Hepatocellular carcinoma,decompensation,and mortality based on hepatitis C treatment:A prospective cohort study

BACKGROUND Prospective studies of the long-term outcomes of patients with hepatitis C virus(HCV)infection after treatment with interferon-based therapy(IBT)or directacting antivirals(DAA)are limited in many Asian countries.AIM To elucidate the incidences of hepatocellular carcinoma(HCC)and death/transplantation based on treatment with IBT or DAA,to compare the outcomes of the sustained virologic response(SVR)to IBT and DAA,and to investigate outcome-determining factors after SVR.METHODS This cohort included 2054 viremic patients(mean age,57 years;46.5%male;27.4%with cirrhosis)prospectively enrolled at seven hospitals between 2007 and 2019.They were classified as the untreated group(n=619),IBT group(n=578),and DAA group(n=857).Outcomes included the incidences of HCC and death/transplantation.The incidences of the outcomes for each group according to treatment were calculated using an exact method based on the Poisson distribution.A multivariate Cox regression analysis was performed to determine the factors associated with HCC or death/transplantation,followed by propensity score matching to confirm the results.RESULTS During a median of 4.1 years of follow-up,HCC and death/transplantation occurred in 113 and 206 patients,respectively,in the entire cohort.Compared with the untreated group,the incidences of HCC and death/transplantation were significantly lower in the IBT group[adjusted hazard ratio(aHR)0.47,95%CI:0.28-0.80 and aHR 0.28,95%CI:0.18-0.43,respectively]and the DAA group(aHR 0.58,95%CI:0.35-0.96,and aHR 0.19,95%CI:0.20-0.68,respectively).Among 1268 patients who attained SVR with IBT(n=451)or DAA(n=816),the multivariable-adjusted analysis showed no differences in the risks of HCC(HR 2.03;95%CI:0.76-5.43)and death/transplantation(HR 1.38;95%CI:0.55-3.49)between the two groups.This was confirmed by a propensity score-matching analysis.Independent factors for HCC after SVR were age,genotype 1,and the presence of cirrhosis.CONCLUSION Treatment and achieving SVR with either IBT or DAA significantly reduced the incidences of HCC and mortality in the Asian patients with HCV infection.The risks of HCC and mortality were not significantly different regardless of whether SVR was induced by IBT or DAA.

Role of multidetector computed tomography in patients with acute infectious colitis

BACKGROUND The role of multidetector computed tomography(MDCT)in patients with acute infectious colitis is still unclear.AIM To examine the usefulness of MDCT in distinguishing the etiology of acute infectious colitis.METHODS Overall,244 patients who met the criteria for acute infectious colitis and visited the Hospital from February 2015 to 2018 were retrospectively enrolled and divided into two groups(bacterial:204,viral:40)according to causes of acute colitis,based on stool PCR.Eleven MDCT parameters,including wall thickening,submucosal edema,mucosal enhancement,serosa involvement,empty colon sign,small bowel involvement,comb sign,continuous distribution,accordion sign,mucosal thickening,and lymph node enlargement,were constructed in a blinded fashion.RESULTS MDCT parameters of wall thickening(OR:13.60;95%CI:5.80–31.88;P<0.001),submucosal edema(OR:36.08;95%CI:13.54–96.13;P<0.001),mucosal enhancement(OR:22.55;95%CI:9.28–54.81;P<0.001),serosal involvement(OR:14.50;95%CI:3.33–63.23;P<0.001),empty colon sign(OR:6.68;95%CI: 2.44–18.32;P < 0.001), continuous distribution (OR: 24.09;95%CI: 9.38–61.90;P < 0.001), accordionsign (OR: 9.02;95%CI: 1.12–72.35;P = 0.038), mucosal thickening (OR: 46.41;95%CI: 10.38–207.51;P< 0.001), and lymph node enlargement (OR: 4.39;95%CI: 1.22–15.72;P = 0.023) were significantlyassociated with bacterial colitis. At least one positive finding in four CT outcomes (submucosaledema, mucosal enhancement, continuous distribution, mucosal thickening) in summer showed ahigh probability of bacterial colitis (sensitivity, 41.67;specificity, 92.50;OR: 24.95).CONCLUSIONMDCT provides many clues that can be useful in suggesting a specific etiology of acute infectiouscolitis.