scholarly journals The albumin–bilirubin score as a predictor of outcomes in Japanese patients with PBC: an analysis using time-dependent ROC

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Takanori Ito ◽  
Masatoshi Ishigami ◽  
Hikaru Morooka ◽  
Kenta Yamamoto ◽  
Norihiro Imai ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Roc Analysis ◽  
Japanese Patients ◽  
Hepatic Function ◽  
Time Dependent ◽  
Prognostic Scores ◽  
Primary Biliary Cholangitis ◽  
Simple Method ◽  
Mayo Score

Abstract The albumin–bilirubin (ALBI) score is calculated using only serum albumin and bilirubin levels, and was developed as a simple method to assess hepatic function. In this study, a total of 409 patients with primary biliary cholangitis (PBC) were enrolled between March 1990 and October 2018. The predictive performances of the ALBI score and other well-established prognostic scores were compared using time-dependent receiver operating characteristic (ROC) analysis. During the follow-up period, 60 patients died, 45 due to liver-related diseases and 15 due to non-liver-related diseases, and 16 patients underwent liver transplantation. Time-dependent ROC analysis showed that the ALBI score has higher the areas under the ROC curves (AUROCs) than the Child–Pugh (C–P) score at each time point; AUROCs at 3, 5, and 10 years after the start of follow-up were 0.94, 0.91, and 0.90 for the ALBI score, and 0.89, 0.88, and 0.82 for the C–P score, respectively. The ALBI score showed the highest AUROCs within 2 years after the start of observation; beyond 2 years, however, the Mayo score had better prognostic ability for mortality and liver transplantation. The ALBI score/grade, derived from objective blood tests, and the Mayo score were superior prognostic tools in PBC patients.

Mo1485 – Long-Term Follow-Up After Recurrence of Primary Biliary Cholangitis Following Liver Transplantation: A Single Center Study

2019 ◽  
Vol 156 (6) ◽  
pp. S-1323
Author(s):  
Shreesh Shrestha ◽  
Thomas B. Wells ◽  
Stephen J. Soufleris ◽  
clanahan michael ◽  
Hemnishil K. Marella ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Primary Biliary Cholangitis ◽  
Single Center ◽  
Single Center Study ◽  
Long Term Follow Up ◽  
Center Study

scholarly journals 1115 Does the Published Evidence Support Cell Transplantation in Liver Disease?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E H Larkin ◽  
E Armstrong
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Cell Transplantation ◽  
Outcome Measures ◽  
Orthotopic Liver Transplantation ◽  
Cell Types ◽  
Prognostic Scores ◽  
Cell Transplant ◽  
Study Protocols

Abstract Introduction Although a significant body of evidence proposes a role for cell transplantation as a bridge or alternative to orthotopic liver transplantation for a range of liver disorders, this therapy is not performed in the United Kingdom. Several cell types, including human hepatocytes and mesenchymal stem cells, have been assessed for safety and efficacy, with numerous transfusion protocols. In this review we critically evaluated published human studies of hepatocyte transplantation in respect of (i) methods used to evaluate efficacy of therapy, particularly the use of validated prognostic scores for liver disease (MELD or Child-Pugh), and (ii) discrepancies in patient outcomes between studies using different cell types and transfusion protocols. Method We reviewed 20 studies on cell transplantation as an alternative to orthotopic liver transplantation. Patient demographics, study design and outcome measures were compared. Outcome measures were post-cell transplant patient survival to (i) the end of the follow-up window, (ii) receipt of a liver transplant, or (iii) death. Results Inconsistencies found in study protocols included strategies for cell transfusion, post-transplant immunosuppression and follow-up interval and duration. Comparison of results was complicated by the outcome measures themselves, as neither receipt of a graft nor mortality can be represented in the prognostic scores used. Furthermore, many studies reported biochemistry data which could not be incorporated into MELD/Child-Pugh score format. Conclusions Meta-analysis of hepatocyte transplant studies is not possible on account of methodological inconsistencies and lack of large, controlled trials. These may be important factors preventing wider adoption of this intervention.

scholarly journals Prediction of Transplant-Free Survival through Albumin-Bilirubin Score in Primary Biliary Cholangitis

2019 ◽  
Vol 8 (8) ◽  
pp. 1258 ◽  
Author(s):  
Fujita ◽  
Nomura ◽  
Morishita ◽  
Shi ◽  
Oura ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Japanese Patients ◽  
Prognostic Scores ◽  
Total Serum ◽  
Primary Biliary Cholangitis ◽  
Pathological Stage ◽  
Free Survival ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Stage 4

Albumin–bilirubin (ALBI) grade is defined using the ALBI score, which is calculated based on total serum bilirubin and albumin. This study aimed to evaluate the diagnostic ability of the ALBI score for determining hepatic fibrosis stage and transplant-free survival in primary biliary cholangitis (PBC) patients. A total of 181 Japanese patients with biopsy-proven or serologically diagnosed PBC were enrolled. The pathological stage was assessed using the Scheuer classification. The ALBI score differentiated fibrosis in stage 4 from that of 3 in the biopsy-proven cohort (p < 0.05). With an ALBI score cut-off value of −1.679, the sensitivity and specificity were 100% and 91.1%, respectively, with a likelihood ratio of 12.3 to differentiate stage 4 from stages 1–3. The ALBI score at the beginning of ursodeoxycholic acid (UDCA) prescription correlated with the two prognostic scores calculated after 1-year UDCA treatment. Kaplan–Meier analysis showed that the baseline ALBI score differentiated liver transplant-free survival (p < 0.05). The ALBI score presented a greater hazard ratio for transplant-free survival than aspartate aminotransferase-to-platelet ratio index (APRI) in Cox proportional hazard model. In conclusion, ALBI score indicates pathological stage in Japanese PBC patients and scores before UDCA prescription predict better liver transplant-free survival, which correlated well with the two major prognostic scores. The prognosis-predicting ability of the ALBI score might surpass that of APRI.

P0085MAYO AND PRO-PKD SCORE CONCORDANCE FOR PROGRESSION OF RENAL FALIURE EVALUATION IN ADPKD PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Irene Capelli ◽  
Valeria Aiello ◽  
Elisa Carretta ◽  
Claudio Graziano ◽  
Nicola Sciascia ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Real Life ◽  
Genetic Mutation ◽  
Prognostic Scores ◽  
Rapid Progression ◽  
Kidney Volume ◽  
Mayo Score ◽  
Rapid Progressors

Abstract Background and Aims Autosomal dominant polycystic kidney disease (ADPKD) is a multisystemic disease characterized by the progressive development of bilateral renal cysts, resulting in enlargement of the kidney volume due to cystic formations, hypertension, haematuria, and loss of renal function. Recent advances in genomics have contributed to have a better understanding of the pathogenesis of the disease suggesting new treatment strategies to inhibit or delay cysts formation and expansion.Since 2015, the European Medicines Agency approved Vaptans as therapy to slow the growth of kidney volume and the decline in kidney function in patients defined rapid progressors. In 2016 European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Working Groups on Inherited Kidney Disorders and European Renal Best Practice (WGIKD/ ERBP) published a position statement for definition of rapid progression. These recommendations included two algorithms to assess indications for initiation of ADPKD treatment. They selected three criteria based on: 1) the relationship between TKV(total kidney volume) and the decline in renal function according CRISP study, using Mayo Clinic Score 2) eGFR slope with an average ≥2.5 mL/min/1.73 m2/ yearly loss of renal function over a period of 5 yearsor 3) the link between genetic mutation and clinical information study using Propkd score.A 5 –years follow-up is not always available to achieve the criteria for rapid progressor, therefore the use of scores in clinical practice is widespread.In this scenario both scores (MAYO and PRO-PKD) are able to define rapid progressor patients and it is possible to use them alternatively as reported in literature. The aim of this study is to evaluate the prognostic scores in a real life experience. Method All ADPKD patients in follow-up in our Nephrology Unit from January 2017 to July 2019 were included in the study. Descriptive statistics were used to summarize demographic and clinical characteristics. Therefore we classified them for TKV, genetic mutation, renal function, Mayo score and Propkd score. Rapid progression was defined as 1C-D-E Mayo and high risk PRO PKD while non rapid progressors was 1A-1B mayo and low and intermediate PRO-PKD. Kappa statistic was used to determinate the concordance between Mayo and PROPKD score. Change in renal function within patients with the same class of score where analysed using Paired Wilcoxon signed rank sum test. Results We examined75 patients, 78% between 18-50 years, equally distributed for sex. The results shown thatdisease was more frequent familiar (88 %) witha percentage of mutations of PKD1 versus PKD2 mutation (90,7%/9,3%). 31patients (41%) had a GFR between 45-89 ml/min, 52patients (69%) achieved the criteria for nephromegaly according guideline (TKV &gt; 750CC). Respectively 76% (57pt) and 21%(16pt) were defined as rapid progressors for Mayo score ad Propkd score. The slope of GFR was worse in patients defined rapid progressor in spite of non rapidprogressor according MAYO score (-2,8 ml/min vs 0,3 ml/min) as for propkd classification (-3 vs - 1,75ml/min). Only for 15 patients the results were concordant for this two scores,43 patients identified as rapid progressor for Mayo score were non rapid progressor for Propkd score, in the same way 2 patients classified for Propkd were not rapid progressor for Mayo score. K of Coen of 0,07. Conclusion High risk patients present a significant decline in renal function in the first year with both score systems, confirming results of previous studies. Currently the scores used to define rapid progressors select patients differently. Concordance between scores il low (K of Cohen 0,076). The Propkd score is more selective compared to Mayo score. NeverthelessProPKD allows to identify some rapid progressor patients excluded from the use of the Mayo score only. The combined use of scoring may however increases the ability to identify progressive patients.

Manifestations of transthyretin-related familial amyloidotic polyneuropathy: Long-term follow-up of Japanese patients after liver transplantation

Surgery Today ◽  
2011 ◽  
Vol 41 (9) ◽  
pp. 1211-1218 ◽  
Author(s):  
Yuki Ohya ◽  
Sadahisa Okamoto ◽  
Masayoshi Tasaki ◽  
Mitsuharu Ueda ◽  
Hirofumi Jono ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Japanese Patients ◽  
Familial Amyloidotic Polyneuropathy ◽  
Long Term Follow Up

scholarly journals Number needed to treat with ursodeoxycholic acid therapy to prevent liver transplantation or death in primary biliary cholangitis

Gut ◽  
2019 ◽  
Vol 69 (8) ◽  
pp. 1502-1509 ◽  
Author(s):  
Maren H Harms ◽  
Rozanne C de Veer ◽  
Willem J Lammers ◽  
Christophe Corpechot ◽  
Douglas Thorburn ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Ursodeoxycholic Acid ◽  
Primary Biliary Cholangitis ◽  
Number Needed To Treat ◽  
Proportional Hazard ◽  
Acid Therapy ◽  
Free Survival ◽  
Cox Proportional Hazard ◽  
Improve Patient

ObjectiveThe clinical benefit of ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC) has never been reported in absolute measures. The aim of this study was to assess the number needed to treat (NNT) with UDCA to prevent liver transplantation (LT) or death among patients with PBC.MethodsThe NNT was calculated based on the untreated LT-free survival and HR of UDCA with respect to LT or death as derived from inverse probability of treatment weighting-adjusted Cox proportional hazard analyses within the Global PBC Study Group database.ResultsWe included 3902 patients with a median follow-up of 7.8 (4.1–12.1) years. The overall HR of UDCA was 0.46 (95% CI 0.40 to 0.52) and the 5-year LT-free survival without UDCA was 81% (95% CI 79 to 82). The NNT to prevent one LT or death within 5 years (NNT5y) was 11 (95% CI 9 to 13). Although the HR of UDCA was similar for patients with and without cirrhosis (0.33 vs 0.31), the NNT5y was 4 (95% CI 3 to 5) and 20 (95% CI 14 to 34), respectively. Among patients with low alkaline phosphatase (ALP) (≤2× the upper limit of normal (ULN)), intermediate ALP (2–4× ULN) and high ALP (>4× ULN), the NNT5y to prevent one LT or death was 26 (95% CI 15 to 70), 11 (95% CI 8 to 17) and 5 (95% CI 4 to 8), respectively.ConclusionThe absolute clinical efficacy of UDCA with respect to LT or death varied with baseline prognostic characteristics, but was high throughout. These findings strongly emphasise the incentive to promptly initiate UDCA treatment in all patients with PBC and may improve patient compliance.

Cytokine Gene Polymorphisms and Overall Survival in Follicular Lymphoma: Results from a Large Population-Based Study.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 820-820
Author(s):  
James R. Cerhan ◽  
Sophia Wang ◽  
Matthew J. Maurer ◽  
Stephen M. Ansell ◽  
Susan M. Geyer ◽  
...  
Keyword(s):  
Overall Survival ◽  
Follicular Lymphoma ◽  
Roc Analysis ◽  
Risk Groups ◽  
Population Based ◽  
Time Dependent ◽  
Clinical Factors ◽  
Immune Genes ◽  
Host Genetic

Abstract Background. The strongest established prognostic factors for follicular lymphoma are age and clinical factors. Biologic studies suggest a major role for the host immunologic environment in follicular lymphomagenesis, which is in part determined by host genetic background. Cytokines are key regulators of immune function and regulation, are highly polymorphic, and have been implicated in lymphoma etiology and prognosis. We evaluated the hypothesis that inherited variability in cytokine and related immune genes impact overall survival in follicular lymphoma. Methods. We genotyped 73 single nucleotide polymorphisms (SNPs) from 44 candidate cytokine and immune genes in 278 follicular lymphoma patients who participated in a population-based case-control study conducted from 1998–2000 in the Detroit, Iowa, Los Angeles and Seattle SEER (Surveillance, Epidemiology and End Results) cancer registries. Baseline clinical data and survival through early 2005 were obtained from cancer registry files. Cox proportional hazards analysis was used to estimate hazard ratios (HR) and corresponding 95% confidence intervals for the association between individual SNPs and overall survival, adjusting for age, demographic and clinical factors. We also used parallel modeling strategies to identify the best summary multi-SNP risk score to predict survival, and applied these results in a time-dependent receiver-operator characteristics (ROC) analysis. Results. The median age at diagnosis was 57 years (range, 25–74), and 59 (21%) of the patients died during follow-up, with a median follow-up of 59 months (range, 27 – 78 months) for surviving patients. In multivariate modeling, SNPs in IL8 (rs4073; HRTT=2.14, 1.26–3.63), IL2 (rs2069762; HRGT/TT=1.80, 1.06–3.05), IL12B (rs3212227; HRAA/CC=1.83, 1.06–3.06), and IL1RN (rs454078; HRAA=1.93, 1.11–3.34) were the strongest and most robust predictors of survival. A summary score of the number of deleterious genotypes from these four genes was strongly associated with survival (p=1.4 × 10−5) after accounting for demographic and clinical variables (HR=2.06 per deleterious genotype, 1.52–2.79). A combination of the four SNPs and the demographic and clinical risk scores was strongly associated with survival (p=1.8 × 10−11); the 5-year Kaplan Meier survival estimates were 96% (93%–100%), 72% (62%–83%) and 58% (48%–72%) for low, intermediate, and high risk groups respectively. In a time-dependent ROC analysis the three risk groups had an area under the curve (AUC) of 0.83 at 72 months of follow-up (95% CI 0.72–0.93). Conclusion: Host genetic variability in immune genes, particularly IL8, IL2, IL12B, and IL1RN, individually and particularly in combination, was associated with overall survival in follicular lymphoma after accounting for demographic and clinical factors. Host immunogenetics is a promising class of prognostic factors in follicular lymphoma that warrants further evaluation.

Relationship between Thyroglobulin and Tumor Detectabilily with Thallium-201 in Differentiated Thyroid Cancer

2000 ◽  
Vol 39 (01) ◽  
pp. 10-15 ◽  
Author(s):  
S. P. Müller ◽  
Ch. Reiners ◽  
A. Bockisch ◽  
Katja Brandt-Mainz
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Roc Analysis ◽  
Tsh Suppression ◽  
Significant Difference ◽  
Test Specificity ◽  
The Relationship ◽  
Tumor Scintigraphy ◽  
Tsh Stimulation

Summary Aim: Tumor scintigraphy with 201-TICI is an established diagnostic method in the follow-up of differentiated thyroid cancer. We investigated the relationship between thyroglobulin (Tg) level and tumor detectability. Subject and methods: We analyzed the scans of 122 patients (66 patients with proven tumor). The patient population was divided into groups with Tg above (N = 33) and below (N = 33) 5 ng/ml under TSH suppression or above (N = 33) and below (N = 33) 50 ng/ml under TSH stimulation. Tumor detectability was compared by ROC-analysis (True-Positive-Fraction test, specificity 90%). Results: There was no significant difference (sensitivity 75% versus 64%; p = 0.55) for patients above and below 5 ng/ml under TSH suppression and a just significant difference (sensitivity 80% versus 58%; p = 0.04) for patients above and below 50 ng/ml under TSH stimulation. In 18 patients from our sample with tumor, Tg under TSH suppression was negative, but 201-TICI-scan was able to detect tumor in 12 patients. Conclusion: Our results demonstrate only a moderate dependence of tumor detectability on Tg level, probably without significant clinical relevance. Even in patients with slight Tg elevation 201-TICI scintigraphy is justified.

The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

2020 ◽  
Vol 133 (1) ◽  
pp. 182-189
Author(s):  
Tae-Jin Song ◽  
Seung-Hun Oh ◽  
Jinkwon Kim
Keyword(s):  
Statin Therapy ◽  
Coil Embolization ◽  
Primary Outcome ◽  
Cox Regression ◽  
Cerebral Aneurysms ◽  
Time Dependent ◽  
Lipid Lowering ◽  
Surgical Clipping ◽  
The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

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