Fibrosis-4 Index Score Predicts Concomitant Coronary Artery Diseases Across the Spectrum of Fatty Liver Disease.

BACKGROUND: 25% of US adults have nonalcoholic fatty liver disease (NAFLD). The independent association between hepatic fibrosis and cardiovascular disease remains controversial. Metabolic dysfunction-associated fatty liver disease (MAFLD) precisely characterizes hepatic steatosis. AIM: We aimed to determine if degree of hepatic fibrosis, with differing metabolic risk factors, is associated with presence of coronary artery disease (CAD). METHODS: Retrospective review of patients with hepatic steatosis at a single center from January 2016-October 2020 was performed. MAFLD diagnosis was based on presence of fatty liver disease and metabolic factors. Descriptive statistics and stepwise multivariable logistic regression were performed. RESULTS: 5288 patients with hepatic steatosis were included. 2821 patients with steatosis and metabolic risks were classified as NAFLD-MAFLD. 1245 patients with steatosis without metabolic risks were classified as non-MAFLD NAFLD. 812 patients with metabolic risks and other liver disease and were classified as non-NAFLD MAFLD. On Multivariate analysis, Fib-4 ≥ 2.67 was an independent risk factor for CAD in the overall fatty liver disease and NAFLD-MAFLD groups. Fib-4 as a continuous variable showed linear association with CAD risk in the overall fatty liver disease, Non-MAFLD NAFLD and NAFLD-MAFLD groups, at Fib-4 values below 2.67. CONCLUSION: Fib-4 ≥ 2.67 is independently predicts concomitant CAD in patients with hepatic steatosis. Fib-4, at levels below 2.67, is significantly associated with concomitant CAD in the all fatty liver disease, Non-MAFLD NAFLD, and NAFLD-MAFLD groups. Emphasizing clinical phenotypes and Fib-4 levels may help target those with an increased risk for CAD.

Azathioprine Monotherapy Is Equivalent to Dual Therapy in Maintaining Remission in Autoimmune Hepatitis.

BACKGROUND: Standard of care treatment for AIH includes prednisone monotherapy or dual therapy prednisone-azathioprine. However, many hepatologists alternatively use azathioprine monotherapy to avoid side effects of long-term corticosteroids. AIMS: To determine whether azathioprine monotherapy is comparable to dual prednisone-azathioprine for maintenance of remission in AIH. METHODS: A retrospective chart review of 260 individuals with AIH from a single institution was performed; 45 individuals were included. Exclusion criteria included concomitant PBC or PSC, use of alternative treatment regimen, and/or failure to reach remission. Treatment regimen received was guided by clinician standard of practice, not patients' clinical factors. Initial remission was defined as normalization of serum ALT for at least two consecutive blood draws. Data were analyzed for 5 years post-remission, recording outcome and dose of prednisone and/or azathioprine. RESULTS: 83% of individuals were female, and average age was 65 years. Median dose of prednisone and azathioprine for the dual-therapy group was 5 mg and 100 mg, respectively, while median azathioprine dose for the monotherapy group was 75 mg. Considering overall outcome, 93% of all patients maintained remission. 80% of the dual-therapy group, and 95% of the azathioprine monotherapy group maintained remission. Using Chi-square analysis to compare the maintenance of remission between dual therapy and azathioprine monotherapy, a p value of 0.28 was calculated. CONCLUSIONS: AASLD guidelines recommend dual prednisone-azathioprine as standard of care for maintenance of remission in AIH. Our results suggest that azathioprine monotherapy is equivalent to prednisone-azathioprine. Azathioprine monotherapy offers a significant advantage in mitigating risks of long-term corticosteroid therapy.

Gender Differences in Hepatology Medical Literature.

BACKGROUND: Studies suggest that gender differences in academic medicine exist. Men frequently have better measures of performance such as number of publications, number of citations, remuneration, and funding. AIMS: To evaluate whether a gender disparity in authorship exists. METHODS: We recorded the gender of first and senior authors of original papers, editorials/reviews from liver-related manuscripts in Gastroenterology, Hepatology, Transplantation, American Journal of Gastroenterology, and Liver Transplantation from January 2014 to 2016. RESULTS: Of 2424 articles reviewed, we excluded 232 (10%) due to inability to determine gender. Among papers analyzed, 72.0% were original and 28.1% reviews/editorials with 65.1% of first authors being male and 34.9% female. Only 20.3% of papers with multiple authors had a female senior author. The proportion of male first and senior authorship between original papers and reviews/editorials was comparable. 72% of original papers had a male as first or senior author, but only 28% females. 71% of review/editorial papers had a male as first or senior author, but only 29% females. When the senior author of an original paper was female, 47.1% of first authors were male and 52.9% female. When the senior author was male, 67.1% of first authors were male and 32.9% female (p < 0.00001). CONCLUSIONS: A significant gender difference exists in Hepatology publications. Female authorship mirrors the percentage of female AASLD membership; however, female senior authorship remains disproportionate. In general, funding for male authors is greater. Fewer women are first authors when the senior author is male, highlighting the importance of female mentorship in Hepatology.