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Öğe Assisting the Diagnosis of Cirrhosis in Chronic Hepatitis C Patients Based on Machine Learning Algorithms: A Novel Non-Invasive Approach(Wiley, 2025) Dirican, Emre; Bal, Tayibe; Onlen, Yusuf; Sarigul, Figen; User, Ulku; Sari, Nagehan Didem; Kurtaran, BehiceAim: This study aimed to determine the important features and cut-off values after demonstrating the detectability of cirrhosis using routine laboratory test results of chronic hepatitis C (CHC) patients in machine learning (ML) algorithms. Methods: This retrospective multicenter (37 referral centers) study included the data obtained from the Hepatitis C Turkey registry of 1164 patients with biopsy-proven CHC. Three different ML algorithms were used to classify the presence/absence of cirrhosis with the determined features. Results: The highest performance in the prediction of cirrhosis (Accuracy = 0.89, AUC = 0.87) was obtained from the Random Forest (RF) method. The five most important features that contributed to the classification were platelet, alpha lpha-feto protein (AFP), age, gamma-glutamyl transferase (GGT), and prothrombin time (PT). The cut-off values of these features were obtained as platelet < 182.000/mm3, AFP > 5.49 ng/mL, age > 52 years, GGT > 39.9 U/L, and PT > 12.35 s. Using cut-off values, the risk coefficients were AOR = 4.82 for platelet, AOR = 3.49 for AFP, AOR = 4.32 for age, AOR = 3.04 for GGT, and AOR = 2.20 for PT. Conclusion: These findings indicated that the RF-based ML algorithm could classify cirrhosis with high accuracy. Thus, crucial features and cut-off values for physicians in the detection of cirrhosis were determined. In addition, although AFP is not included in non-invasive indexes, it had a remarkable contribution in predicting cirrhosis. Trial Registration: Clinicaltrials.gov identifier: NCT03145844Öğe Efficacy and Safety of Direct-Acting Antivirals in Elderly Patients with Chronic Hepatitis C: A Nationwide Real-Life, Observational, Multicenter Study from Turkey(AVES, 2022) Önlen, Yusuf; Bal, Tayibe; Çabalak, Mehmet; Öztoprak, Nefise Çuvalcı; Sarı, Nagehan Didem; Kurtaran, Behice; Şenateş, EbubekirBackground: The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. Methods: In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (?65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. Results: The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P = .879, P = .508 for modified evaluable population and P = .058, P = .788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir+ribavirin had a significantly lower sustained virological response 12 rates (P < .001, P = .047, P = .013, and P = .025, respectively). Conclusion: Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults. Copyright @ Author(s)Öğe Efficacy and Safety of Direct-Acting Antivirals in Patients with Hepatitis C Infection: Nationwide Real-life Data from Türkiye(AVES, 2026) Gunduz, Alper; Öztoprak, Nefise Çuvalcı; Sarı, Nagehan Didem; Kurtaran, Behice; Önlen, Yusuf; Senates, Ebubekir; Tabak, FehmiBackground/Aims: Chronic hepatitis C virus (HCV) infection constitutes a substantial healthcare concern in Türkiye. The clinical application of direct-acting antiviral medications (DAAs) has transformed its management. The goal is to assess the efficacy and safety of DAAs in the real-world setting in Turkish patients with chronic HCV. Materials and Methods: Thirty-seven centers from Türkiye recorded 1807 patients to the database. Patients aged >18 years were enrolled to the study. Their demographics, clinical information, DAAs used, efficacy, and safety information were evaluated. Efficacy and safety results were reported for patients with 12-week post-treatment (SVR12) data. Results: Among the patients, 919 (50.9%) were female with a mean of age 56 ± 15 years (range: 18-97 years) and 238 (13%) were cirrhotic. Liver biopsy was performed in 296 patients. Mean histologic activity index score was 7.68 and fibrosis score was 2.58. Baseline mean viral load was 4.11 × 10⁶ copies/mL. Patients received the following treatments: Paritaprevir+Ritonavir+Ombitasvir+Dasabuvir (PrOD): 706, Ledipasvir+Sofosbuvir: 490, Sofosbuvir+Ribavirin: 176, PrOD+Ribavirin: 175, Ledipasvir+Sofosbuvir+Ribavirin: 156, PrO+Ribavirin: 32, and PrO: 10. Response at the end of treatment was 99.2% (1454/1465) and SVR12 was 97.8% (1289/1318). The DAAs were generally well tolerated. Ten and 13 patients discontinued therapy because of drug-related and unrelated adverse side effects, respectively. Conclusion: This real-world study demonstrated that DAA treatment for HCV is both safe and highly effective. In two-thirds of the patients, the hepatic inflammation is moderate to severe, and fibrosis is moderate to advanced in half of them. Patients' characteristics suggest that HCV infection is often not diagnosed or treated until patients present with moderate-to-severe stage, indicating that diagnostic and therapeutic approaches should be used more effectively. Copyright @ Author(s) – Available online at https://www.turkjgastroenterol.org. Content of this journal is licensed under a Creative Commons Attribution (CC BY) 4.0 International LicenseÖğe In a Real-Life Setting, Direct-Acting Antivirals to People Who Inject Drugs with Chronic Hepatitis C in Turkey(Aves, 2022) Yıldırım, Figen Sarıgül; User, Ülkü; Sari, Nagehan Didem; Kurtaran, Behice; Onlen, Yusuf; Şenateş, Ebubekir; Gündüz, AlperBackground: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naive patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization's objective of eliminating viral hepatitis.
