1
|
Ahmed Z, Ren J, Gonzalez A, Ahmed U, Walayat S, Martin DK, Moole H, Yong S, Koppe S, Dhillon S. Universal Index for Cirrhosis (UIC index): The development and validation of a novel index to predict advanced liver disease. Hepat Med 2018; 10:133-138. [PMID: 30498378 PMCID: PMC6207224 DOI: 10.2147/hmer.s160616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim The purpose of this study was to create and validate a novel serological diagnostic index to predict cirrhosis of all etiologies. Methods This was a retrospective observational study of 771 patients, age >18 years, who underwent a liver biopsy. The stage of fibrosis and routine laboratory values were recorded. The data were randomly separated into 2 datasets (training 50% and testing 50%). A stepwise logistic regression model was used to develop the novel index. The area under the curve of receiver operating characteristic (AUROC) was applied to compare the new index to existing ones (Fibro-Q, FIB4, APRI, AAR), which was also validated in the testing dataset. Results Variables associated with the presence of cirrhosis were first assessed by univariate analysis then by multivariable analysis, which indicated serum glutamic-oxaloacetic acid transaminase, serum glutamic-pyruvic transaminase, international normalized ratio, albumin, blood urea nitrogen, glucose, platelet count, total protein, age, and race were the independent predictors of cirrhosis (P<0.05). Regression formula for prediction of cirrhosis was generated and a novel index was subsequently created. The diagnostic performance of the novel index for predicting cirrhosis was assessed using the receiver operating characteristic curve. The new index had significantly higher AUROC (0.83, 95% CI: 0.79–0.87) than Fibro-Q (0.80, 95% CI: 0.76–0.85), FIB4 (0.79, 95% CI: 0.74–0.83), APRI (0.74, 95% CI: 0.69–0.78), and AAR (0.72, 95% CI: 0.67–0.78). Conclusion The novel index had the highest AUROC curve when compared with current indices and can be applied to all etiologies of chronic liver disease.
Collapse
Affiliation(s)
- Zohair Ahmed
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, IL, USA,
| | - Jinma Ren
- Department of Center for Outcomes Research, University of Illinois College of Medicine, Peoria, IL, USA
| | - Adam Gonzalez
- University of Illinois College of Medicine, Peoria, IL, USA
| | - Umair Ahmed
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Saqib Walayat
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Daniel K Martin
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Harsha Moole
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Sherri Yong
- Department of Pathology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Sean Koppe
- Department of Hepatology, University of Illinois at Chicago, IL, USA
| | - Sonu Dhillon
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine, Peoria, IL, USA
| |
Collapse
|
2
|
Garteiser P, Doblas S, Van Beers BE. Magnetic resonance elastography of liver and spleen: Methods and applications. NMR IN BIOMEDICINE 2018; 31:e3891. [PMID: 29369503 DOI: 10.1002/nbm.3891] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/16/2017] [Accepted: 12/04/2017] [Indexed: 05/06/2023]
Abstract
The viscoelastic properties of the liver and spleen can be assessed with magnetic resonance elastography (MRE). Several actuators, MRI acquisition sequences and reconstruction algorithms have been proposed for this purpose. Reproducible results are obtained, especially when the examination is performed in standard conditions with the patient fasting. Accurate staging of liver fibrosis can be obtained by measuring liver stiffness or elasticity with MRE. Moreover, emerging evidence shows that assessing the tissue viscous parameters with MRE is useful for characterizing liver inflammation, non-alcoholic steatohepatitis, hepatic congestion, portal hypertension, and hepatic tumors. Further advances such as multifrequency acquisitions and compression-sensitive MRE may provide novel quantitative markers of hepatic and splenic mechanical properties that may improve the diagnosis of hepatic and splenic diseases.
Collapse
Affiliation(s)
- Philippe Garteiser
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
| | - Sabrina Doblas
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
| | - Bernard E Van Beers
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
- Department of Radiology, Beaujon University Hospital Paris Nord, Clichy, France
| |
Collapse
|
3
|
Ahmed Z, Ahmed U, Walayat S, Ren J, Martin DK, Moole H, Koppe S, Yong S, Dhillon S. Liver function tests in identifying patients with liver disease. Clin Exp Gastroenterol 2018; 11:301-307. [PMID: 30197529 PMCID: PMC6112813 DOI: 10.2147/ceg.s160537] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background and aims Many patients with liver disease come to medical attention once they have advanced cirrhosis or acute decompensation. Most often, patients are screened for liver disease via liver function tests (LFTs). There is very limited published data evaluating laboratory values with biopsy-proven stages of hepatic fibrosis. We set out to evaluate whether any correlation exists between routine LFTs and stages of hepatic fibrosis. Methods A large retrospective observational study on 771 liver biopsies was conducted for evaluating the stage of fibrosis with AST, ALT, INR, BUN, creatinine, platelets, alkaline phosphatase, bilirubin, and albumin. Mean and 95% confidence intervals were used to describe the distributions of serum markers in different fibrosis stages. Multivariable generalized linear models were used and a two-tailed P-value was calculated. Results ALT was not statistically significant for any stage, and AST was statistically significant for stage 3 and 4 fibrosis. INR was statistically significant only in stage 4 disease but remained near the upper limit of normal range. Albumin failed to show a clinically relevant association. Platelets remained within normal laboratory range for all stages. The remaining laboratory values failed to show statistical and clinical significance. Conclusion The health care burden from chronic liver disease (CLD) will likely continue to rise, unless clinicians are made aware that normal or near normal laboratory findings may be seen in asymptomatic patients. Earlier identification of asymptomatic patients will allow for treatment with new promising modalities and decrease morbidity and mortality from CLD. Our study shows that laboratory values correlate poorly with liver disease.
Collapse
Affiliation(s)
- Zohair Ahmed
- Department of Gastroenterology and Hepatology, University of Illinois, Chicago, IL, USA,
| | - Umair Ahmed
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Saqib Walayat
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Jinma Ren
- Department of Center for Outcomes Research, University of Illinois College of Medicine, Peoria, IL, USA
| | - Daniel K Martin
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Harsha Moole
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Sean Koppe
- Department of Hepatology, University of Illinois at Chicago, Chicago, IL, USA
| | - Sherri Yong
- Department of Pathology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Sonu Dhillon
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine, Peoria, IL, USA
| |
Collapse
|
4
|
MARCOS-GARCÉS V, HARVAT M, MOLINA AGUILAR P, FERRÁNDEZ IZQUIERDO A, RUIZ-SAURÍ A. Comparative measurement of collagen bundle orientation by Fourier analysis and semiquantitative evaluation: reliability and agreement in Masson's trichrome, Picrosirius red and confocal microscopy techniques. J Microsc 2017; 267:130-142. [DOI: 10.1111/jmi.12553] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/26/2017] [Accepted: 02/14/2017] [Indexed: 12/25/2022]
Affiliation(s)
- V. MARCOS-GARCÉS
- Department of Pathology, Faculty of Medicine and Odontology; University of Valencia; Valencia Spain
| | - M. HARVAT
- Department of Pathology, Faculty of Medicine and Odontology; University of Valencia; Valencia Spain
| | - P. MOLINA AGUILAR
- Department of Pathology, Faculty of Medicine and Odontology; University of Valencia; Valencia Spain
| | - A. FERRÁNDEZ IZQUIERDO
- Department of Pathology, Faculty of Medicine and Odontology; University of Valencia; Valencia Spain
- INCLIVA Biomedical Research Institute; Valencia Spain
- Service of Pathology; University Clinical Hospital; Valencia Spain
| | - A. RUIZ-SAURÍ
- Department of Pathology, Faculty of Medicine and Odontology; University of Valencia; Valencia Spain
- INCLIVA Biomedical Research Institute; Valencia Spain
- Biomedical Research Networking Centre in Bioengineering; Biomaterials and Nanomedicine (CIBER-BBN); Spain
| |
Collapse
|
5
|
Cong WM, Bu H, Chen J, Dong H, Zhu YY, Feng LH, Chen J, Committee G. Practice guidelines for the pathological diagnosis of primary liver cancer: 2015 update. World J Gastroenterol 2016; 22:9279-9287. [PMID: 27895416 PMCID: PMC5107692 DOI: 10.3748/wjg.v22.i42.9279] [Citation(s) in RCA: 247] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/15/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
In 2010, a panel of Chinese pathologists reported the first expert consensus for the pathological diagnosis of primary liver cancers to address the many contradictions and inconsistencies in the pathological characteristics and diagnostic criteria for PLC. Since then considerable clinicopathological studies have been conducted globally, prompting us to update the practice guidelines for the pathological diagnosis of PLC. In April 18, 2014, a Guideline Committee consisting of 40 specialists from seven Chinese Societies (including Chinese Society of Liver Cancer, Chinese Anti-Cancer Association; Liver Cancer Study Group, Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Pathology, Chinese Anti-Cancer Association; Digestive Disease Group, Chinese Society of Pathology, Chinese Medical Association; Chinese Society of Surgery, Chinese Medical Association; Chinese Society of Clinical Oncology, Chinese Anti-Cancer Association; Pathological Group of Hepatobiliary Tumor and Liver Transplantation, Chinese Society of Pathology, Chinese Medical Association) was created for the formulation of the first guidelines for the standardization of the pathological diagnosis of PLC, mainly focusing on the following topics: gross specimen sampling, concepts and diagnostic criteria of small hepatocellular carcinoma (SHCC), microvascular invasion (MVI), satellite nodules, and immunohistochemical and molecular diagnosis. The present updated guidelines are reflective of current clinicopathological studies, and include a novel 7-point baseline sampling protocol, which stipulate that at least four tissue specimens should be sampled at the junction of the tumor and adjacent liver tissues in a 1:1 ratio at the 12, 3, 6 and 9 o’clock reference positions. For the purposes of molecular pathological examination, at least one specimen should be sampled at the intratumoral zone, but more specimens should be sampled for tumors harboring different textures or colors. Specimens should be sampled at both adjacent and distant peritumoral liver tissues or the tumor margin in order to observe MVI, satellite nodules and dysplastic foci/nodules distributed throughout the background liver tissues. Complete sampling of whole SHCC ≤ 3 cm should be performed to assess its biological behavior, and in clinical practice, therapeutic borders should be also preserved, even in SHCC. The diagnostic criteria of MVI and satellite nodules, immunohistochemical panels, as well as molecular diagnostic principles, such as clonal typing, for recurrent HCC and multinodule HCC were also proposed and recommended. The standardized process of pathological examination is aimed at ensuring the accuracy of pathological PLC diagnoses as well as providing a valuable frame of reference for the clinical assessment of tumor invasive potential, the risk of postoperative recurrence, long-term survival, and the development of individualized treatment regimens. The updated guidelines could ensure the accuracy of pathological diagnoses of PLC, and provide a valuable frame of reference for its clinical assessment.
Collapse
|
6
|
Comparison of Histochemical Stainings in Evaluation of Liver Fibrosis and Correlation with Transient Elastography in Chronic Hepatitis. Anal Cell Pathol (Amst) 2015; 2015:431750. [PMID: 26665101 PMCID: PMC4664783 DOI: 10.1155/2015/431750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/05/2015] [Accepted: 08/12/2015] [Indexed: 02/05/2023] Open
Abstract
Background and Aim. The best staining to evaluate liver fibrosis in liver hepatitis is still a debated topic. This study aimed to compare Masson's trichrome (MT), Sirius Red (SR), and orcein stainings in evaluating liver fibrosis in chronic HCV hepatitis (CHC) with semiquantitative and quantitative methods (Collagen Proportionate Area (CPA) by Digital Image Analysis (DIA)) and correlate them with transient elastography (TE). Methods. Liver stiffness evaluation of 111 consecutive patients with CHC was performed by TE. Semiquantitative staging by Metavir score system and CPA by DIA were assessed on liver biopsy stained with MT, SR, and orcein. Results. MT, SR, and orcein staining showed concordant results in 89.6% of cases in staging CHC, without significant difference in both semiquantitative and quantitative evaluations of fibrosis. TE values were concordant with orcein levels in 86.5% of the cases and with MT/RS in 77.5% (P < 0.001). No significant correlation between the grade of necroinflammatory activity and TE values was found. Conclusion. In CHC, SR/MT and orcein stainings are almost concordant and when discordant, orcein staining is better related to TE values than MT/RS. This suggests that elastic fibers play a more important role than reticular or collagenous ones in determining stiffness values in CHC.
Collapse
|