Prevalence Of Cirrhosis Research Articles

S1148 Effect of Cannabis Use on Progression of Non-Alcoholic Fatty Liver Disease in Obese Patients: A Propensity-Matched Retrospective Cohort Study

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) describes a condition of pathologic fat accumulation in hepatocytes when a secondary cause cannot be identified (e.g. excessive alcohol use). The spectrum of disease seen in NAFLD includes Non-Alcoholic Fatty Liver (NAFL), and the more pathologic variant, Non-Alcoholic Steatohepatitis (NASH). While NAFL is more common, the hepatocellular injury and inflammation that occurs in NASH contributes significantly to the increased risk of liver failure, cirrhosis, and hepatocellular carcinoma in NAFLD patients. Anti-inflammatory effects of cannabis are well described in experimental literature. Tetrahydrocannabinol (THC) specifically, has been shown to have anti-inflammatory and hepatoprotective activity in myofibroblast and stellate cells. How the hepatoprotective properties of cannabis affect disease manifestation and incidence of NAFLD is the subject of this investigation. The aim of this study is to determine how cannabis use affects the prevalence and progression of NAFLD in obese human subjects. METHODS: We studied the 2016 Healthcare Cost and Utilization Project’s (HCUP) National Inpatient Sample (NIS) discharge records, and gathered data on patients who were obese and at least 18 years of age (N = 879952). The main study outcome was prevalence of the four presentations of NAFLD: Steatosis, Steatohepatitis, Cirrhosis and Hepatocellular Carcinoma. We then compared the prevalence of disease stage between cannabis and non-cannabis users. Lastly, we further matched the non-cannabis group with demographic factors and other patient related confounders. All analysis was done using STATA 14 software. RESULTS: A total of 879,952 obese patients were admitted within the study period. Cannabis users 14,236 (1.6%) had less steatohepatitis (0.4% vs 0.7%, P < 0.001) and cirrhosis (1.1% vs 1.5%, P < 0.001) than non-users. After propensity matched analysis, cannabis use remained significantly associated with less steatohepatitis (0.4% vs 0.5%, P = 0.035). Post-match, there was no statistically significant difference in the prevalence of NAFL, cirrhosis and hepatocellular carcinoma. CONCLUSION: Results from this study suggest that cannabis use is associated with reduced prevalence and progression of steatohepatitis in obese patients. These findings could possibly be explained by the anti-inflammatory and hepatoprotective effect of cannabis on hepatocytes through the endocannabinoid system. Additional studies are needed to further explore this relationship.Table 1a.: Descriptive Statistics of Obese Population: Cannabis and Non-Cannabis Users and Propensity Score MatchTable 1b.: Outcome Statistics of Obese Population: Cannabis and Non-Cannabis Users and Propensity Score Match

S0078 Gender Differences in Outcomes of Acute Pancreatitis in Hospitalized Patients: Results From Nationwide Analysis

INTRODUCTION: Acute pancreatitis (AP) has multiple etiologies, the most common causes being alcohol and gallstone disease. Acute alcohol-induced pancreatitis is more common in men while acute biliary pancreatitis is more common in women. Gender based differences in disease incidence, time of disease onset, disease course, diagnosis, severity, and outcome are well recognized and are documented in literature for numerous illnesses. Gender is found to be independent risk factor for multiple GI diseases. In our study, we looked into gender effect on acute pancreatitis outcome using nationwide analysis. METHODS: We queried the National Inpatient Sample (NIS) databases 2016 and 2017 using International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system to identify all patients with primary diagnosis of Acute Pancreatitis (AP). Statistical analyses were performed using STATA software. RESULTS: A total of 553,480 adult patients with AP were included in the study. Mean age was 51.8 years, and majority of patients were male (53.22%). Female patients were older (52.81 years vs 50.97 years, P < 0.01), had Medicare as the primary insurance (34.89%) and majority were white (64.15%). Female patients had higher prevalence of CHF (5.79% vs 25.4%, P < 0.01), ESRD (2.32% vs 2.00%) and obesity (19.85% vs 14.46%). Male patients had higher prevalence of liver cirrhosis (3.91% vs 3.03%, P < 0.01), Type 1 Diabetes (1.25% vs 1.03%, P < 0.01), Type 2 Diabetes (26.69% vs 23.66%, P < 0.01) and smoking (66.17% vs 30.75%).The total mortality in male patients was 0.67% and in female patients was 0.51%. On multivariate analysis, female patients had significantly lower likelihood of in-hospital mortality compared to male patients (aOR: 0.69, 95% CI: 0.59–0.82, P < 0.01).There was no significant difference in mean LOS, mean hospitalization charges and costs between males and females with AP. Female patients had significantly lower likelihood of shock compared to male patients (aOR: 0.64, 95% CI: 0.56–0.73, P < 0.01), sepsis (aOR: 0.70, 95% CI: 0.65–0.75, P < 0.01), AKI (aOR 0.66, 95% CI: 0.63–0.69, P < 0.01), ICU admission (aOR 0.53, 95% CI: 0.47–0.59, P < 0.01) and pancreatic drainage (aOR 0.61, 95% CI: 0.51–0.72, P < 0.01). CONCLUSION: In our study, we demonstrated that female patients with AP had significantly lower in hospital mortality rates, and in hospital clinical outcomes compared to male patients. Further studies are needed to accurately understand these differences to guide clinical practice.Figure 1.: Outcomes in patients with acute pancreatitis: Male vs Female.

Characteristics of Patients With Chronic Hepatitis B Virus Infection With Genotype E Predominance in Burkina Faso.

Hepatitis B virus (HBV) genotype E (HBV‐E) accounts for the majority of chronic hepatitis B (CHB) infections in West Africa. We aimed to determine factors associated with HBV‐E‐induced hepatocellular carcinoma (HCC) in West Africa. Data on patients from Burkina Faso who were hepatitis B surface antigen positive (HBsAg+) and had CHB were analyzed. HBV viral load and hepatitis B e antigen (HBeAg) status were measured in 3,885 individuals with CHB without HCC (CHB HCC−) and 59 individuals with CHB with HCC (CHB HCC+). HBV genotyping was performed for 364 subjects with CHB HCC− and 41 subjects with CHB HCC+. Overall, 2.5% of the CHB HCC− group was HBeAg+ compared with 0% of the CHB HCC+ group. Of the 364 patients who were CHB HCC− with available genotyping, the frequencies of HBV genotypes E and C/E were 70.3% and 12.9%, respectively. Age (odds ratio [OR] for older age, 1.08; 95% confidence interval [CI], 1.06‐1.10 per 1‐year increase in age), male sex (OR, 2.03; 95% CI, 1.11‐3.69), and HBV viremia (OR, 1.48; 95% CI, 1.31‐1.67 per 1 log10 IU/mL) were each associated with HCC diagnosis. Patients with genotype E had a lower HBeAg prevalence (6.3% vs. 14.9%), lower HBV viral load, and higher prevalence of cirrhosis (14.5% vs. 4.8%) than patients with genotype C/E. Conclusion: HBV‐E is the most common circulating strain (70.3%) in West African patients. HCC was associated with older age, male sex, and high HBV viral load. It is expected that these results will further inform guidance on clinical management of HBV infection in West Africa.

Clinical Outcomes of Acute Pancreatitis in Patients with Cirrhosis According to Liver Disease Severity Scores.

Literature on acute pancreatitis (AP) outcomes in patients with cirrhosis is limited. We aim to investigate the mortality and morbidity of AP in patients with cirrhosis. We conducted a retrospective cohort study, and propensity score matching was done to match cirrhotic with non-cirrhotic patients on a 1:2 basis. Outcomes included inpatient mortality, organs failure, systemic inflammatory response syndrome, and length of hospital stay. We performed subgroup analysis of cirrhotics according to Child-Pugh and MELD scores. Multivariable logistic regression models were tested. From 819 AP patients, cirrhosis prevalence was 4.9% (40). There was no significant difference between cirrhotics and non-cirrhotics for inpatient mortality (7.5% vs. 1.3%, p = 0.1), severe AP (17.5% vs. 7.5%), shock (7.9% vs. 3%), respiratory failure (10% vs. 3.8%), need for intensive care unit (15% vs. 6.3%), systemic inflammatory response syndrome (SIRS) on admission (22.5% vs. 32.5%), and SIRS on day 2 (25% vs. 15%). Cirrhotics had similar rates of pancreatic necrosis, ileus, BISAP score, Marshall score, admission hematocrit, BUN, and hospital length of stay. Finally, cirrhotics who had severe AP, required ICU, and/or die in-hospital appeared to have more severe liver diseases (Child-C, higher MELD score > 17) and had lower AP severity scores (BISAP < 3, Marshall scores < 2). In our study, cirrhotics hospitalized with AP had similar morbidity and mortality when compared to non-cirrhotics.

ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies

ObjectiveThe utility of International Classification of Diseases (ICD) codes relies on the accuracy of clinical reporting and administrative coding, which may be influenced by country-specific codes and coding rules. This...

Lean Americans With Nonalcoholic Fatty Liver Disease Have Lower Rates of Cirrhosis and Comorbid Diseases

Nonalcoholic fatty liver disease (NAFLD) is typically associated with obesity. Little is known about the prevalence of cirrhosis in patients with NAFLD and a normal body mass index (BMI). We determined prevalence of cirrhosis, cardiovascular disease (CVD), and metabolic abnormalities among participants in all BMI categories in the TARGET-NASH study. A total of 3386 patients with NAFLD were enrolled from August 2016 through March 2019. The odds ratios of cirrhosis, CVD, and metabolic abnormalities were estimated by age and race, adjusting for sex and center type. Based on standard BMI cutoff values, 12.8% of study subjects were lean, 27.1% were overweight, 26.5% had class 1 obesity, and 33.7% had class 2 or 3 obesity. Asians accounted for 48.7% of lean participants, and proportions decreased as BMI categories increased (P<.0001). Lower proportions of lean participants had cirrhosis (22.6% vs 40.2% of non-lean participants), CVD history (9.0% vs 14.8% of nonlean participants), diabetes (32.6% vs 53.5% of non-lean participants), hypertension (47.8% vs 67.4% of non-lean participants), or dyslipidemia (54.0% vs 64.1% of non-lean participants). Asian participants had a lower prevalence of cirrhosis, history of CVD, cardiovascular events, and diabetes compared with non-Asians, independent of BMI category. After we adjusted for age, sex, and center type and site, the odds of NAFLD-associated cirrhosis in Asians who were lean was almost half the odds of NAFLD-associated cirrhosis in non-Asians who were lean (odds ratio, 0.47; 95% CI, 0.29-0.77). More than 10% participants in a cohort of persons with NAFLD in the United States are lean; Asians account for almost half of the lean persons with NAFLD. Lean participants had a lower prevalence of cirrhosis, CVD, and metabolic abnormalities than non-lean persons with NAFLD. Asian participants had a significantly lower prevalence of cirrhosis, CVD, and metabolic abnormalities than non-Asians in all BMI categories. ClinicalTrials.gov, Number: NCT02815891.

Morbidity, mortality and case fatality rate from liver cirrhosis in the age aspect in Kyrgyzstan for the period 2010–2017

The purpose is to study the dynamics of morbidity, mortality and case fatality ratefrom liver cirrhosis in the age aspect from 2010–2017 in Kyrgyzstan. Materials and methods : Analyzed state reporting forms No. 12 “Report on morbidity and preventive work (family medicine center, dispensary)” and “C51 — Distribution of deaths by sex, age groups and causes of death” from 2010–2017. Data processed by Microsoft Office Excel. Results : The average cumulative prevalence of liver cirrhosis (K 74) in persons older than 15 years for the period 2010–2017 was 50.9 0 / 0000 , the average incidence is 12.3 0 / 0000 , the mortality is 45.2 0 / 0000 . Persons over 75 years old had the highest mortality rate — 160, 7 0 / 0000 , the age group “45–59 years old” occupied the third position (92.8 0 / 0000 ) after the persons “60–74 years old” (140.9 0 / 0000 ). It is necessary to emphasize the presence of mortality among children and individuals 15–24 years old, although the incidence rates (0.2 0 / 0000 and 2.5 0 / 0000 , respectively) and the proportion (0.2 % and 1.6 %, respectively) were low. In the period 2015–2017 were registered 47 children with “K 74”, of which 15 were fi rst identifi ed, and for 2011–2017 yy. 32 children with a fatal outcome. Over the past 3 years there has been a tendency for the growth of all three indicators in children. For 2010–2017 yy. the average cumulative case fatality ratein persons over 15 years of age prevailed over children in 2,069.9 cases per 10,000 patients (8878.4 0 / 000 and 6808.5 0 / 000 , respectively). The case fatality rateamong adults decreased 1.6 times (11176.8 0 / 000 and 6815.2 0 / 000 , 2010 and 2017, respectively), and among children 1.5 times(4285.7 0 / 000 and 2857.1 0 / 000 , 2015 and 2017, respectively). Conclusion : On the basis of the obtained data, in order to improve the K 74 accounting system, an emergency notifi cation (Form No. 58u) was introduced in the country for newly detected and lethal cases of cirrhosis and liver cancer in the outcome of hepatitis B and C. To develop specifi c prevention measures and control strategies in general, the country needs a register of patients with cirrhosis and liver cancer with etiological interpretation.

In-Hospital Outcomes of Patients with Acute Decompensated Heart Failure and Cirrhosis: An Analysis of the National Inpatient Sample.

IntroductionHeart failure increases morbidity and mortality in patients admitted for cirrhosis. Our objective was to determine if patients with acute decompensated heart failure (ADHF) and cirrhosis would have increased mortality, hospital length of stay (LOS), and total hospital charges compared to patients with only ADHF. There is also a paucity of data regarding the influence of gender, race, ethnicity, insurance, and cirrhosis-related complications on mortality, hospital length of stay, and total hospitalization charges. In this study, we aim to identify risk factors in a national population cohort from 2016.MethodsAll patients above 18 years old with cirrhosis and ADHF admitted in 2016 were identified from the Nationwide Inpatient Sample (NIS). Multivariate regression analysis was used to estimate the odds ratio of in-hospital mortality, average length of stay (LOS), and total hospital charges after adjusting for the following factors: age, gender, race, Charlson and Elixhauser scores, primary insurance payer status, hospital type, hospital bed size, hospital region, and hospital teaching status. Statistical analysis was performed by using the survey procedures function in the statistical analysis system (SAS) software. Statistical significance was defined by the two-sided t-test with a p value < 0.05.ResultsThe overall sample contained 363,050 patients. A total of 355,455 patients were admitted with ADHF and 2% of these patients had concomitant cirrhosis (n = 7595) in 2016. The total mortality rate was 3.4%, hospital LOS was 6.6 days (with a median of 6.5 days), and the mean total hospital charge was $63,120.20. Patients with both ADHF and cirrhosis compared to patients without ADHF had increased mortality, hospital LOS, and cirrhosis-related complications.ConclusionsAs the incidence and prevalence of ADHF and cirrhosis increases worldwide, we urge the medical community to increase surveillance of patients with both diseases and perform rigorous cardiovascular risk assessments as well to improve patient outcomes.

Hodnocení operačního rizika u pacientů s jaterní cirhózou

The prevalence of liver cirrhosis in population is increasing, as well as its prevalence among patients admitted to hospital for elective surgery. These patients are at risk of high postoperative morbidity and mortality. Perioperative risk assessment of patients with liver cirrhosis is a complex procedure. It consists of evaluation of general condition of the patient, including comorbidities and nutritional status, evaluation of the grade of liver disease, and urgency of the surgical procedure. There are no specific guidelines. Proper risk assessment before surgery, considering alternative ways of treatment, is a cornerstone of optimal postoperative course and prevention of complications in patients with liver cirrhosis.

Prediction of Cirrhosis in Patients with Chronic Hepatitis C by Genotype 3.

ABSTRACTBackgroundGenotype 3 increases fibrosis in chronic hepatitis C (CHC).AimTo evaluate the effect of the hepatitis C virus (HCV) genotype on prevalence and severity of liver disease in CHC.Materials and methodsNine hundred and forty-nine individuals with positive anti-HCV from June 2016 to May 2017 were enrolled in the study. We compared biochemical and hematological parameters, HCV RNA load, transient elastography, and ultrasound, in genotype 3 and nongenotype 3 patients. Cirrhosis was diagnosed in patients with liver stiffness measurement (LSM) ≥13 kPa.ResultsOut of 835 CHC patients, overall, genotype 3 had higher LSM (11.3 vs 7.62, p = 0.01), higher aspartate aminotransferase (AST) (88.4 vs 68.6, p = 0.02), and low platelets (228.4 vs 261, p = 0.03) with higher prevalence of cirrhosis (115/415 vs 25/245, p = 0.01) than nongenotype 3. However, decompensation rates were not significantly different between two groups (32/115 vs 7/25, p = 0.98). The subgroup analysis revealed that cirrhotic genotype 3 had advanced age (50 vs 35, p < 0.01), male predominance, and higher AST (74.4 vs 57, p = 0.01) as compared to noncirrhotic genotype 3 patients. On multivariate analysis, age and AST values were higher in cirrhotic than noncirrhotic genotype 3 patients.ConclusionGenotype 3 patients have higher prevalence of cirrhosis and fibrosis compared to nongenotype 3 patients; however, decompensation was not different between two groups.How to cite this articleGupta T, Aggarwal HK, Goyal S, et al. Prediction of Cirrhosis in Patients with Chronic Hepatitis C by Genotype 3. Euroasian J Hepato-Gastroenterol 2020;10(1):7–10.

TO014COMPARISON BETWEEN HIGH FLUX-HD AND OL-HDF ON SURVIVAL AND ADEQUACY: TEN YEARS EXPERIENCE

Abstract Background and Aims Four RCTs have been published that compared on-line HDF (Ol-HDF) with HD. However, to date, an indisputable answer in determining whether patients treated with Ol-HDF had a better survival than those treated with high-flux HD (Hf-HD) has not been reached. The aim of our study was to retrospectively evaluate the impact of the dialysis modality (Hf-HD, Ol-HDF or acetate-free biofiltration AFB) on patient survival and dialysis adequacy. Methods We retrospectively evaluated all the incident patients that started dialysis due to uremia from 01-01-2008 to 31-12-2018 at the U.O. Nephrology ASST Spedali Civili of Brescia. Exclusion criteria were: duration of dialysis treatment less than 3 months, and previous dialytic treatment or kidney transplantation. The dialysis modality performed (Hf-HD vs Ol-HDF), the modality of infusion (pre-dilution or post-dilution) and mean total convective volume (replacement fluid volume + ultrafiltration) during last year’s dialysis session in Ol-HDF were analyzed for each patient. Results During observation 677 patients started HD treatment. 70 patients were excluded due to less than 3 months HD treatment. 607 patients (male 390, 64%) were analyzed. 467 pts (77%) were treated with Hf-HD, 103 pts (17%) with Ol-HDF, 36 pts (6%) with AFB. Median duration of HD treatment was 2.6 years (IQR 1.3; 4.7). Ol-HDF was performed in post-dilution mode in 60% of cases (total convective volume 25±4 L); pre-dilution mode was used in 40% of the cases (total convective volume 51±18 L). Patients in the Ol-HDF group were significantly younger than those in Hf-HD and AFB groups (respectively 59±15 years vs 71±15 vs 78±9, p &amp;lt;0.05), and had less diabetes, hypertension and ischemic heart disease (p&amp;lt;0.05) while presenting similar prevalence of cirrhosis (p=0.93) and peripheral vascular disease (p=0.09). Adequacy indices were similar between groups (eKt/V 1.39±0.02 vs 1.41±0.01 vs 1.44±0.04, p=0.47) as well as the protein intake (PCRn 0.92±0.01 vs 0.93±0.01 vs 0.90±0.03 g/Kg/d, p=0.69) and residual renal function (1.5±0.3 vs 1.6±0.1 vs 0.8±0.4 ml/min, p=0.20). Patients on Ol-HDF more frequently had an AV fistula (71% vs 58% vs 59%, p&amp;lt;0.05). At the end of follow-up, 12% of patients had undergone kidney transplantation, 42% continued dialytic treatment while 43% died. Univariate analysis showed a better survival for Ol-HDF patients (Figure 1) (p &amp;lt;0.05). This benefit was confirmed in multivariate analysis (Figure 2) showing that older age, cirrhosis and ischemic heart disease negatively affect survival, while a high protein intake, use of an AV fistula and Ol-HDF (HR 0.43[0.30-0.61]) are protective. Conclusions The use of Ol-HDF is associated with better survival compared to Hf-HD. This is confirmed after adjustment for demographic and comorbidities of the patients, characterizing Ol-HDF as an independent predictor of better survival.

Mo1701 PREDICTORS OF ADVANCED COLORECTAL ADENOMA: CASE-CONTROL ANALYSIS

Advanced colorectal adenomatous polyps (ACRAP) is a subtype of adenomas that may progress to carcinoma. Early detection and successful removal of advanced adenomas may reduce the incidence of colorectal carcinoma. We performed this single institution case-control study to analyze the clinico-epidemiological characteristics and risk factors of ACRAP. ACRAP has been defined as adenomatous polyps with 10 mm or larger in size, contains a significant villous component, or has high-grade dysplasia. Between 2013 and 2019, 860 patients were referred for screening colonoscopy among whom 158 had ACRAP and 391 had no evidence of colorectal polyps. We reviewed the electronic medical records of all patients (N=549) and retrieved detailed baseline epidemiological and clinical characteristic of all participants at time of colorectal screening. STATA program was used for data management and statistical analyses. Logistic regression was performed to estimate univariate and multivariate Odd ratio (OR) and 95% confidence interval (95% CI) after adjustment for significant confounding factors. Table-1 presents the baseline characteristics of 158 patients ACRAP. Descriptive analysis indicated a significantly high prevalence of cirrhosis and alcohol consumption among patients with ACRAP as compared to non-polyp population, P <.05. In addition, ACRAP was common among whites. The estimated univariate ORs (95% CIs) for cirrhosis, white race, and alcohol consumption were 1.8 (1.2-2.6), 1.8 (1.2-2.6), and 1.7 (1.2-2.5) respectively; p<.05. Multivariate logistic regression analysis showed that the risk for ACRAP development has increased by 50% among cirrhotic patients and by 60% among white population. The estimated multivariate ORs (95% CIs) are 1.5 (1.1-2.2) p=.03 and 1.6 (1.1-2.3) p=.04, for cirrhosis and white race, respectively. The study showed a significant impact of cirrhosis on ACRAP development and higher risk of white race as compared to other races. Future study with a large sample size is warranted to validate our findings.

Assessment of Treatment Strategies to Achieve Hepatitis C Elimination in Canada Using a Validated Model

Achievement of the World Health Organization (WHO) target of eliminating hepatitis C virus (HCV) by 2030 will require an increase in key services, including harm reduction, HCV screening, and HCV treatment initiatives in member countries. These data are not available for Canada but are important for informing a national HCV elimination strategy. To use a decision analytical model to explore the association of different treatment strategies with HCV epidemiology and HCV-associated mortality in Canada and to assess the levels of service increase needed to meet the WHO elimination targets by 2030. Study participants in this decision analytical model included individuals with hepatitis C virus infection in Canada. Five HCV treatment scenarios (optimistic, very aggressive, aggressive, gradual decrease, and rapid decrease) were applied using a previously validated Markov-type mathematical model. The optimistic and very aggressive treatment scenarios modeled a sustained annual treatment of 10 200 persons and 14 000 persons, respectively, from 2018 to 2030. The aggressive, gradual decrease, and rapid decrease scenarios assessed decreases in treatment uptake from 14 000 persons to 10 000 persons per year, 12 000 persons to 8500 persons per year, and 12 000 persons to 4500 persons per year, respectively, between 2018 and 2030. Hepatitis C virus prevalence and HCV-associated health outcomes were assessed for each of the 5 treatment scenarios with the goal of identifying strategies to achieve HCV elimination by 2030. An estimated mean 180 142 persons (95% CI, 122 786-196 862 persons) in Canada had chronic HCV infection at the end of 2017. The optimistic and gradual decrease scenarios estimated a decrease in HCV prevalence from 180 142 persons to 37 246 persons and 37 721 persons, respectively, by 2030. Relative to 2015, this decrease in HCV prevalence was associated with 74%, 69%, and 69% reductions in the prevalence of decompensated cirrhosis, hepatocellular carcinoma, and liver-associated mortality, respectively, leading to HCV elimination by 2030. More aggressive treatment uptake (very aggressive scenario) could result in goal achievement up to 3 years earlier than 2030, although a rapid decrease in the initiation of treatment (rapid decrease scenario) would preclude Canada from reaching the HCV elimination goal by 2030. The study findings suggest that Canada could meet the WHO goals for HCV elimination by 2030 by sustaining the current national HCV treatment rate during the next decade. This target will not be achieved if treatment uptake is allowed to decrease rapidly.

A cross-sectional observational study of lipid profile of cirrhosis of liver patients in a teaching hospital in North Odisha, India

Background: Lipids are essential component of biological membranes: also a part of free molecules and metabolic regulators which control cellular function and homeostasis in the body. Liver plays a central role in lipid metabolism. Cardiovascular disease (CVD) risk stratification includes serum lipid profile. In the general population; global prevalence of cirrhosis from autopsy studies ranges from 4.5% to 9.5%. Deaths from cirrhosis have been estimated to increase and would make it as the 12th leading cause of death in 2020. Although several studies have been conducted on dyslipidemia in cirrhotics in developed countries, there is a paucity of data in this regard in India.Methods: This observational study was carried out amongst 60 cirrhosis patients that fulfils the inclusion and exclusion criteria and attended the medicine OPD and admitted in medicine ward of Pandit Raghunath Murmu Medical College and Hospital, Baripada, Dist. Mayurbhanj, Odisha, India from June 2018 to Jan 2019.Results: In our study we had 52 were male and 8 were female. The average age of the patients in the study was 49.62±13.59 yrs. 91.67 % of the patients were alcoholic. Abdominal distension (93.33%) and ascites (81.67%) were most common presenting complaints. Pallor was present in 65.00% cases. Splenomegaly was present in 29 (48.33%) patients of cirrhosis of liver. Renal dysfunction was present in 22 (36.67%) cases. We found decreased HDLC (&lt;40 mg/ Dl) in 34 (56.67%) cases. Hypolipidemia, in particular decreased HDLC level is also an important risk factor for cardiovascular disease and vascular events.Conclusions: From this study we can conclude that lipid abnormalities are commonly seen in patients with liver cirrhosis and screening for the same is important for intervention with appropriate therapy to prevent cardiovascular events. Further studies on lipid abnormalities in these patients and the need for treatment are recommended.

Cost Effectiveness of Different Strategies for Detecting Cirrhosis in Patients With Nonalcoholic Fatty Liver Disease Based on United States Health Care System

Several strategies are available for detecting cirrhosis in patients with nonalcoholic fatty liver disease (NAFLD), but their cost effectiveness is not clear. We developed a decision model to quantify the accuracy and costs of 9 single or combination strategies, including 3 noninvasive tests (fibrosis-4 [FIB-4], vibration-controlled transient elastography [VCTE], and magnetic resonance elastography [MRE]) and liver biopsy, for the detection of cirrhosis in patients with NAFLD. Data on the diagnostic accuracy, costs, adverse events, and cirrhosis outcomes over a 5-year period were obtained from publications. The diagnostic accuracy, per-patient cost per correct diagnosis of cirrhosis, and incremental cost-effectiveness ratios (ICERs) were calculated for each strategy for base cirrhosis prevalence values of 0.27%, 2%, and 4%. The combination of the FIB-4 and VCTE identified patients with cirrhosis in NAFLD populations with a 0.27%, 2%, and 4% prevalence of cirrhosis with the lowest cost per person ($401, $690, and $1024, respectively) and highest diagnostic accuracy (89.3%, 88.5%, and 87.5% respectively). The combination of FIB-4 and MRE ranked second in cost per person ($491, $781, and $1114, respectively) and diagnostic accuracy (92.4%, 91.6%, 90.6%, respectively). Compared with the combination of FIB-4 and VCTE (least costly), the ICERs were lower for the combination of FIB-4 and MRE ($2864, $2918, and $2921) than the combination of FIB-4 and liver biopsy ($4454, $5156, and $5956) at the cirrhosis prevalence values tested. When the goal was to avoid liver biopsy, FIB-4+ VCTE and FIB-4+ MRE had similar diagnostic accuracies, ranging from 87.5% to 89.3% and 90.6% to 92.4% for a cirrhosis diagnosis, respectively, although FIB-4+ MRE had a slightly higher cost. In our cost-effectiveness analysis based on the US health care system, we found that results from FIB-4, followed by either VCTE, MRE, or liver biopsy, detect cirrhosis in patients with NAFLD with a high level of accuracy and low cost. Compared with FIB-4+ VCTE, which was the least costly strategy, FIB-4+ MRE had a lower ICER than FIB-4+ LB.

Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes: Evaluation of Hepatic Fibrosis and Steatosis Using Fibroscan.

Patients with type 2 diabetes mellitus (T2DM) are at increased risk of non-alcoholic fatty liver disease (NAFLD) and might eventually progress to advanced fibrosis, cirrhosis and hepatocellular carcinoma (HCC). Recommendations on whether to screen for NAFLD in diabetic patients remains conflicted between major guidelines. Transient elastography using FibroScan with CAP (controlled attenuation parameter) can assess both liver steatosis and fibrosis simultaneously. This paper took a new look at the prevalence of NAFLD and the severity of fibrosis among T2DM patients in Vietnam. The study was conducted using a cross-sectional design in T2DM adults who attended Dai Phuoc Ho Chi Minh Polyclinic and Polyclinic of Pham Ngoc Thach University of Medicine. Liver steatosis and fibrosis was assessed by FibroScan. NAFLD was diagnosed if CAP > 233 dB/m (steatosis > 5%). Data were analyzed using STATA 12 software program. We found that a total of 307 type 2 diabetic patients qualified for the study’s criteria. The prevalence of NAFLD in T2DM patients based on FibroScan was 73.3%. Rates of mild, moderate and severe steatosis were 20.5%, 21.8% and 30.9%, respectively. The prevalence of significant fibrosis (≥ F2), advanced fibrosis (≥ F3) and cirrhosis (F4) was 13.0%, 5.9% and 3.6%, respectively. On multivariate analysis, aspartate aminotransferase (AST) (OR: 1.067; 95% CI: 1.017–1.119; p = 0.008) and platelet levels (OR: 0.985; 95% CI: 0.972–0.999; p = 0.034) were independent of risk factors of advanced fibrosis. Thus, our study supports screening for NAFLD and for evaluating the severity of liver fibrosis in T2DM patients.

Non-Alcoholic Cirrhosis and Heart Rate Variability: A Systematic Mini-Review.

Background and Objectives: Cirrhosis is a liver disease that causes about one million deaths annually worldwide. The estimated cirrhosis prevalence ranges from 4.5–9.5% in the general population. Up to 40% of cirrhotic patients are asymptomatic and may be diagnosed late. Studies have described the importance of the functions of the liver and autonomic nervous system (ANS) and their relationship. There is limited information available on non-alcoholic cirrhosis and heart rate variability (HRV), which is a measure of the ANS. This study aimed to evaluate cardiac autonomic modulation through HRV in non-alcoholic cirrhosis individuals reported in previous observational and clinical trial studies. Materials and Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement using the Medline, Scopus, and Web of Science electronic databases. Five studies were identified and reviewed. Results: HRV was decreased in patients with non-alcoholic cirrhosis, even in the first stage. Conclusions: HRV could be used as a complementary method to improve both the diagnosis and prognosis of non-alcoholic cirrhosis.

Impact of Direct Acting Antiviral Therapy for Hepatitis C Virus Infection on Recurrence of Hepatitis C Virus Related Hepatocellular Carcinoma

Abstract Background hepatocellular carcinoma is the fifth most common tumor worldwide and the second most common cause of cancer-related death with a male-to-female predominance greater than 2:1. The presence of cirrhosis represents a key risk factor for the development of HCC. The prevalence of cirrhosis among patients with HCC has been estimated to be 85%-95% and the HCC incidence rate among patients with cirrhosis has been shown to be 2%-4% per year. HCV infection is a leading cause of liver cirrhosis and hence the development of HCC. Egypt has the highest HCV prevalence worldwide; with estimated rate of 10% of Egyptians between 15 – 59 years as reported by the Egyptian Health Issues Survey (EHIS) in 2015. Aim of the Work the aim of this study was to evaluate the impact of Direct Acting Antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection on recurrence of HCV related HCC after intervention. Patients and Methods this study was conducted on 50 patients with previously treated HCC who were treated for HCV infection using direct acting antiviral agents after confirming HCC regression and response to different treatment modalities and were followed for one year after antiviral treatment. A control group of another 50 patients with cured HCC who didn’t receive DAA therapy was included in the study to compare the recurrence rate in both groups and its relation to the antiviral therapy. Results the two groups didn’t differ as regards age, sex, biochemical profile, AFP, CBC and child score. The results of the study came to show an HCC recurrence rate of 38% in patients who received direct acting antiviral therapy after HCC intervention versus 62% in those who didn’t receive antiviral therapy. Conclusion direct acting antiviral drugs didn’t show to increase the risk of HCC recurrence in comparison to the control group. Yet it did not abolish it. So, close follow up of patients with HCC receiving antiviral therapy is highly recommended.

Genomic characterization of HBV-infected hepatocellular carcinoma patients using circulating tumor DNA.

575 Background: Hepatocellular carcinoma (HCC) is a leading cause of mortality, with Hepatitis B virus (HBV) infection as a dominant etiology. Surgery or ablation may be curative for early-stage HCC. Thus, effective detection strategies are needed. We investigated genomic aberrations in circulating tumor DNA (ctDNA) as a potential diagnostic marker of HCC in HBV-infected patients. Methods: We identified early stage (BCLC 0-A) HCC cases (n = 21) and cancer-free controls (n = 15) from a cohort of Asian patients with HBV, undergoing surveillance at Thomas Jefferson University Hospital between 2013-2017. Blood samples were collected. Circulating cell-free DNA was isolated from plasma and assayed by capture-based next-generation sequencing of a targeted panel of 23 genes implicated in HCC pathogenesis. Sequencing data analysis and somatic mutation identification were conducted using a computational pipeline. Using area under the curve (AUC) in receiver operating characteristic analysis, we evaluated gene alterations and clinical factors (age, gender, cirrhosis) in an exploratory early detection HCC model. Results: Mutant ARID1A, ATM, CDKN2A, CTNNB1, ERBB2, TP53 genes were increased in HCC cases relative to non-cancer patients (85.7% vs 53.3%, P = 0.058; 42.9% vs 6.7%, P = 0.025; 38.1% vs 6.7%, P = 0.051; 42.9% vs 0%, P = 0.005; 52.4% vs 13.3%, P = 0.016; 100% vs 66.7%, P = 0.008, respectively). HCC patients had higher prevalence of cirrhosis than controls (90.5% vs. 60%, P = 0.046). Using the 6 mutant genes alone, the AUC for discriminating HCC from non-cancer patients was 0.827 (95% confidence interval [CI]: 0.701-0.953), which was greater than the AUC for discriminating cirrhosis from non-cirrhosis (0.531). When the 6 mutant genes were combined with clinical factors, the AUC of the exploratory HCC detection model increased to 0.914 ( P= 0.045). Conclusions: We identified 6 genomic aberrations in ctDNA that were more prevalent in HCC patients compared with non-cancer patients. Combining these alterations with clinical factors may identify HCC in HBV-infected patients at an early stage. These findings warrant further validation in future studies.

Digestive Surgery at the Cirrhotic Patient.

In chronic liver disease, the incidence of cirrhosis is increasing. About 1 million deaths from cirrhosis are reported annually by WHO, occupying the 11th position in the hierarchy of pathologies that cause death (1). The prevalence of cirrhosis is often underestimated based on the fact that one third of the patients are asymptomatic (2). Regardless of whether it is elective or urgent extra-hepatic surgery, operative interventions in this range of patients are burdened by an increased risk of perioperative morbidity and mortality (3,4). This reality requires the evaluation of the benefit-risk balance for each patient with the surgical firm indication. A journal of the medical literature, presented over the period 1995-2018 (PubMed), noted that the most frequent extrahepatic interventions in the cirrhotic patient were addressed to the cholecyst and CBD (23%), parietal defects (hernias, events) in 17 %, gastric pathology (19%) and rectum-colon (19%).v Liver cirrhosis is frequently associated with abnormalities of coagulation mechanisms: thrombopenia and platelet dysfunctions, decreased coagulation factors but also proteins involved in fibrinolysis. Cardio-circulatory changes are all the more important as the cirrhotic pathology is more evolved, being expressed by hyperkinetic syndrome and systemic vasodilation with hyper-flow, tachycardia and low peripheral resistance (5). The "trigger" element of these anomalies is the portal hypertension and the porto-systemic shunts that involve vasodilating mediators but also the compensatory activation of the renin-angiotensin system (6). The perioperative anaesthetic strategy in the patients is integrated in a multidisciplinary effort of specific management.