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Sarin SK, Choudhury A, Lau GK, Zheng MH, Ji D, Abd-Elsalam S, Hwang J, Qi X, Cua IH, Suh JI, Park JG, Putcharoen O, Kaewdech A, Piratvisuth T, Treeprasertsuk S, Park S, Wejnaruemarn S, Payawal DA, Baatarkhuu O, Ahn SH, Yeo CD, Alonzo UR, Chinbayar T, Loho IM, Yokosuka O, Jafri W, Tan S, Soo LI, Tanwandee T, Gani R, Anand L, Esmail ES, Khalaf M, Alam S, Lin CY, Chuang WL, Soin AS, Garg HK, Kalista K, Batsukh B, Purnomo HD, Dara VP, Rathi P, Al Mahtab M, Shukla A, Sharma MK, Omata M. Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study). Hepatol Int 2020; 14:690-700. [PMID: 32623632 PMCID: PMC7334898 DOI: 10.1007/s12072-020-10072-8] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. METHODS Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. RESULTS Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR = 2.1 (1.1-3.7), p = 0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR = 8.1 (1.9-38.8), p = 0.002] predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5 (11.6%)] or acute decompensation [4 (9%)]. Liver related complications increased (p < 0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC 0.94, HR = 19.2 (95 CI 2.3-163.3), p < 0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis patients. CONCLUSIONS SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.
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Affiliation(s)
- Shiv Kumar Sarin
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
| | - Ashok Choudhury
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - George K Lau
- Humanity and Health Clinical Trial Center, Hong Kong SAR, China
| | - Ming-Hua Zheng
- Department of Hepatology, NAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dong Ji
- Humanity and Health Clinical Trial Center, Hong Kong SAR, China
- Fuyang Second People's Hospital, Fuyang, China
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Jaeseok Hwang
- Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ian Homer Cua
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Global City, Philippines
| | - Jeong Ill Suh
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, South Korea
| | - Jun Gi Park
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, South Korea
| | - Opass Putcharoen
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
| | - Apichat Kaewdech
- Gastroenterology and Hepatology Unit, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Teerha Piratvisuth
- Gastroenterology and Hepatology Unit, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
| | - Sooyoung Park
- Kyungpook National University Hospital, Daegu, South Korea
| | - Salisa Wejnaruemarn
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
| | - Diana A Payawal
- Department of Internal Medicine, Fatima University Medical Center, Valenzuela, Philippines
| | - Oidov Baatarkhuu
- Department of Infectious Diseases, School of Medicine, Mongolian National University of Medical Sciences, Ulan Bator, Mongolia
| | - Sang Hoon Ahn
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Dong Yeo
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Uzziel Romar Alonzo
- Department of Internal Medicine, Fatima University Medical Center, Valenzuela, Philippines
| | | | - Imelda M Loho
- Department of Gastroenterology and Hepatology "Dharmais", National Cancer Hospital, Jakarta, Indonesia
| | | | - Wasim Jafri
- Department of Medicine, WGO Training Center, Aga Khan University, Karachi, Pakistan
| | - Soeksiam Tan
- Department of Hepatology, Selayang Hospital, Batu Caves, Malaysia
| | - Lau Ing Soo
- Department of Hepatology, Selayang Hospital, Batu Caves, Malaysia
| | - Tawesak Tanwandee
- Division of Gastroenterology, Department of Medicine, Faculty of Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rino Gani
- Division of Hepatobiliary, Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia
| | | | - Eslam Saber Esmail
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Mai Khalaf
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Shahinul Alam
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Chun-Yu Lin
- Division of Infectious Diseases, School of Medicine, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Division of Infectious Diseases, School of Medicine, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - A S Soin
- Liver Transplant Surgery, Medanta, The Medicity, Gurugram, Haryana, India
| | - Hitendra K Garg
- Hepatologist and Gastroenterologist, Indraprastha Apollo Hospital, New Delhi, India
| | - Kemal Kalista
- Faculty of Medicine, Cipto Mangunkusumo Hospitall, Universitas, Jakarta, Indonesia
| | - Badamnachin Batsukh
- Department of Infectious Diseases, School of Medicine, Mongolian National University of Medical Sciences, Ulan Bator, Mongolia
| | | | | | - Pravin Rathi
- Department of Gastroenterology, T.N. Medical College, B.Y.L. Nair. Ch. Hospital, Mumbai, India
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Akash Shukla
- Department of Gastroenterology, Seth GSMC and KEM Hospital, Mumbai, India
| | - Manoj K Sharma
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
- The University of Tokyo, Tokyo, Japan
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Sarin SK, Choudhury A, Lau GK, Zheng MH, Ji D, Abd-Elsalam S, Hwang J, Qi X, Cua IH, Suh JI, Park JG, Putcharoen O, Kaewdech A, Piratvisuth T, Treeprasertsuk S, Park S, Wejnaruemarn S, Payawal DA, Baatarkhuu O, Ahn SH, Yeo CD, Alonzo UR, Chinbayar T, Loho IM, Yokosuka O, Jafri W, Tan S, Soo LI, Tanwandee T, Gani R, Anand L, Esmail ES, Khalaf M, Alam S, Lin CY, Chuang WL, Soin AS, Garg HK, Kalista K, Batsukh B, Purnomo HD, Dara VP, Rathi P, Al Mahtab M, Shukla A, Sharma MK, Omata M. Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study). Hepatol Int 2020. [PMID: 32623632 DOI: 10.1007/s12072‐020‐10072‐8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. METHODS Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. RESULTS Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR = 2.1 (1.1-3.7), p = 0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR = 8.1 (1.9-38.8), p = 0.002] predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5 (11.6%)] or acute decompensation [4 (9%)]. Liver related complications increased (p < 0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC 0.94, HR = 19.2 (95 CI 2.3-163.3), p < 0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis patients. CONCLUSIONS SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.
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Affiliation(s)
- Shiv Kumar Sarin
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
| | - Ashok Choudhury
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - George K Lau
- Humanity and Health Clinical Trial Center, Hong Kong SAR, China
| | - Ming-Hua Zheng
- Department of Hepatology, NAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dong Ji
- Humanity and Health Clinical Trial Center, Hong Kong SAR, China.,Fuyang Second People's Hospital, Fuyang, China
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Jaeseok Hwang
- Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ian Homer Cua
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Global City, Philippines
| | - Jeong Ill Suh
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, South Korea
| | - Jun Gi Park
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, South Korea
| | - Opass Putcharoen
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
| | - Apichat Kaewdech
- Gastroenterology and Hepatology Unit, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Teerha Piratvisuth
- Gastroenterology and Hepatology Unit, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
| | - Sooyoung Park
- Kyungpook National University Hospital, Daegu, South Korea
| | - Salisa Wejnaruemarn
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
| | - Diana A Payawal
- Department of Internal Medicine, Fatima University Medical Center, Valenzuela, Philippines
| | - Oidov Baatarkhuu
- Department of Infectious Diseases, School of Medicine, Mongolian National University of Medical Sciences, Ulan Bator, Mongolia
| | - Sang Hoon Ahn
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Dong Yeo
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Uzziel Romar Alonzo
- Department of Internal Medicine, Fatima University Medical Center, Valenzuela, Philippines
| | | | - Imelda M Loho
- Department of Gastroenterology and Hepatology "Dharmais", National Cancer Hospital, Jakarta, Indonesia
| | | | - Wasim Jafri
- Department of Medicine, WGO Training Center, Aga Khan University, Karachi, Pakistan
| | - Soeksiam Tan
- Department of Hepatology, Selayang Hospital, Batu Caves, Malaysia
| | - Lau Ing Soo
- Department of Hepatology, Selayang Hospital, Batu Caves, Malaysia
| | - Tawesak Tanwandee
- Division of Gastroenterology, Department of Medicine, Faculty of Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rino Gani
- Division of Hepatobiliary, Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia
| | | | - Eslam Saber Esmail
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Mai Khalaf
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Shahinul Alam
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Chun-Yu Lin
- Division of Infectious Diseases, School of Medicine, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Division of Infectious Diseases, School of Medicine, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - A S Soin
- Liver Transplant Surgery, Medanta, The Medicity, Gurugram, Haryana, India
| | - Hitendra K Garg
- Hepatologist and Gastroenterologist, Indraprastha Apollo Hospital, New Delhi, India
| | - Kemal Kalista
- Faculty of Medicine, Cipto Mangunkusumo Hospitall, Universitas, Jakarta, Indonesia
| | - Badamnachin Batsukh
- Department of Infectious Diseases, School of Medicine, Mongolian National University of Medical Sciences, Ulan Bator, Mongolia
| | | | | | - Pravin Rathi
- Department of Gastroenterology, T.N. Medical College, B.Y.L. Nair. Ch. Hospital, Mumbai, India
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Akash Shukla
- Department of Gastroenterology, Seth GSMC and KEM Hospital, Mumbai, India
| | - Manoj K Sharma
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan.,The University of Tokyo, Tokyo, Japan
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Sarin SK, Choudhury A, Lau GK, Zheng M, Ji D, Abd-elsalam S, Hwang J, Qi X, Cua IH, Suh JI, Park JG, Putcharoen O, Kaewdech A, Piratvisuth T, Treeprasertsuk S, Park S, Wejnaruemarn S, Payawal DA, Baatarkhuu O, Ahn SH, Yeo CD, Alonzo UR, Chinbayar T, Loho IM, Yokosuka O, Jafri W, Tan S, Soo LI, Tanwandee T, Gani R, Anand L, Esmail ES, Khalaf M, Alam S, Lin C, Chuang W, Soin AS, Garg HK, Kalista K, Batsukh B, Purnomo HD, Dara VP, Rathi P, Mahtab MA, Shukla A, Sharma MK, Omata M. Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study).. [DOI: 10.21203/rs.3.rs-36338/v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Background and Aims: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon co morbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. Methods: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. Result: Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR=2.1(1.1-3.7), p=0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR=8.1(1.9-38.8), p=0.002) predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5(11.6%)] or acute decompensation [4(9%)]. Liver related complications increased (p<0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC-0.94, HR=19.2(95CI 2.3-163.3), p<0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis. Conclusions: SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.
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Affiliation(s)
| | | | - George K Lau
- Humanity and Health Clinical Trial Center, Hong Kong SAR, China
| | - Ming-Hua Zheng
- the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dong Ji
- Fuyang Second People’s Hospital, Fuyang, China
| | | | - Jaeseok Hwang
- Keimyung University Dongsan Hospital,Daegu, South Korea
| | - Xiaolong Qi
- The First Hospital of Lanzhou University, Lanzhou, China
| | | | - Jeong Ill Suh
- Dongguk University Gyeongju Hospital,Gyeongju, South Korea
| | - Jun Gi Park
- Dongguk University Gyeongju Hospital, Gyeongju, South Korea
| | | | | | | | | | - Sooyoung Park
- Kyungpook national University hospital, Daegu, South Korea
| | | | | | | | - Sang Hoon Ahn
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Dong Yeo
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | - Rino Gani
- Cipto Mangunkusuamo Hospital, University of Indonesia
| | | | | | | | - Shahinul Alam
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Chun-Yu Lin
- Kaohsiung Medical University Hospital. Taiwan
| | | | - A S Soin
- Medanta The Medicity, Gurugram, Haryana, India
| | | | - Kemal Kalista
- Cipto Mangunkusumo Hospitall, Faculty of Medicine Universitas. Indonesia
| | | | | | | | - Pravin Rathi
- T.N.Medical College; B.Y.L.Nair. Ch.Hospital. Mumbai, India
| | - Mamun Al Mahtab
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Manoj K Sharma
- Institute of Liver and Biliary Sciences, New Delhi, India
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Sarin SK, Choudhury A, Lau G, Zheng MH, Ji D, Abd-Elsalam S, Hwang J, Qi X, Cua IH, Suh JI, Putcharoen O, Kaewdech A, Piratvisuth T, Treeprasertsuk S, Park S, Wejnaruemarn S, Payawal DA, Baatarkhuu O, Ahn SH, Yeo CD, Alonzo UR, Chinbayar T, Loho IM, Yokosuka O, Jafri W, Tan S, Soo LI, Tanwandee T, Gani R, Anand L, Esmail ES, Khalaf M, Alam S, Lin CY, Chuang WL, Soin AS, Garg HK, Kalista K, Batsukh B, Purnomo HD, Dara VP, Rathi P, Mahtab MA, Shukla A, Sharma MK, Omata M, Task Force APASLCOVID, Spectrum Study APASLCOVIDLI. Pre-Existing Liver Disease Is Associated with Poor Outcome in Patients with SARS CoV-2 Infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study). SSRN Journal 2020. [DOI: 10.2139/ssrn.3611970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Loho IM, Hasan I, Lesmana CRA, Dewiasty E, Gani RA. Hepatocellular Carcinoma in a Tertiary Referral Hospital in Indonesia: Lack of Improvement of One-Year Survival Rates between 1998-1999 and 2013-2014. Asian Pac J Cancer Prev 2017; 17:2165-70. [PMID: 27221913 DOI: 10.7314/apjcp.2016.17.4.2165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The survival of hepatocellular carcinoma (HCC) patients is usually low due to late diagnosis. Cipto Mangunkusumo Hospital as the largest tertiary referral hospital in Indonesia, has recently improved its modalities for advanced HCC management, but there has not been any evaluation on any improvement in HCC patient survival. MATERIALS AND METHODS A retrospective analysis on 114 HCC patients in 2013-2014 were conducted and compared with the database for 77 HCC patients in 1998-1999. Clinical characteristics and treatment received were recorded and the survival of both groups was analyzed using the Kaplan-Meier method and compared using the log-rank test. RESULTS The percentage of HBV positive patients had increased after fifteen years from 32.5% to 67.5%. Only two patients (1.8%) in 2013-2014 were diagnosed with HCC during surveillance program. Proportions of Barcelona Clinic Liver Cancer A, B, C, and D in 2013-2014 were 1.8%, 42%, 28.1%, and 28.1%, respectively. There was an increase in the use of potentially curative treatment, such as surgical resection or combination of loco-regional therapies. The one-year survival rate increased from 24.1% in 1998-1999 to 29.4% in 2013-2014, while the median survival decreased from 146 days to 138 days, but the difference was not statistically significant (p=0.913). CONCLUSIONS There was no improvement in the median survival of HCC patients after fifteen years because most continued to present at late stages. There is an urgent need for a nationwide implementation of a hepatitis screening program and HCC surveillance education.
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Affiliation(s)
- Imelda M Loho
- Internal Medicine Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia E-mail :
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