BACKGROUND Hepatitis E virus(HEV)infection is underdiagnosed due to the use of serological assays with low sensitivity.Although most patients with HEV recover completely,HEV infection among patients with pre-existing ...BACKGROUND Hepatitis E virus(HEV)infection is underdiagnosed due to the use of serological assays with low sensitivity.Although most patients with HEV recover completely,HEV infection among patients with pre-existing chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in decompensated liver disease and death.AIM To demonstrate the prevalence of HEV infection in solid organ transplant(SOT)recipients.METHODS We searched Ovid MEDLINE,EMBASE,and the Cochrane Library for eligible articles through October 2020.The inclusion criteria consisted of adult patients with history of SOT.HEV infection is confirmed by either HEV-immunoglobulin G,HEV-immunoglobulin M,or HEV RNA assay.RESULTS Of 563 citations,a total of 22 studies(n=4557)were included in this metaanalysis.The pooled estimated prevalence of HEV infection in SOT patients was 20.2%[95%confidence interval(CI):14.9-26.8].The pooled estimated prevalence of HEV infection for each organ transplant was as follows:liver(27.2%;95%CI:20.0-35.8),kidney(12.8%;95%CI:9.3-17.3),heart(12.8%;95%CI:9.3-17.3),and lung(5.6%;95%CI:1.6-17.9).Comparison across organ transplants demonstrated statistical significance(Q=16.721,P=0.002).The subgroup analyses showed that the prevalence of HEV infection among SOT recipients was significantly higher in middle-income countries compared to high-income countries.The pooled estimated prevalence of de novo HEV infection was 5.1%(95%CI:2.6-9.6)and the pooled estimated prevalence of acute HEV infection was 4.3%(95%CI:1.9-9.4).CONCLUSION HEV infection is common in SOT recipients,particularly in middle-income countries.The prevalence of HEV infection in lung transplant recipients is considerably less common than other organ transplants.More studies examining the clinical impacts of HEV infection in SOT recipients,such as graft failure,rejection,and mortality are warranted.展开更多
To investigate the prevalence and association of Helicobacter pylori(H.pylori)with end-stage renal disease(ESRD).METHODSSA comprehensive literature search was completed from inception until October 2016.Studies that r...To investigate the prevalence and association of Helicobacter pylori(H.pylori)with end-stage renal disease(ESRD).METHODSSA comprehensive literature search was completed from inception until October 2016.Studies that reported prevalence,relative risks,odd ratios,hazard ratios or standardized incidence ratio of H.pylori among ESRD patients were included.Participants without H.pylori were used as comparators to assess the association between H.pylori infection and ESRD.Pooled risk ratios and 95%CI was calculated using a random-effect model.Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird.RESULTSOf 4546 relevant studies,thirty-seven observational studies met all inclusion criteria.Thirty-five cross-sectional studies were included in the analyses to assess the prevalence and association of H.pylori with ESRD.The estimated prevalence of H.pylori among ESRD patients was 44%(95%CI:40%-49%).The pooled RR of H.pylori in patients with ESRD was 0.77(95%CI:0.59-1.00)when compared with the patients without ESRD.Subgroup analysis showed significantly reduced risk of H.pylori in adult ESRD patients with pooled RR of 0.71(95%CI:0.55-0.94).The data on the risk of ESRD in patients with H.pylori were limited.Two cohort studies were included to assess the risk of ESRD in patients with H.pylori.The pooled risk RR of ESRD in patients with H.pylori was 0.61(95%CI:0.03-12.20).CONCLUSIONThe estimated prevalence of H.pylori in ESRD patients is 44%.Our meta-analysis demonstrates a decreased risk of H.pylori in adult ESRD patients.展开更多
AIM To assess outcomes of kidney transplantation including patient and allograft outcomes in recipients with hepatitis B virus(HBV) infection, and the trends of patient's outcomes overtime.METHODS A literature sea...AIM To assess outcomes of kidney transplantation including patient and allograft outcomes in recipients with hepatitis B virus(HBV) infection, and the trends of patient's outcomes overtime.METHODS A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through October 2017. Studies that reported odds ratios(OR) of mortality or renal allograft failure after kidney transplantation in patients with HBV [defined as hepatitis B surface antigen(HBs Ag) positive] were included. The comparison group consisted of HBs Agnegative kidney transplant recipients. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of Der Simonian and Laird. The protocol for this metaanalysis is registered with PROSPERO(International Prospective Register of Systematic Reviews; no. CRD42017080657).RESULTS Ten observational studies with a total of 87623 kidney transplant patients were enrolled. Compared to HBs Ag-negative recipients, HBs Ag-positive status was significantly associated with increased risk of mortality after kidney transplantation(pooled OR = 2.48; 95%CI: 1.61-3.83). Meta-regression showed significant negative correlations between mortality risk after kidney transplantation in HBs Ag-positive recipients and year of study(slopes =-0.062, P = 0.001). HBs Agpositive status was also associated with increased risk of renal allograft failure with pooled OR of 1.46(95%CI: 1.08-1.96). There was also a significant negative correlation between year of study and risk of allograft failure(slopes =-0.018, P = 0.002). These associations existed in overall analysis as well as in limited cohort of hepatitis C virus-negative patients. We found no publication bias as assessed by the funnel plots and Egger's regression asymmetry test with P = 0.18 and 0.13 for the risks of mortality and allograft failure after kidney transplantation in HBs Ag-positive recipients, respectively.CONCLUSION Among kidney transplant patients, there are significant associations between HBs Ag-positive status and poor outcomes including mortality and allograft failure. However, there are potential improvements in patient and graft survivals in HBs Ag-positive recipients overtime.展开更多
AIM To assess prevalence of pre-existing atrial fibrillation(AF)and/or incidence of AF following liver transplantation,and the trends of patient's outcomes overtime;to evaluate impact of pre-existing AF and post-o...AIM To assess prevalence of pre-existing atrial fibrillation(AF)and/or incidence of AF following liver transplantation,and the trends of patient's outcomes overtime;to evaluate impact of pre-existing AF and post-operative AF on patient outcomes following liver transplantation.METHODS A literature search was conducted utilizing MEDLINE,EMBASE and Cochrane Database from inception throughMarch 2018.We included studies that reported:(1)prevalence of pre-existing AF or incidence of AF following liver transplantation;or(2)outcomes of liver transplant recipients with AF.Effect estimates from the individual study were extracted and combined utilizing randomeffect,generic inverse variance method of DerSimonian and Laird.The protocol for this meta-analysis is registered with PROSPERO(International Prospective Register of Systematic Reviews,No.CRD42018093644).RESULTS Twelve observational studies with a total of 38586 liver transplant patients were enrolled.Overall,the pooled estimated prevalence of pre-existing AF in patients undergoing liver transplantation was 5.4%(95%CI:4.9%-5.9%)and pooled estimated incidence of AF following liver transplantation was 8.5%(95%CI:5.2%-13.6%).Meta-regression analyses were performed and showed no significant correlations between year of study and either prevalence of pre-existing AF(P=0.08)or post-operative AF after liver transplantation(P=0.54).The pooled OR of mortality among liver transplant recipients with pre-existing AF was 2.34(2 studies;95%CI:1.10-5.00).In addition,pre-existing AF is associated with postoperative cardiovascular complications among liver transplant recipients(3 studies;OR:5.15,95%CI:2.67-9.92,I2=64%).With limited studies,two studies suggested significant association between new-onset AF and poor clinical outcomes including mortality,cerebrovascular events,post-transplant acute kidney injury,and increased risk of graft failure among liver transplant recipients(P<0.05).CONCLUSION The overall estimated prevalence of pre-existing AF and incidence of AF following liver transplantation are 5.4%and 8.5%,respectively.Incidence of AF following liver transplant does not seem to decrease overtime.Preexisting AF and new-onset AF are potentially associated with poor clinical outcomes post liver transplantation.展开更多
AIM To investigate the association between hepatitis C virus(HCV) infection and risk of renal cell carcinoma(RCC).METHODS A literature search was performed from inception until February 2016.Studies that reported rela...AIM To investigate the association between hepatitis C virus(HCV) infection and risk of renal cell carcinoma(RCC).METHODS A literature search was performed from inception until February 2016.Studies that reported relative risks,odd ratios,hazard ratios or standardized incidence ratio comparing the risk of RCC among HCV-infected participants vs those without HCV infection were included.Participants without HCV infection were used as comparators.Pooled odds ratios and 95%CI were calculated using a random-effect,generic inverse variance method.RESULTS Seven observational studies were with 196826 patients were included in the analysis to assess the risk of RCC in patients with HCV.A significantly increased risk of RCC among participants with HCV infection was found with a pooled RR of 1.86(95%CI:1.11-3.11).The association between RCC and HCV was marginally insignificant after a sensitivity analysis limited only to studies with adjusted analysis,with a pooled RR of 1.50(95%CI:0.93-2.42).CONCLUSION Our study demonstrated a potential association between HCV infection and RCC.Further studies of RCC surveillance in patients with HCV are required.展开更多
BACKGROUND Hepatorenal syndrome(HRS)is a life-threatening condition among patients with advanced liver disease.Data trends specific to hospital mortality and hospital admission resource utilization for HRS remain limi...BACKGROUND Hepatorenal syndrome(HRS)is a life-threatening condition among patients with advanced liver disease.Data trends specific to hospital mortality and hospital admission resource utilization for HRS remain limited.AIM To assess the temporal trend in mortality and identify the predictors for mortality among hospital admissions for HRS in the United States.METHODS We used the National Inpatient Sample database to identify an unweighted sample of 4938 hospital admissions for HRS from 2005 to 2014(weighted sample of 23973 admissions).The primary outcomes were temporal trends in mortality as well as predictors for hospital mortality.We estimated odds ratios from multilevel mixed effect logistic regression to identify patient characteristics and treatments associated with hospital mortality.RESULTS Overall hospital mortality was 32%.Hospital mortality decreased from 44%in 2005 to 24%in 2014(P<0.001),while there was an increase in the rate of liver transplantation(P=0.02),renal replacement therapy(P<0.001),length of hospital stay(P<0.001),and hospitalization cost(P<0.001).On multivariable analysis,older age,alcohol use,coagulopathy,neurological disorder,and need for mechanical ventilation predicted higher hospital mortality,whereas liver transplantation,transjugular intrahepatic portosystemic shunt,and abdominal paracentesis were associated with lower hospital mortality.CONCLUSION Although there was an increase in resource utilizations,hospital mortality among patients admitted for HRS significantly improved.Several predictors for hospital mortality were identified.展开更多
The global average life expectancy is projected to rise to 80 years by 2040[1].Since cancer is closely linked to aging,its prevalence is expected to grow as the population ages.Advancements in cancer diagnosis and tre...The global average life expectancy is projected to rise to 80 years by 2040[1].Since cancer is closely linked to aging,its prevalence is expected to grow as the population ages.Advancements in cancer diagnosis and treatment have led to an increasing number of cancer survivors.In a 2021 consensus statement,the International Society for Geriatric Oncology updated its top priorities for improving care for older cancer patients[2,3].According to the Global Burden of Disease(GBD)study,there were over four million deaths from gastrointestinal(GI)cancer in 2021[4].The aging population,advancements in cancer management,and shifting risk factors are undoubtedly influencing the prevalence of GI cancers in older adults[5].While aging has increasingly captured the attention of policymakers and stakeholders,epidemiological data on GI cancers in older adults remains limited.Older patients are also underrepresented in GI-specific clinical trials.This study aimed to estimate the global burden of GI cancers in older adults using the most recent GBD 2021[6].展开更多
Background:The recently introduced set of terminologies defining categories of steatotic liver disease(SLD)includes metabolic dysfunction-associated SLD(MASLD),alcohol-associated liver disease(ALD),and metabolic dysfu...Background:The recently introduced set of terminologies defining categories of steatotic liver disease(SLD)includes metabolic dysfunction-associated SLD(MASLD),alcohol-associated liver disease(ALD),and metabolic dysfunction associated steatotic liver disease and increased alcohol intake(MetALD).The present retrospective cohort study examines clinical characteristics,prevalence,and mortality risk across alcoholic intake spectrum in SLD individuals.Methods:Data between 1999 to 2018 were extracted from National Health and Nutrition Examination Survey registries and analysed.Population baseline characteristics were evaluated across classifications of SLD.SLD was confirmed using either fatty liver index(FLI)or United States FLI(US-FLI).Multivariate analyses were used to study mortality-related outcomes.Results:The 20,510 individuals with SLD included were classified into MASLD predominant(69.00%),MetALD(18.77%),and ALD predominant(12.23%)groups.Temporal analysis revealed significant decreases in MASLD prevalence in the SLD population from 1999-2018 in general[average annual percentage change(AAPC)−4.802%,P=0.001],as well as in females,Mexican Americans,and Non-Hispanic Blacks.MetALD prevalence in the SLD population increased from 1999-2018 in general(AAPC+1.635%,P<0.001),and in males,females,Mexican Americans,Non-Hispanic Blacks and other ethnicities.No significant change in ALD prevalence was found.Compared to MASLD predominant individuals,ALD predominant individuals had higher risks of all-cause[hazard ratio(HR):1.189,95%confidence interval(CI):1.026 to 1.378,P=0.02]and cancer-related mortality(subdistribution HR:1.277,95%CI:1.032 to 1.579,P=0.02).No significant difference was observed for all-cause,cancer-related,or cardiovascular disease(CVD)-related mortality in MetALD and CVD-related mortality in ALD predominant individuals,relative to MASLD predominant individuals.Conclusions:ALD predominant patients have higher all-cause and cancer-related mortality risks than MASLD predominant patients but not CVD-related mortality.SLD is highly heterogeneous in clinical characteristics,prevalence,and mortality risks which healthcare professionals must account for to avert adverse health outcomes.展开更多
Background and Aims:Direct-acting antiviral(DAA)therapy is the cornerstone of the treatment of chronic hepatitis C virus(HCV)infection.Eradication of HCV,predicted by the attainment of a sustained virologic response(S...Background and Aims:Direct-acting antiviral(DAA)therapy is the cornerstone of the treatment of chronic hepatitis C virus(HCV)infection.Eradication of HCV,predicted by the attainment of a sustained virologic response(SVR)12 weeks following DAA therapy,is the goal of this treatment.Interestingly,recent studies have reported the possible association between HCV-infected patients with DAA therapy concomitant use of proton pump inhibitors(PPIs)and lower odds of achieving SVR.This meta-analysis was conducted to summarize all available data and to estimate this potential association.Methods:Comprehensive literature review was conducted by first searching the Medline and Embase databases through March 2017 to identify all studies that investigated the safety and efficacy of DAAs in patients with HCV infection taking PPIs versus those without PPIs.Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird.Results:Nine cohort studies with 32,684 participants met the eligibility criteria and were included in the meta-analysis.The use of PPIs concomitant with DAAs among HCV-infected patients was associated with lower odds of achieving SVR compared with non-PPI users(pooled odds ratio(OR):0.74,95%confidence interval(CI):0.63-0.88,I2=24%).Subgroup analysis addressed the association between PPIs use and SVR12 demonstrated the association of PPI users showing lower odds of achieving SVR12 compared with those with no use of PPIs(pooled OR:0.68,95%CI:0.51-0.9,I2=33%).Conclusions:This study demonstrated a significantly increased risk of failure to achieve SVR in HCV-infected patients taking DAA with PPIs compared to non-PPI users.Providers should consider whether PPI therapy is indicated for patients and withdraw of PPI therapy in the absence of indications,especially while on DAA therapy.展开更多
Over the past decades,obesity has become an epidemic worldwide.Obesity impacts health burdens heterogeneously by the regional distribution of fat,not total body fat quantity.Epidemiologic studies reported that regiona...Over the past decades,obesity has become an epidemic worldwide.Obesity impacts health burdens heterogeneously by the regional distribution of fat,not total body fat quantity.Epidemiologic studies reported that regional body fat distribution could represent a significant risk factor for insulin resistance(1),type 2 diabetes mellitus,and cardiovascular disease(2).Nonalcoholic fatty liver disease(NAFLD)affects approximately a fourth of the population worldwide and has been linked with overweight/obesity.However,NAFLD can be seen in individuals without overweight/obesity,which is called lean NAFLD.It has been shown that in terms of body fat distribution,visceral adipose tissue(VAT)has a stronger association with NAFLD and severity in NAFLD than subcutaneous adipose tissue(SAT)(3-6).展开更多
In the present narrative review,we have summarized the current evidence on the natural progression of metabolic dysfunctionassociated steatohepatitis(MASH)cirrhosis observed through the placebo arm in clinical trials ...In the present narrative review,we have summarized the current evidence on the natural progression of metabolic dysfunctionassociated steatohepatitis(MASH)cirrhosis observed through the placebo arm in clinical trials and observational studies.The outcomes scrutinized throughout our review were histology-related changes,non-invasive fibrosis markers,indicators of decompensation,end-stage hepatic complications,and mortality reported during the different clinical trials.Given the short duration of clinical trials,observational studies were included to obtain better insight into the long-term progression and prognosis of MASH cirrhosis.Lastly,new updates about MASH cirrhosis treatments were listed,and the results of these randomized clinical trials were described to enhance our understanding of our current standing in the treatment of MASH cirrhosis.展开更多
文摘BACKGROUND Hepatitis E virus(HEV)infection is underdiagnosed due to the use of serological assays with low sensitivity.Although most patients with HEV recover completely,HEV infection among patients with pre-existing chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in decompensated liver disease and death.AIM To demonstrate the prevalence of HEV infection in solid organ transplant(SOT)recipients.METHODS We searched Ovid MEDLINE,EMBASE,and the Cochrane Library for eligible articles through October 2020.The inclusion criteria consisted of adult patients with history of SOT.HEV infection is confirmed by either HEV-immunoglobulin G,HEV-immunoglobulin M,or HEV RNA assay.RESULTS Of 563 citations,a total of 22 studies(n=4557)were included in this metaanalysis.The pooled estimated prevalence of HEV infection in SOT patients was 20.2%[95%confidence interval(CI):14.9-26.8].The pooled estimated prevalence of HEV infection for each organ transplant was as follows:liver(27.2%;95%CI:20.0-35.8),kidney(12.8%;95%CI:9.3-17.3),heart(12.8%;95%CI:9.3-17.3),and lung(5.6%;95%CI:1.6-17.9).Comparison across organ transplants demonstrated statistical significance(Q=16.721,P=0.002).The subgroup analyses showed that the prevalence of HEV infection among SOT recipients was significantly higher in middle-income countries compared to high-income countries.The pooled estimated prevalence of de novo HEV infection was 5.1%(95%CI:2.6-9.6)and the pooled estimated prevalence of acute HEV infection was 4.3%(95%CI:1.9-9.4).CONCLUSION HEV infection is common in SOT recipients,particularly in middle-income countries.The prevalence of HEV infection in lung transplant recipients is considerably less common than other organ transplants.More studies examining the clinical impacts of HEV infection in SOT recipients,such as graft failure,rejection,and mortality are warranted.
文摘To investigate the prevalence and association of Helicobacter pylori(H.pylori)with end-stage renal disease(ESRD).METHODSSA comprehensive literature search was completed from inception until October 2016.Studies that reported prevalence,relative risks,odd ratios,hazard ratios or standardized incidence ratio of H.pylori among ESRD patients were included.Participants without H.pylori were used as comparators to assess the association between H.pylori infection and ESRD.Pooled risk ratios and 95%CI was calculated using a random-effect model.Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird.RESULTSOf 4546 relevant studies,thirty-seven observational studies met all inclusion criteria.Thirty-five cross-sectional studies were included in the analyses to assess the prevalence and association of H.pylori with ESRD.The estimated prevalence of H.pylori among ESRD patients was 44%(95%CI:40%-49%).The pooled RR of H.pylori in patients with ESRD was 0.77(95%CI:0.59-1.00)when compared with the patients without ESRD.Subgroup analysis showed significantly reduced risk of H.pylori in adult ESRD patients with pooled RR of 0.71(95%CI:0.55-0.94).The data on the risk of ESRD in patients with H.pylori were limited.Two cohort studies were included to assess the risk of ESRD in patients with H.pylori.The pooled risk RR of ESRD in patients with H.pylori was 0.61(95%CI:0.03-12.20).CONCLUSIONThe estimated prevalence of H.pylori in ESRD patients is 44%.Our meta-analysis demonstrates a decreased risk of H.pylori in adult ESRD patients.
文摘AIM To assess outcomes of kidney transplantation including patient and allograft outcomes in recipients with hepatitis B virus(HBV) infection, and the trends of patient's outcomes overtime.METHODS A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through October 2017. Studies that reported odds ratios(OR) of mortality or renal allograft failure after kidney transplantation in patients with HBV [defined as hepatitis B surface antigen(HBs Ag) positive] were included. The comparison group consisted of HBs Agnegative kidney transplant recipients. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of Der Simonian and Laird. The protocol for this metaanalysis is registered with PROSPERO(International Prospective Register of Systematic Reviews; no. CRD42017080657).RESULTS Ten observational studies with a total of 87623 kidney transplant patients were enrolled. Compared to HBs Ag-negative recipients, HBs Ag-positive status was significantly associated with increased risk of mortality after kidney transplantation(pooled OR = 2.48; 95%CI: 1.61-3.83). Meta-regression showed significant negative correlations between mortality risk after kidney transplantation in HBs Ag-positive recipients and year of study(slopes =-0.062, P = 0.001). HBs Agpositive status was also associated with increased risk of renal allograft failure with pooled OR of 1.46(95%CI: 1.08-1.96). There was also a significant negative correlation between year of study and risk of allograft failure(slopes =-0.018, P = 0.002). These associations existed in overall analysis as well as in limited cohort of hepatitis C virus-negative patients. We found no publication bias as assessed by the funnel plots and Egger's regression asymmetry test with P = 0.18 and 0.13 for the risks of mortality and allograft failure after kidney transplantation in HBs Ag-positive recipients, respectively.CONCLUSION Among kidney transplant patients, there are significant associations between HBs Ag-positive status and poor outcomes including mortality and allograft failure. However, there are potential improvements in patient and graft survivals in HBs Ag-positive recipients overtime.
文摘AIM To assess prevalence of pre-existing atrial fibrillation(AF)and/or incidence of AF following liver transplantation,and the trends of patient's outcomes overtime;to evaluate impact of pre-existing AF and post-operative AF on patient outcomes following liver transplantation.METHODS A literature search was conducted utilizing MEDLINE,EMBASE and Cochrane Database from inception throughMarch 2018.We included studies that reported:(1)prevalence of pre-existing AF or incidence of AF following liver transplantation;or(2)outcomes of liver transplant recipients with AF.Effect estimates from the individual study were extracted and combined utilizing randomeffect,generic inverse variance method of DerSimonian and Laird.The protocol for this meta-analysis is registered with PROSPERO(International Prospective Register of Systematic Reviews,No.CRD42018093644).RESULTS Twelve observational studies with a total of 38586 liver transplant patients were enrolled.Overall,the pooled estimated prevalence of pre-existing AF in patients undergoing liver transplantation was 5.4%(95%CI:4.9%-5.9%)and pooled estimated incidence of AF following liver transplantation was 8.5%(95%CI:5.2%-13.6%).Meta-regression analyses were performed and showed no significant correlations between year of study and either prevalence of pre-existing AF(P=0.08)or post-operative AF after liver transplantation(P=0.54).The pooled OR of mortality among liver transplant recipients with pre-existing AF was 2.34(2 studies;95%CI:1.10-5.00).In addition,pre-existing AF is associated with postoperative cardiovascular complications among liver transplant recipients(3 studies;OR:5.15,95%CI:2.67-9.92,I2=64%).With limited studies,two studies suggested significant association between new-onset AF and poor clinical outcomes including mortality,cerebrovascular events,post-transplant acute kidney injury,and increased risk of graft failure among liver transplant recipients(P<0.05).CONCLUSION The overall estimated prevalence of pre-existing AF and incidence of AF following liver transplantation are 5.4%and 8.5%,respectively.Incidence of AF following liver transplant does not seem to decrease overtime.Preexisting AF and new-onset AF are potentially associated with poor clinical outcomes post liver transplantation.
文摘AIM To investigate the association between hepatitis C virus(HCV) infection and risk of renal cell carcinoma(RCC).METHODS A literature search was performed from inception until February 2016.Studies that reported relative risks,odd ratios,hazard ratios or standardized incidence ratio comparing the risk of RCC among HCV-infected participants vs those without HCV infection were included.Participants without HCV infection were used as comparators.Pooled odds ratios and 95%CI were calculated using a random-effect,generic inverse variance method.RESULTS Seven observational studies were with 196826 patients were included in the analysis to assess the risk of RCC in patients with HCV.A significantly increased risk of RCC among participants with HCV infection was found with a pooled RR of 1.86(95%CI:1.11-3.11).The association between RCC and HCV was marginally insignificant after a sensitivity analysis limited only to studies with adjusted analysis,with a pooled RR of 1.50(95%CI:0.93-2.42).CONCLUSION Our study demonstrated a potential association between HCV infection and RCC.Further studies of RCC surveillance in patients with HCV are required.
文摘BACKGROUND Hepatorenal syndrome(HRS)is a life-threatening condition among patients with advanced liver disease.Data trends specific to hospital mortality and hospital admission resource utilization for HRS remain limited.AIM To assess the temporal trend in mortality and identify the predictors for mortality among hospital admissions for HRS in the United States.METHODS We used the National Inpatient Sample database to identify an unweighted sample of 4938 hospital admissions for HRS from 2005 to 2014(weighted sample of 23973 admissions).The primary outcomes were temporal trends in mortality as well as predictors for hospital mortality.We estimated odds ratios from multilevel mixed effect logistic regression to identify patient characteristics and treatments associated with hospital mortality.RESULTS Overall hospital mortality was 32%.Hospital mortality decreased from 44%in 2005 to 24%in 2014(P<0.001),while there was an increase in the rate of liver transplantation(P=0.02),renal replacement therapy(P<0.001),length of hospital stay(P<0.001),and hospitalization cost(P<0.001).On multivariable analysis,older age,alcohol use,coagulopathy,neurological disorder,and need for mechanical ventilation predicted higher hospital mortality,whereas liver transplantation,transjugular intrahepatic portosystemic shunt,and abdominal paracentesis were associated with lower hospital mortality.CONCLUSION Although there was an increase in resource utilizations,hospital mortality among patients admitted for HRS significantly improved.Several predictors for hospital mortality were identified.
文摘The global average life expectancy is projected to rise to 80 years by 2040[1].Since cancer is closely linked to aging,its prevalence is expected to grow as the population ages.Advancements in cancer diagnosis and treatment have led to an increasing number of cancer survivors.In a 2021 consensus statement,the International Society for Geriatric Oncology updated its top priorities for improving care for older cancer patients[2,3].According to the Global Burden of Disease(GBD)study,there were over four million deaths from gastrointestinal(GI)cancer in 2021[4].The aging population,advancements in cancer management,and shifting risk factors are undoubtedly influencing the prevalence of GI cancers in older adults[5].While aging has increasingly captured the attention of policymakers and stakeholders,epidemiological data on GI cancers in older adults remains limited.Older patients are also underrepresented in GI-specific clinical trials.This study aimed to estimate the global burden of GI cancers in older adults using the most recent GBD 2021[6].
文摘Background:The recently introduced set of terminologies defining categories of steatotic liver disease(SLD)includes metabolic dysfunction-associated SLD(MASLD),alcohol-associated liver disease(ALD),and metabolic dysfunction associated steatotic liver disease and increased alcohol intake(MetALD).The present retrospective cohort study examines clinical characteristics,prevalence,and mortality risk across alcoholic intake spectrum in SLD individuals.Methods:Data between 1999 to 2018 were extracted from National Health and Nutrition Examination Survey registries and analysed.Population baseline characteristics were evaluated across classifications of SLD.SLD was confirmed using either fatty liver index(FLI)or United States FLI(US-FLI).Multivariate analyses were used to study mortality-related outcomes.Results:The 20,510 individuals with SLD included were classified into MASLD predominant(69.00%),MetALD(18.77%),and ALD predominant(12.23%)groups.Temporal analysis revealed significant decreases in MASLD prevalence in the SLD population from 1999-2018 in general[average annual percentage change(AAPC)−4.802%,P=0.001],as well as in females,Mexican Americans,and Non-Hispanic Blacks.MetALD prevalence in the SLD population increased from 1999-2018 in general(AAPC+1.635%,P<0.001),and in males,females,Mexican Americans,Non-Hispanic Blacks and other ethnicities.No significant change in ALD prevalence was found.Compared to MASLD predominant individuals,ALD predominant individuals had higher risks of all-cause[hazard ratio(HR):1.189,95%confidence interval(CI):1.026 to 1.378,P=0.02]and cancer-related mortality(subdistribution HR:1.277,95%CI:1.032 to 1.579,P=0.02).No significant difference was observed for all-cause,cancer-related,or cardiovascular disease(CVD)-related mortality in MetALD and CVD-related mortality in ALD predominant individuals,relative to MASLD predominant individuals.Conclusions:ALD predominant patients have higher all-cause and cancer-related mortality risks than MASLD predominant patients but not CVD-related mortality.SLD is highly heterogeneous in clinical characteristics,prevalence,and mortality risks which healthcare professionals must account for to avert adverse health outcomes.
文摘Background and Aims:Direct-acting antiviral(DAA)therapy is the cornerstone of the treatment of chronic hepatitis C virus(HCV)infection.Eradication of HCV,predicted by the attainment of a sustained virologic response(SVR)12 weeks following DAA therapy,is the goal of this treatment.Interestingly,recent studies have reported the possible association between HCV-infected patients with DAA therapy concomitant use of proton pump inhibitors(PPIs)and lower odds of achieving SVR.This meta-analysis was conducted to summarize all available data and to estimate this potential association.Methods:Comprehensive literature review was conducted by first searching the Medline and Embase databases through March 2017 to identify all studies that investigated the safety and efficacy of DAAs in patients with HCV infection taking PPIs versus those without PPIs.Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird.Results:Nine cohort studies with 32,684 participants met the eligibility criteria and were included in the meta-analysis.The use of PPIs concomitant with DAAs among HCV-infected patients was associated with lower odds of achieving SVR compared with non-PPI users(pooled odds ratio(OR):0.74,95%confidence interval(CI):0.63-0.88,I2=24%).Subgroup analysis addressed the association between PPIs use and SVR12 demonstrated the association of PPI users showing lower odds of achieving SVR12 compared with those with no use of PPIs(pooled OR:0.68,95%CI:0.51-0.9,I2=33%).Conclusions:This study demonstrated a significantly increased risk of failure to achieve SVR in HCV-infected patients taking DAA with PPIs compared to non-PPI users.Providers should consider whether PPI therapy is indicated for patients and withdraw of PPI therapy in the absence of indications,especially while on DAA therapy.
文摘Over the past decades,obesity has become an epidemic worldwide.Obesity impacts health burdens heterogeneously by the regional distribution of fat,not total body fat quantity.Epidemiologic studies reported that regional body fat distribution could represent a significant risk factor for insulin resistance(1),type 2 diabetes mellitus,and cardiovascular disease(2).Nonalcoholic fatty liver disease(NAFLD)affects approximately a fourth of the population worldwide and has been linked with overweight/obesity.However,NAFLD can be seen in individuals without overweight/obesity,which is called lean NAFLD.It has been shown that in terms of body fat distribution,visceral adipose tissue(VAT)has a stronger association with NAFLD and severity in NAFLD than subcutaneous adipose tissue(SAT)(3-6).
文摘In the present narrative review,we have summarized the current evidence on the natural progression of metabolic dysfunctionassociated steatohepatitis(MASH)cirrhosis observed through the placebo arm in clinical trials and observational studies.The outcomes scrutinized throughout our review were histology-related changes,non-invasive fibrosis markers,indicators of decompensation,end-stage hepatic complications,and mortality reported during the different clinical trials.Given the short duration of clinical trials,observational studies were included to obtain better insight into the long-term progression and prognosis of MASH cirrhosis.Lastly,new updates about MASH cirrhosis treatments were listed,and the results of these randomized clinical trials were described to enhance our understanding of our current standing in the treatment of MASH cirrhosis.
