<p style="text-align: justify;">INTRODUCTION: Hepatorenal syndrome (HRS) is a functional renal impairment associated with advanced cirrhosis. The best treatment is liver transplantation; however, many patients die before this can be done. Terlipressin improves renal function in HRS, but recent studies have shown similar effects with the cheaper and more readily available norepinephrine. This review included randomized trials comparing noradrenaline to terlipressin for patients with type 1 HRS, as defined by the International Ascites Club.p> <p style="text-align: justify;">OBJECTIVE: To determine the safety and effectiveness of noradrenaline in the management of HRS in terms of 1) reducing mortality, 2) reversal and 3) occurrence of adverse eventsp> <p style="text-align: justify;">METHODOLOGY: For this meta-analysis paper, the researchers utilized an electronic search of databases and manual scanning of reference lists were performed. Standardized eligibility assessment was performed independently by three reviewers. Review Manager 5.0.23 was used to calculate odds ratios (OR) with 95% confidence intervals (CIs) as well as I2 values for inter-trial heterogeneity. Standardized eligibility assessment was performed independently by three reviewers.p> <p style="text-align: justify;">RESULTS: Thirty-six articles were found after electronic and manual searching. Three were assessed for validity and included in the final analysis. The total number of patients across all trials was 95. Noradrenaline was found not to differ from terlipressin in terms of 15-day survival rate (OR 01.17; 95% CI: 0.51-2.66), reversal of HRS (OR1.07; 95% CI: 0.47-2.44), and a post-hoc analysis on disease-free survival (OR 0.78; 95% CI: 0.34-1.79). Results of sensitivity analysis were consistent with the previous findings (15-day survival: OR=1.21 95% CI = 0.52-2.83; HRS reversal: OR= 1.33, 95% CI = 0.56-3.13; disease-free survival: 1.35, CI =0.56-3.25). Only transient adverse effects were noted with either drugs.p> <p style="text-align: justify;">CONCLUSION: There is inconclusive evidence that noradrenaline and terlipressin are significantly different in the reversal of HRS and reduction of mortality. Larger trials on noradrenaline or a non-inferiority trial may be needed to establish the equivalence of noradrenaline with terlipressin.p>
Hepatorenal Syndrome ; Terlipressin ; Norepinephrine ; Survival Rate ; Liver Transplantation ; Ascites ; Disease-free Survival ; Lypressin ; Liver Cirrhosis ; Renal Insufficiency

<p style="text-align: justify;">BACKGROUND AND OBJECTIVES: Previous studies using older diagnostic criteria indicated chronic Hepatitis B and alcohol as the most common etiologies of HCC in the Philippines. No recent studies updated criteria for diagnosis have been published. This study used the diagnostic criteria from the latest APASL guidelines to describe the demographic profile of patients with HCC.p> <p style="text-align: justify;">METHODS: This is a cross-sectional study of adult HCC cases from a liver tumor registry in the Philippine General Hospital from 2009 to 2012. Demographics, AFP levels, BCLC stage, Child-Pugh Score, ECOG performance status, treatments received, and mortality were assessed.p> <p style="text-align: justify;">RESULTS: The HCC prevalence rate was 7.8%, mostly occurring between ages 40 to 65 years. It is more common in males (M:F=4:1). Most of the HCC cases were diagnosed at early stages, with less severity of liver functional impairment compared to older studies. Resection was the common treatment undertaken (50%) and overall mortality rate at the time of hospital discharge was 25%. p> <p style="text-align: justify;">CONCLUSION: The profile of HCC patients in this study is similar to previous studies. More cases were recognized at earlier stages with better liver function, implying better treatment outcomes with surgery, although selection bias is recognized.p>
Human ; Male ; Female ; Middle Aged ; Adult ; Hepatitis B, Chronic ; Prevalence ; Selection Bias ; Hospitals, General ; Liver Neoplasms ; Alcohols

<p style="text-align: justify;">Chorinic hepatitis B virus (CHB) infection is a serious problem that affects over 300 million people worldwide and is highly prevalent in the Asia Pacific region. In the Philippines an estimate 7.3 million Filipinos or 16.7% of adults are chronically infected with HBV, more than twice the average prevalence in the Western Pacific region.p> <p style="text-align: justify;">In view of the above, the Hepatology Society of the Philippines (HSP) embarked on the development of consensus statements on the management of hepatitis B with the primary objectives of standardizing approach to management, empowering other physicians involved in the management of hepatitis B and advancing treatment subsidy by the Philippine Health Insurance Corporation (PhilHealth).p> <p style="text-align: justify;">The local guidelines include screening and vaccination general management, indications for assessment of fibrosis in those who did not meet treatment criteria. indications for treatment, on-treatment and post-treatment monitoring and duration of antiviral treatment. Recommendations on the management of antiviral drug resistance, management of special populations including patients with concurrent HIV or hepatitis C infection, women of child-bearing age (pregnancy and breastfeeding), patients with decompensated liver disease, patients receiving immunosuppressive medications or chemotherapy and patients in the setting of hepatocellular carcinoma are also included. However, the guidelines did not include management for patients with liver and other solid organ transplantation, patients on renal replacement therapy, and children.p> <p style="text-align: justify;">The consensus statements will be amended accordingly as new therapies become available.p>
Hepatitis B ; Consensus ; Hepatitis B, Chronic ; Hepatitis B Virus ; Fibrosis ; Drug Therapy ; Carcinoma, Hepatocellular ; Liver Cirrhosis ; Hepatitis Delta Virus ; Hiv

<p style="text-align: justify;">Hepatitis C virus (HCV) infection is a devastating disease that is increasingly being diagnosed among Filipinos, especially in at-risk populations. There are disease-specific nuances in the evaluation and management of this infection. Furthermore, advances in the field brought about by clinical research are rapidly moulding the way we evaluate and manage HCV patients. Evidently, consensus statements formulated by experts in the field are needed in order to serve as a guide to physicians who see HCV patients in the clinic. With this in mind, the Hepatology Society of the Philippines spearheaded the formation of these statements which aimed to address issues in the diagnosis, evaluation, treatment, and follow-up care of patients with HCV infection.
Recommendations on the specific tests to perform in the evaluation of HCV patients before, during and after treatment, and first-line treatment of patients with acute and chronic HCV infection were provided. Treatment algorithms for chronic HCV infection, divided according to viral genotype, were also devised. We acknowledge the limitations brought about by the local inavailability of some drugs/treatment regimens in the local setting at the time of the formulation of these statements. As such, these statements will be revised as soon as new data become locally applicable.p> <p style="text-align: justify;"> p>
Hepatitis C ; Diagnosis ; Infection ; Consensus ; Carcinoma, Hepatocellular ; Liver Cirrhosis

Introduction: Rising prevalence of non-alcoholic fatty liver disease (NAFLD) suggests its correlation with liver failure worldwide. To date, there is no proven pharmacologic therapy for NAFLD. Pentoxifylline (PTX) with its anti-tumor necrosis factor properties has shown improvement of histological parameters, reductions in transaminase levels and serum cytokines among patients with NAFLD. The main objective is to determine the effectiveness of PTX in the reduction of progression of NAFLD in terms of reducing levels of aspartate transaminase (AST) and alanine transaminase (ALT), improving liver histology parameters and in decreasing TNF-α, IL-6 and IL-8. Methods: A comprehensive literature search showed seven randomized controlled trials (N=222) comparing PTX (1,200mg/day) with placebo. Two reviewers independently selected studies, assessed quality, and extracted and pooled outcomes including AST levels, ALT levels, serum cytokines and liver histology. All selected studies were found to be of low risk of bias based on Cochrane risk of bias assessment tool for randomized trials. Statistical analysis and forrest plot generation were done using the Review Manager Software 5.3. Results: Pooled results showed that PTX significantly reduced the ALT (WMD= -20.08; 95% CI: -40.20, 0.05; p=0.05) and AST (WMD= -11.38; 95% CI: -20.47, -2.29; p=0.01) in NAFLD patients. PTX significantly improved lobular inflammation (WMD= -0.45; 95% CI: -0.89, -0.01; p=0.04), fibrosis (WMD= -0.39; 95% CI: 0.83, 0.05; p=0.08) and NAS score (WMD= -0.52; 95% CI: -1.06, 0.0; p=0.051). Among serum cytokines, greater reduction was demonstrated in TNF-α (WMD= -20.20; 95% CI: -50.46, 10.41; p=0.20). Conclusion Pentoxifylline (PTX) decreases the aminotransferase activities, improves the liver histology and TNF-α of NAFLD patients. Demonstrating effects on serum TNF-α which plays a key role in progression to hepatic steatosis, it may be used as an adjunct to diet and lifestyle modifications in the treatment of NAFLD.
Meta-Analysis ; Non-alcoholic Fatty Liver Disease ; Pentoxifylline

Hepatitis C

Objective: To determine incidence, predictors, and impact of liver injury among hospitalized COVID-19 patients Methods: This is a retrospective cohort study of hospitalized COVID-19 patients at the University of the PhilippinesPhilippine General Hospital. Liver injury (LI) was defined as ALT elevation above institutional cut-off (>50 u/L) and was classified as mild (>1x to 3x ULN), moderate (>3x to 5x ULN), or severe (>5x ULN). Significant liver injury (SLI) was defined as moderate to severe LI. Univariate analysis of SLI predictors was performed. The impact of LI on clinical outcomes was determined and adjusted for known predictors -age, sex, and comorbidities. Results: Of the 1,131 patients, 565 (50.04%) developed LI. SLI was associated with male sex, alcohol use, chronic liver disease, increasing COVID-19 severity, high bilirubin, AST, LDH, CRP, and low lymphocyte count and albumin. An increasing degree of LI correlated with ICU admission. Only severe LI was associated with the risk of invasive ventilation (OR: 3.54, p=0.01) and mortality (OR: 2.76, p=0.01). Severe LI, male sex, cardiovascular disease, and malignancy were associated with longer hospital stay among survivors. Conclusion The liver injury occurred commonly among COVID-19 patients and was associated with important clinicodemographic characteristics. Severe liver injury increases the risk of adverse outcomes among hospitalized patients.
Liver injury ; Coronavirus disease-19 ; Severe Acute Respiratory Syndrome Coronavirus-2 ; Clinical outcomes

Introduction: ILeptospirosis is an important zoonotic disease commonly found in tropical or sub-tropical countries. The most severe form is Weil's syndrome which presents with jaundice, renal failure, and bleeding diatheses. Although jaundice occurs in 38% of patients with leptospirosis, no studies in Asia have focused on the liver biochemical profile of these patients. Characterization of liver biochemical profile and ultrasonographic findings may shed more light on the disease process. Identification of liver biochemical parameters that portend a poor prognosis may also allow for early aggressive intervention. Objective: To describe the liver biochemical profile and liver ultrasonographic findings in adult patients with laboratoryconfirmed leptospirosis, admitted at a tertiary hospital in Manila, Philippines. The association of clinical and laboratory features with clinical outcomes (i.e., severe liver injury, Weil’s syndrome, and mortality) was also investigated. Methods: This retrospective cross-sectional study reviewed all available cases of adult patients with laboratoryconfirmed leptospirosis admitted in the Philippine General Hospital from January 2009 to August 2018. The clinical features, liver biochemical profiles, and ultrasound findings were recorded and analyzed. Comparison between the means of each group based on clinical outcome (i.e., mortality, Weil’s syndrome) was done via Students’ t-test for continuous variables, and calculation of the Odds Ratio for categorical variables. Results: Total and direct bilirubin levels were elevated in patients with leptospirosis compared to serum aminotransferases and alkaline phosphatase levels which were only mildly elevated. Abdominal ultrasound showed typically un-enlarged livers with normal parenchymal echogenicity, normal spleens, and non-dilated biliary trees. Dyspnea was associated with an increased odds for mortality. Although jaundice was present in 39.5% of patients and significantly associated with severe liver injury, this was not associated with mortality. Liver biochemical test values did not differ among patients who expired and those who survived to discharge. The presence of myalgia and abdominal pain increased the odds for Weil's syndrome. Conclusion To date, no local studies have fully described the liver biochemical profile of patients with leptospirosis. Our findings are compatible with previous studies showing that leptospirosis typically presents with predominantly elevated direct bilirubin from cholestasis and systemic infection. Contrary to previous literature, however, our study found no association between jaundice and mortality.
Leptospirosis