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Liu CY, Noda C, van der Geest RJ, Triaire B, Kassai Y, Bluemke DA, Lima JAC. Sex-specific associations in multiparametric 3 T MRI measurements in adult livers. Abdom Radiol (NY) 2023; 48:3072-3078. [PMID: 37378865 DOI: 10.1007/s00261-023-03981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND MRI relaxometry mapping and proton density fat fraction (PDFF) have been proposed for the evaluation of hepatic fibrosis. However, sex-specific relationships of age and body fat with these MRI parameters have not been studied in detail among adults without clinically manifest hepatic disease. We aimed to determine the sex-specific correlation of multiparametric MRI parameters with age and body fat and to evaluate their interplay associations. METHODS 147 study participants (84 women, mean age 48±14 years, range 19-85 years) were prospectively enrolled. 3 T MRI including T1, T2 and T1ρ mapping and PDFF and R2* map were acquired. Visceral and subcutaneous fat were measured on the fat images from Dixon water-fat separation sequence. RESULTS All MRI parameters demonstrated sex difference except for T1ρ. PDFF was more related to visceral than subcutaneous fat. Per 100 ml gain of visceral or subcutaneous fat is associated with 1 or 0.4% accretion of liver fat, respectively. PDFF and R2* were higher in men (both P = 0.01) while T1 and T2 were higher in women (both P < 0.01). R2* was positively but T1 and T2 were negatively associated with age in women (all P < 0.01), while T1ρ was positively related to age in men (P < 0.05). In all studies, R2* was positively and T1ρ was negatively associated with PDFF (both P <0.0001). CONCLUSION Visceral fat plays an essential role in the elevated liver fat. When using MRI parametric measures for liver disease evaluation, the interplay between these parameters should be considered.
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Affiliation(s)
| | - Chikara Noda
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - David A Bluemke
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - João A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bednár R, Líška D, Gurín D, Vnenčaková J, Melichová A, Koller T, Skladaný Ľ. Low back pain in patients hospitalised with liver cirrhosis- a retrospective study. BMC Musculoskelet Disord 2023; 24:310. [PMID: 37076822 PMCID: PMC10114370 DOI: 10.1186/s12891-023-06424-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Lower back pain is a common issue, but little is known about the prevalence of pain in patients with liver cirrhosis during hospitalisation. Therefore, the objective of this study was to determine lower back pain in patients with liver cirrhosis. METHODS The sample consisted of patients with liver cirrhosis (n = 79; men n = 55; women n = 24; mean age = 55.79 ± 12.52 years). The hospitalised patients were mobile. The presence and intensity of pain were assessed in the lumbar spine during hospitalisation. The presence of pain was assessed using the visual analogue pain scale (0-10). The range of motion of the lower spine was assessed using the Schober and Stibor tests. Frailty was measured by Liver Frailty Index (LFI). The condition of liver disease was evaluated using The Model For the End-Stage Liver Disease (MELD) and Child-Pugh score (CPS) and ascites classification. Student's t test and Mann-Whitney test were used for analysis of the difference of group. Analysis of variance (ANOVA) with the Tukey post hoc test was used to test differences between categories of liver frailty index. The Kruskal-Wallis test was used to test pain distribution. Statistical significance was determined at the α-0.05 significance level. RESULT The prevalence of pain in patients with liver cirrhosis was 13.92% (n = 11), and the mean intensity of pain according to the visual analogue scale was 3.73 (± 1.90). Lower back pain was present in patients with ascites (15.91%; n = 7) and without ascites (11.43%; n = 4). The prevalence of lower back pain was not statistically significant between patients with and without ascites (p = 0,426). The base of Schober's assessment mean score was 3.74 cm (± 1.81), and based on Stibor's assessment mean score was 5.84 cm (± 2.23). CONCLUSION Lower back pain in patients with liver cirrhosis is a problem that requires attention. Restricted spinal mobility has been reported in patients with back pain, according to Stibor, compared to patients without pain. There was no difference in the incidence of pain in patients with and without ascites.
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Affiliation(s)
- R Bednár
- Department of Physiatry, Balneology and Rehabilitation of the Slovak Medical University, F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - D Líška
- Faculty of Arts, Department of Physical Education and Sports, Matej Bel University, Tajovského 40, Banská Bystrica, 974 01, Slovakia.
| | - D Gurín
- Faculty of Health Care, Slovak Medical University, Banská Bystrica, Slovakia
| | - J Vnenčaková
- 2nd Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - A Melichová
- Faculty of Health Care, Slovak Medical University, Banská Bystrica, Slovakia
| | - T Koller
- Gastroenterology and Hepatology Subdivision, 5th Department of Internat Medicine, Comenius University, University Hospital Bratislava, Bratislava, Slovakia
| | - Ľ Skladaný
- 2nd Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
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Mukund A, Choudhury SP, Tripathy TP, Ananthashayana VH, Jagdish RK, Arora V, Singh SP, Mishra AK, Sarin SK. Influence of shunt occlusion on liver volume and functions in hyperammonemic cirrhosis patients having large porto-systemic shunts: a randomized control trial. Hepatol Int 2023; 17:150-158. [PMID: 36094625 DOI: 10.1007/s12072-022-10418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Spontaneous-portosystemic-shunts (SPSS) in cirrhosis deprive the liver of nutrient-rich portal blood and contribute to recurrent hepatic encephalopathy (HE). We evaluated the effects of shunt occlusion and redirecting portal blood to liver on its volume and functions. METHODS Cirrhosis patients presenting with recurrent HE and having SPSS were randomized to receive standard medical treatment (SMT) or shunt occlusion (SO). The later was performed by plug-assisted or balloon-occluded retrograde transvenous obliteration. The primary endpoint was change in liver volume after a minimum follow-up of 3 months. Secondary objectives included clinical course, liver disease severity indices, arterial ammonia levels and bone density. RESULTS Of 40 enrolled patients, 4 in SMT and 2 in SO group were lost to follow-up. The SO was complete in 17 and partial in one, achieving non-recurrence of HE in 17 (94.4%). In these patients, the mean liver volume increased (baseline 1040 ± 335 ml to 1132 ± 322 ml, 8.8% increase, p < 0.001) and was observed in 16/18 (88.89%) patients. In the SMT group, the liver volume decreased (baseline 988 ± 270 ml to 904 ± 226 ml, 8.6% reduction, p = 0.009) during the same period. Serum albumin increased in SO group (2.92 ± 0.40 g/dl to 3.30 ± 0.49 g/dl, p = 0.006) but reduced in SMT group (2.89 ± 0.43 g/dl to 2.59 ± 0.65 g/dl, p = 0.047). After SO, the patients showed a reduction in serum-ammonia levels (181.06 ± 86.21 to 107.28 ± 44.53 μ/dl, p = 0.001) and an improvement in MELD-Na and bone density compared to SMT group. There were no major adverse events following shunt occlusion. CONCLUSION Occlusion of large SPSS results in improving the volume and synthetic functions of the liver by restoring hepato-petal portal flow besides reducing serum-ammonia level and recurrence of HE. CLINICALTRIALS gov number, NCT03293459.
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Affiliation(s)
- Amar Mukund
- Department of Intervention Radiology, ILBS, New Delhi, India
| | - Shakti Prasad Choudhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India
| | | | | | - Rakesh Kumar Jagdish
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India
| | - Vinod Arora
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India
| | - Satender Pal Singh
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India
| | - Ajay Kumar Mishra
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India.
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Holman A, Parikh N, Clauw DJ, Williams DA, Tapper EB. Contemporary management of pain in cirrhosis: Toward precision therapy for pain. Hepatology 2023; 77:290-304. [PMID: 35665522 PMCID: PMC9970025 DOI: 10.1002/hep.32598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/03/2023]
Abstract
Chronic pain is highly prevalent in patients with cirrhosis and is associated with poor health-related quality of life and poor functional status. However, there is limited guidance on appropriate pain management in this population, and pharmacologic treatment can be harmful, leading to adverse outcomes, such as gastrointestinal bleeding, renal injury, falls, and hepatic encephalopathy. Chronic pain can be categorized mechanistically into three pain types: nociceptive, neuropathic, and nociplastic, each responsive to different therapies. By discussing the identification, etiology, and treatment of these three mechanistic pain descriptors with a focus on specific challenges in patients with cirrhosis, we provide a framework for better tailoring treatments, including nonpharmacologic therapies, to patients' needs.
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Affiliation(s)
- Alexis Holman
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Neehar Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dan J. Clauw
- Chronic Pain and Fatigue Research Center, Anesthesiology Department, University of Michigan, Ann Arbor, Michigan, USA
| | - David A. Williams
- Chronic Pain and Fatigue Research Center, Anesthesiology Department, University of Michigan, Ann Arbor, Michigan, USA
| | - Elliot B. Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
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Brown RB. Non-Specific Low Back Pain, Dietary Salt Intake, and Posterior Lumbar Subcutaneous Edema. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159158. [PMID: 35954516 PMCID: PMC9368517 DOI: 10.3390/ijerph19159158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 12/10/2022]
Abstract
Low back pain is the world’s leading disability, but the etiology of the majority of low back pain is non-specific with no known cause. Moreover, overuse of opioids to treat low back pain is a widespread problem. This paper proposes that non-specific low back pain may be associated with excessive intake of dietary salt, potentially mediated by posterior lumbar subcutaneous edema. In addition to pain, symptoms of edema include swelling, tightness, and stiff joints, which are common complaints of people with low back pain, along with restricted lumbar range of motion and impaired mobility. Many global populations consume excess sodium chloride, which can lead to fluid overload in hypervolemia, and cause swelling and temporary weight gain associated with low back pain. Numerous conditions comorbid with low back pain are also potentially mediated by excessive salt intake, including migraine headache, hypertension, cardiovascular disease, venous thromboembolism, liver disease, respiratory disorders, chronic kidney disease, pregnancy complications, and multiple sclerosis. Novel approaches to identify and prevent the cause of non-specific low back pain have potential to reduce disability worldwide by reducing low back pain prevalence. More research is needed to confirm the involvement of dietary salt and posterior lumbar subcutaneous edema in non-specific low back pain.
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Affiliation(s)
- Ronald B Brown
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Tsagkaris C, Papadakos SP, Moysidis DV, Papazoglou AS, Koutsogianni A, Papadakis M. Hepatomusculoskeletal disorders: Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease. World J Gastrointest Pathophysiol 2022; 13:124-127. [PMID: 36161230 PMCID: PMC9350596 DOI: 10.4291/wjgp.v13.i4.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/07/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Chronic liver disease can affect many body systems including the musculoskeletal system. The pathogenetic crosstalk between the liver and organs such as the brain and the kidneys has already been described with compound terms merging the organs affected by the pathology, such as the hepatorenal syndrome. Nevertheless, the musculoskeletal manifestations of chronic liver disease have not been coined with such a term to date. Because of this shortage, documenting the musculoskeletal implications of chronic liver disease in both research and clinical practice is challenging. To fill this gap, the authors propose the term hepatomusculoskeletal disorders, a compound term of Greek origin that encompasses all the body structures involved in the aforementioned pathologic crosstalk.
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Affiliation(s)
- Christos Tsagkaris
- Public Health and Policy Working Group, Stg European Student Think Tank, Amsterdam, Netherlands
| | - Stavros P Papadakos
- Laiko General Hospital of Athens, National and Kapodistrian University of Athens, Athens 18233, Greece
| | - Dimitrios V Moysidis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | | | - Alexandra Koutsogianni
- Laiko General Hospital of Athens, National and Kapodistrian University of Athens, Athens 18233, Greece
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, University of Witten-Herdecke, Wuppertal 42283, Germany
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Kamimura H, Imai M, Abe H, Yoshioka A, Hirose K, Ishihara N, Ishikawa T, Terai S. Simultaneous muscular hemorrhages in two regions three years after successfully controlling refractory ascites using transjugular intrahepatic portosystemic shunt treatment: a case report. Clin J Gastroenterol 2022; 15:433-440. [PMID: 35038137 DOI: 10.1007/s12328-022-01591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Various therapies and drugs have been developed to extend the life expectancy of patients with liver cirrhosis. The prolonged prognosis of cirrhotic patients may change the final cause of death in the future. Deep bleeding into the muscle is an uncommon but potentially life-threatening complication of liver cirrhosis. CASE REPORT A 53-year-old man had undergone transjugular intrahepatic portosystemic shunt treatment for refractory ascites, which successfully controlled it for three years. However, he had started drinking again and experienced acute-on-chronic liver failure. He also had severe back pain. Abdominal computed tomography showed hyperdensities in the retroperitoneum and right pleural cavity. Despite blood infusion, he died from acute-on-chronic liver failure. A pathological autopsy revealed bleeding from the iliopsoas and right diaphragmatic muscle simultaneously, evident from the presence of red blood cells located between the muscle sheaths. Disruption of the small vessels in the skeletal muscle fibers was inferred. CONCLUSION This is a critical case that underscores the significance of improving available knowledge based on the cause of final death of the patients with cirrhosis, who now have a good long-term prognosis owing to the latest medical developments.
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Affiliation(s)
- Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Michitaka Imai
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Hiroyuki Abe
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Aiko Yoshioka
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Kanae Hirose
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Noriko Ishihara
- Department of Pathology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
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Ranjan R, Rampal S, Jaiman A, Ali Tokgöz M, Kit Koong J, Ramayah K, Rajaram R. Common musculoskeletal disorders in chronic liver disease patients. Jt Dis Relat Surg 2021; 32:818-823. [PMID: 34842121 PMCID: PMC8650659 DOI: 10.52312/jdrs.2021.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/16/2021] [Indexed: 12/24/2022] Open
Abstract
Chronic liver disease (CLD) is the commonest ailment affecting the hepatobiliary system. Six significant pathologies related to CLD include hepatic osteodystrophy (HO), increased infection susceptibility, sarcopenia, osteonecrosis of the femoral head (OFH), increased risk of periprosthetic complications and fracture. Hepatic osteodystrophy, which comprises osteopenia, osteoporosis, and osteomalacia, refers to alterations in bone mineral metabolism found in patients with CLD. The HO prevalence ranges from 13 to 95%. Low complement levels, poor opsonization capacity, portosystemic shunting, decreased albumin levels, and impaired reticuloendothelial system make the cirrhotic patients more susceptible to developing infectious diseases. Septic arthritis, osteomyelitis, prosthetic joint infection, and cellulitis were common types of CLD-associated infectious conditions. The incidence of septic arthritis is 1.5 to 2-fold higher in patients with cirrhosis. Sarcopenia, also known as muscle wasting, is one of the frequently overlooked manifestations of CLD. Sarcopenia has been shown to be independent predictor of longer mechanical ventilation, hospital stay, and 12-month mortality of post-transplantation. Alcohol and steroid abuse commonly associated with CLD are the two most important contributory factors for non-traumatic osteonecrosis. However, many studies have identified cirrhosis alone to be an independent cause of atraumatic osteonecrosis. The risk of developing OFH in cirrhosis patients increases by 2.4 folds and the need for total hip arthroplasty increases by 10 folds. Liver disease has been associated with worse outcomes and higher costs after arthroplasty. Cirrhosis is a risk factor for arthroplasty complications and is associated with a prolonged hospital stay, higher costs, readmission rates, and increased mortality after arthroplasty. Greater physician awareness of risk factors associated with musculoskeletal complications of CLD patients would yield earlier interventions, lower healthcare costs, and better overall clinical outcomes for this group of patients.
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Affiliation(s)
- Rajat Ranjan
- Integral Institute of Medical Sciences & Research, Integral University, Lucknow, India
| | - Sanjiv Rampal
- Department of Orthopaedics and Traumatology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Ashish Jaiman
- Vardhman Mahavir Medical College & Safdarjung Hospital, Central Institute of Orthopaedics, New Delhi, India
| | - Mehmet Ali Tokgöz
- Ankara Keçiören Training and Research Hospital, Consultant Orthopaedic Surgeon, Ankara, Turkey
| | - Jun Kit Koong
- Department of Surgery, Malaya University Medical Faculty, Kuala Lumpur, Malaysia
| | - Kamarajan Ramayah
- Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ruveena Rajaram
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Swain S, Coupland C, Mallen C, Kuo CF, Sarmanova A, Bierma-Zeinstra SMA, Englund M, Prieto-Alhambra D, Doherty M, Zhang W. Temporal relationship between osteoarthritis and comorbidities: a combined case control and cohort study in the UK primary care setting. Rheumatology (Oxford) 2021; 60:4327-4339. [PMID: 33506862 PMCID: PMC8410005 DOI: 10.1093/rheumatology/keab067] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/10/2021] [Indexed: 12/14/2022] Open
Abstract
Objective To determine the burden of comorbidities in OA and their temporal relationships in the UK. Methods The Clinical Practice Research Datalink (CPRD) GOLD was used to identify people with incident OA and age, gender and practice matched non-OA controls from UK primary care. Controls were assigned the same index date as matched cases (date of OA diagnosis). Associations between OA and 49 individual comorbidities and multimorbidities (two or more comorbidities excluding OA) both before and after OA diagnosis were estimated, adjusting for covariates, using odds ratios (aORs) and hazard ratios (aHRs), respectively. Results During 1997–2017, we identified 221 807 incident OA cases and 221 807 matched controls. Of 49 comorbidities examined, 38 were associated with OA both prior to and following the diagnosis of OA and 2 (dementia and systemic lupus erythematosus) were associated with OA only following the diagnosis of OA. People with OA had a higher risk of developing heart failure [aHR 1.63 (95% CI 1.56, 1.71)], dementia [aHR 1.62 (95% CI 1.56, 1.68)], liver diseases [aHR 1.51 (95% CI 1.37, 1.67)], irritable bowel syndrome [aHR 1.51 (95% CI 1.45, 1.58)], gastrointestinal bleeding [aHR 1.49 (95% CI 1.39, 1.59)], 10 musculoskeletal conditions and 25 other conditions following OA diagnosis. The aOR for multimorbidity prior to the index date was 1.71 (95% CI 1.69, 1.74), whereas the aHR for multimorbidity after the index date was 1.29 (95% CI 1.28, 1.30). Conclusions People with OA are more likely to have other chronic conditions both before and after the OA diagnosis. Further study on shared aetiology and causality of these associations is needed.
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Affiliation(s)
- Subhashisa Swain
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology.,Pain Centre and Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham
| | | | - Chang Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Aliya Sarmanova
- Musculoskeletal Research Unit, Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Department of Orthopaedic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
| | - Michael Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology.,Pain Centre and Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology.,Pain Centre and Versus Arthritis, University of Nottingham, Nottingham, UK
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Chronic Liver Disease Patients have Worse Outcomes and Increased Postoperative Complications After Orthopedic Fractures. J Clin Gastroenterol 2019; 53:e371-e375. [PMID: 30614942 DOI: 10.1097/mcg.0000000000001166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Cirrhotic patients are at a higher risk for sustaining orthopedic fractures with a reported prevalence of 5% to 20%. Cirrhosis also affects wound healing and bleeding risk, and hence, impacts the postoperative outcomes after fracture repair. However, there is limited data available on the postoperative risk factors and clinical outcomes of fractures in patients with chronic liver disease (CLD). METHODS Data from the National Inpatient Sample for the years 2012 to 2015 were analyzed. Patients were identified using ICD-9 codes for any fracture. ICD-9 codes for CLD were used to categorize patients into CLD and non-CLD groups. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges. Secondary outcomes included complications such as postoperative infection, prosthetic failure, bleeding, and improper wound healing. RESULTS A total of 931,193 patient encounters for orthopedic fractures were identified and divided into 17,388 with CLD and 913,806 without CLD (non-CLD). The inpatient mortality in patients with CLD was almost twice that of non-CLD patients (odds ratio, 1.95; 95% confidence interval, 1.8-2.1). Patients with CLD also had a longer mean LOS at 7.4±8.6 days versus 5.6±7.2 days (P<0.001) and higher total hospital charges at $76,198±99,494 versus $64,294±95,673 (P<0.001). CLD patients also had higher rates of infections, improper wound healing, and bleeding. DISCUSSION In this large retrospective study, CLD patients with fractures had significantly higher mortality, LOS and hospital charges. These findings correlate with the higher rates of infection, bleeding, and poorer wound healing in this population. Increased clinician awareness of these risks is a key to improving the care of CLD patients.
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