BACKGROUND/AIMS: We investigated factors associated with the disease progression and development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients during long-term oral nucleos(t)ide analog (NA) therapy. METHODS: This retrospective study included 524 naive CHB patients who received oral NA therapy for more than 48 weeks between January 2003 and December 2007. The primary outcome was 5-year cumulative probability of disease progression and HCC development. Disease progression was defined as cirrhosis development, cirrhotic complications, HCC or liver-related mortality. RESULTS: For the 524 patients, the cumulative probabilities of disease progression and HCC development at 1, 2, 3, 4 and 5 years were 1.1%, 6.3%, 9.0%, 11.6%, and 16.2% and 0.2%, 1.8%, 3.6%, 5.8%, and 9.3%, respectively. In multivariate analysis, age >50 years (hazard ratio [HR], 1.05) and cirrhosis (HR, 2.95) were significant factors for disease progression. Similarly, age >50 years (HR, 1.05), family history of HCC (HR, 5.48), and cirrhosis (HR, 17.16) were significant factors for HCC development. Importantly, longer duration (>12 months) of maintained virological response (<20 IU/mL) reduced the risks of disease progression (HR, 0.19) and HCC development (HR, 0.09). CONCLUSIONS: Longer duration of maintained virological response significantly reduces the risk of disease progression or HCC development in CHB patients undergoing long-term oral NA therapy.
Adult ; Age Factors ; Antiviral Agents/*administration & dosage ; Carcinoma, Hepatocellular/epidemiology/etiology ; *Disease Progression ; Female ; Hepatitis B, Chronic/complications/*drug therapy/*pathology ; Humans ; Liver Cirrhosis/epidemiology/etiology ; Liver Neoplasms/epidemiology/etiology ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Time

BACKGROUND/AIMS: The aim of this study was to describe the types and causes of liver disease in patients from a single community hospital in Korea between April 2005 and May 2010. METHODS: A cohort of patients who visited the liver clinic of the hospital during the aforementioned time period were consecutively enrolled (n=6,307). Consistent diagnostic criteria for each liver disease were set by a single, experienced hepatologist, and the diagnosis of all of the enrolled patients was confirmed by retrospective review of their medical records. RESULTS: Among the 6,307 patients, 528 (8.4%) were classified as acute hepatitis, 3,957 (62.7%) as chronic hepatitis, 767 (12.2%) as liver cirrhosis, 509 (8.1%) as primary liver cancer, and 546 (8.7%) as a benign liver mass or other diseases. The etiologies in the acute hepatitis group in decreasing order of prevalence were hepatitis A (44.3%), toxic hepatitis (32.4%), other hepatitis viruses (13.8%), and cryptogenic hepatitis (9.1%). In the chronic hepatitis group, 51.2% of cases were attributed to viral hepatitis, 33.3% to nonalcoholic fatty liver disease, and 13.0% to alcoholic liver disease (ALD). Of the cirrhoses, 73.4% were attributable to viral causes and 18.1% to alcohol. Of the hepatocellular carcinoma cases, 86.6% were attributed to viral hepatitis and 11.6% to ALD. Among the benign tumors, hemangioma comprised 52.2% and cystic liver disease comprised 33.7%. CONCLUSIONS: Knowledge of the current status of the type and cause of liver disease in Korea may be valuable as a basis for evaluating changing trends in liver disease in that country.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/adverse effects ; Carcinoma, Hepatocellular/epidemiology/etiology/pathology ; Chronic Disease ; Cohort Studies ; Fatty Liver/epidemiology ; Female ; Hepatitis/epidemiology ; Hepatitis, Viral, Human/complications/epidemiology ; Humans ; Liver Cirrhosis/epidemiology/etiology ; Liver Diseases/*diagnosis/epidemiology ; Liver Diseases, Alcoholic/complications/epidemiology ; Liver Neoplasms/epidemiology/etiology/pathology ; Male ; Middle Aged ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Young Adult

BACKGROUND/AIMS: We compared the accuracy and usefulness of clinical diagnostic criteria for hepatocellular carcinoma in a hepatitis B virus (HBV)-endemic area. METHODS: We reviewed the medical records of 355 patients who had undergone liver resection or biopsy at our institution between January 2008 and December 2009. These patients were reevaluated using four noninvasive diagnostic criteria for hepatocellular carcinoma proposed by the European Association for the Study of the Liver (EASL), the American Association for the Study of Liver Diseases (AASLD), the Korean Liver Cancer Study Group and the National Cancer Center (KLCSG/NCC), and National Comprehensive Cancer Network (NCCN) guidelines. RESULTS: The overall sensitivity was highest using the KLCSG/NCC criteria (79.8%), followed by the AASLD (51.5%), EASL (38.4%), and NCCN (10.1%; P<0.001) criteria, whereas the specificity (84.5-98.3%) and positive predictive value (96.2-98.3%) were similar for all of the criteria. The KLCSG/NCC criteria had an acceptable false-positive rate and the highest sensitivity among all of the patients, including those positive for HBsAg, those without liver cancer, and those with a tumor of at least 2 cm. CONCLUSIONS: The KLCSG/NCC and AASLD criteria exhibited the highest sensitivity, and all four guidelines had a high specificity among all of the patients. Based on the sensitivity and false-positive rate, the KLCSG/NCC criteria was the most useful in the majority of patients. Inclusion of HBV infection in the clinical diagnostic criteria for hepatocellular carcinoma would be reasonable and may lead to an improvement in the sensitivity, with acceptable false-positive rates, in HBV-endemic areas.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*diagnosis/etiology/pathology ; Female ; Hepatitis B/complications/*diagnosis/epidemiology ; Hepatitis B Surface Antigens/blood ; Hepatitis C/diagnosis/epidemiology ; Humans ; Liver/pathology ; Liver Neoplasms/*diagnosis/etiology/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Practice Guidelines as Topic ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Young Adult ; alpha-Fetoproteins/analysis

This study sought to determine the value of portal venography with 64-slice MDCT in the evaluation of compensatory circulation resulting from decompensated posthepatitic cirrhosis (PHC), and in the clarification of its anatomic distribution. Thirty-six patients with clinically confirmed compensatory circulations resulting from PHC were enrolled in this study. They underwent thoracicoabdominal triphasic enhancement CT scans with 64-slice MDCT. The data of the portal venous phase acquired were used for obtaining CT-MIP (maximum intensity projection) images of portosystematic collaterals such as gastric fundic and esophageal varices, paraumbilical veins, spleno-renal shunts, and their inflowing and outflowing vessels. On CT-MIP portography, gastric fundic varices were shown in 35 cases (97%) and esophageal varices in 30 cases (83%). The left gastric vein was the common inflowing vessel of the varices in 34 cases (94%); it was mainly originated from splenic vein in 24 cases (67%). With regard to the outflowing vessels, they were commonly azygos vein in 30 cases (83%). As for paraumbilical veins in 7 cases (19%), the inflowing vessel was the left branch of portal vein, and the outflowing vesse was the superficial epigastric vein. Cavernous transformation of the portal vein was seen in 5 cases (14%) and cavernous transformation of splenic vein was seen in 16 cases (44%). CT-MIP venography with 64-row MDCT could be considered as an effective and noninvasive method for detecting the compensatory circulation resulting from decompensated PHC.
Adult ; Aged ; Aged, 80 and over ; Collateral Circulation ; Esophageal and Gastric Varices ; diagnostic imaging ; epidemiology ; Female ; Hepatitis B ; complications ; Humans ; Liver Cirrhosis ; diagnostic imaging ; etiology ; physiopathology ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; pathology ; Portography ; methods ; Tomography, Spiral Computed ; methods

Adult ; Aged ; Aged, 80 and over ; Alcoholism ; Diabetes Mellitus ; epidemiology ; etiology ; Female ; Hepatic Encephalopathy ; epidemiology ; etiology ; Hepatitis B ; complications ; pathology ; Hepatitis B virus ; Humans ; Liver Cirrhosis ; etiology ; pathology ; Liver Cirrhosis, Alcoholic ; etiology ; pathology ; Liver Function Tests ; Liver Neoplasms ; epidemiology ; etiology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

OBJECTIVETo explore clinical and pathological features of chronic hepatitis B (CHB) with hepatic steatosis.

METHODSRetrospective analysis of hepatic steatosis in patients with liver biopsy-proven CHB between January 2005 and June 2008. Detailed clinical, laboratory and pathological data of CHB patients with steatosis were compared with those in sex-, age- matched CHB patients without steatosis. Patients co-infected hepatitis C virus or HIV or suffering from liver diseases of other causes were excluded.

RESULTSHistological hepatic steatosis was found in 33.4% of the 1263 CHB patients. The prevalence of steatosis was increased with time in the study period (20.3%, 28.2%, 32.6%, 65.4%, in trend analysis, P values less than 0.05). Body mass index, fasting plasma glucose, serum triglyceride and total cholesterol level in CHB patients with hepatic steatosis (n = 114) were significantly higher than those in 113 patients without steatosis (t values were 6.811, 2.733, 3.063, 2.340, respectively, P values less than 0.01 or 0.05). Compared to patients without steatosis, serum hepatitis B virus DNA titer in patients with steatosis was significantly lower (x2 = 6.154, P less than 0.05) and reduced sharply with the increased degree of hepatic steatosis (x2 = 4.941, P less than 0.05). There were no differences in liver biochemical test (t values were 0.744, 1.390, -0.029, -1.175, 1.393, respectively, P values more than 0.05), hepatic inflammation grade and fibrosis stage between CHB patients with and without steatosis (x2 = 1.434, 0.106, respectively, P more than 0.05), and these parameters were not associated with different degree of hepatic steatosis (x2 = 2.447, 2.911, respectively, P more than 0.05).

CONCLUSIONSHepatic steatosis is common in patients with CHB, and is related to metabolic disorders. Hepatic steatosis does not affect the severity of CHB. The reverse association of hepatitis B virus titer with the degree of hepatic steatosis needs further investigation.

Alanine Transaminase ; blood ; Biomarkers ; blood ; Body Mass Index ; Cholesterol ; blood ; DNA, Viral ; blood ; Fatty Liver ; epidemiology ; etiology ; pathology ; Female ; Hepatitis B virus ; Hepatitis B, Chronic ; complications ; pathology ; virology ; Humans ; Liver ; pathology ; virology ; Liver Cirrhosis ; epidemiology ; etiology ; pathology ; Male ; Obesity ; complications ; Retrospective Studies ; Risk Factors ; Severity of Illness Index

Alcohol Drinking ; adverse effects ; Hepatitis, Viral, Human ; complications ; diagnostic imaging ; pathology ; Hepatocytes ; pathology ; Humans ; Liver ; diagnostic imaging ; pathology ; Liver Cirrhosis, Alcoholic ; diagnostic imaging ; etiology ; pathology ; Liver Diseases, Alcoholic ; diagnostic imaging ; etiology ; pathology ; Liver Neoplasms ; epidemiology ; etiology ; pathology ; Prognosis ; Radiography ; Risk Factors

Adult ; Aged ; B-Lymphocytes ; pathology ; Female ; Gastric Mucosa ; pathology ; Hepatitis B, Chronic ; complications ; epidemiology ; virology ; Hepatitis C, Chronic ; complications ; epidemiology ; virology ; Humans ; Immunohistochemistry ; Liver ; pathology ; Lymphoma ; etiology ; pathology ; virology ; Male ; Middle Aged ; Staining and Labeling

OBJECTIVETo analyze the prognostic factors for patients with acute-on-chronic liver failure, and to build a scoring system for assessment of the prognosis of liver failure.

METHODS480 patients with acute-on-chronic liver failure in our hospital from January 2006 to June 2008 were enrolled in this study. The patients were divided into improved group and deteriorated group. The clinical data were analyzed by using chi square test, independent-Samples T Test and Binary logistic regression.

RESULTSThe factors that significantly affected the prognosis of Acute-on-chronic Liver Failure included age, hepatitis or liver cirrhosis, Staging, Hyponatremias, alpha-fetoprotein (AFP), the prothrombin time activity (PTA), total bilirubin (TBil), creatinine (Cr), albumin (ALB) and Hepatic encephalopathy, ascites, alimentary tract hemorrhage (P less than 0.05, P less than 0.01). PTA, Hyponatremias, hepatitis or liver cirrhosis, Hepatic encephalopathy and alimentary tract hemorrhage were independent risk factors of prognosis.

CONCLUSIONPTA, Hyponatremias, hepatitis or liver cirrhosis, Hepatic encephalopathy and alimentary tract hemorrhage are important to build a scoring system to assess the prognosis of Acute-on-chronic Liver Failure and may be useful to guide clinical treatment.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biomarkers ; blood ; Child ; Child, Preschool ; Chronic Disease ; Female ; Hepatic Encephalopathy ; complications ; Hepatitis, Viral, Human ; complications ; epidemiology ; Humans ; Hyponatremia ; complications ; Infant ; Liver Failure, Acute ; blood ; etiology ; pathology ; Logistic Models ; Male ; Middle Aged ; Prognosis ; Prothrombin Time ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Young Adult

Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Diabetes Mellitus ; epidemiology ; etiology ; Fatty Liver ; complications ; Female ; Glucose Metabolism Disorders ; epidemiology ; etiology ; Hepatitis B, Chronic ; complications ; virology ; Hepatitis C ; complications ; virology ; Humans ; Liver ; metabolism ; pathology ; Liver Cirrhosis ; epidemiology ; etiology ; Liver Cirrhosis, Alcoholic ; epidemiology ; etiology ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies