Predictors of esophageal varices in patients with HBV-related cirrhosis: a retrospective study

<p>Abstract</p> <p>Background</p> <p>All patients with liver cirrhosis are recommended to undergo an evaluation of esophageal varices (EV) to assess their risk of bleeding. Predicting the presence of EV through non-invasive means may reduce a large number of unnecessary endoscopies. This study was designed to develop a predictive model for varices in patients with Hepatitis B virus-related cirrhosis.</p> <p>Methods</p> <p>The retrospective analysis was performed in 146 patients with Hepatitis B virus-related cirrhosis. The data were assessed by univariate analysis and a multivariate logistic regression analysis. In addition, the receiver operating characteristic curves were also applied to calculate and compare the accuracy of the model and other single parameters for the diagnosis of esophageal varices.</p> <p>Results</p> <p>We found the prevalence of EV in patients with Hepatitis B virus-related cirrhosis to be 74.7%. In addition, platelet count, spleen width, portal vein diameter and platelet count/spleen width ratio were significantly associated with the presence of esophageal varices on univariate analysis. A multivariate analysis revealed that only the spleen width and portal vein diameter were independent risk factors. The area under the receiver operating characteristic curve of regression function (RF) model, which was composed of the spleen width and portal vein diameter, was higher than that of the platelet count. With a cut-off value of 0.3631, the RF model had an excellent sensitivity of 87.2% and an acceptable specificity of 59.5% with an overall accuracy of 80.1%.</p> <p>Conclusion</p> <p>Our data suggest that portal vein diameter and spleen width rather than platelet count may predict the presence of varices in patients with Hepatitis B virus-related cirrhosis, and that the RF model may help physicians to identify patients who would most likely benefit from screenings for EV.</p

Trends in characteristics and outcomes among US adults hospitalised with COVID-19 throughout 2020: An observational cohort study

Objectives To examine the temporal patterns of patient characteristics, treatments used and outcomes associated with COVID-19 in patients who were hospitalised for the disease between January and 15 November 2020. Design Observational cohort study. Setting COVID-19 subset of the Optum deidentified electronic health records, including more than 1.8 million patients from across the USA. Participants There were 51 510 hospitalised patients who met the COVID-19 definition, with 37 617 in the laboratory positive cohort and 13 893 in the clinical cohort. Primary and secondary outcome measures Incident acute clinical outcomes, including in-hospital all-cause mortality. Results Respectively, 48% and 49% of the laboratory positive and clinical cohorts were women. The 50- 65 age group was the median age group for both cohorts. The use of antivirals and dexamethasone increased over time, fivefold and twofold, respectively, while the use of hydroxychloroquine declined by 98%. Among adult patients in the laboratory positive cohort, absolute age/sex standardised incidence proportion for in-hospital death changed by -0.036 per month (95% CI -0.042 to -0.031) from March to June 2020, but remained fairly flat from June to November, 2020 (0.001 (95% CI -0.001 to 0.003), 17.5% (660 deaths /3986 persons) in March and 10.2% (580/5137) in October); in the clinical cohort, the corresponding changes were -0.024 (95% CI -0.032 to -0.015) and 0.011 (95% CI 0.007 0.014), respectively (14.8% (175/1252) in March, 15.3% (189/1203) in October). Declines in the cumulative incidence of most acute clinical outcomes were observed in the laboratory positive cohort, but not for the clinical cohort. Conclusion The incidence of adverse clinical outcomes remains high among COVID-19 patients with clinical diagnosis only. Patients with COVID-19 entering the hospital are at elevated risk of adverse outcomes

Characterization of HBsAg decline in the Tenofovir disoproxil fumarate (TDF) and peginterferon alfa 2A (PEG) combination study for chronic hepatitis B (CHB)

This journal suppl. entitled: Conference Abstracts: 24th Annual Conference of APASL, March 12-15, 2015, Istanbul, TurkeyConference Theme: New Horizons from East to west in HepatologyTopic 10 - Hepatitis B: no. 1149AIM: In study GS-US-174-0149, finite treatment for CHB with (TDF + PEG) 9 48 weeks increases rates of HBsAg loss at week 48 compared to TDF or PEG monotherapy (Kaplan–Meier estimate: 7.5, 0, and 2.4 %, respectively). Quantitative HBsAg data were analyzed to understand on-treatment HBsAg decline by treatment arm. METHODS: 740 patients with non-cirrhotic CHB were randomized 1: 1:1: 1 to (TDF + PEG) 9 48 weeks (Arm A); (TDF + PEG) 9 16 weeks followed by TDF 9 32 weeks (Arm B); continuous TDF (Arm C); PEG 9 48 weeks (Arm D). Quantitative HBsAg levels at baseline and on-treatment were analyzed and compared using Fisher’s or Wilcoxon tests. RESULTS: At baseline, for Arms A-D, respectively, 0.5 %, 1.6 %, 0 %, 1.1 % had HBsAg levels\10 IU/ml (p[0.05). By week 24, 11.1, 4.0, 0.6 and 5.8 % had HBsAg levels\10 IU/ml for Arms A-D, respectively (P\0.05). At Week 48, 15.8, 3.1, 1.2 and 11.3 % achieved HBsAg levels\10 IU/ml for Arms A-D, respectively (P\0.05); though there was no difference between Arms A vs. D (P = 0.26). Significant on-treatment reductions from baseline in HBsAg were seen at Week 48 in Arms A versus D (mean HBsAg change from baseline, -1.1 log10 IU/ml and -0.8 log10 IU/ml, respectively, P\0.05). CONCLUSION: PEG monotherapy and (TDF + PEG) 9 48 weeks resulted in significant on-treatment HBsAg reductions. Despite achieving similar percentages of on-treatment HBsAg\10 IU/mL, patients on TDF + PEG combination therapy for 48 weeks achieved higher rates of HBsAg loss and more profound drop in HBsAg titers than PEG monotherapy at week 48

Predictors of response to tenofovir disoproxil fumarate plus peginterferon alfa-2a combination therapy for chronic hepatitis B

Gilead Sciences, In

Combination of Tenofovir Disoproxil Fumarate and Peginterferon alfa-2a Increases Loss of Hepatitis B Surface Antigen in Patients with Chronic Hepatitis B

Background and aims Patients chronically infected with the hepatitis B virus rarely achieve loss of serum hepatitis B surface antigen (HBsAg) with the standard of care. We evaluated HBsAg loss in patients receiving the combination of tenofovir disoproxil fumarate (TDF) and peginterferon alfa-2a (peginterferon), for a finite duration, in a randomized trial Methods In an open-label, active-controlled study, 740 patients with chronic hepatitis B were randomly assigned to receive TDF plus peginterferon for 48 weeks (group A), TDF plus peginterferon for 16 weeks followed by TDF for 32 weeks (group B), TDF for 120 weeks (group C), or peginterferon for 48 weeks (group D). The primary endpoint was the proportion of patients with serum HBsAg loss at week 72. Results At week 72, 9.1% of subjects in group A had HBsAg loss, compared with 2.8% of subjects in group B, none of the subjects in group C, and 2.8% of subjects in group D. A significantly higher proportion of subjects in group A had HBsAg loss than in group C (P<.001) or group D (P=.003). However, the proportions of subjects with HBsAg loss did not differ significantly between group B and group C (P=.466) or group D (P=.883). HBsAg loss in group A occurred in hepatitis B e antigen-positive and - negative patients with all major viral genotypes. The incidence of common adverse events (including headache, alopecia, and pyrexia) and treatment discontinuation due to adverse events was similar among groups. Conclusion A significantly greater proportion of patients receiving TDF plus peginterferon for 48 weeks had HBsAg loss than those receiving TDF or peginterferon alone. ClinicalTrials.gov no: NCT01277601

Predictors of response to tenofovir disoproxil fumarate plus peginterferon alfa-2a combination therapy for chronic hepatitis B

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