Fibrosis Stage In Patients Research Articles

Endoscopic Ultrasound Shear Wave Elastography for Fibrosis Screening in Patients with Obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Pilot Study (With Video).

Liver fibrosis staging is challenging in patients with obesity and metabolic dysfunction-associated steatotic liver disease (MASLD). Liver biopsies are invasive, whereas non-invasive tests such as vibration-controlled transient elastography (VCTE) can be inaccurate in patients with obesity. We hypothesized that endoscopic ultrasound shear wave elastography (EUS-SWE) is more accurate for liver fibrosis staging in patients with MASLD and obesity, and in this pilot study we aimed to test this hypothesis and establish optimal fibrosis stage cutoffs for EUS-SWE. This was a multicenter, cross-sectional study from prospectively collected data. Consecutive patients who underwent EUS-SWE with subsequent liver biopsy were included. EUS-SWE was compared to Fibrosis-4 Index (FIB-4) and VCTE. Area under the receiver operator characteristic (AUROC) curve analysis was performed, and 90% sensitivity and specific cutoffs were calculated to determine optimal cutoffs. 62 patients were included. Mean body mass index was 40.74kg/m2. EUS-SWE was superior to FIB-4 in discriminating significant fibrosis (F2; AUROC 0.87 vs 0.61, p<0.0048) and advanced fibrosis (F3; AUROC 0.93 vs 0.63 p<0.0001), but not cirrhosis (F4; AUROC 0.95 vs 0.81, p=0.099). EUS-SWE was superior to VCTE in predicting advanced fibrosis and cirrhosis (p=0.0067 and 0.0022 respectively). 90% sensitivity cutoffs for EUS-SWE were 7.50, 8.48, and 11.30 for F2-F4 respectively, and 90% specificity cutoffs were 9.82, 10.20, and 14.60 respectively. In this pilot study, EUS-SWE was superior to FIB-4 and VCTE for liver fibrosis staging in patients with MASLD and obesity (Clinical trial registration number: NCT05728697).

Association between triglyceride glucose-body mass index and the staging of non-alcoholic steatohepatitis and fibrosis in patients with non-alcoholic fatty liver disease

Objective The objective of this study was to thoroughly investigate the clinical value of triglyceride glucose-body mass index (TyG-BMI) in patients diagnosed with non-alcoholic fatty liver disease (NAFLD). Specifically, we aimed to determine its association with non-alcoholic steatohepatitis (NASH) and the progression of liver fibrosis. Methods The study included 393 patients diagnosed with NAFLD after liver biopsy. The patients were divided into two distinct cohorts: a training cohort (N = 320) and a validation cohort (N = 73). The training cohort was further divided into four groups based on TyG-BMI quartiles. The clinical characteristics of the patients in each group were compared in detail, and the association between TyG-BMI and NASH, NAFLD Activity Score (NAS) ≥ 4, at-risk NASH, significant fibrosis, advanced fibrosis, and cirrhosis was analyzed using multiple models. Additionally, we generated receiver operating characteristic (ROC) curves to evaluate the predictive ability of TyG-BMI for NASH and fibrosis staging in patients with NAFLD. Results Patients with higher TyG-BMI values had a significantly higher prevalence of NASH, NAS ≥ 4, at-risk NASH, significant fibrosis, advanced fibrosis, and cirrhosis (all p < .05). TyG-BMI was an independent predictor of these diseases in both unadjusted and adjusted models (all p < .05). ROC curve analysis further revealed the excellent performance of TyG-BMI in predicting NASH, NAS ≥ 4, at-risk NASH, significant fibrosis, advanced fibrosis, and cirrhosis. The validation cohort yielded analogous results. Furthermore, we constructed three multivariate models of TyG-BMI in conjunction with elastography metrics, which demonstrated elevated diagnostic AUC values of 0.782, 0.792, 0.794, 0.785, 0.834, and 0.845, respectively. Conclusion This study confirms a significant association between insulin resistance and NAFLD, including at-risk NASH and fibrosis staging, as assessed using the TyG-BMI index. TyG-BMI and its associated multivariate models can be valuable noninvasive indicators for NAFLD diagnosis, risk stratification, and disease course monitoring.

Prevalence and risk factors of significant fibrosis in chronic hepatitis B patients with concurrent metabolic dysfunction-associated steatotic liver disease

Introduction and objectivesSignificant fibrosis is an indicator of clinical intervention for both chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD). There remains a paucity of data regarding the clinical impact of biopsy-defined MASLD on significant fibrosis in CHB patients. The current study aims to elucidate whether patients with concomitant MASLD are at higher risk of significant fibrosis in patients with CHB. Patients and methodsThis retrospective research of two tertiary hospitals comprised 1818 patients between 2009 and 2021 with CHB and hepatic steatosis who had not received antiviral therapy. Pathologic findings by liver biopsy were contrasted between CHB group (n = 844) and CHB + MASLD (n = 974) group. METAVIR values of F≥2 were used to categorize significant fibrosis. ResultsPatients with CHB + MASLD had more significant fibrosis (35.5 % vs. 23.5 %, p < 0.001) than CHB group. The presence of MASLD [adjusted odds ratio (aOR) 2.055, 95 % confidence interval (CI) 1.635–2.584; p < 0.001] was strongly associated with significant fibrosis in all CHB patients. There was a trend for patients with more cardiometabolic risk factors (CMRFs) to have a higher prevalence of significant fibrosis: (25.7 % in CMRF1 subgroup v.s. 34.9 % in CMRF2 subgroup v.s. 53.7 % in CMRF≥ 3 subgroup, p < 0.001). Patients with CMRF≥3 had a three-fold higher significant fibrosis than those with just one CMRF. ConclusionsMASLD was associated with higher fibrosis stage in patients with CHB. Early detection and intervention are crucial to patients with three or more cardiometabolic risk factors.

Associations between cuprotosis-related genes and the spectrum of metabolic dysfunction-associated fatty liver disease: An exploratory study.

To explore the associations between cuprotosis-related genes (CRGs) across different stages of liver disease in metabolic dysfunction-associated fatty liver disease (MAFLD), including hepatocellular carcinoma (HCC). We analysed several bulk RNA sequencing datasets from patients with MAFLD (n = 331) and MAFLD-related HCC (n = 271) and two MAFLD single-cell RNA sequencing datasets. To investigate the associations between CRGs and MAFLD, we performed differential correlation, logistic regression and functional enrichment analyses. We also validated the findings in an independent Wenzhou PERSONS cohort of MAFLD patients (n = 656) used for a genome-wide association study (GWAS). GLS, GCSH and ATP7B genes showed significant differences across the MAFLD spectrum and were significantly associated with liver fibrosis stages. GLS was closely associated with fibrosis stages in patients with MAFLD and those with MAFLD-related HCC. GLS is predominantly expressed in monocytes and T cells in MAFLD. During the progression of metabolic dysfunction-associated fatty liver to metabolic-associated steatohepatitis, GLS expression in T cells decreased. GWAS revealed that multiple single nucleotide polymorphisms in GLS were associated with clinical indicators of MAFLD. GLS may contribute to liver inflammation and fibrosis in MAFLD mainly through cuprotosis and T-cell activation, promoting the progression of MAFLD to HCC. These findings suggest that cuprotosis may play a role in MAFLD progression, potentially providing new insights into MAFLD pathogenesis.

A combination model of CT-based radiomics and clinical biomarkers for staging liver fibrosis in the patients with chronic liver disease

A combined model was developed using contrast-enhanced CT-based radiomics features and clinical characteristics to predict liver fibrosis stages in patients with chronic liver disease (CLD). We retrospectively analyzed multiphase CT scans and biopsy-confirmed liver fibrosis. 160 CLD patients were randomly divided into 7:3 training/validation ratio. Clinical laboratory indicators associated with liver fibrosis were identified using Spearman's correlation and multivariate logistic regression correlation. Radiomic features were extracted after segmenting the entire liver from multiphase CT images. Feature dimensionality reduction was performed using RF-RFE, LASSO, and mRMR methods. Six radiomics-based models were developed in the training cohort of 112 patients. Internal validation was conducted on 48 randomly assigned patients. Receptor Operating Characteristic (ROC) curves and confusion matrices were constructed to evaluate model performance. The radiomics model exhibited robust performance, with AUC values of 0.810 to 1.000 for significant fibrosis, advanced fibrosis, and cirrhosis. The integrated clinical-radiomics model had superior diagnostic efficacy in the validation cohort, with AUC values of 0.836 to 0.997. Moreover, these models outperformed established biomarkers such as the aspartate aminotransferase to platelet ratio index (APRI) and the fibrosis 4 score (FIB-4), as well as the gamma glutamyl transpeptidase to platelet ratio (GPR), in predicting the fibrotic stages. The clinical-radiomics model holds considerable promise as a non-invasive diagnostic tool for the assessment and staging of liver fibrosis in the patients with CLD, potentially leading to better patient management and outcomes.

Diagnostic accuracy of vibration-controlled transient elastography for staging liver fibrosis in autoimmune liver diseases: A systematic review and meta-analysis.

The assessment of liver fibrosis is crucial for managing autoimmune liver diseases such as primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis (PSC). However, data on the efficacy of noninvasive tests for these diseases are limited. This meta-analysis evaluated the diagnostic accuracy of vibration-controlled transient elastography (VCTE) for staging fibrosis in patients with autoimmune liver disease. Searches were conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases to assess the diagnostic accuracy of VCTE against histology as the reference standard in adult patients with autoimmune liver disease. The summary area under the curve (sAUC) and diagnostic odds ratio were calculated for significant fibrosis (SF), advanced fibrosis (AF), and cirrhosis, according to liver biopsy. Fourteen articles were included, comprising 559 PBC patients from six studies, 388 AIH patients from five studies, and 151 PSC patients from three studies. VCTE demonstrated good performance for fibrosis staging in PBC, AIH, and PSC. In PBC, sAUCs of VCTE were 0.87, 0.89, and 0.99 for staging SF, AF, and cirrhosis, respectively. In AIH, the sAUCs were 0.88, 0.88, and 0.92, respectively, while in PSC, they were 0.88, 0.95, and 0.92, respectively. The cutoff values for AF were 7.5-17.9 kPa in PBC, 8.18-12.1 kPa in AIH, and 9.6 kPa in PSC. VCTE shows high diagnostic accuracy for staging liver fibrosis in patients with autoimmune liver diseases. This non-invasive method serves as a valuable tool for the evaluation and monitoring of fibrosis in these lifelong diseases.

Conditional deletion of CEACAM1 in hepatic stellate cells causes their activation

ObjectivesHepatic CEACAM1 expression declines with advanced hepatic fibrosis stage in patients with metabolic dysfunction-associated steatohepatitis (MASH). Global and hepatocyte-specific deletions of Ceacam1 impair insulin clearance to cause hepatic insulin resistance and steatosis. They also cause hepatic inflammation and fibrosis, a condition characterized by excessive collagen production from activated hepatic stellate cells (HSCs). Given the positive effect of PPARγ on CEACAM1 transcription and on HSCs quiescence, the current studies investigated whether CEACAM1 loss from HSCs causes their activation. MethodsWe examined whether lentiviral shRNA-mediated CEACAM1 donwregulation (KD-LX2) activates cultured human LX2 stellate cells. We also generated LratCre + Cc1fl/fl mutants with conditional Ceacam1 deletion in HSCs and characterized their MASH phenotype. Media transfer experiments were employed to examine whether media from mutant human and murine HSCs activate their wild-type counterparts. ResultsLratCre + Cc1fl/fl mutants displayed hepatic inflammation and fibrosis but without insulin resistance or hepatic steatosis. Their HSCs, like KD-LX2 cells, underwent myofibroblastic transformation and their media activated wild-type HSCs. This was inhibited by nicotinic acid treatment which blunted the release of IL-6 and fatty acids, both of which activate the epidermal growth factor receptor (EGFR) tyrosine kinase. Gefitinib inhibition of EGFR and its downstream NF-κB/IL-6/STAT3 inflammatory and MAPK-proliferation pathways also blunted HSCs activation in the absence of CEACAM1. ConclusionsLoss of CEACAM1 in HSCs provoked their myofibroblastic transformation in the absence of insulin resistance and hepatic steatosis. This response is mediated by autocrine HSCs activation of the EGFR pathway that amplifies inflammation and proliferation.

High Diagnostic Value of Transient Elastography for Advanced Fibrosis and Cirrhosis in Patients With Chronic Hepatitis Delta

Liver biopsy remains the gold standard for fibrosis staging in patients with chronic hepatitis delta (CHD). Here we comparatively evaluated the performance of transient elastography (TE) and biomarkers for the diagnosis of liver fibrosis in patients with CHD. 230 HDV-infected RNA-positive patients from various centers who underwent liver biopsy and liver stiffness measurements (LSM) using Fibroscan®, within a period of 6 months maximum, were investigated retrospectively. AUROC and Youden index were used to establish cut-off values of LSM. TE was compared with other noninvasive tests (NITs): APRI, Fibrosis-4 and Delta-4 fibrosis scores. Histologic fibrosis stage distribution was: 20.4% for F0-F1; 27.0% for F2; 18.7% for F3 and 33.9% for F4. TE demonstrated good diagnostic performance for detecting cirrhosis and advanced fibrosis with AUROC of 0.88 and 0.86, values, which were significantly higher than those obtained with the other NITs (P = .004 and P < .001). With a cutoff value >12 kPa for cirrhosis, sensitivity was 70.5%, specificity 86.2%, positive predictive value (PPV) 72.4% negative predictive value (NPV) 85.1% and accuracy 80.9%. Using 10.4 kPa as cut-off value for F3, sensitivity was 70.2%, specificity 83.5%, PPV 82.5%, NPV 71.7% and accuracy 76.5%. In 89% of patients with LSM ≤ 6.2 kPa, liver biopsy disclosed only absent or minimal fibrosis. TE demonstrated good diagnostic performance for advanced fibrosis and cirrhosis in CHD patients. Advanced fibrosis is highly probable for LSM values ≥10 kPa. LSM values < 6 kPa almost totally exclude significant fibrosis. Between 6 and 10 kPa, liver biopsy should be discussed.

Validation of Baveno VII criteria and other non-invasive diagnostic algorithms for clinically significant portal hypertension in hepatitis delta

Non-invasive tests (NITs) for clinically significant portal hypertension (CSPH) require validation in patients with hepatitis D virus (HDV)-related compensated advanced chronic liver disease (cACLD). Therefore, we aimed to validate existing NIT algorithms for CSPH in this context. Patients with HDV-cACLD (LSM ≥10kPa or histological METAVIR F3/F4 fibrosis) who underwent paired HVPG and NIT assessment at Medical University of Vienna or Hannover Medical School between 2013 and 2023 were retrospectively included. Liver stiffness measurement (LSM), von Willebrand factor to platelet count ratio (VITRO), and spleen stiffness measurement (SSM) were assessed. Individual CSPH risk was calculated according to previously published models (ANTICIPATE, 3P/5P). The diagnostic performance of Baveno VII criteria and refined algorithms (Baveno VII-VITRO, Baveno VII-SSM) was evaluated. The prognostic utility of NITs was investigated in the main cohort and an independent, multicenter, validation cohort. Fifty-one patients (HVPG ≥10mmHg/CSPH prevalence: 62.7%, varices: 42.2%) were included. Patients with CSPH had significantly higher LSM (25.8 [17.2-31.0] vs. 14.0 [10.5-19.8] kPa; p < 0.001), VITRO (n= 31, 3.5 [2.7-4.5] vs. 1.3 [0.6-2.0] %/[G/L]; p < 0.001), and SSM (n= 20, 53.8 [41.7-75.5] vs. 24.0 [17.0-33.9] kPa; p < 0.001). Composite CSPH risk models yielded excellent AUROCs (ANTICIPATE: 0.885, 3P: 0.903, 5P: 0.912). Baveno VII criteria ruled out CSPH with 100% sensitivity and ruled in CSPH with 84.2% specificity. The Baveno VII 'grey zone' (41.1%) was significantly reduced by Baveno VII-VITRO or Baveno VII-SSM algorithms, which maintained diagnostic accuracy. Hepatic decompensation within 2 years only occurred in patients who had CSPH or met Baveno VII rule-in criteria. The prognostic value of NITs was confirmed in the validation cohort comprising 92 patients. Standalone and composite NIT/diagnostic algorithms are useful for CSPH diagnosis in patients with HDV-cACLD. Thus, NITs may be applied to identify and prioritize patients with CSPH for novel antiviral treatments against chronic hepatitis D. Non-invasive tests (NITs) for clinically significant portal hypertension (CSPH) have been developed to identify patients with compensated advanced chronic liver disease (cACLD) at risk of decompensation, but conflicting data has been published regarding the accuracy of liver stiffness measurement (LSM) for the staging of fibrosis in patients infected with hepatitis D virus (HDV). In our study, including 51 patients with HDV-cACLD, LSM- and lab-based NITs yielded high AUROCs for CSPH. Moreover, only patients with CSPH or high non-invasively assessed CSPH risk were at risk of decompensation within 2 years, with the prognostic value of NITs confirmed in a validation cohort. Thus, NITs should be applied and updated in yearly intervals in clinical routine to identify patients with HDV-cACLD at short-term risk of clinical events; NITs may also guide prioritization for novel antiviral treatment options.

Orphan receptor GPR176 in hepatic stellate cells exerts a profibrotic role in chronic liver disease

Background & AimsChronic liver disease (CLD) remains a global health issue associated with a significant disease burden. Liver fibrosis, a hallmark of CLD, is characterised by the activation of hepatic stellate cells (HSCs) that gain profibrotic characteristics including increased production of extracellular matrix protein. Currently, no antifibrotic therapies are available clinically, in part because of the lack of HSC-specific drug targets. Here, we aimed to identify HSC-specific membrane proteins that can serve as targets for antifibrotic drug development. MethodsSmall interfering RNA-mediated knockdown of GPR176 was used to assess the in vitro function of GPR176 in HSCs and in precision cut liver slices (PCLS). The in vivo role of GPR176 was assessed using the carbon tetrachloride (CCl4) and common bile duct ligation (BDL) models in wild-type and GPR176 knockout mice. GPR176 in human CLD was assessed by immunohistochemistry of diseased human livers and RNA expression analysis in human primary HSCs and transcriptomic data sets. ResultsWe identified Gpr176, an orphan G-protein coupled receptor, as an HSC-enriched activation associated gene. In vitro, Gpr176 is strongly induced upon culture-induced and hepatocyte-damage-induced activation of primary HSCs. Knockdown of GPR176 in primary mouse HSCs or PCLS cultures resulted in reduced fibrogenic characteristics. Absence of GPR176 did not influence liver homeostasis, but Gpr176-/- mice developed less severe fibrosis in CCl4 and BDL fibrosis models. In humans, GPR176 expression was correlated with in vitro HSC activation and with fibrosis stage in patients with CLD. ConclusionsGPR176 is a functional protein during liver fibrosis and reducing its activity attenuates fibrogenesis. These results highlight the potential of GPR176 as an HSC-specific antifibrotic candidate to treat CLD. Impact and implicationsThe lack of effective antifibrotic drugs is partly attributed to the insufficient knowledge about the mechanisms involved in the development of liver fibrosis. We demonstrate that the G-protein coupled receptor GPR176 contributes to fibrosis development. Since GPR176 is specifically expressed on the membrane of activated hepatic stellate cells and is linked with fibrosis progression in humans, it opens new avenues for the development of targeted interventions.

The value of APGA score, fibrosis index for diagnosing liver fibrosis in patients with chronic hepatitis B.

Various non-invasive methods have been studied for assessing the fibrosis stage in patients with chronic hepatitis B. However, the performance of APGA, Fibrosis index in diagnosing liver fibrosis remains unclear globally and specifically in Vietnam. An analytical cross-sectional study was performed among 242 patients treated at Thong Nhat Hospital. Both the APGA index and Fibrosis index showed good accuracy in diagnosing significant fibrosis (≥ F2), advanced liver fibro-sis (≥ F3), and cirrhosis (F4) with an area under the curve (AUROC) greater than 0.7. AUROC value of APGA index, Fibrosis index for diagnosing signifcant fibrosis (≥ F2) were 0.828, 0.767 respectively. AUROC value of APGA index, Fibrosis index for diagnosing advanced liver fibrosis (≥ F3) were 0.784, 0.755 respectively. AUROC value of APGA index, Fibrosis index for diagnosing cirrhosis (F4) were 0.736, 0.782 respectively. APGA index and the Fibrosis index were significantly positively correlated with the fibrosis stage (p < 0.001), with the APGA index showing the strongest correlation (r = 0.51, p < 0.001). The APGA values of 6.23, 7.88, and 8.99 can serve as cutoff points for the diagnosis of significant fibrosis (≥F2), advanced fibrosis (≥F3), and cirrhosis (F4) when combined with ARFI data.

Serum level of full-length connective tissue growth factor reflects liver fibrosis stage in patients with Fontan-associated liver disease.

Chronic liver disease leads to liver fibrosis, and an accurate diagnosis of the fibrosis stage is crucial for medical management. Connective tissue growth factor (CTGF) is produced by endothelial cells and platelets and plays a central role in inducing fibrosis in various organs. In the present study, we tested the validity of measuring the serum levels of two types of CTGF to estimate the biopsy-confirmed liver fibrosis stage. We used two detection antibodies targeting the N- and C-terminal of CTGF to measure the serum levels of two forms of CTGF consisting of its full length and its N-terminal fragment. We analyzed the level of CTGF (via enzyme-linked immunosorbent assay) and the liver fibrosis stage in 38 patients with Fontan-associated liver disease (FALD) (26 cases of which were diagnosed pathologically). Correlations were determined by multivariate analysis and the area under the receiver operating characteristic curve. The 65 patients with nonalcoholic fatty liver disease (NAFLD) were included as a disease control group for examination. Full-length CTGF was significantly inversely correlated with liver fibrosis in patients with FALD. Although the platelet count was also associated with the liver fibrosis stage, full-length CTGF was more closely correlated with the fibrosis stage. Furthermore, the level of full-length CTGF was inversely associated with high central venous pressure. Conversely, the serum level of CTGF was not correlated with the fibrosis stage in NAFLD. The serum level of full-length CTGF may be useful for estimating the liver fibrosis stage in patients with FALD.

Molecular detection of Hepatitis C virus (HCV) genotypes and viral loads in chronic hcv infected patients in Kirkuk, Iraq

Abstract Background: Hepatitis C is a disease that has a significant global impact. The World Health Organization estimates that over 150 million people are chronically infected with the hepatitis C virus (HCV). Objectives: The purpose of the study was to make a quantitative determination of the hepatitis C viral load and genotype using real-time polymerase chain reaction (RT-PCR) and to determine how these factors relate to the HCV chronicity. Materials and Methods: A cross-sectional hospital-based study was carried out in Kirkuk city, Iraq. A total of 50 patients with chronic hepatitis C whose ages ranged from 20 to 75 years were the subjects of the study. The control group consisted of 30 apparently healthy persons admitted to the blood bank for blood donation. Five milliliters of blood were drawn for the molecular detection of HCV load and genotype by RT-PCR, detection of hepatitis C antibodies by enzyme-linked immunosorbent assay (ELISA), and biochemical analysis of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total serum bilirubin (TSB). Results: According to the research, 86% of chronic hepatitis C patients with ELISA-detected anti-HCV obtained positive PCR results. Statistically significant (P = 0.01). According to the study, more chronic hepatitis C patients (31 out of 43) had genotype 4 HCV than genotype 1a (27.91%). According to the study, genotype 4 chronic hepatitis C patients exhibited significantly higher viral loads than genotype 1a patients (1901.3 vs. 1693.41 IU/mL; P = 0.01). About 41.94% of men and 58.06% of females with chronic hepatitis C had genotype 4, whereas 33.3% of males and 66.67% of females had genotype 1a. Chronic hepatitis C patients had higher ALT, AST, ALP, and TSB levels than the control group, and the difference was very significant. ALT values were 64.69, 54.8, 285.5, and 4.33 mg/dL. This study found a connection between chronic hepatitis C viral load and ALT, AST, ALP, and TSB levels. Viral load rose as fibrosis progressed, according to this study. Patients without fibrosis had the lowest mean viral load (1235.5 IU/mL), followed by those with stage 1 fibrosis, whereas cirrhosis (stage 4) had the highest (2088.1 IU/mL). Non-fibrotic patients had the lowest virus burden. Conclusions: Genotype 4 of HCV was the most predominant genotype in Kirkuk city and there was a strong positive correlations of ALT and viral load with stages of fibrosis in patients with chronic hepatitis C.

RDW-SD is Superior to RDW-CV in Reflecting Liver Fibrosis Stage in Patients with Chronic Hepatitis B.

The clinical significance of the red blood cell distribution width (RDW)-coefficient of variation (RDW-CV) has been recognized in numerous diseases, but few studies have investigated the usefulness of RDW-standard deviation (RDW-SD). This study aimed to compare the utility of RDW-SD and RDW-CV in evaluating liver fibrosis stage in patients with chronic hepatitis B (CHB). In this retrospective study, we enrolled 720 treatment-naïve CHB patients and 578 healthy controls, and evaluated their clinical parameters. In CHB patients, the associations between RDW-CV and liver fibrosis stage were analyzed as compared to RDW-SD using one-way analysis of variance (ANOVA), Spearman's rank correlation, student's t-test, binary logistic regression, and receiver operating characteristic (ROC) curve. RDW-SD, rather than RDW-CV was significantly elevated in CHB patients compared with healthy controls. Correlation analysis showed a stronger association between RDW-SD and liver fibrosis stage than RDW-CV in CHB patients. RDW-CV and RDW-SD are both independent predictors of significant fibrosis. For the diagnosis of significant fibrosis, the area under the receiver operating characteristic curve (AUC) for RDW-CV was 0.599, while for RDW-SD, it was 0.706. RDW-to-platelet ratio (RPR), a novel index for liver fibrosis calculated as RDW-CV/platelet, exhibited an AUC of 0.730. This AUC increased to 0.752 when RDW-CV in the RPR formula was replaced with RDW-SD. Additionally, subgroup analyses based on age, gender, and HBeAg status showed that the AUC for RDW-SD in diagnosing significant fibrosis was significantly greater than that for RDW-CV, with statistically significant differences. RDW-SD showed superiority in reflecting liver fibrosis stage and diagnosing liver significant fibrosis than RDW-CV in treatment-naïve CHB patients.

SAT-501 - Metabolic profile reflects stages of fibrosis in patients with non-alcoholic fatty liver disease

SAT-501 - Metabolic profile reflects stages of fibrosis in patients with non-alcoholic fatty liver disease

FRI-360 - Elevated JAG1-NOTCH Signaling is Associated with Fibrosis Stages in Patients with PSC

FRI-360 - Elevated JAG1-NOTCH Signaling is Associated with Fibrosis Stages in Patients with PSC

Role of perfusion computed tomography for diagnostic intermediate stages of fibrosis in diffuse liver diseases: prospective study

INTRODUCTION: Despite the wide availability of the use of ultrasonic elastography to assess fibrosis in patients with diffuse liver diseases, this method didn’t have a high specificity for diagnosing intermediate stages of fibrosis.OBJECTIVE: To evaluate the diagnostic effectiveness of perfusion computed tomography (PCT) for detecting intermediate stages of fibrosis in patients with diffuse liver diseases.MATERIALS AND METHODS: PCT of the liver was performed in 73 patients (37 men, 36 women, mean age 47.2±4.4 years). All patients underwent a biochemical blood test, ultrasound elastography, PCT, based on the obtained biochemical blood test and instrumental data, the examined patients were divided into three groups depending on diffuse liver disease: hepatitis (n=25), cirrhosis (n=26), non-alcoholic inflammatory liver disease (n=22). Statistics: The results were processed using the Statistica 10.0 for Windows software package. Identification of the relationship between two quantitative variables that do not obey the normal distribution law was carried out using the Spearman rank correlation coefficient. To assess the diagnostic efficiency of perfusion parameters in patients with DLD, an ROC-analysis (Receiver Operating Characteristic Analysis) was performed. In all statistical analysis procedures, changes were considered statistically significant at a significance level of p&lt;0.05. RESULTS: BV correlated in all three groups of diseases with the elastography in patients with viral hepatitis — (r=–0.5; p&gt;&lt;0.04), in patients with alcoholic cirrhosis (r=0.66; p&gt;&lt;0.02), in patients with non-alcoholic inflammatory liver disease (r=–0.55; p&gt;&lt;0.02). In patients with alcoholic hepatitis — correlation between HAF and elastography index (r=0.98; p&gt;&lt;0.001), with viral hepatitis — HAF and elastography index (r=0.66; p&gt;&lt;0.01). MTT was statistically correlated with elastography index in patients in the alcoholic cirrhosis group (r=0.78; p&gt;&lt;0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p&gt;&lt;0.0001). DISCUSSION: PCT is able to differentiate between minimal and intermediate fibrosis, which accompany not only hepatitis, but also non-alcoholic fatty liver disease, whose diagnosis is very relevant, and the use of ultrasound elastography is limited. CONCLUSION: The BF promotes to the differentiation of intermediate stages of fibrosis, and in combination with ultrasonic elastography can provide a promising direction for the dynamic monitoring of the parenchyma in patients with diffuse liver diseases.&gt; p&lt;0.05.RESULTS: BV correlated in all three groups of diseases with the elastography in patients with viral hepatitis — (r=–0.5; p&lt;0.04), in patients with alcoholic cirrhosis (r=0.66; p&gt;&lt;0.02), in patients with non-alcoholic inflammatory liver disease (r=–0.55; p&lt;0.02). &gt;&lt;0.02). In patients with alcoholic hepatitis — correlation between HAF and elastography index (r=0.98; p&lt;0.001), with viral hepatitis — HAF and elastography index (r=0.66; p&gt;&lt;0.01). MTT was statistically correlated with elastography index in patients in the alcoholic cirrhosis group (r=0.78; p&lt;0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p&gt;&lt;0.0001). &gt;p&lt;0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p&lt;0.0001). &gt;&lt;0.0001).DISCUSSION: PCT is able to differentiate between minimal and intermediate fibrosis, which accompany not only hepatitis, but also non-alcoholic fatty liver disease, whose diagnosis is very relevant, and the use of ultrasound elastography is limited.CONCLUSION: The BF promotes to the differentiation of intermediate stages of fibrosis, and in combination with ultrasonic elastography can provide a promising direction for the dynamic monitoring of the parenchyma in patients with diffuse liver diseases.

Noninvasive diagnosis of liver fibrosis in schistosomiasis japonica: Opportunities and challenges

Noninvasive diagnosis of liver fibrosis in schistosomiasis japonica: Opportunities and challenges

Metabolic Profile Reflects Stages of Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide, with fibrosis stage being the main predictor for clinical outcomes. Here, we present the metabolic profile of NAFLD patients with regards to fibrosis progression. We included all consecutive new referrals for NAFLD services between 2011 and 2019. Demographic, anthropometric and clinical features and noninvasive markers of fibrosis were recorded at baseline and at follow-up. Significant and advanced fibrosis were defined using liver stiffness measurement (LSM) as LSM ≥ 8.1 kPa and LSM ≥ 12.1 kPa, respectively. Cirrhosis was diagnosed either histologically or clinically. Fast progressors of fibrosis were defined as those with delta stiffness ≥ 1.03 kPa/year (25% upper quartile of delta stiffness distribution). Targeted and untargeted metabolic profiles were analysed on fasting serum samples using Proton nuclear magnetic resonance (1H NMR). A total of 189 patients were included in the study; 111 (58.7%) underwent liver biopsy. Overall, 11.1% patients were diagnosed with cirrhosis, while 23.8% were classified as fast progressors. A combination of metabolites and lipoproteins could identify the fast fibrosis progressors (AUROC 0.788, 95% CI: 0.703-0.874, p < 0.001) and performed better than noninvasive markers. Specific metabolic profiles predict fibrosis progression in patients with nonalcoholic fatty liver disease. Algorithms combining metabolites and lipids could be integrated in the risk-stratification of these patients.

The Association Between Serum Hyaluronic Acid Levels and Routine Liver Function Tests in Liver Fibrotic HCV Patients

Abstract Introduction/Objective Liver fibrosis is the excessive accumulation of extracellular matrix proteins, including collagen, that occurs in most types of chronic liver diseases. Advanced liver fibrosis results in cirrhosis, liver failure, and portal hypertension and often requires liver transplantation. Markers (NIM) of Liver Fibrosis, such as hyaluronic acid, help evaluate the stage of fibrosis in patients with liver fibrosis. This study aims to investigate whether or not there is a correlation between serum hyaluronic acid levels and liver function tests in patients who suffer from chronic HCV-induced liver fibrosis. Methods/Case Report This study was conducted on 118 (60 males and 58 females) patients recruited from Internal Medicine Dept., Mansoura University Hospitals, Egypt. The patients were diagnosed with chronic HCV-induced liver fibrosis. Also, we included 50 healthy comparable control subjects (27 males and 23 females). Routine laboratory tests such as AST, ALT, albumin, total bilirubin, and platelets count were performed. The APRI was calculated as [AST/ (upper limits of normal)/ platelets count 109/L]×100. The AST-ALT ratio was calculated as [AST/ ALT]. According to the manufacturer's instructions, the serum levels of hyaluronic acid were measured by radioimmunoassay. Results (if a Case Study enter NA) We observed a statistically significant positive correlation was found between serum hyaluronic acid levels and APRI (r=0.3, p=0.001), ALT (r=0.3, p=0.003), AST (r=0.3 and p=0.01), and total bilirubin (r=0.3 and p=0.002). Furthermore, there was a statistically significant negative correlation between serum hyaluronic acid levels and albumin (r= -0.43, p=0.0001), and platelets count (r= -0.4, p=0.0001). Conclusion The levels of hyaluronic acid in the body and the results of other liver function tests tend to rise in tandem, which suggests a significant relationship between the two. This may assist us in constructing an accurate picture of the patient's condition, which will lead to a more precise diagnosis.