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Modified PAGE-B Predicts the Risk of HCC in Asians with Chronic Hepatitis B on Antiviral Therapy
( Minjong Lee ),( Ji Hyun Kim ),( Young Don Kim ),( Baek Gyu Jun ),( Tae Suk Kim ),( Dae Hee Choi ),( Ki Tae Suk ),( Seonghee Kang ),( Moon Young Kim ),( Young Don Kim ),( Gab Jin Cheon ),( Dong Joon 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Background & Aims: Recently, PAGE-B score has been developed to predict the risk of hepatocellular carcinoma (HCC) in Caucasian patients with chronic hepatitis B (CHB). We aimed to validate PAGE-B scores in Asian patients with CHB. Methods: From 2007 to 2017, we examined 2,844 Asian patients with CHB receiving entecavir/tenofovir therapy. We assessed the performances of PAGE-B and three conventional risk prediction models (CU-HCC, GAG-HCC, and REACH-B) for HCC development. Results: The 5-year cumulative HCC incidence rates were 5.6%. The PAGE- B showed similar AUROCs to CU-HCC, GAG-HCC, and REACH-B at 5 years (0.74 vs 0.70, 0.71, and 0.70 respectively; all P>0.05), HCC incidence rates within 5 years of antiviral therapy initiation in CHB patients were significantly higher compared with rates beyond year 5. Conclusion: PAGE-B showed moderate predictablities in Asian CHB patients receiving entecavir/tenofovir therapy.
( Seong Hee Kang ),( Minjong Lee ),( Moon Young Kim ),( Seul Ki Han ),( Jun Hyeok Lee ),( Baek Gyu Jun ),( Tae Suk Kim ),( Dae Hee Choi ),( Ki Tae Suk ),( Young Don Kim ),( Gab Jin Cheon ),( Dong Joon 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: This study investigated the effect of non-selective ß-blockers (NSBB) in real-life situations and whether low-dose NSBB is beneficial compared to maximally tolerated doses. Methods: Study participant of 890 were divided into two groups: primary prophylaxis (PP) and secondary prophylaxis (SP); 595 in the PP group (NSBB = 370, non-NSBB = 225) and 291 in the SP group (NSBB = 217, non-NSBB = 74). The NSBB group was sub-divided into 2 groups: low-dose (≤ 80 mg) and high-dose (>80 mg). Hepatic venous pressure gradient (HVPG) measurement was performed before NSBB treatment in the majority of patients (n=803). Results: In the PP group, 272 patients received NSBB only, while 98 patients received NSBB plus endoscopic band ligation (EBL) (low-dose NSBB, n=170; high-dose NSBB, n=200). The NSBB group showed similar survival rates to the non-NSBB group. However, NSBB was partially effective for patients who had clinically significant portal hypertension (CSPH, HVPG ≥10 mmHg: hazard ratio [HR], 0.63; P=0.02) or CTP class B/C (HR, 0.59; P=0.01). The low-dose NSBB had significant reductions in the risk of mortality compared with the non-NSBB (HVPG ≥10 mmHg: HR, 0.55; P=0.02 and CTP class B/C: HR, 0.52; P=0.01), but effect size was weaker in the high-dose NSBB. In the SP group, 217 received NSBB plus EBL (low-dose NSBB, n=87; high-dose NSBB, n=130). NSBB prolonged survival regardless of the severity of portal hypertension (adjusted HR, 0.56; P<0.001). The low-dose NSBB had a greater benefit with a 58% risk reduction in mortality compared to a 39% risk reduction in mortality in the high-dose NSBB. Conclusions: NSBB therapy was partially associated with longer survival in patients of the PP group with CSPH. In the SP group, NSBB therapy improved survival, and relatively low-dose NSBB had a greater benefit than standard-titrated high-dose NSBB.
( Ji Hyun Kim ),( Seong Hee Kang ),( Minjong Lee ),( Tae Suk Kim ),( Baek Gyu Jun ),( Moon Young Kim ),( Young Don Kim ),( Gab Jin Cheon ),( Dong Joon Kim ),( Soon Koo Baik ),( Dae Hee Choi ),( Ki Tae 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Previous studies reported that serum myostatin is associated with sarcopenia. We aimed to elucidate the association between serum myostatin levels and hepatocellular carcinoma (HCC) development in patients with alcoholic liver cirrhosis (ALC). Methods: This retrospective multi-center study assessed 201 ALC patients from 2010 to 2016 in four university-affiliated hospitals in Korea. The primary endpoint was development of HCC within 5 years. Index date was time when patients were admitted into hospitals for control of complications from liver cirrhosis. The Cox proportional hazards model analysis was used to assess the association of serum myostatin levels and HCC development in ALC patients. Area under receiver operating characteristic curve (AUROC) of serum myostatin levels for 5-year HCC development was calculated. Serum myostatin levels were measured by enzyme-linked immunosorbent assay using samples which were collected at the index date. Results: During a median follow-up of 2.1 years, 5-year cumulative HCC incidence rates were 8.0% in total population (n=201). The median levels of serum myostatin was 3.6 ng/mL (interquartile [IQR], 2.2-6.6 ng/mL). The AUROC of serum myostatin levels for 5-year HCC development was 0.78 (95% CI, 0.70-0.82). When total patients were divided according to serum myostatin levels, there was a significant difference of HCC development within 5 years between low myostatin group and high myostatin group (HR 4.52, P=0.04). 5-year cumulative HCC incidence rates were 3% in the low myostatin group (n=100); 5-year cumulative HCC incidence rates were 12% in the high myostatin group (n=101). In Cox proportional hazards model analysis, age and serum myostatin levels were an independent risk factor for HCC development (adjusted HR [aHR] of age 1.06, P=0.004 and aHR of myostatin 1.15, P=0.02). Conclusions: Higher serum myostatin levels were significantly associated with a higher risk of HCC development in ALC patients. Serum myostatin levels showed good predictive performance of 5-year HCC development in ALC patients. Serum myostatin levels may represent a promising predictive biomarker in ALC patients, which could identify high-risk patients who need a stringent surveillance.
Ji Hyun Kim,Baek Gyu Jun,Minjong Lee,Hye Ah Lee,Tae Suk Kim,Jeongwon Heo,Da Hye Moon,Seong Hee Kang,Ki Tae Suk,Moon Young Kim,Young Don Kim,Gab Jin Cheon,Soon Koo Baik,Dong Joon Kim,Dae Hee Choi 대한간학회 2022 Clinical and Molecular Hepatology(대한간학회지) Vol.28 No.3
Background/Aims: Sepsis-3 criteria and quick Sequential Organ Failure Assessment (qSOFA) have been advocated to be used in defining sepsis in the general population. We aimed to compare the Sepsis-3 criteria and Chronic Liver Failure-SOFA (CLIF-SOFA) scores as predictors of in-hospital mortality in cirrhotic patients admitted to the emergency department (ED) for infections. Methods: A total of 1,622 cirrhosis patients admitted at the ED for infections were assessed retrospectively. We analyzed their demographic, laboratory, and microbiological data upon diagnosis of the infection. The primary endpoint was inhospital mortality rate. The predictive performances of baseline CLIF-SOFA, Sepsis-3, and qSOFA scores for in-hospital mortality were evaluated. Results: The CLIF-SOFA score proved to be significantly better in predicting in-hospital mortality (area under the receiver operating characteristic curve [AUROC], 0.80; 95% confidence interval [CI], 0.78–0.82) than the Sepsis-3 (AUROC, 0.75; 95% CI, 0.72–0.77, P<0.001) and qSOFA (AUROC, 0.67; 95% CI, 0.64–0.70; P<0.001) score. The CLIF-SOFA, CLIF-C-AD scores, Sepsis-3 criteria, septic shock, and qSOFA positivity were significantly associated with in-hospital mortality (adjusted hazard ratio [aHR], 1.24; 95% CI, 1.19–1.28; aHR, 1.13; 95% CI, 1.09–1.17; aHR, 1.19; 95% CI, 1.15–1.24; aHR, 1.88; 95% CI, 1.42–2.48; aHR, 2.06; 95% CI, 1.55–2.72; respectively; all P<0.001). For CLIF-SOFA scores ≥6, in-hospital mortality was >10%; this is the cutoff point for the definition of sepsis. Conclusions: Among cirrhosis patients presenting with infections at the ED, CLIF-SOFA scores showed a better predictive performance for mortality than both Sepsis-3 criteria and qSOFA scores, and can be a useful tool of risk stratification in cirrhotic patients requiring timely intervention for infection.
( Seong Hee Kang ),( Moon Young Kim ),( Minjong Lee ),( Baek Gyu Jun ),( Tae Suk Kim ),( Dae Hee Choi ),( Ki Tae Suk ),( Young Don Kim ),( Gab Jin Cheon ),( Soon Koo Baik ),( Dong Joon Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: The effect of non-selective β-blockers (NSBB) on survival in cirrhosis is still disputed. Moreover, most physicians use low-dose NSBB for cirrhosis due to decreased systemic pressures. We investigates whether low-dose NSBB can have beneficial effects in cirrhosis and the NSBB impact on survival in both primary prophylaxis (PP) and secondary prophylaxis (SP). Methods: We conducted study involving 890 consecutive patients with/without NSBB treatment in either PP or SP; 596 patients in PP (NSBB = 371, non-NSBB = 225) and 291 patients in SP (NSBB = 217, non-NSBB = 74). The NSBB group was divided into two sub-groups: low-dose NSBB group (≤ 80 mg) and high-dose NSBB group (> 80 mg). Results: In the PP group, 273 received only NSBB, while 98 received NSBB + endoscopic band ligation (EBL) in NSBB patients; 170 patients were in the low-dose and 201 patients were in the high-dose group. During the median follow-up of 40.0 months (Interquartile range [IQR], 15.0-58.8), NSBB showed similar survival rates to non-NSBB (log-rank, P=0.685). In addition, there was no difference in survival between low-dose NSBB compared to high-dose NSBB (log-rank, P=0.311). In the SP group, 217 received NSBB + EBL among the NSBB patients; 87 patients in the low-dose group and 130 patients in the high-dose group. The probability of survival was higher in patients who received NSBB (P<0.001). Multivariate analysis also revealed that NSBB significantly prolonged survival (adjusted hazard ratio, 0.490; P<0.001). However, overall survival did not significantly differ between low-dose NSBB and high-dose NSBB (P=0.131). Conclusions: In cirrhosis, NSBB therapy was associated with a reduced risk of mortality in SP but not in PP. Moreover, our study showed that there was a similar effect on survival when low-dose NSBB was used in SP.