The Role of M30 in Predicting the Severity of Liver Fibrosis and Inflammation in Chronic Hepatitis B Patients

Correlations of Serum Vitamin D Level with Markers of Oxidative Stress and Apoptosis in Liver Cirrhosis

In this study we investigated the relationship between vitamin D and markers of oxidative stress and apoptosis in patients with liver cirrhosis stratified according serum GGT activity. Forty-eight patients with liver cirrhosis of various aetiology were selected, among which 58% cases (n=28) diagnosed with alcoholic liver cirrhosis and 42% (n=20) with cirrhosis after hepatitis virus infection. Each group was divided into three quartiles according GGT activity. 25-hydroxyvitamin D [25-(HO) vit D], markers of oxidative stress (catalase, superoxide dismutase) and apoptosis (M30) were compared. Higher levels of GGT were correlated with elevated AST, ALT and ALP values in both groups. A statistically significant difference was observed when comparing 25-(OH) vit D levels of patients suffering from ethanol-induced liver cirrhosis versus control group for all the quartiles as well as for those from the first quartile of viral-induced liver cirrhosis. For SOD, statistically significant differences were noticed between all cirrhosis subgroups and the control group. CAT values in all cirrhosis subgroups were lower than in control, but significant differences were only between Q2.2 and Q1.3 quartiles and Q2.2 and control. Correlation of 25-(OH) vit D versus SOD yields statistically significant results in ethanol-induced cirrhosis patients. M30 activity was increased in patients with alcoholic cirrhosis compared to controls and those with virus-induced cirrhosis, being correlated with the degree of GGT activity. Our results emphasized that vitamin D deficiency is associated with enhanced liver dysfunction regardless of the trigger responsible for disease onset. Furthermore, vitamin D deficiency augments liver injury by promoting oxidative stress which influence the survival mechanisms of parenchymal liver cells.

Serum caspase-cleaved cytokeratin-18 fragment as a prognostic biomarker in hematological patients with febrile neutropenia

The study aim was to determine the benefit of the measurement of serum caspase-cleaved cytokeratin-18 (CK-18) fragment as a prognostic marker of febrile neutropenia (FN) in hematological patients. The study population consisted of 86 consecutive patients with FN who received intensive chemotherapy for hematological malignancy at the adult hematology ward of Kuopio University Hospital. Twenty-three patients (27%) had acute myeloid leukemia, and 63 patients (73%) were autologous stem cell transplant recipients. Serum caspase-cleaved CK-18 fragment M30, C-reactive protein (CRP) and procalcitonin (PCT) were measured at the onset of FN (d0), on day 1 (d1), and on day 2 (d2). Eight patients (9%) developed severe sepsis, including three patients with septic shock. Eighteen patients (21%) had a blood culture-positive infection. Serum CK-18 fragment peaked on the first day after fever onset in patients with severe sepsis. Higher CK-18 level was associated with severe sepsis, intensive care unit treatment, and fatal outcome, but not with blood culture positivity. In ROC curve analysis, d1 serum CK-18 fragment predicted severe sepsis with an area under the curve (AUC) of 0.767, CRP with an AUC of 0.764, and PCT with an AUC of 0.731. On d2, the best predictive capacity was observed for CRP with an AUC of 0.832. The optimal cutoff of caspase-cleaved CK-18 fragment M30 for predicting severe sepsis was 205 U/L on d1. In hematological patients, serum CK-18 fragment was found to be a potential prognostic marker of severe sepsis at early stages of FN.

Total Keratin-18 (M65) as a Potential, Early, Non-Invasive Biomarker of Hepatocyte Injury in Alcohol Intoxicated Adolescents-A Preliminary Study

BACKGROUND

Underage drinking is associated with health risk behaviors. Serum keratin-18 (CK18) levels are increased in liver diseases and may be biomarkers of outcome. The purpose of this study was to determine if the total CK18 (M65) or caspase-cleaved CK18 (M30) levels were different in adolescents admitted to hospital because of alcohol intoxication and controls with excluded liver diseases.

METHODS

A prospective study included 57 adolescents after alcohol use and 23 control subjects. The concentrations of M30 and M65 in the serum samples were evaluated using an enzyme-linked immunosorbent assay.

RESULTS

The median age was 15 (14-17) years and 49% were male. There were significant differences in M65 levels between the study and control groups (p = 0.03). The concentrations of M30 and M65 were insignificant in adolescents divided into subgroups according to blood alcohol concentrations (BAC). Significant positive correlations were found between BAC and M65 levels (p = 0.038; r = 0.3). In receiver operating characteristic (ROC) analysis M65 (cut-off = 125.966 IU/l, Se = 70.2%, Sp = 43.5%) allowed to differentiate between patients with and without alcohol intoxication (AUC = 0.66, p = 0.03).

CONCLUSION

M65 appears to be a promising non-invasive biomarker of hepatocyte injury during alcohol intoxication in adolescents. Moreover, a higher concentration of M65 may indicate early organ injury before the increase in the activity of liver enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

Hepatic Arterial Blood Flow Index Is Associated with the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B Virus Infection

Background: Liver fibrosis due to Hepatitis B Virus (HBV) infection is an important public health concern worldwide. An accurate assessment of liver fibrosis is crucial for the identification of susceptible patients to severe clinical conditions and selection of treatment for patients with Chronic Hepatitis B (CHB) infection. Today, the development of simple, accurate, cost-effective, and non-invasive liver fibrosis tests is essential in clinical practice. Methods: According to liver biopsy as the reference standard, we compared the efficacy of hepatic arterial blood flow index (HBI) versus liver stiffness measurement (LSM), aspartate aminotransferase-to-platelet count ratio index (APRI), and fibrosis index based on 4 factors (FIB-4) to predict various degrees of liver fibrosis among 87 patients with CHB infection. Results: Spearman’s rank correlation coefficient of HBI versus the degree of liver fibrosis, according to the METAVIR scoring system, was 0.672 (P < 0.001). The area under the receiver operating characteristic curve (AUROC) of HBI (0.884; 95% CI: 0.806 - 0.961; P = 0.000) was greater than that of LSM (0.807; 95% CI: 0.703 - 0.912; P = 0.00), APRI (0.684; 95% CI: 0.556 - 0.812; P = 0.009), and FIB-4 (0.757; 95% CI: 0.641 - 0.873; P = 0.000) for the diagnostic analysis of significant liver fibrosis (≥ F2); similar results were obtained for the prediction of other liver fibrosis stages. Conclusions: The present findings shed new light on the association of HBI with the degree of liver fibrosis in patients with CHB infection. Hepatic Arterial Perfusion Scintigraphy (HAPS) with the measurement of HBI is a promising diagnostic method of liver fibrosis stage, which can guide therapy in CHB patients, although further large-scale studies are needed.

Dynamic prediction of liver cirrhosis risk in chronic hepatitis B patients using longitudinal clinical data

OBJECTIVES

In longitudinal studies, serum biomarkers are often measured longitudinally which is valuable to predict the risk of disease progression. Previous risk prediction models for liver cirrhosis restrict data to baseline or baseline and a single follow-up time point, which failed to incorporate the time-dependent marker information. The aim of this study is to develop risk model in patients with chronic hepatitis B for dynamic prediction of cirrhosis by incorporating longitudinal clinical data.

METHODS

Data from the hospital-based retrospective cohort at the Third Affiliated Hospital of Sun Yat-sen University, from 2004 to 2016, were analyzed. Using the multilevel logistic regression model, the time-dependent marker information and individual characteristics were taken as input, and the risk of at different time as the output.

RESULTS

At the end of follow-up, 8.8% of patients progressed to cirrhosis, the average estimate values of hepatitis B virus DNA and alanine aminotransferase demonstrated a downward trend, the aspartate aminotransferase/alanine aminotransferase ratio showed a flat trend overall. The important predictors were as follows: age, oral antiviral treatment, hepatitis B virus DNA. This risk prediction model had an area under the receiver operator characteristic curve of 0.835 (95% confidence interval: 0.772-0.899) and 0.809 (95% confidence interval: 0.708-0.910) in the derivation and validation sets, respectively.

CONCLUSION

Longitudinal prediction model can be used for dynamic prediction of disease progression and identify changing high-risk patients.