately impacted groups. Methods: Using informatics, we identified patients with possible HBV based on ICD-10 code B18.1, who were seen between May 2010 and July 2021 at a tertiary referral center. We performed retrospective chart review to confirm infection and captured sociodemographic/clinical data. We used descriptive statistics, Kruskal-Wallis and Pearson’s chi squared tests to evaluate for differences between Black and Asian patients. Analyses were conducted using STATA 17.0(College Station, Texas). Results: Out of 673 patients, 509 had confirmed HBV: 308 Black and 201 Asian patients. Compared to Asians, Blacks were older and more likely to be male and US-born. Top birth countries included Haiti, 22%, US, 18%, China, 16%, and Vietnam, 8% (Fig 1a). Risk factors for HBV differed significantly; 44% of Asians had a family history of HBV compared to 8% of Blacks, p < 0.001 (Table). Clinical notes for Black patients were more likely to document history of injection drug use, blood transfusions and tattoos. The predominant HBV genotype was A in Blacks and B in Asians (Fig 1b). Despite no significant differences in prevalence of cirrhosis or infection phenotype, there were treatment differences; 60 % of Blacks vs. 70% of Asians were treated, p 0.04. More Black patients had concurrent HIV or HCV, 14% and 5%, respectively compared to 0-1% of HIV and HCV in Asians. NAFLD was more common in Asians, 27%, vs 12% in Blacks. While 97% of Blacks and 70% of Asians met Hepatocellular carcinoma (HCC) screening criteria, only 67% of Blacks and 44% of Asians of those meeting criteria were screened in the past twelve months. Conclusion: There are significant differences in risk factors, access to care and treatment between Black and Asian patients in our institution. Future studies should seek to understand barriers to treatment and the determinants of inadequate HCC screening in both Asian and Black patients, given the dire consequences of HBV-related HCC in these communities.Figure 1.: a) Birth Country Distribution of HBV Patients, b) Predominant HBV genotype of Black and Asian Patients Table 1. - Demographics and Clinical Characteristics of Black and Asian Patients with HBV Variable Black Asian p-value (n = 308) (n = 201) Median Age, years (IQR) 56.97 (46.21-65.1) 51.54 (42.63-61.86) 0.003 Male Gender, n (%) 199 (64.8) 103 (51.2) 0.002 Hispanic Ethnicity, n (%) 23 (8.1) 3 (1.5) 0.002 English-speakers, n (%) 266 (86.4) 182 (90.6) < 0.001 US-Born, n (%) 73 (32.9) 9 (5.1) < 0.001 Insurance Type, n (%) < 0.001 Private 185 (63.4) 148 (74.8) Medicaid/Medicare 93 (31.9) 33 (16.7) Uninsured 12 (4.1) 12 (6.1) Married (not separated), n (%) 146 (52.1) 143 (72.6) < 0.001 Risk Factors, n (%) Intravenous Drug Use 4 (1.4) 1 (0.5) < 0.001 Intranasal Cocaine 19 (6.6) 1 (0.5) < 0.001 Non-IV Drug Use 19 (6.6) 1 (0.5) < 0.001 Sexually Transmitted Diseases 34 (11.9) 5 (2.5) < 0.001 Transfusions 54 (19.2) 16 (8.1) < 0.001 Family history of hepatitis 11 (3.9) 6 (3.1) < 0.001 Family history of HBV 22 (7.6) 87 (44.4) < 0.001 Family history of HCC 12 (4.2) 37 (18.9) < 0.001 Tattoos 26 (9) 9 (4.6) < 0.001 Other Medical Conditions, n (%) Non-alcoholic Fatty Liver Disease (NAFLD) 32 (11.6) 53 (27.2) < 0.0001 Human Immunodeficiency Virus (HIV) 39 (13.8) 0 (0) < 0.001 Hepatitis C Virus (HCV) 13 (4.5) 2 (1) < 0.001 Ever Treated for HBV, n (%) 166 (60.4) 136 (69.7) 0.037 Currently Treated for HBV, n (%) 148 (52.5) 105 (55) 0.59 Phenotype, n (%) 0.195 Immune tolerant 2 (0.8) 1 (0.5) HbeAg positive active ( > 20000 DNA) 7 (2.7) 2 (1) HbeAg negative active ( > 2000 DNA) 9 (3.5) 6 (3.1) Inactive carrier 175 (67.6) 117 (60.3) Indeterminate 66 (25.5) 68 (35.1) Met criteria for HCC Screening, n (%) 299 (97.1) 141 (70.2) < 0.0001 HCC Screening < 6 months before visit, n (%) 219 (76.6) 91 (46.7) < 0.001 HCC Screening < 12 months before visit, n (%) 190 (66.7) 86 (44.1) < 0.001 Demographics and Clinical Characteristics of Black and Asian Patients with HBVp value of <0.05 is considered significant).

S3103 A Case of Rapidly Progressing Hepatocellular Carcinoma Hidden From Surveillance

Introduction: Hepatocellular carcinoma (HCC) accounts for over 90% of all liver cancers worldwide and carries a high mortality rate. Despite screening efforts, the incidence of HCC still remains high due to the prevalence of viral hepatitis, alcoholic cirrhosis, and non alcoholic fatty liver disease. At present, there are no screening guidelines focusing on non cirrhotic primary biliary cholangitis (PBC) patients. We herein present a case of an 84 year old female who was diagnosed with rapidly progressive HCC in the setting of PBC. Case Description/Methods: An 84 year old female previously diagnosed with anti-mitochondrial antibody negative PBC presented with one week history of diarrhea and 20lb unintentional weight loss over the past year. Physical exam was notable for non tender hepatomegaly. Significant laboratory values include ALP 337 U/L, AST 208 U/L, ALT 52 U/L, INR 1.1, bilirubin total 3.3 mg/dL, Hgb 9.1 g/dL, platelets 309 10^3/uL, and albumin 2.4 g/dL. Social history was negative for tobacco or alcohol use. A CT of the abdomen and pelvis was obtained and revealed a 16 cm mass encompassing the entirety of the right hepatic lobe. A subsequent AFP was >20,000 ng/mL, consistent with HCC and was discharged home with hepatology follow up. She presented 2 week later with shock and was found to have a ruptured HCC which eventually was the cause of death. 6 months prior to admission, she was noted to have normal liver enzymes and AFP <2 ng/mL, but no imaging was obtained as a fibroscan done 12 months prior to admission revealed a liver stiffness of 7.8 kPa (low to moderate probability of advanced fibrosis) and CAP of 229 dB/m (no liver steatosis) (Figure 1). Discussion: Patients with PBC have a slightly increased risk of HCC which is usually diagnosed in the setting of underlying cirrhosis. Current guidelines recommend surveillance in those patients with documented cirrhosis with imaging every 6 months. However, studies have shown that patients with PBC have a 2.4% risk of developing HCC at any histologic stage of PBC, with a male predominance. There are currently no screening guidelines for PBC, which may have led to an earlier diagnosis, and therefore treatment, in our patient who passed away only 2 weeks after presentation due to ruptured HCC. Given the outcome in this case, more aggressive screening might be beneficial even in the non-cirrhotic population who have underlying PBC.Figure 1.: CT and MRI visualizing HCC predominately in right hepatic lobe.

S1171 Elevated Ferritin Is Associated With Increased Prevalence of Cirrhosis but Not Congestive Heart Failure Among Patients With Metabolic Dysfunction-Associated Fatty Liver Disease

S1171 Elevated Ferritin Is Associated With Increased Prevalence of Cirrhosis but Not Congestive Heart Failure Among Patients With Metabolic Dysfunction-Associated Fatty Liver Disease

Accuracy of Ultrasound Elastography and Fibrosis-4 Index (FIB-4) in Ruling Out Cirrhosis in Obese Non-Alcoholic Fatty Liver Disease (NAFLD) Patients.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of advanced liver disease in the USA. Liver biopsy, the gold standard diagnostic test for evaluating liver fibrosis, is associated with significant risk and expense. The accuracy of ultrasound elastography and Fibrosis-4 index (FIB-4) in the obese NAFLD population is unknown. We aimed to compare the accuracy of ultrasound elastography and FIB-4 to liver biopsy in ruling out cirrhosis in NAFLD patients at a tertiary, transplant referral center in the US.Methods: We retrospectively evaluated 93 patients with a mean age of 53 years (SD: 13 years) who underwent liver ultrasound elastography and liver biopsy, and additionally calculated their FIB-4 at the time of biopsy. We compared the liver stiffness measurement (LSM) obtained from ultrasound elastography and FIB-4 with the pathology results for ruling out cirrhosis.Results: 85% of the patients were white, 53% were female, average BMI was 34.7 (SD: 6.7), 52% had diabetes, and 53% had hypertension. For biopsy-proven cirrhosis (prevalence 15%), a cut-off value of 12.5 kilopascals (kPa) for F4 had a sensitivity of 92% and a specificity of 54%. Values below this threshold excluded cirrhosis with 98% certainty. Compared to FIB-4, ultrasound elastography showed higher accuracy in ruling out cirrhosis (92% vs. 80% sensitivity, 98% vs. 95% negative predictive value (NPV), respectively).Conclusion: To our knowledge, this is the first study in a tertiary transplant referral center in the USA to show that ultrasound elastography was superior to FIB-4 and can be used as a reliable screening test to rule out cirrhosis in obese NAFLD patients at a 12.5 kPa cut-off. Therefore, helping to avoid the risk and expense associated with liver biopsy.

Global cirrhosis prevalence trends and attributable risk factors-an ecological study using data from 1990-2019.

Cirrhosis is a major public health issue worldwide with significant morbidity and mortality. We aimed to explore the time series associations between varying levels of risk factors and cirrhosis prevalence and predict the cirrhosis prevalence under alternative scenarios to consolidate evidence for further intervention plans. We collected data of cirrhosis and its risk factors from 1990 to 2019 across 178 countries and used a generalized linear mixed model to explore the time series associations between cirrhosis and risk factors. We simulated scenarios with varying levels of risk factors and investigated benefits gained from the control of risk factors compared with the status quo. The global cirrhosis prevalence varied geographically, with the highest observed in East and Southeast Asia, mainly due to high hepatitis prevalence. Our study revealed that each 1% increase in prevalence of hepatitis B and C, cirrhosis prevalence would correspondingly increase 0.028% and 0.288%. There would be approximately 392.15 million fewer cirrhosis patients if the goals of a 65% reduction in prevalence of hepatitis and a 10% reduction in alcohol consumption were achieved. Given that cirrhosis prevalence has different risk factors depending on geography, it is important to identify an appropriate set of interventions for cirrhosis that are adapted to the epidemiological situation in a specific country. Interventions targeting hepatitis may have a significant impact on global cirrhosis prevalence, therefore, the adoption of specific interventions for hepatitis in high-burden regions and high-risk groups is warranted to lower the global burden of cirrhosis.

Diagnostic Performance of Transient Elastography Versus Two-Dimensional Shear Wave Elastography for Liver Fibrosis in Chronic Viral Hepatitis: Direct Comparison and a Meta-Analysis.

Objective This systematic review and meta-analysis aimed to compare the diagnostic performance of transient elastography (TE) and two-dimensional shear wave elastography (2D-SWE) for staging liver fibrosis in patients with chronic viral hepatitis (CVH). Methods Pubmed, Embase, Web of Science, and Cochrane Library were searched (-01/08/2021) for studies comparing TE with 2D-SWE in patients with CVH. Other etiologies of chronic liver disease (CLD) and articles not published in SCI journals were excluded. The bivariate random-effects model was used to pool the performance of the TE and 2D-SWE. Results Eight articles with a total of 1301 CVH patients were included. The prevalence of significant fibrosis (fibrosis stage ≥ 2), advanced fibrosis (fibrosis stage ≥ 3), and cirrhosis was 50.8%, 44.8%, and 34.7%, respectively. 2D-SWE expressed higher overall accuracy than TE in detecting significant fibrosis (0.93 vs. 0.85, P = 0.04). No significant difference among the overall diagnostic accuracy of TE and 2D-SWE in staging advanced fibrosis and cirrhosis was found. Conclusion TE and 2D-SWE express good to excellent diagnostic accuracies to stage fibrosis in CVH patients. 2D-SWE compares favorably with TE especially for predicting significant fibrosis.

Liver cirrhosis in Roma patients from the perspective of the liver transplant centre

Summary: Introduction: Slovakia is a country with the highest prevalence of liver cirrhosis in the world and a country with the highest proportion of Roma ethnicity at the same time. However, there is only little evidence of Roma representation in national cohorts with cirrhosis. Aims: 1. To determine the prevalence of Roma ethnicity in our cirrhosis and liver transplant registers; to compare their 2. fundamental characteristics and 3. final results with patients from the majority population. Patients and methods: A retrospective study; we acquired data from 1. Cirrhosis registry RH7; 2. Liver transplant registry: a) patients listed active on the liver-transplant waiting list; b) patients underwent first LT. The first source – the cirrhosis registry RH7 (NCT 04767945; since 2014, RH7 has been listing consecutive patients admitted to hospital with liver cirrhosis). Up to 2021, the mode of the ethnicity determination was so-called “ascribed ethnicity”. The second source – the Liver transplant registry (since 2008); the mode of ethnicity determination was identical to the one of RH7. Apart from the ethnicity, the following points were recorded and analyzed in all patients: demographics, elementary cirrhosis-relevant clinical variables such as etiology and MELD score, as well as an elementary LT-relevant variables, such as waiting time and mortality. Results: We present the results on Roma ethnic group in three cohorts from two datasets, i.e. on 1,515 patients from RH7, on 464 waitlisted patients from LT registry and on 302 transplanted patients from LT registry, respectively. The representation of Roma ethnicity in these cohorts were 2%, 4%, and 4%, respectively. Significant differences in age and gender were detected in Roma cirrhotic patients: 46 vs. 55 years (P = 0.001) and female gender 25% vs. 39% (P = 0.042). Of the first time waitlisted candidates for LT, Roma patients were also significantly younger – 42.6 vs. 51.5 years; in addition, Romas had a less prevalent alcohol-associated etiology (ALD) and a more prevalent autoimmune etiology. Finally, Roma patients after first LT were younger – 40.2 vs. 51.6 years, again with lower etiology of ALD – 15% vs. 47% and more autoimmune etiology – 39% vs. 23%. The results of Romas from all cohorts in tertiary care were comparable. Conclusion: 1. the admission of Romas to a tertiary liver care is lower than expected, for unknown reasons; 2. the age of Romas entering tertiary care is approximately ten years lower; 3. the results of Romas in tertiary care is comparable to the majority population. Key words: liver cirrhosis – Roma ethnicity – tertiary liver care – waiting list – liver transplantation

Diabetes mellitus-induced lower urinary tract symptoms and hepatic steatosis in an older male.

SummaryDiabetes mellitus type 2 (DM-2) is one of the important causes of low-grade chronic inflammation (meta inflammation) seen in almost all tissues in the body. Other possible mechanisms involved in the development of lower urinary tract symptoms (LUTS) with DM-2 are the hypertonicity of the peripheral sympathetic nerves and hyperinsulinemia effects on the autonomous nervous system activity. These further suggests that abnormalities in glucose homeostasis influence the hyperproliferation of the prostate cells resulting in benign prostatic hyperplasia (BPH). Similarly, hepatic steatosis, a form of non-alcoholic fatty liver disease (NAFLD) prevalence among patients with DM-2, is as high as 75%. NAFLD has no symptoms in most diabetic patients. In this study, we present a case of a 64-year-old Black male who had worsening urinary urgency and hesitancy for 4 months, with increasing abdominal girth. Patient was found to have symptoms, diagnostic studies, and physical exam findings indicative of BPH and fatty liver disease. He was treated with hepato-protective medications, tighter control of his blood glucose levels, and blood pressure meds for 13 months. Upon follow-up, most of his symptoms were resolved. Timeline of BPH resolution and decrease in liver size following treatment suggest that DM-2 has a strong correlation with the development of BPH and fatty liver disease in most patients living with diabetes.Learning pointsMen with type 2 diabetes mellitus (DM-2) tend to have significantly lower serum PSA level, lower testosterone levels, and larger prostate volume compared to non-diabetic male patients.Patients with DM-2 have higher prevalence of hepatic steatosis, liver cirrhosis, and end-stage liver failure.The role of metformin in reducing hepatic steatosis as stated by several studies is yet to be validated as our patient has been on metformin for 22 years for the management of DM-2 with fatty liver disease.

Variation of Hepatocellular Carcinoma Treatment Patterns and Survival Across Geographic Regions in a Veteran Population.

Veteran populations have five times the incidence of hepatocellular carcinoma (HCC) compared with the general population. The incidence of HCC has increased in the Veteran's Affairs Health System (VAHS), primarily due to the increased prevalence of cirrhosis. This study aimed to characterize differences in treatment patterns and overall survival rates across the five VAHS geographic regions. Using the VA Corporate Data Warehouse, the authors built a comprehensive national dataset of Veteran patients with HCC diagnosed between 2001 and 2015 to compare patients across VAHS regions. A multivariable Cox proportional hazards model was used to identify factors associated with 5-year all-cause mortality. Kaplan-Meier curves were used to visualize the patient survival function, and the log-rank test was applied to test statistical significance. This retrospective study analyzed 13,434 patients. The West region had the highest rate of overall treatment receipt (63.6%), and the Southwest had the lowest rate (52.9%). After adjustment for demographic, clinicopathologic, treatment, and hospital factors, treatment in a non-West region continued to be significantly associated with a 10% to 13% increased risk of 5-year mortality (Midwest: hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.03-1.17; Northeast: HR, 1.10; 95% CI, 1.03-1.17; Southeast: HR, 1.13; 95% CI, 1.06-1.21; Southwest: HR, 1.11; 95% CI, 1.03-1.19) (p < 0.01). Treatment patterns and overall survival rates of HCC patients differ significantly across VAHS geographic regions. Targeted interventions to increase the rate of treatment in the non-West regions are needed to improve survival of HCC Veterans and provide uniformly high-quality care across VAHS facilities.

Long-Term Outcomes Associated with NAFLD, ASCVD, and All-Cause Mortality of Patients with Metabolic Syndrome.

Metabolic syndrome (MetS) patients are at higher risk for nonalcoholic fatty liver disease (NAFLD), atherosclerotic cardiovascular diseases (ASCVD), and death. Given a lack of longitudinal data on patients with MetS in Southeast Asia, this study investigated the incidence of NAFLD and ASCVD and the all-cause mortality rate during a 10-year follow-up of Thai patients with MetS. Retrospective data were collected on 496 MetS patients with ultrasonography or transient elastography results. The patients had been followed up continuously by a university hospital between October 2011 and November 2021, and their mean age was 61.0 ± 10.9 years. Patients with secondary causes of hepatic steatosis were excluded. Cox proportional hazards regression models with time-varying covariates were adopted. During the 10-year follow-up, 17 patients (11.2%) developed NAFLD, and 27 (6.4%) developed ASCVD. The NAFLD and ASCVD incidence rates were 21.7 and 10.9 events per 1000 person years, respectively. The mortality rate was 14.2 deaths per 1000 person years. The prevalence of hypertension, dyslipidemia, ASCVD, NAFLD, advanced fibrosis, and cirrhosis at baseline was significantly higher in the nonsurvival group. The NAFLD incidence and mortality rate of patients with MetS were lower than those in previous studies. Intensive, holistic, and continuous care should be considered for better outcomes.

EARLY PREDICTION OF ESOPHAGEAL VARICES ON THE BASIS OF ASPARTATE AMINO-TRANSFERASE (AST) TO PLATELET RATIO INDEX (APRI) AND TRANSIENT ELASTOGRAPHY IN PATIENTS OF CIRRHOSIS OF LIVER

Objectives: To study the etiological prole in liver cirrhosis patients &amp; to predict development of esophageal varices at the earliest with the help of Aspartate Amino-Transferase (AST) to Platelet ratio index (APRI) and Transient Elastography in these patients. The study wasMethods: conducted on 100 patients with chronic liver disease from June 2019 to June 2021. Informed consent was taken from the patients and detailed history, physical examination, laboratory investigations were carried out &amp; UGI endoscopies were performed. APRI scores &amp; Transient Elastography (broscan) liver stiffness measurement (LSM) values were then correlated with 'presence or absence' of esophageal varices (EVs) and with the 'grading' of varices. Among the 100 patients with liver cirrhosis, the overall prevalence of liver cirrhosis was higher in malesResults: (67.0%) than females (33.0%). The main cause of liver cirrhosis was alcoholic liver disease (39.0%) followed by chronic hepatitis B infection (15.0%). Different APRI cut-offs of 1.9, 1.4, 0.9 were taken &amp; correlated with 'presence or absence' of EVs &amp; with the 'grading' of EVs, but none shows satisfactory negative predictive value (NPV), proving that there is no satisfactory cut-off value of APRI to be used as a predictor of esophageal varices. However, as the APRI score is increasing, the grading of varices found on UGI endoscopy is increasing (r = 0.605, p&lt;0.001). LSM cut-off values of 24KPa, 19KPa &amp; 14KPa were taken &amp; we observed NPV of 75.0% for predicting esophageal varices at LSM cutoff of 14 KPa. Also, as the LSM score is increasing, the grading of varices found on UGI endoscopy is increasing (r = 0.842, p&lt;0.001). APRIConclusion: scores correlate poorly with the 'presence or absence' of esophageal varices but it correlate signicantly with the 'grading' of varices. Transient elastogram liver stiffness values correlate signicantly with the 'presence or absence' of esophageal varices &amp; also with the 'grading' of varices. Liver stiffness value of ≥14.0 KPa can be used as a guide for early prediction of esophageal varices &amp; endoscopy should be done in these patients to prevent fatal GI bleed from esophageal varices by medical management to decrease portal pressure or by early endotherapy in the form of endoscopic variceal ligation (EVL) or sclerotherapy.

Pharmacokinetic and pharmacodynamic simulation for the quantitative risk assessment of linezolid-associated thrombocytopenia.

Linezolid (LZD) may cause thrombocytopenia, which can result in discontinuation of treatment. In this study, the blood LZD trough concentration was estimated based on population pharmacokinetic (PK) parameters derived from two previously published models in the Japanese population to determine the rate of achieving the target trough value when the risk of thrombocytopenia is low and to clarify its relationship with the onset of thrombocytopenia. This study included adult patients hospitalized at Shimane University Hospital, who received LZD treatment for at least 4 days from January 2010 to December 2017. Patients whose platelet count fell below 70% before LZD administration were categorized as the thrombocytopenic group. Patient PK parameters were calculated based on the population PK models described by Matsumoto et al. and Sasaki et al., and these parameters were designated A and B, respectively. Based on these parameters, the rate of achieving an LZD trough concentration of less than 8μg/ml, which is the safety target achievement rate, was calculated using a random simulation for each patient. We further analysed the association between the incidence of thrombocytopenia and patient factors, including safety target achievement rate, through univariate, multivariate, and receiver operating characteristic (ROC) analyses. Patients (n=77) aged 72 ± 11 years and weighing 56.7 ± 10.9kg, with a creatinine clearance (CLcr ) of 60.5 ± 47.2ml/min and a cirrhosis prevalence of 9.1%, were analysed. All patients received LZD at a dose of 600 mg twice daily for a total of 10.9 ± 8.9 days. Univariate analyses revealed significant differences (p < 0.05) in the duration of LZD therapy, serum creatinine, creatinine clearance, LZD clearance, and the safety target achievement rate for parameters A and B between the thrombocytopenic and non-thrombocytopenic groups. A multivariate analysis of these factors stratified with the cutoff values obtained by ROC analysis revealed that the duration of LZD therapy and the safety target achievement rates for parameters A and B were significant factors (odds ratios for duration of LZD therapy: 7.436 [95% confidence interval (CI): 1.918-28.831] and 4.712 [95% CI: 1.567-14.163]; odds ratio for safety target achievement rate: 0.060 [95% CI: 0.016-0.232] and 0.167 [95% CI: 0.056-0.498] for parameters A and B, respectively). When the safety target achievement rates for patients treated with LZD were compared between the thrombocytopenic and non-thrombocytopenic groups, the safety target achievement rate was higher in the non-thrombocytopenic group in both the patients treated with LZD for less than 10 days and those for 10 days or more. Therefore, the safety target achievement rate estimated by the PK/PD simulation may represent to be an important index for risk assessment of LZD-induced thrombocytopenia. The risk of LZD-induced thrombocytopenia, which increased with the duration of LZD therapy, may be predicted using the safety target achievement rate obtained by the blood concentration simulation.

Pre-transplant portal vein thrombosis in non-alcoholic fatty liver disease patients-pathogenesis, risk factors, and implications on management.

Along with the worldwide increase in obesity and metabolic syndrome, non-alcoholic fatty liver disease (NAFLD) and its more severe subset, non-alcoholic steatohepatitis (NASH), are on path to become the leading cause of liver transplantation in the United States. NAFLD, as well as obesity, create an inflammatory milieu via the release of adipocytokines. In turn, the inflammatory environment can trigger an increase in prothrombotic factors. Independent of inflammation, the severity of NASH is associated with a graded increase in hypercoagulability such as an increase in factor VIII, increase in plasminogen activator inhibitor-1, and decrease in protein C. Ultimately, this environment creates an increase in thrombotic risk, leading to higher rates of pre-transplant portal vein thrombosis (PVT) in patients with NASH cirrhosis vesus other causes of cirrhosis. Many studies have shown worse outcomes in liver transplant recipients with PVT as it complicates anastomotic reconstruction which can negatively affect portal blood supply needed for adequate liver functioning. Management and treatment of PVT is not standardized, but from a pharmacologic standpoint, multiple classes of anticoagulants have shown to be successful in recanalization of the portal vein and preventing recurrence of clot with minimal bleeding complications. The increasing prevalence of NASH cirrhosis and subsequent increase in PVT require further research for improved outcomes.

Implementation of decompensated cirrhosis discharge bundle: a university hospital experience

Decompensated liver cirrhosis is a frequent reason for admission to acute medical and gastroenterology units. Over the past 2 decades, a significant rise in the prevalence of liver cirrhosis in the UK has been noted, with the major culprits being alcohol-related liver diseases, hepatitis B and C,

Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

SummaryBackgroundCombating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets.MethodsThe primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B.FindingsIn 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [–5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [–5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000.InterpretationThe prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination.FundingBill & Melinda Gates Foundation.

High risk of complications and mortality in cirrhotic patients with acute pancreatitis

High risk of complications and mortality in cirrhotic patients with acute pancreatitis

Very Low Alcohol Consumption Is Associated with Lower Prevalence of Cirrhosis and Hepatocellular Carcinoma in Patients with Non-Alcoholic Fatty Liver Disease.

The role of moderate alcohol consumption in the evolution of NAFLD is still debated. The aim of this study is to evaluate the impact of current and lifelong alcohol consumption in patients with NAFLD. From 2015 to 2020, we enrolled 276 consecutive patients fulfilling criteria of NAFLD (alcohol consumption up to 140 g/week for women and 210 g/week for men). According to their current alcohol intake per week, patients were divided in: abstainers, very low consumers (C1: <70 g/week) and moderate consumers (C2). We created a new tool, called LACU (Lifetime Alcohol Consuming Unit) to estimate the alcohol exposure across lifetime: 1 LACU was defined as 7 alcohol units per week for 1 drinking year. Patients were divided into lifelong abstainers and consumers and the latter furtherly divided into quartiles: Q1-Q4. Stratification according to alcohol intake, both current and cumulative as estimated by LACU, showed that very low consumers (C1 and Q1-Q3) displayed lower frequency of cirrhosis and hepatocellular carcinoma compared to abstainers and moderate consumers (C2 and Q4). We can speculate that up to one glass of wine daily in the context of a Mediterranean diet may be a long-term useful approach in selected NAFLD patients.