RESUMEN
Point of care tools to assess advanced liver fibrosis, including the NFS, BARD, FIB-4, and APRI, are of major interest due to their non-invasive nature. However, these tools have not been investigated extensively in the Latina population. Given that the highest rate of NAFLD in Latinos and the most severe presentation of NAFLD is more common in women, we hypothesize that ethnicity may play a role in predicting liver fibrosis, particularly in women.We determined whether ethnicity alone or in association with other parameters can predict the severity of fibrosis in women with NAFLD when included in four tools. We retrospectively included 562 Latina and 133 White Caucasian women with history of NAFLD. Associations between ethnicity and liver fibrosis severity using the four cirrhosis predictor models were studied using backward selection multinomial logistic regression.Latina women compared to White showed lower BMI (p<0.001), higher HbA1c (p<0.001), lower prevalence of bariatric surgery (p<0.001), lower likelihood to smoke (p=0.003), and higher prevalence of chronic kidney disease (CKD) stages 3-5 (p=0.01). Some clinical variables were associated with fibrosis but not univocally in each tool. We did not find differences in the outcome of the four models when holding all other factors and examining ethnicity alone between Latina and White women.Although we did not include data on liver histology, this is the first study examining the role of ethnicity in predicting severity of fibrosis using established non-invasive scores and documenting no association between Latina ethnicity and severity of fibrosis in women with NAFLD.
RESUMEN
AIM: To study differences of presentation, management, and prognosis of alcoholic hepatitis in Latinos compared to Caucasians. METHODS: We retrospectively screened 876 charts of Caucasian and Latino patients who were evaluated at University of California Davis Medical Center between 1/1/2002-12/31/2014 with the diagnosis of alcoholic liver disease. We identified and collected data on 137 Caucasians and 64 Latinos who met criteria for alcoholic hepatitis, including chronic history of heavy alcohol use, at least one episode of jaundice with bilirubin ≥ 3.0 or coagulopathy, new onset of liver decompensation or acute liver decompensation in known cirrhosis within 12 wk of last drink. RESULTS: The mean age at presentation of alcoholic hepatitis was not significantly different between Latinos and Caucasians. There was significant lower rate of overall substance abuse in Caucasians compared to Latinos and Latinos had a higher rate of methamphetamine abuse (12.5% vs 0.7%) compared to Caucasians. Latinos had a higher mean number of hospitalizations (5.3 ± 5.6 vs 2.7 ± 2.7, P = 0.001) and mean Emergency Department visits (9.5 ± 10.8 vs 4.5 ± 4.1, P = 0.017) for alcohol related issues and complications compared to Caucasians. There was significantly higher rate of complications of portal hypertension including gastrointestinal bleeding (79.7% vs 45.3%, P < 0.001), spontaneous bacterial peritonitis (26.6% vs 9.5%, P = 0.003), and encephalopathy (81.2% vs 55.5%, P = 0.001) in Latinos compared to Caucasians. CONCLUSION: Latinos have significant higher rates of utilization of acute care services for manifestations alcoholic hepatitis and complications suggesting poor access to outpatient care.