Evaluation of blood-based PRO-C3 testing as a diagnostic marker for staging liver fibrosis: A systematic review and meta-analysis.

BACKGROUND AND AIM: With the global increase in chronic liver disease and cirrhosis, there is an increasing need to identify non-invasive biomarkers to measure the severity of disease progression while reducing reliance on pathological biopsies. This study aimed to comprehensively evaluate the diagnostic value of PRO-C3 as a biomarker for staging liver fibrosis in patients with viral hepatitis or fatty liver disease. METHODS: Articles published until January 6, 2023, were searched in the PubMed, Embase, MEDLINE, Web of Science, and Cochrane Library databases. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate the quality of the included studies. Pooled sensitivity, specificity, diagnostic odds ratio, and likelihood ratios were integrated using a random-effects model, and a summary receiver operating characteristic curve was constructed. Publication bias was also detected. Subgroup and meta-regression analyses, as well as sensitivity analysis, were also performed. RESULTS: Fourteen studies with 4315 patients were included. Summary area under the curve of PRO-C3 for the identification of significant fibrosis (≥ F2) and advanced fibrosis (≥ F3) was 0.80 (95% confidence interval: 0.76-0.83). Subgroup and meta-regression analyses suggested that disease type and sample size may be the primary factors of heterogeneity in PRO-C3 diagnosis of ≥ F2, while study design, study sample type, and enzyme-linked immunosorbent assay kit brand may be the primary sources of heterogeneity in PRO-C3 diagnosis of ≥ F3. CONCLUSIONS: PRO-C3 demonstrated clinically meaningful diagnostic accuracy when used alone as a non-invasive biomarker for diagnosing the liver fibrosis stage in individuals with viral hepatitis or fatty liver disease.

Application of an accelerometer in adjusting parameters and detecting characteristics in the pacemaker rate response.

Objective.To study the application of an accelerometer in adjusting the parameters, setting the sensor indicated rate (SIR) and detecting characteristics in the pacemaker (PM) rate response.Approach.Three-axis (GT9X Link-type) accelerometers were positioned on the waist and chest in 33 participants implanted with rate responsive PMs while wearing an ambulatory ECG recorder (Holter). During the walking test, by collecting vertical axis (Axis-1) activity intensity counts, Axis-1' metabolic equivalent of energy (METaxis-1) and its expected heart rate (HRmet-axis1) were calculated by the relevant equations, and on the basis of the HRmet-axis1as the target heart rate, the SIR was set by programming the rate response slope parameter. During the following daily walking activity, the physical activity parameters and Holter ECG was recorded continuously. After the end of the whole test the analysis on these data recorded was performed retrospectively.Main results.After completing the SIR setting, in 24 participants with complete ventricular pacing the comparison between HRmet-axis1(92.5 ± 7.8 BPM) and the HRvp-Holter(94.0 ± 10.5 BPM) showed no statistical difference (ΔHR: 1.25 ± 6.69 BPM,P: 0.568) during the last one walking test, and there was also no significant difference (ΔHR: 2.8 ± 7.1 BPM,P: 0.398) between the HRmet-axis1(90.7 ± 7.1 BPM) and HRvp-Holter(93.4 ± 10.3 BPM) during daily walking activity. In addition, in the data of 108 time intervals selected during the daily walking activities in the abovementioned 24 participants, METaxis-1and HRvp-Holtercorrelation analysis showed good correlation and the regression equation was HR = 12.4 × MET±43.1 (P<0.0001).Significance.An accelerometer can play an important role in adjusting parameters, setting the SIR and detecting characteristics in the PM rate response.