scholarly journals Diagnostic Accuracy of Hepatic Vein Resistive Index in Detection of Hepatic Fibrosis in Patients of Chronic Liver Disease

2020 ◽  
Vol 24 (3) ◽  
pp. 278-282
Author(s):  
Sidrah Nadeem ◽  
Sana Wasim ◽  
Sidrah Manzoor ◽  
Hareem Ata ◽  
Riffat Raja ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Hepatic Vein ◽  
Resistive Index ◽  
Cost Effective ◽  
Chronic Liver ◽  
Cost Effective Technique ◽  
Sensitivity Specificity

Introduction: If we could prove the diagnostic accuracy of hepatic vein resistive index in detecting liver fibrosis in chronic liver disease patients, this would be beneficial for the patients as it is a non-invasive, readily available, and cost-effective technique for the diagnosis of liver fibrosis. This will help the physicians in the early initiation of definitive management. Materials and Methods: Seventy-five (n=75) patients with hepatitis B aged between 18-50 years were enrolled. Hepatic vein resistive index and liver biopsy were performed in even-patients. Sensitivity, Specificity, PPV, NPV, and overall accuracy of the hepatic vein resistive index was calculated. Results: Average age group studied was  38y ± 8.2 SD. 57.3 % (N=43) were males and 42.7% (n=32) patients were females respectively. Data of this work Exhibits various statistical indicators 77%. 96.7%. 97.2%. 74.3% and 85.3% respectively. Conclusion: Hepatic vein resistive index measured by ultrasonography can detect liver fibrosis in CLD with overall sensitivity, Specificity, PPV, NPV, and accuracy of 77.7%. 96.7%. 97.2%. 74.3% and 85.3% respectively.

scholarly journals Comparison between shear wave elastography and serological findings for the evaluation of fibrosis in chronic liver disease

2021 ◽  
Vol 21 (86) ◽  
pp. e186-e193
Author(s):  
Mahjabeen Liaqat ◽  
◽  
Kashif Siddique ◽  
Imran Yousaf ◽  
Raham Bacha ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Shear Wave ◽  
Shear Wave Elastography ◽  
Chronic Liver ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
Cutoff Values

Aim: In this study, we sought to examine the optimal cutoff values for predicting different stages of liver fibrosis, and to determine the level of agreement between shear wave elastography and aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores in patients with chronic liver disease. Methodology: A descriptive, cross-sectional study was performed at the Radiology Department of Shaukat Khanum Memorial Hospital Lahore from 1 Jun 2019 until 1 June 2020. FIB-4 and APRI scores were determined by the following formula: FIB-4 = (age × AST) ÷ (platelet count × (√ (ALT)) and APRI = (AST÷AST upper limit of normal) ÷ platelet × 100. Data was analyzed with the help of SPSS version 24.0 and Microsoft Excel 2013. Results: Eighty individuals were conveniently selected, of which 62.5% were men and 37.5% were women. The mean age of the subjects was 43.47 SD ± 13.85 years. APRI and FIB-4 scores predicted F4 patients using the cutoff values of 0.47 (Sn. 72%, Sp. 70%) and 1.27 (Sn. 78%, Sp. 73%), respectively. The cutoff values of 0.46 for APRI and 1.27 for FIB-4 predicted F3–F4 patients (Sn. 74% and 77%; Sp. 76% and 76%), respectively. To predict F1–F4 compared to F0, the cutoff value was 0.34 (Sn. 68%, Sp. 75%) for APRI, while the cutoff value for FIB was 0.87 (Sn. 72%, Sp. 75%). The findings suggest that FIB-4 shows better diagnostic accuracy than APRI. Conclusion: This study provides optimal cutoff values for different groups of fibrosis patients for both serum markers. Also, the diagnostic accuracy of FIB-4 for predicting liver fibrosis was found to be superior to APRI in all disease stages.

scholarly journals Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

2015 ◽  
Vol 19 (9) ◽  
pp. 1-410 ◽  
Author(s):  
Catriona Crossan ◽  
Emmanuel A Tsochatzis ◽  
Louise Longworth ◽  
Kurinchi Gurusamy ◽  
Brian Davidson ◽  
...  
Keyword(s):  
Liver Disease ◽  
Cost Effectiveness ◽  
Liver Biopsy ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Cost Effective ◽  
Chronic Liver ◽  
The Cost ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold

BackgroundLiver biopsy is the reference standard for diagnosing the extent of fibrosis in chronic liver disease; however, it is invasive, with the potential for serious complications. Alternatives to biopsy include non-invasive liver tests (NILTs); however, the cost-effectiveness of these needs to be established.ObjectiveTo assess the diagnostic accuracy and cost-effectiveness of NILTs in patients with chronic liver disease.Data sourcesWe searched various databases from 1998 to April 2012, recent conference proceedings and reference lists.MethodsWe included studies that assessed the diagnostic accuracy of NILTs using liver biopsy as the reference standard. Diagnostic studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analysis was conducted using the bivariate random-effects model with correlation between sensitivity and specificity (whenever possible). Decision models were used to evaluate the cost-effectiveness of the NILTs. Expected costs were estimated using a NHS perspective and health outcomes were measured as quality-adjusted life-years (QALYs). Markov models were developed to estimate long-term costs and QALYs following testing, and antiviral treatment where indicated, for chronic hepatitis B (HBV) and chronic hepatitis C (HCV). NILTs were compared with each other, sequential testing strategies, biopsy and strategies including no testing. For alcoholic liver disease (ALD), we assessed the cost-effectiveness of NILTs in the context of potentially increasing abstinence from alcohol. Owing to a lack of data and treatments specifically for fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), the analysis was limited to an incremental cost per correct diagnosis. An analysis of NILTs to identify patients with cirrhosis for increased monitoring was also conducted.ResultsGiven a cost-effectiveness threshold of £20,000 per QALY, treating everyone with HCV without prior testing was cost-effective with an incremental cost-effectiveness ratio (ICER) of £9204. This was robust in most sensitivity analyses but sensitive to the extent of treatment benefit for patients with mild fibrosis. For HBV [hepatitis B e antigen (HBeAg)-negative)] this strategy had an ICER of £28,137, which was cost-effective only if the upper bound of the standard UK cost-effectiveness threshold range (£30,000) is acceptable. For HBeAg-positive disease, two NILTs applied sequentially (hyaluronic acid and magnetic resonance elastography) were cost-effective at a £20,000 threshold (ICER: £19,612); however, the results were highly uncertain, with several test strategies having similar expected outcomes and costs. For patients with ALD, liver biopsy was the cost-effective strategy, with an ICER of £822.LimitationsA substantial number of tests had only one study from which diagnostic accuracy was derived; therefore, there is a high risk of bias. Most NILTs did not have validated cut-offs for diagnosis of specific fibrosis stages. The findings of the ALD model were dependent on assuptions about abstinence rates assumptions and the modelling approach for NAFLD was hindered by the lack of evidence on clinically effective treatments.ConclusionsTreating everyone without NILTs is cost-effective for patients with HCV, but only for HBeAg-negative if the higher cost-effectiveness threshold is appropriate. For HBeAg-positive, two NILTs applied sequentially were cost-effective but highly uncertain. Further evidence for treatment effectiveness is required for ALD and NAFLD.Study registrationThis study is registered as PROSPERO CRD42011001561.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Role of acoustic radiation force impulse elastography, aminotransferase to platelet ratio index and fibrotest for the assessment of significant fibrosis and cirrhosis in chronic liver disease

2020 ◽  
Vol 8 (7) ◽  
pp. 2495
Author(s):  
Anurag Rijhwani ◽  
Laxmi Mohanani ◽  
Ankit Ranjitsinh Chouhan ◽  
Nikunj M. Khatri
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Hepatic Fibrosis ◽  
Liver Stiffness ◽  
Chronic Liver ◽  
Acoustic Radiation Force Impulse ◽  
Significant Fibrosis ◽  
Arfi Elastography

Background: Accurate grading of hepatic fibrosis is important for the application of appropriate intervening strategy. Liver biopsy is the golden standard of fibrotic grading, however wide clinical application is hindered by its inherent drawbacks. Biomechanical-based ultrasonic elastography has received mass attention. However, several clinical studies found that the sole application of ultrasonic elastography may bring evident errors in diagnosing hepatic fibrosis. It is suggested that a combination of ultrasonic elastography and serum liver functions tests holds the potential to overcome those disadvantages. Aims and objectives was to study the diagnostic accuracy of ultrasonography elastography, APRI, fibrotest for significant fibrosis and cirrhosis in patients with chronic liver disease and established the correlation between ARFI elastography, APRI, Fibrotest in grading of liver fibrosisMethods: Sixty three patients with chronic liver disease were studied.  Liver stiffness was evaluated with ARFI elastography. Histologic staging of liver fibrosis served as the reference standard except a very few cirrhotic patients who were graded as cirrhotic on the basis of clinical examination. The required APRI, Fibrotest parameters and relevant clinical history was recorded.  Fibrosis stage was assessed according to the METAVIR classification.Results: ARFI, APRI, and Fibrotest demonstrated a significant correlation with the histological stage. According to ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI. The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage that showed  significant concordance  i.e. 79.3% cases,  out of which 69.8% of total cases were correctly diagnosed on comparison with the gold standard. Fibrotest and ARFI elastography show significant concordance in grading of fibrosis i.e. 82.5%. Cases out of which 68.3% of total cases were correctly diagnosed on comparison with the gold standard.Conclusions: APRI, ARFI, and fibrotest are novel tools among non-invasive modalities to rule out significant fibrosis and cirrhosis in patients with chronic liver disease. ARFI with APRI and ARFI with fibrotest showed enhanced diagnostic accuracy than ARFI or APRI or fibrotest alone for significant liver fibrosis.

scholarly journals Results of liver and spleen endoscopic ultrasonographic elastography predict portal hypertension secondary to chronic liver disease

2020 ◽  
Vol 08 (11) ◽  
pp. E1623-E1632
Author(s):  
Carlos Robles-Medranda ◽  
Roberto Oleas ◽  
Miguel Puga-Tejada ◽  
Manuel Valero ◽  
Raquel Del Valle ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Predictive Value ◽  
Strain Ratio ◽  
Chronic Liver ◽  
Spleen Stiffness ◽  
Eus Elastography ◽  
Sensitivity Specificity

Abstract Background and study aims Assessment of endoscopic ultrasonography (EUS)-elastography of the liver and spleen may identify patients with portal hypertension secondary to chronic liver disease. We aimed to evaluate use of EUS-elastography of the liver and spleen in identification of portal hypertension in patients with chronic liver disease. Patients and methods This was a single-center, diagnostic cohort study. Consecutive patients with liver cirrhosis and portal hypertension underwent EUS-elastography of the liver and spleen. Patients without a history of liver disease were enrolled as controls. The primary outcome was diagnostic yield of liver and spleen stiffness measurement via EUS-elastography in prediction of portal hypertension secondary to chronic liver cirrhosis. Cutoff values were defined through Youden’s index. Overall accuracy was calculated for parameters with an area under the receiver operating characteristic (AUROC) curve ≥ 80 %. Results Among the 61 patients included, 32 had cirrhosis of the liver. Liver and spleen stiffness was measured by the strain ratio and strain histogram, with sensitivity/(1 − specificity) AUROC values ≥ 80 %. For identification of patients with cirrhosis and portal hypertension, the liver strain ratio (SR) had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.3 %, 82.8 %, 84.4 %, and 82.8 %, respectively; the liver strain histogram (SH) had values of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively. EUS elastography of the spleen via the SR reached a sensitivity, specificity, PPV, and NPV of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively, whereas the values of SH were 56.3 %, 89.7 %, 85.7 %, and 65.0 %, respectively. Conclusion Endoscopic ultrasonographic elastography of the liver and spleen is useful for diagnosis of portal hypertension in patients with cirrhosis.

Mac‐2 Binding Protein Glycan Isomer as non‐invasive tool to assess liver fibrosis in children with chronic liver disease

2021 ◽  
Author(s):  
Ola G Behairy ◽  
Soha A El‐Gendy ◽  
Dalia Y Ibrahim ◽  
Amira I Mansour ◽  
Ola S El‐Shimi
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Chronic Liver Disease ◽  
Binding Protein ◽  
Chronic Liver ◽  
Non Invasive

scholarly journals Possible unrecognised liver injury is associated with mortality in critically ill COVID-19 patients

2021 ◽  
Vol 14 ◽  
pp. 175628482110234
Author(s):  
Mario Romero-Cristóbal ◽  
Ana Clemente-Sánchez ◽  
Patricia Piñeiro ◽  
Jamil Cedeño ◽  
Laura Rayón ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Liver Injury ◽  
Chronic Liver Disease ◽  
Critically Ill ◽  
Cox Regression ◽  
Chronic Liver ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
The Impact

Background: Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indices with the prognosis of critically ill COVID-19 patients. Methods: The work presented was an observational study in 214 patients with COVID-19 consecutively admitted to the intensive care unit (ICU). Pre-admission liver fibrosis indices were calculated. In-hospital mortality and predictive factors were explored with Kaplan–Meier and Cox regression analysis. Results: The mean age was 59.58 (13.79) years; 16 patients (7.48%) had previously recognised chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indices were higher in non-survivors [Forns: 6.04 (1.42) versus 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17) versus 1.41 (0.91), p = 0.020)], but no differences were found in liver biochemistry parameters. Patients with any degree of fibrosis either by Forns or FIB-4 had a higher mortality, which increased according to the severity of fibrosis ( p < 0.05 for both indexes). Both Forns [HR 1.41 (1.11–1.81); p = 0.006] and FIB-4 [HR 1.31 (0.99–1.72); p = 0.051] were independently related to survival after adjusting for the Charlson comorbidity index, APACHE II, and ferritin. Conclusion: Unrecognised liver fibrosis, assessed by serological tests prior to admission, is independently associated with a higher risk of death in patients with severe COVID-19 admitted to the ICU.

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