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Novel non-invasive score to predict cirrhosis in the era of hepatitis C elimination: A population study of ex-substance users in Singapore

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Hepatobiliary & Pancreatic Diseases International 2019年第2期18卷 143-148页

作者： Yue Zhao prem harichander thurairajah Rahul Kumar Jessica Tan Eng Kiong Teo John Chen Hsiang Department of Gastroenterology and Hepatology Changi General Hospital

Background: Chronic hepatitis C infection is common among people with history of substance use. Liver fibrosis assessment is a barrier to linkage to care, particularly among those with history of substance users. The use of non-invasive scores can be helpful in predicting liver cirrhosis in the era of HCV elimination, especially in countries where transient elastography(TE) is not available. We compared the commonly used non-invasive scores with a novel non-invasive score in predicting liver cirrhosis in this population. Methods: HCV patients with history of substance use between 2011 and 2016 were analyzed. All patients had TE for liver fibrosis assessment. Clinical performance of established non-invasive scores for fibrosis assessment and novel score were compared. Youden's index was used to determine optimal cut-off of the novel score. Results: A total of 579 patients were included. In multivariate logistic regression, cirrhosis on TE was associated with age( P = 0.002), aspartate aminotransferase(AST)( P = 0.004), and platelet count( P < 0.001), but not alanine aminotransferase(ALT)( P = 0.896). These form the components of modified AST-toplatelet ratio index(APRI) score. Modified APRI was superior to APRI in predicting cirrhosis(AUROC, 0.796 vs. 0.770, P = 0.007), but not fibrosis-4 score(FIB-4)( P = 1.00). Modified APRI at cut-off of 4 has sensitivity, specificity and negative predictive value(NPV) of 94.4%, 26.9% and 92.6%, respectively, and at 19, has sensitivity, specificity and positive predictive value(PPV) of 33.3%, 96.2% and 77.1%, respectively. FIB-4 has a NPV and PPV of 88.6%, 41.8% and 78.5%, 77.6%, at cut-off of 1.45 and 3.25, respectively. Using the cut-off of 4 and 14 for modified APRI, 32.5% of patients can be correctly classified and misses out only 5.6% of cirrhosis patients. Conclusions: Modified APRI score is superior in predicting cirrhosis in HCV population, with 32.5% of the population being correctly classified using cut-off of 4 and 14.

关键词： Hepatitis C Cirrhosis Fibrosis assessment AST-to-platelet ratio index Modified APRI Fibrosis-4 score

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Efficacy and safety of sofosbuvir/velpatasvir with or without ribavirin in hepatitis C genotype 3 compensated cirrhosis:A meta-analysis

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World Journal of Hepatology 2022年第6期14卷 1248-1257页

作者： Jing Hong Loo Wen Xin Flora Xu Jun Teck Low Wei Xuan Tay Le Shaun Ang Yew Chong Tam prem harichander thurairajah Rahul Kumar Yu Jun Wong Yong Loo Lin School of Medicine National University of SingaporeSingapore 119077Singapore Education Resource Center Medical BoardSingapore General HospitalSingapore 100059Singapore Department of Gastroenterology and Hepatology National University HospitalSingapore 119077Singapore Department of Gastroenterology and Hepatology Changi General HospitalSingapore 529889Singapore Duke-NUS Medicine Academic Clinical Program Singapore 100059Singapore

BACKGROUND Hepatitis C virus(HCV)is a leading cause of liver cirrhosis and hepatocellular carcinoma ***/velpatasvir(SOF/VEL)is an effective pangenotypic direct-acting antiviral combination for treatment of chronic HCV *** the addition of ribavirin(RBV)to SOF/VEL improved sustained virological response(SVR12)in genotype 3(GT3)decompensated cirrhosis patients,the benefits of RBV in GT3 compensated cirrhosis patients receiving SOF/VEL remains *** To evaluate the efficacy and safety of SOF/VEL,with or without RBV in GT3 compensated cirrhosis *** We searched four electronic databases(PubMed/Medline,Embase,Cochrane Library and Web of Science)from inception up to June 2021 using both free text and MeSH *** was no restriction on language,geography,publication dates and publication status(full text or abstracts).All GT3 compensated cirrhosis patients treated with 12 wk of SOF/VEL,with or without RBV,were included,regardless of age,gender or prior treatment *** primary outcome was sustained virological response 12-wk posttreatment(SVR12).The secondary outcome was treatment-related adverse events,as defined by symptomatic anemia requiring transfusion or a drop in hemoglobin beyond 2 g/*** pooled relative risk(RR),95%CI and heterogeneity(I^(2))were estimated using Review Manager version *** From 1752 citations,a total of seven studies(2 randomized controlled trials,5 cohort studies)with 1088 subjects were *** SVR12 was similar in GT3 compensated cirrhosis patients,regardless of the use of RBV,for both the intention-to-treat RR 1.03,95%CI:0.99-1.07;I^(2)=0%)and the per-protocol analysis(RR:1.03,95%CI:0.99-1.07;I^(2)=48%).The overall pooled rate of treatment-related adverse events was 7.2%.Addition of RBV increased the pooled risk of treatment-related adverse events in GT3 compensated cirrhosis patients receiving SOF/VEL(RR:4.20,95%CI:1.29-13.68;I^(2)=0%).Subgroup analysis showed that RBV wa

关键词： Direct-acting antiviral Hepatitis C Cirrhosis Sofosbuvir/velpatasvir

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Efficacy of small-volume simethicone given at least 30 min before gastroscopy

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2016年第4期7卷 572-578页

作者： Mingjun Song Andrew Boon Eu Kwek Ngai Moh Law Jeannie Peng Lan Ong Jessica Yi-Lyn Tan prem harichander thurairajah Daphne Shih Wen Ang Tiing Leong Ang Department of Gastroenterology and Hepatology Changi General Hospital

AIMTo evaluate the efficacy of 5 mL simethicone solution in decreasing gastric foam if given at least 30 min before gastroscopy. METHODSThis was a randomized, placebo controlled, endoscopist blinded study performed at Changi General Hospital. Patients were at least 21 years old, had no prior surgical resection of the upper gastrointestinal tract, and scheduled for elective diagnostic gastroscopies. The primary outcome was the total mucosal visibility score (TMVS) which was evaluated using McNally score. The sample size was calculated to be 24 per group (SD 2.4, 80% power, P t test). RESULTSFifty-four patients were randomised to receive either simethicone [1 mL liquid simethicone (100 mg) in 5 mL of water] or placebo (5 mL of water) at least 30 min before their gastroscopy. Six accredited consultants conducted the gastroscopy, and the interobserver agreement of scoring TMVS was good with a Kappa statistic of 0.73. The simethicone group had significantly better mean TMVS compared to placebo (5.78 ± SD 1.65 vs 8.89 ± SD 1.97, P CONCLUSIONWith a premedication time of at least 30 min, 5 mL simethicone can significantly decrease gastric foam, decrease the volume of additional flushes, and shorten gastroscopy time.

关键词： Simethicone premedication Gastroscopy Gastric foam

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The Rising Burden of Hepatocellular Carcinoma: Is the Gender Gap Narrowing?

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Journal of Clinical and Translational Hepatology 2024年第9期12卷 763-764页

作者： James K.H.Ho prem H.thurairajah Daniel Q.Huang Kristie H.Fan Division of Gastroenterology and Hepatology National University HospitalNational University Health SystemSingaporeSingapore

Dear Editors,The landscape of hepatocellular carcinoma(HCC)is continuously *** global trends indicate a significant shift in the epidemiology of HCC from viral-related to non-viral-related ***-associated fatty liver disease has emerged as the fastest-growing contributor to HCC in recent years,due to the increased prevalence of obesity and metabolic risk factors.

关键词： Carcinoma epidemiology obesity

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