Abstract
Background and aims
Transient elastography has been proposed as a tool to predict the risk of decompensation
in patients with chronic liver disease. We aimed to identify risk groups of disease
progression, using a combination of baseline liver stiffness measurement (LSM) and
its change over time (delta-LSM) in patients with compensated advanced chronic liver
disease (cACLD).
Methods
Ninety-four patients with baseline LSM ≥10 kPa, Child–Pugh score 5 and without previous decompensation were included. A second
LSM was performed during follow-up and data on liver function and liver-related events
were collected. The primary endpoint was a composite that included death, liver decompensation
and impairment in at least 1 point in Child–Pugh score.
Results
After a median follow-up of 43.6 months, 15% of patients presented the primary endpoint.
Multivariate analysis identified baseline LSM (OR 1.12, P = 0.002) and delta-LSM (OR 1.02, P = 0.048) as independent predictors of the primary endpoint. A high risk group represented
by patients with baseline LSM ≥21 kPa and delta-LSM ≥10% (risk of progression 47.1%, 95% CI: 23–71%) was identified,
while patients with LSM <21 kPa and delta-LSM <10% presented zero risk of progression (P = 0.03).
Conclusions
Simple classification rules using baseline LSM and delta-LSM identify cACLD patients
at low or high risk of disease progression.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis.Hepatology. 2010; 51: 1445-1449
- Non invasive tools for the diagnosis of liver cirrhosis.World Journal of Gastroenterology. 2014; 20: 18131-18150
- The clinical use of HVPG measurements in chronic liver disease.Nature Reviews Gastroenterology & Hepatology. 2009; 6: 573-582
- Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis.Gastroenterology. 2007; 133: 481-488
- Noninvasive methods to assess liver disease in patients with hepatitis B or C.Gastroenterology. 2012; 142 (1293–302.e4)
- Non-invasive evaluation of liver fibrosis using transient elastography.Journal of Hepatology. 2008; 48: 835-847
- Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease.Alimentary Pharmacology and Therapeutics. 2008; 27: 1261-1268
- Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis.Clinical Gastroenterology and Hepatology. 2013; 11 (1573–84.e1–2; quiz e88–9)
- Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study.Journal of Hepatology. 2011; 55: 1017-1024
- Liver stiffness by transient elastography predicts liver-related complications and mortality in patients with chronic liver disease.PLOS ONE. 2014; 9: e95776
- Transient elastography for predicting clinical outcomes in patients with chronic liver disease.Journal of Viral Hepatitis. 2012; 19: e184-e193
- The accuracy of noninvasive methods in the prediction of clinically relevant outcomes in patients with chronic liver disease.Expert Review of Gastroenterology & Hepatology. 2012; 6: 679-682
- Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis.Hepatology. 2012; 56: 198-208
- Baseline values and changes in liver stiffness measured by transient elastography are associated with severity of fibrosis and outcomes of patients with primary sclerosing cholangitis.Gastroenterology. 2014; 146 (quiz e15–6): 970-979
- Evolution of noninvasive tests of liver fibrosis is associated with prognosis in patients with chronic hepatitis C.Hepatology. 2014; 60: 65-76
- Detection of early portal hypertension with routine data and liver stiffness in patients with asymptomatic liver disease: a prospective study.Journal of Hepatology. 2014; 60: 561-569
- Noninvasive tests for fibrosis and liver stiffness predict 5-year outcomes of patients with chronic hepatitis C.Gastroenterology. 2011; 140 (79 e1-3): 1970-1979
- Prognostic significance of liver stiffness for hepatocellular carcinoma and mortality in HBeAg-negative chronic hepatitis B.Journal of Viral Hepatitis. 2011; 18: 738-744
- Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis.Gastroenterology. 2013; 144 (102–11.e1)
- Risk assessment of development of hepatic decompensation in histologically proven hepatitis B viral cirrhosis using liver stiffness measurement.Digestion. 2012; 85: 219-227
- Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis.Hepatology. 2012; 56: 228-238
- Liver stiffness measurement among patients with chronic hepatitis B and C: results from a 5-year prospective study.PLOS ONE. 2014; 9: e111912
- Baseline and serial liver stiffness measurement in prediction of portal hypertension progression for patients with compensated cirrhosis.Liver International. 2014; 34: 1340-1348
- Prediction of liver-related events using fibroscan in chronic hepatitis B patients showing advanced liver fibrosis.PLoS ONE. 2012; 7: e36676
- Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies.Journal of Hepatology. 2006; 44: 217-231
- Hepatocellular carcinoma: current trends in worldwide epidemiology, risk factors, diagnosis and therapeutics.Expert Review of Gastroenterology & Hepatology. 2009; 3: 353-367
- Significant variations in elastometry measurements made within short-term in patients with chronic liver diseases.Clinical Gastroenterology and Hepatology. 2015; 13 (763–71.e1–6)
Article info
Publication history
Published online: July 04, 2016
Accepted:
June 16,
2016
Received:
March 1,
2016
Identification
Copyright
© 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
