Prevalence Of Liver Cirrhosis Research Articles

Abstract 1018: Characteristics and outcomes of patients with cystic fibrosis and pancreatic cancer: A population-based comparative analysis

Abstract Introduction: Advancements in diagnosis and treatment of cystic fibrosis (CF) has allowed improvement in overall survival which also in part explains the increasing incidence of malignancies among these patients, particularly, gastrointestinal cancers. Existing data related to the characteristics and outcomes of patients with CF and pancreatic cancer (PC) are limited to small case series. We sought to investigate the same using a large population-based database. Methods: We used TriNetX, a national database comprising approximately 74 million patients across 54 healthcare organizations in the United States. We retrospectively identified patients with CF who also had a diagnosis of PC (using ICD-10 codes). We then performed an age, sex and race-matched analysis to compare patients with CF+PC to patients with CF alone. To study the impact of CF diagnosis on PC-related outcomes, we performed a propensity matched analysis between cohorts of patients with CF+PC and patients with PC alone. Kaplan Meier estimates were used for survival analysis. A p-value of <0.05 was considered statistically significant. Results: We identified a total of 41,655 patients with CF, out of which 198 patients had a diagnosis of PC (0.48 %). A total of 180 patients were included in the propensity matched comparative analysis. Patients with CF and PC had a significantly higher prevalence of type 2 diabetes mellitus (42.8% vs 5.6%, p<0.001), hypertension (58.3% vs 5.6%, p<0.001) and hyperlipidemia (40% vs 5.6%, p<0.001) than patients with CF with no PC. No differences in the prevalence of liver cirrhosis were noted (8.9% vs 5.6%, p=0.22). Patients with PC and CF had a significantly lower prevalence of bronchiectasis (15.8% vs 28.7%, p=0.004). In a propensity matched analysis between patients with CF and PC and PC alone, CF did not impact survival among patients with resectable [HR=1.042 (0.35-3.11), p=0.79] or unresectable/advanced PC [HR=1.17 (0.62-2.22), p=0.09]. Conclusion: To our knowledge, this is the largest analysis investigating the characteristics and outcomes of patients with CF and PC. The prevalence of PC in patients with CF is higher than reported prevalence among general population. We found a significantly higher prevalence of diabetes, hypertension and hyperlipidemia and a significantly lower prevalence of bronchiectasis among patients with CF and PC. CF does not appear to impact overall survival among patients with resectable or unresectable or advanced PC. Our findings may inform risk prediction models for PC among patients with CF. Citation Format: Srija Manchkanti, Shiva J. Gaddam, Udhayvir S. Grewal. Characteristics and outcomes of patients with cystic fibrosis and pancreatic cancer: A population-based comparative analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1018.

Hepatitis B and C Viruses: Prevalence and co-factors among patients with liver cirrhosis

Liver cirrhosis is the final pathway of multiple chronic liver diseases and is a pathological entity defined as diffuse hepatic fibrosis and regenerative nodule formation. The objective of this study was to investigate the prevalence and co-factors of hepatitis B and C viruses among patients with liver cirrhosis. A total of 79 patients were registered from 2018 to 2022. The prevalence of liver cirrhosis in 2018, 2019, and 2020. 2021 and 2022 were 21.7%, 13.0%, 19.1%, 6.1% and 8.7%, respectively. The incidence of cirrhosis was significantly (P = 0.01) greater in rural areas than in urban areas. In addition, according to age, the incidence of cirrhosis was significantly (P = 0.001) greater in those >52 years old than in those 18-40 and 41-52 years old. Moreover, the incidence of cirrhosis was greater in females than in males, but the difference was not significant. Without that, the causes of cirrhosis for HBV, HCV and Non-B and Non-C patients were 13% and 40%, 15.7%, respectively. The results showed that causes of cirrhosis were significantly associated with HCV incidence, and the prevalence of underweight, normal, overweight, and obese individuals was 13%, 15.7%, 26.1% and 18.9%, respectively. Prevalence according to BMI categories did significantly differ among the categories. Furthermore, the incidences of diabetes mellitus for patients with HBV and HCV and for non-B and non-C individuals were 21.7%, 47% and 31.3%, respectively, but the incidence of diabetes mellitus was significantly associated with the incidence of HCV. In addition, the incidences of encephalopathy for HBV, HCV and non-B and non-C patients were 20.9%, 47.8%, and 31.3%, respectively, and for Ascites, they were 24.3%, 44.3%, and 31.4%, respectively. Finally, the incidence of cirrhosis was significantly (P = 0.001) greater in smoking patients than in nonsmokers.

Characteristics of liver cirrhosis patients: A literature review

Introduction: Based on data from the World Health Organization (WHO), there is an increase in the number of deaths due to liver cirrhosis from year to year, with the death rate reaching 905,418 in 2000 and soaring to 1,161,914 in 2015. According to a 2016 government public hospital report in Indonesia, The prevalence of liver cirrhosis is estimated at 3.5% of total internal medicine patients, or an average of around 47.4% of all patients treated for cirrhosis. This research using the literature review method aims to describe the characteristics of liver cirrhosis sufferers (gender, etiology of liver cirrhosis, age, child-turcotte-pugh) in Indonesia. Methods: The type of study in this research is a literature review using secondary data in the form of literature that meets the inclusion and exclusion criteria. The inclusion criteria for this research are literature that has been published in the last 10 years, can be accessed in its entirety, literature set in Indonesia, and meets the search keywords. The exclusion criteria in this study were literature with the type of study in the form of a review. Results: A literature search conducted on Google Scholar and Pubmed found eight pieces of literature that met the inclusion and exclusion criteria. Eight pieces of literature are descriptive observational studies. The total samples obtained from the eight pieces of literature were 1010 samples. The time span of the literature obtained was 2015-2023. Before data extraction, each piece of literature was assessed for risk of bias using JBI (Joanna Briggs Institute) critical appraisal. Conclusions: Based on literature review research, cirrhosis sufferers are more likely to suffer from men (685 samples), the elderly age group (>45 years) with hepatitis B etiology (477 samples), and Child-Turcotte-Pugh score category C (397 samples).

Liver Cirrhosis among Young Adults Admitted to the Department of Gastroenterology in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Cirrhosis in young adults is an important health problem worldwide and is a common disease. Patients usually present late in a decompensated state with varied complications. However, national data on the exact burden of the disease is lacking. The aim of this study was to find out the prevalence of liver cirrhosis among young adults admitted to the Department of Gastroenterology in a tertiary care centre. A descriptive cross-sectional study was done among patients admitted to the Department of Gastroenterology in a tertiary care centre between 25 November 2021 to 30 November 2022 after receiving ethical approval from the Institutional Review Committee [Reference number: 227(6-11)E2-078/079]. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Among 989 patients, liver cirrhosis in young adults was seen in 200 (20.22%) (18.12-22.32, 95% Confidence Interval). Chronic alcohol use was the primary cause of cirrhosis seen in 164 (82%) cases. The most typical presenting symptom was abdominal distension seen in 187 (93.50%) patients. The most frequent complication was ascites seen in 184 (92%) patients. The most frequent endoscopic finding was gastro-oesophagal varices seen in 180 (90%) patients. There were 145 (72.50%) men and 55 (27.50%) women. The prevalence of liver cirrhosis in young adults was found to be lower than the other studies done in similar settings. ascites; liver cirrhosis; prevalence.

Positioning of Minimally Invasive Liver Surgery for Hepatocellular Carcinoma: From Laparoscopic to Robot-Assisted Liver Resection.

Laparoscopic liver resection (LLR) is widely accepted in the surgical treatment of hepatocellular carcinoma (HCC) through international consensus conferences and the development of difficulty classifications. LLR has been reported to result in earlier postoperative recovery and fewer postoperative complications than open liver resection (OLR) for HCC. However, the prevalence of liver cirrhosis, obesity, the elderly, HCC recurrence (repeat liver resection), and major resection must be considered for LLR for HCC. Some systematic reviews, meta-analysis studies, and large cohort studies indicated that LLR is technically feasible for selected patients with HCC with these factors that led to less intraoperative blood loss, fewer transfusions and postoperative complication incidences, and shorter hospital stays than OLR. Furthermore, some reported LLR prevents postoperative loss of independence. No difference was reported in long-term outcomes among patients with HCC who underwent LLR and OLR; however, some recent reports indicated better long-term outcomes with LLR. In recent years, robot-assisted liver resection (RALR) has gradually become popular, and its short- and long-term results for HCC are not different from those of LLR. Additionally, RALR is expected to become the mainstay of minimally invasive surgery in the future.

EARLY PREDICTION OF ESOPHAGEAL VARICES ON THE BASIS OF ASPARTATE AMINO-TRANSFERASE (AST) TO PLATELET RATIO INDEX (APRI) AND TRANSIENT ELASTOGRAPHY IN PATIENTS OF CIRRHOSIS OF LIVER

Objectives: To study the etiological prole in liver cirrhosis patients & to predict development of esophageal varices at the earliest with the help of Aspartate Amino-Transferase (AST) to Platelet ratio index (APRI) and Transient Elastography in these patients. The study wasMethods: conducted on 100 patients with chronic liver disease from June 2019 to June 2021. Informed consent was taken from the patients and detailed history, physical examination, laboratory investigations were carried out & UGI endoscopies were performed. APRI scores & Transient Elastography (broscan) liver stiffness measurement (LSM) values were then correlated with 'presence or absence' of esophageal varices (EVs) and with the 'grading' of varices. Among the 100 patients with liver cirrhosis, the overall prevalence of liver cirrhosis was higher in malesResults: (67.0%) than females (33.0%). The main cause of liver cirrhosis was alcoholic liver disease (39.0%) followed by chronic hepatitis B infection (15.0%). Different APRI cut-offs of 1.9, 1.4, 0.9 were taken & correlated with 'presence or absence' of EVs & with the 'grading' of EVs, but none shows satisfactory negative predictive value (NPV), proving that there is no satisfactory cut-off value of APRI to be used as a predictor of esophageal varices. However, as the APRI score is increasing, the grading of varices found on UGI endoscopy is increasing (r = 0.605, p<0.001). LSM cut-off values of 24KPa, 19KPa & 14KPa were taken & we observed NPV of 75.0% for predicting esophageal varices at LSM cutoff of 14 KPa. Also, as the LSM score is increasing, the grading of varices found on UGI endoscopy is increasing (r = 0.842, p<0.001). APRIConclusion: scores correlate poorly with the 'presence or absence' of esophageal varices but it correlate signicantly with the 'grading' of varices. Transient elastogram liver stiffness values correlate signicantly with the 'presence or absence' of esophageal varices & also with the 'grading' of varices. Liver stiffness value of ≥14.0 KPa can be used as a guide for early prediction of esophageal varices & endoscopy should be done in these patients to prevent fatal GI bleed from esophageal varices by medical management to decrease portal pressure or by early endotherapy in the form of endoscopic variceal ligation (EVL) or sclerotherapy.

Implementation of decompensated cirrhosis discharge bundle: a university hospital experience

Decompensated liver cirrhosis is a frequent reason for admission to acute medical and gastroenterology units. Over the past 2 decades, a significant rise in the prevalence of liver cirrhosis in the UK has been noted, with the major culprits being alcohol-related liver diseases, hepatitis B and C,

Risk factors for relapse of autoimmune hepatitis in Japan: A nationwide survey.

Some autoimmune hepatitis (AIH) patients experience relapse during their clinical course, and some risk factors for relapse have been identified previously using a relatively small sample size. The aim of the present study was to identify the risk factors for relapse in recently diagnosed AIH patients using a nationwide survey in Japan. The nationwide survey performed in Japan in 2018 of AIH patients diagnosed between 2014 and 2017 was re-evaluated. A total of 614 patients who received corticosteroids were enrolled in the present study. Associations between relapse and patients' characteristics at diagnosis were evaluated using logistic regression analysis. Relapse was identified in 143 (23.3%) patients after remission. At the time of diagnosis of the disease, there were significant differences in the γ-glutamyl transpeptidase (γ-GTP) level, prevalence of liver cirrhosis, and degree of liver fibrosis. Multivariable logistic regression analysis showed that γ-GTP elevation and liver cirrhosis were significantly associated with relapse. The γ-GTP level at diagnosis could help identify AIH patients at higher risk of relapse.

Worse Outcomes Associated With Liver Transplants: An Increasing Trend.

Background and aimSince individuals in the early stages of liver cirrhosis are typically asymptomatic, the prevalence of liver cirrhosis may be underestimated. Liver cirrhosis has a significant morbidity and mortality rate, with 1.03 million deaths worldwide each year. For end-stage liver disease, liver transplantation is a potential therapeutic option. The goal of our research was to examine the current trend in liver transplants using data from a national database.MethodsUsing the International Classification of Diseases (ICD)-9 codes, we identified individuals who had a liver transplant during the index hospital admission in the Nationwide Inpatient Sample from 2007 to 2011. This national sample of patients is from the United States. We looked at the yearly trend in liver transplants and related outcomes, such as duration of hospitalization (DOH), hospital expenses, and mortality in the hospital. In order to find determinants of mortality, we used a multivariate analysis.ResultsThere were 25,331 patients hospitalized (weighted for national estimate). Between 2007 and 2011, the number of transplants grew by 1.2%. The majority of transplant recipients were Caucasian (57%), with an average age of 54 years, had a private healthcare plan (53%), and had average earnings in the upper quartile by zip code (26%). Patients with a higher Charlson Comorbidity Index (79% had a score of four) were more likely to be admitted to a southern hospital (33%), an academic hospital (>99%), and a large capacity hospital (90%). Seventy percent of liver transplant recipients received cadaver donors. Hepatitis C was the most prevalent reason for transplant (30%), followed by hepatocellular carcinoma (HCC) (29%) and alcoholic liver disease (25%). In 2011, compared to 2007, there was an upward rise in fatality (from 3.8% to 5.1%), average hospital expenditures (from $335,504 to $498,369), and DOH (from 17.4 to 22.7 days). The cost of hospitalization was two billion dollars per year. The independent variables related to an increased mortality on multivariate analysis were African American race (OR: 2.0, 95%, CI: 1.2-3.2; p=0.005) and large capacity hospitals (OR: 2.5, 95% CI: 1.6-4.1; p=0.0002). Predictors linked to lower mortality included private healthcare coverage (vs. Medicare: OR: 0.7, 95%, CI: 0.51-0.97; p=0.03), academic hospital (OR: 0.6, 95% CI: 0.4-0.8; p=0.005), cadaver donor (OR: 0.6, 95% CI: 0.5-0.8; p=0.002), HCC (OR: 0.6, 95% CI: 0.4-0.9; p=0.01), and non-alcoholic steatohepatitis (NASH) cirrhosis (OR: 0.4, 95% CI: 0.2-0.9; p=0.02).ConclusionOur study found an increasing trend in worse outcomes (increased mortality, average hospital costs, and average DOH) after a liver transplant. Patients of the African American race and large capacity hospitals were associated with a higher risk of death, whereas private healthcare plans, academic hospitals, cadaver donors, HCC, and NASH cirrhosis were associated with a lower risk.

Prevalence of sero-markers and non-invasive assessment of liver cirrhosis in patients with Hepatitis B virus infection in Freetown, Sierra Leone: a cross-sectional study

BackgroundHepatitis B virus (HBV) is a major global health problem. Although sub-Saharan Africa has a high proportion of the global burden of HBV, the epidemiology and clinical features of HBV in this region are poorly characterized, and access to diagnostic and treatment services remain limited.MethodsWe conducted a retrospective study of HBV-infected children and adults of all age groups who were evaluated at public and private health facilities in Freetown, Sierra Leone between January 2017 and January 2019. We assessed their clinical presentation, HBV sero-markers, stages of liver disease, prevalence of cirrhosis by non-invasive tools, and the proportion of treatment eligible patients using the criteria recommended by the World Health Organization’s 2015 treatment guidelines for HBV. Logistic regression was used to identify predictors of liver cirrhosis.Results163 HBV patients included in the study, with mean age 32.6 years and 65.0% (106) being males. Most (84.0%) were asymptomatic at presentation. The majority (69.9%) were classified as having HBeAg-negative chronic infection (or inactive HBsAg carrier phase), 24.5% were in the HBeAg-negative immune active phase, 3.1% had HBeAg positive hepatitis, and 2.5% were HBsAg negative. The median Aspartate aminotransferase to Platelet Ratio (APRI) and Fibrosis-4 (FIB-4) scores were 0.37 and 0.80, respectively. The prevalence of cirrhosis was 7.6% and 6.2%, estimated by the APRI and FIB-4 scores, respectively. About 20.0% of patients were eligible for treatment with antiviral agents. Based on APRI scores, the presence of any symptom [adjusted odds ratio (aOR) 20.0, 95% confidence interval (CI) (4.1–85.9); p < 0.001], elevated direct bilirubin [aOR 12.1, 95% CI (1.9–63.0); p = 0.003], and elevated total bilirubin [aOR 16.1, 95% CI (3.2–80.8); p = 0.001] were independent predictors of cirrhosis.ConclusionAlthough most patients with HBV infection were asymptomatic, the prevalence of liver cirrhosis and proportion of patients requiring antiviral treatment were substantial. This small study from a hyperendemic setting in Sierra Leone suggests that routine population-based screening may increase early detection and linkage of HBV patients to care before development of complications. Larger studies are needed to confirm our findings.

Plasma pentosidine levels are associated with prevalent fractures in patients with chronic liver disease.

Osteoporotic fractures negatively impact health-related quality of life and prognosis. Advanced glycation end products (AGEs) impair bone quality and reduce bone strength. The aim of this study was to determine the relationship between plasma levels of pentosidine, a surrogate marker for AGEs, and prevalent fractures in patients with chronic liver disease (CLD). This cross-sectional study included 324 patients with CLD. Vertebral fractures were evaluated using lateral thoracolumbar spine radiographs. Information on prevalent fractures was obtained through a medical interview, medical records, and/or radiography. The patients were classified into low (L), intermediate (I), and high (H) pentosidine (Pen) groups based on baseline plasma pentosidine levels. Of the 324 patients, 105 (32.4%) had prevalent fractures. The prevalence of liver cirrhosis (LC) and prevalent fractures significantly increased stepwise with elevated pentosidine levels. The H-Pen group had the highest prevalence of LC (88.6%, p < 0.001) and prevalent fractures (44.3%, p = 0.007), whereas the L-Pen group had the lowest prevalence of LC (32.1%, p < 0.001) and prevalent fractures (21.0%, p = 0.007). Multiple logistic regression analysis identified pentosidine as a significant independent factor related to prevalent fractures (odds ratio = 1.069, p < 0.001). Pentosidine levels increased stepwise and correlated with liver disease severity. They were markedly high in patients with decompensated LC. In multiple regression analysis, liver functional reserve factors (total bilirubin, albumin, and prothrombin time-international normalized ratio) significantly and independently correlated with pentosidine levels. Plasma pentosidine was significantly associated with prevalent fractures and liver functional reserve in patients with CLD. Pentosidine may be useful in predicting fracture risk and should be closely followed in CLD patients with advanced disease.

Hodnocení operačního rizika u pacientů s jaterní cirhózou

The prevalence of liver cirrhosis in population is increasing, as well as its prevalence among patients admitted to hospital for elective surgery. These patients are at risk of high postoperative morbidity and mortality. Perioperative risk assessment of patients with liver cirrhosis is a complex procedure. It consists of evaluation of general condition of the patient, including comorbidities and nutritional status, evaluation of the grade of liver disease, and urgency of the surgical procedure. There are no specific guidelines. Proper risk assessment before surgery, considering alternative ways of treatment, is a cornerstone of optimal postoperative course and prevention of complications in patients with liver cirrhosis.

The interplay between abdominal aortic aneurysm, metabolic syndrome and fatty liver disease: a retrospective case-control study.

BackgroundAbdominal aortic aneurysm (AAA) and fatty liver disease are both associated with the metabolic syndrome (MS); the aim of this study was to investigate whether patients with AAA are also at a higher risk for fatty liver disease.MethodsA case-control retrospective study. Patients diagnosed with AAA were compared with age- and sex-matched controls regarding the prevalence of fatty liver disease. Extracted data include anthropometric parameters, clinical and laboratory data, and liver imaging.Results995 patients were enrolled in the final analysis, 495 patients with AAA and 500 age- and sex-matched controls. The prevalence of fatty liver disease among AAA subjects was 48.9% compared with 21.2% among the controls (P<0.005). After adjusting for age, smoking, body mass index, and MS components, the logistic regression analysis indicates that AAA (men: OR 1.29, 95% CI 1.17, 1.49, P=0.001; women: OR 1.23, 95% CI 1.06, 1.43, P=0.002), obesity (men: OR 1.32, 95% CI 1.17, 1.59, P<0.001; women: OR 1.32, 95% CI 1.07, 1.52, P=0.012), hypertension (men: OR 1.23, 95% CI 1.13, 1.46, P=0.001; women: OR 1.13, 95% CI 1.00, 1.33, P=0.045), MS (men: OR 1.31, 95% CI 1.19, 1.53, P=0.001; women: OR 1.28, 95% CI 1.16, 1.42, P=0.002) were associated with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH). The prevalence of liver cirrhosis was 1.23%; subjects with obesity, diabetes, hypertension, and AAA had increased risk for cirrhosis (OR 1.89, 95% CI 1.18, 3.22, P=0.014; OR 1.27, 95% CI 1.09, 2.72, P=0.0027; OR 2.08, 95% CI 1.29, 3.42, P=0.004; OR 1.73, 95% CI 1.08, 2.87, P=0.027, respectively).ConclusionAAA patients are at increased risk for NAFLD/NASH, may predict advance liver disease and liver cirrhosis.

Predictive values of neutrophil-lymphocyte ratio as an early indicator for severe acute pancreatitis in the emergency department patients.

CONTEXT:Acute pancreatitis is an acute inflammatory disease presenting with a wide range of severity.AIMS:We investigated the predictive values of the neutrophil-lymphocyte ratio (NLR) as an indicator for severe acute pancreatitis in the emergency department patients.SETTINGS AND DESIGN:This retrospective study was conducted on patients with acute pancreatitis who were diagnosed in the emergency department, from January 2008 to December 2017.SUBJECTS AND METHODS:Patients were classified into either mild-to-moderate severe group or severe group according to the Revised Atlanta Classification for Acute Pancreatitis. Clinical features and laboratory blood test parameters were considered as independent variables.STATISTICAL ANALYSIS USED:Independent variables were analyzed using the Chi-square test and Mann–Whitney U-test to determine statistically significant differences between the two groups. Logistic regression analysis and receiver operating characteristic analysis were performed to evaluate the predictive values of significantly different variables.RESULTS:Of the 672 patients, 52 (7.7%) were classified into the severe group. Tachycardia, fever, prevalence of liver cirrhosis and chronic alcoholism, white blood cell count, NLR, C-reactive protein (CRP), blood urea nitrogen (BUN), creatinine, aspartate transaminase, and total bilirubin were significantly higher in the severe group. Among them, NLR (adjusted odds ratio [aOR]: 1.13; 95% confidence interval [CI]: 1.081–1.181), CRP (aOR: 1.011; 95% CI: 1.004–1.017), BUN (aOR: 1.036; 95% CI: 1.004–1.069), and creatinine (aOR: 1.703; 95% CI: 1.008–2.877) were significant in the logistic regression analysis. NLR showed relatively high sensitivity (82.7%) and specificity (70%) and showed the highest area under the curve (0.821).CONCLUSIONS:The increase in NLR was associated with severe acute pancreatitis. NLR is expected to be useful as a prognostic factor in patients with acute pancreatitis who are visiting the emergency department.

The Effect of Simvastatin on Nitric Oxide and hs-CRP Levels in patients with Liver Cirrhosis at Dr. Moewardi Hospital, Surakarta

Background: The prevalence of liver cirrhosis (SH) worldwide is at seventh place as the cause of death. Increased pressure in the portal vein Portal Hypertension (HP) causes esopha­geal varices and the more likely the patient to bleed. Endothelial dysfunction in cirrhosis of the liver causes a decrease in nitric oxide (NO) levels resulting in an imbalance between relaxation factors and portal vein contractions and increasing hs-CRP levels. Simvastatin can increase NO levels and improve endothelial dysfunction in patients with SH and can reduce levels of hs-CRP. This study aimed to determine the effect of simvastatin administration on nitric oxide and hs-CRP level in patients with liver cirrhosis. Subjects and Method: This was a randomized controlled trial conducted at Dr. Moewardi hospital, Surakarta, Central Java. A sample of 29 patients was divided into treatment and control groups. 14 patients in the treatment group were given simvastatin dose of 20 mg. 15 patients in the control group received a placebo. The dependent variable was a nitric oxide and hs-CRP levels. The inde­pendent variable was Simvastatin administration. Nitric oxide serum level was measured by an enzyme-linked immunosorbent assay (ELISA). Hs-CRP level was measured by the immune­chemilu­minescent method. The data were analyzed by t-test. Results: NO level after Simvastatin 20 mg administration (Mean= 7.93 µg/mL; SD= 1.78 µg/ mL) was higher than before (Mean= 5.14 µg/mL; SD= 2.25 µg/mL) and it was statistically significant (p = 0.001). Hs-CRP level after Simvastatin 20 mg administration (Mean= 2.04 mg/L; SD= 0.80 mg/L) was lowered than before (Mean= 7.82 mg/L; SD= 1.15 mg/L) and it was statistically significant (p= 0.001). Conclusion: Simvastatin administration increases NO serum levels and reduces the hs-CRP level in patients with liver cirrhosis. Keywords : nitric oxide, hs-CRP, simvastatin, liver cirrhosis Correspondence: Budhi Hariyanto. Masters Program in Family Medicine, Universitas Sebelas Maret. Jl. Ir Sutami 36A, Surakarta 57126, Centra Java. Email: antohariyanto787@gmail.com. Mobile: 0823280­10442. Indonesian Journal of Medicine (2019), 4(1): 9-14 https://doi.org/10.26911/theijmed.2019.04.01.02

The burden of HBV infection in HCV patients in Italy and the risk of reactivation under DAA therapy

BackgroundThere is increasing awareness of HBV reactivation in HCV-RNA-positive/HBV-coinfected patients with chronic liver disease (CLD) treated with oral direct-acting antivirals (DAAs). AimTo provide figures on the prevalence of HBV markers in HCV-RNA-positive subjects in Italy, where these findings are lacking. MethodsAll subjects aged ≥18 years with CLD consecutively referring to Italian liver units located throughout country were prospectively enrolled in two national surveys in 2001 and 2014. ResultsThe total number of HCV-RNA-positive cases was 6984; 356 (5.1%) subjects vaccinated against HBV were excluded. A total of 6628 cases were evaluated. The prevalence rates of HBsAg, isolated anti-HBc and anti-HBc/anti-HBs-positivity were 2.9%, 8.1% and 14.7%, respectively. Among the estimated one million HCV-RNA-positive subjects in Italy, a substantial number of subjects are at risk of HBV reactivation due to DAA therapy. The prevalence of liver cirrhosis was higher than that of CLD in HBsAg-positive subjects (4.4% vs. 2.6%, p < 0.01) but not in those positive for other HBV markers. ConclusionsThese findings outline the burden of HBV markers among HCV-RNA-positive subjects in Italy, where in 2017 reimbursement for DAA therapy by the National Health System became universal for all patients with chronic HCV infection. HBV vaccination coverage should be greatly extended, since nearly two thirds of subjects in this study resulted negative for any HBV marker.

Significance of a soft-coagulation system with monopolar electrode for hepatectomy: A retrospective two-institution study by propensity analysis

BackgroundThe VIO soft-coagulation system (VIO) with a monopolar electrode is a novel hemostatic device that provides hemostasis by superficial contact at the bleeding site without carbonization. Because heat injury remains a concern, surgical records and postoperative liver dysfunction were retrospectively evaluated in a cohort study. MethodsBetween September 2010 and March 2016, 322 patients underwent hepatectomy in which hemostatic devices were used at two institutions. Surgical results with use of VIO at one institute (VIO group) were compared with those without use of VIO at a second institute (control group), and propensity analysis was performed. ResultsIn limited resection and segmentectomy or sectionectomy performed in the VIO group, the prevalence of liver cirrhosis was significantly higher and the operation time was significantly longer in comparison with the control group (p < 0.05). In all hepatectomies, postoperative levels of total bilirubin and aspartate or alanine transaminase tended to be increased and prothrombin activity tended to be lower in the VIO group in comparison with the control group (p < 0.05). The prevalence of hepatic failure in the VIO group was significantly higher in comparison with that in the control group (p < 0.05). In cases of segmentectomy or sectionectomy, blood loss was significantly increased in the VIO group in comparison with that in the control group (p < 0.05) Propensity score matching showed that although the surgical records and outcomes were not significantly different between the groups, postoperative liver dysfunction was significant in the VIO group in comparison with the control group (p < 0.05). ConclusionsMild postoperative hepatic thermal injury with VIO was confirmed, and therefore, surgeons should take care when using the VIO system to make frequent wide resected cuts on the surface of the liver.

Helicobacter Pylori Infection in Patients WITH Portal Hypertensive Gastropathy Owing to Liver Cirrhosis—Prevalence and Relation With Disease Severity: A Study From Tertiary Care Centre in North India

Helicobacter Pylori Infection in Patients WITH Portal Hypertensive Gastropathy Owing to Liver Cirrhosis—Prevalence and Relation With Disease Severity: A Study From Tertiary Care Centre in North India

Liver function in alpha-1-antitrypsin deficient individuals at 37 to 40 years of age.

Severe alpha-1-antitrypsin (AAT) deficiency (PiZZ) is a risk factor for liver disease, but the prevalence of liver cirrhosis and hepatocellular cancer in PiZZ adults is unknown. The risk of liver disease in adults with moderate AAT deficiency (PiSZ) is also unknown. A cohort of 127 PiZZ, 2 PiZnull, 54 PiSZ, and 1 PiSnull individuals were identified by the Swedish national neonatal AAT screening program between 1972 and 1974, when all 200,000 newborn infants in Sweden were screened for AAT deficiency. The cohort has been followed up since birth. Our aim was to study liver function and signs of liver disease in this cohort at 37 to 40 years of age in comparison with a matched, random sample of control subjects identified from the population registry.Eighty seven PiZZ, 32 PiSZ, and 92 control subjects (PiMM) answered a questionnaire on medication and alcohol consumption and provided blood samples. Liver stiffness was assessed by Acoustic Radiation Force Impulse (ARFI) elastography in 32 PiZZ, 15 PiSZ, and 51 PiMM subjects.The median of liver function tests and procollagen-III-peptide were within the normal range in all Pi subgroups. However, the PiZZ men had significantly higher plasma bilirubin than the PiMM men (P = 0.018). Plasma ɣ-glutamyl transferase (GGT) was significantly higher in the PiZZ men (P = 0.009) and the PiSZ men (P = 0.021) compared with the PiMM men. The median of liver stiffness was significantly higher in the PiZZ men (P = 0.037) and the PiSZ men (P = 0.032) compared with the PiMM men. The PiZZ women taking medication influencing liver enzymes had significantly higher GGT than the PiMM women on the corresponding treatment (P = 0.023).These AAT-deficient individuals identified by neonatal screening have normal plasma levels of liver function tests, and no clinical signs indicating liver disease at the age of 37 to 40 years. However, bilirubin, GGT, and liver stiffness are significantly higher in PiZZ men than PiMM men.

The Prevention of Liver Cancer and the Epidemiology of Cirrhosis

The prevalence of liver cirrhosis in 133 Romanians as obtained from a published necropsy series was compared with the biopsy pattern seen among 138 Nigerians of the Igbo ethnic group. It was found that the Romanian peak age group of 5059 years was 2 decades older than the Nigerian peak of 30-39 years. It is argued that, although one series was from necropsies and the other from biopsies, their distinct patterns are significant epidemiologically. Therefore, it is recommended that such comparative series, which ought to have an ethnic orientation wherever possible, should be undertaken internationally in order to map out the genetic and environmental factors inherent in liver cirrhosis which should be compared with the cancer of this organ. Indeed, the available evidence is that cirrhosis is the forerunner of malignancy. Accordingly, preventive measures are called for in the quest to lessen the burden of world-wide cancer of the liver. For example, the weighty words of the World Health Organization’s book promote knowledge of the epidemiology of cirrhosis vis-a-vis liver cancer. Public health education is needed, therefore.