Background There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in nonalcoholic fatty liver disease (NAFLD). Aim To compare the performance of the FIB4 index (based on age, aspartate and alanine aminotransferase and platelet counts) with six other non-invasive markers of fibrosis in patients with NAFLD. Methods Using a nation-wide database of 541 adults with NAFLD, jackknife-validated areas under receiver operating characteristic curves (AUROC) of FIB4 and seven other markers were compared. The sensitivity at 90% specificity, 80% positive predictive value, and 90% negative predictive values were determined along with cutoffs for advanced fibrosis. Results The median FIB4 score was 1.11 (IQR=0.74–1.67). The jackknife-validated AUROC for FIB4 was 0.802 (95% CI: 0.758, 0.847) which was higher than that for the NAFLD fibrosis score (0.768 CI:0.720–0.816, p= 0.09), Goteburg University Cirrhosis Index (0.743, CI:0.695–0.791, p< 0.01), AST:ALT ratio (0.742, CI:0.690–0.794, p< 0.015), AST to platelet ratio index (0.730, CI:0.681–0.779, p< 0.001), AST to platelet ratio (0.720, 0.669–0.770, p< 0.001), BARD score (0.70, p< 0.001) and cirrhosis discriminant score (0.666, CI:0.614–0.718, p< 0.001). For a fixed specificity of 90% (FIB4 = 1.93), the sensitivity of identifying advanced fibrosis was only 50% (95% CI: 46, 55). A FIB4 ≥ 2.67 had an 80% positive predictive value and a FIB4 index ≤ 1.30 had a 90% negative predictive value. Conclusions The FIB4 index is superior to seven other non-invasive markers of fibrosis in patients with NAFLD; however its performance characteristics highlight the need for even better non-invasive markers.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the UnitedStates. The association between NAFLD and quality of life (QOL) remains unclear. These data are important to estimate the burden of illness in NAFLD. The aim was to report QOL scores of adults with NAFLD and examine the association between NAFLD severity and QOL. QOL data were collected from adults with NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network using the Short Form 36 (SF-36) survey, and scores were compared with normative U.S. population scores. Liver biopsy histology was reviewed by a central pathology committee. A total of 713 subjects with NAFLD (male ‫؍‬ 269, female ‫؍‬ 444) were included. Mean age of subjects was 48.3 years; 61% had definite nonalcoholic steatohepatitis (NASH), and 28% had bridging fibrosis or cirrhosis. Diabetes was present in 27% of subjects. Subjects with NAFLD had worse physical (mean, 45.2) and mental health scores (mean, 47.6) compared with the U.S. population with (mean, 50) and without (physical, 55.8; mental, 52.5) chronic illness. Subjects with NASH reported lower physical health compared with subjects with fatty liver disease without NASH (44.5 versus 47.1, P ‫؍‬ 0.02). Subjects with cirrhosis had significantly (P < 0.001) poorer physical health scores (38.4) than subjects with no (47.6), mild (46.2), moderate (44.6), or bridging fibrosis (44.6). Cirrhosis was associated with poorer physical health after adjusting for potential confounders. Mental health scores did not differ between participants with and without NASH or by degree of fibrosis. Conclusion: Adults with NAFLD have a significant decrement in QOL. Treatment of NAFLD should incorporate strategies to improve QOL, especially physical health. (HEPATOLOGY 2009;49:1904-1912

Background. Staphylococcus aureus has numerous virulence factors, including exotoxins that may increase the severity of infection. This study was aimed at assessing whether preexisting antibodies to S. aureus toxins are associated with a lower risk of sepsis in adults with S. aureus infection complicated by bacteremia. Methods. We prospectively identified adults with S. aureus infection from 4 hospitals in Baltimore, MD, in 2009-2011. We obtained serum samples from prior to or at presentation of S. aureus bacteremia to measure total immunoglobulin G (IgG) and IgG antibody levels to 11 S. aureus exotoxins. Bacterial isolates were tested for the genes encoding S. aureus exotoxins using polymerase chain reaction (PCR). Results. One hundred eligible subjects were included and 27 of them developed sepsis. When adjusted for total IgG levels and stratified for the presence of toxin in the infecting isolate as appropriate, the risk of sepsis was significantly lower in those patients with higher levels of IgG against α-hemolysin (Hla), δ-hemolysin (Hld), Panton Valentine leukocidin (PVL), staphylococcal enterotoxin C-1 (SEC-1), and phenol-soluble modulin α3 (PSM-α3). Conclusions. Our results suggest that higher antibody levels against Hla, Hld, PVL, SEC-1, and PSM-α3 may protect against sepsis in patients with invasive S. aureus infections.

Objective: To evaluate cervical cancer screening practices and barriers to screening in a sample of lesbians. Methods: Cross-sectional survey data were collected from 225 self-identified lesbians who completed an online questionnaire. Results: Of the respondents, 71% reported receiving a Pap screening test in the past 24 months (routine screeners), and 29% reported receiving a Pap screening test >24 months ago or never (nonroutine screeners). Routine screeners were more likely to be older ( p < 0.01), white ( p ¼ 0.04), and college graduates ( p < 0.01) than nonroutine screeners. Nonroutine screeners were more likely to delay seeking healthcare because of fear of discrimination ( p < 0.01) and were less likely than routine screeners to disclose orientation to their primary care physician ( p < 0.01). After adjusting for age, race, and education, nonroutine screeners perceived fewer benefits from ( p < 0.01) and more barriers ( p < 0.01) to Pap screening tests and were less knowledgeable about screening guidelines ( p < 0.01) than routine screeners, but there was no difference in perceived susceptibility ( p ¼ 0.68), perceived seriousness ( p ¼ 0.68), or risk factor knowledge ( p ¼ 0.35) of cervical cancer. Conclusions: Many lesbians do not screen for cervical cancer at recommended rates. Nonroutine screeners perceive fewer benefits, more barriers, and more discrimination and are less knowledgeable about screening guidelines than routine screeners.