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Yang R, Gui X, Ke H, Yu X, Yan Y, Xiong Y. Accuracy of FIB-4 and APRI scores compared to transient elastography for liver fibrosis in patients with HIV and HBV co-infection. Int J STD AIDS 2023; 34:18-24. [PMID: 36426829 DOI: 10.1177/09564624221116530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to economic shortages and concern about occupational exposure to HIV, liver biopsy and transient elastography (TE) are rarely available in patients with HIV/HBV co-infection in China, where HIV/HBV co-infection is prevalent. METHODS The accuracy of FIB-4 and APRI for predicting liver fibrosis was compared with TE results in a series of 460 HIV/HBV co-infected patients. RESULTS FIB-4 and APRI scores were strongly correlated to liver stiffness measurement scores by TE, and the correlation index was 81.4-96.3. An FIB-4 index >1.5 had a positive predictive value of 95.2% to consider fibrosis with a sensitivity of 85.7%. An APRI index >0.5 had a positive predictive value of 98.2% to consider fibrosis with a sensitivity of 76.0%. A FIB-4 value <1.5 or APRI <0.5 were concordant with TE results to exclude fibrosis in 94.4% and 96.8%, respectively. A FIB-4 value >1.5 or APRI >0.5 were concordant with fibrosis diagnosed by TE in 77.6-89.4% and 70.7-80.9%, respectively. CONCLUSIONS In areas with limited resources, FIB-4 and APRI indexes were accurate, simple and inexpensive methods for assessing liver fibrosis in patients with HIV/HBV co-infection.
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Affiliation(s)
- Rongrong Yang
- Department of Infectious Diseases, 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xien Gui
- Department of Infectious Diseases, 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hengning Ke
- Department of Infectious Diseases, 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xingxia Yu
- Department of Emergency, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yajun Yan
- Department of Infectious Diseases, 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yong Xiong
- Department of Infectious Diseases, 89674Zhongnan Hospital of Wuhan University, Wuhan, China
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Wang AE, Hsieh E, Turner BJ, Terrault N. Integrating Management of Hepatitis C Infection into Primary Care: the Key to Hepatitis C Elimination Efforts. J Gen Intern Med 2022; 37:3435-3443. [PMID: 35484367 PMCID: PMC9551010 DOI: 10.1007/s11606-022-07628-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
Elimination of hepatitis C virus (HCV), a leading cause of liver disease in the USA and globally, has been made possible with the advent of highly efficacious direct acting antivirals (DAAs). DAA regimens offer cure of HCV with 8-12 weeks of a well-tolerated once daily therapy. With increasingly straightforward diagnostic and treatment algorithms, HCV infection can be managed not only by specialists, but also by primary care providers. Engaging primary care providers greatly increases capacity to diagnose and treat chronic HCV and ultimately make HCV elimination a reality. However, barriers remain at each step in the HCV cascade of care from screening to evaluation and treatment. Since primary care is at the forefront of patient contact, it represents the ideal place to concentrate efforts to identify barriers and implement solutions to achieve universal HCV screening and increase curative treatment.
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Affiliation(s)
- Allison E Wang
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA
| | - Eric Hsieh
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA
| | - Barbara J Turner
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA
| | - Norah Terrault
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA.
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, CA, USA.
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Feng JW, Qu Z, Wu BQ, Sun DL, Jiang Y. The preoperative fibrosis score 4 predicts posthepatectomy liver failure in patients with hepatocellular carcinoma. Ann Hepatol 2020; 18:701-707. [PMID: 31167732 DOI: 10.1016/j.aohep.2019.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/27/2019] [Accepted: 04/09/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES The fibrosis score 4 (FIB-4) has been identified as a biochemical surrogate for histological fibrogenesis and fibrosis in cirrhosis. This study investigates the impact of preoperative FIB-4 on postoperative liver failure of patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Data from 205 patients who underwent curative resection for HCC were retrospectively analyzed. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of the FIB-4. Univariate analysis and multivariate analysis were performed to identify risk factors for postoperative liver failure. The clinical outcomes were compared between patients with high FIB-4 and low FIB-4. RESULTS The optimal cutoff value of the FIB-4 was set at 5.92 for postoperative liver failure according to ROC curve. By univariate and multivariate analysis, the number of resected segments, FIB-4, and model for end-stage liver disease score were identified as independent risk factors for postoperative liver failure. Patients with preoperative FIB-4>5.92 had poorer liver function and higher occurrence of postoperative liver failure. CONCLUSIONS Preoperative FIB-4 was associated with postoperative liver failure. Patients with preoperative FIB-4>5.92 carry a high risk of postoperative liver failure.
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Affiliation(s)
- Jia-Wei Feng
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Zhen Qu
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Bao-Qiang Wu
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Dong-Lin Sun
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Yong Jiang
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
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López-Martínez R, Arias-García A, Rodríguez-Algarra F, Castellote-Bellés L, Rando-Segura A, Tarraso G, Vargas-Accarino E, Montserrat-Lloan I, Blanco-Grau A, Caballero-Garralda A, Ferrer-Costa R, Pumarola-Sunye T, Buti-Ferret M, Esteban-Mur R, Quer J, Casis-Saez E, Rodríguez-Frías F. Significant Improvement in Diagnosis of Hepatitis C Virus Infection by a One-Step Strategy in a Central Laboratory: an Optimal Tool for Hepatitis C Elimination? J Clin Microbiol 2019; 58:e01815-19. [PMID: 31694971 PMCID: PMC6935937 DOI: 10.1128/jcm.01815-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023] Open
Abstract
The remarkable effectivity of current antiviral therapies has led to consider the elimination of hepatitis C virus (HCV) infection. However, HCV infection is highly underdiagnosed; therefore, a global strategy for eliminating it requires improving the effectiveness of HCV diagnosis to identify hidden cases. In this study, we assessed the effectiveness of a protocol for HCV diagnosis based on viral load reflex testing of anti-HCV antibody-positive patients (known as one-step diagnosis) by analyzing all diagnostic tests performed by a central laboratory covering an area of 1.5 million inhabitants in Barcelona, Spain, before (83,786 cases) and after (45,935 cases) the implementation of the reflex testing protocol. After its implementation, the percentage of anti-HCV-positive patients with omitted HCV RNA determination remarkably decreased in most settings, particularly in drug treatment centers and primary care settings, where omitted HCV RNA analyses had absolute reductions of 76.4 and 20.2%, respectively. In these two settings, the percentage of HCV RNA-positive patients identified as a result of reflex testing accounted for 55 and 61% of all anti-HCV-positive patients. HCV RNA results were provided in a mean of 2 days. The presence of HCV RNA and age of ≥65 years were significantly associated with advanced fibrosis, assessed using the serological FIB-4 index (odds ratio [OR], 5.92; 95% confidence interval [CI], 3.4 to 10.4). The implementation of viral load reflex testing in a central laboratory is feasible and significantly increases the diagnostic effectiveness of HCV infections, while allowing the identification of underdiagnosed cases.
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Affiliation(s)
- Rosa López-Martínez
- Department of Clinical Biochemistry (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
- Clinical Biochemistry Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Andrea Arias-García
- Department of Clinical Biochemistry (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
- Clinical Biochemistry Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Francisco Rodríguez-Algarra
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Laura Castellote-Bellés
- Department of Clinical Biochemistry (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
- Clinical Biochemistry Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Ariadna Rando-Segura
- PROSICS Barcelona, Microbiology, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Microbiology (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
| | - Guillermo Tarraso
- Department of Clinical Biochemistry (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
- Clinical Biochemistry Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Elena Vargas-Accarino
- Clinical Biochemistry Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Isabel Montserrat-Lloan
- Department of Haematology and Haemotherapy, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Albert Blanco-Grau
- Department of Clinical Biochemistry (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
- Clinical Biochemistry Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Andrea Caballero-Garralda
- Department of Clinical Biochemistry (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
- Clinical Biochemistry Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Roser Ferrer-Costa
- Department of Clinical Biochemistry (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
- Clinical Biochemistry Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Tomas Pumarola-Sunye
- PROSICS Barcelona, Microbiology, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Microbiology (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
- Bioscience and Medicine Schools, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Maria Buti-Ferret
- Department of Internal Medicine and Hepatology, University Hospital Vall d'Hebron, Barcelona, Spain
- Liver Unit-Internal Medicine, Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Carlos III Institute, Madrid, Spain
- Bioscience and Medicine Schools, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Rafael Esteban-Mur
- Department of Internal Medicine and Hepatology, University Hospital Vall d'Hebron, Barcelona, Spain
- Liver Unit-Internal Medicine, Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Carlos III Institute, Madrid, Spain
- Bioscience and Medicine Schools, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Josep Quer
- Department of Internal Medicine and Hepatology, University Hospital Vall d'Hebron, Barcelona, Spain
- Liver Unit-Internal Medicine, Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Carlos III Institute, Madrid, Spain
| | - Ernesto Casis-Saez
- Department of Clinical Biochemistry (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
- Clinical Biochemistry Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Francisco Rodríguez-Frías
- Department of Clinical Biochemistry (Clinical Laboratories), University Hospital Vall d'Hebron, Barcelona, Spain
- Clinical Biochemistry Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Liver Unit-Internal Medicine, Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Carlos III Institute, Madrid, Spain
- Bioscience and Medicine Schools, Autonomous University of Barcelona (UAB), Barcelona, Spain
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Turner BJ, Rochat A, Lill S, Bobadilla R, Hernandez L, Choi A, Guerrero JA. Hepatitis C Virus Screening and Care: Complexity of Implementation in Primary Care Practices Serving Disadvantaged Populations. Ann Intern Med 2019; 171:865-874. [PMID: 31791065 DOI: 10.7326/m18-3573] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) disproportionately affects disadvantaged communities. OBJECTIVE To examine processes and outcomes of Screen, Treat, Or Prevent Hepatocellular Carcinoma (STOP HCC), a multicomponent intervention for HCV screening and care in safety-net primary care practices. DESIGN Mixed-methods retrospective analysis. SETTING 5 federally qualified health centers (FQHCs) and 1 family medicine residency program serving low-income communities in diverse locations with largely Hispanic populations. PATIENTS Persons born in 1945 through 1965 (baby boomers) who had never been tested for HCV and were followed through May 2018. INTERVENTION The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model guided implementation and evaluation. Test costs were covered for uninsured patients. MEASUREMENTS All practices tested patients for anti-HCV antibody (anti-HCV) and HCV RNA. For uninsured patients with chronic HCV in 4 practices, quantitative data also enabled assessment of HCV staging, specialist teleconsultation, direct-acting antiviral (DAA) treatment, and sustained virologic response (SVR). Implementation fidelity and adaptation were assessed qualitatively. RESULTS Anti-HCV screening was done in 13 334 of 27 700 baby boomers (48.1%, varying by practice from 19.8% to 71.3%). Of 695 anti-HCV-positive patients, HCV RNA was tested in 520 (74.8%; 48.9% to 92.9% by practice), and 349 persons (2.6% of those screened) were diagnosed with chronic HCV. In 4 FQHCs, 174 (84.9%) of 205 uninsured patients with chronic HCV had disease staging, 145 (70.7%) had teleconsultation review, 119 (58.0%) were recommended to start DAA therapy, 82 (40.0%) initiated free DAA therapy, 74 (36.1%) completed therapy (27.8% to 60.0% by practice), and 70 (94.6% of DAA completers) achieved SVR. Implementation was promoted by multilevel practice engagement, patient navigation, and anti-HCV screening with reflex HCV RNA testing. LIMITATION No control practices were included, and data were missing for some variables. CONCLUSION Despite a similar framework for STOP HCC implementation, performance varied widely across safety-net practices, which may reflect practice engagement as well as infrastructure or cost challenges beyond practice control. PRIMARY FUNDING SOURCE Cancer Prevention & Research Institute of Texas and Centers for Medicare & Medicaid Services.
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Affiliation(s)
- Barbara J Turner
- Joe R. and Teresa Lozano Long School of Medicine and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas, and Keck Medical Center and Gehr Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California (B.J.T.)
| | - Andrea Rochat
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas (A.R., S.L., R.B., L.H.)
| | - Sarah Lill
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas (A.R., S.L., R.B., L.H.)
| | - Raudel Bobadilla
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas (A.R., S.L., R.B., L.H.)
| | - Ludivina Hernandez
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas (A.R., S.L., R.B., L.H.)
| | - Aro Choi
- Joe R. and Teresa Lozano Long School of Medicine and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas (A.C.)
| | - Juan A Guerrero
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas (J.A.G.)
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Turner BJ, Wang CP, Melhado TV, Bobadilla R, Jain MK, Singal AG. Significant Increase in Risk of Fibrosis or Cirrhosis at Time of HCV Diagnosis for Hispanics With Diabetes and Obesity Compared With Other Ethnic Groups. Clin Gastroenterol Hepatol 2019; 17:1356-1363. [PMID: 30529733 DOI: 10.1016/j.cgh.2018.11.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Advanced liver disease, which includes fibrosis and cirrhosis, has been reported to be more prevalent in Hispanics patients at the time of diagnosis of chronic hepatitis C virus (HCV) infection than non-Hispanic black or non-Hispanic white patients. We performed a propensity score-matched analysis to determine whether metabolic risk factors contribute to this disparity. METHODS We collected data from persons with 748 HCV infection (22% Hispanic, 53% non-Hispanic black, and 26% non-Hispanic white; 23% with advanced liver disease), born from 1945 through 1965, diagnosed at 6 health care systems in Texas. Advanced liver disease was defined as a FIB-4 index score above 3.25. We examined the association between advanced liver disease and race or ethnicity, metabolic risk (based on diabetes mellitus and body mass index [BMI]) and heavy alcohol use in propensity score-matched analyses. RESULTS In propensity-score matched models, among those who were obese (BMI ≥30) with a diagnosis of diabetes, the adjusted odds ratio of advanced liver disease for Hispanics vs non-Hispanic black was 7.89 (95% CI, 3.66-17.01) and adjusted odds ratio = 12.49 (95% CI, 3.24-48.18) for Hispanic vs non-Hispanic white patients (both P < .001). CONCLUSIONS HCV-infected Hispanics with obesity and diabetes have a far higher risk for advanced liver disease than other racial or ethnic groups. These findings highlight the need for HCV treatment and management of probable concurrent fatty liver disease. Even after we accounted for metabolic risk factors, Hispanics were still at higher risk for advanced liver disease, indicating the potential involvement of other factors such as genetic variants.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Chen-Pin Wang
- Department of Epidemiology and Biostatistics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Trisha V Melhado
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Raudel Bobadilla
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mamta K Jain
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
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Lee YC, Hu TH, Hung CH, Lu SN, Chen CH, Wang JH. The change in liver stiffness, controlled attenuation parameter and fibrosis-4 index for chronic hepatitis C patients with direct-acting antivirals. PLoS One 2019; 14:e0214323. [PMID: 30939158 PMCID: PMC6445421 DOI: 10.1371/journal.pone.0214323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/10/2019] [Indexed: 12/17/2022] Open
Abstract
Background and aim Transient elastography and fibrosis-4 index (FIB-4) have been proposed to access hepatic fibrosis and steatosis for patients with chronic liver disease. This study was to determine the changes of liver stiffness (LS), controlled attenuation parameter (CAP) value and FIB-4 and their associated factors for chronic hepatitis C (CHC) patients who underwent direct-acting antivirals (DAAs). Patients and methods Consecutive patients with CHC in advanced fibrosis or compensated cirrhosis undergoing paritaprevir/ritonavir/ombitasvir plus dasabuvir therapy and with LS and CAP before and 12 weeks after treatment were enrolled. The demographics, clinical characteristics and treatment outcomes were reviewed. The changes of LS, FIB-4, CAP and their associated factors were analyzed. Results A total of 213 patients (mean age: 63.7 years) with complete recommended treatment were enrolled. All patients achieved sustained virological response at 12 weeks (SVR12) of follow-up. The mean values of LS, CAP and FIB-4 index before treatment were 18.5kPa, 283dB/m and 5.05 respectively. While there was no significant change in CAP, LS and FIB-4 decreased significantly at the time of SVR12 (p<0.001). Compared with follow-up period, LS and FIB-4 decreased rapidly during DDAs. Multivariate analysis showed that higher baseline LS and FIB-4 were associated with greater reductions at the time of SVR12. Conclusion For CHC patients in advanced fibrosis or compensated cirrhosis, DAAs improved LS and FIB-4 index at SVR12. Higher baseline LS and FIB-4 contributed to greater reductions. However, there was no significant change in CAP value.
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Affiliation(s)
- Yu-Chi Lee
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
| | - Tsung-Hui Hu
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
| | - Chao-Hung Hung
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
- Division of Hepato-Gastroenterology, Department of Medicine, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi City, Taiwan
| | - Sheng-Nan Lu
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
- Division of Hepato-Gastroenterology, Department of Medicine, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi City, Taiwan
| | - Chien-Hung Chen
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
| | - Jing-Houng Wang
- Division of Hepato-Gastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
- * E-mail:
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Kayadibi H. Importance of the selected lower FIB-4 cutoff point. Eur J Gastroenterol Hepatol 2017; 29:862. [PMID: 28181938 DOI: 10.1097/meg.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Huseyin Kayadibi
- Department of Medical Biochemistry, School of Medicine, Hitit University, Corum, Turkey
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