bluuebunny/crossref_metadata_2025_split huggingface dataset:
950 Effects of Probiotics on Intestinal Failure-Associated Liver Disease in Adult Patients Receiving Prolonged Parenteral Support: A Tertiary Care Center Experience
Authors: Alomari Mohammad , Al Momani Laith , Sarmini Muhammad Talal , El Kurdi Bara , Khazaaleh Shrouq , Nehme Fredy , Young Mark , Romero-Marrero Carlos 
Published: October 2019

INTRODUCTION:
It has been hypothesized that dysbiosis plays a significant role in the pathogenesis of intestinal failure-associated liver disease (IFALD). Therefore, we aimed to investigate the effect of probiotics on IFALD in patients receiving prolonged parenteral support, namely home parenteral nutrition (HPN) and intravenous fluids (HIVF).

METHODS:
We identified a cohort of patients with intestinal failure (IF) who received HPN or HIVF for >2 weeks at our tertiary center between January 2005 and August 2016. (Table 1) We excluded patients < 18 years of age, patients with other causes of liver disease, patients who used probiotics for < 30 days, patients with < 6 months follow up and those who had long-term antibiotic use ( >30 days). Bivariable and multivariable logistic regression analyses were used in this study.

RESULTS:
A total of 282 patients who received prolonged parenteral support were included. Eighty-five percent of our sample received PN, while the remaining got HIVF. A total of 78 (27.7%) patients used probiotics. The prevalence of IFALD in patients who used probiotic was 35.9% vs. 54.4% in patients who did not use probiotics, P = 0.005. In multivariable analysis, only small bowel length of 10-90 cm and HPN use showed a significant impact on IFALD, OR = 4.114 (95% CI = 1.557-10.874, P = 0.004), OR = 4.164 (95% CI = 1.325-13.087, P = 0.015) respectively (Table 2).

CONCLUSION:
Our data does not support the use of probiotics to prevent IFALD in patients receiving prolonged parenteral support. Only small bowel length of 10-90 cm and prolonged HPN use showed a significant impact on IFALD.
953 Sustained Decline of Noninvasive Fibrosis Index Values in Patients With Chronic Hepatitis C (CHC) With Sustained Virologic Response (SVR) After Receiving Direct-Acting Antiviral Agents (DAAs)
Authors: Prabhakar Vijay , Lutchman Glen , Ahmed Aijaz , Nguyen Mindie H. , Daugherty Tami , Kwo Paul 
Published: October 2019

INTRODUCTION:
DAAs for CHC are highly effective at achieving SVR. However, there are limited data on outcomes post-SVR. Our aim was to investigate the temporal effect of DAAs on the outcomes of hepatic fibrosis by non-invasive assessment and incidence of HCC post-SVR.

METHODS:
Retrospective longitudinal study in adults with CHC who received DAAs between 2014 and 2018 and achieved SVR at 12 weeks (SVR12) and/or 24 weeks (SVR24). Data abstracted included demographic data, pre-treatment fibrosis stage, DAA regimen, clinical and laboratory data post-SVR. Fibrosis level was determined post-SVR using APRI and FIB-4. Co-primary study outcomes were FIB-4 values and APRI values post-SVR, and incidence of hepatocellular carcinoma. ANOVA and two-sample t-test statistical analyses were performed using Microsoft Excel.

RESULTS:
A total of 532 patients were identified retrospectively. Median age at the end of treatment was 60 (55–65) years, 306 (57.5%) were men, baseline median APRI was 0.92, baseline median FIB-4 was 2.67, and 230/532 (43%) were F4 pre-treatment (Table 1). Hispanics had a higher level of pretreatment fibrosis than non-Hispanics (P < 0.01) and higher BMI than whites and Asians (P < 0.001). We observed a significant sustained reduction in APRI scores post-treatment at SVR12/24, and 1 and 2 years post-SVR and FIB-4 scores at 2 years post-SVR within all fibrosis groups and all races (Tables 2 and 3). Hispanics in our cohort had significantly higher fibrosis levels at 1 and 2 years post SVR compared to blacks and Asians (P < 0.01 and P < 0.05, respectively) but not whites. 159 (70%) women and 224 men (73%) achieved a normal ALT less than 25 or 33. 72% of whites, 67 % of Asians, 81% of blacks, and 76% of Hispanics achieved normal ALT level. 22 (4.14%) patients developed hepatocellular carcinoma (HCC) post-treatment; all had F4 fibrosis prior to treatment initiation.

CONCLUSION:
In a cohort of HCV patients with high prevalence of advanced fibrosis,treatment with DAAs lead to significant improvement in fibrosis indices, across all initial fibrosis stages and races at 1 and 2 years post-SVR. In our cohort, Hispanics had higher baseline fibrosis levels and BMI yet still had a sustained significant improvement 2 years post-SVR though fibrosis levels still remained higher than Asians and blacks. The risk of HCC post-SVR remains in patients with F4 fibrosis.
956 Kasr Alainy Fibrosis Index (KAFI) - A Novel Score Based on Micro RNAs for Diagnosis of Significant Fibrosis: A Biopsy Controlled Study
Authors: Abdel-Haleem Hanan , Omran Dalia , Zekri Abdel Rahman , Ahmed Ola , Moniem Mostafa Abdel , El Ray Ahmed 
Published: October 2019

INTRODUCTION:
Precise identification of HCV induced liver fibrosis is needed for tailoring therapy, monitoring fibrosis regression after sustained virologic response and management of complications. Few studies investigated the role of MicroRNAs in predicting liver fibrosis. The current study evaluated the diagnostic accuracy of circulating miRNAs; miR-122, miR-192, miR-855, miR-375, miR-224, and miR-221 in prediction of hepatic fibrosis and to validate their usefulness against other commonly used noninvasive fibrosis scores using liver biopsy as the gold standard.

METHODS:
Seventy patients with chronic HCV, enrolled from Theodor Bilhariz research institute were included in this study. They were subjected to routine laboratory investigations, HCV-RNA, serum miR-122, 192, 885, 375, 224 and 221 by PCR, ultrasound guided liver biopsy and calculation of the following scores: Fibrosis Index (Fi), Fibro-Alfa , Hui index , aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), Biotechnology Research Center (BRC) score, aspartate to platelet ratio index (APRI), Fibro-Q , Gotebörg University Cirrhosis Index) (GUCI) and FIB-4 score.

RESULTS:
There was no statistically significant difference in laboratory parameters except for miR-122 which was significantly lower in patients with significant and advanced fibrosis (P < 0.0001 and P = 0.007, respectively). Univariate analysis identified miR-122, bilirubin and miR-855 as independent predictors of significant fibrosis. The AUC were 0.78, 0.67and 0.63, respectively (Figure 1a,c). Multivariate analysis selected the best overall formula combining miR-122, bilirubin and miR-855 as a novel noninvasive score for predicting significant liver fibrosis. KAFI Score = 4.558 – (miR-122 × 0.089 + miR-855 × 0.051 + bilirubin × 0.366), where 4.558 is a numeric constant. The area under the ROC curve (AUC) of this score for identifying significant fibrosis was 0.83 (Figure 1d). A cut-off of 0.41 had 77% sensitivity, 75% specificity, 65% positive predictive value, 85 % negative predictive value and 76% efficiency for predicting significant liver fibrosis. The AUCs of FI, Fibro- Alfa, Hui, AAR, BRC, APRI, Fibro-Q, GUCI and FIB 4 were 0.46, 0.53, 0.54, 0.60, 0.61, 0.62, 0.62, 0.62 and 0.67; respectively for predicting significant fibrosis. KAFI score yielded AUC 0.83 for predicting significant fibrosis and 0.80 for predicting advanced fibrosis.

CONCLUSION:
KAFI score is better than the current scores in discriminating hepatic-fibrosis in chronic hepatitis C patients
958 Long Term Data on Effect of Mobilized Peripheral Blood Autologous CD34+ Cell Infusion in Patients With Non- Viral Decompensated Cirrhosis
Authors: Sharma Mithun , Mitnala Sasikala , Rao Padaki N. , Kumar Pavan , Jaggaiahgari Shasidhar , Gupta Rajesh , Da Pramod , Kulkarni Annand , Jagtap Nitin , Singh Jagdeesh Rampal , Reddy Duvurr N. 
Published: October 2019

INTRODUCTION:
The paucity of organs for liver transplant coupled with rising cost have paved the way for research in alternative cell based therapies as a bridge to liver transplantation. Our initial published work with 6 months follow up have now been followed up for 3 years and the data is presented below

METHODS:
Cirrhotic patients of non-viral etiology were divided into 2 groups – standard of care (control, n = 23) or to receive autologous CD34+ cell infusion through hepatic artery (study group n = 22). Patient in study group were admitted in hospital and received Granulocyte Colony stimulating Factor (G-CSF) injections @ 520µgm per day for 3 consecutive days to mobilize CD34+ cells from the bone marrow. On Day 4, leukapheresis was done and CD34+ cells were isolated using CliniMAC magnetic cell sorter. The isolated CD34+ cells were infused into the hepatic artery under radiological guidance. The control group received standard of care treatment for liver cirrhosis and were worked up for liver transplantation as per protocol of the institute. Both groups were followed up every weekly for 4 weeks and then every month for 3 months and then 6 monthly for 3 years

RESULTS:
In control and study group, the cause of cirrhosis was cryptogenic in 18 (78.2%) and 16 (72.72%) and alcohol related in 5(21.7%) and 6(27.27%) respectively. The mean day 3 cell count (cells/µl) was 27.00 ± 20.43 with a viability (%) of 81.84 ± 11.99. and purity of 80-90%. Primary end point analysis revealed that at 4 weeks, the mean serum albumin in the study group increased significantly (2.83 ± 0.36 vs 2.43 ± 0.42, P = 0.001) when compared with controls. This improvement in albumin was however not sustained at 3 months. However, at the end of 3 months there was a statistically significant improvement in serum creatinine in the study group (0.96 ± 0.33 vs 1.42 ± 0.70, P = 0.01) which translated into a significant improvement in the MELD score (15.75 ± 5.13 vs 19.94 ± 6.68, P = 0.04) . However, when these patients were followed up for 3 years, there was no difference in the MELD score and mortality ( 6/23 vs 5/23 ) between the 2 groups

CONCLUSION:
Autologous CD 34 + cell infusion is safe and effectively improved liver function in the short term. However, when they were followed up for 3 years , no difference could be noted in both the arms. Since cirrhosis is a ongoing process, the possible role of repeated infusions needs to be studied or a combination of mesenchymal and hematopoietic stem cells may be more effective.
959 Cirrhosis Patients Admitted With Ascites Have Longer Length of Stay and Higher 30-Day Readmission Rate
Authors: Serigado Soares Da Costa Joao M. , Taylor Rikera , Scheinberg Andrew , Patel Angeli , Jones Patricia D. 
Published: October 2019

INTRODUCTION:
Hospitalizations and readmissions in cirrhosis patients pose a significant economic burden to the health care system. Readmission rates are high for patients with decompensated cirrhosis; 30-day rates are as high as 30–40%. We aimed to identify the frequency and predictors of 30-day readmission rates in patients with decompensated cirrhosis admitted to two academic hospitals.

METHODS:
Using research informatics and validated ICD-10 codes, we identified cirrhosis patients admitted to the University of Miami Hospital (UMH) from 10/1/2017 to 10/1/2018. (Figure 1) After retrospective chart review, we excluded patients without cirrhosis or qualifying admissions. As patients from UMH are often admitted to Jackson Memorial Hospital, those records were also reviewed for admissions during the study period. Univariate analysis was conducted to describe demographics and disease-specific characteristics and identify variables associated with 30-day readmission rates.

RESULTS:
In our sample, 105 patients met inclusion criteria with 208 eligible admissions. Median age was 63 and 67.6% were male. During the index admission, the primary admission diagnosis was ascites in 36 patients, upper GI bleed in 15, and hepatic encephalopathy (HE) in 13. For 41 patients, the reason for admission is listed as other. (Table 1) The average length of stay (LOS) during the index admission was 7 days (±7.5). The readmission rate was 52.7%; the 30-day readmission rate was 25.8%. Twelve patients died during the index admission. Fifty patients had at least one readmission; range (1–8). A higher proportion of ascites patients were readmitted within 30 days, 35.3%, compared to 23.1% in those with GI bleed, 27.7% of HE patients and 17.1% of those with other diagnoses. Those with ascites also had the longest LOS, mean 7.67 days (±10). Noting the above results, we focused on the 47 patients with a primary or secondary diagnosis of ascites. Average time to paracentesis was 2 days. Only one patient with ascites (2.1%) was scheduled for paracentesis prior to discharge; 38 (81.8%) were discharged on diuretics. Fourteen patients (29.8%) were readmitted with a primary diagnosis of ascites (Table 2).

CONCLUSION:
Patients with decompensated cirrhosis are frequently readmitted in less than 30 days; ascites contributed to increased LOS and readmission rates. Additional study is needed to determine if Implementation of core quality measures decreases readmission rates and/or improves quality of life.
965 Safety of Statins in Decompensated Cirrhosis in Patients Listed for Liver Transplantation
Authors: Singh Kevin N. , Mejia Perez Lady Katherine , Singh Amandeep , Carey William 
Published: October 2019

INTRODUCTION:
Statins (S) are important for cardiovascular disease risk reduction, including in those with cirrhosis (C). S may also slow progression of C, reduce portal pressure, and risk of hepatocellular carcinoma (HCC). A recent AASLD NAFLD practice guidance reiterated recommendations of the National Lipid Association's Statin Liver Safety Task Force (Bays et al, Journal of Clinical Lipidology, 2014), recommending S avoidance in decompensated cirrhosis (DC). In this study, we sought to determine whether S in DC use was associated with a higher risk of adverse outcomes.

METHODS:
A retrospective case-controlled study examined S use and outcomes in those with DC listed for liver transplant (LT) between January 2000 and December 2017. The S cohort included those who took S for at least 90 days prior to LT (cases). Listed non-S patients (NS) patients served as controls. The primary aim was to determine S safety (side effects, S discontinuation, change in MELD, non-transplant hospitalization, mortality). Secondary outcomes included evidence of possible S benefit (less new or worsening ascites, GI bleed, hepatic encephalopathy, hepatorenal syndrome (HRS), spontaneous bacterial peritonitis (SBP) and hepatocellullar carcinoma (HCC). Univariate and multivariate analysis of demographic data and outcomes were performed using negative binomial and logistic regression with repeated-measured ANOVAs.

RESULTS:
Eleven hundred ninety-one patients with DC were included. Sixteen percent were taking one of 5 different S (Table 1). There was no apparent serious deleterious effect of continued S use as measured by S discontinuation, progression of MELD score, non-transplant hospitalization, or mortality (Table 2). One developed myalgia not requiring S discontinuation. While S users had moderately higher likelihood of worsening HE, there was a trend for reduction in new HE. Potential S benefit is suggested by lower mortality, hospital admissions, new HCC, ascites, SBP, re-bleeding, and HRS in those taking S. Caution is required in interpreting potential S benefit because of important differences in liver disease distributions and co-morbidities in S and Non S patients.

CONCLUSION:
Conclusion: In decompensated cirrhosis: 1. Statin use is safe. There is no need to discontinue statins once C advances from compensated to DC; 2. Statins may have a protective effect in suppressing HCC, new or worsening ascites, and other important outcomes. Additional study is needed to better understand if there is an interaction of S and HE.
968 Lead (Pb) Exposure and Risk of Non-Alcoholic Fatty Liver Disease and Advanced Fibrosis: An Association Modified by Race/Ethnicity and Gender in NHANES 2011-2016
Authors: Reja Debashis , Visaria Aayush , Tawadros Augustine , Pioppo Lauren , Bhurwal Abhishek , Rustgi Vinod K. 
Published: October 2019

INTRODUCTION:
NAFLD and NASH are most commonly associated with risk factors such as metabolic syndrome and obesity. Increasing evidence support that environmental toxicants may also play a role. Common sources of Lead (Pb) include paint, dust, waterpipes, and gasoline. In this study we aim to investigate the association of Lead toxicity with NAFLD and advanced fibrosis.

METHODS:
A population of 5,590 non-pregnant individuals age 18–74 were included in this secondary analysis of NHANES 2011-2016. Exclusion criteria: AST/ALT > 500 IU/L, alcohol > 10 drinks/week (females)/ >20 drinks/week (males), transferrin saturation > 50%, positive hepatitis B and C serology. NAFLD was defined by Fatty Liver Index score > 60. Advanced fibrosis was defined by National Fibrosis Score > 0.676. Student’s T-test was used for continuous and Rao-Scott Chi-Square test for categorical variables. Comparison across quartiles were done with simple linear regression for continuous, Rao-Scott Chi-Square test for categorical variables. Demographics and patient confounders were adjusted using multivariate logistic regression (SAS 9.4) for odds of NAFLD/Advanced Fibrosis with respect to Lead quartile.

RESULTS:
Increasing exposure to blood Lead levels is significantly associated with increasing age, male gender, longer education, lower BMI, and increasing Mercury levels (see Table 1). After multivariate adjustment for confounding factors, risk of Advanced Fibrosis significantly increased with Lead exposure, (Quartile 4 OR 5.63, 95% CI 3.17–9.99). Upon stratification analysis, this increased risk was highest in males (Q4 OR 16.67, 95% CI 3.96–70.09), African Americans (Q4 OR 9.96, 95% CI 4.45–22.33), and significant trends were positively correlated across all racial groups. Increased exposure to Lead after the median also showed a positive trend for risk of NAFLD (Q4 OR 1.11, 95% CI 0.64–1.92). This positive association was seen in males and whites, however a negative trend was seen in African Americans (see Table 3).

CONCLUSION:
Our findings show a strong association for Advanced Fibrosis and elevated Lead levels, particularly for African Americans and males. NAFLD is also positively associated with Lead exposure. This study can help identify populations in need of aggressive screening. Further studies are needed.
971 Eradication of Hepatitis C by Increasing Identification Rates of the Hepatitis C Virus (HCV) in Baby Boomers Using the Health Maintenance Tab
Authors: Zafar Yousaf , Elkafrawy Ahmed A. , Galappaththy Suguni Loku , Khan Shahryar , Shah Raj 
Published: October 2019

INTRODUCTION:
Chronic HCV is one of the leading causes of cirrhosis and hepatocellular carcinoma in the United States. Current national data shows 75% of HCV infected adults are born between 1945–1965 (baby boomers). The USPSTF recommends one-time screening of this population for HCV. The aim of our study is to assess the impact on the rate of detection of HCV by implementing a screening tool in the health maintenance tab for this subset of high-risk individuals and improving treatment rates

METHODS:
In March 2017, our health center established a Health Maintenance tab for Screening HCV for all baby boomers.Yearly data regarding the number of patients screened, patients who had positive screening, data on confirmatory testing and the number that finally received treatment was collected between March 2012-February 2018. The percentage of patients screened and later confirmed positive was calculated.

RESULTS:
We compared the screening of baby boomers 5 years prior to the health maintenance tab and 1 year after it was introduced. In 2012, a total of 30915 patients were seen in the health facility with 1.83% screened, followed by 2.57% of 30679 patients in 2013, 2.4% from 29614 patients in 2014, 1.8% from 29081 patients in 2015, 1.7% from 28887 patients in 2016 and 7.8% from 29896 in 2017. There was 4.5 times increase in the screening of patients after the intervention. The number of patients who were screened positive with HCV Antibody from March 2012 to Feb 2018 were 15, 15, 55, 73, 64 and 182 in the consecutive years. The number of patients that had confirmatory testing with HCV RNA titers from 2012 to 2018 was 80%, 60%, 83%, 80%, 71.8% and 77.4%. Of those who had HCV RNA titers ordered between 2012 to 2018, the number of patients who were confirmed positive were 9 in 2012, 4 in 2013, 30 in 2014, 35 in 2015, 18 in 2016. The year after the intervention identified 73 patients who had confirmed Hepatitis RNA titers. Of the patients identified as having the infection, 4 were treated in 2012, 2 in 2013, 25 in 2014, 22 in 2015, 18 in 2016 and 52 after the intervention.

CONCLUSION:
Screening baby boomers using the health maintenance tab in the Electronic health record identified more patients who may in fact have Subclinical HCV. Identifying these individuals earlier would help initiate necessary treatment promptly and help prevent chronic complications. However, treatment of identified patients remains a challenge as other socioeconomic problems prevents individuals getting complete eradication of the infection
973 Utility of Gram Stain in the Diagnosis and Management of Spontaneous Bacterial Peritonitis: Promoting High Value Care
Authors: Fahad Hamna , Vozzo Catherine Frakes , Singh Tavankit , McCullough Arthur J. 
Published: October 2019

INTRODUCTION:
The diagnostic criteria for spontaneous bacterial peritonitis (SBP) and culture negative neutrocytic ascites depends largely on neutrophil counts of more than 250 cells / mm3. A positive ascitic fluid culture makes the diagnosis of SBP versus CNNA. In general clinical practice gram stain (GS) and culture are routinely sent for suspected SBP. The yield of microbe from ascitic fluid is low possibly because SBP and CNNA are known to happen with very small concentrations of bacteria, whereas bacterial loads as high as 10^5 organisms/ml are required for a positive GS. The aim of this study was to determine the utility of GS in the diagnosis and management of suspected SBP as an impetus to decrease overall burden of healthcare cost and unnecessary testing.

METHODS:
We retrospectively reviewed patients with ascites and cirrhosis, who underwent paracentesis with body fluid analysis at a large tertiary care hospital in a 1-year period. Patients were identified using institutional procedural codes and ICD 9 and ICD 10 codes for ascites and cirrhosis. We included all adult patients with cirrhosis who had underwent paracentesis in 2017 and had both a culture and a GS sent for analysis. We excluded patients who had any evidence of recent or current source of intra-abdominal infection or had partial labs sent. Variables of interest were date of ascitic fluid studies sent, date of GS results, date of culture results, date of initiation of empiric antibiotics and the date and name of the second antibiotic used. Descriptive statistics were used to analyze data. Costs for GS, culture and body fluid cell count & differential were obtained from the coding and reimbursement department.

RESULTS:
767 patients underwent ascitic fluid testing in our study period. 43 had a positive GS (5.6%). 21 of these had SBP (PMN > 250 and positive culture), one patient had CNNA (PMN > 250 and no culture growth), 20 patients had bacteracitis (PMN < 250 and positive culture) and one patient had PMNs < 250 and no culture growth. Management was changed in 3 cases (0.4%) based on GS alone (Table 1). In one of these patients, therapy was changed again after the culture grew a different organism. Total healthcare cost calculated to be at least $36,672 each year at our center based on $48 per ascitic fluid gram stain sample alone.

CONCLUSION:
Carrying out GS on all ascitic fluid samples is not cost effective and rarely leads to changes in management.