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Background & Aims: We aimed to determine the trends in risk factor control and treatment among patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D) in 2000-2020. Methods: We conducted a territory-wide cohort study of adult patients with NAFLD and T2D diagnosed between 1 January 2000 and 31 July 2021 in Hong Kong. T2D was defined by use of any anti-diabetic agents, laboratory tests and/or diagnosis codes. Results: This study included 16,084 patients with NAFLD and T2D (mean age, 54.8 ± 12.0 years; 7124 male [44.3%]). The percentage of patients achieving individualised haemoglobin A1c (HbA1c) targets increased from 44.5% (95% confidence interval [CI], 42.9-46.1) to 64.8% (95% CI, 64.1-65.5), and percentage of patients achieving individualised low-density lipoprotein-cholesterol (LDL-C) targets increased from 23.3% (95% CI, 21.9-24.7) to 54.3% (95% CI, 53.5-55.1) from 2000-2005 to 2016-2020, whereas percentage of patients achieving blood pressure control (<140/90 mm Hg) remained static at 53.1-57.2%. Combination therapy for diabetes increased, especially among those with poor glycaemic control, but there was no increase in combination therapy for hypertension. Fewer cirrhotic patients achieved blood pressure control and individualised LDL-C targets, but they were more likely to achieve individualised HbA1c targets than non-cirrhotics. Metformin and statins were underused in cirrhotic patients. Younger patients (18-44 years) were less likely to achieve individualised HbA1c targets than middle-aged (45-64 years) and older ones (=65 years). Conclusions: From 2000 to 2020, glycaemic and lipid control improved significantly, whereas blood pressure control remained static among patients with NAFLD and T2D. [ABSTRACT FROM AUTHOR]

Simple Summary: Patient with hepatocellular carcinoma are at an increased risk of variceal haemorrhage, and often require endoscopic workup to look for the presence of high-risk varices prior to starting systemic therapy. The Baveno VII criteria has been a well-validated non-invasive risk stratification tool in predicting high-risk varices for patients with liver cirrhosis, but data on its use in the hepatocellular carcinoma population is lacking. In this study, we successfully validated the Baveno VII criteria as a safe and accurate modality in predicting high-risk varices and hepatic events in patients with hepatocellular carcinoma. The Baveno VII criteria are used in patients with liver cirrhosis to predict high-risk varices in patients with liver cirrhosis. Yet its use in patients with advanced hepatocellular carcinoma (HCC) has not been validated. HCC alone is accompanied with a higher variceal bleeding risk due to its association with liver cirrhosis and portal vein thrombosis. The use of systemic therapy in advanced HCC has been thought to further augment this risk. Upper endoscopy is commonly used to evaluate for the presence of varices before initiation of treatment with systemic therapy. Yet it is associated with procedural risks, waiting time and limited availability in some localities which may delay the commencement of systemic therapy. Our study successfully validated the Baveno VI criteria with a 3.5% varices needing treatment (VNT) missed rate, also with acceptable <5% VNT missed rates when considering alternative liver stiffness (LSM) and platelet cut-offs. The Baveno VII clinically significant portal hypertension rule-out criteria (LSM < 15 kPa and platelet >150 × 109/L) also revealed a low frequency (2%) of hepatic events, whilst the rule-in criteria (LSM > 25 kPa) was predictive of a higher proportion of hepatic events (14%). Therefore, our study has successfully validated the Baveno VII criteria as a non-invasive stratification of the risk of variceal bleeding and hepatic decompensation in the HCC population. [ABSTRACT FROM AUTHOR]

Background We examined the effectiveness of molnupiravir and nirmatrelvir/ritonavir in reducing hospitalization and deaths in a real-world cohort of nonhospitalized patients with coronavirus disease 2019 (COVID-19). Methods This was a territory-wide retrospective cohort study in Hong Kong. Nonhospitalized COVID-19 patients who attended designated outpatient clinics between 16 February and 31 March 2022 were identified. Patients hospitalized on the day of the first clinic appointment or used both oral antivirals were excluded. The primary endpoint was hospitalization. The secondary endpoint was a composite of intensive care unit admission, invasive mechanical ventilation use, and/or death. Results Of 93 883 patients, 83 154 (88.6%), 5808 (6.2%), and 4921 (5.2%) were oral antiviral nonusers, molnupiravir users, and nirmatrelvir/ritonavir users, respectively. Compared with nonusers, oral antiviral users were older and had more comorbidities, lower complete vaccination rate, and more hospitalizations in the previous year. Molnupiravir users were older and had more comorbidities, lower complete vaccination rate, and more hospitalizations in the previous year than nirmatrelvir/ritonavir users. At a median follow-up of 30 days, 1931 (2.1%) patients were hospitalized and 225 (0.2%) patients developed the secondary endpoint. After propensity score weighting, nirmatrelvir/ritonavir use (weighted hazard ratio 0.79; 95% confidence interval [CI], 0.65–0.95; P =.011) but not molnupiravir use (weighted hazard ratio 1.17; 95% CI, 0.99–1.39; P =.062) was associated with a reduced risk of hospitalization than nonusers. The use of molnupiravir or nirmatrelvir/ritonavir was not associated with a lower risk of the secondary endpoint as compared with nonusers. Conclusion Use of nirmatrelvir/ritonavir but not molnupiravir was associated with a reduced risk of hospitalization in real-world nonhospitalized patients with COVID-19. [ABSTRACT FROM AUTHOR]

Objectives: The PAGE‐B model consists of variables at the initiation of antiviral therapy (AVT), whereas the SAGE‐B and CAGE‐B models consist of variables after 5 years of AVT. We aimed to compare the predictive accuracy of three risk prediction models for hepatocellular carcinoma (HCC) development after 5 years of AVT in patients with chronic hepatitis B (CHB). Methods: A total of 1335 patients who initiated entecavir (ETV) treatment between 2006 and 2011 and were followed up for more than 5 years were enrolled in the study. Results: At ETV initiation, the median age was 49 years and the median score of the PAGE‐B model was 14. After 5 years of ETV treatment, the median SAGE‐B and CAGE‐B scores were 6 and 6. During the study period, 93 (7.0%) patients developed HCC after 5‐year treatment. In multivariate analysis, PAGE‐B (hazard ratio [HR] 1.151, 95% confidence interval [CI] 1.087–1.219), SAGE‐B (HR 1.340, 95% CI 1.228–1.463), and CAGE‐B (HR 1.327, 95% CI 1.223–1.440) models independently predicted HCC development after 5 years of treatment (all P < 0.001). The high‐risk groups of the three risk prediction models showed a significantly higher risk of HCC development compared to the medium‐ and low‐risk groups (both P < 0.05). The AUROC of the SAGE‐B (0.772–0.844) and CAGE‐B (0.785–0.838) models was significantly higher than those of the PAGE‐B model (0.696–0.745) in predicting HCC development after 5 years of treatment (both P < 0.05). Conclusion: The SAGE‐B and CAGE‐B models might be better than the PAGE‐B model in predicting HCC development after 5 years of ETV treatment. [ABSTRACT FROM AUTHOR]

Background and objective: Decline in hospitalizations for various respiratory diseases has been reported during the COVID‐19 pandemic, but what led to such an observation is uncertain. Methods: This was a territory‐wide, retrospective cohort study involving all public hospital admissions in Hong Kong from 1 January 2017 to 31 December 2020. Hospital admissions for respiratory diseases, including asthma, COPD and non‐COVID pneumonia, were assessed. COVID‐related admissions were excluded from this study. The time of commencement of the pandemic was taken from the fourth week of January 2020. The associations between air pollutant levels, influenza and mask‐wearing rates with hospital admissions were assessed by mediation analyses. Results: There were altogether 19,485, 78,693 and 238,781 admissions for asthma, COPD and non‐COVID pneumonia from January 2017 to December 2020. There was a marked reduction in hospital admissions of asthma, COPD and non‐COVID pneumonia (37%, 36% and 12% decrease in average daily admissions, respectively) during the COVID‐19 pandemic compared to before. Air pollutant levels and influenza rate were decreased while mask‐wearing rate was increased. Collinearity of mask‐wearing rates and pandemic year was observed. For COPD, NO2, SO2, PM10 and influenza rates (4%, 11%, 4% and 4% of the total effect, respectively), while for non‐COVID pneumonia, PM10 and influenza rates (11% and 52%, respectively) had significant mediation effect on changes in hospital admissions before and during the COVID‐19 pandemic. Conclusion: During the COVID‐19 pandemic, a decrease in air pollutant levels and influenza rate had mediation effect on the reduction in hospitalizations of COPD and non‐COVID pneumonia. The reason behind the observation of decline in respiratory hospitalizations during the COVID‐19 pandemic was uncertain. This study found that air pollutants levels and influenza rate had mediation effects on the decrease in hospitalizations for COPD and non‐COVID pneumonia, but not for asthma during the COVID‐19 pandemic. See relatedEditorial [ABSTRACT FROM AUTHOR]