Predictors of Respiratory Failure Development in a Multicenter Cohort of Inpatients With Cirrhosis.

Introduction: Hospitalized patients with cirrhosis can develop respiratory failure (RF), which is associated with a poor prognosis, but predisposing factors are unclear.

Methods: We prospectively enrolled a multicenter North American cirrhosis inpatient cohort and collected admission and in-hospital data (grading per European Association for the Study of Liver-Chronic Liver Failure scoring system, acute kidney injury [AKI], infections [admission/nosocomial], and albumin use) in an era when terlipressin was not available in North America. Multivariable regression to predict RF was performed using only admission day and in-hospital events occurring before RF.

Acute cholecystitis secondary to infection, complicated by sepsis, gallbladder perforation, hepatic abscess and bacteraemia.

Herein, a case of an immunocompromised patient in his early 70s is discussed who presented with clinical signs and symptoms compatible with sepsis from an intra-abdominal source and who was found to have blood cultures positive for the encapsulated Gram-negative pathogen , with the source of infection determined, via imaging, to be a case of acute cholecystitis complicated by gallbladder perforation, multiple pericholecystic and hepatic abscesses, and persistent bacteraemia. To our knowledge, this represents the first described case of cholecystitis and gallbladder perforation directly attributed to this species, and highlights both the pathogen's capacity to cause severe disease as well as the utility of a multidisciplinary approach to achieve optimal patient outcome.

Role of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization: A Prospective Multi-Center Cohort of Outpatients With Cirrhosis.

Background & Aims: Hospitalizations are a sentinel event in cirrhosis; however, the changing demographics in patients with cirrhosis require updated hospitalization prediction models. Periodontitis is a risk factor for liver disease and potentially progression. The aim of this study was to determine factors, including poor oral health, associated with 3-month hospitalizations in a multi-center cohort of outpatients with cirrhosis.

Inadequate practices for hepatic encephalopathy management in the inpatient setting.

Hepatic encephalopathy (HE) is an important complication of decompensated liver disease. Hospital admission for episodes of HE are very common, with these patients being managed by the hospitalists. These admissions are costly and burdensome to the health-care system.

Real-Time Peer-to-Peer Observation and Feedback Lead to Improvement in Oral Presentation Skills.

Background Oral case presentation is a vital skill in many fields, particularly in medicine, and is taught early on in medical schools. However, there is a diminished focus on the development of this skill during the clinical years. In this study, we investigated whether the implementation of a formal teaching strategy during the internal medicine clerkship rotation can lead to an improvement in oral presentation skills.

The Prediction of In-Hospital Mortality in Decompensated Cirrhosis with Acute-on-Chronic Liver Failure.

Acute-on-chronic liver failure (ACLF) is a condition in cirrhosis associated with organ failure (OF) and high short-term mortality. Both the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) and North American Consortium for the Study of End-Stage Liver Disease (NACSELD) ACLF definitions have been shown to predict ACLF prognosis. The aim of this study was to compare the ability of the EASL-CLIF versus NACSELD systems over baseline clinical and laboratory parameters in the prediction of in-hospital mortality in admitted patients with decompensated cirrhosis.

Liver-Unrelated Comorbid Conditions Do Not Affect Cognitive Performance or Hepatic Encephalopathy Progression in Cirrhosis.

Introduction: We aimed to determine the effect of comorbidities on covert hepatic encephalopathy (CHE) diagnosis and overt hepatic encephalopathy (OHE) development.

Methods: Cirrhotic outpatients underwent CHE testing and 2-year follow-up. Cox regression was performed for time to OHE.

The relationship between chronic arsenic exposure and body measures among US adults: National Health and Nutrition Examination Survey 2009-2016.

Background: Current research on the relationship between arsenic and body measures is inconclusive. We explored the relationship between arsenic and body measures in a large cohort representative of the United States population.

Methods: Data were analyzed from the 2009-2016 National Health and Nutrition Examination Survey (NHANES).

Perspectives of Inpatients With Cirrhosis and Caregivers on Using Health Information Technology: Cross-sectional Multicenter Study.

Background: Health information technology (IT) interventions to decrease readmissions for cirrhosis may be limited by patient-associated factors.

Objective: The aim of this study was to determine perspectives regarding adoption versus refusal of health IT interventions among patient-caregiver dyads.

Methods: Inpatients with cirrhosis and their caregivers were approached to participate in a randomized health IT intervention trial requiring daily contact with research teams via the Patient Buddy app.

What diet should I recommend my patient with Hepatic Encephalopathy?

Purpose Of Review: The burden of malnutrition is high in patients with cirrhosis, especially in those with hepatic encephalopathy (HE). This has a bearing on increased morbidity and mortality. Heightened attention needs to be paid to screen the patients at high nutritional risk both in the outpatient and hospitalized settings.

Focused Education Increases Hepatocellular Cancer Screening in Patients with Cirrhosis Regardless of Functional Health Literacy.

Background: Health education interventions are successful in modifying lifestyle. Functional health literacy (FHL) can determine patient adherence to clinic visits and procedures and may adversely impact the success of these interventions.

Aims: We sought to evaluate the hypothesis that a health education intervention would improve compliance with hepatocellular cancer (HCC) screening and that poor FHL would reduce such compliance.

Thirty-Day Hospital Readmissions: A Predictor of Higher All-cause Mortality for Up to Two Years.

Introduction Readmission within 30 days is used as a standard quality metric for hospitalized patients. We hypothesized that patients who get readmitted within 30 days may have higher short- and long-term mortality. Material and Methods Using administrative data, we retrospectively analyzed 2,353 patients admitted to inpatient medicine service over a period of one year.

Readmissions on Teaching Versus Non-Teaching Services: Are They Any Different?

Introduction There is a paucity of comparative data on readmissions between teaching services (TS) and nonteaching services (NTS). Therefore, we designed this study to determine if there are any differences in readmissions between the two services. Materials and methods A unique cohort of 384 readmissions during one year was retrospectively examined at Hunter Holmes McGuire Veterans Medical Center.

Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort.

Objective: Comorbid conditions are associated with poor prognosis in COVID-19. Registry data show that patients with cirrhosis may be at high risk. However, outcome comparisons among patients with cirrhosis+COVID-19 versus patients with COVID-19 alone and cirrhosis alone are lacking.

Nutritional Assessment in Inpatients With Cirrhosis Can Be Improved After Training and Is Associated With Lower Readmissions.

Malnutrition is widely prevalent in cirrhosis patients, which can worsen sarcopenia, hepatic encephalopathy (HE), and overall prognosis. We aimed to define the frequency of nutritional assessments of patients with cirrhosis in retrospective and prospective (after educational training) cohorts and to evaluate prospective changes along with their effects on 90-day readmissions. This study was conducted in 2 phases.

Neutrophil-to-Lymphocyte Ratio Associates Independently With Mortality in Hospitalized Patients With Cirrhosis.

Background & Aims: The neutrophil to lymphocyte ratio (NLR) is a biomarker of immune dysregulation in patients with cirrhosis and is inexpensive to measure. We investigated the association between NLR and mortality in hospitalized patients with cirrhosis at 4 liver transplant centers, controlling for severity of acute-on-chronic liver failure (ACLF).

Methods: We performed a retrospective study using data from the North American Consortium for the Study of End-stage Liver Disease on patients with index hospitalizations for cirrhosis from December 2011 through December 2016.

The patient buddy app can potentially prevent hepatic encephalopathy-related readmissions.

Background & Aims: Readmissions are a major burden in cirrhosis. A proportion of readmissions in cirrhosis, especially because of hepatic encephalopathy (HE) could be avoided through patient and caregiver engagement. We aimed to define the feasibility of using the Patient Buddy App and its impact on 30-day readmissions by engaging and educating cirrhotic inpatients and caregivers in a pilot study.

Covert Hepatic Encephalopathy: Can My Patient Drive?

Liver cirrhosis is a public health problem and hepatic encephalopathy is one of its main complications, which can be either overt meaning thereby evident and readily diagnosed, or covert/minimal (covert hepatic encephalopathy-CHE) needing psychometric testing for diagnosis. Patients with CHE hepatic encephalopathy have deficits in multiple domains including visuospatial assessment, attention, response inhibition, working memory, along with psychomotor speed to name a few areas. These patients have poor navigational skills, get fatigued easily, and demonstrate poor insight into their driving deficits.