1
|
Yu Z, Yan X, Bai X, Ruan G, Han W, Shu H, Yang H. Association Between Cardiovascular Health and Cirrhosis and Mortality: Insights From a Comprehensive Cross-sectional Study. J Clin Gastroenterol 2024:00004836-990000000-00306. [PMID: 38896423 DOI: 10.1097/mcg.0000000000002033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024]
Abstract
GOAL We aim to explore the relationship between the newly introduced CVH indicator "Life's Essential 8 (LE8)" and cirrhosis. BACKGROUND The global burden of cirrhosis is increasing, with a rising number of deaths, leading to significant societal and economic challenges. Cardiovascular health (CVH) has been found to have potential associations with liver diseases. MATERIALS AND METHODS All participants aged 20 and older from National Health and Nutrition Examination Survey 2005 to 2018 were included. CVH was accessed by LE8, consisting of 4 health behaviors (diet, physical activity, nicotine exposure, and sleep health) and 4 health factors (body mass index, lipid levels, blood sugar, and blood pressure). Cirrhosis was determined based on abnormal liver function test results, with an aspartate aminotransferase to platelet ratio index >2. Participants' mortality status was obtained by matching with the National Death Index and all-cause mortality served as the follow-up endpoint. RESULTS This extensive cross-sectional study reveals that LE8 was not associated with cirrhosis. A higher health behaviors score was associated with lower cirrhosis. Moreover, there is an inverse U-shaped relationship between the LE8 score and all-cause mortality in participants with cirrhosis, signifying a decrease in all-cause mortality when LE8 surpasses 60. A greater health behaviors score is linked to a decreased proportion of all-cause mortality in cirrhosis patients. CONCLUSION Maintaining better health behaviors may be beneficial for cirrhosis, especially through a balanced diet, regular exercise, smoking cessation, and quality sleep.
Collapse
Affiliation(s)
| | | | | | | | - Wei Han
- Epidemiology and Biostatistics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | | | | |
Collapse
|
2
|
Vo-Quang E, Lemoine M. Global elimination of HBV: Is it really achievable? J Viral Hepat 2024. [PMID: 38797984 DOI: 10.1111/jvh.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
Hepatitis B virus (HBV) infection is a major cause of premature death worldwide. In 2016, the World Health Organization (WHO) called for HBV elimination and set up very ambitious elimination targets. The development of effective vaccines, accurate diagnostic tools and safe antiviral drugs make HBV elimination a realistic goal. However, the most constrained-resource regions, which bear the highest burden of HBV, are facing major challenges in implementing strategies to reduce HBV incidence and mortality. Developing simplified approaches adapted to resource-limited settings and scaling up interventions for the prevention and control of HBV globally are urgently needed. Whether HBV elimination will be achieved in an equitable manner and in a reasonable timeframe remains highly uncertain.
Collapse
Affiliation(s)
- Erwan Vo-Quang
- Disease Control & Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Team "Viruses, Hepatology, Cancer", Institut Mondor de Recherche Biomédicale, INSERM U955, Université Paris-Est, Créteil, France
| | - Maud Lemoine
- Team "Viruses, Hepatology, Cancer", Institut Mondor de Recherche Biomédicale, INSERM U955, Université Paris-Est, Créteil, France
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| |
Collapse
|
3
|
Minier N, Guingané AN, Okeke E, Sinkala E, Johannessen A, Andersson MI, Davwar P, Desalegn H, Duguru M, Fall F, Mboup S, Maponga T, Matthews PC, Ramírez Mena A, Ndow G, Orlien SMS, Riches N, Seydi M, Sonderup M, Spearman CW, Stockdale AJ, Taljaard J, Vinikoor M, Wandeler G, Lemoine M, Shimakawa Y, Sombié R. Development and evaluation of a simple treatment eligibility score (HEPSANET) to decentralise hepatitis B care in Africa: a cross-sectional study. Lancet Gastroenterol Hepatol 2024; 9:323-332. [PMID: 38367633 PMCID: PMC7616035 DOI: 10.1016/s2468-1253(23)00449-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Hepatitis B virus (HBV) elimination requires expanding and decentralising HBV care services. However, peripheral health facilities lack access to diagnostic tools to assess eligibility for antiviral therapy. Through the Hepatitis B in Africa Collaborative Network (HEPSANET), we aimed to develop and evaluate a score using tests generally available at lower-level facilities, to simplify the evaluation of antiviral therapy eligibility in people living with HBV. METHODS We surveyed the availability of clinical and laboratory parameters across different health-care levels in sub-Saharan Africa. We used data from the HEPSANET dataset, the largest cross-sectional dataset of treatment-naive people living with HBV in sub-Saharan Africa, to derive and validate the score. Participants from this dataset were included in the analysis if they were aged 18 years or older and had liver fibrosis stages determined by a liver stiffness measurement or liver histopathology. Participants with co-infections or metabolic disorders were excluded. We allocated participants to the derivation and validation sets by geographical site. In the derivation set, we used stepwise logistic regression to identify the best performing parameters for identifying participants that met the 2017 European Association for the Study of the Liver (EASL) criteria. Regression coefficients were converted into integer points to construct simplified algorithms for different health-care levels. In the validation set, we estimated the area under the receiver operating characteristic, sensitivity, and specificity of the simplified algorithm for identifying antiviral therapy eligibility defined by the 2017 EASL criteria. FINDINGS At 11 sites from eight countries that returned surveys, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count were generally available at district hospital levels, and hepatitis B e antigen and point-of-care HBV DNA tests were available only at regional and provincial hospital levels or above. Among 2895 participants included from the HEPSANET database (1740 [60·1%] male, 1155 [39·9%] female), 409 (14·1%) met EASL antiviral therapy eligibility criteria. In the derivation set, the optimal district-level hospital score was: ALT (IU/L), less than 40 (0 points), 40-79 (+1), 80 or greater (+2); AST (IU/L), less than 40 (0), 40-79 (+1), 80 or greater (+2); and platelet counts (109/L), less than 100 (+2), 100-149 (+1), 150 or greater (0). When combined with family history and clinical data for decompensated cirrhosis that do not require any biological tests, a cut-off of 2 points or more had a sensitivity and specificity of 82% (95% CI 76-86) and 95% (93-96) to identify treatment-eligible individuals in the derivation set, and 78% (71-85) and 87% (86-89) in the validation set, respectively. INTERPRETATION Using a score incorporating platelet counts, AST, and ALT, the majority of people living with HBV requiring antiviral therapy can be identified. Our findings suggest that clinical staging can be decentralised down to district hospital level in sub-Saharan Africa. FUNDING European Association for the Study of the Liver Foundation, John C Martin Foundation. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Nicolas Minier
- Insitut Pasteur, Université Paris Cité, Unité d'Épidémiologie des Maladies Émergentes, Paris, France
| | - Alice Nanelin Guingané
- Hepato-Gastroenterology Department, Bogodogo University Hospital Center, Ouagadougou, Burkina Faso
| | - Edith Okeke
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Edford Sinkala
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
| | - Asgeir Johannessen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway
| | - Monique I Andersson
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Division of Medical Virology, Stellenbosch University Faculty of Medicine and Health Sciences & National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
| | - Pantong Davwar
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Hailemichael Desalegn
- Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway; Medical Department, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mary Duguru
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Fatou Fall
- Department of Hepatology and Gastroenterology, Hopital Principal de Dakar, Dakar, Senegal
| | - Souleyman Mboup
- L'Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formations (IRESSEF), Dakar, Senegal
| | - Tongai Maponga
- Division of Medical Virology, Stellenbosch University Faculty of Medicine and Health Sciences & National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK; Division of Infection and Immunity, University College London, London, UK
| | - Adrià Ramírez Mena
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gibril Ndow
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; MRC Unit The Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Stian M S Orlien
- Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway; Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Nicholas Riches
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Moussa Seydi
- Service de Maladies Infectieuses et Tropicales, Centre Regional de Recherche et de Formation, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Mark Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alexander J Stockdale
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Program, Blantyre, Malawi
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Michael Vinikoor
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Yusuke Shimakawa
- Insitut Pasteur, Université Paris Cité, Unité d'Épidémiologie des Maladies Émergentes, Paris, France.
| | - Roger Sombié
- Hepato-Gastroenterology Department, Yalgado Ouédraogo University Hospital Center, Ouagadougou, Burkina Faso
| |
Collapse
|
4
|
Delphin M, Mohammed KS, Downs LO, Lumley SF, Waddilove E, Okanda D, Aliyan N, Van Schalkwyk M, Anderson M, Ocama P, Maponga T, Torimiro J, Iwuji C, Ndung'u T, Matthews PC, Taljaard J. Under-representation of the WHO African region in clinical trials of interventions against hepatitis B virus infection. Lancet Gastroenterol Hepatol 2024; 9:383-392. [PMID: 38367632 PMCID: PMC7616036 DOI: 10.1016/s2468-1253(23)00315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 02/19/2024]
Abstract
The WHO African region bears a disproportionate burden of morbidity and mortality related to chronic hepatitis B virus (HBV) infection and accounts for an estimated 70% of new HBV infections worldwide. We investigated the extent to which HBV clinical trials represented populations in this region by searching the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov for interventional clinical trials published in English between database inception and May 29, 2023, using the search term "Hepatitis B". We identified 1804 unique clinical trials, of which 18 (1·0%) recorded involvement of the WHO African region. There is no evidence that the number of HBV clinical trials in this region has improved over time. The diversity of new interventions and industry sponsorship in the WHO African region were low, with trials of HBV comparing poorly with those of other endemic infectious diseases (eg, malaria, HIV, and SARS-CoV-2). HBV research and clinical trial investigations have neglected the WHO African region, leading to profound health inequities. HBV clinical trials are urgently needed to evaluate the efficacy of newly discovered therapeutics and to ensure that interventions can be equitably distributed and deployed as they become available.
Collapse
Affiliation(s)
| | - Khadija Said Mohammed
- The Francis Crick Institute, London, UK; Division of Biosciences, Faculty of Life Sciences, University College London, London, UK
| | - Louise O Downs
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford, UK; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sheila F Lumley
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford, UK
| | | | - Dorcas Okanda
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Marije Van Schalkwyk
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University-Tygerberg Academic Hospital, Cape Town, South Africa
| | - Motswedi Anderson
- The Francis Crick Institute, London, UK; Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana; Africa Health Research Institute, Durban, South Africa
| | - Ponsiano Ocama
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tongai Maponga
- Division of Medical Virology, Stellenbosch University-National Health Laboratory Service Tygerberg Business Unit, Cape Town, South Africa
| | - Judith Torimiro
- Molecular Biology Laboratory, Chantal Biya International Reference Centre for AIDS Research, Yaounde, Cameroon
| | - Collins Iwuji
- Africa Health Research Institute, Durban, South Africa; Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Thumbi Ndung'u
- Division of Infection and Immunity, University College London, London, UK; Africa Health Research Institute, Durban, South Africa
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK; Division of Infection and Immunity, University College London, London, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Infectious Diseases, University College London Hospital, London, London, UK.
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University-Tygerberg Academic Hospital, Cape Town, South Africa
| |
Collapse
|
5
|
Heller T, Phiri V, Kumwenda T, Mzumara W, Vinikoor MJ, Rambiki E, Wallrauch C. Point-of-care ultrasound to inform antiviral treatment initiation in chronic hepatitis B virus infection in low-resource settings - the PUSH protocol. Ultrasound J 2024; 16:18. [PMID: 38436778 PMCID: PMC10912069 DOI: 10.1186/s13089-024-00369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Chronic Hepatitis B (CHB) is prevalent worldwide and most related deaths occur in low-resource settings. Antiviral treatment of CHB is indicated in those with significant liver disease and markers of viral replication. However, recommended diagnostics such as elastography (a non-invasive imaging measure of fibrosis/cirrhosis) or HBV viral load are often lacking in these settings, which creates barriers to treatment. Point-of-care clinical B-mode ultrasound (US) has potential to overcome implementation barriers in HBV care programs in low-resource settings. METHODS We describe a Point-of-care US protocol for Hepatitis ("PUSH") to check for signs of cirrhosis and hepatocellular carcinoma in the liver of people with CHB. We performed a prospective observational study applying the protocol, first by trainee clinicians and then by trainers, in consecutive patients referred to our clinic for CHB treatment eligibility assessment. All patients additionally underwent physical examination, liver function tests (LFTs) and platelet counts. We describe the PUSH training approach and performance of the protocol. RESULTS Four clinicians and 111 adult patients with HBV infection were included in the development of PUSH. Using US, liver complications of HBV were documented in 31 (27.9%) patients; including cirrhosis in 15 patients, HCC with cirrhosis in 13, and HCC without cirrhosis in 3. Patients with sonographic findings had significantly more clinical symptoms also their LFTs were higher and more frequently indicative for HBV treatment. Of 28 patients with sonographic diagnosis of cirrhosis, 23 (82.1%) showed a nodular liver surface, 24 (85.7%) a coarse echotexture, 20 (71.4%) scarce vessels, and 9 (32.1%) an enlarged caudate lobe. Overall concordance of the findings between assessment of trainees and experienced sonographers was high, ranging from 90 to 95%; trainees were not blinded to clinical and laboratory findings. CONCLUSION Ultrasound can facilitate same-day initiation of antiviral therapy for chronic HBV monoinfection in a resource-limited setting and a streamlined protocol-driven liver ultrasound can be feasibly used by front line clinicians managing HBV.
Collapse
Affiliation(s)
- Tom Heller
- Lighthouse Clinic Trust, Lilongwe, Malawi.
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA.
| | | | | | - Wongani Mzumara
- Directorate of HIV/AIDS, STI and Viral Hepatitis, Ministry of Health, Lilongwe, Malawi
| | - Michael Jeffrey Vinikoor
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | |
Collapse
|
6
|
Sonderup MW, Kamath PS, Awuku YA, Desalegn H, Gogela N, Katsidzira L, Tzeuton C, Bobat B, Kassianides C, Spearman CW. Managing cirrhosis with limited resources: perspectives from sub-Saharan Africa. Lancet Gastroenterol Hepatol 2024; 9:170-184. [PMID: 38215781 DOI: 10.1016/s2468-1253(23)00279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 01/14/2024]
Abstract
Cirrhosis represents the end stage of chronic liver disease. Sub-Saharan Africa, a resource-constrained region, has a high burden of chronic liver disease, with causes including chronic viral hepatitis, excessive alcohol use, and metabolic dysfunction-associated steatotic liver disease (MASLD), the risk of which is burgeoning. The development of liver cirrhosis predicts for morbidity and mortality, driven by both liver dysfunction and the consequences of portal hypertension. Compensated cirrhosis portends a better prognosis than decompensated cirrhosis, highlighting the need for the early diagnosis of cirrhosis and its causes. With resource challenges, the diagnosis and management of cirrhosis is demanding, but less costly and less invasive interventions with substantial benefits, ranging from simple blood tests to transient elastography, are feasible in such settings. Simple interventions are also available to manage the complex manifestations of decompensation, such as β blockers in variceal bleeding prophylaxis, salt restriction and appropriate diuretic use in ascites, and lactulose and generic rifaximin in hepatic encephalopathy. Ultimately, managing the underlying causative factors of liver disease is key in improving prognosis. Management demands expanded policy interventions to increase screening and treatment for hepatitis B and C and reduce alcohol use and the metabolic factors driving MASLD. Furthermore, the skills needed for more specialised interventions, such as transjugular intrahepatic portosystemic shunt procedures and even liver transplantation, warrant planning, increased capacity, and support for regional centres of excellence. Such centres are already being developed in sub-Saharan Africa, demonstrating what can be achieved with dedicated initiatives and individuals.
Collapse
Affiliation(s)
- Mark W Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | | | - Yaw A Awuku
- Department of Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Hailemichael Desalegn
- Department of Internal Medicine, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Neliswa Gogela
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Leolin Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Christian Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences of Douala, University of Douala, Douala, Cameroon
| | - Bilal Bobat
- Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Chris Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
7
|
Sonderup MW, Spearman CW. HBV elimination in Africa-Current status and challenges. Clin Liver Dis (Hoboken) 2024; 23:e0166. [PMID: 38707243 PMCID: PMC11068139 DOI: 10.1097/cld.0000000000000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/15/2024] [Indexed: 05/07/2024] Open
Abstract
1_n81kbjgsKaltura.
Collapse
|
8
|
Spearman CW, Andersson MI, Bright B, Davwar PM, Desalegn H, Guingane AN, Johannessen A, Kabagambe K, Lemoine M, Matthews PC, Ndow G, Riches N, Shimakawa Y, Sombié R, Stockdale AJ, Taljaard JJ, Vinikoor MJ, Wandeler G, Okeke E, Sonderup M. A new approach to prevent, diagnose, and treat hepatitis B in Africa. BMC GLOBAL AND PUBLIC HEALTH 2023; 1:24. [PMID: 38798823 PMCID: PMC11116268 DOI: 10.1186/s44263-023-00026-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/02/2023] [Indexed: 05/29/2024]
Abstract
There are 82 million people living with hepatitis B (PLWHB) in the World Health Organization Africa region, where it is the main cause of liver disease. Effective vaccines have been available for over 40 years, yet there are 990,000 new infections annually, due to limited implementation of hepatitis B birth dose vaccination and antenatal tenofovir prophylaxis for highly viraemic women, which could eliminate mother-to-child transmission. Despite effective and cheap antiviral treatment which can suppress hepatitis B virus replication and reduce the risk of hepatocellular carcinoma (HCC), < 2% of PLWHB are diagnosed, and only 0.1% are treated. As a result, PLWHB are frequently diagnosed only when they have already developed decompensated cirrhosis and late-stage HCC, and consequently 80,000 hepatitis B-associated deaths occur each year. Major barriers include complex treatment guidelines which were derived from high-income settings, lack of affordable diagnostics, lack or insufficient domestic funding for hepatitis care, and limited healthcare infrastructure. Current treatment criteria may overlook patients at risk of cirrhosis and HCC. Therefore, expanded and simplified treatment criteria are needed. We advocate for decentralized community treatment programmes, adapted for low-resource and rural settings with limited laboratory infrastructure. We propose a strategy of treat-all except patients fulfilling criteria that suggest low risk of disease progression. Expanded treatment represents a financial challenge requiring concerted action from policy makers, industry, and international donor agencies. It is crucial to accelerate hepatitis B elimination plans, integrate hepatitis B care into existing healthcare programmes, and prioritize longitudinal and implementation research to improve care for PLWHB.
Collapse
Affiliation(s)
- C. Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Monique I. Andersson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa
| | - Bisi Bright
- LiveWell Initiative, Yesuf Abiodun Street, Victoria Island, Lagos, Nigeria
- Women in Hepatitis Africa, Womens Wellness Center for Hepatitis, Isale Ajoke, Iwaya-Makoko, Lagos State, Nigeria
| | - Pantong M. Davwar
- Department of Internal Medicine, Jos Univeristy Teaching Hospital, Jos, Nigeria
| | - Hailemichael Desalegn
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Alice Nanelin Guingane
- Hepato-Gastroenterology Department, Bogodogo University Hospital Center, Ouagadougou, Burkina Faso
| | - Asgeir Johannessen
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kenneth Kabagambe
- The National Organisation for People Living With Hepatitis B, Kampala, Uganda
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Philippa C. Matthews
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT UK
- Division of Infection and Immunity, University College London, Gower Street, London, WC1E 6BT UK
- Department of Infectious Diseases, University College London Hospital, Euston Road, London, NW1 2BU UK
| | - Gibril Ndow
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Nicholas Riches
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yusuke Shimakawa
- Institut Pasteur, Université Paris Cité, Unité d’Épidémiologie Des Maladies Émergentes, Paris, France
| | - Roger Sombié
- Service d’hépato-Gastroentérologie, CHU Yalgado OUÉDRAOGO, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Alexander J. Stockdale
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunity, University of Liverpool, Liverpool, UK
| | - Jantjie J. Taljaard
- Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Michael J. Vinikoor
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, University of Zambia, Lusaka, Zambia
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Edith Okeke
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Mark Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - on behalf of the Hepatitis B in Africa Collaborative Network (HEPSANET)
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa
- LiveWell Initiative, Yesuf Abiodun Street, Victoria Island, Lagos, Nigeria
- Women in Hepatitis Africa, Womens Wellness Center for Hepatitis, Isale Ajoke, Iwaya-Makoko, Lagos State, Nigeria
- Department of Internal Medicine, Jos Univeristy Teaching Hospital, Jos, Nigeria
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Hepato-Gastroenterology Department, Bogodogo University Hospital Center, Ouagadougou, Burkina Faso
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- The National Organisation for People Living With Hepatitis B, Kampala, Uganda
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Imperial College London, London, UK
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT UK
- Division of Infection and Immunity, University College London, Gower Street, London, WC1E 6BT UK
- Department of Infectious Diseases, University College London Hospital, Euston Road, London, NW1 2BU UK
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Institut Pasteur, Université Paris Cité, Unité d’Épidémiologie Des Maladies Émergentes, Paris, France
- Service d’hépato-Gastroentérologie, CHU Yalgado OUÉDRAOGO, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunity, University of Liverpool, Liverpool, UK
- Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| |
Collapse
|
9
|
Muula GK, Bosomprah S, Sinkala E, Nsokolo B, Musonda T, Hamusonde K, Bhattacharya D, Lauer G, Chung RT, Mulenga LB, Wandeler G, Vinikoor MJ. Hepatitis B viral replication markers and hepatic fibrosis in untreated chronic hepatitis B virus infection with and without HIV coinfection in Zambia. AIDS 2023; 37:2015-2020. [PMID: 37467044 PMCID: PMC10538415 DOI: 10.1097/qad.0000000000003659] [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] [Indexed: 07/21/2023]
Abstract
BACKGROUND To inform novel therapies, a more nuanced understanding of HIV's impact on hepatitis B virus (HBV) natural history is needed, particularly in high burden countries. METHODS In Lusaka, Zambia, we compared prospectively recruited adults (18+ years) with chronic HBV infection, with and without HIV. We excluded those with prior antiviral treatment experience or HBV diagnosis due to clinical suspicion (rather than routine testing). We assessed HBV DNA levels, hepatitis B e antigen (HBeAg), CD4 + (if HIV coinfection), and liver disease (transient elastography, serum alanine aminotransferase). In multivariable analyses, we evaluated the association of HIV overall and by level of CD4 + count on these markers. RESULTS Among 713 adults analyzed, median age was 33 years, 63% were male, and 433 had HBV/HIV coinfection. Median CD4 + count was 200 cells/μl. HBV DNA was greater than 2000 IU/ml for 311 (51.0%) and 227 (32.5%) were HBeAg-positive. 15.5% had advanced fibrosis or cirrhosis. HIV coinfection was associated with five-fold increased HBV DNA levels [adjusted geometric mean ratio, 5.78; 95% confidence interval (CI), 2.29-14.62] and two times the odds of HBeAg-positivity (adjusted odds ratio, 2.54; 95% CI, 1.59-4.08). These associations were significant only at CD4 + counts 100-350 and <100 cells/μl. HIV was not associated with markers of fibrosis or ALT. DISCUSSION HIV's impact on HBV natural history likely depends on the degree and duration of immune suppression. There is strong rationale to monitor HBV DNA in people with HBV/HIV coinfection and immune suppression. A better understanding is needed of mechanisms of increased liver-related mortality in people with HBV/HIV coinfection.
Collapse
Affiliation(s)
- Guy K Muula
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Public Health, University of Ghana, Accra, Ghana
| | - Edford Sinkala
- Department of Medicine, University of Zambia
- University Teaching Hospital, Zambian Ministry of Health
| | - Bright Nsokolo
- Department of Medicine, Levy Mwanawasa Medical University, Lusaka, Zambia
| | | | - Kalongo Hamusonde
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Infectious Diseases, Bern University Hospital
| | - Debika Bhattacharya
- Division of Infectious Diseases, University of California at Los Angeles, Los Angeles, California
| | - Georg Lauer
- Division of Gastroenterology, Massachusetts General Hospital, Boston, USA
| | - Raymond T Chung
- Division of Gastroenterology, Massachusetts General Hospital, Boston, USA
| | | | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Michael J Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Medicine, University of Zambia
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA
| |
Collapse
|
10
|
Chen H, Shen Y, Wu SD, Zhu Q, Weng CZ, Zhang J, Wang MX, Jiang W. Diagnostic role of transient elastography in patients with autoimmune liver diseases: A systematic review and meta-analysis. World J Gastroenterol 2023; 29:5503-5525. [PMID: 37900994 PMCID: PMC10600811 DOI: 10.3748/wjg.v29.i39.5503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/09/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Noninvasive methods have been developed to detect fibrosis in many liver diseases due to the limits of liver biopsy. However, previous studies have focused primarily on chronic viral hepatitis and nonalcoholic fatty liver disease. The diagnostic value of transient elastography for autoimmune liver diseases (AILDs) is worth studying. AIM To compare the diagnostic accuracy of imaging techniques with serum biomarkers of fibrosis in AILD. METHODS The PubMed, Cochrane Library and EMBASE databases were searched. Studies evaluating the efficacy of noninvasive methods in the diagnosis of AILDs [autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC)] were included. The summary area under the receiver operating characteristic curve (AUROC), diagnostic odds ratio, sensitivity and specificity were used to assess the accuracy of these noninvasive methods for staging fibrosis. RESULTS A total of 60 articles were included in this study, and the number of patients with AIH, PBC and PSC was 1594, 3126 and 501, respectively. The summary AUROC of transient elastography in the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis in patients with AIH were 0.84, 0.88 and 0.90, respectively, while those in patients with PBC were 0.93, 0.93 and 0.91, respectively. The AUROC of cirrhosis for patients with PSC was 0.95. However, other noninvasive indices (aspartate aminotransferase to platelet ratio index, aspartate aminotransferase/alanine aminotransferase ratio, fibrosis-4 index) had corresponding AUROCs less than 0.80. CONCLUSION Transient elastography exerts better diagnostic accuracy in AILD patients, especially in PBC patients. The appropriate cutoff values for staging advanced fibrosis and cirrhosis ranged from 9.6 to 10.7 and 14.4 to 16.9 KPa for PBC patients.
Collapse
Affiliation(s)
- Hong Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, Fujian Province, China
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, Shanghai 200032, China
- Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Yue Shen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, Shanghai 200032, China
- Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Sheng-Di Wu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, Fujian Province, China
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, Shanghai 200032, China
- Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Qin Zhu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, Shanghai 200032, China
- Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Cheng-Zhao Weng
- Department of Gastroenterology and Hepatology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, Fujian Province, China
| | - Jun Zhang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, Fujian Province, China
| | - Mei-Xia Wang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, Fujian Province, China
| | - Wei Jiang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, Fujian Province, China
- Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, Shanghai 200032, China
- Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai 200032, China
| |
Collapse
|
11
|
Johannessen A. Is it time for a paradigm shift in treatment guidelines for chronic hepatitis B? Lancet Gastroenterol Hepatol 2023; 8:784. [PMID: 37517416 DOI: 10.1016/s2468-1253(23)00236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Asgeir Johannessen
- Department of Infectious Diseases, Vestfold Hospital, Tønsberg 3103, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| |
Collapse
|
12
|
Matthews PC, Ocama P, Wang S, El-Sayed M, Turkova A, Ford D, Torimiro J, Garcia Ferreira AC, Espinosa Miranda A, De La Hoz Restrepo FP, Seremba E, Mbu R, Pan CQ, Razavi H, Dusheiko G, Spearman CW, Hamid S. Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus. JHEP Rep 2023; 5:100777. [PMID: 37554925 PMCID: PMC10405098 DOI: 10.1016/j.jhepr.2023.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 08/10/2023] Open
Abstract
Prevention of mother-to-child transmission of hepatitis B virus (HBV) infection is a cornerstone of efforts to support progress towards elimination of viral hepatitis. Current guidelines recommend maternal screening, antiviral therapy during the third trimester of high-risk pregnancies, universal and timely HBV birth dose vaccination, and post-exposure prophylaxis with hepatitis B immunoglobulin for selected neonates. However, serological and molecular diagnostic testing, treatment and HBV vaccination are not consistently deployed, particularly in many high endemicity settings, and models predict that global targets for reduction in paediatric incidence will not be met by 2030. In this article, we briefly summarise the evidence for current practice and use this as a basis to discuss areas in which prevention of mother-to-child transmission can potentially be enhanced. By reducing health inequities, enhancing pragmatic use of resources, filling data gaps, developing advocacy and education, and seeking consistent investment from multilateral agencies, significant advances can be made to further reduce vertical transmission events, with wide health, societal and economic benefits.
Collapse
Affiliation(s)
- Philippa C. Matthews
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
- Division of Infection and Immunity, University College London, Gower St, London WC1E 6BT, UK
- Department of Infection, University College London Hospitals, 235 Euston Rd, London NW1 2BU, UK
| | - Ponsiano Ocama
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Su Wang
- Cooperman Barnabas Medical Center, Florham Park, NJ, USA
- Hepatitis B Foundation, Doylestown, PA, USA
| | - Manal El-Sayed
- Department of Paediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anna Turkova
- Medical Research Council Clinical Trials Unit, University College London, 90 High Holborn, London WC1V 6LJ, UK
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit, University College London, 90 High Holborn, London WC1V 6LJ, UK
| | - Judith Torimiro
- Chantal Biya International Reference Centre for Research on Prevention and Management of HIV/AIDS (CIRCB), Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Ana Cristina Garcia Ferreira
- Ministry of Health, Health Surveillance Department, Department of Chronic Diseases and Sexually Transmitted Infections, SRTVN Quadra 701, Lote D, PO700 Building, CEP: 70719-040, Brasília/DF, Brazil
| | - Angélica Espinosa Miranda
- Ministry of Health, Health Surveillance Department, Department of Chronic Diseases and Sexually Transmitted Infections, SRTVN Quadra 701, Lote D, PO700 Building, CEP: 70719-040, Brasília/DF, Brazil
| | | | - Emmanuel Seremba
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robinson Mbu
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Calvin Q. Pan
- Division of Gastroenterology and Hepatology, NYU Langone Health, NYU Grossman School of Medicine, NY, USA
| | - Homie Razavi
- Center for Disease Analysis Foundation, 1120 W South Boulder Rd Suite 102, Lafayette, CO 80026, USA
| | - Geoffrey Dusheiko
- Liver Unit, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - C. Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
13
|
Zhang F, Han Y, Zheng L, Liu J, Wu Y, Bao Z, Liu L, Li W. Association of Non-Invasive Markers with Significant Fibrosis in Patients with Nonalcoholic Fatty Liver Disease: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2023; 16:2255-2268. [PMID: 37545743 PMCID: PMC10403050 DOI: 10.2147/dmso.s417754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose The identification of significant fibrosis is critical for predicting the prognosis of non-alcoholic fatty liver disease (NAFLD). This study aimed to compare the predictive value of chitinase-3-like protein 1 (CHl3L1) and other non-invasive biomarkers, as well as to establish a novel non-invasive diagnostic model for assessing the risk of significant fibrosis in NAFLD. Patients and Methods A total of 71 patients with confirmed NAFLD based on liver biopsy were included in this study. Serum CHI3L1 levels and other non-invasive fibrosis assessment measures were determined. The aspartate aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 Index (FIB-4) were calculated to assess the diagnostic superiority of serum CHI3L1 compared to other non-invasive fibrosis assessment measures. Multivariate logistic regression analysis was conducted to identify relevant variables for constructing a diagnostic model. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic accuracy of each index, including the area under ROC curve (AUC), sensitivity, and specificity. A nomogram was established based on the logistic regression model. Results Serum CHI3LI levels were found to be higher in NAFLD patients with significant fibrosis compared to those without significant fibrosis. Multivariate logistic regression analysis revealed that aspartate aminotransferase (AST), type IV collagen (IV-C), CHI3L1, and liver stiffness measurement (LSM) were identified as potential independent risk factors associated with significant fibrosis in patients. The AUC of CHI3L1 for diagnosing significant liver fibrosis was 0.716 (0.596,0.836), with the optimal cut-off point of 125.315. The nomogram incorporating CHI3LI, AST, IV-C, and LSM further improved the potential predictive value, with an AUC for diagnosing significant fibrosis of 0.864 (0.766,0.962). This was superior to IV-C, CHI3L1, LSM, and APRI (all p < 0.05). Conclusion The diagnostic model constructed by CHI3L1 combined with the existing non-invasive markers AST, IV-C, and LSM can help assess the risk of significant liver fibrosis in NAFLD.
Collapse
Affiliation(s)
- Fan Zhang
- Department of Endocrinology, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
- Department of Clinical Nutrition, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Yan Han
- Department of Endocrinology, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
- Department of Clinical Nutrition, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Liming Zheng
- Clinical Laboratory, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Jianhong Liu
- Department of Pathology, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Yunfei Wu
- Department of Pathology, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Zuowei Bao
- Department of Ultrasonography, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Longgen Liu
- Department of Liver Diseases, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Wenjian Li
- Department of Urology, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| |
Collapse
|