Hepatitis Monthly
Volume:19 Issue: 12, Dec 2019

Today, nonalcoholic fatty liver disease (NAFLD) has become a major health problem owing to its high prevalence. Literature evidence about regression of NAFLD are not as high as its development or progression.

This cohort study was conducted to reveal the factors influencing the regression of the NAFLD.

A population-based study conducted in Shiraz, Iran. Adults older than 18 years were recruited by multistage randomized sampling in 2012, and then in 2017. Demographic, anthropometric, nutritional, and medical characteristics of each interviewee were entered into a valid and reliable questionnaire. Interviewees were categorized into three groups according to the changing of their NAFLD status between two stages of this study; no change, regressed and progressed.

Of the 537 participants, 163 (30.3%) showed regression of their NAFLD compared to 93 (17.3%) that their NAFLD was progressed. Multinomial regression showed that each unit of decrease in BMI (Δ BMI= -1 kg/m2) augmented the relative risk (RR) of improvement of NAFLD by 13.3% (RR: 0.867; 95% CI: 0.776 - 0.969; P = 0.012) and reduced the relative risk of NAFLD deterioration by 14.3% (RR: 1.143; 95% CI: 1.009 - 1.294; P = 0.035).

A significant portion of patients showed regression of their NAFLD by decreasing their BMI. Therefore, BMI as a modifiable variable should be regarded in the management of NAFLD patients.

In a previous publication, a FIB-4 cutoff value of ≥ 1.25, which had been determined in an Asian population, did not allow reliable prediction of the development of hepatocellular carcinoma (HCC) in a patient collective with chronic hepatitis B (CHB) of predominantly non-Asian descent.

Here, we aimed to validate the modified FIB-4 cutoff values as a means of stratifying the HCC risk in a non-Asian cohort seen at an outpatient university hospital liver unit in Germany.

We retrospectively analyzed 350 adult patients with CHB infection. We recorded demographics, laboratory parameters, results from liver imaging, serological hepatitis B markers, antiviral treatment, and histology. We separated patients into two groups based on individual FIB-4 levels. We, then, analyzed the patients’ hazard ratios for HCC and adjusted it for sex, age, antiviral medication, duration of CHB infection, body mass index, alcohol consumption, and type 2 diabetes. An additional sub-analysis was performed by including only non-cirrhotic patients to determine the validity of the proposed cutoffs in that cohort.

The median duration of follow-up was 8.9 years with a range of 1 - 21.3 years. Our patients were 65% males. In comparison with patients that had a low FIB-4 (< 0.3635), those with elevated FIB-4 (≥ 0.3635) had an HCC incidence hazard ratio of 11.67 (95% confidence interval (CI): 2.73 - 49.96; P = 0.001) and an adjusted hazard ratio of 7.90 (95% CI: 1.58 - 39.39; P = 0.012). Elevated FIB-4 non-cirrhotic patients had a hazard ratio (HR) of 15.88 (95% CI: 2.04 - 123.20) for HCC incidence (P < 0.0001) and an adjusted HR of 11.99 (95% CI: 1.36 - 105.72) (P = 0.001).

A FIB-4 value of < 0.3635 appears to be a clinical indicator for a low likelihood of HCC incidence in non-Asian patients with CHB with or without cirrhosis. Further studies in patients of diverse descent are necessary to prove its utility as a clinical tool in this setting.

The present study aimed to determine the hemorheological characteristics of patients with acute severe ulcerative colitis (ASUC) and the effect of rivaroxaban anticoagulation therapy. The study also aimed to further explore the mechanisms and novel pathways underlying ASUC therapy.

Various hemorheology tests were performed on 88 hospitalized ASUC patients, including mean platelet volume (MVP), platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) D-dimer and indicators of thrombelastogram (TEG). All results were compared with those of 40 colonic polyp controls. The ASUC patients were randomly divided into control and treatment groups (n = 44 each). The control group received routine mesalazine and methylprednisolone therapy, while the treatment group received rivaroxaban in addition to routine medicines. Montreal classification was used to evaluate the lesion range and the Mayo scoring system was used to evaluate the activity and treatment efficacy of the disease. The Endoscopic Severity Index of Ulcerative Colitis (UCEIS) was used to evaluate mucosal inflammation and Geboes index was used to evaluate mucosa histology. The percentage of microthrombus in pathological sections was calculated via immunohistochemical staining. The two groups were compared for efficacy, side effects, microthrombosis and hemorrheology after 30 days.

The results revealed that hypercoagulation is an important pathological stage of ASUC. Rivaroxaban anticoagulant therapy added to routine treatment was more effective than conventional treatment alone, which significantly improved the blood coagulation status of patients, alleviated clinical symptoms, relieved the endoscopic and histological outcomes, reduced the required hormone dosage and were worthy of clinical promotion.

Occult hepatitis B virus infection (OBI) is one of the most challenging entities in the field of viral hepatitis. The virological and clinical relevance of OBI in patients treated with novel direct-acting antivirals (DAA) for hepatitis C virus (HCV) infections is currently a topic of hot debate. In cases where hepatitis B surface antigen (HBsAg) is not detected, DAA treatment is often initiated without examining for the presence of hepatitis B virus (HBV) DNA. In this study, the incidence of OBI was investigated in 114 HCV patients prior to application of DAAs who did not respond to pegylated interferon and ribavirin (PEG-INF and RBV) treatment. Serum samples were screened for HBV serological markers (antibody to hepatitis B core antigen [anti-HBc] and HBsAg). Samples positive for anti-HBc without HBsAg were further examined via real-time PCR (qPCR), nested PCR and S-gene mutational analyses. Overall, anti-HBc was detected in 37.7% chronic HCV patients and 2.6% had OBI with a baseline HBV DNA viral load < 2000 IU/mL before DAA therapy. One patient was identified as HBV genotype A1 without mutations in surface protein. Our collective data highlight the importance of clinicians being aware of potential anti-HBc positivity in patients with hepatitis C and the issues surrounding OBI screening before initiation of treatment with novel DAAs.