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Major histocompatibility complex class I‐related chain A (MICA) is a highly polymorphic gene that modulates immune surveillance by binding to its receptor on natural killer cells, and its genetic polymorphisms have been associated with chronic immune‐mediated diseases. The progressive form of nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), is characterized by accumulation of fat and inflammatory cells in the hepatic parenchyma, potentially leading to liver cell injury and fibrosis. To date, there are no data describing the potential role of MICA in the pathogenesis of NAFLD. Therefore, our aim was to assess the association between MICA polymorphism and NASH and its histologic features. A total of 134 subjects were included. DNA from patients with biopsy‐proven NAFLD were genotyped using polymerase chain reaction–sequence‐specific oligonucleotide for MICA alleles. Liver biopsies were assessed for histologic diagnosis of NASH and specific pathologic features, including stage of fibrosis and grade of inflammation. Multivariate analysis was performed to draw associations between MICA alleles and the different variables; P ≤ 0.05 was considered significant. Univariate analysis showed that MICA*011 (odds ratio [OR], 7.14; 95% confidence interval [CI], 1.24‐41.0; P = 0.04) was associated with a higher risk for histologic NASH. Multivariate analysis showed that MICA*002 was independently associated with a lower risk for focal hepatocyte necrosis (OR, 0.24; 95% CI, 0.08‐0.74; P = 0.013) and advanced fibrosis (OR, 0.11; 95% CI, 0.02‐0.70; P = 0.019). MICA*017 was independently associated with a higher risk for lymphocyte‐mediated inflammation (OR, 5.12; 95% CI, 1.12‐23.5; P = 0.035). Conclusion: MICA alleles may be associated with NASH and its histologic features of inflammation and fibrosis. Additional research is required to investigate the potential role of MICA in increased risk or protection against NAFLD.

Background NAFLD impacts patient reported outcomes (PROs). Our aim was to assess the impact of NAFLD on patients’ HRQOL. Methods National Health and Nutrition Examination Survey (NHANES) 2001–2011 data were used to identify adult patients with NAFLD [Fatty Liver Index (FLI) > 60 in absence of other liver disease and excessive alcohol >20 g/day for men, >10 g/day for women]. Patients with other chronic diseases (ex. HIV, cancer, end-stage kidney disease) were excluded. Subjects without any of these conditions were healthy controls. HCV RNA (+) patients were HCV-controls. All patients completed NHANES HRQOL-4 questionnaire. Linear regression determined the association between NAFLD and HRQOL components adjusting for age, gender, race, and BMI. Results Participants with complete data were included ( n  = 9661); 3333 NAFLD (age 51 years and BMI 34 kg/m 2 ); 346 HCV+ (age 49 years; BMI 27 kg/m 2 ) and 5982 healthy controls (age 48 years and BMI 26 kg/m 2 ). The proportion of subjects rating their health as “fair” or “poor” in descending order were HCV controls (30 %) NAFLD (20 %) and healthy controls (10 %) ( p  < 0.001). HRQOL-4 components scores 2–4 were lowest for HCV, followed by NAFLD and then healthy controls (p-values p  = 0.011 to < .0001). After adjustment for age, gender, race, and BMI, NAFLD patients were 18–20 % more likely to report days when their physical health wasn’t good or were unable to perform daily activities as a result ( p  < .0001). Conclusions NAFLD causes impairment of HRQOL. As NAFLD is becoming the most important cause of CLD, its clinical and PRO impact must be assessed.

Hospice offers non-curative symptomatic management to improve patients' quality of life, satisfaction, and resource utilization. Hospice enrollment among patients with chronic liver disease (CLD) is not well studied. The aim of tis tudy is to examine the characteristics of Medicare enrollees with CLD, who were discharged to hospice. Medicare patients discharged to hospice between 2010 and 2014 were identified in Medicare Inpatient and Hospice Files. CLDs and other co-morbidities were identified by International Classification of Diseases-ninth revision codes. Generalized linear model was used to estimate regression coefficients with P-values. Logistic regression was used to calculate odds ratios and 95% confidence intervals. A total of 2,179 CLD patients and 34,986 controls without CLD met the inclusion criteria. Non-alcoholic fatty liver disease, alcoholic liver disease, and hepatitis C virus (HCV) were the most frequent cause of CLD. CLD patients were younger (70 vs. 83 years), more likely to be male (57.7 vs. 39.3%), had longer hospital stay (length of stay, LOS) (19.4 vs. 13.0 days), higher annual charges ($175,000 vs. $109,000), higher 30-day re-hospitalization rates (51.6 vs. 34.2%), and shorter hospice LOS (13.7 vs. 17.7 days) than controls (all P<0.001). Presence of HCV and congestive heart failure were the strongest contributors to increased total annual costs (34% and 31% higher, P<0.001), increased total annual LOS (26% and 43% higher, P<0.001), and increased 30-day readmission risk (2.20 and 2.19 times, respectively). Patients with CLD have longer and costly hospitalizations before hospice enrollment as compared with patients without CLD. It was highly likely that these patients were enrolled relatively late, which could potentially lead to less benefit from hospice.

Aim Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and may be associated with increased mortality. Our aim was to determine whether anthropometric measures are independently associated with mortality in NAFLD. Methods The third National Health and Nutrition Examination Surveys (1988–1994) data was used. Extensive radiologic, serologic and clinical data were available. NAFLD was defined as moderate-to-severe hepatic steatosis on the hepatic ultrasound in the absence of any cause of chronic liver disease (e.g. hepatitis C virus RNA negative, hepatitis B-surface antigen negative, normal transferrin saturation and alcohol consumption <20 gram/day). Anthropometric measures [body mass index (kg/m 2 ), waist, hip, arm, and thigh circumferences (cm), waist-to-hip ratio, percentage of body fat, and sum of skinfolds (mm)], laboratory measures and clinico-demographic data were analyzed. Statistical analyses were conducted with SUDAAN 10.0. Results A total of 10,565 adult participants were included [2,510 (weighted 21 %) with NAFLD and 8,055 non-NAFLD controls]. In multivariate analysis, NAFLD was independently associated with being Mexican-American (including Hispanic or other ethnicity), larger waist circumference (cm), type-2 diabetes, insulin resistance and hypertension. After about 14 years (median) of follow up, liver-specific mortality was independently associated with NAFLD and being White. Conclusions Components of metabolic syndrome, and Mexican-American ethnicity are independently associated with NAFLD. Furthermore, NAFLD is an independent predictors of liver-specific mortality in men and Whites.

To assess recent epidemiologic characteristics, temporal trends, and predictors of death and discharge disposition in patients with sepsis. This is a cross-sectional retrospective cohort study using the US National Inpatient Sample (NIS) data from 2009 to 2012. The study population included adults (18years and older) with sepsis-related International Classification of Diseases, Ninth Revision, Clinical Modification codes at the time of discharge. Factors associated with in-hospital mortality and patient discharge disposition were derived from multivariate analyses using multinomial logistic models by SAS PROC LOGISTIC with GLOGIT link. Of 1 303 640 patients admitted, 15% died, 30% were discharged to home without home care, 34% were transferred to a skilled outpatient facility, and 4% were transferred to another short-term hospital. In-hospital mortality decreased from 16.5% to 13.8% (P<.001) across time. Length of stay also decreased from 6.7 to 5.9days (P<.001). Reductions in mortality and length of stay were seen despite an increase in the number of comorbidities (P<.001). Multivariate analysis revealed that the strongest predictors of in-hospital mortality were respiratory, cardiovascular, and hepatic failures, and neurologic events. The predictors of transfer to an outpatient facility were a major operative procedure, neurologic event, respiratory failure, and weight loss. Weight loss was also an independent predictor of in-hospital mortality. Certain comorbidities and organ failures were associated with death and discharge to a skilled outpatient facility. •The impact of sepsis-related hospitalizations on society extends well beyond lives lost. Our study adds to the body of literature describing long-term morbidity in survivors of sepsis.•Given the long-term morbidity and mortality after discharge, there is a compelling need to improve postdischarge management of sepsis survivors and to further investigate the increased morbidity and mortality experienced by this population.•For the developed world, enhanced patient selection for advanced medical care, especially in the intensive care unit, has great potential to alleviate suffering and reduce cost by aggressively treating infections and appropriately addressing goals of care as soon as possible.•Our results indicated that weight loss was associated with in-hospital mortality and utilization of health care services upon discharge. Hence, aggressive prevention and management of nutrition during the hospital course needs to be addressed.•Sex and race disparities in health care warrant further investigation. Our study indicates that more women with sepsis die in the hospital or are transferred to a skilled outpatient facility.

Background The prevalence of advanced liver disease and its complications may be on the rise within the Medicare population. The study aim was trend assessment for prevalence, mortality and resource utilization of patients with advanced liver disease. Methods A retrospective, cross-sectional design was used to analyze a national sample of non-institutionalized Medicare in/outpatients from 2005 to 2009. Cases were ascertained by International Classification of Diseases, 9th Edition. Outcomes were overall mortality (within 1 year) and resource utilization [hospital length of stay (LOS/days) and institutional costs to Medicare]. Multivariate analyses were used to estimate the odds ratios for mortality predictors; linear regression was used for resource utilization predictors. Results A total of 21,913 beneficiaries with advanced liver disease were identified in the Medicare inpatient and outpatient administrative data sets from 2005 to 2009. Over 70 % of the beneficiaries with advanced liver disease died during study time period with 17 % dying while hospitalized. Predictors of mortality were: admission to the intensive care unit (ICU) and increasing Charlson Comorbidity Index. Predictors for increased LOS and cost were: ICU admission and having a thoracentesis procedure (both indicators of the levels of illness). Conclusions Advanced liver disease and its related complication are increasing in the Medicare population and are associated with very high mortality. Further study is warranted to understand the drivers of the increased prevalence of advanced liver disease for earlier identification and treatment.

Abstract Purpose To assess recent epidemiological characteristics, temporal trends and predictors of death and discharge disposition in patients with sepsis. Material and Methods This is a cross-sectional retrospective cohort study using the USA National Inpatient Sample (NIS) Data from 2009 to 2012. The study population included adults (18 years and older) with sepsis-related ICD-9 CM codes at time of discharge. Factors associated with in-hospital mortality and patient discharge disposition were derived from Multivariate analyses using multinomial logistic models by SAS PROC LOGISTIC with GLOGIT link. Results Of 1 303 640 patients admitted, 15% died, 30% were discharged to home without home care, 34% were transferred to a skilled outpatient facility and 4% were transferred to another short term hospital. In-hospital mortality decreased from 16.5% to 13.8% (P < .001) across time. Length of stay also decreased from 6.7 to 5.9 days (P < .001). Reductions in mortality and LOS were seen despite an increase in the number of comorbidities (P < .001). Multivariate analysis revealed the strongest predictors of in-hospital mortality were respiratory, cardiovascular, and hepatic failures, and neurologic events. The predictors of transfer to an outpatient facility were a major operative procedure, neurologic event, respiratory failure and weight loss. Weight loss was also an independent predictor of in-hospital mortality. Conclusion Certain comorbidities and organ failures were associated with death and discharge to a skilled outpatient facility.