Degree Of Liver Stiffness Research Articles

Relationship between the Duration of Suffering from Diabetes and HbA1c Levels with the Degree of Liver Stiffness in Type 2 Diabetes Mellitus Patients

BACKGROUND : Type 2 diabetes mellitus (DM) is one of the major problems faced by the health system. Diabetes is a multifactorial, chronic and progressive metabolic disorder characterized by chronic hyperglycemia. Persistent hyperglycemia is associated with long-term damage to the liver. Ultrasound elastography is one of imaging modality that can assess liver stiffness, thus can assist clinicians in determining therapy, evaluating, and predicting disease progression. AIMS : Aim of this study was to determine the relationship between liver stiffness degree by using ultrasound elastography with the duration of T2DM and HbA1c levels. METHOD : This study was an observational analytic research with a cross-sectional approach which carried out from May to September 2022 at the radiology department of Dr. Kariadi Hospital Semarang. Fifty subjects were included in this study and Rank-Spearman correlation test was used to analyze the relationship between liver stiffness degree with T2DM duration and HbA1c levels. RESULT : Using ultrasonography elastography, the liver stiffness average was 7.92 + 6.72 kPa. The average of HbA1c levels was 8.55 + 2.63%. T2DM duration average was 9.10 + 6.50 years. The rank-spearman test showed a significant correlation between HbA1c levels and the degree of liver stiffness (p = 0.000) with a correlation coefficient (r) of 0.68. There was no significant correlation between the T2DM duration and the degree of liver stiffness (p = 0.052). CONCLUSION : There was a significant correlation between liver stiffness and HbA1c levels, but there is no correlation between liver stiffness and T2DM duration

Serum remnant cholesterol is a potential predictor of liver stiffness in patients with nonalcoholic fatty liver disease

Background Nonalcoholic fatty liver disease (NAFLD) is associated with dyslipidemia, and the connection between dyslipidemia and remnant cholesterol (RC), a component of triglyceride-rich lipoproteins, remains enigmatic. Methods In this cross-sectional study, our primary aim was to investigate the role of RC in the progression of NAFLD and to provide robust evidence of RC’s involvement in the pathogenesis of NAFLD. We enrolled 2800 NAFLD patients from the National Health and Nutrition Examination Survey (NHANES). Logistic regression was employed to examine the relationship between serum RC levels and liver stiffness, while receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic capability of RC. Results RC exhibited an independent correlation with the extent of liver stiffness, with odds ratios (OR) of 1.02 for liver steatosis (p = 0.014) and 1.02 for liver fibrosis (p = 0.014). To predict NAFLD, the optimal RC thresholds were 17.25 mg/dL for males and 15.25 mg/dL for females in the case of liver steatosis. For advanced liver fibrosis, the best thresholds were 17.25 mg/dL for males and 16.25 mg/dL for females. Conclusions RC demonstrated a positive correlation with the degree of liver stiffness and exhibited superior diagnostic efficacy for liver steatosis and fibrosis compared to other cholesterol indicators.

Advanced fibrosis leads to overestimation of steatosis with quantitative ultrasound in individuals without hepatic steatosis.

The effect of hepatic fibrosis stage on quantitative ultrasound based on the attenuation coefficient (AC) for liver lipid quantification is controversial. The objective of this study was to determine how the degree of fibrosis assessed by magnetic resonance (MR) elastography affects AC based on the ultrasound-guided attenuation parameter according to the grade of hepatic steatosis, using magnetic resonance imaging (MRI)-derived proton density fat fraction (MRIderived PDFF) as the reference standard. Between February 2020 and April 2021, 982 patients with chronic liver disease who underwent AC and MRI-derived PDFF measurement as well as MR elastography were enrolled. Multiple regression was used to investigate whether AC was affected by the degree of liver stiffness. AC increased as liver stiffness progressed in 344 patients without hepatic steatosis (P=0.009). In multivariable analysis, AC was positively correlated with skin-capsule distance (P<0.001), MR elastography value (P=0.037), and MRI-derived PDFF (P<0.001) in patients without hepatic steatosis. In 52 of 982 patients (5%), the correlation between AC and MRIderived PDFF fell outside the 95% confidence interval for the regression line slope. Patients with MRI-derived PDFF lower than their AC (n=36) had higher fibrosis-4 scores, albumin-bilirubin scores, and MR elastography values than patients with MRI-derived PDFF greater than their AC (n=16; P=0.018, P=0.001, and P=0.011, respectively). AC is affected by liver fibrosis (MR elastography value ≥6.7 kPa) only in patients without hepatic steatosis (MRI-derived PDFF <5.2%). These values should be interpreted with caution in patients with advanced liver fibrosis.

DYNAMICS OF VENOUS CONGESTION (VEXUS) AND LIVER STIFFNESS BY TRANSIENT ELASTOGRAPHY IN PATIENTS WITH ARTERIAL HYPERTENSION AND DECOMPENSATED HEART FAILURE

Objective: comprehensive assessment of venous congestion (VC) is relevant in patients with arterial hypertension (AH) and decompensated heart failure (DHF). Design and method: to assess the incidence and severity of VC according to the VExUS protocol (assessment of the IVC diameter, the shape of the portohepatic and renal veins blood flow) and to assess the relationship of VC to the liver stiffness (LS), estimated by transient elastography (TE), in patients with AH and DHF on admission and their dynamic changes during ospitalisation. The METAVIR scale was used to interpret the stages of fibrosis. Routine clinical assessment, VExUS, TE was performed in 52 patients with AH and DHF (men 48%, age 70 ± 11 years (M ± SD), atrial fibrillation 60%, diabetes 40%, chronic anemia 27%, left ventricle ejection fraction (EF LV) 50 [40; 57] %, EF &lt; 40% - 29%,NTproBNP 1421 [754; 2024] pg/ml (Me; IQR)). Exclusion criteria: primary chronic liver disease or acute hepatitis, severe tricuspid regurgitation Results: on admission mild, moderate and severe venous congestion were detected in 31%, 13%, 17% of patients, respectively. 79% of patients had increased liver stiffness - 22% had F1 / F2, 17% had F3 and 40% had F4. At discharge, venous congestion was observed in 38% of patients. Mild, moderate and severe venous congestion was detected in 20%, 12%, 6% of cases respectively. An increase in liver stiffness at discharge was detected in 54%. 29% of patients had F1 / F2, 13% had F3, and 12% had F4. The dynamics of clinical signs of congestion on admission and at discharge is presented in Diagram 1. A significant correlation between severity of VC and degree of increase in LS was observed (r = 0.43, p = 0.001). There is a positive correlation between the LS and VC with NT-proBNP (r = 0.47, p = 0.04 and r = 0.30, p = 0.03, respectively), a significant negative correlation between the severity of VC and LVEF (r = -0.49; p = 0.000), and between the degree of LS with LVEF (r = -0.33; p = 0.018). Conclusions: Correlations were revealed between venous congestion, by VEXUS protocol, and LS in TE with LVEF in patients with AH and DHF

Impact of liver fibrosis and clinical characteristics on dose-adjusted serum methadone concentrations

Background There is limited knowledge on the causes of large variations in serum methadone concentrations and dose requirements. Objectives We investigated the impact of the degree of liver fibrosis on dose-adjusted steady-state serum methadone concentrations. Methods We assessed the clinical and laboratory data of 155 Norwegian patients with opioid use disorder undergoing methadone maintenance treatment in outpatient clinics in the period 2016–2020. A possible association between the degree of liver fibrosis and dose-adjusted serum methadone concentration was explored using a linear mixed-model analysis. Results When adjusted for age, gender, body mass index, and genotypes of CYP2B6 and CYP3A5, the concentration-to-dose ratio of methadone did not increase among the participants with liver fibrosis (Coefficient: 0.70; 95% CI: −2.16, 3.57; P: 0.631), even among those with advanced cirrhosis (−0.50; −4.59, 3.59; 0.810). Conclusions Although no correlation was found between the degree of liver stiffness and dose-adjusted serum methadone concentration, close clinical monitoring should be considered, especially among patients with advanced cirrhosis. Still, serum methadone measurements can be considered a supplement to clinical assessments, taking into account intra-individual variations.

RELIABILITY FACTORS FOR THE MEASUREMENT OF HEPATIC STEATOSIS BY MEANS OF A CONTROLLED ATTENUATION PARAMETER BY TRANSIENT ELASTOGRAPHY

The controlled attenuation parameter (CAP) allows the indirect measurement of liver fat and the indirect the indirect measurement of liver fat and stiffness by transient elastography. Its diagnostic utility has been validated, but the factors for its reliability are unknown. Therefore, the objective is to evaluate the predictors of CAP quality by transient elastography. Retrospective, observational design of transient elastography studies from January 2015 to December 2019 for fatty liver screening, fibrosis evaluation and esophageal varices screening, using Fibroscan 502 Touch with M and XL probes according to the manufacturer's recommendations. Sociodemographic and clinical data and reliability measures were evaluated: degree of liver stiffness (kpa), decibels / meter (db/m), interquartile ranges (IQR <40 and IQR <30), number of total and valid measurements. The data are shown in measures of central tendency and dispersion; for the reliability factors, a univariate and multivariate logistic regression analysis was performed. 1153 studies were analyzed, 52.6% (n = 606) were men, with a median age of 54 years [IQR 44-63] and BMI 27.4 kg / m2 [IQR 24.1-29.7]. The main indication was fatty liver screening 48.8% (n = 558), the median CAP was 262 (215-313) db / m with an interquartile range of 34 (24-47). In 26.2% (n = 302) an incorrect probe was used. The factors associated with reliability with IQR <40 were the XL probe (OR 0.34 CI95% 0.26-0.45), age <54 years (OR 0.71 CI95% 0.55-0.92) and IQR kPa <30 (OR 0.48 CI95% 0.28-0.82) and for the reliability of IQR <30 the use of the XL probe (OR 0.31 CI95% 0.23-0.42) and IQR kPa <30 (OR 0.35 CI95% 0.17-0.71). Evaluating only screening studies (n = 558), the use of the XL probe and age <54 years maintained an independent association for IQR <40 and with respect to IQR <30, only the XL probe maintained this association. Table 1. Current recommendations for quality CAP studies are to obtain valid measurements with IQR <30 and <40, although there is little evidence to support this. It was demonstrated that regardless of the indication, degree of fibrosis and BMI, the use of the XL probe favors the quality of the study and an adequate evaluation of liver stiffness (IQR kPa <30). The main factor that favors the reliability of the CAP IQR <40 and 30 is the use of the XL probe regardless of the indication for use and the body mass index. The authors declare that there is no conflict of interest.

Evaluation of long-term changes of aspartate\u2014platelet ratio index, FIB4, and liver stiffness in chronic hepatitis C patients successfully treated by direct-acting antivirals

BackgroundA large number of chronic hepatitis C patients had been successfully treated by directly acting antivirals; therefore, strategies for the long-term follow-up of these patients have to be planned based on the post-treatment fibrosis stage—the main determinant of prognosis. In this study, we aim to evaluate changes in aspartate-platelet ratio index, FIB4, and liver stiffness in chronic hepatitis C patients who achieved SVR and ended treatment more than 1 year by DAAs.ResultsOne hundred chronic hepatitis C patients who achieved SVR were enrolled at a median of 16 months after the end of treatment by DAAs. According to the baseline liver stiffness, 63 and 37 patients belonged to early (F0, F1, and F2) and advanced (F3 and F4) fibrosis stages, respectively. Both groups showed a decline of the degree of liver stiffness at follow-up compared to the baseline that was statistically significant in the early fibrosis group (5.9±1.5 vs 5.4±2.2 Kpcal, p=0.04), while measurements in the advanced group were (18±8.8 vs 15.9 ± 7.8 Kpcal, p=0.07). Also, serum biomarkers of fibrosis improved in both groups, where the recorded APRI and FIB4 before and after treatment were 0.42±0.3 vs 0.24±0.1, p<0.01 and 1±0.6 vs 0.93 ±0.5, p=0.1 in the early group and 0.85 ±0.5 vs 0.4±0.2, p <0.001 and 2.9±2.3 vs 1.8±1.4, p<0.02) in the advanced group, respectively. Changes in APRI and FIB4 correlated with changes in AST and ALT, but liver stiffness changes were not affected by changes in liver enzymes.ConclusionAlthough long-term improvement of APRI, FIB4, and liver stiffness scores could be achieved in chronic HCV patients after SVR by DAAS. High measurements of liver stiffness before treatment likely persist. We recommend transient elastography as a reliable tool for fibrosis assessment post-treatment.

Prevalence of non-alcoholic fatty liver disease among patients with non-diabetic chronic kidney disease detected by transient elastography.

Non-alcoholic fatty liver disease (NAFLD) shares a close relationship with cardiovascular morbidity and mortality. The purpose of this study is to evaluate the frequency of NAFLD in the patients with non-diabetic chronic kidney disease (CKD). This cross-sectional study included 80 patients with non-diabetic CKD, of which, 50 patients were on hemodialysis (HD) and 30 patients had CKD stage G3-5 not on dialysis. These patients were randomly selected from Ain Shams University Hospitals, Cairo, Egypt. Patients with diabetes mellitus, obesity, alcohol intake, viral hepatitis, or drug-induced liver steatosis were excluded from this study. Importantly, the controlled attenuation parameter (CAP) (dB/m) of liver steatosis (S0-S3) and liver stiffness/fibrosis measurement (F0-F4) were measured using transient elastography (Fibroscan®). Other evaluations included complete blood count, routine blood chemistry, and C-reactive protein (CRP) titer. In total, 45 (56.25%) (30 males, 15 females) out of total 80 studied patients were reported to have NAFLD. There were 29 patients with end-stage renal disease who were on regular HD and 16 patients with pre-dialysis CKD G3-5. The mean CAP values of hepatic steatosis in the patients with CKD on dialysis and patients with pre-dialysis CKD were 265.41 ± 52.73 and 259 ± 44.8dB/m, respectively. A significant association between the severity of hepatic steatosis degree with decreased glomerular filtration rate and increased CKD stage was observed in this study. The degree of liver stiffness was significantly related to an increased hepatic steatosis grade. A significant positive correlation was found between the degree of NAFLD and serum levels of alanine aminotransferase, aspartate transaminase, total cholesterol, triglycerides, low-density lipoprotein, and CRP titer (P < 0.05). Importantly, NAFLD was significantly associated with an evident history of cardiovascular disease (CVD) among the studied patients. A high frequency of NAFLD (56%) was observed among the patients with non-diabetic CKD on hemodialysis and patients with pre-dialysis CKD. NAFLD may be associated with an increased liver stiffness grade and CVD among those patients.

LIVER STIFFNESS MEASURMENT BY FIBROSCAN FOR PREDICTING THE GRADES OF OESOPHAGEAL VARICES IN HCV CIRRHOTIC PATIENTS

Introduction: oesophageal varices is one of the most common and life threatening complications of liver cirrhosis. the need for use of non invasive modalities for its prediction rather than endoscopy is important to decrease burdens and increase patient compliance . Aim: to predict oesophageal varices presence by fibroscan and possible grading by degree of liver stiffness in Hepatitis C Virus related cirrhotic patients. Methods: the study was carried out on 150 patients with HCV related liver cirrhosis attending Ministry of Health outpatient clinics and hospitals after being writtenly consented that they agreed to participate in this study All patients were subjected to full history taking & thorough clinical examination, full laboratory investigations include complete blood picture, liver profile tests , kidney function tests, abdominal ultrasound , liver stiffness measurement by fibroscan and upper GIT endoscopy. The patients were divided according to upper GIT endoscopy results into three groups. Group 1: included 50 patients with liver cirrhosis and without oesophageal varices. Group 2: included 50 patients with liver cirrhosis and small oesophageal varices (Grade II Fibroscan; Grading; Non-invasive methods

Role of Plasma Osteopontin Level as a Predictor of Hepatic Fibrosis Regression and Response to Antiviral Treatment in Patients with Chronic HBV or Chronic HCV Infection

Background: Hepatitis B virus and Hepatitis C virus infection is one of the public health problems in Egypt. So we aimed to evaluate the efficacy of serum osteopontin as predictor of hepatic fibrosis regression and virological response in patients with chronic HBV or HCV infection. Methods: This study has been conducted on 74 HBeAg + ve chronic HBV infection, 74 chronic HCV infection and 74 healthy controls. HBV patients treated with Entecavir. HCV patients treated with sofosbuvir, daclatasvir with or without ribavirin. One year post HBeAg seroconversion and 3 months after end of regular antiviral treatment for patients with chronic HBV and chronic HCV infection respectively, hepatic condition was reevaluated. Results: 14.9% of patients with HBV, failed to achieve undetectable HBV DNA or HBeAg seroconversion and 2.7% of patients with HCV infection, failed to achieve SVR. In chronic HBV, pretreatment high serum osteopontin predict failure of virological response and hepatic fibrosis regression at a cutoff > 115.5, with 90.91% sensitivity, 82.54% specificity. Also high degree of liver stiffness predicts failure of hepatic fibrosis regression at a cutoff > 8.7, with 81.8% sensitivity, 73% specificity. Conclusions: In chronic HBV infection low osteopontin predicts good virological response and hepatic fibrosis regression. But it has no role in predicting SVR or hepatic fibrosis regression in chronic HCV infected patients.

Changes in Liver Congestion in Patients with Budd–Chiari Syndrome following Endovascular Interventions: Assessment with Transient Elastography

PurposeTransient elastography (TE) is routinely used for noninvasive staging of hepatic fibrosis. The objective of the present study was to investigate the role of TE (FibroScan) in determining changes in liver congestion in patients with Budd–Chiari syndrome (BCS) treated by endovascular interventions and determine the effects of pretreatment Meta-analysis of Histological Data in Viral Hepatitis (METAVIR) fibrosis score on posttreatment liver stiffness (LS). Materials and MethodsTwenty-five patients undergoing endovascular procedures for treatment of BCS underwent TE immediately before and within 24 hours after the procedure. Fifteen patients available for 3-month follow-up were again subjected to TE. Mean LS values before and after intervention were compared in 12 of these patients for whom METAVIR scores were available. Pressure gradient changes across the stenosed hepatic veins/inferior vena cava were measured during the procedure. Statistical analysis of these data was performed by Wilcoxon signed-rank test, Mann–Whitney U test, and Pearson product–moment correlation coefficient. ResultsSignificant differences were found between mean LS measurements before and within 24 hours after intervention (Z-score = 4.372) and between the mean values obtained before and 3 months after treatment (Z-score = 3.408). Mean changes in LS values after intervention in patients with METAVIR fibrosis scores ≤ 2 and > 2 were not significant. There was no correlation between changes in pressure gradients and the degree of LS. ConclusionsTE is a useful tool to assess the reduction in hepatic congestion in patients with BCS undergoing endovascular interventions.

Increased liver stiffness measurement values using transient elastography in Egyptian patients with acute viral hepatitis

Transient Elastography (TE) is one of the non-invasive and reproducible tools for assessment of liver fibrosis/ cirrhosis. However, it remains to be determined if ALT flare interferes with fibrosis assessment. 1.1.Aim: To determine the effect of increased serum ALT and AST on liver stiffness measurement in patients with acute viral hepatitis. 1.2.Methods: Thirty consecutive patients with acute hepatitis of viral etiology with elevated liver enzymes (>10 folds of ULN) were prospectively included. Blood samples were collected and TE was done initially and after resolution of hepatitis and after normalization of liver enzymes. Patients with high BMI which could affect TE (> 40 kg/m2) and patients with ascites or liver cirrhosis were excluded. For determination of the etiology of hepatitis, history taking, a detailed physical examination and laboratory tests were performed in all patients. 1.3.Results: The mean age of patients was 32.87 ± 10.2 years old and males represented 46.7% (n=14). In all patients, the degree of liver stiffness at the time of the peak increase in aminotransferases exceeded the cutoff values proposed for the prediction of significant fibrosis or cirrhosis. The mean value of LSM at the time of inclusion in the study was 13.91±6.7 kPa and the mean value of LSM after resolution of hepatitis was 7.7±3.08 kPa. A progressive significant reduction in liver stiffness values was observed (P 0.05). Reduction of mean value of LSM to 6.21 ± 1.14 kPa was observed in 10 patients after 1 year of ALT normalization. 1.4.Conclusion: TE has not demonstrated reliable diagnostic accuracy in patients with acute viral hepatitis.

Effects of HIV infection on the disease progression of hepatitis C in patients with HIV/HCV coinfection

Objective To analyze the differentiation status of CTL and to evaluate its clinical value in patients with HIV/HCV coinfection. Methods Twenty-eight patients with HIV/HCV coinfection and twelve patients with single HCV infection were enrolled in this study. The technique of Fibro-Scan was used to evaluate liver fibrosis. The viral load of HCV was detected by real-time quantitative PCR. Flow cytometry analysis was performed to measure the differentiation status of CTL. Results Both of the levels of alanine transaminase (ALT) and alkaline phosphatase (ALP) in patients with HIV/HCV coinfection were significantly higher than those in patients with single HCV infection [(53.7464±48.1180) U/L vs (27.4750±13.9850) U/L, P=0.012; (24.5071±8.1940) g/L vs (16.9667±7.1890) g/L, P=0.009]. The liver stiffness of patients with HIV/HCV coinfection was higher than that of patients with single HIV infection [(5.9500, 5.8250) Kpa vs (5.1500, 1.0500) Kpa, P=0.117]. Compared with the patients with single HCV infection, the patients with HIV/HCV coinfection showed higher viral loads of HCV [(6.4768, 5.3434) lg copy/ml vs (2.6815, 1.6990) lg copy/ml, P=0.012], but lower clearance rate of HCV [32.14% vs 75%, P=0.032]. Compared with the patients with single HCV infection, the patients with HIV/HCV coinfection showed lower percentages of CD27+ CD28+ CTL [(28.265±15.095)% vs (18.068±10.263)%, P=0.017), but higher percentages of CD27+ /-CD28+ CTL [(62.449±14.561)% vs (71.111±12.681)%, P=0.066]. A trend toward negative correlation was observed between the percentage of CD27+ CD28+ CTL and the degree of liver stiffness (r=-0.310, P=0.058). Conclusion HIV infection could accelerate the progression of liver disease in patients with HIV/HCV coinfection by affecting the differentiation of CTL. Key words: HIV; HCV; Coinfection; CTL differentiation

Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go?

Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go?

Bimodal peaks of liver stiffness in a case of drug-induced liver injury

A 69-year-old male complained of general fatigue and presented with elevation of liver enzymes without any cause of liver injury. We diagnosed him with hepatocellular drug-induced liver injury (DILI). Liver stiffness, which was evaluated according to the shear wave velocity (SWV) using virtual touch tissue quantification, was serially observed during hospitalization. A fast SWV was noted on the date of admission, indicating a "hard" degree of liver stiffness. The SWV gradually decreased until the 20th hospital day. However, the patient's liver enzymes again became elevated on the 20th hospital day, and the SWV simultaneously increased in association with a rise in the total bilirubin level. The laboratory data for the second peak of the SWV indicated mixed-type DILI; therefore, the patient's pathological state transitioned from the hepatocellular type to the mixed type. A liver biopsy performed before discharge revealed a state of recovery from acute inflammation without fibrotic changes. We conclude that the second peak of the SWV may be affected by the presence of intrahepatic cholestasis. We herein report the occurrence of bimodal peaks of liver stiffness in a patient with DILI. In such cases, each peak of liver stiffness may be the result of a different pathological mechanism, namely acute inflammation versus acute intrahepatic cholestasis. Although the detailed mechanisms underlying the development of liver stiffness due to intrahepatic cholestasis remain unclear, this case presented a limitation of virtual touch tissue quantification for evaluation of liver stiffness as fibrosis marker in the liver with intrahepatic cholestasis.

Liver Stiffness Is Associated With Risk of Decompensation, Liver Cancer, and Death in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis

Liver stiffness measurement (LSM), using elastography, can independently predict outcomes of patients with chronic liver diseases (CLDs). However, there is much variation in reporting and consistency of findings. We performed a systematic review and meta-analysis to evaluate the association between LSM and outcomes of patients with CLDs. We performed a systematic review of the literature, through February 2013, for studies that followed up patients with CLDs prospectively for at least 6 months and reported the association between baseline LSM and subsequent development of decompensated cirrhosis or hepatocellular carcinoma (HCC), as well as mortality. Summary relative risk (RR) estimates per unit of LSM and 95% confidence intervals (CIs) were estimated using the random effects model. Our final analysis included 17 studies, reporting on 7058 patients with CLDs. Baseline LSM was associated significantly with risk of hepatic decompensation (6 studies; RR, 1.07; 95% CI, 1.03-1.11), HCC (9 studies; RR, 1.11; 95% CI, 1.05-1.18), death (5 studies; RR, 1.22; 95% CI, 1.05-1.43), or a composite of these outcomes (7 studies; RR, 1.32; 95% CI, 1.16-1.51). We observed considerable heterogeneity among studies-primarily in the magnitude of effect, rather than the direction of effect. This heterogeneity could not be explained by variations in study locations, etiologies and stages of CLD, techniques to measure liver stiffness, adjustment for covariates, or method of imputing relationship in the meta-analysis. Based on a meta-analysis of cohort studies, the degree of liver stiffness is associated with risk of decompensated cirrhosis, HCC, and death in patients with CLDs. LSM therefore might be used in risk stratification.

Liver fibrosis in young Egyptian beta-thalassemia major patients: relation to hepatitis C virus and compliance with chelation

Background. The main causes of liver fibrosis in transfusion-dependent thalassemia major are hepatitis C virus (HCV) infection and hepatic iron overload. The study aimed to assess liver fibrosis in Egyptian adolescents and young adult poly-transfused beta thalassemia patients infected with HCV using liver FibroScan in relation to iron overload and Liver iron concentration (LIC).Material and methods. Fifty-one regularly transfused beta thalassemia patients above 12 years old were subjected to measurement of serum alanine transaminase (ALT), serum ferritin (SF), HCV (antibody and RNA), LIC assessed by hepatic R2* and transient elastography (TE) (FibroScan). FibroTest and liver biopsy were done to 25 patients.Results. Eighty two% of studied thalassemia patients were HCV antibody positive; 21(49%) of them were viremic (HCV RNA positive); median LIC was 12 mg/gm dry weight. There were strong positive correlation between the degree of liver stiffness and Ishak fibrosis score assessed in liver biopsy specimens (P = 0.002) and between FibroScan and FibroTest results (P < 0.001). Patients with HCV viremia showed significantly higher ALT, γ-glutamyl transpeptidase (GGT), SF, LIC and increased liver stiffness compared to patients with no viremia (P = 0.0001, 0.001, 0.012, 0.006 and 0.001) respectively. Liver cirrhosis (TE values > 12.5kPa) was encountered in 23.5% and variable degrees of liver fibrosis (TE values > 6–12.5 kPa) in 35% of studied thalassemic patients.Conclusion. Young beta thalassemia patients with active hepatitis C infection may have hepatic cirrhosis or fibrosis at young age when accompanied with hepatic siderosis. Non invasive Liver FibroScan and Fibro-Test were reliable methods to assess liver fibrosis in young thalassemic-patients.

Liver Stiffness Measurement by Fibroscan Predicts the Presence and Size of Esophageal Varices in Egyptian Patients with HCV Related Liver Cirrhosis

Liver stiffness measured by transient elastgraphy correlates with Hepatic vein pressure gradient, liver Stiffness value of 21 kpa predicts significant portal hypertension. Aim is to predict esophageal varices presence by fibroscan and possible grading by degree of liver stiffness in HCV related cirrhotic patients. Thirty two HCV related cirrhotic patients were recruited, age > 18 years, BMI< 35, no history of: upper GI bleeding, hepatocellular carcinoma, abdominal collaterals, ascites. Patients underwent clinical examination, laboratory investigations, abdominal ultrasonography, upper endoscopy and fibroscan. They divided into (Group I= no varices, Group II =small varices (Grade 1 & 2), Group III = large varices (Grade 3 & 4). Age is higher in Group III than I & II (55+6.6 vs 49.5+4.7 & 48.9+4.7, p-value 0.04) respectively, Groups were gender & BMI matched, fibroscan values in Group I vs II & III were 27 Vs 49.4, p value 0.01, cutoff 29.7 Kpa (sensitivity 95% & specificity 67%) while its value in Group II vs III were 38.4 vs 60.4, p value 0.002, cutoff 38.2 Kpa (sensitivity 100% & specificity77.3%). Platelet count, splenic size, platelet count/splenic size in Group I vs II & III were 107.166 vs 72.900, 13.8 vs 15.4, 803.6 vs 478, p value 0.01, 0.008, 0.005, cutoff 80.000, 14.5, 545, sensitivity & specificity (85%&75%, 75%&75%, 85%&84%) respectively. On multivariate analysis fibroscan (OR 1.113; p=0.005) & platelet count/splenic size (OR 0.995; p=0.012) were positive predictors of esophageal varices presence. Fibroscan is a good non-invasive method to predict esophageal varices presence & possible grading with high sensitivity.

Acute viral hepatitis increases liver stiffness values measured by transient elastography

Liver tissue alterations other than fibrosis may have an impact on liver stiffness measurement. In this study we evaluated 18 patients without a previous clinical history of liver disease, consecutively admitted for acute viral hepatitis. In each patient, aminotransferase determination and liver stiffness measurement were performed on the same study day, at 3 different points: (1) peak increase in aminotransferase; (2) aminotransferase 50% or less of the peak; (3) aminotransferase levels <or=2x the upper limit of normal. In all patients, the degree of liver stiffness at the time of the peak increase in aminotransferases exceeded the cutoff values proposed for the prediction of significant fibrosis or cirrhosis. A progressive significant reduction in liver stiffness values was observed (P < 0.0001) in the follow-up period in parallel with the reduction of aminotransferase levels (P < 0.0001). Moreover, a statistically significant, positive correlation between aminotransferases and liver stiffness measurement (LSM) at the onset of acute viral hepatitis was found (r = 0.53, P = 0.02 and r = 0.51, P = 0.03 for alanine aminotransferase and aspartate aminotransferase, respectively). In conclusion, the extent of necroinflammatory activity needs to be carefully considered in future studies aimed at further validating transient elastography, particularly in patients with absent or low-stage liver fibrosis (in other words, F0-F2 METAVIR). LSM does not represent a reliable instrument to detect the presence of advanced fibrosis and cirrhosis in patients presenting with a clinical picture of acute hepatitis.