Introduction

As the most common form of chronic liver disease, the increasing prevalence of non-alcoholic fatty liver disease (NAFLD) is a global concern. NAFLD and obesity are independently related to an increased risk for atherosclerotic cardiovascular disease (ASCVD), the primary cause of mortality in NAFLD patients. Even though many subjects with NAFLD are normal weight, it still remains uncertain whether their ASCVD risk is of major importance.

Aims & Methods

The aim of this study is to assess and compare the ASCVD risk between lean and obese patients with NAFLD. Normal weight and obese patients were evaluated between January 2020 and February 2023 and their data was analyzed. NAFLD was diagnosed by vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP) and the American College of Cardiology/American Heart Association guidelines was used to evaluate the ASCVD risk. Moreover, medical history and biochemical data were collected.

Results

In total, 221 patients were included in the final analysis. In the obese group, 164 (63.8%) patients were diagnosed with NAFLD, compared to 57 (12.3%) in the lean population. In comparison to those with obese NAFLD, subjects with lean NAFLD had significantly higher ASCVD scores (mean 15.3% vs 22.7%, p<0.001). Moreover, subjects with lean NAFLD and significant liver fibrosis had a higher risk of ASCVD events, compared to their obese counterparts (OR, 2.51 vs 1.95, p=0.034). On the other hand, in terms of liver stiffness measurements, the prevalence of at least significant liver fibrosis was substantially higher in the obese group. Regarding the presence of the components of the metabolic syndrome, the prevalence of type 2 diabetes mellitus was higher the obese group, while changes in the lipid profile and higher systolic blood pressure were more frequently found in lean subjects.

Conclusion

The ASCVD scores of subjects with lean NAFLD were significantly higher than those with obese NAFLD. The presence of significant liver fibrosis was a notable risk factor associated with an ASCVD event in both study groups, but the effects were more pronounced in individuals with a low body mass index.​

Introduction

Although chronic alcohol consumption has progressively decreased in recent years, a third of people over 15 years declare at least one episode of excessive use every month, which ranks Romania on second position, with a rate of 35%, far above the average registered in the EU (20%). Therefore, Romania has one of the highest incidence rates of alcohol-related liver cirrhosis, which has become a major public health problem. This study aimed to investigate the prevalence of liver fibrosis in the asymptomatic alcohol-consuming population.

Aims & Methods

The study aimed to evaluate the relationship between advanced liver fibrosis measured by transient elastography, laboratory parameters, and the amount of alcohol consumed depending on non-modifiable risk factors such as age and gender. Between January 2022 and December 2022, we examined patients with day hospitalization in the Institute of Gastroenterology and Hepatology in Iasi, without liver history, who admitted a moderate or high consumption (women <7 versus >7 drinks/week; men <14 versus >14 drinks/week) for at least one year. The classification of the fibrosis stage by transient elastography was adjusted according to transaminase values. The results were analyzed by univariate analysis and logistic regression to establish models of prediction.

Results

The study included 689 patients with an average age of 49.32±14.31 years, a proportion of 63.7% represented by men. Advanced fibrosis (³ F3) was detected in 19.30% of the examined patients, predominantly in men (14.1%) and patients over 55 years old (12.5%). Excessive alcohol consumption is associated 2 times more with advanced fibrosis in women (OR=5.08; CI 95%: 3.45-9.50, p<0,001) and the group under 40 years old (OR=6.29; CI 95%: 1.67-9.43, p<0,001) compared to men (OR=2.27; CI 95%: 1.76-3.81, p=0,012) respectively patients over 55 years old (OR=3.21; CI 95% : 2.28-4.45 p<0,001). Using logistic regression, it was demonstrated that there was a strong correlation between advanced fibrosis, excessive alcohol consumption, low serum albumin level and the reduction of triglycerides in men (R² Nagelkerke = 0.854; p<0.001) supplemented with the reduction of cholesterol in the age group 40-55 years (R² Nagelkerke = 0.785; p<0.001), respectively of ferritin in those over 55 years old (R² Nagelkerke = 0.804; p<0.001). The association of excessive alcohol consumption, age, low levels of albumin, LDL-cholesterol and C-reactive protein generated a significant predictive model (R² Nagelkerke = 0.784; p<0.001) for female patients.

Conclusion

Screening using transient elastography represents an approach that could provide early diagnosis of advanced liver fibrosis in an asymptomatic population, with the possibility to prevent the evolution of ALD and the development of complications of cirrhosis.

Introduction

Currently, about 25-30% of the world population is affected by non-alcoholic fatty liver disease (NAFLD); over time, about 20% tends to develop a certain degree of inflammation in the liver tissue, defying the non-alcoholic steatohepatitis (NASH). Moreover, approximately 20% of NASH patients evolve into a high-grade liver fibrosis condition that leads to severe liver impairment (cirrhosis) (1, 2, 3).
The serial use of non-invasive fibrosis tests can refine prognosis in patients with non-alcoholic fatty liver disease (NAFLD) and evaluate the progression or improvement of liver fibrosis.

Aims & Methods

We evaluated predictors of improvement or worsening of liver stiffness measurements (LSM) in well characterized cohorts of patients with NAFLD from London (UK) and Milan (Italy).
We included two consecutive cohorts of 405 patients with at least two outpatient visits between 2014 and 2022. The minimum time interval between baseline and follow-up LSM was >6 months. LSM worsening was defined as an increase of >20% kPa if the baseline LSM was ≥5 kPa, or a follow-up LSM >6 kPa if the baseline LSM was <5 kPa. An LSM improvement was defined as an LSM decrease of >20% kPa (if the baseline LSM was >6 kPa).
A significant change in weight was defined as a >5% reduction or increase at follow-up, while a significant change in glycated hemoglobin (HbA1c) was defined as a >10% reduction or increase.
The variation between the true and expected FIB-4 index (based on the patient’s age at the follow-up visit, but using the blood tests performed at the first visit) was calculated. A significant improvement or worsening in FIB-4 was defined as a >20% variation between the actual and “expected” FIB-4.

Results

Of the 405 patients, 282 (70%) were males; mean age was 54±11 years. The median time from the first visits was 20.3 (13.9 – 28.7) months.
128 and 54 patients had an LSM >8 kPa and LSM>12 KPa at follow-up, respectively.
77 patients (19.3%) had an LSM improvement, while 67 (16.8%) had an LSM worsening; 256 patients (63.9%) maintained a stable value.
In patients with an LSM improvement, 22 had an improvement, 12 had worsening, while 37 had stable FIB-4.
In patients with an LSM worsening, 10 had an improvement, 20 had worsening, while 33 had a stable FIB-4.
In multiple logistic regression analysis, LSM worsening was independently associated with an increase in ALT and in HbA1c levels (OR 1.02 and 1.03 respectively), but also with a reduction in total cholesterol and AST levels (OR 0.98 for both). LSM improvement was independently associated with weight and ALT reduction (OR 0.93 and 0.98 respectively), but also with an increased AST level (OR 1.02).

Conclusion

More than 35% of patients with NAFLD have significant changes in their LSM measurements over a period of 20 months, with worsening or improvement at similar rates. Improvement in weight is independently associated with significant improvement in LSM measurements. On the converse, worsening in metabolic comorbidities, particularly glycemic control, could be associated with significant worsening in LSM, further supporting a multidisciplinary model of care.

References

1. Younossi Z, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol 2018;15(1):11-20.
2. Sheka AC, et al. Nonalcoholic Steatohepatitis: A Review. JAMA 2020;323(12):1175-1183.
3. Liu J, et al. Estimating global prevalence, incidence, and outcomes of non-alcoholic fatty liver disease from 2000 to 2021: systematic review and meta-analysis. Chin Med J (Engl). 2022 Jul 20;135(14):1682-1691.

Introduction

Non-alcoholic liver disease (NAFLD) is a leading cause of liver-related morbidity and mortality having an overall prevalence of about 30%. Inflammatory bowel diseases (IBD) are caused by a dysregulated immune response in the hosts, favored by genetic susceptibility. In addition to symptoms related to the digestive tract, about 40% of patients with IBD also experience extraintestinal manifestations. Although, NAFLD has been frequently associated with IBDs, the relationship between these two pathologies remains unclear.

Aims & Methods

The aim of this study was to investigate the prevalence of NAFLD among IBD patients, as well as the factors that connect these two conditions.From January 2022 to November 2022, consecutive IBD patients were enrolled from a tertiary care center hospital in Iasi. All patients' demographic information, clinical characteristics including blood pressure, biological parameters, and anthropometric measurements were collected. Following informed consent, participants underwent a fibroscan evaluation for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP).

Results

A total of 93 patients with IBD were enrolled (65,3% men, 55,6% with ulcerative colitis). 45 (48,3%) of them were diagnosed with NAFLD, with a mean CAP score of 283 ± 33.4 vs. 215 ± 23.7 in patients with IBD only. Regarding liver fibrosis, mean LSM value in the NAFLD group was 6.8 ± 1.9 kPa vs. 5.7 ± 2.3 kPa in the non-NALFD group. Subjects with NAFLD exhibited higher body mass indexes than those with IBD only (26.2 vs. 33.1, p<0.05). In addition, the prevalence of diabetes was much greater among this group (27.5% vs. 0%; p=0.0001), as was the prevalence of elevated HbA1c levels in the absence of a diabetes diagnosis (14% vs. 7.35%; p=0.23). They also had a non-significantly higher mean systolic blood pressure and greater incidences of hypertension. Age (β=0.357, p=0.034), body mass index (BMI) (β=0.185, p=0.048), disease duration (β=0.297, p=0.037), C - reactive protein (β=0.321, p=0.013), fasting plasma glucose (β=0.269, p=0.018) and triglycerides (β=0.273, p=0.021) were strongly associated at the multivariate analysis with the diagnosis of NAFLD in our cohort of patients with IBD. Advanced fibrosis (LSM > 9.7 kPa) was associated with age, BMI and the level of triglycerides. After adjusting for classic metabolic risk factors, age and gender the multivariate logistic regression analysis showed that the presence of IBD (odds ratio, 2.45; 95% confidence interval,1.17–4.391; p < 0.001). Also, in regard to age and male gender they were independent risk factors for NAFLD. Of note, the 10-year risk of myocardial infarction or death estimated by the Framingham risk scores for hard coronary heart disease was higher in the NAFLD group (2.32% vs. 4.27%, p=0.0024).

Conclusion

NAFLD is an intricate condition that has become more common in IBD patients. The connection between these two pathologies is not fully understood, although metabolic disorders, age and male gender have a notable role. Current evidence in the literature suggests a minor risk for the progression of liver fibrosis, the cardiovascular risk appears to be of more concern. Given the information presented above, patients with IBD should be assessed using a multidisciplinary approach.

Introduction

The advent of direct-acting antivirals (DAAs) is a major breakthrough in hepatology representing the therapeutical standard of care in patients with chronic hepatitis C virus infection. Despite high rates of sustained virological response (SVR), DAAs therapy doesn’t eliminate the risk of thrombotic events.

Aims & Methods

We aimed to assess the prevalence of nontumoral portal vein thrombosis (PVT) after SVR.We prospectively analyzed a cohort of patients with HCV-related liver cirrhosis treated with paritaprevir/ritonavir, ombitasvir and dasabuvir (PrOD) ± ribavirin and ledipasvir/sofosbuvir (LED/SOF) ± ribavirin for 12/24 weeks, in a gastroenterology center from Romania, between January 1^st 2016 and July 1^st 2021. All patients with presumption of thrombosis were evaluated by vascular Doppler, abdominal ultrasound and confirmed by CT scan.

Results

The study included 730 patients treated with DAAs, of which 35 were diagnosed with non-malignant PVT after-SVR (15 men and 20 women, mean age 57.86 ± 7,068 years), corresponding to a prevalence of 4.8%. The mean time from SVR to complication was 290.00 ± 116.639 days. Most patients with nontumoral PVT received LED/SOF (71.4%), while the rest received PrOD (28.6%). During the study, an improvement in the Child-Pugh and MELD score was observed at the SVR. The evolution changes slightly at the 48-week assessment, with a slight increase in the proportion of patients in the Child B class and MELD ≥ 15. The pro- and anticoagulant factors evaluated reflect the classic hemostatic profile of patients with liver cirrhosis and PVT, characterized by increased FII, FVIII and FvW and decreased anticoagulant factors (PC, PS, ATIII).

Conclusion

The study included 730 patients treated with DAAs, of which 35 were diagnosed with non-malignant PVT after-SVR (15 men and 20 women, mean age 57.86 ± 7,068 years), corresponding to a prevalence of 4.8%. The mean time from SVR to complication was 290.00 ± 116.639 days. Most patients with nontumoral PVT received LED/SOF (71.4%), while the rest received PrOD (28.6%). During the study, an improvement in the Child-Pugh and MELD score was observed at the SVR. The evolution changes slightly at the 48-week assessment, with a slight increase in the proportion of patients in the Child B class and MELD ≥ 15. The pro- and anticoagulant factors evaluated reflect the classic hemostatic profile of patients with liver cirrhosis and PVT, characterized by increased FII, FVIII and FvW and decreased anticoagulant factors (PC, PS, ATIII).

Introduction

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, with a prevalence of 25% in the adult population. NAFLD encompasses a wide spectrum of histological conditions, from simple steatosis to nonalcoholic steatohepatitis (NASH), fibrosis and cirrhosis. Inflammation is one of the principal hallmarks of NAFLD. Polyclonal free light chains (FLCs) λ and κ reflect B-cell activation and high serum levels of FLCs are observed in a variety of inflammatory conditions.

Aims & Methods

The aim of this study is to evaluate the potential role of FLCs as biomarkers of inflammation and fibrosis in NAFLD/NASH patients. 254 patients with metabolic liver disease were consecutively enrolled in the study. 89 patients had simple steatosis, 88 had NASH, 77 had liver cirrhosis (45 with clinically significant portal hypertension [CSPH]). Diagnosis of NASH was histologically assessed. 101 patients had compensated advanced chronic liver disease (cACLD) based on histology (F>3) or elastography (liver stiffness measurement>15 kPa). Medical and pharmacological anamnesis, anthropometric measurements and laboratory tests (included λ and κ FLCs) were obtained for all patients.

Results

The concentration of total FLCs levels in patients with cirrhosis were higher compared with patients with NAFLD/NASH (p<0.01), while no significant difference in λ and κ FLCs levels were observed between NASH and NAFLD patients. Among patients who underwent biopsy, λFLCs tended to increase gradually with lobular inflammation severity, and patients with advanced fibrosis (F3-4) had a significantly higher FLCs compared with patients with mild-to-moderate fibrosis (F<3; p<0.05). Patients with clinically significant portal hypertension (CSPH) showed higher levels of FLCs compared to patients without CSPH (p<0.01). At multivariate logistic analysis both kFLCs and λFLCs are significantly associated with diagnosis of CSPH and cACLD, independently from age, sex, diabetes, dyslipidemia and obesity. Diagnostic performance of cACLD and CSPH were high for both kFLCs (AUC 0.79 and 0.87 respectively) and λFLCs (AUC 0.81 and 0.89 respectively).

Conclusion

This study highlights the role of adaptive immune system in the pathogenesis of NAFLD. FLCs may be considered useful biomarkers of advanced liver disease (cACLD and CSPH) in patients with NAFLD.