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Zhang Z. Diagnosis of liver diseases based on artificial intelligence. Biotechnol Genet Eng Rev 2023:1-9. [PMID: 36966433 DOI: 10.1080/02648725.2023.2193057] [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: 03/27/2023]
Abstract
Due to a series of problems in the diagnosis of liver disease, the mortality rate of liver disease patients is very high. Therefore, it is necessary for doctors and researchers to find a more effective non-invasive diagnostic method to meet clinical needs. We analyzed data from 416 patients with liver disease and 167 patients without liver disease from northeastern Andhra Pradesh, India. On the basis of considering age, gender and other basic data of patients, this paper uses total bilirubin and other clinical data as parameters to build a diagnostic model. In this paper, the accuracy of artificial intelligence method Random Forest (RF) and Support Vector Machine (SVM) model in the diagnosis of liver patients was compared. The results show that the support vector machine model based on Gaussian kernel function is more excellent in diagnostic accuracy, that is, SVM method is more suitable for the diagnosis of liver diseases.
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Affiliation(s)
- Zhe Zhang
- Faculty of Science, Hong Kong Baptist University, Hongkong, China
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2
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Ding R, Zheng J, Huang D, Wang Y, Li X, Zhou X, Yan L, Lu W, Yang Z, Zhang Z. INR-to-platelet ratio (INPR) as a novel noninvasive index for predicting liver fibrosis in chronic hepatitis B. Int J Med Sci 2021; 18:1159-1166. [PMID: 33526976 PMCID: PMC7847629 DOI: 10.7150/ijms.51799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/18/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: We aimed to investigate whether a novel noninvasive index, i.e., the international normalized ratio-to-platelet ratio (INPR), was a variable in determining liver fibrosis stage in patients with chronic hepatitis B (CHB). Methods: A total of 543 treatment-naïve CHB patients were retrospectively enrolled. Liver histology was assessed according to the Metavir scoring scheme. All common demographic and clinical parameters were analyzed. Results: Based on routine clinical parameters (age, sex, HBeAg status, HBV DNA, hematological parameters, coagulation index, and liver biochemical indicators), a novel index, i.e., the INR-to-platelet ratio (INPR), was developed to magnify the unfavorable effects of liver fibrosis on INR and platelets. The AUCs of INPR for predicting significant fibrosis, advanced fibrosis, and cirrhosis were 0.74, 0.76 and 0.86, respectively. Compared with APRI, FIB-4, and GPR, the INPR had comparable predictive efficacy for significant fibrosis and better predictive performance for advanced fibrosis and cirrhosis. Conclusion: INPR could be an accurate, easily calculated and inexpensive index to assess liver fibrosis in patients with CHB. Further studies are needed to verify this indicator and compare it with other noninvasive methods for predicting liver fibrosis in CHB patients.
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Affiliation(s)
- Rongrong Ding
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Jianming Zheng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Dan Huang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Yanbing Wang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xiufen Li
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xinlan Zhou
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Li Yan
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Wei Lu
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Zongguo Yang
- Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
- ✉ Corresponding authors: Zongguo Yang, MD, PhD, Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel.: +8621-37990333 ext.3268; E-mail: ; ORCID: https://orcid.org/0000-0002-6623-4841; Zhanqing Zhang, MD, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel: +8621-37990333 ext.3245. E-mail: ; ORCID: https://orcid.org/0000-0001-7709-9027
| | - Zhanqing Zhang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
- ✉ Corresponding authors: Zongguo Yang, MD, PhD, Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel.: +8621-37990333 ext.3268; E-mail: ; ORCID: https://orcid.org/0000-0002-6623-4841; Zhanqing Zhang, MD, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel: +8621-37990333 ext.3245. E-mail: ; ORCID: https://orcid.org/0000-0001-7709-9027
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Fragkos KC, Picasso Bouroncle MC, Kumar S, Caselton L, Menys A, Bainbridge A, Taylor SA, Torrealdea F, Kumagai T, Di Caro S, Rahman F, Macnaughtan J, Chouhan MD, Mehta S. Serum Scoring and Quantitative Magnetic Resonance Imaging in Intestinal Failure-Associated Liver Disease: A Feasibility Study. Nutrients 2020; 12:E2151. [PMID: 32707726 PMCID: PMC7400956 DOI: 10.3390/nu12072151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 01/20/2023] Open
Abstract
(1) Background: Intestinal failure-associated liver disease (IFALD) in adults is characterized by steatosis with variable progression to fibrosis/cirrhosis. Reference standard liver biopsy is not feasible for all patients, but non-invasive serological and quantitative MRI markers for diagnosis/monitoring have not been previously validated. Here, we examine the potential of serum scores and feasibility of quantitative MRI used in non-IFALD liver diseases for the diagnosis of IFALD steatosis; (2) Methods: Clinical and biochemical parameters were used to calculate serum scores in patients on home parenteral nutrition (HPN) with/without IFALD steatosis. A sub-group underwent multiparameter quantitative MRI measurements of liver fat fraction, iron content, tissue T1, liver blood flow and small bowel motility; (3) Results: Compared to non-IFALD (n = 12), patients with IFALD steatosis (n = 8) demonstrated serum score elevations in Enhanced Liver Fibrosis (p = 0.032), Aspartate transaminase-to-Platelet Ratio Index (p < 0.001), Fibrosis-4 Index (p = 0.010), Forns Index (p = 0.001), Gamma-glutamyl transferase-to-Platelet Ratio Index (p = 0.002) and Fibrosis Index (p = 0.001). Quantitative MRI scanning was feasible in all 10 sub-group patients. Median liver fat fraction was higher in IFALD steatosis patients (10.9% vs 2.1%, p = 0.032); other parameter differences were non-significant; (4) Conclusion: Serum scores used for non-IFALD liver diseases may be useful in IFALD steatosis. Multiparameter MRI is feasible in patients on HPN.
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Affiliation(s)
- Konstantinos C. Fragkos
- Intestinal Failure Service, Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (K.C.F.); (M.C.P.B.); (S.D.C.); (F.R.)
- UCL Division of Medicine, University College London, London WC1E 6BT, UK;
| | - María Claudia Picasso Bouroncle
- Intestinal Failure Service, Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (K.C.F.); (M.C.P.B.); (S.D.C.); (F.R.)
- UCL Division of Medicine, University College London, London WC1E 6BT, UK;
| | - Shankar Kumar
- UCL Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.K.); (L.C.); (A.M.); (S.A.T.)
| | - Lucy Caselton
- UCL Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.K.); (L.C.); (A.M.); (S.A.T.)
| | - Alex Menys
- UCL Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.K.); (L.C.); (A.M.); (S.A.T.)
| | - Alan Bainbridge
- Department of Medical Physics, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK; (A.B.); (F.T.)
| | - Stuart A. Taylor
- UCL Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.K.); (L.C.); (A.M.); (S.A.T.)
| | - Francisco Torrealdea
- Department of Medical Physics, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK; (A.B.); (F.T.)
| | - Tomoko Kumagai
- UCL Division of Medicine, University College London, London WC1E 6BT, UK;
| | - Simona Di Caro
- Intestinal Failure Service, Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (K.C.F.); (M.C.P.B.); (S.D.C.); (F.R.)
- UCL Division of Medicine, University College London, London WC1E 6BT, UK;
| | - Farooq Rahman
- Intestinal Failure Service, Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (K.C.F.); (M.C.P.B.); (S.D.C.); (F.R.)
- UCL Division of Medicine, University College London, London WC1E 6BT, UK;
| | - Jane Macnaughtan
- UCL Institute for Liver and Digestive Health, University College London, London WC1E 6BT, UK;
| | - Manil D. Chouhan
- UCL Centre for Medical Imaging, University College London, London WC1E 6BT, UK; (S.K.); (L.C.); (A.M.); (S.A.T.)
| | - Shameer Mehta
- Intestinal Failure Service, Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (K.C.F.); (M.C.P.B.); (S.D.C.); (F.R.)
- UCL Division of Medicine, University College London, London WC1E 6BT, UK;
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Yuan X, Duan SZ, Cao J, Gao N, Xu J, Zhang L. Noninvasive inflammatory markers for assessing liver fibrosis stage in autoimmune hepatitis patients. Eur J Gastroenterol Hepatol 2019; 31:1467-1474. [PMID: 31107735 PMCID: PMC7333545 DOI: 10.1097/meg.0000000000001437] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the accuracy of noninvasive inflammatory markers in predicting liver fibrosis stage in patients with autoimmune hepatitis (AIH). PATIENTS AND METHODS We enrolled 55 patients with AIH and 60 healthy controls in this study, and divided them into three groups: F0 (control); F1-F3 (noncirrhotic fibrosis); and F4 (cirrhosis). The following markers were analyzed for all participants: lymphocyte-to-neutrophil ratio (LNR); lymphocyte-to-platelet ratio (LPR); lymphocyte-to-monocyte ratio (LMR); immunoglobulin-to-platelet ratio (IGPR); aminotransferase-to-platelet ratio index (APRI); aspartate aminotransferase-to-alanine aminotransferase ratio (AAR); and fibrosis-4 score (FIB-4). The predictive accuracy of these noninvasive markers was assessed using area under the receiver operating characteristic curve. Multivariate ordinal logistic regression models were used to analyze associations between the noninvasive markers and liver fibrosis stage. RESULTS AAR, LPR, LMR, IGPR, APRI, and FIB-4 were linked to liver fibrosis-stage (P < 0.05), with correlation indices of - 0.219, 0.258, - 0.149, 0.647, 0.841, and 0.704, respectively, but not LNR (P = 0.093). area under the receiver operating characteristic curves of LPR, IGPR, AAR, LMR, APRI, and FIB-4 for detecting cirrhosis (F4 vs. F0-F3) were 0.936 (95% confidence interval: 0.870-1.000, P < 0.001), 0.939 (0.875-1.000, P < 0.001), 0.528 (0.319-0.738, P = 0.768), 0.555 (0.409-0.700, P = 0.568), 0.798 (0.694-0.902, P = 0.002), and 0.881 (0.796-0.967, P < 0.001). Our multivariate ordinal regression analysis showed that LPR and IGPR were associated independently with liver fibrosis stage, with a coefficient of 0.385 (95% confidence interval: 0.103-0.667, P = 0.007) and 14.903 (2.091-27.786, P = 0.023), respectively. CONCLUSION LPR and IGPR were associated independently with liver fibrosis stage in treatment-naive AIH, and were superior to APRI and FIB-4 in detecting cirrhosis.
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Affiliation(s)
- Xiaoling Yuan
- Department of Infectious Disease, Ninth People’s Hospital
- Department of Pathology, Princeton Medical Center, Plainsboro
| | - Sheng-Zhong Duan
- Laboratory of Oral Microbiota and Systemic Diseases, School of Stomatology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Junying Cao
- Department of Infectious Disease, Ninth People’s Hospital
| | - Nan Gao
- Department of Biological Sciences, Rutgers University, Newark
| | - Jie Xu
- Department of Infectious Disease, Ninth People’s Hospital
| | - Lanjing Zhang
- Department of Pathology, Princeton Medical Center, Plainsboro
- Department of Biological Sciences, Rutgers University, Newark
- Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Chemical Biology, Rutgers Ernest Mario School of Pharmacy, Piscataway, New Jersey, USA
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Zhou WJ, Yang J, Zhang G, Hu ZQ, Jiang YM, Yu F. Association between red cell distribution width-to-platelet ratio and hepatic fibrosis in nonalcoholic fatty liver disease: A cross-sectional study. Medicine (Baltimore) 2019; 98:e16565. [PMID: 31348282 PMCID: PMC6709090 DOI: 10.1097/md.0000000000016565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We aimed to assess the association between red cell distribution width-to-platelet ratio (RPR) and hepatic fibrosis in nonalcoholic fatty liver disease. METHODS The 388 subjects fulfilling the diagnostic criteria of Nonalcoholic fatty liver disease (NAFLD) were enrolled in this cross-sectional study. Red cell distribution, platelet, and other clinical and laboratory parameters were measured. RESULTS NAFLD patients with advanced fibrosis had significantly higher RPR than those without fibrosis (P < .001). Spearman correlation analysis showed that RPR were significantly correlated with age, sex, creatinine, hemoglobin, white blood cell, and advanced fibrosis (all with P < .05). Multivariate logistic regression analysis showed that RPR was an independent factor predicting advanced fibrosis (fibrosis-4 calculator ≥1.3) in NAFLD patients (OR: 5.718, 95%CI: 3.326-9.830, P < .001). CONCLUSIONS Our findings suggested that RPR were significantly associated with advanced fibrosis in nonalcoholic fatty liver disease patients.
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Affiliation(s)
- Wen-Jie Zhou
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jing Yang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
| | - Ge Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
| | - Zheng-Qiang Hu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
| | - Yong-Mei Jiang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
| | - Fan Yu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Nan Y, Niu X, Wang R, Zhao S, Fu N, Du J, Wang Y, Wang B, Zhang Y. microRNA-1273g-3p is a useful non-invasive test for the prediction of liver fibrosis in patients with chronic hepatitis C. Exp Ther Med 2019; 17:1817-1824. [PMID: 30783454 PMCID: PMC6364236 DOI: 10.3892/etm.2018.7114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 07/07/2017] [Indexed: 12/12/2022] Open
Abstract
Previous studies using microRNA (miRNA or miR) microarrays have demonstrated that miR-1273g-3p is upregulated in patients with hepatitis C virus (HCV)-associated fibrosis. As miRNAs have been suggested to be promising non-invasive biomarkers, the aim of the present study was to assess whether miR-1273g-3p may be useful as a potential indicator of fibrosis progression in patients with HCV. Liver biopsies were performed on 112 patients with chronic hepatitis C (CHC) and liver stiffness measurements (LSM) were performed using FibroTouch. Liver fibrosis was determined based on Meta-analysis of Histological Data in Viral Hepatitis classification, and the aspartate aminotransferase (AST)-to-platelet count (PLT) ratio index (APRI) and Fibrosis-4 score (FIB-4) were calculated. The diagnostic performance of miR-1273g-3p, LSM, APRI and FIB-4 in predicting fibrosis stage were evaluated and compared by receiver operating characteristic (ROC) analysis. It was demonstrated that miR-1273g-3p levels were significantly positively correlated with the liver fibrosis stage (r=0.657, P<0.001). The results of LSM, APRI and FIB-4, the three non-invasive diagnostic methods, had good consistency with liver biopsy results, and their correlation coefficients with fibrosis staging were 0.815, 0.417 and 0.522, respectively. The areas under the ROC curves of miR-1273g-3p for F≥2 and F=4 stage samples were 0.841 and 0.933, respectively, which were lower than LSM (0.890 and 0.937), and higher than FIB-4 (0.791 and 0.766) and APRI (0.719 and 0.760). Spearman analysis demonstrated that serum miR-1273g-3p levels were significantly positively correlated with age, body mass index, alanine aminotransferase, AST and total bilirubin (all P<0.05), and negatively correlated with PLT (P<0.05). However, no significant correlation was observed between miR-1273g-3p levels, baseline HCV RNA loads and genotype. Therefore, the results demonstrated that miR-1273g-3p levels, as a novel non-invasive test, may be a useful and easy method for predicting the stage of liver fibrosis in patients with CHC, and has a better diagnostic performance than FIB-4 and APRI. Further prospective studies are required to validate the efficacy of miR-1273g-3p as a predictor of liver fibrosis.
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Affiliation(s)
- Yuemin Nan
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
- Correspondence to: Professor Yuemin Nan, Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei 050051, P.R. China, E-mail:
| | - Xuemin Niu
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Rongqi Wang
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Suxian Zhao
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Na Fu
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Jinghua Du
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Yang Wang
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Baoyu Wang
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Yuguo Zhang
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
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Lim SG, Aghemo A, Chen PJ, Dan YY, Gane E, Gani R, Gish RG, Guan R, Jia JD, Lim K, Piratvisuth T, Shah S, Shiffman ML, Tacke F, Tan SS, Tanwandee T, Win KM, Yurdaydin C. Management of hepatitis C virus infection in the Asia-Pacific region: an update. Lancet Gastroenterol Hepatol 2016; 2:52-62. [PMID: 28404015 DOI: 10.1016/s2468-1253(16)30080-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 12/12/2022]
Abstract
The Asia-Pacific region has disparate hepatitis C virus (HCV) epidemiology, with prevalence ranging from 0·1% to 4·7%, and a unique genotype distribution. Genotype 1b dominates in east Asia, whereas in south Asia and southeast Asia genotype 3 dominates, and in Indochina (Vietnam, Cambodia, and Laos), genotype 6 is most common. Often, availability of all-oral direct-acting antivirals (DAAs) is delayed because of differing regulatory requirements. Ideally, for genotype 1 infections, sofosbuvir plus ledipasvir, sofosbuvir plus daclatasvir, or ombitasvir, paritaprevir, and ritonavir plus dasabuvir are suitable. Asunaprevir plus daclatasvir is appropriate for compensated genotype 1b HCV if baseline NS5A mutations are absent. For genotype 3 infections, sofosbuvir plus daclatasvir for 24 weeks or sofosbuvir, daclatasvir, and ribavirin for 12 weeks are the optimal oral therapies, particularly for patients with cirrhosis and those who are treatment experienced, whereas sofosbuvir, pegylated interferon, and ribavirin for 12 weeks is an alternative regimen. For genotype 6, sofosbuvir plus pegylated interferon and ribavirin, sofosbuvir plus ledipasvir, or sofosbuvir plus ribavirin for 12 weeks are all suitable. Pegylated interferon plus ribavirin has been replaced by sofosbuvir plus pegylated interferon and ribavirin, and all-oral therapies where available, but cost and affordability remain a major issue because of the absence of universal health coverage. Few patients have been treated because of multiple barriers to accessing care. HCV in the Asia-Pacific region is challenging because of the disparate epidemiology, poor access to all-oral therapy because of availability, cost, or regulatory licensing. Until these problems are addressed, the burden of disease is likely to remain high.
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Affiliation(s)
- Seng Gee Lim
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.
| | - Alessio Aghemo
- UOC Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University School of Medicine, Taipei, Taiwan
| | - Yock Young Dan
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
| | - Edward Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Rino Gani
- Hepatology Division, Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Robert G Gish
- Stanford University Hospitals and Clinics, Palo Alto, CA, USA
| | - Richard Guan
- Department of Gastroenterology, Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Ji Dong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Xicheng, Beijing, China
| | - Kieron Lim
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
| | - Teerha Piratvisuth
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Samir Shah
- Department of Hepatology, Institute of Liver Disease, HPB Surgery and Transplant, Global Hospital, Parel, Mumbai, India
| | | | - Frank Tacke
- Department of Medicine III, University Hospital Aachen, Aachen, Germany
| | - Soek Siam Tan
- Department of Hepatology, Selayang Hospital, Selangor, Malaysia
| | - Tawesak Tanwandee
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok-noi, Bangkok, Thailand
| | | | - Cihan Yurdaydin
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
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King's score as a novel prognostic model for patients with hepatitis B-associated hepatocellular carcinoma. Eur J Gastroenterol Hepatol 2015; 27:1337-46. [PMID: 26275082 DOI: 10.1097/meg.0000000000000452] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES King's score (KS) has been developed to predict the presence of cirrhosis and hepatocellular carcinoma (HCC) in patients with chronic liver diseases. We aimed to investigate the prognostic significance of the KS in hepatitis B-associated HCC. PATIENTS AND METHODS We retrospectively analyzed 319 hepatitis B-associated HCC patients. Preoperative data were collected to calculate the KS (age × aspartate aminotransferase × international normalized ratio/platelet count). The primary outcomes were overall survival (OS) and disease-free survival (DFS), which was estimated using the Kaplan-Meier method. Then, we carried out a multivariate Cox analysis to assess the independent significance of the KS. Additional analyses were carried out after patients were stratified on the basis of cirrhosis status and therapy methods to investigate the significance of KS in different subgroups. RESULTS During a median follow-up period of 44 months, 199 (62.4%) patients died and 144 (45.1%) experienced recurrence. The cut-off value for the KS was determined to be 33.31 with 56.8% sensitivity and 66.7% specificity. Compared with patients with low KS, the high group showed a higher probability of cirrhosis and worse Child-Pugh class (both P<0.05). Multivariate analysis identified older age, tumor size 5 or more, palliative therapy, high Barcelona Clinic Liver Cancer stage, and high KS as significant factors for predicting poor OS and DFS. A combination of the KS and tumor size showed better discrimination ability for survival than Barcelona Clinic Liver Cancer stage. CONCLUSION The KS is an effective index for predicting OS and DFS in hepatitis B-associated HCC. Larger cohorts are needed to validate our finding.
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Pang Q, Zhang JY, Xu XS, Song SD, Qu K, Chen W, Zhou YY, Miao RC, Liu SS, Dong YF, Liu C. Significance of platelet count and platelet-based models for hepatocellular carcinoma recurrence. World J Gastroenterol 2015; 21:5607-5621. [PMID: 25987786 PMCID: PMC4427685 DOI: 10.3748/wjg.v21.i18.5607] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/02/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the effects of platelet count (PLT) and 11 platelet-based indices on postoperative recurrence of hepatocellular carcinoma (HCC).
METHODS: We retrospectively analyzed 172 HCC patients who were treated by partial hepatectomy. Preoperative data, including laboratory biochemical results, were used to calculate the 11 indices included in the analysis. We performed receiver operating characteristic curve analysis to determine the optimal cut-off values for predicting recurrence. Cumulative rates of HCC recurrence were calculated using Kaplan-Meier survival curves and differences were analyzed by log-rank tests. Multivariate analyses were performed to identify independent predictors of recurrence, early recurrence (within one year after surgery), and late recurrence in HCC. To obtain better prognostic models, PLT-based indices were analyzed separately after being expressed as binary and continuous variables. Two platelet-unrelated, validated HCC prognostic models were included in the analyses as reference indices. Additional analyses were performed after patients were stratified based on hepatitis B virus infection status, cirrhosis, and tumor size to investigate the significance of platelets in different subgroups.
RESULTS: In the study cohort, 44.2% (76/172) of patients experienced HCC recurrence, and 50.6% (87/172) died during a median follow-up time of 46 mo. PLT and five of the 11 platelet-related models were significant predisposing factors for recurrence (P < 0.05). Multivariate analysis indicated that, among the clinical parameters, presence of ascites, PLT ≥ 148 × 109/L, alkaline phosphatase ≥ 116 U/L, and tumor size ≥ 5 cm were independently associated with a higher risk of HCC recurrence (P < 0.05). Independent and significant models included the aspartate aminotransferase/PLT index, fibrosis index based on the four factors, fibro-quotient, aspartate aminotransferase/PLT/γ-glutamyl transpeptidase/alpha-fetoprotein index, and the PLT/age/alkaline phosphatase/alpha-fetoprotein/aspartate aminotransferase index. There were different risk factors between early and late recurrences, and PLT and these indices were more inclined to influence late recurrence. PLT was only predictive of recurrence in non-cirrhotic HCC patients, and was not influenced by tumor size, which was a critical confounder in our study.
CONCLUSION: PLT and PLT-based noninvasive models are effective tools for predicting postoperative recurrence, especially late recurrence. Larger cohorts are needed to validate our findings.
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Rao JG, Gao YF, Ye J, Wei YY, Li F, Zou GZ. Value of Forns index for noninvasive diagnosis of liver fibrosis in chronic hepatitis B patients. Shijie Huaren Xiaohua Zazhi 2015; 23:1818-1824. [DOI: 10.11569/wcjd.v23.i11.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the value of Forns index for noninvasive diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB).
METHODS: The severity of liver fibrosis in 361 CHB patients was assessed by liver biopsy, and routine laboratory indicators were examined to calculate the Forns index. The diagnostic value of Forns index in significant fibrosis, advanced fibrosis and cirrhosis was assessed using the area under the receive operating characteristic curve analysis.
RESULTS: With the increase in the severity of liver fibrosis, the mean age and mean levels of γ-glutamyl transpeptidase (GGT), globulin (GLB), aspartate transaminase (AST) and Forns index gradually increased in patients with chronic HBV infection, and the mean levels of albumin (ALB), HBV DNA, cholesterol and platelet (PLT) gradually decreased, which had significant differences between the S1-S4 groups (P < 0.05). The Spearman rank correlation analysis showed that there was a significantly positive correlation between Forns index and liver fibrosis stage (r = 0.451, P < 0.001). The cutoff value of Forns index was 4.873 for significant liver fibrosis, with a sensitivity of 68.7% and a specificity of 70.3%. The cutoff value of Forns index was 5.432 for advanced liver fibrosis, with a sensitivity of 70.2% and a specificity of 71.8%. The cutoff value of Forns index was 6.289 for cirrhosis, with a sensitivity of 76.7% and a specificity of 81.1%.
CONCLUSION: Forns index is a simple and effective noninvasive model to predict the severity of liver fibrosis.
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Pang Q, Zhang JY, Xu XS, Song SD, Chen W, Zhou YY, Miao RC, Qu K, Liu SS, Dong YF, Liu C. The prognostic values of 12 cirrhosis-relative noninvasive models in patients with hepatocellular carcinoma. Scandinavian Journal of Clinical and Laboratory Investigation 2014; 75:73-84. [PMID: 25465804 DOI: 10.3109/00365513.2014.981759] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hepatocellular carcinogenesis is associated with the progression of cirrhosis, and the latter further aggravates tumor development and prognosis. The aim of the study was to investigate the prognostic values of 12 cirrhosis-relative noninvasive models in hepatocellular carcinoma (HCC). METHODS We retrospectively analyzed 363 HCC patients who either underwent partial hepatectomy (PH) or received transcatheter arterial chemoembolization (TCAE). Preoperative data were collected to calculate these indices using the original formulas. Diagnostic accuracy of these models in detection of cirrhosis was evaluated by area under receiver operating characteristic curve (AUC) analysis. Multivariate analyses were performed to assess the independent prognostic significance of the 12 indicators. RESULTS Aspartate aminotransferase-platelet ratio index (APRI) and Goteborg University Cirrhosis Index (GUCI) were found to be significant in discriminating cirrhotic patients from non-cirrhotic individuals. When the indices were expressed as continuous variables, multivariate analyses indicated that APRI and GUCI were independent indices to predict overall survival in patients underwent PH, with a hazard ratio (HR) value 1.04 (p = 0.005) and 1.07 (p = 0.001), respectively. In the cohort of TACE, APRI and GUCI were independently associated with survival as well. CONCLUSION Of the 12 indices, APRI and GUCI were relatively accurate predictors of cirrhosis status as well as outcome of HCC. As only a limited study population was enrolled in the current study, larger cohorts are needed to validate our results.
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Affiliation(s)
- Qing Pang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an, Shaanxi Province , China
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Sertoglu E, Kayadibi H, Uyanik M. Single parameter or index to predict liver injury? Eur J Gastroenterol Hepatol 2014; 26:1060. [PMID: 25072385 DOI: 10.1097/meg.0000000000000148] [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)
- Erdim Sertoglu
- aBiochemistry Laboratory, Ankara Mevki Military Hospital, Anittepe Dispensary bDepartment of Medical Biochemistry, Gulhane School of Medicine, Ankara cBiochemistry Laboratory, Adana Military Hospital, Adana, Turkey
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