bluuebunny/crossref_metadata_2025_split huggingface dataset:
1051 Association Between Vitamin D Deficiency and Nonalcoholic Fatty Liver Disease (NAFLD)
Authors: Baidoun Firas , Sarmini Muhammad Talal , Alkhadra Yasser , Khoudari George , McCullough Arthur J. 
Published: October 2019

INTRODUCTION:
Nonalcoholic fatty liver disease (NAFLD) is the leading cause for chronic liver disease in western countries and a major leading cause of morbidity and mortality in the United States. Vitamin D deficiency has been associated with obesity,diabetes mellitus and metabolic syndrome, all of which are risk factors for NAFLD. The goal of this study was to investigate the association between vitamin D deficiency and NAFLD using a large inpatient date base.

METHODS:
By using the data from the National Inpatient Sample (NIS) database between 2002 and 2014, we identified the patients with the diagnoses of vitamin D deficiency and NAFLD using the International Classification of Diseases 9th version codes (ICD-9). The control group was the patients without vitamin D deficiency using the ICD-9 codes. We performed multivariate logistic regression analysis to calculate the association between vitamin D deficiency and NAFLD.

RESULTS:
The study had total 101,137,145 patients. The vitamin Ddeficiency group had 339,418 patients (0.34%). We noticed that patients with vitamin D deficiency were older (63 vs 48), and more likely to be African American (17% vs 14%) and female (67% vs 58%) (P < 0.001 for all). The vitamin D deficiency group also had more patients with obesity (16% vs 7%), hyperlipidemia (34% vs 13%), hypertension (59% vs 36%) hypothyroidism (19% vs 8%) uncomplicated diabetes mellitus (21% vs 14%) and chronic diabetes mellitus with complications (8% vs 3%) (P < 0.001 for all). Using Multivariate logistic regression, and after adjusting for potential cofounding factors, patients with vitamin D deficiency had a statistically significant higher rate of NAFLD (Odds Ratio [OR], 2.946, 95% confidence interval [CI], 2.859 -3.036, P < 0.001) compared with patients without vitamin D deficiency.

CONCLUSION:
Based on our study we found that patients with vitamin D deficiency have three times higher risk of having NAFLD compared to patients without vitamin D deficiency. These data emphasize the importance of screening for vitamin Ddeficiency in NAFLD patients. Further studies are needed to assess the role of vitamin D supplement in NAFLD progression.
1058 Real World Effectiveness and Safety of Glecaprevir/Pibrentasvir in Adults With Chronic Hepatitis C Virus Infection: A Meta-Analysis
Authors: Cornberg Markus , Negro Francesco , Lampertico Pietro , Turnes Juan , Curry Michael P. , Brown Ashley , Wedemeyer Heiner , Carrion Jose A. , Wick Nicole , Pangerl Andreas , Larsen Lois , Yu Yao , Persico Marcello 
Published: October 2019

INTRODUCTION:
Glecaprevir/pibrentasvir (G/P) is approved for adults infected with hepatitis C virus (HCV) genotypes 1–6. In clinical trials, G/P was associated with high rates of sustained virologic response at post-treatment Week 12 (SVR12) and was well tolerated. Currently, real-world evidence (RWE) regarding G/P use is being collected. A systematic review and meta-analysis of RWE reporting the effectiveness and safety of G/P were undertaken.

METHODS:
Biosis, Derwent Drug File, Embase®, International Pharmaceutical Abstracts, Medline®, and SciSearch databases were searched using pre-defined terms for “G/P” and “RWE” to identify real-world prospective/retrospective studies (1 January 2017‒15 October 2018) that reported SVR12 and/or safety parameters in HCV-infected adults (N ≥ 20) treated with G/P. Congress presentations up to 12 November 2018 were included. Random effects meta-analysis was used to determine SVR12 and naïve pooling for adverse event (AE) rates. Intention-to-treat (ITT) SVR12 analyses included all patients dosed with G/P; modified ITT (mITT) excluded those who had non-virologic failure.

RESULTS:
10,048 adults treated with G/P in 16 studies were included; ITT SVR12 rates were reported in 14 studies and mITT SVR12 rates in 11 studies. SVR12 rates overall and by subgroups based on ITT and mITT populations are shown (Table 1). AEs were summarised in 6 studies and reported in 12.7% (724/5685) of patients. Treatment discontinuations due to AEs were summarised in 5 studies and reported in 0.5% (24/4508) of patients. The most frequent AEs were pruritus (4.7%; 126/2698), fatigue (4.4%; 146/3305), and headache (2.7%; 102/3759). SVR12 and safety data will be updated in the final presentation.

CONCLUSION:
Consistent with results observed in clinical trials, RWE indicates that G/P is a well-tolerated and highly effective pangenotypic treatment option for a broad range of HCV-infected patients.
1061 Gender Differences in Characteristics of Hospitalized Patients With Cirrhosis: A Prospective Multicenter Inpatient Cohort Study
Authors: Rubin Jessica B. , Srisengfa Yanin , Albhaisi Somaya , Acharya Chathur , Nangia Gayatri , Shaikh Tahira , Thacker Leroy R. , Reddy Rajender , Tandon Puneeta , Bajaj Jasmohan S. , Lai Jennifer C. 
Published: October 2019

INTRODUCTION:
Women with cirrhosis listed for liver transplant have increased waitlist mortality compared with men, but the reasons for this disparity is not well-established. We hypothesized that women with cirrhosis have different comorbidities and reasons for hospitalizations than men - and explored this hypothesis in a large, multi-center cohort of inpatients with cirrhosis.

METHODS:
Our cohort included patients with cirrhosis hospitalized non-electively, prospectively enrolled at 4 academic medical centers 1/2013-2/2017. Data collected included comorbidities, reasons for admission, cirrhosis complications, medications, hospital course, and outcomes. Readmission and mortality rates were compared between women and men using logistic regression.

RESULTS:
Of the 674 hospitalized patients with cirrhosis, 256 (38%) were women. Median age was 56 years; 75% were non-Hispanic White. Women were less likely than men to have cirrhosis from alcohol (34% vs 26%, P < 0.001), and more likely to have NASH (22% vs 15%, P < 0.001). Women and men had similar cirrhosis complications, liver-related medications, MELD (20 vs 20, P = 0.36), and Child-Pugh (9 vs 10, P = 0.36) scores. Women were more likely to have certain non-liver related comorbidities, including insulin-dependent diabetes (23% vs 14%, P = 0.002) and connective tissue disease (4% vs 1%, P = 0.004), as well as to require non-opiate pain medications (14% vs 7%, P = 0.008) or antidepressant/sleep aids (38% vs 28%, P = 0.005). Overall infection rates on admission were similar between women and men (27% vs 22%, P = 0.19), but women were more likely than men to have UTIs (14% vs 4%, P < 0.001) and less likely to have SBP (6% vs 11%, P = 0.04). Rates of other decompensating events were similar between women and men, including GI bleeding, renal dysfunction, and volume overload (P for all > 0.05). There were no differences between women and men in 30d (11% vs 13%, P = 0.60) or 90d (22% vs 27%, P = 0.18) mortality. In logistic regression, female gender was not associated with increased 30d mortality (OR 0.88, 95% CI 0.54-1.43, P = 0.60) or 90d readmission (OR 1.06, 95% CI 0.75-1.48, P = 0.76).

CONCLUSION:
Although women and men hospitalized with cirrhosis have similar severity of liver disease, they differ by their etiologies of cirrhosis, non-liver related comorbidities, infectious complications, and patterns of medication use. Future studies should further explore the role that these non-liver-related factors play in contributing to well-established gender disparities in waitlist outcomes.
1064 Influenza in Cirrhosis Patients: A Multi-Year Nationwide Analysis
Authors: Aloreidi Khalil , Maddika Srikanth , Then Eric O. , Culliford Andrea , Gaduputi Vinaya 
Published: October 2019

INTRODUCTION:
Influenza is an acute and usually self-limited febrile respiratory illness. However, it is associated with increased morbidity and mortality in certain high-risk populations including patients with liver disease. Interestingly, the data on this group has been always limited.

METHODS:
The Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (2010-2014) was used for this analysis. Using with International Classification of Diseases, Ninth Revision, Clinical Modification codes (ICD-9-CM), the patients with a primary discharge diagnosis of influenza were identified. Similarly, the patients with a secondary discharge diagnosis of cirrhosis were identified. Our primary outcome is to assess the effect of cirrhosis on inpatient mortality among patients who were admitted with influenza. Our secondary outcomes include the length of stay and hospitalization charges. Categorical variables were compared using the chi-square test, and continuous variables were compared using Student t-test. All P values were 2 sided, with .05 as the threshold for statistical significance. All analysis was performed with SPSS 25 (IBM, USA).

RESULTS:
There were 36,680 discharges with a primary diagnosis of influenza between 2010 and 2014; 444 of these discharges (1.2%) have a secondary diagnosis of cirrhosis. Patients with influenza with and without Cirrhosis had comparable mean age, sex, and race (Table 1). Cirrhosis among patients with Influenza was associated with a higher mortality rate of 5% compared to 1.8% in patients without cirrhosis (OR 2.85, 95% CI 1.85 to 4.41, P < 0.0001). There was a minor increase in mean length of stay in influenza patients with a history of cirrhosis compared to non-cirrhotics (5.26 days vs 4.48 days, P < 0.0001). The mean hospitalization cost was significantly higher in influenza patients with cirrhosis ($45059.66 vs $32421.75, P < 0.0001). After adjustment for patient characteristics on a multivariable analysis (Table 2), cirrhosis was independently associated with higher mortality among patients with influenza (OR 3.09, 95% CI 1.99 to 4.78, P < 0.0001).

CONCLUSION:
Among the patients who were admitted with influenza, cirrhosis was associated with nearly three times higher mortality compared to non-cirrhotics. The mean length of stay and mean hospitalization cost were also higher in patients with cirrhosis.
1066 Effectiveness of a Nurse-Led Fibroscan Service Towards Enhanced Care in Liver Disease
Authors: Bhandare Anirudh P. , Kendrick Lynne , Coulter Diane , Nadeem Muhammad Iftikhar I. 
Published: October 2019

INTRODUCTION:
Fibroscan as a convenient, non invasive tool for classification of Liver Stiffness (KPA) and fat component (CAP) has gained popularity in the hospital as well as community health services .With burden of liver disease significantly affecting the NHS in terms of finances as well as mortality, an accurate measure of the liver parenchyma assists in delivery of safe enhanced care.We present our nurse led fibroscan service in comparison to conventional modalities in the management of liver disease.

METHODS:
273 patients were referred to the Nurse led Fibroscan service from July 2017-18.The Fibroscan readings were then compared to the USS, biochemistry and liver biopsy results. British Society of Gastroenterology(BSG) guidelines were then used to manage these subjects.

RESULTS:
Out of 273 patients referred 30 were excluded due to difficult procedures. Out of 243 screened, 52.68% were female.An average age of 53.9 years was seen (Median 55,IQR 19).The Fibroscan results were classified based on KPA and CAP for different etiology.Mean ALT of 49.22 was seen. Fibroscan results showed , Normal 9.87% ,Fatty Liver = 50.2%,Fibrosis = 22.2%and Cirrhosis 17.69% and compared to USS. Of the 48 subjects with Normal USS, 22 showed fatty liver, 9 had fibrosis and 2 had cirrhosis on fibroscan showing a 68.75% variance in diagnosis indicating a worsening stage of liver disease. Of the 123 that had fatty liver on USS,81 had the same diagnosis on fibroscan too.There was variance in 34.14% with 3 showing a better diagnosis having Normal fibroscan and 23 and 16 subjects showing fibrosis and cirrhosis respectively, indicating a worsening diagnosis. As Per BSG guidelines, fatty liver disease and ALT of below 50 can be discharged back to the care fo GP. 51.2% of these patients were similarly discharged to the GP. 70 subjects had Cirrhosis on USS 45 had a better diagnosis indicating the variance to be 50%. The total variance in diagnosis was noted in 122 (50.2%) from USS to fibroscan, with 41% (n = 50)having a better stage and 72 (59%) showing worse stage of disease. 44 of these subjects underwent liver biopsies which correlated to the above findings in similar percentage.

CONCLUSION:
Nurse led fibroscan service shows effective monetary benefit in good enhanced care of liver disease. It gives a more accurate diagnosis as compared to USS and also helps in avoiding the invasive liver biopsy in majority of the cases. Utilised in a correct manner it can help in appropriate care of the liver disease patients.
1071 Awareness and Barriers to Hepatitis C Screening for Baby Boomers in Internal Medicine Training: A Nationwide Survey
Authors: Khan Ahmad , Cipriani Allison , Kim Jin A. , Singh Shailendra 
Published: October 2019

INTRODUCTION:
World Health Organization has determined a goal of 65% reduction in Hepatitis C Virus (HCV) related mortality by 2030. Baby Boomers, born between 1945 to 1965, comprises two-thirds of patients with HCV in the United States (US). Despite one-time screening recommendation by CDC and USPTF, HCV screening remains low in this age group. There is no available data to determine the adherence and awareness of HCV screening in internal medicine (IM) training programs for this birth cohort. The objective of this study was to assess adherence, awareness, and barriers to hepatitis C screening among IM residents.

METHODS:
An electronic medical record query was made for HCV screening in patients, born between 1945 to 1965, and seen in IM resident continuity clinics from January 2018 to June 2019. Later, a national survey of the IM residents was conducted to assess the awareness and barriers to HCV screening. A convenience-based sampling method was adopted, and we created a 15-item survey instrument on REDCaP that was disseminated to residents by reaching out to their program directors/coordinators through email.

RESULTS:
A total of 1207 patients with mean age 62.2 years, and 49% of females met inclusion criteria; however, only 63 patients (4.9%) had their HCV status tested. In contrast to that, the results from 186 survey respondents showed that 73.7 % of residents are familiar with CDC recommendation to screen baby boomers for HCV. The respondents estimated to provide care to a mean of 54 ± 17 patients from this cohort per year in their continuity clinics. The participants also identified that patients who undergo screening; only 36% understands the purpose of the testing. Notably, survey respondents stated that 9.4% of patients associate HCV testing with IV drug use, suggesting potential stigmatization with testing. Most common barriers identified in the survey are knowledge gap (51.76%) at either patient or provider end, lack of EMR alerts (11.76%) and time constraints (9.4%) due to increased patient load, or complexity of the patients’ comorbidities. Nevertheless, 61% of the participants suggested that providers need more education and awareness about HCV screening in baby boomers.

CONCLUSION:
Adherence and awareness of HCV screening among Baby Boomers in IM residency training are low. There is a need to increase awareness and overcome these barriers to improve HCV testing in this vulnerable population.
1072 Rates and Predictors for Readmission in Decompensated Cirrhosis at a Large Rural Tertiary Care Hospital
Authors: Khan Ahmad , Sohail Abdullah , Cipriani Allison , McDaniel Bryce A. , Farooq Junaid , Chowdhry Monica , Kemper Suzanne , Singh Shailendra 
Published: October 2019

INTRODUCTION:
Decompensated cirrhosis (DC) is an organ failure state associated with multiorgan involvement. Patients with cirrhosis are frequently readmitted, accounting for a significant portion of the billions of dollars spent annually in hospitalization for chronic liver disease. Various studies involving North American cohorts have reported a varied range of readmissions rates and predictors depending on the location and type of hospital. This study aimed to determine the rates of readmission and validate the predictors of 30 and 90-day readmission at a large rural tertiary care hospital with no liver transplant or hepatology service.

METHODS:
A retrospective chart review of patients with DC discharged from September 2016 to September 2018 was conducted. Patients with DC were identified through ICD- 10 codes listed as primary or secondary discharge diagnosis. Patient demographics, laboratory values, and disease-related risk factors were recorded. Primary outcomes were a 30- and 90-day inpatient readmission. We used multivariate logistic regression to determine predictors of readmission at 30 and 90-days.

RESULTS:
A total of 300 patient charts were selected randomly from a sample of 1500 identified through ICD codes. A total of 180 patients that met the inclusion and exclusion criteria were included for analysis. Mean age of the patients was 60.0 ± 11.8 years and 56.74 %were males. The most common etiology for cirrhosis was alcohol use (42.22%), and the mean MELD-Na score was 17 ± 11.8. Mean length of stay was 7 ± 6.6 days. The 30-day and 90- day readmission rate was 28% and 40% respectively. On multivariate analysis, GI bleed, (OR 8.5, 95% CI 2.7-27.2, P = 0.0003), infection, (OR 8.7, 95% CI 2.0-36.6, P = 0.0003) and electrolyte imbalance, (OR 6.6, 95% CI 1.8-24.6, P = 0.0005) were found to be independent predictors of readmission.

CONCLUSION:
Decompensated cirrhosis is associated with high rates of early and late readmissions at a large rural tertiary care hospital with no liver transplant or hepatology service. The predictors for readmission were also unique. Readmission rates and predictors should be reassessed locally so that structured interventions explicitly targeting the local hospital or region can be taken to prevent these readmissions.
1087 Women and Ethnic Minorities With Alcoholic Hepatitis in the United States Are More Likely to Be Hospitalized in High Safety Net Burden Hospitals
Authors: Ladhani Sanah , Hirode Grishma , Singal Ashwani , Wong Robert 
Published: October 2019

INTRODUCTION:
Recurrent hospitalizations due to alcoholic hepatitis (AH) contribute to significant morbidity, mortality, and economic burden. Underserved safety-net populations and ethnic minorities are disproportionately affected by recurrent AH hospitalizations. We aim to evaluate the impact of a hospital’s safety-net burden (SNB) on in-hospital mortality using a large U.S. inpatient database with a focus on ethnicity-specific disparities.

METHODS:
We retrospectively evaluated the 2012-2014 National Inpatient Sample database, the largest publicly available all-payer inpatient healthcare database in the U.S., to evaluate the impact of hospital SNB on in-hospital mortality among adults with AH. Hospital SNB was defined as the percentage of AH hospitalizations per hospital with Medicaid or uninsured payer status and was categorized into 3 groups (low SNB-lowest quartile, medium SNB-2nd and 3rd quartile, high SNB- 4th quartile). AH hospitalizations were identified using ICD-9 codes. Sex- and ethnicity-specific differences by SNB were evaluated with chi-squared testing. The odds of being hospitalized at a high SNB hospital (vs. low/medium) and the impact of SNB on in-hospital mortality were evaluated using adjusted multivariate logistic regression.

RESULTS:
Among 12,519 AH-related hospitalizations (63.2% male, 66.9% non-Hispanic white, 9.9% African American, 11.8% Hispanic), 30.6% were low SNB, 46.3% were medium SNB, and 23.0% were high SNB. Compared to men with AH, women were significantly more likely to be hospitalized at high SNB hospitals (24.1% vs. 22.4%; OR 1.13, 95% CI 1.03-1.25, P < 0.01). Compared to non-Hispanic whites, African Americans (29.6% vs. 21.1%; OR 1.31, 95% CI 1.10-1.57, P < 0.001) were significantly more likely to be hospitalized at a high SNB hospital, and Hispanics demonstrated a trend towards more likely to be hospitalized at a high SNB hospital (29.2% vs. 21.1%; OR 1.18, 95% CI 0.99-1.42, P = 0.067). Overall in-hospital mortality among AH-related hospitalizations was 2.63%. On multivariate regression, there was a trend towards higher odds of in-hospital mortality for AH-related hospitalizations at high SNB hospitals vs. low/medium SNB hospitals (2.78% vs. 2.58%; OR 1.41, 95% CI 0.95-2.08, P = 0.09).

CONCLUSION:
Among hospitalized adults with AH in the U.S., women and ethnic minorities were significantly more likely to be cared for at high SNB hospitals. High SNB hospitals demonstrated a trend towards higher in-hospital mortality for AH patients.
1098 Rapid Fire Hepatology: A Pilot Study of a Near-Peer, Speed-Teaching Hepatology Curriculum on a Dedicated Inpatient Liver Service
Authors: Goldowsky Alexander , Ardolino Eric , Patwardhan Vilas 
Published: October 2019

INTRODUCTION:
Near-peer teaching, trainees educating other trainees, is a valuable form of teaching in residency, valued equally or greater to faculty-led sessions. While resident teaching has been shown to improve clinical performance, concern exists over this type of education encroaching on clinical duties. Our study seeks to determine whether a resident-led, speed-teaching hepatology curriculum leads to improvement in resident comfort with independent management and teaching of core hepatology topics.

METHODS:
PGY2&3 residents at an academic liver transplant center received teaching scripts based on published practice guidelines to lead 15-minute teaching sessions on 8 hepatology topics. The curriculum was given to interns and residents (4 per month) over 4 weeks. Anonymous pre- and post-rotation surveys assessing comfort with independent management and teaching on these topics were performed (Likert scale 1-5). Statistical analysis used independent sample T-tests of pre- and post-rotation survey responses.

RESULTS:
A total of 18 residents completed the pre- and post-intervention surveys (N = 11 PGY1, N = 7 PGY2/3). In the intervention cohort, there was significant improvement in comfort with independent management and teaching of all topics between the pre- and post-intervention surveys (all P < 0.05) (Table 1). Post-intervention respondents, including PGY1 and 2 residents, showed no difference in comfort with independent management of core topics compared to graduating PGY3s who did not have the intervention, with the exception of hyponatremia, which graduating residents felt more comfort managing (4.32 vs 3.56; P = 0.03). In addition, the post-intervention group felt more comfort than graduating residents teaching on hepatorenal syndrome (4.11 vs 3.38; P = 0.02) and trended towards increased comfort teaching on post-liver transplant complications (2.89 vs 2.08; P = 0.0502) (Table 1).

CONCLUSION:
Our study shows a near-peer resident-led speed-teaching hepatology curriculum is feasible to implement on a busy hepatology inpatient service and leads to improvement in comfort in independently managing and teaching on core hepatology topics. We also found a mixed resident group including PGY1-2s reported comfort with teaching and management similar to that of graduating residents, suggesting that our near-peer curriculum may lead to more rapid knowledge acquisition and trainee confidence with hepatology.