Metabolic-associated fatty liver disease and hepatocellular carcinoma: a prospective study of characteristics and response to therapy.

BACKGROUND AND AIM: The rising incidence of hepatocellular carcinoma (HCC) in Australia is related to increasing rates of metabolic-associated fatty liver disease (MAFLD). This study aimed to prospectively characterize the metabolic profile, lifestyle, biometric features, and response to treatment of HCC patients in an Australian population. METHOD: Multicenter prospective cohort analysis of newly diagnosed HCC patients at six multidisciplinary team meetings over a 2-year period. RESULTS: Three hundred and thirteen (313) newly diagnosed HCC patients with MAFLD (n = 77), MAFLD plus other liver disease (n = 57) (the "mixed" group), and non-MAFLD (n = 179) were included in the study. Alcohol-associated liver disease (ALD) (43%) and MAFLD (43%) were the most common underlying liver diseases. MAFLD-HCC patients were older (73 years vs 67 years vs 63 years), more likely to be female (40% vs 14% vs 20%), less likely to have cirrhosis (69% vs 88% vs 85%), showed higher ECOG, and were less likely to be identified by screening (29% vs 53% vs 45%). Metabolic syndrome was more prevalent in the MAFLD and mixed groups. The severity of underlying liver disease and HCC characteristics were the same across groups. While the MAFLD population self-reported more sedentary lifestyles, reported dietary patterns were no different across the groups. Dyslipidemia was associated with tumor size, and those taking statins had a lower recurrence rate. CONCLUSION: Equal to ALD, MAFLD is now the most common underlying liver disease seen in HCC patients in Australia. Future HCC prevention screening and treatment strategies need to take this important group of patients into consideration.

Correlating pulmonary embolism severity with short term mortality to risk stratify for outpatient management.

AIMS: We ascertain less than 7-day mortality data in suspected pulmonary embolism (PE) in order to risk stratify patients suitable for outpatient imaging. METHODS: Retrospective identification of patients presenting to two emergency departments over a two-year period, with a radiologically confirmed PE. PESI and sPESI scores correlated with death at 1, 3, 7, 30 and 90 days. RESULTS: There was significant correlation between all PESI risk classes and death at 3, 7, 30 and 90 days (p<0.01), but not day 1. No deaths occurred within 1 and 3 days in low risk PESI groups or within 90 days in the low risk sPESI. CONCLUSION: PESI/sPESI could be reliably utilized to risk stratify patients being considered for outpatient investigation of PE.