Beom Kyung Kim

Yonsei University, Sŏul, Seoul, South Korea

Are you Beom Kyung Kim?

Claim your profile

Publications (97)370.59 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Little is known about stopping rules of nucelos(t)ide analog (NA) treatment for chronic hepatitis B (CHB). Methods: A total of 113 consecutive patients with CHB (45 HBeAg-positive and 68 HBeAg-negative CHB patients), who met the cessation criteria of NA treatment as per the Asian-Pacific Association for the Study of the Liver (APASL) guideline, were enrolled in this prospective cohort study. The primary endpoint was to evaluate virological relapse (VR) rate within 1 year, which was defined as reappearance of hepatitis B virus (HBV)-DNA > 2000 IU/mL after cessation of NA treatment. In this cohort, entecavir was used in 81 (71.7 %) and lamivudine in 32 (28.3 %) patients. Results: Within 1 year after NA treatment, VR occurred in 26 (57.8 %) HBeAg-positive patients and in 37 (54.4 %) HBeAg-negative patients. In univariate and subsequent multivariate analysis, age > 40 years [odds ratio (OR) 10.959; 95 % confidence interval (CI) 2.211-54.320; P = 0.003) and a pre-treatment HBV DNA level >2000,000 IU/mL (OR 9.285; 95 % CI 1.545-55.795; P = 0.036) were identified as independent risk factors for VR in HBeAg-positive patients, and age > 40 years (OR 6.690; 95 % CI 1.314-34.057; P = 0.022) and an end-of-treatment HBcrAg level >3.7 log IU/mL (OR 3.751; 95 % CI 1.187-11.856; P = 0.024) were identified in HBeAg-negative patients. During follow up, neither hepatic decompensation nor hepatocellular carcinoma (HCC) occurred, and HBV DNA suppression was achieved in all patients who received antiviral re-treatment. Conclusion: Our data suggested that the APASL stopping rule could be applied if a candidate was properly selected using individual risk factors. However, regular monitoring should be performed after cessation of NA treatment and long-term outcomes need to be evaluated further.
    No preview · Article · Dec 2015 · Journal of Gastroenterology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Hepatologists and colonoscopists often hesitate to perform a colonoscopic polypectomy in patients with chronic liver disease (CLD), especially those with cirrhosis, because of the risk of postpolypectomy bleeding (PPB). We aimed to investigate the incidence and risk factors of delayed PPB after a colonoscopic polypectomy in patients with CLD. Materials and methods In total, 152 patients with CLD who underwent colonoscopic polypectomy from December 2005 to December 2012 were retrospectively reviewed. Results Cirrhosis was identified in 80 (52.6%) patients. During the study period, 442 polyps were removed and delayed PPB developed in 14 (9.2%) patients. The incidence of delayed PPB was significantly higher in patients with cirrhosis than in those without the disease (13.8% [n = 11] vs. 4.2% [n = 3], p = 0.041). The polyp size (odds ratio, 1.087; 95% confidence interval, 1.009-1.172) and cirrhosis (odds ratio, 8.535; 95% confidence interval, 2.417-30.140) were independent risk factors for delayed PPB. In patients with cirrhosis, the optimal cut-off size to identify high-risk polyps for delayed PPB was 10 mm (area under the receiver operating characteristics curve, 0.737; sensitivity, 52%; specificity, 88%). Conclusion Caution is needed when colonoscopic polypectomy is planned in patients with CLD who have larger polyps and cirrhosis.
    No preview · Article · Dec 2015 · Scandinavian Journal of Gastroenterology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To investigate the prevalence and the predictors of silent but substantial liver fibrosis in patients with primary Sjogren's syndrome (pSS). Methods We enrolled 101 pSS patients with normal liver function and structures, and without significant liver diseases or other conditions affecting liver fibrosis. The European league against rheumatism (EULAR) SS patients reported index (ESSPRI) and the EULAR SS disease activity index (ESSDAI) were analyzed. Liver stiffness (LS) was measured using transient elastography and 7.4 kPa was determined as the cutoff value for significant liver fibrosis. Results The median age of patients (91women) was 53 years and the median LS value was 4.7 kPa. The median ESSPRI and ESSDAI showed no correlation with LS values. Twelve patients (11.9%) had significant liver fibrosis. In multivariate logistic regression, white blood cells count ≤ 4,000.0/mm(3) (Odds ratio (OR) 9.821), serum albumin ≤ 3.8 mg/dL (OR 16.770) and aspartate aminotransferase ≥ 27.0 IU/L (OR 20.858) independently predicted silent but substantial liver fibrosis in pSS patients. Conclusions The prevalence of silent but substantial liver fibrosis was 11.9% in pSS and its predictors were leukopenia, decreased serum albumin and increased aspartate aminotransferase levels.
    No preview · Article · Nov 2015 · Modern Rheumatology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Most guidelines suggest combination therapy including nucleoside and nucleotide analogues for the treatment of chronic hepatitis B (CHB) with multidrug resistance (MD-R). However, long-term combination treatment can evoke high costs and safety problems. Therefore, we investigated the efficacy of tenofovir disoproxil fumarate (TDF) mono-rescue therapy for viral suppression in patients with CHB exhibiting MD-R. Methods: We reviewed patients with CHB exhibiting antiviral drug resistance treated by TDF mono-rescue therapy from December 2012 to June 2014. The patients were categorized into three groups: lamivudine-resistance (LAM-R) group (n = 290), and LAM-R + adefovir-resistance (ADV-R) group (n = 43), and LAM-R + entecavir-resistance (ETV-R) group (n = 113). We compared the virologic response rate according to the multiplicity of resistance and investigated the predictive factors of a virologic response. Results: For a median of 15 months (range, 6-24 months) of TDF mono-rescue therapy, the cumulative virologic response rates were 82.8%, 81.4%, and 84.1% in the LAM-R, LAM-R + ADV-R, and LAM-R + ETV-R groups, respectively (P = 0.239). Multivariate analysis revealed that multiplicity of resistance did not influence the achievement of a virologic response (P = 0.218). However, the baseline HBV DNA level significantly influenced the achievement of a virologic response for the treatment of CHB with MD-R (P < 0.001). Conclusion: TDF mono-rescue therapy is an appropriate treatment for CHB with MD-R, and the baseline HBV DNA level is a significant predictive factor for a virologic response. These factors should be considered before treating CHB with MD-R. This article is protected by copyright. All rights reserved.
    No preview · Article · Nov 2015 · Journal of Medical Virology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and aims: We aimed to sub-classify hepatocellular carcinoma (HCC) using Barcelona Clinic Liver Cancer (BCLC) intermediate and advanced stages, which include a highly heterogeneous population. Methods: From two registries ("random" and "voluntary" cohorts in the Korean Liver Cancer Study Group), patients who were newly diagnosed as HCC with intermediate or advanced stage between 2003 and 2005 were considered eligible. Overall survival (OS) was analyzed using Kaplan-Meier method with comparison by log-rank test. Results: Patients with intermediate-stage HCC (n = 994) were sub-classified according to tumor size and Child-Pugh class. Patients with tumor size < 5 cm (B-1), those with tumor size ≥ 5 cm & Child-Pugh A (B-2), and those with tumor size ≥ 5 cm & Child-Pugh B (B-3) had median OS of 30.73, 20.60, and 9.23 months, respectively (p < 0.001 by log-rank test). Among patients with advanced stage HCC (n = 1746), patients were sub-classified according to presence of significant portal vein invasion (sPVI; defined as portal vein invasion in lobar, main, or contralateral branch) and extra-hepatic spread (EHS). Patients with neither sPVI nor EHS (C-1), those with either sPVI or EHS (C-2), and those with both sPVI and EHS (C-3) had median OS of 8.43, 4.63, and 3.63 months, respectively (p < 0.001 by log-rank test). Conclusion: Sub-classification of BCLC intermediate and advanced stages might be useful for determining patient prognosis and guiding treatment strategies for HCC. This article is protected by copyright. All rights reserved.
    No preview · Article · Oct 2015 · Journal of Gastroenterology and Hepatology

  • No preview · Article · Sep 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background & aims: Liver fibrosis is a multifactorial disease that can affect the development of cerebral small vessel diseases (SVDs) including cerebral microbleeds (CMBs), leukoaraiosis, and silent infarctions. Transient elastography can accurately assess the degree of liver fibrosis by measuring liver stiffness (LS). In the present study, we investigated the association between SVDs and LS values. Methods: We recruited 300 participants (mean age 56 years, 170 men) who underwent a comprehensive medical health check-up between January 2011 and December 2012. Transient elastography was taken on the right lobe of the liver through intercostal space with patients lying in the dorsal decubitus position with the right arm in maximal abduction. Mild and significant fibrosis were defined as LS values >5.6 and >8.0 kPa, respectively. The presence of each SVD was determined using the FLAIR, GRE MR imaging as well as T1-, T2-weighted MR images. We tested whether the presence and burden of each type of SVD were different by LS values. Results: Of the different types of SVDs, only the presence (p = 0.001) and number of CMBs (p<0.001) were positively associated with LS values. Multivariate analysis revealed that significant fibrosis (>8.0 kPa) was an independent predictor of CMBs (odds ratio 6.079, 95% confidence interval 1.489-24.819, p = 0.012). However, leukoaraiosis and silent infarctions were not associated with LS values (all p>0.05). Conclusions: The degree of liver fibrosis, as assessed using transient elastography, was independently associated with the presence and burden of CMBs in healthy, asymptomatic participants. Understanding the link between the brain and liver may advance future research on the pathomechanisms of CMBs.
    Preview · Article · Sep 2015 · PLoS ONE
  • Beom Kyung Kim · Seung Up Kim

    No preview · Article · Sep 2015 · Journal of Hepatology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background/aims: Few studies have investigated prognostic factors for the development of liver-related events (LREs) in patients with chronic hepatitis C (CHC) who achieve sustained virological response (SVR). Methods: We analyzed 190 patients with CHC who achieved SVR after treatment with pegylated interferon (peg-IFN) plus ribavirin. LREs were defined as any complications related to cirrhosis, hepatocellular carcinoma (HCC), or liver-related mortality. Results: The mean age was 54.1 years, and 84 of the patients (44.2%) were male. The mean liver stiffness (LS) value at SVR was 7.1±5.4 kPa. During the follow-up period (median, 43.0 months), LREs occurred in 10 patients (5.3%; HCC in eight patients, ascites in one patient, and liver-related mortality in one patient). By multivariate Cox regression analysis, age, α-fetoprotein level, and LS value were independent predictors for LRE development (all p<0.05). Patients with LS values ≥7.0 kPa had a greater risk (hazard ratio, 9.472; 95% confidence interval, 1.018 to 88.126; p=0.048) for LRE development compared to those with LS values <7.0 kPa. Conclusions: The LS value at SVR is useful for predicting LRE development in CHC patients who achieve SVR after treatment with peg-IFN plus ribavirin. Thus, LRE surveillance strategies might be optimized according to the LS values at SVR, even with complete viral eradication.
    No preview · Article · Sep 2015 · Gut and Liver
  • [Show abstract] [Hide abstract]
    ABSTRACT: As data on the effectiveness of tumor markers in detecting hepatocellular carcinoma (HCC) in cirrhotic patients are limited, we investigated the diagnostic accuracy of alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II (PIVKA-II), and Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3). This retrospective study enrolled 361 cirrhotic patients with HCC, and 276 cirrhotic patients without HCC occurrence. Most patients were men (n = 431, 67.7%); the median age was 57.0 years. The main etiology of chronic liver disease was chronic hepatitis B (n = 467, 73.3%). The sensitivity and specificity of combined three biomarkers was 87.0 and 60.1% in overall HCC, and 75.7 and 60.1% in early HCC, respectively (cutoff: 20 ng/mL for AFP, 40 mAU/mL for PIVKA-II, and 5% for AFP-L3). The area under the receiver operating characteristic curve (AUROC) for HCC diagnosis was 0.765 (95% confidence interval [CI], 0.728-0.801) for AFP; 0.823 (95% CI, 0.791-0.854) for PIVKA-II; and 0.755 (95% CI, 0.718-0.792) for AFP-L3. The AUROC for early HCC diagnosis was 0.754 (95% CI, 0.691-0.816) for AFP, 0.701 (95% CI, 0.630-0.771) for PIVKA-II, and 0.670 (95% CI, 0.596-0.744) for AFP-L3. Combining the three tumor markers increased the AUROC to 0.877 (95% CI, 0.851-0.903) for HCC diagnosis, and 0.773 (95% CI, 0.704-0.841) for early HCC diagnosis. Diagnostic accuracy improved upon combining the AFP, PIVKA-II, and AFP-L3 tumor markers compared to each marker alone in detecting HCC and early HCC in cirrhotic patients.
    No preview · Article · Sep 2015 · Scandinavian Journal of Gastroenterology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dickkopf-1 (DKK-1) is a Wnt/β-catenin signaling pathway inhibitor. We investigated whether DKK-1 is related to progression in hepatocellular carcinoma (HCC) cells and HCC patients. In vitro reverse-transcription polymerase chain reaction (RT-PCR), wound healing assays, invasion assays, and ELISAs of patient serum samples were employed. The diagnostic accuracy of the serum DKK-1 ELISA was assessed using receiver operating characteristic (ROC) curves and area under ROC (AUC) analyses. RT-PCR showed high DKK-1 expression in Hep3B and low in 293 cells. Similarly, the secreted DKK-1 concentration in the culture media was high in Hep3B and low in 293 cells. Wound healing and invasion assays using 293, Huh7, and Hep3B cells showed that DKK-1 overexpression promoted cell migration and invasion, whereas DKK-1 knock-down inhibited them. When serum DKK-1 levels were assessed in 370 participants (217 with HCC and 153 without), it was significantly higher in HCC patients than in control groups (median 1.48 ng/mL vs. 0.90 ng/mL, p<0.001). The optimum DKK-1 cutoff level was 1.01 ng/mL (AUC=0.829; sensitivity 90.7%; specificity 62.0%). Although DKK-1 had a higher AUC than alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) (AUC=0.829 vs. 0.794 and 0.815, respectively), they were statistically similar (all p>0.05). When three biomarkers were combined (DKK-1 plus AFP plus DCP), they showed significantly higher AUC (AUC=0.952) than single marker, DKK-1 plus AFP, or DKK-1 plus DCP (all p<0.001). DKK-1 might be a key regulator in HCC progression and a potential therapeutic target in HCC. Serum DKK-1 could complement the diagnostic accuracy of AFP and DCP.
    Full-text · Article · Sep 2015 · Yonsei medical journal
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The emergence of compensatory mutations in the polymerase gene of drug resistant hepatitis B virus (HBV) is associated with treatment failure. We previously identified a multi-drug resistant HBV mutant, which displayed resistance towards lamivudine (LMV), clevudine (CLV), and entecavir (ETV), along with a strong replication capacity. The aim of this study was to identify the previously unknown compensatory mutations, and to determine the clinical relevance of this mutation during antiviral therapy. In vitro mutagenesis, drug susceptibility assay, and molecular modeling studies were performed. The rtL269I substitution conferred 2- to 7-fold higher replication capacity in the wild-type (WT) or YMDD mutation backbone, regardless of drug treatment. The rtL269I substitution alone did not confer resistance to LMV, ETV, adefovir (ADV), or tenofovir (TDF). However, upon combination with YMDD mutation, the replication capacity under LMV or ETV treatment was enhanced by several folds. Molecular modeling studies suggested that the rtL269I substitution affects template binding, which may eventually lead to the enhanced activity of rtI269-HBV polymerase in both WT virus and YMDD mutant. The clinical relevance of the rtL269I substitution was validated by its emergence in association with YMDD mutation in chronic hepatitis B (CHB) patients with sub-optimal response or treatment failure to LMV or CLV. Our study suggests that substitution at rt269 in HBV polymerase is associated with multi-drug resistance, which may serve as a novel compensatory mutation for replication-defective multi-drug resistant HBV.
    Full-text · Article · Aug 2015 · PLoS ONE
  • [Show abstract] [Hide abstract]
    ABSTRACT: We investigated the prevalence and predictors of significant liver fibrosis in patients with systemic sclerosis (SSc) who had no evidences of liver diseases due to viral infection, drug, and heavy alcohol consumption. A total of 44 SSc patients were recruited. In addition to the clinical and laboratory data, the 2013 College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria score, modified Rodnan skin score (mRSS), and Medsger's severity score (MSS) were analysed. Liver stiffness (LS) was measured using transient elastography to assess the degree of liver fibrosis and 7.4 kPa was adopted as the cut-off value for significant liver fibrosis. The median age of patients (38 women) was 54 years and the median disease duration was 41.0 months. The median LS value was 4.6 kPa. The median mRSS and MSS were 7.0 and 5.0, respectively. Six (13.6%) patients had significant liver fibrosis. Disease duration (standardised β=0.375, p=0.018) and MSS (standardised β=0.398, p=0.047) significantly correlated with LS values. In multivariate analysis, disease duration ≥63 months (odds ratio (OR) 19.166, 95% confidence interval 1.090, 336.962, p=0.043) and MSS ≥7 (OR 19.796, 95% confidence interval 1.439, 272.252, p=0.026) independently predicted the presence of significant liver fibrosis. The prevalence of significant liver fibrosis was relatively high (13.6%) and its independent predictors were disease duration and MSS.
    No preview · Article · Aug 2015 · Clinical and experimental rheumatology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Several risk prediction models have been created to predict hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) occurrence, with promising results. However, their prognostic performances need to be validated in the era of antiviral therapy. From 2006 to 2011, patients with chronic HBV infection were recruited and those with a history of HCC or hepatic decompensation were excluded. At enrollment, liver stiffness (LS) was measured using transient elastography. We assessed the performances of conventional HCC prediction models (CU-HCC, GAG-HCC, REACH-B, and LSM-HCC scores) and the modified REACH-B (mREACH-B) score where LS values were incorporated into REACH-B score instead of serum HBV-DNA levels. Of 1308 subjects analyzed, the median age was 50.0 years (883 men). During the follow-up (median 75.3 months), HCC developed in 125 (9.6%) patients. mREACH-B score had the highest areas under the receiver-operating characteristic curves (AUROCs) for the prediction of HCC development at 3-/5-years (0.828/0.806), compared with LSM-HCC (0.777/0.759), GAG-HCC (0.751/0.757), REACH-B (0.717/0.699), and CU-HCC (0.698/0.700) scores respectively, with statistical significances (all p-value<0.05 vs. mREACH-B). When serum HBV-DNA levels were excluded from the formula for REACH-B score, AUROCs for HCC development at 3-/5-years improved paradoxically (from 0.717/0.699 to 0.757/0.732, respectively). In patients with antiviral therapy (n=848), mREACH-B score had the better prognostic performances for HCC development at 3-/5-years, compared to other prediction models. However, in patients without antiviral therapy (n=460), it had the prognostic performances comparable to those of other prediction models. Prognostic performances of mREACH-B score seemed better compared to conventional models. In the era of antiviral therapy, the incorporation of serum HBV-DNA level should be applied cautiously and individual risks should be assessed effectively based on the fibrotic burden. This article is protected by copyright. All rights reserved. © 2015 by the American Association for the Study of Liver Diseases.
    No preview · Article · Aug 2015 · Hepatology
  • [Show abstract] [Hide abstract]
    ABSTRACT: We investigated the long-term efficacy of adefovir add-on lamivudine rescue therapy in lamivudine-resistant chronic hepatitis B (CHB) and the optimal cutoff HBV DNA level that predicts complete virological response (CVR) among patients without CVR after 1 year of treatment. We reviewed 167 lamivudine-resistant CHB patients who received adefovir add-on rescue therapy for up to 5 years. Multivariate analysis, area under the receiver operating characteristic curves, and Youden index were used. Median age was 47.0 years; 112 patients were male. Median baseline HBV DNA level was 6.6 log10 IU/ml; hepatitis B e antigen (HBeAg) was positive in 130 (77.4%) patients. Five-year CVR, alanine aminotransferase normalization, HBeAg seroconversion, and adefovir resistance rates were 86.9%, 92.5%, 16.7%, and 6.0%, respectively. One-year HBV DNA level independently associated with CVR. Optimal cutoff HBV DNA level to predict CVR among patients who failed to achieve CVR at 1 year was 800 IU/ml (area under receiver operating characteristic curve 0.752; sensitivity 49.3%, specificity 93.5%). During the 5-year treatment, 92.1% of patients with favorable response (HBV DNA <800 IU/ml at 1 year) achieved CVR; 45.6% achieved CVR among suboptimal responders (HBV DNA ≥800 IU/ml at 1 year) (P < 0.001). CVR or HBV DNA level <800 IU/ml after 1-year adefovir add-on lamivudine rescue therapy can favorably predict CVR. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Jul 2015 · Journal of Gastroenterology and Hepatology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine factors predictive of discordance in staging liver fibrosis using liver biopsy (LB) and acoustic radiation force impulse (ARFI) elastography in patients with chronic hepatitis B (CHB). Consecutive patients with CHB who underwent LB and ARFI elastography on the same day from November 2010 to March 2013 were prospectively recruited from three tertiary hospitals. We analyzed 105 patients (median age of 47 years). The F0-1, F2, F3, and F4 fibrosis stages were identified in 27 (25.7%), 27 (25.7%), 21 (20.0%), and 30 (28.6%) patients, respectively. The areas under the receiver operating characteristics curves for ARFI elastography in assessing ≥F2, ≥F3, and F4 was 0.814, 0.848, and 0.752, respectively. The discordance of at least one stage between LB and ARFI was observed in 68 patients (64.8%) and of at least two stages in 16 patients (15.2%). In a multivariate analysis, advanced fibrosis stage (F3-4) was the only factor that was negatively correlated with one-stage discordance (p=0.042). Moreover, advanced fibrosis stage was negatively (p=0.016) correlated and body mass index (BMI) was positively (p=0.006) correlated with two-stage discordance. Advanced fibrosis stage (F3-4) was a predictor of nondiscordance between LB and ARFI elastography; BMI also influenced the accuracy of ARFI elastography.
    Full-text · Article · Jun 2015 · Gut and Liver
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) has a close relationship with coronary atherosclerosis. We investigated the association between coronary atherosclerosis and liver fibrosis, represented as coronary artery calcification (CAC) score and live stiffness (LS) value assessed using transient elastography (TE), respectively, in patients with NAFLD. Between January 2013 and March 2014, a total of 285 asymptomatic subjects without chronic liver and ischemic heart diseases who underwent comprehensive medical health check-up were recruited. NAFLD was defined as controlled attenuation parameter (CAP) ≥ 250 dB/m on TE. The median age of the study population (men 161 and women 124) was 56 (interquartile [IQR], 50-63) years. Of these, 142 (49.8%) subjects had NAFLD. Among subjects with NAFLD, CAC score was independently correlated with male gender (β=0.230; P=0.005), elevated erythrocyte sedimentation rate (ESR) (β=0.220; P=0.019), reduced estimated glomerular filtration rate (β=-0.220; P=0.004), increased left ventricular mass index (β=0.226; P=0.027), and higher LS values (β=0.274; P<0.001). In addition, alanine aminotransferase level (β=0.214, P=0.012) and CAC score (β=0.311; P=0.001) are the only independent factors associated with LS values in subjects with NAFLD. Higher CAC score was independently correlated with LS values in subjects with NAFLD. However, it should be further investigated whether TE can be incorporated into a screening tool to identify the high risk population for coronary artery disease. This article is protected by copyright. All rights reserved.
    No preview · Article · May 2015 · Journal of Gastroenterology and Hepatology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to evaluate the estimated glomerular filtration rate (eGFR) during telbivudine (LdT) versus entecavir (ETV) treatment in chronic hepatitis B (CHB) patients with underlying comorbidities such as diabetes mellitus (DM), hypertension, and cirrhosis. From 2010 to 2012, 116 CHB patients treated with LdT and 578 treated with ETV were compared in this real-practice cohort. The mean changes in eGFR (Modification of Diet in Renal Disease [MDRD] formula) from baseline to months 6, 12, and 18 were analyzed using a linear mixed model. In LdT-treated patients, the mean eGFR increased by 7.6% at month 18 compared with the eGFR at baseline (MDRD formula in mL/min/1.73 m2). However, in ETV-treated patients, the mean eGFR decreased by 4.1% at month 18 compared with the eGFR at baseline. In the LdT-treated patients with DM, hypertension, cirrhosis or low eGFR. The eGFR gradually increased over time during LdT treatment, especially in patients with mild abnormal eGFR at baseline, and in those with DM, hypertension, and cirrhosis, whereas a reduction in eGFR was seen with ETV treatment.
    Preview · Article · May 2015 · Gut and Liver
  • [Show abstract] [Hide abstract]
    ABSTRACT: Precise assessment of liver fibrosis is necessary in patients with chronic liver disease. We investigated the performance of red cell volume distribution width (RDW)-to-platelet ratio (RPR) for the assessment of liver fibrosis in patients with chronic hepatitis B (CHB). A total of 482 consecutive patients with CHB who underwent liver biopsy between October 2005 and May 2014 were recruited. Liver stiffness (LS) was measured using transient elastography (TE). FIB-4 score, RPR, and the aspartate aminotransferase-to-platelet ratio index (APRI) were also assessed. 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 RPR 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 (AUROC) of the RPR for predicting significant fibrosis (≥ F2) was 0.747. This result was inferior to TE (0.866, P=0.004), but comparable to FIB-4 (0.782, P=0.427) and APRI (0.716, P=0.507). The AUROC of RPR for predicting cirrhosis (F4) was 0.811, which was inferior to LS (0.915, P<0.001), but comparable to FIB-4 (0.804, P=0.805) and superior to APRI (0.680, P<0.001). The accuracy of RPR was acceptable for the assessment of liver fibrosis in patients with CHB. When TE is not available, RPR assessment is a simple method that can be used to reduce the need for liver biopsy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · May 2015 · Liver international: official journal of the International Association for the Study of the Liver
  • [Show abstract] [Hide abstract]
    ABSTRACT: We aimed to generate and validate a novel risk prediction model for patients with hepatocellular carcinoma (HCC) undergoing trans-arterial chemoembolization (TACE). Patients receiving TACE as the first-line therapy between 2006 and 2009 were selected from the databases of two major tertiary hospitals in Korea. The study population was randomly assigned into training (n=340) and validation (n=145) sets. From a multivariate Cox-regression model for overall survival (OS), tumor Size, tumor Number, baseline Alpha-fetoprotein level, Child-Pugh class, and Objective radiological Response after the first TACE session were selected and then scored to generate a 10-point risk prediction model (named as "SNACOR" model) in the training set. Thereafter, the prognostic performance was assessed in the validation set. In the training set, the time-dependent areas under receiver-operating characteristic curves (AUROCs) for OS at 1-, 3-, and 6-years were 0.783, 0.754, and 0.742, respectively. According to the score of the SNACOR model, patients were stratified into three groups; Low- (score 0-2), Intermediate- (score 3-6), and High-risk group (score 7-10), respectively. The Low-risk group had the longest median OS (49.8 months), followed by Intermediate- (30.7 months) and High-risk group (12.4 months) (log-rank, p<0.001). Compared to the Low-risk group, the Intermediate-risk (hazard ratio [HR] 2.13, p<0.001) and High-risk group (HR 6.17, p<0.001) retained significant risks of death. Similar results were obtained in the validation set. A simple-to-use SNACOR model for patients with HCC treated with TACE might be helpful in appropriate prognostification and guidance for decision of further treatment strategies. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · May 2015 · Liver international: official journal of the International Association for the Study of the Liver

Publication Stats

945 Citations
370.59 Total Impact Points

Institutions

  • 2008-2015
    • Yonsei University
      • • Department of Internal Medicine
      • • Institute of Gastroenterology
      Sŏul, Seoul, South Korea
  • 2007-2015
    • Yonsei University Hospital
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2014
    • Konkuk University
      Sŏul, Seoul, South Korea
    • Chung-Ang University
      Sŏul, Seoul, South Korea
  • 2011
    • University of Seoul
      Sŏul, Seoul, South Korea