Non-alcoholic fatty liver disease and 30-day all-cause mortality in adult patients with community-acquired pneumonia.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a common and serious form of chronic liver disease. Risk factors of NAFLD include obesity and type 2 diabetes which are associated with infections. AIM: We aimed to determine the association of NAFLD with 30-day all-cause mortality in adult patients with community-acquired pneumonia (CAP). METHODS: A retrospective cohort study on hospitalized patients with CAP that was conducted during a period of 4 years. We included patients aged ≥18 years with CAP who underwent abdominal ultrasonography. We compared between patients with and without NAFLD in term of age, gender, body mass index (BMI), comorbidities, CURB-65, pneumonia severity index (PSI), liver enzymes, C-reactive protein (CRP) and 30-day all-cause mortality. We used fibrosis score to distinguish between patients with NAFLD who have advanced fibrosis (F3-F4) and do not have (F0-F2). RESULTS: A total of 561 patients were included in this study. The overall prevalence of NAFLD was 200/561 (35.6%). Significant differences were found between the groups with and without NAFLD in term of BMI, CURB-65, ALT, GGT and CRP. The 30-day all-cause mortality rate was 9.8% (55/561). Among the NAFLD group 34/200 (17%) subjects died vs. 21/361 (5.82%) among patients without NAFLD, P < 0.001. Multi-variate logistic regression analysis after adjusting for other multiple covariates showed that NAFLD with fibrosis score 0-2 [odds ratio (OR) 1.38, 95% confidence interval (CI) 1.12-1.51, P = 0.04], NAFLD with fibrosis score> 2 (1.52; 1.25-1.70, P = 0.03) were associated with 30-day all-cause mortality among patients with CAP. CONCLUSIONS: NAFLD was associated with 30-day all-cause mortality in patients with CAP. This association was more significant in patients with advanced hepatic fibrosis.

Randomised clinical trial: simvastatin as adjuvant therapy improves significantly the Helicobacter pylori eradication rate--a placebo-controlled study.

BACKGROUND: The eradication rate of Helicobacter pylori with standard treatments are decreasing worldwide. AIM: To determine whether adding simvastatin as adjuvant to triple regimen in patients with H. pylori infection will improve the eradication rate. METHODS: We conducted a double-blind, placebo-controlled, randomised clinical trial comparing a 7-day, triple eradication regimen consisting of two antibiotics (clarithromycin 500 mg and amoxicillin 1 g, all twice per day) plus a proton pump inhibitor (omeprazole 20 mg twice daily) supplemented with simvastatin 20 mg (CAO + S) or a comparable placebo (CAO + P). Both the simvastatin and the placebo were taken orally twice daily for 1 week in 113 patients with H. pylori infection. The presence of H. pylori was determined by positive rapid urease test and histology. Eradication was confirmed by ¹³C-urea breath test at least 1 month after treatment. Adverse effects were assessed by questionnaire. RESULTS: A total of 113 patients underwent randomisation. Intention-to-treat analysis (ITT; n = 113) eradication rates were: CAO + S (86%; 95% CI: 78-92%), CAO + P (69%; 95% CI: 64-74%). Per protocol analysis (PP; n = 108) eradication rates were: CAO + S (91%; 95% CI: 84-94%), CAO + P (72%; 95% CI: 65-78%). Eradication rates were higher with CAO + S than CAO + P in PP and ITT (P = 0.03, P = 0.04 respectively). No differences were demonstrated between the two groups concerning compliance or adverse effects. CONCLUSION: In this randomised clinical trial simvastatin as adjuvant to standard therapy improves significantly the H. pylori eradication rate.

On the association between soft drink consumption and Helicobacter pylori infection.

BACKGROUND: The association between soft drink (SD) consumption and Helicobacter pylori infection remains unclear. AIM: To examine the relationship between SD consumption and H. pylori infection. METHODS: A prospective study included individuals who were referred for an upper gastrointestinal endoscopic examination because chronic dyspepsia within a period of 1 year. In addition to determining daily SD consumption and the risk factors for H. pylori infection by asking all study participants to complete a standard questionnaire about their diet, daily eating and drinking habits, and their lifestyle before undergoing the endoscopic examination. H. pylori infection was established by a positive result of the rapid urease test and histology. RESULTS: Of the 312 individuals who were referred for the endoscopic examination because chronic dyspepsia, 269 met the inclusion criteria. H. pylori infection was found in 164 (61%) of the 269 study participants, and, of these, 104/164 individuals were SD consumers with H. pylori infection versus 24/105 individuals without H. pylori infection (63 vs. 23%, respectively, P < 0.001). The results of the multiple logistic regression analysis showed that SD consumption (odds ratio = 4.0; 95 % confidence interval = 3.19­5.82,P < 0.001), was associated with H. pylori infection. CONCLUSION: SD consumption is associated with H. pylori infection in individuals with chronic dyspepsia.

The impact of prior long-term versus short-term statin use on the mortality of bacteraemic patients.

BACKGROUND: The aim of this investigation was to assess the effect of prior statin use on the 30-day in-hospital mortality among bacteraemic patients and to determine the impact of long-term versus short-term statin use on the mortality of bacteraemic patients. PATIENTS AND METHODS: A retrospective study of 342 bacteraemic patients who presented to the emergency department (ED) within a period of 7 years was undertaken. Twenty-three patients did not meet the inclusion criteria. The remaining 319 patients were divided into three groups according to statin use and duration of therapy prior to the bacteraemic episode: group 1 (n = 123) had long-term statin use ≥ 12 weeks, group 2 (n = 35) had short-term statin use < 12 weeks, and group 3 (n = 161) had no statin use. RESULTS: The overall 30-day in-hospital all-cause mortality of patients with statins was lower than patients without statin therapy (13 vs. 24%, p = 0.001). The mortality rate in group 1 was lower than in group 2 (11 vs. 17%, p = 0.04). After adjusting for confounding variables, the results of a multiple Cox regression analysis revealed that the absence of statin use (hazard ratio [HR] = 2.98; 95% confidence interval [CI] 1.59-5.56, p = 0.001) was associated with increased 30-day in-hospital all-cause mortality in bacteraemic patients. CONCLUSIONS: Statins reduce the 30-day in-hospital all-cause mortality of bacteraemic patients. Long-term statin use prior to the bacteraemia improves the survival of bacteraemic patients more than short-term statin use.