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Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)
(Springer Science and Business Media LLC, 2020-09)
Sarin, Shiv Kumar
;
Choudhury, Ashok
;
Lau, George K
;
Zheng, Ming-Hua
;
Ji, Dong
BACKGROUND AND AIMS: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. METHODS: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. RESULTS: Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR = 2.1 (1.1-3.7), p = 0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR = 8.1 (1.9-38.8), p = 0.002] predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5 (11.6%)] or acute decompensation [4 (9%)]. Liver related complications increased (p < 0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC 0.94, HR = 19.2 (95 CI 2.3-163.3), p < 0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis patients. CONCLUSIONS: SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.
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Enhancing access to treatment and programmes for viral hepatitis in an endemic country: a narrative review of literature from 2000 to 2025 (Mongolia)
(Informa UK Limited, 2026)
Dorj, Gantuya
;
Lkhagva, Undram
;
Dorj, Gereltuya
;
Badamnachin, Batsukh
;
Gurbadam, Unenbat
BACKGROUND: Mongolia continues to experience the world's highest incidence of hepatocellular carcinoma (HCC), driven by chronic hepatitis B (HBV) and hepatitis C (HCV) infections. In response, the Mongolian Government has implemented comprehensive public health interventions, including the national 'Healthy Liver Programme,' to reduce viral hepatitis transmission and liver-related morbidity. This narrative review aims to evaluate national strategies, progress, and ongoing challenges in HBV and HCV control. METHODS: Policy documents from government agencies, WHO, and NGOs were reviewed, along with scientific publications retrieved from PubMed, and Embase using terms such as 'HBV,' 'HCV,' and 'treatment access.' Grey literature was also analysed. The review focused on (i) national strategies and action plans; (ii) programmatic interventions, vaccination, screening, and treatment scale-up; and (iii) reported trends in coverage, treatment uptake, and progress towards WHO 2030 elimination targets. Findings were synthesised by comparing policy commitments with implementation outcomes and triangulating evidence across multiple sources. RESULTS: Forty-four peer-reviewed articles and 12 policy documents were included. Mongolia has achieved >95% infant HBV vaccination and 93.9% hepatitis A coverage, reducing HBsAg prevalence among children under five to 0.3% by 2023. Among adults, HBsAg prevalence declined from 6.9% in 2015 to 5.5% in 2023, while HCV prevalence decreased from 6.7% to 3.7%. More than 120,000 HCV infections have been diagnosed, with over half treated through national initiatives; by 2023, 4,700 HBV and 66,959 HCV patients had initiated therapy. Liver cancer incidence decreased from 39.1% in 2016 to 32.7% in 2021, and annual HCC cases fell from 857 in 2015 to 567 in 2022. DISCUSSION: Mongolia aims to reduce viral hepatitis prevalence by 90% and liver-related mortality by 85% in the coming decade. CONCLUSION: While substantial progress has been made, strengthened health system capacity and improved monitoring mechanisms are essential to close remaining gaps and accelerate progress towards hepatitis elimination. SUMMARY: Policy implementation: Mongolia implemented several key policies, including the Targeted Prevention and Control Program to Eradicate Viral Hepatitis (1988-2000), mandatory HBV vaccination, and the Healthy Liver programmes (2016-2020 and 2022-2025).Vaccination programmes: Mongolia was among the first to introduce hepatitis B vaccination for newborns in 1991 and added a pentavalent vaccine in 2005. The HAV vaccine was introduced in 2012, with high coverage rates for children under one year.Healthy liver programme: This programme improved access to diagnostic and treatment options for viral hepatitis, including introducing antiviral medicines and reimbursement for antiviral therapy costs through national health insurance.Success achieved: The incidence of total viral hepatitis was reduced to 0.7 per 10,000 population by 2022, surpassing the goal of 10 per 10,000. HBsAg prevalence in children under five met WHO's regional goal, and HCV prevalence among adults significantly decreased.Treatment access: Patients in Mongolia have access to treatments for HBV, HCV, and HCC with significant reimbursement from the Health Insurance Fund. The affordability of these treatments has improved, making them accessible to a larger population.
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ALBI Score for Predicting Acute Liver Failure in Patients with Acute Hepatitis B and D in Mongolia
(Mongolian National University of Medical Sciences, 2021-04-01)
Badamnachin Batsukh
;
Chimedsuren Оchir
;
Sarantuya Gidaagaya
;
Baatarkhuu Oidov
Objectives: Mongolia is known as one of the countries with a high prevalence of hepatitis B and D virus infection. Although the number of acute hepatitis D cases is decreasing since the national vaccination program against HBV launched in 1991, it is still a main cause of acute liver failure (ALF) in Mongolia. The aim of this study is to determine the prognostic value of an ALBI score in patients with acute hepatitis B with or without D. Methods: A total of 114 patients (58 patients with acute hepatitis B (AHB), five patients with HBV/HDV co-infection, and 51 patients with HBV/HDV superinfection), who were admitted to the National Center for Communicable Diseases between 2017 and 2019 were enrolled into this study. Results: We compared the AHB group to the HBV/HDV superinfection group. The mean age was 25.8±6.5 years in the AHB group vs. 28.9±7.4 years in the HBV/HDV superinfection group (p = 0.019). Also, a majority of patients live in Ulaanbaatar (87.5% vs. 62.7%, p = 0.037). The mean hospitalization days was 23± 11 in the AHB, on the other hand it was 28± 13 in the HBV/HDV superinfection group (p = 0.022). The ALF patients had a higher ALBI score, total bilirubin, transaminase, and INR compared with the non-ALF group. The platelet count was significantly lower in the AHB and HBV/HDV infection group with ALF compared with AHB and HBV/HDV infection without ALF. This study showed that the ALBI score in AHB with ALF patients was significantly higher than in AHB without ALF (p = 0.001 ), and H BV/HDV superinfection with ALF had a higher ALBI score than HBV/HDV superinfection without ALF (p = 0.041 ). The area under the curve (AUC) value was 0.766 for ALBI scores. The cut-off value, sensitivity and specificity of ALBI score values were -1. 71, 72.2%, and 75.6%, respectively. Conclusions: ALBI score determined on admission indicates the likelihood of survival of patients with AHB and AHD.

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