Background and aimsNon-invasive assessment of fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) is challenging, especially in resource-limited settings. MR or transient elastography and many patented serum scores are costly and not widely available. There are limited data on accuracy of serum-based fibrosis scores in urban slum-dwelling population, which is a unique group due to its dietary habits and socioeconomic environment. We did this study to compare the accuracy of serum-based fibrosis scores to rule out significant fibrosis (SF) in this population.MethodsHistological and clinical data of 100 consecutive urban slum-dwelling patients with NAFLD were analysed. Institutional ethics committee permission was taken. Aspartate transaminase (AST) to platelet ratio index (APRI), fibrosis-4 index (FIB-4) and FIB-5 scores were compared among those with non-significant fibrosis (METAVIR; F0 to F1; n=73) and SF (METAVIR; F2 to F4; n=27).ResultsAST (IU/mL) (68.3±45.2 vs 23.9±10.9; p<0.0001), alanine transaminase (IU/mL) (76.4±36.8 vs 27.9±11.4; p<0.0001), FIB-4 (2.40±2.13 vs 0.85±0.52; p<0.0001) and APRI (1.18±0.92 vs 0.25±0.16; p<0.0001) were higher and platelets (100 000/mm3) (1.8±0.8 vs 2.6±0.7; p<0.0001), albumin (g/dL) (3.4±0.50 vs 3.7±0.4; p<0.0001), alkaline phosphatase (IU/L) (60.9±10.2 vs 76.4±12.9; p<0.0001) and FIB-5 (−1.10±6.58 vs 3.79±4.25; p<0.0001) were lower in SF group. APRI had the best accuracy (area under the receiver operating characteristic curve=0.95) followed by FIB-4 (0.78) and FIB-5 (0.75) in ruling out SF.ConclusionsAPRI but not FIB-5 or FIB-4 is accurate in ruling out SF in patients with NAFLD in an urban slum-dwelling population.

Background and Aims Endothelial injury and dysfunction play a detrimental role in the pathogenesis of infections. Endothelium-related molecules have been reported as potential biomarkers for early diagnosis and/or prognosis of infections. The prognostic value of these biomarkers in patients with liver cirrhosis and infections however remain elusive. Methods In this study, we investigated the performance of key soluble endothelial injury biomarkers, including intercellular adhesion molecule 1 (ICAM1), von Willebrand Factor (vWF) antigen, vascular endothelial growth factor receptor 1 (vegfr1), angiopoietin 1 and 2 (Ang1, 2) as mortality predictors in liver cirrhosis patients with severe covid-19 or bacterial sepsis. Results A total of 66 hospitalized patients [admitted in covid-19 ward or liver intensive care unit (ICU)] were included. 22 patients had covid-19 alone while 20 patients had cirrhosis plus covid-19. 24 patients had liver cirrhosis plus bacterial sepsis. Among cirrhosis patients, most common aetiology was alcohol. ICAM1 was increased (p=0.003) while vegfr1 (p<0.0001) and Ang1 (p<0.0001) were reduced in covid-19 patients with cirrhosis, as compared to covid-19 patients alone. Endothelial biomarkers between cirrhosis patients with severe covid-19 or with bacterial sepsis in the ICUs did not differ significantly. In these patients, ICAM1 levels significantly and independently predicted mortality (HR:3.24;1.19-8.86) along with MELD, renal and coagulation failures. The area under the curve for ICAM1 was 0.74, MELD was 0.60 and combined ICAM1 and MELD was 0.70. ICAM1 also positively correlated with the composite organ failure scores recorded 3-5 days post ICU admission (CLIF-OF and SOFA) in this subgroup of patients. Conclusion The study indicates that in patients with liver cirrhosis, elevated plasma ICAM1 serve as an independent predictor of severe covid-19 or sepsis associated 28-day mortality. Lay Summary Bacterial sepsis and covid-19 lead to increased mortality in cirrhosis patients. In this study, we demonstrate that high plasma levels of ICAM1, an endothelial injury biomarker is one of the important factors predicting mortality in critically-ill cirrhotic patients having severe covid-19 or bacterial sepsis.

Background and AimProgression of liver disease in cirrhosis is associated with an increased incidence of portal vein thrombosis (PVT) in cirrhosis. However, evidence suggests that spontaneous recanalization of PVT may occur even without anti‐thrombotic therapy. Thus, the present meta‐analysis was conducted to study the natural history of PVT in cirrhosis, facilitating decisions regarding anticoagulation.MethodsThree electronic databases were searched from 2000 to August 2022 for studies reporting the outcome of PVT in cirrhotics without anticoagulation. The pooled proportions with their 95% confidence intervals (CIs) were calculated using a random‐effect model.ResultsA total of 26 studies (n = 1441) were included in the final analysis. Progression of PVT on follow‐up was seen in 22.2% (95% CI 16.1–28.4), while 77.7% (95% CI 71.6–83.9) remained non‐progressive (improved or stable). The most common outcome was a stable PVT with a pooled event rate of 44.6% (95% CI 34.4–54.7). The pooled rates of regression and complete recanalization of PVT in cirrhotics were 29.3% (95% CI 20.9–37.7) and 10.4% (95% CI 5.0–15.8), respectively. On follow‐up after improvement, pooled recurrence rate of PVT was 24.0% (95% CI 14.7–33.4). MELD score, and presence of ascites had a negative association, while a longer follow‐up duration had positive association with PVT regression.ConclusionApproximately 25% of the cases of PVT in cirrhosis are progressive, 30% cases improve, and 45% remain stable. Future studies are needed to analyze the predictors of spontaneous regression.

BackgroundThe pathogenesis of portal vein thrombosis (PVT) in cirrhosis is multifactorial, with altered hemodynamics being proposed as a possible contributor. The present systematic review was conducted to study the role of assessment of portal hemodynamics for the prediction of PVT in patients with cirrhosis.MethodsThree databases (Medline, Embase, and Scopus) were searched from inception to February 2023 for studies comparing portal venous system parameters in patients with cirrhosis developing PVT with those not. Results were presented as mean difference (MD) or odds ratio (OR) with their 95% confidence intervals (CIs).ResultsA total of 31 studies (patients with cirrhosis: 19 studies, patients with cirrhosis undergoing splenectomy: 12 studies) were included. On pooling the data from multivariable analyses of the included studies, a larger portal vein diameter was a significant predictor of PVT in patients with cirrhosis without or with splenectomy with OR 1.74 (1.12–2.69) and OR 1.55 (1.26–1.92), respectively. On the other hand, a lower portal vein velocity (PVV) was a significant predictor of PVT in cirrhotics without or with splenectomy with OR 0.93 (0.91–0.96) and OR 0.71 (0.61–0.83), respectively. A PVV of <15 cm/s was the most commonly used cut‐off for the prediction of PVT. Patients developing PVT also had a significantly higher splenic length, thickness, and splenic vein velocity.ConclusionThe assessment of portal hemodynamic parameters at baseline evaluation in patients with cirrhosis may predict the development of PVT. Further studies are required to determine the optimal cut‐offs for various parameters.

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