BACKGROUND Simple tools for clinicians to identify cirrhosis in patients with chronic viral hepatitis are medically necessary for treatment initiation,hepatocellular cancer screening and additional medical management....BACKGROUND Simple tools for clinicians to identify cirrhosis in patients with chronic viral hepatitis are medically necessary for treatment initiation,hepatocellular cancer screening and additional medical management.AIM To determine whether platelets or other laboratory markers can be used as a simple method to identify the development of cirrhosis.METHODS Clinical,biochemical and histologic laboratory data from treatment naive chronic viral hepatitis B(HBV),C(HCV),and D(HDV)patients at the NIH Clinical Center from 1985-2019 were collected and subjects were randomly divided into training and validation cohorts.Laboratory markers were tested for their ability to identify cirrhosis(Ishak≥5)using receiver operating characteristic curves and an optimal cut-off was calculated within the training cohort.The final cut-off was tested within the validation cohort.RESULTS Overall,1027 subjects(HCV=701,HBV=240 and HDV=86),66%male,with mean(standard deviation)age of 45(11)years were evaluated.Within the training cohort(n=715),platelets performed the best at identifying cirrhosis compared to other laboratory markers[Area Under the Receiver Operating Characteristics curve(AUROC)=0.86(0.82-0.90)]and sensitivity 77%,specificity 83%,positive predictive value 44%,and negative predictive value 95%.All other tested markers had AUROCs≤0.77.The optimal platelet cut-off for detecting cirrhosis in the training cohort was 143×109/L and it performed equally well in the validation cohort(n=312)[AUROC=0.85(0.76-0.94)].CONCLUSION The use of platelet counts should be considered to identify cirrhosis and ensure optimal care and management of patients with chronic viral hepatitis.展开更多
Hepatitis D virus(HDV)infection is associated with severe liver-related morbidity and mortality.The prevalence of HDV is rising especially among people who abuse drugs and immigrants from endemic areas.Reliable diagno...Hepatitis D virus(HDV)infection is associated with severe liver-related morbidity and mortality.The prevalence of HDV is rising especially among people who abuse drugs and immigrants from endemic areas.Reliable diagnostic assays with enhanced sensitivity and specificity are essential for screening at-risk populations.Until recently,interferon has been the only treatment for hepatitis D.Its efficacy is,however,limited and it is associated with significant side effects.A number of novel antiviral agents that target various stages of the HDV life cycle show promising results.They are currently in different phases of clinical development.This review focuses on the changing epidemiology,novel therapeutic agents,and updated management of chronic hepatitis delta.展开更多
文摘BACKGROUND Simple tools for clinicians to identify cirrhosis in patients with chronic viral hepatitis are medically necessary for treatment initiation,hepatocellular cancer screening and additional medical management.AIM To determine whether platelets or other laboratory markers can be used as a simple method to identify the development of cirrhosis.METHODS Clinical,biochemical and histologic laboratory data from treatment naive chronic viral hepatitis B(HBV),C(HCV),and D(HDV)patients at the NIH Clinical Center from 1985-2019 were collected and subjects were randomly divided into training and validation cohorts.Laboratory markers were tested for their ability to identify cirrhosis(Ishak≥5)using receiver operating characteristic curves and an optimal cut-off was calculated within the training cohort.The final cut-off was tested within the validation cohort.RESULTS Overall,1027 subjects(HCV=701,HBV=240 and HDV=86),66%male,with mean(standard deviation)age of 45(11)years were evaluated.Within the training cohort(n=715),platelets performed the best at identifying cirrhosis compared to other laboratory markers[Area Under the Receiver Operating Characteristics curve(AUROC)=0.86(0.82-0.90)]and sensitivity 77%,specificity 83%,positive predictive value 44%,and negative predictive value 95%.All other tested markers had AUROCs≤0.77.The optimal platelet cut-off for detecting cirrhosis in the training cohort was 143×109/L and it performed equally well in the validation cohort(n=312)[AUROC=0.85(0.76-0.94)].CONCLUSION The use of platelet counts should be considered to identify cirrhosis and ensure optimal care and management of patients with chronic viral hepatitis.
文摘Hepatitis D virus(HDV)infection is associated with severe liver-related morbidity and mortality.The prevalence of HDV is rising especially among people who abuse drugs and immigrants from endemic areas.Reliable diagnostic assays with enhanced sensitivity and specificity are essential for screening at-risk populations.Until recently,interferon has been the only treatment for hepatitis D.Its efficacy is,however,limited and it is associated with significant side effects.A number of novel antiviral agents that target various stages of the HDV life cycle show promising results.They are currently in different phases of clinical development.This review focuses on the changing epidemiology,novel therapeutic agents,and updated management of chronic hepatitis delta.
