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Hu C, Jiang N, Zheng J, Li C, Huang H, Li J, Li H, Gao Z, Yang N, Xi Q, Wang J, Liu Z, Rao K, Zhou H, Li T, Chen Y, Zhang Y, Yang J, Zhao Y, He Y. Liver volume based prediction model for patients with hepatitis B virus-related acute-on-chronic liver failure. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:1253-1263. [PMID: 35029044 PMCID: PMC10078645 DOI: 10.1002/jhbp.1112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/23/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a life-threatening disease with high short-term mortality. Early and accurate prognosis is significant for clinical decisions, in which liver volume (LV) imparts important information. However, LV has not been considered in current prognostic models for HBV-ACLF. METHODS Three hundred and twenty-three patients were recruited to the deriving cohort, while 163 were enrolled to validation cohort. The primary end-point was death within 28 days since admission. Estimated liver volume (ELV) was calculated by the formula based on healthy population. Logistic regression was used to develop a prediction model. Accuracy of models were evaluated by receiver operating characteristic (ROC) curves. RESULTS The ratio of LV to ELV (LV/ELV%) was significantly lower in non-survivors, and LV/ELV% ≤82% indicated poor prognosis. LV/ELV%, Age, prothrombin time (PT), the grade of hepatic encephalopathy (HE), ln-transformed total bilirubin (lnTBil), and log-transformed HBV DNA (Log10 HBV DNA) were identified as independent predictors to develop an LV-based model, LEAP-HBV. The mean area under the ROC (AUC) of LEAP-HBV was 0.906 (95% CI, 0.904-0.908), higher than other non-LV-based models. CONCLUSION Liver volume was an independent predictor, and LEAP-HBV, a prediction model based on LV, was developed for the short-term mortality in HBV-ACLF. This study was registered on ClinicalTrails (NCT03977857).
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Affiliation(s)
- Chunhua Hu
- Department of Infectious Diseases, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Na Jiang
- Department of Infectious Diseases, Xi'an Eighth Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jie Zheng
- Clinical Research Centre, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chenxia Li
- Department of Radiology, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huihong Huang
- Department of Infectious Disease, Ankang Central Hospital, Ankang District, Shaanxi, China
| | - Juan Li
- Department of Infectious Diseases, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hongbing Li
- Department of Infectious Diseases, Weinan Central Hospital, Weinan District, Shaanxi, China
| | - Zhijie Gao
- Department of Infectious Diseases, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nan Yang
- Department of Infectious Diseases, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qi Xi
- Department of Infectious Diseases, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang District, Shaanxi, China
| | - Jing Wang
- Department of Infectious Diseases, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zitong Liu
- Department of Infectious Diseases, Hanzhong Central Hospital, Hanzhong District, Shaanxi, China
| | - Kemeng Rao
- Department of Infectious Diseases, Hanzhong 3201 Hospital, Hanzhong District, Shaanxi, China
| | - Heping Zhou
- Department of Radiology, Ankang Central Hospital, Ankang District, Shaanxi, China
| | - Tianhui Li
- The Key Laboratory of Biomedical Information Engineering, Department of Biomedical Engineering, Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yi Chen
- Department of Infectious Diseases, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuelang Zhang
- Department of Radiology, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jian Yang
- Department of Radiology, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yingren Zhao
- Department of Infectious Diseases, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yingli He
- Department of Infectious Diseases, First Affiliated Teaching Hospital, School of Medicine (SOM), Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Li J, Li J, Ji Q, Wang Z, Wang H, Zhang S, Fan S, Wang H, Kong D, Ren J, Zhou Y, Yang R, Zheng H. Nomogram based on spleen volume expansion rate predicts esophagogastric varices bleeding risk in patients with hepatitis B liver cirrhosis. Front Surg 2022; 9:1019952. [PMID: 36468077 PMCID: PMC9709196 DOI: 10.3389/fsurg.2022.1019952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/31/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND We aimed to explore the risk factors for hemorrhage of esophagogastric varices (EGVs) in patients with hepatitis B cirrhosis and to construct a novel nomogram model based on the spleen volume expansion rate to predict the risk of esophagogastric varices bleeding. METHODS Univariate and multivariate logistic regression analysis was used to analyze the risk factors for EGVs bleeding. Nomograms were established based on the multivariate analysis results. The predictive accuracy of the nomograms was assessed using the area under the curve (AUC or C-index) of the receiver operating characteristic (ROC) and calibration curves. Decision curve analysis was used to determine the clinical benefit of the nomogram. We created a nomogram of the best predictive models. RESULTS A total of 142 patients' hepatitis B cirrhosis with esophagogastric varices were included in this study, of whom 85 (59.9%) had a history of EGVs bleeding and 57 (40.1%) had no EGVs bleeding. The spleen volume expansion rate, serum sodium levels (mmol/L), hemoglobin levels (g/L), and prothrombin time (s) were independent predictors for EGVs bleeding in patients with hepatitis B liver cirrhosis (P < 0.05). The above predictors were included in the nomogram prediction model. The area under the ROC curve (AUROC) of the nomogram was 0.781, the C-index obtained by internal validation was 0.757, and the calibration prediction curve fit well with the ideal curve. The AUROCs of the PLT-MELD and APRI were 0.648 and 0.548, respectively. CONCLUSION In this study, a novel nomogram for predicting the risk of EGVs bleeding in patients with hepatitis B cirrhosis was successfully constructed by combining the spleen volume expansion rate, serum sodium levels, hemoglobin levels, and prothrombin time. The predictive model can provide clinicians with a reference to help them make clinical decisions.
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Affiliation(s)
- Jianghong Li
- First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Junjie Li
- Department of Organ Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Qian Ji
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Zhenglu Wang
- Department of Organ Transplantation, Tianjin First Central Hospital, Tianjin, China
- Key Laboratory of Transplant Medicine, Chinese Academy of Medical Sciences, First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Honghai Wang
- Department of Organ Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Sai Zhang
- School of Medicine, Nankai University, Tianjin, China
| | - Shunli Fan
- First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Hao Wang
- First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Dejun Kong
- School of Medicine, Nankai University, Tianjin, China
| | - Jiashu Ren
- First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Yunhui Zhou
- First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Ruining Yang
- First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Hong Zheng
- Department of Organ Transplantation, Tianjin First Central Hospital, Tianjin, China
- Key Laboratory of Transplant Medicine, Chinese Academy of Medical Sciences, First Central Clinical College, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin First Central Hospital, First Central Clinical College, Tianjin Medical University, Tianjin, China
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Evaluation of Normal Adrenal Gland Volume and Morphometry and Relationship with Waist Circumference in an Adult Population Using Multidetector Computed Tomography. SISLI ETFAL HASTANESI TIP BULTENI 2021; 55:333-338. [PMID: 34712074 PMCID: PMC8526233 DOI: 10.14744/semb.2021.96462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/27/2021] [Indexed: 12/15/2022]
Abstract
Objectives: This study aims to determine the normal range of values of the right, left, and total volume and shape of the adrenal gland (AG) and to evaluate its relationship with gender, age, height, weight, body mass index (BMI), and waist circumference (WC) in multidetector computed tomography (MDCT) images. Methods: The study included 115 MDCT scans, of which 56 were men and 59 were women. For volume measurement, the outlines of the AG were drawn semi-automatically for all patients. Then, collecting the area in each slice, the volumes were automatically measured. The intraclass correlation coefficient (ICC) test was used to analyze intraobserver reliability for repeated measurements with a 95% confidence interval. Participant’s age, gender, weight, height, BMI, and WC were obtained. p<0.05 was considered statistically significant. Results: The mean age of participants was 49.5±17.7 (19–81). The average right AGV (RAGV), left AGV (LAGV), and total AGV were 3.47±1.33, 4.77±1.33, and 8.25±2.74, respectively. The ICC values for all measurements were >0.80–0.90, indicating good and excellent agreement. LAGV was measured as higher than the RAGV. A positive moderate correlation of the AGVs with BMI and WC was observed. Conclusion: The increase in BMI and WC, which are indicators of obesity, correlates with the increase in AGV, we think that the findings will be valuable in evaluating the pathophysiology of the hypothalamic-pituitary-adrenal axis.
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Patel M, Tann M, Liangpunsakul S. CT-scan Based Liver and Spleen Volume Measurement as a Prognostic Indicator for Patients with Cirrhosis. Am J Med Sci 2020; 362:252-259. [PMID: 33947583 DOI: 10.1016/j.amjms.2020.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/07/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Complications of patients with liver disease generally occurs as the consequence of advanced fibrosis and portal hypertension. Non-invasive tools to predict the complications may allow for better risk-stratification and medical management in patients with cirrhosis. The goals of this study were to determine the utility of CT-scan based liver and spleen volume measurement in association with complications and outcomes in patients with cirrhosis. METHODS Baseline demographic and clinical characteristics of 556 patients with cirrhosis who underwent CT scan of the abdomen between January 1-June 30,2009 were reviewed. Liver and spleen volume were measured using semi-automated interactive software and compared to 47 healthy controls. The association between liver and spleen volume and complications of cirrhosis was determined. Independent predictors of survival were analyzed with Cox regression model. RESULTS Patients with cirrhosis had significantly lower total and functional liver volume, larger total and functional spleen volume, and significantly lower total liver to spleen volume ratio when compared to controls. Liver volume, spleen volume, and liver to spleen volume ratio were significantly altered in patients with decompensated stage. Patients with hepatic encephalopathy had significantly lower total liver volume and spleen size was associated with the presence of esophageal varices. Patients with cirrhosis who underwent liver transplantation had significantly lower total liver volume and larger total spleen volume. However, spleen volume was not an independent predictor for mortality. CONCLUSIONS Baseline liver and spleen volume and its ratio are significantly altered in patients with cirrhosis. Spleen volume is also associated with the presence of esophageal varices.
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Affiliation(s)
- Milan Patel
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Mark Tann
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Suthat Liangpunsakul
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States; Roudebush Veterans Administration Medical Center, Indianapolis, IN, United States; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, United States.
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