Inflammation-adapted liver stiffness values for improved fibrosis staging in patients with hepatitis C virus and alcoholic liver disease
Background & Aims It is well known that inflammation increases liver stiffness (LS) in patients with chronic hepatitis C (HCV) and alcoholic liver disease (ALD) independent of fibrosis stage, but no inflammation‐adapted cut‐off values have been settled so far. An early identification of rapid fi...
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| Veröffentlicht in: | Liver international 2015-12, Vol.35 (12), p.2514-2521 |
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| creator | Mueller, Sebastian Englert, Stefan Seitz, Helmut K. Badea, Radu I. Erhardt, Andreas Bozaari, Bita Beaugrand, Michel Lupșor-Platon, Monica |
| description | Background & Aims
It is well known that inflammation increases liver stiffness (LS) in patients with chronic hepatitis C (HCV) and alcoholic liver disease (ALD) independent of fibrosis stage, but no inflammation‐adapted cut‐off values have been settled so far. An early identification of rapid fibrosers, however, is essential to decide whom to treat first with the novel but expensive antiviral drugs.
Methods
Liver stiffness, biopsy‐proven fibrosis stages F0–F4 (METAVIR or Kleiner score) and routine laboratory parameters were studied in 2068 patients with HCV (n = 1391) and ALD (n = 677).
Results
Among the routine parameters for liver damage, AST correlated best with LS (HCV: r = 0.54, P |
| doi_str_mv | 10.1111/liv.12904 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1760928582</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1760928582</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3634-985933b07e72d20ca8764551b9674d9151458808bbfa95612c24e0c1c018fa1a3</originalsourceid><addsrcrecordid>eNp1kEFTGyEYhhmnHbXWg3_A4VgPq3yw7MKxjW3MGO3F1iPDsmBo2d0Im1j_QX920cTcygWYeb7nm_dF6ATIOeRzEfz6HKgk5R46hLIWBaMM3u3elB2gDyn9IgSk5LCPDmgFFCStDtHfWe-C7jo9-qEvdKuXo21xFtqI0-id621KeK3Dyibshoh9t4zDOjPON3FIPmVMP_j-AfseL7PG9mPCT35c4IV9-Y8ZmeC1j6uEdd9iHcywGII32y2tT1Yn-xG9dzoke7y9j9CPb1_vJlfF_Pt0Nvk8LwyrWFlIwSVjDaltTVtKjBZ1VXIOjazqspXAoeRCENE0TkueYxpaWmLAEBBOg2ZH6NPGm2M85lCj6nwyNgTd22GVFNQVkVRwQTN6tkFNDpqidWoZfafjswKiXopXOYF6LT6zp1vtqulsuyPfms7AxQZ48sE-_9-k5rOfb8piM-HTaP_sJnT8raqa1Vzd307V3eX1l8nVlKkb9g8nnZ3b</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1760928582</pqid></control><display><type>article</type><title>Inflammation-adapted liver stiffness values for improved fibrosis staging in patients with hepatitis C virus and alcoholic liver disease</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><creator>Mueller, Sebastian ; Englert, Stefan ; Seitz, Helmut K. ; Badea, Radu I. ; Erhardt, Andreas ; Bozaari, Bita ; Beaugrand, Michel ; Lupșor-Platon, Monica</creator><creatorcontrib>Mueller, Sebastian ; Englert, Stefan ; Seitz, Helmut K. ; Badea, Radu I. ; Erhardt, Andreas ; Bozaari, Bita ; Beaugrand, Michel ; Lupșor-Platon, Monica</creatorcontrib><description>Background & Aims
It is well known that inflammation increases liver stiffness (LS) in patients with chronic hepatitis C (HCV) and alcoholic liver disease (ALD) independent of fibrosis stage, but no inflammation‐adapted cut‐off values have been settled so far. An early identification of rapid fibrosers, however, is essential to decide whom to treat first with the novel but expensive antiviral drugs.
Methods
Liver stiffness, biopsy‐proven fibrosis stages F0–F4 (METAVIR or Kleiner score) and routine laboratory parameters were studied in 2068 patients with HCV (n = 1391) and ALD (n = 677).
Results
Among the routine parameters for liver damage, AST correlated best with LS (HCV: r = 0.54, P < 0.0001 and ALD: r = 0.34, P < 0.0001). In the absence of elevated transaminases, cut‐off values were almost identical between HCV and ALD for F1–2, F3 and F4 (HCV: 5.1, 9.0 and 11.9 kPa vs ALD: 4.9, 8.1 and 10.5 kPa). These cut‐off values increased exponentially as a function of median AST level. The impact of AST on LS was higher in lobular‐pronounced ALD as compared to portal tract‐localized HCV. Most notably, Cohen's weighted Kappa displayed an improved agreement of the novel AST‐dependent cut‐off values with histological fibrosis stage both for HCV (0.68 vs 0.65) and ALD (0.80 vs 0.76).
Conclusions
The novel AST‐adapted cut‐off values improve non‐invasive fibrosis staging in HCV and ALD and may be also applied to other liver diseases. Especially in HCV, they could help to decide whom to treat first with the novel but expensive antiviral drugs.
See Editorial on Page 2495</description><identifier>ISSN: 1478-3223</identifier><identifier>EISSN: 1478-3231</identifier><identifier>DOI: 10.1111/liv.12904</identifier><identifier>PMID: 26121926</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adult ; alcoholic liver disease ; Aspartate Aminotransferases - analysis ; Biopsy - methods ; Disease Progression ; Elasticity Imaging Techniques - methods ; Female ; fibrosis ; hepatitis C ; Hepatitis C, Chronic - complications ; Hepatitis C, Chronic - diagnosis ; Hepatitis C, Chronic - physiopathology ; Humans ; inflammation ; Inflammation - pathology ; Inflammation - physiopathology ; Liver - pathology ; Liver - physiopathology ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - etiology ; Liver Diseases, Alcoholic - complications ; Liver Diseases, Alcoholic - diagnosis ; Liver Diseases, Alcoholic - physiopathology ; liver stiffness ; Male ; Middle Aged ; Patient Acuity ; Prognosis ; Reproducibility of Results</subject><ispartof>Liver international, 2015-12, Vol.35 (12), p.2514-2521</ispartof><rights>2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3634-985933b07e72d20ca8764551b9674d9151458808bbfa95612c24e0c1c018fa1a3</citedby><cites>FETCH-LOGICAL-c3634-985933b07e72d20ca8764551b9674d9151458808bbfa95612c24e0c1c018fa1a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fliv.12904$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fliv.12904$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26121926$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mueller, Sebastian</creatorcontrib><creatorcontrib>Englert, Stefan</creatorcontrib><creatorcontrib>Seitz, Helmut K.</creatorcontrib><creatorcontrib>Badea, Radu I.</creatorcontrib><creatorcontrib>Erhardt, Andreas</creatorcontrib><creatorcontrib>Bozaari, Bita</creatorcontrib><creatorcontrib>Beaugrand, Michel</creatorcontrib><creatorcontrib>Lupșor-Platon, Monica</creatorcontrib><title>Inflammation-adapted liver stiffness values for improved fibrosis staging in patients with hepatitis C virus and alcoholic liver disease</title><title>Liver international</title><addtitle>Liver Int</addtitle><description>Background & Aims
It is well known that inflammation increases liver stiffness (LS) in patients with chronic hepatitis C (HCV) and alcoholic liver disease (ALD) independent of fibrosis stage, but no inflammation‐adapted cut‐off values have been settled so far. An early identification of rapid fibrosers, however, is essential to decide whom to treat first with the novel but expensive antiviral drugs.
Methods
Liver stiffness, biopsy‐proven fibrosis stages F0–F4 (METAVIR or Kleiner score) and routine laboratory parameters were studied in 2068 patients with HCV (n = 1391) and ALD (n = 677).
Results
Among the routine parameters for liver damage, AST correlated best with LS (HCV: r = 0.54, P < 0.0001 and ALD: r = 0.34, P < 0.0001). In the absence of elevated transaminases, cut‐off values were almost identical between HCV and ALD for F1–2, F3 and F4 (HCV: 5.1, 9.0 and 11.9 kPa vs ALD: 4.9, 8.1 and 10.5 kPa). These cut‐off values increased exponentially as a function of median AST level. The impact of AST on LS was higher in lobular‐pronounced ALD as compared to portal tract‐localized HCV. Most notably, Cohen's weighted Kappa displayed an improved agreement of the novel AST‐dependent cut‐off values with histological fibrosis stage both for HCV (0.68 vs 0.65) and ALD (0.80 vs 0.76).
Conclusions
The novel AST‐adapted cut‐off values improve non‐invasive fibrosis staging in HCV and ALD and may be also applied to other liver diseases. Especially in HCV, they could help to decide whom to treat first with the novel but expensive antiviral drugs.
See Editorial on Page 2495</description><subject>Adult</subject><subject>alcoholic liver disease</subject><subject>Aspartate Aminotransferases - analysis</subject><subject>Biopsy - methods</subject><subject>Disease Progression</subject><subject>Elasticity Imaging Techniques - methods</subject><subject>Female</subject><subject>fibrosis</subject><subject>hepatitis C</subject><subject>Hepatitis C, Chronic - complications</subject><subject>Hepatitis C, Chronic - diagnosis</subject><subject>Hepatitis C, Chronic - physiopathology</subject><subject>Humans</subject><subject>inflammation</subject><subject>Inflammation - pathology</subject><subject>Inflammation - physiopathology</subject><subject>Liver - pathology</subject><subject>Liver - physiopathology</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - etiology</subject><subject>Liver Diseases, Alcoholic - complications</subject><subject>Liver Diseases, Alcoholic - diagnosis</subject><subject>Liver Diseases, Alcoholic - physiopathology</subject><subject>liver stiffness</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Acuity</subject><subject>Prognosis</subject><subject>Reproducibility of Results</subject><issn>1478-3223</issn><issn>1478-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEFTGyEYhhmnHbXWg3_A4VgPq3yw7MKxjW3MGO3F1iPDsmBo2d0Im1j_QX920cTcygWYeb7nm_dF6ATIOeRzEfz6HKgk5R46hLIWBaMM3u3elB2gDyn9IgSk5LCPDmgFFCStDtHfWe-C7jo9-qEvdKuXo21xFtqI0-id621KeK3Dyibshoh9t4zDOjPON3FIPmVMP_j-AfseL7PG9mPCT35c4IV9-Y8ZmeC1j6uEdd9iHcywGII32y2tT1Yn-xG9dzoke7y9j9CPb1_vJlfF_Pt0Nvk8LwyrWFlIwSVjDaltTVtKjBZ1VXIOjazqspXAoeRCENE0TkueYxpaWmLAEBBOg2ZH6NPGm2M85lCj6nwyNgTd22GVFNQVkVRwQTN6tkFNDpqidWoZfafjswKiXopXOYF6LT6zp1vtqulsuyPfms7AxQZ48sE-_9-k5rOfb8piM-HTaP_sJnT8raqa1Vzd307V3eX1l8nVlKkb9g8nnZ3b</recordid><startdate>201512</startdate><enddate>201512</enddate><creator>Mueller, Sebastian</creator><creator>Englert, Stefan</creator><creator>Seitz, Helmut K.</creator><creator>Badea, Radu I.</creator><creator>Erhardt, Andreas</creator><creator>Bozaari, Bita</creator><creator>Beaugrand, Michel</creator><creator>Lupșor-Platon, Monica</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201512</creationdate><title>Inflammation-adapted liver stiffness values for improved fibrosis staging in patients with hepatitis C virus and alcoholic liver disease</title><author>Mueller, Sebastian ; Englert, Stefan ; Seitz, Helmut K. ; Badea, Radu I. ; Erhardt, Andreas ; Bozaari, Bita ; Beaugrand, Michel ; Lupșor-Platon, Monica</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3634-985933b07e72d20ca8764551b9674d9151458808bbfa95612c24e0c1c018fa1a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>alcoholic liver disease</topic><topic>Aspartate Aminotransferases - analysis</topic><topic>Biopsy - methods</topic><topic>Disease Progression</topic><topic>Elasticity Imaging Techniques - methods</topic><topic>Female</topic><topic>fibrosis</topic><topic>hepatitis C</topic><topic>Hepatitis C, Chronic - complications</topic><topic>Hepatitis C, Chronic - diagnosis</topic><topic>Hepatitis C, Chronic - physiopathology</topic><topic>Humans</topic><topic>inflammation</topic><topic>Inflammation - pathology</topic><topic>Inflammation - physiopathology</topic><topic>Liver - pathology</topic><topic>Liver - physiopathology</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - etiology</topic><topic>Liver Diseases, Alcoholic - complications</topic><topic>Liver Diseases, Alcoholic - diagnosis</topic><topic>Liver Diseases, Alcoholic - physiopathology</topic><topic>liver stiffness</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Acuity</topic><topic>Prognosis</topic><topic>Reproducibility of Results</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mueller, Sebastian</creatorcontrib><creatorcontrib>Englert, Stefan</creatorcontrib><creatorcontrib>Seitz, Helmut K.</creatorcontrib><creatorcontrib>Badea, Radu I.</creatorcontrib><creatorcontrib>Erhardt, Andreas</creatorcontrib><creatorcontrib>Bozaari, Bita</creatorcontrib><creatorcontrib>Beaugrand, Michel</creatorcontrib><creatorcontrib>Lupșor-Platon, Monica</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Liver international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mueller, Sebastian</au><au>Englert, Stefan</au><au>Seitz, Helmut K.</au><au>Badea, Radu I.</au><au>Erhardt, Andreas</au><au>Bozaari, Bita</au><au>Beaugrand, Michel</au><au>Lupșor-Platon, Monica</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inflammation-adapted liver stiffness values for improved fibrosis staging in patients with hepatitis C virus and alcoholic liver disease</atitle><jtitle>Liver international</jtitle><addtitle>Liver Int</addtitle><date>2015-12</date><risdate>2015</risdate><volume>35</volume><issue>12</issue><spage>2514</spage><epage>2521</epage><pages>2514-2521</pages><issn>1478-3223</issn><eissn>1478-3231</eissn><abstract>Background & Aims
It is well known that inflammation increases liver stiffness (LS) in patients with chronic hepatitis C (HCV) and alcoholic liver disease (ALD) independent of fibrosis stage, but no inflammation‐adapted cut‐off values have been settled so far. An early identification of rapid fibrosers, however, is essential to decide whom to treat first with the novel but expensive antiviral drugs.
Methods
Liver stiffness, biopsy‐proven fibrosis stages F0–F4 (METAVIR or Kleiner score) and routine laboratory parameters were studied in 2068 patients with HCV (n = 1391) and ALD (n = 677).
Results
Among the routine parameters for liver damage, AST correlated best with LS (HCV: r = 0.54, P < 0.0001 and ALD: r = 0.34, P < 0.0001). In the absence of elevated transaminases, cut‐off values were almost identical between HCV and ALD for F1–2, F3 and F4 (HCV: 5.1, 9.0 and 11.9 kPa vs ALD: 4.9, 8.1 and 10.5 kPa). These cut‐off values increased exponentially as a function of median AST level. The impact of AST on LS was higher in lobular‐pronounced ALD as compared to portal tract‐localized HCV. Most notably, Cohen's weighted Kappa displayed an improved agreement of the novel AST‐dependent cut‐off values with histological fibrosis stage both for HCV (0.68 vs 0.65) and ALD (0.80 vs 0.76).
Conclusions
The novel AST‐adapted cut‐off values improve non‐invasive fibrosis staging in HCV and ALD and may be also applied to other liver diseases. Especially in HCV, they could help to decide whom to treat first with the novel but expensive antiviral drugs.
See Editorial on Page 2495</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>26121926</pmid><doi>10.1111/liv.12904</doi><tpages>8</tpages></addata></record> |
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| ispartof | Liver international, 2015-12, Vol.35 (12), p.2514-2521 |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE |
| subjects | Adult alcoholic liver disease Aspartate Aminotransferases - analysis Biopsy - methods Disease Progression Elasticity Imaging Techniques - methods Female fibrosis hepatitis C Hepatitis C, Chronic - complications Hepatitis C, Chronic - diagnosis Hepatitis C, Chronic - physiopathology Humans inflammation Inflammation - pathology Inflammation - physiopathology Liver - pathology Liver - physiopathology Liver Cirrhosis - diagnosis Liver Cirrhosis - etiology Liver Diseases, Alcoholic - complications Liver Diseases, Alcoholic - diagnosis Liver Diseases, Alcoholic - physiopathology liver stiffness Male Middle Aged Patient Acuity Prognosis Reproducibility of Results |
| title | Inflammation-adapted liver stiffness values for improved fibrosis staging in patients with hepatitis C virus and alcoholic liver disease |
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