Etiology Of Chronic Liver Disease Research Articles

Causes of Death among Patients with Hepatocellular Carcinoma According to Chronic Liver Disease Etiology.

This study was conducted to determine whether the causes of death among patients with hepatocellular carcinoma (HCC) differ according to chronic liver disease (CLD) etiology. Between 2011 and 2020, 3977 patients who were newly diagnosed with HCC at our institution were enrolled in this study. We determined whether the cause of death was HCC-related and non-HCC-related. For patients with multiple CLD etiologies, etiology was classified using the following hierarchy: hepatitis C virus (HCV) > hepatitis B virus (HBV) > alcohol-related causes > all negative. All negative was defined as negative for HCV, HBV, and alcohol-related causes. Among 3977 patients, 1415 patients were classified as HCV-related, 1691 patients were HBV-related, 145 patients were alcohol-related, and 725 patients were all negative. HCC-related mortality was the leading cause of death, irrespective of etiology. Among patients who underwent curative treatment, HCC-related mortality was the leading cause of death for patients in the HCV, HBV, and all-negative groups, but not for patients in the alcohol-related group. Among patients 75 years and older who underwent curative treatment, HCC-related mortality was the leading cause of death in the HCV but not HBV or all-negative groups. In conclusion, although most patients with HCC die due to HCC-related causes, non-HCC-related mortality represents a competing event in certain patient subgroups. The current study results underscore the importance of assessing and managing underlying comorbidities, particularly among patients with HCC at risk of non-HCC-related mortality.

Diagnostic Accuracy of a Nurse-Led Transient Elastography: A Study of a Tertiary Hospital Experience.

Once thought rare, liver disease is an emerging cause of significant morbidity and mortality. The rising burden of liver disease necessitates a competent workforce to deliver quality healthcare to patients with liver diseases. Staging liver diseases is essential in disease management. Transient elastography as compared with liver biopsy, the gold standard in staging of the disease, has gained wide acceptance in this field. This study examines the diagnostic accuracy of nurse-led transient elastography in staging fibrosis in chronic liver diseases at a tertiary referral hospital. Audit of records to locate transient elastography and liver biopsy performed within 6 months of interval yielded 193 cases for this retrospective study. A data abstraction sheet was prepared for extracting the relevant data. The content validity index and reliability of the scale were above 0.9. The diagnostic accuracy of liver stiffness evaluation (in kPa) by nurse-led transient elastography to grade fibrosis was categorized as "significant and advanced" and tested against the Ishak staging of liver biopsy. SPSS v.25 was used to perform the analysis. All tests were two-sided at a .01 level of significance. Area under the receiver operating characteristic curve, a graphical plot, illustrated the diagnostic ability of nurse-led transient elastography for significant fibrosis as 0.93 (95% confidence interval [CI] 0.88-0.99; p < .001) and advanced fibrosis as 0.89 (95% CI 0.83-0.93; p < .001). Spearman's ρ correlation between liver stiffness evaluation and liver biopsy was significant ( p = .01). Nurse-led transient elastography showed a significant diagnostic accuracy in staging hepatic fibrosis irrespective of the etiology of chronic liver disease. Given the increase in chronic liver disease, introducing more such nurse-led clinics increases the potential for early detection and improves care outcomes for this population.

High prevalence of liver fibrosis among general population: a Romanian population-based study.

Cirrhosis can be present undected for years prior to a symptomatic presentation. Early detection may result in improved outcomes. Data are lacking, however, regarding the yield of screening in many populations. We aimed to determined prevalence of significant liver fibrosis diagnosed by vibration-controlled transient elastography (VCTE) in apparently healthy Romanians. Between December 2021 and March 2022, we prospectively screened 1,027 subjects from different counties of Northeastern Romania using VCTE and B-mode ultrasonagraphy after a comprehensive medical history questionnaire. Participants with abnormal liver stiffness measurement values were further evaluated by laboratory tests to identify the severity and etiology of chronic liver disease. Overall, 17.9% of subjects had liver stiffness measurments (LSM) ≥8 kpa, including 55 with LSM ≥13.0 kpa. Among these subjects, 26.1% had a history of heavy alcohol intake, 22.3% tested positive for hepatitis B and/or C infection, and 49.5% were diagnosed with NAFLD. The prevalence of elevated LSM was highest among older subjects (>60 y old) and those with diabetes. Among those with LSM ≥13 kPa and ≥9.6 kpa, FIB-4 was <2.67 in 46.9% and 87.5% respectively. There is high prevalence of significant liver fibrosis in the Romanian general population. VCTE is a usefool tool for early detection of liver disease and appears more sensitive than FIB-4.

Efficacy of atezolizumab/bevacizumab combination therapy in BCLC-C cirrhotic patients with hepatocellular carcinoma (HCC) according to the type of disease progression.

557 Background: HCC recurs in 70-80% of cases following potentially curative liver resection (LR) or radiofrequency ablation (RFA) and the immune component of the liver microenvironment plays a key role in early recurrence. The aim of our study was to retrospectively evaluate, under real life conditions, the overall survival (OS) of patients with advanced HCC (BCLC-C stage), either initially presented in the advanced stage or migrating from BCLC-A to BCLC-C stage within 2 years after curative LR or RFA, treated either with atezolizumab-bevacizumab (ATZ/BEV) combination or with TKIs sequentially (sorafenib as first line and cabozantinib as second line treatment). Methods: Sixty cirrhotic patients with advanced HCC (53 males, mean age 67y, 35% with diabetes, CPT-A=68.3%/CPT-B=28.3%, mean MELD/Na=11, ALBI grade I=28.3%/ALBI grade II=61.7%, 45% with varices) who either initially presented on the BCLC-C stage and were treated with ATZ/BEV (group A, N=19) or TKIs (group B, N=15) or who migrated from BCLC-A to BCLC-C stage within 2 years after LR or RFA and were treated with ATZ/BEV (group C, N=12) or TKIs (group D, N=14) were evaluated. Results: The four groups were comparable for all the baseline parameters evaluated (age p=0.9, gender p=0.1, platelets p=0.4, chronic liver disease etiology p=0.6, coexistence of diabetes p=0.3, presence of varices p=0.1, CPT stage p=0.1, ALBI grade p=0.3). Median OS was significantly higher for group C patients (mean survival 33.7m, median OS was not reached at the time of evaluation) compared to group D (mOS=27m), group A (mOS=13m) and group B (mOS=8m) patients, as presented in figure 1. It is important to note that the survival after HCC recurrence for group C patients (mean survival=18.2m, median OS was not reached at the time of evaluation) was significantly higher compared to those of group D patients (mOS=9m). Conclusions: Median survival of TKI-treated patients after HCC recurrence is less than 12m and is comparable to survivals observed in patients who initially classified in BCLC-C stage, irrespective of treatment schedule. ATZ/BEV combination therapy significantly prolongs survival in patients after early HCC recurrence, a finding that strongly supports the rationale for adjuvant ATZ/BEV therapy in high risk of recurrence patients.

Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease: The Prognostic Role of Liver Stiffness Measurement.

Nonalcoholic fatty liver disease (NAFLD), which is nowadays the most common etiology of chronic liver disease, is associated with an increased risk of hepatocellular carcinoma (HCC), with or without cirrhosis. Owing to the high prevalence of NAFLD worldwide, it becomes crucial to develop adequate strategies for surveillance of HCC and new prediction models aiming at stratifying NAFLD population for HCC risk. To this purpose, several noninvasive tests (NITs) have been proposed in the several last years, including clinical parameters, serum biomarkers, and imaging techniques. Most of these tools are focused on the assessment of liver fibrosis. Both ultrasound (US) elastography (especially transient elastography) and magnetic resonance (MR) elastography have been evaluated to estimate HCC risk in NAFLD patients. Recently, the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) include these techniques among the recommended NITs for the assessment of liver fibrosis. The aim of this review is to summarize the most recent data on the role of US and MR elastography in HCC risk stratification in patients with NAFLD.

Changes in the etiology of chronic liver disease by referral to a FibroScan center: Increasing prevalence of the nonalcoholic fatty liver disease.

Chronic liver disease (CLD) is a leading cause of morbidity and mortality worldwide with a wide etiological spectrum. FibroScan® is used for follow-up of fibrosis and steatosis. This single-center study aims to review the distribution of indications by referral to FibroScan®. Demographic characteristics, CLD etiologies, and FibroScan® parameters of the patients who were referred to our tertiary care center between 2013 and 2021 were retrospectively evaluated. Out of 9345 patients, 4946 (52.93%) were males, and the median age was 48 [18-88] years. Nonalcoholic fatty liver disease (NAFLD) was the most common indication (N=4768, 51.02%), followed by hepatitis B (N=3194, 34.18%) and hepatitis C (N=707, 7.57%). Adjusting for age, sex, and CLD etiology, the results revealed that patients with older age (Odds ratio (OR)=2.908; confidence interval (CI)=2.597-3.256; p<0.001) and patients with hepatitis C (OR=2.582; CI=2.168-3.075; p<0.001), alcoholic liver disease (OR=2.019; CI=1.524-2.674, p<0.001), and autoimmune hepatitis (OR=2.138; CI=1.360-3.660, p<0.001) had increased odds of advanced liver fibrosis compared to NAFLD. NAFLD was the most common indication for referral to FibroScan®.

Etiology of Chronic Liver Disease in North-Eastern India: Nafld is the Emerging Predominant Etiology

Etiology of Chronic Liver Disease in North-Eastern India: Nafld is the Emerging Predominant Etiology

Aspartate aminotransferase-to-platelet ratio index can predict the outcome in patients with stable decompensated cirrhosis.

Platelet (PLT)-based biomarkers have been studied for the evaluation of liver fibrosis and cirrhosis. There are no data regarding their prognostic significance in decompensated cirrhosis. We studied 525 stable decompensated patients from the 2 Greek transplant centers. We measured PLT values, mean PLT volume (MPV), red cell distribution width, γ-globulins, and calculated PLT-based scores: aspartate aminotransferase-to-PLT ratio index (APRI), γ-globulin-to-PLT model, and γ-glutamyl transpeptidase-to-PLT ratio (GPR). We followed our cohort for 12 (range: 1-84) months. Baseline mean model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores were 15±6 and 8±2, respectively. On univariate analysis, MPV/PLT (hazard ratio [HR] 3.75, 95% confidence interval [CI] 1-14.5; P=0.05), APRI (HR 1.03, 95%CI 1.006-1.06; P=0.016), GPR (HR 1.096, 95%CI 1.016-1.182; P=0.017) were significantly associated with our patients' outcome (survival vs. death or liver transplantation). In a multivariate model without MELD and CTP scores, APRI was the only significant factor associated with the outcome (HR 1.054, 95%CI 1.009-1.101; P=0.018). APRI had good discriminative ability for the outcome (area under the curve 0.723 vs. 0.675 and 0.656 for MELD and CTP scores, respectively). The optimal cutoff point was 1.3 (sensitivity 71%, specificity 65%). There were 200 patients (38%) with APRI scores <1.3 who had better survival than patients with APRI >1.3 (log rank 22.4, P<0.001). This study found a prognostic role for APRI in stable decompensated cirrhosis, regardless of the underlying etiology of chronic liver disease. This suggests new perspectives for PLT-based noninvasive scores to discriminate patients' outcomes.

Incident portal vein thrombosis in liver transplant recipients in New Zealand: Predictors of risk and validation of portal vein thrombosis risk index calculator.

The risk of spontaneous portal vein thrombosis (PVT) is increased in patients on the waiting list for liver transplantation and increases perioperative risks. A predictive PVT risk-index (PVT-RI) calculator has been proposed to determine the risk of incident PVT. We performed a retrospective analysis on adult liver transplant recipients at the NZ Liver Transplant Unit between January 1998 and February 2020. Variables reviewed included age at listing and transplantation, wait time from listing to transplant, indication for listing, gender, ethnicity, etiology of liver disease, listing MELD score, hepatocellular carcinoma (HCC), moderate-to-severe ascites, hepatic encephalopathy (>grade 2), transjugular intrahepatic portosystemic shunt (TIPSS), spontaneous bacterial peritonitis (SBP), and diabetes. Incident PVT was determined by imaging of patients while on the waiting list and assessment at transplantation. A total of 553 out of 706 patients met the inclusion criteria. Of those 553, 18 (3.3%) patients had incident PVT. The PVT-RI calculator was not validated in our cohort with only one of those 18 (6%) patients having a score of >4.6 (high risk cut-off score). Longer waiting time for transplant and listing for liver failure rather than HCC were independent predictors of the risk of incident PVT. There was no statistically significant difference in the incidence of PVT in viral vs. non-viral and cholestatic vs. non-cholestatic etiology of chronic liver disease. Patients with longer waiting times on the transplant waiting list should be monitored regularly for PVT.

Ultrasound-Based Diagnostic Methods: Possible Use in Fatty Liver Disease Area.

Liver steatosis is a chronic liver disease that is becoming one of the most important global health problems, due to its direct connection with metabolic syndrome, its significant impact on patients' socioeconomic status and frailty, and the occurrence of advanced chronic liver disease. In recent years, there has been rapid technological progress in the ultrasound-based diagnostics field that can help us to quantitatively assess liver steatosis, including continuous attenuation parameters in A and B ultrasound modes, backscatter coefficients (e.g., speed of sound) and ultrasound envelope statistic parametric imaging. The methods used in this field are widely available, have favorable time and financial profiles, and are well accepted by patients. Less is known about their reliability in defining the presence and degree of liver steatosis. Numerous study reports have shown the methods' favorable negative and positive predictive values in comparison with reference investigations (liver biopsy and MRI). Important research has also evaluated the role of these methods in diagnosing and monitoring non-alcoholic fatty liver disease (NAFLD). Since NAFLD is becoming the dominant global cause of liver cirrhosis, and due to the close but complex interplay of liver steatosis with the coexistence of liver fibrosis, knowledge regarding NAFLD's influence on the progression of liver fibrosis is of crucial importance. Study findings, therefore, indicate the possibility of using these same diagnostic methods to evaluate the impact of NAFLD on the patient's liver fibrosis progression risk, metabolic risk factors, cardiovascular complications, and the occurrence of hepatocellular carcinoma. The mentioned areas are particularly important in light of the fact that most of the known chronic liver disease etiologies are increasingly intertwined with the simultaneous presence of NAFLD.

Blood Ammonia Concentration in Children with Chronic Liver Disease: A Tool for Prediction of Esophageal Varices

Background: Esophageal varices (EVs) are a serious complication of portal hypertension in patient with chronic liver disease (CLD). The major portion of ammonia carried by portal blood is shunted into systemic circulation in chronic liver disease. The upper GI endoscopy is currently the best reliable method to diagnose the presence of esophageal varices. But it is invasive, relatively expensive and not easily available. Blood ammonia is a noninvasive and easily accessible laboratory parameter that can predict the presence of esophageal varices.&#x0D; Objectives: To observe the blood ammonia concentration in children with chronic liver disease: a tool for prediction of esophageal varices.&#x0D; Methods: This cross sectional observational study was conducted at the Department of Paediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh from January 2018 to December 2019. A total of 63 cases of CLD were selected. Study sample were selected according to the inclusion and exclusion criteria. Along with proper clinical history, examination &amp; initial investigation, fasting venous blood ammonia level and upper GI endoscopy were done in all patients. Receiver-Operator Characteristic (ROC) curve was analysis to set up a cut-off value of blood ammonia for prediction of esophageal varices. Sensivity, specificity, positive predictive value, negative predictive value and accuracy were determined to see the performance of blood ammonia value as a diagnostic test for esophageal varices.&#x0D; Results: Among the 63 patients, (74.6%) had esophageal varices. Wilson disease was the most common etiology of CLD (43; 68.3%) among the studied patients. The mean blood ammonia level were 40.5± 18.0 (µmol/L), 50.5± 14.3 (µmol/L), 50.7± 9.9 (µmol/L), 53.1± 26.9 (µmol/L) and 71.9± 19.0 (µmol/L) in absent esophageal varices, grade-I, grade-II, grade-III and grade-IV esophageal varices respectively. The difference was statistically significant (&lt;0.05). Moderate correlation (r= 0.452; p value = 0.001) between blood ammonia level and grades of esophageal varices was found. It was observed that wasting of thenar and hypothenar muscle was the most common stigmata, seen in 15 (23.8%) cases, 2 (3.2%) had clubbing, 7 (11.1%) had leuconychia, 1 (1.6%) had palmer erythema, 3 (4.8%) had gynacomasia and 1 (1.6%) had testicular atrophy. Wilson disease was the most common 43 (68.3%). It was observed that 45 (71.4 %) patients had raised serum ALT and 45 (71.4%) had low serum albumin (&lt;3.5 g/dl). Low haemoglobin (&lt;9 gm/dl) was found in 47 (74.6%) cases, raised serum bilirubin level (&gt;1.2 mg/dl) in 29 (46.03%) cases, thrombocytopenia (platelet count &lt;1.50×109/mm3) in 36 (57.1%) patients and prolonged INR (&gt;1.5) in 29 (46.03%) cases, blood ammonia was raised (&gt;32 µmol/L) in 52 (82.5%) cases. It was observed that the mean ± SD blood ammonia level was 56.2± 17.9 µmol/L in esophageal varices present group (n = 47) and 40.5± 18.0 µmol/L in absent esophageal varices group (n = 16). Here p value is 0.004, which is statistically significant.&#x0D; Conclusion: Blood ammonia concentration is a biochemical predictor for assessing the grading of esophageal varices. In the present study, a moderate positive correlation was found between blood ammonia concentration and grades of esophageal varices in children with CLD.

Biological Mechanisms and Related Natural Inhibitors of CD36 in Nonalcoholic Fatty Liver.

Non-alcoholic fatty liver disease (NAFLD), a spectrum of liver disorders from non-alcoholic fatty liver (NAFL) to the more severe non-alcoholic steatohepatitis (NASH), is the leading etiology of chronic liver disease and its global prevalence is increasing. Hepatic steatosis, a condition marked by an abnormal buildup of triglycerides in the liver, is the precursor to NAFLD. Differentiated cluster 36 (CD36), a scavenger receptor class B protein, is a membrane receptor that recognizes multiple lipid and non-lipid ligands. It is generally agreed that CD36 contributes significantly to hepatic steatosis by taking part in fatty acid uptake as well as triglyceride storage and secretion. While there has not been any conclusive research on how CD36 inhibitors prevent NAFLD from progressing and no clinically approved CD36 inhibitors are currently available for use in NAFLD, CD36 remains a target worthy of further investigation in NAFLD. In recent years, the potential role of natural products acting through CD36 in treating non-alcoholic fatty liver disease has attracted much attention. This paper offers an overview of the pathogenesis of CD36 in NAFLD and summarizes some of the natural compounds or extracts that are currently being investigated for modulating NAFLD via CD36 or the CD36 pathway, providing an alternative approach to the development of CD36-related drugs in NAFLD.

S1367 Underlying Etiology of Chronic Liver Disease Impacts Serum Hepcidin Levels: A Meta-Analysis

Introduction: Derangement of hepcidin-iron axis in chronic liver disease (CLD) has been implicated in the development of hepatic iron overload which is associated with accelerated progression of liver disease. Hepcidin is a proposed biomarker for monitoring CLD and has been shown to correlate with hepatic iron stores and histological activity index. Supplementing hepcidin has been suggested as a way of slowing down progression of liver disease. Studies comparing serum hepcidin in patients with CLD to that in controls have been fraught with discrepancies. We carried out a meta-analysis of these studies to gain a better understanding and investigate if serum hepcidin levels are affected by the underlying etiology of CLD. Methods: Pubmed, Embase and Web of Science were searched for studies comparing serum hepcidin in patients with CLD to controls from inception till November 2020. Meta-analysis was carried out using the STATA software applying the random effects model. Results: 1379 records were retrieved after removing duplicates. 24 studies met inclusion criteria. Compared to healthy controls, serum hepcidin was significantly lower in chronic hepatitis C (11 studies) [mean difference -0.93 (95% CI: -1.5 to -0.36), p< 0.01] [Figure A] and alcohol associated liver disease (3 studies) [mean difference -1.21 (95% CI: -1.97 to -0.46), p< 0.01] [Figure B]. There was a trend for lower serum hepcidin in chronic hepatitis B (6 studies) but this was not statistically significant [mean difference -0.61 (95% CI: -1.26 to 0.04), p=0.06] [Figure C]. There was a trend for higher serum hepcidin in non-alcoholic fatty liver disease (11 studies), but this was not statistically significant [mean difference 0.46 (CI: -0.02 to 0.94), p=0.06] [Figure D] [CI: confidence interval]. Conclusion: Serum hepcidin in CLD is influenced by several factors including systemic iron status, inflammation, liver synthetic capacity, presence of metabolic syndrome etc. Targeted therapy should be tailored based on the underlying mechanism.Figure 1.: Meta-analysis showing significantly lower serum hepcidin in CHC (11 studies) [mean difference -0.93 (95% CI: -1.5 to -0.36), p<0.01] [A]; AALD (3 studies) [mean difference -1.21 (95% CI: -1.97 to -0.46), p<0.01] [B]; trend for lower serum hepcidin in CHB (6 studies) [mean difference -0.61 (95% CI: -1.26 to 0.04), p=0.06] [C]; and trend for higher serum hepcidin in NAFLD (11 studies) [mean difference 0.46 (CI: -0.02 to 0.94), p=0.06] [D].Chronic hepatitis C (CHC), alcohol associated liver disease (AALD), Chronic hepatitis B (CHB), non-alcoholic fatty liver disease (NAFLD), number of patients (N), standard deviation (SD), confidence interval (CI).

Diagnostic Performance of Transient Elastography Versus Two-Dimensional Shear Wave Elastography for Liver Fibrosis in Chronic Viral Hepatitis: Direct Comparison and a Meta-Analysis.

Objective This systematic review and meta-analysis aimed to compare the diagnostic performance of transient elastography (TE) and two-dimensional shear wave elastography (2D-SWE) for staging liver fibrosis in patients with chronic viral hepatitis (CVH). Methods Pubmed, Embase, Web of Science, and Cochrane Library were searched (-01/08/2021) for studies comparing TE with 2D-SWE in patients with CVH. Other etiologies of chronic liver disease (CLD) and articles not published in SCI journals were excluded. The bivariate random-effects model was used to pool the performance of the TE and 2D-SWE. Results Eight articles with a total of 1301 CVH patients were included. The prevalence of significant fibrosis (fibrosis stage ≥ 2), advanced fibrosis (fibrosis stage ≥ 3), and cirrhosis was 50.8%, 44.8%, and 34.7%, respectively. 2D-SWE expressed higher overall accuracy than TE in detecting significant fibrosis (0.93 vs. 0.85, P = 0.04). No significant difference among the overall diagnostic accuracy of TE and 2D-SWE in staging advanced fibrosis and cirrhosis was found. Conclusion TE and 2D-SWE express good to excellent diagnostic accuracies to stage fibrosis in CVH patients. 2D-SWE compares favorably with TE especially for predicting significant fibrosis.

P9.04: Evaluation of Quality of Life in Adult Patients After One Year Liver Transplantation

Introduction: Liver transplantation (LT) aims not only to obtain long survival, but also to achieve an excellent quality of life (QOL). The purpose of our study is to assess several QOL aspects of recipients after 1 year of LT and to identify potential factors that might be associated with impaired QOL. Materials and Methods: Retrospective analysis including LT between 2013 to 2021. The Liver Disease Quality of Life questionnaire (LDQOL 1.0), and the consent form to participate of this study were given personally or sent by e-mail. This questionnaire includes 111 items distributed within 20 domains. Fulminant liver failure, hepatorenal transplantation and underaged patients were excluded. Significance was explored using T tests. Differences were considered statistically significant at p < 0.05. Results: This study included 89 patients out of 360 LT (56% male) who answered the survey, age range 24.8–75 years (mean: 52.5). On average, the patients had to wait 360 days before undergoing LT. Primary etiologies of liver disease were: hepatitis C virus (22.5%), alcohol (22.5%), autoimmune cirrhosis (22.5%), primary biliary cirrhosis (14.6%), NASH (6.7%), primary sclerosing cholangitis (3.3%), cryptogenic (2.2%), and others (5.6%). Thirty-one LT also presented hepatocarcinoma (HCC). The vast majority (93%) had moderate to severe liver disease, with 46% Child-Pugh B and 47% Child-Pugh C. After 1 year LT, QOL was improved resulting with a mean of 83,69%. The general well-being domain rated lowest with 69%. Higher scores (89 - 90%) were obtained on effects of liver disease, stigma of liver disease, physical limitations, emotional limitations and loneliness. There was a significant association between the Child-Pugh classification and body pain, emotional well-being, memory and stigma of liver disease (p< 0,05). Lower MELD scores (<18) showed better results after 1 year LT in energy/fatigue, emotional well-being, liver disease symptoms, effects of liver disease and hopelessness domains (p < 0,05). There was no significant difference when QOL was compared according etiology of chronic liver disease, gender, or age. Conclusion: After 1 year of LT, patients result on QOL show a significant improvement, even similar to results published on the common population, in most of the domains surveyed except for body pain, energy and emotional well-being which still need upgrade.

Demographic, clinical and laboratory predictors of hepatic steatosis and fibrosis by elastography

Giriş ve Amaç: Viral hepatitler tüm dünyada en önemli karaciğer hastalığı nedeni olma özelliğini sürdürmektedir. Bunun yanında alkolik ve nonalkolik karaciğer hastalıklarına da artan sıklıkta rastlanmaktadır. Obezite ve diyabet sıklığı ile alkol tüketimindeki artışlar, bu faktörlerin önümüzdeki yıllarda kronik karaciğer hastalıkları etiyolojisinde daha önemli olacağını düşündürmektedir. Karaciğer fibrozisi ve sonucunda gelişen siroz, kronik karaciğer hastalığının başlıca morbidite ve mortalite sebebidir. Çalışmada elastografi ile elde edilen fibrozis ve steatozis sonuçlarının biyokimyasal ve antropometrik parametrelerle olan ilişkisinin incelenmesi amaçlandı. Gereç ve Yöntem: Karadeniz Teknik Üniversitesi Tıp Fakültesi Hastanesi Gastroenteroloji Kliniği’ne başvuran ve elastografi yapılan 50 hasta çalışmaya dâhil edildi. Hastaların biyokimyasal parametreleri ve beden kitle indeksi ile elastografik steatoz ve fibrozis skorları arasındaki ilişki değerlendirildi. Elastografi kontrollü atenüasyon parametresi değerleri Li’nin skalası baz alınarak S0-S3 arasında; fibrozis/elastisite değerleri ise Petroff’un skalası baz alınarak F0-F4 arasında sınıflandırıldı. Bulgular: Çalışmaya dâhil edilen 50 hastanın 26’sı erkek, 24’ü kadındı. Ortalama yaş 49.9 ± 13.4 yıldı. Vücut kitle indeksi için ortanca değer 29.4 kg/m2 olarak saptandı. En sık eşlik eden hastalıklar hipertansiyon (n = 19, %38), diyabetes mellitus (n = 19, %38), hiperlipidemi (n = 11, %22) ve hipotiroidi (n = 7, %14) idi. Hastaların transient elastografi ile ölçülen fibrozis skorları; F0-1 %84 (n = 42), F2 %4 (n = 2), F3 %4 (n = 2 ve F4 %8 (n = 4); elastografi kontrollü atenüasyon parametresi değerleri ise S0 %61.2 (n = 30), S1 %2 (n = 1), S2 %10.2 (n = 5), S3 %6.1 (n = 3), S4 %20.4 (n = 10) şeklinde idi. Steatoz derecesi ≥ S2 olanlarda vücut kitle indeksi ve trigliserit düzeyi anlamlı olarak daha yüksekti (p &amp;lt; 0.05). Fibrozis düzeyi ≥ F2 olanlarda total kolesterol, yüksek dansiteli lipoprotein, alanin aminotransferaz ve gama glutamil transpeptidaz değerleri anlamlı olarak yüksekti (p &amp;lt; 0.05). Alıcı işlem karakteristikleri eğrisi kullanılarak yapılan analiz sonucunda steatoz derecesi ≥ S2 varlığını ön gördüren vücut kitle indeksi değerinin 29.6 kg/m2 olduğu saptanmıştır (%73.7 duyarlılık, %65.5 özgüllük, eğrinin altında kalan: 0.808, %95 güven aralığı: 0.687-0.028). Sonuç: Elastografik olarak karaciğer steatoz ve fibrozisinin belirlenmesi, hastaların rutin takiplerinde klinik durumu, prognozu ve tedavi cevabının değerlendirilmesi açısından faydalı ve etkin bir yöntemdir. Ekonomik nedenlerle uygulanamadığı durumlarda noninvaziv testlerin kullanımı ihmal edilmemelidir.

Fibroscan® and Shear Wave correlated well in hepatic fibrosis evaluation of patients with chronic liver diseases "in real life situation".

Background:A new noninvasive medical device based on ultrasound elastography such as the Shear Wave Elastography (SWE) was designed in order to measure the liver hardness. The purpose of this work was to evaluate the correlation of the results of the liver elasticity measurements obtained by Fibroscan® (FS) and SWE for patients with chronic liver diseases.Methods:Between January and October 2017, the patients who were followed during this period of time underwent noninvasive assessments of liver fibrosis by SWE in the intercostal spaces during abdominal ultrasound procedures and/or FS. The correlation between FS and SWE was estimated and tested at a 0.05 significance level.Results:Four hundred and seventy-six patients were included in this study. The main etiologies of chronic liver disease were non alcoholic fatty disease (NAFLD), chronic viral hepatitis B (HBV) and chronic viral hepatitis C (HCV). All patients underwent a SWE and 167 among them underwent a FS procedure. The patients who were followed revealed a median FS measurement of 5.80 kpa (Q25 = 4.90 kPa; Q75 = 8 kPa) and a median SWE measurement of 7.00 kPa (Q25 = 6.10 kPa; Q75 = 8.10 kPa). We could observe a significant correlation between the FS and SWE measurements (0.49; P = .001) in the total cohort. The average absolute difference between the measurements of these 2 methods was of 2.54 kPa (sd = 3.39). There was no significant correlation for patients with NAFLD no matter whether they presented with signs of suspected non alcoholic steatohepatitis (NASH) or not (R = 0.20; P = .108). All patients intending to perform the examination were able to undergo the SWE, allowing 33.3% of the patients who failed the FS to have a noninvasive evaluation of their fibrosis.Conclusion:The SWE technique proved to be as efficient as the FS one for the evaluation of the liver fibrosis in real life situation.

Clinical Characteristics and Etiology of Chronic Liver Disease among Egyptian Patients in Nile Delta: A Clinical Study

Background: Chronic liver disease (CLD) is an extremely common clinical condition that causes significant morbidity and mortality and was responsible for 1.3 million deaths worldwide. There had been a 46% increase in CLD mortality in the world between 1980 and 2013 and most of this increase has been reported in low-income countries in Asia and Africa including Egypt. These countries are experiencing a demographic and epidemiologic transition in disease burden and Egypt is one of the epicenters of this change. Previously, CLD in Egypt was traditionally attributed to schistosomiasis mainly in the region of the Nile Delta until the mid-1980s.&#x0D; Aims: To capture the modes of clinical presentation and at which stage CLD patients seek clinical care, as well as the dramatic change in the etiological profile of CLD in this area of the Nile Delta&#x0D; Methods: 1013 newly diagnosed CLD patients were selected and identified from the Tanta Liver Center (TLC) across the middle of the Nile Delta. After informed or written consent, all consecutive patients (18 years and above) referred to TLC with suspected or overt chronic liver disease were subjected to full history taking, clinical examination searching for stigmata of chronic liver disease, and laboratory studies including urine, blood sugar, liver biochemical tests (bilirubin, ALT, AST&amp; serum albumin), prothrombin, viral markers (HCV Ab &amp; HBS Ag) and AFP. Imaging studies including the abdominal US for all patients and triphasic CT and liver biopsy in selected patients.&#x0D; Results: About 50% of our CLD patients present at a relatively advanced stage of decompensated cirrhosis (ascites in 39.2%, bleeding in 22.8%, and HCC in 9.3%).&#x0D; CLD patients of schistosomal etiology presented mainly with manifestations of portal hypertension (splenomegaly, UGI Bleed &amp; thrombocytopenia) that was significantly higher than the other 2 groups.&#x0D; The vast majority of our CLD patients (83.5%) have viral etiology, while only 11.1% have schistosomal etiology and the remaining 5.4% have non-identified etiology.&#x0D; Conclusion: based on the results of the present study, it is evident that HCV had replaced schistosomiasis as the predominant cause of CLD in Egypt particularly in the region of the Nile Delta. The late presentation of a good percentage of our CLD patients raises the importance of screening programs for CLD in this endemic area of the Nile Delta.

Association between severity of chronic liver disease with grading of oesophageal varices in children

Chronic liver disease is a uncommon manifestation in the children and many of them presents with oesophageal varices. The aim of this study was to observe the association between severity of chronic liver diseases determined by Child- Pugh score with grading of oesophageal varices. 62 cases (male, 34) were included in the present study. Mean age of the study population was 9.5±3.3 years. Male to female ratio was 1.2:1. Wilson’s disease was the most common etiology of chronic liver disease (64.5%). Of the 62 children, 30.7% had Child class A, 16.1% had Child class B and the remaining 53.2% had Child class C cirrhosis. Oesophageal varices were found in 43 (69.3%) children. On univariate ananlysis low platelet count and splenomegaly were found to be associated with the presence of esophageal varices. Splenomegaly was found as independent predictor for presence of varices on multivariate analysis (OR; 15.51, 95% CI, 3.7-63.5). Furthermore, splenomegaly was also independent risk factor for large esophageal varices. No association was found between Child-Pugh classification (child A, B, C) with grading of oesophageal varices (Grade - I, II, III, IV). Our study showed no positive association between Child-Pugh classifications with grading of esophageal varices. Splenomegaly predicts the presence of oesophageal varices as well as the presence of large esophageal varices. BSMMU J 2022; 15(1): 29-34

Prevalence of underlying cirrhosis etiologies in hepatocellular carcinoma patients of Hispanic versus non-Hispanic ethnicity.

e16163 Background: While the incidence and rates of mortality are in decline for the vast majority of cancers, those of hepatocellular carcinoma (HCC) continue to increase. Forecasts from the Surveillance, Epidemiology, and End Results (SEER) database suggest that the Hispanic population will have the highest incidence rate of HCC in the United States by the end of this decade. As a result, further studies are needed to identify specific risk factors for the development of HCC in this ethnic group. Methods: This was a retrospective, single center study conducted in Southern California to identify the prevalence of underlying cirrhosis etiologies in HCC patients of Hispanic versus non-Hispanic ethnicity. Causes of cirrhosis included nonalcoholic fatty liver disease (NAFLD), viral hepatitis, alcohol, and other chronic liver disease. The designation of NAFLD cirrhosis was assigned to patients in whom there was an exclusion of viral hepatitis B, viral hepatitis C, significant alcohol consumption, other etiology of chronic liver disease, and who had the presence of fatty liver on imaging or were diagnosed with cirrhosis with a concomitant metabolic risk factor (diabetes mellitus, hypertension, hyperlipidemia, or obesity). Results: A total of 165 patients were included in this study. There were 57 patients of Hispanic ethnicity and 108 patients of non-Hispanic ethnicity. No significant differences in age or gender were found between the two groups. When analyzing the prevalence of cirrhosis etiologies, 17 patients (29.8%) of Hispanic background were found to have underlying NAFLD cirrhosis compared to 10 patients (9.3%) of non-Hispanic background (p = 0.001). In contrast, 67 patients (62%) in the non-Hispanic group had diagnoses of cirrhosis associated with viral hepatitis B or C compared to 22 patients (38.6%) in the Hispanic group (p = 0.005). There was no significant difference in the prevalence of alcoholic cirrhosis (24.6% vs 13%, p = 0.08), cirrhosis due to other chronic liver disease (1.8% vs 2.8%, p = 1), or HCC without cirrhosis (5.3% vs 13%, p = 0.178) between Hispanic and non-Hispanic patients, respectively (Table). Conclusions: There were significantly higher rates of NAFLD cirrhosis identified in HCC patients of Hispanic ethnicity compared to those of non-Hispanic ethnicity. With the continually rising incidence rate of HCC in this patient group, it is important for providers to be aware of this association so that appropriate surveillance and prevention strategies may be pursued.[Table: see text]