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Yu H, Huang Y, Li M, Jiang H, Yang B, Xi X, Smayi A, Wu B, Yang Y. Prognostic significance of dynamic changes in liver stiffness measurement in patients with chronic hepatitis B and compensated advanced chronic liver disease. J Gastroenterol Hepatol 2024; 39:2169-2181. [PMID: 38946401 DOI: 10.1111/jgh.16673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 06/07/2024] [Accepted: 06/16/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND AND AIM Liver stiffness measurements (LSMs) are promising for monitoring disease progression or regression. We assessed the prognostic significance of dynamic changes in LSM over time on liver-related events (LREs) and death in patients with chronic hepatitis B (CHB) and compensated advanced chronic liver disease (cACLD). METHODS This retrospective study included 1272 patients with CHB and cACLD who underwent at least two measurements, including LSM and fibrosis score based on four factors (FIB-4). ΔLSM was defined as [(follow-up LSM - baseline LSM)/baseline LSM × 100]. We recorded LREs and all-cause mortality during a median follow-up time of 46 months. Hazard ratios (HRs) and confidence intervals (CIs) for outcomes were calculated using Cox regression. RESULTS Baseline FIB-4, baseline LSM, ΔFIB-4, ΔLSM, and ΔLSM/year were independently and simultaneously associated with LREs (adjusted HR, 1.04, 95% CI, 1.00-1.07; 1.02, 95% CI, 1.01-1.03; 1.06, 95% CI, 1.03-1.09; 1.96, 95% CI, 1.63-2.35, 1.02, 95% CI, 1.01-1.04, respectively). The baseline LSM combined with the ΔLSM achieved the highest Harrell's C (0.751), integrated AUC (0.776), and time-dependent AUC (0.737) for LREs. Using baseline LSM and ΔLSM, we proposed a risk stratification method to improve clinical applications. The risk proposed stratification based on LSM performed well in terms of prognosis: low risk (n = 390; reference), intermediate risk (n = 446; HR = 3.38), high risk (n = 272; HR = 5.64), and extremely high risk (n = 164; HR = 11.11). CONCLUSIONS Baseline and repeated noninvasive tests measurement allow risk stratification of patients with CHB and cACLD. Combining baseline and dynamic changes in the LSM improves prognostic prediction.
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Affiliation(s)
- Hongsheng Yu
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Yinan Huang
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Mingkai Li
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Hao Jiang
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Bilan Yang
- Department of Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, 518033, Shenzhen, China
| | - Xiaoli Xi
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Abdukyamu Smayi
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Bin Wu
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Yidong Yang
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, China
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Kwape L, Gabriel S, Abdelsalem A, Rose P, Bathobakae L, Peterson D, Moodley D, Parker M, Moolla S, Parker A, Siamisang K, Van Rensburg C, Fredericks E. Evaluation of Noninvasive Tools for Predicting Esophageal Varices in Patients With Cirrhosis at Tygerberg Hospital, Cape Town. Int J Hepatol 2024; 2024:9952610. [PMID: 39296589 PMCID: PMC11410406 DOI: 10.1155/2024/9952610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 07/23/2024] [Accepted: 08/06/2024] [Indexed: 09/21/2024] Open
Abstract
Background: In patients with cirrhosis, esophageal variceal hemorrhage (EVH) is a devastating consequence of portal hypertension (PH). Upper endoscopy is considered the gold standard for the detection and diagnosis of esophageal varices (EVs), despite being invasive and costly. This study was aimed at identifying and evaluating the diagnostic accuracy of noninvasive tools in predicting EVs in patients with compensated cirrhosis. Methods: This cross-sectional study included 50 patients with compensated cirrhosis at the Tygerberg Hospital Gastroenterology Clinic in Cape Town between November 2022 and May 2023. We collected clinical, anthropometric, and laboratory data from patients' physical and electronic charts. All patients underwent an abdominal ultrasound, vibration-controlled transient elastography (VCTE) to assess liver and splenic stiffness, and upper endoscopy. In this comparative study, we evaluated the diagnostic accuracy of different noninvasive tools in detecting EVs in patients with compensated cirrhosis. Results: Of the 50 patients included in the study, 30 (60%) were female and 20 (40%) were male. The patients' age ranged from 18 to 83, with a mean age of 46.6 years. Cirrhosis was mainly due to alcohol use (n = 11, 22%), hepatitis B virus (HBV) infection (n = 11, 22%), and autoimmune hepatitis (n = 10, 20%). The patients included in the study were divided into two subgroups: with (n = 34, 68%) or without (n = 16, 32%) EVs. Statistically significant differences were detected between groups in platelet count (PC), liver stiffness measurement (LSM), spleen stiffness measurement (SSM), portal vein diameter (PVD), bipolar spleen diameter (SBD), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), platelet/bipolar spleen diameter ratio (PSR), liver stiffness-spleen size-platelet ratio (LSPS), liver stiffness-spleen stiffness-platelet ratio score (LS3PS), and spleen stiffness-spleen size-platelet ratio score (SSPS) (p < 0.001). The highest diagnostic precision was observed with SSM (96%), SSPS (96%), LS3PS (94%), LSPS (94%), PSR (94%), and PC (92%). SBD (88%), LSM (86%), APRI (82%), and FIB-4 (82%) had the lowest diagnostic accuracy. Conclusion: SSM and SSPS have the highest diagnostic accuracy for predicting the presence of EVs in patients with compensated cirrhosis. LSPS, LS3PS, and PSR come second at 94%. We recommend SSM and SSPS in institutions with transient elastography equipped with the software necessary to measure splenic stiffness. We introduce and propose LS3PS as a novel composite score for predicting the presence of EVs in patients with compensated cirrhosis. Large-sample-size studies are needed to validate these prediction scores and to allow direct comparison with Baveno VII. These prediction tools can help clinicians avoid unnecessary endoscopic procedures in patients with compensated cirrhosis, especially in developing countries with limited resources such as South Africa.
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Affiliation(s)
- Lawrence Kwape
- Division of Gastroenterology and Hepatology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Shiraaz Gabriel
- Division of Gastroenterology and Hepatology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ahmad Abdelsalem
- Division of Gastroenterology and Hepatology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Penelope Rose
- Department of Paediatrics and Child Health Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Lefika Bathobakae
- Internal Medicine St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Dale Peterson
- Division of Gastroenterology and Hepatology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Desiree Moodley
- Division of Gastroenterology and Hepatology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Mohammed Parker
- Division of Gastroenterology and Hepatology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Saadiq Moolla
- Division of Pulmonology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Arifa Parker
- Unit for Infection Prevention and Control Department of Medicine Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- Division of Infectious Diseases Department of Medicine Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Keatlaretse Siamisang
- Department of Family Medicine and Public Health University of Botswana, Gaborone, Botswana
| | - Christoffel Van Rensburg
- Division of Gastroenterology and Hepatology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ernst Fredericks
- Division of Gastroenterology and Hepatology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Jin YJ, Kim HY, Suh YJ, Lee CH, Yu JH, Kim MN, Han JW, Lee HA, An J, Chon YE, Jun DW, Choi M, Kim SU. Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using vibration-controlled transient elastography: Systematic review and meta-analysis. Clin Mol Hepatol 2024; 30:S159-S171. [PMID: 39038958 DOI: 10.3350/cmh.2024.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/19/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUNDS/AIMS Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) can assess fibrotic burden in chronic liver diseases. The systematic review and meta-analysis was conducted to determine whether LSM using VCTE can predict the risk of development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. METHODS A systematic literature search of the Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases (from January 2010 to June 2023) was conducted. Of the 1,345 individual studies identified, 10 studies that used VCTE were finally registered. Hazard ratios (HRs) and the 95% confidence intervals (CIs) were considered summary estimates of treatment effect sizes of ≥11 kilopascal (kPa) standard for HCC development. Meta-analysis was performed using the restricted Maximum Likelihood random effects model. RESULTS Among the ten studies, data for risk ratios for HCC development could be obtained from nine studies. When analyzed for the nine studies, the HR for HCC development was high at 3.33 (95% CI, 2.45-4.54) in CHB patients with a baseline LSM of ≥11 kPa compared to patients who did not. In ten studies included, LSM of ≥11 kPa showed the sensitivity and specificity for predicting HCC development were 61% (95% CI, 50-71%) and 78% (95% CI, 66-86%), respectively, and the diagnostic accuracy was 0.74 (95% CI, 0.70-0.77). CONCLUSION The risk of HCC development was elevated in CHB patients with VCTE-determined LSM of ≥11 kPa. This finding suggests that VCTE-determined LSM values may aid the risk prediction of HCC development in CHB patients.
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Affiliation(s)
- Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Hee Yeon Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Korea
| | - Chae Hyeon Lee
- Pharmacometrics Institute for Practical Education and Training (PIPET), College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hwan Yu
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Mi Na Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Won Han
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jihyun An
- Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Young Eun Chon
- Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dae Won Jun
- Department of Gastroenterology, Hanyang University, College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare, Collaborating Agency, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Yokoyama S, Honda T, Ishizu Y, Imai N, Ito T, Yamamoto K, Mizuno K, Nakamura M, Kawashima H. Predicting early rebleeding and mortality after endoscopic hemostasis of esophagogastric varices: Diagnostic performance of aspartate aminotransferase-to-platelet ratio index and model for end-stage liver disease-Na score. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024. [PMID: 39022894 DOI: 10.1002/jhbp.12057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Endoscopic variceal ligation and sclerotherapy are recommended for esophagogastric variceal bleeding (EGVB) in cirrhosis but can be complicated by early rebleeding and death. This study aimed to identify noninvasive markers accurately predicting early rebleeding and mortality after endoscopic hemostasis for EGVB. METHODS Among 116 patients with endoscopically confirmed EGVB and endoscopic hemostasis, various noninvasive markers were calculated, and their predictive accuracy was compared by receiver-operating characteristic curve analysis. Endpoints included 5-day rebleeding, 5-day mortality, 6-week rebleeding, and 6-week mortality. RESULTS The median age was 63 years. Child-Pugh class B and C patients accounted for 40.5% and 34.5%, respectively. Only the aspartate aminotransferase-to-platelet ratio index (APRI) significantly predicted 5-day rebleeding, with an area under the curve (AUC) of 0.777 (95% confidence interval [CI]: 0.537-1). The model for end-stage liver disease-Na (MELD-Na) score showed good predictive accuracy for 5-day mortality (AUC: 0.839, 95% CI: 0.681-0.997), 6-week rebleeding (AUC: 0.797, 95% CI: 0.663-0.932), and 6-week mortality (AUC: 0.888, 95% CI: 0.797-0.979). CONCLUSIONS Patients with cirrhosis with a high APRI and MELD-Na score were at high risk of early rebleeding and death after EGVB. Allocating appropriate monitoring and care for those patients is necessary.
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Affiliation(s)
- Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Norihiro Imai
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazuyuki Mizuno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Liang BY, Zhang EL, Li J, Long X, Wang WQ, Zhang BX, Zhang ZW, Chen YF, Zhang WG, Mei B, Xiao ZY, Gu J, Zhang ZY, Xiang S, Dong HH, Zhang L, Zhu P, Cheng Q, Chen L, Zhang ZG, Zhang BH, Dong W, Liao XF, Yin T, Wu DD, Jiang B, Yuan YF, Zhang ZL, Chen YB, Li KY, Lau WY, Chen XP, Huang ZY. A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study. Hepatobiliary Surg Nutr 2024; 13:198-213. [PMID: 38617471 PMCID: PMC11007354 DOI: 10.21037/hbsn-22-410] [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: 09/05/2022] [Accepted: 12/21/2022] [Indexed: 04/16/2024]
Abstract
Background Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of hepatocellular carcinoma (HCC) patients. The impact of the degrees of cirrhosis on prediction of post-hepatectomy liver failure (PHLF) remains poorly defined. This study aimed to construct and validate a combined pre- and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients using prospective multi-center's data. Methods Consecutive HCC patients who underwent hepatectomy between May 18, 2019 and Dec 19, 2020 were enrolled at five tertiary hospitals. Preoperative cirrhotic severity scoring (CSS) and intra-operative direct liver stiffness measurement (DSM) were performed to correlate with the Laennec histopathological grading system. The performances of the pre-operative nomogram and combined pre- and intra-operative nomogram in predicting PHLF were compared with conventional predictive models of PHLF. Results For 327 patients in this study, histopathological studies showed the rates of HCC patients with no, mild, moderate, and severe cirrhosis were 41.9%, 29.1%, 22.9%, and 6.1%, respectively. Either CSS or DSM was closely correlated with histopathological stages of cirrhosis. Thirty-three (10.1%) patients developed PHLF. The 30- and 90-day mortality rates were 0.9%. Multivariate regression analysis showed four pre-operative variables [HBV-DNA level, ICG-R15, prothrombin time (PT), and CSS], and one intra-operative variable (DSM) to be independent risk factors of PHLF. The pre-operative nomogram was constructed based on these four pre-operative variables together with total bilirubin. The combined pre- and intra-operative nomogram was constructed by adding the intra-operative DSM. The pre-operative nomogram was better than the conventional models in predicting PHLF. The prediction was further improved with the combined pre- and intra-operative nomogram. Conclusions The combined pre- and intra-operative nomogram further improved prediction of PHLF when compared with the pre-operative nomogram. Trial Registration Clinicaltrials.gov Identifier: NCT04076631.
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Affiliation(s)
- Bin-Yong Liang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Er-Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Li
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Long
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Qiang Wang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bi-Xiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi-Wei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi-Fa Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wan-Guang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Mei
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen-Yu Xiao
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Gu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zun-Yi Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Xiang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Han-Hua Dong
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Cheng
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhan-Guo Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin-Hao Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Dong
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Feng Liao
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Tao Yin
- Department of Hepato-biliary Surgery, Hubei Cancer Hospital, Wuhan, China
| | - Dong-De Wu
- Department of Hepato-biliary Surgery, Hubei Cancer Hospital, Wuhan, China
| | - Bin Jiang
- Department of Hepato-pancreato-biliary Surgery Treatment Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yu-Feng Yuan
- Department of Hepato-biliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhong-Lin Zhang
- Department of Hepato-biliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yao-Bing Chen
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai-Yan Li
- Department of Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi-Yong Huang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Song BG, Kang TW, Sinn DH, Kim YY, Min JH, Hwang JA, Shin J. Ultrasonographic findings of metabolic dysfunction-associated fatty liver disease: A comparative study with non-alcoholic fatty liver disease and clinical characteristics. Clin Imaging 2024; 108:110097. [PMID: 38310832 DOI: 10.1016/j.clinimag.2024.110097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new term proposed to replace non-alcoholic fatty liver disease (NAFLD). We analyzed the ultrasonographic findings of MAFLD and NAFLD. METHODS We conducted a retrospective cross-sectional study of subjects aged ≥19 years who underwent a health screening examination, including ultrasonography, (n = 17,066). Patients were separated into one of three groups; pure MAFLD (n = 5304), pure NAFLD (n = 579), and both NAFLD & MAFLD (n = 11,183). The outcomes were the degree of fatty liver disease and liver cirrhosis, defined by ultrasonography. In addition, the risk of ultrasonographic cirrhosis was assessed in the MAFLD group based on clinical characteristics. RESULTS The pure NAFLD group had a lower risk of severe fatty liver disease than the both NAFLD & MAFLD groups (0.9 % vs. 4.4 %, p < 0.001). Cirrhosis was not diagnosed in the NAFLD group. Cirrhosis was more common in the pure MAFLD group than in the both NAFLD & MAFLD group (0.3 % vs. 0.0 %, p < 0.001). In the MAFLD group, multivariable analysis showed that diagnosis by hepatic steatosis index (Odds ratio [OR], 12.39; 95 % confidence interval [CI], 3.40-45.19; p < 0.001) or significant alcohol intake (OR, 9.58, 95 % CI, 1.93-47.61; p = 0.006) was independently associated with risk of liver cirrhosis on ultrasonography. CONCLUSION Liver cirrhosis was more frequently identified on ultrasonography in patients with MAFLD than in NAFLD. MAFLD diagnosed using the hepatic steatosis index or significant alcohol intake is a risk factor for liver cirrhosis.
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Affiliation(s)
- Byeong Geun Song
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Listopad S, Magnan C, Day LZ, Asghar A, Stolz A, Tayek JA, Liu ZX, Jacobs JM, Morgan TR, Norden-Krichmar TM. Identification of integrated proteomics and transcriptomics signature of alcohol-associated liver disease using machine learning. PLOS DIGITAL HEALTH 2024; 3:e0000447. [PMID: 38335183 PMCID: PMC10857706 DOI: 10.1371/journal.pdig.0000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
Distinguishing between alcohol-associated hepatitis (AH) and alcohol-associated cirrhosis (AC) remains a diagnostic challenge. In this study, we used machine learning with transcriptomics and proteomics data from liver tissue and peripheral mononuclear blood cells (PBMCs) to classify patients with alcohol-associated liver disease. The conditions in the study were AH, AC, and healthy controls. We processed 98 PBMC RNAseq samples, 55 PBMC proteomic samples, 48 liver RNAseq samples, and 53 liver proteomic samples. First, we built separate classification and feature selection pipelines for transcriptomics and proteomics data. The liver tissue models were validated in independent liver tissue datasets. Next, we built integrated gene and protein expression models that allowed us to identify combined gene-protein biomarker panels. For liver tissue, we attained 90% nested-cross validation accuracy in our dataset and 82% accuracy in the independent validation dataset using transcriptomic data. We attained 100% nested-cross validation accuracy in our dataset and 61% accuracy in the independent validation dataset using proteomic data. For PBMCs, we attained 83% and 89% accuracy with transcriptomic and proteomic data, respectively. The integration of the two data types resulted in improved classification accuracy for PBMCs, but not liver tissue. We also identified the following gene-protein matches within the gene-protein biomarker panels: CLEC4M-CLC4M, GSTA1-GSTA2 for liver tissue and SELENBP1-SBP1 for PBMCs. In this study, machine learning models had high classification accuracy for both transcriptomics and proteomics data, across liver tissue and PBMCs. The integration of transcriptomics and proteomics into a multi-omics model yielded improvement in classification accuracy for the PBMC data. The set of integrated gene-protein biomarkers for PBMCs show promise toward developing a liquid biopsy for alcohol-associated liver disease.
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Affiliation(s)
- Stanislav Listopad
- Department of Computer Science, University of California, Irvine, California, United States of America
| | - Christophe Magnan
- Department of Computer Science, University of California, Irvine, California, United States of America
| | - Le Z. Day
- Biological Sciences Division and Environmental and Molecular Sciences Division, Pacific Northwest National Laboratory, Richland, Washington, United States of America
| | - Aliya Asghar
- Medical and Research Services, VA Long Beach Healthcare System, Long Beach, California, United States of America
| | - Andrew Stolz
- Division of Gastrointestinal & Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - John A. Tayek
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Department of Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Torrance, California, United States of America
| | - Zhang-Xu Liu
- Division of Gastrointestinal & Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Jon M. Jacobs
- Biological Sciences Division and Environmental and Molecular Sciences Division, Pacific Northwest National Laboratory, Richland, Washington, United States of America
| | - Timothy R. Morgan
- Medical and Research Services, VA Long Beach Healthcare System, Long Beach, California, United States of America
| | - Trina M. Norden-Krichmar
- Department of Computer Science, University of California, Irvine, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, Irvine, California, United States of America
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8
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Aghajanzadeh T, Talkhabi M, Zali MR, Hatami B, Baghaei K. Diagnostic potential and pathogenic performance of circulating miR-146b, miR-194, and miR-214 in liver fibrosis. Noncoding RNA Res 2023; 8:471-480. [PMID: 37434946 PMCID: PMC10331815 DOI: 10.1016/j.ncrna.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023] Open
Abstract
Liver fibrosis is the excessive accumulation of extracellular matrix proteins. Due to the lack of an accurate test for an early diagnosis of liver fibrosis and the invasiveness of the liver biopsy procedure, there is an urgent need for effective non-invasive biomarkers for screening the patients. we aimed to evaluate the diagnostic performance of circulating miRNAs (miR-146b, -194, -214) and their related mechanisms in the pathogenesis of liver fibrosis. The expression levels of miR-146b, -194, and -214 were quantified in whole blood samples from NAFLD patients using real-time PCR. The competing endogenous RNA (ceRNA) network was constructed and a gene set enrichment analysis (GSEA) was performed for HSC activation-related genes. Also, the transcription factor (TF)-miR co-regulatory network and the survival plot for three miRNAs and core genes were illustrated. The qPCR results showed that the relative expression of miR-146b and miR-214 significantly increased in NAFLD patients, while miR-194 showed significant down-regulation. The ceRNA network analysis implicated NEAT1 and XIST as sponge candidates for these miRNAs. The GSEA results identified 15 core genes involved in HSC activation, primarily enriched in NF-κB activation and autophagy pathways. STAT3, TCF3, RELA, and RUNX1 were considered potential transcription factors connected to miRNAs in the TF-miR network. Our study elucidated three candidate circulating miRNAs differentially expressed in NAFLD that could serve as a promising non-invasive diagnostic tool for early detection strategies. Also, NF-κB activation, autophagy, and negative regulation of the apoptotic process are the main potential underlying mechanisms regulated by these miRNAs in liver fibrosis pathogenesis.
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Affiliation(s)
- Taha Aghajanzadeh
- Department of Animal Sciences and Marine Biology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Talkhabi
- Department of Animal Sciences and Marine Biology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Hatami
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Baghaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Shihana F, Joglekar MV, Schwantes-An TH, Hardikar AA, Seth D. MicroRNAs Signature Panel Identifies Heavy Drinkers with Alcohol-Associated Cirrhosis from Heavy Drinkers without Liver Injury. BIOLOGY 2023; 12:1314. [PMID: 37887024 PMCID: PMC10604848 DOI: 10.3390/biology12101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023]
Abstract
Background: Alcohol-associated liver disease (ALD) is the most common disorder of prolonged drinking. Mechanisms underlying cirrhosis in such patients remain unclear. MicroRNAs play regulatory role in several diseases, are affected by alcohol and may be important players in alcohol use disorders, such as cirrhosis. Methods: We investigated serum samples from heavy chronic alcohol users (80 g/day (male) and 50 g/day (female) for ≥10 years) that were available from our previously reported GenomALC study. A subset of GenomALC drinkers with liver cirrhosis (cases, n = 24) and those without significant liver disease (drinking controls, n = 23) were included. Global microRNA profiling was performed using high-throughput real-time quantitative PCR to identify the microRNA signatures associated with cirrhosis. Ingenuity Pathway Analysis (IPA) software was utilized to identify target mRNAs of significantly altered microRNAs, and molecular pathways were analysed. Identified microRNAs were analysed for correlation with traditional liver disease biomarkers and risk gene variants previously reported from GenomALC genome-wide association study. Results: The expression of 21 microRNAs was significantly downregulated in cases compared to drinking controls (p < 0.05, ∆∆Ct > 1.5-fold). Seven microRNAs (miR-16, miR-19a, miR-27a, miR-29b, miR-101, miR-130a, and miR-191) had a highly significant correlation (p < 0.001) with INR, bilirubin and MELD score. Three microRNAs (miR-27a, miR-130a and miR-191) significantly predicted cases with AUC-ROC 0.8, 0.78 and 0.85, respectively (p < 0.020); however, INR performed best (0.97, p < 0.001). A different set of six microRNAs (miR-19a, miR-26a, miR-101, miR-151-3p, miR-221, and miR-301) showed positive correlation (ranging from 0.32 to 0.51, p < 0.05) with rs10433937:HSD17B13 gene variant, associated with the risk of cirrhosis. IPA analysis revealed mRNA targets of the significantly altered microRNAs associated with cell death/necrosis, fibrosis and increased steatosis, particularly triglyceride metabolism. Conclusions: MicroRNA signatures in drinkers distinguished those with liver cirrhosis from drinkers without liver disease. We identified mRNA targets in liver functions that were enriched for disease pathogenesis pathways.
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Affiliation(s)
- Fathima Shihana
- The Centenary Institute of Cancer Medicine & Cell Biology, The University of Sydney, Sydney, NSW 2006, Australia
- Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Mugdha V. Joglekar
- Diabetes & Islet Biology Group, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (M.V.J.); (A.A.H.)
| | - Tae-Hwi Schwantes-An
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN 46202, USA;
| | - Anandwardhan A. Hardikar
- Diabetes & Islet Biology Group, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (M.V.J.); (A.A.H.)
| | - Devanshi Seth
- The Centenary Institute of Cancer Medicine & Cell Biology, The University of Sydney, Sydney, NSW 2006, Australia
- Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW 2050, Australia
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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10
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Ferrandino G, De Palo G, Murgia A, Birch O, Tawfike A, Smith R, Debiram-Beecham I, Gandelman O, Kibble G, Lydon AM, Groves A, Smolinska A, Allsworth M, Boyle B, van der Schee MP, Allison M, Fitzgerald RC, Hoare M, Snowdon VK. Breath Biopsy ® to Identify Exhaled Volatile Organic Compounds Biomarkers for Liver Cirrhosis Detection. J Clin Transl Hepatol 2023; 11:638-648. [PMID: 36969895 PMCID: PMC10037526 DOI: 10.14218/jcth.2022.00309] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/30/2022] [Accepted: 11/01/2022] [Indexed: 03/29/2023] Open
Abstract
Background and Aims The prevalence of chronic liver disease in adults exceeds 30% in some countries and there is significant interest in developing tests and treatments to help control disease progression and reduce healthcare burden. Breath is a rich sampling matrix that offers non-invasive solutions suitable for early-stage detection and disease monitoring. Having previously investigated targeted analysis of a single biomarker, here we investigated a multiparametric approach to breath testing that would provide more robust and reliable results for clinical use. Methods To identify candidate biomarkers we compared 46 breath samples from cirrhosis patients and 42 from controls. Collection and analysis used Breath Biopsy OMNI™, maximizing signal and contrast to background to provide high confidence biomarker detection based upon gas chromatography mass spectrometry (GC-MS). Blank samples were also analyzed to provide detailed information on background volatile organic compounds (VOCs) levels. Results A set of 29 breath VOCs differed significantly between cirrhosis and controls. A classification model based on these VOCs had an area under the curve (AUC) of 0.95±0.04 in cross-validated test sets. The seven best performing VOCs were sufficient to maximize classification performance. A subset of 11 VOCs was correlated with blood metrics of liver function (bilirubin, albumin, prothrombin time) and separated patients by cirrhosis severity using principal component analysis. Conclusions A set of seven VOCs consisting of previously reported and novel candidates show promise as a panel for liver disease detection and monitoring, showing correlation to disease severity and serum biomarkers at late stage.
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Affiliation(s)
| | | | | | | | | | | | - Irene Debiram-Beecham
- Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, UK
| | | | - Graham Kibble
- Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, UK
| | - Anne Marie Lydon
- Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, UK
| | - Alice Groves
- Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, UK
| | - Agnieszka Smolinska
- Owlstone Medical, Cambridge, UK
- Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, the Netherlands
| | | | | | | | - Michael Allison
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
- Addenbrookes Hepatology and Liver Transplantation Unit, Addenbrookes Hospital, Cambridge, UK
| | - Rebecca C. Fitzgerald
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - Matthew Hoare
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
- Addenbrookes Hepatology and Liver Transplantation Unit, Addenbrookes Hospital, Cambridge, UK
- CRUK Cambridge Institute, Cambridge, UK
| | - Victoria K. Snowdon
- Addenbrookes Hepatology and Liver Transplantation Unit, Addenbrookes Hospital, Cambridge, UK
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11
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Sayed AA, Soliman AM, Marzouk M, Mohammed FF, Desouky S. Bromelain mitigates liver fibrosis via targeting hepatic stellate cells in vitro and in vivo. Tissue Cell 2023; 82:102118. [PMID: 37269556 DOI: 10.1016/j.tice.2023.102118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/05/2023]
Abstract
Various therapeutic approaches are conducted for regression of liver fibrosis and prevent possible further carcinogenic transformation. This study was aimed to assess the prospective therapeutic potential of bromelain against thioacetamide (TAA)-induced liver fibrosis using in-vitro and in vivo approaches. In vitro study, HSC-T6 cell line was used to evaluate the effect of bromelain on HSC-T6 cell viability and apoptosis. In vivo, Rats were treated by TAA for 6 weeks for induction of hepatic fibrosis followed by post treatment by different doses of bromelain and silymarin for further 4 weeks to assess the regression of hepatic fibrosis. The in-vitro findings indicated that bromelain hindered the proliferation of HSCs in concentration dependent manner compared with the untreated cells. The in vivo study revealed that treatment of TAA fibrotic rats with different doses of bromelain and silymarin induced a significant restoration in liver function biomarkers, attenuation of oxidative stress, upregulation of total antioxidant capacity and thereby decline of fibrotic biomarkers and improving histopathological and immunohistochemical changes. In conclusion, This study indicates that bromelain can regress TAA induced hepatic fibrosis in rats via inhibiting HSCs activation, α-SMA expression and the ECM deposition in hepatic tissue in addition to its antioxidants pathway, these findings prove the promising therapeutic potential of bromelain as a novel therapeutic approach for chronic hepatic fibrotic diseases.
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Affiliation(s)
- Amany A Sayed
- Zoology Department, Faculty of Science, Cairo University, Giza 12613, Egypt
| | - Amel M Soliman
- Zoology Department, Faculty of Science, Cairo University, Giza 12613, Egypt
| | - Mohamed Marzouk
- Zoology Department, Faculty of Science, Cairo University, Giza 12613, Egypt
| | - Faten F Mohammed
- Department of Pathology, Faculty of Veterinary Medicine, Cairo University, Giza 12211, Egypt.
| | - Shreen Desouky
- Zoology Department, Faculty of Science, Cairo University, Giza 12613, Egypt
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12
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Meng X, Pan Z, Zhao J, Feng Q. Efficacy and safety of Fufang Biejia Ruangan Tablets as an adjuvant treatment for chronic hepatitis B liver fibrosis: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31664. [PMID: 36401442 PMCID: PMC9678545 DOI: 10.1097/md.0000000000031664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Meta-analysis was used to evaluate the efficacy of Fufang Biejia Ruangan Tablets in the treatment of chronic hepatitis B (CHB) liver fibrosis. METHODS Databases, including PubMed, China Knowledge Network (CNKI), China Biomedical Database (CBM), Wan Fang, VIP database, Embase, and Cochrane Library were searched. The time was searched up to May 2022. The participant intervention comparator outcomes of this study were as follows: P, patients with CHB liver fibrosis; I, Fufang Biejia Ruangan Tablets; C, pharmacological placebo; O, the efficacy rate, alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB), procollagen III protein (PIIIP), hyaluronic acid (HA), laminin (LN), collagen C type IV (IV-C), portal vein diameter, spleen thickness and HBV-DNA negative conversion rate. The Cochrane Risk of Bias tool, Begg's test and Egger's test were used to evaluate the methodological quality of eligible studies. A randomized controlled trial of Fufang Biejia Ruangan Tablets was used to treat CHB liver fibrosis. Three reviewers independently selected trials, extracted data, cross-checked, and performed methodological quality assessments. Data analysis was completed by Review Manager 5.3. RESULTS Twenty-six studies with 2717 patients were included in the meta-analysis. The meta-analysis showed that Fufang Biejia Ruangan Tablets was effective by increasing the efficacy. Fufang Biejia Ruangan Tablets was more efficient in improving ALT, AST, TBIL, ALB, PIIIP, HA, LN, IV-C, portal vein diameter, spleen thickness, and HBV-DNA negative conversion rate with no serious adverse reactions. CONCLUSION It was shown that Fufang Biejia Ruangan Tablets can effectively improve liver function and relieve liver fibrosis, but future research should focus on rigorously designed, multicenter, and large randomized controlled trials.
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Affiliation(s)
- Xiangbo Meng
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Zhengqi Pan
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Jiawei Zhao
- Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan, Hubei Province, China
| | - Quansheng Feng
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
- *Correspondence: Quansheng Feng, School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu 611137, Sichuan Province, China (e-mail: )
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13
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Carteri RB, Grellert M, Borba DL, Marroni CA, Fernandes SA. Machine learning approaches using blood biomarkers in non-alcoholic fatty liver diseases. Artif Intell Gastroenterol 2022; 3:80-87. [DOI: 10.35712/aig.v3.i3.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/15/2022] [Accepted: 05/08/2022] [Indexed: 02/06/2023] Open
Abstract
The prevalence of nonalcoholic fatty liver disease (NAFLD) is an important public health concern. Early diagnosis of NAFLD and potential progression to nonalcoholic steatohepatitis (NASH), could reduce the further advance of the disease, and improve patient outcomes. Aiming to support patient diagnostic and predict specific outcomes, the interest in artificial intelligence (AI) methods in hepatology has dramatically increased, especially with the application of less-invasive biomarkers. In this review, our objective was twofold: Firstly, we presented the most frequent blood biomarkers in NAFLD and NASH and secondly, we reviewed recent literature regarding the use of machine learning (ML) methods to predict NAFLD and NASH in large cohorts. Strikingly, these studies provide insights into ML application in NAFLD patients' prognostics and ranked blood biomarkers are able to provide a recognizable signature allowing cost-effective NAFLD prediction and also differentiating NASH patients. Future studies should consider the limitations in the current literature and expand the application of these algorithms in different populations, fortifying an already promising tool in medical science.
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Affiliation(s)
- Randhall B Carteri
- Department of Nutrition, Methodist University Center - IPA, Porto Alegre 90420-060, Rio Grande do Sul, Brazil
- Department of Health and Behaviour, Catholic University of Pelotas, Pelotas 96015-560, Rio Grande do Sul, Brazil
| | - Mateus Grellert
- Department of Informatics and Statistics, Federal University of Santa Catarina, Florianópolis 88040-900, Santa Catarina, Brazil
| | - Daniela Luisa Borba
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Claudio Augusto Marroni
- Department of Gastroenterology and Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Sabrina Alves Fernandes
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
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14
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Lefeuvre C, Roux M, Blanchard S, Le Guillou-Guillemette H, Boursier J, Lunel-Fabiani F, Jeannin P, Pivert A, Ducancelle A. Analysis of hepatic fibrosis markers in the serum of chronic hepatitis B patients according to basal core promoter/precore mutants. Sci Rep 2022; 12:10261. [PMID: 35715541 PMCID: PMC9205978 DOI: 10.1038/s41598-022-14285-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/03/2022] [Indexed: 12/29/2022] Open
Abstract
The A1762T/G1764A double mutant in the basal core promoter (BCP) region of the hepatitis B virus (HBV) is associated with severe hepatic lesions while the G1899A mutation with the double mutant is associated with a significant reduction in the risk of severe fibrosis. This study aims to measure a number of markers in the serum of patients with chronic HBV infection and to assess relationships between these markers and BCP/precore mutants with consideration of the stage of fibrosis. The serum levels of resistin, TGF-β1, MMP-1, TIMP-1, collagen IA1 and PDGF-BB, which are markers that are known to be involved in the process of hepatic fibrosis, were assayed. The serum levels of PDGF-BB and TIMP-1, and the mutation profile were independently associated with advanced fibrosis. A higher level of TIMP-1 was associated with advanced fibrosis regardless of the mutation status, and a higher level of PDGF-BB was associated with nonsevere fibrosis in patients infected with viruses harboring the A1762T/G1764A or A1762T/G1764A/G1899A mutations. Our results suggest an impact of the A1762T/G1764A mutant on the biological pathway related to TGF-β1 and PDGF-BB. In vitro studies are needed to understand the impact of these mutants on the serum secretion of markers involved in fibrosis severity.
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Affiliation(s)
| | - Marine Roux
- Univ Angers, HIFIH, SFR ICAT, F-49000, Angers, France
| | - Simon Blanchard
- Univ Angers, INSERM Unité 892, CNRS Unit 6299, F-49000, Angers, France
| | | | - Jérôme Boursier
- Univ Angers, CHU Angers, HIFIH, SFR ICAT, F-49000, Angers, France
| | | | - Pascale Jeannin
- Univ Angers, INSERM Unité 892, CNRS Unit 6299, F-49000, Angers, France
| | - Adeline Pivert
- Univ Angers, CHU Angers, HIFIH, SFR ICAT, F-49000, Angers, France
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15
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Luetkens JA, Nowak S, Mesropyan N, Block W, Praktiknjo M, Chang J, Bauckhage C, Sifa R, Sprinkart AM, Faron A, Attenberger U. Deep learning supports the differentiation of alcoholic and other-than-alcoholic cirrhosis based on MRI. Sci Rep 2022; 12:8297. [PMID: 35585118 PMCID: PMC9117223 DOI: 10.1038/s41598-022-12410-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Although CT and MRI are standard procedures in cirrhosis diagnosis, differentiation of etiology based on imaging is not established. This proof-of-concept study explores the potential of deep learning (DL) to support imaging-based differentiation of the etiology of liver cirrhosis. This retrospective, monocentric study included 465 patients with confirmed diagnosis of (a) alcoholic (n = 221) and (b) other-than-alcoholic (n = 244) cirrhosis. Standard T2-weighted single-slice images at the caudate lobe level were randomly split for training with fivefold cross-validation (85%) and testing (15%), balanced for (a) and (b). After automated upstream liver segmentation, two different ImageNet pre-trained convolutional neural network (CNN) architectures (ResNet50, DenseNet121) were evaluated for classification of alcohol-related versus non-alcohol-related cirrhosis. The highest classification performance on test data was observed for ResNet50 with unfrozen pre-trained parameters, yielding an area under the receiver operating characteristic curve of 0.82 (95% confidence interval (CI) 0.71–0.91) and an accuracy of 0.75 (95% CI 0.64–0.85). An ensemble of both models did not lead to significant improvement in classification performance. This proof-of-principle study shows that deep-learning classifiers have the potential to aid in discriminating liver cirrhosis etiology based on standard MRI.
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Affiliation(s)
- Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Nowak
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Wolfgang Block
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Radiotherapy and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine I, Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johannes Chang
- Department of Internal Medicine I, Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christian Bauckhage
- Institute for Computer Science, University of Bonn, Endenicher Allee 19C, 53113, Bonn, Germany.,Media Engineering Department, Fraunhofer IAIS, Schloss Birlinghoven 1, 53757, Sankt Augustin, Germany
| | - Rafet Sifa
- Media Engineering Department, Fraunhofer IAIS, Schloss Birlinghoven 1, 53757, Sankt Augustin, Germany
| | - Alois Martin Sprinkart
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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16
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Liu Y, Méric G, Havulinna AS, Teo SM, Åberg F, Ruuskanen M, Sanders J, Zhu Q, Tripathi A, Verspoor K, Cheng S, Jain M, Jousilahti P, Vázquez-Baeza Y, Loomba R, Lahti L, Niiranen T, Salomaa V, Knight R, Inouye M. Early prediction of incident liver disease using conventional risk factors and gut-microbiome-augmented gradient boosting. Cell Metab 2022; 34:719-730.e4. [PMID: 35354069 PMCID: PMC9097589 DOI: 10.1016/j.cmet.2022.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/06/2022] [Accepted: 03/08/2022] [Indexed: 02/08/2023]
Abstract
The gut microbiome has shown promise as a predictive biomarker for various diseases. However, the potential of gut microbiota for prospective risk prediction of liver disease has not been assessed. Here, we utilized shallow shotgun metagenomic sequencing of a large population-based cohort (N > 7,000) with ∼15 years of follow-up in combination with machine learning to investigate the predictive capacity of gut microbial predictors individually and in conjunction with conventional risk factors for incident liver disease. Separately, conventional and microbial factors showed comparable predictive capacity. However, microbiome augmentation of conventional risk factors using machine learning significantly improved the performance. Similarly, disease-free survival analysis showed significantly improved stratification using microbiome-augmented models. Investigation of predictive microbial signatures revealed previously unknown taxa for liver disease, as well as those previously associated with hepatic function and disease. This study supports the potential clinical validity of gut metagenomic sequencing to complement conventional risk factors for prediction of liver diseases.
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Affiliation(s)
- Yang Liu
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.
| | - Guillaume Méric
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia; Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Aki S Havulinna
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland; Institute of Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Shu Mei Teo
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Matti Ruuskanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Internal Medicine, University of Turku, Turku, Finland
| | - Jon Sanders
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Qiyun Zhu
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Anupriya Tripathi
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, CA, USA; Division of Biological Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Karin Verspoor
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia; School of Computing Technologies, RMIT University, Melbourne, VIC, Australia
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mohit Jain
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, CA, USA; Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Yoshiki Vázquez-Baeza
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA; Department of Computer Science & Engineering, Jacobs School of Engineering, University of California, San Diego, La Jolla, CA, USA
| | - Rohit Loomba
- NAFLD Research Center, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Leo Lahti
- Department of Computing, University of Turku, Turku, Finland
| | - Teemu Niiranen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Internal Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Veikko Salomaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Rob Knight
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, CA, USA; Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA; Department of Computer Science & Engineering, Jacobs School of Engineering, University of California, San Diego, La Jolla, CA, USA
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia; Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Health Data Research UK Cambridge, Wellcome Genome Campus, University of Cambridge, Cambridge, UK; British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK; The Alan Turing Institute, London, UK.
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17
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Coombs PR, Warsa M, Hailu T, Agedew E, Tsegaye B. Establishing an Ultrasound Screening Protocol for Chronic Liver Disease with a Handheld Device: A Pilot Project in Southern Ethiopia. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:702-710. [PMID: 35105496 DOI: 10.1016/j.ultrasmedbio.2021.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
Chronic liver disease (CLD) poses significant challenges in the developing world. The prevalence of this problem and the health burden on local health services are not well understood. The diagnosis and monitoring of CLD are difficult in these settings because of limited access to expensive imaging with limited mobility and/or liver biopsy. The aim of this project was to develop and implement an efficient evidence-based robust ultrasound protocol for the assessment of chronic liver disease using a hand-held ultrasound device that could be effectively used in the developing world. A protocol was established using scoring systems that have established accuracy for the diagnosis of hepatic fibrosis/cirrhosis and hepatic steatosis. Included in the protocol was the identification of hepatic masses, portal venous enlargement, hepatic size and splenic size. Hepatic steatosis was common, identified in 46 of 94 participants (49%). Hepatic fibrosis was observed in only 13 of 94 participants (14%). A significant limitation of the methodology was the inability to validate the results with biopsy or other forms of cross-sectional imaging. The protocol was successfully implemented in a community in a rural setting in South Ethiopia with a mean examination time of around 6 min. It is feasible to use handheld ultrasound for the screening of CLD in remote settings. This project provides an evidence-based framework for further studies in this area.
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Affiliation(s)
- Peter Robert Coombs
- Ultrasound Department, Monash Health Imaging, Monash Medical Centre, Clayton, Melbourne, Australia; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Clayton, Melbourne, Australia.
| | - Mengistu Warsa
- Ultrasound Department, Arba Minch Hospital, Arba Minch, Ethiopia
| | - Tadiwos Hailu
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | | | - Behailu Tsegaye
- Department of Biomedical Sciences, School of Medicine, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
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18
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Sanduzzi-Zamparelli M, Mariño Z, Lens S, Sapena V, Iserte G, Pla A, Granel N, Bartres C, Llarch N, Vilana R, Nuñez I, Darnell A, Belmonte E, García-Criado A, Díaz A, Muñoz-Martinez S, Ayuso C, Bianchi L, Fuster-Anglada C, Rimola J, Forner A, Torres F, Bruix J, Forns X, Reig M. Liver cancer risk after HCV cure in patients with advanced liver disease without non-characterized nodules. J Hepatol 2022; 76:874-882. [PMID: 34856322 DOI: 10.1016/j.jhep.2021.11.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Recognition of non-characterized liver nodules (NCLN) prior to direct-acting antivirals (DAAs) is associated with increased hepatocellular carcinoma (HCC) risk in patients with HCV. The risk of HCC has not been defined in F3/F4 patients in whom NCLN have been ruled-out before starting DAAs and at sustained virological response (SVR). This study aimed to estimate HCC incidence in this population. METHODS We performed a prospective study including HCV-infected patients with F3/F4 fibrosis, without a history of HCC, and who achieved SVR after DAAs. Patients were only included if they had undergone ultrasound imaging that excluded the presence of HCC/NCLN within 30 days after SVR. All patients were evaluated every 6 months until developing primary liver cancer, death or withdrawal of informed consent. HCC incidence was expressed per 100 patient-years (/100PY). Adherence to screening program was calculated every 6 months for the first 48 months. RESULTS A total of 185 patients (63/122, F3/F4) were included. Among those with cirrhosis, 92% were Child-Pugh A and 42.7% had clinically significant portal hypertension (CSPH). Albumin-bilirubin score was 1 in 84.9% and 2 in 15.1% of patients, respectively. The median clinical and radiologic follow-up was 52.4 months and 48 months, respectively. Ten patients developed HCC: HCC incidence was 1.46/100PY (95% CI 0.79-2.71) in the whole cohort, 2.24/100PY (95% CI 1.21-4.17) in F4 only and 3.63/100PY (95% CI 1.95-6.74) in patients with CSPH. No HCC was registered in patients with F3. Median time between SVR and HCC occurrence was 28.1 months; 12 non-primary liver cancers were also identified. CONCLUSIONS Patients with cirrhosis without NCLN at SVR remain at risk of HCC development. The absence of HCC in patients with F3 reinforces their marginal cancer risk, but prospective studies are needed to exclude them from screening programs. LAY SUMMARY Patients with HCV-related cirrhosis, without non-characterized liver nodules at sustained virologic response, remain at risk of hepatocellular carcinoma despite viral cure. However, the cancer risk after successful direct-acting antiviral treatment is marginal in patients with F3 fibrosis without non-characterized liver nodules. If confirmed in larger prospective studies, current screening recommendations may need to be revisited in this group of patients.
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Affiliation(s)
- Marco Sanduzzi-Zamparelli
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Zoe Mariño
- Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Victor Sapena
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Gemma Iserte
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Anna Pla
- Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Núria Granel
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Concepció Bartres
- Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Neus Llarch
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Ramón Vilana
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Isabel Nuñez
- Radiology Department, Hospital Clinic of Barcelona, Spain
| | - Anna Darnell
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Ernest Belmonte
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Angeles García-Criado
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Alba Díaz
- BCLC Group. Department of Pathology, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Sergio Muñoz-Martinez
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Carmen Ayuso
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Luis Bianchi
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Carla Fuster-Anglada
- BCLC Group. Department of Pathology, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Jordi Rimola
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, CIBERehd, University of Barcelona, Spain
| | - Alejandro Forner
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic of Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma of Barcelona, Barcelona, Spain
| | - Jordi Bruix
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain.
| | - Maria Reig
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain.
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19
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Hur M, Park M, Moon HW, Choe WH, Lee CH. Comparison of Non-Invasive Clinical Algorithms for Liver Fibrosis in Patients With Chronic Hepatitis B to Reduce the Need for Liver Biopsy: Application of Enhanced Liver Fibrosis and Mac-2 Binding Protein Glycosylation Isomer. Ann Lab Med 2022; 42:249-257. [PMID: 34635616 PMCID: PMC8548241 DOI: 10.3343/alm.2022.42.2.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/20/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-invasive clinical algorithms for the detection of liver fibrosis (LF) can reduce the need for liver biopsy (LB). We explored the implementation of two serum biomarkers, enhanced liver fibrosis (ELF) and Mac-2 binding protein glycosylation isomer (M2BPGi), in clinical algorithms for LF in chronic hepatitis B (CHB) patients. METHODS Two clinical algorithms were applied to 152 CHB patients: (1) transient elastography (TE) followed by biomarkers (TE/ELF and TE/M2GPGi); (2) biomarker test followed by TE (ELF/TE and M2BPGi/TE). Using the cut-off value or index for the detection of advanced LF (TE≥F3; 9.8 in ELF and 3.0 in M2BPGi), LB was expected to be performed in cases with discordant TE and biomarker results. RESULTS In both algorithms, the expected number of LBs was lower when using M2BPGi than when using ELF (TE/ELF or ELF/TE, 13.2% [N=20]; TE/M2BPGi or M2BPGi/TE, 9.9% [N=15]), although there was no statistical difference (P=0.398). In the TE low-risk group (TE≤F2), the discordance rate was significantly lower in the TE/M2BPGi approach than in the TE/ELF approach (1.5% [2/136] vs. 11.0% [15/136], P=0.002). In the biomarker low-risk group, there was no significant difference between the ELF/TE and M2BPGi/TE approaches (3.9% [5/126] vs. 8.8% [13/147], P=0.118). CONCLUSIONS Both ELF and M2BPGi can be implemented in non-invasive clinical algorithms for assessing LF in CHB patients. Given the lowest possibility of losing advanced LF cases in the low-risk group when using the TE/M2BPGi approach, this combination seems useful in clinical practice.
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Affiliation(s)
- Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mikyoung Park
- Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Won Hyeok Choe
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Chae Hoon Lee
- Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu, Korea
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20
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Yokoyama S, Ishizu Y, Honda T, Imai N, Ito T, Yamamoto K, Tsuzuki T, Ishigami M. Absence of large portal collateral vessels is associated with spontaneous improvement of cirrhotic portal vein thrombosis. Hepatol Res 2022; 52:199-209. [PMID: 34687492 DOI: 10.1111/hepr.13725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/03/2021] [Accepted: 10/20/2021] [Indexed: 01/03/2023]
Abstract
AIM Portal vein thrombosis (PVT) is a major complication in patients with liver cirrhosis (LC). In some cases, PVT decreases spontaneously, but the factors that predict this are still not fully understood. METHODS This was a retrospective, multicenter study that included 77 consecutive patients with cirrhotic PVT. Forty-eight patients did not undergo anticoagulation and 29 patients did between the time of the first diagnosis of PVT and the follow-up radiological imaging undertaken 1-6 months later. A complete disappearance and 25% shrinkage of PVT was defined as complete remission (CR) and partial remission (PR), respectively. Portosystemic collateral vessels larger than 9 mm in diameter were defined as large collateral vessels. RESULTS Complete remission + PR was found in 37.5% of the anticoagulation-naïve patients. On univariate analysis, the absence of large collateral vessels, absence of PVT in the main trunk of the portal vein, a high platelet count, and a low FIB-4 index were significant factors associated with CR + PR. On multivariate analysis, the absence of large collateral vessels was the unique factor associated with CR + PR of PVT (odds ratio 5.9; 95% confidence interval, 1.73-20.1). The CR + PR rate for anticoagulated patients was 44.8%. However, no predictors for a good treatment effect of anticoagulation for PVT were identified. CONCLUSIONS Spontaneous improvement of PVT in patients with LC can be expected when large collateral vessels are absent. For these patients, the option of observing them without anticoagulation can be considered in expectation of spontaneous reduction of PVT.
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Affiliation(s)
- Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Norihiro Imai
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Tomoyuki Tsuzuki
- Department of Internal Medicine, Toyota Kosei Hospital, Toyota, Aichi, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
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21
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Breath-Taking Perspectives and Preliminary Data toward Early Detection of Chronic Liver Diseases. Biomedicines 2021; 9:biomedicines9111563. [PMID: 34829792 PMCID: PMC8615034 DOI: 10.3390/biomedicines9111563] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 12/17/2022] Open
Abstract
The gold standard method for chronic liver diseases diagnosis and staging remains liver biopsy, despite the spread of less invasive surrogate modalities based on imaging and blood biomarkers. Still, more than 50% of chronic liver disease cases are detected at later stages when patients exhibit episodes of liver decompensation. Breath analysis represents an attractive means for the development of non-invasive tests for several pathologies, including chronic liver diseases. In this perspective review, we summarize the main findings of studies that compared the breath of patients with chronic liver diseases against that of control subjects and found candidate biomarkers for a potential breath test. Interestingly, identified compounds with best classification performance are of exogenous origin and used as flavoring agents in food. Therefore, random dietary exposure of the general population to these compounds prevents the establishment of threshold levels for the identification of disease subjects. To overcome this limitation, we propose the exogenous volatile organic compounds (EVOCs) probe approach, where one or multiple of these flavoring agent(s) are administered at a standard dose and liver dysfunction associated with chronic liver diseases is evaluated as a washout of ingested compound(s). We report preliminary results in healthy subjects in support of the potential of the EVOC Probe approach.
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22
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Weber F, Casalini T, Valentino G, Brülisauer L, Andreas N, Koeberle A, Kamradt T, Contini A, Luciani P. Targeting transdifferentiated hepatic stellate cells and monitoring the hepatic fibrogenic process by means of IGF2R-specific peptides designed in silico. J Mater Chem B 2021; 9:2092-2106. [PMID: 33595041 DOI: 10.1039/d0tb02372h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The lack of accurate and easily applicable methods for the diagnosis of liver fibrosis, a disease characterized by an accumulation of the extracellular matrix released by activated hepatic stellate cells (HSCs), has been a major limitation for the clinical management of liver diseases. The identification of biomarkers specific to liver microstructure alterations, combined with a non-invasive optical imaging modality, could guide clinicians towards a therapeutic strategy. In this study, structural information of the insulin-like growth factor 2 receptor (IGF2R), an overexpressed protein on activated HSCs, was used for in silico screening of novel IGF2R-specific peptide ligands. Molecular dynamics simulations, followed by computational alanine scanning of the IGF2R/IGF2 complex, led to the identification of a putative peptide sequence containing the most relevant amino acids for the receptor-ligand interaction (IGF2 E12-C21). The Residue Scan tool, implemented in the MOE software, was then used to optimize the binding affinity of this sequence by amino acid mutations. The designed peptides and their associated scrambled sequences were fluorescently labelled and their binding affinity to LX-2 cells (model for activated human HSCs) was tested using flow cytometry and confocal microscopy. In vitro binding was verified for all sequences (KD ≤ 13.2 μM). With respect to the putative binding sequence, most mutations led to an increased affinity. All sequences have shown superior binding compared to their associated scrambled sequences. Using HPLC, all peptides were tested in vitro for their proteolytic resistance and showed a stability of ≥60% intact after 24 h at 37 °C in 50% v/v FBS. In view of their prospective diagnostic application, a comparison of binding affinity was performed in perpetuated and quiescent-like LX-2 cells. Furthermore, the IGF2R expression for different cell phenotypes was analysed by a quantitative mass spectrometric approach. Our peptides showed increased binding to the perpetuated cell state, indicating their good selectivity for the diagnostically relevant phenotype. In summary, the increased binding affinity of our peptides towards perpetuated LX-2 cells, as well as the satisfactory proteolytic stability, proves that the in silico designed sequences offer a new potential strategy for the targeting of hepatic fibrosis.
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Affiliation(s)
- Florian Weber
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Bern, Switzerland. and Department of Pharmaceutical Technology, Institute of Pharmacy, Friedrich Schiller University Jena, Jena, Germany
| | - Tommaso Casalini
- Institute of Mechanical Engineering and Material Technology, Department of Innovative Technology, SUPSI, Manno, Switzerland and Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Gina Valentino
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Bern, Switzerland. and Department of Pharmaceutical Technology, Institute of Pharmacy, Friedrich Schiller University Jena, Jena, Germany
| | - Lorine Brülisauer
- Department of Pharmaceutical Technology, Institute of Pharmacy, Friedrich Schiller University Jena, Jena, Germany
| | - Nico Andreas
- Institute of Immunology, Jena University Hospital, Jena, Germany
| | - Andreas Koeberle
- Michael Popp Institute and Center for Molecular Biosciences (CMBI), University of Innsbruck, Innsbruck, Austria and Chair of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich Schiller University Jena, Jena, Germany
| | - Thomas Kamradt
- Institute of Immunology, Jena University Hospital, Jena, Germany
| | - Alessandro Contini
- Dipartimento di Scienze Farmaceutiche-Sezione di Chimica Generale e Organica "A. Marchesini", Università degli Studi di Milano, Milano, Italy
| | - Paola Luciani
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Bern, Switzerland. and Department of Pharmaceutical Technology, Institute of Pharmacy, Friedrich Schiller University Jena, Jena, Germany
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23
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Van Dijk AM, Vali Y, Mak AL, Lee J, Tushuizen ME, Zafarmand MH, Anstee QM, Brosnan MJ, Nieuwdorp M, Bossuyt PM, Holleboom AG. Systematic Review with Meta-Analyses: Diagnostic Accuracy of FibroMeter Tests in Patients with Non-Alcoholic Fatty Liver Disease. J Clin Med 2021; 10:jcm10132910. [PMID: 34209858 PMCID: PMC8269151 DOI: 10.3390/jcm10132910] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
Early detection of liver fibrosis is crucial to select the correct care path for patients with non-alcoholic fatty liver disease (NAFLD). Here, we systematically review the evidence on the performance of FibroMeter versions in detecting different levels of fibrosis in patients with NAFLD. We searched four databases (Medline, Embase, the Cochrane library, and Web of Science) to find studies that included adults with NAFLD and biopsy-confirmed fibrosis (F1 to F4), compared with any version of FibroMeter. Two independent researchers screened the references, collected the data, and assessed the methodological quality of the included studies. We used a bivariate logit-normal random effects model to produce meta-analyses. From 273 references, 12 studies were eligible for inclusion, encompassing data from 3425 patients. Meta-analyses of the accuracy in detecting advanced fibrosis (F ≥ 3) were conducted for FibroMeter Virus second generation (V2G), NAFLD, and vibration controlled transient elaFS3stography (VCTE). FibroMeter VCTE showed the best diagnostic accuracy in detecting advanced fibrosis (sensitivity: 83.5% (95%CI 0.58–0.94); specificity: 91.1% (95%CI 0.89–0.93)), followed by FibroMeter V2G (sensitivity: 83.1% (95%CI 0.73–0.90); specificity: 84.4% (95%CI 0.62–0.95)) and FibroMeter NAFLD (sensitivity: 71.7% (95%CI 0.63–0.79); specificity: 82.8% (95%CI 0.71–0.91)). No statistically significant differences were found between the different FibroMeter versions. FibroMeter tests showed acceptable sensitivity and specificity in detecting advanced fibrosis in patients with NAFLD, but an urge to conduct head-to-head comparison studies in patients with NAFLD of the different FibroMeter tests remains.
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Affiliation(s)
- Anne-Marieke Van Dijk
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Location AMC, 1105AZ Amsterdam, The Netherlands; (A.L.M.); (M.N.); (A.G.H.)
- Correspondence: ; Tel.: +31-205665973
| | - Yasaman Vali
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Location AMC, 1105AZ Amsterdam, The Netherlands; (Y.V.); (J.L.); (M.H.Z.); (P.M.B.)
| | - Anne Linde Mak
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Location AMC, 1105AZ Amsterdam, The Netherlands; (A.L.M.); (M.N.); (A.G.H.)
| | - Jenny Lee
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Location AMC, 1105AZ Amsterdam, The Netherlands; (Y.V.); (J.L.); (M.H.Z.); (P.M.B.)
| | - Maarten E. Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2333ZA Leiden, The Netherlands;
| | - Mohammad Hadi Zafarmand
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Location AMC, 1105AZ Amsterdam, The Netherlands; (Y.V.); (J.L.); (M.H.Z.); (P.M.B.)
| | - Quentin M. Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - M. Julia Brosnan
- Internal Medicine Research Unit, Pfizer Inc., Cambridge, MA 02139, USA;
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Location AMC, 1105AZ Amsterdam, The Netherlands; (A.L.M.); (M.N.); (A.G.H.)
| | - Patrick M. Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Location AMC, 1105AZ Amsterdam, The Netherlands; (Y.V.); (J.L.); (M.H.Z.); (P.M.B.)
| | - Adriaan G. Holleboom
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Location AMC, 1105AZ Amsterdam, The Netherlands; (A.L.M.); (M.N.); (A.G.H.)
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Abstract
Early diagnosis of hepatic fibrosis (HF) is pivotal for management to cease progression to cirrhosis and hepatocellular carcinoma. HF is the telltale sign of chronic liver disease, and confirmed by liver biopsy, which is an invasive technique and inclined to sampling errors. The morphologic parameters of cirrhosis are assessed on conventional imaging such as on ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Newer imaging modalities such as magnetic resonance elastography and US elastography are reliable and accurate. More research studies on novel imaging modalities such as MRI with diffusion weighted imaging, enhancement by hepatobiliary contrast agents, and CT using perfusion are essential for earlier diagnosis, surveillance and accurate management. The purpose of this article is to discuss non-invasive CT, MRI, and US imaging modalities for diagnosis and stratify HF.
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Affiliation(s)
- Mayur Virarkar
- Department of Neuroradiology, The University of Texas Health Science Center, Houston, TX.
| | - Ajaykumar C Morani
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa W Taggart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Bhosale
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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25
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Öz A, Çınar T, Taş E, Çağan Efe S, Ayça B, Karabağ T. Assessment of pulmonary arterial stiffness in patients with cirrhosis: A prospective cohort study. Echocardiography 2020; 38:57-63. [PMID: 33226143 DOI: 10.1111/echo.14935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/21/2020] [Accepted: 11/04/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION In the current literature, several studies show that PAS (pulmonary artery stiffness) is associated with RV (right ventricular) dysfunction, PAH (pulmonary arterial hypertension), and disease severity in subjects with structural cardiac disease, HIV (human immunodeficiency virus), and chronic lung disease. Hence, our main aim was to use PAS to show the early changes in the pulmonary vascular region in subjects with cirrhosis. MATERIAL AND METHODS In this prospective cross-sectional study, 39 subjects who were being followed up with cirrhosis and 41 age- and sex-matched healthy subjects were included in this study. For each case, the PAS value was obtained by dividing mean peak velocity of the pulmonary flow by the PfAT (pulmonary flow acceleration time). RESULTS The measured PAS was 23.62 ± 5.87 (Hz/msn) in cirrhotic participants and 19.09 ± 4.16 (Hz/msn) in healthy cases (P < .001). We found a positive statistical significance between PAS and RVSP (right ventricle systolic pressure)/sPAP (systolic pulmonary arterial pressure) (r = .395; P = .013). PAS was an independent predictor that was associated with cirrhosis disease according to multivariate LR (logistic regression) analysis (OR: 1.209; 95% CI: 1.059-1.381; P = .005). CONCLUSION Based on the study results, we consider that PAS may help in the early detection of findings in the pulmonary vascular area, even if the RV function findings or sPAP is within the normal range.
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Affiliation(s)
- Ahmet Öz
- Department of Cardiology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Tufan Çınar
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ebru Taş
- Department of Gastroenterology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Burak Ayça
- Department of Cardiology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Turgut Karabağ
- Department of Cardiology, Istanbul Training and Research Hospital, Istanbul, Turkey
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26
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Hanafy AS, Basha MAK, Wadea FM. Novel markers of endothelial dysfunction in hepatitis C virus-related cirrhosis: More than a mere prediction of esophageal varices. World J Hepatol 2020; 12:850-862. [PMID: 33200022 PMCID: PMC7643206 DOI: 10.4254/wjh.v12.i10.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/15/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection may affect lipid metabolism by enhancing the circulating levels of inflammatory cytokines, together with its impact on endothelial function.
AIM To evaluate the potential correlation of changes in lipid profile, carotid intima-media thickness (CIMT), and ankle-brachial index with the severity of fibrosis, grades of esophageal varices (EVs), and fibrosis indices.
METHODS The study included 240 subjects who were divided into 3 groups; group 1 (n = 90, HCV-related cirrhotic patients with EVs), group 2 (n = 90, HCV-related cirrhotic patients without EVs), and group 3 (n = 60, served as the healthy control group). All patients underwent routine laboratory tests, including a lipid profile assay. Low-density lipoproteins (LDL)/platelet count and platelet/splenic diameter ratios were calculated. Abdominal ultrasonography, CIMT by carotid Doppler, bedside ankle-brachial index (ABI), liver stiffness measurement, and upper gastrointestinal endoscopy were performed.
RESULTS Multivariate logistic regression revealed that very-low-density lipoprotein (VLDL) (β = 0.988, odds ratio 2.5, P = 0.001), LDL/platelet count ratio (β = 1.178, odds ratio 3.24, P = 0.001), CIMT (β = 1.37, odds ratio 3.9, P = 0.001), and ABI (β = 2.3, odds ratio 5.9, P = 0.001) were the key variables associated with significant fibrosis, EVs and endothelial dysfunction. CIMT and LDL/platelet count ratio were predictive of advanced fibrosis and EVs at cutoff values of 1.1 mm and 1 mm, respectively, with an area under the curve (AUC) of 0.966 and 0.960 (P = 0.001), while VLDL and ABI at a cutoff of 16.5 mg/dL and 0.94 were predictive of advanced fibrosis and EVs with an AUC of 0.891 and 0.823, respectively (P = 0.001).
CONCLUSION CIMT, ABI, VLDL, LDL/platelet count ratio are good non-invasive predictors of advanced fibrosis, presence of EVs, and endothelial dysfunction in liver cirrhosis.
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Affiliation(s)
- Amr Shaaban Hanafy
- Department of Internal Medicine, Gastroenterology and Hepatology Division, Zagazig University Hospital, Zagazig 44519, Egypt
| | | | - Fady Maher Wadea
- Department of Internal Medicine, Gastroenterology and Hepatology Division, Zagazig University Hospital, Zagazig 44519, Egypt
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27
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Photoacoustic Imaging for Assessing Tissue Oxygenation Changes in Rat Hepatic Fibrosis. Diagnostics (Basel) 2020; 10:diagnostics10090705. [PMID: 32957666 PMCID: PMC7555416 DOI: 10.3390/diagnostics10090705] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/18/2020] [Accepted: 09/11/2020] [Indexed: 12/29/2022] Open
Abstract
Chronic liver inflammation progressively evokes fibrosis and cirrhosis resulting in compromised liver function, and often leading to cancer. Early diagnosis and staging of fibrosis is crucial because the five-year survival rate of early-stage liver cancer is high. This study investigates the progression of hepatic fibrosis induced in rats following ingestion of diethylnitrosamine (DEN). Changes in oxygen saturation and hemoglobin concentration resulting from chronic inflammation were assayed longitudinally during DEN ingestion by photoacoustic imaging (PAI). Accompanying liver tissue changes were monitored simultaneously by B-mode sonographic imaging. Oxygen saturation and hemoglobin levels in the liver increased over 5 weeks and peaked at 10 weeks before decreasing at 13 weeks of DEN ingestion. The oxygenation changes were accompanied by an increase in hepatic echogenicity and coarseness in the ultrasound image. Histology at 13 weeks confirmed the development of severe fibrosis and cirrhosis. The observed increase in PA signal representing enhanced blood oxygenation is likely an inflammatory physiological response to the dietary DEN insult that increases blood flow by the development of neovasculature to supply oxygen to a fibrotic liver during the progression of hepatic fibrosis. Assessment of oxygenation by PAI may play an important role in the future assessment of hepatic fibrosis.
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28
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Hindman NM, Arif-Tiwari H, Kamel IR, Al-Refaie WB, Bartel TB, Cash BD, Chernyak V, Goldstein A, Grajo JR, Horowitz JM, Kamaya A, McNamara MM, Porter KK, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria ® Jaundice. J Am Coll Radiol 2020; 16:S126-S140. [PMID: 31054739 DOI: 10.1016/j.jacr.2019.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023]
Abstract
Jaundice is the end result of myriad causes, which makes the role of imaging in this setting particularly challenging. In the United States, the most common causes of all types of jaundice fall into four categories including hepatitis, alcoholic liver disease, blockage of the common bile duct by a gallstone or tumor, and toxic reaction to a drug or medicinal herb. Clinically, differentiating between the various potential etiologies of jaundice requires a detailed history, targeted physical examination, and pertinent laboratory studies, the results of which allow the physician to categorize the type of jaundice into mechanical or nonmechanical causes. Imaging modalities used to evaluate the jaundiced patient (all etiologies) include abdominal ultrasound (US), CT, MR cholangiopancreatography, endoscopic retrograde cholangiopancreatography and endoscopic US. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Waddah B Al-Refaie
- Georgetown University Hospital, Washington, District of Columbia; American College of Surgeons
| | | | - Brooks D Cash
- University of Texas McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | | | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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29
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Gheorghe G, Bungău S, Ceobanu G, Ilie M, Bacalbaşa N, Bratu OG, Vesa CM, Găman MA, Diaconu CC. The non-invasive assessment of hepatic fibrosis. J Formos Med Assoc 2020; 120:794-803. [PMID: 32861550 DOI: 10.1016/j.jfma.2020.08.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/30/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Hepatic disease accounts for approximately 2 million deaths/year worldwide. Liver fibrosis, as the last stage of numerous chronic liver diseases, is one of the most relevant prognostic factors. The liver biopsy with the histopathological examination is considered to be the "gold standard" for the identification and staging of the hepatic fibrosis. However, liver biopsy is known as an invasive investigation that has multiple limitations. Research studies conducted in the last few years focused on identifying non-invasive type methods for the evaluation of hepatic fibrosis; usually, there are 2 categories of such investigations: serologic tests and imaging techniques. This narrative review presents the non-invasive investigation methods used in the liver fibrosis evaluation. New molecular perspectives on fibrogenesis and fibrosis regression, as well as the appearance of therapeutic antifibrotic agents, justify the necessity of non-invasive tools to detect and grade liver fibrosis.
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Affiliation(s)
- Gina Gheorghe
- Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
| | - Simona Bungău
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania.
| | - Gabriela Ceobanu
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania.
| | - Mădălina Ilie
- Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
| | - Nicolae Bacalbaşa
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
| | - Ovidiu Gabriel Bratu
- Department of Urology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410028, Oradea, Romania.
| | - Mihnea-Alexandru Găman
- University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania; Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest 022328, Romania.
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; Department of Internal Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
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30
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Quantified MRI and 25OH-VitD3 can be used as effective biomarkers for patients with neoadjuvant chemotherapy-induced liver injury in CRCLM? BMC Cancer 2020; 20:767. [PMID: 32799832 PMCID: PMC7429712 DOI: 10.1186/s12885-020-07282-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background To evaluate proton-density fat-fraction (PDFF) and intravoxel incoherent motion (IVIM) techniques, and human 25-hydroxyvitamin D3 (25OH-VitD3) levels, as potential biomarkers in patients with colorectal cancer with liver metastasis (CRCLM). Changes were compared with those related to chemotherapy-associated steatohepatitis (CASH) and sinusoidal obstruction syndrome (SOS). Methods 63 patients with pathologically confirmed colorectal adenocarcinoma received 4–6 courses of NC before liver resection and underwent magnetic resonance imaging (MRI) with iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantification and IVIM sequences. Blood samples were analyzed using CTCAE. Pathological changes of liver tissues outside the metastases were assessed as the gold standard, and receiver operating characteristic (ROC) curves were analyzed. Results 16 cases had CASH liver injury, 14 cases had SOS changes, and 4 cases had CASH and SOS, and 7 showed no significant changes. Consistency between biochemical indices and pathological findings was poor (kappa = 0.246, p = 0.005). The areas under the ROC curve (AUCs) of ALT, AST, ALP, GGT, and TBIL were 0.571–0.691. AUCs of D, FF, and 25OH-VitD3 exceeded 0.8; when considering these markers together, sensitivity was 85.29% and specificity was 93.13%. ANOVA showed statistically significant differences among D, FF, and 25OH-VitD3 for different grades of liver injury (F = 4.64–26.5, p = 0.000–0.016). Conclusions D, FF, and 25OH-VitD3 are biomarkers for accurate prediction of NC-induced liver injury in patients with CRCLM, while FF and 25OH-VitD3 might be beneficial to distinguish liver injury grades. Trial registration Current Trials was retrospectively registered as ChiCTR1800015242 at Chinese Clinical Trial Registry on March 16, 2018.
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31
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Serum chitinase-3-like protein 1 is a biomarker of liver fibrosis in patients with chronic hepatitis B in China. Hepatobiliary Pancreat Dis Int 2020; 19:384-389. [PMID: 32540209 DOI: 10.1016/j.hbpd.2020.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Serum chitinase-3-like protein 1 (CHI3L1) is a potential biomarker for fibrosis assessment. We aimed to evaluate serum CHI3L1 as a noninvasive diagnostic marker for chronic hepatitis B virus-related fibrosis. METHODS Serum CHI3L1 levels were measured by ELISA in 134 chronic hepatitis B (CHB) patients. Significant fibrosis was defined as a liver stiffness > 9.7 kPa. The performance of CHI3L1 was assessed and compared to that of other noninvasive tests by receiver operating characteristic (ROC) analysis. RESULTS Serum CHI3L1 levels were significantly higher in CHB patients with significant hepatic fibrosis (≥ F2, 81.9 ng/mL) than in those without significant hepatic fibrosis (< F2, 56.5 ng/mL) (P < 0.001). In CHB patients, the specificity and sensitivity of CHI3L1 for predicting significant fibrosis were 75.6% and 59.1%, respectively, with a cut-off of 76.0 ng/mL and an area under the ROC curve of 0.728 (95% CI: 0.637-0.820). CONCLUSIONS Serum CHI3L1 levels could be an effective new serological biomarker for the diagnosis of liver. Moreover, CHI3L1 is feasible in monitoring disease progression.
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32
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X-ray absorption spectroscopy combined with machine learning for diagnosis of schistosomiasis cirrhosis. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.101944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Li K, Qin L, Jiang S, Li A, Zhang C, Liu G, Sun J, Sun H, Zhao Y, Li N, Zhang Y. The signature of HBV-related liver disease in peripheral blood mononuclear cell DNA methylation. Clin Epigenetics 2020; 12:81. [PMID: 32513305 PMCID: PMC7278209 DOI: 10.1186/s13148-020-00847-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022] Open
Abstract
Background Hepatitis B virus (HBV)-related liver disease induces liver damage by hepatic immune and inflammatory response. The association between aberrant peripheral blood mononuclear cell (PBMC) DNA methylation and progression of liver disease and fibrosis remains unclear. Results Here we applied Infinium 450 K BeadChip investigating PBMC genome-wide methylation profiling of 48 HBV-related liver disease patients including 24 chronic hepatitis B (CHB), 14 compensated liver cirrhosis (LC), and 10 decompensated liver cirrhosis (DLC). In total, there were 7888 differentially methylated CpG sites (36.06% hypermethylation, 63.94% hypomethylation) correlate with liver disease progression. LC was difficult to be diagnosed, intermediating between CHB and DLC. We used least absolute shrinkage and selection operator (LASSO)-logistic regression method to perform a LC predictive model. The predicted probability (P) of having LC was estimated by the combined model: P = 1/(1 − e−x), where X = 11.52 − 2.82 × (if AST within the normal range − 0.19 × (percent methylation of cg05650055) − 0.21 × (percent methylation of cg17149911 ). Pyrosequencing validation and confusion matrix analysis was used for internal testing, area under receiver operating characteristic curve (AUROC) of model was 0.917 (95% CI, 0.80–0.977). On the fibrosis progress, there were 1705 genes in LC compared with CHB, whose differentially methylated CpG sites loading within the “promoter” regions (including TSS1500, TSS200, 5′UTR, and the 1st exon of genes) subject into the enrichment analysis using Ingenuity Pathway Analysis (IPA). There were 113 enriched immune-related pathways indicated that HBV-related liver fibrosis progression caused epigenetic reprogramming of the immune and inflammatory response. Conclusions These data support idea that development of HBV-related chronic liver disease is linked with robust and broad alteration of methylation in peripheral immune system. CpG methylation sites serve as relevant biomarker candidates to monitor and diagnose LC, providing new insight into the immune mechanisms understanding the progression of HBV-related liver fibrosis and cirrhosis.
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Affiliation(s)
- Kang Li
- Biomedical Information Center, Beijing You'An Hospital, Capital Medical University, Beijing, China
| | - Ling Qin
- Biomedical Information Center, Beijing You'An Hospital, Capital Medical University, Beijing, China.,Schools of Basic Medical Science, Capital Medical University, Beijing, China
| | | | - Ang Li
- Biomedical Information Center, Beijing You'An Hospital, Capital Medical University, Beijing, China
| | - Chi Zhang
- Biomedical Information Center, Beijing You'An Hospital, Capital Medical University, Beijing, China
| | - Guihai Liu
- Biomedical Information Center, Beijing You'An Hospital, Capital Medical University, Beijing, China.,University of Oxford, Oxford, UK
| | - Jianping Sun
- Biomedical Information Center, Beijing You'An Hospital, Capital Medical University, Beijing, China
| | - Huanqing Sun
- Biomedical Information Center, Beijing You'An Hospital, Capital Medical University, Beijing, China
| | - Yan Zhao
- Clinical Laboratory Center, Beijing You'An hospital, Capital Medical University, Beijing, China
| | - Ning Li
- Departments of Hepatobiliary Surgery, Beijing You'An Hospital, Capital Medical University, Beijing, China.
| | - Yonghong Zhang
- Biomedical Information Center, Beijing You'An Hospital, Capital Medical University, Beijing, China.
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Yang X, Chen X, Xia C, Li S, Zhu L, Xu C. Comparative analysis of the expression profiles of genes related to the Gadd45α signaling pathway in four kinds of liver diseases. Histol Histopathol 2020; 35:949-960. [PMID: 32298459 DOI: 10.14670/hh-18-218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gadd45α (growth arrest and DNA damage inducible alpha) is a member of a group of genes whose transcript levels are increased following stressful conditions that lead to growth arrest and treatment with agents that lead to DNA damage. Gadd45α is upregulated in liver cirrhosis (LC), hepatic cancer (HC), acute liver failure (AHF) and non-alcoholic fatty liver disease(NAFLD). Here, we investigated the essential differences in the Gadd45α signaling pathway in these diseases at the transcriptional level. The results showed that 44, 46, 71 and 27 genes significant changes in these diseases, and the H-cluster showed that the expression of the Gadd45α signaling-related genes was significantly different in the four liver diseases. DAVID functional analysis showed that the Gadd45α signaling pathway-related genes were mainly involved in cell adhesion and migration, cell proliferation, apoptosis, stress and inflammatory responses, etc. Ingenuity pathway analysis (IPA) software was used to predict the functions of the Gadd45α signaling-related genes, and the results indicated that there were significant changes in cell differentiation, DNA damage repair, autophagy, apoptosis and necrosis. Gadd45α signaling pathway is involved in four kinds of liver disease and regulates a variety of activities via P38 MAPK, NF-κB, mTOR/STAT3, P21, PCNA, PI3K/Akt and other signaling pathways. Modulation of Gadd45α may be exploited to prevent the progression of liver disease, and to identify specific treatments for different stages of liver disease. In summary, the Gadd45α signaling pathway is involved in four kinds of liver disease and regulates a variety of physiological activities through various signaling pathways.
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Affiliation(s)
- Xianguang Yang
- College of Life Science, Henan Normal University, Xinxiang, Henan Province, China. .,State Key Laboratory Cultivation Base for Cell Differentiation Regulation and Henan Bioengineering Key Laboratory, Henan Normal University, Xinxiang, Henan Province, China
| | - Xuelin Chen
- State Key Laboratory Cultivation Base for Cell Differentiation Regulation and Henan Bioengineering Key Laboratory, Henan Normal University, Xinxiang, Henan Province, China.,College of Life Science, Henan Normal University, Xinxiang, Henan Province, China
| | - Cong Xia
- State Key Laboratory Cultivation Base for Cell Differentiation Regulation and Henan Bioengineering Key Laboratory, Henan Normal University, Xinxiang, Henan Province, China.,College of Life Science, Henan Normal University, Xinxiang, Henan Province, China
| | - Shuaihong Li
- State Key Laboratory Cultivation Base for Cell Differentiation Regulation and Henan Bioengineering Key Laboratory, Henan Normal University, Xinxiang, Henan Province, China.,College of Life Science, Henan Normal University, Xinxiang, Henan Province, China
| | - Lin Zhu
- State Key Laboratory Cultivation Base for Cell Differentiation Regulation and Henan Bioengineering Key Laboratory, Henan Normal University, Xinxiang, Henan Province, China.,College of Life Science, Henan Normal University, Xinxiang, Henan Province, China
| | - Cunshuan Xu
- State Key Laboratory Cultivation Base for Cell Differentiation Regulation and Henan Bioengineering Key Laboratory, Henan Normal University, Xinxiang, Henan Province, China.,College of Life Science, Henan Normal University, Xinxiang, Henan Province, China
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35
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Da BL, Surana P, Kleiner DE, Heller T, Koh C. The Delta-4 fibrosis score (D4FS): A novel fibrosis score in chronic hepatitis D. Antiviral Res 2019; 174:104691. [PMID: 31837393 DOI: 10.1016/j.antiviral.2019.104691] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Chronic Hepatitis D virus (HDV) infection results in the most severe form of viral hepatitis with a rapid progression to cirrhosis. However, non-invasive fibrosis tests that can accurately predict cirrhosis have not been adequately validated. We aimed to develop a clinically useful non-invasive score that can accurately detect cirrhosis. MATERIAL AND METHODS Patients with chronic HDV diagnosed by liver histology or serum PCR were evaluated. Data regarding demographics, laboratory, imaging, vibration-controlled transient elastography (VCTE), and liver biopsy were collected. The total cohort was randomized into a training and validation cohort. The training cohort was used to develop a novel score, the Delta-4 fibrosis score (D4FS) which was then compared to other non-invasive tests in the validation cohort by area under receiver operating characteristics (AUROC). RESULTS 77 patients with chronic HDV were evaluated: mean age 42.6 (SD:11.1) years, 59.7% male, and 57.1% Asian. The total cohort was then separated into a training (n = 45) and validation (n = 32) cohort with no significant differences in terms of clinical characteristics between the two. From the training cohort, the D4FS was derived from variables of statistical and clinical interest (gamma-glutamyl transpeptidase (GGT), platelet count, alanine aminotransferase (ALT), and liver stiffness measurement (LSM)). The D4FS demonstrated the best AUROC in the validation cohort (0.94) followed by VCTE (0.90), FIB-4 (0.86), APRI (0.81), and AAR (0.71). DISCUSSION The D4FS is a clinically useful non-invasive fibrosis score that can accurately detect cirrhosis in patients with chronic HDV infection. Further studies should be performed to further validate clinical utility.
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Affiliation(s)
- Ben L Da
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Pallavi Surana
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
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36
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Abstract
Sarcoidosis is a multi-organ inflammatory disease of unclear etiology. The hallmark of the disease is the formation of non-caseating granulomas. The prevalence of sarcoidosis is 5-30% in the general population and up to 80% in autopsy series. Hepatic involvement is seen in almost 50% of cases of sarcoidosis, though the clinical consequences are variable. In this study, we describe the case of three patients from our institution with hepatic sarcoidosis. Two of them eventually went on to develop liver cirrhosis.
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Affiliation(s)
- Sara Ghoneim
- Internal Medicine, Case Western Reserve University MetroHealth Medical Center, Cleveland, USA
| | - Sherrie D Williams
- Internal Medicine: Pulmonology, Case Western Reserve University MetroHealth Medical Center, Cleveland, USA
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Deep learning with ultrasonography: automated classification of liver fibrosis using a deep convolutional neural network. Eur Radiol 2019; 30:1264-1273. [PMID: 31478087 DOI: 10.1007/s00330-019-06407-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/24/2019] [Accepted: 08/05/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to develop a deep convolutional neural network (DCNN) for the prediction of the METAVIR score using B-mode ultrasonography images. METHODS Datasets from two tertiary academic referral centers were used. A total of 13,608 ultrasonography images from 3446 patients who underwent surgical resection, biopsy, or transient elastography were used for training a DCNN for the prediction of the METAVIR score. Pathological specimens or estimated METAVIR scores derived from transient elastography were used as a reference standard. A four-class model (F0 vs. F1 vs. F23 vs. F4) was developed. Diagnostic performance of the algorithm was validated on a separate internal test set of 266 patients with 300 images and external test set of 572 patients with 1232 images. Performance in classification of cirrhosis was compared between the DCNN and five radiologists. RESULTS The accuracy of the four-class model was 83.5% and 76.4% on the internal and external test set, respectively. The area under the receiver operating characteristic curve (AUC) for classification of cirrhosis (F4) was 0.901 (95% confidence interval [CI], 0.865-0.937) on the internal test set and 0.857 (95% CI, 0.825-0.889) on the external test set, respectively. The AUC of the DCNN for classification of cirrhosis (0.857) was significantly higher than that of all five radiologists (AUC range, 0.656-0.816; p value < 0.05) using the external test set. CONCLUSIONS The DCNN showed high accuracy for determining METAVIR score using ultrasonography images and achieved better performance than that of radiologists in the diagnosis of cirrhosis. KEY POINTS • DCNN accurately classified the ultrasonography images according to the METAVIR score. • The AUROC of this algorithm for cirrhosis assessment was significantly higher than that of radiologists. • DCNN using US images may offer an alternative tool for monitoring liver fibrosis.
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Licata A, Minissale MG, Montalto FA, Soresi M. Is vitamin D deficiency predictor of complications development in patients with HCV-related cirrhosis? Intern Emerg Med 2019; 14:735-737. [PMID: 30879232 DOI: 10.1007/s11739-019-02072-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Anna Licata
- Medicina Interna ed Epatologia, Dipartimento di Promozione della Salute, Materno-infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, Università di Palermo, Palermo, Italy.
| | - Maria Giovanna Minissale
- Medicina Interna ed Epatologia, Dipartimento di Promozione della Salute, Materno-infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, Università di Palermo, Palermo, Italy
| | - Filippo A Montalto
- Medicina Interna ed Epatologia, Dipartimento di Promozione della Salute, Materno-infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, Università di Palermo, Palermo, Italy
| | - Maurizio Soresi
- Medicina Interna ed Epatologia, Dipartimento di Promozione della Salute, Materno-infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, Università di Palermo, Palermo, Italy
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Jian J, Zhao X, Qin L, Zhao Y, Sun M, Lv W, Hu C. Three-dimensional visualization of fibrous tissues in cirrhotic rats via X-ray phase-contrast computed tomography with iodine staining. JOURNAL OF SYNCHROTRON RADIATION 2019; 26:1354-1360. [PMID: 31274464 DOI: 10.1107/s1600577519006064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
To accurately characterize cirrhosis, knowledge of the 3D fibrous structures is essential. Histology is the gold standard in cirrhosis screening, but it mainly provides structural information in 2D planes and destroys the 3D samples in the process. The aim of this study was to evaluate the potential of X-ray phase-contrast computed tomography (PCCT) with iodine staining for the 3D nondestructive visualization of internal structural details in entire cirrhotic livers with histopathologic correlation. In this study, cirrhotic livers induced by carbon tetrachloride (CCl4) in rats were imaged via PCCT and then histopathologically processed. Characteristics of the cirrhosis, i.e. abnormal nodules surrounded by annular fibrosis, were established and a 3D reconstruction of these structures was also performed via PCCT. Fibrosis area, septal width and nodular size were measured and the correlation for these quantitative measurements between PCCT and histopathologic findings was analyzed. The results showed that fibrous bands, small nodules and angio-architecture in cirrhosis were clearly presented in the PCCT images, with histopathologic findings as standard reference. In comparison with histopathology, PCCT was associated with a very close value for fibrosis area, septal width and nodular size. The quantitative measurements showed a strong correlation between PCCT and histopathology. Additionally, the 3D structures of fibrous bands and microvasculature were presented simultaneously. PCCT provides excellent results in the assessment of cirrhosis characteristics and 3D presentation of these feature structures compared with histopathology. Thus, the technique may serve as an adjunct nondestructive 3D modality for cirrhosis characterization.
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Affiliation(s)
- Jianbo Jian
- College of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Xinyan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
| | - Lili Qin
- College of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Yuqing Zhao
- College of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Mengyu Sun
- College of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Wenjuan Lv
- College of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Chunhong Hu
- College of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, People's Republic of China
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Park SY, Yu SN, Lee EJ, Kim T, Jeon MH, Choo EJ, Park S, Chae JW, In Bang H, Kim TH. Monomicrobial gram-negative necrotizing fasciitis: An uncommon but fatal syndrome. Diagn Microbiol Infect Dis 2019; 94:183-187. [PMID: 30713116 DOI: 10.1016/j.diagmicrobio.2018.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 12/17/2018] [Accepted: 12/26/2018] [Indexed: 12/20/2022]
Abstract
This study aimed to characterize patients with monomicrobial gram-negative necrotizing fasciitis in three university hospitals in Korea. In this study, of the 115 patients with community-acquired necrotizing fasciitis, 67 (58%) had monomicrobial infections: 31 (27%) in the gram-negative group and 36 (31%) in the gram-positive group. The majority of patients in the gram-negative group were infected with Escherichia coli followed by Klebsiella pneumoniae and Vibrio vulnificus. More patients in the gram-negative group showed liver cirrhosis than those in the gram-positive group (39% vs. 14%, P = 0.02). In a multivariable logistic regression analysis, liver cirrhosis (adjusted odds ratio [aOR], 13.7; 95% confidence interval [CI], 2.9-67.0), treatment with antibiotics without surgery (aOR, 10.2; 95% CI, 2.1-48.3), and lower level of albumin (aOR 4.9; 95% CI, 1.6-14.9) were associated with 30-day mortality. Our findings suggest that gram-negative necrotizing fasciitis is more often associated with liver cirrhosis and has poorer outcomes than gram-positive necrotizing fasciitis.
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Affiliation(s)
- Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Shi Nae Yu
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Eun Jung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Tark Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Min Hyok Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Eun Ju Choo
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Joon Won Chae
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Hae In Bang
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
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Hickman L, Tanner L, Christein J, Vickers S. Non-Hepatic Abdominal Surgery in Patients with Cirrhotic Liver Disease. J Gastrointest Surg 2019; 23:634-642. [PMID: 30465191 PMCID: PMC7102012 DOI: 10.1007/s11605-018-3991-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/20/2018] [Indexed: 01/31/2023]
Abstract
Cirrhotic liver disease is an important cause of peri-operative morbidity and mortality in general surgical patients. Early recognition and optimization of liver dysfunction is imperative before any elective surgery. Patients with MELD <12 or classified as Child A have a higher morbidity and mortality than matched controls without liver dysfunction, but are generally safe for elective procedures with appropriate patient education. Patients with MELD >20 or classified as Child C should undergo transplantation before any elective procedure given mortality exceeds 40%. Laparoscopic procedures are feasible and safe in cirrhotic patients.
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Affiliation(s)
- Laura Hickman
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - John Christein
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Selwyn Vickers
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
- Dean's Office, UAB School of Medicine, FOT 1203, 510 20th Street South, Birmingham, AL, 35233, USA.
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Eom YW, Baik SK. Biomarker microfibril-associated glycoprotein 4 for non-invasive diagnosis and therapeutic evaluation of hepatic fibrosis in patients with hepatitis C. Clin Mol Hepatol 2018; 25:37-39. [PMID: 30531664 PMCID: PMC6435975 DOI: 10.3350/cmh.2018.1011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/23/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Young Woo Eom
- Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Ahmed Z, Ren J, Gonzalez A, Ahmed U, Walayat S, Martin DK, Moole H, Yong S, Koppe S, Dhillon S. Universal Index for Cirrhosis (UIC index): The development and validation of a novel index to predict advanced liver disease. Hepat Med 2018; 10:133-138. [PMID: 30498378 PMCID: PMC6207224 DOI: 10.2147/hmer.s160616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim The purpose of this study was to create and validate a novel serological diagnostic index to predict cirrhosis of all etiologies. Methods This was a retrospective observational study of 771 patients, age >18 years, who underwent a liver biopsy. The stage of fibrosis and routine laboratory values were recorded. The data were randomly separated into 2 datasets (training 50% and testing 50%). A stepwise logistic regression model was used to develop the novel index. The area under the curve of receiver operating characteristic (AUROC) was applied to compare the new index to existing ones (Fibro-Q, FIB4, APRI, AAR), which was also validated in the testing dataset. Results Variables associated with the presence of cirrhosis were first assessed by univariate analysis then by multivariable analysis, which indicated serum glutamic-oxaloacetic acid transaminase, serum glutamic-pyruvic transaminase, international normalized ratio, albumin, blood urea nitrogen, glucose, platelet count, total protein, age, and race were the independent predictors of cirrhosis (P<0.05). Regression formula for prediction of cirrhosis was generated and a novel index was subsequently created. The diagnostic performance of the novel index for predicting cirrhosis was assessed using the receiver operating characteristic curve. The new index had significantly higher AUROC (0.83, 95% CI: 0.79–0.87) than Fibro-Q (0.80, 95% CI: 0.76–0.85), FIB4 (0.79, 95% CI: 0.74–0.83), APRI (0.74, 95% CI: 0.69–0.78), and AAR (0.72, 95% CI: 0.67–0.78). Conclusion The novel index had the highest AUROC curve when compared with current indices and can be applied to all etiologies of chronic liver disease.
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Affiliation(s)
- Zohair Ahmed
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, IL, USA,
| | - Jinma Ren
- Department of Center for Outcomes Research, University of Illinois College of Medicine, Peoria, IL, USA
| | - Adam Gonzalez
- University of Illinois College of Medicine, Peoria, IL, USA
| | - Umair Ahmed
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Saqib Walayat
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Daniel K Martin
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Harsha Moole
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Sherri Yong
- Department of Pathology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Sean Koppe
- Department of Hepatology, University of Illinois at Chicago, IL, USA
| | - Sonu Dhillon
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine, Peoria, IL, USA
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Giannitrapani L, Granà W, Licata A, Schiavone C, Montalto G, Soresi M. Nontumorous Portal Vein Thrombosis in Liver Cirrhosis: Possible Role of β-Blockers. Med Princ Pract 2018; 27:466-471. [PMID: 30107378 PMCID: PMC6243908 DOI: 10.1159/000492893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Nonselective β-blockers (NSBB) are used in liver cirrhosis (LC) to prevent variceal bleeding because they decrease portal pressure. A main risk factor for the development of portal vein thrombosis (PVT) in LC is decreased portal vein inflow velocity. The aim of our study was to examine retrospectively the incidence of PVT and its correlation with the use of β-blockers in a cohort of LC patients. SUBJECTS AND METHODS Data from 230 LC patients (90% Child-Pugh class A), who had been followed up for at least 5 years, were reviewed. The diagnosis of PVT was made by ultrasound. The presence of PVT was evaluated with multiple logistic regression analysis where the independent variables were those significant in the univariate analysis. RESULTS The prevalence of PVT at baseline was 4.5%, and the incidence was 4.3% at 5 years; among the subjects taking β blockers, 46.4% were taking NSBB. A total of 19 PVT cases were found. Grade of esophageal varices (p < 0.01), PLT (p < 0.003), INR (p < 0.03), spleen diameter (p < 0.001) and PLT/spleen ratio (p < 0.0005) were significantly associated with PVT. The use of NSBB indicated a higher risk of PVT compared to selective β-blockers (SBB) (p < 0.05). In logistic regression analysis only the grade of esophageal varices was significant (p < 0.02). Univariate analysis of patients taking β-blockers showed an association of PVT with grade of esophageal varices (p < 0.01), CP class (p < 0.02), AST (p < 0.03), ALT and albumin (p < 0.02), PLT count and PLT/LD (p < 0.03), longitudinal diameter of the spleen (p < 0.005), ascites (p < 0.05), portal vein (p < 0.0001) and NSBB (OR 8.1; 95% CI 1.7-38.8). CONCLUSION NSBB seem to play a role in PV thrombogenesis. Further studies are needed, especially in decompensated LC patients.
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Affiliation(s)
- Lydia Giannitrapani
- *Lydia Giannitrapani, Biomedical Department of Internal Medicine and Specialties, University of Palermo, via del Vespro 141, IT-90127 Palermo (Italy), E-Mail
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Pawlowska M, Sobolewska-Pilarczyk M, Domagalski K. Hepatitis C virus infection in children in the era of direct-acting antiviral. World J Gastroenterol 2018; 24:2555-2566. [PMID: 29962813 PMCID: PMC6021773 DOI: 10.3748/wjg.v24.i24.2555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/10/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection remains an important global health problem with chronic infection affecting approximately 11 million children worldwide. The emergence of direct-acting antiviral (DAA) therapies and the development of non-invasive methods for the determination of liver fibrosis will significantly improve the management of paediatric patients with chronic HCV infection in subsequent years. For paediatric patients, a new era of highly effective DAA agents is beginning, and the first results of available clinical trials are very promising. In this era, the identification and monitoring of patients continues to be an important issue. The availability of non-invasive serological and imaging methods to measure hepatic fibrosis enables the identification of patients with significant or advanced liver fibrosis stages. This article summarizes the current data on the epidemiology and progress of research aimed to evaluate the new therapies and non-invasive methods for liver injury in paediatric patients with chronic hepatitis C.
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Affiliation(s)
- Malgorzata Pawlowska
- Department of Paediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
| | - Malgorzata Sobolewska-Pilarczyk
- Department of Paediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
| | - Krzysztof Domagalski
- Centre For Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń 87-100, Poland
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Dawood RM, El-Meguid MA, Ibrahim MK, Bader El Din NG, Barakat A, El-Wakeel K, Alla MDAA, Wu GY, El Awady MK. Dysregulation of fibrosis related genes in HCV induced liver disease. Gene 2018; 664:58-69. [PMID: 29684485 DOI: 10.1016/j.gene.2018.04.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/20/2018] [Accepted: 04/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Liver fibrosis results from a wound healing response to chronic injury, which leads to excessive matrix deposition. Genome wide association studies have showen transcriptional dysregulation in mild and severe liver fibrosis. Recent studies suggested that genetic markers may be able to define the exact stage of liver fibrosis. AIM To define genes or genetic pathways that could serve as markers for staging or as therapeutic targets to halt progression of liver fibrosis. METHODS The study was performed on 105 treatment naïve HCV genotype 4 infected patients [F0-F2, n = 56; F3-F4, n = 49] and 16 healthy subjects. The study included PCR array on 84 fibrosis related genes followed by customization of a smaller array consisting of 11 genes that were designed on the bases of results obtained from the larger array. Genes that displayed significant dysregulation at mRNA levels were validated at protein levels. RESULTS AND DISCUSSION Two major pathways exhibited high dysregulation in early fibrosis as compared with controls or when compared with late fibrosis, these were the TGFβ - related pathway genes and Matrix - deposition associated genes. Hepatic stellate cell (HSC) activators i.e. TGFβ pathway genes [TGFβ1, 2 and 3, their receptors TGFβR1 and 2, signaling molecules SMAD genes and PDGF growth factors] were considerably over-expressed at transcriptional levels as early as F0, whereas expression of their inhibitor TGIF1 was simultaneously down regulated. Matrix proteins including collagen and MMPs were upregulated in early fibrosis whereas tissue inhibitors TIMPs 1 and 2 began over expression in late fibrosis. Expression at protein levels was concordant with RNA data excluding dysregulation at post transcriptional levels. CONCLUSION Since these 2 gene sets are closely interrelated regarding HSC activation and proliferation, we assume that the current findings suggest that they are favorable targets to further search for stage specific markers.
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Affiliation(s)
- Reham M Dawood
- Micrbial Biotechnology Department, National Research Center, Dokki, Cairo, 12622, Egypt.
| | - Mai Abd El-Meguid
- Micrbial Biotechnology Department, National Research Center, Dokki, Cairo, 12622, Egypt
| | - Marwa K Ibrahim
- Micrbial Biotechnology Department, National Research Center, Dokki, Cairo, 12622, Egypt
| | - Noha G Bader El Din
- Micrbial Biotechnology Department, National Research Center, Dokki, Cairo, 12622, Egypt
| | - Ahmed Barakat
- Department of Microbiology, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Khaled El-Wakeel
- Medical Research Division, Biological Anthropology Department, National Research Centre, Dokki, Giza, Egypt
| | - Mohamed Darwish Ahmed Abd Alla
- Tropical Medicine Department, Faculty of Medicine, Al-Azhar University, Gouhar Al-KaedStreet, El-Hussein University Hospital, Al-Darasah, Cairo, 11675, Egypt
| | - George Y Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Hartford, USA
| | - Mostafa K El Awady
- Micrbial Biotechnology Department, National Research Center, Dokki, Cairo, 12622, Egypt
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Nallagangula KS, Nagaraj SK, Venkataswamy L, Chandrappa M. Liver fibrosis: a compilation on the biomarkers status and their significance during disease progression. Future Sci OA 2018; 4:FSO250. [PMID: 29255622 PMCID: PMC5729599 DOI: 10.4155/fsoa-2017-0083] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/06/2017] [Indexed: 02/08/2023] Open
Abstract
Liver fibrosis occurs in response to different etiologies of chronic liver injury. Diagnosing degree of liver fibrosis is a crucial step in evaluation of severity of the disease. An invasive liver biopsy is the gold standard method associated with pain and complications. Biomarkers to detect liver fibrosis include direct markers of extracellular matrix turnover and indirect markers as a reflection of liver dysfunction. Although a single marker may not be useful for successful management, a mathematical equation combining tests might be effective. The main purpose of this review is to understand the diagnostic accuracy of biomarkers and scoring systems for liver fibrosis. Advances in -omics approach have generated clinically significant biomarker candidates for liver fibrosis that need further evaluation.
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Affiliation(s)
| | - Shashidhar Kurpad Nagaraj
- Department of Biochemistry, Sri Devaraj Urs Medical College, SDUAHER, Tamaka, Kolar, Karnataka, India
| | - Lakshmaiah Venkataswamy
- Department of Medicine, Sri Devaraj Urs MedicalCollege, SDUAHER, Tamaka, Kolar, Karnataka, India
| | - Muninarayana Chandrappa
- Department of Community Medicine, Sri DevarajUrs Medical College, SDUAHER, Tamaka, Kolar, Karnataka, India
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Zhao J, Zhai F, Cheng J, He Q, Luo J, Yang X, Shao J, Xing H. Evaluating the Significance of Viscoelasticity in Diagnosing Early-Stage Liver Fibrosis with Transient Elastography. PLoS One 2017; 12:e0170073. [PMID: 28107385 PMCID: PMC5249210 DOI: 10.1371/journal.pone.0170073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/28/2016] [Indexed: 12/31/2022] Open
Abstract
Transient elastography quantifies the propagation of a mechanically generated shear wave within a soft tissue, which can be used to characterize the elasticity and viscosity parameters of the tissue. The aim of our study was to combine numerical simulation and clinical assessment to define a viscoelastic index of liver tissue to improve the quality of early diagnosis of liver fibrosis. This is clinically relevant, as early fibrosis is reversible. We developed an idealized two-dimensional axisymmetric finite element model of the liver to evaluate the effects of different viscoelastic values on the propagation characteristics of the shear wave. The diagnostic value of the identified viscoelastic index was verified against the clinical data of 99 patients who had undergone biopsy and routine blood tests for staging of liver disease resulting from chronic hepatitis B infection. Liver stiffness measurement (LSM) and the shear wave attenuation fitting coefficient (AFC) were calculated from the ultrasound data obtained by performing transient elastography. Receiver operating curve analysis was used to evaluate the reliability and diagnostic accuracy of LSM and AFC. Compared to LSM, the AFC provided a higher diagnostic accuracy to differentiate early stages of liver fibrosis, namely F1 and F2 stages, with an overall specificity of 81.48%, sensitivity of 83.33% and diagnostic accuracy of 81.82%. AFC was influenced by the level of LSM, ALT. However, there are no correlation between AFC and Age, BMI, TBIL or DBIL. Quantification of the viscoelasticity of liver tissue provides reliable measurement to identify and differentiate early stages of liver fibrosis.
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Affiliation(s)
- Jingxin Zhao
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fei Zhai
- Hisky Medical Technology Co., Ltd, Beijing, China
| | - Jun Cheng
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qiong He
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Jianwen Luo
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Xueping Yang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jinhua Shao
- Hisky Medical Technology Co., Ltd, Beijing, China
- * E-mail: (HX); (JS)
| | - Huichun Xing
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- * E-mail: (HX); (JS)
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Meng Z, Zhang Y, Wei Z, Liu P, Kang J, Zhang Y, Ma D, Ke C, Chen Y, Luo J, Gong Z. High serum resistin associates with intrahepatic inflammation and necrosis: an index of disease severity for patients with chronic HBV infection. BMC Gastroenterol 2017; 17:6. [PMID: 28061755 PMCID: PMC5219659 DOI: 10.1186/s12876-016-0558-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Studies have revealed that resistin plays a role as an intrahepatic cytokine with proinflammatory activities. This study investigated the association between serum resistin and fibrosis severity and the possible marker role of resistin in the inflammatory process of chronic hepatitis B. METHODS In this study, 234 subjects with HBV infection were retrospectively selected, including 85 patients with chronic hepatitis B (CHB), 70 patients with HBV-related liver cirrhosis (LC-B), and 79 patients with HBV-related liver failure (LF-B). Serum levels of resistin, IL-1, IL-6, IL-17, IL-23, TNF-α, and TGF-β1 were assayed by ELISA. Demographic and clinical characteristics of patients were extracted from clinical databases of Taihe Hospital, Hubei University of Medicine, including serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), and liver stiffness (LS). RESULTS All the selected patients with HBV infection showed significantly increased levels of serum resistin, which was rarely detectable in the healthy controls. Serum resistin levels in patients with CHB, LC-B, and LF-B were 4.119 ± 5.848 ng/mL, 6.370 ± 6.834 ng/mL, and 6.512 ± 6.076 ng/mL, respectively. Compared with the CHB group, patients with LC-B or LF-B presented with significantly higher serum levels of resistin (p < 0.01). On the other hand, all of the enrolled patients had high serum levels of IL-1, IL-6, IL-17, TNF-α, and TGF-β1, but not IL-23. Interestingly, serum levels of resistin was significantly positively correlated with serum levels of TGF-β1 in LC-B patients (R = 0.3090, p = 0.0290), with IL-17 in LC-B (R = 0.4022, p = 0.0038) and LF-B patients (R = 0.5466, p < 0.0001), and with AST (R = 0.4501, p = 0.0036) and LS (R = 0.3415, p = 0.0310) in CHB patients. CONCLUSIONS High serum resistin associates with intrahepatic inflammation and necrosis and may be used as an index of disease severity for patients with chronic HBV infection.
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Affiliation(s)
- Zhongji Meng
- Department of Infectious Diseases, Hubei University of Medicine, Shiyan, China.,Institute of Biomedicine, Hubei University of Medicine, Shiyan, China
| | - Yonghong Zhang
- Institute of Wudang Chinese Medicine, Hubei University of Medicine, Shiyan, China
| | - Zhiqiang Wei
- Institute of Biomedicine, Hubei University of Medicine, Shiyan, China
| | - Ping Liu
- Department of Infectious Diseases, Hubei University of Medicine, Shiyan, China.,Department of Infectious Diseases, Renmin Hospital of Wuhan University, Zhangzhidong Road. 99, 430060, Wuhan, China
| | - Jian Kang
- Department of Infectious Diseases, Hubei University of Medicine, Shiyan, China
| | - Yinhua Zhang
- Department of Infectious Diseases, Hubei University of Medicine, Shiyan, China
| | - Deqiang Ma
- Department of Infectious Diseases, Hubei University of Medicine, Shiyan, China
| | - Changzheng Ke
- Department of Infectious Diseases, Hubei University of Medicine, Shiyan, China
| | - Yue Chen
- Department of Infectious Diseases, Hubei University of Medicine, Shiyan, China
| | - Jie Luo
- Department of Neurology, Taihe Hospital, Hubei University of Medicine, South Renmin Road. 32, 442000, Shiyan, Hubei, China.
| | - Zuojiong Gong
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Zhangzhidong Road. 99, 430060, Wuhan, China.
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Sheptulina A, Shirokova E, Nekrasova T, Blum H, Ivashkin V. Platelet count to spleen diameter ratio non-invasively identifies severe fibrosis and cirrhosis in patients with autoimmune hepatitis. J Gastroenterol Hepatol 2016; 31:1956-1962. [PMID: 27059170 DOI: 10.1111/jgh.13407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Non-invasive markers are essential to assess the progression of chronic liver diseases to fibrosis/ cirrhosis and the effectiveness of therapeutic strategies. The aim of this study was to evaluate the ability of non-invasive markers to identify significant fibrosis, severe fibrosis, and cirrhosis in patients with autoimmune hepatitis (AIH). METHODS Seventy-six patients with AIH were enrolled in the study and analyzed for the following parameters of liver fibrosis: Fibrosis 4 score (FIB-4), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST to platelet count ratio (APRI), and platelet count to spleen diameter (PC/SD) ratio. All patients underwent liver biopsy. The diagnostic accuracy of tests was evaluated by the area under the receiver operating characteristic curve (AUROC). RESULTS Among the 76 AIH patients, 55 (72.3%) had significant fibrosis (≥ F2), 37 (48.7%) had severe fibrosis (≥ F3), and 29 (38.2%) had cirrhosis (F4). PC/SD ratio (AUROC = 0.840) was superior to AAR (AUROC = 0.756), FIB-4 (AUROC = 0.702), and APRI (AUROC = 0.626) in discriminating between mild and significant fibrosis (≥ F2). The AUROCs of PC/SD ratio, FIB-4, AAR, and APRI were 0.884, 0.742, 0.731, and 0.707, respectively, for severe fibrosis (≥ F3); 0.968, 0.795, 0.744, and 0.723, respectively, for cirrhosis (F4). PC/SD ratio correctly identified 85.1% of patients with severe fibrosis, and 89.6% of patients with cirrhosis. CONCLUSIONS PC/SD ratio proved to be a simple non-invasive tool to correctly identify AIH patients with severe fibrosis and cirrhosis, thereby reducing the need for a liver biopsy in these patients.
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Affiliation(s)
- Anna Sheptulina
- Department of Hepatology, V.H. Vasilenko Clinic of Internal Diseases, Gastroenterology and Hepatology, First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russian Federation
| | - Elena Shirokova
- Department of Hepatology, V.H. Vasilenko Clinic of Internal Diseases, Gastroenterology and Hepatology, First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russian Federation
| | - Tatiana Nekrasova
- Department of Pathology, First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russian Federation
| | - Hubert Blum
- Clinic of Medicine II, University Medical Center, Freiburg, Germany
| | - Vladimir Ivashkin
- Department of Hepatology, V.H. Vasilenko Clinic of Internal Diseases, Gastroenterology and Hepatology, First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russian Federation
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