Simple Noninvasive Marker Research Articles

Simple non-invasive markers as a predictor of fibrosis and viral response in chronic hepatitis C patients

Chronic hepatitis C has a high prevalence and leads to development of cirrhosis and hepatocellular carcinoma. Liver fibrosis staging is one of the main factors that influence the decision to indicate therapy for chronic hepatitis C carriers. Several simple laboratory tests, scores and indices have been proposed for the non-invasive prediction of hepatic fibrosis in patients with chronic hepatitis C. The purpose of this study was to evaluate non-invasive liver fibrosis tests as a predictive factor of fibrosis and non-sustained viral response (relapse/non-responder) in chronic hepatitis C naive patients. We performed a retrospective case-control study with utilization of non-invasive liver fibrosis test, platelet count, aspartate aminotransferase/alanine aminotransferase ratio, age-platelet index and aspartate aminotransferase to platelet ratio index, as a predictor of non-sustained viral response in chronic hepatitis C naive patients between July 2008 and August 2010 in İzmir Atatürk Training and Research Hospital. We observed non-invasive liver fibrosis test to be highly effective in predicting non-sustained viral response patients, especially with age-platelet index (Accuracy=73%, OR=6.93, 95% CI, 2.41-19.8). A strong relationship was shown with multivariate analysis between non-sustained viral response and some non-invasive liver fibrosis tests such as viral load (OR=4.51, 95% CI, 1.16 -17.6, p=0.03) and age-platelet index (OR=11.8, 95% CI, 2.25-62.15, p=0.004). If non-invasive tests could be standardized according to age, gender, race, and body mass index and individualized according to the fibrosis, then a nearly full correlation of non-invasive liver fibrosis test with histologic results could be obtained, stage of fibrosis could be predicted initially, sustained viral response/non-sustained viral response could be estimated, and the need for a repeat biopsy could be eliminated.

Prediction of Acute Cellular Rejection by Peripheral Blood Eosinophilia in Pediatric Living Donor Liver Transplantation

BackgroundAcute cellular rejection (ACR) is a common cause of morbidity following liver transplantation. Several reports have evaluated the predictive value of peripheral blood eosinophilia as a simple noninvasive diagnostic marker for ACR. This study examined whether the relative eosinophil counts (REC) predicted ACR in pediatric living donor liver transplantation (LDLT). MethodsOne hundred three patients underwent LDLT between May 2001 and December 2007. ACR were diagnosed based on the pathological findings. ResultsThe incidence of ACR was 46.6% (48/103); ACR was diagnosed an average of 13.5 days after LDLT. The average REC at 4 and 2 days before the onset ACR (n = 39) within 30 postoperative day (POD) was 4.3% and 7.3%, respectively, and 9.0% at the onset. Patients with ACR showed significantly higher levels of REC compared with those free of ACR (P = .039). REC thresholds of 10% at POD 7 displayed a sensitivity and specificity of ACR detection of 80% and 75%, respectively. Moreover, the accumulated morbidity ratio of ACR within 30 POD was significantly higher with REC >10% at POD 7 (P = .007). ConclusionACR within POD 30 should be considered when REC is >10% at POD 7 after LDLT.

Clinical utility of simple noninvasive markers for prediction of hepatitis C-related fibrosis in Egyptian patients

IntroductionThe decision to treat hepatitis C virus (HCV) is often made on the basis of the presence or absence of significant fibrosis in liver biopsy. Because liver biopsy is invasive, a noninvasive marker to evaluate hepatic fibrosis would be helpful.ObjectivesThe aim of this study was to evaluat

QT dispersion and cardiac involvement in children with Familial Mediterranean fever

Familial Mediterranean fever is a hereditary disease characterised by recurrent and self-terminated attacks of fever and polyserositis. An earlier study found that adult patients of Familial Mediterranean fever had an abnormally longer QT dispersion and corrected QT dispersion, markers for ventricular arrhythmogenicity. QT dispersion is a simple non-invasive arrhythmogenic marker that can be used to assess homogeneity of cardiac repolarisation; however, it has not been studied in children with Familial Mediterranean fever before. The aim of this study was to assess QT dispersion and corrected QT dispersion, and their relationship with systolic and diastolic function of the left ventricle in a group of children with Familial Mediterranean fever. We performed electrocardiography and Doppler echocardiography on patients and controls. Maximum QT, minimum QT, QT dispersion, corrected QT, maximum corrected QT, minimum corrected QT, and corrected QT dispersion intervals were measured from standard 12-lead electrocardiography. No statistically significant differences were found between the groups in QT dispersion, corrected QT dispersion, and systolic-diastolic function of the left ventricle parameters. During the 12 months of follow-up, no ventricular arrhythmias were documented in either group.

QT dispersion and cardiac involvement in patients with juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is the commonest cause of chronic inflammatory arthritis in childhood. Cardiac involvement as pericarditis, myocarditis and valvular disease is known to occur in patients with JIA (JIA), as it does in adults with rheumatoid arthritis. There are, however, few descriptions concerning systolic and diastolic functions of the left ventricle (LV) in children with JIA. QT dispersion (QTd) is simple noninvasive arrhythmogenic marker that can be used to assess homogeneity of cardiac repolarization and which has not been studied in JIA patients before. A recent study found that rheumatoid arthritis patients had an abnormally longer QTd and corrected QT (cQTd) dispersion, markers for ventricular arrhythmogenicity. This study assessed QTd and cQTd and their relation with systolic and diastolic function of the LV in a group of children with JIA. We performed electrocardiography and Doppler echocardiography on patients and controls. Maximum QT (QTmax), minimum QT (QTmin), QTd, corrected QT, maximum corrected QT (cQTmax), minimum corrected QT (cQTmin) and cQTd intervals were measured from standard 12-lead electrocardiography. No statistically significant differences were found between the groups in QTd and cQTd. Among the diastolic parameters, increased late flow velocity, decreased early flow velocity and prolonged isovolumic relaxation time reflected an abnormal relaxation form of diastolic dysfunction. During 12 months of follow-up, no ventricular arrhythmias were documented in either group.

Influence of Intraperitoneal Volume on QT Dispersion in Patients with Continuous Ambulatory Peritoneal Dialysis: Acute Cardiac Impact of Peritoneal Dialysis

Aim: The leading cause of mortality in dialysis patients is cardiovascular complications, including ventricular arrhythmias and sudden cardiac death. QT dispersion (QTd), a simple noninvasive arrhythmogenic marker, is used to assess homogeneity of cardiac repolarization. It was also significantly prolonged in continuous ambulatory peritoneal dialysis (CAPD) patients. The acute cardiac effect of increased abdominal pressure due to infused dialysate during CAPD is not clear yet. In this study we aimed to evaluate corrected QTd (cQTd) and cardiac injury markers such as plasma pro-brain natriuretic peptide (proBNP) and troponin I (TnI) in CAPD patients before and after an infusion of peritoneal dialysate fluid. Methods: Thirty subjects (16 women, 14 men; mean age, 40.21 ± 12.34 years) enrolled in our study. QTd, cQTd, maximum QT (QTmax), maximum corrected QT (cQTmax), minimum QT (QTmin), and minimum corrected QT (cQTmin) intervals were measured from standard 12-lead electrocardiography. Results: We found that cQTmax, cQTmin, and cQTd were not changed from baseline measurement after infusion of dialysate in CAPD patients (460 ± 49 vs. 460 ± 38, p = 0.9; 410 ± 36 vs. 410 ± 41, p = 0.8; 470 ± 30 vs. 460 ± 25, p = 0.7, respectively). There were no statistically significant differences between before and after peritoneal dialysate according to the levels of proBNP and TnI (155.64 ± 76.41 vs. 208.30 ± 118.46, p = 0.2; 0.008 ± 0.007 vs. 0.01 ± 0.011; p = 0.4, respectively). Conclusion: In conclusion, we did not find any significant effect of peritoneal dialysate fluid infusion volume on QTd and cardiac injury markers in patients with chronic renal failure receiving CAPD therapy, which is thought to be a safer modality of dialysis.

Prolonged QRS Duration in Lead V2 and Risk of Life-Threatening Ventricular Arrhythmia in Patients With Brugada Syndrome

Brugada syndrome is an inherited disorder that predisposes some patients to sudden cardiac death. It is not well established which Brugada syndrome patients are at risk of life-threatening arrhythmias. We investigated whether standard 12-lead electrocardiograms (ECG) can identify such patients. The subjects were 35 men with Brugada syndrome (mean age, 50.1 ± 12.4 years). Documented ventricular fibrillation or aborted sudden cardiac arrests were judged to be related to the Brugada syndrome. Ten patients (mean age, 49.6 ± 14.9 years) were symptomatic, and 25 (mean age, 50.3 ± 11.5 years) were asymptomatic. We determined the PR interval, QRS duration, and QT interval from baseline 12-lead ECG leads II and V2 as well as the J point elevation amplitude of lead V2. The QRS interval was measured from QRS onset to the J point in leads II and V2. The only significant difference between the symptomatic and asymptomatic patients was the QRS duration measured from lead V2. The mean QRS interval was 129.0 ± 23.9 ms in symptomatic patients versus 108.3 ± 15.9 ms in asymptomatic patients (P = 0.012). A QRS interval in lead V2 ≥ 120 ms was found to be a possible predictor of a life-threatening ventricular arrhythmia and/or syncope (P = 0.012). Prolonged QRS duration as measured on a standard 12-lead ECG is associated with ventricular arrhythmia and could serve as a simple noninvasive marker of vulnerability to life-threatening cardiac events in patients with Brugada syndrome.

Transient Elastography (Fibroscan®) In Adult Patients with Inherited Bleeding Disorders and Chronic Hepatitis C.

AbstractAbstract 1413Hepatitis virus C (HCV) infection is common in patients with inherited bleeding disorders due to the past use of plasma-derived clotting factor concentrates not treated with virucidal methods. The prognosis of the infection and the outcome of antiviral therapy are related to the stage of liver fibrosis. Since liver biopsy, the gold standard to grade fibrosis, is rarely performed in these patients for cost-benefit reasons, it is important to consider non invasive methods to assess fibrosis such as liver stiffness measurement with transient elastography (TE, Fibroscan®), a technique already validated in non hemophilic patients. We measured TE in 170 patients with inherited bleeding disorders and HCV infection (positive serum HCV-RNA). The main characteristics of these patients are reported in the Table. Steatosis was detected by abdominal ultrasound. Cirrhosis was defined by the presence of irregular liver edge, splenomegaly, dilated portal vein and/or esophageal varices combined either with low platelet count and/or reduced albumin/cholinesterase levels. TE was successfully performed in all but 3 patients, 2 of whom for Body Mass Index (BMI) > 30 kg/m2. Overall, the median value of liver stiffness was 7.2 kPa (interquartile range, IQR: 5.3–11.1) with a median success rate of 100% (IQR: 91–100) and a median IQR value of 1.0 (IQR: 0.7–1.9). HCV genotype or the presence of steatosis did not influence the TE values, whereas higher values were observed in patients with cirrhosis than in those without (median 19.8 kPa, IQR: 14.3–28.1 vs 6.8 kPa, IQR: 5.1–9.1, respectively; p< 0.01). In particular, 18/22 (82%) cirrhotic patients had a liver stiffness value ≥ 12.0 kPa, a cut-off previously identified as associated with severe fibrosis in HCV infected patients. Overall, splenomegaly was present in 51 patients (30%), 16 with cirrhosis and 35 without. In 31/35 (89%) of the latter, TE values were < 12 kPa. Moreover, among patients without cirrhosis, 12 (8%) had TE values ≥ 12 kPa: those patients had ALT and GGT levels significantly higher than patients with TE values < 12 kPa (p<0.05 for both variables). In our cohort TE had a 83% sensitivity, a 95% specificity and a 94% negative predictive value for the detection of severe fibrosis. In the same patients we measured the aspartate aminotransferase-to-platelet ratio index (APRI), a simple non-invasive biochemical marker of liver fibrosis. Median APRI values were significantly higher in patients with cirrhosis than in those without (1.6 vs 0.5, respectively; p<0.01), and a value > 1.5 was observed in 12/22 (55%) patients with cirrhosis. An APRI >1.5 had a 96% specificity and a 93% negative predictive value for the detection of severe fibrosis. Univariate and multivariate linear regression analyses were performed to investigate the relationship between log transformed TE and demographic (age, BMI) or laboratory (ALT, GGT, APRI) variables potentially influencing the TE values. By univariate analysis a linear association was found with age, ALT, GGT, APRI and BMI values (p<0.01 for each). In multivariate analysis APRI, ALT and GGT showed the strongest association with TE, while the statistical significance for BMI and age was marginal. The entire model explained about 50% of the variance of TE (R2= 0.49). Our results confirm that TE is a good tool to assess liver fibrosis also in patients with inherited bleeding disorders and chronic hepatitis C and shows that it can be performed safely in a great proportion of patients with a high success rate. The value of biochemical markers of necroinflammation (such as ALT and GGT) at the time of TE performance may influence the result and should be taken into account in the interpretation of the test.Patients characteristicsMale sex, n (%)162 (95)Bleeding disorderHemophilia A, n (%)139 (82)Hemophilia B, n (%)20 (12)Von Willebrand disease, n (%)11 (6)Median age, years (IQR)41 (34–51)Median liver disease duration, years (IQR)34 (30–38)Median BMI, kg/m2 (IQR)23.5 (21.7–25.4)HCV genotype1, n (%)130 (77)2, n (%)14 (8)3, n (%)22 (13)4, n (%)4 (2)Co-infectionsHIV, n (%)46 (27)HBV, n (%)5 (3)Steatosis, n (%)83 (49)Cirrhosis, n (%)22 (13)Median ALT, (IQR)61 (40–92)Median GGT, (IQR)46 (23–97) Disclosures:No relevant conflicts of interest to declare.

Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers: Results of a multicenter, large-scale study

Preliminary data suggest that non-invasive methods could be useful to assess presence of oesophageal varices (OV) in cirrhotic patients. We aimed to further investigate simple serum non-invasive markers for diagnosing and grading OV. A retrospective set of 510 cirrhotics and a prospective set of 110 cirrhotics were enrolled consecutively in five centers. Platelets, AST-to-ALT ratio, AST-to-platelet-ratio index, Forns' index, Lok index, Fib-4, and Fibroindex were measured within 2 months from upper endoscopy, taken as a gold standard. Performance was expressed as sensitivity, specificity, positive, and negative predictive values (PPV, NPV), accuracy, and area under the curve (AUC). A combination of Lok index (cutoff=1.5) and Forns' index (cutoff=8.8) had 0.80 AUC (0.76-0.84, 95% CI), and high NPV (>90%) to exclude clinically relevant OV, defined as large OV or small OV with red signs or in Child-Pugh C cirrhosis. By applying this combination, upper endoscopy would have been avoided in 1/3 of our cirrhotics. Large OV could be excluded with 96% NPV by Lok index (cutoff=1.5). A combination of Lok index (cutoff=0.9) and Forns' index (cutoff=8.5) predicted presence of any grade OV with good performance: 0.82 AUC (0.76-0.88, 95% CI), 88% PPV. Serum non-invasive markers may be useful as a first line tool to identify cirrhotic patients in which the risk of clinically relevant OV is trivial, and to reduce the number of upper endoscopies. However, we are still far from the possibility of replacing upper endoscopy by simple serum non-invasive markers in the vast majority of patients.

QT dispersion and transmural dispersion of repolarization in patients with familial Mediterranean fever

Familial Mediterranean fever (FMF) is a disease characterized by sporadic, paroxysmal attacks of fever and serosal inflammation. QT dispersion (QTd) and transmural dispersion of repolarization (TDR), simple noninvasive arrhythmogenic markers, that can be used to assess homogeneity of cardiac repolarization, have not been studied in FMF patients before. The aim of our study was to evaluate the QTd and TDR in FMF patients without overt cardiac involvement. A total of 50 patients with FMF (30 men, 20 women, 29.4 ± 11.8 years) and 50 controls (30 men, 20 women; mean age 31.3 ± 11.9 years) were included. QTd, corrected QTd (cQTd), maximum QT (QTmax), maximum corrected QT (cQTmax), minimum QT (QTmin), and minimum corrected QT intervals (cQTmin) and TDR were measured from standard 12-lead electrocardiography (ECG). We found that QTd, QTmax, and TDR were greater in FMF patients than in the control group (36.0 ± 11.4 vs. 20 ± 11.2, P < 0.001 and 354.8 ± 30.9 vs. 342.8 ± 18.0, P = 0.02; 62.0 ± 16.0 vs. 49.0 ± 9.5 P < 0.001, respectively), as were cQTd and cQTmax (40.4 ± 13.5 vs. 21.9 ± 12.4, P < 0.001 and 397.7 ± 40.2 vs. 375.5 ± 25.4 P = 0.001). A modest positive correlation was found between cQTd and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) (r = 0.30, P < 0.001; r = 0.40, P < 0.001; respectively). QTd, which is an index of inhomogeneity of ventricular repolarization and an important predictor of cardiovascular mortality, and TDR, which is a better marker of cardiac repolarization, increased in FMF patients similarly as in other rheumatologic diseases.

QT dispersion and transmural dispersion of repolarization in patients with familial Mediterranean fever

Familial Mediterranean fever (FMF) is a disease characterized by sporadic, paroxysmal attacks of fever and serosal inflammation. QT dispersion (QTd) and transmural dispersion of repolarization (TDR), simple noninvasive arrhythmogenic markers, that can be used to assess homogeneity of cardiac repolarization, have not been studied in FMF patients before. The aim of our study was to evaluate the QTd and TDR in FMF patients without overt cardiac involvement. A total of 50 patients with FMF (30 men, 20 women, 29.4 +/- 11.8 years) and 50 controls (30 men, 20 women; mean age 31.3 +/- 11.9 years) were included. QTd, corrected QTd (cQTd), maximum QT (QTmax), maximum corrected QT (cQTmax), minimum QT (QTmin), and minimum corrected QT intervals (cQTmin) and TDR were measured from standard 12-lead electrocardiography (ECG). We found that QTd, QTmax, and TDR were greater in FMF patients than in the control group (36.0 +/- 11.4 vs. 20 +/- 11.2, P < 0.001 and 354.8 +/- 30.9 vs. 342.8 +/- 18.0, P = 0.02; 62.0 +/- 16.0 vs. 49.0 +/- 9.5 P < 0.001, respectively), as were cQTd and cQTmax (40.4 +/- 13.5 vs. 21.9 +/- 12.4, P < 0.001 and 397.7 +/- 40.2 vs. 375.5 +/- 25.4 P = 0.001). A modest positive correlation was found between cQTd and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) (r = 0.30, P < 0.001; r = 0.40, P < 0.001; respectively). QTd, which is an index of inhomogeneity of ventricular repolarization and an important predictor of cardiovascular mortality, and TDR, which is a better marker of cardiac repolarization, increased in FMF patients similarly as in other rheumatologic diseases.

Syndecan 1 (CD138) serum levels: a novel biomarker in predicting liver fibrosis stage in patients with hepatitis C

Syndecan 1 (CD 138) is a cell surface proteoglycan shed by cells in several pathological conditions, including wound healing. The aim of this study was to test whether CD138 could serve as a non-invasive marker for detection of liver fibrosis and thereby reduce the need for liver biopsy. An estimation set of 134 patients and a validation set of 67 patients with chronic hepatitis C were studied. There were 80 normal healthy volunteers. Patients were staged according to liver biopsies (Metavir fibrosis staging, stage F0, n=35; F1, n=40; F2, n=37, F3, n=39; F4, n=51). Serum CD138 levels were retrospectively measured by enzyme-linked immunoabsorbent assay the same day of the liver biopsy. The primary endpoints were the diagnostic values of CD138 for F2-F4, F3-F4 and F4. Respective areas under receiver operating characteristic curve of CD138 for F2-F4, F3-F4 and F4 diagnosis were 0.82, 0.76 and 0.81. CD138 had a positive predictive value of 82% for F2-F4 diagnosis and a high negative predictive value (86%) and specificity (84%) for exclusion of F4. CD138 is a new simple non-invasive marker for predicting liver fibrosis in patients with chronic hepatitis C. The relevance of this marker in combination with other fibrosis markers should be explored.

Prediction of oesophageal varices in hepatic cirrhosis by using simple non-invasive markers: Results of a multicentre, international study

Prediction of oesophageal varices in hepatic cirrhosis by using simple non-invasive markers: Results of a multicentre, international study

Serum hyaluronic acid: A promising marker of hepatic fibrosis in chronic hepatitis B

Serum hyaluronic acid: A promising marker of hepatic fibrosis in chronic hepatitis B

Nitrites in induced sputum as a simple and cheap non-invasive marker of airway inflammation for asthmatic schoolchildren

To determine if there are differences in the nitric oxide metabolites (nitrites) in sputum of patients with persistent asthma and healthy schoolchildren, we performed a case-control study in a tertiary care hospital in Arequipa, Perú. Nitrites in induced sputum samples were measured using the Griess assay in 30 persistent asthmatics (mean age of 10.1 yr) and 30 controls (mean age of 11.9 yr). The mean +/- s.d. of nitrites among asthmatics was significantly higher than the controls (16.30 +/- 8.6 vs. 10.25 +/- 4.68 nmol/ml, respectively, p = 0.001). Moreover, the nitrite level in the sputum in children with severe persistent asthma was higher than in the level found in the moderate and mild asthmatics (32.83 +/- 9.48 vs. 18.10 +/- 1.96 vs. 11.84 +/- 4.73 nmol/ml, respectively, p < 0.01 for linear trend). This study showed for the first time in children that asthmatics have significantly higher levels of nitrites in induced sputum than healthy controls and that the level of nitrite correlates with the severity of the asthma. Nitrite levels in sputum, a simple and cheap, non-invasive method, may be a good alternative to measure the severity of inflammation in asthmatic children.

Differences in 12‐Lead Electrocardiogram Between Symptomatic and Asymptomatic Brugada Syndrome Patients

Brugada syndrome (BrS) is an inherited disorder that predisposes some subjects to sudden cardiac death (SCD). It is not well established which BrS patients are at risk of severe arrhythmias. Our aim was to study whether standard 12-lead electrocardiogram (ECG) would give useful information for this purpose. This study included 200 BrS probands (142 male, 62%; mean age 42 +/- 16 years). Symptoms related to BrS were defined as syncope, documented ventricular tachyarrhythmia, or SCD. We determined PR, QRS, QTc, T(peak), and T(end) interval from leads II and V(2) and QRS from lead V(5), R'/S ratio from lead aVR (aVR sign), QRS axis, and J-point elevation amplitude from right precordial leads from the baseline ECGs. Sixty-six subjects (33%) had experienced symptoms related to BrS. The only significant difference between the symptomatic and asymptomatic BrS subjects was the QRS duration measured from lead II or lead V(2), for example, the mean QRS in V(2) was 115 +/- 26 ms in symptomatic versus 104 +/- 19 ms in asymptomatic patients (P < 0.001). The optimized cut-off point of V(2) QRS > or =120 ms gave an odds ratio (OR) of 2.5 (95% CI: 1.4-4.6, P = 0.003) for being symptomatic. In a multivariate analysis adjusted with gender, age, and SCN5A mutation, the OR was 2.6 (95% CI: 1.4-4.8, P = 0.004). Prolonged QRS duration, measured from standard 12-lead ECG, is associated with symptoms and could serve as a simple noninvasive risk marker of vulnerability to life-threatening ventricular arrhythmias in BrS.

Can We Predict Esophageal Varices in Patients with Advanced Liver Disease Using Platelet Count?

Purpose: Gastroesophageal varices are present in about 50% of patients with cirrhosis (85% in Childs C and 40% Childs A). VA guidelines recommend esophagogastroduodenoscopy (EGD) for patients with cirrhosis to look for the presence of varices every 2 years. Above guidelines led to a significant increase in EGD. Some of the non invasive markers, studied are spleen size, portal vein flow on ultrasonography, which are very operator dependent, and some times not very helpful in community setting. Stratifying the cirrhotic in high and low risk for varices using simple noninvasive marker, like platelet count, might lead to more efficient and cost effective utilization of EGD. Methods: All patients with cirrhosis were prospectively evaluated as part of an IRB approved protocol. Informed consent was obtained. Patients with clinical evidence of portal hypertension or previously documented varices, as well as patients with co morbidities that can affect the hematological parameters were excluded from the study. Information was collected regarding demographics, medical and surgical history. Significant laboratory values and ultrasonography findings were recorded. All patients underwent EGD for evaluation for varices. All EGDs were performed by one of 2 endoscopists in the presence of a second endoscopist to confirm presence or absence of varices. Results: We are reporting our preliminary data on the association of platelet number with the presence of varices. Age of patients varied from 48 to 80 years with mean of 59 years ± 1.8 (±SEM). A total of 26 patients were studied of which, 8 (31%) had esophageal or gastric varices. The platelet count ranged from 66 to 290 with mean of 147 ± 11 (±SEM). Analysis was done using bivariate correlation using Pearson correlation coefficients. There was a positive correlation coefficient of 0.520, between platelet count of < 100K and presence of varices which was significant with p <.05. Subsequent analysis using platelet cutoff of 125K and 150 K did not show a significant correlation with presence of varices. The platelt count of ≤100, had positive predictive value of 71% for presence of varices. Conclusions: Our preliminary data suggest that patients with platelet counts of less than 100 are more likely to have clinically significant varices on upper endoscopy. If this is further confirmed by larger sample size, we can avoid EGDs in a large proportion of patients by utilizing a simple laboratory value i.e. platelet count.

QT Dispersion Increases with Aging

Age-related changes in cardiovascular system are well-known. Arrhythmias in elderly patients constitute most of the urgencies, consultations, or hospitalizations. QT dispersion (QTd) is a simple noninvasive arrhythmogenic marker to demonstrate the electrical instability of the heart. The aim of this study was to investigate how QTd changes with increasing age by calculating the QTd in the elderly and younger subjects. One hundred and forty-six consecutive subjects (62 males and 84 females; age range: 18-82 years) were enrolled in the study. Sixty-seven of the subjects were 65 years and over (mean age, 70 +/- 4), 79 were younger than 65 (mean age, 37 +/- 11). A 12-lead ECG was recorded. The longest and the shortest QT intervals were measured manually on these ECG recordings. QTd was calculated from the formula, QTd = QTmax - QTmin. Demographic features were similar between the two groups. QTd of the elderly group was found to be significantly higher than the younger group (35.6 +/- 15.6 in elderly, 24.2 +/- 12.4 in younger group, P < 0.001). A positive relationship was found between QTd and age (r = 0.415, P < 0.001). QTd was greater in female than in male (31.9 +/- 16.7 ms vs 26.0 +/- 11.3 ms, respectively, P = 0.018). Our study shows that QTd increases with advancing age. We think that long-term follow-up of these patients would be useful to show if there is any relationship between the clinical outcomes and the increase in QTd.

E9/324 – Serum S-100 proteins (A12 and calprotectin) are associated with bronchoalveolar lavage evidence of airway infection and inflammation in young children with cystic fibrosis and are potential simple non-invasive markers of early lung disease

E9/324 – Serum S-100 proteins (A12 and calprotectin) are associated with bronchoalveolar lavage evidence of airway infection and inflammation in young children with cystic fibrosis and are potential simple non-invasive markers of early lung disease

THE EFFICACY OF SERUM HYALURONIC ACID LEVEL IN PREDICTION OF HEPATIC HISTOPATHOLOGY

Introduction: Fibrosis associated with chronic liver diseases is an insidious process involving inflammatory responses and alterations in the extracellular matrix (EM). Hyaluronic acid (HA) is a basic component of EM of the liver and it was thought that increased serum levels of HA might indicate hepatic fibrosis as a simple non-invasive marker. Aim: The objective of the current study was to investigate the efficacy of serum HA level to predict the histopathological changes, observed in liver biopsies in children with chronic liver diseases, and to determine the relationships between serum HA level and age, sex, etiology of liver disease, and biochemical parameters. Method: The study group consisted of 34 children with clinical and laboratory findings of chronic liver disease with a mean age of 65.31 ± 64 months. All children underwent liver biopsies for diagnostic purposes. The biopsies were stained by hematoxylin-eosin, reticulin and trichrome staining and evaluated blindly by the same pathologist. The degree of fibrosis on biopsy specimens was graded 0 (no fibrosis) to IV according to the Knodell hepatic activity index. The degree of inflammation and reticulin structure was also graded semi-quantitatively. Simultaneously blood samples were obtained just before the liver biopsy for the measurement of HA levels and biochemical tests. Forty-one healthy children were included into the control group. Results: Histopathological examination of 34 biopsy samples revealed stage I fibrosis in 6 patients, stage II fibrosis in 4 patients, stage III fibrosis in 8 patients, stage IV fibrosis in 1 patients, and no fibrosis was found in remaining 15 patients. The average serum level of HA was 79.25 ± 72.65 ng/ml in the study group, while serum HA level was 5.5 ± 6.4 ng/ml in the control group. The difference was statistically significant (p < 0.0001). The average levels of HA regarding the severity of fibrosis were 56.9, 52.6, 146 ng/ml in grade 0, I-II, III-IV fibrosis, respectively. There was a statistically significant correlation between the degree of fibrosis and the serum HA levels (p < 0.05). When the patients were categorized according to the etiologies of chronic liver disease (hepatitis B, metabolic diseases, biliary pathologies, neonatal hepatitis, autoimmune hepatitis and others) the average serum HA level was higher in patients with biliary pathologies when compared to the other groups (p < 0.01). Since there was a statistically significant difference between serum HA a level of children with chronic liver disease and controls, the reticulin stained liver biopsies were evaluated for condensation and collapse of reticulin fibers, and various degree of collapse in reticulin meshwork was found in all biopsy samples. There was no statistically significant correlation between the levels of HA and degree of inflammatory activity in biopsy samples and the characteristics of study group such as age, sex and liver function tests. Summary: Current study suggests that serum HA level may indicate the presence of chronic liver pathology as a noninvasive marker. Patients with grade III-IV fibrosis had the highest serum HA levels. Although serum HA levels were higher in patients with mild fibrosis when compared to controls, the statistical significance of serum HA level as a noninvasive marker became more prominent in children with moderate to severe fibrosis. Conclusion: Detection of a higher serum HA levels in children with liver fibrosis with respect to healthy controls may indicate that serum HA level may be used as a marker in chronic pathologies of the liver.