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Kang CM, Ku HJ, Moon HH, Kim SE, Jo JH, Choi YI, Shin DH. Predicting Safe Liver Resection Volume for Major Hepatectomy Using Artificial Intelligence. J Clin Med 2024; 13:381. [PMID: 38256518 PMCID: PMC10816299 DOI: 10.3390/jcm13020381] [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: 12/06/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Advancements in the field of liver surgery have led to a critical need for precise estimations of preoperative liver function to prevent post-hepatectomy liver failure (PHLF), a significant cause of morbidity and mortality. This study introduces a novel application of artificial intelligence (AI) in determining safe resection volumes according to a patient's liver function in major hepatectomies. (2) Methods: We incorporated a deep learning approach, incorporating a unique liver-specific loss function, to analyze patient characteristics, laboratory data, and liver volumetry from computed tomography scans of 52 patients. Our approach was evaluated against existing machine and deep learning techniques. (3) Results: Our approach achieved 68.8% accuracy in predicting safe resection volumes, demonstrating superior performance over traditional models. Furthermore, it significantly reduced the mean absolute error in under-predicted volumes to 23.72, indicating a more precise estimation of safe resection limits. These findings highlight the potential of integrating AI into surgical planning for liver resections. (4) Conclusion: By providing more accurate predictions of safe resection volumes, our method aims to minimize the risk of PHLF, thereby improving clinical outcomes for patients undergoing hepatectomy.
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Affiliation(s)
- Chol Min Kang
- Department of Applied Biomedical Engineering, The Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Hyung June Ku
- Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea; (H.J.K.); (J.H.J.); (Y.I.C.); (D.H.S.)
| | - Hyung Hwan Moon
- Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea; (H.J.K.); (J.H.J.); (Y.I.C.); (D.H.S.)
- Division of Hepatobiliary-Pancreas and Transplantation, Department of Surgery, Kosin University Gospel Hospital, Busan 49267, Republic of Korea
| | - Seong-Eun Kim
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea;
| | - Ji Hoon Jo
- Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea; (H.J.K.); (J.H.J.); (Y.I.C.); (D.H.S.)
- Division of Hepatobiliary-Pancreas and Transplantation, Department of Surgery, Kosin University Gospel Hospital, Busan 49267, Republic of Korea
| | - Young Il Choi
- Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea; (H.J.K.); (J.H.J.); (Y.I.C.); (D.H.S.)
- Division of Hepatobiliary-Pancreas and Transplantation, Department of Surgery, Kosin University Gospel Hospital, Busan 49267, Republic of Korea
| | - Dong Hoon Shin
- Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea; (H.J.K.); (J.H.J.); (Y.I.C.); (D.H.S.)
- Division of Hepatobiliary-Pancreas and Transplantation, Department of Surgery, Kosin University Gospel Hospital, Busan 49267, Republic of Korea
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2
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Chrabąszcz K, Kołodziej M, Roman M, Pięta E, Piergies N, Rudnicka-Czerwiec J, Bartosik-Psujek H, Paluszkiewicz C, Cholewa M, Kwiatek WM. Carotenoids contribution in rapid diagnosis of multiple sclerosis by Raman spectroscopy. Biochim Biophys Acta Gen Subj 2023:130395. [PMID: 37271406 DOI: 10.1016/j.bbagen.2023.130395] [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: 01/20/2023] [Revised: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
Rapid and accurate diagnosis of any illness determines the success of treatment. The same applies to multiple sclerosis (MS), chronic, inflammatory, and neurodegenerative diseases (ND) of the central nervous system (CNS). Unfortunately, the definitive diagnosis of MS is prolonged and involves mainly clinical symptoms observation and magnetic resonance imaging (MRI) of the CNS. However, as we previously reported, Attenuated Total Reflectance Fourier Transform Infrared (ATR-FTIR) spectroscopy shed new light on the minimally invasive, label-free, and rapid diagnosis of this illness through blood fraction. Herein we introduce Raman spectroscopy coupled with chemometric analysis to provide more detailed information about the biochemical changes behind MS. This pilot study demonstrates that mentioned combination may provide a new diagnostic biomarker and bring closer to rapid MS diagnosis. It has been shown that Raman spectroscopy provides lipid and carotenoid molecules as useful biomarkers which may be applied for both diagnosis and treatment monitoring.
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Affiliation(s)
- Karolina Chrabąszcz
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Krakow, Poland.
| | - Magdalena Kołodziej
- Institute of Medical Sciences, Medical College of Rzeszow University, Kopisto 2a, 35-315 Rzeszow, Poland
| | - Maciej Roman
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Krakow, Poland; SOLARIS, National Synchrotron Radiation Centre, Jagiellonian University, Czerwone Maki 98, 30-392, Krakow, Poland
| | - Ewa Pięta
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Krakow, Poland
| | - Natalia Piergies
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Krakow, Poland
| | - Julia Rudnicka-Czerwiec
- Department of Neurology, Institute of Medical Sciences, Medical College of Rzeszow University, Warzywna 1a, 35-310 Rzeszow, Poland
| | - Halina Bartosik-Psujek
- Department of Neurology, Institute of Medical Sciences, Medical College of Rzeszow University, Warzywna 1a, 35-310 Rzeszow, Poland
| | - Czesława Paluszkiewicz
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Krakow, Poland
| | - Marian Cholewa
- Institute of Physics, College of Natural Sciences, University of Rzeszow, Pigonia Street 1, 35-959 Rzeszow, Poland
| | - Wojciech M Kwiatek
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Krakow, Poland
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Niu X, Zhu L, Xu Y, Zhang M, Hao Y, Ma L, Li Y, Xing H. Global prevalence, incidence, and outcomes of alcohol related liver diseases: a systematic review and meta-analysis. BMC Public Health 2023; 23:859. [PMID: 37170239 PMCID: PMC10173666 DOI: 10.1186/s12889-023-15749-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Alcohol related liver disease (ARLD) is one of the major chronic liver diseases worldwide. This review aimed to describe the global prevalence, incidence, and outcomes of ARLD. METHODS Medline, Embase, The Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched from inception to May 31, 2022. The language was restricted to English or Chinese. According to the criteria, articles describing the basic characteristics of the population were selected. Two reviewers extracted the data independently. RESULTS A total of 372 studies were identified: 353 were used for prevalence analysis, 7 were used for incidence analysis, and 114 were used to for outcome analysis. The prevalence of ARLD worldwide was 4.8%. The prevalence in males was 2.9%, which was higher than female (0.5%). Among the ethnic groups, the percentage was highest in Caucasians (68.9%). Alcoholic liver cirrhosis comprised the highest proportion in the disease spectrum of ARLD at 32.9%. The prevalence of ascites in ARLD population was highest (25.1%). The ARLD population who drinking for > 20 years accounted for 54.8%, and the average daily alcohol intake was 146.6 g/d. About 59.5% of ARLD patients were current or former smokers, and 18.7% were complicated with hepatitis virus infection. The incidence was 0.208/1000 person-years. The overall mortality was 23.9%, and the liver-related mortality was 21.6%. CONCLUSION The global prevalence of ARLD was 4.8% and was affected by sex, region, drinking years, and other factors. Therefore, removing the factors causing a high disease prevalence is an urgent requisite. TRIAL REGISTRATION PROSPERO Nr: CRD42021286192.
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Affiliation(s)
- Xuanxuan Niu
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Lin Zhu
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Yifan Xu
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Menghan Zhang
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Yanxu Hao
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Lei Ma
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Yan Li
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China
| | - Huichun Xing
- Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, 8 Jingshundong Street, Chaoyang District, Beijing, 100015, China.
- Peking University Ditan Teaching Hospital, Beijing, 100015, China.
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Milovanovic T, Lugonja S, Pantic I, Miltenovic S, Vlaisavljevic Z, Mardani A. Cirrhosis Due to Alcohol-Related Liver Disease Hospitalizations in Belgrade, Serbia: A 10-Year Retrospective. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:2271-2280. [PMID: 36415809 PMCID: PMC9647601 DOI: 10.18502/ijph.v51i10.10985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/24/2021] [Indexed: 08/29/2023]
Abstract
BACKGROUND Cirrhosis due to alcohol-related liver disease (ALD cirrhosis) is a significant burden to health systems worldwide. We aimed to determine the trends in hospitalization frequency due to ALD cirrhosis and to analyze their characteristics. METHODS This cross-sectional study used data from the Institute of Public Health of Belgrade database, and included all hospitalization reports which contained code K70.3 (Cirrhosis hepatis alcoholica) as the primary diagnosis, including re-hospitalizations, on the territory of Belgrade, between January 2009 and December 2018. RESULTS A total of 4644 patients with ALD cirrhosis were hospitalized (male: 4154, 89.45%), with a mean age of 58.83±10.02 years. During the 2009-2018 decade, no difference in the number of ALD cirrhosis hospitalizations in subsequent years was observed. Men more commonly developed esophageal and gastric varices with bleeding compared to women (P=0.037), while women developed acute-on-chronic liver failure (ACLF) almost two-times more often compared to men (P<0.001). Patients with hepatocellular carcinoma were significantly older (P<0.001), while those who developed ascites and splenomegaly were significantly younger compared to those who did not (P<0.001 and P=0.04, respectively). Altogether, complications of portal hypertension were registered and reported with very low frequency, and therefore do not represent actual frequencies of these conditions. The median duration of hospital stay was 9 days (range 0-243). Patients in whom lethal outcome occurred during the hospitalization were significantly older, and more commonly developed chronic renal failure. CONCLUSION These data offer an important insight into the ALD cirrhosis-related hospitalizations while drawing attention to inadequate coding as an important public health issue at the same time.
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Affiliation(s)
- Tamara Milovanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sofija Lugonja
- General Hospital “DjordjeJoanovic”, Department of Internal Medicine, Division of gastroenterology, Zrenjanin, Serbia
| | - Ivana Pantic
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Zeljko Vlaisavljevic
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical School of Vocational Studies Medika, Belgrade, Serbia
| | - Abbas Mardani
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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5
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Liu D, Yang Z, Chandler K, Oshodi A, Zhang T, Ma J, Kusumanchi P, Huda N, Heathers L, Perez K, Tyler K, Ross RA, Jiang Y, Zhang D, Zhang M, Liangpunsakul S. Serum metabolomic analysis reveals several novel metabolites in association with excessive alcohol use - an exploratory study. Transl Res 2022; 240:87-98. [PMID: 34743014 PMCID: PMC9506418 DOI: 10.1016/j.trsl.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/16/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023]
Abstract
Appropriate screening tool for excessive alcohol use (EAU) is clinically important as it may help providers encourage early intervention and prevent adverse outcomes. We hypothesized that patients with excessive alcohol use will have distinct serum metabolites when compared to healthy controls. Serum metabolic profiling of 22 healthy controls and 147 patients with a history of EAU was performed. We employed seemingly unrelated regression to identify the unique metabolites and found 67 metabolites (out of 556), which were differentially expressed in patients with EAU. Sixteen metabolites belong to the sphingolipid metabolism, 13 belong to phospholipid metabolism, and the remaining 38 were metabolites of 25 different pathways. We also found 93 serum metabolites that were significantly associated with the total quantity of alcohol consumption in the last 30 days. A total of 15 metabolites belong to the sphingolipid metabolism, 11 belong to phospholipid metabolism, and 7 metabolites belong to lysolipid. Using a Venn diagram approach, we found the top 10 metabolites with differentially expressed in EAU and significantly associated with the quantity of alcohol consumption, sphingomyelin (d18:2/18:1), sphingomyelin (d18:2/21:0,d16:2/23:0), guanosine, S-methylmethionine, 10-undecenoate (11:1n1), sphingomyelin (d18:1/20:1, d18:2/20:0), sphingomyelin (d18:1/17:0, d17:1/18:0, d19:1/16:0), N-acetylasparagine, sphingomyelin (d18:1/19:0, d19:1/18:0), and 1-palmitoyl-2-palmitoleoyl-GPC (16:0/16:1). The diagnostic performance of the top 10 metabolites, using the area under the ROC curve, was significantly higher than that of commonly used markers. We have identified a unique metaboloic signature among patients with EAU. Future studies to validate and determine the kinetics of these markers as a function of alcohol consumption are needed.
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Affiliation(s)
- Danni Liu
- Department of Statistics, Purdue University, West Lafayette, Indiana
| | - Zhihong Yang
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kristina Chandler
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adepeju Oshodi
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ting Zhang
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jing Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Praveen Kusumanchi
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nazmul Huda
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura Heathers
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indiana
| | - Kristina Perez
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kelsey Tyler
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ruth Ann Ross
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Yanchao Jiang
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dabao Zhang
- Department of Statistics, Purdue University, West Lafayette, Indiana
| | - Min Zhang
- Department of Statistics, Purdue University, West Lafayette, Indiana.
| | - Suthat Liangpunsakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indiana; Roudebush Veterans Administration Medical Center, Indianapolis, Indiana.
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6
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Lindvig KP, Hansen TL, Madsen BS, Kjaergaard M, Møller L, Detlefsen S, Krag A, Thiele M. Diagnostic accuracy of routine liver function tests to identify patients with significant and advanced alcohol-related liver fibrosis. Scand J Gastroenterol 2021; 56:1088-1095. [PMID: 34415817 DOI: 10.1080/00365521.2021.1929450] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Alcohol is the leading cause of cirrhosis, but most patients go undetected until decompensation occurs despite frequent contacts with the healthcare system. We aimed to evaluate the diagnostic accuracy of routine liver function tests compared with indirect and direct fibrosis markers and to assess doctors' abilities to diagnose significant and advanced alcohol-related liver fibrosis. METHODS This study was a retrospective evaluation of liver function tests for diagnosing alcohol-related liver disease compared to indirect fibrosis tests, the ELF test, and transient elastography. We also surveyed nine doctors who were presented with 225 patient cases from a cross-sectional, biopsy-controlled, single-centre study that evaluated diagnostic tools for alcohol-related liver fibrosis. The doctors assessed each case for significant (≥F2) or advanced (≥F3) fibrosis. We assessed inter-rater variability with Fleiss' kappa. RESULTS Routine liver function tests had poor diagnostic accuracy (highest area under the ROC curve for platelet count = 0.752) and poor sensitivities (10%-67%) when using the upper or lower normal limits as cut-offs. Indirect fibrosis indices performed significantly better but were still inferior to the ELF test and transient elastography. The nine doctors disagreed substantially in their predictions, with Fleiss' kappa of 0.24 (95% CI0.22-0.26) and 0.51 (0.44-0.55) for significant and advanced fibrosis. All nine doctors exhibited poor case-finding abilities with sensitivities of 22-93%. CONCLUSIONS When using routine liver function tests, doctors may fail to diagnose more than half of all alcohol-overusing patients with advanced fibrosis, probably because they rely on upper and lower normal limits of routine liver function tests.
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Affiliation(s)
- Katrine P Lindvig
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Thor L Hansen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Bjørn S Madsen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Maria Kjaergaard
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Linda Møller
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sönke Detlefsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maja Thiele
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
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7
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Åberg F, Danford CJ, Thiele M, Talbäck M, Rasmussen DN, Jiang ZG, Hammar N, Nasr P, Ekstedt M, But A, Puukka P, Krag A, Sundvall J, Erlund I, Salomaa V, Stål P, Kechagias S, Hultcrantz R, Lai M, Afdhal N, Jula A, Männistö S, Lundqvist A, Perola M, Färkkilä M, Hagström H. A Dynamic Aspartate-to-Alanine Aminotransferase Ratio Provides Valid Predictions of Incident Severe Liver Disease. Hepatol Commun 2021; 5:1021-1035. [PMID: 34141987 PMCID: PMC8183175 DOI: 10.1002/hep4.1700] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 12/15/2022] Open
Abstract
The aspartate-to-alanine aminotransferase ratio (AAR) is associated with liver fibrosis, but its predictive performance is suboptimal. We hypothesized that the association between AAR and liver disease depends on absolute transaminase levels and developed and validated a model to predict liver-related outcomes in the general population. A Cox regression model based on age, AAR, and alanine aminotransferase (ALT) level (dynamic AAR [dAAR]) using restricted cubic splines was developed in Finnish population-based health-examination surveys (FINRISK, 2002-2012; n = 18,067) with linked registry data for incident liver-related hospitalizations, hepatocellular carcinoma, or liver death. The model was externally validated for liver-related outcomes in a Swedish population cohort (Swedish Apolipoprotein Mortality Risk [AMORIS] subcohort; n = 126,941) and for predicting outcomes and/or prevalent fibrosis/cirrhosis in biopsied patients with nonalcoholic fatty liver disease (NAFLD), chronic hepatitis C, or alcohol-related liver disease (ALD). The dynamic AAR model predicted liver-related outcomes both overall (optimism-corrected C-statistic, 0.81) and in subgroup analyses of the FINRISK cohort and identified persons with >10% risk for liver-related outcomes within 10 years. In independent cohorts, the C-statistic for predicting liver-related outcomes up to a 10-year follow-up was 0.72 in the AMORIS cohort, 0.81 in NAFLD, and 0.75 in ALD. Area-under-the-curve (AUC) for detecting prevalent cirrhosis was 0.80-0.83 in NAFLD, 0.80 in hepatitis C, but only 0.71 in ALD. In ALD, model performance improved when using aspartate aminotransferase instead of ALT in the model (C-statistic, 0.84 for outcome; AUC, 0.82 for prevalent cirrhosis). Conclusion: A dAAR score provides prospective predictions for the risk of incident severe liver outcomes in the general population and helps detect advanced liver fibrosis/cirrhosis. The dAAR score could potentially be used for screening the unselected general population and as a trigger for further liver evaluations.
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery ClinicHelsinki University HospitalHelsinki UniversityHelsinkiFinland
- The Transplant InstituteSahlgrenska University HospitalGothenburgSweden
| | - Christopher J. Danford
- Division of Gastroenterology and HepatologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Maja Thiele
- Department of Gastroenterology and HepatologyOdense University HospitalOdenseDenmark
- Department for Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Mats Talbäck
- Unit of EpidemiologyInstitute of Environmental MedicineKarolinska InstitutetStockholmSweden
| | | | - Z. Gordon Jiang
- Division of Gastroenterology and HepatologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Niklas Hammar
- Unit of EpidemiologyInstitute of Environmental MedicineKarolinska InstitutetStockholmSweden
| | - Patrik Nasr
- Department of Health, Medicine, and Caring SciencesLinköping UniversityLinköpingSweden
| | - Mattias Ekstedt
- Department of Health, Medicine, and Caring SciencesLinköping UniversityLinköpingSweden
| | - Anna But
- Biostatistics ConsultingDepartment of Public HealthUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | | | - Aleksander Krag
- Department of Gastroenterology and HepatologyOdense University HospitalOdenseDenmark
- Department for Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Jouko Sundvall
- Department of Government ServicesFinnish Institute for Health and WelfareHelsinkiFinland
| | - Iris Erlund
- Department of Government ServicesFinnish Institute for Health and WelfareHelsinkiFinland
| | | | - Per Stål
- Unit of HepatologyDivision of Upper Gastrointestinal DiseasesKarolinska University HospitalStockholmSweden
- Department of MedicineHuddingeKarolinska InstitutetStockholmSweden
| | - Stergios Kechagias
- Department of Health, Medicine, and Caring SciencesLinköping UniversityLinköpingSweden
| | - Rolf Hultcrantz
- Department of MedicineSolnaKarolinska InstitutetStockholmSweden
| | - Michelle Lai
- Division of Gastroenterology and HepatologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Nezam Afdhal
- Division of Gastroenterology and HepatologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Antti Jula
- Finnish Institute for Health and WelfareHelsinkiFinland
| | - Satu Männistö
- Finnish Institute for Health and WelfareHelsinkiFinland
| | | | - Markus Perola
- Finnish Institute for Health and WelfareHelsinkiFinland
| | - Martti Färkkilä
- Clinic of GastroenterologyHelsinki University and Helsinki University HospitalHelsinkiFinland
| | - Hannes Hagström
- Unit of HepatologyDivision of Upper Gastrointestinal DiseasesKarolinska University HospitalStockholmSweden
- Department of MedicineHuddingeKarolinska InstitutetStockholmSweden
- Unit of EpidemiologyDepartment of Medicine SolnaKarolinska InstitutetStockholmSweden
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8
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Velarde-Ruiz Velasco JA, Higuera-de la Tijera MF, Castro-Narro GE, Zamarripa-Dorsey F, Abdo-Francis JM, Aiza Haddad I, Aldana Ledesma JM, Bielsa-Fernández MV, Cerda-Reyes E, Cisneros-Garza LE, Contreras-Omaña R, Reyes-Dorantes A, Fernández-Pérez NJ, García-Jiménez ES, Icaza-Chávez ME, Kershenobich-Stalnikowitz D, Lira-Pedrín MA, Moreno-Alcántar R, Pérez-Hernández JL, Ramos-Gómez MV, Rizo-Robles MT, Solana-Sentíes S, Torre-Delgadillo A. The Mexican consensus on alcoholic hepatitis. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2020; 85:332-353. [PMID: 32532534 DOI: 10.1016/j.rgmx.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
Alcoholic hepatitis is a frequent condition in the Mexican population. It is characterized by acute-on-chronic liver failure, important systemic inflammatory response, and multiple organ failure. The severe variant of the disease implies elevated mortality. Therefore, the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología brought together a multidisciplinary team of health professionals to formulate the first Mexican consensus on alcoholic hepatitis, carried out utilizing the Delphi method and resulting in 37 recommendations. Alcohol-related liver disease covers a broad spectrum of pathologies that includes steatosis, steatohepatitis, different grades of fibrosis, and cirrhosis and its complications. Severe alcoholic hepatitis is defined by a modified Maddrey's discriminant function score ≥ 32 or by a Model for End-Stage Liver Disease (MELD) score equal to or above 21. There is currently no specific biomarker for its diagnosis. Leukocytosis with neutrophilia, hyperbilirubinemia (> 3 mg/dL), AST > 50 U/l (< 400 U/l), and an AST/ALT ratio > 1.5-2 can guide the diagnosis. Abstinence from alcohol, together with nutritional support, is the cornerstone of treatment. Steroids are indicated for severe disease and have been effective in reducing the 28-day mortality rate. At present, liver transplantation is the only life-saving option for patients that are nonresponders to steroids. Certain drugs, such as N-acetylcysteine, granulocyte-colony stimulating factor, and metadoxine, can be adjuvant therapies with a positive impact on patient survival.
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Affiliation(s)
- J A Velarde-Ruiz Velasco
- Servicio de Gastroenterología; Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México.
| | - M F Higuera-de la Tijera
- Servicio de Gastroenterología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - G E Castro-Narro
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | | | - I Aiza Haddad
- Clínica de Enfermedades Hepáticas, Hospital Ángeles Lomas, Estado de México, México
| | - J M Aldana Ledesma
- Servicio de Gastroenterología; Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | | | | | | | - R Contreras-Omaña
- Centro de Investigación en Enfermedades Hepáticas y Gastroenterología, Pachuca, Hidalgo, México
| | | | | | - E S García-Jiménez
- Servicio de Gastroenterología; Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | | | | | - M A Lira-Pedrín
- Servicio de Medicina Interna y Gastroenterología. Hospital y Centro Médico del Prado, Tijuana, Baja California, México
| | - R Moreno-Alcántar
- Unidad Médica de Alta Especialidad, Hospital de Especialidades CMN SXXI, Ciudad de México, México
| | - J L Pérez-Hernández
- Servicio de Gastroenterología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México; Hospital Central Sur de Alta Especialidad Petróleos Mexicanos, Ciudad de México, México
| | - M V Ramos-Gómez
- Centro Médico Nacional 20 de Noviembre, Ciudad de México, México
| | - M T Rizo-Robles
- Unidad Médica de Alta Especialidad, Hospital de Especialidades CMN SXXI, Ciudad de México, México
| | | | - A Torre-Delgadillo
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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9
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Velarde-Ruiz Velasco J, Higuera-de la Tijera M, Castro-Narro G, Zamarripa-Dorsey F, Abdo-Francis J, Haddad IA, Aldana Ledesma J, Bielsa-Fernández M, Cerda-Reyes E, Cisneros-Garza L, Contreras-Omaña R, Reyes-Dorantes A, Fernández-Pérez N, García-Jiménez E, Icaza-Chávez M, Kershenobich-Stalnikowitz D, Lira-Pedrín M, Moreno-Alcántar R, Pérez-Hernández J, Ramos-Gómez M, Rizo-Robles M, Solana-Sentíes S, Torre-Delgadillo A. The Mexican consensus on alcoholic hepatitis. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [DOI: 10.1016/j.rgmxen.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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10
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Crabb DW, Im GY, Szabo G, Mellinger JL, Lucey MR. Diagnosis and Treatment of Alcohol-Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases. Hepatology 2020; 71:306-333. [PMID: 31314133 DOI: 10.1002/hep.30866] [Citation(s) in RCA: 418] [Impact Index Per Article: 104.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 12/12/2022]
Affiliation(s)
- David W Crabb
- Indiana University School of Medicine, Indianapolis, IN
| | - Gene Y Im
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gyongyi Szabo
- University of Massachusetts Medical School, Worcester, MA
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11
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Godfrey EL, Stribling R, Rana A. Liver Transplantation for Alcoholic Liver Disease: An Update. Clin Liver Dis 2019; 23:127-139. [PMID: 30454827 DOI: 10.1016/j.cld.2018.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Alcoholic liver disease is a serious and increasing contributor to the global liver disease burden. Extensive selection criteria, including a minimum abstinence period, has previously been used to secure good outcomes but new research questions the effectiveness of abstinence periods and has recommended changes in integrated alcohol use treatment to effectively prevent relapse. Patients have unique health concerns, including posttransplantation risks of malignancy and metabolic complications, but overall very good long-term outcomes. Severe alcoholic hepatitis has been increasingly treated with early transplantation without a set sobriety period, with overall favorable outcomes, even with respect to recidivism.
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Affiliation(s)
- Elizabeth L Godfrey
- Department of Student Affairs, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | | | - Abbas Rana
- 6620 Main Street, Suite 1425, Houston, TX 77030, USA
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