Hepatic Insufficiency

The primary outcomes of cirrhosis, decompensated cirrhosis and HCC were defined using relevant physician visit, emergency department visit, hospital diagnosis, procedure, death and pathology codes (Table 1). A secondary outcome of 2-year all-cause mortality following last clinic visit was reported as an overall measure of patient severity of illness.
We built a series of diagnostic algorithms for each outcome ranging from simple (e.g. a single physician visit code) to more complex. This was done to identify the most parsimonious algorithms that were also highly sensitive and/or specific. We aimed to utilize all available health administrative data, and include both hospital-based and outpatient physician visits in our algorithms. Data sources were searched for relevant codes ten years prior to two years following the date of last clinical assessment (up to March 31^st, 2014 for TCLD and August 31^st, 2013 for KHSC).
Cirrhosis algorithms ranged from cirrhosis codes only to combinations with codes for chronic liver disease or any complication (decompensation events, HCC or liver transplant). Algorithms were combined in such a way as to make them more sensitive (“or” combinations) or specific (“and” combinations). As physician visit codes were noted to be less specific, we aimed to increase specificity by combining two or more such codes with hospitalization codes.
Decompensation algorithms included hospital diagnostic and death codes for portal hypertension, hepatorenal syndrome, jaundice, hepatic coma, hepatic failure, bleeding esophageal varices, gastric varices (bleeding not specified), and ascites. There were no physician visit codes available for decompensation events. We included procedure codes for endoscopy or insertion of Sengstaken tube for upper gastrointestinal bleeding, transjugular intrahepatic portosystemic shunt, and paracentesis. Since several of these procedures could occur for reasons other than decompensated cirrhosis (such as bleeding from an ulcer, or ascites secondary to an extra-hepatic malignancy), we tested combinations of procedure codes with a cirrhosis code from a physician visit.
Hepatocellular carcinoma algorithms ranged from simple (a single physician visit code) to more complex. We tested several combinations in order to optimise both sensitivity and specificity. We combined physician visit codes, hospital diagnostic codes, and cause of death codes. Further, we included procedure codes for radiofrequency ablation. Since this procedure can also be used to ablate tumours outside the liver (e.g., renal tumours), we combined ablation codes with an outpatient code for cirrhosis. Finally, we tested our results with and without anatomical and pathology codes from the Ontario Cancer Registry.

The following criteria were included to recruit the participants from Cairo University Hospital's outpatient clinic in Egypt by the research team members: both genders, physically inactive participants (based on the Physical Activity Questionnaire)^{16 (link)}, between the ages of 60 and 75 years old, and body mass index (BMI) of 30–39.9 kg/m².
While the following were the exclusion criteria: smoking, diabetes, consuming alcohol, uncontrolled hypertensive, cardiac arrythmias, heart failure, participated in a diet program for minimum six months prior to the study, taking blood clotting or body weight-regulating medications, recent illness, cognitive impairment, malignancy diseases, donating blood, or participated in any other research during the 90 days prior to the current study.
Patients with muscle weakness or strain, osteoarthritis, bone fracture, renal and hepatic failure, chest infections, and hyper/hypothyroidism were also eliminated. Under the direction of a qualified physician, the participants were following their prescribed medications (Angiotensin-converting enzyme ACE inhibitors) so long as they didn't affect the findings.
The eligible participants were allocated into two groups equally at random: the experimental group, which engaged in an aerobic training as well as received laser phototherapy through a laser watch, and the control group (performed only the exactly prescribed exercise training program). (Fig. 1).Figure 1

Consort diagram of the present study.