Hepatitis Monthly
Volume:21 Issue: 9, Sep 2021

Acute-on-chronic liver failure (ACLF) is always associated with thrombocytopenia or leukocytosis. Therefor the platelet to white blood cell ratio (PWR) in ACLF patients is always reduced.

Here, we assessed the relationship between PWR and prognosis in ACLF patients.

A retrospective cohort of 415 patients, including 100 patients that were diagnosed of chronic hepatitis B, 104 patients suffered of HBV-related liver cirrhosis and 211 patients suffered of HBV-related ACLF, was investigated. Univariate and multivariate COX models were used to investigate the relationship between PWR and 30-day survival in patients with ACLF. Factors affecting PWR in ACLF patients were also analysed using logistic regression analysis.

At baseline, the platelet count in patients with HBV-related ACLF was significantly lower than that in patients with CHB and patients suffered of HBV-related cirrhosis. The PWR value was much higher in the survivors of ACLF than in ACLF patients who died. PWR, age, total bilirubine, prothrombin activity, and aspartate transaminase were independent predictors of the 30-day survival rate of ACLF patients. We also found that ascites and infection were independent factors related to the decrease of PWR in ACLF patients.

The PWR value was significant declined in ACLF patients. And it was independent risk factors for the survival rate of those patients.

This study aimed to identify genes related to the immune score of hepatoblastoma, examine the characteristics of the immune microenvironment of hepatoblastoma, and construct a risk scoring system for predicting the prognosis of hepatoblastoma.

Through using the gene chip data of patients with hepatoblastoma with survival data in the ArrayExpress and GEO databases, the immune score of hepatoblastoma was calculated by the ESITIMATE algorithm, and the prognostic value of immune score in patients with hepatoblastoma was studied by the survival analysis. Genes related to the immune score were identified by the WGCNA algorithm. According to these genes, patients with hepatoblastoma were clustered unsupervised. Finally, the risk scoring system was constructed according to the immune score-related genes.

The immune score calculated by the ESTIMATE algorithm had a good prognostic value in patients with hepatoblastoma. Patients with high immune scores had better OS than those with low immune scores (P < 0.001). A total of 146 immune score-related genes were identified by WGCNA analysis, and univariate COX regression analysis indicated that 59 of the genes had prognostic value. According to the unsupervised clustering results of the 146 immune score-related genes, patients with hepatoblastoma could be divided into two subtypes with different prognoses, namely molecular subtype 1 and subtype 2, with molecular subtype 1 having a better prognosis. The immunocyte infiltration analysis results showed that the difference between the two subtypes was mainly in activated CD4 T cells, activated dendritic cells, CD56 bright natural killer cells, the macrophage, and regulatory T cells. According to the immune score-related genes, a risk scoring system was constructed based on a five-gene signature. After the cut-off value was determined, patients with hepatoblastoma were divided into a high-risk group and a low-risk group. The prognosis of the two groups was different.

The immune score has a good prognostic value in patients with hepatoblastoma. Based on the different expression patterns of immune score-related genes, hepatoblastoma can be divided into two different prognostic molecular subtypes, showing different immunocyte infiltration patterns. The established risk scoring system based on a five-gene signature has a good predictive value in patients with hepatoblastoma.

To investigate clinical characteristics and chronic factors of drug-induced liver injury (DILI) among patients with chronic hepatitis B virus (HBV) infection.

DILI patients were enrolled and divided into DILI group and HBV+DILI group. Laboratory indicators were recorded and analyzed. Multivariate logistic regression and receiver operating characteristic (ROC) curve was used to determine risk factors and predictive value for chronic DILI.

Of all 114 patients, 87 in DILI group and 27 in HBV+DILI group. Baseline total bilirubin (TBIL), direct bilirubin (DBIL), and incidence of chronicity were significantly higher in HBV+DILI group than that in DILI group (P = 0.017, P = 0.037, P = 0.045, respectively). While platelet (PLT) and prothrombin activity (PTA) were significantly lower than those in DILI group (P = 0.022, P = 0.013, respectively). HBV infection, baseline aspartate aminotransferase (AST) > 200 U/L and TBIL > 34.2 μmol/L were predictors of chronic DILI (OR = 4.481 [95%CI, 1.298-15.470], P = 0.018; OR = 8.478 [95%CI, 2.079-34.566], P = 0.003; OR = 7.358 [95%CI, 2.215-24.446], P = 0.001). Area under ROC curve (AUC) of joint diagnosis for chronic DILI was 0.814 (95%CI, 0.704-0.925, P < 0.001), which was significantly higher than that of single parameter prediction. The sensitivity, specificity, positive predictive value, and negative predictive value of joint diagnosis were 81.0%, 73.1%, 40.5%, and 94.4%, respectively.

HBV infection aggravated liver injury. HBV infection, baseline AST > 200 U/L and TBIL > 34.2 μmol/L were predictors of chronic DILI and the joint diagnosis of them could be used to predict chronic DILI effectively.

Novel coronavirus disease 19 (COVID-19), was reported by the WHO as a pandemic in March 2020. It was associated with liver injury in up to 50% of patients. retrospective cohort study to investigate the prevalence and associated factors of liver injury among patients with COVID-19. We include 2319 consecutive COVID-19 patients from April 2020 to November 2020. Liver function tests were performed at baseline, 24–48 h after admission, and before mortality/discharge. We compared Saudis and non-Saudis, in the admission rate, serum ALT level, morbidity, and mortality. Serum ALT was compared between, sexes, between admitted and non-admitted patients, and between deceased and survivors. Men were predominant (1356 [58.5%]) and non-Saudis (1328 [57.3%]). The mean (SD) age was 41.67 18.3 years (18-100). One-third of the patients had comorbidities, and 1022 (44.1%) required hospital admission. Intensive care unit (ICU) transfer was required in 185/1022 (18%) . Male and non-Saudi were most likely to be transferred to the ICU (P<0.001). Hepatocellular liver injury was found in 797 (34.4%) patients. Male and admitted patients were more likely to have hepatic injury (P=0.001). The mortality rate among admitted patients was 17.8% (182/1022). Mortality was associated with older age and hepatic injury (P<0.001 and P=0.004, respectively).

Affordable and effective diagnostic and treatment monitoring algorithms are urgently needed to achieve the global elimination of hepatitis C virus (HCV) infection.

A total of 274 patients were treated with direct-acting antivirals (DAAs) in the Spanish Hospital of Albacete between 2004 and 2020. This study compared the enzyme-immunoassay technique for HCV core antigen (HCVcAg) with the determination of RNA of HCV (HCV RNA) by polymerase chain reaction (PCR) in monitoring treatment with DAA, setting the lower limit of detection of HCVcAg < 3 fmol/L and RNA < 10 IU/mL. In all cases, the P value of differences associated with the contrast test was less than or equal to 0.05.

We evaluated the viral loads of our patients before treatment, during their treatment, and after its completion. The HCV RNA quantification at diagnosis was 2309327 IU/mL. The mean HCVcAg load was 5972 fmol/L. There was a strong correlation between HCVcAg levels and RNA levels with a Spearman rho of 0.832 (P < 0.01). The HCVcAg sensitivity at diagnosis was 99%, but the specificity could not be calculated because there were no true negatives or false positives at this point. Twelve weeks after treatment, in patients with treatment failure, we obtained a mean of 19084 IU/mL for RNA, while for HCVcAg, the mean was 103 fmol/L. At this time point, we also found a strong correlation between HCVcAg levels and HCV RNA levels with a Spearman rho of 0.775 (P < 0.01). Finally, the virological cure was achieved in 99% of our patients. The results for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100%, 99.87%, 86.33%, and 100%, respectively.

HCVcAg determination is an excellent alternative to HCV RNA in the assessment of treatment response. This is particularly relevant in lower- and middle-income countries and resource-limited settings where the high cost of labor, equipment, and reagents can prohibit molecular testing.