Using FIB-4 score as a screening tool in the assessment of significant liver fibrosis (F2) in patients with transfusion dependent beta thalassaemia: a cross sectional study

Objective To evaluated the performance of FIB-4 score as a screening tool to detect significant liver fibrosis (F2) compared to transient elastography (TE) among chronic transfusion-dependent beta-thalassemia (TDT) patients, in a resource-poor setting. Design A cross-sectional study Setting Adolescent and Adult Thalassaemia Care Center (University Medical Unit) Kiribathgoda Sri Lanka. Participants 45 TDT patients who have undergone more than 100 blood transfusions with elevated serum ferritin more than 2000ng/mL were selected for the study. Patients who were serologically positive for hepatitis C antibody were excluded. Outcome measures TE and FIB-4 score were estimated at the time of recruitment in all participants. Pre-defined cut-off values for F2 extracted from previous studies for TE and FIB-4 score were compared. A new cut-off value for FIB-4 score was estimated using ROC curve analysis to improve the sensitivity for F2 prediction. Results Of the selected 45 TDT patients 22(49%) were males. FIB-4 score showed a significant linear correlation with TE (r= 0.52 p< 0.0003). The FIB-4 score was improbable to lead to a false classification of TDT patients to have F2 when the FIB-4 cut-off value was 1.3. On the other hand it had a very low diagnostic yield in missing almost all (except one) of those who had F2. Using a much-lowered cut-off point of 0.32 for FIB-4 we improved the pick-up rate of F2 to 72%. Conclusions Regardless of the cut-off point FIB-4 score cannot be used as a good screening tool to pick-up F2 in patients with TDT irrespective of their splenectomy status. On the contrary at 1.3 cut off value though FIB-4 is a very poor detector for F2 fibrosis it will not erroneously diagnose F2 fibrosis in those who do not have it.

Ability of a Combined FIB4/miRNA181a Score to Predict Significant Liver Fibrosis in NAFLD Patients

Liver biopsy is the gold standard for assessing fibrosis, but there is a need to seek non-invasive biomarkers for this purpose. The aim of this study was to evaluate the correlation between the serum levels of the microRNAs miR-21, miR-29a, miR-122, miR-155 and miR-181a and the phenotypic expression of NAFLD. A cross-sectional study was carried out on 108 NAFLD patients diagnosed by liver biopsy. FIB-4 and NAFLD fibrosis scores were calculated. The comparison between the distributions of microRNA values according to the presence or absence of histological fibrosis (F2–F4) was performed. A multivariate logistic regression analysis was performed to build a score for predicting fibrosis using FIB-4 and Ln (miR-181a) as independent variables. Only miR-181a showed a statistical difference between patients with significant liver fibrosis (>F2) and those without (F0–F1) (p = 0.017). FIB-4 revealed an AUC on the ROC curve of 0.667 to predict clinically significant fibrosis (F2–F4). When assessed using the score in association with Ln (miR-181a), there was an improvement in the ROC curve, with an AUC of 0.71. miR-181a can be used as a non-invasive method of predicting fibrosis in NAFLD, and an association with FIB-4 has the potential to increase the accuracy of each method alone.

Diagnosis of Significant Liver Fibrosis in Patients With Chronic Hepatitis B By Using a Deep Learning-Based Data Integration Network

Background and aims: Chronic hepatitis B virus (CHB) infection remains a major global health burden and the non-invasive and accurate diagnosis of significant liver fibrosis (≥F2) in CHB patients is clinically very important. This study aimed to assess the potential of the joint use of ultrasound images of liver parenchyma, liver stiffness values, and patients’ clinical parameters in a deep learning model to improve the diagnosis of ≥F2 in CHB patients. Methods Of 527 CHB patients who underwent US examination, liver elastography and biopsy, 284 eligible patients were included. We developed a deep learning-based data integration network (DI-Net) to fuse the information of ultrasound images of liver parenchyma, liver stiffness values and patients’ clinical parameters for diagnosing ≥F2 in CHB patients. The performance of DI-Net was cross-validated in a main cohort (n =155) of the included patients and externally validated in an independent cohort (n = 129), with comparisons against single-source data-based models and other non-invasive methods in terms of the area under the receiver-operating-characteristic curve (AUC). Results DI-Net achieved an AUC of 0.943 (95% confidence interval [CI]: 0.893-0.973) in the cross-validation, and an AUC of 0.901 (95% CI: 0.834-0.945) in the external validation, which were significantly greater than those of the comparative methods (AUC ranges: 0.774-0.877 and 0.741-0.848 for cross- and external validations, respectively, Ps < 0.01). Conclusion The joint use of ultrasound images of liver parenchyma, liver stiffness values, and patients’ clinical parameters in a deep learning model could significantly improve the diagnosis of ≥F2 in CHB patients.

Prognostic Value of Inflammatory Indicators in Chronic Hepatitis B Patients With Significant Liver Fibrosis: A Multicenter Study in China

Diagnosis of significant liver fibrosis is essential to facilitate the optimal treatment decisions and improve prognosis in patients with chronic hepatitis B (CHB). We aimed to evaluate the value of inflammatory indicators and construct a nomogram that effectively predicts significant liver fibrosis among CHB patients. 563 CHB patients from two centers in China from 2014 to 2019 were divided into three cohorts (development, internal validation, and independent validation cohorts), assigned into cases with significant fibrosis (liver fibrosis stages ≥2) and those without. Multiple biochemical and serological inflammatory indicators were investigated. Inflammatory indicators, Alanine aminotransferase (ALT) and aspartate aminotransferase (AST), were significantly associated with significant liver fibrosis in CHB patients but limited predictive performance, and then we combined them with prothrombin time activity percentage (PTA) and liver stiffness measurement (LSM) were identified by multivariate logistic regression analysis. Based on these factors, we constructed the nomogram with excellent performance. The area under the receiver operating characteristic curve (AUROC) for the nomogram in the development, internal validation, and independent validation cohorts were 0.860, 0.877, and 0.811, respectively. Our nomogram based on ALT and AST that had excellent performance in predicting significant fibrosis of CHB patients were constructed.

Shear Wave Elastography in Assessment of Liver Fibrosis

Background Liver fibrosis is major medical issues in patients with chronic hepatitis C (CHC). It may lead to cirrhosis, hepatocellular carcinoma (HCC) and liver-related death. Therefore, assessing the degree of fibrosis in patients with chronic liver diseases, especially before the advanced stage, is clinically important to allow early care and prevent fatal liver disease. Objective The plan was to do shear-wave Elastography after fibroscan (TE) in order to assess the stiffness of the liver, detect the changes occurred in hepatitis C patients and measure diagnostic accuracy of 2D- SWE by using TE as reference standard. Methods A cross-section study included 30 persons with positive hepatitis C. They were referred to Radiology department at National Hepatology and tropical medicine research institute. Results Our study included (30) patients who have hepatitis C positive, their ages ranged from (18) years old to (60) years old with mean SD of 52.97 ± 9.43. They were 17 females (56.7%) and 13 males (43.3%). Different liver fibrosis stages were observed by 2D-SWE as following: (FO) 4 patients (13.3%), (Fl) 4 patients (13.3%), (F2) 9 patients (30.0%), (F3) 10 patients (33.3%), (F4) 3 patients (10.0%). While TE (fibroscan) shows (FO) 6 (20.0%), (Fl) 3 patients (10.0%), (F2) 7 patients (23.3%), (F3) 8 patients (26.7%) (F4) 6 patients (20.0%). Our study showed that the relation between TE (fibroscan) and SWE finding had positive correlation of most patients with liver fibrosis with (p-value 0.006 and r-value 0.487). Because the impoltant of significant fibrosis for initiate antiviral protocol therapy, 30 patients classified into FO—FI (non-significant liver fibrosis) versus F2—F4 (significant liver fibrosis). Our study show significant discrimination was found between no/mild fibrosis (FO-FI) and significant fibrosis (F2-F4), shows the sensitivity of SWE in detection of significant fibrosis results is 95.2% and the specificity is 77.8%, PPV 90.91 %, NPV 87.5% and the accuracy 90.0% with cutoff value &gt;5.7kPa. Conclusion SD-SWE is accurate in prediction significant fibrosis (2F2), Thus is expected to overcome the limitation of TE as a reliable method to assess fibrosis induce by hepatitis.

LECT2, A Novel and Direct Biomarker of Liver Fibrosis in Patients With CHB

Chronic hepatitis B (CHB) patients with severe liver fibrosis would be more likely to progress to a poorer prognosis. Treatment is considered once the liver fibrosis reaches significant liver fibrosis (≥S2). Leukocyte cell-derived chemotaxin-2 (LECT2) has been shown to contribute to liver fibrosis progression. No research has focused on the role of LECT2 in liver fibrosis in CHB patients. This study enrolled 227 CHB patients and divided them into the training group (n = 147) and validation group (n = 80), respectively. The expression of LECT2 in serum, protein and mRNA of the human liver tissues was detected to analyze the possible associations between LECT2 and liver fibrosis. A receiver operating characteristic curve (ROC) was used to estimate the efficacy of LECT2 for predicting liver fibrosis. The data showed that there was a positive relationship between LECT2 and the progression of liver fibrosis. In the training group, LECT2 was demonstrated to have better effectiveness than APRI and FIB-4. The AUC was 0.861, 0.698, and 0.734 for significant liver fibrosis, and 0.855, 0.769, and 0.752 for advanced liver fibrosis. Besides, the efficacy of LECT2 in different statuses of patients with CHB was examined and the effectiveness of LECT2 had also been confirmed in the validation group. All the results confirmed that LECT2 could act as a perfect predictor and thus offers a novel and direct biomarker to estimate liver fibrosis more accurately.

Effect of Coffee Consumption on Non-Alcoholic Fatty Liver Disease Incidence, Prevalence and Risk of Significant Liver Fibrosis: Systematic Review with Meta-Analysis of Observational Studies

Background and aim: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Given the anti-fibrotic and antioxidant properties of coffee, this systematic review and meta-analysis aims to provide updated results on the impact of coffee consumption on NAFLD incidence, prevalence, and risk of significant liver fibrosis. Methods: We conducted a comprehensive search in MEDLINE (OvidSP) and Scopus from January 2010 through January 2021. Relative risks for the highest versus the lowest level of coffee consumption were pooled using random-effects models. Heterogeneity and publication bias were evaluated using the Higgins’ I2 statistic and Egger’s regression test, respectively. Results: Eleven articles consisting of two case-control studies, eight cross-sectional studies, and one prospective cohort study were included in the meta-analysis. Of those, three studies with 92,075 subjects were included in the analysis for NAFLD incidence, eight studies with 9558 subjects for NAFLD prevalence, and five with 4303 subjects were used for the analysis of liver fibrosis. There was no association between coffee consumption and NAFLD incidence (RR 0.88, 95% CI 0.63–1.25, p = 0.48) or NAFLD prevalence (RR 0.88, 95% CI 0.76–1.02, p = 0.09). The meta-analysis showed coffee consumption to be significantly associated with a 35% decreased odds of significant liver fibrosis (RR 0.65, 95% CI 0.54–0.78, p < 0.00001). There was no heterogeneity (I2 = 11%, p = 0.34) and no evidence of publication bias (p = 0.134). Conclusion: This meta-analysis supports the protective role of coffee consumption on significant liver fibrosis in patients with NAFLD. However, the threshold of coffee consumption to achieve hepatoprotective effects needs to be established in prospective trials.

Biological Profile of Chronic Hepatitis B and its Predictive Factors According to Liver Histological Activity at the Renaissance Hospital, N’Djamena, Chad

Background: No study in black Africa has investigated the profile of chronic hepatitis B according to the new European association for the study of the liver (EASL) classification. The aim of the study was to determine the biological profile of chronic HBsAg carriers according to the EASL classification of chronic hepatitis B. Method: This is a prospective cross-sectional study carried out in the gastroenterology outpatient department at the Renaissance Hospital in N’Djamena from January, 2018 to July, 2019. All patients with chronic HBsAg were included and documented for at least one year. Patients with hepatitis C, hepatitis D or HIV or alcoholic were excluded. The biological profile was determined according the EASL classification: HBeAg-positive chronic infection, HBeAg-positive chronic hepatitis, HBeAg-negative chronic infection, HBeAg-negative chronic hepatitis and HBsAg-negative phase. Factors associated with presence of significant liver fibrosis were founded by logistical regression. Results: 106 patients were included. The average age were 42.4 years old. The sex ratio was 1.43. The median of the transaminase were 24 IU/ml (AST) and 21 IU/ml (ALT). 61 patients had HBeAg-negative chronic infection (59.8%) and 37 patients had HBeAg-negative chronic hepatitis (36.2%). HBeAg-positive chronic infection and HBeAg-positive chronic hepatitis were both seen in 2% of the cases. Significant liver fibrosis was independently associated with the ALT levels (Odds ratio=1.038 [1.009-1.068]; p=0.009). Conclusion: Chronic HBeAg-negative B infection is the main form in chronic HBsAg-positive carriers. Transaminases are a predictive factor for the presence of hepatic fibrosis.