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Lin HC, Jeng WJ, Liu J, Pan MH, Lee MH, Batrla-Utermann R, Lu SN, Chen CF, Yang HI, Chen CJ. Persistently high HBsAg levels during HBeAg-seropositive stage predict lower risk of hepatocellular carcinoma in chronic hepatitis B patients. Aliment Pharmacol Ther 2024; 59:993-1002. [PMID: 38410882 DOI: 10.1111/apt.17915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/15/2023] [Accepted: 02/11/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND High hepatitis B surface antigen (HBsAg) level predicts hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients with low viral load. The role of longitudinal HBsAg levels in predicting HCC in HBeAg-positive CHB patients remains unknown. METHOD HBeAg-positive CHB participants from the REVEAL-HBV cohort with ≥2 HBsAg measurements before HBeAg seroclearance were enrolled. Group-based trajectory modelling identified distinct HBsAg trajectory groups during a median of 11 years of HBeAg-positive status. Cox regression models were applied for investigating independent predictors of HCC and estimating adjusted hazard ratio (HRadj) with a 95% confidence interval (CI). A p-value less than 0.05 was considered statistically significant. RESULTS A total of 319 patients were enrolled and classified by HBsAg trajectory patterns as (A) persistently high group (n = 72): HBsAg persistently ≥104 IU/mL, and (B) non-stationary group (n = 233): low HBsAg at baseline or declining to <104 IU/mL during the follow-up. Group B had higher proportions of abnormal ALT levels, HBV genotype C and basal core mutation than group A (p < 0.05); age at entry and gender were comparable. The annual incidence of HCC in group A and group B were 0.37% and 1.16%, respectively (p = 0.03). In multivariate analysis, age >40 years (HRadj [95% CI] = 4.11 [2.26-7.48]), genotype C (HRadj [95% CI] = 4.39 [1.96-9.81]) and the non-stationary group (HRadj [95% CI] = 3.50 [1.49-8.21]) were independent predictors of HCC. Basal core promoter mutation was the only risk factor of HCC in the persistently high HBsAg group (HRadj [95% CI] = 32.75 [5.41-198.42]). CONCLUSION Patients with persistently high HBsAg levels during HBeAg-seropositive stage represent a unique population with low risk of HCC development.
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Affiliation(s)
- Hsin-Che Lin
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
- Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Jessica Liu
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Mei-Hung Pan
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | | | - Sheng-Nan Lu
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chuen-Fei Chen
- Mackay Medical College Department of Medicine, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Biomedical Translation Research Center, Academia Sinica, Taipei, Taiwan
- Doctoral Program of Clinical and Experimental Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
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Lin HC, Liu J, Pan MH, Lee MH, Batrla-Utermann R, Lu SN, Jeng WJ, Yang HI, Chen CJ. Rapid Decline Rather Than Absolute Level of HBsAg Predicts Its Seroclearance in Untreated Chronic Hepatitis B Patients From Taiwanese Communities. Clin Transl Gastroenterol 2023; 14:e00586. [PMID: 36988242 PMCID: PMC10461935 DOI: 10.14309/ctg.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Hepatitis B surface antigen (HBsAg) clearance leads to favorable outcomes in patients with chronic hepatitis B. HBsAg levels <200 IU/mL with HBsAg decline >0.5 log 10 IU/mL in 1 year have been reportedly predictive of HBsAg loss. This study aimed to use the REVEAL-hepatitis B virus cohort to validate and simplify this prediction rule and verify whether the simplified algorithm can be used among various clinical subgroups. METHOD We analyzed 707 patients with untreated chronic hepatitis B who had 3 or more HBsAg measurements within 5 years before HBsAg seroclearance or last visit, greater than 1 year apart from one another. Rapid HBsAg decline was defined as HBsAg decline >0.5 log 10 IU/mL in 1 year or >1 log 10 IU/mL in 2 years. Sensitivity, specificity, positive predictive values, and negative predictive values were compared to assess the predictability of HBsAg seroclearance. RESULTS During a median follow-up of 10.7 years, 41 of the 707 patients cleared serum HBsAg. HBsAg levels at all measurements were lower ( P < 0.0001) and HBsAg decline was greater ( P < 0.0001) in patients with seroclearance compared with non-seroclearance patients. The predictive accuracy of predicting 1-year HBsAg loss using only the rapid decline algorithm (sensitivity = 0.4412, specificity = 0.9792, positive predictive value = 0.5172, negative predictive value = 0.972) was the same as the model combining rapid HBsAg decline and HBsAg levels <200 IU/mL. The simplified algorithm including only the rapid decline performed similarly among various levels of HBsAg, hepatitis B virus DNA, and alanine aminotransferase and was independent of inactive carrier state. DISCUSSION HBsAg decline >0.5 log 10 IU/mL/yr was a practical predictor of HBsAg seroclearance within 1 year in our community-based untreated cohort.
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Affiliation(s)
- Hsin-Che Lin
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
- Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - Jessica Liu
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Mei-Hung Pan
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | | | - Sheng-Nan Lu
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung, Taiwan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Biomedical Translation Research Center, Academia Sinica, Taipei, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
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Van Harten AC, Wiste HJ, Weigand SD, Mielke MM, Kremers WK, Eichenlaub U, Batrla-Utermann R, Dyer RB, Algeciras-Schimnich A, Knopman DS, Jack CR, Petersen RC. CSF biomarkers in Olmsted County: Evidence of 2 subclasses and associations with demographics. Neurology 2020; 95:e256-e267. [PMID: 32591471 PMCID: PMC7455353 DOI: 10.1212/wnl.0000000000009874] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/19/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE We studied interrelationships between CSF biomarkers and associations with APOE ε4 genotype, demographic variables, vascular variables, and clinical diagnosis in Olmsted County, Minnesota. METHODS We included 774 Mayo Clinic Study of Aging participants (693 cognitively unimpaired [CU]; 71 with mild cognitive impairment [MCI]). CSF β-amyloid 42 (Aβ42), total tau (t-tau), and hyperphosphorylated tau (p-tau) were analyzed using Aβ42 CSF, t-tau CSF, and p-tau (181P) CSF electrochemiluminescence immunoassays. Bivariate mixture models were used to evaluate latent classes. We used linear regression models to evaluate independent associations of APOE ε4, demographic factors, cardiovascular risk, and diagnosis with CSF biomarker levels. Results were weighted back to the Olmsted County population. RESULTS Interrelationships between CSF Aβ42 and p-tau/t-tau were consistent with 2 latent classes in the general population. In subgroup 1 (n = 547 [71%]), we found a strong positive correlation between Aβ42 and p-tau (ρ = 0.81), while the correlation was much smaller in group 2 (ρ = 0.26, n = 227 [29%]). Group 2 was associated with older age, APOE ε4 genotype, a diagnosis of MCI, and elevated amyloid PET. Overall, APOE ε4 genotype and MCI were associated with Aβ42, while age was associated with p-tau/t-tau. There were no associations with sex, education, or vascular risk. CONCLUSION We hypothesize the population without dementia can be subdivided into participants with and without biological Alzheimer disease (AD) based on the combination of CSF Aβ42 and p-tau/t-tau (represented also by the p-tau/t-tau/Aβ42 ratio). In those without biological AD, common factors such as CSF dynamics may cause a positive correlation between CSF Aβ42 and p-tau/t-tau, while AD leads to dissociation of these proteins.
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Affiliation(s)
- Argonde C Van Harten
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland.
| | - Heather J Wiste
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
| | - Stephen D Weigand
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
| | - Michelle M Mielke
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
| | - Walter K Kremers
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
| | - Udo Eichenlaub
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
| | - Richard Batrla-Utermann
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
| | - Roy B Dyer
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
| | - Alicia Algeciras-Schimnich
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
| | - David S Knopman
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
| | - Clifford R Jack
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
| | - Ronald C Petersen
- From the Departments of Neurology (A.C.V.H., M.M.M., D.S.K., R.C.P.), Health Sciences Research (H.J.W., S.D.W., M.M.M., W.K.K., R.C.P.), Laboratory Medicine and Pathology (R.B.D.), and Radiology (C.R.J.), Mayo Clinic, Rochester, MN; Department of Neurology and Alzheimer Center Amsterdam UMC (A.C.V.H.), the Netherlands; and Roche Diagnostics (U.E., R.B.-U., A.A.-S.), Basel, Switzerland
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Molinuevo JL, Hansson O, Batrla-Utermann R, Bittner T, Aisen PS, Baldor R, Carlsson C, Grief S, Monsch AU, Reiman EM, Vilaseca J, Weiner MW, Simon M, Stutz V, Wahl S, Eichenlaub U, Wild N, Blennow K. P3-239: OPTIMIZED PATHWAYS FOR EARLY DETECTION OF ALZHEIMER'S DISEASE WITH BLOOD-BASED BIOMARKERS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jose Luis Molinuevo
- BarcelonaBeta Brain Research Center; Pasqual Maragall Foundation and Hospital Clinic i Universitari; Barcelona Spain
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences; Lund University; Malmö Sweden
- Skåne University Hospital; Lund Sweden
| | - Richard Batrla-Utermann
- Centralised and Point of Care Solutions; Roche Diagnostics International Ltd; Rotkreuz Switzerland
| | - Tobias Bittner
- Genentech, a member of the Roche Group; Basel Switzerland
| | - Paul S. Aisen
- Alzheimer's Therapeutic Research Institute; San Diego CA USA
| | - Robert Baldor
- Department of Family Medicine; University of Massachusetts Medical School; Worcester MA USA
| | | | - Samuel Grief
- Department of Clinical Family Medicine; University of Illinois College of Medicine; Chicago IL USA
| | - Andreas U. Monsch
- University Center for Medicine of Aging Basel; Felix Platter Hospital; Basel Switzerland
| | | | - Josep Vilaseca
- Universitat De Barcelona; Consortium of Primary Health Care Barcelona Esquerra; Barcelona Spain
| | - Michael W. Weiner
- UCSF Department of Radiology and Biomedical Imaging; San Francisco CA USA
| | - Maryline Simon
- Centralised and Point of Care Solutions; Roche Diagnostics International Ltd; Rotkreuz Switzerland
| | - Vivienne Stutz
- Centralised and Point of Care Solutions; Roche Diagnostics International Ltd; Rotkreuz Switzerland
| | - Simone Wahl
- Centralised and Point of Care Solutions; Roche Diagnostics GmbH; Penzberg Germany
| | | | - Norbert Wild
- Centralised and Point of Care Solutions; Roche Diagnostics GmbH; Penzberg Germany
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory; Sahlgrenska University Hospital; Mölndal Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy; University of Gothenburg; Mölndal Sweden
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Blennow K, Dage J, Johnson SC, Reiman EM, Shaw LM, Simon M, Eichenlaub U, Bittner T, Stutz V, Wahl S, Wild N, Batrla-Utermann R, Molinuevo JL. P2-231: EXPLORING THE NEED FOR ROBUST BIOMARKER ASSAYS IN ALZHEIMER'S DISEASE AND OTHER NEURODEGENERATIVE DISEASES. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kaj Blennow
- Clinical Neurochemistry Laboratory; Sahlgrenska University Hospital; Mölndal Sweden
- Institute of Neuroscience and Physiology, the Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | | | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | | | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - Maryline Simon
- Centralised and Point of Care Solutions; Roche Diagnostics International Ltd; Rotkreuz Switzerland
| | | | - Tobias Bittner
- Genentech, A member of the Roche Group; Basel Switzerland
| | - Vivienne Stutz
- Centralised and Point of Care Solutions; Roche Diagnostics International Ltd; Rotkreuz Switzerland
| | - Simone Wahl
- Centralised and Point of Care Solutions; Roche Diagnostics GmbH; Penzberg Germany
| | - Norbert Wild
- Centralised and Point of Care Solutions; Roche Diagnostics GmbH; Penzberg Germany
| | - Richard Batrla-Utermann
- Centralised and Point of Care Solutions; Roche Diagnostics International Ltd; Rotkreuz Switzerland
| | - Jose Luis Molinuevo
- BarcelonaBeta Brain Research Center; Pasqual Maragall Foundation and Hospital Clinic i Universitari; Barcelona Spain
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Corien van Harten A, Wiste HJ, Mielke MM, Weigand SD, Kremers WK, Eichenlaub U, Batrla-Utermann R, Knopman DS, Jack CR, Petersen RC. O2‐04‐05: CSF BIOMARKERS IN THE GENERAL POPULATION: ASSOCIATIONS WITH DEMOGRAPHICS AND APOE GENOTYPE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schindler SE, Gray JD, Gordon BA, Xiong C, Batrla-Utermann R, Quan M, Wahl S, Benzinger TLS, Holtzman DM, Morris JC, Fagan AM. Cerebrospinal fluid biomarkers measured by Elecsys assays compared to amyloid imaging. Alzheimers Dement 2018; 14:1460-1469. [PMID: 29501462 DOI: 10.1016/j.jalz.2018.01.013] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/15/2017] [Accepted: 01/26/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Levels of amyloid β peptide 42 (Aβ42), total tau, and phosphorylated tau-181 are well-established cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease, but variability in manual plate-based assays has limited their use. We examined the relationship between CSF biomarkers, as measured by a novel automated immunoassay platform, and amyloid positron emission tomography. METHODS CSF samples from 200 individuals underwent separate analysis for Aβ42, total tau, and phosphorylated tau-181 with automated Roche Elecsys assays. Aβ40 was measured with a commercial plate-based assay. Positron emission tomography with Pittsburgh Compound B was performed less than 1 year from CSF collection. RESULTS Ratios of CSF biomarkers (total tau/Aβ42, phosphorylated tau-181/Aβ42, and Aβ42/Aβ40) best discriminated Pittsburgh Compound B-positive from Pittsburgh Compound B-negative individuals. DISCUSSION CSF biomarkers and amyloid positron emission tomography reflect different aspects of Alzheimer's disease brain pathology, and therefore, less-than-perfect correspondence is expected. Automated assays are likely to increase the utility of CSF biomarkers.
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Affiliation(s)
- Suzanne E Schindler
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
| | - Julia D Gray
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian A Gordon
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Chengjie Xiong
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | - Tammie L S Benzinger
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - David M Holtzman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne M Fagan
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA.
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Arnerić SP, Batrla-Utermann R, Beckett L, Bittner T, Blennow K, Carter L, Dean R, Engelborghs S, Genius J, Gordon MF, Hitchcock J, Kaplow J, Luthman J, Meibach R, Raunig D, Romero K, Samtani MN, Savage M, Shaw L, Stephenson D, Umek RM, Vanderstichele H, Willis B, Yule S. Cerebrospinal Fluid Biomarkers for Alzheimer's Disease: A View of the Regulatory Science Qualification Landscape from the Coalition Against Major Diseases CSF Biomarker Team. J Alzheimers Dis 2018; 55:19-35. [PMID: 27662307 PMCID: PMC5115607 DOI: 10.3233/jad-160573] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) drug development is burdened with the current requirement to conduct large, lengthy, and costly trials to overcome uncertainty in patient progression and effect size on treatment outcome measures. There is an urgent need for the discovery, development, and implementation of novel, objectively measured biomarkers for AD that would aid selection of the appropriate subpopulation of patients in clinical trials, and presumably, improve the likelihood of successfully evaluating innovative treatment options. Amyloid deposition and tau in the brain, which are most commonly assessed either in cerebrospinal fluid (CSF) or by molecular imaging, are consistently and widely accepted. Nonetheless, a clear gap still exists in the accurate identification of subjects that truly have the hallmarks of AD. The Coalition Against Major Diseases (CAMD), one of 12 consortia of the Critical Path Institute (C-Path), aims to streamline drug development for AD and related dementias by advancing regulatory approved drug development tools for clinical trials through precompetitive data sharing and adoption of consensus clinical data standards. This report focuses on the regulatory process for biomarker qualification, briefly comments on how it contrasts with approval or clearance of companion diagnostics, details the qualifications currently available to the field of AD, and highlights the current challenges facing the landscape of CSF biomarkers qualified as hallmarks of AD. Finally, it recommends actions to accelerate regulatory qualification of CSF biomarkers that would, in turn, improve the efficiency of AD therapeutic development.
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Affiliation(s)
- Stephen P Arnerić
- Critical Path Institute, Coalition Against Major Diseases, Tucson, AZ, USA
| | | | | | | | - Kaj Blennow
- Clinical Neurochemistry Lab, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | | | - Robert Dean
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium
| | | | | | | | | | | | | | | | - Klaus Romero
- Critical Path Institute, Coalition Against Major Diseases, Tucson, AZ, USA
| | | | | | - Leslie Shaw
- University of Pennsylvania, Philadelphia, PA, USA
| | - Diane Stephenson
- Critical Path Institute, Coalition Against Major Diseases, Tucson, AZ, USA
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9
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Liu J, Hu HH, Lee MH, Korenaga M, Jen CL, Batrla-Utermann R, Lu SN, Wang LY, Mizokami M, Chen CJ, Yang HI. Serum Levels of M2BPGi as Short-Term Predictors of Hepatocellular Carcinoma in Untreated Chronic Hepatitis B Patients. Sci Rep 2017; 7:14352. [PMID: 29085039 PMCID: PMC5662597 DOI: 10.1038/s41598-017-14747-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/13/2017] [Indexed: 12/13/2022] Open
Abstract
This study examines the role of M2BPGi, a novel seromarker for chronic hepatitis, in predicting hepatocellular carcinoma (HCC) among untreated chronic hepatitis B (CHB) patients. In this nested case-control study, 1070 samples were assayed for M2BPGi, including 357 samples from HCC cases, and 713 samples from non-HCC controls, collected at various times throughout follow-up. HCC case samples were stratified according to years prior to diagnosis. Associations between M2BPGi and HCC were examined with multivariate logistic regression. M2BPGi, α-fetoprotein (AFP), and hepatitis B surface antigen (HBsAg) levels were significant independent short-term predictors of HCC, while M2BPGi was insignificant in long-term analyses. Compared to M2BPGi levels <1.0 cut-off index (COI), those with levels ≥2.0 COI had multivariate odds ratios (95% CI) for HCC of 7.40 (2.40-22.78), 6.46 (2.58-16.18), and 2.24 (0.97-5.15), respectively, for prediction of HCC within 1-2, 2-5, and ≥5 years. Higher proportions of individuals had M2BPGi levels ≥2.0 COI in samples closer to HCC diagnosis. Areas under receiver operating characteristic curves for models with M2BPGi, AFP, and HBsAg levels predicting HCC within 1-2, 2-5, and >5 years were 0.84, 0.81, and 0.75. M2BPGi is a strong and independent short-term predictor of HCC in CHB patients.
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Affiliation(s)
- Jessica Liu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hui-Han Hu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Masaaki Korenaga
- The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Chin-Lan Jen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | | | - Sheng-Nan Lu
- Department of Gastroenterology, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Li-Yu Wang
- MacKay Medical College, New Taipei City, Taiwan
| | - Masashi Mizokami
- The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventative Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan.
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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10
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de Wilde A, van Maurik IS, Kunneman M, Bouwman F, Zwan M, Willemse EAJ, Biessels GJ, Minkman M, Pel R, Schoonenboom NSM, Smets EMA, Wattjes MP, Barkhof F, Stephens A, van Lier EJ, Batrla-Utermann R, Scheltens P, Teunissen CE, van Berckel BNM, van der Flier WM. Alzheimer's biomarkers in daily practice (ABIDE) project: Rationale and design. Alzheimers Dement (Amst) 2017; 6:143-151. [PMID: 28239639 PMCID: PMC5318541 DOI: 10.1016/j.dadm.2017.01.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction The Alzheimer's biomarkers in daily practice (ABIDE) project is designed to translate knowledge on diagnostic tests (magnetic resonance imaging [MRI], cerebrospinal fluid [CSF], and amyloid positron emission tomography [PET]) to daily clinical practice with a focus on mild cognitive impairment (MCI) Methods ABIDE is a 3-year project with a multifaceted design and is structured into interconnected substudies using both quantitative and qualitative research methods. Results Based on retrospective data, we develop personalized risk estimates for MCI patients. Prospectively, we collect MRI and CSF data from 200 patients from local memory clinics and amyloid PET from 500 patients in a tertiary setting, to optimize application of these tests in daily practice. Furthermore, ABIDE will develop strategies for optimal patient-clinician conversations. Discussion Ultimately, this will result in a set of practical tools for clinicians to support the choice of diagnostic tests and facilitate the interpretation and communication of their results.
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Affiliation(s)
- Arno de Wilde
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Ingrid S van Maurik
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Marleen Kunneman
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Femke Bouwman
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Marissa Zwan
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Eline A J Willemse
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands; Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ruth Pel
- Vilans, Utrecht, The Netherlands
| | | | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands; Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | | | | | | | - Philip Scheltens
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
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11
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O'Bryant SE, Mielke MM, Rissman RA, Lista S, Vanderstichele H, Zetterberg H, Lewczuk P, Posner H, Hall J, Johnson L, Fong YL, Luthman J, Jeromin A, Batrla-Utermann R, Villarreal A, Britton G, Snyder PJ, Henriksen K, Grammas P, Gupta V, Martins R, Hampel H. Blood-based biomarkers in Alzheimer disease: Current state of the science and a novel collaborative paradigm for advancing from discovery to clinic. Alzheimers Dement 2017; 13:45-58. [PMID: 27870940 PMCID: PMC5218961 DOI: 10.1016/j.jalz.2016.09.014] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022]
Abstract
The last decade has seen a substantial increase in research focused on the identification of blood-based biomarkers that have utility in Alzheimer's disease (AD). Blood-based biomarkers have significant advantages of being time- and cost-efficient as well as reduced invasiveness and increased patient acceptance. Despite these advantages and increased research efforts, the field has been hampered by lack of reproducibility and an unclear path for moving basic discovery toward clinical utilization. Here we reviewed the recent literature on blood-based biomarkers in AD to provide a current state of the art. In addition, a collaborative model is proposed that leverages academic and industry strengths to facilitate the field in moving past discovery only work and toward clinical use. Key resources are provided. This new public-private partnership model is intended to circumvent the traditional handoff model and provide a clear and useful paradigm for the advancement of biomarker science in AD and other neurodegenerative diseases.
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Affiliation(s)
- Sid E O'Bryant
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Robert A Rissman
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, UCSD School of Medicine, La Jolla, CA, USA
| | - Simone Lista
- AXA Research Fund and UPMC Chair, Paris, France; Department de Neurologie, Institut de la Memorie et de la Maladie d'Alzheimer (IM2A) et Institut du Cerveau et du la Moelle epiniere (ICM), Hospital de la Pitie-Salpetriere, Sorbonne Universites, Universite Pierre et Marie Curie, Paris, France
| | | | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gotenburg, Molndal, Sweden; UCL Institute of Neurology, London, UK
| | - Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Bialystok, Poland
| | | | - James Hall
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Leigh Johnson
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Yiu-Lian Fong
- Johnson & Johnson, London Innovation Center, London, UK
| | - Johan Luthman
- Neuroscience Clinical Development, Clinical Neuroscience Eisai, Woodcliff Lake, NJ, USA
| | | | | | - Alcibiades Villarreal
- Centro de Neurociencias y Unidad de Investigacion Clinica, Instituto de Investigaciones Cientificas y Servicios de Alta Tecnologia (INDICASAT AIP), Ciudad del Saber, Panama, Panama
| | - Gabrielle Britton
- Centro de Neurociencias y Unidad de Investigacion Clinica, Instituto de Investigaciones Cientificas y Servicios de Alta Tecnologia (INDICASAT AIP), Ciudad del Saber, Panama, Panama
| | - Peter J Snyder
- Department of Neurology, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Kim Henriksen
- Neurodegenerative Diseases, Nordic Bioscience Biomarkers and Research, Herlev, Denmark
| | - Paula Grammas
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, RI, USA
| | - Veer Gupta
- Faculty of Health, Engineering and Sciences, Center of Excellence for Alzheimer's Disease Research and Care, School of Medical Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Ralph Martins
- Faculty of Health, Engineering and Sciences, Center of Excellence for Alzheimer's Disease Research and Care, School of Medical Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Harald Hampel
- AXA Research Fund and UPMC Chair, Paris, France; Department de Neurologie, Institut de la Memorie et de la Maladie d'Alzheimer (IM2A) et Institut du Cerveau et du la Moelle epiniere (ICM), Hospital de la Pitie-Salpetriere, Sorbonne Universites, Universite Pierre et Marie Curie, Paris, France
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12
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Chien J, Liu J, Lee MH, Jen CL, Batrla-Utermann R, Lu SN, Wang LY, You SL, Yang HI, Chen CJ. Risk and predictors of hepatocellular carcinoma for chronic hepatitis B patients with newly developed cirrhosis. J Gastroenterol Hepatol 2016; 31:1971-1977. [PMID: 27118149 DOI: 10.1111/jgh.13422] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Most studies on risk predictors of hepatocellular carcinoma (HCC) among cirrhotic chronic hepatitis B patients do not confirm the date at cirrhosis diagnosis. We examined HCC risk and predictors in chronic hepatitis B patients with newly diagnosed cirrhosis. METHODS 4155 HBsAg seropositive participants were followed every 6-12 months with seromarker testing. Cirrhosis was ascertained through abdominal ultrasonography and computerized linkage with national health insurance profiles. Predictors included in Cox proportional hazards models were age, HBeAg serostatus, serum levels of HBsAg, alanine aminotransferase (ALT), alpha-fetoprotein (AFP), and ALDH2 rs671 genotypes. RESULTS A total of 301 patients developed cirrhosis, 76 of whom later developed HCC after 2462 person-years, showing an average annual incidence of 3.1%. The 15-year cumulative HCC risk among cirrhotics was 39.8% with a lifetime (30-80 years old) HCC risk of 78.5%. The adjusted HR's (95% CI, P-value) were 14.26 (3.17-64.08, P = 0.0005) for age at cirrhosis diagnosis of ≥60 years (vs 30-39 years), 2.85 (1.49-5.46, P = 0.0015) for HBeAg seropositivity (vs HBeAg seronegativity with HBsAg levels <1000 IU/mL), 0.35 (0.20-0.59, P < 0.0001) for AA/AG genotypes of rs671 (vs GG genotype), 3.68 (1.70-7.99, P = 0.0010) for ALT levels >45 U/L (vs <15 U/L), 3.52 (1.78-6.93, P = 0.0003) for AFP levels >20 ng/mL (vs <10 ng/mL), and 2.64 (1.38-5.07, P = 0.0035) for HBsAg levels ≥1000 IU/mL (vs <1000 IU/mL among HBeAg seronegatives). CONCLUSIONS Older age, GG genotype of ALDH2 rs671, HBeAg seropositivity, and elevated serum levels of ALT, AFP, and HBsAg at cirrhosis diagnosis were HCC risk predictors in cirrhotic chronic hepatitis B patients.
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Affiliation(s)
- Justin Chien
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Jessica Liu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Lan Jen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | | | - Sheng-Nan Lu
- Department of Gastroenterology, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Li-Yu Wang
- MacKay Medical College, New Taipei City, Taiwan
| | - San-Lin You
- Department of Public Health, College of Medicine, Catholic Fu-Jen University, New Taipei City, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan.,Graduate Institute of Epidemiology and Preventative Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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13
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Liu J, Yang HI, Lee MH, Jen CL, Batrla-Utermann R, Lu SN, Wang LY, You SL, Chen CJ. Serum Levels of Hepatitis B Surface Antigen and DNA Can Predict Inactive Carriers With Low Risk of Disease Progression. Hepatology 2016; 64:381-9. [PMID: 27079545 DOI: 10.1002/hep.28552] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/14/2016] [Indexed: 02/06/2023]
Abstract
UNLABELLED Serum levels of hepatitis B virus (HBV) DNA (≤2000 IU/mL) and hepatitis B surface antigen (HBsAg) (<1000 IU/mL) have been shown to distinguish inactive carriers with high accuracy. The goal of this study was to validate the predictability of one-time measurement of quantitative HBsAg and HBV DNA levels for inactive carrier status and chronic hepatitis B (CHB) progression in a community-based cohort. This study included 1529 participants chronically infected with HBV genotype B or C from the REVEAL-HBV cohort. They were ascertained as inactive or active CHB after 18 months of follow-up. Validity of the one-time measurement was assessed by sensitivity, specificity, and receiver operating characteristic curves, while associations with clinical outcomes were calculated with Cox proportional hazards regressions. The one-time baseline measurement of HBsAg <1000 IU/mL and HBV DNA <2000 IU/mL distinguished inactive carriers from active CHB with a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 71%, 85%, 83%, 74%, and 78%, respectively. Those identified as inactive carriers using the one-time baseline measurement had multivariate adjusted hazard ratios of 0.36 (95% confidence interval [CI], 0.20-0.63) and 0.36 (0.23-0.56) for hepatocellular carcinoma and liver cirrhosis, respectively, and an adjusted rate ratio of 6.97 (95% CI, 5.21-9.33) for HBsAg seroclearance. Areas under the receiver operating characteristic curve of predicting these outcomes using the one-time definition were similar to those obtained when using long-term follow-up defined carrier status for prediction. CONCLUSION This study confirms the predictability of a one-time combined HBsAg and HBV DNA measurement for future inactive carriers. This single-point strategy provides new and complementary information useful for management of patients with chronic hepatitis B infection. (Hepatology 2016;64:381-389).
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Affiliation(s)
- Jessica Liu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chin-Lan Jen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | | | - Sheng-Nan Lu
- Department of Gastroenterology, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Li-Yu Wang
- MacKay Medical College, New Taipei City, Taiwan
| | - San-Lin You
- Department of Public Health, College of Medicine, Catholic Fu-Jen University, New Taipei City, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan.,Graduate Institute of Epidemiology and Preventative Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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14
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Yang HI, Tseng TC, Liu J, Lee MH, Liu CJ, Su TH, Batrla-Utermann R, Chan HLY, Kao JH, Chen CJ. Incorporating Serum Level of Hepatitis B Surface Antigen or Omitting Level of Hepatitis B Virus DNA Does not Affect Calculation of Risk for Hepatocellular Carcinoma in Patients Without Cirrhosis. Clin Gastroenterol Hepatol 2016; 14:461-468.e2. [PMID: 26598229 DOI: 10.1016/j.cgh.2015.10.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/15/2015] [Accepted: 10/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Tests for hepatitis B virus (HBV) DNA are expensive, and levels of hepatitis B surface antigen (HBsAg) can help determine the risk for hepatocellular carcinoma (HCC) in patients with chronic HBV infection. We investigated how adding data to knowing the level of HBsAg or excluding measurement of HBV DNA affected the accuracy of the Risk Estimation for Hepatocellular Carcinoma in Chronic Hepatitis B (REACH-B) scoring system in determining the risk for HCC. METHODS We collected data from 3584 patients with chronic HBV infection who were positive for HBsAg, free of cirrhosis, and participated in the community-based Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer (REVEAL)-HBV cohort (208 cases of HCC) from 1991 through 1992; they were followed up until December 31, 2008. Data from this cohort were used to derive our scoring system. We validated our system using data from 2688 HBsAg-seropositive patients (191 cases of HCC) who participated in the hospital-based Elucidation of Risk Factors for Disease Control or Advancement in Taiwanese Hepatitis B Carriers (ERADICATE-B) study at the National Taiwan University Hospital from 1985 through 2000; they were followed up until December 31, 2010. We also validated the system using data from 426 patients with chronic HBV infection who participated in the Chinese University of Hong Kong (CUHK) study (46 cases of HCC) from 1997 through 2000; patients were followed up for a median of 225 weeks. Discrimination and calibration were evaluated using area under the receiver operating characteristic (AUROC) curves and calibration charts. RESULTS When data on HBsAg were added to the REACH-B scoring system, it identified patients in the ERADICATE-B study who developed HCC within 3, 5, and 10 years, with AUROC curve values of 0.92 (95% confidence interval [CI], 0.82-1.02), 0.78 (95% CI, 0.70-0.86), and 0.80 (95% CI, 0.76-0.84), respectively. It identified patients in the CUHK study who developed HCC in 3, 5, and 10 years, with AUROC curve values of 0.85 (95% CI, 0.75-0.95), 0.82 (95% CI, 0.70-0.93), and 0.78 (95% CI, 0.70-0.870), respectively. When data on HBV DNA were removed from the REACH-B scoring system, it identified patients in the ERADICATE-B cohort who developed HCC in 3, 5, and 10 years, with AUROC curve values of 0.90 (95% CI, 0.81-1.0), 0.76 (95% CI, 0.68-0.85), and 0.78 (95% CI, 0.73-0.82), respectively. It identified patents in the CUHK cohort who developed HCC in 3, 5, and 10 years, with AUROC curve values of 0.84 (95% CI, 0.79-0.92), 0.81 (95% CI, 0.71-0.91), and 0.79 (95% CI, 0.72-0.87). These modified systems identified patients who developed HCC with similar levels of accuracy as the original REACH-B score (P > .05 in tests of noninferiority). CONCLUSIONS Including data on serum level of HBsAg or removing data on level of HBV DNA do not alter the accuracy of the REACH-B scoring system in determining HCC risk in patients with chronic HBV infection without cirrhosis. It might be cost effective to replace the test for HBV DNA with assays to measure HBsAg in determining HCC risk. These modified scoring systems might replace the REACH-B system in specific situations.
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Affiliation(s)
- Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tai-Chung Tseng
- Division of Gastroenterology, Department of Internal Medicine, Taipei Tzuchi Hospital, Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jessica Liu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Jen Liu
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, and Hepatitis Research Center, National Taiwan University, Taipei, Taiwan
| | - Tung-Hung Su
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, and Hepatitis Research Center, National Taiwan University, Taipei, Taiwan
| | | | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
| | - Jia-Horng Kao
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, and Hepatitis Research Center, National Taiwan University, Taipei, Taiwan; Department of Medical Research, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
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15
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Wilde A, Bouwman F, Zwan MD, Biessels GJ, Minkman M, Schoonenboom NS, Smets EM, Wattjes M, Schaeuble B, Batrla-Utermann R, Scheltens P, Teunissen CE, Berckel BN, Flier WM. P3‐142: Alzheimer's biomarkers in daily practice (ABIDE): Study design. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Arno Wilde
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Femke Bouwman
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Marissa D. Zwan
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | | | | | | | | | - Mike Wattjes
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | | | | | - Philip Scheltens
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Charlotte E. Teunissen
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical Center, Alzheimer Center VUMCNeurocampusAmsterdamNetherlands
| | - Bart N.M. Berckel
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Wiesje M. Flier
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
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16
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Liu J, Tseng TC, Yang HI, Lee MH, Batrla-Utermann R, Jen CL, Lu SN, Wang LY, You SL, Chen PJ, Chen CJ, Kao JH. Predicting Hepatitis B Virus (HBV) Surface Antigen Seroclearance in HBV e Antigen-Negative Patients With Chronic Hepatitis B: External Validation of a Scoring System. J Infect Dis 2014; 211:1566-73. [DOI: 10.1093/infdis/jiu659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/12/2014] [Indexed: 01/14/2023] Open
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17
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Liu J, Yang HI, Lee MH, Lu SN, Jen CL, Batrla-Utermann R, Wang LY, You SL, Hsiao CK, Chen PJ, Chen CJ. Spontaneous seroclearance of hepatitis B seromarkers and subsequent risk of hepatocellular carcinoma. Gut 2014; 63:1648-57. [PMID: 24225939 DOI: 10.1136/gutjnl-2013-305785] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The associations between long-term risk of hepatocellular carcinoma (HCC) and spontaneous seroclearance of HBV e antigen (HBeAg), HBV DNA and HBV surface antigen (HBsAg) have never been examined by a prospective study using serially measured seromarkers. This study aimed to assess the importance of spontaneous HBeAg, HBV DNA and HBsAg seroclearance in the prediction of HCC risk. METHODS This study included 2946 HBsAg seropositive individuals who were seronegative for antibodies against HCV and free of liver cirrhosis. Serial serum samples collected at study entry and follow-up health examinations were tested for HBeAg, HBV DNA and HBsAg. Cox proportional hazards models were used to calculate the HRs of developing HCC after seroclearance of HBV markers. RESULTS The HR (95% CI) of developing HCC after seroclearance of HBeAg, HBV DNA and HBsAg during follow-up was 0.63 (0.38 to 1.05), 0.24 (0.11 to 0.57) and 0.18 (0.09 to 0.38), respectively, after adjustment for age, gender and serum level of alanine aminotransferase at study entry. High HBV DNA levels at the seroclearance of HBeAg (mean±SD, 4.35±1.64 log10 IU/mL) may explain the non-significant association between HBeAg seroclearance and HCC risk. Among HBeAg seronegative participants with detectable serum HBV DNA at study entry, the lifetime (30-75-years-old) cumulative incidence of HCC was 4.0%, 6.6% and 14.2%, respectively, for those with seroclearance of both HBV DNA and HBsAg, seroclearance of HBV DNA only, and seroclearance of neither. CONCLUSIONS Spontaneous seroclearance of HBV DNA and HBsAg are important predictors of reduced HCC risk.
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Affiliation(s)
- Jessica Liu
- The Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hwai-I Yang
- The Genomics Research Center, Academia Sinica, Taipei, Taiwan Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung, Taiwan Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Sheng-Nan Lu
- Department of Gastroenterology, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chin-Lan Jen
- The Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | | | - Li-Yu Wang
- MacKay College of Medicine, Taipei, Taiwan
| | - San-Lin You
- The Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Chuhsing K Hsiao
- Graduate Institute of Epidemiology and Preventative Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Pei-Jer Chen
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Jen Chen
- The Genomics Research Center, Academia Sinica, Taipei, Taiwan Graduate Institute of Epidemiology and Preventative Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Liu J, Yang HI, Lee MH, Batrla-Utermann R, Jen CL, Lu SN, Wang LY, You SL, Hsiao CK, Chen CJ. Distinct seromarkers predict different milestones of chronic hepatitis B progression. Hepatology 2014; 60:77-86. [PMID: 24700432 DOI: 10.1002/hep.27083] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/11/2014] [Indexed: 12/14/2022]
Abstract
UNLABELLED Spontaneous seroclearance of hepatitis B e antigen (HBeAg) and hepatitis B virus (HBV) DNA undetectability are important milestones of chronic hepatitis B and major treatment endpoints of antiviral therapy. This study investigated the role of serum hepatitis B surface antigen (HBsAg) levels and established models for predicting HBeAg seroclearance and HBV DNA undetectability. A total of 2,139 HBsAg-seropositive, anti-HCV-seronegative, and treatment-naïve participants without liver cirrhosis at study entry were included. Spontaneous HBeAg seroclearance and HBV DNA undetectability were analyzed in 431 HBeAg-seropositive participants and 1,708 HBeAg-seronegative participants, respectively. Regression coefficients of predictors in Cox proportional hazard models were converted into integer scores for predicting seroclearance and predictive accuracy was assessed with time-dependent receiver operating characteristic (ROC) curves. The HBV DNA level was the most important predictor of HBeAg seroclearance but serum HBsAg level was the most significant predictor of HBV DNA undetectability. Compared to individuals with HBsAg levels ≥ 10,000 IU/mL, the multivariate-adjusted rate ratio (95% confidence interval) of HBV DNA undetectability was 1.20 (0.62-2.30), 2.49 (1.31-4.75), and 6.08 (3.19-11.61) for those with serum HBsAg levels of 1,000-9,999, 100-999, and <100 IU/mL, respectively. The area under the ROC curve (AUROC) of the prediction models for predicting the 5- and 10-year probabilities of HBeAg seroclearance and HBV DNA undetectability were 0.85 (0.80-0.90) and 0.78 (0.73-0.83) for HBeAg seroclearance, and 0.77 (0.72-0.82) and 0.73 (0.70-0.76) for HBV DNA undetectability. CONCLUSION Prediction models incorporating important host and virus factors can predict HBeAg seroclearance and HBV DNA undetectability. Serum HBsAg levels rather than HBV DNA is the most important predictor of spontaneous HBV DNA undetectability. Serum HBsAg levels should be monitored in the management of patients with HBeAg-seronegative chronic hepatitis B.
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Affiliation(s)
- Jessica Liu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
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Lee MH, Yang HI, Liu J, Batrla-Utermann R, Jen CL, Iloeje UH, Lu SN, You SL, Wang LY, Chen CJ. Prediction models of long-term cirrhosis and hepatocellular carcinoma risk in chronic hepatitis B patients: risk scores integrating host and virus profiles. Hepatology 2013; 58:546-54. [PMID: 23504622 DOI: 10.1002/hep.26385] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 03/08/2013] [Indexed: 12/07/2022]
Abstract
UNLABELLED Integrating host and HBV characteristics, this study aimed to develop models for predicting long-term cirrhosis and hepatocellular carcinoma (HCC) risk in chronic hepatitis B virus (HBV) patients. This analysis included hepatitis B surface antigen (HBsAg)-seropositive and anti-HCV-seronegative participants from the Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer in HBV (R.E.V.E.A.L.-HBV) cohort. Newly developed cirrhosis and HCC were ascertained through regular follow-up ultrasonography, computerized linkage with national health databases, and medical chart reviews. Two-thirds of the participants were allocated for risk model derivation and another one-third for model validation. The risk prediction model included age, gender, HBV e antigen (HBeAg) serostatus, serum levels of HBV DNA, and alanine aminotransferase (ALT), quantitative serum HBsAg levels, and HBV genotypes. Additionally, the family history was included in the prediction model for HCC. Cox's proportional hazards regression coefficients for cirrhosis and HCC predictors were converted into risk scores. The areas under receiver operating curve (AUROCs) were used to evaluate the performance of risk models. Elder age, male, HBeAg, genotype C, and increasing levels of ALT, HBV DNA, and HBsAg were all significantly associated with an increased risk of cirrhosis and HCC. The risk scores estimated from the derivation set could accurately categorize participants with low, medium, and high cirrhosis and HCC risk in the validation set (P<0.001). The AUROCs for predicting 3-year, 5-year, and 10-year cirrhosis risk ranged 0.83-0.86 and 0.79-0.82 for the derivation and validation sets, respectively. The AUROC for predicting 5-year, 10-year, 15-year risk of HCC ranged 0.86-0.89 and 0.84-0.87 in the derivation and validation sets, respectively. CONCLUSION The risk prediction models of cirrhosis and HCC by integrating host and HBV profiles have excellent prediction accuracy and discriminatory ability. They may be used for clinical management of chronic hepatitis B patients.
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Affiliation(s)
- Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Liu J, Lee MH, Batrla-Utermann R, Jen CL, Iloeje UH, Lu SN, Wang LY, You SL, Hsiao CK, Yang HI, Chen CJ. A predictive scoring system for the seroclearance of HBsAg in HBeAg-seronegative chronic hepatitis B patients with genotype B or C infection. J Hepatol 2013; 58:853-60. [PMID: 23246508 DOI: 10.1016/j.jhep.2012.12.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/31/2012] [Accepted: 12/05/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Seroclearance of hepatitis B surface antigen (HBsAg) is the most ideal end point in the treatment of chronic hepatitis B. This study develops a predictive scoring system to assess whether the addition of serum levels HBsAg may improve the predictability of HBsAg loss. METHODS This study included 2491 untreated participants with genotype B or C HBV infection, who were HBsAg-seropositive, HBeAg-seronegative, anti-HCV-seronegative, and cirrhosis free at study entry. Regression coefficients of predictors in Cox Regression models were converted into integer scores for predicting HBsAg seroclearance. Predictive accuracy was assessed with area under the receiver operating characteristic curves (AUROC), and predictive accuracies of models with and without serum HBsAg levels were compared. RESULTS Low serum levels of both HBsAg and HBV DNA were the strongest predictors of spontaneous HBsAg seroclearance. Compared to baseline serum HBsAg levels ≥1000 IU/ml, the multivariate adjusted rate ratio of spontaneous HBsAg seroclearance was 10.96 (7.92-15.16) for those with baseline serum HBsAg levels <100 IU/ml. The predictive ability of HBsAg levels was modified by HBV viral load, showing a weaker effect in those with higher viral loads, and the strongest effect among those with undetectable viral loads. The inclusion of serum HBsAg levels greatly improved the AUROC for predicting HBsAg seroclearance at the fifth (from 0.79 [0.787-0.792] to 0.89 [0.889-0.891]) and tenth year (from 0.73 [0.728-0.732] to 0.84 [0.839-0.841]) after study entry. CONCLUSIONS Incorporated into an easy-to-use scoring system, HBV viral load and quantitative serum HBsAg levels can accurately predict HBsAg seroclearance.
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Affiliation(s)
- Jessica Liu
- Graduate Institute of Epidemiology and Preventative Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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