Fibroscan Results Research Articles

Correlation of Liver Fibroscan Results with Liver Elastographyand Liver Enzymes in Patients with Fatty Liver

Background: Accurate diagnosis of fatty liver is crucial for prognosis and treatment planning. Objectives: This study aimed to correlate liver fibroscan results with shear wave elastography and liver enzyme levels in fatty liver patients. Methods: In a cross-sectional study, 80 fatty liver patients from Shahid Motahari Clinic in Shiraz was examined over six months. Diagnoses were made using fibroscan (Echosense 500) and CAP scores, while the Hepatorenal Index was measured with shear wave elastography (Sypersonic, Aixplorer elit). Previous sonography reports were collected for correlation. Results: Patients’ average age was 50.91 years so that 45% were men, and 55% were women. About 78.8% diagnosed with fatty liver by ultrasound were also diagnosed by elastography (true positive). A weak, non-significant positive correlation was observed between the Ratio and CAP score (r = 0.18, P = 0.87). ALT predicted fatty liver by elastography with 83.6% sensitivity and 64.7% specificity. Few studies in Iran have explored elastography and fibroscan correlation in fatty liver. Conclusions: Shear wave elastography is a valuable non-invasive technique for predicting fatty liver.

6649 Associations of Fibroscan Results with Body Composition and Laboratory Measures in Patients with Obesity and Inflammation

Abstract Disclosure: A. Lyman: None. E. Nwosu: None. H.K. Gopalakrishna: None. Y. Rotman: None. N. Abdul Majeed: None. J. Lazareva: None. S.M. Brady: None. A.P. Demidowich: Grant Recipient; Self; Dexcom, Inc. J.A. Yanovski: Grant Recipient; Self; Soleno Therapeutics (DCCR), Rhythm Pharmaceuticals (setmelanotide), Hikma Pharmaceuticals (colchicine), Versanis Bio (bimagrumab. Background: Obesity and inflammation are believed to contribute to hepatic dysfunction and risk for metabolic dysfunction-associated steatohepatitis (MASH). Fibroscan (Echosens) can non-invasively quantify liver fat content (LFC) by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) by transient elastography as a surrogate for fibrosis. Other surrogate markers for liver fibrosis include Fibrosis-4 (FIB-4) and the AST-to-Platelet Ratio Index (APRI) indices. Central obesity is a stronger predictor of MASH than appendicular fat. It is unknown whether the associations between these measures hold in a population with obesity and inflammation. Hypotheses: We hypothesized that LFC and LSM would be positively associated with Body Mass Index (BMI), central obesity (trunk), but not appendicular fat percentage, as well as with HOMA-IR, hs-CRP, and both FIB-4 and APRI indices in patients with obesity and inflammation. Methods: A convenience sample of adult participants with BMI ≥30 kg/m2 and hs-CRP ≥2.0 mg/L in a clinical trial (n=38) underwent body composition by DXA, Fibroscan, and fasting blood sampling for glucose, insulin, hs-CRP, AST, ALT, and platelets, all on the same day. LSM results were considered valid if the interquartile range for > 10 measurements was ≤30%. ANCOVA analysis was used to examine associations between these parameters. Results: The cohort had a mean age=48 years (SD=12.5 years), BMI=39.3 kg/m2 (SD=6.0 kg/m2,), CAP=296.0 dB/m (SD=54.0 dB/m), LSM=5.9 kPa (SD=2.4 kPa), hs-CRP=7.2 mg/L (SD=6.1 mg/L), HOMA-IR=5.9 (SD=4.5), FIB-4=0.80 (SD=0.33), and APRI=0.24 (SD=0.11). Using univariate linear regression analysis, we found CAP to be positively associated with increased trunk body fat % (p=0.009, partial η2=0.202) and BMI (p=0.006, partial η2=0.195) independent of sex. Similarly, LSM was positively correlated with increased trunk body fat % (p=0.047, partial η2=0.125), APRI (p=0.025, partial η2=0.156), and log-transformed HOMA-IR (p=0.018, partial η2=0.150). We did not observe significant associations between hs-CRP, FIB-4 or appendicular body fat % with CAP or LSM in our population. Conclusion: As hypothesized, measures of liver fat content and fibrosis by Fibroscan CAP and LSM were positively associated with body composition (predominantly trunkal fat), measures of insulin resistance, and laboratory indices of hepatic fibrosis and steatosis in people with obesity and inflammation. Presentation: 6/3/2024

Empagliflozin add-on therapy is superior to metformin monotherapy in diabetic patients with NAFLD: An open-label, single-center, pilot clinical trial.

The prevalence of non-alcoholic fatty liver disease (NAFLD), which is characterized by hepatic steatosis, inflammation, and advanced fibrosis, is high among type-2 diabetes mellitus (T2DM) patients. Empagliflozin (EMPA), a sodium-glucose cotransporter-2 inhibitor, has been well established to improve glycemic status in T2DM. However, evidence of the desirable effects of EMPA, when added to the standard treatment in diabetics with coexisting NAFLD, has yet to be determined. The main objective of the current study is to explore the benefits of EMPA on hepatic fat content in patients with T2DM and NAFLD, who received metformin (MET) monotherapy. In this open-label clinical trial study, 60 patients with T2DM and NAFLD were assigned to either the MET + EMPA or MET group in an up-titrated manner for 24 weeks. Anthropometric characteristics, blood glucose indices, lipid profile, liver enzymes, and steatosis grades were measured at baseline and 24 weeks after the intervention. The results showed that in patients with a mean age of 53.26 ± 7.64 who received MET+ EMPA, all the parameters had a greater decrease than the MET group. In addition, the reduction of FBS, BS, HbA1C, TG, and ALT had a statistically significant difference between the two groups after 24 weeks follow-up (p < 0.05). Notably, in the MET+ EMPA group, there was a substantial improvement in steatosis grades based on the fibroscan and ultrasound modality results. The EMPA add-on therapeutic schedule in uncontrolled T2DM patients with NAFLD significantly ameliorated steatosis stages, liver function, anthropometric features, and biochemical parameters.

NLRP3 inflammasome pathway involved in the pathogenesis of metabolic associated fatty liver disease

The prevalence of Metabolic-associated fatty liver disease (MAFLD) has been steadily increasing worldwide, paralleling the global epidemic of obesity and diabetes. It is estimated that approximately one-quarter of the global population is affected by MAFLD. Despite its high prevalence, MAFLD often goes undiagnosed due to the lack of specific symptoms in its early stages. However, as the disease progresses, it can lead to more severe liver-related complications such as fibrosis, cirrhosis, and hepatocellular carcinoma. Therefore, we aimed to investigate the expression levels of the nucleotide-binding oligomerization domain, leucine-rich repeat (LRR)—containing proteins (NLR) family pyrin domain-containing protein 3 [NLRP3] inflammasome pathway components, NLRP3 and interleukin 1β (IL-1β) genes in patients with MAFLD with various degrees of steatosis and fibrosis. Participants were classified into two equal groups; MAFLD group: consisted of 120 patients with different degrees of hepatic fibrosis and steatosis based on fibro scan results. The non-MAFLD group was comprised of 107 participants. Molecular analysis of pyrin domain-containing protein 3 and IL-1β relative gene expressions was performed in the blood of all participants, using Real-time quantitative polymerase chain reaction (RT-qPCR). Patients with post-MAFLD hepatic fibrosis had significantly higher relative gene expression levels of IL-1β and NLRP3; with IL-1β > 1.1 had AUC of 0.919, sensitivity of 88.33, specificity of 96.26, PPV of 96.4, and NPV of 88 and 92.3 accuracy (p value < 0.001). NLRP3 > 1.33 had a sensitivity of 97.5, specificity of 99.07, PPV of 99.2, NPV of 97.2, and 98.3 accuracy with an AUC of 0.991 (p value < 0.001) as predictors of post-MAFLD hepatic fibrosis.. A significant increase in the mean relative gene expression levels of both IL-1β and NLRP3 found in patients with early fibrosis (F0-F1-2); 31.97 ± 11.8 and 6.76 ± 2.18, respectively; compared with patients with advanced hepatic fibrosis stages (F2-F3); 2.62 ± 3.71 and 4.27 ± 2.99 (p < 0.001 each). The present study provides novel evidence for the possible involvement of IL-1β and NLRP3 inflammasome in metabolic-associated fatty liver disease pathogenesis and could be valid markers for the early detection of post-MAFLD hepatic fibrosis.

Extracellular Vesicles Modulate Liver Cells Viability and Reactive Oxygen Species in Patients Following a Very Low-Calorie Ketogenic Diet.

The VLCKD is a diet recognized to promote rapid fat mobilization and reduce inflammation, hepatic steatosis, and liver fibrosis. Extracellular vesicles (EVs) mediate cell-to-cell communication. The aim of the study is to investigate the role of circulating EVs in cell proliferation, ketone bodies, and ROS production in patients on an 8-week VLCKD regimen. Participants were classified as responders (R) or non-responders (NR) to VLCKD treatment based on their fibroscan results. In vitro experiments with the hepatic cell lines HEPA-RG (normal hepatocytes) and LX-2 (stellate cells) were conducted to investigate the effects of circulating EVs on cell viability, ROS production, and ketone body presence. The findings reveal a notable reduction in cell viability in both cell lines when treated with exosomes (EXOs). In contrast, treatment with microvesicles (MVs) did not appear to affect cell viability, which remained unchanged. Additionally, the levels of ketone bodies measured in urine were not consistently correlated with the reduction of fibrosis in responders (R). Similarly, an increase in ketone bodies was observed in non-responders (NR), which was also not aligned with the expected reduction in fibrosis. This inconsistency stands in stark contrast to the levels of Reactive Oxygen Species (ROS), which exhibited a clear and consistent pattern in accordance with the dietary intervention. Finally, in this preliminary study, ROS has been identified as a potential diet adherence marker for VLCKD patients; the ROS levels reliably follow the progression of the fibrosis response, providing a more accurate reflection of the therapeutic effects.

Evaluation of hepatic injury in chronic hepatitis B and C using APRI and FIB-4 indices compared to fibroscan results.

Hepatitis B (HBV) and hepatitis C viruses (HCV) are significant causes of liver disease worldwide. Liver fibrosis (LF) is a complication of chronic liver damage caused by HBV and HCV due to our limited knowledge comparing the diagnostic performance of platelet to aspartate aminotransferase ratio index (APRI) and fibrosis-4 (FIB-4) index with fibroscan. This study evaluated liver damage in HBV and HCV using APRI, FIB-4, and fibroscan indices. This retrospective cohort descriptive-analytical study was conducted on patients with HBV and HCV. This study uses laboratory results and imaging to investigate liver damage in chronic HBV and HCV patients. APRI and FIB-4 were computed based on laboratory results. A total of 185 patients (82 hepatitis B and 103 hepatitis C) were included in the study. Thirteen patients had liver cirrhosis. There was no statistically significant difference between the fibroscan results in the two groups (P=0.99). The HBV group's mean APRI and FIB-4 were lower than HCV, but no significant difference was observed (P>0.05). Our results in HBV and HCV patients showed that APRI and FIB-4 accomplished well anticipating cirrhosis with an area under the receiver operating characteristic curve (AUC) of 0.771-0.845 and 0.871-0.910, respectively. Fibroscan is a powerful tool superior to APRI and FIB-4 in predicting LF and cirrhosis. Nevertheless, APRI and FIB-4 are inexpensive and non-invasive indicators with acceptable efficacy in predicting advanced fibrosis or cirrhosis. However, these two measures are not reliable in low-grade fibrosis.

FIB-4, APRI, and NFS Scores Compared to FibroScan for the Assessment of Liver Fibrosis in Patients with NAFLD

Background: NAFLD is a spectrum of liver disease ranging from fatty liver to steatohepatitis, fibrosis and cirrhosis. Due to the epidemic proportion of individuals with NAFLD worldwide, liver biopsy evaluation is impractical, and noninvasive assessment for the diagnosis of NASH and fibrosis is needed. In this study we aimed to compare FIB-4, APRI, and NFS score to FibroScan for the assessment of hepatic fibrosis in patients with NAFLD. Methods: This prospective study included 103 patients with NAFLD and was conducted in the Hepato-Gastroenterology Unit of Functional Digestive Explorations at CHU Ibn SINA in RABAT MOROCCO and covers the period from 01/2016 to 04/2023. A checklist was used to record the demographic features and biological data of the patients. Then, all patients underwent FibroScan using the FibroScan compact 530 device (Echosens, France). Results: Of the 103 patients with NAFLD included in this study, with a mean age of 54.4 ± 11.4 years, 35(34%) were male and 68 (66%) were female. Based on FibroScan results, 58 patients (56.3%) were classified as F1, 13 (12.6%) as F2, 5 (4.9 %) as F3, and 27 (26.2 %) as F4. A significant correlation was found between FibroScan and FIB-4 (r = 0.365), APRI (r = 0.376), and NFS score (r = 0.356) (P &lt; 0.001). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of APRI at the 0.64 cut-off for the differentiation of F3F4 from F2F1 were 59.4, 84.5, 63.3, 82.2 and 76.7%. FIB-4 at the 1.8 cut-off 68.8, 83.1, 64.7, 85.5, 78.6% and NFS at the 0.89 cut-off 71.9, 69, 51.1, 84.5 and 69.9% respectively. Moreover, the area under the receiver operating curve of APRI, FIB-4, and NFS for the differentiation of F3F4 from F1F2 was 0.782, 0.779, and 0.723, respectively. Conclusions: Based on these results, APRI appears to be the most appropriate substitute of FibroScan for the detection of significant fibrosis in NAFLD patients.

Correlation of Platelet-Derived Growth Factor-BB Levels as a Biomarker of Liver Fibrosis with the Degree of Fibrosis Based on Fibroscan in Chronic Hepatitis B Patients

Background: Liver fibrosis is scar tissue that forms due to excessive accumulation of ECM proteins due to chronic liver injury, mediated by cytokines involving complex cellular interactions, such as platelet-derived growth factor-BB (PDGF-BB). In Indonesia, no research has been conducted to determine the correlation between PDGF-BB levels and the degree of liver fibrosis based on fibroscan. The aim of this study is to assess the correlation between PGDF-BB levels and the degree of liver fibrosis based on fibroscan in chronic hepatitis B.&#x0D; Methods: A cross-sectional study was conducted on the chronic hepatitis B population at the internal medicine clinic of Dr. Mohammad Hoesin General Hospital Palembang from January to Agustus 2023. The assessment uses fibroscan to determine the degree of liver fibrosis, measured in kilopascals (kPa). PDGF-BB levels measured by ELISA.&#x0D; Results: From 40 subjects, the majority of chronic hepatitis B patients were women (57,5%). The lowest PDGF-BB level was found in chronic hepatitis B patients with fibroscan F0, and the highest PDGF-BB level in fibroscan F4. Fibroscan results are directly proportional to PDGF-BB level.&#x0D; Conclusion: PDGF-BB has a strong positive correlation with the degree of fibroscan in chronic hepatitis B patients in Dr. Mohammad Hoesin General Hospital. The higher the range of PDGF-BB levels, the higher the degree of fibroscan in chronic hepatitis B patients.

AST/ALT ratio, APRI, and FIB-4 compared to FibroScan for the assessment of liver fibrosis in patients with chronic hepatitis B in Bandar Abbas, Hormozgan, Iran

BackgroundChronic hepatitis B (CHB) is a significant risk factor for liver-related disorders. Hepatic fibrosis staging by liver biopsy in these patients can lead to complications. This study aimed to compare aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, AST to platelet ratio index (APRI), and fibrosis-4 (FIB-4) with FibroScan results for the evaluation of hepatic fibrosis in CHB patients.MethodsThis cross-sectional study included patients with CHB referred to the outpatient clinics of Bandar Abbas, Hormozgan, Iran, in 2021. The age and sex of the participants were noted. FibroScan evaluation was done for all subjects. Moreover, AST, ALT, and platelet counts were measured in their blood samples within one month of the FibroScan evaluation.ResultsOf the 267 CHB patients evaluated in the present study (mean age: 45.45 ± 18.16 years), 173 (64.8%) were male. According to FibroScan results, 65 CHB patients (24.3%) had F1, 53 (19.9%) F2, 38 (14.2%) F3, and 20 (7.5%) F4 liver fibrosis. There was a significant correlation between FibroScan results and the three indices of AST/ALT ratio, APRI, and FIB-4 (P < 0.001), with the strongest correlation between FibroScan results and APRI (r = 0.682). With an area under the receiver operating characteristic (AUROC) curve of 0.852 (95% confidence interval [CI] 0.807; 0.897, P < 0.001), APRI ≥ 0.527 had the best diagnostic accuracy (77.15%) for the detection of any grade of liver fibrosis. Although the AUROC curve of APRI and FIB-4 was similar (0.864) for distinguishing between F3/F4 and F0-F2 of liver fibrosis, FIB-4 had the best diagnostic accuracy (82.02%).ConclusionsAPRI can rule out 95.4% of F3/F4 of liver fibrosis and rule in any grade of liver fibrosis in CHB patients by 90.78%. Therefore, APRI appears to be the best substitute for FibroScan in the assessment of liver fibrosis in patients with CHB.

Increased frequency of hepatic steatosis and fibrosis in patients with gout detected by transient elastography.

It has been suggested that gout is associated with non-alcoholic fatty liver disease (NAFLD). Our aim was to assess NAFLD in gout patients using the validated non-invasive imaging technique, transient elastography (FibroScan). FibroScans in consecutive gout patients in a single centre from 11/1/2016 to 11/1/2021 and reviewed retrospectively. FibroScan results include the E- score (kPA), measuring liver stiffness, and controlled attenuation parameter (CAP) score (dB/m), assessing steatosis. In addition, a FIB-4 fibrosis score was calculated. 47 gout patients (7 females, 14.9%; 40 males, 85.1%) underwent FibroScans. The mean age was 59.8 years, the mean body mass index (BMI) was 30.95 kg/m2, and gout duration 0-49 years. Tophi were present in 11 (26.2%). Comorbidities included dyslipidaemia (86.7%), diabetes mellitus (31.1%), known liver disease (33.3%), current alcohol consumption (46.8%), ALT or AST elevations (54.4%), and hyperuricaemia (53.7%). FibroScan results revealed hepatic steatosis (CAP >238 dB/m) in 40 (85.1%) and were significantly associated with BMI (r=0.53, p=0.0001) but not age, serum urate (SU), glucose, triglycerides, ALT, AST. FibroScan also revealed fibrosis (E score >7) in 9 (19.1%); severe fibrosis (cirrhosis) in 8. Fibrosis was significantly associated with age (p=0.03) and known liver disease (p=0.003) but not BMI, SU, or comorbidities. The FIB-4 score was significantly associated with the fibrosis score (r2=0.24, p=0.0009) but not with CAP, ALT, or AST. Despite not being associated with common gout comorbidities, fatty liver and liver fibrosis were common in this gout cohort, suggesting FibroScan screening in gout patients to assess NAFLD, irrespective of serum transaminase levels.

E007 Is there an urgent need to change the methotrexate monitoring guidelines to incorporate fibroscan?

Abstract Background/Aims Methotrexate (MTX) is a widely used DMARD for which routine blood monitoring is required to identify hepatotoxicity and bone marrow suppression. Despite routine monitoring and normal liver function tests some patients develop hepatic fibrosis. Transient elastography (fibroscan) offers an excellent non-invasive approach to measure the stiffness of the liver as a form of assessing hepatic fibrosis and would prove extremely useful to monitor the effects of MTX in our patient groups. Methods A retrospective study was conducted between January 2021 and August 2022. Inflammatory arthritis patients who have been on MTX for more than five years were selected for the study. Their fibroscan results were obtained and their median value (kilopascals), if they had an ultrasound in the past showing cirrhosis, metabolic risk factors such as obesity (BMI&amp;gt;30), presence of type 2 diabetes and alcohol consumption (&amp;gt;14 units/week) were recorded from their clinic letters. Results Of the 56 patients, there were 18 males and 38 females. 29% of the patients had a median fibroscan value of more than 7 kpa (n = 16). Of these 16 patients, 50% of the patients had a metavir score of F2 (n = 8), 25% of the patients had a metavir score of F3 (n = 4) and 25% of the patients had a metavir score of F4 (n = 4). Of the 16 patients (11 RA and 5 PSA) with high median value, 46% had a BMI &amp;gt; 30 kg/m2 (n = 7), 13% had a diagnosis of type 2 diabetes mellitus (n = 2) and none of the patients had consumed more than 14 units/week of alcohol. Of the 16 patients with high median value, 12% (n = 2) had a diagnosis of cirrhosis on ultrasound. One patient had extremely high median value of 26 had underlying ILD, right heart failure and possible cardiac cirrhosis. 1 patient had developed frank cirrhosis and the high fibroscan results were noted subsequently. For all the patients with high metavir score of F4 and above, MTX therapy was discontinued. Conclusion A significant percentage of the cohort (29%) had a high median value above 7 of which 25% of the patients had F4 fibrosis despite having normal liver function tests. The study illustrates the need for a different modality in addition to the routine blood monitoring for the patients on MTX with metabolic risk factors. Therefore, it is vital to obtain a baseline fibroscan in high-risk patient group with preexisting metabolic risk factors prior to initiating MTX therapy and monitor every 5 years thereafter. This will help the clinician to safely continue MTX in this group of patients without the fear of worsening liver fibrosis. Disclosure S. Ramalingam: None. M. Sayed: None. S. Alam: None. D. Makkuni: None.

Evaluating the non-invasive tools for assessment of liver fibrosis in children with intrahepatic cholestasis prior to partial biliary diversion: tertiary-center experience

BackgroundThe liver biopsy is an essential element of evaluating progression of liver disease in children with Progressive Familial Intrahepatic Cholestasis (PFIC) and Allagille Syndrome (AGS). Several noninvasive techniques, including radiological imaging and blood biomarkers assay, can be used to evaluate liver stiffness.ObjectivesTo identify whether liver Transient elastography (FibroScan) and AST/PLT Ratio Index (APRI) could be reliable tools to assess the degree of fibrosis prior to partial biliary diversion (PBD).MethodsA prospective cohort in which all patients with PFIC and AGS who underwent PBD from July 2019 to July 2021 were included. Preoperative liver functions, pelvic-abdominal ultrasonography and FibroScan assessments were performed while intraoperative liver biopsy was obtained.ResultsEight patients with chronic cholestatic liver disease who were candidates for PBD due to intractable pruritus were enrolled, including PFIC (n = 6; 75%), and AGS (n = 2; 25%). The liver FibroScan results were similar to the liver biopsy histopathological assessment in 87.5% of cases. APRI ranged from 0.1 to 3.2 (median = 1.2). In four cases (50%), APRI was consistent with histological evaluation of liver samples. The FibroScan results were in concordance with APRI results in three patients (37.5%).ConclusionThe current cohort demonstrated that fibroScan was consistent with histopathology in 87.5% of patients, highlighting its value in determining the degree of liver fibrosis prior to surgery, whereas the APRI was only consistent with histopathology in half of cases.

To scan or not to scan: Use of transient elastography in an integrated health system.

Non-invasive tests, such as Fibrosis-4 index and transient elastography (commonly FibroScan), are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease (NAFLD). In 2018, a clinical decision support tool (CDST) was implemented to guide primary care providers (PCPs) on use of FibroScan for NAFLD. To analyze how this CDST impacted health care utilization and patient outcomes. We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017 (pre-CDST) or January 2018 to December 2020 (post-CDST). Outcomes included FibroScan result, laboratory tests, imaging studies, specialty referral, patient morbidity and mortality. We identified 958 patients who had FibroScan, 115 before and 843 after the CDST was implemented. The percentage of FibroScans ordered by PCPs increased from 33% to 67.1%. The percentage of patients diagnosed with early F1 fibrosis, on a scale from F0 to F4, increased from 7.8% to 14.2%. Those diagnosed with advanced F4 fibrosis decreased from 28.7% to 16.5%. There were fewer laboratory tests, imaging studies and biopsy after the CDST was implemented. Though there were more specialty referrals placed after the CDST was implemented, multivariate analysis revealed that healthcare utilization aligned with fibrosis score, whereby patients with more advanced disease had more referrals. Very few patients were hospitalized or died. This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.

Gene-by-Environment Interaction in Non-Alcoholic Fatty Liver Disease and Depression: The Role of Hepatic Transaminases.

Non-alcoholic fatty liver disease (NAFLD) encompasses a range of liver conditions, from benign fatty accumulation to severe fibrosis. The global prevalence of NAFLD has risen to 25-30%, with variations across ethnic groups. NAFLD may advance to hepatocellular carcinoma, increases cardiovascular risk, is associated with chronic kidney disease, and is an independent metabolic disease risk factor. Assessment methods for liver health include liver biopsy, magnetic resonance imaging, ultrasound, and vibration-controlled transient elastography (VCTE by FibroScan). Hepatic transaminases are cost-effective and minimally invasive liver health assessment methods options. This study focuses on the interaction between genetic factors underlying the traits (hepatic transaminases and the FibroScan results) on the one hand and the environment (depression) on the other. We examined 525 individuals at risk for metabolic disorders. We utilized variance components models and likelihood-based statistical inference to examine potential GxE interactions in markers of NAFLD, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and the AST/ALT ratio, and Vibration-Controlled Transient Elastography (VCTE by FibroScan). We calculated the Fibroscan-AST (FAST) score (a score that identifies the risk of progressive non-alcoholic steatohepatitis (NASH) and screened for depression using the Beck Depression Inventory-II (BDI-II). We identified significant G × E interactions for AST/ALT ratio × BDI-II, but not AST, ALT, or the FAST score. Our findings support that genetic factors play a role in hepatic transaminases, especially the AST/ALT ratio, with depression influencing this relationship. These insights contribute to understanding the complex interplay of genetics, environment, and liver health, potentially guiding future personalized interventions.

Abstract 15289: Association Between Liver Stiffness and Prevalence of Stroke: Analysis of the National Health and Nutrition Examination Survey 2017 - 2020

Introduction: While cirrhotic patients increase risk of hemorrhagic and thrombotic events, association of liver stiffness with stroke remaines unclear. Hypothesis: Severity of liver stiffness is associated with higher prevalence of stroke. Methods: A cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 included adult participants aged 21 to 79 years. Association between prevalence of self-reported stroke and liver stiffness stratified for 4 fibrosis scores measured by Fibroscan ™ were analyzed by multivariate logistic regression. Results: A total of 8,416 patients with Fibroscan results were identified (mean age 49 + 16 years old; 52% female; 32% white). Overall, 377 patients (4.5%) had a stroke. The number of participants stratified by 4 fibrotic stages of mild (F0F1), moderate (F2), severe fibrosis (F3), and cirhosis (F4) were 6,243 (74.2%), 826 (9.8%), 122 (1.4%), and 155 (1.8%) patients, respectively. In multivariate logistic regression, after controlling for age, race, gender, diabetic status, body mass index (&lt;25 vs &gt; 25 kg/m 2 ), and high systolic blood pressure ( &lt; 130 vs &gt;130 mmHg), individuals with severe fibrotic liver (F3 and F4) were significantly more likely to have a stroke (adjusted odds ratio (OR) 1.64; p= 0.044; 95% confidence interval (CI) 1.01, 2.65; Figure 1). Furthermore, we found that patients with cirrhosis (F4) were the most at risk to have a stroke (adjusted OR 1.91; p= 0.037; 95% CI 1.04, 3.49; Figure 1). Conclusions: In this cross-sectional data, there is a graded association between severe fibrotic liver disease measured by Fibroscan ™ and elevated prevalence of stroke. Longitudinal studies including additional risk factors of stroke such as hyperlipidemia, hypertension and atrial fibrillation need to be further evaluated.

ESTIMATION OF LIPID PROFILE AND GLYCEMIC STATUS AND LIVER ENZYMES, AMONG PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE

Aim: The aim of the study is mainly to evaluate the association of obesity, liver enzymes, lipid profile and glycemic status with Non -alcoholic Fatty Liver Disease (NAFLD). Methods: This cross-sectional observational study Results: This study shows that characteristics of studied population (n = 400) as control, The study population was categorized into three age groups viz. 18-35 yrs, 36-60 yrs and &gt;60 yrs. Out of the 400 subjects studied more than 50% belonged to the age group 36-60 years, 27.5% to the age group18-35 years and the remainder to the group above 60 years. The genders wise distribution of study group is presented 53% of the subjects were females and 47% subjects were males. 59.5% of the subjects were obese according to the WHOs classification of BMI for Asians. 18.5% were overweight and the remaining 22% were normal. 25% of the subjects were diabetics and 20 % were hypertensives. The association between the prevalence of NAFLD and the age categories mentioned previously, gender, BMI &amp; comorbidities was tested using Chi-Square test. There was a significant association with age, BMI, DM and HTN with a P-value of 0.003, 0.0.000, 0.000 and 0.000 respectively. No significant association was found with gender. The results of Chi-square tests performed to find out the association between NAFLD &amp; serum levels of liver enzymes. There was no significant association between NAFLD and liver enzymes. The results of the Chi-square tests performed to find out the association between NAFLD &amp; serum lipid levels. A significant association was found between the prevalence of NAFLD and total cholesterol, triglycerides, LDL-C and VLDL-C. No significant association was observed between NAFLD and HDL-C. The association between NAFLD and the glycemic status was tested. There was a significant association between plasma fasting glucose level and NAFLD. The percentage of subjects diagnosed with NAFLD in each of the various stages according to their Fibroscan results. Among the 75 NAFLD patients, 80 % of patients were in fatty liver stage, 17,3% had had progressed to NASH and 2.7% progressed to the fibrosis stage. None of the patients were found to have liver cirrhosis. There was a significant association between the HBA1c and the progression of NAFLD with a P-value of 0.001. A significant association was found to exist between the various stages of NAFLD and the plasma fasting glucose level. The P-value was 0.025. The results are summarized in different tables. Conclusion: The Prevalence of NAFLD in the study population was 18.8%.The prevalence of NAFLD was higher among males. Age, BMI and co-morbidities like diabetes and hypertension were significantly associated with NAFLD. A significant association between NAFLD and total cholesterol, triglycerides, LDL-C, VLDL-C &amp; fasting glucose was observed. There was a significant association between disease progression and glucose intolerance.

Diagnostic Accuracy of Red Cell Distribution Width to Platelet Ratio for Detection of Liver Fibrosis Compared with Fibroscan in Chronic Hepatitis B Egyptian patients

Background and Aims: The decision to treat chronic hepatitis B Virus infection (CHB) may necessitate an assessment of the degree of liver fibrosis. Guidelines recommend Fibroscan examination in such cases. However, it is costly and not widely available. Red cell distribution width (RDW) and platelet count are simple parameters obtained from the blood pictures; and their ratio RDW to platelet ratio (RPR) was claimed to correlate with liver fibrosis. We aimed to assess the ability of RPR to replace the costly fibroscan in the detection of significant fibrosis in chronic hepatitis B patients. Patients and Methods: This cross-sectional study was conducted in the Tropical medicine department, Tanta University, Egypt, between December 2018 and September 2019. One hundred and twenty-five patients with CHB were included and divided according to the fibroscan examination into: Group I: patients with no significant fibrosis (n=66), Group II: patients with significant (≥ F2) fibrosis (n=59). RPR was calculated for all patients and tested against Fibroscan results. Results: Both groups were matched in regards to age, sex, viral load, and steatosis. There was a significant positive correlation between the degree of stiffness measured by FibroScan in patients with a significant degree of fibrosis and serum bilirubin, a quantitative polymerase chain reaction of hepatitis B virus DNA (HBV DNA PCR), and fibrosis-4 score (FIB-4 score) (P value= 0.020, 0.049, and 0.0402, respectively). However, RPR was not correlated to the degree of fibrosis in fibroscan examination. Conclusions: The accuracy of RDW to platelet ratio (RPR) for the detection of fibrosis in CHB patients is questionable. FIB-4 is correlated with liver stiffness measurement (LSM) in patients with significant fibrosis (F2 or more). Neither RPR, AST to Platelet Ratio Index (APRI) or FIB4 can replace fibroscan for grading of fibrosis in CHB patients for evaluation to start therapy.

S1325 Association of Alcohol Consumption With Diastolic Hypertension in Patients With Mild Liver Stiffness: Analysis of the National Health and Nutrition Examination Survey 2017-2020

Introduction: While excessive alcohol consumption is associated with arterial hypertension. Cirrhotic patient’s risk for hypertension remains unclear due to both vasodilatation and vasoconstriction effect. We aim to examine the association between alcohol consumption and hypertension in patients with different degrees of liver fibrosis. Methods: A cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 included adult participants. Association between alcohol consumption and both systolic and diastolic hypertension (SHTN and DHTN) defined as SBP and DBP ≥120 and ≥80 mmHg, respectively were analyzed by multivariate logistic regression. Prespecified subgroup analyses were performed to investigate potential effect modifiers. Results: A total of 9,693 patients were identified (mean age 50±19 years old; 51% female; 35% white). Among the participants with Fibroscan results, they were stratified into 3 groups based on the number of alcohol drinks per day (0-1 drink per day (G1), 2,126 [36%]; 1-4 drinks per day (G2), 2,612 [45%]; > 4 drinks per day (G3), 1,125 [20%]). After controlling for age, race, gender, body mass index, diabetic status, hyperlipidemic status, serum creatinine, urinary albumin:creatinine ratio, and fibrotic liver stage (< F2 = mild and ≥F2 = significant with fibrosis scores of < 7.5 and ≥7.5 kPa, respectively), the G2 and G3 had greater the odds of having SHTN but not statistically significant. (ORG21.26; P 0.155; 95%CI 0.9076, 1.760; ORG3 1.30, P 0.180, 95%CI 0.886, 1.909). Both G2 and G3 were significantly more likely to develop DHTN (ORG2 1.53, P 0.018, 95%CI 1.076, 2.172; OR3G3 1.88, P0.002 95%CI 1.259, 2.802). Subgroup analysis revealed a significant increased odds of developing DHTN in G2 and G3 only for those with mild fibrosis (< F2; ORG2 1.45, P 0.048, 95%CI 1.004, 2.151; OR G3 1.83, P 0.006, 95%CI 1.186, 2.833). The magnitude and direction of the association were similar for participants with significant fibrosis (≥F2; ORG21.64, P 0.363, 95%CI 0.566, 4.728; OR G3 1.86, P 0.308, 95%CI 0.564, 6.168; Figure A). The alcohol – SHTN association remains no statistical significance in all subgroups (Figure B). There was no effect modification observed between alcohol consumption and key covariates. Conclusion: In this study, there is an association between alcohol intake and DHTN in mild fibrotic liver patients. Longitudinal studies are required to further evaluate this association and possible underlying mechanisms.Figure 1.: Distribution of diastolic (A) and systolic (B) hypertension stratified by the amount of alcohol consumption per day and the severity of liver fibrosis

S1438 Incidence and Early Detection of Patients With Nonalcoholic Fatty Liver Disease: A QI Project

Introduction: Non-Alcoholic Fatty liver disease (NAFLD) is under-recognized in Primary care clinics. Early diagnosis in Primary care clinics is essential to help understand the magnitude of the burden and initiate measures to prevent its silent progression. With the rising incidence of NAFLD, it will soon become a major health care burden in the future. We aim to establish a screening algorithm for early detection of NAFLD and educate patients on primary preventive measures to avoid the development of cirrhosis from fatty liver. Methods: We created an algorithm that was tested in a cohort of patients recruited from the primary care center. Inclusion criteria: Presence of established Type two diabetes Mellitus (T2DM),Components of metabolic syndrome like BMI >27, CAD and dyslipidemia etc, Elevated Liver Enzymes or history of fatty liver by any imaging modality. Exclusion criteria : Alcoholics, known liver disease from other causes. Clinical and demographic data collected were age, sex, BMI, comorbidities, and lab results to calculate Fibrosis-4 and AST to Platelet Ratio Index (APRI) Scores. Patients with FIB-4 score greater than 1.45 and APRI score greater than 0.7 were instructed to get Fibroscan. Results: Between August 2020 and October 2021, 203 patients were screened in the primary care clinic for NAFLD. A total of 51 patients met the inclusion and exclusion criteria. A total of 7 people (13%) had insufficient data. The median age in our study was 60 years. In terms of comorbidities, 52 % had T2DM, 77 % had hypertension, 52 % had hyperlipidemia, and the median for the BMI over 30.9. 9% had APRI score between 0.7 and 0.99, and 16% had an APRI score of > 1. 34% of our patients had their FIB-4 index between 1.45 and 3.25 and the remaining 16% had a FIB-4 index more than 3.25. A total of 26 patients had a Fibroscan to determine the stage. The Kpa ranges between 5.3-7.2 and the CPA ranges between 246 and 361 dB/m. Patients with high APRI and FIB-4 score and abnormal fibroscan results are referred to Liver clinic for further management. (Figure) Conclusion: This study demonstrates that a stepwise prospective application of an algorithm using inclusion and exclusion criteria in clinical practice settings can lead to the early identification of patients with NAFLD. Increasing awareness among health care providers to implement screening strategies in Clinics is necessary. Further studies on implementation in larger size populations are needed along with education and long-term management of these patients. (Table)Figure 1.: Algorithm followed for the study Table 1. - Demographic and Clinical data of the study Demographics Total Patients (44) Male, N (%) 22 (50) Age, (Median, IQR) 60, (54.5- 68) BMI, Median (IQR) 30.9, (27.97- 35.08) Comorbidities Hypertension N, (%) 34, (77) Diabetes N, (%) 23, (52) Dyslipidemia N, (%) 23, (52) Laboratory Parameters Aspartate Aminotransferase- U/L, (Median, IQR) 28 (19- 37) Alanine Aminotransferase- U/L, (Median, IQR) 27 (21- 44) Fibrosis Lab assessment FIB4 %(< 1.45, 1.45- 3.25, >3.25) 50, 34,16 APRI % (< 0.7, 0.7- 0.99, >1) 75, 9, 16 Non-Invasive imagingLiver Elastography (Range) 5.3- 7.2 kPa. 247- 361 CAP score (dB/m)

Role of fibroscan in assessing the extent of liver involvement among chronic hepatitis B and C cases

Chronic liver diseases (CLD) cause significant morbidity and mortality worldwide, accounting for approximately 2 million deaths annually. The majority of CLDs include alcoholic liver disease, chronic viral hepatitis, including hepatitis B and C, non-alcoholic fatty liver disease (NAFLD), and hemochromatosis. Of these, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for a substantial proportion of liver diseases which is responsible for liver damage ranging from minor disorders to liver cirrhosis and hepatocellular carcinoma (HCC). Fibroscan is a novel non-invasive method for assessing hepatic fibrosis by measuring liver stiffness.&#x0D; The aim. The present study was conducted to know the prevalence of blood-born viral pathogens (HBV, HCV) among patients with chronic liver diseases (CLD) and also to assess the role of Fibroscan and liver function tests (LFT) in evaluating the extent of chronic liver disease.&#x0D; Material and methods: The present study comprised 100 chronic liver disease patients attending the gastroenterology department. All the chronic liver disease cases were tested for Hepatitis B and Hepatitis C viral infections using a rapid Immunochromatography assay. Simultaneously they were subjected to liver function tests and fibroscan to assess the extent of fibrosis by staging from F0 to F4.&#x0D; Results: When screened for bloodborne viral pathogens, 46 % were HBV positive, 10 % were HCV, and none were HIV positive. No co-infection was detected. HBV was identified as the most typical cause of CLD in about 46 %, followed by non-viral/non-infectious (alcoholic, metabolic, autoimmune) cause in 44 % and 10 %, the cause for CLD was HCV. As per fibroscan results, 80 % of HCV and 39 % of HBV patients were in the stage of cirrhosis/advanced fibrosis.&#x0D; Conclusion: HBV was the predominant cause of CLD. Liver stiffness has recently been shown to be a good predictor of clinical outcomes. A fibroscan will help in the decision-making process in staging the disease and choice of treatment in viral hepatitis cases