A novel smartphone scleral‐image based tool for assessing jaundice in decompensated cirrhosis patients

Abstract

Background and Aim: Serum bilirubin is an established marker of liver disease. Reliable tools for non-invasive assessment of jaundice in cirrhosis patients, at risk of clinical decompensation, are highly desirable. While smartphone-based imaging has been described in neonatal jaundice, it has not been investigated in advanced cirrhosis patients. Methods: We included 46 hospitalized patients with acute cirrhosis decompensation and jaundice. Scleral images using an Android smartphone were taken to derive "Scleral Color Values (SCV)," which were matched with same day serum bilirubin measurements. In 29 patients, repeat SCV and bilirubin measurements were performed over time. We analyzed the relationship of SCV and its dynamics with serum bilirubin, clinical scores, and patient outcomes. Results: Of 46 patients, 26 (57%) had alcoholic hepatitis as the decompensation precipitant. Seven patients died during admission; a further 12 following hospital discharge. SCV had an excellent linear correlation with serum bilirubin (rho = 0.90, P < 0.001); changes in SCV and serum bilirubin across different time points, were also closely associated (rho = 0.77, P < 0.001). SCV correlated significantly with CLIF Consortium Acute Decompensation score (rho = 0.38, P < 0.001) and grade of Acute-on-Chronic Liver Failure (rho = 0.42, P = 0.039). SCV was higher in patients who died, however, not significantly ], P = 0.22). The associations of SCV with clinical parameters mirrored those of serum bilirubin. Conclusion: Smartphone-based assessment of jaundice shows excellent concordance with serum bilirubin and is associated with clinical parameters in acute cirrhosis decompensation. This approach offers promise for remote assessment of cirrhosis patients at-risk of decompensation, post hospital discharge.

Assessment of bilirubin levels in patients with cirrhosis via forehead, sclera and lower eyelid smartphone images

“…For assessing bilirubin levels in patients with cirrhosis, owing to the simpler image capture for the sclera, we recommend the use of the sclera as the imaging site. See our clinical paper presenting results based on the scleral imaging site and how they correlate with clinical scores such as Clinical Liver Failure Consortium Acute-Decompensation score and grade of Acute-on-Chronic Liver Failure [ 16 ]. The very strong correlation of predicted bilirubin via the sclera with TSB even at values greater than 20x the upper limit of normal, indicates promising clinical utility for real-world application.…”

Emerging digital technologies to help patients with cirrhosis

“…Given the inclusion of serum bilirubin in clinical scoring systems for acute hepatic deterioration, scleral images taken from smartphones may serve as useful biomarkers for clinical parameters of disease severity. [12] Commercially available fitness and sleep trackers have also been studied in patients with cirrhosis to assess for covert HE. Buckholz et al collected sleep data from 25 patients using a multi-sensor device validated for 4-stage sleep detection.…”

“…In a study of 46 patients with alcohol-associated hepatitis, scleral images showed a strong correlation with serum bilirubin at baseline and over time. Given the inclusion of serum bilirubin in clinical scoring systems for acute hepatic deterioration, scleral images taken from smartphones may serve as useful biomarkers for clinical parameters of disease severity 12 …”