LiverScreen project: study protocol for screening for liver fibrosis in the general population in European countries.

BACKGROUND: The development of liver cirrhosis is usually an asymptomatic process until late stages when complications occur. The potential reversibility of the disease is dependent on early diagnosis of liver fibrosis and timely targeted treatment. Recently, the use of non-invasive tools has been suggested for screening of liver fibrosis, especially in subjects with risk factors for chronic liver disease. Nevertheless, large population-based studies with cost-effectiveness analyses are still lacking to support the widespread use of such tools. The aim of this study is to investigate whether non-invasive liver stiffness measurement in the general population is useful to identify subjects with asymptomatic, advanced chronic liver disease. METHODS: This study aims to include 30,000 subjects from eight European countries. Subjects from the general population aged ≥ 40 years without known liver disease will be invited to participate in the study either through phone calls/letters or through their primary care center. In the first study visit, subjects will undergo bloodwork as well as hepatic fat quantification and liver stiffness measurement (LSM) by vibration-controlled transient elastography. If LSM is ≥ 8 kPa and/or if ALT levels are ≥1.5 x upper limit of normal, subjects will be referred to hospital for further evaluation and consideration of liver biopsy. The primary outcome is the percentage of subjects with LSM ≥ 8kPa. In addition, a health economic evaluation will be performed to assess the cost-effectiveness and budget impact of such an intervention. The project is funded by the European Commission H2020 program. DISCUSSION: This study comes at an especially important time, as the burden of chronic liver diseases is expected to increase in the coming years. There is consequently an urgent need to change our current approach, from diagnosing the disease late when the impact of interventions may be limited to diagnosing the disease earlier, when the patient is asymptomatic and free of complications, and the disease potentially reversible. Ultimately, the LiverScreen study will serve as a basis from which diagnostic pathways can be developed and adapted to the specific socio-economic and healthcare conditions in each country. TRIAL REGISTRATION: This study is registered on Clinicaltrials.gov ( NCT03789825 ).

Psychological Burden of Hepatic Encephalopathy on Patients and Caregivers.

OBJECTIVES: Hepatic encephalopathy (HE) is common in advanced cirrhosis and is characterized by marked neuropsychiatric abnormalities. However, despite its severity and effects on brain function, the impact of HE on psychological status of patients has not been adequately assessed. The aim of this study was to evaluate the effect of HE on psychological status of patients and their informal caregivers. METHODS: Fifteen patients with cirrhosis and episodic or persistent HE and their corresponding informal caregivers were included. Semistructured interviews were performed in patients and caregivers. Quality of life (QoL) was assessed by the short-form 36 in both patients and caregivers, and the Zarit burden score was measured in caregivers. The analysis of interviews was performed using qualitative methodology. RESULTS: HE causes a major psychological impact on patients with HE. The first episode of HE caused a very significant impact that was reported with deep feelings, mainly of fear, anger, misery, anxiety, and sorrow, which persisted with time. Symptoms causing more psychological impact on patients were impaired ability to walk and speak. All effects were associated with a marked impairment in QoL. The psychological impact was also marked in caregivers who had a major burden, as assessed by the Zarit score. Moreover, QoL, particularly the mental component score, was markedly impaired in caregivers in intensity similar to that of patients. DISCUSSION: HE has a profound psychological impact on patients and their informal caregivers, associated with a marked negative influence on QoL. The psychological effects of HE on patients and caregivers should be evaluated and treated.

Neutrophil Gelatinase-Associated Lipocalin for Assessment of Acute Kidney Injury in Cirrhosis: A Prospective Study.

Kidney biomarkers appear to be useful in differential diagnosis between acute tubular necrosis (ATN) and other types of acute kidney injury (AKI) in cirrhosis, particularly hepatorenal syndrome (HRS-AKI). Distinction is important because treatment is different. However, kidney biomarkers are still not used in clinical practice. The aim of the current study was to investigate the accuracy of several biomarkers in differential diagnosis of AKI and in predicting kidney outcome and patient survival. This was a prospective study of 320 consecutive cases of AKI in patients hospitalized for decompensated cirrhosis. Evaluation of AKI was made with a diagnostic algorithm that included identification and removal/treatment of precipitating factors and albumin administration (1 g/kg for 2 days) to patients with AKI stage 1B or greater. Urinary neutrophil gelatinase-associated lipocalin (NGAL), monomeric NGAL (mNGAL), interleukin-18, and standard biomarkers were measured at diagnosis and on days 3, 7, and 14. Of the 320 cases, 153 were hypovolemia-induced AKI (48%), 93 were HRS-AKI (29%), 39 were ATN (12%), and 35 were due to miscellaneous causes (11%). Among all biomarkers, urinary NGAL measured at day 3 had the greatest accuracy for differential diagnosis between ATN and other types of AKI (area under the receiver operating characteristic curve, 0.87; 95% confidence interval, 0.78-0.95). The cutoff with the best predictive accuracy for ATN diagnosis was 220 µg/g creatinine. Progression of AKI during hospitalization was associated with persistently high NGAL levels, and NGAL was an independent predictive factor of AKI progression. Likewise, NGAL was also an independent predictive factor of 28-day mortality together with Model for End-Stage Liver Disease score. Conclusion: These results support the use of NGAL in clinical practice within the context of a diagnostic algorithm for differential diagnosis of AKI and outcome prediction in cirrhosis.

Efectos en la intención de compra de pirelli mediante el patrocinio deportivo en el world superbike / Effects on the pirelli`s purchase intention through sports sponsorship at the world superbike / Efeitos na intenção de compra de pirelli mediante o patrocínio esportivo no world superbike

En los últimos años, el patrocinio deportivo se ha convertido en una importante industria mundial, como parte integrada de la estrategia de comunicación dentro del departamento de marketing de las corporaciones. Eventos deportivos como World Superbike (SBK), se conciben como muy atractivos en dicha estrategia de patrocinio. Esta investigación analiza el efecto en la intención de compra de la marca Pirelli, a partir de su estrategia de patrocinio de SBK, mediante la administración de un cuestionario a 140 asistentes a la penúltima prueba del circuito de 2015, celebrada en Jerez (España). Los resultados muestran una intención de compra de un 80% a favor. Se ha encontrado una asociación entre la actitud hacia el evento, y el conocimiento de las marcas patrocinadoras, así como entre la actitud hacia el evento y la actitud frente a Pirelli. Por otro lado, no se han encontrado variables predictoras para la intención de compra.

In recent years, sports sponsorship has become an important global industry, as an integrated part of the communication strategies within the marketing department of corporations. Sports events like World Superbike are conceived as very attractive in this sponsorship strategy. This research analyzes the effect on the purchase intention of the Pirelli brand based its SBK sponsorship strategy; by administering a questionnaire to 140 attendees to the 2015 penultimate circuit test held in Jerez (Spain). The results show a purchase intention of 80% in favor. An association between the attitude towards the event and the knowledge of the sponsoring brands has been found, as well as, between the attitude towards the event and the attitude towards Pirelli. On the other hand, no predictor variables have been found for the purchase intention.

Nos últimos anos o patrocínio esportivo converteu-se em uma importante indústria mundial, como parte integrada da estratégia de comunicação dentro do departamento de marketing das corporações. Eventos esportivos como World Superbike concebem-se como muito atraentes em dita estratégia de patrocínio. Esta investigação analisa o efeito na intenção de compra da marca Pirelli a partir de sua estratégia de patrocínio de SBK, mediante a administração de um questionário a 140 assistentes à penúltima prova do circuito de 2015 celebrada em Jerez (Espanha). Os resultados mostram uma intenção de compra de 80% a favor. Encontrou-se uma associação entre a atitude para o evento e o conhecimento das marcas patrocinadoras, bem como entre a atitude para o evento e a atitude em frente à Pirelli. Por outro lado, não se encontraram variáveis reveladoras para a intenção de compra.