Diabetes impairs the haemodynamic response to non‐selective betablockers in compensated cirrhosis and predisposes to hepatic decompensation

Paternostro, Rafael; Jachs, Mathias; Hartl, Lukas; Simbrunner, Benedikt; Scheiner, Bernhard; Bauer, Dávid; Schwabl, Philipp; Semmler, Georg; Trauner, Michael; Mandorfer, Mattias; Reiberger, Thomas

doi:10.1111/apt.17653

Cited by 6 publications

(2 citation statements)

References 43 publications

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“…Another notable accomplishment of using Agile scores in clinical practice lies in their ability to predict liver-related events, as recently reported [ 21 , 24 , 25 ]. Since these scores incorporate factors like diabetes [ 26 ], which predisposes to hepatic decompensation, and other variables related to prediction of liver-related events (including hepatocellular carcinoma) [ 27 ], we anticipate that this field will remain highly dynamic and lively, with continued validation and exploration of the Agile scores.…”

Section: Discussionmentioning

confidence: 99%

FAST and Agile–the MASLD drift: Validation of Agile 3+, Agile 4 and FAST scores in 246 biopsy-proven NAFLD patients meeting MASLD criteria of prevalent caucasian origin

Taru,

Tefas,

Neamti

et al. 2024

PLoS ONE

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Background MASLD is a prevalent chronic liver condition with substantial clinical implications. This study aimed to assess the effectiveness of three new, elastography-based, scoring systems for advanced fibrosis ≥F3 (Agile 3+), cirrhosis F4 (Agile 4), and fibrotic NASH: NASH + NAS ≥4 + F≥2 (FAST score), in a cohort of biopsy-proven NAFLD meeting MASLD criteria. Our secondary aim was to compare their diagnostic performances with those of other fibrosis prediction tools: LSM-VCTE alone, and common, easily available scores (FIB-4 or APRI). Methods Single-center, retrospective study, on consecutive patients with baseline laboratory tests, liver biopsy, and reliable LSM-VCTE measurements. The discrimination between tests was evaluated by analyzing the AUROCs. Dual cut-off approaches were applied to rule-out and rule-in ≥F3, F4 and fibrotic NASH. We tested previously reported cut-off values and provided our best thresholds to achieve Se ≥85%, Se ≥90%, and Sp ≥90%, Sp ≥95%. Results Among 246 patients, 113 (45.9%) were women, and 75 (30.5%) presented diabetes. Agile 3+ and Agile 4 demonstrated excellent performance in identifying ≥F3 and F4, achieving AUROCs of 0.909 and 0.968, while the FAST score yielded acceptable results in distinguishing fibrotic NASH. When compared to FIB-4 and LSM-VCTE, both Agile 3+ and Agile 4 performed better than FIB-4 and had a similar performance to LSM-VCTE, but with higher diagnostic accuracy, hence reducing the grey zone. Conclusion Agile 3+ and Agile 4 are reliable, non-invasive tests for identifying advanced fibrosis or cirrhosis in MASLD patients, while FAST score demonstrates moderate performance in identifying fibrotic NASH.

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Section: Discussionmentioning

confidence: 99%

FAST and Agile–the MASLD drift: Validation of Agile 3+, Agile 4 and FAST scores in 246 biopsy-proven NAFLD patients meeting MASLD criteria of prevalent caucasian origin

Taru,

Tefas,

Neamti

et al. 2024

PLoS ONE

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“…Aktuelle Untersuchungen deuten interessanterweise darauf hin, dass das Vorhandsein eines Diabetes mellitus Typ 2 sowie ein erhöhter BMI die HVPG-Antwort auf NSBB bei Patienten mit kompensierter Leberzirrhose einschränken können, was im Falle eines klinischen Therapieversagens bei diesen Patientengruppen bedacht werden sollte [26].…”

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Medikamentöse Therapie der portalen Hypertension

Martin,

Goeser,

Kasper

2024

Dtsch Med Wochenschr

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In western industrialized nations, liver cirrhosis is the most common cause of portal hypertension. Portal hypertension is defined by a persistent increase in portal pressure >7mmHg. An HVPG >10mmHg defines the presence of clinically significant portal hypertension. The presence of clinically significant portal hypertension (CSPH) in patients with liver cirrhosis is a key risk factor for the transition from a compensated to a decompensated stage of the disease. CPSH can be determined invasively by measuring HPVG or noninvasively by measuring liver stiffness, platelet count and spleen stiffness. If acute decompensation manifests itself (e.g. ascites, esophageal variceal bleeding), this is associated with a significant increase in patient morbidity and mortality. Non-selective beta blockers (NSBB) are the standard medical therapy for portal hypertension in the presence of CSPH. Due to the additional α1-antiadrenergic effects, carvedilol leads to a greater reduction in portal pressure compared to traditional NSBB (e.g. Propanolol). In patients with compensated liver cirrhosis, carvedilol is better than traditional NSBB at reducing the risk of variceal bleeding and the occurrence of hepatic decompensation. The early identification of CSPH and evaluation of drug therapy to reduce portal hypertension is therefore crucial to improve the prognosis of patients.

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Editorial: Negative impact of diabetes mellitus and obesity on the prognosis of patients with chronic liver disease

Llop,

Calleja

2023

Aliment Pharmacol Ther

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Diabetes impairs the haemodynamic response to non‐selective betablockers in compensated cirrhosis and predisposes to hepatic decompensation

Cited by 6 publications

References 43 publications

FAST and Agile–the MASLD drift: Validation of Agile 3+, Agile 4 and FAST scores in 246 biopsy-proven NAFLD patients meeting MASLD criteria of prevalent caucasian origin

FAST and Agile–the MASLD drift: Validation of Agile 3+, Agile 4 and FAST scores in 246 biopsy-proven NAFLD patients meeting MASLD criteria of prevalent caucasian origin

Medikamentöse Therapie der portalen Hypertension

Editorial: Negative impact of diabetes mellitus and obesity on the prognosis of patients with chronic liver disease

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