Increased liver stiffness in extrahepatic cholestasis caused by choledocholithiasis

Background

Extrahepatic cholestasis that is caused by benign and malignant diseases has been reported to increase liver stiffness (LS), as measured by transient elastography (TE).

Objectives

The aim of this study was to evaluate LS in patients with extrahepatic cholestasis due to choledocholithiasis before and after endoscopic sphincterotomy and stone removal.

Patients and Methods

LS was measured by TE (Fibroscan) in patients with extrahepatic cholestasis that was caused by choledocholithiasis before and 1 month after endoscopic sphincterotomy and successful stone removal.

Results

We studied 12 patients (7 females, 5 males), aged 36 to 76 years (mean age 57.1 ± 11.6 years), with extrahepatic cholestasis that was caused by choledocholithiasis. LS was increased in all patients (range: 6.2-18.4 kPa; mean: 8.9 ± 3.5 kPa) before endoscopic therapy. Successful biliary drainage was effected by sphincterotomy and stone removal in all patients, which led to a significant decline in LS to 3.9-8.1 kPa (Mean: 5.6 ± 1.2 kPa; p < 0.001) within a mean observation time of 29 days. The decrease in LS values correlated significantly with a decline in serum total bilirubin levels (r = 0.691; p < 0.0001).

Conclusions

Extrahepatic cholestasis due to choledocholithiasis increases LS and should be excluded before assesing liver fibrosis by transient elastography.     

Circadian blood pressure variation in patients with type 2 diabetes--relationship to macro- and microvascular subclinical organ damage

Aims

To explore the association between nocturnal blood pressure (BP) dipper status and macro- and microvascular organ damage in type 2 diabetes.

Methods

Cross-sectional data from 663 patients with type 2 diabetes, aged 55–66 years, were analysed. Nurses measured office BP and ambulatory BP during 24 h. Individuals with ≥10% difference in nocturnal systolic blood pressure (SBP) relative to daytime values were defined as dippers. Non-dippers were defined as <10% nocturnal decrease in SBP. Estimated glomerular filtration rate (GFR) was calculated and microalbuminuria was measured by albumin:creatinine ratio (ACR). Aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries.

Results

We identified 433 dippers and 230 subjects with a nocturnal non-dipping pattern. Nocturnal SBP dipping was independently of office SBP associated with decreased PWV (p = 0.008), lower ACR (p = 0.001) and NT-proBNP (p = 0.001) and increased GFR (p < 0.001).

Conclusions

We conclude that diurnal BP variation provides further information about early macro- and microvascular subclinical organ damage that goes beyond standardized office BP measurements in patients with type 2 diabetes.     

Determination of cardiovascular parameters in burn patients using arterial waveform analysis: a review

Optimizing cardiovascular function to ensure adequate tissue oxygen delivery is a key objective in the care of critically ill burn patients. In recent years several less invasive hemodynamic monitoring techniques (arterial waveform analysis techniques) have become available in clinical practice. These alternative techniques provide beat-to-beat cardiac output measurement and permit preload assessment using volumetric parameters. The aim of this article is to review the currently available data regarding to use of less invasive hemodynamic monitoring methods using the pulse wave analysis in burn unit setting.     

Borderline high serum calcium levels are associated with arterial stiffness and 10‐year cardiovascular disease risk determined by Framingham risk score

Recent epidemiological data indicate that the concentration of circulating calcium is related to cardiovascular disease (CVD) mortality. We determined whether serum calcium level is related to arterial stiffness and 10‐year CVD risk calculated by Framingham risk score (FRS). We examined the association of normal‐range serum calcium level with arterial stiffness and FRS in 565 Korean adults participating at the Health Promotion Center of Gangnam Severance Hospital between March 2016 and May 2017. High brachial‐ankle pulse wave velocity (baPWV) was defined as >1460 cm/s, and high FRS was defined as ≥10 percent for 10‐year CVD risk. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for high baPWV and high FRS were calculated using multiple logistic regression analysis after adjusting for confounding variables. The OR (95% CI) for high baPWV was 3.91 (1.15‐7.36) per 1 mg/dL increment of serum calcium after adjusting for age, sex, body mass index, smoking status, exercise regularity, alcohol consumption, mean blood pressure, fasting plasma glucose, triglyceride, HDL‐cholesterol, C‐reactive protein, γ‐glutamyltransferase, uric acid level, phosphate level, potassium level, and presence of hypertension, diabetes and dyslipidemia medications (P = 0.024). A positive association between serum calcium level and high FRS was also observed after adjusting for the same covariables (OR, 3.54 [95% CI, 1.01‐12.44], P = 0.048). Serum calcium level was independently and positively associated with baPWV and 10‐year CVD risk estimates. Early detection of higher serum calcium level may be important for the assessment of arterial stiffness and future risk of a cardiovascular event.     

Pulse wave velocity progression over a medium‐term follow‐up in hypertensives: Focus on uric acid

The role of uric acid (UA) on the arterial stiffness progression has been evaluated only in three studies. Our aim was to evaluate its role as a possible determinant of the pulse wave velocity (PWV) progression over a 3.7 ± 0.5 years follow‐up period in hypertensive patients. Specific sex analysis was done due to the well‐known sex interaction with UA levels. We enrolled 422 consecutive hypertensive outpatients. At baseline anamnestic, blood pressure (BP) and laboratory data as well as PWV were assessed. PWV was performed again at follow‐up examination. Hyperuricemia was defined as a UA > 6 mg/dL for women and > 7 mg/dL for men. Baseline age was 53.2 ± 13 years, 58% were males, systolic and diastolic BP (SBP/DBP) 141.7 ± 17.7/86.8 ± 10.8 mm Hg, UA 5.2 ± 1.4 mg/dL, and PWV 8.5 ± 1.9 m/s. At follow‐up, despite better BP values (−8.5 ± 24.6 for SBP and −7.5 ± 15.4 for DBP), PWV increases to 9.1 ± 2.3 m/s (P < 0.001) with mean ΔPWV of+ 0.5 ± 2.2 m/s. A total of 61 patients were hyperuricemic (14.4%), and they present higher PWV baseline (9.0 ± 2.5 vs 8.5 ± 1.8 m/s, P = 0.03) without significant differences in ΔPWV. Hyperuricemic female (6.2%, 11 patients) presents higher baseline PWV without significant differences in ΔPWV. No differences were found in arterial stiffness in hyperuricemic males (20.4%, 50 patients). UA showed association with baseline and ΔPWV in the whole population but it loses statistical significance at the linear regression model. Same figures were also for sex analysis. Our findings provide evidence that baseline UA levels are not determinants of PWV progression over a median follow‐up of 3.8 years’ in hypertensive patients.     

The association between salt intake and arterial stiffness is influenced by a sex‐specific mediating effect through blood pressure in normotensive adults: The ELSA‐Brasil study

High salt intake is known to increase blood pressure (BP) and also to be associated with carotid‐femoral pulse wave velocity (cf‐PWV). However, recent data showed a sex‐specific pattern in the salt‐induced rise of BP. Thus, we aimed to investigate whether the association between salt intake and arterial stiffness also has a sex‐specific pattern. A total of 7755 normotensive participants with a validated 12‐h overnight urine collection in which daily salt intake was estimated were included. cf‐PWV, as well as clinical and anthropometric parameters, was measured. Salt intake positively correlated with cf‐PWV, in which the linear regression was steeper in women than in men (0.0199 ± 0.0045 vs 0.0326 ± 0.0052 m/s per gram of salt, P < .05). cf‐PWV increases over the salt quartiles in men and women. However, after adjustment for confounders, the association remained significant only for men. In the path analysis, the direct path (men: 0.048 P < .001, women: 0.029 P = .028) was higher in men while that mediated by SBP (men: 0.020 P < .001, women: 0.034 P < .001) was higher in women. We clearly demonstrated that high salt intake has a direct and independent effect increasing arterial stiffness regardless of sex. Also, the association between salt intake and arterial stiffness is more dependent on BP in normotensive women than it is in normotensive men. These results highlight the need for a sex‐specific approach in the evaluation of cardiovascular risk associated with dietary habits.     

Comparison of FibroTouch and FibroScan for staging fibrosis in chronic liver disease: Single-center prospective study

BackgroundThe aim of this study was to compare the diagnostic accuracy of the FibroTouch and FibroScan in patients with chronic liver disease (CLD) for staging fibrosis.MethodsA prospective study was conducted in 435 CLD patients between 2014 and 2017. Index tests (FibroTouch, FibroScan, APRI, and FIB-4 score) and a reference standard (liver biopsy) were performed within one week.ResultsThe area under the receiver operating curve (AUROC) of the FibroTouch was similar with that of the FibroScan for the diagnosis of significant fibrosis, severe fibrosis, or cirrhosis; however, the AUROC of the FibroTouch was higher than that of APRI or FIB‐4 (p < 0.001). There was a significant correlation (rho = 0.85, p < 0.001) between the FibroTouch and FibroScan for liver stiffness. The overall diagnostic accuracy of FibroTouch for significant fibrosis, severe fibrosis, or cirrhosis was 73.3%, 83.2%, or 84.1%, respectively. No significant differences between the FibroTouch and FibroScan were detected regarding the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy. The optimal cut-off values for each stage of fibrosis were similar between the FibroTouch and FibroScan.ConclusionThe FibroTouch is a valuable diagnostic tool for diagnosing liver fibrosis with good diagnostic accuracy which was comparable with that of the FibroScan, but superior to that of the APRI and FIB-4.