Factors associated with unrecognized cirrhosis in patients with hepatocellular carcinoma

Yi-Te Lee,Mohammad A. Karim,Hye Chung Kum,Sulki Park,Nicole E. Rich,Mazen Noureddin,Amit G. Singal,Ju Dong Yang 대한간학회 2023 Clinical and Molecular Hepatology(대한간학회지) Vol.29 No.2

Background/Aims: Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and can go undiagnosed for years, leading to underuse of HCC surveillance in clinical practice. We characterized the frequency and associated factors of unrecognized cirrhosis in a national sample of patients with HCC from the United States. Methods: HCC patients aged 68 years and older, diagnosed during 2011 to 2015 were included from the SEERMedicare Linked Database. If cirrhosis was diagnosed within 6 months immediately preceding HCC diagnosis or after HCC diagnosis, cases were categorized as unrecognized cirrhosis. Factors associated with unrecognized cirrhosis were identified using logistic regression analyses. Factors associated with overall survival were evaluated using Cox regression analyses. Results: Among 5,098 HCC patients, 74.8% patients had cirrhosis. Among those with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR: 2.12, 95% CI: 1.83–2.46), non-Hispanic Black race (aOR: 1.93, 95% CI: 1.45–2.57), and NAFLD etiology (aOR: 4.46, 95% CI: 3.68–5.41) were associated with having unrecognized cirrhosis. Among NAFLD-related HCC patients, male sex (aOR: 2.32, 95% CI: 1.71–3.14) was associated with unrecognized cirrhosis. Unrecognized cirrhosis was independently associated with worse overall survival (aHR: 1.17, 95% CI: 1.08–1.27) compared to recognized cirrhosis. Conclusions: Unrecognized cirrhosis is common in NAFLD-related HCC, particularly among male and Black patients, highlighting these groups as important intervention targets to improve HCC surveillance uptake and outcomes.

Changes in Characteristics of Patients with Liver Cirrhosis Visiting a Tertiary Hospital over 15 Years: a Retrospective Multi-Center Study in Korea

Jang Won Young,정우진,장병국,황재석,이헌주,Hwang Moon Joo,Kweon Young Oh,Tak Won Young,Park Soo Young,Lee Su Hyun,Lee Chang Hyeong,Kim Byung Seok,Kim Si Hye,Suh Jeong Ill,Park Jun Gi 대한의학회 2020 Journal of Korean medical science Vol.35 No.29

Background: Liver cirrhosis has become a heavy burden not only for patients, but also for our society. However, little is known about the recent changes in clinical outcomes and characteristics of patients with cirrhosis-related complications in Korea. Therefore, we aimed to evaluate changes in characteristics of patients with liver cirrhosis in Daegu-Gyeongbuk province in Korea over the past 15 years. Methods: We retrospectively reviewed the medical records of 15,716 liver cirrhotic patients from 5 university hospitals in Daegu-Gyeongbuk province from 2000 to 2014. The Korean Standard Classification of Diseases-6 code associated with cirrhosis was investigated through medical records and classified according to the year of first visit. Results: A total of 15,716 patients was diagnosed with cirrhosis. A number of patients newly diagnosed with cirrhosis has decreased each year. In 2000, patients were most likely to be diagnosed with hepatitis B virus (HBV) cirrhosis, followed by alcoholic cirrhosis. There was a significant decrease in HBV (P < 0.001), but alcohol, hepatitis C virus (HCV), and non- alcoholic fatty liver disease (NAFLD) showed a significant increase during the study period (alcohol, P = 0.036; HCV, P = 0.001; NAFLD, P = 0.001). At the time of initial diagnosis, the ratio of Child-Turcotte-Pugh (CTP) class A gradually increased from 23.1% to 32.9% (P < 0.001). The most common cause of liver-related hospitalization in 2000 was hepatocellular carcinoma (HCC) (25.5%); in 2014, gastrointestinal bleeding with esophageal and gastric varices (21.4%) was the most common cause. Cases of hospitalization with liver-related complication represented 76.4% of all cases in 2000 but 70.9% in 2014. Incidence rate of HCC has recently increased. In addition, HCC-free survival was significantly lower in CTP class A than in classes B and C. Finally, there was significant difference in HCC occurrence according to causes (P < 0.001). HBV and HCV cirrhosis had lower HCC-free survival than alcoholic and NAFLD cirrhosis. Conclusion: In recent years, the overall number of cirrhosis patients has decreased. This study confirmed the recent trend in decrease of cirrhosis, especially of cirrhosis due to HBV, and the increase of HCV, alcoholic and NAFLD cirrhosis. Targeted screening for at-risk patients will facilitate early detection of liver diseases allowing effective intervention and may have decreased the development of cirrhosis and its complications.

환자표본자료를 이용한 간경변증 환자의 의료이용 특성 및 의료비용 분석

김혜린,박재아,신지영,박승후,이의경 한국임상약학회 2016 한국임상약학회지 Vol.26 No.4

Background: Liver cirrhosis causes substantial socio-economic burden and is one of the major severe liver diseases in Korea. Nonetheless, there is only a few studies that analyzes disease burden of liver cirrhosis in Korea. Such study must be carried out due to its increasing need from the invention of new drugs for chronic hepatitis and demand for cost-effectiveness analyses. Methods: Patient sample data with ensured representativeness was analyzed retrospectively to compare the medical costs and uses for patients with compensated cirrhosis and decompensated cirrhosis. Patient claims data that include K74 and K703 from the year of 2014 were selected. Within the selected data, decompensated cirrhosis patient was identified if complications such as ascites (R18), encephalopathy (B190), hepatic failure (K72), peritonitis (K65), or esophageal varices (I85) were included, and they were compared to compensated cirrhosis patients. Results: 6,565 patients were included in the analysis. The average cost per patient was 6,471,020 (SD 8,848,899) KRW and 2,173,203 (4,220,942) KRW for decompensated cirrhosis and compensated cirrhosis, respectively. For inpatients, the average hospitalized days was 38.0 (56.4) days and 27.2 (57.2) days for decompensated cirrhosis and compensated cirrhosis, respectively. For outpatients, the average number of visits was 8.7 (9.1) days and 5.3 (7.5) days for compensated cirrhosis and decompensated cirrhosis, respectively. Conclusion: Compared to compensated cirrhosis patients, decompensated cirrhosis patients had higher costs, especially for hospitalization, injection, examination, and drugs administrated within medical institutions.

간경변 환자에 발생한 비외상 횡문근융해증의 임상 특성

김민정 ( Min Jeong Kim ),이홍식 ( Hong Sik Lee ),김경진 ( Kyung Jin Kim ),정록선 ( Rok Son Choung ),임형준 ( Hyung Joon Yim ),이상우 ( Sang Woo Lee ),최재현 ( Jai Hyun Choi ),김창덕 ( Chang Duck Kim ),류호상 ( Ho Sang Ryu ),현진해 대한소화기학회 2005 대한소화기학회지 Vol.46 No.3

목적: 횡문근융해증은 다양한 비외상 원인에 의해 발생할 수 있고 급성신부전 등의 합병증이 동반될 수 있는 질환이다. 그러나 간경변 환자들에서 발생한 비외상 횡문근융해증은 몇몇 산별적인 보고가 있을 뿐이고 임상 특성은 잘 알려져 있지 않은 상태이다. 저자들은 알코올 및 비알코올 간경변 환자들에게 병발된 비외상 횡문근융해증의 임상 특성을 알아보았다. 대상 및 방법: 2001년 10월부터 2004년 9월까지 고려대학교 안산병원 소화기내과에 간경변으로 입원한 환자 중 외상 없이 자발적인 횡문근융해증의 소견을 보인 19예를 대상으로 임상 특성, 검사 소견 및 치료 성적을 분석 하였다. 결과: 대상 환자 19예 중 남자 14예, 여자 5예였고, 평균연령은 49.6세(32-74세)였다. 알코올 간경변에 병발한 횡문근융해증군은 알코올(50.0%)이, 비알코올 간경변에 병발한 횡문근융해증군은 분명한 원인이 없는 자발적인 경우(69.2%)가 주된 원인이었다. 알코올 간경변에 병발한 횡문근융해증군은 대체로 비특이 증상을, 비알코올 간경변에 병발한 횡문근융해증군은 전형적인 증상을 호소하는 경우가 많았다. 대상 간경변군에서는 사망한 환자가 없었으나, 비대상 간경변군에서는 8명(57.1%)이 사망하여, 비대상 변화 유무에 따른 사망률의 유의한 차이를 보였다(p=0.04). 핍뇨는 8예(42.1%), 급성신부전은 12예(63.2%)에서 발생하였고, 전체 사망 환자 수는 8예(42.1%)였다. 핍뇨와 급성신부전이 발생하였을 때 사망률이 유의하게 증가하였다. 결론: 간경변 환자에서 비외상 횡문근융해증은 치명적인 결과를 초래할 수 있는 질환으로 특히 비대상 간경변 환자와 경과 중 핍뇨와 급성신부전이 발생한 경우에서 사망률이 높았다. 따라서, 간경변증 환자에서 횡문근 융해증의 발생 가능성을 항상 염두에 두고 의심될 경우 신속히 진단하여 적극적인 치료를 시행해야 한다. Background/Aims: Rhabdomyolysis is a serious and lethal condition that can be induced not only by traumatic causes but also by a variety of nontraumatic causes. However, there are few reports about rhabdomyolysis developed in patients with liver cirrhosis. We carried out this study to elucidate the clinical characteristics and courses of rhabdomyolysis in patients with liver cirrhosis. Methods: We analyzed 19 cases of nontraumatic rhabdomyolysis in patients with liver cirrhosis who had admitted at Korea University Ansan Hospital between October 2001 and September 2004. Results: Alcohol (50%) was the main etiology of rhabdomyolysis in alcoholic liver cirrhosis patients, and the precipitating factors were not apparent (69.2%) in majority of nonalcoholic liver cirrhosis patients with rhabdomyolysis. Nonalcoholic liver cirrhosis patients had complaints of pain referable to the musculoskeletal system, but alcoholic liver cirrhosis patients had no typical complaints. Mortality of rhabdomyolysis in liver cirrhosis patients was high (42.1%), especially in decompensated liver cirrhosis patients (p=0.04). In nonalcoholic liver cirrhosis patients, the development of oliguria (p=0.007) and acute renal failure (p=0.049) in the course of rhabdomyolysis increased the mortality significantly. Conclusions: In cirrhosis patients, rhabdomyolysis showed a poor prognosis, especially in nonalcoholic liver cirrhosis with oliguria, acute renal failure, or decompensated liver cirrhosis. It is believed that a high clinical suspicion for the occurrence of rhabdomyolysis in liver cirrhosis patients can lead to quicker recognition and better patient care. (Korean J Gastroenterol 2005;46:218-225)

HCV, Acute, LT : Risk of Cirrhosis and Hepatocellular Carcinoma in Chronic Hepatitis C; A Single Center Experience

( Hyun Jung Lee ),( Eileen L Yoon ),( Sang Jun Suh ),( Keun Hee Kang ),( Hae Rim Kim ),( Seong Hee Kang ),( Yang Jae Yoo ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Soon 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: The long-term benefits of interferon (IFN) -based therapy on preventing cirrhosis and hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients have not been well investigated in Korea. Our study aimed to assess the incidence of cirrhosis and HCC and to identify the risk factors associated with disease progression in CHC patients during 10 years. Methods: A total of 280 patients who were registered as CHC between 2001 and 2010 were retrospectively reviewed. Results: Among 280 subjects, 222 patients (79.3%) received antiviral treatment. Cirrhosis already existed in 37 patients (13.2%) at baseline. Of the 243 patients who had not cirrhosis initially, 17 (7.0%) developed cirrhosis. The 10-year cumulative incidence of cirrhosis was significantly lower among patients with antiviral therapy (8.2%) than those without antiviral therapy (43.0%) (P<0.001). Among patients with antiviral therapy, sustained virologic responders (0.6%) had significantly lower incidence of cirrhosis than non-responders (16.7%) (P<0.001). Cox proportional hazards regression showed sustained virologic responders was the only significant independent factor for reducing risk of cirrhosis development (hazard ratio=0.086, P=0.029). During the follow-up period, 17 patients (6.1%) developed HCC. All these patients had pre-existing cirrhosis (11 patients) or newly developed cirrhosis (6 patients) at the time of HCC diagnosis. The 10-year cumulative incidence of HCC was higher among patients without antiviral therapy (42.7%) than those with antiviral therapy (6.1%) (P<0.001). But, multivariate analysis showed underlying cirrhosis was the only independent risk factor associated with HCC development (hazard ratio=7.702, P=0.010). Conclusions: A sustained virologic response (SVR) secondary to IFN-based therapy could reduce cirrhosis development CHC patients. But, the strongest predictor for the development of HCC was underlying cirrhosis rather than antiviral therapy or SVR.

Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock

Surat Tongyoo,Kamonlawat Sutthipool,Tanuwong Viarasilpa,Chairat Permpikul 대한중환자의학회 2022 Acute and Critical Care Vol.37 No.1

Background: In septic shock patients with cirrhosis, impaired liver function might decrease lactate elimination and produce a higher lactate level. This study investigated differences in initial lactate, lactate clearance, and lactate utility between cirrhotic and non-cirrhotic septic shock patients.Methods: This is a retrospective cohort study conducted at a referral, university-affiliated medical center. We enrolled adults admitted during 2012–2018 who satisfied the septic shock diagnostic criteria of the Surviving Sepsis Campaign: 2012. Patients previously diagnosed with cirrhosis by an imaging modality were classified into the cirrhosis group. The initial lactate levels and levels 6 hours after resuscitation were measured and used to calculate lactate clearance. We compared initial lactate, lactate at 6 hours, and lactate clearance between the cirrhosis and non-cirrhosis groups. The primary outcome was in-hospital mortality.Results: Overall 777 patients were enrolled, of whom 91 had previously been diagnosed with cirrhosis. Initial lactate and lactate at 6 hours were both significantly higher in cirrhosis patients, but there was no difference between the groups in lactate clearance. A receiver operating characteristic curve analysis for predictors of in-hospital mortality revealed cut-off values for initial lactate, lactate at 6 hours, and lactate clearance of >4 mmol/L, >2 mmol/L, and <10%, respectively, among non-cirrhosis patients. Among patients with cirrhosis, the cut-off values predicting in-hospital mortality were >5 mmol/L, >5 mmol/L, and <20%, respectively. Neither lactate level nor lactate clearance was an independent risk factor for in-hospital mortality among cirrhotic and non-cirrhotic septic shock patients.Conclusions: The initial lactate level and lactate at 6 hours were significantly higher in cirrhosis patients than in non-cirrhosis patients.

B형간염 만연 지역에서 수술적 절제술을 시행한 C형간염 연관 간세포암 환자에서의 간경변 동반비율

신동현 ( Dong Hyun Sinn ),곽금연 ( Geum Youn Gwak ),백용한 ( Yong Han Paik ),최문석 ( Moon Seok Choi ),이준혁 ( Joon Hyeok Lee ),고광철 ( Kwang Cheol Koh ),조재원 ( Jae Won Joh ),백승운 ( Seung Woon Paik ),유병철 ( Byung Chul Y 대한간암학회 2014 대한간암학회지 Vol.14 No.2

Background/Aims: Cirrhosis has generally been considered a prerequisite for hepatitis C virus (HCV)-infected livers to develop hepatocellular carcinoma (HCC), but HCCs that arise in absence of cirrhosis has been reported. We assessed the prevalence and significance of cirrhosis in HCV-related HCC patients who underwent surgical resection. Methods: A total of 78 HCC patients (65 male [83.3%]; mean age, 64.2 ± 8.6 years) were evaluated for the presence of cirrhosis. Cirrhosis was assessed based on histology, aspartate aminotransferase-to-platelet ratio index (APRI) as well as clinical criteria, such as ascites, varices, thrombocytopenia, splenomegaly, and radiographic configuration of cirrhosis. Results: Based on histology, cirrhosis, septal fibrosis, periportal fibrosis and no fibrosis was noticed in 33.3%, 60.3%, 5.1% and 1.3% of patients, respectively. The clinical criteria of cirrhosis were present in 76.9% of patients. APRI > 1.0 was seen in 47.4% of patients. There was no evidence of cirrhosis in 18 patients (23.1%), either by histology or clinically. Cirrhosis by histology was an independent factor for overall survival [hazard ratio: 3.87 (95% CI: 1.24 ? 12.00), P=0.019]. Conclusions: Quite proportion of HCC patients had no evidence of cirrhosis, either by histology or clinically. Careful follow-up for HCC may be necessary even for non-cirrhotic HCVinfected Korean patients. (J Liver Cancer 2014;14:108-114)

Alcohol, NAFLD, Other : The Change of the Complications and Cause of Death of the Alcoholic Liver Cirrhosis

( Hee Yeon Kim ),( Chang Wook Kim ),( Chang Don Lee ),( Jong Young Choi ),( Sae Hwan Lee ),( Moon Young Kim ),( Byoung Kuk Jang ),( Hyun Young Woo ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: There have been limited data on the epidemiology of alcoholic liver cirrhosis. The aim of this study was to investigate the temporal evolution of patterns of alcoholic cirrhosis compared to non-alcoholic cirrhosis over the last decade. Methods: ICD-10 was initially used to identify patients who had hospitalized due to the complication of cirrhosis. Patient information was retrospectively collected from medical record database of five referral hospitals in Korea during 2002 and 2011. The etiology, complications and the cause of death were compared. Results: One thousand seven hundred seventy and 1552 admission episodes were recorded in 2002 and 2011, respectively. Alcoholic cirrhosis accounted for 47.3% and 48.6 % of admission episodes in 2002 and 2011, respectively. A male predominance was noticeable for alcoholic cirrhosis with the prevalence rate of 91% and 88.6% in 2002 and 2011, respectively. Variceal bleeding was the most common decompensation complications requiring hospital admissions in both the 2002 and the 2011 records. Among cirrhotic complications for hospitalization, the proportion of hepatocellular carcinoma had increased in 2011 compared to 2002 (5.8% vs 3.6% for alcoholic cirrhosis, 18.3% vs 8.8% for non-alcoholic cirrhosis). The common causes of deaths for alcoholic cirrhosis were hepatic encephalopathy, variceal bleeding and hepatic failure in order, and hepatorenal syndrome, hepatic failure, and variceal bleeding in or- der in 2002 and 2011, respectively. Conclusions: The decrease in liver cirrhosis deaths attributable to variceal bleeding or hepatic encephalopathy was observed during 2002 and 2011. Improvements in treatment of acute complications could possibly explain this trend.

The cut-off value of transient elastography to the value of hepatic venous pressure gradient in alcoholic cirrhosis

( Se Ri Ryu ),( Jeong-ju Yoo ),( Seong Hee Kang ),( Soung Won Jeong ),( Moon Young Kim ),( Young Kyu Cho ),( Young Chang ),( Sang Gyune Kim ),( Jae Young Jang ),( Young Seok Kim ),( Soon Koo Baik ),( 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.1

Background/Aims: The hepatic venous pressure gradient (HVPG) reflects portal hypertension, but its measurement is invasive. Transient elastography (TE) is a noninvasive method for evaluating liver stiffness (LS). We investigated the correlation between the value of LS, LS to platelet ratio (LPR), LS-spleen diameter-to-platelet ratio score (LSPS) and HVPG according to the etiology of cirrhosis, especially focused on alcoholic cirrhosis. Methods: Between January 2008 and March 2017, 556 patients who underwent HVPG and TE were consecutively enrolled. We evaluated LS, LPR, and LSPS according to the etiology of cirrhosis and analyzed their correlations with HVPG. Results: The LS value was higher in patients with alcoholic cirrhosis than viral cirrhosis based on the HVPG (43.5 vs. 32.0 kPa, P<0.001). There were no significant differences in the LPR or LSPS between alcoholic and viral cirrhosis groups, and the areas under the curves for the LPR and LSPS in subgroups according to HVPG levels were not superior to that for LS. In alcoholic cirrhosis, the LS cutoff value for predicting an HVPG ≥10 mmHg was 32.2 kPa with positive predictive value (PPV) of 94.5% and 36.6 kPa for HVPG ≥12 mmHg with PPV of 91.0%. Conclusions: The LS cutoff value should be determined separately for patients with alcoholic and viral cirrhosis. In alcoholic cirrhosis, the LS cutoff values were 32.2 and 36.6 kPa for predicting an HVPG ≥10 and ≥12 mmHg, respectively. However, there were no significant differences in the LPR or LSPS between alcoholic and viral cirrhosis groups. (Clin Mol Hepatol 2021;27:197-206)

간경변증의 원인적 분류와 형태학적 특성 -간생검 조직을 대상으로-

한은경,박찬일,이상인 대한병리학회 1990 Journal of Pathology and Translational Medicine Vol.24 No.4