Drug induced liver injury(DILI)is a common cause of acute liver injury.Paracetamol,also known as acetaminophen,is a widely used anti-pyretic that has long been established to cause liver toxicity once above therapeuti...Drug induced liver injury(DILI)is a common cause of acute liver injury.Paracetamol,also known as acetaminophen,is a widely used anti-pyretic that has long been established to cause liver toxicity once above therapeutic levels.Hepatotoxicity from paracetamol overdose,whether intentional or nonintentional,is the most common cause of DILI in the United States and remains a global issue.Given the increased prevalence of combination medications in the form of pain relievers and antihistamines,paracetamol can be difficult to identify and remains a significant cause of acute hepatotoxicity,as evidenced by its contribution to over half of all acute liver failure cases in the United States.This is especially concerning given that,when co-ingested with other medications,the rise in serum paracetamol levels may be delayed past the 4-hour post-ingestion mark that is currently used to determine patients that require medical therapy.This review serves to describe the clinical and pathophysiologic features of hepatotoxicity secondary to paracetamol and provide an update on current available knowledge and treatment options.展开更多
BACKGROUND Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis.There is limited data on the outcomes of patients with esophageal variceal b...BACKGROUND Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis.There is limited data on the outcomes of patients with esophageal variceal bleeding in teaching versus nonteaching hospitals.Because esophageal variceal bleeding requires complex management,it may be hypothesized that teaching hospitals have lower mortality.AIM To assess the differences in mortality,hospital length of stay(LOS)and cost of admission for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the US.METHODS The National Inpatient Sample is the largest all-payer inpatient database consisting of approximately 20%of all inpatient admissions to nonfederal hospitals in the United States.We collected data from the years 2008 to 2014.Cases of variceal bleeding were identified using the International Classification of Diseases,Ninth Edition,Clinical Modification codes.Differences in mortality,LOS and cost were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and comorbidities.RESULTS Between 2008 and 2014,there were 58362 cases of esophageal variceal bleeding identified.Compared with teaching hospitals,mortality was lower in nonteaching hospitals(8.0%vs 5.3%,P<0.001).Median LOS was shorter in nonteaching hospitals as compared to teaching hospitals(4 d vs 5 d,P<0.001).A higher proportion of non-white patients were managed in teaching hospitals.As far as procedures in nonteaching vs teaching hospitals,portosystemic shunt insertion(3.1%vs 6.9%,P<0.001)and balloon tamponade(0.6%vs 1.2%)were done more often in teaching hospitals while blood transfusions(64.2%vs 59.9%,P=0.001)were given more in nonteaching hospitals.Using binary logistic regression models and adjusting for baseline patient demographics and comorbid conditions the mortality,LOS and cost in teaching hospitals remained higher.CONCLUSION In patients admitted for esophageal variceal bleeding,mortality,length of stay and cost were higher in teaching hospitals versus nonteaching hospitals when controlling for other confounding factors.展开更多
BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise worldwide.This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitali...BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise worldwide.This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization.AIM To identify trends and adverse outcomes for 30 d readmissions for CD and UC.METHODS This was a retrospective,interrupted trends study involving all adult(≥18 years)30 d readmissions of CD and UC from the National Readmission Database(NRD)between 2008 and 2018.Patients<18 years,elective,and traumatic hospitalizations were excluded from this study.We identified hospitalization characteristics and readmission rates for each calendar year.Trends of inpatient mortality,mean length of hospital stay(LOS)and mean total hospital cost(THC)were calculated using a multivariate logistic trend analysis adjusting for age,gender,insurance status,comorbidity burden and hospital factors.Furthermore,trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations.Stata®Version 16 software(StataCorp,TX,United States)was used for statistical analysis and P value≤0.05 were considered statistically significant.RESULTS Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC.We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9%in 2010 to 17.6%in 2018(P-trend<0.001),CD specific readmission rate from 7.1%in 2010 to 8.2%in 2018(P-trend<0.001),30-day all-cause readmission rate of UC from 14.1%in 2010 to 15.7%in 2018(P-trend=0.003),and UC specific readmission rate from 5.2%in 2010 to 5.6%in 2018(P-trend=0.029).There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions.However,we found an increasing trend of mean THC for UC readmissions.After comparison,there was no statistical difference in the trends for 30 d all-cause readmission rate,inpatient mortality,and mean LOS between CD and UC readmissions.CONCLUSION There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.展开更多
Background and Aims:There has been increasing evidence that vitamin D deficiency may increase the risk of metabolic syndrome.Since metabolic syndrome is a major risk factor for non-alcoholic fatty liver disease (NAFLD...Background and Aims:There has been increasing evidence that vitamin D deficiency may increase the risk of metabolic syndrome.Since metabolic syndrome is a major risk factor for non-alcoholic fatty liver disease (NAFLD),we aimed to investigate the association between vitamin D and the severity and mortality of NAFLD.Methods:Data was obtained from the United States Third National Health and Nutrition Examination Survey conducted in 1988-1994,with followup mortality data through 2011.NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other liver diseases and categorized as normal,mild,moderate or severe.The severity of hepatic fibrosis was determined by NAFLD fibrosis score (NFS).ANOVA (F-test) was used to evaluate the association between vitamin D level and degree of NAFLD,and Cox proportional hazards regression analysis was used for survival analyses.Results:Vitamin D levels for normal,mild,moderate and severe steatosis were 25.1 ± 0.29 ng/mL,24.7 ± 0.42 ng/mL,23.7 ± 0.37 ng/mL and 23.6 ± 0.60 ng/mL,respectively (trend p < 0.001).Likewise,vitamin D levels for low,intermediate and high NFS categories were 24.7 ± 0.38 ng/mL,23.4 ± 0.42 ng/mL and 21.5 ± 0.57 ng/mL,respectively (trend p < 0.001).After median-follow up over 19 years,vitamin D deficiency was significantly associated with diabetes-and Alzheimer's diseaserelated mortality (hazard ratio (HR):3.64,95%CI:1.51-8.82 and HR:4.80,95%CI:1.53-15.1,respectively),with a borderline significance in overall mortality (HR:1.16,95%CI:0.99-1.36,p =0.06).Conclusion:Vitamin D level was inversely related to the degree of liver steatosis and fibrosis.Moreover,vitamin D deficiency was associated with diabetes-and Alzheimer's disease-related mortality in NAFLD patients.展开更多
文摘Drug induced liver injury(DILI)is a common cause of acute liver injury.Paracetamol,also known as acetaminophen,is a widely used anti-pyretic that has long been established to cause liver toxicity once above therapeutic levels.Hepatotoxicity from paracetamol overdose,whether intentional or nonintentional,is the most common cause of DILI in the United States and remains a global issue.Given the increased prevalence of combination medications in the form of pain relievers and antihistamines,paracetamol can be difficult to identify and remains a significant cause of acute hepatotoxicity,as evidenced by its contribution to over half of all acute liver failure cases in the United States.This is especially concerning given that,when co-ingested with other medications,the rise in serum paracetamol levels may be delayed past the 4-hour post-ingestion mark that is currently used to determine patients that require medical therapy.This review serves to describe the clinical and pathophysiologic features of hepatotoxicity secondary to paracetamol and provide an update on current available knowledge and treatment options.
文摘BACKGROUND Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis.There is limited data on the outcomes of patients with esophageal variceal bleeding in teaching versus nonteaching hospitals.Because esophageal variceal bleeding requires complex management,it may be hypothesized that teaching hospitals have lower mortality.AIM To assess the differences in mortality,hospital length of stay(LOS)and cost of admission for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the US.METHODS The National Inpatient Sample is the largest all-payer inpatient database consisting of approximately 20%of all inpatient admissions to nonfederal hospitals in the United States.We collected data from the years 2008 to 2014.Cases of variceal bleeding were identified using the International Classification of Diseases,Ninth Edition,Clinical Modification codes.Differences in mortality,LOS and cost were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and comorbidities.RESULTS Between 2008 and 2014,there were 58362 cases of esophageal variceal bleeding identified.Compared with teaching hospitals,mortality was lower in nonteaching hospitals(8.0%vs 5.3%,P<0.001).Median LOS was shorter in nonteaching hospitals as compared to teaching hospitals(4 d vs 5 d,P<0.001).A higher proportion of non-white patients were managed in teaching hospitals.As far as procedures in nonteaching vs teaching hospitals,portosystemic shunt insertion(3.1%vs 6.9%,P<0.001)and balloon tamponade(0.6%vs 1.2%)were done more often in teaching hospitals while blood transfusions(64.2%vs 59.9%,P=0.001)were given more in nonteaching hospitals.Using binary logistic regression models and adjusting for baseline patient demographics and comorbid conditions the mortality,LOS and cost in teaching hospitals remained higher.CONCLUSION In patients admitted for esophageal variceal bleeding,mortality,length of stay and cost were higher in teaching hospitals versus nonteaching hospitals when controlling for other confounding factors.
文摘BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise worldwide.This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization.AIM To identify trends and adverse outcomes for 30 d readmissions for CD and UC.METHODS This was a retrospective,interrupted trends study involving all adult(≥18 years)30 d readmissions of CD and UC from the National Readmission Database(NRD)between 2008 and 2018.Patients<18 years,elective,and traumatic hospitalizations were excluded from this study.We identified hospitalization characteristics and readmission rates for each calendar year.Trends of inpatient mortality,mean length of hospital stay(LOS)and mean total hospital cost(THC)were calculated using a multivariate logistic trend analysis adjusting for age,gender,insurance status,comorbidity burden and hospital factors.Furthermore,trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations.Stata®Version 16 software(StataCorp,TX,United States)was used for statistical analysis and P value≤0.05 were considered statistically significant.RESULTS Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC.We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9%in 2010 to 17.6%in 2018(P-trend<0.001),CD specific readmission rate from 7.1%in 2010 to 8.2%in 2018(P-trend<0.001),30-day all-cause readmission rate of UC from 14.1%in 2010 to 15.7%in 2018(P-trend=0.003),and UC specific readmission rate from 5.2%in 2010 to 5.6%in 2018(P-trend=0.029).There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions.However,we found an increasing trend of mean THC for UC readmissions.After comparison,there was no statistical difference in the trends for 30 d all-cause readmission rate,inpatient mortality,and mean LOS between CD and UC readmissions.CONCLUSION There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.
基金This work was supported in part by the National Research Foundation of Korea (Grant 2014R1A2A10052872 to Sung-Hoon Kim)
文摘Background and Aims:There has been increasing evidence that vitamin D deficiency may increase the risk of metabolic syndrome.Since metabolic syndrome is a major risk factor for non-alcoholic fatty liver disease (NAFLD),we aimed to investigate the association between vitamin D and the severity and mortality of NAFLD.Methods:Data was obtained from the United States Third National Health and Nutrition Examination Survey conducted in 1988-1994,with followup mortality data through 2011.NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other liver diseases and categorized as normal,mild,moderate or severe.The severity of hepatic fibrosis was determined by NAFLD fibrosis score (NFS).ANOVA (F-test) was used to evaluate the association between vitamin D level and degree of NAFLD,and Cox proportional hazards regression analysis was used for survival analyses.Results:Vitamin D levels for normal,mild,moderate and severe steatosis were 25.1 ± 0.29 ng/mL,24.7 ± 0.42 ng/mL,23.7 ± 0.37 ng/mL and 23.6 ± 0.60 ng/mL,respectively (trend p < 0.001).Likewise,vitamin D levels for low,intermediate and high NFS categories were 24.7 ± 0.38 ng/mL,23.4 ± 0.42 ng/mL and 21.5 ± 0.57 ng/mL,respectively (trend p < 0.001).After median-follow up over 19 years,vitamin D deficiency was significantly associated with diabetes-and Alzheimer's diseaserelated mortality (hazard ratio (HR):3.64,95%CI:1.51-8.82 and HR:4.80,95%CI:1.53-15.1,respectively),with a borderline significance in overall mortality (HR:1.16,95%CI:0.99-1.36,p =0.06).Conclusion:Vitamin D level was inversely related to the degree of liver steatosis and fibrosis.Moreover,vitamin D deficiency was associated with diabetes-and Alzheimer's disease-related mortality in NAFLD patients.
