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Kalkan Ç, Yılmaz Y, Erdoğan BD, Savaş B, Yurdcu E, Çalışkan A, Keskin O, Gencdal G, Zeybel M, Törüner M, Bozdayi AM, Idilman R, Yurdaydin C. Non-invasive fibrosis markers for assessment of liver fibrosis in chronic hepatitis delta. J Viral Hepat 2023; 30:406-416. [PMID: 36651603 DOI: 10.1111/jvh.13806] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
Assessment of liver fibrosis by non-invasive means is clinically important. Studies in chronic hepatitis delta (CHD) are scarce. We evaluated the performance of eight serum fibrosis markers [fibrosis-4 score (FIB-4), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), age-platelet index (API), AST-to platelet-ratio-index (APRI), Goteborg University Cirrhosis Index (GUCI), Lok index, cirrhosis discriminant score (CDS) and Hui score] in CHD and chronic hepatitis B (CHB). Liver stiffness was assessed by transient elastography (TE) in CHD. The ability of fibrosis markers to detect significant fibrosis and cirrhosis were evaluated in 202 CHB and 108 CHD patients using published and new cut-offs through receiver operating characteristics (ROC) analysis. The latter was also applied to obtain cut-offs for TE. APRI, Fib-4, API and Hui score were assessed for significant fibrosis, and APRI, GUCI, Lok index, CDS and AAR for cirrhosis determination. Fibrosis markers displayed weak performance in CHB for significant fibrosis with area under ROC (AUROC) curves between 0.62 and 0.71. They did slightly better for CHD. TE displayed an AUROC of 0.92 and performed better than serum fibrosis markers (p < 0.05 for fibrosis markers). For cirrhosis determination, CDS and Lok Index displayed an AUROC of 088 and 0.89 in CHB and GUCI, Lok index and APRI displayed AUROCs around 0.90 in CHD. TE displayed the best AUROC (0.95). Hence TE is superior to serum fibrosis markers for diagnosing significant liver fibrosis and cirrhosis. GUCI, Lok index and APRI displayed a reasonable performance in CHD, which needs further confirmation.
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Affiliation(s)
- Çağdaş Kalkan
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Yusufcan Yılmaz
- Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey
| | | | - Berna Savaş
- Department of Pathology, Ankara University Medical School, Ankara, Turkey
| | - Esra Yurdcu
- Hepatology Institute, Ankara University, Ankara, Turkey
| | - Aysun Çalışkan
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Onur Keskin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Genco Gencdal
- Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Müjdat Zeybel
- Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust & University of Nottingham, Nottingham, UK
| | - Murat Törüner
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | | | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey.,Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey
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Karakaya F, Özer S, Kalkan Ç, Tüzün EA, Çalışkan A, Keskin O, Kabaçam G, Karatayli S, Karatayli E, Bozdayi AM, Idilman R, Yurdaydin C. Discontinuation of lamivudine treatment in HBeAg-negative chronic hepatitis B: a pilot study with long-term follow-up. Antivir Ther 2017; 22:559-570. [PMID: 28240596 DOI: 10.3851/imp3144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Finite treatment of hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) with nucleoside/nucleotide analogues (NAs) is important in resource-limited countries. Outcome of treatment discontinuation in patients on long-term lamivudine (LVD) was assessed in a single centre observational pilot study in the current study. METHODS Non-cirrhotic patients on LVD for at least 5 years with undetectable HBV DNA on at least two consecutive assessments were offered to stop treatment. Biochemical, serological and virological measures were determined at 3-6 month intervals after treatment discontinuation. Serum quantitative hepatitis B surface antigen (HBsAg) was determined at treatment discontinuation and 5-6 years thereafter. NA treatment was re-instituted in patients with confirmed viral rebound defined as HBV DNA >20,000 IU/ml. Relapser patients were no longer followed but were re-assessed 6 years after treatment cessation. RESULTS LVD was discontinued in 23 patients. 8 patients relapsed within 1 year and NA treatment was restarted; 15 patients (65%) were non-relapsers. Thirteen of them were followed for at least 5 years. Two patients had undetectable HBV DNA throughout the follow-up period. In the rest, HBV DNA fluctuated at low levels. Two patients cleared HBsAg 24 and 36 months after stopping treatment. Quantitative HBsAg levels 5-7 years after treatment discontinuation were lower in non-relapser compared to relapser patients (1.21 IU/ml ±0.98 versus 2.71 ±0.76; P=0.002). Of 8 relapser patients 1 patient had HBsAg levels less than 100 IU/ml compared to 11 out of 13 non-relapser patients (P=0.0022). CONCLUSIONS These data suggest that cessation of NA treatment is a viable option after a reasonable treatment duration in patients with HBeAg-negative CHB and that HBsAg clearance may become an achievable target in these patients.
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Affiliation(s)
- Fatih Karakaya
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - Sevil Özer
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - Çağdaş Kalkan
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - E Ali Tüzün
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - Aysun Çalışkan
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - Onur Keskin
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - Gökhan Kabaçam
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | | | | | | | - Ramazan Idilman
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey.,Hepatology Institute, University of Ankara, Ankara, Turkey
| | - Cihan Yurdaydin
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey.,Hepatology Institute, University of Ankara, Ankara, Turkey
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Ünal E, Çalışkan A, Songur M, Türkcan B, Kubat E, Sarıtaş A. PP-161 SUBCLAVIAN STEAL SYNDROME CAUSING ANGINA IN A CABG PATIENT. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Şimşek E, Çalışkan A, Tutün U, Kubat E, Soran B, İşcan Z, Boyacı A, Birincioglu L. OP-180 TAPSE SCORING AND PROGNOSIS IN TRICUSPID VALVE REPLACEMENT. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70181-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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