Transcatheter vs surgical aortic‐valve replacement in low‐ to intermediate‐surgical‐risk candidates: A meta‐analysis and systematic review

The American and European expert documents recommend transcatheter aortic valve replacement (TAVR) for inoperable or high‐surgical‐risk patients with severe aortic stenosis. In comparison, efficacy of TAVR is relatively less studied in low‐ to intermediate‐surgical‐risk patients. We sought to discover whether TAVR can be as effective as surgical aortic valve replacement (SAVR) in low‐ to intermediate‐surgical‐risk candidates. Four randomized clinical trials (RCTs) and 8 prospective matched studies were selected using PubMed/MEDLINE, Embase, and Cochrane Library (inception: March 2017). Results were reported as random‐effects odds ratio (OR) with 95% confidence interval (CI). Among 9851 patients, analyses of RCTs showed that all‐cause mortality was comparable between TAVR and SAVR (short term, OR: 1.19, 95% CI: 0.86‐1.64, P = 0.30; mid‐term, OR: 0.97, 95% CI: 0.75‐1.26, P = 0.84; and long term, OR: 0.97, 95% CI: 0.81‐1.16, P = 0.76). The analysis restricted to matched studies showed similar outcomes. In the analysis stratified by study design, no significant differences were noted in the RCTs for stroke, whereas TAVR was better than SAVR in matched studies at short term only (OR: 0.46, 95% CI: 0.33‐0.65, P < 0.001). TAVR is associated with reduced risk of acute kidney injury and new‐onset atrial fibrillation (P < 0.05). However, increased incidence of permanent pacemaker implantation and paravalvular leaks was observed with TAVR. TAVR can provide similar mortality outcome compared with SAVR in low‐ to intermediate‐surgical‐risk patients with critical aortic stenosis. However, both procedures are associated with their own array of adverse events.     

Trends,etiologies, and predictors of 90‐day readmission after percutaneous ventricular assist device implantation: A national population‐based cohort study

Percutaneous ventricular assist devices (pVADs) are indicated to provide hemodynamic support in high‐risk percutaneous interventions and cardiogenic shock. However, there is a paucity of published data regarding the etiologies and predictors of 90‐day readmissions following pVAD use. We studied the data from the US Nationwide Readmissions Database (NRD) for the years 2013 and 2014. Patients with a primary discharge diagnosis of pVAD use were collected by searching the database for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedural code 37.68 (Impella and TandemHeart devices). Amongst this group, we examined 90‐day readmission rates. Comorbidities as identified by “CM_” variables provided by the NRD were also extracted. The Charlson Comorbidity Index was calculated using appropriate ICD‐9‐CM codes, as a secondary diagnosis. A 2‐level hierarchical logistic regression model was then used to identify predictors of 90‐day readmission following pVAD use. Records from 7074 patients requiring pVAD support during hospitalization showed that 1562 (22%) patients were readmitted within 90 days. Acute decompensated heart failure (22.6%) and acute coronary syndromes (11.2%) were the most common etiologies and heart failure (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.17–1.67), chronic obstructive pulmonary disease (OR: 1.26, 95% CI: 1.07–1.49), peripheral vascular disease (OR: 1.305, 95% CI: 1.09–1.56), and discharge into short‐ or long‐term facility (OR: 1.28, 95% CI: 1.08–1.51) were independently associated with an increased risk of 90‐day readmission following pVAD use. This study identifies important etiologies and predictors of short‐term readmission in this high‐risk patient group that can be used for risk stratification, optimizing discharge, and healthcare transition decisions.     

Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study

While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000‐Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV‐HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9 months, respectively (P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral (HR 0.60%, 95% CI 0.35‐0.98; P=.03) and HCV‐related HCC (HR 0.51%, 95% CI 0.30‐0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral‐related HCC. Further studies are needed to determine the underlying factor(s) responsible.     

Cardioprotective effect of Chinese herbal medicine for anthracycline-induced cardiotoxicity in cancer patients: A meta-analysis of prospective studies

Background:To assess the benefits and harmful effects of Chinese herbal medicine (CHM) formulations in preventing anthracyclines (ANT)-induced cardiotoxicity.Method:The Cochrane Library, Pubmed and EMBASE databases were electronically searched for relevant randomized controlled trials (RCTs) published till December 2021 in English or Chinese-language, in addition to manual searches through the reference lists of the selected papers, and the Chinese Conference Papers Database. Data was extracted by 2 investigators independently.Result:Seventeen RCTs reporting 11 different CHMs were included in this meta-analysis. The use of CHM reduced the occurrence of clinical heart failure (RR 0.48, 95% CI 0.39 to 0.60, P < .01) compared to the control group. Data on subclinical heart failure in terms of LVEF values showed that CHM reduced the occurrence of subclinical heart failure (RR 0.47, 95% CI 0.35 to 0.62, P < .01) as well.Conclusion:CHM is an effective and safe cardioprotective intervention that can potentially prevent ANT-induced cardiotoxicity. However, due to the insufficient quality of the included trials, our results should be interpreted with cautious.     

Chinese herbal medicine for Mild Cognitive Impairment and Age Associated Memory Impairment: a review of randomised controlled trials

This review assesses the effectiveness and safety of Chinese herbal medicines (CHM) for Mild Cognitive Impairment (MCI) and Age Associated Memory Impairment (AAMI). Electronic searches of English and Chinese databases and hand searches of Chinese journal holdings were conducted. Randomised controlled trials comparing orally administered CHM with placebo, no intervention or other therapy were considered. Ginkgo biloba was excluded. Ten trials met inclusion criteria. Eight different CHM were investigated. Methodological quality was assessed using the Jadad scale and five studies scored three or above. Two studies compared CHM with placebo and eight with another intervention. This review found an overall benefit on some outcome measures for the eight CHMs involved in the 10 RCTs but methodological and data reporting issues were evident. Meta-analysis of three studies found the effects of the CHMs were at least equivalent to piracetam on Mini-Mental State Examination (MMSE) scores. No severe adverse events were reported.     

Interaction of alcohol intake and cofactors on the risk of cirrhosis

Objective: Evaluation of the interaction between alcohol intake and cofactors [hepatitis B virus (HBV), hepatitis C virus (HCV), body mass index] and coffee consumption on the risk of cirrhosis. Design: Seven hundred and forty‐nine consecutive patients with chronic liver disease referring to units for liver or alcohol diseases in Italy during a 6‐months period. Teetotalers were excluded. The odds ratios (OR) for cirrhosis were evaluated using chronic hepatitis cases as the control group. Results: An alcohol intake of more than 3 units/day resulted associated with the likelihood of cirrhosis both in males (OR 4.3; 95% CI=2.5–7.3) and in females (OR 5.7; 95% CI=2.3–14.5). A multiplicative interaction on the risk of cirrhosis between risky alcohol intake and HBsAg or HCV‐Ab/HCV‐RNA positivity was observed. A reduction of cirrhosis risk was observed in subjects consuming more than 3 alcohol units/day with increasing coffee intake. The OR for the association with cirrhosis decreased from 2.3 (95% CI=1.2–4.4) in subjects drinking 0–2 cups of coffee/day to 1.4 (95% CI=0.6–3.6) in those drinking more than 2 cups/day. Conclusions: In subjects with an alcohol intake >3 units/day the coexistence of HBV or HCV multiplies the risk of cirrhosis. Coffee represents a modulator of alcoholic cirrhosis risk.     

Use of cyclooxygenase inhibitor and the risk of hepatocellular carcinoma in patients with chronic hepatitis B: A nested case‐control study using a nationwide population‐based data

The study aimed to investigate the relationship between the use of COX inhibitors and the risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B (CHB) using a nationwide population‐based data. A nested case‐control study was conducted using the National Health Insurance Service–National Sample Cohort (NHIS‐NSC) from 2002 to 2013 in Korea. We compared the use of COX inhibitors between HCC cases and matched controls by categorizing 5 groups according to the cumulative defined daily dose (cDDD, <28, 28‐90, 91‐180, 181‐360, and >360) adjusting the use of antiviral agents. A total of 4980 patients with CHB were analysed as 996 HCC cases and 3984 matched controls. The number of COX inhibitor users (≥28 cDDD) was 358 patients (36%) and 1814 patients (45%) in the HCC group and control group, respectively. The use of COX inhibitors was significantly associated with a decreased risk of HCC development compared with nonusers (adjusted odds ratio [OR] 0.62, 95% confidence interval [CI] 0.52‐0.73, P < .001). There was a dose‐dependent inverse relationship between the use of COX inhibitors and the risk of HCC. The adjusted ORs were 0.75 (95% CI: 0.63‐0.90), 0.41 (95% CI: 0.31‐0.56), 0.38 (95% CI: 0.25‐0.57) and 0.49 (95% CI: 0.31‐0.79) for the 28‐90, 91‐180, 181‐360 and >360 cDDDs, respectively (P < .01). In conclusion, the use of COX inhibitors was associated with a reduced risk of HCC in CHB. COX inhibitor may have a chemopreventive role in HCC development in patients with chronic liver disease.     

A meta‐analytic assessment of the risk of chronic kidney disease in patients with chronic hepatitis C virus infection

Epidemiological studies have reported conflicting results regarding hepatitis C virus (HCV) infection and the risk of chronic kidney disease (CKD). We systematically reviewed the literature to determine the risk of developing CKD in HCV‐infected individuals compared to uninfected individuals. MEDLINE and PUBMED were searched to identify observational studies that had reported an association between HCV and CKD or end‐stage renal disease (ESRD) through January 2015. Quantitative estimates [hazard ratio (HR) or odds ratio (OR)] and their 95% confidence intervals (CI) were extracted from each study. A random‐effects meta‐analysis was performed. Fourteen studies evaluating the risk of developing CKD/ESRD in HCV‐infected individuals (n = 336 227) compared to uninfected controls (n = 2 665 631) were identified‐ nine cohort studies and five cross‐sectional studies. The summary estimate indicated that individuals with HCV had a 23% greater risk of presenting with CKD compared to uninfected individuals (risk ratio = 1.23; 95% CI: 1.12–1.34). Results were similar by study type, for cohorts (HR = 1.26; 95% CI: 1.12–1.40) and cross‐sectional studies (OR = 1.21; 95% CI: 1.09–1.32). Country‐stratified analysis demonstrated a significantly increased risk between HCV and CKD in the Taiwanese subgroup (risk ratio = 1.28; 95% CI: 1.12–1.34) and the US subgroup (risk ratio = 1.17; 95% CI: 1.01–1.32). Egger regression revealed no evidence of publication bias. HCV infection is associated with a greater risk of developing and progression of CKD compared to uninfected controls.     

Psychoactive medications and crash involvement requiring hospitalization for older drivers: a population-based study

OBJECTIVES: To determine the association between psychoactive medications and crash risk in drivers aged 60 and older. DESIGN: Retrospective population‐based case‐crossover study. SETTING: A database study that linked the Western Australian Hospital Morbidity Data System and the Pharmaceutical Benefits Scheme. PARTICIPANTS: Six hundred sixteen individuals aged 60 and older who were hospitalized as the result of a motor vehicle crash between 2002 and 2008 in Western Australia. MEASUREMENTS: Hospitalization after a motor vehicle crash. RESULTS: Greater risk for a hospitalization crash was found for older drivers prescribed benzodiazepines (odds ratio (OR)=5.3, 95% confidence interval (CI)=3.6–7.8, P<.001), antidepressants (OR=1.8, 95% CI=1.0–3.3, P=.04), and opioid analgesics (OR=1.5, 95% CI=1.0–2.3, P=.05). Crash risk was significantly greater in men prescribed a benzodiazepine (OR=6.2, 95% CI=3.2–12.2, P<.001) or an antidepressant (OR=2.7, 95% CI=1.1–6.9, P=.03). Women prescribed benzodiazepines (OR=4.9, 95% CI=3.1–7.8, P<.001) or opioid analgesics (OR=1.8, 95% CI=1.1–3.0, P=.03) also had a significantly greater crash risk. Subgroup analyses further suggested that drivers with (OR=4.0, 95% CI=2.9–8.1, P<.001) and without (OR=6.0, 95% CI=3.8–9.5, P<.001) a chronic condition who were prescribed benzodiazepines were at greater crash risk. Drivers with a chronic condition taking antidepressants (OR=3.4, 95% CI=1.3–8.5, P=.01) also had a greater crash risk. CONCLUSION: Psychoactive medication usage was associated with greater risk of a motor vehicle crash requiring hospitalization in older drivers.     

A prospective study of the association between smoking and later alcohol drinking in the general population

Aims To address the possible prospective association between smoking habits and risk of later heavy drinking in the adult population. Design Pooled population‐based long‐term cohort studies with repeated assessments of smoking and alcohol habits. Setting Copenhagen, Denmark. Participants A total of 14 130 non‐ to moderate drinkers at baseline, who attended re‐examination. Measurements Among the non‐ to moderate drinkers we addressed the relation between smoking habits at first examination and the risk of becoming a heavy and excessive drinker at follow‐up. Findings Level of tobacco consumption at first examination predicted an increased risk of becoming a heavy and excessive drinker in a dose‐dependent manner. Men who smoked more than 25 g of tobacco per day had adjusted odds ratios of 2.12 (95% confidence interval (CI): 1.44–3.11) and 3.95 (95% CI: 1.93–8.95) for becoming heavy and excessive drinkers, compared to participants who had never smoked. Equivalent estimates among women were 1.76 (95% CI: 1.02–3.04) and 2.21 (95% CI: 1.00–4.58), respectively. Conclusions This study suggests that tobacco use is associated quantitatively with later risk of heavier drinking.     

Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes

Background and aims: To examine the association between maternal hepatitis B and C mono‐ and co‐infections with singleton pregnancy outcomes in the state of Florida. Methods: We analysed all Florida births from 1998 to 2007 using birth certificate records linked to hospital discharge data. The main outcomes of interest were selected pregnancy outcomes including preterm birth, low birth weight (LBW), small for gestational age (SGA), fetal distress, neonatal jaundice and congenital anomaly. Results: The study sample consisted of 1 670 369 records. Human immunodeficiency virus co‐infection and all forms of substance abuse were more frequent in mothers with hepatitis B and C infection. After using multivariable modelling to adjust for important socio‐demographical variables and obstetric complications, women with hepatitis C infection were more likely to have infants born preterm [odds ratio (OR), 1.40; 95% confidence intervals (CI), 1.15–1.72], with LBW (OR, 1.39; 95% CI, 1.11–1.74) and congenital anomaly (OR, 1.55; 95% CI, 1.14–2.11). In addition, women with hepatitis B infection were less likely to have infants born SGA (OR, 0.79; 95% CI, 0.66–0.95). Conclusions: Our findings provide further understanding of the association between maternal hepatitis B or C carrier status and perinatal outcomes. Infants born to women with hepatitis C infection appear to be at risk for poor birth outcomes, including preterm birth, LBW and congenital anomaly.     

Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a case–control study in China

Background/Aims: The risk factors for cholangiocarcinoma are incompletely defined in China, especially for intrahepatic cholangiocarcinoma (ICC). We evaluated the risk factors for both ICC and extrahepatic cholangiocarcinoma (ECC). Methods: A case–control study in which cases were cholangiocarcinoma patients referred to Peking Union Medical College Hospital (PUMCH) between 1998 and 2008 and controls were healthy individuals. Controls were randomly selected from an existing database of healthy individuals at the Health Screening Center of PUMCH. Data on liver disease, family history, diabetes, smoking and drinking were collected by a retrospective review of the patients' records and health examination reports or by interview. Results: A total of 190 patients (61 ICC; 129 ECC) and 380 age‐ and sex‐matched controls were enrolled. HBsAg (P<0.001) and anti‐HBc without HBsAg (P=0.001) were significantly related to ICC. The adjusted odds ratios (OR) and 95% confidence intervals (CI) were 18.1 (95% CI: 7.5–44.0) and 3.6 (95% CI: 1.7–7.6) respectively. Diabetes mellitus (P=0.007), cholecystolithiasis (P=0.004) and previous cholecystectomy (P<0.001) were significantly associated with ECC. The prevalence of cirrhosis was higher in ICC than that in ECC (P<0.001). Furthermore, on excluding the ICC patients with cirrhosis, ICC patients showed significant independent associations with HBsAg (OR: 7.3; 95% CI: 3.1–17.2) and anti‐HBc without HBsAg (OR: 2.4; 95% CI: 1.1–5.2). Conclusion: Cirrhosis and chronic hepatitis B virus infection are risk factors for ICC, while cholecystolithiasis, diabetes and previous cholecystectomy are risk factors for ECC.     

Exploratory study of the ‘weekend effect’ for acute medical admissions to public hospitals in Queensland,Australia

Aims: To determine whether in‐hospital deaths of patients admitted through emergency departments with acute exacerbations of chronic obstructive pulmonary disease (COPD), acute myocardial infarction, intracerebral haemorrhage and acute hip fracture are increased by weekend versus weekday admission (the ‘weekend effect’). Methods: We performed a retrospective analysis of statewide administrative data from public hospitals in Queensland, Australia, during the 2002/2003–2006/2007 financial years. The primary outcome was 30‐day in‐hospital mortality. The secondary outcome of 2‐day in‐hospital mortality helped determine whether increased mortality of weekend admissions was closely linked to weekend medical care. Results: During the study period, there were 30 522 COPD, 17 910 acute myocardial infarction, 4183 acute hip fracture and 1781 intracerebral haemorrhage admissions. There was no significant weekend effect on 30‐day in‐hospital mortality for COPD (adjusted risk ratio = 0.92, 95% CI: 0.81–1.04, P= 0.222), intracerebral haemorrhage (adjusted risk ratio = 1.01, 95% CI: 0.86–1.16, P= 0.935) or acute hip fracture (adjusted risk ratio = 0.78, 95% CI: 0.54–1.03, P= 0.13). There was a significant weekend effect for acute myocardial infarction (adjusted risk ratio = 1.15, 95% CI: 1.03–1.26, P= 0.007). Two‐day in‐hospital mortality showed similar results. Conclusion: This is the first Australian study on the ‘weekend effect’ (in a cohort other than neonates), and the first study worldwide to assess specifically the weekend effect among COPD patients. Observed patterns were consistent with overseas research. There was a significant weekend effect for myocardial infarction. Further research is needed to determine whether location (e.g. rural), clinical (e.g. disease severity) and service provision factors (e.g. access to invasive procedures) influence the weekend effect for acute medical conditions in Australia.     

Advanced chronic kidney disease: Relationship to outcomes post‐TAVR,a meta‐analysis

Chronic kidney disease (CKD) is associated with worse outcomes in high‐surgical‐risk patients undergoing transcatheter aortic valve replacement (TAVR). However, it is unclear whether this relationship is apparent in lower‐surgical‐risk patients. We sought to analyze existing literature to assess whether or not advanced CKD is associated with increased mortality or a greater incidence of adverse events (specifically major stroke, bleeding, and vascular complications). We searched PubMed and Embase (2008–2017) for relevant studies. Studies with <1 year follow‐up and those not evaluating advanced CKD or outcomes post‐TAVR were excluded. Our co–primary endpoints were the incidence of short‐term mortality (defined as in‐hospital or 30‐day mortality) and long‐term mortality (1 year). Our secondary endpoints included incidence of major stroke, life‐threatening bleeding, and major vascular complications. Eleven observational studies with a total population of 10709 patients met the selection criteria. Among patients with CKD there was an increased risk of short‐ and long‐term mortality in high‐surgical‐risk patients who underwent TAVR (hazard ratio [HR]: 1.51, 95% confidence interval [CI]: 1.22–1.88 and HR: 1.56, 95% CI: 1.38–1.77, respectively; P < 0.01). However, there was no association between CKD and mortality in low‐ to intermediate‐risk patients (HR: 1.35, 95% CI: 0.98–1.84, P = 0.06 in short‐term and HR: 1.08, 95% CI: 0.92–1.27, P = 0.34 in long‐term). In low‐ to intermediate‐risk TAVR patients, advanced CKD is not associated with increased mortality or poorer safety outcomes. These findings should be factored into the clinical decision‐making process regarding TAVR candidacy.     

Interferon therapy of acute hepatitis C in dialysis patients: meta‐analysis

Summary. The efficacy and safety of antiviral therapy in patients with acute hepatitis C on long‐term dialysis remains unclear, although a number of small clinical studies have been published addressing this issue. We evaluated the efficacy and safety of interferon therapy in chronic dialysis patients with acute hepatitis C by performing a systematic review of the literature with a meta‐analysis of clinical studies. The primary outcome was sustained virological response (SVR, as a measure of efficacy); the secondary outcome was dropout rate (as a measure of tolerability). We used the random effects model of DerSimonian and Laird, with heterogeneity and sensitivity analyses. We identified eight clinical studies (173 unique patients), three (37.5%) being controlled clinical trials (CCTs). Among CCTs, the viral response was much more common in study (patients on antiviral therapy) than control (patients who did not receive therapy) groups; the pooled odds ratio of SVR being 27.06, 95% Confidence Intervals (95% CI), 9.26; 79.1 (P =0.00001). No difference in the dropout rate between study and control patients was shown, odds ratio = 0.920 (95% CI, 0.367; 1.92), NS. Pooling all study results (n = 8 studies) demonstrated that the summary estimate for SVR and dropout rate was 58% (95% CI, 38; 77) and 9% (95% CI, 4; 14), respectively. The most frequent side‐effects requiring interruption of the treatment were flu‐like symptoms (n = 4, 18%), followed by haematological changes and loss to follow‐up. A strong relationship between increasing age and reported dropout rate was recognized (P = 0.001). The studies were heterogeneous with regard to SVR but not to dropout rate. Our meta‐analysis of CCTs showed that the viral response after antiviral therapy was more common than the spontaneous viral clearance in dialysis patients with acute hepatitis C. Pooled analysis demonstrated that IFN‐based therapy of acute hepatitis C in dialysis populations gives SVR in around one half of patients. These results support IFN‐based therapy for acute hepatitis C in patients on maintenance dialysis.     

Current but not past hepatitis B virus infection is associated with a decreased risk of nonalcoholic fatty liver disease in the Chinese population: A case‐control study with propensity score analysis

The relation between hepatitis B virus (HBV) infection and fatty liver has been addressed by several observational studies, but their results remain controversial. To date, no study has precisely investigated the association of current and past HBV infection with the risk of nonalcoholic fatty liver disease (NAFLD) in the Chinese population. Therefore, we conducted a hospital‐based case‐control study in southwestern China to clarify this issue. A total of 631 newly ultrasound‐diagnosed NAFLD cases and 2357 controls were selected from 123 243 consecutive patients admitted to a tertiary‐care hospital between January 2015 and December 2016. Multivariate logistic regression was employed to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). A propensity score was developed for adjustment and matching. Subgroup analysis was conducted to identify potential effect modifiers. Current and past HBV infection had an overall prevalence of 9.7% and 55.2%, respectively. In the fully adjusted model, current HBV infection was associated with a decreased risk of NAFLD (OR 0.64; 95% CI 0.42‐0.95). A similar inverse association was observed in both propensity‐score‐adjusted (OR 0.58; 95% CI 0.40‐0.86) and propensity‐score‐matched analyses (OR 0.61; 95% CI 0.40‐0.92).The inverse association was stronger in patients with hypertension than in those without (P_interaction = .018).No significant association between past HBV infection and NAFLD risk was found. In conclusion, current but not past HBV infection is associated with a decreased risk of NAFLD in the Chinese population. The corresponding biological mechanisms remain to be elucidated.     

Short communication: patterns of chronic and acute diseases after natural disasters - a study from the International Committee of the Red Cross field hospital in Banda Aceh after the 2004 Indian Ocean tsunami

Objective To assess the pattern of diseases in a natural disaster, which are not necessarily a direct consequence of the event but can impact on the way health assistance is to be provided. Methods Cross‐sectional, record‐based study in the International Committee of the Red Cross field hospital in Aceh, Indonesia, established immediately after the tsunami in 2004. Patients who presented to hospital from January 15 to 31, and whose diagnoses were available, were included in the study. Results One thousand one hundred and eighty‐eight residents of Aceh participated. 43.5% of the diagnoses was chronic diseases. The odds of chronic vs. acute diseases increased by 16.4% per day up to January 23 [95% confidence interval (CI): 7.8–25.6%] and decreased thereafter by 13.1% (95% CI: 6.6–19.1%) per day. The odds of acute diseases were 34% lower among females than males (95% CI: 16–49%) and 4.3 times higher among children than the rest of the population (95% CI: 2.4–7.6). There were relatively few trauma cases among females and children. Conclusions Medical teams providing relief after acute disasters should be prepared to provide healthcare for chronic diseases too. A delay in the presentation of many acute conditions has implications for long‐term health consequences of disasters, such as disability.     

Prediction of Contrast‐Induced Nephropathy With Persistent Renal Dysfunction and Adverse Long‐term Outcomes in Patients With Acute Myocardial Infarction Using the Mehran Risk Score

Background:

Contrast‐induced nephropathy (CIN) has been generally considered to be transient and associated with unfavorable clinical outcomes.

Hypothesis:

The aim of this study was to investigate whether Mehran risk score could predict CIN with persistent renal dysfunction and long‐term clinical outcomes in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI).

Methods:

We analyzed the clinical data of 1041 AMI patients. The primary end point was defined as major adverse cardiovascular and cerebrovascular event (MACCE) including death, reinfarction, target vessel revascularization, heart failure requiring hospital admission, and stroke. Patients were categorized into 4 groups according to risk scores: low (≤ 5, n = 596), moderate (6–10, n = 265), high (11–15, n = 111), and very high (≥16, n = 69).

Results:

Among the 148 patients (14.2%) who developed CIN, persistent renal dysfunction was observed in 68 patients. Presence in high‐ or very high‐risk groups was the most important independent risk factor of CIN with persistent renal dysfunction (odds ratio: 3.35, 95 confidence interval [CI]: 1.89–5.92, P < 0.001). Furthermore, patients in higher‐risk groups experienced significantly more MACCE and mortality 2 years after PCI. Using multivariate analysis, significant increase in the hazard ratio (HR) for MACCE was noted in moderate‐ (HR: 1.40, 95% CI: 0.97–2.03, P = 0.075), high‐ (HR 1.96, 95% CI: 1.22–3.15, P = 0.006), and very high‐risk (HR 2.40, 95% CI: 1.36–4.21, p = 0.002) groups, compared with the low‐risk group. The very high‐risk group had approximately 6‐fold increase in mortality over the low‐risk group (HR: 6.22, 95% CI: 2.77–13.95, P < 0.001).

Conclusions:

Mehran risk score predicted CIN with persistent renal dysfunction and long‐term clinical outcomes in patients with AMI. Drs. Jin Wi and Young‐Guk Ko contributed equally to the preparation of the article. This study was supported partly by grants from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (No. A085012, A102064, and A110879); the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (No.A08 5136); Yonsei University (6‐2009‐0008); Korea Institute of Medicine; and the Cardiovascular Research Center, Seoul, Korea. The authors have no other funding, financial relationships, or conflicts of interest to disclose.     

Sex and age differences in lipid response to chronic infection with the hepatitis C virus in the United States National Health and Nutrition Examination Surveys

Summary. Low levels of serum lipids were reported in subjects chronically infected with the hepatitis C virus (HCV) and correlated with poorer clinical outcomes. Whether HCV ‘hypo‐lipidemia’ is constant across age, sex and race has not been systematically explored. We therefore investigated the association between HCV infection and serum lipid levels in two independent National Health and Nutrition Examination Survey (NHANES) cohorts. HCV antibody status and serum lipid levels were obtained from 14 369 adults from NHANES 1999–2006 and 12 261 from NHANES III (enrolled in 1988–1994). In multivariable models, the prevalence of HCV‐associated hypo‐low density lipoprotein‐cholesterol was highest among women >50 years of age in both NHANES 1999–2006 (OR: 10.51, 95% CI: 2.86, 38.62) and III (OR: 24.21, 95% CI: 6.17, 94.92), but among women <50 years of age, the odds ratios were 3.01 (95% CI: 1.00, 9.04) for NHANES 1999–2006 and 0.52 (95% CI: 0.14, 1.88) for III, respectively. HCV by age interaction among women was significant in both cohorts (P < 0.001 and P = 0.004, respectively). Among men, the odds ratios of HCV‐associated hypo‐LDL‐cholesterol were 2.74 (95% CI: 1.55, 4.85) in NHANES 1999–2006 and 3.84 (95% CI: 1.66, 8.88) in III, respectively, with no significant age effects. Similar patterns were observed for total‐cholesterol, but no significantly discernable patterns for high density lipoprotein‐cholesterol and triglycerides. Results show that HCV infection is associated with lower total‐ and LDL‐cholesterol in two US population‐based cohorts, and this relationship varies significantly by age and sex, suggesting a possible influence of sex hormones on host lipid response to HCV infection.