Thongprayoon, Charat

Despite preexisting cytomegalovirus (CMV) immunity, CMV‐seropositive liver transplantation (LT) patients remain at risk of CMV infection. We hypothesized that the pre‐transplant CMV antibody titer correlates with the risk of CMV reactivation. We conducted a retrospective study of CMV‐seropositive LT recipients who did not receive anti‐CMV prophylaxis from 2007 to 2013. The pre‐transplant CMV immunoglobulin G (IgG) titer, which was measured with an enzyme‐linked fluorescent immunoassay, was assessed as a risk factor for CMV reactivation with multivariate Cox proportional hazards models. The population consisted of 225 CMV‐seropositive LT patients with a median age of 57 years (interquartile range, 47‐62 years). The CMV titer distributions were as follows: <60 (40%) and ≥60 AU/mL (60%). The Kaplan‐Meier estimates for CMV infection were 17% at 3 months, 18% at 6 months, and 19% at 12 months after transplantation. In a univariate analysis, a marginally significant increased risk of CMV infection was seen in LT recipients with a pre‐transplant CMV IgG titer < 60 AU/mL versus ≥ 60 AU/mL [hazard ratio (HR), 1.79; 95% confidence interval (CI), 0.98‐3.28 (P =0.06)]. This risk was statistically significant in the subgroup of recipients who received allografts from CMV‐seropositive donors [HR, 2.21; 95% CI, 1.15‐4.26 (P =0.02)]. In a multivariate analysis, a pre‐transplant CMV IgG titer < 60 AU/mL was significantly associated with CMV infection [HR, 3.11; 95% CI, 1.60‐6.03 (P < 0.001)]. The other risk factors were high body mass index, donor CMV seropositivity, prolonged cold ischemic time, use of an interleukin‐2 receptor antagonist for induction therapy, and high numbers of post‐transplant infections. A lower pre‐transplant CMV antibody titer is significantly associated with CMV infection after LT. Quantitative measurement of CMV‐specific humoral immunity may have a potential role in improving the CMV prevention strategy in CMV‐seropositive LT recipients.Liver Transpl 21:539–546, 2015. © 2015 AASLD.

AimTo investigate the association between primary biliary cirrhosis (PBC) and risk of coronary artery disease (CAD).MethodsWe conducted a systematic review and meta‐analysis of published observational studies that reported relative risks, odd ratios, hazard ratios or standardized incidence ratios with 95% confidence intervals (CI) comparing CAD risk in patients with PBC versus non‐PBC controls. Pooled risk ratios and 95% confidence intervals were combined using a random‐effect model and generic inverse variance of DerSimonian and Laird methods.ResultFour studies with 3362 patients with PBC were identified and included in our data analysis. The pooled risk ratio of CAD in patients with PBC was 1.57 (95% CI, 1.21–2.06). The statistical heterogeneity was low with an I2 of 38%.ConclusionOur study demonstrated a statistically significant increased risk of CAD among patients with PBC.

Purpose: The strategy used to improve effective checklist use in intensive care unit (ICU) setting is essential for checklist success. This study aimed to test the hypothesis that an electronic checklist could reduce ICU provider workload, errors, and time to checklist completion, as compared to a paper checklist. Methods: This was a simulation-based study conducted at an academic tertiary hospital. All participants completed checklists for 6 ICU patients: 3 using an electronic checklist and 3 using an identical paper checklist. In both scenarios, participants had full access to the existing electronic medical record system. The outcomes measured were workload (defined using the National Aeronautics and Space Association task load index [NASA-TLX]), the number of checklist errors, and time to checklist completion. Two independent clinician reviewers, blinded to participant results, served as the reference standard for checklist error calculation. Results: Twenty-one ICU providers participated in this study. This resulted in the generation of 63 simulated electronic checklists and 63 simulated paper checklists. The median NASA-TLX score was 39 for the electronic checklist and 50 for the paper checklist ( P = .005). The median number of checklist errors for the electronic checklist was 5, while the median number of checklist errors for the paper checklist was 8 ( P = .003). The time to checklist completion was not significantly different between the 2 checklist formats ( P = .76). Conclusion: The electronic checklist significantly reduced provider workload and errors without any measurable difference in the amount of time required for checklist completion. This demonstrates that electronic checklists are feasible and desirable in the ICU setting.

Abstract Background/Objectives The risk of chronic kidney disease ( CKD ) in patients who regularly drink soda is controversial. The objective of this meta‐analysis was to evaluate the associations between consumption of sugar‐sweetened and artificially sweetened soda and CKD . Methods A literature search was performed using MEDLINE , EMBASE and the C ochrane D atabase of S ystematic R eviews from inception until 30 J une 2014. Studies that reported odds ratios or hazard ratios comparing the risk of CKD in patients consuming significant amounts of either sugar‐sweetened or artificially sweetened soda versus those who did not consume soda were included. Pooled risk ratios ( RR ) and 95% confidence intervals ( CI ) were calculated using a random‐effects, generic inverse variance method. Results Five studies were included in our analysis of the association between consumption of sugar‐sweetened soda and CKD . The pooled RR of CKD in patients consuming sugar‐sweetened soda was 1.58 (95% CI 1.00–2.49). Four studies were selected to assess the association between consumption of artificially sweetened soda and CKD . The pooled RR of CKD in patients consuming artificially sweetened soda was 1.33 (95% CI 0.82–2.15). Conclusions Our study demonstrates statistically significant increased risks of CKD in patients consuming sugar‐sweetened soda, but not in patients consuming artificially sweetened soda. This finding suggests that sugar‐sweetened soda consumption is associated with CKD and may impact clinical management and primary prevention of CKD in high‐risk patients.

AbstractA possible causal relationship between sarcoidosis and malignancy has been the subject of debates for decades. To better understand this association, we conducted a systematic review and meta‐analysis of cohort studies that reported relative risk, hazard ratio or standardized incidence ratio with 95% confidence interval (CI) comparing the incidence of malignancy in patients with sarcoidosis versus non‐sarcoidosis participants. Pooled risk ratios (RR) and 95% CI were calculated using a random‐effect, generic inverse variance methodology. Five studies were identified and included in our data analyses. The pooled RR of malignancy in patients with sarcoidosis was 1.21 (95% CI: 1.04–1.40). However, when we performed a sensitivity analysis that included only studies that compared the incidence of malignancy after the first year of the diagnosis of sarcoidosis with the incidence of malignancy after the first year of index date for non‐sarcoidosis controls, the pooled risk ratio decreased and did not reach statistical significance (RR 1.13, 95% CI: 0.97–1.32). Furthermore, analysis for publication bias has suggested that publication bias in favour of positive studies may be present. In conclusion, after accounting for possible detection bias and publication bias, there does not appear be a significant association between sarcoidosis and malignancy.