Simple Noninvasive Systems Predict Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease

Angulo, Paul; Bugianesi, Elisabetta; Bjõrnsson, Einar; Charatcharoenwitthaya, Phunchai; Mills, Peter R.; Barrera, Francisco; Hafliðadóttir, Svanhildur; Day, Christopher P.; George, Jacob

doi:10.1053/j.gastro.2013.06.057

Cited by 447 publications

(413 citation statements)

References 32 publications

Supporting

Mentioning

389

Contrasting

Unclassified

Order By: Relevance

“…Although several noninvasive serum markers such as ICG15, FIB-4 index and APRI are associated with clinical outcomes in HCV-related HCC patients, no reports have assessed the impact of preoperative GSA index on clinical outcomes in HCV-related HCC patients treated with SR (21)(22)(23)(24). Hence, we conducted the current analysis.…”

Section: Discussionmentioning

confidence: 99%

Clinical implication of the preoperative GSA index in 99mTc-GSA scintigraphy in hepatitis C virus-related hepatocellular carcinoma

et al. 2014

View full text Add to dashboard Cite

Abstract. We aimed to examine the relationship between the preoperative GSA index [uptake ratio of the liver to the liver plus heart at 15 min (LHL15) to uptake ratio of the heart at 15 min to that at 3 min (HH15) ratio] calculated from 99m Tc-labeled diethylene triamine pentaacetate-galactosyl human serum albumin ( 99m Tc-GSA) scintigraphy and background liver fibrosis and to investigate whether the GSA index can be a useful predictor in hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) patients treated with surgical resection (SR). A total of 213 HCV-related HCC patients were analyzed. Receiver operating characteristic (ROC) curve analysis was performed for calculating the area under the ROC (AUROC) for nine noninvasive parameters including GSA index, indocyanine green retention at 15 min, aspartate aminotransferase (AST) to platelet ratio index, FIB-4 index, AST to alanine aminotransferase ratio, serum albumin, total bilirubin, platelet count and prothrombin time for cirrhosis. We also examined predictive factors associated with overall survival (OS) and recurrence-free survival (RFS) after SR in univariate and multivariate analyses. There were 153 males and 60 females with the mean age of 69.9 years. The median observation periods were 2.8 years. The mean maximum tumor size was 4.1 cm. HH15 ranged from 0.452 to 0.897. LHL15 ranged from 0.669 to 0.982. The mean value of the GSA index was 1.41. Among the nine parameters, the GSA index yielded the highest AUROC for cirrhosis with a level of 0.786 at an optimal cut-off value of 1.37 (sensitivity, 65.9%; specificity, 79.0%). In multivariate analyses, the GSA index was an independent predictor (P<0.001) linked to RFS and it had a marginal significance in terms of OS (P= 0.074). In conclusion, the preoperative GSA index can be a useful predictor in HCV-related HCC patients treated with SR. IntroductionHepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancer-related death (1-3). In Japan, most HCC cases are due to chronic hepatitis C virus (HCV) infection (3). Curative therapies for HCC consist of liver transplantation, surgical resection (SR) and radiofrequency ablation (RFA) (1-3). The clinical outcome of HCC patients undergoing these therapies has improved substantially in recent years due to treatment advances. However, HCC often recurs even after curative therapies, leading to high mortality, and the pattern of HCC recurrence is frequently ectopic as well as local. The identification of predictive factors and effective management of HCC recurrence are essential for improving survival, even after curative treatment (1-5). Tc-labeled diethylene triamine pentaacetate-galactosyl human serum albumin ( 99m Tc-GSA) is a radiopharmaceutical that binds specifically to the hepatic asialoglycoprotein receptor (ASGP-R). Expression of ASGP-R has been reported to be decreased in patients with chronic liver damage and thus it has been widely used to assess liver functional reserve in various pathologica...

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical implication of the preoperative GSA index in 99mTc-GSA scintigraphy in hepatitis C virus-related hepatocellular carcinoma

et al. 2014

View full text Add to dashboard Cite

show abstract

“…2 In fact, patients with NAFLD are 5-15 times more likely to die from cardiovascular complications and 2-9 times more likely to die from malignancy than from liver-related complications. 3,4 This reflects the biology of NAFLD. We are just beginning to uncover the genetics that predispose patients to NAFLD, such as patatin-like phospholipase domain-containing protein 3, that when married to a Western diet and a sedentary lifestyle produce obesity, diabetes, dyslidemia, and NAFLD.…”

Section: Causes Of Death In Patients With Nafld Before Transplantmentioning

confidence: 98%

“…However, it is clear that patients with NAFLD are more likely to die from cardiovascular disease and malignancy than from complications of liver disease. 3,4 Natural history studies have demonstrated that patients with NAFLD have increased atherogenicity that can result in myocardial infarction, peripheral vascular disease, and stroke. 2 In fact, patients with NAFLD are 5-15 times more likely to die from cardiovascular complications and 2-9 times more likely to die from malignancy than from liver-related complications.…”

Section: Causes Of Death In Patients With Nafld Before Transplantmentioning

confidence: 99%

Debate-a bridge too far: Nonalcoholic fatty liver disease will not exhaust the donor pool

M.D.

2014

Liver Transpl

View full text Add to dashboard Cite

1. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are increasing in incidence and prevalence; however, needing liver transplant and surviving to liver transplant are different. 2. NAFLD patients are 5-15 times more likely to die from cardiovascular complications and 2-9 times more likely to die from malignancy than from liverrelated complications. 3. NASH patients referred for liver transplantation are more commonly denied for comorbid conditions, progress slower, and are more often delisted or die while awaiting transplant than their hepatitis C virus (HCV) counterparts. 4. Although simultaneous liver-kidney transplantation (SLKT) numbers have markedly increased, when comparing the percentage of total SLKTs by indication between 2002 and 2011, NASH has increased 2.4-fold, whereas HCV has decreased 0.77-fold. 5. Liver transplantation is not the solution to NASH.Noninvasive diagnosis followed by intervention (medical therapy or better yet bariatric surgery) should be the preferred way to treat NASH, long before liver transplantation is needed.There is no question that nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are increasing in incidence and prevalence in the world 1 ; this is not the subject of our debate. Without change, more patients with NAFLD/NASH will develop decompensated cirrhosis and hepatocellular carcinoma (HCC) and require liver transplantation. However, requiring liver transplantation and receiving liver transplantation with acceptable long-term outcomes are different. Therefore, we debate (1) the ability of NAFLD/NASH patients to survive to transplant, despite their many competing risks for death, in an era of organ shortage and Share 35; and (2) the utility of liver transplantation, which worsens complications of the metabolic syndrome, as opposed to more effective and less expensive procedures, such as bariatric surgery, that target the actual disease and can improve liver health and also reduce complications of the metabolic syndrome. PREVALENCE OF NAFLD AND NASHNAFLD now affects approximately 30% of the US adult population and almost 70% of type 2 diabetics.1,2 Fortunately, only a small subset of patients with NAFLD (6%-16%) has NASH. However, NASH rates vary based on 2 critical risk factors: (1) type 2 diabetes and (2) obesity. As a result, >35% of morbidly obese type 2 diabetic individuals have NASH. Overall, autopsy studies place the general population prevalence of NASH at 3%-5%.

show abstract

“…163,167 This index was developed to amplify the opposing effects of hepatic fibrosis on the serum AST level and the platelet count in patients with chronic hepatitis C. 167 Results have varied according to the choice of cut-off values, but validation 168 Furthermore, the FIB-4 test has a negative predictive value for advanced fibrosis of 90% and a sensitivity of 70% (Table 2). 168 The FIB-4 test can correctly classify hepatic fibrosis in 87% of patients with co-infections with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), and render liver biopsy examination unnecessary in 71%.…”

Section: Apri Test For Hepatic Fibrosismentioning

confidence: 99%

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

Czaja

2014

Aliment Pharmacol Ther

View full text Add to dashboard Cite

SummaryBackgroundImmunosuppressive treatment of autoimmune hepatitis can prevent or reverse hepatic fibrosis, but these anti‐fibrotic effects are inconsistent secondary gains.AimTo describe the anti‐fibrotic effects of current therapies for autoimmune hepatitis, discuss the pathogenic mechanisms of hepatic fibrosis that might be targeted by anti‐fibrotic interventions, indicate the non‐invasive diagnostic tests of hepatic fibrosis that must be validated in autoimmune hepatitis and to suggest promising treatment opportunities.MethodsStudies cited in PubMed from 1972 to 2013 for autoimmune hepatitis, hepatic fibrosis, cirrhosis, anti‐fibrotic therapy and non‐invasive tests of hepatic fibrosis were selected.ResultsHepatic fibrosis improves in 53–57% of corticosteroid‐treated patients with autoimmune hepatitis; progressive fibrosis slows or is prevented in 79%; and cirrhosis may be reversed. Progressive hepatic fibrosis is associated with liver inflammation, and the inability to fully suppress inflammatory activity within 12 months is associated with progression to cirrhosis (54%) and death or need for liver transplantation (15%). Liver tissue examination remains the gold standard for assessing hepatic fibrosis, but laboratory and radiological tests may be useful non‐invasive methods to measure the fibrotic response. Severe liver inflammation can confound radiological assessments, and the preferred non‐invasive test in autoimmune hepatitis is uncertain. Individualised treatment adjustments and adjunctive anti‐fibrotic therapies are poised for study in this disease.ConclusionsThe prevention and reversal of hepatic fibrosis are achievable objectives in autoimmune hepatitis. Strategies that evaluate individualised therapies adjusted to the rapidity and completeness of the inflammatory response, and the use of adjunctive anti‐fibrotic interventions, must be evaluated.

show abstract

Simple Noninvasive Systems Predict Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease

Cited by 447 publications

References 32 publications

Clinical implication of the preoperative GSA index in 99mTc-GSA scintigraphy in hepatitis C virus-related hepatocellular carcinoma

Clinical implication of the preoperative GSA index in 99mTc-GSA scintigraphy in hepatitis C virus-related hepatocellular carcinoma

Debate-a bridge too far: Nonalcoholic fatty liver disease will not exhaust the donor pool

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

Contact Info

Product

Resources

About