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Acute pancreatitis is a common disease, and the mortality rate can be high. Thus, a risk assessment should be performed early to optimize treatment. We compared simple prognostic markers with the bedside index for severity in acute pancreatitis (BISAP) scoring system to identify the best predictors of severity and mortality. This retrospective study stratified disease severity based on the revised Atlanta criteria. The accuracies of the markers for predicting severe AP (SAP) were assessed using receiver operating characteristic curves. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each marker. Multivariate logistic regression analyses were used to identify independent predictors of SAP and mortality. The area under the curve (AUC) for the BISAP score was classified as fair for predicting SAP. The neutrophil-to-lymphocyte ratio at 48 hours (NLR48 h) and the C-reactive protein level at 48 hours (CRP48 h) had the best AUCs and were independently associated with SAP. When both criteria were met, the AUC was 0.89, sensitivity was 68%, and specificity was 92%. CRP48 h and hematocrit at 48 hours were independently associated with mortality. NLR48 h and CRP48 h were independently associated with SAP but not superior to the BISAP score at admission. Assessing NLR48 h and CRP48H together was most suitable for predicting SAP. The CRP level was a good predictive marker for mortality.

Chronic liver diseases (CLDs) are a public health problem, even if frequently they are underdiagnosed. Hepatic steatosis (HS), encountered not only in nonalcoholic fatty liver disease (NAFLD) but also in chronic viral hepatitis, alcoholic liver disease, etc., plays an important role in fibrosis progression, regardless of CLD etiology; thus, detection and quantification of HS are imperative. Controlled attenuation parameter (CAP) feature, implemented in the FibroScan® device, measures the attenuation of the US beam as it passes through the liver. It is a noninvasive technique, feasible and well accepted by patients, with lower costs than other diagnostic techniques, with acceptable accuracy for HS quantification. Multiple studies have been published regarding CAP performance to quantify steatosis, but due to the heterogeneity of CLD etiologies, of steatosis prevalence, etc., it had widely variable calculated cut-off values, which in turn limited the day-to-day utility of CAP measurements in clinical practice. This paper reviews published studies trying to suggest cut-off values usable in clinical practice.

Aim To evaluate the performance of 2D Shear-Wave Elastography from General Electric (2D-SWE.GE), implemented on the new LOGIQ P9 system, for the non-invasive assessment of liver fibrosis, and to identify liver stiffness (LS) cut-off values for predicting different stages of fibrosis, using Transient Elastography (TE) as the reference method. Material and Method Our study included 234 consecutive subjects, with or without chronic hepatopathies, in whom LS was evaluated in the same session by means of two elastographic techniques: TE (FibroScan, EchoSens) and 2D-SWE.GE (LOGIQ P9, GE Healthcare). Reliable liver stiffness measurements (LSM) were defined for TE as the median value of 10 measurements with an interquartile range/median ratio (IQR/M) Results Reliable LS measurements were obtained in 217/234 (92.7%) subjects by 2D-SWE.GE and in 222/234 (94.8%) by TE, so the final analysis included 205 subjects (p = 0.454). 36% (74/205) of subjects included in the study were healthy liver subjects. Based on TE [1] cut-off values we divided the rest of our cohort into 4 groups: F Conclusion The mean LS values for normal subjects for 2D-SWE-GE (P9) was 5.05 ± 0.83 kPa. The best 2D-SWE.GE (P9) cut-off values for predicting F ≥ 2, F ≥ 3 and F = 4 were 6.8 kPa, 7.6 kPa and 9.3 kPa.

Background Liver biopsy (LB) is still considered to be the gold standard for assessment of liver fibrosis. Objectives To evaluate the effectiveness of various non-invasive methods for predicting liver fibrosis, including transient elastography (TE), APRI score, Lok score, Forns score, FIB-4 score, Fibrosis Index, King score, and Bonacini score, in comparison with the effectiveness of LB and to create a new scoring system for fibrosis prediction. Patients and Methods This study included 212 patients with chronic HCV hepatitis. LB, TE, and various biological tests were performed during a single hospital visit. Using established formulae, data from these tests were used to create scores for assessment of liver fibrosis. Results The results of all the tests showed significant correlation with histological fibrosis. TE results (r = 0.62), King score (r = 0.57), and APRI score (r = 0.56) showed the closest correlation with severity of fibrosis. The following formula was derived from our data by multiple regression: Predicted liver fibrosis score (PLF score) = 0.956 + 0.084 × TE - 0.004 × King score + 0.124 × Forns score + 0.202 × APRI score. A direct correlation (r = 0.68) was found between the PLF score and liver fibrosis. The cut-off values of the PLF score for various stages of fibrosis were: F ≥ 1, 1.77 (Area under ROC curve (AUROC) = 0.76); F ≥ 2, 2.18 (AUROC = 0.78); F ≥ 3, 2.47 (AUROC = 0.86); and F = 4, 2.98 (AUROC = 0.97). Conclusions We found that our newly developed PLF score, which is derived from the scores of multiple tests, is more strongly correlated with fibrosis than each component score used individually. The PLF score is more effective than TE for predicting severe fibrosis, but they have similar effectiveness in predicting liver cirrhosis.

Contrast Enhanced Ultrasound is an imaging method that can evaluate imediatelly focal liver lesions discovered by ultrasound.The aim of this study is to demonstrate if Contrast Enhanced Ultrasound can be reliable as a diagnostic method for hepatocellular carcinoma.We included in our retrospective monocentric study all patients evaluated in our Department during 2 years, which had hepatocellular carcinoma as final diagnosis (using Contrast Enhanced Ultrasound, Contrast Enhanced Computed Tomography, Magnetic Resonance Imaging or biopsy). 91 patients with chronic liver diseases were evaluated, with a total of 114 liver nodules. The enhancement pattern of the nodules was evaluated according to the 2008 guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology. The lesions with arterial enhancement and washout in the portal or late phase were considered hepatocellular carcinoma. The nodules were classified according to their size in ≤3 cm and3 cm.Of all nodules, 103 had hyperenhancing arterial pattern and washout was observed in 79 cases. In our study, this method established the diagnosis of hepatocellular carcinoma in 45 of 55 cases with liver nodules larger than 3 cm (81.8%) vs. 34 of 59 cases with nodules smaller than 3 cm (57.6%) (p0.001).69.3% of all hepatocellular carcinoma had a typical enhancement pattern on Contrast Enhanced Ultrasound, performing better in nodules larger than 3 cm, than in smaller nodules (p0.001).

Background & Aims: Transient elastography (TE) is a noninvasive technique used to measure liver stiffness to estimate the severity of fibrosis. The range of liver stiffness measurements (LSMs) in healthy individuals is unclear. We performed a systematic review to determine the range of LSMs, examined by TE, in healthy individuals and individuals who are susceptible to fibrosis. Methods: We collected data from 16,082 individuals, in 26 cohorts, identified from systematic searches of Embase, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies of liver stiffness measurements. Studies analyzed included apparently healthy adults (normal levels of liver enzymes, low-risk alcohol use patterns, and negative for markers of viral hepatitis). The presence of diabetes, hypertension, dyslipidemia, or steatosis, based on ultrasound examination, was known for most participants. We performed a meta-analysis of data from individual participants. The cohort was divided into 4 groups; participants with a body mass index