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Qazi Arisar FA, Salinas-Miranda E, Ale Ali H, Lajkosz K, Chen C, Azhie A, Healy GM, Deniffel D, Haider MA, Bhat M. Development of a Radiomics-Based Model to Predict Graft Fibrosis in Liver Transplant Recipients: A Pilot Study. Transpl Int 2023; 36:11149. [PMID: 37720416 PMCID: PMC10503435 DOI: 10.3389/ti.2023.11149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 08/09/2023] [Indexed: 09/19/2023]
Abstract
Liver Transplantation is complicated by recurrent fibrosis in 40% of recipients. We evaluated the ability of clinical and radiomic features to flag patients at risk of developing future graft fibrosis. CT scans of 254 patients at 3-6 months post-liver transplant were retrospectively analyzed. Volumetric radiomic features were extracted from the portal phase using an Artificial Intelligence-based tool (PyRadiomics). The primary endpoint was clinically significant (≥F2) graft fibrosis. A 10-fold cross-validated LASSO model using clinical and radiomic features was developed. In total, 75 patients (29.5%) developed ≥F2 fibrosis by a median of 19 (4.3-121.8) months. The maximum liver attenuation at the venous phase (a radiomic feature reflecting venous perfusion), primary etiology, donor/recipient age, recurrence of disease, brain-dead donor, tacrolimus use at 3 months, and APRI score at 3 months were predictive of ≥F2 fibrosis. The combination of radiomics and the clinical features increased the AUC to 0.811 from 0.793 for the clinical-only model (p = 0.008) and from 0.664 for the radiomics-only model (p < 0.001) to predict future ≥F2 fibrosis. This pilot study exploring the role of radiomics demonstrates that the addition of radiomic features in a clinical model increased the model's performance. Further studies are required to investigate the generalizability of this experimental tool.
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Affiliation(s)
- Fakhar Ali Qazi Arisar
- Ajmera Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- National Institute of Liver and GI Diseases, Dow University of Health Sciences, Karachi, Pakistan
| | - Emmanuel Salinas-Miranda
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network/Sinai Health System, Toronto, ON, Canada
| | - Hamideh Ale Ali
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network/Sinai Health System, Toronto, ON, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Catherine Chen
- Ajmera Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Amirhossein Azhie
- Ajmera Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Gerard M. Healy
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network/Sinai Health System, Toronto, ON, Canada
| | - Dominik Deniffel
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network/Sinai Health System, Toronto, ON, Canada
| | - Masoom A. Haider
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network/Sinai Health System, Toronto, ON, Canada
| | - Mamatha Bhat
- Ajmera Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Zanelatto ADCO, Lacerda GDS, Accardo CDM, do Rosário NF, da Silva AA, Motta G, Tersariol ILDS, Xavier AR. Cathepsin B and Plasma Kallikrein Are Reliable Biomarkers to Discriminate Clinically Significant Hepatic Fibrosis in Patients with Chronic Hepatitis-C Infection. Microorganisms 2022; 10:1769. [PMID: 36144371 PMCID: PMC9501310 DOI: 10.3390/microorganisms10091769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to determine the biomarker performance of the proteolytic enzymes cathepsin B (Cat B) and plasma kallikrein (PKa) and transforming growth factor (TGF)-β to detect hepatic fibrosis (HF) in chronic hepatitis C (CHC) patients. We studied 53 CHC patients and 71 healthy controls (HCs). Hepatic-disease stage was determined by liver biopsies, aminotransferase:platelet ratio index (APRI) and Fibrosis (FIB)4. Hepatic inflammation and HF in CHC patients were stratified using the METAVIR scoring system. Cat-B and PKa activities were monitored fluorometrically. Serum levels of TGF-β (total and its active form) were determined using ELISA-like fluorometric methods. Increased serum levels of Cat B and PKa were found (p < 0.0001) in CHC patients with clinically significant HF and hepatic inflammation compared with HCs. Levels of total TGF-β (p < 0.0001) and active TGF-β (p < 0.001) were increased in CHC patients compared with HCs. Cat-B levels correlated strongly with PKa levels (r = 0.903, p < 0.0001) in CHC patients but did not correlate in HCs. Levels of Cat B, PKa and active TGF-β increased with the METAVIR stage of HF. Based on analyses of receiver operating characteristic (ROC) curves, Cat B and PKa showed high diagnostic accuracy (area under ROC = 0.99 ± 0.02 and 0.991 ± 0.007, respectively) for distinguishing HF in CHC patients from HCs. Taken together, Cat B and PKa could be used as circulating biomarkers to detect HF in HCV-infected patients.
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Affiliation(s)
| | - Gilmar de Souza Lacerda
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica—LAMAP, Faculdade de Medicina, Universidade Federal Fluminense, Niterói 24033-900, RJ, Brazil
- Departamento de Patologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói 24033-900, RJ, Brazil
| | - Camila de Melo Accardo
- Departamento de Bioquímica, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04044-020, SP, Brazil
| | - Natalia Fonseca do Rosário
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica—LAMAP, Faculdade de Medicina, Universidade Federal Fluminense, Niterói 24033-900, RJ, Brazil
| | - Andréa Alice da Silva
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica—LAMAP, Faculdade de Medicina, Universidade Federal Fluminense, Niterói 24033-900, RJ, Brazil
| | - Guacyara Motta
- Departamento de Bioquímica, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04044-020, SP, Brazil
| | | | - Analucia Rampazzo Xavier
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica—LAMAP, Faculdade de Medicina, Universidade Federal Fluminense, Niterói 24033-900, RJ, Brazil
- Departamento de Patologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói 24033-900, RJ, Brazil
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Mitrovic B, Gluvic ZM, Obradovic M, Radunovic M, Rizzo M, Banach M, Isenovic ER. Non-alcoholic fatty liver disease, metabolic syndrome, and type 2 diabetes mellitus: where do we stand today? Arch Med Sci 2022; 19:884-894. [PMID: 37560721 PMCID: PMC10408022 DOI: 10.5114/aoms/150639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/02/2022] [Indexed: 08/11/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD), metabolic syndrome (MetS), and type 2 diabetes (T2DM) are metabolic disorders that belong to a highly prevalent disease cluster with a significant impact on public health worldwide. MetS is a complex condition characterized by metabolism perturbations that include glucose intolerance, insulin resistance, dyslipidaemia, associated pro-inflammatory state, and arterial hypertension. Because the components of MetS commonly co-occur, the management of these disorders cannot be considered separate issues. Thus NAFLD, recognized as a hepatic manifestation of MetS, is frequently associated with T2DM. This review analyses the underlying connections between these diseases and the risks associated with their co-occurrence. The effective management of NAFLD associated with MetS and T2DM involves an early diagnosis and optimal treatment of each condition leading to improvement in glycaemic and lipid regulation, liver steatosis, and arterial hypertension. The net effect of such treatment is the prevention of atherosclerotic cardiovascular diseases and liver fibrosis.
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Affiliation(s)
- Bojan Mitrovic
- University Clinical-Hospital Centre Zemun-Belgrade, Clinic of Internal medicine, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zoran M. Gluvic
- University Clinical-Hospital Centre Zemun-Belgrade, Clinic of Internal medicine, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Obradovic
- Department of Radiobiology and Molecular Genetics, “VINČA” Institute of Nuclear Sciences – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Maja Radunovic
- Faculty of Stomatology, Pancevo, University Business Academy, Novi Sad, Serbia
| | - Manfredi Rizzo
- Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Esma R. Isenovic
- Department of Radiobiology and Molecular Genetics, “VINČA” Institute of Nuclear Sciences – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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Soh EG, Lee YH, Kim YR, Yoon KH, Choi KH. Usefulness of 2-D shear wave elastography for evaluation of hepatic fibrosis and treatment response in patients with autoimmune hepatitis. Ultrasonography 2022; 41:740-749. [PMID: 36195317 PMCID: PMC9532207 DOI: 10.14366/usg.21266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/03/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Eun Gyu Soh
- Department of Radiology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Hwan Lee
- Department of Radiology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
- Correspondence to: Young Hwan Lee, MD, PhD, Department of Radiology, Wonkwang University Hospital, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Korea Tel. +82-63-859-1920 Fax. +82-63-851-4749 E-mail:
| | - Youe Ree Kim
- Department of Radiology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Kwon-Ha Yoon
- Department of Radiology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Keum Ha Choi
- Department of Pathology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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Marri UK, Madhusudhan KS. Dual-Energy Computed Tomography in Diffuse Liver Diseases. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1742432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractDual-energy computed tomography (DECT) is an advancement in the field of CT, where images are acquired at two energies. Materials are identified and quantified based on their attenuation pattern at two different energy beams using various material decomposition algorithms. With its ability to identify and quantify materials such as fat, calcium, iron, and iodine, DECT adds great value to conventional CT and has innumerable applications in body imaging. Continuous technological advances in CT scanner hardware, material decomposition algorithms, and image reconstruction software have led to considerable growth of these applications. Among all organs, the liver is the most widely investigated by DECT, and DECT has shown promising results in most liver applications. In this article, we aim to provide an overview of the role of DECT in the assessment of diffuse liver diseases, mainly the deposition of fat, fibrosis, and iron and review the most relevant literature.
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Affiliation(s)
- Uday Kumar Marri
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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Kaur N, Goyal G, Garg R, Tapasvi C, Chawla S, Kaur R. Potential role of noninvasive biomarkers during liver fibrosis. World J Hepatol 2021; 13:1919-1935. [PMID: 35069998 PMCID: PMC8727215 DOI: 10.4254/wjh.v13.i12.1919] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/18/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] Open
Abstract
Various types of liver disease exist, such as hepatitis and alcoholic liver disease. These liver diseases can result in scarring of liver tissue, cirrhosis, and finally liver failure. During liver fibrosis, there is an excess and disorganized accumulation of extracellular matrix (ECM) components which cause the loss of normal liver cell functions. For patients with chronic liver disease, fibrosis prediction is an essential part of the assessment and management. To diagnose liver fibrosis, several invasive and noninvasive markers have been proposed. However, the adoption of invasive markers remains limited due to their inherent characteristics and poor patient acceptance rate. In contrast, noninvasive markers can expedite the clinical decision through informed judgment about disease stage and prognosis. These noninvasive markers are classified into two types: Imaging techniques and serum biomarkers. However, the diagnostic values of biomarkers associated with liver fibrosis have also been analyzed. For example, the serum levels of ECM proteins can react to either matrix accumulation or degradation. During virus-host interactions, several regulatory steps take place to control gene expression, such as the change in cellular microRNA expression profiles. MicroRNAs are a class of non-coding RNAs (18-20 long nucleotides) that function by post-transcriptional regulation of gene expression. Although various noninvasive markers have been suggested in recent years, certain limitations have restricted their clinical applications. Understanding the potential of non-invasive biomarkers as a therapeutic option to treat liver fibrosis is still in progress.
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Affiliation(s)
- Navneet Kaur
- Department of Biochemistry, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot 151203, Punjab, India
| | - Gitanjali Goyal
- Department of Biochemistry, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot 151203, Punjab, India
| | - Ravinder Garg
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot 151203, Punjab, India
| | - Chaitanya Tapasvi
- Department of Radiodiagnosis, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot 151203, Punjab, India
| | - Sonia Chawla
- Department of Biochemistry, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot 151203, Punjab, India
| | - Rajneet Kaur
- Department of Biochemistry, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot 151203, Punjab, India
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Dong B, Huang S, Chang J, Chen X, Yan J. Comparison of Sound Touch Elastography, Sound Touch Quantify, and 4 Serum Fibrosis Indexes for the Diagnosis of Liver Fibrosis in Patients With Chronic Hepatitis B. Ultrasound Q 2021; 37:123-128. [PMID: 34057912 DOI: 10.1097/ruq.0000000000000485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ABSTRACT The aim of this research was to compare the use of shear wave elastography (sound touch elastography [STE] and sound touch quantify [STQ]) and serum liver fibrosis indexes in the evaluation and staging of chronic hepatitis B (CHB) liver fibrosis. Sound touch elastography is a form of 2-dimensional shear wave elastography, and STQ is a form of point shear wave elastography. Between June 2018 and March 2019, 122 patients with CHB were assessed using STE and STQ. Serum liver biomarkers tests were undertaken, and liver biopsy was performed, and these were used to assign a pathological stage based on the Scheuer scoring system. A receiver operating characteristic curve was used to analyze the diagnostic value of noninvasive methods for evaluating and staging liver fibrosis. The cutoff values of STE for liver fibrosis stages S2 to S4 were 8.85, 9.97, and 10.29 kPa, respectively, and the areas under the receiver operating characteristic (AUCs) curve were 0.703, 0.821, and 0.900, respectively. The cutoff values of STQ for liver fibrosis stages S2 to S4 were 11.31, 13.81, and 20.60 kPa, respectively, and the AUCs were 0.674, 0.807, and 0.893, respectively. The AUCs of STE and STQ in diagnosing fibrosis stage were significantly higher than those of liver serum biomarkers (P < 0.05). The AUCs for the ability of the aspartate transaminase-to-platelet ratio index, the fibrosis index based on the 4 factors, the King score, and the Forns index to diagnose S2 fibrosis were 0.502, 0.624, 0.542, and 0.616, respectively, and the AUCs for their ability to diagnose S4 fibrosis were 0.856, 0.861, 0.883, and 0.823, respectively. Both STE and STQ are noninvasive methods for the assessment of liver fibrosis in CHB patients, with better diagnostic performances than those of 4 serum fibrosis indexes.
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Affiliation(s)
- Bingtian Dong
- Department of Ultrasound, Chenggong Hospital Affiliated to Xiamen University
| | - Shu Huang
- Department of Ultrasound, Chenggong Hospital Affiliated to Xiamen University
| | - Jiandong Chang
- Department of Ultrasound, Traditional Chinese Medicine Hospital of Xiamen, Xiamen, China
| | - Xiaoyan Chen
- Department of Ultrasound, Traditional Chinese Medicine Hospital of Xiamen, Xiamen, China
| | - Jianping Yan
- Department of Ultrasound, Chenggong Hospital Affiliated to Xiamen University
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Rioux JA, Hewlett M, Davis C, Bowen CV, Brewer K, Clarke SE, Beyea SD. Mapping of fatty acid composition with free-breathing MR spectroscopic imaging and compressed sensing. NMR IN BIOMEDICINE 2021; 34:e4241. [PMID: 31898379 PMCID: PMC8244113 DOI: 10.1002/nbm.4241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a growing health problem, and a major challenge in NAFLD management is identifying which patients are at risk of progression to more serious disease. Simple measurements of liver fat content are not strong predictors of clinical outcome, but biomarkers related to fatty acid composition (ie, saturated vs. unsaturated fat) may be more effective. MR spectroscopic imaging (MRSI) methods allow spatially resolved, whole-liver measurements of chemical composition but are traditionally limited by slow acquisition times. In this work we present an accelerated MRSI acquisition based on spin echo single point imaging (SE-SPI), which, using appropriate sampling and compressed sensing reconstruction, allows free-breathing acquisition in a mouse model of fatty liver disease. After validating the technique's performance in oil/water phantoms, we imaged mice that had received a normal diet or a methionine and choline deficient (MCD) diet, some of which also received supplemental injections of iron to mimic hepatic iron overload. SE-SPI was more resistant to the line-broadening effects of iron than single-voxel spectroscopy measurements, and was consistently able to measure the amplitudes of low-intensity spectral peaks that are important to characterizing fatty acid composition. In particular, in the mice receiving the MCD diet, SE-SPI showed a significant decrease in a metric associated with unsaturated fat, which is consistent with the literature. This or other related metrics may therefore offer more a specific biomarker of liver health than fat content alone. This preclinical study is an important precursor to clinical testing of the proposed method. MR-based quantification of fatty acid composition may allow for improved characterization of non-alcoholic fatty liver disease. A spectroscopic imaging method with appropriate sampling strategy allows whole-liver mapping of fat composition metrics in a free-breathing mouse model. Changes in metrics like the surrogate unsaturation index (UIs) are visible in mice receiving a diet which induces fat accumulation in the liver, as compared to a normal diet; such metrics may prove useful in future clinical studies of liver disease.
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Affiliation(s)
- James A. Rioux
- Biomedical Translational Imaging CentreHalifaxNova ScotiaCanada
- Department of Diagnostic RadiologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
| | - Miriam Hewlett
- Biomedical Translational Imaging CentreHalifaxNova ScotiaCanada
- Department of Medical BiophysicsUniversity of Western OntarioLondonOntarioCanada
| | - Christa Davis
- Biomedical Translational Imaging CentreHalifaxNova ScotiaCanada
| | - Chris V. Bowen
- Biomedical Translational Imaging CentreHalifaxNova ScotiaCanada
- Department of Diagnostic RadiologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
- School of Biomedical EngineeringDalhousie UniversityHalifaxNova ScotiaCanada
| | - Kimberly Brewer
- Biomedical Translational Imaging CentreHalifaxNova ScotiaCanada
- Department of Diagnostic RadiologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
- School of Biomedical EngineeringDalhousie UniversityHalifaxNova ScotiaCanada
| | - Sharon E. Clarke
- Biomedical Translational Imaging CentreHalifaxNova ScotiaCanada
- Department of Diagnostic RadiologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
| | - Steven D. Beyea
- Biomedical Translational Imaging CentreHalifaxNova ScotiaCanada
- Department of Diagnostic RadiologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
- School of Biomedical EngineeringDalhousie UniversityHalifaxNova ScotiaCanada
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Abstract
PURPOSE OF REVIEW Aging-related comorbidities, including liver disease, represent the main drivers of morbidity and mortality in people with HIV (PWH). Nonalcoholic fatty liver disease (NAFLD) seems a frequent comorbidity in aging PWH nowadays. NAFLD results from a fat deposition into the liver parenchyma that may evolve to nonalcoholic steatohepatitis (NASH), a state of hepatocellular inflammation and injury in response to the accumulated fat leading to liver fibrosis and cirrhosis. We here review the current status of knowledge regarding this emerging comorbidity in PWH. RECENT FINDINGS Recent studies suggest that PWH are at higher risk for both NASH and NASH-related liver fibrosis. Several hypothesized pathogenic mechanisms may account for this finding, including increased metabolic comorbidities, hepatotoxic effect of lifelong antiretroviral therapy, and chronic HIV infection. In clinical practice, non-invasive diagnostic tests, such as serum biomarkers and elastography, may help identify patients with NASH-related fibrosis, thus improving risk stratification, and enhancing clinical management decisions, including early initiation of interventions such as lifestyle changes and potential pharmacologic interventions. Clinicians should remain informed of the frequency, significance, and diagnostic and management approach to NASH in PWH.
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Affiliation(s)
- Adriana Cervo
- Division of Infectious Diseases, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
- Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro", University of Palermo, Palermo, Italy
| | - Mohamed Shengir
- Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Keyur Patel
- Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, Toronto, Canada
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, Chronic Viral Illness Service Royal Victoria Hospital, McGill University Health Centre, 1001 Blvd. Décarie, Montreal, QC H4A 3J1, Canada.
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Marri UK, Das P, Shalimar, Kalaivani M, Srivastava DN, Madhusudhan KS. Noninvasive Staging of Liver Fibrosis Using 5-Minute Delayed Dual-Energy CT: Comparison with US Elastography and Correlation with Histologic Findings. Radiology 2021; 298:600-608. [PMID: 33399510 DOI: 10.1148/radiol.2021202232] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Normalized iodine concentration (NIC) (ratio of iodine concentration of liver to that of aorta) of liver at delayed dual-energy CT (DECT) may reflect the amount of fibrosis based on the extent of iodine uptake. Purpose To stage liver fibrosis by using 5-minute delayed DECT and compare findings with those of transient elastography (TE), shear-wave elastography (SWE), and histologic examination. Materials and Methods This prospective study included patients with chronic liver disease who were scheduled to undergo multiphase abdominal CT and liver biopsy from January 2017 to September 2018. Fifty individuals being screened as renal donors comprised the control group. Study participants underwent TE, SWE, multiphasic DECT (including 5-minute delayed dual-energy scanning), and liver biopsy. Multiphasic DECT and SWE were performed in the control group. The NIC of the right lobe of the liver (RNIC) was compared with liver stiffness (LS) as measured with TE and SWE and with the METAVIR fibrosis stage (ranging from F0 to F4). Diagnostic performance was assessed by using areas under the receiver operating characteristic curve (AUCs). Results A total of 107 participants (mean age, 35 years ± 12 [standard deviation]; 57 men) and 50 control subjects (mean age, 47 years ± 11; 29 women) were evaluated. The RNIC showed strong correlation with METAVIR stage (Spearman ρ = 0.81, P < .001). The AUC for RNIC with each METAVIR stage ranged between 0.86 (95% CI: 0.76, 0.97) and 0.96 (95% CI: 0.92, 0.99). The cut-off value of RNIC was 0.24 (sensitivity: 85% [86 of 101 participants; 95% CI: 77%, 91%]; specificity: 83% [84 of 101 participants; 95% CI: 42%, 98%]) for stage F1 fibrosis and 0.29 (sensitivity: 84% [67 of 80 participants; 95% CI: 74%, 90%]; specificity: 81% [65 of 80 participants; 95% CI: 63%, 92%]) for stage F2 fibrosis. RNIC correlated well with LS as measured with TE and SWE (Spearman ρ = 0.60 and 0.64, respectively; P < .001). Conclusion Normalized iodine concentration of liver at 5-minute delayed dual-energy CT showed strong correlation with the histologic stages of liver fibrosis and good diagnostic performance in estimating liver fibrosis. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Chandarana and Shanbhogue in this issue.
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Affiliation(s)
- Uday Kumar Marri
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Prasenjit Das
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Shalimar
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Mani Kalaivani
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Deep Narayan Srivastava
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kumble Seetharama Madhusudhan
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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11
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Winters AC, Mittal R, Schiano TD. A review of the use of transient elastography in the assessment of fibrosis and steatosis in the post-liver transplant patient. Clin Transplant 2019; 33:e13700. [PMID: 31441967 DOI: 10.1111/ctr.13700] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/21/2019] [Accepted: 08/18/2019] [Indexed: 12/13/2022]
Abstract
Liver biopsy is considered the gold standard method for diagnosing and staging liver disease, particularly in the post-liver transplant setting. Given the invasive nature of biopsy, alternate means for accurately assessing liver fibrosis and steatosis are preferred especially as the number of patients with fatty liver disease is increasing. Transient elastography has been validated as a useful tool for evaluation of liver fibrosis, as has controlled attenuation parameter index as a tool for assessing steatosis. It is a non-invasive, rapid, and highly reproducible approach to demonstrate the presence of fibrosis among non-transplant patients with chronic liver disease of various etiologies. However, it has not yet found wide acceptance in liver transplant recipients. There are few published studies evaluating the merits and applicability of transient elastography to assess allografts after liver transplantation. We review the published data on the use of transient elastography with concurrent controlled attenuation parameter in liver transplant recipients and recommend its greater use to follow allograft function over time.
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Affiliation(s)
- Adam C Winters
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, CA, USA
| | - Rasham Mittal
- Transplant Hepatology, Southern California Permanente Medical Group, Kaiser Permanente, Los Angeles, CA, USA
| | - Thomas D Schiano
- Department of Medicine, Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Srivastava A, Jong S, Gola A, Gailer R, Morgan S, Sennett K, Tanwar S, Pizzo E, O'Beirne J, Tsochatzis E, Parkes J, Rosenberg W. Cost-comparison analysis of FIB-4, ELF and fibroscan in community pathways for non-alcoholic fatty liver disease. BMC Gastroenterol 2019; 19:122. [PMID: 31296161 PMCID: PMC6624894 DOI: 10.1186/s12876-019-1039-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 06/26/2019] [Indexed: 01/07/2023] Open
Abstract
Background The identification of patients with advanced liver fibrosis secondary to non-alcoholic fatty liver disease (NAFLD) remains challenging. Using non-invasive liver fibrosis tests (NILT) in primary care may permit earlier detection of patients with clinically significant disease for specialist review, and reduce unnecessary referral of patients with mild disease. We constructed an analytical model to assess the clinical and cost differentials of such strategies. Methods A probabilistic decisional model simulated a cohort of 1000 NAFLD patients over 1 year from a healthcare payer perspective. Simulations compared standard care (SC) (scenario 1) to: Scenario 2: FIB-4 for all patients followed by Enhanced Liver Fibrosis (ELF) test for patients with indeterminate FIB-4 results; Scenario 3: FIB-4 followed by fibroscan for indeterminate FIB-4; Scenario 4: ELF alone; and Scenario 5: fibroscan alone. Model estimates were derived from the published literature. The primary outcome was cost per case of advanced fibrosis detected. Results Introduction of NILT increased detection of advanced fibrosis over 1 year by 114, 118, 129 and 137% compared to SC in scenarios 2, 3, 4 and 5 respectively with reduction in unnecessary referrals by 85, 78, 71 and 42% respectively. The cost per case of advanced fibrosis (METAVIR ≥F3) detected was £25,543, £8932, £9083, £9487 and £10,351 in scenarios 1, 2, 3, 4 and 5 respectively. Total budget spend was reduced by 25.2, 22.7, 15.1 and 4.0% in Scenarios 2, 3, 4 and 5 compared to £670 K at baseline. Conclusion Our analyses suggest that the use of NILT in primary care can increases early detection of advanced liver fibrosis and reduce unnecessary referral of patients with mild disease and is cost efficient. Adopting a two-tier approach improves resource utilization.
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Affiliation(s)
- Ankur Srivastava
- UCL Institute for Liver and Digestive Health, Royal Free Campus, London, NW3 2PF, UK.
| | - Simcha Jong
- Science Based Business, Leiden University, Snellius Building, Niels Bohrweg 1, 2333 CA, Leiden, Netherlands
| | - Anna Gola
- Health Economist, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Ruth Gailer
- Department of Primary care and Population Health, Upper 3rd Floor, Royal Free Hospital, London, NW3 2PF, UK
| | - Sarah Morgan
- Camden Clinical Commissioning Group, 75 Hampstead Rd, London, NW1 2PL, UK
| | - Karen Sennett
- Islington Clinical Commissioning Group Laycock St, London, N1 1TH, UK
| | - Sudeep Tanwar
- UCL Institute for Liver and Digestive Health, Royal Free Campus, London, NW3 2PF, UK
| | - Elena Pizzo
- Department of Applied Health Research, UCL 1-19 Torrington Place, London, WC1E7HB, UK
| | - James O'Beirne
- UCL Institute for Liver and Digestive Health, Royal Free Campus, London, NW3 2PF, UK
| | - Emmanuel Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Campus, London, NW3 2PF, UK
| | - Julie Parkes
- Public Health Sciences and Medical Statistics, University of Southampton, Southampton, UK
| | - William Rosenberg
- UCL Institute for Liver and Digestive Health, Royal Free Campus, London, NW3 2PF, UK
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13
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Liu W, Li X, Zheng W, Yao R, Zheng J. Preoperative evaluation of the degree of liver fibrosis based on matter-element analysis using serological indicators in patients with hepatocellular carcinoma. Biosci Trends 2019; 13:70-76. [PMID: 30867373 DOI: 10.5582/bst.2018.01311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Evaluation of the degree of liver fibrosis is an important basis for the clinical diagnosis and treatment of patients with hepatocellular carcinoma (HCC). It is meaningful to make a preoperative evaluation with non-invasive methods. In the current study, 12 commonly used preoperative serological indicators from 161 HCC patients with different degree of liver fibrosis were collected retrospectively, and 8 of the indicators (ALB, PA, TBil, INR, AST, GGT, ALP, and PT) were ultimately used in matter-element analysis to create a formula. The relationship between those results and the histological sub-classification of the Laennec liver fibrosis scoring system was analyzed. The calculated value of R from this formula will indicate the differing degree of liver fibrosis in a patient: i) the value of 0.802 ≤ R < 1 indicates the early stage of liver cirrhosis, which corresponds to Laennec stages 0-3; ii) the value of 0.752 ≤ R < 0.802 indicates the mild stage of liver cirrhosis, which corresponds to Laennec stage 4A; iii) the value of 0.698 ≤ R < 0.752 indicates the moderate stage of liver cirrhosis, which corresponds to Laennec stage 4B; and iv) the value of 0.444 ≤ R < 0.698 indicates the severe stage of liver cirrhosis, which corresponds to Laennec stage 4C. The hope is that this formula for preoperative evaluation of the degree of liver fibrosis using non-invasive methods would be useful in the clinical diagnosis and treatment of patients with HCC in the future.
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Affiliation(s)
- Wei Liu
- Department of Hepatopancreatobilary Surgery, The First College of Clinical Medical Sciences, Three Gorges University
| | - Xiaosong Li
- Department of Hepatopancreatobilary Surgery, The First College of Clinical Medical Sciences, Three Gorges University
| | - Weihong Zheng
- Department of Pharmacology, Medical Science College, Three Gorges University
| | - Rucheng Yao
- Department of Hepatopancreatobilary Surgery, The First College of Clinical Medical Sciences, Three Gorges University
| | - Jun Zheng
- Department of Hepatopancreatobilary Surgery, The First College of Clinical Medical Sciences, Three Gorges University
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14
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Wang TZ, Lin DD, Jin BX, Sun XY, Li N. Plasma microRNA: A novel non-invasive biomarker for HBV-associated liver fibrosis staging. Exp Ther Med 2018; 17:1919-1929. [PMID: 30783469 DOI: 10.3892/etm.2018.7117] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to evaluate the potential use of 7 plasma miRNAs for liver fibrosis staging in patients with chronic hepatitis B virus (HBV) infection. Relative levels of miRNAs were measured using quantitative polymerase chain reaction and used to develop a diagnostic panel. A receiver operating characteristic (ROC) curve was drawn to evaluate the performance of individual miRNAs and the whole panel. It was identified that hsa-miR-122 exhibited significantly different expression levels between F4 and F3, F2, F1, and F0 fibrosis stages (P<0.05), and between F2 and F1 stages (P=0.045); hsa-miR-146a-5p, hsa-miR-29c-3p and hsa-miR-223 exhibited significantly different expression levels between F4 and F0 stages. ROC analysis revealed that hsa-miR-122-5p, hsa-miR-223 and hsa-miR-29c-3p identified patients with ≥F2 fibrosis with area under the curve (AUC) =0.745, 0.631 and 0.670, respectively. hsa-miR-122-5p identified patients with ≥F3 disease (AUC=0.783). hsa-miR-122-5p, hsa-miR-223 and hsa-miR-29c-3p identified patients with cirrhosis with AUC=0.776, 0.617 and 0.619, respectively. The miRNA panel exhibited a higher accuracy compared with individual miRNAs in discriminating between ≥F2, ≥F3 and F4 fibrosis stages with AUC=0.904, 0.889 and 0.835, respectively. hsa-miR-122-5p, hsa-miR-146a, hsa-miR-29c and hsa-miR-223 were positively correlated with fibrosis stage. hsa-miR-122-5p and hsa-miR-381-3p were negatively correlated with alanine aminotransferase, aspartate transaminase and HBV viral DNA load. These 7 miRNAs may serve as potential biomarkers of liver fibrosis in patients with HBV-associated fibrosis. The miRNA panel may serve as a novel non-invasive method for liver fibrosis staging.
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Affiliation(s)
- Tie-Zheng Wang
- Department of General Surgery, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Dong-Dong Lin
- Department of General Surgery, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Bo-Xun Jin
- Department of General Surgery, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Xiang-Ying Sun
- Beijing QuantoBio Biotechnology Co. Ltd., Beijing Economic-Technological Development Area, Beijing 100176, P.R. China
| | - Ning Li
- Department of General Surgery, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, P.R. China
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15
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Bellamkonda S, Paruthikunnan SM, Kadavigere R, Sripathi S. Role of Shear Wave Elastography in the Assessment of Fibrosis in Chronic Liver Disease. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318799340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate the diagnostic performance of shear wave elastography in the estimation of fibrosis in patients with chronic liver disease by using biopsy and/or serum markers as reference standard. Materials and methods: 100 patients underwent point quantification-shear wave elastography, for whom noninvasive serum fibrosis indices like APRI, FIB-4, and King’s score were calculated. The receiver-operator characteristic (ROC) curve analysis was performed. Results: The shear wave elastography measurements showed moderate agreement with APRI, FIB-4, and fair agreement with King’s score. The AUROC for differentiating F0-F1, F2-F3, F2-F3, and F4 are 0.873 and 0.504 respectively using APRI as reference standard. The cutoff values derived for differentiating F0-F1 and F2-F3 was 7.07 and for differentiating F2-F3 and F4 was 11.94. Conclusion: The diagnostic performance of shear wave elastography is comparable with that of serum fibrosis indices APRI and FIB-4.
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Affiliation(s)
- Sravya Bellamkonda
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Samir M. Paruthikunnan
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Rajagopal Kadavigere
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Smiti Sripathi
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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16
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Sobhy A, Fakhry M M, A Azeem H, Ashmawy AM, Omar Khalifa H. Significance of biglycan and osteopontin as non-invasive markers of liver fibrosis in patients with chronic hepatitis B virus and chronic hepatitis C virus. J Investig Med 2018; 67:681-685. [PMID: 30385593 DOI: 10.1136/jim-2018-000840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2018] [Indexed: 12/17/2022]
Abstract
Several studies were performed to evaluate the degree of liver fibrosis by non-invasive markers. We aimed to assess the diagnostic value of both biglycan (BGN) and osteopontin (OPN) as non-invasive markers of hepatic fibrosis in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). This study was performed on 100 patients with CHB virus, 100 patients with CHC virus and 100 normal controls. All participants were subjected to the following laboratory tests: hemoglobin, platelet, alanine aminotransferase, aspartate aminotransferase, albumin, international normalized ratio, HBs Ag, hepatitis C virus (HCV) antibody, hepatitis B virus DNA, HCV RNA, liver biopsy, BGN and OPN. We found that BGN level was significantly increased in the CHB group compared with the controls (p<0.001), but the level was not different between the CHC group and the controls (p<0.96). OPN was increased in both the CHB and CHC groups compared with the controls (p<0.001). Positive correlation was found between fibrosis stages and BGN level of the CHB group (r=0.64; p<0.001) and between fibrosis stages and OPN level of the CHB (r=0.63; p<0.001) and CHC (r=0.59; p<0.03) groups. The area under the curve (AUC), sensitivity and specificity of BGN were 1.0, 100% and 100% in predicting fibrosis in patients with CHB, and 0.50, 26% and 78% in predicting fibrosis in patients with CHC. OPN had an AUC of 0.997, sensitivity of 96% and specificity of 100% in predicting fibrosis in patients with CHB, and 0.974, 96.5% and 100% in predicting fibrosis in patients with CHC. In conclusion, BGN and OPN could be considered non-invasive markers for liver fibrosis assessment.
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Affiliation(s)
- Ali Sobhy
- Clinical Pathology Department., Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Mohammed Fakhry M
- Gastroenterology and Hepatology Department, Faculty of Medicine., Al-Azhar University, Assiut
| | - Haitham A Azeem
- Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Ahmed M Ashmawy
- Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hamed Omar Khalifa
- Public Health andCommunity Medicine Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
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17
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Schachter JL, Patel M, Horton SR, Mike Devane A, Ewing A, Abrams GA. FibroSURE and elastography poorly predict the severity of liver fibrosis in Fontan-associated liver disease. CONGENIT HEART DIS 2018; 13:764-770. [PMID: 30101472 DOI: 10.1111/chd.12650] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/24/2018] [Accepted: 06/10/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE As the population of patients with Fontan circulation surviving into adulthood increases, hepatic cirrhosis has grown to be a significant cause of morbidity and mortality. Early detection of advanced hepatic fibrosis is imperative for proper intervention and consideration for heart or combined heart/liver transplantation. Noninvasive biomarkers and elastography have been evaluated for their diagnostic utility with variable results in the Fontan population. DESIGN The cohort included 14 patients age 26.4 SD 7.5 who underwent Fontan surgery. All patients were evaluated with FibroSURE, shear wave elastography (SWE), hepatic duplex sonography, and liver biopsy. Liver fibrosis on biopsy was evaluated according to the congestive hepatic fibrosis system. RESULTS In our cohort, 100% of patients had fibrosis with 36% demonstrating advanced fibrosis. FibroSURE agreed with liver biopsy in only 5 out of 14 cases (36%): underestimating in 7 and overestimating in 2 individuals. SWE agreed with liver biopsy in 0% of cases: overestimating in 10 and underestimating in 4 cases. None of the duplex sonography indices predicted the presence or severity of liver fibrosis. CONCLUSION This study demonstrates that children who have undergone a Fontan procedure universally develop some hepatic fibrosis and a significant number have advanced fibrosis by adulthood. The FibroSURE blood test, SWE, and hepatic duplex sonography were unable to accurately predict the presence or severity of hepatic fibrosis when compared with liver biopsy. Further studies are needed to investigate novel noninvasive methods and/or biomarkers that can adequately detect advanced hepatic fibrosis before the development of cirrhosis and hepatic decompensation.
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Affiliation(s)
- Jessica L Schachter
- Department of Medicine, Greenville Memorial Hospital, Greenville, South Carolina
| | - Manisha Patel
- Department of Cardiology, Greenville Memorial Hospital, Greenville, South Carolina
| | - Samuel R Horton
- Department of Pathology, Greenville Memorial Hospital, Greenville, South Carolina
| | - A Mike Devane
- Department of Radiology, Greenville Memorial Hospital, Greenville, South Carolina
| | - Alex Ewing
- Department of Quality, Greenville Memorial Hospital, Greenville, South Carolina
| | - Gary A Abrams
- Department of Gastroenterology, Greenville Memorial Hospital, Greenville, South Carolina
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18
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Mebus S, Nagdyman N, Kügel J, Zachoval R, Braun SL, Haverkämper G, Opgen-Rhein B, Berger F, Horster S, Schoetzau J, Salvador CP, Bauer U, Hess J, Ewert P, Kaemmerer H. Non-invasive assessment of liver changes in Eisenmenger patients. Int J Cardiol 2018; 249:140-144. [PMID: 29121718 DOI: 10.1016/j.ijcard.2017.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Eisenmenger syndrome as a severe form of cyanotic congenital heart disease results in a complex multisystemic disorder. Due to increased systemic venous pressure and the inability to ensure systemic perfusion and metabolic requirements, the liver may develop congestion, fibrosis or cirrhosis. This study aimed to assess hepatic abnormalities in Eisenmenger patients non-invasively. METHODS AND RESULTS 10 adults with Eisenmenger syndrome (six female; median age 44.2years; range 23-62years) were enrolled and hepatic involvement was assessed - using clinical assessment, laboratory analysis, hepatic fibrotic markers, abdominal sonography and liver stiffness measurements (transient elastography (TE) and acoustic radiation force impulse imaging (ARFI)). Using imaging and laboratory analysis, 60% (6/10) of the Eisenmenger patients had signs of liver fibrosis (5/10) or cirrhosis (1/10). While TE, however, showed no relevant liver abnormalities in any Eisenmenger patient, ARFI detected liver fibrosis in 5/10 and cirrhosis and 1/10 patients. CONCLUSIONS Adult Eisenmenger patients are at increased risk of hepatic impairment. Non-invasive screening could be helpful in detecting liver alterations. In our small series, however, TE could not detect fibrosis or cirrhosis in any affected patient, while ARFI was very reliable. Patients should be transferred to centres, where a multidisciplinary expert knowledge is available and a close collaboration between cardiologists and hepatologists exists.
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Affiliation(s)
- Siegrun Mebus
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Nicole Nagdyman
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Johanna Kügel
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Reinhart Zachoval
- Department of Gastroenterology and Hepatology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Siegmund Lorenz Braun
- Institute of Laboratory Medicine, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Guido Haverkämper
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Opgen-Rhein
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin and Charité Universitätsmedizin Berlin, Berlin, Germany; DZHK (German Cardiovascular Research Centre), partner site Berlin, Berlin, Germany
| | - Sophia Horster
- Department of Gastroenterology and Hepatology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jörg Schoetzau
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Claudia Pujol Salvador
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Ulrike Bauer
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - John Hess
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany.
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19
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Liu J, Ren W, Ai H, Dun G, Ji Y, Zhang Y, Wan Q, Lin S. Acoustic Structure Quantification Versus Point Shear Wave Speed Measurement for the Assessment of Liver Fibrosis in Viral Hepatitis B. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1177-1186. [PMID: 29609809 DOI: 10.1016/j.ultrasmedbio.2018.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 12/05/2017] [Accepted: 02/22/2018] [Indexed: 06/08/2023]
Abstract
This study was conducted to evaluate the value of acoustic structure quantification (ASQ) technology versus that of point shear wave speed measurement (PSWSM) imaging technology for the assessment of liver fibrosis stage. A total of 104 patients with chronic hepatitis B (CHB) and 30 healthy control patients underwent ASQ and PSWSM examinations. Seven quantitative parameters were obtained from ASQ, and a principal component analysis was used to establish the integrative indicators. A quantitative parameter, known as the shear wave speed (SWS, m/s), was obtained from the PSWSM. The METAVIR scores for the assessment of pathologic liver fibrosis were used as a benchmark. Liver fibrosis stages exhibited a good correlation with the integrative indicators and SWS (r = 0.682, p <0.001; r = 0.651, p <0.001). The areas under the receiver operating characteristic curves for ASQ and PSWSM were 0.705 and 0.854 for mild liver fibrosis (F ≥ 1, p = 0.045), 0.813 and 0.743 for significant liver fibrosis (F ≥ 2, p = 0.115), 0.839 and 0.857 for severe liver fibrosis (F ≥ 3, p = 0.417) and 0.874 and 0.971 for liver cirrhosis (F = 4, p = 0.016), respectively. In conclusion, both ASQ and PSWSM were promising ultrasonic methods for assessing liver fibrosis in patients with CHB; however, PSWSM was more valuable for identifying mild liver fibrosis (F ≥ 1) and cirrhosis (F = 4) than ASQ, and the combination of PSWSM and ASQ improved the accuracy of diagnosing severe liver fibrosis (F ≥ 3).
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Affiliation(s)
- Jianxue Liu
- Department of Infectious Disease, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, China; Department of Ultrasonography, Baoji Central Hospital, Baoji, China
| | - Wei Ren
- Department of Infectious Disease, Baoji Central Hospital, Baoji, China
| | - Hong Ai
- Department of Ultrasonography, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, China
| | - Guoliang Dun
- Department of Ultrasonography, Baoji Central Hospital, Baoji, China
| | - Yonghao Ji
- Department of Ultrasonography, Baoji Central Hospital, Baoji, China
| | - Yaoren Zhang
- Department of Ultrasonography, Baoji Central Hospital, Baoji, China
| | - Qinyun Wan
- Department of Ultrasonography, Baoji Central Hospital, Baoji, China
| | - Shumei Lin
- Department of Infectious Disease, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, China.
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20
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Omran D, Zayed RA, Nabeel MM, Mobarak L, Zakaria Z, Farid A, Hassany M, Saif S, Mostafa M, Saad OK, Yosry A. Evaluating Diagnostic Accuracy of Noninvasive Tests in Assessment of Significant Liver Fibrosis in Chronic Hepatitis C Egyptian Patients. Viral Immunol 2018; 31:315-320. [PMID: 29630460 DOI: 10.1089/vim.2017.0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Stage of liver fibrosis is critical for treatment decision and prediction of outcomes in chronic hepatitis C (CHC) patients. We evaluated the diagnostic accuracy of transient elastography (TE)-FibroScan and noninvasive serum markers tests in the assessment of liver fibrosis in CHC patients, in reference to liver biopsy. One-hundred treatment-naive CHC patients were subjected to liver biopsy, TE-FibroScan, and eight serum biomarkers tests; AST/ALT ratio (AAR), AST to platelet ratio index (APRI), age-platelet index (AP index), fibrosis quotient (FibroQ), fibrosis 4 index (FIB-4), cirrhosis discriminant score (CDS), King score, and Goteborg University Cirrhosis Index (GUCI). Receiver operating characteristic curves were constructed to compare the diagnostic accuracy of these noninvasive methods in predicting significant fibrosis in CHC patients. TE-FibroScan predicted significant fibrosis at cutoff value 8.5 kPa with area under the receiver operating characteristic (AUROC) 0.90, sensitivity 83%, specificity 91.5%, positive predictive value (PPV) 91.2%, and negative predictive value (NPV) 84.4%. Serum biomarkers tests showed that AP index and FibroQ had the highest diagnostic accuracy in predicting significant liver fibrosis at cutoff 4.5 and 2.7, AUROC was 0.8 and 0.8 with sensitivity 73.6% and 73.6%, specificity 70.2% and 68.1%, PPV 71.1% and 69.8%, and NPV 72.9% and 72.3%, respectively. Combined AP index and FibroQ had AUROC 0.83 with sensitivity 73.6%, specificity 80.9%, PPV 79.6%, and NPV 75.7% for predicting significant liver fibrosis. APRI, FIB-4, CDS, King score, and GUCI had intermediate accuracy in predicting significant liver fibrosis with AUROC 0.68, 0.78, 0.74, 0.74, and 0.67, respectively, while AAR had low accuracy in predicting significant liver fibrosis. TE-FibroScan is the most accurate noninvasive alternative to liver biopsy. AP index and FibroQ, either as individual tests or combined, have good accuracy in predicting significant liver fibrosis, and are better combined for higher specificity.
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Affiliation(s)
- Dalia Omran
- 1 Department of Endemic Medicine and Hepato-Gastroenterology, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Rania A Zayed
- 2 Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Mohammed M Nabeel
- 1 Department of Endemic Medicine and Hepato-Gastroenterology, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Lamiaa Mobarak
- 3 Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute , Cairo, Egypt
| | - Zeinab Zakaria
- 1 Department of Endemic Medicine and Hepato-Gastroenterology, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Azza Farid
- 3 Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute , Cairo, Egypt
| | - Mohamed Hassany
- 3 Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute , Cairo, Egypt
| | - Sameh Saif
- 3 Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute , Cairo, Egypt
| | - Muhammad Mostafa
- 4 Endemic Medicine Department, Ahmed Maher Hospital , Cairo, Egypt
| | | | - Ayman Yosry
- 1 Department of Endemic Medicine and Hepato-Gastroenterology, Faculty of Medicine, Cairo University , Cairo, Egypt
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SHFI: A Novel Noninvasive Predictive Model for Significant Fibrosis in Patients With Chronic Hepatitis B. HEPATITIS MONTHLY 2018. [DOI: 10.5812/hepatmon.63310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Performance of transient elastography and serum fibrosis biomarkers for non-invasive evaluation of recurrent fibrosis after liver transplantation: A meta-analysis. PLoS One 2017; 12:e0185192. [PMID: 28953939 PMCID: PMC5617176 DOI: 10.1371/journal.pone.0185192] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/07/2017] [Indexed: 02/06/2023] Open
Abstract
Recurrent fibrosis after liver transplantation (LT) impacts on long-term graft and patient survival. We performed a meta-analysis to compare the accuracy of non-invasive methods to diagnose significant recurrent fibrosis (stage F2-F4) following LT. Studies comparing serum fibrosis biomarkers, namely AST-to-platelet ratio index (APRI), fibrosis score 4 (FIB-4), or transient elastography (TE) with liver biopsy in LT recipients were systematically identified through electronic databases. In the meta-analysis, we calculated the weighted pooled odds ratio and used a fixed effect model, as there was no significant heterogeneity between studies. Eight studies were included for APRI, four for FIB-4, and twelve for TE. The mean prevalence of significant liver fibrosis was 37.4%. The summary odds ratio was significantly higher for TE (21.17, 95% CI confidence interval 14.10–31.77, p = 1X10-30) as compared to APRI (9.02, 95% CI 5.79–14.07; p = 1X10-30) and FIB-4 (7.08, 95% CI 4.00–12.55; p = 1.93X10-11). In conclusion, TE performs best to diagnose recurrent fibrosis in LT recipients. APRI and FIB-4 can be used as an estimate of significant fibrosis at centres where TE is not available. Longitudinal assessment of fibrosis by means of these non-invasive tests may reduce the need for liver biopsy.
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Incidence and Predictors of Advanced Liver Fibrosis by a Validated Serum Biomarker in Liver Transplant Recipients. Can J Gastroenterol Hepatol 2017; 2017:4381864. [PMID: 28409147 PMCID: PMC5376470 DOI: 10.1155/2017/4381864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/13/2015] [Indexed: 12/29/2022] Open
Abstract
Background and Aims. Serum fibrosis biomarkers have shown good accuracy in the liver transplant (LT) population. We employed a simple serum biomarker to elucidate incidence and predictors of advanced fibrosis after LT over a long follow-up period. Methods. We included 440 consecutive patients who underwent LT between 1991 and 2013. Advanced liver fibrosis was defined as FIB-4 > 3.25 beyond 12 months after LT. Results. Over 2030.5 person-years (PY) of follow-up, 189 (43%) developed FIB-4 > 3.25, accounting for an incidence of 9.3/100 PY (95% confidence interval [CI], 8.1-10.7). Advanced fibrosis was predicted by chronic HCV infection (adjusted hazard ratio (aHR) = 3.96, 95% CI 2.92-5.36, p < 0.001), hypoalbuminemia (aHR = 2.31, 95% CI 1.72-3.09; p < 0.001), and hyponatremia (aHR = 1.48, 95% CI 1.09-2.01; p = 0.01). LT recipients with more than 1 predictor had a higher incidence of advanced fibrosis, the highest being when all 3 predictors coexisted (log-rank: p < 0.001). Conclusions. Chronic HCV infection, hypoalbuminemia, and hyponatremia predict progression to advanced liver fibrosis following LT. Patients with these risk factors should be serially monitored using noninvasive fibrosis biomarkers and prioritized for interventions.
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Lin CL, Kao JH. New perspectives of biomarkers for the management of chronic hepatitis B. Clin Mol Hepatol 2016; 22:423-431. [PMID: 28081591 PMCID: PMC5266347 DOI: 10.3350/cmh.2016.0069] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022] Open
Abstract
With recent advances in molecular and genomic investigations, the impact of hepatitis B viral and host factors on the progression of chronic HBV infection has been explored. For viral factors, hepatitis B viral load is a strong predictor for liver disease progression. Hepatitis B viral kinetics appear to be important for successful anti-viral therapy. Serum HBsAg level serves as a complementary marker to viral load for the prediction of HBV-related adverse outcomes in patients with low viral load. In those with low viral load, high serum HBsAg level is associated with higher risks of cirrhosis and HCC. Hepatitis B core-related antigen (HBcrAg) induces host immune responses, and the reduction of the HBcrAg level as well as the increment of total anti-HBc level are significantly associated with favorable outcomes. HBV genotypes (genotype C/D) and mutants (basal core promoter and deletion mutation in pre-S genes) are well known viral genetic markers to predict disease progression. For host factors, serum inflammatory biomarkers have been developed to evaluate the HBV-associated hepatic necroinflammation and fibrosis. Host single nucleotide polymorphism on sodium taurocholate cotransporting polypeptide (NTCP, an HBV entry receptor) may be associated with a decreased risk for cirrhosis and HCC. In conclusion, patients with chronic hepatitis B should be evaluated with relevant viral and host markers to identify those who are at a higher risk of liver disease progression and then receive timely antiviral therapy.
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Affiliation(s)
- Chih-Lin Lin
- Department of Gastroenterology, Renai branch, Taipei City Hospital, Taipei, Taiwan.,Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Research, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan
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Zhuang Y, Ding H, Zhang Y, Sun H, Xu C, Wang W. Two-dimensional Shear-Wave Elastography Performance in the Noninvasive Evaluation of Liver Fibrosis in Patients with Chronic Hepatitis B: Comparison with Serum Fibrosis Indexes. Radiology 2016; 283:873-882. [PMID: 27982760 DOI: 10.1148/radiol.2016160131] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose To investigate the value of two-dimensional (2D) shear-wave elastography (SWE) in the assessment of hepatic fibrosis in patients with chronic hepatitis B (CHB) and to compare the diagnostic performance of this modality with that of liver fibrosis indexes. Materials and Methods The ethics committee approved this study, and informed consent was obtained. From July 2015 to May 2016, 539 subjects who underwent partial hepatectomy were divided into groups according to the Scheuer system by using a resected liver specimen. All patients were examined with 2D SWE and underwent preoperative serologic testing to measure liver stiffness and values of serum fibrosis models, which were compared with histologic findings. Performance of noninvasive methods was determined for index (304 patients) and validation (155 patients) cohorts by using areas under the receiver operating characteristic curve (AUCs). Results For association with substantial fibrosis (≥S2), severe fibrosis (≥S3), and cirrhosis (S4) in the index cohort, the optimal cutoff values of liver stiffness were 7.6, 9.2, and 10.4 kPa, respectively, and AUC values were 0.97, 0.96, and 0.98, respectively. The 2D SWE findings, aspartate transaminase-to-platelet ratio index (APRI), fibrosis index based on the four factors (FIB-4), King's score, and Forns index significantly correlated with hepatic fibrosis stages (ρ = 0.88, ρ = 0.41, ρ = 0.40, ρ = 0.43 and ρ = 0.45, respectively; P < .05). The AUCs for APRI, FIB-4, King's score, and Forns index were 0.77, 0.73, 0.79, and 0.77, respectively, in the diagnosis of substantial fibrosis and 0.70, 0.71, 0.72, and 0.74, respectively, in the diagnosis of cirrhosis. In the validation cohort, AUCs of noninvasive methods used to assess different fibrosis stages did not significantly differ from those for the index cohort. AUCs of 2D SWE in the diagnosis of substantial fibrosis, severe fibrosis, and cirrhosis were 0.97, 0.97, and 0.98, respectively, which were significantly higher than those in serum models (P < .05). Conclusion The 2D SWE protocol could be used to predict substantial fibrosis, severe fibrosis, and cirrhosis in patients with CHB with notably higher diagnostic accuracy than that attained with serum fibrosis models. © RSNA, 2016.
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Affiliation(s)
- Yuan Zhuang
- From the Departments of Ultrasound (Y. Zhuang, H.D., Y. Zhang, W.W.), Surgery (H.S.), and Pathology (C.X.), Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China
| | - Hong Ding
- From the Departments of Ultrasound (Y. Zhuang, H.D., Y. Zhang, W.W.), Surgery (H.S.), and Pathology (C.X.), Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China
| | - Yue Zhang
- From the Departments of Ultrasound (Y. Zhuang, H.D., Y. Zhang, W.W.), Surgery (H.S.), and Pathology (C.X.), Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China
| | - Huichuan Sun
- From the Departments of Ultrasound (Y. Zhuang, H.D., Y. Zhang, W.W.), Surgery (H.S.), and Pathology (C.X.), Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China
| | - Chen Xu
- From the Departments of Ultrasound (Y. Zhuang, H.D., Y. Zhang, W.W.), Surgery (H.S.), and Pathology (C.X.), Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China
| | - Wenping Wang
- From the Departments of Ultrasound (Y. Zhuang, H.D., Y. Zhang, W.W.), Surgery (H.S.), and Pathology (C.X.), Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China
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AST/ALT ratio is not useful in predicting the degree of fibrosis in chronic viral hepatitis patients. Eur J Gastroenterol Hepatol 2015; 27:1361-6. [PMID: 26352130 DOI: 10.1097/meg.0000000000000468] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM Noninvasive tests are primarily used for staging hepatic fibrosis in patients with chronic liver disease. In clinical practice, serum aminotransferase levels, coagulation parameters, and platelet count have been used to predict whether or not a patient has cirrhosis. In addition, several studies have evaluated the accuracy of combinations (or ratios) of these measures. The present study aimed to investigate the relationship between five noninvasive models [AST/ALT ratio (AAR), aspartate aminotransferase to platelet ratio index (APRI), Bonacini cirrhosis discriminant score (CDS), age-platelet index (APind), and King's score] and the degree of hepatic fibrosis as determined by biopsy in patients with chronic hepatitis B and C. PATIENTS AND METHODS A total of 380 patients with viral hepatitis (237 with chronic hepatitis B and 143 with chronic hepatitis C) who were seen at our clinic between January 2005 and January 2011 were retrospectively analyzed. The degree of fibrosis was determined using the Ishak score. Patients with a fibrosis score of 0-2 were considered to have low fibrosis and those with a score between 3 and 6 were considered to have high fibrosis. Five noninvasive models were compared between the groups with low and high fibrosis. RESULTS There were statistically significant differences between the hepatitis B and C patients with high and low fibrosis with respect to APind (4.49±2.35 vs. 2.41±1.84; P<0.001 in hepatitis B and 4.83±2.25 vs. 2.92±1.88; P<0.001 in hepatitis C), APRI (1.00±1.17 vs. 0.47±0.39; P<0.001 in hepatitis B and 1.01±1.01 vs. 0.41±0.29; P<0.001 in hepatitis C), CDS (4.53±1.90 vs. 3.58±1.30; P<0.001 in hepatitis B and 4.71±2.03 vs. 3.42±1.49; P<0.05 in hepatitis C), and King's score (24.31±3.14 vs. 7.65±6.70; P<0.001 in hepatitis B and 24.82±2.55 vs. 8.33±7.29; P<0.001 in hepatitis C). There were no significant differences in the AAR between the hepatitis B and C patients with high and low fibrosis (0.78±0.31 vs. 0.74±0.34; P=0.082 in hepatitis B and 0.91±0.40 vs. 0.85±0.27; P=0.25 in hepatitis C). The area under the receiver-operating characteristic curve of the APind, APRI, CDS, and King's score in the hepatitis B group were 0.767, 0.710, 0.646, and 0.770, respectively; these values were 0.732, 0.763, 0.677, and 0.783, respectively, in the hepatitis C group. CONCLUSION In conclusion, our data suggest that four of the five noninvasive methods evaluated in this study can be used to predict advanced fibrosis in patients with hepatitis B and C. However, there was no significant relationship between the degree of hepatic fibrosis and the AAR score, indicating that AAR is not useful in estimating the fibrosis stage in hepatitis B and C patients.
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Orasan OH, Iancu M, Sava M, Saplontai-Pop A, Cozma A, Sarlea ST, Lungoci C, Ungureanu MI, Negrean V, Sampelean D, Dumitrascu DL. Non-invasive assessment of liver fibrosis in chronic viral hepatitis. Eur J Clin Invest 2015; 45:1243-51. [PMID: 26426402 DOI: 10.1111/eci.12543] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/25/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hyaluronic acid (HA), ASAT to Platelet Ratio Index (APRI), ASAT/ALAT ratio, Fibrosis 4 score (FIB4) and FibroScan were studied as non-invasive markers of liver fibrosis (F) in chronic viral hepatitis B (CHB) and C (CHC), in an attempt to avoid the complications of liver puncture biopsy, considered the gold standard in the evaluation of F. The aim of our research was to study whether HA, APRI, ASAT/ALAT ratio, FIB4 and FibroScan are useful non-invasive markers in predicting severe F in Romanian patients. PATIENTS AND METHODS This was a prospective multicenter transversal and observational study, which included 76 patients with CHB/CHC. The independent effect of studied markers was tested using multiple binary logistic regression. RESULTS In patients with CHB and CHC, the APRI cut-off value for F4 was 0·70 ng/mL (Se = 77%, Sp = 78%), the FIB4 cut-off value was 2·01 (Se = 77%, Sp = 69%), and the FibroScan cut-off value was 13·15 (Se = 92%, Sp = 88%). For patients with CHB/CHC, there was a significant linear positive correlation between F and HA (r = 0·42, P = 0·001), FibroScan (r = 0·67, P < 0·001), APRI (r = 0·46, P < 0·001) and FIB4 (r = 0·51, P < 0·001). Considering age, sex and body mass index as possible confounding factors or covariates in multivariable logistic modelling, FibroScan was the unique test that able to significantly highlight the presence of F4 score in CHB/CHC patients (P = 0·009) while FIB4 test seems to have a tendency to statistical significance. CONCLUSION FibroScan, APRI and FIB4 are useful non-invasive tests for the evaluation of F4 in patients with CHB and CHC.
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Affiliation(s)
- Olga H Orasan
- 4th Medical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Iancu
- Medical Informatics and Biostatistics, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Madalina Sava
- 4th Medical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Angela Cozma
- 4th Medical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Corneliu Lungoci
- 4th Surgical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marius-Ionut Ungureanu
- Department of Public Health and Management, University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Vasile Negrean
- 4th Medical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dorel Sampelean
- 4th Medical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Thavorn K, Coyle D. Transient Elastography and Controlled Attenuation Parameter for Diagnosing Liver Fibrosis and Steatosis in Ontario: An Economic Analysis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2015; 15:1-58. [PMID: 26664666 PMCID: PMC4664940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Liver fibrosis is characterized by a buildup of connective tissue due to chronic liver damage. Steatosis is the collection of excessive amounts of fat inside liver cells. Liver biopsy remains the gold standard for the diagnosis of liver fibrosis and steatosis, but its use as a diagnostic tool is limited by its invasive nature and high cost. OBJECTIVES To evaluate the cost-effectiveness and budget impact of transient elastography (TE) with and without controlled attenuation parameter (CAP) for the diagnosis of liver fibrosis or steatosis in patients with hepatitis B, hepatitis C, alcoholic liver disease, and nonalcoholic fatty liver disease. DATA SOURCES An economic literature search was performed using computerized databases. For primary economic and budget impact analyses, we obtained data from various sources, such as the Health Quality Ontario evidence-based analysis, published literature, and the Institute for Clinical Evaluative Sciences. REVIEW METHODS A systematic review of existing TE cost-effectiveness studies was conducted, and a primary economic evaluation was undertaken from the perspective of the Ontario Ministry of Health and Long-Term Care. Decision analytic models were used to compare short-term costs and outcomes of TE compared to liver biopsy. Outcomes were expressed as incremental cost per correctly diagnosed cases gained. A budget impact analysis was also conducted. RESULTS We included 10 relevant studies that evaluated the cost-effectiveness of TE compared to other noninvasive tests and to liver biopsy; no cost-effectiveness studies of TE with CAP were identified. All studies showed that TE was less expensive but associated with a decrease in the number of correctly diagnosed cases. TE also improved quality-adjusted life-years in patients with hepatitis B and hepatitis C. Our primary economic analysis suggested that TE led to cost savings but was less effective than liver biopsy in the diagnosis of liver fibrosis. TE became more economically attractive with a higher degree of liver fibrosis. TE with CAP was also less expensive and less accurate than liver biopsy. LIMITATIONS The model did not take into account long-term costs and consequences associated with TE and liver biopsy and did not include costs to patients and their families, or patient preferences related to diagnostic information. CONCLUSIONS TE showed potential cost savings compared to liver biopsy. Further investigation is needed to determine the long-term impacts of TE on morbidity and mortality in Canada and the optimal diagnostic modality for liver fibrosis and steatosis.
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Bhat M, Ghali P, Rollet-Kurhajec KC, Bhat A, Wong P, Deschenes M, Sebastiani G. Serum fibrosis biomarkers predict death and graft loss in liver transplantation recipients. Liver Transpl 2015; 21:1383-94. [PMID: 26194602 DOI: 10.1002/lt.24217] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 06/25/2015] [Accepted: 07/05/2015] [Indexed: 12/11/2022]
Abstract
Noninvasive serum fibrosis biomarkers predict clinical outcomes in pretransplant patients with chronic liver disease. We investigated the role of serum fibrosis biomarkers and of changes in biomarkers in predicting death and graft loss after liver transplantation (LT). We included 547 patients who underwent LT between 1991 and 2012 and who met the following criteria: patient and graft survival > 12 months; serum fibrosis biomarkers aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis score 4 (FIB-4), and nonalcoholic fatty liver disease (NAFLD) fibrosis score available at 1 year after LT; and a minimum follow-up of 1 year. Delta of fibrosis biomarkers was defined as (end of follow-up score--baseline score)/follow-up duration. Baseline and delta fibrosis biomarkers were associated with death: APRI > 1.5 (adjusted hazard ratio [aHR], 2.2; 95% confidence interval [CI], 1.4-3.3; P < 0.001) and delta APRI > 0.5 (aHR, 5.3; 95% CI, 3.4-8.2; P < 0.001); FIB-4 > 3.3 (aHR, 1.9; 95% CI, 1.3-2.8; P = 0.002) and delta FIB-4 > 1.4 (aHR, 2.4; 95% CI, 1.4-4.1; P = 0.001); and NAFLD fibrosis score > 0.7 (aHR, 1.9; 95% CI, 1.3-2.9; P = 0.002) and delta NAFLD fibrosis score (aHR, 3.7; 95% CI, 2.6-5.4; P < 0.001). Baseline and delta fibrosis biomarkers were associated also with graft loss. In conclusion, serum fibrosis biomarkers 1 year after LT and changes in serum fibrosis biomarkers predict death and graft loss in LT recipients. They may help in risk stratification of LT recipients and identify patients requiring closer monitoring.
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Affiliation(s)
- Mamatha Bhat
- Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, Canada
| | - Peter Ghali
- Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, Canada
| | - Kathleen C Rollet-Kurhajec
- Chronic Viral Illness Service, Department of Medicine, McGill University Health Center, Montreal, Canada
| | - Aparna Bhat
- Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, Canada
| | - Philip Wong
- Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, Canada
| | - Marc Deschenes
- Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, Canada
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, Canada.,Chronic Viral Illness Service, Department of Medicine, McGill University Health Center, Montreal, Canada
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Intermediate fibrosis staging in hepatitis C: a problem not overcome by optimal samples or pathologists’ expertise. Ann Hepatol 2015. [DOI: 10.1016/s1665-2681(19)30759-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Abstract
GOALS/BACKGROUND Aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 index are noninvasive biomarkers to evaluate hepatic fibrosis. However, their usefulness in chronic hepatitis B (CHB) patients remains unclear. METHODS A total of 631 CHB patients were enrolled and randomly divided into a training set (n=420) and a validation set (n=211). Areas under receiver operating characteristic (AUROC) curves for FIB-4 index and APRI were compared to evaluate their diagnostic values in identifying significant fibrosis and cirrhosis. RESULTS The AUROC of FIB-4 index for the diagnosis of significant fibrosis and cirrhosis in the entire cohort was higher than that of APRI (0.769 vs. 0.704, P=0.0003 and 0.869 vs. 0.706, P<0.0001). By using cutoff APRI of 0.38 and 4.04 in the validation set, the diagnostic accuracy for absence of significant fibrosis and presence of cirrhosis was 67.7% and 76.8%. At cutoff FIB-4 index of 0.87 and 3.40 in the validation set, the diagnostic accuracy for absence of significant fibrosis and presence of cirrhosis was 69.2% and 84.4%. Compared with patients with concordance, patients with overestimated score by FIB-4 index had a significantly higher serum alanine aminotransferase (ALT) level (299±245 vs. 168±196 U/L, P=0.001) as well as a higher ratio of hepatitis flare (ALT>400 U/L) (25% vs. 7.9%, P=0.008). CONCLUSIONS FIB-4 index proves to be more reliable than APRI in predicting significant fibrosis and cirrhosis in CHB patients. By using FIB-4 index, a substantial proportion of patients could be identified correctly as significant fibrosis and cirrhosis without further invasive liver biopsy.
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Sebastiani G, Alshaalan R, Wong P, Rubino M, Salman A, Metrakos P, Deschenes M, Ghali P. Prognostic Value of Non-Invasive Fibrosis and Steatosis Tools, Hepatic Venous Pressure Gradient (HVPG) and Histology in Nonalcoholic Steatohepatitis. PLoS One 2015; 10:e0128774. [PMID: 26083565 PMCID: PMC4471234 DOI: 10.1371/journal.pone.0128774] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/30/2015] [Indexed: 02/07/2023] Open
Abstract
Background & Aims Non-invasive diagnostic methods for liver fibrosis predict clinical outcomes in viral hepatitis and nonalcoholic fatty liver disease (NAFLD). We specifically evaluated prognostic value of non-invasive fibrosis methods in nonalcoholic steatohepatitis (NASH) against hepatic venous pressure gradient (HVPG) and liver histology. Methods This was a retrospective cohort study of 148 consecutive patients who met the following criteria: transjugular liver biopsy with HVPG measurement; biopsy-proven NASH; absence of decompensation; AST-to-Platelets Ratio Index (APRI), fibrosis-4 (FIB-4), NAFLD fibrosis score, ultrasound, hepatic steatosis index and Xenon-133 scan available within 6 months from biopsy; a minimum follow-up of 1 year. Outcomes were defined by death, liver transplantation, cirrhosis complications. Kaplan–Meier and Cox regression analyses were employed to estimate incidence and predictors of outcomes, respectively. Prognostic value was expressed as area under the curve (AUC). Results During a median follow-up of 5 years (interquartile range 3-8), 16.2% developed outcomes, including 7.4% who died or underwent liver transplantation. After adjustment for age, sex, diabetes, the following fibrosis tools predicted outcomes: HVPG >10mmHg (HR=9.60; 95% confidence interval [CI] 3.07-30.12), histologic fibrosis F3-F4 (HR=3.14; 1.41-6.95), APRI >1.5 (HR=5.02; 1.6-15.7), FIB-4 >3.25 (HR=6.33; 1.98-20.2), NAFLD fibrosis score >0.676 (HR=11.9; 3.79-37.4). Prognostic value was as follows: histologic fibrosis stage, AUC=0.85 (95% CI 0.76-0.93); HVPG, AUC=0.81 (0.70-0.91); APRI, AUC=0.89 (0.82-0.96); FIB-4, AUC=0.89 (0.83-0.95); NAFLD fibrosis score, AUC=0.79 (0.69-0.91). Neither histologic steatosis nor non-invasive steatosis methods predicted outcomes (AUC<0.50). Conclusions Non-invasive methods for liver fibrosis predict outcomes of patients with NASH. They could be used for serial monitoring, risk stratification and targeted interventions.
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Affiliation(s)
- Giada Sebastiani
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- * E-mail:
| | - Rasha Alshaalan
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Philip Wong
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Maria Rubino
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ayat Salman
- Section of Hepatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter Metrakos
- Section of Hepatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc Deschenes
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter Ghali
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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Sun B, Li YG, Lan YH. Fibroscan for diagnosis and treatment of chronic liver disease. Shijie Huaren Xiaohua Zazhi 2015; 23:1433-1439. [DOI: 10.11569/wcjd.v23.i9.1433] [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] [Indexed: 02/06/2023] Open
Abstract
Liver biopsy is still the golden standard in the diagnosis of chronic liver diseases, but it is invasive, which limits its application. Therefore, the search for a reliable noninvasive diagnostic method has attracted more and more attention. Since Fibroscan (FS) was launched in 2003, scholars have paid more attention to this modality, because it is non-invasive, painless, rapid and objective. In this paper, we will review the value of FS in the diagnosis and treatment of chronic liver disease.
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Stefanescu H, Radu C, Procopet B, Lupsor-Platon M, Habic A, Tantau M, Grigorescu M. Non-invasive ménage à trois for the prediction of high-risk varices: stepwise algorithm using lok score, liver and spleen stiffness. Liver Int 2015; 35:317-25. [PMID: 25228102 DOI: 10.1111/liv.12687] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 08/23/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Liver stiffness (LS), spleen stiffness (SS) and serum markers have been proposed to non-invasively assess portal hypertension or oesophageal varices (EV) in cirrhotic patients. We aimed to evaluate the performance of a stepwise algorithm that combines Lok score with LS and SS for diagnosing high-risk EV (HREV) and to compare it with other already-validated non-invasive methods. METHODS We performed a cross-sectional study including 136 consecutive compensated cirrhotic patients with various aetiologies, divided into training (90) and validation (46) set. Endoscopy was performed within 6 months from inclusion for EV screening. Spleen diameter was assessed by ultrasonography. LS and SS were measured using Fibroscan. Lok score, platelet count/spleen diameter ratio, LSM-spleen diameter to platelet ratio score and oesophageal varices risk score (EVRS) were calculated and their diagnostic accuracy for HREV was assessed. The algorithm classified patients as having/not-having HREV. Its performance was tested and compared in both groups. RESULTS In the training set, all variables could select patients with HREV with moderate accuracy, the best being LSPS (AUROC = 0.818; 0.93 sensitivity; 0.63 specificity). EVRS, however, was the only independent predictor of HREV (OR = 1.521; P = 0.032). The algorithm correctly classified 69 (76.66%) patients in the training set (P < 0.0001) and 36 (78.26%) in the validation one. In the validation group, the algorithm performed slightly better than LSPS and EVRS, showing 100% sensitivity and negative predicted value. CONCLUSION The stepwise algorithm combining Lok score, LS and SS could be used to select patients at low risk of having HREV and who may benefit from more distanced endoscopic evaluation.
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Affiliation(s)
- Horia Stefanescu
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Silva Junior RG, Schmillevitch J, Nascimento MDFA, Miranda MLQ, Brant PEAC, Schulz PO, Vieira A, Szutan LA. Acoustic radiation force impulse elastography and serum fibrosis markers in chronic hepatitis C. Scand J Gastroenterol 2014; 49:986-92. [PMID: 24742130 DOI: 10.3109/00365521.2014.909528] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Liver biopsy (LB) remains the gold standard for the assessment of liver fibrosis, although it is invasive and can have complications. The present study compares several noninvasive methods of fibrosis assessment in chronic hepatitis C (CHC), including acoustic radiation force impulse (ARFI) elastography, aspartate aminotransferase:platelet ratio index (APRI), Forns, FIB-4, and King scores versus percutaneous LB. MATERIAL AND METHODS This prospective study enrolled 51 untreated CHC patients. Biological tests necessary for the calculation of the scores (according to the classic formulas) were performed within a week of LB. The time interval between LB and tissue stiffness, assessed according to the Metavir score, was <6 months. Cutoff values were determined using area under receiver-operating characteristic curves (AUROC). RESULTS The best test for predicting significant fibrosis (F ≥2 Metavir) was ARFI elastography with an AUROC of 0.90, followed by FIB-4 (AUROC = 0.86), King (AUROC = 0.85), Forns (AUROC = 0.84), and APRI (AUROC = 0.82). For a cutoff of 1.31 m/s, ARFI had 89.3% sensitivity (Se) and 87% specificity (Sp). The best test for predicting cirrhosis was ARFI elastography with an AUROC of 0.98, followed by FIB-4 (AUROC = 0.94), King (AUROC = 0.90), APRI (AUROC = 0.82), and Forns (AUROC = 0.81). For a cutoff of 1.95 m/s, ARFI had 100% Se and 95.2% Sp. CONCLUSION ARFI elastography had very good accuracy for the assessment of liver fibrosis. It was more effective than APRI, Forns, King, and FIB-4 scores for the prediction of significant fibrosis and cirrhosis in CHC patients.
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Affiliation(s)
- Roberto Gomes Silva Junior
- Liver and Portal Hypertension Group, Santa Casa de São Paulo School of Medical Sciences , São Paulo , Brazil
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Abstract
Chronic liver diseases of differing etiologies are among the leading causes of mortality and morbidity worldwide. Establishing accurate staging of liver disease is very important for enabling both therapeutic decisions and prognostic evaluations. A liver biopsy is considered the gold standard for assessing the stage of hepatic fibrosis, but it has many limitations. During the last decade, several noninvasive markers for assessing the stage of hepatic fibrosis have been developed. Some have been well validated and are comparable to liver biopsy. This paper will focus on the various noninvasive biochemical markers used to stage liver fibrosis.
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Feuth T, Arends JE, Lieveld FI, Mundt MW, Hoepelman AI, Siersema PD, van Erpecum KJ. Impact of transient elastography on clinical decision-making in patients with chronic viral hepatitis. Scand J Gastroenterol 2013; 48:1074-81. [PMID: 23886398 DOI: 10.3109/00365521.2013.819441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Transient elastography is a noninvasive tool to quantify liver fibrosis by liver stiffness measurements (LSMs). Previous studies have extensively evaluated the accuracy of LSMs compared to liver biopsy. In this retrospective study we explore potential impact of LSMs on clinical decisions in chronic viral hepatitis. MATERIAL AND METHODS LSM-based medical advice whether to start antiviral treatment and/or surveillance for hepatocellular carcinoma (HCC) and clinical follow-up after LSMs were analyzed in 349 patients. RESULTS In 20% of 184 hepatitis B virus (HBV)-infected patients and 38% of 165 hepatitis C virus (HCV)-infected patients, significant fibrosis (≥F2) was detected. In 5% (n = 7) of the 129 untreated HBV patients and in 12% (n = 19) of the HCV-infected patients, antiviral treatment was recommended solely based on LSMs. Advice for surveillance for HCC was in 40 patients based solely on LSMs (11% of all patients). Furthermore, 95% of 19 non-viremic HCV-patients (after spontaneous clearance or sustained viral response) could be discharged due to favorable LSMs (≤F2). Medical advice was followed by the treating physician in the majority of cases. However, in only 47% of 51 HCV-infected patients with advice to start treatment, this was followed in clinical practice. CONCLUSIONS Transient elastography has a major impact on clinical practice, both as an indication to start or postpone antiviral treatment, to start surveillance for HCC, and to discharge HCV patients from follow-up after viral clearance and favorable LSMs. Medical advice to start antiviral treatment is followed in the large majority of HBV patients, but in only half of HCV patients.
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Affiliation(s)
- Thijs Feuth
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
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Zarski JP, Sturm N, Guechot J, Zafrani ES, Vaubourdolle M, Thoret S, Margier J, David-Tchouda S, Bosson JL. Contribution of the ELFG test in algorithms of non-invasive markers towards the diagnosis of significant fibrosis in chronic hepatitis C. PLoS One 2013; 8:e59088. [PMID: 23555619 PMCID: PMC3605459 DOI: 10.1371/journal.pone.0059088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/11/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS We aimed to determine the best algorithms for the diagnosis of significant fibrosis in chronic hepatitis C (CHC) patients using all available parameters and tests. PATIENTS AND METHODS We used the database from our study of 507 patients with histologically proven CHC in which fibrosis was evaluated by liver biopsy (Metavir) and tests: Fibrometer®, Fibrotest®, Hepascore®, Apri, ELFG, MP3, Forn's, hyaluronic acid, tissue inhibitor of metalloproteinase-1 (TIMP1), MMP1, collagen IV and when possible Fibroscan™. For the first test we used 90% negative predictive value to exclude patients with F≤1, next an induction algorithm was applied giving the best tests with at least 80% positive predictive value for the diagnosis of F≥2. The algorithms were computed using the R Software C4.5 program to select the best tests and cut-offs. The algorithm was automatically induced without premises on the part of the investigators. We also examined the inter-observer variations after independent review of liver biopsies by two pathologists. A medico-economic analysis compared the screening strategies with liver biopsy. RESULTS In "intention to diagnose" the best algorithms for F≥2 were Fibrometer ®, Fibrotest®, or Hepascore® in first intention with the ELFG score in second intention for indeterminate cases. The percentage of avoided biopsies varied between 50% (Fibrotest® or Fibrometer®+ELFG) and 51% (Hepascore®+ELFG). In "per-analysis" Fibroscan™+ELFG avoided liver biopsy in 55% of cases. The diagnostic performance of these screening strategies was statistically superior to the usual combinations (Fibrometer® or Fibrotest®+Fibroscan™) and was cost effective. We note that the consensual review of liver biopsies between the two pathologists was mainly in favor of F1 (64-69%). CONCLUSION The ELFG test could replace Fibroscan in most currently used algorithms for the diagnosis of significant fibrosis including for those patients for whom Fibroscan™ is unusable.
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Affiliation(s)
- Jean-Pierre Zarski
- Hepato-Gastroenterology Clinic, DIGIDUNE Pole, Grenoble University Hospital, Grenoble, France.
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Contribution of the ELFG test in algorithms of non-invasive markers towards the diagnosis of significant fibrosis in chronic hepatitis C. PLoS One 2013. [PMID: 23555619 DOI: 10.1371/journal.pone.0059088.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS We aimed to determine the best algorithms for the diagnosis of significant fibrosis in chronic hepatitis C (CHC) patients using all available parameters and tests. PATIENTS AND METHODS We used the database from our study of 507 patients with histologically proven CHC in which fibrosis was evaluated by liver biopsy (Metavir) and tests: Fibrometer®, Fibrotest®, Hepascore®, Apri, ELFG, MP3, Forn's, hyaluronic acid, tissue inhibitor of metalloproteinase-1 (TIMP1), MMP1, collagen IV and when possible Fibroscan™. For the first test we used 90% negative predictive value to exclude patients with F≤1, next an induction algorithm was applied giving the best tests with at least 80% positive predictive value for the diagnosis of F≥2. The algorithms were computed using the R Software C4.5 program to select the best tests and cut-offs. The algorithm was automatically induced without premises on the part of the investigators. We also examined the inter-observer variations after independent review of liver biopsies by two pathologists. A medico-economic analysis compared the screening strategies with liver biopsy. RESULTS In "intention to diagnose" the best algorithms for F≥2 were Fibrometer ®, Fibrotest®, or Hepascore® in first intention with the ELFG score in second intention for indeterminate cases. The percentage of avoided biopsies varied between 50% (Fibrotest® or Fibrometer®+ELFG) and 51% (Hepascore®+ELFG). In "per-analysis" Fibroscan™+ELFG avoided liver biopsy in 55% of cases. The diagnostic performance of these screening strategies was statistically superior to the usual combinations (Fibrometer® or Fibrotest®+Fibroscan™) and was cost effective. We note that the consensual review of liver biopsies between the two pathologists was mainly in favor of F1 (64-69%). CONCLUSION The ELFG test could replace Fibroscan in most currently used algorithms for the diagnosis of significant fibrosis including for those patients for whom Fibroscan™ is unusable.
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Attallah AM, El-Far M, Omran MM, Farid K, Albannan MS, El-Dosoky I. Noninvasive diagnosis of liver fibrosis and cirrhosis in chronic hepatitis C patients. J Clin Lab Anal 2013; 27:121-9. [PMID: 23460258 DOI: 10.1002/jcla.21572] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/14/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We aimed to derive a simple noninvasive test for liver-fibrosis staging and then estimate its performance against four simple noninvasive tests in chronic hepatitis C (CHC) patients. METHODS CHC patients were divided into two cohorts: an estimation set (n = 324) and a validation set (n = 524). Liver fibrosis was staged according to the METAVIR scoring system. Statistical analysis was done using stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs). RESULTS Biotechnology Research Center (BRC) score was constructed combining several blood markers that proved useful to stage liver fibrosis. Aspartate aminotransferase /alanine aminotransferase ratio (AAR), aspartate to platelet ratio index (APRI), Fibro-α, King, and BRC scores correlated with the histological fibrosis stages with correlation coefficient 0.26, 0.36, 0.58, 0.45, and 0.73, respectively. BRC score produced AUCs 0.87, 0.83, and 0.89 for significant (F2-F4), advanced fibrosis (F3-F4), and cirrhosis (F4), respectively. These results were reproduced in the validation study with no significant difference yielding AUCs 0.85 for F2-F4, 0.82 for F3-F4, and 0.88 for F4. CONCLUSION BRC score, a novel noninvasive test, is a useful and easy tool to evaluate liver fibrosis in CHC patients and seems more efficient than AAR, APRI, Fibro-α score, and King's score in this group of Egyptian patients.
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Affiliation(s)
- Abdelfattah M Attallah
- Research & Development Department, Biotechnology Research Center, New Damietta City, Egypt.
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Purnak T, Olmez S, Torun S, Efe C, Sayilir A, Ozaslan E, Tenlik I, Kalkan IH, Beyazit Y, Yuksel O. Mean platelet volume is increased in chronic hepatitis C patients with advanced fibrosis. Clin Res Hepatol Gastroenterol 2013; 37:41-6. [PMID: 22572524 DOI: 10.1016/j.clinre.2012.03.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/18/2012] [Accepted: 03/28/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Liver biopsy is the gold standard procedure for documenting liver damage in chronic hepatitis C (CHC), as for many other chronic liver diseases. Mean platelet volume (MPV) is a laboratory marker obtained from complete blood count (CBC) analysers in routine clinical practice. The goal of the present study was to evaluate whether MPV would be useful in predicting liver histologic severity in CHC. PATIENTS AND METHODS A total of 59 patients with CHC and 25 control subjects were recruited into the present study. There were 26 men and 33 women in the CHC group and 12 men and 13 women in the control group. MPV was recorded at the time of admission. The clinical characteristics of CHC patients, including demographics, laboratory and liver biopsy findings, were reviewed. RESULTS A statistically significant increase in MPV values was observed in CHC patients (8.54 ± 0.63 fL) compared to healthy controls (7.65 ± 0.42 fL) (P < 0.001). Moreover, MPV values were significantly higher among patients with advanced fibrosis as compared to those with mild fibrosis (8.99 ± 0.57 fL vs. 8.19 ± 0.50 fL P < 0.001). Receiver operator characteristic (ROC) curve analysis suggested that the optimum cut-off point for MPV value in advanced fibrosis was 8.75 fL. (Sensitivity: 80.8%, specificity: 81.8%, positive predictive value [PPV] 77.8%, negative predictive value [NPV] 84.4%, accuracy 81.3%, AUC: 0.98 P < 0.001) CONCLUSION The current study showed that MPV is increased in CHC with advanced fibrosis. Calculation of MPV along with the use of other markers may give further information about liver fibrosis severity in CHC.
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Affiliation(s)
- Tugrul Purnak
- Department of Gastroenterology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Tsang JPK, Poon WL, Luk HM, Fung CW, Ching CK, Mak CM, Lam CW, Siu TS, Tam S, Wong VCN. Arginase deficiency with new phenotype and a novel mutation: contemporary summary. Pediatr Neurol 2012; 47:263-9. [PMID: 22964440 DOI: 10.1016/j.pediatrneurol.2012.06.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 06/20/2012] [Indexed: 10/27/2022]
Abstract
In areas without expanded newborn screening, instead of presenting neonatally, patients with arginase deficiency typically present with spastic paraplegia in early childhood. Diagnosis of this rare neurometabolic disease poses the first challenge because it is often misdiagnosed as cerebral palsy during initial stages. We describe arginase deficiency in a 20-year-old woman with spastic paraplegia, progressive dystonia, dementia, peripheral neuropathy, epilepsy, liver cirrhosis, and non-B/non-C hepatocellular carcinoma. A novel homozygous mutation NM_000045.2 (ARG1):c.673del (p.Arg225GlyfsX5) was detected. We suggest that all children presenting with progressive neurodegeneration or spastic paraplegia in the absence of risk factors for cerebral palsy should be screened for inborn errors of metabolism, including arginase deficiency. For monitoring urea cycle defects, noninvasive imaging screening for liver fibrosis and hepatocellular carcinoma can help ensure early detection, with potential treatment implications.
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Affiliation(s)
- Jane Pui Ki Tsang
- Department of Radiology, Tuen Mun Hospital, Hong Kong Special Administrative Region, China
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The therapeutic effects of tectorigenin on chemically induced liver fibrosis in rats and an associated metabonomic investigation. Arch Pharm Res 2012; 35:1479-93. [DOI: 10.1007/s12272-012-0819-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/21/2012] [Accepted: 02/27/2012] [Indexed: 12/13/2022]
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El-Shabrawi MHF, Zein El Abedin MY, Omar N, Kamal NM, Elmakarem SA, Khattab S, El-Sayed HM, El-Hennawy A, Ali ASM. Predictive accuracy of serum hyaluronic acid as a non-invasive marker of fibrosis in a cohort of multi-transfused Egyptian children with β-thalassaemia major. Arab J Gastroenterol 2012; 13:45-8. [PMID: 22980590 DOI: 10.1016/j.ajg.2012.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 03/28/2012] [Accepted: 06/10/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND STUDY AIM Liver disease remains a major cause of morbidity and mortality in patients with β-thalassaemia major (β-TM); therefore, its identification at an early stage is of great significance. Serum hyaluronic acid (HA) is considered as a non-invasive marker that appears early before pathological changes occur. We aim to determine the predictive accuracy of HA in detecting and staging hepatic fibrosis in β-TM patients. PATIENTS AND METHODS 30 Egyptian children with β-TM, and 15 age and sex-matched controls were studied. All had abdominal ultrasonography (US), measurement of serum amino-transferases (ALT, AST); hepatitis C, B and human immunodeficiency viruses (HCV, HBV, HIV) sero-markers, serum ferritin and HA. Liver biopsy was done for patients and fibrosis was scaled using Metavir scoring system and liver iron concentration (LIC) was measured. RESULTS Twenty patients (67.7%) had sero-markers of HCV, none had HBV or HIV. Serum HA was significantly higher in patients (90.78±28.79 ng/ml) compared to controls (21.1±13.24 ng/ml) with p<0.05. No difference between HCV infected and non-infected patients was detected. Positive significant correlation was detected between serum HA and stages of fibrosis by histopathology and US. No correlation was found between serum HA and age, sex, weight, height, haemoglobin level, platelet count, AST, serum ferritin, necro-inflammatory grade, and LIC. CONCLUSIONS Serum HA is a valuable non-invasive marker that may contribute to the assessment of liver fibrosis in multi-transfused children and adolescents with β-TM, irrespective of concomitant HCV infection.
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Fouad SA, Esmat S, Omran D, Rashid L, Kobaisi MH. Noninvasive assessment of hepatic fibrosis in Egyptian patients with chronic hepatitis C virus infection. World J Gastroenterol 2012; 18:2988-94. [PMID: 22736923 PMCID: PMC3380327 DOI: 10.3748/wjg.v18.i23.2988] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 10/15/2011] [Accepted: 10/21/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the accuracy of specific biochemical markers for the assessment of hepatic fibrosis in patients with chronic hepatitis C virus (HCV) infection.
METHODS: One hundred and fifty-four patients with chronic HCV infection were included in this study; 124 patients were non-cirrhotic, and 30 were cirrhotic. The following measurements were obtained in all patients: serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, total bilirubin, prothrombin time and concentration, complete blood count, hepatitis B surface antigen (HBsAg), HCVAb, HCV-RNA by quantitative polymerase chain reaction, abdominal ultrasound and ultrasonic-guided liver biopsy. The following ratios, scores and indices were calculated and compared with the results of the histopathological examination: AST/ALT ratio (AAR), age platelet index (API), AST to platelet ratio index (APRI), cirrhosis discriminating score (CDS), Pohl score, Göteborg University Cirrhosis Index (GUCI).
RESULTS: AAR, APRI, API and GUCI demonstrated good diagnostic accuracy of liver cirrhosis (80.5%, 79.2%, 76.6% and 80.5%, respectively); P values were: < 0.01, < 0.05, < 0.001 and < 0.001, respectively. Among the studied parameters, AAR and GUCI gave the highest diagnostic accuracy (80.5%) with cutoff values of 1.2 and 1.5, respectively. APRI, API and GUCI were significantly correlated with the stage of fibrosis (P < 0.001) and the grade of activity (P < 0.001, < 0.001 and < 0.005, respectively), while CDS only correlated significantly with the stage of fibrosis (P < 0.001) and not with the degree of activity (P > 0.05). In addition, we found significant correlations for the AAR, APRI, API, GUCI and Pohl score between the non-cirrhotic (F0, F1, F2, F3) and cirrhotic (F4) groups (P values: < 0.001, < 0.05, < 0.001, < 0.001 and < 0.005, respectively; CDS did not demonstrate significant correlation (P > 0.05).
CONCLUSION: The use of AAR, APRI, API, GUCI and Pohl score measurements may decrease the need for liver biopsies in diagnosing cirrhosis, especially in Egypt, where resources are limited.
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Interleukin 6 (IL6) as a predictor outcome in patients with compensated cirrhosis and symptomatic gall stones after cholecystectomy. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2012. [DOI: 10.1016/j.ejmhg.2012.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bruha R, Dvorak K, Petrtyl J. Alcoholic liver disease. World J Hepatol 2012; 4:81-90. [PMID: 22489260 PMCID: PMC3321494 DOI: 10.4254/wjh.v4.i3.81] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 09/07/2011] [Accepted: 03/17/2012] [Indexed: 02/06/2023] Open
Abstract
Alcohol use disorders affect millions of individuals worldwide. Alcohol consumption is directly associated with liver disease mortality and accounts for elevated social and economic costs. Alcoholic liver disease (ALD) may take the form of acute involvement (alcoholic hepatitis) or chronic liver disease (steatosis, steatohepatitis, fibrosis and cirrhosis). The severity and prognosis of alcohol-induced liver disease depends on the amount, pattern and duration of alcohol consumption, as well as on the presence of liver inflammation, diet, nutritional status and genetic predisposition of an individual. While steatosis is an almost completely benign disease, liver cirrhosis is associated with marked morbidity, mortality and life expectancy shortening. The median survival of patients with advanced cirrhosis is 1-2 years. Severe acute alcoholic hepatitis (AH) is associated with mortality as high as 50%. It has been managed with corticoids, pentoxifylline and enteral nutrition, although evidence based data are still conflicting. Some author suggest that pentoxifylline could be a better first-line treatment in patients with severe AH. Absolute abstinence is a basic condition for any treatment of acute or chronic ALD, the other therapeutical procedure being of a supportive nature and questionable significance. Acamprosate appears to be an effective treatment strategy for supporting continuous abstinence in alcohol dependent patients. Patients with advanced liver cirrhosis who demonstrably abstain can be considered for liver transplantation, which leads to a markedly prolonged life expectancy. The crucial step in ALD prevention is in the prevention of alcohol abuse, whereas the prevention of liver injury in active alcohol abusers is not clinically applicable.
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Affiliation(s)
- Radan Bruha
- Radan Bruha, 4th Department of Internal Medicine, General Teaching Hospital, First Faculty of Medicine, Charles University, 12808 Prague, Czech Republic
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Sebastiani G, Alberti A. How far is noninvasive assessment of liver fibrosis from replacing liver biopsy in hepatitis C? J Viral Hepat 2012; 19 Suppl 1:18-32. [PMID: 22233410 DOI: 10.1111/j.1365-2893.2011.01518.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic hepatitis C represents a major cause of progressive liver disease that can eventually evolve into cirrhosis and its end-stage complications. Formation and accumulation of fibrosis in the liver is the common pathway that leads to evolutive liver disease. Precise staging of liver fibrosis is essential for patient management in clinical practice because the presence of bridging fibrosis represents a strong indication for antiviral therapy, while cirrhosis requires a specific follow-up. Liver biopsy has always represented the standard of reference for assessment of hepatic fibrosis, but it has limitations: it is invasive, costly and prone to sampling errors. Recently, blood markers and instrumental methods have been proposed for the noninvasive assessment of liver fibrosis in hepatitis C. However, international guidelines do not recommend the widespread use of noninvasive methods for liver fibrosis in clinical practice. This is because of, in some cases, unsatisfactory accuracy and incomplete validation of others. Some studies suggest that the effectiveness of noninvasive methods for assessing liver fibrosis may increase when they are combined, and a number of sequential and synchronous algorithms have been proposed for this purpose, with the aim of reducing rather than substituting liver biopsies. This may represent a rational and reliable approach for implementing noninvasive assessment of liver fibrosis in clinical practice. It could allow more comprehensive first-line screening of liver fibrosis in hepatitis C than would be feasible with liver biopsy alone.
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Affiliation(s)
- G Sebastiani
- VIMM-Venetian Institute of Molecular Medicine, Padua, Italy
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Zarski JP, Sturm N, Guechot J, Paris A, Zafrani ES, Asselah T, Boisson RC, Bosson JL, Guyader D, Renversez JC, Bronowicki JP, Gelineau MC, Tran A, Trocme C, De Ledinghen V, Lasnier E, Poujol-Robert A, Ziegler F, Bourliere M, Voitot H, Larrey D, Rosenthal-Allieri MA, Fouchard Hubert I, Bailly F, Vaubourdolle M. Comparison of nine blood tests and transient elastography for liver fibrosis in chronic hepatitis C: the ANRS HCEP-23 study. J Hepatol 2012; 56:55-62. [PMID: 21781944 DOI: 10.1016/j.jhep.2011.05.024] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 04/13/2011] [Accepted: 05/03/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Blood tests and transient elastography (Fibroscan™) have been developed as alternatives to liver biopsy. This ANRS HCEP-23 study compared the diagnostic accuracy of nine blood tests and transient elastography (Fibroscan™) to assess liver fibrosis, vs. liver biopsy, in untreated patients with chronic hepatitis C (CHC). METHODS This was a multicentre prospective independent study in 19 French University hospitals of consecutive adult patients having simultaneous liver biopsy, biochemical blood tests (performed in a centralized laboratory) and Fibroscan™. Two experienced pathologists independently reviewed the liver biopsies (mean length=25±8.4 mm). Performance was assessed using ROC curves corrected by Obuchowski's method. RESULTS Fibroscan™ was not interpretable in 113 (22%) patients. In the 382 patients having both blood tests and interpretable Fibroscan™, Fibroscan™ performed similarly to the best blood tests for the diagnosis of significant fibrosis and cirrhosis. Obuchowski's measure showed Fibrometer® (0.86), Fibrotest® (0.84), Hepascore® (0.84), and interpretable Fibroscan™ (0.84) to be the most accurate tests. The combination of Fibrotest®, Fibrometer®, or Hepascore® with Fibroscan™ or Apri increases the percentage of well classified patients from 70-73% to 80-83% for significant fibrosis, but for cirrhosis a combination offers no improvement. For the 436 patients having all the blood tests, AUROC's ranged from 0.82 (Fibrometer®) to 0.75 (Hyaluronate) for significant fibrosis, and from 0.89 (Fibrometer® and Hepascore®) to 0.83 (FIB-4) for cirrhosis. CONCLUSIONS Contrarily to blood tests, performance of Fibroscan™ was reduced due to uninterpretable results. Fibrotest®, interpretable Fibroscan™, Fibrometer®, and Hepascore® perform best and similarly for diagnosis of significant fibrosis and cirrhosis.
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Affiliation(s)
- Jean-Pierre Zarski
- Clinique Universitaire d'Hépato-Gastroentérologie-Pôle DIGIDUNE-CHU de Grenoble, France.
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Relation of serum insulin-like growth factor-1 (IGF-1) levels with hepatitis C virus infection and insulin resistance. Transl Res 2011; 158:155-62. [PMID: 21867981 DOI: 10.1016/j.trsl.2011.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Revised: 04/22/2011] [Accepted: 04/25/2011] [Indexed: 01/13/2023]
Abstract
The prospect of the growing worldwide epidemic of hepatitis C virus (HCV) infection and type 2 diabetes mellitus certainly merits attention toward their controversial relationship. Insulin-like growth factor-1 (IGF-1) plays an important role in glucose homeostasis. This study is a cross-sectional study considered as an initial investigation aimed to evaluate the effect of HCV infection on serum IGF-1, as well as to find out whether IGF-1 has a role in development of insulin resistance (IR) in HCV infection. A total of 45 subjects divided into 3 groups were included in the study: chronic HCV-infected patients (15 patients), chronic HCV-infected diabetic patients (15 patients), and diabetic patients without HCV infection (15 patients), along with 15 healthy controls. HCV RNA was quantified using real-time polymerase chain reaction (PCR). Serum IGF-1 levels were measured by enzyme-linked immunosorbent assay (ELISA). Homeostasis model assessment of insulin resistance [HOMA-IR], insulin sensitivity [HOMA-S], and β-cell function [HOMA-β] were determined by previously validated mathematic indexes. Fasting blood glucose, insulin levels, and liver parameters including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined. IGF-1 levels were significantly lower in the 3 patient groups compared with controls (P = 0.001). The HCV group demonstrated high HOMA-IR and HOMA-β with a positive correlation between HOMA-IR and either HOMA-β or fasting insulin (P < 0.001). In addition, a negative correlation was found between IGF-1 levels and both AST and ALT, and HOMA-IR was correlated positively with AST activity (P < 0.05). In HCV patients with detectable viremia, IGF-1 levels were correlated negatively with HOMA-β (P < 0.01) and with HOMA-IR. However, this correlation did not reach statistical significance (P = 0.074). No significant correlation was found between HCV viral load and the studied parameters. In conclusion, low IGF-I levels might have a role in IR among HCV viremic patients.
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