Journal of Clinical Medicine

Editorial

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5 pages, 225 KiB

Open AccessEditorial

Cirrhosis, a Global and Challenging Disease

by José Ignacio Fortea, Javier Crespo and Ángela Puente

J. Clin. Med. 2022, 11(21), 6512; https://doi.org/10.3390/jcm11216512 - 2 Nov 2022

Cited by 4 | Viewed by 2137

Abstract

Cirrhosis is the result of sustained liver damage leading to the diffusion of hepatic fibrosis, wherein the normal hepatic architecture is replaced by abnormally organized nodules separated by fibrous septa that connect the different vascular structures of the hepatic lobule [...] Full article

(This article belongs to the Special Issue The Clinical Management of Liver Cirrhosis: Current Concepts, Recent Advances and Future Trends)

Research

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12 pages, 2458 KiB

Open AccessArticle

Noninvasive Liver Fibrosis Staging: Comparison of MR Elastography with Extracellular Volume Fraction Analysis Using Contrast-Enhanced CT

by Keigo Yano, Hiromitsu Onishi, Takahiro Tsuboyama, Atsushi Nakamoto, Takashi Ota, Hideyuki Fukui, Mitsuaki Tatsumi, Takumi Tanigaki, Kunihito Gotoh, Shogo Kobayashi, Keiichiro Honma, Hidetoshi Eguchi and Noriyuki Tomiyama

J. Clin. Med. 2022, 11(19), 5653; https://doi.org/10.3390/jcm11195653 - 25 Sep 2022

Cited by 3 | Viewed by 1802

Abstract

Purpose: To compare the accuracy of liver fibrosis staging with MR elastography and of staging with extracellular volume fraction (fECV) analysis using contrast-enhanced CT. Methods: This retrospective study included 60 patients who underwent both MR elastography and contrast-enhanced CT before liver surgery between [...] Read more.

Purpose: To compare the accuracy of liver fibrosis staging with MR elastography and of staging with extracellular volume fraction (fECV) analysis using contrast-enhanced CT. Methods: This retrospective study included 60 patients who underwent both MR elastography and contrast-enhanced CT before liver surgery between October 2013 and July 2020. Two radiologists independently measured liver stiffness of MR elastography and fECV of CT images. Accuracy for liver fibrosis staging was assessed using receiver operating characteristic (ROC) analysis. Correlations between liver stiffness or fECV and liver fibrosis were also evaluated by means of the Spearman rank correlation coefficient. Results: The areas under the ROC curves for MR elastography for each stage differentiation of ≥F1 (0.85, 0.82 for the two radiologists), ≥F2 (0.88, 0.89), ≥F3 (0.87, 0.86), and F4 (0.84, 0.83) were greater than those for fECV analysis with CT (0.64, p = 0.06, 0.69, p = 0.2; 0.62, p < 0.005, 0.63, p < 0.005; 0.62, p < 0.005, 0.62, p < 0.01; and 0.70, p = 0.08, 0.71, p = 0.2, respectively). The correlation coefficients between liver stiffness and liver fibrosis in A0 (0.67, 0.69 for the two radiologists), A1 (0.64, 0.66) and A2 group (0.58, 0.51) were significantly higher than those between fECV and liver fibrosis (0.28, 0.30; 0.27, 0.31; and 0.23, 0.07; p < 0.05 for all comparisons). Conclusion: MR elastography allows for more accurate liver fibrosis staging compared with fECV analysis with CT. In addition, MR elastography may be less affected than fECV analysis by the inflammatory condition. Full article

(This article belongs to the Special Issue The Clinical Management of Liver Cirrhosis: Current Concepts, Recent Advances and Future Trends)

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11 pages, 452 KiB

Open AccessArticle

Usefulness of the Trabecular Bone Score in Assessing the Risk of Vertebral Fractures in Patients with Cirrhosis

by Yui Ogiso, Tatsunori Hanai, Kayoko Nishimura, Takao Miwa, Toshihide Maeda, Kenji Imai, Atsushi Suetsugu, Koji Takai and Masahito Shimizu

J. Clin. Med. 2022, 11(6), 1562; https://doi.org/10.3390/jcm11061562 - 12 Mar 2022

Cited by 5 | Viewed by 2139

Abstract

The trabecular bone score (TBS), a surrogate measure of bone microarchitecture, provides complementary information to bone mineral density (BMD) in the assessment of osteoporotic fracture risk. This cross-sectional study aimed to determine whether TBS can identify patients with liver cirrhosis that are at [...] Read more.

The trabecular bone score (TBS), a surrogate measure of bone microarchitecture, provides complementary information to bone mineral density (BMD) in the assessment of osteoporotic fracture risk. This cross-sectional study aimed to determine whether TBS can identify patients with liver cirrhosis that are at risk of vertebral fractures. We enrolled 275 patients who completed evaluations for lumbar BMD, TBS, and vertebral fractures between November 2018 and April 2021. BMD was measured using dual-energy X-ray absorptiometry (DXA), TBS was calculated by analyzing DXA images using TBS iNsight software, and vertebral fractures were evaluated using Genant’s semi-quantitative method with lateral X-ray images. Factors associated with vertebral fractures and their correlation with the TBS were identified using regression models. Of the enrolled patients, 128 (47%) were female, the mean age was 72 years, and 62 (23%) were diagnosed with vertebral fractures. The prevalence of vertebral fractures was higher in women than in men (33% vs. 14%; p < 0.001). The unadjusted odds ratio (OR) of the vertebral fractures for one standard deviation decrease in TBS and BMD was 2.14 (95% confidence interval [CI], 1.69–2.73) and 1.55 (95% CI, 1.26–1.90), respectively. After adjusting for age, sex, and BMD, the adjusted OR of the vertebral fractures in TBS was 2.26 (95% CI, 1.52–3.35). Multivariate linear regression analysis showed that TBS was independently correlated with age (β = −0.211), body mass index (β = −0.251), and BMD (β = 0.583). TBS can help identify patients with cirrhosis at risk of vertebral fractures. Full article

(This article belongs to the Special Issue The Clinical Management of Liver Cirrhosis: Current Concepts, Recent Advances and Future Trends)

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13 pages, 1056 KiB

Open AccessArticle

The Role of Urinary N-Acetyl-β-d-glucosaminidase in Cirrhotic Patients with Acute Kidney Injury: Multicenter, Prospective Cohort Study

by Jeong-Ju Yoo, Jung Hyun Kwon, Young Seok Kim, Soon Woo Nam, Ji Won Park, Hee Yeon Kim, Chang Wook Kim, Seung Kak Shin, Young Eun Chon, Eun Sun Jang, Sook-Hyang Jeong, Jin Woo Lee, Do Seon Song, Jin Mo Yang, Sung Won Lee, Hae Lim Lee, Young Kul Jung, Hyung Joon Yim, Bora Lee, Sang Gyune Kim and Ju Hyun Kim Show full author list Hide full author list

J. Clin. Med. 2021, 10(19), 4328; https://doi.org/10.3390/jcm10194328 - 23 Sep 2021

Cited by 9 | Viewed by 2172

Abstract

Background and Aims: Currently, it is difficult to predict the reversibility of renal function and to discriminate renal parenchymal injury in cirrhotic patients with acute kidney injury (AKI). The aim of this study is to evaluate whether urine N-acetyl-β-d-Glucosaminidase (NAG) [...] Read more.

Background and Aims: Currently, it is difficult to predict the reversibility of renal function and to discriminate renal parenchymal injury in cirrhotic patients with acute kidney injury (AKI). The aim of this study is to evaluate whether urine N-acetyl-β-d-Glucosaminidase (NAG) can predict the survival and response to terlipressin in cirrhotic patients with AKI. Methods: Two hundred sixty-two cirrhotic consecutive patients who developed AKI were prospectively enrolled from 11 tertiary medical centers in Korea between 2016 to 2019. AKI was defined as an increase in serum Cr (SCr) of 0.3 mg/dL or a 50% increase in baseline SCr. Patients diagnosed with hepatorenal syndrome (HRS-AKI) were treated with terlipressin plus albumin. Results: The patients were 58.8 ± 12.9 years old on average and were predominantly male (72.5%). The mean MELD score was 25.3 ± 9.1. When classified according to the AKI phenotype, there were 119 pre-renal, 52 acute tubular necrosis, 18 miscellaneous, and 73 HRS-AKI patients. However, the urine NAG was not effective at discriminating AKI phenotypes, except for HRS-AKI. The baseline urine NAG increased as the baseline AKI stage increased (p < 0.001). In addition, within the same AKI stage, the urine NAG values were significantly lower in the AKI-resolved group than in the unresolved group. The urine NAG level was significantly lower in living patients compared with those who died or who underwent a liver transplant within 3 months (p = 0.005). In the multivariate analysis, the increased urine NAG was a significant risk factor for the 3-month transplant-free survival (TFS) rate, especially in patients with Child–Pugh class ≤ B or MELD < 24. The urine NAG did not predict the response to terlipressin treatment in patients with HRS. Conclusions: Urine NAG is strongly associated with the severity of AKI in patients with liver cirrhosis and is useful for predicting the 3-month TFS. Full article

(This article belongs to the Special Issue The Clinical Management of Liver Cirrhosis: Current Concepts, Recent Advances and Future Trends)

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11 pages, 791 KiB

Open AccessArticle

Hepatic Hydrothorax—An Independent Decompensating Event Associated with Long-Term Mortality in Patients with Cirrhosis

by Daniela Matei, Rares Craciun, Dana Crisan, Bogdan Procopet, Tudor Mocan, Sergiu Pasca, Roxana Zaharie, Bogdan Popovici and Zeno Sparchez

J. Clin. Med. 2021, 10(16), 3688; https://doi.org/10.3390/jcm10163688 - 20 Aug 2021

Cited by 15 | Viewed by 2515

Abstract

Background: Hepatic hydrothorax (HH) is an understudied complication of decompensated cirrhosis. We aimed to evaluate the long-term prognosis of patients with HH by comparing them with a matched non-HH group. Methods: This retrospective study included 763 consecutive patients hospitalized for decompensated cirrhosis and [...] Read more.

Background: Hepatic hydrothorax (HH) is an understudied complication of decompensated cirrhosis. We aimed to evaluate the long-term prognosis of patients with HH by comparing them with a matched non-HH group. Methods: This retrospective study included 763 consecutive patients hospitalized for decompensated cirrhosis and ascites. Ninety-seven patients with HH were matched for survival analysis with non-HH patients based on liver disease severity. Results: The prevalence of HH was 13.1%. Patients with HH had significantly worse overall liver function. Upon matching, patients with HH had a lower long-term survival (15.4% vs. 30.9% at 5 years) with a mean overall survival of 22.2 ± 2.2 months for the HH group vs. 27.1 ± 2.6 months for the non-HH group (Log Rank–0.05). On multivariate survival analysis using Cox regression, the MELD-Na score, ALBI grade, hepato-renal syndrome, and grade III ascites had a significant impact on mortality in patients with HH. In patients with HH, a MELD-Na score ≥ 16, ALBI grade III, hepato-renal syndrome, or severe ascites delineated high-mortality risk groups. Conclusions: HH is consistently associated with more advanced liver disease. Patients with HH have worse long-term survival, their prognosis being closely intertwined with overlapping decompensating events. Full article

(This article belongs to the Special Issue The Clinical Management of Liver Cirrhosis: Current Concepts, Recent Advances and Future Trends)

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Review

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26 pages, 2148 KiB

Open AccessReview

Portal Vein Thrombosis in the Setting of Cirrhosis: A Comprehensive Review

by Aitor Odriozola, Ángela Puente, Antonio Cuadrado, Coral Rivas, Ángela Anton, Francisco José González, Raúl Pellón, Emilio Fábrega, Javier Crespo and José Ignacio Fortea

J. Clin. Med. 2022, 11(21), 6435; https://doi.org/10.3390/jcm11216435 - 30 Oct 2022

Cited by 9 | Viewed by 9469

Abstract

Portal vein thrombosis constitutes the most common thrombotic event in patients with cirrhosis, with increased rates in the setting of advanced liver disease. Despite being a well-known complication of cirrhosis, the contribution of portal vein thrombosis to hepatic decompensation and overall mortality is [...] Read more.

Portal vein thrombosis constitutes the most common thrombotic event in patients with cirrhosis, with increased rates in the setting of advanced liver disease. Despite being a well-known complication of cirrhosis, the contribution of portal vein thrombosis to hepatic decompensation and overall mortality is still a matter of debate. The incorporation of direct oral anticoagulants and new radiological techniques for portal vein recanalization have expanded our therapeutic arsenal. However, the lack of large prospective observational studies and randomized trials explain the heterogenous diagnostic and therapeutic recommendations of current guidelines. This article seeks to make a comprehensive review of the pathophysiology, clinical features, diagnosis, and treatment of portal vein thrombosis in patients with cirrhosis. Full article

(This article belongs to the Special Issue The Clinical Management of Liver Cirrhosis: Current Concepts, Recent Advances and Future Trends)

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13 pages, 3551 KiB

Open AccessReview

Prevalence of the Absence of Cirrhosis in Subjects with NAFLD-Associated Hepatocellular Carcinoma

by Marco Castellana, Rossella Donghia, Luisa Lampignano, Fabio Castellana, Roberta Zupo, Rodolfo Sardone, Giovanni De Pergola and Gianluigi Giannelli

J. Clin. Med. 2021, 10(20), 4638; https://doi.org/10.3390/jcm10204638 - 9 Oct 2021

Cited by 8 | Viewed by 1812

Abstract

Background. Hepatocellular carcinoma (HCC) is most commonly considered as a complication of cirrhosis. However, an increasing number of HCC in subjects with non-alcoholic fatty liver disease (NAFLD) without cirrhosis is being reported. We conducted a meta-analysis to assess the prevalence of the absence [...] Read more.

Background. Hepatocellular carcinoma (HCC) is most commonly considered as a complication of cirrhosis. However, an increasing number of HCC in subjects with non-alcoholic fatty liver disease (NAFLD) without cirrhosis is being reported. We conducted a meta-analysis to assess the prevalence of the absence of cirrhosis in NAFLD-associated HCC. Methods. Four databases were searched until March 2021 (CRD42021242969). The original articles included were those reporting data on the presence or absence of cirrhosis among at least 50 subjects with NAFLD-associated HCC. The number of subjects with absent cirrhosis in each study was extracted. For statistical pooling of data, a random-effects model was used. Subgroup analyses according to the continent, target condition and reference standard for the diagnosis of cirrhosis were conducted. Results. Thirty studies were included, evaluating 13,371 subjects with NAFLD-associated HCC. The overall prevalence of cases without cirrhosis was 37% (95%CI 28 to 46). A higher prevalence was reported in Asia versus Europe, North America and South America (45, 36, 37 and 22%, respectively) as well as in studies adopting histology only as the reference standard for the diagnosis of cirrhosis versus histology and other modalities (e.g., radiology, endoscopy, biochemistry or overt clinical findings) (53 and 27%, respectively). No difference was found between studies including subjects with non-alcoholic steatohepatitis (NASH) only, versus NAFLD with or without NASH (p = 0.385). One in three subjects with NAFLD-associated HCC presented without cirrhosis. This should be reflected in future guidelines and surveillance programs adapted to allow for the early detection of these cancers too. Full article

(This article belongs to the Special Issue The Clinical Management of Liver Cirrhosis: Current Concepts, Recent Advances and Future Trends)

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12 pages, 6869 KiB

Open AccessReview

Serum Biomarkers of Liver Fibrosis Staging in the Era of the Concept “Compensated Advanced Chronic Liver Disease”

by Koji Fujita and Tsutomu Masaki

J. Clin. Med. 2021, 10(15), 3340; https://doi.org/10.3390/jcm10153340 - 28 Jul 2021

Cited by 5 | Viewed by 3826

Abstract

Non-invasive indexes of liver fibrosis based on blood examinations have been developed for decades, partially replacing liver biopsy examinations. Recently, the concept of liver cirrhosis was revised and converted to “compensated advanced chronic liver diseases” since the Baveno VI consensus statement in 2015. [...] Read more.

Non-invasive indexes of liver fibrosis based on blood examinations have been developed for decades, partially replacing liver biopsy examinations. Recently, the concept of liver cirrhosis was revised and converted to “compensated advanced chronic liver diseases” since the Baveno VI consensus statement in 2015. The term “compensated advanced chronic liver diseases” was established based on the premise that serum biomarkers were not able to differentiate cirrhosis from severe fibrosis. The difficulty to histologically distinguish cirrhosis from severe fibrosis had been pointed out in 1977, when the definition and nomenclatures of cirrhosis had been determined by the World Health Organization. That was decades before serum biomarkers available at present were investigated. Though we are accustomed to differentiating the fibrosis stage as stage 1, 2, 3 (severe fibrosis), and 4 (cirrhosis), differentiation of cirrhosis from severe fibrosis is difficult even by histopathological examination. The current review will provide readers a framework to revise how to apply serum biomarkers on liver fibrosis staging in an era of the concept of “compensated advanced chronic liver disease”. Full article

(This article belongs to the Special Issue The Clinical Management of Liver Cirrhosis: Current Concepts, Recent Advances and Future Trends)

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