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Diagnosis, Management, and Prognosis of Liver Disease and Its Syndromes

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: 31 August 2024 | Viewed by 5548

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Special Issue Editor

Prof. Dr. Chien Hao Huang

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Guest Editor

1. Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
2. College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Interests: chemoembolization; portal vein; chronic liver failure; liver disease; viral hepatitis

Special Issue Information

Dear Colleagues,

The prompt and accurate diagnosis, management, and prognosis of acute and chronic liver disease and its associated syndromes, such as cirrhosis-associated immune dysfunction syndrome (CAIDS) or acute-on-chronic liver failure (ACLF), are of the utmost importance. The delayed or inaccurate diagnosis, management, and prognosis of acute and chronic liver disease or its related syndromes lead to increased morbidity and mortality. For example, the early diagnosis of hepatitis B (HBV) flare through the identification of elevated ALT and HBV-DNA and the subsequent application of antiviral therapy can reduce the risk of severe hepatitis flares and even HBV-ACLF. In a similar vein, prompt diagnostic paracentesis, combined with appropriate antibiotic therapy, can reduce the risk of in-hospital mortality among patients with suspected spontaneous bacterial peritonitis. Furthermore, accurate prognostic markers can help us to identify patients at risk or those of a futile status, such as patients with ACLF and high CLIF-C ACLF scores (≥70) who, after 48 hours of intensive care, may reach the threshold of futility for further ongoing intensive support. The best treatment options in this scenario remain to be determined but may include palliative care.

This Special Issue on the “Diagnosis, Management, and Prognosis of Liver Disease and Its Syndromes” covers all aspects addressed in the studies and reviews on the well-established diagnosis, management, and prognosis of acute/chronic liver disease and its syndromes, as well as new diagnostic tools, the development of treatment modalities, and novel prognostic markers. Examples of such markers include obeticholic acid or semaglutide for non-alcoholic steatohepatitis (NASH) and the neutrophil-to-lymphocyte ratio (NLR) as an indicator of the severity of steatosis and fibrosis.

Prof. Dr. Chien Hao Huang
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

acute liver disease
chronic liver disease
viral hepatitis
liver cirrhosis
non-alcoholic steatohepatitis (NASH)
diagnosis
treatment
prognosis score

Published Papers (4 papers)

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Research

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16 pages, 1957 KiB

Open AccessArticle

A Validated Composite Score Demonstrates Potential Superiority to MELD-Based Systems in Predicting Short-Term Survival in Patients with Liver Cirrhosis and Spontaneous Bacterial Peritonitis—A Preliminary Study

by Yan-Ting Lin, Wei-Ting Chen, Tsung-Han Wu, Yu Liu, Li-Tong Liu, Wei Teng, Yi-Chung Hsieh, Yen-Mu Wu, Chien-Hao Huang, Chao-Wei Hsu and Rong-Nan Chien

Diagnostics 2023, 13(15), 2578; https://doi.org/10.3390/diagnostics13152578 - 02 Aug 2023

Cited by 1 | Viewed by 856

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhosis patients with ascites, leading to high mortality rates if not promptly treated. However, specific prediction models for SBP are lacking. Aims: This study aimed to compare commonly used cirrhotic prediction models (CTP score, MELD, MELD-Na, iMELD, and MELD 3.0) for short-term mortality prediction and develop a novel model to improve mortality prediction. Methods: Patients with the first episode of SBP were included. Prognostic values for mortality were assessed using AUROC analysis. A novel prediction model was developed and validated. Results: In total, 327 SBP patients were analyzed, with HBV infection as the main etiologies. MELD 3.0 demonstrated the highest AUROC among the traditional models. The novel model, incorporating HRS, exhibited superior predictive accuracy for in-hospital in all patients and 3-month mortality in HBV-cirrhosis, with AUROC values of 0.827 and 0.813 respectively, surpassing 0.8. Conclusions: MELD 3.0 score outperformed the CTP score and showed a non-significant improvement compared to other MELD-based scores, while the novel SBP model demonstrated impressive accuracy. Internal validation and an HBV-related cirrhosis subgroup sensitivity analysis supported these findings, highlighting the need for a specific prognostic model for SBP and the importance of preventing HRS development to improve SBP prognosis. Full article

(This article belongs to the Special Issue Diagnosis, Management, and Prognosis of Liver Disease and Its Syndromes)

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Graphical abstract

19 pages, 1807 KiB

Open AccessArticle

Hemoglobin and Endotoxin Levels Predict Sarcopenia Occurrence in Patients with Alcoholic Cirrhosis

by Akihiko Shibamoto, Tadashi Namisaki, Junya Suzuki, Takahiro Kubo, Satoshi Iwai, Fumimasa Tomooka, Soichi Takeda, Yuki Fujimoto, Takashi Inoue, Misako Tanaka, Aritoshi Koizumi, Nobuyuki Yorioka, Takuya Matsuda, Shohei Asada, Yuki Tsuji, Yukihisa Fujinaga, Norihisa Nishimura, Shinya Sato, Hiroaki Takaya, Koh Kitagawa, Kosuke Kaji, Hideto Kawaratani, Takemi Akahane, Akira Mitoro and Hitoshi Yoshiji Show full author list Hide full author list

Diagnostics 2023, 13(13), 2218; https://doi.org/10.3390/diagnostics13132218 - 29 Jun 2023

Cited by 2 | Viewed by 989

Abstract

Alcohol is a major risk factor of liver cirrhosis (LC). This study aimed to elucidate a surrogate marker of sarcopenia in patients with LC of different etiology. Out of 775 patients with LC, 451 were assessed for handgrip strength and skeletal muscle mass (by computed tomography). They were then divided into two groups: alcoholic cirrhosis (AC; n = 149) and nonalcoholic cirrhosis (NAC; n = 302). Endotoxin activity (EA) levels were measured with an EA assay. Group AC showed significantly higher platelet counts (p = 0.027) and lower blood urea nitrogen levels and fibrosis-4 index than group NAC (p = 0.0020 and p = 0.038, respectively). The risk factors of sarcopenia were age ≥ 65 years, female sex, CP-C LC, Hb levels < 12 g/dL, and EA level > 0.4 in all patients with LC; hemoglobin (Hb) levels < 12 g/dL and EA level > 0.4 in group AC; and age ≥ 65 years, CP-C LC, and Hb levels < 12 g/dL in group NAC. The prediction accuracy of Hb for sarcopenia in group AC, group NAC, and all patients was 83.6%, 75.9%, and 78.1% (sensitivity: 92.0%, 69.0%, and 80.2%; specificity: 66.4%, 71.0%, and 64.0%), respectively. Although not significant, the predictive performance was better when using the combination of Hb and EA measurements than when using Hb alone in group AC but was comparable in all patients. Hb levels can predict sarcopenia in patients with LC, but in those with AC, the combination of Hb and EA improves the prediction performance. Full article

(This article belongs to the Special Issue Diagnosis, Management, and Prognosis of Liver Disease and Its Syndromes)

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15 pages, 980 KiB

Open AccessArticle

Bacteremia (Sepsis), Hepatorenal Syndrome, and Serum Creatinine Levels Rather than Types or Microbial Patterns Predicted the Short-Term Survival of Cirrhotic Patients Complicated with Spontaneous Bacterial Peritonitis

by Chien-Hao Huang, Sheng-Fu Wang, Chen-Hung Lee, Yen-Mu Wu, Ching Chang, Bo-Huan Chen, Yu-Tung Huang and Yu-Pin Ho

Diagnostics 2023, 13(1), 94; https://doi.org/10.3390/diagnostics13010094 - 28 Dec 2022

Cited by 2 | Viewed by 2209

Abstract

(1) Background: Spontaneous bacterial peritonitis (SBP) is a major and severe complication in cirrhosis patients with ascites. Over the years, advance in antibiotic treatment has led to changes in microbial patterns in some regions, including the emergence of extended-spectrum beta-lactamases resistant (ESBL)-producing bacteria and an increase in Gram-positive bacteria (GPC). In addition, three SBP types (classic SBP, culture-negative neutrophilic ascites (CNNA), and monomicrobial non-neutrocytic bacterascites (MNB)), may also have different prognoses. Therefore, the study aimed to investigate the microbial pattern and the predictors of short-term outcomes in patients with SBP. (2) Methods: Patients discharged with a diagnosis of the first episode of SBP between January 2006 and July 2017 were enrolled. Patients’ clinical, demographic, hematological, and biochemical data were obtained at diagnosis, and the model for end-stage liver disease (MELD)-based scores were calculated accordingly. Patients were followed up until February 2018 or until death. (3) Results: A total of 327 patients were analyzed. The prevalence of classic SBP was nearly equivalent to CNNA. As for the microbial pattern, Gram-negative bacillus (GNB) remained more prevalent than GPC (75 vs. 25%), with E. coli being the most common bacterial species, followed by K. Pneumoniae and then Staphylococcus. The percentage of ESBL strain in culture-positive patients was 10.9%. By univariable and multivariable logistic regression survival analysis, there was no significant difference in predicting short-term mortality among the three SBP types, neither between GNB vs. GPC nor between ESBL- and non-ESBL-producing bacteria. Only bacteremia (sepsis), hepatorenal syndrome (HRS), and serum creatinine (Cr) were independent predictors of in-hospital and 3-month mortality, whereas HRS and Cr were independent predictors of 6-month mortality. (4) Conclusions: SBP types, Gram stain result, and ESBL strain did not affect survival. Only bacteremia (sepsis), HRS, and serum Cr independently predicted the short-term mortality in patients with SBP. Full article

(This article belongs to the Special Issue Diagnosis, Management, and Prognosis of Liver Disease and Its Syndromes)

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Review

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26 pages, 1030 KiB

Open AccessReview

Diagnosis, Management, and Prognosis of Cystic Fibrosis-Related Liver Disease in Children

by Dana-Teodora Anton-Păduraru, Alice Nicoleta Azoicăi, Felicia Trofin, Alina Mariela Murgu, Dana Elena Mîndru, Ana Simona Bocec, Codruța Olimpiada Iliescu Halițchi, Gabriela Rusu Zota, Diana Păduraru and Eduard Vasile Nastase

Diagnostics 2024, 14(5), 538; https://doi.org/10.3390/diagnostics14050538 - 03 Mar 2024

Viewed by 793

Abstract

Cystic fibrosis (CF) is a multifaceted disorder predominantly investigated for its pulmonary manifestations, yet patients with CF also exhibit a spectrum of extrapulmonary manifestations, notably those involving the hepatobiliary system. The latter constitutes the third leading cause of morbidity and mortality in individuals with CF. Cystic fibrosis-related liver disease (CFLD), with an escalating prevalence, manifests diverse clinical presentations ranging from hepatomegaly to cirrhosis and hepatopulmonary syndrome. Consequently, early detection and appropriate management are imperative for sustaining the health and influencing the quality of life of CF patients afflicted with CFLD. This review aims to consolidate existing knowledge by providing a comprehensive overview of hepatobiliary manifestations associated with CF. It delineates the clinical hepatobiliary manifestations, diagnostic methodologies, incorporating minimally invasive markers, and therapeutic approaches, encompassing the impact of novel CFTR modulators on CFLD. Given the exigency of early diagnosis and the intricate management of CFLD, a multidisciplinary team approach is essential to optimize care and enhance the quality of life for this subset of patients. In conclusion, recognizing CF as more than solely a pulmonary ailment, the authors underscore the imperative for further clinical investigations to establish a more robust evidence base for CFLD management within the continuum of this chronic disease. Full article

(This article belongs to the Special Issue Diagnosis, Management, and Prognosis of Liver Disease and Its Syndromes)

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