Novel markers of endothelial dysfunction in hepatitis C virus-related cirrhosis: More than a mere prediction of esophageal varices

Abstract

BACKGROUND Hepatitis C virus (HCV) infection may affect lipid metabolism by enhancing the circulating levels of inflammatory cytokines, together with its impact on endothelial function. AIM To evaluate the potential correlation of changes in lipid profile, carotid intima-media thickness (CIMT), and ankle-brachial index with the severity of fibrosis, grades of esophageal varices (EVs), and fibrosis indices. METHODS The study included 240 subjects who were divided into 3 groups; group 1 ( n = 90, HCV-related cirrhotic patients with EVs), group 2 ( n = 90, HCV-related cirrhotic patients without EVs), and group 3 ( n = 60, served as the healthy control group). All patients underwent routine laboratory tests, including a lipid profile assay. Low-density lipoproteins (LDL)/platelet count and platelet/splenic diameter ratios were calculated. Abdominal ultrasonography, CIMT by carotid Doppler, bedside ankle-brachial index (ABI), liver stiffness measurement, and upper gastrointestinal endoscopy were performed. RESULTS Multivariate logistic regression revealed that very-low-density lipoprotein (VLDL) (β = 0.988, odds ratio 2.5, P = 0.001), LDL/platelet count ratio (β = 1.178, odds ratio 3.24, P = 0.001), CIMT (β = 1.37, odds ratio 3.9, P = 0.001), and ABI (β = 2.3, odds ratio 5.9, P = 0.001) were the key variables associated with significant fibrosis, EVs and endothelial dysfunction. CIMT and LDL/platelet count ratio were predictive of advanced fibrosis and EVs at cutoff values of 1.1 mm and 1 mm, respectively, with an area under the curve (AUC) of 0.966 and 0.960 ( P = 0.001), while VLDL and ABI at a cutoff of 16.5 mg/dL and 0.94 were predictive of advanced fibrosis and EVs with an AUC of 0.891 and 0.823, respectively ( P = 0.001). CONCLUSION CIMT, ABI, VLDL, LDL/platelet count ratio are good non-invasive predictors of advanced fibrosis, presence of EVs, and endothelial dysfunction in liver cirrhosis.

The Clinical Significance of Lipids/Lipoproteins Impairment in the Context of Cirrhosis: An Updated Review

“…38 Similarly, Hanafy et al have reported that VLDL <16.5 mg/dL and an LDL/platelet count ratio >1 can predict advanced fibrosis, the presence of EVs, and endothelial dysfunction among patients with HCV-related cirrhosis. 39 Moreover, it has been shown that HDL-C values ≤0.54 mmol/L can predict the 6-week mortality among HBV-related cirrhotic patients with acute gastrointestinal bleeding. 40 Two possible interpretations may account for this condition.…”

Ultrasound Evaluation of Liver in Patients Who Had History of Hepatitis C

“…Into three classes -diffuse, focal and multifocal -all of which have the potential to induce changes in the size, shape, and echogenicity of the liver. [10]It is best to make the diagnosis with ultrasound technology with a 3.5-8MHz curved probe in normal patients. Evaluation of chronic liver disease using abdominal ultrasound technology includes evaluation of liver size, echo texture and parenchyma of liver, liver nodule, liver surface, intrahepatic vessels, portal vein diameter and its complications such as spleen size, ascites and collaterals.…”