Controlled attenuation parameter does not predict hepatic decompensation in patients with advanced chronic liver disease

Scheiner, Bernhard; Steininger, Lisa; Semmler, Georg; Unger, Lukas; Schwabl, Philipp; Bucsics, Theresa; Paternostro, Rafael; Ferlitsch, Arnulf; Trauner, Michael; Reiberger, Thomas; Mandorfer, Mattias

doi:10.1111/liv.13943

Cited by 40 publications

(35 citation statements)

References 41 publications

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“…Interestingly, studies investigating the influence of CAP on disease progression (i.e., hepatic decompensation and mortality) in patients with ACLD showed inconsistent results [37][38][39]. Moreover, we did not observe an association between PNPLA3 genotype and CAP values in a previous study from our center [40].…”

Section: Discussioncontrasting

confidence: 72%

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Performance of Controlled Attenuation Parameter in Patients with Advanced Chronic Liver Disease and Portal Hypertension

et al. 2019

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Background Liver stiffness (LS) measured by vibration-controlled transient elastography (VCTE) is influenced by liver fibrosis and hepatic perfusion pressure. VCTE-based controlled attenuation parameter (CAP) is a noninvasive marker for hepatic steatosis (HS). Aims To investigate the diagnostic performance of CAP in patients with advanced chronic liver disease (ACLD)/portal hypertension (PHT: hepatic venous pressure gradient (HVPG) ≥ 6 mmHg). Methods Eighty-eight patients with LS ≥ 10 kPa and/or HVPG ≥ 6 mmHg who underwent simultaneous liver biopsy, CAP, and HVPG measurement were included. HS was histologically graded according to the modified Brunt classification. Results Patient characteristics: Mean MELD:11 (standard derivation [SD] ± 4), median HVPG:16 (interquartile range [IQR]10-19) mmHg, median LS:27.4 (IQR 16.2-48.9) kPa, and mean CAP:221 (SD ± 75) dB/m. According to histology, 47 (53.4%) patients had no HS (S0), 28 (31.8%) had S1, 11 (12.5%) had S2, and 2 (2.3%) had S3. The area under the receiver operating characteristic curve (AUROC) of CAP for diagnosing any HS (S0 vs. ≥ S1) was 0.692 (95% confidence interval [95% CI] 0.582-0.802) in the overall cohort, 0.830 (95% CI 0.637-1.0) in patients with HVPG < 10 mmHg, and 0.629 (95% CI 0.497-0.761) in patients with clinically significant portal hypertension (CSPH; HVPG ≥ 10 mmHg; n = 69). Using the established cutoff for any HS (248 dB/m), the sensitivity/specificity of CAP was only 48.8%/76.6%, respectively. In contrast, the AUROC and sensitivity/specificity (cutoff 268 dB/m) for diagnosing HS ≥ S2 were 0.842 (95% CI 0.747-0.936) and 84.6%/81.3%, respectively. CAP correlated with the percentage of steatotic hepatocytes (Spearman's ρ = 0.402; p ≤ 0.001) and showed a weak correlation with liver stiffness (ρ = 0.225; p = 0.035). Conclusions The diagnostic performance of CAP for any HS seems to be limited in patients with ACLD, if CSPH is present.

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Section: Discussioncontrasting

confidence: 72%

“…Moreover, we did not observe an association between PNPLA3 genotype and CAP values in a previous study from our center [40]. Therefore, we hypothesized that the diagnostic performance of CAP for diagnosing HS may be worse in patients with ACLD and CSPH [37].…”

Section: Discussionmentioning

confidence: 67%

Performance of Controlled Attenuation Parameter in Patients with Advanced Chronic Liver Disease and Portal Hypertension

et al. 2019

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“…CAP has been an important addition to the applicability of TE, but important caveats apply. Whereas an elevated LS is uniformly associated with worse clinical outcomes in patients with chronic liver disease, such as a higher risk of decompensating events, HCC development, and decreased survival, steatosis as measured by CAP has not been associated with the development of liver cancer or decompensating events . Thus, steatosis is an unreliable marker for disease progression and does not portend a poor clinical course, unlike elevations in LS.…”

Section: Methodsmentioning

confidence: 99%

A review of the use of transient elastography in the assessment of fibrosis and steatosis in the post–liver transplant patient

Winters

Mittal

Schiano

2019

Clinical Transplantation

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Liver biopsy is considered the gold standard method for diagnosing and staging liver disease, particularly in the post-liver transplant setting. Given the invasive nature of biopsy, alternate means for accurately assessing liver fibrosis and steatosis are preferred especially as the number of patients with fatty liver disease is increasing.Transient elastography has been validated as a useful tool for evaluation of liver fibrosis, as has controlled attenuation parameter index as a tool for assessing steatosis. It is a non-invasive, rapid, and highly reproducible approach to demonstrate the presence of fibrosis among non-transplant patients with chronic liver disease of various etiologies. However, it has not yet found wide acceptance in liver transplant recipients. There are few published studies evaluating the merits and applicability of transient elastography to assess allografts after liver transplantation. We review the published data on the use of transient elastography with concurrent controlled attenuation parameter in liver transplant recipients and recommend its greater use to follow allograft function over time.

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“…In our study, next to uric acid, only triglycerides and transaminase levels were significantly different between lean patients with or without significant steatosis. As outlined above, it remains unclear whether "isolated" steatosis impacts on survival [10]. Additionally, there are controversial results regarding the question if "lean NAFLD" has a worse survival than "obese NAFLD."…”

Section: Discussionmentioning

confidence: 99%

Hepatic Steatosis in Lean Patients: Risk Factors and Impact on Mortality

et al. 2019

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Background The prognostic impact of liver steatosis in obese patients is well established. Limited data on the risk factors for and impact of hepatic steatosis in lean patients are available. Aims Assess risk factors for liver steatosis in lean patients and investigate its impact on survival. Methods Patients without viral hepatitis and with a BMI ≤ 25 kg/m 2 undergoing liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) by transient elastography were retrospectively identified. Clinical characteristics and laboratory test results were obtained at the time of LSM/CAP measurement. National death registry data were obtained in order to assess survival. Results Among n = 218 lean patients, n = 97 (34.5%) showed significant liver steatosis (CAP ≥ 268 dB/m), while n = 184 (65.5%) had no or just mild steatosis (CAP < 268 dB/m). Patients with steatosis had higher GGT (238.0(± 450.3) vs. 112.1(± 180.0) IU/mL; p = 0.013), AST (63(± 67.4) vs. 38.5(± 32.9) IU/mL; p = 0.001), ALT (59.1(± 58.8) vs. 44.3(± 52.7) IU/mL; p = 0.048) and triglyceride levels (120.1(± 80.3) vs. 96.1(± 58.2) mg/dL; p = 0.014), and showed a trend toward more severe fibrosis (LSM 15.6(± 19.5) vs. 12.0(± 15.7) kPa; p = 0.115). In multivariate binary logistic regression analysis, only serum uric acid levels were independently associated with liver steatosis (odds ratio 1.43 per unit mg/dL; 95% CI 1.001-2.054; p = 0.049). During a mean follow-up of 38.9(± 10.6) months, n = 14 patients (5.0%) died. In the absence of advanced fibrosis, survival after 1 year was similar in patients without (98.7%) and with (98.6%) significant steatosis. Patients with advanced fibrosis had worse 1-year survival without concomitant significant steatosis (84.8%) than patients with steatosis (95.8%; log-rank p < 0.001). Conclusions High serum uric acid levels increase the risk of liver steatosis in lean patients. Liver fibrosis but not hepatic steatosis is a risk factor for impaired survival in lean patients.

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Controlled attenuation parameter does not predict hepatic decompensation in patients with advanced chronic liver disease

Abstract: CAP does not predict the development of first (cACLD)/further (DC) hepatic decompensation, while serum albumin levels and MELD-Na are of prognostic value. This article is protected by copyright. All rights reserved.

Cited by 40 publications

References 41 publications

Performance of Controlled Attenuation Parameter in Patients with Advanced Chronic Liver Disease and Portal Hypertension

Performance of Controlled Attenuation Parameter in Patients with Advanced Chronic Liver Disease and Portal Hypertension

A review of the use of transient elastography in the assessment of fibrosis and steatosis in the post–liver transplant patient

Hepatic Steatosis in Lean Patients: Risk Factors and Impact on Mortality

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