Nationwide US data on readmission rates for patients with cirrhosis admitted with hepatorenal syndrome (HRS) is lacking. We reviewed 30-day readmission rates after HRS-related hospitalizations, the associated predictors of readmissions, and their impact on resource utilization and mortality in the United States.
We identified all adults admitted with HRS between 2016 and 2019 using the Nationwide Readmission database of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. The primary outcome was all-cause 30-day readmission rate. Secondary outcomes were inpatient mortality rate, predictors of readmission, and resource utilization.
We identified 245 850 hospitalizations of patients admitted for HRS in the United States from 2016 to 2019. Of these, 214 890 met the inclusion criteria. Mean age was 59.16 years, and 61.31% were males. Medicare was the most common primary payer (44.82%) followed by Medicaid (25.58%). The readmission rate was 24.6% within 30 days of discharge from index hospitalization. The most common cause of readmission was alcoholic cirrhosis with ascites (14.87%), followed by sepsis (9.32%) and unspecified hepatic failure (9%). The in-hospital mortality rate for index hospitalization was 29.52% and 14.35% among those readmitted within 30 days. The mean length of stay (12.33 days vs. 7.15 days, p < 0.01) and hospitalization costs ($44 903 vs. $22 353, p < 0.01) were higher for index hospitalizations than readmissions.
Our study demonstrated that all-cause 30-day readmission and in-hospital mortality rates after the development of HRS were strikingly high. This warrants health policies and interventions at the institutional level, including close post-hospital discharge follow-up, to decrease readmission rates, improve patient outcomes, and reduce cost burden.
Hepatitis B virus (HBV) infection causes liver disease, including hepatocellular carcinoma. Controlling viral activity is crucial to reducing complications. Tenofovir may offer benefits over entecavir, but it is unclear if switching from entecavir to tenofovir improves outcomes. This study assesses the clinical impact of switching to tenofovir therapy for chronic HBV infection.
Following the PRISMA guidelines, we conducted a literature search within the Cochrane Library, PubMed, MEDLINE, Embase, and Scopus for studies of patients with HBV infection who were switched to tenofovir from entecavir or were maintained on entecavir. Both formulations of tenofovir, that is, tenofovir disoproxil fumarate and tenofovir alafenamide were included and analyzed in subgroup analysis. Meta-analyses were performed with RevMan 5.4 using a random-effects model, with statistical significance set at p < 0.05.
A total of eight studies, comprising 833 patients, were included in the meta-analysis. Tenofovir showed a significantly higher likelihood of achieving complete virological response (RR 5.60; 95% CI 3.51–8.94; p < 0.00001) and a greater reduction in HBV DNA levels (MD −1.03 log IU/mL; 95% CI −1.69 to −0.36; p = 0.002) compared to entecavir. However, there was no significant difference in HBsAg reduction or HBeAg seroconversion between the two groups. ALT reductions were not statistically significant overall, although entecavir showed better outcomes in subgroup analysis.
Switching from entecavir to tenofovir improves virological response and reduces HBV DNA levels, but shows no significant advantage in HBsAg reduction, HBeAg seroconversion, or overall, ALT reduction.
The efficacy of vonoprazan-based dual and triple therapy vs. lansoprazole-based triple therapy in the treatment of H. pylori infection was largely consistent regardless of age, sex, race, ethnicity, BMI, alcohol intake, smoking status, and study drug compliance.
Endoscopic submucosal dissection (ESD) has become the treatment of choice for many superficial gastric neoplasms. Clinical outcomes are increasingly comparable between Japanese and Western series; however, data are lacking on the validity of risk stratification tools in Western cohorts. We aimed to evaluate clinical outcomes, explore risk stratification, and compare our data with published Western series.
We conducted a retrospective, observational cohort study in a single tertiary referral center over a 13-year period. Primary outcomes were rates of en bloc, complete (R0) and curative resection. Secondary outcomes included adverse events, recurrence, metachronous lesions, eCura grades, and ESGE criteria. A comparative analysis was performed with existing published series from Western centers.
Totally 112 patients were included in the study cohort. 50.9% were male, 87.5% Caucasian, and median age was 75.5 years (IQR 14.3 years). Lesions were predominantly antral (36.6%) or body (35.7%); median size 20 mm (IQR 15 mm). Rates of en bloc, R0 resection, and curative resection were 96.4%, 89.3%, and 78.6% (identical between eCura and ESGE), respectively. Adverse events occurred in 5.8%, recurrence in 0%, and metachronous lesions in 9.9%. Our data compared favorably with a review existing Western series, which illustrates increasing adoption of ESD and stable outcomes over time.
ESD represents a safe and effective method of treatment for gastric neoplasia in the Western setting. This study highlights the potential for excellent outcomes in a single center with a heterogeneous patient cohort and supports the use of eCura in guiding post procedural management.
Pollen exposure may induce seasonal onset of eosinophilic esophagitis. However, whether serum pollen-specific immunoglobulin E positivity can predict such seasonal eosinophilic esophagitis onset remains unclear. Here, we aimed to evaluate the association between pollen-specific immunoglobulin E positivity and the seasonal onset of eosinophilic esophagitis during the pollen dispersal period.
We seasonally classified eosinophilic esophagitis patients and compared their clinical and endoscopic findings. Seasonal trends with respect to the positivity rate of serum pollen-specific immunoglobulin E were examined. Pollens such as alder, cedar, cypress, birch, orchard grass, timothy, ragweed, and mugwort were evaluated. We classified patients into two groups: tested positive or negative for each pollen-specific immunoglobulin E. We then evaluated whether the positivity of each pollen-specific immunoglobulin E was associated with the seasonal onset of eosinophilic esophagitis during the pollen dispersal period.
We included 122 patients diagnosed with eosinophilic esophagitis between 2010 and 2019. Among them, 31 (25.4%), 42 (34.4%), 29 (23.8%), and 20 (16.4%) patients were diagnosed during spring, summer, fall, and winter, respectively. No significant differences were observed in clinical and endoscopic findings across seasons. No significant seasonal trends were observed in the positivity rate of each pollen-specific immunoglobulin E. The positivity rate of alder-specific immunoglobulin E was significantly associated with the seasonal onset of eosinophilic esophagitis (P < 0.01). However, the positivity rates of other pollen-specific immunoglobulin E were not associated with the seasonal onset of eosinophilic esophagitis.
Serum alder-specific immunoglobulin E positivity was associated with the seasonal onset of eosinophilic esophagitis.
A 73-year-old female with metastatic renal cell carcinoma (RCC) presented with melena and lethargy. She was found to be iron deficient with a hemoglobin of 101 g/L. Her gastroscopy found six irregular pedunculated non-bleeding polyps, 10–20 mm in diameter. Histopathology of the resected polyp returned as metastatic clear cell renal cell carcinoma. Gastric metastases from any primary malignancy are rare and metastatic RCC accounts for only 7% of these tumors. Furthermore, while RCC commonly metastasises to the lung, bone and lymph nodes, metastasis to the gastrointestinal tract is extremely rare, occurring in <1% of patients. Presentation of RCC as a gastric polyp is usually a late event, and on average occurs 6.7 years after initial diagnosis of RCC. Therefore, this case highlights a rare but important late complication of RCC, presenting as gastrointestinal bleeding secondary to gastric metastases.
This study explored the use of transperineal intestinal ultrasound (TPIUS) for assessment of ulcerative colitis (UC) in pregnancy. 8 pregnant women with UC underwent TP-US, clinical assessment and fecal calprotectin. TP-IUS was well tolerated and feasible with adequate rectal views obtained in all trimesters of pregnancy. No correlation between TP-IUS, clinical, or biochemical rectal disease activity assessment was found in this small cohort. Further studies are required to define the optimal technique and references ranges in the pregnant population.
HCV is marked by genetic diversity that impacts disease progression and outcome. Using the NHANES data from 266 HCV-infected adults (2011–2020), this study infers that genotype 1a is the most prevalent (60.2%). Genotype 3 was associated with higher transaminase levels, though not statistically significant. These findings suggest a more aggressive phenotype for genotype 3. Despite pan-genotypic treatment guidelines, this underscores the importance of continued HCV genotype surveillance and consideration for genotype-specific treatment and monitoring strategies.
Chronic constipation negatively impacts work productivity and patients' quality of life. This retrospective study assessed the correlation between symptoms of chronic constipation and work/activity impairment with and without the use of laxative treatment.
This cross-sectional, observational, web-based survey was conducted using the Work Productivity and Activity Impairment-Chronic Constipation Questionnaire and included Japanese patients with chronic constipation receiving prescribed medication. Outcomes of interest included total work productivity and activity impairment and their correlation with constipation symptoms.
Among the 2351 analyzed patients (mean [SD] age, 51.7 [13.8] years), 80.7% were females, 63.3% had a disease duration of ≥10 years, and 1424 were working. The averages of total activity impairment, total work productivity impairment, presenteeism, and absenteeism were 39.2%, 33.9%, 31.2%, and 5.0%, respectively. The annual work productivity loss per patient was estimated to be 1.343 million Japanese Yen. Symptoms that had a statistically significant positive correlation with total work impairment (P < 0.05) were abdominal discomfort/nausea, abdominal pain, abdominal bloating, and unpredictable defecation timing. Total activity impairment was significantly (P < 0.05) affected by abdominal discomfort/nausea, abdominal bloating, abdominal pain, incomplete defecation, unpredictable defecation timing, loss of defecation desire, and straining. Work productivity and daily activity had improved in 71.2% and 72.6% of patients, respectively, after they received treatment.
Symptoms of constipation, particularly abdominal symptoms and unpredictable defecation timing, can have a negative impact on work productivity and daily activity. Treatment focused on these symptoms may reduce the socio-economic burden of chronic constipation in Japan.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：