RESUMEN

Major histocompatibility complex class I-related chain A (MICA) is a highly polymorphic gene that modulates immune surveillance by binding to its receptor on natural killer cells, and its genetic polymorphisms have been associated with chronic immune-mediated diseases. The progressive form of nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), is characterized by accumulation of fat and inflammatory cells in the hepatic parenchyma, potentially leading to liver cell injury and fibrosis. To date, there are no data describing the potential role of MICA in the pathogenesis of NAFLD. Therefore, our aim was to assess the association between MICA polymorphism and NASH and its histologic features. A total of 134 subjects were included. DNA from patients with biopsy-proven NAFLD were genotyped using polymerase chain reaction-sequence-specific oligonucleotide for MICA alleles. Liver biopsies were assessed for histologic diagnosis of NASH and specific pathologic features, including stage of fibrosis and grade of inflammation. Multivariate analysis was performed to draw associations between MICA alleles and the different variables; P ≤ 0.05 was considered significant. Univariate analysis showed that MICA*011 (odds ratio [OR], 7.14; 95% confidence interval [CI], 1.24-41.0; P = 0.04) was associated with a higher risk for histologic NASH. Multivariate analysis showed that MICA*002 was independently associated with a lower risk for focal hepatocyte necrosis (OR, 0.24; 95% CI, 0.08-0.74; P = 0.013) and advanced fibrosis (OR, 0.11; 95% CI, 0.02-0.70; P = 0.019). MICA*017 was independently associated with a higher risk for lymphocyte-mediated inflammation (OR, 5.12; 95% CI, 1.12-23.5; P = 0.035). Conclusion: MICA alleles may be associated with NASH and its histologic features of inflammation and fibrosis. Additional research is required to investigate the potential role of MICA in increased risk or protection against NAFLD.

Asunto(s)

Antígenos de Histocompatibilidad Clase I/genética , Enfermedad del Hígado Graso no Alcohólico/genética , Adulto , Alelos , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Enfermedad del Hígado Graso no Alcohólico/inmunología , Enfermedad del Hígado Graso no Alcohólico/patología , Polimorfismo Genético

RESUMEN

OBJECTIVE: To evaluate the impact of a pediatric epilepsy care management intervention on emergency department visits, hospitalizations, and seizure freedom. METHODS: We conducted a prospective observational study at a single academic medical center. Children with epilepsy with high risk of frequent emergency department use were enrolled in the intervention from January through May 2015, which included a baseline visit and follow-up support from a care management team. Controls selected from the same institution received standard of care. Baseline and follow-up information were collected from electronic health records and surveys (Family Impact Scale, Pediatric Epilepsy Medication Self-Management Questionnaire). Propensity score-weighted logistic regression compared emergency department visits, unplanned hospitalizations, and 3-month seizure freedom after 1 year in the intervention vs control groups. RESULTS: A total of 56 children were enrolled in the intervention and 359 received standard of care. The intervention group was younger and had greater use of health services at baseline. When comparing the intervention to standard of care after 1 year, we found no significant difference in the risk of any emergency department visit (adjusted odds ratio [OR] 2.2, 95% confidence interval [CI] 0.6-8.5) or seizure freedom (adjusted OR 2.5, 95% CI 0.3-21.5). However, the risk of unplanned hospital admissions remained higher in the intervention group (adjusted OR 23.1, 95% CI 5.1-104). CONCLUSION: We did not find that children with epilepsy who received a care management intervention had less use of health services or better clinical outcomes after a year compared with controls. The study is limited by small sample size and nonrandomized study design.

Asunto(s)

Epilepsia/terapia , Evaluación de Programas y Proyectos de Salud/métodos , Adolescente , Niño , Preescolar , Estudios de Cohortes , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Pediatría/métodos , Estudios Prospectivos

RESUMEN

GOALS/BACKGROUND: We aimed to assess temporal changes in the different types of liver disease (LD) cases and outcomes from emergency departments (EDs) across the United States. STUDY: We used data from the National Inpatient Survey database from 2005 to 2011. The International Classification of Diseases, Ninth Revision (ICD-9) clinical modification codes identified hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholic liver disease (ALD), nonalcoholic fatty liver disease (NAFLD), and other LDs including autoimmune hepatitis. We excluded cases without LD, nonhepatocellular carcinoma-related cancers, human immunodeficiency virus infection, or those with missing information. Logistic regression was used to estimate odds ratios with 95% confidence intervals. Controls were matched to cases without LD. RESULTS: During the study period, 20,641,839 cases were seen in EDs. Of these, 1,080,008 cases were related to LD and were matched to controls without LD (N=19,557,585). The number of cases with LD increased from 123,873 (2005) to 188,501 (2011) (P<0.0001). Among cases with LD, diagnosis of HCV, HBV, and ALD remained stable during the study years (41.60% vs. 38.20%, 3.70% vs. 2.80%, and 41.4% vs. 38.5%, respectively), whereas NAFLD doubled [6.00% of all LD (2005) to 11.90% of all LD (2011) (P<0.0001)]. Diagnosis of LD in the ED independently predicted increased patient mortality [odds ratio, 1.20 (1.17 to 1.22)]. CONCLUSIONS: The number of LD cases presenting to EDs is increasing, and a diagnosis of LD is associated with a higher patient mortality for those admitted through the ED. There is a dramatic increase of NAFLD diagnoses in the ED.

Asunto(s)

Servicio de Urgencia en Hospital/estadística & datos numéricos , Hepatopatías/epidemiología , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Adulto , Anciano , Estudios Transversales , Bases de Datos Factuales , Femenino , Humanos , Hepatopatías/mortalidad , Hepatopatías/fisiopatología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/mortalidad , Estados Unidos/epidemiología

RESUMEN

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States. Metabolic syndrome (MS) components are highly prevalent in NAFLD. Our aim is to assess the relationship of NAFLD and MS with long-term outcome of mortality.The Third National Health and Nutrition Examination Survey (NHANES) was utilized. NAFLD was diagnosed by ultrasound in the presence of hepatic steatosis and no other causes of chronic liver disease. History of MS and its components were obtained from self-reported NHANES questionnaires. Mortality was obtained from Mortality-Linkage File, through December 31, 2011. Chi-square test was used for categorical variables and Cox proportional models estimated hazard ratios with 95% confidence interval.NAFLD cohort (n = 3613) had a median age of 43 years, 73% white, and 50% male. NAFLD group with at least one MS condition was significantly older, had higher body mass index, more likely to have insulin resistance, and heart disease compared to NAFLD group without MS. Over 19-years of follow-up, 1039 people died. Compared to NAFLD patients without MS, presence of one MS component increased the risk of mortality at 8-year (2.6% vs 4.7%) and 16-year (6% vs 11.9%) (P < .001). After adjusting for socio-demographic factors, NAFLD with all MS components was associated with overall, cardiac and liver-mortality. Increased number of MS components was associated with lower survival (P < .0001).Patients with NAFLD and MS have higher mortality risk compared to NAFLD patients without MS. These NAFLD patients should be prioritized for the development of treatment regimens.

Asunto(s)

Síndrome Metabólico/epidemiología , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Adulto , Distribución por Edad , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Femenino , Humanos , Resistencia a la Insulina , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Enfermedad del Hígado Graso no Alcohólico/mortalidad , Encuestas Nutricionales , Modelos de Riesgos Proporcionales , Factores de Riesgo , Distribución por Sexo , Estados Unidos

RESUMEN

INTRODUCTION AND AIM: The impact of type of liver disease on parity rates hasn't been described. Our aim was to assess the parity rates among women with CLD. MATERIAL AND METHODS: The National Health and Nutrition Examination Survey-III (1988-1994) data were used to identify adult female participants with a diagnosis of CLD. Participants were asked about their reproductive health status. Parity was defined as having at least one live birth. Hepatic ultrasound, serologic, medical examination and clinical data were available to determine the presence and type of CLD. Body mass index (kg/m2) was divided into 3 categories (< 30; 30-35; 36+). RESULTS: A total of 3,502 (865 NAFLD, 737 other CLD, 1,901 control) subjects were included. Patients with NAFLD were more likely to have at least one live birth than patients with other CLD and controls (77% in NAFLD vs. 72% in controls). Multivariate analysis revealed that presence of CLD other than NAFLD (OR: 0.46 [95% CI, 0.34-0.63]) and having a college or higher degree (OR: 0.48 [95% CI, 0.34-0.68]) were negatively associated while having low income (OR: 11.06 [95% CI, 6.86-17.82]) and being African American (OR: 3.93 [95% CI, 2.59-5.98]) were positively associated with having at least one live birth. CONCLUSIONS: This study revealed that patients with CLD other than NAFLD were less likely to have at least one live birth. NAFLD and obesity were associated with higher rates of live births which can potentially be explained by weight gain post live birth leading to obesity and its associated-NAFLD.

Asunto(s)

Negro o Afroamericano/estadística & datos numéricos , Índice de Masa Corporal , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Paridad/fisiología , Salud Reproductiva , Adulto , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Humanos , Incidencia , Recién Nacido , Modelos Lineales , Nacimiento Vivo , Pruebas de Función Hepática , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Encuestas Nutricionales , Oportunidad Relativa , Embarazo , Valores de Referencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Estados Unidos , Adulto Joven

RESUMEN

OBJECTIVES: Hospice offers non-curative symptomatic management to improve patients' quality of life, satisfaction, and resource utilization. Hospice enrollment among patients with chronic liver disease (CLD) is not well studied. The aim of tis tudy is to examine the characteristics of Medicare enrollees with CLD, who were discharged to hospice. METHODS: Medicare patients discharged to hospice between 2010 and 2014 were identified in Medicare Inpatient and Hospice Files. CLDs and other co-morbidities were identified by International Classification of Diseases-ninth revision codes. Generalized linear model was used to estimate regression coefficients with P-values. Logistic regression was used to calculate odds ratios and 95% confidence intervals. RESULTS: A total of 2,179 CLD patients and 34,986 controls without CLD met the inclusion criteria. Non-alcoholic fatty liver disease, alcoholic liver disease, and hepatitis C virus (HCV) were the most frequent cause of CLD. CLD patients were younger (70 vs. 83 years), more likely to be male (57.7 vs. 39.3%), had longer hospital stay (length of stay, LOS) (19.4 vs. 13.0 days), higher annual charges ($175,000 vs. $109,000), higher 30-day re-hospitalization rates (51.6 vs. 34.2%), and shorter hospice LOS (13.7 vs. 17.7 days) than controls (all P<0.001). Presence of HCV and congestive heart failure were the strongest contributors to increased total annual costs (34% and 31% higher, P<0.001), increased total annual LOS (26% and 43% higher, P<0.001), and increased 30-day readmission risk (2.20 and 2.19 times, respectively). CONCLUSIONS: Patients with CLD have longer and costly hospitalizations before hospice enrollment as compared with patients without CLD. It was highly likely that these patients were enrolled relatively late, which could potentially lead to less benefit from hospice.

Asunto(s)

Hepatitis C Crónica/epidemiología , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Hepatopatías Alcohólicas/epidemiología , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Costos de la Atención en Salud , Insuficiencia Cardíaca/economía , Insuficiencia Cardíaca/epidemiología , Hepatitis C Crónica/economía , Cuidados Paliativos al Final de la Vida/economía , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/economía , Modelos Lineales , Hepatopatías/economía , Hepatopatías/epidemiología , Hepatopatías Alcohólicas/economía , Modelos Logísticos , Masculino , Medicare , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/economía , Oportunidad Relativa , Readmisión del Paciente/estadística & datos numéricos , Distribución por Sexo , Estados Unidos/epidemiología

RESUMEN

PURPOSE: (1) To evaluate how well resident physicians use a novel EEG spectral analysis tool (the median power spectrogram; MPS) to detect seizures. (2) To assess the capability of the MPS to identify different seizure types. METHODS: 120 EEG records from children with intractable seizures were converted to MPS by taking the median power across leads and using multi-taper spectral estimation. Twelve blinded neurology residents were trained to interpret the spectrogram with a five-minute video tutorial and post-test. Two residents independently assessed each set for presence of seizures. Their performance was compared to seizures identified using conventional EEG. Two blinded neurologists separately reviewed the EEGs and spectrograms to independently categorize the seizures. Their results were used to determine the spectrogram's capability to reveal seizures and visualize different seizure types for the user. RESULTS: Three key MPS features distinguished seizures from inter-ictal background: power difference relative to background, down-sloping resonance bands, and power in high frequencies. Using these features, residents identified seizures with 77% sensitivity and 72% specificity. 86% (51/59) of focal seizures and 81% (22/27) of generalized seizures were detected by at least one resident. Missed seizures included brief (<60s) seizures, tonic seizures, seizures with predominant delta (0-4Hz) activity, and seizures evident primarily in supplementary low temporal leads. CONCLUSIONS: The MPS is a novel qEEG modality that requires minimal training to interpret. It enables physicians without extensive neurophysiology training to identify seizures with sensitivity and specificity comparable to more complex multi-modal qEEG displays.

Asunto(s)

Electroencefalografía/métodos , Convulsiones/diagnóstico , Adolescente , Encéfalo/fisiopatología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Sistemas de Atención de Punto , Convulsiones/fisiopatología , Sensibilidad y Especificidad , Procesamiento de Señales Asistido por Computador , Adulto Joven

RESUMEN

INTRODUCTION: Hepatitis B (HBV) and C viruses (HCV) are important causes of hepatocellular carcinoma (HCC). Our aim was to assess mortality and resource utilization of patients with HCC-related to HBV and HCV. MATERIAL AND METHODS: National Cancer Institute's Surveillance, Epidemiology and End Results (SEER)-Medicare linked database (2001-2009) was used. Medicare claims included patient demographic information, diagnoses, treatment, procedures, ICD-9 codes, service dates, payments, coverage status, survival data, carrier claims, and Medicare Provider Analysis and Review (MEDPAR) data. HCC related to HBV/HCV and non-cancer controls with HBV/HCV were included. Pair-wise comparisons were made by t-tests and chi-square tests. Logistic regression models to estimate odds ratios (ORs) with 95% confidence intervals (CIs) were used. RESULTS: We included 2,711 cases of HCC (518 HBV, 2,193 HCV-related) and 5,130 non-cancer controls (1,321 HBV, 3,809 HCV). Between 2001-2009, HCC cases related to HBV and HCV increased. Compared to controls, HBV and HCV patients with HCC were older, more likely to be male (73.2% vs 48.9% and 57.1% vs. 50.5%), die within one-year (49.3% vs. 20.3% and 52.2% vs. 19.2%), have decompensated cirrhosis (44.8% vs. 6.9% and 53.9% vs. 10.4%) and have higher inpatient ($60.471 vs. $47.223 and $56.033 vs. $41.005) and outpatient charges ($3,840 vs. $3,328 and $3,251 vs. $2,096) (all P < 0.05). In two separate multivariate analyses, independent predictors of one-year mortality were older age, being male and the presence of decompensated cirrhosis. CONCLUSIONS: The rate of viral hepatitis-related HCC is increasing. Mortality and resource utilization related to HBV and HCV-related HCC is substantial.

Asunto(s)

Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/terapia , Recursos en Salud/estadística & datos numéricos , Hepatitis B/mortalidad , Hepatitis B/terapia , Hepatitis C/mortalidad , Hepatitis C/terapia , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Carcinoma Hepatocelular/economía , Carcinoma Hepatocelular/virología , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Análisis Costo-Beneficio , Femenino , Recursos en Salud/economía , Hepatitis B/economía , Hepatitis B/virología , Hepatitis C/economía , Hepatitis C/virología , Costos de Hospital , Humanos , Cirrosis Hepática/mortalidad , Cirrosis Hepática/terapia , Cirrosis Hepática/virología , Neoplasias Hepáticas/economía , Neoplasias Hepáticas/virología , Modelos Logísticos , Masculino , Medicare , Análisis Multivariante , Oportunidad Relativa , Pronóstico , Factores de Riesgo , Programa de VERF , Factores Sexuales , Factores de Tiempo , Estados Unidos

RESUMEN

ABSTRACT Introduction. HCV has been suspected to potentially cause degenerations in the central nervous system. Parkinson's disease is the second most common neurodegenerativo disorder. Our aim was to assess the prevalence of Parkinson's disease among patients with HCV infection. Material and methods. For this study, we used Medicare database from 2005-2010. Medicare database contains information on enrollment, coverage, diagnosis recorded with International Classification of Disease, Ninth Revision (ICD- 9). From combined inpatient and outpatient files, Parkinson's disease was identified as the first diagnosis by ICD-9 code 332.0. Other study variables were; age, gender, race (White and No White), and Medicare eligibility status. Simple distribution comparison by HCV status examined with t-test for numerical variables and χ2 test for categorical variables in the main analytical cohort as well as in the propensity score matched cohort. Results. A total of 1,236,734 patients (median age 76 years, 41% male, and 85% White) was identified among over 47 million claims. Of these, 6040 patients (0.5%) were infected with HCV. Overall, 0.8% (N = 49) of the HCV group and 1.3% (N = 16,004) of the Non-HCV group had Parkinson's disease (P < 0.001). When the study groups matched for age, gender and race, the prevalence of Parkinson's disease was similar between HCV and Non-HCV groups (P > 0.05). Discussion. This study revealed that, among Medicare population, HCV was not associated with Parkinson disease.

Asunto(s)

Humanos , Anciano , Anciano de 80 o más Años , Enfermedad de Parkinson/epidemiología , Hepatitis C/epidemiología , Enfermedad de Parkinson/diagnóstico , Factores de Tiempo , Estados Unidos/epidemiología , Distribución de Chi-Cuadrado , Prevalencia , Factores de Riesgo , Bases de Datos Factuales , Medicare , Hepatitis C/diagnóstico

RESUMEN

INTRODUCTION: HCV has been suspected to potentially cause degenerations in the central nervous system. Parkinson's disease is the second most common neurodegenerative disorder. Our aim was to assess the prevalence of Parkinson's disease among patients with HCV infection. MATERIAL AND METHODS: For this study, we used Medicare database from 2005-2010. Medicare database contains information on enrollment, coverage, diagnosis recorded with International Classification of Disease, Ninth Revision (ICD-9). From combined inpatient and outpatient files, Parkinson's disease was identified as the first diagnosis by ICD-9 code 332.0. Other study variables were; age, gender, race (White and No White), and Medicare eligibility status. Simple distribution comparison by HCV status examined with t-test for numerical variables and ?2 test for categorical variables in the main analytical cohort as well as in the propensity score matched cohort. RESULTS: A total of 1,236,734 patients (median age 76 years, 41% male, and 85% White) was identified among over 47 million claims. Of these, 6040 patients (0.5%) were infected with HCV. Overall, 0.8% (N = 49) of the HCV group and 1.3% (N = 16,004) of the Non-HCV group had Parkinson's disease (P < 0.001). When the study groups matched for age, gender and race, the prevalence of Parkinson's disease was similar between HCV and Non-HCV groups (P > 0.05). DISCUSSION: This study revealed that, among Medicare population, HCV was not associated with Parkinson disease.

Asunto(s)

Hepatitis C/epidemiología , Enfermedad de Parkinson/epidemiología , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Bases de Datos Factuales , Femenino , Hepatitis C/diagnóstico , Humanos , Masculino , Medicare , Enfermedad de Parkinson/diagnóstico , Prevalencia , Factores de Riesgo , Factores de Tiempo , Estados Unidos/epidemiología

RESUMEN

Hepatocellular carcinoma (HCC) is among the most common types of cancer. Liver transplantation (LT) and surgical resection (SR) are primary surgical treatment options for HCC.The aim of the study was to assess mortality within 2 years postdiagnosis among patients with HCC according to their treatment modalities.We examined data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database between 2001 and 2009. SEER registries collect demographics, cancer stage and historical types, and treatments. Medicare claims include diagnoses, procedures, and survival status for each beneficiary. Patients with HCC were identified using the International Classification of Disease Oncology, Third Edition Site code C22.0 and Histology Code 8170-8175. Treatment modalities were LT, SR, or nonsurgical treatment.Total of 11,187 cases was included (age at diagnosis: 72 years, 69% male, 67% White). HCC patients who underwent LT were younger (61 vs 71 years), sicker (presence of decompensated cirrhosis: 80% vs 23%), and less likely to die within 2 years (29% vs 44%, all P < 0.01), compared to SR patients. In multivariate analysis, older age (HR: 1.01 [95% CI = 1.01-1.01]), stage of HCC other than local (HR: 1.81[95%CI = 1.70-1.91]), and being treated with SR (HR: 1.95 [95%CI = 1.55-2.46]) were independent predictors of mortality within 2 years. Furthermore, the presence of decompensated cirrhosis (HR: 1.84 [95%CI = 1.73-1.96]) and alcoholic liver disease (HR: 1.19[95%CI = 1.11-1.28]) increased within 2 years mortality.Mortality within 2 years postdiagnosis of HCC was significantly higher in patients treated with SR than LT.

Asunto(s)

Carcinoma Hepatocelular/mortalidad , Neoplasias Hepáticas/mortalidad , Trasplante de Hígado , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/cirugía , Estudios Transversales , Femenino , Humanos , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Programa de VERF , Estados Unidos/epidemiología

RESUMEN

PURPOSE: To assess recent epidemiologic characteristics, temporal trends, and predictors of death and discharge disposition in patients with sepsis. MATERIAL AND METHODS: This is a cross-sectional retrospective cohort study using the US National Inpatient Sample (NIS) data from 2009 to 2012. The study population included adults (18years and older) with sepsis-related International Classification of Diseases, Ninth Revision, Clinical Modification codes at the time of discharge. Factors associated with in-hospital mortality and patient discharge disposition were derived from multivariate analyses using multinomial logistic models by SAS PROC LOGISTIC with GLOGIT link. RESULTS: Of 1 303 640 patients admitted, 15% died, 30% were discharged to home without home care, 34% were transferred to a skilled outpatient facility, and 4% were transferred to another short-term hospital. In-hospital mortality decreased from 16.5% to 13.8% (P<.001) across time. Length of stay also decreased from 6.7 to 5.9days (P<.001). Reductions in mortality and length of stay were seen despite an increase in the number of comorbidities (P<.001). Multivariate analysis revealed that the strongest predictors of in-hospital mortality were respiratory, cardiovascular, and hepatic failures, and neurologic events. The predictors of transfer to an outpatient facility were a major operative procedure, neurologic event, respiratory failure, and weight loss. Weight loss was also an independent predictor of in-hospital mortality. CONCLUSION: Certain comorbidities and organ failures were associated with death and discharge to a skilled outpatient facility.

Asunto(s)

Pacientes Internos/estadística & datos numéricos , Alta del Paciente , Sepsis/epidemiología , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Estudios Transversales , Bases de Datos Factuales , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sepsis/mortalidad , Estados Unidos/epidemiología

RESUMEN

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease worldwide with tremendous clinical burden. The economic burden of NAFLD is not well studied. GOAL: To assess the economic burden of NAFLD. STUDY: Medicare beneficiaries (January 1, 2010 to December 31, 2010) with NAFLD diagnosis by International Classification of Diseases, Ninth Revision codes in the absence of other liver diseases were selected. Inpatient and outpatient resource utilization parameters were total charges and total provider payments. NAFLD patients with compensated cirrhosis (CC) were compared with decompensated cirrhosis (DC). RESULTS: A total of 976 inpatients and 4742 outpatients with NAFLD were included-87% were white, 36% male, 30% had cardiovascular disease (CVD) or metabolic syndrome conditions, and 12% had cirrhosis. For inpatients, median total hospital charge was $36,289. NAFLD patients with cirrhosis had higher charges and payments than noncirrhotic NAFLD patients ($61,151 vs. $33,863 and $18,804 vs. $10,146, P<0.001). Compared with CC, NAFLD patients with DC had higher charges and payments (P<0.02). For outpatients, median total charge was $9,011. NAFLD patients with cirrhosis had higher charges and payments than noncirrhotic NAFLD patients ($12,049 vs. $8,830 and $2,586 vs. $1,734, P<0.001). Compared with CC, DC patients had higher total charges ($15,187 vs. $10,379, P=0.04). In multivariate analysis, variables associated with increased inpatient resource utilization were inpatient mortality, DC, and CVD; for outpatients, having CVD, obesity, and hypertension (all P<0.001). CONCLUSIONS: NAFLD is associated with significant economic burden to Medicare. Presence of cirrhosis and CVD are associated with increased resource utilization.

Asunto(s)

Atención Ambulatoria/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Cirrosis Hepática , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Anciano , Atención Ambulatoria/economía , Femenino , Recursos en Salud , Hospitalización/economía , Humanos , Beneficios del Seguro , Masculino , Medicare , Enfermedad del Hígado Graso no Alcohólico/economía , Estados Unidos/epidemiología

RESUMEN

BACKGROUND: NAFLD impacts patient reported outcomes (PROs). Our aim was to assess the impact of NAFLD on patients' HRQOL. METHODS: National Health and Nutrition Examination Survey (NHANES) 2001-2011 data were used to identify adult patients with NAFLD [Fatty Liver Index (FLI) > 60 in absence of other liver disease and excessive alcohol >20 g/day for men, >10 g/day for women]. Patients with other chronic diseases (ex. HIV, cancer, end-stage kidney disease) were excluded. Subjects without any of these conditions were healthy controls. HCV RNA (+) patients were HCV-controls. All patients completed NHANES HRQOL-4 questionnaire. Linear regression determined the association between NAFLD and HRQOL components adjusting for age, gender, race, and BMI. RESULTS: Participants with complete data were included (n = 9661); 3333 NAFLD (age 51 years and BMI 34 kg/m(2)); 346 HCV+ (age 49 years; BMI 27 kg/m(2)) and 5982 healthy controls (age 48 years and BMI 26 kg/m(2)). The proportion of subjects rating their health as "fair" or "poor" in descending order were HCV controls (30 %) NAFLD (20 %) and healthy controls (10 %) (p < 0.001). HRQOL-4 components scores 2-4 were lowest for HCV, followed by NAFLD and then healthy controls (p-values p = 0.011 to < .0001). After adjustment for age, gender, race, and BMI, NAFLD patients were 18-20 % more likely to report days when their physical health wasn't good or were unable to perform daily activities as a result (p < .0001). CONCLUSIONS: NAFLD causes impairment of HRQOL. As NAFLD is becoming the most important cause of CLD, its clinical and PRO impact must be assessed.

Asunto(s)

Adaptación Psicológica , Fallo Renal Crónico/psicología , Enfermedad del Hígado Graso no Alcohólico/psicología , Calidad de Vida/psicología , Factores de Edad , Actitud Frente a la Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Factores Sexuales , Encuestas y Cuestionarios , Estados Unidos

RESUMEN

New incidents of chronic hepatitis C (CH-C) have stabilized yet the full impact of CH-C is not realized.Assess inpatient mortality and resource utilization for CH-C patients hospitalized in the United States.Adult CH-C patients were identified from The National Inpatient Sample (NIS) 2005 to 2009 database using the International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes (070.51, 070.54, 070.70, 070.71, 070.41, and 070.44) also used to identify comorbidities.324,823 hospitalized CH-C patients were identified. Of these, 13.63% (N = 44,288) were older than 65. The rate of hospitalization for the elderly cohort steadily increased over the study period with Medicare as the payer for the majority (86%). This cohort had higher inpatient charges, approximately a half day longer hospital stay (P < 0.001) and more moderate or severe illness. During the index hospitalization, older CH-C patients were twice more likely to die than the younger age-group (5% versus 2%, P < 0.001). In the adjusted model, older age (OR: 1.02 [95% CI, 1.02-1.03]), severity of illness (OR: 12.06 [95% CI, 10.68-13.62]), and number of diagnoses (OR: 1.10 [95% CI, 1.09-1.11]) were associated with higher in-hospital mortality; severity of illness and having private insurance were significantly associated with charge per hospital stay (P < 0.001).The number of CH-C patients 65 and older increased due to the aging of the baby boomer population. Early treatment of CH-C patients with highly effective, well-tolerated, new anti-HCV regimens may prevent this significant societal burden.

Asunto(s)

Atención a la Salud/estadística & datos numéricos , Hepatitis C Crónica/mortalidad , Adulto , Factores de Edad , Anciano , Femenino , Hepatitis C Crónica/terapia , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiología , Adulto Joven

RESUMEN

UNLABELLED: Hepatocellular carcinoma (HCC) is increasingly reported in patients with nonalcoholic fatty liver disease (NAFLD). Our aim was to assess the prevalence and mortality of patients with NAFLD-HCC. We examined Surveillance, Epidemiology and End Results (SEER) registries (2004-2009) with Medicare-linkage files for HCC, which was identified by the International Classification of Diseases for Oncology, third edition codes using topography and morphology codes 8170-8175. Medicare-linked data was used to identify NAFLD, hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholic liver disease (ALD), and other liver disease using International Classification of Diseases, Ninth Revision, Clinical Modification codes. NAFLD was also defined by clinical diagnosis (cryptogenic cirrhosis, obese-diabetics with cryptogenic liver disease). A logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of HCC. In addition, adjusted hazard ratios for 1-year mortality were estimated by Cox's proportional hazard regression. A total of 4,929 HCC cases and 14,937 controls without HCC were included. Of the HCC cases, 54.9% were related to HCV, 16.4% to ALD, 14.1% to NAFLD, and 9.5% to HBV. Across the 6-year period (2004 to 2009), the number of NAFLD-HCC showed a 9% annual increase. NAFLD-HCC were older, had shorter survival time, more heart disease, and were more likely to die from their primary liver cancer (all P < 0.0001). Of those who received a transplant after HCC (n = 488), only 5% were related to NAFLD-HCC. In multivariate analysis, NAFLD increased the risk of 1-year mortality (OR, 1.21; 95% CI: 1.01-1.45). Additionally, older age, lower income, unstaged HCC increased risk of 1-year mortality while receiving a liver transplant (LT), and having localized tumor stage were protective (all P < 0.05). CONCLUSIONS: NAFLD is becoming a major cause of HCC in the United States. NAFLD HCC is associated with shorter survival time, more advanced tumor stage, and lower possibility of receiving a LT.

Asunto(s)

Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/epidemiología , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/epidemiología , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Anciano , Femenino , Humanos , Masculino , Prevalencia , Tasa de Supervivencia , Factores de Tiempo , Estados Unidos

RESUMEN

BACKGROUND: The prevalence of advanced liver disease and its complications may be on the rise within the Medicare population. The study aim was trend assessment for prevalence, mortality and resource utilization of patients with advanced liver disease. METHODS: A retrospective, cross-sectional design was used to analyze a national sample of non-institutionalized Medicare in/outpatients from 2005 to 2009. Cases were ascertained by International Classification of Diseases, 9th Edition. Outcomes were overall mortality (within 1 year) and resource utilization [hospital length of stay (LOS/days) and institutional costs to Medicare]. Multivariate analyses were used to estimate the odds ratios for mortality predictors; linear regression was used for resource utilization predictors. RESULTS: A total of 21,913 beneficiaries with advanced liver disease were identified in the Medicare inpatient and outpatient administrative data sets from 2005 to 2009. Over 70 % of the beneficiaries with advanced liver disease died during study time period with 17 % dying while hospitalized. Predictors of mortality were: admission to the intensive care unit (ICU) and increasing Charlson Comorbidity Index. Predictors for increased LOS and cost were: ICU admission and having a thoracentesis procedure (both indicators of the levels of illness). CONCLUSIONS: Advanced liver disease and its related complication are increasing in the Medicare population and are associated with very high mortality. Further study is warranted to understand the drivers of the increased prevalence of advanced liver disease for earlier identification and treatment.

Asunto(s)

Recursos en Salud/estadística & datos numéricos , Hepatopatías/terapia , Medicare , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/estadística & datos numéricos , Comorbilidad , Cuidados Críticos/estadística & datos numéricos , Estudios Transversales , Recursos en Salud/economía , Costos de Hospital , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Modelos Lineales , Hepatopatías/diagnóstico , Hepatopatías/economía , Hepatopatías/mortalidad , Modelos Logísticos , Masculino , Medicare/economía , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Paracentesis/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos

RESUMEN

BACKGROUND AND AIM: Non-alcoholic steatohepatitis (NASH) is the progressive form of non-alcoholic fatty liver disease (NAFLD). A liver biopsy is considered the "gold standard" for diagnosing/staging NASH. Identification of NAFLD/NASH using non-invasive tools is important for intervention. The study aims were to: develop/validate the predictive performance of a non-invasive model (index of NASH [ION]); assess the performance of a recognized non-invasive model (fatty liver index [FLI]) compared with ION for NAFLD diagnosis; determine which non-invasive model (FLI, ION, or NAFLD fibrosis score [NFS]) performed best in predicting age-adjusted mortality. METHODS: From the National Health and Nutrition Examination Survey III database, anthropometric, clinical, ultrasound, laboratory, and mortality data were obtained (n = 4458; n = 861 [19.3%] NAFLD by ultrasound) and used to develop the ION model, and then to compare the ION and FLI models for NAFLD diagnosis. For validation and diagnosis of NASH, liver biopsy data were used (n = 152). Age-adjusted Cox proportional hazard modeling estimated the association among the three non-invasive tests (FLI, ION, and NFS) and mortality. RESULTS: FLI's threshold score > 60 and ION's threshold score > 22 had similar specificity (FLI = 80% vs ION = 82%) for NAFLD diagnosis; FLI < 30 (80% sensitivity) and ION < 11 (81% sensitivity) excluded NAFLD. An ION score > 50 predicted histological NASH (92% specificity); the FLI model did not predict NASH or mortality. The ION model was best in predicting cardiovascular/diabetes-related mortality; NFS predicted overall or diabetes-related mortality. CONCLUSIONS: The ION model was superior in predicting NASH and mortality compared with the FLI model. Studies are needed to validate ION.

Asunto(s)

Técnicas de Diagnóstico del Sistema Digestivo , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Adulto , Biopsia , Enfermedades Cardiovasculares/mortalidad , Diabetes Mellitus/mortalidad , Diagnóstico Diferencial , Femenino , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Modelos Teóricos , Enfermedad del Hígado Graso no Alcohólico/mortalidad , Modelos de Riesgos Proporcionales

Asunto(s)

Autoanticuerpos/sangre , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/etiología , Endotelio Vascular/patología , Proteína HMGB1/sangre , Proteínas de Neoplasias/sangre , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Proteoglicanos/sangre , Anciano , Biomarcadores/sangre , Enfermedad de la Arteria Coronaria/patología , Enfermedad de la Arteria Coronaria/fisiopatología , Endotelio Vascular/fisiopatología , Ensayo de Inmunoadsorción Enzimática , Femenino , Citometría de Flujo , Humanos , Hiperlipidemias , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/patología , Enfermedad del Hígado Graso no Alcohólico/fisiopatología , Riesgo , Índice de Severidad de la Enfermedad

RESUMEN

BACKGROUND: Hepatocellular carcinoma (HCC) is an important complication of cirrhosis. Our aim was to assess the inpatient economic and mortality of HCC in the USA METHODS: Five cycles of Nationwide Inpatient Sample (NIS) conducted from 2005 to 2009 were used. Demographics, inpatient mortality, severity of illness, payer type, length of stay (LoS) and charges were available. Changes and associated factors related to inpatient HCC were assessed using simple linear regression. Odds ratios and 95% CIs for hospital mortality were analysed using log-linked regression model. To estimate the sampling variances for complex survey data, we used Taylor series approach. SAS(®) v.9.3 was used for statistical analysis. RESULTS: From 2005 to 2009, 32,697,993 inpatient cases were reported to NIS. During these 5 years, primary diagnosis of HCC increased from 4401 (2005), 4170 (2006), 5065 (2007), 6540 (2008) to 6364 (2009). HCC as any diagnosis increased from 68 per 100,000 discharges (2005) to 99 per 100,000 (2009). However, inpatient mortality associated with HCC decreased from 12% (2005) to 10% (2009) (P < 0.046) and LoS remained stable. However, median inflation-adjusted charges at the time of discharge increased from $29,466 per case (2005) to $31,656 per case (2009). Total national HCC charges rose from $1.0 billion (2005) to $2.0 billion (2009). In multivariate analysis, hospital characteristic was independently associated with decreasing in-hospital mortality (all P < 0.05). Liver transplantation for HCC was the main contributor to high inpatient charges. Longer LoS and other procedures also contributed to higher inpatient charges. CONCLUSIONS: There is an increase in the number of inpatient cases of HCC. Although inpatient mortality is decreasing and the LoS is stable, the inpatient charges associated with HCC continue to increase.

Asunto(s)

Carcinoma Hepatocelular/economía , Carcinoma Hepatocelular/mortalidad , Recursos en Salud/economía , Costos de Hospital , Pacientes Internos , Neoplasias Hepáticas/economía , Neoplasias Hepáticas/mortalidad , Carcinoma Hepatocelular/terapia , Femenino , Recursos en Salud/estadística & datos numéricos , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/economía , Modelos Lineales , Neoplasias Hepáticas/terapia , Trasplante de Hígado/economía , Trasplante de Hígado/mortalidad , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Alta del Paciente/economía , Factores de Riesgo , Factores de Tiempo , Estados Unidos/epidemiología