BACKGROUND Clostridioides(formerly Clostridium)difficile infection(CDI)is an increasingly frequent cause of morbidity and mortality in hospitalized patients.Multiple risk factors are documented in the literature that ...BACKGROUND Clostridioides(formerly Clostridium)difficile infection(CDI)is an increasingly frequent cause of morbidity and mortality in hospitalized patients.Multiple risk factors are documented in the literature that includes,but are not limited to,antibiotics use,advanced age,and gastric acid suppression.Several epidemiological studies have reported an increased incidence of CDI in advanced liver disease patients.Some have also demonstrated a higher prevalence of nosocomial infections in cirrhotic patients.AIM To use a large nationwide database,we sought to determine CDI’s risk among liver cirrhosis patients in the United States.METHODS We queried a commercial database(Explorys Inc^(TM),Cleveland,OH,United States),and obtained an aggregate of electronic health record data from 26 major integrated United States healthcare systems comprising 360 hospitals in the United States from 2018 to 2021.Diagnoses were organized into the Systematized Nomenclature of Medicine Clinical Terms(SNOMED–CT)hierarchy.Statistical analysis for the multivariable model was performed using Statistical Package for Social Sciences(SPSS version 25,IBM CorpTM).For all analyses,a two-sided P value of<0.05 was considered statistically significant.RESULTS There were a total of 19387760 patients in the database who were above 20 years of age between the years 2018-2021.Of those,133400 were diagnosed with liver cirrhosis.The prevalence of CDI amongst the liver cirrhosis population was 134.93 per 100.000 vs 19.06 per 100.000 in non-cirrhotic patients(P<0.0001).The multivariate analysis model uncovered that cirrhotic patients were more likely to develop CDI(OR:1.857;95%CI:1.665-2.113,P<0.0001)compared to those without any prior history of liver cirrhosis.CONCLUSION In this large database study,we uncovered that cirrhotic patients have a significantly higher CDI prevalence than those without cirrhosis.Liver cirrhosis may be an independent risk factor for CDI.Further prospective studies are needed to clarify this possible risk association that may lead to the implementation of screening methods in this high-risk population.展开更多
Driven by the tremendous availability of data,artificial intelligence(AI)using deep learning has emerged as a breakthrough computer technology in the last few decades and has recently been acknowledged by the Task For...Driven by the tremendous availability of data,artificial intelligence(AI)using deep learning has emerged as a breakthrough computer technology in the last few decades and has recently been acknowledged by the Task Force on AI as a golden opportunity for research.With its ability to understand,learn from and build on non-linear relationships,AI aims to individualize medical care in an attempt to save time,cost,effort and improve patient’s safety.AI has been applied in multiple medical fields with substantial progress made in gastroenterology mainly to facilitate accurate detection of pathology in different disease processes,among which inflammatory bowel disease(IBD)seems to drag significant attention,specifically by interpreting imaging studies,endoscopic images and videos and-to a lesser extent-disease genomics.Moreover,models have been built to predict IBD occurrence,flare ups,persistence of histological inflammation,disease-related structural abnormalities as well as disease remission.In this article,we will review the applications of AI in IBD in the present medical literature at multiple points of IBD timeline,starting from disease prediction via genomic assessment,diagnostic phase via interpretation of radiological studies and AI-assisted endoscopy,and the role of AI in the evaluation of therapy response and prognosis of IBD patients.展开更多
Hemochromatosis,either hereditary hemochromatosis(HH)or secondary hemochromatosis,consists of the accumulation of iron in the liver,heart,and other organs.It leads to end-organ damage in a proportion of affected subje...Hemochromatosis,either hereditary hemochromatosis(HH)or secondary hemochromatosis,consists of the accumulation of iron in the liver,heart,and other organs.It leads to end-organ damage in a proportion of affected subjects.Although liver-related morbidity(cirrhosis and hepatocellular carcinoma[HCC])and mortality are well established,the frequency of these complications remains controversial.The aim of this study is to examine the rate of hospitalization and the incidence of iron overload-related comorbidities in patients with hemochromatosis between the years of 2002 and 2010.We queried the Nationwide Inpatient Sample(NIS)database from the year 2002 to 2010.We included adults(age≥18 years)and used the ICD-CM 9 code 275.0x to identify hospitalized patients with a diagnosis of hemochromatosis.Data analysis for this study was generated using SAS software version 9.4.A total of 168,614 hospitalized patients between 2002 and 2010 had a diagnosis of hemochromatosis.The majority were males(57%)with a median age of 54 years(37–68),with a predominance of white patients(63.3%)followed by black(26.8%).The rate of hospitalization among patients with hemochromatosis increased by 79%between the years 2002 and 2010(34.5/100,000 in 2002 vs 61.4/100,000 in 2010).The main associated diagnoses were diabetes mellitus(20.2%),cardiac disease,including arrhythmias(14%)and cardiomyopathy(dilated 3.8%;peri-,endo-,myocarditis 1.3%),liver cirrhosis(8.6%),HCC(1.6%),and acute liver failure(0.81%).Of note,HCC was associated with cirrhosis in 1188 patients(43%of HCC patients)and male sex(87%).Diagnostic biopsies were performed in 6023(3.6%)of those patients and liver transplant was performed in 881(0.5%).In-hospital mortality occurred in 3638(2.16%)patients.In this large database study,we found a rising trend in hospitalization for hemochromatosis,possibly due to the increased recognition of this entity and billing for the condition.The incidence of cirrhosis in hemochromatosis was found to be similar to other studies(8.6%vs 9%).However,the rate of HCC was lower than previous reports(1.6%vs 2.2%–14.9%),and only 43%of HCC was associated with cirrhosis.This raises important pathophysiologic questions regarding the impact of iron overload in HCC.There has been an increase in the rate of hospitalization for patients with a diagnosis of hemochromatosis.This may be related to an increased recognition of hemochromatosis as the underlying etiology for conditions such as diabetes,cardiomyopathy,cirrhosis,and HCC.Further prospective studies are needed to clarify the burden of liver disease in HH and secondary iron overload.展开更多
文摘BACKGROUND Clostridioides(formerly Clostridium)difficile infection(CDI)is an increasingly frequent cause of morbidity and mortality in hospitalized patients.Multiple risk factors are documented in the literature that includes,but are not limited to,antibiotics use,advanced age,and gastric acid suppression.Several epidemiological studies have reported an increased incidence of CDI in advanced liver disease patients.Some have also demonstrated a higher prevalence of nosocomial infections in cirrhotic patients.AIM To use a large nationwide database,we sought to determine CDI’s risk among liver cirrhosis patients in the United States.METHODS We queried a commercial database(Explorys Inc^(TM),Cleveland,OH,United States),and obtained an aggregate of electronic health record data from 26 major integrated United States healthcare systems comprising 360 hospitals in the United States from 2018 to 2021.Diagnoses were organized into the Systematized Nomenclature of Medicine Clinical Terms(SNOMED–CT)hierarchy.Statistical analysis for the multivariable model was performed using Statistical Package for Social Sciences(SPSS version 25,IBM CorpTM).For all analyses,a two-sided P value of<0.05 was considered statistically significant.RESULTS There were a total of 19387760 patients in the database who were above 20 years of age between the years 2018-2021.Of those,133400 were diagnosed with liver cirrhosis.The prevalence of CDI amongst the liver cirrhosis population was 134.93 per 100.000 vs 19.06 per 100.000 in non-cirrhotic patients(P<0.0001).The multivariate analysis model uncovered that cirrhotic patients were more likely to develop CDI(OR:1.857;95%CI:1.665-2.113,P<0.0001)compared to those without any prior history of liver cirrhosis.CONCLUSION In this large database study,we uncovered that cirrhotic patients have a significantly higher CDI prevalence than those without cirrhosis.Liver cirrhosis may be an independent risk factor for CDI.Further prospective studies are needed to clarify this possible risk association that may lead to the implementation of screening methods in this high-risk population.
文摘Driven by the tremendous availability of data,artificial intelligence(AI)using deep learning has emerged as a breakthrough computer technology in the last few decades and has recently been acknowledged by the Task Force on AI as a golden opportunity for research.With its ability to understand,learn from and build on non-linear relationships,AI aims to individualize medical care in an attempt to save time,cost,effort and improve patient’s safety.AI has been applied in multiple medical fields with substantial progress made in gastroenterology mainly to facilitate accurate detection of pathology in different disease processes,among which inflammatory bowel disease(IBD)seems to drag significant attention,specifically by interpreting imaging studies,endoscopic images and videos and-to a lesser extent-disease genomics.Moreover,models have been built to predict IBD occurrence,flare ups,persistence of histological inflammation,disease-related structural abnormalities as well as disease remission.In this article,we will review the applications of AI in IBD in the present medical literature at multiple points of IBD timeline,starting from disease prediction via genomic assessment,diagnostic phase via interpretation of radiological studies and AI-assisted endoscopy,and the role of AI in the evaluation of therapy response and prognosis of IBD patients.
文摘Hemochromatosis,either hereditary hemochromatosis(HH)or secondary hemochromatosis,consists of the accumulation of iron in the liver,heart,and other organs.It leads to end-organ damage in a proportion of affected subjects.Although liver-related morbidity(cirrhosis and hepatocellular carcinoma[HCC])and mortality are well established,the frequency of these complications remains controversial.The aim of this study is to examine the rate of hospitalization and the incidence of iron overload-related comorbidities in patients with hemochromatosis between the years of 2002 and 2010.We queried the Nationwide Inpatient Sample(NIS)database from the year 2002 to 2010.We included adults(age≥18 years)and used the ICD-CM 9 code 275.0x to identify hospitalized patients with a diagnosis of hemochromatosis.Data analysis for this study was generated using SAS software version 9.4.A total of 168,614 hospitalized patients between 2002 and 2010 had a diagnosis of hemochromatosis.The majority were males(57%)with a median age of 54 years(37–68),with a predominance of white patients(63.3%)followed by black(26.8%).The rate of hospitalization among patients with hemochromatosis increased by 79%between the years 2002 and 2010(34.5/100,000 in 2002 vs 61.4/100,000 in 2010).The main associated diagnoses were diabetes mellitus(20.2%),cardiac disease,including arrhythmias(14%)and cardiomyopathy(dilated 3.8%;peri-,endo-,myocarditis 1.3%),liver cirrhosis(8.6%),HCC(1.6%),and acute liver failure(0.81%).Of note,HCC was associated with cirrhosis in 1188 patients(43%of HCC patients)and male sex(87%).Diagnostic biopsies were performed in 6023(3.6%)of those patients and liver transplant was performed in 881(0.5%).In-hospital mortality occurred in 3638(2.16%)patients.In this large database study,we found a rising trend in hospitalization for hemochromatosis,possibly due to the increased recognition of this entity and billing for the condition.The incidence of cirrhosis in hemochromatosis was found to be similar to other studies(8.6%vs 9%).However,the rate of HCC was lower than previous reports(1.6%vs 2.2%–14.9%),and only 43%of HCC was associated with cirrhosis.This raises important pathophysiologic questions regarding the impact of iron overload in HCC.There has been an increase in the rate of hospitalization for patients with a diagnosis of hemochromatosis.This may be related to an increased recognition of hemochromatosis as the underlying etiology for conditions such as diabetes,cardiomyopathy,cirrhosis,and HCC.Further prospective studies are needed to clarify the burden of liver disease in HH and secondary iron overload.
