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Zhou Z, Chen C, Sun M, Xu X, Liu Y, Liu Q, Wang J, Yin Y, Sun B. A decision tree model to predict liver cirrhosis in hepatocellular carcinoma patients: a retrospective study. PeerJ 2023; 11:e15950. [PMID: 37641600 PMCID: PMC10460570 DOI: 10.7717/peerj.15950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023] Open
Abstract
Background The severity of liver cirrhosis in hepatocellular carcinoma (HCC) patients is essential for determining the scope of surgical resection. It also affects the long-term efficacy of systemic anti-tumor therapy and transcatheter arterial chemoembolization (TACE). Non-invasive tools, including aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 (FIB-4), and γ-glutamyl transferase to platelet ratio (GPR), are less accurate in predicting cirrhosis in HCC patients. We aimed to build a novel decision tree model to improve diagnostic accuracy of liver cirrhosis. Patients and Methods The Mann-Whitney U test, χ2 test, and multivariate logistic regression analysis were used to identify independent cirrhosis predictors. A decision tree model was developed using machine learning algorithms in a training cohort of 141 HCC patients. Internal validation was conducted in 99 HCC patients. The diagnostic accuracy and calibration of the established model were evaluated using receiver operating characteristic (ROC) and calibration curves, respectively. Results Sex and platelet count were identified as independent cirrhosis predictors. A decision tree model integrating imaging-reported cirrhosis, APRI, FIB-4, and GPR was established. The novel model had an excellent diagnostic performance in the training and validation cohorts, with area under the curve (AUC) values of 0.853 and 0.817, respectively. Calibration curves and the Hosmer-Lemeshow test showed good calibration of the novel model. The decision curve analysis (DCA) indicated that the decision tree model could provide a larger net benefit to predict liver cirrhosis. Conclusion Our developed decision tree model could successfully predict liver cirrhosis in HCC patients, which may be helpful in clinical decision-making.
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Affiliation(s)
- Zheyu Zhou
- Department of General Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Graduate School of Peking Union Medical College, Nanjing, China
| | - Chaobo Chen
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, China
- Department of Hepatobiliary and Transplantation Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Meiling Sun
- Department of Hepatobiliary and Transplantation Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoliang Xu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Liu
- Department of Hepatobiliary and Transplantation Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Qiaoyu Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jincheng Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yin Yin
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Beicheng Sun
- Department of General Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Graduate School of Peking Union Medical College, Nanjing, China
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Moosavy SH, Eftekhar E, Davoodian P, Nejatizadeh A, Shadman M, Zare S, Nazarnezhad MA. AST/ALT ratio, APRI, and FIB-4 compared to FibroScan for the assessment of liver fibrosis in patients with chronic hepatitis B in Bandar Abbas, Hormozgan, Iran. BMC Gastroenterol 2023; 23:145. [PMID: 37170243 PMCID: PMC10173614 DOI: 10.1186/s12876-023-02780-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/22/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Chronic hepatitis B (CHB) is a significant risk factor for liver-related disorders. Hepatic fibrosis staging by liver biopsy in these patients can lead to complications. This study aimed to compare aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, AST to platelet ratio index (APRI), and fibrosis-4 (FIB-4) with FibroScan results for the evaluation of hepatic fibrosis in CHB patients. METHODS This cross-sectional study included patients with CHB referred to the outpatient clinics of Bandar Abbas, Hormozgan, Iran, in 2021. The age and sex of the participants were noted. FibroScan evaluation was done for all subjects. Moreover, AST, ALT, and platelet counts were measured in their blood samples within one month of the FibroScan evaluation. RESULTS Of the 267 CHB patients evaluated in the present study (mean age: 45.45 ± 18.16 years), 173 (64.8%) were male. According to FibroScan results, 65 CHB patients (24.3%) had F1, 53 (19.9%) F2, 38 (14.2%) F3, and 20 (7.5%) F4 liver fibrosis. There was a significant correlation between FibroScan results and the three indices of AST/ALT ratio, APRI, and FIB-4 (P < 0.001), with the strongest correlation between FibroScan results and APRI (r = 0.682). With an area under the receiver operating characteristic (AUROC) curve of 0.852 (95% confidence interval [CI] 0.807; 0.897, P < 0.001), APRI ≥ 0.527 had the best diagnostic accuracy (77.15%) for the detection of any grade of liver fibrosis. Although the AUROC curve of APRI and FIB-4 was similar (0.864) for distinguishing between F3/F4 and F0-F2 of liver fibrosis, FIB-4 had the best diagnostic accuracy (82.02%). CONCLUSIONS APRI can rule out 95.4% of F3/F4 of liver fibrosis and rule in any grade of liver fibrosis in CHB patients by 90.78%. Therefore, APRI appears to be the best substitute for FibroScan in the assessment of liver fibrosis in patients with CHB.
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Affiliation(s)
- Seyed Hamid Moosavy
- Department of Internal Medicine, Infectious and Tropical Disease Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran
| | - Ebrahim Eftekhar
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran
| | - Parivash Davoodian
- Infectious and Tropical Disease Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran
| | - Abdolazim Nejatizadeh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran
| | - Mohammad Shadman
- Infectious and Tropical Disease Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran
| | - Shahram Zare
- Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran
| | - Mirza Ali Nazarnezhad
- Infectious and Tropical Disease Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran.
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Liu X, Zhou J, Zhu L, Zhang X, Li F. Diagnostic accuracy of apparent diffusion coefficient values combined with γ-glutamyl transpeptidase-to-platelet ratio parameters for predicting hepatitis B-related fibrosis. Clin Res Hepatol Gastroenterol 2022; 46:101968. [PMID: 35649482 DOI: 10.1016/j.clinre.2022.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The accuracy of non-invasive liver fibrosis diagnosis based on the apparent diffusion coefficient (ADC) value combined with the γ-glutamyl transpeptidase-to-platelet ratio (GPR) model to predict the stage of hepatitis B-related fibrosis has not been reported. This study aimed to evaluate the diagnostic efficacy of ADC value combined with GPR for liver fibrosis grading. METHODS The data of 180 patients with chronic hepatitis B (CHB) diagnosed by liver biopsy were analyzed. The ADC value, GPR, and their combination were assessed in different cirrhosis stages using receiver operating characteristic curve analysis to evaluate their value in diagnosing liver fibrosis. RESULTS We observed that liver fibrosis stages were inversely associated with ADC values (r=-0.691, P<0.001), and positively associated with GPR (r=0.502, P<0.001). The area under the curve for diagnostic efficacy of ADC values, GPR, and their combination for F≥2 liver fibrosis was 0.831, 0.749, and 0.858, respectively, and for F≥3 was 0.872, 0.771, and 0.903, respectively. The diagnostic cutoffs of the combination for each stage were -7.07, -12.21 and -37.75, respectively. CONCLUSIONS The combined diagnostic tool of ADC and GPR may improve the accuracy of hepatitis B-related liver fibrosis diagnosis, especially for F≥3.
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Affiliation(s)
- Xingxiang Liu
- Department of Laboratory Medicine, Huai'an Infectious Disease Hospital, Jiangsu, China
| | - Jian Zhou
- Department of Gastroenterology, Huai'an Hospital of Huai'an City, Jiangsu, China
| | - Liyao Zhu
- Department of Hepatology, Huai'an Infectious Disease Hospital, Jiangsu, China
| | - Xin Zhang
- Department of Medical Imaging, Huai'an Infectious Disease Hospital, Jiangsu, China.
| | - Feng Li
- Department of Medical Imaging, Huai'an Infectious Disease Hospital, Jiangsu, China.
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Domerecka W, Kowalska-Kępczyńska A, Homa-Mlak I, Michalak A, Mlak R, Mazurek M, Cichoż-Lach H, Małecka-Massalska T. The Usefulness of Extended Inflammation Parameters and Systemic Inflammatory Response Markers in the Diagnostics of Autoimmune Hepatitis. Cells 2022; 11:cells11162554. [PMID: 36010631 PMCID: PMC9406892 DOI: 10.3390/cells11162554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/02/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Introduction: Autoimmune hepatitis (AIH) is a chronic disease. A persistent autoimmune reaction in the liver is significantly related to the systemic inflammatory response. Extended Inflammation Parameters (EIP) can be used to assess the activation of immune cells such as activated neutrophils (NEUT-RI and NEUT-GI) and activated lymphocytes (RE-LYMP and AS-LYMP) in the phase of active inflammation. The role of the systemic inflammatory response markers should also be emphasised, especially: NLR, PLR, and RLR, which have recently been widely studied as markers in autoimmune skin diseases or liver diseases. (2) Materials and Methods: The study included 30 patients with AIH and 30 healthy volunteers. The parameters of the EIP group (RE-LYMP, AS-LYMP, NEUT-RI, NEUT-GI), calculated haematological indices Red Blood Cell Distribution Width-to-Platelet Ratio (RPR), Mean Platelet Volume-to-Platelet Ratio (MPR), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Red Blood Cell Distribution Width-to-Lymphocyte Ratio (RLR), and selected blood morphological and biochemical indices were analysed. The aim of the study was to assess the usefulness of the EIP and systemic inflammatory response markers in the diagnostics of AIH. (3) Results: Compared to the controls, the patients with AIH showed significantly higher EIP values: NEUT-RI (48.05 vs. 43.30), NEUT-GI (152.65 vs. 147.40), RE-LYMP (0.07 vs. 0.03), and the inflammatory response markers: MPR (0.05 vs. 0.04), RPR (0.07 vs. 0.05), and NLR (2.81 vs. 1.42. Among the examined markers, EIP has significant diagnostic potential: NEUT-RI (AUC = 0.86), NEUT-GI (AUC = 0.80), and RE-LYMP (AUC = 0.78), and so do calculated haematological indices, i.e., MPR (AUC = 0.75), PLR (AUC = 1.00), and RLR (AUC = 1.00) Moreover, the importance of NEUT-GI (AUC = 0.89), MPR (AUC = 0.93), PLR (AUC = 0.86), RPR (AUC = 0.91), and FIB-4 (AUC = 0.83) in the detection of liver fibrosis in the course of AIH has also been proven. (4) Conclusions: EIP and systemic inflammatory response markers may turn out to be useful in detecting AIH and in looking for features of already developed liver cirrhosis in its course.
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Affiliation(s)
- Weronika Domerecka
- Chair and Department of Human Physiology, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland
- Correspondence:
| | - Anna Kowalska-Kępczyńska
- Department of Biochemical Diagnostics, Chair of Laboratory Diagnostics, Medical University of Lublin, 20-081 Lublin, Poland
| | - Iwona Homa-Mlak
- Chair and Department of Human Physiology, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland
| | - Agata Michalak
- Department of Gastroenterology with Endoscopy Unit, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Radosław Mlak
- Chair and Department of Human Physiology, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland
| | - Marcin Mazurek
- Chair and Department of Human Physiology, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland
| | - Halina Cichoż-Lach
- Department of Gastroenterology with Endoscopy Unit, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Teresa Małecka-Massalska
- Chair and Department of Human Physiology, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland
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Luo J, Du Z, Liang D, Li M, Yin Y, Chen M, Yang L. Gamma-Glutamyl Transpeptidase-to-Platelet ratio predicts liver fibrosis in patients with concomitant chronic hepatitis B and nonalcoholic fatty liver disease. J Clin Lab Anal 2022; 36:e24596. [PMID: 35808928 PMCID: PMC9396178 DOI: 10.1002/jcla.24596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/16/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the correlation of gamma-glutamyl transpeptidase-to-platelet ratio (GPR), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis index-4 (FIB-4), and liver stiffness measurement (LSM) in the diagnosis of liver fibrosis, and perform a diagnostic value of GPR for predicting fibrosis in CHB patients with NAFLD. METHODS A retrospective study was conducted on CHB patients concurrent with NAFLD between September 2019 and December 2020. They were divided into control group (LSM ≤ 9.7 kpa) and fibrosis group (LSM ≥ 9.8 kpa). Demographic data were collected; ALT, AST, and PLT were also detected. LSM was measured by transient elastography (TE). The GPR, APRI, and FIB-4 were calculated. The correlation between GPR, APRI, FIB-4, and LSM was compared. The accuracy of predicting liver fibrosis using GPR, APRI, and FIB-4 was assessed. RESULTS Eighty-five CHB patients with NAFLD were enrolled. Multivariate analysis showed that age (p = 0.005), GGT (p = 0.001), and PLT (p = 0.013) were the independent risk factors for LSM. The GPR (p = 0.008), APRI (p = 0.001), and FIB-4 (p = 0.001) values in fibrosis group were higher than control group. Pearson linear correlation was used to analyze the correlations between LSM and GPR, APRI, and FIB-4. LSM was correlated with GPR, APRI, and FIB-4. The AUCs of GPR, APRI, and FIB4 were 0.805, 0.766, and 0.826 in assessing liver fibrosis, respectively. No significant differences in the areas of GPR were comparable to that of APRI and FIB-4. CONCLUSION GPR has a good correlation with LSM in assessing liver fibrosis and can be used as a noninvasive index for the assessment of liver fibrosis in patients with concomitant CHB and NAFLD.
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Affiliation(s)
- Jie Luo
- Department of Hepatology, The Third Affiliated Hospital of Shenzhen University, ShenZhen LuoHu People's Hospital, Shenzhen, China
| | - Zhan Du
- Department of Medical Examination, The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu People's Hospital, Shenzhen, China
| | - Dongli Liang
- Department of Hepatology, The Third Affiliated Hospital of Shenzhen University, ShenZhen LuoHu People's Hospital, Shenzhen, China
| | - Manni Li
- Department of Hepatology, The Third Affiliated Hospital of Shenzhen University, ShenZhen LuoHu People's Hospital, Shenzhen, China
| | - Yanyao Yin
- Department of Hepatology, The Third Affiliated Hospital of Shenzhen University, ShenZhen LuoHu People's Hospital, Shenzhen, China
| | - Mingfa Chen
- Department of Hepatology, The Third Affiliated Hospital of Shenzhen University, ShenZhen LuoHu People's Hospital, Shenzhen, China
| | - Liuqing Yang
- Department of Infectious Disease, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
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Barré T, Fontaine H, Ramier C, Di Beo V, Pol S, Carrieri P, Marcellin F, Cagnot C, Dorival C, Zucman-Rossi J, Zoulim F, Carrat F, Protopopescu C. Elevated coffee consumption is associated with a lower risk of elevated liver fibrosis biomarkers in patients treated for chronic hepatitis B (ANRS CO22 Hepather cohort). Clin Nutr 2022; 41:610-619. [DOI: 10.1016/j.clnu.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/04/2022] [Accepted: 01/15/2022] [Indexed: 11/03/2022]
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Lv D, Wang Z, Ji S, Wang X, Hou H. Plasma Levels of Homocysteine is Associated with Liver Fibrosis in Health Check-Up Population. Int J Gen Med 2021; 14:5175-5181. [PMID: 34512000 PMCID: PMC8423488 DOI: 10.2147/ijgm.s329863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/24/2021] [Indexed: 01/02/2023] Open
Abstract
Object Studies have shown a link between homocysteine (Hcy) and heart diseases, kidney diseases, cerebrovascular diseases, liver diseases, and other pathological conditions. However, the relationship between Hcy and liver fibrosis (LF) is unclear. Here, we studied the link between plasma Hcy concentration and LF. Methods We determined and recorded the plasma Hcy concentration, general biochemical parameters, and liver stiffness measurement (LSM) in 1582 subjects, followed by statistical data analyses. Results During different stages of LF, we found a considerable difference (p <0.001 unless specified) in body mass index (BMI), sex, age, Hcy, the levels of alanine transaminase (ALT), gamma-glutamyl transpeptidase (GGT; P = 0.012), triglycerides (TG; P = 0.006), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBS), and platelet count (PLT). There was a strong association between the plasma Hcy concentration and the serum biomarkers of LF (P <0.001) and the values of LSM (P <0.001). Conclusion The plasma Hcy concentration was substantially different among different stages of LF. The higher the plasma Hcy concentration, the more evident was the degree of LF.
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Affiliation(s)
- Dan Lv
- Physical Examination Center, Hebei General Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Zepu Wang
- Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Shuai Ji
- Physical Examination Center, Hebei General Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Xiaoxi Wang
- Physical Examination Center, Hebei General Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Huiqing Hou
- Physical Examination Center, Hebei General Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
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Gemcioglu E, Davutoglu M, Catalbas R, Karabuga B, Kaptan E, Aypak A, Kalem AK, Özdemir M, Yeşilova NY, Kalkan EA, Civak M, Kücüksahin O, Erden A, Ates I. Predictive values of biochemical markers as early indicators for severe COVID-19 cases in admission. Future Virol 2021. [PMCID: PMC8114836 DOI: 10.2217/fvl-2020-0319] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aim: COVID-19 is a pandemic that causes high morbidity and mortality, especially in severe patients. In this study, we aimed to search and explain the relationship between biochemical markers, which are more common, easily available and applicable to diagnose and to stage the disease. Materials & methods: In this study, 609 patients were evaluated retrospectively. 11 biochemical parameters were included in analysis to explain the relationship with severity of disease. Results: Nearly, all the parameters that have been evaluated in this study were statistically valuable as a predictive parameter for severe disease. Areas under the curve of blood urea nitrogen (BUN)/albumin ratio (BAR), CALL score and lymphocyte/C-reactive protein ratio were 0.795, 0.778 and 0.770. The BAR and neutrophil/albumin ratios provide important prognostic information for decision-making in severe patients with COVID-19. Conclusion: High BAR and neutrophil/albumin ratios may be a better predictor of severity COVID-19 than other routinely used parameters in admission.
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Affiliation(s)
- Emin Gemcioglu
- Ankara City Hospital, Department of Internal Medicine, Ankara 06800, Turkey
| | - Mehmet Davutoglu
- Yıldırım Beyazıt University School of Medicine, Department of Internal Medicine, Ankara 06800, Turkey
| | - Ramis Catalbas
- Yıldırım Beyazıt University School of Medicine, Department of Internal Medicine, Ankara 06800, Turkey
| | - Berkan Karabuga
- Yıldırım Beyazıt University School of Medicine, Department of Internal Medicine, Ankara 06800, Turkey
| | - Enes Kaptan
- Yıldırım Beyazıt University School of Medicine, Department of Internal Medicine, Ankara 06800, Turkey
| | - Adalet Aypak
- Ankara City Hospital, Department of Infectious Diseases & Clinical Microbiology, Ankara 06800, Turkey
| | - Ayse K Kalem
- Yıldırım Beyazıt University School of Medicine, Department of Infectious Diseases & Clinical Microbiology, Ankara 06800, Turkey
| | - Mustafa Özdemir
- Ankara City Hospital, Department of Internal Medicine, Ankara 06800, Turkey
| | - Necati Y Yeşilova
- Ankara City Hospital, Department of Internal Medicine, Ankara 06800, Turkey
| | - Emra A Kalkan
- Ankara City Hospital, Department of Internal Medicine, Ankara 06800, Turkey
| | - Musa Civak
- Ankara City Hospital, Department of Internal Medicine, Ankara 06800, Turkey
| | - Orhan Kücüksahin
- Yıldırım Beyazıt University School of Medicine, Department of Rheumatology, Ankara 06800, Turkey
| | - Abdulsamet Erden
- Ankara City Hospital, Department of Rheumatology, Ankara 06800, Turkey
| | - Ihsan Ates
- Ankara City Hospital, Department of Internal Medicine, Ankara 06800, Turkey
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Zhang T, Hickner B, Cotton R, Nguyen Galvan NT, Vierling JM, O'Mahony C, Goss JA, Rana A. Donor Gamma-Glutamyl Transferase Is Associated With Liver Allograft Discard and Failure. Prog Transplant 2021; 31:101-107. [PMID: 33729047 DOI: 10.1177/15269248211002800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The disparity between the number of individuals on the wait list and available liver allografts creates the need for a system that maximizes donor liver utilization and predicts graft failure. RESEARCH QUESTION This study aimed to determine the relationship between donor Gamma-Glutamyl Transferase (GGT), liver discard, and graft failure. DESIGN Through multivariate analysis from 53 966 deceased liver donors, we adjusted for donor clinical and demographic characteristics and compared donor GGT with allograft discard. We compared donor GGT ranges with graft failure and analyzed data from 47 269 liver recipients. RESULTS After adjusting for other factors, donor GGT was significantly associated with liver discard, with GGT over 200 U/L being most significant (OR 2.74, CI 2.51-2.99). Donor GGT under 20 U/L was also found to be a protective factor for post-transplant graft failure (HR 0.91, CI 0.83 - 1.00). CONCLUSION Going forward, GGT should be included among other characteristics associated with allograft discard considered during the procurement process.
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Affiliation(s)
- Theodore Zhang
- School of Medicine, 3989Baylor College of Medicine, Houston, TX, USA
| | - Brian Hickner
- School of Medicine, 3989Baylor College of Medicine, Houston, TX, USA
| | - Ronald Cotton
- Division of Abdominal Transplantation, Michael E DeBakey, Department of General Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Nhu Thao Nguyen Galvan
- Division of Abdominal Transplantation, Michael E DeBakey, Department of General Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - John M Vierling
- Division of Gastroenterology, Nutrition & Hepatology, 3989Baylor College of Medicine, Houston, TX, USA
| | - Christine O'Mahony
- Division of Abdominal Transplantation, Department of General Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - John A Goss
- Division of Abdominal Transplantation, Department of General Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Abbas Rana
- Division of Abdominal Transplantation, Michael E DeBakey, Department of General Surgery, 3989Baylor College of Medicine, Houston, TX, USA
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Raadsen M, Du Toit J, Langerak T, van Bussel B, van Gorp E, Goeijenbier M. Thrombocytopenia in Virus Infections. J Clin Med 2021; 10:jcm10040877. [PMID: 33672766 PMCID: PMC7924611 DOI: 10.3390/jcm10040877] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
Thrombocytopenia, which signifies a low platelet count usually below 150 × 109/L, is a common finding following or during many viral infections. In clinical medicine, mild thrombocytopenia, combined with lymphopenia in a patient with signs and symptoms of an infectious disease, raises the suspicion of a viral infection. This phenomenon is classically attributed to platelet consumption due to inflammation-induced coagulation, sequestration from the circulation by phagocytosis and hypersplenism, and impaired platelet production due to defective megakaryopoiesis or cytokine-induced myelosuppression. All these mechanisms, while plausible and supported by substantial evidence, regard platelets as passive bystanders during viral infection. However, platelets are increasingly recognized as active players in the (antiviral) immune response and have been shown to interact with cells of the innate and adaptive immune system as well as directly with viruses. These findings can be of interest both for understanding the pathogenesis of viral infectious diseases and predicting outcome. In this review, we will summarize and discuss the literature currently available on various mechanisms within the relationship between thrombocytopenia and virus infections.
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Affiliation(s)
- Matthijs Raadsen
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
| | - Justin Du Toit
- Department of Haematology, Wits University Donald Gordon Medical Centre Johannesburg, Johannesburg 2041, South Africa;
| | - Thomas Langerak
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
| | - Bas van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Center Plus, 6229 HX Maastricht, The Netherlands;
- Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 GT Maastricht, The Netherlands
| | - Eric van Gorp
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
- Department of Internal Medicine, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
- Department of Internal Medicine, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
- Correspondence:
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11
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Shiau H, Guffey D, Loomes KM, Seidman C, Ragozzino E, Molleston JP, Schady D, Leung DH. Biopsy Validated Study of Biomarkers for Liver Fibrosis and Transplant Prediction in Inherited Cholestasis. Hepatol Commun 2020; 4:1516-1526. [PMID: 33024920 PMCID: PMC7527690 DOI: 10.1002/hep4.1569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022] Open
Abstract
Alagille syndrome (ALGS) and progressive familial intrahepatic cholestasis (PFIC) are inherited cholestatic disorders with risk of developing end‐stage liver disease requiring liver transplantation (LT). We investigated aspartate aminotransferase‐to‐platelet ratio index (APRI), Fibrosis‐4 score (FIB‐4), and conjugated bilirubin as biomarkers to assess fibrosis severity and risk for LT among children with ALGS and PFIC. This multicenter, cross‐sectional study included 64 children with ALGS or PFIC (per genetics or strict clinical criteria) with APRI, FIB‐4, and conjugated bilirubin levels collected within ±90 days of their most recent liver biopsy. A single, blinded pathologist staged all biopsies (metavir; F0‐F2: nonsevere, F3‐F4: severe). Logistic regression and area under the receiver operating characteristic curve analysis (AUC) were used to assess biomarker associations with fibrosis severity and risk for LT. In ALGS, only APRI distinguished F3‐F4 (AUC 0.72, P = 0.012), with a cutoff greater than 2.97 demonstrating a sensitivity of 61.5% (95% confidence interval 0.32, 0.86) and specificity of 81.5% (0.62, 0.94). In ALGS, a 50% increase of APRI increased the odds of F3‐F4 by 1.31‐fold (1.04, 1.65; P = 0.023). In ALGS, APRI (AUC 0.87; P < 0.001) and FIB‐4 (AUC 0.84; P < 0.001) were able to predict risk for LT. In PFIC, only APRI distinguished F3‐4 (AUC 0.74, P = 0.039), with a cutoff greater than 0.99 demonstrating a sensitivity of 80% (0.44, 0.98) and specificity of 64.3% (0.35, 0.87). In PFIC, only FIB‐4 was able predict risk for LT (AUC 0.80; P = 0.002). In ALGS or PFIC, conjugated bilirubin could not distinguish F3‐F4 or predict risk for LT. Conclusion: This liver biopsy–validated study suggests that APRI is able to distinguish F3‐F4 from F0‐F2 in ALGS and PFIC. APRI and FIB‐4 may also serve as predictors of risk for LT in ALGS (APRI and FIB‐4) and PFIC (FIB‐4).
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Affiliation(s)
- Henry Shiau
- Pediatric Gastroenterology, Hepatology, and Nutrition Baylor College of Medicine Houston TX.,Texas Children's Hospital Houston TX
| | - Danielle Guffey
- Institute for Clinical and Translational Research Baylor College of Medicine Houston TX
| | - Kathleen M Loomes
- Pediatric Gastroenterology, Hepatology, and Nutrition University of Pennsylvania Perelman School of Medicine Philadelphia PA.,Children's Hospital of Philadelphia Philadelphia PA
| | | | | | - Jean P Molleston
- Pediatric Gastroenterology, Hepatology, and Nutrition Indiana University-Riley Hospital for Children Indianapolis IN
| | - Deborah Schady
- Pathology and Immunology Baylor College of Medicine Houston TX
| | - Daniel H Leung
- Pediatric Gastroenterology, Hepatology, and Nutrition Baylor College of Medicine Houston TX.,Texas Children's Hospital Houston TX
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12
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Review of Serum Biomarkers and Models Derived from Them in HBV-Related Liver Diseases. DISEASE MARKERS 2020; 2020:2471252. [PMID: 32774512 PMCID: PMC7391085 DOI: 10.1155/2020/2471252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/11/2020] [Indexed: 12/13/2022]
Abstract
A series of predictive scoring systems is available for stratifying the severity of conditions and assessing the prognosis in patients with HBV-related liver diseases. We show nine of the most popular serum biomarkers and their models (i.e., serum cystatin C, homocysteine, C-reactive protein, C-reactive protein to albumin ratio, aspartate aminotransferase to platelet ratio index, fibrosis index based on four factors, gamma-glutamyl transpeptidase to platelet ratio, albumin-bilirubin score, and gamma-glutamyl transpeptidase to albumin ratio) that have gained great interest from clinicians. Compared with traditional scoring systems, these serum biomarkers and their models are easily acquired, simple, and relatively inexpensive. In the present review, we summarize the latest studies focused on these serum biomarkers and their models as diagnostic and prognostic indexes in HBV-related liver diseases.
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13
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Guedes KS, Sanchez BAM, Gomes LT, Fontes CJF. Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax. PLoS One 2019; 14:e0224877. [PMID: 31765438 PMCID: PMC6876935 DOI: 10.1371/journal.pone.0224877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023] Open
Abstract
Acute infection with Plasmodium vivax, classically associated with benign disease, has been presenting as serious and even fatal disease in recent years. Severe disease is mainly due to biochemical and hematological alterations during the acute phase of infection. In the present cross-sectional study, the aspartate aminotransferase-to-platelet ratio index (APRI) was evaluated as a method for identifying patients at risk of severe vivax malaria. This retrospective study included 130 patients with confirmed P. vivax infection between June 2006 and January 2018. Clinical-epidemiological data were obtained from medical records. Hematological and biochemical parameters were determined using automated equipment. The criteria of severity for infection by Plasmodium falciparum, established by the World Health Organization (WHO), were adapted to classify patients with danger signs of severe vivax malaria. Of the 130 patient’s records evaluated, 19 (14.6%) had one or more signs and symptoms of severe malaria. The mean APRI values among patients with and without severe malaria were 2.11 and 1.09, respectively (p = 0.044). Among those with severe disease, the proportion with an APRI value above 1.50 was 30% compared to the 10% among those without severe disease (p = 0.007). The area under the receiver operating characteristic curve (95% CI), calculated to assess the accuracy of the APRI in discriminating between patients with and without severe disease, was 0.645 (0.494; 0.795). An APRI cutoff of 0.74 resulted in sensitivity of 74.0%, specificity of 56.0%, and accuracy of 65.0%. This study shows that the APRI is elevated in patients with evidence of infection by P. vivax. Based on the good sensitivity found in this study, we conclude that this simple index can serve as a diagnostic biomarker to identify patients at risk of severe disease during the acute phase of P. vivax infection.
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Affiliation(s)
- Karla Sena Guedes
- Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
| | | | | | - Cor Jesus Fernandes Fontes
- Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil.,Júlio Müller University Hospital, Federal University of Mato Grosso, Cuiabá, Brazil
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14
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Mao W, Wu J. Haematologic indices in hepatitis B virus-related liver disease. Clin Chim Acta 2019; 500:135-142. [PMID: 31654630 DOI: 10.1016/j.cca.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 02/07/2023]
Abstract
Several markers and prognostic scores have been identified for predicting the development and progression of liver disease; among them, haematological parameters (the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), RDW to platelet ratio (RPR), mean platelet volume (MPV), and mean corpuscular volume (MCV)) have recently gained significant interest. Compared with traditional prognostic factors, haematological indices are easy to obtain and relatively inexpensive. There is growing evidence that these haematological indices play a key role in HBV-related liver diseases and has been proposed as a predictive marker of adverse outcomes in these patients. This article focuses on discussing the diagnostic and prognostic value of the haematological indices in patients with HBV-related liver diseases.
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Affiliation(s)
- WeiLin Mao
- Department of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, PR China
| | - JianPing Wu
- Department of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, PR China.
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15
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Lu W, Zhang YP, Zhu HG, Zhang T, Zhang L, Gao N, Chang DY, Yin J, Zhou XY, Li MY, Li YT, Li ZZ, He Q, Geng Y. Evaluation and comparison of the diagnostic performance of routine blood tests in predicting liver fibrosis in chronic hepatitis B infection. Br J Biomed Sci 2019; 76:137-142. [PMID: 31062646 DOI: 10.1080/09674845.2019.1615717] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background & aims: Biopsy is the gold standard for staging liver fibrosis, but it may be accompanied by complications. As an alternative, non-invasive markers such as transient elastography (for liver fibrosis) and certain combinations of routine blood markers (liver function tests, full blood count) have been developed although their clinical significance remains controversial. Here, we compare the diagnostic values of non-invasive markers for liver fibrosis in patients with chronic hepatitis B infection. Methods: Transient elastography and routine laboratory tests were performed in 196 patients. Diagnostic performances were compared and were assessed based on the area under the curve (AUC) of a receiver operating characteristic (ROC) analysis. Results: Elevated GGT to platelet ratio (GPR), the fibrosis index FIB-4 [based on age, AST, platelets and ALT], platelet to lymphocyte ratio (PLR) and total bilirubin were independent predictors of liver stiffness defined by transient elastography (all P < 0.001). The AUCs of GPR in predicting both advanced fibrosis and cirrhosis were significantly larger than that of FIB-4 (P = 0.037 and P = 0.008, respectively) and AST-to-platelet ratio index (APRI) (P = 0.008 and P = 0.005). FIB-4, APRI and red cell volume distribution width-to-platelet ratio (RPR) had similar diagnostic values in discriminating different levels of liver fibrosis. Conclusions: GPR showed the best diagnostic value and RPR and PLR are easily available and inexpensive markers in evaluating fibrosis and cirrhosis. The diagnostic values of these laboratory markers are useful in diagnosing advanced fibrosis or cirrhosis, and in confirming the different levels of liver fibrosis.
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Affiliation(s)
- W Lu
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - Y P Zhang
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - H G Zhu
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - T Zhang
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - L Zhang
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - N Gao
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - D Y Chang
- b Department of Gastroenterology and Hepatology , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - J Yin
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - X Y Zhou
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - M Y Li
- c Department of Microbiology and Infectious Disease Center , Peking University Health Science Center , Beijing , China
| | - Y T Li
- d Key Laboratory of Medical Molecular Virology of Ministries of Health and Education, Shanghai Medical College , Fudan University , Shanghai , China
| | - Z Z Li
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - Q He
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - Y Geng
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
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16
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Tan L, Meng Y, Zeng T, Wang Q, Long T, Wu S, Guan X, Fu H, Zheng W, Tian Y, Chen J, Yu J, Wu Y, Li H, Cao L. Clinical diagnostic significance of prealbumin, cholinesterase and retinol binding protein in liver cirrhosis combined with encephalopathy. Br J Biomed Sci 2018; 76:24-28. [PMID: 30392460 DOI: 10.1080/09674845.2018.1523673] [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] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Hepatic encephalopathy is a common consequence of liver cirrhosis, but diagnosis can be difficult as it is based on clinical criteria alone. We hypothesised that serum prealbumin, cholinesterase and retinol binding protein (RBP) can help support the diagnosis of hepatic encephalopathy. METHODS We enrolled 306 cirrhotic patients (110 with encephalopathy), 100 chronic hepatitis B patients and 50 healthy controls, measuring routine liver function tests (ALT, AST, GGT, ALP, and bilirubin), albumin, prothrombin time, prealbumin, cholinesterase and RBP by routine methods. Logistic regression analysis and areas under the receiver operating characteristic curves (AUCs) were used to find predictive factors for hepatic encephalopathy. RESULTS There were differences in all laboratory indices between the three groups (all p < 0.001). In univariate analysis, albumin, prothrombin time, prealbumin, cholinesterase and RBP were significantly altered in those with encephalopathy (p < 0.01), but only prealbumin, cholinesterase and RBP levels were significant predictors in multivariate analysis, and each was linked to the severity of liver fibrosis defined by the Child-Pugh score (all p < 0.001). The AUCs (95% CI) of prealbumin, cholinesterase and RBP for diagnosing liver cirrhosis with hepatic encephalopathy were comparable at 0.85 (81-90), 0.81 (0.76-0.85) and 0.81 (0.76-0.86), respectively (all p < 0.01). CONCLUSIONS Serum prealbumin, cholinesterase and RBP levels are of potential clinical value in diagnosis of liver cirrhosis complicated by encephalopathy.
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Affiliation(s)
- L Tan
- a Department of Clinical Laboratory Science, Jiangxi Province Key Laboratory of Laboratory Medicine , the Second Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - Y Meng
- b School of Public Health , Nanchang University , Nanchang , Jiangxi , China
| | - T Zeng
- a Department of Clinical Laboratory Science, Jiangxi Province Key Laboratory of Laboratory Medicine , the Second Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - Q Wang
- b School of Public Health , Nanchang University , Nanchang , Jiangxi , China
| | - T Long
- b School of Public Health , Nanchang University , Nanchang , Jiangxi , China
| | - S Wu
- b School of Public Health , Nanchang University , Nanchang , Jiangxi , China
| | - X Guan
- b School of Public Health , Nanchang University , Nanchang , Jiangxi , China
| | - H Fu
- b School of Public Health , Nanchang University , Nanchang , Jiangxi , China
| | - W Zheng
- b School of Public Health , Nanchang University , Nanchang , Jiangxi , China
| | - Y Tian
- a Department of Clinical Laboratory Science, Jiangxi Province Key Laboratory of Laboratory Medicine , the Second Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - J Chen
- a Department of Clinical Laboratory Science, Jiangxi Province Key Laboratory of Laboratory Medicine , the Second Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - J Yu
- a Department of Clinical Laboratory Science, Jiangxi Province Key Laboratory of Laboratory Medicine , the Second Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - Y Wu
- a Department of Clinical Laboratory Science, Jiangxi Province Key Laboratory of Laboratory Medicine , the Second Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - H Li
- a Department of Clinical Laboratory Science, Jiangxi Province Key Laboratory of Laboratory Medicine , the Second Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
| | - L Cao
- a Department of Clinical Laboratory Science, Jiangxi Province Key Laboratory of Laboratory Medicine , the Second Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China
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17
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Mousa N, Abdel-Razik A, Sheta T, Shabana W, Zakaria S, Awad M, Abd Elsalam M, El-Wakeel N, Elkashef W, Effat N, Elgamal A, Deiab AG, Eldars W. Serum leptin and homeostasis model assessment-IR as novel predictors of early liver fibrosis in chronic hepatitis B virus infection. Br J Biomed Sci 2018; 75:192-196. [PMID: 30079841 DOI: 10.1080/09674845.2018.1505187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains unclear. We hypothesised links between serum leptin and insulin resistance in non-diabetic patients with chronic viral hepatitis B infection and their relation to liver fibrosis. METHODS We recruited 190 untreated patients with chronic HBV infection and 72 healthy controls. Serum leptin, fasting glucose, insulin, liver function tests (LFTs), C-peptide and Homeostasis model assessment-IR (HOMA-IR) were measured/calculated by ELISA and standard techniques. RESULTS Serum leptin, C-peptide (both P < 0.001), HOMA-IR (P = 0.021) and several LFTs were increased in patients with chronic HBV-infection. In multivariate regression analysis, both HOMA-IR (P = 0.003) and leptin (P = 0.002) were significant independent predictors of HBV infection. There were significant positive correlations (P < 0.01) between leptin and HOMA-IR (r = 0.81), between serum leptin and METAVIR activity (r = 0.95), and between HOMA-IR and BMI (r = 0.75), fasting glucose (r = 0.005), and fasting insulin (r = 0.81). Several LFTs, glucose and insulin correlated modestly (r = 0.61-0.69, P < 0.05) with leptin. CONCLUSION Serum leptin may be related to the rate of fibrosis progression in nondiabetic patients with chronic HBV infection. Follow-up by serial measurement of serum leptin and HOMA-IR in non diabetic HBV-infected patients may be used as a non-invasive marker of early liver fibrosis.
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Affiliation(s)
- N Mousa
- a Department of Tropical Medicine , Mansoura University , Mansoura , Egypt
| | - A Abdel-Razik
- a Department of Tropical Medicine , Mansoura University , Mansoura , Egypt
| | - T Sheta
- b Internal Medicine Department , Mansoura University , Mansoura , Egypt
| | - W Shabana
- a Department of Tropical Medicine , Mansoura University , Mansoura , Egypt
| | - S Zakaria
- a Department of Tropical Medicine , Mansoura University , Mansoura , Egypt
| | - M Awad
- b Internal Medicine Department , Mansoura University , Mansoura , Egypt
| | - M Abd Elsalam
- b Internal Medicine Department , Mansoura University , Mansoura , Egypt
| | - N El-Wakeel
- c Department of Medical Microbiology and Immunology , Mansoura University , Mansoura , Egypt
| | - W Elkashef
- d Department of Pathology , Mansoura University , Mansoura , Egypt
| | - N Effat
- e Clinical Pathology Department , Mansoura University , Mansoura , Egypt
| | - A Elgamal
- f Department of Tropical Medicine , Menoufia University , Mansoura , Egypt
| | - A G Deiab
- b Internal Medicine Department , Mansoura University , Mansoura , Egypt
| | - W Eldars
- c Department of Medical Microbiology and Immunology , Mansoura University , Mansoura , Egypt
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