Wattanachayakul, Phuuwadith

ABSTRACTBackgroundMetabolic dysfunction‐associated steatotic liver disease (MASLD) affects over one third of the global population and is closely linked to gastrointestinal, oncological, and cardiovascular diseases. As the most common cause of steatotic liver disease (SLD), MASLD is often referred to as “fatty liver” in general health information searches. With the Internet becoming a primary source of healthcare information, this study aimed to evaluate global and regional public interest in steatotic liver disease using Google Trends data from January 2004 to December 2024.MethodsA comprehensive analysis was performed using Google Trends with the search term “fatty liver disease.” Interest levels were quantified using Google Trends indices, and temporal patterns were evaluated using average annual percent change (AAPC). Regional variations were assessed to identify geographic hotspots of public interest.ResultsGlobal interest in MASLD demonstrated significant growth (AAPC: 6.77%, 95% Confidence interval [CI]: 5.33–8.23), with a 264% increase from 2004 to 2024. Peak interest was observed in August 2024 (index: 100) compared to the lowest point in June 2007. Iran showed the highest country‐specific search volume (index: 100), while within the United States, West Virginia demonstrated the greatest relative interest (index: 100). Key topics associated with MASLD included “liver,” “symptoms,” “disease,” and “therapy.”ConclusionsSubstantial growth in global public interest in MASLD, with distinct temporal and geographical patterns, provides insights to develop targeted awareness campaigns and educational interventions, particularly in regions with low search volumes. Future research should examine the relationship between online search patterns and clinical outcomes in MASLD.

Abstract Background Acute pancreatitis, a prevalent gastrointestinal condition, frequently necessitates hospitalization and is associated with potential adverse in-hospital outcomes. Recent data showed the detrimental effects of COVID-19 infection on acute pancreatitis, particularly in patients with severe COVID-19 infections. However, limited information exists on the specific impacts of COVID-19 infection in patients hospitalized for acute pancreatitis. Methods We analyzed the 2020 U.S. National Inpatient Sample (NIS) to investigate the effects of COVID-19 infection on cases primarily admitted due to acute pancreatitis. Participants aged 18 and above were identified using relevant ICD-10 CM codes. Adjusted odds ratios (aORs) for specified outcomes were calculated through multivariable logistic and linear regression analyses. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Statistical significance was established at a P value of 0.05. Results We identified 252,435 patients with a primary discharge diagnosis of acute pancreatitis. The mean age was 50.1 years; 48.6% were female. Caucasians accounted for 41%, followed by Hispanics. Of these, 1.05% (2,675/252,435) had a concurrent diagnosis of COVID-19 infection. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 3.71; 95% CI 2.01, 6.84, P < 0.001), prolonged length of stay (β LOS 1.05; 95% CI 0.46, 1.64, P < 0.001), increased hospitalization charge ( β charge 9,327; 95% CI 820, 17834, P < 0.001), and acute respiratory failure (aOR 2.49; 95% CI 1.75, 3.53, P < 0.001), We observed non-significant, but increased, risks of shock, acute kidney injury (AKI), pancreatic pseudocyst, acute respiratory distress syndrome (ARDS), and mechanical ventilation in COVID-19 positive patients. Conclusion In conclusion, our study underscores that COVID-19 infection is associated with higher in-hospital mortality, prolonged hospital stays, and increased incidence of acute respiratory failure in patients diagnosed with acute pancreatitis. Future longitudinal studies are warranted to comprehensively assess the long-term health sequelae in this population. Disclosures All Authors: No reported disclosures

Abstract Background Acute diverticulitis, a prevalent gastrointestinal condition, frequently necessitates hospitalization and is associated with potential adverse in-hospital outcomes. Recent data showed the detrimental effects of COVID-19 infection on acute diverticulitis, particularly in patients with severe COVID-19 infections. However, limited information exists on the specific impacts of COVID-19 infection in patients hospitalized for acute diverticulitis. Methods We analyzed the 2020 U.S. National Inpatient Sample (NIS) to investigate the effects of COVID-19 infection on cases primarily admitted due to acute diverticulitis. Participants aged 18 and above were identified using relevant ICD-10 CM codes. Adjusted odds ratios (aORs) for specified outcomes were calculated through multivariable logistic and linear regression analyses. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Statistical significance was established at a P value of 0.05. Results We identified 167,170 patients with a primary discharge diagnosis of acute pancreatitis. The mean age was 60.1 years; 56.8% were female. Caucasians accounted for the majority, followed by Hispanics. Of these, 0.90% (1,504/167,170) had a concurrent diagnosis of COVID-19 infection. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 8.43; 95% CI 4.32, 16.42, P < 0.001), prolonged length of stay (β LOS 2.02; 95% CI 1.27, 2.77, P < 0.001) and increased hospitalization charge ( β charge 17,813.27; 95% CI 4,080, 31,546, P < 0.001), We observed non-significant, but increased, risks of shock, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and mechanical ventilation in COVID-19 positive patients. Conclusion In conclusion, our study revealed that COVID-19 infection is associated with higher in-hospital mortality, prolonged hospital stays, and increased hospitalization charges in patients diagnosed with acute diverticulitis. Future longitudinal studies are warranted to comprehensively assess the long-term health sequelae in this population. Disclosures All Authors: No reported disclosures

Background: Revascularization of small vessel coronary artery disease (SvCAD) is still challenging despite the extensive use of drug-eluting stents (DESs), mainly because of an increase in target vessel failure. Drug-coated balloon (DCB) has emerged as an alternative strategy in SvCAD. However, the safety and efficacy of DCB in SvCAD is still controversial. We conducted a meta-analysis comparing the clinical outcomes of DCB and DES in SvCAD patients. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2024. Included studies were published randomized control trials (RCTs) that compared major adverse cardiac events (MACE), target-lesion revascularization (TLR), and target-vessel revascularization (TVR) between DCB and DES in SvCAD patients. Data from each study were combined using the random-effects model. Results: Six RCTs were included in this meta-analysis involving 1,534 SvCAD patients (775 underwent revascularization with DCB and 759 with DES). There was no difference in MACE, TLR, and TVR between DCB and DES groups ([OR] 1.14, 95% CI 0.64-2.00, I 2 =58.2%, p=0.657, [OR] 1.34, 95% CI 0.56-3.23, I 2 =48.5%, p=0.516, and [OR] 1.09, 95% CI 0.59-2.01, I 2 =49.6%, p=0.795, respectively) (Figure 1). There was no publication bias observed in Funnel plot as well as no small-study effect observed in Egger’s test. Conclusions: As compared to DES, our study showed that DCB was associated with similar clinical outcomes and could be a potential alternative strategy in SvCAD patients.

Introduction: Chronic total coronary occlusion (CTO) management remains a challenge. Several studies have reported the benefits of percutaneous coronary intervention (PCI) in CTO. However, the outcomes of PCI vs optimal medical therapy (OMT) are still controversial. We conducted an extensive review and meta-analysis to compare the clinical outcomes between PCI and OMT in CTO. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2024. Included studies were published cohort (prospective or retrospective) with propensity score matching analysis and randomized trials that reported all-cause death, cardiac death, and myocardial infarction (MI) with PCI and OMT in CTO patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate odd ratios and 95% confidence intervals. Results: Sixteen studies, 6 randomized controlled trials (RCTs) and 11 observational studies with propensity score with matching (PSMs), were included in this meta-analysis involving 8,316 CTO patients (4,332 underwent PCI and 4,084 received OMT). In the overall analysis, all-cause death, cardiac death, and MI were significantly reduced in PCI compared to OMT group, respectively ([OR] 0.65, 95% CI 0.55-0.76, I 2 =0.0%, p<0.001, [OR] 0.60, 95% CI 0.49-0.74, I 2 =0.0%, p<0.001, and [OR] 0.72, 95% CI 0.52-0.99, I 2 =19.0%, p=0.041). Conclusions: Our study is the most updated meta-analysis to assess the impact of PCI compared to OMT in patients with CTO, analyzing the data being derived from PSMs and RCTs, that demonstrated significant impact of PCI on all-cause death, cardiac mortality, and MI.

Introduction: Menopause is known to be associated with myocardial infarction (MI). However, the association between menopause age and MI onset in a nationally representative population remains unknown. Objective: To examine the correlation between age of menopause and age of MI onset in the general population and the association between early menopause (onset of menopause ≤ 40 years old) and early onset of MI (onset of MI ≤ 40 years old). Methods: A cross-sectional study was conducted using a population from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The questionnaire collected self-reported data on the participants' menopause age and their age of first MI. The relationship between these two parameters was analyzed by multivariate linear and logistic regression analyses. Multivariate analysis was adjusted for race, age, body mass index (BMI), smoking status, diabetes mellitus (DM), hypertension, and dyslipidemia status. Results: Among 2,200 postmenopausal females, 90 (4.1%) have had MI. The study involved 85 postmenopausal females who reported both menopause age and MI onset, with a mean ± SD age of 55 ± 13 years. This study found a significant association between menopause age and MI onset. After adjusting for confounders, it was found that every 1-year increase in the age of menopause will delay the onset of MI by 0.28 years, with a 95% CI of 0.013 to 0.552 (Table 1A, Graph 1A, Graph 1B). Additionally, early menopause carries an almost significantly increased risk of 2.11 times (95% CI: 1.00, 4.45) for early-onset MI. After adjusting for confounders, the magnitude of the association was lower and not statistically significant, but the direction remains (OR (95% CI): 2.08 (0.87, 4.95)). However, after stratification with comorbidities, DM status was identified as an effect modifier, with early MI significantly observed in patients with DM in both univariate and multivariate analyses, with OR (95% CI) of 3.03 (1.10, 8.37) and 4.88 (1.26, 18.96), respectively (Table 2A). Conclusion: This study demonstrated a positive association between menopause age and MI onset in a generally representative population. This suggests that prolonged estrogen exposure due to late menopause may delay the onset of MI. Additionally, early menopause was associated with early MI onset in the DM population. Further longitudinal studies are required to examine the potential mechanisms involved in menopause onset and MI onset.

Background: There is suspicion that estrogen may protect against atherosclerosis. Women who experience menarche earlier, and thus have earlier estrogen exposure, might develop atherosclerosis later. The relationship between menarche age and the onset of angina pectoris, a symptom of coronary artery disease, remains unknown. Goal: This study aims to find the correlation between menarche age and the onset age of angina pectoris, and the association between early menarche (onset of menarche ≤ 10 y/o) and early onset of angina pectoris (onset of angina pectoris ≤ 40 y/o). Methods: A cross-sectional study using a population from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The question collects self-reported data on onset of menarche and onset of angina pectoris. The relationship between menarche age and age in onset of angina pectoris was analyzed by linear and logistic regression analysis. Multivariate analysis adjusted for race, age, body mass index (BMI), smoking , diabetes mellitus (DM), hypertension, and dyslipidemia status. Results: Among 4,816 females who reported their menarche age, 88(1.8 %) have had an angina pectoris. The study involved 82 females who reported both the age of menarche and the age of onset of angina pectoris. The mean ± SD of the age at menarche and the age at onset of angina pectoris was 12.53 ± 1.79 y/o and 51.66 ± 15.16 y/o, respectively. The study found a significant association between the menarche age and the age at onset of angina pectoris. After adjusting for confounders, we found that every 1-year increase in the age of menarche will delay the onset of angina pectoris by 1.43 years, with a 95% CI of 0.01 to 2.86.(Table 1A,Graph 1A-1B) We also found that early menarche has a significantly increased risk 2.8 times (95%CI: 1.3, 6.2) of early onset of angina pectoris.After adjusting for confounders, the association became even stronger. The odds ratio (OR) increased to 3.3 (95%CI: 1.4, 8.0), indicating that women with early menarche were 3.3 times more likely to experience early angina pectoris compared to those with later menarche.(Table 2A) Conclusion: In contrast to our hypothesis, age at menarche is positively associated with onset of angina pectoris. The earlier onset of menarche is linked to the earlier onset of angina pectoris. We suspected that factors beyond estrogen levels may contribute to this unexpected finding. Additional studies are needed to examine the cause of this correlation.

Abstract Background Short sleep is linked to increased acute myocardial infarction (MI) risk.However, the association of weekend-to-weekday sleep patterns with MI in a nationally representative population remains unknown. The goal is to investigate how weekday and weekend sleep durations affect myocardial infarction (MI) in the general population, and if longer weekend sleep can offset insufficient weekday sleep's effects. Methods A cross-sectional study utilized data from the 2017-2020 NHANES to examine the relationship between sleep patterns and MI. Participants self-reported their average sleep durations on weekdays (1) and weekends (2), along with the calculated weekend-to-weekday sleep duration ratio (SDR) (3). Logistic regression models, adjusting for various factors, including demographics and comorbidities, were employed to analyze the association. Those with SDR &gt; 1 had more weekend sleep, while an SDR = 1 indicated equal sleep durations. Results The study involved 9,205 adult participants, with a mean ± SD age of 68.8 ± 10.8 years and 30.7% being female. Among them, 4.65% (428 patients) had a history of MI. The mean ± SD of weekday and weekend sleep hours was 7.6 ± 1.7 and 8.3 ± 1.8 hours, respectively. For weekday sleep duration, after univariate analysis, individuals compared to those in Q1 were statistically significant 0.72 times less likely in Q2 and 1.4 times more likely in Q4 to experience MI . While MI was 0.76 times less likely to occur among participants in Q3, it was not statistically significant (95% CI Q2: 0.54, 0.96; Q4: 1.05, 1.76; Q3:0.57, 1.00). After adjusting, participants only in Q3 were statistically significant 0.71 times less likely to develop MI.(Q3: 95% CI 0.51, 0.99). For weekend sleep duration, the univariate analysis showed that individuals in Q2, Q3, and Q4 were significantly less likely to experience MI (OR = 0.63, 0.67, and 0.69; 95% CIs: 0.48-0.82, 0.51-0.87, 0.53-0.90, respectively) After adjusting, only participants in Q2 were statistically significant less likely to develop MI (OR = 0.71; 95% CI 0.52 - 0.96). For the weekend-to-weekday sleep duration ratio (SDR), after univariate analysis, individuals were statistically significant 0.54 times less likely, and 1.5 times more likely to experience MI in those whose SDR is more than 1, and those whose SDR equals 1, respectively (95% CI SDR &gt; 1: 1.14, 1.98; SDR = 1: 0.39, 0.72). After adjusting, participants with SDR more than 1 were statistically significant 0.69 times less likely to develop MI. Conclusions Moderate sleep durations on weekdays (in Q3), weekends (in Q2), along with SDR more than 1, were negatively linked with MI in a general population. This implies that sleep durations on both weekends and weekdays have comparable associations with MI. Additionally, full recovery sleep on weekends following sleep-deprived weekdays, might reduce MI risk. Further studies are needed to explore impact of weekend and weekday sleep patterns on MI.Histogram and Margins plotTable of Odd ratios

Background: Although BP is associated with kidney outcomes, its clinical significance in living kidney donors (LKD) is unknown. We aim to examine the association between pre-donation BP and the risk of kidney function decline in LKD. Methods: A retrospective cohort study using OPTN/SRTR including adult LKD, who underwent donation between 6/1972 and 9/2022, was utilized to examine the association of quartile (Q) of pre-donation SBP and DBP with time-to-event of ≥35% decline in post-donation eGFR from pre-donation eGFR by multiple Cox regression. Results: Of 174,311 adult LKD, mean±SD age was 41±12 years and 60% were female. Mean pre-donation SBP and DBP were 122±13 and 74±9 mmHg, respectively. Mean pre-donation SBP in Q 1, 2, 3, and 4 were 106±6, 117±2, 126±3, and 140±9 mmHg, respectively and the corresponding DBP were 62±5, 71±2, 78±2, and 86±5 mmHg, respectively. The median (IQR) of pre-donation eGFR was 91 (75, 111) mL/min/1.73 m2. Median(IQR) eGFR at immediate post-donation, 6-, 12-, and 24-months post-donation were 50 (40, 62), 54 (44, 67), 55 (45, 68), and 57 (47, 70) mL/min/1.73 m2, respectively. Out of 38,780 LKD with post-donation eGFR data at 6, 12, or 24 months, 31,054 had the event of ≥35% decline in post-donation eGFR from pre-donation eGFR with a median time to follow-up of 6.77 months(IQR 5.93, 12.67). The incidence rate of the event was 0.08 person-months. Compared to patients with SBP in Q 1, those with SBP in Q 2, 3, and 4 had a significantly increased risk for the event(HRSBP Q2,3,4 1.05, 1.08, and 1.15; P <0.001 – 0.003) but only patients with DBP in Q 3 and 4 had a significantly increased risk for the event (HRSBP Q3,4 1.04 and 1.09). After adjusting for age, gender, race/ethnicity, U.S. citizenship, education level, history of pre-donation HTN, diabetes, pre-donation BMI, DBP, and urine protein:creatinine ratio, there was a J-shaped association between pre-donation SBP and post-donation eGFR decline and only patients in the Q 2 became significantly associated with lower the risk for the event (HR 0.87, 95%CI 0.76, 0.99; Fig1). The pre-donation DBP – post-donation eGFR association was similar to the SBP – eGFR association but there was no statistically significant in all Q (Fig2). There was no effect-measured modifier for all covariates. Conclusions: Pre-donation SBP in a normal range(113 - 120 mmHg) is associated with the lowest risk for a post-donation eGFR decline. BP control in the normal range should be achieved for potential LKD.

81 Background: Recent data suggest an association between cardiovascular disease burden and biliary cancer patients. However, the outcomes of hospitalized patients for biliary-pancreatic malignancy with concurrent acute decompensated heart failure (ADHF) are not well understood. Therefore, our objective is to assess the impact of ADHF on patients hospitalized for biliary-pancreatic malignancy. Methods: We used the 2020 U.S. National Inpatient Sample (NIS) to study patients hospitalized for biliary tract and pancreatic malignancy with concurrent acute decompensated heart failure (ADHF) identified by ICD-10 CM codes. Adjusted odds ratios (aORs) for predefined outcomes were determined via multivariable logistic and linear regression analyses. The primary outcome examined was inpatient mortality, while secondary outcomes included complications related to various body systems. Results: We identified 43,009 patients with a primary discharge diagnosis of biliary tract and pancreatic cancer. The mean age was 68.5 years; 49.4% were female. Caucasians accounted for 68%, followed by Hispanics (13%). Of these, 6.27% (3,699/43,009) had a concurrent diagnosis of heart failure. In the survey's multivariable logistic and linear regression analysis, accounting for patient and hospital confounding factors, ADHF demonstrated significant associations with higher in-hospital mortality (aOR 1.63; 95% CI 1.09, 2.44, p = 0.015). In addition, a significant association between ADHF and various adverse in-hospital outcome was observed including prolonged mean length of stay (Beta 1.45; 95% CI 0.67, 2.24, p < 0.001), increased mean total hospital cost (Beta 3,757; 95% CI: 2,641, 36,630, p = 0.024), elevated risk of shock (aOR 2.75; 95% CI: 1.77, 4.26, p < 0.001), higher risk of sepsis (aOR 1.71, 95% CI: 1.09, 2.68, p = 0.018), increased risk of acute respiratory failure (aOR 3.18, 95% CI: 2.25, 4.51, p < 0.001), and heightened risk of acute kidney injury (aOR 1.57; 95% CI: 1.24, 1.99, p < 0.001). Conclusions: Among patients hospitalized for biliary-pancreatic malignancy, concurrent ADHF is linked to increased mortality risk and various in-hospital adverse complications. Additional long-term studies are required for a comprehensive understanding of this association.