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Said E, Abdel-Gawad M, Abdelsameea E, Elshemy EE, Abdeen N, Elbasiony M, Omran D, Elesnawy Y, Eid A, Lashen SA, Elbahr O, Naguib GG, Afify S, Bahbah EI, Alboraie M. Vibration Controlled Transient Elastography in Screening for Silent Liver Diseases. Eur J Gastroenterol Hepatol 2023; 35:1204-1210. [PMID: 37577784 DOI: 10.1097/meg.0000000000002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
OBJECTIVES The objective of this study was to screen for significant hepatic fibrosis or steatosis in asymptomatic, apparently healthy subjects by using Vibration-controlled transient elastography and controlled attenuation parameter (CAP). METHODS Prospectively, 433 asymptomatic apparently healthy adults were included. Fibroscan/CAP examination was performed for all of them. Subjects with liver stiffness measurement > 6 kPa or CAP >248 dB/m were further evaluated to assess underlying chronic liver disease. RESULTS According to fibroscan/CAP examination, subjects were classified into four subgroups: normal (119) with CAP score of 215.85 ± 24.81 dB/m and fibrosis score of 4.47 ± 0.81 kPa, subjects with steatosis only 133 with CAP score of 309.41 ± 42.6 dB/m and fibrosis score of 4.74 ± 0.82 kPa, subjects with both steatosis and fibrosis 95 with CAP score of 318.20 ± 39.89 dB/m and fibrosis score of 7.92 ± 2.58 kPaand subjects with fibrosis only 86 with CAP score of 213.48 ± 22.62 dB/m and fibrosis score of 6.96 ± 1.11 kPa. S0 was present in 205 (47.3%), S1 in 48 (10.2%), S2 in 16 (3.7%) and S3 in 168 (38.8%) of studied subjects, whereas F0-1 was present in 371 (85.7%), F2 in 44 (10.16%), F3 in 16 (3.7%) subjects and F4 in only one (0.23%) subject. Subjects with both steatosis and fibrosis showed significantly higher transaminases, triglycerides and total cholesterol levels than other subgroups. CONCLUSIONS Most asymptomatic, apparently healthy subjects (72%) have significant steatosis and fibrosis. Liver stiffness measurement and CAP might represent promising first-line noninvasive procedures to screen for silent liver diseases in the general population.
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Affiliation(s)
- Ebada Said
- Hepatology, Gastroenterology and Infectious Diseases Department, Benha Faculty of Medicine, Benha University, Banha
| | - Muhammad Abdel-Gawad
- Hepatology, Gastroenterology, and Infectious Diseases Department, Al-Azhar University, Assiut
| | - Eman Abdelsameea
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El-Kom
| | - Eman Elsayed Elshemy
- Hepatology gastroenterology and Infectious Diseases Department, Al-Azhar University, Cairo
| | - Nermeen Abdeen
- Tropical Medicine Department, Faculty of Medicine, Alexandria University, Alexandria
| | - Mohamed Elbasiony
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura
| | - Dalia Omran
- Department of Endemic Medicine and Hepatogastroenterology, Kasralainy School of Medicine, Cairo University, Cario
| | | | - Alshaimaa Eid
- Hepatology gastroenterology and Infectious Diseases Department, Al-Azhar University, Cairo
| | - Sameh A Lashen
- Department of Internal Medicine (Hepatology and Gastroenterology division), Faculty of Medicine, Alexandria University, Alexandria
| | - Osama Elbahr
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El-Kom
| | | | - Shimaa Afify
- Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo
| | | | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
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Braun A, Mühlberg R, Fischer M, Haas NA, Meyer Z. Liver stiffness in Fontan patients: the effect of respiration and food intake. Front Med (Lausanne) 2023; 10:1192017. [PMID: 37746087 PMCID: PMC10512863 DOI: 10.3389/fmed.2023.1192017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives For several years, patients with single ventricle hearts have been palliated according to the Fontan principle. One well known long-term consequence in these patients is the Fontan-associated liver disease and fibrosis, which occurs due to the chronically increased Central Venous Pressure (CVP) after Fontan palliation. It carries an increased risk of liver cirrhosis and hepatocellular carcinoma over time. Liver elastography (LE) is a non-invasive, safe, and feasible ultrasound method to determine liver stiffness and the stage of liver fibrosis. Usually, this examination must be performed in a sober condition and strict inspiratory hold to optimize the results and may therefore be difficult to perform on children as a routine examination. However, the influence of food intake and respiration on these results in Fontan patients is unclear. To optimize the implementation for this examination especially in children, the effects of food intake and breathing maneuvers on liver stiffness in patients with Fontan circulation were investigated. Methods For this prospective study, 25 Fontan patients (group 1) and 50 healthy volunteers (group 2) were examined. The two groups were additionally divided into two age categories (group 1a: 10-19 years; group 1b: 20-29 years; group 2a: 15-19 years; group 2b: 20-25 years). Liver stiffness was measured by liver elastography once before food intake (=T0, with 6 h of fasting). Subsequently the participants consumed a standardized chocolate drink (500 mL) with nutritional distribution corresponding to a standardized meal (600 kcal). Liver stiffness was then determined 15, 30, 45, 60, 90, 120, 150, and 180 min after ingestion. Each measurement of liver stiffness was performed during maximal inspiratory and expiratory holds. The study was reviewed and approved by the responsible ethics committee. Results In group 2 there was a significant increase in liver stiffness after food intake at T15, T30, and T45 during inspiration measurements (T0 = 4.0 kPa vs. T15 = 4.9 kPa, difference = 22.5%; T0 = 4.0 kPa vs. T30 = 4.9 kPa difference = 22.5%; T0 = 4.0 kPa vs. T45 = 4.3 kPa difference = 7.5%), as well as during expiration at T15 and T30 (T0 = 4.5 kPa vs. T15 = 5.1 kPa, difference = 14.7%; T0 = 4.5 kPa vs. T30 = 4.9 kPa difference = 7.8%). Whereas in Fontan patients (group 1) liver stiffness did not differ significantly at any time between fasting (T0) and postprandial values. The respiratory maneuvers in the healthy subjects (group 2) differed significantly only before food intake (T0) (group 2: insp = 3.97 kPa vs. exp. = 4.48 kPa difference = 11.3%). In the Fontan group (group 1), there was no significant difference between the respiratory phases at any point. The different age categories showed no significant difference in liver stiffness. Conclusion With these results we could demonstrate for the first time that in Fontan patients the time of food intake (i.e., fasting) has no clinical significance for the values obtained in liver elastography. We could also demonstrate that the breathing maneuvers during the examination had only minimal clinical impact on the results of liver elastography in patients with normal circulation and no effect in patients with Fontan-circulation. Consequently, liver elastography for Fontan patients is reliable independently of food intake and breathing maneuvers and can also be performed on younger patients, who are unable to follow breathing commands or longer fasting periods, without any impairment of the results. These results should encourage a routine use of LE in the follow-up of Fontan patients.
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Lee TG, Park PG, Park YB, Huh JH, Lee SW. Clinical Link between the BARD Score at Diagnosis and Mortality during Follow-Up in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. J Clin Med 2023; 12:5679. [PMID: 37685746 PMCID: PMC10488870 DOI: 10.3390/jcm12175679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
This study investigated whether the BARD score at diagnosis could predict all-cause mortality in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). This study included 236 immunosuppressive drug-naïve patients without chronic liver diseases such as viral hepatitis, non-alcoholic fatty liver disease (NAFLD), and advanced liver diseases and their clinical data at diagnosis, such as age, sex, and the Birmingham Vasculitis Activity Score (BVAS). The BARD score was calculated by the sum of aspartate transaminase (AST)/alanine transaminase (ALT) ratio ≥ 0.8 (+2 points), body mass index (BMI) ≥ 28 kg/m2 (+1 point), and the presence of type 2 diabetes mellitus (T2DM) (+1 point). All-cause mortality was investigated as a poor outcome of AAV. The median age of AAV patients was 60.0 years, and 34.7% were men. Among AAV patients, 7, 50, and 187 scored 1, 1, and 2 points owing to having a BMI ≥ 28 kg/m2, T2DM, and an AST/ALT ratio ≥ 0.8, respectively. Patients with a BARD score ≥ 2 and those with a BARD score ≥ 3 exhibited significantly lower cumulative patient survival rates than those without (p = 0.038 and p = 0.003, respectively). In the multivariable Cox analysis, among the two cut-offs of the BARD scores, only a BARD score ≥ 3 (HR 2.866), along with age (HR 1.061), male sex (HR 2.327), and BVAS (HR 1.100), was independently associated with all-cause mortality during follow-up. In conclusion, this study was the first to demonstrate that the BARD score ≥ 3 at AAV diagnosis could predict all-cause mortality during follow-up in AAV patients.
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Affiliation(s)
- Tae-Geom Lee
- Department of Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Pil-Gyu Park
- Division of Rheumatology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea;
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Ji-Hye Huh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Sharma D, Choudhary NS, Dhampalwar S, Saraf N, Duseja A, Gautam D, Soin AS, Sud R. Liver Stiffness Values in Persons with Normal Histology. J Clin Exp Hepatol 2023; 13:10-14. [PMID: 36647399 PMCID: PMC9840077 DOI: 10.1016/j.jceh.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background and aims Most studies to date have focused on liver stiffness measurement (LSM) in patients with different chronic liver diseases, and normal LSM is defined based on normal liver function tests or the absence of fibrosis. Very few studies have defined LSM based on completely normal liver biopsies. The current study was done to define the distribution of LSM values in individuals with normal liver biopsies. Methods All prospective liver donors presenting to Medanta, the Medicity hospital between September 2020 and September 2021 fulfilling the eligibility criteria were included in this study. Results A total of 63 donors (36 females and 27 males) were included in the study, 37 (58.7%) donors had normal liver biopsies, and 26 (41.2%) donors showed the presence of non-alcoholic fatty liver disease. LSM values in the normal liver histology group were 5.01 ± 1.99 kPa by the M probe and 5.34 ± 2.25 kPa by the XL probe. Even though the correlation was weak (r = 0.29, P = 0.03), M probe LSM correlated positively with body mass index. There was a good correlation between the LSM measured by the M probe and the XL probe (r = 0.73, P = <0.001). Conclusions LSM value in the biopsy-proven normal liver histology group was 5.01 ± 1.99 by the M probe and 5.34 ± 2.25 by the XL probe.
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Affiliation(s)
- Deepak Sharma
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurugram, India
| | - Narendra S. Choudhary
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, India
| | - Swapnil Dhampalwar
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, India
| | - Neeraj Saraf
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dheeraj Gautam
- Department of Pathology, Medanta The Medicity, Gurugram, India
| | - Arvinder S. Soin
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, India
| | - Randhir Sud
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurugram, India
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Jung CY, Ryu GW, Kim HW, Ahn SH, Kim SU, Kim BS. Advanced liver fibrosis measured by transient elastography predicts chronic kidney disease development in individuals with non-alcoholic fatty liver disease. Diabetologia 2022; 65:518-527. [PMID: 34932136 DOI: 10.1007/s00125-021-05627-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS Non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) are progressive chronic conditions that share important cardiometabolic risk factors and pathogenic mechanisms. We investigated the association between liver fibrosis measured by transient elastography (TE) and the risk of incident CKD in individuals with NAFLD. METHODS A total of 5983 participants with NAFLD (defined as controlled attenuation parameter >222 dB/m) but without CKD who underwent TE between March 2012 and August 2018 were selected. The primary outcome was incident CKD, defined as the occurrence of eGFR <60 ml min-1 [1.73 m]-2 or proteinuria (≥1+ on dipstick test) on two consecutive measurements during follow-up. The secondary outcome was a 25% decline in eGFR measured on two consecutive visits. RESULTS The mean age was 51.8 years and 3756 (62.8%) participants were male. During 17,801 person-years of follow-up (mean follow-up of 3.0 years), 62 participants (1.0%) developed incident CKD. When stratified into TE-defined fibrosis stages (F0-F4), multivariable Cox models revealed that risk of incident CKD was 5.40-fold (95% CI 2.46, 11.84; p < 0.001) higher in the F3/F4 group (≥9.5 kPa) than in the F0 group (<5.5 kPa). During 17,577 person-years of follow-up (mean follow-up of 3.0 years), 201 participants (3.4%) experienced the secondary outcome, for which the F3/F4 group had a 3.22-fold higher risk (95% CI 1.96, 5.28; p < 0.001) than the F0 group. CONCLUSIONS/INTERPRETATION In this large cohort of individuals with NAFLD but without baseline CKD, advanced liver fibrosis measured by TE was significantly associated with a higher risk of incident CKD.
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Affiliation(s)
- Chan-Young Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geun Woo Ryu
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University, College of Medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University, College of Medicine, Seoul, Republic of Korea.
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
| | - Beom Seok Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Huang H, Li B, Song J, Ye G, Tang X, Qu T, Yan L, Wen T, Li B, Wang W, Wu H, Xu M, Yang J, Luo Y. Can ultrasound elastography assess liver quality in brain-dead donors and predict early allograft dysfunction after transplantation? Acad Radiol 2021; 28 Suppl 1:S112-S117. [PMID: 34756817 DOI: 10.1016/j.acra.2020.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the role of two-dimensional shear wave elastography (2D SWE) in assessing graft quality before liver transplantation and the relationship between donor liver stiffness (LS) and early allograft dysfunction (EAD) after transplantation. METHODS Eighty-three donors from January 2018 to December 2018 were involved in this prospective study. Liver stiffness measurements (LSMs) were performed using 2D SWE. The differences in LS values between discarded and transplanted grafts were analyzed. The relationship of donor LS with recipient EAD was also evaluated. RESULTS Our results suggest that the donor LS values were higher in discarded grafts than in transplanted grafts (24.0 ± 10.9 kPa vs 10.0 ± 2.6 kPa, p < 0.001). LSM failed in one donor. According to multivariate logistic regression analysis, the donor LS values ≥10.9 kPa (odds ratio [OR] 4.042, 95% confidence interval [CI] 1.133-14.421, p = 0.031), BMI (OR 1.287, 95% CI 1.025-1.616, p = 0.030) and INR (OR 6.703, 95% CI 1.338-33.589, p = 0.021) were independently associated with EAD. CONCLUSION Donor LSM conducted by 2D SWE might represent an effective quantitative method to evaluate graft quality. Donor LS might predict recipient EAD after liver transplantation.
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Affiliation(s)
- He Huang
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Bo Li
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Jiulin Song
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Guilin Ye
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Xiao Tang
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China; Department of Ultrasound, Chengdu Second People's Hospital, No. 10 Qingyun South Street, Chengdu, 610017, Sichuan Province, China
| | - Tingting Qu
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Lunan Yan
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Tianfu Wen
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Bo Li
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Wentao Wang
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Hong Wu
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Mingqing Xu
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Jiayin Yang
- Department of Hepatic Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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Núñez A, Belmonte I, Miranda E, Barrecheguren M, Farago G, Loeb E, Pons M, Rodríguez-Frías F, Gabriel-Medina P, Rodríguez E, Genescà J, Miravitlles M, Esquinas C. Association between circulating alpha-1 antitrypsin polymers and lung and liver disease. Respir Res 2021; 22:244. [PMID: 34526035 PMCID: PMC8442448 DOI: 10.1186/s12931-021-01842-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/08/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) is considered one of the most common genetic diseases and is characterised by the misfolding and polymerisation of the alpha-1 antitrypsin (AAT) protein within hepatocytes. The relevance of circulating polymers (CP) of AAT in the pathogenesis of lung and liver disease is not completely understood. Therefore, the main objective of our study was to determine whether there is an association between the levels of CP of AAT and the severity of lung and liver disease. METHOD This was a cross-sectional study in patients with different phenotypes of AATD and controls. To quantify CP, a sandwich ELISA was performed using the 2C1 monoclonal antibody against AAT polymers. Sociodemographic data, clinical characteristics, and liver and lung parameters were collected. RESULTS A cohort of 70 patients was recruited: 32 Pi*ZZ (11 on augmentation therapy); 29 Z-heterozygous; 9 with other genotypes. CP were compared with a control group of 47 individuals (35 Pi*MM and 12 Pi*MS). ZZ patients had the highest concentrations of CP (p < 0.001) followed by Z heterozygous. The control group and patients with Pi*SS and Pi*SI had the lowest CP concentrations. Pi*ZZ also had higher levels of liver stiffness measurements (LSM) than the remaining AATD patients. Among patients with one or two Z alleles, two patients with lung and liver impairment showed the highest concentrations of CP (47.5 µg/mL), followed by those with only liver abnormality (n = 6, CP = 34 µg/mL), only lung (n = 18, CP = 26.5 µg/mL) and no abnormalities (n = 23, CP = 14.3 µg/mL). Differences were highly significant (p = 0.004). CONCLUSIONS Non-augmented Pi*ZZ and Z-patients with impaired lung function and increased liver stiffness presented higher levels of CP than other clinical phenotypes. Therefore, CP may help to identify patients more at risk of developing lung and liver disease and may provide some insight into the mechanisms of disease.
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Affiliation(s)
- Alexa Núñez
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Irene Belmonte
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Elena Miranda
- Department of Biology and Biotechnologies, 'Charles Darwin' and Pasteur Institute - Cenci Bolognetti Foundation, Sapienza University of Rome, Rome, Italy
| | - Miriam Barrecheguren
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Georgina Farago
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Eduardo Loeb
- Pneumology Department, Teknon Medical Center, Barcelona, Spain
| | - Mònica Pons
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francisco Rodríguez-Frías
- Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
- Department of Clinical Biochemistry, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, (CIBEREHD), Barcelona, Spain
- Clinical Biochemistry Research Group/Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo Gabriel-Medina
- Department of Clinical Biochemistry, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Esther Rodríguez
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joan Genescà
- Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, (CIBEREHD), Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Cristina Esquinas
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
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Güngörer V, Öztürk M, Özlü MY, Arslan Ş. What is the impact of methotrexate on liver in patients with juvenile idiopathic arthritis? Results of liver SWE performed in a single centre. Mod Rheumatol 2021; 32:776-782. [PMID: 34918139 DOI: 10.1093/mr/roab064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/02/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Long-term therapy with low-dose methotrexate (MTX) is widely used in treatment of rheumatic diseases, in children. The purpose of this study was to evaluate liver elasticity in patients with juvenile idiopathic arthritis (JIA) who received MTX and compare the results with control group. METHODS Liver elasticity was evaluated with shear wave elastography (SWE) technique in 25 patients aged 3-17 years who were followed up with JIA and received MTX and compared with 25 healthy controls of the same age and weight. Factors that had an effect on liver elasticity were examined. RESULTS The mean SWE value of patients was 2.64 ± 2.13 m/s and 24.10 ± 18.50 kPa, whereas 1.83 ± 0.16 m/s and 10.09 ± 1.83 kPa in control group. There was a significant difference in liver elasticity in the patient and control groups. When the patients were evaluated as Group 1 (< 1000 mg) and Group 2 (≥ 1000 mg) according to the cumulative MTX dose, no significant difference was obtained. There was positive correlation between liver elasticity and weekly MTX dose and age. CONCLUSIONS Our study revealed that liver elasticity significantly decreased in patients who received MTX when compared with the control group. The elastography technique will be understood better over time and used safely in many areas.
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Affiliation(s)
- Vildan Güngörer
- Department of Pediatric Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mehmet Öztürk
- Department of Radiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mustafa Yasir Özlü
- Department of Radiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Şükrü Arslan
- Department of Pediatric Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
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9
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Effenberger M, Grander C, Fritsche G, Bellmann-Weiler R, Hartig F, Wildner S, Seiwald S, Adolph TE, Zoller H, Weiss G, Tilg H. Liver stiffness by transient elastography accompanies illness severity in COVID-19. BMJ Open Gastroenterol 2020; 7:e000445. [PMID: 32665398 PMCID: PMC10577726 DOI: 10.1136/bmjgast-2020-000445] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/13/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Severe liver damage is associated with worse outcome in COVID-19. Our aim was to explore the degree of liver damage, liver stiffness (LS) and severity of illness in patients with COVID-19. DESIGN We investigated 32 patients with COVID-19 admitted to the University Hospital of Innsbruck in a prospective cross-sectional study. We performed laboratory testing, liver and spleen sonography and elastography to measure organ stiffness. RESULTS 12 patients (38%) showed elevated aminotransferases and gamma-glutamyltransferase levels. LS was positively correlated with elevated aminotransferase levels in patients with COVID-19 compared with those without elevated enzymes. Even mild liver damage raised LS significantly in COVID-19 as it was in patients with gastrointestinal symptoms. Furthermore, higher LS measurements were significantly associated with illness severity like pneumonia, need for mechanical ventilation, and even death. CONCLUSION Transient elastography is a useful and non-invasive tool to assess onset and severity of acute liver injury in patients with COVID-19 patients. Increased LS seems to be predictive for a more severe and complicated course of disease.
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Affiliation(s)
- Maria Effenberger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Grander
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Gernot Fritsche
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Frank Hartig
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Sophie Wildner
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefanie Seiwald
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Timon Erik Adolph
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Heinz Zoller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Gunter Weiss
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
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10
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Liver stiffness in chronic hepatitis C virus infection. ACTA ACUST UNITED AC 2020; 57:85-98. [PMID: 30447147 DOI: 10.2478/rjim-2018-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The severity of liver fibrosis can be assessed noninvasively today by liver stiffness measurements. Vibration-controlled transient elastography, shear wave elastography or magnetic resonance elastography are techniques increasingly used for this purpose. METHODS This article presents the recent advances in the use of new techniques for liver fibrosis assessment in chronic hepatitis C: the correlation between liver stiffness values and liver fibrosis estimated by liver biopsies, the prognosis role of liver stiffness values, their usefulness in monitoring the treatment response, in assessing the severity of portal hypertension and in estimating the presence of esophageal varices. Scientific articles from January 2017 to January 2018 were searched in PubMed and PubMed Central databases, using the terms "liver stiffness" and "hepatitis C". RESULTS The median liver stiffness values measured with different techniques are not identical, so that FibroScan thresholds cannot be used on any other elastographic machine. The higher the liver's stiffness measurement, the higher the liver-related events in patients with chronic hepatitis C. A liver stiffness measurement over 17 kPa could be an independent predictor for the presence of esophageal varices as well as a spleen with a longitudinal span ≥ 15 cm for patients with a value of liver stiffness < 17 kPa. A progressive and persistent decrease in liver stiffness is dependent on sustained virological response achievement. The lack of liver stiffness decrease has been associated with relapsers and a low value of liver stiffness at baseline. CONCLUSION Liver stiffness provides clues about the severity and evolution of liver disease.
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11
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Shiha GES, Mousa N. Transient Elastography in Chronic Liver Diseases. LIVER DISEASES 2020:545-552. [DOI: 10.1007/978-3-030-24432-3_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
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12
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Obrzut M, Atamaniuk V, Obrzut B, Ehman R, Cholewa M, Rzucidło M, Pozaruk A, Gutkowski K. Normative values for magnetic resonance elastography-based liver stiffness in a healthy population. Pol Arch Intern Med 2019; 129:321-326. [PMID: 30793705 PMCID: PMC6731548 DOI: 10.20452/pamw.4456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Chronic liver disease resulting in fibrosis, and ultimately cirrhosis, is a significant cause of morbidity and mortality worldwide. None of the conventional imaging techniques are able to detect early fibrosis and compare its grade with the histopathologic scale. Liver biopsy, as the diagnostic standard for liver fibrosis, also has limitations and is not well accepted by patients. Magnetic resonance elastography is a well‑established technique for evaluating liver stiffness and may replace invasive procedures. Detection of liver fibrosis in its early stages, however, requires a detailed knowledge of normal liver stiffness. OBJECTIVES This study aimed to determine normal liver stiffness values in healthy volunteers. PATIENTS AND METHODS A total of 102 volunteers (mean age, 21.6 years; range, 20-28 years) with no history of gastrointestinal, hepatobiliary, or cardiovascular disease were enrolled in the study. Liver stiffness was evaluated by magnetic resonance elastography with a 1.5T clinical magnetic resonance scanner. Images of the induced transverse wave propagation were obtained and converted to tissue stiffness maps (elastograms). RESULTS The mean (SD) liver stiffness for the entire group of volunteers was 2.14 (0.28) kPa (range, 1.37-2.66 kPa). For women, the mean (SD) stiffness value was 2.14 (0.30) kPa (range, 1.37-2.66 kPa), and for men, 2.14 (0.25) kPa (range, 1.54-2.54 kPa). CONCLUSIONS Liver stiffness in a healthy adult cohort did not exceed 2.7 kPa and is not influenced by sex, body mass index, or fat content.
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Affiliation(s)
- Marzanna Obrzut
- Department of Biophysics, Faculty of Mathematics and Natural Sciences, University of Rzeszów, Rzeszów, Poland
| | - Vitaliy Atamaniuk
- Department of Biophysics, Faculty of Mathematics and Natural Sciences, University of Rzeszów, Rzeszów, Poland
| | - Bogdan Obrzut
- Department of Obstetrics and Gynaecology, Provincial Clinical Hospital No 2 in Rzeszow, University of Rzeszów, Rzeszów, Poland
| | - Richard Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Marian Cholewa
- Department of Biophysics, Faculty of Mathematics and Natural Sciences, University of Rzeszów, Rzeszów, Poland
| | - Mateusz Rzucidło
- Department of Gastroenterology and Hepatology with Internal Disease Unit, Teaching Hospital No. 1 in Rzeszów, Rzeszów, Poland
| | - Andrii Pozaruk
- Department of Biophysics, Faculty of Mathematics and Natural Sciences, University of Rzeszów, Rzeszów, Poland,Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Krzysztof Gutkowski
- Department of Gastroenterology and Hepatology with Internal Disease Unit, Teaching Hospital No. 1 in Rzeszów, Rzeszów, Poland
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13
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Chronic hepatitis C infection - Noninvasive assessment of liver fibrosis in the era of direct acting antivirals. Dig Liver Dis 2019; 51:183-189. [PMID: 30553749 DOI: 10.1016/j.dld.2018.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 02/07/2023]
Abstract
Significant advancements in the diagnosis and treatment of chronic hepatitis C infection and its associated fibrosis have revolutionized treatment of these patients over the last several years. Liver biopsy, the gold standard diagnostic method for evaluating liver fibrosis level, was routinely used prior to initiation of hepatitis C therapy, placing patients at an inherent risk of adverse events. The recent advent of noninvasive serologic and nonserologic measures of hepatic fibrosis level has reduced the need for liver biopsy significantly, thereby minimizing its associated risks. These noninvasive methods have been extensively studied in the era of interferon therapies and are increasingly recognized in the realm of direct acting antiviral agents as well. Their validation of use after having achieved a sustained virologic response is yet to occur, but the future remains promising. This review focuses on the various non-invasive diagnostic modalities of liver fibrosis and discusses how they can be applied to the care of patients undergoing direct acting antiviral therapy for hepatitis C. In the constantly evolving landscape of hepatitis C therapy, the review underscores the important prognostic value of fibrosis staging prior to HCV treatment and suggests potential uses for non-invasive fibrosis assessment following successful HCV eradication.
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14
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The effect of vitamin D pathway genes and deferasirox pharmacogenetics on liver iron in thalassaemia major patients. THE PHARMACOGENOMICS JOURNAL 2019; 19:417-427. [PMID: 30651574 DOI: 10.1038/s41397-019-0071-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 10/01/2018] [Accepted: 12/21/2018] [Indexed: 02/07/2023]
Abstract
Monitoring and treating iron overload is crucial in transfusion-dependent thalassaemia patients. Liver stiffness measurement by transient elastography and T2* magnetic resonance imaging represent non-invasive ways to evaluate the adequacy of the iron chelation treatment. We explored the role of single nucleotide polymorphisms involved in vitamin D metabolism, transport and activity, and in deferasirox metabolism on liver iron burden parameters. One-hundred and five beta-thalassaemia patients, treated with deferasirox, have been enrolled. Drug plasma Ctrough and AUC were measured by a HPLC-UV method. Allelic discrimination was performed by real-time PCR. Age, UGT1A1-364 CT/TT and CYP27B1 -1260 GT/TT positively predicted liver stiffness values. Deferasirox dose and serum ferritin negatively predicted T2* data, whereas age and CYP2D6 1457 GG genotype positively influenced these values. The discoveries of this research may be useful for personalized medicine and the proposed method could be applied in patients with hereditary hemochromatosis and myelodysplastic syndromes.
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15
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Pawlowska M, Sobolewska-Pilarczyk M, Domagalski K. Hepatitis C virus infection in children in the era of direct-acting antiviral. World J Gastroenterol 2018; 24:2555-2566. [PMID: 29962813 PMCID: PMC6021773 DOI: 10.3748/wjg.v24.i24.2555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/10/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection remains an important global health problem with chronic infection affecting approximately 11 million children worldwide. The emergence of direct-acting antiviral (DAA) therapies and the development of non-invasive methods for the determination of liver fibrosis will significantly improve the management of paediatric patients with chronic HCV infection in subsequent years. For paediatric patients, a new era of highly effective DAA agents is beginning, and the first results of available clinical trials are very promising. In this era, the identification and monitoring of patients continues to be an important issue. The availability of non-invasive serological and imaging methods to measure hepatic fibrosis enables the identification of patients with significant or advanced liver fibrosis stages. This article summarizes the current data on the epidemiology and progress of research aimed to evaluate the new therapies and non-invasive methods for liver injury in paediatric patients with chronic hepatitis C.
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Affiliation(s)
- Malgorzata Pawlowska
- Department of Paediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
| | - Malgorzata Sobolewska-Pilarczyk
- Department of Paediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
| | - Krzysztof Domagalski
- Centre For Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń 87-100, Poland
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16
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Felicani C, De Molo C, Stefanescu H, Conti F, Mazzotta E, Gabusi V, Nardi E, Morselli-Labate AM, Andreone P, Serra C. Point quantification elastography in the evaluation of liver elasticity in healthy volunteers: a reliability study based on operator expertise. J Ultrasound 2018; 21:89-98. [PMID: 29790083 PMCID: PMC5972110 DOI: 10.1007/s40477-018-0300-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/17/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The assessment of liver fibrosis is essential in the management of patients with chronic liver diseases. Liver biopsy is considered the gold standard procedure for this purpose, though the recent development of new elastosonographic techniques to measure liver stiffness (LS) noninvasively is promising. Point quantification elastography (PQE) showed good results but less is known about the level of skill needed to obtain reliable results. The aim of the study was to evaluate the reproducibility of PQE in assessing LS in healthy subjects comparing three operators with different expertise. METHODS Between December 2012 and April 2013, 50 consecutive healthy volunteers (18 males, 32 females), median age 30 years (range 25-66) and BMI 22.4 (range 16.7-33.6) were submitted to PQE (iU22 Philips, Bothell, WA, USA) by three operators: two US and elastography providers (one expert and one with intermediate skill) and a skilled transient elastography (Fibroscan) operator with no expertise in US. Intra- and inter-observer agreements were assessed by intraclass correlation coefficient (ICC). RESULTS PQE measurement was obtained in all subjects by all evaluators. No significant differences of mean liver stiffness were found among operators (P = 0.980). Intra-observer agreement was excellent 0.918 (0.941 for expert, 0.917 for intermediate and 0.888 for novice). The ICC of the inter-observer agreement among the three ratters was excellent (0.882) and was higher in normal than overweight patients (0.923 vs. 0.603; P = 0.011). CONCLUSION PQE is a reliable and reproducible non-invasive method for the assessment of LE, and can be performed also by a non-experienced operator.
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Affiliation(s)
- Cristina Felicani
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Horia Stefanescu
- Department of Hepatology, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
- Department of Medical and Surgical Sciences, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabio Conti
- Department of Medical and Surgical Sciences, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elena Mazzotta
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Veronica Gabusi
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elena Nardi
- Department of Medical and Surgical Sciences, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Pietro Andreone
- Department of Medical and Surgical Sciences, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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17
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Erman A, Sathya A, Nam A, Bielecki JM, Feld JJ, Thein HH, Wong WWL, Grootendorst P, Krahn MD. Estimating chronic hepatitis C prognosis using transient elastography-based liver stiffness: A systematic review and meta-analysis. J Viral Hepat 2018; 25:502-513. [PMID: 29239068 DOI: 10.1111/jvh.12846] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022]
Abstract
Chronic hepatitis C (CHC) is a leading cause of hepatic fibrosis and cirrhosis. The level of fibrosis is traditionally established by histology, and prognosis is estimated using fibrosis progression rates (FPRs; annual probability of progressing across histological stages). However, newer noninvasive alternatives are quickly replacing biopsy. One alternative, transient elastography (TE), quantifies fibrosis by measuring liver stiffness (LSM). Given these developments, the purpose of this study was (i) to estimate prognosis in treatment-naïve CHC patients using TE-based liver stiffness progression rates (LSPR) as an alternative to FPRs and (ii) to compare consistency between LSPRs and FPRs. A systematic literature search was performed using multiple databases (January 1990 to February 2016). LSPRs were calculated using either a direct method (given the difference in serial LSMs and time elapsed) or an indirect method given a single LSM and the estimated duration of infection and pooled using random-effects meta-analyses. For validation purposes, FPRs were also estimated. Heterogeneity was explored by random-effects meta-regression. Twenty-seven studies reporting on 39 groups of patients (N = 5874) were identified with 35 groups allowing for indirect and 8 for direct estimation of LSPR. The majority (~58%) of patients were HIV/HCV-coinfected. The estimated time-to-cirrhosis based on TE vs biopsy was 39 and 38 years, respectively. In univariate meta-regressions, male sex and HIV were positively and age at assessment, negatively associated with LSPRs. Noninvasive prognosis of HCV is consistent with FPRs in predicting time-to-cirrhosis, but more longitudinal studies of liver stiffness are needed to obtain refined estimates.
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Affiliation(s)
- A Erman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Toronto, ON, Canada
| | - A Sathya
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - A Nam
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - J M Bielecki
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Toronto, ON, Canada
| | - J J Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, ON, Canada
| | - H-H Thein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - W W L Wong
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - P Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - M D Krahn
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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18
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Lee JH, Yoo GS, Hee Kang S, Uh Y. Is carbohydrate deficient transferrin (CDT) a useful biomarker to identify alcohol abuse in advanced liver fibrosis? Alcohol Alcohol 2017; 52:749-750. [DOI: 10.1093/alcalc/agx056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 01/22/2023] Open
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19
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Kim SU, Song D, Heo JH, Yoo J, Kim BK, Park JY, Kim DY, Ahn SH, Kim KJ, Han KH, Kim YD. Liver fibrosis assessed with transient elastography is an independent risk factor for ischemic stroke. Atherosclerosis 2017; 260:156-162. [PMID: 28222857 DOI: 10.1016/j.atherosclerosis.2017.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The relationship between liver fibrosis and the occurrence of ischemic stroke is unknown. We investigated the correlation between liver fibrosis assessed with transient elastography (TE) and the risk of ischemic stroke. METHODS Between April 2013 and August 2014, patients with acute ischemic stroke and subjects who underwent a health check-up were included in the study. Liver fibrotic burden was assessed with TE in all participants. The degree of liver fibrosis was compared between groups by using various multiple logistic regression models and propensity-score matched analyses. RESULTS Two hundred ninety-five patients with ischemic stroke (stroke group) and 1942 subjects with health check-up (control group) were included. The mean liver stiffness (LS) on TE (5.6 vs. 4.1 kPa) and the proportion of significant fibrosis (>8 kPa) (9.2% vs. 1.8%) were significantly higher in the stroke than in the control group (all p<0.05). These trends were observed regardless of body mass index, the degree of hepatic steatosis, and metabolic syndrome (all p<0.05). The adjusted odds ratio (OR) for ischemic stroke was 1.268 (95% confidence intervals [CI] 1.183-1.358) per 1 kPa increase and 12.033 (95% CI 5.180-27.948) for significant fibrosis, compared with no fibrosis (all p < 0.05). Propensity-score matched analysis also confirmed that liver fibrosis was independently associated with the risk of ischemic stroke (OR 1.804 [95% CI 1.461-2.230] per 1 kPa increase, 13.184 [95% CI 3.127-55.645] for significant fibrosis, compared with no fibrosis; all p<0.001). CONCLUSIONS The degree of liver fibrosis, assessed with TE, was significantly associated with the risk of ischemic stroke.
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Affiliation(s)
- Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Yong Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Do Young Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang Joon Kim
- Severance Executive Healthcare Clinic, Seoul, South Korea; Severance Check-up Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
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20
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Mukund A, Pargewar SS, Desai SN, Rajesh S, Sarin SK. Changes in Liver Congestion in Patients with Budd-Chiari Syndrome following Endovascular Interventions: Assessment with Transient Elastography. J Vasc Interv Radiol 2017; 28:683-687. [PMID: 28153486 DOI: 10.1016/j.jvir.2016.11.091] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 11/14/2016] [Accepted: 11/28/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Transient elastography (TE) is routinely used for noninvasive staging of hepatic fibrosis. The objective of the present study was to investigate the role of TE (FibroScan) in determining changes in liver congestion in patients with Budd-Chiari syndrome (BCS) treated by endovascular interventions and determine the effects of pretreatment Meta-analysis of Histological Data in Viral Hepatitis (METAVIR) fibrosis score on posttreatment liver stiffness (LS). MATERIALS AND METHODS Twenty-five patients undergoing endovascular procedures for treatment of BCS underwent TE immediately before and within 24 hours after the procedure. Fifteen patients available for 3-month follow-up were again subjected to TE. Mean LS values before and after intervention were compared in 12 of these patients for whom METAVIR scores were available. Pressure gradient changes across the stenosed hepatic veins/inferior vena cava were measured during the procedure. Statistical analysis of these data was performed by Wilcoxon signed-rank test, Mann-Whitney U test, and Pearson product-moment correlation coefficient. RESULTS Significant differences were found between mean LS measurements before and within 24 hours after intervention (Z-score = 4.372) and between the mean values obtained before and 3 months after treatment (Z-score = 3.408). Mean changes in LS values after intervention in patients with METAVIR fibrosis scores ≤ 2 and > 2 were not significant. There was no correlation between changes in pressure gradients and the degree of LS. CONCLUSIONS TE is a useful tool to assess the reduction in hepatic congestion in patients with BCS undergoing endovascular interventions.
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Affiliation(s)
- Amar Mukund
- Departments of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi110070, India.
| | - Sudheer S Pargewar
- Departments of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi110070, India
| | - Saloni N Desai
- Departments of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi110070, India
| | - S Rajesh
- Departments of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi110070, India
| | - Shiv K Sarin
- Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi110070, India
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21
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Andersen SB, Ewertsen C, Carlsen JF, Henriksen BM, Nielsen MB. Ultrasound Elastography Is Useful for Evaluation of Liver Fibrosis in Children-A Systematic Review. J Pediatr Gastroenterol Nutr 2016; 63:389-99. [PMID: 26925609 DOI: 10.1097/mpg.0000000000001171] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Adult studies have proven ultrasound elastography as a validated measure of liver fibrosis. The present study aimed to review the available literature on ultrasound elastography in children to evaluate the ability of the method to distinguish healthy from fibrotic liver tissue and investigate whether cutoff values for liver fibrosis in children have been established. METHODS A literature search was performed in MEDLINE, EMBASE, the Cochrane Library, and Web of Science to identify studies on ultrasound elastography of the liver in children. Only original research articles in English concerning ultrasound elastography in children with and without liver disease, younger than 18 years, were included. All reference lists of the included articles were hand-searched for further references. RESULTS Twenty-seven articles were included. Elastography in children without liver disease was investigated in 14 studies and were comparable to those existing for adults. Twelve studies compared elastography with liver biopsy in children with liver disease and found that cirrhosis was correctly diagnosed, whereas it was more difficult to assess severe fibrosis correctly. For the distinction between no, mild, and moderate fibrosis in children with liver disease the method was less accurate. Ultrasound elastography was able to differentiate between children with and without liver fibrosis. In children without liver disease ultrasound, elastography showed consistent liver stiffness values comparable to those found in adults. No fibrosis-specific cutoffs were proposed. CONCLUSIONS Ultrasound elastography was able to diagnose cirrhosis, distinguish healthy from fibrotic liver tissue, and showed consistent liver stiffness values in children without liver disease.
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Affiliation(s)
- Sofie Bech Andersen
- *Department of Radiology, Rigshospitalet, Copenhagen, Denmark, University Hospital, Copenhagen †Center for Fast Ultrasound Imaging (CFU), Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
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Lee SW, Kim BK, Park JY, Kim DY, Ahn SH, Song J, Park YB, Lee SK, Han KH, Kim SU. Clinical predictors of silent but substantial liver fibrosis in primary Sjogren's syndrome. Mod Rheumatol 2016; 26:576-582. [PMID: 26587876 DOI: 10.3109/14397595.2015.1113629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/23/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To investigate the prevalence and the predictors of silent but substantial liver fibrosis in patients with primary Sjogren's syndrome (pSS). METHODS We enrolled 101 pSS patients with normal liver function and structures, and without significant liver diseases or other conditions affecting liver fibrosis. The European league against rheumatism (EULAR) SS patients reported index (ESSPRI) and the EULAR SS disease activity index (ESSDAI) were analyzed. Liver stiffness (LS) was measured using transient elastography and 7.4 kPa was determined as the cutoff value for significant liver fibrosis. RESULTS The median age of patients (91women) was 53 years and the median LS value was 4.7 kPa. The median ESSPRI and ESSDAI showed no correlation with LS values. Twelve patients (11.9%) had significant liver fibrosis. In multivariate logistic regression, white blood cells count ≤4000.0/mm(3) (Odds ratio [OR] 9.821), serum albumin ≤3.8 mg/dL (OR 16.770) and aspartate aminotransferase (AST) ≥ 27.0 IU/L (OR 20.858) independently predicted silent but substantial liver fibrosis in pSS patients. CONCLUSIONS The prevalence of silent but substantial liver fibrosis was 11.9% in pSS and its predictors were leukopenia, decreased serum albumin and increased AST levels.
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Affiliation(s)
- Sang-Won Lee
- a Division of Rheumatology, Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea
| | - Beom Kyung Kim
- b Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea , and
- c Liver Cirrhosis Clinical Research Center , Seoul , South Korea
| | - Jun Yong Park
- b Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea , and
- c Liver Cirrhosis Clinical Research Center , Seoul , South Korea
| | - Do Young Kim
- b Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea , and
- c Liver Cirrhosis Clinical Research Center , Seoul , South Korea
| | - Sang Hoon Ahn
- b Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea , and
- c Liver Cirrhosis Clinical Research Center , Seoul , South Korea
| | - Jungsik Song
- a Division of Rheumatology, Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea
| | - Yong-Beom Park
- a Division of Rheumatology, Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea
| | - Soo-Kon Lee
- a Division of Rheumatology, Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea
| | - Kwang-Hyub Han
- b Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea , and
- c Liver Cirrhosis Clinical Research Center , Seoul , South Korea
| | - Seung Up Kim
- b Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea , and
- c Liver Cirrhosis Clinical Research Center , Seoul , South Korea
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Staufner C, Haack TB, Köpke MG, Straub BK, Kölker S, Thiel C, Freisinger P, Baric I, McKiernan PJ, Dikow N, Harting I, Beisse F, Burgard P, Kotzaeridou U, Lenz D, Kühr J, Himbert U, Taylor RW, Distelmaier F, Vockley J, Ghaloul-Gonzalez L, Ozolek JA, Zschocke J, Kuster A, Dick A, Das AM, Wieland T, Terrile C, Strom TM, Meitinger T, Prokisch H, Hoffmann GF. Recurrent acute liver failure due to NBAS deficiency: phenotypic spectrum, disease mechanisms, and therapeutic concepts. J Inherit Metab Dis 2016; 39:3-16. [PMID: 26541327 DOI: 10.1007/s10545-015-9896-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/28/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Acute liver failure (ALF) in infancy and childhood is a life-threatening emergency and in about 50% the etiology remains unknown. Recently biallelic mutations in NBAS were identified as a new molecular cause of ALF with onset in infancy, leading to recurrent acute liver failure (RALF). METHODS The phenotype and medical history of 14 individuals with NBAS deficiency was studied in detail and functional studies were performed on patients' fibroblasts. RESULTS The phenotypic spectrum of NBAS deficiency ranges from isolated RALF to a multisystemic disease with short stature, skeletal dysplasia, immunological abnormalities, optic atrophy, and normal motor and cognitive development resembling SOPH syndrome. Liver crises are triggered by febrile infections; they become less frequent with age but are not restricted to childhood. Complete recovery is typical, but ALF crises can be fatal. Antipyretic therapy and induction of anabolism including glucose and parenteral lipids effectively ameliorates the course of liver crises. Patients' fibroblasts showed an increased sensitivity to high temperature at protein and functional level and a disturbed tethering of vesicles, pointing at a defect of intracellular transport between the endoplasmic reticulum and Golgi. CONCLUSIONS Mutations in NBAS cause a complex disease with a wide clinical spectrum ranging from isolated RALF to a multisystemic phenotype. Thermal susceptibility of the syntaxin 18 complex is the basis of fever dependency of ALF episodes. NBAS deficiency is the first disease related to a primary defect of retrograde transport. Identification of NBAS deficiency allows optimized therapy of liver crises and even prevention of further episodes.
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Affiliation(s)
- Christian Staufner
- Department of General Pediatrics, Division of Neuropediatrics and Pediatric Metabolic Medicine, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Tobias B Haack
- Institute of Human Genetics, Technische Universität München, 81675, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Marlies G Köpke
- Institute of Human Genetics, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Beate K Straub
- Institute of Pathology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Stefan Kölker
- Department of General Pediatrics, Division of Neuropediatrics and Pediatric Metabolic Medicine, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Christian Thiel
- Department of General Pediatrics, Division of Neuropediatrics and Pediatric Metabolic Medicine, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | | | - Ivo Baric
- Department of Pediatrics, University Hospital Center Zagreb and University of Zagreb, School of Medicine, 10000, Zagreb, Croatia
| | | | - Nicola Dikow
- Institute of Human Genetics, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Inga Harting
- Department of Neuroradiology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Flemming Beisse
- Ophthalmology Department, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Peter Burgard
- Department of General Pediatrics, Division of Neuropediatrics and Pediatric Metabolic Medicine, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Urania Kotzaeridou
- Department of General Pediatrics, Division of Neuropediatrics and Pediatric Metabolic Medicine, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Dominic Lenz
- Department of General Pediatrics, Division of Neuropediatrics and Pediatric Metabolic Medicine, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Joachim Kühr
- Children's Hospital Karlsruhe, 76133, Karlsruhe, Germany
| | - Urban Himbert
- Children's Hospital St. Elisabeth, 56564, Neuwied, Germany
| | - Robert W Taylor
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Felix Distelmaier
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University Düsseldorf, 40225, Duesseldorf, Germany
| | - Jerry Vockley
- University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, 15224, USA
| | - Lina Ghaloul-Gonzalez
- University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, 15224, USA
| | - John A Ozolek
- Department of Pathology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
| | - Johannes Zschocke
- Division of Human Genetics, Innsbruck Medical University, 6020, Innsbruck, Austria
| | - Alice Kuster
- Inborn Errors of Metabolism, Pediatric Intensive Care Unit, University Hospital of Nantes, 44093, Nantes, France
| | - Anke Dick
- Department of Pediatrics, University Hospital Würzburg, 97080, Wuerzburg, Germany
| | - Anib M Das
- Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases, Hannover Medical School, 30625, Hannover, Germany
| | - Thomas Wieland
- Institute of Human Genetics, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Caterina Terrile
- Institute of Human Genetics, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Tim M Strom
- Institute of Human Genetics, Technische Universität München, 81675, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Technische Universität München, 81675, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Holger Prokisch
- Institute of Human Genetics, Technische Universität München, 81675, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Georg F Hoffmann
- Department of General Pediatrics, Division of Neuropediatrics and Pediatric Metabolic Medicine, University Hospital Heidelberg, 69120, Heidelberg, Germany.
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Kim YD, Song D, Heo JH, Kim SU, Kim BK, Park JY, Kim DY, Ahn SH, Kim KJ, Han KH. Relationship between Cerebral Microbleeds and Liver Stiffness Determined by Transient Elastography. PLoS One 2015; 10:e0139227. [PMID: 26421848 PMCID: PMC4589390 DOI: 10.1371/journal.pone.0139227] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/10/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND & AIMS Liver fibrosis is a multifactorial disease that can affect the development of cerebral small vessel diseases (SVDs) including cerebral microbleeds (CMBs), leukoaraiosis, and silent infarctions. Transient elastography can accurately assess the degree of liver fibrosis by measuring liver stiffness (LS). In the present study, we investigated the association between SVDs and LS values. METHODS We recruited 300 participants (mean age 56 years, 170 men) who underwent a comprehensive medical health check-up between January 2011 and December 2012. Transient elastography was taken on the right lobe of the liver through intercostal space with patients lying in the dorsal decubitus position with the right arm in maximal abduction. Mild and significant fibrosis were defined as LS values >5.6 and >8.0 kPa, respectively. The presence of each SVD was determined using the FLAIR, GRE MR imaging as well as T1-, T2-weighted MR images. We tested whether the presence and burden of each type of SVD were different by LS values. RESULTS Of the different types of SVDs, only the presence (p = 0.001) and number of CMBs (p<0.001) were positively associated with LS values. Multivariate analysis revealed that significant fibrosis (>8.0 kPa) was an independent predictor of CMBs (odds ratio 6.079, 95% confidence interval 1.489-24.819, p = 0.012). However, leukoaraiosis and silent infarctions were not associated with LS values (all p>0.05). CONCLUSIONS The degree of liver fibrosis, as assessed using transient elastography, was independently associated with the presence and burden of CMBs in healthy, asymptomatic participants. Understanding the link between the brain and liver may advance future research on the pathomechanisms of CMBs.
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Affiliation(s)
- Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Joon Kim
- Severance Executive Healthcare Clinic, Yonsei University Health System, Seoul, Korea
- Severance Check-up Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Improvement of BMI after Lifestyle Intervention Is Associated with Normalisation of Elevated ELF Score and Liver Stiffness in Obese Children. BIOMED RESEARCH INTERNATIONAL 2015; 2015:457473. [PMID: 26273620 PMCID: PMC4529902 DOI: 10.1155/2015/457473] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/04/2015] [Indexed: 12/26/2022]
Abstract
Background. Noninvasive tools to diagnose nonalcoholic fatty liver disease (NAFLD), including transient elastography (TE) and enhanced liver fibrosis panel (ELF), have only been evaluated in children with biopsy-proven NAFLD. We evaluated the prevalence of ELF and TE abnormalities in obese children without clinical liver disease and examined the effects of BMI stabilization on ELF and TE in a longitudinal approach. Methods. 39 obese children (17 m, age 12.3 (7.6–17.4) years) who participated in a 12-month lifestyle-intervention program underwent TE and ELF testing at baseline and at completion of the program. Results were compared with data from a nonobese paediatric cohort. Results. TE and ELF at baseline were significantly elevated compared to controls (TE: 5.9 (3.4–8.3) kPa versus 4.45 (2.45–8.85) kPa, P < 0.01; ELF: 9.0 (7.87–9.60) versus 8.6 (7.33–11.52), P = 0.033). All children with elevated TE and ELF results had normal transaminases. After the program, ELF and TE normalized. Reduction of ELF and TE was associated with a decrease in BMI centile. Conclusion. Abnormal TE and ELF results in obese children suggest presence of NAFLD even when transaminases are normal. TE and ELF might be used as monitoring tools for NAFLD. BMI stabilisation normalizes TE and ELF, underlining the impact of lifestyle intervention.
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EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63:237-64. [PMID: 25911335 DOI: 10.1016/j.jhep.2015.04.006] [Citation(s) in RCA: 1320] [Impact Index Per Article: 132.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023]
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Alsebaey A, Allam N, Alswat K, Waked I. Normal liver stiffness: A study in living donors with normal liver histology. World J Hepatol 2015; 7:1149-1153. [PMID: 26052404 PMCID: PMC4450192 DOI: 10.4254/wjh.v7.i8.1149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/10/2015] [Accepted: 04/01/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To define the normal range of liver stiffness (LS) values using transient elastography in living-related liver transplantation candidate donors with normal liver histology. METHODS LS was measured using Fibroscan in 50 (16 women, 34 men) healthy potential donors (mean age 28.4 ± 5.9 years) who were being evaluated for liver donation for their relatives at the National Liver Institute, Menoufeya University, Egypt. All potential donors had normal liver tests and were negative for hepatitis B or C virus infection. Abdominal ultrasounds showed normal findings. None of the subjects had diabetes, hypertension, renal impairment, heart disease, or body mass index > 30 kg/m(2). All subjects had normal liver histology upon liver biopsy. They all donated the right lobe of their liver with successful outcomes. RESULTS The mean LS was 4.3 ± 1.2 kPa (range: 1.8-7.1 kPa). The 5(th) and 95(th) percentiles of normal LS were 2.6 kPa and 6.8 kPa, respectively, with a median of 4 kPa; the interquartile range was 0.6 ± 0.4. LS measurements were not significantly different between men and women (4.4 ± 1.1 kPa vs 3.9 ± 1.3 kPa) and did not correlate with age. However, stiffness values were significantly lower in subjects with a body mass index < 26 kg/m(2) compared to those with an index ≥ 26 kg/m(2) (4.0 ± 1.1 kPa vs 4.6 ± 1.2 kPa; P <0.05). There were no differences in hospital stay or postoperative bilirubin, albumin,alanine and aspartate transaminases, or creatinine levels (at discharge) between donors with livers stiffness ≤ 4 kPa and those with stiffness > 4 kPa. CONCLUSION Healthy donors with normal liver histology have a median LS of 4 kPa. Stiffness values are elevated relative to increase in body mass index.
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Affiliation(s)
- Ayman Alsebaey
- Ayman Alsebaey, Naglaa Allam, Imam Waked, Hepatology Department, National Liver Institute, Menoufeya University, Menoufeya 32511, Egypt
| | - Naglaa Allam
- Ayman Alsebaey, Naglaa Allam, Imam Waked, Hepatology Department, National Liver Institute, Menoufeya University, Menoufeya 32511, Egypt
| | - Khalid Alswat
- Ayman Alsebaey, Naglaa Allam, Imam Waked, Hepatology Department, National Liver Institute, Menoufeya University, Menoufeya 32511, Egypt
| | - Imam Waked
- Ayman Alsebaey, Naglaa Allam, Imam Waked, Hepatology Department, National Liver Institute, Menoufeya University, Menoufeya 32511, Egypt
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A comparative study of strain and shear-wave elastography in an elasticity phantom. AJR Am J Roentgenol 2015; 204:W236-42. [PMID: 25714307 DOI: 10.2214/ajr.14.13076] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the diagnostic accuracy of strain and shear-wave elastography for determining targets of varying stiffness in a phantom. The effect of target diameter on elastographic assessments and the effect of depth on shear-wave velocity were also investigated. MATERIALS AND METHODS. We examined 20 targets of varying diameters (2.5-16.7 mm) and stiffnesses (8, 14, 45, and 80 kPa) with a 4-9-MHz linear-array transducer. Targets were evaluated 10 times with three different methods-shear-wave elastography, strain ratio, and strain histogram analysis-yielding 600 evaluations. AUCs were calculated for data divided between different stiffnesses. A 1.5-6-MHz curved-array transducer was used to assess the effect of depth (3.5 vs 6 cm) on shear-wave elastography in 80 scans. Mixed model analysis was performed to assess the effect of target diameter and depth. RESULTS. Strain ratio and strain histogram AUCs were higher than the shear-wave velocity AUC (p < 0.001) in data divided as 80 versus 45, 14, and 8 kPa. In data divided as 80 and 45 versus 14 and 8 kPa, the methods were equal (p = 0.959 and p = 1.000, respectively). Strain ratios were superior (p = 0.030), whereas strain histograms were not significantly better (p = 0.083) than shear-wave elastography in data divided as 80, 45, and 14 versus 8 kPa. Target diameter had an effect on all three methods (p = 0.001). Depth had an effect on shear-wave velocity (p = 0.001). CONCLUSION. The ability to discern different target stiffnesses varies between shear-wave and strain elastography. Target diameter affected all methods. Shear-wave elastography is affected by target depth.
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Schenk JP, Alzen G, Klingmüller V, Teufel U, El Sakka S, Engelmann G, Selmi B. Measurement of real-time tissue elastography in a phantom model and comparison with transient elastography in pediatric patients with liver diseases. Diagn Interv Radiol 2015; 20:90-9. [PMID: 24317333 DOI: 10.5152/dir.2013.13116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to determine the comparability of real-time tissue elastography (RTE) and transient elastography (TE) in pediatric patients with liver diseases. MATERIALS AND METHODS RTE was performed on the Elasticity QA Phantom Model 049 (Computerized Imaging Reference Systems Company Inc., Norfolk, Virginia, USA), which has five areas with different levels of stiffness. RTE measurements of relative stiffness (MEAN [mean value of tissue elasticity], AREA [% of blue color-coded stiffer tissue]) in the phantom were compared with the phantom stiffness specified in kPa (measurement unit of TE). RTE and TE were performed on 147 pediatric patients with various liver diseases. A total of 109 measurements were valid. The participants had following diseases: metabolic liver disease (n=25), cystic fibrosis (n=20), hepatopathy of unknown origin (n=11), autoimmune hepatitis (n=12), Wilson's disease (n=11), and various liver parenchyma alterations (n=30). Correlations between RTE and TE measurements in the patients were calculated. In addition, RTE was performed on a control group (n=30), and the RTE values between the patient and control groups were compared. RESULTS The RTE parameters showed good correlation in the phantom model with phantom stiffness (MEAN/kPa, r=-0.97; AREA/kPa, r=0.98). However, the correlation of RTE and TE was weak in the patient group (MEAN/kPa, r=-0.23; AREA/kPa, r=0.24). A significant difference was observed between the patient and control groups (MEAN, P = 5.32 e-7; AREA, P = 1.62 e-6). CONCLUSION In the phantom model, RTE was correlated with kPa, confirming the presumed comparability of the methods. However, there was no direct correlation between RTE and TE in patients with defined liver diseases under real clinical conditions.
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Affiliation(s)
- Jens-Peter Schenk
- From the Division of Pediatric Radiology (J-P.S., S.E.S., B.S. e-mail: ), Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; the Department of Pediatric Radiology (G.A., V.K.), University Clinic Giessen & Marburg, Giessen, Germany; the Department of General Pediatrics (U.T., G.E.), University Hospital of Heidelberg, Germany
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Chon YE, Jung KS, Kim KJ, Joo DJ, Kim BK, Park JY, Kim DY, Ahn SH, Han KH, Kim SU. Normal controlled attenuation parameter values: a prospective study of healthy subjects undergoing health checkups and liver donors in Korea. Dig Dis Sci 2015; 60:234-242. [PMID: 25118979 DOI: 10.1007/s10620-014-3293-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 07/13/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS The controlled attenuation parameter (CAP) is a noninvasive method of assessing hepatic steatosis. We defined the normal range of CAP values in healthy subjects and evaluated the associated factors. METHODS CAP values were measured in a cohort of healthy subjects who were screened as living liver transplantation donors and those who underwent health checkups. Subjects with current or a history of chronic liver disease, abnormalities on liver-related laboratory tests, or fatty liver on ultrasonography or biopsy were excluded. RESULTS The mean age of the 264 recruited subjects (131 males and 133 females; 76 potential liver donors and 188 subjects who had undergone health checkups) was 49.2 years. The mean CAP value was 224.8 ± 38.7 dB/m (range 100.0-308.0 dB/m), and the range of normal CAP values (5th-95th percentiles) was 156.0-287.8 dB/m. The mean CAP value was significantly higher in the health checkup than in the potential liver donor group (227.5 ± 42.0 vs. 218.2 ± 28.3 dB/m, P = 0.040). CAP values did not differ significantly according to gender or age in either group (all P > 0.05). In a multivariate linear regression analysis, body mass index (β = 0.271, P = 0.024) and triglyceride levels (β = 0.348, P = 0.008) were found to be independently associated with CAP values. CONCLUSION We determined the normal range of CAP values and found that body mass index and triglyceride levels were associated with the CAP values of healthy subjects.
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Affiliation(s)
- Young Eun Chon
- Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea
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Alsebaey A. Normal liver stiffness: A study in living donors with normal liver histology. World J Hepatol 2015. [DOI: https://doi.org/10.4254/wjh.v7.i8.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Alsebaey A. Normal liver stiffness: A study in living donors with normal liver histology. World J Hepatol 2015. [DOI: https:/doi.org/10.4254/wjh.v7.i8.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Huang Z, Zheng J, Zeng J, Wang X, Wu T, Zheng R. Normal liver stiffness in healthy adults assessed by real-time shear wave elastography and factors that influence this method. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2549-2555. [PMID: 25282481 DOI: 10.1016/j.ultrasmedbio.2014.05.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 06/03/2023]
Abstract
Real-time shear wave elastography (SWE) is a novel two-dimensional elastographic method that is used to estimate the severity of liver fibrosis. However, the normal range of liver stiffness (LS) and the possible factors that influence SWE are not well understood. The aims of the current study are to define the normal range of LS in healthy subjects and to explore the factors that may affect SWE. A total of 509 healthy subjects underwent SWE to determine the stiffness of their livers, and the effects of gender, age and body mass index (BMI) on LS were analyzed. The effects of different factors on SWE, including the testing position, measurement depth and size of the region of interest (ROI), were analyzed in 137 subjects. SWE imaging was successfully performed in 502 healthy subjects (98.6%, 502/509). The mean value of the SWE measurements in 502 individuals was 5.10 ± 1.02 kPa, and the 95% confidence interval was 5.02-5.19 kPa (range: 2.4-8.7 kPa). We found that the detective position within the liver had a significant impact on the liver stiffness measurement (LSM), and the lowest coefficient of variation (CV = 8%) was obtained for LSMs made at segment V. LS was greater at a depth >5 cm (5.78 ± 1.66 kPa) compared with depths ≤5 cm (4.66 ± 0.77 kPa, p < 0.001); LS was also greater in men than in women (5.45 ± 1.02 kPa vs. 4.89 ± 0.96 kPa, p < 0.001). However, there were no significant differences in the LS values regarding the size of the ROI, age or BMI (all p > 0.05). The mean LS value in all 502 healthy subjects was 5.10 ± 1.02 kPa. The mean LS value obtained by SWE was not influenced by the size of the ROI, age or BMI, but the mean value was significantly influenced by the different segments of the liver, the detection depth and gender.
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Affiliation(s)
- Zeping Huang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jian Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jie Zeng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoli Wang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Tao Wu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
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Lee HW, Yoo EJ, Kim BK, Kim SU, Park JY, Kim DY, Ahn SH, Han KH. Prediction of development of liver-related events by transient elastography in hepatitis B patients with complete virological response on antiviral therapy. Am J Gastroenterol 2014; 109:1241-1249. [PMID: 24957159 DOI: 10.1038/ajg.2014.157] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/05/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In the era of antiviral therapy, the prognostic significance of serum hepatitis B virus (HBV) DNA level as a biological gradient substantially diminished, as most patients can achieve complete virological response (CVR). We aimed to investigate the predictive roles of liver stiffness (LS) for liver-related events (LREs) among patients with CVR. METHODS We analyzed 192 patients with chronic HBV infection who achieved CVR (defined as HBV DNA <20 IU/ml) through entecavir therapy. LS values at CVR were measured using transient elastography. LREs were defined as any cirrhotic complication, hepatocellular carcinoma, and liver-related mortality. RESULTS The median age of the patients was 49 years, and 134 (69.8%) were male. The median LS value at CVR was 8.8 kPa. During follow-up, LREs occurred in 25 (13.0%) patients. When the population was stratified into three groups (<8.0 kPa, 8.0-13.0 kPa, and >13.0 kPa), cumulative LRE incidences increased significantly in association with LS values (log-rank test, P=0.001). Patients with an LS value >13.0 kPa (hazard ratio (HR)=12.336, 95% confidence interval (CI) 1.335-114.010; P=0.027) and 8.0-13.0 kPa (HR=8.832, 95% CI 1.092-71.432; P=0.041) were at significantly greater risk compared with those with an LS value <8.0 kPa. On multivariate analysis, age and LS values were seen to be independent predictors (all P<0.05). When LS values were incorporated into the REACH-B scoring model instead of serum HBV DNA level, a better predictive performance was seen compared with a conventional approach (areas under the receiver operating characteristic curve, 0.814 vs. 0.629, respectively). CONCLUSIONS LS values at CVR are useful for predicting forthcoming LRE development. Thus, in the era of potent antiviral therapy, tailored surveillance strategies might be established based upon LS values at CVR.
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Affiliation(s)
- Hye Won Lee
- 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] The first two authors contributed equally to this work
| | - Eun Jin Yoo
- 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] The first two authors contributed equally to this work
| | - Beom Kyung Kim
- 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Seung Up Kim
- 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Jun Yong Park
- 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Do Young Kim
- 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Sang Hoon Ahn
- 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Brain Korea 21 Project for Medical Science, Seoul, Korea
| | - Kwang-Hyub Han
- 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Brain Korea 21 Project for Medical Science, Seoul, Korea
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Cequera A, García de León Méndez M. Biomarkers for liver fibrosis: Advances, advantages and disadvantages. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2014. [DOI: 10.1016/j.rgmxen.2014.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Concurrent use of methotrexate and celecoxib increases risk of silent liver fibrosis in rheumatoid arthritis patients with subclinical reduced kidney function. Clin Rheumatol 2014; 33:1415-23. [DOI: 10.1007/s10067-014-2719-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 05/31/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
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[Biomarkers for liver fibrosis: advances, advantages and disadvantages]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2014; 79:187-99. [PMID: 24954541 DOI: 10.1016/j.rgmx.2014.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/21/2014] [Indexed: 12/17/2022]
Abstract
Liver cirrhosis in Mexico is one of the most important causes of death in persons between the ages of 25 and 50 years. One of the reasons for therapeutic failure is the lack of knowledge about the molecular mechanisms that cause liver disorder and make it irreversible. One of its prevalent anatomical characteristics is an excessive deposition of fibrous tissue that takes different forms depending on etiology and disease stage. Liver biopsy, traditionally regarded as the gold standard of fibrosis staging, has been brought into question over the past decade, resulting in the proposal for developing non-invasive technologies based on different, but complementary, approaches: a biological one that takes the serum levels of products arising from the fibrosis into account, and a more physical one that evaluates scarring of the liver by methods such as ultrasound and magnetic resonance elastography; some of the methods were originally studied and validated in patients with hepatitis C. There is great interest in determining non-invasive markers for the diagnosis of liver fibrosis, since at present there is no panel or parameter efficient and reliable enough for diagnostic use. In this paper, we describe the biomarkers that are currently being used for studying liver fibrosis in humans, their advantages and disadvantages, as well as the implementation of new-generation technologies and the evaluation of their possible use in the diagnosis of fibrosis.
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Abstract
Liver fibrosis is the final common pathway for almost all causes of chronic liver injury. Liver fibrosis is now known to be a dynamic process having significant potential for resolution. Therefore, fibrosis prediction is an essential part of the assessment and management of patients with chronic liver disease. As such, there is strong demand for reliable liver biomarkers that provide insight into disease etiology, diagnosis, therapy, and prognosis in lieu of more invasive approaches such as liver biopsy. Current diagnostic strategies range from use of serum biomarkers to more advanced imaging techniques including transient elastography and magnetic resonance imaging. In addition to these modalities, there are other approaches including the use of novel, but yet to be validated, biomarkers. In this chapter, we discuss the biomarkers of liver fibrosis including the use of invasive and noninvasive biomarkers and disease-specific biomarkers in various chronic liver diseases.
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Chon YE, Kim SU, Park JY, Kim DY, Ahn SH, Han KH, Chon CY, Lee S. Dynamics of the liver stiffness value using transient elastography during the perioperative period in patients with valvular heart disease. PLoS One 2014; 9:e92795. [PMID: 24670988 PMCID: PMC3966817 DOI: 10.1371/journal.pone.0092795] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/25/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIMS Liver congestion due to heart failure in patients with valvular heart disease (VHD) can result in an overestimate of the liver stiffness (LS) as assessed by transient elastography (TE). This prospective pilot study investigated the dynamics of LS during the perioperative valve operation period. METHODS Thirty-two patients who underwent a valve operation (case) and 12 who underwent a varicose vein operation (control) were prospectively enrolled. LS and cardiologic parameters at three time points [baseline, post-operative day (POD)7, and POD90] were collected. RESULTS LS at three time points were consistently higher in the case group than those in the control group, although all participants did not show evidence of underlying chronic liver disease (all P<0.05). In the case group, LS at POD7 increased slightly from the LS at baseline (median 7.9→8.4 kPa, P = 0.816), whereas LS at POD90 decreased significantly from the LS at POD7 (median 8.4→6.0 kPa; P = 0.026). LS was significantly correlated with N-terminal-pro brain natriuretic peptide (NT-proBNP) (ρ = 0.412), left ventricular ejection fraction (ρ = -0.494), and central venous pressure during the operation (ρ = 0.555) at baseline (all P<0.05). LS was significantly correlated with NT-proBNP (ρ = 0.526) and right ventricular pressure (ρ = 0.572) at POD7, whereas LS was significantly correlated with NT-proBNP (ρ = 0.590) at POD90 (all P<0.05). CONCLUSIONS LS can be overestimated in patients with VHD due to hepatic congestion. However, LS can be dynamically reversed during the perioperative period reflecting the restoration of cardiac function after a successful operation.
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Affiliation(s)
- Young Eun Chon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Chae Yoon Chon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
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Lee S, Kim DY. Non-invasive diagnosis of hepatitis B virus-related cirrhosis. World J Gastroenterol 2014; 20:445-459. [PMID: 24574713 PMCID: PMC3923019 DOI: 10.3748/wjg.v20.i2.445] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/25/2013] [Accepted: 12/06/2013] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis B (CHB) infection is a major public health problem associated with significant morbidity and mortality worldwide. Twenty-three percent of patients with CHB progress naturally to liver cirrhosis, which was earlier thought to be irreversible. However, it is now known that cirrhosis can in fact be reversed by treatment with oral anti-nucleotide drugs. Thus, early and accurate diagnosis of cirrhosis is important to allow an appropriate treatment strategy to be chosen and to predict the prognosis of patients with CHB. Liver biopsy is the reference standard for assessment of liver fibrosis. However, the method is invasive, and is associated with pain and complications that can be fatal. In addition, intra- and inter-observer variability compromises the accuracy of liver biopsy data. Only small tissue samples are obtained and fibrosis is heterogeneous in such samples. This confounds the two types of observer variability mentioned above. Such limitations have encouraged development of non-invasive methods for assessment of fibrosis. These include measurements of serum biomarkers of fibrosis; and assessment of liver stiffness via transient elastography, acoustic radiation force impulse imaging, real-time elastography, or magnetic resonance elastography. Although significant advances have been made, most work to date has addressed the diagnostic utility of these techniques in the context of cirrhosis caused by chronic hepatitis C infection. In the present review, we examine the advantages afforded by use of non-invasive methods to diagnose cirrhosis in patients with CHB infections and the utility of such methods in clinical practice.
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Cha SW, Jeong WK, Kim Y, Kim MY, Kim J, Kim SY, Ryu JA, Kim TY, Sohn JH, Kim YH. Nondiseased liver stiffness measured by shear wave elastography: a pilot study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:53-60. [PMID: 24371099 DOI: 10.7863/ultra.33.1.53] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the value of liver stiffness in patients without liver disease using shear wave elastography and to determine the liver stiffness threshold value for identifying patients with chronic liver diseases. METHODS A total of 150 patients who underwent liver sonography coupled with shear wave elastography were enrolled. On the basis of clinical and pathologic criteria, they were assigned to 1 of 2 groups: nondiseased liver (n = 97) and noncirrhotic chronic liver disease (n = 53). Liver stiffness was measured in the right liver, and the median value of 10 measurements was calculated. Both mean and median values in the nondiseased liver group were compared with those in the noncirrhotic chronic liver disease group. To validate this comparison, liver stiffness of the patients who underwent liver biopsy revealing either no fibrosis (fibrosis score F0; n = 5) or substantial fibrosis (F2; n = 14) was also investigated and compared. To determine the optimal threshold value for determining chronic liver disease, a receiver operating characteristic curve analysis was performed. RESULTS The mean liver stiffness value in the nondiseased liver group was 5.4 kPa. In the noncirrhotic chronic liver disease group, the mean value was 8.1 kPa. Differences between the nondiseased liver and both noncirrhotic chronic liver disease groups were statistically significant (P < .001). The optimal liver stiffness threshold value for discriminating nondiseased liver from noncirrhotic chronic liver disease was 6.9 kPa. The sensitivity using this threshold was 94%. In the biopsy-proven patients, the mean liver stiffness values were 6.0 kPa in the F0 group and 9.9 kPa in the F2 group. CONCLUSIONS The range of liver stiffness in patients with nondiseased liver and the optimal threshold value for discriminating these patients from those with chronic liver disease were identified.
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Affiliation(s)
- Seung Woo Cha
- current address: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul 135-710, Korea.
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The concomitant use of meloxicam and methotrexate does not clearly increase the risk of silent kidney and liver damages in patients with rheumatoid arthritis. Rheumatol Int 2013; 34:833-40. [PMID: 24362788 DOI: 10.1007/s00296-013-2920-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 12/06/2013] [Indexed: 01/08/2023]
Abstract
We investigated whether the concomitant use of meloxicam and methotrexate might induce kidney and liver damages in patients with rheumatoid arthritis (RA). We enrolled 101 RA patients with normal kidney and liver functions taking meloxicam and methotrexate concomitantly for more than 6 months. Blood and urine tests were performed. Estimated glomerular filtration rate (eGFR) and liver stiffness measurement (LSM) were used for evaluating silent kidney and liver damages. Ultrasonography was also performed to exclude structural abnormalities. We adopted 90 mL/min/1.73 mm(2) and 5.3 kPa as the cutoff for an abnormal eGFR and LSM. The mean age (85 women) was 51.9 years. The mean eGFR was 97.0 mL/min/1.73 m(2) and the mean LSM was 4.7 kPa. The mean weekly dose of methotrexate was 13.4 mg. The mean weekly dose of methotrexate did not correlate with eGFR or LSM. Neither the cumulative dose of meloxicam or methotrexate nor the mean weekly dose of methotrexate showed the significant odds ratio or relative risk for abnormal eGFR and LSM values. The use of higher-dose MTX, above 15 mg per week, with meloxicam did not significantly increase the risk for abnormal LSM and eGFR (RR = 2.042, p = 0.185; RR = 0.473, p = 0.218). The concomitant use of meloxicam and MTX did not clearly increase the risk of silent kidney or liver damage in RA patients with normal laboratory results taking MTX and meloxicam concurrently for over 6 months.
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Venkatesh SK, Wang G, Teo LLS, Ang BWL. Magnetic resonance elastography of liver in healthy Asians: normal liver stiffness quantification and reproducibility assessment. J Magn Reson Imaging 2013; 39:1-8. [PMID: 24123300 DOI: 10.1002/jmri.24084] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 01/24/2013] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine normal liver stiffness values evaluated with magnetic resonance elastography (MRE) in healthy normal Asian volunteers and assess its reproducibility. MATERIALS AND METHODS Liver stiffness was evaluated with MRE in 41 healthy Asians (23 females, 18 males; mean age, 41.8 years, and mean body mass index [BMI], 23.4 kg/m(2) ) on a 1.5T clinical scanner. The correlations between mean liver stiffness and age, gender, BMI, and fat fraction percentage of the liver were studied. Another 12 volunteers underwent liver MRE exams on two separate days 4-6 weeks apart under similar conditions for reproducibility assessment. Intraclass correlation coefficient (ICC) analysis was performed and within-subject coefficient of variation (CV) of stiffness was estimated. RESULTS The mean ± standard deviation (SD) of liver stiffness in normal healthy Asian subjects was 2.09 ± 0.22 kPa (95% confidence interval [CI], 2.04-2.15 kPa; range 1.68-2.48 kPa). The mean liver stiffness did not significantly correlate with age, gender, BMI, or fat content of the liver. The ICC for mean liver stiffness was 0.90 (95% CI, 0.78-0.96) and CV ranged from 2.2%-11.4%. CONCLUSION The liver stiffness in normal Asians is not affected by age, gender, BMI, or fat content. Liver stiffness with MRE is highly reproducible.
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Affiliation(s)
- Sudhakar K Venkatesh
- Radiology, Mayo Clinic, Rochester, Minnesota, USA; Diagnostic Imaging, National University Health System, Singapore
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Lee SH, Joo DJ, Kim SU, Kim MS, Lee AL, Choi GH, Choi JS, Han KH, Kim SI. Graft function measured by transient elastography in living donor liver transplantation: preliminary. Transplant Proc 2013; 45:3028-3031. [PMID: 24157028 DOI: 10.1016/j.transproceed.2013.08.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Liver stiffness measurements (LSMs) using transient elastography (TE) provide a noninvasive means to assess liver fibrosis that correlate with hepatic cholestasis. However, few studies have examined the correlation of TE to obtain LSMs with perioperative clinical and laboratory parameters in living donor liver transplantation (LDLT). PATIENTS AND METHODS We retrospectively reviewed forty-eight subjects who underwent LDLT between November 2010 and October 2012. All donors and recipients underwent TE, abdominal computed tomography (CT), and biochemical tests within 1 month before and at 1 week after transplantation. Using a cut-off LSM of 7.5 kPa, which we arbitrarily assigned to be indicative of significant fibrosis, we divided our study population into ≤7.5 kPa (group L; n = 15, 31.3%) versus >7.5 kPa; (group H; n = 33, 68.8%). RESULTS Pretransplantation serum total bilirubin, international normalized ratio, and Model for End-stage Liver Disease scores of recipients were significantly higher in group H than group L. Regarding the pretransplantation donor characteristics, the graft-recipient weight ratio was significantly smaller among those in group H (P = .039). In addition, the post-transplantation 1-week serum total bilirubin level was significantly higher in group H (2.3 mg/dL versus 1.2 mg/dL, P = .015), although neither biliary complications norhepatic congestion was identified by abdominal CT. Among the 1-week post-transplantation laboratory findings, only total bilirubin positively correlated with LSM (P = .044). CONCLUSIONS This pilot study suggested that a high LSM after LDLT suggests intrahepatic cholestasis and portal hypercirculation in the graft, irrespective of liver fibrosis, outflow obstruction, or biliary obstruction.
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Affiliation(s)
- S H Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea; Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
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Hasson H, Merli M, Galli L, Gallotta G, Carbone A, Messina E, Bagaglio S, Morsica G, Salpietro S, Castagna A, Lazzarin A, Uberti-Foppa C. Non-invasive fibrosis biomarkers - APRI and Forns - are associated with liver stiffness in HIV-monoinfected patients receiving antiretroviral drugs. Liver Int 2013; 33:1113-20. [PMID: 23534616 DOI: 10.1111/liv.12159] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 03/04/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS HIV-monoinfected patients are susceptible to liver injury by different factors and may develop liver fibrosis, which requires adequate clinical management in terms of therapy and disease monitoring. We aimed to evaluate the presence of liver fibrosis identified by transient elastography (TE), its relationships with indirect biochemical markers [the aspartate aminotransferase/platelet ratio index (APRI), the Forns index and FIB-4] and its predictive factors in HIV-monoinfected patients receiving antiretroviral therapy (ART). METHODS Seventy-two HIV-monoinfected patients underwent TE and were evaluated using APRI, Forns and FIB-4. The clinical, immunological, virological and other biochemical characteristics were evaluated at the time of TE, together with their history of ART. RESULTS Seven patients (10%) had liver stiffness (LS) values predicting cirrhosis, and 12 (17%) had values predicting significant or advanced fibrosis. Higher indirect biochemical scores of liver fibrosis were significantly associated with higher LS values [APRI rs = 0.4296 (P < 0.001); Forns rs = 0.4754 (P < 0.001); FIB-4 rs = 0.285 (P = 0.015)]. At multivariable analysis, APRI (β = 2.7405; P = 0.036), Forns (β = 1.4174; P = 0.029) and triglyceride levels (β = 1.3028; P = 0.007) were independently associated with LS. CONCLUSIONS Indirect fibrosis biomarkers may increase the probability to detect liver injury enhancing a specific diagnostic workup and so contribute to improving the clinical management of HIV-monoinfected patients with clinically suspected liver disease.
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Affiliation(s)
- Hamid Hasson
- Department of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
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Northcott MJ, Ong WL, Walsh M, McCarthy P, Belleli D, Tran H, Street A, Kemp W, Davis AK. Prevalence of transfusion-acquired hepatitis C in an Australian bleeding disorders population. Haemophilia 2013; 19:847-52. [DOI: 10.1111/hae.12204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 12/30/2022]
Affiliation(s)
- M. J. Northcott
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - W. L. Ong
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - M. Walsh
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - P. McCarthy
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - D. Belleli
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - H. Tran
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - A. Street
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - W. Kemp
- Gastroenterology Department; The Alfred Hospital; Melbourne Australia
| | - A. K. Davis
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
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Ling W, Lu Q, Quan J, Ma L, Luo Y. Assessment of impact factors on shear wave based liver stiffness measurement. Eur J Radiol 2013; 82:335-341. [PMID: 23116805 DOI: 10.1016/j.ejrad.2012.10.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/19/2012] [Accepted: 10/01/2012] [Indexed: 02/06/2023]
Abstract
Shear wave based ultrasound elastographies have been implemented as non-invasive methods for quantitative assessment of liver stiffness. Nonetheless, there are only a few studies that have investigated impact factors on liver stiffness measurement (LSM). Moreover, standard examination protocols for LSM are still lacking in clinical practice. Our study aimed to assess the impact factors on LSM to establish its standard examination protocols in clinical practice. We applied shear wave based elastography point quantification (ElastPQ) in 21 healthy individuals to determine the impact of liver location (segments I-VIII), breathing phase (end-inspiration and end-expiration), probe position (sub-costal and inter-costal position) and examiner on LSM. Additional studies in 175 healthy individuals were also performed to determine the influence of gender and age on liver stiffness. We found significant impact of liver location on LSM, while the liver segment V displayed the lowest coefficient of variation (CV 21%). The liver stiffness at the end-expiration was significantly higher than that at the end-inspiration (P=2.1E-05). The liver stiffness was 8% higher in men than in women (3.8 ± 0.7 kPa vs. 3.5 ± 0.4 kPa, P=0.0168). In contrast, the liver stiffness was comparable in the different probe positions, examiners and age groups (P>0.05). In conclusion, this study reveals significant impact from liver location, breathing phase and gender on LSM, while furthermore strengthening the necessity for the development of standard examination protocols on LSM.
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Affiliation(s)
- Wenwu Ling
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China.
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Han SH, Kim SU, Kim CO, Jeong SJ, Park JY, Choi JY, Kim DY, Ahn SH, Song YG, Han KH, Kim JM. Abnormal liver stiffness assessed using transient elastography (Fibroscan®) in HIV-infected patients without HBV/HCV coinfection receiving combined antiretroviral treatment. PLoS One 2013; 8:e52720. [PMID: 23300987 PMCID: PMC3536776 DOI: 10.1371/journal.pone.0052720] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 11/20/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIMS Liver stiffness measurement (LSM) using transient elastography (Fibroscan®) can identify individuals with potential underlying liver disease. We evaluated the prevalence of abnormal LSM values as assessed using LSM and its predictors in HIV-infected asymptomatic patients receiving combined antiretroviral treatment (cART) without HBV/HCV coinfection. METHODS We prospectively recruited 93 patients who had consistently been undergoing cART for more than 12 months at Severance Hospital in Seoul, Republic of Korea, from June to December 2010. LSM values >5.3 kPa were defined as abnormal. RESULTS Thirty-nine (41.9%) had abnormal LSM values. On multivariate correlation analysis, the cumulative duration of boosted and unboosted protease inhibitors (PIs) were the independent factors which showed a negative and positive correlation to LSM values, respectively (β = -0.234, P = 0.023 and β = 0.430, P<0.001). In multivariate logistic regression analysis, the cumulative exposure duration of boosted-PIs and γ-glutamyltranspeptidase levels were selected as the independent predictors which showed a negative and positive correlation with abnormal LSM values, respectively (odds ratio [OR], 0.941; 95% confidence interval [CI], 0.889-0.997; P = 0.039 and OR, 1.032; 95% CI, 1.004-1.060; P = 0.023). CONCLUSION The high percentage of HIV-infected asymptomatic patients receiving cART without HBV/HCV coinfection had abnormal LSM values. The cumulative exposure duration of boosted-PIs and γ-GT level were independent predictors which showed a negative and positive correlation with abnormal LSM values, respectively.
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Affiliation(s)
- Sang Hoon Han
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine and Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Oh Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Yong Park
- Department of Internal Medicine and Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine and Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine and Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Goo Song
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine and Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - June Myung Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Lee SW, Park HJ, Kim BK, Han KH, Lee SK, Kim SU, Park YB. Leflunomide increases the risk of silent liver fibrosis in patients with rheumatoid arthritis receiving methotrexate. Arthritis Res Ther 2012; 14:R232. [PMID: 23107811 PMCID: PMC3580544 DOI: 10.1186/ar4075] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/14/2012] [Accepted: 10/25/2012] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION We identified silent liver fibrosis in patients with rheumatoid arthritis (RA) using transient elastography, and investigated medication that correlated with abnormal liver stiffness measurement (LSM) values. METHODS We consecutively enrolled 105 patients with RA taking methotrexate over 24 weeks with normal liver functions and no history of underlying chronic liver disease. Blood tests were performed, and body mass index and metabolic syndrome were assessed. We checked LSM values, and adopted 5.3 kPa as the cutoff for abnormal LSM values. The cumulative doses of medications including methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, prednisolone, meloxicam, and celecoxib were calculated. RESULTS The median age of patients (20 men and 85 women) was 52.4 years. The median LSM value was 4.7 kPa and 24 (22.9%) patients had abnormal LSM values. Gamma-glutamyltranspeptidase levels and the cumulative doses of leflunomide and prednisolone significantly correlated with LSM values (P<0.05). The cumulative dose of leflunomide, but not methotrexate, was significantly higher in patients with abnormal LSM values than that in patients with normal LSM values (P = 0.008). When RA patients receiving leflunomide plus methotrexate were classified into two groups according to the optimal cutoff cumulative dose of leflunomide (19,170 mg), abnormal LSM values were more frequently identified in patients with high cumulative dose of leflunomide (odds ratio, 12.750; P<0.001). CONCLUSIONS The cumulative dose of leflunomide was the only independent predictor of abnormal LSM values in patients with RA who had received methotrexate for more than six months.
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Affiliation(s)
- Sang-Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu Seoul, 120-752, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine,; 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
| | - Hee-Jin Park
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu Seoul, 120-752, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine,; 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu Seoul, 120-752, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
- Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu Seoul, 120-752, Korea
- Department of Medical Sciences, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
- Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
| | - Soo-Kon Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu Seoul, 120-752, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine,; 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
- Department of Medical Sciences, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu Seoul, 120-752, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
- Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
| | - Yong-Beom Park
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu Seoul, 120-752, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine,; 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
- Department of Medical Sciences, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu; Seoul, 120-752, Korea
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