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Article ; Online: Bridging the Gap: Screening for Nonalcoholic Fatty Liver Disease in the Primary Care Population.

Chadha, Nikita / Sterling, Richard K

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

2022 Volume 20, Issue 11, Page(s) 2448–2450

MeSH term(s)	Humans ; Non-alcoholic Fatty Liver Disease/diagnosis ; Liver ; Mass Screening ; Primary Health Care
Language	English
Publishing date	2022-02-18
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2119789-1
ISSN	1542-7714 ; 1542-3565
ISSN (online)	1542-7714
ISSN	1542-3565
DOI	10.1016/j.cgh.2022.02.029
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Outnumbered: Control Prothrombin Time in Maddrey's Discriminant Function Impacts Steroid Use but Not Mortality in Alcoholic Hepatitis.

Healey, Marcus / Sterling, Richard K

Biology

2022 Volume 11, Issue 12

Abstract: Background and aims: In alcoholic hepatitis (AH), increases in the total bilirubin (TB) and the prothrombin time (PT), which are included in the Maddrey's discriminant function (MDF) and the model for end-stage liver disease (MELD), are associated with ... ...

Abstract	Background and aims: In alcoholic hepatitis (AH), increases in the total bilirubin (TB) and the prothrombin time (PT), which are included in the Maddrey's discriminant function (MDF) and the model for end-stage liver disease (MELD), are associated with poor outcomes. However, the impact of which control PT in the MDF to use compared to the MELD on the outcomes in AH is unknown. Our aim is to determine whether the choice of the control PT used in the MDF calculations has any impact on steroid use and survival when compared to the MELD in those with AH. Methods: Through retrospective chart review, we analyzed 882 subjects who were admitted from 2012 to 2020 with acute AH. Their MDF was calculated [(TB + 4.6 × (PT-control)] using the following three different control PTs: 12, 13.5, and 14.8 s, and was compared to the MELD. The primary outcomes were steroid use and 30-day survival. Results: When it was stratified by the control PT, the percentage of MDF ≥ 32 (the threshold for steroids) decreased with increasing control PT (70%, 61%, and 52%, respectively), along with decreased steroid use (91%, 84%, and 75%, respectively). Those who received steroids were not shown to have improved 30-day survival compared to those who did not receive steroids ( Conclusion: While the choice of PT control in the MDF impacted the use of steroids in AH, the use of steroids and the choice of PT control used did not impact the overall survival. Regardless of which control PT was used in the MDF, the MELD was better at predicting 30-day survival. Important information: Background: Treatment with steroids is indicated in alcoholic hepatitis (AH) with Maddrey discriminant function (MDF) ≥ 32 and the model for end-stage liver disease (MELD) ≥ 20. The impact that the control prothrombin time (PT) value that is used in MDF has on steroid use and survival in AH is poorly understood. Findings: The choice of control PT that is used when calculating the MDF impacts the use of steroids but does not impact mortality. The MELD was better than the MDF at any control PT used in predicting survival in acute AH. Implications for patient care: Providers should be aware that higher control PT's have an effect on treatment decisions but should not generally impact survival in this population. The MELD appears to better predict 30-day survival in this population.
Language	English
Publishing date	2022-12-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2661517-4
ISSN	2079-7737
ISSN	2079-7737
DOI	10.3390/biology11121833
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Hepatitis-Induced Porphyria: Are Direct-Acting Antiviral Agents the Way of the Future?

John, Jason J / Sterling, Richard K

ACG case reports journal

2021 Volume 8, Issue 5, Page(s) e00581

Abstract: Porphyria cutanea tarda (PCT) is the most common porphyria and has a strong association with hepatitis C virus (HCV) infection and iron overload. Previous HCV treatment regimens, including interferon with or without ribavirin, may precipitate PCT relapse. ...

Abstract	Porphyria cutanea tarda (PCT) is the most common porphyria and has a strong association with hepatitis C virus (HCV) infection and iron overload. Previous HCV treatment regimens, including interferon with or without ribavirin, may precipitate PCT relapse. Few case reports have shown that newer oral therapies, such as direct-acting antiviral agents, can successfully treat PCT parallel with HCV treatment. We present a case of a patient with non-iron-associated mixed porphyria that dramatically improved with direct-acting antiviral agent therapy for his HCV supporting the association of porphyria with chronic HCV.
Language	English
Publishing date	2021-05-14
Publishing country	United States
Document type	Case Reports
ZDB-ID	2814825-3
ISSN	2326-3253
ISSN	2326-3253
DOI	10.14309/crj.0000000000000581
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Article ; Online: Reply.

Schmoyer, Christopher J / Sterling, Richard K

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

2020 Volume 19, Issue 9, Page(s) 1989–1990

Language	English
Publishing date	2020-11-12
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2119789-1
ISSN	1542-7714 ; 1542-3565
ISSN (online)	1542-7714
ISSN	1542-3565
DOI	10.1016/j.cgh.2020.11.012
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Article ; Online: Reply.

Schmoyer, Christopher J / Sterling, Richard K

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

2020 Volume 19, Issue 4, Page(s) 857

Language	English
Publishing date	2020-11-26
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2119789-1
ISSN	1542-7714 ; 1542-3565
ISSN (online)	1542-7714
ISSN	1542-3565
DOI	10.1016/j.cgh.2020.06.021
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ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Prevalence and predictors of abnormal alanine aminotransferase in patients with HCV who have achieved SVR.

Chadha, Nikita / Turner, Alan / Sterling, Richard K

Journal of viral hepatitis

2022 Volume 30, Issue 1, Page(s) 73–78

Abstract: Chronic hepatitis C virus (HCV) is common. Treatment with direct acting antivirals (DAA) result in high sustained virologic response (SVR) associated with normalization of alanine aminotransferase (ALT). However, abnormal ALT after SVR has been observed. ...

Abstract	Chronic hepatitis C virus (HCV) is common. Treatment with direct acting antivirals (DAA) result in high sustained virologic response (SVR) associated with normalization of alanine aminotransferase (ALT). However, abnormal ALT after SVR has been observed. Since fatty liver disease can co-exist with HCV, its impact on abnormal ALT after SVR is unknown. This was a retrospective case-control analysis evaluating those with SVR and baseline fatty liver disease by transient elastography defined by controlled attenuated parameter (CAP) was performed. Abnormal ALT was defined as >1.5 ULN. The primary analysis compared abnormal ALT at SVR-12 and beyond in those with and without fatty liver disease. Six-hundred and ninety-three patients with SVR-12 were evaluated. Abnormal ALT at SVR-12 was present in 8.2% and was similar in those with and without fatty liver disease. Abnormal ALT at SVR-12 was associated with atrial fibrillation (p = .02), CAP (p = .047), age (p = .08), baseline ALT (p = .008), BMI (p = .002) and obesity (p = .02). On multivariate analysis, only BMI was associated with abnormal ALT at SVR-12 (p = .017). ALT at follow-up after SVR-12 was available in 264 patients. In those with initial normal ALT (n = 244), 11.5% had a delayed abnormal ALT and in those with initial abnormal ALT (n = 20), 47% remained abnormal while 53% normalized. Abnormal ALT after SVR following treatment with DAA is uncommon and related to increased BMI, but not related to underlying fatty liver disease assessed by CAP. The pattern of ALT can vary, and long-term follow-up is needed to assess the clinical impact of abnormal ALT after SVR.
MeSH term(s)	Humans ; Antiviral Agents/therapeutic use ; Alanine Transaminase ; Hepatitis C, Chronic/complications ; Hepatitis C, Chronic/drug therapy ; Hepatitis C, Chronic/epidemiology ; Sustained Virologic Response ; Retrospective Studies ; Prevalence ; Hepacivirus/genetics
Chemical Substances	Antiviral Agents ; Alanine Transaminase (EC 2.6.1.2)
Language	English
Publishing date	2022-11-02
Publishing country	England
Document type	Journal Article
ZDB-ID	1212497-7
ISSN	1365-2893 ; 1352-0504
ISSN (online)	1365-2893
ISSN	1352-0504
DOI	10.1111/jvh.13763
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Ultrashort direct-acting antiviral prophylaxis for human immunodeficiency virus and hepatitis C virus coinfected donor positive to human immunodeficiency virus-positive kidney transplants.

Moinuddin, Irfan / Yakubu, Idris / Bhati, Aditya / Morales, Megan / Sterling, Richard K / Gupta, Gaurav

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2023

Language	English
Publishing date	2023-12-13
Publishing country	United States
Document type	Letter
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1016/j.ajt.2023.12.008
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Article: The Prevalence and Impact of Hepatic Steatosis on Response to Direct-Acting Antiviral Therapy in HIV-HCV Coinfection.

Johnson, Leigh P / Sterling, Richard K

Biology

2020 Volume 9, Issue 4

Abstract: 1) Background: Direct-acting antiviral therapy for chronic hepatitis C virus (HCV) infection is associated with high sustained virologic response (SVR) and overcomes negative predictive factors, including steatosis, in patients without human ... ...

Abstract	(1) Background: Direct-acting antiviral therapy for chronic hepatitis C virus (HCV) infection is associated with high sustained virologic response (SVR) and overcomes negative predictive factors, including steatosis, in patients without human immunodeficiency virus (HIV) coinfection. The impact of steatosis on SVR in patients with HIV-HCV coinfection is unknown. (2) Methods: A retrospective analysis of patients treated with direct-acting antivirals was performed. Demographic, laboratory and direct-acting antiviral regimen data were prospectively collected. Metabolic syndrome and its components-diabetes mellitus, hypertension, dyslipidemia and obesity-were assessed. Hepatic steatosis (≥5%) was defined by liver biopsy or controlled attenuation parameter (CAP) measurement during vibration-controlled transient elastography (VCTE). (3) Results: A total of 151 HIV-HCV-coinfected patients on combined antiretroviral therapy and direct-acting antiviral therapy were included in this analysis. Prevalence of steatosis by liver biopsy (n = 34) or CAP (≥263 db/m) during VCTE (n = 92) was 27% and was independently associated with obesity (OR 3.11; 95% CI 1.43-6.82;
Language	English
Publishing date	2020-04-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2661517-4
ISSN	2079-7737
ISSN	2079-7737
DOI	10.3390/biology9040087
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Outnumbered: Control Prothrombin Time in Maddrey’s Discriminant Function Impacts Steroid Use but Not Mortality in Alcoholic Hepatitis

Healey, Marcus / Sterling, Richard K.

Biology (Basel). 2022 Dec. 16, v. 11, no. 12

2022

Abstract: Background and aims: In alcoholic hepatitis (AH), increases in the total bilirubin (TB) and the prothrombin time (PT), which are included in the Maddrey’s discriminant function (MDF) and the model for end-stage liver disease (MELD), are associated with ... ...

Abstract	Background and aims: In alcoholic hepatitis (AH), increases in the total bilirubin (TB) and the prothrombin time (PT), which are included in the Maddrey’s discriminant function (MDF) and the model for end-stage liver disease (MELD), are associated with poor outcomes. However, the impact of which control PT in the MDF to use compared to the MELD on the outcomes in AH is unknown. Our aim is to determine whether the choice of the control PT used in the MDF calculations has any impact on steroid use and survival when compared to the MELD in those with AH. Methods: Through retrospective chart review, we analyzed 882 subjects who were admitted from 2012 to 2020 with acute AH. Their MDF was calculated [(TB + 4.6 × (PT–control)] using the following three different control PTs: 12, 13.5, and 14.8 s, and was compared to the MELD. The primary outcomes were steroid use and 30-day survival. Results: When it was stratified by the control PT, the percentage of MDF ≥ 32 (the threshold for steroids) decreased with increasing control PT (70%, 61%, and 52%, respectively), along with decreased steroid use (91%, 84%, and 75%, respectively). Those who received steroids were not shown to have improved 30-day survival compared to those who did not receive steroids (p = 0.41). The ability of the MDF for each control PT threshold to predict 30-day survival was similar (AUROC 0.735), and was lower compared to the MELD (0.767). Conclusion: While the choice of PT control in the MDF impacted the use of steroids in AH, the use of steroids and the choice of PT control used did not impact the overall survival. Regardless of which control PT was used in the MDF, the MELD was better at predicting 30-day survival. Important information: Background: Treatment with steroids is indicated in alcoholic hepatitis (AH) with Maddrey discriminant function (MDF) ≥ 32 and the model for end-stage liver disease (MELD) ≥ 20. The impact that the control prothrombin time (PT) value that is used in MDF has on steroid use and survival in AH is poorly understood. Findings: The choice of control PT that is used when calculating the MDF impacts the use of steroids but does not impact mortality. The MELD was better than the MDF at any control PT used in predicting survival in acute AH. Implications for patient care: Providers should be aware that higher control PT’s have an effect on treatment decisions but should not generally impact survival in this population. The MELD appears to better predict 30-day survival in this population.
Keywords	alcoholic hepatitis ; bilirubin ; models ; mortality ; patient care ; prothrombin ; steroid hormones
Language	English
Dates of publication	2022-1216
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article ; Online
ZDB-ID	2661517-4
ISSN	2079-7737
ISSN	2079-7737
DOI	10.3390/biology11121833
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Test characteristics for combining non-invasive liver fibrosis staging modalities in individuals with Hepatitis C virus.

Epstein, Rachel L / Buzzee, Benjamin / White, Laura F / Feld, Jordan J / Castera, Laurent / Sterling, Richard K / Linas, Benjamin P / Taylor, Lynn E

Journal of viral hepatitis

2024

Abstract: Non-invasive methods have largely replaced biopsy to identify advanced fibrosis in hepatitis C virus (HCV). Guidelines vary regarding testing strategy to balance accuracy, costs and loss to follow-up. Although individual test characteristics are well- ... ...

Abstract	Non-invasive methods have largely replaced biopsy to identify advanced fibrosis in hepatitis C virus (HCV). Guidelines vary regarding testing strategy to balance accuracy, costs and loss to follow-up. Although individual test characteristics are well-described, data comparing the accuracy of using two tests together are limited. We calculated combined test characteristics to determine the utility of combined strategies. This study synthesizes empirical data from fibrosis staging trials and the literature to estimate test characteristics for Fibrosis-4 (FIB4), APRI or a commercial serum panel (FibroSure®), followed by transient elastography (TE) or FibroSure®. We simulated two testing strategies: (1) second test only for those with intermediate first test results (staged approach), and (2) second test for all. We summarized empiric data with multinomial distributions and used this to estimate test characteristics of each strategy on a simulated population of 10,000 individuals with 4.2% cirrhosis prevalence. Negative predictive value (NPV) for cirrhosis from a single test ranged from 98.2% (95% CB 97.6-98.8%) for FIB-4 to 99.4% (95% CB 99.0-99.8%) for TE. Using a staged approach with TE second, sensitivity for cirrhosis rose to 93.3-96.9%, NPV to 99.7-99.8%, while PPV dropped to <32%. Using TE as a second test for all minimally changed estimated test characteristics compared with the staged approach. Combining two non-invasive fibrosis tests barely improves NPV and decreases or does not change PPV compared with a single test, challenging the utility of serial testing modalities. These calculated combined test characteristics can inform best methods to identify advanced fibrosis in various populations.
Language	English
Publishing date	2024-02-07
Publishing country	England
Document type	Journal Article
ZDB-ID	1212497-7
ISSN	1365-2893 ; 1352-0504
ISSN (online)	1365-2893
ISSN	1352-0504
DOI	10.1111/jvh.13925
Database	MEDical Literature Analysis and Retrieval System OnLINE

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