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Papers by pegah golabi

International Journal of General Medicine

Many with post-acute SARS-CoV-2 (PASC) have persistent symptoms impacting physical and cognitive ... more Many with post-acute SARS-CoV-2 (PASC) have persistent symptoms impacting physical and cognitive function, decreased health and health-related life quality. Monoclonal antibody (mAb) treatment was available to acutely infected patients which might improve these outcomes. Purpose: To compare patient perception of PASC symptoms for those receiving bamlanivimab or casirivimab and imdevimab (mAbs) to those not receiving this treatment (non-mAbs). To compare changes between these groups in symptoms, function and quality of life over a 6-month follow-up. Patients and Methods: Consented adults >28 days post-infection with positive SARS-CoV-2 qPCR or antigen test and SARS-CoV-2 infection between March of 2020 and July of 2022 were enrolled. This prospective, repeated measure observational study reports baseline through 6-month follow-up. Extensive sociodemographic data, detailed medical history, COVID-19 symptom history, and standardized measures of well-being, depression, anxiety, stigma, cognition, symptom assessment, distress, and health status were collected. Results: 323 participants [101 mAb, 221 non-mAb, 52.7±15.5 years, 47.7% male, body mass index (BMI) 31.4±8.4] were analyzed. Fewer symptoms at baseline were reported in mAb versus non-mAb participants (1.06±1.31 vs 1.78±2.15, respectively p=0.0177) 6 months: (0.911±1.276 mAb vs.1.75±2.22 non-mAb, p=0.0427). Both groups showed significant within-group decreases in symptom number (52 to 21 mAb, 126 to 63 non-mAb) and symptom burden (p=0.0088 mAb, p<0.00001 non-mAb). mAb patients had significantly shorter infection-to-baseline interval (days) (120.4±55.3 mAb vs 194.0±89.3 non-mAb, p<0.00001); less frequent history of myocardial infarction (0.0 vs 3.9%, p=0.0464); headache (2.0% vs.11.8%, p=0.0046), rash (3.1% vs 9.9%, p=0.0377), and miscellaneous muscle complaints (2.0% vs 12.3%, p=0.0035), plus significantly better 6-month mood. (2.2% vs 13.2%, p=0.0390). Conclusion: mAb treated participants had reduced symptom burden and consistently reported fewer symptoms than non-mAb at all time points despite less time since acute illness. Both groups reported a statistically significant decrease in symptoms by 6-month visit with no statistically significant differences between them at follow-up.

Gastroenterology, 2019

Background: Global prevalence of HCV among chronic HD recipients is around 9.5% (Goodkin DA, 2013... more Background: Global prevalence of HCV among chronic HD recipients is around 9.5% (Goodkin DA, 2013). Given this high prevalence, HCV screening of HD subjects is routinely recommended. Additionally, recently approved anti-HCV regimens have high efficacy and good safety in HD recipients. Since HD subjects qualify for Medicare coverage, data on the prevalence and outcomes of HCV in these patients will be important. Aim: Assess the prevalence, resource utilization and mortality amongst Medicare beneficiaries with HCV receiving chronic HD. Methods: We used Medicare database (2005-2016) to assess the prevalence and outcomes of HCV in chronic HD recipients by using ICD-9&10 codes. Mortality was assessed by Medicare-linked death registry while healthcare utilization included episodes of care, length of stay, total charges/payments. Independent predictors of outcomes were evaluated in multiple generalized linear or logistic regression models. Results: Of 15.5 million Medicare recipients (5% sample of 12-year datasets), 291,663 subjects were receiving chronic HD (67.3±15.2 years, 55% male, 55% white, 49% age-based Medicare eligibility). Prevalence of HCV in Medicare subjects on HD was 4.2% which was higher than in Medicare subjects not on HD (0.78%) (p=<0.0001). These prevalence trends remained stable over the study period (Figure). As expected, HCV patients on HD were more commonly cirrhotic (31.6% vs. 5.7%, p<0.0001). In multivariate survival analysis, in addition to age [OR: 1.053 (95% CI=1.053-1.054)], being male [1.067 (1.048-1.086) and having cirrhosis (3.4 (3.3-3.6) (all p<0.0001) were independent predictors of 1-year mortality. The mean total inpatient payment for HCV patients on HD remained stable after adjustment for inflation [2005

Obesity Surgery, 2021

Background Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in morbidly obese patient... more Background Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in morbidly obese patients, and fibrosis is an independent predictor of mortality. Noninvasive tests (NITs) are being developed for the detection of advanced fibrosis (AF). Purpose To assess the performance of three NITs (NAFLD fibrosis score, NFS, fibrosis-4 index, FIB-4, and aspartate aminotransferase-to-platelet ratio, APRI), in the identification of AF among morbidly obese patients. Materials and Methods Patients, who underwent bariatric surgery between 2004 and 2009 and had liver biopsy, were included. Fibrosis stages ≥ F2 and ≥ F3 were defined as significant and AF, respectively. Published and optimal thresholds (Youden index) for NFS, FIB-4 and APRI, sensitivity, specificity, positive and negative predictive values (PPV-NPV), and area under the receiver operator curves (AUROC) were evaluated. Results Among 584 patients (mean age 43.3 ± 11.3 years, 21.2% male, 75% white, mean BMI 45.5 ± 8.80), 31.7% had NA...

Diabetes, 2020

Background: The ELF test (score calculated from markers of fibrosis: hyaluronic acid, procollagen... more Background: The ELF test (score calculated from markers of fibrosis: hyaluronic acid, procollagen III amino-terminal peptide, and tissue inhibitor of matrix metalloproteinase 1) is a non-invasive blood test used to estimate fibrosis stage in chronic liver disease. Since NAFLD patients with advanced fibrosis are at the highest risk for adverse long-term outcomes, the aim is to assess performance of ELF for identification of advanced fibrosis in patients with NAFLD. Methods: Patients with biopsy-proven NAFLD were included. ELF scores were calculated using an ADVIA Centaur XP analyzer. Results: There were 409 patients with NAFLD: 47 ± 12.9 years, 30% male, 70% white, 34% type 2 diabetes (T2DM), 56% hyperlipidemia, 54% hypertension, mean (SD) BMI 41.0 ± 10.0 kg/m2, ALT 48.4 ± 42.0 U/L, mean ELF score was 9.0 ± 1.3. Of the study cohort, 23% patients (N=93) had advanced fibrosis. Patients with advanced fibrosis had significantly higher ELF: 10.2 ± 1.3 vs. 8.6 ± 1.0, p<0.0001. There was...

Hepatology Communications, 2019

Cardiovascular diseases (CVDs) are the leading cause of mortality in patients with nonalcoholic f... more Cardiovascular diseases (CVDs) are the leading cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). Our aim was to assess the association of atherosclerotic cardiovascular disease (ASCVD) risk scores with overall and cardiac-specific mortality among patients with NAFLD. We used the National Health and Nutrition Examination Survey III with the National Death Index-linked mortality files. NAFLD was defined by ultrasound as presence of steatosis in the absence of secondary causes of liver disease. High risk for CVD was defined as a 10-year ASCVD score ≥7.5%. Hazard ratios (HRs) and population-attributable fractions (PAFs) of high risk for CVD were calculated. Among 1,262 subjects with NAFLD (47.9% men; 41.2% white; mean age, 56.3 years), the prevalence of high risk for CVD was 55.9% and 4.8% had advanced fibrosis. After a median follow-up of 17.7 years, 482 subjects (38.2%) died of overall causes, of whom 382 (79.3%) had a high risk for CVD. The unadjusted over...

BMC Gastroenterology, 2019

Background: The prevalence and outcomes of non-alcoholic fatty liver disease (NAFLD) among elderl... more Background: The prevalence and outcomes of non-alcoholic fatty liver disease (NAFLD) among elderly have not been well described. Our aim was to assess the prevalence, risk factors and mortality of NAFLD in individuals older than 60 years. Methods: The data from the Third National Health and Nutrition Examination Survey with linked mortality files were utilized. NAFLD was defined by United States Fatty Liver Index in the absence of other causes of liver disease. Cox proportional hazards models were used to assess all-cause and cardiovascular (CV) mortality. All analyses were performed using SAS software. Results: Three thousand two hundred seventy-one NHANES-III participants were included. The prevalence rates from NAFLD were 40.3% (95% CI: 37.2-43.5%) and 39.2% (95% CI: 34.4-44.0%) among 60-74 and > 74 years old. Among aged 60-74, the risks for 5-year and 10-year all-cause mortality were associated with presence of NAFLD [adjusted hazard ratios: 1.60 (95% CI: 1.24-1.96) for 5-year and 1.22 (95%CI: 1.01-1.49) for 10-year]. CV mortality were higher in this group were (aHR: 2.12 (95% CI: 1.20-3.75) for 5-year and 1.06 (95%CI: 0.73-1.52) for 10-year]. In contrast, in individuals > 74 years old, diagnosis of NAFLD was not associated with all-cause or CVD mortality. Conclusions: NAFLD is common among elderly population. Although NAFLD is associated with increased risk of mortality for 60-74-year-old individuals, this risk was not increased in those older than 74 years.

Hepatology Communications, 2018

Dyslipidemia is one of the common risk factors for NAFLD and is associated with cardiovascular (C... more Dyslipidemia is one of the common risk factors for NAFLD and is associated with cardiovascular (CV) mortality, which is the most common cause of death in NAFLD. Lipid‐lowering agents (LLAs) are used to reduce CV events in the general population. Our aim was to assess whether the use of LLAs in patients with NAFLD can reduce the risk of CV mortality. We used the third National Health and Nutrition Examination Survey mortality linked files. Mortality was determined from the National Death Index records through 2011. NAFLD was diagnosed by ultrasound after exclusion of other causes of liver disease. After inclusion and exclusion, the cohort consisted of 2,566 patients with NAFLD (45.8% < 45 years of age, 52.8% male, 75.4% white). Those who were taking LLAs were more likely to be older, non‐Hispanic white, and had significantly higher rates of diabetes mellitus (DM), hyperlipidemia, hypertension, metabolic syndrome, and history of CV disease (CVD) (all P< 0.01). In our multivariat...

Medicine, 2018

Nonalcoholic steatohepatitis (NASH)-related cirrhosis and cryptogenic cirrhosis (CC) have become ... more Nonalcoholic steatohepatitis (NASH)-related cirrhosis and cryptogenic cirrhosis (CC) have become leading indications for liver transplantation (LT) in the US. Our aim was to compare the trends, clinical presentation, and outcomes for transplant candidates with NASH and CC. The Scientific Registry of Transplant Recipients (1994-2016) was used to select adult LT candidates and recipients with primary diagnoses of NASH and CC without hepatocellular carcinoma. Two lakh twenty-three thousand three hundred ninety-one LT candidates were listed between 1994 and 2016. Of these, 16,214 (7.3%) were listed for CC and 11,598 (5.2%) for NASH. Before 2004, NASH was seldom coded for an indication for LT, but became more common after 2009. Averaged across the study period, CC candidates compared with NASH candidates were younger and had fewer conditions of metabolic syndrome (MS). CC patients were more likely to have MS components in comparison to candidates with other chronic liver diseases (CLDs) (all P < .0001). For most of the study period, patients with CC or NASH were similarly more likely to be taken off the list due to deterioration or death, with to patients with other CLDs. Post-LT data were available for 14,052 transplant recipients with NASH or CC. With the exception of post-transplant diabetes, the outcomes of patients transplanted for CC and NASH were similar to those of other CLD patients. Number of LT due to CC and NASH cirrhosis is increasing. In the past decade, there is a shift from LT listing diagnosis from CC to NASH potentially related to increased awareness about NASH in transplant centers in the US. Abbreviations: CC = cryptogenic cirrhosis, CLD = chronic liver diseases, HCC = hepatocellular carcinoma, HCV = hepatitis C virus, HRSA = The Health Resources and Services Administration, LT = liver transplantation, MELD = the model for end-stage liver disease, MS = metabolic syndrome, NAFLD = nonalcoholic fatty liver disease, NASH = nonalcoholic steatohepatitis, OPTN = Organ Procurement and Transplantation Network, SRTR = Scientific Registry of Transplant Recipients.

Therapeutic Advances in Gastroenterology, 2018

Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming the most common type of chronic live... more Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming the most common type of chronic liver disease worldwide. From the spectrum of NAFLD, it is nonalcoholic steatohepatitis (NASH) that predominantly predisposes patients to higher risk for development of cirrhosis and hepatocellular carcinoma. There is growing evidence that the risk of progression to cirrhosis and hepatocellular carcinoma is not uniform among all patients with NASH. In fact, NASH patients with increasing numbers of metabolic diseases such as diabetes, hypertension, visceral obesity and dyslipidemia are at a higher risk of mortality. Additionally, patients with higher stage of liver fibrosis are also at increased risk of mortality. In this context, NASH patients with fibrosis are in the most urgent need of treatment. Also, the first line of treatment for NASH is lifestyle modification with diet and exercise. Nevertheless, the efficacy of lifestyle modification is quite limited. Additionally, vitamin E and piog...

Medicine, 2018

Background: Various etiologies of chronic liver disease often result in cirrhosis. Beside obvious... more Background: Various etiologies of chronic liver disease often result in cirrhosis. Beside obvious liver-related complications, cirrhosis also leads to loss of muscle mass and decreased exercise capacity. In this study, our aim was to conduct a systematic review of literature to investigate the efficacy of exercise interventions in patients with cirrhosis. Method: PubMed was used to perform the literature search. The mesh terms used were the following: (liver (and) cirrhosis (and) exercise or (exercise therapy)). The following terms were excluded: Non-alcoholic fatty liver disease (NAFLD). The search was limited to the English language and human research. The initial search was conducted on December 6, 2016 and re-reviewed May 2017. Results: Seven studies met selection criteria. Training interventions ranged between 4 and 14 weeks in duration with an exercise frequency of 3 to 5 days per week. Most studies demonstrated an increase in maximal oxygen consumption using gas exchange tech...

Hepatology (Baltimore, Md.), Jan 17, 2018

Primary biliary cholangitis (PBC) is a disease of small bile-ducts, which can lead to morbidity a... more Primary biliary cholangitis (PBC) is a disease of small bile-ducts, which can lead to morbidity and mortality. Our aim was to assess recent trends in mortality and healthcare utilization of PBC patients in Medicare program. Data from Medicare beneficiaries between 2005 and 2015 (5% random samples) were used. The diagnosis of PBC was established with ICD-9 code 571.6 used for both primary and secondary diagnoses. Mortality was assessed by Medicare-linked death registry. Healthcare utilization included episodes of care, length of stay, total charges/payments. Independent predictors of outcomes were evaluated in multiple generalized linear or logistic regression models. The study cohort included a total of 6,375 inpatient/outpatient Medicare beneficiaries (mean age 69.8 years, 17% male, 88% white and 18% with disability). Over the study period, 1-year mortality remained stable (9.1% to 14.3%, p=0.11). Independent predictors of 1-year mortality were older age, male gender, black race, t...

Clinics in Liver Disease, 2017

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) have been increa... more Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) have been increasingly recognized as global health problems. Treatment strategies have been focusing on patients with more advanced liver disease. Lifestyle modification and vitamin E treatment are effective in the treatment of NAFLD; other treatment options are not approved and not based on strong evidence. New agents are mainly targeting oxidative stress, inflammation, apoptosis, peroxisome proliferator-activated receptor family, insulin resistance, bile acid metabolism, farnesoid X receptor, and lipid metabolism. Phase II and III studies are underway, targeting different points of NAFLD and NASH pathogenesis, which will help in developing personalized treatment options.

Annals of Hepatology, 2017

Introduction. Hepatitis B (HBV) and C viruses (HCV) are important causes of hepatocellular carcin... more Introduction. Hepatitis B (HBV) and C viruses (HCV) are important causes of hepatocellular carcinoma (HCC). Our aim was to assess mortality and resource utilization of patients with HCC-related to HBV and HCV. Material and methods. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER)-Medicare linked database (2001-2009) was used. Medicare claims included patient demographic information, diagnoses, treatment, procedures, ICD-9 codes, service dates, payments, coverage status, survival data, carrier claims, and Medicare Provider Analysis and Review (MEDPAR) data. HCC related to HBV/HCV and non-cancer controls with HBV/HCV were included. Pair-wise comparisons were made by t-tests and chi-square tests. Logistic regression models to estimate odds ratios (ORs) with 95% confidence intervals (CIs) were used. Results. We included 2,711 cases of HCC (518 HBV, 2,193 HCV-related) and 5,130 non-cancer controls (1,321 HBV, 3,809 HCV). Between 2001-2009, HCC cases relat...

Annals of Hepatology, 2017

Introduction. HCV has been suspected to potentially cause degenerations in the central nervous sy... more Introduction. HCV has been suspected to potentially cause degenerations in the central nervous system.…

Journal of critical care, 2017

To assess recent epidemiologic characteristics, temporal trends, and predictors of death and disc... more 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...

Clinics in Liver Disease, 2017

HCV infection is associated with several dermatologic diseases, such as symptomatic mixed cryoglo... more HCV infection is associated with several dermatologic diseases, such as symptomatic mixed cryoglobulinemia, lichen planus, porphyria cutanea tarda, and necrolytic acral erythema. Most of the dermatologic manifestations may be caused by immune complexes. In the interferon and ribavirin era, treatment was associated with dermatologic side effects. The new generation of interferon-free and ribavirin-free anti-HCV regimens is devoid of dermatologic side effects.

Medicine, 2017

Hepatocellular carcinoma (HCC) is among the most common types of cancer. Liver transplantation (L... more Hepatocellular carcinoma (HCC) is among the most common types of cancer. Liver transplantation (LT) and surgical resection (SR) are primary surgical treatment options for HCC. The aim of the study was to assess mortality within 2 years postdiagnosis among patients with HCC according to their treatment modalities. We examined data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database between 2001 and 2009. SEER registries collect demographics, cancer stage and historical types, and treatments. Medicare claims include diagnoses, procedures, and survival status for each beneficiary. Patients with HCC were identified using the International Classification of Disease Oncology, Third Edition Site code C22.0 and Histology Code 8170-8175. Treatment modalities were LT, SR, or nonsurgical treatment. Total of 11,187 cases was included (age at diagnosis: 72 years, 69% male, 67% White). HCC patients who underwent LT were younger (61 vs 71 years), sicker (presence of decompensated cirrhosis: 80% vs 23%), and less likely to die within 2 years (29% vs 44%, all P < 0.01), compared to SR patients. In multivariate analysis, older age (HR: 1.01 [95% CI = 1.01-1.01]), stage of HCC other than local (HR: 1.81[95%CI = 1.70-1.91]), and being treated with SR (HR: 1.95 [95%CI = 1.55-2.46]) were independent predictors of mortality within 2 years. Furthermore, the presence of decompensated cirrhosis (HR: 1.84 [95%CI = 1.73-1.96]) and alcoholic liver disease (HR: 1.19[95%CI = 1.11-1.28]) increased within 2 years mortality. Mortality within 2 years postdiagnosis of HCC was significantly higher in patients treated with SR than LT.

Medicine, 2016

Mental and emotional health (MEH) impairment is commonly encountered in hepatitis C patients. Alt... more Mental and emotional health (MEH) impairment is commonly encountered in hepatitis C patients. Although the exact mechanism remains unknown, alterations in neurotransmitter and cytokine levels maybe associated with hepatitis C virus (HCV)-related MEH issues.The aim of the study was to assess association of serum biomarkers with self-reports of MEH in HCV patients before treatment and after achieving sustained virologic response (SVR).The HCV genotype-1-infected patients who achieved SVR at 12 weeks after treatment with ledipasvir (LDV)/sofosbuvir (SOF) ± ribavirin (RBV) were selected. Frozen serum samples from baseline, end of treatment (EOT), and posttreatment week 4 (PTW4) were used to assay 16 cytokines and monoamine neurotransmitters. Validated self-reports were used to assess MEH.Hundred patients were evaluated. Mean age was 53 years (57% male, 86% white). Compared with baseline, emotional well-being and emotional health significantly increased by EOT, and role emotional, emotio...

Medicine, 2016

New incidents of chronic hepatitis C (CH-C) have stabilized yet the full impact of CH-C is not re... more New incidents of chronic hepatitis C (CH-C) have stabilized yet the full impact of CH-C is not realized. Assess inpatient mortality and resource utilization for CH-C patients hospitalized in the United States. Adult CH-C patients were identified from The National Inpatient Sample (NIS) 2005 to 2009 database using the International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes (070.51, 070.54, 070.70, 070.71, 070.41, and 070.44) also used to identify comorbidities. 324,823 hospitalized CH-C patients were identified. Of these, 13.63% (N ¼ 44,288) were older than 65. The rate of hospitalization for the elderly cohort steadily increased over the study period with Medicare as the payer for the majority (86%). This cohort had higher inpatient charges, approximately a half day longer hospital stay (P < 0.001) and more moderate or severe illness. During the index hospitalization, older CH-C patients were twice more likely to die than the younger age-group (5% versus 2%, P < 0.001). In the adjusted model, older age (OR: 1.02 [95% CI, 1.02-1.03]), severity of illness (OR: 12.06 [95% CI, 10.68-13.62]), and number of diagnoses (OR: 1.10 [95% CI, 1.09-1.11]) were associated with higher in-hospital mortality; severity of illness and having private insurance were significantly associated with charge per hospital stay (P < 0.001). The number of CH-C patients 65 and older increased due to the aging of the baby boomer population. Early treatment of CH-C patients with highly effective, well-tolerated, new anti-HCV regimens may prevent this significant societal burden.

International Journal of General Medicine

Many with post-acute SARS-CoV-2 (PASC) have persistent symptoms impacting physical and cognitive ... more Many with post-acute SARS-CoV-2 (PASC) have persistent symptoms impacting physical and cognitive function, decreased health and health-related life quality. Monoclonal antibody (mAb) treatment was available to acutely infected patients which might improve these outcomes. Purpose: To compare patient perception of PASC symptoms for those receiving bamlanivimab or casirivimab and imdevimab (mAbs) to those not receiving this treatment (non-mAbs). To compare changes between these groups in symptoms, function and quality of life over a 6-month follow-up. Patients and Methods: Consented adults >28 days post-infection with positive SARS-CoV-2 qPCR or antigen test and SARS-CoV-2 infection between March of 2020 and July of 2022 were enrolled. This prospective, repeated measure observational study reports baseline through 6-month follow-up. Extensive sociodemographic data, detailed medical history, COVID-19 symptom history, and standardized measures of well-being, depression, anxiety, stigma, cognition, symptom assessment, distress, and health status were collected. Results: 323 participants [101 mAb, 221 non-mAb, 52.7±15.5 years, 47.7% male, body mass index (BMI) 31.4±8.4] were analyzed. Fewer symptoms at baseline were reported in mAb versus non-mAb participants (1.06±1.31 vs 1.78±2.15, respectively p=0.0177) 6 months: (0.911±1.276 mAb vs.1.75±2.22 non-mAb, p=0.0427). Both groups showed significant within-group decreases in symptom number (52 to 21 mAb, 126 to 63 non-mAb) and symptom burden (p=0.0088 mAb, p<0.00001 non-mAb). mAb patients had significantly shorter infection-to-baseline interval (days) (120.4±55.3 mAb vs 194.0±89.3 non-mAb, p<0.00001); less frequent history of myocardial infarction (0.0 vs 3.9%, p=0.0464); headache (2.0% vs.11.8%, p=0.0046), rash (3.1% vs 9.9%, p=0.0377), and miscellaneous muscle complaints (2.0% vs 12.3%, p=0.0035), plus significantly better 6-month mood. (2.2% vs 13.2%, p=0.0390). Conclusion: mAb treated participants had reduced symptom burden and consistently reported fewer symptoms than non-mAb at all time points despite less time since acute illness. Both groups reported a statistically significant decrease in symptoms by 6-month visit with no statistically significant differences between them at follow-up.

Gastroenterology, 2019

Background: Global prevalence of HCV among chronic HD recipients is around 9.5% (Goodkin DA, 2013... more Background: Global prevalence of HCV among chronic HD recipients is around 9.5% (Goodkin DA, 2013). Given this high prevalence, HCV screening of HD subjects is routinely recommended. Additionally, recently approved anti-HCV regimens have high efficacy and good safety in HD recipients. Since HD subjects qualify for Medicare coverage, data on the prevalence and outcomes of HCV in these patients will be important. Aim: Assess the prevalence, resource utilization and mortality amongst Medicare beneficiaries with HCV receiving chronic HD. Methods: We used Medicare database (2005-2016) to assess the prevalence and outcomes of HCV in chronic HD recipients by using ICD-9&10 codes. Mortality was assessed by Medicare-linked death registry while healthcare utilization included episodes of care, length of stay, total charges/payments. Independent predictors of outcomes were evaluated in multiple generalized linear or logistic regression models. Results: Of 15.5 million Medicare recipients (5% sample of 12-year datasets), 291,663 subjects were receiving chronic HD (67.3±15.2 years, 55% male, 55% white, 49% age-based Medicare eligibility). Prevalence of HCV in Medicare subjects on HD was 4.2% which was higher than in Medicare subjects not on HD (0.78%) (p=<0.0001). These prevalence trends remained stable over the study period (Figure). As expected, HCV patients on HD were more commonly cirrhotic (31.6% vs. 5.7%, p<0.0001). In multivariate survival analysis, in addition to age [OR: 1.053 (95% CI=1.053-1.054)], being male [1.067 (1.048-1.086) and having cirrhosis (3.4 (3.3-3.6) (all p<0.0001) were independent predictors of 1-year mortality. The mean total inpatient payment for HCV patients on HD remained stable after adjustment for inflation [2005

Obesity Surgery, 2021

Background Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in morbidly obese patient... more Background Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in morbidly obese patients, and fibrosis is an independent predictor of mortality. Noninvasive tests (NITs) are being developed for the detection of advanced fibrosis (AF). Purpose To assess the performance of three NITs (NAFLD fibrosis score, NFS, fibrosis-4 index, FIB-4, and aspartate aminotransferase-to-platelet ratio, APRI), in the identification of AF among morbidly obese patients. Materials and Methods Patients, who underwent bariatric surgery between 2004 and 2009 and had liver biopsy, were included. Fibrosis stages ≥ F2 and ≥ F3 were defined as significant and AF, respectively. Published and optimal thresholds (Youden index) for NFS, FIB-4 and APRI, sensitivity, specificity, positive and negative predictive values (PPV-NPV), and area under the receiver operator curves (AUROC) were evaluated. Results Among 584 patients (mean age 43.3 ± 11.3 years, 21.2% male, 75% white, mean BMI 45.5 ± 8.80), 31.7% had NA...

Diabetes, 2020

Background: The ELF test (score calculated from markers of fibrosis: hyaluronic acid, procollagen... more Background: The ELF test (score calculated from markers of fibrosis: hyaluronic acid, procollagen III amino-terminal peptide, and tissue inhibitor of matrix metalloproteinase 1) is a non-invasive blood test used to estimate fibrosis stage in chronic liver disease. Since NAFLD patients with advanced fibrosis are at the highest risk for adverse long-term outcomes, the aim is to assess performance of ELF for identification of advanced fibrosis in patients with NAFLD. Methods: Patients with biopsy-proven NAFLD were included. ELF scores were calculated using an ADVIA Centaur XP analyzer. Results: There were 409 patients with NAFLD: 47 ± 12.9 years, 30% male, 70% white, 34% type 2 diabetes (T2DM), 56% hyperlipidemia, 54% hypertension, mean (SD) BMI 41.0 ± 10.0 kg/m2, ALT 48.4 ± 42.0 U/L, mean ELF score was 9.0 ± 1.3. Of the study cohort, 23% patients (N=93) had advanced fibrosis. Patients with advanced fibrosis had significantly higher ELF: 10.2 ± 1.3 vs. 8.6 ± 1.0, p<0.0001. There was...

Hepatology Communications, 2019

Cardiovascular diseases (CVDs) are the leading cause of mortality in patients with nonalcoholic f... more Cardiovascular diseases (CVDs) are the leading cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). Our aim was to assess the association of atherosclerotic cardiovascular disease (ASCVD) risk scores with overall and cardiac-specific mortality among patients with NAFLD. We used the National Health and Nutrition Examination Survey III with the National Death Index-linked mortality files. NAFLD was defined by ultrasound as presence of steatosis in the absence of secondary causes of liver disease. High risk for CVD was defined as a 10-year ASCVD score ≥7.5%. Hazard ratios (HRs) and population-attributable fractions (PAFs) of high risk for CVD were calculated. Among 1,262 subjects with NAFLD (47.9% men; 41.2% white; mean age, 56.3 years), the prevalence of high risk for CVD was 55.9% and 4.8% had advanced fibrosis. After a median follow-up of 17.7 years, 482 subjects (38.2%) died of overall causes, of whom 382 (79.3%) had a high risk for CVD. The unadjusted over...

BMC Gastroenterology, 2019

Background: The prevalence and outcomes of non-alcoholic fatty liver disease (NAFLD) among elderl... more Background: The prevalence and outcomes of non-alcoholic fatty liver disease (NAFLD) among elderly have not been well described. Our aim was to assess the prevalence, risk factors and mortality of NAFLD in individuals older than 60 years. Methods: The data from the Third National Health and Nutrition Examination Survey with linked mortality files were utilized. NAFLD was defined by United States Fatty Liver Index in the absence of other causes of liver disease. Cox proportional hazards models were used to assess all-cause and cardiovascular (CV) mortality. All analyses were performed using SAS software. Results: Three thousand two hundred seventy-one NHANES-III participants were included. The prevalence rates from NAFLD were 40.3% (95% CI: 37.2-43.5%) and 39.2% (95% CI: 34.4-44.0%) among 60-74 and > 74 years old. Among aged 60-74, the risks for 5-year and 10-year all-cause mortality were associated with presence of NAFLD [adjusted hazard ratios: 1.60 (95% CI: 1.24-1.96) for 5-year and 1.22 (95%CI: 1.01-1.49) for 10-year]. CV mortality were higher in this group were (aHR: 2.12 (95% CI: 1.20-3.75) for 5-year and 1.06 (95%CI: 0.73-1.52) for 10-year]. In contrast, in individuals > 74 years old, diagnosis of NAFLD was not associated with all-cause or CVD mortality. Conclusions: NAFLD is common among elderly population. Although NAFLD is associated with increased risk of mortality for 60-74-year-old individuals, this risk was not increased in those older than 74 years.

Hepatology Communications, 2018

Dyslipidemia is one of the common risk factors for NAFLD and is associated with cardiovascular (C... more Dyslipidemia is one of the common risk factors for NAFLD and is associated with cardiovascular (CV) mortality, which is the most common cause of death in NAFLD. Lipid‐lowering agents (LLAs) are used to reduce CV events in the general population. Our aim was to assess whether the use of LLAs in patients with NAFLD can reduce the risk of CV mortality. We used the third National Health and Nutrition Examination Survey mortality linked files. Mortality was determined from the National Death Index records through 2011. NAFLD was diagnosed by ultrasound after exclusion of other causes of liver disease. After inclusion and exclusion, the cohort consisted of 2,566 patients with NAFLD (45.8% < 45 years of age, 52.8% male, 75.4% white). Those who were taking LLAs were more likely to be older, non‐Hispanic white, and had significantly higher rates of diabetes mellitus (DM), hyperlipidemia, hypertension, metabolic syndrome, and history of CV disease (CVD) (all P< 0.01). In our multivariat...

Medicine, 2018

Nonalcoholic steatohepatitis (NASH)-related cirrhosis and cryptogenic cirrhosis (CC) have become ... more Nonalcoholic steatohepatitis (NASH)-related cirrhosis and cryptogenic cirrhosis (CC) have become leading indications for liver transplantation (LT) in the US. Our aim was to compare the trends, clinical presentation, and outcomes for transplant candidates with NASH and CC. The Scientific Registry of Transplant Recipients (1994-2016) was used to select adult LT candidates and recipients with primary diagnoses of NASH and CC without hepatocellular carcinoma. Two lakh twenty-three thousand three hundred ninety-one LT candidates were listed between 1994 and 2016. Of these, 16,214 (7.3%) were listed for CC and 11,598 (5.2%) for NASH. Before 2004, NASH was seldom coded for an indication for LT, but became more common after 2009. Averaged across the study period, CC candidates compared with NASH candidates were younger and had fewer conditions of metabolic syndrome (MS). CC patients were more likely to have MS components in comparison to candidates with other chronic liver diseases (CLDs) (all P < .0001). For most of the study period, patients with CC or NASH were similarly more likely to be taken off the list due to deterioration or death, with to patients with other CLDs. Post-LT data were available for 14,052 transplant recipients with NASH or CC. With the exception of post-transplant diabetes, the outcomes of patients transplanted for CC and NASH were similar to those of other CLD patients. Number of LT due to CC and NASH cirrhosis is increasing. In the past decade, there is a shift from LT listing diagnosis from CC to NASH potentially related to increased awareness about NASH in transplant centers in the US. Abbreviations: CC = cryptogenic cirrhosis, CLD = chronic liver diseases, HCC = hepatocellular carcinoma, HCV = hepatitis C virus, HRSA = The Health Resources and Services Administration, LT = liver transplantation, MELD = the model for end-stage liver disease, MS = metabolic syndrome, NAFLD = nonalcoholic fatty liver disease, NASH = nonalcoholic steatohepatitis, OPTN = Organ Procurement and Transplantation Network, SRTR = Scientific Registry of Transplant Recipients.

Therapeutic Advances in Gastroenterology, 2018

Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming the most common type of chronic live... more Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming the most common type of chronic liver disease worldwide. From the spectrum of NAFLD, it is nonalcoholic steatohepatitis (NASH) that predominantly predisposes patients to higher risk for development of cirrhosis and hepatocellular carcinoma. There is growing evidence that the risk of progression to cirrhosis and hepatocellular carcinoma is not uniform among all patients with NASH. In fact, NASH patients with increasing numbers of metabolic diseases such as diabetes, hypertension, visceral obesity and dyslipidemia are at a higher risk of mortality. Additionally, patients with higher stage of liver fibrosis are also at increased risk of mortality. In this context, NASH patients with fibrosis are in the most urgent need of treatment. Also, the first line of treatment for NASH is lifestyle modification with diet and exercise. Nevertheless, the efficacy of lifestyle modification is quite limited. Additionally, vitamin E and piog...

Medicine, 2018

Background: Various etiologies of chronic liver disease often result in cirrhosis. Beside obvious... more Background: Various etiologies of chronic liver disease often result in cirrhosis. Beside obvious liver-related complications, cirrhosis also leads to loss of muscle mass and decreased exercise capacity. In this study, our aim was to conduct a systematic review of literature to investigate the efficacy of exercise interventions in patients with cirrhosis. Method: PubMed was used to perform the literature search. The mesh terms used were the following: (liver (and) cirrhosis (and) exercise or (exercise therapy)). The following terms were excluded: Non-alcoholic fatty liver disease (NAFLD). The search was limited to the English language and human research. The initial search was conducted on December 6, 2016 and re-reviewed May 2017. Results: Seven studies met selection criteria. Training interventions ranged between 4 and 14 weeks in duration with an exercise frequency of 3 to 5 days per week. Most studies demonstrated an increase in maximal oxygen consumption using gas exchange tech...

Hepatology (Baltimore, Md.), Jan 17, 2018

Primary biliary cholangitis (PBC) is a disease of small bile-ducts, which can lead to morbidity a... more Primary biliary cholangitis (PBC) is a disease of small bile-ducts, which can lead to morbidity and mortality. Our aim was to assess recent trends in mortality and healthcare utilization of PBC patients in Medicare program. Data from Medicare beneficiaries between 2005 and 2015 (5% random samples) were used. The diagnosis of PBC was established with ICD-9 code 571.6 used for both primary and secondary diagnoses. Mortality was assessed by Medicare-linked death registry. Healthcare utilization included episodes of care, length of stay, total charges/payments. Independent predictors of outcomes were evaluated in multiple generalized linear or logistic regression models. The study cohort included a total of 6,375 inpatient/outpatient Medicare beneficiaries (mean age 69.8 years, 17% male, 88% white and 18% with disability). Over the study period, 1-year mortality remained stable (9.1% to 14.3%, p=0.11). Independent predictors of 1-year mortality were older age, male gender, black race, t...

Clinics in Liver Disease, 2017

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) have been increa... more Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) have been increasingly recognized as global health problems. Treatment strategies have been focusing on patients with more advanced liver disease. Lifestyle modification and vitamin E treatment are effective in the treatment of NAFLD; other treatment options are not approved and not based on strong evidence. New agents are mainly targeting oxidative stress, inflammation, apoptosis, peroxisome proliferator-activated receptor family, insulin resistance, bile acid metabolism, farnesoid X receptor, and lipid metabolism. Phase II and III studies are underway, targeting different points of NAFLD and NASH pathogenesis, which will help in developing personalized treatment options.

Annals of Hepatology, 2017

Introduction. Hepatitis B (HBV) and C viruses (HCV) are important causes of hepatocellular carcin... more Introduction. Hepatitis B (HBV) and C viruses (HCV) are important causes of hepatocellular carcinoma (HCC). Our aim was to assess mortality and resource utilization of patients with HCC-related to HBV and HCV. Material and methods. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER)-Medicare linked database (2001-2009) was used. Medicare claims included patient demographic information, diagnoses, treatment, procedures, ICD-9 codes, service dates, payments, coverage status, survival data, carrier claims, and Medicare Provider Analysis and Review (MEDPAR) data. HCC related to HBV/HCV and non-cancer controls with HBV/HCV were included. Pair-wise comparisons were made by t-tests and chi-square tests. Logistic regression models to estimate odds ratios (ORs) with 95% confidence intervals (CIs) were used. Results. We included 2,711 cases of HCC (518 HBV, 2,193 HCV-related) and 5,130 non-cancer controls (1,321 HBV, 3,809 HCV). Between 2001-2009, HCC cases relat...

Annals of Hepatology, 2017

Introduction. HCV has been suspected to potentially cause degenerations in the central nervous sy... more Introduction. HCV has been suspected to potentially cause degenerations in the central nervous system.…

Journal of critical care, 2017

To assess recent epidemiologic characteristics, temporal trends, and predictors of death and disc... more 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...

Clinics in Liver Disease, 2017

HCV infection is associated with several dermatologic diseases, such as symptomatic mixed cryoglo... more HCV infection is associated with several dermatologic diseases, such as symptomatic mixed cryoglobulinemia, lichen planus, porphyria cutanea tarda, and necrolytic acral erythema. Most of the dermatologic manifestations may be caused by immune complexes. In the interferon and ribavirin era, treatment was associated with dermatologic side effects. The new generation of interferon-free and ribavirin-free anti-HCV regimens is devoid of dermatologic side effects.

Medicine, 2017

Hepatocellular carcinoma (HCC) is among the most common types of cancer. Liver transplantation (L... more Hepatocellular carcinoma (HCC) is among the most common types of cancer. Liver transplantation (LT) and surgical resection (SR) are primary surgical treatment options for HCC. The aim of the study was to assess mortality within 2 years postdiagnosis among patients with HCC according to their treatment modalities. We examined data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database between 2001 and 2009. SEER registries collect demographics, cancer stage and historical types, and treatments. Medicare claims include diagnoses, procedures, and survival status for each beneficiary. Patients with HCC were identified using the International Classification of Disease Oncology, Third Edition Site code C22.0 and Histology Code 8170-8175. Treatment modalities were LT, SR, or nonsurgical treatment. Total of 11,187 cases was included (age at diagnosis: 72 years, 69% male, 67% White). HCC patients who underwent LT were younger (61 vs 71 years), sicker (presence of decompensated cirrhosis: 80% vs 23%), and less likely to die within 2 years (29% vs 44%, all P < 0.01), compared to SR patients. In multivariate analysis, older age (HR: 1.01 [95% CI = 1.01-1.01]), stage of HCC other than local (HR: 1.81[95%CI = 1.70-1.91]), and being treated with SR (HR: 1.95 [95%CI = 1.55-2.46]) were independent predictors of mortality within 2 years. Furthermore, the presence of decompensated cirrhosis (HR: 1.84 [95%CI = 1.73-1.96]) and alcoholic liver disease (HR: 1.19[95%CI = 1.11-1.28]) increased within 2 years mortality. Mortality within 2 years postdiagnosis of HCC was significantly higher in patients treated with SR than LT.

Medicine, 2016

Mental and emotional health (MEH) impairment is commonly encountered in hepatitis C patients. Alt... more Mental and emotional health (MEH) impairment is commonly encountered in hepatitis C patients. Although the exact mechanism remains unknown, alterations in neurotransmitter and cytokine levels maybe associated with hepatitis C virus (HCV)-related MEH issues.The aim of the study was to assess association of serum biomarkers with self-reports of MEH in HCV patients before treatment and after achieving sustained virologic response (SVR).The HCV genotype-1-infected patients who achieved SVR at 12 weeks after treatment with ledipasvir (LDV)/sofosbuvir (SOF) ± ribavirin (RBV) were selected. Frozen serum samples from baseline, end of treatment (EOT), and posttreatment week 4 (PTW4) were used to assay 16 cytokines and monoamine neurotransmitters. Validated self-reports were used to assess MEH.Hundred patients were evaluated. Mean age was 53 years (57% male, 86% white). Compared with baseline, emotional well-being and emotional health significantly increased by EOT, and role emotional, emotio...

Medicine, 2016

New incidents of chronic hepatitis C (CH-C) have stabilized yet the full impact of CH-C is not re... more New incidents of chronic hepatitis C (CH-C) have stabilized yet the full impact of CH-C is not realized. Assess inpatient mortality and resource utilization for CH-C patients hospitalized in the United States. Adult CH-C patients were identified from The National Inpatient Sample (NIS) 2005 to 2009 database using the International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes (070.51, 070.54, 070.70, 070.71, 070.41, and 070.44) also used to identify comorbidities. 324,823 hospitalized CH-C patients were identified. Of these, 13.63% (N ¼ 44,288) were older than 65. The rate of hospitalization for the elderly cohort steadily increased over the study period with Medicare as the payer for the majority (86%). This cohort had higher inpatient charges, approximately a half day longer hospital stay (P < 0.001) and more moderate or severe illness. During the index hospitalization, older CH-C patients were twice more likely to die than the younger age-group (5% versus 2%, P < 0.001). In the adjusted model, older age (OR: 1.02 [95% CI, 1.02-1.03]), severity of illness (OR: 12.06 [95% CI, 10.68-13.62]), and number of diagnoses (OR: 1.10 [95% CI, 1.09-1.11]) were associated with higher in-hospital mortality; severity of illness and having private insurance were significantly associated with charge per hospital stay (P < 0.001). The number of CH-C patients 65 and older increased due to the aging of the baby boomer population. Early treatment of CH-C patients with highly effective, well-tolerated, new anti-HCV regimens may prevent this significant societal burden.