FIB-4 index-based surveillance for advanced liver fibrosis in diabetes patients

Tan

J of Gastro and Hepatol

et al. 2022

The Malaysian Society of Gastroenterology and Hepatology saw the need for a consensus statement on metabolic dysfunction‐associated fatty liver disease (MAFLD). The consensus panel consisted of experts in the field of gastroenterology/hepatology, endocrinology, bariatric surgery, family medicine, and public health. A modified Delphi process was used to prepare the consensus statements. The panel recognized the high and increasing prevalence of the disease and the consequent anticipated increase in liver‐related complications and mortality. Cardiovascular disease is the leading cause of mortality in MAFLD patients; therefore, cardiovascular disease risk assessment and management is important. A simple and clear liver assessment and referral pathway was agreed upon, so that patients with more severe MAFLD can be linked to gastroenterology/hepatology care, while patients with less severe MAFLD can remain in primary care or endocrinology, where they are best managed. Lifestyle intervention is the cornerstone in the management of MAFLD. The panel provided a consensus on the use of statin, angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker, sodium–glucose cotransporter‐2 inhibitor, glucagon‐like peptide‐1 agonist, pioglitazone, vitamin E, and metformin, as well as recommendations on bariatric surgery, screening for gastroesophageal varices and hepatocellular carcinoma, and liver transplantation in MAFLD patients. Increasing the awareness and knowledge of the various stakeholders on MAFLD and incorporating MAFLD into existing noncommunicable disease‐related programs and activities are important steps to tackle the disease. These consensus statements will serve as a guide on MAFLD for clinicians and other stakeholders.

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Malaysian Society of Gastroenterology and Hepatology consensus statement on metabolic dysfunction‐associated fatty liver disease

Tan

J of Gastro and Hepatol

et al. 2022

“…Our patient had a fatty liver and diabetes, and the Fib-4 index indicated moderate fibrosis of the liver; it cannot be denied that chronic liver damage may have caused the HCC or chronic liver damage contributed to the elevation of the serum VEGF level. However, HCC rarely developed in patients with a Fib-4 index of <2.67 (7) . Therefore, the inflammation caused by RS3PE syndrome may have a synergistic effect on carcinogenesis.…”

Section: Discussionmentioning

confidence: 99%

Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Syndrome Precedes the Development of Hepatocellular Carcinoma

Ohwada

Akutsu

Masaki

et al. 2022

JMA J

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is characterized by bilateral synovitis and marked pitting edema of the hands and/or feet. Despite the unknown etiology of RS3PE, several reports have described the putative association of this disease with malignant tumors. We herein report the findings of a 76-year-old man with RS3PE syndrome who developed hepatocellular carcinoma 3 years after achieving clinical remission of RS3PE using corticosteroid treatment; high vascular endothelial growth factor and tumor necrosis factor-alpha levels were considered to have contributed to carcinogenesis in this patient. The sequence of clinical events in this case strongly suggests that careful follow-up, even after clinical remission, is necessary for patients with RS3PE syndrome whose malignancy is not confirmed at diagnosis.

“…Second, we did not generally define liver cirrhosis with a liver biopsy, given the standardized strategies that aim to prevent unnecessary healthcare-associated risks. Instead, we analyzed the FIB-4 index, validated in various patient settings with patient age and laboratory profiles [ 22 , 30 , 31 , 32 , 33 ]. Third, our analysis did not include some liver-disease-relevant data, such as INR, due to incomplete collection.…”

Section: Discussionmentioning

confidence: 99%

Baseline Circulating miR-125b Levels Predict a High FIB-4 Index Score in Chronic Hepatitis B Patients after Nucleos(t)ide Analog Treatment

Tsai²,

Li³

et al. 2022

Biomedicines

The regulatory role of microRNAs (miRNAs) in HBV-associated HCC pathogenesis has been reported previously. This study aimed to investigate the association between serum miR-125b and liver fibrosis progression in chronic hepatitis B (CHB) patients after nucleos(t)ide analog (NA) treatment. Baseline serum miR-125b levels and other relevant laboratory data were measured for 124 patients who underwent 12-month NA therapy. Post-12-month NA therapy, serum miR-125, platelet, AST, and ALT levels were measured again for post-treatment FIB-4 index calculation. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for a higher post-treatment FIB-4 index. Results showed that baseline miR-125b levels were inversely correlated with the post-treatment FIB-4 index (ρ = −0.2130, p = 0.0082). In logistic regression analyses, age (OR = 1.17, p < 0.0001), baseline platelet level (OR = 0.98, p = 0.0032), and ALT level (OR = 1.00, p = 0.0241) were independent predictors of FIB-index > 2.9 post-12-month treatment. The baseline miR-125b level was not significantly associated with a higher post-treatment FIB-4 index (p = 0.8992). In 59 patients receiving entecavir (ETV) monotherapy, the alternation of serum miR-125b in 12 months and age were substantially associated with a higher post-treatment FIB-4 index (> 2.9), suggesting that miR-125b is a reliable biomarker for detecting early liver fibrosis under specific anti-HBV NA treatments (e.g., ETV).