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"Etiology"

Original Article

Hepatic neoplasm

Global burden of primary liver cancer and its association with underlying aetiologies, sociodemographic status, and sex differences from 1990–2019: A DALY-based analysis of the Global Burden of Disease 2019 study
Sungchul Choi, Beom Kyung Kim, Dong Keon Yon, Seung Won Lee, Han Gyeol Lee, Ho Hyeok Chang, Seoyeon Park, Ai Koyanagi, Louis Jacob, Elena Dragioti, Joaquim Radua, Jae Il Shin, Seung Up Kim, Lee Smith
Clin Mol Hepatol 2023;29(2):433-452.
Published online January 4, 2023
DOI: https://doi.org/10.3350/cmh.2022.0316
Background/Aims
Global distribution of dominant liver cancer aetiologies has significantly changed over the past decades. This study analyzed the updated temporal trends of liver cancer aetiologies and sociodemographic status in 204 countries and territories from 1990 to 2019.
Methods
The Global Burden of Disease 2019 report was used for statistical analysis. In addition, we performed stratification analysis to five quintiles using sociodemographic index and 21 geographic regions.
Results
The crude numbers of liver cancer disease-adjusted life years (DALYs) and deaths significantly increased during the study period (DALYs; 11,278,630 in 1990 and 12,528,422 in 2019, deaths; 365,215 in 1990 and 484,577 in 2019). However, the Age-standardized DALY and mortality rates decreased. Hepatitis B virus (HBV) remains the leading cause of liver cancer DALYs and mortality, followed by hepatitis C virus (HCV), alcohol consumption, and non-alcoholic steatohepatitis/non-alcoholic fatty liver disease (NASH/NAFLD). Although Age-standardized DALY and mortality rates of liver cancer due to HBV and HCV have decreased, the rates due to alcohol consumption and NASH/NAFLD have increased. In 2019, the population of the East Asia region had the highest Age-standardized DALY and mortality rates, followed by high-income Asia-Pacific and Central Asia populations. Although East Asia and high-income Asia-Pacific regions showed a decrease during the study period, Age-standardized DALY rates increased in Central Asia. High-income North American and Australasian populations also showed a significant increase in Age-standardized DALY.
Conclusions
Liver cancer remains an ongoing global threat. The burden of liver cancer associated with alcohol consumption and NASH/NAFLD is markedly increasing and projected to continuously increase.

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Editorial

Liver fibrosis, cirrhosis, and portal hypertension

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Special topic: Alcoholic liver diseases
The 14th International Symposium on Alcoholic Liver and Pancreatic Diseases and Cirrhosis (ISALPDC)

Long non-coding RNAs in liver diseases: Focusing on nonalcoholic fatty liver disease, alcohol-related liver disease, and cholestatic liver disease
Sen Han, Ting Zhang, Praveen Kusumanchi, Nazmul Huda, Yanchao Jiang, Zhihong Yang, Suthat Liangpunsakul
Clin Mol Hepatol 2020;26(4):705-714.
Published online October 1, 2020
DOI: https://doi.org/10.3350/cmh.2020.0166
Long non-coding RNAs (lncRNAs), a class of transcribed RNA molecules with the lengths exceeding 200 nucleotides, are not translated into protein. They can modulate protein-coding genes by controlling transcriptional and posttranscriptional processes. The dysregulation of lncRNAs has been related to various pathological disorders. In this review, we summarized the current knowledge of lncRNAs and their implications in the pathogenesis of three common liver diseases: nonalcoholic fatty liver disease, alcohol-related liver disease, and cholestatic liver disease. Future studies to further define the role of lncRNAs and their mechanisms in various types of liver diseases should be explored. An improved understanding from these studies will provide us a useful perspective leading to mechanism-based intervention by targeting specific lncRNAs for the treatment of liver diseases.

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Original Articles

Artificial intelligence, epidemiology, methodology, or others

Type and cause of liver disease in Korea: single-center experience, 2005-2010
Sang Soo Lee, Young-Sang Byoun, Sook-Hyang Jeong, Yeo Myung Kim, Ho Gil, Bo-Young Min, Mun Hyuk Seong, Eun Sun Jang, Jin-Wook Kim
Korean J Hepatol 2012;18(3):309-315.
Published online September 25, 2012
DOI: https://doi.org/10.3350/cmh.2012.18.3.309
Background/Aims

The aim of this study was to describe the types and causes of liver disease in patients from a single community hospital in Korea between April 2005 and May 2010.

Methods

A cohort of patients who visited the liver clinic of the hospital during the aforementioned time period were consecutively enrolled (n=6,307). Consistent diagnostic criteria for each liver disease were set by a single, experienced hepatologist, and the diagnosis of all of the enrolled patients was confirmed by retrospective review of their medical records.

Results

Among the 6,307 patients, 528 (8.4%) were classified as acute hepatitis, 3,957 (62.7%) as chronic hepatitis, 767 (12.2%) as liver cirrhosis, 509 (8.1%) as primary liver cancer, and 546 (8.7%) as a benign liver mass or other diseases. The etiologies in the acute hepatitis group in decreasing order of prevalence were hepatitis A (44.3%), toxic hepatitis (32.4%), other hepatitis viruses (13.8%), and cryptogenic hepatitis (9.1%). In the chronic hepatitis group, 51.2% of cases were attributed to viral hepatitis, 33.3% to nonalcoholic fatty liver disease, and 13.0% to alcoholic liver disease (ALD). Of the cirrhoses, 73.4% were attributable to viral causes and 18.1% to alcohol. Of the hepatocellular carcinoma cases, 86.6% were attributed to viral hepatitis and 11.6% to ALD. Among the benign tumors, hemangioma comprised 52.2% and cystic liver disease comprised 33.7%.

Conclusions

Knowledge of the current status of the type and cause of liver disease in Korea may be valuable as a basis for evaluating changing trends in liver disease in that country.

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Recent Etiology and Clinical Features of Acute Viral Hepatitis in a Single Center of Korea
Hyung Min Kang , Sook Hyang Jeong , Jin Wook Kim , Don Hun Lee , Chang Kyu Choi , Young Soo Park , Jin Hyuk Hwang , Na Young Kim , Dong Ho Lee
Korean J Hepatol 2007;13(4):495-502.
Published online November 30, 1999
DOI: https://doi.org/10.3350/kjhep.2007.13.4.495
Background/Aims
The etiology of acute viral hepatitis in Korea has been dynamically changing during the recent years. The aim of this study was to investigate the recent etiology and the clinical features of acute viral hepatitis in a single center of Korea. Methods: We performed a retrospective analysis of a prospective cohort of 55 patients who were diagnosed with acute viral hepatitis A to E during the period from May 2005 to August 2006. In addition to the clinically acute manifestations, the confirmatory serological tests were performed for the diagnosis of acute hepatitis A, B, C and E. Results: The proportion of patients with acute viral hepatitis A, B, C, E and others were 56.4% (n=31), 12.7% (n=7), 18.2% (n=10), 9.1% (n=5) and 3.6% (n=2), respectively. The mean age of the patients with acute hepatitis A, B, C and E were 29.1±4.38, 38.7±11.72, 45.3±17.62 and 32.4±6.58 years, respectively. There was no fatal case. All cases of acute hepatitis B and six out of ten cases of acute hepatitis C recovered spontaneously. Four out of the five patients with acute hepatitis E had no history of travel to endemic area. Conclusions: The most common etiology of acute viral hepatitis in Korea is hepatitis A virus, and hepatitis C and B virus were the next most common causes. The sporadic cases of acute hepatitis E were not rare, and coinfection of HAV and HEV was observed. A multicenter, prospective study is warranted in the future. (Korean J Hepatol 2007;13:495-502)

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    So Young Kwon
    The Korean Journal of Hepatology.2009; 15(Suppl 6): S7.     CrossRef
  • An Epidemiological Analysis of Hepatitis A Virus Serologic Markers during the Recent Four Years in Korea
    Anna Lee, Hyun-Sun Lim, Chung-Mo Nam, Sean-Mi Song, Hye-Ryoung Yoon, Kyoung-Ryul Lee
    Annals of Laboratory Medicine.2009; 29(6): 563.     CrossRef
  • Current status of liver diseases in Korea: Hepatitis B
    Hee Bok Chae, Jong-Hyun Kim, Ja Kyung Kim, Hyung Joon Yim
    The Korean Journal of Hepatology.2009; 15(Suppl 6): S13.     CrossRef
  • Changes in Liver Stiffness after Acute or Chronic Liver Injury due to Viral Hepatitis - Does Fibrosis Exist after Recovery from Acute Viral Hepatitis?
    Jeong Han Kim, Hyung Joon Yim, Seung Young Kim, Jae Hong Ahn, Young Kul Jung, Moon Kyung Joo, Su Hyun Kim, Ji Hoon Kim, Yeon Seok Seo, Jong Eun Yeon, Hong Sik Lee, Soon Ho Um, Sang Woo Lee, Kwan Soo Byun, Jae Hyun Choi, Ho Sang Ryu
    The Korean Journal of Gastroenterology.2009; 54(3): 155.     CrossRef
  • Clinical outcomes and predictive factors of spontaneous survival in patients with fulminant hepatitis A
    Jwa Min Kim, Yoon-Seon Lee, Jae Ho Lee, Won Kim, Kyung Soo Lim
    The Korean Journal of Hepatology.2008; 14(4): 474.     CrossRef
  • The Pattern of Vaccine Administration Accessed by Vaccine Consumption in a University Hospital
    Jung-Soo Kim, Yong Soo Baek, Moon-Hyun Chung, Jin-Soo Lee, Kyung Sun Oh
    Infection and Chemotherapy.2008; 40(3): 154.     CrossRef
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The Change of the Etiology , Complications and Cause of Death of the Liver Cirrhosis in 1990 s
Yo Seb Han,Byung Ho Kim,Il Yyun Baek,Dong Kuen Lee,Kyung Jin Kim,Seok Ho Dong,Hyo Jong Kim,Yung Woon Chang,Joung Il Lee,Rin Chang
Korean J Hepatol 2000;6(3):328-339.
Background
Alcoholic liver disease has increased. The causes of death in liver cirrhosis have changed. The author tried to categorize the etiology and complications of liver cirrhosis and analyze the causes of death in the 1990s. Method: The author retrospectively reviewed medical records of 1,175 patients diagnosed as having liver cirrhosis at Kyung Hee University Hospital from January 1991 through December 1998. The etiology, complications and the cause of death were compared between the early (1991-1994) and the late (1995-1998) periods. Results: The proportion of male patients (73.3%) was still about 3 times that of female patients. There was no difference in age at the time of diagnosis between early and late periods (51.4 11.1 and 51.2 11.2 years respectively). Hepatitis B virus (HBV) infection was still the most common cause of liver cirrhosis (57.0%) and alcohol was the next (31.1%). The complications of liver cirrhosis at the time of diagnosis were, in order: esophageal varices, ascites, and variceal bleeding. But there was no significant difference between the periods. The proportion of Child grade B was the most common at the time of diagnosis in both periods, but Child grade A increased in the late period. The most common cause of death was liver failure and the next cause was variceal bleeding in the early period. Hepatorenal syndrome was the second most common cause in the late period. Conclusion: There was no change in the etiology between early and late periods. HBV infection was still the most common etiology but the incidence of alcoholic liver cirrhosis might have increased in the 1990s. The proportion of the Child B at initial diagnosis was the highest (around 50%) but that of Child A increased in the late period. Among the causes of death, liver failure and hepatorenal syndrome had a tendency to increase in the late period.
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Clinical Characteristics of Acute Toxic Liver Injury
Jin Bae Kim , Joo Hyun Sohn , Hang Lak Lee , Jong Pyo Kim , Dong Soo Han , Joon Soo Hahm , Dong Hoo Lee , Chun Suhk Kee
Korean J Hepatol 2004;10(2):125-134.
Background/Aims
Recently, acute toxic liver injury has been reported to be the most common cause of acute hepatitis. The frequency and clinical manifestations of acute toxic liver injury was evaluated. Methods: The medical records of 68 patients demonstrating clinically significant acute toxic liver injury were retrospectively reviewed. Patients with mild biochemical abnormalities were excluded. Results: The annual retrospectively reviewed. Patients with mild biochemical abnormalities were excluded. Results: The annual percentage of toxic liver injury ranged from 50% to 90% among acute hepatitis groups. Among the causes, prescribed drugs (group D) accounted for 55%, herbs or plant products (group H) for 42% and both accounted for 3%. Antibiotics and anti-inflammatory drugs were the most common agents (78%) among group D. The mean age of the patients was 43 and 70% of patients were female. Of the population, common symptoms were jaundice, weakness, fatigue, and nausea. Initial ALT and AST levels were 847 879 and 664 625 IU/L, and initial total bilirubin was 7.5 8.1 ㎎/dL. Acute toxic liver injury occurred after a mean of 32 days after first exposure. Liver injury resolved within a mean of 32 days. Hepatocellular, mixed, and cholestatic type was 45.2%, 32.3%, 22.5%, respectively. Conclusions: Recently, acute toxic liver injury has been the most common cause of acute hepatitis in Korea. Prescribed drugs and herbs or plant products are equally important etiologic agents of toxic liver injury. However, etiologic difference may not affect clinical courses or outcomes. A nationwide investigation of the hepatotoxicity of drugs, herbs or other plant products is required. (Korean J Hepatol 2004;10:125-134)
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Clinical Features of Fulminant Hepatic Failure in a Tertiary Hospital with a Liver Transplant Center in Korea
Nae Yun Heo , Young Suk Lim , Jeong Min Kang , Se Il Oh , Chan Sun Park , Seok Won Jung , Yoon Sun Lee , Kang Mo Kim , Han Chu Lee , Young Hwa Chung , Yung Sang Lee ,
Korean J Hepatol 2006;12(1):82-92.
Background/Aims: Striking geographic differences have been noted in the etiology of fulminant hepatic failure (FHF). The prognosis of patients with FHF who do not receive liver transplantation in a timely manner is quite dismal. This study intended to identify the etiology and outcome of FHF in Korean adults and to examine the role of urgent living-donor liver transplantation (LDLT) for treating this unique situation. Methods: We identified all the adult FHF patients who were referred to our unit between 1999 and 2004. FHF was defined as severe acute hepatitis complicated by the rapid development of hepatic encephalopathy within 8 weeks of the initial symptoms in the patients without a previous history of liver disease. Results: One hundred fourteen patients (47 males and 67 females) were identified. The mean age was 39.5±15.3 years. Drugs were the most common cause (28.1%) of FHF (herbal medications, 9.6%), and acute viral infection accounted for 23.7% (HBV accounted for 15.8%). Indeterminate etiologies were noted in 34%. The 90-day survival rate of the nontransplant group was only 15%. Fourteen patients received liver transplants (13 right- lobe LDLT, 1 cadaveric whole liver), and 12 of these (85.7%) survived and showed good graft function during 22 months of median follow-up. Conclusions: Although the causes of FHF in Korea were diverse, HBV infection and herbal medications were responsible for a significant proportion of the cases. Since urgent LDLT improved the overall survival rate of patients with FHF, this should be considered as an important treatment option for patients suffering with FHF. (Korean J Hepatol 2006;12:82-92)
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Etiologic and Laboratory Analyses of Ascites in Patients who Underwent Diagnostic Paracentesis
Young Hwangbo , Ji Heon Jung , Jae Joon Shim , Byung Ho Kim , Sung Hoon Jung , Chang Kyun Lee , Jae Young Jang , Seok Ho Dong , Hyo Jong Kim , Young Woon Chang , Rin Chan
Korean J Hepatol 2007;13(2):185-195.
Background/Aims
Liver cirrhosis and malignant tumors are two major causes of ascites according to the reports from Western countries, 80% and 10% respectively. Assuming that there might be regional differences in etiologies and changes in their frequency over time, we investigated causes of ascites and the diagnostic usefulness of various laboratory tests. Methods: Medical records of 366 patients, who underwent diagnostic paracentesis in the mid-1990s (1996 and 1997) and early 2000s (2001 and 2002), were retrospectively reviewed. The etiology was confirmed by histology, imaging studies, and ascites analyses. Results: The frequency of cirrhotic ascites was 59.6%, cancer-related 25.7%, tuberculous peritonitis 6.6%, and others 8.1%. Among cirrhotics, the frequency of cases related to hepatitis B decreased significantly from 72% to 55% over time, and alcoholic cirrhosis increased from 18% to 34%. Among cancer-related ascites, peritoneal carcinomatosis type was 75.5% (primary sites: stomach 24.5%, pancreas 15.9%, colon 15.9%, lung 7.4%, etc), metastatic liver cancers 8.5%, hepatocellular carcinoma without cirrhosis 6.4%, etc. The sensitivity of serum-ascites albumin gradient for the diagnosis of cirrhotic ascites was 91.4%, and total protein in ascites also revealed a comparable diagnostic sensitivity, 90%. The diagnostic sensitivity of adenosine deaminase for tuberculous peritonitis was 94.2%, and its positive predictive value was 75%. Conclusions: Liver cirrhosis is the leading cause of ascites, especially alcoholic cirrhosis has significantly increased. The next common etiology is cancer-related, and its frequency in Korea is higher than in western countries. Tuberculous peritonitis is still prevalent, and adenosine deaminase could precisely differentiate it from other causes. (Korean J Hepatol 2007;13:185-195)
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