NSBB monotherapy may decrease all-cause mortality and the risk of first variceal bleeding in cirrhotic patients with large esophageal varices. Additionally, NSBB carry a lower risk of serious complications compared to VBL. Therefore, NSBB may be the preferred initial approach for primary prophylaxis of esophageal variceal bleeding. This article is protected by copyright. All rights reserved.

Thoetchai (Bee) Peeraphatdit developed the concept, acquired and analyzed the data, drafting the manuscript; Patrick Kamath, Vijay Shah and Douglas Simonetto designed the study, developed the concept and critically revised the paper; Brian Davis and Vivek Desai acquired and analyzed the data; Victor Karpyak, Suthat Liangpunsakul, Arun Sanyal and Naga Chalasani critically revised the paper.

Identifying patients at high risk for acute kidney injury (AKI) during hospitalization among patients admitted with severe alcoholic hepatitis (AH) is an unmet clinical need. We performed a multicentric prospective cohort study using data from 4 different cohorts on well-characterized patients hospitalized with severe AH. Data collected on 773 AH patients from 4 cohorts across the globe were randomly split into test (n = 390) and validation (n = 383) cohorts. We found that 32% of the patients developed inpatient AKI in the test cohort. Approximately 60% of patients met criteria for systemic inflammatory response syndrome (SIRS) at admission. Hepatic encephalopathy, SIRS, and Model for End-Stage Liver Disease score at admission predicted inpatient AKI with odds ratios of 3.86, 2.24, and 1.14, respectively. The AKI risk score developed using these predictors stratified risk of inpatient AKI to low (score <3), moderate (3-4), and high (>4). These findings were replicated in the validation cohort. In the whole study cohort, patients with AKI had a lower 90-day survival (53% versus 77%; P < 0.001). Those with AKI risk score of >4 had significantly lower 90-day survival as compared with those with risk scores between 3 and 4 and <3 (47% versus 68% versus 88%; P < 0.001). In conclusion, AKI occurs frequently in AH patients and negatively impacts short-term mortality. The AKI risk score is useful in identifying patients at high risk for inpatient AKI and may be useful for developing new therapeutic strategies to prevent AKI in patients with AH.

CorrespondenceClear cell adenocarcinoma of the colon arising in endometriosis: a rare variant of primary colonic adenocarcinoma Colonic adenocarcinomas composed predominantly or exclusively of cells with clear cytoplasm are extremely rare.

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