scholarly journals Noninvasive Evaluation of Liver Fibrosis in a Sample of Putative Inactive HBV Carriers in Rome, Italy

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Marco Delle Monache ◽  
Alessio Petrelli ◽  
Alessandra Rossi ◽  
Roberto Cecere ◽  
Concetta Mirisola ◽  
...  
Keyword(s):  
Liver Disease ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Demographic Variables ◽  
Hbv Dna ◽  
Noninvasive Evaluation ◽  
Noninvasive Methods ◽  
Hbsag Carriers ◽  
Risk Of Progression ◽  
Outpatient Departments

Background. Noninvasive methods are useful for investigating patients with chronic HBV infection. The severity of liver disease in inactive HBsAg carriers can be noninvasively assessed by transient elastography (TE) alone or in association with biochemical markers of fibrosis. Objectives. The study evaluates the effectiveness of the TE compared to common fibrosis scores (FSs), APRI, Forns Index, and FIB4, for identifying significant fibrosis in Italian and foreigner HBsAg carriers. To investigate the risk of progression of the liver disease, liver stiffness (LS) and HBV-DNA were monitored over time. Methods. Viral load, biochemical parameters, and LS have been retrospectively evaluated in 125 putative inactive HBV carriers, who visited two outpatient departments (Colleferro Hospital and INMP) from 01/03/2014 to 31/12/2019. Differences in clinical, biochemical, and demographic variables between Italians and foreigners were analyzed. 66 of 125 patients were followed up for 24 months by monitoring liver stiffness and HBV-DNA. Results. Mean overall LS was 5.55 ± 1.92 kPa; 18 (14.4%) patients had a LS ≥7.5 kPa. Mean of APRI, Forns, and FIB4 was 0.29 ± 0.11, 4.15 ± 1.63, and 1.16 ± 0.59, respectively. FS did not differ between the patients with LS <7.5 kPa and those with LS ≥7.5 kPa. Italians displayed a significant lower ALT (0.53 ± 0.18 vs. 0.67 ± 0.33, p < 0.05 ) and AST (0.59 ± 0.16 vs. 0.70 ± 0.21, p < 0.01 ) value than foreigners. No differences in LS and HBV-DNA levels were observed. In 66 patients followed up for 24 months, HBV-DNA increased by ≥2000 UI/ml after 12 months in 15 individuals and remained ≥2000 UI/ml after 24 months in 10/15 individuals. 7/10 patients showed LS ≥ 7.5 kPa after 24 months, and 4 of them underwent antiviral therapy for HBV. Patients with HBV-DNA <2000 IU/ml had a significantly lower LS than those with HBV-DNA ≥2000 IU/ml (5.30 ± 1.43 vs. 7.69 ± 1.07, p < 0.0001 ). Conclusions. Analysis shows lower effectiveness of FS vs. TE in the assessment of putative inactive HBV carriers. Furthermore, using FibroScan® and HBV-DNA can identify “false” inactive carriers.

scholarly journals Noninvasive Methods, including Transient Elastography, for the Detection of Liver Disease in Adults with Cystic Fibrosis

2015 ◽  
Vol 29 (3) ◽  
pp. 139-144 ◽  
Author(s):  
Matthew D Sadler ◽  
Pam Crotty ◽  
Linda Fatovich ◽  
Stephanie Wilson ◽  
Harvey R Rabin ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Liver Disease ◽  
Diagnostic Performance ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Roc Curves ◽  
Noninvasive Methods ◽  
Predictive Values ◽  
Area Under Roc Curve ◽  
Sensitivity Specificity

BACKGROUND: Liver disease is the third leading cause of mortality in patients with cystic fibrosis (CF). However, detection of CF-associated liver disease (CFLD) is challenging.OBJECTIVE: To evaluate the diagnostic performance of noninvasive methods for the detection of CFLD with a focus on transient elastography (TE).METHODS: Patients at the Adult CF Clinic of Calgary and Southern Alberta (n=127) underwent liver stiffness measurement (LSM) by TE using the FibroScan (FS, Ecosens, France) M probe; aspartate amino-transferase to platelet ratio index (APRI) and FibroTest (FT) scores were also calculated. The diagnostic performance of these tools for the detection of CFLD (defined as two or more the following criteria: abnormal liver biochemistry, hepatomegaly or sonographic abnormalities other than steatosis) were compared using the area under ROC curves.RESULTS: Forty-seven percent of the cohort was male. The median age was 27 years (interquartile range [IQR] 22 to 37 years) and body mass index 21 kg/m2(IQR 19 kg/m2to 23 kg/m2); 25% of patients were on ursodeoxycholic acid and 12% had undergone lung transplantation. The prevalence of CFLD was 14% (n=18). FS was successful in all patients; one (0.8%) patient had poorly reliable results (IQR/M >30% and LSM ≥7.1kPa). Compared with patients without CFLD (n=109), individuals with CFLD had higher median LSM according to FS (3.9 kPa [IQR 3.4 to 4.9 kPa] versus 6.4 kPa [IQR 4.4 to 8.0 kPa]), APRI (0.24 [IQR 0.17 to 0.31] versus 0.50 [IQR 0.22 to 1.18]) and FT scores (0.08 [IQR 0.05 to 1.5] versus 0.18 [IQR 0.11 to 0.35]; all P<0.05). Area under ROC curve for FS, APRI and FT for the detection of CFLD were 0.78 (95% CI 0.65 to 0.92), 0.72 (95% CI 0.56 to 0.87) and 0.76 (95% CI 0.62 to 0.90) (P not significant). At a threshold of >5.2 kPa, the sensitivity, specificity, positive and negative predictive values of LSM according to FS for detecting CFLD were 67%, 83%, 40% and 94%, respectively.CONCLUSIONS: FS, APRI and FT were useful noninvasive methods for detecting CFLD in adults.

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 Noninvasive Evaluation of Portal Hypertension Using a Supervised Learning Technique

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Mindaugas Marozas ◽  
Romanas Zykus ◽  
Andrius Sakalauskas ◽  
Limas Kupčinskas ◽  
Arūnas Lukoševičius
Keyword(s):  
Portal Hypertension ◽  
Supervised Learning ◽  
Evaluation Method ◽  
Clinical Laboratory ◽  
Transient Elastography ◽  
Venous Pressure ◽  
Noninvasive Evaluation ◽  
Noninvasive Methods ◽  
Supervised Learning Algorithms ◽  
Clinically Significant

Portal hypertension (PHT) is a key event in the evolution of different chronic liver diseases and leads to the morbidity and mortality of patients. The traditional reliable PHT evaluation method is a hepatic venous pressure gradient (HVPG) measurement, which is invasive and not always available or acceptable to patients. The HVPG measurement is relatively expensive and depends on the experience of the physician. There are many potential noninvasive methods to predict PHT, of which liver transient elastography is determined to be the most accurate; however, even transient elastography lacks the accuracy to be a perfect noninvasive diagnostic method of PHT. In this research, we are focusing on noninvasive PHT assessment methods that rely on selected best-supervised learning algorithms which use a wide set of noninvasively obtained data, including demographical, clinical, laboratory, instrumental, and transient elastography measurements. In order to build the best performing classification meta-algorithm, a set of 21 classification algorithms have been tested. The problem was expanded by selecting the best performing clinical attributes using algorithm-specific filtering methods that give the lowest error rate to predict clinically significant PHT. The suggested meta-algorithm objectively outperforms other methods found in literature and can be a good substitute for invasive PHT evaluation methods.

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.

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