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2.
Medicine (Baltimore) ; 98(52): e18527, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876748

RESUMO

This study aim was to evaluate whether plasma D-dimer levels could serve as a novel prognostic biomarker for 1-month mortality in patients with HBV-related decompensated cirrhosis (HBV-DeCi).This was a retrospective study that enrolled 132 HBV-DeCi patients. Univariate and multivariate regression models were used to identify risk factors for mortality. The area under the receiver operating characteristic curve was calculated to estimate and compare the predictive values of different prognostic markers.In the present study, the plasma D-dimer levels were higher in the nonsurviving group than in the surviving group. Additionally, the D-dimer level was positively correlated with the model for end-stage liver disease (MELD) score. The results of multivariate analysis showed that both the MELD score and D-dimer level are independent predictors of 1-month mortality in HBV-DeCi patients (both P < .01).Plasma D-dimer can be considered a new additional prognostic marker for 1-month mortality in HBV-DeCi patients.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hepatite B Crônica/mortalidade , Cirrose Hepática/mortalidade , Adulto , Idoso , Biomarcadores/sangue , Feminino , Hepatite B Crônica/sangue , Hepatite B Crônica/complicações , Hepatite B Crônica/diagnóstico , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos
3.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414767

RESUMO

BACKGROUND: The C-reactive protein to albumin ratio (CAR) is a novel inflammation index that has recently been used as a marker for poor prognosis or mortality in various patient groups. This study aimed to evaluate the association between the CAR and 30-day mortality in patients with hepatitis B virus-related decompensated cirrhosis (HBV-DeCi). METHODS: This was a retrospective cohort study of 113 patients who had been diagnosed with HBV-DeCi. Univariate and multivariate regression models were used to determine risk factors for mortality. RESULTS: The CAR was observed to be significantly higher in the non-surviving patients compared to the surviving patients. Moreover, the CAR was positively correlated with the model for end-stage liver disease (MELD) score and Child-Pugh score. In multivariate analysis, the CAR and the MELD score were independent prognostic factors for HBV-DeCi patients. CONCLUSIONS: A high CAR value at admission can serve as an independent predictor of 1-month mortality in patients with HBV-DeCi.


Assuntos
Proteína C-Reativa/análise , Hepatite B Crônica/complicações , Cirrose Hepática/complicações , Albumina Sérica/análise , Adulto , Idoso , Feminino , Hepatite B Crônica/mortalidade , Humanos , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
4.
Gastroenterology ; 157(4): 1055-1066.e11, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31251928

RESUMO

BACKGROUND & AIMS: Trends of mortality associated with extrahepatic complications of chronic liver disease might be changing. We studied trends in mortality from extrahepatic complications of viral hepatitis, alcoholic liver disease (ALD), and nonalcoholic fatty liver disease in the United States. METHODS: We performed a population-based study using US Census and the National Center for Health Statistics mortality records from 2007 through 2017. We identified trends in age-standardized mortality using Joinpoint trend analysis with estimates of annual percent change. RESULTS: The liver-related mortality among patients with hepatitis C virus (HCV) infection increased from 2007 through 2013 and then decreased once patients began receiving treatment with direct-acting antiviral (DAA) agents, from 2014 through 2017. Among patients with HCV infection, the age-standardized mortality for extrahepatic cancers was 2.6%, for cardiovascular disease was 1.9%, and for diabetes was 3.3%. Among individuals with hepatitis B virus infection, liver-related mortality decreased steadily from 2007 through 2017. During the study, age-standardized mortality from hepatitis B virus-related extrahepatic complications increased by an average of 2.0% each year. Although liver-related mortality from ALD continued to increase, mortality from extrahepatic complications of ALD did not change significantly during the 11-year study. Among patients with nonalcoholic fatty liver disease, the cause of death was most frequently cardiovascular disease, which increased gradually over the study period, whereas liver-related mortality increased rapidly. CONCLUSIONS: In an analysis of US Census and the National Center for Health Statistics mortality records, we found that after widespread use of DAA agents for treatment of viral hepatitis, cause-specific mortality from extrahepatic cancers increased, whereas mortality from cardiovascular disease or diabetes increased only among patients with HCV infection. These findings indicate the need to reassess risk and risk factors for extrahepatic cancer, cardiovascular disease, and diabetes in individuals successfully treated for HCV infection with DAA agents.


Assuntos
Causas de Morte/tendências , Hepatite B Crônica/mortalidade , Hepatite C Crônica/mortalidade , Hepatopatias Alcoólicas/mortalidade , Hepatopatia Gordurosa não Alcoólica/mortalidade , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Censos , Bases de Dados Factuais , Atestado de Óbito , Feminino , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/tratamento farmacológico , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Humanos , Hepatopatias Alcoólicas/diagnóstico , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Prevalência , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
6.
BMC Gastroenterol ; 19(1): 74, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092203

RESUMO

BACKGROUND: Antiviral treatment for chronic hepatitis B (CHB) is largely unavailable in sub-Saharan Africa; hence, little is known about the prognosis after initiating treatment in African CHB patients. In this study we aimed to assess predictors of mortality in one of the largest CHB cohorts in sub-Saharan Africa. METHODS: Two-hundred-and-seventy-six CHB patients who started treatment with tenofovir disoproxil fumarate at a public hospital in Ethiopia between March 18, 2015, and August 1, 2017, were included in this analysis. Patients were followed up until October 1, 2017, and deaths were ascertained through hospital records and telephone interview with relatives. Decompensated cirrhosis was defined as current or past evidence of ascites, either by clinical examination or by ultrasonography. Cox proportional hazard models were used to identify independent predictors of mortality. RESULTS: Thirty-five patients (12.7%) died during follow-up, 33 of whom had decompensated cirrhosis at recruitment. The median duration from start of treatment to death was 110 days (interquartile range 26-276). The estimated survival was 90.3, 88.2 and 86.3% at 6, 12 and 24 months of follow-up, respectively. Independent predictors of mortality were decompensated cirrhosis (adjusted hazard ratio [AHR] 23.68; 95% CI 3.23-173.48; p = 0.002), body mass index < 18.5 kg/m2 (AHR 3.65; 95% CI 1.73-7.72; p = 0.001) and older age (per 1-year increment; AHR 1.06; 95% CI 1.02-1.10; p = 0.007). CONCLUSIONS: Decompensated cirrhosis, low body mass index and older age were independent predictors of mortality. Improved access to antiviral treatment and earlier initiation of therapy could improve the survival of African CHB patients. TRIAL REGISTRATION: NCT02344498 ( ClinicalTrials.gov identifier). Registered 16 January 2015.


Assuntos
Antivirais/uso terapêutico , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/mortalidade , Tenofovir/uso terapêutico , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , Etiópia/epidemiologia , Feminino , Hepatite B Crônica/complicações , Humanos , Cirrose Hepática/fisiopatologia , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Adulto Jovem
7.
Gut Liver ; 13(5): 557-568, 2019 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-31023007

RESUMO

Background/Aims: Barcelona Clinic Liver Cancer (BCLC) C stage demonstrates considerable heterogeneity because it includes patients with either symptomatic tumors (performance status [PS], 1-2) or with an invasive tumoral pattern reflected by the presence of vascular invasion (VI) or extrahepatic spread (EHS). This study aimed to derive a more relevant staging system by modification of the BCLC system considering the prognostic implication of PS. Methods: A total of 7,501 subjects who were registered in the Korean multicenter hepatocellular carcinoma (HCC) registry database from 2008 to 2013 were analyzed. The relative goodness-of-fit between staging systems was compared using the Akaike information criterion (AIC) and integrated area under the curve (IAUC). Three modified BCLC (m-BCLC) systems (#1, #2, and #3) were devised by reducing the role of PS. Results: As a result, the BCLC C stage, which includes patients with PS 1-2 without VI/EHS, was reassigned to stage 0, A, or B according to their tumor burden in the m-BCLC #2 model. This model was identified as the most explanatory and desirable model for HCC staging by demonstrating the smallest AIC (AIC=70,088.01) and the largest IAUC (IAUC=0.722), while the original BCLC showed the largest AIC (AIC=70,697.17) and the smallest IAUC (IAUC=0.705). The m-BCLC #2 stage C was further subclassified into C1, C2, C3, and C4 according to the Child-Pugh score, PS, presence of EHS, and tumor extent. The C1 to C4 subgroups showed significantly different overall survival distribution between groups (p<0.001). Conclusions: An accurate and relevant staging system for patients with HCC was derived though modification of the BCLC system based on PS.


Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Carcinoma Hepatocelular/mortalidade , Feminino , Hepatite B Crônica/complicações , Hepatite B Crônica/mortalidade , Hepatite C Crônica/complicações , Hepatite C Crônica/mortalidade , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Sistema de Registros , República da Coreia/epidemiologia , Análise de Sobrevida , Carga Tumoral
8.
Biomed Res Int ; 2019: 7272045, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949507

RESUMO

Background: Some studies have reported that renal dysfunction is associated with poor prognosis in cirrhotic patients. Serum cystatin C (CysC) is an accurate biomarker for early renal dysfunction. This study aimed to assess the prognostic value of serum CysC levels in patients with hepatitis B virus-related decompensated cirrhosis (HBV-DeCi). Methods: This retrospective study included 75 subjects who had been diagnosed with HBV-DeCi. The association between serum CysC and prognosis was estimated by receiver operating characteristic curve analysis and a multivariable logistic regression model. Results: Serum CysC levels were higher in nonsurvivors than in survivors and were positively correlated with model for end-stage liver disease (MELD) scores. In multivariate analysis, CysC and the MELD score were independent prognostic factors in all HBV-DeCi patients. However, only serum CysC was an independent factor predicting mortality in patients with normal creatinine levels. Conclusions: These data suggest that high serum CysC levels can be considered an independent biomarker of 3-month mortality in patients with HBV-DeCi.


Assuntos
Cistatina C/sangue , Doença Hepática Terminal , Vírus da Hepatite B , Hepatite B Crônica , Cirrose Hepática , Adulto , Idoso , Biomarcadores/sangue , China/epidemiologia , Doença Hepática Terminal/sangue , Doença Hepática Terminal/mortalidade , Feminino , Seguimentos , Hepatite B Crônica/sangue , Hepatite B Crônica/mortalidade , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
9.
Anticancer Res ; 39(4): 2217-2226, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30952770

RESUMO

BACKGROUND/AIM: Fibroblast growth factor (FGF), vascular endothelial growth factor, and hepatocyte growth factor play a critical role in the pathogenesis of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: We assessed nine single nucleotide polymorphisms (SNPs) in the FGF1, FGF2, FGF receptor (FGFR)-2, Flt-1, and c-MET genes in 245 HCC patients and 483 chronic hepatitis B virus (HBV) carriers without HCC. RESULTS: Kaplan-Meier analysis showed that patients with the FGF2 rs308447 TT genotype had shorter overall survival than patients with the CC or CT genotype (p=0.016) and that FGF2 rs308379 A allele carriers had shorter overall survival than patients with the TT genotype (p=0.020). CONCLUSION: Multivariate Cox proportional analysis revealed that the FGF2 rs308379 A allele (hazard ratio(HR)=1.663, p=0.004) and advanced tumor stage (HR=3.430, p<0.001) were independent prognostic factors for overall survival in patients with HCC.


Assuntos
Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/mortalidade , Fator 2 de Crescimento de Fibroblastos/genética , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/mortalidade , Receptor Tipo 2 de Fator de Crescimento de Fibroblastos/genética , Adulto , Carcinoma Hepatocelular/etiologia , Feminino , Hepatite B Crônica/complicações , Hepatite B Crônica/genética , Hepatite B Crônica/mortalidade , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/etiologia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Taxa de Sobrevida
10.
Hepatol Int ; 13(2): 157-164, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30706354

RESUMO

BACKGROUND: In Taiwan, the national hepatitis B virus vaccination program and national viral hepatitis therapy program were implemented to control the infections of hepatitis viruses and their progressive illnesses. Studies have evaluated the impacts of two national health programs on many liver-related diseases, but not on acute and chronic viral hepatitis. The purpose of this study was to evaluate the impact on the mortality of acute and chronic viral hepatitis. METHODS: Poisson regression models were used to estimate the adjusted rate ratios of the different period groups and corresponding 95% confidence intervals for childhood, adulthood and elderhood, and to estimate the adjusted rate ratios of vaccinated cohorts and corresponding 95% confidence intervals. RESULTS: Compared with period of 2000-2003, the adjusted rate ratios for period groups of 2008-2011 and 2012-2015 reported a significantly increasing risk of acute and chronic viral hepatitis mortality, except for the childhood and female adulthood. For population without vaccination, the adjusted rate ratios of acute and chronic viral hepatitis B mortality were 0.99 (95% CIs 0.88-1.12), 1.30 (95% CIs 1.17-1.45) and 1.42 (95% CIs 1.28-1.55) for periods of 2004-2007, 2008-2011 and 2012-2015, respectively, comparing with unimplemented period of national viral hepatitis therapy program. Compared with 1967-1983 cohorts, the adjusted rate ratio of 1984-2000 cohorts was 0.46 (95% CIs 0.28-0.75), and the adjusted rate ratios were 0.49 (95% CIs 0.28-0.87) and 0.35 (95% CIs 0.11-1.05) for male and female, respectively. CONCLUSION: This study revealed the significantly higher mortality rates of acute and chronic viral hepatitis during the implemented period of national viral hepatitis therapy program, comparing the unimplemented period. Such ineffectiveness may be attributable to the low coverage rate. The national vaccination program was currently an effective strategy for controlling the mortality of viral hepatitis.


Assuntos
Antivirais/uso terapêutico , Hepatite B/mortalidade , Hepatite B/terapia , Programas de Imunização , Programas Nacionais de Saúde , Vacinas contra Hepatite Viral , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Hepatite B Crônica/mortalidade , Hepatite B Crônica/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Fatores Sexuais , Taiwan/epidemiologia , Cobertura Vacinal , Adulto Jovem
11.
Clin Lab ; 65(1)2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30775885

RESUMO

BACKGROUND: Recent reports suggest that the lymphocyte-to-monocyte ratio (LMR) is a potential biomarker for predicting clinical outcomes. In the present study, LMR in patients with hepatitis B virus-related decompensated cirrhosis (HBV-DeCi) was investigated to evaluate whether LMR may have utility as a new predictive marker for mortality in HBV-DeCi patients. METHODS: This was a retrospective cohort study that included 135 patients with HBV-DeCi. Logistic regression analysis and receiver operating characteristic curve were employed to assess the independent predictors for 1-month mortality rate of patients with HBV-DeCi. RESULTS: A significantly lower LMR was detected in non-surviving patients than in surviving patients, and a lower LMR was associated with increased 1-month mortality. Multivariate analysis suggested that both LMR and the model for endstage liver disease were independent predictors of 1-month mortality in patients with HBV-DeCi (both p < 0.001). CONCLUSIONS: Our results suggest that a low LMR can be considered a new independent biomarker for predicting 30-day mortality in patients with HBV-DeCi.


Assuntos
Hepatite B Crônica/complicações , Cirrose Hepática/complicações , Linfócitos , Monócitos , Adulto , Idoso , Feminino , Vírus da Hepatite B/fisiologia , Hepatite B Crônica/mortalidade , Hepatite B Crônica/virologia , Humanos , Cirrose Hepática/mortalidade , Cirrose Hepática/patologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
12.
JAMA Oncol ; 5(1): 30-36, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30267080

RESUMO

Importance: Entecavir and tenofovir disoproxil fumarate have comparable efficacy in achieving surrogate end points, including virologic response, and are equally recommended as first-line treatments for patients with chronic hepatitis B (CHB). However, it is unclear whether treatment with these drugs is associated with equivalent clinical outcomes, especially development of hepatocellular carcinoma (HCC). Objective: To compare entecavir and tenofovir in terms of the risk of HCC and death or liver transplant in patients with CHB infection. Design, Setting, and Participants: A nationwide historical population cohort study involving treatment-naive adult patients with CHB who started treatment with entecavir (n = 11 464) or tenofovir disoproxil fumarate (n = 12 692) between January 1, 2012, and December 31, 2014, using data from the Korean National Health Insurance Service database. As validation, a hospital cohort of patients with CHB treated with entecavir (n = 1560) or tenofovir (n = 1141) in a tertiary referral center between January 1, 2010, and December 31, 2016, were analyzed. Nationwide cohort data were retrieved from January 1, 2010, to December 31, 2016, and hospital cohort data from January 1, 2010, to October 31, 2017. Main Outcomes and Measures: Cumulative incidence rates of HCC and death and transplant rates. Results: Among the population cohort of 24 156, the mean (SD) age was 48.9 (9.8) years, and 15 120 patients (62.6%) were male. Among the hospital cohort of 2701, the mean (SD) age was 48.8 (10.5) years and 1657 patients (61.3%) were male. In the population cohort, the annual incidence rate of HCC was significantly lower in the tenofovir group (0.64 per 100 person-years [PY]) than in the entecavir group (1.06 per 100 PY). By multivariable-adjusted analysis, tenofovir therapy was associated with a significantly lower risk of HCC (hazard ratio [HR], 0.61; 95% CI, 0.54-0.70) and all-cause mortality or transplant (HR, 0.77; 95% CI, 0.65-0.92) compared with entecavir. The tenofovir group also showed a significantly lower risk of HCC in the 10 923-pair propensity score-matched population cohort (HR, 0.62; 95% CI, 0.54-0.70) and 869-pair propensity score-matched hospital cohort (HR, 0.68; 95% CI, 0.46-0.99) compared with the entecavir group. Conclusions and Relevance: This study suggests that tenofovir treatment was associated with a significantly lower risk of HCC compared with entecavir treatment in a population-based cohort of adults with CHB; these findings were validated in a hospital cohort. Given the poor prognosis of patients with HCC, these findings may have considerable clinical implications in prevention of this cancer in patients with CHB infection.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/prevenção & controle , Guanina/análogos & derivados , Hepatite B Crônica/tratamento farmacológico , Neoplasias Hepáticas/prevenção & controle , Tenofovir/uso terapêutico , Adulto , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/virologia , Causas de Morte , Bases de Dados Factuais , Feminino , Guanina/uso terapêutico , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/mortalidade , Hepatite B Crônica/virologia , Humanos , Incidência , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiologia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , República da Coreia/epidemiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
J Infect Chemother ; 25(1): 12-16, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30366861

RESUMO

BACKGROUND: Entecavir (ETV) is a nucleoside analogue (NA) that is effective for treatment of chronic hepatitis B (CHB) due to its low resistance rates and potent antiviral effects. We aimed to evaluate the clinical, biochemical and virological response to ETV in patients without a prior use of nucleos(t)ide (NA-naïve) vs. those who failed prior NA use (NA-experienced) in the treatment of CHB. METHODS: Patients treated between April 2012 and December 2017 were retrospectively studied. A comparison was made between patients treated with ETV in NA-naïve Vs. NA-experienced. Complete virological response (CVR) was defined as achieving undetectable HBV-DNA level, up to 15 IU/ml, partial virological response (PVR) as 15-200 IU/ml and >200 IU/ml for no virological response (NVR) after one year of therapy. RESULTS: Overall, 148 patients were included (69 NA-naïve and 79 NA-experienced). In NA-naïve group, 51%, 17% and 32% achieved CVR, PVR and NVR vs. 17%, 9% and 75% in NA-experienced group, respectively (p < 0.001). HBsAg seroconversion was achieved in 5.8% in NA-naïve group vs. 6.3% in NA-experienced group (p = 1.00). HBeAg seroconversion was 17% in NA-naïve group and 25% in NA-experienced group (p = 0.24). There was no significant difference in alanine transaminase normalization or in mortality rate between both groups; p = 0.87 and p = 1.00 respectively. CONCLUSION: ETV therapy in CHB results in a better virological response in NA-naïve patients compared to NA-experienced. There were no differences between both groups in regards to the rate of HBsAg or HBeAg seroconversions, biochemical improvements or mortality.


Assuntos
Antivirais/uso terapêutico , Guanina/análogos & derivados , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B Crônica/tratamento farmacológico , Adulto , Idoso , Alanina Transaminase/sangue , Antivirais/farmacologia , DNA Viral/sangue , Feminino , Guanina/farmacologia , Guanina/uso terapêutico , Antígenos de Superfície da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/imunologia , Antígenos E da Hepatite B/sangue , Antígenos E da Hepatite B/imunologia , Vírus da Hepatite B/imunologia , Hepatite B Crônica/sangue , Hepatite B Crônica/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Soroconversão
14.
BMC Gastroenterol ; 18(1): 179, 2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30509201

RESUMO

BACKGROUND: Acute decompensation (AD) has been shown to be associated with a high mortality rate for cirrhosis patients. This study aimed to develop a prognostic nomogram to evaluating the individual prognosis for AD of cirrhosis in chronic hepatitis B (CHB). METHODS: The nomogram was developed using data from a retrospective study on 509 patients hospitalized for AD of CHB cirrhosis from October 2008 to February 2014 at the Beijing Ditan Hospital, Capital Medical University. The predictive accuracy, discriminative ability, and clinical net benefit were evaluated by concordance index (C-index), calibration curves, and decision curve analysis (DCA). The results were validated on 620 patients consecutively enrolled from January 2005 to December 2010 at the Renji Hospital, Shanghai Jiao Tong University,. RESULTS: On multivariate analysis of the derivation cohort, independent factors included in the nomogram were age, previous decompensation, bacterial infection, hepatic encephalopathy, and total bilirubin. The calibration curve for the probability of survival showed good agreement between the nomogram and actual observation. The nomogram had a C-index of 0.897, which was statistically higher than the C-index values of CTP (0.793), MELD (0.821), SOFA (0.868), or the Chronic Liver Failure Consortium AD (CLIF-C AD) (0.716) scores (p <  0.001 for all). Using DCA, the nomogram also demonstrated superior net benefits over other score models. The results were confirmed in the validation cohort. CONCLUSIONS: The proposed nomogram enables more-accurate individualized prediction of survival than MELD, CTP, SOFA, or CLIF-C AD scores for AD of CHB cirrhosis patients.


Assuntos
Hepatite B Crônica/mortalidade , Cirrose Hepática/mortalidade , Nomogramas , Adulto , Feminino , Hepatite B Crônica/complicações , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Lancet ; 392(10161): 2313-2324, 2018 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-30496122

RESUMO

Chronic hepatitis B virus infection is a global public health threat that causes considerable liver-related morbidity and mortality. It is acquired at birth or later via person-to-person transmission. Vaccination effectively prevents infection and chronic hepatitis B virus carriage. In chronically infected patients, an elevated serum hepatitis B virus DNA concentration is the main risk factor for disease progression, although there are other clinical and viral parameters that influence disease outcomes. In addition to liver biochemistry, virological markers, and abdominal ultrasonography, non-invasive assessment of liver fibrosis is emerging as an important assessment modality. Long-term nucleos(t)ide-analogue therapy is safe and well tolerated, achieves potent viral suppression, and reduces the incidence of liver-related complications. However, a need to optimise management remains. Promising novel therapies are at the developmental stage. With current vaccines, therapies, and an emphasis on improving linkage to care, WHO's goal of eliminating hepatitis B virus as a global health threat by 2030 is achievable.


Assuntos
Vírus da Hepatite B/efeitos dos fármacos , Hepatite B Crônica/epidemiologia , Cirrose Hepática/tratamento farmacológico , Fígado/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , DNA Viral/sangue , Progressão da Doença , Feminino , Vírus da Hepatite B/genética , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/imunologia , Hepatite B Crônica/mortalidade , Humanos , Fígado/química , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Nucleosídeos/administração & dosagem , Nucleosídeos/uso terapêutico , Fatores de Risco , Ultrassonografia/métodos , Vacinação/métodos , Organização Mundial da Saúde/organização & administração
16.
World J Gastroenterol ; 24(40): 4606-4614, 2018 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-30386110

RESUMO

AIM: To investigate survival rate and incidence of hepatocellular carcinoma (HCC) in patients with decompensated cirrhosis in the antiviral era. METHODS: We used the Korean Health Insurance Review and Assessment. Korea's health insurance system is a public single-payer system. The study population consisted of 286871 patients who were prescribed hepatitis B antiviral therapy for the first time between 2007 and 2014 in accordance with the insurance guidelines. Overall, 48365 antiviral treatment-naïve patients treated between 2008 and 2009 were included, and each had a follow-up period ≥ 5 years. Data were analyzed for the 1st decompensated chronic hepatitis B (CHB) and treatment-naïve patients (n = 7166). RESULTS: The mean patient age was 43.5 years. The annual mortality rates were 2.4%-19.1%, and 5-year cumulative mortality rate was 32.6% in 1st decompensated CHB treatment-naïve subjects. But the annual mortality rates sharply decreased to 3.4% (2.4%-4.9%, 2-5 year) after one year of antiviral treatment. Incidence of HCC at first year was 14.3%, the annual incidence of HCC decreased to 2.5% (1.8%-3.7%, 2-5 year) after one year. 5-year cumulative incidence of HCC was 24.1%. Recurrence rate of decompensated event was 46.9% at first year, but the annual incidence of second decompensation events in decompensated CHB treatment-naïve patients was 3.4% (2.1%-5.4%, 2-5 year) after one year antiviral treatment. 5-year cumulative recurrence rate of decompensated events was 60.6%. Meanwhile, 5-year cumulative mortality rate was 3.1%, and 5-year cumulative incidence of HCC was 11.5% in compensated CHB treatment-naïve patients. CONCLUSION: Long term outcome of decompensated cirrhosis treated with antiviral agent improved much, and incidence of hepatocellular carcinoma and mortality sharply decreased after one year treatment.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/epidemiologia , Hepatite B Crônica/tratamento farmacológico , Cirrose Hepática/patologia , Neoplasias Hepáticas/epidemiologia , Adulto , Carcinoma Hepatocelular/virologia , Feminino , Seguimentos , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/mortalidade , Hepatite B Crônica/patologia , Hepatite B Crônica/virologia , Humanos , Incidência , Cirrose Hepática/mortalidade , Cirrose Hepática/virologia , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Recidiva , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
17.
Am J Gastroenterol ; 113(11): 1629-1638, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30315283

RESUMO

OBJECTIVES: Antiviral treatment modifies the natural history of chronic hepatitis B (CHB)-related cirrhosis as reflected by improving Model for End-Stage Liver Disease (MELD) score over time. We evaluated the impact of on-treatment change of MELD score on clinical outcomes in patients with CHB-related cirrhosis. METHODS: Cirrhotic CHB patients who received entecavir and/or tenofovir disoproxil fumarate for at least 6 months in Hong Kong between 2005 and 2016 were identified. The primary outcome was all-cause mortality; secondary outcomes were hepatocellular carcinoma (HCC), and hepatic events including ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatorenal syndrome, hepatic encephalopathy, and liver transplantation. RESULTS: We identified 1743 cirrhotic CHB patients. Their mean MELD score decreased from 12.3 ± 5.5 at baseline to 11.0 ± 4.7 at month 6. At a median (interquartile range) follow-up of 3.9 (1.9-6.0) years, 290 (16.6%) patients died; 201 (11.5%) developed HCC. Among 1140 patients without prior hepatic events, 150 (13.2%) developed hepatic events. Among 464 patients with baseline MELD score ≥15, the 6-year cumulative mortality was 72.8, 36.7, and 23.1% for unchanged or increased MELD score, 1-5 point improvement in MELD score, and >5 point improvement in MELD score at month 6, respectively (log-rank test, P < 0.001); the corresponding 6-year cumulative incidence of hepatic events was 52.7, 30.5, and 23.9% in the three subgroups (Gray's test, P = 0.004). Patients with MELD score <15 at month 6 had lower risk of mortality and hepatic events (all P < 0.001). CONCLUSIONS: On-treatment improvement of MELD score correlates with reduced risk of mortality and hepatic events in cirrhotic CHB patients.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/epidemiologia , Doença Hepática Terminal/diagnóstico , Hepatite B Crônica/tratamento farmacológico , Cirrose Hepática/diagnóstico , Neoplasias Hepáticas/epidemiologia , Idoso , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/virologia , Progressão da Doença , Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/patologia , Doença Hepática Terminal/virologia , Feminino , Hepatite B Crônica/mortalidade , Hepatite B Crônica/patologia , Hepatite B Crônica/virologia , Humanos , Incidência , Estimativa de Kaplan-Meier , Cirrose Hepática/mortalidade , Cirrose Hepática/patologia , Cirrose Hepática/virologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
18.
Clin Infect Dis ; 67(8): 1278-1284, 2018 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-30265321

RESUMO

Background: The epidemiology of acute hepatitis A and E has been changing over the last 2 decades. The impact of concomitant chronic hepatitis B (CHB) on clinical outcomes remains unclear. We aimed to evaluate the morbidity and mortality of patients with acute hepatitis A or E with and without underlying CHB. Methods: We identified consecutive patients with acute hepatitis A or E based on hepatitis serology from the electronic medical records of the Hospital Authority of Hong Kong from January 2000 to December 2016. Hepatic events, all-cause mortality, and liver-related mortality within 30 days of the diagnosis of acute hepatitis were evaluated. Results: The cohort included 1068 cases of acute hepatitis A and 846 cases of acute hepatitis E. More patients with acute hepatitis E than those with acute hepatitis A had underlying CHB (13.5% vs 8.0%; P < .001). Patients with hepatitis E had more all-cause mortality (3.9% vs 0.6%; P < .001), liver-related mortality (2.0% vs 0.3%; P < .001), and hepatic events (2.8% vs 0.3%; P < .001) within 30 days from diagnosis. In patients with acute hepatitis E, underlying renal failure (adjusted hazard ratio [aHR], 3.90; P < .001) and age ≥50 years (aHR, 3.25; P = .036) were associated with 30-day all-cause mortality, whereas CHB (aHR, 3.34; P = .02) was associated with 30-day liver-related mortality. Conclusions: The mortality is higher in patients with acute hepatitis E than in those with hepatitis A. Coexisting CHB is the independent risk factor for liver-related mortality in patients with acute hepatitis E.


Assuntos
Hepatite B Crônica/mortalidade , Hepatite E/complicações , Hepatite E/mortalidade , Fígado/virologia , Doença Aguda , Adulto , Idoso , Antivirais/uso terapêutico , Estudos de Coortes , DNA Viral/sangue , Feminino , Hepatite A/complicações , Hepatite A/mortalidade , Hepatite B Crônica/tratamento farmacológico , Hong Kong/epidemiologia , Humanos , Fígado/patologia , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Vigilância em Saúde Pública , Sistema de Registros , Fatores de Risco , Adulto Jovem
19.
Aliment Pharmacol Ther ; 48(7): 750-760, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30069888

RESUMO

BACKGROUND: HBV-related acute-on-chronic liver failure (HBV-ACLF) deteriorates rapidly in the short term, which necessitates accurate initial clinical decision making. AIMS: To develop a novel prognostic score for patients with HBV-ACLF and clarify the role of thyroid hormones in HBV-ACLF. METHODS: A retrospective cohort of 635 HBV-ACLF patients was enrolled to develop and validate a novel prognostic score for HBV-ACLF. Additionally, a cross-sectional cohort (n = 199) and a prospective longitudinal HBV-ACLF cohort (n = 56) were recruited to clarify the association between thyroid hormone status and the 30-day mortality of HBV-ACLF. RESULTS: HINT, a novel prognostic score based on hepatic encephalopathy, INR, neutrophil count, and thyroid-stimulating hormone (TSH) using the deriving cohort (n = 426), was significantly higher in non-survivors than survivors (1.17 ± 2.38 vs -1.87 ± 1.26, P < 0.0001). The AUROC of HINT for 30-day mortality was 0.889, which was significantly higher than that of the Child-Pugh, MELD, CLIF-SOFA, CLIF-C ACLF, and COSSH-ACLF scores (all P < 0.05). These results were confirmed in the validation cohort (n = 209), except that the AUROC of HINT was comparable to that of COSSH-ACLF (P = 0.357). Among thyroid hormones, only the TSH level on admission was significantly lower in non-survivors than in survivors (P = 0.01). During the 14-day longitudinal observation, TSH levels increased significantly in the improvement group (P < 0.001) but did not change in the deterioration or fluctuation groups, and gradually increased in survivors (P < 0.001) but not in non-survivors. CONCLUSIONS: HINT, as a prognostic score for HBV-ACLF, is simpler than and superior to the Child-Pugh, MELD, CLIF-SOFA, and CLIF-C ACLF scores and at least comparable with the COSSH-ACLF score. Sequential TSH measurements may facilitate prediction of the clinical course of ACLF.


Assuntos
Insuficiência Hepática Crônica Agudizada/diagnóstico , Insuficiência Hepática Crônica Agudizada/virologia , Vírus da Hepatite B/fisiologia , Hepatite B Crônica/complicações , Hepatite B Crônica/diagnóstico , Modelos Estatísticos , Insuficiência Hepática Crônica Agudizada/mortalidade , Adulto , Tomada de Decisão Clínica , Estudos de Coortes , Estudos Transversais , Feminino , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/mortalidade , Encefalopatia Hepática/virologia , Hepatite B Crônica/mortalidade , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mortalidade , Prognóstico , Curva ROC , Projetos de Pesquisa , Estudos Retrospectivos , Fatores de Tempo
20.
Gastroenterology ; 155(4): 1154-1163.e3, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30009816

RESUMO

BACKGROUND & AIMS: Although treatment of hepatitis C virus (HCV) infection has improved, the prevalence of alcoholic liver disease (ALD) has been increasing, so we need an updated estimate of the burden and etiology-specific mortality of chronic liver diseases. We studied trends in age-standardized mortality of chronic liver diseases in adults at least 20 years old in the United States from 2007 through 2016. METHODS: We collected data from the US Census and National Center for Health Statistics mortality records and identified individuals with HCV infection, ALD, nonalcoholic fatty liver disease, or hepatitis B virus infection using ICD-10 codes. We obtained temporal mortality rate patterns using joinpoint trend analysis with estimates of annual percentage change (APC). RESULTS: Age-standardized HCV-related mortality increased from 7.17 per 100,000 persons in 2007 to 8.14 per 100,000 persons in 2013, followed by a marked decrease in the time period at which patients began receiving treatment with direct-acting antiviral agents (from 8.09 per 100,000 persons in 2014 to 7.15 per 100,000 persons in 2016). The APC in HCV mortality increased 2.0%/year from 2007 through 2014 but decreased 6.4%/year from 2014 through 2016. In contrast, age-standardized mortality increased for ALD (APC 2.3% from 2007 through 2013 and APC 5.5% from 2013 through 2016) and nonalcoholic fatty liver disease (APC 6.1% from 2007 through 2013 and APC 11.3% from 2013 through 2016). Mortality related to hepatitis B virus decreased steadily from 2007 through 2016, with an average APC of -2.1% (95% CI -3.0 to -1.2). Etiology-based mortality in minority populations was higher. HCV-related mortality (per 100,000 persons) was highest in non-Hispanic blacks (10.28) and whites (6.92), followed by Hispanics (5.94), and lowest in non-Hispanic Asians (2.33). Non-Hispanic Asians had higher mortality for hepatitis B virus infection (2.82 per 100,000 vs 1.02 for non-Hispanic blacks and 0.47 for non-Hispanic whites). CONCLUSION: In our population-based analysis of chronic liver disease mortality in the United States, the decrease in HCV-related mortality coincided with the introduction of direct-acting antiviral therapies, whereas mortality from ALD and nonalcoholic fatty liver disease increased during the same period. Minorities in the United States have disproportionately higher mortality related to chronic liver disease.


Assuntos
Hepatite B Crônica/mortalidade , Hepatite C Crônica/mortalidade , Hepatopatias Alcoólicas/mortalidade , Hepatopatia Gordurosa não Alcoólica/mortalidade , Adulto , Afro-Americanos , Distribuição por Idade , Antivirais/uso terapêutico , Americanos Asiáticos , Causas de Morte/tendências , Censos , Grupo com Ancestrais do Continente Europeu , Feminino , Disparidades nos Níveis de Saúde , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/etnologia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/etnologia , Hispano-Americanos , Humanos , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/etnologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/etnologia , Prevalência , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
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