Objectives
To evaluate the relationship between metabolic syndrome and the frequency and severity of lower urinary tract symptoms (LUTS).
Patients and Methods
In all, 4666 men aged 55–100 years ...consulting a general practitioner during a 12‐day period in December 2009 have been included in this observational study. LUTS were defined according to the International Prostate Symptom Score (IPSS) and metabolic syndrome with the National Cholesterol Education Program/Adult Treatment Panel III definition. We studied the correlation between metabolic syndrome and its individual components, and the severity of LUTS (IPSS and treatment for LUTS). Analyses were adjusted for body mass index, age, and prostate‐specific antigen level.
Results
Metabolic syndrome was reported in 51.5% of the patients and 47% were treated for LUTS. There was a significant link between metabolic syndrome and treated LUTS (P < 0.001). The risk of being treated for LUTS also increased with an increasing number of metabolic syndrome components present. Metabolic syndrome was positively correlated with the severity of the LUTS (P < 0.001) for overall IPSS and both voiding and storage scores (P < 0.001). Each component of the metabolic syndrome (except high‐density lipoprotein‐cholesterol) appeared as an independent risk factor of high IPSS and of LUTS treatment in multivariate analysis. Metabolic syndrome was positively correlated with prostate volume.
Conclusions
Our results suggest a significant relationship between LUTS linked to benign prostatic hyperplasia and metabolic syndrome, in terms of frequency and severity. The risk of being treated for LUTS also increased with an increasing number of metabolic syndrome components present. The prevention of such modifiable factors by the promotion of dietary changes and regular physical activity practice may be of great importance for public health.
Transient elastometry is a noninvasive procedure used to measure fibrosis when patients are diagnosed with liver disease; it might be used to monitor changes over time. We investigated whether there ...are short-term variations in stiffness measurements that are not attributable to changes in fibrosis by studying patients with stable liver disease.
We performed a retrospective analysis of 531 paired liver stiffness measurements made by Fibroscan when the study began (LSM1) and at follow-up (LSM2), more than 1 day and less than 1 year apart, from 432 stable (for body mass index, waist circumference, and alcohol consumption), untreated, immunocompetent patients with chronic liver disease (from January 2006 through March 2009). Variations between the first and follow-up measurements were expressed as absolute (LSM2-LSM1, kPa) or relative (LSM2-LSM1/LSM1*100) or as changes in fibrosis stage.
There was >20% variation in 49.7%, >30% in 34.3%, and >50% in 12.2% of paired measurements; this variation was constant across the spectrum of LSM1 values. The variations produced a 1-fibrosis stage difference in 31.5% of pairs and a ≥ 2-stage difference in 9.8% of pairs. Patients with LSM1 >7 kPa had increased probability of having a different stage of fibrosis at LSM2, compared with patients with LSM1 <7 kPa. Factors associated with variation included measurements made by 2 different operators or at least 1 non-senior operator, ratios of interquartile range:median values, significant fibrosis (≥ 7 kPa) at LSM1, baseline body mass index, or a 2-fold difference in level of alanine aminotransferase between measurements. When the analyses were restricted to measurements made by the same operator, the variation was slightly reduced; fibrosis stage differed between measurements for only 34.3% of cases.
Operator-related and patient-related factors produce significant variations in liver stiffness measurements made by transient elastometry, limiting its use in monitoring patients. These variations are unrelated to disease progression. The lowest levels of variation occur in measurements made in patients with no or early-stage fibrosis or by a single experienced operator.
Objectives
To evaluate the relationship between metabolic syndrome and the frequency and severity of lower urinary tract symptoms (
LUTS
).
Patients and Methods
In all, 4666 men aged 55–100 years ...consulting a general practitioner during a 12‐day period in
D
ecember 2009 have been included in this observational study.
LUTS
were defined according to the International Prostate Symptom Score (
IPSS
) and metabolic syndrome with the National Cholesterol Education Program/Adult Treatment Panel
III
definition. We studied the correlation between metabolic syndrome and its individual components, and the severity of
LUTS
(
IPSS
and treatment for
LUTS
). Analyses were adjusted for body mass index, age, and prostate‐specific antigen level.
Results
Metabolic syndrome was reported in 51.5% of the patients and 47% were treated for
LUTS
. There was a significant link between metabolic syndrome and treated
LUTS
(
P
< 0.001). The risk of being treated for
LUTS
also increased with an increasing number of metabolic syndrome components present. Metabolic syndrome was positively correlated with the severity of the
LUTS
(
P
< 0.001) for overall
IPSS
and both voiding and storage scores (
P
< 0.001). Each component of the metabolic syndrome (except high‐density lipoprotein‐cholesterol) appeared as an independent risk factor of high
IPSS
and of
LUTS
treatment in multivariate analysis. Metabolic syndrome was positively correlated with prostate volume.
Conclusions
Our results suggest a significant relationship between
LUTS
linked to benign prostatic hyperplasia and metabolic syndrome, in terms of frequency and severity. The risk of being treated for
LUTS
also increased with an increasing number of metabolic syndrome components present. The prevention of such modifiable factors by the promotion of dietary changes and regular physical activity practice may be of great importance for public health.
Liver biopsy is considered as the gold standard for assessing non-alcoholic fatty liver disease (NAFLD) histologic lesions. The aim of this study was to determine the diagnostic utility of ...non-invasive markers of fibrosis, validated in chronic viral hepatitis and alcoholic liver disease (FibroTest, FT), in patients with NAFLD.
170 patients with suspected NAFLD were prospectively included in a reference center (Group 1), 97 in a multicenter study (Group 2) and 954 blood donors as controls. Fibrosis was assessed on a 5 stage histological scale validated by Kleiner et al from F0 = none, F1 = perisinusoidal or periportal, F2 = perisinusoidal and portal/periportal, F3 = bridging and F4 = cirrhosis. Histology and the biochemical measurements were blinded to any other characteristics. The area under the ROC curves (AUROC), sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV, NPV) were assessed.
In both groups FT has elevated and not different AUROCs for the diagnosis of advanced fibrosis (F2F3F4): 0.86 (95%CI 0.77-0.91) versus 0.75 (95%CI 0.61-0.83; P = 0.10), and for F3F4: 0.92 (95%CI 0.83-0.96) versus 0.81 (95%CI 0.64-0.91; P = 0.12) in Group 1 and Group 2 respectively. When the 2 groups were pooled together a FT cutoff of 0.30 had a 90% NPV for advanced fibrosis (Se 77%); a FT cutoff of 0.70 had a 73% PPV for advanced fibrosis (Sp 98%).
In patients with NAFLD, FibroTest, a simple and non-invasive quantitative estimate of liver fibrosis reliably predicts advanced fibrosis.
Liver biopsy is considered the gold standard for assessing histologic lesions of non-alcoholic fatty liver disease (NAFLD). The aim was to develop and validate a new biomarker of non alcoholic steato ...hepatitis (NASH) the NashTest (NT) in patients with NAFLD.
160 patients with NAFLD were prospectively included in a training group, 97 were included in a multicenter validation group and 383 controls. Histological diagnoses used Kleiner et al's scoring system, with 3 classes for NASH: "Not NASH", "Borderline", "NASH"). The area under the ROC curves (AUROC), sensitivity (Se), specificity (Sp), and positive and negative predictive values (PPV, NPV) were assessed.
NT was developed using patented algorithms combining 13 parameters: age, sex, height, weight, and serum levels of triglycerides, cholesterol, alpha2macroglobulin, apolipoprotein A1, haptoglobin, gamma-glutamyl-transpeptidase, transaminases ALT, AST, and total bilirubin. AUROCs of NT for the diagnosis of NASH in the training and validation groups were, respectively, 0.79 (95%C I 0.69-0.86) and 0.79 (95% CI 0.67-0.87; P = 0.94); for the diagnosis of borderline NASH they were: 0.69 (95% CI 0.60-0.77) and 0.69 (95% CI 0.57-0.78; P = 0.98) and for the diagnosis of no NASH, 0.77 (95% CI 0.68-0.84) and 0.83 (95% CI 0.67-0.90; P = 0.34). When the two groups were pooled together the NashTest Sp for NASH = 94% (PPV = 66%), and Se = 33% (NPV = 81%); for borderline NASH or NASH Sp = 50% (PPV = 74%) and Se = 88% (NPV = 72%).
In patients with non-alcoholic fatty liver disease, NashTest, a simple and non-invasive biomarker reliably predicts the presence or absence of NASH.
PDF