Factores de riesgo de fibrosis avanzada en enfermedad hepática esteatósica asociada a disfunción metabólica en pacientes con diabetes mellitus 2

Determinar factores de riesgo sociodemográficos, antropométricos, bioquímico-metabólicos, clínicos y comorbilidades asociadas a fibrosis avanzada por enfermedad hepática esteatósica asociada a disfunción metabólica en pacientes con diabetes mellitus tipo 2. Estudio de casos y controles. Se revisaron 174 historias clínicas de pacientes con enfermedad hepática esteatósica asociada a disfunción metabólica y diabetes mellitus tipo 2 atendidos en el Hospital Nacional Dos de Mayo de 2009 a 2018. Los casos fueron pacientes con fibrosis avanzada y los controles sin fibrosis. La presencia de fibrosis avanzada fue definida por paneles clínicos predictores y/o resultado de biopsia hepática. Para determinar asociación se calculó odds ratio, chi cuadrado de Pearson y análisis de regresión logística. Se encontró asociación con edad > 60 años, un índice de masa corporal ≥ 25 kg/m2 , perímetro abdominal en varones ≥ 94 cm y perímetro abdominal ≥ 88 cm en mujeres, tiempo de enfermedad de diabetes > 10 años; complicaciones crónicas microvasculares; HDL en mujeres 60 años, índice de masa corporal elevado, perímetro abdominal en mujeres, HDL bajo en mujeres, complicaciones crónicas microvasculares e hipertensión. Se encontraron como factores de riesgo de fibrosis avanzada, edad mayor a 60 años, índice de masa corporal elevado, perímetro abdominal ≥ 88 cm en mujeres, complicaciones crónicas microvasculares, nivel bajo de HDL en mujeres e hipertensión arterial como principal comorbilidad.

To determine sociodemographic, anthropometric, biochemical-metabolic, clinical risk factors and comorbidities associated with advanced fibrosis due metabolic dysfunction associated steatotic liver disease in patients with diabetes mellitus type 2. Case-control study. We reviewed 174 medical records of patients with metabolic dysfunction associated steatotic liver disease and type 2 diabetes mellitus treated at the Hospital Nacional Dos de Mayo from 2009 to 2018. The cases were patients with advanced fibrosis and controls without fibrosis. The presence of advanced fibrosis was defined by predictive clinical panels and/or liver biopsy result. To determine association, odds ratio, Pearson's chi-square and logistic regression analysis were calculated. An association was found with age > 60 years, a body mass index ≥ 25 kg/m2 , abdominal circumference in men ≥ 94 cm and abdominal circumference ≥ 88 cm in women, time of diabetes disease >10 years; chronic microvascular complications; HDL in women 60 years, high body mass index, abdominal circumference in women, low HDL in women, chronic microvascular complications and hypertension remained independent risk factors. The risk factors for advanced fibrosis were age over 60 years, high body mass index, abdominal circumference ≥ 88 cm in women, chronic microvascular complications, low HDL level in women and hypertension as the main comorbidity.

Evaluation of inflammatory and liver injury biomarkers among drug-naive viral hepatitis B patients: A study in a referral laboratory, Ghana

Background and Aim: Globally, hepatitis B virus (HBV) infection is among the commonest chronic infections and the leading cause of liver cancer. This study evaluated inflammatory and liver injury biomarkers among newlydiagnosed HBV-infected patients to reveal inflammation and liver injury levels. Patients and Methods: This case-control study was conducted among 146 newly diagnosed drug-naive patients and 64 blood donors. Questionnaires were administered to obtain demographic data. Blood samples were collected to assess viral serological markers, inflammatory markers, liver function, and hematological indices. Also, noninvasive markers of liver fibrosis (APRI: aspartate transaminase - platelet ratio index, FIB-4: fibrosis 4 index, and AAR: aspartate - alanine transaminase ratio) were mathematically derived. The patients were categorized into acute and chronic infections based on their viral serological markers. Results: Overall, 81.5% of the patients had an acute HBV infection, whereas 18.5% had a chronic HBV infection. There was a significant increase in the biomarkers of inflammation, C-reactive protein (CRP) and interleukin 6, and liver injury (liver transaminases, FIB-4 index, and APRI) among the drug-naive chronic HBV-infected patients. The study also revealed significant anemia and leucocytosis in patients with chronic HBV infection. Further, the study showed a strong correlation between CRP and alanine transaminase among patients with chronic HBV infection. Conclusion: There was increased anemia, inflammation, and liver fibrosis among the drug-naive chronic HBVinfected patients; hence, public education is required so patients with viral hepatitis B in Ghana would visit the clinic earlier enough for proper clinical management.

Albumin- bilirubin score as a non-invasive serum biomarker for advanced liver fibrosis and cirrhosis in Egyptian patients with chronic hepatitis C infection: A case-control study

Background: In many health systems, primary care is the main source of health care services. Liver cirrhosis is a silent disease that causes no signs or symptoms until decompensation occurs. Therefore, a simple and readily accessible tool for predicting advanced liver fibrosis and cirrhosis is needed to aid general practitioners in primary care settings. Aim: To explore the predictive performance of Albumin Bilirubin (ALBI) score as a non-invasive serum biomarker for advanced liver fibrosis and cirrhosis. Methods: This case-control study was conducted at Zagazig University Hospitals, Egypt, and comprised 400 participants divided into two equal groups. Group (I): 200 chronic HCV patients with advanced liver fibrosis and cirrhosis [F3-F4] and Group (II): 200 healthy controls. ALBI score was calculated for all study participants. Results: The AUROC for the ALBI score was 0.832 (95% CI: 0.787-0.872) (p-value) Conclusion: ALBI score is reliable for predicting advanced liver fibrosis and cirrhosis and could be valuable in primary care

Mejora del curso clínico de la cirrosis hepática por virus de hepatitis C posterior al tratamiento efectivo con antivirales de acción directa / Improvement of clinical course of liver cirrhosis due to chronic hepatitis C after sucessful treatment with direct acting antivirals

RESUMEN Los antivirales de acción directa son drogas nuevas altamente efectivas y seguras para el tratamiento de la hepatitis C crónica. Sin embargo, a pesar de la erradicación del virus de hepatitis C en pacientes con cirrosis hepática descompensada, aun es controversial su efecto en la mejora del cuadro clínico, disminución de complicaciones asociadas, riesgo de desarrollo de hipertensión portal y hepatocarcinoma. Presentamos dos pacientes con cirrosis hepática descompensada Child B por hepatitis C quienes recibieron tratamiento con drogas antivirales de acción directa. Luego del tratamiento, y confirmada la carga viral indetectable - respuesta viral sostenida - ambos pacientes mostraron una mejora significativa del curso clínico de la cirrosis hepática - Child A - y disminución de los niveles de fibrosis hepática determinados por métodos no invasivos.

ABSTRACT Direct-acting antivirals are new drugs, highly effective and safe against chronic hepatitis C. However, despite of hepatitis C erradication in patients with decompensated liver cirrhosis, their effect in improving the clinical course, reducing liver-related complications and the risk of developing portal hypertension and hepatocellular carcinoma is still controversial. We present two patients with decompensated liver cirrhosis Child B due to hepatitis C who received treatment with direct-acting antiviral drugs. After treatment, and with the confirmation of undetectable viral load - sustained viral response - both patients showed significant improvement in the clinical course of liver cirrhosis - Child A - and a decrease in the amount of liver fibrosis measured with non invasive methods.

STUDY OF LIVER FIBROSIS IN CHRONIC VIRAL HEPATITIS PATIENTS USING SHEAR WAVE ELASTOGRAPHY WITH ELASTOGRAPHY POINT QUANTIFICATION / Шинэ санаа Шинэ нээлт

@#BACKGROUND: Chronic viral hepatitis is the most important public health problems and main cause of liver fibrosis. Progressive hepatic fibrosis will gradually lead to liver cirrhosis, hepato-cellular carcinoma and liver failure and deaths. Study of liver fibrosis is becomes an essential issue of prevention, prognosis and radical treatment plan. The evaluation of liver fibrosis using ultrasound based-electrographic shear wave elastography (SWE) with elastography point quantification (ElastPQ) is a modern non-invasive method. This study is aimed to evaluate diagnostic value of SWE with ElastPQ feature of liver fibrosis. MATERIAL: A total of 110 patients with chronic viral (B, C and D) infection and 50 healthy controls were involved. Quantitative evaluation of LS was performed by Philips iU 22 ultrasound system with ElastPQ using convex transducer C5-1. RESULTS: In HBV patients: no fibrosis F0 score 7, mean liver stiffness was 3.1±0.28 kPa, mild liver fibrosis F1 score 26, mean LS was 4.9±0.90 kPa, F2 score 4, mean LS was 8.0±0.56 kPa, F3 score 3, mean LS was 11.0±0.83 kPa, and F4 score or liver cirrhosis 2, mean LS was 17±4.3 kPa, respectively. In patients HCV; F0 score -5, mean LS was 3.2±0,08 kPa, F1-36, mean LS was 5.0±0.94 kPa, F2 score-10, mean LS was 8.1±0.90 kPa, F3-10, mean LS was 10.9±1.03kPa, and F4 score 5, mean LS 15.9±2.8kPa, respectively. In patients with HBV, HDV; F0 score-1, liver stiffness was 3.2kPa, F1-13, mean LS was 4.9±0.72 kPa, F2 score 2, mean LS was 8.0±0.56kPa, F3 score, LS was 10.8kPa, F4 score 1, LS was 20.1kPa, respectively. CONCLUSIONS: Shear wave elastography with elastography point quantification technique is a reliable that can to detect of the earlier fibrosis stage in chronic viral hepatitis patients. ElastPQ SWE method is an optimal to monitor liver tissue stiffness in patients with chronic liver diseases.

What we need to know when performing and interpreting US elastography

According to the increasing need for accurate staging of hepatic fibrosis, the ultrasound (US) elastography techniques have evolved significantly over the past two decades. Currently, US elastography is increasingly used in clinical practice. Previously published studies have demonstrated the excellent diagnostic performance of US elastography for the detection and staging of liver fibrosis. Although US elastography may seem easy to perform and interpret, there are many technical and clinical factors which can affect the results of US elastography. Therefore, clinicians who are involved with US elastography should be aware of these factors. The purpose of this article is to present a brief overview of US techniques with the relevant technology, the clinical indications, diagnostic performance, and technical and biological factors which should be considered in order to avoid misinterpretation of US elastography results.

Objective Ultrasonographic Findings for Diagnosis of Liver Cirrhosis: A Comparison between Images Obtained with Low Frequency and High Frequency Probes on a PACS

PURPOSE: We aimed to evaluate objective ultrasonography (US) findings for diagnosis of liver cirrhosis and to correlate the utility between the use of the low frequency and high frequency probes for images analyzed on the picture archiving and communications system (PACS). MATERIALS AND METHODS: A total of 87 patients participated in the study; 19 patients that had a clinically proven normal liver and 68 patients that had biopsy-proven chronic liver disease were evaluated with the use of US for the status of the liver. Multiple variables such as a 'smooth surface,' 'irregular nodular surface,' 'homogeneous echotexture,' 'heterogeneous appearance mixed with hypoechoic and hyperechoic echotexture' and 'hypoechoic honeycomb like echotexture' were evaluated based on images obtained with the use of both low frequency and high frequency probes by two observers. The diagnoses obtained after US were correlated with the histological results using assess agreement as statistical method. The concordance rate was calculated to correlate the utility between the use of the low frequency and high frequency probes. RESULTS: An 'irregular nodular surface' showed high interobserver agreement for the diagnosis of liver cirrhosis on images obtained with the low frequency probe (kappa= 0.61). In addition, 'hypoechoic honeycomb' showed high interobserver agreement on images obtained with the high frequency probe (kappa= 0.60). The use of the low frequency probe was associated with more accuracy for the diagnosis of liver cirrhosis (73%). CONCLUSION: Objective US findings for the diagnosis of liver cirrhosis are an 'irregular nodular surface' on images obtained with use of a low frequency probe and a 'hypoechoic honeycomb' on images with use of a high frequency probe.