BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term...BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.展开更多
A recent study by Sala-Miquel et al investigated the diagnostic effectiveness of follow-up strategies in patients with non-metastatic colorectal cancer(CRC)after surgical resection.This research highlighted the signif...A recent study by Sala-Miquel et al investigated the diagnostic effectiveness of follow-up strategies in patients with non-metastatic colorectal cancer(CRC)after surgical resection.This research highlighted the significance of using computed tomography(CT),colonoscopy,and tumor markers for the early detection of recurrence or metastasis.The findings indicated that strict adherence to follow-up protocols can contribute to decreased mortality rates among these patients.However,the study has several limitations that must be considered.It was retrospective and conducted at a single center,which may affect the generalizability of the results.Further,the absence of a control group and the exclusion of stage IV patients limit the study's applicability.Methodological issues,including insufficient adjustment for confounding variables,a lack of sensitivity analyses,and limitations in time-dependent covariate analysis,further constrain the conclusions'robustness.Moreover,while the study emphasizes the role of CT scans,it does not adequately address their potential risks and underrepresents the importance of colonoscopy.Future research should focus on multicenter,prospective studies that integrate personalized follow-up approaches and explore innovative technologies to enhance the efficacy of follow-up strategies in CRC management.By addressing these limitations,researchers can improve the applicability and impact of follow-up strategies in the care of CRC patients.展开更多
The recent study published by Lee et al examined the discrepancies between endoscopic and histologic evaluations of mucosal inflammation in active ileal Crohn’s disease(CD).While this research contributes to our unde...The recent study published by Lee et al examined the discrepancies between endoscopic and histologic evaluations of mucosal inflammation in active ileal Crohn’s disease(CD).While this research contributes to our understanding of the limitations of current biopsy protocols,it raises several concerns about the generalizability of its findings,sample size,and methodology.One major limitation was the exclusion of patients with ileal strictures,ileostomies,or J-pouches,which reduced the applicability of the results to the wider CD population.Furthermore,the biopsy protocol's focus on single biopsies from specific locations may inadequately capture the patchy inflammation characteristic of CD.The study also uses histologic indices primarily developed for ulcerative colitis,which may not be suitable for assessing CD.It is recommended that multi-center studies be conducted and histologic indices specific to CD be developed to improve the relevance of future research.Additionally,researchers should consider the influence of treatment regimens on the findings.Addressing these limitations would enhance the clinical significance of the study and inform better diagnostic and therapeutic approaches for CD.展开更多
In a recent study by He et al,the nomogram integrates postoperative serum tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen,thereby improving the accuracy of identifying high-risk patients c...In a recent study by He et al,the nomogram integrates postoperative serum tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen,thereby improving the accuracy of identifying high-risk patients compared to relying solely on preoperative markers,which has significant implications for customizing adjuvant therapy and potentially improving outcomes for this aggressive form of cancer.However,the study’s single-center design and short follow-up period may limit the generalizability of its findings and potentially introduce reporting bias.Future studies could consider additional confounding factors,such as adjuvant chemotherapy and variations in surgical techniques,to improve the model’s accuracy.Furthermore,it would be valuable to validate the nomogram in broader,prospective cohorts and explore the inclusion of additional markers like circulating tumor DNA to refine further its predictive power and applicability across diverse patient populations.展开更多
A recent study by Qin et al emphasized the potential of zinc finger protein 71(ZNF71)as a promising biomarker for hepatocellular carcinoma(HCC).The authors offered valuable insights into the relationship between ZNF71...A recent study by Qin et al emphasized the potential of zinc finger protein 71(ZNF71)as a promising biomarker for hepatocellular carcinoma(HCC).The authors offered valuable insights into the relationship between ZNF71 and various clinical and pathological stages of HCC.However,several limitations are required to be addressed to improve the findings.These limitations include concerns regarding patient selection,the generalizability of the results,and the necessity for functional validation to establish ZNF71’s specific role in the progression of HCC.Furthermore,statistical issues related to multiple comparisons,confounding variables,and the inherent heterogeneity of high-throughput datasets warrant careful consideration.Future research should focus on multi-institutional cohorts,utilize in vivo models,and compare ZNF71 with established biomarkers to strengthen the clinical relevance of ZNF71.展开更多
Metabolic-associated fatty liver disease(MAFLD),formerly known as nonalcoho-lic fatty liver disease,is an increasing global health challenge with substantial implications for metabolic and cardiovascular health(CVH).A...Metabolic-associated fatty liver disease(MAFLD),formerly known as nonalcoho-lic fatty liver disease,is an increasing global health challenge with substantial implications for metabolic and cardiovascular health(CVH).A recent study by Fu et al investigated the relationship between CVH metrics,specifically Life’s Simple 7 and Life’s Essential 8,and the prevalence of MAFLD.While this study offered important insights into the relationship between CVH and MAFLD,several me-thodological limitations,unaddressed confounding factors,and potential biases that could impact the interpretation of their findings should be considered.The study’s cross-sectional nature restricted the ability to draw causal conclusions,and it did not fully account for potential confounding factors such as dietary habits,genetic predispositions,and medication use.Furthermore,relying on tran-sient elastography to diagnose MAFLD introduces certain diagnostic limitations.Longitudinal study designs,advanced statistical modeling techniques,and diverse population groups should be utilized to strengthen future research.Exploring the mechanistic pathways that link CVH metrics to MAFLD through multi-omics approaches and interventional studies will be essential in formulating targeted prevention and treatment strategies.Structural equation modeling and machine learning techniques could provide a more refined analysis of these interrelated factors.Additionally,future research should employ longitudinal study designs and explore genetic and epigenetic influences to enhance our un-derstanding of CVH and MAFLD interactions.展开更多
A recent study by Luo et al examined the relationship between the pathological types of pancreatic cancer(PC)and their imaging characteristics.While this study presented an important step toward improving diagnostic a...A recent study by Luo et al examined the relationship between the pathological types of pancreatic cancer(PC)and their imaging characteristics.While this study presented an important step toward improving diagnostic accuracy for PC,we have several concerns regarding its generalizability,cohort selection,imaging variability,statistical methods,and potential confounding factors.We recommended that future research adopt multi-center,prospective designs to improve representation and minimize bias.Additionally,incorporating advanced imaging techniques such as radiomics and artificial intelligence and conducting more comprehensive statistical analyses would be valuable.By implementing these strategies,future studies can yield more reliable and externally validated findings that improve the clinical applicability of imaging-based differentiation of PC.Addressing these methodological issues could significantly advance the field of gastrointestinal oncology and improve patient management and outcomes.展开更多
Fluoropyrimidines(FP),including 5-fluorouracil and its prodrug capecitabine,are commonly employed in treating various solid tumors.Nonetheless,their use is frequently constrained by severe toxicities in 20%-30%of pati...Fluoropyrimidines(FP),including 5-fluorouracil and its prodrug capecitabine,are commonly employed in treating various solid tumors.Nonetheless,their use is frequently constrained by severe toxicities in 20%-30%of patients.Pharmacogenetic testing for dihydropyrimidine dehydrogenase(DPYD)deficiency,based on DPYD polymorphisms,has notably decreased severe adverse events,improving the safety of FP therapy.A recent D'Amato et al study evaluated the prevalence of DPYD polymorphisms and their effect on FP tolerability among Italian patients with gastrointestinal cancers.Although this study provided important insights into the significance of DPYD testing,its retrospective nature,inconsistency in testing DPYD variants,and lack of consideration for socioeconomic and confounding factors showed considerable limitations.Expanding the screening to include DPYD variants,addressing confounding biases through robust statistical analyses,and implementing prospective studies are critical next steps to strengthen the clinical evidence.Furthermore,the absence of a comprehensive cost-effectiveness analysis highlights the need for further financial assessments to advocate for broader implementation.We emphasized integrating DPYD-guided dosing,pre-treatment genetic counseling,and standardized testing procedures into clinical practice to improve patient outcomes and minimize treatment-related toxicities.展开更多
A recent study by Long et al used a predictive model to explore the efficacy of radiomics based on multiparametric magnetic resonance imaging in predicting metachronous liver metastasis(MLM)in newly diagnosed rectal c...A recent study by Long et al used a predictive model to explore the efficacy of radiomics based on multiparametric magnetic resonance imaging in predicting metachronous liver metastasis(MLM)in newly diagnosed rectal cancer(RC)patients.The machine learning algorithms,particularly the random forest model(RFM),appeared well-matched to the complex nature of radiomics data.The predictive capabilities of the RFM,as evidenced by the area under the curve of 0.919 in the training cohort and 0.901 in the validation cohort,highlighted its potential clinical utility.However,we highlighted several methodological limi-tations,including excluding genomic markers,potential biases from the retro-spective design,limited generalizability due to a single-center study,and variability in image interpretation.We propose further investigation into inte-grating multi-omic data,conducting larger multicenter studies,and utilizing advanced imaging techniques.Additionally,we highlighted the importance of interdisciplinary collaboration to improve predictive model development and advocate for cost-effectiveness analyses to facilitate clinical integration.Overall,this predictive model may improve the early detection and management of MLM in RC patients,with promising avenues for future exploration.Ongoing research in this domain can potentially improve clinical outcomes and the quality of care for RC patients.展开更多
Gastric cancer(GC)has remained one of the leading causes of cancer-related deaths globally.The development of noninvasive biomarkers in cancer diagnosis and treatment has gained substantial traction in recent years.Re...Gastric cancer(GC)has remained one of the leading causes of cancer-related deaths globally.The development of noninvasive biomarkers in cancer diagnosis and treatment has gained substantial traction in recent years.Recent evidence highlights hypercoagulation as a promising prognostic biomarker,particularly in locally advanced GC(LAGC)who underwent radical resection after neoadjuvant immunochemotherapy(NICT).A recent study by Li et al showed that hypercoagulation is a valuable prognostic indicator for patients with LAGC who have undergone radical resection following NICT.While the study addresses an important clinical issue and provides insightful findings,the present study offered valuable insights;the applicability of these findings was constrained by the retrospective design,the focus on a single center,and the small sample size of the existing studies.Additionally,vital confounders,such as preoperative comorbidities and systemic inflammation,are inadequately addressed.Future studies should focus on prospective multicenter trials,incorporating advanced predictive models such as machine learning algorithms to integrate coagulation markers with other clinical variables for personalized risk stratification.In addition,we are required to validate findings to examine the biological mechanisms correlating hypercoagulation to tumor progression.Integrating machine learning,comprehensive biomarker panels,and real-world data would allow the researchers to have personalized risk stratification,improve predictive accuracy,and optimize clinical decision-making.Finally,A multidisciplinary approach,including lifestyle interventions and imaging modalities,is essential to improve outcomes among patients with GC.展开更多
The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodo...The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodological challenges hinder its immediate use in clinical practice.Notably,the current research was retrospective,lacks comparative studies with fecal calprotectin,and did not provide long-term predictive data.Further prospective studies are needed to improve the applicability of LRG.Moreover,integrating LRG with additional biomarkers and employing artificial intelligence techniques may improve its effectiveness in disease monitoring.Future research should address interobserver variability,assess LRG's cost-effectiveness,and standardize endoscopic healing definitions to ensure broader applicability.Advancing these areas is vital for establishing LRG's role in precision medicine strategies for the management of CD.展开更多
Metabolic dysfunction-associated steatotic liver disease,previously known as nonalcoholic fatty liver disease(NAFLD),is becoming increasingly common and is associated with significant morbidity and mortality related t...Metabolic dysfunction-associated steatotic liver disease,previously known as nonalcoholic fatty liver disease(NAFLD),is becoming increasingly common and is associated with significant morbidity and mortality related to both liver and non-liver issues.In its early stages,NAFLD is characterized by immune cell dysregulation,which suggests that immune-targeted therapies could be a viable treatment option for nonalcoholic steatohepatitis.A recent study by Zhu et al.investigated the role of autoantibodies in metabolic dysfunction-associated stea-totic liver disease at various histological stages.While the research provided valuable insights,several methodological concerns are noted,which include the study’s retrospective design,a limited panel of autoantibodies,and a lack of a prospective study design that adequately controls for confounding factors such as age,comorbidities and lifestyle.Furthermore,the interpretation of positive antinuclear antibodies as evidence of autoimmune involvement in NAFLD is questioned due to the possibility of nonspecific immune responses.Recommend-ations to improve the study’s design include conducting prospective studies,implementing more detailed antibody profiling,and adjusting for demographic and clinical factors.Future studies should address these issues to improve the clinical relevance and credibility of findings related to autoimmunity in NAFLD.展开更多
A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic...A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic-clinical model demonstrated strong predictive capabilities,achieving an area under the curve of 0.951 in the training cohort and 0.930 in the validation cohort.The results highlight the potential of noninvasive prediction models in assessing esophageal variceal bleeding risk,aiding in timely clinical decision-making.Additionally,manual delineation of regions of interest raises the risk of observer bias despite efforts to minimize it.The study adjusted for clinical covariates,while some potential confounders,such as socioeconomic status,alcohol use,and liver function scores,were not included.Additionally,an imbalance in cohort sizes between the training and validation groups may reduce the statistical power of validation.Expanding the validation cohort and incorporating multi-center external validation would improve generalizability.Future studies should focus on incorporating long-term patient outcomes,exploring additional imaging modalities,and integrating automated segmentation techniques to refine the predictive model.展开更多
Gastrointestinal bleeding(GIB)presents a significant challenge for patients with hematologic malignancies,especially those with severe thrombocytopenia.Although endoscopic intervention is frequently used in managing G...Gastrointestinal bleeding(GIB)presents a significant challenge for patients with hematologic malignancies,especially those with severe thrombocytopenia.Although endoscopic intervention is frequently used in managing GIB,its safety and effectiveness in this high-risk group remain unclear.A recent study by Alhumayyd et al provided insight into this issue.However,it has notable limitations,including its retrospective nature,small sample size,and failure to adjust for important confounding factors such as disease severity,hemodynamic status,and platelet function.The study’s findings indicated that urgent endoscopy may help decrease the incidence of recurrent bleeding;however,it did not show a clear benefit in terms of mortality.Future research ought to prioritize prospective,multicenter studies that employ standardized protocols and incorporate risk stratification models to better understand the impact of endoscopic treatment for GIB in these patients.Additionally,integrating platelet function assays could improve clinical decision-making.Addressing these research gaps is essential for improving patient outcomes and developing effective guidelines for managing GIB in individuals with thrombocytopenia.展开更多
A recent study by Zhang et al developed a neural network-based predictive model for estimating doses to the uninvolved liver during stereotactic body radiation therapy(SBRT)in liver cancer.The study reported a signifi...A recent study by Zhang et al developed a neural network-based predictive model for estimating doses to the uninvolved liver during stereotactic body radiation therapy(SBRT)in liver cancer.The study reported a significant advancement in personalized radiotherapy by improving accuracy and reducing treatment-related toxicity.The model demonstrated strong predictive performance with R-values above 0.8,indicating its potential to improve treatment consistency.However,concerns arise from the small sample size and exclusion criteria,which may limit generalizability.Future studies should incorporate larger,more diverse patient cohorts,explore potential confounding factors such as tumor characteristics and delivery technique variability,and address the long-term effects of SBRT.展开更多
The outbreak of coronavirus disease-2019(COVID-19,previously known as 2019 nCoV)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in Wuhan City,China,has spread rapidly around the world.Mo...The outbreak of coronavirus disease-2019(COVID-19,previously known as 2019 nCoV)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in Wuhan City,China,has spread rapidly around the world.Most patients from the first cluster had an epidemiological connection to the Wuhan's Huanan Seafood Wholesale Market.Available evidence has shown that SARSCoV-2 can be easily transmitted from person to person through close contact and respiratory droplets,posing a substantial challenge to public health.At present,the research on SARS-CoV-2 is still in the primary stages.However,dexamethasone and remdesivir are appeared to be promising medical therapies.Still,there is no definite specific treatment,and the mainstay of treatment is still focused on supportive therapies.Currently,over 150 vaccines are under investigation.It is necessary to understand the nature of the virus and its clinical characteristics in order to find effectively manage the disease.The knowledge about this virus is rapidly evolving,and clinicians must update themselves regularly.The present review comprehensively summarizes the epidemiology,pathogenesis,clinical characteristics,and management of COVID-19 based on the current evidence.展开更多
BACKGROUND Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019(COVID-19).However,the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorl...BACKGROUND Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019(COVID-19).However,the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understood AIM We aimed to assess the prevalence of elevated liver chemistries in hospitalized patients with COVID-19 and compare the serum liver chemistries to predict the severity and in-hospital mortality.METHODS This retrospective,observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System(Baltimore,MD,United States).Demographic data,clinical characteristics,laboratory findings,treatment measures,and outcome data were collected.Cox regression modeling was used to explore variables associated with abnormal liver chemistries on admission with disease severity and prognosis RESULTS A total of 2698(70.4%)had abnormal alanine aminotransferase(ALT)at the time of admission.Other more prevalent abnormal liver chemistries were aspartate aminotransferase(AST)(44.4%),alkaline phosphatase(ALP)(16.1%),and total bilirubin(T-Bil)(5.9%).Factors associated with liver injury were older age,Asian ethnicity,other race,being overweight,and obesity.Higher ALT,AST,T-Bil,and ALP levels were more commonly associated with disease severity.Multivariable adjusted Cox regression analysis revealed that abnormal AST and T-Bil were associated with the highest mortality risk than other liver injury indicators during hospitalization.Abnormal AST,T-Bil,and ALP were associated with a need for vasopressor drugs,whereas higher levels of AST,T-Bil,and a decreased albumin levels were associated with mechanical ventilation CONCLUSION Abnormal liver chemistries are common at the time of hospital admission in COVID-19 patients and can be closely related to the patient’s severity and prognosis.Elevated liver chemistries,specifically ALT,AST,ALP,and T-Bil levels,can be used to stratify risk and predict the need for advanced therapies in these patients.展开更多
BACKGROUND Celiac disease(CD)has been associated with gastrointestinal malignancies.However,the magnitude of the risk of pancreatic cancer(PC)associated with CD is much less clear,and risks have not been estimated fro...BACKGROUND Celiac disease(CD)has been associated with gastrointestinal malignancies.However,the magnitude of the risk of pancreatic cancer(PC)associated with CD is much less clear,and risks have not been estimated from large populations.AIM To assess the risk of PC in CD patients.METHODS We conducted a population-based,multicenter,propensity score-matched cohort study with consecutive patients diagnosed with CD using the TriNeTx research network platform.We examined the incidence of PC in patients with CD compared with a matched cohort of patients without CD(non-CD,controls).Each patient in the main group(CD)was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.The incidence of PC was estimated using a Cox proportional hazards model with a hazard ratio(HR)and 95%confidence interval(CI).RESULTS A total of 389980 patients were included in this study.Among them,155877 patients had a diagnosis of CD,and the remaining 234103 individuals without CD were considered a control cohort.The mean duration of follow-up for patients in the CD and control cohorts was 5.8±1.8 and 5.9±1.1 years,respectively.During the follow-up,309 patients with CD developed PC,whereas 240 patients developed PC in the control group(HR=1.29;95%CI:1.09-1.53).In the secondary analyses in the first year after diagnosis of CD,patients with CD were at a significant increase in risk for PC;151 patients with CD had an incidence of PC compared with 96 incidences of PC among the patients in the non-CD control group(HR=1.56;95%CI:1.20-2.01)and sensitivity analysis showed similar magnitude to the one generated in the primary and secondary analysis.CONCLUSION Patients with CD are at increased risk of PC.Risk elevation persists beyond the first year after diagnosis to reference individuals without CD from the general population.展开更多
BACKGROUND Liver fibrosis is a common pathway of liver injury and is a feature of most chronic liver diseases.Fibrosis progression varies markedly in patients with hepatitis C virus(HCV).Liver stiffness has been recom...BACKGROUND Liver fibrosis is a common pathway of liver injury and is a feature of most chronic liver diseases.Fibrosis progression varies markedly in patients with hepatitis C virus(HCV).Liver stiffness has been recommended as a parameter of fibrosis progression/regression in patients with HCV.AIM To investigate changes in liver stiffness measured by transient elastography(TE)in a large,racially diverse cohort of United States patients with chronic hepatitis C(CHC).METHODS We evaluated the differences in liver stiffness between patients treated with direct-acting antiviral(DAA)therapy and untreated patients.Patients had≥2 TE measurements and no prior DAA exposure.We used linear regression to measure the change in liver stiffness between first and last TE in response to treatment,controlling for age,sex,race,diabetes,smoking status,human immunodeficiency virus status,baseline alanine aminotransferase,and baseline liver stiffness.Separate regression models analyzed the change in liver stiffness as measured by kPa,stratified by cirrhosis status.RESULTS Of 813 patients,419(52%)initiated DAA treatment.Baseline liver stiffness was 12 kPa in 127(16%).Median time between first and last TE was 11.7 and 12.7 mo among treated and untreated patients,respectively.There was no significant change in liver stiffness observed over time in either the group initiating DAA treatment(0.016 kPa/month;CI:-0.051,0.084)or in the untreated group(0.001 kPa/mo;CI:-0.090,0.092),controlling for covariates.A higher baseline kPa score was independently associated with decreased liver stiffness.CONCLUSION DAA treatment was not associated with a differential change in liver stiffness over time in patients with CHC compared to untreated patients.展开更多
BACKGROUND Patients with autoimmune hepatitis(AIH)require life-long immunosuppressive agents that may increase the risk of poor coronavirus disease 2019(COVID-19)outcomes.There is a paucity of large data at the popula...BACKGROUND Patients with autoimmune hepatitis(AIH)require life-long immunosuppressive agents that may increase the risk of poor coronavirus disease 2019(COVID-19)outcomes.There is a paucity of large data at the population level to assess whether patients with AIH have an increased risk of severe diseases.AIM To evaluate the impact of pre-existing AIH on the clinical outcomes of patients with COVID-19.METHODS We conducted a population-based,multicenter,propensity score-matched cohort study with consecutive adult patients(≥18 years)diagnosed with COVID-19 using the TriNeTx research network platform.The outcomes of patients with AIH(main group)were compared to a propensity score-matched cohort of patients:(1)Without chronic liver disease(CLD);and(2)Patients with CLD except AIH(non-AIH CLD)control groups.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.The primary outcome was all-cause mortality,and secondary outcomes were hospitalization rate,need for critical care,severe disease,mechanical ventilation,and acute kidney injury(AKI).For each outcome,the risk ratio(RR)and confidence intervals(CI)were calculated to compare the association of AIH with the outcome.RESULTS We identified 375 patients with AIH,1647915 patients with non-CLD,and 15790 patients with non-AIH CLD with COVID-19 infection.Compared to non-CLD patients,the AIH cohort had an increased risk of all-cause mortality(RR=2.22;95%CI:1.07-4.61),hospitalization rate(RR=1.78;95%CI:1.17-2.69),and severe disease(RR=1.98;95%CI:1.19-3.26).The AIH cohort had a lower risk of hospitalization rate(RR=0.72;95%CI:0.56-0.92),critical care(RR=0.50;95%CI:0.32-0.79),and AKI(RR=0.56;95%CI:0.35-0.88)compared to the non-AIH CLD patients.CONCLUSION Patients with AIH are associated with increased hospitalization risk,severe disease,and all-cause mortality compared to patients without pre-existing CLD from the diagnosis of COVID-19.However,patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD.展开更多
文摘BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.
文摘A recent study by Sala-Miquel et al investigated the diagnostic effectiveness of follow-up strategies in patients with non-metastatic colorectal cancer(CRC)after surgical resection.This research highlighted the significance of using computed tomography(CT),colonoscopy,and tumor markers for the early detection of recurrence or metastasis.The findings indicated that strict adherence to follow-up protocols can contribute to decreased mortality rates among these patients.However,the study has several limitations that must be considered.It was retrospective and conducted at a single center,which may affect the generalizability of the results.Further,the absence of a control group and the exclusion of stage IV patients limit the study's applicability.Methodological issues,including insufficient adjustment for confounding variables,a lack of sensitivity analyses,and limitations in time-dependent covariate analysis,further constrain the conclusions'robustness.Moreover,while the study emphasizes the role of CT scans,it does not adequately address their potential risks and underrepresents the importance of colonoscopy.Future research should focus on multicenter,prospective studies that integrate personalized follow-up approaches and explore innovative technologies to enhance the efficacy of follow-up strategies in CRC management.By addressing these limitations,researchers can improve the applicability and impact of follow-up strategies in the care of CRC patients.
文摘The recent study published by Lee et al examined the discrepancies between endoscopic and histologic evaluations of mucosal inflammation in active ileal Crohn’s disease(CD).While this research contributes to our understanding of the limitations of current biopsy protocols,it raises several concerns about the generalizability of its findings,sample size,and methodology.One major limitation was the exclusion of patients with ileal strictures,ileostomies,or J-pouches,which reduced the applicability of the results to the wider CD population.Furthermore,the biopsy protocol's focus on single biopsies from specific locations may inadequately capture the patchy inflammation characteristic of CD.The study also uses histologic indices primarily developed for ulcerative colitis,which may not be suitable for assessing CD.It is recommended that multi-center studies be conducted and histologic indices specific to CD be developed to improve the relevance of future research.Additionally,researchers should consider the influence of treatment regimens on the findings.Addressing these limitations would enhance the clinical significance of the study and inform better diagnostic and therapeutic approaches for CD.
文摘In a recent study by He et al,the nomogram integrates postoperative serum tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen,thereby improving the accuracy of identifying high-risk patients compared to relying solely on preoperative markers,which has significant implications for customizing adjuvant therapy and potentially improving outcomes for this aggressive form of cancer.However,the study’s single-center design and short follow-up period may limit the generalizability of its findings and potentially introduce reporting bias.Future studies could consider additional confounding factors,such as adjuvant chemotherapy and variations in surgical techniques,to improve the model’s accuracy.Furthermore,it would be valuable to validate the nomogram in broader,prospective cohorts and explore the inclusion of additional markers like circulating tumor DNA to refine further its predictive power and applicability across diverse patient populations.
文摘A recent study by Qin et al emphasized the potential of zinc finger protein 71(ZNF71)as a promising biomarker for hepatocellular carcinoma(HCC).The authors offered valuable insights into the relationship between ZNF71 and various clinical and pathological stages of HCC.However,several limitations are required to be addressed to improve the findings.These limitations include concerns regarding patient selection,the generalizability of the results,and the necessity for functional validation to establish ZNF71’s specific role in the progression of HCC.Furthermore,statistical issues related to multiple comparisons,confounding variables,and the inherent heterogeneity of high-throughput datasets warrant careful consideration.Future research should focus on multi-institutional cohorts,utilize in vivo models,and compare ZNF71 with established biomarkers to strengthen the clinical relevance of ZNF71.
文摘Metabolic-associated fatty liver disease(MAFLD),formerly known as nonalcoho-lic fatty liver disease,is an increasing global health challenge with substantial implications for metabolic and cardiovascular health(CVH).A recent study by Fu et al investigated the relationship between CVH metrics,specifically Life’s Simple 7 and Life’s Essential 8,and the prevalence of MAFLD.While this study offered important insights into the relationship between CVH and MAFLD,several me-thodological limitations,unaddressed confounding factors,and potential biases that could impact the interpretation of their findings should be considered.The study’s cross-sectional nature restricted the ability to draw causal conclusions,and it did not fully account for potential confounding factors such as dietary habits,genetic predispositions,and medication use.Furthermore,relying on tran-sient elastography to diagnose MAFLD introduces certain diagnostic limitations.Longitudinal study designs,advanced statistical modeling techniques,and diverse population groups should be utilized to strengthen future research.Exploring the mechanistic pathways that link CVH metrics to MAFLD through multi-omics approaches and interventional studies will be essential in formulating targeted prevention and treatment strategies.Structural equation modeling and machine learning techniques could provide a more refined analysis of these interrelated factors.Additionally,future research should employ longitudinal study designs and explore genetic and epigenetic influences to enhance our un-derstanding of CVH and MAFLD interactions.
文摘A recent study by Luo et al examined the relationship between the pathological types of pancreatic cancer(PC)and their imaging characteristics.While this study presented an important step toward improving diagnostic accuracy for PC,we have several concerns regarding its generalizability,cohort selection,imaging variability,statistical methods,and potential confounding factors.We recommended that future research adopt multi-center,prospective designs to improve representation and minimize bias.Additionally,incorporating advanced imaging techniques such as radiomics and artificial intelligence and conducting more comprehensive statistical analyses would be valuable.By implementing these strategies,future studies can yield more reliable and externally validated findings that improve the clinical applicability of imaging-based differentiation of PC.Addressing these methodological issues could significantly advance the field of gastrointestinal oncology and improve patient management and outcomes.
文摘Fluoropyrimidines(FP),including 5-fluorouracil and its prodrug capecitabine,are commonly employed in treating various solid tumors.Nonetheless,their use is frequently constrained by severe toxicities in 20%-30%of patients.Pharmacogenetic testing for dihydropyrimidine dehydrogenase(DPYD)deficiency,based on DPYD polymorphisms,has notably decreased severe adverse events,improving the safety of FP therapy.A recent D'Amato et al study evaluated the prevalence of DPYD polymorphisms and their effect on FP tolerability among Italian patients with gastrointestinal cancers.Although this study provided important insights into the significance of DPYD testing,its retrospective nature,inconsistency in testing DPYD variants,and lack of consideration for socioeconomic and confounding factors showed considerable limitations.Expanding the screening to include DPYD variants,addressing confounding biases through robust statistical analyses,and implementing prospective studies are critical next steps to strengthen the clinical evidence.Furthermore,the absence of a comprehensive cost-effectiveness analysis highlights the need for further financial assessments to advocate for broader implementation.We emphasized integrating DPYD-guided dosing,pre-treatment genetic counseling,and standardized testing procedures into clinical practice to improve patient outcomes and minimize treatment-related toxicities.
文摘A recent study by Long et al used a predictive model to explore the efficacy of radiomics based on multiparametric magnetic resonance imaging in predicting metachronous liver metastasis(MLM)in newly diagnosed rectal cancer(RC)patients.The machine learning algorithms,particularly the random forest model(RFM),appeared well-matched to the complex nature of radiomics data.The predictive capabilities of the RFM,as evidenced by the area under the curve of 0.919 in the training cohort and 0.901 in the validation cohort,highlighted its potential clinical utility.However,we highlighted several methodological limi-tations,including excluding genomic markers,potential biases from the retro-spective design,limited generalizability due to a single-center study,and variability in image interpretation.We propose further investigation into inte-grating multi-omic data,conducting larger multicenter studies,and utilizing advanced imaging techniques.Additionally,we highlighted the importance of interdisciplinary collaboration to improve predictive model development and advocate for cost-effectiveness analyses to facilitate clinical integration.Overall,this predictive model may improve the early detection and management of MLM in RC patients,with promising avenues for future exploration.Ongoing research in this domain can potentially improve clinical outcomes and the quality of care for RC patients.
文摘Gastric cancer(GC)has remained one of the leading causes of cancer-related deaths globally.The development of noninvasive biomarkers in cancer diagnosis and treatment has gained substantial traction in recent years.Recent evidence highlights hypercoagulation as a promising prognostic biomarker,particularly in locally advanced GC(LAGC)who underwent radical resection after neoadjuvant immunochemotherapy(NICT).A recent study by Li et al showed that hypercoagulation is a valuable prognostic indicator for patients with LAGC who have undergone radical resection following NICT.While the study addresses an important clinical issue and provides insightful findings,the present study offered valuable insights;the applicability of these findings was constrained by the retrospective design,the focus on a single center,and the small sample size of the existing studies.Additionally,vital confounders,such as preoperative comorbidities and systemic inflammation,are inadequately addressed.Future studies should focus on prospective multicenter trials,incorporating advanced predictive models such as machine learning algorithms to integrate coagulation markers with other clinical variables for personalized risk stratification.In addition,we are required to validate findings to examine the biological mechanisms correlating hypercoagulation to tumor progression.Integrating machine learning,comprehensive biomarker panels,and real-world data would allow the researchers to have personalized risk stratification,improve predictive accuracy,and optimize clinical decision-making.Finally,A multidisciplinary approach,including lifestyle interventions and imaging modalities,is essential to improve outcomes among patients with GC.
文摘The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodological challenges hinder its immediate use in clinical practice.Notably,the current research was retrospective,lacks comparative studies with fecal calprotectin,and did not provide long-term predictive data.Further prospective studies are needed to improve the applicability of LRG.Moreover,integrating LRG with additional biomarkers and employing artificial intelligence techniques may improve its effectiveness in disease monitoring.Future research should address interobserver variability,assess LRG's cost-effectiveness,and standardize endoscopic healing definitions to ensure broader applicability.Advancing these areas is vital for establishing LRG's role in precision medicine strategies for the management of CD.
文摘Metabolic dysfunction-associated steatotic liver disease,previously known as nonalcoholic fatty liver disease(NAFLD),is becoming increasingly common and is associated with significant morbidity and mortality related to both liver and non-liver issues.In its early stages,NAFLD is characterized by immune cell dysregulation,which suggests that immune-targeted therapies could be a viable treatment option for nonalcoholic steatohepatitis.A recent study by Zhu et al.investigated the role of autoantibodies in metabolic dysfunction-associated stea-totic liver disease at various histological stages.While the research provided valuable insights,several methodological concerns are noted,which include the study’s retrospective design,a limited panel of autoantibodies,and a lack of a prospective study design that adequately controls for confounding factors such as age,comorbidities and lifestyle.Furthermore,the interpretation of positive antinuclear antibodies as evidence of autoimmune involvement in NAFLD is questioned due to the possibility of nonspecific immune responses.Recommend-ations to improve the study’s design include conducting prospective studies,implementing more detailed antibody profiling,and adjusting for demographic and clinical factors.Future studies should address these issues to improve the clinical relevance and credibility of findings related to autoimmunity in NAFLD.
文摘A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic-clinical model demonstrated strong predictive capabilities,achieving an area under the curve of 0.951 in the training cohort and 0.930 in the validation cohort.The results highlight the potential of noninvasive prediction models in assessing esophageal variceal bleeding risk,aiding in timely clinical decision-making.Additionally,manual delineation of regions of interest raises the risk of observer bias despite efforts to minimize it.The study adjusted for clinical covariates,while some potential confounders,such as socioeconomic status,alcohol use,and liver function scores,were not included.Additionally,an imbalance in cohort sizes between the training and validation groups may reduce the statistical power of validation.Expanding the validation cohort and incorporating multi-center external validation would improve generalizability.Future studies should focus on incorporating long-term patient outcomes,exploring additional imaging modalities,and integrating automated segmentation techniques to refine the predictive model.
文摘Gastrointestinal bleeding(GIB)presents a significant challenge for patients with hematologic malignancies,especially those with severe thrombocytopenia.Although endoscopic intervention is frequently used in managing GIB,its safety and effectiveness in this high-risk group remain unclear.A recent study by Alhumayyd et al provided insight into this issue.However,it has notable limitations,including its retrospective nature,small sample size,and failure to adjust for important confounding factors such as disease severity,hemodynamic status,and platelet function.The study’s findings indicated that urgent endoscopy may help decrease the incidence of recurrent bleeding;however,it did not show a clear benefit in terms of mortality.Future research ought to prioritize prospective,multicenter studies that employ standardized protocols and incorporate risk stratification models to better understand the impact of endoscopic treatment for GIB in these patients.Additionally,integrating platelet function assays could improve clinical decision-making.Addressing these research gaps is essential for improving patient outcomes and developing effective guidelines for managing GIB in individuals with thrombocytopenia.
文摘A recent study by Zhang et al developed a neural network-based predictive model for estimating doses to the uninvolved liver during stereotactic body radiation therapy(SBRT)in liver cancer.The study reported a significant advancement in personalized radiotherapy by improving accuracy and reducing treatment-related toxicity.The model demonstrated strong predictive performance with R-values above 0.8,indicating its potential to improve treatment consistency.However,concerns arise from the small sample size and exclusion criteria,which may limit generalizability.Future studies should incorporate larger,more diverse patient cohorts,explore potential confounding factors such as tumor characteristics and delivery technique variability,and address the long-term effects of SBRT.
文摘The outbreak of coronavirus disease-2019(COVID-19,previously known as 2019 nCoV)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in Wuhan City,China,has spread rapidly around the world.Most patients from the first cluster had an epidemiological connection to the Wuhan's Huanan Seafood Wholesale Market.Available evidence has shown that SARSCoV-2 can be easily transmitted from person to person through close contact and respiratory droplets,posing a substantial challenge to public health.At present,the research on SARS-CoV-2 is still in the primary stages.However,dexamethasone and remdesivir are appeared to be promising medical therapies.Still,there is no definite specific treatment,and the mainstay of treatment is still focused on supportive therapies.Currently,over 150 vaccines are under investigation.It is necessary to understand the nature of the virus and its clinical characteristics in order to find effectively manage the disease.The knowledge about this virus is rapidly evolving,and clinicians must update themselves regularly.The present review comprehensively summarizes the epidemiology,pathogenesis,clinical characteristics,and management of COVID-19 based on the current evidence.
文摘BACKGROUND Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019(COVID-19).However,the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understood AIM We aimed to assess the prevalence of elevated liver chemistries in hospitalized patients with COVID-19 and compare the serum liver chemistries to predict the severity and in-hospital mortality.METHODS This retrospective,observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System(Baltimore,MD,United States).Demographic data,clinical characteristics,laboratory findings,treatment measures,and outcome data were collected.Cox regression modeling was used to explore variables associated with abnormal liver chemistries on admission with disease severity and prognosis RESULTS A total of 2698(70.4%)had abnormal alanine aminotransferase(ALT)at the time of admission.Other more prevalent abnormal liver chemistries were aspartate aminotransferase(AST)(44.4%),alkaline phosphatase(ALP)(16.1%),and total bilirubin(T-Bil)(5.9%).Factors associated with liver injury were older age,Asian ethnicity,other race,being overweight,and obesity.Higher ALT,AST,T-Bil,and ALP levels were more commonly associated with disease severity.Multivariable adjusted Cox regression analysis revealed that abnormal AST and T-Bil were associated with the highest mortality risk than other liver injury indicators during hospitalization.Abnormal AST,T-Bil,and ALP were associated with a need for vasopressor drugs,whereas higher levels of AST,T-Bil,and a decreased albumin levels were associated with mechanical ventilation CONCLUSION Abnormal liver chemistries are common at the time of hospital admission in COVID-19 patients and can be closely related to the patient’s severity and prognosis.Elevated liver chemistries,specifically ALT,AST,ALP,and T-Bil levels,can be used to stratify risk and predict the need for advanced therapies in these patients.
文摘BACKGROUND Celiac disease(CD)has been associated with gastrointestinal malignancies.However,the magnitude of the risk of pancreatic cancer(PC)associated with CD is much less clear,and risks have not been estimated from large populations.AIM To assess the risk of PC in CD patients.METHODS We conducted a population-based,multicenter,propensity score-matched cohort study with consecutive patients diagnosed with CD using the TriNeTx research network platform.We examined the incidence of PC in patients with CD compared with a matched cohort of patients without CD(non-CD,controls).Each patient in the main group(CD)was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.The incidence of PC was estimated using a Cox proportional hazards model with a hazard ratio(HR)and 95%confidence interval(CI).RESULTS A total of 389980 patients were included in this study.Among them,155877 patients had a diagnosis of CD,and the remaining 234103 individuals without CD were considered a control cohort.The mean duration of follow-up for patients in the CD and control cohorts was 5.8±1.8 and 5.9±1.1 years,respectively.During the follow-up,309 patients with CD developed PC,whereas 240 patients developed PC in the control group(HR=1.29;95%CI:1.09-1.53).In the secondary analyses in the first year after diagnosis of CD,patients with CD were at a significant increase in risk for PC;151 patients with CD had an incidence of PC compared with 96 incidences of PC among the patients in the non-CD control group(HR=1.56;95%CI:1.20-2.01)and sensitivity analysis showed similar magnitude to the one generated in the primary and secondary analysis.CONCLUSION Patients with CD are at increased risk of PC.Risk elevation persists beyond the first year after diagnosis to reference individuals without CD from the general population.
基金Supported by the National Center for Advancing Translational Sciences,No.5KL2TR001077-05(to Po-Hung Chen).
文摘BACKGROUND Liver fibrosis is a common pathway of liver injury and is a feature of most chronic liver diseases.Fibrosis progression varies markedly in patients with hepatitis C virus(HCV).Liver stiffness has been recommended as a parameter of fibrosis progression/regression in patients with HCV.AIM To investigate changes in liver stiffness measured by transient elastography(TE)in a large,racially diverse cohort of United States patients with chronic hepatitis C(CHC).METHODS We evaluated the differences in liver stiffness between patients treated with direct-acting antiviral(DAA)therapy and untreated patients.Patients had≥2 TE measurements and no prior DAA exposure.We used linear regression to measure the change in liver stiffness between first and last TE in response to treatment,controlling for age,sex,race,diabetes,smoking status,human immunodeficiency virus status,baseline alanine aminotransferase,and baseline liver stiffness.Separate regression models analyzed the change in liver stiffness as measured by kPa,stratified by cirrhosis status.RESULTS Of 813 patients,419(52%)initiated DAA treatment.Baseline liver stiffness was 12 kPa in 127(16%).Median time between first and last TE was 11.7 and 12.7 mo among treated and untreated patients,respectively.There was no significant change in liver stiffness observed over time in either the group initiating DAA treatment(0.016 kPa/month;CI:-0.051,0.084)or in the untreated group(0.001 kPa/mo;CI:-0.090,0.092),controlling for covariates.A higher baseline kPa score was independently associated with decreased liver stiffness.CONCLUSION DAA treatment was not associated with a differential change in liver stiffness over time in patients with CHC compared to untreated patients.
文摘BACKGROUND Patients with autoimmune hepatitis(AIH)require life-long immunosuppressive agents that may increase the risk of poor coronavirus disease 2019(COVID-19)outcomes.There is a paucity of large data at the population level to assess whether patients with AIH have an increased risk of severe diseases.AIM To evaluate the impact of pre-existing AIH on the clinical outcomes of patients with COVID-19.METHODS We conducted a population-based,multicenter,propensity score-matched cohort study with consecutive adult patients(≥18 years)diagnosed with COVID-19 using the TriNeTx research network platform.The outcomes of patients with AIH(main group)were compared to a propensity score-matched cohort of patients:(1)Without chronic liver disease(CLD);and(2)Patients with CLD except AIH(non-AIH CLD)control groups.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.The primary outcome was all-cause mortality,and secondary outcomes were hospitalization rate,need for critical care,severe disease,mechanical ventilation,and acute kidney injury(AKI).For each outcome,the risk ratio(RR)and confidence intervals(CI)were calculated to compare the association of AIH with the outcome.RESULTS We identified 375 patients with AIH,1647915 patients with non-CLD,and 15790 patients with non-AIH CLD with COVID-19 infection.Compared to non-CLD patients,the AIH cohort had an increased risk of all-cause mortality(RR=2.22;95%CI:1.07-4.61),hospitalization rate(RR=1.78;95%CI:1.17-2.69),and severe disease(RR=1.98;95%CI:1.19-3.26).The AIH cohort had a lower risk of hospitalization rate(RR=0.72;95%CI:0.56-0.92),critical care(RR=0.50;95%CI:0.32-0.79),and AKI(RR=0.56;95%CI:0.35-0.88)compared to the non-AIH CLD patients.CONCLUSION Patients with AIH are associated with increased hospitalization risk,severe disease,and all-cause mortality compared to patients without pre-existing CLD from the diagnosis of COVID-19.However,patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD.
