Association of HFE gene C282Y and H63D mutations with liver cirrhosis in the Lithuanian population

BACKGROUND AND OBJECTIVE

Liver cirrhosis is the end-stage disease of chronic liver injury. Due to differences in the natural course of chronic liver diseases, identification of genetic factors that influence individual outcomes is warranted. HFE-linked hereditary hemochromatosis (HH) predisposes disease progression to cirrhosis; however, the role of heterozygous C282Y or H63D mutations in the development of cirrhosis in the presence of other etiological factors is still debated. The aim of this study was to determine the association between heterozygous C282Y and H63D mutations and non-HH liver cirrhosis in Lithuanian population.

MATERIALS AND METHODS

The patient cohort consisted of 209 individuals. Diagnosis of cirrhosis was confirmed by clinical, laboratory parameters, liver biopsy, and radiological imaging. Control samples were obtained from 1005 randomly selected unrelated healthy individuals. HFE gene mutations were determined using the PCR-RFLP method.

RESULTS

The most common causes of cirrhosis were hepatitis C (33.9%), hepatitis B (13.6%), and alcohol (25.8%). C282Y allele was associated with the presence of cirrhosis (OR=2.07; P=0.005); this was also observed under recessive model for C282Y (OR=2.06, P=0.008). The prevalence of C282Y allele was higher in cirrhotic men than in controls (7.0% vs. 2.8%, P=0.002). The carriage of H63D risk allele (OR=1.54; P=0.02), heterozygous C282Y/wt and homozygous H63D/H63D genotypes were associated with liver cirrhosis in males (OR=2.48, P=0.008, and OR=4.13, P=0.005, respectively).

CONCLUSIONS

Heterozygous C282Y mutation of the HFE gene was associated with liver cirrhosis in the Lithuanian population. In gender-related analysis, heterozygous C282Y and homozygous H63D mutations were linked to liver cirrhosis in men, not in women.

Liver and spleen transient elastography predicts portal hypertension in patients with chronic liver disease: a prospective cohort study

BACKGROUND

To assess correlation between liver or spleen stiffness measurement by transient elastography (TE) and hepatic venous pressure gradient (HVPG) in patients with chronic liver disease as well find optimal and rule in/rule out cut-offs for prognosis of clinically significant (CSPH) and severe (SPH) portal hypertension.

METHODS

In this prospective study patients with different chronic liver diseases were included. TE was performed at the same day prior to HVPG measurement. HVPG was measured using catheter tip occlusion technique. Based on HVPG, patients were categorized into groups of CSPH and SPH. Cut-off values were established by applying ROC curve analysis.

RESULTS

The study included 107 consecutive patients referred for HVPG measurement or transjugular liver biopsy. Successful spleen TE was performed in 99 of the patients. Liver and spleen TE strongly correlated with HVPG, r = 0.75 and r = 0.62, respectively. Accuracy to detect CSPH was 88.7% for liver stiffness of 17.4 kPa and 77.7% for spleen stiffness of 47.6 kPa. Accuracy to detect SPH was 83.1% for liver stiffness of 20.6 kPa and 77.7 % for spleen stiffness of 50.7 kPa. Liver stiffness <11.4 kPa could rule out CSPH with 55.2% specificity and >21.9 kPa rule in CSPH with 74.4% sensitivity. Liver stiffness <12.1 kPa could rule out SPH with 50.0% specificity and >35 kPa rule in SPH with 58.2% sensitivity.

CONCLUSIONS

Liver and spleen stiffness correlate with HVPG and could be used to predict CSPH or SPH. Spleen elastography was not superior to liver elastography in predicting portal hypertension.

Combination of transient elastography with serum-based non-invasive tests improves prediction of liver fibrosis in patients with chronic hepatitis C: a prospective cohort study

The work was carried out at the Lithuanian University of Health Sciences Hospital Kaunas Clinics. Background. To date, there is not enough data to conclude whether the combination of different non-invasive liver fibrosis tests could improve the accuracy in prediction of liver fibrosis. The aim of this study was to assess correlation between transient elastography (TE), aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 score (FIB4) and histological stage of fibrosis (F). Materials and methods. In this prospective study the correlation of TE, APRI and FIB4 with the stage of fibrosis was assessed in 140 patients with chronic HCV hepatitis. TE, APRI and FIB4 were measured the same day before biopsy. Fibrosis was evaluated using the METAVIR score. Cut-off values were established by applying the ROC curve analysis. All non-invasive tests were combined into pairs in order to evaluate the accuracy of fibrosis prediction. Results. The stage of fibrosis correlated with TE (R-0.74), FIB4 (R-0.67) and APRI (R-0.58). To detect F4 TE cut-off value 12.1 kPa had 93.8% sensitivity and 85% specificity; APRI cut-off value 1.42 (84.4/81.1) and FIB4 cutoff value 2.89 (84.4/84.0) were established. To determine F ≥ 3 – 10.3 kPa (91.1/83.9), 1.28 (77.8/78.5), 2.28 (84.4/81.7); F ≥ 2 8.5 kPa (80.9/74.3), 1.12 (72.1/78.6), 1.63 (82.4/75.7); F  ≥  1 5.35  kPa (85.4/100), 0.45 (89.2/87.5), 0.89 (87.7/75). Significant increase of accuracy was observed in TE/APRI (p – 0.008) and FIB4/APRI (p – 0.02) groups to predict F ≥ 1, and TE/FIB4 to predict F ≥ 2 (p – 0.04) and F ≥ 1 (p – 0.04). Conclusions. Combined use of TE/APRI, FIB4/APRI increased the accuracy to predict F ≥ 1, and TE/FIB4 combination increased the accuracy to predict F ≥ 2 and F ≥ 1.

Acute and 14-day hepatic venous pressure gradient response to carvedilol and nebivolol in patients with liver cirrhosis

BACKGROUND AND OBJECTIVE

Alternative drug therapies are needed for the treatment of portal hypertension. The aim of this randomized study was to evaluate and compare the effects of carvedilol and nebivolol on the hepatic venous pressure gradient (HVPG) response in the patients with liver cirrhosis.

MATERIAL AND METHODS

In total, 20 cirrhotic patients were randomized into 2 groups and treated with carvedilol (n=10) or nebivolol (n=10). HVPG was measured at baseline, 60 minutes after the administration of carvedilol (25 mg) or nebivolol (5 mg), and after 14 days of carvedilol (25 mg) or nebivolol (5 mg) administered daily. RESULTS. Carvedilol significantly reduced HVPG from 22.2 mm Hg (SD, 4.4) to 15.2 mm Hg (SD, 3.7) after 60 minutes and to 16.4 mm Hg (SD, 2.9) after 14 days (P<0.01). Nebivolol reduced HVPG from 19.7 mm Hg (SD, 2.5) to 15.7 mm Hg (SD, 2.6) and 16.7 mm Hg (SD, 3.2), respectively (P<0.02). Carvedilol effectively decreased HVPG in a greater proportion of the patients after an acute probe (88% vs. 57%) and after 14 days of the treatment (88% vs. 28%, P<0.05) in comparison with nebivolol.

CONCLUSION

Carvedilol and nebivolol reduce HVPG in cirrhotic patients; however, the effect of carvedilol on the HVPG reduction might be superior to that of nebivolol, especially after 14 days of treatment.