Alita Mishra

Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009

Hepatocellular carcinoma (HCC) is increasingly reported in patients with nonalcoholic fatty liver disease (NAFLD). Our aim was to assess the prevalence and mortality of patients with NAFLD‐HCC. We examined Surveillance, Epidemiology and End Results (SEER) registries (2004‐2009) with Medicare‐linkage files for HCC, which was identified by the International Classification of Diseases for Oncology, third edition codes using topography and morphology codes 8170‐8175. Medicare‐linked data was used to identify NAFLD, hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholic liver disease (ALD), and other liver disease using International Classification of Diseases, Ninth Revision, Clinical Modification codes. NAFLD was also defined by clinical diagnosis (cryptogenic cirrhosis, obese‐diabetics with cryptogenic liver disease). A logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of HCC. In addition, adjusted hazard ratios for 1‐year mortality were estimated by Coxs proportional hazard regression. A total of 4,929 HCC cases and 14,937 controls without HCC were included. Of the HCC cases, 54.9% were related to HCV, 16.4% to ALD, 14.1% to NAFLD, and 9.5% to HBV. Across the 6‐year period (2004 to 2009), the number of NAFLD‐HCC showed a 9% annual increase. NAFLD‐HCC were older, had shorter survival time, more heart disease, and were more likely to die from their primary liver cancer (all P < 0.0001). Of those who received a transplant after HCC (n = 488), only 5% were related to NAFLD‐HCC. In multivariate analysis, NAFLD increased the risk of 1‐year mortality (OR, 1.21; 95% CI: 1.01‐1.45). Additionally, older age, lower income, unstaged HCC increased risk of 1‐year mortality while receiving a liver transplant (LT), and having localized tumor stage were protective (all P < 0.05). Conclusions: NAFLD is becoming a major cause of HCC in the United States. NAFLD HCC is associated with shorter survival time, more advanced tumor stage, and lower possibility of receiving a LT. (Hepatology 2015;62:1723–1730)

In-Hospital Mortality and Economic Burden Associated With Hepatic Encephalopathy in the United States From 2005 to 2009

BACKGROUND & AIMS Hepatic encephalopathy (HE) is a major complication of cirrhosis that causes substantial mortality and utilization of resources. METHODS We analyzed 5 cycles of the Nationwide Inpatient Sample, conducted between 2005 and 2009, to determine national estimates of incidence, prevalence, inpatient mortality, severity of illness, and resource utilization for inpatients with HE. RESULTS The yearly inpatient incidence of HE ranged from 20,918 (2005) to 22,931 (2009) (P = .2226), comprising approximately 0.33% of all hospitalizations in the United States. Over the 5-year period of analysis, mortality of inpatients with HE remained relatively stable, at 14.13%-15.61% (P = .062); however, the proportion of patients with major and extreme severity of illness increased (P < .0001). The average length of inpatient stay increased from 8.1 to 8.5 days (P = .019). The average total inpatient charges increased from

Systematic review with meta‐analysis: non‐alcoholic steatohepatitis ‐ a case for personalised treatment based on pathogenic targets

46,663 to

In patients with non-alcoholic fatty liver disease, metabolically abnormal individuals are at a higher risk for mortality while metabolically normal individuals are not

63,108 per case (P < .0001). Furthermore, total national charges related to HE increased from

Non-alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity: a population-based study.

4676.7 million (2005) to

Knowledge about infection is the only predictor of treatment in patients with chronic hepatitis C

7244.7 million (2009). In multivariate analysis, independent predictors of inpatient mortality included the number of diagnoses per admission (odds ratio [OR] = 1.022; 95% confidence interval [CI], 1.016-1.029 per diagnosis), number of procedures per admission (OR = 1.192 per procedure; 95% CI, 1.177-1.208), and major or extreme severity of illness (OR = 3.16; 95% CI, 2.84-3.50). The most important predictors of cost, charge, and length of stay were admission to a large, urban hospital; use of Medicaid or Medicaid as the payer; major or extreme severity of illness; number of diagnoses at discharge; and procedures per admission (P < .05). CONCLUSIONS Resource utilization increased from 2005 to 2009 for patients discharged from US hospitals with the diagnosis of HE. The inpatient mortality rate, however, remained stable, despite a trend toward more severe disease.

Epidemiology and Natural History of Non-alcoholic Fatty Liver Disease.

Non‐alcoholic fatty liver disease (NAFLD) is an umbrella term, which encompasses simple steatosis and non‐alcoholic steatohepatitis (NASH). The entire spectrum of NAFLD has been associated with metabolic syndrome. NASH is associated with increased mortality compared with that of the general population. Many therapeutic options for NASH have been studied. However, there is very little evidence supporting the efficacy of most regimens for the treatment of NASH.

The impact of chronic hepatitis C on resource utilisation and in-patient mortality for Medicare beneficiaries between 2005 and 2010

BACKGROUND AND AIM Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease and is strongly associated with metabolic syndrome. The aim of this study is to compare the clinical profile and long-term outcome in NAFLD patients with or without metabolic syndrome. METHODS The initial cohort (N=6709) was identified from National Health and Nutrition Examination Survey-III (NHANES III, 1988-94) data. Laboratory profiles, body measurement examinations, and mortality data were linked to self-reported questionnaires of demographic and health risk information. NAFLD was defined as significant steatosis on hepatic ultrasound after exclusion of other chronic liver diseases (N=1448). NAFLD patients were classified according to presence or absence of metabolic syndrome. Mortality was determined through December 31, 2006. Cox models were used to estimate hazard ratios and 95% confidence intervals for all-cause, cardiovascular and liver-specific mortality differences between two sub-cohorts of NAFLD with and without metabolic syndrome. RESULTS NAFLD participants with metabolic syndrome were more likely to be Non-Hispanic white, older, and have higher aminotransferase levels. All-cause mortality (P<.001) and cardiovascular mortality (P<.001) were higher in NAFLD patients with metabolic syndrome. Furthermore, the presence of metabolic syndrome was independently associated with overall mortality, liver-specific mortality, and cardiovascular mortality. Age was an independent predictor of both all-cause and cardiovascular mortality. Elevated liver enzymes and obesity were two other independent predictors of liver-specific mortality. There were no differences in all-cause, liver-related, or cardiovascular mortality between groups of individuals without liver disease and individuals with NAFLD without metabolic syndrome (metabolically-normal). CONCLUSIONS Diagnosis of NAFLD with metabolic syndrome is an independent predictor of all-cause, liver-specific, and cardiovascular mortality. In contrast, mortality of metabolically-normal NAFLD patients is similar to the cohort without liver disease.

Inpatient resource utilization, disease severity, mortality and insurance coverage for patients hospitalized for hepatitis C virus in the United States.

High intensity exercise improves metabolic status and may potentially mobilise hepatic fat.

Trends in outpatient resource utilizations and outcomes for Medicare beneficiaries with nonalcoholic fatty liver disease.

HCV is the leading cause of cirrhosis and liver cancer in the U.S. The Center for Disease Control (CDC) has recently recommended ‘Birth Cohort Screening’ of the U.S. Adult population to reduce the future burden of undiagnosed HCV infections in the U.S. Our aim was to assess independent predictors of receiving treatment in a cohort of HCV‐infected patients. The Hepatitis C follow‐up questionnaires of the National Health and Nutrition Examination Surveys (NHANES) conducted from 2001 to 2010 were used. The NHANES participants who tested positive for HCV RNA were followed by CDC 6 months after initial testing with questions related to their awareness of their infection and history or intention to receive treatment. A total of 500 NHANES participants tested positive for HCV RNA and were targeted for follow‐up. Of these, only 203 had completed the follow‐up questionnaire (response rate of 40.6%). Of these, only 101 (50%) knew about their HCV positivity before NHANES, and from them, only 34 (17%) had received treatment. In multivariate analysis, prior knowledge about their HCV infection in HCV‐positive individuals was independently associated with receiving routine care from a doctor or HMO, with higher income, female gender, being in poor or fair health and not consuming excessive amounts of alcohol. On the other hand, the knowledge about HCV infection was the only independent predictor of receiving anti‐HCV treatment (odds ratio 6.14). Knowledge about having HCV infection is the only independent predictor of receiving treatment. Therefore, birth cohort screening of the U.S. General population could lead to wider identification of HCV and potentially better management of the future burden of HCV and its complications.