Hispanic Ethnicity is Associated with Increased Morbidity and Mortality in Patients with Alcoholic Liver Disease
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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Ann Hepatol. 2017;16:164-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 94 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 52 "PDF" => 31 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Graft Calcification Caused by a Torsion of the Hepatic Vein after a Living-Related Donor Liver Transplantation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "164" "paginaFinal" => "168" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0015" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 730 "Ancho" => 2076 "Tamanyo" => 167957 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">The follow-up liver triphase CT studies after re-exploration. <span class="elsevierStyleBold">A.</span> CT study of 3rd week: A large portion of hypo-enhancement with heterogeneity of the liver parenchyma in the graft was noted. Congestion with hypo-perfusion was likely. <span class="elsevierStyleBold">B.</span> CT study of 8th week: The liver graft enlarged in size, compatible with liver regeneration. Geographic calcification was noted in the previous congestion areas of the liver graft, probably resulting from congestion necrosis. Some resolution of necrosis was present.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Kuo-Shyang Jeng, Chun-Chieh Huang, Cheng-Kuan Lin, Chien-Chu Lin, Kuo-Hsin Chen" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Kuo-Shyang" "apellidos" => "Jeng" ] 1 => array:2 [ "nombre" => "Chun-Chieh" "apellidos" => "Huang" ] 2 => array:2 [ "nombre" => "Cheng-Kuan" "apellidos" => "Lin" ] 3 => array:2 [ "nombre" => "Chien-Chu" "apellidos" => "Lin" ] 4 => array:2 [ "nombre" => "Kuo-Hsin" "apellidos" => "Chen" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119303758?idApp=UINPBA00004N" "url" => "/16652681/0000001600000001/v1_201905311015/S1665268119303758/v1_201905311015/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Hispanic Ethnicity is Associated with Increased Morbidity and Mortality in Patients with Alcoholic Liver Disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "169" "paginaFinal" => "171" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alexander M. Sy, Rafael Ching, Gonzalo Olivares, Carlos Vinas, Ruth Chang, Nora V. Bergasa" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Alexander M." "apellidos" => "Sy" "email" => array:1 [ 0 => "toshi_sy@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Rafael" "apellidos" => "Ching" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Gonzalo" "apellidos" => "Olivares" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Carlos" "apellidos" => "Vinas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "Ruth" "apellidos" => "Chang" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff1" ] ] ] 5 => array:3 [ "nombre" => "Nora V." "apellidos" => "Bergasa" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff2" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Medicine, Metropolitan Hospital Center, New York and New York Medical College, Valhalla, New York, USA" "etiqueta" => "*" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Division of Gastroenterology and Hepatology, Metropolitan Hospital Center, New York, USA" "etiqueta" => "**" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence and reprint request:" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">Dear Editor,</p><p id="p0010" class="elsevierStylePara elsevierViewall">Alcoholic liver disease (ALD) encompasses a broad spectrum of liver pathology, from steatosis to alcoholic st-eatohepatitis, cirrhosis, and hepatocellular carcinoma. Alcohol has a synergistic effect with other chronic liver diseases leading to accelerated progression. Racial and ethnic differences have been documented for some chronic diseases, including hypertension, heart failure, and ALD. Women are more susceptible to ALD than men when exposed to similar amounts of alcohol, and Hispanics are more prone to develop ALD than blacks and Caucasians.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Accordingly, the aim of this study was to characterize patients with ALD admitted to a community hospital that serves a predominantly Hispanic population in East Harlem in New York City to learn the spectrum of liver disease in hospitalized patients from the community.</p><p id="p0015" class="elsevierStylePara elsevierViewall">We conducted a retrospective review of charts of patients aged 18 to 85 years admitted to the Medicine service at Metropolitan Hospital Center with a diagnosis of ALD identified by the use of ICD-9 codes from 2002, when the hospital instituted its electronic medical records, to 2011. Demographic data, co-morbidities, intensive care unit admission, and need for mechanical ventilation were recorded. The 3 months survival after discharge was also documented. Pregnancy, incomplete documentation, and anticoagulation therapy were the exclusion criteria. Statistical analysis was done by the use of χ<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and Fisher exact test for categorical data by the use of SAS program. A p value of < 0.05 was considered statistically significant. The study was approved by the New York Medical College Institutional Review Board.</p><p id="p0020" class="elsevierStylePara elsevierViewall">ALD was identified in 165 patients. The group was comprised of 138 males and 27 females, 118 of whom (71.5%) were of Hispanic and 47 (28.5%) were of non-Hispanic ethnicity, which was comprised of 34 blacks, 12 Caucasians and 1 Asian. The average age was 53 years. The comorbidities and alcohol use in the study group is provided in the table. The proportion of patients that reported drinking at the time of admission and the estimated daily grams of alcohol consumed by the subjects was higher in the non-Hispanic group than in the Hispanic group, both exhibiting a statistically significant difference; however, data on these two factors were not available in all patients (<a class="elsevierStyleCrossRef" href="#t0010">Table 1</a>).</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0025" class="elsevierStylePara elsevierViewall">There was a significant difference between the number of non-Hispanic (n = 104) and Hispanic (n = 7) patients who did not require intensive care unit admission (p = 0.015). There was also a significant difference between non-Hispanic (n = 16) and Hispanic (n = 7) patients who did not require mechanical ventilation. In addition, a significant association was found for patients who did not require mechanical ventilation stratified by non-Hispanic (n = 132) population and Hispanic women (n = 10) (p = 0.0006) although, the need for mechanical ventilation was not different between Non-Hispanic (n = 9) and Hispanic women (n = 10) (p = 0.086). Eighteen of the 165 patients had died at 90 days post admission, 12 non-Hispanic and 6 Hispanic. In a stratified analysis, there was a significant association between mortality and the Hispanic women group and non-Hispanic patients (p = 0.0007); however, the 90 day mortality for Hispanic (n = 6) <span class="elsevierStyleItalic">vs.</span> non-Hispanic women (n = 1) was not significantly different (p = 0.20).</p><p id="p0030" class="elsevierStylePara elsevierViewall">The study revealed that the majority of patients admitted to the hospital with ALD was of the Hispanic ethnicity. This finding may be a reflection of the population that uses the hospital for care; however, it raises the question of a potential increase in the prevalence of ALD in the Hispanic group.</p><p id="p0035" class="elsevierStylePara elsevierViewall">An important finding of this study was that ALD was associated with heightened morbidity and mortality, as suggested by the increased number of intensive care unit admissions, and the need for mechanical ventilation in Hispanic patients. The reason for the increase in the severity of ALD in the Hispanic group is not apparent from the study. In this regard, the proportion of subjects that was drinking on admission and the grams of daily alcohol drunk by them was higher in the non-Hispanic group than in the Hispanic group; however, this information was not available for all subjects, thus, the data cannot be interpreted accurately. Ethnic disparities have been reported in some chronic health conditions<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> although they are not well documented in ALD; in this context, it is possible that the increase in the severity of ALD in the Hispanic subjects was due to the ethnicity itself.</p><p id="p0040" class="elsevierStylePara elsevierViewall">The inflammatory response to alcohol is reported to be increased in chronic alcohol users which may lead to multi-organ failure. In the lungs, alcohol impairs the host's innate pulmonary defense mechanism directly, by altering the normal alveolar barrier function, and indirectly, by affecting the circulating blood cells such as neutrophils, monocytes, and macrophages thus making ALD patients prone to infections, such as <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> and increased risk for adult respiratory distress syndrome (ARDS) and mechanical ventilation support.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This study showed that the non-Hispanic population did not require mechanical ventilation and intensive care unit admission as frequently as the Hispanic group. A similar observation was reported in a study on blunt trauma patients that documented that Hispanic as compared to black patients were associated with a higher mortality and case fatality rates for ARDS.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="p0045" class="elsevierStylePara elsevierViewall">This study also revealed that Hispanic women were at increased risk for mechanical ventilation as compared to the entire non-Hispanic population, however, there was no difference when compared to non-Hispanic women; the lack of significant difference of this finding may be due to the relatively small sample size of the study. Nevertheless, in general, women are more susceptible to alcohol hepatotoxicity which is reported to be secondary to a decreased in the enzyme alcohol dehydrogenase activity, heightened gut permeability leading to increased endotox-in levels in the blood which is associated with oxidative stress and inflammation, and enhanced body fat content, which is associated with augmented concentration of the substance.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="p0050" class="elsevierStylePara elsevierViewall">In East Harlem, a substantial proportion of the population is comprised of immigrants from Central and South America<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in whom metabolic syndrome, a risk factor for fatty liver, prevails. In this context, DM and HTN were significantly prevalent in the Hispanic group. Hispanic ethnicity, however, is heterogeneous thus nonalcoholic fatty liver disease (NAFLD) cannot be generalized to all subjects from this group. In support of this idea is a study that reported that persons of Central American background had a higher prevalence of NAFLD as compared to that from Caribbean origin (e.g. Puerto Rico, Dominican Republic, and Cuba) and these differences were not explained by modifiable factors such as diet or physical ac-tivities.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Accordingly, we hypothesize that Hispanic ethnicity of a certain nature increases the vulnerability to ALD perhaps by genetic susceptibility to fatty liver that may be worsened by alcohol, the threshold of which to cause liver injury may be decreased in Hispanic subjects compared to other ethnic and racial groups.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-12" "fechaAceptado" => "2016-11-24" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "t0010" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hispanic ethnicity n = 118 (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-Hispanic ethnicity n = 47 (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (6.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (38.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alcohol use at the time of admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92 (78) 26 (22)<a class="elsevierStyleCrossRef" href="#tbl1fn1"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (87.2) 6 (12.8)<a class="elsevierStyleCrossRef" href="#tbl1fn1"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alcohol > 80 grams \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (53.3) 55 (46.7)<a class="elsevierStyleCrossRef" href="#tbl1fn1"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (51) 23 (49)<a class="elsevierStyleCrossRef" href="#tbl1fn1"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2046048.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tbl1fn1" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="np0010">No available data.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Comorbidities and alcohol use in the study group.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 7 | 6 | 13 |
| 2024 September | 12 | 11 | 23 |
| 2024 August | 12 | 10 | 22 |
| 2024 July | 7 | 1 | 8 |
| 2024 June | 3 | 3 | 6 |
| 2024 May | 6 | 6 | 12 |
| 2024 April | 6 | 7 | 13 |
| 2024 March | 7 | 7 | 14 |
| 2024 February | 4 | 9 | 13 |
| 2024 January | 3 | 3 | 6 |
| 2023 December | 4 | 2 | 6 |
| 2023 November | 3 | 4 | 7 |
| 2023 October | 4 | 5 | 9 |
| 2023 September | 2 | 4 | 6 |
| 2023 August | 4 | 5 | 9 |
| 2023 July | 3 | 7 | 10 |
| 2023 June | 1 | 2 | 3 |
| 2023 May | 5 | 3 | 8 |
| 2023 April | 3 | 2 | 5 |
| 2023 March | 11 | 1 | 12 |
| 2023 February | 4 | 1 | 5 |
| 2023 January | 7 | 3 | 10 |
| 2022 December | 0 | 10 | 10 |
| 2022 November | 4 | 7 | 11 |
| 2022 October | 4 | 8 | 12 |
| 2022 September | 3 | 4 | 7 |
| 2022 August | 1 | 6 | 7 |
| 2022 July | 6 | 5 | 11 |
| 2022 June | 6 | 5 | 11 |
| 2022 May | 5 | 5 | 10 |
| 2022 April | 5 | 7 | 12 |
| 2022 March | 6 | 6 | 12 |
| 2022 February | 10 | 7 | 17 |
| 2022 January | 24 | 4 | 28 |
| 2021 December | 4 | 10 | 14 |
| 2021 November | 6 | 5 | 11 |
| 2021 October | 8 | 9 | 17 |
| 2021 September | 6 | 7 | 13 |
| 2021 August | 7 | 5 | 12 |
| 2021 July | 6 | 12 | 18 |
| 2021 June | 6 | 10 | 16 |
| 2021 May | 11 | 10 | 21 |
| 2021 April | 18 | 14 | 32 |
| 2021 March | 4 | 10 | 14 |
| 2021 February | 6 | 8 | 14 |
| 2021 January | 4 | 6 | 10 |
| 2020 December | 5 | 2 | 7 |
| 2020 November | 9 | 6 | 15 |
| 2020 October | 9 | 6 | 15 |
| 2020 September | 10 | 5 | 15 |
| 2020 August | 15 | 7 | 22 |
| 2020 July | 9 | 5 | 14 |
| 2020 June | 7 | 7 | 14 |
| 2020 May | 7 | 4 | 11 |
| 2020 April | 3 | 1 | 4 |
| 2020 March | 17 | 4 | 21 |
| 2020 February | 16 | 1 | 17 |
| 2020 January | 17 | 4 | 21 |
| 2019 December | 14 | 3 | 17 |
| 2019 November | 27 | 5 | 32 |
| 2019 September | 1 | 0 | 1 |
| 2019 August | 1 | 1 | 2 |
| 2019 July | 1 | 1 | 2 |
| 2019 June | 1 | 8 | 9 |
| 2019 May | 2 | 4 | 6 |
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