Letter to the Editor: Liver stiffness by transient elastography to detect porto‐sinusoidal vascular liver disease

Hepatology ◽  
2021 ◽  
Author(s):  
Lianqing Lou ◽  
Xiaofei Li
Keyword(s):  
Liver Disease ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Letter To The Editor

ASSESSMENT OF LIVER FIBROSIS IN ALCOHOLIC PATIENTS BY USING FIBROSCAN IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 43-47
Author(s):  
Veenit Kumar Prasad ◽  
Bapilal Bala ◽  
Biswadev Basumazumder ◽  
Achintya Narayan Ray
Keyword(s):  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
Transient Elastography ◽  
Wide Spectrum ◽  
Tertiary Care ◽  
Disease Patient ◽  
Liver Stiffness ◽  
Care Hospital ◽  
Non Invasive ◽  
Number Of Patients

INTRODUCTION: Alcoholic liver disease is one of the major causes of premature deaths worldwide. Alcohol induced liver injury is the most prevalent cause of liver disease and effects 10% to 20% of population worldwide. Alcoholic liver disease comprises a wide spectrum of pathological changes ranging from steatosis, alcoholicsteato-hepatitis, Cirrhosis and nally hepatocellular carcinoma. Our aims in this study are to detect this change by non invasive method by liver broscan and its clinical implications. MATERIALS AND METHODS: Total 200 patients were taken for observational study, conducted at Coochbehar Government Medical college and hospital both outpatient department and indoor patients from May 2019 to January 2020. Liver stiffness was assessed by ultrasound based method of transient elastography using Fibroscan machine. Gradation of liver stiffness was expressed in kilopascals (KPa). RESULTS: Maximum number of patients of alcoholic liver disease were between 40 - 49 years of age (42.5%). Male patients is 87.5% and female patients 12.5%. distribution of Rural population is 36 % and Urban population is 64%. Majority of population85 patients (42.5%) had fatty liver and 40 patients (20%) have hepatomegaly, 41 patients (20.5%) had Coarse echotexture of liver parenchyma and 54 patients (27%) had Splenomegaly, 62 patients (31%) had Nodular liver and 62 patients. It is observed that 11 patients (5.5%) had Fibroscan score ≤7.5 and 47 patients (23.5%) had broscan score 7.6 -9.9 and 40 patients (20%) had broscan score 10-12.4, 36 patients (18 %) had broscan score 12.5 – 14.6 and 66 patients (33%) have broscan score ≥ 14.7. CONCLUSIONS: Transient Elastography (TE) is a newer non invasive assessment technique to detect the progression of brosis or brosis in alcoholic liver disease patient. Major advantage is it is noninvasive (costeffective) so that we can early detect progression of this cirrhosis and can give efforts to halt the disease progression.

scholarly journals Low Sensitivity to Thrombomodulin Correlates with Liver Stiffness in Advanced Chronic Liver Disease

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4948-4948
Author(s):  
Justine Brodard ◽  
Sara Calzavarini ◽  
Andrea de Gottardi ◽  
Anne Angelillo-Scherrer
Keyword(s):  
Liver Disease ◽  
Discriminant Analysis ◽  
Chronic Liver Disease ◽  
Thrombin Generation ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Study Groups ◽  
Lower Sensitivity ◽  
Clinically Significant ◽  
Low Sensitivity

Advanced chronic liver disease (ACLD) is characterized by changes in the coagulation system that embrace not only hypo-, but also hyper-coagulability. Global hemostatic tests such as thrombin generation (TG) assays are used to evaluate the hemostatic balance, in order to better assess bleeding and thrombotic risks. In addition, procoagulant state in ACLD patients has been demonstrated using modified TG assays with thrombomodulin (TM), a cofactor for protein C activation. Evaluation of the liver stiffness by transient elastography (Fibroscan) is a reliable method for the diagnosis of cirrhosis and disease staging. Increased liver stiffness is associated with clinically significant portal hypertension (PVT) in patients with ACLD. Here, we aimed to investigate whether TG parameters in patients with ACLD could be associated to liver stiffness. Of 147 enrolled patients with ACLD, we excluded 69 patients (5 patients received anticoagulation, 3 were on chemotherapy, 48 with other liver diseases and 13 had a history of orthotopic liver transplantation), leaving a study sample of 78 patients. Liver stiffness measurement (LSM) was performed by transient elastography in each patient. Cut-offs of 13 and 21 kPa were used to subgroup the studied ACLD patients sample, as a LSM of ≥13 kPa has been associated with the diagnosis of cirrhosis and ≥21 kPa with the development of a clinically significant PVT (Deillon et al., 2019). TG was evaluated by ST Genesia® Thrombin Generation System (STG) using Thromboscreen with/without TM (TS-TM/+TM) assay and the Calibrated Automated Thrombography (CAT) using PPP reagent low (Stago) with/without TM. TG was measured by STG in 50 patients with ACLD. ETP inhibition by TM correlated with LSM (r =-0.339, p=0.0184). The discriminant analysis (ANOVA with multiple comparison) among the study groups showed that ETP inhibition by TM was higher in ACLD patients with LSM <13 kPa than in those with LSM ≥13 but <21 kPa (p=0.003), indicating a lower sensitivity to TM in patients with liver stiffness values ≥13 but <21 kPa. However, there was no difference in ETP inhibition by TM between the group with LSM ≥13 but <21 kPa and the group with LSM ≥21 kPa (p=0.995). TG was measured by CAT in 56 patients with ACLD and ETP inhibition by TM was evaluated using a normalized ETP ratio in presence and in absence of TM. Similarly to STG data, ETP inhibition by TM measured by CAT correlated with LSM (r=0.4108, p=0.0018). The discriminant analysis among the study groups revealed that ETP inhibition by TM was higher in ACLD patients with LSM <13 kPa than in those with ≥13 but <21 kPa (p=0.0098) as well as with the group with LSM ≥21kPa (p=0.0022), indicating a lower sensitivity to TM in patients with liver stiffness values ≥13 kPa. However, there was no difference in ETP inhibition by TM between the group with LSM ≥13 but <21 and the group with LSM ≥21 kPa (p=0.721). In addition, TG was measured by both by STG and CAT in 35 patients with ACLD in order to compare the two methods. ETP inhibition by TM measured by STG correlated with the normalized ETP inhibition determined by CAT (r = -0.61, p<0.0001). Low sensitivity to TM measured in ST Genesia® and CAT, correlated with liver stiffness in patients with ACLD. Sensitivity to TM discriminated between ACLD groups with low (≤13 kPa) and high (≥13 kPa) LSM, confirming a procoagulant state in patients with ALCD. However, it did not differ between patients with ACLD with high LSM (≥13 and <21 kPa) and patients prone to the decompensation defined by higher (≥21 kPa) LSM. Sensitivity to TM measurements determined by ST Genesia® correlated with those obtained with CAT. Further studies are needed to determine whether sensitivity to TM and LSM in patients with ACLD could help to identify patients at higher risk of portal vein thrombosis Disclosures No relevant conflicts of interest to declare.

Repeating measurements by transient elastography in non-alcoholic fatty liver disease patients with high liver stiffness

2018 ◽  
Vol 34 (1) ◽  
pp. 241-248 ◽  
Author(s):  
Jeremy Chak-Lun Chow ◽  
Grace Lai-Hung Wong ◽  
Anthony Wing-Hung Chan ◽  
Sally She-Ting Shu ◽  
Carmen Ka-Man Chan ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease ◽  
High Liver

Reliability of Transient Elastography-Based Liver Stiffness for Diagnosing Portal Hypertension in Patients with Alcoholic Liver Disease: A Diagnostic Meta-Analysis with Specific Cut-Off Values

2019 ◽  
Vol 41 (01) ◽  
pp. 60-68 ◽  
Author(s):  
Jinzhen Song ◽  
Zida Ma ◽  
Jianbo Huang ◽  
Yan Luo ◽  
Romanas Zykus ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Sensitivity And Specificity ◽  
Alcoholic Liver Disease ◽  
Transient Elastography ◽  
Meta Analysis ◽  
Liver Stiffness ◽  
Cochrane Library ◽  
Bivariate Model ◽  
Disease Etiology

Abstract Background Transient elastography-based liver stiffness value (TE-LSV) has been studied for the diagnosis of portal hypertension. Liver stiffness is influenced by the disease etiology. We aimed to perform a meta-analysis to determine the performance of TE-LSV for diagnosing portal hypertension in patients with alcoholic liver disease (ALD). Methods We searched PubMed, Web of Science, Ovid and Cochrane library. A bivariate model was used to compute sensitivity and specificity. A random effects model was used to pool diagnostic odds ratios. Results 9 studies with 679 patients were included. The pooled sensitivity and specificity based on a cut-off value around 21.8 kPa for clinically significant portal hypertension (CSPH) were 0.89 (95 % confidence interval (CI), 0.83–0.93) and 0.71(95 % CI, 0.64–0.78), respectively. For severe portal hypertension (SPH), the pooled sensitivity and specificity for a cut-off value around 29.1 kPa were 0.88 (95 % CI, 0.83–0.92) and 0.74 (95 % CI, 0.67–0.81), respectively. Conclusion TE-LSV showed good performance for diagnosing portal hypertension in patients with ALD. The optimal cut-off value for CSPH and SPH was around 21.8 kPa and 29.1 kPa, respectively, and these two cut-off values showed good sensitivity and modest specificity. The etiology should be clear before using TE-LSV for portal hypertension.

Unified interpretation of liver stiffness measurement by M and XL probes in non-alcoholic fatty liver disease

Gut ◽  
2019 ◽  
Vol 68 (11) ◽  
pp. 2057-2064 ◽  
Author(s):  
Vincent Wai-Sun Wong ◽  
Marie Irles ◽  
Grace Lai-Hung Wong ◽  
Sarah Shili ◽  
Anthony Wing-Hung Chan ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
The Body ◽  
Liver Stiffness Measurement ◽  
Alcoholic Fatty Liver ◽  
Stiffness Measurement ◽  
Alcoholic Fatty Liver Disease

ObjectiveThe latest model of vibration-controlled transient elastography (VCTE) automatically selects M or XL probe according to patients’ body built. We aim to test the application of a unified interpretation of VCTE results with probes appropriate for the body mass index (BMI) and hypothesise that this approach is not affected by hepatic steatosis.DesignWe prospectively recruited 496 patients with non-alcoholic fatty liver disease who underwent VCTE by both M and XL probes within 1 week before liver biopsy.Results391 (78.8%) and 433 (87.3%) patients had reliable liver stiffness measurement (LSM) (10 successful acquisitions and IQR:median ratio ≤0.30) by M and XL probes, respectively (p<0.001). The area under the receiver operating characteristic curves was similar between the two probes (0.75–0.88 for F2–4, 0.83–0.91 for F4). When used in the same patient, LSM by XL probe was lower than that by M probe (mean difference 2.3 kPa). In contrast, patients with BMI ≥30 kg/m2 had higher LSM regardless of the probe used. When M and XL probes were used in patients with BMI <30 and ≥30 kg/m2, respectively, they yielded nearly identical median LSM at each fibrosis stage and similar diagnostic performance. Severe steatosis did not increase LSM or the rate of false-positive diagnosis by XL probe.ConclusionHigh BMI but not severe steatosis increases LSM. The same LSM cut-offs can be used without further adjustment for steatosis when M and XL probes are used according to the appropriate BMI.

scholarly journals Ipragliflozin ameliorates liver damage in non-alcoholic fatty liver disease

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 402-409 ◽  
Author(s):  
Teruki Miyake ◽  
Sakiko Yoshida ◽  
Shinya Furukawa ◽  
Takenori Sakai ◽  
Fujimasa Tada ◽  
...  
Keyword(s):  
Body Weight ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Transient Elastography ◽  
Liver Steatosis ◽  
Liver Stiffness ◽  
Gamma Glutamyl Transpeptidase ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

AbstractBackgroundThere are few effective medications for non-alcoholic steatohepatitis (NASH). We investigated the efficacy of ipragliflozin (selective sodium-glucose cotransporter-2 inhibitor [SGLT2I]) for the treatment of patients with type 2 diabetes mellitus (T2DM) complicated by non-alcoholic fatty liver disease (NAFLD).MethodsWe prospectively enrolled patients with T2DM complicated by NAFLD treated at our institutions from January 2015 to December 2016. Patients received oral ipragliflozin (50 mg/day) once daily for 24 weeks. Body composition was evaluated using an InBody720 analyzer. We used transient elastography to measure liver stiffness and the controlled attenuation parameter for the quantification of liver steatosis in patients with NASH.ResultsForty-three patients with T2DM and NAFLD were enrolled (12 with biopsy-proven NASH and 31 with NAFLD diagnosed by ultrasonography). After 24 weeks, body weight, hemoglobin A1c (HbA1c), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase, body fat mass, and steatosis were significantly decreased compared to baseline measurements in patients with NASH. However, muscle mass was not reduced, and liver stiffness showed a statistically insignificant tendency to decrease. NAFLD patients also showed a significant reduction in body weight, HbA1c, AST, and ALT compared to baseline measurements. ConclusionIpragliflozin may be effective in patients with T2DM complicated by NAFLD.

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