bluuebunny/crossref_metadata_2025_split huggingface dataset:
2955 Nearly One-Half of Patients With Recurrence of Hepatocellular Carcinoma Did Not Receive Any HCC-Directed Surgical Therapies: An Analysis of the 1973-2015 Surveillance Epidemiology and End Results Cancer Database
Authors: Zhang Julia A. , Hirode Grishma , Wong Robert 
Published: October 2019

INTRODUCTION:
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality with high rates of recurrence despite treatment. The characteristics and outcomes of HCC recurrence are not well studied. We utilize a national cancer registry to evaluate predictors of overall survival in recurrent HCC.

METHODS:
Using National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer registry, we retrospectively evaluated U.S. adults with recurrence of HCC from 1973-2015. HCC tumor stage was assessed with the SEER historic staging system (localized, regional, distant) and HCC treatment was assessed using SEER's site-specific surgery variable (no treatment, locoregional therapy, surgical resection, and liver transplantation (LT)). Overall survival was evaluated using Kaplan Meier and Cox proportional hazards models.

RESULTS:
Among 275 patients with recurrence of HCC (76.7% male, mean age at initial HCC diagnosis 61 ± 11 years, 48.7% non-Hispanic white, 14.9% Hispanic, 7.6% African American, 27.6% Asian/Pacific Islanders), the majority of patients had localized stage at initial HCC diagnosis (76.4%). At time of HCC recurrence, the proportion of patients with distant/advanced stage was 4 times higher than at initial diagnosis (8.7% vs. 2.2%, P < 0.01). At initial HCC diagnosis, 24.6% did not receive any HCC-directed surgical therapies. At the time of recurrence, overall treatment rates were significantly lower, with 46.6% not receiving any HCC-directed surgical therapies and only 28.7% receiving surgical resection or LT. Median survival was 98 months (95% CI 85-118) after initial HCC diagnosis and 36 months (95% CI 31-48) after HCC recurrence. Significantly higher risk of death was associated with increasing age at time of HCC diagnosis (HR 1.02, 95% CI 1.01–1.04, P < 0.01) and distant stage at diagnosis of recurrence compared to localized stage (HR 2.11, 95% CI 1.26-3.53, P < 0.01). There was a trend towards lower risk of death in Asians compared to non-Hispanic whites (HR 0.67, 95% CI 0.44-1.03, P = 0.07). Receipt of any HCC-directed surgical therapy either for the initial HCC or HCC recurrence was associated with significantly lower risk of death.

CONCLUSION:
Among U.S. adults who developed recurrence of HCC, nearly half did not receive any HCC-directed surgical therapy at time of HCC recurrence. Older age and more advanced tumor stage at recurrence were associated with significantly higher risk of death despite HCC treatment.
2957 Retrospective Review of Patients With Chronic Hepatitis B in Las Vegas, Nevada
Authors: Fajardo Noel R. , Cremonini Filippo , Lapasaran Alex , Dela Cruz-Acupan Jasmine 
Published: October 2019

INTRODUCTION:
The estimated annual incidence of clearance of Hepatitis B surface antigen (HBsAg) is 1–2% in Asian populations. The spontaneous seroclearance of HBsAg in patients with chronic Hepatitis B infection in the Western world is seldomly reported. HBsAg loss is a relatively rare outcome in the natural history of chronic Hepatitis B. Aim of this study was to assess the incidence of spontaneous seroconversion of Hepatitis B surface antigen and the natural development of immunity to HBV virus as evidenced by development of Hepatitis B surface antibody (HBsAb) in a US-based outpatient population.

METHODS:
Electronic medical records from January 2010 to May 2019 at a large outpatient community-based Gastroenterology practice were retrospectively reviewed. Seroconversion of HBsAg and appearance of HBsAb were recorded. Serologic markers for Hepatitis B infection, AST, ALT, and alpha fetoprotein levels were also recorded.

RESULTS:
A total of 263 charts were reviewed. One hundred seventy nine (179/263; 68%) of these patients had a positive HBsAg upon referral. Fifty five had a history of Hep B treatment; 124 (124/179; 69%) were treatment-naïve. Forty six (46/179; 26%) had chronic active Hepatitis B, and seventy three (73/179; 40%) were lost to follow up. Five (5/179; 2.7%) patients seroconverted to negative HBsAg. Four of these patients subsequently developed immunity as evidenced by the appearance of HBsAb (4/179; 2.2%). Sixty seven (67/263; 25.5%) of all referred patients had immunity to Hepatitis B through natural infection. Thirteen (13/263; 4.9%) patients had incomplete serologies; 4 (4/263; 1.5%) patients were caught in the “window period” with both negative HBsAg and HBsAb. All four patients who had a documented loss of HBsAg were male, Asians (Filipino), aged 48-65 years. The average time from referral to HBsAg clearance was 8-9 years. None of the 4 patients had a positive Hepatitis delta agent, concomitant infection with Hepatitis C, or elevated AFP.

CONCLUSION:
Chronic HBV infection poses a significant socio-economic burden specially among immigrant communities from endemic geographic regions. Continued adherence to CDC guidelines for HBV screening should be encouraged among high risk patient populations. Further race/ethnicity and community based studies on the natural history of chronic HBV infection will further increase knowledge of disease prevention and cure.
2958 Assessing the Association Between Psoriasis and Nonalcoholic Liver Disease
Authors: Sarmini Muhammad Talal , Asfari Mohammad Maysara , Fahad Hamna , Alomari Mohammad , Al-Khadra Yasser , Dasarathy Srinivasan , McCullough Arthur J. 
Published: October 2019

INTRODUCTION:
Psoriasis is an inflammatory disorder that is associated with increased risk for multiple comorbidities. It is reported in the literature that psoriasis can increase the risk for nonalcoholic fatty liver disease (NAFLD) which is the most common liver disease in the United States (US). We aimed in this study to assess the risk for NAFLD in psoriasis patients using large database.

METHODS:
Using data from the National Inpatient Sample (NIS) database between 2002 and 2014, we identified patients who were diagnosed with psoriasis. The control group was the patients who did not have a diagnosis of psoriasis. We then performed multivariate logistic regression analysis for the association between NAFLD and psoriasis.

RESULTS:
The total population was comprised of 101,137,145 patients, of which 274,491 (0.271%) were diagnosed with psoriasis. These patients with psoriasis were older (60 vs 48) and less likely to be females (49.1% vs 58.4%) and African American (6% vs 14.3%) (P < 0.001). In addition, psoriasis patients had more diabetes mellitus with or without complications (4.7% vs 3.2%) and (22.5% vs 14.1%) respectively (P < 0.001 for all). Furthermore, the psoriasis patients had more hypertension (HTN) (54.4% vs 36.4%), hyperlipidemia (HLD) (23.3% vs 13.4%), obesity (16.4% vs 6.9%) and hypothyroidism (12.2% vs 7.8%) (P < 0.001 for all). Using Multivariate logistic regression, and after adjusting for potential cofounding factors including: (age, race, gender, HTN, HLD, DM, hypothyroidism and obesity), psoriasis patients had a statistically significant higher rate of NAFLD (Odds Ratio [OR], 2.13, 95% confidence interval [CI], 2.05-2.22, P < 0.001).

CONCLUSION:
Based on these data, patients with psoriasis are twice more likely to have NAFLD which is known to increases the risk for cardiovascular disease and diabetes mellitus. Early recognition and appropriate treatment which includes mainly life style modifications and controlling risk factors for NAFLD are essential in preventing progression of NAFLD in these patients.
2959 How Does the FibroScan® Agree With the Liver Biopsy With Respect to Hepatic Steatosis and Fibrosis?
Authors: Lopez Carmen , Rao Shanti , Faruqui Saamia , Howard Elizabeth , Moehlen Martin 
Published: October 2019

INTRODUCTION:
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries. Liver biopsy is the current gold standard to diagnose, grade, and stage NAFLD; however, it is invasive, costly, and prone to sampling error. Fibroscan® (FS) is an FDA approved noninvasive test that employs vibration-controlled transient elastography to estimate liver fibrosis. FS also has a “controlled attenuation parameter” (CAP) that measures the degree of attenuation by hepatic fat. Many non-U.S. based studies have supported the use of CAP in the estimation of hepatic steatosis. Due to Louisiana's unique biodiversity, there is a theoretical conundrum that generalizability of outside data on CAP may not be reliable on local subjects. Therefore, we aim to assess the agreement of these tools in our patient population.

METHODS:
A retrospective chart review was performed that identified patients using ICD-10 and CPT codes from Tulane Hospital with fatty liver who had both a FS and liver biopsy performed within one year of each other. Between April 2018 and January 2019, 36 eligible patients were identified. The data collected was de-identified and then analyzed using SAS version 9.4. Using accepted cut-offs, we categorized the FS stiffness data into Metavir fibrosis stages and the CAP scores into steatosis grades. We tested the agreement between the FS and the liver biopsy by calculating kappa values.

RESULTS:
The figures show the association between FS findings and liver biopsy as it pertains to fibrosis and steatosis, respectively. We dichotomized and compared the presence or absence of hepatic steatosis and cirrhosis by FS and liver biopsy. While there was no difference between the two tests for either steatosis or fibrosis (P = 0.71 and P = 0.16), they were only reproducible 25% and 22% of the time, respectively.

CONCLUSION:
Our study represents a unique sample of a busy liver practice where both a liver biopsy and FS were performed. We found fair agreement of presence/absence of steatosis or cirrhosis between FS and liver biopsy; however, our sample was too small to see agreement for precise grading and staging between these modalities. Limitations are small population size and the potential change in grading that may occur between the time of biopsy and FS. Lastly, our study may be prone to a selection bias, as liver biopsy is often obtained after an incongruent noninvasive test and clinical. Despite these limitations, this study demonstrates fair agreement between FS and liver biopsy.
2964 Real World Evidence Demonstrates a Difference in the Presenting Characteristics of Cirrhotic Patients Who Received Albumin Compared to Those Who Received Only Crystalloids
Authors: Davis E. Anne , Kim W. Ray , Sindhwani Navreet S. , Telang Santosh , Runken M. Chris , Lodaya Kunal , Raghunathan Karthik 
Published: October 2019

INTRODUCTION:
Cirrhosis affects over 633,000 adults in the US with recent mortality rates increasing by 3.4% annually. Readmission rates have also been shown to be high. These patients may be resuscitated with albumin, crystalloids, or both.

METHODS:
This study used real-world data to examine differences in the burden of disease among adults admitted with cirrhosis who were treated with albumin (<24 hours (early) versus >24 hours (late) after admission) versus crystalloids alone, between January 1, 2009, and December 31, 2016. We used a nationwide Electronic Health Record database (Cerner Health Facts®) and compared Model for End-stage Liver Disease Sodium (MELD-Na) score and Elixhauser Comorbidity Index across the fluid resuscitation groups.

RESULTS:
We identified 86,432 patients admitted with cirrhosis. The mean age was 59.2 years and the majority (55.4%) were male. Patients who received albumin (n = 26,835) had higher MELD-Na scores at presentation (mean score 22.0 in patients treated early and mean score 19.5 in patients treated late), versus patients who received only crystalloids (n = 59,597; mean score 14.1). Additionally, at presentation, patients who received albumin had a higher Elixhauser Comorbidity Index (mean 18.8 and 19.9 in patients receiving albumin early versus late respectively) versus patients who received crystalloids alone (mean 16.3).

CONCLUSION:
Cirrhotic patients who were treated with albumin had, at presentation, a higher MELD-Na score and Elixhauser Index, which represents a greater burden of disease compared to patients treated with only crystalloids. Further research is needed to examine differences in clinical and economic outcomes, including complications of cirrhosis such as acute kidney injury, spontaneous bacterial peritonitis, ascites, and procedures of large volume paracentesis, following different fluid resuscitation regimens.
2966 A Sub-Analysis of Puerto Rican Hepatitis C Infected Patients Enrolled in the Phase 2 and 3 Glecaprevir-Pibrentasvir Clinical Program
Authors: Sepúlveda-Arzola Gladys , Rosado-Carrión Barbara , Lovell Sandra , Bugarin Gabriela , Aponte Fernando , Crown Eric D. , Rodríguez-Pérez Federico 
Published: October 2019

INTRODUCTION:
Chronic hepatitis C virus (HCV) infection is a leading cause of cirrhosis and advanced liver disease, and viral clearance is associated with reduced risk of developing cirrhosis, hepatic decompensation, and death. Glecaprevir (NS3/4A protease inhibitor) and pibrentasvir (NS5A inhibitor) are direct-acting antivirals (DAAs) co-formulated as a once-daily, fixed-dose combination regimen (G/P) to treat genotype (GT) 1‒6 HCV infection. G/P has been licensed in the United States and Europe, supported by a phase 2/3 global clinical trial program demonstrating high efficacy with a favorable safety profile. The objective of this study was to describe the clinical characteristics and virologic response to G/P in Puerto Rican (PR) patients included in the G/P clinical program.

METHODS:
Data were pooled from 14 phase 2, 3, and 3b clinical trials conducted in 32 countries and representing 3,233 treatment-naive and treatment-experienced patients with chronic HCV GT1–6 infection who received G/P once-daily for 8, 12, or 16 weeks. The primary endpoints were percentage of patients with sustained virologic response 12 weeks after treatment (SVR12) and percentage with treatment-emergent adverse events (AEs).

RESULTS:
From the 3,233 patients included in the G/P clinical program, this sub-analysis included 79 (2%) patients from sites in Puerto Rico. Overall, 52 (66%) were male, 64 (81%) were white race and the median age was 56 years (range: 29–78). Most patients were infected with HCV GT1 (n = 69; 87%), of whom 71% (49/69) had GT1a infection, and overall, 63 (80%) were treatment-naïve. Additionally, 39 (53%) patients had baseline fibrosis stage F0–F1, while 25 (34%) had stage F4. The overall SVR12 rate was 97.5% (77/79), with two patients not achieving SVR12 due to non-virologic reasons (both missing SVR12 data). AEs occurred in 38 (48%) patients, with none leading to discontinuation. Serious AEs occurred in 4 (5%) patients but none were deemed by investigators to be related to DAAs. There were 4 (5%) grade ≥3 laboratory abnormalities, and none were deemed clinically meaningful.

CONCLUSION:
G/P achieved high SVR12 rates and was well-tolerated in Puerto Rican patients enrolled in the G/P clinical trial program. The efficacy and safety profile of G/P in Puerto Rican patients was comparable to the overall patient population in the G/P registrational trial program, and SVR12 rates were comparable to real-world studies of G/P.
2969 Implementation of a Proper Inoculation and Transport Technique for Ascitic Fluid in Patients With Suspected Spontaneous Bacterial Peritonitis: A Quality Improvement Project
Authors: Williams Mary-Jane O. , Akhondi Hossein A. , Ayutyanont Napatkamon , Faris Frank 
Published: October 2019

INTRODUCTION:
Spontaneous bacterial peritonitis (SBP) is a fatal complication of cirrhosis. Abdominal paracentesis needs to be performed to collect ascitic fluid for analysis with a good technique. In our hospital, we routinely collected the ascitic fluid in general purpose test tubes. To maximize the yield, we implemented a quality improvement (QI) project to use blood culture bottles for this matter. This is because SBP is a low-colony-count mono-microbial infection similar to bacteremia and the low concentration of bacteria in infected ascites and small volume obtained by conventional methods provides minimal sensitivities and very low yields.

METHODS:
For baseline, pre-implementation yield rate, the charts for all the patients age 18-85 years old who underwent paracentesis from 2011-2017 in our center were reviewed. All these patients had cirrhosis, abdominal tenderness and identified as having SBP using the ICD diagnostic criteria. Patients with use of antibiotics within the previous week were excluded. Their ascitic fluid was collected in the conventional test tube bottles and results of the fluid analysis were based on these samples. For QI implementation, we created an order set in our electronic medical record to use blood culture bottles for ascitic fluid collection. Appropriate handling of the ascitic fluid was taught to laboratory technicians. For post-implementation yield rate, data from patients who were tested with the new protocol will be evaluated and compared to that of pre-implementation.

RESULTS:
Data from 60 patients with SBP was tabulated. Baseline positivity rate for the samples collected with regular test tubes was calculated (as determined by PMN >250 cells/mm3). 60% of the samples were positive and 40% negative. Post-implementation data will be determined and final results will be provided during the conference in October.

CONCLUSION:
SBP can occur through bacteremic seeding, translocation of gut bacteria, or decreased intestinal motility in cirrhotic patients who are presumed to be malnourished and immunocompromised. Ascitic fluid collected with a suboptimal technique with delays and use of standard test tubes leads to falsely negative results and sub-standard treatment of patients. Immediate inoculation of fluid into blood culture bottles will likely increase the yield and direct the treatments.
2970 Non-Cirrhotic Portal Hypertension in Myeloproliferative Disease: Left and Right-Sided Component of Portal Hypertension
Authors: Sharma Mithun , Rao Padaki N. , Reddy Duvurr N. 
Published: October 2019

INTRODUCTION:
NCPH is the presence of portal hypertension (PH) in the absence of cirrhosis. While Schistosomiasis is the commonest cause in West, myeloproliferative diseases (MPD) characterized by cellular proliferation of one or more hematologic cell lines resulting in extra-medullary hematopoiesis predominantly in the spleen and occasionally in liver may cause PH. Pathogenesis of NCPH in MPD revolves around the concept of left sided portal hypertension. This study presents a cohort of Indian patients of NCPH with MPD.

METHODS:
260 patients with NCPH were evaluated and 9 MPD was diagnosed based on 2008 WHO-criteria. Cirrhosis was ruled out by fibroscan and liver biopsy. All patients underwent a pro coagulant screen which included protein-C, protein-S, factor-V leiden, antithrombin D, anti phospholipid antibody, prothrombin gene deficiency and Jak-2 mutation study. Routine PH evaluation and Fibroscan and liver biopsy was done in all cases.

RESULTS:
Out of 9 patients 4 (44.4%) each had polycythemia-rubra-vera (PRV) and myelofibrosis while 1 had essential thrombocytosis. Median age was 50 ± 7 yrs with 8 male and 1 female patient. 5 (55.5%) presented with symptomatic splenomegaly, 1 (11.1%) with ascites and 3 (33%) with GI bleed and comprised of 64.3% in PRV. Splenomegaly was universally present and hepatomegaly in 44.4%. Isolated gastric varices was present in 3 and gastroesophageal varices in 4 and isolated esophageal varices in 2 patients. Except for Jak-2 mutation found positive in 100% cases of PRV and 66.7% cases of MF, none of the other markers were positive. None, except 1 patient on liver biopsy showed sinusoidal deposits. 8/9 patients underwent endoscopic therapy for varices and were given prophylaxis with carvedilol. Mean follow up was 40 months and none had recurrent bleed or worsening of liver function due to PH.

CONCLUSION:
True incidence MPD causing PH is under-recognised. Our results are similar to other studies from Asia. Unlike other studies, we did not find portal vein thrombosis. MPD patients had huge splenomegaly leading to increased blood flow through the splenic vein leading to left sided portal hypertension. Myeloid metaplasia in liver can also leading to right-sided PH. Whether beta blockers would help as primary or secondary prophylaxis without this component is inconclusive. However, in our cohort of patient they were helpful. Rescue therapy like splenectomy, JAK 2 inhibitors, TIPS etc may be reserved for the refractory cases.
2973 Can BE3A Score Predict Improved Outcomes in Patients With Decompensated Cirrhosis Receiving Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection?
Authors: Nawaz Arif , Riaz Saherish , Iqbal Haseeb , Khan Zohaib , Ali Bushra , Chowdhry Asad , Farooq Abdul , Nawaz Shahmeer , Chaudhry Hafsa , Arshad Abru , Arif Ayesha 
Published: October 2019

INTRODUCTION:
Hepatitis C virus (HCV) treatment is now recommended in all patients, except those with a shortened life expectancy that cannot be altered by viral eradication. Treatment with direct-acting antiviral (DAA) agents can reduce Model for End-Stage Liver Disease and Child-Pugh-Turcotte (CPT) scores in patients with decompensated HCV cirrhosis caused. To assist decision making a scoring system known as BE3A had been devised to predict the outcome of these patients treated with DAAs.

METHODS:
This was a retrospective study of 44 patients with Child Pugh class B and C cirrhosis undergoing Sofosbuvir based therapy in combination with Daclatasvir ± Ribavirin. Baseline parameters of the BE3A score including BMI, Encephalopathy, Albumin, Ascites and ALT were recorded. Inclusion criteria was age 18-65 years, chronic HCV infection, with detectable HCV plasma RNA, and decompensated cirrhosis (CPT B or C). Patients with Hepatocellular carcinoma, Post liver transplant CHC, eGFR <30 ml/min and not on sofobuvir based regime were excluded. The patients were followed up for 36 weeks and patients were reassessed for their CTP class and MELD score. Data was analyzed using SPSS.

RESULTS:
Data was collected on 44 patients with SVR12 on DAA therapy. 42/44 patients were alive at 36 weeks with one patient each dying with BE3A scores of 1 and 3 respectively (one with score of 3 had several co-morbidities). 7%, 52%, 33% and 7% patients had scores of 1, 2, 3 and 4 respectively. Majority of the patients with scores of 3 and 4 had improved outcomes as evidenced by a reduction in their MELD scores but no patient had a change of their CTP class to A.

CONCLUSION:
Our study provides us real life data on the ability of the BE3A score to predict outcomes in patients with decompensated liver cirrhosis undergoing DAA therapy. It does predict improved outcome in terms of an improved MELD and CTP scores but this treatment does not lead to a change in the CTP class in our patients. We feel that a longer term follow up may result in this improved outcome. This ability to predict treatment outcomes is particularly relevant in resource constrained countries like Pakistan in order to prioritize treatment for the patients most likely to benefit from treatment. In addition Sofosbuvir/Daclatasvir ± Ribavirin based combination is very economical as compared to the other regimens and may be used in resource poor countries with acceptable results.