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All Journal Medical Journal of Indonesia The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
C Rinaldi A Lesmana
Divisi Hepatobilier, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, RSUPN Cipto Mangunkusumo, Jakarta
Medicine & Pharmacology

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Liver Function and Treatment Modalities are Predictors of Survival in Patients with Hepatocellular Carcinoma Hasan, Irsan; Loho, Imelda Maria; Lesmana, Cosmas Rinaldi; Gani, Rino A.
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 3
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Introduction. Hepatocellular carcinoma (HCC) is a major health problem in Indonesia because most patients are diagnosed in late stages when curative treatment is no longer possible. The aim of this study is to evaluate one-year survival rate, prognostic factors, and treatment modalities of patients with hepatocellular carcinoma. Methods. A retrospective analysis was done in patients with HCC who were admitted to Cipto Mangunkusumo General Hospital (CMGH) between January 2013 and March 2014. Clinical parameters and treatment modalities were evaluated. Patients outcome at one-year of follow-up were recorded from medical records or patients were contacted by phone call. Survival curve was produced using Kaplan-Meier method and a multivariate analysis was conducted using Cox proportional hazards model. Results. A total of 114 patients were included in this study. Incidence of mortality was 57% and one-year survival rate was 29.4% with median survival as long as 135 days (approximately 4.5 months). According to the BCLC staging system, patients who were diagnosed as early, intermediate, late, and terminal stages were 2 (1.8%), 48 (42.1%), 32 (28.1%), and 32 (28.1%), respectively. Poor liver function (Child-Pugh C class) was diagnosed in 26.3% of patients. Only two patients were diagnosed during surveillance process. Proportion of patients treated with curative/palliative modalities and best supportive care were 34.2% and 65.8%, respectively. In multivariate analysis, Child-Pugh classification and treatment modalities were significant prognostic factors with p-value of <0,001 for both factors. Conclusion. Liver function and treatment modalities are predictors of survival in patients with HCC.
Perbedaan Hasil Pemeriksaan Bioelectric Impedance Analysis antara Status Nutrisi Baik dan Malnutrisi pada Penderita Penyakit Gastrointestinal dan Hati yang Dirawat Inap di RSCM Tahun 2013 Taufiq, Taufiq; Syam, Ari Fahrial; Lesmana, C Rinaldi; Suwarto, Suhendro
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 2
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Pendahuluan. Bioelectric Impedance Analysis (BIA) mulai banyak digunakan dalam mengevaluasi status nutrisi. Belum ada data penelitian nutrisi di Indonesia yang menggunakan BIA. Penelitian ini dilakukan untuk mengetahui perbedaan rerata hasil pemeriksaan BIA antara status nutrisi baik dan malnutrisi pada penderita penyakit gastrointestinal dan hati yang dirawat inap. Metode. Penelitian potong lintang retrospektif terhadap penderita yang dirawat inap di ruang perawatan interna RSCM periode 1 Juni-31 Desember 2013, untuk mengetahui perbedaan rerata hasil pemeriksaan BIA penderita status nutrisi baik dan malnutrisi pada penyakit gastrointestinal dan hati yang dirawat inap. Hasil. Dari 28 penderita dengan status nutrisi baik, 71,57% laki-laki, dan 21,47% wanita. Dari 28 penderita malnutrisi, 53,60% laki-laki, dan 46,40% wanita. Rerata hasil pemeriksaan BIA antara penderita nutrisi baik dan malnutrisi adalah: lean body mass, 49,5 ± 8,59 vs. 39,68 ± 6,28 kg, po(3,73-10,11)o vs 3,46o(0,40-6,51)o; p<0,001.Simpulan. Pada penderita penyakit gastrointestinal dan hati yang dirawat inap dengan status nutrisi baik, memiliki nilaibody mass, body Fell mass,total body water dan phase angle hasil pemeriksaan BIA yang lebih tinggi dibandingkandengan penderita malnutrisi.
Profil Klinis dan Kesintasan Pasien Karsinoma Sel Hati di Rumah Sakit Rujukan Tersier Indonesia Tahun 2015-2021 Hasan, Irsan; Gani, Rino Alvani; Sulaiman, Andri Sanityoso; Kurniawan, Juferdy; Lesmana, Cosmas Rinaldi A.; Jasirwan, Chyntia Olivia M; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Teressa, Maria
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
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Introduction. Hepatocellular carcinoma (HCC) is the most common primary liver cancer in the world and Indonesia. This study aimed to describe the clinical presentation and survival rate of HCC patients in Dr. Cipto Mangunkusumo Hospital (RSCM) as the Indonesian tertiary referral hospital in year 2015-2021 Methods. Cohort study was performed in year 2015-2021. Clinical presentations at the time of diagnosis were recorded from electronical health record. All HCC patients were followed up until death. One-year survival based on staging was assessed using log rank test and presented with Kaplan Meier curve. Results. A total of 799 HCC patients were included. Majority of HCC patients were male, 619 patients (77.5%), and aged 55 (SD 11.9) years. Hepatitis B was the major etiology, found in 500 patients (62.6%). Median of alfa feto-protein (AFP) was 1,109 (0.8-3,462,499) ng/ml. At the time of diagnosis, Barcelona Clinic Liver Cancer (BCLC) stage C (37.7%) was the most commonly found. Portal vein thrombosis was found in 205 patients (25.7%). There were 271 (33.9%) HCC patients received curative and palliative treatment, and others had supportive care. One year survival rate of HCC was 61.2%. One year survival rate of HCC based on staging for BCLC A, BCLC B, BCLC C, and BCLC D were 91.1%, 68.6%, 47.6%, and 13.3%, respectively (log-rank test: p<0.001). Conclusion. The majority of patients diagnosed with HCC were at an advanced stage so that the one-year survival is poor.
Perlemakan Hati Non-Alkoholik dan Risiko Fibrosis Hati pada Pasien Hepatitis B Kronik Sulaiman, Andri Sanityoso; Hasan, Irsan; Lesmana, Cosmas Rinaldi A.; Kurniawan, Juferdy; Jasirwan, Chyntia Olivia Maurine; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Introduction. Prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing throughout the world due to sedentary lifestyle and dietary habit, including in patients with chronic hepatitis B (CHB). In several studies, advanced of liver disease were more likely observed among those CHB patients with NAFLD. NAFLD might increase the risk of liver disease progression in CHB patients, but prior investigations were still limited. This study aimed to determine the association between NAFLD and risk of liver fibrosis in CHB patients. Methods. All patients with positive serum hepatitis B surface antigen in the Hepatobilier Data Registry, Cipto Mangunkusumo Hospital, were included in this study. Based on abdominal ultrasonography, patients were divided into two group (group I: non-NAFLD – hepatitis B patients vs. group II: NAFLD – hepatitis B patients). Data demographic and clinical examination were collected. Significant liver fibrosis was defined as stage liver fibrosis above 7 kPa (≥ F2). Logistic regression was used to identify NAFLD as risk factor for significant fibrosis. Variables were expressed as prevalence odd ratio (POR) with 95% CI. P values <0.05 were considered statistically significant. Results. Among 130 hepatitis B patients, 45 patients (34.6%) were diagnosed with NAFLD. Of 45 patients in group II, 36 patients (80%) had significant liver fibrosis. It was observed that a higher percentage of patients in group II were HBeAg negative compared to those in group I (66.7% vs. 35.9%; p=0.038). Furthermore, group II also displayed higher levels of liver stiffness compared to group I (12.22 (8.6 kPa) vs. 8.57 (7.8 kPa); p 0.016). In multivariate analysis, NAFLD was significantly associated with significant liver fibrosis (POR: 5.87; CI95%: 2.48 – 13.86; p < 0.001) after adjusted with HBeAg status. Conclusion. NAFLD associated with the higher risk of liver fibrosis in patients with hepatitis B. Modification of lifestyle and potential therapeutic intervention may help in reducing the progression of liver fibrosis.
Evaluasi Pengukuran Kekakuan Limpa dalam Memprediksi Perdarahan Varises Esofagus Berulang pada Pasien Sirosis Hati Tahir, Andi Cahaya; Kurniawan, Juferdy; Simadibrata, Marcellus; Rizka, Aulia; Shatri, Hamzah; Lesmana, Cosmas Rinaldi A.; Mulansari, Nadia Ayu
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 1
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Introduction. Esophageal variceal bleeding is one of the complications caused by an increase in pressure within the portal vein blood vessels. The gold standard examination for portal pressure is the hepatic venous pressure gradient (HVPG), but HVPG examination is invasive, involving transjugular catheterization of the hepatic vein. Currently, non-invasive methods for measuring portal hypertension are being developed to predict esophageal varices and esophageal variceal bleeding using spleen stiffness measurements. This study aimed to evaluate the accuracy of spleen stiffness measurement in predicting recurrent esophageal variceal bleeding in patients with liver cirrhosis. Methods. This study used a retrospective cohort design with secondary data sourced from medical records at Cipto Mangunkusumo Hospital. Spleen stiffness assessment was conducted using the vibration controlled transient elastography (VCTE) spleen-dedicated stiffness measurement (FibroScan®, Echosens, France) with a frequency of 100Hz. After six weeks post-first esophageal variceal bleeding in liver cirrhosis patients, an evaluation of recurrent esophageal variceal bleeding was performed. The collected data were analyzed using SPSS 26. The ability of spleen stiffness measurement to predict recurrent esophageal variceal bleeding was assessed by evaluating the AUROC (area under the curve of receiver operating characteristic) curve. Results. A total of 102 liver cirrhosis patients who experienced first-time esophageal variceal bleeding were included in the study. Recurrent esophageal variceal bleeding was found in 23/102 (22.5%) liver cirrhosis patients. There was a significant difference in spleen stiffness values between the two groups, with higher values in the group of patients with recurrent esophageal variceal bleeding (90.9 kPa (IQR: 86.5 – 96.2) vs. 59.3 kPa (IQR: 45.2 – 74.3), p < 0.001). The AUC value of spleen stiffness for predicting recurrent esophageal variceal bleeding provided good predictability, with an AUC value of 0.898 (95% CI 0.808 – 0.988), p < 0.001. The cut-off value of spleen stiffness at 70 kPa yielded a sensitivity of 87% and specificity of 65% in predicting recurrent esophageal variceal bleeding. Conclusion. Spleen stiffness measurement can be beneficial as an evaluation method to assess the likelihood of recurrent esophageal variceal bleeding in patients with liver cirrhosis at the 6th week after the first bleeding episode.
Esophageal Varices Rebleeding Prophylaxis Treatment: Who is the Champion? Lesmana, Cosmas Rinaldi Adithya
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: 10.24871/2432023193

Abstract

Portal hypertension (PH) is still a big challenge in clinical practice, where the presence of esophageal varices (EV) is the most common complication found in liver cirrhosis (LC) patients. The progression of PH condition in LC patients would lead to decompensated stage with more complications, such as variceal bleeding, the presence of ascites, hepatic encephalopathy, and hepatorenal syndrome.[1,2] Bleeding of EV (BEV) is a critical clinical which carry high mortality. Therefore, not only early detection and how the PH condition can be diagnosed well, but also how we can manage to prevent its complication, especially for primary as well as secondary BEV prophylaxis.[3]
Management of Complex Biliary Cases in A Tertiary Referral Setting: Real World Lessons and Their Role in Shaping Future Clinical Strategies Lesmana, Cosmas Rinaldi Adithya; Paramitha, Maria Satya; Pratiwi, Yulia Estu; Ho, Khek Yu; Lesmana, Laurentius Adrianto
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: 10.24871/25120242-10

Abstract

Background: In the era of laparoscopic procedure, innovative non-surgical approaches have emerged for managing biliary tract disorders. Techniques such as therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and interventional endoscopic ultrasound (EUS) are increasingly being utilized. However, a clear consensus on a stepwise approach to managing difficult biliary disorders remains elusive. Therefore, this study was performed to evaluate the impact of endoscopic approach management on the outcomes of complex biliary cases.Methods: A retrospective study was conducted using an endoscopy database over two-year period. The characteristics of the study subjects, including demography and clinical data, were presented descriptively. The technical success rate was defined as the completion of the procedure performed on the patients. A bivariate analysis was conducted to evaluate the outcomes of therapy.Results: Sixty-one subjects with similar proportions in malignant (44.3%) and non-malignant (55.7%) etiologies in this retrospective database study were considered as complex biliary cases. Among them, 16.4% underwent a combination of therapeutic ERCP and EUS in one session based on the complexity of the case. Additionally, 8.2% of the subjects underwent ERCP with additional single operator cholangioscopy procedure. One subject (1.6%) underwent a rendezvous ERCP procedure through a percutaneous approach, while 4.9% underwent EUS-guided biliary drainage procedure. This study revealed no significant association between all mortality outcomes and baseline characteristics of the patients. Furthermore, there were no significant associations between mortality and the need for re-intervention, post-procedural pain, or the occurrence of acute pancreatitis.Conclusion: Complex biliary cases require a good clinical approach algorithm to decide which procedure comes first based on a comprehensive evaluation consisting of the patient’s factor, expertise, cost, and the risk of complications.
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
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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.
Pengaruh Durasi Pengobatan dan Preferensi Pasien Kanker Stadium Akhir terhadap Layanan Homecare di Rumah Sakit Medistra pada Tahun 2021-2023 Putra, Peter Brian Sutanto, Dr; Suwangto, Erfen Gustiawan, Dr; Djuartina, Tena, Dr; Budianto, Iskandar Rahardjo, Dr; Lesmana, C. Rinaldi A.
Jurnal Penyakit Dalam Indonesia
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Introduction. Cancer is still an enormous health problem in the world and rank second as the most common cause of mortality. End-stage cancer requires end-of-life or palliative care to improve the patient’s quality of life before death. Homecare services have become an option for providing palliative care to avoid long-term hospital stays. The study aimed to provide an overview of the treatment duration and other factors in end-stage cancer patients regarding the selection of homecare services at Medistra Hospital during the period of 2021-2023. Methods. This study with a cross-sectional design analyzed medical records of end-stage cancer patients who received palliative homecare services at Medistra Hospital from 2021 to 2023. Chi-square analysis was used to describe the association between gender, treatment duration, and cancer type with the decision to choose homecare services. The Mann-Whitney test was conducted to describe the relationship between age and the decision to choose homecare. Results. Out of 595 end-stage cancer patients, 429 chose to undergo palliative homecare. Males represented the majority in both the homecare group (53.1%) and the non-homecare group (56.6%). Patients who chose homecare were generally older (median age 65 years) compared to those who did not (median age 61 years, p = 0.002). Hematologic cancers were most common in the non-homecare group (25.3%), while gastrointestinal cancers were the most prevalent in the homecare group (39.9%). Patients with a treatment duration of less than 8 weeks from diagnosis were more likely to choose homecare, while those with a duration of 8 weeks or more were more likely to decline homecare (98.6% vs. 3.6%, p <0.001). Conclusion. Treatment duration and age are significant factors that related to the decision of end-stage cancer patients to choose homecare services.
Peran Prediktif IL-6, IL-10, dan TNF-α Plasma terhadap Gagal Ginjal Akut pada Pasien dengan COVID-19 Derajat Sedang dan Berat Gathmyr, Dewi; Bonar, Maruhum Bonar H; Susilo, Adityo; Harimurti, Kuntjoro; Nainggolan, Ginova; Tagor, Alvin; Shatri, Hamzah; Lesmana, Cosmas Rinaldi Adithya; Amin, Zulkifli
Jurnal Penyakit Dalam Indonesia
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Introduction. Acute kidney injury (AKI) is associated with higher mortality rate in COVID-19 patients due to inflammation and immune dysregulation. This study aimed to correlate serum levels of IL-6, IL-10, and TNF-α with serum creatinine changes and their roles to predict incidence of acute kidney injury (AKI) in patients with moderate and severe COVID-19. Methods. This prospective cohort study was conducted among patients with moderate to severe COVID-19 in Pertamina Central Hospital Jakarta, Indonesia during November 2020 to January 2021. All serum levels of cytokines (IL-6, IL-10, and TNF-α) and creatinine were collected on the first day and seventh day of hospitalization. They might be collected earlier if the patients died or discharged early. AKI was defined as deterioration in serum creatinine or urine output based on Kidney Disease Improving Global Outcomes (KDIGO) guideline. The correlation between cytokine and creatinine serum level changes were analyzed using Spearman test. Receiver operator characteristic curve was calculated to explore predictive roles of cytokines on AKI incidence. Results. A total of 43 patients were included in the study, with a mean age of 59.3 years (SD 12.59), and the majority were male (74%). The incidence of AKI was 7%. Serum creatinine changes were correlated with serum levels changes IL-10 (r= -0.343; p=0.024), but not for IL-6 (r=-0.198; p=0.202) and TNF-α (r=-0.129, p=0.409). Meanwhile, serum TNF-α level on the first day was able to predict AKI incidence on the seventh day of hospitalization (AUC 85%; p=0.045; 95% CI=0.737 to 0.963). Conclusions. TNF-α on the first day is potential to be predictor on AKI incidence on the seventh day in moderate and severe COVID-19 patients.
Co-Authors Aditama, Humala Prika Adityo Susilo, Adityo Agus Sudiro Waspodo Alvin Nursalim Andri Sanityoso Andri Sanityoso Sulaeman Andri Sanityoso Sulaiman Angga, Billy Aprilicia, Gita Ari Fahrial Syam Ari Fahrial Syam Ari Fahrial Syam Aulia Rizka, Aulia Baiq Kirana DN Mandasari Benny Philipi Billy Angga Bonar, Maruhum Bonar H Budianto, Iskandar Rahardjo, Dr C Martin Rumende Chyntia Olivia M. Jasirwan Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Cleopas Martin Rumende Dadang Makmun Dewi Gathmyr DIAH ISKANDRIATI Diana Sunardi Djuartina, Tena, Dr E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edy Rizal Wahyudi Fera Ibrahim Ginova Nainggolan Gita Aprilicia Gita Aprilicia Hanif, Muhammad Yusuf Hasan Maulahela, Hasan Hendra Koncoro Hendra Koncoro Ho, Khek Yu Ignatius R Tenggara, Ignatius R Ikhwan Rinaldi Imelda Maria Loho Imelda Maria Loho, Imelda Maria Irsan Hasan Irsan Hasan Jasirwan, Chyntia Olivia M Juferdy Kurniawan Kemal F Calista Kemal Fariz Kalista Kemal Fariz Kalista Kemal Fariz Kalista, Kemal Fariz Kuntjoro Harimurti Laurentius A Lesmana Laurentius A Lesmana Laurentius A Lesmana, Laurentius A Lesmana, Laurentius Adrianto Levina S Pakasi Lianda Siregar Lutfie Lutfie, Lutfie Marcellus Simadibrata Maulana Suryamin, Maulana Muhammad Yusuf Hanif Nababan, Saut Horas H. Nadia Ayu Mulansari, Nadia Ayu Nikko Darnindro Pakasi, Levina S Paramitha, Maria Satya Perdana Aditya, Perdana Philipi, Benny Pratiwi, Yulia Estu Purwita Wijaya Laksmi Putra, Peter Brian Sutanto, Dr Rino A Gani Rino A. Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rudy Hidayat Saut HH Nababan Saut Horas H. Nababan Saut Horas Hatoguan Nababan Sepmeitutu, Iwandheny Suhendro Suwarto Suhendro Suwarto, Suhendro Sulaeman, Andri Sanityoso Suwangto, Erfen Gustiawan, Dr Suzanna Immanuel Syahrizal Syarif Tagor, Alvin Tahir, Andi Cahaya Taufiq Taufiq Taufiq Taufiq Teng, Wei Teressa, Maria THARIQAH SALAMAH, THARIQAH Triyanta Yuli Pramana Ummi Ulfah Madina, Ummi Ulfah Waldemar Simanjuntak Waldemar Simanjuntak Willy Brodus Uwan Willy Brodus Uwan, Willy Brodus Zulkifli Amin