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Validation of the albumin-bilirubin score for identifying decompensation risk in patients with compensated cirrhosis

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World Journal of Gastroenterology 2023年第32期29卷 4873-4882页

作者： Huttakan Navadurong Kessarin Thanapirom Salisa Wejnaruemarn thaninee prasoppokakorn Roongruedee Chaiteerakij Piyawat Komolmit Sombat Treeprasertsuk Division of Gastroenterology Department of MedicineFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Department of Medicine Queen Savang Vadhana Memorial HospitalChonburi 20110Thailand

BACKGROUND The albumin-bilirubin(ALBI)score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma(HCC).It can detect small changes in liver dysfunction and has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various *** To investigate the ALBI score for identifying decompensation risk at the 3-year follow-up in patients with compensated *** One-hundred and twenty-three patients with compensated cirrhosis without HCC in King Chulalongkorn Memorial Hospital diagnosed by imaging were retrospectively enrolled from January 2016 to December 2020.A total of 113 patients(91.9%)had Child A cirrhosis with a median model for end-stage liver disease(MELD)score of less than *** clinical and laboratory variables and decompensation events were *** ALBI score was calculated and validated to classify decompensation risk into low-,middle-,and high-risk groups using three ALBI grade ranges(ALBI grade 1:≤-2.60;grade 2:>-2.60 but≤-1.39;grade 3:>-1.39).Decompensation events were defined as ascites development,variceal bleeding,or grade 3 or 4 hepatic *** Among 123 cirrhotic patients enrolled,13.8%(n=17)developed decompensating events at a median time of 25[95%confidence interval(CI):17-31]*** baseline ALBI score in compensated cirrhosis was significantly lower than that of patients who developed decompensation events[-2.768(-2.956 to-2.453)vs-2.007(-2.533 to-1.537);P=0.01].Analysis of decompensation risk at 3 years showed that ALBI score had a time-dependent area under the curve(tAUC)of 0.86(95%CI:0.78-0.92),which was significantly better than that of ALBI-Fibrosis-4(ALBI-FIB4)score(tAUC=0.77),MELD score(tAUC=0.66),Child-Pugh score(tAUC=0.65),and FIB-4 score(tAUC=0.48)(P<0.05 for all).The 3-year cumulative incidence of decompensation was 3.1%,22.6%,and 50%in the low-,middle-,and high-risk groups,respectively(P

关键词： Albumin-bilirubin score Compensated cirrhosis Hepatic decompensation risk

Modified albumin-bilirubin predicted survival of unresectable hepatocellular carcinoma patients treated with immunotherapy

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World Journal of Gastrointestinal Oncology 2023年第10期15卷 1771-1783页

作者： Huttakan Navadurong thaninee prasoppokakorn Nanicha Siriwong Chonlada Phathong Nattaya Teeyapun Suebpong Tanasanvimon Kessarin Thanapirom Piyawat Komolmit Pisit Tangkijvanich Sombat Treeprasertsuk Roongruedee Chaiteerakij Department of Medicine Division of GastroenterologyFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand The Thai Red Cross Society Bangkok 10330Thailand Department of Medicine Division of OncologyFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Center of Excellence in Hepatitis and Liver Cancer Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology Division of GastroenterologyFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand

BACKGROUND Modified albumin-bilirubin(mALBI)grade has been established as a survival determinant in hepatocellular carcinoma(HCC)patients who receive locoregional and targeted *** To investigate whether mALBI could predict survival in unresectable HCC(uHCC)patients who were treated with atezolizumab plus bevacizumab(AB).METHODS A single-center,retrospective cohort study enrolled uHCC patients who received AB treatment between September 2020 and April 2023 and were followed up until June *** association between mALBI and patient survival was determined using Cox proportional hazards *** Of the 83 patients,67 patients(80.7%)were male with the mean age of 60.6 *** them,22 patients(26.5%)were classified as Barcelona Clinic Liver Cancer B,and 61 patients(73.5%)were classified as Barcelona Clinic Liver Cancer *** was present in 76 patients(91.6%),with 58 patients classified as Child-Turcotte-Pugh(CTP)A and 18 as CTP *** median overall survival(OS)and progression-free survival were 13.0 mo[95%confidence interval(CI):5.2-20.8]and 9.0 mo(95%CI:5.0-13.0),*** patients were divided into two groups based on mALBI grades:42 patients(50.6%)in the mALBI 1+2a group;and 41 patients(49.4%)in the mALBI 2b+3 *** the median follow-up period of 7.0 mo,the mALBI 1+2a group exhibited significantly better survival compared to the mALBI 2b+3 group,with a median OS that was not reached vs 3.0 mo(95%CI:0.1-6.0,P<0.001).In a subgroup of patients with CTP A,the mALBI 1+2a group also showed significantly longer survival compared to the mALBI 2b+3 group,with a median OS that was not reached vs 6.0 mo(95%CI:3.4-8.6,P<0.001).In the multivariate analysis,both CTP class and mALBI grade were independently associated with survival,with adjusted hazard ratios(95%CI)of 2.63(1.19-5.78,P=0.020)and 3.90(1.71-8.90,P=0.001),*** mALBI grades can determine survival of uHCC patients receiving AB treatment,particularly those who

关键词： Unresectable hepatocellular carcinoma Atezolizumab plus bevacizumab Modified albumin-bilirubin grade Immunotherapy Liver function

Validation model of fibrosis-8 index score to predict significant fibrosis among patients with nonalcoholic fatty liver disease

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World Journal of Gastroenterology 2022年第15期28卷 1563-1573页

作者： thaninee prasoppokakorn Wah-Kheong Chan Vincent Wai-Sun Wong Panyavee Pitisuttithum Sanjiv Mahadeva Nik Raihan Nik Mustapha Grace Lai-Hung Wong Howard Ho-Wai Leung Pimsiri Sripongpun Sombat Treeprasertsuk Department of Medicine Division of GastroenterologyFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Department of Medicine Division of GastroenterologyDivision of Gastroenterology and Hepatology UnitFaculty of MedicineUniversity of MalayaKuala Lumpur 50603Malaysia Department of Medicine and Therapeutics The Chinese University of Hong KongHong KongChina Department of Medicine Division of General Internal MedicineFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Department of Pathology Hospital Sultanah BahiyahAlor SetarKedah 05460Malaysia Department of Anatomical and Cellular Pathology The Chinese University of Hong KongHong KongChina Department of Internal Medicine Prince of Songkla UniversityHat Yai 90110Thailand Department of Medicine Division of Gastroenterology and HepatologyStanford University School of MedicinePalo AltoCA 94305United States

BACKGROUND Identifying hepatic fibrosis is crucial for nonalcoholic fatty liver disease(NAFLD)*** fibrosis-8(FIB-8)score,recently developed by incorporating four additional variables into the fibrosis-4(FIB-4)score,showed better performance in predicting significant fibrosis in *** To validate the FIB-8 score in a biopsy-proven NAFLD cohort and compare the diagnostic performance of the FIB-8 and FIB-4 scores and NAFLD fibrosis score(NFS)for predicting significant *** We collected the data of biopsy-proven NAFLD patients from three Asian centers in three *** the patients with available variables for the FIB-4 score(age,platelet count,and aspartate and alanine aminotransferase levels)and FIB-8 score(the FIB-4 variables plus 4 additional parameters:The body mass index(BMI),albumin to globulin ratio,gamma-glutamyl transferase level,and presence of diabetes mellitus)were *** fibrosis stage was scored using nonalcoholic steatohepatitis CRN criteria,and significant fibrosis was defined as at least fibrosis stage *** A total of 511 patients with biopsy-proven NAFLD and complete data were included for *** these 511 patients,271(53.0%)were female,with a median age of 51(interquartile range:41,58)*** median BMI was 29(26.3,32.6)kg/m2,and 268(52.4%)had *** the 511 NAFLD patients,157(30.7%)had significant fibrosis(≥F2).The areas under the receiver operating characteristic curves of the FIB-8 and FIB-4 scores and NFS for predicting significant fibrosis were 0.774,0.743,and 0.680,*** FIB-8 score demonstrated significantly better performance for predicting significant fibrosis than the NFS(P=0.001)and was also clinically superior to FIB-4,although statistical significance was not reached(P=0.073).The low cutoff point of the FIB-8 score for predicting significant fibrosis of 0.88 showed 92.36%sensitivity,and the high cutoff point of the FIB-8 score for predicting significant fibrosis of 1.

关键词： Nonalcoholic fatty liver disease Fibrosis-8 score Fibrosis-4 score Nonalcoholic fatty liver disease fibrosis score

Urinary neutrophil gelatinase‐associated lipocalin:A novel biomarker for predicting chronic kidney disease in patients with nonalcoholic fatty liver disease

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Portal Hypertension & Cirrhosis 2022年第3期1卷 157-166页

作者： Huttakan Navadurong thaninee prasoppokakorn Nattachai Srisawat Roongruedee Chaiteerakij Piyawat Komolmit Pisit Tangkijvanich Sombat Treeprasertsuk Department of Medicine Division of GastroenterologyFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkokThailand Department of Medicine Division of NephrologyFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkokThailand Excellent Center for Critical Care Nephrology King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkokThailand Liver Fibrosis and Cirrhosis Research Unit Chulalongkorn UniversityBangkokThailand Department of Biochemistry and Liver Research Unit Faculty of MedicineChulalongkorn UniversityBangkokThailand

Aims:Nonalcoholic fatty liver disease(NAFLD)and chronic kidney disease(CKD)are common diseases *** of a high prevalence of CKD in NAFLD patients have been *** neutrophil gelatinaseassociated lipocalin(NGAL)is a reliable biomarker for renal dysfunction,and it is recommended for early detection of acute kidney injury(AKI)in cirrhotic ***,there is no evidence for using urine NGAL to predict CKD in NAFLD *** aim to determine the proportion of CKD and identify the predictive value of NGAL and other factors associated with CKD in these ***:A single‐center,cross‐sectional study was conducted between July 2018 and December 2019 in consecutive NAFLD patients diagnosed by transient elastography(TE)or liver biopsy at a tertiary care university hospital in Bangkok,*** liver fibrosis is defined as fibrosis stages 3–*** definition of CKD is estimated glomerular filtration rate(eGFR)<60 ml⋅min−1⋅1.73m−2 based on the Kidney Disease Improving Global Outcomes(KDIGO)guideline *** NGAL level was measured by enzyme linked immunosorbent assay ***:A total of 101 NAFLD patients were included with a mean age of 54±16 *** these patients,14(13.9%),13(12.9%),and 32(31.7%)had fibrosis stages 2,3,and 4,*** percent(9 of 101)of patients with NAFLD with a mean eGFR of 42.66±17.42 ml⋅min−1⋅1.73m−*** statistically significant factors associated with CKD were a higher level of urine NGAL(55.1[25.15–150.60]vs.15.1[9.67–25.15]ng/ml;p=0.006),a higher level of TE(17.3[6.85–46.20]vs.7.7[5.6–11.7]kPa;p=0.038),and a presence of advanced fibrosis(77.8%vs.40.7%;p=0.041),compared to those without *** NGAL was the only significant factor associated with CKD in NAFLD *** cutoff level of urine NGAL at 36.75 ng/ml showed odds ratio of 21.27(95%CI:3.97–113.82;p<0.001)and 1.02(95%CI:1.00–1.04;p=0.024)by univariate and multivariate analyses,*** selected urine NGAL cu

关键词： chronic kidney disease nonalcoholic fatty liver disease urinary neutrophil gelatinase‐associated lipocalin