Ungprasert, Patompong

Background Uric acid is a natural antioxidant. Previous studies have suggested a protective role of hyperuricemia against liver fibrosis among patients with nonalcoholic fatty liver disease (NAFLD). However, the results were conflicting. Methods MEDLINE and EMBASE databases were searched through August 2016 for studies that investigated the association between hyperuricemia and fibrosis stage among patients with biopsy-proven NAFLD. Pooled odds ratio and 95% confidence interval were calculated using a random-effects model, generic inverse variance method of DerSimonian and Laird. The between-study heterogeneity of effect size was quantified using the Q statistic and I 2. Results A total of five observational studies with 749 NAFLD patients were identified. Patients with NAFLD who had hyperuricemia were not significantly more likely or less likely to have advanced liver fibrosis (defined as fibrosis stage of ≥3) compared with patients with NAFLD who had normal serum uric with the pooled odds ratio of 0.72 (95% confidence interval: 0.34–1.53). The statistical heterogeneity was low with an I 2 of 22% (P heterogeneity=0.27). Conclusion Significant protective role of hyperuricemia against the development of advanced liver fibrosis in patients with NAFLD was not observed in this meta-analysis.

Abstract Rationale Patients with sarcoidosis may have an increased risk of infection similar to other immune-mediated disorders. However, the data are still limited. Objectives To investigate the risk of hospitalized infection among patients with sarcoidosis, using a population-based cohort. Methods Using the Rochester Epidemiology Project record-linkage system, a cohort of incident cases of sarcoidosis in Olmsted County, Minnesota from 1976 to 2013 was identified. Diagnosis was confirmed by individual medical record review. For each patient with sarcoidosis, a sex- and age-matched comparator without sarcoidosis was randomly selected from the same population. Medical records of cases and comparators were individually reviewed for hospitalized infection that occurred after the index date. The cumulative incidence of hospitalized infection overall and by type of infection, adjusted for the competing risk of death, was estimated. Cox models were used to compare the rate of first hospitalized infection between cases and comparators and to evaluate the association between use of immunosuppressive agents and hospitalized infection among cases. Results Three hundred and forty-five cases and 345 comparators were identified. Patients with sarcoidosis had a higher risk of a hospitalized infection with a hazard ratio (HR) of 2.00 (95% confidence interval [CI], 1.41–2.84), adjusted for age, sex, and calendar year of index date. Use of oral glucocorticoids was a significant predictor of hospitalized infection with an HR of 3.03 (95% CI, 1.33–6.90) for oral glucocorticoids not exceeding 10 mg/day and an HR of 4.48 (95% CI, 1.54–13.03) for oral glucocorticoids greater than 10 mg/day. Conclusions Patients with sarcoidosis are at increased risk of hospitalized infection. Glucocorticoid therapy is strongly associated with this increased risk.

Background: Several immune-mediated inflammatory disorders, such as rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus have been linked to an increased risk of venous thromboembolism (VTE). However, the data on ankylosing spondylitis (AS) are limited. Methods: We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing the risk of VTE and possible pulmonary embolism (PE) in patients with AS versus non-AS participants. Pooled risk ratio and 95% confidence intervals were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. Results: Of 423 potentially relevant articles, three studies met our inclusion criteria and thus, were included in the data analysis. The pooled risk ratio of VTE in patients with AS was 1.60 (95% confidence interval: 1.05–2.44). The statistical heterogeneity of this study was high with an I 2 of 93%. Conclusion: Our study demonstrated a statistically significant increased VTE risk among patients with AS.

Background/Objectives: Helicobacter pylori (H. pylori) is the most common chronic bacterial infection. Patients with H. pylori infection may be at an increased risk of nonalcoholic fatty liver disease (NAFLD) because of chronic inflammation and insulin resistance. Several epidemiologic studies attempting to determine this risk have yielded inconsistent results. This meta-analysis was conducted with the aims to summarize all available evidence and estimate the risk of NAFLD in patients with H. pylori infection. Methods: A literature search was performed using MEDLINE and EMBASE database from inception to June 2016. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of NAFLD among patients with H. pylori infection versus without H. pylori infection were included. Pooled odds ratios and 95% confidence intervals were calculated using a random-effect, generic inverse variance method. Results: Six studies met our eligibility criteria and were included in this analysis. We found a statistically significant increased risk of NAFLD among patients with H. pylori infection with the pooled odds ratios of 1.21 (95% confidence interval, 1.07-1.37). The statistical heterogeneity was low with an I 2 of 49%. Conclusions: A significantly increased risk of NAFLD among patients with H. pylori infection was demonstrated in this meta-analysis. Further studies are required to clarify how this risk should be addressed in clinical practice.

Abstract Background The association between hyperuricaemia and nonalcoholic fatty liver disease ( NAFLD ), one of the leading causes of cirrhosis worldwide, has been demonstrated in recent epidemiological studies. This meta‐analysis was conducted to summarize all available data and to estimate the risk of NAFLD among subjects with hyperuricaemia. Methods Comprehensive literature review was conducted using MEDLINE and EMBASE database through August 2016 to identify studies that compared the risk of NAFLD among subjects with hyperuricaemia vs those with normal uric acid level. Effect estimates from individual study were extracted and combined together using random‐effect, generic inverse variance method of DerSimonian and Laird. Results Twenty‐five studies met the eligibility criteria and were included in the meta‐analysis. The risk of NAFLD in subjects with hyperuricaemia was significantly higher than subjects with normal uric acid level with the pooled odds ratio ( OR ) of 1.97 (95% confidence interval ( CI ), 1.69‐2.29). The heterogeneity between studies of the overall analysis was high with an I 2 of 87%. Subgroup analysis based on 11 studies that provided data on males subgroup and nine studies that provided data on females subgroup showed that the risk was significantly increased for both sexes with pooled OR of 1.64 (95% CI , 1.40‐1.93) among males and pooled OR of 2.21 (95% CI , 1.85‐2.64) among females. Conclusions A significantly increased risk of NAFLD among patients with hyperuricaemia was demonstrated in this meta‐analysis. Further studies are required to establish the role of uric acid in the pathogenesis of NAFLD .

AbstractBackgroundThe association between periodontitis and systemic diseases has been increasingly recognized. However, the data on the association between periodontitis and psoriasis are still limited.ObjectivesTo summarize all available data on the association between periodontitis and the risk of psoriasis.MethodsTwo investigators independently searched published studies indexed in MEDLINE and EMBASE databases from inception to July 2016 using a search strategy that included terms for psoriasis and periodontitis. Studies were included if the following criteria were met: (i) case–control or cohort study comparing the risk of psoriasis in subjects with and without periodontitis; (ii) subjects without periodontitis were used as comparators in cohort studies while participants without psoriasis were used as controls in case–control studies; and (iii) effect estimates and 95% confidence intervals (CI) were provided. Point estimates and standard errors from each study were extracted and combined together using the generic inverse variance technique described by DerSimonian and Laird.ResultsTwo cohort studies and three case–control studies met the inclusion criteria and were included in the meta‐analysis. The pooled risk ratio of psoriasis in patients with periodontitis versus comparators was 1.55 (95% CI, 1.35–1.77). The statistical heterogeneity was insignificant with an I2 of 18%. Subgroup analysis according to study design revealed a significantly higher risk among patients with periodontitis with a pooled RR of 1.50 (95% CI, 1.37–1.64) for cohort studies and a pooled RR of 2.33 (95% CI, 1.51–3.60) for case–control studies.ConclusionsPatients with periodontitis have a significantly elevated risk of psoriasis.

Background/objectives Nonalcoholic fatty liver disease (NAFLD) is a worldwide public health concern. Coffee might have a protective effect against NAFLD. However, the results of previous reports are conflicting. Therefore, we carried out this meta-analysis to summarize all available data. Methods This study consisted of two meta-analyses. The first meta-analysis included observational studies comparing the risk of NAFLD in patients who did and did not drink coffee. The second analysis included studies comparing the risk of liver fibrosis between NAFLD patients who did and did not drink coffee. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated. Results Out of 355 articles, five studies fulfilled our eligibility criteria and were included in the analysis. The risk of NAFLD in patients who drank coffee was significantly lower than that in patients who did not pooled RR 0.71 (95% CI, 0.60–0.85). We also found a significantly decreased risk of liver fibrosis among NAFLD patients who drank coffee compared with those who did not, with a pooled RR of 0.70 (95% CI, 0.60–0.82). However, it should be noted that the definition of regular coffee consumption varied between studies, which is the main limitation of this meta-analysis. Conclusion Our study found a significantly decreased risk of NAFLD among coffee drinkers and significantly decreased risk of liver fibrosis among patients with NAFLD who drank coffee on a regular basis. Whether consumption of coffee could be considered a preventative measure against NAFLD needs further investigations.

Background/objectives Hepatitis C virus (HCV) infection is one of the most common causes of cirrhosis. Several studies have linked caffeine consumption to a lower degree of liver fibrosis and inflammation among patients with chronic HCV infection, but the results were inconsistent. This meta-analysis was carried out with the aim of assessing the impact of caffeine consumption among HCV-infected patients. Participants and methods A literature search was performed using MEDLINE and EMBASE from inception to January 2016. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of advanced liver fibrosis or the risk of moderate to severe liver inflammation among HCV-infected patients who consumed caffeine on a regular basis versus those who did not were included. Pooled odds ratios (OR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse-variance method. Results Five studies were included in the fibrosis analysis. The pooled OR of advanced liver fibrosis in HCV-infected patients who consumed caffeine on a regular basis versus those who did not was 0.48 (95% CI, 0.30–0.76, I 2=52%). Three studies were included in the inflammation analysis. The pooled OR of moderate to severe histologic inflammation among HCV-infected patients who consumed caffeine on a regular basis versus those who did not was 0.61 (95% CI, 0.35–1.04, I 2=43%). Conclusion Our study showed a decreased risk of advanced liver fibrosis and liver inflammation among HCV-infected patients who consumed caffeine on a regular basis. Whether consumption of caffeine plays a role in the management of HCV infection requires further investigations.

Background/objectives Gallstone disease and its complications are common, particularly in Western populations. Recent studies have reported a significantly increased risk of gallstones among hepatitis C virus-infected patients. However, the data on patients with hepatitis B virus (HBV) infection are still limited. This meta-analysis was carried out with the aim of summarizing all available evidence. Patients and methods A literature search was performed using MEDLINE and the EMBASE database from inception to May 2016. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of gallstones among HBV-infected patients versus patients without HBV infection were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse-variance method. Results Nine studies fulfilled our eligibility criteria and were included in the analysis. We found no significant association between HBV infection and the risk of gallstones, with a pooled OR of 1.10 (95% CI, 0.91–1.33). The statistical heterogeneity was moderate, with an I 2 of 69%. Subgroup analysis was carried out. The pooled OR of cross-sectional studies was 1.01 (95% CI, 0.91–1.12; I 2 0%), whereas the pooled OR of case–control studies was 1.53 (95% CI, 0.85–2.74; I 2 80%). Conclusion A significant association between HBV infection and the risk of gallstones was not observed in this study.