Person: ERGELEN, RABİA
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ERGELEN
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RABİA
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Publication Metadata only A comparison of FibroMeter (TM) NAFLD Score, NAFLD fibrosis score, and transient elastography as noninvasive diagnostic tools for hepatic fibrosis in patients with biopsy-proven non-alcoholic fatty liver disease(INFORMA HEALTHCARE, 2014) ÇELİKEL, ÇİĞDEM; Aykut, Umut Emre; Akyuz, Umit; Yesil, Atakan; Eren, Fatih; Gerin, Fatma; Ergelen, Rabia; Celikel, Cigdem Ataizi; Yilmaz, YusufBackground: Noninvasive markers that purport to distinguish patients with non-alcoholic fatty liver disease (NAFLD) with fibrosis from those without must be evaluated rigorously for their classification accuracy. Herein, we seek to compare the diagnostic performances of three different noninvasive methods (FibroMeter (TM) NAFLD score, NAFLD Fibrosis score (NFSA), and Transient Elastrography [TE]) for the detection of liver fibrosis in NAFLD patients. Methods: A total of 88 patients with biopsy-proven NAFLD were included. The Kleiner system was used for grading fibrosis in liver biopsies. The FibroMeter (TM) NAFLD score was determined using a proprietary algorithm (regression score). The NFSA score was calculated based on age, hyperglycemia, body mass index, platelets, albumin and serum aminotransferase levels. TE was performed using the Fibroscan apparatus. Results: The sensitivities/specificities for the FibroMeter (TM) NAFLD score, NFSA, and TE for the diagnosis of significant fibrosis (F2 + F3 + F4 fibrosis) were 38.6%/86.4%, 52.3%/88.6%, and 75.0%/93.2%, respectively. The areas under the receiver operating characteristic curves of TE were significantly higher than those of both the FibroMeter (TM) NAFLD score and NFSA. No significant differences were found between the FibroMeter (TM) NAFLD score and NFSA for the detection of significant and severe fibrosis, although the diagnostic performance of the FibroMeter (TM) NAFLD score was higher than that of the NFSA score for cirrhosis. Conclusions: In summary, TE showed the best diagnostic performance for the noninvasive assessment of liver fibrosis in NAFLD patients. The diagnostic performances of the FibroMeter (TM) NAFLD score and NFSA did not differ significantly for the detection of both significant and severe fibrosis.Publication Metadata only Nonalcoholic Steatohepatitis Score is an Independent Predictor of Right Ventricular Dysfunction in Patients with Nonalcoholic Fatty Liver Disease(WILEY-HINDAWI, 2015) SÜNBÜL, MURAT; Sunbul, Murat; Kivrak, Tarik; Durmus, Erdal; Akin, Hakan; Aydin, Yucel; Ergelen, Rabia; Yilmaz, Yusuf; Agirbasli, MehmetObjectiveNonalcoholic fatty liver disease (NAFLD) is associated with increased risk of cardiovascular disease and impaired left ventricular (LV) function, yet the impact of NAFLD on right ventricular (RV) function remains unclear. We investigate the RV functional properties in patients with NAFLD. MethodsNinety consecutive patients with the diagnosis of biopsy-proven NAFLD and 45 age- and sex-matched controls were included. All patients underwent an echocardiographic examination. RV function was evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE). ResultsMean fibrosis stage and nonalcoholic steatohepatitis (NASH) scores were 1.31.1 and 5.2 +/- 1.6, respectively. NAFLD patients displayed decreased RV function compared to controls. NAFLD patients with liver fibrosis (67 patients) had significantly lower RV function assessed by GLS (global longitudinal strain) compared to patients without liver fibrosis (18.9 +/- 3.4% vs. 21.6 +/- 2.3%, P<0.001). NASH score 5 was associated with lower RV-GLS (18.9 +/- 3.1% vs. 21.0 +/- 3.4%, P=0.006). NASH score inversely correlated with RV-GLS (r=-0.370, P<0.001) such as patients with impaired RV-GLS (<19%) showed significantly higher NASH score compared to normal RV-GLS group (5.8 +/- 1.4 vs. 4.8 +/- 1.7, P=0.009). Logistic regression analysis revealed that NASH score was an independent predictor of impaired RV function in patients with NAFLD. ConclusionsPatients with NAFLD have impaired RV function. NASH score inversely correlates with RV-GLS and independently predicts impaired RV function in patients with NAFLD.Publication Metadata only Comparison of Doppler ultrasound and transient elastography in the diagnosis of significant fibrosis in patients with nonalcoholic steatohepatitis(SPRINGER, 2016) ÇELİKEL, ÇİĞDEM; Ergelen, Rabia; Yilmaz, Yusuf; Asedov, Ruslan; Celikel, Cigdem; Akin, Hakan; Bugdayci, Onur; Altun, Ersan; Tuney, DavutBackground: Liver fibrosis is an important prognostic determinant in patients with nonalcoholic steatohepatitis (NASH). Hepatic artery resistivity index (HARI) is a doppler ultrasonography (US) parameter that is used to follow up microcirculatory resistance in fatty liver. We aimed to asses whether it is possible to demonstrate significant fibrosis by means of doppler US in comparison with transient elastography (TE) and liver biopsy in NASH patients. Patients and methods: A total of 63 (mean age 47.1 +/- 8.4 years, 39 male, 24 female) biopsy-proven NASH patients were enrolled in this prospective study. The study population was classified into two groups: significant and no-significant fibrosis patients. Doppler US and TE were performed in two groups. Results: HARI and TE values were significantly higher in significant fibrosis group (0.81 +/- 0.05 vs. 0.63 +/- 0.14, p < 0.0005; 15.9 +/- 4.8 vs. 6.2 +/- 2.6 kilopascals, p < 0.0005; respectively). Based on the ROC curve, the optimal cut-off value of HARI for a significant fibrosis was >0.75, which yielded a sensitivity of 78% and a specificity of 75%, with the area under the curve at 0.90. The optimal cut-off value of TE for a significant fibrosis was >9.8 kilopascals, which yielded a sensitivity of 90% and a specificity of 91%, with the area under the curve at 0.95. HARI values were moderately correlated with TE values (r = 0.53, p < 0.001). Conclusion: Doppler US has moderate % sensitivity and % specificity, which is lower compared with TE for the diagnosis significant fibrosis. However, it may be used as an alternative method for the assessment of fibrosis in patients with NASH who are not good candidates for TE evaluation.Publication Metadata only Arterial stiffness in patients with non-alcoholic fatty liver disease is related to fibrosis stage and epicardial adipose tissue thickness(ELSEVIER IRELAND LTD, 2014) SÜNBÜL, MURAT; Sunbul, Murat; Agirbasli, Mehmet; Durmus, Erdal; Kivrak, Tarik; Akin, Hakan; Aydin, Yucel; Ergelen, Rabia; Yilmaz, YusufObjective: Non-alcoholic fatty liver disease (NAFLD) is associated with atherosclerosis and reduced vascular compliance. The purpose of this study was to examine the relationships between arterial stiffness measures, the histological severity of NAFLD, and epicardial fat thickness (EFT). Methods: A total of 100 patients with biopsy-proven NAFLD and 50 age-and sex-matched controls were enrolled. The histological severity was assessed in all NAFLD patients. Measurements of arterial stiffness [pulse-wave velocity (PWV) and augmentation index (AIx)] were carried out using a Mobil-O-Graph arteriograph system. EFT was assessed by means of echocardiography. Results: Compared with controls, NAFLD patients had significantly higher PWV and AIx values. Stepwise linear regression analysis demonstrated that the liver fibrosis score and EFT were independent predictors of both PWV and AIx values in NAFLD patients. Conclusions: Patients with NAFLD have an increased arterial stiffness, which reflects both the severity of liver fibrosis and increased EFT values. (C) 2014 Elsevier Ireland Ltd. All rights reserved.Publication Metadata only Not only type 2 diabetes but also prediabetes is associated with portal inflammation and fibrosis in patients with non-alcoholic fatty liver disease(ELSEVIER SCIENCE INC, 2014) ERGELEN, RABİA; Yilmaz, Yusuf; Senates, Ebubekir; Yesil, Atakan; Ergelen, Rabia; Colak, YasarAims: Growing evidence suggests that not only type 2 diabetes (T2D) but also prediabetes (PD) is common in patients with non-alcoholic fatty liver disease (NAFLD). However, few data exist on how PD impacts the histological characteristics of NAFLD patients. In this exploratory study, we sought to investigate the associations of PD and T2D with the severity of the histological features in patients with NAFLD. Methods: The population consisted of 280 patients with biopsy-proven NAFLD. The associations of PD and T2D with the severity of histological features of NAFLD were analyzed using multiple logistic (or ordinal logistic) regression models after adjustment for confounding factors. Results: PD and T2D was noted in 102 (36.4%) and 92 (32.8%) of patients, respectively. Of the 92 patients with T2D, ten (10.9%) were diagnosed de novo after the OGTT. PD and T2D were significantly associated with more severe portal inflammation (P < 0.01); the adjusted odds ratios (ORs) of PD and T2D for having a higher grade of portal inflammation were 1.8 [95% CI, 1.1, 3.2] and 2.6 [95% CI, 1.3, 5.8]), respectively. A similar relationship was observed for liver fibrosis (P < 0.001); specifically, the adjusted ORs of PD and T2D for having a higher grade of hepatic fibrosis were 2.4[95% CI, 1.3, 3.7] and 3.8 [95% CI, 1.9, 6.1]), respectively. Conclusion: Not only T2D but also PD is independently associated with portal inflammation and fibrosis in NAFLD patients. PD may be useful as a clinical indicator of patients who are likely to have already more severe histological findings. (C) 2014 Elsevier Inc. All rights reserved.Publication Metadata only Detection of hepatic steatosis using the controlled attenuation parameter: a comparative study with liver biopsy(TAYLOR & FRANCIS LTD, 2014) ÇELİKEL, ÇİĞDEM; Yilmaz, Yusuf; Yesil, Atakan; Gerin, Fatma; Ergelen, Rabia; Akin, Hakan; Celikel, Cigdem Ataizi; Imeryuz, NeseObjective. Measurements of controlled attenuation parameter (CAP) with transient elastography (FibroScan (R); EcoSens SA, Paris, France) may provide an accurate noninvasive assessment of hepatic steatosis. Herein, we prospectively determined the accuracy of liver fat quantification with CAP values in patients with chronic liver diseases and compare the results with those of histological assessment of steatosis as reference standard. Materials and methods. We enrolled 50 Turkish patients with various forms of chronic liver diseases. All patients underwent both CAP assessment and ultrasonography-guided liver biopsy. Results. On liver biopsy, 16 (32%) patients had S0, 12 (24%) had S1, 9 (18%) had S2, and 13 (26%) had S3. The CAP values increased significantly (p < 0.001) for each steatosis stage on liver biopsy: S0, 222 dB/m; S1, 250 dB/m; S2, 270 dB/m; and S3, 318 dB/m. A cutoff value of 257 dB/m could distinguish significant steatosis (S2-S3) from S0 (Sn 89%, Sp 83%, positive likelihood ratio 5.33, negative likelihood ratio 0.13, AUROC = 0.93). Multivariable analysis indicated that neither liver fibrosis (p = 0.58) nor disease etiology (p = 0.96) had a significant impact on the association between CAP and the stage of steatosis. Conclusion. The determination of CAP using transient elastography can represent an important step forward toward the goal of an imaging liver biopsy.