BACKGROUND Liver fibrosis leads to liver-related events in patients with chronic hepatitis C (CHC) infection. Although non-invasive tests (NITs) are critical to early detection of the development of liver fibrosis, the prognostic role of NITs remains unclear due to the limited types of NITs and liver outcomes explored in previous studies. AIM To determine the prognostic value of NITs for risk stratification in CHC patients. METHODS The protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019128176). The systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search was performed using MEDLINE and EMBASE databases under a timeframe from the inception of the databases through February 25, 2020. We restricted our search to CHC cohort studies reporting an association between liver fibrosis assessed by NITs and the development of hepatocellular carcinoma, decompensation, or mortality. Pooled hazard ratios (HR) and area under the receiver operating characteristic (AUROC) for each NIT were estimated using a random effects model. Subgroup analyses were performed for NITs assessed at pre-treatment or post-treatment with sustained virologic response (SVR), treatment with either pegylated interferon and ribavirin or direct acting antiviral, Eastern or Western countries, and different cutoff points. RESULTS The present meta - analysis included 29 cohort studies, enrolling 69339 CHC patients. Fibrosis-4 (FIB-4) index, aspartate aminotransferase to platelet ratio (APRI) score, and liver stiffness measurement (LSM) were found to have hepatocellular carcinoma predictive potential with pooled adjusted HRs of 2.48 [95% confidence interval (CI): 1.91-3.23, I 2 = 96%], 4.24 (95%CI: 2.15-8.38, I 2 = 20%) and 7.90 (95%CI: 3.98-15.68, I 2 = 52%) and AUROCs of 0.81 (95%CI: 0.73-0.89, I 2 = 77%), 0.81 (95%CI: 0.75-0.87, I 2 = 68%), and 0.79 (95%CI: 0.63-0.96, I 2 = 90%), respectively. Pooled adjusted HR with a pre-treatment FIB-4 cutoff of 3.25 was 3.22 (95%CI: 2.32-4.47, I 2 = 80%). Pooled adjusted HRs for post-treatment with SVR FIB-4, APRI, and LSM were 3.01 (95%CI: 0.32-28.61, I 2 = 89%), 9.88 (95%CI: 2.21-44.17, I 2 = 24%), and 6.33 (95%CI: 2.57-15.59, I 2 = 17%), respectively. Pooled adjusted HRs for LSM in patients with SVR following direct acting antiviral therapy was 5.55 (95%CI: 1.47-21.02, I 2 = 36%). Pooled AUROCs for po...
Introduction: While excessive alcohol consumption is associated with arterial hypertension. Cirrhotic patient's risk for hypertension remains unclear due to both vasodilatation and vasoconstriction effect. We aim to examine the association between alcohol consumption and hypertension in patients with different degrees of liver fibrosis. Methods: A cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 included adult participants. Association between alcohol consumption and both systolic and diastolic hypertension (SHTN and DHTN) defined as SBP and DBP $120 and $80 mmHg, respectively were analyzed by multivariate logistic regression. Prespecified subgroup analyses were performed to investigate potential effect modifiers. Results: A total of 9,693 patients were identified (mean age 50619 years old; 51% female; 35% white). Among the participants with Fibroscan results, they were stratified into 3 groups based on the number of alcohol drinks per day (0-1 drink per day (G1), 2,126 [36%]; 1-4 drinks per day (G2), 2,612 [45%]; . 4 drinks per day (G3), 1,125 [20%]). After controlling for age, race, gender, body mass index, diabetic status, hyperlipidemic status, serum creatinine, urinary albumin:creatinine ratio, and fibrotic liver stage (, F2 5 mild and $F2 5 significant with fibrosis scores of , 7.5 and $7.5 kPa, respectively), the G2 and G3 had greater the odds of having SHTN but not statistically significant.
Background: Galangin is a natural flavonoid found in honey and Alpinia officinarum. Several reports have suggested the anti-mutagenic, antioxidant, anti-proliferative, and apoptotic effects. However, the antihypertensive effect of galangin in renovascular hypertension has not been investigated. Aims:This study aims to investigate the effect of galangin on blood pressure and cardiac changes in renovascular hypertension.Methods: Male Sprague Dawley rats (180-220 g) were induced hypertension by clipping the left renal artery, 2-kidney-1-clip (2K-1C). After 3 weeks of the induction period, galangin (30 and 60 mg/kg) and losartan (10 mg/kg) were given to the rats for 4 weeks (n = 8/group). Blood pressure and cardiac function were evaluated at the end of the experimental day. The level of angiotensin-converting enzyme (ACE) activity, angiotensin II, and oxidative stress markers were assessed in the plasma and cardiac tissue of rats. The protein expression of angiotensin II receptor type 1 (AT1R), transforming growth factor-beta 1 (TGF-b 1) and collagen type I (Col I) were determined in cardiac tissue. Statistical analysis was carried out by one-way ANOVA followed by Tukey post hoc test. A p value less than 0.05 was considered statistically significant.Results: Hypertension and cardiac dysfunction and hypertrophy were observed in 2K-1C rats compared to the sham-operated rats (p < 0.05). Treatment with galangin (30 and 60 mg/kg) decreased high blood pressure and improved cardiac function as well as alleviated left ventricular hypertrophy in 2K-1C hypertensive rats (p < 0.05). This result was related with the reduction of systemic ACE activity and angiotensin II levels in 2K-1C hypertensive rats that were treated with galangin (p < 0.05). Moreover, the expression of AT1R, TGF-b 1 and Col I in cardiac tissue was modulated by treatment with galangin (p < 0.05).Additionally, galangin showed anti-oxidative effects as it reduced the production of superoxide and malondialdehyde levels in cardiac tissue of rats (p < 0.05). Conclusion:Galangin exhibited an antihypertensive effect and alleviated cardiac alteration in renovascular hypertensive rats. The underlying mechanism might be related to its inhibitory effects on renin-angiotensin system and anti-oxidative properties renal artery stenosis-induced hypertensive rats. Furthermore, the beneficial effect of galangin on heart might mediate the suppression of AT1R, TGF-b 1 and Col I pathway.
Introduction: Although inadequate sleep is known to associate with cardiovascular (CV) outcomes including stroke, association between sleep duration and stroke is unclear. Hypothesis: Shorter sleep duration is associated with higher risk of stroke. Methods: A retrospective cross-sectional analysis of the 2017-2020 National Health and Nutrition Examination Survey (NHANES) included adult participants aged 21 to 79 years with self-reported history of stroke and sleep duration was studied. Association of sleep duration, stratified into short (<6 hours) and normal sleep durations (≥6 hours), and stroke was evaluated by multivariate logistic regression. Results: A total of 8,416 participants were identified, of which mean age was 48.25±16 years old, 51.5% were female and mean sleep duration was 7.529 ± 1.651 hours. Overall, 377 patients (4.5%) had a stroke, of which mean sleep duration was 7.545 ± 2.132. Mean sleep duration of non-stroke population was 7.528 ± 1.626. The difference of mean sleep duration between these two groups was statistically significant (0.017 hours; P < 0.001; 95% Cl -0.156,0.189; Figure1). The majority of the study participants reported a normal sleep duration (7426 participants, 88.2%) and the remaining 913 participants (10.8%) had a short sleep duration. Compared with the normal sleep duration group, participants with the short sleep duration had significantly lesser the odds of stroke (adjusted odds ratio 0.574; P < 0.001; 95% CI 0.424,0.777) after adjusted for baseline risk factors including age, gender, ethnicity, body mass index (<25 vs. ≥25 kg/m 2 ), history of hypertension and diabetes. Conclusions: Contrary to previous reports, this study shows that sleep duration is positively associated with risk of stroke. Further long-term studies that focus on understanding the pathophysiology using non-self-reported method are required to elucidate effect of sleep quality and optimal sleep duration on the adverse CV outcomes.
Introduction: While cirrhotic patients increase risk of hemorrhagic and thrombotic events, association of liver stiffness with stroke remaines unclear. Hypothesis: Severity of liver stiffness is associated with higher prevalence of stroke. Methods: A cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 included adult participants aged 21 to 79 years. Association between prevalence of self-reported stroke and liver stiffness stratified for 4 fibrosis scores measured by Fibroscan ™ were analyzed by multivariate logistic regression. Results: A total of 8,416 patients with Fibroscan results were identified (mean age 49 + 16 years old; 52% female; 32% white). Overall, 377 patients (4.5%) had a stroke. The number of participants stratified by 4 fibrotic stages of mild (F0F1), moderate (F2), severe fibrosis (F3), and cirhosis (F4) were 6,243 (74.2%), 826 (9.8%), 122 (1.4%), and 155 (1.8%) patients, respectively. In multivariate logistic regression, after controlling for age, race, gender, diabetic status, body mass index (<25 vs > 25 kg/m 2 ), and high systolic blood pressure ( < 130 vs >130 mmHg), individuals with severe fibrotic liver (F3 and F4) were significantly more likely to have a stroke (adjusted odds ratio (OR) 1.64; p= 0.044; 95% confidence interval (CI) 1.01, 2.65; Figure 1). Furthermore, we found that patients with cirrhosis (F4) were the most at risk to have a stroke (adjusted OR 1.91; p= 0.037; 95% CI 1.04, 3.49; Figure 1). Conclusions: In this cross-sectional data, there is a graded association between severe fibrotic liver disease measured by Fibroscan ™ and elevated prevalence of stroke. Longitudinal studies including additional risk factors of stroke such as hyperlipidemia, hypertension and atrial fibrillation need to be further evaluated.
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