Shereen A. Saleh

PTU-008 Interleukin 23 as a non-invasive test of disease severity in patients with ulcerative colitis

Introduction Studies have found increased expression of IL-23 in inflamed and non-inflamed mucosa of patients with ulcerative colitis (UC). This study was done to evaluate serum interleukin-23 as a non-invasive test for ulcerative colitis disease and assessed its correlation with the disease severity. Methods A prospective case-control study where 80 patients were recruited, and allocated into two groups: Group I: included forty patients diagnosed with UC by clinical, endoscopic and histopathologic features. Group II (control group): included 40 patients without UC, matched in age and gender, who had colonoscopy for various indications but had a normal colonoscopy and normal histopathology. In patients with UC, disease severity was assessed using the Mayo Scoring System for assessing UC activity. Serum IL-23 level was quantified using Quantikine Human IL-23 Immunoassay by R and D Systems Europe, Ltd. ELISA kit. IL-23 levels were compared in the 2 groups, also correlation with severity was obtained. Analysis of the data was done using SPSS (Statistical System for Social Science version 16). Kruskal Wallis test was used to compare the 2 groups regarding quantitative nonparametric variables. Spearman correlation was used to rank variables positively or inversely. Receiver operating curve (ROC) was used to find the best cut off and validity of IL-23. The one-way ANOVA test was used to assess the relationship between the severity of UC and IL-23 levels. Results Patients with UC had higher level of interleukin 23 (234.5+161 pg/mL) compared to controls (54.2+15 pg/mL). A positive correlation was found between the level of IL-23 and disease severity. A cut off value of IL-23=68 pg/mL was the best to differentiate between cases and controls. Performing the receiver operating characteristic curve (ROC) revealed that the best cut off values of IL-23 to identify the severity of ulcerative colitis were 105 pg/mL for mild cases (80% sensitivity), 200 pg/mL for moderate cases (60% sensitivity), and 270 pg/mL for severe cases (81% sensitivity). Conclusion Our findings reinforce the suggestion that IL-23 level measurement may be of value as a non-invasive test in the diagnosis and disease severity assessment in patients with UC. Further studies on a larger scale would be needed to evaluate whether this could be used for monitoring of response to treatment. In view of IL-23 antagonists currently being studied in UC patients, the predictability of response to IL-23 antagonists guided by IL-23 levels is an area that could be explored.

Efficacy of contrast-enhanced FDG PET/CT in patients awaiting liver transplantation with rising alpha-fetoprotein after bridge therapy of hepatocellular carcinoma

ObjectiveTo assess the diagnostic accuracy and illustrate positive findings of contrast-enhanced fluorine-18 fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) image in patients awaiting liver transplantation (LT) with rising alpha-fetoprotein (AFP) after bridge therapy of hepatocellular carcinoma (HCC).Materials and methodsThis prospective study included 100 patients who were waiting for LT and who previously underwent locoregional therapy (LRT) of HCC. These patients had rising AFP levels on a routine follow-up examination awaiting LT. All patients underwent a contrast-enhanced 18F-FDG PET/CT examination. We calculated for each patient the maximum standardised uptake value (SUVmax) of the tumour and the ratio of the tumoral SUVmax to the normal-liver SUVmax. The diagnostic accuracy and positive contrast-enhanced findings of 18F-FDG PET/CT were established by histopathology and clinical and imaging follow-up as the reference standards.ResultsContrast-enhanced 18F-FDG PET/CT detected tumour relapse in 78 patients (13 patients had intrahepatic lesions, 10 patients had extrahepatic metastases and 55 patients with combined lesions). The sensitivity, specificity and accuracy values of contrast-enhanced 18F-FDG PET/CT examination in the detection of HCC recurrence were 92.8%, 94.1% and 93%, respectively. A significant correlation was found between the AFP level and SUVmax ratio (r = 0.2283; p = 0.0224). The best threshold for 18F-FDG PET positivity was >1.21.ConclusionContrast-enhanced 18F-FDG PET/CT is a valuable tool for the detection of intrahepatic HCC recurrence or extrahepatic metastasis following rising AFP levels after LRT of HCC, and should be incorporated during routine workup awaiting LT.Key Points•18F-FDG PET/CT is a valuable tool for the detection of HCC recurrence•18F-FDG PET/CT should be incorporated during routine workup awaiting liver transplantation•Significant correlation was found between AFP level and SUVmax ratio•The best threshold for18F-FDG PET positivity was >1.21• The ideal cut-off value for AFP was >202

Evaluation of interleukin 23 (IL-23) as a non-invasive test of disease severity in patients with ulcerative colitis

BACKGROUND AND STUDY AIMS Studies have found increased expression of IL-23 in inflamed and non-inflamed mucosa of patients with ulcerative colitis (UC). We hypothesized that serum interleukin-23 as a non-invasive test has a role in pathogenesis of ulcerative colitis disease and correlates with the disease severity. PATIENTS AND METHODS Forty patients with biopsy proven ulcerative colitis, recruited from Ain Shams University hospitals were included. Forty healthy subjects matched in age and gender were also included in the study as a control group. Serum IL-23 level was quantified using quantitative ELISA technique (Enzyme linked Immunosorbent Assay). RESULTS Patients with UC had higher level of interleukin 23 (234.5 ± 161 pg/mL) compared to control subjects (54.2 ± 15 pg/mL) and the level of IL-23 correlated with the disease severity. Cut off value of IL-23 at 68 pg/mL was the best to differentiate between cases and control subjects. Receiver operating characteristic curve (ROC) revealed that the best cut off for IL-23 to detect mild cases of ulcerative colitis was at105 pg/mL, to detect moderate cases at 200 pg/mL and to detect severe cases was at 270 pg/mL with sensitivity 80% to mild cases, 60% to moderate cases and 81% to severe cases. CONCLUSION Our findings confirm the suggestion that IL-23 level measurement may be of value as a non-invasive test in the diagnosis and disease severity assessment in patients with UC.

Serum ferritin as a non-invasive marker in the prediction of hepatic fibrosis among Egyptian patients with non-alcoholic fatty liver disease: Ferritin in non-alcoholic fatty liver disease

Many studies have found a relationship between hepatic iron, serum ferritin, and non‐alcoholic fatty liver disease (NAFLD) or its progress. The aim of this study is to assess the value of serum ferritin as a non‐invasive marker in the prediction of hepatic fibrosis in NAFLD.

Sex hormone profile in male patients with hepatitis C virus-related liver cirrhosis and its reflection on clinical presentation

Background and aim Gonadal function is affected significantly in male patients with cirrhosis. The aim of this study was to assess the level of sex hormones in male patients with hepatitis C virus-related liver cirrhosis and its reflection on clinical presentation. Patients and methods This cross-sectional study was carried out on 40 consecutive male patients with hepatitis C virus-related cirrhosis of Child–Pugh class C in addition to 20 age-matched healthy male participants (control group). All were subjected to an assay of serum hormonal levels: total and free testosterone, estradiol (E2), sex hormone-binding globulin (SHBG), and free androgen index. Results Feminine hair distribution was detected in 38 (95%) patients, gynecomastia in 29 (72.5%) patients, palmar erythema in 27 (67.5%) patients, and spider naevi in 15 (37.5%) patients. The levels of serum total and free testosterone were significantly lower, whereas those of serum E2 and SHBG were significantly higher in cases than in control participants (P<0.001). There was a significant negative correlation between SHBG and free and total testosterone, and a significant positive correlation between SHBG and E2 (P<0.001). Patients with gynecomastia, feminine hair distribution, and spider naevi showed significantly high E2 levels (P=0.005, 0.041, and 0.038, respectively). Free androgen index was significantly lower, whereas the E2/free testosterone ratio was significantly higher in cases than in control participants (P<0.001). Conclusion Male patients with decompensated liver cirrhosis have a hypoandrogenic and hyperestrogenic state that correlates with clinical signs of feminization.

Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

AIM To evaluate the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients. METHODS This prospective study included twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty age- and sex-matched healthy control subjects. All underwent neuro-psychiatric examination, laboratory investigations, radiological studies and psychometric tests including trail making test A (TMT A), TMT B, digit symbol test and serial dotting test. The psychometric hepatic encephalopathy score (PHES) was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group. RESULTS Before LT, psychometric tests showed highly significant deficits in cirrhotic patients in comparison to controls (P < 0.001). There was a statistically significant improvement in test values in the patient group after LT; however, their values were still significantly worse than those of the controls (P < 0.001). The PHES detected MHE in 16 patients (80%) before LT with a median value of -7 ± 3.5. The median PHES value was significantly improved following LT, reaching -4.5 ± 5 (P < 0.001), and the number of patients with MHE decreased to 11 (55%). The pre-transplant model for end-stage liver disease (MELD) score ≥ 15 was significantly related to the presence of post-transplant MHE (P = 0.005). More patients in whom reversal of MHE was observed had a pre-transplant MELD score < 15. CONCLUSION Reversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score < 15.

Relation between hepatitis B viral load and liver fibrosis assessed using transient elastography in patients with chronic hepatitis B virus infection

Background Several hepatitis B (HB) viral factors such as viral load and genotype were shown to anticipate clinical outcomes. Noninvasive tests assessing liver fibrosis are widely preferred. Aim The aim of this study was to find the relation between HB viral load and liver fibrosis stage assessed using transient elastography in chronic HB patients. Patients and methods This study included 60 chronic HB patients who were divided into two groups. Thirty patients with fibrosis stages F1–F2 constituted group 1, and 30 patients with fibrosis stages F3–F4 constituted group 2. The stage of liver fibrosis was assessed using FibroScan. HB viral load was measured with PCR. Results The median (interquartile range) of HB virus PCR in groups 1 and 2 was 33.5 (16.0–515.5) and 82.5 (16.0–535.0), respectively, with a nonsignificant difference between the two groups (P=0.834). It was 220.0 (16.0–1014.0) and 77.0 (16.0–335.0) in patients with and those without cirrhosis, respectively, with a nonsignificant difference (P=0.552). Receiver operating characteristic analysis showed area under curve of 0.516 for differentiating between the two groups. Conclusion HB viral load was nonsignificantly higher in patients with higher grades of liver fibrosis and cirrhosis with weak diagnostic performance in differentiation between different fibrosis stages.