Liver Disease Subjects Research Articles

Iron depletion attenuates steatosis in a mouse model of non-alcoholic fatty liver disease: Role of iron-dependent pathways

Background & aimsIron has been proposed as influencing the progression of liver disease in subjects with non-alcoholic fatty liver disease (NAFLD). We have previously shown that, in the Hfe−/− mouse model of hemochromatosis, feeding of a high-calorie diet (HCD) leads to increased liver injury. In this study we investigated whether the feeding of an iron deficient/HCD to Hfe−/− mice influenced the development of NAFLD. MethodsLiver histology was assessed in Hfe−/− mice fed a standard iron-containing or iron-deficient diet plus or minus a HCD. Hepatic iron concentration, serum transferrin saturation and free fatty acid were measured. Expression of genes implicated in iron regulation and fatty liver disease was determined by quantitative real-time PCR (qRT-PCR). ResultsStandard iron/HCD-fed mice developed severe steatosis whereas NAS score was reduced in mice fed iron-deficient HCD. Mice fed iron-deficient HCD had lower liver weights, lower transferrin saturation and decreased ferroportin and hepcidin gene expression than HCD-fed mice. Serum non-esterified fatty acids were increased in iron-deficient HCD-fed mice compared with standard iron HCD. Expression analysis indicated that genes involved in fatty-acid binding and mTOR pathways were regulated by iron depletion. ConclusionsOur results indicate that decreasing iron intake attenuates the development of steatosis resulting from a high calorie diet. These results also suggest that human studies of agents that modify iron balance in patients with NAFLD should be revisited.

Factors Associated with Prognosis of Non-Alcoholic Fatty Liver Disease

Background: At the junction between obesity, metabolic syndrome and liver failure, lies Non-alcoholic fatty liver disease. Recent studies elaborated on role of metformin in patients with non-alcoholic fatty liver disease. This observation has not been studied at a global scale, neither it was investigated in different ethnical groups.
 Objectives: We aim at determining the risk factors associated with prognosis of non-alcoholic fatty liver disease among a cohort of patients in Southern West Bank, Palestine.
 Methods: A retrospective cohort study involving 300 NAFLD patients who visited the internal medicine department at Hebron Governmental Hospital from October 2017 till September 2018. Two hundred and three patients diagnosed with non-alcoholic fatty liver disease, were included in this study. Lab test results within the past 6 months, comorbidity and medication history were collected from patients` profiles. Data was analyzed using SPSS V20. Liver Fibrosis score was determined by using non-alcoholic fatty liver disease fibrosis score calculator.
 Results: Two hundred and three non-alcoholic fatty liver disease patients (58.6% females), 54.78 (±12.27) years old were included in the study. Almost 65.5% of these patients have BMI >30 Kg/m2. It was found that, 62.25% of the 58 diabetic patients in this study had liver fibrosis score > 0.676 comparing to non-alcoholic fatty liver disease patients who are non-diabetic. There was a significant relationship between diabetes and fibrosis score, α=0.000. There was also a significant relationship between hyperlipidemia and fibrosis score of non-alcoholic fatty liver disease patients, α=0.023. We found a significant relationship between fibrosis score and hypertension, α=0.000. In the same context, there was a significant relationship between NAFLD patients who were on statin therapy and those who were not using statin therapy, α= 0.015. Metformin was not associated with significant relationship between users and non-users non-alcoholic fatty liver disease subjects.
 Conclusion: Diabetes mellitus, hypertension, hyperlipidemia and statin use were associated with NAFLD prognosis.

Effect of angiotensin converting enzyme gene studies in nonalcoholic fatty liver disease subjects

Effect of angiotensin converting enzyme gene studies in nonalcoholic fatty liver disease subjects

Clinical and anthropometric characteristics of non-obese non-alcoholic fatty liver disease subjects in Japan.

The underlying mechanism of non-obese non-alcoholic fatty liver disease (NAFLD) has not been fully elucidated. We classified patients with NAFLD by sex and body mass index and compared their clinical features to clarify the background pathophysiology of non-obese NAFLD. A total of 404 patients with NAFLD were divided according to their body mass index (<25 [non-obese], 25 to <30 [obese], and ≥30 [severe obese]), and were further compared with 253 patients without obesity and NAFLD (non-NAFLD). The proportion of the individuals with non-obese NAFLD was 25.7% in men and 27.6% in women. The male and female non-obese NAFLD groups had lower skeletal muscle mass and muscle strength than the obese NAFLD groups. The visceral fat area, although low, was ≥100cm2 in 59.3% of men and 43.8% of women. An increase in liver fat accumulation, hepatic fibrosis, homeostasis model assessment of insulin resistance, and leptin levels was modest in the non-obese NAFLD group compared with a marked increase in the obese NAFLD groups. The muscle mass of the non-obese NAFLD group was similar to that of the non-NAFLD group, but muscle steatosis was particularly common among women. Multivariate analysis revealed that the factors contributing to increased liver fat accumulation in the non-obese NAFLD group were visceral fat area, HbA1c, myostatin, and leptin. In patients with non-obese NAFLD, a sex difference was observed in the clinical features. In addition to increased visceral fat, decreased muscle mass and muscle strength, muscle atrophy (presarcopenia), and impaired glucose tolerance were considered to be important pathophysiological factors.

Co-exposure to multi-walled carbon nanotube and lead ions aggravates hepatotoxicity of nonalcoholic fatty liver via inhibiting AMPK/PPARγ pathway.

Multi-walled carbon nanotubes (MWCNTs) have been widely used in sewage disposal, water purification, and disinfection. Co-exposure to MWCNTs and heavy metal ions is common during water disposal. However, the hepatotoxicity of co-exposure to MWCNTs and lead ions for nonalcoholic fatty liver disease (NAFLD) subjects has not been investigated. NAFLD mice were fed intragastrically with MWCNTs and lead acetate (PbAc). Combined administration of MWCNTs and PbAc significantly damaged the liver function, and aggravated the nonalcoholic steatohepatitis phenotype as well as the hepatic fibrosis and steatosis in NAFLD mice. Furthermore, MWCNTs and PbAc significantly induced apoptosis in primary hepatocytes isolated from NAFLD mice. Combined administration of MWCNTs and PbAc also resulted in hepatic lipid peroxidation by inducing antioxidant defense system dysfunction, and significantly enhanced the expression levels of inflammatory cytokines in NAFLD mice livers. Meanwhile, combined administration of MWCNTs and PbAc may exert its hepatotoxicity in the NAFLD via inhibiting the adenosine 5‘-monophosphate activated protein kinase (AMPK)/peroxisome proliferator-activated receptors γ (PPARγ) pathway. Taken together, we conclude that co-exposure to MWCNTs and PbAc can remarkably aggravate the hepatotoxicity in NAFLD mice via inhibiting the AMPK/PPARγ pathway. This study may provide a biosafety evaluation for the application of nanomaterials in wastewater treatment.

Immune System Response to Weight Loss among Obese Saudi Non-Alcoholic Fatty Liver Disease Subjects

Ninety obese Saudi individuals with NAFLD enrolled in our study, the range of the participants’ age was 42-53 years, where the range of BMI was 32-36 kg/m2. Participants were randomly assigned in group (A) received weight reducing program for 3 months, where group (B) received no intervention.

Comparison of Two Diagnostic Criteria for Hepatopulmonary Syndrome-High Prevalence in Biliary Atresia.

There is lack of clarity regarding the exact prevalence of hepatopulmonary syndrome (HPS) in pediatric liver diseases owing to lack of standardized diagnostic criteria. Thus, we aimed to do a comparative study of HPS with respect to its prevalence using the available diagnostic criteria. All consecutive children with biliary atresia (BA) and other chronic liver diseases (CLDs) were studied. Prevalence of HPS was compared using the 2 available criteria: demonstration of intrapulmonary vascular dilatation along with either alveolar-arterial oxygen difference (P [A-a] O2) on arterial blood gas analysis of more than 15 mmHg (criteria 1), or higher than age-appropriate calculated value for P (A-a) O2 (criteria 2). A total of 42 children in BA group and 62 in the non-BA CLD group were included. Using the criteria 1, the prevalence of HPS was 42.3%: 57.1% in the BA group and 32.2% in the CLD group, whereas using criteria 2, the prevalence was 48.1%: 61.9% in the BA group and 38.7% in the CLD group. Criteria 2 diagnosed 6 additional patients with HPS compared to criteria 1 (P value 0.405). BA subjects had higher risk (2.9-3 folds) of developing HPS compared to other CLDs. There is high prevalence of HPS in pediatric liver disease subjects. Age-appropriate formula for HPS diagnosis may be better applicable in pediatric population. BA subjects have a higher risk of developing HPS compared to other CLDs overall, irrespective of the severity of liver disease and/or portal hypertension.

Sequential Combination of FIB-4 Followed by M2BPGi Enhanced Diagnostic Performance for Advanced Hepatic Fibrosis in an Average Risk Population.

The fibrosis-4 (FIB-4) index is the most widely used estimated formula to screen for advanced hepatic fibrosis; however, it has a considerable intermediate zone. Here, we propose an algorithm to reduce the intermediate zone and improve the diagnostic performance of screening for advanced liver fibrosis by incorporating Mac-2-binding protein glycan isomer (M2BPGi) into a FIB-4 based screening strategy in an average risk group. Four-hundred eighty-eight healthy and chronic liver disease subjects were analyzed using a 1:1 propensity score matched for age and sex. Advanced liver fibrosis (≥F3) was defined by magnetic resonance elastography (MRE, ≥3.6 kPa). Classification tree analysis was employed to improve diagnostic performance using a combination of the FIB-4 index and M2BPGi. The median serum M2BPGi levels of healthy subjects, patients without advanced fibrosis, and those with the condition were 0.48, 0.94, and 2.93, respectively. The area under the receiver operating characteristic (AUROC) curve of M2BPGi (0.918) for advanced fibrosis was the highest compared to those of the FIB-4 index (0.887), APRI (0.873), and AST/ALT ratio (0.794). When M2BPGi was incorporated following the FIB-4 index, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 87.1%, 82.5%, 54.0%, and 96.4%, respectively. Moreover, 74.3% (133/179) of cases in the intermediate zone of the FIB-4 index avoided unnecessary referrals. Two-step pathway (FIB-4 followed by M2BPGi) could reduce unnecessary referrals and/or liver biopsies in an average-risk population.

Combined effect of n-3 fatty acids and phytosterol esters on alleviating hepatic steatosis in non-alcoholic fatty liver disease subjects: a double-blind placebo-controlled clinical trial.

The aim of this study was to investigate the combined effect of n-3 fatty acids (EPA and DHA, at an EPA:DHA ratio of 150:500) and phytosterol esters (PS) on non-alcoholic fatty liver disease (NAFLD) patients. We conducted a randomised, double-blind, placebo-controlled trial. Ninety-six NAFLD subjects were randomly assigned to the following groups: the PS group (receiving 3·3 g/d PS); the FO group (receiving 450 mg EPA + 1500 mg DHA/d); the PS + FO combination group (receiving 3·3 g/d PS and 450 mg EPA + 1500 mg DHA/d) and the PO group (a placebo group). The baseline clinical characteristics of the four groups were similar. The primary outcome was liver:spleen attenuation ratio (L:S ratio). The percentage increase in liver-spleen attenuation (≤1) in the PS + FO group was 36 % (P = 0·083), higher than those in the other three groups (PS group, 11 %, P = 0·519; FO group, 18 %, P = 0·071; PO group, 15 %, P = 0·436). Compared with baseline, transforming growth factor-β (TGF-β) was significantly decreased in the three study groups at the end of the trial (PS, P = 0·000; FO, P = 0·002; PS + FO, P = 0·001) and TNF-α was significantly decreased in the FO group (P = 0·036), PS + FO group (P = 0·005) and PO group (P = 0·032) at the end of the intervention. Notably, TGF-β was reduced significantly more in the PS + FO group than in the PO group (P = 0·032). The TAG and total cholesterol levels of the PS + FO group were reduced by 11·57 and 9·55 %, respectively. In conclusion, co-supplementation of PS and EPA + DHA could increase the effectiveness of treatment for hepatic steatosis.

Natural history, risk factors, and outcome of hepatopulmonary syndrome in pediatric liver diseases.

Limited pediatric literature is available regarding hepatopulmonary syndrome (HPS) especially in subjects with biliary atresia (BA) despite its proven prognostic significance. Thus, we aimed to study the natural history, risk factors, and outcome of HPS in BA and other chronic liver disease (CLD) subjects. All children (BA and other non-BA CLDs) older than 6months of age were included in the study. HPS was diagnosed on the basis of standard international criteria. Also, fractional exhaled nitric oxide (FeNO) was measured at baseline. During the study period from January 2017 to December 2018, there were 42 children in BA and 62 in the CLD group. The overall prevalence of HPS was 42.3%: 57.1% in the BA group and 32.2% in the CLD group. Median age at HPS diagnosis was 14.4months and 90months in the BA and non-BA CLD groups, respectively. By the end of study period, the prevalence of HPS in the BA group further increased to 73.8% at 0.7% per month. Lower serum albumin (p < 0.05) in BA and higher splenic Z scores (p 0.013) in other CLDs were found to be significant risk factors for HPS. FeNO measurement did not reach diagnostic significance. Prevalence of HPS is higher and also develops at an earlier age in the BA group compared to other CLDs. Also, risk of HPS development increases with increasing disease duration in BA. Lower serum albumin in BA and higher splenic Z scores in other CLDs may predict risk for HPS development.

Association between triglyceride glucose-body mass index and risk factors linked to non-alcoholic liver disease in subjects with metabolic syndrome

AbstractIntroductionNon-alcoholic fatty liver disease (NAFLD) is a chronic liver condition, whose prevalence increases in parallel with obesity, diabetes and metabolic syndrome (MetS) rates. The aim of the study was to investigate the relationships between the triglyceride glucose-body mass index (TyG-BMI) with lifestyle, dietary variables, and metabolic risk factors linked to NAFLD in subjects diagnosed with MetS.Materials and methodsA baseline cross-sectional study on 331 participants (aged 65.8 ± 5.1 years) recruited in Navarra was conducted. Subjects were stratified by tertiles of the TyG-BMI index. Dietetic, Mediterranean diet adherence (MedDiet-17 points) and physical activity data were assessed through validated questionnaires. Sociodemographic, lifestyle, anthropometric and biochemical parameters were also recoreded. The Cockcroft-Gault equation was performed to estimate clearance of creatinine. For comparisons between TyG-BMI tertiles and several variables, ANCOVA and chi-square test analyses were performed.ResultsSubjects in T3 of TyG-BMI index were more likely to have diabetes (50.9%). Interestingly, physical activity decreases across tertiles (p = 0.030). There were no differences between tertiles in energy intake and MedDiet adherence. However, total meat consumption is highest in T3. ANCOVA test after adjustment for potential confounders revealed that participants in T3 showed more several clinical and metabolic alterations. Moreover, ALT (p = 0.002) and GGT (p = 0.047) levels increased and mean corpuscular volume decreased across tertiles of the TyG-BMI index.DiscussionObesity, MetS and insulin resistance (IR) play a key role in the development of NAFLD promoting lipotoxicity and overproduction of proinflammatory mediators. This state induces hepatic steatosis and liver injury. Some studies suggest TyG-BMI index as a surrogate marker of IR and risk to NAFLD(1). In our study, patients in the highest TyG-BMI tertile showed more adverse cardio-metabolic profile, lower physical activity and higher total meat intake. In summary, the TyG-BMI index could be a simple and reliable marker to characterize the risk of NAFLD among individuals diagnosed with MetS.

Association of liver biomarkers and cytokeratin-18 in Nonalcoholic fatty liver disease patients.

Objective:To investigate the association of gold standard liver biomarkers with serum cytokeratin 18 (CK18), serum Alanine aminotransferase (ALT) and serum aspartate (AST).Methods:This was cross sectional study. It was conducted at Mayo Hospital from January 2016 to December 2017. It comprised of 148 non-alcoholic fatty liver disease subjects of age 40-60 years. After written informed consent, study anthropometric measurements (age, height, waist circumference and hip circumference) were taken and serum AST, ALT and CK-18 were estimated by sandwiched ELISA technique. Data was analyzed using SPSS 21.0. Descriptive were presented as mean and standard deviation. Association between CK18, serum AST and ALT were analyzed by regression analysis and are presented as beta coefficient. P-value ≤ 0.05 was taken as significant.Results:Study comprised of 148 subjects with mean age 44.81±6.2. Of total population 29.1% were male and 70.9% were female. Significant positive association of CK18 was found with serum ALT (P-value 0.005*). However, no association was found between AST and serum CK18. (P-value 0.29).Conclusion:Significant positive association was found between Serum CK18 and serum ALT.

Insulin resistance and plasma glucose tolerance abnormalities in Nigerians with chronic liver disease

AimsGlucose tolerance abnormalities are frequently observed in patients with chronic liver disease (CLD). Insulin resistance (IR) has been suggested to be a major factor responsible for these abnormalities in CLD. However studies relating IR with severity of CLD are scarce in Nigeria. This study assessed insulin resistance and glucose tolerance abnormalities in CLD and their relationship with the severity of CLD in a tertiary hospital in South-West, Nigeria. MethodsThis cross sectional study involved 100 subjects with CLD. Ethical clearance was obtained and informed consent was granted by participants. Participants were interviewed using a structured proforma; physical examination and relevant investigations were performed. Insulin resistance was measured using the homeostasis model assessment (HOMA-IR) Data was analysed using Statistical Package for Social Sciences version 20.0 and p value of <0.05 was considered significant. ResultsMean age of the study participants was 51.9 ± 11.9 years, and mean duration of CLD was 15.9 ± 5.8 months. Glucose tolerance abnormalities were present in 66 subjects (66%) and increased from 16.1% in Child Pugh's class A to 90.0% in class C.HOMA-IR positively correlated with age, body mass index, serum blood glucose, duration and severity of CLD. Increasing age, presence of hepatocellular carcinoma, Child Pugh's class B and class C were associated with glucose tolerance abnormalities. ConclusionGlucose tolerance abnormalities and insulin resistance were highly prevalent among chronic liver disease subjects studied and seemed to parallel the severity of CLD, determined by the Child Pugh's score.

THU-019-Impact of metabolic stress on the pathogenesis of autoimmune liver disease in subjects bearing missense variant of negative immune regulator Lnk/Sh2b3

THU-019-Impact of metabolic stress on the pathogenesis of autoimmune liver disease in subjects bearing missense variant of negative immune regulator Lnk/Sh2b3

Comparison of the Prevalence of Metabolic Disease Between Two Types of Urbanization in China.

Objective: China is experiencing the world's largest urbanization. There are two primary types of urbanization in China: rural-to-urban migration and in situ urbanization, represented by Zhejiang Shangyu (SY) and Jiangsu Nanjing (NJ), respectively. Our aim is to compare changes in the prevalence of metabolic disease between these two types of urbanization in China.Methods: This is a cross-sectional study derived from the SPECT-China 2014 study. This study includes subjects and metabolic parameters from SY and NJ. Furthermore, biochemical and anthropometric indexes were taken into consideration and compared between the areas of interest.Results: The prevalence rates of diabetes, prediabetes and healthy subjects were 6.5, 17.9, and 75.7% in SY and 16.0, 31.0, and 53.0% in NJ, respectively. Industrial and agricultural jobs accounted for 77.9% and 32.0% of employment in SY and NJ, respectively. Fasting plasma glucose (FPG) was higher in SY than in NJ; however, HbA1c was lower in SY than in NJ. There was a significant difference in nonalcoholic fatty liver disease (NAFLD) and healthy subjects between SY and NJ (P < 0.05). Significant differences were also found with respect to body mass index (BMI), waist circumference (WC) and hip circumference (HC) between these two locations (P < 0.001). Logistic regression analysis revealed that the prevalence of prediabetes, diabetes, overweight, obesity and dyslipidemia was higher in NJ than in SY.Conclusions: In situ urbanization has notably changed occupational distribution. The prevalence rates of diabetes, obesity, and NAFLD were increased in rapidly urbanized areas. Thus, more attention should be paid to rapidly urbanizing areas to reduce the prevalence of metabolic disease.

Risk factors for developing liver cancer in people with and without liver disease.

BackgroundThe National Liver Cancer Surveillance Program (NLCSP) targets patients with liver diseases that lead to liver cancer in South Korea. This study aimed to investigate the risk of liver disease leading to liver cancer using nationally representative data to establish an efficient NLCSP.MethodsThis study used data from the National Health Insurance Service National Sample Cohort (NHIS-NSC) from 2002 to 2013. A retrospective matched cohort design was applied to compare the development of liver cancer in patients with and without liver disease. Cox- proportional hazard regression for liver cancer with competing risk of death was performed for all subjects or each group stratified according to age or income level.ResultsA total of 66,192 patients with liver disease and matched subjects without liver disease were included in the study. The incidences of liver cancer among patients with and without liver disease within a median 8-year follow-up period were 2.68% (n = 1,772) and 0.34% (n = 210), respectively. Cox- regression analysis for liver cancer incidence indicated that cirrhosis had the highest risk (hazard ratio [HR]: 18.13, 95% confidence interval [CI]: 15.24–21.58), followed by hepatitis B (HR: 9.32, 95% CI: 8.00–10.85). Subgroup analysis showed that the presence of liver disease was an important risk factor in younger as well as elderly people, and a higher risk of liver disease was also observed in the patients with Medicaid.ConclusionsAttention should be paid to the development of liver cancer in young people under 50 years old and preventive efforts to decrease the incidence of liver cancer among Medicaid recipients is needed.

Factors influencing on health-related quality of life in South Korean with chronic liver disease

BackgroundThe objective of this study was to determine health-related quality of life (HRQoL) among chronic liver disease (CLD) subjects in South Korea using EuroQol five-dimension questionnaire (EQ-5D).MethodThe sample consisted of 139 subjects with CLD from the sixth Korean National Health and Nutrition Examination Survey (KNHNES VI). Data were analyzed using SPSS program for descriptive statistics, t-test, ANOVA, Scheffe’s test and hierarchical multiple regression.ResultsResults indicated that marital status (P < 0.01), occupation (P < 0.01), basic livelihood security recipient status (P < 0.05), hepatocellular carcinoma (P < 0.05), subjective health status (P < 0.01), and depression (P < 0.001) were significant predictors of HRQoL. Health behaviors (alcohol intake, sleep duration) variables were insignificant.ConclusionIn conclusion, marital status, occupation, basic livelihood security recipient status (BLSRS), hepatocellular carcinoma (HCC), subjective health status (SHS), and depression were confirmed to be factors affecting the HRQoL. We should be provide to continuous monitoring and education of adequate alcohol intake for patients with CLD. Findings of this study might be used to develop community based health programs and policies for CLD.

Variation in the Plasma Levels of Polyunsaturated Fatty Acids in Control vis-à-vis Nonalcoholic Fatty Liver Disease Subjects and Its Possible Association with Gut Microbiome.

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are becoming a major cause of chronic liver diseases globally. Polyunsaturated fatty acids (PUFA) have been postulated as a potential treatment for NAFLD. They can be obtained from diet and are also endogenously synthesized by enzymes delta-6-desaturase (D6D), delta-5-desaturase, and elongases. The current study is aimed at investigating the differences in the intake and levels of plasma PUFA between NAFLD patients and controls in Asian Indians. This correlation further propelled a pilot study to check for the differences in the gut microbiome of NASH subjects versus controls. One hundred forty-seven subjects were recruited and were grouped into healthy controls and cases. Subjects filled a food frequency questionnaire to assess PUFA intake. Plasma samples were subjected to gas chromatography analysis. For characterizing the gut microbiome, fecal samples of 20 NASH and healthy controls were analyzed by 16s rRNA gene sequencing. Alpha and beta diversity metrics and taxonomic analysis were carried out. Plasma levels of eicosapentaenoic acid, γ-linoleic acid and D6D enzyme activity were significantly lower in cases. Dietary intake of total n-6 and n-3 PUFA did not differ between the two groups. Relative abundance of Streptococcus and Clostridium ramosum was significantly higher in NASH patients compared with healthy controls. This study demonstrates, for the first time, decreased D6D enzyme activity and plasma PUFA levels in NAFLD patients. Furthermore, it demonstrates gut dysbiosis in histologically proven NASH patients vis-à-vis healthy controls.

Sa1878 - Local and Exogenous Cytokines Contribute to the Visceral Adipose (VAT) Derived Inflammatory Cascade Observed in Obese Non-Alcoholic Liver Disease (NAFLD) Subjects

Sa1878 - Local and Exogenous Cytokines Contribute to the Visceral Adipose (VAT) Derived Inflammatory Cascade Observed in Obese Non-Alcoholic Liver Disease (NAFLD) Subjects

Tu1465 - Health Factors Predictive of One Year Follow-up Completion in Chronic Liver Disease (CLD) Subjects

Tu1465 - Health Factors Predictive of One Year Follow-up Completion in Chronic Liver Disease (CLD) Subjects