Cases Of Cirrhosis Research Articles

Single-Cell RNA Transcriptomics Reveals the State of Hepatic Lymphatic Endothelial Cells in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure.

Acute-on-chronic liver failure (ACLF) is an acutely decompensated cirrhosis syndrome with high short-term mortality. Very little is known about the relationship between the lymphatic system and ACLF. We explored the role of hepatic lymphatic vessels (LVs) and lymphatic endothelial cells (LyECs) in ACLF using human liver samples with the help of single-cell RNA-sequencing (scRNA-seq) technology. Here, ACLF exhibited more severe liver injury and inflammation than cirrhosis, as indicated by significant increases in plasma levels of alanine/aspartate aminotransferases and total bilirubin. Compared with cirrhosis cases, the number of intrahepatic LVs was decreased significantly in ACLF patients. ScRNA-seq revealed that many monocyte/macrophages infiltrated into the liver of ACLF cases. Meanwhile, scRNA-seq revealed a group of apoptotic and dysfunctional LyECs, which were the result of secreted phosphoprotein 1 (SPP1) released from infiltrating monocyte/macrophages. In vitro, SPP1 increased the proportion of dead LyECs significantly and impaired the ability of tube formation of LyECs in a dose- and time-dependent manner. In conclusion, ACLF is associated with less LV and LyEC dysfunction, at least in part mediated by SPP1 released from infiltrating monocyte/macrophages. Hepatic LVs and LyECs can be a novel therapeutic strategy for ACLF.

Clinical characteristics of 500 hospitalized patients with liver cirrhosis: a retrospective analysis from a tertiary hospital in Beijing

Objective: To understand the clinical characteristics of hospitalized patients with liver cirrhosis, so as to provide theoretical basis for disease diagnosis and treatment, formulation of intervention measures, and improve the level of disease diagnosis and treatment. Methods: Hospitalized patients who were initially diagnosed with liver cirrhosis at Peking University First Hospital from August 2017 to December 2018 were selected retrospectively as the research objects. Liver cirrhosis demographic data, etiology, severity classification, incidence of complications, diagnosis and prognosis were recorded. Statistical analysis was performed using SPSS software. Results: Among all liver cirrhosis cases, there were 291 males and 209 females, with a male-to-female ratio of 1.4:1 and an age of 59.5±12.9 years as at August 2017 to December 2018. HBV infection, alcoholic liver disease, and autoimmune liver diseases were the most common etiology of liver cirrhosis. HBV infection alone, HBV infection combined with other factors, alcoholic liver disease alone, alcoholic liver disease combined with other factors, autoimmune liver disease alone, and autoimmune liver disease combined with other factors were presented in 163 (32.6%), 57 (11.4%), 47 (9.4%), 63 (12.6%), 85 (17.0%), and 22 (4.4.0%) cases, respectively. Ascites (221 cases, 44.2%), followed by esophagogastric varices (214 cases, 42.8%), and other including hypersplenism (137 cases), liver cancer (126 cases), upper digestive system tract hemorrhage (66 cases), hepatic encephalopathy (40 cases), infection (37 cases), portal vein thrombosis (23 cases), hepatorenal syndrome (20 cases) were the most common complications. The most common site of infection was the abdominal cavity (20 cases), accounting for 54.1%; followed by respiratory tract infection (8 cases), accounting for 21.6% in patients with liver cirrhosis with concurrent infection. Among them, there were 32 cases of bacterial infection alone, one case of bacterial infection combined with fungal infection, one case of bacterial infection combined with viral infection, and three cases of unknown pathogens. There were 69 cases in Child Pugh grade C, and the average hospitalization times were 12.6 days in terms of prognosis. There were total seven cases of death, of which five cases were due to upper gastrointestinal hemorrhage and two due to hepatic encephalopathy. Conclusion: HBV infection, ascites, and upper gastrointestinal bleeding were the most common etiologies, complications, and causes of death in patients with liver cirrhosis at our hospital.

Identifying and Exploring the Candidate Susceptibility Genes of Cirrhosis Using the Multi-Tissue Transcriptome-Wide Association Study.

Objective: We identify and explore the candidate susceptibility genes for cirrhosis and their underlying biological mechanism. Methods: We downloaded the genome-wide association studies summary data of 901 cirrhosis cases and 451,363 controls and integrated them with reference models of five potential tissues from the Genotype-Tissue Expression (GTEx) Project, including whole blood, liver, pancreas, spleen, and thyroid, to identify genes whose expression is predicted to be associated with cirrhosis. Then, we downloaded gene expression data of individuals with hepatocellular carcinoma from TCGA database to conduct differential expression analysis to validate these identified genes and explored their possible role in driving cirrhosis via functional enrichment and gene set enrichment analysis (GSEA). Results: We identified 10 significant genes (SKIV2L, JPH4, UQCC2, RP11-91I8.3, MAU2, ERAP1, PUS3, ZNF677, ARHGAP40, and SHANK3) associated with cirrhosis at a Bonferroni-corrected threshold of p < 0.01, among which two (SKIV2L and JPH4) were identified in the liver and five (SKIV2L, JPH4, MAU2, SHANK3, and UQCC2) were validated by differential expression analysis at an FDR-corrected threshold of p < 0.01. The enrichment analysis showed that the degradation process of RNA, which is enriched by 58 genes, is significantly under-enriched in liver cancer tissues (p = 0.0268). Conclusion: We have identified several candidate genes for cirrhosis in multiple tissues and performed differential genetic analysis using the liver cancer database to verify the significant genes. We found that the genes SKIV2L and JPH4 identified in the liver are of particular concern. Finally, through enrichment analysis, we speculate that the process of mRNA transcription and RNA degradation may play a role in cirrhosis.

Analysis of the diagnostic efficiency of combining multiple laboratory hematological indicators in alpha-fetoprotein-negative hepatocellular carcinoma

Objective: To establish a diagnostic model for alpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) by combining multiple laboratory hematological indicators and explore its clinical diagnostic efficiency. Methods: A total of 124 inpatients, including 110 males and 14 females, aged 57 (51, 66) years, who were first diagnosed with AFP-NHCC in the PLA General Hospital were included from December 2011 to June 2017. Meanwhile, 331 cases of non-HCC were enrolled as the control group, including 279 males and 52 females, aged 58 (51, 63) years old, with 47 cases of hepatitis B virus (HBV) infection, 40 cases of liver cirrhosis, 64 cases of hepatic hemangioma or cysts, 7 cases of liver nodules, 8 cases of fatty liver, 146 cases of non-liver disease and 19 health controls. Subjects in the AFP-NHCC group and the control group were divided into a training group and a validation group. A total of 196 subjects were involved in the training group, including 103 AFP-NHCC patients and 93 non-HCC patients (19 healthy controls, 25 patients with HBV infection, 22 patients with liver cirrhosis, 23 patients with hepatic hemangioma or cyst, and 4 patients with liver nodules). The differences in laboratory parameters were analyzed, and a diagnostic model of AFP-NHCC under different AFP levels was established. Likewise, 259 subjects, including 113 patients with liver disease, were involved in the validation group to verify the diagnostic efficiency of the model for AFP-NHCC. The receiver operating characteristic (ROC) curve was used to analyze the sensitivity and specificity of different models, and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of different models. Results: In the training group, the indicators of AFP-NHCC diagnostic model included platelet (PLT), prothrombin activity (PTA), serum albumin (ALB), prothrombin time (PT) and carbohydrate antigen 19-9 (CA19-9), and the AUC of the model was 0.848 (95%CI: 0.786-0.911) when AFP≤5 μg/L. Similarly, the indicators of AFP-NHCC diagnostic model included PLT, PTA, ALB, PT and hematocrit (HCT), and the AUC of the model was 0.839 (95%CI: 0.780-0.897) when AFP≤10 μg/L. When AFP≤20 μg/L, the indicators of AFP-NHCC diagnostic model contained PLT, PTA, ALB, PT, HCT and AFP, and the AUC of the model was 0.866 (95%CI: 0.815-0.917). The AUC values of these three models were higher than those of AFP and CA19-9 alone for the diagnosis of AFP-NHCC [0.634 (95%CI: 0.560-0.709), 0.691 (95%CI:0.620-0.761), all P<0.05]. The indicators screened by these three models were combined to establish the final diagnostic model, and the AUC of the model was 0.873 (95%CI: 0.824-0.923), with the sensitivity of 78.6% (81/103) and the specificity of 81.7% (76/93). In the validation group, the predictive AUC of the final model in liver disease patients was 0.892 (95%CI: 0.832-0.951), with the sensitivity of 100% (21/21) and the specificity of 71.7% (66/92), while in the total validation population, the predictive AUC was 0.931 (95%CI: 0.890-0.972), with the sensitivity of 100.0% (21/21) and the specificity of 75.6% (180/238). Conclusion: The final diagnostic model includes PLT, PTA, ALB, PT, HCT, CA19-9 and AFP, which has higher sensitivity and specificity, and has good diagnostic efficiency for the clinical diagnosis of AFP-NHCC.

The world’s first case of liver cirrhosis in a child with Castleman’s disease

The world’s first case of liver cirrhosis in a child with Castleman’s disease

HBV elimination in sub-Saharan Africa: Rwanda's approach to health system integration

Liver cirrhosis and liver cancer are major causes of morbidity and mortality in the sub-Saharan African region. This region has the highest age-standardised death rate due to cirrhosis, and more than half of all cases of cirrhosis are attributable to hepatitis B virus (HBV) or hepatitis C virus (HCV) across all sub-regions. The attributable fraction due to HBV is particularly concerning, given the higher oncogenic potential of HBV genotypes that predominate in the region, as well as the higher risk of hepatocellular carcinoma associated with vertical HBV transmission.

Acquired Thrombophilic Hypercoagulable States Seen in Patients with Liver Cirrhosis: A Single Center Study

Among the common hemostatic issues of the patients of liver cirrhosis, deep venous thrombosis, pulmonary embolism, and intrahepatic thrombus development are more often ignored. With an estimated frequency ranging from 0.6 to 26 percent, portal venous thrombosis is another potentially dangerous consequence of liver cirrhosis. Objectives: To determine the frequency of various acquired thrombophilic / hypercoagulable states seen in patients with liver cirrhosis. Study design: Descriptive, cross sectional. Settings: Department of Medicine, Allied Hospital, Faisalabad Study duration: 30th June 2019 to 29th December 2019 Materials &amp; Methods: Cirrhosis cases ranging in age from 25 to 75 years old and of both genders were included in the study. Patients with HCC, heritable thrombophilias such as the Factor V leiden mutation, congenital budd chiari, and cholestatic liver disorders such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis were also eliminated. To assess for hepatic decompensation, ultrasonography, LFTs, and other baseline procedures were performed. Doppler USG was performed in each case with the assistance of the Radiology Department of Allied Hospital Faisalabad to assess for DVT, Budd-Chiari syndrome, and Portal venous thrombosis. Results: Mean age of the patients enrolled was 52.08 ± 10.47 years. Among these 840 patients, 461 (54.88%) were male and 379 (45.12%) were females (ratio 1.2 : 1). Mean AST levels were 77.49 ± 8.93 units/liter. Mean ALT levels were 88.51 ± 9.17 units/liter. Mean total bilirubin levels were 8.33 ± 1.65 mg/dl. Frequency of various acquired thrombophilic / hypercoagulable states seen in patients with liver cirrhosis were as follows; portal vein thrombosis in 136 (16.19%) patients, budd chiari syndrome in 102 (12.14%), deep vein thrombosis in 96 (11.43%) and pulmonary embolism in 108 (12.86%) patients. Conclusion: This study concluded that frequency of various acquired thrombophilic / hypercoagulable states seen in patients with liver cirrhosis is quite high. Keywords: liver cirrhosis, hypercoagulable states, portal vein thrombosis.

Correlation of Ultrasonographically Measured Splenic Size with Endoscopic Grading of Esophageal Varices in Cirrhosis of Liver

Background: Cirrhosis is the end stage of chronic liver disease, resulting in formation of fibrous tissue, derangement of liver architecture and ultimately results in portal hypertension and its complication. Objective: To find out the correlation between splenic size and endoscopic grading of esophageal varices in diagnosed cases of cirrhosis of liver. Methods: This prospective observational cross-sectional study was carried out in the Department of Radiology and Imaging in collaboration with GHPD, BIRDEM, Dhaka. 110 liver cirrhosis patients with or without esophageal varices diagnosed by endoscopy of UGIT referred to the department of Radiology and Imaging were included in this study on the basis of selection criteria. Result: The following observations and results were obtained in this study the mean age was 44.81 (±14.42) years, minimum age was 18 years and maximum age was 65 years. Majority 69% were male and 31% were female. Esophageal variceal grading of the study population majority 47(42.73%) were grade I, 24(21.82%) were grade II, 16(14.55%) were grade III, 12(10.91%) were grade IV and 11(10%) were no varices. Splenic size by ultrasonography, majority 66(60%) were 12-14.9 cm, 37(33.64%) were ≥15 cm and 07(6.36%) were &lt; 12 cm. In splenic size ≤ 15 cm, grading of esophageal varices, 15.07% had no varices, 60.27% had grade I, 20.55% had grade II, 2.74% had grade III and 1.37% had grade IV. In splenic size ≥ 15 cm grading of esophageal varices, 8.11% had grade I, 24.32% had grade II, 37.84% had grade III and 29.73% had grade IV. That means there is a positive correlation between ultrasonographically measured splenic size and endoscopic grading of esophageal varices in liver cirrhosis patients. Conclusion: Positive correlation was found between ultrasonographically measured splenic size with endoscopic grading of esophageal varices. Bangladesh Crit Care J March 2022; 10 (1): 57-61

GWO BASED OPTIMISTIC FEATURE SELECTION FOR PREDICTION OF ADVANCED LIVER FIBROSIS

The present populace of India is 1,362,255,678 as of January, 2019, in view of the most recent United Nations estimates [1]. Worldwide examinations calculate that there are 8.7 million individuals living with chronic Hepatitis in India. Chronic Hepatitis disease represents 12-32 per cent of liver malignant growth and 10-20 per cent of cirrhosis cases in India. The vast majority with constant Hepatitis B or C are ignorant of diseases and are at genuine danger of creating cirrhosis or liver malignant growth.Machine learning fits a few procedures superior to other traditional methods like Biopsy. This paper evaluate various machine learning methods to predict advanced liver fibrosis by using patient’s blood report to build up the optimization and classification models. The METAVIR score is a device used to assess the seriousness of fibrosis seen on a liver biopsy test from a human who has chronic hepatitis. Based on the METAVIR score [2,3,4] chronic hepatitis divided into three parts, first one is classified as mild stage, second one is moderate stage and third one is advanced stage of fibrosis. Grey Wolf Optimization, Random Forest Classifier and Decision tree procedure models forpropelled fibrosis chance expectation were produced. ROC curve and confusion matrix was evaluated to compare the accuracy of proposed methods.

Cost-Effectiveness of Hepatitis B Testing and Vaccination of Adults Seeking Care for Sexually Transmitted Infections.

The estimated number of people living with hepatitis B virus (HBV) infection acquired through sexual transmission was 103,000 in 2018, with an estimated incidence of 8300 new cases per year. Although hepatitis B (HepB) vaccination is recommended by the Advisory Committee for Immunization Practices for persons seeking evaluation and treatment for sexually transmitted infections (STIs), prevaccination testing is not yet recommended. Screening may link persons with chronic hepatitis B to care and reduce unnecessary vaccination. We used a Markov model to calculate the health impact and cost-effectiveness of 1-time HBV testing combined with the first dose of the HepB vaccine for adults seeking care for STI. We ran a lifetime, societal perspective analysis for a hypothetical population of 100,000 aged 18 to 69 years. The disease progression estimates were taken from recent cohort studies and meta-analyses. In the United States, an intervention that costs less than $100,000 per quality-adjusted life-year (QALY) is generally considered cost-effective. The strategies that were compared were as follows: (1) vaccination without HBV screening, (2) vaccination and hepatitis B surface antigen (HBsAg) screening, (3) vaccination and screening with HBsAg and anti-HBs, and (4) vaccination and screening with HBsAg, anti-HBs, and anti-HBc. Data were obtained from Centers for Medicare & Medicaid services reimbursement, the Centers for Disease Control and Prevention vaccine price list, and additional cost-effectiveness literature. Compared with current recommendations, the addition of 1-time HBV testing is cost-saving and would prevent an additional 138 cases of cirrhosis, 47 cases of decompensated cirrhosis, 90 cases of hepatocellular carcinoma, 33 liver transplants, and 163 HBV-related deaths, and gain 2185 QALYs, per 100,000 adults screened. Screening with the 3-test panel would save $41.6 to $42.7 million per 100,000 adults tested compared with $41.5 to $42.5 million for the 2-test panel and $40.2 to $40.3 million for HBsAg alone. One-time HBV prevaccination testing in addition to HepB vaccination for unvaccinated adults seeking care for STI would save lives and prevent new infections and unnecessary vaccination, and is cost-saving.

Chronic liver diseases must be reduced worldwide: it is time to act

There were an estimated 1·5 billion cases of chronic liver disease worldwide in 2017,1 including 10·6 million cases of decompensated cirrhosis and 112 million cases of compensated cirrhosis.2 Cirrhosis accounted for an estimated 1·32 million deaths in the same year.2 This burden, which is probably underestimated,2 is highly concerning.

Type 2 Diabetes, PNPLA3 rs738409 Polymorphism, and the Risk of Liver Cirrhosis: Analysis of Taiwan Biobank.

Type 2 diabetes (T2D) and liver cirrhosis remain significant public health threats in Taiwan. These conditions are reported to be associated with the rs738409 polymorphism of the patatin-like phospholipase domain-containing protein three gene (PNPLA3) in European populations. We assessed the effect of T2D and PNPLA3 rs738409 polymorphism on liver cirrhosis among Taiwan Biobank (TWB) participants. In total, 17,985 participants in TWB had their health records linked to the National Health Insurance Research Database (NHIRD). Participants included those who visited the assessment centers between 2008 and 2015, with an age range between 30 and 70 years of age. We performed logistic regression analysis to investigate the odds ratios (OR) for liver cirrhosis among participants based on the T2D status and rs738409 genotypes. Genotyping was performed using the Axiom Genome-Wide TWB Array Plate. In our analysis, 150 of the 17,619 eligible participants were identified as cirrhosis cases. Based on the univariate analysis, liver cirrhosis was positively associated with T2D (OR, 1.83; 95% CI 1.23–2.70) whereas, the variant rs738409 was not (regardless of the genetic model). The variant and T2D, however, showed significant interactions in the additive, genotype, and dominant models (p values of 0.0302, 0.0395, and 0.0455, respectively). We observed a statistically significant association between T2D and liver cirrhosis and variant rs738409 with an OR of 1.71 (95% CI, 1.03–2.84) for individuals carrying a G allele compared to those with a C allele and 2.92 (95% CI 1.07–7.99) for GG compared to CC individuals. According to our study, Taiwanese adults with T2D and the rs738409 GG genotype are more likely to develop liver cirrhosis.

Universal Hepatitis B Antibody Screening and Vaccination in Pregnancy: A Cost-Effectiveness Analysis.

To evaluate the cost effectiveness of universal screening for hepatitis B immunity and vaccination among pregnant women in the United States. We designed a decision-analytic model to evaluate the outcomes, costs, and cost effectiveness associated with universal hepatitis B virus (HBV) immunity screening in pregnancy with vaccination of susceptible individuals compared with no screening. A theoretical cohort of 3.6 million women, the approximate number of annual live births in the United States, was used. Outcomes included cases of HBV, hepatocellular carcinoma, decompensated cirrhosis, liver transplant and death, in addition to cost and quality-adjusted life-years (QALYs). Model inputs were derived from the literature, and the willingness-to-pay threshold was $50,000 per QALY. Univariate sensitivity analyses and Monte Carlo simulation models were performed to evaluate the robustness of the results. In a theoretical cohort of 3.6 million women, universal HBV immunity screening and vaccination resulted in 1,702 fewer cases of HBV, seven fewer cases of decompensated cirrhosis, four fewer liver transplants, and 11 fewer deaths over the life expectancy of a woman after pregnancy. Universal screening and vaccination were found to be cost effective, with an incremental cost-effectiveness ratio of $1,890 per QALY. Sensitivity analyses demonstrated the model was robust even when the prevalence of HBV immunity was high and the annual risk of HBV acquisition low. Among pregnant women in the United States, universal HBV immunity screening and vaccination of susceptible persons is cost effective compared with not routinely screening and vaccinating.

Expression and Clinical Values of Serum miR-155 and miR-224 in Chinese Patients with HCV Infection.

BackgroundTo investigate the expression of serum miR-155 and miR-224 among patients with hepatitis C virus (HCV) infection and analyze their clinical values.MethodsA total of 116 patients suffering from HCV infection admitted to our hospital and 70 healthy subjects were selected. According to the diagnostic results, patients with HCV infection were divided into 48 cases of chronic hepatitis C (CHC), 43 cases of liver cirrhosis and 25 cases of hepatocellular carcinoma (HCC). The expression signature for miR-155 and miR-224 was detected in serum samples. ROC curve and Pearson correlation test were conducted to investigate their diagnostic value and correlation.ResultsThe expression extent for serum miR-155 and miR-224 increased along with the increase of malignancy (all P < 0.05). According to ROC curve, the area under the curve (0.918, 95% CI: 0.856–0.974) of miR-155 and miR-224 combined in the diagnosis of HCC was the largest, and its sensitivity and specificity were 93.0% and 86.2%. There is a positive relationship for expression level between miR-155 and miR-224 in CHC and HCC group (all P < 0.001).ConclusionmiR-155 and miR-224 are remarkably increased in patients suffering from HCV infection. The combination of miR-155 and miR-224 has a good diagnostic value for HCC caused by HCV infection.

Direct acting antiviral治療後に原発不明癌を発症し急激な転機を辿ったC型肝硬変の1例

Direct acting antiviral治療後に原発不明癌を発症し急激な転機を辿ったC型肝硬変の1例

Epidemiology and disease burden of non-alcoholic steatohepatitis in greater China: a systematic review.

Non-alcoholic steatohepatitis (NASH) is a progression of non-alcoholic fatty liver disease. The increasing burden of NASH has become a major concern of public health in greater China. This study aimed to characterize the epidemiology, disease burden, and treatment of NASH in greater China to better inform national disease management and delivery of health services. We conducted a systematic review searching four English databases (Web of Science, PubMed, Medline, and Cochrane Central) and three Chinese databases (CNKI, Wanfang, and VIP). We identified articles published from database inception to October 10, 2020 which reported NASH epidemiology, disease burden, and/or intervention in Chinese adults. Of 44,115 articles retrieved, 33 were eligible for inclusion. Overall prevalence of NASH ranged from 2.4 to 6.1% in greater China, with a more substantial burden among males, the aged, and those in Hong Kong and Taiwan. Most NASH patients suffered from several comorbidities, including obesity, diabetes, and cardiovascular conditions. PNPLA3 rs738409 G allele and haptoglobin 2-2 genotype drove the fibrosis progression in NASH. Increasingly prevalent cases of cirrhosis and hepatocellular carcinoma caused a higher NASH-related mortality. Compared with normal population, NASH patients experienced markedly poorer quality of life and heavier costs. This is the first comprehensive overview of NASH among Chinese population that revealed an overwhelming impact of social and healthcare burden associated with the condition. Further high-quality studies are needed to improve the understanding and management of NASH in greater China.

Effect of increased alcohol consumption during COVID-19 pandemic on alcohol-associated liver disease: A modeling study.

Background and AimsAlcohol consumption increased during the COVID‐19 pandemic in 2020 in the United States. We projected the effect of increased alcohol consumption on alcohol‐associated liver disease (ALD) and mortality.Approach and ResultsWe extended a previously validated microsimulation model that estimated the short‐ and long‐term effect of increased drinking during the COVID‐19 pandemic in individuals in the United States born between 1920 and 2012. We modeled short‐ and long‐term outcomes of current drinking patterns during COVID‐19 (status quo) using survey data of changes in alcohol consumption in a nationally representative sample between February and November 2020. We compared these outcomes with a counterfactual scenario wherein no COVID‐19 occurs and drinking patterns do not change.One‐year increase in alcohol consumption during the COVID‐19 pandemic is estimated to result in 8000 (95% uncertainty interval [UI], 7500–8600) additional ALD‐related deaths, 18,700 (95% UI, 17,600–19,900) cases of decompensated cirrhosis, and 1000 (95% UI, 1000–1100) cases of HCC, and 8.9 million disability‐adjusted life years between 2020 and 2040. Between 2020 and 2023, alcohol consumption changes due to COVID‐19 will lead to 100 (100–200) additional deaths and 2800 (2700–2900) additional decompensated cirrhosis cases. A sustained increase in alcohol consumption for more than 1 year could result in additional morbidity and mortality.ConclusionsA short‐term increase in alcohol consumption during the COVID‐19 pandemic can substantially increase long‐term ALD‐related morbidity and mortality. Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high‐risk alcohol drinking in the United States.

Assessment of Plasma Vitronectin as Diagnostic and Prognostic Marker of Hepatocellular Carcinoma in Patients with Hepatitis C Virus Cirrhosis

Background: hepatitis C is an inflammatory liver disease caused by the hepatitis C infection (HCV), and without treatment, almost 50% will progress to liver cirrhosis. Hepatocellular carcinoma (HCC) is the most frequent type of primary liver cancer and the fourth leading cause of cancer-related mortality. Aim of the study: the objective of this study was to evaluate the serum level of vitronectin (VTN) compared to AFP and determine their role as diagnostic and prognostic markers of HCV-related liver diseases. Subject and Methods: this study involved 52 HCV patients from which 26 patients were cirrhotic, and 26 patients had HCC (on top of hepatitis C virus-related cirrhosis) plus 10 healthy people as a control group. It was carried out in Gastroenterology and Hepatology Unit, Internal Medicine Department, Zagazig University Hospitals, Egypt. All individuals in this study were subjected to physical examination, full history taking, liver function tests, assessment of serum levels of Vitronectin (VTN) and alpha-fetoprotein (AFP) before and after the intervention within three months. Results: serum level of vitronectin increased significantly in cirrhosis patients and HCC patients than controls (p = 0.0041), (p &lt; 0.001), respectively, and in HCC than cirrhosis patients (p &lt; 0.001). Significant positive correlations were observed between levels of serum VTN and AFP in all HCV patients as well as cirrhotic patients (p &lt; 0.001, p = 0.011, respectively). On the contrary, VTN and AFP didn’t show a significant correlation in HCC patients’ group. Moreover, the median serum level of VTN decreased significantly after treatment in patients with HCC (p &lt; 0.001). At cut-off 38.5 ng/mL for AFP it shows sensitivity 80.8%, specificity 76.9% to differentiate HCC from cirrhosis cases. While VTN shows 84.6% sensitivity, 96.2% specificity at cut-off 26.5 μg/mL. Regarding clinicopathological characteristics and VTN levels, half of patients were stage B, 63.9% had tumor size &gt;3 cm, 84.6% had more than one focal lesion. Conclusions: these results may allow one to speculate a potential role of Vitronectin in diagnosis and prognosis of HCC on top of cirrhosis related to HCV infection in addition to AFP and US and CT.

The Value of Serum MidKine as a Marker of Hepatocellular Carcinoma on Top of Hepatitis C Virus Related Cirrhosis

Background: Hepatocellular carcinoma (HCC) is characterized by the deficiency of specific symptoms in the early stages of the disease and a poor prognosis. Biomarkers that have the diagnostic ability to distinguish between inflammation, cirrhosis, and HCC are needed for early case detection. MidKine (MK) is overexpressed in many malignancies, including hepatocellular carcinoma, gastric carcinoma, colon carcinoma, lung carcinoma, urinary bladder carcinoma and prostate carcinoma. Objective: The objective is to evaluate serum MidKine as a marker of HCC in HCV-related liver cirrhosis. Patients and Methods: This study included 50 patients with HCC (on top of hepatitis C virus-related cirrhosis), 20 cirrhotic patients due to chronic HCV infection, and 10 normal subjects as a control group. History, examination, and laboratory investigations were performed on all subjects in the three groups including MK and Alpha fetoprotein (AFP) serum levels. Results: Serum levels of AFP and MK were higher in the HCC group than in the other study groups (P < 0.001). AFP was positive in 35 (70%) and negative in 15 (30%) whereas MK was positive in all HCC cases. There was a statistically significant correlation between MK serum levels and AFP serum levels, tumor size, and tumor stage. Conclusion: MidKine is a novel sensitive biomarker that could be used for early detection of HCC and has a high significance in differentiation between cirrhosis and HCC cases. MidKine levels are correlated with HCC stages and sizes.

Study of common precipitating factors and clinical outcome of hepatic encephalopathy in known case of cirrhosis of liver

Background and Aim: Earlier studies for evaluation of cause and outcome of hepatic encephalopathy (HE) in cirrhosis of the liver have shown varying results. Patients with HE can have varying outcomes. We undertook this study to assess the clinical spectrum of HE, precipitating factors in addition to the outcome.