Secondary angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease: Results from the nationwide inpatient sample

BACKGROUND Chronic kidney disease is associated with angiodysplasia of gastrointestinal tract leading to increased risk of gastrointestinal bleeding.AIM To determine the nationwide prevalence,trends,predictors and resource utilization of angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalizations.METHODS The Nationwide Inpatient Sample database from 2009 to 2014,was utilized to conduct a retrospective study on patients with angiodysplasia associatedgastrointestinal bleeding and end-stage renal disease.Hospitalizations with endstage renal disease were included in the Nationwide Inpatient Sample database and a subset of hospitalizations with end-stage renal disease and angiodysplasiaassociated gastrointestinal bleeding were identified with International Classification of Diseases,9th revision,Clinical Modification codes for both endstage renal disease(585.6)and angiodysplasia(569.85,537.83).RESULTS The prevalence of angiodysplasia-associated gastrointestinal bleeding was 0.45%(n=24709)among all end-stage renal disease patients(n=5505252)that were hospitalized.Multivariate analysis indicated that the following were significant factors associated with higher odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients:an increasing trend from 2009-2014(P<0.01),increasing age(P<0.0001);African American race(P=0.0206);increasing Charlson-Deyo Comorbidity Index(P<0.01);hypertension(P<0.0001);and tobacco use(P<0.0001).Diabetes mellitus(P<0.0001)was associated with lower odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients.In comparison with urban teaching hospitals,rural and urban nonteaching hospitals were associated with decreased odds of angiodysplasia associated-gastrointestinal hemorrhage.CONCLUSION Angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease patients showed an increasing trend from 2009-2014.Advanced age,African American race,overall high comorbidities,hypertension and smoking were significant factors for angiodysplasia-associated gastrointestinal bleeding in bleeding in these patients.

Latent hepatitis B is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C

AIM:To study the potential association between hepatocellular carcinoma(HCC)in patients with chronic hepatitis C(CHC),cirrhosis and latent hepatitis B(LHB)infection,defined as the absence of detectable serum hepatitis B surface antigen(HBsAg)and the presence of hepatitis B core antibody(HBcAb).METHODS:This retrospective analysis is comprised of 185 cirrhotic patients with HCC who were hepatitis C virus antibody(HCV Ab)(+)and HBsAg(-)at Wayne State University between 1999 and 2008.From these,108 patients had HCV polymerase chain reaction confirmation of viremia while the remaining(77)were considered to have CHC on the basis of a positive HCV Ab and the absence of any other cause of liver disease.Controls were drawn from our institutional database from the same time period and consisted of 356 HBsAg(-)age,race and gender matched patients with HCV RNA-confirmed CHC and without evidence of HCC.A subgroup of controls included 118matched patients with liver cirrhosis.χ2test and t test were used for data analysis.RESULTS:Seventy-seven percent of patients in all3 groups were African Americans.Patients with HCC had a significantly higher body mass index(P=0.03),a higher rate of co-infection with human immunodeficiency virus(HIV)(P=0.05)and a higher prevalence of alcohol abuse(P=0.03)than the controls.More patients with HCC had LHB than controls(78%vs39%,P=0.01).Sixty three percent of patients with HCC were both hepatitis B surface antigen(HBsAb)(-)and HBcAb(+)compared to 23%of controls(P<0.01).When compared to cirrhotic controls,the frequency of HBcAb(+)remained higher in patients with HCC(78%vs 45%,P=0.02).Patients with HCC were more likely to be both HBsAb(-)and HBcAb(+)than the cirrhotic controls(63%vs 28%,P=0.01).Although not statistically significant,100%of CHC and HIV coinfected patients with HCC(n=11)were HBcAb(+)when compared to controls(44%;n=9).CONCLUSION:These data suggest that LHB occurs at a significantly increased frequency in patients with CHC and HCC than in patients with CHC without HCC.

Overestimate of Fibrosis by FIBROSpect(R) Ⅱ in African Americans Complicates the Management of their Chronic Hepatitis C

Background:Evaluation of advanced fibrosis in patients with hepatitis C virus (HCV) infection is used to facilitate decisions on treatment strategy and to initiate additional screening measures.Unfortunately,most studies have predominately Caucasian (Cau) patients and may not be as relevant for African Americans (AA).Aims:This study specifically addresses the issue of defining minimal vs.significant fibrosis in African Americans (AA) with chronic hepatitis C (CHC) using noninvasive assays.Methods:All patients (n =319) seen between 1 January 2008 and 30 June 2013 for whom a FibroSpect II(R) (FSII) assay was performed and had data for calculation of aspartate aminotransferase (AST)platelet ratio index (APRI) and Fibrosis-4 (FIB-4) were identified using the medical records.Results:When liver biopsy score and FSII assay results for the AA patients with CHC were compared,31% of AA had advanced FSII fibrosis scores (F2-F4) despite a biopsy score of F0-F1.In contrast,10% of Cau over-scored.The AA false positive rate was 14% for APRI and 34% for FIB-4.Combining FSII with either APRI (7% false positive) or FIB-4 (10% false positive) improved the false positive rate in AA to 7% (FSII + APRI) and 10%(FSII + FIB-4) but reduced the sensitivity for significant fibrosis.Conclusions:The FSII assay overestimates fibrosis in AA and should be used with caution since these patients may not have significant fibrosis.If the APRI or FIB-4 assay is combined with the FSII assay,minimal fibrosis in AA can be defined without subjecting the patients to a subsequent biopsy.