bluuebunny/crossref_metadata_2025_split huggingface dataset:
944 Prevalence Rate of Colorectal Cancer in Various Chronic Liver Disease Groups in the United States Between 2014 and 2019: A Population-Based Study
Authors: Lindsey Adrian , Jit Patel 
Published: October 2019

INTRODUCTION:
Prior studies have suggested that the risk of colorectal cancer (CRC) may be increased in individuals with cirrhosis and chronic liver disease (CLD). It is well known that a diagnosis of PSC has increased risk of CRC, but there is little date as to whether other causes of CLD have increased CRC risk as well. Some prior studies have been limited by small sample sizes, and to our knowledge no large study has been performed comparing CRC risk between the different causes of chronic liver disease.

METHODS:
We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the United States from 1999 to 2019. We identified an aggregated patient cohort of eligible patients with “Diagnosis: Alcoholic liver cirrhosis”, “Diagnosis: Chronic Viral hepatitis”, “Diagnosis: Autoimmune hepatitis”, and “Diagnosis: PBC” followed by a diagnosis of “Primary malignant neoplasm of colon and/or rectum” between May 2014 and May 2019, based on Systematized Nomenclature Of Medicine – Clinical Terms (SNOMED-CT).

RESULTS:
Of the 36,813,060 individuals active in the database between May 2014 and 2019, we identified 7,350 individuals with PBC with an overall prevalence rate of 20.0 per 100,000 persons; 66,160 individuals with alcoholic cirrhosis (AC) with overall prevalence rate of 180 per 100,000 persons; 186,840 individuals with chronic viral hepatitis (CVH) with overall prevalence rate of 508 per 100,000 persons; and 13,540 individuals with autoimmune hepatitis (AH) with overall prevalence rate of 36.8 per 100,00 persons. In the PBC group, 60 were found to have CRC with overall prevalence rate of 816/100,000, OR 2.1 [95%CI (1.62 to 2.64) P < 0.0001]. In the AC group 400 were found to have CRC with overall prevalence rate of 605/100,000, OR 1.54 [95%CI (1.40 to 1.70) P < 0.0001]. In the CVH group 890 were found to have CRC with overall prevalence of 473/100,000, OR 1.21 [95%CI (1.41 to 1.30) P < 0.0001]. In the AH group 50 were found to have CRC with overall prevalence of 369/100,000, OR 0.94 [95%CI (0.712 to 1.24) P = 0.6647].

CONCLUSION:
To our knowledge, this is one of the first large studies to describe the epidemiology of CRC in chronic alcoholic, viral, and autoimmune diseases. We found that the estimated prevalence of CRC to be the highest in the PBC group at 816/100,000 and that CRC in the PBC and AC groups had increased risk compared to non liver disease with ORs of 2.1 and 1.54 respectively.
954 Evaluation of Reasons for Admission in Patients With Decompensated Cirrhosis and Their Burden on Health Care Costs and Mortality Over the Years: Nationwide Analysis
Authors: Patel Kalpesh , Kabaria Savan , Patel Pavan , Shulik Oleg , Pyrsopoulos Nikolaos T. 
Published: October 2019

INTRODUCTION:
Cirrhosis is considered the late stage irreversible sequela of progressive fibrosis and distortion of hepatic architecture. Patients with decompensated cirrhosis have significant morbidity and mortality and may present with signs of upper GI bleeding, ascites, confusion, and kidney injury. The aim of our study was to evaluate and report the trends for the most common causes of decompensation in patients with cirrhosis.

METHODS:
A retrospective cohort analysis was performed using the Nationwide Inpatient Sample (NIS) from 2007–2014. All patients with a diagnosis of cirrhosis, elective admission, and age greater than 18 years were included in our analysis. We evaluated those who had primary admission diagnosis for ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, esophageal variceal bleeding, and hepatorenal syndrome (HRS). We evaluated the trends of mortality, the length of stay, and cost of hospitalization.

RESULTS:
Ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, esophageal variceal bleeding, and HRS accounted for 44,614 admissions from 2007–2014 as a primary diagnosis. Mortality for HRS decreased from 36.59% to 24.05% (P < 0.001) from 2007 to 2014, representing average overall mortality of 30.32%. Furthermore, average length of stay (LOS) for spontaneous bacterial peritonitis went from 7.22 days to 6.42 days (P < 0.05). Average LOS went from 9.07 days to 7.88 days (P < 0.05) for hepatic encephalopathy. Average total charges of hospitalization went from $51,665 to $71,779 (P < 0.001) from 2007 to 2014 for hepatic encephalopathy. Average total charges of hospitalization went from $19,692 to $32,336 (P < 0.001) from 2007 to 2014 for ascites. Mortality for bleeding from esophageal varices increased from 5.21% to 6.11% (P < 0.001) from 2007 to 2014, representing average overall mortality of 5.59%. Average total charges of hospitalization went from $34,107 to $51,424 (P < 0.001) from 2007 to 2014 for hepatic encephalopathy.

CONCLUSION:
Admission for HRS represents approximately 30% overall mortality in patients with decompensated cirrhosis in our study. On the contrary, while the total mean charge for hospitalization increases, spontaneous bacterial peritonitis and hepatic encephalopathy has had significant decrease in LOS from 2007–2014. Clinicians should be vigilant for patients admitted for HRS as it represents high mortality. Further prospective studies are warranted to evaluate the causes for high mortality in decompensated cirrhosis.
957 Awareness and Utilization of the Baveno VI Criteria to Predict Gastroesophageal Varices in Compensated Cirrhotic Patients
Authors: Shah Samip , Hung Chun Kit , Bernstein David , Lee Tai-Ping 
Published: October 2019

INTRODUCTION:
The Baveno VI criteria states that patients with a platelet count greater than 150,000/µl and liver stiffness less than 20 kPa on transient elastography (TE) are at low risk for gastroesophageal varices in compensated cirrhosis and can safely forego screening endoscopy (EGD). Despite being validated in multiple studies, the familiarity with this criteria and degree of utilization is unclear among gastroenterologists.

METHODS:
An 11-question multiple choice survey was distributed to gastroenterologists including fellows in training. Questions pertained to clinicians’ approach to compensated cirrhotic patients. Baseline data was obtained from all respondents regarding years in practice, practice setting, state of practice, volume of EGDs performed annually for screening varices, rates of diagnosis of varices, and frequency of ordering TE in compensated cirrhotics. Respondents were then asked about their familiarity and use of the Baveno VI criteria, their willingness to adopt it in their practice, and their reservations with the criteria. Responses were anonymous and recorded from 4/24/19 to 6/9/19.

RESULTS:
One hundred twenty-two completed surveys were analyzed. The experience of the respondents ranged from being in fellowship to being in practice over 20 years, Graph 1. The most common practice setting was within an academic teaching hospital (n = 77, 63.1%), and 115 respondents (94.3%) reported adherence to screening EGD at time of diagnosis of cirrhosis at least 75% of the time. Most respondents (n = 75, 61.5%) endorsed ordering TE less than 25% of the time. Furthermore, the majority of respondents (n = 106, 86.9%) either were unfamiliar with the criteria or did not use them in clinical practice despite familiarity, Graph 2. Reservations about adopting the criteria centered on a perceived lack of substantiated data regarding TE (n = 44, 36.1%) and its absence from guidelines by predominant GI societies (n = 27, 22.1%), Table 1.

CONCLUSION:
Our survey showed that a majority of gastroenterologists are unaware of the existence and potential use of the Baveno VI criteria. As in any invasive procedure, EGD has an inherent risk of complications. Additionally, the costs associated with screening EGDs may pose an unnecessary economic burden to the healthcare system. Provision of validated data, education of the criteria, availability of non-invasive TE, and incorporation of the criteria into GI societies’ guidelines may increase the awareness and implementation of the criteria into clinical practice.
974 One, Three, and Five Years Post Transplant Outcomes in Diabetic Patients After Liver Transplant for NASH Cirrhosis: A Single Centre Study
Authors: Fahad Hamna , Singh Amandeep , Lan Nan , Singh Kevin , Wakim-Fleming Jamile 
Published: October 2019

INTRODUCTION:
Beside immunosuppression, patients undergoing liver transplantation (LT) for non-alcoholic steatohepatitis (NASH) cirrhosis are at additional risk of complications due to a myriad of comorbidities that accompany the metabolic syndrome. We aimed to assess post-LT outcomes at one, three and five year intervals for patients with type-2 diabetes mellitus who underwent LT for NASH cirrhosis.

METHODS:
Using ICD-9 codes all type diabetics with the diagnosis of non-alcoholic fatty liver disease (NAFLD) were identified between January 2000 and Decemeber 2015. Of these, those who had biopsy-proven NAFLD and underwent LT for NASH cirrhosis were recognized and subsequently followed to assess outcomes at one-, three- and five-years. A P-value of < 0.05 was considered significant.

RESULTS:
60 out of 1300 patients underwent LT for NASH-cirrhosis. Mean age was 59.6 ± 7.6 years; mean BMI was 31.2 ± 6.3 kg/m2. Mean MELD score at listing was 17.9 ± 9.1 and on the day of LT was 20.1 ± 9.3. Median post-LT follow-up was 66.5 months (IQR 59.5). Follow-up was available for 57, 50 and 34 patients at 1, 3 and 5 years, respectively. Infection was the most common complication within the first year (35%). Cardiovascular (CV) events were most common overall, effecting 25.3% patients in year 1, 32 % in 3 years and 23.5 % in a 5-year period. Post-LT biliary complications were seen in 22.8%, 12.9% and 8%, respiratory complications in 4%, 2% and 0%; gastrointestinal complications in 1%, 2%, 1% and renal complications in 9%, 5%, and 1% within one, three and five years, respectively. 29.6% patients had an episode of rejection within one year of transplant, 7 % within 3 years and 3.3% in 5 years (P = 0.02). A worsening trend was seen in steatosis of the graft across the years 20%, 39.3%, 42.9 % for year 1, 3 and 5 ((P = 0.02). Rates of complications were not statistically different for patients who had normal versus those with elevated gylcated hemoglobin post LT, or for those who lost weight ( >5 lbs), except at year 3 (P < 0.05) (Figure 1).

CONCLUSION:
Patients undergoing LT for NASH-cirrhosis are at a high risk of developing post-LT infectious and cardiovascular complications. Risk of developing steatosis in the graft also increases every year. These patients need to continue dietary and lifestyle modifications to reduce the risk of future complications, even after LT.
976 Fibroscan™, FIB-4, and NAFLD Fibrosis Score as Point of Care Non-Invasive Tests for Management of Non-Alcoholic Fatty Liver Disease and Other Chronic Liver Diseases
Authors: Younossi Zobair , Stepanova Maria , Felix Sean , Jeffers Tom , Younossi Elena , Allawi Hossain , Cable Rebecca , Lam Brian , Racila Andrei , Younossi Issah , Henry Linda , Ranagan Jane , Nader Fatema 
Published: October 2019

INTRODUCTION:
Fibroscan™ (FS) is a clinically useful tool for non-invasive assessment of fibrosis in patients with chronic liver disease (CLD). We aimed to assess the performance of FS as a point-of-care testing in real clinical practice of gastroenterology/hepatology.

METHODS:
During routine outpatient visits, patients with various etiologies of CLD had FS administered and laboratory tests collected. Advanced fibrosis was defined as a liver stiffness of ≥11.4 kPa and advanced steatosis as a controlled attenuation parameter (CAP) ≥ 260 dB/m. Non-invasive test (NIT) scores were calculated for fibrosis: FIB-4 (advanced fibrosis in patients with the score ≥ 2.67), AST-to-Platelet Ratio (APRI; advanced fibrosis ≥ 1.0), NAFLD Fibrosis Score (NFS; advanced fibrosis ≥ 0.676). Patients with advanced fibrosis status by NITs and a subgroup with liver biopsy data were used for concordance assessment (Cohen’s kappa statistic; Table 1) with FS for each major CLD etiology. Another subgroup of patients had FS administered twice (median period 12 months); these data were used to assess test-retest concordance of FS.

RESULTS:
There were 416 patients included: 28 with chronic hepatitis B (CHB), 32 with chronic hepatitis C (CHC), 270 with non-alcoholic fatty liver disease (NAFLD). Patients were 53.4 ± 12.7 years old, 47% male, 59% white, 12% black, 10% Hispanic, 10% Asian, 33% with type 2 diabetes. Patients with CHC had the highest mean liver stiffness (12.8 ± 13.4 kPa vs. 7.9 ± 7.0 kPa in others, P = 0.0006) while patients with NAFLD had the highest CAP (308 ± 51 dB/m vs. 258 ± 64 dB/m, P < 0.00001). The test-retest concordance for advanced fibrosis by FS was substantial [kappa = 0.70 (0.43–0.97),agreement in 45 out of 49 patients] and moderate for advanced steatosis [kappa was 0.41 (0.12–0.79),agreement in 38/49 patients]. In patients with CHC, the highest concordance of advanced fibrosis by FS was by FIB-4 [kappa = 0.58 (0.25–0.91)] and APRI [0.46 (0.12–0.81)]. Similarly, in patients with NAFLD, the highest concordance of advanced fibrosis by FS was with the stage of histologic fibrosis by liver biopsy [N = 66: kappa = 0.55 (0.35–0.74)] and NFS [kappa = 0.50 (0.32–0.67)].

CONCLUSION:
Non-invasive tests such as Fibroscan™, NFS, and FIB-4 provide useful information for assessment of advanced fibrosis in clinical practice of patients with CLD.
986 The Risk of Depression in Patients With Nonalcoholic Fatty Liver Disease
Authors: Sarmini Muhammad Talal , Fahad Hamna , Asfari Mohammad Maysara , Alomari Mohammad , Al-Khadra Yasser , Singh Amandeep , Dasarathy Srinivasan , McCullough Arthur J. 
Published: October 2019

INTRODUCTION:
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States. The association of depression with chronic liver disease is reported in the literature, but the previous studies that established this association were limited in size. Therefore, we aimed in this study is to evaluate the association between NAFLD and depression using very large database.

METHODS:
Using data from the National Inpatient Sample (NIS) database between 2002 and 2014, we identified all patients who were diagnosed with NAFLD using appropriate ICD 9 coding. The control group was the patients who did not have a diagnosis of NAFLD. We then performed multivariate logistic regression analysis for the association between NAFLD and depression.

RESULTS:
The total population was comprised of 101,231,036 patients, of which 365,701 (0.36%) were diagnosed with NAFLD. Patients in the NAFLD group were older (53 vs 48), less likely to be females (57.7% vs 58.4%) and African American (9.3% vs 14.3%) (P < 0.001 for all). In addition, NAFLD patients had more obesity (26.2% vs 6.9%), smoking (13.9% vs 9.5%), hypothyroidism (12.2% vs 7.8%) and diabetes mellitus (DM) with or without complications (5.6% vs 3.2%) and (30.7% vs 14.1%) respectively, (P < 0.001 for all). Using Multivariate logistic regression, and after adjusting for potential cofounding factors including: (age, gender, race, obesity, smoking, DM and hypothyroidism), NAFLD group had a statistically significant higher rate of depression (Odds Ratio [OR] 1.75, 95% confidence interval [CI] 1.73–1.77, P < 0.0001) compared with the non-NAFLD group.

CONCLUSION:
Our analysis of very large nationwide database showed that patients with NAFLD were more likely to have depression compared to patients without NAFLD. This finding highlights the importance of depression screening in patients with NAFLD which can help improve their quality of life.
991 BALAD and BALAD-2 Predict Survival of Hepatocellular Carcinoma Patients: A North American Cohort Study
Authors: Wongjarupong Nicha , Negron Gabriela , Ahn Keun Soo , Yang Ju Dong , Giama Nasra H. , Mara Kristin , Harmsen William S. , Therneau Terry , Roberts Lewis R. 
Published: October 2019

INTRODUCTION:
The discontinuous BALAD and continuous BALAD-2 scores derived from bilirubin, albumin, alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive AFP (AFP-L3), and des-gamma-carboxyprothrombin (DCP) are effective in predicting HCC patient mortality, but have not been validated in North America. We validated the BALAD and BALAD-2 scores in North America.

METHODS:
Data from 148 HCC patients seen from 2000–2015 with results for all five biomarkers at diagnosis were abstracted. Hazard ratios (HR) and C-statistics were calculated.

RESULTS:
75 of the 148 patients died during a median follow-up of 33 months (0.3-145 months),. The 1-year and 3-year survival rates were 70.8% and 47.6%, respectively. 114 (77%) patients had cirrhosis with a median MELD of 9.5 (range 6.4-29.5). HCC etiologies were HCV (34%), NASH (34%), alcohol (14%), and HBV (10%). Primary treatments were liver transplant, 21 (14%), surgical resection, 32 (22%), local ablation, 10 (7%), transarterial chemoembolization or radioembolization, 47 (32%), chemotherapy, 11 (7%), best supportive care, 9 (6%), and unknown treatment, 18 (12%). MELD, tumor size (cm), ≥2 tumors, tumor number, and neutrophil-lymphocyte ratio >4 significantly increased mortality with HR (95%CI) of 1.12 (1.06–1.18) per unit increase in MELD, 1.06 (1.0004–1.12) per cm increase in size, 1.21 (1.03–1.43) per number of tumor, and 1.93 (1.16–3.24). For the BALAD score analysis, 12, 49, 40, 31, 16 and 0 patients had BALAD scores of 0–5 respectively. The HR (95%CI) for death were 1.24 (0.42–3.67), 1.79 (0.61–5.26), 2.83 (0.95–8.38), and 7.19 (2.26–22.91) for BALAD scores 1, 2, 3, and 4 vs. BALAD 0. For the BALAD-2 analysis, 58, 35, 33, and 22 patients were BALAD-2 classes 1, 2, 3, and 4. The HR (95%CI) for death were 1.25 (0.65–2.40), 1.75 (0.94–3.23), and 6.20 (3.29–11.68) for BALAD-2 classes 2, 3, and 4 vs. BALAD-2 class 1. A multivariate model incorporating maximal tumor diameter, tumor number, neutrophil-lymphocyte ratio and BALAD had HR of 1.43 (1.14–1.81) per increase of 1 BALAD score. A similar multivariate model with BALAD-2 had HR of 1.50 (1.18–1.90) per increase of 1 BALAD-2 class. BALAD, BALAD-2 and BCLC had similar C-statistics of 0.69, 0.68, and 0.67.

CONCLUSION:
The BALAD score and BALAD-2 class at HCC diagnosis can predict survival of HCC patients in North America. AFP, AFP-L3, and DCP in the BALAD models incorporate HCC tumor biology and make the BALAD model distinguish from other previous predictive models.
992 Venous Thromboembolism Prophylaxis in Hospitalized Patients With Chronic Liver Disease and the Bleeding and Thrombosis Risk: A Systematic Review and Meta-Analysis
Authors: Wongjarupong Nicha , Laoveeravat Passisd , Udompap Prowpanga , Vantanasiri Kornpong , Bakker Caitlin 
Published: October 2019

INTRODUCTION:
Patients with chronic liver disease, especially cirrhosis have an increased risk in both venous thromboembolism (VTE) and bleeding. Most of hospitalized chronic liver disease patients, however, were not given the VTE prophylaxis during admission.

METHODS:
A systematic search was conducted for studies published up to May 2019 using MEDLINE, EMBASE, and Cochrane Library. We included cohort studies of patients with chronic liver disease who were hospitalized for ≥48 hours which compared patients with and without VTE prophylaxis. Study quality was assessed using Newcastle-Ottawa scale (NOS). A random-effects model was used to determine relative risk (RR) with 95% confidence interval (CI) for bleeding and thrombotic events.

RESULTS:
After screening 2462 abstracts, 188 potentially studies were assessed. Seven retrospective cohorts met the criteria and were included in this meta-analysis. Only one study matched intervention group and controls and was done with propensity score. In total, there were 1,855 patients who received VTE prophylaxis and 2,915 patients who did not receive VTE prophylaxis. Regarding bleeding events, there were 76 patients (4.0%) and 231 patients (7.9%) in prophylaxis and no prophylaxis group, respectively. There was no increase of bleeding event in the VTE prophylaxis compared to the no-VTE prophylaxis group with pulled RR of 0.70 (0.30–1.64, I2 = 87%). Regarding thrombosis risk, there were 34 patients (1.8%) and 68 patients (2.3%) in prophylaxis and no prophylaxis group, respectively. There was no increase of thrombosis event in the VTE prophylaxis compared to the no-VTE prophylaxis group with pulled RR of 0.76 (0.44-1.31, I2 = 17%). When included only patients with INR ≥ 1.4 or with cirrhosis, the RR of patients with VTE prophylaxis for bleeding was 0.73 (0.31–1.69, I2 = 74%) and thrombosis was 1.13 (0.67–1.92, I2 = 0%).

CONCLUSION:
This meta-analysis found no difference of bleeding and thrombosis events between chronic liver disease patients with and without VTE prophylaxis. The similar results were seen with subgroup analysis of patients with elevated INR or cirrhosis. However, with limitation of retrospective study, the patients who received prophylaxis tended to have less advanced liver disease, which potentially had less risk of bleeding and risk of thrombosis. Further study with liver disease staging and coagulopathy risk matched for intervention and control groups is warranted.
993 Trends of Portal Vein Thrombosis Comorbidities Among Decompensated Cirrhosis in a Nationwide Inpatient Cohort
Authors: Fan Xiaowen , Hershman Melissa , Weisberg Ilan 
Published: October 2019

INTRODUCTION:
Portal vein thrombosis (PVT) is commonly associated with cirrhosis. Previous studies showed increasing PVT prevalence but declining PVT mortality in decompensated cirrhosis. However, the trends of PVT associated comorbidities have not been well studied in this population.

METHODS:
We conducted a retrospective cohort study utilizing the 2000-2014 National Inpatient Sample (NIS) Database. Patients older than 18 years with decompensated cirrhosis were included, defined by an ICD-9-CM coding for cirrhosis plus a decompensating event or portal hypertensive sequelae. Those who had liver transplantation or hepatocellular carcinoma were excluded. We further grouped patients with alcoholic cirrhosis vs non-alcoholic cirrhosis. The primary outcomes included the trends of esophageal variceal bleeding, acute kidney injury (AKI), and mesenteric ischemia. The secondary outcome was trend of transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis with PVT. Analysis was performed using Cochran-Armitage test and further adjusted by patients' age, sex, and race.

RESULTS:
The total number of hospitalizations with decompensated cirrhosis and PVT was 51,925. During years 2000 to 2014, among all-cause decompensated cirrhosis with PVT, AKI prevalence increased from 12.6% to 33.3% (OR 1.09, P < 0.001), mesenteric ischemia prevalence increased from 5.5% to 9.2% (OR 1.06, P < 0.001), esophageal variceal bleed prevalence declined from 27.7% to 13.0% (OR 0.96, P < 0.001), and TIPS rate declined from 8.7% to 4.2% (OR 0.96, P = 0.001). These results remained statistically significant after adjusting for patients’ age, sex, and race. Subgroup analysis showed similar trends in alcoholic and non-alcoholic cirrhosis, though the declining prevalence rates of esophageal variceal bleed and TIPS in alcoholic cirrhosis did not reach statistical significance after adjustment.

CONCLUSION:
Among decompensated cirrhosis complicated by PVT, prevalence of AKI and mesenteric ischemia was found to be rising. Advancements in radiologic imaging technologies may explain increased detection of mesenteric ischemia. Esophageal variceal bleeding and TIPS prevalence were found to be decreasing, likely due to widespread utilization of endoscopy for primary and secondary prophylaxis of variceal hemorrhage. Given ongoing evidence supporting the safety of direct oral anticoagulants for treatment of PVT in cirrhosis, the utilization of TIPS for therapy of nonocclusive and localized PVT is likely to decline.