Canadian liver journal最新文献

{"title":"Liver injury in post-acute COVID-19 syndrome: A systematic review and meta-analysis of early observational studies.","authors":"Paul Mundra, Zeena Kailani, Mohammad Yaghoobi, Priscilla Matthews, Matthew Tobis, Shadi Sadeghian, Siwar Albashir","doi":"10.3138/canlivj-2024-0010","DOIUrl":"10.3138/canlivj-2024-0010","url":null,"abstract":"<p><strong>Background: </strong>Post-acute COVID-19 syndrome (PACS; long COVID) is characterized by persistent or delayed symptoms at least 4 weeks from acute COVID-19 infection. Given the well-documented incidence of liver injury in acute COVID-19, this systematic review aims to assess the odds of liver injury in earlier experiencers of PACS.</p><p><strong>Methods: </strong>Observational studies published prior to March 2022 were screened for data describing liver injury (defined per primary study) in patients with PACS.</p><p><strong>Results: </strong>A total of 2,117 abstracts and 35 full texts were screened, of which 26 met the inclusion criteria. The mean time since acute COVID infection across all studies was 195.5 days. Seven studies included COVID-negative control groups. Twenty-three studies measured lab findings, and nine studies measured imaging or elastography. Five studies were eligible for meta-analysis of odds ratios, which did not demonstrate a statistically significant difference in odds for liver injury in patients with PACS compared with COVID-negative patients (OR 2.22 [95% CI 0.51-9.61; <i>p</i> = 0.28]). Newcastle-Ottawa Scale assessments for all studies found 24 of 26 studies with high to very high risk of bias. ROBINS-E assessments for studies included in the meta-analysis found five of five studies with high to very high risk of bias.</p><p><strong>Conclusions: </strong>Overall, our findings demonstrate no statistical difference in odds ratios of liver injury in patients with PACS compared with COVID-negative controls. As such, routine assessment and monitoring of liver injury in patients with PACS may not be required; however, higher quality data with lower risk of bias are required to make recommendations of higher certainty.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"470-489"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steatotic liver disease arising in an asymptomatic 20-year-old man with panhypopituitarism and elevated transaminases.","authors":"Nicole Wiebe, Ashley Stueck, Magnus McLeod","doi":"10.3138/canlivj-2024-0030","DOIUrl":"10.3138/canlivj-2024-0030","url":null,"abstract":"<p><strong>Background: </strong>Steatotic liver disease (SLD) may be caused by cardiometabolic risk factors, drugs/toxins, viral hepatitis, genetic diseases, malnutrition, or panhypopituitarism. SLD can advance to steatohepatitis with resulting lipid accumulation, inflammation, and hepatocellular damage. SLD is associated with pituitary dysfunction, in particular growth hormone deficiency, as insulin resistance leads to lipid buildup and oxidative stress. Growth hormone replacement may improve liver steatosis and fibrosis in patients with hypopituitarism.</p><p><strong>Case: </strong>We report a case of a 20-year-old man who was referred to Hepatology with abnormal liver enzymes. He had panhypopituitarism from a resected pituitary mass, for which he was treated with levothyroxine, hydrocortisone, growth hormone, and testosterone. He presented with elevated liver enzymes, normal liver function, obesity, dyslipidemia, and had no extrahepatic manifestations of chronic liver disease. Work-up for secondary causes of liver disease, including infectious, autoimmune, drug-induced, and genetic causes, were negative. An abdominal ultrasound revealed moderate hepatic steatosis with mild hepatomegaly and splenomegaly. His liver enzymes remained elevated, and his biochemical liver function remained normal despite withdrawal of hepatotoxic medications. Liver biopsy showed grade II/III steatohepatitis with stage III-IV fibrosis. The biopsy results suggested that panhypopituitarism, with growth hormone deficiency and related metabolic dysfunction, caused his liver disease.</p><p><strong>Conclusions: </strong>This is a unique case of an aggressive form of SLD due to panhypopituitarism, and treating growth hormone deficiency with hormone replacement did not improve liver enzymes or liver damage. Physicians should recognize SLD as a serious complication of panhypopituitarism and resulting growth hormone deficiency and follow patients closely given the risk of disease progression.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"511-516"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the magnetic resonance elastography and FIB-4 (MEFIB) Index and vibration-controlled transient elastography for significant metabolic dysfunction-associated steatotic liver disease fibrosis.","authors":"Chinmay Bera, Mina Fakhriyehasl, Nashla Hamdan Perez, Heather Mary-Kathleen Kosick, Keyur Patel, Kartik Jhaveri","doi":"10.3138/canlivj-2024-0007","DOIUrl":"10.3138/canlivj-2024-0007","url":null,"abstract":"<p><strong>Background: </strong>Significant fibrosis (≥stage 2) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is considered a high risk for morbidity and mortality. The magnetic resonance elastography (MRE) and FIB-4 (MEFIB) Index (MRE ≥ 3.3 kPa and FIB-4 ≥ 1.6) has been proposed as an alternative to liver biopsy, particularly in identifying patients for therapeutic intervention. However, MRE is not widely available. Our aim was to compare the MEFIB Index with other simpler, non-invasive markers.</p><p><strong>Methods: </strong>A single-centre retrospective analysis of steatotic liver disease patients with MRE and vibration-controlled transient elastography (VCTE) was carried out between March 2019 and June 2022. Demographic and laboratory data were collected to calculate various fibrosis scores.</p><p><strong>Results: </strong>Our cohort included 77 patients with a mean ± SD age of 51 ± 13 years, 44/77 (57%) female, BMI 34.5 ± 6.7 kg/m², and 33/77 (43%) with diabetes mellitus. Significant MEFIB Index fibrosis (F2-4) compared with F0-1 was significantly associated with older age (61.6 versus 48.9 years), higher VCTE score (18.2 versus 10.6 kPa), NAFLD Fibrosis Score (0.11 versus -1.68), and Aspartate Aminotransferase-To-Platelet Ratio Index (APRI; 1.43 versus 0.44). A logistic regression model showed that age (odds ratio [OR]: 1.16; 95% CI: 1.05-1.29; <i>p</i> = 0.005) and APRI (OR: 10.86; 95% CI: 1.56-75.68; <i>p</i> = 0.016) were independently associated with MEFIB Index and predicted MEFIB F ≥ 2 with an area under the receiver operating characteristic curve of 0.95 (95% CI: 0.87-0.98).</p><p><strong>Conclusions: </strong>In patients with MASLD, simple clinical and biochemical parameters may provide an alternative to predict significant fibrosis based on the MEFIB score. This may be useful in non-tertiary centres where VCTE and MRE are not routinely available.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"419-426"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic encephalopathy and driving safety: A survey of patient counseling and regulatory reporting by health care professionals in British Columbia, Canada.","authors":"Nawaf T Aboalfaraj, Rana K Talab, Alexander R Hemy, Sedrah K Talab, Eric M Yoshida","doi":"10.3138/canlivj-2024-0026","DOIUrl":"10.3138/canlivj-2024-0026","url":null,"abstract":"<p><strong>Background: </strong>Hepatic encephalopathy (HE) is a neuropsychiatric syndrome resulting from liver dysfunction, leading to significant cognitive and motor impairments. These impairments can severely affect daily activities, including driving. This research explores the public safety issue of HE and driving safety, focusing on the knowledge and practices of health care professionals.</p><p><strong>Methods: </strong>An electronic survey was distributed across various institutions in British Columbia, Canada, targeting 191 health care professionals, including attending physicians, residents, nurse practitioners, medical students, and fellows from various specialties. The survey assessed the training received, frequency of discussions about driving safety, and actions taken regarding advising patients to stop driving.</p><p><strong>Results: </strong>This study revealed significant gaps in addressing driving safety protocols by health care providers among patients with HE. Only 19.9% of professionals routinely ask their patients about driving, and few engage in specific discussions about driving safety. Internal medicine and gastroenterology specialists, who are most likely to care for patients with HE, reported low practices of screening for and educating about HE and driving safety.</p><p><strong>Conclusions: </strong>The findings underscore the need for increased awareness and proactive discussions among health care providers regarding driving safety in patients with HE. Implementing routine assessments and discussions in HE management protocols can enhance patient safety. Future research should focus on developing standardized guidelines and evaluating the effectiveness of interventions in reducing driving-related risks.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"439-446"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Mariam Ragheb et al.","authors":"Sajil Fatima, Minahil Zafar, Muhammad Ali Muzammil","doi":"10.3138/canlivj-2024-0039","DOIUrl":"10.3138/canlivj-2024-0039","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"415-416"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a nurse practitioner-led post-discharge transitional care program for patients with liver disease: A retrospective cohort study.","authors":"Marjan Naghshbandi, Simon Y Huang, Hemant Shah, Colina Yim, Elizabeth Lee, Michael Caesar, Andrew Hope, Timothy Cy Chan, Vahid Sarhangian","doi":"10.3138/canlivj-2024-0020","DOIUrl":"10.3138/canlivj-2024-0020","url":null,"abstract":"<p><strong>Background: </strong>We evaluated an outpatient, nurse practitioner-led transitional care program with respect to its efficacy in reducing unplanned readmission rates for patients with liver disease.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from an academic health system in Toronto, Ontario. The study included all admissions associated with an ICD10 code of R18 (ascites), I85.0 or I98.3 (variceal bleeding), or K70-K77 (diseases of the liver). Patients were selected to receive the transitional care (intervention group) or not (no-intervention group) by discretion of the hepatologists. We used a proportional hazard model to estimate the associations between receiving the intervention and the marginal probability of 30-, 60-, and 90-day readmission in the presence of death as a competing risk. We conducted sensitivity analyses to examine the robustness of our estimates to various sources of bias, including adjusting for propensity of receiving the intervention estimated using a logistic regression model.</p><p><strong>Results: </strong>A total of 803 admissions were included. Receiving transitional care was associated with a reduction in risk of 30-day readmission (HR 0.51; 95% CI 0.30-0.85), 60-day readmission (HR 0.60; 95% CI 0.40-0.91), and 90-day readmission (HR 0.55; 95% CI 0.37-0.83). The negative associations remained statistically significant under the sensitivity analyses, except for the propensity-adjusted estimate for the 60-day outcome.</p><p><strong>Conclusions: </strong>A nurse practitioner-led transitional care program could be effective in reducing the risk of readmission for patients with liver disease. Future studies are needed to standardize the referral process and prospectively measure the effectiveness and financial value of the program.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"427-438"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Commentary on Ragheb et al.","authors":"Nabiha Faisal, Gerald Minuk","doi":"10.3138/canlivj-2024-0046","DOIUrl":"10.3138/canlivj-2024-0046","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"417-418"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe acute allograft rejection 22 years after liver transplantation.","authors":"Monica Dahiya, Michael Minkley, Daniel R Owen, Trana Hussaini, Ben Cox, Vladimir Marquez, Daljeet Chahal, Eric M Yoshida","doi":"10.3138/canlivj-2024-0004","DOIUrl":"10.3138/canlivj-2024-0004","url":null,"abstract":"<p><p>Early acute cellular rejection occurs commonly within the first month after liver transplantation, is easily reversible with treatment, and has little impact on long-term graft survival. In contrast, late allograft rejection, typically defined as occurring after 3-6 months post-transplantation, can lead to the development of chronic rejection and graft loss. Alloreactivity and the risk of rejection decreases with time, since transplantation and many long-term liver transplant recipients can maintain graft function with minimal immunosuppression. We describe a case of acute allograft rejection 22 years and 5 months after liver transplantation. The patient, transplanted for biliary atresia as a young child, had three prior episodes of allograft rejection: two within the first month of transplantation, and one 4 years after. Subsequent to this, she had normal liver biochemistry and was maintained on minimal immunosuppression for many years. Following a diagnosis of immune thrombocytopenic purpura and marginal zone lymphoma, she was switched from tacrolimus to mycophenolate monotherapy, and subsequently developed significantly elevated liver enzymes, and biopsy confirmed severe acute allograft rejection. Our experience demonstrates that despite the liver being an immunotolerant organ, which often can be maintained with minimal immunosuppression post-transplantation, acute allograft rejection can occur at any stage and should always be considered as a possible cause of liver biochemistry abnormalities.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"500-504"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An educational video increases disease-related knowledge in hospitalized patients with decompensated cirrhosis.","authors":"Bryce Tkachuk, Matthew Robrigado, Sarah Blayney, Katie Caldwell, Emily Johnson, Ashley Hyde, Ben Vandermeer, Puneeta Tandon","doi":"10.3138/canlivj-2024-0037","DOIUrl":"10.3138/canlivj-2024-0037","url":null,"abstract":"<p><strong>Background: </strong>The Cirrhosis Care Alberta (CCAB) Project has created an expert-guided educational video for patients with decompensated cirrhosis. The effect of this video on improving disease-related knowledge in patients with decompensated cirrhosis has yet to be determined.</p><p><strong>Methods: </strong>In-patients with decompensated cirrhosis were prospectively recruited between November 2022 and August 2023. A pre-post-intervention design employing a questionnaire on managing complications of decompensated cirrhosis was used to evaluate whether the CCAB educational video was effective in improving disease-related knowledge, the primary outcome. Baseline knowledge was defined as preintervention questionnaire scores. Learning was defined as the difference between postintervention and preintervention questionnaire scores. Follow-up occurred 30 days when the same questionnaire was readministered. Univariate and multivariate regression analyses evaluated if any participant demographics and disease-related characteristics predicted baseline knowledge or learning.</p><p><strong>Results: </strong>Fifty participants were included. Study participants were predominantly biologically male (62%), aged 40-75 (78%), and had an average of 2.4 (SD: 2.8) prior cirrhosis-related hospitalizations. The mean baseline knowledge score among participants was 62% (SD: 17.3). The mean questionnaire scores following the educational video rose to 72.5% (SD: 20.2%, <i>p</i> < 0.001). Sixteen (32%) participants completed the 30-day follow-up questionnaire with a mean score of 78.8% (SD: 14.7, <i>p</i> = 0.02). Univariate analysis demonstrated that age, number of prior cirrhosis-related hospitalizations, and number of decompensating events predicted baseline knowledge scores (<i>p</i> values < 0.05).</p><p><strong>Conclusion: </strong>The CCAB educational video is effective in improving disease-related knowledge scores. Further investigation evaluating this effect on clinical outcomes is needed.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"458-469"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are we doing enough to detect alcohol use disorder? The case for accessible AST testing in Canada.","authors":"Maya Deeb, Gurpreet Malhi, Natasha Chandok","doi":"10.3138/canlivj-2024-0029","DOIUrl":"10.3138/canlivj-2024-0029","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 3","pages":"325-326"},"PeriodicalIF":0.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}