Sepsis during short bowel syndrome hospitalizations:Identifying trends,disparities,and clinical outcomes in the United States

BACKGROUND Short bowel syndrome(SBS)hospitalizations are often complicated with sepsis.There is a significant paucity of data on adult SBS hospitalizations in the United States and across the globe.AIM To assess trends and outcomes of SBS hospitalizations complicated by sepsis in the United States.METHODS The National Inpatient Sample was utilized to identify all adult SBS hospitalizations between 2005-2014.The study cohort was further divided based on the presence or absence of sepsis.Trends were identified,and hospitalization characteristics and clinical outcomes were compared.Predictors of mortality for SBS hospitalizations complicated with sepsis were assessed.RESULTS Of 247097 SBS hospitalizations,21.7%were complicated by sepsis.Septic SBS hospitalizations had a rising trend of hospitalizations from 20.8%in 2005 to 23.5%in 2014(P trend<0.0001).Compared to non-septic SBS hospitalizations,septic SBS hospitalizations had a higher proportion of males(32.8%vs 29.3%,P<0.0001),patients in the 35-49(45.9%vs 42.5%,P<0.0001)and 50-64(32.1%vs 31.1%,P<0.0001)age groups,and ethnic minorities,i.e.,Blacks(12.4%vs 11.3%,P<0.0001)and Hispanics(6.7%vs 5.5%,P<0.0001).Furthermore,septic SBS hospitalizations had a higher proportion of patients with intestinal transplantation(0.33%vs 0.22%,P<0.0001),inpatient mortality(8.5%vs 1.4%,P<0.0001),and mean length of stay(16.1 d vs 7.7 d,P<0.0001)compared to the non-sepsis cohort.A younger age,female gender,White race,and presence of comorbidities such as anemia and depression were identified to be independent predictors of inpatient mortality for septic SBS hospitalizations.CONCLUSION Septic SBS hospitalizations had a rising trend between 2005-2014 and were associated with higher inpatient mortality compared to non-septic SBS hospitalizations.

Association of non-alcoholic fatty liver disease with gallstone disease in the United States hospitalized patient population

BACKGROUND Gallstones and cholecystectomy have been proposed as risk factors for nonalcoholic fatty liver disease(NAFLD).The reason for this may be that both gallstones,as well as NAFLD share several risk factors with regards to their development.Currently,there is a lack of sufficient evidence showing an association between these clinical conditions.AIM To determine whether there is a meaningful association between gallstones and cholecystectomy with NAFLD.METHODS We queried the National Inpatient Sample database from the years 2016 and 2017 using International Classification of Diseases,10th revision,Clinical Modification diagnosis codes to identify hospitalizations with a diagnosis of gallstone disease(GSD)(includes calculus of gallbladder without cholecystitis without obstruction and acquired absence of gallbladder)as well as NAFLD(includes simple fatty liver and non-alcoholic steatohepatitis).Odds ratios(ORs)measuring the association between GSD(includes gallstones and cholecystectomy)and NAFLD were calculated using logistic regression after adjusting for confounding variables.RESULTS Out of 14294784 hospitalizations in 2016-2017,159259 were found to have NAFLD.The prevalence of NAFLD was 3.3%in patients with GSD and 1%in those without.NAFLD was prevalent in 64.3%of women with GSD as compared to 35.7%of men with GSD.After controlling for various confounders associated with NAFLD and GSD,multivariate-adjusted analysis showed that there was an association between NAFLD with gallstones[OR=6.32;95%confidence interval(CI):6.15-6.48]as well as cholecystectomy(OR=1.97;95%CI:1.93-2.01).The association between NAFLD and gallstones was stronger in men(OR=6.67;95%CI:6.42-6.93)than women(OR=6.05;95%CI:5.83-6.27).The association between NAFLD and cholecystectomy was stronger in women(OR=2.01;95%CI:1.96-2.06)than men(OR=1.85;95%CI:1.79-1.92).P value was less than 0.001 for all comparisons.CONCLUSION NAFLD is more prevalent in women with GSD than men.The association between NAFLD and cholecystectomy/gallstones indicates that they may be risk factors for NAFLD.

Elevated liver enzymes portends a higher rate of complication and death in SARS-CoV-2

BACKGROUND Severe acute respiratory syndrome coronavirus 2,or coronavirus disease-2019(COVID-19),has infected millions worldwide since its discovery in Wuhan,China in December 2019,but little is still known about the disease process.Preliminary research in China notes liver function tests(LFTs)abnormalities are common in COVID-19 patients,suggesting decreased hepatic function,and that abnormalities in LFTs are related to complicated disease course and negative outcomes.However,there has been limited large-scale data assessing COVID-19’s association with liver dysfunction and negative outcomes.AIM To investigate how COVID-19 affects the liver function and disease course in patients infected with the virus treated at Henry Ford Hospital from March to September 2020.METHODS A total of 8028 patients infected with COVID-19 were identified and included in the study at a single academic center.Data from medical charts on laboratory testing including aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(AP),and bilirubin levels,past history of liver disease,and disease course indicators including hospital admission,intensive care unit(ICU)admission,intubation,and death were recorded and analyzed.Elevated liver enzymes were defined as ALT/AST greater than 60,AP greater than 150,or bilirubin greater than 1.5,super-elevated liver enzymes were defined as ALT/AST greater than 120,AP greater than 300,or bilirubin greater than 3.0.RESULTS A total of 8028 COVID-19 patients were identified and included in the study.Data from medical charts on LFTs(namely,AST,ALT,AP,and bilirubin levels),past history of liver disease,and disease course indicators(hospital/ICU admission,intubation,death)were recorded and analyzed.LFTs from 3937 patients were available for interpretation.45% were found to have elevated or super-elevated LFT.When compared to COVID-19 patients without elevated LFTs,this cohort was found to have significantly higher odds of hospital admittance,ICU admission,intubation,and death(all P<0.001).248(3.1%)had a history of liver disease.Those with elevated and super elevated LFTS had significantly higher odds of having a past history of liver disease(P<0.001).CONCLUSION The findings from this study suggest that in patients who have tested positive for COVID-19,those with elevated and super elevated liver enzyme levels have significantly higher odds of hospital admittance,ICU admittance,intubation and death in comparison to those COVID-19 patients without elevated liver enzyme levels.