Kosin Medical Journal

Review article

Autoimmune hepatitis: current concepts in epidemiology, diagnosis, and management: Brian J. Wentworth, Kwang Il Seo; Kosin Med J. 2025;40(4):249-269. Published online December 29, 2025; DOI: https://doi.org/10.7180/kmj.25.140

4,105 View
83 Download

Abstract PDF PubReader ePub: Autoimmune hepatitis is a rare immune-mediated liver disease that can progress to cirrhosis and liver failure. Its global incidence and prevalence are increasing, with a marked female predominance and substantial regional variation. Diagnosis requires the exclusion of alternative causes of liver disease and the integration of clinical, serologic, and histologic features. First-line induction therapy has traditionally relied on corticosteroids, with or without azathioprine, although recent evidence supports mycophenolate mofetil as an alternative first-line, steroid-sparing agent. Nonetheless, a subset of patients are intolerant of or have an inadequate response to first-line therapies, which complicates management and necessitates the use of less well-validated immunosuppressive regimens. Special clinical situations, including pregnancy, overlap syndromes, liver transplantation, and hepatocellular carcinoma, pose additional management challenges. For most patients, the primary therapeutic goal is complete biochemical response, although subclinical histologic inflammation may persist in some cases. Accordingly, careful long-term monitoring is essential to assess disease progression and to detect disease-specific or immunosuppression-related complications. This review concisely summarizes the current literature on autoimmune hepatitis and provides busy clinicians with a practical, evidence-based primer on disease management.

Original article

Platelet count as a predictor of advanced-stage liver cirrhosis: a comparative study with established fibrosis markers: Hyung Hwan Moon, Kwang Il Seo, Hyunyong Hwang, Young Il Choi, Dong Hoon Shin, Myunghee Yoon, Bohyeon Kim, Yeha Joo; Kosin Med J. 2025;40(4):308-316. Published online December 26, 2025; DOI: https://doi.org/10.7180/kmj.25.143

3,214 View
34 Download

Abstract PDF PubReader ePub: Background
Accurate assessment of liver fibrosis is critical for the management of chronic liver disease. Noninvasive biomarkers are increasingly being investigated as alternatives to liver biopsy. Platelet count has emerged as a potential predictor of advanced fibrosis and may complement established indices such as the fibrosis-4 (FIB-4) score and the aspartate aminotransferase-to-platelet ratio index (APRI).
Methods
This prospective analysis included 101 patients with histologically confirmed data obtained through liver biopsy or hepatic resection. Platelet count, APRI, FIB-4, Model for End-Stage Liver Disease score, Mac-2 binding protein glycosylation isomer (M2BPGi), and albumin-bilirubin score were measured and correlated with fibrosis stage using the METAVIR scoring system. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed to assess the predictive performance of each marker.
Results
Platelet count demonstrated an inverse correlation with fibrosis severity and was identified as the most reliable predictor of advanced fibrosis (METAVIR ≥3), with an area under the ROC curve of 0.822. Using a cutoff value of 184,000, platelet count yielded a sensitivity of 69.2% and a specificity of 87.8% for the detection of significant fibrosis.
Conclusions
Platelet count is a simple, widely available, and robust predictor of liver fibrosis, outperforming APRI, FIB-4, and M2BPGi in multivariate analysis. Validation in larger, independent cohorts is warranted to confirm its clinical utility.

Case report

Brain hemorrhage in patients with advanced hepatocellular carcinoma treated with atezolizumab and bevacizumab: two case reports: Bangju Kim, Hyun Joon Park, Sang Uk Lee, Kwang Il Seo, Jung Wook Lee, Sumin Jo, Jun Yeb Nam; Kosin Med J. 2025;40(2):150-156. Published online June 30, 2025; DOI: https://doi.org/10.7180/kmj.25.114

3,258 View
28 Download
1 Citations

Abstract PDF PubReader ePub

A combination of atezolizumab and bevacizumab is currently recommended for treating unresectable advanced-stage hepatocellular carcinoma (HCC), as it has demonstrated superior overall survival and progression-free survival compared to sorafenib. However, concerns have been raised regarding serious adverse events associated with bevacizumab, such as gastrointestinal perforation, fistula, hemorrhage, and arterial thromboembolism. In particular, patients with liver cirrhosis (LC) show an increased risk of variceal bleeding. However, brain hemorrhage associated with the use of bevacizumab in patients with HCC and LC is extremely rare. We encountered two cases of brain hemorrhage in patients with HCC and LC who underwent treatment with atezolizumab and bevacizumab. One patient had no history of hypertension, while the other patient had hypertension that was well-controlled with medication and an unruptured brain aneurysm located on the right side of the anterior communicating artery. Both patients experienced brain hemorrhage after two treatment cycles of atezolizumab with bevacizumab. One patient died due to brain hemorrhage, while the other patient recovered from subarachnoid hemorrhage with successful coil embolization. This case report suggests that if a patient has any high-risk factors associated with brain hemorrhage, physicians should thoroughly consider alternative treatment options for advanced HCC, as brain hemorrhage could be fatal.

Citations

Citations to this article as recorded by

Spontaneous intracerebral hemorrhage associated with lenvatinib in advanced hepatocellular carcinoma without conventional risk factors: a case report literature review
Hyunmin Ji, Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim
Frontiers in Oncology.2026;[Epub] CrossRef

Original article

A prospective study of the correlation between hepatic fibrosis and noninvasively measured fibrosis markers including serum M2BPGi and acoustic radiation force impulse elastography: Kwang Il Seo, Hyunyong Hwang, Byung Cheol Yun, Hyung Hwan Moon, Young Il Choi, Dong Hoon Shin, Myunghee Yoon; Kosin Med J. 2022;37(2):146-153. Published online June 24, 2022; DOI: https://doi.org/10.7180/kmj.22.110

5,661 View
55 Download
2 Citations

Abstract PDF PubReader ePub

Background
Mac-2 binding protein glycosylation isomer (M2BPGi) was introduced as a noninvasively measurable serologic marker for liver fibrosis. Acoustic radiation force impulse imaging (ARFI) elastography is another noninvasive method of measuring hepatic fibrosis. There are limited data about the correlations between histologic fibrosis grade and noninvasively measured markers, including M2BPGi and ARFI.
Methods
This prospective study was conducted among patients admitted consecutively for liver resection, cholecystectomy, or liver biopsy. ARFI elastography, serum M2BPGi levels, and the AST to Platelet Ratio Index (APRI) score were evaluated before histologic evaluation. Histologic interpretation was performed by a single pathologist using the METAVIR scoring system.
Results
In patients with high METAVIR scores, M2BPGi levels and ARFI values showed statistically significant differences between patients with fibrosis and those without fibrosis. In 41 patients with hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels also tended to increase (p=0.161). ARFI values changed significantly as METAVIR scores increased (p=0.039). In 33 patients without hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels significantly increased (p=0.040). ARFI values also changed significantly as METAVIR scores increased (p=0.033). M2BPGi levels were significantly correlated with ARFI values (r=0.604, p<0.001), and APRI values (r=0.704, p<0.001), respectively.
Conclusions
Serum M2BPGi levels increased with liver fibrosis severity and could be a good marker for diagnosing advanced hepatic fibrosis regardless of the cause of liver disease.

Citations

Citations to this article as recorded by

Platelet count as a predictor of advanced-stage liver cirrhosis: a comparative study with established fibrosis markers
Hyung Hwan Moon, Kwang Il Seo, Hyunyong Hwang, Young Il Choi, Dong Hoon Shin, Myunghee Yoon, Bohyeon Kim, Yeha Joo
Kosin Medical Journal.2025; 40(4): 308. CrossRef
Predicting Safe Liver Resection Volume for Major Hepatectomy Using Artificial Intelligence
Chol Min Kang, Hyung June Ku, Hyung Hwan Moon, Seong-Eun Kim, Ji Hoon Jo, Young Il Choi, Dong Hoon Shin
Journal of Clinical Medicine.2024; 13(2): 381. CrossRef

First
Prev
Page of 1
Next
Last

Search