bluuebunny/crossref_metadata_2025_split huggingface dataset:
981 Spleen Stiffness Using Elastography as Predictor of Esophageal Varices in Cirrhotic Patients
Authors: Tulsi Rani , Ul Haque Muhammad Manzoor , Farid Muhammad , Hanif Farina , Devi Asha , Luck Nasir Hassan , Tulsi Rinkal , Mehmood Nasir , Danish Muhammad 
Published: October 2019

INTRODUCTION:
Prediction of EV by the measurement of splenic stiffness (SS) by Transient elastography (TE) in cirrhotic patients has been recently proposed. Splenomegaly and splenic stiffness in cirrhosis can be explained by enlargement and hyper activation of the splenic lymphoid tissue, increased angiogenesis, fibrogenesis and passive congestion due to portal hypertension. Thus, the aim of this study is to assess diagnostic accuracy of spleen stiffness as a predictor for the presence of esophageal varices in liver cirrhosis using EGD as gold standard. Spleen stiffness measurement is non-invasive technique as compared to EGD so this test can be used to stratify the liver cirrhotic patient who need screening EGD compared those who do not need it.

METHODS:
Patients were enrolled from June 2018 to May 2019, all patient with cirrhosis undergoing screening EGD were offered to participate in the study. After fulfilling the inclusion criteria, a blood sample for platelet count, INR, CTP and MELD score was taken. Splenic stiffness was measured by fibroscan by expert radiologist prior to undergoing screening EGD. Exclusion criteria was followed strictly to avoid confounding variables. All information along including age, gender, spleen stiffness, presence or absence of EV were entered in the Performa.

RESULTS:
Total of 97 patients were included in the study, mean age of patients was 41.1 ± 15.1, predominantly were males 61(62.9%), while 55 (56.7%) belonged to urban areas of province. Common etiologies for cirrhosis includes HCV 49(50.5%) followed by HBV 16(16.5%), HBV and HDV coinfection 10(10.3%), autoimmune hepatitis 7(7.2%) and others were 8 (8.2%). Most patients belonged to CTP class A 58(59.8%), Mean MELD score were 11.7 ± 5.5. Mean platelets and albumin of patients were 128 ± 86.3 and 3.3 ± 0.7. Total 25 (25.7%) had ascites and 55 (56.7%) had esophageal varices on screening EGD and 6(6.2%) patient had fundal varix. Student t-test showed a significant association of low platelets (P = 0.0001, 118.3 vs 57.5) and high splenic stiffness (P = 0.0001, 37.9 vs 23.0) with the presence of esophageal varices. Area under ROC was calculated for APRI, FIB-4 and splenic stiffness was 0.81, 0.79 and 0.93 respectively.

CONCLUSION:
Splenic stiffness can more reliably predict the presence of esophageal varices as compare to other noninvasive test like APRI and FIB-4. So it can be used to stratify the patient who needs screening EGD and minimize the false negative results.
982 Development of Hepatocellular Carcinoma After Treatment of Hepatitis C at a Diverse, Urban Center
Authors: Modi Krishna , Mansour Jonathan , Jafri Syed-Mohammed 
Published: October 2019

INTRODUCTION:
This study investigates the clinical outcomes for patients treated for chronic hepatitis C, and factors that led to increased development of hepatocellular carcinoma (HCC) and overall mortality.

METHODS:
This is a retrospective study conducted at a single center institution. Inclusion criterion was patients who completed treatment for chronic hepatitis C in 2015. Patients were excluded if they failed to follow up after receiving therapy. The data studied are patient demographics, relevant medical history, HCC screening, and HCC development.

RESULTS:
This study had 367 patients and majority of them were treated with ledipasvir/sofosbuvir (87.7%), and the remainder were also given ribavirin. Most patients had prior treatment for hepatitis C (57.8%). There were 132 patients (36.0%) who had cirrhosis, and 28 patients (7.6%) who underwent liver transplantation. SVR was achieved in 341 patients (92.9%). Screening was continued in 253 patients (68.9%). Of all the cirrhosis patients only 50% of patients continued the screening. A total of 39 patients (10.6%) developed HCC. There was a statistically significant increase in screening for older patients versus than in younger patients (65 versus 61 years old). More patients continued screening if they failed to achieve SVR (69.2% versus 28.0%) or had known cirrhosis (49.6% versus 20.1%). There was a statistically significant increase in development of HCC in patients that did not achieve SVR (50.0% versus 7.4%), underwent liver transplantation (32.1% vs 8.6%), or had known cirrhosis (17.6% versus 6.4%). No significant differences were observed in HCC development between different viral genotypes, history of prior treatment, or whether they received ribavirin during this treatment. Mortality was greater in patients that identified as black (12.0% versus 5.3%), failed to achieve SVR (23.0% versus 7.7%) or developed HCC (23.7% versus 6.4%).

CONCLUSION:
This study shows that patients are more likely develop HCC if fail to reach SVR, have known cirrhosis, or undergo liver transplantation. Patients were more likely to get HCC screening if they failed to reach SVR, and known cirrhosis, but still half the patients with cirrhosis did not get screening. There was no significant difference in HCC development based on viral genotypes, having prior therapy, or whether ribavirin is used. Mortality was noted to be increased in people who identified as Black, failed to achieve SVR, and developed HCC.
987 The Epidemiology and Trend Analysis of Hepatocellular Carcinoma 2002-2014: A Population-Based Study
Authors: Sarmini Muhammad Talal , Asfari Mohammad Maysara , Alomari Mohammad , Romero-Marrero Carlos 
Published: October 2019

INTRODUCTION:
Hepatocellular carcinoma (HCC) is one of the most common malignancies and it is considered the fourth leading cause of malignancy related death in the world. Previous studies suggested that the incidence of HCC continues to rise in the United States (US) and worldwide. Hence, we conducted this study to assess the national trend in the US. Further, we wanted to assess all-cause mortality and baseline characteristics of this population using a nationwide inpatient database.

METHODS:
Using data from the National Inpatient Sample (NIS) database between 2002 and 2014, we identified all patients who were diagnosed with HCC using appropriate ICD 9 coding. We examined also the temporal trends of the length of stay (LOS) and all-cause of mortality (ACM) during admission using the Cochrane-Armitage method for this group over the studied period.

RESULTS:
Out of 101,231,036, we identified total of 824,053 (0.8%) of patients with HCC. Patients with HCC admitted 2010-2014, compared to those admitted 2002-2009, were younger (60 vs 61), (P < 0.001). They were also less likely to be females (46.5% vs 53.5%) and more likely to be Caucasians (51.9% vs 48.1%), (P < 0.001 for all). Furthermore, patients in the first group had more smoking (59.6% vs 40.4%), cirrhosis (51.6% vs 48.8%), hepatitis C virus (HCV) (51.2% vs 48.8%) and nonalcoholic fatty liver disease (NAFLD) (65.1% vs 34.9%), (P < 0.001 for all). On the hand, patients admitted 2002-2009 had more hepatitis B virus (HBV) (57.7% vs 42.3%, P < 0.001) compared to patients admitted 2010-2014. Using trend analysis, the annual prevalence of patients admitted with HCC has significantly increased form 39,935 (0.5%) in 2002 to 70,979 (1%) in 2014, (P < 0.001). ACM of patients admitted with HCC improved from 13.4% in 2002 to 9.2% in 2014, (P < 0.001). In addition, the mean LOS for patients admitted with HCC has decreased gradually from 6.46 in 2002 to 5.77 in 2014 during the studied period, (P < 0.001).

CONCLUSION:
The analysis of very large inpatient data showed that the prevalence of HCC has doubled since 2002 through 2014 and this finding requires immediate attention. Our analysis showed that ACM and mean LOS of HCC patients have improved through this period of time. Screening for HCC in high risk patients remains the key for further improvement in outcomes in this population.
989 Clinicians Fail to Screen for HDV in Patients With HBV Despite Guideline Recommendations
Authors: Moore Andrew , Mitchell Justin , Reau Nancy 
Published: October 2019

INTRODUCTION:
Hepatitis D virus (HDV) requires the presence of the hepatitis B virus (HBV) for replication. Due to limited access to testing and lack of reporting, it is unknown how many HBV patients are co-infected with HDV, but estimates state that anywhere from 5% to 42% of those with chronic HBV are also co-infected with HDV. HBV-HDV co-infection is considered one of the most aggressive forms of viral hepatitis as it leads to cirrhosis and hepatocellular carcinoma more rapidly and results in fulminant liver failure in up to 5% of those affected. EASL recommends that in patients with HBV, other causes of chronic liver disease, including HDV, should be tested for. Additionally, AASLD recommends the testing of HBsAg+ positive persons at increased risk for HDV, specifically HIV+ and HCV-Ab+ individuals. We hypothesized that adherence to these guidelines is poor.

METHODS:
339 patients who were HBsAg+ were seen at our tertiary academic institution between January 1, 2014, and January 1, 2019. Demographic information including age, sex, and race was captured by chart review as was co-infection with HIV or HCV. We evaluated if patients were ever screened for HDV using the HDV-Ab.

RESULTS:
339 patients were HBsAg+, of which 82 were also HBeAg+. 90 (27%) were screened for HDV with only 1 patient (0.3%) testing positive for HDV; 249 (73%) were never screened for hepatitis D. Only 1 of 9 patients (11%) who tested positive for HIV was screened for HDV, and only 1 of 13 patients (8%) who tested positive for HCV was screened for HDV. With respect to race, 111 patients were black, 117 were Asian, 56 were Caucasian, and 55 were other/unknown. The highest rate of screening was noted among Asians at 32%.

CONCLUSION:
Guidelines recommend screening for HDV in patients with HBV, especially those coinfected with HIV or HCV. Unfortunately, adherence to these guidelines was poor, with the lowest screening rates in those with HIV and HCV who are considered highest risk. With an expected prevalence of 5–42%, many HDV-HBV coinfected patients remain unrecognized and at risk for aggressive liver disease. Lack of awareness to guideline recommendations may contribute to poor screening rates, and it is evident that reflexive screening for patients who have HBV needs to be emphasized.
994 The Performance of the NAFLD Fibrosis Score in Hispanics With Type 2 Diabetes and Biopsy-Proven NAFLD
Authors: Barbara Mary , Annunziata Giuseppe , Noureddin Mazen , Alkhouri Naim 
Published: October 2019

INTRODUCTION:
In patients with nonalcoholic fatty liver disease, Hispanic ethnicity and the presence of type 2 diabetes mellitus (T2DM) are associated with advanced fibrosis (AF). The NAFLD fibrosis score (NFS) is a noninvasive test that has been validated to predict AF but was originally developed in mainly a Caucasian population. The aim of our study was to assess the performance of NFS in Hispanic patients with T2DM and biopsy proven NAFLD

METHODS:
This was a single institutional study in south Texas. Using ICD 9/ ICD 10 codes, a retrospective chart review between 2010–2017 identified 55,670 patients with T2DM between ages 18–80. 479 out of 55,670 patients had a liver biopsy. The stage of liver fibrosis was scored from F0 to F4 with (F0-2) defined as early fibrosis and (F3-4) as advanced fibrosis (AF). NFS was calculated and patients were divided into three groups: low score (<-1.45), intermediate score ( -1.45-0.676) and high score consistent with advance fibrosis (>0.676). Analysis was performed using Stata IC 15. A P value < 0.05 was considered statistically significant. Area under the ROC curve (AUC) analysis was done to determine NFS accuracy

RESULTS:
After excluding patients with missing data to calculate NFS and those with liver transplant, total of 311 patients were included in the study. The mean age was 55.15 ± 9 years, 55.31% were females, mean BMI 33.16 ± 7.9 kg/m2, mean AST 45.56 ± 44.78 U/L, ALT 52.03 ± 38.75 U/L, albumin 3.44 ± 0.60 g/dl, platelets 203.97 ± 84.61 KuL, and the mean NFS was 0.627 ± 1.78. 40% of the patients (125 out of 311) had AF proven by liver biopsy. AF was more predominant among females (43% vs 35%). AUC for NFS to predict AF was 0.73, SE 0.02, 95% CL [0.68-0.79], P < 0.001. At the low cutoff point; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 97%, 11 %, 42 % and 78%, respectively and 67%,72%, 61% and 76% at the high cutoff point ( >0.676). Interestingly, 47% of the cohort was in the intermediate score, 24% of the intermediate group had AF (F3-4) vs 76 % had early fibrosis (F0-2)

CONCLUSION:
NFS had a fair diagnostic accuracy for predicting the presence of AF in Hispanic patients with NAFLD and T2DM with AUC of 0.73. A large percentage of our cohort was in the intermediate zone indicating the need for sequential testing with other noninvasive tests to improve accuracy
1005 Worse Functional Status at Time of Liver Transplant Waitlist Registration Is Associated With Significantly Greater Prevalence of Hepatic Encephalopathy, Ascites, and Spontaneous Bacterial Peritonitis
Authors: McCabe Patrick , Hirode Grishma , Liu Benny , Bhuket Taft , Wong Robert 
Published: October 2019

INTRODUCTION:
Poor functional status (FS) is associated higher liver transplant (LT) waitlist mortality. Whether this higher risk of death is mediated by higher prevalence of cirrhosis complications is not clear. We aim to evaluate the impact of FS at time LT waitlist registration on odds of hepatic encephalopathy (HE), ascites, and spontaneous bacterial peritonitis (SBP) among adults listed for LT.

METHODS:
Using 2003-2018 United Network for Organ Sharing LT data, we retrospectively evaluated the impact of FS on prevalence of HE, ascites, and SBP among U.S. adults listed for LT using Karnofsky Performance Status categories (KPS-1: FS 80-100%, KPS-2: 60-70%, KPS-3: 40-50%, KPS-4: 10-30%). We further stratified patients by etiology: hepatitis C (HCV), nonalcoholic steatohepatitis (NASH), alcoholic liver disease (ALD), and combined HCV/ALD. Comparisons of HE, ascites, and SBP prevalence between groups utilized chi-squared methods and adjusted multivariate logistic regression.

RESULTS:
Among 101,249 adults listed for LT (70.1% male, 72.7% non-Hispanic white, 20.3% HCC) 38.2% were KPS-1, 35.6% KPS-2, 14.5% KPS-3, and 11.7% KPS-4. Patients with worse FS were more likely to have HE, ascites, and SBP at time of waitlist registration (HE: 82% (KPS-4) vs. 52% (KPS-1); ascites: 68% (KPS-1) vs. 93% (KPS-4); SBP: 4% (KPS-1) vs. 17% (KPS-4), P < 0.001 for all)) (Figure 1). On multivariate regression, worse FS was associated with greater odds of HE (KPS-4 vs. KPS-1: OR 1.62, 95% CI 1.52-1.73, P < 0.01), ascites (KPS-4 vs. KPS-1: OR 1.41, 95% CI 1.29-1.54, P < 0.01), and SBP (KPS-4 vs. KPS-1: 2.12, 95% CI 1.93-2.33, P < 0.01). Compared to HCV patients, greater odds of HE and ascites were observed in NASH (ascites, OR 1.32, 95% CI 1.25-1.39, P < 0.01), ALD (ascites, OR 1.58, 95% CI 1.52-1.65, P < 0.01), and HCV/ALD (ascites, OR 1.40, 95% CI 1.32-1.49, P < 0.01). While ALD and HCV/ALD patients also had greater odds of SBP vs. HCV, NASH patients had lower odds of SBP (OR 0.92, 95% CI 0.85-0.99, P = 0.03). When stratified by etiology, similar trends were observed, with worse FS strongly associated with greater odds of HE, ascites, and SBP across all etiologies.

CONCLUSION:
Worse FS is associated with higher odds of cirrhosis complications including ascites, HE, and SBP, which was observed across all liver disease etiologies. Disease-specific comparisons showed higher odds of ascites, HE, and SBP in HCV vs. other etiologies, with the exception of lower odds of SBP in NASH patients vs. HCV.
1007 Sex-Specific and Ethnicity-Specific Disparities in Receipt of Hepatocellular Carcinoma (HCC) Treatment Among a Cohort of Patients Who Developed HCC Recurrence
Authors: Zhang Julia A. , Hirode Grishma , Wong Robert 
Published: October 2019

INTRODUCTION:
Despite receiving cancer-directed therapies, there is a high rate of cancer recurrence among patients with hepatocellular carcinoma (HCC). Our study aims to focus on the subset of patients with HCC recurrence to evaluate sex- and ethnicity-specific disparities in receipt of treatment.

METHODS:
Adults with HCC who developed HCC recurrence were identified using 1973-2015 U.S. National Cancer Institute’s Surveillance, Epidemiology, and End Results cancer registry. HCC tumor stage was assessed with the SEER historic staging system (localized, regional, distant) and HCC treatment received was assessed with SEER’s site-specific surgery variable (no treatment, locoregional therapy, surgical resection, and liver transplantation (LT)). Comparisons of tumor stage at diagnosis and receipt of HCC treatment between groups were assessed using chi-square testing and multivariate logistic regression models.

RESULTS:
Among 275 patients with recurrence of HCC (76.7% male, 48.7% non-Hispanic Whites, 14.9% Hispanic, 27.6% Asian/Pacific Islanders), 24.6% did not receive any HCC-directed surgical treatment, 21.9% received locoregional therapies, 42.3% surgical resection, and 11.2% LT. Compared to women, men were significantly less likely to receive any HCC treatment after initial diagnosis of HCC (OR 0.33, 95% CI 0.14-0.76, P = 0.01), including surgical resection or LT (OR 0.53, 95% CI 0.29-0.96, P = 0.037). Compared to non-Hispanic Whites, significantly lower rates of any HCC treatment were observed in Hispanics (OR 0.40, 95% CI 0.19-0.84, P = 0.015) and higher rates of treatment were seen in Asian/Pacific Islanders (OR 2.28, 95% CI 1.02-5.12, P = 0.045). On multivariate analysis, there were significantly lower odds of receiving any therapy for the initial HCC diagnosis in men vs. women (OR 0.27, 95% CI 0.11-0.68, P < 0.01) and in Hispanics vs. non-Hispanic Whites (OR 0.32, 95% CI 0.15-0.72, P < 0.01). Asian/Pacific Islanders were more likely to receive treatment compared to non-Hispanic Whites (OR 2.72, 95% CI 1.15-6.44, P = 0.023). There were no significant differences in receipt of treatment for the HCC recurrence based on sex or ethnicity.

CONCLUSION:
Among U.S. adults with HCC who developed HCC recurrence, nearly one quarter did not receive any HCC-directed surgical therapies at initial diagnosis. Men and Hispanics were significantly less likely to receive any HCC-directed therapies for the initial HCC diagnosis.
1009 The Use of a “Pop Up” Identification System Can Lead to the Identification and a High Percentage of Treatment of Patients With Chronic Hepatitis C
Authors: Snyder Ned , Curry Curtis , Jerrels Leon 
Published: October 2019

INTRODUCTION:
The World health Assembly has set as a goal the elimination of hepatitis C (HCV) as a public health threat by 2030. In the United States, a problem with elimination of HCV is that many patients that are infected are not identified, and the majority who screen positive for HCV, for a variety of reasons, do not receive treatment. In Texas, it has been estimated that only 25% of patients identified as infected actually receive treatment. The cost of treatment has decreased significantly, and lack of coordinated care may partially account for the low treatment rates. The majority of patients with chronic HCV were born 1945-1965, and it has been recommended that patients in this birth cohort be routinely screened with hepatitis c antibody. Kelsey-Seybold Clinic is an accountable health care organization that has about 1 1/2 million patient visits a year. At least 2/3's of the patients receive essentially all their care in our system. currently, there is a pop up message in the electronic medical records of patients in the 1945-1965 cohort when they are seen by their primary care physician as a reminder to check the HCV antibody if not previously done. We wanted to determine if this coordinated system led to a higher percentage of patients being treated than historically reported.

METHODS:
Utilizing the appropriate codes, we examined the data base for 2018 to see 1) what number of patients in this birth cohort with a positive HCV antibody had a HCV RNA performed 2) what number were referred for treatment 3)what number received treatment.

RESULTS:
A total of 8902 patients in the cohort were screened, and 136 (1.5%) were positive for HCV antibody. 113 of the 136 (83.1%) had a positive HCV RNA. At this time, 97 of the 113 have been seen by gastroenterology and hepatology and 85 have so far received anti-viral therapy for a treatment rate of 75.2%. At the time of presentation, updated treatment numbers and response rates will be available.

CONCLUSION:
Utilizing a system of coordinated care, we have been able to identify a large number of patients in the 1945-1965 birth cohort, and subsequently treat a higher percentage of actively infected patients than has been previously noted.
1012 Impact of Treatment With Direct Anti Viral Agents on Health Related Quality of Life Using Chronic Liver Disease Questionnaire in Chronic Hepatitis C Patients
Authors: Khan Shoaib Ahmed , Hanif Farina , Laeeq Syed Mudassir , Luck Nasir Hassan , Majid Zain , Mehmood Nasir , Kumar Sandeep 
Published: October 2019

INTRODUCTION:
Health related quality of life (HRQOL) is important for the physical and psychosocial wellbeing of patients with chronic illnesses. The Chronic Liver Disease Questionnaire (CLDQ) is validated to assess HRQOL. We aim to determine the effect on HRQOL and associated predictive factors in patients treated with direct antiviral agent for Hepatitis C.

METHODS:
Patients receiving sofosbuvir, daclatasvir and ribavirin combination for 12 weeks for Hepatitis C eradication were enrolled. CLDQ consisted of 29 questions assessed on a seven point Likert scale, consisting of 6 domains; Abdomen symptoms, Fatigue, Systemic symptoms, Activity, Emotional function and Worry. Higher score was indicative of minimum symptoms.

RESULTS:
In 168 patients, majority were females (53 %) with mean age of 45.6 ± 10.8 yrs. Most of study population were uneducated (47 %) and had a low socioeconomic status (60.1%). End of treatment response was achieved in all participants. Mean CLDQ score before and after HCV treatment was 3.8 ± 1.0 and 5.2 ± 1.7, respectively (P = 0.00). Median Child score before and after treatment was 10 and 9, respectively. (P = 0.00) Similarly, MELD score improved from 13 to 10 after treatment. (P = 0.00) Statistical significant improvement in all domain of CLDQ score was also observed after treatment. (P = 0.00) On multiple regression analysis pretreatment systemic and activity score showed statistical significant association with post treatment CLDQ score.

CONCLUSION:
We report positive impact of HRQOL in hepatitis C patients treated with direct antiviral agents. Pre-treatment Systemic and Activity scores are statistically significant predictors of improvements in HRQOL.