Liver Fibrosis Score In Patients Research Articles

Diagnostic performance of non-invasive liver fibrosis scores in patients with early-intermediate hepatocellular carcinoma

PurposeHepatocellular carcinoma (HCC) arises in individuals with underlying liver disease. Diagnosing the degree of hepatic fibrosis helps to determine the severity of the underlying liver disease and may influence therapeutic decisions in HCC patients. Non-invasive fibrosis scores can be used to estimate the degree of fibrosis in liver disease patients, but most of these scores were developed in patients with viral hepatitis and without HCC. This study explored the ability of the Fibrosis-4 Index (FIB-4), the AST/Platelet Ratio Index (APRI), and the AST/ALT ratio to diagnose or exclude advanced fibrosis (METAVIR F3/4 versus F0-2) in patients with early-intermediate, potentially resectable HCC.MethodsWe retrospectively reviewed 119 patients who underwent hepatic resection for HCC at a tertiary centre (2007–2019), 75 of whom had advanced fibrosis (prevalence 63%). Histological assessment of the surgical liver specimen was used as a reference standard for the degree of fibrosis.ResultsOverall diagnostic performance was highest for the FIB-4 Index, with an area under the receiver operating characteristic curve (AUROC) of 0.82, compared with 0.78 for APRI, and 0.56 for the AST/ALT ratio. Using established cut-off values, FIB-4 achieved a 90% positive predictive value at the higher cut-off (3.25) and a 90% negative predictive value at the lower cut-off (1.45).ConclusionThe FIB-4 Index could reliably diagnose or exclude advanced fibrosis in patients with early-intermediate HCC, and may thus have a role in guiding therapeutic decisions in these patients.

Liver Fibrosis Scores as Predictors of Long-term Outcomes in Patients with ST-segment Elevation Myocardial Infarction

Background: Liver fibrosis scores (LFSs) are novel tools for predicting cardiovascular events in patients with coronary artery disease. This study was aimed at examining the prognostic value of LFSs in patients with ST-segment elevation myocardial infarction (STEMI). Methods: Between 2015 and 2019, 866 patients diagnosed with STEMI were consecutively enrolled. The definition of major cardiovascular events (MACEs) was all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, and acute limb ischemia. We evaluated the predictive values of LFSs for MACEs with receiver operating characteristic (ROC) curve and restricted cubic spline (RCS) analysis. Kaplan-Meier (K-M) analysis was conducted to explore the relationship between LFSs and MACEs. Results: During a median follow-up of 4 years, 155 MACEs were observed. K-M analysis of MACEs revealed significantly lower event-free survival rates in patients with intermediate or high, rather than low, NFS, FIB-4, BARD, and Forns scores. The multivariable-adjusted hazard ratios (95% CI) for MACEs in patients with high versus low risk scores were 1.343 (0.822–2.197) for NFS, 1.922 (1.085–3.405) for FIB-4, 2.395 (1.115–5.142) for BARD, and 2.271 (1.250–4.125) for Forns. The ROC curve indicated that the predictive ability for MACEs was non significantly improved by addition of the NFS (AUC = 0.7274), FIB-4 (AUC = 0.7199), BARD (AUC = 0.7235), and Forns (AUC = 0.7376) scores into the basic model (AUC = 0.7181). RCS revealed a tendency toward a nonlinear positive association of MACEs with NFS, FIB-4, and particularly Forns scores. Conclusion: LFSs have potential utility for predicting adverse outcomes in patients with STEMI, thus indicating the importance of managing metabolic dysregulation.

Association between Major Adverse Cardiovascular Events and the Liver Fibrosis Score in Patients with and without Coronary Artery Disease: From the FU-CCTA Registry.

The liver fibrosis score reflects the degree of hepatic scarring and has been reported to be associated with cardiovascular disease. Using a coronary artery computed tomography angiography registry at the Fukuoka University Hospital (FU-CCTA registry), we investigated the association between major adverse cardiovascular events (MACEs) and the liver fibrosis score (fibrosis-4 index (FIB-4I)) in 612 patients who underwent CCTA to screen for coronary artery disease and performed a prognosis survey for up to 5 years. The primary endpoint was MACEs (all-cause mortality, acute myocardial infarction, ischemic stroke, coronary revascularization). FIB-4I in all patients and in patients with hypertension (HTN) was significantly higher in the MACE group than in the non-MACE group. The event-free survival rate of MACEs targeting only patients with HTN was significantly lower in patients with a high risk of liver fibrosis (FIB-4I values of 2.67 or higher) than in those with a low or intermediate risk (less than 2.67). However, no significant difference was observed in all patients or in patients without HTN. Finally, FIB-4I and body mass index were independent factors associated with MACEs in patients with HTN. In conclusion, the liver fibrosis score may be an independent predictor of MACEs in hypertensive patients undergoing CCTA.

Prognostic implication of liver fibrosis scores in patients with non-ischemic dilated cardiomyopathy.

Liver fibrosis was associated with adverse outcomes in various cardiovascular diseases. The current risk stratification of non-ischemic dilated cardiomyopathy (NIDCM) still largely depends on the left ventricular ejection fraction (LVEF). At present, the relationship between liver fibrosis and prognosis in patients with NIDCM remains blank. A total of 433 NIDCM patients were analysed in this study. Liver fibrosis was assessed by three liver fibrosis scores (LFS), including aspartate aminotransferase to platelet ratio index (APRI), aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT ratio), and gamma-glutamyltransferase to platelet ratio (GPR). The primary endpoint was defined as all-cause mortality or heart transplantation (ACM/HTx). During a median follow-up period of 1.7 years, 140 ACM/HTx events occurred. Positive associations were observed between LFS and ACM/HTx. Patients with elevated APRI, AST/ALT ratio, and GPR scores exhibited increased ACM/HTx (all P < 0.05). Intermediate-to-high APRI [hazard ratio (HR) 1.66, 95%CI 1.06-2.61, P = 0.027], AST/ALT ratio (HR 1.59, 95%CI 1.07-2.36, P = 0.021), and GPR (HR 1.64, 95%CI 1.11-2.42, P = 0.013) were independently associated with increased risk of ACM/HTx, even after adjusting for LVEF and other covariates. The positive relationship remains consistent across different subgroups, including those with diabetes and obesity. Elevated liver fibrosis scores were associated with a worse outcome beyond LVEF in patients with NIDCM, which may provide additional prognostic value in the management of NIDCM.

Роль вітаміну D у розвитку, перебігу та лікуванні артеріальної гіпертензії

The literature review considers the new universal molecule empagliflozin, which managed to change the glucose‑centric approach in endocrinology to an organoprotective one. The results of the pivotal clinical trials conducted with empagliflozin (EMPA‑REG‑OUTCOME, EMPEROR‑REDUCED, EMPEROR‑PRESERVED and EMPULSE) strongly support the ability of empagliflozin to reduce rates of cardiovascular death or hospitalization for heart failure and to slow down the progression of chronic kidney disease. Among the confirmed and potentially favorable metabolic consequences of empagliflozin administration, the following should be emphasized: a selective antihyperglycemic effect only in conditions of hyperglycemia/glucosuria, which does not depend either on insulin production or sensitivity of peripheral tissues to insulin but is limited only by the glomerular filtration rate. This effect allows avoiding hypoglycemia even in patients without diabetes. The drug is one of the most durable among oral hypoglycemic agents and allows to maintain the achieved HbA1c values for 6 — 8 years, delaying the initiation of insulin therapy in patients with type 2 diabetes mellitus. Empagliflozin was superior to placebo in preventing death from cardiovascular disease, nonfatal myocardial infarction, or nonfatal stroke in patients with type 2 diabetes mellitus. This effect resulted from the significant reduction in the risk of cardiovascular mortality without significant changes in nonfatal myocardial infarction or nonfatal stroke. Combination with other oral and injectable hypoglycemic drugs is possible. In case of combination with sulfonylurea drugs or insulin, the dose of the latter needs to be adjusted in the direction of its decrease. Weight loss of up to 2 — 3 kg against the background of empagliflozin is an expected phenomenon that can modify blood pressure indicators and insulin resistance. Empagliflozin has the ability to reduce steatosis and improve liver fibrosis scores in patients with NAFLD without type 2 diabetes mellitus.&#x0D;

Metabolic dysfunction-associated fatty liver disease and liver fibrosis score in patients with COVID-19 as predictors of adverse clinical outcomes: an artificial intelligent application through machine learning

Introduction and aims. Patients with coronavirus disease-2019 (COVID-19) and metabolic-dysfunction associated fatty liver disease (MAFLD) appear to be at higher risk for severe manifestations like acute respiratory distress syndrome, especially in the youngest decades. Our aim was to examine whether patients with imaging-defined MAFLD and/or with increased non-invasive liver fibrosis scores (FIB-4) are at higher risk for severe illness from COVID-19, using a machine learning model.

Combination antiretroviral therapy is associated with reduction in liver fibrosis scores in patients with HIV and HBV co-infection

BackgroundLiver fibrosis is common in individuals with HIV/HBV co-infection, but whether cART could reverses liver fibrosis is unclear.MethodsThis was a retrospective observational study. Binary logistic regression was used to assess predictors of liver fibrosis in individuals with HIV/HBV co-infection. Comparison of FIB-4 scores before and after cART were compared using X2 test and t test.ResultsFour hundred and fifty-eight individuals with HIV/HBV co-infection were included in this study. It was found that cART (HR 0.016, 95% CI: 0.009–0.136; P < 0.001) was one of protection factors to against liver fibrosis. Forty individuals who had normal levels of ALT, AST and PLT during the whole course of diseases were stratified into FIB-4 < 1.45 (n = 14), 1.45 ≤ FIB-4 ≤ 3.25 (n = 19) and FIB-4 > 3.25 (n = 7) groups by their FIB-4 scores before cART. In 1.45 ≤ FIB-4 ≤ 3.25 group, 57.9%(11/19) of the individuals dropped to FIB-4 < 1.45 group by cART; in FIB-4 > 3.25 group, 85.7%(6/79) dropped to 1.45 ≤ FIB-4 ≤ 3.25 group, while 14.3%(1/7) dropped to FIB-4 < 1.45 group. In cART-naive group, 1 year, 2–5 years and 5–10 years post-cART groups, FIB-4 scores were 4.29 ± 0.43, 3.63 ± 0.38, 2.90 ± 0.36 and 2.52 ± 0.38, respectively (P = 0.034); and the incidence of liver fibrosis were 7.38%(104/141), 63.6%(98/154), 60.8%(62/102) and 47.5%(29/61), respectively (P = 0.004).ConclusioncART was associated with decreased FIB-4 scores and the benefit of cART in reversing liver fibrosis can sustain for a decade in patients with HIV/HBV co-infection.

Re-Print Non-Aspirin Nsaids Use is Associated with Lowering of Liver Fibrosis Scores in Patients with Fatty Liver Disease

Only a few studies are available with appropriate data on the effects of non-aspirin, non-steroidal anti-inflammatory drugs (NSAID’s) use in patients with fatty liver disease. We performed a retrospective study of 1347 patients with imaging studies that showed fatty liver disease from 2016 through 2019. Then we determined the change in validated indices using Fibrosis-4 (FIB4) and NAFLD fibrosis score (NFS). Patient’s clinical information, including NSAID’s use, was collected at baseline and then yearly. Using generalized linear model, we estimated the association between the non-aspirin NSAID’s use and change in the baseline indices. Non-aspirin NSAID’s use was found to be associated with significant lowering of FIB-4 score (0.596 units lower, p-value &lt;0.0001) and NFS score (0.431 units lower, p-value 0.0027) every year. In this retrospective study of patients with fatty liver disease found on imaging, non-aspirin NSAID’s use was associated with lowering of fibrotic scores, suggesting that non- aspirin containing NSAID’s use might be associated with a lower risk for advanced fibrosis in patients with fatty liver disease. Summary: Non-aspirin NSAID’s use is associated with lowering of hepatic fibrosis scores in patients with fatty liver disease.

Non-aspirin NSAIDs use is associated with lowering of liver fibrosis scores in patients with fatty liver disease

Only a few studies are available with appropriate data on the effects of non-aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) use in patients with fatty liver disease. We performed a retrospective study of 1347 patients with imaging studies that showed fatty liver disease from 2016 through 2019. We then determined the change in validated indices using Fibrosis-4 (FIB4) and NAFLD fibrosis score (NFS). Patient clinical information, including NSAIDs use, was collected at baseline and then yearly. Using generalized linear models, we estimated the association between non-aspirin NSAIDs use and change in baseline indices. Non-aspirin NSAIDs use was found to be associated with significant lowering of FIB-4 score (0.596 units lower, p-value &lt;0.0001) and NFS (0.431 units lower, p-value 0.0027) every year. In this retrospective study of patients with fatty liver disease found on imaging, non-aspirin NSAID use was associated with lowering of fibrosis scores, suggesting that NSAID use might be associated with a lower risk for advanced fibrosis in fatty liver disease.

Non-aspirin NSAIDs use is associated with lowering of liver fibrosis scores in patients with fatty liver disease

Non-aspirin NSAIDs use is associated with lowering of liver fibrosis scores in patients with fatty liver disease

Cytokines, paraoxonase-1, periostin and non-invasive liver fibrosis scores in patients with non-alcoholic fatty liver disease and persistently elevated aminotransferases: A pilot study.

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. The aim of this study was to evaluate the possible association between paraoxonase-1 (PON1), periostin (POSTN), tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10 serum concentration with non-invasive liver fibrosis scores, in a cohort of patients with NAFLD. We studied a cohort of 52 patients diagnosed with NAFLD. The NAFLD fibrosis score (NFS), Fibrosis-4 Index (FIB-4), AST to platelet ratio index (APRI) and BARD scores were calculated for each patient. We determined the PON1, POSTN, TNF-α, IL-6, and IL-10 serum values using ELISA kits. There was no correlation between PON1 or POSTN serum levels and non-invasive liver fibrosis. The TNF-α serum values were independently associated with the liver fibrosis scores (P=0.02 for NFS and P=0.002 for FIB-4). Age and metabolic syndrome were also independently linked to the fibrosis scores. In conclusion, serum levels of TNF-α, age and metabolic syndrome were associated with the non-invasive liver fibrosis scores.

Short-term orlistat therapy improves fatty infiltration indices and liver fibrosis scores in patients with non-alcoholic fatty liver disease and metabolic syndrome

Background and study aimsPatients with non-alcoholic fatty liver disease (NAFLD) exhibit features of metabolic syndrome, including a high body mass index, central obesity, high blood pressure, and abnormal lipid profile values. Orlistat, an intestinal lipase enzyme inhibitor, improves insulin resistance. We aimed to investigate the effects of short-term therapy with orlistat on the components of metabolic syndrome associated with NAFLD and explore its effect on liver fibrosis scores. Patients and methodsAn open-label placebo-controlled clinical study using orlistat for 12 weeks was carried out on 50 patients with NAFLD. They were divided into a placebo group (Group I) and an orlistat treatment group (120 mg per day, Group II). The diagnosis of NAFLD was made by ultrasonography and laboratory investigations. Anthropometric and blood pressure measurements and hepatic liver enzymes, fasting lipids, and blood glucose levels were determined before and after treatment. Lipid indices including cholesterol (Chol-I), triglyceride (TG-I), triglyceride-glucose (TYG-I), and the scores for lipid fibrosis using the NAFLD fibrosis score (NFS) and Fibrosis-4 score (Fib-4) were also determined. ResultsOrlistat significantly improved the anthropometric and metabolic indices (TG-I, TYG-I) and liver enzymes. Orlistat demonstrated a favorable impact on the NAS and Fib-4 scores for liver fibrosis. ConclusionOrlistat improves the components of metabolic syndrome, leading to the improvement of insulin resistance and thereby improves fatty infiltration of the liver. To a lesser extent, orlistat improved the liver fibrosis scores.

Liver Fibrosis Scoring Systems as Novel Tools for Predicting Cardiovascular Outcomes in Patients Following Elective Percutaneous Coronary Intervention.

BackgroundPrevious studies have suggested a strong association of liver fibrosis scores (LFSs) with cardiovascular outcomes in patients with different cardiovascular diseases. Nonetheless, it is basically blank regarding the prognostic significance of LFSs in patients following percutaneous coronary intervention (PCI). This study sought to examine the potential role of LFSs in predicting long‐term outcomes in a large cohort of patients with stable coronary artery disease after elective PCI.Methods and ResultsIn this multicenter, prospective study, we consecutively enrolled 4003 patients with stable coronary artery disease undergoing PCI. Eight currently available noninvasive LFSs were assessed for each subject. All patients were followed up for the occurrence of cardiovascular events including cardiovascular death, nonfatal myocardial infarction, and stroke. During an average follow‐up of 5.0±1.6 years, 315 (7.87%) major cardiovascular events were recorded. Subjects who developed cardiovascular events were more likely to have intermediate or high LFSs, including nonalcoholic fatty liver disease fibrosis score; fibrosis‐4 score; body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes mellitus score (BARD); and aspartate aminotransferase/alanine aminotransferase ratio. Furthermore, compared with subjects with low scores, those with intermediate plus high score levels had significantly increased risk of cardiovascular events (adjusted hazard ratios ranging 1.57–1.92). Moreover, the addition of non‐alcoholic fatty liver disease fibrosis score; fibrosis‐4 score; or body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes mellitus score into a model with established cardiovascular risk factors significantly improved the prediction ability.ConclusionsHigh LFSs levels might be useful for predicting adverse prognosis in patients with stable coronary artery disease following PCI, suggesting the possibility of the application of LFSs in the risk stratification before elective PCI.

Impact of liver fibrosis score on prognosis in patients with previous myocardial infarction: A prospective cohort study.

Liver fibrosis score (LFS) has been used for predicting the cardiovascular outcomes (CVOs) in diverse populations. However, the association of LFS with CVOs in patients with previous myocardial infarction (MI) remains undetermined. We aimed to examine the prognostic value of LFS in patients with prior MI in a prospective cohort. A total of 3718 patients with previous MI were consecutively enrolled from March 2009 to January 2019. Five LFSs including the fibrosis-4 (FIB-4) score, non-alcohol fatty liver disease fibrosis score (NFS), Forns score, HUI score and BARD score were used. The CVOs covered major adverse cardiac event (MACEs), cardiovascular mortality and all-cause mortality. Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). During a mean follow-up of 47.4±24.8months, 431 (11.6%) MACEs occurred. Kaplan-Meier analysis demonstrated that higher LFSs resulted in a significantly higher probability of CVOs. Compared to the lowest score group, multivariable-adjusted HRs (95% CIs) of the highest group of FIB-4, NFS, Forns score, HUI score and BARD score were 1.75 (1.32-2.33), 2.37 (1.70-3.33), 2.44 (1.61-3.73), 1.58 (1.16-2.14) and 1.27 (1.03-1.57) respectively. These LFSs were also independent predictors of cardiovascular mortality and all-cause mortality. Similar results were observed across subgroups analysis. The addition of LFSs to a prediction model significantly increased the C-statistic for CVOs. The present study firstly demonstrated that LFS could be used as a risk stratification tool for predicting CVOs in patients with previous MI, which should be evaluated further.

Abstract 15135: Liver Fibrosis Scores Predict Cardiovascular Outcomes in Patients With Previous Myocardial Infarction

Introduction: Liver fibrosis score (LFS) has been used for predicting the cardiovascular outcomes (CVOs) in diverse populations. However, the association of LFS with CVOs in patients with previous myocardial infarction (MI) remains undetermined. Hypothesis: The aim of the present study was to examine the prognostic value of LFS in patients with prior MI in a prospective cohort. Methods: A total of 3718 patients with previous MI were consecutively enrolled from March 2009 to January 2019. Five LFSs were used including the fibrosis-4 (FIB-4) score, non-alcohol fatty liver disease fibrosis score (NFS), Forns score, HUI score and BARD score in the current study. The CVOs covered major adverse cardiac event (MACE), hard endpoint, cardiovascular mortality and all-cause mortality. Cox proportional hazards model was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: During a mean follow-up of 47.4±24.8 months, 431 (11.6%) MACE occurred. Kaplan-Meier analysis demonstrated that higher LFSs resulted in a significantly higher probability of CVOs. Compared to the lowest score group, multivariable-adjusted HRs (95% CI) for the highest group of FIB-4, NFS, Forns score, HUI score and BARD score were 1.76 (1.33-2.34), 2.39 (1.71-3.34), 2.46 (1.62-3.74), 1.60 (1.18-2.17) and 1.28 (1.03-1.58), respectively. These LFSs were also independent predictors of hard endpoint, cardiovascular mortality and all-cause mortality. Similar results were observed across subgroups analysis. The addition of LFSs to a prediction model significantly increased the C-statistic for CVOs. Conclusions: The present study firstly demonstrated that LF scores might affect the prognosis in patients with previous MI, suggesting that LF scores may be helpful to further risk stratification and supporting LF scores screening in patients with previous MI.

S0834 Characterization of Biochemical Non-Invasive Liver Fibrosis Scores in Patients With Inflammatory Bowel Disease

S0834 Characterization of Biochemical Non-Invasive Liver Fibrosis Scores in Patients With Inflammatory Bowel Disease

Non‐invasive detection of portal hypertension by enhanced liver fibrosis score in patients with different aetiologies of advanced chronic liver disease

Background and AimsThe enhanced liver fibrosis (ELF) score comprises serum markers of fibrogenesis and matrix remodelling and was developed to detect liver fibrosis, however, it may also be useful for the non‐invasive detection of portal hypertension (PHT).MethodsELF score and its single components (TIMP1/PIIINP/HA) were analysed in 201 patients with advanced chronic liver disease (ACLD; ie hepatic venous pressure gradient (HVPG) ≥6 mm Hg). Patients with pre‐/post‐hepatic PHT, hepatocellular carcinoma beyond Milan criteria, and history of TIPS implantation or liver transplantation were excluded.ResultsELF and its single components correlated with HVPG in the overall cohort: ELF: r = .443, TIMP1: r = .368, PIIINP:r = .332, and HA:r = .419 (all P < .001). The strength of the correlation between ELF and HVPG decreased in higher HVPG strata: 6‐9 mm Hg:r = .569(P = .004), 10‐19 mm Hg:r = .304 (P = .001) and ≥20 mm Hg:r = −.023(P = .853).Area under the receiver operating characteristics (AUROC) of ELF score to detect clinically significant PHT (CSPH; HVPG ≥ 10 mm Hg) was 0.833. Importantly, HA alone yielded an AUROC of 0.828. Detection of CSPH in strictly compensated ACLD (cACLD) patients was less accurate: AUROC: 0.759 (P < .001). CSPH was ruled‐in by ELF ≥ 11.1 with a PPV of 98% (sensitivity: 61%/specificity: 92%/NPV:24%), but CSPH could not be ruled‐out.ELF score had a low AUROC of 0.677 (0.60‐0.75; P < .001) for the diagnosis of high‐risk PHT (HRPH; HVPG ≥ 20mm Hg) and, thus, HRPH could not be ruled‐in by ELF. However, ELF < 10.1 ruled‐out HRPH with a NPV of 95% (sensitivity: 97%/specificity: 26%/PPV: 39%).ConclusionThe ELF score correlates with HVPG at values <20 mm Hg. An ELF ≥ 11.1 identifies patients with a high probability of CSPH, while an ELF < 10.1 may be used to rule‐out HRPH.

1047 Changes in Liver Fibrosis Scores in Patients With New Onset Type 2 Diabetes on Triple Therapy With Exenatide/Pioglitazone/Metformin vs. Conventional Therapy: Year Two Results

INTRODUCTION: Patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2DM) are at higher risk of developing advanced fibrosis. Certain diabetes medications such as pioglitazone and GLP1 agonists have shown some efficacy against NAFLD in small clinical trials. The Durability of Combination Therapy With Exenatide/Pioglitazone/Metformin vs. Conventional Therapy in New Onset T2DM trial is an ongoing interventional trial assessing the effects of two different approaches to treating T2D (ClinicalTrials.gov Identifier: NCT01107717). The aim of the current study was to evaluate the effects of these two approaches on liver fibrosis scores after two years of treatment. METHODS: Newly diagnosed, drug-naïve T2DM patients were enrolled into the study. Medical history, clinical characteristics were obtained, and blood was drawn for the measurement of plasma glucose concentration, HbA1c, CBC, and blood chemistries. Subjects were randomized to receive in an open label fashion an initial combination therapy with metformin (2000 mg) plus pioglitazone (45 mg) and exenatide 10 µg BID (triple therapy) or sequential addition of metformin followed by sulfonylurea and insulin (conventional therapy) to maintain HbA1c &lt; 6.5%. Subjects were seen every 3 months for follow-up visits and at 2 years all baseline measurements were repeated. Liver fibrosis scores that were calculated included AST/ALT ration, APRI, FIB-4 and NFS. RESULTS: Baseline characteristics are listed in Table 1; patients were well matched. Liver fibrosis scores at baseline and at 2 years are listed in Table 2. To compare the effect of each therapy on liver fibrosis scores, the ratio between the 2-year values of liver fibrosis scores to the baseline values was compared amongst the two treatment groups with ANOVA. Both therapies significantly reduced liver fibrosis scores but no significant difference was noted between the two treatment arms. CONCLUSION: In this randomized trial in patients with new-onset T2D, good control of HbA1c was associated with reduction in liver fibrosis scores at 2 years but the use of pioglitazone and GLP1 agonist did not have an added benefit over conventional therapy. The effects of longer duration of treatment are currently being evaluated in addition to assessment of fibrosis by Fibroscan and MR elastography.

An Open-label Randomized Clinical Study to Compare the Effects of a Nutritional Supplement versus Vitamin E on Fibroscan Score in Nonalcoholic Steatohepatitis (NASH) Patients

Background: Despite the benefit of lifestyle changes, there is no standard treatment for Fibrotic NASH. However the concept of reversibility of liver fibrosis and cirrhosis with various natural biologically active compounds and antioxidant micro-nutrients is not new. Aim: The aim of this study was to compare effectiveness of Viusid® (a nutritional supplement) and Vitamin E in reducing steatosis and liver fibrosis score in patients with fibrotic NASH. Methods: 52 patients diagnosed with nondiabetic and noncirrhotic NASH on liver fibroscan were divided into 2 groups randomly and given Viusid® 3 sachets daily to 25 patients or Vitamin E 800 IU daily to 27 patients along with a hypocaloric diet and exercise for 3 months. Results: After 3 months treatment with Viusid®, as compared with Vitamin E, was associated with a significant reduction of both mean steatosis score (CAP value reduces from 286±16.3 to 208±18.5 dB/m in Viusid® group vs. from 278±14.4 to 253±12.1 dB/m in Vitamin E group; p 0.00001). Conclusions: Viusid® was superior to Vitamin E in reducing steatosis & fibrosis score in nondiabetic and noncirrhotic NASH patients. However, further large scale trial is needed to better assess the value of Viusid® for fibrotic NASH management.

Increased Peripheral Platelet Count is Unrelated to Decreased Liver Fibrosis Score Following lamivudine Treatment of Patients with Chronic Hepatitis B

Background and study aims: Liver fibrosis score is associated with peripheral platelet count in patients with chronic hepatitis B (CHB). Lamivudine therapy decreases the liver fibrosis score in these patients. The aim of this study was to evaluate the relationship between increasing peripheral platelet count and decreasing liver fibrosis scores in patients with CHB on lamivudine therapy. Patients and methods: One hundred and fifty-three patients with CHB who received at least 2-years of lamivudine therapy in a tertiary care center were enrolled in the study. Patients with splenomegaly and/or bi- or pancytopenia were excluded. Liver biopsy had been performed prior to and at the end of the second year of the lamivudine therapy. Lamivudine-induced alterations of aspartate aminotransferase, alanine aminotransferase levels, fibrosis score, and peripheral platelet count were compared with Wilcoxon test. A p-value of less than 0.05 was regarded as significant. Results: Of 153 patients, 99 (64.7%) were male and mean age (± SD) was 39.05 ± 11.8 years. HBeAg was found to be positive in 71 (46.4%) patients. Lamivudine decreased aspartate aminotransferase, alanine aminotransferase levels, fibrosis score, and increased peripheral platelet count. Increased peripheral platelet count showed a significant correlation with decreased alanine aminotransferase levels (p 0.05). Conclusions: Increased peripheral platelet count during the lamivudine therapy is not related decreased liver fibrosis score in patients with CHB.