scholarly journals Liver Cirrhosis, Etiology and Clinical Characteristics Disparities among Minority Population

2019 ◽  
Author(s):  
Muhammad Abu Tailakh ◽  
Liat Poupko ◽  
Najwan Kayyal ◽  
Alsana Ali ◽  
Ohad Etzion ◽  
...  

Abstract Background: Liver cirrhosis (LC) is a common disease with varied primary causes and ethnic disparities. We aimed to determine the frequency, clinical characteristics, and outcomes of LC among the Arab Bedouin (AB) population in southern Israel. Methods: This retrospective and follow-up study enrolled all patients diagnosed with LC at the gastroenterology and hepatology department or the internal medicine ward. Patient records were reviewed for demographic, clinical data, and mortality. Clinical primary outcomes were defined as death, hepatocellular carcinoma or liver transplantation. Results: We included 820 patients 69 (8.4%) AB and 752 (91.6%) Jewish patients. Incidence of cirrhosis found in our study was much lower among AB patients, 5-10/100,000/year, compared with 20-40/100,000 per year in Jewish patients. Age at diagnosis was 42.6±16.9 years among Bedouins compared to 61±13 years (p<0.001) among Jews. The study included 25 (36.2%) male AB and 472 (63%) male Jewish patients (p<0.001). The most frequent causes of LC among AB were cryptogenic (24.6%), hepatitis B (18.8%) and autoimmune hepatitis (17.4%), while hepatitis C (41.7%), fatty liver (16.5%) and alcoholic liver disease (15.5%) were most common among Jewish patients. An all-cause mortality of 41.8% was found in AB patients compared to 63.4% in Jewish patients (p<0.001). Primary clinical outcomes were found by 34 (49%) AB patients and by 510 (67.9%) Jewish patients (p=0.002), with 46 and 608 events, retrospectively. Conclusions: The incidence of liver cirrhosis among Arab Bedouin is lower than that in the Jewish population, with disparities in etiology, age at diagnosis, presence of complications and mortality.

2019 ◽  
Author(s):  
Muhammad Abu Tailakh ◽  
Liat Poupko ◽  
Najwan Kayyal ◽  
Alsana Ali ◽  
Ohad Etzion ◽  
...  

Abstract Background Liver cirrhosis (LC) is a common disease with varied primary causes and ethnic disparities. We aimed to determine the frequency, clinical characteristics, and outcomes of liver cirrhosis among the Arabs population in southern Israel.Methods This retrospective and follow-up study enrolled all patients diagnosed with liver cirrhosis at the gastroenterology and hepatology department or the internal medicine ward. Patient records were reviewed for demographic, clinical data, and mortality. Clinical primary outcomes were defined as death, hepatocellular carcinoma or liver transplantation.Results We included 820 patients 69 (8.4%) Arabs and 752 (91.6%) Jewish patients. Incidence of cirrhosis was much lower among Arabs patients, 5-10/100,000/year, compared with 20-40/100,000 per year in Jewish patients. Age at diagnosis was 42.6±16.9 years among Bedouins compared to 61±13 years (p<0.001) among Jews. The study included 25 (36.2%) male Bedouins and 472 (63%) male Jews (p<0.001). The most frequent causes of liver cirrhosis among Arabs were cryptogenic (24.6%), hepatitis B (18.8%) and autoimmune hepatitis (17.4%), while hepatitis C (41.7%), fatty liver (16.5%) and alcoholic liver disease (15.5%) were most common among Jewish patients. An all-cause mortality of 41.8% was found in Arabs patients, compared to 63.4% in Jewish patients (p<0.001). Primary clinical outcomes were found by 34 (49%) Arabs patients and by 510 (67.9%) Jewish patients (p=0.002), with 46 and 608 events, retrospectively.Conclusions The incidence of liver cirrhosis among Arabs is lower than that in the Jewish population, with disparities in etiology, age at diagnosis, presence of complications and mortality.


2019 ◽  
Vol 15 (5) ◽  
pp. 656-662 ◽  
Author(s):  
E. Yu. Okshina ◽  
M. M. Loukianov ◽  
S. Yu. Martsevich ◽  
S. S. Yakushin ◽  
N. P. Kutishenko ◽  
...  

Aim. To assess the demographic and clinical characteristics, drug treatment and outcomes in patients with a history of acute cerebrovascular accident (ACVA) and with concomitant history of myocardial infarction (MI) in clinical practice based on outpatient and hospital parts of REGION registry.Material and methods. The total 1886 patients with a history of ACVA (aged of 70.6±12.5 years, 41.9% men) were enrolled into the outpatient registry REGION (Ryazan) and the hospital registry REGION (Moscow). 356 patients had ACVA and a history of MI (group “ACVA+MI” and 1530 patients had ACVA without history of MI (group “ACVA without MI”). The incidence of cardiovascular diseases (CVD), non-CVD comorbidities, drug therapy and outcomes were analyzed.Results. In the group ACVA+MI compared with group ACVA without MI the significantly higher proportions of patients with the following conditions (diagnosis) were revealed: arterial hypertension (AH) – 99.1% and 94.2%; coronary heart disease (CHD) – 100% and 57%; chronic heart failure (CHF) – 61.5% and 41.8%; atrial fibrillation (AF) – 42.7% and 23.8%; repeated ACVA – 32.9% and 18.9%, respectively, p<0.0001 for all. In ACVA+MI and ACVA without MI groups the respective proportions of patients were smokers – 16.2% and 23.7% (p=0.10), had a family history of premature CVD – 3.2% and 1.2% (p=0.01), and had a hypercholesterolemia – 47% and 59.7% (p<0.001). The incidence of drug administration with proved positive prognostic effect was insufficient in both groups, but higher in the ACVA+MI group compared with ACVA without MI group (on average 47.1% and 40%, respectively), including: anticoagulants in AF – 19.1% and 21.4% (p=0.55); antiplatelets in CHD without AF – 69.4% and 42% (p<0.001); statins in CHD – 26.4% and 17.2% (p<0.001); beta-blockers in CHF – 39% and 23.8% (p=0.002), respectively. During 4- year follow-up in the group ACVA+MI compared with group ACVA without MI there were significantly higher all-cause mortality – 44.9% and 26.8% (p<0.001), nonfatal recurrent ACVA – 13.7% and 5.6% (p=0.0001), and nonfatal MI – 6.9% and 1.0% (p<0.0001), respectively.Conclusion. The proportion of patients with a history of MI was 18.9% among the patients with a history of ACVA. In patients of ACVA+MI group, compared with patients of ACVA without MI group a higher incidence of the following characteristics was revealed: a presence of AH, CHD, CHF, AF, repeated ACVA and a family history of premature CVD. The incidence of taking drug with proved positive effect on prognosis in patients of the compared groups was insufficient, especially of statins and anticoagulants in AF. During the follow-up period ACVA+MI group was characterized by a higher all-cause mortality and higher incidence of nonfatal ACVA and MI. In these patients the improvement of the quality of pharmacotherapy and of the secondary prevention effectiveness are the measures of especial importance. 


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.A Baturova ◽  
M.M Demidova ◽  
J Carlson ◽  
D Erlinge ◽  
P.G Platonov

Abstract Introduction New onset AF is a known complication in patients with acute ST-segment elevation myocardial infarction (STEMI). However, whether new-onset AF affects the long-term prognosis to the same extent as pre-existing AF is not fully clarified and prescription of oral anticoagulants (OAC) in patients with new-onset AF remains a matter of debates. Purpose We aimed to assess the impact of new-onset AF in STEMI patients undergoing primary percutaneous intervention (PCI) on outcome during long-term follow-up in comparison with pre-existing AF and to evaluate effect of OAC therapy in patients with new-onset AF on survival. Methods Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010 (age 66±12 years, 70% male). AF prior to STEMI was documented by record linkage with the Swedish National Patient Register and review of ECGs obtained from the digital archive containing ECGs recorded in the hospital catchment area since 1988. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission, including new-onset AF and OAC at discharge. All-cause mortality was assessed using the Swedish Cause-of-Death Register 8 years after discharge. Results AF prior to STEMI was documented in 177 patients (8%). Among patients without pre-existing AF (n=2100), new-onset AF was identified in 151 patients (7%). Patients with new-onset AF were older than those without AF history (74±9 vs 65±12 years, p&lt;0.001), but did not differ in regard to other clinical characteristics. Among 2149 STEMI survivors discharged alive, 523 (24%) died during 8 years of follow-up. OAC was prescribed at discharge in 45 (32%) patients with new onset AF and in 49 (31%) patients with pre-existing AF, p=0.901. In a univariate analysis, both new-onset AF (HR 2.18, 95% CI 1.70–2.81, p&lt;0.001) and pre-existing AF (HR 2.80, 95% CI 2.25–3.48, p&lt;0.001) were associated with all-cause mortality, Figure 1. After adjustment for age, gender, cardiac failure, diabetes, BMI and smoking history, new-onset AF remained an independent predictor of all-cause mortality (HR 1.40, 95% CI 1.02–1.92, p=0.037). OAC prescribed at discharge in patients with new-onset AF was not significantly associated with survival (univariate HR 0.86, 95% CI 0.50–1.50, p=0.599). Conclusion New-onset AF developed during hospital admission with STEMI is common and independently predicts all-cause mortality during long-term follow-up after STEMI with risk estimates similar to pre-existing AF. The effect of OAC on survival in patients with new-onset AF is inconclusive as only one third of them received OAC therapy at discharge. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None


Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Deepakraj Gajanana ◽  
Abel Romero-Corral ◽  
Mahek Shah ◽  
Parichart Junpapart ◽  
Vincent M Figueredo ◽  
...  

Background: Past data suggest ischemic cardiomyopathy (ICM) is associated with worse prognosis when compared to non-ischemic cardiomyopathy(NICM). With advances in heart failure management, this relationship deserves a fresh look. We hypothesize that all cause mortality from NICM is lower when compared to ICM over five year period. Methods: We retrospectively studied consecutive heart failure patients with left ventricular ejection fraction(EF) less than 35% admitted to Einstein Medical Center Philadelphia between 01/01/2007 to 12/31/2007. Data pertaining to patient demographics and clinical characteristics were obtained. All cause mortality was obtained at 5 years using hazard ratio to account for time to event. Results: The final cohort consisted of 360 patients of which 63%(224 of 360) had NICM. Mean age was 61±16 years for NICM and 66±11 yrs for ICM. African Americans constituted 83%(185 of 224) of NICM and 59%(80 of 136) of ICM. The clinical characteristics are as shown in the table. There were 160 deaths over the follow up period. Age, CKD, dyslipidemia and EF were significant predictors of mortality. ICM cohort had 81 deaths out of 136(60%) as compared to 85 out of 185((39%) in NICM over the follow up period. However, when adjusted for age, DM, CKD and days of follow-up, there was no statistically significant difference in mortality between the two groups over the five year follow up period. Conclusions: In this study, there was no significant mortality difference between ICM and NICM. We also found that despite advances in heart failure management in the last two decades, in clinical practice they are under-utilized.


2021 ◽  
Vol 96 (3) ◽  
pp. 241-246
Author(s):  
Su Yeon Lee ◽  
Kyunghee Lim

Pericardial effusion is a common disease seen by echocardiography, and it is found in 3–9% of annual echocardiograms. Although moderate pericardial effusion has been reported in some cases, it is usually asymptomatic and is rarely accompanied by cardiac tamponade. A large pericardial effusion may be due to various causes, including idiopathic causes, tuberculosis, cancer, connective tissue disease, infection, and hypothyroidism. Recent advances in analytic and imaging techniques have increased our ability to diagnose the cause of pericardial effusion accurately. This information is important for determining the proper treatment based on each case’s clinical characteristics. We report a case of large, recurrent pericardial effusion accompanied by hypothyroidism with initial increased levels of tumor markers, including cancer antigen 125, carcinoembryonic antigen, and alpha-fetoprotein. The patient was treated with thyroid hormone only. In follow-up images, the pericardial effusion was resolved and all of the tumor markers were normalized.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5359-5359 ◽  
Author(s):  
Caitlin L. Costello

Background The median age of patients diagnosed with multiple myeloma (MM) is approximately 70 years old. It is an uncommon malignancy in persons younger than 40 years, representing only 2% of all patients diagnosed with MM. It has been suggested that young patients may present with more aggressive and less common disease features, frequently delaying the initial diagnosis and thereby affecting outcomes. With this background, we explored the outcome of young MM patients presenting to our institution over the past thirteen years. Methods We performed a retrospective review of a cohort of 236 patients with MM who received treatment for active MM at the University of California, San Diego Moores Cancer Center between January 2000 and July 2013.  The demographics and disease features of patients up to 40 years of age at diagnosis were analyzed using descriptive statistics. The survival outcomes of these young patients were compared with the remainder of the cohort using the Kaplan-Meier method. Results Nineteen (6.5%) out of the 236 patients with MM were ²40 years of age at diagnosis, with a median age of 35.5 years old. The median follow-up of this group of young patients was 42 months (range 5-92). The patient and disease characteristics are outlined in Table 1. Seven young patients (37%) had MM with no heavy chain component, including light chain only secreting or non-secretory disease.  Seven patients (37%) had a non-IgG paraprotein. Nine (56%) patients presented with extramedullary plasmacytomas. Two (10%) patients had plasma cell leukemia. All patients received at least one treatment regimen that included a novel agent. Fifteen patients (79%) had received high-dose therapy, and four patients (21%) underwent allogeneic stem cell transplantation (SCT) after at least one prior autologous SCT. The 5-year and 7-year overall survival (OS) from diagnosis was 51.7% and 28%, respectively, and the median OS was 60.7 months. In contrast, the median OS of patients ≥41 years old at diagnosis was 78.6 months (p=0.15, figure 1). Conclusion In this single center study with long follow up, we demonstrate that patients diagnosed with MM ²40 years of age exhibit several high-risk features and frequently present with advanced stage disease. Despite the use of novel agents in this population, there is a statistical trend towards a worse outcome with an 18-month difference in median overall survival when compared to older patients with MM. More aggressive treatment strategies are needed to improve survival in this young patient population. Disclosures: No relevant conflicts of interest to declare.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Natacha Rodrigues ◽  
Afonso N Ferreira ◽  
Pedro António ◽  
Mafalda Carrington ◽  
João De Sousa ◽  
...  

Abstract Background and Aims Heart Failure (HF) and chronic kidney disease (CKD) are both epidemic, frequently simultaneous and sharing well knowned risk factors. Implantable devices can improve quality of life and reduce mortality in a selected population. Data derived from meta-analyses show both survival benefit in CKD patients receiving devices and increased risk of death in device patients with CKD. Little is Known about the impact of glomerular filtration rate (GFR) across the different stages of CKD in the vital prognoses of HF patients submitted to cardiac resynchronization therapy (CRT) or implantable cardiac defibrillator (ICD) implants. To evaluate the impact of CKD in all-cause mortality in HF patients who implanted a CRT or ICD. Method Prospective single-center study of patients who implanted CRT or ICD between 2015 and 2019. Clinical characteristics were evaluated at baseline and mortality was assessed using the national registry. CKD was evaluated according to the GFR by CKD-EPI equation according to the KDIGO guidelines. We performed univariate and multivariate analysis to compare clinical characteristics of patients who died and who survived using the Cox regression and Kaplan-Meier methods. For the predictor GFR levels, and according to the KDIGO classification, we assessed the best cut-off value for mortality using the area under the ROC curve (AUC) method. Results From 2015-2019, 974 devices were implanted, 414 ICDs and 560 CRTs (23.3% female, 67.6±12.1, follow-up duration 26.4±16.5 months). A total of 161 patients (16.5%) died during follow-up. GFR at the time of device implant was significantly lower in patients who died compared to those who survived (49.7 vs 67.3ml/min/1.73m2, p&lt;0.001). When evaluating predictors for all-cause mortality by multivariate analysis, GFR at the time of device implant was an independent predictor of mortality, even when adjusted for age, gender, arterial hypertension and diabetes (HR 1.12; 95% CI 1.04-1.16, p&lt;0.001). The best GFR cut-off value to predict mortality with a 69% sensitivity and 65% specificity was 75ml/min/1.73m2 (AUC 0.70). Patients with a GFR &lt; 75ml/min/1.73m2 at the time of implant have a 2.5-fold higher risk of death (HR 2.5; 95% CI 1.6-3.9, p&lt;0.001). Risk of death significantly increases along GFR decline, almost doubling each stage, with 2.7 for stage 3a (p=0.2), 5.5 for stage 3b, 9.5 for stage 4 and 14.7-fold higher risk of death for stage 5 (p&lt;0.001). Conclusion In our cohort of HF patients who underwent CRT or ICD implant, glomerular filtration rate was an independent predictor for all-cause mortality. Additionally, GFR&lt;75ml/min/1.73m2 at the time of device implant increased by 2.5-fold the risk of death, the risk doubles for each CKD stage increase, reaching a dramatic 14.7- fold higher risk of death for stage 5 patients. CKD should not postpone device implant, as its deterioration significantly increases the risk of death.


Author(s):  
Muhammad Abu Tailakh ◽  
Liat Poupko ◽  
Najwan Kayyal ◽  
Ali Alsana ◽  
Asia Estis-Deaton ◽  
...  

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7558-7558
Author(s):  
R. Kouz ◽  
S. Sreenivasappa ◽  
K. Adab ◽  
B. Ciobanu ◽  
S. Ofori ◽  
...  

7558 Background: Lung cancer is the leading cause of cancer death. Response and survival of patients (pts) with stage III lung cancer in minority population is not well studied. Methods: 79 pts treated between 2001 and 2006 were studied as a retrospective cohort. Clinical and survival data were analyzed using fisher's test, chi square test, Kaplan Meier analyses. Results: 33 Pts had Stage IIIA; Median age at diagnosis was 58 yrs (37–75). 14 were males (42.4%) 19 females (57.6%) 26 African American (78.8%) and 7 Caucasians (21.2%). Median number of co morbidities 2 (0–4). Mean follow up was 25 months (mo) (2 - 93), 19 had surgery (12 Lobectomy (36.4%), 7 Pneumonectomy (21.2%)) and 14 were unresectable (42.4%). All pts received adjuvant chemotherapy. Unresectable pts received chemotherapy and radiation, 8 carboplatin and gemcitabine and 6 cisplatin and etoposide. Median time to progression in resectable IIIA was 23 mo (2- 67), unresectable IIIA was 12 mo (3–93). Median survival in pts with resection was 26 mo (2 - 67), unresectable was 12 mo (5 - 93). Overall survival and time to progression was not influenced by sex, race, tumor type. 46 pts had stage IIIB, median age at diagnosis 57.5 yrs (40–68). 31 were males (67.4%) 15 females (32.6%) 29 African Americans (63%) 11 Caucasians (23.9) 3 Asians (6.5%) and 3 Hispanics (6.5%). Median follow up was 10 mo (3–97). All pts received chemotherapy and radiation. 23 received cisplatin and etoposide (50%), 14 carboplatin and gemcitabine (30%), 5 carboplatin and etoposide (9%), 5 carboplatin and paclitaxel (9%). 13 had complete response (28.3%), 15 partial response (32.6%), 2 stable disease (4.3%) and 10 Progression (21.7%). Median time to progression was 9 mo (3–97). Median overall survival was 10 mo (3–97). Overall survival and time to progression was not influenced by sex, race, tumor type, chemotherapy regimen. Conclusions: In this minority based cohort response, time to progression, overall survival in both IIIA and IIIB pts is much lower then historical controls. The overall survival and time to progression in both IIIA and IIIB is not influenced by race, sex, tumor type and type of chemotherapy regimen. Further investigations of disease and healthcare disparities in the underserved minority population, are warranted. No significant financial relationships to disclose.


2022 ◽  
Vol 11 (1) ◽  
pp. 241
Author(s):  
Mateusz Sokolski ◽  
Konrad Reszka ◽  
Tomasz Suchocki ◽  
Barbara Adamik ◽  
Adrian Doroszko ◽  
...  

Background: Patients with heart failure (HF) are at high risk of unfavorable courses of COVID-19. The aim of this study was to evaluate characteristics and outcomes of COVID-19 patients with HF. Methods: Data of patients hospitalized in a tertiary hospital in Poland between March 2020 and May 2021 with laboratory-confirmed COVID-19 were analyzed. The study population was divided into a HF group (patients with a history of HF) and a non-HF group. Results: Out of 2184 patients (65 ± 13 years old, 50% male), 12% had a history of HF. Patients from the HF group were older, more often males, had more comorbidities, more often dyspnea, pulmonary and peripheral congestion, inflammation, and end-organ damage biomarkers. HF patients had longer and more complicated hospital stay, with more frequent acute HF development as compared with non-HF. They had significantly higher mortality assessed in hospital (35% vs. 12%) at three (53% vs. 22%) and six months (72% vs. 47%). Of 76 (4%) patients who developed acute HF, 71% died during hospitalization, 79% at three, and 87% at six months. Conclusions: The history of HF identifies patients with COVID-19 who are at high risk of in-hospital complications and mortality up to six months of follow-up.


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