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Reiberger T, Lens S, Cabibbo G, Nahon P, Zignego AL, Deterding K, Elsharkawy AM, Forns X. EASL position paper on clinical follow-up after HCV cure. J Hepatol 2024; 81:326-344. [PMID: 38845253 DOI: 10.1016/j.jhep.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 07/26/2024]
Abstract
Following the advent of direct-acting antivirals (DAAs), hepatitis C virus (HCV) infection can be cured in almost all infected patients. This has led to a number of clinical questions regarding the optimal management of the millions of patients cured of HCV. This position statement provides specific guidance on the appropriate follow-up after a sustained virological response in patients without advanced fibrosis, those with compensated advanced chronic liver disease, and those with decompensated cirrhosis. Guidance on hepatocellular carcinoma risk assessment and the management of extrahepatic manifestations of HCV is also provided. Finally, guidance is provided on the monitoring and treatment of reinfection in at-risk patients. The recommendations are based on the best available evidence and are intended to help healthcare professionals involved in the management of patients after treatment for HCV.
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Affiliation(s)
- Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Sabela Lens
- Liver Unit, Hospital Clinic Barcelona. IDIBAPS. Liver and Digestive Diseases Networking Biomedical Research Centre (CIBERehd). University of Barcelona. Spain
| | - Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties PROMISE, University of Palermo, Italy
| | - Pierre Nahon
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Unit, Bobigny; Université Sorbonne Paris Nord, F-93000 Bobigny; Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de Recherche des Cordeliers, Université de Paris, France
| | - Anna Linda Zignego
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Katja Deterding
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School. Germany
| | - Ahmed M Elsharkawy
- Liver Unit, Queen Elizabeth Hospital Birmingham. NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham, United Kingdom
| | - Xavier Forns
- Liver Unit, Hospital Clinic Barcelona. IDIBAPS. Liver and Digestive Diseases Networking Biomedical Research Centre (CIBERehd). University of Barcelona. Spain.
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Jiang Y, Glandorff C, Sun M. GSH and Ferroptosis: Side-by-Side Partners in the Fight against Tumors. Antioxidants (Basel) 2024; 13:697. [PMID: 38929136 PMCID: PMC11201279 DOI: 10.3390/antiox13060697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/26/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Glutathione (GSH), a prominent antioxidant in organisms, exhibits diverse biological functions and is crucial in safeguarding cells against oxidative harm and upholding a stable redox milieu. The metabolism of GSH is implicated in numerous diseases, particularly in the progression of malignant tumors. Consequently, therapeutic strategies targeting the regulation of GSH synthesis and metabolism to modulate GSH levels represent a promising avenue for future research. This study aimed to elucidate the intricate relationship between GSH metabolism and ferroptosis, highlighting how modulation of GSH metabolism can impact cellular susceptibility to ferroptosis and consequently influence the development of tumors and other diseases. The paper provides a comprehensive overview of the physiological functions of GSH, including its structural characteristics, physicochemical properties, sources, and metabolic pathways, as well as investigate the molecular mechanisms underlying GSH regulation of ferroptosis and potential therapeutic interventions. Unraveling the biological role of GSH holds promise for individuals afflicted with tumors.
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Affiliation(s)
- Yulang Jiang
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.J.); (C.G.)
- Internal Medicine in Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Diseases, Institute of Liver Diseases, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Christian Glandorff
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.J.); (C.G.)
- Internal Medicine in Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Diseases, Institute of Liver Diseases, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- University Clinic of Hamburg at the HanseMerkur Center of TCM, 20251 Hamburg, Germany
| | - Mingyu Sun
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.J.); (C.G.)
- Internal Medicine in Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Diseases, Institute of Liver Diseases, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Thiéfin G, Bertrand D, Untereiner V, Garnotel R, Bronowicki JP, Sockalingum GD. Serum infrared spectral profile is predictive of the degree of hepatic fibrosis in chronic hepatitis C patients. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 305:123433. [PMID: 37774586 DOI: 10.1016/j.saa.2023.123433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
Assessment of liver fibrosis is crucial to guide the therapeutic strategy in patients with chronic liver disease. We investigated the potential of serum Fourier transform infrared (FTIR) spectroscopy for assessing the degree of hepatic fibrosis in patients with chronic hepatitis C (CHC). The study was conducted on dried serum samples from 94 CHC patients at different histological stages of hepatic fibrosis: METAVIR F0 (n = 20), F1 (n = 17), F2 (n = 20), F3 (n = 20) and F4 (n = 17). Transmission FTIR spectra were acquired in the 4000-400 cm-1 range. Wavenumbers were selected by genetic algorithm (GA) according to their diagnostic performance as assessed by a partial least squares discriminant analysis (PLS-DA) model using a training and a validation set to differentiate severe stages of fibrosis from mild or moderate ones. The GA procedure was applied 50 times on randomly selected sets. Furthermore, the best set of wavenumbers was re-tested in 1000 randomly selected validation sets. Wavenumbers selected by GA corresponded to functional groups present in lipids, proteins, and carbohydrates. This model allowed to identify patients with cirrhosis (METAVIR F4), patients with advanced fibrosis (METAVIR F3 and F4), and patients with significant fibrosis (METAVIR F2, F3 and F4), with AUROC (Area Under the Receiver Operating Characteristic) of 0.88, 0.85 and 0.85, respectively. Thus, serum FTIR spectroscopy appears to have a strong potential as a new diagnostic tool for assessing the degree of fibrosis in patients with chronic liver disease.
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Affiliation(s)
- Gérard Thiéfin
- Université de Reims Champagne-Ardenne, BioSpecT-EA7506, UFR de Pharmacie, 51097 Reims, France; Service d'Hépato-Gastroentérologie et de Cancérologie Digestive, Centre Hospitalier Universitaire de Reims, 51092 Reims, France
| | | | - Valérie Untereiner
- Université de Reims Champagne-Ardenne, Plateforme en Imagerie Cellulaire et Tissulaire (PICT), 51097 Reims Cedex, France
| | - Roselyne Garnotel
- Université de Reims Champagne-Ardenne, BioSpecT-EA7506, UFR de Pharmacie, 51097 Reims, France; Laboratoire de Biochimie-Pharmacologie-Toxicologie, Centre Hospitalier Universitaire de Reims, 51092, Reims, France
| | - Jean-Pierre Bronowicki
- Service d'Hépato-Gastroentérologie, CHRU de Nancy-Brabois, Vandœuvre-lès-Nancy, 54511, France
| | - Ganesh D Sockalingum
- Université de Reims Champagne-Ardenne, BioSpecT-EA7506, UFR de Pharmacie, 51097 Reims, France.
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Ivashkin VT, Chulanov VP, Mamonova NA, Maevskaya MV, Zharkova MS, Tikhonov IN, Bogomolov PO, Volchkova EV, Dmitriev AS, Znojko OO, Klimova EA, Kozlov KV, Kravchenko IE, Malinnikova EY, Maslennikov RV, Mikhailov MI, Novak KE, Nikitin IG, Syutkin VE, Esaulenko EV, Sheptulin AA, Shirokova EN, Yushchuk ND. Clinical Practice Guidelines of the Russian Society for the Study of the Liver, the Russian Gastroenterological Association, the National Scientific Society of Infectious Disease Specialists for the Diagnosis and Treatment of Chronic Hepatitis C. RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2023; 33:84-124. [DOI: 10.22416/1382-4376-2023-33-1-84-124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Аim:diagnosis and treatment algorithms in the clinical recommendations intended for general practitioners, gastroenterologists, infectious disease specialists, hepatologists on the of chronic hepatitis C are presented.Summary.Chronic viral hepatitis C is a socially significant infection, the incidence of which in the Russian Federation remains significantly high. Over the past 10 years, great progress has been made in the treatment of hepatitis C — direct acting antiviral drugs have appeared. The spectrum of their effectiveness allows to achieve a sustained virological response in more than 90 % of cases, even in groups that were not previously considered even as candidates for therapy or were difficult to treat — patients receiving renal replacement therapy, after liver transplantation (or other organs), at the stage of decompensated liver cirrhosis, HIV co-infected, etc. Interferons are excluded from the recommendations due to their low effectiveness and a wide range of adverse events. The indications for the treatment have been expanded, namely, the fact of confirmation of viral replication. The terms of dispensary observation of patients without cirrhosis of the liver have been reduced (up to 12 weeks after the end of therapy). Also, these recommendations present approaches to active screening of hepatitis in risk groups, preventive and rehabilitation measures after the end of treatment.Conclusion.Great success has been achieved in the treatment of chronic hepatitis C. In most cases, eradication of viral HCV infection is a real task even in patients at the stage of cirrhosis of the liver, with impaired renal function, HIV co-infection, after solid organs transplantation.
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Affiliation(s)
- V. T. Ivashkin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V. P. Chulanov
- Center for Epidemiologically Significant Infectious Diseases, National Medical Research Center for Phthisiopulmonology and Infectious Diseases
| | - N. A. Mamonova
- Center for Epidemiologically Significant Infectious Diseases, National Medical Research Center for Phthisiopulmonology and Infectious Diseases
| | - M. V. Maevskaya
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M. S. Zharkova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - I. N. Tikhonov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - P. O. Bogomolov
- M.F. Vladimirsky Moscow Regional Research Clinical Institute
| | - E. V. Volchkova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A. S. Dmitriev
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O. O. Znojko
- Moscow State University of Medicine and Dentistry
| | | | | | | | - E. Yu. Malinnikova
- Department of Virology, Russian Medical Academy of Continuing Professional Education
| | - R. V. Maslennikov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M. I. Mikhailov
- North-Western State Medical University named after I.I. Mechnikov
| | | | | | - V. E. Syutkin
- Sklifosovsky Clinical and Research Institute for Emergency Medicine; Russian State Research Center — Burnazyan Federal Medical Biophysical Center
| | | | - A. A. Sheptulin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - E. N. Shirokova
- Sechenov First Moscow State Medical University (Sechenov University)
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Goyal A, Dalia T, Ranka S, Sauer AJ, Hu J, Cernik C, Nuqali A, Chandler J, Parimi N, Dennis K, Majmundar M, Tayeb T, Haglund J, Shah Z, Vidic A, Gupta B, Haglund NA. Impact of Biopsy Proven Liver Fibrosis on Patients Undergoing Evaluation and Treatment for Advanced Heart Failure Surgical Therapies. Am J Cardiol 2023; 194:46-55. [PMID: 36947946 DOI: 10.1016/j.amjcard.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 03/24/2023]
Abstract
There is a paucity of data regarding the impact of liver fibrosis on patients with stage D heart failure (HF). We conducted a retrospective study (January 1, 2017 to December 12, 2020) in patients with stage D HF who underwent liver biopsy as part of their advanced HF therapy evaluation. Baseline characteristics and 1-year outcomes were compared between no- or mild-to-moderate-fibrosis (grade 0 to 2) and advanced-fibrosis (grade 3 to 4) groups. Of 519 patients with stage D HF, 136 who underwent liver biopsy (113 [83%] no or mild-to-moderate fibrosis and 23 [17%] advanced fibrosis) were included. A total of 71 patients (52%) received advanced HF therapies (23 heart transplantation, 48 left ventricular assist devices). One-year mortality was higher among patients with advanced fibrosis (52% vs 18%, p <0.001). Further subgroup analysis suggested a trend toward increased 1-year mortality among patients with advanced fibrosis who underwent advanced therapies (37% vs 13%, p = 0.09). There was a trend of lower likelihood of receiving advanced HF therapies in the advanced-fibrosis group, only 1 heart transplantation and 7 left ventricular assist devices, but it did not reach statistical significance (35% vs 56%, p = 0.06). After adjustment for confounders, degree of liver fibrosis was an independent predictor of mortality (odds ratio 6.2; 95% 1.27 to 30.29, p = 0.02). We conclude that advanced liver fibrosis is common among patients with stage D HF who undergo evaluation for advanced HF surgical therapies and significantly increases 1-year mortality. Further larger studies are needed to support our findings.
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Affiliation(s)
- Amandeep Goyal
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Tarun Dalia
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Sagar Ranka
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Andrew J Sauer
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Jinxiang Hu
- Departments of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, Kansas
| | - Colin Cernik
- Departments of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, Kansas
| | - Abdulelah Nuqali
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Jonathan Chandler
- Departments of Internal Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Nikhil Parimi
- Departments of Internal Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Katie Dennis
- Departments of Pathology, The University of Kansas Health System, Kansas City, Kansas
| | - Monil Majmundar
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Taher Tayeb
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Jennifer Haglund
- Departments of Gastroenterology and Hepatology, The University of Kansas Health System, Kansas City, Kansas
| | - Zubair Shah
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Andrija Vidic
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Bhanu Gupta
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Nicholas A Haglund
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas.
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Canivet CM, Costentin C, Irvine KM, Delamarre A, Lannes A, Sturm N, Oberti F, Patel PJ, Decaens T, Irles-Depé M, Fouchard I, Hermabessière P, Roux M, Barthelon J, Calès P, Powell EE, de Ledinghen V, Boursier J. Validation of the new 2021 EASL algorithm for the noninvasive diagnosis of advanced fibrosis in NAFLD. Hepatology 2023; 77:920-930. [PMID: 35822302 DOI: 10.1002/hep.32665] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND AIMS The European Association for the Study of the Liver (EASL) has recently proposed an algorithm for the diagnosis of advanced liver fibrosis. We aimed to evaluate the diagnostic accuracy of this algorithm in nonalcoholic fatty liver disease (NAFLD). APPROACH AND RESULTS One thousand fifty-one patients with NAFLD, liver biopsy, and four noninvasive tests (NITs; Fibrosis-4 [FIB4], vibration controlled transient elastography [VCTE], FibroMeter, Fibrotest) were included. The enhanced liver fibrosis (ELF) score was available in 396 patients. A cohort of 230 patients from primary care/diabetes clinics had FIB4, VCTE, and ELF. Compared with the performance of single NITs, agreement between two NITs (FIB4 and VCTE, VCTE and patented serum tests) increased specificity and positive predictive value by 20%, thus justifying the sequential use proposed in the EASL algorithm. The FIB4/VCTE/FibroMeter and FIB4/VCTE/Fibrotest algorithms performed similarly, providing 85% diagnostic accuracy and a liver biopsy requirement rate of only 10%. The FIB4/VCTE/ELF algorithm performed similarly in the subgroup where ELF was available. Simulations of algorithm accuracies at different prevalence showed that positive predictive values rapidly increased, reaching a plateau above 75% starting at 15% prevalence. Negative predictive values remained higher than 90% up to 25% prevalence. The rate of liver biopsy requirement remained stable, increasing by only 5% between low and high prevalence settings. When the EASL algorithm was applied in the primary care/diabetes clinic cohort, liver biopsy requirement was only 3%, and the agreement among the three steps provided 75% positive predictive value. CONCLUSIONS Our study validates the algorithm proposed by the EASL in its latest 2021 guidelines for the diagnosis of advanced fibrosis in the setting of NAFLD.
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Affiliation(s)
- Clémence M Canivet
- Service d'Hépato-Gastroentérologie et Oncologie Digestive , Centre Hospitalier Universitaire d'Angers , Angers , France
- Laboratoire HIFIH, UPRES EA3859, SFR 4208 , Université d'Angers , Angers , France
| | - Charlotte Costentin
- Université Grenoble Alpes, Institute for Advanced Biosciences , Research Center UGA/Inserm U 1209/CNRS 5309 , Grenoble , France
- Service d'Hépato-Gastroentérologie , Centre Hospitalier universitaire Grenoble-Alpes , La tronche , France
| | - Katharina M Irvine
- Mater Research , The University of Queensland, Translational Research Institute , Woolloongabba, Brisbane , Queensland , Australia
- Centre for Liver Disease Research, Translational Research Institute , The University of Queensland , Woolloongabba, Brisbane , Queensland , Australia
| | - Adèle Delamarre
- Service d'Hépatologie, Hôpital Haut-Lévêque , Centre Hospitalier Universitaire de Bordeaux , Pessac , France
- INSERM U1312 , Université de Bordeaux , Bordeaux , France
| | - Adrien Lannes
- Service d'Hépato-Gastroentérologie et Oncologie Digestive , Centre Hospitalier Universitaire d'Angers , Angers , France
- Laboratoire HIFIH, UPRES EA3859, SFR 4208 , Université d'Angers , Angers , France
| | - Nathalie Sturm
- Service d'Anatomie et de Cytologie Pathologique , Centre Hospitalier universitaire Grenoble-Alpes , La tronche , France
| | - Frederic Oberti
- Service d'Hépato-Gastroentérologie et Oncologie Digestive , Centre Hospitalier Universitaire d'Angers , Angers , France
- Laboratoire HIFIH, UPRES EA3859, SFR 4208 , Université d'Angers , Angers , France
| | - Preya J Patel
- Liver Unit , Freeman Hospital , Newcastle Upon Tyne , UK
| | - Thomas Decaens
- Université Grenoble Alpes, Institute for Advanced Biosciences , Research Center UGA/Inserm U 1209/CNRS 5309 , Grenoble , France
- Service d'Hépato-Gastroentérologie , Centre Hospitalier universitaire Grenoble-Alpes , La tronche , France
| | - Marie Irles-Depé
- Service d'Hépatologie, Hôpital Haut-Lévêque , Centre Hospitalier Universitaire de Bordeaux , Pessac , France
- INSERM U1312 , Université de Bordeaux , Bordeaux , France
| | - Isabelle Fouchard
- Service d'Hépato-Gastroentérologie et Oncologie Digestive , Centre Hospitalier Universitaire d'Angers , Angers , France
- Laboratoire HIFIH, UPRES EA3859, SFR 4208 , Université d'Angers , Angers , France
| | - Paul Hermabessière
- Service d'Hépatologie, Hôpital Haut-Lévêque , Centre Hospitalier Universitaire de Bordeaux , Pessac , France
- INSERM U1312 , Université de Bordeaux , Bordeaux , France
| | - Marine Roux
- Laboratoire HIFIH, UPRES EA3859, SFR 4208 , Université d'Angers , Angers , France
| | - Justine Barthelon
- Service d'Hépato-Gastroentérologie , Centre Hospitalier universitaire Grenoble-Alpes , La tronche , France
| | - Paul Calès
- Service d'Hépato-Gastroentérologie et Oncologie Digestive , Centre Hospitalier Universitaire d'Angers , Angers , France
- Laboratoire HIFIH, UPRES EA3859, SFR 4208 , Université d'Angers , Angers , France
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Translational Research Institute , The University of Queensland , Woolloongabba, Brisbane , Queensland , Australia
- Department of Gastroenterology and Hepatology , Princess Alexandra Hospital , Woolloongabba, Brisbane , Queensland , Australia
| | - Victor de Ledinghen
- Service d'Hépatologie, Hôpital Haut-Lévêque , Centre Hospitalier Universitaire de Bordeaux , Pessac , France
- INSERM U1312 , Université de Bordeaux , Bordeaux , France
| | - Jérôme Boursier
- Service d'Hépato-Gastroentérologie et Oncologie Digestive , Centre Hospitalier Universitaire d'Angers , Angers , France
- Laboratoire HIFIH, UPRES EA3859, SFR 4208 , Université d'Angers , Angers , France
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7
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Emara MH, Zaghloul M, Amer IF, Mahros AM, Ahmed MH, Elkerdawy MA, Elshenawy E, Rasheda AMA, Zaher TI, Haseeb MT, Emara EH, Elbatae H. Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics. World J Hepatol 2023; 15:216-224. [PMID: 36926231 PMCID: PMC10011914 DOI: 10.4254/wjh.v15.i2.216] [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: 11/13/2022] [Revised: 12/25/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
Acute variceal bleeding in patients with liver cirrhosis and portal hypertension (PHT) is the most serious emergency complication among those patients and could have catastrophic outcomes if not timely managed. Early screening by esophago-gastro-duodenoscopy (EGD) for the presence of esophageal varices (EVs) is currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in studies to investigate and validate non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder (GB) wall thickness (GBWT) measurement has been found promising in many published research articles. We aim to highlight the validity of sonographic GBWT measurement in the prediction of EVs based on the available evidence. We searched databases including Cochrane library, PubMed, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cut-offs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive gastropathy. Among cirrhotics, GBWT > 3.5 mm predicts the presence of advanced (grade III-IV) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Ibrahim F Amer
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Aya M Mahros
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mahmoud A Elkerdawy
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Eslam Elshenawy
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Abdelrahman M Ahmed Rasheda
- Department of Internal Medicine, Gastroenterology Unit, Security Forces Hospital, Riyadh 11481, Saudi Arabia
| | - Tarik I Zaher
- Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Mona Talaat Haseeb
- Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Emad Hassan Emara
- Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Hassan Elbatae
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
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8
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Lee DH, Sung SU, Lee YK, Lim IH, Jang H, Joo SK, Park JH, Chang MS, So YH, Kim W. A sequential approach using the age-adjusted fibrosis-4 index and vibration-controlled transient elastography to detect advanced fibrosis in Korean patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2022; 55:994-1007. [PMID: 35005800 DOI: 10.1111/apt.16766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/02/2021] [Accepted: 12/24/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Vibration-controlled transient elastography (VCTE) has shown good diagnostic performance in predicting fibrosis stages in patients with non-alcoholic fatty liver disease (NAFLD). However, an optimal diagnostic approach to detect advanced fibrosis in patients with NAFLD has not been established. APPROACH AND RESULTS We prospectively collected data from 539 subjects who underwent liver biopsy at a single centre between January 2014 and December 2019. Diagnostic performance was estimated using the area under the receiver-operating characteristic curve (AUROC). Several models combining the fibrosis 4 index (FIB-4) score and liver stiffness measurement (LSM) were analysed to reduce the need for unnecessary liver biopsies. We observed significant fibrosis (≥F2), advanced fibrosis (≥F3) and cirrhosis (F4) in 173 (32.1%), 74 (13.7%) and 46 subjects (8.5%), respectively. The AUROCs (95% CI) for LSMs to diagnose ≥F2, ≥F3 and F4 were 0.82 (0.78-0.85), 0.92 (0.89-0.94) and 0.95 (0.93-0.97), respectively. Optimal LSM cut-off values were 6.7 (≥F2), 8.3 (≥F3) and 9.8 (F4) kPa. LSMs were affected by waist circumference, serum albumin and fibrosis stage (R2 = 0.315). Abdominal obesity, elevated transaminase, diabetes mellitus and high IQR/Median were associated with the discordance of ≥2 fibrosis stages between LSMs and histologic data. The sequential use of the age-adjusted FIB-4 and LSMs yielded the least uncertainty (5.3%) in classifying disease severity with the highest diagnostic accuracy (81%) among a variety of non-invasive test combinations. CONCLUSIONS The sequential approach of age-adjusted FIB-4 and VCTE could represent a practical diagnostic strategy to detect advanced fibrosis in NAFLD (ClinicalTrials.gov #NCT02206841).
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Affiliation(s)
- Dong Hyeon Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Se Un Sung
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Kyu Lee
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ik Hyeon Lim
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heejoon Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Sae Kyoung Joo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Jeong Hwan Park
- Department of Pathology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Mee Soo Chang
- Department of Pathology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Young Ho So
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Won Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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9
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Hur M, Park M, Moon HW, Choe WH, Lee CH. Comparison of Non-Invasive Clinical Algorithms for Liver Fibrosis in Patients With Chronic Hepatitis B to Reduce the Need for Liver Biopsy: Application of Enhanced Liver Fibrosis and Mac-2 Binding Protein Glycosylation Isomer. Ann Lab Med 2022; 42:249-257. [PMID: 34635616 PMCID: PMC8548241 DOI: 10.3343/alm.2022.42.2.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/20/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Non-invasive clinical algorithms for the detection of liver fibrosis (LF) can reduce the need for liver biopsy (LB). We explored the implementation of two serum biomarkers, enhanced liver fibrosis (ELF) and Mac-2 binding protein glycosylation isomer (M2BPGi), in clinical algorithms for LF in chronic hepatitis B (CHB) patients. Methods Two clinical algorithms were applied to 152 CHB patients: (1) transient elastography (TE) followed by biomarkers (TE/ELF and TE/M2GPGi); (2) biomarker test followed by TE (ELF/TE and M2BPGi/TE). Using the cut-off value or index for the detection of advanced LF (TE≥F3; 9.8 in ELF and 3.0 in M2BPGi), LB was expected to be performed in cases with discordant TE and biomarker results. Results In both algorithms, the expected number of LBs was lower when using M2BPGi than when using ELF (TE/ELF or ELF/TE, 13.2% [N=20]; TE/M2BPGi or M2BPGi/TE, 9.9% [N=15]), although there was no statistical difference (P=0.398). In the TE low-risk group (TE≤F2), the discordance rate was significantly lower in the TE/M2BPGi approach than in the TE/ELF approach (1.5% [2/136] vs. 11.0% [15/136], P=0.002). In the biomarker low-risk group, there was no significant difference between the ELF/TE and M2BPGi/TE approaches (3.9% [5/126] vs. 8.8% [13/147], P=0.118). Conclusions Both ELF and M2BPGi can be implemented in non-invasive clinical algorithms for assessing LF in CHB patients. Given the lowest possibility of losing advanced LF cases in the low-risk group when using the TE/M2BPGi approach, this combination seems useful in clinical practice.
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Affiliation(s)
- Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mikyoung Park
- Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Won Hyeok Choe
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Chae Hoon Lee
- Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu, Korea
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10
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Cuesta-Sancho S, Márquez-Coello M, Illanes-Álvarez F, Márquez-Ruiz D, Arizcorreta A, Galán-Sánchez F, Montiel N, Rodriguez-Iglesias M, Girón-González JA. Hepatitis C: Problems to extinction and residual hepatic and extrahepatic lesions after sustained virological response. World J Hepatol 2022; 14:62-79. [PMID: 35126840 PMCID: PMC8790402 DOI: 10.4254/wjh.v14.i1.62] [Citation(s) in RCA: 2] [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: 03/06/2021] [Revised: 08/02/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Loss of follow-up or reinfections hinder the expectations of hepatitis C eradication despite the existence of highly effective treatments. Moreover, the elimination of the infection does not imply the reversion of those chronic alterations derived from the previous infection by hepatitis C virus (HCV). This review analyzes the risk factors associated with loss to follow-up in diagnosis or treatment, and the possibility of reinfection. Likewise, it assesses the residual alterations induced by chronic HCV infection considering the liver alterations (inflammation, fibrosis, risk of decompensation, hepatocellular carcinoma, liver transplantation) and, on the other hand, the comorbidities and extrahepatic manifestations (cryoglobulinemia, non-Hodgkin lymphoma, peripheral insulin resistance, and lipid, bone and cognitive alterations). Peculiarities present in subjects coinfected with human immunodeficiency virus are analyzed in each section.
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Affiliation(s)
- Sara Cuesta-Sancho
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Mercedes Márquez-Coello
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Francisco Illanes-Álvarez
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Denisse Márquez-Ruiz
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Ana Arizcorreta
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Fátima Galán-Sánchez
- Microbiología, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Natalia Montiel
- Microbiología, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Manuel Rodriguez-Iglesias
- Microbiología, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - José-Antonio Girón-González
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
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11
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Olveira Martín A, García Montes ML, Sanchez-Azofra M. Risk of hepatocellular carcinoma in patients with chronic hepatitis c infection and stage 3 fibrosis after sustained virological response. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:309-311. [DOI: 10.17235/reed.2022.8840/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Kosick HMK, Keyrouz A, Adeyi O, Sebastiani G, Patel K. A Stepwise Algorithmic Approach and External Validation Study for Noninvasive Prediction of Advanced Fibrosis in Nonalcoholic Fatty Liver Disease. Dig Dis Sci 2021; 66:4046-4057. [PMID: 33389416 DOI: 10.1007/s10620-020-06748-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Advanced F3-4 fibrosis predicts liver-related mortality in nonalcoholic fatty liver disease (NAFLD). Noninvasive tests, designed to rule in/out advanced fibrosis, are limited by indeterminates, necessitating biopsy. We aimed to determine whether stepwise combinations of noninvasive serum-based tests and elastography (VCTE) could predict F3-4, reduce indeterminates, and decrease liver biopsies. METHODS AND RESULTS Five hundred forty-one biopsy-proven NAFLD cases were identified between 2010 and 2018 from two Canadian centers. Characteristics of training (n = 407)/validation (n = 134) cohorts included: males 54%/59%; mean age 48.5/52.5 years; mean body mass index 32.3/33.6 kg/m2; diabetes mellitus 30%/34%; and F3-4 48%/43%. For training/validation cohorts, area under the receiver operating curve (AUROC) for FIB-4, AST-platelet ratio index (APRI), NAFLD fibrosis score (NFS), BARD score, and AST/ALT ratio ranged from 0.70 to 0.83/0.68 to 0.81, with indeterminates 25-39%/34-45%, for F3-4. In the training cohort, parallel FIB-4 + NFS had good accuracy (AUROC = 0.81) but was limited by 38% indeterminates and 16% misclassified. Sequential FIB-4 → NFS reduced indeterminates to 10%, and FIB-4 → VCTE to 0%, misclassified 20-22%, while maintaining high specificity (0.88-0.92) and accuracy (AUROC 0.75-0.78) for combined cohorts. Liver biopsy could have been avoided in 27-29% of patients using sequential algorithms. CONCLUSIONS Sequential FIB-4 ➔ NFS/VCTE predicts F3-4 with high specificity and good accuracy, while reducing indeterminates and need for biopsy. Parallel algorithms are limited by high indeterminates. Sequential FIB-4 ➔ NFS had similar accuracy to VCTE-containing algorithms. Validation in low-prevalence cohorts may allow for potential use in community or resource-limited areas for risk stratification.
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Affiliation(s)
- Heather Mary-Kathleen Kosick
- Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
| | - Aline Keyrouz
- Division of Gastroenterology and Hepatology, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Oyedele Adeyi
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Keyur Patel
- Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
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13
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Jung J, Loomba RR, Imajo K, Madamba E, Gandhi S, Bettencourt R, Singh S, Hernandez C, Valasek MA, Behling C, Richards L, Fowler K, Sirlin C, Nakajima A, Loomba R. MRE combined with FIB-4 (MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis. Gut 2021; 70:1946-1953. [PMID: 33214165 PMCID: PMC8131405 DOI: 10.1136/gutjnl-2020-322976] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/10/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with non-alcoholic fatty liver disease (NAFLD) with ≥stage 2 fibrosis are at increased risk for liver-related mortality and are candidates for pharmacological therapies for treatment of NAFLD. The aim of this prospective cohort study is to examine the diagnostic accuracy of MR elastography (MRE) combined with fibrosis-4 (FIB-4) in diagnosing ≥stage 2 fibrosis (candidates for pharmacological therapies). DESIGN This is a cross-sectional analysis of a prospective cohort (University of California at San Diego (UCSD)-NAFLD) including 238 consecutive patients with contemporaneous MRE and biopsy-proven NAFLD. Non-alcoholic steatohepatitis-Clinical Research Network-Histologic Scoring System was used to assess histology. The radiologist and pathologist were blinded to clinical, pathological and imaging data, respectively. Receiver operating characteristics (ROCs) were determined to examine the diagnostic accuracy of MRE and FIB-4 for diagnosis of ≥stage 2 fibrosis in NAFLD. We then validated these findings in an independent validation cohort derived from Yokohama City University in Japan (Japan-NAFLD Cohort; N=222 patients). RESULTS In the UCSD-NAFLD (training) Cohort, MRE demonstrated a clinically significant diagnostic accuracy for the detection of ≥stage 2 fibrosis with an area under the ROC curve (AUROC) of 0.93 (95% CI 0.90 to 0.97) vs FIB-4 with an AUROC of 0.78 (95% CI 0.71 to 0.85), which was both clinically and statistically significant (p<0.0001). We then combined MRE with FIB-4 (MRE ≥3.3 kPa and FIB-4 ≥1.6) to develop a clinical prediction rule to rule in ≥stage 2 fibrosis patients which had positive predictive value (PPV) of 97.1% (p<0.02) in the UCSD-NAFLD cohort (AUROC of 0.90 (95% CI 0.85 to 0.95)) which remained significant at PPV of 91.0% (p<0.003) in the Japan-NAFLD Cohort (AUROC of 0.84 (95% CI 0.78 to 0.89)). CONCLUSION MRE combined with FIB-4 (MEFIB) index may be used for non-invasive identification of candidates for (≥stage 2 fibrosis) pharmacological therapy among patients with NAFLD with a high PPV.
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Affiliation(s)
- Jinho Jung
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Rohan R Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Kento Imajo
- Yokohama City University Graduate School of Medicine, Department of Gastroenterology, Yokohama, Japan
| | - Egbert Madamba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Sanil Gandhi
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Ricki Bettencourt
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Seema Singh
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Carolyn Hernandez
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Mark A. Valasek
- University of California at San Diego, Department of Pathology, La Jolla, United States
| | - Cynthia Behling
- Sharp Medical Group, Department of Pathology, San Diego, United States
| | - Lisa Richards
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Kathryn Fowler
- University of California at San Diego, Liver Imaging Group, Department of Radiology, La Jolla, United States
| | - Claude Sirlin
- University of California at San Diego, Liver Imaging Group, Department of Radiology, La Jolla, United States
| | - Atsushi Nakajima
- Yokohama City University Graduate School of Medicine, Department of Gastroenterology, Yokohama, Japan
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, California, USA .,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
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14
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Combination of FIB-4 with ultrasound surface nodularity or elastography as predictors of histologic advanced liver fibrosis in chronic liver disease. Sci Rep 2021; 11:19275. [PMID: 34588540 PMCID: PMC8481285 DOI: 10.1038/s41598-021-98776-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022] Open
Abstract
Reliable and available non-invasive methods for hepatic fibrosis assessment are important in chronic liver disease (CLD). Our aim was to compare stepwise algorithms combining standard ultrasound with serum markers and transient elastography (TE) for detecting advanced fibrosis (F3-4) and cirrhosis. Retrospective single center study between 2012 and 2018 of CLD patients with biopsy, TE, blood tests, and liver ultrasound parameters of surface nodularity (SN), lobar redistribution, and hepatic vein nodularity. Our cohort included 157 patients (51.6% males), mean age 47.6 years, predominantly non-alcoholic fatty liver disease and viral hepatitis (61%), with F3-4 prevalence of 60.5%. Area under the curve for F3-4 was 0.89 for TE ≥ 9.6 kPa and 0.80 for FIB-4 > 3.25. In multivariate modeling, TE ≥ 9.6 kPa (OR 21.78) and SN (OR 3.81) had independent association with F3-4; SN (OR 5.89) and TE ≥ 10.2 kPa (OR 15.73) were independently associated with cirrhosis. Two stepwise approaches included FIB-4 followed by SN or TE; sensitivity and specificity of stepwise SN were 0.65 and 1.00, and 0.89 and 0.33 for TE ≥ 9.6 kPa, respectively. Ultrasound SN and TE were independently predictive of F3-4 and cirrhosis in our cohort. FIB-4 followed by SN had high specificity for F3-4.
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15
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Kang Q, Xu J, Luo H, Tan N, Chen H, Cheng R, Pan J, Han Y, Yang Y, Liu D, Xi H, Yu M, Xu X. Direct antiviral agent treatment leads to rapid and significant fibrosis regression after HCV eradication. J Viral Hepat 2021; 28:1284-1292. [PMID: 34105867 DOI: 10.1111/jvh.13558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/22/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022]
Abstract
Limited data are currently available regarding fibrosis progression after hepatitis C virus (HCV) eradication. The goal of the present study was to evaluate the effects of HCV eradication on liver stiffness measurements (LSMs), aspartate aminotransferase/platelet ratio index (APRI) scores, fibrosis-4(FIB-4) scores, chitinase-3-like protein 1 (CHI3L1) levels and Golgi protein 73 (GP73) levels in patients with chronic hepatitis C (CHC). One hundred and two patients who received direct antiviral agents (DAAs) therapy at Peking University First Hospital participated in the present study. Clinical information and serum samples were collected at baseline, at the end of treatment (EOT), and at the weeks 12, 24 and 48 after treatment (W12, W24 and W48, respectively). Of the 102 patients, 51 had mild-to-moderate fibrosis (F1/F2), and 51 had advanced fibrosis (F3/F4). The LSMs improved for all patients at the EOT, with observed changes of 2.85 kPa, and the decrease continued to W12. However, a more pronounced improvement was noted for the advanced fibrosis (F3/F4) patients, with a change of 3.6 kPa from baseline to the EOT. Significant decreases between the baseline and EOT measurements were observed in the APRI and FIB-4 scores [0.64 (0.39-1.21) vs. 0.35 (0.26-0.52), p<0.001; 2.53 (1.30-3.91) vs. 1.87 (0.89-2.5), p<0.001], after which the values decreased until W12, with no significant difference observed. Serum CHI3L1 and GP73 levels were profoundly decreased at the EOT compared with those at baseline [134.07 (154.49) vs. 103.75 (98.04), p=0.025; 98.24 (64.76) vs. 88.91 (50.89), p=0.002]. DAA treatments could significantly improve liver fibrosis of CHC patients as evidenced by decreased liver stiffness, APRI scores and FIB-4 scores. Improvements in liver fibrosis markers (especially serum CHI3L1 and GP73) were prominent in patients with advanced fibrosis, indicating that serum CHI3L1 and GP73 could be noninvasive markers for monitoring fibrosis in CHC patients. Significance Statement The prospective cohort evaluated the effect of direct antiviral agents (DAAs) on fibrosis regression after hepatitis C virus (HCV) eradication of Chinese people in the real-world study. This study highlighted that rapid and significant fibrosis regression rather than reduction in inflammation was achieved with DAA treatment, and this regression could be detected as early as the end of treatment. We found the serum CHI3L1 and GP73 levels can be used to monitor changes in fibrosis in CHC patients.
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Affiliation(s)
- Qian Kang
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Jinghang Xu
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Hao Luo
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Ning Tan
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Hongyu Chen
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Ran Cheng
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Jiali Pan
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Yifan Han
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Yuqing Yang
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Dan Liu
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Hongli Xi
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Min Yu
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
| | - Xiaoyuan Xu
- Departments of Infectious Diseases, Peking University First Hospital, Beijing, People's Republic of China
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16
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Pokorska-Śpiewak M, Dobrzeniecka A, Lipińska M, Tomasik A, Aniszewska M, Marczyńska M. Liver Fibrosis Evaluated With Transient Elastography in 35 Children With Chronic Hepatitis C Virus Infection. Pediatr Infect Dis J 2021; 40:103-108. [PMID: 33021594 DOI: 10.1097/inf.0000000000002913] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this prospective study was to analyze liver fibrosis in teenagers with chronic hepatitis C (CHC) using noninvasive methods. METHODS Thirty-five patients with CHC, 12-17 years of age (mean 14.2 ± 1.8 years; 22/35, 63% male) were included. Most of them (29/35, 83%) were infected vertically, 21/35 (60%) were treatment-naive, 30/35 (86%) were infected with genotype 1 and 5/35 (14%) were infected with genotype 4 HCV. In all patients, evaluation of liver fibrosis was performed using transient elastography (TE) and measurement of the following serum biomarkers: aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis-4 index (FIB-4). Using liver stiffness measurement (LSM) results as a reference, the diagnostic performance of APRI and FIB-4 was assessed by calculating area under the receiver operating characteristics curve. RESULTS Transient elastography results revealed no or mild fibrosis (F0/1 in METAVIR scale) in 31/35 (89%) patients. In 4/35 (11%) patients, significant fibrosis was observed (F ≥ 2), including 3/35 (9%) with cirrhosis (F4). The median APRI was 0.32, and the median FIB-4 was 0.32. LSM was associated with both APRI and FIB-4 [r = 0.61, 95% confidence interval (CI) 0.35-0.79, P = 0.0001; and r = 0.60, 95% CI 0.32-0.78, P = 0.0002, respectively]. For the diagnosis of significant fibrosis, the area under the receiver operating characteristics (95% CI) for both APRI and FIB-4 was 0.855 (0.695-0.951). APRI, with a cutoff >0.374, predicted significant fibrosis, with 100% sensitivity and 67.7% specificity, whereas FIB-4, with a cutoff >0.402, predicted significant fibrosis, with 75.0% sensitivity and 90.3% specificity. CONCLUSIONS Significant fibrosis, including cirrhosis, may occur in teenagers with CHC. Serum biomarkers (APRI, FIB-4) correlate positively with LSM.
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Affiliation(s)
- Maria Pokorska-Śpiewak
- From the Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- Pediatric Infectious Diseases Unit, Regional Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | - Anna Dobrzeniecka
- Pediatric Infectious Diseases Unit, Regional Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | - Marta Lipińska
- From the Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- Pediatric Infectious Diseases Unit, Regional Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | - Anna Tomasik
- From the Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- Pediatric Infectious Diseases Unit, Regional Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | - Małgorzata Aniszewska
- From the Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- Pediatric Infectious Diseases Unit, Regional Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | - Magdalena Marczyńska
- From the Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- Pediatric Infectious Diseases Unit, Regional Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
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17
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Noninvasive biomarkers predict improvement in liver fibrosis after successful generic DAAs based therapy of chronic hepatitis C in Egypt. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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18
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Pawlotsky JM, Negro F, Aghemo A, Berenguer M, Dalgard O, Dusheiko G, Marra F, Puoti M, Wedemeyer H. EASL recommendations on treatment of hepatitis C: Final update of the series ☆. J Hepatol 2020; 73:1170-1218. [PMID: 32956768 DOI: 10.1016/j.jhep.2020.08.018] [Citation(s) in RCA: 595] [Impact Index Per Article: 148.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 02/08/2023]
Abstract
Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Clinical care for patients with HCV-related liver disease has advanced considerably thanks to an enhanced understanding of the pathophysiology of the disease, as well as developments in diagnostic procedures and improvements in therapy and prevention. These therapies make it possible to eliminate hepatitis C as a major public health threat, as per the World Health Organization target, although the timeline and feasibility vary from region to region. These European Association for the Study of the Liver recommendations on treatment of hepatitis C describe the optimal management of patients with recently acquired and chronic HCV infections in 2020 and onwards.
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19
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Chen YP, Huang LW, Lin XY, Hu XM, Liang XE, Jiang RL. Alanine aminotransferase influencing performances of routine available tests detecting hepatitis B-related cirrhosis. J Viral Hepat 2020; 27:826-836. [PMID: 32187804 DOI: 10.1111/jvh.13293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/11/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022]
Abstract
The performances of routine tests such as FIB-4 and APRI in detecting cirrhosis and significant fibrosis in chronic hepatitis B (CHB) have been shown to be discrepant between studies. Novel tests such as red cell distribution width-platelet ratio (RPR), γ-glutamyl transpeptidase to platelet ratio (GPR) and easy liver fibrosis test (eLIFT) are introduced recently. To evaluate the aminotransferase influence on the performance of these routine tests, a total of 1005 CHB patients who underwent liver biopsies and routine tests were retrospectively analysed. The diagnostic cut-offs referring to likelihood ratio were determined for excluding or including cirrhosis diagnosis and also for ruling in significant fibrosis diagnosis. The performances of RPR, FIB-4, eLIFT and APRI in detecting cirrhosis seemed improved at higher ALT levels, while GPR was conversely impaired. The likelihood ratio was ∝ for APRI cut-off 2 diagnosing cirrhosis in ALT < 2 upper limit of normal (ULN), 14.6 for APRI cut-off 1.5 determining significant fibrosis in ALT ≤ 5ULN and 20.6 for FIB-4 cut-off 3.2 diagnosing ≥ F3 in the total cohort, respectively. The optimal cut-offs for cirrhosis diagnosis were increased with higher ALTs by tests which included aminotransferase, but not for RPR. The proportions of patients classified as having cirrhosis or no cirrhosis stratified by ALT level cut-offs were superior. Stepwise applying RPR, GPR and eLIFT would determine 60% of patients as having cirrhosis or no cirrhosis with an accuracy of 93.0%. In conclusion, the performance of aminotransferase comprising tests in detecting cirrhosis in CHB were influenced by ALT levels. Thus, ALT stratified cut-offs may be a preferred alternative. In resource-limited settings, stepwise applying routine tests could be recommended as a preferred measurement for cirrhosis detection.
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Affiliation(s)
- Yong-Peng Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Hepatology Unit, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,Department of Internal Medicine, Nanfang Hospital Taihe Branch, Guangzhou, China
| | - Li-Wen Huang
- Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Shunde, China
| | - Xiao-Yu Lin
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao-Min Hu
- Hepatology Unit, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xie-Er Liang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rong-Long Jiang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Hepatology Unit, Shenzhen Hospital, Southern Medical University, Shenzhen, China
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20
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Loomba R, Adams LA. Advances in non-invasive assessment of hepatic fibrosis. Gut 2020; 69:1343-1352. [PMID: 32066623 PMCID: PMC7945956 DOI: 10.1136/gutjnl-2018-317593] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
Liver fibrosis should be assessed in all individuals with chronic liver disease as it predicts the risk of future liver-related morbidity and thus need for treatment, monitoring and surveillance. Non-invasive fibrosis tests (NITs) overcome many limitations of liver biopsy and are now routinely incorporated into specialist clinical practice. Simple serum-based tests (eg, Fibrosis Score 4, non-alcoholic fatty liver disease Fibrosis Score) consist of readily available biochemical surrogates and clinical risk factors for liver fibrosis (eg, age and sex). These have been extensively validated across a spectrum of chronic liver diseases, however, tend to be less accurate than more 'complex' serum tests, which incorporate direct measures of fibrogenesis or fibrolysis (eg, hyaluronic acid, N-terminal propeptide of type three collagen). Elastography methods quantify liver stiffness as a marker of fibrosis and are more accurate than simple serum NITs, however, suffer increasing rates of unreliability with increasing obesity. MR elastography appears more accurate than sonographic elastography and is not significantly impacted by obesity but is costly with limited availability. NITs are valuable for excluding advanced fibrosis or cirrhosis, however, are not sufficiently predictive when used in isolation. Combining serum and elastography techniques increases diagnostic accuracy and can be used as screening and confirmatory tests, respectively. Unfortunately, NITs have not yet been demonstrated to accurately reflect fibrosis change in response to treatment, limiting their role in disease monitoring. However, recent studies have demonstrated lipidomic, proteomic and gut microbiome profiles as well as microRNA signatures to be promising techniques for fibrosis assessment in the future.
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Affiliation(s)
- Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Epidemiology, University of California at San Diego, La Jolla, California, USA
| | - Leon A Adams
- Medicine and Pharmacology, The University of Western Australia, Nedlands, Western Australia, Australia
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21
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Kanwal F, Kramer JR, Asch SM, Cao Y, Li L, El-Serag HB. Long-Term Risk of Hepatocellular Carcinoma in HCV Patients Treated With Direct Acting Antiviral Agents. Hepatology 2020; 71:44-55. [PMID: 31222774 DOI: 10.1002/hep.30823] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/10/2019] [Indexed: 02/03/2023]
Abstract
Sustained virologic response (SVR) after direct acting antiviral agents (DAAs) holds promise for reducing hepatocellular cancer (HCC). DAAs have recently been available long enough to estimate the long-term risk. We conducted a retrospective cohort study of hepatitis C virus (HCV) patients who achieved SVR with DAAs from 129 Veterans Health Administration hospitals between January 1, 2015, and December 31, 2015, with follow-up through September 30, 2018. We calculated the overall and quarterly HCC incidence rates. We examined the effect of demographic, clinical, and behavioral factors and the decline or increase of FIB-4 and aspartate aminotransferase to platelet ratio index (APRI) on HCC risk. Among the 18,076 patients with SVR, 544 incident cases of HCC were diagnosed during the mean 2.9 years of follow-up. The cumulative 1, 2, and 3-year risks of HCC were 1.1%, 1.9% and 2.8%, respectively. Cirrhosis was strongly associated with HCC risk (adjusted hazard ratio = 4.13, 95% confidence interval = 3.34-5.11). The quarterly incidence rate of HCC remained stable between 1.00 and 1.23/100 person-years (PY) and 1.5 to 2.3/100 PY in patients with cirrhosis. The risk of HCC was the highest in patients who had persistently high FIB-4/APRI and both with and without cirrhosis. HCC risk fell in patients with cirrhosis who experienced a decrease of FIB-4/APRI scores yet remained higher than the accepted threshold for HCC surveillance. HCC risk was also higher in patients with alcohol use, older age, and infection with HCV genotype 3. Most patients treated at an early stage of liver fibrosis had a stable low risk. Conclusion: Patients successfully treated with DAAs and at risk of HCC did not regress after 3.6 years of follow-up. HCC risk remained above the accepted thresholds for surveillance in patients with cirrhosis. These data have important implications for HCC surveillance in cured HCV patients.
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Affiliation(s)
- Fasiha Kanwal
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.,Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Jennifer R Kramer
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Steven M Asch
- Center for Innovation to Implementation (Ci2i), Palo Alto Veterans Affairs Medical Center, Palo Alto, CA.,Division of Primary Care and Population Health, Stanford University, Palo Alto, CA
| | - Yumei Cao
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hashem B El-Serag
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.,Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
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22
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Guillaume M, Moal V, Delabaudiere C, Zuberbuhler F, Robic MA, Lannes A, Metivier S, Oberti F, Gourdy P, Fouchard-Hubert I, Selves J, Michalak S, Peron JM, Cales P, Bureau C, Boursier J. Direct comparison of the specialised blood fibrosis tests FibroMeter V2G and Enhanced Liver Fibrosis score in patients with non-alcoholic fatty liver disease from tertiary care centres. Aliment Pharmacol Ther 2019; 50:1214-1222. [PMID: 31617224 DOI: 10.1111/apt.15529] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/03/2019] [Accepted: 09/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Enhanced Liver Fibrosis score (ELF) and the FibroMeterV2G are two specialized blood fibrosis tests which include direct markers of liver fibrosis. They have been shown to be more accurate than the simple blood fibrosis tests FIB4 and the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS). AIMS To directly compare the accuracies of ELF and FibroMeterV2G for the non-invasive diagnosis of liver fibrosis in NAFLD. METHODS Four hundred and seventeen patients with biopsy-proven NAFLD were enrolled from two tertiary care centres. Four blood fibrosis tests were calculated: ELF, FibroMeterV2G , NFS, and FIB4. Advanced fibrosis F3/4 on liver biopsy (NASH CRN scoring) was the primary endpoint. RESULTS Areas under the receiver operating characteristic (AUROC) curve for advanced fibrosis were not significantly different between the direct markers of liver fibrosis (hyaluronate, PIIINP, TIMP-1, alpha2-macroglobulin) and the simple blood fibrosis tests NFS and FIB4. ELF (0.793 ± 0.022) and FibroMeterV2G (0.804 ± 0.021) had significantly higher AUROC than NFS (0.722 ± 0.025, P < .010) and FIB4 (0.739 ± 0.024, P < .020). AUROC for advanced fibrosis and Obuchowski index were not significantly different between ELF and FibroMeterV2G . Algorithms using first ELF or FibroMeterV2G and then liver biopsy in case of undetermined diagnosis provided high diagnostic accuracy for advanced fibrosis: 90% sensitivity, 90% specificity, 93% negative predictive value, 85% positive predictive value, and 90% correct classification. In these algorithms, the rate of liver biopsy was 45.3% with ELF versus 39.3% with FibroMeterV2G (P = .065). CONCLUSIONS ELF and FibroMeterV2G have equal accuracy and perform better than the simple FIB4 and NFS tests for the non-invasive diagnosis of advanced liver fibrosis in patients with NAFLD from tertiary care centres.
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Affiliation(s)
- Maeva Guillaume
- Hepato-Gastroenterology Department, Toulouse University Hospital, Toulouse, France.,Institut CARDIOMET, Fédération Hospitalo-Universitaire IMPACT, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), UMR1048, INSERM/UPS, Toulouse University, Toulouse, France
| | - Valerie Moal
- Biochemistry Department, Angers University Hospital, Angers, France.,HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | | | - Floraine Zuberbuhler
- HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France.,Hepato-Gastroenterology Department, Angers University Hospital, Angers, France
| | - Marie-Angèle Robic
- Hepato-Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Adrien Lannes
- HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France.,Hepato-Gastroenterology Department, Angers University Hospital, Angers, France
| | - Sophie Metivier
- Hepato-Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Frederic Oberti
- HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France.,Hepato-Gastroenterology Department, Angers University Hospital, Angers, France
| | - Pierre Gourdy
- Institut CARDIOMET, Fédération Hospitalo-Universitaire IMPACT, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), UMR1048, INSERM/UPS, Toulouse University, Toulouse, France.,Diabetology Department, Toulouse University Hospital, Toulouse, France
| | - Isabelle Fouchard-Hubert
- HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France.,Hepato-Gastroenterology Department, Angers University Hospital, Angers, France
| | - Janick Selves
- Pathology Department, Toulouse University Hospital, Toulouse, France
| | - Sophie Michalak
- HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France.,Pathology Department, Angers University Hospital, Angers, France
| | - Jean-Marie Peron
- Hepato-Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Paul Cales
- HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France.,Hepato-Gastroenterology Department, Angers University Hospital, Angers, France
| | - Christophe Bureau
- Hepato-Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Jerome Boursier
- HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France.,Hepato-Gastroenterology Department, Angers University Hospital, Angers, France
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23
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Boursier J, Guillaume M, Leroy V, Irlès M, Roux M, Lannes A, Foucher J, Zuberbuhler F, Delabaudière C, Barthelon J, Michalak S, Hiriart JB, Peron JM, Gerster T, Le Bail B, Riou J, Hunault G, Merrouche W, Oberti F, Pelade L, Fouchard I, Bureau C, Calès P, de Ledinghen V. New sequential combinations of non-invasive fibrosis tests provide an accurate diagnosis of advanced fibrosis in NAFLD. J Hepatol 2019; 71:389-396. [PMID: 31102719 DOI: 10.1016/j.jhep.2019.04.020] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/20/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Advanced liver fibrosis is an important diagnostic target in non-alcoholic fatty liver disease (NAFLD) as it defines the subgroup of patients with impaired prognosis. The non-invasive diagnosis of advanced fibrosis is currently limited by the suboptimal positive predictive value and the grey zone (representing indeterminate diagnosis) of fibrosis tests. Here, we aimed to determine the best combination of non-invasive tests for the diagnosis of advanced fibrosis in NAFLD. METHODS A total of 938 patients with biopsy-proven NAFLD were randomized 2:1 into derivation and validation sets. All patients underwent liver stiffness measurement with vibration controlled transient elastography (VCTE) and blood fibrosis tests (NAFLD fibrosis score, Fibrosis-4 [FIB4], Fibrotest, Hepascore, FibroMeter). FibroMeterVCTE, which combines VCTE results and FibroMeter markers in a single test, was also calculated in all patients. RESULTS For the diagnosis of advanced fibrosis, VCTE was significantly more accurate than the blood tests (area under the receiver operating characteristic curve [AUROC]: 0.840 ± 0.013, p ≤0.005). FibroMeter was the most accurate blood test (AUROC: 0.793 ± 0.015, p ≤0.017). The combinatory test FibroMeterVCTE outperformed VCTE and blood tests (AUROC: 0.866 ± 0.012, p ≤0.005). The sequential combination of FIB4 then FibroMeterVCTE (FIB4-FMVCTE algorithm) or VCTE then FibroMeterVCTE (VCTE-FMVCTE algorithm) provided an excellent diagnostic accuracy of 90% for advanced fibrosis, with liver biopsy only required to confirm the diagnosis in 20% of cases. The FIB4-FMVCTE and VCTE-FMVCTE algorithms were significantly more accurate than the pragmatic algorithms currently proposed. CONCLUSION The sequential combination of fibrosis tests in the FIB4-FMVCTE and VCTE-FMVCTE algorithms provides a highly accurate solution for the diagnosis of advanced fibrosis in NAFLD. These algorithms should now be validated for the diagnosis of advanced liver fibrosis in diabetology or primary care settings. LAY SUMMARY The evaluation of liver fibrosis is mandatory in non-alcoholic fatty liver disease (NAFLD), as advanced fibrosis identifies the subgroup of patients with impaired prognosis. FibroMeterVCTE is a new fibrosis test combining blood markers and the result of vibration controlled transient elastography (VCTE) into a single diagnostic test. Our results show that FibroMeterVCTE outperforms other blood fibrosis tests and VCTE alone for the diagnosis of advanced fibrosis in a large multi-centric cohort of 938 patients with biopsy-proven NAFLD. Sequential algorithms using a simple blood test or VCTE as a first-line procedure, then FibroMeterVCTE as a second-line test accurately classified 90% of patients.
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Affiliation(s)
- Jérôme Boursier
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire d'Angers, Angers, France; Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, Angers, France.
| | - Maeva Guillaume
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Institut CARDIOMET, Fédération Hospitalo-Universitaire IMPACT, Toulouse, France
| | - Vincent Leroy
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; INSERM U1209, Université Grenoble-Alpes, Grenoble, France
| | - Marie Irlès
- Service d'Hépatologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Marine Roux
- Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, Angers, France
| | - Adrien Lannes
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire d'Angers, Angers, France; Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, Angers, France
| | - Juliette Foucher
- Service d'Hépatologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Floraine Zuberbuhler
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire d'Angers, Angers, France; Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, Angers, France
| | - Cyrielle Delabaudière
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Justine Barthelon
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Sophie Michalak
- Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, Angers, France; Département de Pathologie Tissulaire et Cellulaire, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Jean-Baptiste Hiriart
- Service d'Hépatologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Jean-Marie Peron
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Institut CARDIOMET, Fédération Hospitalo-Universitaire IMPACT, Toulouse, France
| | - Theophile Gerster
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Brigitte Le Bail
- Service d'Anatomopathologie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Jeremie Riou
- MINT UMR INSERM 1066, CNRS 6021, Angers University, France
| | - Gilles Hunault
- Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, Angers, France
| | - Wassil Merrouche
- Service d'Hépatologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Frederic Oberti
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire d'Angers, Angers, France; Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, Angers, France
| | - Laurence Pelade
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Isabelle Fouchard
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire d'Angers, Angers, France; Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, Angers, France
| | - Christophe Bureau
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Institut CARDIOMET, Fédération Hospitalo-Universitaire IMPACT, Toulouse, France
| | - Paul Calès
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire d'Angers, Angers, France; Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, Angers, France
| | - Victor de Ledinghen
- Service d'Hépatologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; INSERM U1053, Université de Bordeaux, Bordeaux, France
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24
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Menard M, Lecoindre A, Cadoré JL, Chevallier M, Pagnon A, Hernandez J, Leal RO, Hugonnard M, Miette V, Destro M, Rannou B, Benchekroun G, Lecoindre P. Use of serum biomarkers in staging of canine hepatic fibrosis. J Vet Diagn Invest 2019; 31:665-673. [PMID: 31347473 DOI: 10.1177/1040638719866881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Accurate staging of hepatic fibrosis (HF) is important for treatment and prognosis of canine chronic hepatitis. HF scores are used in human medicine to indirectly stage and monitor HF, decreasing the need for liver biopsy. We developed a canine HF score to screen for moderate or greater HF. We included 96 dogs in our study, including 5 healthy dogs. A liver biopsy for histologic examination and a biochemistry profile were performed on all dogs. The dogs were randomly split into a training set of 58 dogs and a validation set of 38 dogs. A HF score that included alanine aminotransferase, alkaline phosphatase, total bilirubin, potassium, and gamma-glutamyl transferase was developed in the training set. Model performance was confirmed using the internal validation set, and was similar to the performance in the training set. The overall sensitivity and specificity for the study group were 80% and 70% respectively, with an area under the curve of 0.80 (0.71-0.90). This HF score could be used for indirect diagnosis of canine HF when biochemistry panels are performed on the Konelab 30i (Thermo Scientific), using reagents as in our study. External validation is required to determine if the score is sufficiently robust to utilize biochemical results measured in other laboratories with different instruments and methodologies.
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Affiliation(s)
- Maud Menard
- Internal Medicine Department, Université Paris-Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France (Menard, Benchekroun)
| | - Alexis Lecoindre
- Internal Medicine Department (Lecoindre A, Cadoré, Hugonnard), VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Étoile, France
| | - Jean-Luc Cadoré
- Internal Medicine Department (Lecoindre A, Cadoré, Hugonnard), VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Étoile, France
| | | | | | - Juan Hernandez
- Internal Medicine Department, Centre Hospitalier Vétérinaire Frégis, Arcueil, France (Hernandez, Leal)
| | - Rodolpho Oliveira Leal
- Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal (Leal)
| | - Marine Hugonnard
- Internal Medicine Department (Lecoindre A, Cadoré, Hugonnard), VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Étoile, France
| | | | | | - Benoît Rannou
- Laboratoire de biologie médicale (Rannou), VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Étoile, France
| | - Ghita Benchekroun
- Internal Medicine Department, Université Paris-Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France (Menard, Benchekroun)
| | - Patrick Lecoindre
- Internal Medicine Department (Lecoindre A, Cadoré, Hugonnard), VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Étoile, France
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25
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Papadopoulos N, Vasileiadi S, Papavdi M, Sveroni E, Antonakaki P, Dellaporta E, Koutli E, Michalea S, Manolakopoulos S, Koskinas J, Deutsch M. Liver fibrosis staging with combination of APRI and FIB-4 scoring systems in chronic hepatitis C as an alternative to transient elastography. Ann Gastroenterol 2019; 32:498-503. [PMID: 31474797 PMCID: PMC6686098 DOI: 10.20524/aog.2019.0406] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Liver disease severity must be determined before treatment of chronic hepatitis C (CHC). We evaluated the diagnostic performance of the APRI and FIB-4 scores compared to transient elastography liver stiffness (TE-LS) in detecting significant fibrosis (F3) or cirrhosis (F4). Methods: We retrospectively enrolled 575 patients with CHC who underwent TE-LS between May 2014 and September 2018: 365 (63.5%) male, mean age 51.54±12.4 years. APRI and FIB-4 scores were compared to TE-LS. Results : One hundred patients (17.5%) had TE-LS values between 9 and 11.9 kPa, and were classified as F3, while 265 (46%) were classified as F4 (TE-LS ≥12 kPa). APRI and FIB-4 scores predicted F4 patients adequately using cutoff values of 0.65 (sensitivity 85.5%, specificity 77%) and 1.63 (sensitivity 91%, specificity 77%), respectively. Cutoff values of 0.64 for APRI and 1.46 for FIB-4 predicted F3/F4 patients (sensitivity 72% and 81.5%; specificity 83% and 79%, respectively). The use of these cutoff values with APRI and FIB-4 in combination adequately predicted patients with significant fibrosis or cirrhosis (positive predictive value 91.5%), while cutoff values of 0.3 and 0.98, respectively, predicted F1/F2 patients with specificity 94.5% and sensitivity 26.5%, suggesting that in 58.5% of patients TE-LS could possibly be avoided. Conclusions: The APRI/FIB-4 combination performed well in predicting significant fibrosis, while FIB-4 performed well in predicting cirrhosis. These noninvasive biochemical markers could be used as screening tools instead of LS measurement, which is not widely available. Further prospective validation studies are required to confirm this finding.
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Affiliation(s)
- Nikolaos Papadopoulos
- 1 Department of Internal Medicine, 417 Army Share Fund Hospital of Athens (Nikolaos Papadopoulos, Eirini Sveroni)
| | - Sofia Vasileiadi
- Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch)
| | - Maria Papavdi
- Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch)
| | - Eirini Sveroni
- 1 Department of Internal Medicine, 417 Army Share Fund Hospital of Athens (Nikolaos Papadopoulos, Eirini Sveroni)
| | - Pinelopi Antonakaki
- Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch)
| | - Erminia Dellaporta
- Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch)
| | - Evangelia Koutli
- Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch)
| | - Stavroula Michalea
- Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch)
| | - Spilios Manolakopoulos
- Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch).,Laiko General Hospital, Athens, Greece, Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens (Spilios Manolakopoulos), Greece
| | - John Koskinas
- Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch)
| | - Melanie Deutsch
- Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch)
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Non-invasive Fibrosis Assessment of Patients with Hepatitis C: Application of Society Guidelines to Clinical Practice. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s11901-019-00471-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Zhang ZQ, Yang B, Zou H, Xiong L, Miao XY, Wen Y, Zhou JJ. ALBI/ST ratio versus FIB-4 and APRI as a predictor of posthepatectomy liver failure in hepatocellular carcinoma patients. Medicine (Baltimore) 2019; 98:e15168. [PMID: 30985698 PMCID: PMC6485818 DOI: 10.1097/md.0000000000015168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A precise and noninvasive method to predict posthepatectomy liver failure (PHLF) in clinical practice is still lacking. Liver fibrosis or cirrhosis accompanied with varying degrees of portal hypertension plays an important role in the occurrence of PHLF in hepatocellular carcinoma (HCC) patients. This study aims to compare the predictive ability of the albumin-bilirubin score to spleen thickness ratio (ALBI/ST) versus fibrosis-4 index (FIB-4) and aspartate aminotransferase to platelet count ratio index (ARPI) for the occurrence of PHLF. We retrospectively enrolled 932 patients who underwent liver resection for HCC between 2010 and 2017. The predictive accuracy of ALBI/ST ratio, FIB-4, and APRI for occurrence of PHLF was evaluated by receiver operating characteristic curve analysis. PHLF was diagnosed in 69 (7.4%) patients. The ALBI/ST ratio was found to be a significant predictor of PHLF. The AUC of ALBI/ST (AUC = 0.774; 95% CI, 0.731-0.817; P <.001) was larger than that of FIB-4 (AUC = 0.696; 95% CI, 0.634-0.759; P <.001) and APRI (AUC = 0.697; 95% CI, 0.629-0.764; P <.001). Multivariate analysis demonstrated that ALBI/ST ratio was a strong risk factor of PHLF in all hepatectomy subgroups. In conclusion, the ALBI/ST ratio has a superior predictive ability for PHLF compared with APRI and FIB-4.
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Hansen JF, Christiansen KM, Staugaard B, Moessner BK, Lillevang S, Krag A, Christensen PB. Combining liver stiffness with hyaluronic acid provides superior prognostic performance in chronic hepatitis C. PLoS One 2019; 14:e0212036. [PMID: 30742668 PMCID: PMC6370278 DOI: 10.1371/journal.pone.0212036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/26/2019] [Indexed: 12/15/2022] Open
Abstract
Background Non-invasive methods are the first choice for liver fibrosis evaluation in chronic liver diseases, but few studies investigate the ability of combined methods to predict outcomes. Methods 591 chronic hepatitis C patients with baseline liver stiffness (LSM) by FibroScan and hyaluronic acid measurements were identified retrospectively. The patients were grouped by baseline LSM: < 10kPa, 10–16.9kPa, and 17-75kPa. Primary outcomes were all-cause mortality and liver-related mortality, analyzed using cox regression and competing risk regression models, respectively. Results Median follow-up was 46.1 months. Prevalence of cirrhosis at baseline was 107/591 (18.1%). Median LSM was 6.8kPa (IQR 5.3–11.6) and divided into groups, 404/591 (68.4%) had a LSM < 10kPa, 100/591 (16.9%) had a LSM between 10–16.9kPa and 87/591 (14.7%) had a LSM between 17-75kPa. There were 69 deaths, 27 from liver-related disease. 26 patients developed cirrhosis and 30 developed complications of cirrhosis. The mortality rate in the 17-75kPa group was 9.7/100 person-years, compared to 2.2/100 person-years and 1.1/100 person-years in the 10–16.9kPa and <10kPa groups (p<0.005). Liver-related mortality increased 10-fold for each group (p<0.005). Cirrhotic complications occurred almost exclusively in the 17-75kPa group, with an incidence of 10.3/100 person-years, compared to 1.8/100 person-years and 0.2/100 person-years in the 10–16.9kPa and <10kPa groups (p<0.005). Median hyaluronic acid in the 17-75kPa group was approximately 200ng/mL. Patients with a LSM 17-75kPa had significantly higher risks of death, liver-related death, and complications to cirrhosis if their hyaluronic acid measurement was more than or equal to 200ng/mL at baseline, with hazard ratios of 3.25 (95% CI 1.48–7.25), 7.7 (95% CI 2.32–28), and 3.2 (95% CI 1.35–7.39), respectively. Conclusions The combination of LSM and circulating hyaluronic acid measurements significantly improved prognostic ability, relative to LSM alone. Combined static and dynamic markers of liver fibrosis could provide superior risk prediction.
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Affiliation(s)
- Janne Fuglsang Hansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | | | - Benjamin Staugaard
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | | | - Søren Lillevang
- Clinical Immunological Department, Odense University Hospital, Odense, Denmark
| | - Aleksander Krag
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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El-Sheikh RM, Mansy SS, Nessim IG, Hosni HN, El Hindawi A, Hassanein MH, AbdelFattah AS. Carbamoyl phosphate synthetase 1 (CPS1) as a prognostic marker in chronic hepatitis C infection. APMIS 2019; 127:93-105. [PMID: 30698308 DOI: 10.1111/apm.12917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/08/2018] [Indexed: 12/11/2022]
Abstract
This study aims to assess the value of carbamoyl phosphate synthetase 1 (CPS1), as a non-invasive serum marker, for the evolution of chronic HCV infection and hepatic fibrosis. Seventy-two patients with HCV positive serum RNA and 15 health volunteers were enrolled in this study. Out of 72 patients, 10 patients had decompensated liver with ascites. Quantitative analysis of CPS1 was performed in the harvested sera and corresponding liver biopsies using ELISA and immunohistochemistry techniques respectively. Also, mitochondrial count using electron microscopy, urea analysis and conventional liver tests were done. Patients were grouped into (F1 + F2) and (F3 + F4) representing stages of moderate and severe fibrosis respectively. Tissue and serum CPS1 (s.CPS1) correlated significantly in moderate and severe fibrosis. Patients with severe fibrosis showed significantly higher levels of s.CPS1 (p-value ≤ 0.05) and significantly lower mitochondrial counts (p-value = 0.0065) than those with moderate fibrosis. S.urea positively correlated with s.CPS1 only in the decompensated group, at which s.urea reached maximal levels. In conclusion, s.CPS1 is a potential non-invasive marker for the assessment of severity and progression of HCV in relation to mitochondrial dysfunction. Also, increased s.urea with the progression of the disease is mainly due to a concurrent renal malfunction, which needs further investigation.
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Affiliation(s)
- Ranya M El-Sheikh
- Electron Microscopy Research Department (Pathology), Theodor Bilharz Research Institute, Giza, Egypt
| | - Soheir S Mansy
- Electron Microscopy Research Department (Pathology), Theodor Bilharz Research Institute, Giza, Egypt
| | - Iris G Nessim
- Clinical Chemistry Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Hala N Hosni
- Faculty of Medicine, Pathology Department, Cairo University, Cairo, Egypt
| | - Ali El Hindawi
- Faculty of Medicine, Pathology Department, Cairo University, Cairo, Egypt
| | - Moataz H Hassanein
- Hepatogastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed S AbdelFattah
- Hepatogastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt
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Chronic hepatitis C infection - Noninvasive assessment of liver fibrosis in the era of direct acting antivirals. Dig Liver Dis 2019; 51:183-189. [PMID: 30553749 DOI: 10.1016/j.dld.2018.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 02/07/2023]
Abstract
Significant advancements in the diagnosis and treatment of chronic hepatitis C infection and its associated fibrosis have revolutionized treatment of these patients over the last several years. Liver biopsy, the gold standard diagnostic method for evaluating liver fibrosis level, was routinely used prior to initiation of hepatitis C therapy, placing patients at an inherent risk of adverse events. The recent advent of noninvasive serologic and nonserologic measures of hepatic fibrosis level has reduced the need for liver biopsy significantly, thereby minimizing its associated risks. These noninvasive methods have been extensively studied in the era of interferon therapies and are increasingly recognized in the realm of direct acting antiviral agents as well. Their validation of use after having achieved a sustained virologic response is yet to occur, but the future remains promising. This review focuses on the various non-invasive diagnostic modalities of liver fibrosis and discusses how they can be applied to the care of patients undergoing direct acting antiviral therapy for hepatitis C. In the constantly evolving landscape of hepatitis C therapy, the review underscores the important prognostic value of fibrosis staging prior to HCV treatment and suggests potential uses for non-invasive fibrosis assessment following successful HCV eradication.
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Abstract
Chronic hepatitis C virus (HCV) infection is a leading cause of death, especially in immunocompromised patients. The lack of clear prevalence data in the Middle East makes it difficult to estimate the true morbidity and mortality burden of HCV. In Kuwait, estimating the burden of disease is complicated by the constant flow of expatriates, many of whom are from HCV-endemic areas. The development of new and revolutionary treatments for HCV necessitates the standardization of clinical practice across all healthcare institutions. While international guidelines from the American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL) do address this evolving treatment landscape, the cost-driven treatment prioritization of patients by these guidelines and unique HCV genotype presentation in the Kuwaiti population prompted the development of a more tailored approach. The predominant HCV genotypes prevalent in Kuwait are genotypes 4 and 1. The Kuwait Hepatology Club (KHC), comprising hepatologists across all major institutions in Kuwait, conducted several consensus meetings to develop the scoring criteria, evaluate all current evidence, and propose screening, diagnosis, and treatment suggestions for the management of HCV in this population. While these treatment suggestions were largely consistent with the 2016 AASLD and 2015 EASL guidelines, they also addressed gaps in the unmet needs of the Kuwaiti population with HCV.
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Affiliation(s)
- Motaz Fathy Saad
- Haya Al-Habib Gastroenterology and Hepatology Center, Mubarak Alkabir Hospital, Hawaly, Kuwait,
| | - Saleh Alenezi
- Unit of Gastroenterology and Hepatology, Department of Medicine, Farwaniya Hospital, Kuwait City, Kuwait
| | - Haifaa Asker
- Thunayan Al-Ghanim Gastroenterology and Hepatology Center, Al-Amiri Hospital, Kuwait City, Kuwait
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Moon HW, Park M, Hur M, Kim H, Choe WH, Yun YM. Usefulness of Enhanced Liver Fibrosis, Glycosylation Isomer of Mac-2 Binding Protein, Galectin-3, and Soluble Suppression of Tumorigenicity 2 for Assessing Liver Fibrosis in Chronic Liver Diseases. Ann Lab Med 2018; 38:331-337. [PMID: 29611383 PMCID: PMC5895862 DOI: 10.3343/alm.2018.38.4.331] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/14/2017] [Accepted: 01/29/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Liver biopsies have been partially replaced by noninvasive methods for assessing liver fibrosis. We explored the usefulness of four novel biomarkers, enhanced liver fibrosis (ELF), glycosylation isomer of Mac-2 binding protein (M2BPGi), galectin-3, and soluble suppression of tumorigenicity 2 (sST2), in association with liver fibrosis. METHODS ELF, M2BPGi, galectin-3, and sST2 were assayed in 173 patients with chronic liver diseases. The results were analyzed according to fibrosis grade (F0/1, F2, and F3/4) by transient elastography (TE). RESULTS ELF, M2BPGi, galectin-3, and sST2 values differed significantly according to TE grade; ELF and M2BPGi values were higher in F2 and F3/4 than in F0/1 (P≤0.001, all), sST2 values were higher in F3/4 than in F0/1 and F2 (P<0.05), and galectin-3 values were higher in F3/4 than in F0/1 (P=0.0036). ELF and M2BPGi showed good TE fibrosis detection performance (area under the curves [AUC], 0.841 and 0.833 for ≥F2; and 0.837 and 0.808 for ≥F3). The sensitivity and specificity for predicting TE grade F≥2 were 84.1% and 76.7% for ELF and 63.6% and 91.5% for M2BPGi. CONCLUSIONS This is the first study to compare the liver fibrosis assessment of four novel biomarkers: ELF, M2BPGi, galectin-3, and sST2. The biomarkers varied significantly according to TE grade, and each biomarker showed a different trend. ELF and M2BPGi seem to have comparable good performance for detecting liver fibrosis.
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Affiliation(s)
- Hee Won Moon
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mikyoung Park
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea.
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Won Hyeok Choe
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yeo Min Yun
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
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Jiang H, Zheng T, Duan T, Chen J, Song B. Non-invasive in vivo Imaging Grading of Liver Fibrosis. J Clin Transl Hepatol 2018; 6:198-207. [PMID: 29951365 PMCID: PMC6018309 DOI: 10.14218/jcth.2017.00038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/25/2017] [Accepted: 11/29/2017] [Indexed: 02/05/2023] Open
Abstract
Liver fibrosis (LF), a common consequence of chronic liver diseases with various etiologies, is characterized by excessive accumulation of macromolecules, including collagen, glycoproteins and proteoglycans, in the liver. LF can result in hepatic dysfunction, cirrhosis, portal hypertension and, in some cases, hepatocellular carcinoma. As the current gold standard for diagnosing LF, liver biopsy, however, is invasive and prone to sampling errors and procedure-related complications. Therefore, developing noninvasive, precise and reproducible imaging tests for diagnosing and staging LF is of great significance. Conventional ultrasound (US), computed tomography (CT) and magnetic resonance (MR) imaging can depict morphological alterations of advanced LF, but have relatively limited capability characterizing early-stage LF. In order to optimize the diagnostic performances of noninvasive imaging techniques for LF across its entire spectrum of severity, a number of novel methods, including US elastography, CT perfusion imaging and various MR imaging-based techniques, have been established and introduced to clinical practice. In this review, we intended to summarize current noninvasive imaging techniques for LF, with special emphasis on the possible roles, advantages and limitations of the new emerging imaging modalities.
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Affiliation(s)
- Hanyu Jiang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Tianying Zheng
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Ting Duan
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Jie Chen
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Bin Song
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
- *Correspondence to: Bin Song, Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China. Tel: +86-28-85423680, +86-13881918066, E-mail:
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Zeremski M, Martinez A. Liver Disease and Fibrosis Assessment in Substance Use-Related Disorders. Clin Pharmacol Drug Dev 2018; 6:164-168. [PMID: 28263455 DOI: 10.1002/cpdd.312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/15/2016] [Indexed: 12/15/2022]
Abstract
Substance users have the highest prevalence of hepatitis C virus (HCV) infection but have rarely been treated, largely because of their mistrust of the health care system, misconceptions about the consequences of the infection, and concerns regarding interferon-related side effects. With the development of highly efficacious, interferon-free therapeutic regimens without significant side effects, the concept of colocating HCV and substance use treatment would appear to be highly feasible. This process has been further facilitated by widespread clinical adaptation of noninvasive assays for fibrosis assessment, which could be performed routinely in substance use treatment facilities. The most commonly used noninvasive fibrosis assessment methods are serum marker indexes and transient elastography, both of which are very accurate in detecting cirrhosis or the absence of fibrosis, but much less successful in identifying intermediate fibrosis stages. The effect of drugs of abuse on the liver is not completely understood or sufficiently studied. There are no indications that heroin and cocaine affect fibrosis progression, but some recreational drugs (eg, alcohol and cannabis) can induce hepatic injury. In addition, knowledge gaps exist on the effect of impaired liver function on metabolism or transport of agents used to treat substance disorders as well as their interactions with HCV antivirals.
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Affiliation(s)
- Marija Zeremski
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Anthony Martinez
- Division of Gastroenterology, Hepatology, and Nutrition, State University of New York at Buffalo, Buffalo, NY, USA
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Talal AH, Venuto CS, Younis I. Assessment of Hepatic Impairment and Implications for Pharmacokinetics of Substance Use Treatment. Clin Pharmacol Drug Dev 2018; 6:206-212. [PMID: 28263464 DOI: 10.1002/cpdd.336] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/30/2016] [Indexed: 12/12/2022]
Abstract
Although the liver is the primary site of metabolism and biliary excretion for many medications, data are limited on the liver's pharmacokinetic abilities in cirrhosis. Cirrhosis develops through collagen deposition, eventually culminating in end-stage liver disease that compromises hepatic drug metabolism. Consequently, the US Food and Drug Administration (FDA) recommends evaluating the pharmacokinetics of medications in subjects with hepatic impairment if hepatic metabolism constitutes more than 20% of their elimination or if they have a narrow therapeutic range. A variety of noninvasive indices and radiologic procedures can be employed to assess hepatic drug metabolism and excretion. The Child-Pugh score is the most commonly used scale for assessing hepatic impairment among drugs submitted for US FDA approval. The score, originally developed to guide operative mortality in patients undergoing hepatic resection, has not been modified since its inception 5 decades ago. Furthermore, the score was not originally intended to be a guide for potential dose modification in patients with hepatic impairment. These reasons, in combination with the availability of a variety of new imaging modalities and an enhanced understanding of hepatic biology, should foster the development of novel methods to assess the effect of hepatic impairment on liver drug metabolism.
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Affiliation(s)
- Andrew H Talal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Charles S Venuto
- Center for Human Experimental Therapeutics, University of Rochester, Rochester, NY, USA.,AIDS Clinical Trials Group Pharmacology Specialty Laboratory, New York State Center of Excellence in Bioinformatics and Life Sciences; School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Islam Younis
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Mendes LC, Stucchi RS, Vigani AG. Diagnosis and staging of fibrosis in patients with chronic hepatitis C: comparison and critical overview of current strategies. Hepat Med 2018; 10:13-22. [PMID: 29662329 PMCID: PMC5892613 DOI: 10.2147/hmer.s125234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In the past years, what has always been considered undisputed true in liver fibrosis staging has been challenged. Diagnostic performance of histological evaluation has proven to be significantly influenced by sample- and observer-related variabilities. Differentiation between lower levels of fibrosis remains difficult for many, if not all, test modalities, including liver biopsy but, perhaps, such a distinction is not indispensable in light of current therapeutic approaches. Biomarkers and elastography offer, nonetheless, high predictive values for advanced fibrosis and cirrhosis and correlate well with liver-related outcomes. Necroinflammation, steatosis, and hemodynamic changes may significantly interfere with elastography-based techniques, and longitudinal follow-up strategies must be tailored in light of these findings. Knowledge of different test modalities and diagnostic performance indicators can allow for better clinical decision-making and resource allocation.
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Affiliation(s)
- Leandro César Mendes
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - Raquel Sb Stucchi
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - Aline G Vigani
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
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Boursier J, de Ledinghen V, Leroy V, Calès P. Reply to: "Pitfalls in the non-invasive assessment of liver fibrosis with eLIFT-FM VCTE algorithm" and to "Application of the new eLIFT test for the non-invasive diagnosis of advanced liver fibrosis in people with type 2 diabetes". J Hepatol 2018; 68:605-606. [PMID: 28987517 DOI: 10.1016/j.jhep.2017.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/23/2017] [Indexed: 12/04/2022]
Affiliation(s)
- Jérôme Boursier
- Hepatology Department, University Hospital, Angers, France; HIFIH Laboratory, Bretagne Loire University, Angers, France.
| | - Victor de Ledinghen
- Hepatology Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France; INSERM U1053, Bordeaux University, Bordeaux, France
| | - Vincent Leroy
- Hepato-Gastroenterology Clinic, University Hospital, Grenoble, France; INSERM U823, Grenoble Alpes University, Grenoble, France
| | - Paul Calès
- Hepatology Department, University Hospital, Angers, France; HIFIH Laboratory, Bretagne Loire University, Angers, France
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Petta S, Wong VWS, Cammà C, Hiriart JB, Wong GLH, Vergniol J, Chan AWH, Di Marco V, Merrouche W, Chan HLY, Marra F, Le-Bail B, Arena U, Craxì A, de Ledinghen V. Serial combination of non-invasive tools improves the diagnostic accuracy of severe liver fibrosis in patients with NAFLD. Aliment Pharmacol Ther 2017; 46:617-627. [PMID: 28752524 DOI: 10.1111/apt.14219] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/03/2017] [Accepted: 06/21/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The accuracy of available non-invasive tools for staging severe fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is still limited. AIM To assess the diagnostic performance of paired or serial combination of non-invasive tools in NAFLD patients. METHODS We analysed data from 741 patients with a histological diagnosis of NAFLD. The GGT/PLT, APRI, AST/ALT, BARD, FIB-4, and NAFLD Fibrosis Score (NFS) scores were calculated according to published algorithms. Liver stiffness measurement (LSM) was performed by FibroScan. RESULTS LSM, NFS and FIB-4 were the best non-invasive tools for staging F3-F4 fibrosis (AUC 0.863, 0.774, and 0.792, respectively), with LSM having the highest sensitivity (90%), and the highest NPV (94%), and NFS and FIB-4 the highest specificity (97% and 93%, respectively), and the highest PPV (73% and 79%, respectively). The paired combination of LSM or NFS with FIB-4 strongly reduced the likelihood of wrongly classified patients (ranging from 2.7% to 2.6%), at the price of a high uncertainty area (ranging from 54.1% to 58.2%), and of a low overall accuracy (ranging from 43% to 39.1%). The serial combination with the second test used in patients in the grey area of the first test and in those with high LSM values (>9.6 KPa) or low NFS or FIB-4 values (<-1.455 and <1.30, respectively) overall increased the diagnostic performance generating an accuracy ranging from 69.8% to 70.1%, an uncertainty area ranging from 18.9% to 20.4% and a rate of wrong classification ranging from 9.2% to 11.3%. CONCLUSION The serial combination of LSM with FIB-4/NFS has a good diagnostic accuracy for the non-invasive diagnosis of severe fibrosis in NAFLD.
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Affiliation(s)
- S Petta
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - V W-S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - C Cammà
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - J-B Hiriart
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - G L-H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - J Vergniol
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - A W-H Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
| | - V Di Marco
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - W Merrouche
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - H L-Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - F Marra
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - B Le-Bail
- INSERM U1053, Bordeaux University, Bordeaux, France.,Service de Pathologie, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - U Arena
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - A Craxì
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - V de Ledinghen
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France.,INSERM U1053, Bordeaux University, Bordeaux, France
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Affiliation(s)
- Elliot B Tapper
- From the Division of Gastroenterology and Hepatology and the Institute for Healthcare Policy and Innovation, University of Michigan (E.B.T., A.S.-F.L.), and the Veterans Affairs Hospital (E.B.T.) - both in Ann Arbor
| | - Anna S-F Lok
- From the Division of Gastroenterology and Hepatology and the Institute for Healthcare Policy and Innovation, University of Michigan (E.B.T., A.S.-F.L.), and the Veterans Affairs Hospital (E.B.T.) - both in Ann Arbor
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Lei B, Liu Y, Dong C, Chen X, Zhang X, Diao X, Yang G, Liu J, Yao S, Li H, Yuan J, Li S, Le X, Lin Y, Zeng W. Assessment of liver fibrosis in chronic hepatitis B via multimodal data. Neurocomputing 2017. [DOI: 10.1016/j.neucom.2016.09.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Assessment of liver fibrosis with acoustic radiation force impulse imaging versus liver histology in patients with chronic hepatitis C: a pilot study. Eur J Gastroenterol Hepatol 2017; 29:951-955. [PMID: 28471822 DOI: 10.1097/meg.0000000000000903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acoustic radiation force impulse imaging (ARFI) involves the mechanical excitation of tissues using short-duration acoustic pulses to generate localized displacements in tissue. The displacements results in shear-wave propagation, tracked by ultrasonography (US) correlation-based methods and recorded in meters per seconds. AIM To compare (ARFI) integrated into a conventional US with the standard histological examination of liver biopsy specimens for the assessment of liver fibrosis. MATERIALS AND METHODS Histological fibrosis staging with standard liver biopsy using the Metavir scoring system as well as fibrosis assessment using ARFI were performed to 80 patients with chronic hepatitis C over a 3-month period. RESULTS ARFI findings were identical to the biopsy findings in 61 (76.25%) patients.Fifty-eight (67.5%) patients with an early fibrosis stage (F0, F1, and F2) by histology had identical fibrosis stages using ARFI.Only 20 out of 26 patients with an advanced fibrosis stage (F3 and F4) using ARFI had advanced fibrosis histologically. In the advanced fibrosis stages, the sensitivity of ARFI was 70% and specificity was 80%, with positive and negative predictive values of 53.8 and 88.9%, respectively. The accuracy of detection of advanced fibrosis by ARFI was 77.5%. CONCLUSION ARFI imaging is a promising noninvasive US-based method for the assessment of liver fibrosis.
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Non-invasive liver fibrosis assessment and HCV treatment initiation within a systematic screening program in HIV/HCV coinfected patients. Wien Klin Wochenschr 2017; 130:105-114. [PMID: 28744597 PMCID: PMC5816107 DOI: 10.1007/s00508-017-1231-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/26/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Hepatitis C virus (HCV) therapy should be considered without delay in all patients with significant (SIGFIB) or advanced liver fibrosis (ADVFIB). We aimed to investigate the rates of treatment initiation with interferon-free regimens within a screening program for SIGFIB/ADVFIB in human immunodeficiency virus/HCV coinfected patients (HIV/HCV). METHODS The FIB-4 was calculated in all HIV/HCV from 2014-2016. HIV/HCV were counselled by the HIV clinic and referred to the Division of Gastroenterology and Hepatology for transient elastography (TE) and evaluation for HCV therapy. Patients were stratified by FIB-4 of </≥1.45 (established cut-off for ruling out ADVFIB) and SIGFIB/ADVFIB were defined by liver stiffness >7.1 kPa/>9.5 kPa, respectively. RESULTS Among 1348 HIV+ patients, 16% (210/1348) had detectable HCV-RNA. One hundred HIV/HCV had a FIB-4 ≥1.45. Among these, 57% (57/100) underwent TE. The majority of these patients had SIGFIB (75%; 43/57) or ADVFIB (37%; 21/57), however, interferon-free treatment was initiated in only 56% (24/43). In addition, fifty-two percent (57/110) of HIV/HCV with FIB-4 <1.45 underwent TE. Interestingly, 40% (23/57) and 18% (10/57) of these patients showed SIGFIB or even ADVFIB, respectively, and 78% (18/23) finally received interferon-free treatment. Overall, only 20% (42/210) of HIV/HCV received interferon-free treatment. CONCLUSION FIB-4 was not useful for ruling out SIGFIB/ADVFIB in our cohort of HIV/HCV. Treatment was initiated only in a small proportion (20%) of HIV/HCV during the first 2 years of interferon-free treatment availability, although the observed proportion of patients with SIGFIB (assessed by TE) was considerably higher (58%). Thus, it requires the ongoing combined efforts of both HIV and HCV specialists to increase treatment uptake rates in this special population.
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Adams LA, Sterling RK. Developing a new algorithm to diagnose advanced liver fibrosis: A lift or a nudge in the right direction? J Hepatol 2017; 66:1111-1113. [PMID: 28219771 DOI: 10.1016/j.jhep.2017.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/07/2017] [Accepted: 02/11/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Leon A Adams
- School of Medicine and Pharmacology, The University of Western Australia, Nedlands, Australia.
| | - Richard K Sterling
- Section of Hepatology, Virginia Commonwealth University, Richmond, VA, USA
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Development of a Simple Noninvasive Model to Predict Significant Fibrosis in Patients with Chronic Hepatitis B: Combination of Ultrasound Elastography, Serum Biomarkers, and Individual Characteristics. Clin Transl Gastroenterol 2017; 8:e84. [PMID: 28383564 PMCID: PMC5415893 DOI: 10.1038/ctg.2017.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 02/24/2017] [Indexed: 12/14/2022] Open
Abstract
Objectives: The accurate assessment of liver fibrosis is clinically important in patients with chronic hepatitis B (CHB). Blood tests and elastography are now widely used for the noninvasive diagnosis of liver fibrosis in CHB patients. The aim of this study was to develop a new and more accurate predictive model, which combines elastography data, serum biomarkers, and individual characteristics, to discriminate between CHB patients with and without significant liver fibrosis. Methods: Two noninvasive methods, specifically, an ultrasound elastography technique termed acoustic radiation force impulse imaging (ARFI) and a blood test, were used to assess a cohort of 345 patients (estimation group, 218 patients; validation group, 127 patients) with CHB. Multivariate logistic regression analysis revealed that ARFI, the aspartate aminotransferase (AST) to platelet ratio, and age were significantly associated with fibrosis. Based on these results, we constructed and validated a model for the diagnosis of significant hepatic fibrosis. Results: The area under the receiver operating characteristic (ROC) curve was 0.921 for the estimation group and 0.929 for the validation group, significantly higher than those for ARFI (0.887, 0.893) and for the AST-to-platelet ratio index (APRI; 0.811, 0.859). Using an optimal cutoff of 3.05 in the validation group, all the indices of the proposed model, including accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic odds ratio, were better than those for ARFI or APRI. Conclusions: We developed a simple noninvasive model that used ultrasound elastography, routine serum biomarkers, and individual characteristics to accurately differentiate significant fibrosis in patients with CHB. Compared with elastography or the biomarker index alone, this model was significantly more accurate and robust.
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Calès P, Boursier J, Lebigot J, de Ledinghen V, Aubé C, Hubert I, Oberti F. Liver fibrosis diagnosis by blood test and elastography in chronic hepatitis C: agreement or combination? Aliment Pharmacol Ther 2017; 45:991-1003. [PMID: 28164327 DOI: 10.1111/apt.13954] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 12/09/2016] [Accepted: 01/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND In chronic hepatitis C, the European Association for the Study of the Liver and the Asociacion Latinoamericana para el Estudio del Higado recommend performing transient elastography plus a blood test to diagnose significant fibrosis; test concordance confirms the diagnosis. AIM To validate this rule and improve it by combining a blood test, FibroMeter (virus second generation, Echosens, Paris, France) and transient elastography (constitutive tests) into a single combined test, as suggested by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. METHODS A total of 1199 patients were included in an exploratory set (HCV, n = 679) or in two validation sets (HCV ± HIV, HBV, n = 520). Accuracy was mainly evaluated by correct diagnosis rate for severe fibrosis (pathological Metavir F ≥ 3, primary outcome) by classical test scores or a fibrosis classification, reflecting Metavir staging, as a function of test concordance. RESULTS Score accuracy: there were no significant differences between the blood test (75.7%), elastography (79.1%) and the combined test (79.4%) (P = 0.066); the score accuracy of each test was significantly (P < 0.001) decreased in discordant vs. concordant tests. Classification accuracy: combined test accuracy (91.7%) was significantly (P < 0.001) increased vs. the blood test (84.1%) and elastography (88.2%); accuracy of each constitutive test was significantly (P < 0.001) decreased in discordant vs. concordant tests but not with combined test: 89.0 vs. 92.7% (P = 0.118). Multivariate analysis for accuracy showed an interaction between concordance and fibrosis level: in the 1% of patients with full classification discordance and severe fibrosis, non-invasive tests were unreliable. The advantage of combined test classification was confirmed in the validation sets. CONCLUSIONS The concordance recommendation is validated. A combined test, expressed in classification instead of score, improves this rule and validates the recommendation of a combined test, avoiding 99% of biopsies, and offering precise staging.
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Affiliation(s)
- P Calès
- Liver-Gastroenterology Department, University Hospital, Angers, France.,HIFIH Laboratory, UNIV Angers, Université Bretagne Loire, Angers, France
| | - J Boursier
- Liver-Gastroenterology Department, University Hospital, Angers, France.,HIFIH Laboratory, UNIV Angers, Université Bretagne Loire, Angers, France
| | - J Lebigot
- HIFIH Laboratory, UNIV Angers, Université Bretagne Loire, Angers, France
| | - V de Ledinghen
- Liver-Gastroenterology Department, Pessac University Hospital, INSERM 1053, Segalen University, Bordeaux, France
| | - C Aubé
- HIFIH Laboratory, UNIV Angers, Université Bretagne Loire, Angers, France
| | - I Hubert
- Liver-Gastroenterology Department, University Hospital, Angers, France.,HIFIH Laboratory, UNIV Angers, Université Bretagne Loire, Angers, France
| | - F Oberti
- Liver-Gastroenterology Department, University Hospital, Angers, France.,HIFIH Laboratory, UNIV Angers, Université Bretagne Loire, Angers, France
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Liang XE, Zhong C, Huang L, Yang S, Zhu Y, Chen Y, Hou J. Optimization of hepatitis B cirrhosis detection by stepwise application of transient elastography and routine biomarkers. J Gastroenterol Hepatol 2017; 32:459-465. [PMID: 27346683 DOI: 10.1111/jgh.13475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Significant inflammation may overestimate liver stiffness and result in false positive diagnosis by transient elastography for chronic hepatitis B (CHB) cirrhosis detection. This study tries to further improve the performance by stepwise combination with routine biomarkers. METHODS A total of 236 compensated CHB patients with alanine transferase lower than five times upper limit of normal, liver biopsies, transient elastography, and routine blood tests were included. Performance of stepwise combination of transient elastography and routine biomarkers was analyzed. RESULTS The area under the receiver operating characteristics curve for detecting cirrhosis was 0.876 for transient elastography, 0.794 for fibrosis index based on the four factors (FIB-4), 0.765 for age-platelet index (API), 0.715 for aspartate aminotransferase-platelet ratio index (APRI), and 0.661 for alanine-aspartate aminotransferase ratio, respectively. The numbers for significant fibrosis were 0.844, 0.662, 0.595, 0.695, and 0.510 in the same order. The proportion of patients determined as cirrhosis or non-cirrhosis was 66.5% by transient elastography, 41.1% by FIB-4, 14.4% by API, and 24.2% by APRI, respectively; the numbers for significant fibrosis were 55.5% by transient elastography, 11.9% by APRI, and none by the other serum markers. Stepwise combination of transient elastography and FIB-4/APRI increased positive predictive value of confirming cirrhosis diagnosis from 0.677 to 0.808 and 0.724, respectively; and the proportion of patients being determined in the state of cirrhosis and obviating liver biopsy was up to 76%. CONCLUSION By transient elastography-based stepwise combination with readily available serum markers, performance of detecting compensated CHB cirrhosis could be significantly improved in terms of diagnosis accuracy and proportion of obviating liver biopsy.
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Affiliation(s)
- Xie Er Liang
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Disease and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chunxiu Zhong
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Disease and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liwen Huang
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Disease and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuling Yang
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Disease and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Youfu Zhu
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Disease and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongpeng Chen
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Disease and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinlin Hou
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Disease and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
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de Oliveira AC, El-Bacha I, Vianna MV, Parise ER. Utility and limitations of APRI and FIB4 to predict staging in a cohort of nonselected outpatients with hepatitis C. Ann Hepatol 2017; 15:326-32. [PMID: 27049486 DOI: 10.5604/16652681.1198801] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic hepatitis C(CHC) staging is important for therapeutic decision-making. Identification of noninvasive markers can provide alternatives to liver biopsy. AIM To assess the value of APRI and FIB4 for CHC fibrosis staging in a cohort of nonselected outpatients from a referral center in Sao Paulo, Brazil. MATERIAL AND METHODS Medical records of 798 adult outpatients were analyzed retrospectively. For calculations of APRI and FIB4, the original descriptions were considered, and markers were compared with degree of liver injury. RESULTS Overall, 49.3% of participants were female, and mean age was 56.9 ± 12.5 years. Genotype 1 was predominant (71.7 vs. 23.7% genotype 3); 64% had significant fibrosis, 44% had advanced fibrosis, and 28% had cirrhosis. The areas under the receiver operating curve for significant fibrosis, advanced fibrosis, and cirrhosis, respectively, were 0.809, 0.819, and 0.815 for the APRI marker and 0.803, 0.836 and 0.852 for FIB4. Using the recommended cut off values, approximately 30-40% of the patients could not be classified. In the remainder, either APRI or FIB4 alone correctly diagnosed 80-85% of cases. Concomitant or consecutive use of both APRI and FIB4 increased the number of the cases correctly diagnosed only slightly, but also increased the number of patients not classified within the cutoff values. CONCLUSIONS In conclusion, use of the APRI or FIB4 markers for detection of hepatic fibrosis may be a viable alternative at referral centers for treatment of CHC in low- and middle-income countries. Despite relatively good accuracy, a significant number of patients could not be assessed by these methods.
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Affiliation(s)
- Ana Cláudia de Oliveira
- Department of Medicine, Federal University of São Carlos (UFSCar), Brazil; Gastroenterology Division, Department of Internal Medicine, Federal University of São Paulo (UNIFESP), Brazil
| | - Ibrahin El-Bacha
- Gastroenterology Division, Department of Internal Medicine, Federal University of São Paulo (UNIFESP), Brazil
| | - Mônica V Vianna
- Gastroenterology Division, Department of Internal Medicine, Federal University of São Paulo (UNIFESP), Brazil
| | - Edison R Parise
- Gastroenterology Division, Department of Internal Medicine, Federal University of São Paulo (UNIFESP), Brazil
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Karanjia RN, Crossey MME, Cox IJ, Fye HKS, Njie R, Goldin RD, Taylor-Robinson SD. Hepatic steatosis and fibrosis: Non-invasive assessment. World J Gastroenterol 2016; 22:9880-9897. [PMID: 28018096 PMCID: PMC5143756 DOI: 10.3748/wjg.v22.i45.9880] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/10/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic liver disease is a major cause of morbidity and mortality worldwide and usually develops over many years, as a result of chronic inflammation and scarring, resulting in end-stage liver disease and its complications. The progression of disease is characterised by ongoing inflammation and consequent fibrosis, although hepatic steatosis is increasingly being recognised as an important pathological feature of disease, rather than being simply an innocent bystander. However, the current gold standard method of quantifying and staging liver disease, histological analysis by liver biopsy, has several limitations and can have associated morbidity and even mortality. Therefore, there is a clear need for safe and non-invasive assessment modalities to determine hepatic steatosis, inflammation and fibrosis. This review covers key mechanisms and the importance of fibrosis and steatosis in the progression of liver disease. We address non-invasive imaging and blood biomarker assessments that can be used as an alternative to information gained on liver biopsy.
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