Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy

Seung Up Kim; Yeon Seok Seo; Han Ah Lee; Mi Na Kim; Eun Hwa Kim; Ha Yan Kim; Yu Rim Lee; Hye Won Lee; Jun Yong Park; Do Young Kim; Sang Hoon Ahn; Kwang Hyub Han; Seong Gyu Hwang; Kyu Sung Rim; Soon Ho Um; Won Young Tak; Young Oh Kweon; Beom Kyung Kim; Soo Young Park

doi:10.1016/j.cgh.2019.06.028

Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy

Seung Up Kim, Yeon Seok Seo, Han Ah Lee, Mi Na Kim, Eun Hwa Kim, Ha Yan Kim, Yu Rim Lee, Hye Won Lee, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang Hyub Han, Seong Gyu Hwang, Kyu Sung Rim, Soon Ho Um, Won Young Tak, Young Oh Kweon, Beom Kyung Kim, Soo Young Park

Research output: Contribution to journal › Article › peer-review

24 Citations (Scopus)

Abstract

Background & Aims: Researchers previously developed a scoring system to determine the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection, based on the presence of cirrhosis, patient age, male sex, and diabetes (called the CAMD scoring system). We validated the CAMD scoring system and compared its performance with that of other risk assessment models in an independent cohort. Methods: We followed up 3277 patients with chronic HBV infection (mean age, 48.7 y; 62.6% male; 32.4% with cirrhosis) who were treated with entecavir (n = 1725) or tenofovir (n = 1552) as the first-line antiviral agent in 4 academic teaching hospitals in the Republic of Korea. The primary outcome was development of HCC. We evaluated the ability of the CAMD, PAGE-B, and mPAGE-B scoring systems to identify patients who would develop HCC using integrated area under the curve (iAUC) analysis. Results: Over a median follow-up period of 58.2 months, 8.9% of the patients developed HCC. Patients who developed HCC were older, more likely to be male, and had higher proportions of cirrhosis and diabetes than patients who did not develop HCC (all P <.05). CAMD scores identified patients who developed HCC with an iAUC of 0.790, mPAGE-B scores with an iAUC of 0.769, and PAGE-B scores with an iAUC of 0.760. The 5-year cumulative risks of HCC were 1.3% in patients with low CAMD scores (<8), 8.0% in patients with intermediate CAMD scores (8–13), and 24.3% in patients with high CAMD scores (>13) (P <.001 for comparison of low- vs intermediate-score groups and between intermediate- vs high-score groups). The predicted and observed probabilities of HCC had excellent agreement. Conclusions: We validated the CAMD scoring system in determining the risk of HCC in patients with chronic HBV treatment receiving entecavir or tenofovir treatment. Validation was performed in a cohort of patients in the Republic of Korea, where most patients have genotype C2 HBV infection.

Original language	English
Pages (from-to)	693-699.e1
Journal	Clinical Gastroenterology and Hepatology
Volume	18
Issue number	3
DOIs	https://doi.org/10.1016/j.cgh.2019.06.028
Publication status	Published - 2020 Mar

Bibliographical note

Publisher Copyright:
© 2020 AGA Institute

Keywords

CAMD Score
Hepatitis B Virus
Hepatocellular Carcinoma
Model
Prediction
Validation

ASJC Scopus subject areas

Hepatology
Gastroenterology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.cgh.2019.06.028

Cite this

Kim, S. U., Seo, Y. S., Lee, H. A., Kim, M. N., Kim, E. H., Kim, H. Y., Lee, Y. R., Lee, H. W., Park, J. Y., Kim, D. Y., Ahn, S. H., Han, K. H., Hwang, S. G., Rim, K. S., Um, S. H., Tak, W. Y., Kweon, Y. O., Kim, B. K., & Park, S. Y. (2020). Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy. Clinical Gastroenterology and Hepatology, 18(3), 693-699.e1. https://doi.org/10.1016/j.cgh.2019.06.028

Kim, SU, Seo, YS, Lee, HA, Kim, MN, Kim, EH, Kim, HY, Lee, YR, Lee, HW, Park, JY, Kim, DY, Ahn, SH, Han, KH, Hwang, SG, Rim, KS, Um, SH, Tak, WY, Kweon, YO, Kim, BK & Park, SY 2020, 'Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy', Clinical Gastroenterology and Hepatology, vol. 18, no. 3, pp. 693-699.e1. https://doi.org/10.1016/j.cgh.2019.06.028

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title = "Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy",

abstract = "Background & Aims: Researchers previously developed a scoring system to determine the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection, based on the presence of cirrhosis, patient age, male sex, and diabetes (called the CAMD scoring system). We validated the CAMD scoring system and compared its performance with that of other risk assessment models in an independent cohort. Methods: We followed up 3277 patients with chronic HBV infection (mean age, 48.7 y; 62.6% male; 32.4% with cirrhosis) who were treated with entecavir (n = 1725) or tenofovir (n = 1552) as the first-line antiviral agent in 4 academic teaching hospitals in the Republic of Korea. The primary outcome was development of HCC. We evaluated the ability of the CAMD, PAGE-B, and mPAGE-B scoring systems to identify patients who would develop HCC using integrated area under the curve (iAUC) analysis. Results: Over a median follow-up period of 58.2 months, 8.9% of the patients developed HCC. Patients who developed HCC were older, more likely to be male, and had higher proportions of cirrhosis and diabetes than patients who did not develop HCC (all P <.05). CAMD scores identified patients who developed HCC with an iAUC of 0.790, mPAGE-B scores with an iAUC of 0.769, and PAGE-B scores with an iAUC of 0.760. The 5-year cumulative risks of HCC were 1.3% in patients with low CAMD scores (<8), 8.0% in patients with intermediate CAMD scores (8–13), and 24.3% in patients with high CAMD scores (>13) (P <.001 for comparison of low- vs intermediate-score groups and between intermediate- vs high-score groups). The predicted and observed probabilities of HCC had excellent agreement. Conclusions: We validated the CAMD scoring system in determining the risk of HCC in patients with chronic HBV treatment receiving entecavir or tenofovir treatment. Validation was performed in a cohort of patients in the Republic of Korea, where most patients have genotype C2 HBV infection.",

keywords = "CAMD Score, Hepatitis B Virus, Hepatocellular Carcinoma, Model, Prediction, Validation",

author = "Kim, {Seung Up} and Seo, {Yeon Seok} and Lee, {Han Ah} and Kim, {Mi Na} and Kim, {Eun Hwa} and Kim, {Ha Yan} and Lee, {Yu Rim} and Lee, {Hye Won} and Park, {Jun Yong} and Kim, {Do Young} and Ahn, {Sang Hoon} and Han, {Kwang Hyub} and Hwang, {Seong Gyu} and Rim, {Kyu Sung} and Um, {Soon Ho} and Tak, {Won Young} and Kweon, {Young Oh} and Kim, {Beom Kyung} and Park, {Soo Young}",

note = "Publisher Copyright: {\textcopyright} 2020 AGA Institute",

year = "2020",

month = mar,

doi = "10.1016/j.cgh.2019.06.028",

language = "English",

volume = "18",

pages = "693--699.e1",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders Ltd",

number = "3",

}

TY - JOUR

T1 - Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy

AU - Kim, Seung Up

AU - Seo, Yeon Seok

AU - Lee, Han Ah

AU - Kim, Mi Na

AU - Kim, Eun Hwa

AU - Kim, Ha Yan

AU - Lee, Yu Rim

AU - Lee, Hye Won

AU - Park, Jun Yong

AU - Kim, Do Young

AU - Ahn, Sang Hoon

AU - Han, Kwang Hyub

AU - Hwang, Seong Gyu

AU - Rim, Kyu Sung

AU - Um, Soon Ho

AU - Tak, Won Young

AU - Kweon, Young Oh

AU - Kim, Beom Kyung

AU - Park, Soo Young

PY - 2020/3

Y1 - 2020/3

N2 - Background & Aims: Researchers previously developed a scoring system to determine the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection, based on the presence of cirrhosis, patient age, male sex, and diabetes (called the CAMD scoring system). We validated the CAMD scoring system and compared its performance with that of other risk assessment models in an independent cohort. Methods: We followed up 3277 patients with chronic HBV infection (mean age, 48.7 y; 62.6% male; 32.4% with cirrhosis) who were treated with entecavir (n = 1725) or tenofovir (n = 1552) as the first-line antiviral agent in 4 academic teaching hospitals in the Republic of Korea. The primary outcome was development of HCC. We evaluated the ability of the CAMD, PAGE-B, and mPAGE-B scoring systems to identify patients who would develop HCC using integrated area under the curve (iAUC) analysis. Results: Over a median follow-up period of 58.2 months, 8.9% of the patients developed HCC. Patients who developed HCC were older, more likely to be male, and had higher proportions of cirrhosis and diabetes than patients who did not develop HCC (all P <.05). CAMD scores identified patients who developed HCC with an iAUC of 0.790, mPAGE-B scores with an iAUC of 0.769, and PAGE-B scores with an iAUC of 0.760. The 5-year cumulative risks of HCC were 1.3% in patients with low CAMD scores (<8), 8.0% in patients with intermediate CAMD scores (8–13), and 24.3% in patients with high CAMD scores (>13) (P <.001 for comparison of low- vs intermediate-score groups and between intermediate- vs high-score groups). The predicted and observed probabilities of HCC had excellent agreement. Conclusions: We validated the CAMD scoring system in determining the risk of HCC in patients with chronic HBV treatment receiving entecavir or tenofovir treatment. Validation was performed in a cohort of patients in the Republic of Korea, where most patients have genotype C2 HBV infection.

AB - Background & Aims: Researchers previously developed a scoring system to determine the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection, based on the presence of cirrhosis, patient age, male sex, and diabetes (called the CAMD scoring system). We validated the CAMD scoring system and compared its performance with that of other risk assessment models in an independent cohort. Methods: We followed up 3277 patients with chronic HBV infection (mean age, 48.7 y; 62.6% male; 32.4% with cirrhosis) who were treated with entecavir (n = 1725) or tenofovir (n = 1552) as the first-line antiviral agent in 4 academic teaching hospitals in the Republic of Korea. The primary outcome was development of HCC. We evaluated the ability of the CAMD, PAGE-B, and mPAGE-B scoring systems to identify patients who would develop HCC using integrated area under the curve (iAUC) analysis. Results: Over a median follow-up period of 58.2 months, 8.9% of the patients developed HCC. Patients who developed HCC were older, more likely to be male, and had higher proportions of cirrhosis and diabetes than patients who did not develop HCC (all P <.05). CAMD scores identified patients who developed HCC with an iAUC of 0.790, mPAGE-B scores with an iAUC of 0.769, and PAGE-B scores with an iAUC of 0.760. The 5-year cumulative risks of HCC were 1.3% in patients with low CAMD scores (<8), 8.0% in patients with intermediate CAMD scores (8–13), and 24.3% in patients with high CAMD scores (>13) (P <.001 for comparison of low- vs intermediate-score groups and between intermediate- vs high-score groups). The predicted and observed probabilities of HCC had excellent agreement. Conclusions: We validated the CAMD scoring system in determining the risk of HCC in patients with chronic HBV treatment receiving entecavir or tenofovir treatment. Validation was performed in a cohort of patients in the Republic of Korea, where most patients have genotype C2 HBV infection.

KW - CAMD Score

KW - Hepatitis B Virus

KW - Hepatocellular Carcinoma

KW - Model

KW - Prediction

KW - Validation

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U2 - 10.1016/j.cgh.2019.06.028

DO - 10.1016/j.cgh.2019.06.028

M3 - Article

C2 - 31252188

AN - SCOPUS:85072520941

SN - 1542-3565

VL - 18

SP - 693-699.e1

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

IS - 3

ER -

Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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