AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwe...AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review. Univariable and multivariable logistic regression were performed to determine BB use and their association with measures of physical frailty. Competing risk analyses were performed to determine the effect of BB use on wait-list mortality, as defined by death or delisting for being too sick for transplant.RESULTS Of 344 patients, 35% were female, median age was 60, median model for end stage liver disease was 15, and 53% were prescribed a BB. Compared to those not on BB, patients on BB were similar except for percentage female(25% vs 46%; P < 0.001) and BMI(29 vs 28; P = 0.008). With respect to tests of physical frailty, BB use was not associated with increased odds of frailty(by the Liver Frailty Index), exhaustion, or low physical activity. BB use was, however, significantly associated with a decreased adjusted risk of mortality(SHR 0.55; P = 0.005).CONCLUSION In patients with cirrhosis awaiting liver transplantation, BB use is not associated with physical frailty. We confirmed the known survival benefits with BB use, and concerns about adverse effects should not deter their utilization when indicated.展开更多
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related to worldwide death with a great geographical variation. To be eligible for curative therapy at the time of diagnosis is important. However,...Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related to worldwide death with a great geographical variation. To be eligible for curative therapy at the time of diagnosis is important. However, the majority of cases are diagnosed at late stages. This can be achieved with applicable screening modalities. Until now, many organizations around the world have developed guidelines according to their own evidence-based data for screening of HCC. The purpose of this article is to review the screening modalities of HCC to assist gastroenterologists and providers involved in the management of HCC.展开更多
基金Supported by the Paul B.Beeson Career Development Award in Aging Research,No.K23AG048337
文摘AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review. Univariable and multivariable logistic regression were performed to determine BB use and their association with measures of physical frailty. Competing risk analyses were performed to determine the effect of BB use on wait-list mortality, as defined by death or delisting for being too sick for transplant.RESULTS Of 344 patients, 35% were female, median age was 60, median model for end stage liver disease was 15, and 53% were prescribed a BB. Compared to those not on BB, patients on BB were similar except for percentage female(25% vs 46%; P < 0.001) and BMI(29 vs 28; P = 0.008). With respect to tests of physical frailty, BB use was not associated with increased odds of frailty(by the Liver Frailty Index), exhaustion, or low physical activity. BB use was, however, significantly associated with a decreased adjusted risk of mortality(SHR 0.55; P = 0.005).CONCLUSION In patients with cirrhosis awaiting liver transplantation, BB use is not associated with physical frailty. We confirmed the known survival benefits with BB use, and concerns about adverse effects should not deter their utilization when indicated.
文摘Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related to worldwide death with a great geographical variation. To be eligible for curative therapy at the time of diagnosis is important. However, the majority of cases are diagnosed at late stages. This can be achieved with applicable screening modalities. Until now, many organizations around the world have developed guidelines according to their own evidence-based data for screening of HCC. The purpose of this article is to review the screening modalities of HCC to assist gastroenterologists and providers involved in the management of HCC.
