Utility of magnetic resonance elastography for predicting ascites in patients with chronic liver disease

Abe, Kazumichi; Takahashi, Atsushi; Imaizumi, Hiromichi; Hayashi, Manabu; Okai, Ken; Kanno, Yukiko; Sato, Naoya; Kenjo, Akira; Marubashi, Shigeru; Ohira, Hiromasa

doi:10.1111/jgh.13927

Cited by 7 publications

(4 citation statements)

References 39 publications

(62 reference statements)

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“…Ajmera et al [33] noted that the cumulative incidence of liver-related events in patients with NAFLD having LS < 3.63 kPa is very low at 0.5% per year. By contrast, LS thresholds predicting hepatic decompensation range from 5.0 to 6.48 kPa for each etiology [34,35,36,37,38]. In this study, which included multiple etiologies, the prevalence of thrombocytopenia significantly increased at LS ≥ 3.5 kPa, and the prevalence of varices and ascites increased at ≥4.5 and ≥5.1 kPa, respectively (p < 0.01).…”

Section: Discussionmentioning

confidence: 59%

Mildly Low Serum Sodium Levels in Chronic Liver Disease: At Risk for Sarcopenia and Portal Hypertension

Nakamura,

Yoshimura,

Ichikawa

2023

Cureus

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Objective: Hyponatremia and sarcopenia in advanced chronic liver disease (ACLD) are both associated with portal hypertension (PHT) and worse prognosis. This study investigated their interrelationship.Methods: This retrospective study analyzed 751 patients with CLD who underwent magnetic resonance elastography (MRE) at Nippon Kokan Hospital (Kawasaki, Japan). Patients were classified and studied in five groups based on serum sodium (Na) levels: <135, 135-136, 137-138, 139-140, and >140 mEq/L. PHT was assessed by thrombocytopenia, varices, and ascites, and magnetic resonance imaging (MRI) data were used to diagnose sarcopenia.Results: The proportions of the five groups were 3/4/13/32/48 (%), and the mean liver stiffness (LS) was 6.6/5.7/4.2/3.2/3.2 (kPa), with significant progressive increases at Na < 139 (p < 0.01). The incidence of all PHT events and sarcopenia also increased at <139 (each p < 0.01). By contrast, the LS thresholds for predicting thrombocytopenia, varices, and ascites increased from 3.5 to 4.7 and 5.1, respectively, and were the same at 3.4 for low Na (<139) and sarcopenia (all p < 0.01). Multivariate analysis of factors associated with low Na identified LS and sarcopenia as independent factors (p < 0.05 both). In the Cox proportional hazards model, low Na was a significant prognostic factor in ACLD (hazard ratio (HR) 5.33, p < 0.01); however, the albumin-bilirubin (ALBI) score (HR 2.49) and sarcopenia (HR 4.03) were extracted in the multivariate analysis (p < 0.05 both).Conclusions: Studies using MRE imaging showed that low Na levels in CLD are associated with worse prognosis, not only due to elevated LS (i.e., PHT) but also the strong association with sarcopenia.

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Section: Discussionmentioning

confidence: 59%

Mildly Low Serum Sodium Levels in Chronic Liver Disease: At Risk for Sarcopenia and Portal Hypertension

Nakamura,

Yoshimura,

Ichikawa

2023

Cureus

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“…Patients with grade 1 ascites exhibit significantly shorter survival than those without ascites [33,34]. The cut-off values of LS predicting hepatic decompensation on MRE have been investigated for various etiologies, ranging from 5.80 to 6.48 kPa [30,[35][36][37]. Therefore, the clinical significance of the two identified landmarks on MRE (LS≥ 4 kPa and LS ≥ 6 kPa) in this study, encompassing multiple etiologies of ACLD, seems plausible.…”

Section: Discussionmentioning

confidence: 91%

“…MRE is currently regarded as the most accurate NIT for diagnosing and staging liver fibrosis, with the LS in healthy adults reported to be 2.10 kPa [29,30]. Recent reports indicate the utility of LS measurement by MRE in predicting liver-related events and assessing mortality risk in ACLD patients.…”

Section: Discussionmentioning

confidence: 99%

Liver Disease-Related Sarcopenia: A Predictor of Poor Prognosis by Accelerating Hepatic Decompensation in Advanced Chronic Liver Disease

Nakamura,

Yoshimura,

Ichikawa

2023

Cureus

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BackgroundSarcopenia is considered a prognostic factor for advanced chronic liver disease (ACLD) independent of liver function, but the underlying mechanisms are unknown. Here, we investigated whether sarcopenia contributed to hepatic decompensation and worsened prognosis. MethodsThis was a single-center retrospective study of 708 patients with chronic liver disease who underwent magnetic resonance elastography (MRE). Magnetic resonance imaging (MRI) was used to diagnose sarcopenia and hepatic decompensation (presence of ascites). ResultsThe incidence of sarcopenia (29% overall) and age were significantly correlated to increased liver stiffness (LS) (p < 0.01 each), but age did not differ for LS ≥ 4 kPa. Rates of thrombocytopenia and varices increased at ≥4 kPa, and ascites (n = 52) accounted for 81% of patients with ≥6 kPa LS. Age, alcoholic liver disease, Creactive protein, sodium level, and controlling nutritional status score were extracted as factors contributing to sarcopenia (all p < 0.05). In ACLD, sarcopenia was an independent predictor of ascites (p < 0.01), and in a follow-up analysis of 163 patients without ascites at baseline, the incidence of ascites in patients with sarcopenia was significantly higher, even after adjusting for LS and liver severity (p < 0.01). The Cox proportional hazards model indicated albumin-bilirubin score and sarcopenia as independent prognostic factors (p < 0.01 each). ConclusionsIn ACLD, both portal hypertension and liver disease-related sarcopenia were found to occur at ≥4 kPa. Sarcopenia was accompanied by mildly decreased sodium levels and contributed to the early development of ascites and poor prognosis, independent of liver function.

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“…Several gastrointestinal disorders have been associated with osteoporosis and osteopenia, including IBD, celiac disease and chronic liver disease [ 115 , 116 , 117 , 118 ]. Indeed, osteoporosis and arthritis are leading causes of morbidity in IBD patients [ 94 ].…”

Section: The Bone As Frequent Target Of Extraintestinal Ibd Manifesta...mentioning

confidence: 99%

Pivotal Role of Intestinal Microbiota and Intraluminal Metabolites for the Maintenance of Gut–Bone Physiology

Grüner

Ortlepp

Mattner

2023

IJMS

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Intestinal microbiota, and their mutual interactions with host tissues, are pivotal for the maintenance of organ physiology. Indeed, intraluminal signals influence adjacent and even distal tissues. Consequently, disruptions in the composition or functions of microbiota and subsequent altered host–microbiota interactions disturb the homeostasis of multiple organ systems, including the bone. Thus, gut microbiota can influence bone mass and physiology, as well as postnatal skeletal evolution. Alterations in nutrient or electrolyte absorption, metabolism, or immune functions, due to the translocation of microbial antigens or metabolites across intestinal barriers, affect bone tissues, as well. Intestinal microbiota can directly and indirectly alter bone density and bone remodeling. Intestinal dysbiosis and a subsequently disturbed gut–bone axis are characteristic for patients with inflammatory bowel disease (IBD) who suffer from various intestinal symptoms and multiple bone-related complications, such as arthritis or osteoporosis. Immune cells affecting the joints are presumably even primed in the gut. Furthermore, intestinal dysbiosis impairs hormone metabolism and electrolyte balance. On the other hand, less is known about the impact of bone metabolism on gut physiology. In this review, we summarized current knowledge of gut microbiota, metabolites and microbiota-primed immune cells in IBD and bone-related complications.

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Utility of magnetic resonance elastography for predicting ascites in patients with chronic liver disease

Abstract: Compared with serum fibrosis markers, MRE has higher diagnostic performance in predicting the presence of ascites. MRE-based LS has the potential to predict the presence of ascites in CLD patients.

Cited by 7 publications

References 39 publications

Mildly Low Serum Sodium Levels in Chronic Liver Disease: At Risk for Sarcopenia and Portal Hypertension

Mildly Low Serum Sodium Levels in Chronic Liver Disease: At Risk for Sarcopenia and Portal Hypertension

Liver Disease-Related Sarcopenia: A Predictor of Poor Prognosis by Accelerating Hepatic Decompensation in Advanced Chronic Liver Disease

Pivotal Role of Intestinal Microbiota and Intraluminal Metabolites for the Maintenance of Gut–Bone Physiology

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