In-vitro evaluation of contrast media for assessment of regional perfusion distribution by electrical impedance tomography (EIT).

C irrhosis is the 12th leading cause of death in the United States. 1 Complications of cirrhosis, such as ascites, variceal hemorrhage, hepatic encephalopathy, and renal impairment have a negative impact on patients' health-related quality of life, and account for most deaths in patients with cirrhosis. 2 Palliative and hospice care programs can decrease the burden of symptoms, reduce hospitalization, and improve end-of-life care. 3 There are limited data on the utilization of hospice in cirrhosis; a population that has received limited attention from the palliative care community. Thus, we aimed to identify trends and variations in both places of death and hospice utilization 4 in cirrhosis.

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We read with interest the article by Blais et al. [1] recently published in the Journal. In an analysis of a random sample of 255 patients with Nonalcoholic Fatty Liver Disease (NAFLD) in the Veteran Affairs (VA) hospital system with dyslipidemia, only 152 (59.6 %) were on statin therapy. We sought to validate these findings in larger, non-VA hospital systems in the USA. Additionally, because women are greatly underrepresented in the VA cohort (5 %), we sought to identify gender differences in statin use.We used Explorys (Cleveland, OH), a private clinical registry based on billing codes, electronic medical records, and laboratory results from 26 major healthcare organizations and 360,000 providers covering about 50 million unique lives in the USA [2]. Using International Classification of Diseases version 9 code 571.8, we identified patients with NAFLD (age 18-65 years) and low-density lipoprotein (LDL) levels of C190 mg/dL (class I indication for statin therapy in the adult treatment panel guidelines [3]). We excluded patients with AST or ALT Cthree times upper limit of normal.We identified 9960 patients with NAFLD and LDL C190 mg/dL (59 % female, 82 % Caucasians). Diabetes was diagnosed in 44 % of the patients, and 73 % had hypertension. Overall, 7030 (71 %) of the patients had a statin prescription. There was no difference in statin prescription between males and females (p = 0.86). However, African Americans had a higher rate of statin prescription than Caucasians (76 vs. 70 %, p \ 0.001).In summary, our findings of a large non-VA ''realworld'' cohort of NAFLD with significant LDL elevation showed underutilization of statin in this high-risk population. There seems to be a small racial disparity, but no gender differences were observed in statin utilization. Quality improvement projects should focus on optimization of statin utilization in this patient population.