Objectives: Inflammation is a feature of non-alcoholic fatty liver disease progression and plays an important role in hepatic steatosis and fibrosis. Since there are no studies in the literature showing the relationship between hepatosteatosis with the systemic immune-inflammation index (SII) and pan-immune inflammation value (PIV), we aimed to evaluate the relationship between these biomarkers and hepatosteatosis in childhood. Methods: We included 133 consecutive obese children and adolescents aged 6–18 years into this single-center, retrospective, and cross-sectional study. Anthropometric, physical examination, radiological and laboratory data were obtained and recorded from the file records of each case. Results: When we grouped the patient population according to the grade of hepatosteatosis, there was a statistically significant difference between the groups in terms of SII and PIV values (p<0.05, for both). In the analyzes performed to identify independent predictors of hepatosteatosis pubertal status (p=0.019) and PIV value (p<0.001) were found to be significant as independent predictors. Moreover, in the analysis performed to predict severity of hepatic steatosis, regression analysis was performed by dividing the groups into groups with and without severe adiposity. As a result of this analysis, HOMA-IR (p=0.019) and PIV value (p=0.028) were found to be significant in the prediction of severe hepatic adiposity. Conclusions: Our findings showed that increased PIV levels were associated with the presence and severity of hepatic steatosis, but not with SII.

Objective: This study aimed to investigate the relationship between computed tomography (CT)-derived Hounsfield Unit (HU) measurements and dual-energy X-ray absorptiometry (DXA) and to evaluate the feasibility of using contrast-enhanced abdominal CT as a complementary tool in the assessment of bone health in liver transplant recipients. Methods: This retrospective descriptive and analytical study included adult liver transplant recipients who underwent both contrast-enhanced abdominal CT and DXA within a three-month interval. HU measurements were obtained from sagittal and axial reformatted images at the lumbar spine (L1–L4) and femoral neck. All CT examinations were performed using a standardized venous-phase protocol. DXA-derived T-scores from the lumbar spine and femur served as the reference standard. Correlation analyses and receiver operating characteristic (ROC) curves were used to evaluate associations between HU values and BMD, as well as the diagnostic performance of HU in identifying low bone density. Results: A total of 259 recipients (mean age 55.7 ± 14.4 years; 62.9% male) were included. Based on lumbar spine DXA, 17.8% had normal BMD, 36.7% were osteopenic, and 45.5% were osteoporotic. CT-derived HU values at both the lumbar spine and femoral neck were significantly lower in patients with reduced BMD and showed a graded decline across worsening DXA categories. HU values demonstrated positive correlations with corresponding T-scores. Diagnostic performance for detecting osteoporosis was fair, with AUCs of 0.700 (sagittal), 0.698 (axial), and 0.751 (femoral). Conclusion: Contrast-enhanced abdominal CT provides useful ancillary information for opportunistic bone health assessment. CT-derived HU values offer a rapid and cost-effective complementary tool but should not replace DXA in the diagnostic evaluation of osteoporosis

Acute kidney injury (AKI) significantly contributes to the mortality and morbidity rates among pediatric liver transplant (LT) recipients. Our study aimed to assess the potential factors contributing to AKI in pediatric LT patients and to analyze the impact of AKI on postoperative mortality and hospitalization duration. About 235 pediatric LT patients under the age of 18 between the years 2015 and 2021 were evaluated retrospectively. The relationship between preoperative and intraoperative variables of the patients and AKI developed when the early postoperatıve period was assessed. A correlation was found between the patients’ preoperative age, albumin levels, and AKI. AKI was found to be associated with the duration of surgery and intraoperative blood transfusion. Our findings revealed that the severity of AKI in pediatric LT patients is linked to extended surgical durations and increased blood transfusions resulting from hemodynamically compromised blood loss. Furthermore, independent risk factors for AKI were identified as prolonged warm ischemia and the overall duration of the operation. Demiroz D, Colak YZ, Ozdes OO, Ucar M, Ali Erdogan M, Toprak HI, et al. Incidence and Risk Factors of Acute Kidney İnjury in Pediatric Liver Transplant Patients: A Retrospective Study. Indian J Crit Care Med 2024;28(1):75–79.

Pediatric liver transplant (LT) recipients are at increased risk of impaired bone mineral accrual due to chronic liver disease, growth disturbances, and post-transplant metabolic factors. Although dual-energy X-ray absorptiometry (DXA) remains the reference method for evaluating bone mineral density (BMD), opportunistic assessment using routine abdominal computed tomography (CT) has emerged as a potential adjunct tool. This study aimed to evaluate the potential of using routine abdominal CT scans to assess bone health in pediatric LT recipients by comparing lumbar vertebral Hounsfield unit (HU) values with those obtained using DXA. This retrospective study included 62 pediatric LT recipients who underwent both abdominal CT and lumbar spine DXA within a 3-month period. HU values were measured at vertebral levels L1–L4 in both the sagittal and axial planes. DXA z -scores were classified according to International Society for Clinical Densitometry pediatric guidelines. Correlation and receiver operating characteristic (ROC) analyses were performed to determine the diagnostic performance of HU values. Patients with low bone mineral density had significantly lower sagittal HU values ( p < 0.05). Moderate correlation was found between sagittal mean HU and DXA z -scores ( r = 0.429, p = 0.003), whereas weaker correlation was observed for axial HU values ( r = 0.266, p = 0.037). ROC analysis demonstrated a moderate discriminative ability for sagittal HU (AUC = 0.713, p = 0.016), with an optimal cut-off value of 188 HU yielding 83% sensitivity and 68% specificity. Conclusion : CT-derived HU values from routine abdominal imaging may provide valuable supplementary information on bone health in pediatric LT recipients. However, CT-based bone assessment should be considered a complementary approach, enhancing clinical decision-making by providing supportive quantitative information in scenarios where DXA is unavailable or impractical. What is Known: • Pediatric liver transplant recipients are at increased risk of impaired bone mineral accrual, and DXA remains the reference standard for pediatric bone mineral density assessment. • In adults, vertebral HU values from routine CT correlate with bone mineral density, but evidence in pediatric populations remains limited. What is New: • CT-derived sagittal vertebral HU values showed a moderate correlation with DXA lumbar z-scores in pediatric liver transplant recipients, whereas axial measurements were weaker. • A sagittal mean threshold of ~188 HU demonstrated a moderate diagnostic performance for identifying low bone mineral density, supporting opportunistic contrast-enhanced CT as a complementary—not replacement—tool to DXA.