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All Journal Universa Medicina The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Dwijo Anargha Sindhughosa, Dwijo Anargha
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Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Severity of Liver Injury and Its Relation to Clinical Outcome and Duration of Hospitalization in COVID 19 Patients Kumbara, Cokorde Istri Yuliandari Krisnawardani; Mariadi, I Ketut; Somayana, Gde; Wibawa, I Dewa Nyoman; Sindhughosa, Dwijo Anargha
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202447-52

Abstract

Background: Coronavirus Disease 2019 (COVID-19) can affect not only the respiratory system but also other organs such as the liver. Liver injury tends to occur in severe disease of COVID-19 patients and might contribute to clinical outcomes for patients. This study aimed to find the relationship between the severity of liver injury with clinical outcome and duration of hospitalizations.Methods: This study was a retrospective study of hospitalized COVID-19 patients period April 2020 to April 2021. The inclusion criteria were severe COVID-19 patients who developed a liver injury. The severity of the liver injury was classified into mild, moderate, and severe. The relationship between the severity of liver injury with clinical outcome and duration of hospitalization was analyzed. Univariate and logistic regression were used. Results: 90 samples fill the inclusion criteria. The liver injury severity was statistically significantly related to clinical outcome patients (p= 0.047), which is the increase in liver injury severity resulting in poor clinical outcomes. No significant relationship was found between the severity of liver injury with the duration of hospitalization.Conclusion: liver injury increases mortality in severe COVID-19 patients.
Correlation of Simple Laboratory Result Parameters to CTP and MELD Scores, and the Diagnostic Role of Simple Laboratory Indexes to Cirrhosis Decompensation Dewi, Ni Nyoman Gita Kharisma; Dewi, Ni Luh Putu Yunia; Dewi, Putu Itta Sandi Lesmana; Pamungkas, Kadek Mercu Narapati; Sindhughosa, Dwijo Anargha; Mariadi, I Ketut
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202427-33

Abstract

BackgroundCirrhosis of the liver is a final condition of all chronic liver diseases. Liver cirrhosis is the leading cause of increasing morbidity and mortality in adults worldwide. Systemic inflammation has been suggested to play an important role in causing progressive liver damage and is one of the leading causes of compensated and decompensated liver cirrhosis.Aim of StudyEvaluate the correlation of neutrophil-lymphocyte ratio (NLR), albumin-bilirubin ratio (ABR), albumin-bilirubin score (ALBI), aspartate aminotransferase to platelet ratio (APRI), albumin-creatinine ratio (ACR), lymphocyte-monocyte ratio (LMR), de ritis ratio to the severity of liver cirrhosis as assessed by CTP score and MELD score. In addition, this study also evaluated the diagnostic ability of NLR, ABR, ALBI, APRI, ACR, LMR, de ritis ratio, and CTP and MELD scores in predicting decompensated liver cirrhosis.MethodWe conducted a cross-sectional study involving patients diagnosed with liver cirrhosis at Prof DR IGNG Ngoerah General Hospital. All patients were diagnosed based on clinical history, physical examination, and investigations. This study enrolled 96 cirrhotic patients regardless of etiology. Laboratory examination results recorded platelets, neutrophils, lymphocytes, monocytes, AST, ALT, albumin, and creatinine. Then NLR, ACR, APRI, LMR, de raitis, ALBI, and ABR are calculated. CTP and MELD scores were calculated by taking data from the patient's medical recordResultOf the 96 patients tested in our study, the majority were male (66). The study found a significant moderate to very strong relationship to the MELD score between ACR, APRI, ALBI, ABR, LMR, WBC, sodium, and albumin. Neutrophil to lymphocyte ratio, ACR, De ritis, APRI, LMR, ALBI, ABR, sodium levels, and albumin have a moderate to very strong significant relationship to CTP score. ACR, De ritis, APRI, LMR, ALBI, ABR, WBC, sodium, and albumin levels with respective cut-offs £ 3.6; ≥ 1.5; ≥ 0.3; £ 2.8; ≥ 0.7; £1.6; ≥ 6.7, £ 136.50, and £ 3.0 can be used to help predict decompensated cirrhosisConclusionIn addition to using the CTP score and MELD score as a tool to predict the severity of liver cirrhosis, data from laboratory examination results in the form of albumin and ABR levels can help establish the diagnosis of decompensated cirrhosis. The sensitivity and specificity of ABR were 96.8% and 75.4% with a cut-off of £  1.6, while albumin levels were 93.5% and 81.5% with an amount off of £  3.0.
Knowledge, Attitude and Obstacles of Colorectal Cancer Screening in Primary Health Care in Bali, Indonesia Mariadi, I Ketut; Somayana, Gde; Sindhughosa, Dwijo Anargha
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 3 (2023): VOLUME 24, NUMBER 3, December, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2432023235

Abstract

Background: The knowledge of CRC and its screening methods of healthcare workers is the bedrock of CRC early detection particularly in countries lacking national screening programs. Unknown factors influencing colorectal cancer early detection program implementation. We aimed to evaluate the knowledge and attitudes of primary health care (PHC) provider regarding CRC screening and identify the barriers associated with the screening plan.Methods: A cross-sectional study was conducted among PHC physicians and nurses in public primary health care centers in Bali, Indonesia. A 44-item self-administered questionnaire was used to assess the knowledge, attitude and practice of CRC screening. The questionnaire was spread using google form. Results: Two hundred and five respondents have participated in this study. The average duration of doing practice in PHC is 6.6 years. In knowledge of CRC, 50.2% of them have good knowledge, and there is no difference between PCPs vs nurses (51.9% vs 47.3%; p=0.53). In attitude toward CRC screening, 58.5% out of the have good attitude, and there is no difference between PCPs vs nurses (60.3% vs 55.4%; p=0.50). The barriers of the screening was divided into two areas, a barrier from the health care system and patients. There was no association between knowledge and attitude towards CRC screening (p=0.63).Conclusion: The majority of health workers' knowledge and attitudes toward CRC screening were in the "good" category. The patient's fear of being diagnosed with cancer, as well as the patient's fear and anxiety of screening tests, is the most significant barrier to colorectal cancer screening.
Association Between Bile Reflux and Gastric Mucosal Damage Severity in Patients with Dyspepsia Saturti, Tjokorda Istri Anom; Mariadi, I Ketut; Triyanayasa, I Nyoman; Sindhughosa, Dwijo Anargha; Kuwai, Toshio
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 2 (2024): VOLUME 25, NUMBER 2, August, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2522024295

Abstract

Background: Bile acid reflux stands out as a notable risk factor for dyspepsia. Among patients with bile acid reflux, common endoscopic findings include mucosal erythema, the presence of bile acid on the mucosa, erosions, hyperrugosity, and gastric mucosal atrophy. This study aims to elucidate the association between bile acid levels in gastric fluid and the degree of gastric mucosal damage.Methods: This cross-sectional study involved dyspeptic patients who underwent endoscopic examination at Prof. Dr. I.G.N.G. Ngoerah Denpasar Hospital. Bile acid analysis was conducted through the enzymatic calorimetric method, while assessment of mucosal damage relied on the Lanza score, evaluated independently by two observers. Mucosal damage severity was categorized as either mild (score 0-2) or severe (score 3-5). Statistical analyses included Cohen’s kappa for interobserver agreement, bivariate analysis, and logistic regression.Results: Of the 99 subjects involved in the study, 58.6% were male. H. pylori antibodies were detected in 21% of the participants, while 48% exhibited a pH below 2.77. Additionally, 48% reported a history of NSAID consumption. The mean bile acid level in gastric fluid was 156.07 μmol/L, with a median of 170.09 μmol/L (categorized as high if ≥ 170.09 μmol/L, and low if 170.09 μmol/L). During endoscopic examination, mild mucosal damage was observed in 61%, and severe damage in 39% (kappa 1, P 0.001). A statistically significant relationship between gastric f luid bile acid levels and mucosal damage was evident (P 0.05).Conclusion: This study concludes that there was a relationship between the level of bile acid in gastric fluid and the degree of mucosal damage.
Low albumin-to-creatinine ratio: a novel predictor of 90-day mortality in hepatocellular carcinoma with liver cirrhosis Pamungkas, Kadek Mercu Narapati; Dewi, Putu Itta Sandi Lesmana; Dewi, Ni Luh Putu Yunia; Dewi, Ni Nyoman Gita Kharisma; Sindhughosa, Dwijo Anargha; Mariadi, I Ketut
Universa Medicina Vol. 43 No. 3 (2024)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2024.v43.313-320

Abstract

BackgroundDespite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. Lowered serum albumin in hepatocellular carcinoma, an advanced stage of liver cirrhosis, indicates a worsening condition. Hepatorenal syndrome, marked by increased serum creatinine, is a key mortality indicator. The aim of this study was to determine the serum albumin-to-creatinine ratio (sACR) as a predictor of mortality in patients with HCC and liver cirrhosis. MethodsThis retrospective cohort study included 37 patients with HCC and liver cirrhosis. Patient characteristics, sACR, model of end-stage liver disease (MELD) score, and Child-Turcotte-Pugh (CTP) score were obtained from medical records. The optimal cut-off point for the sACR was determined using receiver operating characteristic (ROC) analysis to evaluate its predictive ability for 90-day mortality. Survival analysis was conducted using the Kaplan-Meier method with a log-rank test, and Cox regression was employed to obtain hazard ratios (HR) to estimate the patient’s prognosis. ResultsA low sACR cut-off of 2.32 was identified. Kaplan-Meier analysis confirmed that sACR met the proportional hazard assumption. sACR <2.32 was a significant predictor of 90-day mortality (HR 6.52; 95% CI 1.80-23.63; p=0.004), comparable to MELD 40 (HR 41.3; 95% CI 1.98-862.90; p=0.016) and CTP category (HR =2.19;95%CI: 0.79-6.06;p=0.131). Conclusion The sACR is a novel predictor of 90-day mortality in HCC patients with liver cirrhosis. Lower sACR is associated with overall survival and may help to design strategies to personalize management approaches among patients with HCC and liver cirrhosis.
Hepatic Encephalopathy Scoring Model in Hepatic Cirrhosis Based on Clinical and Laboratory Parameter Pamungkas, Kadek Mercu Narapati; Lesmana Dewi, Putu Itta Sandi; Dewi, Ni Luh Putu Yunia; Kharisma Dewi, Ni Nyoman Gita; Sindhughosa, Dwijo Anargha; Mariadi, Ketut
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 3 (2024): VOLUME 25, NUMBER 3, December, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/253202416-23

Abstract

Background: Hepatic Encephalopathy (HE) is a serious complication with a wide spectrum of clinical symptoms, from minimal changes to profound coma. HE is hard to diagnose without advanced laboratory parameters such as ammoni. This study aims to develop a scoring model to diagnose HE using clinical and laboratory parameters. Methods: An analytical cross-sectional study collected data from 96 hospitalized patients with liver cirrhosis from November 2021 to January 2022. Employing multivariate logistic regression analysis, the study aimed to identify autonomous factors associated with HE. Each significant variable was used to calculate patient probabilities. The score for each variable was computed utilizing the (B/SE)/lowest(B/SE) formula, demonstrating robust discriminatory capability. The scoring model was formulated and evaluated based on its sensitivity and specificity.Results: Nineteen point eight percent, equivalent to ninenteen patients, were admitted with HE. The scoring model was crafted based on nineteen variables. There were four significant variables in this model: Aspartate Aminotransferase (AST) (p=0.01), Total Bilirubin (p=0.007), Fibrosis-4-Index (FIB-4) (p=0.014), and Ascites (p=0.016). Each variable was scored as 1 for AST, -1 for total bilirubin, 1 for FIB-4-index, and 1 for Ascites. The probability was 2%, 14.2%, 57%, 91.4%, and 50%, following the total score of -1, 0, 1, 2, and 3, respectively. The sensitivity and specificity of the scoring model were 68.4% and 85.3%, respectively (AUC=84.7%).Conclusion: Daily laboratory and clinical manifestations related to hepatic cirrhosis could give a clue to diagnosing hepatic encephalopathy. 
The Neutrophil Percentage-to-Albumin Ratio (NPAR) is Associated with In-Hospital Mortality in Patients with Liver Cirrhosis Lastiana, Ni Made Putri; Mariadi, Ketut; Sindhughosa, Dwijo Anargha; Kumar, Manoj
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 2 (2025): VOLUME 26, NUMBER 2, AGUSTUS, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2622025101-106

Abstract

Background: Studies show that the Neutrophil Percentage-to-Albumin Ratio (NPAR) predicts mortality in a number of illnesses. On the other hand, there is currently limited clinical support for using NPAR in liver cirrhosis patients. Investigating the associated of NPAR and hospital mortality outcome patients with liver cirrhosis is the goal of this study.Methods: All cirrhosis patients who were admitted to the hospital were included in this retrospective cohort analysis. The percentage of neutrophils and albumin levels on the first day of hospitalization were compared to determine the NPAR. Data were analyzed using the Mann-Whitney test, operating curve (ROC) analysis, and Kaplan-Meier survival curves. P-value 0.05 was considered statistically significant. Results: This study included 98 patients with liver cirrhosis. It was found that NPAR had a high incidence of patient mortality compared to surviving patients who were hospitalised (35.13 vs. 25.33, p 0.001). The median overall survival for all subjects was 10 days, indicating that 50% of the subjects had died within 10 days. According to ROC analysis, NPAR has an ideal cutoff value of 29.63 and can be utilized as a predictor of in-hospital mortality (sensitivity 74.1%, specificity 72.7%, AUC 0.8, p 0.001). Survival analysis stratified by NPAR showed that patients with NPAR ≥ 29.63 had a lower median survival compared to those with NPAR 29.6.Conclusion: In patients with liver cirrhosis, the Neutrophil Percentage-to-Albumin Ratio (NPAR) is a metric that can be used to assess in-hospital mortality outcomes
Co-Authors Dewi, Ni Luh Putu Yunia Dewi, Ni Nyoman Gita Kharisma Dewi, Putu Itta Sandi Lesmana Gde Somayana I Dewa Nyoman Wibawa I Ketut Mariadi Kharisma Dewi, Ni Nyoman Gita Kumar, Manoj Kumbara, Cokorde Istri Yuliandari Krisnawardani Kuwai, Toshio Lastiana, Ni Made Putri Lesmana Dewi, Putu Itta Sandi Mariadi, Ketut Pamungkas, Kadek Mercu Narapati Saturti, Tjokorda Istri Anom Triyanayasa, I Nyoman