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Diagnostics
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Diagnosis and Management of Liver Cirrhosis and Portal Hypertension
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Diagnosis and Management of Liver Cirrhosis and Portal Hypertension

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 July 2023) | Viewed by 33613

Special Issue Editors

Prof. Dr. Ivica Grgurević

E-Mail Website
Guest Editor
Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
Interests: liver cirrhosis; liver diseases; cirrhosis; liver
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Mária Papp

E-Mail Website
Co-Guest Editor
Clinical Center, Institute of Gastroenterology 98, University of Debrecen, Nagyerdei blv., H-4032 Debrecen, Hungary
Interests: inflammatory bowel disease; ulcerative colitis; liver cirrhosis; gastrointestinal diseases; liver diseases; cirrhosis; liver failure; liver diseases and immunology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Chronic liver diseases impose a significant health burden worldwide, especially when they reach the stage of cirrhosis and portal hypertension. Age-standardised death rates from liver cirrhosis have declined over the last three decades in the most regions of the world, most likely as the result of expanding knowledge and better healthcare, except for Eastern Europe and Central Asia, which are facing increased rates of heavy alcohol consumption. In the same period, the absolute number of deaths from cirrhosis increased by nearly 50%, representing 2.4% of all deaths in 2017, most likely reflecting the expansion of the world’s population and unmet needs in the field. Despite available vaccines and/or medications viral hepatitis remains a challenging issue, and non-alcoholic fatty liver disease is becoming the leading cause of liver-related morbidity with multisystemic implications. The early identification, precise diagnosis, and prognostic stratification, represent the most important steps towards successful treatment and improved outcomes of patients with liver disease. Diagnostic landscape in hepatology has significantly changed, evolving from classical invasive methods, such as liver biopsy and hepatic venous pressure gradient measurements to sophisticated non-invasive tools encompassing biochemistry, various “omics” approaches, and a myriad of ultrasound and magnetic resonance-based methods that are likely to be further improved by artificial intelligence.  These steps forward in the diagnostic arena have been followed by equally exciting advances in therapeutic approaches, with new compounds and devices having been introduced and others awaiting to be evaluated and applied in clinical practice. The aim of this Special Issue of Diagnostics is to collate the current knowledge and apply it to the cutting-edge new research in diagnosis and treatment of liver cirrhosis and portal hypertension, thus providing a contribution to the global efforts to fight against these devastating conditions.

Prof. Dr. Ivica Grgurević
Prof. Dr. Mária Papp
Guest Editors

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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

  • liver cirrhosis
  • portal hypertension
  • esophageal varices
  • ascites
  • acute on chronic liver failure
  • liver fibrosis
  • liver steatosis
  • liver biopsy
  • proteomics in cirrhosis and portal hypertension
  • genomics in cirrhosis and portal hypertension
  • liver ultrasound
  • liver elastography
  • steatosis quantification
  • non-invasive methods
  • imaging in cirrhosis and portal hypertension
  • magnetic resonance elastography
  • contrast-enhanced ultrasound in cirrhosis and portal hypertension
  • machine-based learning in cirrhosis and portal hypertension
  • artificial intelligence in cirrhosis and portal hypertension
  • treatment of cirrhosis and portal hypertension

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Published Papers (8 papers)

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Research

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10 pages, 1208 KiB  
Article
Correlation between a New Point-Shear Wave Elastography Device (X+pSWE) with Liver Histology and 2D-SWE (SSI) for Liver Stiffness Quantification in Chronic Liver Disease
by Matteo Garcovich, Mattia Paratore, Laura Riccardi, Maria Assunta Zocco, Maria Elena Ainora, Geltrude Mingrone, Antonio Gasbarrini and Maurizio Pompili
Diagnostics 2023, 13(10), 1743; https://doi.org/10.3390/diagnostics13101743 - 15 May 2023
Cited by 1 | Viewed by 1858
Abstract
Background: The aim of this study was to investigate the feasibility, the correlation with previously validated 2D-SWE by supersonic imagine (SSI), and the accuracy in fibrosis-staging of a novel point shear-wave elastography device (X+pSWE) in patients with chronic liver disease. Methods: This prospective [...] Read more.
Background: The aim of this study was to investigate the feasibility, the correlation with previously validated 2D-SWE by supersonic imagine (SSI), and the accuracy in fibrosis-staging of a novel point shear-wave elastography device (X+pSWE) in patients with chronic liver disease. Methods: This prospective study included 253 patients with chronic liver diseases, without comorbidities potentially affecting liver stiffness. All patients underwent X+pSWE and 2D-SWE with SSI. Among them 122 patients also underwent liver biopsy and were classified according to histologic fibrosis. Agreement between the equipment was assessed with Pearson coefficient and Bland–Altman analysis, while receiver operator characteristic curve (ROC) analysis with Youden index was used to establish thresholds for fibrosis staging. Results: A very good correlation was found between X+pSWE and 2D-SWE with SSI (r2 = 0.94; p < 0.001), with X+pSWE average liver stiffness values 0.24 kPa lower than those obtained with SSI. AUROC of X+pSWE for the staging of significant fibrosis (F2), severe fibrosis (F3) and cirrhosis (F4) using SSI as a reference standard was 0.96 (95% CI, 0.93–0.99), 0.98 (95% CI, 0.97–1) and 0.99 (95% CI, 0.98–1), respectively. The best cut-off values for diagnosing fibrosis ≥F2, ≥F3 and F4 were, respectively, 6.9, 8.5 and 12 for X+pSWE. According to histologic classification, X+pSWE correctly identified 93 out of 113 patients (82%) for F ≥ 2 and 101 out of 113 patients (89%) for F ≥ 3 using the aforementioned cut-off values. Conclusion: X+pSWE is a useful novel non-invasive technique for staging liver fibrosis in patients with chronic liver disease. Full article
(This article belongs to the Special Issue Diagnosis and Management of Liver Cirrhosis and Portal Hypertension)
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10 pages, 744 KiB  
Article
Impact of COVID-19 on Patients with Decompensated Liver Cirrhosis
by Tudor Voicu Moga, Camelia Foncea, Renata Bende, Alina Popescu, Adrian Burdan, Darius Heredea, Mirela Danilă, Bogdan Miutescu, Iulia Ratiu, Teofana Otilia Bizerea-Moga, Ioan Sporea and Roxana Sirli
Diagnostics 2023, 13(4), 600; https://doi.org/10.3390/diagnostics13040600 - 6 Feb 2023
Cited by 4 | Viewed by 1893
Abstract
The aim of this study was to assess the impact of COVID-19 infection on patients with decompensated liver cirrhosis (DLC) in terms of acute-on-chronic liver failure (ACLF), chronic liver failure acute decompensation (CLIF-AD), hospitalization, and mortality. In this retrospective study, we analyzed patients [...] Read more.
The aim of this study was to assess the impact of COVID-19 infection on patients with decompensated liver cirrhosis (DLC) in terms of acute-on-chronic liver failure (ACLF), chronic liver failure acute decompensation (CLIF-AD), hospitalization, and mortality. In this retrospective study, we analyzed patients with known DLC who were admitted to the Gastroenterology Department with COVID-19. Clinical and biochemical data were obtained to compare the development of ACLF, CLIF-AD, days of hospitalization, and the presence of independent factors of mortality in comparison with a non-COVID-19 DLC group. All patients enrolled were not vaccinated for SARS-CoV-2. Variables used in statistical analyses were obtained at the time of hospital admission. A total of 145 subjects with previously diagnosed liver cirrhosis were included; 45/145 (31%) of the subjects were confirmed with COVID-19, among which 45% had pulmonary injury. The length of hospital stay (days) was significantly longer in patients with pulmonary injury compared to those without (p = 0.0159). In the group of patients with COVID-19 infection, the proportion of associated infections was significantly higher (p = 0.0041). Additionally, the mortality was 46.7% in comparison with only 15% in the non-COVID-19 group (p = 0.0001). Pulmonary injury was associated with death during admission in multivariate analysis in both the ACLF (p < 0.0001) and the non-ACLF (p = 0.0017) group. COVID-19 significantly influenced disease progression in patients with DLC in terms of associated infections, hospitalization length, and mortality. Full article
(This article belongs to the Special Issue Diagnosis and Management of Liver Cirrhosis and Portal Hypertension)
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Review

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14 pages, 3276 KiB  
Review
Clinical Implications and Management of Spontaneous Portosystemic Shunts in Liver Cirrhosis
by Simona Juncu, Horia Minea, Irina Girleanu, Laura Huiban, Cristina Muzica, Stefan Chiriac, Sergiu Timofeiov, Florin Mihai, Camelia Cojocariu, Carol Stanciu, Anca Trifan and Ana-Maria Singeap
Diagnostics 2024, 14(13), 1372; https://doi.org/10.3390/diagnostics14131372 - 28 Jun 2024
Cited by 5 | Viewed by 2943
Abstract
Portal hypertension from chronic liver disease leads to the formation of collateral blood vessels called spontaneous portosystemic shunts (SPSS). These shunts may form from existing vessels or through neo-angiogenesis. Their location affects clinical outcomes due to varying risks and complications. This review summarizes [...] Read more.
Portal hypertension from chronic liver disease leads to the formation of collateral blood vessels called spontaneous portosystemic shunts (SPSS). These shunts may form from existing vessels or through neo-angiogenesis. Their location affects clinical outcomes due to varying risks and complications. This review summarizes current knowledge on SPSS, covering their clinical impact and management strategies. Recent data suggest that SPSS increases the risk of variceal bleeding, regardless of shunt size. The size of the shunt is crucial in the rising incidence of hepatic encephalopathy (HE) linked to SPSS. It also increases the risk of portopulmonary hypertension and portal vein thrombosis. Detecting and assessing SPSS rely on computed tomography (CT) and magnetic resonance imaging. CT enables precise measurements and the prediction of cirrhosis progression. Management focuses on liver disease progression and SPSS-related complications, like HE, variceal bleeding, and portopulmonary hypertension. Interventional radiology techniques such as balloon-occluded, plug-assisted, and coil-assisted retrograde transvenous obliteration play a pivotal role. Surgical options are rare but are considered when other methods fail. Liver transplantation (LT) often resolves SPSS. Intraoperative SPSS ligation is still recommended in patients at high risk for developing HE or graft hypoperfusion. Full article
(This article belongs to the Special Issue Diagnosis and Management of Liver Cirrhosis and Portal Hypertension)
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33 pages, 2046 KiB  
Review
The Intestinal Microbiota in the Development of Chronic Liver Disease: Current Status
by Josip Stojic, Michał Kukla and Ivica Grgurevic
Diagnostics 2023, 13(18), 2960; https://doi.org/10.3390/diagnostics13182960 - 15 Sep 2023
Cited by 8 | Viewed by 2203
Abstract
Chronic liver disease (CLD) is a significant global health burden, leading to millions of deaths annually. The gut–liver axis plays a pivotal role in this context, allowing the transport of gut-derived products directly to the liver, as well as biological compounds from the [...] Read more.
Chronic liver disease (CLD) is a significant global health burden, leading to millions of deaths annually. The gut–liver axis plays a pivotal role in this context, allowing the transport of gut-derived products directly to the liver, as well as biological compounds from the liver to the intestine. The gut microbiota plays a significant role in maintaining the health of the digestive system. A change in gut microbiome composition as seen in dysbiosis is associated with immune dysregulation, altered energy and gut hormone regulation, and increased intestinal permeability, contributing to inflammatory mechanisms and damage to the liver, irrespective of the underlying etiology of CLD. The aim of this review is to present the current knowledge about the composition of the intestinal microbiome in healthy individuals and those with CLD, including the factors that affect this composition, the impact of the altered microbiome on the liver, and the mechanisms by which it occurs. Furthermore, this review analyzes the effects of gut microbiome modulation on the course of CLD, by using pharmacotherapy, nutrition, fecal microbiota transplantation, supplements, and probiotics. This review opens avenues for the translation of knowledge about gut–liver interplay into clinical practice as an additional tool to fight CLD and its complications. Full article
(This article belongs to the Special Issue Diagnosis and Management of Liver Cirrhosis and Portal Hypertension)
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13 pages, 2755 KiB  
Review
Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease
by Tina Tomić Mahečić, Robert Baronica, Anna Mrzljak, Ana Boban, Ivona Hanžek, Dora Karmelić, Anđela Babić, Slobodan Mihaljević and Jens Meier
Diagnostics 2022, 12(12), 3172; https://doi.org/10.3390/diagnostics12123172 - 15 Dec 2022
Cited by 3 | Viewed by 4995
Abstract
Over the last decades, individualized approaches and a better understanding of coagulopathy complexity in end-stage liver disease (ESLD) patients has evolved. The risk of both thrombosis and bleeding during minimally invasive interventions or surgery is associated with a worse outcome in this patient [...] Read more.
Over the last decades, individualized approaches and a better understanding of coagulopathy complexity in end-stage liver disease (ESLD) patients has evolved. The risk of both thrombosis and bleeding during minimally invasive interventions or surgery is associated with a worse outcome in this patient population. Despite deranged quantitative and qualitative coagulation laboratory parameters, prophylactic coagulation management is unnecessary for patients who do not bleed. Transfusion of red blood cells (RBCs) and blood products carries independent risks for morbidity and mortality, including modulation of the immune system with increased risk for nosocomial infections. Optimal coagulation management in these complex patients should be based on the analysis of standard coagulation tests (SCTs) and viscoelastic tests (VETs). VETs represent an individualized approach to patients and can provide information about coagulation dynamics in a concise period of time. This narrative review will deliver the pathophysiology of deranged hemostasis in ESLD, explore the difficulties of evaluating the coagulopathies in liver disease patients, and examine the use of VET assays and management of coagulopathy using coagulation factors. Methods: A selective literature search with PubMed as the central database was performed with the following. Full article
(This article belongs to the Special Issue Diagnosis and Management of Liver Cirrhosis and Portal Hypertension)
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16 pages, 1364 KiB  
Review
Ultrasound-Based Diagnostic Methods: Possible Use in Fatty Liver Disease Area
by Andrej Hari
Diagnostics 2022, 12(11), 2822; https://doi.org/10.3390/diagnostics12112822 - 16 Nov 2022
Cited by 2 | Viewed by 7630
Abstract
Liver steatosis is a chronic liver disease that is becoming one of the most important global health problems, due to its direct connection with metabolic syndrome, its significant impact on patients’ socioeconomic status and frailty, and the occurrence of advanced chronic liver disease. [...] Read more.
Liver steatosis is a chronic liver disease that is becoming one of the most important global health problems, due to its direct connection with metabolic syndrome, its significant impact on patients’ socioeconomic status and frailty, and the occurrence of advanced chronic liver disease. In recent years, there has been rapid technological progress in the ultrasound-based diagnostics field that can help us to quantitatively assess liver steatosis, including continuous attenuation parameters in A and B ultrasound modes, backscatter coefficients (e.g., speed of sound) and ultrasound envelope statistic parametric imaging. The methods used in this field are widely available, have favorable time and financial profiles, and are well accepted by patients. Less is known about their reliability in defining the presence and degree of liver steatosis. Numerous study reports have shown the methods’ favorable negative and positive predictive values in comparison with reference investigations (liver biopsy and MRI). Important research has also evaluated the role of these methods in diagnosing and monitoring non-alcoholic fatty liver disease (NAFLD). Since NAFLD is becoming the dominant global cause of liver cirrhosis, and due to the close but complex interplay of liver steatosis with the coexistence of liver fibrosis, knowledge regarding NAFLD’s influence on the progression of liver fibrosis is of crucial importance. Study findings, therefore, indicate the possibility of using these same diagnostic methods to evaluate the impact of NAFLD on the patient’s liver fibrosis progression risk, metabolic risk factors, cardiovascular complications, and the occurrence of hepatocellular carcinoma. The mentioned areas are particularly important in light of the fact that most of the known chronic liver disease etiologies are increasingly intertwined with the simultaneous presence of NAFLD. Full article
(This article belongs to the Special Issue Diagnosis and Management of Liver Cirrhosis and Portal Hypertension)
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25 pages, 2226 KiB  
Review
Ultrasound Methods for the Assessment of Liver Steatosis: A Critical Appraisal
by Dorotea Bozic, Kristian Podrug, Ivana Mikolasevic and Ivica Grgurevic
Diagnostics 2022, 12(10), 2287; https://doi.org/10.3390/diagnostics12102287 - 22 Sep 2022
Cited by 18 | Viewed by 9029
Abstract
The prevalence of the non-alcoholic fatty liver disease has reached major proportions, being estimated to affect one-quarter of the global population. The reference techniques, which include liver biopsy and the magnetic resonance imaging proton density fat fraction, have objective practical and financial limitations [...] Read more.
The prevalence of the non-alcoholic fatty liver disease has reached major proportions, being estimated to affect one-quarter of the global population. The reference techniques, which include liver biopsy and the magnetic resonance imaging proton density fat fraction, have objective practical and financial limitations to their routine use in the detection and quantification of liver steatosis. Therefore, there has been a rising necessity for the development of new inexpensive, widely applicable and reliable non-invasive diagnostic tools. The controlled attenuation parameter has been considered the point-of-care technique for the assessment of liver steatosis for a long period of time. Recently, many ultrasound (US) system manufacturers have developed proprietary software solutions for the quantification of liver steatosis. Some of these methods have already been extensively tested with very good performance results reported, while others are still under evaluation. This manuscript reviews the currently available US-based methods for diagnosing and grading liver steatosis, including their classification and performance results, with an appraisal of the importance of this armamentarium in daily clinical practice. Full article
(This article belongs to the Special Issue Diagnosis and Management of Liver Cirrhosis and Portal Hypertension)
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Other

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11 pages, 2819 KiB  
Brief Report
Evaluation of Spleen Stiffness in Young Healthy Volunteers Using Magnetic Resonance Elastography
by Marzanna Obrzut, Vitaliy Atamaniuk, Richard L. Ehman, Meng Yin, Marian Cholewa, Krzysztof Gutkowski, Wojciech Domka, Dorota Ozga and Bogdan Obrzut
Diagnostics 2023, 13(17), 2738; https://doi.org/10.3390/diagnostics13172738 - 23 Aug 2023
Cited by 1 | Viewed by 1910
Abstract
Purpose: Magnetic resonance elastography (MRE) has been established as the most accurate noninvasive technique for diagnosing liver fibrosis. Recent publications have suggested that the measurement of splenic stiffness is useful in setting where portal hypertension may be present. The goal of the current [...] Read more.
Purpose: Magnetic resonance elastography (MRE) has been established as the most accurate noninvasive technique for diagnosing liver fibrosis. Recent publications have suggested that the measurement of splenic stiffness is useful in setting where portal hypertension may be present. The goal of the current study was to compile normative data for MRE-assessed stiffness measurements of the spleen in young adults. Materials and Methods: A total of 100 healthy young Caucasian volunteers (65 females and 35 males) in the age range of 20 to 32 years were enrolled in this study. The participants reported no history of chronic spleen and liver disease, normal alcohol consumption, and a normal diet. The MRE data were acquired by using a 1.5 T whole-body scanner and a 2D GRE pulse sequence with 60 Hz excitation. Spleen stiffness was calculated as a weighted mean of stiffness values in the regions of interest manually drawn by the radiologist on three to five spleen slices. Results: Mean spleen stiffness was 5.09 ± 0.65 kPa for the whole group. Male volunteers had slightly higher splenic stiffness compared to females: 5.28 ± 0.78 vs. 4.98 ± 0.51 kPa, however, this difference was not statistically significant (p = 0.12). Spleen stiffness did not correlate with spleen fat content and liver stiffness but a statistically significant correlation with spleen volume was found. Conclusions: The findings of this study provide normative values for 2D MRE-based measurement of spleen stiffness in young adults, a basis for assessing the value of this biomarker in young patients with portal system pathologies. Full article
(This article belongs to the Special Issue Diagnosis and Management of Liver Cirrhosis and Portal Hypertension)
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