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Non-invasive tests have been developed to determine the severity of liver disease in patients with alcohol use disorder (AUD). We aimed to assess the severity of liver steatosis and liver fibrosis (LF) in a cohort of patients with AUD using liver elastography and biological scores., Materials and Methods: A prospective study was performed on 172 subjects, without previously known liver disease, with a positive AUDIT-C score, serum markers, and vibration-controlled transient elastography (VCTE) with Controlled Attenuation Parameter (CAP)., Results: From 172 subjects with positive AUDIT-C test, VCTE diagnosed advanced fibrosis (F3) in 13.9% (24/172) of the subjects and liver cirrhosis (F4) in 17.5% (30/172). Moderate and severe steatosis was found in 18.6% (32/172), respectively 52.3% (90/172). Significant correlations were found between liver stiffness and APRI (r=0.33, p=0.001), FIB-4(r=0.31, p=0.0012) and the age-platelet index (r=0.25, p=0.008). FIB-4 (p=0.01) and age-platelet index (p=0.03) were independently associated with the presence of advanced fibrosis. Age-platelet index (AUC- 0.82) performed significantly better than AST/ALT (AUC- 0.55) and APRI (AUC- 0.58) (p= 0.0001 and p= 0.0014, respectively), but no differences were found when compared to FIB-4 (AUC- 0.77) (p=0.35) for predicting advanced fibrosis., Conclusion: In conclusion, in a cohort of patients with AUD, 70.9% presented moderate and severe liver steatosis and 17.5% were newly diagnosed with liver cirrhosis.

Aim: To establish the influence of different factors on the correlation between liver stiffness (LS) measurements by ARFI and liver fibrosis, evaluated by liver biopsy (LB). We assessed the following factors: the success rate (SR) and interquartile range (IQR) interval, the place where ARFI was performed, liver steatosis, the quality of the specimen obtained by LB., Methods: We studied 471 patients: 82 with LB, 82 healthy volunteers and 307 with cirrhosis. We performed 10 valid ARFI measurements, a median value was calculated, expressed in meters/second., Results: Valid measurements were not obtained in 11 patients. There was a direct, strong, correlation (r=0.694) between ARFI and fibrosis (p<0.0001). There were no statistically significant differences between the mean ARFI values obtained in segments V vs. VIII (p=0.89). Considering the IQR and SR, the correlation of ARFI with fibrosis was: for IQR<30% and SR ≥ 60%: r=0.722 and for IQR>30% and/or SR ≤ 60%: r=0.268 (p=0.0001). The quality of the liver specimen (2-3 cm long vs. >3 cm) did not influence the correlation of ARFI with fibrosis., Conclusions: To obtain the best correlation between ARFI and fibrosis, IQR must be <30% and SR ≥ 60%. These technical parameters must be introduced to improve the ARFI value for LS evaluation.

Background: Type 2 diabetes mellitus (T2DM), obesity, hyperlipidemia, and hypertension are considered risk factors for developing non-alcoholic fatty liver disease (NAFLD). This study aims to assess steatosis and fibrosis severity in a cohort of T2DM patients, using vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP). Material and method: We performed a prospective study in which, in each patient, we aimed for 10 valid CAP and liver stiffness measurements (LSM). To discriminate between fibrosis stages, we used the following VCTE cut-offs: F ≥ 2–8.2 kPa, F ≥ 3–9.7 kPa, and F4 - 13.6 kPa. To discriminate between steatosis stages, we used the following CAP cut-offs: S1 (mild) – 274 dB/m, S2 (moderate) – 290dB/m, S3 (severe) – 302dB/m. Results: During the study period, we screened 776 patients; 60.3% had severe steatosis, while 19.4% had advanced fibrosis. Female gender, BMI, waist circumference, elevated levels of AST, total cholesterol, triglycerides, blood glucose, and high LSM were associated with severe steatosis (all p-value < 0.05). BMI, waist circumference, elevated levels of AST, HbA1c, and CAP were associated with advanced fibrosis (all p-values < 0.05). Conclusion: Higher BMI (obesity) comprises a higher risk of developing severe steatosis and fibrosis. Individualized screening strategies should be established for NAFLD according to different BMI. [ABSTRACT FROM AUTHOR]

Aim: Nonalcoholic Fatty Liver Disease (NAFLD) is increasing in frequency in daily practice and evaluation of liver steatosis, fibrosis and inflammation severity are essential for prognosis assessment. The aim was to evaluate the usefulnessof a new liver steatosis quantification system - Ultrasound-Guided Attenuation Parameter (UGAP) from General Electric Healthcare, using Controlled Attenuation Parameter (CAP) as the reference method.Material and Method: 179 consecutive subjects, in whom liver steatosis was assessed in the same session using UGAP, implemented on LOGIQ E10 system (GE Healthcare), and CAP (FibroScan, EchoSens). To discriminate between steatosis stages by CAP, we used the cut-offs recommended by the manufacturer: S1 (mild) - 230 dB/m, S2 (moderate) - 275 dB/m, S3 (severe) - 300 dB/m.Results: We classified our cohort by means of CAP into the following groups: S0 (no steatosis): 48/176 (27.2%), S1 (mild): 56/176 (31.6%), S2 (moderate): 14/176 (7.3%) and S3 (severe): 59/176 (33.9%). The mean UGAP values increased with the steatosis grade and for each group were the following: S0: 198.3±25.7 dB/m, S1: 216.86±26.3 dB/m, S2: 237.79±26.3 dB/m, and S3: 270.8±31.62 dB/m respectively (p<0.001). A very good positive correlation was found between UGAP and CAP values (r=0.73, p<0.0001). The best cut-off values for predicting different grades of liver steatosis using CAP as the reference were: S1 - 192.5 dB/m (AUC 0.83); S2 - 231 dB/m (AUC 0.90) and S3 - 248 dB/m (AUC 0.91).Conclusion: UGAP seems to be a good method for liver steatosis quantification and correlates strongly with CAP values. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the performance and optimal cut-off points of UDFF for the non-invasive assessment of liver steatosis, using transient elastography (TE) with CAP as a reference method. We included 271 consecutive patients, with or without chronic liver disease (43.7% female, mean age 53.3 ± 13.05 years). Liver steatosis was evaluated in the same session by two techniques: UDFF - using a Siemens ACUSON Sequoia system (Deep Abdominal Transducer-DAX) and by CAP – using a FibroScan Compact M 530 device (M and XL probes). The following CAP cut-off values were used to differentiate among different grades of steatosis: 248dB/m for mild steatosis (S1), 268 dB/m for moderate steatosis (S2) and 280 dB/m for severe steatosis (S3). According to BMI, from the 271 patients 41% were obese, 34% were overweight and 25% normal weight. The correlation between UDFF and CAP was good, r=0.75, p<0.0001. We calculated the following UDFF optimal cut-off values to differentiate among steatosis grades: for S1->5% [(with 88.4% Se, 77.5% Sp,73.8% NPV, 90.3% PPV and an AUC of 0.92 (0.89-0.95), p<0.0001];for S2 >10% [(with 69.3% Se, 99% Sp, 99.1% NPV, 67.9% PPV and an AUC of 0.95 (0.92-0.97), p<0.0001]; and for S3 >15% [(with46.9% Se, 100% Sp, 100% NPV, 60.5% PPV and an AUC of 0.93 (0.89-0.96), p<0.0001]. UDFF is a good method for classifying steatosis severity with the following cut-offs:> 5% for mild steatosis,> 10% for moderate steatosis and > 15% for severe steatosis,the specificity increasing with steatosis severity. [ABSTRACT FROM AUTHOR]

Aim: The aim of our study was to assess the influence of liver residual mass in cirrhotic patients on the liver stiffness (LS), measured by ARFI elastography. Methods: Two hundreds eleven cirrhotic patients were enrolled. To evaluate the liver residual mass, the Child-Pugh and MELD scores were used and 10 valid ARFI measurements were performed. The correlation between Child-Pugh, MELD scores and the LS were evaluated. Results: Valid ARFI measurements were not obtained in 3 patients. A direct, very low correlation between the LS values and the Child-Pugh (r=0.264, p<0.001) and MELD scores (r=0.194, p=0.005) was found. A direct, low correlation between LS measurements and total bilirubin (r=0.271, p<0.001) and an inverse, low correlation with albumin (r=-0.270, p<0.001), prothrombin time (r=-0.196, p=0.006), cholinesterase (r=-0.241, p=0.003) was obtained. The LS mean values were statistically significant higher in patients with Child-Pugh class B vs. A (p=0.002) and in Child-Pugh C vs. A (p<0.001). The values were not significantly different in patients with Child-Pugh B vs. C (p=0.06). Conclusions: Higher values of LS measurements by means of ARFI could be an indicator of decreased liver functional reserve, evaluated by means of Child Pugh or Meld scores. [ABSTRACT FROM AUTHOR]

Noninvasive tools are well accepted by patients for fibrosis assessment in chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD). Transient elastography (TE) is an accepted alternative to liver biopsy for fibrosis evaluation. NAFLD is quite frequent in clinical practice and it is difficult to identify those patients who have nonalcoholic steatohepatitis (NASH). The aim of this study was to assess the value of simple biological tests (APRI, FIB 4 Index and BARD score) for ruling out the presence of significant and severe fibrosis and their correlation with TE in diabetic patients with NAFLD. We conducted a prospective study which included 469 diabetic patients (p) out of which 454 had steatosis (average age 61 ± 9.3 years, 55.1% female), evaluated both by serum markers (TGO, TGP, platelets) and by TE-Fibroscan (Echosens,Paris, France), with incorporated CAP function. Based on specific formulas we calculated APRI, FIB4 index and BARD score. Liver stiffness measurements (LSM) were considered reliable if 10 valid values with an IQR/median < 30% were obtained. For differentiation between stages of liver fibrosis, the following cut-off values were used [1]: significant fibrosis > 8.5 kPa, severe fibrosis > 10.1kPa, and for steatosis we considered: S1(mild)-230-275 db/m, S2 (moderate)-275-300 db/m, S3 (severe) > 300 db/m. We tried to rule out significant fibrosis by using APRI < 0.5 (77%p) - 63% of them with LSM < 8.5 kPa, resulting in NPV of 85.7%; and severe fibrosis by using APRI < 2 (98.5%p) - 80.6% of them with LSM < 10.1 kPa, resulting in NPV of 86%. We found a moderate, but significant correlation between liver fibrosis assessed by TE and liver fibrosis predicted by APRI (Pearson r = 0.5, p = 0.001). Regarding FIB4 score, we found that 94%p had FIB4 < 2.6, thus ruling out severe fibrosis, among which 99% had LSM < 10.1kPa, resulting in NPV of 85%. The correlation between FIB4 and TE was weak, but statistically significant (r = 0.23, p = 0.0001). 18.3% of patients had a BARD score < 2, 95.2% of them with LSM < 10.1 kPa, resulting in a strong NPV of 86.1%. simple tests such as APRI score < 2, FIB4 score < 2.6 and BARD score < 2 can quite accurately rule out advanced fibrosis. These simple scores could be used as first line tests to rule out patients with advanced fibrosis. [ABSTRACT FROM AUTHOR]

Objective: to highlight the prevalence of liver fibrosis stages assessed by transient elastography (TE) in a large cohort of patients in a single study center. Material and method: 22400 liver stiffness(LS) assessments by mean of TE have been performed in our Department during an 11 years period(2007-2018). The study included patients with chronic liver diseases of various etiology. In each patient, 10 valid LS measurements were obtained either with M probe or with XL probe. If no valid LS measurements could be obtained, the evaluation was declared as failure. Reliable LSM were defined as median value of 10 measurements with Interquartile range/median (IQR/M)≤30%, and a Success Rate (SR)≥60%. To discriminate between LS stages by TE we used the following cut-offs[1]: F2-7 kPa; F3-9.5 kPa and F4-12 kPa. Results: The feasibility in our cohort was 90.1%, 2238 of 22400 measurements(9.9%) were failed or unreliable. The etiology of chronic liver diseases evaluated by TE was: hepatitis C virus infection:35%(7838 patients), hepatitis B virus infection:20.5%(4601), dual hepatitis virus infection:1.5%(332), alcoholic liver disease:5.2%(1172), Non-Alcoholic Steatohepatitis (NASH):6.8%(1518), Both Alcoholic and Non-Alcoholic Steatohepatitis(BASH):0.3%(72) and other etiologies:30.7%(6867). Based on TE cut-off values, the severity of liver fibrosis in our group was as follows:F<2:9783 patients(48.5%); F2:3132 patients(15.6%); F3:1714 patients(8.5%) and F4:5533 patients(27.4%). Conclusion: Transient elastography had a feasibility of 90.1% in this large cohort, almost half of the patients(48.5%) having at most mild fibrosis, and approximately one quarter having cirrhosis (27.4%). [ABSTRACT FROM AUTHOR]