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All Journal Cermin Dunia Kedokteran The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia Cermin Dunia Kedokteran
Juferdy Kurniawan
Divisi Hepatobilier, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Jakarta
Health Professions Medicine & Pharmacology Public Health

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Sarkopenia sebagai Faktor Risiko Varises Esofagus Risiko Tinggi berdasarkan Stratifikasi Child-Pugh Pasien Sirosis Hati Sepmeitutu, Iwandheny; Kurniawan, Juferdy; Maulahela, Hasan; Rinaldi, Ikhwan; Shatri, Hamzah; Pramana, Triyanta Yuli; Makmun, Dadang; Lesmana, Cosmas Rinaldi A; Hidayat, Rudy; Laksmi, Purwita Wijaya; Sunardi, Diana
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 3
Publisher : UI Scholars Hub

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Abstract

Background The high prevalence of sarcopenia in chronic liver disease negatively impacts the quality of life and increases the risk of various complications of cirrhosis, one of which is the development of esophageal varices. The aim of this study was to determine the prevalence of sarcopenia in cirrhosis patients based on the severity of liver cirrhosis and to explore the association of sarcopenia with high-risk esophageal varices stratified by Child-Pugh. Methods This observational cross-sectional study involved patients with liver cirrhosis at Cipto Mangunkusumo Hospital between January and September 2023. Sarcopenia was defined as a reduction in muscle mass accompanied by decreased grip strength or walking speed, according to the AWGS 2019 criteria (Asian Working Group for Sarcopenia). Multivariate logistic regression analysis was conducted to evaluate the association between sarcopenia and high-risk esophageal varices. Results A total of 155 patients with liver cirrhosis were included in this study. The majority of liver cirrhosis patients were males, with hepatitis B being the most commonly found etiology. The prevalence of sarcopenia was found in 40.0% of Child-Pugh A patients, 53.8% of Child-Pugh B patients, and 50.0% of Child-Pugh C patients with a p-value of 0.411. The high-risk of esophageal varices was found more frequently in Child-Pugh B (53.8%) and Child-Pugh C (50.0%) compared to Child-Pugh A (25.6%) with a p-value of 0.013. Bivariate analysis showed that the presence of sarcopenia in liver cirrhosis patients has a statistically significant association with an increased risk of high-risk esophageal varices, especially in the Child-Pugh B and C subgroups of liver cirrhosis patients (OR = 7.50 (95% CI: 1.48 – 37.91, p<0.030)). However, no association was found between sarcopenia and high-risk esophageal varices in the Child-Pugh A subgroup (OR = 1.46 (95% CI: 0.65 – 3.29, p<0.477)). Conclusion Sarcopenia significantly increases the risk of high-risk esophageal varices in liver cirrhosis, especially in those with Child-Pugh B and C classification.
Pilihan Tatalaksana Penyakit Perlemakan Hati Non-Alkohol (Non-Alcoholic Fatty Liver Disease/ NAFLD) Stefanus Imanuel Setiawan; Juferdy Kurniawan
Cermin Dunia Kedokteran Vol 48 No 3 (2021): Obstetri - Ginekologi
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v48i3.54

Abstract

Penyakit perlemakan hati non-alkohol (non-alcoholic fatty liver disease/ NAFLD) merupakan kondisi adanya steatosis hepatik, inflamasi, dan kerusakan hepatosit (ballooning degeneration). NAFLD tidak hanya dianggap penyakit hati primer, tetapi juga merupakan bagian dari sindrom metabolik atau kondisi resistensi insulin dan penyakit terkait gaya hidup seperti diabetes, dislipidemia, dan hipertensi. Strategi tatalaksana NAFLD dimulai dari modifikasi gaya hidup, dapat dilanjutkan dengan terapi komponen sindrom metabolik, farmakoterapi, hingga penatalaksanaan sirosis. Non-alcoholic fatty liver disease refers to a steatosis in liver, associated with inflammation and destruction of hepatocyte (ballooning degeneration). NAFLD is considered as primary liver disease, but also as a component of metabolic syndrome related to insulin resistance and other life-style-related diseases i.e diabetes mellitus, dyslipidemia, and hypertension. Strategies in NAFLD management start with lifestyle modification, continued with pharmacological approaches targeting metabolic syndrome and complications related to cirrhosis.
EUS-Guided Portal Pressure Gradient Measurement in Patients with Portal Hypertension: Evidence-Based Case Report Hidayat, Putra Nur; Kurniawan, Juferdy
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 23, No 3 (2022): VOLUME 23, NUMBER 3, December 2022
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2332022253-257

Abstract

Aim: This evidence-based case report aims to assess the accuracy of EUS-PPG measurement in patients with portal hypertension.Method: A literature search was performed using PubMed, Cochrane, ProQuest, and EBSCO. A total of 2 articles were selected after meeting the inclusion and exclusion criteria. Critical study assessment was conducted to assess the validity, importance, and applicability of the study.Results: As a result, the first study found higher EUS-PPG measurement values in patients with clinical parameters of portal hypertension and the second study found a good correlation between EUS-PPG measurement values with hepatic vein pressure gradient (HVPG) and transjugular intrahepatic portosystemic shunt (TIPS) portal pressure gradient (PPG).Conclusion: From these two studies, it can be concluded that EUS-PPG measurement is a safe, effective, and feasible method to be performed on patients.
Variabel dan Model Prediktor Perdarahan Varises Esofagus Berulang pada Pasien Sirosis Hati di RSUPN Dr. Cipto Mangunkusumo Sari, Ifani Media; Kurniawan, Juferdy; Kalista, Kemal Fariz; Rizka, Aulia; Ginanjar, Eka; Nasution, Sally Aman; Nainggolan, Leonard, MD. Internal medicine, Tropic-Infection spesialist; Koesnoe, Sukamto
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Introduction. Liver cirrhosis is a chronic condition associated with severe complications, including esophageal variceal bleeding, which carries high morbidity and mortality rates. Approximately 60% of patients with cirrhosis experience recurrent bleeding within one year, with a mortality rate of 20–60% within six weeks after the initial bleeding episode. Therefore, identifying predictors of recurrent bleeding is essential for improving preventive strategies. This study aimed to identify predictors of recurrent esophageal variceal bleeding in patients with liver cirrhosis and to develop a predictive model. Methods. This retrospective study included 220 patients with liver cirrhosis and a history of esophageal variceal bleeding based on medical record data. The variables analyzed included age, platelet count, red color sign, spontaneous bacterial peritonitis, splenomegaly, number of endoscopic variceal ligation (EVL) bands, portal hypertensive gastropathy, and Child–Pugh score. Statistical analyses were performed to identify independent predictors and to develop a prediction model. Results. Recurrent esophageal variceal bleeding occurred in 33.6% of patients. Patients with recurrent bleeding were more likely to be male, younger, have hepatitis B as the underlying etiology, a Child–Pugh score ≥7, a platelet count <150,000/µL, and ≥3 EVL bands placed during treatment. Bivariate analysis demonstrated that a Child–Pugh score ≥7, platelet count <150,000/µL, ≥3 EVL bands, the presence of a red color sign, and splenomegaly were significantly associated with recurrent esophageal variceal bleeding in patients with liver cirrhosis. The final prediction model consisted of three variables: Child–Pugh score, platelet count, and number of EVL bands, with a maximum total score of 4 points. The model demonstrated good predictive performance, with an area under the receiver operating characteristic curve (AUC) of 0.81. Conclusions. The predictors of recurrent esophageal variceal bleeding in patients with liver cirrhosis were Child–Pugh score, platelet count, and the number of EVL bands. The resulting prediction model demonstrated good statistical performance and may be useful for risk stratification in clinical practice.
Hubungan Penggantian Imunosupresan Tidak Terencana dengan Aktivitas Penyakit Lupus Eritematosus Sistemik: Studi Kohort Retrospektif di RSUPN Dr. Cipto Mangunkusumo, Jakarta Amanda, Rosvitha; Koesnoe, Sukamto; Widhani, Alvina; Rinaldi, Ikhwan; Susilo, Adityo; Kurniawan, Juferdy; Putranto, Rudi; Karim, Birry
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Introduction. Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease with diverse clinical manifestations. Treatment stabilization is crucial for optimal disease control, but the consistency of immunosuppressive therapy may be affected by non-ideal conditions, including drug unavailability or adverse effects. This study aimed to assess the association between unplanned immunosuppressant switching and increased disease activity in SLE patients. Methods. A retrospective cohort study of SLE patients meeting the inclusion criteria, whose disease activity was evaluated using the MEX-SLEDAI score during immunosuppressant substitution. Participants were grouped into an exposed group undergoing unplanned immunosuppressant switching due to drug unavailability and a comparison group continuing maintenance therapy without switching. Disease activity was assessed using the MEX-SLEDAI score during follow-up. Results. A total of 213 SLE patients were included; 45 patients (21.1%) experienced increased disease activity. Unplanned immunosuppressant substitution was significantly associated with increased disease activity (RR 2.06; 95% CI 1.18–3.60; p=0.011), and remained significant after adjustment for confounders (aRR 1.82; 95% CI 1.05–3.15; p=0.034). Subgroup analysis showed most flares occurred within the first three months after substitution, and mycophenolate-containing replacement regimens were associated with a lower risk of increased disease activity (p=0.025). Conclusions. Unplanned immunosuppressant substitution is associated with increased disease activity in SLE patients. Close monitoring following switching is essential to maintain disease stability.
Co-Authors -, Gunawan - -, Gunawan - A, GM Yudi Prasetia Adityo Susilo, Adityo Agnes Elsha Maria Simbolon Alvina Widhani, Alvina Amanda, Rosvitha Amin, Bany Faris Andhika Rachman Andri Sanityoso Andri Sanityoso Sulaiman Anggi Anggelina Permatasari Aprilicia, Gita Aravinda Pravita Ario Perbowo Putra Ario Perbowo Putra, Ario Perbowo Aulia Rizka, Aulia Baiq Kirana DN Mandasari Bany Faris Amin Birry Karim Budiman, Refael Alfa C Rinaldi A Lesmana Chairunisa, Shafira Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Dadang Makmun Dela Ryana Swaraghani Dewi ANGGRAENI Dewi Martalena Diana Sunardi E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Eka Ginanjar Esthika Dewiasty, Esthika Felix Firyanto Widjaja GM Yudi Prasetia A Gunawan - - Hanif, Muhammad Yusuf Hasan Maulahela Ikhwan Rinaldi Imanuel Setiawan, Stefanus Irfan Kresnadi Irfan Kresnadi Irsan Hasan Jasirwan, Chyntia Olivia M Karenina, Vannessa Kemal F Calista Kemal Fariz Kalista Kemal Fariz Kalista Kemal Fariz Kalista, Kemal Fariz Kie Chen Kresna Adhiatma Kresnadi, Irfan Kuntjoro Harimurti Kurniyanto Kurniyanto Kurniyanto, Kurniyanto Leonard Nainggolan Lutfie Lutfie, Lutfie Marcellus Simadibrata Marcellus Simadibrata Muhammad Yusuf Hanif Nababan, Saut Horas H. Nadia Ayu Mulansari, Nadia Ayu Nainggolan, Leonard, MD. Internal medicine, Tropic-Infection spesialist Permatasari, Anggi Anggelina Prasetyadi, Yosafat Lambang Purwita Wijaya Laksmi Putra Nur Hidayat Putri, Trivani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rudi Putranto Rudy Hidayat Sakinah Rahma Sari Sally Aman Nasution, Sally Aman Sari, Ifani Media Sari, Sakinah Rahma Saut HH Nababan Saut Horas Hatoguan Nababan Sepmeitutu, Iwandheny Shafira Chairunisa Siahaan, Billy Stinggo Simbolon, Agnes Elsha Maria Stefanus Imanuel Setiawan Sukamto Koesnoe Swaraghani, Dela Ryana Syahrizal Syarif Tahir, Andi Cahaya Teguh Karyadi Teressa, Maria Trivani Putri Triyanta Yuli Pramana Vannessa Karenina Widayat Djoko Santoso Widayat Djoko Santoso, Widayat Djoko Yosafat Lambang Prasetyadi