Liver Disease Status Research Articles

Evaluation and Management of Nutritional Consequences of Chronic Liver Diseases.

Liver diseases are the major predisposing conditions for the development of malnutrition, sarcopenia, and frailty. Recently, the mechanism of the onset of these complications has been better established. Regardless of the etiology of the underlying liver disease, the clinical manifestations are common. The main consequences are impaired dietary intake, altered macro- and micronutrient metabolism, energy metabolism disturbances, an increase in energy expenditure, nutrient malabsorption, sarcopenia, frailty, and osteopathy. These complications have direct effects on clinical outcomes, survival, and quality of life. The nutritional status should be assessed systematically and periodically during follow-up in these patients. Maintaining and preserving an adequate nutritional status is crucial and should be a mainstay of treatment. Although general nutritional interventions have been established, special considerations are needed in specific settings such as decompensated cirrhosis, alcohol-related liver disease, and metabolic-dysfunction-associated fatty liver disease. In this review, we summarize the physiopathology and factors that impact the nutritional status of liver disease. We review how to assess malnutrition and sarcopenia and how to prevent and manage these complications in this setting.

The Triglyceride-Glucose Index is Associated with Vitamin D Status in Metabolic-Associated Fatty Liver Disease.

Vitamin D deficiency was thought to be associated with insulin resistance and metabolic-associated fatty liver disease (MAFLD). The aim of this study was to investigate the relationship between the triglyceride-glucose (TyG) index, a useful surrogate biomarker of insulin resistance, and vitamin D status in patients with MAFLD. A total of 566 patients with MAFLD were included in this retrospective cross-sectional study. Clinical characteristics were compared between participants with and without vitamin D deficiency. The association between the TyG index and serum 25-hydroxyvitamin D [25(OH)D] levels was determined by Spearman correlation analysis and logistic regression analysis. The receiver operating characteristic curve (ROC) was used to assess the diagnostic efficacy of TyG index for vitamin D deficiency in MAFLD patients. The TyG index levels were higher in the vitamin D deficient group than in the non-vitamin D deficient group, and serum 25(OH)D was negatively correlated with the TyG index. The TyG index was an independent risk factor for vitamin D deficiency in patients with MAFLD. The area under the curve (AUC) of the TyG index for the identification of vitamin D deficiency in MAFLD patients was 0.744 (95% CI: 0.701-0.787, p<0.001). The TyG index is negatively associated with vitamin D status in patients with MAFLD. In patients with MAFLD, a higher TyG index may be an indication of a higher prevalence of vitamin D deficiency.

The natural history of cystic fibrosis liver disease a prospective cohort study

BackgroundOur understanding of the natural history of cystic fibrosis liver disease (CFLD) is limited, leading to uncertainty for patients their families and clinicians when liver abnormalities are identified. Aimto determine the incidence of CFLD, identify risk factors and document the natural history of liver abnormalities in cystic fibrosis (CF). MethodsThe Irish longitudinal study of CFLD (ILSCFLD) prospectively enrolled 95% of children with CF in 2007. Their liver disease status was classified as (i) advanced liver disease with portal hypertension (CFLD). (ii) nonspecific cystic fibrosis liver disease (NSCFLD) (iii) no liver disease (NoLD) Results480/522 (91.9%) children were followed for a median 8.53 years IQR 1.28, of whom 35 (7.29%) had CFLD, 110 (22.9%) NSCFLD and 335 (69.79%) had NoLD. At follow-up 28/445 (6.29%) participants without CFLD at baseline, progressed to CFLD (Incidence 7.51/1000 person years (Pyrs) (95%CI 4.99–10.86). Of these 25/28(89.28%) were <10 years. No participant >10 years of age without clinical or radiological evidence of liver disease at baseline progressed to CFLD.During follow-up 18/35(51.43%) participants with CFLD died or received a transplant, MTx rate 7.75/100 Pyrs (95%CI 4.59–12.25) compared to NSCFLD 2.33/100 Pyrs (95%CI 1.44–3.56) and NoLD 1.13/100 Pyrs (95%CI 0.77–1.59). CFLD was an independent risk factor for mortality in CF. Children with CFLD also had a shorter life expectancy. ConclusionThe incidence of CFLD was highest in children under10 years. Children over10 years, with normal hepatic function did not develop CFLD. Research to identify the cause and improve outcome should focus on young children.

Follow-up of liver metastases: a comparison of deep learning and RECIST 1.1.

To compare liver metastases changes in CT assessed by radiologists using RECIST 1.1 and with aided simultaneous deep learning-based volumetric lesion changes analysis. A total of 86 abdominal CT studies from 43 patients (prior and current scans) of abdominal CT scans of patients with 1041 liver metastases (mean = 12.1, std = 11.9, range 1-49) were analyzed. Two radiologists performed readings of all pairs; conventional with RECIST 1.1 and with computer-aided assessment. For computer-aided reading, we used a novel simultaneous multi-channel 3D R2U-Net classifier trained and validated on other scans. The reference was established by having an expert radiologist validate the computed lesion detection and segmentation. The results were then verified and modified as needed by another independent radiologist. The primary outcome measure was the disease status assessment with the conventional and the computer-aided readings with respect to the reference. For conventional and computer-aided reading, there was a difference in disease status classification in 40 out of 86 (46.51%) and 10 out of 86 (27.9%) CT studies with respect to the reference, respectively. Computer-aided reading improved conventional reading in 30 CT studies by 34.5% for two readers (23.2% and 46.51%) with respect to the reference standard. The main reason for the difference between the two readings was lesion volume differences (p = 0.01). AI-based computer-aided analysis of liver metastases may improve the accuracy of the evaluation of neoplastic liver disease status. AI may aid radiologists to improve the accuracy of evaluating changes over time in metastasis of the liver. • Classification of liver metastasis changes improved significantly in one-third of the cases with an automatically generated comprehensive lesion and lesion changes report. • Simultaneous deep learning changes detection and volumetric assessment may improve the evaluation of liver metastases temporal changes potentially improving disease management.

Oxidative balance score is inversely associated with the incidence of non-alcoholic fatty liver disease

The contribution of the balance between overall oxidative stress and antioxidant status in non-alcoholic fatty liver disease (NAFLD) is unclear. The oxidative balance score (OBS) comprises dietary and lifestyle pro- and antioxidant components that indicate the overall oxidative stress burden. We investigated the association between OBS and the incidence of NAFLD in middle-aged and older Korean adults. Among the 10,030 participants of the Korean Genome and Epidemiology Study_Ansan and Ansung cohort, 5065 without NAFLD at baseline were selected for secondary analysis. OBS was categorized into quartiles. Multiple Cox proportional hazard regression analyses were performed to estimate the hazard ratio (HR) and 95% confidence interval (CI) for NAFLD incidence by sex-specific OBS quartile groups after adjusting for confounders. During the follow-up period (median 13.4 years), 913 (43.2%) men and 1288 (43.9%) women were newly diagnosed with NAFLD. Compared with that of the lowest quartile (Q1) group, the adjusted HR (95% CI) for NAFLD incidence in Q2, Q3, and Q4 groups was 0.85 (0.71-1.00), 0.65 (0.54-0.78), and 0.50 (0.40-0.62) in men, and 0.85 (0.73-0.99), 0.66 (0.56-0.77), and 0.48 (0.40-0.59) in women, respectively, and for NAFLD incidence, per incremental change in OBS, was 0.90 (0.87-0.92) in men and 0.88 (0.86-0.90) in women. A higher OBS was significantly associated with a lower risk for NAFLD incidence. Maintaining a healthy lifestyle and an antioxidant-rich diet is a potentially viable strategy for preventing NAFLD.

Transition patterns of metabolic dysfunction-associated fatty liver disease status in relation to arterial stiffness progression: a health check-up cohort study

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new diagnostic criterion based on hepatic steatosis and metabolic dysfunction. However, a comprehensive evaluation of the association of MAFLD dynamic transitions with arterial stiffness progression has yet to be conducted. This cohort study included 8807 Chinese health check-up participants (median follow-up = 50.2 months). Participants were categorized into four groups according to MAFLD status at baseline and follow-up (none, persistent, developed and regressed). Arterial stiffness progression was assessed by the annual brachial-ankle pulse wave velocity (ba-PWV) increase and arterial stiffness incidence. Compared with the non-MAFLD group, the annual increase in ba-PWV was highest in the persistent-MAFLD group [6.75 cm/s/year, (95% CI 4.03–9.33)], followed by the developed—[6.35 cm/s/year, (95% CI 3.80–8.91)] and the regressed—[1.27 cm/s/year, (95% CI − 2.18 to 4.72)] MAFLD groups. Similarly, compared with the non-MAFLD group, the persistent-MAFLD group had a 1.31-fold increased arterial stiffness risk [OR 1.31; 95% CI 1.03–1.66]. The associations of MAFLD transition patterns with arterial stiffness incidence did not differ across any clinically specific subgroups evaluated. Furthermore, the potential effect of dynamic changes in cardiometabolic risk factors on arterial stiffness incidence among persistent-MAFLD participants was mostly driven by annual fasting glucose and triglyceride increases. In conclusion, persistent MAFLD was associated with an increased risk of arterial stiffness development. Moreover, in persistent-MAFLD subjects, elevated blood glucose and triglyceride levels might facilitate the arterial stiffness incidence.

THU-466 - The risk of liver-related long term outcomes is altered by dynamic changes in metabolic dysfunction-associated fatty liver disease status: a nationwide cohort study

THU-466 - The risk of liver-related long term outcomes is altered by dynamic changes in metabolic dysfunction-associated fatty liver disease status: a nationwide cohort study

Roux-en-Y gastric bypass induces hepatic transcriptomic signatures and plasma metabolite changes indicative of improved cholesterol homeostasis

Roux-en-Y gastric bypass (RYGB), the most effective surgical procedure for weight loss, decreases obesity and ameliorates comorbidities, such as non-alcoholic fatty liver (NAFLD) and cardiovascular (CVD) diseases. Cholesterol is a major CVD risk factor and modulator of NAFLD development, and the liver tightly controls its metabolism. How RYGB surgery modulates systemic and hepatic cholesterol metabolism is still unclear. We studied the hepatic transcriptome of 26 patients with obesity but not diabetes before and 1 year after undergoing RYGB. In parallel, we measured quantitative changes in plasma cholesterol metabolites and bile acids (BAs). RYGB surgery improved systemic cholesterol metabolism and increased plasma total and primary BA levels. Transcriptomic analysis revealed specific alterations in the liver after RYGB, with the downregulation of a module of genes implicated in inflammation and the upregulation of three modules, one associated with BA metabolism. A dedicated analysis of hepatic genes related to cholesterol homeostasis pointed towards increased biliary cholesterol elimination after RYGB, associated with enhancement of the alternate, but not the classical, BA synthesis pathway. In parallel, alterations in the expression of genes involved in cholesterol uptake and intracellular trafficking indicate improved hepatic free cholesterol handling. Finally, RYGB decreased plasma markers of cholesterol synthesis, which correlated with an improvement in liver disease status after surgery. Our results identify specific regulatory effects of RYGB on inflammation and cholesterol metabolism. RYGB alters the hepatic transcriptome signature, likely improving liver cholesterol homeostasis. These gene regulatory effects are reflected by systemic post-surgery changes of cholesterol-related metabolites, corroborating the beneficial effects of RYGB on both hepatic and systemic cholesterol homeostasis. Roux-en-Y gastric bypass (RYGB) is a widely used bariatric surgery procedure with proven efficacy in body weight management, combatting cardiovascular disease (CVD) and non-alcoholic fatty liver disease (NAFLD). RYGB exerts many beneficial metabolic effects, by lowering plasma cholesterol and improving atherogenic dyslipidemia. Using a cohort of patients undergoing RYGB, studied before and 1 year after surgery, we analyzed how RYGB modulates hepatic and systemic cholesterol and bile acid metabolism. The results of our study provide important insights on the regulation of cholesterol homeostasis after RYGB and open avenues that could guide future monitoring and treatment strategies targeting CVD and NAFLD in obesity.

The change of non-alcoholic fatty liver disease is associated with risk of incident diabetes.

The effect of change in non-alcoholic fatty liver disease (NAFLD) status on incident diabetes has not been well studied. We aimed to investigate the association of NAFLD development and remission with the risk of incident diabetes during a median of 3.5-year follow-up. A total of 2690 participants without diabetes were recruited in 2011-2012 and assessed for incident diabetes in 2014. Abdominal ultrasonography was used to determine the change of NAFLD. 75g oral glucose tolerance test (OGTT) was performed to determine diabetes. NAFLD severity was assessed using Gholam's model. The odds ratios (ORs) for incident diabetes were estimated by logistic regression models. NAFLD was developed in 580 (33.2%) participants and NAFLD remission occurred in 150 (15.9%) participants during a median of 3.5-year follow-up. A total of 484 participants developed diabetes during follow-up, including 170 (14.6%) in consistent non-NAFLD group, 111 (19.1%) in NAFLD developed group, 19 (12.7%) in NAFLD remission group, and 184 (23.2%) in sustained NAFLD group. The development of NAFLD increased the risk of incident diabetes by 43% (OR, 1.43; 95%CI, 1.10-1.86) after adjustment for multiple confounders. Compared with sustained NAFLD group, remission of NAFLD reduced the risk of incident diabetes by 52% (OR, 0.48; 95%CI, 0.29-0.80). The effect of NAFLD alteration on incident diabetes was not changed after adjustment for body mass index or waist circumference, change of body mass index or waist circumference. In NAFLD remission group, participants with non-alcoholic steatohepatitis (NASH) at baseline were more likely to develop diabetes (OR, 3.03; 95%CI, 1.01-9.12). NAFLD development increases the risk of incident diabetes, whereas NAFLD remission reduces the risk of incident diabetes. Moreover, presence of NASH at baseline could attenuate the protective effect of NAFLD remission on incident diabetes. Our study suggests that early intervention of NAFLD and maintenance of non-NAFLD are important for prevention of diabetes.

Transient decrease in B-type natriuretic peptide level after liver transplantation does not ensure favorable post-transplant 30-day outcomes.

High B-type natriuretic peptide (BNP) levels within the first 3 postoperative days (postBNPPOD3) after liver transplantation (LT) are greatly predictive of the 30-day mortality. We evaluated clinical impact of transient decrease in postBNPPOD3 compared to pretransplant BNP (preBNP) level on mortality and major adverse cardiac event (MACE) within 30 days after LT. We retrospectively evaluated 3,811 LT patients who measured delta BNP (deltaBNP), defined by serial postBNPPOD3 minus preBNP. Thirty-day all-cause mortality and MACE were estimated in patients with deltaBNP < 0 (n = 594, 15.6%) and > 0 (n = 3,217, 84.4%), respectively. Kaplan-Meier survival and multivariable Cox regression analysis were used. Within 30 days, 100 (2.6%) of all patients died. Unexpectedly, 30-day mortality rate (6.1% [95% CI: 4.2-8.4%] vs. 2.0% [95% CI: 1.5-2.5%], P < 0.001) and MACE (24.2% [95% CI: 20.4-28.5%] vs. 15.3% [95% CI: 14.0-16.7%], P < 0.001) were higher in patients with deltaBNP < 0 compared to those with deltaBNP > 0, respectively. Patients with deltaBNP < 0 had higher preBNP level (median [interquartile range], 251 [118, 586] vs. 43 [21, 92] pg/ml, P < 0.001) and model for end-stage liver disease score (26 [14, 37] vs. 14 [9, 23], P < 0.001) and more transfused intraoperatively. DeltaBNP < 0 remained significant after adjustments for potential confounders in multivariable analysis of 30-day mortality and MACE. DeltaBNP < 0 within the first 3 postoperative days is mainly attributed to pre-LT severe liver and cardiac disease status, therefore, transient decrease in BNP level after LT does not ensure favorable post-LT 30-day outcomes.

Impact of General Anesthesia on the Right Atrial Pressure During Transjugular Intrahepatic Portosystemic Shunt Creation: A Propensity Score Match Analysis.

To evaluate the effect of general anesthesia on right atrial (RA) pressure measurements during transjugular intrahepatic portosystemic shunt (TIPS) placement using propensity score match analysis. A single-institution database was used to identify 664 patients who underwent TIPS creation under either conscious sedation (CS) or general anesthesia (GA) between 2009 and 2018. A propensity-matched cohort was created using logistic regression of sedation method on demographics, liver disease status, and indications. Paired analyses were performed using mixed models for RA pressure and Cox proportional hazards model with robust standard errors for mortality. Of the 664 patients, 270 patients were matched based on similar characteristics (135 for GA and 135 for CS). Indications for TIPS creation included intractable ascites (n = 170, 63%), hepatic hydrothorax (n = 30, 11%), variceal bleeding (n = 43, 16%), and other (n = 27, 10%). Pre-TIPS RA pressure was greater in the matched GA group as compared to CS group by a mean of 4.2mmHg (p < 0.0001). Similarly, post-TIPS RA pressure was greater in the matched GA group as compared to CS group by a mean of 3.3mmHg (p < 0.0001). Pre- and post-procedure RA pressure was found to have no association with post-procedure mortality (0.8891, HR 1.077; p 0.917, HR 0.997; respectively). Utilization of GA during TIPS creation raises the intra-procedural RA pressure compared to CS. However, this elevated intra-procedural RA pressure does not appear to be predictive of mortality post-TIPS creation.

Association between the dual use of electronic and conventional cigarettes and NAFLD status in Korean men.

This study investigated the association between smoking types, including dual use (usage of both combustible cigarettes and e-cigarettes), and non-alcoholic fatty liver disease (NAFLD) status in Korean men. Data from the 7th and 8th Korea National Health and Nutrition Examination Survey (KNHANES) 2016-2020 were used. The presence of NAFLD was defined by the respective cut-off values for the Hepatic Steatosis Index (HSI), NAFLD Ridge Score (NRS), and Korea National Health and Nutrition Examination Survey NAFLD score (KNS). Multivariate logistic regression analyses were used to determine the associations between smoking types and NAFLD as determined by HSI, NRS, and KNS. After adjustment for confounders, an independent association was observed between dual use and NAFLD (HSI: AOR=1.47; 95% CI: 1.08-1.99, p=0.014; NRS: AOR=2.21; 95% CI: 1.70-2.86, p=0.000; KNS: AOR=1.35; 95% CI: 1.01-1.81, p=0.045). Cigarette only smokers also had significantly higher odds of NAFLD compared to never smokers for all of the NAFLD indices (HSI: AOR=1.22; 95% CI: 1.05-1.42, p=0.008; NRS: AOR=2.13; 95% CI: 1.87-2.42, p=0.000; KNS: AOR=1.33; 95% CI: 1.14-1.55, p=0.000). In subgroup analyses, no significant interaction effects were found for age, BMI, alcohol consumption, income, physical activity, and the diagnosis of T2DM. Moreover, cigarette only smokers and dual users differed significantly in terms of log-transformed urine cotinine and pack-years. The relationship between smoking type and pack-years was attenuated after stratification by age. This study shows that the dual use of e-cigarettes and combustible cigarettes is associated with NAFLD. Age differences may explain why dual users, with a greater proportion of young people, appear to have fewer pack-years than cigarette only smokers. Further research should be conducted to investigate the adverse effects of dual use on hepatic steatosis.

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic biomarkers in unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (atezo-bev).

504 Background: Although Atezo-Bev is the standard of care front line therapy for patients with unresectable HCC, a clinically relevant proportion of patients do not respond, underscoring the need to identify patients most likely to benefit from this therapy. Systemic inflammation is a key risk factor for HCC tumorigenesis and progression and has been associated with poor clinical outcomes. We aimed to evaluate the prognostic value of the inflammatory markers, NLR and PLR, in patients with HCC treated with Atezo-Bev. These markers also have the advantage of being readily available in routine practice and inexpensive. Methods: The association of NLR and PLR with overall survival (OS) was analyzed using a retrospective database of patients with unresectable HCC treated with Atezo-Bev at 14 institutions across the United States, Europe, and Asia from 2019 to 2022. The effect of NLR and PLR on progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) was also assessed. Outcomes of patients with NLR ≥ 5 vs. NLR &lt; 5 and PLR ≥ 300 vs. PLR &lt; 300 were compared. Univariable and multivariable logistic regression models were used to evaluate associations, and survival analyses were performed using the Kaplan-Meier method. Results: The cohort consisted of 296 patients, with a median age of 66 years. The majority of the patients were male (83%), cirrhotic (75%), and had a viral etiology of HCC (66%). All included patients had Child Pugh class A liver disease and good performance status with ECOG score either 0 (47%) or 1 (53%). After a median follow-up of 9.93 months, patients with NLR ≥ 5 had a shorter OS compared to patients with NLR &lt; 5 in univariate analysis (hazard ratio [HR] 2.71, 95% CI 1.71-4.27, P &lt; 0.001), and in multivariate analysis, NLR ≥ 5 remained an independent prognosticator of worse OS (HR 2.01, 95% CI 1.22-3.56, P = 0.007). PLR ≥ 300, compared to PLR &lt; 300, was also associated with shorter OS (HR 2.24, 95% CI 1.71-4.27, P = 0.007) in univariate analysis but not in multivariate analysis (HR 1.01, 95% CI 0.52-1.96, P = 0.99). Both NLR ≥ 5 and PLR ≥ 300 were correlated with shorter PFS on univariate analysis (HR 1.54, 95% CI 1.05-2.25, P = 0.03; HR 1.72, 95% CI 1.04-2.83, P = 0.04; respectively) but not in multivariate analysis (HR 1.31, 95% CI 0.84-2.04, P = 0.24; HR 1.18, 95% CI 0.65-2.13, P = 0.59; respectively). NLR ≥ 5 and NLR &lt; 5 did not differ in ORR (24% vs. 32%, P = 0.39) or DCR (71% vs. 79%, P = 0.24). No differences were observed between patients with PLR ≥ 300 vs. patients with PLR &lt; 300 in ORR (33% vs. 30%, P = 0.81) or DCR (62% vs. 70%, P = 0.09). Conclusions: NLR ≥ 5 was an independent prognosticator of worse OS in patients with unresectable HCC treated with Atezo-Bev and is a prognostic marker worthy of further study and validation.

Safety and Efficacy of Endoscopic Retrograde Cholangio-Pancreatography in Patients of Liver Cirrhosis: A Case-Control Study.

Background With the improvement in noninvasive diagnostic imaging modalities, Endoscopic Retrograde Cholangio-Pancreatography (ERCP) has evolved into a primarily therapeutic procedure. Besides being efficacious and one of the most commonly done procedures, ERCP is also associated with a high risk of complications. However, there is a lack of studies analyzing the safety and success of ERCP in patients with liver cirrhosis. We retrospectively evaluated the outcome of ERCP in patients with cirrhosis of the liver compared to non-cirrhotic patients using the database from our institute. Methods Patients with liver cirrhosis who underwent ERCP from January 2010 to March 2020 were analyzed. This was a matched case-control study in which one cirrhotic patient undergoing ERCP was age and gender-matched randomly to one non-cirrhotic patient. We compared adverse events and the success rate of ERCP between cirrhotic patients and non-cirrhotic patients. The primary outcome of the study was analyzing the prevalence of procedure-related adverse events and their independent risk factors in patients of cirrhosis compared to the non-cirrhotic population. Results Two hundred patients were analyzed in both groups. Choledocholithiasis was the most common reason for ERCP in both groups. Mean Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease (MELD) score in the cirrhosis group were 9.16 ±1.78 and 19.09 ±7.06 respectively. Patients in the cirrhosis group had a significantly higher frequency of complications compared to the controls: 41 (20.5 %) versus 15 (7.5%), p < 0.01. Bleeding was the most common adverse event in both groups: 19 (9.5%) vs 6(3%). High International Normalised Ratio (INR), low platelets, and cholangitis at presentation were independently predictive of post-ERCP complications. Despite a similar technical success rate, the clinical success rate was lower in the cirrhotic than in the noncirrhotic group (83.9% versus 97.9%, p=0.006). Conclusion The prevalence of complications following ERCP was nearly three-fold higher in patients with cirrhosis than in non-cirrhotic patients. These events were related primarily to cholangitis, coagulopathy, and the advanced status of chronic liver disease.

993: UTILIZATION OF PALLIATIVE CARE CONSULTS IN LIVER DISEASE PATIENTS AT A MAJOR LIVER TRANSPLANT CENTER

Introduction: Palliative care (PC) consults for end-stage liver disease patients are underutilized. Reasons cited include misconceptions about PC and poor reimbursement. However, early consults have shown to improve symptom management and lower costs. University Hospital (UH) is a transplant center providing advanced liver care. Our study looks at UH’s use of PC consults compared to other centers, and of aggressive therapies and code status changes in patients with versus without PC consultation. Methods: 100 patients were randomly selected from a “liver pre-transplant” list between 01/01/2021 – 01/01/2022. We collected: sex, age, undergoing orthoptic liver transplant (OLT) evaluation, listed or transplanted, admission related to liver disease and code status. We looked at the most recent/relevant admission for any ICU care, whether palliative care consults were placed outside or in ICU and any code status changes. For patients with an ICU stay, we recorded data on intubation, pressors and continuous veno-venous hemodialysis (CVVHD) use. Results: Of the 100 patients, 26 were under OLT evaluation: 11 were listed, 15 were not. Of the 74 patients not under evaluation, 39 were transplanted and 35 not listed. Of the OLT listed patients, 6 (54.55%) were admitted. None required ICU and 1 (16.67%) had a PC consult and a code status change. Of those not evaluated/listed/transplanted, 12 patients (34.29%) were admitted; 2 (16.67%) required ICU and 3 (25%) had PC consulted with 1 done in the ICU with a code status change. Out of all the admissions that required ICU level of care, 17 (80.95%) underwent intubation, 5 (23.81%) required pressors, and 6 (28.57%) underwent CVVHD. Of those with ICU stays and PC consults, 3 (75%) required pressors and CVVHD and all were intubated. Conclusions: 25% of admitted non-OLT-listed patients and 16.67% of OLT listed patients had PC consults. Other studies reported 34.4% of non-transplanted and 11% of de-listed/non-transplant patients were referred to PC. Overall, UH demonstrates a similar utilization of PC consultation as other liver centers. Use of aggressive therapies did not appear to be influenced by PC. Study limitations include a small sample size only from a single admission. Future studies should examine how including PC in pre-OLT evaluations would affect patient outcomes.

Gastrointestinal manifestations in patients with COVID-19 it’s correlation with overall clinical outcomes

Background: The coronavirus disease 2019 (COVID-19) is not just a disease of the respiratory system. The virus can affect the gastrointestinal (GI) tract as well. Recognizing the various manifestations in every organ system is important because these manifestations can contribute to community-based transmission. Aim: The aim of this study is to report the impact of gastrointestinal associated with coronavirus disease (COVID-19). Methods: A retrospective study was conducted in our COVID-19 isolation department at Queen Alia Military Hospital, Royal Medical Services, Amman, Jordan between Mar 2020 and Sep 2021 for all eligible COVID-19 infected hospitalized patients. Because of the retrospective nature of our research, a sign consent form was waived. All admitted COVID-19 infected patients, who were admitted for at least 3 days and whose retrieved data from our electronic medical record system (Hakeem) were available, were grouped into either Higher Liver Disease Status (Status I) and Lower Liver Disease Status (Status II). Higher versus lower liver disease statuses were based on Child-Pugh Score ≥8 or &lt;8, respectively. An independent T-Tests was used to analyze the non-parametric and parametric outcomes’ data.

NON-ALCOHOLIC FATTY LIVER DISEASE AND ITS ASSOCIATION WITH ANTHROPOMETRY, GLYCEMIC STATUS AND DYSLIPIDEMIA IN TYPE 2 DIABETES MELLITUS

Non-alcoholic fatty liver diseaseis emergingto be a major health issue globally and is seen with high prevalence in patients suffering from type 2 diabetes mellitus. It has shown strong association with insulin resistance and obesity.Our study intended to study the link betweenNon-alcoholic fatty liver disease and glycemic status, anthropometryalong with dyslipidemia in type 2 diabetes mellitus. This study has been done in a tertiary Institute fromNovember 2019 to October 2021.Total 126 Type 2 diabetics fulfilling inclusion criteria were included in this study. Non-alcoholic fatty liver disease was seen among 77 (61.11%) patients. The statistically significant parameters werewaist circumference ,Body Mass Index, , waist to hip ratio, raised post meal sugars, Glycated Hemoglobin, cholesterol levels, Triglycerides, LDL-C, and raised Transaminases (SGOT and SGPT).Type 2 diabetes mellitus and Non alcoholic fatty liver diseaseare part in a vicious cycle that contributes to cardiometabolic risk factors for future micro and macro-vascular problems.This leads to a breakdown in glycemic control and alterations in lipid level. Thus, non-alcoholic fatty liver disease can be considered to be a target to treat for diabetics especially those with considerable fibro progression and relevant family history of metabolic problems.Patients inflictedwith Type 2 diabetes mellitus may need early screening to prevent complications of liver disease

Causal relationships between metabolic-associated fatty liver disease and iron status: Two-sample Mendelian randomization.

Dysregulated iron homeostasis plays an important role in the hepatic manifestation of metabolic-associated fatty liver disease (MAFLD). We investigated the causal effects of five iron metabolism markers, regular iron supplementation and MAFLD risk. Genetic summary statistics were obtained from open genome-wide association study databases. Two-sample bidirectional Mendelian randomization analysis was performed to estimate the causal effect between iron status and MAFLD, including Mendelian randomization inverse-variance weighted, weighted median methods and Mendelian randomization-Egger regression. The Mendelian randomization-PRESSO outlier test, Cochran's Q test and Mendelian randomization-Egger regression were used to assess outliers, heterogeneity and pleiotropy respectively. Mendelian randomization inverse-variance weighted results showed that the genetically predicted per standard deviation increase in liver iron (Data set 2: odds ratio 1.193, 95% confidence interval [CI] 1.074-1.326, p=.001) was associated with an increased MAFLD risk, consistent with the weighted median estimates and Mendelian randomization-Egger regression, although Data set 1 was not significant. Mendelian randomization inverse-variance weighted analysis showed that genetically predicted MAFLD was significantly associated with increased serum ferritin levels in both datasets (Dataset 1: β=.038, 95% CI=.014 to .062, p=.002; Dataset 2: β=.081, 95% CI=.025 to .136, p=.004), and a similar result was observed with the weighted median methods for Dataset 2 instead of Mendelian randomization-Egger regression. This study uncovered genetically predicted causal associations between iron metabolism status and MAFLD. These findings underscore the need for improved guidelines for managing MAFLD risk by emphasizing hepatic iron levels as a risk factor and ferritin levels as a prognostic factor.

Medications for early treatment of COVID-19 in Australia.

Early treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can prevent hospitalisation and death in patients with coronavirus disease 2019 (COVID-19) who have one or more risk factors for serious COVID-19 progression. While early treatment presents a range of logistical challenges, clinicians are nevertheless aided by a growing number of approved medications for early treatment of COVID-19. Medications include drugs that inhibit SARS-CoV-2 viral replication, anti-SARS-CoV-2 monoclonal antibody formulations that provide passive immunisation, and immunomodulatory drugs that suppress the body's inflammatory response. Several drugs with different modes of action are approved in Australia for early treatment of COVID-19, including nirmatrelvir plus ritonavir, molnupiravir, and monoclonal antibody formulations. Although these drugs are recommended, clinicians are encouraged to remain up to date on current indications, contraindications and the clinical efficacy of these drugs against SARS-CoV-2 variants currently circulating in communities. Other treatments, including hydroxychloroquine, ivermectin and dietary supplements, have been popularised but are not recommended for early treatment of COVID-19. As new drugs and new data on use of existing approved drugs become available, clinicians face a growing challenge in determining the optimal treatments from the array of options. As it stands, early treatment of COVID-19 needs to be individualised depending on age, pregnancy status, existing medications, and renal and liver disease status. Future treatments in development might have roles in patients with lower risk profiles and in reducing transmission as we learn to live with SARS-CoV-2.

Parenchyma-Sparing Liver Resection or Regenerative Liver Surgery: Which Way to Go?

Liver resection for malignant tumors should respect oncological margins while ensuring safety and improving the quality of life, therefore tumor staging, underlying liver disease and performance status should all be attentively assessed in the decision process. The concept of parenchyma-sparing liver surgery is nowadays used as an alternative to major hepatectomies to address deeply located lesions with intricate topography by means of complex multiplanar parenchyma-sparing liver resections, preferably under the guidance of intraoperative ultrasound. Regenerative liver surgery evolved as a liver growth induction method to increase resectability by stimulating the hypertrophy of the parenchyma intended to remain after resection (referred to as future liver remnant), achievable by portal vein embolization and liver venous deprivation as interventional approaches, and portal vein ligation and associating liver partition and portal vein ligation for staged hepatectomy as surgical techniques. Interestingly, although both strategies have the same conceptual origin, they eventually became caught in the never-ending parenchyma-sparing liver surgery vs. regenerative liver surgery debate. However, these strategies are both valid and must both be mastered and used to increase resectability. In our opinion, we consider parenchyma-sparing liver surgery along with techniques of complex liver resection and intraoperative ultrasound guidance the preferred strategy to treat liver tumors. In addition, liver volume-manipulating regenerative surgery should be employed when resectability needs to be extended beyond the possibilities of parenchyma-sparing liver surgery.