Cirrhotic Group Research Articles

Examine the Vitamin-D Status of HCV-Infected Patients and Control in Lahore, Pakistan

Introduction: Hepatitis C virus is a serious health issue that can remain fatal owing to their dire repercussions. HCV causes approximately 710,500 deaths each year, has over 190 million individuals affected
 Objective: Serum Vitamin-D has an important part in inflammatory and infections illnesses, particularly liver diseases. The purpose of this experiment was to examine the Vitamin-D status of HCV-diseased cases and control in Lahore, Pakistan.
 Methods: From the 25th of August, 2019 to the 25th of February, 2020, we conducted randomized cross-sectional research on 78 people at Services Hospital in Lahore. Fifty-one individuals tested positive for hepatitis C RNA-PCR (25 salaried cirrhotic and 25 decompensated cirrhotic cases). In addition, 24 healthy controls were selected who did not have liver problems. ARTUS ® HCV QS-RGQ V1 was used to perform HCV RNA–PCR. Chemiluminescence was used to determine vitamin D levels. For descriptive statistics, SPSS version 20 was employed.
 Results: When compared to untreated (32.43 ng/mL), average level of Vitamin-D in Treated patients remained considerably inferior in supplied and fluid resuscitation hepatocellular carcinoma (28.88 ng/mL & 21.67 ng/mL, respectively). In this research, 78.6 percent of HCV patients had suboptimal Vitamin-D levels. Vitamin-D deficiency (22-28 ng/mL) was seen in both healthy people (46.9 percent) and HCV sufferers (38.3 percent) (P 0.002). Furthermore, Vitamin-D levels were shown to have an inverse association with more multi - organ failure, having 56.3 percent of respiratory failure cirrhosis people undergoing from Vitamin-D insufficiency, relative to 14.7 percent in the recovered cirrhotic groups (P 0.0002).
 Conclusion: Suboptimal levels of Vitamin-D (inadequacy before lack) remain more common in hepatitis C comparison to well controls. Vitamin-D insufficiency were found to be directly related to somatic symptoms.

Impact of cirrhosis on long-term survival outcomes of patients with intrahepatic cholangiocarcinoma.

BackgroundThe correlation between cirrhosis and the long‐term oncological outcome in intrahepatic cholangiocarcinoma (ICC) is debatable, and this study aimed to explore the impact of cirrhosis on the long‐term prognosis of patients with ICC.MethodsA total of 398 ICC patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2018. The diagnosis of cirrhosis was based on the Ishak fibrosis score provided by the SEER database. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analysis were performed to minimize the potential confounders. Overall survival (OS) and cancer‐specific survival (CSS) were observed, and the Cox regression model was used to select potential factors that affect the prognosis of the patients with ICC.ResultsOf the included patients, there were 142 patients and 256 patients in the cirrhotic and noncirrhotic groups, respectively. Additionally, 299 of 398 patients (75.1%) died following a median follow‐up of 19 months (interquartile range [IQR], 7, 43). The OS and CSS indicated advantage trend in the noncirrhotic group than the cirrhotic group in either the original cohort (OS: 17 vs 12 months, p = 0.023; CSS: 26 vs 15 months, p = 0.004) or the PSM (OS: 17 vs 12 months, p = 0.52; CSS: 22 vs 14 months, p = 0.15) or IPTW (OS: 20 vs 13 months, p = 0.163; CSS: 22 vs 15 months, p = 0.059) cohorts. Subgroup analyses displayed that the prognosis of patients who experienced surgery for ICC in the noncirrhotic group was better than that of the cirrhotic group with regard to OS and CSS.ConclusionsCollectively, it seems that the noncirrhotic patients have similar relative OS but better CSS compared with that of the cirrhotic patients.

Role of Serum Cystatin C as a Diagnostic Tool for Renal Function in Cirrhotic Patients

Background: Assessment of cystatin C levels could be valuable in the early detection of renal dysfunction because they increase faster than the creatinine levels as the GFR decreases. The aim of this work was to evaluate serum cystatin C as a diagnostic tool for renal dysfunction in cirrhotic patients with and without hepatorenal syndrome (HRS). Methods: This case-control study was conducted on 60 patients from the Tropical Medicine Department of Tanta University Hospitals and 10 people served as healthy control volunteers. Serum cystatin C was measured in the three groups. Results: A significant difference was observed among the three groups as cystatin C was higher in patients with HRS compared to the cirrhotic group and healthy controls. Conclusion: Serum cystatin C is a good predictor for hepatorenal syndrome with a good correlation with serum creatinine, blood urea, GFR, and creatinine clearance.

The Correlation of Mean Platelet Volume and Neutrophil-lymphocyte Ratio Measurements, and the Ishak Fibrosis Score in Our Patients with Chronic Hepatitis B

Background:The ishak score determined by liver biopsy is the most reliable indicator of fibrosis, but biopsy is an invasive procedure. Numerous noninvasive tests have been investigated to determine the hepatic fibrosis score. We aimed to investigate the relationship between the mean platelet volume(MPV) and neutrophillymphocyte ratio (NLR) measurements in patients with chronic hepatitis B virus (CHB) infection, and liver fibrosis stage, which was determined by biopsy and ishak score. Material and Method:CHB patients followed between 2016 and 2020 in our gastroenterology outpatient clinic were included in our study. CHB patients; They were divided into two groups as non-cirrhotic group (ishak fibrosis score in biopsy; F0-F4) and cirrhotic group (F5-F6). Then, 30 healthy control (HC) groups consisting of health personnel who had routine health screenings and blood tests in the same period were formed. MPV, NLR measurements of these two main groups and CHB subgroups and liver biopsy results of CHB patients were evaluated retrospectively, and possible relationships between the groups were investigated. Results:There was no statistically significant difference between the mean age and gender of the cases in the CHB and HC groups. A total of 54 patients with CHB were identified, of which 13 patients were cirrhotic and 41 patients were non-cirrhotic. MPV measurements were found to be significantly higher in the CHB group than in the SC group (11.15±1.77; 10.02±0.92; p=0.002). While there was no significant difference between NLR measurements, it was found to be higher in the CHB group (1.98±0.81; 1.81±0.69). While there was no significant difference between the cirrhotic and non-cirrhotic subgroups of the CHB group in terms of NLR (1.86±0.68; 2.36±1.04) and MPV (11.09±1.89; 11.35±1.36) measurements, NLR and MPV measurements were higher in the cirrhotic group. Conclusion:In our study, MPV values were found to be significantly increased in patients in the CHB group compared to the HC group. In addition, although not statistically significant, NLR and MPV measurements were found to be higher in the cirrhotic group than in the non-cirrhotic group. According to our study, it can be thought that with increasing MPV and NLR measurements in HBV patients, there may be an increase in chronicity and fibrosis scores without an invasive procedure such as biopsy.

Liver cirrhosis is a risk factor for poor prognosis of acute cholangitis caused by choledocholithiasis

Introduction and objectivesAcute cholangitis, which is characterized by biliary infection and acute liver injury, may impact cirrhosis prognosis. However, the prognosis itself remains unclear. Materials and methodsThis multicenter retrospective cohort study compared the mortality and liver function change between patients with and without cirrhosis who underwent endoscopic treatment for acute cholangitis caused by choledocholithiasis between January 2004 and December 2019. ResultsWe analyzed 699 patients, 44 of whom had cirrhosis. The cirrhotic group had a significantly higher 30-day mortality rate than the noncirrhotic group (14% vs. 1%; P < 0.001). The cirrhotic group also had significantly lower total bilirubin and albumin recovery. However, all patients with cirrhosis who survived achieved total-bilirubin recovery, and 91% achieved albumin recovery within 90 days. In multivariable Cox regression analysis, the independent risk factors for total-bilirubin recovery included cirrhosis (hazard ratio, 0.37; 95%CI, 0.24‒0.58; P < 0.001) and high total-bilirubin level (0.46; 95%CI, 0.34‒0.60; P < 0.001), whereas those for albumin recovery were cirrhosis (0.51; 95%CI, 0.33‒0.79; P = 0.002), high age (0.62; 95%CI, 0.47‒0.82; P < 0.001), organ dysfunction (0.62; 95%CI, 0.39‒0.96; P = 0.03), low albumin level (0.57; 95%CI, 0.36‒0.91; P = 0.02), and high C-reactive protein level (0.73; 95%CI, 0.56‒0.95; P = 0.02). ConclusionsPatients with cirrhosis complicated with acute cholangitis had poor prognosis. Recovery of liver function after endoscopic treatment was slow; nevertheless, most patients who survived could recover within 90 days.

Sero-reactivity to three distinct regions within the hepatitis C virus alternative reading frame protein (ARFP/core+1) in patients with chronic HCV genotype-3 infection.

Hepatitis C virus (HCV) infection affects more than 71 million people worldwide. The disease slowly progresses to chronic, long-term liver injury which leads to hepatocellular carcinoma (HCC) in 5 % of infections. The alternative reading frame protein (ARFP/core+1) is encoded by a sequence overlapping the HCV core gene in the +1 reading frame. Its role in hepatitis C pathogenesis and the viral life cycle is unclear, although some observers have related its production to disease progression and the development of HCC. The aim of this study was to determine whether ARFP is immunogenic in patients with chronic HCV genotype 3 infection and to assess whether sero-reactivity is associated with disease progression, particularly to HCC. Immunogenic epitopes within the protein were predicted by a bioinformatics tool, and three −20 aa length-peptides (ARFP-P1, ARFP-P2 and ARFP-P3) were synthesized and used in an avidin-biotin ARFP/core+1 peptide ELISA. Serum samples from 50 patients with chronic HCV genotype 3 infection, 50 genotype-1 patients, 50 HBV patients and 110 healthy controls were tested. Sero-reactivity to the ARFP peptides was also tested and compared in 114 chronic HCV genotype-3 patients subdivided on the basis of disease severity into non-cirrhotic, cirrhotic and HCC groups. Chronic HCV genotype-3 patients showed noticeable rates of reactivity to ARFP and core peptides. Seropositivity rates were 58% for ARFP-P1, 47 % for ARFP-P2, 5.9 % for ARFP-P3 and 100 % for C22 peptides. There was no significant difference between these seroreactivities between HCV genotype-3 patients with HCC, and HCV genotype-3 patients with and without liver cirrhosis. Patients with chronic HCV genotype-3 infection frequently produce antibodies against ARFP/core+1 protein. ARFP peptide reactivity was not associated with disease severity in patients with HCV genotype-3. These results support the conclusion that ARFP/core+1 is produced during HCV infection, but they do not confirm that antibodies to ARFP can indicate HCV disease progression.

Toll- like receptor 2 polymorphism and IL-6 profile in relation to disease progression in chronic HBV infection: a case control study in Egyptian patients

Chronic hepatitis B (CHB) has a wide range of outcomes depending on host immune responses mainly Toll-like receptors (TLRs) signaling and released cytokines. Toll-like receptor 2 (TLR2) single nucleotide polymorphisms (SNPs) and interleukin 6 (IL-6) may influence the course of CHB. We aimed to elucidate the relation between TLR-2 polymorphism, IL-6 profile, and CHB progression. We analyzed TLR-2 polymorphism (SNP; rs3804099) in 185 CHB patients and 60 controls using TaqMan allelic discrimination assay. Serum IL-6 levels were assessed by ELISA. IL-6 levels were considerably higher in active CHB and cirrhotic patients compared with inactive carriers and controls (P < 0.001). IL-6 showed positive correlation with ALT and advanced fibrosis in active CHB patients (r = 0.31, P = 0.02). A significant positive correlation was noticed between IL-6 and HBV DNA PCR in all CHB groups. TT genotype of rs3804099/TLR-2 was significantly more prevalent in inactive carriers compared to active hepatitis patients (P = 0.04, OR = 0.39 and 95% CI: 0.16–0.95). Both heterozygous CT and mutant TT genotypes were significantly more frequent among inactive carriers compared to cirrhotic patients (P = 0.01, OR = 0.33, 95% CI: 0.13–0.81 and P = 0.009, OR = 0.32, 95% CI: 0.13–0.77). TT genotype was significantly related to lower IL-6 levels in active hepatitis and cirrhotic groups (P = 0.005 and P = 0.001, respectively) showing that TLR mutations would be associated with milder hepatitis activity and lower possibility for disease progression. There may be a positive association between TLR2 rs3804099 polymorphism and hepatitis B activity. IL-6 is a good indicator of CHB disease progression.

Comparing Frequency of Cardiovascular Autonomic Neuropathy in Diabetic Cirrhotic with Non Diabetic Cirrhotic Patients

Cardiac autonomic neuropathy is most common secondary complication of diabetes mellitusis frequently undiagnosed and neglected complication even though it is an independent predictor of mortality and morbidity. This phenomenon can be further exacerbated with co-morbidities like cirrhosis. High prevalence of diabetes as well as cirrhosis has been reported in Pakistan. However, proper knowledge and information regarding incidence of diabetesin cirrhosis induced cardiovascular autonomic neuropathy in is lacking.So, its early detection and timely management is needed to prevent cirrhotic and diabetic cardiomyopathy. Our objective is to determine and compare the frequency of cardiovascular autonomic neuropathy in diabetic cirrhotic and non-diabetic cirrhotic patients. Methods:Cross sectional study was done on120 patients enrolled in Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan. Two groups, diabetic cirrhotic and nondiabetic cirrhotic patients were taken.Those diabetic cirrhotic patients were selected, who had controlled glycemic levels due to proper medication, and patients of both groups had a definite diagnosis of cirrhosis liver. Cardiac autonomic neuropathy was determined in each patient using five standard tests. There after Bellavere,s scoring system was applied to assess the extent of cardiac autonomic dysfunction in each subject. Results: There were 33 males and 27 females in diabetic cirrhotic group and 31 males and 29 females in non-diabetic cirrhotic group. The mean age was 57.48 ± 10.80 years in diabetic cirrhotic patients whereas in the non-diabetic cirrhotic patients, mean age was 51.92 ± 14.21 years. In the diabetic cirrhotic group, 52 patients had parasympathetic tests derangement and 50 patients had sympathetic tests derangement. In non-diabetic cirrhotic 48 patients had parasympathetic tests derangement and 47 patients had sympathetic test derangement. After analysing the results of frequency of cardiovascular autonomic neuropathy, the comparison between the two groups reveal that there is no significant difference between the two groups. Conclusions:This study shows that cardiovascular autonomic neuropathy develops frequently in cirrhotic subjects, that it is found with comparable frequency in diabetics and non-diabetics, and that it increases in severity with increase in severity of liver damage, suggesting that liver damage contributes to the neurological deficit.

Real-world study evaluating the incidence of liver damage conditions in patients with primary liver cancer using immune checkpoint inhibitor-based combination therapy

Objective: To evaluate the incidence of immune checkpoint inhibitor-based combination therapy-induced liver damage in patients with primary liver cancer. Methods: Clinical data of 65 hospitalized cases of primary liver cancer treated with programmedcelldeath-1its ligand programmed death-ligand 1(PD-1/PD-L1) antibody in the Department of Infectious Diseases of the Second Affiliated Hospital of Chongqing Medical University from January 1, 2018 to March 31, 2021 were retrospectively analyzed. The degree of liver injury before and after treatment was assessed according to CTCAE v5.0. Patients were grouped according to gender, age, presence or absence of cirrhosis, baseline Child-Pugh score, BCLC stage, and treatment regimen to compare the incidence of liver injury under different conditions. The χ (2) test or rank-sum test was used for comparison among multiple groups. Results: 46 cases (70.77%) had liver damage of any grade according to the CTCAE V5.0 criteria during the treatment and observation period. All 6 cases who received standardized anti-hepatitis B virus (HBV) treatment developed liver damage. 10 (15.38%), 15 (23.08%), 19 (29.23%), and 2 (3.08%) cases had grade 1, 2, 3, and 4 liver damage respectively. There was no statistically significant difference in the incidence of liver damage between male and female patients (68.33% and 100%, P = 0.180). There was no statistically significant difference in the incidence of liver damage among different age groups (P = 0.245). The incidence of liver damage in cirrhotic and non-cirrhotic group was 72.22%, and 63.64% (P = 0.370), respectively. The incidence of liver damage in patients with baseline Child-Pugh class A, B, and C were 71.43%, 61.11% and 100%, respectively, and the difference was not statistically significant (P = 0.878). The incidence of liver damage was not statistically significantly different under different BCLC stages (P = 1.000). The incidence of liver damage in the PD-1/PD-L1 antibody monotherapy, PD-1/PD-L1 antibody combined with targeted drug therapy, and PD-1/PD-L1 antibody combined with TACE/radiofrequency ablation treatment group were 60.00%, 67.85%, and 86.67%, respectively. There was no statistically significant difference in the incidence of liver damage between the treatment regimen (P = 0.480). Conclusion: Immune checkpoint inhibitor therapy-induced liver damage is common in patients with primary liver cancer; however, it rarely severely endangers the patient's life. Additionally, patient's gender, age, presence or absence of cirrhosis, baseline liver function, BCLC stage and the immunotherapy regimen has no effect on the incidence of immune-related liver damage.

Estimated glomerular filtration rate by formulas in patients with cirrhosis: An unreliable procedure.

In cirrhosis, the reliability of formulas that estimate renal function, either those specifically developed in this population or the classic equations, has not been properly quantified. We studied the agreement between estimated (eGFR) and measured glomerular filtration rate (mGFR) in cirrhosis. Renal function was estimated with 56 formulas including specific equations: Glomerular Filtration Rate Assessment in Liver Disease (GRAIL), Royal Free Hospital Cirrhosis (RFHC) and Mindikoglu-eGFR, and measured with a gold standard procedure; plasma clearance of iohexol using dried blood spots sampling in a group of cirrhotics. The agreement eGFR-mGFR was evaluated with specific tests: total deviation index (TDI), concordance correlation coefficient (CCC) and coverage probability (CP). We defined acceptable agreement as values: TDI<10%, CCC≥0.9 and CP>90%. A total of 146 patients (age 65±9years, 81% male) were evaluated; 61 (42%) Child A, 67 (46%) Child B and 18 (12%) Child C. Median MELD-Na was 14 (9-15). The agreement between eGFR and mGFR was poor: TDI averaged was of 73% (90% of the estimations ranged from ±73% of mGFR); CCC averaged was 0.7 indicating low concordance and CP averaged 22% indicating that 78% of the estimations have an error>10%. Specific formulas showed also poor agreement: TDI was 82%, 70% and 37% for the GRAIL, RFHC and Mindikoglu equations, respectively. Overall, formulas poorly estimated renal function in cirrhotic patients. Specific formulas designed for cirrhosis did not outperform classic equations. eGFR must be considered with caution in cirrhotic patients.

Risk Factors Associated With Quality of Life in Patients With Hepatitis B Virus Related Cirrhosis.

Aim: To evaluate health-related quality of life (HRQoL) of chronic hepatitis B (CHB) and hepatitis B virus (HBV) related cirrhosis patients and analyzed specific differences in all dimensions of HRQoL.Methods: A total of 349 patients met selection criteria were enrolled. The 36-Item Short-Form Health Survey was adopted.Results: Results showed that the physiological HRQoL of the cirrhotic group was significantly lower than that of the non-cirrhotic group (P = 0.003), the psychological HRQoL was also lower (P = 0.006). HRQoL was significantly negatively correlated with liver stiffness (P = 0.001). We further evaluated the risk factors associated with poor HRQoL in HBV-related cirrhosis patients. Results showed that positive HBV DNA viral load (OR = 6.296, P = 0.041) and HCC family history (OR = 36.211, P = 0.001) were independent factors associated with HRQoL in HBV-related cirrhosis. For better risk stratification of patients, multivariable analyses were conducted to explore the independent factors that affected specific physiological and psychological HRQoL. In specific physiological HRQoL, results show that marital status (OR = 9.971, P = 0.034), positive HBV DNA viral load (OR = 6.202, P = 0.042) and antiviral drugs (OR = 0.45, P = 0.031) were independent factors associated with physiological HRQoL in cirrhosis patients. In psychological HRQoL, only HCC family history was independent risk factors associated with psychological HRQoL (OR = 42.684, P = 0.002).Conclusion: We found that the impaired HRQoL dimensions of HBV related cirrhosis patients differ between the various subpopulations. According to our results, risk stratification, medical decision making and personalizing interventions could be made.

Hepatectomy outcomes in patients with hepatitis C virus-related hepatocellular carcinoma with or without cirrhosis.

PurposeHepatocellular carcinoma (HCC) is rare in HCV patients without cirrhosis, and little is known about the postoperative results of these patients. The present study compares the outcomes of cirrhotic and non-cirrhotic groups after liver resection (LR) in solitary HCV-related HCC patients and identifies risk factors for prognosis according to the presence or absence of cirrhosis in these patients.MethodsTwo hundred and 7 adult hepatectomy patients with treatment-naïve solitary HCV-related HCC were identified prospectively at our institution between July 2005 and May 2019.ResultsThe non-cirrhotic group had better liver function than the cirrhotic group based on platelet count, liver function tests, liver stiffness measurement, and indocyanine green retention rate at 15 minutes but were older than the cirrhotic group. Consistently, noninvasive markers in the cirrhotic group were significantly higher than in the non-cirrhotic group. The cumulative disease-free survival and overall survival in the non-cirrhotic group were significantly higher than in the cirrhotic group. HCC recurrence was related to major LR and α-FP of >40 ng/mL and death was related to long hospitalization and α-FP of >40 ng/mL in multivariate analysis. Noninvasive markers and the presence of cirrhosis were not related to HCC recurrence or death in multivariate analyses.ConclusionThe cirrhotic group showed poor prognosis due to poor liver function after LR compared to the non-cirrhotic group, but this was not sustained in multivariate analysis. The factors influencing HCC recurrence and death were different in the cirrhotic and non-cirrhotic groups.

Evaluation of the level of serum neuropilin-1 in patients with chronic liver diseases and hepatocellular carcinoma

Background Hepatocellular carcinoma (HCC) is the tumor of hepatocytes and occurs mainly in patients with liver inflammation, liver fibrosis, and cirrhotic livers. Recent studies hypothesize that neuropilin-1 (NRP-1) can be a specific indicator for HCC as it shows high levels in cases of HCC only. Aims To study serum NRP-1 in chronic liver diseases and HCC. Patients and methods Our research included 80 Egyptian subjects who were divided into three groups; Group I(20 healthy controls), Group II(30 patients with HCC and hepatitis C) and Group III (30 patients with liver cirrhosis and hepatitis C). Results Albumin, blood alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase enzymes, and urea showed a significant decrease in HCC and cirrhotic groups in comparison with controls. There was an increase in the mean values of NRP-1 in HCC and cirrhotic patient groups in comparison with controls, and there was also a significant increase in the HCC patient group in comparison with the cirrhotic patient group. In cirrhotic patients, there was a significant positive correlation between NRP-1 and each of alpha-fetoprotein (AFP), AST, ALT, and prothrombin time. In patients with HCC, there was a significant positive correlation between NRP-1 and each of AFP, AST, and ALT. There was an increase in serum AFP in the HCC group in comparison with both control and cirrhotic patient groups and a significant increase in the cirrhotic patient group in comparison with the control group. Conclusion Serum NRP-1 levels in cirrhotic patients with hepatitis C virus may guide us about progression to HCC. In these patients, if NRP-1 levels were found to be high, follow-up with radiological studies could be done.

Safety and Immunogenicity of SARS-CoV-2 Vaccines in Patients With Chronic Liver Diseases (CHESS-NMCID 2101): A Multicenter Study

Background & AimsWe aimed to assess the safety and immunogenicity of inactivated whole-virion severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in patients with chronic liver diseases (CLD) in this study.MethodsThis was a prospective, multi-center, open-label study. Participants aged over 18 years with confirmed CLD and healthy volunteers were enrolled. All participants received 2 doses of inactivated whole-virion SARS-CoV-2 vaccines. Adverse reactions were recorded within 14 days after any dose of SARS-CoV-2 vaccine, laboratory testing results were collected after the second dose, and serum samples of enrolled subjects were collected and tested for SARS-CoV-2 neutralizing antibodies at least 14 days after the second dose.ResultsA total of 581 participants (437 patients with CLD and 144 healthy volunteers) were enrolled from 15 sites in China. Most adverse reactions were mild and transient, and injection site pain (n = 36; 8.2%) was the most frequently reported adverse event. Three participants had grade 3 aminopherase elevation (defined as alanine aminopherase >5 upper limits of normal) after the second dose of inactivated whole-virion SARS-CoV-2 vaccination, and only 1 of them was judged as severe adverse event potentially related to SARS-CoV-2 vaccination. The positive rates of SARS-CoV-2 neutralizing antibodies were 76.8% in the noncirrhotic CLD group, 78.9% in the compensated cirrhotic group, 76.7% in the decompensated cirrhotic group (P = .894 among CLD subgroups), and 90.3% in healthy controls (P = .008 vs CLD group).ConclusionInactivated whole-virion SARS-CoV-2 vaccines are safe in patients with CLD. Patients with CLD had lower immunologic response to SARS-CoV-2 vaccines than healthy population. The immunogenicity is similarly low in noncirrhotic CLD, compensated cirrhosis, and decompensated cirrhosis.

Higher Accumulation of Visceral Adipose Tissue Is an Independent Risk Factor for Hepatocellular Carcinoma among Viral Hepatitis Patients with Non-Cirrhotic Livers.

Simple SummaryHepatocellular carcinoma (HCC) occurring in non-cirrhotic livers is often overlooked in clinical practice because the present HCC surveillance strategies usually focus only on patients with cirrhotic livers. This study aimed to determine the risk factors for HCC among viral hepatitis patients with non-cirrhotic livers. The findings of this study could be very useful in detecting HCC at an early stage, especially in patients with viral hepatitis who may not have developed extensive cirrhosis.This study aimed to determine the risk factors for hepatocellular carcinoma in non-cirrhotic livers among viral hepatitis patients. A total of 333 HCC cases, including 69 hepatitis B virus (HBV)-related and 264 hepatitis C virus (HCV)-related, were divided into cirrhotic (Fibrosis-4 [FIB-4] index > 3.25) and non-cirrhotic groups (FIB-4 index ≤ 3.25). The clinical characteristics of the two groups were compared. The independent risk factors for the development of HCC were analyzed using logistic regression analysis. The patients with HBV-related HCC were significantly younger, had better Child-Pugh scores, lower FIB-4 index and Mac-2 binding protein glycosylated isomers (M2BPGi) levels, more progressive cancer stage, and higher alpha-fetoprotein (AFP) levels than those with HCV-related HCC. Diabetes mellitus and hypertension were less common in patients with HBV-related HCC. The non-cirrhotic group with HBV-related HCC had a higher visceral adipose tissue index (VATI), better Child-Pugh score, and higher hemoglobin A1c (HbA1c), whereas the one with HCV-related HCC had a higher proportion of men, higher VATI, better Child-Pugh score, higher HbA1c, and a higher prevalence of hypertension, than the corresponding cirrhotic groups. Logistic regression analyses demonstrated that age, male sex, VATI, HbA1c, the presence of hypertension, and HBV etiology were independent risk factors for HCC in a non-cirrhotic liver. A high accumulation of VAT is a risk factor for HCC in patients with non-cirrhotic livers.

In Egyptian Patients with Hepatocellular Carcinoma the role of MicroRNA-215

Abstract Introduction/Objective MicroRNAs (miRNAs) are a class of evolutionarily conserved small non-coding RNAs which are make a contribution in the regulation of gene expression and protein translation, and they play vital roles in differentiation, cell growth, and the development of diverse types of cancers. Methods/Case Report Our research was done in hepatology and gastroenterology department at the National Liver Institute, Menoufia University. It included 135 patients and 60 healthy subjects serving as control group. We have 3 groups: Group I (Control) This group included 60 apparently healthy individuals. They were 32 males and 28 females, whose ages ranged from 39 to 67 years old (mean ±SD= 51.67 ± 6.40 years). Group II (Cirrhosis) This group included 75 patients with liver cirrhosis due to chronic HCV infection. They were 41 males and 34 females whose ages ranged from 41 to 68 years old (mean ±SD= 54±6.73 years). Group III (HCC) Sixty patients with HCC were included. They were 35 males and 25 females, whose ages ranged from 41 to 70 years old (mean ±SD= 53.97±6.15 years). Laboratory Investigations Complete blood count (CBC), Liver tests: aspartate transaminase (AST) and alanine transaminase (ALT), serum albumin, total and direct bilirubin, alkaline phosphatase and INR were measured. Serum creatinine was also measured. The analysis of serum alpha fetoprotein (AFP) (ng/ml) was done. Chronic HCV infection was diagnosed by detection of HCV antibody and HCV RNA by real time PCR. Anti-HCV antibody was detected by means of a third generation enzyme immunoassay. Quantification of HCV RNA level was performed by means of COBAS Taqman 84 (Roche) real time HCV RNA Assay with lower detection limit 15 IU/ml. Results (if a Case Study enter NA) In control group, miRNA-215 ranged from 1.60 to 21.30 with a median value of 6.89. In cirrhotic patients group, it ranged from 0.70 to 14.65 with a median value of 2.85. In patients with HCC group, it ranged from 0.03 to 10.95 with a median value of 0.52 (pg/ml). MiRNA-215 and AFA mean levels showed a statistically significant difference (p &amp;lt;0.001) between the three studied groups. Conclusion In conclusion, MicroRNA-215 was proved to be significantly lower in HCC patients compared to cirrhotic patients and control group. This marker might be used as a potential serologic marker for HCC and a complementary diagnostic tool in monitoring cirrhotic patients for detection of HCC.

A Diagnostic Value of Serum Level Cyclase-Associated Plasma Protein 2 Versus Alpha Fetoproteins as a novel Biomarker for Detection of Hepato-Cellular Carcinoma in Egyptian Patients with Liver Cirrhosis

Abstract Background HCC is the third deadliest and fifth most common cancer worldwide, despite the widespread use of surveillance programs in at risk populations, more than half of HCC cases are diagnosed late, and curative therapies such as surgical resection, radiofrequency ablation or TACE are possible in less than 30% of patients. Objective To assess the value of plasma cyclase-associated protein 2 level in diagnosis of hepatocellular carcinoma among the Egyptian patients with chronic hepatitis c virus. Patients and Methods This study has been carried out in the department of Internal Medicine and Gastroenterology in Ain Shams University Hospitals and Manshiet El-Bakry general hospital, Department of Gastrohepatology. This study evaluate the significance of Plasma CAP2 level as a new diagnostic marker for HCC patients with post hepatitis C liver cirrhosis where (80) persons, divided into three groups; Group A included (30) patients with post hepatitis C liver cirrhosis without HCC, Group B included (40) patients with post hepatitis C liver cirrhosis and HCC, and Group C included (10) healthy subjects as a control group. Results In this study CAP2 was significantly higher in HCC group than in cirrhotic and control groups (p &amp;lt; 0.001) with mean levels (30.7±12.4), (14.4±7.6), and (6.9±4.3) ng/ml respectively although in HCC patients with negative or low AFP levels. This finding could imply the role of CAP2 in diagnosing early and AFP negative HCC patients. Conclusion CAP2 is significantly elevated in HCC group than in cirrhotic and control groups with better sensitivity and specificity than AFP at cut off values ≥15.9 ng/ml and ≥53.2 ng/ml respectively. Such results support using of CAP2 as a better diagnostic marker for HCC. AFP and CAP-2 were higher in multiple lesions than in single lesions, but the differences were significant only in CAP-2 with ≥27.3 ng/ml in differentiating multiple from solitary lesions Considering the HCC if both of them were positive decreased sensitivity but had perfect specificity.

Role of bile acids in the prediction of hepatocellular carcinoma in HCV-induced liver cirrhosis

BackgroundBile acids are essential organic molecules synthesized from cholesterol in the liver and regarded as indicators of hepatobiliary impairment; however, their role in the pathogenesis of hepatocellular carcinoma (HCC) is still unclear. The study aimed to examine the feasibility of bile acids in distinguishing HCC from post hepatitis C virus liver cirrhosis. A UPLC/MS was used to measure 14 bile acids in patients with noncirrhotic HCV disease (n = 50), cirrhotic HCV disease (n = 50), hepatocellular carcinoma (n = 50), and control group (n = 50).ResultsThe progression of liver cirrhosis to HCC was associated with a significant increase in serum bile acids compared to the normal or the noncirrhotic HCV disease (p < 0.05). The fold changes in bile acids concentrations showed a trend that HCC > cirrhotic HCV disease > noncirrhotic HCV disease. Four conjugated acids GCA, GCDCA, GUDCA, and TCDCA steadily increased across the different groups. ROC curves analysis revealed that these bile acids discriminated noncirrhotic liver patients from HCC (AUC 0.850–0.963), with a weaker potential to distinguish chronic liver cirrhosis from HCC (AUC 0.414–0.638).ConclusionThe level of serum bile acid was associated primarily with liver cirrhosis, with little value in predicting the progress of chronic liver cirrhotic disease into hepatocellular carcinoma.

Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: a retrospective, multicentre, nested case–control study

The association between prognosis of variceal bleeding and portal vein thrombosis (PVT) is unclear. In this multicentre study, we determined the effect of PVT on rebleeding and mortality in patients with acute variceal bleeding (AVB) after oesophageal variceal band ligation (EVL). Cirrhotic patients with AVB who had undergone EVL were included. The patients were allocated to either the PVT group or the control cirrhotic group (CCG) based on the presence or absence of PVT. One-year rebleeding episodes and mortality after EVL were recorded. A total of 218 cirrhotic patients with AVB from 3 centres were included. Patients with PVT had a higher rate of 14-day and 6-week rebleeding than those without PVT (14-day: 8.26% vs. 1.83%, p = 0.03; 6-week: 11.92% vs. 1.83%, p = 0.003). The rates of 5-day failure (3.67% vs. 0.92%, p = 0.175), 1-year rebleeding (21.10% vs. 20.18%, p = 0.867), and 14-day, 6-week, and 1-year mortality were similar between the groups (14-day: 3.67% vs. 0.92%, p = 0.175; 6-week: 3.67% vs. 0.92%, p = 0.175; 1-year: 3.67% vs. 1.83%, p = 0.408). The Child-Pugh class [p = 0.022, hazard ratio (HR): 1.453; 95% confidence interval (CI) 1.056-1.998], PVT (p = 0.050, HR: 4.622, 95% CI 0.999-21.395), albumin < 30g/L (p = 0.023, HR: 5.886, 95% CI 1.272-27.245), and number of bands (p = 0.010, HR: 1.207, 95% CI 1.046-1.393) were identified as the predictors for 14-day rebleeding; the multivariate analysis revealed only the number of bands (p = 0.009, HR: 1.247, 95% CI 1.056-1.473) as the independent factor. PVT (p = 0.012, HR: 6.732, 95% CI 1.519-29.835) and albumin < 30g/L (p = 0.027, HR: 3.643, 95% CI 1.160-11.441) were identified as predictors for 6-week rebleeding; however, only PVT (p = 0.015, HR: 6.380, 95% CI 1.427-28.515) was found to be the independent factor in the multivariate analysis. Further analysis showed that superior mesenteric vein (SMV) thrombosis is the only risk factor predicting 6-week rebleeding in patients with PVT (p = 0.032, HR: 3.405, 95% CI 1.112-10.429). PVT was associated with high 14-day and 6-week rebleeding in patients after EVL. SMV thrombosis was the only risk factor for 6-week rebleeding in patients with PVT. High albumin levels may serve as a protective factor for the 14-day and 6-week rebleeding risk. PVT was not responsible for mortality after EVL during 1-year follow-up.

Relation of phosphatase and tensin homolog gene polymorphism with hepatocellular carcinoma among hepatitis C-infected patients

Objective To study the significance of two phosphatase and tensin homolog (PTEN) gene polymorphisms, PTEN IVS4 rs3830675 and rs701848, as a risk factor for hepatocellular carcinoma (HCC) in chronic hepatitis C-infected patients. Background PTEN polymorphisms have been reported to be involved in multiple cancers. There are few reports concerning the linkage between the PTEN gene and liver cancer risk. Patients and methods The study was conducted on 200 participants. Of them, 80 had proven HCC, 60 were cirrhotic patients with no evidence of focal lesion, and 60 were healthy age-matched and sex-matched volunteers, enrolled in the study as a control group. PTEN IVS4 rs3830675 and rs701848 assessments by PCR-restricted fragment length polymorphism technique were done for all participants. Results The frequency of IVS4 rs3830675(––) genotype in patients with HCC was 56%, which is significantly increased compared with cirrhotic group (11.7%) and control group (10%). The combined dominant model (––/–+) was significantly higher than (++) genotype in patients with HCC compared with cirrhotic and control groups. The PTEN rs701848 polymorphisms (TT, TC, or CC) showed no significant difference among the three studied groups as well as allele distributions (T or C). Conclusion PTEN (IVS4 rs3830675) deletion (––) genotype may be a risk factor for HCC in chronic hepatitis C-infected patients more than (++) genotype. However, PTEN polymorphism (rs701848) was of no significance.