Epidemiology of Chronic Liver Disease in the United States

Yang, Yihan; Luk, Jeffrey; Sofair, André N.

doi:10.1007/978-3-319-94355-8_6

Clinical Epidemiology of Chronic Liver Diseases 2018

DOI: 10.1007/978-3-319-94355-8_6

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Epidemiology of Chronic Liver Disease in the United States

Yihan Yang

Jeffrey Luk

André N. Sofair

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Cited by 2 publications

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“…Alcohol-associated liver disease (ALD) is 1 of the 3 leading etiologies of chronic liver disease—the 12th leading cause of death in the United States 1–3 —and one of the most common reasons for liver transplantation. The prevalence of ALD 4 and the number of patients with ALD requiring transplant have increased 5,6 .…”

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confidence: 99%

Prognostic Factors in Alcohol-associated Liver Disease Patients Presenting With First Evidence of Ascites

Fahoum

Shen²,

Basu

et al. 2023

Journal of Clinical Gastroenterology

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Goals:To identify factors associated with transplantation and death in alcohol-associated liver disease (ALD) patients presenting with first evidence of ascites.Background: Ascites development is a poor prognostic sign for patients with cirrhosis. Among ALD patients, the baseline factors at time of ascites development that are associated with eventual transplantation or death are currently unknown.Study: Adult patients with ascites in the "Evaluating Alcohol Use in Alcohol-related Liver Disease Prospective Cohort Study" (NCT03267069 clinicaltrials.gov) were identified from 2016 to 2020. Demographic, clinical, and laboratory factors at initial ascites presentation were identified as potential predictors of transplant and death as competing risks.Results: A total of 96 patients were identified. Median (interquartile range) follow-up time was 2.00 years (0.87 to 3.85). By last followup, 34/96 patients had been transplanted (35.4%) and 11/96 had died (11.4%). Prognostic factors for transplant included age per decade [hazard ratio (HR): 0.52 (95% CI, 0.33 to 0.83)], employed status [HR: 0.35 (95% CI, 0.14 to 0.90)], and sodium [HR: 0.94 (95% CI, 0.90 to 0.99)], whereas prognostic factors for death were body mass index [HR: 1.11 (95% CI, 1.00 to 1.22)], Charlson index [HR: 2.14 [95% CI, 1.13 to 4.08]), Maddrey Discriminant Function > 32 (HR: 5.88 (95% CI, 1.18, 29.39)], aspartate aminotransferase [HR: 0.99 (95% CI, 0.98 to 0.997)], and a prior 12-month abstinence period [HR: 5.53 (95% CI, 1.10 to 27.83)], adjusted for age, sex, and ALD subcategory.Conclusions: Several factors at initial ascites presentation are associated with increased risk of transplantation or death and validation in larger cohorts will allow for improved risk stratification for ALD patients.

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confidence: 99%

Prognostic Factors in Alcohol-associated Liver Disease Patients Presenting With First Evidence of Ascites

Fahoum

Shen²,

Basu

et al. 2023

Journal of Clinical Gastroenterology

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“…Screening rates for HBV in the VA is 28.5% [4]. The Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES) reported that among those screened, prevalence of HBV infection is 1% compared to 0.27-0.50% in the general population [5]. Among U.S. veterans the rate of HBV infection varies by race: Asians 6.1%, African Americans 1.8%, Caucasians 0.7%, and Hispanics 0.6% [6].…”

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Veterans with Hepatitis B, who is Being Missed and Why?

Hussain¹,

Chen²,

Krishnamurthy³

2020

Clin Res Open Access

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Background and Aim: On May 23, 2018 the Veterans Administration (VA) issued a directive to establish policies for improving prevention, early diagnosis, and treatment for all viral hepatitis including Chronic Hepatitis B (CHB). The goals of our study were to identify patients with a positive HBsAg test at the Dayton VA Medical Center who would benefit from medical care for CHB with our gastroenterology (GI) clinic, identify reasons for lack of treatment, and re-establish patients into the GI clinic. Methods:We reviewed patients with a diagnosis of Chronic Hepatitis B using ICD-9 and ICD-10 codes who were receiving care at the Dayton VA Medical Center through May 23, 2018. Data were gathered retrospectively for demographics, clinical labs, imaging, and presence of cirrhosis, treatment status, and hepatocellular carcinoma surveillance. Following American Association for the Study of Liver Diseases guidelines for Hepatitis B, we used patient data to identify those who would benefit from further GI follow-up.Results: A total of 61 patients had a diagnosis of CHB, 11 with cirrhosis and 50 without cirrhosis. Among patients with cirrhosis, four were not on treatment (two noncompliant with follow-up, one with severe comorbidities, one lack of provider knowledge). For patients without cirrhosis, 43/50 were not on treatment. Of these 43, 16/43 (37.2%) patients did not have an indication for treatment. For the remaining 27/43 patients: 22/43 (51.2%) were non-compliant with follow-up visits, 4/43 (9.3%) had severe comorbidities, and 1/43 (2.3%) was not treated due to lack of provider knowledge.Excluding patients with severe comorbidities, loss of surface antigen, normal serum alanine aminotransferase (ALT), or low viral load, 26 patients (3 with cirrhosis and 23 without cirrhosis) would benefit from follow-up with a GI provider. We mailed letters to these patients encouraging them to follow up with the GI department at our facility. One-half of these patients (13/26) responded, with 11/13 (85%) agreeing to re-establish care in the GI clinic and 2/13 (15%) declining. We contacted the primary care provider for the 13 patients who did not respond, requesting patients to be referred to GI after a discussion with their patients. Conclusion:We were successful in re-establishing 50% of patients with HBsAg back with our GI providers through enhanced identification procedures, direct contact with patients, and collaboration with other health care providers. This study can be the framework for future efforts to improve screening, diagnosis, treatment, and surveillance of patients affected by CHB.

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Epidemiology of Chronic Liver Disease in the United States

Cited by 2 publications

References 45 publications

Prognostic Factors in Alcohol-associated Liver Disease Patients Presenting With First Evidence of Ascites

Prognostic Factors in Alcohol-associated Liver Disease Patients Presenting With First Evidence of Ascites

Veterans with Hepatitis B, who is Being Missed and Why?

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