Juferdy Kurniawan

Hyperuricemia as an independent risk factor for non-alcoholic fatty liver disease (NAFLD) progression evaluated using controlled attenuation parameter-transient elastography: Lesson learnt from tertiary referral center

BACKGROUND AND AIM Hyperuricemia is one of the metabolic parameter which has been considered to play an important role in non-alcoholic fatty liver disease (NAFLD). However, there is still lack of studies about association between serum uric acid with liver disease progression in NAFLD. This study aimed to know the association between hyperuricemia with moderate to severe steatosis and significant fibrosis along with other metabolic factors in NAFLD patients evaluated using Controlled Attenuation Parameter (CAP) - Transient Elastography (TE). METHODS This is a prospective study in NAFLD patients who came to our tertiary referral center University hospital hepatobiliary outpatients clinic. All patients underwent metabolic parameters measurement including serum uric acid level and CAP-TE examination. Cutoff value used for significant liver fibrosis ≥7 kPa and ≥285 dB/m for moderate-severe steatosis. RESULTS Of 113 NAFLD patients, there were 45 patients with moderate-severe steatosis and 34 patients with significant fibrosis. Multivariate analysis showed only high level of fasting blood glucose (OR 2756; 95% CI 1.131-6.717) and low HDL level (OR 4.196, 95% CI 1.22-14.430) to be independent risk factors of moderate-severe steatosis. High level of fasting blood glucose (OR 3.98, 95% CI 1.105-14.389) and hyperuricemia (OR 2.501, 95% CI 1.095-5.714) were found to be independent risk factors for significant liver fibrosis. CONCLUSION Hyperuricemia is found to be an independent risk factor for significant liver fibrosis.

Factors Associated with Surveillance for Early Detection of Hepatocellular Carcinoma in Liver Cirrhosis Patients

Background: The minimal number of hepatocellular carcinoma (HCC) patients diagnosed through surveillance is proposed as the cause of persistently low number of survival. It is important to identify the proportion of surveillance for early detection of HCC in patients with liver cirrhosis and related factors. This study aimed to determine the proportion of surveillance for early detection of HCC in patients with liver cirrhosis and related factors. Method: A cross-sectional study of patients with liver cirrhosis at RSCM from January to December 2013. The data was obtained from medical records and confirmed by telephone. Surveillance was required for abdominal ultrasound with or without AFP at least once a year within 3 years after that period. Factors studied were gender, ethnicity, education level, income level, availability of medical insurance, location of residence, surveillance education, cirrhosis aetiology, and severity of cirrhosis. Then, logistic regression test was used in the multivariate analysis. Results: From 200 patients, 50 patients (25,0%) underwent surveillance, 150 patients (75,0%) did not. Bivariate analysis revealed 4 variables with p < 0.25, gender (p = 0,056), ethnicity (p = 0, 231), surveillance education (p = 0,005), and severity of cirrhosis (p = 0, 005). Multivariate analysis showed that the risk factors for surveillance were surveillance education (OR = 2,598; CI 95% (1,325 - 5,094), p = 0,005) and severity of cirrhosis (OR = 1.815; CI 95% = 1,210-2,724; p = 0,004). Conclusion: Surveillance education and severity of cirrhosis were the factors associated with surveillance for early detection of HCC in liver cirrhosis patients.

Complete Remission after Sequential Therapy of Drug Eluting Beads Transarterial Chemoembolization and Liver Resection in Large Solitary Nodule Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the fifth most prevalent and the second highest cause of death among cancer. The treatment of large solitary nodule HCC is still challenging. Transarterial chemoembolization (TACE) and liver resection are two modalities of therapy in HCC management. However, recurrence rate from each therapy is relatively high. We report a case of 46-year-old man diagnosed with large solitary nodule HCC, who was treated with drug eluting bead TACE (DEB-TACE) prior to liver resection. Studies about this combination are still limited and showed various results.

Tumor Response Evaluation Transarterial Chemoembolization-treated Hepatocellular Carcinoma

Transarterial chemoembolization (TACE) is the standard of care for patients with intermediate stage hepatocellular carcinoma (HCC), as recommended by Barcelona Clinic Liver Cancer (BCLC) 2016 staging system. Data showed that patients treated with conventional TACE had longer median survival time (18-28,7 months) compared to those who did not (9,2-19,7 months).1 However, the clinicians have to select carefully which of their patients are suitable for undergoing TACE.2

Liver Transplant in Hepatocellular Carcinoma: Indication and Prognostic Factors

Hepatocellular carcinoma (HCC) is the most common type of liver cancer. There are several treatment modalities according to Barcelona treatment algorithm. Liver transplant is one of the curative option treatments, with its indication and prognostic factors. Carefully selected patients for liver transplant in HCC case will result in the same or slightly inferior survival rate compare with liver transplant in non-malignancy case.

Antiviral Therapy for Hepatitis C Prophylaxis in Percutaneous Exposure and Acute Hepatitis C

Incidence of percutaneous exposure to hepatitis C virus (HCV) is still quite high, particularly in medical staffs. Though not all will cause infection, but if acute HCV infection occurs, it usually develops into chronic hepatitis which finally causes cirrhosis and hepatocellular carcinoma. Untill now, there is no standard method either in regiments, administration time, or duration of administration to prevent HCV infection after exposure occurs, as well as the use of antiviral therapy in acute HCV. HCV therapy target is viral eradication, thus the therapy response is defined using virological parameter than clinical parameter. Different from hepatitis B virus (HBV), immunoglobulin administration after exposure to HCV is not recommended as it is not proven to prevent transmission, similarly with pegylated interferon (PEG-IFN) or interferon (IFN) administration. In addition, several studies concluded that risk of HCV transmission after percutaneous exposure is low, therefore regular strict monitoring (monthly in the first 16 weeks after exposure) to clinical and laboratory results (HCV-RNA, alanine aminotransferase) is more required, so that detection and early treatment to acute HCV can be performed, considering that several studies showed that early monotherapy using IFN/PEG-IFN in acute HCV could reach quite high sustained virological response (SVR). Keywords: hepatitis C, post exposure prophylaxis, acute infection treatment