Background: Liver cell carcinoma (LCC) and hepatic failure (HF) are significant contributors to liver-related mortality in the United States. This study assessed LCC- and HF-related mortality trends (1999–2023) using CDC WONDER data, stratified by demographics and geography.
Methods: Deaths among U.S. adults aged ≥25 years with LCC (ICD-10: C22.0) or HF (ICD-10: K72.9) as underlying or contributing causes were analyzed. AAMRs per 1,000,000 were calculated by direct standardization to the 2000 U.S. standard population. Joinpoint regression estimated annual percent changes (APCs) in AAMRs, stratified by sex (1999–2023) and race/ethnicity, urban-rural status, census region, and state (1999–2020).
Results: From 1999–2023, 22,963 adult deaths were recorded (77.6% men). Overall AAMR declined from 1999–2007 (APC: −2.4), was stable through 2017 (APC: +0.2), then fell through 2023 (APC: −3.5). Male AAMR followed a non-linear trajectory (APC: −2.1, 1999–2010; +0.7, 2010–2017; −4.4, 2017–2023); female AAMR was stable post-2006 (APC: −0.1). NH Asian or Pacific Islanders showed the steepest decline (APC: −6.7); Hispanics increased post-2010 (APC: +0.6). Metropolitan AAMR declined overall; non-metropolitan AAMR increased (APC: +1.3). The West had the highest regional AAMR (5.6 per 1,000,000); Hawaii the highest state-level AAMR (10.3 per 1,000,000).
Conclusion: LCC- and HF-related mortality declined overall, with descriptive subgroup variation by sex, race/ethnicity, urbanization, and geography. Targeted screening, hepatitis management, and equitable healthcare access are needed to address these patterns.
S. Khan, Muneeb Khawar, Muhammad Haris Khan et al.· ASIDE Gastroenterology· 0 citations
Background: WATCHMAN and Amplatzer Amulet devices are an effective alternative to oral anticoagulation for left atrial appendage closure (LAAC) in non-valvular atrial fibrillation (NVAF) patients. This study aims to compare their safety and efficacy. Methods: This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Embase, and ScienceDirect, were searched from inception to May 2025 for comparative studies in NVAF patients. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed via I2 statistic; statistical significance was at P < 0.05. Results: Sixteen studies were included. No significant differences were found in ischemic stroke (RR 1.10, 95% CI 0.83–1.46; P = 0.51; I2 = 0%), all-cause mortality (RR 0.92, 95% CI 0.75–1.14; P = 0.45; I2 = 0%), major bleeding (RR 1.11, 95% CI 0.90–1.38; P = 0.33; I2 = 0%), minor bleeding (RR 1.11, 95% CI 0.76–1.61; P = 0.59; I2 = 22%), cardiac mortality (RR 0.86, 95% CI 0.39–1.93; P = 0.72; I2 = 51%), major procedure-related complications (RR 0.93, 95% CI 0.44–1.96; P = 0.55; I2 = 62%), cardiac tamponade (RR 0.57, 95% CI 0.25–1.29; P = 0.18; I2 = 30%), device embolization (RR 0.74, 95% CI 0.30–1.86; P = 0.53; I2 = 0%), vascular complications (RR 0.74, 95% CI 0.34–1.52; P = 0.38; I2 = 0%), or peridevice leak (RR 0.88, 95% CI 0.56–1.36; P = 0.55; I2 = 77%). WATCHMAN showed higher device thrombosis (RR 1.73, 95% CI 1.20–2.49; P = 0.003; I2 = 0%) but lower pericardial effusion (RR 0.47, 95% CI 0.29–0.76; P = 0.002; I2 = 0%). Conclusions: WATCHMAN and Amulet demonstrate no significant difference in efficacy and safety for most LAAC outcomes, including stroke and major bleeding. However, WATCHMAN is associated with a significantly lower risk of pericardial effusion but a higher risk of device thrombosis.
Samir Shamieh, Barakat Alsaqqa, Armstrong Nicholas Kpachi et al.· Annals of Medicine and Surge...· 0 citations
BackgroundNew-onset atrial fibrillation (AF) is a common complication of sepsis, affecting 5-25% of patients, and is associated with increased mortality and ischemic stroke. With limited high-quality evidence, the net clinical benefit of early oral anticoagulant (OAC) initiation in this high-risk setting remains uncertain.MethodsAdults ≥18 hospitalized with sepsis who developed new-onset AF within 3 days were identified from the TriNetX database. Cohort one included patients who received at least three doses of OAC within 3 days after AF onset and was compared to those who did not receive OAC (cohort two). Propensity score matching (1:1; 90 covariates; caliper 0.1) was employed to balance the groups. The primary outcomes assessed were evaluated at 7, 14, and 30 days. Risk ratios and risk differences with 95% confidence intervals were estimated using intention-to-treat analysis.ResultsAmong 136,172 eligible patients, 10,773 were matched per group. Early OAC use was associated with significantly lower mortality at 7, 14, and 30 days (RR 0.19-0.35; all p < 0.001) and reduced ischemic stroke risk across the same intervals (RR 0.74-0.83; p ≤ 0.004). Major bleeding rates were also lower (RR 0.40-0.49; all p < 0.001). MACEs showed a modest reduction at 7 days (RR 0.92; p = 0.001) but not afterward. Thromboembolic events were similar beyond the first week. The need for thrombolytics (RR 0.55-0.59) and anti-hemorrhagic therapy (RR≈0.69) consistently remained lower with OACs (all p < 0.001). Falsification outcomes were neutral, except for a minimal late increase for osteoarthritis at 30 days (RR 1.16; p = 0.03).ConclusionIn sepsis-associated NOAF, early OAC initiation was associated with reduced short-term mortality and ischemic stroke without excess bleeding or thromboembolic risk. The large magnitude of mortality benefit and paradoxical reduction in bleeding likely reflect residual confounding by clinical stability and patient selection. Findings warrant cautious interpretation given the observational design; prospective trials are needed.
A. Qadeer, Michele Fouad, Doaa Bayomi et al.· Journal of Intensive Care Me...· 0 citations
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