1
|
Kudaravalli S, Huang DQ, Yeh ML, Trinh L, Tsai PC, Hsu YC, Kam LY, Nguyen VH, Ogawa E, Lee DH, Ito T, Watanabe T, Enomoto M, Preda CM, Ko MKL, Wan-Hin Hui R, Atsukawa M, Suzuki T, Marciano S, Barreira A, Do S, Uojima H, Takahashi H, Quek SXZ, Toe Wai Khine HH, Ishigami M, Itokawa N, Go MS, Kozuka R, Marin RI, Sandra I, Li J, Zhang JQ, Wong C, Yoshimaru Y, Vo DKH, Tseng CH, Lee CJ, Inoue K, Maeda M, Hoang JK, Chau A, Chuang WL, Dai CY, Huang JF, Huang CF, Buti M, Tanaka Y, Gadano AC, Yuen MF, Cheung R, Lim SG, Trinh HN, Toyoda H, Yu ML, Nguyen MH. Sex and ethnic disparities in hepatitis B evaluation and treatment across the world. J Hepatol 2024; 81:33-41. [PMID: 38906621 DOI: 10.1016/j.jhep.2024.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/21/2024] [Accepted: 02/09/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND & AIMS Oral antiviral therapy with nucleos(t)ide analogues (NAs) for chronic hepatitis B (CHB) is well-tolerated and lifesaving, but real-world data on utilization are limited. We examined rates of evaluation and treatment in patients from the REAL-B consortium. METHODS This was a cross-sectional study nested within our retrospective multinational clinical consortium (2000-2021). We determined the proportions of patients receiving adequate evaluation, meeting AASLD treatment criteria, and initiating treatment at any time during the study period. We also identified factors associated with receiving adequate evaluation and treatment using multivariable logistic regression analyses. RESULTS We analyzed 12,566 adult treatment-naïve patients with CHB from 25 centers in 9 countries (mean age 47.1 years, 41.7% female, 96.1% Asian, 49.6% Western region, 8.7% cirrhosis). Overall, 73.3% (9,206 patients) received adequate evaluation. Among the adequately evaluated, 32.6% (3,001 patients) were treatment eligible by AASLD criteria, 83.3% (2,500 patients) of whom were initiated on NAs, with consistent findings in analyses using EASL criteria. On multivariable logistic regression adjusting for age, sex, cirrhosis, and ethnicity plus region, female sex was associated with adequate evaluation (adjusted odds ratio [aOR] 1.13, p = 0.004), but female treatment-eligible patients were about 50% less likely to initiate NAs (aOR 0.54, p <0.001). Additionally, the lowest evaluation and treatment rates were among Asian patients from the West, but no difference was observed between non-Asian patients and Asian patients from the East. Asian patients from the West (vs. East) were about 40-50% less likely to undergo adequate evaluation (aOR 0.60) and initiate NAs (aOR 0.54) (both p <0.001). CONCLUSIONS Evaluation and treatment rates were suboptimal for patients with CHB in both the East and West, with significant sex and ethnic disparities. Improved linkage to care with linguistically competent and culturally sensitive approaches is needed. IMPACT AND IMPLICATIONS Significant sex and ethnic disparities exist in hepatitis B evaluation and treatment, with female treatment-eligible patients about 50% less likely to receive antiviral treatment and Asian patients from Western regions also about 50% less likely to receive adequate evaluation or treatment compared to Asians from the East (there was no significant difference between Asian patients from the East and non-Asian patients). Improved linkage to care with linguistically competent and culturally sensitive approaches is needed.
Collapse
Affiliation(s)
- Sahith Kudaravalli
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States; Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, United States
| | - Daniel Q Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lindsey Trinh
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States
| | - P C Tsai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Leslie Y Kam
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States
| | - Vy H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Dong Hyun Lee
- Division of Gastroenterology, Department of Internal Medicine, Good Gang-An Hospital, Busan, South Korea
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan
| | - Tsunamasa Watanabe
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaru Enomoto
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Carmen Monica Preda
- Department of Gastroenterology and Hepatology, Clinic Fundeni Institute, Romania
| | - Michael K L Ko
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Rex Wan-Hin Hui
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Masanori Atsukawa
- Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Takanori Suzuki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Ana Barreira
- Liver Unit, Department of Internal Medicine, Hospital Universitari Valle d'Hebron and Universitat Autònoma de Barcelona, and CIBEREHD del Instituto Carlos III. Barcelona, Spain
| | - Son Do
- Digestive Health Associates of Texas, United States
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Sabrina X Z Quek
- Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | | | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan
| | - Norio Itokawa
- Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Min Seok Go
- Division of Gastroenterology, Department of Internal Medicine, Good Gang-An Hospital, Busan, South Korea
| | - Ritsuzo Kozuka
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Raluca Ioana Marin
- Department of Gastroenterology and Hepatology, Clinic Fundeni Institute, Romania
| | - Irina Sandra
- Department of Gastroenterology and Hepatology, Clinic Fundeni Institute, Romania
| | - Jiayi Li
- Wong Clinics, San Francisco, California, United States
| | - Jian Q Zhang
- Chinese Hospital, San Francisco, California, United States
| | | | - Yoko Yoshimaru
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Dang K H Vo
- Digestive Health Associates of Texas, United States
| | - Cheng-Hao Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chul-Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Good Gang-An Hospital, Busan, South Korea
| | - Kaori Inoue
- Liver Center, Saga University Hospital, Saga, Japan
| | - Mayumi Maeda
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States
| | - Joseph K Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States
| | - Angela Chau
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Maria Buti
- Liver Unit, Department of Internal Medicine, Hospital Universitari Valle d'Hebron and Universitat Autònoma de Barcelona, and CIBEREHD del Instituto Carlos III. Barcelona, Spain
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan; Department of Clinical Laboratory Medicine, Nagoya City University Hospital, Nagoya, Japan; Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Man-Fung Yuen
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, United States
| | - Seng Gee Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Huy N Trinh
- San Jose Gastroenterology, San Jose, California, United States
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, United States.
| |
Collapse
|
2
|
Nah EH, Choi YJ, Cho S, Park H, Kim S, Kwon E, Cho HI. Changes in nonalcoholic fatty liver disease and M2BPGi due to lifestyle intervention in primary healthcare. PLoS One 2024; 19:e0298151. [PMID: 38421976 PMCID: PMC10903829 DOI: 10.1371/journal.pone.0298151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/06/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND A healthy lifestyle is the most important method for managing nonalcoholic fatty liver disease (NAFLD). Mac-2-binding protein glycosylated isomer (M2BPGi) has been suggested as a biomarker for NAFLD. This study aimed to determine the efficacy of personalized lifestyle interventions on NAFLD remission. METHODS This single-arm intervention study recruited participants with NAFLD who underwent health checkups at seven health-promotion centers in five South Korean cities. Fatty liver diagnosis was based on ultrasonography (US). The 109 individuals were recruited for personalized lifestyle interventions of hypocaloric diets and exercise. The participants attended the lifestyle intervention programs once per month for the first 3 months, and once every 3 months for the subsequent 6 months. In addition to sessions through center visits, phone-based intervention and self-monitoring at 4-, 5-, 7-, and 8-month were provided during the 9-month intervention period. And phone-based self-monitoring were also provided monthly during the 3-month follow-up period. The primary outcome was NAFLD remission at month 12 as measured on US and magnetic resonance elastography. The secondary outcomes were the changes in metabolic factors and M2BPGi. RESULTS The 108 individuals (62 males and 46 females; age 51.1±12.4 years, mean±standard deviation) were finally analyzed after the 12month intervention. Body mass index, waist circumference (WC), blood pressure, blood lipids (total cholesterol, triglycerides, and HDL-C), and fasting blood sugar levels were improved relative to baseline (all P<0.05). Fatty liver at or above the moderate grade according to US was decreased at month 12 relative to baseline (67.6% vs 50.9%) (P = 0.002). M2BPGi levels decreased during the 12-month study period (P<0.001). M2BPGi levels were moderately correlated with hepatic fat fraction by magnetic resonance imaging (r = 0.33, P = 0.05). WC (OR = 0.82, 95% CI = 0.67-1.00, P = 0.05) and HDL-C (OR = 1.17, 95% CI = 1.03-1.32, P = 0.014) were associated with remission of fatty liver in the multivariate analysis. CONCLUSION The personalized lifestyle intervention was effective in improving fatty liver and metabolic factors, but not hepatic stiffness, in NAFLD. TRIAL REGISTRATION ICTRP, cris.nih.go.kr (KCT0006380).
Collapse
Affiliation(s)
- Eun-Hee Nah
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Yong Jun Choi
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Seon Cho
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Hyeran Park
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Suyoung Kim
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Eunjoo Kwon
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Han-Ik Cho
- MEDIcheck LAB, Korea Association of Health Promotion, Seoul, South Korea
| |
Collapse
|
3
|
Parola M, Pinzani M. Liver fibrosis in NAFLD/NASH: from pathophysiology towards diagnostic and therapeutic strategies. Mol Aspects Med 2024; 95:101231. [PMID: 38056058 DOI: 10.1016/j.mam.2023.101231] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
Liver fibrosis, as an excess deposition of extracellular matrix (ECM) components, results from chronic liver injury as well as persistent activation of inflammatory response and of fibrogenesis. Liver fibrosis is a major determinant for chronic liver disease (CLD) progression and in the last two decades our understanding on the major molecular and cellular mechanisms underlying the fibrogenic progression of CLD has dramatically improved, boosting pre-clinical studies and clinical trials designed to find novel therapeutic approaches. From these studies several critical concepts have emerged, starting to reveal the complexity of the pro-fibrotic microenvironment which involves very complex, dynamic and interrelated interactions between different hepatic and extrahepatic cell populations. This review will offer first a recapitulation of established and novel pathophysiological basic principles and concepts by intentionally focus the attention on NAFLD/NASH, a metabolic-related form of CLD with a high impact on the general population and emerging as a leading cause of CLD worldwide. NAFLD/NASH-related pro-inflammatory and profibrogenic mechanisms will be analysed as well as novel information on cells, mediators and signalling pathways which have taken advantage from novel methodological approaches and techniques (single cell genomics, imaging mass cytometry, novel in vitro two- and three-dimensional models, etc.). We will next offer an overview on recent advancement in diagnostic and prognostic tools, including serum biomarkers and polygenic scores, to support the analysis of liver biopsies. Finally, this review will provide an analysis of current and emerging therapies for the treatment of NAFLD/NASH patients.
Collapse
Affiliation(s)
- Maurizio Parola
- Dept. Clinical and Biological Sciences, Unit of Experimental Medicine and Clinical Pathology, University of Torino, Corso Raffaello 30, 10125, Torino, Italy.
| | - Massimo Pinzani
- UCL Institute for Liver and Digestive Health, Division of Medicine - Royal Free Hospital, London, NW32PF, United Kingdom.
| |
Collapse
|
4
|
Curry MP, Tam E, Schneider C, Abdelgelil N, Hassanien T, Afdhal NH. The Use of Noninvasive Velacur® for Discriminating between Volunteers and Patients with Chronic Liver Disease: A Feasibility Study. Int J Hepatol 2024; 2024:8877130. [PMID: 38274398 PMCID: PMC10807935 DOI: 10.1155/2024/8877130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/11/2023] [Accepted: 12/02/2023] [Indexed: 01/27/2024] Open
Abstract
Background and Aims Nonalcoholic fatty liver disease is the leading cause of chronic liver disease globally and can progress to cirrhosis, liver failure, and liver cancer. Current AASLD, AGA, and ADA guidelines recommend assessment for liver fibrosis in all patients with NAFLD. Serum biomarkers for fibrosis, while widely available, have notable limitations. Imaging-based noninvasive testing for liver fibrosis/cirrhosis is more accurate and is becoming more widespread. Methods We evaluated the feasibility of a novel shear wave absolute vibroelastography (S-WAVE) modality called Velacur® for assessing liver stiffness measurement (LSM) for fibrosis and attenuation coefficient estimation (ACE) in differentiating patients with chronic liver disease from normal healthy controls. Results Fifty-four healthy controls and 89 patients with NAFLD or cured HCV with a prior known LSM of >8 kPa were enrolled, and all subjects were evaluated with FibroScan® and Velacur®. Velacur® was able to discriminate patients with increased liver stiffness as determined by a FibroScan® score of >8 kPa from healthy controls with an AUC of 0.938 (0.88-0.96). For assessment of steatosis in NAFLD patients only, Velacur® could identify patients with steatosis from healthy controls with an AUC of 0.831 (0.777-0.880). The Velacur® scan quality assessment was superior in healthy controls, as compared to patients, and the scan quality, as assessed by the quality factor (QF) and interquartile range (IQR)/median, was affected by BMI. Velacur® was safe and well tolerated by patients, and there were no adverse events. Conclusion Velacur® assessment of liver stiffness measurement and liver attenuation is comparable to results obtained by FibroScan® and is an alternative technology for monitoring liver fibrosis progression in patients with chronic liver disease. This trial is registered with NCT03957070.
Collapse
Affiliation(s)
- Michael P. Curry
- Division of Gastroenterology, Hepatology and Clinical Nutrition, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Edward Tam
- Pacific Gastroenterology Associates, Vancouver, BC, Canada
| | | | | | | | - Nezam H. Afdhal
- Division of Gastroenterology, Hepatology and Clinical Nutrition, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
5
|
Pereira LDJM, Pereira JAC, Fontani V, Rinaldi S. REAC Reparative Treatment: A Promising Therapeutic Option for Alcoholic Cirrhosis of the Liver. J Pers Med 2023; 13:1698. [PMID: 38138925 PMCID: PMC10744513 DOI: 10.3390/jpm13121698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Alcoholic liver disease (ALD) is a significant global health concern associated with excessive alcohol consumption. ALD encompasses various liver conditions with complex pathogenesis and progression influenced by environmental, genetic, and epigenetic factors. Alcoholic cirrhosis of the liver (ALC) is particularly prevalent among socially disadvantaged individuals, and current pharmacotherapy options provide limited treatment. This study aims to explore the potential benefits of radio electric asymmetric conveyer (REAC) technology and its tissue optimization reparative treatment (TO-RPR) in managing ALC. The liver possesses remarkable regenerative capabilities closely tied to its bioelectrical properties. REAC TO-RPR is a novel biotechnological therapeutic approach that aims to enhance and expedite reparative processes in injured tissues by restoring disrupted cellular endogenous bioelectric fields. This study seeks to optimize understanding of REAC TO-RPR's impact on liver function and clinical outcomes in ALC patients. By investigating the mechanisms underlying liver's reparative abilities and evaluating the efficacy of REAC TO-RPR, this research aims to address the urgent need for improved interventions in managing ALC. The findings hold potential for developing innovative treatment approaches, improving patient outcomes, and reducing the societal and individual burden associated with ALC.
Collapse
Affiliation(s)
| | | | - Vania Fontani
- Research Department, Rinaldi Fontani Foundation, 50144 Florence, Italy
- Department of Reparative and Regenerative Medicine, Rinaldi Fontani Institute, 50144 Florence, Italy
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, 50144 Florence, Italy
| | - Salvatore Rinaldi
- Research Department, Rinaldi Fontani Foundation, 50144 Florence, Italy
- Department of Reparative and Regenerative Medicine, Rinaldi Fontani Institute, 50144 Florence, Italy
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, 50144 Florence, Italy
| |
Collapse
|
6
|
Huang DQ, Tran A, Yeh ML, Yasuda S, Tsai PC, Huang CF, Dai CY, Ogawa E, Ishigami M, Ito T, Kozuka R, Enomoto M, Suzuki T, Yoshimaru Y, Preda CM, Marin RI, Sandra I, Tran S, Quek SXZ, Khine HHTW, Itokawa N, Atsukawa M, Uojima H, Watanabe T, Takahashi H, Inoue K, Maeda M, Hoang JK, Trinh L, Barnett S, Cheung R, Lim SG, Trinh HN, Chuang WL, Tanaka Y, Toyoda H, Yu ML, Nguyen MH. Antiviral therapy substantially reduces HCC risk in patients with chronic hepatitis B infection in the indeterminate phase. Hepatology 2023; 78:1558-1568. [PMID: 37184202 DOI: 10.1097/hep.0000000000000459] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/16/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND AIMS HCC risk in chronic hepatitis B (CHB) is higher in the indeterminate phase compared with the inactive phase. However, it is unclear if antiviral therapy reduces HCC risk in this population. We aimed to evaluate the association between antiviral therapy and HCC risk in the indeterminate phase. APPROACH AND RESULTS We analyzed 855 adult (59% male), treatment-naïve patients with CHB infection without advanced fibrosis in the indeterminate phase at 14 centers (USA, Europe, and Asia). Inverse probability of treatment weighting (IPTW) was used to balance the treated (n = 405) and untreated (n = 450) groups. The primary outcome was HCC development. The mean age was 46±13 years, the median alanine transaminase was 38 (interquartile range, 24-52) U/L, the mean HBV DNA was 4.5±2.1 log 10 IU/mL, and 20% were HBeAg positive. The 2 groups were similar after IPTW. After IPTW (n = 819), the 5-, 10-, and 15-year cumulative HCC incidence was 3%, 4%, and 9% among treated patients (n = 394) versus 3%, 15%, and 19%, among untreated patients (n = 425), respectively ( p = 0.02), with consistent findings in subgroup analyses for age >35 years, males, HBeAg positive, HBV DNA>1000 IU/mL, and alanine transaminase CONCLUSIONS Antiviral therapy reduces HCC risk by 70% among patients with indeterminate-phase CHB. These data have important implications for the potential expansion of CHB treatment criteria.
Collapse
Affiliation(s)
- Daniel Q Huang
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew Tran
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Ming-Lun Yeh
- Department of Internal Medicine, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Satoshi Yasuda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Pei-Chien Tsai
- Department of Internal Medicine, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Department of Internal Medicine, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia Yen Dai
- Department of Internal Medicine, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ritsuzo Kozuka
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Masaru Enomoto
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Takanori Suzuki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Yoko Yoshimaru
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Carmen M Preda
- Department of Gastroenterology and Hepatology, Clinic Fundeni Institute, Bucharest, Romania
| | - Raluca I Marin
- Department of Gastroenterology and Hepatology, Clinic Fundeni Institute, Bucharest, Romania
| | - Irina Sandra
- Department of Gastroenterology and Hepatology, Clinic Fundeni Institute, Bucharest, Romania
| | - Sally Tran
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Sabrina X Z Quek
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
| | - Htet Htet Toe Wai Khine
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Norio Itokawa
- Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Masanori Atsukawa
- Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsunamasa Watanabe
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Kaori Inoue
- Liver Center, Saga University Hospital, Saga, Japan
| | - Mayumi Maeda
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Joseph K Hoang
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Lindsey Trinh
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Scott Barnett
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Ramsey Cheung
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare, Palo Alto, California, USA
| | - Seng Gee Lim
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huy N Trinh
- San Jose Gastroenterology, San Jose, California, USA
| | - Wan-Long Chuang
- Department of Internal Medicine, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ming-Lung Yu
- Department of Internal Medicine, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Mindie H Nguyen
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| |
Collapse
|
7
|
Kumari S, George M. Diagnostic Accuracy of a Nurse-Led Transient Elastography: A Study of a Tertiary Hospital Experience. Gastroenterol Nurs 2023; 46:118-127. [PMID: 36882920 DOI: 10.1097/sga.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/29/2022] [Indexed: 03/09/2023] Open
Abstract
Once thought rare, liver disease is an emerging cause of significant morbidity and mortality. The rising burden of liver disease necessitates a competent workforce to deliver quality healthcare to patients with liver diseases. Staging liver diseases is essential in disease management. Transient elastography as compared with liver biopsy, the gold standard in staging of the disease, has gained wide acceptance in this field. This study examines the diagnostic accuracy of nurse-led transient elastography in staging fibrosis in chronic liver diseases at a tertiary referral hospital. Audit of records to locate transient elastography and liver biopsy performed within 6 months of interval yielded 193 cases for this retrospective study. A data abstraction sheet was prepared for extracting the relevant data. The content validity index and reliability of the scale were above 0.9. The diagnostic accuracy of liver stiffness evaluation (in kPa) by nurse-led transient elastography to grade fibrosis was categorized as "significant and advanced" and tested against the Ishak staging of liver biopsy. SPSS v.25 was used to perform the analysis. All tests were two-sided at a .01 level of significance. Area under the receiver operating characteristic curve, a graphical plot, illustrated the diagnostic ability of nurse-led transient elastography for significant fibrosis as 0.93 (95% confidence interval [CI] 0.88-0.99; p < .001) and advanced fibrosis as 0.89 (95% CI 0.83-0.93; p < .001). Spearman's ρ correlation between liver stiffness evaluation and liver biopsy was significant ( p = .01). Nurse-led transient elastography showed a significant diagnostic accuracy in staging hepatic fibrosis irrespective of the etiology of chronic liver disease. Given the increase in chronic liver disease, introducing more such nurse-led clinics increases the potential for early detection and improves care outcomes for this population.
Collapse
Affiliation(s)
- Sanju Kumari
- Sanju Kumari, MSc(N), was a student, College of Nursing, Institute of Liver and Biliary Sciences, New Delhi, India
- Mini George, PhD, is Principal, College of Nursing, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Mini George
- Sanju Kumari, MSc(N), was a student, College of Nursing, Institute of Liver and Biliary Sciences, New Delhi, India
- Mini George, PhD, is Principal, College of Nursing, Institute of Liver and Biliary Sciences, New Delhi, India
| |
Collapse
|
8
|
Buckholz AP, Brown RS. Noninvasive Fibrosis Testing in Chronic Liver Disease Including Caveats. Clin Liver Dis 2023; 27:117-131. [PMID: 36400461 DOI: 10.1016/j.cld.2022.08.008] [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: 01/31/2023]
Abstract
Assessment of liver fibrosis is important as the range of liver disease management has expanded, rendering biopsy both imperfect and impractical in many situations. Noninvasive tests of fibrosis leverage laboratory, imaging and elastography techniques to estimate disease extent, often with the goal of identifying advanced fibrosis. This review attempts to summarize their utility across a broad range of possible clinical scenarios while considering the central tenets of health care quality: access, quality, and cost. For each test, it also discusses the caveats whereby each test may have reduced effectiveness and how to consider each in a typical clinical setting.
Collapse
Affiliation(s)
- Adam P Buckholz
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue 4th Floor, New York, NY 10021, USA
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue 4th Floor, New York, NY 10021, USA.
| |
Collapse
|
9
|
Huang DQ, Lee DH, Le MH, Le A, Yeo YH, Trinh HN, Chung M, Nguyen V, Johnson T, Zhang JQ, Wong C, Wong C, Li J, Cheung R, Nguyen MH. Liver Complications in Untreated Treatment-Ineligible versus Treated Treatment-Eligible Patients with Hepatitis B. Dig Dis 2023; 41:115-123. [PMID: 36070707 PMCID: PMC9909719 DOI: 10.1159/000526933] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A substantial number of patients who do not meet treatment criteria for chronic hepatitis B (CHB) later develop adverse outcomes such as cirrhosis and hepatocellular carcinoma (HCC). Our aim was to determine whether current practice guidelines adequately identify CHB patients who will benefit from antiviral therapy. METHODS We performed a retrospective cohort study comparing the incidence of adverse liver outcomes (cirrhosis and/or HCC) in untreated treatment-ineligible (at baseline and throughout follow-up) versus treated treatment-eligible patients according to standard American Association for the Study of Liver Diseases (AASLD) 2018 guidance (alanine aminotransferase [ALT] >70/50 U/L for men/women plus hepatitis B virus [HBV] DNA >20,000/2,000 IU/mL for HBeAg+/-) and with a sensitivity analyses using a lower threshold (ALT >40 U/L and HBV DNA >2,000 IU/mL). RESULTS We reviewed records of 5,840 patients from 5 clinics in California and identified 2,987 treatment-naive non-HCC CHB patients. Of those, 271 patients remained untreated treatment-ineligible, 514 patients were treatment-eligible and initiated treatment, with 5-year cumulative adverse liver incidences of 12.5% versus 7.2%, p = 0.074. On multivariable analysis adjusting for age, sex, diabetes, albumin, platelet count, and HBV DNA, compared to treated treatment-eligible patients, untreated treatment-ineligible patients had a significantly higher risk of adverse liver outcomes (adjusted hazard ratio: 2.38, 95% confidence interval 1.03-5.48, p = 0.04) in main analysis by AASLD 2018 criteria but not in sensitivity analysis using the lower treatment threshold (p = 0.09). CONCLUSION Patients never meeting standard AASLD 2018 criteria for antiviral therapy and never treated had twice the risk of developing cirrhosis and/or HCC when compared to eligible and treated patients.
Collapse
Affiliation(s)
- Daniel Q. Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
| | - Dong Hyun Lee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Good Gang-An Hospital, Busan, Republic of Korea,Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Michael H. Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - An Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Yee Hui Yeo
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Huy N. Trinh
- San Jose Gastroenterology, San Jose, California, USA
| | - Mimi Chung
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vy Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Tiffani Johnson
- University of California, Berkeley, Berkeley, California, USA
| | | | | | | | - Jiayi Li
- Palo Alto Medical Foundation, Mountain View Division, Mountain View, California, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA,Department of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare, Palo Alto, California, USA
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA,*Mindie H. Nguyen,
| |
Collapse
|
10
|
Associations between Extracellular Matrix Protein 1 Gene Polymorphism and Progression of Liver Disease. Genet Res (Camb) 2022; 2022:9304264. [PMID: 36299684 PMCID: PMC9586790 DOI: 10.1155/2022/9304264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/21/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Our study aimed to investigate the relationship between extracellular matrix 1 (ECM1) gene polymorphism and progression of liver fibrosis in the Chinese population. Methods A total 656 patients with hepatitis B virus (HBV) infection and 298 healthy individuals of the Chinese Han population were recruited for a retrospective case-control study. Of the disease group, 104 cases had chronic hepatitis B (CHB), 266 had LC, and 286 had hepatocellular carcinoma (HCC). Subjects were frequency-matched according to age and gender. Polymorphisms of the ECM1 gene were examined using the MassARRAY SNP genotyping method. Results There were no associations between genotype and allele frequencies of ECM1 rs3737240 and rs13294 loci with the risk of CHB and CHB-related HCC. After adjustment for age, sex, smoking status, and drinking habits, the GT genotype was dramatically related to a reduced risk of chronic HBV infection in both non-HCC (OR = 0.68, 95% CI: 0.49-0.94) and total chronic HBV infection patients (OR = 0.75, 95% CI: 0.56-1.00). Haplotype analyses revealed twelve protective haplotypes against total chronic HBV infection and four against non-HCC chronic HBV infection. Conclusion ECM1 gene polymorphism in rs3834087 and rs3754217 loci is associated with a reduced risk of chronic HBV infection but not with liver fibrosis development and the occurrence of HCC.
Collapse
|
11
|
Noninvasive surrogates are poor predictors of liver fibrosis in patients with Fontan circulation. J Thorac Cardiovasc Surg 2022; 164:1176-1185.e3. [PMID: 35034765 DOI: 10.1016/j.jtcvs.2021.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/02/2021] [Accepted: 12/16/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Patients with Fontan circulation exhibit a high incidence of liver fibrosis and cirrhosis. Transient elastography (TE) and the enhanced liver fibrosis (ELF) test have proven useful as noninvasive surrogate markers of liver fibrosis for other chronic liver diseases. We evaluated whether TE and the ELF score can predict the degree of liver fibrosis in patients with Fontan circulation. METHODS We retrospectively reviewed the medical records of 45 adult patients with at least 10 years of Fontan duration who had undergone liver biopsy and investigated the relation between the fibrosis stage and TE and the ELF test results. Additionally, the association of these variables and other biochemical and hemodynamic parameters was assessed. RESULTS The mean age was 25.9 years and the mean Fontan duration was 20.8 years. Advanced liver fibrosis was present in 36 (80.0%) patients. TE or ELF score are comparable for patients with and without advanced liver fibrosis (mean 23.3 vs 24.8 kPa [P = .85] for TE; mean 8.94 vs 9.25 [P = .44] for the ELF score). However, N-terminal pro-brain natriuretic peptide level and ventricular end-diastolic pressure were higher in patients with advanced liver fibrosis (mean 224 vs 80 pg/mL [P < .01]; and mean 12 vs 9 mm Hg [P = .04], respectively). No independent predictor of advanced liver fibrosis was found in multivariate analysis. CONCLUSIONS TE and the ELF score were unable to predict the degree of liver fibrosis in Fontan patients. Liver biopsy remains as the only valid method to assess fibrotic burden in this population.
Collapse
|
12
|
Roeb E, Canbay A, Bantel H, Bojunga J, de Laffolie J, Demir M, Denzer UW, Geier A, Hofmann WP, Hudert C, Karlas T, Krawczyk M, Longerich T, Luedde T, Roden M, Schattenberg J, Sterneck M, Tannapfel A, Lorenz P, Tacke F. Aktualisierte S2k-Leitlinie nicht-alkoholische Fettlebererkrankung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – April 2022 – AWMF-Registernummer: 021–025. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:1346-1421. [PMID: 36100202 DOI: 10.1055/a-1880-2283] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- E Roeb
- Gastroenterologie, Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Gießen, Deutschland
| | - A Canbay
- Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Deutschland
| | - H Bantel
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - J Bojunga
- Medizinische Klinik I Gastroent., Hepat., Pneum., Endokrin., Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - J de Laffolie
- Allgemeinpädiatrie und Neonatologie, Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Gießen und Marburg, Gießen, Deutschland
| | - M Demir
- Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Charité Mitte, Berlin, Deutschland
| | - U W Denzer
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg, Marburg, Deutschland
| | - A Geier
- Medizinische Klinik und Poliklinik II, Schwerpunkt Hepatologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - W P Hofmann
- Gastroenterologie am Bayerischen Platz - Medizinisches Versorgungszentrum, Berlin, Deutschland
| | - C Hudert
- Klinik für Pädiatrie m. S. Gastroenterologie, Nephrologie und Stoffwechselmedizin, Charité Campus Virchow-Klinikum - Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Karlas
- Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - M Krawczyk
- Klinik für Innere Medizin II, Gastroent., Hepat., Endokrin., Diabet., Ern.med., Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - T Longerich
- Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - T Luedde
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Roden
- Klinik für Endokrinologie und Diabetologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - J Schattenberg
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - M Sterneck
- Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | - A Tannapfel
- Institut für Pathologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - P Lorenz
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - F Tacke
- Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Charité Mitte, Berlin, Deutschland
| | | |
Collapse
|
13
|
Updated S2k Clinical Practice Guideline on Non-alcoholic Fatty Liver Disease (NAFLD) issued by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) - April 2022 - AWMF Registration No.: 021-025. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:e733-e801. [PMID: 36100201 DOI: 10.1055/a-1880-2388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
|
14
|
Ehman RL. Magnetic resonance elastography: from invention to standard of care. Abdom Radiol (NY) 2022; 47:3028-3036. [PMID: 35852570 PMCID: PMC9538645 DOI: 10.1007/s00261-022-03597-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 01/18/2023]
Abstract
In 1995, a vivid image of diffracting waves in red and blue was published on the cover of the journal SCIENCE. An article in that issue described a new imaging technology called magnetic resonance elastography (MRE) (Muthupillai in Science 269:1854-1857, 1995). In 2004, quantitative images of liver stiffness in vivo, obtained with MRE, were demonstrated for the first time at the annual meeting of the International Society for Magnetic Resonance in Medicine. Only five years later, the technology had become widely available as an FDA-cleared diagnostic tool for patient care. MRE has emerged as a reliable non-invasive diagnostic method for detecting and staging liver fibrosis. Deployed on more than 2000 MRI systems worldwide, MRE has received a Category I CPT code from the American Medical Association, based on clinical availability and efficacy. For many patients, MRE now provides a safe, more comfortable, and much less expensive alternative to liver biopsy for diagnosing liver fibrosis. Although progress in radiology is notable for a history of very rapid translation of technology innovations to patient care, the path is rarely linear. This article reflects on the story of MRE, the advances and the setbacks, and the lessons that were learned in the process.
Collapse
|
15
|
Huang K, Li Q, Zeng W, Chen X, Liu L, Wan X, Feng C, Li Z, Liu Z, Dong C. Ultrasound score combined with liver stiffness measurement by sound touch elastography for staging liver fibrosis in patients with chronic hepatitis B: a clinical prospective study. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:271. [PMID: 35434021 PMCID: PMC9011233 DOI: 10.21037/atm-22-505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/16/2022] [Indexed: 11/06/2022]
Abstract
Background A noninvasive and precise diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB) is crucial for establishing the optimal time and strategy of therapy and for predicting treatment response. This study aimed to assess the diagnostic performance of ultrasound (US) score and liver stiffness measurement (LSM) of sound touch elastography (STE) in diagnosing liver fibrosis stages and to investigate whether combining these methods would improve liver fibrosis staging. Methods US and STE examinations were performed in CHB patients included. Liver biopsy was used as a reference standard. A diagnostic marker with the optimal linear combination (LC) of US score and LSM of STE, namely LC marker, was established for noninvasive assessment of liver fibrosis stages. The diagnostic performance of the LC marker was evaluated by using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). Results A total of 291 subjects, including 242 patients with CHB and 49 healthy volunteers, were included. Correlation analysis showed that the correlation of liver fibrosis stages to the LC marker (Spearman's r=0.846, P<0.001) was higher than that of LSM (r=0.771, P<0.001) or US score (r=0.825, P<0.001) alone. The results showed that the overall diagnostic performance of the LC marker in predicting a fibrosis stage of ≥F1, ≥F2, ≥F3, and =F4 {AUCs: 0.943 [95% confidence interval (CI): 0.917-0.948], 0.906 (0.871-0.915), 0.953 (0.923-0.969), and 0.961 (0.922-0.973), respectively} were better than those of the US score [AUCs: 0.916 (0.883-0.948, P=0.014), 0.875 (0.835-0.915, P<0.001), 0.934 (0.898-0.969, P=0.001), and 0.918 (0.864-0.973, P<0.001), respectively] or LSM [AUCs: 0.858 (0.812-0.948, P<0.001), 0.867 (0.826-0.915, P=0.006), 0.930 (0.894-0.969, P<0.023), and 0.958 (0.918-0.973, P=0.778), respectively]. Conclusions The LC marker with the optimal combination of LSM and US score may be considered as a promising diagnostic model for noninvasive staging of liver fibrosis.
Collapse
Affiliation(s)
- Kun Huang
- National Clinical Research Center for Infectious Disease, Department of Ultrasound, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Qinyuan Li
- Ultrasound Imaging Department, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Weimei Zeng
- First Medical College of Guangdong Medical University, Zhanjiang, China
| | - Xin Chen
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Li Liu
- Shenzhen Research Institute of Big Data, the Chinese University of Hong Kong, Shenzhen, China
| | - Xiang Wan
- Shenzhen Research Institute of Big Data, the Chinese University of Hong Kong, Shenzhen, China
| | - Cheng Feng
- National Clinical Research Center for Infectious Disease, Department of Ultrasound, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Zhiyan Li
- National Clinical Research Center for Infectious Disease, Department of Ultrasound, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Zhong Liu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Changfeng Dong
- National Clinical Research Center for Infectious Disease, Department of Ultrasound, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| |
Collapse
|
16
|
Qi S, Li J, He X, Zhou J, Chen Z, Li X, Zhang B, Ma H, You H, Huang J. Identification and Validation of Novel Serum Autoantibodies Biomarkers for Staging Liver Fibrosis in Patients With Chronic Hepatitis B. Front Med (Lausanne) 2022; 8:807087. [PMID: 35059422 PMCID: PMC8764302 DOI: 10.3389/fmed.2021.807087] [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: 11/01/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: Liver fibrosis monitoring is essential in patients with chronic hepatitis B (CHB). However, less robust, noninvasive diagnostic methods for staging liver fibrosis, other than liver biopsy, are available. Our previous study demonstrated a panel of cellular proteins recognized by autoantibodies that may have potential value in discrimination of CHB and liver cirrhosis. We aim to assess the diagnostic value of these serum autoantibodies for staging liver fibrosis. Methods: Candidate autoantigens were screened and assessed by microarray analysis in 96 healthy controls and 227 CHB patients with pre-treatment biopsy-proven METAVIR fibrosis score, comprising 69, 115, and 43 cases with S0-1, S2-3, and S4 stages, respectively. Autoantibodies with potential diagnostic value for staging liver fibrosis were verified by enzyme-linked immunosorbent assays (ELISA). Receiver operating characteristic curve was conducted to evaluate autoantibody performance. Results: Microarray analysis identified autoantigens CENPF, ACY1, HSPA6, and ENO1 with potential diagnostic value for liver fibrosis staging, among which CENPF and ACY1 were validated using ELISA. CENPF and ACY1 autoantibodies had area under the curve values of 0.746 and 0.685, 58.14 and 74.42% sensitivity, and 88.41 and 60.87% specificity, respectively, for discriminating liver fibrosis stages S4 and S0-1. The prevalence of CENPF and ACY1 autoantibodies was not correlated with age, sex or level of inflammation. Conclusions: Autoimmune responses may be elicited during progression of liver fibrosis, and serum autoantibodies may be a valuable biomarker for staging liver fibrosis deserving of further study.
Collapse
Affiliation(s)
- Saiping Qi
- Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Healthcare Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaomin He
- Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jialing Zhou
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhibin Chen
- Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaojin Li
- Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bei Zhang
- Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong Ma
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong You
- Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian Huang
- Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
17
|
Manusov EG, Diego VP, Sheikh K, Laston S, Blangero J, Williams-Blangero S. Non-alcoholic Fatty Liver Disease and Depression: Evidence for Genotype × Environment Interaction in Mexican Americans. Front Psychiatry 2022; 13:936052. [PMID: 35845438 PMCID: PMC9283683 DOI: 10.3389/fpsyt.2022.936052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
This study examines the impact of G × E interaction effects on non-alcoholic fatty liver disease (NAFLD) among Mexican Americans in the Rio Grande Valley (RGV) of South Texas. We examined potential G × E interaction using variance components models and likelihood-based statistical inference in the phenotypic expression of NAFLD, including hepatic steatosis and hepatic fibrosis (identified using vibration controlled transient elastography and controlled attenuation parameter measured by the FibroScan Device). We screened for depression using the Beck Depression Inventory-II (BDI-II). We identified significant G × E interactions for hepatic fibrosis × BDI-II. These findings provide evidence that genetic factors interact with depression to influence the expression of hepatic fibrosis.
Collapse
Affiliation(s)
- Eron Grant Manusov
- Department of Human Genetics, The University of Texas Rio Grande Valley, Brownsville, TX, United States.,School of Medicine, South Texas Diabetes and Obesity Institute, The University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Vincent P Diego
- Department of Human Genetics, The University of Texas Rio Grande Valley, Brownsville, TX, United States.,School of Medicine, South Texas Diabetes and Obesity Institute, The University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Khalid Sheikh
- School of Medicine, The University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Sandra Laston
- Department of Human Genetics, The University of Texas Rio Grande Valley, Brownsville, TX, United States.,School of Medicine, South Texas Diabetes and Obesity Institute, The University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - John Blangero
- Department of Human Genetics, The University of Texas Rio Grande Valley, Brownsville, TX, United States.,School of Medicine, South Texas Diabetes and Obesity Institute, The University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Sarah Williams-Blangero
- Department of Human Genetics, The University of Texas Rio Grande Valley, Brownsville, TX, United States.,School of Medicine, South Texas Diabetes and Obesity Institute, The University of Texas Rio Grande Valley, Brownsville, TX, United States
| |
Collapse
|
18
|
Mingkai L, Sizhe W, Xiaoying W, Ying L, Wu B. OUP accepted manuscript. Gastroenterol Rep (Oxf) 2022; 10:goac005. [PMID: 35186298 PMCID: PMC8849285 DOI: 10.1093/gastro/goac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to assess the performance of transient elastography (TE), two-dimensional shear wave elastography (2D-SWE), and magnetic resonance elastography (MRE) for staging significant fibrosis and cirrhosis in untreated chronic hepatitis B (CHB) patients. Methods Pubmed, Embase, Web of Science, and Cochrane Library were searched for terms involving CHB, TE, 2D-SWE, and MRE. Other etiologies of chronic liver disease, previous treatment in patients, or articles not published in SCI journals were excluded. Hierarchical non-linear models were used to evaluate the diagnostic accuracy of TE, 2D-SWE, and MRE. Heterogeneity was explored via analysis of threshold effect and meta-regression. Results Twenty-eight articles with a total of 4,540 untreated CHB patients were included. The summary areas under the receiver-operating characteristic curves (AUROCs) using TE, 2D-SWE, and MRE for predicting significant fibrosis (SF) were 0.84, 0.89, and 0.99, respectively. The AUROC values of TE, 2D-SWE, and MRE for staging cirrhosis were 0.9, 0.94, and 0.99, respectively. Based on the meta-analysis of studies with head-to-head comparison, 2D-SWE is superior to TE (0.92 vs 0.85, P < 0.01) in staging significant fibrosis. Conclusion TE, 2D-SWE, and MRE express acceptable diagnostic accuracies in staging significant fibrosis and cirrhosis in untreated CHB patients. 2D-SWE outperforms TE in detecting significant fibrosis in treatment-naive people with hepatitis B virus.
Collapse
Affiliation(s)
- Li Mingkai
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, P. R. China
| | - Wan Sizhe
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, P. R. China
| | - Wu Xiaoying
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, P. R. China
| | - Lin Ying
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
| | - Bin Wu
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, P. R. China
- Corresponding author. Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong 510630, P. R. China. Tel: +86-20-85253333; Fax: +86-20-85253336;
| |
Collapse
|
19
|
Non-invasive diagnosis and follow-up of non-alcoholic fatty liver disease. Clin Res Hepatol Gastroenterol 2022; 46:101769. [PMID: 34332133 DOI: 10.1016/j.clinre.2021.101769] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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
NAFLD is a frequent disease that affects 25% of the worldwide population. There is no specific diagnostic test for NAFLD, and the diagnosis mainly relies on the elimination of the other causes of chronic liver diseases with liver biopsy kept for unsure diagnoses. Non-invasive tests are now available to assess NAFLD severity and therefore to help physicians decide on the patient management and follow-up. These non-invasive tests can also be used to define pathways that organize referrals from primary care and diabetology clinics to the liver specialist, with the ambition to improve the screening of asymptomatic patients with NAFLD and advanced liver disease. NAFLD being the liver expression of the metabolic syndrome, physicians need also take care to screen for diabetes and to evaluate the cardiovascular risk in those patients. These recommendations from the French Association for the Study of the Liver (AFEF) aim at providing guidance on the following questions: how to diagnose NAFLD; how non-invasive tests should be used to assess NAFLD severity; how to follow patients with NAFLD; when to perform liver biopsy in NAFLD; and how to decide referral to the liver specialist for a patient with NAFLD.
Collapse
|
20
|
Huang DQ, Nguyen MH. Cost-effectiveness of HCC surveillance among HCV patients after sustained virological response with direct-acting antivirals. Liver Int 2021; 41:3036-3037. [PMID: 34587343 DOI: 10.1111/liv.15072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Daniel Q Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
21
|
Dong B, Lyu G, Chen Y, Lin G, Wang H, Qin R, Gu J. Comparison of two-dimensional shear wave elastography, magnetic resonance elastography, and three serum markers for diagnosing fibrosis in patients with chronic hepatitis B: a meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:1077-1089. [PMID: 33487039 DOI: 10.1080/17474124.2021.1880894] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Two-dimensional shear wave elastography (2D-SWE), magnetic resonance elastography (MRE), aspartate transaminase-to-platelet ratio index (APRI), fibrosis index based on 4 factors (FIB-4), and King's score have been proposed for diagnosing fibrosis. METHODS Literature databases were searched until October 1st, 2020. The summary area under the receiver operating characteristic curve (AUROC), the summary diagnostic odds ratios, and the summary sensitivities and specificities were used to assess the performance of these noninvasive methods for staging fibrosis. RESULTS Our final data contained 72 studies. The prevalence of significant fibrosis, advanced fibrosis, and cirrhosis was 58.3%, 36.2%, and 20.5%, respectively, in chronic hepatitis B (CHB). For 2D-SWE and MRE, the summary AUROCs were 0.89 and 0.97, 0.95 and 0.97, and 0.94 and 0.97 for significant fibrosis, advanced fibrosis, and cirrhosis, respectively. The summary AUROCs using APRI and FIB-4 for detecting significant fibrosis, advanced fibrosis, and cirrhosis were 0.76 and 0.75, 0.74 and 0.77, and 0.77 and 0.82, respectively. The summary AUROCs of King's score for detecting significant fibrosis and cirrhosis were 0.77 and 0.83, respectively. CONCLUSION MRE and 2D-SWE may show the best diagnostic accuracy for predicting fibrosis in CHB. Among the three serum markers, King's score may be more useful for diagnosing fibrosis.
Collapse
Affiliation(s)
- Bingtian Dong
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Guorong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.,Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, Fujian Province, China
| | - Yuping Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Guofu Lin
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Respirology Medicine Centre of Fujian Province, Quanzhou, Fujian Province, China
| | - Huaming Wang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Ran Qin
- Department of Ultrasound, The Chenggong Hospital, Xiamen University, Xiamen, Fujian Province, China
| | - Jionghui Gu
- Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| |
Collapse
|
22
|
Shi Y, Qi YF, Lan GY, Wu Q, Ma B, Zhang XY, Ji RY, Ma YJ, Hong Y. Three-dimensional MR Elastography Depicts Liver Inflammation, Fibrosis, and Portal Hypertension in Chronic Hepatitis B or C. Radiology 2021; 301:154-162. [PMID: 34374594 DOI: 10.1148/radiol.2021202804] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The value of measuring mechanical properties to categorize various pathophysiologic states of the liver is as yet undetermined in chronic hepatitis B (CHB) or C (CHC). Purpose To evaluate multiparametric three-dimensional (3D) MR elastography as a means of detecting early necroinflammation, distinguishing necroinflammation from fibrosis, and gauging the severity of portal hypertension (PH) in CHB or CHC. Materials and Methods From January 2015 to September 2019, participants with CHB or CHC were prospectively enrolled from a single institution and were divided into two groups: those with liver biopsy and no evidence of PH (group 1) and those with PH and a hepatic venous pressure gradient (HVPG) measurement (group 2). For group 3, healthy volunteers were separately recruited from a nearby community. Multiple viscoelastic parameters (shear stiffness [SS], storage modulus, loss modulus, and damping ratio [DR]) were determined at 3D MR elastography at 60 Hz, and multivariable logistic or linear regression analysis was used to assess associations of mechanical parameters with histologic scores and HVPG. Results A total of 155 participants (median age, 41 years [interquartile range, 32-48 years]; 85 women) were in group 1 (training set: n = 78, validation set: n = 77), 85 participants (median age, 57 years [interquartile range, 43-61 years]; 51 women) in group 2, and 60 healthy volunteers (median age, 49 years [interquartile range, 27-64 years]; 38 men) in group 3. The liver DR was higher in participants with necroinflammation (DR, 0.13 ± 0.03) versus those without (at liver fibrosis stage F0) (DR, 0.10 ± 0.02; P < .001). Liver DR and SS together performed well in the diagnosis of necroinflammation (area under the receiver operating characteristic curve [AUC], 0.88 [95% CI: 0.79, 0.96]) and the scoring of moderate to severe activity (AUC, 0.88 [95% CI: 0.81, 0.95]) in the validation data set. Liver DR (regression coefficient [β] = -30.3 [95% CI: -58.0, -2.5]; P = .03) and splenic SS (β = 2.3 [95% CI: 1.7, 2.9]; P < .001) were independently associated with HVPG. Conclusion Three-dimensional MR elastography may detect early necroinflammation, distinguish necroinflammation from liver fibrosis, and correlate with hepatic venous pressure gradient in chronic hepatitis B and C. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Reeder in this issue.
Collapse
Affiliation(s)
- Yu Shi
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Ya-Fei Qi
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Gong-Yu Lan
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Qijun Wu
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Bing Ma
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Xian-Yi Zhang
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Ruo-Yun Ji
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Yu-Jia Ma
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Yang Hong
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| |
Collapse
|
23
|
Predicting the stages of liver fibrosis with multiphase CT radiomics based on volumetric features. Abdom Radiol (NY) 2021; 46:3866-3876. [PMID: 33751193 DOI: 10.1007/s00261-021-03051-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 12/14/2022]
Abstract
PURPOSES To develop and externally validate a multiphase computed tomography (CT)-based machine learning (ML) model for staging liver fibrosis (LF) by using whole liver slices. MATERIALS AND METHODS The development dataset comprised 232 patients with pathological analysis for LF, and the test dataset comprised 100 patients from an independent outside institution. Feature extraction was performed based on the precontrast (PCP), arterial (AP), portal vein (PVP) phase, and three-phase CT images. CatBoost was utilized for ML model investigation by using the features with good reproducibility. The diagnostic performance of ML models based on each single- and three-phase CT image was compared with that of radiologists' interpretations, the aminotransferase-to-platelet ratio index, and the fibrosis index based on four factors (FIB-4) by using the receiver operating characteristic curve with the area under the curve (AUC) value. RESULTS Although the ML model based on three-phase CT image (AUC = 0.65-0.80) achieved higher AUC value than that based on PCP (AUC = 0.56-0.69) and PVP (AUC = 0.51-0.74) in predicting various stage of LF, significant difference was not found. The best CT-based ML model (AUC = 0.65-0.80) outperformed the FIB-4 in differentiating advanced LF and cirrhosis and radiologists' interpretation (AUC = 0.50-0.76) in the diagnosis of significant and advanced LF. CONCLUSION All PCP, PVP, and three-phase CT-based ML models can be an acceptable in assessing LF, and the performance of the PCP-based ML model is comparable to that of the enhanced CT image-based ML model.
Collapse
|
24
|
Clinical significance of small molecule metabolites in the blood of patients with different types of liver injury. Sci Rep 2021; 11:11642. [PMID: 34079030 PMCID: PMC8172926 DOI: 10.1038/s41598-021-91164-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/13/2021] [Indexed: 01/30/2023] Open
Abstract
To understand the characteristic of changes of serum metabolites between healthy people and patients with hepatitis B virus (HBV) infection at different stages of disease, and to provide reference metabolomics information for clinical diagnosis of liver disease patients. 255 patients with different stages of HBV infection were selected. 3 mL blood was collected from each patient in the morning to detect differences in serum lysophosphatidylcholine, acetyl-l-carnitine, oleic acid amide, and glycocholic acid concentrations by UFLC-IT-TOF/MS. The diagnostic values of four metabolic substances were evaluated by receiver operating characteristic (ROC) curve. The results showed that the optimal cut-off value of oleic acid amide concentration of the liver cirrhosis and HCC groups was 23.6 mg/L, with a diagnostic sensitivity of 88.9% and specificity of 70.6%. The diagnostic efficacies of the three substances were similar in the hepatitis and HCC groups, with an optimal cut-off value of 2.04 mg/L, and a diagnostic sensitivity and specificity of 100% and 47.2%, respectively. The optimal cut-off value of lecithin of the HBV-carrier and HCC groups was 132.85 mg/L, with a diagnostic sensitivity and specificity of 88.9% and 66.7%, respectively. The optimal cut-off value of oleic acid amide of the healthy and HCC groups was 129.03 mg/L, with a diagnostic sensitivity and specificity of 88.4% and 83.3%, respectively. Lysophosphatidylcholine, acetyl-l-carnitine, and oleic acid amide were potential metabolic markers of HCC. Among them, lysophosphatidylcholine was low in the blood of HCC patients, and its diagnostic efficacy was better than that of acetyl-l-carnitine and oleic acid amide, providing reference metabolomics information in clinical diagnosis and future research.
Collapse
|
25
|
Dong BT, Huang S, Lyu GR, Qin R, Gu JH. Assessment of liver fibrosis with liver and spleen stiffness measured by sound touch elastography, serum fibrosis markers in patients with chronic hepatitis B. J Dig Dis 2021; 22:342-350. [PMID: 33851510 DOI: 10.1111/1751-2980.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the performance of liver stiffness (LS) and spleen stiffness (SS) by using the sound touch elastography (STE) technique and compare with those of the splenic index, aspartate transaminase-to-platelet ratio index (APRI), fibrosis-4 (FIB-4) index, King's score and combined models for diagnosing and staging fibrosis in chronic hepatitis B (CHB). METHODS One hundred patients with CHB underwent STE and serological tests. LS and SS values were measured with STE technique, and splenic index was calculated. Staging of fibrosis was determined with liver biopsy. Correlations between the individual parameters and the stage of fibrosis were evaluated with the Spearman correlation analysis. The area under the receiver operating characteristic curve (AUROC) was calculated to analyze the performance of all methods. RESULTS Among all individual parameters, LS showed the highest AUROC for diagnosing fibrosis of ≥S2, ≥S3, and S4 stages (AUROC: 0.70, 0.86, and 0.96, respectively; all P < 0.05). The AUROC of combined model 1 (LS and SS) and 2 (LS, SS, APRI, FIB-4 index, King's score) for diagnosing ≥S2, ≥S3, and S4 fibrosis were 0.70, 0.86, 0.97, and 0.70, 0.86, 0.96, respectively, which were higher than those of APRI, FIB-4 index and the King's score (P < 0.05). No significant differences were found between two combined models and LS for staging fibrosis (P > 0.05). CONCLUSIONS LS measurement is reliable for diagnosing and staging fibrosis in CHB, with a better performance than SS, splenic index and serum biomarkers. It is also comparable with the performance of combined models.
Collapse
Affiliation(s)
- Bing Tian Dong
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Shu Huang
- Department of Ultrasound, Chenggong Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
| | - Guo Rong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Ran Qin
- Department of Ultrasound, Chenggong Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
| | - Jiong Hui Gu
- Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| |
Collapse
|
26
|
Jiang H, Fowler KJ, Bashir MR. The Varied Modalities of Liver Elastography and How Each Fits Into a Hepatology Practice. Clin Liver Dis (Hoboken) 2021; 17:326-329. [PMID: 33968398 PMCID: PMC8087904 DOI: 10.1002/cld.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Hanyu Jiang
- Department of RadiologyWest China HospitalSichuan UniversityChengduSichuanChina,Department of Radiology and Center for Advanced Magnetic Resonance DevelopmentDuke University Medical CenterDurhamNC
| | - Kathryn J. Fowler
- Liver Imaging GroupDepartment of RadiologyUniversity of California San DiegoSan DiegoCA
| | - Mustafa R. Bashir
- Department of Radiology and Center for Advanced Magnetic Resonance DevelopmentDuke University Medical CenterDurhamNC,Department of Medicine (Gastroenterology)Duke University Medical CenterDurhamNC
| |
Collapse
|
27
|
Li Z, Cao H, Yao M, Lei X. Effect of acupuncture combined with Shenqi Yigan Decoction on liver function and T cell subsets in patients with HBV-induced liver fibrosis. Am J Transl Res 2021; 13:3409-3417. [PMID: 34017516 PMCID: PMC8129288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the effect of acupuncture combined with Shenqi Yigan Decoction on liver function and T cell subsets in patients with Hepatitis B virus-induced liver fibrosis. METHODS All of the 90 patients with HBV-induced liver fibrosis were divided into two groups with the control group (n=45) treated with the conventional treatment, and the observation group (n=45) treated with acupuncture and Shenqi Yigan decoction based on the observation group. The seroconversion rate of hepatitis Be antigen (HBeAg), the liver function, the serum indexes of liver fibrosis of hyaluronic acid (HA), laminin (LN), type III procollagen (PC III), type IV collagen (IV-C), the T cell subsets and the inflammatory factors were compared between the two groups. RESULTS After 2 and 4 months of treatment, the HBeAg seroconversion rate of patients in the observation group was higher than that of the control group, but the difference was not significant (P>0.05). And the HBeAg seroconversion rate of patients in the observation group was significantly higher than that of the control group after 6 months treatment (P<0.05). After treatment, the serum levels of the liver function index of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (Tbil), the liver fibrosis index of HA, LN, PC III, and the inflammatory factor of type IV collagen (IV-C), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in the two groups were lower than those before treatment, in addition, the levels of there index were lower in the observation group (all P<0.05). After treatment, the proportion of CD3+, CD4+ T lymphocyte subsets and CD4+/CD8+ in peripheral blood of the two groups were increased, and the proportion of CD8+ was decreased. The change range of the observation group was larger than that of the observation group (all P<0.01). The proportion of patients with liver fibrosis grade F1 in the observation group after treatment was significantly higher than that before treatment, and the proportion of patients with liver fibrosis grade F2 to F3 was significantly lower than that before treatment. There was a significant difference in liver fibrosis grade between the two groups after treatment (P<0.05). CONCLUSION The combined treatment of acupuncture and Shenqi Yigan decoction can significantly improve the liver function of patients with HBV-induced liver fibrosis, delay the progress of liver fibrosis, improve the cellular immune function and reduce the inflammatory reaction.
Collapse
Affiliation(s)
- Zonglin Li
- Department of Traditional Chinese Medicine, Affiliated Hospital of North Sichuan Medical CollegeNanchong, Sichuan Province, China
| | - Hongchun Cao
- Department of Traditional Chinese Medicine, Affiliated Hospital of North Sichuan Medical CollegeNanchong, Sichuan Province, China
| | - Ming Yao
- First Department of Internal Medicine, Nanchong Hospital of Traditional Chinese MedicineNanchong, Sichuan Province, China
| | - Xiao Lei
- Department of Traditional Chinese Medicine, Affiliated Hospital of North Sichuan Medical CollegeNanchong, Sichuan Province, China
| |
Collapse
|
28
|
Serai SD, Panganiban J, Dhyani M, Degnan AJ, Anupindi SA. Imaging Modalities in Pediatric NAFLD. Clin Liver Dis (Hoboken) 2021; 17:200-208. [PMID: 33868666 PMCID: PMC8043697 DOI: 10.1002/cld.994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Suraj D. Serai
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA,Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Jennifer Panganiban
- Department of Gastroenterology, Hepatology and NutritionThe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Manish Dhyani
- Department of RadiologyLahey Hospital and Medical CenterBurlingtonMA
| | - Andrew J. Degnan
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Sudha A. Anupindi
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA,Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| |
Collapse
|
29
|
Nah EH, Cho S, Kim S, Chu J, Kwon E, Cho HI. Prevalence of liver fibrosis and associated risk factors in the Korean general population: a retrospective cross-sectional study. BMJ Open 2021; 11:e046529. [PMID: 33762246 PMCID: PMC7993338 DOI: 10.1136/bmjopen-2020-046529] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The health burden of chronic liver disease is increasing worldwide. Its main histological consequence is liver fibrosis, and eventually cirrhosis. This process is rarely diagnosed at the pre-cirrhotic stage due to it being asymptomatic. Little is known about the prevalence of liver fibrosis and associated risk factors in the general population. The aims of this study were to determine the prevalence and distribution of liver fibrosis using magnetic resonance elastography (MRE), as well as the risk factors associated with liver fibrosis in the asymptomatic general population. DESIGN, SETTING AND PARTICIPANTS This cross-sectional retrospective study consecutively selected subjects who underwent health check-ups including MRE at 13 health promotion centres in Korea between 2018 and 2020. Liver fibrosis was estimated using MRE with cut-off values for significant and advanced liver fibrosis of 2.90 and 3.60 kPa, respectively. PRIMARY AND SECONDARY OUTCOME MEASURES The Χ2 test was used to compare the prevalence of liver fibrosis according to sex and age groups. Multivariable logistic regression analyses were performed to identify the factors for significant and advanced liver fibrosis. RESULTS Among the 8183 subjects, 778 (9.5%) had ≥significant fibrosis (≥2.9 kPa), which included 214 (2.6%) subjects with ≥advanced fibrosis (≥3.6 kPa). Multivariable analysis revealed that liver fibrosis was associated with age (OR=1.34, 95% CI=1.18 to 1.51), male sex (OR=3.18, 95% CI=1.97 to 5.13), diabetes (OR=2.43, 95% CI=1.8 to 3.28), HBsAg positivity (OR=3.49, 95% CI=2.55 to 4.79), abnormal liver function test (OR=1.9, 95% CI=1.49 to 2.42) and obesity (OR=1.77, 95% CI=1.35 to 2.32) (all p<0.001), as well as metabolic syndrome (OR=1.4, 95% CI=1.05 to 1.87) (p=0.024). CONCLUSIONS The prevalence of significant or more liver fibrosis was high in the Korean general population and much higher among individuals with risk factors. This suggests that screening of liver fibrosis should be considered in general population, especially among high-risk groups.
Collapse
Affiliation(s)
- Eun-Hee Nah
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Seon Cho
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Suyoung Kim
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Jieun Chu
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Eunjoo Kwon
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Han-Ik Cho
- MEDIcheck LAB, Korea Association of Health Promotion, Seoul, South Korea
| |
Collapse
|
30
|
Zhou X, Rao J, Wu X, Deng R, Ma Y. Comparison of 2-D Shear Wave Elastography and Point Shear Wave Elastography for Assessing Liver Fibrosis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:408-427. [PMID: 33342618 DOI: 10.1016/j.ultrasmedbio.2020.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
Progressive liver fibrosis may result in cirrhosis, portal hypertension and increased risk of hepatocellular carcinoma. We performed a meta-analysis to compare liver fibrosis staging in chronic liver disease patients using 2-D shear wave elastography (2-D SWE) and point shear wave elastography (pSWE). The PubMed, Web of Science and Cochrane Library databases were searched until May 31, 2020 for studies evaluating the diagnostic performance of 2-D SWE and pSWE in assessing liver fibrosis. Pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios and area under receiver operating characteristic curve were estimated using the bivariate random effects model. As a result, 71 studies with 11,345 patients were included in the analysis. The pooled sensitivities of 2-D SWE and pSWE significantly differed for the detection of significant fibrosis (F ≥ 2; 0.84 vs. 0.76, p < 0.001) and advanced fibrosis (F ≥ 3; 0.90 vs. 0.83, p = 0.003), but not for detection of cirrhosis (F = 4; 0.89 vs. 0.85, p = 0.090). The pooled specificities of 2-D SWE and pSWE did not significantly differ for detection of F ≥ 2 (0.81 vs. 0.79, p = 0.753), F ≥ 3 (0.87 vs. 0.83, p = 0.163) or F = 4 (0.87 vs. 0.84, p = 0.294). Both 2-D SWE and pSWE have high sensitivity and specificity for detecting each stage of liver fibrosis. Two-dimensional SWE has higher sensitivity than pSWE for detection of significant fibrosis and advanced fibrosis.
Collapse
Affiliation(s)
- Xiaozhuan Zhou
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiawei Rao
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xukun Wu
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ronghai Deng
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yi Ma
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
31
|
Role of Noninvasive Tests in Clinical Gastroenterology Practices to Identify Patients With Nonalcoholic Steatohepatitis at High Risk of Adverse Outcomes: Expert Panel Recommendations. Am J Gastroenterol 2021; 116:254-262. [PMID: 33284184 DOI: 10.14309/ajg.0000000000001054] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is generally considered a silent and potentially reversible condition. The subtype of NAFLD that can be classified as nonalcoholic steatohepatitis (NASH) can progress to advanced fibrosis and cirrhosis. Because of the metabolic nature of the pathogenic mechanism underlying NAFLD and NASH, it is often accompanied by common comorbidities such as obesity, insulin resistance, and type 2 diabetes mellitus. The increase in the prevalence of these comorbidities has resulted in a parallel increase in the prevalence of NAFLD and NASH, globally, nationally, and even in children. In recent years, it has been identified that the stage of fibrosis is the most important predictor of liver outcomes; therefore, identifying patients with NAFLD and NASH with more advanced stages of fibrosis can be essential for optimal management. Several noninvasive tools for diagnosing and staging NAFLD and NASH are available, but simple and straightforward recommendations on the use of these tools are not. Recognizing these unmet needs, hepatologists who are members of the American College of Gastroenterology and the Chronic Liver Disease Foundation created a practical decision tree/algorithm to risk stratify NAFLD/NASH as a resource in gastroenterology/hepatology clinical practices. This review will provide insight into how this algorithm was developed, describe it in detail, and provide recommendations for its use in clinical practice.
Collapse
|
32
|
Gomes NBN, Torres US, Ferraz MLCG, D'Ippolito G. Autoimmune hepatitis in practice, from diagnosis to complications: What is the role of imaging? A clinicoradiological review. Clin Imaging 2021; 74:31-40. [PMID: 33429144 DOI: 10.1016/j.clinimag.2020.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/19/2020] [Accepted: 12/28/2020] [Indexed: 12/12/2022]
Abstract
Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease of unknown origin that can lead to liver cirrhosis, hepatocellular carcinoma (HCC), liver transplantation or death. The diagnosis is performed upon a multifactorial score. Treatment is based on the combination of immunosuppressants and aims at clinical, laboratory and histological remission, the latter being the most difficult to be achieved and proven. The absence of liver inflammation, defined by biopsy, is the main determinant in remission or therapeutic modification. Imaging exams have a limited role in this clinical management and the main findings are those related to chronic liver disease. Imaging's relevance, therefore, lies mainly in helping to exclude overlapping syndromes and in assessing complications related to cirrhosis, such as in screening for HCC. In recent years, however, the radiological literature has been witnessing increasing advances with regard to imaging biomarkers in liver disease, leading some authors to consider a future of virtual liver biopsy performed by magnetic resonance imaging. The present study aims to review the role of imaging in the management of AIH in the light of recent advances in the current literature and to provide an illustrated guide with the main findings described in the disease.
Collapse
Affiliation(s)
- Natália Borges Nunes Gomes
- Fleury Group, São Paulo, Brazil; Department of Diagnostic Imaging, Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ulysses S Torres
- Fleury Group, São Paulo, Brazil; Department of Diagnostic Imaging, Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | | | - Giuseppe D'Ippolito
- Fleury Group, São Paulo, Brazil; Department of Diagnostic Imaging, Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
33
|
Jiang K, Mohammad MK, Dar WA, Kong J, Farris AB. Quantitative assessment of liver fibrosis by digital image analysis reveals correlation with qualitative clinical fibrosis staging in liver transplant patients. PLoS One 2020; 15:e0239624. [PMID: 32986732 PMCID: PMC7521727 DOI: 10.1371/journal.pone.0239624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022] Open
Abstract
Technologies for digitizing tissues provide important quantitative data for liver histopathology investigation. We aimed to assess liver fibrosis degree with quantitative morphometric measurements of histopathological sections utilizing digital image analysis (DIA) and to further investigate if a correlation with histopathologic scoring (Scheuer staging) exists. A retrospective study of patients with at least two post-liver transplant biopsies having a Scheuer stage of ≤ 2 at baseline were gathered. Portal tract fibrotic percentage (%) and size (μm2) were measured by DIA, while clinical fibrosis score was measured by the Scheuer system. Correlations between DIA measurements and Scheuer scores were computed by Spearman correlation analysis. Differences between mean levels of fibrosis (score, size, and percentage) at baseline versus second visit were computed by Student’s t-test. P values < 0.05 were considered significant. Of 22 patients who met the study criteria, 54 biopsies were included for analysis. Average levels ±standard error [S.E.] of portal tract fibrotic percentage (%) and size (μm2) progressed from 46.5 ± 3.6% at baseline to 61.8 ± 3.8% at the second visit (P = 0.005 by Student’s t-test), and from 28,075 ± 3,232 μm2 at base line to 67,146 ± 10,639 μm2 at the second visit (P = 0.002 by Student’s t-test), respectively. Average levels of Scheuer fibrosis scores progressed from 0.55±0.19 at baseline to 1.14±0.26 at the second visit (P = 0.02 by Student’s t-test). Portal tract fibrotic percentage (%) and portal tract fibrotic size were directly correlated with clinical Scheuer fibrosis stage, with Spearman correlation coefficient and P value computed as r = 0.70, P < 0.0001 and r = 0.41, P = 0.002, respectively. Digital quantitative assessment of portal triad size and fibrosis percentage demonstrates a strong correlation with visually assessed histologic stage of liver fibrosis and complements the standard assessment for allograft monitoring, suggesting the utility of future WSI analysis.
Collapse
Affiliation(s)
- Kun Jiang
- Department of Pathology, Emory University, Atlanta, Georgia, United States of America
- Department of Pathology, University of South Florida, Tampa, Florida, United States of America
| | - Mohammad K. Mohammad
- Department of Pathology, Emory University, Atlanta, Georgia, United States of America
| | - Wasim A. Dar
- Department of Surgery, The University of Texas Health Science Center, Houston, Texas, United States of America
| | - Jun Kong
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, United States of America
- Department of Computer Science, Georgia State University, Atlanta, Georgia, United States of America
- Department of Computer Science, Emory University, Atlanta, Georgia, United States of America
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, United States of America
- Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
| | - Alton B. Farris
- Department of Pathology, Emory University, Atlanta, Georgia, United States of America
- Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| |
Collapse
|
34
|
MR elastography of the liver: comparison of three measurement methods. Clin Radiol 2020; 75:715.e1-715.e7. [DOI: 10.1016/j.crad.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
|
35
|
Castro L, García-Mejido JA, Arroyo E, Carrera J, Fernández-Palacín A, Sainz JA. Influence of epidemiological characteristics (age, parity and other factors) in the assessment of healthy uterine cervical stiffness evaluated through shear wave elastography as a prior step to its use in uterine cervical pathology. Arch Gynecol Obstet 2020; 302:753-762. [PMID: 32712928 DOI: 10.1007/s00404-020-05671-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate stiffness changes occurring in the healthy uterine cervix according to age, parity, phase of the menstrual cycle and other factors by shear wave elastography (SWE). METHODS Evaluations of cervical speed and stiffness measurements were performed in 50 non-pregnant patients without gynaecological pathology using SWE transvaginal ultrasound. We performed the evaluation in the midsagittal plane of the uterine cervix with measurements at 0.5, 1 and 1.5 cm from external cervical os, at both anterior and posterior cervical lips. RESULTS We evaluated 44 patients by SWE and obtained a total average velocity of 3.48 ± 1.08 m/s and stiffness of 42.39 ± 25.33 kPa. We found differences in speed and stiffness according to the cervical lip and depth evaluated; thus, we observed a velocity of 2.70 m/s at 0.5 cm of depth in the anterior lip and 3.53 m/s at 1.5 cm of depth in the posterior lip (p < 0.05). We observed differences according to parity, obtaining a wave transmission speed of 2.67 m/s and 4.41 m/s at the cervical canal of nulliparous and multiparous patients, respectively (p < 0 0.002). We observed differences according to patient age (from a speed of 2.75 m/s at the cervical canal in the age group of 20-35 years to 5.05 m/s in the age group > 50 years) (p < 0.008). We did not observe differences in speed or stiffness according to the phase of the menstrual cycle, BMI, smoking status or the presence or absence of non-HPV infections. CONCLUSIONS The wave transmission speed and stiffness of the uterine cervix evaluated by SWE varies according to the cervical lip and depth of the evaluation as well as according to the parity and age of the patient.
Collapse
Affiliation(s)
- Laura Castro
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain.
| | - Eva Arroyo
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - Jara Carrera
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - José Antonio Sainz
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| |
Collapse
|
36
|
Analysis of pathological changes and related factors in liver tissue of HBeAg-negative patients with low HBsAg levels. Clin Exp Med 2020; 20:577-586. [PMID: 32656675 DOI: 10.1007/s10238-020-00645-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
The relationship between pathological changes in liver tissue and the level of hepatitis B surface antigen (HBsAg) remains unclear. This study aimed to analyze the pathological changes in liver tissue and its related factors in patients with low-level HBsAg in order to provide a basis for judging the condition of these patients. A retrospective study was performed on 96 chronic hepatitis B patients with HBsAg levels < 1400 IU/ml and > 0.05 IU/ml. The histopathological examination of these patients was conducted. Univariate and multivariate analyses were used to determine risk factors for pathological changes. Among the 96 patients, 57.3% (55) had inflammatory events ≥ G2 and 33.4% (33) had fibrosis ≥ S2. HBV infection duration (p = 0.001) and splenic vein diameter (p = 0.001) were independent risk factors of liver inflammation (≥ G2) in patients with low-level HBsAg, while AST (p = 0.006) and PLT (p = 0.005) were independent risk factors of liver fibrosis (≥ S2). Moreover, HBV infection duration (p < 0.001) and spleen vein (p = 0.001) were independent factors of potential antiviral treatment. Liver inflammation and fibrosis are still common in patients with low-level HBsAg; thus, the monitoring and appropriate antiviral treatment cannot be ignored.
Collapse
|
37
|
Loomba R, Adams LA. Advances in non-invasive assessment of hepatic fibrosis. Gut 2020; 69:1343-1352. [PMID: 32066623 PMCID: PMC7945956 DOI: 10.1136/gutjnl-2018-317593] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
Liver fibrosis should be assessed in all individuals with chronic liver disease as it predicts the risk of future liver-related morbidity and thus need for treatment, monitoring and surveillance. Non-invasive fibrosis tests (NITs) overcome many limitations of liver biopsy and are now routinely incorporated into specialist clinical practice. Simple serum-based tests (eg, Fibrosis Score 4, non-alcoholic fatty liver disease Fibrosis Score) consist of readily available biochemical surrogates and clinical risk factors for liver fibrosis (eg, age and sex). These have been extensively validated across a spectrum of chronic liver diseases, however, tend to be less accurate than more 'complex' serum tests, which incorporate direct measures of fibrogenesis or fibrolysis (eg, hyaluronic acid, N-terminal propeptide of type three collagen). Elastography methods quantify liver stiffness as a marker of fibrosis and are more accurate than simple serum NITs, however, suffer increasing rates of unreliability with increasing obesity. MR elastography appears more accurate than sonographic elastography and is not significantly impacted by obesity but is costly with limited availability. NITs are valuable for excluding advanced fibrosis or cirrhosis, however, are not sufficiently predictive when used in isolation. Combining serum and elastography techniques increases diagnostic accuracy and can be used as screening and confirmatory tests, respectively. Unfortunately, NITs have not yet been demonstrated to accurately reflect fibrosis change in response to treatment, limiting their role in disease monitoring. However, recent studies have demonstrated lipidomic, proteomic and gut microbiome profiles as well as microRNA signatures to be promising techniques for fibrosis assessment in the future.
Collapse
Affiliation(s)
- Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Epidemiology, University of California at San Diego, La Jolla, California, USA
| | - Leon A Adams
- Medicine and Pharmacology, The University of Western Australia, Nedlands, Western Australia, Australia
| |
Collapse
|
38
|
Jeon SK, Lee JM, Joo I, Yoon JH, Lee DH, Han JK. Two-dimensional Shear Wave Elastography with Propagation Maps for the Assessment of Liver Fibrosis and Clinically Significant Portal Hypertension in Patients with Chronic Liver Disease: A Prospective Study. Acad Radiol 2020; 27:798-806. [PMID: 31494001 DOI: 10.1016/j.acra.2019.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the diagnostic performance of liver stiffness (LS) measurements on two-dimensional (2D) shear wave elastography (SWE) for the assessment of hepatic fibrosis using LS measurements on MR elastography (MRE) as the reference standard and the prediction of clinically significant portal hypertension (CSPH). METHODS In this prospective study, 101 patients with chronic liver disease or cirrhosis underwent both MRE and SWE. After exclusion of technical failure on MRE (n = 5), technical failure/unreliable measurement on SWE (n = 4), LS measurements obtained on SWE with the aid of propagation maps were correlated with those of the MRE using Pearson's correlation analysis. Diagnostic performances for significant fibrosis (≥F2: MRE of ≥2.99 kPa) or cirrhosis (F4: MRE of ≥3.63 kPa) and for the prediction of CSPH were assessed using receiver operating characteristics (ROC) curve analysis. RESULTS LS values on SWE showed a strong correlation with those on MRE (r = 0.846, P < 0.001). For the diagnosis of significant fibrosis or cirrhosis in patients with hepatitis B virus-related liver disease (n = 75), SWE showed areas under the ROC curves (AUC) of 0.975 and 0.912, respectively (95% confidence interval [CI], 0.910-997, and 0.824-0.965). For the prediction of CSPH, the AUC of SWE was 0.818 (95% CI, 0.712-0.898), and when an LS value of 11.5 kPa was applied as a cut-off, SWE showed a sensitivity of 81.5% and a specificity of 72.9%. CONCLUSION LS measurements on 2D SWE were demonstrated to be well correlated with those obtained with MRE, and thus, may provide good diagnostic performance for the prediction of hepatic fibrosis and the presence of CSPH.
Collapse
Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| |
Collapse
|
39
|
Kromrey ML, Le Bihan D, Ichikawa S, Motosugi U. Diffusion-weighted MRI-based Virtual Elastography for the Assessment of Liver Fibrosis. Radiology 2020; 295:127-135. [DOI: 10.1148/radiol.2020191498] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
40
|
Nah EH, Cho S, Kim S, Kim HS, Cho HI. Diagnostic performance of Mac-2 binding protein glycosylation isomer (M2BPGi) in screening liver fibrosis in health checkups. J Clin Lab Anal 2020; 34:e23316. [PMID: 32227396 PMCID: PMC7439422 DOI: 10.1002/jcla.23316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/27/2020] [Accepted: 03/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mild-to-moderate fibrosis is rarely diagnosed because the disease is asymptomatic in the early stage. The serum level of Mac-2 binding protein glycosylation isomer (M2BPGi) has been found to increase with the severity of liver fibrosis. The aim of this study was to determine the diagnostic performance of M2BPGi in screening liver fibrosis using magnetic resonance elastography (MRE) as a reference standard and to compare it with using the aspartate aminotransferase-to-platelet ratio (APRI) and the Fibrosis-4 index (FIB-4) in health checkups. METHODS This cross-sectional study consecutively selected subjects at health examinations who underwent MRE and M2BPGi testing at eight health promotion centers in Korea between January and September 2019. The serum M2BPGi level was measured using the chemiluminescence enzyme immunoassay method. The measured levels were indexed using the cutoff index (COI). COI values of M2BPGi were compared with the MRE results. RESULTS The median (interquartile) values of COI for fibrosis stages F0 (normal liver stiffness), F1 (mild fibrosis), F2 (significant fibrosis), and ≥F3 (advanced fibrosis) were 0.49 (0.34-0.61), 0.48 (0.38-0.68), 0.64 (0.43-1.03), and 1.01 (0.75-1.77), respectively (P < .0001). The AUCs of the COI for the screening of fibrosis stage ≥F1, ≥F2, and ≥F3 were 0.591, 0.698, and 0.853, respectively. Using a threshold of 0.75 for COI to exclude advanced fibrosis had a sensitivity, specificity, and negative predictive value of 80.0%, 77.9%, and 98.9%, respectively. The AUC for excluding advanced fibrosis was better for M2BPGi than for FIB-4 and APRI. CONCLUSION Serum M2BPGi was useful for screening significant and advanced fibrosis in health checkups.
Collapse
Affiliation(s)
- Eun-Hee Nah
- Department of Laboratory Medicine, Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Seon Cho
- Department of Laboratory Medicine, Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Suyoung Kim
- Department of Laboratory Medicine, Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Hye-Sun Kim
- MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea
| | - Han-Ik Cho
- MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea
| |
Collapse
|
41
|
Abstract
Currently, despite the use of a preventive vaccine for several decades as well as the use of effective and well-tolerated viral suppressive medications since 1998, approximately 250 million people remain infected with the virus that causes hepatitis B worldwide. Hepatitis C virus (HCV) and hepatitis B virus (HBV) are the leading causes of liver cancer and overall mortality globally, surpassing malaria and tuberculosis. Linkage to care is estimated to be very poor both in developing countries and in high-income countries, such as the United States, countries in Western Europe, and Japan. In the United States, by CDC estimates, only one-third of HBV-infected patients or less are aware of their infection. Some reasons for these low rates of surveillance, diagnosis, and treatment include the asymptomatic nature of chronic hepatitis B until the very late stages, a lack of curative therapy with a finite treatment duration, a complex natural history, and a lack of knowledge about the disease by both care providers and patients. In the last 5 years, more attention has been focused on the important topics of HBV screening, diagnosis of HBV infection, and appropriate linkage to care. There have also been rapid clinical developments toward a functional cure of HBV infection, with novel compounds currently being in various phases of progress. Despite this knowledge, many of the professional organizations provide guidelines focused only on specific questions related to the treatment of HBV infection. This focus leaves a gap for care providers on the other HBV-related issues, which include HBV's epidemiological profile, its natural history, how it interacts with other viral hepatitis diseases, treatments, and the areas that still need to be addressed in order to achieve HBV elimination by 2030. Thus, to fill these gaps and provide a more comprehensive and relevant document to regions worldwide, we have taken a global approach by using the findings of global experts on HBV as well as citing major guidelines and their various approaches to addressing HBV and its disease burden.
Collapse
|
42
|
Sterling RK, King WC, Wahed AS, Kleiner DE, Khalili M, Sulkowski M, Chung RT, Jain MK, Lisker-Melman M, Wong DK, Ghany MG. Evaluating Noninvasive Markers to Identify Advanced Fibrosis by Liver Biopsy in HBV/HIV Co-infected Adults. Hepatology 2020; 71:411-421. [PMID: 31220357 PMCID: PMC6923615 DOI: 10.1002/hep.30825] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/16/2019] [Indexed: 12/13/2022]
Abstract
Noninvasive biomarkers are used increasingly to assess fibrosis in patients with chronic liver disease. We determined the utility of dual cutoffs for noninvasive biomarkers to exclude and confirm advanced fibrosis in hepatitis B virus (HBV)-human immunodeficiency virus (HIV) co-infected patients receiving combined antiretroviral therapy. Participants were anti-HIV/hepatitis B surface antigen-positive adults from eight clinical sites in the United States and Canada of the Hepatitis B Research Network. Fibrosis was staged by a central pathology committee using the Ishak fibrosis score (F). Clinical, laboratory, and vibration-controlled transient elastography (VCTE) data were collected at each site. Dual cutoffs for three noninvasive biomarkers (aspartate aminotransferase-to-platelet ratio index, Fibrosis-4 index [FIB-4], and liver stiffness by VCTE) with the best accuracy to exclude or confirm advanced fibrosis (F ≥ 3) were determined using established methodology. Of the 139 enrolled participants, 108 with a liver biopsy and having at least one noninvasive biomarker were included: 22% had advanced fibrosis and 54% had normal alanine aminotransferase. The median (interquartile range) of APRI (n = 106), FIB-4 (n = 106), and VCTE (n = 63) were 0.34 (0.26-0.56), 1.35 (0.99-1.89), and 4.9 (3.8-6.8) kPa, respectively. The area under the curve for advanced fibrosis was 0.69 for APRI, 0.66 for FIB-4, and 0.87 for VCTE. VCTE cutoffs of 5.0 kPa or less (to exclude) and 8.8 kPa or greater (to confirm) advanced fibrosis had a sensitivity of 92.3% and specificity of 96.0%, respectively, and accounted for 65.1% of participants. Among the 34.9% with values between the cutoffs, 26.1% had advanced fibrosis. Considering APRI or FIB-4 jointly with VCTE did not improve the discriminatory capacity. Conclusion: VCTE is a better biomarker of advanced fibrosis compared with APRI or FIB-4 in HBV/HIV co-infected adults on combined antiretroviral therapy. Using VCTE dual cutoffs, approximately two-thirds of patients could avoid biopsy to determine advanced fibrosis.
Collapse
Affiliation(s)
| | - Wendy C King
- University of Pittsburgh Graduate School of Public Health, Pittsburgh
| | - Abdus S. Wahed
- University of Pittsburgh Graduate School of Public Health, Pittsburgh
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Yue W, Li Y, Geng J, Wang P, Zhang L. Aspartate aminotransferase to platelet ratio can reduce the need for transient elastography in Chinese patients with chronic hepatitis B. Medicine (Baltimore) 2019; 98:e18038. [PMID: 31804310 PMCID: PMC6919398 DOI: 10.1097/md.0000000000018038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED In the absence of liver biopsy and transient elastography (TE), aspartate aminotransferase to platelet ratio (APRI), fibrosis-4 score (FIB-4), and gammaglutamyl transpeptidase to platelet ratio (GPR) are simple and inexpensive methods for the detection of liver fibrosis. AIMS We compared the performance of APRI, FIB-4, and GPR scores against TE in predicting the presence of liver fibrosis and cirrhosis, determined the optimal cut-off values for fibrosis and cirrhosis prediction, and reviewed the need for further TE assessment in resource-limited areas in China. METHODS TE and basic laboratory tests were performed in 2014 consecutive patients with chronic hepatitis B (CHB), and then compared to APRI, FIB-4, and GPR. RESULTS For the detection of significant fibrosis, the areas under the receiver operating characteristic (AUROC) curves for APRI, FIB-4, and GPR were 0.83, 0.75, and 0.77, respectively. For the detection of cirrhosis, the AUROC curves for APRI, FIB-4, and GPR were 0.90, 0.84, and 0.84, respectively. The cutoff of APRI was 0.35, with 78% sensitivity and 63% negative predictive value (NPV), to exclude significant fibrosis (F ≥ 2). At an APRI of 0.6, results showed a 94% specificity, 100% positive predictive value (PPV) and 7.9 positive likelihood ratio (PLR) in detecting significant fibrosis. Thus, patients with an APRI of <0.35 or >0.6 demonstrated correct prediction of liver fibrosis. These results translated to 1250 out of the 2014 patients avoiding the need for TE with a diagnostic accuracy of >80%. CONCLUSIONS The APRI score accurately assessed fibrosis and reduced the need for TE in almost two-thirds of Chinese patients with CHB.
Collapse
Affiliation(s)
- Wei Yue
- Department of Infectious Disease, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yan Li
- Department of VIP Internal Medicine, The First People's Hospital of Yunnan Province
| | - Jiawei Geng
- Department of Infectious Disease, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Ping Wang
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology
| | - Li Zhang
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology
- Department of VIP Internal Medicine, The First People's Hospital of Yunnan Province
| |
Collapse
|
44
|
Park HS, Choe WH, Han HS, Yu MH, Kim YJ, Jung SI, Kim JH, Kwon SY. Assessing significant fibrosis using imaging-based elastography in chronic hepatitis B patients: Pilot study. World J Gastroenterol 2019; 25:3256-3267. [PMID: 31333316 PMCID: PMC6626721 DOI: 10.3748/wjg.v25.i25.3256] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/20/2019] [Accepted: 06/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Accurate detection of significant fibrosis (fibrosis stage 2 or higher on the METAVIR scale) is important especially for chronic hepatitis B (CHB) patients with high viral loads but with normal or mildly elevated alanine aminotransferase (ALT) levels because the presence of significant fibrosis is accepted as the indication for antiviral treatment. Liver biopsy is the reference standard for diagnosing significant fibrosis, but it is an invasive procedure. Consequently, noninvasive imaging-based measurements, such as magnetic resonance elastography (MRE) or two-dimensional shear-wave elastography (2D-SWE), have been proposed for the quantitative assessment of liver fibrosis.
AIM To explore MRE and 2D-SWE to identify fibrosis stage, and to compare their performance with that of serum-based indices.
METHODS The study enrolled 63 treatment-naïve CHB patients with high viral loads but with normal or mildly elevated ALT levels who underwent liver biopsy before a decision was made to initiate antiviral therapy. MRE and 2D-SWE were performed, and serum-based indices, such as FIB-4 and aspartate transaminase to platelet ratio index (APRI), were calculated. The diagnostic performances of MRE, 2D-SWE, FIB-4, and APRI for assessing significant fibrosis (≥ F2) and cirrhosis (F4) were evaluated with liver histology as the reference standard, using receiver operating characteristic analyses.
RESULTS The liver fibrosis stage was F0/F1 in 19, F2 in 14, F3 in 14, and F4 in 16 patients, respectively. MRE significantly discriminated F2 from F0/1 (P = 0.022), whereas 2D-SWE showed a broad overlap in distinguishing those stages. MRE showed a higher correlation coefficient value with fibrosis stage than 2D-SWE with fibrosis stage (0.869 vs 0.649, Spearman test; P < 0.001). Multivariate linear regression analyses showed that fibrosis stage was the only factor affecting the values of MRE (P < 0.001), whereas body mass index (P = 0.042) and fibrosis stage (P < 0.001) were independent factors affecting 2D-SWE values. MRE performance for diagnosing significant fibrosis was better [area under the curve (AUC) = 0.906, positive predictive value (PPV) 97.3%, negative predictive value (NPV) 69.2%] than that of FIB-4 (AUC = 0.697, P = 0.002) and APRI (AUC = 0.717, P = 0.010), whereas the performance of 2D-SWE (AUC = 0.843, PPV 86%, NPV 65%) was not significantly different from that of FIB-4 or APRI.
CONCLUSION Compared to SWE, MRE might be more precise non-invasive assessment for depicting significant fibrosis and for making-decision to initiate antiviral-therapy in treatment-naïve CHB patients with normal or mildly-elevated ALT levels.
Collapse
Affiliation(s)
- Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Won Hyeok Choe
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Jeong Han Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - So Young Kwon
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, South Korea
| |
Collapse
|
45
|
Lefebvre T, Wartelle-Bladou C, Wong P, Sebastiani G, Giard JM, Castel H, Murphy-Lavallée J, Olivié D, Ilinca A, Sylvestre MP, Gilbert G, Gao ZH, Nguyen BN, Cloutier G, Tang A. Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis. Eur Radiol 2019; 29:6477-6488. [PMID: 31278577 DOI: 10.1007/s00330-019-06331-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/16/2019] [Accepted: 06/13/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE). METHODS This prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method. RESULTS TE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85-0.93), 0.90 (95% CI 0.85-0.94), and 0.94 (95% CI 0.91-0.96). CONCLUSION MRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis. TRIAL REGISTRATION NCT02044523 KEY POINTS: • The technical failure rate was similar between MRE and US-based elastography techniques. • Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis. • MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis.
Collapse
Affiliation(s)
- Thierry Lefebvre
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Medical Physics Unit, McGill University, Montreal, Canada
| | - Claire Wartelle-Bladou
- Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada
| | - Philip Wong
- Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC), Montreal, Canada
| | - Giada Sebastiani
- Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC), Montreal, Canada
| | - Jeanne-Marie Giard
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada
| | - Hélène Castel
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada
| | - Jessica Murphy-Lavallée
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada
| | - Damien Olivié
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada
| | - André Ilinca
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Marie-Pierre Sylvestre
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal (ESPUM), Montreal, Canada
| | - Guillaume Gilbert
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,MR Clinical Science, Philips Healthcare Canada, Markham, Canada
| | - Zu-Hua Gao
- Department of Pathology, McGill University, Montreal, Canada
| | - Bich N Nguyen
- Service of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Guy Cloutier
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,Institute of Biomedical Engineering, Université de Montréal, Montreal, Canada.,Laboratory of Biorheology and Medical Ultrasonics (LBUM), Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - An Tang
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada. .,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada. .,Institute of Biomedical Engineering, Université de Montréal, Montreal, Canada.
| |
Collapse
|
46
|
Jeon SK, Lee JM, Joo I, Yoon JH, Lee DH, Lee JY, Han JK. Prospective Evaluation of Hepatic Steatosis Using Ultrasound Attenuation Imaging in Patients with Chronic Liver Disease with Magnetic Resonance Imaging Proton Density Fat Fraction as the Reference Standard. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1407-1416. [PMID: 30975533 DOI: 10.1016/j.ultrasmedbio.2019.02.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 06/09/2023]
Abstract
The purpose of our study was to investigate the diagnostic performance of 2-D ultrasound attenuation imaging (ATI) for the assessment of hepatic steatosis in patients with chronic liver disease using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as the reference standard. We prospectively analyzed 87 patients with chronic liver disease who had reliable measurements at both ATI and MRI-PDFF. For the detection of hepatic steatosis of MRI-PDFF ≥5% and MRI-PDFF ≥10%, ATI measurements yielded areas under the receiver operating characteristic curve of 0.76 and 0.88, respectively (95% confidence intervals: 0.66-0.85 and 0.79-0.94). Attenuation coefficients at ATI were moderately correlated with MRI-PDFF (ρ = 0.66). In conclusion, attenuation coefficients at ultrasound ATI were well correlated with MRI-PDFF and, thus, may provide good diagnostic performance in the assessment of hepatic steatosis, making these coefficients a promising tool for the non-invasive assessment and quantification of hepatic steatosis.
Collapse
Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| |
Collapse
|
47
|
Dong XQ, Wu Z, Li J, Wang GQ, Zhao H. Declining in liver stiffness cannot indicate fibrosis regression in patients with chronic hepatitis B: A 78-week prospective study. J Gastroenterol Hepatol 2019; 34:755-763. [PMID: 30290019 DOI: 10.1111/jgh.14498] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/17/2018] [Accepted: 09/26/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM Little reliable data are available about the liver stiffness measurement (LSM) for fibrosis monitoring in chronic hepatitis B (CHB) patients on antiviral therapy. We aimed to assess the accuracy of LSM in fibrosis monitoring during 78-week antiviral therapy in CHB patients. METHODS Five hundred fifty-six treatment-naïve CHB patients with qualified LSM and liver biopsy at baseline were analyzed. Patients receiving entecavir-based therapy were prospectively followed to 78 weeks for second LSM and liver biopsy. Serologic detection, LSM, and liver biopsy were performed on the same day. Necro-inflammatory activity was also evaluated. RESULTS Areas under receiver operating characteristics curves of LSM at baseline and week 78 for significant fibrosis (≥ F3), advanced fibrosis (≥ F4), and liver cirrhosis (≥ F5) was 0.84, 0.87, 0.83 and 0.76, 0.85, 0.88, respectively. Patients with the same fibrosis stage but higher histology activity index score tend to have higher LSM at baseline. Liver stiffness decreased rapidly (3.8 [1.6-8.6] kPa) in parallel with baseline histology activity index scores from 11.3 (7.8-16.7) kPa at baseline to 6.4 (5.1-8.8) kPa at week 78. Greater decline of LSM in patients with only inflammation improvement was observed as compared with those without inflammation improvement (5.2 [2.5-9.7] vs 1.8 [0.2-8.1] kPa, P = 0.013). Baseline Ishak fibrosis score was the only predictor of 78-week fibrosis improvement (odds ratio, 1.859; P = 0.000). CONCLUSIONS In CHB patients receiving 78-week antiviral treatment, LSM could diagnosis different liver fibrosis stages, decrease in absolute LSM value could reflect the remission of liver inflammation, and baseline Ishak fibrosis score was the only predictor for 78-week fibrosis reversion.
Collapse
Affiliation(s)
- Xiao-Qin Dong
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China
| | - Zhao Wu
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China
| | - Jun Li
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China.,Peking University International Hospital, Beijing, China
| | - Gui-Qiang Wang
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China.,The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China.,Peking University International Hospital, Beijing, China
| | - Hong Zhao
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China.,Peking University International Hospital, Beijing, China
| | | |
Collapse
|
48
|
Agbim U, Asrani SK. Non-invasive assessment of liver fibrosis and prognosis: an update on serum and elastography markers. Expert Rev Gastroenterol Hepatol 2019; 13:361-374. [PMID: 30791772 DOI: 10.1080/17474124.2019.1579641] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Non-invasive assessment of fibrosis is increasingly utilized in clinical practice to diagnose hepatic fibrosis. Non-invasive assessment of liver fibrosis relies on biologic and/or physical properties to assess tissue fibrosis. Serum markers estimate fibrosis by incorporating markers reflecting hepatic function (indirect markers) and/or markers measuring extracellular matrix degradation/fibrogenesis (direct markers). Radiology based techniques relay the mechanical properties and stiffness of a tissue, with increased stiffness associated with more advanced fibrosis. Areas covered: In this comprehensive review, the recent literature discussing serum markers and elastography-based techniques will be covered. These modalities are also explored in the setting of various liver diseases. Expert opinion: The etiology of liver disease and clinical context should be taken into consideration when non-invasive markers are incorporated in clinical practice. Non-invasive assessment of fibrosis has been most extensively utilized in hepatitis C, followed by hepatitis B and nonalcoholic fatty liver disease, but its role remains less developed in other etiologies of liver disease such as alcohol-associated liver disease and autoimmune liver disease. The role of non-invasive markers in predicting progression or regression of fibrosis, development of liver-related events and survival needs to be further explored.
Collapse
Affiliation(s)
- Uchenna Agbim
- a Division of Transplant Surgery, Department of Surgery , University of Tennessee Health Science Center , Memphis , TN , USA
| | | |
Collapse
|
49
|
Obuchowski NA, Mozley PD, Matthews D, Buckler A, Bullen J, Jackson E. Statistical Considerations for Planning Clinical Trials with Quantitative Imaging Biomarkers. J Natl Cancer Inst 2018; 111:19-26. [DOI: 10.1093/jnci/djy194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Nancy A Obuchowski
- Cleveland Clinic Foundation, Quantitative Health Sciences/JJN3, Cleveland, OH
| | | | | | | | | | - Edward Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
50
|
Lejealle C, Castera L. Non-invasive Fibrosis Testing in Patients with Chronic Hepatitis B. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11901-018-0439-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|