bluuebunny/crossref_metadata_2025_split huggingface dataset:
1036 Liver Transplant Referral Patterns for Severe Alcoholic Hepatitis With Recent Alcohol Use
Authors: Hsu Angela , Choden Tenzin , Hsu Christine 
Published: October 2019

INTRODUCTION:
Liver transplant is the most effective treatment to optimize survivorship in severe alcoholic hepatitis which has a six month mortality rate of 70%. In recent years, multi-center data demonstrated a drastic mortality benefit of early liver transplant and questions the six month alcohol sobriety requirement at some transplant centers. The purpose of this study is to determine whether or not community gastroenterology (GI) providers are aware of the survival benefits of early liver transplant in severe alcoholic hepatitis and to examine what factors impact their decision to refer.

METHODS:
This study was designed as a cross sectional survey targeting GI providers and fellows within the Washington, DC area. The surveys were distributed both in paper and electronic form via email and local academic meetings. Data was analyzed using Chi-Squared analysis and two sample T-test to detect statistically significant differences between groups.

RESULTS:
Forty-five surveys were completed by GI physicians (34 attendings, 11 fellows). There was a wide range in the number of years since completion of academic training (range = 0-45 years, average = 14 years). Overall, 40% (17/42) of all participants stated that an active drinking status made them less likely to refer for transplant. Participants who completed training >10 years ago overestimated the rate of alcohol recidivism compared to their counterparts (P = 0.005); however, there was no statistically significant difference in their likelihood to refer active alcohol users for transplant. Although not statistically significant, participants who were more likely to refer active drinkers for transplant completed their last academic training more recently than their counterparts (10 vs 17 years ago, P = 0.14). Factors associated with a higher tendency to refer active users for liver transplant included working for a liver transplant center (P = 0.007) and awareness that peak mortality occurs within two months of last drink (P = 0.001).

CONCLUSION:
Despite the survival benefits of early liver transplant in severe alcoholic hepatitis, 40% of gastroenterologists surveyed state they are less likely to refer active alcohol users for liver transplant. Education regarding low recidivism rates and drastic benefits in survival outcomes even in patients with less than six months of alcohol sobriety should be disseminated to community gastroenterologists, especially at non-transplant centers.
1039 Hepatic Steatosis as an Indicator of Chronic Hepatitis B Virus Infection Severity
Authors: Lim Huei-Wen , Qiu He , Khuwaja Samreen , Liu Audrey , Lee Tai-Ping 
Published: October 2019

INTRODUCTION:
Chronic hepatitis B virus (HBV) infection is a leading cause of liver-related morbidity and mortality affecting 248 million individuals worldwide. Non-alcoholic fatty liver disease (NAFLD) is a common occurrence in chronic HBV infection. It ranges from simple steatosis to active inflammation of nonalcoholic steatohepatitis, and subsequent fibrosis, cirrhosis and an increase risk of hepatocellular carcinoma. Our study aims to assess the causal effect of NAFLD among chronic HBV patients.

METHODS:
We performed a retrospective chart review of all treated and untreated chronic HBV patients at Sandra Atlas Bass Center for Liver Diseases over the past 5 years. Medical records of study subjects with a diagnosis of NAFLD age ≥ 18 years and <90 years were reviewed. Patients were stratified into the following two groups: (1) mild-moderate steatosis (S0-S2) and (2) severe steatosis (S3). Patients with other co-existing chronic liver diseases were excluded. Clinical data as shown on Table 1 were analyzed. Continuous variables were statistically analyzed with student’s T-test. Categorical variables were analyzed with Pearson’s chi-squared test.

RESULTS:
We identified 110 patients with HBV infection and NAFLD, of which 68 (61.8%) patients had severe hepatic steatosis. Co-morbidities and ethnicities did not significantly differ among the two studied groups. Patients in the mild-moderate steatosis group had statistically higher HDL level (53.4 vs 46.6mg/dL, P = 0.033) and a lower ALT level (31.0 vs 47.7U/L, P = 0.027) than that observed in the severe steatosis group. Thirty-one percent of patients with severe steatosis were also found to have F2-F4 disease compared to 7% in the mild-moderate steatosis group (P = 0.013). Sixty-three percent of patients in the severe steatosis group required treatment with HBV anti-viral therapy compared to 31% in the mild-moderate steatosis group (P = 0.001). Tenofovir alafenamide (48.2%) was the HBV anti-viral therapy most commonly used.

CONCLUSION:
Our study showed that patients with severe steatosis tend to have lower HDL but higher ALT and fibrosis stage, and are twice as likely to require anti-HBV therapy. Hepatic steatosis may be an indicator of the severity of chronic HBV infection. Further studies are warranted to understand the correlation between NAFLD and chronic HBV infection.
1042 Direct-Acting Antivirals for the Treatment of Hepatitis C Genotypes 1 to 5 in Sub-Saharan Africa
Authors: Sultan Amir , Braimoh Grace , Bane Abate , Debes Jose D. 
Published: October 2019

INTRODUCTION:
The use of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus infection (HCV) has exposed the possibility of global elimination of the virus worldwide. However, a large number of HCV-infected individuals reside in resource-limited settings such as sub-Saharan Africa (SSA). There is very limited knowledge of the use of DAAs in SSA

METHODS:
We developed a single-arm prospective study to assess response to DAAs in 164 individuals infected with HCV genotypes 1 to 5 in Addis Ababa, Ethiopia. The majority of patients were treated with Ledipasvir/Sofosbuvir (LDP/SOF) with or without Ribavirin (RBV) or Sofosbuvir with Ribavirin (SOF/RBV). Before initiation of treatment, every patient underwent an abdominal ultrasound, evaluation of liver function markers and calculation of aspartate transaminase to Platelet Ratio Index (APRI) to determine fibrosis status. HCV RNA levels were determined at baseline and 12 weeks after end of treatment.

RESULTS:
HCV treatment with DAAs was completed by all 164 enrolled individuals. The median age of patients was 52 years (IQR 42-60) and 55% of them were females. Seventy-six percent of individuals had genotype 4, 14% genotype 2, 6% genotype 1, 2.5% genotype 5 and 1.5% genotype 3. The median HCV RNA level before treatment was 1.300.555 IU/L (IQR: 649825-3182800), and the median APRI score was 1.49 (IQR 1.13-2.24) with 19 % of participants showing evidence of cirrhosis on imaging. Sixty-seven percent of patients were treated using LDP/SOF, 18.5% using LDP/SOF/RBV and 14.6% using SOF/RBV, all for a total of 12 weeks. The sustained virologic response (SVR) rate across all genotypes was 98.8%. In those individuals with cirrhosis, SVR was 93.5% and in non-cirrhotics 100% regardless of APRI-based fibrosis level. Two patients failed to achieve SVR. Both showed evidence of decompensated cirrhosis and one had failed previous therapy with interferon. Among reported side effects, fatigue was the most commonly reported at 11%, followed by nausea in 1.2% of subjects. All side effected subsidized after end of treatment.

CONCLUSION:
Our study demonstrates for the first time successful treatment of HCV with DAAs among different viral genotypes in Sub-Saharan Africa, demonstrating the feasibility of HCV elimination in resource-limited settings.
1044 The Prevalence of Liver Fibrosis in Hispanic Adolescents With Nonalcoholic Fatty Liver Disease Is High and Independent of the Presence of Prediabetes and Diabetes
Authors: Sandhu Sanjeet 
Published: October 2019

INTRODUCTION:
Prediabetes and Type 2 diabetes (T2DM) are risk factors for nonacloholic fattty liver disease (NAFLD), an increasing cause of liver disease in the United States. Hispanics develop NAFLD and may progress to liver fibrosis at a younger age when compared to non-Hispanic whites. Relying on Serum Alanine Aminotransferase (ALT) levels are inaccurate to determine the presence of fibrosis. We sought to compare the prevalence of fibrosis in Hispanic children with NAFLD and insulin resistance compared to Hispanic children with NAFLD but without insulin resistance

METHODS:
Adolescent Hispanics (8-17 years of age) with overweight or obesity who were referred for suspected NAFLD based on the presence of elevated ALT or fatty infiltration on ultrasonography were included. Shear wave transient elastography was used to determine suspected fibrosis in those with A1c ≥ 5.7% compared to a control group with A1c < 5.7%. A value of >5.1kPa was used to define suspected fibrosis. Statistical analysis was done using R Core Team Statistical Software. P value < 0.05 was considered statistically significant.

RESULTS:
The study cohort consisted of of 67 patients with mean age of 13.71 years old with 55.2% male. Mean BMI Standard Deviation was 2.44 and the mean ALT was 93.6 U/L. There were 34 patients with A1c < 5.7% with mean liver stiffness of 5.68 kPa and 33 patients with A1c ≥ 5.7 with mean liver stiffness of 5.41 kPa (P = 0.44). The prevalence of suspected fibrosis (>5.1kPa) in obese, Hispanic adolescents presenting for suspected NAFLD was 62.7% with no significant correlation to A1c value (P = 0.69) or degree of obesity as determined by BMI percentile (P = 0.37). ALT (r = 0.13, P = .35) or AST (r = 0.15, P = .28) were not good predictors of liver stiffness either.

CONCLUSION:
Liver fibrosis should be suspected in all obese, Hispanic adolescents presenting with suspected NAFLD independent of the degree of obesity, A1c, ALT or AST values. Earlier intervention in this high risk population is crucial to long term hepatic health.
1057 National Demographic and Economic Trends of Primary Malignant Liver Neoplasms in the United States From 2000-2015
Authors: Khiew Yii Chun , Tsoukas Stephen 
Published: October 2019

INTRODUCTION:
Primary malignant liver neoplasms involve tumors arising from hepatocytes and biliary epithelium. Risk factors include host factors, co-morbid diseases, and environmental exposures. The purpose of this study is to analyze trends in demographics, mortality, inpatient costs, and risk factors.

METHODS:
The Nationwide Inpatient Sample (NIS) database generated from the Healthcare Cost and Utilization Project was used to obtain a subset of discharge level data obtained from every 3 years from 2000 to Q3 2015. All cases with primary ICD-9 diagnosis code of primary malignant liver neoplasm were identified. Analysis included patient and hospital demographics, total inpatient cost, inpatient mortality, and the presence of secondary diagnoses for known risk factors of hepatocellular carcinoma (chronic viral hepatitis, alcoholic liver disease, and non-alcoholic fatty liver diseases (NAFLD).

RESULTS:
A total of 79,200 discharges were recorded between 2000 and 2015. There was an initial 24.1% increase in prevalence between 2000 and 2009 (9949 to 16266 cases), with a subsequent plateau across 2012 and 2015. There was a consistent male predominance (approximate ratio of 2.4 to 1). While the majority of patients across all years were between the ages of 45-84, there were fewer cases of 18-44 year olds from 2000 to 2015. Rates have increased in Caucasian, African-American, and Hispanic populations, with regional predominance in the South. There was a concurrent increase in secondary diagnoses of chronic HCV and non-alcoholic liver diseases (59.1% and 49.4% relative increase from 2000 to 2015 respectively). Despite a reduction of in-hospital mortality, total charges per annum increased from $25,306 in 2000 to an extrapolated $100,581 in 2015.

CONCLUSION:
This study highlights the increasing burden of primary liver neoplasms in the United States. Despite reduction of in-hospital mortality, the annual cost has increased significantly. Further studies are required to elucidate factors contributing to increasing charges, and regional and racial variation. Future strategies should focus on the effect of risk factor reduction such as early detection and treatment of viral hepatitis and NAFLD.
1060 The Use of Albumin in Cirrhotics: Data From a Tertiary Care Center
Authors: Mishra Kajali , Ashraf Taha , Venkat Deepak 
Published: October 2019

INTRODUCTION:
Human albumin solution is an expensive colloid preparation commonly used in cirrhotics’ management. Approved indications of albumin administration in cirrhotics include large volume paracentesis (LVP), hepatorenal syndrome (HRS), and spontaneous bacterial peritonitis (SBP). Albumin use is not routinely recommended in inflammatory and hypovolemic states. The aim of this study is to identify albumin utilization patterns in a tertiary care center and to assess potential areas of improvement in albumin prescribing strategies.

METHODS:
We performed a retrospective chart review of 342 cirrhotic patients who received 25% albumin solution during their admission from January 2016 to January 2018. Baseline demographics, etiology of cirrhosis, and severity was noted. Indications for albumin administration were reviewed and other clinical variables were gathered. Patients with and without indications for albumin were compared using chi-square tests for categorical variables and two-sample t-tests for continuous variables.

RESULTS:
There were 342 cirrhotic patients included in this study. 187 (55%) were male, 227 (66%) were Caucasian and the mean age was 59 ± 11 years. The most common cirrhotic etiologies were Alcohol (n = 95, 28%), Nonalcoholic steatohepatitis (NASH) (n = 84, 25%) and Hepatitis C (n = 72, 21%). There were 187 (55%) patients who had at least one approved indication for albumin; out of those patients, 167 (48.4%) had HRS, 66 (19%) had SBP, and 77 (23%) underwent LVP. African Americans were more likely to receive albumin in the absence of an indication, as compared to Caucasians (P = 0.047). Patients who received albumin without an indication had a higher incidence of septic shock (34% vs 21%, P = 0.008); sepsis with acute kidney injury (AKI) (22% vs 12% P = 0.017); and history of HRS (35% vs 19% P = 0.0005) or SBP (37% vs 25% P = 0.018). No differences were detected between the two groups for age, gender, BMI, MELD, MELD NA, and etiology.

CONCLUSION:
There is a high rate of non-indicated albumin administration in cirrhotic patients. Apart from approved indications which have mortality benefit, shock, hypovolemia, or a history of SBP/HRS are influencing physicians to use albumin in cirrhotics. It is important to establish clinical protocols for judicial use of this expensive and limited resource.
1076 Prevalence of Cirrhotic Cardiomyopathy and Its Correlation With Serum Pro-BNP Levels, HRS, SBP, and Mortality
Authors: Kapoor Neha , Mehta Vimal , Kumar Suresh , Kar Premashis 
Published: October 2019

INTRODUCTION:
Cardiac dysfunction is common in patients with cirrhosis. This study aims at estimating the Prevalence of Cirrhotic Cardiomyopathy and its correlation with pro-BNP levels, Hepatorenal Syndrome (HRS), SBP (Spontaneous bacterial peritonitis) And Mortality.

METHODS:
This was a prospective study in which we used newer technique Doppler Echocardiography and also did conventional 2D and Doppler echocardiography in cirrhotic patients. Additionally, QTc interval, pro-BNP, Tropinin T levels were measured. Patients were followed up for 6 month to look for any new complications that developed like hepato-renal syndrome, Spontaneous bacterial peritonitis or any mortality.

RESULTS:
In our study 53 cirrhotic patients were compared with 30 controls whose age and sex was matched. The results in 53 cirrhotic patients: mean age 43.81 ± 12.31yr, M:F: 49:4)etiology:alcoholic-27,nonalcoholic-26,child score(A-0,B-15,C-38),MELD Score was 18.17 ± 1.69 in diastolic dysfunction group and 16.36 ± 1.70 in cirrhotic patients without diastolic dysfunction. Doppler Echocardiography showed mean early diastolic velocity of 11.6 ± 2.6 vs 19.8 ± 6 cm/sec(P < 0.01) and mean late diastolic velocity of 10.7 ± 2.9 vs 8.4 ± 3.1 cm/sec(P < .05).The mean Doppler E- velocity was 0.76 ± .16 vs 0.88 ± 0.14 (P < 0.05),A-velocity was 0.72 ± 0.25 vs 0.53 ± 0.11(P < 0.01), DT was 231 ± 49.60 vs 212.9 ± 61.9 (p-NS) and E/A ratio was 1.14 ± 0.34 vs 1.7 ± 0.43(P < 0.01). The troponin-T levels were <.01ng/ml(normal range).The mean pro-BNP level was 447.62 ± 225.72 pg/ml (normal for our lab < 125 pg/ml).Mean QTc interval was 509.37 ± 54.32 msec.

CONCLUSION:
The study showed that diastolic dysfunction is highly prevalent (56.6% of study population) in cirrhosis. QTc interval and BNP were also significantly raised. In addition Cirrhosis complications like Hepatorenal Syndrome (HRS), SBP (Spontaneous bacterial peritonitis), and Hepatic Encephalopathy were more common in cirrhotic cardiomyopathy group.
1082 N-Acetylcysteine: A Novel Agent for Patients With Ischemic Hepatopathy
Authors: Kothari Shana , Kalinowski Michael , Brindise Elizabeth , Kobeszko Matthew , Silva Rogelio 
Published: October 2019

INTRODUCTION:
Acute ischemic hepatopathy is diffuse hepatic injury from hypoperfusion leading to a profound elevation in aminotransferases; it accounts for 1 to 2.5 percent of patients admitted to an intensive care unit. Recent studies showed that N-Acetylcysteine (NAC) provides mortality benefit and improves transplant-free survival in patients with non-acetaminophen induced liver injury, however no studies have shown its effects on ischemic hepatopathy. In studies utilizing murine models, NAC was found beneficial in ischemic injury given its anti-apoptotic, anti-inflammatory, and anti-oxidant properties. We aim to evaluate the trend of hepatic function tests, use of vasopressor requirements, and length of intensive care stay for patients admitted with ischemic hepatopathy who received the 72-hour-NAC protocol compared to those who did not.

METHODS:
In this retrospective single-center study, we identified adult patients with ischemic hepatopathy from cardiogenic, septic, or hypovolemic shock within a three year period. Chart review was performed and data trends in transaminases, bilirubin, coagulation tests, creatinine, vasopressor requirements, and the number of intensive care days were collected. Univariate analysis was performed.

RESULTS:
A total of 30 patients with ischemic hepatopathy were included; 15 patients received the 72-hour NAC protocol and 15 patients did not. No differences were found in median age or gender between both groups. A statistical improvement in the aspartate aminotransferase (AST) (-93.6% vs -72.8%, P = 0.003) and creatinine (-38.2% vs 19.3%, P = 0.000) was observed in the NAC group compared to the non-NAC group. Median vasopressor days were fewer and length of stay was higher in the NAC group compared to the control, but not statistically significant. There was no significant difference in mortality.

CONCLUSION:
Based on our data, NAC use is associated with improved renal function at 72 hours. The NAC group appeared to have a more rapid improvement of AST, alanine aminotransferase (ALT), and bilirubin compared to the control group; however, only AST reached statistical significance, likely due to the small sample size. This pilot study shows potential clinical benefit of NAC as a treatment modality for ischemic hepatopathy. Higher-powered, randomized controlled trials are needed to further validate these observations.
1083 Health-Related Quality of Life Decreases With Disease Progression From Chronic Liver Disease to Cirrhosis and Hepatocellular Carcinoma
Authors: Salcedo Juan , Viray Terilyn , Feun Lynn , Selvaggi Gennaro , Martin Paul M. , Jones Patricia D. 
Published: October 2019

INTRODUCTION:
Health-related quality of life (HRQOL), an important outcome for cancer patients, is reliably measured by the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep). FACT-Hep predicts disease progression, treatment response and survival in HCC patients. This study aimed to evaluate HRQOL in diverse HCC patients compared to patients with chronic liver disease (CLD) and cirrhosis.

METHODS:
Since 2018, we have enrolled patients with CLD, cirrhosis and HCC from the University of Miami and Jackson Memorial Hospitals into an observational longitudinal cohort. Clinical data is extracted from the electronic medical record. Participants complete various surveys, including the FACT-Hep version 4.0. Descriptive statistics were used for demographics and disease-specific characteristics. Each FACT-HEP subscale was prorated and combined, if valid. Disease subgroups were compared using Pearson’s chi-squared or Kruskal-Wallis tests. In a subset of participants who completed the Perceived Stress Scale (PSS-10), stress was correlated with HRQOL.

RESULTS:
From 1/2018 to 3/2019, 333 patients enrolled; 103 have CLD, 131 have cirrhosis and, 99 have HCC (91 cirrhotic HCC and 8 noncirrhotic HCC). The sample is 4% Asian, 16% Black, 34% White and 42% Hispanic. Median age of the CLD group was 54 years vs. 58 years for cirrhotics and 65 years for HCC patients, P < 0.001. Table 1. The FACT-Hep was completed by 223; the prorated score was valid in 211. There were no significant differences in physical, social, or emotional well-being when comparing disease groups. In contrast, participants with cirrhosis or cirrhotic HCC had significantly worse functional well-being compared to those with CLD or noncirrhotic HCC, P 0.001. Patients with cirrhosis with or without HCC scored lowest (worst) on the hepatobiliary subscale. HRQOL was best in non-cirrhotic HCC patients, then CLD patients, then cirrhotic patients followed by cirrhotic-HCC patients, P 0.004. Table 2. The PSS-10 was administered to 38 participants who completed the FACT-Hep. There was a correlation between stress and HRQOL; as stress increased from low to moderate to high, HRQOL decreased significantly, P 0.003. Significant racial differences in HRQOL, P 0.05, disappeared when stratified by disease group.

CONCLUSION:
Low HRQOL in HCC patients is likely driven by cirrhosis; non-cirrhotic HCC patients had the highest HRQOL. Therefore, alleviation of cirrhosis symptoms may improve HRQOL for most HCC patients.