Liver stiffness increases acutely during sickle cell vaso‐occlusive crisis

Abstract

Background & Aims Acute vaso-occlusive crisis (VOC) in sickle cell disease (SCD) is an important cause of end-organ damage. It is estimated that 10–39% of VOC occurs with hepatic involvement. Current assessments of hepatic involvement during VOC are unsatisfactory. We investigated transient elastography (TE) as a marker of hepatic involvement, its relationship with histology, and biochemical markers during VOC. Methods SCD patients were evaluated with biochemical markers and TE at steady-state and during VOC. Change in TE and biochemical markers were correlated to length of hospital stay. When available, liver biopsy and tricuspid regurgitation velocity (TRV) at steady-state were correlated with TE. Results 23 patients were evaluated (mean age=34.3 years, standard deviation=7.96). In 15 patients with liver biopsies, TE correlated with fibrosis (p=0.01) and TRV (p=0.0063), but not hepatic iron. Hemolysis biomarkers changed during VOC (p<0.022), but not alanine aminotransferase (ALT). Paired comparison of TE at steady-state and during VOC showed an increased from 6.2 to 12.3 kPa (p=0.0029). Increasing TE during VOC associated with increasing ALT and alkaline phosphatase (p=0.0088 and 0.0099, respectively). At steady-state, increasing inflammation on biopsy (p=0.0037) and TRV (p=0.0075) correlated with increasing TE during VOC. Increased hospital stay was associated with higher ALT (p=0.041), lower albumin (p=0.046), hemoglobin/hematocrit (p<0.0021) but not TE. Conclusions TE may identify patients with hepatic involvement during VOC independent of biochemical measures. Increase in TE may reflect both hepatic passive congestion and hepatic involvement during VOC. TE may serve as a physiological biomarker for hepatic features of VOC.

Interim assessment of liver damage in patients with sickle cell disease using new non‐invasive techniques

“…endothelial inflammation, haemolysis). It has already been shown by Koh et al () that TE increases during periods of increased erythrocyte sickling. ELF scores may well be confounded by the background of ongoing haemolysis and vaso‐occlusion present in patients with SCD.…”

A review of gradient stiffness hydrogels used in tissue engineering and regenerative medicine

“…Human tissues and the ECM present different mechanical properties . This varies from very soft tissue such as the brain (1 kPa) and liver (3 kPa) to moderate stiffness including muscle and very stiff tissue, such as bone (15 MPa) . Pelham and Wang first reported that substrate stiffness could affect the motility and spread of fibroblasts and kidney epithelial cells .…”

“…3 This varies from very soft tissue such as the brain (1 kPa) and liver (3 kPa) to moderate stiffness including muscle and very stiff tissue, such as bone (15 MPa). [4][5][6][7][8] Pelham and Wang first reported that substrate stiffness could affect the motility and spread of fibroblasts and kidney epithelial cells. 9,10 Since then, there have been increasingly widespread and profound studies on substrate stiffness and cell interactions, such as adhesion, 11 migration, 12,13 cell differentiation and proliferation.…”

Kidney Ultrasound Elastography: Review

“…Some of them were about animals [36][37][38][39][40][41][42] , some of them were about MRI or MR elastography [43][44][45][46][47][48][49][50][51][52] , some of them were about other organ systems [53][54][55][56][57][58][59][60][61][62][63][64][65] , some of them were about elastography technic 28,[66][67][68][69] and some of them were about non elastography related kidney studies 70 . We excluded these articles.…”