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Shahanas SM, Verma R, Kumar K, Verma M, Srivastavsa DC, Budhwani P. A Study on the Prevalence of HCV Genotypes and the Effect of Direct-Acting Antiviral Therapy on Clinical and Laboratory Parameters in HCV-Infected Patients at a Tertiary Care Center in North India. Indian J Community Med 2024; 49:203-208. [PMID: 38425980 PMCID: PMC10900459 DOI: 10.4103/ijcm.ijcm_865_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/06/2023] [Indexed: 03/02/2024] Open
Abstract
Background The purpose of this study was to investigate the prevalence and distribution of different HCV genotypes, as well as to evaluate clinical and laboratory parameters in HCV-infected patients before and after DAA treatment. Material and Methods An open-label prospective study was conducted on 50 HCV-infected individuals. The HCV-infected patients underwent a baseline evaluation with complete history, examination, and other clinical investigations. These patients received the appropriate DAA according to the genotype for 3 months. At the end of 3 months, these patients were again evaluated clinically. Results The majority of instances were among younger age groups. Genotype 3 (66%) was the most common. There was a statistically significant difference found in clinical parameters regarding total bilirubin (p=0.008), SGOT (p=0.001), SGPT (p=0.035), ALP (p=<0.001) and Blood Urea Nitrogen (p = 0.004). When 1a vs 1b intragroup comparison was drawn, there was a significant mean difference found in SGOT (p value= 0.053) and Creatinine (p=0.050) parameters while rest shows no significant difference when associated. In the comparison of 1a vs 3 or 4, none of the parameters shows significant difference while; when 1b vs 3 or 4 comparison was laid out, SGOT and Creatinine was found near to significant. Conclusion This study concludes that with the availability of DAAs, highly effective, short-duration, and safe regimens have created better outcomes for patients with HCV infection, especially in those groups where SVR was low with prior therapies or in those where IFN-based treatment strategies were contraindicated.
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Affiliation(s)
| | - Rajeev Verma
- Department of Medicine, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Kanishka Kumar
- Department of Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Manisha Verma
- Department of Pediatrics, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | | | - Priyanka Budhwani
- Department of Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
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Ding Y, Zhang P, Deng T, Yan X, Zhang M, Xie Z, Huang G, Wang P, Cai T, Zhang X, Xiao X, Xia Y, Liu B, Peng Y, Tang X, Hu M, Xiao Y, Li X, Clercq ED, Li G, Zhou Z. Association of human leukocyte antigen (HLA) footprints with the comorbidity of latent autoimmune diabetes in adults (LADA) and hepatitis C virus (HCV) infection: A multicenter cross-sectional study. Diabetes Metab Syndr 2024; 18:102939. [PMID: 38181721 DOI: 10.1016/j.dsx.2023.102939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
AIMS This study aims to investigate the interplay between hepatitis C virus (HCV) infection and major forms of diabetes: type 1 diabetes (T1D), type 2 diabetes (T2D), and latent autoimmune diabetes in adults (LADA). METHODS This multicenter study analyzed a cohort of 2699 diabetic and 7344 non-diabetic subjects who visited medical centers in China from 2014 to 2021. T1D, T2D, LADA, and HCV were diagnosed using standard procedures. High-throughput sequencing was conducted to identify genetic footprints of human leukocyte antigen (HLA) alleles and haplotypes at the DRB1, DQA1, and DQB1 loci. RESULTS HCV infection was detected in 3 % (23/766) of LADA patients, followed by 1.5 % (15/977) of T2D patients, 1.4 % (13/926) of T1D patients, and 0.5 % (38/7344) of non-diabetic individuals. HCV prevalence was significantly higher in people with diabetes than in non-diabetic individuals (p < 0.01). HLA alleles (DQB1*060101, DQB1*040101) and haplotypes (DRB1*080302-DQA1*010301-DQB1*060101) in LADA patients with HCV revealed higher frequencies than in LADA patients without HCV (adjusted p < 0.03). Furthermore, a higher risk of diabetes complications was found among LADA patients with HCV infection (p < 0.001). CONCLUSIONS LADA patients are susceptible to HCV infection, potentially associated with certain HLA alleles/haplotypes. Early diagnosis and treatment of HCV infection among people with diabetes are important for the management of severe complications.
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Affiliation(s)
- Yujin Ding
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Pan Zhang
- Xiangya School of Public Health, Hunan Children's Hospital Affiliated with The Xiangya School of Medicine, Central South University, Changsha, China
| | - Tuo Deng
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiang Yan
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Min Zhang
- Department of Hepatology and Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiguo Xie
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Gan Huang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ping Wang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ting Cai
- Xiangya School of Public Health, Hunan Children's Hospital Affiliated with The Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaoli Zhang
- Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Xinqiang Xiao
- Department of Hepatology and Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ying Xia
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Bingwen Liu
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ya Peng
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaohan Tang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Min Hu
- Department of Clinical Laboratory, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Xiao
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Erik De Clercq
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Guangdi Li
- Xiangya School of Public Health, Hunan Children's Hospital Affiliated with The Xiangya School of Medicine, Central South University, Changsha, China.
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Ministry of Education), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China.
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Du R, Xu R, Huang J, Wang H, Wang M, Liao Q, Shan Z, Zhong H, Zheng Y, Rong X, Fu Y. HCV 6a was expanding and became the predominant subtype among blood donors between 2004 and 2019 in Guangdong, China. Virol Sin 2022; 37:765-768. [PMID: 35842093 PMCID: PMC9583116 DOI: 10.1016/j.virs.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/15/2022] [Indexed: 11/19/2022] Open
Abstract
Currently, HCV 6a has replaced 1b as the most prevalent subtype in blood donors in Guangdong. HCV 6a was the predominant subtype in males and older donors, while 1b predominated in females and younger donors. HCV 6a may expand from Guangdong to other districts of China, and is worthy of attention.
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Affiliation(s)
- Rongsong Du
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023)
| | - Ru Xu
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023)
| | - Jieting Huang
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023)
| | - Hao Wang
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023)
| | - Min Wang
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023)
| | - Qiao Liao
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023)
| | - Zhengang Shan
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023)
| | - Huishan Zhong
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023)
| | - Yourong Zheng
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023)
| | - Xia Rong
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023).
| | - Yongshui Fu
- Guangzhou Blood Center, Guangzhou, 510095, China; The Key Medical Laboratory of Guangzhou, Guangzhou, 510095, China (2021-2023); Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, 510515, China.
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Wang R, Wang X, Zhang L, Feng G, Liu M, Zeng Y, Xie Z. The epidemiology and disease burden of children hospitalized for viral infections within the family Flaviviridae in China: A national cross-sectional study. PLoS Negl Trop Dis 2022; 16:e0010562. [PMID: 35788743 PMCID: PMC9286261 DOI: 10.1371/journal.pntd.0010562] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/15/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Viruses of the family Flaviviridae, including Japanese encephalitis virus (JEV), dengue virus (DENV), yellow fever virus (YFV) and hepatitis C virus (HCV), are widely distributed worldwide. JEV, DENV and YFV belong to the genus Flavivirus, whereas HCV belongs to the genus Hepacivirus. Children’s symptoms are usually severe. As a result, rates of hospitalization due to infection with these viruses are high. The epidemiology and disease burden of hospitalized children have rarely been described in detail to date. The objective of this study was to report the general epidemiological characteristics, clinical phenotype, length of stay (LOS), burden of disease, and potential risk factors for hospitalized children infected with JEV, DENV, YFV, or HCV in Chinese pediatric hospitals. Methodology A cross-sectional study of epidemiology and disease burden of children hospitalized for Flaviviridae virus infections between December 2015 and December 2020 in China was performed. Face sheets of discharge medical records (FSMRs) were collected from 27 tertiary children’s hospitals in the Futang Research Center of Pediatric Development and aggregated into FUTang Update medical REcords (FUTURE). Information on sociodemographic variables, clinical phenotype, and LOS as well as economic burden was included in FSMRs and compared using appropriate statistical tests. Findings The study described 490 children aged 0–15 years hospitalized for infections with Flaviviridae viruses. Japanese encephalitis (JE) cases are the highest, accounting for 92.65% of the total hospitalization cases caused by Flaviviridae virus infection. The incidence of JE peaked from July to October with a profile of a high proportion of severe cases (68.06%) and low mortality (0.44%). Rural children had a significantly higher incidence than urban children (91.63%). Most hospitalized dengue cases were reported in 2019 when dengue outbreaks occurred in many provinces of China, although only 14 dengue cases were collected during the study period. Yellow fever (YF) is still an imported disease in China. The hospitalizations for children with hepatitis C (HC) were not high, and mild chronic HC was the main clinical phenotype of patients. Among the four viral infections, JE had the highest disease burden (LOS and expenditure) for hospitalized children. Conclusion First, the present study reveals that JE remains the most serious disease due to Flaviviridae virus infection and threatens children’s health in China. Many pediatric patients have severe illnesses, but their mortality rate is lower, suggesting that existing treatment is effective. Both JEV vaccination and infection control of rural children should represent a focus of study. Second, although the dual risks of indigenous epidemics and imports of DENV still exist, the prevalence of DENV in children is generally manageable. Third, YFV currently shows no evidence of an epidemic in China. Finally, the proportion of children with chronic hepatitis C (CHC) is relatively large among hospitalized children diagnosed with HCV. Thus, early and effective intervention should be offered to children infected with HCV to ease the burden of CHC on public health. We performed a general epidemiological and disease burden assessment of 490 hospitalized children infected with any virus from the family Flaviviridae [Japanese encephalitis virus (JEV), dengue virus (DENV), yellow fever virus (YFV) and hepatitis C virus (HCV)] from December 2015 to December 2020 with confirmed clinical presentation and laboratory results. Our study found that hospitalization for Japanese encephalitis (JE) predominated in children who lived in rural areas, and the infection was rate was considerably higher in summer and autumn (July–October) compared with other months. In addition, children hospitalized with JE have the largest share of disease burden. However, the overall low rate of hospitalization and mortality of children shows that China’s JE prevention and control policies remain effective. However, the prevention, control and surveillance of JEV in rural areas should not be neglected. Dengue and yellow fever have not yet caused serious public health concerns among children in China, but the spatial and temporal distributions of viral infection must be assessed to be alert to the indigenous spread of imported cases. CHC is a refractory phenotype of HCV infection in children; thus, early screening and intervention are encouraged given the insidious appearance of symptoms in the early stages after HCV infection. These findings can help to understand the epidemic status of viruses classified in the family Flaviviridae in children and the disease burden of hospitalized children, which is conducive to precise prevention and control, optimization of the allocation of resources, and the formulation of more reasonable and effective policies.
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Affiliation(s)
- Ran Wang
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xinyu Wang
- Big Data Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Linlin Zhang
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Guoshuang Feng
- Big Data Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Mengjia Liu
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yueping Zeng
- Medical Record Management Office, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zhengde Xie
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- * E-mail:
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Liu Y, Zheng J, Hao J, Wang RR, Liu X, Gu P, Yu H, Yu Y, Wu C, Ou B, Peng Z. Global burden of primary liver cancer by five etiologies and global prediction by 2035 based on global burden of disease study 2019. Cancer Med 2022; 11:1310-1323. [PMID: 35118819 PMCID: PMC8894698 DOI: 10.1002/cam4.4551] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Using data from the global burden of disease (GBD) between 1990 and 2019 to report the leading etiological factors and hazards for liver cancer by HBV (LCHB), HCV (LCHC), alcoholic use (LCAL), NASH (LCNA), and other causes (LCOT). METHOD The estimated annual percentage change (EAPC) and age-standardized incidence rate (ASR) in different districts, sex, and age are used to quantify the change of etiologies of liver cancer. Age-period-cohort models were performed to predict the primary liver cancer incidence and case numbers. RESULTS Based on the GBD database of the whole world for the five etiologies of liver cancer in 2019, the percentage of incidence of LCAL, LCHB, LCHC, LCNA, and LCOT are 18.4%, 41%, 28.5%, 6.8%, and 5.3%, respectively. Fiver etiologies of liver cancer show gender differences, with LCHB and LCAL being more prevalent in men, and LCHC, LCNA being more prevalent in women. Besides, live cancer of males is because of alcohol using and smoking, while the reason of liver cancer of females is drug use, high BMI and high fasting plasma glucose. Interestingly, the incidence of LCHC in women over 85 years old, LCNA in women over 75 years old, and LCOT in women over 75 years old were all higher than that in men. According to the future prediction, the incidence rate of liver cancer itself, as well as the five causes of liver cancer, tends to decrease gradually after 2019, while the incidence rate of LCNA in males will continue to increase until 2025. CONCLUSIONS The incidence of liver cancer has been increasing and its major causes vary considerably at global, regional, or national levels, also vary by gender and age group.
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Affiliation(s)
- Yuan Liu
- Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinxin Zheng
- Department of Nephrology, Ruijin Hospital, Institute of Nephrology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialing Hao
- Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rang Rang Wang
- Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xueni Liu
- Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Peng Gu
- Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hongwei Yu
- Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Yu
- Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chuanxing Wu
- Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Baochi Ou
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhihai Peng
- Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of General Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.,Organ Transplantation Institute of Xiamen University, Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen, China
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Almosa FAM, Alnasser AHA, Al-Tawfiq JA. Distribution of hepatitis C virus (HCV) genotypes in a Saudi Arabian hospital during the 2015-2020 period. LE INFEZIONI IN MEDICINA 2021; 29:450-455. [PMID: 35146350 PMCID: PMC8805486 DOI: 10.53854/liim-2903-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/15/2021] [Indexed: 06/14/2023]
Abstract
Hepatitis C virus (HCV) is the leading cause of chronic liver disease. HCV genotypes and subtypes are important predictors of disease progression and antiviral treatment response. To our knowledge, there had been limited studies of HCV genotypes in Qatif, Saudi Arabia. This study aims to assess the distribution of HCV genotypes in Qatif Central Hospital, Qatif, Saudi Arabia. This is a retrospective study of adult patients with HCV infection between January 2015 and December 2020. Only patients with documented HCV genotyping were included. A total of 356 HCVinfected patients fulfilled the inclusion criteria and were included in further analysis. Of those patients, 179 (50.3%) were males, and most were Saudi (N=347, 97.5%). The median age was 60 years, and 191 (53.7%) were 50-69 years of age. Genotype 2 was present in 118 (33.1%) of the patients, followed by genotype 4 in 92 (25.8%), genotype 1B in 62 (17.4%), and genotype 1A in 37 (10.4%). The study showed that HCV genotype 2 is the predominant variant among chronic HCV patients in the study population. Monitoring the epidemiology of HCV genotypes may provide guidance in treatment decisions.
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Affiliation(s)
- Fadel Ali M. Almosa
- Gastroenterology Unit, Department of Internal Medicine, Qatif Central Hospital, Ministry of Health, Qatif, Saudi Arabia
| | - Ali Hassan A. Alnasser
- Department of Laboratory, Dhahran Eye Specialist Hospital, Ministry of Health, Dhahran, Saudi Arabia
| | - Jaffar A. Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Cheng XD, Xu HF, Wei F, Jiang LX, Zhou HZ. The genotype analysis of the hepatitis C virus in Heilongjiang Province, China. Medicine (Baltimore) 2021; 100:e25203. [PMID: 33950918 PMCID: PMC8104223 DOI: 10.1097/md.0000000000025203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 02/25/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: Hepatitis C virus (HCV) infection is a major public health issue. HCV genotype identification is clinically important to tailor the dosage and duration of treatment, and recombination in intra-patient populations of HCV may lead to the generation of escape mutants, as previously observed for other RNA viruses. Up to now, there is no study assessing HCV genotypes and subtypes in Heilongjiang Province, China.Methods: To determine genotype and phylogenetic analysis of HCV in Heilongjiang Province is crucial. In this study, we amplified 3 genome regions (5'UTR, E1, and NS5B) of 30 HCV patients in Heilongjiang Province, amplified products were analyzed by bioinformatics.Results: We found that 23 specimens had concordant subtypes in the 3 gene regions (2a and 1b), 7 HCV patients were considered the recombinants, the recombination pattern of the 7 HCV patients in the 5'UTR, E1, and NS5B region as followed: 1b/2a/1b, 2a/2a/1b, 1b/2a/2a, 1b/2a/1b, 1b/2a/1b, 1b/2a/1b, 2a/2a/1b.Conclusions: The findings in the present study showed that a higher recombination rate (23%) than other researches, and the recombination of 2a/1b in the 5'UTR, E1, and NS5B region was only found in the present study up to now.
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Affiliation(s)
- Xue-Di Cheng
- Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, Shandong
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Hua-Feng Xu
- Department of Laboratory Diagnosis, Heilongjiang Provincial Hospital
| | - Feng Wei
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Li-Xin Jiang
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Hai-Zhou Zhou
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
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8
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Birjandi MM, Oroei M. The prevalence of positive rapid diagnostic test of hepatitis C virus infection in Ghana. Pan Afr Med J 2020; 36:322. [PMID: 33193976 PMCID: PMC7603834 DOI: 10.11604/pamj.2020.36.322.22490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction hepatitis C virus (HCV) infection is one of the most common viral hepatitis in Africa. Rapid diagnostic test (RDT) is a useful tool to identify antibody anti-HCV in point of care. In this study, we decided to determine prevalence of cases with positive rapid diagnostic test of HCV infection. Methods this cross-sectional study was conducted in a polyclinic, Accra, Ghana. Using convenience sampling, 728 participants were screened with blood-based RDT and interviewed about personal risk behaviors for transmission of HCV. Data was entered in SPSS version 18 and analyzed. Results there was 1.6% positive RDT in our participants. The mean age of them was 29.58 ± 12.31 years old that were younger than the participants with negative RDT (p: 0.027). The rate of positive test was 66.67% in women and 33.33% in men. There was a negative association between age and RDT positive (aOR: 0.91, 95%CI 0.85-0.96). The odds of positive RDT in married participants was 6.32 fold others after adjusting model (p: 0.014). There were no important risk behavior for HCV, except one person with history of contacting blood or needles. Conclusion the risk of positive RDT has a reverse relationship with aging and also it has an increase in married individuals. Therefore preventive education and screening for HCV should be a priority in young and middle-aged adults because of more sexual activity.
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Affiliation(s)
| | - Mahbobeh Oroei
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Aziz H, Fatima S, Faheem M. Indeterminate Prediction of Hepatitis C Virus Genotype by Commercial Real-Time Polymerase Chain Reaction Assay Resolving by Sequencing to Avoid the Consequence of Inaccurate Typing. Viral Immunol 2020; 33:507-513. [PMID: 32429831 DOI: 10.1089/vim.2019.0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Pakistan is ranked second highest after Egypt in hepatitis C virus (HCV) infection. Accurate typing is mandatory to be compliant with the World Health Organization strategy to eliminate HCV infection in 2030. We characterized the HCV genotypes using Abbott real-time polymerase chain reaction assay and indeterminate samples were sequenced. We also investigated the distribution of HCV genotype among different age groups and gender in chronic HCV patients. One thousand thirteen samples were tested for HCV genotyping using Abbott real-time HCV genotyping assay. RNA extraction from plasma was done using the m2000sp platform. The amplification and detection of genotypes was done on m2000rt instrument. The lower limit of detection assay is 500 IU/mL. The indeterminate genotypes were analyzed by sequencing of the NS5B region. We found genotype 1 in 1.68%, genotype 1b in 0.89%, genotype 1a in 0.79%, genotype 2 in 0.6, genotype 3 in 94.37%, genotype 4 in 0.4%, genotype 5 in 0.09%, and indeterminate genotype result were found in 1.18%. Abbott assay could not identify 12 samples of genotype 3 (1.18%) and gave the indeterminate result. It also fails to assign some of the samples of genotype 1 into 1a and 1b. The indeterminate genotypes were resolved by sequencing followed by phylogenetic analysis. Genotype 3 is the predominant genotype and significantly higher in females as compared with males. Genotype 1a is more common in males than in females. Indeterminate HCV genotypes on sequencing analysis identify as genotype 3a and likewise subtype of genotype1 as 1a.
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Affiliation(s)
- Hafsa Aziz
- Nuclear Medicine, Oncology, and Radiotherapy Institute, Islamabad, Pakistan
| | - Shazia Fatima
- Nuclear Medicine, Oncology, and Radiotherapy Institute, Islamabad, Pakistan
| | - Mohammad Faheem
- Nuclear Medicine, Oncology, and Radiotherapy Institute, Islamabad, Pakistan
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Ye D, Tang Y, Gu Y, Haleem H, Zhang L, Zhang Y, Xu C, Zhao J. Evaluation of the effectiveness of a pilot study of hospital-based hepatitis C epidemic surveillance. Medicine (Baltimore) 2019; 98:e18334. [PMID: 31860986 PMCID: PMC6940170 DOI: 10.1097/md.0000000000018334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the effectiveness of hospital-based hepatitis C epidemic surveillance initiated by China's CDC STD/AIDS (National Center for AIDS/STD Control and Prevention of Chinese Center for Disease Control and Prevention) Prevention and Control Center in 2017.A total of 104,666 anti-hepatitis C virus (HCV) and 633 HCV-RNA detection records in our hospital from 2014 to 2017 were used to analyze the anti-HCV and HCV-RNA detection rates and positive rates in patients before and after implementation of epidemic surveillance.We found that the estimated HCV positive rate was 0.395% in all patients, and this rate increased to 0.533% after the pilot research. The positive rates of anti-HCV were significantly enhanced, although certain differences were observed among different departments. Significant increase of positive rate of HCV-RNA was only found in the inpatients from nonsurgical departments. Eighty-one cases were diagnosed after this pilot research, exceeding the 70 total cases in the previous 3 years. Most cases were diagnosed by nonsurgical departments; the upward trend of the cases diagnosed by surgical departments cannot be ignored.Our study indicates expanding anti-HCV and HCV-RNA detection in the target populations in hospitals is a useful strategy for finding more occult HCV infection. In addition, our results provide useful pilot data of the seroepidemiology of Hepatitis C for the special populations in hospitals, which will provide valuable information for public health research.
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Affiliation(s)
- Dongxian Ye
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University
| | - Yuqing Tang
- Department of Preventative Medicine, Zhejiang Provincial Key Laboratory of Pathological and Physiological Technology, School of Medicine, Ningbo University, Ningbo, Zhejiang, P.R. China
| | - Yuanliang Gu
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University
| | - Harris Haleem
- Department of Preventative Medicine, Zhejiang Provincial Key Laboratory of Pathological and Physiological Technology, School of Medicine, Ningbo University, Ningbo, Zhejiang, P.R. China
| | - Libo Zhang
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University
| | - Youping Zhang
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University
| | - Chunxia Xu
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University
| | - Jinshun Zhao
- Department of Preventative Medicine, Zhejiang Provincial Key Laboratory of Pathological and Physiological Technology, School of Medicine, Ningbo University, Ningbo, Zhejiang, P.R. China
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A 2-year retrospective study of viral and host-associated risk factors in Pakistani hepatocellular carcinoma patients. Eur J Gastroenterol Hepatol 2019; 31:1103-1109. [PMID: 30829691 DOI: 10.1097/meg.0000000000001384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Persistent chronic hepatitis C (CHC) infection is associated strongly with serious complications such as hepatitis C virus-associated liver cirrhosis (HCV-LC) and hepatitis C virus-associated hepatocellular carcinoma (HCV-HCC). The aim of this study was to assess the distribution of hepatitis C virus (HCV) genotypes among HCV-positive patients and examine the potential associations between viral and host-associated factors with the risk of developing HCV-HCC. PATIENTS AND METHODS HCV-positive patients (n = 300) were enrolled and divided into three groups: CHC (n = 171), HCV-LC (n = 51), and HCV-HCC (n = 78). RESULTS HCV genotype 3a showed the highest prevalence among HCV-positive individuals (66% of patients), followed by genotype 1a (15% of patients). The proportion of individuals infected with mixed HCV genotypes was higher among HCV-HCC patients. Interestingly, there were a significantly higher proportion of women (54/78; 69.2%) among HCV-HCC patients compared with CHC patients (89/171 or 52%; χ = 6.47; P=1 × 10). Women with HCV had two-fold higher odds of developing HCV-HCC (odds ratio = 2.07, 95% confidence interval: 1.18-3.71). In comparison with CHC patients, significantly more HCV-HCC patients were 50 years of age or older (59/78 or 75.6% of HCV-HCC patients and 61/171 or 35.7% of CHC patients; χ = 34.27; P < 0.0001), suggesting that HCV-positive patients aged 50 years or older had an ~five-fold higher risk of developing HCV-HCC (odds ratio = 5.6, 95% confidence interval: 3.02-10.01). CONCLUSION In summary, HCV genotype 3a had the highest prevalence in the studied HCV-positive population, and women and older patients were at a higher risk of developing HCV-LC and HCV-HCC following CHC infections.
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Bayırlı Turan D, Kuruoğlu T, Gümüş D, Kalaycı F, Şerefhanoğlu K. Üçüncü basamak bir hastaneye başvuran hastalarda HBsAg ve anti-HCV seroprevalansı: Altı yıllık retrospektif veriler. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.502958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Shamshirian A, Alizadeh-Navaei R, Pourfathollah AA, Alipoor R, Mohseni AR. Seroprevalence and geographical distribution of hepatitis C virus in Iranian patients with thalassemia: a systematic review and meta-analysis. J LAB MED 2019. [DOI: 10.1515/labmed-2018-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Abstract
Background
Thalassemia as a hereditary hemoglobinopathy is the most common monogenic disease worldwide. Patients with thalassemia require regular blood transfusion, which provides the risk for the transmission of hepatitis C virus (HCV) as the most common post-transfusion infection in such patients, and this rate is very diverse in different parts of the world. We aimed to determine the prevalence of HCV among patients with thalassemia in Iran.
Methods
In this study, we searched for articles on the prevalence of HCV among Iranian thalassemia patients in English and Persian databases up to 2017. Heterogeneities were assessed by using an I-square (I2) test. Prevalence and 95% confidence interval (CI) were calculated using the random effects model.
Results
In total, 37 studies with 9185 patients were included in the meta-analysis. The prevalence of HCV among Iranian thalassemia patients was 17.0% (95% CI: 14.5–19.8). The rate of prevalence among male and female subjects was 17.4% (95% CI: 13.8–21.9) and 16.8% (95% CI: 13.2–21.1), respectively.
Conclusions
We found that the prevalence of HCV among Iranian thalassemia patients declined over time and the Iranian Blood Transfusion Organization has had a reasonable performance in HCV screening.
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Heath K. Cost-effectiveness analysis of treatment timing considering the future entry of lower-cost generics for hepatitis C. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:539-550. [PMID: 30288069 PMCID: PMC6159796 DOI: 10.2147/ceor.s171248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Cost-benefit analyses are crucial to inform treatment policies, particularly when the cost of patented drugs is very high. The cost of patented drugs is the limiting factor in hepatitis C treatment. However, hepatitis C drug costs are expected to fall following patent expiration, due to generic drug introduction. Methods An existing mathematical model by Shih et al was extended to consider lower-cost future generics in health economic models of hepatitis C. The model compared the cost-effectiveness of treating patients now with patented drugs vs postponing treatment until after patent expiration. Results For ledipasvir-sofosbuvir, this study finds that it is almost always more cost effective to treat hepatitis C with high-cost patented drugs immediately rather than waiting for patent expiry. For ledipasvir-sofosbuvir, a generic would need to enter the market at <16.40% of the patented price for delayed treatment to be cost effective. The further that patent expiry is in the future, the more cost effective delayed treatment becomes; however, uncertainty about generic pricing and market entry times are also higher if patent expiry is in the distant future. Conclusion It is more cost effective to treat hepatitis C sooner rather than later, regardless of the stage of the disease, and despite the high cost of patented drugs. However, patented drugs are being produced globally for prices much lower than those seen in the UK. Therefore, negotiation of patented drug prices with pharmaceutical companies may be a crucial step in cost effective treatment of hepatitis C.
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Affiliation(s)
- Katherine Heath
- Mathematical Ecology Research Group, Department of Zoology, University of Oxford, Oxford OX1 3PS, UK, .,New College, Oxford OX1 3BN, UK,
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Lei JH, Liang J, Gong X, Xiao XQ, Chen Z, Peng F. Analysis of Transmission Routes of Hepatitis C Virus Based on Virus Genotyping in 341 Cases with Different Suspected Initial Infection Time Points in Hunan Province, China. Med Sci Monit 2018; 24:5232-5241. [PMID: 30055000 PMCID: PMC6078012 DOI: 10.12659/msm.907424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Few investigations have been reported on the changing trends in transmission routes of hepatitis C virus (HCV) and the corresponding HCV genotype (GT) distribution in Hunan province, China. Material/Methods HCV GTs, suspected viral transmission routes, and time of initial infections were investigated in 341 HCV-infected patients in 2016. Results Genotype 1 (GT1) (72.1%) was the most prevalent HCV GT, followed by GT6 (17.6%), GT3 (7.6%), and GT2 (2.6%). GT4 and GT5 were not found. The predominant HCV transmission routes were blood-related routes (57.5%) and intravenous drug use (IDU) (15.0%); 52.2% of the patients got HCV infection before 1994, 25.6% from 1994 to 1998, and 22.2% after 1998; 93.5% of the infections via blood-related transmission routes were with HCV GT1, 61.5% via IDU or feculent sexual contact were with HCV GT6, and 50.0% via non-healthcare invasive procedures were with HCV GT6. HCV infections via IDU or feculent sexual behavior were more prevalent in young males, while infections via invasive cosmetic procedures occurred more in young females, and both had a shorter time interval from suspected infection to confirmed clinical diagnosis. Multinomial logistic regression confirmed the time points of the initial HCV infections and suspected viral transmission routes were correlated with HCV GT distribution. Conclusions HCV GT1 infections via blood-related transmission routes in Hunan province have continually decreased since 1994. However, younger patients infected with HCV, especially with HCV GT6 via IDU, feculent sexual behavior, and non-healthcare invasive procedures, have significantly increased.
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Affiliation(s)
- Jian-Hua Lei
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Jun Liang
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Xing Gong
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Xin-Qiang Xiao
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Zi Chen
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Feng Peng
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
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Distribution of Hepatitis C Virus Genotypes in Rasht, Capital City of Guilan Province, Northern Part of Iran. HEPATITIS MONTHLY 2018. [DOI: 10.5812/hepatmon.62030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Shen YN, Yu MX, Gao Q, Li YY, Huang JJ, Sun CM, Qiao N, Zhang HX, Wang H, Lu Q, Wang T. External validation of non-invasive prediction models for identifying ultrasonography-diagnosed fatty liver disease in a Chinese population. Medicine (Baltimore) 2017; 96:e7610. [PMID: 28746214 PMCID: PMC5627840 DOI: 10.1097/md.0000000000007610] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Several prediction models for fatty liver disease (FLD) are available with limited externally validation and less comprehensive evaluation. The aim was to perform external validation and direct comparison of 4 prediction models (the Fatty Liver Index, the Hepatic Steatosis Index, the ZJU index, and the Framingham Steatosis Index) for FLD both in the overall population and the obese subpopulation.This cross-sectional study included 4247 subjects aged 20 to 65 years recruited from the north of Shanxi Province in China. Anthropometric and biochemical features were collected using standard protocols. FLD was diagnosed by liver ultrasonography. We assessed all models in terms of discrimination, calibration, and decision curve analysis.The original models performed well in terms of discrimination for the overall population, with the area under the receiver operating characteristic curves (AUCs) around 0.85, while AUCs for obese individuals were around 0.68. Nevertheless, the predicted risks did not match well with the observed risks both in the overall population and the obese subpopulation. The FLI 2006 was 1 of the 2 best models in terms of discrimination (AUCs were 0.87 and 0.72 for the overall population and the obese subgroup, respectively) and had the best performance in terms of calibration, and attained the highest net benefit.The FLI 2006 is overall the best tool to identify high risk individuals and has great clinical utility. Nonetheless, it does not perform well enough to quantify the actual risk of FLD, which need to be (re)calibrated for clinical use.
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Affiliation(s)
- Ya-Nan Shen
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Ming-Xing Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Qian Gao
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Yan-Yan Li
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Jian-Jun Huang
- Department of Neurosurgery, General Hospital of Datong Coal Mining Group, Datong, China
| | - Chen-Ming Sun
- Department of Neurosurgery, General Hospital of Datong Coal Mining Group, Datong, China
| | - Nan Qiao
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Hai-Xia Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Hui Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
| | - Qing Lu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Tong Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan
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