Rate Of Chronic Liver Disease Research Articles

Burden of Wilson Disease among patients and care partners in the United States: results from a cross-sectional survey

Objective This study assessed the burden of Wilson Disease (WD) among patients and care partners (WD-CPs) in the US and compared it to a US general population of adults (GPs) and care partners (GP-CPs). Methods This cross-sectional, self-reported survey included patients with WD and WD-CPs aged ≥18 years recruited through the Wilson Disease Association (WDA), while data for GPs and GP-CPs were obtained from the 2022 National Health and Wellness Survey. GPs and GP-CPs were propensity score matched (3:1) with WD patients and WD-CPs for demographics and health characteristics. Bivariate analysis evaluated differences in comorbidity burden and health-related outcomes of the WD cohorts compared to matched GP cohorts. Results Thirty-seven patients with WD and 53 WD-CPs completed the survey. Most patients reported some treatment burden (73.3%), experienced sleep problems (60%), and visited a healthcare provider (HCP) in the past 6 months (91.9%). Compared with matched GPs, patients with WD had a significantly higher mortality risk (p < .001) and reported greater rates of chronic liver disease, cirrhosis (both, p < .001), migraines (p = .032), non-alcoholic steatohepatitis (p = .004), sleep problems (p = .009) and HCP visits (p = .002). Most WD-CPs (75.5%) reported high burden of caring (mean ZBI-12 score, 26.5) and more negative impact on esteem than GP-CPs. Conclusion This study highlights the burden of WD experienced by patients and WD-CPs, with patients experiencing high treatment burden, comorbidity burden and healthcare resource utilization, and WD-CPs experiencing high impact of caring, including impact on employment and self-esteem.

Association of depressive symptoms with chronic liver disease among middle-aged and older adults in China

BackgroundThe relationship between depressive symptoms and chronic liver disease (CLD) is still unclear. We aimed to determine whether depressive symptoms are associated with CLD in a large population sample.MethodsThe data was from the China Health and Retirement Longitudinal Study (CHARLS), an ongoing nationally representative prospective cohort study. Depressive symptoms were assessed with the catchment-area epidemiology survey-depression (CES-D). CLD was identified by the patient’s self-report about a physician’s diagnosis at each visit. Multi-adjusted logistic regression and Cox regression models were used.ResultsA total of 14,995 participants (53.1% female; mean age: 58.85 ± 9.87 years) and 13,405 participants (53.64% female; mean age: 58.58 ± 9.69 years) were included in the cross-sectional and longitudinal analyses, respectively. In the cross-sectional analysis, the odds ratio of CLD in patients with moderate and severe depressive symptoms were 1.46 [95% confidence interval (CI), 1.16–1.83] and 1.78 (95% CI, 1.23–2.56) than those with none/mild depressive symptoms, respectively. In the longitudinal analysis, compared to participants with none/mild depressive symptoms, the hazard rates of CLD in those with moderate and severe depressive symptoms were 1.65 (95%CI, 1.33–2.03) and 1.80 (95%CI, 1.24–2.60). And the 50th percentile difference of time (years) at the incidence of CLD in participants with moderate and severe depressive symptoms were − 0.83 (95%CI, −1.18, −0.49) and − 0.96 (95%CI, −1.56, −0.35), respectively.ConclusionElevated depressive symptoms were associated with an increased risk of CLD among middle-aged and older adults in China.

S1532 Age Standardized Incidence and Mortality Rates of Chronic Liver Disease in the United States From 1990-2019: State Level Analysis From the Global Burden of Disease

S1532 Age Standardized Incidence and Mortality Rates of Chronic Liver Disease in the United States From 1990-2019: State Level Analysis From the Global Burden of Disease

A cross-sectional study on assessment of drug practice pattern in a chronic liver disease patient at a tertiary care teaching hospital

Background: Chronic liver disease (CLD) is a progression of disease in the liver for more than 6 months which includes, progressive destruction of liver parenchyma followed by regeneration and fibrosis which leads to cirrhosis. The prevalence rate of CLD was estimated around 1.5 billion worldwide. Among the causes in 2016, cirrhosis holds the 11th place in the order of mortality and 15th place in the order of morbidity worldwide and in 2017, CLD caused death around 1.32 million. Aims and Objectives: The aim of the study was to assess the drug practice pattern in CLD patients in a tertiary care teaching hospital. Materials and Methods: A prospective, observational, and cross sectional study was done at SRM Medical College Hospital and Research Centre. A total of 105 CLD patients were included in the study after considering the inclusion and exclusion criteria. Prescriptions were reviewed to know the prescribing indicators and patient indicators. Results: One hundred and five prescription were reviewed, out of which the most commonly prescribed drugs were, antiulcer drug group 56 (53%), hepatoprotective agents 53 (50%), anti-microbial agents 39 (37%) followed by nutrients supplements 17 (16%), laxatives 13 (12%), and diuretics 10(8.5%). Conclusion: The most commonly prescribed drugs were antiulcer drug to reduce the gastric secretion, hepatoprotective agents to improve the liver function, and anti-microbial agents to decrease the secondary bacterial infections.

Gastrointestinal and liver disease in patients with schizophrenia: A narrative review.

Schizophrenia is a severe mental illness which can have a devastating impact on an individual’s quality of life. Comorbidities are high amongst patients and life expectancy is approximately 15 years less than the general population. Despite the well-known increased mortality, little is known about the impact of gastrointestinal and liver disease on patients with schizophrenia. We aimed to review the literature and to make recommendations regarding future care. Literature searches were performed on PubMed to identify studies related to gastrointestinal and liver disease in patients with schizophrenia. High rates of chronic liver disease were reported, with Non-Alcoholic Fatty Liver Disease being of particular concern; antipsychotics and metabolic syndrome were contributing factors. Rates of acute liver failure were low but have been associated with antipsychotic use and paracetamol overdose. Coeliac disease has historically been linked to schizophrenia; however, recent research suggests that a causal link is yet to be proven. Evidence is emerging regarding the relationships between schizophrenia and peptic ulcer disease, inflammatory bowel disease and irritable bowel syndrome; clinical vigilance regarding these conditions should be high. Patients with schizophrenia poorly engage with bowel cancer screening programmes, leading to late diagnosis and increased mortality. Clozapine induced constipation is a significant issue for many patients and requires close monitoring. There is a significant burden of gastrointestinal and liver disease amongst patients with schizophrenia. Better levels of support from all members of the medical team are essential to ensure that appropriate, timely care is provided.

Immunotherapies for hepatocellular carcinoma.

Cases of hepatocellular carcinoma (HCC) are rapidly rising. This is particularly the case in the Western world, as a result of increasing rates of chronic liver disease, secondary to lifestyle‐associated risk factors and the lack of an established screening programme for the general population. Traditionally, radical/curative treatment options for HCC, including liver transplantation and surgical resection are reserved for the minority of patients, presenting with an early stage cancer. For patients with advanced disease, Sorafenib and Lenvatinib were, until recently, the only licensed systemic treatments, and provided only limited survival benefits at the cost of a multitude of potential side effects. Recent scientific advances in the field of cancer immunotherapy have renewed significant interest in advanced HCC, in order to fulfil this apparent area of unmet clinical need. This has led to the success and recent regulatory approval of an Atezolizumab/Bevacizumab combination for the first‐line treatment of advanced HCC following results from the IMbrave150 clinical trial in 2019, with further immune checkpoint inhibitors currently undergoing testing in advanced clinical trials. Furthermore, other cancer immunotherapies, including chimeric antigen receptor T‐cells, dendritic cell vaccines and oncolytic viruses are also in early stage clinical trials, for the treatment of advanced HCC. This review will summarise the major approaches that have been and are currently in development for the systemic treatment of advanced HCC, their advantages, drawbacks, and predictions of where this revolutionary treatment field will continue to travel for the foreseeable future.

Predictive Analysis and Evaluation Model of Chronic Liver Disease Based on BP Neural Network with Improved Ant Colony Algorithm.

Timely prediction of the mechanism and characteristics of chronic liver disease using next-generation information technology is an effective way to improve the diagnosis rate of chronic liver disease. In this paper, we have proposed a modified backpropagation (BP) neural network with improved ant colony optimization algorithm to process multiple index attribute items describing chronic liver disease and construct a chronic liver disease assessment model. The proposed model is very effective in detecting chronic liver disease on time with acceptable level of accuracy and precision ratio. To verify these claims, the proposed scheme is checked experimentally where 125 groups of 20-dimensional medical test index data items of patients with chronic liver disease were analyzed. Moreover, 13-dimensional index items were preferentially selected as test index attribute items with high sensitivity to chronic liver disease using well-known ROC curves. The 13-dimensional index items were reduced to 5-dimensional comprehensive data items by principal component analysis. The proposed neural network-based model was trained with 115 sets of test indicator sample sets, and the remaining 10 sets of sample sets were used as test samples. Compared with the original 20-dimensional data as the neural network input, the proposed model not only reduces the complexity but also improves the prediction accuracy by 15.07%.

Racial, Gender, and Socioeconomic Disparities in Liver Transplantation.

Liver transplantation (LT) is a life-saving therapy; therefore, equitable distribution of this scarce resource is of paramount importance. We searched contemporary literature on racial, gender, and socioeconomic disparities across the LT care cascade in referral, waitlist practices, allocation, and post-LT care. We subsequently identified gaps in the literature and future research priorities. Studies found that racial and ethnic minorities (Black and Hispanic patients) have lower rates of LT referral, more advanced liver disease and hepatocellular carcinoma at diagnosis, and are less likely to undergo living donor LT (LDLT). Gender-based disparities were observed in waitlist mortality and LT allocation. Women have lower LT rates after waitlisting, with size mismatch accounting for much of the disparity. Medicaid insurance has been associated with higher rates of chronic liver disease and poor waitlist outcomes. After LT, some studies found lower overall survival among Black compared with White recipients. Studies have also shown lower literacy and limited educational attainment were associated with increased posttransplant complications and lower use of digital technology. However, there are notable gaps in the literature on disparities in LT. Detailed population-based estimates of the advanced liver disease burden and LT referral and evaluation practices, including for LDLT, are lacking. Similarly, little is known about LT disparities worldwide. Evidence-based strategies to improve access to care and reduce disparities have not been comprehensively identified. Prospective registries and alternative "real-world" databases can provide more detailed information on disease burden and clinical practices. Modeling and simulation studies can identify ways to reduce gender disparities attributed to size or inaccurate estimation of renal function. Mixed-methods studies and clinical trials should be conducted to reduce care disparities across the transplant continuum.

Gender differences and influenza-associated mortality in hospitalized influenza A patients during the 2018/19 season.

In this study we analyzed gender differences in the clinical presentation of patients with molecular confirmed influenza A. Additionally, we tried to identify predictors of influenza-associated mortality. In this prospective observational multi-center-study we included all influenza-positive patients ≥ 18years who were hospitalized and treated on flu-isolation-wards in three hospitals in Vienna during the 2018/19 influenza season. Diagnoses were made via Cobas® Liat® POCT. 490 Patients (48.8% female) tested positive for influenza A. Female patients were older (median age 76 years vs. 70 years, p < 0.001). Male patients had a higher rate of chronic liver disease in history (8.8% vs. 2.9%, p = 0.006), myositis (11.7% vs. 3.1%, p < 0.001) and ICU admissions (9.6% vs. 4.6%, p = 0.03). The in-hospital mortality rate was 4.3% and increased to 9.5% during the 90-day follow-up period. Female patients > 75years had a significantly higher in-hospital mortality rate than ≤ 75-year-old females (9.2% vs. 1.7%, p = 0.019). This effect was not observed in male patients (5.4% vs. 1.9%, p = ns). Age > 75years (OR 5.49, 95% CI 1.10-27.43), acute heart failure (OR 3.56, 95% CI 1.03-12.05) and ICU admission (OR 6.1, 95% CI 0.98-37.91) were predictors for in-hospital mortality for female patients, while any malignancy (OR 9.4, 95% CI 1.90-46.54) and ICU admission (OR 7.05, 95% CI 1.44-34.55) were predictors in male patients. Gender is associated with differences in clinical presentation and complications of influenza A virus infection. Women with acute heart failure or aged > 75years have an increased risk of influenza associated in-hospital mortality, while ICU admission and any malignancy are predictors for male patients. Mortality rates in patients > 75years are 5-10 times higher compared to their non-hospitalized influenza-negative Austrian counterparts.

Liver Transplantation in Patients with Sickle Cell Disease in the United States

BackgroundUp to 30% of patients with sickle cell disease (SCD) develop chronic liver disease via etiologies including sickle cell hepatopathy, acquired viral hepatitis, or secondary hemochromatosis. It is unclear how many patients with SCD ultimately undergo liver transplantation (LT) and what factors are associated with survival after LT. In this study, we examined LT outcomes in these patients by reviewing the Scientific Registry of Transplant Recipients (SRTR) and our institutional experience. MethodsAnalysis of the SRTR identified 23 LT recipients and five simultaneous liver and kidney transplantation (SLKT) recipients with SCD. Patient demographics and graft and patient survival were analyzed. Two patients with SCD at our institution underwent SLKT. ResultsReview of the SRTR revealed that recipients with SCD had significantly higher model for end-stage liver disease scores (33 versus 21, P = 0.004), preoperative intensive care unit admission (43.5% versus 19.1%, P = 0.007), preoperative dialysis (17.4% versus 4.9%, P = 0.009), and were more likely to be status 1 (26.1% versus 12.1%, P = 0.041) when compared with the reference population of African American LT recipients. Despite being higher risk at the time of LT, patients with SCD had equivalent posttransplant graft and patient survival when compared with the reference population (P = 0.5 and P = 0.2, respectively) and a 2:1 propensity score–matched group (P = 0.5 and P = 0.2, respectively). Two recent SLKT recipients with SCD from our institution have performed well with stable allograft function. ConclusionsData from the SRTR demonstrate that patients with SCD can expect equivalent graft and patient survival after LT despite exhibiting more comorbidities at the time of LT. The low number of patients with SCD who underwent LT in the SRTR in comparison with the rate of chronic liver disease in this population raises the question as to whether a disparity in access to LT exists for this complex population.

Treatment Options for Thrombocytopenia in Patients With Chronic Liver Disease Undergoing a Scheduled Procedure.

Thrombocytopenia is a consequence of portal hypertension and is the most common hematological manifestation of chronic liver disease (CLD) (ie, cirrhosis). Data indicates the rates of CLD are increasing and, as a result, so will the incidence of this complication. Although bleeding risks are only relevant when elective procedures are performed, this is a frequent concern as these procedures are commonly part of the spectrum of care for patients with cirrhosis. As such, thrombocytopenia remains a pertinent issue. Fortunately, we now have effective and accurate treatment modalities to raise platelet counts before scheduled procedures, known as thrombopoietin receptor agonists. Two drugs in this therapeutic class (avatrombopag and lusutrombopag) are now approved for the treatment of thrombocytopenia in adults with CLD undergoing a procedure and have revolutionized how this is managed. Although there is progress in the field, peer-reviewed literature and expert guidance are lacking. Recognizing these unmet needs, a group of expert hepatologists comprised this review, which summarizes the most current and relevant peer-reviewed literature on thrombocytopenia in CLD and provides clinical expertise on this timely topic.

First detection of hepatitis E virus genotype 3 as a common infectious agent in patients with chronic liver damage in Mexico

Introduction and ObjectivesTo characterize the virological features of hepatitis E virus (HEV) in serum from patients exhibiting chronic liver damage. MethodsA data-base of 513 unrelated individuals from West-Mexico with liver-disease determined by clinical and biochemical tests and transient elastography between 2011 and 2016 were retrospectively analyzed. According to infectious etiologies, patients were classified as hepatitis B virus (HBV)-, hepatitis C virus (HCV)-infected patients, and patients exhibiting chronic liver damage with non-identified infectious etiological agent (NIIEA). Available serum samples from NIIEA-patients were tested by RT-nPCR for the presence of HEV-RNA and partially sequenced for genotyping. ResultsOut of the 513 cases, 5.85% were patients infected with HBV, 67.64% with HCV, and 26.51% were NIIEA-patients. Among 76 available samples from NIIEA-cases, 30.26% tested positive for HEV-RNA. Twelve (15.79%) partial HEV sequences allowed phylogenetic analysis, revealing the classification of HEV as HEV-Gt3. Advanced fibrosis (F3–F4 stage) was found in a 26.1% of patients with HEV-active infection. ConclusionAlthough HCV is the main infectious agent related to chronic liver disease in Mexico, liver damage without an infectious etiology is common. Our findings reveal that an elevated rate of chronic liver disease might be represented by autochthonous infection of HEV-Gt3, whose detection makes Mexico unique in Latin-America with the circulation of HEV strains belonging to three genotypes (Gt1, Gt2, and Gt3). Thus, HEV infection should be a matter of health concern, and mandates for HEV screening to properly handle this commonly undiagnosed disease.

Lowering the upper limit of serum alanine aminotransferase levels may reveal significant liver disease in the elderly.

This study sought to determine the prevalence of significant liver disease in those subjects with serum alanine aminotransferase levels in the range between the current and the newly suggested upper limit of normal (termed the delta range). The files of the previous study subjects (who underwent at least one alanine aminotransferase measurement in 2002 and followed to 2012) were reviewed for a diagnosis of chronic liver disease; aspartate aminotransferase/platelet ratio index, FIB-4 and alanine aminotransferase/aspartate aminotransferase ratio were used to evaluate liver fibrosis. The prevalence of significant liver disease, by diagnoses and fibrosis scores was compared between subjects with alanine aminotransferase levels in the delta range (men, 42–45 IU/L; women, 26–34 IU/L) and in the newly suggested normal range (men, 15–42 IU/L; women, 10–26 IU/L). The cohort included 49,634 subjects (41% male, mean age 83±6 years) of whom 2022 were diagnosed with chronic liver disease including 366 with cirrhosis. Compared to subjects with alanine aminotransferase levels in the newly suggested normal range, subjects with alanine aminotransferase levels in the delta range had a significantly higher rate of chronic liver disease (men, 15.3% vs. 4.9%; women, 7.8% vs. 3.3%) and of cirrhosis specifically (men, 4.2% vs. 0.9%; women, 1.5% vs. 0.4%) and also had higher mean fibrosis scores (P <0.001 for all). Lowering the current upper limit of normal of serum alanine aminotransferase may help to identify elderly patients at risk of significant liver disease.

Mortality trends of liver diseases from 1981 to 2016 and the projection to 2035 in Taiwan: An age-period-cohort analysis.

Projections on liver diseases mortality can provide a basis for evaluating the World Health Organization's "25 by 25" goal and can help healthcare systems design appropriate control strategies. This study evaluated whether the 25 by 25 goal can be achieved in Taiwan and discussed possible future control strategies. Age-period-cohort models are used to estimate the mortality trends of liver diseases from 1981 to 2016 and project these trends to 2035. For chronic liver disease and cirrhosis among men, the age-adjusted mortality rate decreased from 1981 to 1991, increased until 1999, and subsequently decreased again until 2016. For women, the age-adjusted mortality rate exhibited an increasing but up-and-down trend from 1981 to 1998 and a decreasing trend to 2016. For liver cancer among men, the age-adjusted mortality rate exhibited an increasing trend from 1981 to 2002 and a decreasing trend to 2016. For women, the age-adjusted mortality rate exhibited an increasing trend from 1981 to 2003 and a decreasing trend to 2016. The age-adjusted mortality rates of chronic liver disease, cirrhosis and liver cancer for both sexes are projected to decrease by more than 30% from 2016 to 2025 and by more than 55% from 2016 to 2035. These results indicated that the 25 by 25 goal can be achieved for liver diseases mortality in Taiwan. In addition to viral hepatitis, the following risk factors may become the major causes of liver diseases in Taiwan in the future: alcohol and tobacco use, diabetes and obesity.

Abstract A34: Risk factors for liver disease/cancer among adults of Mexican descent in the United States and Mexico

Abstract A34: Risk factors for liver disease/cancer among adults of Mexican descent in the United States and Mexico

High frequency of the PNPLA3 rs738409 [G] single-nucleotide polymorphism in Hmong individuals as a potential basis for a predisposition to chronic liver disease.

An exploratory study was performed to determine the prevalence of the patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs78409 [G] allele among the Hmong as a risk factor for nonalcoholic fatty liver disease (NAFLD). NAFLD/nonalcoholic steatohepatitis is the world's most common chronic liver disease and is expected to replace viral hepatitis as the leading cause of cirrhosis and potential precursor to hepatocellular carcinoma (HCC). Of all populations in California, the Hmong experience the highest risk of death from HCC and the highest prevalence of metabolic syndrome risk factors among Asians that predispose them to NAFLD. Here a genetic explanation was sought for the high rates of chronic liver disease among the Hmong. The literature pointed to the PNPLA3 rs738409 [G] allele as a potential genetic culprit. Cell-free DNA was isolated from 26 serum samples previously collected in community settings. Quantitative polymerase chain reaction-based single-nucleotide polymorphism (SNP) genotyping was performed with a validated TaqMan SNP genotyping assay, and results were analyzed with TaqMan Genotyper software. The PNPLA3 rs738409 [C>G] variant occurred at a frequency of 0.46 (12 of 26; 95% confidence interval, 0.27-0.67). This carrier rate would rank the Hmong as the third highest population in the 1000 Genomes Project. Although this small sample size limits the generalizability, the high frequency rates of this allele along with the presence of metabolic syndrome risk factors warrant further studies into the etiology of NAFLD among the Hmong. Cancer 2018;124:1583-9. © 2018 American Cancer Society.

The impact on patients of a nurse-led clinical service in gastroenterology

Higher rates of chronic liver disease have resulted in a significant increase in the number of patients needing regular abdominal paracentesis for ascites. Waiting times for admission at the Royal Wolverhampton NHS Trust had become longer and delays in intervention and treatment became inevitable. In 2014, the Trust developed a nurse-led abdominal paracentesis day-case service. A qualitative evaluation of the service was conducted using in-depth patient interviews and surveys to determine the impact of the service, including how the new nursing role affected the patient experience. The results show that the nurse-led clinical service in gastroenterology positively impacts patients' experiences. Following this innovation, the service was extended to provide intravenous infusions for gastroenterology patients via the day-case unit. With appropriate training and competency assessments, nurses can now perform selected medical procedures safely and effectively, thereby facilitating nursing staff to expand and develop their roles. This development has substantial implications for nursing and is an important contribution to the debate on the future direction of the nursing profession.

Vascular patterning sets the stage for macro and micro hepatic architecture.

Background The liver is a complex organ with a variety of tissue components that require a precise architecture for optimal function of metabolic and detoxification processes. As a result of the delicate orchestration required between the various hepatic tissues, it is not surprising that impairment of hepatic function can be caused by a variety of factors leading to chronic liver disease. Results Despite the growing rate of chronic liver disease, there are currently few effective treatment options besides orthotopic liver transplantation. Better therapeutic options reside in the potential for genetic and cellular therapies that promote progenitor cell activation aiding de novo epithelial and vascular regeneration, cell replacement, or population of bioartificial hepatic devices. In order to explore this area of new therapeutic potential, it is crucial to understand the factors that promote hepatic function through regulating cell identities and tissue architecture. Conclusions In this commentary, we review the signals regulating liver cell fates during development and regeneration and highlight the importance of patterning the hepatic vascular systems to set the groundwork for the macro and micro hepatic architecture of the epithelium.

National trends and inpatient outcomes of inflammatory bowel disease patients with concomitant chronic liver disease

Background. There is little information on the frequency of chronic liver disease among hospitalized patients with inflammatory bowel disease (IBD). In this study, we seek to define the common etiologies contributing to chronic liver disease among IBD patients and to identify potential risk factors predictive of increased mortality in this population. Methods. We analyzed the Nationwide Inpatient Sample from 1988 to 2006 to determine the frequency of chronic liver disease among patients with IBD and to determine their in-hospital outcomes. Results. From 1988 to 2006, the age-adjusted rate of chronic liver disease among hospitalized patients with IBD has increased from 4.35 per 100,000 persons in 1988–2001 to 7.45 per 100,000 persons in 2004–2006. The most common etiologies contributing to chronic liver disease among IBD patients were: primary sclerosing cholangitis, unspecified chronic hepatitis, chronic hepatitis C, and nonalcoholic fatty liver disease. Compared to IBD patients without liver disease, there was more than a twofold higher rate of inpatient morality among IBD patients with concomitant liver disease (2.7% vs. 1.3%, p < 0.01). The multivariate analysis showed that factors predictive of inpatient mortality include age >50, spontaneous bacterial peritonitis, ascites, hepatic encephalopathy, presence of cirrhosis, malnutrition, Clostridium difficile colitis, and hospital-acquired pneumonia. Conclusion. There is a higher rate of inpatient mortality among patients with concomitant IBD and chronic liver disease compared to IBD alone. Early recognition and management of complications related to portal hypertension among patients with IBD and chronic liver disease is particularly important in order to reduce inpatient mortality and morbidity.

Mo1254 Reduction in Colectomy- and Health Care-Related Costs in Ulcerative Colitis Patients Treated With Adalimumab Compared With Standard Therapy

Background: There is little information on the frequency of chronic liver disease among hospitalized patients with Inflammatory Bowel Disease (IBD). In this study, we seek to define common etiologies contributing chronic liver disease among IBD patients and identifying potential risk factors predictive of increased mortality in this population. Methods: We analyzed the Nationwide Inpatient Sample from 1988-2006 to determine the frequency of chronic liver disease among patients with IBD and to determine their in-hospital outcomes. A multivariate analysis was performed to identify factors predictive of increased inpatient mortality. Results: From 1988 to 2006, the age-adjusted rate of chronic liver disease among hospitalized patients with IBD has nearly tripled from 0.75 per 100,000 persons in 19882001 to 2.15 per 100, 000 persons in 2004-2006. The most common etiologies contributing to chronic liver disease among Ulcerative Colitis patients were: primary sclerosing cholangitis (50.62%), cryptogenic cirrhosis (20.17%), non-alcoholic fatty liver disease (12.73%), chronic hepatitis C (11.00%), primary biliary cirrhosis (4.15%), and chronic hepatitis B (1.33%). In contrast, the most common etiologies contributing to chronic liver disease in Crohn's patients were: primary sclerosing cholangitis (26.54%), chronic hepatitis C (23.99%), cryptogenic cirrhosis (23.99%), non-alcoholic fatty liver disease 20.26%), chronic hepatitis B (3.05%), and primary biliary cirrhosis (2.17%). Compared to IBD patients without concomitant liver disease, there was a 2.5-fold higher rate of inpatient morality among IBD patients with concomitant liver disease (2.76% vs. 1.29%, p ,0.01). The multivariate analysis showed that factors predictive of inpatient mortality among IBD patients with liver disease include— age .50 (OR 1.83 95% CI 1.44, 2.34), spontaneous bacterial peritonitis (OR 2.93 95% CI 2.24, 3.83), hepatic encephalopathy (OR 3.77, 2.75, 5.16), presence of cirrhosis (1.93 OR 95% CI 1.51, 2.48), and Clostridium difficile colitis (OR 2.36 95% 1.29, 4.32). Geographic location, hospital size, and variceal hemorrhage were not predictive of increased mortality. Conclusions: The age-adjusted rate of chronic liver disease among hospitalized IBD patients has nearly tripled since 1988. There is a higher rate of inpatient mortality among patients with concomitant IBD and chronic liver disease. Factors predictive of increased morality include older age, Clostridium difficile infection, hepatic encephalopathy, spontaneous bacterial peritonitis, and the presence of cirrhosis. Therefore, early recognition and management of complications related to portal hypertension among patients with IBD and chronic liver disease is particularly important in order to reduce inpatient mortality and morbidity.