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Rizvi I, Solipuram D, Kaur N, Komel A, Batool S, Wang J. The enigma of sickle cell hepatopathy: Pathophysiology, clinical manifestations and therapy. Br J Haematol 2024. [PMID: 38978231 DOI: 10.1111/bjh.19620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/19/2024] [Indexed: 07/10/2024]
Abstract
Sickle cell disease (SCD) is one of the most common genetic disorders in the world predominantly affecting economically disadvantaged populations. There is a notable discrepancy between the growing adult SCD population and available diagnostic and therapeutic interventions for SCD. Sickle cell hepatopathy (SCH) is an all-inclusive term to describe the acute and chronic liver manifestations of SCD. The pathophysiology of SCH follows no defined pattern or sequence that poses challenges to clinicians and researchers alike. Evidence is lacking for this underreported disease at various levels from diagnostic to therapeutic options. This paper reviews the basic pathophysiology, clinical features, biochemical and radiological findings of various SCH manifestations and outlines the management of each condition. Old and new therapy options in SCD including hydroxyurea, red blood cell exchange transfusion, ursodeoxycholic acid, voxelotor, l-glutamine and crizanlizumab have been reviewed to investigate the role of these options in treating SCH. The role of liver transplant, haematopoietic stem cell transplant and gene therapy in SCH patients have been reviewed.
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Affiliation(s)
- Insia Rizvi
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Divya Solipuram
- Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA
| | - Navneet Kaur
- Internal Medicine, North Alabama Medical Center, Florence, Alabama, USA
| | - Aqsa Komel
- Internal Medicine, Nishtar Medical College and Hospital, Multan, Punjab, Pakistan
| | - Saba Batool
- Internal Medicine, Carle Health Methodist Hospital, Peoria, Illinois, USA
| | - Jennifer Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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Hassanzadeh M, Sanat ZM, Khayatian S, Sotoudeheian M, Shahbazian A, Hoseini S. Acute sickle cell hepatopathy: A case report and literature review. J Natl Med Assoc 2024; 116:119-125. [PMID: 38383222 DOI: 10.1016/j.jnma.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/01/2023] [Accepted: 09/30/2023] [Indexed: 02/23/2024]
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy with protean clinical manifestations. The liver could be affected by various SCD-associated complications of an overlapping nature. The clinical presentations of "sickle cell hepatopathy" range from clinically asymptomatic patients to those with life-threatening complications. Herein we report an SCD patient who presented with right upper quadrant abdominal pain and jaundice, eventually diagnosed as a self-limited form of acute sickle cell hepatopathy with overlapping features of acute hepatic crisis and benign intrahepatic cholestasis. Using this patient as an illustration, we will review the spectrum of hepatobiliary presentations in the SCD population.
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Affiliation(s)
- Morteza Hassanzadeh
- Department of Internal Medicine, School of Medicine, Colorectal Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Zahra Momayez Sanat
- Department of Internal Medicine, School of Medicine, Digestive Diseases Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Somayeh Khayatian
- Department of Internal Medicine, School of Medicine, Digestive Diseases Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Amirmasoud Shahbazian
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Duvoux C, Blaise L, Matimbo JJ, Mubenga F, Ngongang N, Hurtova M, Laurent A, Augustin J, Calderaro J, Reizine E, Luciani A, Habibi A, Bachir D, Vole G, Gellen-Dautremer J, Leroy V, Levesque E, Bartolucci P. The liver in sickle cell disease. Presse Med 2023; 52:104212. [PMID: 37981193 DOI: 10.1016/j.lpm.2023.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Liver involvement in SCD patients is frequent but often misdiagnosed or underestimated, except in case of advanced liver diseases. Because of so far poorly recognized forms of chronic SCD-related vascular injury that can silently evolved towards end stages or facilitate ACLF, any persisting liver function tests abnormalities should be carefully investigated, following the above proposed algorithm. Work up and management must be considered multidisciplinary in relationship with a Hepatologist. Early SCD hepatopathy should prompt revision of SCD management to prevent further liver injury and decompensation, discussing transfusion exchanges and hydro urea when not yet initiated, and control for any cofactor of liver injury. The role of HSCT in early SCD hepatopathies also deserves evaluation. In advanced SCD hepatopathies, liver transplantation, which has been rarely performed so far, is the only therapeutic option associated with improved survival. It should definitely be discussed- either electively in case of decompensation in SCD cirrhosis or jaundice/recurrent cholangitis in cholestatic diseases, with excellent outcome, - or emergently in case of ALF or ACLF with more mitigate results. To improve knowledge and management of SCD liver diseases, creation of national and international registries, as well as longitudinal observational cohorts are encouraged.
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Affiliation(s)
- Christophe Duvoux
- Department of Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital-APHP, University Paris Est Créteil, France.
| | - Lorraine Blaise
- Department of Hepatology and Liver Oncology, Avicenne Hospital-APHP, Bobigny, France
| | - Jean-Jacques Matimbo
- Department of Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital-APHP, University Paris Est Créteil, France; Department of Hepatology and Liver Oncology, Avicenne Hospital-APHP, Bobigny, France; Department of Hepatology and Gastroenterology, Clinique Universitaire Kinshasa, Democratic Republic of Congo
| | | | - Norbert Ngongang
- Department of Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital-APHP, University Paris Est Créteil, France
| | - Monika Hurtova
- Department of Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital-APHP, University Paris Est Créteil, France
| | - Alexis Laurent
- Department of Digestive & HPB Surgery, Henri Mondor Hospital-APHP, University Paris Est Créteil, France
| | - Jérémy Augustin
- Department of Pathology, Henri Mondor Hospital-APHP, University Paris Est Créteil, France
| | - Julien Calderaro
- Department of Pathology, Henri Mondor Hospital-APHP, University Paris Est Créteil, France
| | - Edouard Reizine
- Department of Radiology, Henri Mondor Hospital-APHP, University Paris Est Créteil, France
| | - Alain Luciani
- Department of Radiology, Henri Mondor Hospital-APHP, University Paris Est Créteil, France
| | - Anoosha Habibi
- UMGGR, Department of Internal Medicine, Sickle Cell National Referral Center, Henri Mondor-Hospital APHP, University Paris Est Créteil, France; IMRB, UPEC, INSERM, EFS, Team Pirenne. University Paris Est Créteil, France
| | - Dora Bachir
- UMGGR, Department of Internal Medicine, Sickle Cell National Referral Center, Henri Mondor-Hospital APHP, University Paris Est Créteil, France
| | - Geoffroy Vole
- UMGGR, Department of Internal Medicine, Sickle Cell National Referral Center, Henri Mondor-Hospital APHP, University Paris Est Créteil, France; IMRB, UPEC, INSERM, EFS, Team Pirenne. University Paris Est Créteil, France
| | | | - Vincent Leroy
- Department of Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital-APHP, University Paris Est Créteil, France
| | - Eric Levesque
- Department of Anesthesia and Surgical Intensive Care-liver ICU, Henri Mondor Hospital-APHP, University Paris Est Créteil, France
| | - Pablo Bartolucci
- UMGGR, Department of Internal Medicine, Sickle Cell National Referral Center, Henri Mondor-Hospital APHP, University Paris Est Créteil, France; IMRB, UPEC, INSERM, EFS, Team Pirenne. University Paris Est Créteil, France
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Mohamed KA, Nephew LD, Kaur H. Sickle cell hepatopathy: An underrecognized and undertreated cause of chronic liver disease. Clin Liver Dis (Hoboken) 2023; 22:229-232. [PMID: 38143814 PMCID: PMC10745239 DOI: 10.1097/cld.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/05/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Kawthar A. Mohamed
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lauren D. Nephew
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Harleen Kaur
- Department of Medicine, Division of Gastroenterology and Hepatology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Li J, Han KX, Shen JP, Sun WJ, Gao L, Gao YF. Value of XGBoost machine learning model for diagnosis of hepatitis B cirrhosis. Shijie Huaren Xiaohua Zazhi 2023; 31:544-554. [DOI: 10.11569/wcjd.v31.i13.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/25/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The progression of chronic hepatitis B into cirrhosis is slow and easily ignored, and the construction of a noninvasive diagnostic model for cirrhosis based on routine clinical indicators has become a hot research topic. However, there is still a lack of machine learning models regarding the early diagnosis of cirrhosis.
AIM To investigate the performance of the extreme gradient boosting (XGBoost) machine model in the diagnosis of hepatitis B cirrhosis.
METHODS A retrospective analysis was performed on 1087 patients with chronic hepatitis B virus infection (CHBV) diagnosed for the first time at the Department of Infection, The First/Second Affiliated Hospital of Anhui Medical University from 2010 to 2018. The patients were divided into training and validation sets in a 3:1 ratio according to the randomization principle. Clinical data of all study participants were collected and prediction models were constructed using XGBoost machine learning model. Meanwhile, the aspartate aminotransferase/platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores were calculated and compared with the XGBoost machine learning model. Area under the curve (AUC) was used to assess the model discrimination, and calibration curve (CA) and decision curve analysis (DCA) were used to assess the model calibration and benefit.
RESULTS A total of 1087 CHBV patients were included, including 817 in the training set and 270 in the validation set. There was no statistical difference between the training and validation sets for all predictor variables (P > 0.05). Cirrhosis occurred in 103 patients in the training set, and APRI and FIB-4 scores were significantly higher in cirrhotic patients than in non-cirrhotic patients (P < 0.05). The relative importance of platelets was the highest among all predictors. The AUCs of the model in the training and validation sets were 0.95 and 0.86 (P < 0.05), respectively, and the Kappa values were 0.78 and 0.74, which suggested that the model was reproducible. CA curve analysis indicated that the model predicted a high degree of agreement with the true situation fit. DCA of the training and validation sets implied that the developed model could result in a high degree of benefit for patients. XGBoost machine learning model was significantly more efficient for the diagnosis of cirrhosis than APRI and FIB-4 scores.
CONCLUSION The XGBoost machine learning model constructed in this study based on common clinical information of CHBV patients has an excellent performance for the diagnosis of cirrhosis and deserves further clinical promotion.
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Affiliation(s)
- Ji Li
- Department of Infection, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Ke-Xing Han
- Department of Infection, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jia-Pei Shen
- Department of Infection, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Wei-Jie Sun
- Department of Infection, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Long Gao
- Department of Infection, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Yu-Feng Gao
- Department of Infection, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
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Burley NB, Miller KD. Acute Liver Failure in Sickle Cell Disease: A Perfect Storm. Cureus 2021; 13:e15680. [PMID: 34159039 PMCID: PMC8212850 DOI: 10.7759/cureus.15680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Sickle cell hepatopathy is a well-described but uncommonly seen complication of sickle cell disease and is usually caused by multiple overlapping processes. A more acute liver complication is hepatic sequestration which is important to recognize in order to initiate life-saving treatment. A 33-year-old woman with sickle cell disease complicated by painful crises, splenic infarction and significant alcohol abuse presented with gastrointestinal distress, pain crisis, acute-on-chronic anemia, and hyperbilirubinemia in the setting of greater than baseline alcohol consumption. She was found to have hepatomegaly, encephalopathy, severe jaundice, and severe hyperbilirubinemia. She was treated with red cell exchange and supportive care which resulted in an improvement in her symptoms as well as hyperbilirubinemia. She was discharged with plans for monthly red cell exchange, iron chelation therapy, and close monitoring of liver disease was planned upon discharge. This case illustrates that chronic liver disease can occur in sickle cell disease (Hgb SS) especially in the setting of acquired iron overload. More acutely, sequestration is a serious and life-threatening complication of sickle cell disease that can culminate in acute liver failure. Primary treatment for hepatic sequestration is red cell exchange along with management of contributing comorbidities, and symptomatic management of encephalopathy. In end-stage liver disease, transplantation may be considered in the context of the patient’s clinical status.
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