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Qadri S, Yki-Järvinen H. Surveillance of the liver in type 2 diabetes: important but unfeasible? Diabetologia 2024; 67:961-973. [PMID: 38334817 PMCID: PMC11058902 DOI: 10.1007/s00125-024-06087-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024]
Abstract
Fatty liver plays a pivotal role in the pathogenesis of the metabolic syndrome and type 2 diabetes. According to an updated classification, any individual with liver steatosis and one or more features of the metabolic syndrome, without excess alcohol consumption or other known causes of steatosis, has metabolic dysfunction-associated steatotic liver disease (MASLD). Up to 60-70% of all individuals with type 2 diabetes have MASLD. However, the prevalence of advanced liver fibrosis in type 2 diabetes remains uncertain, with reported estimates of 10-20% relying on imaging tests and likely overestimating the true prevalence. All stages of MASLD impact prognosis but fibrosis is the best predictor of all-cause and liver-related mortality risk. People with type 2 diabetes face a two- to threefold increase in the risk of liver-related death and hepatocellular carcinoma, with 1.3% progressing to severe liver disease over 7.7 years. Because reliable methods for detecting steatosis are lacking, MASLD mostly remains an incidental finding on imaging. Regardless, several medical societies advocate for universal screening of individuals with type 2 diabetes for advanced fibrosis. Proposed screening pathways involve annual calculation of the Fibrosis-4 (FIB-4) index, followed by a secondary test such as transient elastography (TE) for intermediate-to-high-risk individuals. However, owing to unsatisfactory biomarker specificity, these pathways are expected to channel approximately 40% of all individuals with type 2 diabetes to TE and 20% to tertiary care, with a false discovery rate of up to 80%, raising concerns about feasibility. There is thus an urgent need to develop more effective strategies for surveying the liver in type 2 diabetes. Nonetheless, weight loss through lifestyle changes, pharmacotherapy or bariatric surgery remains the cornerstone of management, proving highly effective not only for metabolic comorbidities but also for MASLD. Emerging evidence suggests that fibrosis biomarkers may serve as tools for risk-based targeting of weight-loss interventions and potentially for monitoring response to therapy.
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Affiliation(s)
- Sami Qadri
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Hannele Yki-Järvinen
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Minerva Foundation Institute for Medical Research, Helsinki, Finland.
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2
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García-Mateo S, Martínez-Domínguez SJ, Gargallo-Puyuelo CJ, Gallego B, Alfambra E, Aso MC, Martinez-Micaelo N, Amigó N, Martínez-García J, Baptista PM, Sanz B, Ballesta S, Espinosa J, Tejero C, Gomollón F. Cardiovascular risk assessment in inflammatory bowel disease with metabolic dysfunction-associated steatotic liver disease. Med Clin (Barc) 2024; 162:409-416. [PMID: 38423940 DOI: 10.1016/j.medcli.2023.11.032] [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] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) has been reported to increase the risk of early atherosclerosis even in young patients. Moreover, metabolic dysfunction-associated steatotic liver disease (MASLD), which has been linked to IBD, is a well-recognized but underdiagnosis entity related to cardiovascular risk. We analyze the impact of MASLD in IBD patients' cardiovascular risk through both advanced lipoprotein profile sorted by nuclear magnetic resonance spectroscopy, and carotid artery intima-media thickness (CIMT). METHODS Cross-sectional cohort study which involves 941 IBD adult outpatients. Of them, 50 patients with IBD who met criteria for MASLD and 50 with IBD without MASLD, matched by sex and age were included. Alterations in CIMT were evaluated considering abnormal measures above the 75th percentile adjusted for sex and age. Specific advanced lipoprotein profile was also carried out. RESULTS Most of the patients had an abnormal CIMT (58%). MASLD (OR=5.05, CI 95%=1.71-14.92) and female sex (OR=3.32, CI 95%=1.03-10) were significantly associated with CIMT alterations. Dense LDL particles (with high cholesterol composition in general cohort (OR=3.62, 95% CI=1.07-12.19) and high triglycerides density in young subgroup (OR=6.25, 95% CI=1.04-50) but not total LDL cholesterol were associated with CIMT alterations. CONCLUSIONS MASLD and female sex are associated with early atherosclerosis in IBD patients. Dense LDL particle in combination with vascular imaging findings should be evaluated as non-invasive tools in the management of cardiovascular risk in IBD patients.
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Affiliation(s)
- Sandra García-Mateo
- Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain.
| | - Samuel J Martínez-Domínguez
- Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Carla J Gargallo-Puyuelo
- Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Beatriz Gallego
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Erika Alfambra
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - María C Aso
- Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | | | - Nuria Amigó
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain; Biosfer Teslab, Plaça del Prim 10, 2on 5a, 43201 Reus, Spain
| | - Javier Martínez-García
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; University of Zaragoza, Department of Multiscale in Mechanical and Biological Engineering, Spain
| | - Pedro M Baptista
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Borja Sanz
- Department of Endocrinology, Manises Hospital, 46940 Valencia, Spain
| | - Sara Ballesta
- Department of Neurology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
| | - Judith Espinosa
- Department of Neurology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
| | - Carlos Tejero
- Department of Neurology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
| | - Fernando Gomollón
- Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
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Zyśk B, Ostrowska L, Smarkusz-Zarzecka J, Orywal K, Mroczko B, Cwalina U. Evaluation of the Diagnostic Utility of Selected Serum Adipokines and Cytokines in Subjects with MASLD-A Pilot Study. Nutrients 2024; 16:1381. [PMID: 38732626 PMCID: PMC11085733 DOI: 10.3390/nu16091381] [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] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Excess adipose tissue, particularly of the visceral type, triggering chronic low-grade inflammation and altering its secretory profile, is a contributing factor to the initiation and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to compare the levels of selected adipokines and cytokines in individuals with normal weight and obesity, assessing their potential for diagnosing MASLD and establishing a cutoff point for body fat content associated with hepatic steatosis development. The research involved 99 participants categorized by body mass index and MASLD presence, undergoing body composition analysis, liver elastography, biochemical tests, and evaluation of adipokines and cytokines in serum. The results indicated elevated IL-6 (interleukin 6) serum levels in individuals with obesity with MASLD compared to the normal-weight group without MASLD. The multivariate regression analysis demonstrated a connection between hepatic steatosis and total adipose tissue content, VAT (visceral adipose tissue), VAT/SAT (subcutaneous adipose tissue) ratio, HOMA-IR (homeostasis model assessment of insulin resistance), IL-6, Il-1β (interleukin 1β), and MMP-2 (matrix metalloproteinase 2). Among the adipokines and cytokines examined in this study, interleukin 6 was the strongest predictor of MASLD regardless of gender. In addition, an association between the development of hepatic steatosis and higher serum IL-1β levels and higher adipose tissue was observed in women. However, further studies on a larger group of patients are needed to consider the use of these cytokines as markers of MASLD. The HOMA-IR index demonstrated potential diagnostic utility in identifying hepatic steatosis.
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Affiliation(s)
- Beata Zyśk
- Department of Dietetics and Clinical Nutrition, Medical University of Bialystok, Mieszka I 4B Street, 15-054 Bialystok, Poland; (L.O.)
| | - Lucyna Ostrowska
- Department of Dietetics and Clinical Nutrition, Medical University of Bialystok, Mieszka I 4B Street, 15-054 Bialystok, Poland; (L.O.)
| | - Joanna Smarkusz-Zarzecka
- Department of Dietetics and Clinical Nutrition, Medical University of Bialystok, Mieszka I 4B Street, 15-054 Bialystok, Poland; (L.O.)
| | - Karolina Orywal
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Bialystok, Poland (B.M.)
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Bialystok, Poland (B.M.)
| | - Urszula Cwalina
- Department of Biostatistics and Medical Informatics, Medical University of Bialystok, Szpitalna 37 Street, 15-295 Bialystok, Poland
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Barana L, Nelva A, Scivetti P, Costanzo M, Fanelli CG. Diagnosis of hepatic steatosis and steatohepatitis in people with new-onset type 2 diabetes: a multidisciplinary approach. Endocrine 2024; 84:412-419. [PMID: 38347338 DOI: 10.1007/s12020-024-03715-5] [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: 10/04/2023] [Accepted: 01/23/2024] [Indexed: 05/08/2024]
Abstract
AIMS Non-Alcoholic-Fatty-Liver-Disease (NAFLD) is the most common cause of chronic liver disease in Western countries; closely linked to obesity and type 2 diabetes (T2DM), it is an additional cardiovascular risk factor. The aim of this study is to investigate the prevalence of NAFLD at T2DM onset. METHODS 122 newly diagnosed T2DM patients were enroled; NAFLD was diagnosed using ultrasound and fibrosis risk calculated with an FIB4-score. Intermediate and high-risk patients were referred to a hepatologist and underwent transient elastography (TE). RESULTS At T2DM diagnosis, 25% of patients were overweight, 47% were obese; ultrasound steatosis was present in 79% of patients; the average FIB-4 score was 1.4 (0.7). The NAFLD population was characterised by higher presence of obesity (60%, p 0.06); hypertension (56%, p 0.00); AST (26.3 (23.6) UI/L; p 0.00); ALT (49.3(41.0) UI/L p 0.00); FIB-4 score (1.6 (0.8); p 0.00). Among patients referred to a hepatologist, at TE, 65% had severe steatosis, 22% significant fibrosis and 25% advanced fibrosis. CONCLUSION This is the first proposal of a NAFLD screening model at T2DM diagnosis. The high prevalence of fibrosis found at the early stage T2DM confirms the compelling need for early management of NAFLD through cost-effective screening and long-term monitoring algorithms.
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Affiliation(s)
- L Barana
- Diabetology and Endocrinology, Nuovo Ospdale degli Infermi di Biella, Ponderano, Biella, 13875, Italy.
- Section of Endocrinology and Metabolism, Department of Medicine, University of Perugia, Piazzale Gambuli 1, Perugia, 06129, Italy.
| | - A Nelva
- Diabetology and Endocrinology, Nuovo Ospdale degli Infermi di Biella, Ponderano, Biella, 13875, Italy
| | - P Scivetti
- Internal Medicine, Nuovo Ospdale degli Infermi di Biella, Ponderano, Biella, 13875, Italy
| | - M Costanzo
- Internal Medicine, Nuovo Ospdale degli Infermi di Biella, Ponderano, Biella, 13875, Italy
| | - C G Fanelli
- Section of Endocrinology and Metabolism, Department of Medicine, University of Perugia, Piazzale Gambuli 1, Perugia, 06129, Italy
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Paediatric steatotic liver disease has unique characteristics: A multisociety statement endorsing the new nomenclature. J Pediatr Gastroenterol Nutr 2024; 78:1190-1196. [PMID: 38529849 DOI: 10.1002/jpn3.12156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 03/27/2024]
Abstract
Nonalcoholic fatty liver disease (NAFLD) has been a commonly used term and diagnosis in paediatric hepatology, gastroenterology, and endocrinology clinics for over 30 years. A multisociety Delphi process has determined a new name "Steatotic Liver Disease" (SLD) as the overarching term for disorders associated with hepatic lipid accumulation. Our Societies give our support to steatotic liver disease as the best overarching term for use in our communities. Metabolic dysfunction-associated steatotic liver disease (MASLD) overcomes many of the shortcomings of the name NAFLD. Here, we highlight several points of the new nomenclature that are of particular importance for our community and their consequences for implementation including: diagnostic criteria, considering alternate diagnoses, practical implementation, research, advocacy, and education for paediatricians. As with all nomenclature changes, it will take a concerted effort from our paediatric societies to help integrate the optimal use of this into practice.
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Khan SH, Hafeez A, Khan Y, Khalid UB, Shah S, Ghauri AA. Association Between Triglyceride-Glucose Index and Homeostasis Model Assessment for Insulin Resistance with Estimated Glucose Disposal Rate. J Coll Physicians Surg Pak 2024; 34:617-619. [PMID: 38720227 DOI: 10.29271/jcpsp.2024.05.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/13/2023] [Indexed: 05/14/2024]
Abstract
This cross-sectional study was aimed to compare insulin resistance, Triglyceride- Glucose (TyG) index, fatty liver index (FLI) and hepatic steatosis index (HSI), glycaemic and lipids among groups/quartiles based upon estimated Glucose Disposal Rate (eGDR) from August 2022 to December 2022 among 249 male participants. The eGDR results in (mg/kg/min) were divided into four quartiles as: Group-I: {<6.88, n = 62}, Group-II: {<6.88-9.45, n = 63}, Group-III: {9.46-10.39, n = 62}, and Group-IV: {>10.39, n = 62}. Fasting plasma glucose (FPG), HbA1c, low density lipoprotein (LDL), homeostasis model assessment for insulin-resistance (HOMAIR), and TyG index demonstrated significant worsening increase from high to low eGDR groups. Receiver operating curve (ROC) analysis to calculate area under curve (AUC) for diagnostic efficiency candidate indices for eGDR demonstrated highest AUC for FLI as AUC: 0.736 (95% CI: 0.669-0.803), p < 0.001, followed by FPG: AUC: 0.682 (95% CI: 0.606-0.757), HOMAIR: AUC: 0.670 (95% CI: 0.602-0.739), HSI: AUC: 0.660 (95% CI: 0.589-0.731), TyG index: 0.658 (95% CI: 0.583-0.732), and HbA1c: 0.639 (95% CI: 0.583-0.732). Glycaemic measures, lipid indices, insulin resistance and TyG index deteriorated with declining eGDR. Diagnostic performance as evaluated by AUC for eGDR was highest for FLI, followed by FPG, HOMAIR, HSI, TyG index, HbA1c, and triglycerides. Key Words: Triglyceride, Insulin, Glucose, Diabetes.
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Affiliation(s)
- Sikandar Hayat Khan
- Department of Pathology, Combined Military Hospital, National University of Medical Sciences (NUMS), Multan, Pakistan
| | - Ayesha Hafeez
- Department of Pathology, Combined Military Hospital, National University of Medical Sciences (NUMS), Multan, Pakistan
| | - Yasser Khan
- Department of Pathology, Combined Military Hospital, National University of Medical Sciences (NUMS), Multan, Pakistan
| | - Usama Bin Khalid
- Department of Pathology, Combined Military Hospital, National University of Medical Sciences (NUMS), Multan, Pakistan
| | - Shahrukh Shah
- Department of Pathology, Combined Military Hospital, National University of Medical Sciences (NUMS), Multan, Pakistan
| | - Ahsan Ahmad Ghauri
- Department of Pathology, Combined Military Hospital, National University of Medical Sciences (NUMS), Multan, Pakistan
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Fouad Y, Ghazinyan H, Alboraie M, Al Khatry M, Desalegn H, Al-Ali F, El-Shabrawi MHF, Ocama P, Derbala M, Barakat S, Awuku YA, Ndububa DA, Sabbah M, Hamoudi W, Ng'wanasayi M, Elwakil R, Ally R, Al-Busafi SA, Hashim A, Esmat G, Shiha G. Joint position statement from the Middle East and North Africa and sub-Saharan Africa on continuing to endorse the MAFLD definition. J Hepatol 2024; 80:e194-e197. [PMID: 38342440 DOI: 10.1016/j.jhep.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/13/2024]
Affiliation(s)
- Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt.
| | - Hasmik Ghazinyan
- Gastroenterology and Hepatology Service, Yerevan Medical Scientific Center, Yerevan, Armenia
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Maryam Al Khatry
- Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, Emirates Health Services, Ministry of Health, United Arab Emirates
| | - Hailemichael Desalegn
- Department of Internal Medicine, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fuad Al-Ali
- Department of Gastroenterology, Royal Hayat Hospital, Faculty of Medicine, Kuwait University, Kuwait
| | - Mortada H F El-Shabrawi
- Paediatric Hepatology Unit, Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ponsiano Ocama
- School of Medicine, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moutaz Derbala
- Gastroenterology and Hepatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Salma Barakat
- National Center for Gastrointestinal and Liver Diseases, Ibn Sina Hospital, Ministry of Health, Khartoum, Sudan
| | - Yaw Asante Awuku
- Department of Medicine and Therapeutics, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Dennis Amajuoyi Ndububa
- Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Meriam Sabbah
- Department of Gastroenterology, Habib Thameur Hospital, Tunis, Tunisia
| | - Waseem Hamoudi
- Internal Medicine Department, Al-Bashir Hospital, Amman, Jordan
| | | | - Reda Elwakil
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Reidwan Ally
- Department of Gastroenterology, Univ of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Said A Al-Busafi
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Almoutaz Hashim
- Department of Internal Medicine, Jeddah University, Jeddah, Saudi Arabia
| | - Gamal Esmat
- Departement of Endemic Medicine and Hepatogastrenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gamal Shiha
- Egyptian Liver Research Institute and Hospital, Mansoura, Egypt; Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Martínez-Montoro JI, Martínez-Sánchez MA, Balaguer-Román A, Fernández-Ruiz VE, Hernández-Barceló JE, Ferrer-Gómez M, Frutos MD, Núñez-Sánchez MÁ, Fernández-García JC, Ramos-Molina B. Triglyceride to HDL Cholesterol Ratio for the Identification of MASLD in Obesity: A Liver Biopsy-Based Case-Control Study. Nutrients 2024; 16:1310. [PMID: 38732557 PMCID: PMC11085202 DOI: 10.3390/nu16091310] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Associations between dyslipidemia and metabolic dysfunction-associated steatotic liver disease (MASLD) have been reported. Previous studies have shown that the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio may be a surrogate marker of MASLD, assessed by liver ultrasound. However, no studies have evaluated the utility of this ratio according to biopsy-proven MASLD and its stages. Therefore, our aim was to evaluate if the TG/HDL-C ratio allows for the identification of biopsy-proven MASLD in patients with obesity. We conducted a case-control study in 153 patients with obesity who underwent metabolic surgery and had a concomitant liver biopsy. Fifty-three patients were classified as no MASLD, 45 patients as metabolic dysfunction-associated steatotic liver-MASL, and 55 patients as metabolic dysfunction-associated steatohepatitis-MASH. A receiver operating characteristic (ROC) analysis was performed to assess the accuracy of the TG/HDL-C ratio to detect MASLD. We also compared the area under the curve (AUC) of the TG/HDL-C ratio, serum TG, and HDL-C. A higher TG/HDL-C ratio was observed among patients with MASLD, compared with patients without MASLD. No differences in the TG/HDL-C ratio were found between participants with MASL and MASH. The greatest AUC was observed for the TG/HDL-C ratio (AUC 0.747, p < 0.001) with a cut-off point of 3.7 for detecting MASLD (sensitivity = 70%; specificity = 74.5%). However, no statistically significant differences between the AUC of the TG/HDL-C ratio and TG or HDL-C were observed to detect MASLD. In conclusion, although an elevated TG/HDL-C ratio can be found in patients with MASLD, this marker did not improve the detection of MASLD in our study population, compared with either serum TG or HDL-C.
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Affiliation(s)
- José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain;
| | - María Antonia Martínez-Sánchez
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.M.-S.); (A.B.-R.); (V.E.F.-R.); (M.F.-G.)
| | - Andrés Balaguer-Román
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.M.-S.); (A.B.-R.); (V.E.F.-R.); (M.F.-G.)
- Department of General and Digestive System Surgery, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain;
| | - Virginia Esperanza Fernández-Ruiz
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.M.-S.); (A.B.-R.); (V.E.F.-R.); (M.F.-G.)
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain
| | | | - Mercedes Ferrer-Gómez
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.M.-S.); (A.B.-R.); (V.E.F.-R.); (M.F.-G.)
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain
| | - María Dolores Frutos
- Department of General and Digestive System Surgery, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain;
| | - María Ángeles Núñez-Sánchez
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.M.-S.); (A.B.-R.); (V.E.F.-R.); (M.F.-G.)
| | - José Carlos Fernández-García
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
| | - Bruno Ramos-Molina
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.M.-S.); (A.B.-R.); (V.E.F.-R.); (M.F.-G.)
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9
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Ferraioli G, Barr RG. Recent advances in noninvasive assessment of liver steatosis. Pol Arch Intern Med 2024; 134:16703. [PMID: 38501721 DOI: 10.20452/pamw.16703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Due to the steatosis epidemic, noninvasive quantification of liver fat content is of great interest. Magnetic resonance (MR) techniques, including proton MR spectroscopy (MRS) and MR chemical shift imaging can quantify liver fat by measuring, directly or indirectly (the latter), the proton density fat fraction (PDFF). They have shown excellent diagnostic accuracy and are currently the reference standard for the noninvasive assessment of liver steatosis and are used in clinical trials for evaluating the change in liver fat over time. Using ultrasound (US), three different quantitative parameters can be obtained to estimate liver fat: attenuation coefficient, backscatter coefficient, and speed of sound. Controlled attenuation parameter (CAP), which estimates the attenuation of the US beam, was the first algorithm available and is performed with a non-imaging system. Currently, several other algorithms are available on B-mode imaging ultrasound systems, and they have shown an accuracy similar to or higher than the CAP. This article reports the current knowledge about their application in patients with metabolic dysfunction-associated steatotic liver disease.
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Affiliation(s)
- Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, United States
- Southwoods Imaging, Boardman, Ohio, United States
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Ikura Y, Okubo T, Sakai Y. Liver biopsy in the post-hepatitis C virus era in Japan. World J Gastroenterol 2024; 30:1949-1957. [PMID: 38681127 PMCID: PMC11045496 DOI: 10.3748/wjg.v30.i14.1949] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/05/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
In Japan, liver biopsies were previously crucial in evaluating the severity of hepatitis caused by the hepatitis C virus (HCV) and diagnosing HCV-related hepatocellular carcinoma (HCC). However, due to the development of effective antiviral treatments and advanced imaging, the necessity for biopsies has significantly decreased. This change has resulted in fewer chances for diagnosing liver disease, causing many general pathologists to feel less confident in making liver biopsy diagnoses. This article provides a comprehensive overview of the challenges and potential solutions related to liver biopsies in Japan. First, it highlights the importance of considering steatotic liver diseases as independent conditions that can coexist with other liver diseases due to their increasing prevalence. Second, it emphasizes the need to avoid hasty assumptions of HCC in nodular lesions, because clinically diagnosable HCCs are not targets for biopsy. Third, the importance of diagnosing hepatic immune-related adverse events caused by immune checkpoint inhibitors is increasing due to the anticipated widespread use of these drugs. In conclusion, pathologists should be attuned to the changing landscape of liver diseases and approach liver biopsies with care and attention to detail.
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Affiliation(s)
- Yoshihiro Ikura
- Department of Pathology, Takatsuki General Hospital, Takatsuki 569-1192, Osaka Prefecture, Japan
| | - Takako Okubo
- Department of Pathology, Takatsuki General Hospital, Takatsuki 569-1192, Osaka Prefecture, Japan
| | - Yasuhiro Sakai
- Department of Pathology, Kansai Medical University Medical Center, Moriguchi 570-8507, Japan
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11
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Rhee EJ. Multiple Definitions of Fatty Liver Disease: Which One Most Accurately Predicts Diabetes? Endocrinol Metab (Seoul) 2024; 39:397-398. [PMID: 38693820 PMCID: PMC11066444 DOI: 10.3803/enm.2024.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024] Open
Affiliation(s)
- Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Wiegand J, Petroff D, Karlas T. Metabolic dysfunction associated steatotic liver disease-Clinicians should not underestimate the role of steatosis. United European Gastroenterol J 2024; 12:277-278. [PMID: 38174620 PMCID: PMC11017754 DOI: 10.1002/ueg2.12520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Johannes Wiegand
- Division of HepatologyDepartment of Medicine IILeipzig University Medical CentreLeipzigGermany
| | - David Petroff
- Clinical Trial Centre LeipzigUniversity of LeipzigLeipzigGermany
| | - Thomas Karlas
- Division of GastroenterologyDepartment of Medicine IILeipzig University Medical CentreLeipzigGermany
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13
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Sherman MS, Challa PK, Przybyszewski EM, Wilechansky RM, Uche-Anya EN, Ott AT, McGoldrick J, Goessling W, Khalili H, Simon TG. A natural language processing algorithm accurately classifies steatotic liver disease pathology to estimate the risk of cirrhosis. Hepatol Commun 2024; 8:e0403. [PMID: 38551386 PMCID: PMC10984665 DOI: 10.1097/hc9.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Histopathology remains the gold standard for diagnosing and staging metabolic dysfunction-associated steatotic liver disease (MASLD). The feasibility of studying MASLD progression in electronic medical records based on histological features is limited by the free-text nature of pathology reports. Here we introduce a natural language processing (NLP) algorithm to automatically score MASLD histology features. METHODS From the Mass General Brigham health care system electronic medical record, we identified all patients (1987-2021) with steatosis on index liver biopsy after excluding excess alcohol use and other etiologies of liver disease. An NLP algorithm was constructed in Python to detect steatosis, lobular inflammation, ballooning, and fibrosis stage from pathology free-text and manually validated in >1200 pathology reports. Patients were followed from the index biopsy to incident decompensated liver disease accounting for covariates. RESULTS The NLP algorithm demonstrated positive and negative predictive values from 93.5% to 100% for all histologic concepts. Among 3134 patients with biopsy-confirmed MASLD followed for 20,604 person-years, rates of the composite endpoint increased monotonically with worsening index fibrosis stage (p for linear trend <0.005). Compared to simple steatosis (incidence rate, 15.06/1000 person-years), the multivariable-adjusted HRs for cirrhosis were 1.04 (0.72-1.5) for metabolic dysfunction-associated steatohepatitis (MASH)/F0, 1.19 (0.92-1.54) for MASH/F1, 1.89 (1.41-2.52) for MASH/F2, and 4.21 (3.26-5.43) for MASH/F3. CONCLUSIONS The NLP algorithm accurately scores histological features of MASLD from pathology free-text. This algorithm enabled the construction of a large and high-quality MASLD cohort across a multihospital health care system and disclosed an accelerating risk for cirrhosis based on the index MASLD fibrosis stage.
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Affiliation(s)
- Marc S. Sherman
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Brigham Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prasanna K. Challa
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric M. Przybyszewski
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert M. Wilechansky
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eugenia N. Uche-Anya
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashley T. Ott
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Jessica McGoldrick
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wolfram Goessling
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Brigham Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hamed Khalili
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tracey G. Simon
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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14
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Vaduva CC, Saceanu S, Cartu D, Novac MB, Boldeanu MV, Goganau AM, Dira L, Boldeanu L. Acute fatty liver with pancreatitis in pregnancy after in vitro fertilization - literature review and case report. Eur Rev Med Pharmacol Sci 2024; 28:3251-3262. [PMID: 38708483 DOI: 10.26355/eurrev_202404_36053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Acute fatty liver disease in pregnancy (AFLP) is a low-incidence condition that usually affects women in the third trimester of pregnancy or the early postpartum period. This article reviews recent advances in the diagnosis and treatment of AFLP with pancreatitis in pregnancy induced by in vitro fertilization (IVF). CASE REPORT A rare case of AFLP and pancreatitis occurred in a pregnant woman with an IVF-induced twin pregnancy delivered by cesarean section. Diagnosis of this condition is difficult, and delay in accurate diagnosis and timely and appropriate treatment can lead to serious complications such as acute pancreatitis or extensive damage to multiple organs and systems, which can have significant consequences. The main therapeutic approach was the rapid administration of drugs accompanied by therapeutic measures to support liver function and pancreatic complications. CONCLUSIONS We would like to reemphasize the importance of multidisciplinary management and rapid intervention in AFLP with acute pancreatitis after IVF.
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Affiliation(s)
- C C Vaduva
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Craiova, Romania.
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15
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González IA, Saeed O, Mustafa M, Segura SE, Collins K, Hou T, Mesa H, Lee SM, Zhang D, Lin J, Cummings OW. Incidental findings during donor liver assessment: Single center experience. Ann Diagn Pathol 2024; 69:152266. [PMID: 38266545 DOI: 10.1016/j.anndiagpath.2024.152266] [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] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
Intraoperative consultation of donor liver is an important part of transplant evaluation and determination of liver eligibility. In this study, we describe incidental pathologic findings discovered during the pretransplant evaluation of liver donors in our Institution from 1/2010 to 12/2022. During this 13-year period 369 intraoperative consultations from 262 liver donors were performed. Of those cases, incidental findings were identified in 22 cases (5.9 %) from 19 donors (7.3 %); two donors had more than one lesion. The median age of this subset of patients was 53 years (range: 18-70) and females predominated (63 %). Sixteen of the donors had abnormal findings in the liver: 6 bile duct hamartoma (BDH), 5 hyalinized nodule with Histoplasma capsulatum, 5 focal nodular hyperplasia (FNH), 2 bile duct adenomas (BDA), 1 biliary cyst and 1 hemangioma. One donor had both FNH and a BDH. One BDH and 1 BDA case was misdiagnosed as malignancy during the frozen section evaluation. Three donors had extrahepatic pathologies: a pancreatic tail schwannoma, a low-grade appendiceal mucinous neoplasm, and a lymph node with metastatic endometrial endometrioid adenocarcinoma. Of the 19 livers, the final organ disposition was available for 9: 6 were transplanted (67 %) and 3 were discarded (33 %). Two of the 3 discarded organs were misdiagnosed BDH and BDA cases, and one was incorrectly reported as having 90 % microvesicular steatosis during the frozen assessment. We present the clinicopathologic characteristics of liver donors with incidental findings during the pre-transplant evaluation which could lead to unwarranted graft dismissal if misdiagnosed. Additionally, incidental fungal infections can have implications for immunosuppressive therapy and the decision to use or reject the graft.
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Affiliation(s)
- Iván A González
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America.
| | - Omer Saeed
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Mohamed Mustafa
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Sheila E Segura
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Katrina Collins
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Tieying Hou
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Hector Mesa
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Sun M Lee
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Jingmei Lin
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Oscar W Cummings
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
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16
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Le MH, Henry L, Nguyen MH. In response to: Steatotic liver disease-know your enemies. Clin Mol Hepatol 2024; 30:284-286. [PMID: 38373421 PMCID: PMC11016486 DOI: 10.3350/cmh.2024.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Affiliation(s)
- Michael H. Le
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA
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17
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Turan Gökçe D, Arı D, Aydın O, Turhan N, Altunsoy A, Ökten RS, Akdoğan Kayhan M. Tigecycline-Associated Hepatic Steatosis After Liver Transplant: A Case Report. EXP CLIN TRANSPLANT 2024; 22:318-321. [PMID: 38742325 DOI: 10.6002/ect.2023.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Tigecycline is a parenteral glycycline antibiotic that is used to treat severe infections caused by susceptible organisms, butitis also associated with hepatotoxicity. We present 2 similar patients with hepatic steatosis possibly associated with early tigecycline after transplant. In the first case, a 61-year-old woman underwent liver transplant for acute severe hepatitis; 6 days posttransplant, because of nonroutine resistant fever, the patient received tigecycline combined with daptomycin. Retransplant was applied to the patient on day 12 posttransplant because of acute liver failure secondary to hepatic vein thrombosis. After retransplant, biochemical levels gradually increased, exceeding the upper limit of normal. In liver biopsy, the patient had macrovesicular steatosis in 70% to 80% ofthe parenchyma. In the second case, a 53-yearold woman underwent liver transplant for liver cirrhosis. Tigecycline was added to the treatment because of recurrent fever on day 6 after transplant, with treatment also comprising piperacillin-tazobactam and meropenem. On day 15 of the patient's tigecycline treatment, her liver function tests were elevated. In liver biopsy, the patient had 30% to 40% macrovesicular steatosis and canalicular cholestasis in the parenchyma, especially in zone 3. Reports of hepatic steatosis associated with early tigecycline after transplant are quite new to the literature.
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Affiliation(s)
- Dilara Turan Gökçe
- From the Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
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18
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Niedecker RW, Delaney JA, Doyle MF, Sparks AD, Sitlani CM, Buzkova P, Zeb I, Tracy RP, Psaty BM, Budoff MJ, Olson NC. Investigating peripheral blood monocyte and T-cell subsets as non-invasive biomarkers for asymptomatic hepatic steatosis: results from the Multi-Ethnic Study of Atherosclerosis. Front Immunol 2024; 15:1243526. [PMID: 38596669 PMCID: PMC11002077 DOI: 10.3389/fimmu.2024.1243526] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024] Open
Abstract
Background Circulating immune cells have gained interest as biomarkers of hepatic steatosis. Data on the relationships between immune cell subsets and early-stage steatosis in population-based cohorts are limited. Methods This study included 1,944 asymptomatic participants of the Multi-Ethnic Study of Atherosclerosis (MESA) with immune cell phenotyping and computed tomography measures of liver fat. Participants with heavy alcohol use were excluded. A liver-to-spleen ratio Hounsfield units (HU) <1.0 and liver attenuation <40 HU were used to diagnose liver fat presence and >30% liver fat content, respectively. Logistic regression estimated cross-sectional associations of immune cell subsets with liver fat parameters adjusted for risk factors. We hypothesized that higher proportions of non-classical monocytes, Th1, Th17, and memory CD4+ T cells, and lower proportions of classical monocytes and naive CD4+ T cells, were associated with liver fat. Exploratory analyses evaluated additional immune cell phenotypes (n = 19). Results None of the hypothesized cells were associated with presence of liver fat. Higher memory CD4+ T cells were associated with >30% liver fat content, but this was not significant after correction for multiple hypothesis testing (odds ratio (OR): 1.31, 95% confidence interval (CI): 1.03, 1.66). In exploratory analyses unadjusted for multiple testing, higher proportions of CD8+CD57+ T cells were associated with liver fat presence (OR: 1.21, 95% CI: 1.02, 1.44) and >30% liver fat content (OR: 1.34, 95% CI: 1.07, 1.69). Conclusions Higher circulating memory CD4+ T cells may reflect liver fat severity. CD8+CD57+ cells were associated with liver fat presence and severity, but replication of findings is required.
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Affiliation(s)
- Rhys W. Niedecker
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Joseph A. Delaney
- General Internal Medicine, University of Washington, Seattle, WA, United States
| | - Margaret F. Doyle
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Andrew D. Sparks
- Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Colleen M. Sitlani
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Petra Buzkova
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, United States
| | - Irfan Zeb
- Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, United States
- Department of Biochemistry, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Matthew J. Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Nels C. Olson
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, United States
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19
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Stefan N, Roden M. Diabetes and Fatty Liver. Exp Clin Endocrinol Diabetes 2024; 132:136-141. [PMID: 38325402 DOI: 10.1055/a-2166-6824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Norbert Stefan
- German Center for Diabetes Research (DZD), Germany
- Heisenberg Professorship and Chair of Clinical Experimental Diabetology, Department of Internal Medicine IV, Endocrinology, Diabetology, and Nephrology, University Hospital, Tübingen, Germany
- Department of Pathophysiology of Prediabetes of the Institute for Diabetes Research and Metabolic Diseases (IDM) of Helmholtz Centre Munich at the University of Tübingen, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Germany
- Division for Endocrinology and Diabetology, Medical Faculty of the Heinrich Heine University and University Hospital, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Düsseldorf, Germany
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20
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Gambella A, Salvi M, Molinaro L, Patrono D, Cassoni P, Papotti M, Romagnoli R, Molinari F. Improved assessment of donor liver steatosis using Banff consensus recommendations and deep learning algorithms. J Hepatol 2024; 80:495-504. [PMID: 38036009 DOI: 10.1016/j.jhep.2023.11.013] [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: 08/28/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND & AIMS The Banff Liver Working Group recently published consensus recommendations for steatosis assessment in donor liver biopsy, but few studies reported their use and no automated deep-learning algorithms based on the proposed criteria have been developed so far. We evaluated Banff recommendations on a large monocentric series of donor liver needle biopsies by comparing pathologists' scores with those generated by convolutional neural networks (CNNs) we specifically developed for automated steatosis assessment. METHODS We retrospectively retrieved 292 allograft liver needle biopsies collected between January 2016 and January 2020 and performed steatosis assessment using a former intra-institution method (pre-Banff method) and the newly introduced Banff recommendations. Scores provided by pathologists and CNN models were then compared, and the degree of agreement was measured with the intraclass correlation coefficient (ICC). RESULTS Regarding the pre-Banff method, poor agreement was observed between the pathologist and CNN models for small droplet macrovesicular steatosis (ICC: 0.38), large droplet macrovesicular steatosis (ICC: 0.08), and the final combined score (ICC: 0.16) evaluation, but none of these reached statistically significance. Interestingly, significantly improved agreement was observed using the Banff approach: ICC was 0.93 for the low-power score (p <0.001), 0.89 for the high-power score (p <0.001), and 0.93 for the final score (p <0.001). Comparing the pre-Banff method with the Banff approach on the same biopsy, pathologist and CNN model assessment showed a mean (±SD) percentage of discrepancy of 26.89 (±22.16) and 1.20 (±5.58), respectively. CONCLUSIONS Our findings support the use of Banff recommendations in daily practice and highlight the need for a granular analysis of their effect on liver transplantation outcomes. IMPACT AND IMPLICATIONS We developed and validated the first automated deep-learning algorithms for standardized steatosis assessment based on the Banff Liver Working Group consensus recommendations. Our algorithm provides an unbiased automated evaluation of steatosis, which will lay the groundwork for granular analysis of steatosis's short- and long-term effects on organ viability, enabling the identification of clinically relevant steatosis cut-offs for donor organ acceptance. Implementing our algorithm in daily clinical practice will allow for a more efficient and safe allocation of donor organs, improving the post-transplant outcomes of patients.
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Affiliation(s)
- Alessandro Gambella
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy; Division of Liver and Transplant Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Massimo Salvi
- Department of Electronics and Telecommunications, PolitoBIOMed Lab, Politecnico di Torino, Biolab, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Luca Molinaro
- Division of Pathology, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Damiano Patrono
- General Surgery 2U, Liver Transplant Center, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mauro Papotti
- Division of Pathology, Department of Oncology, University of Turin, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U, Liver Transplant Center, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Filippo Molinari
- Department of Electronics and Telecommunications, PolitoBIOMed Lab, Politecnico di Torino, Biolab, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
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21
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Xie L, Guo H. Question on the Use of BMI ≥25 kg/m 2 to Define Obesity to Analyze the Incidence and Risk Factors of Hepatic Steatosis and Hepatic Fibrosis in the Chinese Population. Gastroenterology 2024; 166:542. [PMID: 37690770 DOI: 10.1053/j.gastro.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Lu Xie
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Huijun Guo
- First Affiliated Hospital of Henan University of Chinese Medicine; Henan Key Laboratory of Viral Diseases, Prevention and Treatment of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China
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22
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Boutari C, Athyros VG. The Association Between Liver Histology and Cardiovascular Risk: Time to Introduce Steatotic Liver Disease Screening in High-Risk Patient Groups? Angiology 2024; 75:205-207. [PMID: 37691291 DOI: 10.1177/00033197231201706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Chrysoula Boutari
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Vasilios G Athyros
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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23
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Dallio M, Romeo M, Vaia P, Auletta S, Mammone S, Cipullo M, Sapio L, Ragone A, Niosi M, Naviglio S, Federico A. Red cell distribution width/platelet ratio estimates the 3-year risk of decompensation in Metabolic Dysfunction-Associated Steatotic Liver Disease-induced cirrhosis. World J Gastroenterol 2024; 30:685-704. [PMID: 38515952 PMCID: PMC10950628 DOI: 10.3748/wjg.v30.i7.685] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND For compensated advanced chronic liver disease (cACLD) patients, the first decompensation represents a dramatically worsening prognostic event. Based on the first decompensation event (DE), the transition to decompensated advanced chronic liver disease (dACLD) can occur through two modalities referred to as acute decompensation (AD) and non-AD (NAD), respectively. Clinically Significant Portal Hypertension (CSPH) is considered the strongest predictor of decompensation in these patients. However, due to its invasiveness and costs, CSPH is almost never evaluated in clinical practice. Therefore, recognizing non-invasively predicting tools still have more appeal across healthcare systems. The red cell distribution width to platelet ratio (RPR) has been reported to be an indicator of hepatic fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). However, its predictive role for the decompensation has never been explored. AIM In this observational study, we investigated the clinical usage of RPR in predicting DEs in MASLD-related cACLD patients. METHODS Fourty controls and 150 MASLD-cACLD patients were consecutively enrolled and followed up (FUP) semiannually for 3 years. At baseline, biochemical, clinical, and Liver Stiffness Measurement (LSM), Child-Pugh (CP), Model for End-Stage Liver Disease (MELD), aspartate aminotransferase/platelet count ratio index (APRI), Fibrosis-4 (FIB-4), Albumin-Bilirubin (ALBI), ALBI-FIB-4, and RPR were collected. During FUP, DEs (timing and modaities) were recorded. CSPH was assessed at the baseline and on DE occurrence according to the available Clinical Practice Guidelines. RESULTS Of 150 MASLD-related cACLD patients, 43 (28.6%) progressed to dACLD at a median time of 28.9 months (29 NAD and 14 AD). Baseline RPR values were significantly higher in cACLD in comparison to controls, as well as MELD, CP, APRI, FIB-4, ALBI, ALBI-FIB-4, and LSM in dACLD-progressing compared to cACLD individuals [all P < 0.0001, except for FIB-4 (P: 0.007) and ALBI (P: 0.011)]. Receiving operator curve analysis revealed RPR > 0.472 and > 0.894 as the best cut-offs in the prediction respectively of 3-year first DE, as well as its superiority compared to the other non-invasive tools examined. RPR (P: 0.02) and the presence of baseline-CSPH (P: 0.04) were significantly and independently associated with the DE. Patients presenting baseline-CSPH and RPR > 0.472 showed higher risk of decompensation (P: 0.0023). CONCLUSION Altogether these findings suggest the RPR as a valid and potentially applicable non-invasive tool in the prediction of timing and modalities of decompensation in MASLD-related cACLD patients.
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Affiliation(s)
- Marcello Dallio
- Department of Precision Medicine, Hepatogastroenterology Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Mario Romeo
- Department of Precision Medicine, Hepatogastroenterology Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Paolo Vaia
- Department of Precision Medicine, Hepatogastroenterology Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Salvatore Auletta
- Department of Precision Medicine, Hepatogastroenterology Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Simone Mammone
- Department of Precision Medicine, Hepatogastroenterology Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Marina Cipullo
- Department of Precision Medicine, Hepatogastroenterology Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Luigi Sapio
- Department of Precision Medicine, Clinical Biochemistry Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Angela Ragone
- Department of Precision Medicine, Clinical Biochemistry Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Marco Niosi
- Department of Precision Medicine, Hepatogastroenterology Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Silvio Naviglio
- Department of Precision Medicine, Clinical Biochemistry Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Alessandro Federico
- Department of Precision Medicine, Hepatogastroenterology Division, University of Campania Luigi Vanvitelli, Naples 80138, Italy
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Zampaglione L, Marello N, Petignat PA. [Metabolic steatotic liver disease: the move towards an inclusive definition]. Rev Med Suisse 2024; 20:311-315. [PMID: 38323767 DOI: 10.53738/revmed.2024.20.860.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Steatotic liver disease is the most common liver pathology worldwide, comprises a wide range of liver diseases linked to metabolic dysfunction, excessive alcohol consumption, drug reactions and infectious and genetic origins. Following several years of deliberation, the major liver disease societies have recently adopted a new nomenclature and updated diagnostic criteria for steatotic liver diseases, aimed at better reflecting our evolving understanding of their pathophysiology. This article summarizes these newly adopted designations, explores the basis for these nomenclatures, presents recent epidemiological data and discusses new diagnostic criteria and recent advances in therapeutic approaches for steatotic liver disease.
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Affiliation(s)
- Lucia Zampaglione
- Service de médecine interne générale, Centre hospitalier du Valais romand, Hôpital de Sion, 1951 Sion
| | - Noémie Marello
- Service de médecine interne générale, Centre hospitalier du Valais romand, Hôpital de Sion, 1951 Sion
| | - Pierre-Auguste Petignat
- Service de médecine interne générale, Centre hospitalier du Valais romand, Hôpital de Sion, 1951 Sion
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25
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van Son K, te Nijenhuis-Noort L, Boone S, Mook-Kanamori D, Holleboom A, Roos P, Lamb H, Alblas G, Coenraad M, Rosendaal F, de Mutsert R, Tushuizen M. Prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in a middle-aged population with overweight and normal liver enzymes, and diagnostic accuracy of noninvasive proxies. Medicine (Baltimore) 2024; 103:e34934. [PMID: 38181294 PMCID: PMC10766322 DOI: 10.1097/md.0000000000034934] [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: 05/03/2023] [Accepted: 08/04/2023] [Indexed: 01/07/2024] Open
Abstract
The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing at an alarming rate. Elevated liver enzymes are a primary reason to refer patients for further testing. However, liver enzymes within the normal range do not exclude the presence of MASLD. We examined the prevalence of MASLD in a middle-aged population with overweight and normal liver enzymes. In addition, we examined the accuracy of 4 sets of noninvasive proxies for MASLD. We included 1017 participants from the Netherlands epidemiology of obesity cohort study with body mass index ≥25 kg/m2 and liver enzymes (asparate aminotransferase, alanine aminotransferase, gamma-glutamyltranspeptidase) within normal range. The diagnostic accuracy of biomarker scores (fatty liver index, liver fat score [LFS], STEATO-ELSA, and hepatic steatosis index) was determined against elevated hepatic triglyceride content measured by 1proton magnetic resonance spectroscopy. Participants (mean age 56 years, 49% women), had a median body mass index of 29.6 kg/m2 and a median hepatic triglyceride content of 4.4%. MASLD was present in 42% of participants and was more common in men than women, with respectively 47% and 36% being affected. The LFS showed the highest accuracy with an area under the curve of 0.72. We identified metabolic syndrome as the prime predictor for MASLD with an odds ratio of 2.95 (95% confidence interval 2.20-3.98). The prevalence of MASLD in middle-aged men and women with overweight and liver enzymes within the normal range is over 40%. LFS showed the highest accuracy to detect MASLD, but, overall, biomarker scores performed relatively poor. The presence of metabolic syndrome was the prime predictor of MASLD.
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Affiliation(s)
- K.C. van Son
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - S.C. Boone
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - D.O. Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A.G. Holleboom
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - P.R. Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - H.J. Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G. Alblas
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - M.J. Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F.R. Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R. de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M.E. Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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26
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Peng Q, Zhu T, Huang J, Liu Y, Huang J, Zhang W. Factors and a model to predict three-month mortality in patients with acute fatty liver of pregnancy from two medical centers. BMC Pregnancy Childbirth 2024; 24:27. [PMID: 38178044 PMCID: PMC10765840 DOI: 10.1186/s12884-023-06233-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Acute fatty liver of pregnancy (AFLP) is an uncommon but potentially life-threatening complication. Lacking of prognostic factors and models renders prediction of outcomes difficult. This study aims to explore factors and develop a prognostic model to predict three-month mortality of AFLP. METHODS This retrospective study included 78 consecutive patients fulfilling both clinical and laboratory criteria and Swansea criteria for diagnosis of AFLP. Univariate and multivariate cox regression analyses were used to identify predictive factors of mortality. Predictive efficacy of prognostic index for AFLP (PI-AFLP) was compared with the other four liver disease models using receiver operating characteristic (ROC) curve. RESULTS AFLP-related three-month mortality of two medical centers was 14.10% (11/78). International normalised ratio (INR, hazard ratio [HR] = 3.446; 95% confidence interval [CI], 1.324-8.970), total bilirubin (TBIL, HR = 1.005; 95% CI, 1.000-1.010), creatine (Scr, HR = 1.007; 95% CI, 1.001-1.013), low platelet (PLT, HR = 0.964; 95% CI, 0.931-0.997) at 72 h postpartum were confirmed as significant predictors of mortality. Artificial liver support (ALS, HR = 0.123; 95% CI, 0.012-1.254) was confirmed as an effective measure to improve severe patients' prognosis. Predictive accuracy of PI-AFLP was 0.874. Area under the receiver operating characteristic curves (AUCs) of liver disease models for end-stage liver disease (MELD), MELD-Na, integrated MELD (iMELD) and pregnancy-specific liver disease (PSLD) were 0.781, 0.774, 0.744 and 0.643, respectively. CONCLUSION TBIL, INR, Scr and PLT at 72 h postpartum are significant predictors of three-month mortality in AFLP patients. ALS is an effective measure to improve severe patients' prognosis. PI-AFLP calculated by TBIL, INR, Scr, PLT and ALS was a sensitive and specific model to predict mortality of AFLP.
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Affiliation(s)
- QiaoZhen Peng
- Department of Obstetrics, Xiangya Hospital, Central South University, Hunan, Changsha, 410008, China
| | - TeXuan Zhu
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, 450052, China
| | - JingRui Huang
- Department of Obstetrics, Xiangya Hospital, Central South University, Hunan, Changsha, 410008, China
| | - YueLan Liu
- Department of Obstetrics, Xiangya Hospital, Central South University, Hunan, Changsha, 410008, China
| | - Jian Huang
- Department of Obstetrics and Gynecology, the Second Xiangya Hospital, Central South University, Hunan, Changsha, 410011, China
| | - WeiShe Zhang
- Department of Obstetrics, Xiangya Hospital, Central South University, Hunan, Changsha, 410008, China.
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Durmazer E, Demir M, Onay H, Gunsar F. Chanarin-Dorfman Syndrome diagnosed at the stage of liver transplantation: A rare lipid storage disease. J Clin Lipidol 2024; 18:e125-e128. [PMID: 37968200 DOI: 10.1016/j.jacl.2023.10.003] [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] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/25/2023] [Accepted: 10/07/2023] [Indexed: 11/17/2023]
Abstract
Chanarin-Dorfman Syndrome (CDS) is a rare lipid storage disease with ichthyosis, hepatomegaly, myopathy, neuropathy, deafness, and ocular findings. Here, we aim to present an elderly CDS case and highlight the new endocrinological findings. A 66-year-old male patient with cirrhosis was hospitalized for liver transplantation. We suspected Chanarin-Dorfman Syndrome with ichthyosis, fatty liver, and syndromic facial features with bilateral ectropion, deafness, and malocclusion. We showed the lipid droplets in neutrophils called patognomonic Jordans' anomaly. Homozygous c.47+1 G>A mutation in the ABHD5 (NM_016006.6) gene were detected by clinical exome sequencing. Out of <160 CDS cases in the literature, this is the second eldest CDS patient and first with adrenal insufficiency, parathyroid lipoadenoma and atrophic pancreas. Clinicians should be aware of CDS as a rare cause of fatty liver. We recommend a blood smear and genetic analyses in patients with severe ichtiosis, ectropion, deafness and multiple endocrinolgic disorders.
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Affiliation(s)
- Esra Durmazer
- Ege University Faculty of Medicine (Dr Durmazer), Department of Internal Medicine, Izmir, Turkey.
| | - Meryem Demir
- Ege University Faculty of Medicine (Dr Demir), Department of Immunology and Allergy, Izmir, Turkey
| | - Huseyin Onay
- Multigen Genetic Disease Diagnosis Center (Dr Onay), Izmir, Turkey
| | - Fulya Gunsar
- Ege University Faculty of Medicine (Dr Gunsar), Department of Gastroenterology, Izmir, Turkey
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28
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Zhang N, Jiang Z, Li M, Zhang D. A novel multi-feature learning model for disease diagnosis using face skin images. Comput Biol Med 2024; 168:107837. [PMID: 38086142 DOI: 10.1016/j.compbiomed.2023.107837] [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] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Facial skin characteristics can provide valuable information about a patient's underlying health conditions. OBJECTIVE In practice, there are often samples with divergent characteristics (commonly known as divergent samples) that can be attributed to environmental factors, living conditions, or genetic elements. These divergent samples significantly degrade the accuracy of diagnoses. METHODOLOGY To tackle this problem, we propose a novel multi-feature learning method called Multi-Feature Learning with Centroid Matrix (MFLCM), which aims to mitigate the influence of divergent samples on the accurate classification of samples located on the boundary. In this approach, we introduce a novel discriminator that incorporates a centroid matrix strategy and simultaneously adapt it to a classifier in a unified model. We effectively apply the centroid matrix to the embedding feature spaces, which are transformed from the multi-feature observation space, by calculating a relaxed Hamming distance. The purpose of the centroid vectors for each category is to act as anchors, ensuring that samples from the same class are positioned close to their corresponding centroid vector while being pushed further away from the remaining centroids. RESULTS Validation of the proposed method with clinical facial skin dataset showed that the proposed method achieved F1 scores of 92.59%, 83.35%, 82.84% and 85.46%, respectively for the detection the Healthy, Diabetes Mellitus (DM), Fatty Liver (FL) and Chronic Renal Failure (CRF). CONCLUSION Experimental results demonstrate the superiority of the proposed method compared with typical classifiers single-view-based and state-of-the-art multi-feature approaches. To the best of our knowledge, this study represents the first to demonstrate concept of multi-feature learning using only facial skin images as an effective non-invasive approach for simultaneously identifying DM, FL and CRF in Han Chinese, the largest ethnic group in the world.
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Affiliation(s)
- Nannan Zhang
- The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen, China; Shenzhen Research Institute of Big Data, Shenzhen, China.
| | - Zhixing Jiang
- The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen, China; Shenzhen Research Institute of Big Data, Shenzhen, China.
| | - Mu Li
- Harbin Institute of Technology at Shenzhen, Shenzhen, China.
| | - David Zhang
- The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen, China; Shenzhen Research Institute of Big Data, Shenzhen, China.
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Noureddin M, Wei L, Castera L, Tsochatzis EA. Embracing Change: From Nonalcoholic Fatty Liver Disease to Metabolic Dysfunction-Associated Steatotic Liver Disease Under the Steatotic Liver Disease Umbrella. Clin Gastroenterol Hepatol 2024; 22:9-11. [PMID: 37848118 DOI: 10.1016/j.cgh.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Mazen Noureddin
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Underwood Center for Digestive Disorders, Department of Medicine, Houston Methodist Hospital, Houston, Texas; Houston Research Institute, Houston, Texas
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Laurent Castera
- Université Paris-Cité, Inserm, Centre de Recherche sur l'Inflammation, Paris, France; Service d'Hé patologie, Hô pital Beaujon, Assistance-Publique Hô pitaux de Paris, Clichy, France
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom
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30
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Liu CL, Chen DJ, Chen CY, Zhou XH, Jiang Y, Liu JY, Chen YE, Hu CR, Dong JJ, Li P, Wen M, Li YH, Zhang HL. [Clinical analysis of 86 cases of acute fatty liver of pregnancy]. Zhonghua Fu Chan Ke Za Zhi 2023; 58:896-902. [PMID: 38123195 DOI: 10.3760/cma.j.cn112141-20230814-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective: To investigate the clinical characteristics and maternal and fetal prognosis of pregnant women with acute fatty liver of pregnancy (AFLP). Methods: The clinical data of 86 AFLP pregnant women admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to August 2022 were collected, and their general data, clinical characteristics, laboratory tests and maternal and fetal outcomes were retrospectively analyzed. Results: (1) General information: the age of the 86 pregnant women with AFLP was (30.8±5.4) years, and the body mass index was (21.0±2.5) kg/m2. There were 50 primiparas (58.1%, 50/86) and 36 multiparas (41.9%, 36/86). There were 64 singleton pregnancies (74.4%, 64/86) and 22 twin pregnancies (25.6%, 22/86). (2) Clinical characteristics: the main complaints of AFLP pregnant women were gastrointestinal symptoms, including epigastric pain (68.6%, 59/86), nausea (47.7%, 41/86), anorexia (46.5%, 40/86), vomiting (39.5%, 34/86). The main non-gastrointestinal symptoms were jaundice of skin and/or scleral (54.7%, 47/86), edema (38.4%, 33/86), fatigue (19.8%, 17/86), bleeding tendency (16.3%, 14/86), polydipsia or polyuria (14.0%, 12/86), skin itching (8.1%, 7/86), and 17.4% (15/86) AFLP pregnant women had no obvious symptoms. (3) Laboratory tests: the incidence of liver and kidney dysfunction and abnormal coagulation function in AFLP pregnant women was high, and the levels of blood ammonia, lactate dehydrogenase and lactic acid were increased, and the levels of hemoglobin, platelet and albumin decreased. However, only 24 cases (27.9%, 24/86) of AFLP pregnant women showed fatty liver by imageology examination. (4) Pregnancy outcomes: ① AFLP pregnant women had a high incidence of pregnancy complications, mainly including renal insufficiency (95.3%, 82/86), preterm birth (46.5%, 40/86), hypertensive disorders in pregnancy (30.2%, 26/86), gestational diabetes mellitus (36.0%, 31/86), fetal distress (24.4%, 21/86), pulmonary infection (23.3%, 20/86), disseminated intravascular coagulation (16.3%, 14/86), multiple organ dysfunction syndrome (16.3%, 14/86), hepatic encephalopathy (9.3%, 8/86), and intrauterine fetal death (2.3%, 2/86). ② Treatment and outcome of AFLP pregnant women: the intensive care unit transfer rate of AFLP pregnant women was 66.3% (57/86). 82 cases were improved and discharged after treatment, 2 cases were transferred to other hospitals for follow-up treatment, and 2 cases (2.3%, 2/86) died. ③ Neonatal outcomes: except for 2 cases of intrauterine death, a total of 106 neonates were delivered, including 39 cases (36.8%, 39/106) of neonatal asphyxia, 63 cases (59.4%, 63/106) of neonatal intensive care unit admission, and 3 cases (2.8%, 3/106) of neonatal death. Conclusions: AFLP is a severe obstetric complication, which is harmful to mother and fetus. In the process of clinical diagnosis and treatment, attention should be paid to the clinical manifestations and laboratory tests of pregnant women, early diagnosis and active treatment, so as to improve maternal and fetal outcomes.
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Affiliation(s)
- C L Liu
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou 510150, China
| | - D J Chen
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou 510150, China
| | - C Y Chen
- Department of Obstetrics and Gynecology, the Third Clinical College of Guangzhou Medical University, Guangzhou 511436, China
| | - X H Zhou
- Department of Obstetrics and Gynecology, the Third Clinical College of Guangzhou Medical University, Guangzhou 511436, China
| | - Y Jiang
- Department of Obstetrics and Gynecology, the Third Clinical College of Guangzhou Medical University, Guangzhou 511436, China
| | - J Y Liu
- Department of Obstetrics and Gynecology, the Third Clinical College of Guangzhou Medical University, Guangzhou 511436, China
| | - Y E Chen
- Department of Obstetrics and Gynecology, the Third Clinical College of Guangzhou Medical University, Guangzhou 511436, China
| | - C R Hu
- Department of Obstetrics and Gynecology, the Third Clinical College of Guangzhou Medical University, Guangzhou 511436, China
| | - J J Dong
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou 510150, China
| | - P Li
- Department of Obstetrics and Gynecology, the Maternal and Child Health Hospital of Hunan Province, Changsha 410028, China
| | - M Wen
- Department of Obstetrics and Gynecology, the Fourth People's Hospital of Guiyang, Guiyang 550007, China
| | - Y H Li
- Department of Obstetrics and Gynecology, the First People's Hospital of Yulin, Yulin 537000, China
| | - H L Zhang
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou 510150, China
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Zhang Y, Kuai WT, Zhang YZ, Song YS, He DH, Pei JJ, Xu L. [Construction of a diagnostic model for fatty liver using human body composition analysis]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:1277-1282. [PMID: 38253071 DOI: 10.3760/cma.j.cn501113-20230731-00024] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Objective: To construct a diagnostic model for fatty liver using body composition analysis and further evaluate the diagnostic effect of the model on fatty liver. Methods: 726 cases with chronic liver disease who visited Tianjin Second People's Hospital from April 2019 to June 2022 and had body composition analysis tests were retrospectively enrolled and were divided into a fatty liver group (551 cases with fatty liver) and a control group (175 cases without fatty liver) according to the measured values of abdominal ultrasound and controlled attenuation parameter. An independent sample t-test and a non-parametric rank sum test were used for statistical processing. Logistic regression was used to construct a diagnostic model. Hosmer-Lemeshow was used to validate the fit of model. Receiver operating characteristic curve was used to confirm the diagnostic efficiency of the model. In addition, 341 cases of chronic liver disease who visited Tianjin Second People's Hospital were included to further verify the application effect of the model between July 2022 and February 2023. Results: Compared with the control group, the differences in various indicators of body composition analysis in the fatty liver group were statistically significant (P < 0.05). Basal metabolic rate (X1), visceral fat area (X2), and body fat (X3) were eventually included in the diagnostic model for BCA-FL (body composition analysis-fatty liver)= -7.771+0.002X1-0.035X2+0.456X3 with the Hosmer-Lemeshow test (P=0.059). The measured area under the receiver operating characteristic curve, the sensitivity, and the specificity were 0.888, 0.889, and 0.726, respectively, when the diagnostic threshold value was 0.615 with the Youden index and the receiver operating characteristic curve. In the validated model group, the area under the receiver operating characteristic curve, Youden index, sensitivity, and specificity were 0.875, 0.624, 0.799, and 0.825, respectively. Conclusion: The diagnostic model BCA-FL for fatty liver constructed using human body composition analysis has good diagnostic efficacy and is suitable for screening fatty liver in different basic liver disease populations.
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Affiliation(s)
- Y Zhang
- Tianjin Second People's Hospital, Tianjin 300192, China
| | - W T Kuai
- Tian jin Research Institute of Liver Disease, Tian jin 300192, China
| | - Y Z Zhang
- Tianjin Second People's Hospital, Tianjin 300192, China
| | - Y S Song
- Tianjin Third Central Hospital, Tianjin 300170, China
| | - D H He
- Tianjin Second People's Hospital, Tianjin 300192, China
| | - J J Pei
- Tianjin Second People's Hospital, Tianjin 300192, China
| | - L Xu
- Tianjin Second People's Hospital, Tianjin 300192, China Tian jin Research Institute of Liver Disease, Tian jin 300192, China
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Brügge M, Pecks U, Iannaccone A, Palz-Fleige M, Stepan H, Tauscher A. [Acute Fatty Liver of Pregnancy - Case Series]. Z Geburtshilfe Neonatol 2023; 227:466-473. [PMID: 37490932 DOI: 10.1055/a-2096-6230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
With a prevalence of 0,01-0,03%, acute fatty liver in pregnancy (AFLP) is a rare and dangerous complication of pregnancy and is difficult to distinguish from other, sometimes more common, pregnancy diseases such as HELLP syndrome, aHUS and TTP because of its mostly non-specific symptoms. Due to its rarity, AFLP is often not obvious to the obstetrician as a possible differential diagnosis. Yet early diagnosis and the fastest possible delivery is the only causal therapy and is important for the mortality rate. In the present manuscript, the pathophysiology, diagnosis and therapy of acute fatty liver in pregnancy are highlighted for the clinical routine based on case descriptions from three university hospitals, and reference is made to possible findings that are helpful in establishing the diagnosis. The angiogenic preeclampsia marker sFlt-1 plays a role and provides new opportunities to consider pathophysiological approaches.
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Affiliation(s)
- Martina Brügge
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Antonella Iannaccone
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Essen, Essen, Germany
| | - Monika Palz-Fleige
- Klinik für Gynäkologie und Geburtshilfe, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Holger Stepan
- Geburtsmedizin, Universitätsfrauenklinik Leipzig, Leipzig, Germany
| | - Anne Tauscher
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Leipzig, Leipzig, Germany
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Pascut D, Giraudi PJ, Banfi C, Ghilardi S, Tiribelli C, Bondesan A, Caroli D, Minocci A, Grugni G, Sartorio A. Proteome profiling identifies circulating biomarkers associated with hepatic steatosis in subjects with Prader-Willi syndrome. Front Endocrinol (Lausanne) 2023; 14:1254778. [PMID: 38034016 PMCID: PMC10684934 DOI: 10.3389/fendo.2023.1254778] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by loss of expression of paternal chromosome 15q11.2-q13 genes. Individuals with PWS exhibit unique physical, endocrine, and metabolic traits associated with severe obesity. Identifying liver steatosis in PWS is challenging, despite its lower prevalence compared to non-syndromic obesity. Reliable biomarkers are crucial for the early detection and management of this condition associated with the complex metabolic profile and cardiovascular risks in PWS. Methods Circulating proteome profiling was conducted in 29 individuals with PWS (15 with steatosis, 14 without) using the Olink Target 96 metabolism and cardiometabolic panels. Correlation analysis was performed to identify the association between protein biomarkes and clinical variables, while the gene enrichment analysis was conducted to identify pathways linked to deregulated proteins. Receiver operating characteristic (ROC) curves assessed the discriminatory power of circulating protein while a logistic regression model evaluated the potential of a combination of protein biomarkers. Results CDH2, CTSO, QDPR, CANT1, ALDH1A1, TYMP, ADGRE, KYAT1, MCFD, SEMA3F, THOP1, TXND5, SSC4D, FBP1, and CES1 exhibited a significant differential expression in liver steatosis, with a progressive increase from grade 1 to grade 3. FBP1, CES1, and QDPR showed predominant liver expression. The logistic regression model, -34.19 + 0.85 * QDPR*QDPR + 0.75 * CANT1*TYMP - 0.46 * THOP1*ALDH1A, achieved an AUC of 0.93 (95% CI: 0.63-0.99), with a sensitivity of 93% and specificity of 80% for detecting steatosis in individuals with PWS. These biomarkers showed strong correlations among themselves and were involved in an interconnected network of 62 nodes, related to seven metabolic pathways. They were also significantly associated with cholesterol, LDL, triglycerides, transaminases, HbA1c, FLI, APRI, and HOMA, and showed a negative correlation with HDL levels. Conclusion The biomarkers identified in this study offer the potential for improved patient stratification and personalized therapeutic protocols.
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Affiliation(s)
- Devis Pascut
- Liver Cancer Unit, Fondazione Italiana Fegato - ONLUS, Trieste, Italy
| | - Pablo J. Giraudi
- Metabolic Liver Disease Unit, Fondazione Italiana Fegato - ONLUS, Trieste, Italy
| | - Cristina Banfi
- Unit of Functional Proteomics, Metabolomics, and Network analysis, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Stefania Ghilardi
- Unit of Functional Proteomics, Metabolomics, and Network analysis, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Claudio Tiribelli
- Liver Cancer Unit, Fondazione Italiana Fegato - ONLUS, Trieste, Italy
- Metabolic Liver Disease Unit, Fondazione Italiana Fegato - ONLUS, Trieste, Italy
| | - Adele Bondesan
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-endocrinological Research, Piancavallo-Verbania, Italy
| | - Diana Caroli
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-endocrinological Research, Piancavallo-Verbania, Italy
| | - Alessandro Minocci
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Division of Metabolic Diseases, Piancavallo-Verbania, Italy
| | - Graziano Grugni
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-endocrinological Research, Piancavallo-Verbania, Italy
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Division of Auxology, Piancavallo-Verbania, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-endocrinological Research, Piancavallo-Verbania, Italy
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Chen CP, Wang LK, Wu FT, Pan YT, Wu PS, Chen WL, Lee MS, Wang W. High-level mosaic trisomy 21 at amniocentesis in a pregnancy associated with positive NIPT for trisomy 21, prenatal progressive decrease of the trisomy 21 cell line, acute fatty liver of pregnancy and intrauterine fetal death in late gestation. Taiwan J Obstet Gynecol 2023; 62:896-900. [PMID: 38008511 DOI: 10.1016/j.tjog.2023.09.003] [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] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE We present high-level mosaic trisomy 21 at amniocentesis in a pregnancy associated with positive non-invasive prenatal testing (NIPT) for trisomy 21, prenatal progressive decrease of the trisomy 21 cell line, acute fatty liver of pregnancy and intrauterine fetal death (IUFD) in late gestation. CASE REPORT A 32-year-old, primigravid woman underwent amniocentesis at 17 weeks of gestation because of positive NIPT for trisomy 21 at 12 weeks of gestation. This pregnancy was conceived by in vitro fertilization. She did not have obesity, diabetes mellitus, hepatic biliary disorders and preeclampsia. Amniocentesis revealed a karyotype of 47,XY,+21[10]/46,XY[11], and array comparative genomic hybridization (aCGH) analysis on uncultured amniocytes revealed the result of arr (21) × 2-3. She was referred for genetic counseling, and repeat amniocentesis performed at 21 weeks of gestation revealed the karyotype of 47,XY,+21[10]/46,XY[28]. The parental karyotypes and fetal ultrasound findings were normal. Simultaneous molecular analysis on uncultured amniocytes showed no uniparental disomy 21, but a maternal origin of trisomy 21 by quantitative fluorescent polymerase chain reaction (QF-PCR) and the result of arr 21q11.2q22.3 × 2.5 by aCGH analysis. At 27 weeks of gestation, she underwent a third amniocentesis, of which conventional cytogenetic analysis revealed the result of 47,XY,+21[5]/46,XY[17] in cultured amniocytes, and aCGH analysis revealed arr 21q11.2q22.3 × 2.48, and interphase fluorescence in situ hybridization (FISH) analysis revealed 39% (39/100 cells) mosaicism fro trisomy 21 in uncultured amniocytes. At 36 weeks of gestation, the woman suffered from a sudden onset of acute fatty liver and IUFD. A 3522-g male baby was delivered without Down syndrome phenotype. The umbilical cord had a karyotype of 47,XY,+21[10]/46,XY[30]. aCGH analysis on the skin and placenta showed arr 21q11.2q22.3 × 2.73 and arr 21q11.2q22.3 × 2.75, respectively. QF-PCR analysis of umbilical cord, placenta and skin showed a maternal origin of trisomy 21. CONCLUSION High-level mosaic trisomy 21 at amniocentesis can be associated with prenatal progressive decrease of the trisomy 21 cell line in cultured amniocytes and perinatal fetal mortality and maternal morbidity.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Liang-Kai Wang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Tzu Wu
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yen-Ting Pan
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | | | - Wen-Lin Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Meng-Shan Lee
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wayseen Wang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
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Giannini EG, Borgonovo G, Marenco S, Cesaretti M. Letter to the Editor: Objective evaluation of liver steatosis in donor organs-Potential usefulness of noninvasive assessment. Liver Transpl 2023; 29:E42-E43. [PMID: 37325924 DOI: 10.1097/lvt.0000000000000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giacomo Borgonovo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgery, University of Genoa, Genoa, Italy
| | - Simona Marenco
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Manuela Cesaretti
- HPB and Liver Transplantation Department, ARNAS Brotzu, Cagliari, Italy
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Yip TCF, Fan JG, Wong VWS. China's Fatty Liver Crisis: A Looming Public Health Emergency. Gastroenterology 2023; 165:825-827. [PMID: 37343791 DOI: 10.1053/j.gastro.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Terry Cheuk-Fung Yip
- Medical Data Analytics Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China.
| | - Vincent Wai-Sun Wong
- Medical Data Analytics Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
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37
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Adams LA, Schulte PJ, Allen AM. Use of noninvasive scores to predict hepatic steatosis: Flaws and caveats. Hepatology 2023; 78:1029-1031. [PMID: 37185880 DOI: 10.1097/hep.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Leon A Adams
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Phillip J Schulte
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Alina M Allen
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation(s)
- Marilena Durazzo
- Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Arianna Ferro
- Department of Medical Sciences, University of Turin, Turin, Italy
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Masi D, Gangitano E, Criniti A, Ballesio L, Anzuini A, Marino L, Gnessi L, Angeloni A, Gandini O, Lubrano C. Obesity-Associated Hepatic Steatosis, Somatotropic Axis Impairment, and Ferritin Levels Are Strong Predictors of COVID-19 Severity. Viruses 2023; 15:v15020488. [PMID: 36851702 PMCID: PMC9968194 DOI: 10.3390/v15020488] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
The full spectrum of SARS-CoV-2-infected patients has not yet been defined. This study aimed to evaluate which parameters derived from CT, inflammatory, and hormonal markers could explain the clinical variability of COVID-19. We performed a retrospective study including SARS-CoV-2-infected patients hospitalized from March 2020 to May 2021 at the Umberto I Polyclinic of Rome. Patients were divided into four groups according to the degree of respiratory failure. Routine laboratory examinations, BMI, liver steatosis indices, liver CT attenuation, ferritin, and IGF-1 serum levels were assessed and correlated with severity. Analysis of variance between groups showed that patients with worse prognoses had higher BMI and ferritin levels, but lower liver density, albumin, GH, and IGF-1. ROC analysis confirmed the prognostic accuracy of IGF-1 in discriminating between patients who experienced death/severe respiratory failure and those who did not (AUC 0.688, CI: 0.587 to 0.789, p < 0.001). A multivariate analysis considering the degrees of severity of the disease as the dependent variable and ferritin, liver density, and the standard deviation score of IGF-1 as regressors showed that all three parameters were significant predictors. Ferritin, IGF-1, and liver steatosis account for the increased risk of poor prognosis in COVID-19 patients with obesity.
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Affiliation(s)
- Davide Masi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Elena Gangitano
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Criniti
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Laura Ballesio
- Department of Radiology, Anatomo–Pathology and Oncology, Sapienza University of Rome, 00185 Rome, Italy
| | - Antonella Anzuini
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Luca Marino
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00185 Rome, Italy
- Emergency Medicine Unit, Department of Emergency-Acceptance, Critical Areas and Trauma, Policlinico “Umberto I”, 00161 Rome, Italy
| | - Lucio Gnessi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonio Angeloni
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
- Emergency Medicine Unit, Department of Emergency-Acceptance, Critical Areas and Trauma, Policlinico “Umberto I”, 00161 Rome, Italy
| | - Orietta Gandini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Carla Lubrano
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence:
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Cholongitas E, Chrysavgis L. Noninvasive diagnosis of hepatic steatosis in patients with severe obesity: a clinically challenging issue. Pol Arch Intern Med 2023; 133:16415. [PMID: 36692042 DOI: 10.20452/pamw.16415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Evangelos Cholongitas
- First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens Laiko, Athens, Greece.
| | - Lampros Chrysavgis
- First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens Laiko, Athens, Greece
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Lu X, Song M, Gao N. Extracellular Vesicles and Fatty Liver. Adv Exp Med Biol 2023; 1418:129-141. [PMID: 37603277 DOI: 10.1007/978-981-99-1443-2_9] [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] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Fatty liver is a complex pathological process caused by multiple etiologies. In recent years, the incidence of fatty liver has been increasing year by year, and it has developed into a common chronic disease that seriously affects people's health around the world. It is an important risk factor for liver cirrhosis, liver cancer, and a variety of extrahepatic chronic diseases. Therefore, the early diagnosis and early therapy of fatty liver are important. Except for invasive liver biopsy, there is still a lack of reliable diagnosis and staging methods. Extracellular vesicles are small double-layer lipid membrane vesicles derived from most types of cells. They play an important role in intercellular communication and participate in the occurrence and development of many diseases. Since extracellular vesicles can carry a variety of biologically active substances after they are released by cells, they have received widespread attention. The occurrence and development of fatty liver are also closely related to extracellular vesicles. In addition, extracellular vesicles are expected to provide a new direction for the diagnosis of fatty liver. This article reviews the relationship between extracellular vesicles and fatty liver, laying a theoretical foundation for the development of new strategies for the diagnosis and therapy of fatty liver.
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Affiliation(s)
- Xiya Lu
- Department of Endoscopy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Meiyi Song
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Na Gao
- Department of Endoscopy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
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Janati-Idrissi Y, Slama L, Taheri H, Saadi H, Mimouni A. [Recurrent acute fatty liver of pregnancy: About a case and a review of the literature]. Gynecol Obstet Fertil Senol 2022; 50:620-623. [PMID: 35489651 DOI: 10.1016/j.gofs.2022.04.002] [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] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
Acute fatty liver of pregnancy (AFLP) is a specific but rare hepatopathy that can usually complicate the third trimester of pregnancy. It is potentially fatal for the mother and the fetus. To our knowledge, only eight cases of recurrence have been published, we report a new case. The first episode presented by our 23-year-old patient was suspected in front of a cutaneous-mucosal jaundice with vomiting occurring on pregnancy of 35weeks of gestation (WG). Hyperleucytosis, abnormalities of the hepatic balance, as well as a hypoglycemia were biological elements supporting the diagnostic beam. On the other hand, medical imaging could not bring a clear confirmation. The evolution was favorable after deferred delivery by caesarean section for pulmonary maturation. Three years later, she presented to the obstetrical emergency room at 36weeks and six days of gestation, with a clinical and biological picture almost similar to that of the first episode. A caesarean section was then indicated for suspicion of recurrence. The evolution is favorable for the mother and her children. The interest of the communication on the risk of recurrence, the clinical and biological monitoring in particular in the third trimester of the subsequent pregnancy are imperative, in order to improve the prognosis of this pathology.
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Affiliation(s)
- Y Janati-Idrissi
- CHU Mohammed VI, service de gynécologie-obstétrique, Oujda, Maroc.
| | - L Slama
- CHU Mohammed VI, service de gynécologie-obstétrique, Oujda, Maroc
| | - H Taheri
- CHU Mohammed VI, service de gynécologie-obstétrique, Oujda, Maroc
| | - H Saadi
- CHU Mohammed VI, service de gynécologie-obstétrique, Oujda, Maroc
| | - A Mimouni
- CHU Mohammed VI, service de gynécologie-obstétrique, Oujda, Maroc
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Lim J, Han S, Lee D, Shim JH, Kim K, Lim Y, Lee HC, Jung D, Lee S, Kim K, Choi J. Identification of hepatic steatosis in living liver donors by machine learning models. Hepatol Commun 2022; 6:1689-1698. [PMID: 35377548 PMCID: PMC9234640 DOI: 10.1002/hep4.1921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/20/2021] [Accepted: 01/18/2022] [Indexed: 01/16/2023] Open
Abstract
Selecting an optimal donor for living donor liver transplantation is crucial for the safety of both the donor and recipient, and hepatic steatosis is an important consideration. We aimed to build a prediction model with noninvasive variables to evaluate macrovesicular steatosis in potential donors by using various prediction models. The study population comprised potential living donors who had undergone donation workup, including percutaneous liver biopsy, in the Republic of Korea between 2016 and 2019. Meaningful macrovesicular hepatic steatosis was defined as >5%. Whole data were divided into training (70.5%) and test (29.5%) data sets based on the date of liver biopsy. Random forest, support vector machine, regularized discriminant analysis, mixture discriminant analysis, flexible discriminant analysis, and deep neural network machine learning methods as well as traditional logistic regression were employed. The mean patient age was 31.4 years, and 66.3% of the patients were men. Of the 1652 patients, 518 (31.4%) had >5% macrovesicular steatosis on the liver biopsy specimen. The logistic model had the best prediction power and prediction performances with an accuracy of 80.0% and 80.9% in the training and test data sets, respectively. A cut-off value of 31.1% for the predicted risk of hepatic steatosis was selected with a sensitivity of 77.7% and specificity of 81.0%. We have provided our model on the website (https://hanseungbong.shinyapps.io/shiny_app_up/) under the name DONATION Model. Our algorithm to predict macrovesicular steatosis using routine parameters is beneficial for identifying optimal potential living donors by avoiding superfluous liver biopsy results.
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Affiliation(s)
- Jihye Lim
- Department of GastroenterologyAsan Liver CenterAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Seungbong Han
- Department of BiostatisticsKorea University College of MedicineSeoulRepublic of Korea
| | - Danbi Lee
- Department of GastroenterologyAsan Liver CenterAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Ju Hyun Shim
- Department of GastroenterologyAsan Liver CenterAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Kang Mo Kim
- Department of GastroenterologyAsan Liver CenterAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Young‐Suk Lim
- Department of GastroenterologyAsan Liver CenterAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Han Chu Lee
- Department of GastroenterologyAsan Liver CenterAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Dong Hwan Jung
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Sung‐Gyu Lee
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Ki‐Hun Kim
- Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Jonggi Choi
- Department of GastroenterologyAsan Liver CenterAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
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BhatB NM. Serum IgA levels and IgA/IgG ratio in Alcoholic Liver Disease. J Assoc Physicians India 2022; 70:11-12. [PMID: 35443491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED The patient's history is inaccurate and unreliable in diagnosis of ALD. None of laboratory test gives an unequivocal indication of Alcohol Abuse. GGT indicates Alcohol Abuse only in background of normal LFT. After the onset of liver disease due to any etiology, GGT rise parallel to ALP. Although, AST/ALT>2 is useful marker for ALD, its valid only in Steatohepatitis. The ratio may be normal in Cirrhosis. Although serum carbohydrate deficit transferrin is most specific biomarker for ALD, its an acute phase reactant, its valid only in Steatohepatitis, not in Cirrhosis. The main metabolite of ethanol is acetaldehyde which accumulates in alcoholics. Acetaldehyde binds exposed proteins which trigger immunoglobulin production.The antibodies directed against acetaldehyde adducts are predominantly IgA type. MATERIAL All subjects admitted to hospital with ALD with cirrhotic dose consumption were studied. The stage of ALD was decided based on serum albumin, Ultrasound abdomen and Fibroscan. Those seronegative for Viral Hepatitis were included in the study. Serum IgA, Serum IgA/IgG ratio, serum AST/ALT ratio, serum GGT and MCV were computed and correlated using Pearson's Chi-square test and ANOVA test. OBSERVATION A total of 55 patients were studied. Mean age was 44 years with male preponderance of 91%. 24% were in steatosis,32% were in steatohepatitis, while 44% were in cirrhosis. Normal serum IgA upto 300 mg/dl. In this study, mean IgA in steatosis - 701 mg/dl, in steatohepatitis 1180mg/dl and cirrhosis- 1181 mg/dl. Normal serum IgA/ IgG ratio upto 0.2. In this study, this ratio in steatosis -0.3, steatohepatitis -0.5, cirrhosis- 0.6. There was significant correlation between IgA levels with advancing stages of ALD and amount of alcohol consumed. Since majority of subjects were cirrhotics where AST and ALT were normal, there was no association between AST/ALT ratio and IgA/IgG ratio. There was significant correlation between serum GGT and IgA/IgG ratio since majority were active alcoholics. Serum IgA>1200 mg/dl and IgA/IgG >0.5 correlated with onset of Hepatorenal Syndrome. CONCLUSION The present study shows that IgA concentration increases in all stages of ALD, while AST/ ALT ratio increase only in Steatosis/Hepatitis. Although Hypergammaglobulinemia is known to occur in CLD, the fraction of immunoglobulin elevated indicates etiology of Liver Disease. IgA is elevated fraction in ALD. Its level can be used to decide the stage of ALD and prognosis.
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Affiliation(s)
- Nagaraj M BhatB
- Mysore Medical College and Research Institute, Irwin Road, Bantwal, Mysore
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Hao WJ, Zou LY. [Clinical analysis of 34 cases of acute fatty liver of pregnancy]. Zhonghua Fu Chan Ke Za Zhi 2022; 57:172-178. [PMID: 35385954 DOI: 10.3760/cma.j.cn112141-20210914-00518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To analyze the characteristics, diagnosis and prognosis of acute fatty liver of pregnancy (AFLP), and to guide the management of AFLP patients. Methods: The clinical data of 34 AFLP patients admitted to Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2009 to December 2019 were retrospectively analyzed. The general situation, diagnostic characteristics, treatment and maternal and neonatal prognosis of the AFLP patients were collected and analyzed. Results: The incidence of AFLP in our hospital was 0.022% (34/152 383). The age of onset was (30.6±4.9) years old, and the gestational age was (35.3±2.4) weeks. Most of the first symptom was gastrointestinal symptoms of unknown cause in the third trimester of pregnancy (53%, 18/34), accompanied by different degrees of elevated liver enzymes. Cesarean section was performed in 97% (33/34) of patients for termination of pregnancy. Only one pregnant woman was diagnosed prenatal and delivered vaginally, and the prognosis of both mother and infant was good. Five cases were transferred to intensive care unit, including 2 cases of acute renal failure, 1 case of gastrointestinal bleeding and 2 cases of disseminated intravascular coagulation. There was no maternal death. Severe asphyxia occurred in 2 neonates. Conclusions: Attention should be paid to the digestive tract symptoms during the third trimester of pregnancy and the diversity of clinical manifestations of AFLP for early detection. Once AFLP is diagnosed, pregnancy should be terminated as soon as possible to improve maternal and infant outcomes.
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Affiliation(s)
- W J Hao
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - L Y Zou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
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Cao W, Chen T, Jiang W, Geng Y, Xie B, Wang Q, Wang X. Timely identification and successful treatment of acute fatty liver of pregnancy without obvious clinical symptoms: Case reports. Medicine (Baltimore) 2022; 101:e28723. [PMID: 35119019 PMCID: PMC8812678 DOI: 10.1097/md.0000000000028723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/27/2021] [Accepted: 01/11/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Acute fatty liver of pregnancy (AFLP) is a rare and potentially fatal complication that occurs in the third trimester or early postpartum period. The diagnosis of AFLP is based on typical clinical and laboratory features and imaging examinations. PATIENT CONCERNS Case 1: a 25-year-old pregnant woman was hospitalized for threatened preterm birth at gestation of 35weeks and 2 days gestation. Laboratory tests revealed liver dysfunction, coagulopathy, hypoglycemia, hypoproteinemia, leukocytosis, and elevated creatinine and uric acid levels. Case 2: a 28-year-old (nulliparous) became pregnant after in vitro fertilization-embryo transfer at 29 weeks and 1 days' gestation and came to the obstetric ward for vaginal bleeding. At 34 weeks and 1 day, laboratory investigations showed high serum creatinine, uric acid, liver dysfunction, coagulopathy, and hypoglycemia. DIAGNOSES Two patients did not show obvious clinical symptoms, while the ultrasound findings confirmed a diagnosis of AFLP. INTERVENTIONS Immediate delivery and comprehensive supportive treatment are the most important methods for the treatment of AFLP. OUTCOMES The 2 patients and their babies were discharged from the hospital in a good condition. LESSONS Special attention should be paid to mothers with AFLP after in vitro fertilization-embryo transfer. The clinical presentation of AFLP is variable, hence laboratory features and ultrasound examination may be important methods for screening for AFLP.
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Affiliation(s)
- Weiping Cao
- Departments of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu, PR China
| | - Tingmei Chen
- Departments of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu, PR China
| | - Wen Jiang
- Department of Nursing, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, PR China
| | - Yinping Geng
- Department of Ultrasound, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu, PR China
| | - Bing Xie
- Departments of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu, PR China
| | - Qin Wang
- Departments of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu, PR China
| | - Xinzhi Wang
- New drug screening center, Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, PR China
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Lampignano L, Donghia R, Sila A, Bortone I, Tatoli R, De Nucci S, Castellana F, Zupo R, Tirelli S, Giannoccaro V, Guerra V, Panza F, Lozupone M, Mastronardi M, De Pergola G, Giannelli G, Sardone R. Mediterranean Diet and Fatty Liver Risk in a Population of Overweight Older Italians: A Propensity Score-Matched Case-Cohort Study. Nutrients 2022; 14:nu14020258. [PMID: 35057439 PMCID: PMC8779579 DOI: 10.3390/nu14020258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 12/21/2022] Open
Abstract
Hepatic steatosis, often known as fatty liver, is the most common hepatic disease in Western countries. The latest guidelines for the treatment of nonalcoholic fatty liver disease emphasize lifestyle measures, such as changing unhealthy eating patterns. Using a propensity score-matching approach, this study investigated the effect of adhering to a Mediterranean diet (MedDiet) on fatty liver risk in an older population (≥65 years) from Southern Italy. We recruited 1.403 subjects (53.6% men, ≥65 years) who completed a food frequency questionnaire (FFQ) and underwent clinical assessment between 2015 and 2018. For the assessment of the liver fat content, we applied the Fatty Liver Index (FLI). To evaluate the treatment effect of the MedDiet, propensity score matching was performed on patients with and without FLI > 60. After propensity score-matching with the MedDiet pattern as treatment, we found a higher consumption of red meat (p = 0.04) and wine (p = 0.04) in subjects with FLI > 60. Based on the FLI, the inverse association shown between adherence to the MedDiet and the risk of hepatic steatosis shows that the MedDiet can help to prevent hepatic steatosis. Consuming less red and processed meat, as well as alcoholic beverages, may be part of these healthy lifestyle recommendations.
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Affiliation(s)
- Luisa Lampignano
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
| | - Rossella Donghia
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
| | - Annamaria Sila
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
| | - Ilaria Bortone
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
| | - Rossella Tatoli
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
| | - Sara De Nucci
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
| | - Fabio Castellana
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
| | - Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
| | - Sarah Tirelli
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
| | | | - Vito Guerra
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
| | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 11, 70125 Bari, Italy; (F.P.); (M.L.)
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 11, 70125 Bari, Italy; (F.P.); (M.L.)
| | - Mauro Mastronardi
- Inflammatory Bowel Disease Unit, National Institute of Gastroenterology, “Saverio De Bellis” Research Hospital, 70013 Bari, Italy;
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy;
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology, “Saverio De Bellis” Research Hospital, 70013 Bari, Italy;
| | - Rodolfo Sardone
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Bari, Italy; (L.L.); (R.D.); (A.S.); (I.B.); (R.T.); (S.D.N.); (F.C.); (R.Z.); (S.T.); (V.G.)
- Correspondence:
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Shaked O, Demetris J, Levitsky J, Feng S, Loza BL, Punch J, Reyes J, Klintmalm G, Jackson W, DesMarais M, Sayre P, Shaked A, Reddy KR. Impact of Donor and Recipient Clinical Characteristics and Hepatic Histology on Steatosis/Fibrosis Following Liver Transplantation. Transplantation 2022; 106:106-116. [PMID: 33982909 PMCID: PMC8349377 DOI: 10.1097/tp.0000000000003681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Deceased donor and recipient predictors of posttransplant steatosis/steatohepatitis and fibrosis are not well known. Our aim was to evaluate the prevalence and assess donor and recipient predictors of steatosis, steatohepatitis, and fibrosis in liver transplantation recipients. METHODS Using the immune tolerance network A-WISH multicenter study (NCT00135694), donor and recipient demographic and clinical features were collected. Liver biopsies were taken from the donor liver at transplant, and from recipients per protocol and for-cause (ie, abnormal transaminases and to rule out rejection) and were interpreted by a central pathologist. RESULTS One hundred eighty-three paired donor/recipients liver biopsies at the time of transplant and posttransplant follow-up (median time 582 d; average time to last biopsies was 704 d [SD ± 402 d]) were analyzed. Donor steatosis did not influence recipient steatosis or fibrosis. Ten of 183 recipients had steatohepatitis on the last biopsy. Recipient body mass index at the time of liver biopsy was the most influential factor associated with posttransplant steatosis. Both donor and recipient metabolic syndrome features were not associated with graft steatosis. Untreated hepatitis C viral (HCV) infection was the most influential factor associated with the development of allograft fibrosis. CONCLUSIONS In a large experience evaluating paired donor and recipient characteristics, recipient body mass index at the time of liver biopsy was most significantly associated with posttransplant steatosis. Untreated HCV etiology influenced graft fibrosis. Thus relative to untreated HCV, hepatic fibrosis in those with steatosis/steatohepatitis is less common though long-term follow-up is needed to determine the course of posttransplant fibrosis. Emphasis on recipient weight control is essential.
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Affiliation(s)
- Oren Shaked
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jack Demetris
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Josh Levitsky
- Division of Hepatology and Comprehensive Transplant Center, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Sandy Feng
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Bao-Li Loza
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeff Punch
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jorge Reyes
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Goran Klintmalm
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Whitney Jackson
- Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO, USA
| | | | - Peter Sayre
- Immune Tolerance Network, San Francisco, CA, USA
| | - Abraham Shaked
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - K. Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
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Nah EH, Cho S, Park H, Noh D, Kwon E, Cho HI. Subclinical steatohepatitis and advanced liver fibrosis in health examinees with nonalcoholic fatty liver disease (NAFLD) in 10 South Korean cities: A retrospective cross-sectional study. PLoS One 2021; 16:e0260477. [PMID: 34818372 PMCID: PMC8612540 DOI: 10.1371/journal.pone.0260477] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
Background Nonalcoholic steatohepatitis (NASH) has a risk of progressing to cirrhosis. The prevalence of NASH and its associated risk factors in community populations are relatively unknown. This study aimed to determine the prevalence of NASH and advanced liver fibrosis using magnetic resonance elastography (MRE), and determine those risk factors in health examinees with asymptomatic fatty liver. Methods This study consecutively selected subjects who underwent health checkups at 13 health-promotion centers in 10 Korean cities between 2018 and 2020. Hepatic steatosis and stiffness were assessed using ultrasonography and MRE, respectively. Stages of liver stiffness were estimated using MRE with cutoff values for NASH and advanced liver fibrosis of 2.91 and 3.60 kPa, respectively. Results The overall prevalence of NASH and advanced liver fibrosis in the subjects with fatty liver were 8.35% and 2.04%, respectively. Multivariate logistic regression analysis indicated that central obesity (OR = 5.12, 95% CI = 2.70–9.71), increased triglyceride (OR = 3.29, 95% CI = 1.72–6.29), abnormal liver function test (OR = 3.09, 95% CI = 1.66–5.76) (all P<0.001), and decreased high-density lipoprotein cholesterol (OR = 5.18, 95% CI = 1.78–15.05) (P = 0.003) were associated with NASH. The main risk factor for advanced liver fibrosis was diabetes (OR = 4.46, 95% CI = 1.14–17.48) (P = 0.032). Conclusion NASH or advanced liver fibrosis is found in one-tenth of health examinees with asymptomatic fatty liver. This suggests that early detection of NASH should be considered to allow early interventions such as lifestyle changes to prevent the adverse effects of NASH and its progression in health examinees with asymptomatic fatty liver.
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Affiliation(s)
- Eun-Hee Nah
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Seon Cho
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Hyeran Park
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Dongwon Noh
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Eunjoo Kwon
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Han-Ik Cho
- MEDIcheck LAB, Korea Association of Health Promotion, Seoul, Korea
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50
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Furuhashi M, Muranaka A, Yuda S, Tanaka M, Koyama M, Kawamukai-Nishida M, Takahashi S, Higashiura Y, Miyamori D, Nishikawa R, Ohnishi H, Saitoh S, Shimamoto K, Miura T. Independent Association of Fatty Liver Index With Left Ventricular Diastolic Dysfunction in Subjects Without Medication. Am J Cardiol 2021; 158:139-146. [PMID: 34474907 DOI: 10.1016/j.amjcard.2021.07.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 12/29/2022]
Abstract
Nonalcoholic fatty liver disease has been reported to be potentially linked to cardiovascular disease. Fatty liver index (FLI) is a noninvasive and simple predictor of nonalcoholic fatty liver disease. However, little is known about the relationship between FLI and cardiac function, especially in a general population. We investigated the relationships of FLI with echocardiographic parameters in 185 subjects (men/women: 79/106) of the Tanno-Sobetsu Study, a population-based cohort, who were not being treated with any medication and who underwent echocardiography. FLI was negatively correlated with high-density lipoprotein cholesterol and peak myocardial velocity during early diastole (e'; r = -0.342, p <0.001), an index of left ventricular (LV) diastolic function, and ratio of peak mitral velocities during early and late diastole (E/A) and was positively correlated with age, systolic and diastolic blood pressures, creatinine, uric acid, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein, ratio of mitral to myocardial early diastolic peak velocity (E/e'), left atrial volume index and LV mass index. No significant correlation was found between FLI and LV ejection fraction. Stepwise multivariable regression analysis showed that FLI was independently and negatively associated with e' after adjustment of age, gender, high-density lipoprotein cholesterol, homeostasis model assessment of insulin resistance, and high-sensitivity C-reactive protein. Conversely, e' was independently and negatively associated with FLI after adjustment of age, gender, systolic blood pressure, and LV ejection fraction. In conclusion, elevated FLI is independently associated with LV diastolic dysfunction in a general population without medication. FLI would be a novel marker of LV diastolic dysfunction as an early sign of myocardial injury.
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Affiliation(s)
- Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Yuda
- Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Marenao Tanaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mina Kawamukai-Nishida
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoko Takahashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yukimura Higashiura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Daisuke Miyamori
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shigeyuki Saitoh
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Nursing, Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Sciences, Sapporo, Japan
| | | | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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