Acoustic radiation force impulse elastography and liver fibrosis risk scores in severe obesity

ABSTRACT Objective: Identifying significant fibrosis is crucial to evaluate the prognosis and therapeutic interventions in patients with nonalcoholic fatty liver disease (NAFLD). We assessed the performance of acoustic radiation force impulse (ARFI) elastography, APRI, FIB-4, Forns, NFS and BARD scores in determining liver fibrosis in severe obesity. Subjects and methods: A prospective study included 108 patients undergoing bariatric surgery. Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score. Patients were assessed with serological markers and shear wave velocity of the liver was measured with the Siemens S2000 ultrasound system preoperatively. Optimal cut-off values were determined using the area under the receiver operating characteristic curves (AUROC). Results: In the entire cohort prevalence of NAFLD was 80.6%, steatohepatitis 25.9% and significant fibrosis 19.4%. The best tests for predicting significant fibrosis were FIB-4 and Forns scores (both AUROC 0.78), followed by APRI (AUROC 0.74), NFS (AUROC 0.68), BARD (AUROC 0.64) and ARFI (AUROC 0.62). ARFI elastography was successful in 73% of the patients. Higher body mass index (BMI) correlated with invalid ARFI measurements. In patients with BMI < 42 kg/m2, ARFI showed 92.3% sensitivity and 82,6% specificity for the presence of significant fibrosis, with AUROC 0.86 and cut-off 1.32 m/s. Conclusions: FIB-4 and Forns scores were the most accurate for the prediction of significant fibrosis in bariatric patients. Applicability and accuracy of ARFI was limited in individuals with severe obesity. In patients with BMI < 42 kg/m2, ARFI elastography was capable for predicting significant fibrosis with relevant accuracy.

Evaluación de la fibrogénesis hepática en pacientes con esteatohepatitis no alcohólica tratados con propóleos rojo oral cubano / Evaluation of hepatic fibrogenesis in patients with nonalcoholic steatohepatitis treated with cuban oral red propolis

Introducción: La enfermedad por depósito graso no alcohólica constituye una pandemia del mundo contemporáneo. Su espectro silente atraviesa estadios de cronicidad y puede llegar a la cirrosis hepática y sobre esta pudiera desarrollarse un hepatocarcinoma. No existen tratamientos y solo se puede actuar sobre los factores de riesgo. Objetivo: Evaluar el efecto citohepatoprotector y antifibrótico del propóleos rojo cubano oral en pacientes con esteatohepatitis no alcohólica. Métodos: Se realizó un estudio longitudinal prospectivo en pacientes seleccionados de las consultas de Gastroenterología, Endocrinología y Medicina Interna del Hospital Clínico Quirúrgico Hermanos Ameijeiras durante el periodo de abril 2017 a abril 2018. El universo de estudio fue de 120 pacientes con diagnóstico imagenológico de hígado graso. La muestra quedó conformada por 70 pacientes con diagnóstico de hígado graso, y que cumplieron criterios de inclusión y exclusión. Las pruebas estadísticas aplicadas fueron análisis de frecuencia y porcentaje para las variables demográficas. La prueba T para las muestras relacionadas evaluó el comportamiento enzimático al inicio y al final del tratamiento y los cambios elastográficos fueron analizados mediante test de Kappa y porcentaje. Resultados: Las variables bioquímicas estudiadas mostraron una disminución estadísticamente significativa al final del tratamiento. Los cambios elastográficos al final del estudio evidenciaron la efectividad del tratamiento, en el cual el 91,4 por ciento de los pacientes evolucionaron hacia el menor grado de fibrosis. Conclusiones: El propóleos rojo cubano demostró ser un apifármaco con acción citohepatoprotectora y antifibrótica de valor terapéutico(AU)

Introduction: Nonalcoholic fat deposition disease is a pandemic in the contemporary world. Its silent spectrum goes through stages of chronicity and it can reach liver cirrhosis and on this a hepatic carcinoma could develop. There are no treatments and medical handling can act on only risk factors. Objective: To evaluate cytohepatoprotective and antifibrotic effect of oral Cuban red propolis in patients with nonalcoholic steatohepatitis. Methods: A prospective longitudinal study was carried out in selected patients from the Gastroenterology, Endocrinology and Internal Medicine consultations at Hermanos Ameijeiras Clinical Surgical Hospital from April 2017 to April 2018. The study universe was 120 patients with imaging diagnosis of fatty liver. The sample consisted of 70 patients with fatty liver diagnosis, who met the inclusion and exclusion criteria. Frequency and percentage analysis for the demographic variables were the statistical tests applied. The T test for the related samples evaluated the enzymatic behavior at the beginning and at the end of the treatment and the elastography changes were analyzed using Kappa and percentage tests. Results: The biochemical variables studied showed statistically significant decrease at the end of the treatment, which evidenced the effectiveness of the treatment. 91.4 percent of the patients progressed to a lower degree of fibrosis. Conclusions: Cuban red propolis proved to be a therapeutic drug with cytohepathoprotective and antifibrotic action(AU)

Liver Elastography: Clinical Signifcance And Our Experience

INTRODUCTION: Chronic liver disease and cirrhosis affect millions of peoples worldwide, cause range from alcoholism, hepatitis B and hepatitis C and hepatotoxic drugs. Unfortunately, Chronic liver disease and cirrhosis have long latent period before their clinical presentation. The gold standard for assessment of liver fibrosis is biopsies which is not only expensive, painful and have potential for complications. They often need to be repeated for assessment of progression or resolution. Further liver biopsies rely on small tissue sample which can also yield inadequate results. By early detection of patients at risk of developing liver cirrhosis, we may be able to stop, delay and possibly revert progression of disease and reduce complications. Easy to do, noninvasive procedure and easily repeatable, liver elastography provides quantitative data to assess tissue stiffness which is virtual biopsy. The introduction of liver elastography is invaluable to reduce the requirement for liver biopsy, to allow for follow-up of patients undergoing new antiviral therapy with chronic liver disease, and to allow for preoperative assessment of those with liver cancer for optimal selection of therapy options. 1,2,3 Grey scale sonographic evaluation of liver morphology for the prediction of the presence and status of cirrhosis is invaluable but subjective . Furthermore, it is not uncommon to have normal appearing liver even with quite advanced disease. Historically, therefore, diagnosis and staging of liver cirrhosis have been performed based on invasive liver biopsy. At histology, liver fibrosis is graded from METAVIR stage F0, indicating a 4,5,6 normal liver, through to METAVIR stage F4, indicating cirrhosis . Patients with METAVIR stage F2 and F3 are felt to have clinically important fibrosis necessitating special attention and referral to hepatology service as these patients are at risk for portal hypertension, liver failure, and development of HCC. This article reviews the clinical significance of liver elastography, its advantage over gray scale ultrasonography and our experience.

Lobeglitazone, a Novel Thiazolidinedione, Improves Non-Alcoholic Fatty Liver Disease in Type 2 Diabetes: Its Efficacy and Predictive Factors Related to Responsiveness

Despite the rapidly increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D), few treatment modalities are currently available. We investigated the hepatic effects of the novel thiazolidinedione (TZDs), lobeglitazone (Duvie) in T2D patients with NAFLD. We recruited drug-naïve or metformin-treated T2D patients with NAFLD to conduct a multicenter, prospective, open-label, exploratory clinical trial. Transient liver elastography (Fibroscan®; Echosens, Paris, France) with controlled attenuation parameter (CAP) was used to non-invasively quantify hepatic fat contents. Fifty patients with CAP values above 250 dB/m were treated once daily with 0.5 mg lobeglitazone for 24 weeks. The primary endpoint was a decline in CAP values, and secondary endpoints included changes in components of glycemic, lipid, and liver profiles. Lobeglitazone-treated patients showed significantly decreased CAP values (313.4 dB/m at baseline vs. 297.8 dB/m at 24 weeks; P = 0.016), regardless of glycemic control. Lobeglitazone improved HbA1C values (7.41% [57.5 mM] vs. 6.56% [48.2 mM]; P < 0.001), as well as the lipid and liver profiles of the treated patients. Moreover, multivariable linear regression analysis showed that hepatic fat reduction by lobeglitazone was independently associated with baseline values of CAP, liver stiffness, and liver enzymes, and metformin use. Lobeglitazone treatment reduced intrahepatic fat content, as assessed by transient liver elastography, and improved glycemic, liver, and lipid profiles in T2D patients with NAFLD. Further randomized controlled trials using liver histology as an end point are necessary to evaluate the efficacy of lobeglitazone for NAFLD treatment (Clinical trial No. NCT02285205).

Elastografia ARFI na quantificação dos graus de fibrose hepática / ARFI elastography in quantifying the degree of hepatic fibrosis

A quantificação do grau de fibrose do fígado é essencial para avaliar os pacientes com doença hepática crônica. Novos métodos de diagnósticos não-invasivos têm sido desenvolvidos com o objetivo de reduzir o número de biópsia hepática. Em 2009, a elastografia ARFI aparece em um software acoplado ao equipamento de ultrassom convencional. A literatura tem demonstrada a alta precisão entre ARFI elastografia e a biópsia do fígado. A vantagem do método a ser acoplado a equipamento de ultrassons convencionais é a visualização do fígado, e que ele pode ser usado durante o exame de ultrassom de rotina.

The quantification of the degree of liver fibrosis is essential to evaluate the patients with chronic liver disease. New noninvasive diagnostic methods have been developed with the aim of reducing the number of liver biopsy. In 2009, the ARFI elastography appears, a software coupled to conventional ultrasound equipment. The literature has demonstrated high accuracy between ARFI elastography and liver biopsy. The advantage of the method to be coupled to conventional ultrasound equipment is the visualization of the liver and that it can be used during routine ultrasound examination.