Argueta, Pedro Palacios

ABSTRACT Introduction Metabolic dysfunction‐associated steatotic liver disease (MASLD) and steatohepatitis (MASH) represent a spectrum of liver conditions that can gradually progress to cirrhosis. Sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors have shown benefits in reducing hepatic steatosis and liver‐related events in MASLD. This study aims to assess whether SGLT‐2 inhibitors are associated with a reduced risk of all‐cause mortality and disease‐specific outcomes in patients with MASH cirrhosis and type 2 diabetes (T2D). Methods A retrospective cohort study was performed using TriNetX. Patients with T2D and MASH cirrhosis on SGLT‐2 inhibitors were matched 1:1 with other glucose‐lowering drugs (oGLDs) based on demographics, comorbidities and medications. Primary outcomes included all‐cause mortality, hepatic decompensation and major adverse liver outcomes (MALO). Cox‐proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence interval (CI). Results A total of 51 427 patients with MASH cirrhosis and T2D were identified, of which 6833 (13.28%) were on SGLT‐2 inhibitors. Patients on SGLT‐2 inhibitors ( n = 6449, mean age 63.7 years, 52.9% female) were matched with 6449 individuals (mean age 63.9 years, 53.5% female) on oGLDs. The SGLT‐2 inhibitors cohort had statistically significantly lower risk of all‐cause mortality (HR: 0.58, 95% CI: 0.53–0.63), hepatic decompensation (HR: 0.85, 95% CI: 0.81–0.90) and MALO (HR: 0.88, 95% CI: 0.83–0.93). Conclusion SGLT‐2 inhibitors are associated with a reduced risk of all‐cause mortality in patients with MASH cirrhosis and T2DM, which may be partly attributable to a lower risk of hepatic decompensation and subsequent events. Further studies are warranted as SGLT‐2 inhibitors may serve as an adjunctive therapy for patients with MASH cirrhosis.

Abstract Background/Aim Limited data exists on 30-day readmission rates, readmission causes and predictors following Ischemic Colitis (IC). The aim is to identify etiologies for the above using a national database. Methods A retrospective cohort study using the 2019 National Readmission Database (NRD) of adult patients with an index admission (IA) for IC from January to November and were readmitted within 30 days of discharge was performed. The primary outcome was readmission of any cause. Secondary outcomes were mortality and resource utilization associated with readmission. Independent risk factors for all-cause readmission were identified using Cox regression analysis. Results A total of 6,853 IC patients were identified. Readmission within 30 days occurred in 762 (11%). The primary readmission cause was sepsis. A total of 325 patients died during the IA and additional 30 patients died within 30 days of discharge. Independent predictors of readmission were discharge to short term hospital, a Charlson comorbidity index score ≥ 2 and admission at large size hospital. Having private insurance and undergoing colonoscopy were associated with lower readmission odds. Economic burden of readmission was $12 million in total costs and $51.4 million in total charges. Conclusion Among admitted IC patients, 30-day readmission rate was 11% with half of those secondary to sepsis. Undergoing colonoscopy during the IA is associated with 34% less risk of readmission and disposition to other facilities appears associated with increased early readmission risk. Prospective evaluation to confirm these findings along with development of optimal care strategies to reduce readmission post IC episodes are needed.