Performance of spleen stiffness measurement to rule out high-risk varices in patients with porto-sinusoidal vascular disorder.

BACKGROUND AIMS: Baveno VII consensus suggests that screening endoscopy can be spared in patients with compensated cirrhosis when spleen stiffness measurement (SSM) by vibration-controlled transient elastography (VCTE) is ≤40 kPa as they have a low probability of high-risk varices (HRV). Conversely, screening endoscopy is required in all patients with porto-sinusoidal vascular disorder (PSVD). This study aimed to evaluate the performance of SSM-VCTE to rule out HRV in patients with PSVD and signs of portal hypertension. APPROACH RESULTS: We retrospectively included patients with PSVD, ≥1 sign of portal hypertension, without history of variceal bleeding, who underwent a SSM-VCTE within 2 years before or after an upper endoscopy in 21 VALDIG centers, divided into a derivation and a validation cohort. 154 patients were included in the derivation cohort; 43% had HRV. By multivariable logistic regression analysis, SSM-VCTE >40 kPa and serum bilirubin ≥1 mg/dL were associated with HRV. SSM-VCTE ≤40 kPa combined with bilirubin <1 mg/dL had a sensitivity of 96% to rule out HRV, and could spare 38% of screening endoscopies, with 4% of HRV missed, and a 95% negative predictive value (NPV). In the validation cohort, including 155 patients, SSM combined with bilirubin could spare 21% of screening endoscopies, with 4% of HRV missed and a 94% NPV. CONCLUSION: This study gathering a total of 309 PSVD patients showed that SSM-VCTE ≤40 kPa combined with bilirubin <1 mg/dL identifies patients with PSVD and portal hypertension with a probability of HRV <5%, in whom screening endoscopy can be spared.

Multiparametric ultrasound evaluation of liver fibrosis, steatosis, and viscosity in patients with chronic liver disease.

AIMS: This study assessed the effectiveness of three ultrasound-based techniques (2D-SWE.PLUS, Att.PLUS, Vi.PLUS) for non-invasive evaluation of liver fibrosis, steatosis, and inflammation in chronic liver disease (CLD) patients.Materials and methods: Involving 209 consecutive compensated CLD patients, the study compared these ultrasound methods from Aixplorerwith standard Vibration-controlled Transient Elastography (VCTE) and Controlled Attenuation Parameter (CAP) from Fibroscan, alongside non-invasive serological markers. RESULTS: High validity rates were observed in measurements: 99% for VCTE, 89% for 2D-SWE.PLUS/Vi.PLUS, and 96.6% for Att.PLUS. 2D-SWE.PLUS showed a strong correlation with VCTE (R=0.91) and excelled at a lower Stability Index (80%), with optimal cut-offs for moderate and severe fibrosis at 8 kPa and 10 kPa, respectively. 2D-SWE.PLUS was superior to Fib4, eLIFT, APRI, BARD, and NFS in detecting advanced CLD. Att.PLUS moderately correlated with CAP (R=0.47) for steatosis grades, while Viscosity was highly effective in identifying significant fibrosis (AUC=0.87) but less so for inflammation. CONCLUSIONS: 2D-SWE.PLUS demonstrated superior diagnostic precision in liver fibrosis, exceeding other non-invasive markers. Att.PLUS was relatively accurate for liver steatosis, and viscosity more effectively indicated fibrosis stages than inflammation in CLD patients.

Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival.

BACKGROUND: Malnutrition is frequently encountered in patients with cirrhosis and appears to significantly impact their prognosis. While evaluating the burden of malnutrition in cirrhosis is gathering momentum, as suggested by multiple recently published reports, there is still a persistent scarcity of solid data in the field, especially with regards to the role of nutritional interventions. AIM: To assess the prevalence of malnutrition in patients with advanced cirrhosis and to evaluate its impact on survival. METHODS: One hundred and one consecutive patients with advanced cirrhosis were screened for malnutrition using the Subjective Global Assessment (SGA) criteria and the mid-arm circumference (MAC). Malnutrition was defined as SGA class B and C and MAC < 10th percentile. All patients were interviewed regarding their food intake using an adapted questionnaire. Subsequently, total energy intake was calculated and further subdivided in main nutrients. The data were then compared to the available recommendations at the time of analysis to assess adherence. RESULTS: 54/79 patients (68.4%) in the decompensated group had malnutrition, while only 3/22 patients (13.6%) were malnourished in the compensated group. After a median follow-up time of 27 mo (0-53), the overall mortality was 70%. Survival was significantly lower among patients with malnutrition. The mortality rates were 50% at 1 year and 63% at 2 years for the patients with malnutrition, compared to 21% at 1 year and 30% at 2 years for patients without malnutrition (P = 0.01). On multivariate analysis, the factors independently associated with mortality were age, creatinine level and adherence to the protein intake recommendations. The mortality was lower in patients with the appropriate protein intake: 8% at 1 year and 28% at 2 years in the adherent group, compared to 47% at 1 year and 56% at 2 years in the non-adherent group. CONCLUSION: The prevalence of malnutrition is high among patients with advanced cirrhosis and might be related in part to a low adherence to nutritional recommendations, especially with regards to protein intake.

A Rare Association between Left Lobe Secondary Biliary Cirrhosis and Budd-Chiari Syndrome Secondary to Hepatocellular Carcinoma in the Non-Cirrhotic Right Liver Lobe.

Liver cirrhosis is a diffuse chronic liver disease affecting the entire liver. The fibrosis accumulation and distribution in the liver are known to be heterogeneous. "Localized" or "focal" cirrhosis is only anecdotically reported. Acute hepatitis E virus (HEV) infection is uncommon in western countries, especially in temperate climate areas and is very often missed or underdiagnosed. However, it may be responsible of up to 15% of acute-on-chronic liver failure cases. We present the case of a 35-year-old patient with a very uncommon association of Budd-Chiari syndrome secondary to hepatocellular carcinoma (HCC) developed on a non-cirrhotic right liver lobe and secondary biliary cirrhosis of the left liver lobe, that further complicated with acute HEV infection leading to acute-on-chronic liver failure and death.