Introduction

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is recognized as the cause of a severe multisystem disease that may require intensive care unit (ICU) treatment. Because of its known hepatic tropism, this virus may be responsible for fatal liver damage. The aim of our study was to evaluate the association between elevated fib4 and the incidence of death in patients hospitalized for SARS-CoV-2 infection in an ICU.

Aims & Methods

We conducted a retrospective descriptive and analytical study including patients hospitalized for COVID19 between 2020 and 2021 in an intensive care unit. A description of the collected clinical and biological variables was first performed with calculation of the FIB4 index. We then performed an analytical study using SPSS software to determine the association between high FIB4 score and infection severity, estimated by mortality and length of hospital stay.

Results

A total of 330 patients were enrolled, with a clear male predominance of 64.2% and a sex ratio of 1.7. The mean age was 62.5 years. Diabetes and hypertension, at 45.5% and 38.2%, respectively, were the most common comorbidities. Sixteen point one percent of patients were smokers and 9.4% were overweight or obese. Overall, 68.2% of patients had cytolysis on admission and 13.3% had thrombocytopenia. Twenty seven point three percent of patients had a fib4>3.25. Median hospital stay was 7.5 days (1-100). Fib4 > 3.25 was significantly associated with death (p=0.006), as were age over 60 years (p=0.025), the presence of pre-existing lung disease (p=0.054), AST levels (p=0.001) and ALT levels (p=0.008). In contrast, fib4 > 3.25 was not significantly associated with longer hospital stay. On multivariate analysis, fib4 > 3.25 was significantly associated with the occurrence of death (odds ratio, 2.109; 95% CI, 1.0054 to 4.43), whereas age (p=0.09), platelet count (p=0.075), ASAT level (p=0.8) and ALAT level (p=0.503) showed no significant difference between the 2 groups.

Conclusion

According to our results, fib4>3.25 was significantly associated with a higher mortality in IUC patients with COVID19.

Introduction

Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) is currently the leading cause of chronic liver disease worldwide, affecting more than 65% of patients with Type 2 Diabetes Mellitus (T2DM). The aim of our study was to determine the prevalence of MASLD among T2DM patients, with or without coexisting significant fibrosis, to assess its association with diabetic complications, and to identify the factors linked to MASLD in our population.

Aims & Methods

We conducted a retrospective, descriptive, and analytical study including T2DM patients admitted to the Endocrinology Department in 2019. MASLD diagnosis was based on the presence of hepatic steatosis detected by abdominal ultrasound or a Hepatic Steatosis Index (HSI) >36. Fibrosis was assessed using the Fibrosis-4 (FIB-4) index (with a threshold of ≥1.3 or <1.3). Chronic Kidney Disease (CKD) associated with T2DM was defined by an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² and/or dipstick-positive proteinuria (>1+). Diabetic Peripheral Neuropathic Pain (DPNP) was assessed using the Douleur Neuropathique 4 (DN4) questionnaire, and Diabetic Retinopathy was diagnosed via dilated eye examination.

Results

Among the 202 patients included, the median age was 57 years (±12 years) with a marked female predominance (sex ratio = 2.6). Regarding comorbidities, 58.4% of patients had hypertension and 34.2% had dyslipidemia. The median Body Mass Index (BMI) was 27 kg/m² (±5.62), with overweight or obesity present in 61.4% of the cohort. The median duration of diabetes was 10 years (±7.8 years). Impaired renal function (eGFR <60 ml/min/1.73 m²) was found in 9.9% of patients, and proteinuria in 6.9%. Diabetic neuropathy (DN4 score ≥4) was present in 7.9% of patients, while diabetic retinopathy was diagnosed in 37.6% of cases.
The prevalence of MASLD in our cohort was 73.3%. The median FIB-4 score was 0.91 (±0.63), with 25.7% of patients presenting a FIB-4 >1.3. Statistical analysis identified several factors significantly associated with the presence of MASLD: female sex (p=0.004), dyslipidemia (p=0.004), BMI (p<0.001), alanine aminotransferase (ALT) levels (p<0.001), low-density lipoprotein cholesterol (LDL-C) levels (p=0.006), and triglyceride levels (p=0.013). In particular, higher BMI was strongly associated with MASLD (Odds Ratio [OR] = 1.970; 95% Confidence Interval [CI]: 1.580–2.460; p<0.001), as were elevated ALT levels (OR = 1.115; 95% CI: 1.053–1.18; p<0.001).
However, after adjustment, LDL-C levels (p=0.163), triglycerides (p=0.402), dyslipidemia (p=0.329), and sex (p=0.360) were no longer significantly associated with MASLD. Finally, a significantly higher proportion of CKD was observed in patients with MASLD (22.3%) compared to those without MASLD (9.2%, p=0.036), although this association was not maintained in the subgroup with advanced fibrosis (FIB-4 >1.3).

Conclusion

Our study confirmed the high prevalence of MASLD among patients with T2DM. Early screening is therefore essential, particularly in female patients and in those presenting with chronic kidney disease or other associated cardiometabolic risk factors such as obesity and dyslipidemia.

References

Younossi ZM, Golabi P, Price JK, Owrangi S, Gundu-Rao N, Satchi R, Paik JM. The Global Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Among Patients With Type 2 Diabetes. Clin Gastroenterol Hepatol. 2024 Oct;22(10):1999-2010.e8. doi: 10.1016/j.cgh.2024.03.006. Epub 2024 Mar 21. PMID: 38521116.

Introduction

Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is now recognized as the leading cause of chronic liver disease. Diagnosis can be made by simple tests available in primary care setting, particularly abdominal ultrasound and FIB4 index. More accurate assessment of fibrosis and specialized follow-up may be necessary to prevent progression to cirrhosis or hepatocellular carcinoma.

Aims & Methods

The aim of our study was to define the prevalence of hepatic steatosis and MASLD in a hospital cohort, to analyze the factors associated with MASLD in our population, and to select patients who need more accurate fibrosis assessment and closer follow up. A prospective descriptive and analytical study was conducted over a 7 months period. After consenting to participate to the study, patients consulting our department for gastroenterological or proctological complaints were included, excluding those followed up for known chronic liver disease. Epidemiologic and clinical data were collected, followed by abdominal ultrasonography. We first divided our population into 2 groups according to the presence of steatosis on ultrasound. FIB4 index were then calculated for patients with steatosis. Statistical analysis was performed with IBM SPSS Statistics 20.0 software.

Results

Among the 450 patients included, the prevalence of hepatic steatosis was 24.88 %. The mean age was 50.6 (16 - 98 years). Older age (p = 0.005), obesity (p = 0.02) and diabetes (p < 0.001) were significantly associated with the presence of steatosis. In the steatotic population, 37.5% were diabetic (88.09% of type 2 diabetes), and 20.5% hypertensive. All these patients were overweight or obese, with a mean BMI of 29.01 kg/m² and a mean waist circumference of 92.7 cm. Seven point forteen percent were drinking alcohol, with an average intake of 25 g/week. Twenty-two patients (29.34%) were found to have a Fib4 > 1.3. Comparing these two steatotic subgroups, we found a significant difference in diabetes and obesity, which were significantly more prevalent in the Fib4>1.3 group (p<0.001 and p=0.02, respectively).

Conclusion

Our study confirms the high prevalence of hepatic steatosis, especially MASLD, which becomes a major public health problem. Advanced age, diabetes and obesity were the main risk factors associated with MASLD in our study. These data highlight the importance of systematic screening for fibrosis in these populations, as well as specialized follow-up.

Introduction

Acute abdominal pain is a common reason for consultation in gastroenterology emergency departments among elderly patients. Diagnosis can be challenging due to atypical symptoms, which may delay treatment and increase the risk of complications or even threaten short-term survival.

Aims & Methods

This study aims to analyze the frequency, causes, and specific characteristics of acute abdominal pain in elderly patients to improve their management.
Materials and Methods: This is a retrospective descriptive study conducted over one year (December 2023 to December 2024), including all patients over 65 years old who consulted the gastroenterology emergency department for acute abdominal pain. Data were collected from medical records and entered into Excel.

Results

A total of 300 patients presented to the gastroenterology emergency department for acute abdominal pain, of whom 60 were over 65 years old, representing 20% of cases. There was a slight male predominance, with a male-to-female sex ratio of 1.3. Among the elderly patients, 25% were managed on an outpatient basis, while 75% were hospitalized.
Regarding medical history, 25.2% of patients had hypertension, 17.6% had diabetes, 9.2% had a history of heart disease, 21.8% had cirrhosis, 17.3% had undergone previous surgery, and 19.4% had no significant medical history.
Abdominal pain was associated with vomiting in 10.6% of cases, diarrhea in 8.5%, bowel obstruction in 9.4%, and gastrointestinal bleeding in 6%. A general deterioration was observed in 42.7% of patients.
The pain was diffuse in 34.2% of cases, epigastric in 28.5%, and localized to the right hypochondrium in 17.2% of patients.
All patients underwent additional diagnostic tests. C-reactive protein was measured in all cases, with elevated levels in 72% of patients (mean: 68.3 mg/L). An abdominopelvic CT scan was performed in 76.4% of patients, while 39.7% had an abdominal ultrasound. Standard abdominal X-rays showed air-fluid levels in four patients, pneumoperitoneum in three cases, and signs suggestive of a sigmoid volvulus in one patient.
Digestive causes were the most frequent, with acute pancreatitis being the leading diagnosis (16.5%), followed by intestinal obstruction (9.3%), cholecystitis (7.3%), portal vein thrombosis (6.7%), diverticulitis (5.8%), cholangitis (3.9%), liver abscess (3.3%), and sigmoid volvulus (1.6%). A tumor-related cause was identified in 6.4% of patients.
Extra-digestive causes accounted for 13.3% of cases, including cardiac conditions (5%), urinary tract disorders (5%), and gynecological conditions (3.3%).
All patients received appropriate medical and/or surgical treatment along with symptomatic management.

Conclusion

Multiple diagnoses can be responsible for acute abdominal pain in elderly patients, some of which are life-threatening in the short term. More than one-third of cases require surgical intervention. It is crucial to establish clear guidelines to improve patient management and reduce morbidity and mortality in this vulnerable population.

Introduction

Non-alcoholic Fatty Liver Disease (NAFLD), is a state of hyperinflammation which is associated with release of pro-inflammatory cytokines. Obesity, diabetes and metabolic syndrome, which are usually accompanied by hepatosteatosis, are risk factors for severe Covid-19 infection.

Aims & Methods

We aimed to investigate the association of hepatosteatosis and liver fibrosis by non-invasive markers (FIB-4 and APRI) with the prognosis of Covid-19 disease among hospitalized patients. In this retrospective and observational study, 500 patients with the diagnosis of Covid-19 between March 2020 and March 2022 and underwent Thorax Computed Tomography (CT) were included. Demographics, clinical characteristics and laboratory data at admission were recorded. Liver-spleen attenuation value difference (CT _L-S) was obtained from CT images and non-invasive fibrosis markers as APRI and FIB-4 scores were calculated (1). Advanced fibrosis was defined as FIB-4>2.67, APRI≥1. Severe outcomes were defined as either intensive care unit (ICU) admission or mortality.

Results

Among the patients, 129 (25.8%) were admitted to the ICU, and mortality occurred in 53 (10.3%) cases. According to CT _L-S value, hepatosteatosis was in 32.6% of the cases. 82.8% of cases with hepatosteatosis were male, mean age was 52.6±13.5, 82% were overweight or obese. Hypertension and diabetes were the most common comorbidities. Among ICU patients, hepatosteatosis was found in 41.8% and ICU admission was associated with hepatosteatosis (p=0.002). Of the patients with hepatosteatosis, 58% of patients have FIB-4>1.3 and of these, FIB-4 and APRI score were significantly high in patients with ICU admission and mortality (p=0,001). Of the patients both with hepatosteatosis and advanced fibrosis, 71% were admitted to the ICU, mortality was seen in 32.5%. Mortality was significantly higher in patients with hepatosteatosis and advanced fibrosis according to the FIB-4 score (p=0.001). In the ROC analysis, combination of FIB-4 score and attenuation had highest sensitivity (sensitivity: 88.37%; Negative Predictive Value 90.85%; p=0.001) in determining the need for ICU need. The need for ICU follow-up was found to be 5 times higher in patients with a high FIB-4 score and low attenuation value [(Odds ratio (OR) 5.101; 95% Confidence Interval (CI): 2.865-9.083)]. The risk factors for the need for intensive care in patients with hepatosteatosis were advanced age, presence of fibrosis, high ferritin and IL-6 level in univariate analysis, whilst only high ferritin level was defined as a risk factor in multivariate analysis. Inflammation markers such as IL-6 and ferritin were significantly higher in patients with hepatosteatosis and fibrosis.

Conclusion

Hepatosteatosis and fibrosis determined by non-invasive tests were found to be associated with severe Covid-19 infection. Hepatosteatosis and fibrosis may increase inflammation-related markers such as ferritin and IL-6 and may create a synergistic effect with infectious conditions. Likewise high ferritin level in Covid-19 patients with hepatosteatosis is a risk factor for severe disease. CT_L-S and fibrosis scores have strong negative predictive value in the diagnostic evaluation for severity of Covid-19 disease.

References

1. Byun J, Lee SS, Sung YS, Shin Y, Yun J, Kim HS, et al. CT indices for the diagnosis of hepatic steatosis using non-enhanced CT images: development and validation of diagnostic cut-off values in a large cohort with pathological reference standard. European Radiology. 2019 Aug 1; 29(8):4427–35.

Introduction

Patients with acute severe ulcerative colitis (ASUC) have a lifetime risk of an acute flare requiring hospital stay. The diagnosis of acute severe ulcerative colitis is based on Truelove and Witts criteria and the treatment by intravenous steroids showed improved clinical remission and reduced mortality. However, some patients respond poorly to systemic steroids and need a medical treatment by of anti TNF agents or a surgical treatment by colectomy. The aim of our work is to study the ACE score as a predictive factor of surgery in acute severe ulcerative colitis.

Aims & Methods

We conducted a retrospective study on the Hepato gastro enterology department in IBN Rochd University Hospital of CASABLANCA, including all the admissions of patients with acute severe ulcerative colitis between 2016 and 2023. Demographic (sex, age, smoking habits ,age of the diagnosis, prior episodes of severe ulcerative colitis, extent of the disease according to Montreal classification, maintenance medication prior to hospital admission) , clinical (lichtiger score at admission and 3 days after IV steroid, laboratory (albumin, CRP) at day 1 and day 3 during hospital stay and endoscopic (Mayo score and UCEIS) characteristics of the patients were collected from medical records. The primary outcome was to calculate the ACE score and determine the association between a high score and a major risk of surgery. The score ACE was calculated following this formula: albumin≤30 g/L{score=1}+ CRP ≥50 mg/L{score=1} + increased endoscopic severity {score=1} predicting 78.1% of no responders .

Results

97 patients were included in the study. The median age was 28 years with interquartile range (IQ) [15, 64]. The sex ratio was 1. 22,7% had a history of smoking. For 53 patients, acute severe ulcerative colitis was inaugural. At day1, the median C-reactive protein (CRP) was 84 mg/dl and the mean of albumin level was 29.9+/-6.28. The evolution at day 5 was marked by the persistence of a high Lichtiger score in 21 patients. 10 were treated with anti TNF alpha and 11 underwent colectomy. Younger age (<20 years) and inaugural acute severe ulcerative colitis was significantly associated with a higher risk of colectomy (p=0.019; p=0.001). Elevated C-reactive protein (>45) at day 3 (p=0.004), decreased albumin level (<30g/L) (p=0.02) and positive oxford criteria (p<0.01) was also significantly associated with colectomy risk. The ACE (Albumin, CRP, Endoscopic) score was calculated in our patients, and a higher score of 3 was significantly associated to a major risk of colectomy.

Conclusion

Multiple biomarkers have been used to predict a non-response to steroids in the situation of acute severe ulcerative colitis. The most used is Travis score at day 3. The ACE score has been used recently in many studies , and confirm its ability to predict non responders to first line medical therapy. Further research and validation of these scoring systems are warranted to enhance their accuracy and reliability in predicting the need for a second line therapy or surgery.

References

1. Dinesen LC, Walsh AJ, Protic MN, Heap G, Cummings F, Warren BF, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis. oct 2010;4(4):431‑7.

Introduction

Noninvasive assessment of liver fibrosis is essential in the management of chronic liver diseases. APRI and FIB-4 are simple, low-cost tools widely used for this purpose. This study aimed to evaluate the diagnostic performance of APRI and FIB-4 in identifying significant fibrosis (≥F2) and cirrhosis (F4), using transient elastography (FibroScan) as the reference standard, and to explore their clinical and biochemical correlations.

Aims & Methods

We conducted a cross-sectional study at the Institute of Gastroenterology and Hepatology, Iași, Romania, between January 1^st, 2024 and April 1^st, 2025. A total of 106 patients with chronic liver disease were included. Laboratory tests were used to calculate APRI and FIB-4 scores, and liver stiffness was measured by FibroScan. For diagnostic accuracy we performed ROC curve analysis and Pearson correlation coefficients were used to assess relationships between noninvasive scores and clinical-biological variables. Statistical analysis was performed using MedCalc® Statistical Software version 23.2.1 (MedCalc Software Ltd, Ostend, Belgium).

Results

For the detection of significant fibrosis (≥F2), the area under the ROC curve (AUC) was 0.748 for APRI (p < 0.001) and 0.752 for FIB-4 (p < 0.001). In diagnosing cirrhosis (F4 ≥12.5 kPa), FIB-4 demonstrated superior diagnostic accuracy (AUC 0.836, p < 0.001) compared to APRI (AUC 0.797, p < 0.001). A FIB-4 threshold of 1.45 provided a sensitivity of 68.6% and a specificity of 83.3% for detecting significant fibrosis. High cut-offs (≥2.0 for APRI and ≥4.0 for FIB-4) were associated with a specificity exceeding 96%. A significant positive correlation was observed between APRI and FIB-4 (r = 0.96, p < 0.001). Moreover, FIB-4 correlated moderately with FibroScan values (r = 0.514), while APRI showed a weaker correlation (r = 0.423).

Conclusion

The results of this study confirm that both APRI and FIB-4 are effective noninvasive tools for the staging of liver fibrosis, with FIB-4 demonstrating superior diagnostic accuracy, particularly for cirrhosis. The moderate correlation between FIB-4 and FibroScan (r = 0.514) supports its potential role as a reliable surrogate marker, especially in settings where access to elastography is limited, outperforming the weaker correlation of APRI (r = 0.423) that suggests a lower predictive power, aligning with findings from previous studies that emphasized FIB-4's stronger association with liver stiffness and histological fibrosis progression. The high specificity associated with elevated cut-off values enhances the clinical applicability of these scores for ruling in advanced fibrosis and cirrhosis, minimizing the need for unnecessary imaging or biopsies. Overall, integrating FIB-4 and APRI into routine clinical practice could improve early identification of at-risk patients, optimize resource allocation, and facilitate timely therapeutic interventions.

References

1. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol. 2021 Sep;75(3):659-689. doi: 10.1016/j.jhep.2021.05.025. Epub 2021 Jun 21. PMID: 34166721.
2. Gür-Altunay D, Yürük-Atasoy P. How Successful Are APRI and FIB-4 Scores in Predicting Liver Fibrosis in Chronic Hepatitis B Patients? Infect Dis Clin Microbiol. 2023 Dec 29;5(4):332-340. doi: 10.36519/idcm.2023.276. PMID: 38633858; PMCID: PMC10986711.
3. Rungta S, Kumari S, Deep A, Verma K, Swaroop S. APRI and FIB-4 performance to assess liver fibrosis against predefined Fibroscan values in chronic hepatitis C virus infection. J Family Med Prim Care. 2021 Nov;10(11):4082-4088. doi: 10.4103/jfmpc.jfmpc_666_21. Epub 2021 Nov 29. PMID: 35136771; PMCID: PMC8797084.