M. L. Cowan

Chronic Liver Disease—An Increasing Problem: A Study of Hospital Admission and Mortality Rates in England, 1979–2005, with Particular Reference to Alcoholic Liver Disease

AIMS To determine time trends in hospital admissions for chronic liver disease in England between 1989/1990 and 2002/2003, mortality rates in England and Wales between 1979 and 2005, and the influence of alcohol-related disease on these trends. METHODS Hospital episode statistics for admissions in England were obtained from the Information Center for Health and Social Care and mortality data for England and Wales from the Office for National Statistics. RESULTS Hospital admission rates for chronic liver disease increased by 71% in males and 43% in females over the study period. This increase was largely due to alcoholic liver disease, admission rates for which more than doubled between 1989/1990 and 2002/2003. While there was a smaller rise for chronic viral hepatitis B and C, admission rates declined for hepatitis A, autoimmune hepatitis, and primary biliary cirrhosis. Mortality rates for chronic liver disease more than doubled between 1979 and 2005. Two thirds of these deaths were attributable to alcohol-related liver disease in 2005. The highest rate of alcoholic liver disease mortality was in the 45-64 age group, and the largest percentage increase between 1979 and 2005 occurred in the 25-34 age group. CONCLUSIONS Hospital admissions and mortality in England from chronic liver disease are increasing. The underlying reasons are complex, but alcohol-induced liver disease makes a major contribution. There are clear social and health implications if the trend continues and addressing alcohol-related liver disease should be a public health priority.

Outcomes of critically ill patients with cirrhosis admitted to intensive care: an important perspective from the non-transplant setting.

Aliment Pharmacol Ther 2010; 32: 233–243

Clostridium difficile infection and inflammatory bowel disease

Abstract The importance of Clostridium difficile (C. difficile) infection amongst patients with inflammatory bowel disease (IBD) is increasingly being recognized. Recent studies have demonstrated a concerning trend towards increased rates of infection, morbidity, mortality and health costs, and guidelines now promote testing for C. difficile in IBD patients experiencing a relapse. This critical review focuses on the epidemiology, risk factors, pathogenesis, treatment options and outcomes associated with C. difficile infection in patients with IBD.

Clostridium difficile-Associated Disease Acquired in the Cardiothoracic Intensive Care Unit

OBJECTIVES To determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired while in the cardiothoracic intensive care unit (CTICU). DESIGN A 5-year retrospective study. SETTING The CTICU. PARTICIPANTS All CTICU patients with a positive C difficile stool toxin assay 48 hours after admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The results of all CTICU patients with a positive C difficile stool toxin assay were obtained from the Microbiology Department. Each patients medical notes and charts then were reviewed in turn. A total of 27 of 5,199 (0.5%) CTICU patients acquired CDAD. The median age was 74 years (IQR 68-77), and 17 (63%) patients were male. There were 21 (78%) surgical patients; 13 (62%) were elective admissions. The most frequent diagnosis on admission was valvular heart disease (10 [37%] patients). Sixteen (59%) patients underwent coronary artery bypass graft (CABG) surgery and/or valvular heart surgery. The median interval between CTICU admission and CDAD diagnosis was 10 days (IQR 5-18). Previously identified risk factors for ICU-acquired CDAD included age >65 years (23), antibiotic use (26), and medical device requirements (27). At the time of diagnosis, 14 (52%) patients had moderate CDAD. After treatment initiation, 8 (30%) patients developed worsening CDAD. The 30-day in-hospital mortality rate for CTICU-acquired CDAD was 26% (7 patients). CONCLUSIONS C difficile-associated disease rarely is acquired in the CTICU. Approximately one third of patients may experience disease progression, and just over a quarter may die within 30 days of diagnosis. The implementation of recommended severity definitions and treatment algorithms may reduce complication rates and merits prospective evaluation.

A study of muscle tissue oxygenation and peripheral microcirculatory dysfunction in cirrhosis using near infrared spectroscopy.

Background: The circulatory dysfunction associated with cirrhosis is well described. Reduced systemic vascular resistance and high cardiac output are the main features of the hyperdynamic state, but involvement of the peripheral microcirculation in this process is poorly understood. Near infrared spectroscopy (NIRS) has been used to assess muscle tissue oxygenation (StO2) in haemorrhagic and septic shock. Vascular occlusion testing (VOT) can produce dynamic changes in StO2 which represent tissue oxygen extraction, delivery, and hence, surrogate markers of microvascular function.

The increasing hospital disease burden of haemochromatosis in England.

Background  Hereditary haemochromatosis is a preventable cause of liver disease with an increasing disease burden.

Gastrointestinal Hemorrhage on the Intensive Care Unit

Gastrointestinal bleeding in the critical care environment is a relatively common clinical event with an incidence of approximately 100/100,000 population per year in both the UK and the USA [1, 2]. Of these bleeding events, 14 % occur in patients already hospitalized. Gastrointestinal bleeding can be the primary reason for admission or can develop as a secondary co-morbid factor. Patients with this complication can have an increased length of stay on the intensive care unit (ICU) and up to a four-fold rise in mortality [3]. This chapter will describe the nature of gastrointestinal bleeding in critical care, the etiologies and risk factors that may predispose to gastrointestinal bleeding, and the variety of therapeutic options available to the clinician. Upper gastrointestinal stress-related mucosal disease, variceal hemorrhage, and lower gastrointestinal bleeding will be considered separately.