Severity Of Chronic Liver Disease Research Articles

ECM1 attenuates hepatic fibrosis by interfering with mediators of latent TGF-β1 activation

ObjectiveExtracellular matrix protein 1 (ECM1) serves as a gatekeeper of hepatic fibrosis by maintaining transforming growth factor-β1 (TGF-β1) in its latent form. ECM1 knockout (KO) causes latent (L) TGF-β1 activation,...

Association of Platelet Count with Severity of Chronic Liver Disease

Introduction: Chronic liver disease (CLD) is a significant global health concern, encompassing a range of liver pathologies with varying degrees of severity. This cross- sectional study aims to investigate the relationship between platelet count and the severity of CLD. Platelet count is a readily available and cost-effective clinical parameter that may serve as a valuable prognostic marker for CLD progression.  Materials and Method: The study included 122 patients in Chitwan Medical College Teaching Hospital (CMCTH) diagnosed with CLD during one year starting from March 2022. Data were collected using the proforma specially designed for this study. Parameters like age and gender, as well as brief clinical data, including liver function tests, imaging findings, and platelet count, were collected. Patients were then classified into different stages of severity based on established criteria, i.e. child Pugh Score system (CTP score). Statistical analyses were performed using a statistical package for the social science (SPSS); statistical program version 20.0, to explore the association between platelet count and CLD severity.  Results: The majority of patients who had chronic liver disease were found to be high in the age group of 40-60 years. Thrombocytopenia was found in 72.1% of chronic liver disease patients. After classifying the severity of chronic liver disease, it was found that 55.7% of patients had a severe disease that was CTP-C, 36.1% were found to be CTP-B and 8.2% were CTP-A. In patients with normal platelet count, 44.1% had CTP-B, 41.2 had CTPC and 14.7% had CTP-A score. In patients with thrombocytopenia, 61.4% had CTP-C, 33.0% had CTP- B and 5.7% had CTP-A score.  Conclusion: This study provides a valuable snapshot of the potential association between platelet count and the severity of chronic liver disease. The prevalence of thrombocytopenia across different disease stages underscores its clinical relevance. The platelet count is decreased in chronic liver disease, however, it cannot be defined as the sole predictor for the severity of CLD.

Study on Red Cell Indices in Chronic Liver Disease in Tertiary Level Hospital

Background: Chronic liver disease (CLD) in the clinical context is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis. Liver diseases are frequently associated with hematological abnormalities. Bleeding and defective blood coagulation contributes to the anemia in CLD patients. Other mechanisms of anemia include aplastic anemia secondary to previous hepatitis, or side effects of treatment of hepatitis with chemotherapeutic agent. Other different factors, such as malabsorption, malnutrition or direct toxic effect also contribute to hematological abnormalities. The examination of complete blood count is common, economically cheap and readily available laboratory procedure. Red cell indices are valuable in the evaluation of morphologic characteristic of anaemias or hematological abnormalities in CLD patients. Objectives: To assess the red cell indices in chronic liver disease patients. Materials & method: This descriptive type of cross-sectional study was conducted in Department of Medicine, Dhaka Medical College Hospital, Dhaka, among 75 cases of Chronic liver disease patients. Samples were selected by purposive sampling technique. Detail demographic data were collected from the patients and recorded in structured case report form. Clinical examination and relevant investigation were done meticulously. Data was processed and analysed with the help of computer program SPSS and Microsoft excel. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Results was presented by tabulation and graphical presentation in the form of tables, pie chart, graphs, bar diagrams, histogram & charts etc. Result: Maximum number of patients, 37(49.3%) were between 31-40 years of age with mean age of the patient was 37.58 ± 8.23 years. Out of 75 cases 58(77.0%) patients were male and 17(23.0%) were female. Male-female ratio was 3.34:1. Majority of patients belonged to Child Pugh score B. Prevalence of anaemia was 54(72%) in CLD patients. Microcytic anaemia was predominant and Normocytic anaemia was second most common. Hb concentration & MCV decreases with the severity of Child Pugh score. Abnormalities of red cell indices were positively associated with severity of CLD. Conclusion: Present study concluded that chronic liver diseases are associated with hematological abnormalities. Patients with severe hepatocellular disease develop defects of blood coagulation as a consequence of endothelial dysfunction, thrombocytopenia, deficiencies of coagulation factors and various associated disorders. In overall patients, Child Pugh class C cases had significant low hemoglobin in comparison to rest of group. Assessing the severity and type of anaemia by red cell indices is a useful tool for proper treatment, prognosis in patients of CLD for reducing the mortality and morbidity. J MEDICINE 2024; 25: 41-45

Correlation of fasting serum cholesterol level with severity of chronic liver disease.

Objective: To evaluate correlation of fasting serum cholesterol level with severity of chronic liver disease (CLD). Study Design: Cross-sectional Survey. Setting: North Medical Ward, Mayo Hospital Lahore. Period: June 2020 to December 2020. Material & Methods: Patients having chronic liver disease with age 25-85 years and of either gender, were included. After 12 hours of fasting, 5ml of blood was drawn from patients under all aseptic precautions into sterile disposable syringes and blood samples were sent to laboratory for measurement of total cholesterol. Total cholesterol (TC) in mg/dl was noted from their reports. CLD severity patients was defined by using Modified Child Pugh classifications. Data was entered in SPSS version 20 and analyzed by same software. Results: Total 100 cases diagnosed with chronic liver disease (CLD) were studied, with an average age of 53.8±10.76 years. The majority of participants, constituting 72%, were male. Overall average TC was 119.85±31.51mg/dl. Out of all 27% patients belonged to CPT class A, 28% had CPT class B and 45% had CPT class C. Spearman correlation between Child Pugh score and total cholesterol level was calculated. A negative spearman correlation was found as r= -.672. It was significant at the level of 0.01. Conclusion: As per the study conclusion, total serum cholesterol level was observed to be the significantly corelated with degree of liver damage. The significance of this correlation highlights the potential clinical utility of serum total cholesterol as a prognostic tool for evaluating the degree of liver damage.

Serum uric acid level in chronic liver disease and its correlation with Child-Pugh score in a tertiary care hospital from South India.

Chronic liver disease (CLD) is one of the important causes of morbidity and mortality in our country, and since the damage to the liver is irreversible, we have to look for many severity markers or predictors for the prognosis of the patient. In this study, we have tried to correlate the level of serum uric acid (UA) with the severity of CLD presented as a Child-Pugh score. A cross-sectional observational study was conducted at Vijayanagar Institute of Medical Science (VIMS), Ballari, Karnataka, from October 2015 to June 2017 in the Department of General Medicine. Fifty patients diagnosed with CLD, aged between 18 and 65 years, of either gender, were enrolled in the study. Serum UA levels were measured, and liver function and coagulation parameters were assessed. A statistical analysis was performed to evaluate the association between serum UA levels, liver function test, and coagulation parameters. In our study, the mean serum UA level was 6.52 mg/dl and was raised in patients with CLD in correlation to its severity. Alcoholic liver disease (ALD) was the most common etiology for CLD (80%) followed by hepatitis B (Hep B) virus infection (12%) and hepatitis C (Hep C) virus infection (6%). Serum UA levels increased as the Child-Turcotte-Pugh (CTP) score increased. The mean UA level in CTP class C was 8.29 mg/dl. Various parameters such as serum aspartate aminotransferase (AST), alanine transaminase (ALT), alkaline phosphatase, total bilirubin, international normalized ratio (INR), calcium, and albumin were significantly associated with serum UA levels in CLD patients. The correlation between rising blood UA levels and the Child-Pugh score shows that UA estimate may be a valid and affordable indicator for assessing the extent of liver cirrhosis in CLD.

Investigation on the short‐term outcome and prognostic impact of predisposition, and precipitants in inpatients with chronic liver disease from Chinese AcuTe on CHronic LIver FailurE (CATCH‐LIFE) cohorts

AbstractAimThe study aimed to investigate the short‐term outcomes of hospitalized patients with chronic liver disease (CLDs) and assess the prognostic impact of predisposition and precipitants, which currently remains unclear.MethodsThe study included 3970 hospitalized patients with CLDs from two prospective longitudinal multicenter studies (NCT02457637 and NCT03641872) conducted in highly endemic hepatitis B virus (HBV) areas. Competing risk analysis was used to evaluate the effect of predispositions, including the etiology and severity of CLDs and precipitants; on sequential 28, 90, and 365‐day liver transplantation (LT)‐free mortality.ResultsAmong all enrolled patients, 76.8% of adverse outcomes (including death and LT) within one year occurred within 90 days. Compared with alcoholic etiology, the association of HBV etiology with poorer outcomes was remarkably on the 28th day (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.07–3.06; p = 0.026); however, and diminished or became insignificant at 90 days and 365 days. Cirrhosis increased the adjusted risk for 365‐day (HR, 1.50; CI, 1.13–1.99; p = 0.004) LT‐free mortality when compared with noncirrhosis. In patients with cirrhosis, prior decompensation (PD) independently increased the adjusted risk of 365‐day LT‐free mortality by 1.25‐fold (p = 0.021); however, it did not increase the risk for 90‐day mortality. Neither the category nor the number of precipitants influenced the adjusted risk of 28 or 90‐day LT‐free mortality.ConclusionsThe 90‐day outcome should be considered a significant endpoint for evaluating the short‐term prognosis of hospitalized patients with CLD. Predisposing factors, other than etiology, mainly affected the delayed (365‐day) outcome. Timely effective therapy for CLD etiology, especially antiviral treatments for HBV, and post‐discharge long‐term surveillance monitoring in cirrhotic patients undergoing PD are suggested to enhance disease management and reduce mortality.

A study of thyroid function profile in patients of chronic liver disease and its correlation with child Pugh score

Background: Chronic liver disease (CLD) is a continuous process of inflammation, destruction, and regeneration of liver parenchyma, which leads to fibrosis and cirrhosis. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism, as well as the synthesis of thyroid binding globulin. A complex relationship exists between thyroid and liver in health and disease. Methods: 103 patients of CLD were included in this study from December 2020 to September 2022. They were classified as per child Pugh scoring after clinical assessment and investigations. Serum TSH, FT3, FT4 levels were measured for all the patients. Results: Out of 103 patients and it was found that 19 (18.44%) patients belonged CTP class A, 40 (38.83%) patients had CTP score of class B, while maximum 44 (42.71%) patients belonged CTP class C. There was significant positive correlation between CTP class and TSH values (p<0.001) with mean (SD) of CTP class A, B and C were 2.42 (0.76), 3.9 (1.02) and 5.91 (1.08) respectively. There was significant negative correlation between CTP class and FT3 values (p<0.001) and between CTP class and FT4 values (p<0.001). Conclusions: Our study found that there was significant positive correlation of S.TSH values with severity of CLD as assessed by CTP score, while FT3 and FT4 were having significant negative correlation.

Aggravating Effects of Hepatitis E Virus Infection on Patients with Chronic Liver Disease in Ibn-Sina Hospital Sudan

Background: Hepatitis E virus (HEV) is one of the most common causes of acute hepatitis. Sudan is considered as hyper-endemic for HEV. HEV infection in patients with preexisting chronic liver diseases (CLDs) has been reported to result in severe clinical manifestations and poor outcomes. However data on the role of HEV infection in worsening of pre-existing CLD are limited.
 Objective: To determine hepatitis E virus (HEV) infection and its effect on severity of CLD.
 Methods: A descriptive cross-sectional study that consecutively enrolled 87 CLD patients in Ibn-Sina Specialized Hospital was carried out during the period from August 2020 to December 2020. Data regarding demographics, CLD causes, clinical manifestations and comorbidities were collected. The screening for anti-HEV antibodies was performed in all patients by using enzyme linked immuno-sorbent assay (ELISA).
 Results: Hepatitis B virus (HBV) was the commonest etiology of chronic liver diseases being detected in 45/87(51.7%) patients. On the other hand;among all subjects; 43/87(49.4%) patients were HEV seropositive with anti-HEV Ig-G being detected in 32(36.8%) and concurrent anti-HEV Ig-M and Ig-G in 11(12.6%) patients. Jaundice (OR= 3.8, CI95%: 1.5-9.4; P. value=0.004), HCC (OR= 4.1, CI95%: 1.4-11.9; P. value=0.008), child-Pugh class-C (OR= 26, CI95%: 5.4-94.0; P. value=0.000) and child-Pugh class-B (OR= 5.3, CI95%: 1.6-17.0; P. value=0.000) were associated independently with anti-HEV positivity.
 Conclusion: The frequency of hepatitis E virus (HEV) among Sudanese patients with chronic liver disease (CLD) was considerably high (mainly past infection- Ig-G). Furthermore, HEV was associated with advanced liver failure statuses (child-Pugh class-B & C), jaundice, and hepatocellular carcinoma.

The value of contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine for predicting decompensation and transplant-free survival in chronic liver disease.

To investigate the value of contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine for predicting clinical outcomes in patients with chronic liver disease (CLD). Three hundred and fourteen CLD patients who underwent gadobenate dimeglumine-enhanced hepatic magnetic resonance imaging were stratified into three groups: nonadvanced CLD (n = 116), compensated advanced CLD (n = 120), and decompensated advanced CLD (n = 78) groups. The liver-to-portal vein contrast ratio (LPC) and liver-spleen contrast ratio (LSC) at the hepatobiliary phase were measured. The value of LPC for predicting hepatic decompensation and transplant-free survival was assessed using Cox regression analysis and Kaplan-Meier analysis. The diagnostic performance of LPC was significantly better than LSC in evaluating the severity of CLD. During a median follow-up period of 53.0months, the LPC was a significant predictor for hepatic decompensation (p < 0.001) in patients with compensated advanced CLD. The predictive performance of LPC was higher than that of the model for end-stage liver disease score (p = 0.006). With the optimal cut-off value, patients with LPC ≤ 0.98 had a higher cumulative incidence of hepatic decompensation than patients with LPC > 0.98 (p < 0.001). The LPC was also a significant predictive factor for transplant-free survival in patients with compensated advanced CLD (p = 0.007) and those with decompensated advanced CLD (p = 0.002). Contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine is a valuable imaging biomarker for predicting hepatic decompensation and transplant-free survival in CLD patients. • The liver-to-portal vein contrast ratio (LPC) significantly outperformed liver-spleen contrast ratio in evaluating the severity of chronic liver disease. • The LPC was a significant predictor for hepatic decompensation in patients with compensated advanced chronic liver disease. • The LPC was a significant predictor for transplant-free survival in patients with compensated and those with decompensated advanced chronic liver disease.

Correlation of Serum Testosterone Section Levels in Men with Severity of Liver Dysfunction in Chronic Liver DiseaseAn Observational Study at a Tertiary Care Centre in Uttarakhand, India

Introduction: Chronic Liver Disease (CLD) and/or cirrhosis of liver represent different liver disorders of varying severity in which liver injury, inflammation, and fibrosis continue for more than 6 months. Various aetiologies including drugs toxins, alcohol abuse, infections, autoimmune disorders, genetic and metabolic diseases are implicated for CLD. Regardless, the aetiology of the CLD, the serum testosterone falls as the disease advances. Aim: To study the serum testosterone level in male patients with CLD and its correlation with the severity of the disease. Materials and Methods: A prospective observational study was conducted on patients reporting to Himalayan Hospital in OPD and IPD between June 2021 to May 2022. A total of 58 male patients of CLD were recruited. All patients were examined with clinical history, physical examination, laboratory blood and biochemical and radiological investigations, including total serum testosterone estimation. Testosterone value of &lt;3 ng/mL was considered as low level. Child-Turcotte-Pugh (CTP) scores and Model for End-Stage Liver Disease-sodium (MELD-Na) scores were calculated to assess the severity of CLD. Results: The mean age of the patients was 47.87±10.3 years. The majority of patients, 52/58(89.65%), had low serum testosterone levels. As the severity of CLD increases, the testosterone falls progressively, and the finding was statistically significant (p-value=0.001). The mean testosterone levels (0.9±0.38) in patients with MELD-Na score of ≥20 was significantly (p-value=0.02) lower than the patients with MELDNa score of &lt;20. There was a strong negative correlation between low testosterone and CLD severity. Conclusion: Overall, 89.65% of the patients had a low testosterone level. Serum testosterone level can be an independent marker for the severity of CLD in male patients.

Study of cardiovascular dysfunction in chronic liver disease in a tertiary care hospital in eastern India

Background: Chronic liver disease (CLD) exhibits characteristic hemodynamic changes along with pathological changes in the myocardium. Compensated by the decreased systemic vascular resistance, overt heart failure is usually not seen, and thus cardiac pathology is frequently overlooked. Aims and Objectives: The objectives of the study were to study the presence, types, and severity of cardiovascular (CV) dysfunction in patients of CLD. Materials and Methods: An observational cross-sectional study on 50 patients of CLD at Calcutta National Medical College and Hospital, with all relevant investigations. Results: Out of a sample of 50 patients, of which 14.3% were mild, 34.3% moderate and 51.4% severe CLD (by Child-Pugh Class), 28.6% had a high normal heart rate (90 to 100/min), 45.7% had increased stroke volume index, and 42.9% increased cardiac index, reflecting hyperdynamic circulation. In 42% cases, left ventricular ejection fraction was increased more than 65%, reflecting hyperdynamic circulation, but decreased &lt;55% in 23% cases, which may be an indicator of cirrhotic cardiomyopathy. Ejection fraction is significantly (P=0.016) increased after paracentesis in 33.3% patients, reflecting the mechanical effect of ascites on cardiac function. Diastolic dysfunction was present in 60% (P=0.012) and left ventricular mass index was increased in 45.7% cases. All the parameters correlated with increasing Child-Pugh Class severity of CLD. Conclusion: A high level of awareness is needed to take into account the presence of CV dysfunction and cirrhotic cardiomyopathy in patients of CLD and predict the risk of adverse cardiac events. Specific treatment modalities need further study to improve prognosis in these patients.

Effect of liver cirrhosis on theophylline trough concentrations: A comparative analysis of organ impairment using Child-Pugh and MELD scores.

Theophylline clearance is known to be reduced in patients with chronic liver diseases (CLDs) such as chronic hepatitis (CH) and liver cirrhosis (LC). The Child-Pugh (CP) score is generally used for pharmacokinetic evaluation, whilst a model for end-stage liver disease (MELD) has not yet been fully evaluated. This study aimed to predict theophylline clearance in patients with LC classified based on CP and MELD scores by population pharmacokinetic (PPK) analysis. PPK analysis included 433 steady-state trough concentrations from 192 Japanese bronchial asthma patients with and without CLDs and was performed using NONMEM. The severity of LC was assessed by CP and MELD scores. The final CP and MELD models which described apparent theophylline clearance (CL/F) were obtained. The CP model showed that the mean CL/F in patients without CLDs, CH patients and LC patients with CP class A, B and C was 0.0473, 0.0413, 0.0330, 0.0280 and 0.0209 L/h kg-1 , respectively. The MELD model predicted that CL/F in patients without CLDs, CH patients and LC patients with MELD scores of <10, 10-14, 15-19, 20-24 and ≥25 was 0.0472, 0.0413, 0.0324, 0.0268, 0.0230, 0.0197 and 0.0155 L/h kg-1 , respectively. CL/F in various stages of LC was evaluated, and a change in CL/F was highly dependent on the severity of CLDs in both models. The MELD model provided a more accurate and precise description of theophylline clearance in LC than the CP model, which may be due to the wider dynamic range of the MELD score.

Endoscopic Ultrasound-Guided Porto-systemic Pressure Gradient Measurement Correlates with Histological Hepatic Fibrosis.

Endoscopic ultrasound is a novel diagnostic approach to chronic liver diseases (CLDs), and EUS-guided porto-systemic pressure gradient measurement (EUS-PPG) is an important expansion with a well-developed technique. However, the clinical value and applicability of EUS-PPG measurement in predicting histologically advanced hepatic fibrosis remain unknown. This was a single-center retrospective study on patients with various CLDs undergoing EUS-PPG and EUS-guided liver biopsy (EUS-bx) to assess if EUS-PPG measurements correlate with histological fibrosis stage and various surrogate markers for severity of CLDs and its safety. Cases with EUS-PPG were identified at the University of California Irvine, a tertiary endoscopy center, between January 2014 and March 2020. In 64 patients, the mean age was 57.5; 40 (62.5%), males; mean Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores, 5.9 and 10.4, respectively. The procedure success rate was 100%. Twenty-nine (45.3%) had EUS-PPG ≥ 5mmHg that was associated with clinical cirrhosis (p < 0.0001), clinical portal hypertension (p = 0.002), hepatic decompensation (p = 0.013), MELD-Na > 10 (p = 0.036), PLTs ≤ 120 × 109/L (p = 0.001), INR ≥ 1.05 (p = 0.007), presence of EV, GV, or PHG (p < 0.0001), biopsy-proven fibrosis stage ≥ 3 (p = 0.002), APRI > 2 (p = 0.001), and FIB-4 > 3.25 (p = 0.001). Multivariable analysis confirmed that EUS-PPG ≥ 5mmHg was significantly associated with liver biopsy-proven fibrosis stage ≥ 3 (LR 27.0, 95% CI = 1.653-360.597, p = 0.004), independent of C-cirrhosis, C-PHTN, thrombocytopenia, splenomegaly, and APRI score > 2, and FIB-4 score > 3.25. There were no serious complications related to EUS-PPG procedures. EUS-PPG measurements provide excellent correlation with histological hepatic fibrosis stage and various clinical, laboratory, endoscopic and imaging variables indicative of advanced liver disease without serious adverse events.

Prevalence and correlation of sarcopenia with severity of chronic liver disease

Background and Aims: Sarcopenia has implications for prognosis of chronic liver disease (CLD). There is a dearth of Indian data on sarcopenia in CLD. We evaluated the prevalence of sarcopenia in CLD using different techniques and correlated it with the severity of CLD.

Role of serum Nogo-B as a biomarker for diagnosis of chronic liver diseases and its severity

BackgroundNogo-B is one of the members of the reticulon family. Nogo-B influences the proliferation of the hepatic stellate cells inducing liver fibrotic changes. We aimed at measuring the serum levels of Nogo-B in patients with chronic liver disease (CLD) with different etiologies. Ninety subjects were included, 18 of them were normal healthy individuals and 72 had liver disease (fibrosis/cirrhosis) with different etiologies: post-hepatitis C infection, post-hepatitis B infection, NASH, and autoimmune hepatitis. Serum Nogo-B was assessed using ELISA. Patients were subdivided according to the Child-Pugh score into 3 groups: group 1—Child A (24 patients); group 2—Child B (24 patients); and group 3—Child C (24 patients).ResultsSerum Nogo-B levels were found to be significantly higher in patients (1477.92 ± 1113.50) when compared with healthy control (301.28 ± 180.87) (p < 0.001). There was a statistically significant difference in serum Nogo-B level between the three sub-groups of patients (p < 0.001). A positive correlation was found between serum Nogo-B and MELD score (r = 0.46, p-value < 0.001). However, there was no correlation found between Nogo-B and FIB-4 index or APRI score. There was a significant positive correlation between serum Nogo-B level and coagulation profile and serum bilirubin. An inverse correlation was found between serum Nogo-B with serum albumin. A ROC curve was done to examine the validity of Nogo-B in the diagnosis of liver cirrhosis, and the area under the curve was found to be 0.979, a cutoff value of 600 with a sensitivity of 97.2% and a specificity of 94.4% (p-value < 0.001).ConclusionNogo-B had a high value in the identification of patients with any severity of CLD. There is a highly significant correlation between Nogo-B and the synthetic function of the liver; it could be used as a measure of hepatic functional reserve.

Health-related quality of life in outpatients with chronic liver disease: a cross-sectional study

BackgroundThe symptoms and complications related to chronic liver disease (CLD) have been shown to affect patient well-being. Currently there is limited research data on how CLD severity may affect both health-related quality of life (HRQOL) and the development of depressive symptoms in CLD patients. Moreover, the ongoing advances in CLD treatment, and its effect on HRQOL, highlight the need for further studies. Therefore, the aim of the present study was to evaluate if the CLD severity may affect the HRQOL and the development of depressive symptoms.MethodsA cross-sectional study was conducted. Patients with CLDs were identified at their regular visits to the outpatient clinic of the Sant’Orsola-Malpighi Hospital in Bologna, between September 2016 and July 2017. HRQOL was measured with Short Form 12 (SF-12) and Nottingham Health Profile (NHP) questionnaires; depressive symptoms were measured with Beck Depression Inventory-II (BDI). CLD severity was measured using the MELD score and the sample was stratified into five classes according to it. Group comparisons were conducted using the Kruskal–Wallis test.ResultsTwo hundred and fifty-four patients were included. Mean age was 62.84 years (SD 11.75) and 57.9% were male. Most participants were affected by compensated cirrhosis (140.2%) and chronic hepatitis (40.2%), with a disease duration ≥ 5 years (69.3%). Regarding the MELD score, 67.7% of patients belonged to Class I, 29.9% to Class II, and 2.4% to Class III. There were not patients belonging to the Classes IV and V.No statistically significant differences were found in all SF-12 and NHP domains between the MELD classes, except for CLD impact on sexual life and holidays (p = 0.037 and p = 0.032, respectively). A prevalence rate of 26% of depressive symptoms was reported, no statistically significant differences were found in BDI-II total scores between the three MELD classes.ConclusionsAll domains of HRQOL and depression were altered in CLDs patients, nevertheless CLD severity was not confirmed as an affecting factor for HRQOL.

Comparison of Outcomes of Patients With Versus Without Chronic Liver Disease Undergoing Percutaneous Coronary Intervention

There are limited data on the outcomes of chronic liver disease (CLD) patients admitted for percutaneous coronary intervention (PCI). All PCI hospitalizations from the Nationwide Inpatient Sample (2004 to 2015) were analyzed and stratified by the presence, cause and severity of CLD, as well as the indication for PCI. Multivariable logistic regression analysis was performed to determine the adjusted odds ratios (aOR) of in-hospital adverse outcomes in patients with CLD compared with those without CLD. Among 7,296,679 PCI admissions, 54,368 (0.7%) had a CLD diagnosis. Among patients with CLD, 36,853 (67.8%) had severe CLD. Patients with CLD had higher likelihood of adverse outcomes including major adverse cardiovascular and cerebrovascular events (MACCE) (aOR 1.25, 95%CI 1.20 to 1.30), mortality (aOR 1.43, 95%CI 1.35 to 1.51), major bleeding (aOR 2.22, 95%CI 2.12 to 2.32). When accounting for severity, only severe CLD subgroup was more likely to have MACCE and all-cause mortality compared to no-CLD patients (p <0.001). Among CLD etiologic subgroups, those with 'alcohol-related liver disease' and 'other CLD' were consistently more likely to develop MACCE, all-cause mortality and major bleeding in comparison to no-CLD patients, while 'chronic viral hepatitis' subgroup had only increased odds of major bleeding (p <0.001). In conclusion, CLD patients admitted for PCI are more likely to have worse in-hospital outcomes, particularly in the severe CLD subgroup and 'alcohol-related liver disease' and 'other CLD' etiologic subgroups.

PNPLA3 is the dominant SNP linked to liver disease severity at time of first referral to a tertiary center

BackgroundSingle nucleotide polymorphisms (SNPs) in genes including PNPLA3, TM6SF2, HSD17B13 and SERPINA1 have been identified as risk modifiers of progression in chronic liver disease (CLD). However, it is unclear whether genotyping for these risk variants is useful in clinical routine. MethodsLiver disease severity was assessed by liver stiffness measurement (LSM) and by presence of clinical manifestations of advanced-chronic liver disease (ACLD) in 779 consecutive CLD patients at the time of referral to a tertiary center. The associations of risk variants with CLD severity were calculated individually and in a combined model using a polygenic risk-score. ResultsNon-alcoholic fatty liver disease (NAFLD) was the most common etiology (n = 511, 65.6%), and ACLD was present in 217 (27.9%) patients. The PNPLA3-G-allele remained independently associated with higher LSM (adjusted-B: 2.508 [95%CI: 0.887–4.130], P = 0.002) or the presence of ACLD (aOR: 1.562 [95%CI: 1.097–2.226], P = 0.013). SERPINA1-Z-allele was also independently associated with LSM (adjusted-B: 4.558 [95%CI: 1.182–7.934], P = 0.008), while the other risk alleles did not attain statistical significance. Combining these risk alleles into a polygenic risk-score was significantly associated with LSM (adjusted-B: 0.948 [95%CI: 0.153–1.743], P = 0.020). ConclusionPNPLA3 risk-variants are linked to liver disease severity at the time of first referral to an outpatient hepatology clinic.

Minimal hepatic encephalopathy may be present despite the absence of non-invasive and elastography evidence of cirrhosis in patients with primary biliary cholangitis

PurposeMinimal hepatic encephalopathy (MHE) is an important complication of chronic liver disease (CLD); however, MHE burden in patients with primary biliary cholangitis (PBC) has not been determined yet. Therefore, our study aimed to assess the prevalence of MHE in a typical cohort of middle-aged, patients with PBC suspicion of liver fibrosis and to investigate the relationship between MHE, basic laboratory tests and the stage of liver fibrosis. Patients and methodsFifty-one patients (38 with PBC and 13 controls), were prospectively enrolled. Portosystemic Encephalopathy-Syndrome test was used to diagnose MHE. Elastography point qualification (ElastPQ) and non-invasive markers (APRI and FIB-4) were used to assess liver fibrosis. The severity of CLD was assessed using the Model of End-Stage Liver Disease (MELD) and Child-Pugh score. ResultsMHE was diagnosed in 9 patients (24.3%) with PBC and none in the control group. As many as 44.4% of the patients with MHE had neither advanced fibrosis nor cirrhosis, as demonstrated using non-invasive markers of liver fibrosis or ElastPQ. The MELD score was the only predictor of MHE with cut-off value 8.5 [AUC ​= ​0.753, CI95% ​= ​0.569 to 0.938)] with sensitivity of 56%, specificity of 85% and accuracy of the test of 78%. Non-invasive markers of liver fibrosis and ElastPQ did not predict MHE. ConclusionsMHE may occur in PBC despite no evidence of advanced liver fibrosis or cirrhosis. The slightly elevated MELD score may indicate a substantially increased risk of MHE in patients with PBC.

Using qualitative descriptors of chronic liver disease on MRI: A practice prone to error

PurposeAssess accuracy of qualitative descriptors for chronic liver disease (CLD) in radiology reports compared to histopathological staging. MethodsDatabase search for patients with hepatitis B/C (HBV/HCV) CLD, abdominal MRI during 2009–2016, and liver biopsy within 6 months of MRI or prior biopsy showing cirrhosis. Reports reviewed for mention of CLD and associated descriptors. Findings stratified into categories: normal/no mention of CLD; changes of CLD without qualitative descriptor; mild/early; moderate; severe/advanced and cirrhosis. Descriptive ranges categorized to the lesser degree. Percent concordance/discordance of descriptors and Scheuer stage (F0-F4), false positive (FP), false negative (FN) and sensitivity/specificity calculated. Results309 patients, median age 54 (24–74). 91% had HCV (282/309), 7% HBV and 2% both HBV/HCV. Biopsy showed 19% without CLD/F0; 8% F1, 15% F2, 15% F3 and 43% F4. 188 MRI reports (61%) stated CLD was present; however, 16 had no fibrosis on histopathology (9% FP). 39% (121/309) did not mention or stated no CLD; however, 78 had CLD on histopathology (64% FN). 59% of FN were early fibrosis (F1 or F2), 27% F3 and 11% F4. Overall sensitivity and specificity was 69% and 73%, respectively. 77% (145/188) of MRI reports used a descriptive qualifier when describing CLD. 10% were concordant with exact histopathology staging. Of discordant reports, 90% identified CLD but under-called severity. ConclusionAbdominal radiologists can detect CLD on MRI but degree of CLD is often under-called compared to histopathology suggesting radiologists should refrain from qualitative descriptors in assessing CLD on MRI and reaffirms the need for quantitative imaging.