How effective are APRI, FIB-4, FIB-5 scores in predicting liver fibrosis in chronic hepatitis B patients?

Liver fibrosis is the most important factor in the prognosis and treatment plan of patients with chronic hepatitis B (CHB). Aspartate aminotransferase (AST)-to-platelet ratio index (APRI), fibrosis index based on 4 factors (FIB-4), and fibrosis index based on 5 factors (FIB-5) scores are noninvasive fibrosis markers, and previous comparative studies have shown that they are as effective as liver biopsy in detecting liver fibrosis in different liver diseases. The aim of our study is to investigate whether existing scoring systems are effective in demonstrating fibrosis in CHB patients and to compare the APRI, FIB 4, and FIB 5 scores in differentiating early and advanced fibrosis in 123 patients who underwent liver biopsy for CHB infection. APRI, FIB-4, and FIB-5 scores of patients who underwent liver biopsy due to CHB were calculated by means of calculators and recorded to be compared with liver biopsies in terms of fibrosis scoring. One hundred twenty-three patients who underwent liver biopsy due to chronic hepatitis B were included in the study. APRI (area under the receiver-operating characteristic [ROC] curve 0.728), FIB-4 (area under the ROC curve 0.693) and FIB-5 (area under the ROC curve 0.643) scores were evaluated as significant predictors of advanced fibrosis. The scoring system with the highest positive and negative predictive value was evaluated as FIB-4. APRI, FIB-4, and FIB-5 scoring systems are appropriate scoring systems in the assessment of advanced fibrosis in patients with CHB. Our study is the first to compare APRI, FIB-4, and FIB-5 values in CHB patients, and more comprehensive studies are needed.

Post COVID-19 irritable bowel syndrome.

OBJECTIVES: The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. DESIGN: GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. RESULTS: The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. CONCLUSION: Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls. TRIAL REGISTRATION NUMBER: NCT04691895.

Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study.

INTRODUCTION: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month. METHODS: The GI-COVID-19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire. RESULTS: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID+ and 296 COVID-) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P < 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels. DISCUSSION: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection.

The importance of complete blood count parameters in the screening of gastric cancer.

INTRODUCTION: Gastric cancer is ranked fourth among all cancers in the world and second in cancer-related deaths. Gastritis leads to the activation of neutrophils, lymphocytes, macrophages, and platelets. Long-term inflammation leads to multistage histopathologic changes called Correa tract, which includes gastritis, atrophy, intestinal metaplasia (IM), dysplasia, and cancer stages. AIM: To determine if there is any difference in haematological parameters between gastric cancer (GC) patients, patients with IM, and healthy controls (HC). MATERIAL AND METHODS: Seventy-three GC patients, 79 patients with IM, and 70 HCs were included in the study. Demographics and laboratory parameters of complete blood count were extracted from the hospital medical database records. RESULTS: The mean Hb levels were statistically significant between all three groups. Mean red cell distribution width (RDW), white blood cells (WBC), mean platelet volume (MPV), platelet distribution width (PDW), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and monocyte-to-lymphocyte (MLR) levels were statistically significantly different between gastric cancer and healthy controls. Mean RDW, MPV, and PDW levels were statistically significantly different between the IM and healthy control groups. Mean WBC, NLR, PLR, and MLR levels were statistically significantly different between the gastric cancer and IM groups. CONCLUSIONS: RDW, platelet count, NLR, MLR, and PLR have diagnostic value and can help to distinguish patients with GC from those with IM. These parameters are accessible easily, the cost is not high, and it may help patients not to delay endoscopic screening.

Clinical Significance of Serum Vascular Endothelial Growth Factor, Pigment Epithelium-Derived Factor, Tumor Necrosis Factor Alpha, and Progranulin Levels in Patients with Gastric Cancer and Gastric Precancerous Lesions.

BACKGROUND: The purpose of this study is to evaluate serum levels of vascular endothelial growth factor (VEGF), pigment epithelium-derived factor (PEDF), tumor necrosis factor alpha (TNF-α), and progranulin in patients with gastric cancer (GC) and precancerous lesions (PCL) and to determine the usefulness of these markers as diagnostic biomarkers in these diseases. METHOD: A total of 32 GC patients, 35 PCL patients, and 23 healthy controls participated in the study. The serum levels of VEGF, PEDF, TNF-α, and progranulin were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: The mean serum VEGF levels were 30.6 ± 12.98 pg/mL in GC, 18.2 ± 5.72 pg/mL in PCL, and 17.5 ± 5.59 pg/mL in controls. GC VEGF levels were significantly higher than both PCL and control groups (p < 0.001). The mean serum PEDF levels were 1516.1 ± 993.8 pg/mL in GC, 1039.1 ± 1002.3 pg/mL in PCL, and 767.5 ± 661.5 pg/mL in controls. The serum PEDF level in the GC group was significantly higher than that in both PCL and control groups (p = 0.004 and p = 0.038, respectively). The mean serum TNF-α levels were 46.7 ± 14.82 pg/mL in GC, 38.4 ± 11.89 pg/mL in PCL, and 33.8 ± 12.77 pg/mL in controls. There was a significant difference between GC and controls (p = 0.022) in TNF-α levels. The mean serum progranulin levels in GC were 2496.6 ± 737.8 pg/mL, 2332.0 ± 482.1 pg/mL in PCL, and 1288.7 ± 830.9 pg/mL in controls. Progranulin levels in both GC and PCL groups were significantly higher than that in the control group (p < 0.001 for both). CONCLUSION: There were significant differences among patients with GC and PCL and healthy controls in terms of serum VEGF, PEDF, TNF-α, and progranulin levels.

Serum interleukin-35 and pentraxin-3 levels in patients with mild acute pancreatitis.

INTRODUCTION: Interleukin-35 (IL-35) is a newly defined potent anti-inflammatory cytokine that is predominantly produced by regulatory T cells, and pentraxin-3 belongs to the acute-phase proteins. AIM: To measure the serum IL-35 and pentraxin-3 levels in the early phase of mild acute pancreatitis (AP). MATERIAL AND METHODS: Eighty-three patients with mild AP and 30 healthy controls were included in the study. The serum levels of IL-35 and pentraxin-3 were measured by enzyme-linked immunosorbent assay upon admission and at the 48th hour after diagnosis. RESULTS: The mean value of serum IL-35 levels in patients with mild acute pancreatitis at admission was 5.91 ng/ml (4.21-7.90) and was significantly lower than those in healthy controls (25.53 ng/ml (12.79-54.73, p < 0.001)) and 48-hour value were (6.79 ng/ml (4.42-9.62) (p = 0.015)). The mean value of serum pentraxin-3 levels in patients at the time of admission was 6.75 ng/ml (4.42-9.62) and there was no significant difference from healthy controls, at 7.64 ng/ml (6.58-8.62, p > 0.05). Also there was no significant difference between the mean value at admission and the mean value at 48-hour, 6.75 ng/ml (4.74-9.06, p > 0.05). CONCLUSIONS: Interleukin-35 can be used in diagnosis and follow-up in patients with mild AP.

Expression of M30 and M65 in celiac disease. Analytical cross-sectional study

ABSTRACT BACKGROUND: The role of villous atrophy in apoptosis, a distinctive feature of celiac disease, is a matter of controversy. The aim of this study was to determine the apoptosis rate through immunohistochemical staining for M30 and M65 in celiac disease cases. DESIGN AND SETTING: Analytical cross-sectional study in a tertiary-level center. METHODS: Duodenal biopsies from 28 treatment-naive patients with celiac disease, 16 patients with potential celiac disease, 10 patients with a gluten-free diet and 8 controls were subjected to immunohistochemical staining for the end-apoptotic marker M30 and the total cell death marker M65. H-scores were compared. Several laboratory parameters were recorded concomitantly, and at the one-year follow-up for celiac disease and potential celiac disease patients. RESULTS: There was a significant difference in H-score for M30 expression between the celiac disease, potential celiac disease and gluten-free diet groups (P = 0.009). There was no significant difference in H-score for M65 expression. There was a positive correlation between the H-score for M30 expression and the anti-tissue transglutaminase immunoglobulin A (anti-tTgIgA) and anti-tissue transglutaminase immunoglobulin G (anti-tTgIgG) levels (R = 0.285, P = 0.036; and R = 0.307, P = 0.024, respectively); and between the H-score for M65 expression and the anti-tTgIgA and anti-tTgIgG levels (R = 0.265, P = 0.053; and R=0.314, P = 0.021, respectively). There was no difference between celiac disease and potential celiac disease patients regarding the laboratory parameters selected. CONCLUSION: The rates of apoptosis and nutritional deficiencies in patients with potential celiac disease were similar to those in patients with celiac disease.

Expression of M30 and M65 in celiac disease. Analytical cross-sectional study.

BACKGROUND: The role of villous atrophy in apoptosis, a distinctive feature of celiac disease, is a matter of controversy. The aim of this study was to determine the apoptosis rate through immunohistochemical staining for M30 and M65 in celiac disease cases. DESIGN AND SETTING: Analytical cross-sectional study in a tertiary-level center. METHODS: Duodenal biopsies from 28 treatment-naive patients with celiac disease, 16 patients with potential celiac disease, 10 patients with a gluten-free diet and 8 controls were subjected to immunohistochemical staining for the end-apoptotic marker M30 and the total cell death marker M65. H-scores were compared. Several laboratory parameters were recorded concomitantly, and at the one-year follow-up for celiac disease and potential celiac disease patients. RESULTS: There was a significant difference in H-score for M30 expression between the celiac disease, potential celiac disease and gluten-free diet groups (P = 0.009). There was no significant difference in H-score for M65 expression. There was a positive correlation between the H-score for M30 expression and the anti-tissue transglutaminase immunoglobulin A (anti-tTgIgA) and anti-tissue transglutaminase immunoglobulin G (anti-tTgIgG) levels (R = 0.285, P = 0.036; and R = 0.307, P = 0.024, respectively); and between the H-score for M65 expression and the anti-tTgIgA and anti-tTgIgG levels (R = 0.265, P = 0.053; and R=0.314, P = 0.021, respectively). There was no difference between celiac disease and potential celiac disease patients regarding the laboratory parameters selected. CONCLUSION: The rates of apoptosis and nutritional deficiencies in patients with potential celiac disease were similar to those in patients with celiac disease.

Absence of non-alcoholic fatty liver disease in the presence of insulin resistance is a strong predictor for colorectal carcinoma.

BACKGROUND: Colorectal carcinoma (CRC) and non-alcoholic fatty liver disease (NAFLD) share common risk factors. Insulin resistance (IR) has an important role in both diseases. It has been speculated that the prevalence of colorectal neoplasms might be increased in patients with NAFLD. However, It is unclear whether NAFLD is an actual risk factor or any association is incidental coexistance due to the role of IR in both disease. We aimed to assess the risk for CRC in patients with NAFLD in relation to IR. METHOD: This study was designed prospectively and cross-sectionally. We determined NAFLD by ultrasonography and measured IR by the homeostatic model of assessment-insulin resistance model. RESULTS: The prevalences of CRC and adenoma were shown to be significantly higher in patients with IR (respectively; P: 0.005, P: 0.008). But prevalence of CRC was found to be significantly lower in subjects with NAFLD (P: 0.001). On multivariate logistic regression analysis, the risks of colorectal adenoma and carcinoma were significantly associated with the presence of IR (respectively; OR: 2.338, 95% CI: 1.080-4.993, P: 0.003 and : 5.023, 95% CI: 1.789-9.789, P: 0.001). The risk for CRC was significantly associated with the absence of NAFLD (OR: 7.380, 95% CI: 3.069-7.961, P: 0.010). The absence of NAFLD in the presence of IR was associated with significantly high risk for CRC (OR: 5.218, 95% CI: 1.538-7.448, P: 0.017). CONCLUSION: The risk of CRC can increased in subjects with IR but without NAFLD. The absence of NAFLD in the presence of IR may predict the CRC.