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Ma S, Zhou L, Lin S, Li M, Luo J, Chen L. Noninvasive Models to Assess Liver Inflammation and Fibrosis in Chronic HBV Infected Patients with Normal or Mildly Elevated Alanine Transaminase Levels: Which One Is Most Suitable? Diagnostics (Basel) 2024; 14:456. [PMID: 38472929 DOI: 10.3390/diagnostics14050456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalence of substantial inflammation or fibrosis in treatment-naïve patients with chronic hepatitis B (CHB) and normal alanine transaminase (ALT) levels is high. A retrospective analysis was conducted on 559 consecutive patients with hepatitis B virus infection, who underwent liver biopsy, to investigate the value of noninvasive models based on routine serum markers for evaluating liver histology in CHB patients with normal or mildly elevated ALT levels and to provide treatment guidance. After comparing 55 models, we identified the top three models that exhibited excellent performance. The APGA model, based on the area under the receiver operating characteristic curve (AUROC), demonstrated a superior ability to evaluate significant (AUROC = 0.750) and advanced fibrosis (AUROC = 0.832) and demonstrated a good performance in assessing liver inflammation (AUROCs = 0.779 and 0.874 for stages G ≥ 2 and G ≥ 3, respectively). APGA also exhibited significant correlations with liver inflammation and fibrosis stage (correlation coefficients, 0.452 and 0.405, respectively (p < 0.001)). When the patients were stratified into groups based on HBeAg status and ALT level, APGA consistently outperformed the other 54 models. The other top two models, GAPI and XIE, also outperformed models based on other chronic hepatitis diseases. APGA may be the most suitable option for detecting liver fibrosis and inflammation in Chinese patients with CHB.
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Affiliation(s)
- Shasha Ma
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Lian Zhou
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Shutao Lin
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Mingna Li
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jing Luo
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Lubiao Chen
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
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Feng S, Tu H, Chen L. A novel model predicted liver cirrhosis constructed by ultrasound and serological in autoimmune liver hepatitis. Medicine (Baltimore) 2023; 102:e35295. [PMID: 37747028 PMCID: PMC10519531 DOI: 10.1097/md.0000000000035295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
To establish a noninvasive model based on two-dimensional shear wave elasticity (2D-SWE) technology, ultrasound feature and serological indicators to predict cirrhosis in autoimmune hepatitis (AIH) and verified. Patients with AIH confirmed by liver biopsy with liver ultrasound and serological examination were collected from January 2019 to May 2022. Patients were divided into cirrhosis and non-cirrhosis groups. Basic indexes, ultrasound indexes and serological indexes were collected. Multivariable logistic regression used for screening independent risk factors predicting cirrhosis, construct the AIH cirrhosis prediction model, named autoimmune hepatitis cirrhosis (AIHC). Determine best cutoff score according to the Youden index, verified the model's predictive efficacy. One hundred forty-six patients were collected. The following indicators were independent risk factors for predicting cirrhosis: LS (OR: 1.416, P = .015), splenomegaly (OR: 10.446, P = .006), complement C4 (OR: 0.020, P = .009). The best cutoff score was 65, with a sensitivity 88.9% and specificity 75.6%; the area under curve was 0.901, AIHC possessed a higher net reclassification index (NRI) and integrated discrimination improvement compared with other indexes, and AIHC had the best clinical decision curve. The AIHC constructed in this study has better predictive efficacy than other noninvasive indexes, and we visualized the model for easy application, which was worth further promotion in clinical practice.
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Affiliation(s)
- Siyi Feng
- Department of Ultrasound, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Haibin Tu
- Department of Ultrasound, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Lihong Chen
- Department of Ultrasound, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
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Xie R, Li J, Zhang H, Wang LM, Huang CR, Chen LW. Total serum bile acids predict therapy for HBeAg-negative chronic hepatitis B patients with borderline ALT and high HBV DNA. J Infect Dev Ctries 2022; 16:1336-1342. [PMID: 36099378 DOI: 10.3855/jidc.15915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 06/10/2022] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION The introduction of antiviral therapy in chronic hepatitis B (CHB) infection depends on precise evaluation of hepatic lesions. Total serum bile acids (TSBAs) are highly sensitive in monitoring liver dysfunction. We evaluated the predictive role of TSBAs for hepatic lesions in CHB patients with borderline alanine aminotransferase (ALT) and high level of hepatitis B virus (HBV) DNA copies. METHODOLOGY 328 CHB patients were enrolled, 241 were hepatitis B e antigen (HBeAg)-positive and 87 were HBeAg-negative. Patients were further divided into two entities according to inflammation/fibrosis evaluated by liver biopsy, low-grade (inflammation grade < 2 and fibrosis stage < 2) and high-grade (inflammation grade ≥ 2 or/and fibrosis stage ≥ 2) cohorts. TSBAs were compared with noninvasive tools including aspartate aminnotransferase (AST)-to-platelet ratio index (APRI), fibrosis-4 (FIB-4) and red cell distribution width (RDW)-to-platelet ratio (RPR) to predict high-grade hepatic lesions in CHB subgroups. RESULTS TSBAs, APRI, FIB-4 and RPR were statistically different between low- and high-grade patients in HBeAg-positive cohort. Only TSBAs showed significant difference between low and high grade in HBeAg-negative patients. Similarly, APRI, FIB-4 and RPR were correlated with different division of inflammation/fibrosis only in HBeAg-positive while TSBAs were correlated with inflammation/fibrosis levels in both HBeAg-positive and HBeAg-negative groups. Of the four indicators, the receiver operating characteristic (ROC) curve analysis showed that TSBAs have the maximum AUC (area under the curve) in HBeAg-negative group but the minimum in HBeAg-positive cohort. CONCLUSIONS TSBAs can be used for predicting antiviral therapy in CHB patients with HBeAg-negative, borderline ALT and high HBV DNA.
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Affiliation(s)
- Ran Xie
- Department of Laboratory Medicine, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jiao Li
- Department of Laboratory Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Hao Zhang
- Department of Laboratory Medicine, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ling-Mei Wang
- Department of Laboratory Medicine, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Cheng-Rong Huang
- Department of Laboratory Medicine, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Li-Wen Chen
- Department of Laboratory Medicine, The Second Hospital of Anhui Medical University, Hefei, Anhui, China.
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Hsu WF, Chang KC, Chen TH, Lin CH, Lin YC, Tsai MH, Chen PY, Wang HW, Chu CS, Peng CY. Comparison of 10 noninvasive models for predicting overall survival in patients with intermediate-stage hepatocellular carcinoma. Medicine (Baltimore) 2021; 100:e27000. [PMID: 34414987 PMCID: PMC8376350 DOI: 10.1097/md.0000000000027000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Intermediate-stage hepatocellular carcinoma (HCC) is heterogeneous in terms of tumor size, number, and effects on liver function. Various noninvasive models have been proposed to assess functional hepatic reserve or fibrosis severity in patients with HCC. This study assessed the feasibility of 10 noninvasive models and compared their prognostic ability for patients with intermediate-stage HCC.This study retrospectively enrolled 493 patients with intermediate-stage HCC who received treatment at China Medical University Hospital from January 2012 to November 2018. Demographic data, clinical features, and factors associated with overall survival (OS) were recorded at baseline. Receiver-operating characteristic curve analysis and the DeLong method were respectively employed to evaluate and compare the models' OS prediction performance.Of the 493 patients, 373 (75.7%) were male, and 275 (55.8%) had liver cirrhosis (LC). The median age was 64 years (interquartile range: 55-72). Most patients had tumor volume ≤50% (n = 424, 86.0%), and the maximum tumor size was 6.0 (4.0-8.5) cm. The median α-fetoprotein was 36.25 (6.13-552.91) ng/mL. The patients underwent transarterial chemoembolization (TACE, n = 349) or surgery (n = 144). The median follow-up period was 26.07 (9.77-48.27) months. Across the 10 models, the albumin-bilirubin (ALBI) score had the highest area under the receiver operating characteristic curve (AUROC) (0.644, 95% confidence interval: 0.595-0.693) in all patients. In subgroup analyses, the Lok index, platelet-albumin-bilirubin score, ALBI score, and Lok index had the highest AUROC values in patients without cirrhosis, with cirrhosis, undergoing TACE, and undergoing surgery, respectively. Multivariate Cox regression analysis revealed that independent predictors of longer OS were ALBI grade 1 in all patients, patients with LC, and patients undergoing TACE and Lok index grade 1 in patients without LC and patients undergoing surgery.Among the 10 noninvasive models, ALBI score exhibited the highest diagnostic value in predicting OS for all patients, patients with cirrhosis, and those undergoing TACE, and Lok index grade exhibited the highest diagnostic value in predicting OS in patients without cirrhosis and those undergoing surgery.
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Affiliation(s)
- Wei-Fan Hsu
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital
- Graduate Institute of Biomedical Sciences, China Medical University
- School of Medicine, China Medical University
- Liver Cancer Team of China Medical University Hospital
| | - Kai-Chih Chang
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital
| | - Te-Hong Chen
- Department of Surgery
- Liver Cancer Team of China Medical University Hospital
| | - Chien-Hung Lin
- Department of Radiology
- Liver Cancer Team of China Medical University Hospital
| | - Ying-Chun Lin
- Department of Radiation Oncology
- Liver Cancer Team of China Medical University Hospital
| | - Ming-Hung Tsai
- Division of Hematology and Oncology, Department of Internal Medicine
- Liver Cancer Team of China Medical University Hospital
| | - Pei-Yu Chen
- Department of Pathology, China Medical University Hospital
- Liver Cancer Team of China Medical University Hospital
| | - Hung-Wei Wang
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital
- School of Medicine, China Medical University
- Liver Cancer Team of China Medical University Hospital
| | - Chia-Sheng Chu
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital
- Liver Cancer Team of China Medical University Hospital
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital
- School of Medicine, China Medical University
- Liver Cancer Team of China Medical University Hospital
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Wu Z, Dong X, Wang G, Zhao H. Clinical noninvasive markers for antiviral therapy decision in chronic hepatitis B with alanine aminotransferase less than two times upper limit of normal. J Viral Hepat 2019; 26:287-296. [PMID: 30380162 DOI: 10.1111/jvh.13030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/12/2022]
Abstract
Liver biopsy is the reference method for antiviral therapy decision-making in chronic hepatitis B (CHB) when alanine aminotransferase (ALT) is less than two times of upper limit of normal (<2ULN). Our aim was to explore noninvasive markers for antiviral therapy decision in CHB with ALT <2ULN. A total of 452 treatment-naïve CHB patients with ALT < 2ULN who had undergone liver biopsy were analysed in this prospective multi-centre study. If liver biopsy showed moderate or severe inflammation (histology activity index ≥ 5) or significant fibrosis (Ishak fibrosis score ≥ 3), antiviral treatment was recommended. We analysed data using univariate and multivariate analyses and receiver operating characteristic curves (ROC). Two hundred and sixty-nine (59.5%) of 452 cases with ALT < 2ULN had moderate, severe or significant inflammation. Aspartate aminotransferase (AST) (P = 0.03), anti-hepatitis B virus core antibody (anti-HBc) (P = 0.003) and liver stiffness measurement (LSM) (P = 0.000) were independent variables for antiviral therapy decision-making, with area under the ROC curve (AUROC) of 0.718, 0.703 and 0.819, respectively. Our novel AAF index, which combined AST, anti-HBc and LSM, showed better performance with AUROC of 0.876, 0.877 and 0.876 in estimation, validation and total set. Finally, 247 (54.6%) of 452 patients could avoid liver biopsy based on AAF index. Furthermore, performances of 23 noninvasive models were unsatisfactory for antiviral therapy decision with AUROC < 0.800, which were inferior to AAF index. In conclusion, AST, anti-HBc and LSM were related to antiviral therapy decision-making among CHB patients with ALT < 2ULN. Thus, the novel AAF index was a more reliable noninvasive model for antiviral therapy decision-making.
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Affiliation(s)
- Zhao Wu
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China
| | - Xiaoqin Dong
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China
| | - Guiqiang Wang
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China.,The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang, China.,Peking University International Hospital, Beijing, China
| | - Hong Zhao
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China.,Peking University International Hospital, Beijing, China
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Lin YJ, Gao XM, Pan WW, Gao S, Yu ZZ, Xu P, Fan XP. A model to predict the onset of non-alcoholic fatty liver disease within 2 years in elderly adults. J Gastroenterol Hepatol 2017; 32:1739-1745. [PMID: 28183156 DOI: 10.1111/jgh.13760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/09/2017] [Accepted: 02/08/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic hepatitis, which leads to cirrhosis and hepatocellular carcinoma. However, it is difficult to identify subjects at high risk for NAFLD onset. This study aims to construct a model to predict the onset of NAFLD within 2 years in elderly adults. METHODS This study included and followed 3378 initial NAFLD-free subjects aged 60 years or over for 2 years, which were randomly divided into a training set and a validation set. NAFLD was diagnosed on ultrasound. Clinical and laboratory data were recorded at baseline. A model was constructed in the training set to predict the onset of NAFLD and validated in the validation set. RESULTS Body mass index, hemoglobin, fasting blood glucose, and triglycerides were identified as predictors for the onset of NAFLD. A risk score (R) was calculated by them. It classified the subjects into low-risk group (R ≤ -2.88), moderate-risk group (-2.88 < R ≤ -1.26), and high-risk group (R > -1.26). In the training set, 4.68% of the participants in the low-risk group, 11.59% of the participants in the moderate-risk group, and 31.02% of the participants in the high-risk group developed NAFLD. In the validation set, 5.84% of the participants in the low-risk group, 10.57% of the participants in the moderate-risk group, and 29.44% of the participants in the high-risk group developed NAFLD. CONCLUSIONS This study developed a model to predict the onset of NAFLD in elderly adults, which might provide indications for intervention to these subjects.
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Affiliation(s)
- Ya-Jie Lin
- Organization Department, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xi-Mei Gao
- Health Examination Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Wei-Wei Pan
- Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Shuai Gao
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zhen-Zhen Yu
- Health Examination Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ping Xu
- Health Examination Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiao-Peng Fan
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Ferrero H, Buigues A, Martínez J, Simón C, Pellicer A, Gómez R. A novel homologous model for noninvasive monitoring of endometriosis progression. Biol Reprod 2017; 96:302-312. [PMID: 28203742 DOI: 10.1095/biolreprod.116.140756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 11/23/2016] [Accepted: 12/12/2016] [Indexed: 12/16/2023] Open
Abstract
To date, several groups have generated homologous models of endometriosis through the implantation of endometrial tissue fluorescently labeled by green fluorescent protein (GFP) or tissue from luciferase-expressing transgenic mice into recipient animals, enabling noninvasive monitoring of lesion signal. These models present an advantage over endpoint models, but some limitations persist; use of transgenic mice is laborious and expensive, and GFP presents poor tissue penetration due to the relatively short emission wavelength. For this reason, a homologous mouse model of endometriosis that allows in vivo monitoring of generated lesions over time and mimics human lesions in recipient mice would be most desirable. In this regard, using C57BL/6 and B6N-Tyrc-Brd/BrdCrCrl mice, we optimized a decidualization protocol to obtain large volumes of decidual endometrium and mimic human lesions. Subsequently, to obtain a more robust and reliable noninvasive monitoring of lesions, we used the fluorescent reporter mCherry, which presents deeper tissue penetration and higher photostability, showing that endometrial tissue was properly labeled with 1 × 108 PFU/mL mCherry adenoviral vectors. mCherry-labeled endometriotic tissue was implanted in recipient mice, generating lesions that displayed characteristics typical of human endometriotic lesions, such as epithelial cells forming glands, local inflammation, collagen deposits, and new vessel formation. In vivo monitoring demonstrated that subcutaneous implantation on ventral abdomen of recipient mice provided the most intense and reliable signal for noninvasive lesion monitoring over a period of at least 20 days. This homologous model improves upon previously reported models of endometriosis and provides opportunities to study mechanism underlying endometriotic lesion growth and progression. We created a cost-effective but accurate homologous mouse model of endometriosis that allows the study of growth and progression of endometriotic lesions over early time points in lesion development through noninvasive monitoring.
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Affiliation(s)
- Hortensia Ferrero
- Fundación Instituto Valenciano de Infertilidad (FIVI), Valencia, Spain
- Instituto Universitario IVI/INCLIVA, Valencia, Spain
| | - Anna Buigues
- Instituto Universitario IVI/INCLIVA, Valencia, Spain
- Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
| | | | - Carlos Simón
- Fundación Instituto Valenciano de Infertilidad (FIVI), Valencia, Spain
- Instituto Universitario IVI/INCLIVA, Valencia, Spain
- Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
| | - Antonio Pellicer
- Fundación Instituto Valenciano de Infertilidad (FIVI), Valencia, Spain
- Instituto Universitario IVI/INCLIVA, Valencia, Spain
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
| | - Raúl Gómez
- Instituto Universitario IVI/INCLIVA, Valencia, Spain
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Gao S, Li XY, Fan YC, Sun FK, Han LY, Li F, Ji XF, Wang K. A noninvasive model to predict liver histology in HBeAg-positive chronic hepatitis B with alanine aminotransferase ≤ 2upper limit of normal. J Gastroenterol Hepatol 2017; 32:215-220. [PMID: 27207016 DOI: 10.1111/jgh.13452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Liver biopsy remains the gold standard to evaluate liver histology. However, it has several limitations. This study aims to construct a noninvasive model to predict liver histology for commencing antiviral therapy in HBeAg-positive chronic hepatitis B (CHB) with aminotransferase (ALT) ≤ 2 upper limit of normal (ULN). METHODS Two hundred and ninety-eight patients with HBeAg-positive CHB, ALT ≤ 2ULN and HBV-DNA ≥20 000 IU/ml were enrolled and randomly divided into a training group and a validation group. A noninvasive model was constructed in the training group to predict significant liver histological change [necroinflammatory activity grade (G) ≥ 2 or fibrosis stage (S) ≥ 2] and then validated in the validation group. RESULTS Aspartate aminotransferase, HBsAg, platelet, and albumin were identified as independent predictors. A model was constructed by them. It had an area under the receiver operating characteristic curve of 0.875 in the training group, 0.858 in the validation group and 0.868 in the entire cohort. Using a cut-off point of -0.96, it showed 93% sensitivity, 90% negative predictive value (NPV) in the training group and 95% sensitivity, 94% NPV in the validation group. Using a cut-off point of 0.96, it showed 95% specificity, 91% positive predictive value (PPV) in the training group and 89% specificity, 80% PPV in the validation group. CONCLUSIONS This study constructed a noninvasive model to predict liver histology in HBeAg-positive CHB with ALT ≤ 2ULN, which might reduce the clinical need for liver biopsy.
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Affiliation(s)
- Shuai Gao
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xin-You Li
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yu-Chen Fan
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Institute of Hepatology, Shandong University, Jinan, Shandong, China
| | - Feng-Kai Sun
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Li-Yan Han
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Institute of Hepatology, Shandong University, Jinan, Shandong, China
| | - Feng Li
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiang-Fen Ji
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Kai Wang
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Institute of Hepatology, Shandong University, Jinan, Shandong, China
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Varsos GV, Kolias AG, Smielewski P, Brady KM, Varsos VG, Hutchinson PJ, Pickard JD, Czosnyka M. A noninvasive estimation of cerebral perfusion pressure using critical closing pressure. J Neurosurg 2015; 123:638-48. [PMID: 25574566 DOI: 10.3171/2014.10.jns14613] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cerebral blood flow is associated with cerebral perfusion pressure (CPP), which is clinically monitored through arterial blood pressure (ABP) and invasive measurements of intracranial pressure (ICP). Based on critical closing pressure (CrCP), the authors introduce a novel method for a noninvasive estimator of CPP (eCPP). METHODS Data from 280 head-injured patients with ABP, ICP, and transcranial Doppler ultrasonography measurements were retrospectively examined. CrCP was calculated with a noninvasive version of the cerebrovascular impedance method. The eCPP was refined with a predictive regression model of CrCP-based estimation of ICP from known ICP using data from 232 patients, and validated with data from the remaining 48 patients. RESULTS Cohort analysis showed eCPP to be correlated with measured CPP (R = 0.851, p < 0.001), with a mean ± SD difference of 4.02 ± 6.01 mm Hg, and 83.3% of the cases with an estimation error below 10 mm Hg. eCPP accurately predicted low CPP (< 70 mm Hg) with an area under the curve of 0.913 (95% CI 0.883-0.944). When each recording session of a patient was assessed individually, eCPP could predict CPP with a 95% CI of the SD for estimating CPP between multiple recording sessions of 1.89-5.01 mm Hg. CONCLUSIONS Overall, CrCP-based eCPP was strongly correlated with invasive CPP, with sensitivity and specificity for detection of low CPP that show promise for clinical use.
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Affiliation(s)
- Georgios V Varsos
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Peter Smielewski
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Ken M Brady
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | | | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - John D Pickard
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, United Kingdom;,Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
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