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Boursier J, Vergniol J, Guillet A, Hiriart JB, Lannes A, Le Bail B, Michalak S, Chermak F, Bertrais S, Foucher J, Oberti F, Charbonnier M, Fouchard-Hubert I, Rousselet MC, Calès P, de Lédinghen V. Diagnostic accuracy and prognostic significance of blood fibrosis tests and liver stiffness measurement by FibroScan in non-alcoholic fatty liver disease. J Hepatol 2016; 65:570-8. [PMID: 27151181 DOI: 10.1016/j.jhep.2016.04.023] [Citation(s) in RCA: 263] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/09/2016] [Accepted: 04/23/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS NAFLD is highly prevalent but only a small subset of patients develop advanced liver fibrosis with impaired liver-related prognosis. We aimed to compare blood fibrosis tests and liver stiffness measurement (LSM) by FibroScan for the diagnosis of liver fibrosis and the evaluation of prognosis in NAFLD. METHODS Diagnostic accuracy was evaluated in a cross-sectional study including 452 NAFLD patients with liver biopsy (NASH-CRN fibrosis stage), LSM, and eight blood fibrosis tests (BARD, NAFLD fibrosis score, FibroMeter(NAFLD), aspartate aminotransferase to platelet ratio index (APRI), FIB4, FibroTest, Hepascore, FibroMeter(V2G)). Prognostic accuracy was evaluated in a longitudinal study including 360 NAFLD patients. RESULTS LSM and FibroMeter(V2G) were the two best-performing tests in the cross-sectional study: AUROCs for advanced fibrosis (F3/4) were, respectively, 0.831±0.019 and 0.817±0.020 (p⩽0.041 vs. other tests); rates of patients with ⩾90% negative/positive predictive values for F3/4 were 56.4% and 46.7% (p<0.001 vs. other tests); Obuchowski indexes were 0.834±0.014 and 0.798±0.016 (p⩽0.036 vs. other tests). Two fibrosis classifications were developed to precisely estimate the histological fibrosis stage from LSM or FibroMeter(V2G) results without liver biopsy (diagnostic accuracy, respectively: 80.8% vs. 77.4%, p=0.190). Kaplan-Meier curves in the longitudinal study showed that both classifications categorised NAFLD patients into subgroups with significantly different prognoses (p<0.001): the higher was the class of the fibrosis classification, the worse was the prognosis. CONCLUSIONS LSM and FibroMeter(V2G) were the most accurate of nine evaluated tests for the non-invasive diagnosis of liver fibrosis in NAFLD. LSM and FibroMeter(V2G) fibrosis classifications help physicians estimate both fibrosis stage and patient prognosis in clinical practice. LAY SUMMARY The amount of liver fibrosis is the main determinant of the liver-related prognosis in patients with non-alcoholic fatty liver disease (NAFLD). We evaluated eight blood tests and FibroScan in a cross-sectional diagnostic study and found that FibroScan and the blood test FibroMeter(V2G) were the two most accurate tests for the non-invasive evaluation of liver fibrosis in NAFLD. A longitudinal prognostic study showed these two tests initially developed for the diagnosis are also prognostic markers as they allow for the stratification of NAFLD patients in several subgroups with significantly different prognosis.
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Affiliation(s)
- Jérôme Boursier
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France; HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France.
| | - Julien Vergniol
- Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Anne Guillet
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France
| | - Jean-Baptiste Hiriart
- Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Adrien Lannes
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France
| | - Brigitte Le Bail
- Service de Pathologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Sophie Michalak
- Département de Pathologie Cellulaire et Tissulaire, Centre Hospitalier Universitaire, Angers, France
| | - Faiza Chermak
- Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | | | - Juliette Foucher
- Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Frédéric Oberti
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France; HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France
| | - Maude Charbonnier
- Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Isabelle Fouchard-Hubert
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France; HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France
| | - Marie-Christine Rousselet
- HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France; Département de Pathologie Cellulaire et Tissulaire, Centre Hospitalier Universitaire, Angers, France
| | - Paul Calès
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France; HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France
| | - Victor de Lédinghen
- Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; INSERM U1053, Université Bordeaux, Bordeaux, France
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Sarfaraz MO, Myers RP, Coffin CS, Gao ZH, Shaheen AAM, Crotty PM, Zhang P, Vogel HJ, Weljie AM. A quantitative metabolomics profiling approach for the noninvasive assessment of liver histology in patients with chronic hepatitis C. Clin Transl Med 2016; 5:33. [PMID: 27539580 PMCID: PMC4990529 DOI: 10.1186/s40169-016-0109-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/14/2016] [Indexed: 12/13/2022] Open
Abstract
Background High-throughput technologies have the potential to identify non-invasive biomarkers of liver pathology and improve our understanding of basic mechanisms of liver injury and repair. A metabolite profiling approach was employed to determine associations between alterations in serum metabolites and liver histology in patients with chronic hepatitis C virus (HCV) infection. Methods Sera from 45 non-diabetic patients with chronic HCV were quantitatively analyzed using 1H-NMR spectroscopy. A metabolite profile of advanced fibrosis (METAVIR F3-4) was established using orthogonal partial least squares discriminant analysis modeling and validated using seven-fold cross-validation and permutation testing. Bioprofiles of moderate to severe steatosis (≥33 %) and necroinflammation (METAVIR A2-3) were also derived. The classification accuracy of these profiles was determined using areas under the receiver operator curves (AUROCSs) measuring against liver biopsy as the gold standard. Results In total 63 spectral features were profiled, of which a highly significant subset of 21 metabolites were associated with advanced fibrosis (variable importance score >1 in multivariate modeling; R2 = 0.673 and Q2 = 0.285). For the identification of F3–4 fibrosis, the metabolite bioprofile had an AUROC of 0.86 (95 % CI 0.74–0.97). The AUROCs for the bioprofiles for moderate to severe steatosis were 0.87 (95 % CI 0.76–0.97) and for grade A2–3 inflammation were 0.73 (0.57–0.89). Conclusion This proof-of-principle study demonstrates the utility of a metabolomics profiling approach to non-invasively identify biomarkers of liver fibrosis, steatosis and inflammation in patients with chronic HCV. Future cohorts are necessary to validate these findings. Electronic supplementary material The online version of this article (doi:10.1186/s40169-016-0109-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Omair Sarfaraz
- Department of Biological Sciences, University of Calgary, 2500 University Drive, North West, Calgary, AB, T2N 1N4, Canada. .,Department of Medicine-Pathology and Molecular Medicine, McMaster University, Hamilton, ON, L8N 3Z5, Canada. .,Dept. of Medicine/Dept. of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Health Sciences Centre, Hamilton, ON, L8S4K1, Canada.
| | - Robert P Myers
- Liver Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Hospital Drive North West, Calgary, AB, T2N 4Z6, Canada
| | - Carla S Coffin
- Liver Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Hospital Drive North West, Calgary, AB, T2N 4Z6, Canada
| | - Zu-Hua Gao
- Department of Pathology, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Abdel Aziz M Shaheen
- Liver Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Hospital Drive North West, Calgary, AB, T2N 4Z6, Canada
| | - Pam M Crotty
- Liver Unit, Teaching and Wellness Building, University of Calgary, Hospital Drive, North West, Calgary, AB, T2N 4Z6, Canada
| | - Ping Zhang
- Department of Chemistry, University of Calgary, 2500 University Dr. NW Calgary, Calgary, AB, T2N 1N4, Canada
| | - Hans J Vogel
- Department of Biological Sciences, University of Calgary, 2500 University Drive, North West, Calgary, AB, T2N 1N4, Canada
| | - Aalim M Weljie
- Metabolomics Research Center, Department of Biological Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada. .,Department of Pharmacology, University of Pennsylvania, Philadelphia, PA, 19104, USA. .,Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19081, USA.
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Alghamdi AS, Alghamdi M, Sanai FM, Alghamdi H, Aba-Alkhail F, Alswat K, Babatin M, Alqutub A, Altraif I, Alfaleh F. SASLT guidelines: Update in treatment of Hepatitis C virus infection. Saudi J Gastroenterol 2016; 22 Suppl:S25-57. [PMID: 27538727 PMCID: PMC5004485 DOI: 10.4103/1319-3767.188067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Abdullah S. Alghamdi
- Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Mohammed Alghamdi
- Department of Medicine, Division of Gastroenterology, King Fahd Military Complex, Dhahran, Saudi Arabia
| | - Faisal M Sanai
- Department of Medicine, Division of Gastroenterology, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Hamdan Alghamdi
- Department of Hepatobiliary Sciences and Liver Transplantation King Abdulaziz Medical City, and King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faisal Aba-Alkhail
- Department of Medicine, Division of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khalid Alswat
- Department of Medicine, Gastroenterology unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Babatin
- Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Adel Alqutub
- Department of Medical Specialties, Gastroenterology and Hepatology Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Altraif
- Department of Hepatobiliary Sciences and Liver Transplantation King Abdulaziz Medical City, and King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faleh Alfaleh
- Department of Medicine, Gastroenterology unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Lizaola B, Bonder A, Tapper EB, Afdhal N. Role of Noninvasive Fibrosis Methods in Management of Chronic Hepatitis B Virus. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s11901-016-0311-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Desnoyer A, Pospai D, Lê MP, Gervais A, Heurgué-Berlot A, Laradi A, Harent S, Pinto A, Salmon D, Hillaire S, Fontaine H, Zucman D, Simonpoli AM, Muret P, Larrouy L, Bernard Chabert B, Descamps D, Yazdanpanah Y, Peytavin G. Pharmacokinetics, safety and efficacy of a full dose sofosbuvir-based regimen given daily in hemodialysis patients with chronic hepatitis C. J Hepatol 2016; 65:40-47. [PMID: 26952005 DOI: 10.1016/j.jhep.2016.02.044] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) infection is an independent risk factor for chronic kidney disease and leads to faster liver disease progression in patients requiring hemodialysis than in those with normal renal function. Little is known about the use of a sofosbuvir-containing regimen for infected patients on hemodialysis. We aimed to describe the pharmacokinetics, safety and efficacy of sofosbuvir in 2 dosing regimens and associated antiviral agents in HCV-infected patients requiring hemodialysis. METHODS Multicenter, prospective and observational study of patients receiving sofosbuvir, 400mg once daily (n=7) or 3 times a week (n=5), after hemodialysis with simeprevir, daclatasvir, ledipasvir or ribavirin was conducted. Drug plasma concentrations were determined by liquid chromatography-tandem mass spectrometry before and after a 4h hemodialysis and 1.5h after last drug intake at the end of hemodialysis. RESULTS Plasma concentrations of sofosbuvir or its inactive metabolite sofosbuvir-007 did not accumulate with either regimen between hemodialysis sessions or throughout the treatment course. Sofosbuvir-007 extraction ratio (52%) was consistent with historical data. In one patient receiving the once daily regimen, sofosbuvir-007 half-life was slightly higher (38h) than for patients with normal renal function receiving a full dose. Hemodialysis did not remove any other associated anti-HCV agents. Clinical and biological tolerance was good for all patients. Two relapses occurred with the 3 times a week regimen and none with the once daily. CONCLUSIONS A regimen including sofosbuvir, 400mg once daily, could be proposed for HCV-infected patients requiring hemodialysis and should be associated with close clinical, biological, cardiovascular, and therapeutic drug monitoring. LAY SUMMARY Hepatitis C Virus (HCV) infection in hemodialysis patients is prevalent and aggressive. Effective anti-HCV treatment in these patients may stabilize their renal disease. However, sofosbuvir, the cornerstone of most anti-HCV-containing regimens, should not be administered to these patients until more data is available. In this pharmacokinetic study, sofosbuvir full dose (400mg once daily) administered every day with another direct antiviral agent did not accumulate in hemodialysis patients and was safe and effective.
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Affiliation(s)
- Aude Desnoyer
- Pharmaco-Toxicology Department, Bichat-Claude Bernard Hospital, APHP, Paris, France.
| | - Dan Pospai
- Gastroenterology Department, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Minh Patrick Lê
- Pharmaco-Toxicology Department, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Anne Gervais
- Infectious Diseases & Tropical Department, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | | | | | - Stanislas Harent
- Infectious Diseases & Tropical Department, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Adriana Pinto
- Infectious Diseases & Tropical Department, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Dominique Salmon
- Internal Medicine Department, Cochin Hospital, APHP, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Sophie Hillaire
- Gastroenterology Department, Foch Hospital, Suresnes, France
| | - Hélène Fontaine
- Gastroenterology Department, Cochin Hospital, APHP, Paris Descartes University, Sorbonne Paris Cité, Inserm U1016, Paris, France
| | - David Zucman
- Infectious Diseases Department, Foch Hospital, Suresnes, France
| | | | - Patrice Muret
- Clinical Pharmaco-Toxicology Department, University Hospital of Besançon, INSERM U1098, Besançon, France
| | - Lucile Larrouy
- Virology Department, Bichat-Claude Bernard Hospital, APHP, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, IAME, INSERM UMR 1137, Paris, France
| | | | - Diane Descamps
- Virology Department, Bichat-Claude Bernard Hospital, APHP, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, IAME, INSERM UMR 1137, Paris, France
| | - Yazdan Yazdanpanah
- Infectious Diseases & Tropical Department, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Gilles Peytavin
- Pharmaco-Toxicology Department, Bichat-Claude Bernard Hospital, APHP, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, IAME, INSERM UMR 1137, Paris, France
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Editorial: A New Spin on Magnetic Resonance Elastography. Am J Gastroenterol 2016; 111:834-7. [PMID: 27249983 DOI: 10.1038/ajg.2016.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/11/2022]
Abstract
The development of hepatic fibrosis is the hallmark of liver disease progression. Identifying fibrosis across the spectrum, from early stages to cirrhosis has become a major unmet need. Newer imaging techniques that measure liver elastography (stiffness) as a surrogate of fibrosis seem to outperform serum tests. The current study compares two-dimensional (2D) gradient-recalled echo magnetic resonance elastography (MRE) to three-dimensional (3D) spin-echo echo-planar imaging MRE. 3D-SE-EPI MRE was able to image more liver volume in less time with fewer technical failures. The current study demonstrates that 3D-SE-EPI MRE appears marginally superior to 2D-GRE and may evolve into the new gold standard.
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Dahari H, Canini L, Graw F, Uprichard SL, Araújo ESA, Penaranda G, Coquet E, Chiche L, Riso A, Renou C, Bourliere M, Cotler SJ, Halfon P. HCV kinetic and modeling analyses indicate similar time to cure among sofosbuvir combination regimens with daclatasvir, simeprevir or ledipasvir. J Hepatol 2016; 64:1232-9. [PMID: 26907973 PMCID: PMC5081285 DOI: 10.1016/j.jhep.2016.02.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/24/2015] [Accepted: 02/08/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Recent clinical trials of direct-acting-antiviral agents (DAAs) against hepatitis C virus (HCV) achieved >90% sustained virological response (SVR) rates, suggesting that cure often took place before the end of treatment (EOT). We sought to evaluate retrospectively whether early response kinetics can provide the basis to individualize therapy to achieve optimal results while reducing duration and cost. METHODS 58 chronic HCV patients were treated with 12-week sofosbuvir+simeprevir (n=19), sofosbuvir+daclatasvir (n=19), or sofosbuvir+ledipasvir in three French referral centers. HCV was measured at baseline, day 2, every other week, EOT and 12weeks post EOT. Mathematical modeling was used to predict the time to cure, i.e., <1 virus copy in the entire extracellular body fluid. RESULTS All but one patient who relapsed achieved SVR. Mean age was 60±11years, 53% were male, 86% HCV genotype-1, 9% HIV coinfected, 43% advanced fibrosis (F3), and 57% had cirrhosis. At weeks 2, 4 and 6, 48%, 88% and 100% of patients had HCV<15IU/ml, with 27%, 74% and 91% of observations having target not detected, respectively. Modeling results predicted that 23 (43%), 16 (30%), 7 (13%), 5 (9%) and 3 (5%) subjects were predicted to reach cure within 6, 8, 10, 12 and 13weeks of therapy, respectively. The modeling suggested that the patient who relapsed would have benefitted from an additional week of sofosbuvir+ledipasvir. Adjusting duration of treatment according to the modeling predicts reduced medication costs of 43-45% and 17-30% in subjects who had HCV<15IU/ml at weeks 2 and 4, respectively. CONCLUSIONS The use of early viral kinetic analysis has the potential to individualize duration of DAA therapy with a projected average cost saving of 16-20% per 100-treated persons.
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Affiliation(s)
- Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA; Theoretical Biology & Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - Laetitia Canini
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom
| | - Frederik Graw
- Center for Modeling and Simulation in the Biosciences, BioQuant Center, Heidelberg University, Heidelberg, Germany
| | - Susan L Uprichard
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | | | | | - Emilie Coquet
- Internal Medicine and Infectious Disease, Hôpital Européen, Marseille, France
| | - Laurent Chiche
- Internal Medicine and Infectious Disease, Hôpital Européen, Marseille, France
| | - Aurelie Riso
- Division of Hepatology, Hôpital Saint Joseph, Marseille, France
| | | | - Marc Bourliere
- Division of Hepatology, Hôpital Saint Joseph, Marseille, France
| | - Scott J Cotler
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | - Philippe Halfon
- Laboratoire Alphabio, Marseille, France; Internal Medicine and Infectious Disease, Hôpital Européen, Marseille, France.
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Dyvorne HA, Jajamovich GH, Bane O, Fiel MI, Chou H, Schiano TD, Dieterich D, Babb JS, Friedman SL, Taouli B. Prospective comparison of magnetic resonance imaging to transient elastography and serum markers for liver fibrosis detection. Liver Int 2016; 36:659-66. [PMID: 26744140 PMCID: PMC4842106 DOI: 10.1111/liv.13058] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/24/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Establishing accurate non-invasive methods of liver fibrosis quantification remains a major unmet need. Here, we assessed the diagnostic value of a multiparametric magnetic resonance imaging (MRI) protocol including diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE)-MRI and magnetic resonance elastography (MRE) in comparison with transient elastography (TE) and blood tests [including ELF (Enhanced Liver Fibrosis) and APRI] for liver fibrosis detection. METHODS In this single centre cross-sectional study, we prospectively enrolled 60 subjects with liver disease who underwent multiparametric MRI (DWI, DCE-MRI and MRE), TE and blood tests. Correlation was assessed between non-invasive modalities and histopathologic findings including stage, grade and collagen content, while accounting for covariates such as age, sex, BMI, HCV status and MRI-derived fat and iron content. ROC curve analysis evaluated the performance of each technique for detection of moderate-to-advanced liver fibrosis (F2-F4) and advanced fibrosis (F3-F4). RESULTS Magnetic resonance elastography provided the strongest correlation with fibrosis stage (r = 0.66, P < 0.001), inflammation grade (r = 0.52, P < 0.001) and collagen content (r = 0.53, P = 0.036). For detection of moderate-to-advanced fibrosis (F2-F4), AUCs were 0.78, 0.82, 0.72, 0.79, 0.71 for MRE, TE, DCE-MRI, DWI and APRI, respectively. For detection of advanced fibrosis (F3-F4), AUCs were 0.94, 0.77, 0.79, 0.79 and 0.70, respectively. CONCLUSIONS Magnetic resonance elastography provides the highest correlation with histopathologic markers and yields high diagnostic performance for detection of advanced liver fibrosis and cirrhosis, compared to DWI, DCE-MRI, TE and serum markers.
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Affiliation(s)
- Hadrien A. Dyvorne
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, One Gustave Levy Place, Box 1234, New York, NY 10029 USA
| | - Guido H. Jajamovich
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, One Gustave Levy Place, Box 1234, New York, NY 10029 USA
| | - Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, One Gustave Levy Place, Box 1234, New York, NY 10029 USA
| | - M. Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, One Gustave Levy Place, Box 1234, New York, NY 10029 USA
| | - Hsin Chou
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, One Gustave Levy Place, Box 1234, New York, NY 10029 USA
| | - Thomas D. Schiano
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, One Gustave Levy Place, Box 1234, New York, NY 10029 USA
| | - Douglas Dieterich
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, One Gustave Levy Place, Box 1234, New York, NY 10029 USA
| | - James S. Babb
- Department of Radiology, New York University Langone Medical Center, New York, NY
| | - Scott L. Friedman
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, One Gustave Levy Place, Box 1234, New York, NY 10029 USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, One Gustave Levy Place, Box 1234, New York, NY 10029 USA,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, One Gustave Levy Place, Box 1234, New York, NY 10029 USA
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Festi D, Schiumerini R, Marasco G, Scaioli E, Pasqui F, Colecchia A. Non-invasive diagnostic approach to non-alcoholic fatty liver disease: current evidence and future perspectives. Expert Rev Gastroenterol Hepatol 2016; 9:1039-53. [PMID: 25993881 DOI: 10.1586/17474124.2015.1049155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Non-alcoholic fatty liver disease is a new epidemic liver disease, thus, its early diagnosis and the identification of those patients with the worst prognosis is mandatory. Liver biopsy is still the diagnostic gold standard, even if it is associated to a significant rate of complications; moreover, the interpretation of histological samples is not always univocal. Several non-invasive alternative scores have been proposed for the diagnostic approach to non-alcoholic fatty liver disease. This article evaluates the performance of the currently available non-invasive diagnostic strategies. The authors also suggest a potential diagnostic algorithm, with two or more non-invasive techniques, to increase the overall accuracy for identifying patients with worst prognosis, and to minimize the recourse to liver biopsy.
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Affiliation(s)
- Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Hospital, Via Massarenti 9, 40138 Bologna, Italy
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Patel K, Tillmann HL, Matta B, Sheridan MJ, Gardner SD, Shackel NA, McHutchison JG, Goodman ZD. Longitudinal assessment of hepatitis C fibrosis progression by collagen and smooth muscle actin morphometry in comparison to serum markers. Aliment Pharmacol Ther 2016; 43:356-63. [PMID: 26560052 DOI: 10.1111/apt.13471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/21/2015] [Accepted: 10/21/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Assessment of fibrosis progression in chronic liver disease relies upon non-invasive tools and changes in semi-quantitative histopathology scores that may not be reliable. AIM To assess the diagnostic performance of the FibroSURE (FS) index and collagen/alpha smooth muscle actin (α-SMA) morphometry in relation to longitudinal changes in fibrosis on paired biopsies. METHODS The study cohort included 201 chronic hepatitis C (CHC) nonresponders enrolled in a prior phase II anti-fibrotic study. Serum FS and paired biopsies, with both collagen and α-SMA morphometry, were evaluated at baseline and week 52. RESULTS Study patients were mostly male (67%) and Caucasian (77%), with Ishak stages 2 (n = 79), 3 (n = 88) and 4 (n = 30), excluded (n = 4 stage 1 or 5). Mean biopsy length was 22.9 mm. For baseline Ishak 2/3 vs. 4, there were no significant differences in AUROCs for collagen (0.71), SMA (0.66) or FS (0.70). At week 52, 62% of patients had no change in Ishak stage, but collagen/α-SMA increased by 34-51% (P < 0.0001), and FS decreased by 5% (P = 0.008). Among the 33% of patients with +/-1 Ishak stage change, FS changes were not significant, but α-SMA increased 29-72%, and collagen increased by 12-38% (P = 0.01 for +1 only). CONCLUSIONS Longitudinal changes in collagen and α-SMA morphometry are apparent prior to change in histological stage or FibroSURE in CHC nonresponders with intermediate fibrosis. This likely reflects quantitative morphological differences that are not detected by routine histological staging or serum markers such as FibroSURE.
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Affiliation(s)
- K Patel
- Duke Clinical Research Institute, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA.,Liver Cell Biology, Centenary Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - H L Tillmann
- Duke Clinical Research Institute, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA
| | - B Matta
- Duke University Medical Center, Durham, NC, USA
| | - M J Sheridan
- Inova Research Center, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - S D Gardner
- Infectious Diseases Therapeutic Area Unit, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - N A Shackel
- Liver Cell Biology, Centenary Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - Z D Goodman
- Hepatic Pathology Consultation and Research, Inova Fairfax Hospital, Falls Church, VA, USA
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Younossi ZM, Stepanova M, Estep M, Negro F, Clark PJ, Hunt S, Song Q, Paulson M, Stamm LM, Brainard DM, Subramanian GM, McHutchison JG, Patel K. Dysregulation of distal cholesterol biosynthesis in association with relapse and advanced disease in CHC genotype 2 and 3 treated with sofosbuvir and ribavirin. J Hepatol 2016; 64:29-36. [PMID: 26341824 DOI: 10.1016/j.jhep.2015.08.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/21/2015] [Accepted: 08/24/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) modulates host lipid metabolism for its replication and lifecycle. Our aims were to assess changes in the serum lipid and distal (post-squalene) cholesterol biosynthesis metabolite profile of HCV genotypes (GT) 2 and 3 patients treated with sofosbuvir+ribavirin. METHODS Serum samples [baseline, treatment week 12, 4weeks post-treatment] were analyzed for apolipoproteins B and E (apoB/E), total cholesterol, HDL, LDL, and 11 post-squalene sterol metabolites using a GC/MS platform. RESULTS We selected 127 patients (GT2 n=50, GT3 n=77), 50% cirrhotic patients, and 42% who experienced a virological relapse. At baseline, GT3 patients had lower level of serum lipids, apoB/E, 7-dehydrocholesterol, desmosterol, lathosterol, compared to GT2 (p<0.006). Baseline lathosterol was lower in relapsers with cirrhosis compared to cirrhotic patients with SVR (p=0.003). From baseline to treatment week 12, serum lipids, apoB/E, and key sterol pathway metabolites (7-dehydrocholesterol, desmosterol, lathosterol, lanosterol) increased in GT3. In contrast, in GT2 patients, apoB/E and dihydrolanosterol decreased with viral suppression (p<0.025). At follow-up week 4, cirrhotic SVR patients showed substantially greater increases in apoB and total sterols compared to cirrhotic relapsers regardless of HCV genotype. After adjustment for genotype and gender, baseline lathosterol was independently associated with virologic response (p=0.04). CONCLUSION HCV GT3 is associated with reduced circulation of lipids involved in the distal cholesterol biosynthesis pathway, resulting in relative hypocholesterolemia. HCV suppression during sofosbuvir+ribavirin restores distal sterol metabolites indicating viral interference with de novo lipogenesis or selective retention by hepatocytes.
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Affiliation(s)
- Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, United States; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States.
| | - Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Michael Estep
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | | | | | - Sharon Hunt
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, United States; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | | | | | | | | | | | | | - Keyur Patel
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, United States
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Arrayhani M, Sqalli T, Tazi N, El Youbi R, Chaouch S, Aqodad N, Ibrahimi SA. Non invasive assessment of liver fibrosis in chronic hemodialysis patients with viral hepatitis C. Pan Afr Med J 2015; 22:273. [PMID: 26958136 PMCID: PMC4765332 DOI: 10.11604/pamj.2015.22.273.2311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 04/22/2014] [Indexed: 12/29/2022] Open
Abstract
The liver biopsy has long been the "gold standard" for assessing liver fibrosis in patients with hepatitis C. It's an invasive procedure which is associated with an elevated bleeding, especially in chronic hemodialysis patients. Main goal is to assess liver fibrosis in chronic hemodialysis with HCV by Fibroscan and by biological scores (APRI, Forns and Fib-4), and to measure the correlation between these tests. Cross-sectional study including all chronic hemodialysis patients with hepatitis C virus, in two public hemodialysis centers of Fez. All patients were evaluated for liver fibrosis using noninvasive methods (FibroScan and laboratory tests). Subsequently, the correlation between different tests has been measured. 95 chronic hemodialysis were studied, twenty nine patients (30.5%) with chronic hepatitis C. The average age was 52.38 ± 16.8 years. Nine liver fibrosis cases have been concluded by forns score. Fibroscan has objectified significant fibrosis in 6 cases. On the other side APRI has objectified sgnifivant fibrosis only in 3 cases. The Fib-4 showed severe fibrosis in five cases. The results have been most consistent between APRI and Fib-4, followed by Fibroscan and Forns, then APRI and FibroScan.
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Affiliation(s)
| | - Tarik Sqalli
- Nephrology Department, University Hospital Hassan II, Fez, Morocco
| | - Nada Tazi
- Nephrology Department, University Hospital Hassan II, Fez, Morocco
| | - Randa El Youbi
- Nephrology Department, University Hospital Hassan II, Fez, Morocco
| | | | - Nourdin Aqodad
- Gastroenterology Department, University Hospital Hassan II, Fez, Morocco
| | - Sidi Adil Ibrahimi
- Gastroenterology Department, University Hospital Hassan II, Fez, Morocco
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Lurie Y, Webb M, Cytter-Kuint R, Shteingart S, Lederkremer GZ. Non-invasive diagnosis of liver fibrosis and cirrhosis. World J Gastroenterol 2015; 21:11567-11583. [PMID: 26556987 PMCID: PMC4631961 DOI: 10.3748/wjg.v21.i41.11567] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/23/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023] Open
Abstract
The evaluation and follow up of liver fibrosis and cirrhosis have been traditionally performed by liver biopsy. However, during the last 20 years, it has become evident that this “gold-standard” is imperfect; even according to its proponents, it is only “the best” among available methods. Attempts at uncovering non-invasive diagnostic tools have yielded multiple scores, formulae, and imaging modalities. All are better tolerated, safer, more acceptable to the patient, and can be repeated essentially as often as required. Most are much less expensive than liver biopsy. Consequently, their use is growing, and in some countries the number of biopsies performed, at least for routine evaluation of hepatitis B and C, has declined sharply. However, the accuracy and diagnostic value of most, if not all, of these methods remains controversial. In this review for the practicing physician, we analyze established and novel biomarkers and physical techniques. We may be witnessing in recent years the beginning of the end of the first phase for the development of non-invasive markers. Early evidence suggests that they might be at least as good as liver biopsy. Novel experimental markers and imaging techniques could produce a dramatic change in diagnosis in the near future.
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65
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Jain P, Tripathi BK, Gupta B, Bhandari B, Jalan D. Evaluation of Aspartate Aminotransferase-to-Platelet Ratio Index as a Non-Invasive Marker for Liver Cirrhosis. J Clin Diagn Res 2015; 9:OC22-4. [PMID: 26672800 DOI: 10.7860/jcdr/2015/13944.6814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/19/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Liver biopsy is considered as a gold standard for the diagnosis of cirrhosis. Till date there is no non-invasive marker to replace it. AIM To investigate the effectiveness of Aspartate aminotransferase-to-platelet ratio index (APRI) as a non-invasive marker for liver cirrhosis. MATERIALS AND METHODS Fifty-one patients with cirrhosis, identified on USG abdomen were included in study. Platelet count and Aspartate aminotransferase (AST) were done using haematology automatic analyser and automatic HITACHI-912 Auto Analyser respectively. APRI was calculated for every patient using the formula {(AST / ULN) x 100}/platelet count (10(9)/L). Predictive accuracy was evaluated with a receiver-operating characteristics (ROC) curve. RESULTS APRI correctly classified 49 (96.1%) patients of cirrhosis with area under the ROC curve of 0.973 (95% CI) at cut-off 0.65 with negative predictive value (NPV) and Positive predictive value (PPV) of 96% and 96.1% respectively. The sensitivity and specificity of the test was found to be 96% and 96.1% respectively. CONCLUSION APRI could identify cirrhosis with high degree of accuracy in the studied patients.
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Affiliation(s)
- Princi Jain
- Ex Resident, Department of Medicine, VMMC & SJH , New Delhi, India
| | - B K Tripathi
- Professor, Department of Medicine, VMMC & SJH , New Delhi, India
| | - B Gupta
- Ex Professor and Head, Department of Medicine, VMMC & SJH , New Delhi, India
| | - Bharti Bhandari
- Assistant Professor, Department of Physiology, AIIMS , Jodhpur, India
| | - Divesh Jalan
- Assistant Professor, Department of Orthopaedics, AIIMS , Jodhpur, India
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Thavorn K, Coyle D. Transient Elastography and Controlled Attenuation Parameter for Diagnosing Liver Fibrosis and Steatosis in Ontario: An Economic Analysis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2015; 15:1-58. [PMID: 26664666 PMCID: PMC4664940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Liver fibrosis is characterized by a buildup of connective tissue due to chronic liver damage. Steatosis is the collection of excessive amounts of fat inside liver cells. Liver biopsy remains the gold standard for the diagnosis of liver fibrosis and steatosis, but its use as a diagnostic tool is limited by its invasive nature and high cost. OBJECTIVES To evaluate the cost-effectiveness and budget impact of transient elastography (TE) with and without controlled attenuation parameter (CAP) for the diagnosis of liver fibrosis or steatosis in patients with hepatitis B, hepatitis C, alcoholic liver disease, and nonalcoholic fatty liver disease. DATA SOURCES An economic literature search was performed using computerized databases. For primary economic and budget impact analyses, we obtained data from various sources, such as the Health Quality Ontario evidence-based analysis, published literature, and the Institute for Clinical Evaluative Sciences. REVIEW METHODS A systematic review of existing TE cost-effectiveness studies was conducted, and a primary economic evaluation was undertaken from the perspective of the Ontario Ministry of Health and Long-Term Care. Decision analytic models were used to compare short-term costs and outcomes of TE compared to liver biopsy. Outcomes were expressed as incremental cost per correctly diagnosed cases gained. A budget impact analysis was also conducted. RESULTS We included 10 relevant studies that evaluated the cost-effectiveness of TE compared to other noninvasive tests and to liver biopsy; no cost-effectiveness studies of TE with CAP were identified. All studies showed that TE was less expensive but associated with a decrease in the number of correctly diagnosed cases. TE also improved quality-adjusted life-years in patients with hepatitis B and hepatitis C. Our primary economic analysis suggested that TE led to cost savings but was less effective than liver biopsy in the diagnosis of liver fibrosis. TE became more economically attractive with a higher degree of liver fibrosis. TE with CAP was also less expensive and less accurate than liver biopsy. LIMITATIONS The model did not take into account long-term costs and consequences associated with TE and liver biopsy and did not include costs to patients and their families, or patient preferences related to diagnostic information. CONCLUSIONS TE showed potential cost savings compared to liver biopsy. Further investigation is needed to determine the long-term impacts of TE on morbidity and mortality in Canada and the optimal diagnostic modality for liver fibrosis and steatosis.
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Oberg K, Modlin IM, De Herder W, Pavel M, Klimstra D, Frilling A, Metz DC, Heaney A, Kwekkeboom D, Strosberg J, Meyer T, Moss SF, Washington K, Wolin E, Liu E, Goldenring J. Consensus on biomarkers for neuroendocrine tumour disease. Lancet Oncol 2015; 16:e435-e446. [PMID: 26370353 PMCID: PMC5023063 DOI: 10.1016/s1470-2045(15)00186-2] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/24/2015] [Accepted: 03/26/2015] [Indexed: 02/06/2023]
Abstract
Management of neuroendocrine neoplasia represents a clinical challenge because of its late presentation, lack of treatment options, and limitations in present imaging modalities and biomarkers to guide management. Monoanalyte biomarkers have poor sensitivity, specificity, and predictive ability. A National Cancer Institute summit, held in 2007, on neuroendocrine tumours noted biomarker limitations to be a crucial unmet need in the management of neuroendocrine tumours. A multinational consensus meeting of multidisciplinary experts in neuroendocrine tumours assessed the use of current biomarkers and defined the perquisites for novel biomarkers via the Delphi method. Consensus (at >75%) was achieved for 88 (82%) of 107 assessment questions. The panel concluded that circulating multianalyte biomarkers provide the highest sensitivity and specificity necessary for minimum disease detection and that this type of biomarker had sufficient information to predict treatment effectiveness and prognosis. The panel also concluded that no monoanalyte biomarker of neuroendocrine tumours has yet fulfilled these criteria and there is insufficient information to support the clinical use of miRNA or circulating tumour cells as useful prognostic markers for this disease. The panel considered that trials measuring multianalytes (eg, neuroendocrine gene transcripts) should also identify how such information can optimise the management of patients with neuroendocrine tumours.
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Affiliation(s)
- Kjell Oberg
- Department of Medical Sciences, Endocrine Oncology, Uppsala University, Uppsala, Sweden
| | | | - Wouter De Herder
- Section of Endocrinology, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
| | | | - David Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - David C Metz
- Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Anthony Heaney
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Dik Kwekkeboom
- Department of Nuclear Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
| | | | - Timothy Meyer
- University College London Cancer Institute, London, UK
| | - Steven F Moss
- Brown University, Liver Research Center, Providence, RI, USA
| | - Kay Washington
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward Wolin
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Eric Liu
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James Goldenring
- Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, TN, USA
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Giannini EG, Afdhal NH, Sigal SH, Muir AJ, Reddy KR, Vijayaraghavan S, Elkashab M, Romero-Gómez M, Dusheiko GM, Iyengar M, Vasey SY, Campbell FM, Theodore D. Non-cirrhotic thrombocytopenic patients with hepatitis C virus: Characteristics and outcome of antiviral therapy. J Gastroenterol Hepatol 2015; 30:1301-8. [PMID: 25777337 DOI: 10.1111/jgh.12942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Thrombocytopenia is frequently observed in patients with chronic hepatitis C virus (HCV) infection and cirrhosis, although it can also be observed in patients without cirrhosis by a virus-mediated phenomenon. This study assessed the prevalence, characteristics, and outcomes of antiviral therapy in patients with chronic HCV infection and thrombocytopenia not associated with cirrhosis. METHODS The study included 1268 patients with HCV infection and thrombocytopenia enrolled in the phase 3 ENABLE studies that assessed the impact of eltrombopag on achieving a sustained virologic response to pegylated interferon and ribavirin. The study population was subdivided according to baseline FibroSURE test results into patients with non-cirrhosis (FibroSURE < 0.4) and cirrhosis-related (FibroSURE ≥ 0.75) thrombocytopenia. RESULTS Compared with patients with cirrhosis-related thrombocytopenia (n = 995; 78.5%), non-cirrhotic patients with thrombocytopenia (n = 59; 4.6%) were younger (mean age [95% confidence interval (CI)]: 43.9 [40.7-47.2] vs 52.7 [52.2-53.3] years; P < 0.0001), predominantly female (64% [51-76] vs 30% [27-33]; P < 0.0001), and less frequently had a Model for End-Stage Liver Disease score ≥ 10 (24% [14-37] vs 45% [42-49]; P = 0.0012), low albumin levels (≤ 35 g/L; 2% [0-9] vs 32% [29-35]; P < 0.0001), and prevalence of diabetes mellitus (3% [0-12] vs 21% [19-24]; P = 0.0005). The sustained virologic response rate was higher in non-cirrhotic patients with thrombocytopenia (46% [95% CI, 33-59] vs 16% [14-18]; P < 0.0001). CONCLUSIONS Patients with thrombocytopenia associated with HCV who have lower FibroSURE test results may have better preserved liver function and higher sustained virologic response rates than patients with cirrhosis.
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Affiliation(s)
| | - Nezam H Afdhal
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel H Sigal
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Andrew J Muir
- Duke Clinical Research Institute, Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA
| | - K Rajender Reddy
- University of Pennsylvania School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Magdy Elkashab
- Department of Hepatology, Toronto Liver Center, Toronto, Canada
| | - Manuel Romero-Gómez
- Unit for Medical and Surgical Management of Digestive Diseases and CIBERehd, Valme University Hospital, University of Seville, Sevilla, Spain
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Lu WJ, Saxena N, Luk JM, Kaul SC, Wadhwa R. Circulating mortalin autoantibody--a new serological marker of liver cirrhosis. Cell Stress Chaperones 2015; 20:715-9. [PMID: 25905813 PMCID: PMC4463917 DOI: 10.1007/s12192-015-0592-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/02/2015] [Accepted: 04/10/2015] [Indexed: 12/14/2022] Open
Abstract
Mortalin is a stress chaperone belonging to the Hsp70 family of proteins. Frequently enriched in cancers, it is a multifunctional protein and regulates cell proliferation, apoptosis, mitochondrial functions, and the activity of tumor suppressor protein p53. In the present study, we investigated circulating mortalin and its autoantibody in normal, cirrhosis, and cancerous liver. We found that although mortalin is enriched in liver cancer cells and tumors, it is not detected in the serum of either the liver cirrhosis or cancer patients. In contrast, mortalin autoantibody was detected in patients' sera and showed significant correlation with the occurrence of cirrhosis. It is suggested as a potential noninvasive marker for liver cirrhosis.
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Affiliation(s)
- Wen-Jing Lu
- />Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA
- />Department of Surgery, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Nishant Saxena
- />Drug Discovery and Assets Innovation, DBT-AIST International Laboratory for Advanced Biomedicine (DAILAB), Biomedical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - John M. Luk
- />Department of Surgery, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Sunil C. Kaul
- />Drug Discovery and Assets Innovation, DBT-AIST International Laboratory for Advanced Biomedicine (DAILAB), Biomedical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
- />National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Higashi, Tsukuba, Ibaraki 305 8562 Japan
| | - Renu Wadhwa
- />Drug Discovery and Assets Innovation, DBT-AIST International Laboratory for Advanced Biomedicine (DAILAB), Biomedical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
- />National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Higashi, Tsukuba, Ibaraki 305 8562 Japan
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Kanwal F, White DL, Jiao L, Tavakoli-Tabasi S, Sansgiry S, Ramsey DJ, Kuzniarek J, Spiegelman A, El-Serag HB. Genetic Variants in Interleukin-28B Are Associated with Diabetes and Diabetes-Related Complications in Patients with Chronic Hepatitis C Virus Infection. Dig Dis Sci 2015; 60:2030-7. [PMID: 25663241 DOI: 10.1007/s10620-015-3545-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 01/19/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies have shown that host interleukin-28B (IL28B) genetic polymorphisms are associated with insulin resistance in patients with chronic hepatitis C virus (HCV) infection. However, the clinical relevance of this relationship is unclear. AIMS We examined the association between IL28B genotype for rs12980275 and risk of type 2 diabetes and diabetes-related complications. METHODS We used a cross-sectional study of prospectively recruited male veterans with chronic HCV. We employed logistic regression analysis and adjusted for patients' age, race, body mass index, and hepatic fibrosis. RESULTS A total of 528 participants were recruited (mean age 59.1 years; 38.5 % African-American; 40.3 % advanced fibrosis). Of these, 36.1 % were homozygous for favorable AA allele for rs12980275, 49.0 % were heterozygous (AG), and 14.0 % were homozygous for the unfavorable allele (GG). Prevalence of diabetes was significantly lower in patients with both favorable alleles (AA) than that with at least one unfavorable IL28B G allele (21.1 vs. 30.2 %, p = 0.02). Similarly, patients who were homozygous for the favorable alleles had lower prevalence of diabetes-related complications than patients with any unfavorable IL28B allele (5.7 vs. 12.2 %, p = 0.01). This association did not change after adjusting for sociodemographic characteristics, body mass index, and stage of hepatic fibrosis (adjusted ORdiabetes 0.56, 95 % CI 0.35-0.89; ORdiabetes-related complications 0.47, 95 % CI 0.23-0.96). CONCLUSIONS Patients who have favorable AA IL28B alleles have a lower prevalence of diabetes and related complications compared with patients with unfavorable IL28B rs12980275 genotype. IL28B genotype information may be used to counsel HCV patients regarding their individualized risk of diabetes and diabetes-related complications.
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Affiliation(s)
- Fasiha Kanwal
- Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
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Lo Re V, Lynn K, Stumm ER, Long J, Nezamzadeh MS, Baker JF, Hoofnagle AN, Kapalko AJ, Mounzer K, Zemel BS, Tebas P, Kostman JR, Leonard MB. Structural Bone Deficits in HIV/HCV-Coinfected, HCV-Monoinfected, and HIV-Monoinfected Women. J Infect Dis 2015; 212:924-33. [PMID: 25754980 DOI: 10.1093/infdis/jiv147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/02/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is associated with reduced bone mineral density (BMD) and increased fracture rates, particularly in women. The structural underpinnings for skeletal fragility in coinfected women have not been characterized. We used tibial peripheral quantitative computed tomography to evaluate skeletal parameters in women, by HIV/HCV status. METHODS We conducted a cross-sectional study among 50 HIV/HCV-coinfected, 51 HCV-monoinfected, and 50 HIV-monoinfected women. Tibial volumetric BMD and cortical dimensions were determined with peripheral quantitative computed tomography. Race-specific z scores for age were generated using 263 female reference participants without HIV infection or liver disease. RESULTS Coinfected participants had lower mean z scores for trabecular volumetric BMD (-0.85), cortical volumetric BMD (-0.67), cortical area (-0.61), and cortical thickness (-0.77) than reference participants (all P < .001). The smaller cortical dimensions were due to greater mean z scores for endosteal circumference (+0.67; P < .001) and comparable z scores for periosteal circumference (+0.04; P = .87). Trabecular volumetric BMD was lower in coinfected than in HCV- or HIV-monoinfected participants. HCV-infected women with stage 3-4 liver fibrosis had lower mean z scores for trabecular volumetric BMD, cortical thickness, and total hip BMD those with stage 0-2 fibrosis. CONCLUSIONS Compared with healthy reference patients, HIV/HCV-coinfected women had decreased tibial trabecular volumetric BMD, diminished cortical dimensions, and significant endocortical bone loss.
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Affiliation(s)
- Vincent Lo Re
- Division of Infectious Diseases Division of Center for AIDS Research Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology
| | - Kenneth Lynn
- Division of Infectious Diseases Division of Center for AIDS Research
| | - Emily R Stumm
- Division of Infectious Diseases Division of Center for AIDS Research
| | - Jin Long
- Healthcare Analytics Unit, Children's Hospital of Philadelphia
| | - Melissa S Nezamzadeh
- Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology
| | | | | | | | - Karam Mounzer
- Jonathan Lax Treatment Center, Philadelphia FIGHT, Pennsylvania
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia
| | - Pablo Tebas
- Division of Infectious Diseases Division of Center for AIDS Research
| | - Jay R Kostman
- Division of Infectious Diseases Division of Center for AIDS Research
| | - Mary B Leonard
- Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology Department of Pediatrics and Medicine, Stanford University, California
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Meng F, Zheng Y, Zhang Q, Mu X, Xu X, Zhang H, Ding L. Noninvasive evaluation of liver fibrosis using real-time tissue elastography and transient elastography (FibroScan). JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:403-410. [PMID: 25715361 DOI: 10.7863/ultra.34.3.403] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to assess liver fibrosis with real-time tissue elastography and to compare the results with those of transient elastographic (FibroScan; Echosens, Paris, France) measurements by using liver biopsy as the reference standard. METHODS Real-time tissue elastography and percutaneous liver biopsy were performed in 166 patients with chronic hepatitis B (estimation group). The relationship between the parameters obtained via real-time tissue elastography and the hepatic fibrosis stage was evaluated by a stepwise multiple linear regression, and the regression equation was used to calculate the liver fibrosis index. The diagnostic performance of the liver fibrosis index was validated and compared with FibroScan in 121 other patients with chronic hepatitis B (validation group). RESULTS The liver fibrosis index was calculated as follows: liver fibrosis index = 0.043 low-strain area ratio + 4.520 skewness + 0.033 mean - 1.002 kurtosis. The liver fibrosis index and liver stiffness measured by FibroScan were both significantly associated with the fibrosis stage in the validation group (r= 0.667 and 0.664, respectively; both P< .001). The areas under the receiver operating characteristic curves for the liver fibrosis index and liver stiffness were 0.880 and 0.909 for predicting substantial fibrosis (scores ≥F2), 0.868 and 0.874 for predicting severe fibrosis (≥F3), and 0.752 and 0.815 for predicting cirrhosis (F4), respectively. CONCLUSIONS Real-time tissue elastography is an effective method for assessing liver fibrosis, with diagnostic performance similar to that of transient elastography.
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Affiliation(s)
- Fankun Meng
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China (F.M., Y.Z., X.M., X.X., H.Z., L.D.); and Department of Ultrasound, Hitachi Medical Corporation, Beijing, China (Q.Z.).
| | - Ying Zheng
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China (F.M., Y.Z., X.M., X.X., H.Z., L.D.); and Department of Ultrasound, Hitachi Medical Corporation, Beijing, China (Q.Z.)
| | - Qi Zhang
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China (F.M., Y.Z., X.M., X.X., H.Z., L.D.); and Department of Ultrasound, Hitachi Medical Corporation, Beijing, China (Q.Z.)
| | - Xiaojie Mu
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China (F.M., Y.Z., X.M., X.X., H.Z., L.D.); and Department of Ultrasound, Hitachi Medical Corporation, Beijing, China (Q.Z.)
| | - Xiaoluan Xu
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China (F.M., Y.Z., X.M., X.X., H.Z., L.D.); and Department of Ultrasound, Hitachi Medical Corporation, Beijing, China (Q.Z.)
| | - Haiying Zhang
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China (F.M., Y.Z., X.M., X.X., H.Z., L.D.); and Department of Ultrasound, Hitachi Medical Corporation, Beijing, China (Q.Z.)
| | - Lei Ding
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China (F.M., Y.Z., X.M., X.X., H.Z., L.D.); and Department of Ultrasound, Hitachi Medical Corporation, Beijing, China (Q.Z.)
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Abdollahi M, Pouri A, Ghojazadeh M, Estakhri R, Somi M. Non-invasive serum fibrosis markers: A study in chronic hepatitis. ACTA ACUST UNITED AC 2015; 5:17-23. [PMID: 25901293 PMCID: PMC4401163 DOI: 10.15171/bi.2015.05] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 12/05/2014] [Accepted: 01/04/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Chronic hepatitis is specified as inflammatory disease of the liver lasting for more than six months. Role of noninvasive fibrosis markers as prognostication factors of the presence or absence of significant fibrosis on liver biopsy of patients with chronic hepatitis is the aim of this study. METHODS Two hundred twenty-one patients with chronic hepatitis involved in the study between 2011 and 2013. Routine biochemical indices and serum fibrosis markers such as aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST to platelet ratio index (APRI) and Fibrosis 4 score (FIB-4) were evaluated, and the histological grade and stage of the liver biopsy specimens were scored according to the Ishak scoring system. Diagnostic accuracies of these markers for prediction of significant fibrosis were assessed by Receiver Operating Characteristic (ROC) curve analysis. RESULTS Contemporaneous laboratory indices for imputing AAR, APRI, and FIB-4 were identified with liver biopsies. From all, 135 males (61.1%) and 86 females (38.9%), with mean age of 39.6±14.4 were studied. Significant correlation between stages of fibrosis and FIB-4, APRI and AAR were detected, with a correlation coefficient higher than that of other markers in the patients with Hepatitis B (r = 0.46), C (r = 0.58) and autoimmune hepatitis (r = 0.28). FIB-4 (AUROC = 0.84) and APRI (AUROC = 0.78) were superior to AAR at distinguishing severe fibrosis from mild-to-moderate fibrosis and gave the highest diagnostic accuracy. CONCLUSION Application of these markers was good at distinguishing significant fibrosis and decreased the need for staging liver biopsy specimens among patients with chronic hepatitis.
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Affiliation(s)
| | - Aliasghar Pouri
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rasoul Estakhri
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadhossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Zalai D, Sherman M, McShane K, Shapiro CM, Carney CE. The importance of fatigue cognitions in chronic hepatitis C infection. J Psychosom Res 2015; 78:193-8. [PMID: 25433976 DOI: 10.1016/j.jpsychores.2014.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/09/2014] [Accepted: 11/12/2014] [Indexed: 12/17/2022]
Abstract
UNLABELLED Chronic Hepatitis C virus (HCV) infection is a source of significant public health burden worldwide. Fatigue is a cardinal patient reported consequence of the disease. HCV infection associated fatigue leads to significant impairment in the quality of life and day-to-day functioning. Despite its clinical significance, the factors that contribute to adverse impact of fatigue in HCV infection are largely unknown. OBJECTIVES This study evaluated the contributions of insomnia, depression symptoms, and fatigue-specific cognitions to fatigue-related functional impairment. METHODS Fatigue, insomnia, depression symptoms, as well as fatigue cognitions were assessed in participants (36% females; age>18 years, N=115) with chronic HCV infection at a tertiary hepatitis clinic. RESULTS Sixty percent of participants reported clinically significant fatigue (Fatigue Severity Index FSS ≥ 4). Comorbidities and fatigue perceptions accounted for 61% of the variation of fatigue. Fatigue perceptions were the main predictors of adverse fatigue outcomes (B=.114, 95% CI=.054-.154). Patients with clinically significant fatigue were four-times more likely than less fatigued patients to believe that the main cause of their fatigue was the infection. CONCLUSION Patients' beliefs about their fatigue were the main predictors of adverse fatigue outcomes. These results suggest that fatigue associated with chronic hepatitis C infection can be conceptualized using a cognitive behavioral approach. This was the first study to evaluate the role of both comorbid mood/sleep and cognitive predictors of fatigue in a single model. Integrating the findings into existing treatment strategies could improve patient reported outcomes in chronic hepatitis C infection.
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Affiliation(s)
- Dora Zalai
- Dept. of Psychology, Ryerson University, Toronto, Canada.
| | - Morris Sherman
- Dept. of Gastroenterology, University Health Network, University of Toronto, Toronto, Canada
| | - Kelly McShane
- Dept. of Psychology, Ryerson University, Toronto, Canada
| | - Colin M Shapiro
- Dept. of Psychiatry, University Health Network, University of Toronto, Toronto, Canada; Dept. of Ophthalmology, University Health Network, University of Toronto, Toronto, Canada
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Abstract
Newer noninvasive tests have begun to replace liver biopsy for staging purposes. The clinician must evaluate these tools and apply them to individual patients. None of these modalities give the exact same staging of fibrosis as a liver biopsy, but they are excellent tools for risk stratification. Still, it should be recognized that there are disease-specific issues with different utilizations and cutoffs for different clinical diseases. This article provides a framework for incorporating the use of serum biomarkers and elastography-based approaches to stage fibrosis into clinical practice. This review also covers recent developments in this rapidly advancing area.
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Affiliation(s)
- Alan Bonder
- Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elliot B Tapper
- Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nezam H Afdhal
- Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Deffieux T, Gennisson JL, Bousquet L, Corouge M, Cosconea S, Amroun D, Tripon S, Terris B, Mallet V, Sogni P, Tanter M, Pol S. Investigating liver stiffness and viscosity for fibrosis, steatosis and activity staging using shear wave elastography. J Hepatol 2015; 62:317-24. [PMID: 25251998 DOI: 10.1016/j.jhep.2014.09.020] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 09/10/2014] [Accepted: 09/15/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Quantitative shear wave elastography was shown to be an effective tool for the non-invasive diagnosis and staging of chronic liver diseases. The liver shear modulus, estimated from the propagation velocity of shear waves, is correlated to the degree of fibrosis and can therefore be used for the non-invasive staging of fibrosis. METHODS We performed a clinical prospective study in a total of 120 patients with various chronic liver diseases to compare the accuracy of supersonic shear imaging (SSI), a technique based on acoustic radiation and ultrafast ultrasound imaging, to 1D transient elastography (FibroScan) for the staging and grading of fibrosis as assessed by liver biopsy. Since shear wave propagation spectroscopy can also provide additional mechanical information on soft tissues, such as viscosity, we also investigated those new mechanical parameters as possible predictors of fibrosis, steatosis, and disease activity. RESULTS SSI was successfully performed in 98.3% of patients and it was shown to be as accurate as FibroScan for the staging of fibrosis both for the whole population (N=120) and for the subgroup with viral hepatitis (n=70) (AUC=0.85 [0.77-0.96] and 0.89 [0.81-0.97] for significant fibrosis, AUC=0.90 [0.83-0.97] and 0.87 [0.75-0.98] for cirrhosis, with respect to SSI [n=68/70] and FibroScan [n=66/68]). Viscosity could also be used to stage the degree of fibrosis (AUC=0.76 [0.64-0.87] for significant fibrosis and AUC=0.87 [0.74-0.99] for cirrhosis), for the subgroup of patients with viral hepatitis (n=67/70) but was a poor predictor of disease activity and steatosis levels. CONCLUSIONS Supersonic shear imaging is a robust technique for the staging of liver fibrosis. Liver viscosity was found to be correlated with fibrosis but not to steatosis or disease activity.
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Affiliation(s)
- Thomas Deffieux
- Institut Langevin, ESPCI ParisTech, PSL University, CNRS UMR7587, INSERM U979, Paris, France.
| | - Jean-Luc Gennisson
- Institut Langevin, ESPCI ParisTech, PSL University, CNRS UMR7587, INSERM U979, Paris, France
| | - Laurence Bousquet
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Marion Corouge
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Simona Cosconea
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Dalila Amroun
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Simona Tripon
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Benoit Terris
- Service d'anatomo-pathologie, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Vincent Mallet
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Philippe Sogni
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Mickael Tanter
- Institut Langevin, ESPCI ParisTech, PSL University, CNRS UMR7587, INSERM U979, Paris, France
| | - Stanislas Pol
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
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Hua J, Liu GQ, Bao H, Sheng L, Guo CJ, Li H, Ma X, Shen JL. The role of liver stiffness measurement in the evaluation of liver function and esophageal varices in cirrhotic patients. J Dig Dis 2015; 16:98-103. [PMID: 25385497 DOI: 10.1111/1751-2980.12210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to evaluate the efficacy of liver stiffness measurement (LSM) in predicting the presence and severity of esophageal varices (EV) and investigating its association with liver function (LF) in patients with liver cirrhosis. METHODS Medical records of 90 cirrhotic patients who underwent LSM by transient elastography were retrospectively reviewed. The relationship between LSM and the presence and severity of EV was evaluated by esophagogastroduodenoscopy (EGD) and multislice spiral computed tomography (MSCT). Another 25 healthy individuals were included as controls. RESULTS LSM was significantly associated with the Child-Pugh score in cirrhotic patients, with the highest LSM in those with Child-Pugh C. Patients with clinically decompensated cirrhosis had a higher LSM than those with compensated cirrhosis (36.75 ± 16.54 kPa vs 17.65 ± 10.87 kPa, P < 0.01). However, there was no significant difference in LSM value between patients with severe EV and those with no or non-severe EV determined by endoscopy (28.18 ± 17.44 kPa vs 31.00 ± 18.44 kPa) or MSCT (29.71 ± 18.39 kPa vs 24.90 ± 14.80 kPa). The diagnostic value of LSM for predicting severe EV was low in unselected cirrhotic patients. The presence of EV examined by EGD and MSCT was similar to each other. CONCLUSIONS LSM could be used to evaluate the progression of liver cirrhosis continuously. However, its role in assessing EV grades in advanced cirrhosis needs further confirmation. MSCT can assess EV accurately and may serve as an alternative to endoscopy in the assessment of portal hypertension.
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Affiliation(s)
- Jing Hua
- Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
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An update on the management of chronic hepatitis C: 2015 Consensus guidelines from the Canadian Association for the Study of the Liver. Can J Gastroenterol Hepatol 2015; 29:19-34. [PMID: 25585348 PMCID: PMC4334064 DOI: 10.1155/2015/692408] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chronic hepatitis C remains a significant medical and economic burden in Canada, affecting nearly 1% of the population. Since the last Canadian consensus conference on the management of chronic hepatitis C, major advances have occurred that warrant a review of recommended management approaches for these patients. Specifically, direct-acting antiviral agents with dramatically improved rates of virological clearance compared with standard therapy have been developed and interferon-free, all-oral antiviral regimens have been approved. In light of this new evidence, an update to the 2012 Canadian Association for the Study of the Liver consensus guidelines on the management of hepatitis C was produced. The present document reviews the epidemiology of hepatitis C in Canada, preferred diagnostic testing approaches and recommendations for the treatment of chronically infected patients with the newly approved antiviral agents, including those who have previously failed peginterferon and ribavirin-based therapy. In addition, recommendations are made regarding approaches to reducing the burden of hepatitis C in Canada.
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80
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Hong MZ, Zhang RM, Chen GL, Huang WQ, Min F, Chen T, Xu JC, Pan JS. Liver stiffness measurement-based scoring system for significant inflammation related to chronic hepatitis B. PLoS One 2014; 9:e111641. [PMID: 25360742 PMCID: PMC4216134 DOI: 10.1371/journal.pone.0111641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/26/2014] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Liver biopsy is indispensable because liver stiffness measurement alone cannot provide information on intrahepatic inflammation. However, the presence of fibrosis highly correlates with inflammation. We constructed a noninvasive model to determine significant inflammation in chronic hepatitis B patients by using liver stiffness measurement and serum markers. METHODS The training set included chronic hepatitis B patients (n = 327), and the validation set included 106 patients; liver biopsies were performed, liver histology was scored, and serum markers were investigated. All patients underwent liver stiffness measurement. RESULTS An inflammation activity scoring system for significant inflammation was constructed. In the training set, the area under the curve, sensitivity, and specificity of the fibrosis-based activity score were 0.964, 91.9%, and 90.8% in the HBeAg(+) patients and 0.978, 85.0%, and 94.0% in the HBeAg(-) patients, respectively. In the validation set, the area under the curve, sensitivity, and specificity of the fibrosis-based activity score were 0.971, 90.5%, and 92.5% in the HBeAg(+) patients and 0.977, 95.2%, and 95.8% in the HBeAg(-) patients. The liver stiffness measurement-based activity score was comparable to that of the fibrosis-based activity score in both HBeAg(+) and HBeAg(-) patients for recognizing significant inflammation (G ≥3). CONCLUSIONS Significant inflammation can be accurately predicted by this novel method. The liver stiffness measurement-based scoring system can be used without the aid of computers and provides a noninvasive alternative for the prediction of chronic hepatitis B-related significant inflammation.
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Affiliation(s)
- Mei-Zhu Hong
- Department of Infectious Diseases, Chenggong Hospital affiliated to Xiamen University (the 174th Hospital of PLA), Xiamen, Fujian, China
| | - Ru-Mian Zhang
- Hepatology Unit and Department of Infectious Diseases, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian, China
| | - Guo-Liang Chen
- Hepatology Unit and Department of Infectious Diseases, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian, China
| | - Wen-Qi Huang
- Department of Infectious Diseases, Chenggong Hospital affiliated to Xiamen University (the 174th Hospital of PLA), Xiamen, Fujian, China
| | - Feng Min
- Department of Infectious Diseases, Chenggong Hospital affiliated to Xiamen University (the 174th Hospital of PLA), Xiamen, Fujian, China
| | - Tian Chen
- Department of Infectious Diseases, Chenggong Hospital affiliated to Xiamen University (the 174th Hospital of PLA), Xiamen, Fujian, China
| | - Jin-Chao Xu
- Department of Infectious Diseases, Chenggong Hospital affiliated to Xiamen University (the 174th Hospital of PLA), Xiamen, Fujian, China
| | - Jin-Shui Pan
- Department of Gastroenterology, Zhongshan Hospital affiliated to Xiamen University, Xiamen, Fujian, China
- * E-mail:
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81
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Variability in definitions of transaminase upper limit of the normal impacts the APRI performance as a biomarker of fibrosis in patients with chronic hepatitis C: "APRI c'est fini ?". Clin Res Hepatol Gastroenterol 2014; 38:432-9. [PMID: 24924901 DOI: 10.1016/j.clinre.2014.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/08/2014] [Accepted: 04/15/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aspartate aminotransferase platelet ratio index (APRI) is a validated, non-patented blood test for diagnosing fibrosis or cirrhosis in patients with chronic hepatitis C. We assess the impact of two limitations, the variability of the upper limit of normal for aspartate aminotransferase (AST-ULN) and the risk of overestimating fibrosis stage due to necroinflammatory activity. METHODS The variability of AST-ULN was assessed by an overview of the literature and an assessment of AST-ULN in 2 control populations 7521 healthy volunteers and 393 blood donors. We assessed the impact of AST-ULN variability on APRI performance for estimating fibrosis prevalence and on the Obuchowski measure using individual data of 1651 patients with APRI, FibroTest and biopsy. RESULTS The overview, and the analysis of the control populations found that ULN-AST ranged from 26 to 49 IU/L according to gender, body mass index and serum cholesterol. When this AST-ULN variability was applied to the chronic hepatitis group, the prevalence of advanced fibrosis and cirrhosis as presumed by APRI varied (P<0.001) from 34.7% to 68.5%, and from 11.4% to 32.3%, respectively. This spectrum effect induced variability in APRI performance, which could be similar 0.862 (if AST-ULN=26 IU/L) or lower 0.820 (AST-ULN≥30IU/L) than the stable FibroTest performance (0.867; P=0.35 and P<0.0001 respectively). When applied to 18 acute hepatitis C patients, the rate of false positives of APRI varied from 0% to 61% due to AST-ULN. CONCLUSION The AST-ULN variability is high highly associated with the variability of metabolic risk factors between the different control groups. This variability induces a spectrum effect, which could cause misleading interpretations of APRI performance for the staging of fibrosis, comparisons of APRI with other non-invasive tests, and estimates of false positive rate.
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Modlin IM, Drozdov I, Alaimo D, Callahan S, Teixiera N, Bodei L, Kidd M. A multianalyte PCR blood test outperforms single analyte ELISAs (chromogranin A, pancreastatin, neurokinin A) for neuroendocrine tumor detection. Endocr Relat Cancer 2014; 21:615-28. [PMID: 25015994 DOI: 10.1530/erc-14-0190] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A critical requirement in neuroendocrine tumor (NET) management is a sensitive, specific and reproducible blood biomarker test. We evaluated a PCR-based 51 transcript signature (NETest) and compared it to chromogranin A (CgA), pancreastatin (PST) and neurokinin A (NKA). The multigene signature was evaluated in two groups: i) a validation set of 40 NETs and controls and ii) a prospectively collected group of NETs (n=41, 61% small intestinal, 50% metastatic, 44% currently treated and 41 age-sex matched controls). Samples were analyzed by a two-step PCR (51 marker genes) protocol and ELISAs for CgA, PST and NKA. Sensitivity comparisons included χ(2), non-parametric measurements, ROC curves and predictive feature importance (PFAI) analyses. NETest identified 38 of 41 NETs. Performance metrics were: sensitivity 92.8%, specificity 92.8%, positive predictive value 92.8% and negative predictive value 92.8%. Single analyte ELISA metrics were: CgA 76, 59, 65, and 71%; PST 63, 56, 59, and 61% and NKA 39, 93, 84, and 60%. The AUCs (ROC analysis) were: NETest: 0.96±0.025, CgA: 0.67±0.06, PST 0.56±0.06, NKA: 0.66±0.06. NETest significantly outperformed single analyte tests (area differences: 0.284-0.403, Z-statistic 4.85-5.9, P<0.0001). PFAI analysis determined NETest had most value (69%) in diagnosis (CgA (13%), PST (9%), and NKA (9%)). Test data were consistent with the validation set (NETest >95% sensitivity and specificity, AUC =0.98 vs single analytes: 59-67% sensitivity, AUCs: 0.58-0.63). The NETest is significantly more sensitive and efficient (>93%) than single analyte assays (CgA, PST or NKA) in NET diagnosis. Blood-based multigene analytic measurement will facilitate early detection of disease recurrence and can predict therapeutic efficacy.
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Affiliation(s)
- Irvin M Modlin
- Wren Laboratories35 NE Industrial Road, Branford, Connecticut 06405, USA
| | - Ignat Drozdov
- Wren Laboratories35 NE Industrial Road, Branford, Connecticut 06405, USA
| | - Daniele Alaimo
- Wren Laboratories35 NE Industrial Road, Branford, Connecticut 06405, USA
| | - Stephen Callahan
- Wren Laboratories35 NE Industrial Road, Branford, Connecticut 06405, USA
| | - Nancy Teixiera
- Wren Laboratories35 NE Industrial Road, Branford, Connecticut 06405, USA
| | - Lisa Bodei
- Wren Laboratories35 NE Industrial Road, Branford, Connecticut 06405, USA
| | - Mark Kidd
- Wren Laboratories35 NE Industrial Road, Branford, Connecticut 06405, USA
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Elesawy BH, Abd El Hafez A, Dorgham LS, El-Askary A. Limited reliability of five non-invasive biomarkers in predicting hepatic fibrosis in chronic HCV mono-infected patients opposed to METAVIR scoring. Pathol Res Pract 2014; 210:922-8. [PMID: 25123964 DOI: 10.1016/j.prp.2014.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/16/2014] [Accepted: 07/04/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver biopsy is gold standard for fibrosis assessment in hepatitis C virus (HCV) infection but its limitations led to the identification of non-invasive biomarkers. This study assesses the reliability of five biomarkers in estimating the stage of liver fibrosis/cirrhosis in chronic HCV patients versus METAVIR scoring. METHODS One hundred HCV monoinfected patients who underwent liver biopsy and blood sampling were included. Liver fibrosis was staged (F0-4) and required laboratory tests were performed. AAR, API, APRI, FIB-4 and Pohl score were calculated and their receiver operating curves (ROCs), sensitivities, specificities, predictive values and accuracies were evaluated. RESULTS There were 27, 44, and 29 patients at F0-F1, F2-F3, and F4 groups. Significant statistical differences were found regarding AST, vireamia, platelet count, prothrombin time and all biomarkers. From ROCs only Pohl score predicted significant fibrosis and cirrhosis but with low accuracy. AAR, API and APRI showed moderate performance at low cut-offs, but had limited predictive values or accuracies at higher cut-offs. FIB-4 was the least accurate test. The diagnostic reliability of these biomarkers was limited to patients with suspected insignificant fibrosis. CONCLUSIONS This study verified the limited reliability for AAR, API, APRI, FIB-4 and Pohl score in estimating the stage of hepatic fibrosis in HCV infected patients opposed to METAVIR scoring.
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Affiliation(s)
- Basem Hasan Elesawy
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Amal Abd El Hafez
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Laila Shehata Dorgham
- Department of Public Health, National Liver Institute, Menoufia University, Egypt; Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.
| | - Ahmad El-Askary
- Department of Medical Biochemistry, Faculty of Medicine, Al-Azhar University, Egypt; Department of Medical Laboratory Sciences, Taif University, College of Applied Medical Sciences, Taif, Saudi Arabia.
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Zeremski M, Dimova RB, Benjamin S, Makeyeva J, Yantiss RK, Gambarin-Gelwan M, Talal AH. FibroSURE as a noninvasive marker of liver fibrosis and inflammation in chronic hepatitis B. BMC Gastroenterol 2014; 14:118. [PMID: 24990385 PMCID: PMC4086988 DOI: 10.1186/1471-230x-14-118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/19/2014] [Indexed: 12/19/2022] Open
Abstract
Background Noninvasive markers of liver fibrosis have not been extensively studied in patients with chronic hepatitis B virus (HBV) infection. Our aim was to evaluate the capacity of FibroSURE, one of the two noninvasive fibrosis indices commercially available in the United States, to identify HBV infected patients with moderate to severe fibrosis. Methods Forty-five patients who underwent liver biopsy at a single tertiary care center were prospectively enrolled and had FibroSURE performed within an average interval of 11 days of the biopsy. Results Of the 45 patients, 40% were Asian, 40% were African American, and 13% were Caucasian; 27% were co-infected with HIV and 67% had no or mild fibrosis. We found FibroSURE to have moderate capacity to discriminate between patients with moderate to high fibrosis and those with no to mild fibrosis (area under receiver operating characteristic [AUROC] curve = 0.77; 95% confidence interval [CI] [0.61, 0.92]). When we combined the fibrosis score determined by FibroSURE with aspartate aminotransferase (AST) measurements and HIV co-infection status, the discriminatory ability significantly improved reaching an AUROC of 0.90 (95% CI [0.80, 1.00]). FibroSURE also had a good ability to differentiate patients with no or mild from those with moderate to high inflammation (AUROC = 0.83; 95% CI [0.71, 0.95]). Conclusions FibroSURE in combination with AST levels has an excellent capacity to identify moderate to high fibrosis stages in chronic HBV-infected patients. These data suggest that FibroSURE may be a useful substitute for liver biopsy in chronic HBV infection.
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Affiliation(s)
- Marija Zeremski
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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85
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Study of hepatic stiffness in hepatitis C virus-related liver diseases by acoustic radiation force impulse imaging. EGYPTIAN LIVER JOURNAL 2014. [DOI: 10.1097/01.elx.0000451424.56306.e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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86
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Boursier J, Brochard C, Bertrais S, Michalak S, Gallois Y, Fouchard-Hubert I, Oberti F, Rousselet MC, Calès P. Combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver-prognosis in chronic hepatitis C. Aliment Pharmacol Ther 2014; 40:178-88. [PMID: 24889599 DOI: 10.1111/apt.12813] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/15/2014] [Accepted: 05/07/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent longitudinal studies have emphasised the prognostic value of noninvasive tests of liver fibrosis and cross-sectional studies have shown their combination significantly improves diagnostic accuracy. AIM To compare the prognostic accuracy of six blood fibrosis tests and liver biopsy, and evaluate if test combination improves the liver-prognosis assessment in chronic hepatitis C (CHC). METHODS A total of 373 patients with compensated CHC, liver biopsy (Metavir F) and blood tests targeting fibrosis (APRI, FIB4, Fibrotest, Hepascore, FibroMeter) or cirrhosis (CirrhoMeter) were included. Significant liver-related events (SLRE) and liver-related deaths were recorded during follow-up (started the day of biopsy). RESULTS During the median follow-up of 9.5 years (3508 person-years), 47 patients had a SLRE and 23 patients died from liver-related causes. For the prediction of first SLRE, most blood tests allowed higher prognostication than Metavir F [Harrell C-index: 0.811 (95% CI: 0.751-0.868)] with a significant increase for FIB4: 0.879 [0.832-0.919] (P = 0.002), FibroMeter: 0.870 [0.812-0.922] (P = 0.005) and APRI: 0.861 [0.813-0.902] (P = 0.039). Multivariate analysis identified FibroMeter, CirrhoMeter and sustained viral response as independent predictors of first SLRE. CirrhoMeter was the only independent predictor of liver-related death. The combination of FibroMeter and CirrhoMeter classifications into a new FM/CM classification improved the liver-prognosis assessment compared to Metavir F staging or single tests by identifying five subgroups of patients with significantly different prognoses. CONCLUSIONS Some blood fibrosis tests are more accurate than liver biopsy for determining liver prognosis in CHC. A new combination of two complementary blood tests, one targeted for fibrosis and the other for cirrhosis, optimises assessment of liver-prognosis.
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Affiliation(s)
- J Boursier
- Liver-Gastroenterology Department, University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France
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Calès P, Boursier J, Ducancelle A, Oberti F, Hubert I, Hunault G, de Lédinghen V, Zarski JP, Salmon D, Lunel F. Improved fibrosis staging by elastometry and blood test in chronic hepatitis C. Liver Int 2014; 34:907-17. [PMID: 24102852 DOI: 10.1111/liv.12327] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 08/20/2013] [Indexed: 12/13/2022]
Abstract
AIMS Our main objective was to improve non-invasive fibrosis staging accuracy by resolving the limits of previous methods via new test combinations. Our secondary objectives were to improve staging precision, by developing a detailed fibrosis classification, and reliability (personalized accuracy) determination. METHODS All patients (729) included in the derivation population had chronic hepatitis C, liver biopsy, 6 blood tests and Fibroscan. Validation populations included 1584 patients. RESULTS The most accurate combination was provided by using most markers of FibroMeter and Fibroscan results targeted for significant fibrosis, i.e. 'E-FibroMeter'. Its classification accuracy (91.7%) and precision (assessed by F difference with Metavir: 0.62 ± 0.57) were better than those of FibroMeter (84.1%, P < 0.001; 0.72 ± 0.57, P < 0.001), Fibroscan (88.2%, P = 0.011; 0.68 ± 0.57, P = 0.020), and a previous CSF-SF classification of FibroMeter + Fibroscan (86.7%, P < 0.001; 0.65 ± 0.57, P = 0.044). The accuracy for fibrosis absence (F0) was increased, e.g. from 16.0% with Fibroscan to 75.0% with E-FibroMeter (P < 0.001). Cirrhosis sensitivity was improved, e.g. E-FibroMeter: 92.7% vs. Fibroscan: 83.3%, P = 0.004. The combination improved reliability by deleting unreliable results (accuracy <50%) observed with a single test (1.2% of patients) and increasing optimal reliability (accuracy ≥85%) from 80.4% of patients with Fibroscan (accuracy: 90.9%) to 94.2% of patients with E-FibroMeter (accuracy: 92.9%), P < 0.001. The patient rate with 100% predictive values for cirrhosis by the best combination was twice (36.2%) that of the best single test (FibroMeter: 16.2%, P < 0.001). CONCLUSION The new test combination increased: accuracy, globally and especially in patients without fibrosis, staging precision, cirrhosis prediction, and even reliability, thus offering improved fibrosis staging.
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Affiliation(s)
- Paul Calès
- Liver-Gastroenterology Department, CHU Angers, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France
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KASL clinical practice guidelines: management of hepatitis C. Clin Mol Hepatol 2014; 20:89-136. [PMID: 25032178 PMCID: PMC4099340 DOI: 10.3350/cmh.2014.20.2.89] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 05/20/2014] [Indexed: 12/16/2022] Open
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89
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Salkic NN, Jovanovic P, Hauser G, Brcic M. FibroTest/Fibrosure for significant liver fibrosis and cirrhosis in chronic hepatitis B: a meta-analysis. Am J Gastroenterol 2014; 109:796-809. [PMID: 24535095 DOI: 10.1038/ajg.2014.21] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 12/30/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Extent of liver fibrosis is one of the most important factors in determining prognosis and the need for active treatment in chronic hepatitis B (CHB). Noninvasive alternatives such as FibroTest/Fibrosure (FT) have been developed in order to overcome the shortcomings of liver biopsy (LB). We aimed to systematically review studies describing the diagnostic accuracy of FT for predicting CHB-related fibrosis. METHODS MEDLINE and EMBASE searches and hand searching methods were performed to identify studies that assessed the diagnostic accuracy of FibroTest in HB patients using LB as a reference standard. We used a hierarchical summary receiver operating curves model and the bivariate model to produce summary receiver operating characteristic curves and pooled estimates of sensitivity and specificity. RESULTS We included 16 studies (N=2494) and 13 studies (N=1754) in the heterogenous meta-analysis for liver fibrosis and cirrhosis, respectively. The area under the hierarchical summary receiver operating curve for significant liver fibrosis and for all included studies was 0.84 (95% confidence interval (CI): 0.78-0.88). At the FT threshold of 0.48, the sensitivity, specificity, and diagnostic odds ratio (DOR) of FT for significant fibrosis were 61 (48-72%), 80 (72-86%), and 6.2% (3.3-11.9), respectively. The area under the hierarchical summary receiver operating curve for liver cirrhosis and for all included studies was 0.87 (95% CI: 0.85-0.90). At the FT threshold of 0.74, the sensitivity, specificity, and DOR of FT for cirrhosis were 62 (47-75%), 91 (88-93%), and 15.7% (8.6-28.8), respectively. CONCLUSIONS FibroTest is of value in exclusion of patients with CHB-related cirrhosis, but has suboptimal accuracy in the detection of significant fibrosis and cirrhosis. It is necessary to further improve the test or combine it with other noninvasive modalities in order to improve accuracy.
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Affiliation(s)
- Nermin N Salkic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Predrag Jovanovic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Goran Hauser
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Majda Brcic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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90
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Pang JXQ, Zimmer S, Niu S, Crotty P, Tracey J, Pradhan F, Shaheen AAM, Coffin CS, Heitman SJ, Kaplan GG, Swain MG, Myers RP. Liver stiffness by transient elastography predicts liver-related complications and mortality in patients with chronic liver disease. PLoS One 2014; 9:e95776. [PMID: 24755824 PMCID: PMC3995722 DOI: 10.1371/journal.pone.0095776] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/29/2014] [Indexed: 12/18/2022] Open
Abstract
Background Liver stiffness measurement (LSM) by transient elastography (TE, FibroScan) is a validated method for noninvasively staging liver fibrosis. Most hepatic complications occur in patients with advanced fibrosis. Our objective was to determine the ability of LSM by TE to predict hepatic complications and mortality in a large cohort of patients with chronic liver disease. Methods In consecutive adults who underwent LSM by TE between July 2008 and June 2011, we used Cox regression to determine the independent association between liver stiffness and death or hepatic complications (decompensation, hepatocellular carcinoma, and liver transplantation). The performance of LSM to predict complications was determined using the c-statistic. Results Among 2,052 patients (median age 51 years, 65% with hepatitis B or C), 87 patients (4.2%) died or developed a hepatic complication during a median follow-up period of 15.6 months (interquartile range, 11.0–23.5 months). Patients with complications had higher median liver stiffness than those without complications (13.5 vs. 6.0 kPa; P<0.00005). The 2-year incidence rates of death or hepatic complications were 2.6%, 9%, 19%, and 34% in patients with liver stiffness <10, 10–19.9, 20–39.9, and ≥40 kPa, respectively (P<0.00005). After adjustment for potential confounders, liver stiffness by TE was an independent predictor of complications (hazard ratio [HR] 1.05 per kPa; 95% confidence interval [CI] 1.03–1.06). The c-statistic of liver-stiffness for predicting complications was 0.80 (95% CI 0.75–0.85). A liver stiffness below 20 kPa effectively excluded complications (specificity 93%, negative predictive value 97%); however, the positive predictive value of higher results was sub-optimal (20%). Conclusions Liver stiffness by TE accurately predicts the risk of death or hepatic complications in patients with chronic liver disease. TE may facilitate the estimation of prognosis and guide management of these patients.
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Affiliation(s)
- Jack X. Q. Pang
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott Zimmer
- Medical Services, Alberta Health Services, Calgary, Alberta, Canada
| | - Sophia Niu
- Medical Services, Alberta Health Services, Calgary, Alberta, Canada
| | - Pam Crotty
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jenna Tracey
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Faruq Pradhan
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Abdel Aziz M. Shaheen
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carla S. Coffin
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven J. Heitman
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G. Kaplan
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mark G. Swain
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert P. Myers
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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Abstract
Chronic liver diseases of differing etiologies are among the leading causes of mortality and morbidity worldwide. Establishing accurate staging of liver disease is very important for enabling both therapeutic decisions and prognostic evaluations. A liver biopsy is considered the gold standard for assessing the stage of hepatic fibrosis, but it has many limitations. During the last decade, several noninvasive markers for assessing the stage of hepatic fibrosis have been developed. Some have been well validated and are comparable to liver biopsy. This paper will focus on the various noninvasive biochemical markers used to stage liver fibrosis.
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92
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Gressner OA, Gao C. Monitoring fibrogenic progression in the liver. Clin Chim Acta 2014; 433:111-22. [PMID: 24607331 DOI: 10.1016/j.cca.2014.02.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/21/2014] [Accepted: 02/23/2014] [Indexed: 02/07/2023]
Abstract
The clinical course of chronic liver diseases is significantly dependent on the progression rate of fibrosis which is the unstructured replacement of injured parenchyma by extracellular matrix. Despite intensive studies, the clinical opportunities for patients with fibrosing liver diseases have not improved. This will be changed by increasing knowledge of new pathogenetic mechanisms, which complement the "canonical principle" of fibrogenesis. The latter is based on the activation of hepatic stellate cells and their transdifferentiation to myofibroblasts induced by hepatocellular injury and consecutive inflammatory mediators such as TGF-β. Stellate cells express a broad spectrum of matrix components. New mechanisms indicate that the heterogeneous pool of (myo-)fibroblasts can be supplemented by epithelial-mesenchymal transition (EMT) from cholangiocytes and potentially also from hepatocytes to fibroblasts, by influx of bone marrow-derived fibrocytes in the damaged liver tissue and by differentiation of a subgroup of monocytes to fibroblasts after homing in the damaged tissue. These processes are regulated by the cytokines TGF-β and BMP-7, chemokines, colony-stimulating factors, metalloproteinases and numerous trapping proteins. They offer innovative diagnostic and therapeutic options. As an example, modulation of TGF-β/BMP-7 ratio changes the rate of EMT, and so the simultaneous determination of these parameters and of the connective tissue growth factor (CTGF) in serum might provide information on fibrogenic activity. Also, proteomic and glycomic approaches of serum are under investigation to set up specific protein profiles in patients with liver fibrosis. The aim of this article is to present the current pathogenetic concepts of liver fibrosis and to discuss established and novel diagnostic approaches to reflect the process of hepatic fibrogenesis in the medical laboratory.
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Affiliation(s)
| | - Chunfang Gao
- Department of Laboratory Medicine, Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China.
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93
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Kanwal F, White DL, Tavakoli-Tabasi S, Jiao L, Lin D, Ramsey DJ, Spiegelman A, Kuzniarek J, El-Serag HB. Many patients with interleukin 28B genotypes associated with response to therapy are ineligible for treatment because of comorbidities. Clin Gastroenterol Hepatol 2014; 12:327-333.e1. [PMID: 23978349 PMCID: PMC3971998 DOI: 10.1016/j.cgh.2013.08.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 06/27/2013] [Accepted: 08/19/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Interleukin (IL)-28B (interferon-λ 3) genotype is the strongest predictor of response of patients with hepatitis C virus (HCV) infection to antiviral therapy. However, patients with HCV infection often have physical or mental comorbidities that contraindicate or complicate treatment, regardless of their genotype. The potential role of IL28B genotype within the context of patients' clinical and social environment is therefore unclear. METHODS We characterized the IL28B genotype (for rs12980275 and rs8099917) in 308 patients (mean age, 56 y; 25% African American; 38% with advanced-stage fibrosis) with genotype 1 HCV infection seen at the Michael E. DeBakey Veterans Administration Medical Center in Houston, Texas, from May 1, 2009, through April 1, 2012. We evaluated their eligibility for antiviral treatment based on clinical and social factors such as physical or mental health comorbidity, ongoing alcohol or drug use, and noncompliance with treatment evaluation. RESULTS Of the 308 subjects, 40% were homozygous for rs12980275 (associated with response to therapy), 46% were heterozygous, and 15% were homozygous for alleles associated with reduced response to therapy. Overall, 36% of patients were considered to be ineligible for treatment; of these, 40% had the rs12980275 genotype. More than half of the patients with rs12980275 who were ineligible for treatment were excluded because of mental health comorbidities; one-third of these patients had advanced fibrosis. The reason(s) for treatment exclusion resolved in only 8% of patients during a mean 1.5 years of follow-up evaluation. CONCLUSIONS In a well-characterized cohort of patients with HCV, a large proportion (40%) with IL28B polymorphisms associated with response to therapy is ineligible for treatment because of contraindications. One potential role of IL28B genotype analysis could be to identify patients who, although not currently eligible for antiviral treatment, could become so by modifying fixable exclusions to treatment.
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Affiliation(s)
- Fasiha Kanwal
- Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
| | - Donna L White
- Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Shahriar Tavakoli-Tabasi
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Li Jiao
- Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Derek Lin
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - David J Ramsey
- Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Houston, Texas; Section of Health Services Research, Baylor College of Medicine, Houston, Texas
| | | | - Jill Kuzniarek
- Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Houston, Texas; Section of Health Services Research, Baylor College of Medicine, Houston, Texas
| | - Hashem B El-Serag
- Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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Poynard T, Imbert-Bismut F, Munteanu M, Ratziu V. FibroTest-FibroSURE™: towards a universal biomarker of liver fibrosis? Expert Rev Mol Diagn 2014; 5:15-21. [PMID: 15723588 DOI: 10.1586/14737159.5.1.15] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Among the noninvasive alternatives to liver biopsy, several studies have demonstrated the predictive value and superior benefit/risk ratio to biopsy of two combinations of simple serum biochemical markers in patients infected with hepatitis B and C virus. These include FibroTest (BioPredictive) for the quantitative assessment of fibrosis, and ActiTest (BioPredictive) for the quantitative assessment of necroinflammatory activity (HCV-FibroSURE, LabCorp). The possible causes of false negatives and positives are also better identified. These tests, which are now available in 12 countries, can facilitate the screening and management of the most frequent liver diseases.
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Affiliation(s)
- Thierry Poynard
- Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
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Tae HJ, Jun DW, Choi YY, Kwak MJ, Lee MH. Assessment of risk of complications in cirrhosis using portal thallium scans. World J Gastroenterol 2014; 20:228-234. [PMID: 24415876 PMCID: PMC3886013 DOI: 10.3748/wjg.v20.i1.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/12/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the usefulness of a novel thallium scan shunt index for assessing portosystemic shunt-related cirrhotic complications.
METHODS: We enrolled 209 chronic hepatitis B-related cirrhosis patients. After rectal thallium instillation, radioactive isotope activity in the heart and liver was measured. The ratio of radiation uptake between the heart and the liver was calculated (the shunt index). This value indicates the degree of portosystemic circulation shunting. Blood tests, serum biochemistry tests, abdominal ultrasonography, gastroscopy and examination of clinical features such as the occurrence of varices, bleeding and hepatic encephalopathy were performed. Multivariate analysis was used to identify independent risk factors for complications. We compared the cumulative incidence rates of complications during the follow-up period.
RESULTS: The thallium scan shunt index was significantly higher in the decompensated liver cirrhosis group than in the compensated liver cirrhosis group (0.91 ± 0.39 vs 0.39 ± 0.32, P < 0.001). It was also higher in the varices group, the hepatic encephalopathy group, and the variceal bleeding group than in the control group (P < 0.001). Multivariate analysis showed that the index was an independent risk factor for predicting decompensated liver cirrhosis. When the cut-off value was 0.75, the shunt index had a sensitivity of 82.6%, a specificity of 84%, a positive predictive value of 61.5%, and a negative predictive value of 94.4% in diagnosing decompensated cirrhosis. When the shunt index was greater than 0.75, there was a significant increase in the number of decompensated events.
CONCLUSION: The thallium shunt index is a good predictor of cirrhosis-related complications.
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96
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Modlin IM, Oberg K, Taylor A, Drozdov I, Bodei L, Kidd M. Neuroendocrine tumor biomarkers: current status and perspectives. Neuroendocrinology 2014; 100:265-77. [PMID: 25300695 DOI: 10.1159/000368363] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/10/2014] [Indexed: 12/20/2022]
Abstract
The identification of accurate harbingers of disease status and therapeutic efficacy are critical requirements in precise diagnosis and effective management. Initially, tissue analysis was regarded as ideal but invasive strategies represent risk compared with peripheral blood sampling. Thus far, most biomarkers, whether in tissue or blood/urine, have been single analytes with varying degrees of sensitivity and specificity. Some analytes have not exhibited robust metrics or have lacked methodological rigor. Neuroendocrine disease represents an area of dire biomarker paucity since the individual biomarkers (gastrin, insulin, etc.) are not widely applicable to the diverse types of neuroendocrine neoplasia. Broad-spectrum markers such as chromogranin A have limitations in sensitivity, specificity and reproducibility. Monoanalytes cannot define the multiple variables (proliferation, metabolic activity, invasive potential, metastatic propensity) that constitute tumor growth. The restricted status of the neuroendocrine neoplasia field has resulted in a lack of comprehensive knowledge of the molecular and cellular biology of the disease, with tardy application of innovative technology. This overview examines limitations in current practice and describes contemporary viable strategies under evaluation, including the identification of novel analytes (gene transcripts, microRNA), circulating tumor cells and metabolic imaging agents that identify disease. Novel requirements are necessary to develop biomathematical algorithms for synchronous calibration of multiple molecular markers and predictive nomograms that interface biological variables to delineate disease progress or treatment efficacy. Optimally, the application of novel techniques and amalgamations of multianalyte assessment will provide a personalized molecular disease signature extrapolative of neuroendocrine neoplasia status and likelihood of progression and predictive of therapeutic opportunity.
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97
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Gabr SA, Alghadir AH. Prediction of fibrosis in hepatitis C patients: assessment using hydroxyproline and oxidative stress biomarkers. Virusdisease 2013; 25:91-100. [PMID: 24426315 DOI: 10.1007/s13337-013-0182-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 11/11/2013] [Indexed: 12/27/2022] Open
Abstract
This study aims to evaluate the diagnostic accuracy of aspartate aminotransferase (AST), alanine aminotransferase (ALT), hydroxyproline (Hyp), malondialdhyde (MDA), superoxide dismutase (SOD), and total antioxidant status (TAS) biomarkers in comparison with Metavir scoring for assessing the severity of hepatic fibrosis in the HCV patients. The histological activity index (HAI) was evaluated in liver biopsy by Metavir scoring system in 150 patients with HCV. HCV initial screening, further genotyping and biochemical data analysis were performed in serum using ELISA and biochemical assays. Out of the 150 HCV patients in this study, the most prevalent HCV genotype was genotype 4 (97 %). The significant fibrosis was estimated in 83.3 % of patients using the Metavir scoring system. They classified into 40 % of patients with mild fibrosis (F0-F1); 60 % with significant fibrosis (F2-4) and 20 % had cirrhosis (F4). Patients with cirrhosis (F4) showed significant correlation (P < 0.001) with increase in ALT, AST, AST/ALT, Hyp, Hyp/platelet count ratio, APRI, MDA, older age, and decrease (P < 0.001) in SOD, TAS, and platelet count compared to other stages of liver fibrosis. In our population, using optimized cut-off values of AST/ALT, APRI, Hyp, MDA, SOD, and TAS, significant fibrosis could be predicted accurately with a range of (80-90 %), and cirrhosis with a range of (67-97 %) of HCV patients. Our study showed that, oxidative stress and Hyp markers could be useful as noninvasive diagnostic markers in the assessment of hepatic fibrosis.
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Affiliation(s)
- Sami A Gabr
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt ; Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
| | - Ahmad H Alghadir
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
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98
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Sporea I, Bota S, Jurchis A, Sirli R, Grădinaru-Tascău O, Popescu A, Ratiu I, Szilaski M. Acoustic radiation force impulse and supersonic shear imaging versus transient elastography for liver fibrosis assessment. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1933-1941. [PMID: 23932281 DOI: 10.1016/j.ultrasmedbio.2013.05.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 05/06/2013] [Accepted: 05/09/2013] [Indexed: 06/02/2023]
Abstract
Our study compared three elastographic methods--transient elastography (TE), acoustic radiation force impulse (ARFI) imaging and supersonic shear imaging (SSI)--with respect to the feasibility of their use in liver fibrosis evaluation. We also compared the performance of ARFI imaging and SSI, with TE as the reference method. The study included 332 patients, with or without hepatopathies, in which liver stiffness was evaluated using TE, ARFI and SSI. Reliable measurements were defined as a median value of 10 (TE, ARFI imaging) or 5 (SSI) liver stiffness measurements with a success rate ≥60% and an interquartile range interval <30%. A significantly higher percentage of reliable measurements were obtained using ARFI than by using TE and SSI: 92.1% versus 72.2% (p < 0.0001) and 92.1% versus 71.3% (p < 0.0001). Higher body mass index and older age were significantly associated with inability to obtain reliable measurements of liver stiffness using TE and SSI. In 55.4% of patients, reliable liver stiffness measurements were obtained using all three elastographic methods, and ARFI imaging and TE were similarly accurate in diagnosing significant fibrosis and cirrhosis, with TE as the reference method.
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Affiliation(s)
- Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
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99
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Gutkowski K, Hartleb M, Kacperek-Hartleb T, Kajor M, Mazur W, Zych W, Walewska-Zielecka B, Habior A, Sobolewski M. Laboratory-based scoring system for prediction of hepatic inflammatory activity in patients with autoimmune hepatitis. Liver Int 2013; 33:1370-7. [PMID: 23651331 DOI: 10.1111/liv.12198] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 04/13/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS In autoimmune hepatitis (AIH), inflammation is closely related to fibrosis. Although transaminase levels are commonly used to assess hepatic inflammation, they may not relate directly to the histology. We developed a noninvasive diagnostic score as an alternative to liver biopsy to help optimize treatment for AIH and monitor disease progress. METHODS Eighty-two participants with type 1 AIH who had undergone liver biopsy were included (44 in training and 38 in validation sets). Liver histology was assessed according to the histologic activity index (HAI; score 0-18) and Ishak's histologic fibrosis index (HFI; score 0-6). High inflammation was defined as HAI>4, and advanced fibrosis was defined as HFI>2. Routine laboratory test findings and stepwise linear regression were used to develop the best models predicting HAI and HFI. The best cut-off value to predict high inflammation and advanced fibrosis for these formulas was then calculated based on receiver-operating characteristic analysis. RESULTS The cut-off value for a model predicting high inflammation was ≥3.57 (AUROC = 0.93; 95% CI: 0.86-1.00), with 100% sensitivity and 85% specificity. High inflammation was confirmed with an 81% positive predictive value and excluded with a 100% negative predictive value. In the validation set, the sensitivity, specificity, positive predictive value and negative predictive values were 100, 56, 88 and 100% respectively. The diagnostic yield of the fibrosis score was unsatisfactory. CONCLUSIONS The noninvasive inflammatory score based on four routine laboratory parameters discriminated patients with and without significant hepatic inflammation and may facilitate follow-up of type 1 AIH patients.
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Affiliation(s)
- Krzysztof Gutkowski
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
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100
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El-Kamary SS, Mohamed MM, El-Raziky M, Shardell MD, Shaker OG, ElAkel WA, Esmat G. Liver fibrosis staging through a stepwise analysis of non-invasive markers (FibroSteps) in patients with chronic hepatitis C infection. Liver Int 2013; 33:982-90. [PMID: 23509874 PMCID: PMC3793639 DOI: 10.1111/liv.12139] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 02/13/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-invasive fibrosis markers can distinguish between liver fibrosis stages in lieu of liver biopsy or imaging elastography. AIMS To develop a sensitive, non-invasive, freely-available algorithm that differentiates between individual liver fibrosis stages in chronic hepatitis C virus (HCV) patients. METHODS Chronic HCV patients (n = 355) at Cairo University Hospital, Egypt, with liver biopsy to determine fibrosis stage (METAVIR), were tested for preselected fibrosis markers. A novel multistage stepwise fibrosis classification algorithm (FibroSteps) was developed using random forest analysis for biomarker selection, and logistic regression for modelling. FibroSteps predicted fibrosis stage using four steps: Step 1 distinguished no(F0)/mild fibrosis(F1) vs. moderate(F2)/severe fibrosis(F3)/cirrhosis(F4); Step 2a distinguished F0 vs. F1; Step 2b distinguished F2 vs. F3/F4; and Step 3 distinguished F3 vs. F4. FibroSteps was developed using a randomly-selected training set (n = 234) and evaluated using the remaining patients (n = 118) as a validation set. RESULTS Hyaluronic Acid, TGF-β1, α2-macroglobulin, MMP-2, Apolipoprotein-A1, Urea, MMP-1, alpha-fetoprotein, haptoglobin, RBCs, haemoglobin and TIMP-1 were selected into the models, which had areas under the receiver operating curve (AUC) of 0.973, 0.923 (Step 1); 0.943, 0.872 (Step 2a); 0.916, 0.883 (Step 2b) and 0.944, 0.946 (Step 3), in the training and validation sets respectively. The final classification had accuracies of 94.9% (95% CI: 91.3-97.4%) and 89.8% (95% CI: 82.9-94.6%) for the training and validation sets respectively. CONCLUSIONS FibroSteps, a freely available, non-invasive liver fibrosis classification, is accurate and can assist clinicians in making prognostic and therapeutic decisions. The statistical code for FibroSteps using R software is provided in the supplementary materials.
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Affiliation(s)
- Samer S. El-Kamary
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA,Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA,Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mona M. Mohamed
- Department of Zoology, Faculty of Science, Cairo University, Cairo, Egypt
| | | | - Michelle D. Shardell
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Olfat G. Shaker
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
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