Pancreatic steatosis and iron overload increases cardiovascular risk in non-alcoholic fatty liver disease

ObjectiveTo assess the prevalence of pancreatic steatosis and iron overload in non-alcoholic fatty liver disease (NAFLD) and their correlation with liver histology severity and the risk of cardiometabolic diseases.MethodA prospective, multicenter study including NAFLD patients with biopsy and paired Magnetic Resonance Imaging (MRI) was performed. Liver biopsies were evaluated according to NASH Clinical Research Network, hepatic iron storages were scored, and digital pathology quantified the tissue proportionate areas of fat and iron. MRI-biomarkers of fat fraction (PDFF) and iron accumulation (R2*) were obtained from the liver and pancreas. Different metabolic traits were evaluated, cardiovascular disease (CVD) risk was estimated with the atherosclerotic CVD score, and the severity of iron metabolism alteration was determined by grading metabolic hiperferritinemia (MHF). Associations between CVD, histology and MRI were investigated.ResultsIn total, 324 patients were included. MRI-determined pancreatic iron overload and moderate-to severe steatosis were present in 45% and 25%, respectively. Liver and pancreatic MRI-biomarkers showed a weak correlation (r=0.32 for PDFF, r=0.17 for R2*). Pancreatic PDFF increased with hepatic histologic steatosis grades and NASH diagnosis (p<0.001). Prevalence of pancreatic steatosis and iron overload increased with the number of metabolic traits (p<0.001). Liver R2* significantly correlated with MHF (AUC=0.77 [0.72-0.82]). MRI-determined pancreatic steatosis (OR=3.15 [1.63-6.09]), and iron overload (OR=2.39 [1.32-4.37]) were independently associated with high-risk CVD. Histologic diagnosis of NASH and advanced fibrosis were also associated with high-risk CVD.ConclusionPancreatic steatosis and iron overload could be of utility in clinical decision-making and prognostication of NAFLD

Atuação da equipe multiprofissional frente à parada Cardiorrespiratória na Unidade de Terapia Intensiva / Performance of the multiprofessional team front of Cardiorespiratory arrest in the Intensive Care Unit

Objetivo: O objetivo deste estudo é conhecer e identificar por meio da literatura científica a atuação dos profissionais durante a ocorrência de parada cardiorrespiratória no setor de urgência e emergência.  Metodologia: Trata-se de uma revisão integrativa realizada partir das seguintes etapas: escolha do tema, construção da pergunta de pesquisa através do acrônimo PICo (paciente, interesse, contexto), escolha dos Descritores em Ciências da Saúde (DeCS), definição dos critérios de inclusão/exclusão dos artigos científicos; coleta, análise e discussão dos dados dos estudos selecionados, exposição da síntese das evidências encontradas. A questão norteadora foi definida a partir do PICo. A população estudada foram os adultos, com interesse na atuação da equipe multiprofissional frente à parada cardiorrespiratória no setor de urgência e emergência. Dessa forma, questiona-se como é realizada a atuação da equipe multiprofissional frente à parada cardiorrespiratória?  Resultados e Discussão: A atuação da equipe multiprofissional frente à parada cardiorrespiratória é indispensável para reversão do quadro clínico do paciente, de modo que possibilite uma reanimação rápida e diminuição dos riscos de óbito. Destaca-se que durante a realização da manobra de reanimação, os profissionais sofrem desgaste físico e mental. Considerações Finais: A equipe multidisciplinar precisa ter conhecimento sobre a atuação de cada de acordo com a sua categoria e mantendo a sincronização nesses casos, permitindo que aja uma boa comunicação para eficácia das condutas referente a reanimação. Enfatiza-se a importância da sistematização no atendimento para divisão de funções e o momento certo de cada especialidade intervir

Sepse associada ao cateter venoso central em pacientes adultos internados em uma unidade de terapia intensiva / Central venous catheter-associated sepsis in adult patients admitted to an intensive care unit

Objetivo: O objetivo deste estudo é conhecer e identificar por meio da literatura científica os fatores associados a infecções durante a utilização do CVC na Unidade de Terapia Intensiva com enfoque principal na sepse. Metodologia: Trata-se de uma revisão integrativa realizada partir das seguintes etapas: escolha do tema, construção da pergunta de pesquisa através do acrônimo PICo (paciente, interesse, contexto), escolha dos Descritores em Ciências da Saúde (DeCS), definição dos critérios de inclusão/exclusão dos artigos científicos; coleta, análise e discussão dos dados dos estudos selecionados, exposição da síntese das evidências encontradas. A questão norteadora foi definida a partir do PICo. A população estudada foram os adultos, com interesse nos fatores associados à sepse durante a utilização do cateter venoso central em pacientes internados na unidade de terapia intensiva. Dessa forma, questiona-se quais os fatores influenciam para o acometimento por sepse na Unidade de Terapia Intensiva em virtude do cateter venoso central? Resultados e Discussão: Quando há preparação e qualidade por parte da equipe durante o manuseio correto do cateter venoso central (CVC) para realização da manutenção e remoção do dispositivo viabiliza a diminuição de acometimento por sepse. Considerações Finais: A UTI precisa fornecer serviços de qualidade para prestação de cuidados assistenciais holísticos e humanizados sem comprometer a vida do indivíduo internado no setor, viabilizar a comunicação entre profissionais e paciente para fortalecimento de vínculo e maior segurança para ambos

Pancreatic steatosis and iron overload increases cardiovascular risk in non-alcoholic fatty liver disease

[EN] ObjectiveTo assess the prevalence of pancreatic steatosis and iron overload in non-alcoholic fatty liver disease (NAFLD) and their correlation with liver histology severity and the risk of cardiometabolic diseases. MethodA prospective, multicenter study including NAFLD patients with biopsy and paired Magnetic Resonance Imaging (MRI) was performed. Liver biopsies were evaluated according to NASH Clinical Research Network, hepatic iron storages were scored, and digital pathology quantified the tissue proportionate areas of fat and iron. MRI-biomarkers of fat fraction (PDFF) and iron accumulation (R2*) were obtained from the liver and pancreas. Different metabolic traits were evaluated, cardiovascular disease (CVD) risk was estimated with the atherosclerotic CVD score, and the severity of iron metabolism alteration was determined by grading metabolic hiperferritinemia (MHF). Associations between CVD, histology and MRI were investigated. ResultsIn total, 324 patients were included. MRI-determined pancreatic iron overload and moderate-to severe steatosis were present in 45% and 25%, respectively. Liver and pancreatic MRI-biomarkers showed a weak correlation (r=0.32 for PDFF, r=0.17 for R2*). Pancreatic PDFF increased with hepatic histologic steatosis grades and NASH diagnosis (p<0.001). Prevalence of pancreatic steatosis and iron overload increased with the number of metabolic traits (p<0.001). Liver R2* significantly correlated with MHF (AUC=0.77 [0.72-0.82]). MRI-determined pancreatic steatosis (OR=3.15 [1.63-6.09]), and iron overload (OR=2.39 [1.32-4.37]) were independently associated with high-risk CVD. Histologic diagnosis of NASH and advanced fibrosis were also associated with high-risk CVD. ConclusionPancreatic steatosis and iron overload could be of utility in clinical decision-making and prognostication of NAFLD.This study was funded by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (PI19/0380), GILEAD Sciences (Grant Number: GLD19/00050) and Sociedad Valenciana de Patologia Digestiva (2021/094).Marti-Aguado, D.; Ten-Esteve, A.; Baracaldo-Silva, CM.; Crespo, A.; Coello, E.; Merino-Murgui, V.; Fernandez-Paton, M.... (2023). Pancreatic steatosis and iron overload increases cardiovascular risk in non-alcoholic fatty liver disease. Frontiers in Endocrinology. 14. https://doi.org/10.3389/fendo.2023.12134411

Automated Whole-Liver MRI Segmentation to Assess Steatosis and Iron Quantification in Chronic Liver Disease

[EN] Background: Standardized manual region of interest (ROI) sampling strategies for hepatic MRI steatosis and iron quantification are time consuming, with variable results. Purpose: To evaluate the performance of automatic MRI whole-liver segmentation (WLS) for proton density fat fraction (PDFF) and iron estimation (transverse relaxometry [R2*]) versus manual ROI, with liver biopsy as the reference standard. Materials and Methods: This prospective, cross-sectional, multicenter study recruited participants with chronic liver disease who underwent liver biopsy and chemical shift-encoded 3.0-T MRI between January 2017 and January 2021. Biopsy evaluation included histologic grading and digital pathology. MRI liver sampling strategies included manual ROI (two observers) and automatic wholeliver (deep learning algorithm) segmentation for PDFF- and R2*-derived measurements. Agreements between segmentation methods were measured using intraclass correlation coefficients (ICCs), and biases were evaluated using Bland-Altman analyses. Linear regression analyses were performed to determine the correlation between measurements and digital pathology. Results: A total of 165 participants were included (mean age 6 standard deviation, 55 years +/- 12; 96 women; 101 of 165 participants [61%] with nonalcoholic fatty liver disease). Agreements between mean measurements were excellent, with ICCs of 0.98 for both PDFF and R2*. The median bias was 0.5% (interquartile range, 20.4% to 1.2%) for PDFF and 2.7 sec(-1) (interquartile range, 0.2-5.3 sec(-1)) for R2* (P,.001 for both). Margins of error were lower for WLS than ROI-derived parameters (-0.03% for PDFF and 20.3 sec(-1) for R2*). ROI and WLS showed similar performance for steatosis (ROI AUC, 0.96; WLS AUC, 0.97; P = .53) and iron overload (ROI AUC, 0.85; WLS AUC, 0.83; P = .09). Correlations with digital pathology were high (P < .001) between the fat ratio and PDFF (ROI r = 0.89; WLS r = 0.90) and moderate (P < .001) between the iron ratio and R2* (ROI r = 0.65; WLS r = 0.64). Conclusion: Proton density fat fraction and transverse relaxometry measurements derived from MRI automatic whole-liver segmentation (WLS) were accurate for steatosis and iron grading in chronic liver disease and correlated with digital pathology. Automated WLS estimations were higher, with a lower margin of error than manual region of interest estimations.Supported by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (grant PI19/0380), and Gilead Sciences (grant GLD19/00050).Marti-Aguado, D.; Jimenez-Pastor, AM.; Alberich-Bayarri, Á.; Rodríguez-Ortega, A.; Alfaro-Cervello, C.; Mestre-Alagarda, C.; Bauza, M.... (2022). Automated Whole-Liver MRI Segmentation to Assess Steatosis and Iron Quantification in Chronic Liver Disease. Radiology. 302(2):345-354. https://doi.org/10.1148/radiol.2021211027345354302

Digital Pathology Enables Automated and Quantitative Assessment of Inflammatory Activity in Patients with Chronic Liver Disease

Traditional histological evaluation for grading liver disease severity is based on subjective and semi-quantitative scores. We examined the relationship between digital pathology analysis and corresponding scoring systems for the assessment of hepatic necroinflammatory activity. A prospective, multicenter study including 156 patients with chronic liver disease (74% nonalcoholic fatty liver disease-NAFLD, 26% chronic hepatitis-CH etiologies) was performed. Inflammation was graded according to the Nonalcoholic Steatohepatitis (NASH) Clinical Research Network system and METAVIR score. Whole-slide digital image analysis based on quantitative (I-score: inflammation ratio) and morphometric (C-score: proportionate area of staining intensities clusters) measurements were independently performed. Our data show that I-scores and C-scores increase with inflammation grades (p ρ = 0.85–0.88), but only moderate for NAFLD (ρ = 0.5–0.53). I-score (p = 0.008) and C-score (p = 0.002) were higher for CH than NAFLD. Our MATLAB algorithm performed better than QuPath software for the diagnosis of low-moderate inflammation (p p < 0.001). In conclusion, quantitative and morphometric metrics of inflammatory burden obtained by digital pathology correlate well with pathologists’ scores, showing a higher accuracy for the evaluation of CH than NAFLD