Alanine aminotransferase influencing performances of routine available tests detecting hepatitis B-related cirrhosis

Red cell distribution width/platelet ratio predicts decompensation of metabolic dysfunction-associated steatotic liver disease-related compensated advanced chronic liver disease

Prognostication of compensated advanced chronic liver disease (cACLD) is of paramount importance for the physician-and-patient communication and for rational clinical decisions. The paper published by Dallio et al reports on red cell distribution width (RDW)/platelet ratio (RPR) as a non-invasive biomarker in predicting decompensation of metabolic dysfunction-associated steatotic liver disease (MASLD)-related cACLD. Differently from other biomarkers and algorithms, RPR is inexpensive and widely available, based on parameters which are included in a complete blood count. RPR is computed on the grounds of two different items, one of which, RDW, mirrors the host's response to a variety of disease stimuli and is non-specific. The second parameter involved in RPR, platelet count, is more specific and has been used in the hepatological clinic to discriminate cirrhotic from non-cirrhotic chronic liver disease for decades. Cardiovascular disease is the primary cause of mortality among MASLD subjects, followed by extra-hepatic cancers and liver-related mortality. Therefore, MASLD biomarkers should be validated not only in terms of liver-related events but also in the prediction of major adverse cardiovascular events and cardiovascular mortality and extra-hepatic cancers. Adequately sized multi-ethnic confirmatory investigation is required to define the role and significance of RPR in the stratification of MASLD-cACLD.

Clinical characteristics and changes in serum CXCL10 and CXCL16 levels in patients with severe mycoplasma pneumonia

To explore the clinical characteristics and changes in serum CXCL10 and CXCL16 in patients with severe mycoplasma pneumonia, and to analyze the risk factors of severe mycoplasma pneumonia. About 258 children with acute mycoplasma pneumoniae pneumonia (MPP) admitted to the respiratory department of a certain hospital from January 2020 to December 2022 were selected as the study subjects. According to the severity of MPP, patients are divided into 2 groups, namely the mild illness group (Q group) and the severe illness group (Z group). The number of cases in these 2 groups of children is 167 and 91, respectively. The serum CXCL10, CXCL16, and other indicators of 2 groups are tested. Compared to group Q, patients in group Z have a higher proportion of extrapulmonary complications, longer cough time, longer shortness of breath, and longer wheezing time (P < .05). The serum CXCL16 is higher and the proportion of pleural effusion is higher (P < .01). There are more cases of fever, longer fever duration, longer hospital stay, higher serum CXCL10, and higher D-dimer levels (P < .001). The area under the curve of the probability curve for predicting severe mycoplasma pneumonia is 0.975 (P < .05). Children with severe mycoplasma pneumonia have significantly longer fever duration and hospital stay than those with mild symptoms. The serum levels of CXCL10 and CXCL16 are significantly elevated.

Optimal use of red cell volume distribution width-to-platelet ratio to exclude cirrhosis in patients with chronic hepatitis B

Background and aims

Hepatitis B virus (HBV) infection is a major public health issue worldwide as it may cause serious liver diseases such as cirrhosis and hepatocellular carcinoma (HCC). Ruling out cirrhosis is important when treating chronic hepatitis B (CHB). The aim of this study was to compare the performance of the aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis score based on four factors (FIB-4), and red cell volume distribution width-to-platelet ratio (RPR) in diagnosing liver fibrosis stages and to identify new cut-off values to rule out cirrhosis.

Methods

Between 2005 and 2020, 2182 eligible individuals who underwent liver biopsy were randomly assigned to derivation and validation cohorts in a 6:4 ratio. A grid search was applied to identify optimal cut-off values with a sensitivity of >90% and a negative predictive value (NPV) of at least 95%.

Results

Overall, 1309 individuals (175 patients with cirrhosis) were included in the derivation dataset, and 873 (117 patients with cirrhosis) were included in the validation cohort. The area under the receiver operating characteristic curve of RPR for diagnosing cirrhosis was 0.821, which was comparable to that of APRI (0.818, P = 0.7905) and FIB-4 (0.803, P = 0.2395). When applying an RPR of 0.06, cirrhosis was correctly identified with a sensitivity of 93.1% and an NPV of 97.1%, while it misclassified 12 of 175 (6.9%) patients in the derivation cohort. In the validation cohort, RPR had a sensitivity and NPV of 97.4% and 99.0%, respectively, and only misclassified 3 of 117 (2.6%) patients. Subgroup analysis indicated that the new RPR cut-off value performed more consistently than that of APRI and FIB-4 in all subgroups.

Conclusion

A recently established cut-off value for RPR (≤0.06) was validated and was more effective than APRI and FIB-4 in excluding patients with cirrhosis due to a higher sensitivity and NPV and a lower misclassification rate. This simple and dependable test could have significant clinical implications in identifying patients who require monitoring for portal hypertension-associated complications and screening for HCC, particularly in middle and primary healthcare settings.

Combinations of liver lobe and spleen volumes obtained on magnetic resonance imaging to predict esophagogastric variceal bleeding in hepatitis B-related cirrhotic patients: A prospective cohort study

To evaluate whether combinations of liver lobe and spleen volumes obtained on magnetic resonance imaging (MRI) could predict esophagogastric variceal bleeding (EVB) in hepatitis B-related cirrhotic patients. Ninety-six consecutive patients with hepatitis B-related cirrhosis underwent upper abdominal contrast-enhanced MRI within 1 week after initial hospitalization, and grouped based on outcomes of EVB during the 2 years' follow-up after being discharged. Total liver volume (TLV), spleen volume (SV) and 4 liver lobe volumes including right lobe volume (RV), left medial lobe volume (LMV), left lateral lobe volume (LLV), and caudate lobe volume (CV) were measured on MRI. Percentages of individual liver lobe volumes in TLV (including RV/TLV, LMV/TLV, LLV/TLV, and CV/TLV), ratios of SV to individual liver lobe volumes (including SV/RV, SV/LMV, SV/LLV, and SV/CV), and SV/TLV were statistically analyzed to predict EVB. Patients with EVB had lower RV than without EVB (P value = .001), whereas no differences in LMV, LLV, CV, and TLV were found (P values >.05 for all). Among percentages of individual liver lobe volumes in TLV, RV/TLV was lower whereas LMV/TLV and LLV/TLV were greater in patients with EVB than without EVB (P values <.05 for all). SV, ratios of SV to individual liver lobe volumes, and SV/TLV in patients with EVB were larger than without EVB (P values <.05 for all). Among parameters with difference between patients with and without EVB, SV/RV could best predict EVB with an area under receiver operating characteristic curve of 0.84. SV/RV could best predict EVB in hepatitis B-related cirrhotic patients.

Optimized cutoffs of gamma-glutamyl transpeptidase-to-platelet ratio, aspartate aminotransferase-to-platelet ratio index, and fibrosis-4 scoring systems for exclusion of cirrhosis in patients with chronic hepatitis B

Accurate prediction of the extent of fibrosis is of great clinical importance in patients infected with chronic hepatitis B (CHB). This study aimed to compare the performance of gamma-glutamyl transpeptidase-to-platelet ratio (GPR), aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) in evaluating liver fibrosis stages and to identify optimized cutoffs to exclude cirrhosis. Consecutive patients with CHB with liver biopsies were enrolled and randomly divided into derivation and validation cohorts. Areas under the receiver operating characteristic curve were used to evaluate the diagnostic performance of APRI, FIB-4, and GPR to distinguish fibrosis stages. New cutoffs with a sensitivity of at least 90% and a negative predictive value (NPV) of more than 95% were identified. A total of 880 individuals were enrolled in this study. The derivation data set consisted of 617 patients, with 82 patients with cirrhosis. In the validation cohort (n = 263), 29 patients had cirrhosis. APRI, FIB-4, and GPR had comparable diagnostic performance for diagnosing significant fibrosis. GPR outperformed APRI (p < 0.05) in the prediction of cirrhosis. A newly identified GPR score of 0.35 had a sensitivity and NPV of 93.9% and 98.0%, respectively, and misclassified 5 of 82 (6.1%) patients with cirrhosis in the derivation group. All new cutoffs identified in this study also reached our goal in the validation cohort. The new GPR score could rule out a larger proportion of individuals without cirrhosis, and the subgroup analysis showed more stable performance. However, the lower cutoff dose increases the need for further testing compared to the conventional cutoff. Conclusion: A newly identified cutoff for GPR (<0.35) could rule out more patients without cirrhosis compared to APRI and FIB-4 and have low misclassification rates.

Prognostic Value of Serum Exosomal AHCY Expression in Hepatitis B-Induced Liver Cirrhosis

Objective: We aimed to investigate serum exosomal adenosylhomocysteinase (AHCY) expression in hepatitis B-induced liver cirrhosis (HBV-LC) patients and to determine the prognostic value of serum exosomal AHCY. Methods: We collected serum samples from 100 patients with chronic hepatitis B (CHB) and from 114 HBV-LC patients to test serum exosomal AHCY expression using ELISA. Results: Compared with the CHB and Grade A and B HBV-LC groups, the level of exosomal AHCY expression was significantly higher in the HBV-LC group [376.62 (291.50-448.02) vs. 248.12 (189.28-324.63), P > 0.001] and the Grade C HBV-LC group [408.70 (365.63-465.76) vs. 279.76 (215.16-336.07), P > 0.001], respectively. Serum exosomal AHCY expression and MELD score had a significant positive correlation (r = 0.844, P < 0.001). Survival curve analysis showed that patients with low exosomal AHCY expression had significantly longer survival than patients with high exosomal AHCY expression (P = 0.0038). The receiver operating characteristics (ROC) curve showed that the area under the curve (AUC) value for the mortality prediction ability of serum exosomal AHCY in HBV-LC patients was 0.921, which was higher than the values for the MELD score (AUC 0.815) and Child-Pugh classification (AUC 0.832), with a sensitivity and specificity of 93.41 and 76.00%, respectively. Conclusions: The serum exosomal AHCY level is a novel potential prognostic biomarker in HBV-LC patients, which may be great significance for the prognosis of HBV-LC patients.