Degree Of Fibrosis In Patients Research Articles

Establishment and evaluation of noninvasive diagnostic models for liver fibrosis in patients with chronic hepatitis B

Objective: To establish the model of liver fibrosis based on noninvasive indices, and to investigate the diagnostic value of this model. Methods: A total of 838 patients with chronic hepatitis B (CHB) who underwent liver biopsy in our hospital from March 2003 to October 2013 were selected, and the results of blood tests and B-ultrasound were collected. The correlation between these indices and liver fibrosis stage was analyzed. A logistic regression analysis was performed to establish a predictive model, and the value of this model was examined in validation group. The t-test, Mann-Whitney U non-parametric test, and chi-square test were used for data analysis. A Spearman rank correlation analysis was used for bivariate correlation analysis, and a dichotomous logistic stepwise regression analysis was used for multivariate analysis. Results: In the model group, a model (FV) consisting of age, platelet count (PLT), γ-glutamyl transferase (GGT), albumin/globulin ratio (A/G), and splenic square area (SSA) was established. The areas under the receiver operating characteristic curve (AUROCs) of the model FV were 0.892, 0.910, and 0.915, respectively, in diagnosing significant liver fibrosis (S2-4), progressive liver fibrosis (S3-4), and early-stage liver cirrhosis (S4), with sensitivities of 77.6%, 83.7%, and 86.0%, respectively, specificities of 89.7%, 84.5%, and 83.7%, respectively, and accuracy of 82.1%, 84.2%, and 84.2%, respectively. There were no significant differences in AUROCs between the validation group and the model group (Z = 0.360, 0.885, and 0.046, all P > 0.05). In all patients, FV had significantly higher AUROCs in the diagnosis of liver fibrosis than FIB4 index and S index (Z = 4.569/3.423, 5.640/4.709, and 4.652/4.439, all P < 0.05). With < 0.374 and ≥ 0.577 as the cut-off values for the exclusion and diagnosis of significant liver fibrosis, 61.1% (512/838) of all patients could avoid liver biopsy, and the accuracy was 92.6% (474/512). Conclusion: The noninvasive model based on age, PLT, GGT, A/G, and SSA can accurately predict liver fibrosis degree in patients with CHB with good reproducibility; therefore, it can be used for dynamic monitoring of liver fibrosis degree in clinical practice.

Determining the Role of Serum Hyluronic Acid Levels to Degree of Fibrosis in Patients with Chronic Viral Hepatitis

Determining the Role of Serum Hyluronic Acid Levels to Degree of Fibrosis in Patients with Chronic Viral Hepatitis

FRI-143 - Characterization and evaluation of hepatic fibrosis degree in patients with chronic hepatitis B virus infection with normal transaminases

FRI-143 - Characterization and evaluation of hepatic fibrosis degree in patients with chronic hepatitis B virus infection with normal transaminases

Diagnostic value of optimised real-time sonoelastography in the assessment of liver fibrosis in chronic hepatitis B and C.

AimTo optimise the method of real-time elastography (RTE) in the assessment of liver fibrosis using an in-house prepared method for elastogram analysis, as well as a semiquantitative analysis based on newly introduced parameters.Material and methodsSonoelastography was performed in 94 patients with various degrees of liver fibrosis and also in 25 healthy volunteers. As a reference method for diagnostic efficacy of sonoelastography-based parameters used for the assessment of fibrosis degree in patients with chronic B and C hepatitis, a liver biopsy was used. Patient’s elastograms were analysed using in-house prepared software, Pixel Count, calculating two semiquantitative parameters: mean stiffness fraction (MSF%) and intrinsic stiffness ratio (ISR).ResultsStatistically significant differences between distributions of the above presented parameters for different degrees of liver fibrosis were revealed. Indices of diagnostic efficacy for detection of significant liver fibrosis (F ≥ 2) using MSF% amounted to: sensitivity – 76%, specificity – 87% and ISR: 81% and 87%, respectively. Sensitivity of both parameters in detection of cirrhosis (F = 4) was equal to 88% and specificity amounted to: for MSF% – 84% and ISR – 86%. Interobserver reproducibility determined for both of the above parameters was high, intraclass correlation coefficients (ICC) were 0.91 for MSF% and 0.93 for ISR.ConclusionsReal-time elastography applied in this study, using in-house prepared Pixel Count software, provided good reproducibility and diagnostic efficacy, especially specificity, in the assessment of liver fibrosis degree.

Clinical Significance of Neutrophil to Lymphocyte Ratio and Mean Platelet Volume for Predicting the Severity of Hepatic Fibrosis in Patients with Chronic Hepatitis B [Kronik Hepatit B Hastalarinda Karaciger Fibrozisinin Ciddiyetinin Belirlenmesinde Notrofil/Lenfosit Orani ve Ortalama Trombosit Hacminin Klinik Onemi

In this study, we aimed to determine the clinical significance of the neutrophil to lymphocyte (NLR) ratio, mean platelet volume (MPV) and other biochemical parameters for predicting the degree of liver fibrosis in patients with chronic hepatitis B (CHB) infection. A total of 95 biopsy-proven naive CHB cases patients were included in the study. The complete blood count variables including white blood cell, hemoglobin, hematocrit, platelet count, neutrophil, lymphocyte, MPV, and other routine biochemical parameters were tested. Liver biopsy samples were examined using the Ishak scoring system. Individuals with a fibrosis score of 0, 1 and 2 were included in Group 1 and 3,4,5 and 6 were included in Group 2. Data analyses were carried out using SPSS 15 software. Statistical significance was set at a p-value of less than 0.05.Of the 95 cases, 76 (80%) were men and 19 (20%) were women. The mean age of the patients was 39.91±18.6 years, and 30 cases (31.5%) had HBeAg positivity. Fibrosis scores of 36 cases (37.8%) were greater than or equal to 3, whereas 59 cases (62.2%) had fibrosis scores less than 3. There was a significant difference between these two groups for NLR (Group 1; 2.38± 0.96, Group 2; 1.64 ± 0.60, p

Abstract 16572: Association of Atrial Fibrosis With Major Adverse Cardiac Events in Patients With Non-valvular Atrial Fibrillation

Background: Extensive of atrial fibrosis has been demonstrated to significantly predict success of catheter ablation. However, impact of extensive fibrosis on other aspects of patient care and long-term prognosis is unknown. Methods: We conducted a historical cohort study to assess the hypothesis that increased degree of atrial fibrosis is independently associated with major adverse cardiac events (MACE). We reviewed 853 patients with non-valvular atrial fibrillation (NVAF) and quantified fibrosis. Logistic regression models were used to evaluate the association of percent fibrosis on experiencing a MACE. Linear splines were utilized to allow the functional form of the exposure to vary at high (&gt;15%) and low (&lt;15%) fibrosis scores. The outcome of interest was a composite of MACE: myocardial infarction (MI), ischemic stroke (IS), or venous thromboembolism (VTE). Results: The mean age of the cohort was 66.2±12.4 with 66% male and 79% white. During a median follow-up of 2.9 years, 69 (8.1%), 46 (5.4%), 52 (6.1%), and 156 (18.3%) of patients experienced an MI, IS, VTE, or MACE, respectively. High fibrosis patients were more likely to be older, male, and have a higher CHA2DS2-VASc score. In the unadjusted analysis, increased fibrosis was associated with increased odds of a MI (OR [95% CI] P-Value: 1.30 [1.00, 1.68] 0.05) or any MACE (1.28 [1.06, 1.56] 0.01), but not with IS or VTE. After adjusting for potential confounders, increasing fibrosis levels had significantly increased odds of MI (1.53 [1.02, 2.28] 0.04) and VTE (1.52 [1.17, 2.86] &lt;0.01) when fibrosis levels were above 15%. There was no significant association below 15%. The odds of a MACE was significant above 15% (1.64 [1.18, 2.27] &lt;0.01) and across all fibrosis scores (1.23 [1.01, 1.49] 0.04), but was insignificant when only fibrosis levels below 15% were examined. Conclusions: Advanced degree of atrial fibrosis in patients with NVAF is independently associated with increased risk of MI, VTE and a composite of MACE.

Diagnostic value of FibroTest for liver fibrosis in patients with chronic hepatitis B

To determine the diagnostic value of FibroTest (FT) for liver fibrosis in patients with chronic hepatitis B (CHB). One hundred and forty-two patients with CHB were tested for the following five indicators: alpha2-microglobulin (a2-MG), haptoglobin (Hp), gamma-glutarnyl peptidase (GGT), total bilirubin (TBIL), and apolipoprotein A1 (ApoA1). The resultant data, along with the age and sex of the patients, were put into an algorithm to compute the final results of the FT. During the same period of FT, all of the CHB patients underwent liver stiffness measurement by FibroScan (FS) as well as liver biopsy. Considering the liver biopsy as the gold standard, we determined receiver operating characteristic (ROC) curves at different endpoints. Calculation of the area under the ROC curves (AUROC) was performed to evaluate the diagnostic importance of FT, FS towards the treatment of liver fibrosis in patients with CHB. Significant fibrosis (Scheuer score (S) more than or equal to 2) was predicted with an AUROC for FS, FT of 0.827 (0.753-0.900), 0.897 (0.844-0.949). Significant fibrosis (S more than or equal to 3) was predicted with an AUROC for FS, FT of 0.883 (0.818-0.949), 0.968 (0.932-1.00). Significant fibrosis (S=4) was predicted with an AUROC for FS, FT of 0.943 (0.893-0.993), 0.991 (0.973-1.00). s FT is a novel tool that can be used to assess the degree of fibrosis in patients with CHB.

Utility of Shear Wave Elastography for Diagnosing Chronic Autoimmune Thyroiditis.

The aims of this study were to evaluate the utility of shear wave elastography (SWE) using acoustic radiation force impulse (ARFI) for diagnosing chronic autoimmune thyroiditis (CAT) and to verify the effect of fibrotic thyroid tissue on shear wave velocity (SWV). The subjects were 229 patients with 253 normal thyroid lobes (controls) and 150 CAT lobes. The SWV for CAT (2.47 ± 0.57 m/s) was significantly higher than that for controls (1.59 ± 0.41 m/s) (P < 0.001). The area under the receiver operating characteristics (ROC) curve for CAT was 0.899, and the SWV cut-off value was 1.96 m/s. The sensitivity, specificity, and diagnostic accuracy were 87.4%, 78.7%, and 85.1%, respectively. Levels of anti-thyroperoxidase antibodies and thyroid isthmus thickness were correlated with tissue stiffness in CAT. However, there was no correlation between levels of anti-thyroglobulin antibodies and tissue stiffness. Quantitative SWE is useful for diagnosing CAT, and it is possible that SWE can be used to evaluate the degree of fibrosis in patients with CAT.

Serum Levels of Hepatitis B Surface Antigen Predict Severity of Fibrosis in Patients With E Antigen-Positive Chronic Hepatitis B

Noninvasive techniques are needed to assess hepatic fibrosis in patients with chronic hepatitis B. We developed a scoring system to determine the degree of fibrosis in patients with genotype B or genotype C hepatitis B virus (HBV) infection and positive for the hepatitis B e antigen. We performed a retrospective study to identify baseline variables associated with the severity of fibrosis (METAVIR scores, F0-F4) in a large phase 3 clinical trial of predominantly Asian patients (n = 710), using multivariate logistic regression analyses. Significant variables were used to construct predictive models using optimal cut-off values. The final model was validated in similar patients from a large phase 4 clinical trial (n = 465). We developed 2 prediction scoring systems (PSs). PS1 analyzed data on HBV genotype (B vs. C), patient age (<30 vs. ≥30 y), level of hepatitis B surface antigen (≤17,500 vs. >17,500 IU/mL), and level of alanine aminotransferase (≤3-fold vs. >3-fold the upper limit of normal). PS2 analyzed data on only age and level of hepatitis B surface antigen. PS1 identified patients with F0 to F1 vs. F2 to F4 fibrosis with more than 87% specificity and a positive predictive value greater than 75; it identified patients with F0 to F2 vs. F2 to F4 fibrosis with approximately 95% specificity and a positive predictive value (PPV) of approximately 97%. PS2 identified patients with F0 to F1 fibrosis with less accuracy than PS1, but identified patients with F0 to F2 fibrosis with an almost identical level of sensitivity and PPV. We developed a simple scoring system to determine the severity of fibrosis in patients with genotypes B or C HBV infection who are hepatitis B e antigen positive. Our system differentiated patients with no or mild fibrosis (F0-F1) from those with marked or severe (F2-F4) fibrosis with a high PPV. The high level of specificity for the identification of nonsevere fibrosis (F0-F2) limits the risk of overlooking patients with severe fibrosis (F3-F4).

Mo1458 Endosonography-Guided Gallbladder Drainage With a Lumen Apposing Stent Reduced Recurrent Biliary Events After Acute Cholecystitis As Compared to Percutaneous Cholecystostomy

Area under the ROC curve was 0.68 (95% CI 0.540.82), p-value 0.05 Mo1457 Endoscopic Ultrasound Correlates With Histology in Patients With Chronic Pancreatitis Undergoing Total Pancreatectomy Elham Afghani*, Amitasha Sinha, Michael Cruise, Mahya Faghih, Martin a. Makary, Kenzo Hirose, Marcia I. Canto, Mouen Khashab, Anne Marie Lennon, Vikesh K. Singh GI, Johns Hopkins, Baltimore, MD; Pathology, Johns Hopkins Hospital, Baltimore, MD; Surgery, Johns Hopkins Hospital, Baltimore, MD Background: Endoscopic ultrasound (EUS) is commonly used to diagnose chronic pancreatitis (CP). However, there have been few studies which have evaluated EUS with histology. Aims: To evaluate the association between EUS scoring with the degree of fibrosis in patients with CP who have undergone total pancreatectomy (TP). Methods: All consecutive adult patients with CP (ageR18 years) who underwent preoperative EUS followed by TP from 8/2011 to 10/2013 were included. EUS criteria were defined by the 9 ductal and parenchymal features. Surgical wedge biopsies were obtained from the head and body/tail during TP and histology was evaluated by a pathologist blinded to the results of EUS. Perilobular and intralobular fibrosis scores were determined from the wedge biopsy specimen for each patient and averaged. Mild fibrosis was defined as a fibrosis score (FS) of 0-6 and severe fibrosis was defined as FS of 7-12. The association between FS and EUS criteria was evaluated using Pearson’s correlation coefficient. The diagnostic accuracy of EUS for predicting severe fibrosis was assessed using the area under receiver operating characteristic curve (AUROC). Results: There were 29 patients (68.9% females, mean age of 44 12 years). All patients underwent EUS at mean time of 27.6 15.3 weeks prior to TP. There were 8 (27.5%) patients with calcifications. There were 13 (44.8%) patients with mild and 16 (55.2%) with severe fibrosis. There was a significant correlation between FS and EUS criteria (rZ0.57, 95% CI 0.28, 0.78, p!0.001) as seen in Figure 1. The diagnostic accuracy of EUS for predicting severe fibrosis by AUROC was 0.65 (95% CI 0.45, 0.85). An EUS cut-off of R6 criteria had a sensitivity of 37.5% but specificity and positive predictive value of 100% for severe fibrosis. Conclusion: EUS correlates with fibrosis but no criteria threshold is accurate enough to predict severe fibrosis. AB444 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014 Mo1458 Endosonography-Guided Gallbladder Drainage With a Lumen Apposing Stent Reduced Recurrent Biliary Events After Acute Cholecystitis As Compared to Percutaneous Cholecystostomy Anthony Y. Teoh*, Takao Itoi, Philip W. Chiu, Raymond S. Tang, Charing C. Chong, Enders K. NG, Francis K.L. Chan, James Y. Lau Surgery, Chinese University of Hong Kong, Hong Kong, Hong Kong; Tokyo Medical University Hospital, Tokyo, Japan; Institute of Digestive Disease, Hong Kong, Hong Kong Background: Endosonography-guided gallbladder drainage (EGBD) has been shown to be feasible in previous studies. However, how the approach compares to percutaneous cholecystostomy (PTC) in patients who were unsuitable for surgery is uncertain. Methods: This was a retrospective case-controlled study of all patients who suffered from acute cholecystitis and were deemed high-risk for surgery, that were admitted to the Prince of Wales Hospital between January 2010 and November 2013. The patients that received EGBD were matched with those that received PTC based on sex, age and American society of anesthesiology grading. EGBD was performed using a linear echoendoscope (GF-UCT180 Olympus, Japan) and a lumen apposing stent (AXIOS, Xlumena, CA, USA) was used to drain the gallbladder in to the stomach or duodenum. Outcome measurements included technical and clinical success, morbidities, mortalities, the number of device-related events and unplanned admissions. Results EGBD was performed in 18 patients and they were case-matched with 18 patients who received PTC. There were no significant differences in background demographics between the EGBD and PTC groups(Table 1). All procedures were technically successful and clinical success was obtained in 88.9% and 94.4% of the patients respectively. 11 patients in the EGBD group underwent cholecystoscopy and all stones were removed in 81.8% of the patients. There were no differences in morbidities (33% vs 33.3%, P Z 1) and mortalities (11.1% vs 5.6%, P Z 1). Patients who underwent PTC suffered from significantly more device related events (61.1% vs 16.7%, P Z 0.015) and required more unplanned admissions (2.11 +/2.32 vs 0.11 +/0.47, P Z 0.002). The causes of device-related events in the PTC group included dislodgement, slipping of anchoring sutures and peri-tubal leak. Conclusion: EGBD and PTC were both effective means of obtaining gallbladder drainage. In the absence of a percutaneous tubing, EGBD was associated with reduced number of device-related events and unplanned admissions. Furthermore, EGBD allowed for removal of gallstones after the procedure. Comparison of outcomes between EGBD and PTC. EGBD N [ 18 PTC N [ 18

Gender and menopause impact severity of fibrosis among patients with nonalcoholic steatohepatitis

Estrogens inhibit stellate cell activation and fibrogenesis. Thus, gender and reproductive states may influence the degree of fibrosis in patients with nonalcoholic steatohepatitis (NASH). To investigate the association between gender, menopause, and the severity of liver fibrosis in patients with NASH, we analyzed 541 adult patients enrolled from our Duke Liver Clinics (n = 338) and the Duke Metabolic and Weight Loss Surgery Program (n = 203) who had a histologic diagnosis of NASH. Multiple ordinal logistic regression models were used to assess the association between gender, menopause, and severity of liver fibrosis. Overall, men, premenopausal, and postmenopausal women composed 35.1%, 28.4%, and 36.5% of the population, respectively. The mean age was 48 years and 22% had advanced fibrosis. After adjusting for covariates (enrolling site, grades of portal inflammation, and hepatocyte ballooning) and potential confounders (race, body mass index, diabetes/prediabetes, hypertension), adjusted cumulative odd ratio (ACOR) and 95% confidence interval (CI) for greater fibrosis severity was 1.4 (0.9, 2.1) (P = 0.17) for postmenopausal women and 1.6 (1.0, 2.5) (P = 0.03) for men, having premenopausal women as a reference. There was borderline interaction between gender and age group divided by age 50, the average age at menopause in the U.S. (P = 0.08): ACOR and 95% CI of having greater fibrosis severity in men compared to women was 1.8 (1.1, 2.9) for patients with age <50 years (P = 0.02) and 1.2 (0.7, 2.1) for patients with age ≥50 years (P = 0.59). Men are at a higher risk of having more severe fibrosis compared to women before menopause, while postmenopausal women have a similar severity of liver fibrosis compared to men. These findings may be explained by the protective effects of estrogen against fibrogenesis.

Validation of Hepascore as a Predictor of Liver Fibrosis in Patients with Chronic Hepatitis C Infection

Introduction. Liver biopsy is an invasive determinator for hepatic fibrosis. Serum biomarkers can probably be used as an alternative to liver biopsy in assessment of the degree of fibrosis in patients with chronic Hepatitis C. Method. Eighty patients with chronic Hepatitis C were included in the study using simple nonrandom sampeling metod. After fulfillment of liver biopsy, the patients were categorized according to the METAVIR Scoring system. The Hepascore algorithm is computed based on age, sex, and the serum levels of total bilirubin, δ-glutamyl transferase, α2-Macroglobulin, and hyaluronic acid. The spearman and ROC tests were used. Results. According to the liver biopsy results, 12, 25, 20, 7 and 16 patients had F0, F1, F2, F3, and F4, respectively. With regard to the 0.34 cut-off point Hepascore had 67%, 56%, 64%, and 56% sensitivity, specificity, respectively, positive prediction value (PPV), and negative prediction value (NPV), respectively, for diagnosis of significant fibrosis. For a Hepascore cut-off point 0.61, sensitivity, specificity, respectively, PPV and NPB 82%, 86%, 70%, and 92% in diagnosis of severe fibrosis. For a Hepascore cut-off point 0.84, sensitivity, specificity, PPV and NPB were respectively 100%, 97%, 89%, and 100% for diagnosis of cirrhosis. Conclusion. Hepascore has a high value in diagnosis of the level of fibrosis, particularly cirrhosis. Therefore, it can be used for primary screening of patients to determine the need for liver biopsy.

Single stage and multistage classification models for the prediction of liver fibrosis degree in patients with chronic hepatitis C infection

Predicting significant fibrosis or cirrhosis in patients with hepatitis C virus has persistently preoccupied the research agenda of many specialized research centers. Many studies have been conducted to evaluate the use of readily available laboratory tests to predict significant fibrosis or cirrhosis with the purpose to substantially reduce the number of biopsies performed. Although many of them reported significant predictive values of several serum markers for the diagnosis of cirrhosis, none of these diagnostic techniques was successful in accurately predicting early stages of liver fibrosis. Therefore, in this study a single stage classification model and a multistage stepwise classification model based on Neural Network, Decision Tree, Logistic Regression, and Nearest Neighborhood clustering, have been developed to predict individual's liver fibrosis degree. Results showed that the area under the receiver operator curve (AUROC) values of the multistage model ranged from 0.874 to 0.974 which is a higher range than what is reported in current researches with similar conditions.

Acoustic Liver Biopsy in Patients with Hepatitis C and Advanced Liver Fibrosis Using Endoscopic Ultrasound

Transabdominal ultrasound cannot be used to quantitate fibrosis in patients with advanced liver fibrosis due to variability in the abdominal wall thickness and composition. This variability can be eliminated by using endoscopic ultrasound. The purpose of this study was to determine the amount of fibrosis in the liver of hepatitis C patients with advanced fibrosis using endoscopic ultrasound. Endoscopic ultrasound images of the liver were recorded by keeping the gain, contrast, frequency, magnification and acoustic power constant on the ultrasound processor. Videotaped images of the liver were digitized on Image-Pro Plus software. Using adobe Photoshop, a histogram was produced to quantitate the luminosity of the five areas of interest per image. Quantification of the ultrasound images were done by two independent investigators blinded to the Ishak liver fibrosis score. The mean luminosity of the ultrasound images were compared with the Ishak fibrosis score. The study was performed in seven patients (mean age 54years; 3 male, 4 female) with hepatitis C and advanced liver fibrosis. The correlation between the two independent investigators for the ultrasound images was 0.93. The correlation between the mean luminosity on ultrasound images to the Ishak fibrosis score was r=0.77, r=0.72 and r=0.73 for the most hyperechoic area of interest, total hyperechoic area and for the entire liver, respectively. A new technique was developed that uses endoscopic ultrasound to evaluate the degree of fibrosis in patients with advanced liver fibrosis. There is a good correlation between the luminosity on endoscopic ultrasound and the Ishak fibrosis score.

Avaliação das citocinas IL-10 e IL-13 como mediadores na progressão da fibrose de Symmers em portadores de esquistossomose mansônica na forma hepatoesplênica

To investigate the serum levels of IL-10 and IL-13 in patients with hepatosplenic schistosomiasis mansoni (HSM), evaluating the role of these cytokines in the development of hepatic fibrosis. The study was prospective and analytical, developed at the Department of Surgery, Federal University of Pernambuco, Keizo Asami Laboratory of Immunology. We studied three groups: Group I - 25 patients with hepatosplenic schistosomiasis mansoni who were not submitted to surgery; Group II - 30 individuals who underwent splenectomy and ligature of left gastric vein; Group III - 33 subjects without hepatosplenic schistosomiasis mansoni or any other disease or condition that could compromise the hepatic functional reserve. Serum concentrations of IL-10 and IL-13 were obtained through ELISA. Considering their non-parametric nature, all concentrations were analyzed by Kruskal-Wallis test, with p<0.05 used to reject the null hypothesis. The mean concentrations of IL-10 in ng/mL in serum were GI: 50.0 ± 59.0; GII: 38.0 ± 270; GIII: 38.0 ± 20.0. Concentrations of IL-13 in ng/mL in the serum of patients were respectively: 41.0 ± 93.0 in GI, 16.0 ± 17.0 in GII and 18.0 ± 34.0 in GIII. There was no significant difference between the mean concentrations of IL-10 and IL-13 between the study groups (p> 0.05). The mean serum concentrations of IL-10 and IL-13 were similar in all three groups, indicating that possibly the presence of these cytokines in serum is not associated with different degrees of Symmers fibrosis in patients with hepatosplenic schistosomiasis mansoni.

Correlation between serum fibrosis markers and the degree of liver fibrosis in patients with chronic hepatitis

Correlation between serum fibrosis markers and the degree of liver fibrosis in patients with chronic hepatitis

Statins are Associated with Milder Degrees of Fibrosis in Patients with Chronic Hepatitis C

Purpose: Statins are known to have pleiotropic effects above and beyond lipid lowering including anti-inflammatory, and insulin sensitizing effects. Recently they are also found to have antiviral effects against hepatitis C. The effect of statins on liver fibrosis in hepatitis C patients has not been previously assessed. We evaluated the association of statin use with stage of liver fibrosis in patients with chronic hepatitis C infection utilizing a database created to look at interactions of hepatitis C and diabetes mellitus. Methods: In a nested cohort study from the cross sectional analysis of 5266 US veterans followed at the NY metropolitan area that was designed to examine the association of Hep C and diabetes, we identified patients with HCV who underwent liver biopsies between 2000 to 2007 and had been on statins for at least 1 year. In our database 332 patients had biopsies of whom 276 (83%) had complete data. All liver biopsies were read by 3 pathologists and reviewed with one hepatopathologist as per routine protocol. Modified Ishak score was used for the degree of fibrosis (0–4). Results: Of the 276 patients with hepatitis C and liver biopsies mean age (years) = 52.6 ± 0.35 (±SEM), BMI = 29.4 ± 1.3 Kg/m2. 40.8% of the patients were white, 42.1% black, and 13.8% Hispanic. 22 patients (8%) were on statins. Of those patients who are on statins a significantly higher proportion had stage 0 to 2 fibrosis (81.8%) as opposed to (61.0%) of non-statins users, P= 0.04. In a logistic regression model, after adjusting for age and BMI, the odds of having mild liver fibrosis (stage 0–2) in statin users was 3.4 (1.11–10.9) 95% CI, P= 0.032. Conclusion: In patients with chronic hepatitis C, the use of statins was associated with a milder degree of fibrosis on liver biopsy. Further studies are needed to confirm our findings and provide mechanistic insights into the effects of statins on liver fibrosis in the hepatitis C population.

Non‐invasive prediction of the degree of liver fibrosis in patients with hepatitis C using an ultrasound contrast agent. A pilot study

It has been shown that the severity of hepatic fibrosis in patients with hepatitis C can be predicted non-invasively by measuring intrahepatic circulatory time (IHCT) using a microbubble agent with spectral Doppler analysis. The aim of this study was to assess whether this technique is reproducible using a third-generation microbubble agent and contrast harmonic imaging, which are becoming the standard ultrasound techniques in all radiology departments. Twenty-three untreated patients with hepatitis C, who had undergone a recent liver biopsy, were studied prospectively. Based on their histological fibrosis score, patients were divided into four groups (fibrosis levels 1-4). Contrast harmonic imaging was carried out after an intravenous bolus of a microbubble agent (Optison; Amersham Health, Milwaukee, WI, USA). IHCT was calculated by measuring the difference between the hepatic vein and hepatic artery microbubble arrival times. The IHCT was compared with the degree of fibrosis. Significant differences were shown between the groups for IHCT. There were significant differences between fibrosis levels 1 and 3 and between fibrosis levels 1 and 4. This study has shown that calculation of IHCT using a third-generation microbubble agent and contrast harmonic imaging can differentiate mild fibrosis from more severe degrees of fibrosis in patients with hepatitis C.

Serum hyaluronic acid as a noninvasive marker of hepatic fibrosis in chronic hepatitis B

Background/Aims:Chronic hepatitis B is a serious global health problem. Liver biopsy is currently recommended as the gold standard for the evaluation of the degree of fibrosis in patients with chronic hepatitis B. This procedure, however, is invasive and has potential complications. In this study, we attempted to validate the level of hyaluronic acid as a simple laboratory test to discriminate between patients with and without significant fibrosis in chronic hepatitis B.Methods:This study included 93 patients with chronic hepatitis B who had undergone percutaneous liver biopsy from 2003 to 2006. At the time of biopsy, a sample of serum was taken for the hyaluronic acid (HA) assay. Histological assessment consisted of the semiquantitative analysis of the degree of fibrosis according to the criteria proposed by the Ishak system. These findings were then compared by using statistical analysis.Results:HA levels and stage groups of fibrosis were well correlated (Spearman r = 0.945, P < 0.005). There was a significant increase in HA levels when considering S0 to S6. The mean values of HA concentrations were 59.7 ± 10.5 ng/mL for stages 0–2, 149.4 ± 15.9 ng/mL for stages 3–4 , and 284.5 ± 14.5 ng/mL for the last group (stages 5-6). There were significant differences between the three groups. Serum HA levels of cases with extensive fibrosis were significantly higher than in those with mild and moderate fibrosis (P = 0.0001, P = 0.0005, and P = 0.0001, respectively).Conclusion:Serum HA level is a precise predictor of extensive liver fibrosis in chronic hepatitis B. HA is well correlated with the stage of fibrosis and can reflect the severity of fibrosis. Thus, it can be used as a noninvasive test to monitor these patients.

Liver Fibrosis Is Associated with Decreased Peripheral Platelet Count in Patients with Chronic Hepatitis B and C

Thrombocytopenia is a common complication of chronic liver diseases, but its pathogenesis is not clear. Although generally attributed to hypersplenism, other factors should also be considered. We investigated the relationship between the peripheral platelet count and the degree of fibrosis in patients with chronic viral hepatitis. In an effort to avoid the effects of hypersplenism, we excluded patients with splenomegaly and/or bi- or pan-cytopenia. Seven hundred eighty-four patients (265 chronic viral hepatitis C and 519 chronic viral hepatitis B) were included in the study. Univariate analysis showed that the peripheral platelet count had a negative correlation with fibrosis score, necroinflammatory activity, and age in both groups. In multivariate analysis, the peripheral platelet count had a similar correlation with the fibrosis score and age, but not with necroinflammatory activity, in both groups. The peripheral platelet count decreased more significantly in females with chronic hepatitis C but not in the chronic hepatitis B group. In conclusion, a decrease in peripheral platelet count may be a sign of an increase in the degree of fibrosis during the course of chronic viral hepatitis B and C and factors other than hypersplenism may play a role in this decrease in the peripheral platelet count.