Hepatology Communications最新文献

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The impact of surging transplantation of alcohol-associated liver disease on transplantation for HCC and other indications. 酒精相关肝病移植手术激增对肝癌和其他适应症移植手术的影响。
IF 5.6 2区 医学
Hepatology Communications Pub Date : 2024-07-05 eCollection Date: 2024-07-01 DOI: 10.1097/HC9.0000000000000455
Divya Ayyala-Somayajula, Jennifer L Dodge, Kali Zhou, Norah A Terrault, Liyun Yuan
{"title":"The impact of surging transplantation of alcohol-associated liver disease on transplantation for HCC and other indications.","authors":"Divya Ayyala-Somayajula, Jennifer L Dodge, Kali Zhou, Norah A Terrault, Liyun Yuan","doi":"10.1097/HC9.0000000000000455","DOIUrl":"10.1097/HC9.0000000000000455","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation (LT) for alcohol-associated liver disease (ALD) is increasing and may impact LT outcomes for patients listed for HCC and other indications.</p><p><strong>Methods: </strong>Using US adults listed for primary LT (grouped as ALD, HCC, and other) from October 8, 2015, to December 31, 2021, we examined the impact of center-level ALD LT volume (ATxV) on waitlist outcomes in 2 eras: Era 1 (6-month wait for HCC) and Era 2 (MMaT-3). The tertile distribution of ATxV (low to high) was derived from the listed candidates as Tertile 1 (T1): <28.4%, Tertile 2 (T2): 28.4%-37.6%, and Tertile 3 (T3): >37.6% ALD LTs per year. Cumulative incidence of waitlist death and LT within 18 months from listing by LT indication were compared using the Gray test, stratified on eras and ATxV tertiles. Multivariable competing risk regression estimated the adjusted subhazard ratios (sHRs) for the risk of waitlist mortality and LT with interaction effects of ATxV by LT indication (interaction p).</p><p><strong>Results: </strong>Of 56,596 candidates listed, the cumulative waitlist mortality for those with HCC and other was higher and their LT probability was lower in high (T3) ATxV centers, compared to low (T1) ATxV centers in Era 2. However, compared to ALD (sHR: 0.92 [0.66-1.26]), the adjusted waitlist mortality for HCC (sHR: 1.15 [0.96-1.38], interaction p = 0.22) and other (sHR: 1.13 [0.87-1.46], interaction p = 0.16) were no different suggesting no differential impact of ATxV on the waitlist mortality. The adjusted LT probability for HCC (sHR: 0.89 [0.72-1.11], interaction p = 0.08) did not differ by AtxV while it was lower for other (sHR: 0.82 [0.67-1.01], interaction p = 0.02) compared to ALD (sHR: 1.04 [0.80-1.34]) suggesting a differential impact of ATxV on LT probability.</p><p><strong>Conclusions: </strong>The high volume of LT for ALD does not impact waitlist mortality for HCC and others but affects LT probability for other in the MMAT-3 era warranting continued monitoring.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 7","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Liver macrophages revisited: The expanding universe of versatile responses in a spatiotemporal context. 重访肝脏巨噬细胞:时空背景下不断扩大的多功能反应宇宙。
IF 5.6 2区 医学
Hepatology Communications Pub Date : 2024-07-05 eCollection Date: 2024-07-01 DOI: 10.1097/HC9.0000000000000491
Adrien Guillot, Frank Tacke
{"title":"Liver macrophages revisited: The expanding universe of versatile responses in a spatiotemporal context.","authors":"Adrien Guillot, Frank Tacke","doi":"10.1097/HC9.0000000000000491","DOIUrl":"10.1097/HC9.0000000000000491","url":null,"abstract":"<p><p>The liver is a vital organ that continuously adapts to a wide and dynamic diversity of self-antigens and xenobiotics. This involves the active contribution of immune cells, particularly by the liver-resident macrophages, the Kupffer cells (KCs), which exert a variety of central functions in liver homeostasis and disease. As such, KCs interact with their microenvironment to shape the hepatic cellular landscape, control gut-derived signal integration, and modulate metabolism. On injury, the rapid recruitment of bone marrow monocyte-derived macrophages alters this status quo and, when unrestrained, drastically compromises liver homeostasis, immune surveillance, and tissue organization. Several factors determine the functional roles of liver macrophages in these processes, such as their ontogeny, activation/polarization profile and, importantly, spatial distribution within the liver. Loss of tolerance and adaptability of the hepatic immune environment may result in persistent inflammation, hepatic fibrosis, cirrhosis, and a tumorigenic niche promoting liver cancer. In this review, we aim at providing the most recent breakthroughs in our understanding of liver macrophage biology, particularly their diversity and adaptability in the hepatic spatiotemporal context, as well as on potential therapeutic interventions that may hold the key to tackling remaining clinical challenges of varying etiologies in hepatology.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 7","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Erratum: Gut microbiota and metabolic biomarkers in metabolic dysfunction-associated steatotic liver disease (MASLD). 勘误:代谢功能障碍相关性脂肪性肝病(MASLD)中的肠道微生物群和代谢生物标志物。
IF 5.6 2区 医学
Hepatology Communications Pub Date : 2024-07-05 eCollection Date: 2024-07-01 DOI: 10.1097/HC9.0000000000000493
{"title":"Erratum: Gut microbiota and metabolic biomarkers in metabolic dysfunction-associated steatotic liver disease (MASLD).","authors":"","doi":"10.1097/HC9.0000000000000493","DOIUrl":"10.1097/HC9.0000000000000493","url":null,"abstract":"","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 7","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical and genetic risk factors for progressive fibrosis in metabolic dysfunction-associated steatotic liver disease. 代谢功能障碍相关性脂肪肝进行性纤维化的临床和遗传风险因素。
IF 5.6 2区 医学
Hepatology Communications Pub Date : 2024-07-05 eCollection Date: 2024-07-01 DOI: 10.1097/HC9.0000000000000487
David E Kaplan, Craig C Teerlink, Tae-Hwi Schwantes-An, Trina M Norden-Krichmar, Scott L DuVall, Timothy R Morgan, Philip S Tsao, Benjamin F Voight, Julie A Lynch, Marijana Vujković, Kyong-Mi Chang
{"title":"Clinical and genetic risk factors for progressive fibrosis in metabolic dysfunction-associated steatotic liver disease.","authors":"David E Kaplan, Craig C Teerlink, Tae-Hwi Schwantes-An, Trina M Norden-Krichmar, Scott L DuVall, Timothy R Morgan, Philip S Tsao, Benjamin F Voight, Julie A Lynch, Marijana Vujković, Kyong-Mi Chang","doi":"10.1097/HC9.0000000000000487","DOIUrl":"10.1097/HC9.0000000000000487","url":null,"abstract":"<p><strong>Background: </strong>Fibrosis-4 (FIB4) is a recommended noninvasive test to assess hepatic fibrosis among patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Here, we used FIB4 trajectory over time (ie, \"slope\" of FIB4) as a surrogate marker of liver fibrosis progression and examined if FIB4 slope is associated with clinical and genetic factors among individuals with clinically defined MASLD within the Million Veteran Program Cohort.</p><p><strong>Methods: </strong>In this retrospective cohort study, FIB4 slopes were estimated through linear regression for participants with clinically defined MASLD and FIB4 <2.67 at baseline. FIB4 slope was correlated with demographic parameters and clinical outcomes using logistic regression and Cox proportional hazard models. FIB4 slope as a quantitative phenotype was used in a genome-wide association analysis in ancestry-specific analysis and multiancestry meta-analysis using METAL.</p><p><strong>Results: </strong>FIB4 slopes, generated from 98,361 subjects with MASLD (16,045 African, 74,320 European, and 7996 Hispanic), showed significant associations with sex, ancestry, and cardiometabolic risk factors (p < 0.05). FIB4 slopes also correlated strongly with hepatic outcomes and were independently associated with time to cirrhosis. Five genetic loci showed genome-wide significant associations (p < 5 × 10-8) with FIB4 slope among European ancestry subjects, including 2 known (PNPLA3 and TM6SF2) and 3 novel loci (TERT 5.1 × 10-11; LINC01088, 3.9 × 10-8; and MRC1, 2.9 × 10-9).</p><p><strong>Conclusions: </strong>Linear trajectories of FIB4 correlated significantly with time to progression to cirrhosis, with liver-related outcomes among individuals with MASLD and with known and novel genetic loci. FIB4 slope may be useful as a surrogate measure of fibrosis progression.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 7","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Erratum: Correlation between clinical and pathological findings of liver injury in 27 patients with lethal COVID-19 infections in Brazil. 勘误:巴西 27 名致命 COVID-19 感染者肝损伤的临床和病理结果之间的相关性。
IF 5.6 2区 医学
Hepatology Communications Pub Date : 2024-06-27 eCollection Date: 2024-07-01 DOI: 10.1097/HC9.0000000000000492
{"title":"Erratum: Correlation between clinical and pathological findings of liver injury in 27 patients with lethal COVID-19 infections in Brazil.","authors":"","doi":"10.1097/HC9.0000000000000492","DOIUrl":"10.1097/HC9.0000000000000492","url":null,"abstract":"","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 7","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hepatocyte-specific loss of DDB1 attenuates hepatic steatosis but aggravates liver inflammation and fibrosis in MASH. 肝细胞特异性缺失 DDB1 可减轻肝脂肪变性,但会加重 MASH 的肝脏炎症和纤维化。
IF 5.6 2区 医学
Hepatology Communications Pub Date : 2024-06-27 eCollection Date: 2024-07-01 DOI: 10.1097/HC9.0000000000000474
Qiuxia Gu, Yushun Chang, Yan Jin, Jing Fang, Tong Ji, Jie Lin, Xi Zhu, Binzhi Dong, Hanning Ying, Xiaoxiao Fan, Zheyong Li, Zerui Gao, Yongfen Zhu, Yifan Tong, Xiujun Cai
{"title":"Hepatocyte-specific loss of DDB1 attenuates hepatic steatosis but aggravates liver inflammation and fibrosis in MASH.","authors":"Qiuxia Gu, Yushun Chang, Yan Jin, Jing Fang, Tong Ji, Jie Lin, Xi Zhu, Binzhi Dong, Hanning Ying, Xiaoxiao Fan, Zheyong Li, Zerui Gao, Yongfen Zhu, Yifan Tong, Xiujun Cai","doi":"10.1097/HC9.0000000000000474","DOIUrl":"10.1097/HC9.0000000000000474","url":null,"abstract":"<p><strong>Background: </strong>MASH is a common clinical disease that can lead to advanced liver conditions, but no approved pharmacotherapies are available due to an incomplete understanding of its pathogenesis. Damaged DNA binding protein 1 (DDB1) participates in lipid metabolism. Nevertheless, the function of DDB1 in MASH is unclear.</p><p><strong>Methods: </strong>Clinical liver samples were obtained from patients with MASH and control individuals by liver biopsy. Hepatocyte-specific Ddb1-knockout mice and liver Hmgb1 knockdown mice were fed with a methionine-and choline-deficient diet to induce MASH.</p><p><strong>Results: </strong>We found that the expression of DDB1 in the liver was significantly decreased in MASH models. Hepatocyte-specific ablation of DDB1 markedly alleviated methionine-and choline-deficient diet-induced liver steatosis but unexpectedly exacerbated inflammation and fibrosis. Mechanistically, DDB1 deficiency attenuated hepatic steatosis by downregulating the expression of lipid synthesis and uptake genes. We identified high-mobility group box 1 as a key candidate target for DDB1-mediated liver injury. DDB1 deficiency upregulated the expression and extracellular release of high-mobility group box 1, which further increased macrophage infiltration and activated HSCs, ultimately leading to the exacerbation of liver inflammation and fibrosis.</p><p><strong>Conclusions: </strong>These data demonstrate the independent regulation of hepatic steatosis and injury in MASH. These findings have considerable clinical implications for the development of therapeutic strategies for MASH.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 7","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Randomized clinical trial on safety of the natriuretic peptide ularitide as treatment of refractory cirrhotic ascites. 关于钠尿肽 ularitide 治疗难治性肝硬化腹水安全性的随机临床试验。
IF 5.6 2区 医学
Hepatology Communications Pub Date : 2024-06-27 eCollection Date: 2024-07-01 DOI: 10.1097/HC9.0000000000000481
Rasmus H Gantzel, Emilie E Møller, Niels K Aagaard, Hugh Watson, Peter Jepsen, Henning Grønbæk
{"title":"Randomized clinical trial on safety of the natriuretic peptide ularitide as treatment of refractory cirrhotic ascites.","authors":"Rasmus H Gantzel, Emilie E Møller, Niels K Aagaard, Hugh Watson, Peter Jepsen, Henning Grønbæk","doi":"10.1097/HC9.0000000000000481","DOIUrl":"10.1097/HC9.0000000000000481","url":null,"abstract":"<p><strong>Background: </strong>Sodium and water retention is a mainstay of the pathophysiology leading to ascites formation in patients with advanced cirrhosis. Refractory ascites denotes the most severe ascites status with limited treatment options and a poor prognosis. We investigated the efficacy and safety of the natriuretic peptide ularitide in patients with refractory cirrhotic ascites.</p><p><strong>Methods: </strong>We conducted a randomized placebo-controlled trial investigating ularitide to manage refractory ascites. Until trial termination after interim analyses, we randomized 17 participants in a 2:1 ratio between ularitide (n=11) and placebo (n=6). While hospitalized, the participants received treatment for up to 48 hours. The primary efficacy endpoint was a change in renal water excretion, and secondary end points included changes in renal sodium excretion rate and body weight. The starting dose was 30 ng/kg/min, though later reduced to 20 for safety reasons.</p><p><strong>Results: </strong>In contrast to the study hypothesis, the mean urine production decreased after 24 hours of ularitide treatment compared with the baseline level (22.8 vs. 47.5 mL/h, p=0.04) and decreased more in participants randomized to ularitide than placebo (24.7 vs. -6.2 mL/h, p=0.05). Ularitide did not increase the renal sodium excretion rate or reduce the weight gain. The incidence rate ratio of adverse reactions in ularitide versus placebo was 8.5 (95% CI: 2-35, p=0.003). Participants treated with ularitide developed serious blood pressure reductions, impacting their renal responsiveness.</p><p><strong>Conclusions: </strong>Ularitide in doses of 20-30 ng/kg/min did not benefit urine production and renal sodium excretion rate in patients with refractory ascites. The participants randomized to ularitide overall developed more adverse reactions than placebo. EudraCT no. 2019-002268-28.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 7","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Selective internal radiation therapy for unresectable HCC: The SIRT downstaging study. 选择性内放射治疗不可切除的 HCC:SIRT 降期研究
IF 5.6 2区 医学
Hepatology Communications Pub Date : 2024-06-27 eCollection Date: 2024-07-01 DOI: 10.1097/HC9.0000000000000475
Hélène Regnault, Julia Chalaye, Athena Galetto-Pregliasco, Clara Perrin, Haytham Derbel, Giuliana Amaddeo, Sébastien Mulé, Marie Lequoy, Hicham Kobeiter, Edouard Reizine, Emmanuel Itti, Christophe Duvoux, Alexis Laurent, Vincent Leroy, Daniele Sommacale, Diana Rasolonirina, Alain Luciani, Julien Calderaro, Vania Tacher, Raffaele Brustia
{"title":"Selective internal radiation therapy for unresectable HCC: The SIRT downstaging study.","authors":"Hélène Regnault, Julia Chalaye, Athena Galetto-Pregliasco, Clara Perrin, Haytham Derbel, Giuliana Amaddeo, Sébastien Mulé, Marie Lequoy, Hicham Kobeiter, Edouard Reizine, Emmanuel Itti, Christophe Duvoux, Alexis Laurent, Vincent Leroy, Daniele Sommacale, Diana Rasolonirina, Alain Luciani, Julien Calderaro, Vania Tacher, Raffaele Brustia","doi":"10.1097/HC9.0000000000000475","DOIUrl":"10.1097/HC9.0000000000000475","url":null,"abstract":"<p><strong>Background: </strong>Selective internal radiation therapy (SIRT) is recommended as a downstaging (DS) strategy for solitary unresectable HCC <8 cm. The aim of this study was to report the results of acquired experience in a tertiary center for all unresectable HCCs.</p><p><strong>Methods: </strong>We conducted a retrospective, observational study using data collected from consecutive patients undergoing SIRT between October 2013 and June 2020. DS was considered achieved when a curative treatment could be proposed 6 months after SIRT.</p><p><strong>Results: </strong>One hundred twenty-seven patients were included (male = 90%, 64 ± 11 y), of whom 112 (n = 88%) had cirrhosis. HCC was classified as BCLC stage C in 64 patients (50%), with a median diameter of 61 mm, an infiltrative pattern in 51 patients (40%), and portal vein invasion in 62 (49%) patients. Fifty patients (39%) achieved DS 6 months following SIRT, with 29 of them (23%) undergoing curative treatment in a median time of 4.3 months: 17 (13%) were transplanted, 11 (85%) had liver resection, and 1 patient had a radiofrequency ablation. The median overall survival of patients with or without DS was 51 versus 10 months, respectively (p < 0.001). In patients who achieved DS, progression-free survival was higher in patients who underwent surgery: 47 versus 11 months (p < 0.001). Four variables were independently associated with DS: age (OR: 0.96, 95% CI: [0.92, 0.99]; p = 0.032), baseline α-fetoprotein (OR: 1.00, 95% CI: [1.00, 1.00]; p = 0.034), HCC distribution (OR: 0.3, 95% CI: [0.11, 0.75]; p = 0.012), and ALBI grade (OR: 0.34. 95% CI: [0.14, 0.80]; p = 0.014).</p><p><strong>Conclusions: </strong>These results suggest that SIRT in patients with unresectable HCC could be an effective treatment: DS was achieved for around 39% of the patients and more than half of these then underwent curative treatment.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 7","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit. 利用创新的信息技术解决方案,在全科医生中筛查晚期慢性肝病患者:肝脏工具包。
IF 5.6 2区 医学
Hepatology Communications Pub Date : 2024-06-27 eCollection Date: 2024-07-01 DOI: 10.1097/HC9.0000000000000482
David S Prince, Shakira Hoque, Christy Kim, Salim Maher, Jane Miller, Phoebe Chomley, Janice Pritchard-Jones, Sally Spruce, Nathan McGarry, David Baker, Penelope Elix, Ken Liu, Simone I Strasser, Brendan Goodger, Amany Zekry, Geoffrey W McCaughan
{"title":"Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit.","authors":"David S Prince, Shakira Hoque, Christy Kim, Salim Maher, Jane Miller, Phoebe Chomley, Janice Pritchard-Jones, Sally Spruce, Nathan McGarry, David Baker, Penelope Elix, Ken Liu, Simone I Strasser, Brendan Goodger, Amany Zekry, Geoffrey W McCaughan","doi":"10.1097/HC9.0000000000000482","DOIUrl":"10.1097/HC9.0000000000000482","url":null,"abstract":"<p><strong>Background: </strong>Identifying patients with undiagnosed advanced chronic liver disease (ACLD) is a public health challenge. Patients with advanced fibrosis or compensated cirrhosis have much better outcomes than those with decompensated disease and may be eligible for interventions to prevent disease progression.</p><p><strong>Methods: </strong>A cloud-based software solution (\"the Liver Toolkit\") was developed to access primary care practice software to identify patients at risk of ACLD. Clinical history and laboratory results were extracted to calculate aspartate aminotransferase-to-platelet ratio index and fibrosis 4 scores. Patients identified were recalled for assessment, including Liver Stiffness Measurement (LSM) via transient elastography. Those with an existing diagnosis of cirrhosis were excluded.</p><p><strong>Results: </strong>Existing laboratory results of more than 32,000 adults across nine general practices were assessed to identify 703 patients at increased risk of ACLD (2.2% of the cohort). One hundred seventy-nine patients (26%) were successfully recalled, and 23/179 (13%) were identified to have ACLD (LSM ≥10.0 kPa) (10% found at indeterminate risk [LSM 8.0-9.9 kPa] and 77% low risk of fibrosis [LSM <8.0 kPa]). In most cases, the diagnosis of liver disease was new, with the most common etiology being metabolic dysfunction-associated steatotic liver disease (n=20, 83%). Aspartate aminotransferase-to-platelet ratio index ≥1.0 and fibrosis 4 ≥3.25 had a positive predictive value for detecting ACLD of 19% and 24%, respectively. Patients who did not attend recall had markers of more severe disease with a higher median aspartate aminotransferase-to-platelet ratio index score (0.57 vs. 0.46, p=0.041).</p><p><strong>Conclusions: </strong>This novel information technology system successfully screened a large primary care cohort using existing laboratory results to identify patients at increased risk ACLD. More than 1 in 5 patients recalled were found to have liver disease requiring specialist follow-up.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 7","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gallbladder dysfunction caused by MYPT1 ablation triggers cholestasis-induced hepatic fibrosis in mice. MYPT1 消融导致的胆囊功能障碍会诱发小鼠胆汁淤积性肝纤维化。
IF 5.6 2区 医学
Hepatology Communications Pub Date : 2024-06-27 eCollection Date: 2024-07-01 DOI: 10.1097/HC9.0000000000000473
Ye Wang, Zhi-Hui Jiang, Yu-Wei Zhou, Tian-Tian Qiu, Han Wang, Min-Sheng Zhu, Xin Chen, Xue-Na Zhang
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