Assessment of liver fibrosis by transient elastography (Fibroscan®) in patients with A1AT deficiency

Introduction: Increasing evidence suggests an association between metabolic associated fatty liver disease (MAFLD) and chronic kidney disease (CKD). Timely prediction of early kidney dysfunction (EKD) is thus essential in this population, although a screening method is not stablished. We aimed to evaluate the role of transient elastography (TE) in predicting EKD in patients with MAFLD. Methods: Prospective cohort study that included patients with MAFLD scheduled for evaluation, between May/2019 and January/2020. Demographic, clinical and laboratory data, and TE parameters were obtained. EKD was defined as microalbuminuria (urinary albumin-to-creatinine ratio 30-300mg/g) and estimated glomerular filtration rate≥60mL/min/1.73m2. Significant liver fibrosis was defined as liver stiffness measurement (LSM)≥8.2kPa. Results: Included 45 patients with MALFD, 53.3% female gender, mean age of 53.5±10.9years. EKD was found in 17.8% of patients. MAFLD patients with EKD were significantly more obese (body mass index≥30) (75.0% vs 32.4%,p=0.045) and had significantly higher LSM (8.5±4.1 vs 5.8±2.2kPa,p=0.01). After adjustment of potential confounders for EKD the presence of liver fibrosis, remained a significant predictor of EKD, being associated with a 14.3-fold increased risk of EKD (p=0.04). The optimal cutoff value of LSM to predict EKD was 6.1kPa (sensitivity:85.7%; specificity:67.6%). Conclusion: Significant liver fibrosis is associated with a significant increased risk of EKD in patients with MAFLD, regardless of other comorbidities. Higher levels of LSM, particularly >6.1kPa, alert for timely identification of EKD and associated comorbidities, as well as their control, in order to prevent the development of CKD in the long term.

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FRI0118 RISK OF LIVER FIBROSIS ON TRANSIENT ELASTOGRAPHY IN PATIENTS WITH RHEUMATIC DISEASE UNDER LONG-TERM METHOTREXATE TREATMENT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3553 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 640.1-640

Author(s):

S. J. Choi ◽

J. S. Lee ◽

S. H. Nam ◽

W. J. Seo ◽

J. S. Oh ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Autoimmune Disease ◽

Liver Fibrosis ◽

Rheumatic Disease ◽

Logistic Regression Analysis ◽

Takayasu Arteritis ◽

Transient Elastography ◽

Liver Stiffness

Background:Methotrexate (MTX) is a cornerstone drug for the treatment of rheumatic disease and low doses of MTX are both tolerable and safe, with monitored toxicity, assessed via the liver function test. However, there is still controversy regarding the risk of liver fibrosis with long-term use of MTX. Transient elastography is commonly used to assess and monitor fibrosis progression in patients with chronic liver disease.Objectives:The present study aims to investigate liver fibrosis using transient elastography and related factors in patients with rheumatic disease receiving long-term MTX.Methods:The present retrospective, longitudinal, cross-sectional study included patients with an autoimmune disease who are taking cumulative MTX dosed over 7 g, and who had liver fibrosis upon examination using transient elastography. Liver fibrosis was defined as liver stiffness, valued over 7.2 kPa. Logistic regression analysis was performed to identify factors associated with liver fibrosis, and receiver operating characteristics analysis was used to determine the predictive value of each factor.Results:We included 83 patients with autoimmune disease, with a median MTX cumulative dose of 11.6 (range 7.3-16.0) g. Sixty-eight patients (81.9%) had rheumatoid arthritis (RA), and 13 patients (15.7%) had Takayasu arteritis. The median MTX exposure duration was 18 (range 9-31) years. The median liver stiffness value was 4 (range 1.8-10.2) kPa. Five patients (6%) showed liver fibrosis (3 patients; RA, 2 patients; Takayasu arteritis). In the linear regression analysis, cumulative MTX dose showed a tendency towards a positive correlation with increasing liver stiffness value (r2 =0.039, p = 0.074). In the logistic regression analysis, cumulative MTX dose was associated with a higher risk of liver fibrosis (OR: 1.734, 95% CI: 1.060–2.837, p = 0.029). In addition, cumulative MTX dose had an area under the curve (AUC) of 0.813 (95% CI 0.695-0.930) and a sensitivity of 80% and specificity of 71.8% at a cut-off value of 12.7 g.Conclusion:Liver fibrosis was observed in 6% of patients with long-term MTX use and higher cumulative MTX doses increased the risk of liver fibrosis. Thus, transient elastography should be considered in patients exposed to high cumulative doses of MTX.Disclosure of Interests:None declared

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How to adjust the inflammation-induced overestimation of liver fibrosis using transient elastography?

Hepatology Research ◽

10.1111/j.1872-034x.2012.01096.x ◽

2013 ◽

Vol 43 (2) ◽

pp. 182-184 ◽

Cited By ~ 3

Author(s):

Kentaro Yoshioka

Keyword(s):

Liver Fibrosis ◽

Transient Elastography

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TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population

Journal of Clinical Medicine ◽

10.3390/jcm10132907 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2907

Author(s):

Alba Martínez-Escudé ◽

Guillem Pera ◽

Anna Costa-Garrido ◽

Lluís Rodríguez ◽

Ingrid Arteaga ◽

...

Keyword(s):

Risk Factor ◽

Liver Fibrosis ◽

General Population ◽

Transient Elastography ◽

Atherogenic Dyslipidemia ◽

Control Group ◽

Cross Sectional ◽

Alcoholic Fatty Liver ◽

Increased Risk ◽

Tsh Levels

Thyroid hormones may be a risk factor for the development of non-alcoholic fatty liver disease (NAFLD) and its progression to liver fibrosis. The aim of this study is to investigate the relationship between thyroid stimulating hormone (TSH) levels, NAFLD, and liver fibrosis in the general population. A descriptive cross-sectional study was performed in subjects aged 18–75 years randomly selected from primary care centers between 2012 and 2016. Each subject underwent clinical evaluation, physical examination, blood tests and transient elastography. Descriptive and multivariate logistic regression analyses were used to identify factors associated with NAFLD and fibrosis. We included 2452 subjects (54 ± 12 years; 61% female). Subjects with TSH ≥ 2.5 μIU/mL were significantly associated with obesity, atherogenic dyslipidemia, metabolic syndrome (MetS), hypertransaminasemia and altered cholesterol and triglycerides. The prevalence of NAFLD and liver fibrosis was significantly higher in subjects with TSH ≥ 2.5 (μIU/mL). We found a 1.5 times increased risk of NAFLD, 1.8 and 2.3 times increased risk of liver fibrosis for cut-off points of ≥ 8.0 kPa and ≥ 9.2 kPa, respectively, in subjects with TSH ≥ 2.5 μIU/mL compared with TSH < 2.5 μIU/mL (control group), independent of the presence of MetS. These findings remained significant when stratifying TSH, with values ≥ 10 μIU/mL.

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Non-invasive methods in the assessment of portal hypertension severity

Gastroenterologie a hepatologie ◽

10.48095/ccgh2021125 ◽

2021 ◽

Vol 75 (2) ◽

pp. 125-133

Author(s):

Soňa Franková ◽

Jan Šperl

Keyword(s):

Portal Hypertension ◽

Liver Fibrosis ◽

Shear Wave ◽

Transient Elastography ◽

Venous Pressure ◽

Liver Stiffness ◽

Invasive Technique ◽

Hepatic Veins ◽

Oesophageal Varices ◽

Non Invasive

Portal hypertension represents a wide spectrum of complications of chronic liver diseases and may present by ascites, oesophageal varices, splenomegaly, hypersplenism, hepatorenal and hepatopulmonary syndrome or portopulmonary hypertension. Portal hypertension and its severity predicts the patient‘s prognosis: as an invasive technique, the portosystemic gradient (HPVG – hepatic venous pressure gradient) measurement by hepatic veins catheterisation has remained the gold standard of its assessment. A reliable, non-invasive method to assess the severity of portal hypertension is of paramount importance; the patients with clinically significant portal hypertension have a high risk of variceal bleeding and higher mortality. Recently, non-invasive methods enabling the assessment of liver stiffness have been introduced into clinical practice in hepatology. Not only may these methods substitute for liver biopsy, but they may also be used to assess the degree of liver fibrosis and predict the severity of portal hypertension. Nowadays, we can use the quantitative elastography (transient elastography, point shear-wave elastrography, 2D-shear-wave elastography) or magnetic resonance imaging. We may also assess the severity of portal hypertension based on the non-invasive markers of liver fibrosis (i.e. ELF test) or estimate clinically signifi cant portal hypertension using composite scores (LSPS – liver spleen stiff ness score), based on liver stiffness value, spleen diameter and platelet count. Spleen stiffness measurement is a new method that needs further prospective studies. The review describes current possibilities of the non-invasive assessment of portal hypertension and its severity.

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Reliability of Transient Elastography as a non-Invasive Technique for Detection of Fibrosis in Budd Chiari Syndrome Patients after Endovascular Intervention

QJM ◽

10.1093/qjmed/hcab107 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed F Montasser ◽

Eman M Barakat ◽

Mohamed S Ghazy ◽

Sara M Abdelhakam ◽

Hend E Ebada ◽

...

Keyword(s):

Liver Fibrosis ◽

Liver Biopsy ◽

Transient Elastography ◽

Liver Stiffness ◽

Endovascular Intervention ◽

Invasive Technique ◽

Budd Chiari Syndrome ◽

Metavir Score ◽

Before And After ◽

Chiari Syndrome

Abstract Aim of the work To test the reliability of fibroscan in detection of fibrosis in patients with Budd Chiari syndrome before and after endovascular intervention (after elimination of hepatic congestion). Background transient elastography (TE) is a noninvasive methodology that has been used to monitor liver stiffness in patients with chronic viral hepatitis. One of the limitations for accurate assessment of liver fibrosis by TE is the liver congestion. Liver congestion can result from Budd Chiari syndrome (BCS).The treatment of BCS is through restoring the flow of the blood between the portal vein to the inferior vena cava, which will lead to decongestion of the liver.TE, will be tested after liver decongestion for proper detection of liver fibrosis. Patients and methods This was a prospective cohort study conducted on 25 Egyptian patients with confirmed diagnosis of primary Budd-Chiari Syndrome (BCS) in the period from June 2017 to September 2019. TE was performed three days before endovascular intervention and three months after it. Liver biopsy was taken during the intervention for assessment of METAVIR score. Comparison was done between TE assessments before and after intervention in detection of the degree of liver fibrosis in comparison to METAVIR score measured in liver biopsy. Results FVLM was the most common hypercoagulable cause in the involved patients. There was significant drop in Liver Stiffness Measurements (LSM) measured three months post-intervention indicating improvement of liver fibrosis after relieving liver congestion but still not correlated to the METAVIR scores measured in the liver biopsy. Conclusion Liver congestion has high impact on Liver stiffness measurement giving overestimation which improves significantly after decongestion of the liver by the endovascular intervention.

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