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Basal values and changes of liver stiffness predict the risk of disease progression in compensated advanced chronic liver disease

  • Mònica Pons
    Affiliations
    Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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  • Macarena Simón-Talero
    Affiliations
    Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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  • Laura Millán
    Affiliations
    Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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  • Meritxell Ventura-Cots
    Affiliations
    Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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  • Begoña Santos
    Affiliations
    Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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  • Salvador Augustin
    Correspondence
    Corresponding author at: Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain. Tel.: +34 932746140.
    Affiliations
    Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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  • Joan Genescà
    Affiliations
    Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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      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

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