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  • Wiley  (28)
  • Lee, Hye Won  (28)
  • 1
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    MAFLD might be better in identifying subjects with sarcopenia or cardiovascular risk than NAFLD: A nationwide study
    Wiley ; 2023
    In:  Journal of Gastroenterology and Hepatology Vol. 38, No. 9 ( 2023-09), p. 1598-1609
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    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
    URL: Article
    DOI: 10.1111/jgh.v38.9
    DOI: 10.1111/jgh.16261
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2006782-3
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  • 2
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    Association between the severity of liver fibrosis and cardiovascular outcomes in patients with type 2 diabetes
    Wiley ; 2021
    In:  Journal of Gastroenterology and Hepatology Vol. 36, No. 6 ( 2021-06), p. 1703-1713
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    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
    URL: Article
    DOI: 10.1111/jgh.v36.6
    DOI: 10.1111/jgh.15387
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2006782-3
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  • 3
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    Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than non‐alcoholic fatty liver disease
    Wiley ; 2023
    In:  Liver International Vol. 43, No. 3 ( 2023-03), p. 608-625
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    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
    URL: Article
    DOI: 10.1111/liv.v43.3
    DOI: 10.1111/liv.15508
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2124684-1
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  • 4
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    A multi‐centre study of trends in hepatitis B virus‐related hepatocellular carcinoma risk over time during long‐term entecavir therapy
    Wiley ; 2020
    In:  Journal of Viral Hepatitis Vol. 27, No. 12 ( 2020-12), p. 1352-1358
    Details
    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
    URL: Article
    DOI: 10.1111/jvh.v27.12
    DOI: 10.1111/jvh.13384
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2007924-2
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  • 5
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    Screening, confirmation, and treatment rates of hepatitis C virus infection in a tertiary academic medical center in South Korea
    Wiley ; 2021
    In:  Journal of Gastroenterology and Hepatology Vol. 36, No. 9 ( 2021-09), p. 2479-2485
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    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
    URL: Article
    DOI: 10.1111/jgh.v36.9
    DOI: 10.1111/jgh.15514
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2006782-3
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  • 6
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    Switching from tenofovir and nucleoside analogue therapy to tenofovir monotherapy in virologically suppressed chronic hepatitis B patients with antiviral resistance
    Wiley ; 2018
    In:  Journal of Medical Virology Vol. 90, No. 3 ( 2018-03), p. 497-502
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    In: Journal of Medical Virology, Wiley, Vol. 90, No. 3 ( 2018-03), p. 497-502
    Abstract: It is unclear whether chronic hepatitis B (CHB) patients with antiviral resistance, who achieve a complete virologic response (CVR) with tenofovir disoproxil fumarate (TDF) and nucleoside analogue (NUC) combination therapy, maintain CVR if switched to TDF monotherapy. We investigated the persistence of CVR after cessation of NUC in virologically suppressed antiviral resistant CHB patients using TDF+NUC combination therapy. This study recruited 76 antiviral‐resistant CHB patients showing CVR on TDF+entecavir (ETV) ( n  = 52), TDF+lamivudine (LAM; n  = 14), and TDF+telbivudine (LdT; n  = 10) combination therapy, who were switched to TDF monotherapy as step‐down therapy. At baseline, 47 patients were male and the median age was 53.0 years (range: 30‐78 years); 72.3% cases were hepatitis B e antigen‐positive (HBeAg+) and 23.7% were of liver cirrhosis. The median duration of TDF+NUC combination therapy was 20.8 months (range: 3‐46 months). At a median follow‐up of 24.7 months (range: 12‐48 months) after switching to TDF monotherapy, all 76 patients maintained CVR, regardless of the duration of combination therapy and the type of prior NUC and antiviral resistance. Renal dysfunction was not observed during the treatment period. The step‐down strategy of switching from TDF+NUC combination therapy to TDF monotherapy in virologically suppressed CHB patients with antiviral resistance should be considered.
    Type of Medium: Online Resource
    ISSN: 0146-6615 , 1096-9071
    URL: Issue
    URL: Article
    DOI: 10.1002/jmv.v90.3
    DOI: 10.1002/jmv.24986
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 752392-0
    detail.hit.zdb_id: 1475090-9
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  • 7
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    Controlled attenuation parameter ( CAP ) for detection of hepatic steatosis in patients with chronic liver diseases: a prospective study of a native Korean population
    Wiley ; 2014
    In:  Liver International Vol. 34, No. 1 ( 2014-01), p. 102-109
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    In: Liver International, Wiley, Vol. 34, No. 1 ( 2014-01), p. 102-109
    Abstract: Controlled attenuation parameter ( CAP ) is a non‐invasive method of measuring hepatic steatosis using a process based on transient elastography. We investigated the diagnostic accuracy of CAP in detecting hepatic steatosis in patients with chronic liver disease ( CLD ). Methods A total of 135 patients with CLD who underwent liver biopsy and CAP were consecutively enrolled in this prospective study. The performance of CAP for detection of hepatic steatosis compared with liver biopsy was calculated using area under receiver operating characteristics curves ( AUROC ). Steatosis was categorized into S0 ( 〈 5%), S1 (5–33%), S2 (34–66%) and S3 ( 〉 66% of hepatocytes). Results Male gender predominated ( n  = 87, 64%) and the median age was 51 years. The aetiologies of CLD included non‐alcoholic fatty liver disease ( n  = 56, 41.5%) and chronic viral hepatitis because of hepatitis B ( n  = 47, 34.8%) and C ( n  = 12, 8.9%). Steatosis repartition was: S0 31.1% ( n  = 42), S1 43.7% ( n  = 59), S2 18.5% ( n  = 25) and S3 6.7% ( n  = 9) respectively. In the multivariate analysis, steatosis grade and body mass index were independently associated with CAP (all P  〈   0.001), whereas fibrosis stage and activity grade were not. The AUROC s of CAP were 0.885 for ≥S1 (sensitivity 73.1%, specificity 95.2%), 0.894 for ≥S2 (sensitivity 82.4%, specificity 86.1%) and 0.800 for S3 (sensitivity 77.8%, specificity 84.1%). The optimal cut‐off CAP values that maximized the Youden index were 250 dB/m (≥S1), 299 dB/m (≥S2), and 327 dB/m (=S3) respectively. Conclusions Our data showed that CAP had high diagnostic accuracy for detecting hepatic steatosis in patients with CLD and suggested that CAP is also applicable for Asian patients.
    Type of Medium: Online Resource
    ISSN: 1478-3223 , 1478-3231
    URL: Issue
    URL: Article
    DOI: 10.1111/liv.2013.34.issue-1
    DOI: 10.1111/liv.12282
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 2124684-1
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  • 8
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    External validation of the modified PAGE‐B score in Asian chronic hepatitis B patients receiving antiviral therapy
    Wiley ; 2019
    In:  Liver International Vol. 39, No. 9 ( 2019-09), p. 1624-1630
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    In: Liver International, Wiley, Vol. 39, No. 9 ( 2019-09), p. 1624-1630
    Abstract: The modified PAGE‐B (mPAGE‐B) score comprising age, gender, platelet count and albumin was recently proposed to predict hepatocellular carcinoma (HCC) risk among chronic hepatitis B (CHB) patients undergoing antivirals. Here, in the independent cohort, we externally validated the predictive performance of the mPAGE‐B score and compared it with those of conventional HCC prediction models. Methods We consecutively recruited CHB patients treated with lamivudine, entecavir or tenofovir as the first‐line antiviral regimen. Patients with decompensated cirrhosis or HCC at baseline were excluded. Predictive performances of the mPAGE‐B score and other models were assessed with comparison. Results Among 1330 patients, 9.6% developed HCC during follow‐up. The mPAGE‐B score provided the highest Harrell's c‐index (0.769), followed by the GAG‐HCC (0.751), PAGE (0.744), REACH‐B (0.686) and CU‐HCC (0.618) scores. The mPAGE‐B score showed the similar performance to the PAGE‐B and GAG‐HCC scores and the better performance than the REACH‐B and CU‐HCC scores. Cumulative HCC probabilities at 5‐ and 7‐years were 0.0% and 0.0% in low‐risk group (mPAGE‐B score ≤ 8), 6.1% and 10.8% in intermediate‐risk group (mPAGE‐B score 9‐12) and 18.7% and 26.7% in high‐risk group (mPAGE‐B score ≥ 13) respectively (both P   〈  0.001 between adjacent two groups). C‐indices of the mPAGE‐B score were 0.785 and 0.724 among subgroups treated with entecavir or tenofovir (n = 1011) and with lamivudine (n = 319), respectively, which are overall similar to those of the PAGE‐B score. Conclusion The mPAGE‐B score showed acceptable predictive performances. Compared to the PAGE‐B score, addition of albumin as a constituent provided the marginal benefit.
    Type of Medium: Online Resource
    ISSN: 1478-3223 , 1478-3231
    URL: Issue
    URL: Article
    DOI: 10.1111/liv.v39.9
    DOI: 10.1111/liv.14129
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2124684-1
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  • 9
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    Feasibility of dynamic risk prediction for hepatocellular carcinoma development in patients with chronic hepatitis B
    Wiley ; 2018
    In:  Liver International Vol. 38, No. 4 ( 2018-04), p. 676-686
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    In: Liver International, Wiley, Vol. 38, No. 4 ( 2018-04), p. 676-686
    Abstract: Several risk prediction models for hepatocellular carcinoma ( HCC ) development are available. We explored whether the use of risk prediction models can dynamically predict HCC development at different time points in chronic hepatitis B ( CHB ) patients. Methods Between 2006 and 2014, 1397 CHB patients were recruited. All patients underwent serial transient elastography at intervals of 〉 6 months. Results The median age of this study population (931 males and 466 females) was 49.0 years. The median CU ‐ HCC , REACH ‐B, LSM ‐ HCC and mREACH ‐B score at enrolment were 4.0, 9.0, 10.0 and 8.0 respectively. During the follow‐up period (median, 68.0 months), 87 (6.2%) patients developed HCC . All risk prediction models were successful in predicting HCC development at both the first liver stiffness ( LS ) measurement (hazard ratio [ HR ] = 1.067‐1.467 in the subgroup without antiviral therapy [ AVT ] and 1.096‐1.458 in the subgroup with AVT ) and second LS measurement ( HR  = 1.125‐1.448 in the subgroup without AVT and 1.087‐1.249 in the subgroup with AVT ). In contrast, neither the absolute nor percentage change in the scores from the risk prediction models predicted HCC development (all P  〉   .05). The mREACH ‐B score performed similarly or significantly better than did the other scores ( AUROC s at 5 years, 0.694‐0.862 vs 0.537‐0.875). Conclusions Dynamic prediction of HCC development at different time points was achieved using four risk prediction models, but not using the changes in the absolute and percentage values between two time points. The mREACH ‐B score was the most appropriate prediction model of HCC development among four prediction models.
    Type of Medium: Online Resource
    ISSN: 1478-3223 , 1478-3231
    URL: Issue
    URL: Article
    DOI: 10.1111/liv.2018.38.issue-4
    DOI: 10.1111/liv.13583
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 10
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    Red cell volume distribution width‐to‐platelet ratio in assessment of liver fibrosis in patients with chronic hepatitis B
    Wiley ; 2016
    In:  Liver International Vol. 36, No. 1 ( 2016-01), p. 24-30
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    In: Liver International, Wiley, Vol. 36, No. 1 ( 2016-01), p. 24-30
    Abstract: Precise assessment of liver fibrosis is necessary in patients with chronic liver disease. We investigated the performance of red cell volume distribution width‐to‐platelet ratio for the assessment of liver fibrosis in patients with chronic hepatitis B. Methods A total of 482 consecutive patients with chronic hepatitis B who underwent liver biopsy between October 2005 and May 2014 were recruited. Liver stiffness was measured using transient elastography. FIB ‐4 score, red cell volume distribution width‐to‐platelet ratio and the aspartate aminotransferase‐to‐platelet ratio index were also assessed. Results A total of 271 (56.2%) patients were males. The median age was 44 years. F1, F2, F3 and F4 fibrosis stages were identified in 68 (14.1%), 137 (28.4%), 64 (13.3%) and 213 (44.2%) of the patients respectively. The mean red cell volume distribution width‐to‐platelet ratio increased with liver fibrosis severity: F1, 0.065; F2, 0.077; F3, 0.097 and F4, 0.121 ( P   〈  0.01). The area under the receiver operating characteristic curve of the red cell volume distribution width‐to‐platelet ratio for predicting significant fibrosis (≥F2) was 0.747. This result was inferior to transient elastography (0.866, P  =   0.004), but comparable to FIB ‐4 (0.782, P  =   0.427) and aspartate aminotransferase‐to‐platelet ratio index (0.716, P  =   0.507). The area under the receiver operating characteristic curve of red cell volume distribution width‐to‐platelet ratio for predicting cirrhosis (F4) was 0.811, which was inferior to liver stiffness (0.915, P  〈   0.001), but comparable to FIB ‐4 (0.804, P  =   0.805) and superior to aspartate aminotransferase‐to‐platelet ratio index (0.680, P  〈   0.001). Conclusions The accuracy of red cell volume distribution width‐to‐platelet ratio was acceptable for the assessment of liver fibrosis in patients with chronic hepatitis B. When transient elastography is not available, red cell volume distribution width‐to‐platelet ratio assessment is a simple method that can be used to reduce the need for liver biopsy.
    Type of Medium: Online Resource
    ISSN: 1478-3223 , 1478-3231
    URL: Issue
    URL: Article
    DOI: 10.1111/liv.2016.36.issue-1
    DOI: 10.1111/liv.12868
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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