Serum uric acid levels and prognosis of patients with non-alcoholic fatty liver disease.

Uric acid (UA) is associated with non-alcoholic fatty liver disease (NAFLD). However, it is unclear whether UA plays a predictive role in NAFLD prognosis. This study aimed to explore the relationship between UA levels and mortality in NAFLD patients without severe renal disease. Data were obtained from the Third National Health and Nutrition Examination Survey (NHANES). Time-dependent Cox regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for mortality. Overall, 2493 individuals with NAFLD and estimated glomerular filtration rate (eGFR) > 60 mL/min/1.73 m2 were included in this study. The median follow-up period was 26.58 years. Patients were divided into high and low-UA groups according to UA levels. Time-independent Cox regression showed that UA level was not an independent risk factor for mortality in NAFLD patients without decreased eGFR (P > 0.05). After matching for age and sex using the propensity score matching method, UA remained not independently associated with death in NAFLD patients (P > 0.05). Similar results were found for cardiovascular-related and cancer-related deaths. Although UA is closely related to NAFLD, UA levels are not independently associated with the long-term survival of patients with NAFLD without decreased eGFR.

The prognostic role of diet quality in patients with MAFLD and physical activity: data from NHANES.

BACKGROUND AND OBJECTIVES: Dietary control and increased physical activity (PA) are recommended for patients with metabolic (dysfunction-) associated fatty liver disease (MAFLD). However, not all patients can sustain both exercise and a healthy diet. This study explored the interaction between dietary quality, PA levels, and mortality in MAFLD patients. METHODS: The Third National Health and Nutrition Examination Survey and linked mortality data were used in this study. Diet quality was assessed with the Healthy Eating Index (HEI). PA level was calculated by multiply self-reported exercise frequency and its Metabolic Equivalent A high-quality diet was associated. A Cox proportional hazard model was used to explore risk factors for mortality in MAFLD patients. RESULTS: In total, 3709 participants with MAFLD were included in the final analysis. The median follow-up time was 26.2 (interquartile range 19.3-28.1) years and 1549 (41.8%) deaths were recorded over follow-up. Cox multivariate regression was used to adjust for potential confounders of mortality. The results showed both HEI score and PA level were inversely correlated with all-cause mortality (P < 0.05). In the subgroup analysis stratified by PA level, higher diet quality decreased all-cause mortality, cardiovascular-related mortality and cancer-related mortality in PA inactive of MAFLD patients (P < 0.05), but these correlations were not present in active PA groups. CONCLUSION: Healthy diet and physical activity may have different impact as lifestyle interventions for MAFLD. A high-quality diet is associated less mortality in inactive individuals with MAFLD but not in those with active PA levels. Sedentary individuals require healthier diet.

Functional iron deficiency anemia was associated with higher mortality in chronic kidney disease patients: the NHANES III follow-up study.

Anemia, a common complication of chronic kidney disease (CKD), is associated with poor prognosis. However, it is not completely clear whether this association is caused by anemia per se or other comorbidities. Whether different types of iron deficiency anemia can predict the outcomes of CKD remains unclear. The dataset from NHANES III was analyzed and Cox multivariate regression models and propensity score matching (PSM) method were used to evaluate the effect of anemia on mortality. Of 4103 patients with CKD, 14.6% had anemia. Among those with anemia, 38.8% had absolute iron deficiency (AID), and 19.8% had functional iron deficiency (FID). During the median follow-up time of 13.8 years, 2964 deaths and 804 cardiovascular deaths were observed. Anemia was robustly associated with a high risk of all-cause mortality in CKD patients after adjusting covariates by two multivariate regression models (Model 1: HR = 1.485, 95%CI:1.340-1.647, p < 0.001; Model 2: HR = 1.391, 95%CI:1.250-1.546, p < 0.001). In the PSM cohort, anemia was still an independent risk factor for all-cause mortality (Model 1: HR = 1.443, 95%CI: 1.256-1.656, p < 0.001; Model 2: HR = 1.357, 95%CI:1.177-1.564, p < 0.001). In the CKD population, anemia patients with FID had the highest risk of mortality than the other anemia groups (p < 0.05), while AID had a mortality rate similar to those without anemia (p > 0.05). In conclusion, anemia was associated with a worse prognosis in patients with CKD, which may be attributed to the higher mortality risk of FID rather than AID. AID wasn't associated with a higher mortality rate compared with CKD patients without anemia.

The trends of disease burden due to high temperature in Mainland China from 1990 to 2019 and its prediction to 2030.

The risk of high-temperature-related diseases is increasing owing to global warming. This study aimed to assess the trend of disease burden caused by high temperatures in Mainland China from 1990 to 2019 and to predict the trend of disease burden over the next 10 years. The latest data were downloaded from the Global Burden of Disease Database (GBD) for analysis, and the disease burden related to high temperature was described by mortality and disability-adjusted life-years (DALYs) and stratified by etiology, sex, and age. Statistical analyses were performed using the R software. In 2019, there were 13,907 deaths attributed to high temperatures in Mainland China, and this was 29.55% higher than the 10,735 deaths in 1990. Overall, the age-standardized mortality and DALYs attributed to high temperatures showed a downward trend from 1990 to 2019. We observed an etiological shift in high-temperature-related diseases. The age-standardized DALYs contribution attributed to high temperatures in 1990 was mainly from communicable, maternal, neonatal, and nutritional diseases (CMNND) (21.81/100,000), followed by injury (18.30/100,000) and non-communicable diseases (10.40/100,000). In 2019, the largest contribution shifted to non-communicable diseases (10.07/100,000), followed by injuries (5.21/100,000), and CMNND (2.30/100,000). The disease burden attributed to high temperatures was higher in males than in females and increased with age. In 2030, the mortality rate and DALYs due to high temperatures are predicted to decrease further, and the largest contribution will come from chronic non-communicable diseases, the occurrence of which will remain at a high level over the next 10 years. The burden of disease due to high temperatures in Mainland China is still heavy, mainly due to population aging and an increase in non-communicable diseases.

Evaluating the global, regional, and national impact of syphilis: results from the global burden of disease study 2019.

Syphilis is a global public health concern. This study aimed to assess the global and regional burden of syphilis from 1990 to 2019. Disease burden was evaluated using disability-adjusted life-years (DALYs) and prevalence. Data were extracted from the 2019 global burden of disease Study, an open database available for download. Age-standardized rates (ASR) and estimated annual percentage changes (EAPC) were calculated to evaluate the syphilis burden over time. In 2019, the total number of prevalent cases of syphilis was 49.71 million worldwide. The ASR of prevalence was stable from 1990 to 2019 with an EAPC of 0.00 (95% CI - 0.10-0.11). The number of DALYs caused by syphilis was 7.36 million in 2019, reflecting a reduction of 16.38% compared with that in 1990 (8.80 million). The ASR of DALYs exhibited a decreasing trend from 1990 to 2019 (EAPC = - 1.01; 95% CI - 1.19 to - 0.84), with the highest rates observed in the younger age group (< 14 years old). In 2019, the highest ASR of DALYs was found in low sociodemographic index (SDI) regions (239.21/100,000), and the lowest in high SDI regions (3.14/100,000). Generally, the ASR of DALYs decreased as the SDI increased. The top three countries with the highest ASR of DALYs for syphilis were the Solomon Islands, Equatorial Guinea, and Liberia. While the global prevalence of syphilis remained persistently high from 1990 to 2019, there has been a recent decrease in the ASR of DALYs. Increased attention should be dedicated to younger populations and regions characterized by low SDIs.

MAFLD is associated with increased all-cause mortality in low cardiovascular-risk individuals but not in intermediate to high-risk individuals.

BACKGROUND AND AIMS: Metabolic-associated fatty liver disease (MAFLD) is increasingly recognized as a systematic disease rather than just a liver disease alone, which raises concerns about its long-term impact on different populations. This study aimed to clarify the effects of MAFLD on long-term outcomes among different cardiovascular risk-stratified populations. METHODS AND RESULTS: Eligible individuals in the Third National Health and Nutrition Examination Surveys (NHANES Ⅲ, 1988-1994) were enrolled. Participants were classified into low, intermediate, or high cardiovascular-risk populations according to the Framingham general equations. Kaplan-Meier survival analysis and Cox regression models were used to investigate the association between MAFLD and long-term outcomes in different cardiovascular-risk populations. A total of 8897 adults were enrolled in the final analysis. The median ages in the non-MAFLD and MAFLD groups were 44 and 49 years old, respectively. During a median follow-up of 22.8 years, a total of 2991 deaths were recorded, including 1694 deaths (30.3%) in non-MAFLD and 1297 deaths (39.2%) in MAFLD (P < 0.001). In the low cardiovascular-risk population, MAFLD individuals had increased all-cause mortality than non-MAFLD individuals (HR = 1.206, 95% CI:1.0338-1.400, P = 0.014). However, similar results were not observed in intermediate or high-cardiovascular-risk individuals. Further analysis of cause-specific mortality suggested that MAFLD was associated with higher cancer-related mortality in the low-risk population (HR = 1.313, 95% CI:1.000-1.725, P = 0.049). CONCLUSIONS: MAFLD was associated with increased all-cause mortality among individuals with low cardiovascular risk, rather than those with an intermediate or high cardiovascular risk.

The association between serum 25-hydroxyvitamin D and the prevalence of herpes simplex virus.

Previous studies have reported a potential anti-infection effect for vitamin D. However, the relationship between vitamin D status and herpes simplex virus (HSV) infection has not yet been evaluated. Therefore, this study aimed to determine the association between serum 25-hydroxyvitamin D [25(OH)D] and infection with HSV types 1 and 2 (HSV-1 and HSV-2). Data were collected from the National Health and Nutrition Examination Survey from 2007 to 2016. The association between 25(OH)D and HSV prevalence was evaluated using propensity score matching (PSM) and univariate and multivariate logistic regression analyses. Overall, 14 174 participants were included in the final analysis. Before PSM, 8639 (60.9%) had positive HSV-1 and 2636 (18.6%) had HSV-2. The HSV-1 and HSV-2 positive groups had more females and older individuals (p < 0.05). The HSV-2 patients had lower 25(OH)D levels than those with HSV-1. Age and gender did not differ in the groups after PSM (p > 0.05). The 25(OH)D level was significantly lower in the HSV-1 and HSV-2 groups than in the non-HSV infection groups. Multivariate logistic regression showed that serum 25(OH)D level was negatively associated with HSV-1 and HSV-2 infection (odds ratio [OR] = 0.730 and 0.691, p < 0.001, respectively). Vitamin D deficiency was an independent risk factor for both HSV-1 and HSV-2 (adjusted OR = 2.205 and 2.704, p < 0.001, respectively). Lower serum 25(OH)D levels correlated significantly with increased HSV-1 and HSV-2 infection risk.

The risk of COVID-19 can be predicted by a nomogram based on m6A-related genes.

BACKGROUND: The expression of m6A-related genes and their significance in COVID-19 patients are still unknown. METHODS: The GSE177477 and GSE157103 datasets of the Gene Expression Omnibus were used to extract RNA-seq data. The expression of 26 m6A-related genes and immune cell infiltration in COVID-19 patients were analyzed. Finally, we built and validated a nomogram model to predict the risk of COVID-19 infection. RESULTS: There were significant differences in 11 m6A regulatory factors between patients with COVID-19 and healthy individuals. The classification of disease subtypes based on m6A-related gene levels can be distinguished. COVID-19 patients in GSE177477 were classified into two categories based on m6A-related genes. The patients in cluster A were all symptomatic, while those in cluster B were asymptomatic. A significant correlation was also found between immune cells and m6A-related genes. Finally, seven m6A-related disease-characteristic genes, HNRNPA2B1, ELAVL1, RBM15, RBM15B, YTHDC1, HNRNPC, and WTAP, were screened to construct a nomogram model for predicting risk. The calibration curve, decision curve analysis, and clinical impact curve analysis were used to show that the nomogram model was effective and had a high net efficacy for risk prediction. CONCLUSIONS: m6A-related genes were correlated with immune cells. The nomogram model effectively predicted COVID-19 risk. Moreover, m6A-related genes may be associated with the presence or absence of symptoms in COVID-19 patients.

The m7G Modification Level and Immune Infiltration Characteristics in Patients with COVID-19.

Purpose: The 7-methylguanosine (m7G)-related genes were used to identify the clinical severity and prognosis of patients with coronavirus disease 2019 (COVID-19) and to identify possible therapeutic targets. Patients and Methods: The GSE157103 dataset provides the transcriptional spectrum and clinical information required to analyze the expression of m7G-related genes and the disease subtypes. R language was applied for immune infiltration analysis, functional enrichment analysis, and nomogram model construction. Results: Most m7G-related genes were up-regulated in COVID-19 and were closely related to immune cell infiltration. Disease subtypes were grouped using a clustering algorithm. It was found that the m7G-cluster B was associated with higher immune infiltration, lower mechanical ventilation, lower intensive care unit (ICU) status, higher ventilator-free days, and lower m7G scores. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that differentially expressed genes (DEGs) between m7G-cluster A and B were enriched in viral infection and immune-related aspects, including COVID-19 infection; Th17, Th1, and Th2 cell differentiation, and human T-cell leukemia virus 1 infection. Finally, through machine learning, six disease characteristic genes, NUDT4B, IFIT5, LARP1, EIF4E, LSM1, and NUDT4, were screened and used to develop a nomogram model to estimate disease risk. Conclusion: The expression of most m7G genes was higher in COVID-19 patients compared with that in non-COVID-19 patients. The m7G-cluster B showed higher immune infiltration and milder symptoms. The predictive nomogram based on the six m7G genes can be used to accurately assess risk.

Serum high-sensitive C-reactive protein is a simple indicator for all-cause among individuals with MAFLD.

High-sensitive C-reactive protein (hs-CRP) is one of the diagnostic components for metabolic (-dysfunction) associated fatty liver disease (MAFLD). This study aimed to explore the relationship between hs-CRP level and 25-year mortality in patients with MAFLD. The study data were from the Third National Health and Nutrition Examination Survey 1988-1994. All participants were followed up until December 2015 and the outcome of each participant was ascertained from National Death Index records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) of all-cause mortality, cardiovascular-related mortality, and malignancy-related mortality. A total of 4,145 participants with MAFLD were included in final analysis. The median follow-up period was 22.3 years (interquartile range 16.9-24.2). There were 1,610 (38.8%) all-cause deaths. The leading cause of death was malignant neoplasms (365/1,610, 22.7%), followed by cardiovascular diseases (342/1,610, 21.2%). Of the 4,145 patients with MAFLD, 1,293 (31.2%) had an hs-CRP level greater than 0.5 mg/dl. Those with hs-CRP > 0.5 mg/dl were older, more likely to be female and had greater derangements of metabolic profiles than those with lower hs-CRP. The results of Cox regression analysis showed that hs-CRP ≥ 0.5 mg/dl was an independent risk factor for all-cause mortality (HR = 1.394, 95% CI 1.253-1.551), cardiovascular mortality (HR = 1.497, 95% CI 1.190-1.885) and malignant neoplasms related mortality (HR = 1.290, 95% CI 1.030-1.615) after adjusting for risk factors. This study confirms that hs-CRP is an independent predictive factor of poor prognosis in patients with MAFLD.

Validation of Non-invasive Fibrosis Scores for Predicting Advanced Fibrosis in Metabolic-associated Fatty Liver Disease.

Background and Aims: Metabolic-associated fatty liver disease (MAFLD) is a newly proposed terminology from 2020; yet, the applicability of conventional noninvasive fibrosis models is still unknown for it. We aimed to evaluate the performance of conventional noninvasive fibrosis scores in MAFLD. Methods: The NHANES 2017-2018 datasets were used to compare the performances of different noninvasive fibrosis scores in MAFLD, including the aspartate aminotransferase (AST) to platelet ratio index (APRI), body mass index (BMI)-AST/alanine aminotransferase (ALT) ratio and diabetes score (BARD), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS). Moreover, Asian patients with biopsy-proven MAFLD were enrolled to further validate the findings. Results: A total of 2,622 participants in the National Health and Nutrition Examination Survey (NHANES) cohort and 293 patients with MAFLD in the Asian cohort were included. Patients in the Asian cohort had a lower BMI and higher liver enzymes (p<0.001). The area under the receiver operating characteristic curve (AUROC) of NFS was the largest in the NHANES cohort and Asian cohorts (0.679 and 0.699, respectively). The AUROC of NFS was followed by APRI, FIB-4, and BARD in the NHANES cohort (0.616, 0.601, and 0.589, respectively). In the Asian cohort, the AUROC of APRI, FIB-4, and BARD for predicting advanced fibrosis were 0.625, 0.683, and 0.615, respectively. The performance of FIB-4 was better in the Asian cohort than that in the NHANES cohort. Conclusions: NFS is better for predicting advanced fibrosis in MAFLD. FIB-4 can be an alternative choice for MAFLD with high liver enzymes when NFS is unavailable. Novel efficient noninvasive fibrosis scoring systems are highly required for patients with MAFLD.

Fatty liver disease reverses the obesity paradox in chronic kidney disease stages 3-5: A follow-up study of NHANES III.

High body mass index (BMI) has been associated with better survival in patients with end-stage kidney disease. Individuals with fatty liver disease (FLD) have a higher risk of chronic kidney disease. It remains unclear whether the survival benefit of high BMI in patients with chronic kidney disease is present when there is concomitant FLD. This study used the data set from the Third American National Health and Nutrition Examination Survey and the corresponding survival data. The Cox proportional hazards model was used to evaluate the effect of BMI on mortality. A total of 12,445 participants were included. The prevalence of FLD was 39.8%. The median follow-up time (with interquartile range) was 22.8 (20.8-24.8) years. During this period, 3749 (30.1%, 14.4 of 1000 person-year) deaths were observed. Among these, 1169 (31.2%) died within the first 10 years. The Cox regression analysis showed that the BMI level was not associated with 25-year mortality in patients with decreased glomerular filtration rate (GFR < 60 ml/min/1.73 m2 ), but 10-year mortality was significantly lower in patients with BMI ≥ 25 kg/m2 than in those with BMI < 25 kg/m2 (p = 0.049). Multivariate analysis showed BMI ≥ 25 kg/m2 was an independent protective factor for 10-year mortality (hazard ratio [HR] 0.691, 95% confidence interval [CI] 0.559-0.856; p = 0.001). This protective effect of higher BMI was lost in patients with FLD (HR 0.884, 95% CI 0.585-1.335; p = 0.557) but persisted in the non-FLD group (HR 0.625, 95% CI 0.479-0.816; p = 0.001). The survival benefit of overweight/obesity for patients with decreased GFR, which was attenuated by the presence of FLD, only existed in the first decade.

The association between Toxoplasma infection and mortality: the NHANES epidemiologic follow-up study.

BACKGROUND: Toxoplasma gondii has been reported to be associated with higher mortality in patients with schizophrenia. This study aimed to explore the relationship between T. gondii infection and 25-year mortality based on data from the Third National Health and Nutrition Examination Survey (NHANES III) database. METHODS: Cases with serum T. gondii antibody test results were included in this study and the corresponding mortality dataset was obtained from the US National Center for Health Statistics (NCHS). Propensity score matching (PSM) was used to match age and sex between groups. The Cox proportional hazards model was used to evaluate the effect of T. gondii infection on mortality. RESULTS: A total of 14,181 cases were included in the analysis, of which 3831 (27.0%) were seropositive for T. gondii antibody. The median follow-up time of the whole cohort was 22.5 (interquartile range 16.3, 24.5) years. A total of 5082 deaths were observed in this cohort, a mortality rate of 35.8%. All-cause mortality was significantly higher in the seropositive group than in the seronegative group (50.0% vs 30.6%, P < 0.001). Kaplan-Meier analysis showed a significant difference in the survival time between two groups before and after PSM. Multivariate analysis showed that T. gondii infection was independently associated with higher all-cause mortality after adjusting for potential confounders. CONCLUSIONS: Toxoplasma gondii infection is associated with higher mortality in general population.

Deep Learning-Based Universal Expert-Level Recognizing Pathological Images of Hepatocellular Carcinoma and Beyond.

Background and Aims: We aim to develop a diagnostic tool for pathological-image classification using transfer learning that can be applied to diverse tumor types. Methods: Microscopic images of liver tissue with and without hepatocellular carcinoma (HCC) were used to train and validate the classification framework based on a convolutional neural network. To evaluate the universal classification performance of the artificial intelligence (AI) framework, histological images from colorectal tissue and the breast were collected. Images for the training and validation sets were obtained from the Xiamen Hospital of Traditional Chinese Medicine, and those for the test set were collected from Zhongshan Hospital Xiamen University. The accuracy, sensitivity, and specificity values for the proposed framework were reported and compared with those of human image interpretation. Results: In the human-machine comparisons, the sensitivity, and specificity for the AI algorithm were 98.0, and 99.0%, whereas for the human experts, the sensitivity ranged between 86.0 and 97.0%, while the specificity ranged between 91.0 and 100%. Based on transfer learning, the accuracies of the AI framework in classifying colorectal carcinoma and breast invasive ductal carcinoma were 96.8 and 96.0%, respectively. Conclusion: The performance of the proposed AI framework in classifying histological images with HCC was comparable to the classification performance achieved by human experts, indicating that extending the proposed AI's application to diagnoses and treatment recommendations is a promising area for future investigation.

Spatial-temporal analysis of HIV/AIDS and syphilis in mainland China from 2007 to 2017.

Human immune deficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and syphilis are the most common sexually transmitted diseases (STDs) worldwide, as well as in China. The objective of this study is to describe the trend of spatial and temporal variation of HIV/AIDS and syphilis in mainland China from 2007 to 2017. Stratified analysis was conducted according to age and the GDP per capita. Estimated Annual Percentage Change (EAPC) was calculated and spatial autocorrelation analysis was used to evaluate the epidemiology and identify clusters. The morbidity of new HIV infection increased from 2.5034/100 000 in 2007 to 6.9247/100 000 in 2017, with an EAPC of 9.84 (95% confidence interval [CI]: 9.07-10.60). From 2007 to 2017, the morbidity of syphilis presented a significant upward trend from 15.8834/100 000 to 34.4867/100 000 (EAPC = 6.48, 95% CI: 4.23-8.73). The number of new HIV infections (205 084) and syphilis (921 279) were highest in the 20-30 years old group, where the incidence decreased with age over 20 years. In general, HIV and syphilis infection had the same incidence trend according to age and time stratification. The morbidity of new HIV infection was mainly reported from Xinjiang and southwestern China. As for syphilis, the highest was found in Zhejiang in Xinjiang and southeast coastal areas. Both HIV and syphilis infection showed a nonrandom positive correlation by Moran's I value. The High-High cluster areas of HIV infection were concentrated in southwestern and eastern China due to syphilis. A highly significant positive correlation was found between gross domestic product per capita and syphilis infection (p < 0.05) but was not associated with HIV infection. The incidence of AIDS/HIV and syphilis is increasing year by year, and a higher prevalence is found in younger individuals. More attention should be paid to HIV infection in the southwest, syphilis in southeast coastal areas, and both the two diseases in Xinjiang.

Validation of five hepatic steatosis algorithms in metabolic-associated fatty liver disease: A population based study.

BACKGROUND AND AIM: Non-invasive hepatic steatosis algorithms are recommended in detecting metabolic-associated fatty liver disease (MAFLD) in epidemiological studies. However, the diagnostic accuracy of these models is unclear. This study aimed to evaluate the diagnostic efficiency of five common models in a national survey population. METHODS: The Third National Health and Nutrition Examination Survey (NHANES III) datasets were used in this study. The fatty liver index (FLI), hepatic steatosis index (HSI), non-alcoholic liver disease-liver fat score (NAFLD-LFS), the steato text (ST), and visceral adiposity index (VAI) were evaluated. RESULTS: The prevalence of MAFLD in the general population was 31.2%. The proportion of MAFLD estimated using the NAFLD-LFS (30.8%) was the closest to the real number, whereas the ST model (66.1%) significantly overestimated the prevalence of MAFLD in this cohort. The FLI (36.9%) and HSI models (38.5%) also slightly overestimated the prevalence of MAFLD in the study population. The FLI had the highest area under the receiver operating characteristic (AUROC) value (0.793) among all models, with a sensitivity of 57.0%, a specificity of 83.8%, a positive predictive value (PPV) of 67.3%, and a negative predictive value (NPV) of 77.0%. The combination of the original algorithm with additional metabolic dysfunction criteria did not improve the diagnostic efficiency. The discriminative ability for MAFLD in all models was lower in participants with a normal body mass index (BMI). CONCLUSIONS: Non-invasive models, especially the FLI, have satisfactory diagnostic performance in detecting MAFLD. However, models in people with normal BMIs require further development.

The global disease burden of varicella-zoster virus infection from 1990 to 2019.

Data on the global epidemiology of varicella-zoster virus infection (VZVI) is limited. This study aimed to investigate the burden of VZVI based on the global burden of disease study 2019 data. The age-standardized rates, including the incidence, death, disability-adjusted life years (DALYs), and the estimated annual percentage changes (EAPC) of VZVI were calculated to evaluate the disease burden of VZVI. The global numbers of incident and death cases due to VZVI were 83 963 744 and 14 553, respectively. The age-standardized incidence rate of VZVI increased slightly all over the world, while the age-standardized death and DALYs rate decreased from 1990 to 2019 (EAPC = -2.31 and -1.61, respectively). The younger age (<5 years old) and older groups had the highest VZVI burden. The high sociodemographic index (SDI) region had the highest age-standardized incidence rates in 2019 (1236.28/100 000, 95% uncertainty interval [UI]: 1156.66-1335.50) and the low SDI region had the lowest incidence (1111.24/100 000, 95% UI: 1040.46-1209.55). The age-standardized death and DALYs rate of VZVI decreased with the increase of SDI. Amongst the 21 geographical regions, the high-income Asia-Pacific (1269.08/100 000) region had the highest age-standardized incidence rate in 2019, while Sub-Saharan Africa had the highest age-standardized death and DALYs rate. The global incidence of VZVI has continued to increase in the past 3 decades, while the age-standardized death and DALYs rates have decreased. More attention should be paid to the younger and older population, as well as low SDI regions.

Validation of conventional non-invasive fibrosis scoring systems in patients with metabolic associated fatty liver disease.

BACKGROUND: Non-invasive fibrosis scores are not yet validated in the newly defined metabolic associated fatty liver disease (MAFLD). AIM: To evaluate the diagnostic performance of four non-invasive scores including aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes score (BARD), and nonalcoholic fatty liver disease fibrosis score (NFS) in patients with MAFLD. METHODS: Consecutive patients with histologically confirmed MAFLD were included. The discrimination ability of different non-invasive scores was compared. RESULTS: A total of 417 patients were included; 156 (37.4%) of them had advanced fibrosis (Metavir ≥ F3). The area under receiver operating characteristic curve of FIB-4, NFS, APRI, and BARD for predicting advanced fibrosis was 0.736, 0.724, 0.671, and 0.609, respectively. The area under receiver operating characteristic curve of FIB-4 and NFS was similar (P = 0.523), while the difference between FIB-4 and APRI (P = 0.001) and FIB-4 and BARD (P < 0.001) was statistically significant. The best thresholds of FIB-4, NFS, APRI, and BARD for diagnosis of advanced fibrosis in MAFLD were 1.05, -2.1, 0.42, and 2. A subgroup analysis showed that FIB-4, APRI, and NFS performed worse in the pure MAFLD group than in the hepatitis B virus-MAFLD group. CONCLUSION: APRI and BARD scores do not perform well in MAFLD. The FIB-4 and NFS could be more useful, but a new threshold is needed. Novel non-invasive scoring systems for fibrosis are required for MAFLD.

MAFLD Criteria May Overlook a Subtype of Patient with Steatohepatitis and Significant Fibrosis.

INTRODUCTION: Metabolic associated fatty liver disease (MAFLD) is a novel concept for fatty liver disease. Different from non-alcoholic fatty liver disease (NAFLD), the diagnosis of MAFLD requires the presence of metabolic risks. This study aimed to characterize patients with liver steatosis but without metabolic risks (non-MR-steatosis) which may not be diagnosed by MAFLD criteria. METHODS: Consecutive patients who underwent biopsy were included in this study. The clinic-pathological characteristics of non-MR-steatosis, NAFLD and MAFLD were compared. RESULTS: A total of 1217 cases were included. There were 426 (35.00%) cases with MAFLD, 585 (48.07%) with NAFLD and 168 (13.80%) with non-MR-steatosis. The majority of the cases were infected with HBV (93.26%). The age and metabolic profiles were highest in MAFLD and lowest in non-MR-steatosis. The body mass index (BMI) level was also lowest in non-MR-steatosis (20.78 ± 1.54 kg/m2). The ALT and AST levels of the non-MR-steatosis group were not statistically different from those of MAFLD or NAFLD groups (p > 0.05). Histologically, there was no significant difference in the degrees of inflammation and fibrosis among the three groups. The severity of steatosis in non-MR-steatosis group was lower than MAFLD or NAFLD groups (p < 0.05). These results were consistent in both HBV and non-HBV subgroups. CONCLUSION: MAFLD criteria may overlook some steatotic patients without metabolic risks, who may also have steatohepatitis and significant fibrosis.

Risk Factors and Prognosis in Patients with COVID-19 and Liver Injury: A Retrospective Analysis.

PURPOSE: COVID-19 is a new infectious disease with global spread. The aim of the present study was to explore possible risk factors and evaluate prognosis in COVID-19 with liver injury. METHODS: A retrospective study was conducted on 356 COVID-19 patients in the Third People's Hospital of Yichang, Hubei, China. Clinical characteristics and laboratory tests between patients with and without liver injury were compared, while risk factors of COVID-19-related liver injury were analyzed. Univariate and multivariate Cox regression analyses were conducted to identify risk factors of in-hospital death. RESULTS: Of the patients with liver injury, severe and critical types of COVID-19 comprised 12.43% and 14.69%, respectively, higher than in patients without liver injury (both P<0.05). CRP and male sex were independent risk factors for for patients with liver injury, while decreased lymphocyte count (HR 0.024, 95% CI 0.001-0.821) and elevated monocytes (HR 1.951, 95% CI 1.040-3.662) and CRP (HR 1.028, 95% CI 1.010-1.045) were independent risk factors of prognosis of death in COVID-19 patients with liver injury. CONCLUSION: Liver injury is a common complication in severe COVID-19 patients. Male sex and elevated CRP were independent risk factors in COVID-19 complicated by liver damage. Liver damage with increased CRP and monocyte count and decreased lymphocyte count may imply a poor prognosis.