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Adiri WN, Basil B, Onyia CP, Asogwa P, Ugwuanyi OJ, Obienu O, Ijoma UN, Nwokediuko SC. Association between serum vitamin D status and severity of liver cirrhosis: implications for therapeutic targeting in Nigerian patients. BMC Gastroenterol 2024; 24:259. [PMID: 39135191 PMCID: PMC11318153 DOI: 10.1186/s12876-024-03353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Liver cirrhosis is a chronic and progressive liver disease with significant global health implications. Recent evidence suggests an association between serum vitamin D levels and the severity of liver cirrhosis, potentially serving as a therapeutic target. This study aimed to investigate the relationship between serum vitamin D status and the severity of liver cirrhosis in a population of Nigerian patients. METHODS This analytical, cross-sectional study involved 201 participants, including 103 with liver cirrhosis and 98 age- and sex-matched controls. Serum vitamin D was measured using ELISA, with deficiency defined as < 20 ng/ml. Cirrhosis severity was assessed using Child-Pugh and MELD scores. Spearman's correlation was used to assess the relationship between vitamin D and severity of liver cirrhosis while ordinal regression analysis assessed its performance as an indicator of the disease severity. RESULT Among cirrhotic patients, 36.9% were deficient, 31.1% insufficient, and 32.0% had sufficient vitamin D levels. Serum vitamin D showed strong negative correlations with Child-Pugh and MELD scores (r = -0.696, p < 0.001; r = -0.734, p < 0.001, respectively). Ordinal regression showed that higher vitamin D levels were associated with lower severity scores (Child-Pugh: OR = 0.856, 95% CI: 0.815-0.900, p < 0.001; MELD: OR = 0.875, 95% CI: 0.837-0.915, p < 0.001). CONCLUSION Lower serum vitamin D levels correlated with increased liver cirrhosis severity, suggesting its potential as both a prognostic marker and therapeutic target. Further studies should investigate the efficacy of vitamin D supplementation in improving cirrhosis outcomes.
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Affiliation(s)
- Winnifred Njideka Adiri
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Bruno Basil
- Department of Chemical Pathology, Benue State University, Makurdi, Nigeria.
| | - Chinwe Philomena Onyia
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Promise Asogwa
- Department of Medicine, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Oluchi Joy Ugwuanyi
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Olive Obienu
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Uchenna Nkemdilim Ijoma
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Slyvester Chuks Nwokediuko
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
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Panezai MQ, Taha Yaseen R, Ahmed Khan S, Abrar G, Ali Khalid M, Ul Haque MM, Lail G, Kumar D, Laeeq SM, Hassan Luck N. Predictors of Frailty in Patients With Liver Cirrhosis. Cureus 2024; 16:e61626. [PMID: 38966454 PMCID: PMC11222761 DOI: 10.7759/cureus.61626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction Frailty is noticed in a large number of cirrhotic patients with advanced liver disease. Frailty not only disposes cirrhotic patients to increased rates of decompensation and hospitalization but also leads to prolonged hospital stay and increased psychological and social impact, resulting in the delisting of these patients from the transplant list. Therefore, our aim was to identify the factors that are independent predictors of frailty in patients with liver cirrhosis. Methods This cross-sectional study was carried out at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from March 1, 2022, to August 31, 2022. All the patients diagnosed with liver cirrhosis and aged 18-70 years were included in the study. The excluded patients comprised those with disorders that over-estimate frailty such as cardiopulmonary disease and hepatocellular carcinoma. The measurement of the Liver Frailty Index (LFI) was done using the hand grip strength method, timed chair stands, and balance testing. Patients with LFI >4.5 were considered frail. All data was entered and analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States). Continuous variables were analyzed using the student-t test while categorical variables were analyzed using the chi-square test. Variables with significance on univariate analysis then underwent multivariate analysis to identify the independent predictors of frailty in cirrhotic patients. A p-value < 0.05 was considered statistically significant. Results A total of 132 patients were included in the study. Out of them, 89 (67.4%) were males. On assessment, 51 (38.6%) patients were frail on presentation. On univariate analysis, female gender, advanced age, raised total leucocyte count, increased percentage of neutrophils on peripheral smear, raised serum creatinine, raised total bilirubin, raised prothrombin time, high Child Turcotte Pugh (CTP) score, and high model for end-stage liver disease along with low hemoglobin and low serum albumin levels were statistically significantly associated with frailty in cirrhosis. On multivariate analysis, female gender, age >40 years, CTP>B7, Hemoglobin <10g/dl, and neutrophils >60% on peripheral smear were independent predictors of liver frailty in cirrhotic patients. Conclusion Female gender, advanced age, increased neutrophils on peripheral smear, decreased hemoglobin along with increased degree of liver dysfunction were independent predictors of increased frailty in patients with chronic liver disease.
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Affiliation(s)
- Muhammad Qaiser Panezai
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Raja Taha Yaseen
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Shoaib Ahmed Khan
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Ghazi Abrar
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Muhammad Ali Khalid
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | | | - Ghulamullah Lail
- Department of Medicine/Gastroentelogy, Jinnah Medical & Dental College, Karachi, PAK
| | - Danish Kumar
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Syed Mudassir Laeeq
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Nasir Hassan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
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Sallam M, Khalil R. Contemporary Insights into Hepatitis C Virus: A Comprehensive Review. Microorganisms 2024; 12:1035. [PMID: 38930417 PMCID: PMC11205832 DOI: 10.3390/microorganisms12061035] [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: 04/30/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Hepatitis C virus (HCV) remains a significant global health challenge. Approximately 50 million people were living with chronic hepatitis C based on the World Health Organization as of 2024, contributing extensively to global morbidity and mortality. The advent and approval of several direct-acting antiviral (DAA) regimens significantly improved HCV treatment, offering potentially high rates of cure for chronic hepatitis C. However, the promising aim of eventual HCV eradication remains challenging. Key challenges include the variability in DAA access across different regions, slightly variable response rates to DAAs across diverse patient populations and HCV genotypes/subtypes, and the emergence of resistance-associated substitutions (RASs), potentially conferring resistance to DAAs. Therefore, periodic reassessment of current HCV knowledge is needed. An up-to-date review on HCV is also necessitated based on the observed shifts in HCV epidemiological trends, continuous development and approval of therapeutic strategies, and changes in public health policies. Thus, the current comprehensive review aimed to integrate the latest knowledge on the epidemiology, pathophysiology, diagnostic approaches, treatment options and preventive strategies for HCV, with a particular focus on the current challenges associated with RASs and ongoing efforts in vaccine development. This review sought to provide healthcare professionals, researchers, and policymakers with the necessary insights to address the HCV burden more effectively. We aimed to highlight the progress made in managing and preventing HCV infection and to highlight the persistent barriers challenging the prevention of HCV infection. The overarching goal was to align with global health objectives towards reducing the burden of chronic hepatitis, aiming for its eventual elimination as a public health threat by 2030.
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Affiliation(s)
- Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Roaa Khalil
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
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Panezai MQ, Taha Yaseen R, Lail G, Ali Khalid M, Ismail H, Majid Z, Kumar D, Shahzad S, Laeeq SM, Hassan Luck N. Correlation of Model for End Stage Liver Disease (MELD), MELD-Sodium (MELD-Na), and Child-Turcotte-Pugh (CTP) Score With Frailty in Patients With Hepatitis C Virus (HCV) Related Cirrhosis. Cureus 2023; 15:e40574. [PMID: 37465808 PMCID: PMC10351912 DOI: 10.7759/cureus.40574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The model for end stage liver disease (MELD), model for end stage liver disease-sodium (MELD Na), and Child-Turcotte-Pugh (CTP) score are independent predictors of mortality in cirrhotic patients. Approximately 43% of cirrhotic patients with advanced disease are frail and can have detrimental effects on the disease prognosis and survival including delisting from the transplant list and increased risk of post-transplant complications. Therefore, our aim was to determine the correlation of MELD, MELD-Na, and CTP score with frailty in patients with hepatitis C virus (HCV) related cirrhosis. METHODS This cross-sectional study was conducted at the Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation from 1st January 2022 to 30th June 2022. All the patients of either gender aged between 18 and 70 years with serological evidence of HCV and features of cirrhosis on ultrasound abdomen were included in the study. Patients with conditions over estimating frailty were excluded from the study. Liver Frailty Index (LFI) was calculated using grip strength measured in kilograms, timed chair stands, and balance testing. CTP and MELD-Na scores for each patient were also recorded. All the data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY). The correlation of MELD, MELD-Na, and CTP with LFI was analyzed using the Pearson correlation coefficient and a p-value < 0.05 was considered statistically significant. RESULTS A total of 274 patients were included in the study. Out of them, 185 (67.5%) were males. The mean CTP score was 8.1 + 2.1, MELD score of 13.6 + 7.1, MELD-Na score of 15 + 6.6, and LFI of 4.1 + 0.83. LFI was found to be weakly correlated with MELD (r = 0.278) (p < 0.001), MELD-Na score (r = 0.41) (p < 0.001), and CTP score (r = 0.325) (p < 0.001). CONCLUSION Weak correlation was noted between LFI, CTP, MELD, and MELD-Na scores in HCV-associated chronic liver disease. Therefore, frailty along with MELD, MELD-Na, and CTP must be assessed before considering the patients for liver transplantation.
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Affiliation(s)
| | - Raja Taha Yaseen
- Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Ghulamullah Lail
- Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Muhammad Ali Khalid
- Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Hina Ismail
- Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Zain Majid
- Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Danish Kumar
- Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Saleem Shahzad
- Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Syed Mudassir Laeeq
- Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Nasir Hassan Luck
- Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK
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Ogholoh OD, Zaccheus AO, Ikubor JE, Nwafor NN, Idowu BM, Ogholoh GI. Portal vein congestion index in patients with and without chronic liver disease. J Ultrason 2023; 23:e53-e60. [PMID: 37520748 PMCID: PMC10379837 DOI: 10.15557/jou.2023.0011] [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] [Received: 10/25/2022] [Accepted: 03/10/2023] [Indexed: 08/01/2023] Open
Abstract
Aim of the study Portal vein congestion index has shown promise in detecting early portal venous hemodynamic changes in chronic liver disease. The aim of this study was to compare the portal vein congestion index of adult patients with chronic liver disease to that of healthy controls, and to evaluate the differences in portal vein congestion index, if any, between the common etiologies of chronic liver disease (chronic viral hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease). Method and materials Eighty participants with chronic liver disease and 80 healthy controls had their sociodemographic variables, anthropometric indices, liver size/echotexture, spleen size, presence of ascites, and portal vein parameters (diameter, cross-sectional area, velocity, and congestion index) evaluated. P ≤0.05 was considered statistically significant. Results There were 48 (60%) males and 32 (40%) females in the control group, while 56 (70%) males and 24 (30%) females were included in the chronic liver disease group (p = 0.185). Of the eighty people with chronic liver disease, 57 (71.2%) were diagnosed with alcoholic liver disease, while 23 (28.8%) were diagnosed with chronic viral hepatitis. There were no cases of non-alcoholic fatty liver disease during the study period. The mean liver spans of the control and chronic liver disease groups were 13.45 ± 0.85 cm and 16.50 ± 4.96 cm, respectively. All the controls had normal hepatic parenchymal echogenicity, while 45 (56.3%) subjects with chronic liver disease (36 alcoholic liver disease and 9 chronic viral hepatitis) had increased hepatic echogenicity. The mean values of the portal vein congestion index for the control and chronic liver disease groups were 0.0775 ± 0.02 cm/sec and 0.1037 ± 0.03 cm/sec, respectively (p <0.0001). Conclusion The chronic liver disease group showed a significantly higher mean portal vein congestion index than the control group.
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Affiliation(s)
- Oghenetejiri Denise Ogholoh
- Department of Radiology, Delta State University, Abraka and Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | | | - Joyce Ekeme Ikubor
- Department of Radiology, Delta State University, Abraka and Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - Nkem Nnenna Nwafor
- Department of Radiology, Faculty of Clinical Sciences, College of Health Sciences, University of Uyo, Uyo, Akwa Ibom State, Nigeria
| | - Bukunmi Michael Idowu
- Department of Radiology, Union Diagnostics and Clinical Services Plc, Yaba, Lagos State, Nigeria
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Glasenapp JH, Zuchinali P, Alba VD. TRANSLATION AND CROSS-CULTURAL ADAPTATION OF THE ROYAL FREE HOSPITAL-NUTRITIONAL PRIORITIZING TOOL (RFH-NPT). ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:84-90. [PMID: 37194784 DOI: 10.1590/s0004-2803.202301000-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/16/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Nutritional screening is defined by American Society for Parenteral and Enteral Nutrition (ASPEN) as a process to identify individuals at risk of malnutrition. Malnutrition is a prevalent condition in cirrhotic patients, and it results in important prognostic implications. Most of the commonly used instruments fail in considering the particularities of cirrhotic patients. The Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is a nutritional screening tool developed and validated to identify malnutrition risk in patients with liver disease. OBJECTIVE The study's aim was to conduct the transcultural adaptation (translation and adaptation) of RFH-NPT tool to Portuguese (Brazil). METHODS The process of cultural translation and adaptation followed the Beaton et al. methodology. The process involved the steps of initial translation, synthesis translation, back translation pretest of the final version with 40 nutritionists and a specialists committee. The internal consistency was calculated with the Cronbach coefficient and the content validation was verified with the content validation index. RESULTS Forty clinical nutritionists with experience in treatment of adult patients participated in the step of cross-cultural adaptation. The alpha Cronbach coefficient was 0.84, which means high reliability. In the specialists analyzes all the tool's questions achieved a validation content index higher than 0.8, showing high agreement. CONCLUSION The NFH-NPT tool was translated and adapted to Portuguese (Brazil) and showed high reliability.
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Affiliation(s)
- Joana Hoch Glasenapp
- Programa de Pós-Graduação em Alimentação, Nutrição e Saúde, Porto Alegre, RS, Brasil
| | - Priccila Zuchinali
- Montreal University Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - Valesca Dall' Alba
- Programa de Pós-Graduação em Alimentação, Nutrição e Saúde, Porto Alegre, RS, Brasil
- Programa de Pós-Graduação em Gastroenterologia e Hepatologia, Porto Alegre, RS, Brasil
- Hospital de Clínicas de Porto Alegre, Divisão de Nutrição, Porto Alegre, RS, Brasil
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Individuals' Perceptions of Liver Cirrhosis. Gastroenterol Nurs 2022; 45:410-418. [DOI: 10.1097/sga.0000000000000683] [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: 12/15/2021] [Accepted: 06/15/2022] [Indexed: 12/05/2022] Open
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Mun H, So ES. Prevalence of liver cirrhosis based on the metabolic health and weight criteria: Report from the Korea National Health and Nutrition Examination Survey (KNHANES) data analysis. Ann Hepatol 2022:100721. [PMID: 35504573 DOI: 10.1016/j.aohep.2022.100721] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recent studies have proposed two distinctive types of obesity, metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO), based on various physiological factors. This study sought to explore the relationship between the metabolic obesity types and the incidence of liver cirrhosis (LC) in a large nationally-representative population. METHODS Data on 27,629 adults with MHO or MUHO, were analyzed from the Korea National Health and Nutrition Examination Survey (KNHANES) obtained from 2015 through 2019. Four categories of metabolic health and weight (MHW) were generated for analysis: (1) MHO, (2) MUHO, (3) Metabolically unhealthy normal weight (MUHNW), and (4) Metabolically healthy normal weight (MHNW). Statistical analyzes were performed with univariate and multivariate logistic regression. RESULTS The prevalence of LC did not show statistically significant differences among the MHW categories: 0.5% in MHO, 0.4% in MUHO, 0.2% in MHNW, and 0.3% in MUHNW. The unadjusted analysis showed a significant association between self-reported LC and MUHO, but this association was not evident in the adjusted analysis. In the adjusted analysis of the prevalence of laboratory LC, a significant association emerged in the MUHO group, followed in descending order of magnitude by the MHO and MUHNW groups. A favorable fasting blood glucose level was the only factor associated with increased prevalence of reported LC in MUHO. CONCLUSIONS The study demonstrated a difference in the prevalence of LC between MHO and MUHO. Our study concludes that the MHO phenotype is a transient status with regard to metabolic abnormalities, and caution is necessary when evaluating MHO.
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Affiliation(s)
- Hyukjin Mun
- School of Nursing, Hanyang University, Seoul, Republic of Korea
| | - Eun Sun So
- College of Nursing, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54896, Republic of Korea.
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Ferreira S, Marroni CA, Stein JT, Rayn R, Henz AC, Schmidt NP, Carteri RB, Fernandes SA. Assessment of resting energy expenditure in patients with cirrhosis. World J Hepatol 2022; 14:802-811. [PMID: 35646265 PMCID: PMC9099101 DOI: 10.4254/wjh.v14.i4.802] [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: 12/01/2021] [Revised: 01/13/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malnutrition affects 20% to 50% of patients with cirrhosis. It may be associated with serious complications and has a direct impact on prognosis. Resting energy expenditure (REE) is an important parameter to guide the optimization of therapy and recovery of nutritional status in patients with cirrhosis. However, the REE of patients with cirrhosis is still unclear, casting doubt upon the optimal nutritional management approach.
AIM To identify the best method that predicts the REE of cirrhotic patients, using indirect calorimetry (IC) as the gold standard.
METHODS An observational study was performed on 90 patients with cirrhosis. REE was assessed by IC, bioelectrical impedance analysis (BIA), and predictive formulas, which were compared using Bland-Altman plots and the Student’s t-test.
RESULTS REE values measured by IC (1607.72 ± 257.4 kcal) differed significantly from those determined by all other methods (BIA: 1790.48 ± 352.1 kcal; Harris & Benedict equation: 2373.54 ± 254.9 kcal; IOM equation: 1648.95 ± 185.6 kcal; Cunningham equation: 1764.29 ± 246.2 kcal), except the Food and Agriculture Organization of the United Nations, World Health Organization, and United Nations University (FAO/WHO/UNU) (1616.07 ± 214.6 kcal) and McArdle (1611.30 ± 241.8 kcal) equations. We found no significant association when comparing IC and 24-h dietary recall among different Child-Pugh classes of cirrhosis.
CONCLUSION The IOM and FAO/WHO/UNU equations have the best agreement with the CI. These results indicate a possibility of different tools for the clinical practice on cirrhotic patients.
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Affiliation(s)
- Shaiane Ferreira
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Cláudio Augusto Marroni
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Jessica Taina Stein
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Roberta Rayn
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Ana Cristhina Henz
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Natália P Schmidt
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Randhall B Carteri
- Department of Nutrition, Centro Universitário Metodista - IPA, Porto Alegre 90420-060, Brazil
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas 96015-560, Brazil
| | - Sabrina Alves Fernandes
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
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Sarvestany SS, Kwong JC, Azhie A, Dong V, Cerocchi O, Ali AF, Karnam RS, Kuriry H, Shengir M, Candido E, Duchen R, Sebastiani G, Patel K, Goldenberg A, Bhat M. Development and validation of an ensemble machine learning framework for detection of all-cause advanced hepatic fibrosis: a retrospective cohort study. Lancet Digit Health 2022; 4:e188-e199. [DOI: 10.1016/s2589-7500(21)00270-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/31/2021] [Accepted: 11/23/2021] [Indexed: 02/08/2023]
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Detection of all-cause advanced hepatic fibrosis using an ensemble machine learning framework. THE LANCET DIGITAL HEALTH 2022; 4:e152-e153. [DOI: 10.1016/s2589-7500(22)00026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/03/2022] [Indexed: 11/22/2022]
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Diagnostic and prognostic significance of cell death markers in patients with cirrhosis and acute decompensation. PLoS One 2022; 17:e0263989. [PMID: 35176084 PMCID: PMC8853504 DOI: 10.1371/journal.pone.0263989] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Background The transition from compensated to decompensated liver cirrhosis is a hallmark of disease progression, however, reliable predictors to assess the risk of decompensation in individual patients from routine diagnostics are lacking. Here, we characterize serum levels of cell death-associated markers and routine biochemistry from patients with chronic liver disease with and without decompensation. Methods A post-hoc analysis was based on prospectively collected clinical data from 160 patients with chronic liver disease, stably compensated or decompensated at baseline or during follow-up, over a median period of 721 days. Serum levels of damage-associated molecular patterns (DAMPs) and routine biochemistry are quantified at baseline (for all patients) and during follow-up (for patients with acute decompensation). The panel of DAMPs assessed in this study comprises high-mobility group-box protein 1 (HMGB1), cytochrome C (cyt C), soluble Fas-ligand (sFasL), interleukin 6 (IL-6), soluble cytokeratin-18 (CK18-M65) and its caspase‐cleaved fragment CK18-M30. Results In this cohort study, 80 patients (50%) were diagnosed with alcoholic liver cirrhosis, 60 patients (37.5%) with hepatitis C virus- and 20 patients (13.5%) with hepatitis B virus-related liver cirrhosis. At baseline, 17 patients (10.6%) showed decompensated liver disease and another 28 patients (17.5%) developed acute decompensation during follow-up (within 24 months). One hundred fifteen patients showed stable liver disease (71.9%). We found DAMPs significantly elevated in patients with decompensated liver disease versus compensated liver disease. Patients with acute decompensation during follow-up showed higher baseline levels of IL-6, sFasL, CK18-M65 and–M30 (P<0.01) compared to patients with stably compensated liver disease. In multivariate analyses, we found an independent association of baseline serum levels of sFasL (P = 0.02; OR = 2.67) and gamma-glutamyl transferase (GGT) (P<0.001; OR = 2.1) with acute decompensation. Accuracy of the marker combination for predicting acute decompensation was high (AUC = 0.79). Elevated aminotransferase levels did not correlate with decompensated liver disease and acute decompensation. Conclusions DAMPs are elevated in patients with decompensated liver disease and patients developing acute decompensation. The prognostic value of a marker combination with soluble Fas-ligand and GGT in patients with liver cirrhosis should be further evaluated.
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Stelmach M, de Almeida Medeiros KA, Carvalho BJ, Pipek LZ, de Mesquita GHA, Nii F, Martines DR, Iuamoto LR, D'Albuquerque LAC, Meyer A, Andraus W. Instrument to evaluate the knowledge of patient with cirrhosis on his disease: construction and validity. BMC Gastroenterol 2021; 21:83. [PMID: 33622249 PMCID: PMC7903789 DOI: 10.1186/s12876-021-01665-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/12/2021] [Indexed: 11/27/2022] Open
Abstract
Background The application of measurement instruments is a strategy to evaluate the patient's knowledge about the disease. This study aims to build an instrument that evaluates the patient's knowledge about liver cirrhosis. Method This study includes three phases. The first one was the construction of the instrument based on a literature review. In the second phase, five experts were participated in the evaluation of the instrument, to check the validity of the content. Quantitative and qualitative analyzes were made. The tool used was the CVI (Content Validity Index) and it was used the semantic study of the questions. The third phase was the process of the restructuring the instrument. Results The final version of the instrument consisted of 36 questions. The instrument was evaluated in 91.7 by the average CVI and 94.4% by the universal CVI. Conclusions The questions are properly structured and clear, therefore, understandable. Thus, the final instrument presented satisfactory content validity, so that, it reached the aim of this study.
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Affiliation(s)
- Mariana Stelmach
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, São Paulo, Brazil
| | | | | | | | | | - Fernanda Nii
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Leandro Ryuchi Iuamoto
- Center of Acupuncture, Department of Orthopaedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Luiz Augusto Carneiro D'Albuquerque
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, São Paulo, Brazil
| | - Alberto Meyer
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, São Paulo, Brazil.
| | - Wellington Andraus
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, São Paulo, Brazil
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14
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Treem WR, Palmer M, Lonjon-Domanec I, Seekins D, Dimick-Santos L, Avigan MI, Marcinak JF, Dash A, Regev A, Maller E, Patwardhan M, Lewis JH, Rockey DC, Di Bisceglie AM, Freston JW, Andrade RJ, Chalasani N. Consensus Guidelines: Best Practices for Detection, Assessment and Management of Suspected Acute Drug-Induced Liver Injury During Clinical Trials in Adults with Chronic Viral Hepatitis and Adults with Cirrhosis Secondary to Hepatitis B, C and Nonalcoholic Steatohepatitis. Drug Saf 2021; 44:133-165. [PMID: 33141341 PMCID: PMC7847464 DOI: 10.1007/s40264-020-01014-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 02/07/2023]
Abstract
With the widespread development of new drugs to treat chronic liver diseases (CLDs), including viral hepatitis and nonalcoholic steatohepatitis (NASH), more patients are entering trials with abnormal baseline liver tests and with advanced liver injury, including cirrhosis. The current regulatory guidelines addressing the monitoring, diagnosis, and management of suspected drug-induced liver injury (DILI) during clinical trials primarily address individuals entering with normal baseline liver tests. Using the same laboratory criteria cited as signals of potential DILI in studies involving patients with no underlying liver disease and normal baseline liver tests may result in premature and unnecessary cessation of a study drug in a clinical trial population whose abnormal and fluctuating liver tests are actually due to their underlying CLD. This position paper focuses on defining best practices for the detection, monitoring, diagnosis, and management of suspected acute DILI during clinical trials in patients with CLD, including hepatitis C virus (HCV) and hepatitis B virus (HBV), both with and without cirrhosis and NASH with cirrhosis. This is one of several position papers developed by the IQ DILI Initiative, comprising members from 16 pharmaceutical companies in collaboration with DILI experts from academia and regulatory agencies. It is based on an extensive literature review and discussions between industry members and experts from outside industry to achieve consensus regarding the recommendations. Key conclusions and recommendations include (1) the importance of establishing laboratory criteria that signal potential DILI events and that fit the disease indication being studied in the clinical trial based on knowledge of the natural history of test fluctuations in that disease; (2) establishing a pretreatment value that is based on more than one screening determination, and revising that baseline during the trial if a new nadir is achieved during treatment; (3) basing rules for increased monitoring and for stopping drug for potential DILI on multiples of baseline liver test values and/or a threshold value rather than multiples of the upper limit of normal (ULN) for that test; (4) making use of more sensitive tests of liver function, including direct bilirubin (DB) or combined parameters such as aspartate transaminase:alanine transaminase (AST:ALT) ratio or model for end-stage liver disease (MELD) to signal potential DILI, especially in studies of patients with cirrhosis; and (5) being aware of potential confounders related to complications of the disease being studied that may masquerade as DILI events.
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Affiliation(s)
| | - Melissa Palmer
- Takeda, Cambridge, MA, USA
- Liver Consulting LLC, New York, NY, USA
| | | | | | | | - Mark I Avigan
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Ajit Dash
- , Genentech, South San Francisco, CA, USA
| | - Arie Regev
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Eric Maller
- Pfizer, Collegeville, PA, USA
- MEMS Biopharma Consulting, LLC, Wynnewood, PA, USA
| | | | | | - Don C Rockey
- Medical University of South Carolina, Charleston, SC, USA
| | | | - James W Freston
- University of Connecticut Health Center, Farmington, CT, USA
| | - Raul J Andrade
- Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Universidad de Málaga, Málaga, Spain
| | - Naga Chalasani
- Indiana University School of Medicine, Indianapolis, IN, USA.
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15
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Fernandes SA, Leonhardt LR, Silva DMD, Alves FD, Marroni CA. Bioelectrical impedance vector analysis evaluates cellularity and hydration in cirrhotic patients. World J Hepatol 2020; 12:1276-1288. [PMID: 33442454 PMCID: PMC7772738 DOI: 10.4254/wjh.v12.i12.1276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/07/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malnutrition in cirrhotic patients is correlated with mortality and a better response to liver transplantation. However, recovery of the nutritional status in these patients is a challenge due to the difficulty in establishing a reliable nutritional diagnosis. The bioelectrical impedance vector analysis (BIVA) method appears as a feasible tool in clinical practice to define the physiological state of cirrhotic patients by assessing hydration and body cellularity.
AIM To evaluate body composition in cirrhotic patients using BIVA.
METHODS This retrospective cross-sectional study was carried out by following cirrhotic outpatients at a hospital in Porto Alegre, Brazil. A tetrapolar bioelectrical impedance analysis device was used to evaluate cellularity and hydration and to perform the BIVA. The BIVA graphic was elaborated by software and for statistical analysis a significance level of 5% (P ≤ 0.05) was considered.
RESULTS One hundred and ninety patients, 61.1% males, with a mean age of 56.6 ± 11.0 years, were evaluated. Of these, 56.3% had Child-Turcotte-Pugh (CTP) A score, and the prevalent etiology was hepatitis C virus (47.4%). The patients were classified according to cellularity and hydration by the quadrants and ellipses of the BIVA method, quadrant 1 (47.9%); quadrant 2 (18.9%); quadrant 3 (14.2%); and quadrant 4 (18.9%). Those classified in quadrant 1 and 2 had a higher phase angle compared to those in quadrants 3 and 4 (P < 0.001). Quadrant 2 patients had a lower average age than the other groups. The association with CTP score showed that patients in quadrant 2 had a higher proportion of CTP A, and those in quadrant 4 had a higher proportion of CTP C (P < 0.052).
CONCLUSION The BIVA method allows identification of the cellularity and hydration status of cirrhotic patients, and its association with clinical factors determines the disease severity, age and prognostic index.
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Affiliation(s)
- Sabrina Alves Fernandes
- Department of Nutrition, Centro Universitário Metodista IPA, Porto Alegre 90420-060, RS, Brazil
| | - Lara Rigon Leonhardt
- Gastroenterology and Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 91760-470, RS, Brazil
| | - Daniella Miranda da Silva
- Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
| | - Fernanda Donner Alves
- Department of Nutrition, Centro Universitário Ritter dos Reis - Uniritter, Porto Alegre 90840-440, Rio Grande do Sul, Brazil
| | - Cláudio Augusto Marroni
- Gastroenterology and Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 91760-470, RS, Brazil
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16
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Kagadis GC, Drazinos P, Gatos I, Tsantis S, Papadimitroulas P, Spiliopoulos S, Karnabatidis D, Theotokas I, Zoumpoulis P, Hazle JD. Deep learning networks on chronic liver disease assessment with fine-tuning of shear wave elastography image sequences. Phys Med Biol 2020; 65:215027. [PMID: 32998480 DOI: 10.1088/1361-6560/abae06] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic liver disease (CLD) is currently one of the major causes of death worldwide. If not treated, it may lead to cirrhosis, hepatic carcinoma and death. Ultrasound (US) shear wave elastography (SWE) is a relatively new, popular, non-invasive technique among radiologists. Although many studies have been published validating the SWE technique either in a clinical setting, or by applying machine learning on SWE elastograms, minimal work has been done on comparing the performance of popular pre-trained deep learning networks on CLD assessment. Currently available literature reports suggest technical advancements on specific deep learning structures, with specific inputs and usually on a limited CLD fibrosis stage class group, with limited comparison on competitive deep learning schemes fed with different input types. The aim of the present study is to compare some popular deep learning pre-trained networks using temporally stable and full elastograms, with or without augmentation as well as propose suitable deep learning schemes for CLD diagnosis and progress assessment. 200 liver biopsy validated patients with CLD, underwent US SWE examination. Four images from the same liver area were saved to extract elastograms and processed to exclude areas that were temporally unstable. Then, full and temporally stable masked elastograms for each patient were separately fed into GoogLeNet, AlexNet, VGG16, ResNet50 and DenseNet201 with and without augmentation. The networks were tested for differentiation of CLD stages in seven classification schemes over 30 repetitions using liver biopsy as the reference. All networks achieved maximum mean accuracies ranging from 87.2%-97.4% and area under the receiver operating characteristic curves (AUCs) ranging from 0.979-0.990 while the radiologists had AUCs ranging from 0.800-0.870. ResNet50 and DenseNet201 had better average performance than the other networks. The use of the temporal stability mask led to improved performance on about 50% of inputs and network combinations while augmentation led to lower performance for all networks. These findings can provide potential networks with higher accuracy and better setting in the CLD diagnosis and progress assessment. A larger data set would help identify the best network and settings for CLD assessment in clinical practice.
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Affiliation(s)
- George C Kagadis
- 3DMI Research Group, Department of Medical Physics, School of Medicine, University of Patras, Rion GR 26504, Greece. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America
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17
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Yang JY, Moon AM, Kim H, Pate V, Barritt AS, Crowley MJ, Buse JB, Stürmer T, Alexopoulos AS. Newer second-line glucose-lowering drugs versus thiazolidinediones on cirrhosis risk among older US adult patients with type 2 diabetes. J Diabetes Complications 2020; 34:107706. [PMID: 32843283 PMCID: PMC7657660 DOI: 10.1016/j.jdiacomp.2020.107706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
AIMS Type 2 diabetes (T2D) accelerates progression of chronic liver disease to cirrhosis, yet the effects of most glucose-lowering drugs (GLDs) on cirrhosis risk in T2D are unknown. To address this gap, we compared cirrhosis risk following initiation of newer second-line GLDs vs. thiazolidinediones (TZDs), which improve histology in non-alcoholic fatty liver disease. MATERIALS AND METHODS Using the US Medicare Fee-for-Service database (2007-2015) and an active comparator, new-user design, we estimated crude incidence rates (IRs) and propensity-score adjusted hazard ratios (aHR) for incident cirrhosis, comparing newer GLDs (dipeptidyl peptidase-4 inhibitors (DPP4i), glucagon-like peptide-1 receptor agonists (GLP1RA), and sodium-glucose co-transporter 2 inhibitors (SGLT2i)) vs. TZDs. RESULTS Among 239,549 total initiators, we observed 318, 151, and < 30 cirrhosis events when comparing DPP4i vs. TZD, GLP1RA vs. TZD, and SGLT2i vs. TZD, respectively. IRs ranged from 1.7 [95% CI, 0.8-3.6] to 3.6 [2.5-5.2] events per 1000 person-years. Point aHR estimates for cirrhosis were elevated among newer GLD initiators vs. TZD (DPP4i: 1.15 [0.89-1.50]; GLP1RA: 1.34 [0.82-2.20]; SGLT2i: 1.16, [0.44-3.08]), although estimates were imprecise due to short durations of drug exposure. CONCLUSIONS We observed mildly elevated cirrhosis risk with newer GLDs vs. TZD; however, uncertainty remains due to imprecise and statistically non-significant effect estimates.
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Affiliation(s)
- Jeff Y Yang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America.
| | - Andrew M Moon
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Hannah Kim
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Virginia Pate
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - A Sidney Barritt
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Matthew J Crowley
- Department of Medicine, Division of Endocrinology, Duke University, Durham, NC, United States of America; Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, United States of America
| | - John B Buse
- Department of Medicine, Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Anastasia-Stefania Alexopoulos
- Department of Medicine, Division of Endocrinology, Duke University, Durham, NC, United States of America; Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, United States of America
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18
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Elhani I, Pillebout E, Terrier B, Hankard A, Vrtovsnik F, Jourde-Chiche N, Greillier S, Groh M, Belfeki N, Bigot A, de Boysson H, Pageaux GP, Raffray L, Urbanski G, Ollivier I, Maillot F, Aouba A, Audemard-Verger A. IgA Vasculitis With Underlying Liver Cirrhosis: A French Nationwide Case Series of 20 Patients. J Rheumatol 2020; 48:735-740. [PMID: 32801133 DOI: 10.3899/jrheum.200293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Immunoglobulin A vasculitis (IgAV) and nephropathy (IgAN) share common immunological mechanisms. Liver cirrhosis is well known to be associated with IgAN. Here, we aimed to describe the presentation and outcome of IgAV patients with underlying cirrhosis. METHODS We conducted a French nationwide retrospective study of adult patients presenting with both IgAV and cirrhosis. Baseline characteristics were compared to those of the 260 patients included in the French nationwide IgAV registry (IGAVAS). RESULTS Twenty patients were included, and 7 (35%) were female. The mean ± SD age was 62.7 ± 11 years. At baseline, compared with IGAVAS patients, patients with underlying cirrhosis were older (62.7 ± 11 vs 50.1 ± 18, P < 0.01) and displayed more constitutional symptoms (weight loss 25% vs 8%, P = 0.03). Patients with underlying cirrhosis were also more likely to exhibit elevated serum IgA levels (5.6 g/L vs 3.6 g/L, P = 0.02). Cirrhosis and IgAV were diagnosed simultaneously in 12 patients (60%). Cirrhosis was mainly related to alcohol intake (n = 15, 75%), followed by nonalcoholic steato-hepatitis (n = 2), chronic viral hepatitis (n = 1), hemochromatosis (n = 1), and autoimmune hepatitis (n = 1). During follow-up with a median of 17 months (IQR 12-84), 10/13 (77%) exhibited IgAV remission at Month 3. One patient presented a minor relapse. Six patients died, but no deaths were related to IgAV. CONCLUSION We report the first case series of IgAV patients with underlining cirrhosis, to our knowledge, which was mainly alcohol related. The liver disease did not seem to affect baseline vasculitis characteristics. Physicians should investigate the existence of liver cirrhosis at IgAV diagnosis, especially in the context of alcohol abuse.
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Affiliation(s)
- Ines Elhani
- I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie
| | | | - Benjamin Terrier
- B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris
| | - Antoine Hankard
- I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - François Vrtovsnik
- F. Vrtovsnik, MD, Department of Nephrology, Bichat-Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris
| | - Noémie Jourde-Chiche
- N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille
| | - Sophie Greillier
- N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille
| | - Matthieu Groh
- M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes
| | - Nabil Belfeki
- N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun
| | - Adrien Bigot
- A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours
| | - Hubert de Boysson
- I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Georges-Philippe Pageaux
- G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier
| | - Loïc Raffray
- L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion
| | - Geoffrey Urbanski
- G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d'Angers, Angers
| | - Isabelle Ollivier
- I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France
| | - Francois Maillot
- A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours
| | - Achille Aouba
- I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Alexandra Audemard-Verger
- A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours;
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19
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Yao Y, Yang D, Huang Y, Dong M. Predictive value of insulin-like growth factor 1-Child-Turcotte-Pugh score for mortality in patients with decompensated cirrhosis. Clin Chim Acta 2020; 505:141-147. [PMID: 32119835 DOI: 10.1016/j.cca.2020.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/13/2020] [Accepted: 02/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies have used a modified version of the Child-Turcotte-Pugh (CTP) score to include insulin-like growth factor 1 (IGF-1) concentrations, denoted the Insulin-like Growth Factor 1-Child-Turcotte-Pugh (IGF-CTP) system. We evaluated the predictive power of IGF-CTP for 1-year mortality in patients with decompensated cirrhosis (DC). METHODS A total of 386 patients with DC were retrospectively analyzed. Comparison of distribution of patients with decompensated cirrhosis according to Insulin-like Growth Factor-1-Child-Turcotte-Pugh and Child-Turcotte-Pugh scores were performed. Area under the receiver operating characteristic curves (AUROCs) for IGF-CTP, CTP and the Model for End-stage Liver Disease (MELD) scores were evaluated to compare predictive value. Univariate and multivariate analyses were carried out to determine potential risk factors for 1-y mortality. RESULTS During the 1-y follow-up, 94 patients died. Significantly more patients (both surviving and non-surviving) were classified as IGF-CTP stage C than CTP stage C. The AUROC of IGF-CTP was significantly higher than that of CTP and MELD in the training and validation cohorts. Multivariate analysis indicated IGF-CTP score and IGF-1 to be independently associated with mortality. CONCLUSION The IGF-CTP score is independently associated with mortality for patients with DC, and offers more accurate prediction of 1-y mortality than either CTP or MELD score for these patients.
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Affiliation(s)
- Yifan Yao
- Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, 79 Qingchun Road, Hangzhou 310003, China.
| | - Donglei Yang
- Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, 79 Qingchun Road, Hangzhou 310003, China
| | - Yandi Huang
- Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, 79 Qingchun Road, Hangzhou 310003, China
| | - Minya Dong
- Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, 79 Qingchun Road, Hangzhou 310003, China
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20
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Poordad F, Castro RE, Asatryan A, Aguilar H, Cacoub P, Dieterich D, Marinho RT, Carvalho A, Siddique A, Hu YB, Charafeddine M, Bondin M, Khan N, Cohen DE, Felizarta F. Long-term safety and efficacy results in hepatitis C virus genotype 1-infected patients receiving ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin in the TOPAZ-I and TOPAZ-II trials. J Viral Hepat 2020; 27:497-504. [PMID: 31954087 DOI: 10.1111/jvh.13261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/27/2022]
Abstract
The 3-DAA regimen consisting of ombitasvir/paritaprevir/ritonavir plus dasabuvir (OBV/PTV/r + DSV) ± ribavirin (RBV) has shown high sustained virologic response rates (~95%) in phase 3 clinical trials including >2300 HCV genotype 1-infected patients. Real-world evidence studies have confirmed the effectiveness of OBV/PTV/r ± DSV ± RBV in patients with chronic HCV genotype 1 infection and are consistent with clinical trial results. TOPAZ-I and TOPAZ-II are ongoing phase 3b trials, assessing safety, efficacy and long-term progression of liver disease and clinical outcomes for up to 5 years post-treatment in patients treated with OBV/PTV/r + DSV ± RBV. High rates of sustained virologic response (SVR) were achieved regardless of presence or absence of cirrhosis.In this report, we assessed the long-term progression of liver disease and incidence of clinical outcomes up to 3 years of post-treatment follow-up in patients with chronic HCV GT1 infection who were treated with (OBV/PTV/r + DSV) ± RBV in the TOPAZ-I and TOPAZ-II studies. Improvements were observed in liver disease markers including FIB-4, METAVIR and Child-Pugh scores as well as platelet counts. Clinical outcomes related to long-term progression of liver disease such as liver decompensation were infrequent (<1%). Hepatocellular carcinoma (HCC) occurred in 1.4% of cirrhotic patients.
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Affiliation(s)
- Fred Poordad
- The Texas Liver Institute, University of Texas Health, San Antonio, TX, USA
| | - RuiSarmento E Castro
- Hospital Centre of Porto (Portugal), Biomedical School of Medicine (University of Porto), Porto, Portugal
| | | | | | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, AP HP, Groupe hospitalier La Pitié-Salpêtrière, Paris, France.,Sorbonne Universités, UPMC Univ, Paris, France
| | - Douglas Dieterich
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rui Tato Marinho
- Gastroenterology and Hepatology Department, Centro Hospitalar de Universitário Lisboa Norte and Medical School of Lisbon, University of Lisbon, Lisbon, Portugal
| | - Armando Carvalho
- Internal Medicine Department, Hospitais da Universidade de Coimbra (Centro Hospitalar e Universitário de Coimbra), Coimbra, Portugal
| | - Asma Siddique
- Virginia Mason Hospital and Seattle Medical Center, Seattle, WA, USA
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Philips CA, Augustine P, Rajesh S, Ahamed R, George T, Padsalgi G, Paramaguru R, Valiathan G, John SK. Granulocyte Colony-Stimulating Factor Use in Decompensated Cirrhosis: Lack of Survival Benefit. J Clin Exp Hepatol 2020; 10:124-134. [PMID: 32189927 PMCID: PMC7067994 DOI: 10.1016/j.jceh.2019.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Granulocyte colony-stimulating factor (GCSF) has been utilized in decompensated cirrhosis (DC) for improving transplant-free survival (TFS). Data from multiple centers are conflicting with regard to patient outcomes. In this retrospective study, we present our 'real-world experience' of GCSF use in a large group of DC. METHODS From September 2016 to September 2018, 1231 patients with cirrhosis were screened, of which 754 were found to have decompensation(s). Seventy-three patients with active ascites, jaundice, or both completed GCSF treatment (10 mcg/kg per day for 5 days, followed by 5 mcg/kg/day once every third day for total 12 doses). Per-protocol analysis (n = 56) was performed to study clinical events, liver disease severity, and outcomes at 3, 6, and 12 months after treatment. Modified intention-to-treat (mITT, n = 100) analysis was performed to study overall survival at 180 days. Outcomes were compared with a matched historical control (HC) group (n = 24). RESULTS Nine (16%, n = 56), 24 (43%, n = 56), and 36 (75%, n = 48) patients died at 3, 6, and 12-month follow-up after GCSF. The commonest cause of death was sepsis (53%) followed by progressive liver failure (33%). Nine percent of patients developed hepatocellular carcinoma on follow-up at the end of 1 year. Acute variceal bleeds, overt hepatic encephalopathy, intensive unit admissions, and liver disease severity scores were higher after treatment at the end of 1 year. The Child-Pugh score >11 and model for end-stage liver disease-sodium score >25 and > 20 predicted worse outcomes at all time points and at 6 and 12 months after GCSF, respectively. Compared to a matched HC group, patients receiving GCSF had higher mortality (75% vs 46%, P = 0.04) at one year. mITT analysis revealed poor overall survival at 6 months compared to HCs (48% vs 75%, P = 0.04). CONCLUSION Survival in DC was shorter than what was expected in the natural history of the disease after GCSF use.
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Key Words
- AKI, acute kidney injury
- AUC, area under the receiver operating curve
- AVB, acute variceal bleeding
- BMSCs, Bone marrow–derived stem cells
- CTP score, Child–Pugh score
- DC, decompensated cirrhosis
- DP, darbepoetin
- GCSF, granulocyte colony-stimulating factor
- HC, historical control
- HCC
- HCC, hepatocellular carcinoma
- HE, hepatic encephalopathy
- ICU, intensive care unit
- INR, international normalized ratio
- LT, liver transplantation
- MELD-Na, model for end-stage liver disease-sodium
- NASH, nonalcoholic steatohepatitis
- RCT, randomized controlled trial
- SBP, spontaneous bacterial peritonitis
- SMT, standard medical treatment
- TFS, transplant free survival
- encephalopathy
- erythropoietin
- growth factor
- hyponatremia
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Affiliation(s)
- Cyriac A. Philips
- The Liver Unit, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala
| | - Philip Augustine
- Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala
| | - Sasidharan Rajesh
- Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala
| | - Rizwan Ahamed
- Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala
| | - Tom George
- Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala
| | - Guruprasad Padsalgi
- Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala
| | | | - Gopakumar Valiathan
- Gastrointestinal and Hepatobiliary Surgery, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala
| | - Solomon K. John
- Hepatobiliary and Transplant Surgery, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala
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22
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Son JH, Lee SS, Lee Y, Kang BK, Sung YS, Jo S, Yu E. Assessment of liver fibrosis severity using computed tomography-based liver and spleen volumetric indices in patients with chronic liver disease. Eur Radiol 2020; 30:3486-3496. [PMID: 32055946 DOI: 10.1007/s00330-020-06665-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate whether the liver and spleen volumetric indices, measured on portal venous phase CT images, could be used to assess liver fibrosis severity in chronic liver disease. METHODS From 2007 to 2017, 558 patients (mean age 48.7 ± 13.1 years; 284 men and 274 women) with chronic liver disease (n = 513) or healthy liver (n = 45) were retrospectively enrolled. The liver volume (sVolL) and spleen volume (sVolS), normalized to body surface area and liver-to-spleen volume ratio (VolL/VolS), were measured on CT images using a deep learning algorithm. The correlation between the volumetric indices and the pathologic liver fibrosis stages combined with the presence of decompensation (F0, F1, F2, F3, F4C [compensated cirrhosis], and F4D [decompensated cirrhosis]) were assessed using Spearman's correlation coefficient. The performance of the volumetric indices in the diagnosis of advanced fibrosis, cirrhosis, and decompensated cirrhosis were evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS The sVolS (ρ = 0.47-0.73; p < .001) and VolL/VolS (ρ = -0.77-- 0.48; p < .001) showed significant correlation with liver fibrosis stage in all etiological subgroups (i.e., viral hepatitis, alcoholic and non-alcoholic fatty liver, and autoimmune diseases), while the significant correlation of sVolL was noted only in the viral hepatitis subgroup (ρ = - 0.55; p < .001). To diagnose advanced fibrosis, cirrhosis, and decompensated cirrhosis, the VolL/VolS (AUC 0.82-0.88) and sVolS (AUC 0.82-0.87) significantly outperformed the sVolL (AUC 0.63-0.72; p < .001). CONCLUSION The VolL/VolS and sVolS may be used for assessing liver fibrosis severity in chronic liver disease. KEY POINTS • Volumetric indices of liver and spleen measured on computed tomography images may allow liver fibrosis severity to be assessed in patients with chronic liver disease.
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Affiliation(s)
- Jung Hee Son
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Yedaun Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Bo-Kyeong Kang
- Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - SoRa Jo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Eunsil Yu
- Department of Diagnostic Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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23
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Nartey YA, Asem M, Agyei-Nkansah A, Awuku YA, Setorglo J, Duah A, Bampoh S, Ayawin J, Asibey SO, Ye W, Afihene MY, Roberts L, Plymoth A. Nutritional management of cirrhosis patients: A qualitative study exploring perceptions of patients and health workers in Ghana. Clin Nutr ESPEN 2019; 34:18-22. [PMID: 31677706 DOI: 10.1016/j.clnesp.2019.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/30/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Malnutrition is common among patients with end stage liver disease including liver cirrhosis and liver cancer. Optimal nutrition is important to reduce morbidity and mortality of these patients. There is limited qualitative data on nutritional status and management of chronic liver disease patients. We aimed to explore the knowledge, opinions and practices of cirrhosis patients and health workers in nutritional management of cirrhosis in Ghana, in order to determine whether there is a need to improve nutritional care for cirrhosis patients. METHODS We conducted a qualitative study using semi-structured interviews of cirrhotic patients (n = 16) and healthcare providers (n = 27) in three academic centers in Accra, Kumasi and Cape Coast (Ghana). Recruitment was by purposive sampling of patients attending specialist liver disease clinics. The recorded data were analyzed using NVivo 11 software, with generation of codes, themes and subthemes. RESULTS The major themes that emerged from the data included nutrition as part of care delivery during the hospital visit, nutritional recommendations, dietary changes and long-term practice improvement. The results showed that patients and health workers felt dietary recommendations for patients were frequently addressed, but could be significantly improved. We found that in the opinion of study participants, local guidelines are important and necessary in nutritional management of cirrhosis patients, and that participants felt it was difficult to change dietary habits following cirrhosis diagnosis. CONCLUSIONS These results suggest that nutritional management of cirrhosis patients in Ghana requires improvement. Strategies to improve this could include a multi-disciplinary approach to nutritional management, development of local guidelines and continued nutritional assessment, monitoring and follow-up.
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Affiliation(s)
- Yvonne Ayerki Nartey
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Internal Medicine, School of Medical Sciences University of Cape Coast, Cape Coast, Ghana.
| | - Mawuena Asem
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Yaw Asante Awuku
- Department of Internal Medicine, School of Medical Sciences University of Cape Coast, Cape Coast, Ghana
| | - Jacob Setorglo
- Department of Clinical Nutrition and Dietetics, School of Medical Sciences University of Cape Coast, Cape Coast, Ghana
| | - Amoako Duah
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Sally Bampoh
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Joshua Ayawin
- Department of Medicine, Komfo-Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Lewis Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota, USA
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Metformin prevents liver tumourigenesis by attenuating fibrosis in a transgenic mouse model of hepatocellular carcinoma. Oncogene 2019; 38:7035-7045. [PMID: 31409896 DOI: 10.1038/s41388-019-0942-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 12/24/2022]
Abstract
Metformin is a hypoglycaemic agent used to treat type 2 diabetes mellitus (DM2) patients, with a broad safety profile. Since previous epidemiological studies had shown that the incidence of hepatocellular carcinoma (HCC) decreased significantly in metformin treated DM2 patients, we hypothesised that intervention with metformin could reduce the risk of neoplastic transformation of hepatocytes. HCC is the most common primary liver malignancy and it generally originates in a background of liver fibrosis and cirrhosis. In the present study, we took advantage of a transgenic mouse (TG221) characterized by microRNA-221 overexpression, with cirrhotic liver background induced by chronic administration of carbon tetrachloride (CCl4). This mouse model develops fibrosis, cirrhosis and liver tumours that become visible in 100% of mice at 5-6 months of age. Our results demonstrated that metformin intervention improves liver function, inhibits hepatic stellate cell (HSC) activation, reduces liver fibrosis, depletes lipid accumulation in hepatocytes, halts progression to decompensated cirrhosis and abrogates development HCC in CCl4 challenged transgenic mouse model. The study establishes the rationale for investigating metformin in cirrhotic patients regardless of concomitant DM2 status.
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25
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Portal hypertension: The desperate search for the placenta. Curr Res Transl Med 2018; 67:56-61. [PMID: 30503816 DOI: 10.1016/j.retram.2018.09.001] [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: 02/26/2018] [Revised: 09/17/2018] [Accepted: 09/30/2018] [Indexed: 12/10/2022]
Abstract
We propose that the circulatory impairments produced, in both portal hypertension and liver cirrhosis, to a certain degree resemble those characterizing prenatal life in the fetus. In fact, the left-right circulatory syndrome is common in cirrhotic patients and in the fetus. Thus, in patients with portal hypertension and chronic liver failure, the re-expression of a blood circulation comparable to fetal circulation is associated with the development of similar amniotic functions, i.e., ascites production and placenta functions, and portal vascular enteropathy. Therefore, these re-expressed embryonic functions are extra-embryonic and responsible for prenatal trophism and development.
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26
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Matthews K, MacGilchrist A, Coulter‐Smith M, Jones J, Cetnarskyj R. A nurse‐led FibroScan
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outreach clinic encourages socially deprived heavy drinkers to engage with liver services. J Clin Nurs 2018; 28:650-662. [DOI: 10.1111/jocn.14660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/22/2018] [Accepted: 08/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Karen Matthews
- Centre for Liver and Digestive Disorders Royal Infirmary of Edinburgh Edinburgh UK
- Department of Nursing Centre for Applied Social Sciences Queen Margaret University Musselburgh UK
| | | | | | - Jacklyn Jones
- Department of Nutritional Science Queen Margaret University Musselburgh UK
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27
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Patient Views on Advance Care Planning in Cirrhosis: A Qualitative Analysis. Can J Gastroenterol Hepatol 2018; 2018:4040518. [PMID: 30079330 PMCID: PMC6069582 DOI: 10.1155/2018/4040518] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 02/20/2018] [Indexed: 02/07/2023] Open
Abstract
AIM To investigate patient experiences and perceptions of advance care planning (ACP) process in cirrhosis. METHODS Purposive sampling was used to identify and recruit participants (N = 17) from discrete patient groups: compensated with no prior decompensation, decompensated and not yet listed for transplant, transplant wait listed, medical contraindications for transplant, and low socioeconomic status. Review and discussion of local ACP videos, documents, and experiences with ACP occurred in two individual interviews and four focus groups. Data were analyzed using inductive content analysis including iterative processes of open coding, categorization, and abstraction. RESULTS Three overarching categories emerged: (1) lack of understanding about disease trajectories and ACP processes, (2) roles of alternate decision makers, and (3) preferences for receiving ACP information. Most patients desired advanced care-planning conversations before the onset of decompensation (specifically hepatic encephalopathy) with a care provider with whom they had a trusting, preexisting relationship. Involvement of the alternate decision makers was of critical importance to participants, as was the use of direct, easy to understand patient education tools that address practical issues. CONCLUSION Our findings support the need for early advance care planning in the outpatient setting. Outpatient clinicians may play a key role in facilitating these discussions.
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28
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Dong N, Chen WT, Bao M, Lu Y, Qian Y, Lu H. Self-Management Behaviors Among Patients With Liver Cirrhosis in Shanghai, China: A Cross-Sectional Study. Clin Nurs Res 2018; 29:448-459. [PMID: 29806496 DOI: 10.1177/1054773818777914] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Effective self-management of liver cirrhosis requires medication adherence and lifestyle modifications. The purpose of this study was to investigate the self-management behaviors of liver cirrhosis patients and how their knowledge of cirrhosis, psychological status, and self-efficacy contributes to self-management practices in Shanghai, China. Subjects were recruited from the hepatology units in an infectious hospital in Shanghai, China. Self-administered questionnaires were collected and medical charts were reviewed by the research staff. A total of 134 subjects were enrolled from November 2016 to March 2017. The results indicate that the self-management behaviors mean score was 2.51 out of 4 and that depression, severity of cirrhosis, and self-efficacy significantly affected self-management behaviors and explained 22.9% of the total variance. The findings also indicate that psychological stress, disease severity, and self-efficacy affected self-management behaviors in liver cirrhosis patients. Interventions focusing on decreasing depression and enhancing self-efficacy according to disease severity should improve self-management behaviors in this population.
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Affiliation(s)
- Ning Dong
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | | | - Meijuan Bao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yan Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuqian Qian
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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29
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Cervantes-Garcia D, Cuellar-Juarez AG, Borrego-Soto G, Rojas-Martinez A, Aldaba-Muruato LR, Salinas E, Ventura-Juarez J, Muñoz-Ortega MH. Adenoviral‑bone morphogenetic protein‑7 and/or doxazosin therapies promote the reversion of fibrosis/cirrhosis in a cirrhotic hamster model. Mol Med Rep 2017; 16:9431-9440. [PMID: 29039539 PMCID: PMC5780000 DOI: 10.3892/mmr.2017.7785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/15/2017] [Indexed: 12/13/2022] Open
Abstract
Liver fibrosis occurs in the presence of continuous insults, including toxic or biological agents. Novel treatments must focus on ceasing the progression of cellular damage, promoting the regeneration of the parenchyma and inhibition of the fibrotic process. The present study analyzed the effect of bone morphogenetic protein (BMP)-7 gene therapy with or without co-treatment with doxazosin in a model of liver cirrhosis in hamsters. The serum alanine aminotransferase, aspartate aminotransferase and albumin levels were analyzed spectrophotometrically. Tissue hepatic samples were analyzed by hematoxylin and eosin for parenchymal structure and Sirius red for collagen fiber content. BMP-7 and α-smooth muscle actin (SMA)-positive cells were detected by immunohistochemistry. BMP-7 and collagen type I content in hepatic tissue were analyzed by western blotting, and tissue inhibitor of metalloproteinases (TIMP)-2 and matrix metalloproteinase (MMP)-13 expression levels were detected by reverse transcription-quantitative polymerase chain reaction. The present study detected a significant reduction of collagen type I deposits in the group treated with adenoviral-transduction with BMP-7 and doxazosin. In animals with BMP-7 and doxazosin therapy, α-SMA-positive cells were 31.7 and 29% significantly decreased compared with animals with placebo, respectively. Adenoviral-BMP-7 transduction and/or doxazosin treatments actively induced decrement in type I collagen deposition via increased MMP-13 and reduced TIMP-2 expression. In conclusion, the adenovirus-BMP-7 gene therapy and the doxazosin therapy are potential candidates for the diminution of fibrosis in the liver, although combination of both therapies does not improve the individual anti-fibrotic effect once cirrhosis is established.
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Affiliation(s)
- Daniel Cervantes-Garcia
- Department of Microbiology, Basic Sciences Center, Autonomous University of Aguascalientes, 20131 Aguascalientes, Mexico
| | | | - Gissela Borrego-Soto
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, 64710 Nuevo Leon, Mexico
| | - Augusto Rojas-Martinez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, 64710 Nuevo Leon, Mexico
| | - Liseth Rubi Aldaba-Muruato
- Department of Morphology, Basic Sciences Center, Autonomous University of Aguascalientes, 20131 Aguascalientes, Mexico
| | - Eva Salinas
- Department of Microbiology, Basic Sciences Center, Autonomous University of Aguascalientes, 20131 Aguascalientes, Mexico
| | - Javier Ventura-Juarez
- Department of Morphology, Basic Sciences Center, Autonomous University of Aguascalientes, 20131 Aguascalientes, Mexico
| | - Martin Humberto Muñoz-Ortega
- Department of Chemistry, Basic Sciences Center, Autonomous University of Aguascalientes, 20131 Aguascalientes, Mexico
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