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Gabriel-Medina P, Ferrer-Costa R, Ciudin A, Augustin S, Rivera-Esteban J, Pericàs JM, Selva DM, Rodriguez-Frias F. Accuracy of a sequential algorithm based on FIB-4 and ELF to identify high-risk advanced liver fibrosis at the primary care level. Intern Emerg Med 2024; 19:745-756. [PMID: 37952070 PMCID: PMC11039533 DOI: 10.1007/s11739-023-03441-2] [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: 12/02/2022] [Accepted: 06/21/2023] [Indexed: 11/14/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, and liver fibrosis is the strongest predictor of morbimortality. We aimed to assess the performance of a sequential algorithm encompassing the Fibrosis 4 (FIB-4) and Enhanced Liver Fibrosis (ELF) scores for identifying patients at risk of advanced fibrosis. This cross-sectional study included one hospital-based cohort with biopsy-proven NAFLD (n = 140) and two primary care cohorts from different clinical settings: Type 2 Diabetes (T2D) follow-up (n = 141) and chronic liver disease (CLD) initial study (n = 138). Logistic regression analysis was performed to assess liver fibrosis diagnosis models based on FIB-4 and ELF biomarkers. The sequential algorithm retrieved the following accuracy parameters in predicting stages F3-4 in the biopsy-confirmed cohort: sensitivity (85%), specificity (73%), negative predictive value (79%) and positive predictive value (81%). In both T2D and CLD cohorts, a total of 28% of patients were classified as stages F3-4. Furthermore, of all F3-4 classified patients in the T2D cohort, 80% had a diagnosis of liver disease and 44% were referred to secondary care. Likewise, of all F3-4 classified patients in the CLD cohort, 71% had a diagnosis of liver disease and 44% were referred to secondary care. These results suggest the potential utility of this algorithm as a liver fibrosis stratifying tool in primary care, where updating referral protocols to detect high-risk F3-4 is needed. FIB-4 and ELF sequential measurement is an efficient strategy to prioritize patients with high risk of F3-4 in populations with metabolic risk factors.
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Affiliation(s)
- Pablo Gabriel-Medina
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain.
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain.
- Clinical Biochemistry Research Team, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain.
| | - Roser Ferrer-Costa
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain.
- Clinical Biochemistry Research Team, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain.
| | - Andreea Ciudin
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Diabetes and Metabolism Department, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029, Madrid, Spain
| | - Salvador Augustin
- Liver Unit, Internal Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - Jesus Rivera-Esteban
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain
- Liver Unit, Internal Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - J M Pericàs
- Liver Unit, Internal Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - D M Selva
- Diabetes and Metabolism Department, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029, Madrid, Spain
| | - Francisco Rodriguez-Frias
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain
- Clinical Biochemistry Research Team, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
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Armandi A, Merizian T, Werner MM, Coxson HO, Sanavia T, Birolo G, Gashaw I, Ertle J, Michel M, Galle PR, Labenz C, Emrich T, Schattenberg JM. Variability of transient elastography-based spleen stiffness performed at 100 Hz. Eur Radiol Exp 2023; 7:79. [PMID: 38087079 PMCID: PMC10716091 DOI: 10.1186/s41747-023-00393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Spleen stiffness measurement (SSM) performed by transient elastography at 100 Hz is a novel technology for the evaluation of portal hypertension in advanced chronic liver disease, but technical aspects are lacking. We aimed to evaluate the intraexamination variability of SSM and to determine the best transient elastography protocol for obtaining robust measurements to be used in clinical practice. METHODS We analyzed 253 SSM exams with up to 20 scans for each examination, performed between April 2021 and June 2022. All SSM results were evaluated according to different protocols by dividing data into groups of n measurements (from 2 to 19). Considering as reference the median SSM values across all the 20 measurements, we calculated the distribution of the absolute deviations of each protocol from the reference median. This analysis was repeated 1,000 times by resampling the data. Distributions were also stratified by etiology (chronic liver disease versus clinically significant portal hypertension) and different SSM ranges: < 25 kPa, 25-75, and > 75 kPa. RESULTS Overall, we observed that the spleen stiffness exam had less variability if it exceeded 12 measurements, i.e., absolute deviations ≤ 5 kPa at 95% confidence. For exams with higher SSM values (> 75 kPa), as seen in clinically significant portal hypertension, at least 15 measurements are highly recommendable. CONCLUSIONS Fifteen scans per examination should be considered for each SSM exam performed at 100 Hz to achieve a low intraexamination variability within a reasonable time in clinical practice. RELEVANCE STATEMENT Performing at least 15 scans per examination is recommended for 100 Hz SSM in order to achieve a low intraexamination variability, in particular for values > 75 kPa compatible with clinically significant portal hypertension. KEY POINTS • Spleen stiffness measurement by transient elastography is used for stratification in patients with portal hypertension. • At 100 Hz, this method may have intraexamination variability. • A minimum of 15 scans per examination achieves a low intraexamination variability.
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Affiliation(s)
- Angelo Armandi
- Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Talal Merizian
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Merle Marie Werner
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Harvey O Coxson
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach & Ingelheim, Germany
| | - Tiziana Sanavia
- Computational Biomedicine Unit, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - Giovanni Birolo
- Computational Biomedicine Unit, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - Isabella Gashaw
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach & Ingelheim, Germany
| | - Judith Ertle
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Maurice Michel
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Peter R Galle
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Christian Labenz
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Tilman Emrich
- Department of Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Jörn M Schattenberg
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany.
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Carrión JA, Graupera I, Vergara M, Morillas RM, Pericàs JM, Poca M, Amador A, Fernández R, Monllor T, Muñoz L, Bartres C, Genescà J, Ginés P, Forns X. Clinical practice guidelines of the Catalan Society of Gastroenterology about hepatic elastography 2022. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:732-746. [PMID: 36435378 DOI: 10.1016/j.gastrohep.2022.11.005] [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: 09/30/2022] [Revised: 11/03/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION After almost 20 years using transient elastography (TE) for the non-invasive diagnosis of liver fibrosis, its use has been extended to population screening, evaluation of steatosis and complications of cirrhosis. For this reason, the «Catalan Society of Gastroenterology» commissioned a group of experts to update the first document carried out in 2011. MATERIAL AND METHODS The working group (8 doctors and 4 nurses) prepared a panel of questions based on the online survey «Hepatic Elastography in Catalonia 2022» following the PICO structure and the Delphi method. RESULTS The answers are presented with the level of evidence, the degree of recommendation and the final consensus after being evaluated by two external reviewers. CONCLUSION Transient elastography uses the simplest and most reliable elastographic method to quantify liver fibrosis, assess steatosis, and determine the risk of complications in patients with cirrhosis. The document has been endorsed by the "Catalan Society of Gastroenterology" and the "Col·legi Oficial d'Infermeres i Infermers de Barcelona".
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Affiliation(s)
- José Antonio Carrión
- Sección de Hepatología, Servicio de Digestivo, Hospital del Mar, Barcelona, España; IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, España; Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, España.
| | - Isabel Graupera
- Servicio de Hepatología, Hospital Clínic, Barcelona, España; Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, España; Centros de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Departamento de Medicina, Facultad de Medicina i Ciencias de la Salud, Universidad de Barcelona, Barcelona, España
| | - Mercedes Vergara
- Centros de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Unidad de Hepatología, Servicio de Digestivo, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí I3PT, Sabadell, España; Departamento de Medicina, Facultad de Medicina i Ciencias de la Salud, Universidad Autónoma de Barcelona, Barcelona, España
| | - Rosa Maria Morillas
- Centros de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Departamento de Medicina, Facultad de Medicina i Ciencias de la Salud, Universidad Autónoma de Barcelona, Barcelona, España; Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital Germans Trias i Pujol, Badalona, España; Instituto de Investigación en Ciéncias de la Salud Germans Trias i Pujol (IGTP), Badalona, España
| | - Juan Manuel Pericàs
- Centros de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Servicio de Hepatología, Hospital Universitario Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - Maria Poca
- Centros de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Departamento de Medicina, Facultad de Medicina i Ciencias de la Salud, Universidad Autónoma de Barcelona, Barcelona, España; Servicio de Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Institut de Recerca Hospital de Sant Pau-IIB Sant Pau, Barcelona, España
| | - Alberto Amador
- Departamento de Medicina, Facultad de Medicina i Ciencias de la Salud, Universidad de Barcelona, Barcelona, España; Unidad de Hepatología, Hospital Universitario de Bellvitge, Barcelona, España; IDIBELL, Barcelona, España
| | - Rosa Fernández
- Sección de Hepatología, Servicio de Digestivo, Hospital del Mar, Barcelona, España; IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, España
| | - Teresa Monllor
- Unidad de Hepatología, Servicio de Digestivo, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí I3PT, Sabadell, España
| | - Laura Muñoz
- Unidad de Hepatología, Servicio de Aparato Digestivo, Hospital Germans Trias i Pujol, Badalona, España; Instituto de Investigación en Ciéncias de la Salud Germans Trias i Pujol (IGTP), Badalona, España
| | | | - Joan Genescà
- Centros de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Departamento de Medicina, Facultad de Medicina i Ciencias de la Salud, Universidad Autónoma de Barcelona, Barcelona, España; Servicio de Hepatología, Hospital Universitario Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - Pere Ginés
- Servicio de Hepatología, Hospital Clínic, Barcelona, España; Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, España; Centros de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Departamento de Medicina, Facultad de Medicina i Ciencias de la Salud, Universidad de Barcelona, Barcelona, España
| | - Xavier Forns
- Servicio de Hepatología, Hospital Clínic, Barcelona, España; Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, España; Centros de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Departamento de Medicina, Facultad de Medicina i Ciencias de la Salud, Universidad de Barcelona, Barcelona, España
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Canillas L, Broquetas T, Carrión JA, Pagano G, Soriano A, Garrido E, Fernández R, Viu A, Romero J, Díaz G, Cañete N, Coll S, Naranjo D, Bessa X, Garcia‐Retortillo M, Puigvehí M. Follow-up evaluation of patients with liver test abnormalities detected during SARS-CoV2 infection. J Viral Hepat 2022; 29:823-834. [PMID: 35708160 PMCID: PMC9350227 DOI: 10.1111/jvh.13718] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 01/08/2023]
Abstract
Abnormal liver function tests (A-LFTs) during admission for coronavirus disease-19 (COVID-19) are frequent, but its evolution after COVID-19 resolution remains unexplored. We evaluated factors related to A-LFTs during COVID-19 and assessed the liver outcome after patients' discharge. This is a observational study including: (1) retrospective analysis of variables related to A-LFTs during COVID-19; and (2) follow-up evaluation with blood test, transient elastography and liver biopsy in those with persistent A-LFTs. A-LFTs were defined according to CTCAEv4.0. Among 595 patients, 366 (61.5%) showed A-LFTs. The ratio of partial pressure of oxygen and inspired oxygen fraction (P/F) below 200, ferritin ≥1000 ng/mL, male gender and antibiotic and immunomodulatory treatments were related to A-LFTs. Follow-up evaluation was performed in 153 individuals. Persistent A-LFTs at follow-up was similar in patients with/without A-LFTs during admission (14.1% vs. 4.9%, p = 0.104). Fifteen (93%) and 58 (39%) patients with/without A-LFTs at follow-up showed metabolic fatty liver disease criteria (p < 0.001), which were histologically confirmed. In conclusion, A-LFTs during COVID-19 were related to infection severity. Abnormalities remitted at follow-up in >80% of patients, and no correlation between A-LFTs at admission and at follow-up was found. Most patients with A-LFTs at follow-up had non-invasive and histologically proven fatty liver disease.
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Affiliation(s)
- Lidia Canillas
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Teresa Broquetas
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - José A. Carrión
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain
| | - Giulia Pagano
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain
| | - Agnès Soriano
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain
| | - Esther Garrido
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Rosa Fernández
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Ana Viu
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Judit Romero
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Gemma Díaz
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Nuria Cañete
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Susana Coll
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | | | - Xavier Bessa
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Montserrat Garcia‐Retortillo
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Marc Puigvehí
- Liver Section, Gastroenterology DepartmentHospital del MarBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
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Boursier J, Decraecker M, Bourlière M, Bureau C, Ganne-Carrié N, de Lédinghen V. Quality criteria for the measurement of liver stiffness. Clin Res Hepatol Gastroenterol 2022; 46:101761. [PMID: 34325013 DOI: 10.1016/j.clinre.2021.101761] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/23/2021] [Indexed: 02/04/2023]
Abstract
Liver elastography offers the possibility of a quick, non-invasive, and painless evaluation of the liver with immediate results at bedside. Transient elastography is the most validated technology, and many others such as point shear wave elastography, 2D-shear wave elastography, or magnetic resonance elastography have been developed. To ensure the best evaluation, several conditions of examination must be respected for liver stiffness measurement. Indeed, patient, operator and examination characteristics have all been shown to influence the result of liver stiffness measurement. Food intake increases liver stiffness, whereas withdrawal in alcoholics is associated with a decrease in elastography results. Inter-observer reproducibility of the measurement seems suboptimal, and the influence of the operator experience is still being debated. The measurement site and the FibroScan® probe must be correctly chosen. Finally, the intrinsic characteristics and quality criteria of the measurement, especially the interquartile range/median ratio, must be carefully checked to avoid overestimation of liver stiffness. Most of the results come from studies which have evaluated transient elastography, with less data available for the other technologies. Liver stiffness measurement could appear as a simple way to explore the liver, but several conditions must be met before deciding the patient management according to its result.
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Affiliation(s)
- Jérôme Boursier
- Laboratoire HIFIH, UPRES EA3859, SFR ICAT 4208, Université d'Angers, Angers, France.
| | - Marie Decraecker
- Service d'hépato-gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, pessac & INSERM U1053, Université de Bordeaux, Bordeaux, France
| | - Marc Bourlière
- Service d'hépato-gastroentérologie, Hôpital Saint Joseph & INSERM UMR 1252 IRD SESSTIM Aix Marseille Université, Marseille, France
| | - Christophe Bureau
- Service d'hépatologie, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Nathalie Ganne-Carrié
- Service d'hépatologie, Hôpital Avicenne, APHP, Université Sorbonne Paris Nord, Bobigny & INSERM UMR 1138, Centre de Recherche des Cordeliers, Université de Paris, France
| | - Victor de Lédinghen
- Service d'hépato-gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, pessac & INSERM U1053, Université de Bordeaux, Bordeaux, France
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Broquetas T, Herruzo-Pino P, Mariño Z, Naranjo D, Vergara M, Morillas RM, Forns X, Carrión JA. Elastography is unable to exclude cirrhosis after sustained virological response in HCV-infected patients with advanced chronic liver disease. Liver Int 2021; 41:2733-2746. [PMID: 34525253 DOI: 10.1111/liv.15058] [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: 10/07/2020] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver fibrosis and transient elastography (TE) correlation in hepatitis C virus (HCV)-infected patients with compensated advanced chronic liver disease (cACLD) after the sustained virological response (SVR) is unknown. AIMS To evaluate TE accuracy at identifying cirrhosis 3 years after HCV-eradication. METHODS Prospective, multi-centric study including HCV-cACLD patients before direct-acting antivirals (DAA). Diagnostic accuracy of TE (area under ROC, AUROC) to identify cirrhosis 3 years after SVR was evaluated. RESULTS Among 746 HCV-infected patients (95.4% with TE ≥10 kPa), 76 (10.2%) underwent a liver biopsy 3 years after SVR. Before treatment, 46 (63%) showed a TE>15 kPa. The TE before DAA was the best variable for predicting cirrhosis (METAVIR, F4) after SVR (AUROC = 0.79). Liver function parameters, serological non-invasive tests (APRI and FIB-4), and TE values improved after SVR. However, liver biopsy 3 years after HCV elimination (median time = 38.4 months) showed cirrhosis in 41 (53.9%). Multivariate analysis (OR (95% CI), P) showed that HCV-genotype 3 (20.81 (2.12-201.47), .009), and TE before treatment (1.21 (1.09-1.34), <.001) were the only variables associated with cirrhosis after SVR. However, the accuracy of TE after SVR was poor (AUROC = 0.75) and 6 (27.3%) out of 22 patients with a TE <8 kPa had cirrhosis. Similar results were found with APRI and FIB-4 scores. CONCLUSIONS Cirrhosis is present, 3 years after SVR, in more than half of HCV-cACLD patients even with the normalisation of liver function parameters, serological non-invasive tests and TE values. The low diagnostic accuracy of non-invasive methods after SVR reinforces the need for long-term surveillance.
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Affiliation(s)
- Teresa Broquetas
- Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Departament de Medicina de la UAB, Barcelona, Spain
| | - Paula Herruzo-Pino
- Universitat Autònoma de Barcelona (UAB), Departament de Medicina de la UAB, Barcelona, Spain
| | - Zoe Mariño
- Liver Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Dolores Naranjo
- Gastrointestinal and Hepatobiliary Pathology Section, Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Mercedes Vergara
- Liver Unit, Digestive Disease Department, Parc Taulí Sabadell Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Mª Morillas
- Hepatology Department, Hospital Germans Trias i Pujol, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José A Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Departament de Medicina de la UAB, Barcelona, Spain
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Dietrich CF, Shi L, Wei Q, Dong Y, Cui XW, Löwe A, Worni M, Ferraioli G. What does liver elastography measure? Technical aspects and methodology. Minerva Gastroenterol (Torino) 2020; 67:129-140. [PMID: 33267564 DOI: 10.23736/s2724-5985.20.02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Elastography can be thought as an extension of the ancient technique of palpation. After giving a short introduction to the history of elastography, the different technologies that are nowadays available and the physics behind them, the article focuses on the assessment of liver stiffness in patients with diffuse liver disease using shear wave elastography (SWE). Practical advices on how to perform the SWE techniques and on the factors that should be considered for a correct interpretation of the results are given. This paper aimed to provide a practical guide for beginners and advanced clinical users to better understand technical aspects, methodologies and terminology.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland -
| | - Long Shi
- Department of Ultrasound, Jingmen N. 2 People's Hospital, Jingmen, China
| | - Qi Wei
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Axel Löwe
- Department Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland
| | - Mathias Worni
- Department of Visceral Surgery, Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara University Hospital, Basel, Switzerland.,Swiss Institute for Translational and Entrepreneurial Medicine, Stiftung Lindenhof, Campus SLB, Bern, Switzerland.,Department of Surgery, Clinic Beau Site, Bern, Switzerland
| | - Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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8
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Puthenpura MM, Patel V, Fam J, Katz L, Tichansky DS, Myers S. The Use of Transient Elastography Technology in the Bariatric Patient: a Review of the Literature. Obes Surg 2020; 30:5108-5116. [PMID: 32981002 DOI: 10.1007/s11695-020-05002-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022]
Abstract
Transient elastography (TE) is a non-invasive technology that demonstrates promise in assessing liver steatosis and fibrosis without the risks of traditional percutaneous liver biopsy. Many studies have examined its reliability in respect to liver biopsy, but fewer have examined using TE in obese and bariatric surgery patients. With evidence showing that bariatric surgery can lead to improvement of liver steatosis and fibrosis, TE has the potential to provide a simple avenue of hepatic assessment in patients before and after procedures. This review article investigates what is known about the reliability of TE and its implementation in obese and bariatric surgery patients.
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Affiliation(s)
- Max M Puthenpura
- Department of Surgery, Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA, 19129, USA.
| | - Vishal Patel
- The Center for Liver Disease, Tower Health Transplant Institute, 420 S 5th Ave, West Reading, PA, 19611, USA
| | - John Fam
- Department of Surgery, Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA, 19129, USA.,Tower Health Weight Loss Surgery and Wellness Center, 1220 Broadcasting Rd, Wyomissing, PA, 19610, USA
| | - Leon Katz
- Department of Surgery, Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA, 19129, USA.,Tower Health Weight Loss Surgery and Wellness Center, 1220 Broadcasting Rd, Wyomissing, PA, 19610, USA
| | - David S Tichansky
- Department of Surgery, Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA, 19129, USA.,Tower Health Weight Loss Surgery and Wellness Center, 1220 Broadcasting Rd, Wyomissing, PA, 19610, USA
| | - Stephan Myers
- Department of Surgery, Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA, 19129, USA.,Tower Health Weight Loss Surgery and Wellness Center, 1220 Broadcasting Rd, Wyomissing, PA, 19610, USA
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9
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Impact of sustained virological response with DAAs on gastroesophageal varices and Baveno criteria in HCV-cirrhotic patients. J Gastroenterol 2020; 55:205-216. [PMID: 31493238 DOI: 10.1007/s00535-019-01619-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/25/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Direct-acting antivirals (DAAs) show high efficacy and safety in HCV-cirrhotic patients, but most maintain clinically significant portal hypertension after sustained virological response (SVR). Non-invasive Baveno and expanded-Baveno criteria can identify patients without high-risk gastroesophageal varices (GEV) who have no need for endoscopic surveillance. However, data after SVR are scarce. We performed a multicenter study to evaluate SVR effects over GEV and diagnostic accuracy of non-invasive criteria after SVR. METHODS HCV-cirrhotic patients receiving DAAs and baseline endoscopic evaluation were included (November 2014-October 2015). GEV were classified as low risk (LR-GEV) (< 5 mm) or high risk (HR-GEV) (≥ 5 mm or with risk signs). Transient elastography (TE) and endoscopy were performed during follow-up. RESULTS SVR was achieved in 230 (93.1%) of 247 included patients, 151 (65.7%) with endoscopic follow-up. Among 64/151 (42.4%) patients without baseline GEV, 8 (12.5%) developed GEV after SVR. Among 50/151 (33.1%) with baseline LR-GEV, 12 (24%) developed HR-GEV. Patients with GEV progression showed TE ≥ 25 kPa before treatment (64.7%) or ≥ 20 kPa after SVR (66.7%). Only 6% of patients without GEV and LSM < 25 kPa before treatment, and 10% of those with baseline LSM < 25 kPa and LSM < 20 kPa after SVR showed GEV progression after 36 months. The negative predictive value of Baveno and expanded-Baveno criteria to exclude HR-GEV was maintained after SVR (100% and 90.7%, respectively). CONCLUSIONS HCV-cirrhotic patients can develop HR-GEV after SVR. Surveillance is especially recommended in those with GEV before antiviral treatment. Baveno and expanded-Baveno criteria can be safely applied after SVR. https://clinicaltrials.gov: NCT02758509.
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10
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Arieira C, Monteiro S, Xavier S, Dias de Castro F, Magalhães J, Marinho C, Pinto R, Costa W, Pinto Correia J, Cotter J. Transient elastography: should XL probe be used in all overweight patients? Scand J Gastroenterol 2019; 54:1022-1026. [PMID: 31322445 DOI: 10.1080/00365521.2019.1644367] [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] [Indexed: 02/04/2023]
Abstract
Background: Obesity is one of the main factors of transient elastography (TE) failure, considering body mass index (BMI) ≥28 kg/m2 as a limiting factor. The XL probe was designed to overcome this limitation. Aim: To compare the feasibility of the M and XL probes in patients with BMI ≥ 28 kg/m2, to evaluate differences in mean values of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) between the two probes and find predictive factors of TE failure. Material and methods: Prospective study, including all patients with BMI ≥ 28 kg/m2 consecutively admitted for TE. Results: Included 161 patients. Measurements with M probe were reliable in 69.6% of the patients, with 68.2% of valid measurements in obese population and 58.9% in patients with skin-capsule distance (SCD) >25 mm. In 40 patients (81.6%) with an invalid M probe measurement, a reliable result was obtained with XL probe. We found that SCD >25 mm was the only predictor of M probe failure (OR: 4.9, CI: 1.64-14.63, p = .004). In those patients in which TE was possible with both probes (n = 112), mean CAP was 304 ± 49 dB/m2 with M probe and 301 ± 50 dB/m2 with XL probe (p = .59). Regarding liver stiffness, a mean value of 7.58 ± 3.47 kpas was obtained with the M probe and 6.21 ± 3.44 kpas with the XL probe (p < .001). Conclusion: There is a reliable applicability of the M probe in a high number (68.2%) of patients with a BMI ≥30 kg/m2. A SCD >25 mm was the only predictive factor of M probe failure. Mean values of LSM with XL probe were lower than those obtained with M probe.
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Affiliation(s)
- Cátia Arieira
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Sara Monteiro
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Sofia Xavier
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Francisca Dias de Castro
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Joana Magalhães
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Carla Marinho
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Rui Pinto
- Surgery Department, Hospital da Senhora da Oliveira , Guimarães , Portugal
| | - Washington Costa
- Surgery Department, Hospital da Senhora da Oliveira , Guimarães , Portugal
| | - José Pinto Correia
- Surgery Department, Hospital da Senhora da Oliveira , Guimarães , Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira , Guimarães , Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho , Braga/Guimarães , Portugal.,ICVS/3B's, PT Government Associate Laboratory , Braga/Guimarães , Portugal
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11
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Caballeria L, Augustin S, Broquetas T, Morillas RM, Vergara M, Virolés S, Hernández MR, Serra I, Goday A, Vila L, Siso-Almirall A, Solans R, Fernández-Real JM, Carrión JA, Graupera I, Ginès P. Recommendations for the detection, diagnosis and follow-up of patients with non-alcoholic fatty liver disease in primary and hospital care. Med Clin (Barc) 2019; 153:169-177. [PMID: 31178295 DOI: 10.1016/j.medcli.2019.01.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 12/18/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, with a prevalence of 20-30% in the general population and 60-80% in at-risk populations. In a not negligible percentage of patients, NAFLD progresses from steatosis to different stages of fibrosis and cirrhosis. Due to its high prevalence, NAFLD has become a significant health problem that requires specific action in detection, diagnosis, follow-up and treatment. Furthermore, given that NAFLD presents an increased risk of cardiovascular morbidity and mortality, a multidisciplinary approach is required for its treatment and follow-up. Patients with early stages of the disease, without fibrosis, can be diagnosed and receive treatment in the Primary Care setting, while those with more advanced liver disease benefit from specialised follow-up in the hospital setting to prevent and treat liver complications. This consensus document, prepared by the Catalan Societies of Digestology, Primary Care, Endocrinology, Diabetes and Internal Medicine, arises from the need to design strategies to guide patient flows between Primary and Hospital Care in order to offer patients with NAFLD the best care according to the stage of their disease. The consensus document describes the most commonly used non-invasive diagnostic methods for patient diagnosis and two algorithms have been designed for patient management in both Primary Care and Hospital Care.
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Affiliation(s)
- Llorenç Caballeria
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, España; Societat Catalana de Medicina Familiar i Comunitària (CAMFIC), Barcelona, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
| | - Salvador Augustin
- Servei de Medicina Interna - Hepatologia, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Instituto de Salud Carlos III, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
| | - Teresa Broquetas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Instituto de Salud Carlos III, España; Sección de Hepatología, Servicio de Digestivo, Hospital del Mar, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
| | - Rosa Maria Morillas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Instituto de Salud Carlos III, España; Secció de Hepatologia, Servei Aparell Digestiu, Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
| | - Mercè Vergara
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Instituto de Salud Carlos III, España; Unidad de Hepatología, Servicio Digestivo, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
| | - Silvia Virolés
- Unitat de Digestiu, Servei Medicina Interna, Hospital de Figueres, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
| | - Mª Rosario Hernández
- Societat Catalana de Medicina Familiar i Comunitària (CAMFIC), Barcelona, España; Centre Atenció Primària-La Marina, SAP Esquerre Barcelona, Institut Català de la Salut, Barcelona, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
| | - Isabel Serra
- Departament d'Hepatologia, Hospital Dr. Josep Trueta, Girona, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
| | - Alberto Goday
- Servicio de Endocrinología, Hospital del Mar, Barcelona, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades de la Obesidad y Nutrición (CiberOBN), Instituto de Salud Carlos III, España; Associació Catalana de Diabetes, Barcelona, España
| | - Lluis Vila
- Servei d'Endocrinologia i Nutrició, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España; Societat Catalana d'Endocrinologia i Nutrició, Barcelona, España
| | | | - Rosa Solans
- Societat Catalano-Balear de Medicina Interna (SCBMI) de l'Acadèmia de Ciències Mèdiques de Catalunya i Balears (ACMCB), Barcelona, España
| | - Jose Manuel Fernández-Real
- Centro de Investigación Biomédica en Red de Enfermedades de la Obesidad y Nutrición (CiberOBN), Instituto de Salud Carlos III, España; Servei d'Endocrinologia i Nutrició, Hospital de Girona «Dr. Josep Trueta». Institut d'Investigació Biomèdica de Girona (IdIbGi), Departament de Ciències Mèdiques, Facultat de Medicina, Universitat de Girona, Girona, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
| | - Jose Antonio Carrión
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Instituto de Salud Carlos III, España; Sección de Hepatología, Servicio de Digestivo, Hospital del Mar, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
| | - Isabel Graupera
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Instituto de Salud Carlos III, España; Servei d'Hepatologia, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España.
| | - Pere Ginès
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Instituto de Salud Carlos III, España; Servei d'Hepatologia, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Grupo de trabajo sobre «Hígado graso no alcohólico» de la Societat Catalana de Digestologia, Barcelona, España
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12
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Puigvehí M, De Cuenca B, Viu A, Diago M, Turnes J, Gea F, Pascasio JM, Lens S, Cabezas J, Badia E, Olveira A, Morillas RM, Torras X, Montoliu S, Cordero P, Castro JL, Salmerón J, Molina E, Sánchez-Ruano JJ, Moreno J, Antón MD, Moreno JM, De la Vega J, Calleja JL, Carrión JA. Eight weeks of Paritaprevir/r/Ombitasvir + Dasabuvir in HCV genotype 1b with mild-moderate fibrosis: Results from a real-world cohort. Liver Int 2019; 39:90-97. [PMID: 30160363 DOI: 10.1111/liv.13950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/27/2018] [Accepted: 08/22/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS The interferon-free regimen paritaprevir/ritonavir, ombitasvir + dasabuvir (PTV/r/OBV/DSV) has shown high efficacy in patients with hepatitis C virus (HCV) genotype 1b infection when administered for 8 or 12 weeks, but data regarding the 8-week treatment are scarce. The aim of our study was to assess the efficacy and safety of the 8-week administration of PTV/r/OBV/DSV in a real-world cohort. METHODS We performed a multicentre observational study from Spanish Hepa-C database including patients receiving 8 weeks of PTV/r/OBV/DSV (October 2016-November 2017). Those with advanced fibrosis, with non-genotype 1b or who were treatment-experienced were excluded. RESULTS A total of 211 patients were registered from 23 Spanish centres; eleven were excluded. At baseline, 42.5% (n = 85) were male, median (range) age was 57 (23-86), ALT was 45 (11-494) IU/mL, viral load was 6.1 (3.3-8.2) log10 IU/mL, and 74.5% had mild liver fibrosis (F0-F1) and 25.5% moderate fibrosis (F2). At the end of treatment (EOT), HCV viral load was undetectable in 100% (200/200). Seven patients relapsed after treatment discontinuation. Sustained virological response (SVR12) rates by intention-to-treat analysis were 96% (192/200). Regarding treatment safety, 2 patients developed ALT elevation >5x ULN, but there were no treatment discontinuations. One patient died 7 weeks after EOT. CONCLUSION Treatment with PTV/r/OBV/DSV in genotype 1b-infected treatment-naive patients with mild-moderate fibrosis shows excellent efficacy and safety in real life, similarly to clinical trials. Clinicaltrials.gov, number: NCT03122132.
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Affiliation(s)
- Marc Puigvehí
- Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Ana Viu
- Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Juan Turnes
- Complejo Hospitalario Universitario de Pontevedra, IIS Galicia Sur, Pontevedra, Spain
| | - Francisco Gea
- Hospital Universitario Ramón y Cajal, CIBERehd, Madrid, Spain
| | | | - Sabela Lens
- Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona, Spain
| | | | - Ester Badia
- Hospital Universitario de Burgos, Burgos, Spain
| | | | | | - Xavier Torras
- Hospital de la Santa Creu i Sant Pau, CIBERehd, Barcelona, Spain
| | | | | | | | | | - Esther Molina
- Centro Hospitalario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - José M Moreno
- Centro Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - José L Calleja
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - José A Carrión
- Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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Shiha GE, El-Etreby S, Bahgat M, Hamed M, El Sherbini M, Ghoneem EA, Zalata K, Soliman RE, El Basiouny MA, Mikhail NN. Chronic Hepatitis C Patients with Obesity: Do we Need two Operators for Accurate Evaluation of Liver Stiffness? Ann Hepatol 2018; 17:795-801. [PMID: 30145567 DOI: 10.5604/01.3001.0012.3138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Transient elastography is gaining popularity as a non-invasive method for predicting liver fibrosis, but inter observer agreement and factors influencing reproducibility have not been adequately assessed. MATERIAL AND METHODS This cross-sectional study was conducted at Specialized Medical Hospital and the Egyptian Liver Foundation, Mansoura, Egypt. The inclusion criteria were: age older than 18 years and chronic infection by hepatitis C. The exclusion criteria were the presence of ascites, pacemaker or pregnancy. Three hundred and fifty-six patients participated in the study. Therefore, 356 pairs of exams were done by two operators on the same day. RESULTS The overall inter observer agreement ICC was 0.921. The correlation the two operators was excellent (Spearman's value q = 0.808, p < 0.001). Inter-observer reliability values were κ = 0.557 (p < 0.001). A not negligible discordance of fibrosis staging between operators was observed (87 cases, 24.4%). Discordance of at least one stage and for two or more stages of fibrosis occurred in 60 (16.9%) and 27 cases (7.6%) respectively. Obesity (BMI ≥ 30 kg/m2) is the main factor associated with discordance (p = 0.002). CONCLUSION Although liver stiffness measurement has had an excellent correlation between the two operators, TE presented an inter-observer variability that may not be negligible.
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Affiliation(s)
- Gamal E Shiha
- Egyptian Liver Research Institute and Hospital (ELRIH), Sherbin, El Mansoura, Egypt
| | - Shahira El-Etreby
- Hepatology and Gastroenterology Unit, Internal Medicine. Department, Faculty of Medicine, Mansoura University, Egypt
| | - Mounir Bahgat
- Hepatology and Gastroenterology Unit, Internal Medicine. Department, Faculty of Medicine, Mansoura University, Egypt
| | - Magdy Hamed
- Hepatology and Gastroenterology Unit, Internal Medicine. Department, Faculty of Medicine, Mansoura University, Egypt
| | - Mohamed El Sherbini
- Hepatology and Gastroenterology Unit, Internal Medicine. Department, Faculty of Medicine, Mansoura University, Egypt
| | - Elsayed A Ghoneem
- Hepatology and Gastroenterology Unit, Internal Medicine. Department, Faculty of Medicine, Mansoura University, Egypt
| | - Khaled Zalata
- Pathology Department, Faculty of Medicine, Mansoura University, Egypt
| | - Reham E Soliman
- Egyptian Liver Research Institute and Hospital (ELRIH), Sherbin, El Mansoura, Egypt
| | | | - Nabiel Nh Mikhail
- Egyptian Liver Research Institute and Hospital (ELRIH), Sherbin, El Mansoura, Egypt
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14
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Tsukano N, Miyase S, Saeki T, Mizobe K, Iwashita H, Arima N, Fujiyama S. Usefulness of virtual touch quantification for staging liver fibrosis in patients with hepatitis C, and factors affecting liver stiffness measurement failure compared with liver biopsy. Hepatol Res 2018; 48:373-382. [PMID: 29226524 DOI: 10.1111/hepr.13041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/10/2017] [Accepted: 12/02/2017] [Indexed: 02/08/2023]
Abstract
AIM The assessment of liver fibrosis in patients with hepatitis C is important to predict carcinogenesis. In this study, we evaluated the usefulness of virtual touch quantification (VTQ) for staging liver fibrosis, and investigated factors causing discrepancies between the estimated fibrosis stage using VTQ and the pathological fibrosis stage. METHODS Patients with hepatitis C (n = 302) were assessed using VTQ and underwent pathological liver investigation within 1 week before and after VTQ. A receiver operator characteristic (ROC) curve was obtained for VTQ, fibrosis-4 (FIB-4) index, and aspartate aminotransferase-to-platelet ratio index (APRI), and each area under the ROC curve (AUROC) was compared to predict fibrosis stage. We used univariate and multivariate analyses to investigate the factors related to the discrepancy between the estimated fibrosis stage using VTQ and the pathological fibrosis stage. RESULTS At any stage, VTQ was the most accurate for staging liver fibrosis. The VTQ cut-off values were 1.33 m/s (AUROC = 0.822) for ≥F2, 1.51 m/s (AUROC = 0.836) for ≥F3, and 1.92 m/s (AUROC = 0.890) for F4. Skin liver capsule distance (SCD) was the most relevant factor for the discrepancy between the estimated fibrosis stage using VTQ and the pathological fibrosis stage. The SCD cut-off value was 17.5 mm. CONCLUSIONS Virtual touch quantification is a non-invasive, simple method that is more accurate for staging liver fibrosis than the FIB-4 index and APRI. However, when the SCD is longer than 17.5 mm, there may be measurement failures.
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Affiliation(s)
- Natsumi Tsukano
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Shiho Miyase
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Tatsuhiko Saeki
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Keiko Mizobe
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Hirofumi Iwashita
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Nobuyuki Arima
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Shigetoshi Fujiyama
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
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15
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Chapman T, Dubinsky T, Barr RG. Ultrasound Elastography of the Liver: What the Clinician Needs to Know. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1293-1304. [PMID: 28258611 DOI: 10.7863/ultra.16.08001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Todd Chapman
- University of Washington Medical Center, Seattle, Washington, USA
| | | | - Richard G Barr
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Radiology Consultants, Youngstown, Ohio, USA
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Enhanced liver fibrosis test using ELISA assay accurately discriminates advanced stage of liver fibrosis as determined by transient elastography fibroscan in treatment naïve chronic HCV patients. Clin Exp Med 2017; 18:45-50. [PMID: 28567544 DOI: 10.1007/s10238-017-0463-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/08/2017] [Indexed: 12/14/2022]
Abstract
Evaluation of liver fibrosis stage is crucial in the assessment of chronic HCV patients, regarding decision to start treatment and during follow-up. Our aim was to assess the validity of the enhanced liver fibrosis (ELF) score in discrimination of advanced stage of liver fibrosis in naïve chronic HCV patients. We prospectively evaluated liver fibrosis stage in one hundred eighty-one naïve chronic HCV Egyptian patients by transient elastography (TE)-FibroScan. Patients were categorized into mild to moderate fibrosis (≤F2) group and advanced fibrosis (≥F3) group. The ELF score components, hyaluronic acid (HA), amino-terminal propeptide of type-III-procollagen (PIIINP) and tissue inhibitor of metalloproteinase type-1 (TIMP-1), were done using ELISA test. The mean values of ELF and its individual components significantly correlated with the hepatic fibrosis stage as measured by TE-FibroScan (P value 0.001). ELF cutoff value of 9.8 generated a sensitivity of 77.8%, specificity of 67.1%, area under the receiver operator characteristic curve (AUROC) of 0.76 with 95% confidence interval [CI] (0.68-0.83) for detecting advanced fibrosis (F ≥ 3). ELF panel is a good, reliable noninvasive test and showed comparable results to TE-FibroScan in detecting liver fibrosis stage in treatment naïve chronic HCV patients.
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Puigvehí M, Hernández J, Broquetas T, Coll S, Garcia-Retortillo M, Cañete N, Giménez MD, Garcia M, Bory F, Salvadó M, Solà R, Carrión JA. Diagnostic Accuracy of the Enhanced Liver Fibrosis (ELF®) Score Using HCV-Infected Serum Samples Cryopreserved for up to 25 Years. PLoS One 2016; 11:e0164883. [PMID: 27984583 PMCID: PMC5161309 DOI: 10.1371/journal.pone.0164883] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/03/2016] [Indexed: 01/11/2023] Open
Abstract
Introduction & Aims Cryopreservation of serum samples is a standard procedure for biomedical research in tertiary centers. However, studies evaluating the long-term biological stability of direct liver fibrosis markers using cryopreserved samples are scarce. Methods We compared the stability of hyaluronic acid (HA), tissue inhibitor of metalloproteinases (TIMP-1) and amino-terminal propeptide of type III procollagen (PIIINP) in 225 frozen serum samples of HCV-infected patients with a paired liver biopsy for up to 25 years (1990–2014). Moreover, we assessed the diagnostic accuracy (AUROC) of the Enhanced Liver Fibrosis (ELF®) score to identify significant fibrosis (F2-4) and its predictive capacity to identify clinical events during follow-up. Results Seventy-six patients (39,8%) had mild fibrosis (F0-1) and 115 (60,2%) significant fibrosis (F2-4). HA, PIIINP and TIMP-1 values remained stable during the period from 1995 to 2014 while those of 1990–94 were slightly higher. We did not find significant differences in the median ELF® values during the 20-year period from 1995–2014 in patients with mild (from 8,4 to 8,7) and significant fibrosis (from 9,9 to 10,9) (p = ns between periods and fibrosis stages). The AUROCs of ELF® to identify significant fibrosis were high in all the periods (from 0,85 to 0,91). The ELF® score showed a good predictive capability to identify clinical events during follow-up. Conclusions The biological stability of direct serum markers (HA, PIIINP and TIMP-1) using HCV-infected samples cryopreserved for 20 years is good. Therefore, the diagnostic accuracy of the ELF® score to identify significant fibrosis and clinical events during follow-up is very high.
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Affiliation(s)
- Marc Puigvehí
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Teresa Broquetas
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Susanna Coll
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Montserrat Garcia-Retortillo
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Nuria Cañete
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Maria Dolors Giménez
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mar Garcia
- Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Felipe Bory
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
| | | | - Ricard Solà
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - José A. Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- * E-mail:
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Staugaard B, Christensen PB, Mössner B, Hansen JF, Madsen BS, Søholm J, Krag A, Thiele M. Feasibility of transient elastography versus real-time two-dimensional shear wave elastography in difficult-to-scan patients. Scand J Gastroenterol 2016; 51:1354-9. [PMID: 27310486 DOI: 10.1080/00365521.2016.1193217] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Transient elastography (TE) is hampered in some patients by failures and unreliable results. We hypothesized that real time two-dimensional shear wave elastography (2D-SWE), the FibroScan XL probe, and repeated TE exams, could be used to obtain reliable liver stiffness measurements in patients with an invalid TE examination. METHODS We reviewed 1975 patients with 5764 TE exams performed between 2007 and 2014, to identify failures and unreliable exams. Fifty-four patients with an invalid TE at their latest appointment entered a comparative feasibility study of TE vs. 2D-SWE. RESULTS The initial TE exam was successful in 93% (1835/1975) of patients. Success rate increased from 89% to 96% when the XL probe became available (OR: 1.07, 95% CI 1.06-1.09). Likewise, re-examining those with a failed or unreliable TE led to a reliable TE in 96% of patients. Combining availability of the XL probe with TE re-examination resulted in a 99.5% success rate on a per-patient level. When comparing the feasibility of TE vs. 2D-SWE, 96% (52/54) of patients obtained a reliable TE, while 2D-SWE was reliable in 63% (34/54, p < 0.001). The odds of a successful 2D-SWE exam decreased with higher skin-capsule distance (OR = 0.77, 95% CI 0.67-0.98). CONCLUSIONS Transient elastography can be accomplished in nearly all patients by use of the FibroScan XL probe and repeated examinations. In difficult-to-scan patients, the feasibility of TE is superior to 2D-SWE.
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Affiliation(s)
- Benjamin Staugaard
- a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark ;,b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Peer Brehm Christensen
- a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark ;,b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Belinda Mössner
- a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark
| | - Janne Fuglsang Hansen
- a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark ;,b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Bjørn Stæhr Madsen
- b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;,c Department of Gastroenterology and Hepatology , Odense University Hospital , Odense , Denmark
| | - Jacob Søholm
- d Department of Medicine , Lillebaelt Hospital , Kolding , Denmark
| | - Aleksander Krag
- b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;,c Department of Gastroenterology and Hepatology , Odense University Hospital , Odense , Denmark
| | - Maja Thiele
- b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark ;,c Department of Gastroenterology and Hepatology , Odense University Hospital , Odense , Denmark ;,e OPEN, Odense Patient Data Exploratory Network , Odense University Hospital , Odense , Denmark
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Kumagai E, Korenaga K, Korenaga M, Imamura M, Ueyama M, Aoki Y, Sugiyama M, Murata K, Masaki N, Kanto T, Mizokami M, Watanabe S. Appropriate use of virtual touch quantification and FibroScan M and XL probes according to the skin capsular distance. J Gastroenterol 2016; 51:496-505. [PMID: 26463734 DOI: 10.1007/s00535-015-1127-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/23/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Appropriate utilization of different diagnostic modalities is essential for the accurate liver stiffness measurements (LSM) in patients with chronic liver diseases. The aim of this study was to evaluate the efficacy of Virtual Touch Quantification (VTQ) and the FibroScan M and XL probes in term of accurate LSM and to identify factors associated with inadequate measurements in obese and non-obese Japanese patients. METHODS A total of 664 consecutive patients with chronic liver disease were prospectively enrolled. LSM were evaluated concurrently with VTQ and the FibroScan M and XL probes. LSM quality was categorized as inadequate (success rate <60% and/or interquartile range/median value of ≥30%) or adequate. RESULTS No significant differences in the rate of inadequate LSM were observed among the three diagnostic modalities. In multivariate analysis, skin capsule distance (SCD) was strongly associated with inadequate rates obtained with VTQ and the M probe [odds ratio (OR) 1.28, P < 0.0001 and OR 1.20, P < 0.0001, respectively]. Inadequate LSM rates with both VTQ and the M probe increased with longer SCD, with a significant difference between subgroups at an SCD of ≥22.5 mm (VTQ 54.0%; M probe 51.1%; XL probe 25.2%; P < 0.0001). The rates of inadequate LSM rates with VTQ were significantly lower than those with the XL probe at an SCD of <17.5 mm. A total of 15 liver biopsy specimens obtained from nonalcoholic fatty liver disease patients confirmed the diagnostic accuracy and high applicability of the XL probe. CONCLUSIONS Long SCD reduced the diagnostic performance of the FibroScan® M probe and VTQ. LSM modalities should be selected according to SCD.
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Affiliation(s)
- Erina Kumagai
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan.,The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine at Kohnodai, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan.,Department of Gastroenterology, Juntendo University School of Medicine, Hongo, Bunkyo, Tokyo, Japan
| | - Keiko Korenaga
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan
| | - Masaaki Korenaga
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan. .,The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine at Kohnodai, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan.
| | - Masatoshi Imamura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan
| | - Misuzu Ueyama
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan.,The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine at Kohnodai, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan.,Department of Gastroenterology, Juntendo University School of Medicine, Hongo, Bunkyo, Tokyo, Japan
| | - Yoshihiko Aoki
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan
| | - Masaya Sugiyama
- The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine at Kohnodai, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Kazumoto Murata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan.,The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine at Kohnodai, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Naohiko Masaki
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan.,The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine at Kohnodai, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Tatsuya Kanto
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan.,The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine at Kohnodai, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Masashi Mizokami
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan.,The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine at Kohnodai, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Sumio Watanabe
- Department of Gastroenterology, Juntendo University School of Medicine, Hongo, Bunkyo, Tokyo, Japan
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Factors Associated with the Quality of Transient Elastography. Dig Dis Sci 2015; 60:2177-82. [PMID: 25757447 DOI: 10.1007/s10620-015-3611-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/25/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transient elastography is a noninvasive method for the evaluation of fibrosis in chronic liver disease. However, its reliability is variable, and the factors associated with its accuracy have not been identified completely. AIMS To identify the factors associated with the reliability of transient elastography. METHODS A total of 2033 transient elastography measurements were taken from March 2009 to October 2013. Reliability was determined according to the interquartile range/median (IQR/M < 0.30 = reliable; IQR/M < 0.10 = very reliable). Other indicators such as the percentage of successful measurements (>60 %), time of performance, and probe size were recorded. Potential factors that could affect the reliability of the procedure were analyzed using multivariate logistic regression. RESULTS Slightly less than 5 % of the measurements were unsuccessful, and 83 % of the successful measurements were found to be reliable. Factors associated with an unsuccessful measurement were female gender, incorrect probe size, and the presence of HCV infection. Unreliable measurements were associated with use of the procedure as part of a clinical study and success rate. Very reliable evaluations were associated with >10 measurements, the presence of chronic hepatic disease, and a success rate of >60 %. CONCLUSIONS The operator and clinical and anthropometric characteristics are factors that influence the success and reliability of transient elastography. Improvements in the quality of the procedure are needed to provide better diagnostic accuracy in clinical practice.
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