Background. Portal hypertension, an elevation in the hepatic venous pressure gradient (HVPG), can be used to monitor disease progression and response to therapy in cirrhosis. Since obtaining HVPG measurements is invasive, reliable noninvasive methods of assessing portal hypertension are needed. Methods. Noninvasive markers of fibrosis, including magnetic resonance elastography (MRE) shear wave velocity, were correlated with histologic fibrosis and HVPG measurements in hepatitis C (HCV) and/or HIV-infected patients with advanced liver disease enrolled in a clinical trial of treatment with simtuzumab, an anti-LOXL2 antibody. Results. This exploratory analysis includes 23 subjects: 9 with HCV monoinfection, 9 with HIV and HCV, and 5 with HIV and nonalcoholic steatohepatitis. Median Ishak fibrosis score was 4 (range 1–6); 11 subjects (48%) had cirrhosis. Median HVPG was 6 mmHg (range 3–16). Liver stiffness measured by MRE correlated with HVPG (r = 0.64, p = 0.01), histologic fibrosis score (r = 0.71, p = 0.004), noninvasive fibrosis indices, including APRI (r = 0.81, p < 0.001), and soluble LOXL2 (r = 0.82, p = 0.001). On stepwise multivariate regression analysis, MRE was the only variable independently associated with HVPG (R2 = 0.377, p = 0.02). Conclusions. MRE of the liver correlated independently with HVPG. MRE is a valid noninvasive measure of liver disease severity and may prove to be a useful tool for noninvasive portal hypertension assessment. Trial Registration Number. This trial is registered with NCT01707472.

Idiopathic pulmonary arterial hypertension (IPAH) related hospitalizations contribute to morbidity, mortality and incur substantial healthcare costs. Several advances in management have been achieved over the last decade. The objective of this study is to compare hospitalization related to IPAH between 2007 and 2017 using Nationwide In-patient Sample Database (NIS).METHODS: Retrospective, observational, population-based cohort analysis. NIS is the largest and most comprehensive all-payer database of inpatient hospitalizations in the US. IPAH was identified using the ICD9-CM (416.0) and ICD-10 codes (I27.0) for 2007 and 2017 respectively. We included patients 18 years or older from the years 2007 and 2017. Total hospitalizations, demographics, primary payer, bed size, location/teaching status of the hospital, region of hospital, comorbidities, all-cause mortality, the median length of stay, and median charges were analyzed.RESULTS: IPAH diagnosis was associated with 0.05% of all hospitalizations reviewed in 2007 and 0.03% in 2017. Hospitalizations occurred mostly in females compared to males (11,542 (65.2%) in 2007 vs. 6380 (68.4%) in 2017), but latter carried a higher mortality. Whites continued to have a higher total number of hospitalizations for IPAH than other races in 2007 and 2017 (67.4% vs. 64.1%). The number of IPAH hospitalizations did decrease from 17,713 in 2007 to 9,330 in 2017 (p<0.001) with most being at large bed hospitals (2007(11,820 (66.8%)) vs. 2017( 5,665 (60.7%)). Regional variations in trends were also noted. There was no significant difference in the median length of stay between the 2 years. Medicare was the primary payer in most admissions in both years (11,931 (67.4%) in 2007 vs 5795 (62.3%) in 2017). Total all-cause mortality (IPAH Hospitalization) decreased in 2017 (4.8%) compared to 2007 (6.4%) (p<0.001). Multivariate analysis of factors associated with inpatient mortality revealed the following: Age group 45-64 (OR 2.09, P<0.001) and over 65 (OR 4.09, P < .0001) had a greater rate of mortality compared to the age group 18-44. Males had higher mortality (OR 1.18, p¼0.015) than females. Blacks (OR 0.79, p¼0.014) and Hispanics (OR 0.65, p¼0.003) had lower mortality than whites. Fewer patients had cardiac arrest in 2017 vs 2007 (145 (1%) vs 169(1.6%)) Increased risk of death in the event of cardiac arrest was noted (OR 27.22, p<0.001) Total charges in United States Dollars (USD) increased substantially in 2017 compared to 2007 ($26,016 vs. $46,450). CONCLUSIONS: NIS based hospitalization data comparing 2007 to 2017 revealed the following findings:1. Significant reduction in IPAH related hospitalizations2. Reduced all-cause mortality related to hospitalization3. Increased healthcare costs CLINICAL IMPLICATIONS: IPAH is linked to an increased risk of morbidity and mortality. Further epidemiological studies are needed to understand the nuances in IPAH related hospitalizations and outcomes.

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Background and Objectives: With the growing recreational cannabis use and recent reports linking it to hypertension, we sought to determine the risk of hypertensive crisis (HC) hospitalizations and major adverse cardiac and cerebrovascular events (MACCE) in young adults with cannabis use disorder (CUD+). Material and Methods: Young adult hospitalizations (18–44 years) with HC and CUD+ were identified from National Inpatient Sample (October 2015–December 2017). Primary outcomes included prevalence and odds of HC with CUD. Co-primary (in-hospital MACCE) and secondary outcomes (resource utilization) were compared between propensity-matched CUD+ and CUD- cohorts in HC admissions. Results: Young CUD+ had higher prevalence of HC (0.7%, n = 4675) than CUD- (0.5%, n = 92,755), with higher odds when adjusted for patient/hospital-characteristics, comorbidities, alcohol and tobacco use disorder, cocaine and stimulant use (aOR 1.15, 95%CI:1.06–1.24, p = 0.001). CUD+ had significantly increased adjusted odds of HC (for sociodemographic, hospital-level characteristics, comorbidities, tobacco use disorder, and alcohol abuse) (aOR 1.17, 95%CI:1.01–1.36, p = 0.034) among young with benign hypertension, but failed to reach significance when additionally adjusted for cocaine/stimulant use (aOR 1.12, p = 0.154). Propensity-matched CUD+ cohort (n = 4440, median age 36 years, 64.2% male, 64.4% blacks) showed higher rates of substance abuse, depression, psychosis, previous myocardial infarction, valvular heart disease, chronic pulmonary disease, pulmonary circulation disease, and liver disease. CUD+ had higher odds of all-cause mortality (aOR 5.74, 95%CI:2.55–12.91, p < 0.001), arrhythmia (aOR 1.73, 95%CI:1.38–2.17, p < 0.001) and stroke (aOR 1.46, 95%CI:1.02–2.10, p = 0.040). CUD+ cohort had fewer routine discharges with comparable in-hospital stay and cost. Conclusions: Young CUD+ cohort had higher rate and odds of HC admissions than CUD-, with prevalent disparities and higher subsequent risk of all-cause mortality, arrhythmia and stroke.

Background Obstructive sleep apnea (OSA) is often present in coronary artery disease patients and confers a high risk of complications following percutaneous coronary interventions (PCI). The impact of two commonly associated comorbid conditions, chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS, Pickwickian syndrome) in OSA patients undergoing PCI has never been studied. Methods The National Inpatient Sample (NIS; 2007-2014) was queried using the International Classification of Diseases, Clinical Modification 9 (ICD-9-CM) codes to compare baseline characteristics, comorbidities, and outcomes in adults undergoing PCI with OSA, COPD-overlap syndrome, and OSA+OHS. Results Of a total of 4,792,177 PCI-related inpatient encounters, OSA, OSA-COPD overlap syndrome, and OSA+OHS were found to be present in 153,706 (median age 62 years, 79.4% male), 65135 (median age 65 years, 66.0% male), and 2291 (median age 63 years, 58.2% males) patients, respectively. The OHS+OSA cohort, when compared to the COPD-OSA and OSA cohorts, was found to have the worst outcomes in terms of all-cause mortality (2.8% vs. 1.5% vs. 1.1%), hospital stay (median 6 vs. 3 vs. 2 days), hospital charges ($147, 209 vs. $101,416 vs. $87,983). Complications, including cardiogenic shock (7.3% vs. 3.4% vs. 2.6%), post-procedural myocardial infarction (11.2% vs. 7.1% vs. 6.0%), iatrogenic cardiac complications (6.1% vs. 3.5% vs. 3.7%), respiratory failure, acute kidney injury, infections, and pulmonary embolism, were also significantly higher in patients with OHS+OSA. Adjusted multivariable analysis revealed equivalent results with OHS+OSA having worse outcomes than OSA-COPD and OSA. Conclusion Concomitant OHS and COPD were linked to worse clinical outcomes in patients with OSA undergoing PCI. Future prospective studies are warranted to fully understand related pathophysiology, evaluate and validate long-term outcomes, and formulate effective preventive and management strategies.