Prevalence of hepatic steatosis as assessed by controlled attenuation parameter (CAP) in subjects with metabolic risk factors in primary care. A population-based study.

BACKGROUND: Primary care is the ideal setting for early identification of patients with non-alcoholic fatty liver disease (NAFLD). NAFLD is a potentially progressive disease that may lead to cirrhosis and liver cancer but is frequently underrecognized because subjects at risk are often not evaluated. Controlled attenuation parameter (CAP) is a reliable method for non-invasive quantification of liver fat. It has the advantage of simultaneous measurement of liver stiffness (LS), an estimate of liver fibrosis. There is no information on CAP in subjects with risk factors from primary care. AIM: To investigate the prevalence of hepatic steatosis, as estimated by CAP, in subjects from the community with metabolic risk factors and correlate findings with clinical and biochemical characteristics and LS. PATIENTS AND METHODS: Population-based study of 215 subjects with metabolic risk factors without known liver disease identified randomly from a primary care center. A control group of 80 subjects matched by age and sex without metabolic risk factors was also studied. CAP and LS were assessed using Fibroscan. RESULTS: Subjects with risk factors had CAP values higher than those of control group (268±64 vs 243±49dB/m,p<0.001). Prevalence of severe steatosis (CAP> 280dB/m) in subjects with risk factors was 43%. In multivariate analysis, fatty liver index (FLI) and HOMA were independent predictive factors of severe steatosis. There was a direct correlation between CAP and FLI values (r = 0.52,p<0.001). Interestingly, prevalence of increased LS was 12.6% in the risk group vs 0% in the control group (p<0.001). Increased LS occurred predominantly in subjects with high CAP values. CONCLUSIONS: A high proportion of subjects with metabolic risk factors seen in primary care have severe steatosis. FLI could be used as a surrogate of CAP. Increased LS was found in a significant proportion of subjects with risk factors but not in control subjects.

[Prospective analysis of central venous catheter colonization and related factors]. / Análisis prospectivo de la colonización de catéteres centrales y sus factores relacionados.

OBJECTIVE: To evaluate the incidence of central venous catheter (CVC) colonization in inpatient units of the Institut de Malalties Digestives i Metabòliques (IMDiM) of Hospital Clinic (Barcelona, Spain) with a view to reducing the risk of infection. METHOD: A 4-month descriptive, prospective and longitudinal study was performed. A total of 230 patients admitted to the IMDiM with CVC were included during the study period. At catheter removal, the tip was cultured and, if the patient had fever, two blood cultures were also obtained. A database was created. Data were analyzed using SPSS v.11.0. Variables were compared with the Chi-square and Student's t-tests and a multivariate analysis was performed using Cox logistic regression. A value of P<0.05 was considered significant. RESULTS: Catheter tip culture was positive in 45.2%. The rate of catheter-related bloodstream infections was 2.9 per thousand catheter-days, which was clinically significant. The probability of catheter tip contamination 10 days after placement was 25%. Multivariate analysis revealed that the independent variables associated with a higher risk of infection were catheter type, changes of dressing, and infected bacterial stopcocks. CONCLUSIONS: These results suggest that: 1) the protocol for catheter insertion and care should be reviewed and updated, 2) catheter removal should be considered after the 10th day, 3) the appropriate type of catheter should be selected, the catheter with the lowest number of lumens should be used, and changes of catheter dressing should be reduced.

Análisis prospectivo de la colonización de catéteres centrales y sus factores relacionados / Prospective analysis of central venous catheter colonization and related factors

Objetivo. Conocer la incidencia de colonización de los catéteres venosos centrales (CVC) en las unidades de hospitalización del Institut de Malalties Digestives i Metaboliques (IMDiM) del Hospital Clínic de Barcelona con intención de reducir el riesgo de infección. Método. Estudio descriptivo, prospectivo y longitudinal, de 4 meses de duración. Fueron objeto de estudio los pacientes ingresados en las unidades del IMDiM, portadores de CVC (n = 230). Al retirar el catéter, se procedía al cultivo de la punta del mismo, realizándose 2 hemocultivos si el paciente presentaba fiebre. Se creó una base de datos. Se analizó con SPSS versión 11.0. Las variables se compararon mediante prueba de χ2, test de la t de Student y se realizó un análisis multivariante mediante la regresión logística de Cox, considerándose significativa una p igual o inferior a 0,05. Resultados. El cultivo de punta de catéter fue positivo en el 45,2%, con una tasa de bacteriemia relacionada con catéter, clínicamente significativa de 2,9 ‰ días de catéter. La probabilidad de contaminación de punta de catéter fue del 25% a los 10 días de colocación. Realizado el análisis multivariado, observamos que el tipo de catéter, el cambio de apósito y la infección bacteriana de las llaves, fueron las 3 variables independientes asociadas a un mayor riesgo de infección. Conclusiones. Estos resultados sugieren que: 1) se debería revisar y actualizar el protocolo de inserción y mantenimiento de catéteres; 2) valorar la permanencia de éstos a partir del 10.º día, y 3) seleccionar adecuadamente el tipo de catéter que se va a colocar, utilizar el de menor número de luces necesario, así como disminuir el número de cambios de apósito(AU)

Objective: To evaluate the incidence of central venous catheter (CVC) colonization in inpatient units of the Institut de Malalties Digestives i Metabòliques (IMDiM) of Hospital Clinic (Barcelona, Spain) with a view to reducing the risk of infection. Method: A 4-month descriptive, prospective and longitudinal study was performed. A total of 230 patients admitted to the IMDiM with CVC were included during the study period. At catheter removal, the tip was cultured and, if the patient had fever, two blood cultures were also obtained. A data base was created. Data were analyzed using SPSS v.11.0. Variables were compared with the Chi-square and Student’s t-tests and a multivariate analys is was performed using Cox logistic regression. Avalue of P<0.05was considered significant. Results: Catheter tip culture was positive in 45.2%. The rate of catheter-related blood stream infections was 2.9 % catheter-days, which was clinically significant. The probability of catheter tip contamination 10 days after placement was 25%. Multivariateanalysis revealed that the independent variables associated with a higher risk of infection were catheter type, changes of dressing, and infected bacterial stopcocks. Conclusions: These results suggestthat: 1) the protocol for catheter insertion and care should be reviewed and up dated, 2 catheter removal should be considered after the 10th day, 3) the appropriate type of catheter should be selected, the catheter with the lowest number of lumens should be used, and changes of catheter dressing should be reduced(AU)