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  • Wiley  (26)
  • Kim, Beom Kyung  (26)
  • Lee, Hye Won  (26)
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  • Wiley  (26)
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  • 1
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 38, No. 9 ( 2023-09), p. 1598-1609
    Abstract: Clinical features of non‐alcoholic fatty liver disease (NAFLD), but not fulfilling the diagnostic criteria of metabolic dysfunction‐associated fatty liver disease (MAFLD), remain unclear. We investigated the risk of sarcopenia and cardiovascular disease (CVD) in MAFLD and non‐metabolic risk (MR) NAFLD. Methods Subjects were selected from the Korean National Health and Nutrition Examination Surveys 2008–2011. Liver steatosis was assessed using fatty liver index. Significant liver fibrosis was defined using fibrosis‐4 index, categorized by age cut‐offs. Sarcopenia was defined as the lowest quintile sarcopenia index. Atherosclerotic CVD (ASCVD) risk score 〉  10% was defined as high probability. Results A total of 7248 subjects had fatty liver (137 with non‐MR NAFLD, 1752 with MAFLD/non‐NAFLD, and 5359 with overlapping MAFLD and NAFLD). In non‐MR NAFLD group 28 (20.4%) had significant fibrosis. The risk of sarcopenia (adjusted odds ratio [aOR] = 2.71, 95% confidence index [CI]  = 1.27–5.78) and high probability of ASCVD (aOR = 2.79, 95% CI = 1.23–6.35) was significantly higher in MAFLD/non‐NAFLD group than in non‐MR NAFLD group (all P   〈  0.05). The risk of sarcopenia and high probability of ASCVD was similar between subjects with and without significant fibrosis in non‐MR NAFLD group (all P   〉  0.05). However, the risk was significantly higher in MAFLD group than in non‐MR NAFLD group (aOR = 3.38 for sarcopenia and 3.73 for ASCVD; all P   〈  0.05). Conclusions The risks of sarcopenia and CVD were significantly higher in MAFLD group but did not differ according to fibrotic burden in non‐MR NAFLD group. The MAFLD criteria might be better for identifying high‐risk fatty liver disease than the NAFLD criteria.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2006782-3
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  • 2
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 36, No. 6 ( 2021-06), p. 1703-1713
    Abstract: Cardiovascular disease (CVD) is the principal cause of death in patients with type 2 diabetes (T2D). In this study, we assessed whether liver fibrosis predicted the risk of CVD in patients with T2D. Methods A total of 1481 patients who had commenced oral antidiabetic drugs to treat newly diagnosed T2D between 2006 and 2010 were recruited. The fibrosis‐4 index (FIB‐4), non‐alcoholic fatty liver disease fibrosis score (NFS), and BARD score were used to assess fibrotic burden at the time of T2D diagnosis. Results During the follow‐up period (median 88.1 [interquartile range 36.6–113.6] months), 242 (16.3%) patients developed CVD. CVD occurred frequently in older patients and was associated with hypertension; metabolic syndrome; obesity; smoking; administration of statin, which is an antihyperlipidemic drug; lower platelet counts; lower alanine aminotransferase, total cholesterol, and HbA1c levels; higher C‐peptide and homeostatic model assessment of insulin resistance levels; and higher FIB‐4, NFS, and BARD score (all P   〈  0.05). FIB‐4 (hazard ratio [HR] = 1.163), NFS (HR = 1.322), BARD score (HR = 1.564), metabolic syndrome (HR = 1.556), smoking (HR = 2.829), and statin use (HR = 0.603) independently predicted the risk of CVD (all P   〈  0.05). The cumulative incidence of CVD was significantly different among groups stratified by liver fibrotic burden (all P   〈  0.05, log‐rank test). Competing risk analysis showed a significant association between the severity of liver fibrosis and CVD development (all P   〈  0.001, Gray's test). Conclusions The severity of liver fibrosis independently predicted CVD in patients with T2D. Thus, assessment of liver fibrosis might allow physicians to optimize the timing of appropriate cardiovascular interventions in such patients.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2006782-3
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  • 3
    In: Liver International, Wiley, Vol. 43, No. 3 ( 2023-03), p. 608-625
    Abstract: Cardiovascular disease (CVD) is the main cause of mortality in subjects with non‐alcoholic fatty liver disease (NAFLD). We investigated the association between CVD risk and metabolic dysfunction‐associated fatty liver disease (MAFLD) or NAFLD and the influence of significant liver fibrosis on the CVD risk. Methods Subjects who underwent a comprehensive medical check‐up were recruited (2014–2019). Significant liver fibrosis was defined using NAFLD fibrosis score, fibrosis‐4 index, aspartate aminotransferase to platelet ratio index, or FibroScan‐aspartate aminotransferase score. High probability of atherosclerotic CVD (ASCVD) was defined as ASCVD risk score  〉  10%. Results Of the study population ( n  = 78 762), 27 047 (34.3%) and 24 036 (30.5%) subjects had MAFLD and NAFLD respectively. A total of 1084 (4.0%) or 921 (3.8%) subjects had previous CVD history in MAFLD or NAFLD subgroup respectively. The previous CVD history and high probability of ASCVD were significantly higher in MAFLD or NAFLD subgroup with significant liver fibrosis than in the other groups (all p   〈  .001). In multivariable analysis, MAFLD was independently associated with previous CVD history after adjusting for confounders (adjusted odds ratio [aOR] = 1.10, p  = .038), whereas NAFLD was not (all p   〉  .05). MAFLD (aOR = 1.40) or NAFLD (aOR = 1.22) was independently associated with high probability of ASCVD after full adjustment respectively (all p   〈  .001). Significant liver fibrosis was independently associated with previous CVD history and high probability of ASCVD after adjustment in MAFLD or NAFLD subgroup respectively (all p   〈  .05). Conclusion MAFLD might better identify subjects with CVD risk than NAFLD. Fibrosis assessment might be helpful for detailed prognostication in subjects with MAFLD.
    Type of Medium: Online Resource
    ISSN: 1478-3223 , 1478-3231
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2124684-1
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  • 4
    In: Journal of Viral Hepatitis, Wiley, Vol. 27, No. 12 ( 2020-12), p. 1352-1358
    Abstract: The risk of developing hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC) is reduced by antiviral therapy. Here, we evaluated the chronological trends in HCC development risk starting in 2007, when entecavir reimbursement was first initiated in South Korea. Treatment‐naïve patients with chronic hepatitis B (CHB) receiving entecavir 0.5 mg/d were stratified into three groups according to entecavir start time: early (2007‐2010), middle (2011‐2012) and late (2013‐2014) cohorts Among 2442 patients, cumulative probabilities of developing HCC after 1, 3 and 5 years were, respectively, 1.7%, 5.1%, and 8.2% (early cohort; n = 672); 1.5%, 5.1% and 8.9% (middle cohort; n = 757); and 1.2%, 5.3% and 10.6% (late cohort; n = 1013; P   〉  .05 between each pair). Older age, male, positive hepatitis B e antigen, liver cirrhosis, Child‐Pugh class B (vs A) and lower platelet count significantly predicted HCC development in univariate analysis ( P   〈  .001), whereas entecavir start time (early vs middle vs late cohorts) did not affect the risk of HCC development ( P  = .457). A multivariate analysis revealed that older age (adjusted hazard ratio [aHR]=1.041), male gender (aHR = 2.069), liver cirrhosis (aHR = 3.771) and Child‐Pugh class B (vs A, aHR = 1.548) were independently associated with an increased risk of HCC development, whereas higher platelet count was independently associated with a reduced risk of HCC development (aHR = 0.993; all P   〈  .05). In conclusion, the risk of developing HCC among patients receiving entecavir in South Korea has been stable since 2007. To establish more effective HCC surveillance programs, further studies regarding the carcinogenic roles of nonviral factors are required.
    Type of Medium: Online Resource
    ISSN: 1352-0504 , 1365-2893
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2007924-2
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  • 5
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 36, No. 9 ( 2021-09), p. 2479-2485
    Abstract: Several barriers prevent the proper screening, diagnosis, and treatment of hepatitis C virus (HCV) infection. We aimed to evaluate the status of HCV screening, confirmation, and treatment rates in a tertiary academic medical center in Korea. Methods Patients who visited Severance Hospital between 2015 and 2019 were eligible in this retrospective study. The testing and positivity rates for anti‐HCV antibodies and HCV RNA were sequentially analyzed. Results Between 2015 and 2019, 252 057 patients (117 131 men, 46.5%) who underwent anti‐HCV antibody testing were retrospectively reviewed. The median age of the study population was 51.0 years. Patients with positive anti‐HCV antibody test results ( n  = 2623, 1.0%) showed a higher proportion of liver cirrhosis (17.6% vs 2.0%) and unfavorable laboratory test results (all P   〈  0.05). The positivity rates were 1.3% and 0.8% in the medical and surgical departments, respectively. HCV RNA was tested in 1628 (62.1%) patients, with a 57.4% ( n  = 928) positivity rate. The medical department had a higher HCV RNA testing rate than the surgical department (75.4% vs 40.8%). Among the 928 patients who showed positivity for HCV RNA, 847 (90.7%) underwent genotype testing (mostly 1 and 2 [95.4%]). The treatment rate was 66.9% ( n  = 567); it was higher in the gastroenterology department (70.8%) than in the non‐gastroenterology departments (62.3%). Conclusions A considerable proportion of patients testing positive for anti‐HCV antibodies were not referred for proper management. Systematic and automated screening and referral systems, which may help identify patients requiring treatment for HCV infection, are necessary even in tertiary academic medical centers.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2006782-3
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  • 6
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 38, No. 8 ( 2023-08), p. 1372-1380
    Abstract: Hepatic decompensation is a major complication of liver cirrhosis. We validated the predictive performance of the newly proposed CHESS‐ALARM model to predict hepatic decompensation in patients with hepatitis B virus (HBV)‐related cirrhosis and compared it with other transient elastography (TE)‐based models such as liver stiffness‐spleen size‐to‐platelet (LSPS), portal hypertension (PH), varices risk scores, albumin‐bilirubin (ALBI), and albumin‐bilirubin‐fibrosis‐4 (ALBI‐FIB‐4). Methods Four hundred eighty‐two patients with HBV‐related liver cirrhosis between 2006 and 2014 were recruited. Liver cirrhosis was clinically or morphologically defined. The predictive performance of the models was assessed using a time‐dependent area under the curve (tAUC). Results During the study period, 48 patients (10.0%) developed hepatic decompensation (median 93 months). The 1‐year predictive performance of the LSPS model (tAUC = 0.8405) was higher than those of the PH model (tAUC = 0.8255), ALBI‐FIB‐4 (tAUC = 0.8168), ALBI (tAUC = 0.8153), CHESS‐ALARM (tAUC = 0.8090), and variceal risk score (tAUC = 0.7990). The 3‐year predictive performance of the LSPS model (tAUC = 0.8673) was higher than those of the PH risk score (tAUC = 0.8670), CHESS‐ALARM (tAUC = 0.8329), variceal risk score (tAUC = 0.8290), ALBI‐FIB‐4 (tAUC = 0.7730), and ALBI (tAUC = 0.7451). The 5‐year predictive performance of the PH risk score (tAUC = 0.8521) was higher than those of the LSPS (tAUC = 0.8465), varices risk score (tAUC = 0.8261), CHESS‐ALARM (tAUC = 0.7971), ALBI‐FIB‐4 (tAUC = 0.7743), and ALBI (tAUC = 0.7541). However, there was no significant difference in the predictive performance among all models at 1, 3, and 5 years ( P   〉  0.05). Conclusions The CHESS‐ALARM score was able to reliably predict hepatic decompensation in patients with HBV‐related liver cirrhosis and showed similar performance to the LSPS, PH, varices risk scores, ALBI, and ALBI‐FIB‐4.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2006782-3
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  • 7
    In: Journal of Viral Hepatitis, Wiley, Vol. 28, No. 11 ( 2021-11), p. 1570-1578
    Abstract: It is unclear whether tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) is more effective for preventing hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B (CHB). In this study, we compared the effectiveness of these two antiviral agents for preventing HCC. We included treatment‐naïve CHB patients undergoing antiviral therapy with TDF only (TDF group) or a TAF‐based regimen (TAF group) at three academic teaching hospitals from 2012 to 2019. The TAF group included patients receiving TAF as first‐line treatment and patients switching from TDF to TAF. Patients with decompensated cirrhosis or HCC at enrollment were excluded. Cumulative probabilities of HCC were assessed using Kaplan‐Meier methodology. In total, 2,117 patients were included: 1,832 in the TDF group and 285 in the TAF group. The annual HCC incidence was not significantly different between TDF and TAF groups: 1.66 vs. 1.19 per 100 person‐years [PY], respectively (multivariate analysis: adjusted hazard ratio [HR] 0.774 [reference: TDF group]; p  = .438). Male, liver cirrhosis, hepatitis B e antigen negativity, Fibrosis‐4 index 〉 3.25 and low albumin were independently associated with a higher risk of HCC. Propensity score‐matched and inverse probability of treatment weighting analyses yielded similar results: 1.56 vs. 1.19 per 100 PY, respectively (HR 1.175; p  = .708) and 1.66 vs. 1.29 per 100 PY, respectively (HR 0.888; p  = .446). The risk of HCC development was not significantly different between TDF and TAF groups of CHB patients. Further studies with a larger sample size and longer follow‐up are required to validate our results.
    Type of Medium: Online Resource
    ISSN: 1352-0504 , 1365-2893
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2007924-2
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  • 8
    In: Journal of Viral Hepatitis, Wiley, Vol. 29, No. 4 ( 2022-04), p. 289-296
    Abstract: Renal safety is a critical issue in chronic hepatitis B (CHB) patients receiving long‐term entecavir (ETV) or tenofovir disofuroxil fumarate (TDF) therapy. We investigated their effects on estimated glomerular filtration rate (eGFR). Treatment‐naive CHB patients receiving ETV or TDF for ≥1 year were recruited. The eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration equation. We calculated average annual percent change (AAPC) in eGFR using Joinpoint regression. At the beginning of the observation, the ETV group had more unfavorable conditions than the TDF group: lower eGFR and higher FIB‐4 and APRI than the TDF group (all p   〈  .001). After 6 years of antiviral therapy, the mean eGFR in the ETV group ( n  = 1793) was maintained (96.0 at first year to 95.6 ml/min/1.73 m 2 at sixth year; AAPC −0.09%; p  = .322), whereas that in the TDF group ( n  = 1240) significantly decreased annually (101.9 at first year to 96.9 ml/min/1.73 m 2 at sixth year; AAPC −0.88%; p   〈  .001). Notably, in the TDF group, even patients without diabetes (AAPC −0.80%; p  = 0.001) or hypertension (AAPC −0.87%; p  = .001) experienced significant decrease in eGFR. Expectably, accompanying diabetes (AAPC −1.59%; p  = .011) or hypertension (AAPC −1.00%; p  = .002) tended to accelerate eGFR decrease. TDF treatment (odds ratio 1.66, p   〈  .001), along with eGFR 〈 60 ml/min/1.73 m 2 , serum albumin 〈 3.5 mg/dl, and hypertension, were independently associated with ongoing renal dysfunction, defined as a negative slope of the mean eGFR change. In conclusion, compared with ETV, long‐term TDF treatment induced slow, but progressive renal dysfunction. Although the annual eGFR change by TDF was small, careful monitoring is necessary, especially in patients requiring life‐long therapy.
    Type of Medium: Online Resource
    ISSN: 1352-0504 , 1365-2893
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2007924-2
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  • 9
    In: Hepatology Research, Wiley, Vol. 51, No. 4 ( 2021-04), p. 406-416
    Abstract: Risk prediction models for hepatocellular carcinoma (HCC) development are available. However, the influence of antiviral therapy (AVT) on these models in patients with chronic hepatitis B is unknown. Methods The dynamic changes in risk prediction models during AVT and the association between risk prediction model and the risk of chronic hepatitis B‐related HCC development were investigated. Between 2005 and 2017, 4917 patients with chronic hepatitis B (3361 noncirrhotic, 1556 cirrhotic) were recruited. Results The mean age of the study population was 49.3 years and 60.6% ( n  = 2980) of the patients were male. The mean Chinese University‐HCC (CU‐HCC) score was 12.7 at baseline in the overall study population, and decreased significantly (mean, 8.7) after 1 year of AVT ( p   〈  0.001). The score was maintained throughout 5 years of AVT (mean, 8.4–8.8; p   〉  0.05). The proportion of high‐risk patients (CU‐HCC score ≥ 20) was 28.9% at baseline, and decreased significantly after 1 year of AVT (5.0%; p   〈  0.001), and remained stable through 5 years of AVT (2.2%–3.6%; p   〉  0.05). In addition to the score at baseline, the CU‐HCC score at 1 year of AVT independently predicted the risk of HCC development (hazard ratio = 1.072; p   〈  0.001), together with male gender and platelet count (all p   〈  0.05). Conclusions The CU‐HCC score significantly decreased at 1 year of AVT and was maintained thereafter. The CU‐HCC score after 1 year of AVT independently predicted the risk of HCC development in patients with chronic hepatitis B.
    Type of Medium: Online Resource
    ISSN: 1386-6346 , 1872-034X
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2006439-1
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  • 10
    In: Journal of Viral Hepatitis, Wiley, Vol. 27, No. 9 ( 2020-09), p. 932-940
    Abstract: The use of tenofovir disoproxil fumarate (TDF) is associated with a risk of renal dysfunction. We investigated whether TDF is associated with the deterioration of renal function in patients with hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC) requiring frequent computed tomography (CT) evaluations and transarterial chemoembolization (TACE) sessions, when compared to entecavir (ETV). Between 2007 and 2017, 493 patients with HBV‐related HCC were enrolled. The number of CT evaluations and TACE sessions were collected through 3 years of follow‐up. The median age of the study population (373 men and 120 women; 325 with ETV and 168 with TDF) was 56.5 years. TDF was significantly associated with a serum creatinine increase (≥25% from the baseline; unadjusted hazard ratio [uHR] = 1.620) and an estimated glomerular filtration rate (eGFR) reduction ( 〈 20% from the baseline) (uHR = 1.950) (all P   〈  .05), when compared to ETV. In addition, CT evaluations ≥4 times/year were significantly associated with a serum creatinine increase (uHR = 2.709), eGFR reduction (uHR = 3.274) and chronic kidney disease (CKD) progression (≥1 CKD stage from the baseline) (uHR = 1.980) (all P   〈  .05). In contrast, TACE was not associated with all renal dysfunction parameters (all P   〉  .05). After adjustment, TDF use was independently associated with the increased risk of eGFR reduction (adjusted HR [aHR] = 1.945; P  = .023), whereas CT evaluation ≥4 times/year was independently associated with the increased risk of serum creatinine increase (aHR = 2.898), eGFR reduction (aHR = 3.484) and CKD progression (aHR = 1.984) (all P   〈  .01). In conclusion, patients with HBV‐related HCC treated with TDF and frequent CT evaluations should be closely monitored for the detection of associated renal dysfunction.
    Type of Medium: Online Resource
    ISSN: 1352-0504 , 1365-2893
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2007924-2
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