Skip to main content
Top
Published in: BMC Gastroenterology 1/2023

Open Access 01-12-2023 | Hepatocellular Carcinoma | Study Protocol

A rapid, non-invasive, clinical surveillance for CachExia, sarcopenia, portal hypertension, and hepatocellular carcinoma in end-stage liver disease: the ACCESS-ESLD study protocol

Authors: Patrik Nasr, Mikael Forsgren, Wile Balkhed, Cecilia Jönsson, Nils Dahlström, Christian Simonsson, Shan Cai, Anna Cederborg, Martin Henriksson, Henrik Stjernman, Martin Rejler, Daniel Sjögren, Gunnar Cedersund, Wolf Bartholomä, Ingvar Rydén, Peter Lundberg, Stergios Kechagias, Olof Dahlqvist Leinhard, Mattias Ekstedt

Published in: BMC Gastroenterology | Issue 1/2023

Login to get access

Abstract

Background

Liver cirrhosis, the advanced stage of many chronic liver diseases, is associated with escalated risks of liver-related complications like decompensation and hepatocellular carcinoma (HCC). Morbidity and mortality in cirrhosis patients are linked to portal hypertension, sarcopenia, and hepatocellular carcinoma. Although conventional cirrhosis management centered on treating complications, contemporary approaches prioritize preemptive measures. This study aims to formulate novel blood- and imaging-centric methodologies for monitoring liver cirrhosis patients.

Methods

In this prospective study, 150 liver cirrhosis patients will be enrolled from three Swedish liver clinics. Their conditions will be assessed through extensive blood-based markers and magnetic resonance imaging (MRI). The MRI protocol encompasses body composition profile with Muscle Assement Score, portal flow assessment, magnet resonance elastography, and a abbreviated MRI for HCC screening. Evaluation of lifestyle, muscular strength, physical performance, body composition, and quality of life will be conducted. Additionally, DNA, serum, and plasma biobanking will facilitate future investigations.

Discussion

The anticipated outcomes involve the identification and validation of non-invasive blood- and imaging-oriented biomarkers, enhancing the care paradigm for liver cirrhosis patients. Notably, the temporal evolution of these biomarkers will be crucial for understanding dynamic changes.

Trial registration

Clinicaltrials.gov, registration identifier NCT05502198. Registered on 16 August 2022. Link: https://​classic.​clinicaltrials.​gov/​ct2/​show/​NCT05502198.
Literature
1.
go back to reference Mokdad AA, Lopez AD, Shahraz S, Lozano R, Mokdad AH, Stanaway J, Murray CJ, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med. 2014;12:145.PubMedPubMedCentralCrossRef Mokdad AA, Lopez AD, Shahraz S, Lozano R, Mokdad AH, Stanaway J, Murray CJ, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med. 2014;12:145.PubMedPubMedCentralCrossRef
2.
go back to reference Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70:151–71.PubMedCrossRef Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70:151–71.PubMedCrossRef
4.
go back to reference García-Pagán J-C, Gracia-Sancho J, Bosch J. Functional aspects on the pathophysiology of portal hypertension in cirrhosis. J Hepatol. 2012;57:458–61.PubMedCrossRef García-Pagán J-C, Gracia-Sancho J, Bosch J. Functional aspects on the pathophysiology of portal hypertension in cirrhosis. J Hepatol. 2012;57:458–61.PubMedCrossRef
5.
go back to reference Palaniyappan N, Cox E, Bradley C, Scott R, Austin A, O’Neill R, Ramjas G, et al. Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging. J Hepatol. 2016;65:1131–9.PubMedPubMedCentralCrossRef Palaniyappan N, Cox E, Bradley C, Scott R, Austin A, O’Neill R, Ramjas G, et al. Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging. J Hepatol. 2016;65:1131–9.PubMedPubMedCentralCrossRef
6.
go back to reference Yoo J, Kim SW, Lee DH, Bae JS, Cho EJ. Prognostic role of spleen volume measurement using computed tomography in patients with compensated chronic liver disease from hepatitis B viral infection. Eur Radiol. 2021;31:1432–42.PubMedCrossRef Yoo J, Kim SW, Lee DH, Bae JS, Cho EJ. Prognostic role of spleen volume measurement using computed tomography in patients with compensated chronic liver disease from hepatitis B viral infection. Eur Radiol. 2021;31:1432–42.PubMedCrossRef
8.
go back to reference Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul J-L, Schirmacher P, et al. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182–236.CrossRef Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul J-L, Schirmacher P, et al. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182–236.CrossRef
9.
go back to reference Park HJ, Jang HY, Kim SY, Lee SJ, Won HJ, Byun JH, Choi SH, et al. Non-enhanced magnetic resonance imaging as a surveillance tool for hepatocellular carcinoma: comparison with ultrasound. J Hepatol. 2020;72:718–24.PubMedCrossRef Park HJ, Jang HY, Kim SY, Lee SJ, Won HJ, Byun JH, Choi SH, et al. Non-enhanced magnetic resonance imaging as a surveillance tool for hepatocellular carcinoma: comparison with ultrasound. J Hepatol. 2020;72:718–24.PubMedCrossRef
10.
go back to reference Gupta P, Soundararajan R, Patel A, Kumar-M P, Sharma V, Kalra N. Abbreviated MRI for hepatocellular carcinoma screening: a systematic review and meta-analysis. J Hepatol. 2021;75:108–19.PubMedCrossRef Gupta P, Soundararajan R, Patel A, Kumar-M P, Sharma V, Kalra N. Abbreviated MRI for hepatocellular carcinoma screening: a systematic review and meta-analysis. J Hepatol. 2021;75:108–19.PubMedCrossRef
11.
go back to reference Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.PubMedCrossRef Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.PubMedCrossRef
12.
go back to reference Tandon P, Ney M, Irwin I, Ma MM, Gramlich L, Bain VG, Esfandiari N, et al. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl. 2012;18:1209–16.PubMedCrossRef Tandon P, Ney M, Irwin I, Ma MM, Gramlich L, Bain VG, Esfandiari N, et al. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl. 2012;18:1209–16.PubMedCrossRef
13.
go back to reference Montano-Loza AJ, Meza-Junco J, Prado CM, Lieffers JR, Baracos VE, Bain VG, Sawyer MB. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10(166–173):e161. Montano-Loza AJ, Meza-Junco J, Prado CM, Lieffers JR, Baracos VE, Bain VG, Sawyer MB. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10(166–173):e161.
14.
go back to reference Lai JC, Tandon P, Bernal W, Tapper EB, Ekong U, Dasarathy S, Carey EJ. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74:1611–44.PubMedCrossRef Lai JC, Tandon P, Bernal W, Tapper EB, Ekong U, Dasarathy S, Carey EJ. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74:1611–44.PubMedCrossRef
15.
go back to reference Linge J, Heymsfield SB, Dahlqvist LO. On the definition of sarcopenia in the presence of aging and obesity—initial Results from UK biobank. J Gerontol A. 2020;75:1309–16.CrossRef Linge J, Heymsfield SB, Dahlqvist LO. On the definition of sarcopenia in the presence of aging and obesity—initial Results from UK biobank. J Gerontol A. 2020;75:1309–16.CrossRef
16.
go back to reference Linge J, Ekstedt M, Dahlqvist LO. Adverse muscle composition is linked to poor functional performance and metabolic comorbidities in NAFLD. JHEP Rep. 2021;3:100197.PubMedCrossRef Linge J, Ekstedt M, Dahlqvist LO. Adverse muscle composition is linked to poor functional performance and metabolic comorbidities in NAFLD. JHEP Rep. 2021;3:100197.PubMedCrossRef
20.
go back to reference Hanai T, Shiraki M, Ohnishi S, Miyazaki T, Ideta T, Kochi T, Imai K, et al. Rapid skeletal muscle wasting predicts worse survival in patients with liver cirrhosis. Hepatol Res. 2016;46:743–51.PubMedCrossRef Hanai T, Shiraki M, Ohnishi S, Miyazaki T, Ideta T, Kochi T, Imai K, et al. Rapid skeletal muscle wasting predicts worse survival in patients with liver cirrhosis. Hepatol Res. 2016;46:743–51.PubMedCrossRef
21.
go back to reference West J, Romu T, Thorell S, Lindblom H, Berin E, Holm A-CS, Åstrand LL, et al. Precision of MRI-based body composition measurements of postmenopausal women. PLoS One. 2018;13:e0192495.PubMedPubMedCentralCrossRef West J, Romu T, Thorell S, Lindblom H, Berin E, Holm A-CS, Åstrand LL, et al. Precision of MRI-based body composition measurements of postmenopausal women. PLoS One. 2018;13:e0192495.PubMedPubMedCentralCrossRef
22.
go back to reference Middleton MS, Haufe W, Hooker J, Borga M, Dahlqvist Leinhard O, Romu T, Tunón P, et al. Quantifying abdominal adipose tissue and thigh muscle volume and hepatic proton density fat fraction: repeatability and accuracy of an MR imaging–based, semiautomated analysis method. Radiology. 2017;283:438–49.PubMedCrossRef Middleton MS, Haufe W, Hooker J, Borga M, Dahlqvist Leinhard O, Romu T, Tunón P, et al. Quantifying abdominal adipose tissue and thigh muscle volume and hepatic proton density fat fraction: repeatability and accuracy of an MR imaging–based, semiautomated analysis method. Radiology. 2017;283:438–49.PubMedCrossRef
23.
go back to reference Campagna F, Montagnese S, Ridola L, Senzolo M, Schiff S, De Rui M, Pasquale C, et al. The animal naming test: an easy tool for the assessment of hepatic encephalopathy. Hepatology. 2017;66:198–208.PubMedCrossRef Campagna F, Montagnese S, Ridola L, Senzolo M, Schiff S, De Rui M, Pasquale C, et al. The animal naming test: an easy tool for the assessment of hepatic encephalopathy. Hepatology. 2017;66:198–208.PubMedCrossRef
24.
go back to reference Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–36.PubMedPubMedCentralCrossRef Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–36.PubMedPubMedCentralCrossRef
25.
go back to reference Loria A, Escheik C, Gerber NL, Younossi ZM. Quality of life in cirrhosis. Curr Gastroenterol Rep. 2013;15:1–7.CrossRef Loria A, Escheik C, Gerber NL, Younossi ZM. Quality of life in cirrhosis. Curr Gastroenterol Rep. 2013;15:1–7.CrossRef
26.
go back to reference Younossi ZM, Guyatt G, Kiwi M, Boparai N, King D. Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut. 1999;45:295–300.PubMedPubMedCentralCrossRef Younossi ZM, Guyatt G, Kiwi M, Boparai N, King D. Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut. 1999;45:295–300.PubMedPubMedCentralCrossRef
27.
go back to reference Hjortswang H, Järnerot G, Curman B, Sandberg-Gertzén H, Tysk C, Blomberg B, Almer S, et al. The short health scale: a valid measure of subjective health in ulcerative colitis. Scand J Gastroenterol. 2006;41:1196–203.PubMedCrossRef Hjortswang H, Järnerot G, Curman B, Sandberg-Gertzén H, Tysk C, Blomberg B, Almer S, et al. The short health scale: a valid measure of subjective health in ulcerative colitis. Scand J Gastroenterol. 2006;41:1196–203.PubMedCrossRef
28.
go back to reference Krarup AL, Peterson E, Ringström G, Törnblom H, Hjortswang H, Simrén M. The short health scale. J Clin Gastroenterol. 2015;49:565–70.PubMedCrossRef Krarup AL, Peterson E, Ringström G, Törnblom H, Hjortswang H, Simrén M. The short health scale. J Clin Gastroenterol. 2015;49:565–70.PubMedCrossRef
29.
go back to reference Stjernman H, Grännö C, Järnerot G, Ockander L, Tysk C, Blomberg B, Ström M, et al. Short health scale: a valid, reliable, and responsive instrument for subjective health assessment in Crohn’s disease. Inflamm Bowel Dis. 2008;14:47–52.PubMedCrossRef Stjernman H, Grännö C, Järnerot G, Ockander L, Tysk C, Blomberg B, Ström M, et al. Short health scale: a valid, reliable, and responsive instrument for subjective health assessment in Crohn’s disease. Inflamm Bowel Dis. 2008;14:47–52.PubMedCrossRef
30.
go back to reference Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–94.PubMedCrossRef Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–94.PubMedCrossRef
31.
go back to reference Norman K, Stobäus N, Gonzalez MC, Schulzke J-D, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr. 2011;30:135–42.PubMedCrossRef Norman K, Stobäus N, Gonzalez MC, Schulzke J-D, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr. 2011;30:135–42.PubMedCrossRef
32.
go back to reference Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, White L. Midlife hand grip strength as a predictor of old age disability. Jama. 1999;281:558–60.PubMedCrossRef Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, White L. Midlife hand grip strength as a predictor of old age disability. Jama. 1999;281:558–60.PubMedCrossRef
33.
go back to reference Wang CW, Feng S, Covinsky KE, Hayssen H, Zhou L-Q, Yeh BM, Lai JC. A comparison of muscle function, mass, and quality in liver transplant candidates: results from the functional assessment in liver transplantation (FrAILT) study. Transplantation. 2016;100:1692.PubMedPubMedCentralCrossRef Wang CW, Feng S, Covinsky KE, Hayssen H, Zhou L-Q, Yeh BM, Lai JC. A comparison of muscle function, mass, and quality in liver transplant candidates: results from the functional assessment in liver transplantation (FrAILT) study. Transplantation. 2016;100:1692.PubMedPubMedCentralCrossRef
34.
go back to reference Sasso M, Beaugrand M, De Ledinghen V, Douvin C, Marcellin P, Poupon R, Sandrin L, et al. Controlled attenuation parameter (CAP): a novel VCTE™ guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010;36:1825–35.PubMedCrossRef Sasso M, Beaugrand M, De Ledinghen V, Douvin C, Marcellin P, Poupon R, Sandrin L, et al. Controlled attenuation parameter (CAP): a novel VCTE™ guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010;36:1825–35.PubMedCrossRef
35.
go back to reference West J, Dahlqvist Leinhard O, Romu T, Collins R, Garratt S, Bell JD, Borga M, et al. Feasibility of MR-based body composition analysis in large scale population studies. PLoS One. 2016;11:e0163332.PubMedPubMedCentralCrossRef West J, Dahlqvist Leinhard O, Romu T, Collins R, Garratt S, Bell JD, Borga M, et al. Feasibility of MR-based body composition analysis in large scale population studies. PLoS One. 2016;11:e0163332.PubMedPubMedCentralCrossRef
36.
go back to reference Linge J, Borga M, West J, Tuthill T, Miller MR, Dumitriu A, Thomas EL, et al. Body composition profiling in the UK biobank imaging study. Obesity. 2018;26:1785–95.PubMedCrossRef Linge J, Borga M, West J, Tuthill T, Miller MR, Dumitriu A, Thomas EL, et al. Body composition profiling in the UK biobank imaging study. Obesity. 2018;26:1785–95.PubMedCrossRef
37.
go back to reference Borga M, Ahlgren A, Romu T, Widholm P, Dahlqvist Leinhard O, West J. Reproducibility and repeatability of MRI-based body composition analysis. Magn Reson Med. 2020;84:3146–56.PubMedCrossRef Borga M, Ahlgren A, Romu T, Widholm P, Dahlqvist Leinhard O, West J. Reproducibility and repeatability of MRI-based body composition analysis. Magn Reson Med. 2020;84:3146–56.PubMedCrossRef
38.
go back to reference Nasr P, Iredahl F, Dahlström N, Rådholm K, Henriksson P, Cedersund G, Dahlqvist Leinhard O, et al. Evaluating the prevalence and severity of NAFLD in primary care: the EPSONIP study protocol. BMC Gastroenterol. 2021;21:1.CrossRef Nasr P, Iredahl F, Dahlström N, Rådholm K, Henriksson P, Cedersund G, Dahlqvist Leinhard O, et al. Evaluating the prevalence and severity of NAFLD in primary care: the EPSONIP study protocol. BMC Gastroenterol. 2021;21:1.CrossRef
40.
go back to reference Blachier M, Leleu H, Peck-Radosavljevic M, Valla D-C, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58:593–608.PubMedCrossRef Blachier M, Leleu H, Peck-Radosavljevic M, Valla D-C, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58:593–608.PubMedCrossRef
42.
go back to reference Taylor RS, Taylor RJ, Bayliss S, Hagström H, Nasr P, Schattenberg JM, Ishigami M, et al. Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and Meta-analysis. Gastroenterology. 2020;158:1611–1625.e1612.PubMedCrossRef Taylor RS, Taylor RJ, Bayliss S, Hagström H, Nasr P, Schattenberg JM, Ishigami M, et al. Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and Meta-analysis. Gastroenterology. 2020;158:1611–1625.e1612.PubMedCrossRef
43.
go back to reference Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, Planas R, et al. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol. 2009;50:923–8.PubMedPubMedCentralCrossRef Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, Planas R, et al. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol. 2009;50:923–8.PubMedPubMedCentralCrossRef
44.
go back to reference Villanueva C, Torres F, Sarin SK, Shah HA, Tripathi D, Brujats A, Rodrigues SG, et al. Carvedilol reduces the risk of decompensation and mortality in patients with compensated cirrhosis in a competing-risk meta-analysis. J Hepatol. 2022;77:1014–25.PubMedCrossRef Villanueva C, Torres F, Sarin SK, Shah HA, Tripathi D, Brujats A, Rodrigues SG, et al. Carvedilol reduces the risk of decompensation and mortality in patients with compensated cirrhosis in a competing-risk meta-analysis. J Hepatol. 2022;77:1014–25.PubMedCrossRef
45.
go back to reference Kanwal F, Singal AG. Surveillance for hepatocellular carcinoma: current best practice and future direction. Gastroenterology. 2019;157:54–64.PubMedCrossRef Kanwal F, Singal AG. Surveillance for hepatocellular carcinoma: current best practice and future direction. Gastroenterology. 2019;157:54–64.PubMedCrossRef
46.
go back to reference Llovet JM, Kelley RK, Villanueva A, Singal AG, Pikarsky E, Roayaie S, Lencioni R, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7:6.PubMedCrossRef Llovet JM, Kelley RK, Villanueva A, Singal AG, Pikarsky E, Roayaie S, Lencioni R, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7:6.PubMedCrossRef
47.
go back to reference Park HJ, Kim SY, Singal AG, Lee SJ, Won HJ, Byun JH, Choi SH, et al. Abbreviated magnetic resonance imaging vs ultrasound for surveillance of hepatocellular carcinoma in high-risk patients. Liver Int. 2022;42:2080–92.PubMedCrossRef Park HJ, Kim SY, Singal AG, Lee SJ, Won HJ, Byun JH, Choi SH, et al. Abbreviated magnetic resonance imaging vs ultrasound for surveillance of hepatocellular carcinoma in high-risk patients. Liver Int. 2022;42:2080–92.PubMedCrossRef
48.
go back to reference Huang DQ, Fowler KJ, Liau J, Cunha GM, Louie AL, An JY, Bettencourt R, et al. Comparative efficacy of an optimal exam between ultrasound versus abbreviated MRI for HCC screening in NAFLD cirrhosis: a prospective study. Aliment Pharmacol Ther. 2022;55:820–7.PubMedPubMedCentralCrossRef Huang DQ, Fowler KJ, Liau J, Cunha GM, Louie AL, An JY, Bettencourt R, et al. Comparative efficacy of an optimal exam between ultrasound versus abbreviated MRI for HCC screening in NAFLD cirrhosis: a prospective study. Aliment Pharmacol Ther. 2022;55:820–7.PubMedPubMedCentralCrossRef
49.
go back to reference Marks RM, Ryan A, Heba ER, Tang A, Wolfson TJ, Gamst AC, Sirlin CB, et al. Diagnostic per-patient accuracy of an abbreviated hepatobiliary phase gadoxetic acid–enhanced MRI for hepatocellular carcinoma surveillance. Am J Roentgenol. 2015;204:527–35.CrossRef Marks RM, Ryan A, Heba ER, Tang A, Wolfson TJ, Gamst AC, Sirlin CB, et al. Diagnostic per-patient accuracy of an abbreviated hepatobiliary phase gadoxetic acid–enhanced MRI for hepatocellular carcinoma surveillance. Am J Roentgenol. 2015;204:527–35.CrossRef
50.
go back to reference Besa C, Lewis S, Pandharipande PV, Chhatwal J, Kamath A, Cooper N, Knight-Greenfield A, et al. Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid. Abdom Radiol. 2017;42:179–90.CrossRef Besa C, Lewis S, Pandharipande PV, Chhatwal J, Kamath A, Cooper N, Knight-Greenfield A, et al. Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid. Abdom Radiol. 2017;42:179–90.CrossRef
51.
go back to reference Kang SH, Jeong WK, Baik SK, Cha SH, Kim MY. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle. 2018;9:860–70.PubMedPubMedCentralCrossRef Kang SH, Jeong WK, Baik SK, Cha SH, Kim MY. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle. 2018;9:860–70.PubMedPubMedCentralCrossRef
52.
go back to reference Ha Y, Kim D, Han S, Chon YE, Lee YB, Kim MN, Lee JH, et al. Sarcopenia predicts prognosis in patients with newly diagnosed hepatocellular carcinoma, independent of tumor stage and liver function. Cancer Res Treat. 2018;50:843–51.PubMedCrossRef Ha Y, Kim D, Han S, Chon YE, Lee YB, Kim MN, Lee JH, et al. Sarcopenia predicts prognosis in patients with newly diagnosed hepatocellular carcinoma, independent of tumor stage and liver function. Cancer Res Treat. 2018;50:843–51.PubMedCrossRef
53.
go back to reference Borga M, West J, Bell JD, Harvey NC, Romu T, Heymsfield SB, Dahlqvist LO. Advanced body composition assessment: from body mass index to body composition profiling. J Investig Med. 2018;66:1–9.PubMedPubMedCentralCrossRef Borga M, West J, Bell JD, Harvey NC, Romu T, Heymsfield SB, Dahlqvist LO. Advanced body composition assessment: from body mass index to body composition profiling. J Investig Med. 2018;66:1–9.PubMedPubMedCentralCrossRef
Metadata
Title
A rapid, non-invasive, clinical surveillance for CachExia, sarcopenia, portal hypertension, and hepatocellular carcinoma in end-stage liver disease: the ACCESS-ESLD study protocol
Authors
Patrik Nasr
Mikael Forsgren
Wile Balkhed
Cecilia Jönsson
Nils Dahlström
Christian Simonsson
Shan Cai
Anna Cederborg
Martin Henriksson
Henrik Stjernman
Martin Rejler
Daniel Sjögren
Gunnar Cedersund
Wolf Bartholomä
Ingvar Rydén
Peter Lundberg
Stergios Kechagias
Olof Dahlqvist Leinhard
Mattias Ekstedt
Publication date
01-12-2023

Other articles of this Issue 1/2023

BMC Gastroenterology 1/2023 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.