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Leite N, Tadiotto MC, Corazza PRP, de Menezes Junior FJ, Carli MEC, Milano-Gai GE, Lopes WA, Gaya AR, Brand C, Mota J, Radominski RB. Responsiveness on metabolic syndrome criteria and hepatic parameters after 12 weeks and 24 weeks of multidisciplinary intervention in overweight adolescents. J Endocrinol Invest 2022; 45:741-752. [PMID: 34780051 DOI: 10.1007/s40618-021-01699-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/01/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aimed to evaluate the effect and individual responsiveness after 12 (12wk) and 24 weeks (24wk) of physical exercise (PE) and nutritional guidance (NG) on metabolic syndrome (MetS) criteria and hepatic parameters in overweight adolescents. METHODS The study comprised 94 overweight adolescents, aged between 10 and 16 years old, from both sexes, allocated into groups: PE and NG (PENGG, n = 64) and control with NG (NGCG, n = 30). Variables were collected at baseline, 12wk, and 24wk. Weight, height, abdominal circumference (AC), blood pressure, and peak oxygen consumption (VO2peak), as well as insulin, triglycerides (TAG), high-density lipoprotein (HDL-c), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were evaluated. HOMA-IR and QUICKI were calculated. PE session consisted of 45 min of indoor cycling, 45 min of walking, and 20 min of stretching, three times a week. The NG consisted of three collective sessions in the first 12wk. Anova, effect size, and prevalence of responders were used for statistical analysis. RESULTS The PENGG12wk reduced anthropometric and metabolic measurements, while increased VO2peak and HDL-c. The PEG24wk promoted anthropometric, blood pressure, metabolic, and VO2peak improvements, but participants without PE returned to pre-exercise status and presented worsening AST and ALT concentrations. Frequencies of respondents in PENGG12wk versus (vs) NGCG12wk were, respectively, AC (69.1% vs 17.6%, p < 0.01), HDL-c (87.2% vs 23.5%, p < 0.01), TAG (67.3% vs 41.7%, p = 0.05) and ALT (45.5% vs 5,9%; p = 0.003). CONCLUSION Interventions with PE were effective to reduce MetS components in 12wk and maintenance in 24wk, showing anthropometric, metabolic, and VO2peak improvements. Higher individual responses were observed in 12wk and in 24wk, important changes in overweight adolescent's therapy. LEVEL OF EVIDENCE Level I, evidence obtained from well-designed controlled trials randomization. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION Brazilian Registry of Clinical Trials (RBR-4v6h7b) and date of registration April 4th, 2020.
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Affiliation(s)
- N Leite
- Department of Physical Education, Federal University of Parana, Street Cel. Francisco H. dos Santos, 100, Jardim das Américas, Curitiba, Paraná, 81531-980, Brazil.
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal.
| | - M C Tadiotto
- Department of Physical Education, Federal University of Parana, Street Cel. Francisco H. dos Santos, 100, Jardim das Américas, Curitiba, Paraná, 81531-980, Brazil
| | - P R P Corazza
- Department of Physical Education, Federal University of Parana, Street Cel. Francisco H. dos Santos, 100, Jardim das Américas, Curitiba, Paraná, 81531-980, Brazil
| | - F J de Menezes Junior
- Department of Physical Education, Federal University of Parana, Street Cel. Francisco H. dos Santos, 100, Jardim das Américas, Curitiba, Paraná, 81531-980, Brazil
| | - M E C Carli
- Department of Physical Education, Federal University of Parana, Street Cel. Francisco H. dos Santos, 100, Jardim das Américas, Curitiba, Paraná, 81531-980, Brazil
| | - G E Milano-Gai
- Department of Physical Education, Federal University of Parana, Street Cel. Francisco H. dos Santos, 100, Jardim das Américas, Curitiba, Paraná, 81531-980, Brazil
| | - W A Lopes
- Department of Physical Education, Federal University of Parana, Street Cel. Francisco H. dos Santos, 100, Jardim das Américas, Curitiba, Paraná, 81531-980, Brazil
- Department of Physical Education, State University of Maringá, Maringá, Paraná, Brazil
| | - A R Gaya
- Department of Physical Education, Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - C Brand
- Graduate Program in Health Promotion, University of Santa Cruz Do Sul, Santa Cruz Do Sul, Rio Grande do Sul, Brazil
| | - J Mota
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - R B Radominski
- Department of Nutrition, Federal University of Paraná, Curitiba, Paraná, Brazil
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Loglio A, Ferenci P, Uceda Renteria SC, Tham CYL, Scholtes C, Holzmann H, van Bömmel F, Borghi M, Perbellini R, Rimondi A, Farina E, Trombetta E, Manunta M, Porretti L, Prati D, Ceriotti F, Zoulim F, Bertoletti A, Lampertico P. Safety and effectiveness of up to 3 years' bulevirtide monotherapy in patients with HDV-related cirrhosis. J Hepatol 2022; 76:464-469. [PMID: 34699951 DOI: 10.1016/j.jhep.2021.10.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
The entry inhibitor bulevirtide (BLV) received conditional approval from the EMA in July 2020 for the treatment of adult patients with compensated chronic hepatitis delta. However, the effectiveness and safety of BLV administered as monotherapy beyond 48 weeks in difficult-to-treat patients with HDV-related cirrhosis is presently unknown. Herein, we describe the first patients with HDV-related compensated cirrhosis who were treated with BLV (10 mg/day as a starting dose) for up to 3 years on a compassionate use program. Patients were also monitored for HBcrAg and HBV RNA levels, and HDV- and HBV-specific T-cell markers. In the patient who stopped BLV at week 48, after achieving a virological and biochemical response, the initial virological and biochemical rebound was followed by alanine aminotransferase normalization coupled with low HDV RNA and HBsAg levels. In the 2 patients treated continuously for 3 years, virological and biochemical responses were maintained throughout the treatment period even after dose reduction. In a patient with advanced compensated cirrhosis, liver function tests significantly improved, esophageal varices disappeared, and histological/laboratory features of autoimmune hepatitis resolved. Overall, no safety issues were recorded, as bile salt increase was asymptomatic. While serum HBV RNA levels remained undetectable in all patients, HBV core-related antigen levels showed a progressive, yet modest decline during long-term BLV treatment. No HDV-specific interferon-γ-producing T cells were detected, neither after HDV reactivation (after BLV withdrawn in Patient 1) nor during 3 years of BLV treatment. In conclusion, this report shows that continuous administration of BLV monotherapy for 3 years leads to excellent virological and clinical responses in patients with HDV-related cirrhosis who had contraindications to interferon-based therapies.
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Affiliation(s)
- Alessandro Loglio
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Peter Ferenci
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | | | - Christine Y L Tham
- Program Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | | | | | - Florian van Bömmel
- Section of Hepatology, Department of Gastroenterology, University Hospital Leipzig, Leipzig
| | - Marta Borghi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Riccardo Perbellini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Alessandro Rimondi
- CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elisa Farina
- CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elena Trombetta
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Flow cytometry service, Milan, Italy
| | - Maria Manunta
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Transfusion Medicine and Hematology, Biobank POLI-MI, Milan, Italy
| | - Laura Porretti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Flow cytometry service, Milan, Italy
| | - Daniele Prati
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Transfusion Medicine and Hematology, Biobank POLI-MI, Milan, Italy
| | - Ferruccio Ceriotti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Virology Unit, Milan, Italy
| | - Fabien Zoulim
- Hospices Civils de Lyon, INSERM Unit 1052, Lyon University, France
| | - Antonio Bertoletti
- Program Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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Abstract
Drug-induced liver injury (DILI) has a very variable clinical and biochemical phenotype and differs widely in severity, from mild injury to life-threatening liver failure. Chronic injury has also been reported to occur at a variable frequency, ranging from 3.4% to 39%, 6-12 months after discontinuing the implicated agent. This wide range is probably related to various definitions of chronic liver injury and variable selection of patients. The long-term sequalae of this chronic injury in terms of morbidity and mortality are unclear, although rare vanishing bile duct syndrome is associated with an unfavourable prognosis, with increased risk of chronic liver failure and need for liver transplantation. Other forms of long-term sequalae associated with DILI are progressive fibrosis, autoimmune-like hepatitis, secondary sclerosing cholangitis, sinusoidal obstruction syndrome and, as a common final stage, the development of cirrhosis, portal hypertension and its complications. Immune checkpoint inhibitors, which can cause an autoimmune-like phenotype have also recently been shown to cause sclerosing cholangitis with cytotoxic T CD8+ cell infiltration in biliary tracts. DILI has been shown to have a significant impact on health-related quality of life but very little is known about its psychological consequences in the long-term. Further investigations with structured long-term follow-up and periodic quality of life surveys are needed to assess the impact of DILI on psychological outcomes, particularly in those with chronic sequelae.
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Affiliation(s)
- Einar S Björnsson
- Faculty of Medicine, University of Iceland, Iceland; Department of Gastroenterology, Landspitali University Hospital Reykjavik, Iceland.
| | - Raul J Andrade
- Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Malaga, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
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Ricke J, Schinner R, Seidensticker M, Gasbarrini A, van Delden OM, Amthauer H, Peynircioglu B, Bargellini I, Iezzi R, De Toni EN, Malfertheiner P, Pech M, Sangro B. Liver function after combined selective internal radiation therapy or sorafenib monotherapy in advanced hepatocellular carcinoma. J Hepatol 2021; 75:1387-1396. [PMID: 34454995 DOI: 10.1016/j.jhep.2021.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/09/2021] [Accepted: 07/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS SORAMIC is a previously published randomised controlled trial assessing survival in patients with advanced hepatocellular carcinoma who received sorafenib with or without selective internal radiation therapy (SIRT). Based on the per-protocol (PP) population, we assessed whether the outcome of patients receiving SIRT+sorafenib vs. sorafenib alone was affected by adverse effects of SIRT on liver function. METHODS The PP population consisted of 109 (SIRT+sorafenib) vs. 173 patients (sorafenib alone). Comparisons were made between subgroups who achieved a significant survival benefit or trend towards improved survival with SIRT and the inverse group without a survival benefit: <65 years-old vs. ≥65 years-old, Child-Pugh 5 vs. 6, no transarterial chemoembolisation (TACE) vs. prior TACE, no cirrhosis vs. cirrhosis, non-alcohol- vs. alcohol-related aetiology. The albumin-bilirubin (ALBI) score was used to monitor liver function over time during follow-up. RESULTS ALBI scores increased in all patient groups during follow-up. In the PP population, ALBI score increases were higher in the SIRT+sorafenib than the sorafenib arm (p = 0.0021 month 4, p <0.0001 from month 6). SIRT+sorafenib conferred a survival benefit compared to sorafenib alone in patients aged <65 years-old, those without cirrhosis, those with Child-Pugh 5, and those who had not received TACE. A higher increase in ALBI score was observed in the inverse subgroups in whom survival was not improved by adding SIRT (age ≥65 years-old, p <0.05; cirrhosis, p = 0.07; Child-Pugh 6, p <0.05; prior TACE, p = 0.08). CONCLUSION SIRT frequently has a negative, often subclinical, effect on liver function in patients with hepatocellular carcinoma, which may impair prognosis after treatment. Careful patient selection for SIRT as well as prevention of clinical and subclinical liver damage by selective treatments, high tumour uptake ratio, and medical prophylaxis could translate into better efficacy. CLINICAL TRIAL NUMBER EudraCT 2009-012576-27, NCT01126645 LAY SUMMARY: This study of treatments in patients with hepatocellular carcinoma found that selective internal radiation therapy (SIRT) has an adverse effect on liver function that may affect patient outcomes. Patients should be carefully selected before they undergo SIRT and the treatment technique should be optimised for maximum protection of non-target liver parenchyma.
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Affiliation(s)
- Jens Ricke
- Department of Radiology, Ludwig Maximilan University Munich, München, Germany.
| | - Regina Schinner
- Department of Radiology, Ludwig Maximilan University Munich, München, Germany
| | - Max Seidensticker
- Department of Radiology, Ludwig Maximilan University Munich, München, Germany
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Medicina interna e gastroenterologia, Roma, Italy
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Holger Amthauer
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Irene Bargellini
- Department of Vascular and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Roberto Iezzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Peter Malfertheiner
- Department of Radiology and Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Maciej Pech
- Departments of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain
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Abstract
OBJECTIVE This study aimed to determine the effectiveness of using total, individual serum, or urinary bile acids (BA) as potential markers of liver dysfunction. METHODS We searched the PubMed and Web of Science databases using the following keywords- "serum bile acids," "liver dysfunction," "liver injury," "liver disease," "traditional liver function tests," "Chronic liver disease," "acute liver injury". The search was complemented by manual screening of the list of references for relevant articles. We selected only English-language manuscripts for adult patients based on predetermined inclusion and exclusion criteria. Animal studies and studies on neonates and children were not included. OUTCOME MEASURES Changes in BA concentrations or ratios at or prior to changes in liver function tests. RESULTS A total of 547 studies were identified, of which 28 were included after reading the entire manuscript. These studies included 1630 patients and 836 controls published between 1990 and 2017. The methods used in BA assays varied significantly, and the studies did not agree. on specific individual BA or BA ratios as biomarkers of specific liver injury or dysfunction. Except for the prognostic value of BA in intrahepatic cholestasis of pregnancy (ICP), studies have failed to provide evidence for BA as a liver biomarker. CONCLUSIONS Despite the research conducted on BA for over 27 years, there are inconsistencies in the reported results and a lack of solid evidence to support the use of individual BA or BA ratios as biomarkers of liver injury. Adequately conducted studies needed to resolve this limitation in the literature.
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Affiliation(s)
- Samy A. Azer
- Gastroenterologist and Chair of Curriculum Development and Research Unit, Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rana Hasanato
- Clinical Biochemistry Consultant and Chair of Biochemistry Unit, Director of the Laboratories at King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Kolamunnage-Dona R, Berhane S, Potts H, Williams EH, Tanner J, Janowitz T, Hoare M, Johnson P. Sorafenib is associated with a reduced rate of tumour growth and liver function deterioration in HCV-induced hepatocellular carcinoma. J Hepatol 2021; 75:879-887. [PMID: 34052255 PMCID: PMC9158473 DOI: 10.1016/j.jhep.2021.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Sorafenib has been the standard of care for patients with advanced hepatocellular carcinoma and although immunotherapeutic approaches are now challenging this position, it retains an advantage in HCV-seropositive patients. We aimed to quantify the rate of tumour progression in patients receiving sorafenib and relate this figure to survival, both overall, and according to viral status. METHODS Using serial data from an international clinical trial we applied a joint model to combine survival and progression over time in order to estimate the rate of tumour growth as assessed by tumour burden and serum alpha-fetoprotein, and the impact of treatment on liver function. RESULTS High tumour burden at baseline was associated with an increased risk of death. In patients still alive at the end of the study, the progression in relation to tumour burden was very low compared to those who died within the study. Overall, the change in mean tumour burden was 0.12 mm per day or an absolute growth rate of 3.6 mm/month. Median doubling time was 665 days. For those who progressed above 0.12 mm per day or the 12% rate, median survival was 234 days compared to 384 days if the rate was below 12%. Tumour growth rate and serum alpha-fetoprotein rise were significantly lower in those who were HCV seropositive as was the rate of decline in liver function. These results were replicated in 2 independent patient groups. CONCLUSION Our analysis suggests that sorafenib treatment is associated with improved survival in patients with advanced hepatocellular carcinoma mainly by decreasing the rate of tumour growth and liver function deterioration among patients with HCV infection. LAY SUMMARY Among patients receiving sorafenib for advanced hepatocellular carcinoma the rate of tumour growth (as assessed by changes in tumour size and the biomarker alpha-fetoprotein) and the deterioration of liver function is less in those who have the hepatitis C virus, than in those who do not.
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Affiliation(s)
| | - Sarah Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK; Institute of Applied Health Research, University of Birmingham, UK
| | - Harry Potts
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - James Tanner
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Tobias Janowitz
- CRUK Cambridge Institute, University of Cambridge, Cambridge, UK; Cold Spring Harbor Laboratory, NY, USA; Northwell Health Cancer Institute, NY, USA
| | - Matthew Hoare
- CRUK Cambridge Institute, University of Cambridge, Cambridge, UK; Department of Medicine, University of Cambridge, Cambridge, UK
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK.
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Hoofnagle JH, Bonkovsky HL, Phillips EJ, Li YJ, Ahmad J, Barnhart H, Durazo F, Fontana RJ, Gu J, Khan I, Kleiner DE, Koh C, Rockey DC, Seeff LB, Serrano J, Stolz A, Tillmann HL, Vuppalanchi R, Navarro VJ. HLA-B*35:01 and Green Tea-Induced Liver Injury. Hepatology 2021; 73:2484-2493. [PMID: 32892374 PMCID: PMC8052949 DOI: 10.1002/hep.31538] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/25/2020] [Accepted: 08/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Herbal supplements, and particularly multi-ingredient products, have become increasingly common causes of acute liver injury. Green tea is a frequent component in implicated products, but its role in liver injury is controversial. The aim of this study was to better characterize the clinical features, outcomes, and pathogenesis of green tea-associated liver injury. APPROACH AND RESULTS Among 1,414 patients enrolled in the U.S. Drug-Induced Liver Injury Network who underwent formal causality assessment, 40 cases (3%) were attributed to green tea, 202 to dietary supplements without green tea, and 1,142 to conventional drugs. The clinical features of green tea cases and representation of human leukocyte antigen (HLA) class I and II alleles in cases and control were analyzed in detail. Patients with green tea-associated liver injury ranged in age from 17 to 69 years (median = 40) and developed symptoms 15-448 days (median = 72) after starting the implicated agent. The liver injury was typically hepatocellular (95%) with marked serum aminotransferase elevations and only modest increases in alkaline phosphatase. Most patients were jaundiced (83%) and symptomatic (88%). The course was judged as severe in 14 patients (35%), necessitating liver transplantation in 3 (8%), but rarely resulting in chronic injury (3%). In three instances, injury recurred upon re-exposure to green tea with similar clinical features, but shorter time to onset. HLA typing revealed a high prevalence of HLA-B*35:01, found in 72% (95% confidence interval [CI], 58-87) of green tea cases, but only 15% (95% CI, 10-20) caused by other supplements and 12% (95% CI, 10-14) attributed to drugs, the latter rate being similar to population controls (11%; 95% CI, 10.5-11.5). CONCLUSIONS Green tea-related liver injury has distinctive clinical features and close association with HLA-B*35:01, suggesting that it is idiosyncratic and immune mediated.
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Affiliation(s)
- Jay H Hoofnagle
- Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH), Bethesda, MD
| | - Herbert L Bonkovsky
- National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD
- Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Yi-Ju Li
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Jawad Ahmad
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Huiman Barnhart
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Francisco Durazo
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Robert J Fontana
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI
| | - Jiezhun Gu
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Ikhlas Khan
- National Center for Natural Products Research, University of Mississippi, University, MI
| | - David E Kleiner
- The Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD
| | - Don C Rockey
- Digestive Disease Research Center, Medical University of South Carolina, Charleston, SC
| | - Leonard B Seeff
- Department of Medicine, Einstein Healthcare Network, Philadelphia, PA
| | - Jose Serrano
- Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH), Bethesda, MD
| | - Andrew Stolz
- Department of Medicine, University of Southern California School of Medicine, Los Angeles, CA
| | - Hans L Tillmann
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, East Carolina University, Greenville, NC
| | - Raj Vuppalanchi
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Victor J Navarro
- Department of Medicine, Einstein Healthcare Network, Philadelphia, PA
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Yip TCF, Lui GCY, Wong VWS, Chow VCY, Ho THY, Li TCM, Tse YK, Hui DSC, Chan HLY, Wong GLH. Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19. Gut 2021; 70:733-742. [PMID: 32641471 PMCID: PMC7371491 DOI: 10.1136/gutjnl-2020-321726] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Data on serial liver biochemistries of patients infected by different human coronaviruses (HCoVs) are lacking. The impact of liver injury on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains unclear. DESIGN This was a retrospective cohort study using data from a territory-wide database in Hong Kong. COVID-19, severe acute respiratory syndrome (SARS) and other HCoV patients were identified by diagnosis codes and/or virological results. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2 × upper limit of normal (ie, 80 U/L). The primary end point was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation and/or death. RESULTS We identified 1040 COVID-19 patients (mean age 38 years, 54% men), 1670 SARS patients (mean age 44 years, 44% men) and 675 other HCoV patients (mean age 20 years, 57% men). ALT/AST elevation occurred in 50.3% SARS patients, 22.5% COVID-19 patients and 36.0% other HCoV patients. For COVID-19 patients, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation and 4 (0.4%) died. ALT/AST elevation was independently associated with primary end point (adjusted OR (aOR) 7.92, 95% CI 4.14 to 15.14, p<0.001) after adjusted for albumin, diabetes and hypertension. Use of lopinavir-ritonavir ±ribavirin + interferon beta (aOR 1.94, 95% CI 1.20 to 3.13, p=0.006) and corticosteroids (aOR 3.92, 95% CI 2.14 to 7.16, p<0.001) was independently associated with ALT/AST elevation. CONCLUSION ALT/AST elevation was common and independently associated with adverse clinical outcomes in COVID-19 patients. Use of lopinavir-ritonavir, with or without ribavirin, interferon beta and/or corticosteroids was independently associated with ALT/AST elevation.
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Affiliation(s)
- Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Viola Chi-Ying Chow
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tracy Hang-Yee Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Timothy Chun-Man Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David Shu-Cheong Hui
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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9
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Depaire M, Larrue H, Rudler M, Nault JC, Bureau C. Futility criteria for preemptive TIPS in patients with cirrhosis and variceal bleeding are still missing in most severe patients! J Hepatol 2021; 74:997-999. [PMID: 33340574 DOI: 10.1016/j.jhep.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Martin Depaire
- Service d'Hépatologie Hopital Rangueil et CHU Toulouse et Université Paul Sabatier, Toulouse3, France
| | - Hélène Larrue
- Service d'Hépatologie Hopital Rangueil et CHU Toulouse et Université Paul Sabatier, Toulouse3, France
| | - Marika Rudler
- Service d'Hépatologie Hôpital La Pitié Salpétrière APHP, Paris, France
| | - Jean Charles Nault
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Paris, France; Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138, Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France
| | - Christophe Bureau
- Service d'Hépatologie Hopital Rangueil et CHU Toulouse et Université Paul Sabatier, Toulouse3, France.
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10
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Iavarone M, D'Ambrosio R, Soria A, Triolo M, Pugliese N, Del Poggio P, Perricone G, Massironi S, Spinetti A, Buscarini E, Viganò M, Carriero C, Fagiuoli S, Aghemo A, Belli LS, Lucà M, Pedaci M, Rimondi A, Rumi MG, Invernizzi P, Bonfanti P, Lampertico P. High rates of 30-day mortality in patients with cirrhosis and COVID-19. J Hepatol 2020; 73:1063-1071. [PMID: 32526252 PMCID: PMC7280108 DOI: 10.1016/j.jhep.2020.06.001] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities, but its impact on patients with cirrhosis is currently unknown. Herein, we aimed to evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis. METHODS In this multicentre retrospective study, patients with cirrhosis and a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. Clinical and biochemical data at diagnosis of COVID-19 and at the last outpatient visit were obtained through review of medical records. RESULTS Fifty patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virus-related, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/polypnea, 22% encephalopathy, 96% needed hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with a model for end-stage liver disease (MELD) score ≥15 increased from 13% to 26% (p = 0.037), acute-on-chronic liver failure and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. The severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections. CONCLUSION COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis. LAY SUMMARY Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities. Herein, we assessed its impact on patients with cirrhosis. Infection with COVID-19 was associated with liver function deterioration and elevated mortality in patients with cirrhosis.
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Affiliation(s)
- Massimo Iavarone
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy.
| | - Roberta D'Ambrosio
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Alessandro Soria
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano - Bicocca School of Medicine, Monza, Italy
| | - Michela Triolo
- Gastroenterology 1 - Hepatology & Transplantology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Paolo Del Poggio
- UO Gastroenterologia. Policlinico S. Marco, Zingonia-Bergamo, Italy
| | | | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Angiola Spinetti
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Elisabetta Buscarini
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Ospedale Maggiore, Crema, Italy
| | - Mauro Viganò
- Division of Hepatology, Ospedale San Giuseppe, Italy
| | - Canio Carriero
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Stefano Fagiuoli
- Gastroenterology 1 - Hepatology & Transplantology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Luca S Belli
- Hepatology and Gastroenterology Unit, Niguarda Hospital, Milan, Italy
| | - Martina Lucà
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marianna Pedaci
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Ospedale Maggiore, Crema, Italy; University of Milan, Milan, Italy
| | - Alessandro Rimondi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; University of Milan, Milan, Italy
| | - Maria Grazia Rumi
- Division of Hepatology, Ospedale San Giuseppe, Italy; University of Milan, Milan, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Paolo Bonfanti
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano - Bicocca School of Medicine, Monza, Italy
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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11
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Kajiwara A, Kinowaki K, Akuta N, Kasuya K, Muraishi N, Iritani S, Kawamura Y, Fujiyama S, Sezaki H, Hosaka T, Saitoh S, Kobayashi M, Kobayashi M, Arase Y, Ikeda K, Suzuki F, Kumada H, Suzuki Y. Diagnosis and Resection Treatment of Triplet Hepatocellular Carcinomas with a non-B non-C Background in a Middle Aged Man over a Period of 6-years. Intern Med 2020; 59:2511-2516. [PMID: 32581173 PMCID: PMC7662038 DOI: 10.2169/internalmedicine.5055-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We report a 71-year-old man with non-B non-C chronic liver damage who had been regularly visiting our hospital since he was 38 years of age. He underwent three partial hepatectomies for hepatocellular carcinoma (HCC) diagnosed at 65, 67, and 71 years of age, respectively. A histopathological examination showed moderately-differentiated HCC, and chronic hepatitis with mild fibrosis stage in non-tumor areas. alpha-fetoprotein (AFP) and PIVKAII were not useful for the early prediction of HCC, but TERT promotor mutation (C228T) in serum cell-free DNA was useful. This is the first report on the importance of long-term follow-up in non-B non-C chronic liver damage, regardless of the fibrosis stage.
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Affiliation(s)
| | | | - Norio Akuta
- Department of Hepatology, Toranomon Hospital, Japan
| | | | | | | | | | | | | | | | | | | | | | - Yasuji Arase
- Department of Hepatology, Toranomon Hospital, Japan
| | - Kenji Ikeda
- Department of Hepatology, Toranomon Hospital, Japan
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12
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Wang M, Yan W, Qi W, Wu D, Zhu L, Li W, Wang X, Ma K, Ni M, Xu D, Wang H, Chen G, Yu H, Ding H, Xing M, Han M, Luo X, Chen T, Guo W, Xi D, Ning Q. Clinical characteristics and risk factors of liver injury in COVID-19: a retrospective cohort study from Wuhan, China. Hepatol Int 2020; 14:723-732. [PMID: 33026573 PMCID: PMC7539280 DOI: 10.1007/s12072-020-10075-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has rapidly become a major international public health concern. This study was designed to evaluate the clinical characteristics and risk factors of COVID-19-associated liver injury. METHODS A fraction of 657 COVID-19 patients were retrospectively analyzed. Clinical and laboratory data were derived from electronic medical records and compared between patients with or without liver injury. Multivariate logistic regression method was used to analyze the risk factors for liver injury. RESULTS Among 657 patients, 303 (46.1%) patients had liver injury with higher rate in severe/critically ill patients [148/257 (57.6%)] than those in moderate cases [155/400 (38.8%)]. The incidence of liver injury was much higher in male [192/303 (63.4%)] than female [111/303 (36.6%)], and in severe/critical patients [148/303 (48.8%)] with percutaneous oxygen saturation ≤ 93% [89/279 (31.9%)] or peak body temperature ≥ 38.5 °C [185/301 (61.5%)] on admission. Liver injury-related inflammations included increased white blood cells, neutrophils and decreased lymphocytes. More patients with liver injury than without had increased serum IL-2R, TNFα, ferritin, hsCRP, PCT, ESR, γ-GT, and LDH. Multivariate regression analysis revealed that increasing odds of liver injury were related to male, higher serum hsCRP (≥ 10 mg/L), and neutrophil-to-lymphocyte ratio (NLR) (≥ 5). Moreover, more deceased patients (14/82 (17%)) had significantly elevated serum TBIL than discharged patients [25/532 (4.7%)]. CONCLUSION Liver injury is a common complication in COVID-19 patients. The potential risk factors of liver injury include male, hsCRP and NLR score. A close monitor of liver function should be warned in COVID-19 patients, especially in severe/critical individuals.
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Affiliation(s)
- Ming Wang
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weiming Yan
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weipeng Qi
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Di Wu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lin Zhu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weina Li
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaojing Wang
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ke Ma
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ming Ni
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dong Xu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongwu Wang
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Guang Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Haijing Yu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongfang Ding
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mingyou Xing
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Meifang Han
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoping Luo
- Department of Paediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Guo
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Dong Xi
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Qin Ning
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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13
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Sarin SK, Choudhury A, Lau GK, Zheng MH, Ji D, Abd-Elsalam S, Hwang J, Qi X, Cua IH, Suh JI, Park JG, Putcharoen O, Kaewdech A, Piratvisuth T, Treeprasertsuk S, Park S, Wejnaruemarn S, Payawal DA, Baatarkhuu O, Ahn SH, Yeo CD, Alonzo UR, Chinbayar T, Loho IM, Yokosuka O, Jafri W, Tan S, Soo LI, Tanwandee T, Gani R, Anand L, Esmail ES, Khalaf M, Alam S, Lin CY, Chuang WL, Soin AS, Garg HK, Kalista K, Batsukh B, Purnomo HD, Dara VP, Rathi P, Al Mahtab M, Shukla A, Sharma MK, Omata M. Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study). Hepatol Int 2020; 14:690-700. [PMID: 32623632 PMCID: PMC7334898 DOI: 10.1007/s12072-020-10072-8] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. METHODS Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. RESULTS Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR = 2.1 (1.1-3.7), p = 0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR = 8.1 (1.9-38.8), p = 0.002] predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5 (11.6%)] or acute decompensation [4 (9%)]. Liver related complications increased (p < 0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC 0.94, HR = 19.2 (95 CI 2.3-163.3), p < 0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis patients. CONCLUSIONS SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.
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Affiliation(s)
- Shiv Kumar Sarin
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
| | - Ashok Choudhury
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - George K Lau
- Humanity and Health Clinical Trial Center, Hong Kong SAR, China
| | - Ming-Hua Zheng
- Department of Hepatology, NAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dong Ji
- Humanity and Health Clinical Trial Center, Hong Kong SAR, China
- Fuyang Second People's Hospital, Fuyang, China
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Jaeseok Hwang
- Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ian Homer Cua
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Global City, Philippines
| | - Jeong Ill Suh
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, South Korea
| | - Jun Gi Park
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, South Korea
| | - Opass Putcharoen
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
| | - Apichat Kaewdech
- Gastroenterology and Hepatology Unit, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Teerha Piratvisuth
- Gastroenterology and Hepatology Unit, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
| | - Sooyoung Park
- Kyungpook National University Hospital, Daegu, South Korea
| | - Salisa Wejnaruemarn
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
| | - Diana A Payawal
- Department of Internal Medicine, Fatima University Medical Center, Valenzuela, Philippines
| | - Oidov Baatarkhuu
- Department of Infectious Diseases, School of Medicine, Mongolian National University of Medical Sciences, Ulan Bator, Mongolia
| | - Sang Hoon Ahn
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Dong Yeo
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Uzziel Romar Alonzo
- Department of Internal Medicine, Fatima University Medical Center, Valenzuela, Philippines
| | | | - Imelda M Loho
- Department of Gastroenterology and Hepatology "Dharmais", National Cancer Hospital, Jakarta, Indonesia
| | | | - Wasim Jafri
- Department of Medicine, WGO Training Center, Aga Khan University, Karachi, Pakistan
| | - Soeksiam Tan
- Department of Hepatology, Selayang Hospital, Batu Caves, Malaysia
| | - Lau Ing Soo
- Department of Hepatology, Selayang Hospital, Batu Caves, Malaysia
| | - Tawesak Tanwandee
- Division of Gastroenterology, Department of Medicine, Faculty of Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rino Gani
- Division of Hepatobiliary, Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia
| | | | - Eslam Saber Esmail
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Mai Khalaf
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Shahinul Alam
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Chun-Yu Lin
- Division of Infectious Diseases, School of Medicine, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Division of Infectious Diseases, School of Medicine, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - A S Soin
- Liver Transplant Surgery, Medanta, The Medicity, Gurugram, Haryana, India
| | - Hitendra K Garg
- Hepatologist and Gastroenterologist, Indraprastha Apollo Hospital, New Delhi, India
| | - Kemal Kalista
- Faculty of Medicine, Cipto Mangunkusumo Hospitall, Universitas, Jakarta, Indonesia
| | - Badamnachin Batsukh
- Department of Infectious Diseases, School of Medicine, Mongolian National University of Medical Sciences, Ulan Bator, Mongolia
| | | | | | - Pravin Rathi
- Department of Gastroenterology, T.N. Medical College, B.Y.L. Nair. Ch. Hospital, Mumbai, India
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Akash Shukla
- Department of Gastroenterology, Seth GSMC and KEM Hospital, Mumbai, India
| | - Manoj K Sharma
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
- The University of Tokyo, Tokyo, Japan
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14
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Abstract
BACKGROUND Abnormal liver function has been reported in patients with COVID-19 infection. The aim of our study was to report on the prevalence of liver injury in our cohort, to evaluate the association of mild versus severe liver injury with mortality in COVID-19 patients and to scrutinize the temporal pattern of viral detection and liver injury. METHODS We present data from a German cohort of 147 SARS-CoV-2 infected patients. The patients were divided into 3 groups according to their liver status during treatment. The first group included patients without elevated alanine aminotransferase or bilirubin, the third group patients meeting the biochemical criteria of acute liver failure (ALF), and the second group all other patients. RESULTS Liver injury was detected in 75 (50.7%) and 93 (63%) patients by admission and during treatment, respectively. ALF was associated with the male sex, younger age, and higher BMI. Mortality was associated with the presence of ALF (OR = 9.423, 95% CI: 2.410-36.858) in contrast to milder liver injury (OR 1.101, 95% CI: 0.435-2.791). In 30% of patients with mild liver injury and in 50% of ALF patients, peak liver injury was observed at a time point when the virus was no longer detectable in the respiratory tract. CONCLUSION Mild liver injury was not associated with worse outcome in our cohort, and the pattern of liver injury did not fit well to the theory of SARS-CoV-2 directly causing liver impairment. Instead, severe liver injury in our cohort was associated multiple-organ failure and acute vascular events.
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Affiliation(s)
- Olympia E Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany,
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frank Herbstreit
- Department of Anesthesiology and Intensive Care, Essen University Hospital, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, Universitätsmedizin Essen, University Duisburg-Essen, Essen, Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
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15
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Schattenberg JM, Labenz C, Wörns MA, Menge P, Weinmann A, Galle PR, Sprinzl MF. Patterns of liver injury in COVID-19 - a German case series. United European Gastroenterol J 2020; 8:814-819. [PMID: 32588791 PMCID: PMC7435007 DOI: 10.1177/2050640620931657] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Reports of liver injury in patients with novel coronavirus disease 2019 (COVID-19) are emerging from China and the USA. A wide variety of liver function test abnormalities and few cases of severe liver failure have been reported. No data on the hepatic phenotype from Europe are available at current. METHODS We report a case series of 44 consecutive patients hospitalized for COVID-19 in Germany. RESULTS At the time of admission, aspartate aminotransferase greater than the upper limit of normal was present in 70%, while alanine aminotransferase was elevated in 15.8%. Markers of cholestatic liver injury were altered only in a minority of patients. During hospitalization, 31% and 22% experienced increasing aspartate aminotransferase and alanine aminotransferase, respectively, when transaminases were normal at admission. Severe liver injury defined by 3×> upper limit of normal was observed in 9.1% over a mean time of 10.5 days. Importantly, patients exhibited cytotoxicity including lactate dehydrogenase and creatinine kinase elevations, but no signs of relevant liver function impairment. CONCLUSION In summary, in a case series of hospitalized patients in Germany, cytotoxicity in the absence of severe liver dysfunction at admission and only few cases suggestive of severe liver injury during hospital were observed.
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Affiliation(s)
- Jörn M Schattenberg
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
- Metabolic Liver Research Program, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Christian Labenz
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
- Metabolic Liver Research Program, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Philipp Menge
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Arndt Weinmann
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter R Galle
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin F. Sprinzl
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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Abstract
Small dense low-density lipoprotein (sdLDL) is a distinct low-density lipoprotein (LDL) cholesterol subclass that has been reported to be associated with metabolic disease. On the other hand, the relationship between the sdLDL level and the nonalcoholic fatty liver disease (NAFLD) severity is unclear. In this study, the sdLDL level was measured in patients with NAFLD to assess its potential as a biomarker for evaluating NAFLD. One hundred and twenty-six patients diagnosed with NAFLD at a single referral hospital from January 2018 to August 2019 were enrolled. The lipoprotein profile was analyzed from a blood test of NAFLD patients, and transient elastography (TE, Fibroscan) was performed to evaluate the degree of NAFLD. Among the 126 patients, 83 patients that could confirm the lipoprotein profile and TE results were finally enrolled in the study. The controlled attenuation parameter (CAP) value obtained from TE did not show any correlation with the total cholesterol, LDL. But, the sdLDL level showed a significant positive correlation with the CAP value (r = 0.237, P = .031), and the sdLDL/LDL ratio also showed a significant positive correlation with the CAP value (r = 0.235, P = .032). The liver stiffness (LS) measured by TE and the sdLDL level were positively correlated in patients with NAFLD (rho = 0.217, P = .049). The sdLDL/LDL ratio also showed a significant positive correlation with the LS value (rho = 0.228, P = .038). In addition, the fatty liver index also showed a significant positive correlation with the sdLDL/LDL ratio (r = 0.448, P = .000). In this study, the sdLDL level measured by a blood test of NAFLD patients showed a positive correlation with the CAP value and LS, which indicate the degree of hepatic steatosis and fibrosis. These results suggest the possibility of the sdLDL level as a new biomarker of NAFLD, but further studies will be needed to support these results.
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Affiliation(s)
- Ha Won Hwang
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine
| | - Jung Hwan Yu
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine
| | - Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, South Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine
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Kumar-M P, Mishra S, Jha DK, Shukla J, Choudhury A, Mohindra R, Mandavdhare HS, Dutta U, Sharma V. Coronavirus disease (COVID-19) and the liver: a comprehensive systematic review and meta-analysis. Hepatol Int 2020; 14:711-722. [PMID: 32623633 PMCID: PMC7335221 DOI: 10.1007/s12072-020-10071-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023]
Abstract
Background Liver function derangements have been reported in coronavirus disease (COVID-19), but reported rates are variable. Methods We searched PubMed and Embase with terms COVID and SARS-COV-2 from December 1, 2019 till April 5, 2020. We estimated overall prevalence, stratified prevalence based on severity, estimated risk ratio (RR), and estimated standardized mean difference (SMD) of liver function parameters in severe as compared to non-severe COVID. Random effect method utilizing inverse variance approach was used for pooling the data. Results In all, 128 studies were included. The most frequent abnormalities were hypoalbuminemia [61.27% (48.24–72.87)], elevations of gamma-glutamyl transferase (GGT) [27.94% (18.22–40.27)], alanine aminotransferase (ALT) [23.28% (19.92–27.01)], and aspartate aminotransferase (AST) [23.41% (18.84–28.70)]. Furthermore, the relative risk of these abnormalities was higher in the patients with severe COVID-19 when compared to non-severe disease [Hypoalbuminemia—2.65 (1.38–5.07); GGT—2.31 (1.6–3.33); ALT—1.76 (1.44–2.15); AST—2.30 (1.82–2.90)]. The SMD of hypoalbuminemia, GGT, ALT, and AST elevation in severe as compared to non-severe were − 1.05 (− 1.27 to − 0.83), 0.76 (0.40–1.12), 0.42 (0.27–0.56), and 0.69 (0.52–0.86), respectively. The pooled prevalence and RR of chronic liver disease as a comorbidity was 2.64% (1.73–4) and 1.69 (1.05–2.73) respectively. Conclusion The most frequent abnormality in liver functions was hypoalbuminemia followed by derangements in gamma-glutamyl transferase and aminotransferases, and these abnormalities were more frequent in severe disease. The systematic review was, however, limited by heterogeneity in definitions of severity and liver function derangements. Graphic abstract Graphical depiction of the summary of meta-analytic findings a) pooled prevalence of abnormalities b) Risk ratio of abnormality in severe versus non-severe COVID-19 c) standardized mean difference (SMD) between severe and non-severe group and d) pooled prevalence for parameters based on severity stratification for bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), albumin, globulin and acute hepatic injury (AHI) . Also estimates for overall/total liver disease (TLD) and chronic liver disease (CLD) amongst COVID-19 patients are depicted in a, b, d. For d) In addition to severity stratification, Overall (all studies for a particular estimate) and combined (only those studies which reported severity) estimates are provided.![]() Electronic supplementary material The online version of this article (10.1007/s12072-020-10071-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubhra Mishra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daya Krishna Jha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayendra Shukla
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arup Choudhury
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshal S. Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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McCabe P, Galoosian A, Wong RJ. Patients with Alcoholic Liver Disease Have Worse Functional Status at Time of Liver Transplant Registration and Greater Waitlist and Post-transplant Mortality Which Is Compounded by Older Age. Dig Dis Sci 2020; 65:1501-1511. [PMID: 31642005 DOI: 10.1007/s10620-019-05891-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/03/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Worse functional status correlates with increased mortality on the liver transplant (LT) waitlist. Whether functional status affects LT outcomes equally across cirrhosis etiologies is unclear. AIMS We evaluate the impact of functional status on waitlist and post-LT mortality stratified by etiology and age. METHODS Functional status among US adults from 2005 to 2017 United Network for Organ Sharing LT registry data was retrospectively evaluated using Karnofsky Performance Status Score (KPS-1 = functional status 80-100%, KPS-2 = 60-70%, KPS-3 = 40-50%, KPS-4 = 10-30%). Waitlist and post-LT survival were stratified by KPS and cirrhosis etiology, including alcoholic liver disease (ALD), nonalcoholic steatohepatitis (NASH), hepatitis C (HCV), and HCV/ALD, and evaluated using Kaplan-Meier and multivariate Cox proportional hazard models. RESULTS Among 94,201 waitlist registrants (69.4% men, 39.5% HCV, 26.7% ALD, 23.2% NASH), ALD patients had worse functional status compared to HCV (KPS-4: 17.2% vs. 8.3%, p < 0.001). Worse functional status at time of waitlist registration was associated with higher 90-day waitlist mortality with the greatest effect in ALD (KPS-4 vs. KPS-1: ALD HR 2.16, 95% CI 1.83-2.55; HCV HR 2.17, 95% CI 1.87-2.51). Similar trends occurred in 5-year post-LT survival with ALD patients the most harmed. Compared to patients < 50 years, patients ≥ 65 years had increased waitlist mortality at 90-days if they had HCV or HCV/ALD, and 5-year post-LT mortality regardless of cirrhosis etiology with ALD patients most severely affected. CONCLUSIONS In a retrospective cohort study of patients, US ALD patients had disparately worse functional status at time of LT waitlist registration. Worse functional status correlated with higher risk of waitlist and post-LT mortality, affecting ALD and HCV patients the most.
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Affiliation(s)
- Patrick McCabe
- Division of Gastroenterology and Hepatology, Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Artin Galoosian
- Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland, Care Pavilion 5th Floor, Endoscopy Unit, Oakland, CA, 94602, USA.
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Zeng J, Yang RX, Sun C, Pan Q, Zhang RN, Chen GY, Hu Y, Fan JG. Prevalence, clinical characteristics, risk factors, and indicators for lean Chinese adults with nonalcoholic fatty liver disease. World J Gastroenterol 2020; 26:1792-1804. [PMID: 32351294 PMCID: PMC7183864 DOI: 10.3748/wjg.v26.i15.1792] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/19/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic diseases in the world. Nowadays, the percentage of non-obese or lean patients with NAFLD is increasing. NAFLD in non-obese populations, especially the lean subgroup with a normal waist circumference (WC), might lead to more problems than obese individuals, as these individuals may not visit clinics for NAFLD diagnosis or ignore the diagnosis of NAFLD. If the precise characteristics of these populations, especially the lean subgroup, are identified, the clinicians would be able to provide more appropriate advice and treatment to these populations.
AIM To investigate the prevalence, clinical characteristics, risk factors, and possible indicators for NAFLD in lean Chinese adults with a normal WC.
METHODS People without diabetes mellitus or significant alcohol consumption who underwent routine health examinations were included. Their fatty liver index (FLI), abdominal ultrasonography results, and controlled attenuation parameter were all assessed. Genotyping for single-nucleotide polymorphisms associated with NAFLD was performed in another small group consisting of biopsy-proven NAFLD subjects and healthy controls.
RESULTS A total of 2715 subjects who underwent routine health examinations were included in the study. Among 810 lean participants with a normal WC, 142 (17.5%) fulfilled the diagnostic criteria for NAFLD. Waist-height ratio, hemoglobin, platelets, and triglycerides were significant factors associated with the presence of NAFLD in these participants. The appropriate cut-off value of the FLI score in screening for NAFLD in the lean subjects with a normal WC was 25.15, which had a 77.8% sensitivity and 75.9% specificity. There was no significant difference in the single-nucleotide polymorphisms in the SIRT1, APOC3, PNPLA3, AGTR1, and PPARGC1A genes between lean subjects with and without NAFLD (P < 0.05).
CONCLUSION NAFLD is not uncommon in lean Chinese adults even with a normal WC. Metabolic factors, rather than genetic factors, may play important roles in the development of NAFLD in this population. A lower cut-off value of the FLI score in screening for NAFLD should be used for lean Chinese adults with a normal WC.
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Affiliation(s)
- Jing Zeng
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Rui-Xu Yang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Chao Sun
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Qin Pan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Rui-Nan Zhang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Guang-Yu Chen
- Clinical Epidemiology Research Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Ying Hu
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Children’s Digestion and Nutrition, Shanghai 200092, China
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20
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Cao X, Shang QH, Chi XL, Zhang W, Xiao HM, Sun MM, Chen G, An Y, Lv CL, Wang L, Nan YM, Chen CY, Tan ZN, Liu XE, Zhuang H. Serum N-glycan markers for diagnosing liver fibrosis induced by hepatitis B virus. World J Gastroenterol 2020; 26:1067-1079. [PMID: 32205997 PMCID: PMC7080998 DOI: 10.3748/wjg.v26.i10.1067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/10/2020] [Accepted: 01/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is the primary cause of hepatitis with chronic HBV infection, which may develop into liver fibrosis, cirrhosis and hepatocellular carcinoma. Detection of early-stage fibrosis related to HBV infection is of great clinical significance to block the progression of liver lesion. Direct liver biopsy is regarded as the gold standard to detect and assess fibrosis; however, this method is invasive and prone to clinical sampling error. In order to address these issues, we attempted to find more convenient and effective serum markers for detecting HBV-induced early-stage liver fibrosis.
AIM To investigate serum N-glycan profiling related to HBV-induced liver fibrosis and verify multiparameter diagnostic models related to serum N-glycan changes.
METHODS N-glycan profiles from the sera of 432 HBV-infected patients with liver fibrosis were analyzed. Significant changed N-glycan levels (peaks) (P < 0.05) in different fibrosis stages were selected in the modeling group, and multiparameter diagnostic models were established based on changed N-glycan levels by logistic regression analysis. The receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic efficacy of N-glycans models. These models were then compared with the aspartate aminotransferase to platelet ratio index (APRI) , fibrosis index based on the four factors (FIB-4), glutamyltranspeptidase platelet albumin index (S index), GlycoCirrho-test, and GlycoFibro-test. Furthermore, we combined multiparameter diagnostic models with alanine aminotransferase (ALT) and platelet (PLT) tests and compared their diagnostic power. In addition, the diagnostic accuracy of N-glycan models was also verified in the validation group of patients.
RESULTS Multiparameter diagnostic models constructed based on N-glycan peak 1, 3, 4 and 8 could distinguish between different stages of liver fibrosis. The area under ROC curves (AUROCs) of Model A and Model B were 0.890 and 0.752, respectively differentiating fibrosis F0-F1 from F2-F4, and F0-F2 from F3-F4, and surpassing other serum panels. However, AUROC (0.747) in Model C used for the diagnosis of F4 from F0-F3 was lower than AUROC (0.795) in FIB-4. In combination with ALT and PLT, the multiparameter models showed better diagnostic power (AUROC = 0.912, 0.829, 0.885, respectively) when compared with other models. In the validation group, the AUROCs of the three combined models (0.929, 0.858, and 0.867, respectively) were still satisfactory. We also applied the combined models to distinguish adjacent fibrosis stages of 432 patients (F0-F1/F2/F3/F4), and the AUROCs were 0.917, 0.720 and 0.785.
CONCLUSION Multiparameter models based on serum N-glycans are effective supplementary markers to distinguish between adjacent fibrosis stages of patients caused by HBV, especially in combination with ALT and PLT.
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Affiliation(s)
- Xi Cao
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Qing-Hua Shang
- Department of Liver Disease, No. 88 Hospital of Chinese People’s Liberation Army, Tai'an 271000, Shandong Province, China
| | - Xiao-Ling Chi
- Department of Hepatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Wei Zhang
- Department of Liver Disease, No. 88 Hospital of Chinese People’s Liberation Army, Tai'an 271000, Shandong Province, China
| | - Huan-Ming Xiao
- Department of Hepatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Mi-Mi Sun
- Department of Liver Disease, No. 88 Hospital of Chinese People’s Liberation Army, Tai'an 271000, Shandong Province, China
| | - Gang Chen
- Department of Liver Disease, No. 88 Hospital of Chinese People’s Liberation Army, Tai'an 271000, Shandong Province, China
| | - Yong An
- Department of Liver Disease, No. 88 Hospital of Chinese People’s Liberation Army, Tai'an 271000, Shandong Province, China
| | - Chun-Lei Lv
- Department of Liver Disease, No. 88 Hospital of Chinese People’s Liberation Army, Tai'an 271000, Shandong Province, China
| | - Lin Wang
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Yue-Min Nan
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei Province, China
| | - Cui-Ying Chen
- Department of Molecular Biomedical Research, Xian si-da Biotechnology Company Limited, Nanjing 210000, Jiangsu Province, China
| | - Zong-Nan Tan
- Department of Molecular Biomedical Research, Xian si-da Biotechnology Company Limited, Nanjing 210000, Jiangsu Province, China
| | - Xue-En Liu
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Hui Zhuang
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
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Ishii M, Itano O, Shinoda M, Kitago M, Abe Y, Hibi T, Yagi H, Takeuchi A, Tsujikawa H, Abe T, Kitagawa Y. Pre-hepatectomy type IV collagen 7S predicts post-hepatectomy liver failure and recovery. World J Gastroenterol 2020; 26:725-739. [PMID: 32116420 PMCID: PMC7039827 DOI: 10.3748/wjg.v26.i7.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/11/2020] [Accepted: 01/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors. However, a method for preoperative evaluation of hepatic reserve has not yet been established. Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve. When determining eligibility for hepatectomy, the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.
AIM To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.
METHODS This study was a retrospective cohort study. We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016. Early post-hepatectomy liver failure (PHLF) was defined using the International Study Group of Liver Surgery’s definition of PHLF. Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of < 2 mg/dL and > 2.8 g/dL, respectively, and the time taken for Child-Pugh score to return to Child-Pugh class A.
RESULTS Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function. Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S ≤ 6 ng/mL than in those with type IV collagen 7S > 6 ng/mL. In additional analyses, similar results were observed in patients without chronic viral hepatitis associated with fibrosis.
CONCLUSION Preoperative type IV collagen 7S is a preoperative predictor of PHLF and long-term postoperative liver function recovery. It can also be used in patients without chronic hepatitis virus.
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Affiliation(s)
- Masatsugu Ishii
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba 286-8686, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Ayano Takeuchi
- Department of Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hanako Tsujikawa
- Department of Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tokiya Abe
- Department of Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
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Johansen MJ, Gade J, Stender S, Frithioff-Bøjsøe C, Lund MAV, Chabanova E, Thomsen HS, Pedersen O, Fonvig CE, Hansen T, Holm JC. The Effect of Overweight and Obesity on Liver Biochemical Markers in Children and Adolescents. J Clin Endocrinol Metab 2020; 105:5588552. [PMID: 31617910 DOI: 10.1210/clinem/dgz010] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/20/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Elevated plasma concentrations of liver enzymes are routinely used as markers of liver injury in adults and children. Currently, the age- and sex-specific effects of adiposity on pediatric liver enzyme concentrations are unclear. METHODS We included participants from 2 cohorts of Danish children and adolescents: 1858 from a population-based cohort and 2155 with overweight or obesity, aged from 6 to 18 years. Age- and sex-specific percentile curves were calculated for fasting plasma concentrations of alanine transaminase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), gamma-glutamyltransferase (GGT), bilirubin, and alkaline phosphatase (ALP) in both cohorts. Hepatic fat content was assessed by proton magnetic resonance spectroscopy in 458 participants. RESULTS Concentrations of ALT, AST, LDH, and ALP decreased with age in both girls and boys, while GGT and bilirubin were comparable across age groups in girls and increased slightly with age in boys. Children and adolescents with overweight or obesity exhibited higher concentrations of ALT in all age groups. Concentrations of ALT, and to a lesser degree GGT, increased with age in boys with overweight or obesity. Optimal ALT cut-points for diagnosing hepatic steatosis (liver fat content > 5%) was 24.5 U/L for girls (sensitivity: 55.6%, specificity: 84.0%), and 34.5 U/L for boys (sensitivity: 83.7%, specificity: 68.2%). CONCLUSIONS Pediatric normal values of liver enzymes vary with both age and sex. Overweight and obesity is associated with elevated biochemical markers of liver damage. These findings emphasize the need for prevention and treatment of overweight and obesity in children and adolescents. (J Clin Endocrinol Metab XX: 0-0, 2019).
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Affiliation(s)
- Magnus J Johansen
- The Children's Obesity Clinic, European Centre of Management (COM/EASO), Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- Department of Radiology, Herlev Gentofte Hospital, Herlev, Denmark
| | - Julie Gade
- The Children's Obesity Clinic, European Centre of Management (COM/EASO), Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- Department of Radiology, Herlev Gentofte Hospital, Herlev, Denmark
| | - Stefan Stender
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Christine Frithioff-Bøjsøe
- The Children's Obesity Clinic, European Centre of Management (COM/EASO), Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten A V Lund
- The Children's Obesity Clinic, European Centre of Management (COM/EASO), Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik S Thomsen
- Department of Radiology, Herlev Gentofte Hospital, Herlev, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cilius E Fonvig
- The Children's Obesity Clinic, European Centre of Management (COM/EASO), Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- Department of Pediatrics, Kolding Hospital a part of Lillebaelt Hospital, Kolding, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- University of Southern Denmark, Faculty of Health Sciences, Odense, Denmark
| | - Jens-Christian Holm
- The Children's Obesity Clinic, European Centre of Management (COM/EASO), Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
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Ulku A, Akcam AT. Importance of Multislice Computed Tomography in Determining the Severity of Chronic Liver Disease State. Transplant Proc 2019; 51:2408-2412. [PMID: 31402246 DOI: 10.1016/j.transproceed.2019.01.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND In the present study, we aimed to put forward the relationship between multidetector computed tomography findings and scores for liver function evaluation. METHOD Included in the study were 51 patients with liver cirrhosis. Preoperative creatinine levels, international normalized ratio and alpha-fetoprotein values, albumin and sodium levels, the presence of ascites and varices, Model for End-Stage Liver Disease (MELD) scores, MELD-Sodium (MELD-Na) scores, and Child-Turcotte-Pugh Classification, the presence of ascites and varices, the size of liver, the size and diameter of the spleen, portal vein diameter, splenic artery diameter, and proper hepatic and right hepatic artery diameter were all determined. RESULTS Although the correlation between the spleen diameter and the MELD scores (P <.001) and MELD-Na scores (P = .02) was strong, there was no association with the Child-Turcotte-Pugh Classification (P = .08). Despite the correlations between portal vein diameter (P = .04) and splenic artery diameter (P = .04) and MELD scores, no association was detected with MELD-Na scores and the Child-Pugh scores. Even though a negative correlation between proper hepatic artery diameter (P = .18) and MELD-Na scores was noted, no statistically significant correlation could be identified with any scoring systems. In the multivariate linear regression analyses, the correlation between the portal vein diameter and MELD scores was significant as a radiologic finding. In the multiple linear regression analyses, the negative correlation between the right hepatic artery and MELD-Na scores diameter was statistically significant. In the multiple linear regression analyses, there was no statistically significant correlation between preoperative radiologic findings and Child-Turcotte-Pugh Classification. CONCLUSION We believe that preoperative multislice computed tomography imaging in patients with chronic liver disease may contribute to the diagnosis of disease, the determination of vascular anomalies, and the grading of the severity of the disease.
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Affiliation(s)
- Abdullah Ulku
- Department of General Surgery, Cukurova University, Adana, Turkey
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Nho K, Kueider-Paisley A, Ahmad S, MahmoudianDehkordi S, Arnold M, Risacher SL, Louie G, Blach C, Baillie R, Han X, Kastenmüller G, Trojanowski JQ, Shaw LM, Weiner MW, Doraiswamy PM, van Duijn C, Saykin AJ, Kaddurah-Daouk R. Association of Altered Liver Enzymes With Alzheimer Disease Diagnosis, Cognition, Neuroimaging Measures, and Cerebrospinal Fluid Biomarkers. JAMA Netw Open 2019; 2:e197978. [PMID: 31365104 PMCID: PMC6669786 DOI: 10.1001/jamanetworkopen.2019.7978] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Increasing evidence suggests an important role of liver function in the pathophysiology of Alzheimer disease (AD). The liver is a major metabolic hub; therefore, investigating the association of liver function with AD, cognition, neuroimaging, and CSF biomarkers would improve the understanding of the role of metabolic dysfunction in AD. OBJECTIVE To examine whether liver function markers are associated with cognitive dysfunction and the "A/T/N" (amyloid, tau, and neurodegeneration) biomarkers for AD. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, serum-based liver function markers were measured from September 1, 2005, to August 31, 2013, in 1581 AD Neuroimaging Initiative participants along with cognitive measures, cerebrospinal fluid (CSF) biomarkers, brain atrophy, brain glucose metabolism, and amyloid-β accumulation. Associations of liver function markers with AD-associated clinical and A/T/N biomarkers were assessed using generalized linear models adjusted for confounding variables and multiple comparisons. Statistical analysis was performed from November 1, 2017, to February 28, 2019. EXPOSURES Five serum-based liver function markers (total bilirubin, albumin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase) from AD Neuroimaging Initiative participants were used as exposure variables. MAIN OUTCOMES AND MEASURES Primary outcomes included diagnosis of AD, composite scores for executive functioning and memory, CSF biomarkers, atrophy measured by magnetic resonance imaging, brain glucose metabolism measured by fludeoxyglucose F 18 (18F) positron emission tomography, and amyloid-β accumulation measured by [18F]florbetapir positron emission tomography. RESULTS Participants in the AD Neuroimaging Initiative (n = 1581; 697 women and 884 men; mean [SD] age, 73.4 [7.2] years) included 407 cognitively normal older adults, 20 with significant memory concern, 298 with early mild cognitive impairment, 544 with late mild cognitive impairment, and 312 with AD. An elevated aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio and lower levels of ALT were associated with AD diagnosis (AST to ALT ratio: odds ratio, 7.932 [95% CI, 1.673-37.617]; P = .03; ALT: odds ratio, 0.133 [95% CI, 0.042-0.422]; P = .004) and poor cognitive performance (AST to ALT ratio: β [SE], -0.465 [0.180]; P = .02 for memory composite score; β [SE], -0.679 [0.215]; P = .006 for executive function composite score; ALT: β [SE], 0.397 [0.128]; P = .006 for memory composite score; β [SE], 0.637 [0.152]; P < .001 for executive function composite score). Increased AST to ALT ratio values were associated with lower CSF amyloid-β 1-42 levels (β [SE], -0.170 [0.061]; P = .04) and increased amyloid-β deposition (amyloid biomarkers), higher CSF phosphorylated tau181 (β [SE], 0.175 [0.055]; P = .02) (tau biomarkers) and higher CSF total tau levels (β [SE], 0.160 [0.049]; P = .02) and reduced brain glucose metabolism (β [SE], -0.123 [0.042]; P = .03) (neurodegeneration biomarkers). Lower levels of ALT were associated with increased amyloid-β deposition (amyloid biomarkers), and reduced brain glucose metabolism (β [SE], 0.096 [0.030]; P = .02) and greater atrophy (neurodegeneration biomarkers). CONCLUSIONS AND RELEVANCE Consistent associations of serum-based liver function markers with cognitive performance and A/T/N biomarkers for AD highlight the involvement of metabolic disturbances in the pathophysiology of AD. Further studies are needed to determine if these associations represent a causative or secondary role. Liver enzyme involvement in AD opens avenues for novel diagnostics and therapeutics.
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Affiliation(s)
- Kwangsik Nho
- Center for Computational Biology and Bioinformatics, Indiana Alzheimer Disease Center, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis
| | | | - Shahzad Ahmad
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Matthias Arnold
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Shannon L. Risacher
- Center for Computational Biology and Bioinformatics, Indiana Alzheimer Disease Center, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis
| | - Gregory Louie
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Colette Blach
- Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
| | | | - Xianlin Han
- University of Texas Health Science Center at San Antonio, San Antonio
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
| | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
| | - Michael W. Weiner
- Center for Imaging of Neurodegenerative Diseases, Department of Radiology, San Francisco Veterans Affairs Medical Center and University of California, San Francisco
| | - P. Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Institute of Brain Sciences, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Cornelia van Duijn
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
- Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
| | - Andrew J. Saykin
- Center for Computational Biology and Bioinformatics, Indiana Alzheimer Disease Center, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Institute of Brain Sciences, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
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Whitfield JB, Zhu G, Madden PAF, Montgomery GW, Heath AC, Martin NG. Biomarker and Genomic Risk Factors for Liver Function Test Abnormality in Hazardous Drinkers. Alcohol Clin Exp Res 2019; 43:473-482. [PMID: 30589442 PMCID: PMC6445646 DOI: 10.1111/acer.13949] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/21/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Alcohol dependence and long-term excessive alcohol use may cause liver damage, but only some patients develop cirrhosis. Similarly, high alcohol intake without evident liver disease often but not always produces abnormal enzymatic liver function tests (LFTs), particularly gamma-glutamyl transferase (GGT). We postulate that the factors predisposing to cirrhosis in alcoholics and to liver enzyme abnormality in drinkers are similar, and that biochemical LFTs could therefore be useful as markers of risk of alcoholic liver disease in excessive drinkers. METHODS Data from participants in twin and twin-family studies on alcohol use and dependence were used to identify 1,003 people who had reported excessive alcohol intake (28 drinks or more per week). A total of 962 of these provided blood for biochemical tests at the same time. Body mass index (BMI) and biomarkers of metabolic syndrome, inflammation, and iron stores were used in logistic regression with abnormality in serum GGT, alanine aminotransferase (ALT), or aspartate aminotransferase (AST) as outcomes. We conducted genome-wide association analyses for GGT, ALT, and AST separately in the group reporting excessive alcohol intake (N = 951) and a low-intake group reporting 14 drinks or fewer per week (N = 8,716), and compared results. RESULTS Abnormal GGT and ALT among excessive drinkers were associated with higher BMI, triglycerides, insulin, uric acid, C-reactive protein, ferritin, and transferrin saturation; and with lower high-density-lipoprotein cholesterol. Abnormal AST was associated with triglycerides, ferritin, and transferrin saturation. ALT was significantly associated with variants at reported genetic loci for alcoholic liver disease (PNPLA3, rs738409, p = 0.0076; TM6SF2, rs10401969, p = 0.0076; HSD17B13, rs10433879, p = 0.0024). CONCLUSIONS Known risk factors for alcoholic cirrhosis including obesity and markers of metabolic syndrome, iron overload and inflammation are associated with liver enzyme abnormality in excessive drinkers.
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Affiliation(s)
- John B Whitfield
- QIMR Berghofer Medical Research Institute , Brisbane, Queensland
| | - Gu Zhu
- QIMR Berghofer Medical Research Institute , Brisbane, Queensland
| | - Pamela A F Madden
- Department of Psychiatry , Washington University School of Medicine, St. Louis, Missouri
| | - Grant W Montgomery
- Institute for Molecular Bioscience , The University of Queensland, St. Lucia, Queensland
| | - Andrew C Heath
- Department of Psychiatry , Washington University School of Medicine, St. Louis, Missouri
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Abstract
Cholestasis in drug-induced liver injury (DILI) can be assessed by biochemical and pathologic methods, but the agreement between the 2 methods remains unclear.The aim of this study was to identify the accurate method for assessment of cholestasis in DILI.The DILI standard established and revised by the Council for International Organizations of Medical Sciences (CIOMS) (R values were calculated by liver function at different time points), cholestatic liver disease guideline (European Association for the Study of the Liver, EASL), and liver pathology were used to assess, compare, and analyze the cholestasis in 133 patients with DILI.The R values at different time points in CIOMS standard had no statistical difference for the assessment of cholestatic DILI (a = 0.05, χ = 1.51, P = .679). There were statistical differences among the results of CIOMS, EASL, and pathology (a = 0.05, χ = 99.97, P < .001). EASL standard had no statistical difference with pathology (a = 0.003, χ = 8.00, P = .005).CIOMS and EASL standards based on biochemical parameters underestimated cholestatic DILI, as compared to liver pathology.
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Affiliation(s)
- Mindan Xing
- Peace Hospital Affiliated to Changzhi Medical College, Shanxi Changzhi
| | - Lu Zhai
- Tianjin Second People's Hospital, Tianjin Institute of Hepatology, Tianjin
| | - Jia Li
- Tianjin Second People's Hospital, Tianjin Institute of Hepatology, Tianjin
| | - Qian Li
- Tianjin Second People's Hospital, Tianjin Institute of Hepatology, Tianjin
| | - Min Gao
- Tianjin Second People's Hospital, Tianjin Institute of Hepatology, Tianjin
| | - Jun Wen
- Tianjin Second People's Hospital, Tianjin Institute of Hepatology, Tianjin
| | - Zengli Xu
- Xiang Yang No 1 Peoples Hospital, Hubei Xiangyang, China
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Tse JR, Jeffrey RB, Kamaya A. Performance of Hepatic Artery Velocity in Evaluation of Causes of Markedly Elevated Liver Tests. Ultrasound Med Biol 2018; 44:2233-2240. [PMID: 30143340 DOI: 10.1016/j.ultrasmedbio.2018.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/14/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to assess the utility of peak systolic proper hepatic artery velocity (HAV) in differentiating causes of severely elevated liver function tests. HAV, hepatic artery resistive index and portal vein velocity of 41 patients with severely elevated liver function tests were evaluated. In 19 patients (46%), the causes were structural (e.g., cholecystitis, cholangitis), whereas in 22 patients (54%) the causes were non-structural (e.g., rhabdomyolysis, drug-induced liver injury). The average HAV for structural causes was 138 ± 68cm/s, and for non-structural causes, 65 ± 29cm/s (p < 0.0001). An HAV >100cm/s was correlated with structural causes (p = 0.0001). With respect to diagnostic performance, this threshold was 79% sensitive and 86% specific, with a high positive likelihood ratio (5.8) and low negative likelihood ratio (0.24). The resistive index and portal vein velocity were not statistically different. In patients with severely elevated liver function tests, an HAV >100cm/s can help distinguish structural from non-structural causes, which may guide management while awaiting definitive laboratory tests.
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Affiliation(s)
- Justin R Tse
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
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Liu JX, Au Yeung SL, Kwok MK, Leung JYY, Lin SL, Hui LL, Leung GM, Schooling CM. Birth weight, gestational age and late adolescent liver function using twin status as instrumental variable in a Hong Kong Chinese birth cohort: "Children of 1997". Prev Med 2018; 111:190-197. [PMID: 29545162 DOI: 10.1016/j.ypmed.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/25/2018] [Accepted: 03/09/2018] [Indexed: 02/04/2023]
Abstract
Birth weight (BW) is inversely associated with diabetes and liver function in Mendelian Randomization studies. Observationally, lower BW is usually also associated with poorer liver function. However, these studies could be confounded by socioeconomic position. Here we assessed if BW is associated with liver function in a unique population with little socio-economic patterning of BW, using both instrumental variable and an observational analysis. We used instrumental variable analysis (IVA) to assess the association of BW with liver function (alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, and albumin) at ~17 years with twin status as an instrumental variable in the prospective population-representative "Children of 1997" birth cohort (n = 8327). We also conducted an observational analysis adjusted for sex, maternal age, maternal migrant status, smoking and parental socio-economic position. A generalized linear model with gamma family was used for ALT, ALP, and bilirubin because they are not normally distributed. Using IVA, BW was not associated with ALT, ALP or bilirubin, but was possibly negatively associated with albumin (-1.12 g/L, 95% confidence interval (CI) -2.08 to -0.16). Observationally, BW was negatively associated with ALT (-1.23 IU/L, 95% CI -2.16 to -0.30), ALP (-1.72 IU/L, 95% CI -3.43 to -0.01) and higher albumin (-0.23 g/L, 95% CI -0.40 to -0.06). Poor liver function may be a pathway by which the risks of lower BW are actuated. This insight might help identify post-natal targets of intervention to mitigate the adverse health effects of lower birth weight.
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Affiliation(s)
- Jun Xi Liu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - June Yue Yan Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shi Lin Lin
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Gabriel Matthew Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA.
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Hasegawa D, Onishi H, Matsutomo N. [Novel Index (Hepatic Receptor: IHR) to Evaluate Hepatic Functional Reserve Using (99m)Tc-GSA Scintigraphy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:121-127. [PMID: 26902376 DOI: 10.6009/jjrt.2016_jsrt_72.2.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE This study aimed to evaluate the novel index of hepatic receptor (IHR) on the regression analysis derived from time activity curve of the liver for hepatic functional reserve. METHODS Sixty patients had undergone (99m)Tc-galactosyl serum albumin ((99m)Tc-GSA) scintigraphy in the retrospective clinical study. Time activity curves for liver were obtained by region of interest (ROI) on the whole liver. A novel hepatic functional predictor was calculated with multiple regression analysis of time activity curves. In the multiple regression function, the objective variables were the indocyanine green (ICG) retention rate at 15 min, and the explanatory variables were the liver counts in 3-min intervals until end from beginning. Then, this result was defined by IHR, and we analyzed the correlation between IHR and ICG, uptake ratio of the heart at 15 minutes to that at 3 minutes (HH15), uptake ratio of the liver to the liver plus heart at 15 minutes (LHL15), and index of convexity (IOC). RESULTS Regression function of IHR was derived as follows: IHR=0.025×L(6)-0.052×L(12)+0.027×L(27). The multiple regression analysis indicated that liver counts at 6 min, 12 min, and 27 min were significantly related to objective variables. The correlation coefficient between IHR and ICG was 0.774, and the correlation coefficient between ICG and conventional indices (HH15, LHL15, and IOC) were 0.837, 0.773, and 0.793, respectively. IHR had good correlation with HH15, LHL15, and IOC. CONCLUSIONS The finding results suggested that IHR would provide clinical benefit for hepatic functional assessment in the (99m)Tc-GSA scintigraphy.
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Gudowska M, Wojtowicz E, Cylwik B, Gruszewska E, Chrostek L. The Distribution of Liver Steatosis, Fibrosis, Steatohepatitis and Inflammation Activity in Alcoholics According to FibroMax Test. ADV CLIN EXP MED 2015; 24:823-7. [PMID: 26768633 DOI: 10.17219/acem/28485] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The diagnosis of alcoholic liver diseases is based on the history of alcohol abuse, clinical evidence of liver disease and laboratory abnormalities. The new non-invasive biomarkers have higher sensitivity to quantify and predict steatosis and fibrosis than ultrasonography. OBJECTIVES The aim of this study was to evaluate the prevalence of liver diseases in alcoholics by means of FibroMax. MATERIAL AND METHODS A total of 142 consecutive alcoholics were enrolled in the study. The prevalence of liver diseases was assayed by means of non-invasive biomarkers: fibrosis by FibroTest, steatosis by SteatoTest, steatohapatitis by AshTest (alcoholic origin) and NashTest (non-alcoholic origin) and necroinflammatory activity by ActiTest. RESULTS 38.7% of alcoholics do not have fibrosis, 38%--steatosis, 94.1%--alcoholic steatohepatitis, 56.6%--non-alcoholic steatohepatitis and 33.6%--necroinflammatory activity. The insignificant fibrosis (F<2) is present in 37.2%, advanced (F≥2)--15.3% and cirrhosis (F4)--in 8.8%. Insignificant steatosis (S<2) is observed in 31.3% and advanced (S≥2) in 30.5%. Minimal alcoholic steatohepatitis (H1) exists in 5.2% patients, moderate (H2) in none of the patient and severe (H3) in only one patient (0.7%). The distribution of NashTest scores is as following: N0--56.6%, N1--38.2% and N2--5.1%. Insignificant inflammatory activity (A<2) is present in 40.8% of alcoholic patients but significant (A≥2) in 25.5%. The frequency of severe steatosis (F3) and necroinflammatory activity (A3) in patients with cirrhosis (F4) is 50% for each of them. CONCLUSIONS The prevalence of advanced fibrosis and cirrhosis evaluated by means of FibroMax in alcoholics is higher than in alcoholic liver disease (ALD) and lower than in mixed, alcoholic and non-alcoholic ones. This may indicate the presence of non-alcoholic liver disease in alcoholics.
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Affiliation(s)
- Monika Gudowska
- Department of Biochemical Diagnostics, Medical University in Białystok, Poland
| | | | - Bogdan Cylwik
- Department of Pediatric Laboratory Diagnostics, Medical University in Białystok, Poland
| | - Ewa Gruszewska
- Department of Biochemical Diagnostics, Medical University in Białystok, Poland
| | - Lech Chrostek
- Department of Biochemical Diagnostics, Medical University in Białystok, Poland
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Lee J, Shin JS, Kim MR, Byun JH, Lee SY, Shin YS, Kim H, Byung Park K, Shin BC, Lee MS, Ha IH. Liver enzyme abnormalities in taking traditional herbal medicine in Korea: A retrospective large sample cohort study of musculoskeletal disorder patients. J Ethnopharmacol 2015; 169:407-412. [PMID: 25956676 DOI: 10.1016/j.jep.2015.04.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/04/2015] [Accepted: 04/26/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The objective of this study is to report the incidence of liver injury from herbal medicine in musculoskeletal disease patients as large-scale studies are scarce. Considering that herbal medicine is frequently used in patients irrespective of liver function in Korea, we investigated the prevalence of liver injury by liver function test results in musculoskeletal disease patients. MATERIALS AND METHODS Of 32675 inpatients taking herbal medicine at 7 locations of a Korean medicine hospital between 2005 and 2013, we screened for liver injury in 6894 patients with liver function tests (LFTs) at admission and discharge. LFTs included t-bilirubin, AST, ALT, and ALP. Liver injury at discharge was assessed by LFT result classifications at admission (liver injury, liver function abnormality, and normal liver function). In analyses for risk factors of liver injury at discharge, we adjusted for age, sex, length of stay, conventional medicine intake, HBs antigen/antibody, and liver function at admission. RESULTS A total 354 patients (prevalence 5.1%) had liver injury at admission, and 217 (3.1%) at discharge. Of the 354 patients with liver injury at admission, only 9 showed a clinically significant increase after herbal medicine intake, and 225 returned to within normal range or showed significant liver function recovery. Out of 4769 patients with normal liver function at admission, 27 (0.6%) had liver injury at discharge. In multivariate analyses for risk factors, younger age, liver function abnormality at admission, and HBs antigen positive were associated with injury at discharge. CONCLUSIONS The prevalence of liver injury in patients with normal liver function taking herbal medicine for musculoskeletal disease was low, and herbal medicine did not exacerbate liver injury in most patients with injury prior to intake.
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Affiliation(s)
- Jinho Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Joon-Shik Shin
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Me-Riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Jang-Hoon Byun
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Seung-Yeol Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Ye-Sle Shin
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Hyejin Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Ki Byung Park
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Byung-Cheul Shin
- Busan National University, Yangsan Campus, 49 Busandaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Myeong Soo Lee
- Division of Medical Research, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea.
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Glišić TM, Perišić MD, Dimitrijevic S, Jurišić V. Doppler assessment of splanchnic arterial flow in patients with liver cirrhosis: correlation with ammonia plasma levels and MELD score. J Clin Ultrasound 2014; 42:264-269. [PMID: 24449379 DOI: 10.1002/jcu.22135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/11/2013] [Accepted: 12/16/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE To assess the clinical significance of blood flow velocity and resistance index (RI) in the visceral arteries of patients with liver cirrhosis with respect to plasma ammonia (NH3) level and liver function. METHODS We included 80 patients with liver cirrhosis (58 men) and 20 healthy controls (11 men). Duplex Doppler ultrasonography was used to assess flow velocity and RI in the hepatic (HA), right (RRA), and left renal (LRA), and splenic (SA) (LA) artery. Plasma NH3 was measured by biochemistry. Liver function was assessed by MELD score (model of end-stage liver disease). RESULTS HA, LRA, and SA systolic flow velocities were greater, whereas RRA diastolic velocity was lower in patients with liver cirrhosis than in controls RI was higher in LRA, RRA, SA, and HA in patients with liver cirrhosis than in controls. NH3 levels were significantly elevated in all patients with liver cirrhosis (p < 0.05) and significantly correlated with RI of RRA, LRA, and SA. CONCLUSION We found greater renal, hepatic, and LA RI in patients with liver cirrhosis than in healthy controls. The correlation we found between elevated renal artery RI (≥0.70) and MELD score emphasizes the risk of renal dysfunction during progression of liver cirrhosis.
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Affiliation(s)
- Tijana M Glišić
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Serbia
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Lehmann DF. Call for a moratorium on routine liver function testing in patients treated with HMG-CoA reductase inhibitors (statins). Clin Ther 2011; 33:1696-7. [PMID: 22108303 DOI: 10.1016/j.clinthera.2011.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 09/14/2011] [Indexed: 11/28/2022]
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Srirajaskanthan R, Valliani D. Azathioprine induced hepatitis in patients with inflammatory bowel disease. Int J Clin Pharm 2011; 33:724-5. [PMID: 21892694 DOI: 10.1007/s11096-011-9557-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 08/22/2011] [Indexed: 11/24/2022]
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Copur M, Erdogan A. Risperidone rechallenge for marked liver function test abnormalities in an autistic child. Recent Pat Endocr Metab Immune Drug Discov 2011; 5:237-239. [PMID: 21913889 DOI: 10.2174/187221411797265872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/24/2011] [Accepted: 03/14/2011] [Indexed: 05/31/2023]
Abstract
Risperidone have been reported to commonly lead to asymptomatic elevation of liver enzymes in adult population, and recently in children and adolescents. Results from controlled clinical trials, reports of spontaneous adverse events, and published studies/ case reports suggest that severe hepatotoxicity may be rare but can occur in the pediatric population. In the following case report, we describe a 5-year-old male patient diagnosed as autism with severe distruptive behavior. Substantial improvement was achieved with risperidone therapy. Increase in liver enzymes at the beginning of the risperidone treatment was successfully managed with multidisciplinary approach as the treatment was initially withdrawn, afterwards restarted and carefully continued. We demonstrated that risperidone may be cautiously rechallenged in selected pediatric patients who showed marked psychiatric improvement with risperidone on the face of liver enzymes elevation. Some important patents on risperidone delivery and their use for the treatment of autism are also outlined.
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Affiliation(s)
- Mazlum Copur
- Department of Child and Adolescent Psychiatry, Bakirkoy Mental Health and Neurology and Training Research Hospital, Bakirkoy Ruh ve Sinir Hastaliklari Hastanesi, Istanbul- Turkey.
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El-Shafei HM. Assessment of liver function among nickel-plating workers in Egypt. East Mediterr Health J 2011; 17:490-494. [PMID: 21796966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Currently no reports are available from Egypt regarding occupational exposure to nickel and its effects on the liver. The aim of this study was to assess the liver function of workers occupationally exposed to nickel. Standard liver function tests were applied to blood samples from 25 nickel-plating workers in Damietta, Egypt and 30 administrative workers as a reference group. Levels of urine nickel, measured by inductively coupling plasma-emission spectroscopy, were significantly higher in nickel-exposed workers compared with the reference group. The levels of alanine aminotransferase and aspartate aminotransferase were significantly higher in nickel-exposed workers. The level of serum albumin was significantly negatively correlated and the levels of serum aminotransferases, and serum gamma-glutamyl-transpeptidase were significantly positively correlated with urine nickel levels. Liver function is compromised in nickel-plating workers compared with non-exposed administrative workers.
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Kim JE, Lee JY, Kim YJ, Yoon JH, Kim SH, Lee JM, Han JK, Choi BI. Acoustic radiation force impulse elastography for chronic liver disease: comparison with ultrasound-based scores of experienced radiologists, Child-Pugh scores and liver function tests. Ultrasound Med Biol 2010; 36:1637-1643. [PMID: 20800940 DOI: 10.1016/j.ultrasmedbio.2010.07.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 06/12/2010] [Accepted: 07/20/2010] [Indexed: 05/29/2023]
Abstract
The purpose of our study was to investigate whether acoustic radiation force impulse (ARFI) elastography provides better diagnostic performance for diagnosis of chronic liver disease and correlates better with Child-Pugh scores and liver function tests, compared with an ultrasound (US) scoring system based on visual assessment of conventional B-mode US images by experienced radiologists. Five hundred and twenty-one patients with clinically proven chronic liver disease (n = 293), fatty liver (n = 95) or normal liver (n = 133) were included in this study. B-mode liver US and ARFI elastography were performed in all patients. ARFI elastography was performed at least five times, with each measurement obtained at a different area of the right hepatic lobe; mean shear wave velocity (SWV) was calculated for each patient. The mean SWV was compared with US-based scores from two radiologists (based on liver surface nodularity, parenchyma echotexture and hepatic vein contour), Child-Pugh scores and liver function tests. The mean SWV of the normal liver group was 1.08 m/s ± 0.15; of the fatty liver group, 1.02 m/s ± 0.16; and of the chronic liver disease group, 1.66 m/s ± 0.60 (p < 0.001). The area under the receiver operating characteristics curve of the mean SWV in ARFI elastography was significantly higher than that of the conventional B-mode US-based scores by two radiologists (0.89 vs. 0.74 and 0.77, p < 0.05), with a sensitivity of 75.4% and a specificity of 89.5% at the cut-off value of 1.22 m/s. The sensitivity of the mean SWV was significantly higher than the US-based scores (p < 0.001), although the specificity was not (p > 0.05). The mean SWV was better correlated with Child-Pugh scores and all liver function tests (except total protein) than the US-based scores from two radiologists. In conclusion, ARFI elastography showed better diagnostic performance than visual assessment of experienced radiologists for diagnosis of chronic liver disease, as well as for evaluation of the severity of chronic liver disease.
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Affiliation(s)
- Ji Eun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Kasapoglu B, Turkay C, Bayram Y, Koca C. Role of GGT in diagnosis of metabolic syndrome: a clinic-based cross-sectional survey. Indian J Med Res 2010; 132:56-61. [PMID: 20693590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND & OBJECTIVES The aim of this study is to know if the liver function tests (LFT), especially gamma glutamyl transferase (GGT), have a predictive value in diagnosis of metabolic syndrome (MS). METHODS A cross-sectional, single-center study was carried out with 908 subjects. Four hundred and forty two of these subjects were diagnosed with MS with IDF criteria; while other 466 were sex and age matched healthy control subjects. Blood pressure, liver function tests, fasting blood glucose levels and lipid profile of the subjects were recorded. RESULTS The mean values of alanine amino transferase (ALT), aspartate aminotransferase (AST) and GGT levels were statistically significantly higher in MS group. The mean values of liver enzymes, for female/ male subjects in MS group, AST; ALT and GGT respectively, were; 20.5/19.7 U/l; 25.9/28.5 U/l; 35.9/42.1 U/l. When the sample is divided into quartiles of the GGT levels, increase in GGT is positively correlated with increased MS prevalence. In ROC analysis GGT is as strongly associated with the IDF diagnostic components as is each individual IDF component, except elevated systolic blood pressure. In covariance analysis, there was significant relationship between elevated GGT levels and MS presence after adjustment for age, sex and MS diagnostic criteria; but not AST and ALT levels. In multivariance analysis, in MS group, a high GGT was positively associated with CVD prevalance (odds ratio: 2.011, 95% CI 1.10-4.57) compared to low GGT group independent of age, sex and smoking habits. INTERPRETATION & CONCLUSIONS Elevated liver enzymes, although in normal ranges, especially at upper quartiles, play a central role in early diagnosis of fat overflow to the liver. Regarding the availability and simplicity of these tests in routine clinical practice, they, especially GGT, have potential to be considered in algorithms for metabolic syndrome.
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Affiliation(s)
- B Kasapoglu
- Fatih University Medical School, Department of Internal Medicine, Ankara, Turkey.
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Suk KT, Kim CH, Baik SK, Kim MY, Park DH, Kim KH, Kim JW, Kim HS, Kwon SO, Lee DK, Han KH, Um SH. Gallbladder wall thickening in patients with acute hepatitis. J Clin Ultrasound 2009; 37:144-148. [PMID: 19035335 DOI: 10.1002/jcu.20542] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Gallbladder wall thickening (GWT) is often observed in patients with acute hepatitis (AH). However, little is known regarding the relationship between AH and GWT. We analyzed the characteristics of GWT in patients with AH. METHOD Between April 2002 and April 2007, 232 patients with AH underwent a sonographic examination. The clinical and laboratory findings of patients with GWT were evaluated and compared with patients without GWT. Data were recorded for the following variables: gender, age, laboratory findings, duration of symptom, presence of gallstone, and etiology of GWT. RESULTS A total of 147 (63%) patients with AH had GWT. GWT in patients with an alanine aminotransferase level more than 500 IU/l (5.2 +/- 3.4 mm) was greater than that in other patients (3.9 +/- 2.3 mm; p < 0.05). Hepatitis A virus infection (odds ratio = 3.17 [1.42-7.09]), female gender (odds ratio = 2.47 [1.34-4.56]), and an elevated total bilirubin level (odds ratio = 1.09 [1.03-1.15]) were positively associated with GWT. CONCLUSION The incidence of GWT in patients with AH was 63%, and there was an association with hepatitis A virus infection, female gender, and an elevated total bilirubin level.
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Affiliation(s)
- Ki Tae Suk
- Division of Gastroenterology & Hepatology, Department of Internal Medicine and Institute of Lifelong Health, Yonsei University Wonju College of Medicine, Wonju, South Korea
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Okanoue T, Shima T, Mizuno M, Matsumoto M, Umemura A. [Management of hepatitis C and fatty liver: a consciousness survey among gastroenterologists and general internists]. Nihon Shokakibyo Gakkai Zasshi 2008; 105:1737-1748. [PMID: 19057159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A questionnaire survey including hepatic function test values was performed to elucidate the medical treatment of hepatic diseases by gastroenterologists and general internists. Serum ALT level was considered to be an index of destruction of hepatic cells in 94 and 80% of gastroenterologists and general internists, respectively. Serum gamma-GTP values were used as an index of bile stasis and destruction of the bile duct cells by 93% and 70% of the gastroenterologists, respectively and in 61% and 49% of the internists, respectively. In addition, for hepatitis C, gastroenterologists considered the mean serum ALT values (standard values for drug therapy introduction) as > or =62IU/L, while general internists considered it as > or =79IU/L. In the case of fatty liver, the mean serum ALT values considered by gastroenterologists and general internists were > or =93IU/L and > or =90IU/L, respectively. These survey results suggest that there is a need for research-based clarification of hepatic function test values regulating therapy and unification of guidelines for standard values in medical treatment.
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Xu QH, Shu X, Chen LB, Huang HH, Zhang K, Li G. [Relationships between liver function test, serum HBeAg or HBV DNA level and liver pathological changes in patients with chronic hepatitis B]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2008; 22:422-424. [PMID: 19544633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between liver function test, serum HBeAg, HBV DNA level and liver pathological changes in patients with chronic hepatitis B. METHODS 233 patients with chronic hepatitis B accept liver puncture biopsy, liver function test, HBeAg detection and HBV DNA fluorescent quantitation PCR detection. Comparisons of liver function test, HBeAg and HBV DNA level were conducted among different liver pathological changes including inflammation grading and fibrosis staging. RESULTS In different inflammation grading groups, ALT was highest in group G3 and lowest in group G(0-1)(P = 0.016); TBil was highest in group G4 and lowest in group G(0-1) (P = 0.000); HBV DNA level was highest in group G4 and lowest in group G(0-1), but not statistically significant among groups (P = 0.463). In different fibrosis staging groups, ALT was highest in group S3 and lowest in group S(0-1), but not statistically significant among groups (P = 0.562); TBil was highest in group S4 and lowest in group S2 (P = 0.039); HBV DNA level was highest in group S3 and lowest in group S(0-1), but not statistically significant among groups (P = 0.395). In HBeAg positive group,the proportion of G(3-4) in inflammation grading or S(3-4) in fibrosis staging was lower than that in HBeAg negative group (46% vs. 52%, P = 0.438; 38% vs. 53%, P = 0.025; respectively). CONCLUSION HBV DNA level can not indicate the severity of liver inflammation or fibrosis in chronic HBV infection. Patients with HBeAg negative often are complicated with more severity of liver fibrosis. In routine liver function test, TBil level correlates with liver inflammation grading or fibrosis staging; ALT level also correlates with liver inflammation grading but not with fibrosis staging.
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Affiliation(s)
- Qi-huan Xu
- Department of Infectious Disease, Third Affiliated Hospital, Sun Yet-sen University, Guangzhou 510630, China.
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Sundaram M, Mohanakrishnan J, Murugavel KG, Shankar EM, Solomon S, Srinivas CN, Solomon SS, Pulimi S, Piwowar-Manning E, Dawson S, Livant E, Kumarasamy N, Balakrishnan P. Ethnic variation in certain hematological and biochemical reference intervals in a south Indian healthy adult population. Eur J Intern Med 2008; 19:46-50. [PMID: 18206601 DOI: 10.1016/j.ejim.2007.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 04/27/2007] [Accepted: 06/06/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND We established the biochemical and hematological reference intervals among a south Indian healthy adult population attending an HIV referral centre in Chennai, southern India. METHODS In a cross sectional study, 213 study subjects (129 male and 84 female) were studied between March and August 2005. All of the parameters were analyzed using standard hematological and biochemical techniques. RESULTS Certain biochemical (viz. total bilirubin, alanine transaminase, albumin, creatinine, total protein, lipid profile, creatine phosphokinase, uric acid and lactate) and hematological (mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and lymphocyte levels) parameters presented higher upper limits. In addition, the upper limits of white blood cell count, platelet count, hematocrit, red blood cell count and hemoglobin level were low in comparison to the currently reported ranges. CONCLUSION Ethnic variation in reference intervals was observed in certain biochemical and hematological analytes in a south Indian adult population.
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Affiliation(s)
- M Sundaram
- YRG Centre for AIDS Research and Education, Voluntary Health Services Hospital Campus, Taramani, Chennai-600 113, India
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Donnan PT, McLernon D, Steinke D, Ryder S, Roderick P, Sullivan FM, Rosenberg W, Dillon JF. Development of a decision support tool to facilitate primary care management of patients with abnormal liver function tests without clinically apparent liver disease [HTA03/38/02]. Abnormal Liver Function Investigations Evaluation (ALFIE). BMC Health Serv Res 2007; 7:54. [PMID: 17437630 PMCID: PMC1868021 DOI: 10.1186/1472-6963-7-54] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 04/16/2007] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Liver function tests (LFTs) are routinely performed in primary care, and are often the gateway to further invasive and/or expensive investigations. Little is known of the consequences in people with an initial abnormal liver function (ALF) test in primary care and with no obvious liver disease. Further investigations may be dangerous for the patient and expensive for Health Services. The aims of this study are to determine the natural history of abnormalities in LFTs before overt liver disease presents in the population and identify those who require minimal further investigations with the potential for reduction in NHS costs. METHODS/DESIGN A population-based retrospective cohort study will follow up all those who have had an incident liver function test (LFT) in primary care to subsequent liver disease or mortality over a period of 15 years (approx. 2.3 million tests in 99,000 people). The study is set in Primary Care in the region of Tayside, Scotland (pop approx. 429,000) between 1989 and 2003. The target population consists of patients with no recorded clinical signs or symptoms of liver disease and registered with a GP. The health technologies being assessed are LFTs, viral and auto-antibody tests, ultrasound, CT, MRI and liver biopsy. The study will utilise the Epidemiology of Liver Disease In Tayside (ELDIT) database to determine the outcomes of liver disease. These are based on hospital admission data (Scottish Morbidity Record 1), dispensed medication records, death certificates, and examination of medical records from Tayside hospitals. A sample of patients (n = 150) with recent initial ALF tests or invitation to biopsy will complete questionnaires to obtain quality of life data and anxiety measures. Cost-effectiveness and cost utility Markov model analyses will be performed from health service and patient perspectives using standard NHS costs. The findings will also be used to develop a computerised clinical decision support tool. DISCUSSION The results of this study will be widely disseminated to primary care, as well as G.I. hospital specialists through publications and presentations at local and national meetings and the project website. This will facilitate optimal decision-making both for the benefit of the patient and the National Health Service.
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Affiliation(s)
- Peter T Donnan
- Tayside Centre for General Practice, Community Health Sciences, University of Dundee, Dundee, UK
| | - David McLernon
- Tayside Centre for General Practice, Community Health Sciences, University of Dundee, Dundee, UK
| | - Douglas Steinke
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Stephen Ryder
- Directorate of Medicine, Division of Gastroenterology, Queen's Medical Centre, University Hospital NHS Trust, Nottingham, UK
| | - Paul Roderick
- Public Health Sciences and Medical Statistics Group, School of Medicine, University of Southampton, UK
| | - Frank M Sullivan
- Tayside Centre for General Practice, Community Health Sciences, University of Dundee, Dundee, UK
| | - William Rosenberg
- School of Medicine, Division of Infection, Inflammation and Repair, University of Southampton, UK
| | - John F Dillon
- Division of Pathology and Neurosciences, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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Abstract
The risk of an abnormal liver test in 813 patients with multiple sclerosis or clinically isolated syndrome enrolled in placebo arms of clinical trials was greater than expected for alanine aminotransferase (ALT) (relative risk [RR] 3.7; 95% CI: 2.3 to 6.0) and aspartate aminotransferase (AST) (RR 2.2; 95% CI: 1.3 to 3.6), although not alkaline phosphatase (AP) or total bilirubin, at first presentation. Abnormal test results were associated with higher body mass index (ALT only), male gender (ALT only), and a relapsing-remitting (vs secondary-progressive) course (ALT and AST only).
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Affiliation(s)
- H Tremlett
- Faculty of Medicine, Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
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Giordano P, Efron J, Vernava AM, Weiss EG, Nogueras JJ, Wexner SD. Strategies of follow-up for colorectal cancer: a survey of the American Society of Colon and Rectal Surgeons. Tech Coloproctol 2006; 10:199-207. [PMID: 16969616 DOI: 10.1007/s10151-006-0280-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Accepted: 01/17/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND The postoperative surveillance of patients who have undergone curative treatment for colorectal cancer (CRC) is controversial. The aim of this study was to investigate the follow-up practice of colorectal surgeons in the United States. METHODS A postal survey was sent to 1641 active members of the American Society of Colon and Rectal Surgeons practicing in the United States to assess the frequency of follow-up and the methods used in the surveillance of asymptomatic patients following curative surgery for CRC. RESULTS Only 582 (36%) of the questionnaires that were sent were returned fully completed. Of these, 173 surgeons (30%) followed their patients according to guidelines. Ninety-four percent of surgeons during the first year and 81% during the second year saw their patients regularly every 3 or 6 months. The most widely used tests were colonoscopy and carcinoembryonic antigen (CEA) testing. There was wide discrepancy in the frequency of follow-up and techniques employed, with only about 50% of surgeons following recommended practice. CONCLUSIONS Surveillance strategies mainly rely on clinical examination, CEA monitoring and colonoscopy. No clear consensus on surveillance programs for CRC patients exists.
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Affiliation(s)
- P Giordano
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Abstract
Over the past 10 years, there have been 137 patient safety incidents in England associated with methotrexate prescribing. Recent reports show that Australia has similar concerns. Using the valuable tool of an audit, we reviewed our departmental prescribing practices for 49 patients with psoriasis on methotrexate. Results highlighted poor documentation that patients were receiving appropriate information sheets detailing complications of the drug. Inconsistencies between prescribers were also noted, particularly in regards to haematological monitoring. A review of the current published work and the guidelines of other leading centres was performed and consistent, evidence-based guidelines were produced for the department. Such guidelines are essential in order to minimize the recognized complications of methotrexate. Recent studies highlight procollagen peptide III as a valuable adjunct for monitoring hepatotoxicity, while there is no longer a significant role for routine recording of cumulative dose. It would be valuable to repeat the audit to ensure a change in practice and an improved adherence to common guidelines.
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Affiliation(s)
- Claire Grills
- Department Dermatology, Churchill Hospital, Oxford, UK.
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47
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Abstract
AIMS To evaluate how often laboratory markers [Mean corpuscular volume (MCV), Gamma-glutamyl transferase, Aspartate aminotransferase, Alanine aminotransferase, or Carbohydrate-deficient transferrin (CDT)] and the Alcohol Use Disorders Identification Test (AUDIT) are used to detect alcohol abuse in primary health care. METHODS Cross-sectional self-administered questionnaire survey to all 3193 primary health care physicians in Finland. Response rate was (65.7%). RESULTS CDT was used at least occasionally by 43.4% of the physicians. Corresponding figures were 53.4% for conventional alcohol laboratory markers (MCV, transaminases) and 67.0% for AUDIT. Almost all the respondents used some laboratory marker to detect alcohol abuse. The use of brief alcohol intervention was associated with the greater likelihood that a physician uses different methods to detect alcohol abuse. The data also indicates that gender, age, and having a specialist licence influence activity in using different methods. CONCLUSIONS Considering the ambivalences in relation to alcohol issues in health care, the use of CDT and AUDIT are reasonably frequent. This may indicate that tools to facilitate the work may also help in adapting new activities.
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Affiliation(s)
- Mauri Aalto
- National Public Health Institute, PO Box 33, FIN-00251 Helsinki, Finland.
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Dolman JM, Hawkes ND. Combining the audit questionnaire and biochemical markers to assess alcohol use and risk of alcohol withdrawal in medical inpatients. Alcohol Alcohol 2005; 40:515-9. [PMID: 16103035 DOI: 10.1093/alcalc/agh189] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Alcohol consumption is often under-reported in patients admitted to general hospitals with acute illness. For alcohol-dependent individuals hospital admission results in an enforced period of abstinence with potential alcohol withdrawal symptoms, and possible life threatening complications. Early detection of alcohol use is therefore beneficial to patients and health services. The purpose of this study was to investigate the performance of the alcohol use disorders identification test (AUDIT) questionnaire in the acute medical setting, and the effect of combining routine biological markers-glutamyltransferase, alanine aminotransferase, aspartate aminotransferase, and mean corpuscular volume (MCV) on its performance in the early identification of in-patients with alcohol use disorders and at risk of developing symptoms of alcohol withdrawal. METHODS Prospective study in consecutive patients admitted to an acute medical admissions ward. All patients were screened using the AUDIT questionnaire and routine blood tests. Patients were then monitored for symptoms of withdrawal using clinical institute withdrawal assessment for alcohol (CIWA-Ar). RESULTS Of the 874 patients screened using the AUDIT, 98 (11%) screened positive of whom 17 (2% of the 874) experienced clinically significant alcohol withdrawal symptoms, when using serial CIWA-Ar. The AUDIT and serial CIWA-Ar detected all patients who went on to manifest acute withdrawal symptoms. There was no loss of sensitivity at an AUDIT cut-off of 13 or more compared with the lower cut-off of 8 or more. A positive predictive value of 17.3% for an AUDIT score of 8 or more in the detection of withdrawal, increased to 47.1% when found in combination with at least two abnormal biological markers whilst maintaining a sensitivity of 94.1% and specificity of 97.9%. CONCLUSION These findings confirm that AUDIT is a useful alcohol screen in general medical settings and that its ability to correctly predict which patients will experience alcohol withdrawal is increased when used in combination with biological markers.
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Affiliation(s)
- Jonathan M Dolman
- Musgrove Park Academy, Taunton and Somerset Hospital, Musgrove Park, Taunton, Somerset, TA1 5DA, UK.
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Adams LA, Bulsara M, Rossi E, DeBoer B, Speers D, George J, Kench J, Farrell G, McCaughan GW, Jeffrey GP. Hepascore: an accurate validated predictor of liver fibrosis in chronic hepatitis C infection. Clin Chem 2005; 51:1867-73. [PMID: 16055434 DOI: 10.1373/clinchem.2005.048389] [Citation(s) in RCA: 370] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Staging hepatic fibrosis by liver biopsy guides prognosis and treatment of hepatitis C, but is invasive and expensive. We sought to create an algorithm of serum markers that accurately and reliably predict liver fibrosis stage among hepatitis C patients. METHODS Ten biochemical markers were measured at time of liver biopsy in 117 untreated hepatitis C patients (training set). Multivariate logistic regression and ROC curve analyses were used to create a predictive model for significant fibrosis (METAVIR F2, F3, and F4), advanced fibrosis (F3 and F4), and cirrhosis (F4). The model was validated in 104 patients from other institutions. RESULTS A model (Hepascore) of bilirubin, gamma-glutamyltransferase, hyaluronic acid, alpha(2)-macroglobulin, age, and sex produced areas under the ROC curves (AUCs) of 0.85, 0.96, and 0.94 for significant fibrosis, advanced fibrosis, and cirrhosis, respectively. In the training set, a score > or = 0.5 (range, 0.0-1.0) was 92% specific and 67% sensitive for significant fibrosis, a score <0.5 was 81% specific and 95% sensitive for advanced fibrosis, and a score <0.84 was 84% specific and 71% sensitive for cirrhosis. Among the validation set, the AUC for significant fibrosis, advanced fibrosis, and cirrhosis were 0.82, 0.90, and 0.89, respectively. A score > or = 0.5 provided a specificity and sensitivity of 89% and 63% for significant fibrosis, whereas scores <0.5 had 74% specificity and 88% sensitivity for advanced fibrosis. CONCLUSIONS A model of 4 serum markers plus age and sex provides clinically useful information regarding different fibrosis stages among hepatitis C patients.
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Affiliation(s)
- Leon A Adams
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Australia
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