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Wazir H, Abid M, Essani B, Saeed H, Ahmad Khan M, Nasrullah F, Qadeer U, Khalid A, Varrassi G, Muzammil MA, Maryam A, Syed ARS, Shah AA, Kinger S, Ullah F. Diagnosis and Treatment of Liver Disease: Current Trends and Future Directions. Cureus 2023; 15:e49920. [PMID: 38174191 PMCID: PMC10763979 DOI: 10.7759/cureus.49920] [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: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
This narrative review delves into the intricate landscape of liver diseases, providing a comprehensive background of the diverse conditions that afflict this vital organ. Liver diseases, ranging from viral hepatitis and non-alcoholic fatty liver disease (NAFLD) to cirrhosis and hepatocellular carcinoma (HCC), pose significant global health challenges. Understanding these diseases' multifaceted origins and progression is pivotal for developing effective diagnostic and therapeutic strategies. The epidemiology and etiology of liver diseases emphasize the global impact of viral hepatitis, with hepatitis B and C as significant contributors. Concurrently, the rising prevalence of NAFLD, linked to lifestyle factors and metabolic syndrome, underscores the intricate relationship between modern living and liver health. Chronic liver diseases often evolve insidiously, progressing from inflammation to fibrosis and, ultimately, to cirrhosis - a stage characterized by irreversible scarring and compromised function. The heightened risk of HCC in advanced liver disease stages further underscores the urgency of effective diagnostic and therapeutic interventions. The evolving landscape of non-invasive diagnostic tools is explored for their role in enabling early detection and accurate staging of liver diseases. In the realm of treatment, there is a continuous transition toward personalized medicine, customized to suit the unique profiles of individual patients. This shift encompasses a broad spectrum, ranging from personalized pharmacological interventions to lifestyle modifications and surgical options. Delving into innovative therapies, such as gene editing and immunomodulation, offers a glimpse into the promising future directions that have the potential to redefine the landscape of liver disease diagnosis and treatment.
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Affiliation(s)
- Hina Wazir
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Marium Abid
- Medicine, Jinnah Medical and Dental College, Karachi, PAK
| | - Binish Essani
- Medicine, Jinnah Medical and Dental College, Karachi, PAK
| | - Hira Saeed
- Medicine, Federal Medical College, Islamabad, PAK
| | | | - Fnu Nasrullah
- Internal Medicine, Shadab Medical Center, Karachi, PAK
| | - Usama Qadeer
- Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Ayesha Khalid
- Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | | | | | - Areeba Maryam
- Emergency Medicine, Holy Family Hospital, Rawalpindi, PAK
| | | | - Abdul Ahad Shah
- Dermatology, Medical College, Dow University of Health Sciences, Karachi, PAK
| | | | - Farhan Ullah
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
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Liang JX, Ampuero J, Niu H, Imajo K, Noureddin M, Behari J, Lee DH, Ehman RL, Rorsman F, Vessby J, Lacalle JR, Mózes FE, Pavlides M, Anstee QM, Harrison SA, Castell J, Loomba R, Romero-Gómez M. An individual patient data meta-analysis to determine cut-offs for and confounders of NAFLD-fibrosis staging with magnetic resonance elastography. J Hepatol 2023; 79:592-604. [PMID: 37121437 PMCID: PMC10623141 DOI: 10.1016/j.jhep.2023.04.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND & AIMS We conducted an individual patient data meta-analysis to establish stiffness cut-off values for magnetic resonance elastography (MRE) in staging liver fibrosis and to assess potential confounding factors. METHODS A systematic review of the literature identified studies reporting MRE data in patients with NAFLD. Data were obtained from the corresponding authors. The pooled diagnostic cut-off value for the various fibrosis stages was determined in a two-stage meta-analysis. Multilevel modelling methods were used to analyse potential confounding factors influencing the diagnostic accuracy of MRE in staging liver fibrosis. RESULTS Eight independent cohorts comprising 798 patients were included in the meta-analysis. The area under the receiver operating characteristic curve (AUROC) for MRE in detecting significant fibrosis was 0.92 (sensitivity, 79%; specificity, 89%). For advanced fibrosis, the AUROC was 0.92 (sensitivity, 87%; specificity, 88%). For cirrhosis, the AUROC was 0.94 (sensitivity, 88%, specificity, 89%). Cut-offs were defined to explore concordance between MRE and histopathology: ≥F2, 3.14 kPa (pretest probability, 39.4%); ≥F3, 3.53 kPa (pretest probability, 24.1%); and F4, 4.45 kPa (pretest probability, 8.7%). In generalized linear mixed model analysis, histological steatohepatitis with higher inflammatory activity (odds ratio 2.448, 95% CI 1.180-5.079, p <0.05) and high gamma-glutamyl transferase (GGT) concentration (>120U/L) (odds ratio 3.388, 95% CI 1.577-7.278, p <0.01] were significantly associated with elevated liver stiffness, and thus affecting accuracy in staging early fibrosis (F0-F1). Steatosis, as measured by magnetic resonance imaging proton density fat fraction, and body mass index(BMI) were not confounders. CONCLUSIONS MRE has excellent diagnostic performance for significant, advanced fibrosis and cirrhosis in patients with NAFLD. Elevated inflammatory activity and GGT level may lead to overestimation of early liver fibrosis, but anthropometric measures such as BMI or the degree of steatosis do not. IMPACT AND IMPLICATIONS This individual patient data meta-analysis of eight international cohorts, including 798 patients, demonstrated that MRE achieves excellent diagnostic accuracy for significant, advanced fibrosis and cirrhosis in patients with NAFLD. Cut-off values (significant fibrosis, 3.14 kPa; advanced fibrosis, 3.53 kPa; and cirrhosis, 4.45 kPa) were established. Elevated inflammatory activity and gamma-glutamyltransferase level may affect the diagnostic accuracy of MRE, leading to overestimation of liver fibrosis in early stages. We observed no impact of diabetes, obesity, or any other metabolic disorder on the diagnostic accuracy of MRE.
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Affiliation(s)
- Jia-Xu Liang
- Digestive Diseases Unit and CIBERehd, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (HUVR/CSIC/US), University of Seville, Seville, Spain; Department of Diagnostic Radiology, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, China
| | - Javier Ampuero
- Digestive Diseases Unit and CIBERehd, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (HUVR/CSIC/US), University of Seville, Seville, Spain
| | - Hao Niu
- Digestive System and Clinical Pharmacology Unit, Virgen de la Victoria University Hospital, Biomedical Research Institute of Malaga and Nanomedicine Platform-IBIMA (Plataforma BIONAND), University of Malaga, Málaga, Spain; Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBERehd), Carlos III Health Institute, Madrid, Spain
| | - Kento Imajo
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine; Yokohama, Japan
| | - Mazen Noureddin
- Fatty Liver Program, Division of Digestive and Liver Diseases, Comprehensive Transplant Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jaideep Behari
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dae Ho Lee
- Department of Internal Medicine, Gachon University College of Medicine (Gachon University Gil Medical Center), Incheon, South Korea
| | - Richard L Ehman
- Department of Diagnostic Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Fredrik Rorsman
- Department of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden
| | - Johan Vessby
- Department of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden
| | - Juan R Lacalle
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Ferenc E Mózes
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Michael Pavlides
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Quentin M Anstee
- Translational and Clinical Research Institute; Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle Upon Tyne Hospitals, NHS Trust, Newcastle Upon Tyne, UK
| | - Stephen A Harrison
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Javier Castell
- Department of Radiology, Virgen del Rocío University Hospital, Seville, Spain
| | - Rohit Loomba
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA; NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Manuel Romero-Gómez
- Digestive Diseases Unit and CIBERehd, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (HUVR/CSIC/US), University of Seville, Seville, Spain.
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