Cases Of Cirrhosis Research Articles

Cardiac & Pulmonary Complications Seen in Liver Cirrhosis-An Observational Study at a Tertiary Care Hospital

INTRODUCTION: Cirrhosis is a condition that is defined histopathologically and has a variety of clinical manifestations and complications, some of which can be life-threatening. Patients with cirrhosis and portal hypertension exhibit characteristic cardiovascular & pulmonary hemodynamic changes. The cardiovascular complications include systolic dysfunction, diastolic dysfunction & electrochemical abnormalities like prolonged QT interval in Electrocardiogram (ECG), and Respiratory complications include Consolidation, Pleural Effusion & Pulmonary Arterial Hypertension, which may be due to Hepatopulmonary or Portopulmonary syndrome STUDY DESIGN: A two-year prospective observational study was conducted from July,2014 to June 2016 AIM: To study the different cardiac and pulmonary complications in the patients of Liver Cirrhosis. MATERIALS & METHODS: A two-year prospective observational study was conducted from July,2014 to June 2016 at a tertiary care hospital in Ahmedabad, Gujarat, India, including 30 patients (>12 years old), who were known cases of cirrhosis of liver as well as those newly diagnosed with it, with cardiopulmonary complications, developed after liver cirrhosis, in the absence of other etiological factors. Clinical profile with laboratory studies and diagnostic tests were studied. RESULTS: This study showed that cardiopulmonary complications in cirrhotic patients are more frequently seen in males than females, which commonly manifest during third & fourth decade. Dyspnoea is the most common symptom seen in the study. Among the pulmonary complications, Pneumonia & Hydrothorax are more common compared to hepatopulmonary & portopulmonary syndromes, and among cardiac complications, Diastolic dysfunction is a major complication in such patients, which increases with increasing severity of cirrhosis, as indicated by CP score. CONCLUSION: Among these patients, Cardiac and pulmonary complications have nearly the same incidences.

Retrospective, single-center evaluation of liver cirrhosis cases in a geriatric population

GIRIŞ ve AMAC: Bircok ulkenin yasli populasyonunda karaciger sirozu hakkinda yeterli epidemiyolojik veri olmadigi icin gastroenteroloji klinigimizde yatan karaciger sirozu tanili geriatrik olgularin retrospektif olarak degerlendirilmesi amaclandi. YONTEM ve GERECLER: Calismaya Ege Universitesi Tip Fakultesi Gastroenteroloji kliniginde yatmis 65 yas ve uzeri karaciger sirozu tanili 99 hasta dahil edildi. Hasta dosyalarindan sosyodemografik, klinik ve laboratuvar verileri kaydedilmistir. BULGULAR: Calismaya dahil edilen 99 yasli hastanin yas ortalamasi 71.7 ± 5,2 yil, % 59’u erkek idi. Hepatoseluler karsinom ile etiyoloji, asit varligi, Model of End-Stage Liver Disease skoru ve Child-Turcotte-Pugh skoru arasinda istatistiksel olarak anlamli iliski saptanmistir (sirasiyla, p = 0,003, p = 0,009, p = 0,033, p = 0,003). Ozofagus varisi varligi ile Child-Turcotte-Pugh sinifi ve skoru, total bilirubin, Model of End-Stage Liver Disease skoru ve asit varligi arasinda istatistiksel olarak anlamli iliski saptanmistir (sirasiyla, p <0.0001, p = 0,001, p = 0,011, p = 0,004, p = 0,004). TARTIŞMA ve SONUC: Gastroenteroloji klinigimizde yatan yaslilarda karaciger sirozunun ana etiyolojisi Hepatit C virusu olup sirotik populasyonun neredeyse ucte birini olusturmaktadir. Hastaneye yatis nedenleri arasinda ilk sirada hepatoseluler karsinom yer almaktadir. Karaciger sirozu tanisiyla hastaneye yatirilan yaslilar siroz komplikasyonlari acisindan dikkatle degerlendirilmeli, Child-Turcotte-Pugh ve Model of End-Stage Liver Disease skorlamasi yapilarak, ozellikle karaciger nakli acisindan uygunluklari da goz onunde bulundurularak takip ve tedavi edilmelidir.

Platelet Count/Splenic Diameter Ratio to Predict Oesophageal Varices in Portal Hypertension

Background: One of the major causes of morbidity and mortality in Nepal is portal hypertension due to liver cirrhosis. In rural areas where a lot of cases of cirrhosis of liver are prevalent and endoscopic expertise and facilities are not available, predicting the presence of esophageal varices through non-invasive means may reduce a large number of unnecessary endoscopies. This study is to identify the relationship of platelet count /splenic bipolar diameter ratio with the presence of esophageal varices in portal hypertension.&#x0D; Materials and methods: Eighty patients were included in this study between Jestha 2072 to Baisakh 2073 with the diagnosis of portal hypertension admitted in Bir hospital, Kathmandu which is a tertiary hospital of government of Nepal, which were mostly due to liver cirrhosis. The patients fulfilling the inclusion criteria underwent lab investigations, ultra sonogram and UGI endoscopy. The data were assessed for descriptive studies and means were compared using t-test. The cut off value of platelet count to spleen diameter ratio of 1150 was used to predict the presence or absence of oesophageal varices. Statistical analysis was done using SPSS 20 software&#x0D; Results: Platelet count to splenic diameter ratio with a cut off value of 1150 has sensitivity of 89.7%, specificity of 83.3%, positive predictive value of 96.8% and negative predictive value of 58.8% (p= 0.002, CI=95%) with 89.5 % accuracy.&#x0D; Conclusion: Platelet count to splenic bipolar diameter ratio can be a good predictor of presence of esophageal varices in patients with portal hypertension in the resource poor settings.

Analysis of Autopsy Results in Patients with Liver Cirrhosis over 2015-2018

Objective: to analyze the mortality structure of patients with liver cirrhosis over 2015-2018 in Gomel.Material and methods. A retrospective cohort analysis of 130 findings of postmortem autopsy of patients with liver cirrhosis has been performed (data of the departments of Gomel Regional Pathology Bureau at Gomel Regional Infectious Clinical Hospital, Gomel City Clinical Hospital No. 3 and Gomel City Clinical Hospital No. 2, 2015-2018). The age and gender structure of the patients, etiology and cause of death were analyzed. The data were entered and analyzed in MS Excel, 2010.Results. Most frequently, the patients with cirrhosis die at 50-59 and usually of hepatorenal syndrome (HRS), gastrointestinal bleeding, and acute posthemorrhagic anemia. Non-viral hepatitis as a cause of cirrhosis is more prevalent (61.5 %) than viral hepatitis, while the etiology for more than a third of the cirrhosis cases (38.5 %) is not determined. Most of the patients who died were of the working age (67.7 %) and mainly males (56.2 %). More than a third of the patients (38.5 %) had been dependent on alcohol, while only 11.5 % patients had been dia nosed with alcohol related cirrhosis.Conclusion. Thus, liver cirrhosis is still a socially topical issue for young ablebodied people. There remains a tendency to underestimate the alcoholic etiology of cirrhosis, as well as the uncertainty of the etiology of a significant part of detected cirrhosis cases.

Prognostic significance and economic burden of hepatic encephalopathy in liver cirrhosis in German hospitals based on G-DRG data

Hepatic encephalopathy (HE) represents a frequent complication of liver cirrhosis with negative effects on patients' lives. The prevalence of clinical HE is estimated to be between 30-45 %. Regardless of its clinical and prognostic relevance HE is considered to be underdiagnosed. Beyond a systematic analysis of mortality of HE, we investigated the economic impact and reimbursement situation for HE in patients with liver cirrhosis in Germany. For the retrospective analysis, anonymized data (2011-2015) concerning expenses and diagnoses (§ 21-4 KHEntgG) were obtained from 74 participating hospitals of the Diagnosis Related Groups (DRG) Project of the German Gastroenterological Association (DGVS). Furthermore, results were compared with case data from all German hospitals provided by the German Federal Authority on Statistics (Statistische Bundesamt (Destatis), Wiesbaden). In participating hospitals 59 093 cases with liver cirrhosis were identified of which 14.6 % were coded as having HE. Hospital mortality was threefold increased compared to cirrhosis-patients without HE (20.9 versus 7.5 %). Cases with cirrhosis as well as the proportion with HE increased over time. Compared to all patients with cirrhosis, reimbursement for HE patients produced a deficit (of up to 634 € for HE grade 4). Mortality is threefold increased in patients with cirrhosis when an additional HE is diagnosed. Hospitals participating in the DGVS-DRG-project coded 2 % more HE cases among their cirrhosis cases than the rest of hospitals either because of a selection bias for greater disease severity or because of better coding quality. At present, reimbursement for HE patients on the basis of F-DRG-system produced a deficit.

Hepatic cirrhosis according to the forensic medical autopsy data from Moscow for the period of 2007-2016

Study purpose is to demonstrate the dynamics of mortality due to hepatic cirrhosis according to forensic medical autopsy data over the period from 2007 to 2016. Material and methods ― 268,139 protocols of forensic autopsies were studied to identify the number of deaths by hepatic cirrhosis over ten years between 2012 and 2016 and to determine the number of cases of liver failure associated with cirrhosis. To clarify the dynamics of mortality due to hepatic cirrhosis, a comparative analysis of two chronologically consecutive five-year periods, 2007-2011 and 2012-2016, has been conducted. The age of deceased by hepatic cirrhosis was studied. The number of cases with a histologically verified form of hepatic cirrhosis was specified. The average values and the percentage ratio of the number of examinations performed to the total number of all autopsies for non-violent death cases were calculated. Results ― Over ten years of study, death by hepatic cirrhosis was diagnosed 3,092 times, including 749 times with histologically confirmed liver failure. In 2009, there was an abrupt increase in mortality due to hepatic cirrhosis by the factor of 3.8, and the lowest mortality level was found in 2016. When comparing the mentioned two quinquennia, the first of them, 2007-2011, was characterized by an increase in the number of diagnosed hepatic cirrhosis. During the second one, 2012-2016, on the contrary, the dynamics of a decrease in the number of hepatic cirrhosis was revealed. At the average, the annual decrease in the number of hepatic cirrhosis diagnosed during the forensic medical examinations of corpses was 7.7%. The number of established cases of liver failure during the first five-year period compared with the data on the second one was significantly greater. In 2010, there were 109 such cases, in 2016 only 13. Among the histologically verified diagnoses, micronodular and mixed forms of hepatic cirrhosis prevailed. Most of the cases of hepatic cirrhosis were found in men aged within 31-40. Conclusion ― It has been found that over the past five years there has been a shift in the forensic-medical mortality values due to hepatic cirrhosis from the increasing trend to the decreasing one. If within the period of 2007-2011 an increase in diagnosed hepatic cirrhosis was observed, then during 2012-2016 a pronounced decreasing tendency in the number of such diagnoses was disclosed. During that time the number of histologically verified cases of hepatic failure decreased by 43.0%. As a cause of death, hepatic cirrhosis was more often recorded in men aged within 30–40.

Assessment of miR-212 and Other Biomarkers in the Diagnosis and Treatment of HBV-infection-related Liver Diseases.

Our study aims to detect the sensitivity of the new biomarker miR-212 existing in serum exosomes along with other hepatocellular carcinoma biomarkers such as AFP (alpha-fetoprotein), CA125 (carbohydrate antigen-ca125), and Hbx protein in the diagnosis of HBV-related liver diseases. We also aim to study the roles of these biomarkers in the progression of chronic hepatitis B and provide scientific data to show the clinical value of these biomarkers. We selected 200 patients with HBV-infection (58 cases of chronic hepatitis B, 47 cases of hepatocellular carcinoma, 30 cases of compensatory phase cirrhosis, and 65 cases of decompensatory phase cirrhosis), 31 patients with primary liver cancer without HBV infection, and 70 healthy individuals as the control group. The expression level of serum AFP and CA125 was detected with electrochemiluminescence immunoassay. The expression level of the Hbx protein was detected with ELISA. Meanwhile, the expression level of miR-212 in serum was analyzed with RT-qPCR. We collected patients' clinical information following the Child-Pugh classification and MELD score criterion, and statistical analysis was made between the expression level of miR-212 and the collected clinical indexes. Lastly, we predicted the target genes of the miR-212 and its functions using bioinformatics methods such as cluster analysis and survival prediction. Compared to the control group, the expression level of miR-212 in HBV infected patients was remarkably increased (P<0.05), especially between the HBV-infection Hepatocellular carcinoma group and the non-HBVinfection liver cancer group (P<0.05). The expression of miR-212 was increased in patients' Child-Pugh classification, MELD score, and TNM staging. Moreover, the sensitivity and specificity of miR-212 were superior to AFP, CA125, and HBx protein. There is a linear relationship between disease progression and expression level of miR-212 in the serum of HBV infected patients. This demonstrates that miR-212 plays a significant role in liver diseases. miR-212 is expected to be a new biomarker used for the diagnosis and assessment of patients with HBV-infection-related liver diseases.

Methylation of tumour suppressor genes RUNX3, RASSF1A and E-Cadherin in HCV-related liver cirrhosis and hepatocellular carcinoma

ABSTRACTBackground: HCV infection is related to aberrant methylation of several genes. RASSF1A, E-Cadherin and RUNX3 are tumour suppressor genes that may be inactivated by hypermethylation in many tumours including hepatocellular carcinoma (HCC). We hypothesized that methylation is a diagnostic biomarker for HCC in patients with HCV-related liver cirrhosis.Methods: We recruited 207 cases of HCV-related liver cirrhosis, 193 HCC patients and 53 healthy controls. Methylation-specific polymerase chain reaction for detection of circulating hypermethylated RASSF1A, E-Cadherinand RUNX3. Alpha fetoprotein (AFP) was measured by commercial immunoassay.Results: Significant hypermethylation of the three genes was found in the HCC group compared to both cirrhosis and healthy groups (P < 0.001), whereas no significant difference in hypermethylation was found between cirrhosis and healthy groups (P = 0.17, 0.50 and 0.14, respectively). No significant links were found between hypermethylated RASSF1A, E-Cadherin and RUNX3 and stages of Barcelona Clinic of Liver Cancer score (P =0.21, 0.63 and 0.98, respectively). No significant associations were found between AFP value and hypermethylated genes in cirrhosis and HCC groups (P = 0.82) except with E-Cadherin in HCC (P = 0.02). In multiple regression analysis, RASSF1A and E-Cadherin were predictors of HCC within cirrhosis cases, but only E-Cadherin was an independent risk factor for prediction of HCC in cases with low AFP (P = 0.01).Conclusions: The presence of hypermethylated serum RASSF1A, E-Cadherin and RUNX3 is linked to HCC in patients with HCV-related cirrhosis. Only E-Cadherin is an independent risk factor for prediction of HCC with low AFP. These findings may be of diagnostic value.

Cost-effectiveness of augmenting universal hepatitis B vaccination with immunoglobulin treatment: a case study in Zhejiang Province, East China

ABSTRACT Objective To evaluate the cost-effectiveness of the current strategy combining universal vaccination with hepatitis B immunoglobulin (HBIG) treatment for infants of hepatitis B surface antigen (HBsAg) positive mothers compared with universal vaccination with hepatitis B vaccine only. Methods A decision tree model with a Markov process was constructed and used to simulate the lifetime of the birth cohort in Zhejiang Province during 2016. The current strategy was compared against universal vaccination with respect to costs and health effects. Costs were assessed from the health care system perspective. Health effects were measured by the number of hepatitis B virus (HBV) related diseases and deaths avoided and quality-adjusted life-years (QALYs) gained. The incremental cost‑effectiveness ratio (ICER) is calculated and compared to standard willingness-to-pay thresholds. A one-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) were performed to assess parameter uncertainties. Results Over the cohort’s lifetime, 182 acute symptomatic infections, 2215 chronic infections, 872 cases of cirrhosis, 595 cases of hepatocellular carcinoma (HCC) and 1,350 HBV-related deaths among the cohort of 624,000 infants would be further avoided by the current strategy compared to universal vaccination. Universal vaccination was dominated by the current strategy that produced not only higher total QALYs, but also had lower costs. The results remained robust over a wide range of assumptions. Conclusions The current strategy was cost saving compared to universal vaccination, and continuing the current strategy is recommended to further decrease the burden of hepatitis B.

PIN57 ECONOMIC EVALUATION OF AN ELECTRONIC HEALTH RECORD ALERT BY AGE IN PRIMARY CARE FOR THE DETECTION OF PATIENTS WITH CHRONIC HEPATITIS C

Increasing the diagnosis of hepatitis C virus (HCV) in the population with the highest prevalence is necessary to identify hidden cases of infected people, aiming to the virus elimination. In Valencia Region (Spain), an economic evaluation based on an electronic health record (EHR) alert in primary care was conducted to detect undiagnosed chronic subjects born between 1955 and 1975, in comparison with the non-application of the alert, followed by antiviral therapy. A decision tree evaluating the diagnosis and antiviral treatment and a lifetime Markov model projecting quality-adjusted life years (QALYs) and healthcare costs were created to estimate the cost-utility comparing both alternatives from the Public Healthcare System perspective. The model parameters included epidemiological data, antiviral clinical effectiveness, transition probabilities, cost and utilities and were obtained from official Valencia Region sources and published literature. Efficiency was measured as incremental cost-utility ratio (ICUR). In addition, the impact on the burden of the disease (cases avoided) was estimated. Univariate sensitivity analyses were performed to evaluate parameter uncertainty. The incremental results per patient of the EHR alert by age (vs non alert) were 3.3 QALYs and €10,880. For a willingness-to-pay threshold of €20,000 per QALY gained, the EHR alert by age was cost-effective with an ICUR of €3,321 per QALY. Healthcare outcomes with the EHR alert by age generated the detection of 269,548 patients non previously tested, of whom 1,331 would be HCV positive (vs 23 without alert). The EHR alert is estimated to decrease the cases of decompensated cirrhosis by 93%, hepatocellular carcinoma by 87%, liver transplants by 90% and liver-related deaths by 89%. were robust in the univariate sensitivity analyses. An EHR alert by age for the detection of HCV patients is an efficient strategy, obtaining significant healthcare benefits associated to the reduction of hepatic complications and mortality.

Hepatocellular carcinoma and non-alcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is considered the most common liver disorder worldwide, affecting 25.2% of the general population. In fact, NAFLD is among the most common etiologies for hepatocellular carcinoma (HCC). The burden of NAFLD is primarily driven by the epidemic of obesity and type 2 diabetes which are expected to worsen throughout the world. In this context, the burden of NAFLD and associated HCC and cirrhosis are also expected to increase. Despite its growing disease burden, diagnostic tools and treatment modalities remain very limited. This conundrum of increasing prevalence and limited treatment options will be reflected as increasing number of NAFLD-related cirrhosis and HCC cases. This article reviews the most updated information about NAFLD-related HCC and provides some insight into strategies that must be considered to reduce its potential disease burden.

3016 Can Primary Biliary Cirrhosis Cause Bradycardia?

INTRODUCTION: Obstructive jaundice is a known cause of sinus bradycardia. It is usually attributed to the effect of bile salts on the electrophysiology of the heart and mainly on the SA node. But can Primary biliary cirrhosis cause bradycardia? Here, we are presenting a case of sinus bradycardia with a junctional rhythm that could be secondary to primary biliary cirrhosis. CASE DESCRIPTION/METHODS: A 65-year-old female with a history of primary biliary cirrhosis complicated by esophageal varices and recurrent ascites. The patient presented with a syncopal episode. The patient had a history of episodes of lightheadedness for several days before admission. Upon arrival at the hospital, the patient was bradycardiac with heart rate around 30 and she was hypotensive. She was given several doses of atropine and then she was started on dopamine drip. Initial EKG showed that the patient has a junctional rhythm. After reviewing the patient cardiac history, we found that the patient didn't have any heart issues before and she had a coronary angiogram done one year ago and showed normal coronaries. Medications were reviewed and showed that the patient was on Metoprolol 25 mg twice daily for anxiety and she was on it for more than 10 years and there were no recent changes in the dose. Labs showed that the patient had mild elevation is AST 41 IU/L and ALT 62 IU/L. Total serum bilirubin was 1.7 mg/dl (mildly elevated) and direct bilirubin was 0.7 mg/dl (mildly elevated). After beta-blocker was held, the patient heart rate improved, and dopamine drip was discontinued. DISCUSSION: This is a case of primary biliary cirrhosis who presented with symptomatic bradycardia. This patient was on beta-blockers for a long period of time and she didn't have any heart issues given her last coronary angiogram and echocardiogram were normal. We believe that one of the contributors of the patient bradycardia is the primary biliary cirrhosis itself as it can cause bradycardia which is believed to be secondary to bile salts. In conclusion, primary biliary cirrhosis should be considered as a cause of bradycardia and the use of metoprolol in those patients should be closely monitored as Metoprolol is primarily metabolized by the liver and can intensify the bradycardia.

3172 A Rare Complication of Hepatic Cirrhosis: Nephrotic Syndrome in IgA Nephropathy

INTRODUCTION: There have been many documented cases of cirrhosis and associated Parenchymal renal disease (Ig-A nephropathy, glomerulonephritis). We discuss here rare case of hepatorenal syndrome type 2, in-patient with no clinically and imaging finding indicative of portal hypertension. Also, further interesting finding is to have nephrotic range proteinuria in nephritic syndrome. CASE DESCRIPTION/METHODS: 56-Year-old Indian male with no past medical or surgical history presented with complaints of generalized weakness and occasional abdominal discomfort. He denied significant family history and alcohol, tobacco or illicit drug use. Ultrasonography (USG) abdomen showed cirrhotic changes. All work up including autoimmune panel negative, hence diagnosed with idiopathic liver cirrhosis. Patient managed with conservative approach, as there were no changes indicative of portal hypertension including Esophagogastroduodenoscopy. After about a year, on routine follow up he found to have his serum creatinine (Cr) progressed from 0.8 to 3.8 mg/dl. Repeat USG abdomen showed diffuse liver parenchymal disease with mild ascites and normal size of kidney with cortical thickness. Urine Microscopy revealed proteinuria and hematuria with 24 hour measured urinary protein 5 gm. Renal biopsy was performed and showed diffuse proliferative glomerulonephritis-Ig A Nephropathy (nephritic syndrome with nephrotic range proteinuria). Autoimmune profile was negative. Hospital course was complicated by septic shock and hemorrhagic cystitis. Patient was treated with inotropes, Pulse dose of intravenous methylprednisolone, albumin and other supportive approach. Decision was made not to continue cyclophosphamide due to hemorrhagic cystitis. Patient Cr later stabilized after peak of 4.3 mg/dl. Presently, is on diuretics and prednisone with Cr is stable around 1.3 mg/dl. DISCUSSION: Hepatorenal syndrome is divesting complication of liver cirrhosis, which can occur due to various mechanism one of which is described as in our case. Literature has focused mainly on mechanism of Ig-A nephropathy in portal hypertension. Our aim for this case report is to focus on monitoring renal function in cirrhotic patient even without no evidence of portal hypertension as there is no firm correlation between degree of portal hypertension and severity of IG A nephropathy. Thus, further studies can effect future era of hepatic transplant by more effectively understanding complex mechanism and managing complications.

Ability of Noninvasive Scoring Systems to Identify Individuals in the Population at Risk for Severe Liver Disease

Noninvasive scoring systems are used to identify persons with advanced liver fibrosis. We investigated the ability of scoring systems to identify individuals in the general population at risk for future liver-related events. We collected data from the Swedish Apolipoprotein Mortality Risk cohort on persons 35 to 79 years old who had blood samples collected from 1985 through 1996. We collected APRI (n= 127,302), BARD (n= 75,303), FIB-4 (n= 126,941), Forns (n= 122,419), and the nonalcoholic fatty liver disease (NAFLD) fibrosis scores (NFS, n= 13,160). We ascertained incident cases of cirrhosis or complications by linking Swedish health data registers. Cox regression was used to estimate hazard ratios (HRs) for severe liver disease at 5, 10, and a maximum follow-up time of 27 years. The predictive ability of the scores was evaluated using area under the receiver operating characteristic (AUROC) curve and C-statistics analyses. Our specific aims were to investigate the predictive capabilities of scoring systems for fatal and nonfatal liver disease, determine whichscoring system has the highest level of accuracy, and investigate the predictive abilities of the scoring systems in persons with a higher probability of NAFLD at baseline. A similar proportion of individuals evaluated by each scoring system developed cirrhosis or complications thereof (1.0%-1.4%). The incidence of any outcome was increased in intermediate- and high-risk groups compared with low-risk groups, with HRs at 10 years in the high-risk group ranging from 1.67 for the BARD score to 45.9 for the APRI score. The predictive abilities of all scoring systems decreased with time and were higher in men. All scoring systems were more accurate in persons with risk factors for NAFLD at baseline, with AUROCs reaching 0.83. Higher scores from noninvasive scoring systems to evaluate fibrosis are associated with an increased risk of cirrhosis in a general population, but their predictive ability is modest. Performance was better when patientswere followed for shorter time periods and in persons with a higher risk of NAFLD, with AUROC values reaching 0.83. New scoring systems are needed to evaluate risk of fibrosis in the general population and in primary care.

The Burden of Liver Cirrhosis and Underlying Etiologies: Results from the Global Burden of Disease Study 2017

Background: Liver cirrhosis is a major health issues throughout the world and is characterized as the end-stage of chronic liver disease. The etiologies of liver cirrhosis including hepatitis, alcohol, NASH and other causes, but rare study explored the prevalence trend of liver cirrhosis caused by specific etiologies. Aiming to study the pattern and prevalence trend of liver cirrhosis, we conducted the study. Methods: Based on the Global Burden of Disease 2017, we collected detailed data of liver cirrhosis during the period from 1990 to 2017. Age standardized prevalence rate (ASR) and estimated annual percentage changes (EAPC) were used to estimate the trend of liver cirrhosis prevalence by population, etiology and region. Findings: Globally, the prevalence cases of liver cirrhosis increased 74.55% from 1990 to 2017. The worldwide ASR of liver cirrhosis increase 0.75 per year during the period. Among the etiologies, NASH caused liver cirrhosis accounted for 59.46% in 2017. The ASR of liver cirrhosis caused by NASH increased 1.74 per year all over the world during the period. Additionally, the ASR of liver cirrhosis caused by NASH increased in 195 countries and territories and in all 5 SDI regions. Besides, the ASR of liver cirrhosis caused by alcohol use also increased. Contrary, the ASR of liver cirrhosis caused by HBV and HCV decreased. The ASR of liver cirrhosis caused by other causes remained stable during the same period. The increasing pattern was heterogeneous across regions and countries. The most pronounced increases were found in middle-high and high SDI regions, especially in Caribbean, Andean Latin America and Southern Latin America. Interpretation: By using vaccine and direct-acting antiviral therapy, the number of people suffered HBV and HCV decreased, but liver cirrhosis still confirmed to be a major threat to human health. Additionally, the number of people with cirrhosis caused by alcohol use and NASH continues to grow. Thus, more target and specific strategies should be established in various countries based on the etiology and prevalence trend of liver cirrhosis. Funding: This study was supported by the Hunan Provincial Natural Science Foundation of China (No. 2018JJ3715 and No. 2017JJ3448). Declaration of Interest: The authors declare no conflicts of interest. Ethical Approval: Not required.

LONG NON-CODING RNA H19 AS POTENTIAL BIOMARKER FOR HCV GENOTYPE 4 INDUCED HEPATOCELLULAR CARCINOMA PATIENTS

The H19 gene is an oncofetal RNA expressed during embryo development and in several types of cancer. However, little is known about the role of the plasma H19 in liver cancer diagnosis. The current study aimed at measuring the plasma levels of long non-coding RNAs (H19) expression in chronic liver disease (CLD) due to HCV genotype 4 infections with/without cirrhosis and Hepatocellular carcinoma (HCC) patients in an attempt to evaluate the potential benefits of these new circulating, noninvasive, diagnostic, prognostic and epigenetic markers for liver cirrhosis and carcinogenesis of Egyptian patients. A hundred subjects were included in this study, divided into two groups; Group I (50 patients) were classified into subgroup Ia (CLD without cirrhosis, n=25) and subgroup Ib (CLD with cirrhosis, n=25), Group II (CLD patients with HCC, n=25), and control (Healthy volunteer, n=25). The expression of lncRNAs (H19) genes was analyzed by Real-Time PCR. LncRNAs (H19) showed upregulation in all diseased groups, which was in consistence with the progression of the disease toward the HCC stage. In addition, H19 showed a diagnostic ability to discriminate between cases of cirrhosis and HCC compared to healthy control (p< 0.001), while it did not show a discrimination significance differences between cirrhotic cases and non cirrhotic cases. By using receiver operating characteristic curve (ROC) analysis, it was found that H19 could diagnose HCC with AUC (81.4%). The increased H19 expression was associated with advanced tumor stages and higher grades. Plasma level of H19 marker might serve as a potential non-invasive biomarker for diagnosis of HCC.

Significant Correlation Between Grip Strength and m2bpgi in Patients with Chronic Liver Diseases.

We sought to compare the impact upon grip strength (GS) between the Mac-2 binding protein glycosylation isomer (M2BPGi) and the Fibrosis-4 (FIB4) index in chronic liver disease (CLD) patients (n = 376: 171 males and 205 females, and 137 liver cirrhosis (LC) cases (36.4%)). Factors linked to the low GS (<26 kg in male and <18 kg in female) were also investigated using univariate and multivariate analyses. The median GS in males was 35.5 kg, while that in females was 21.1 kg. The median M2BPGi was 1.11 cutoff index, whereas the median FIB4 index was 2.069. In both male (P < 0.0001) and female (P = 0.0001), GS in LC patients was significantly lower than that in non-LC patients. In males, M2BPGi (r = −0.4611, P < 0.0001) and the FIB4 index (r = −0.4556, P < 0.0001) significantly correlated with GS. Similarly, in females, M2BPGi (r = −0.33326, P < 0.0001) and our FIB4 index (r = −0.26388, P = 0.0001) also significantly correlated with GS. In the multivariate analyses of factors linked to the low GS, independent factors were: M2BPGi (P = 0.0003) and skeletal muscle index (P = 0.0007) in males, and age (P < 0.0001) and serum albumin level (P = 0.0484) in females. In conclusion, liver fibrosis markers were well-correlated with GS in CLD patients. In particular, M2BPGi can be helpful for predicting the low GS in male patients.

Nötrofil/lenfosit oranı kronik Hepatit C hastalarında fibrozis belirteci olarak kullanılabilir mi?

Background: It is reported that about 170-200 million people are chronically infected with Hepatitis C virus (HCV) in the world. In developed countries, about 25% of cirrhosis cases, one third of hepatocellular cancers, and 40% of all chronic hepatitis cases are caused by HCV. In this study, we want to determine the utility of neutrophil/lymphocyte ratio (NLR) to predict the fibrosis in patients with chronic hepatitis C. Methods: In our study NLR was prospectively investigated whether it can predict, or not the fibrosis on patients who diagnosed Chronic hepatitis C (CHC) and underwent liver biopsy in July 2011 - January 2013 by Kayseri Training and Research Hospital, Department of Gastroenterology. Results: 81 patients diagnosed with CHC and underwent liver biopsy were included in the study. Fibrosis and necroinflammatory activity in liver biopsy specimens was determined in accordance to Ishak fibrosis scoring system. All Ishak scores were re-scored according to France METAVIR Cooperative Study Group as Score 0, 1, 2, 3, 4. In such re-scored METAVIR scores, Score 0, 1, 2 were defined as low fibrosis and Score 3, 4 were defined as high fibrosis. 46 of 81 patients (% 57) were in low fibrosis group and 35 of them (43%) were in high fibrosis group. When Comparing the NLRs; it is seen that in low fibrosis group NLR was 2.09 and in high fibrosis group NLR was 1.72 (p=0.038). It is seen that AST predicts fibrosis because of AST/ALT ratio was higher due to increase in favor of AST especially in patients with cirrhosis. Furthermore, NLR predicts fibrosis with 60% sensitivity and 65.2 % specificity if cutt off value is taken as 1.77. Conclusion: According to our results, NLR can predicts the degree of liver fibrosis in chronic liver disease, despite it’s lower sensitivity and specificity.

A case of liver cirrhosis due to hypopituitarism in adolescence after nasopharyngeal carcinoma radiotherapy

Nonalcoholic fatty liver disease is a metabolic stress liver injury, including simple hepatic steatosis, nonalcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma (HCC). Liver fibrosis in NASH patients progressed by an average of 7 to 10 years, and the incidence of cirrhosis in NAH patients was only 0.6% to 3.0% after 10 to 20 years of follow-up. This case reports a 21-year-old man with pituitary dysfunction and cirrhosis, whose condition develops rapidly. The mechanism may be that growth hormone deficiency affects liver signaling transduction pathways to make the liver metabolism disordered, causing nonalcoholic fatty liver disease. In this report, the pathogenesis, diagnosis and treatment of this case of cirrhosis duo to hypopituitarism in adolescence are reviewed retrospectively to improve the understanding of the diagnosis and therapy of this disease. Key words: Hypopituitarism; Growth hormone deficiency; Nonalcoholic fatty liver disease; Cirrhosis

Alcohol Consumption and Risk of Liver Cirrhosis: A Systematic Review and Meta-Analysis.

To systematically summarize the risk relationship between different levels of alcohol consumption and incidence of liver cirrhosis. MEDLINE and Embase were searched up to March 6, 2019, to identify case-control and cohort studies with sex-specific results and more than 2 categories of drinking in relation to the incidence of liver cirrhosis. Study characteristics were extracted and random-effects meta-analyses and meta-regressions were conducted. A total of 7 cohort studies and 2 case-control studies met the inclusion criteria, providing data from 2,629,272 participants with 5,505 cases of liver cirrhosis. There was no increased risk for occasional drinkers. Consumption of one drink per day in comparison to long-term abstainers showed an increased risk for liver cirrhosis in women, but not in men. The risk for women was consistently higher compared to men. Drinking ≥5 drinks per day was associated with a substantially increased risk in both women (relative risk [RR] = 12.44, 95% confidence interval [CI]: 6.65-23.27 for 5-6 drinks, and RR = 24.58, 95% CI: 14.77-40.90 for ≥7 drinks) and men (RR = 3.80, 95% CI: 0.85-17.02, and RR = 6.93, 95% CI: 1.07-44.99, respectively). Heterogeneity across studies indicated an additional impact of other risk factors. Alcohol is a major risk factor for liver cirrhosis with risk increasing exponentially. Women may be at higher risk compared to men even with little alcohol consumption. More high-quality research is necessary to elucidate the role of other risk factors, such as genetic vulnerability, body weight, metabolic risk factors, and drinking patterns over the life course. High alcohol consumption should be avoided, and people drinking at high levels should receive interventions to reduce their intake.