Controlled attenuation parameter reflects steatosis in compensated advanced chronic liver disease

Abstract

Abbreviations: AUROC, area under the receiving operating characteristic curves; BMI, body mass index; cACLD, compensated advanced chronic liver disease; CAP, controlled attenuation parameter; IQR, interquartile range; LR, likelihood ratio; LSM, liver stiffness measurement; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; TJLB, transjugular liver biopsy; ULN, upper limit of normality. AbstractBackground & Aims: Controlled attenuation parameter (CAP) for steatosis assessment has not been validated in compensated advanced chronic liver disease compensated advanced chronic liver disease (cACLD). We primarily aimed at assessing the accuracy of CAP for the diagnosis and quantification of steatosis in cACLD.Secondary aim: to assess the validity of non-invasive criteria for cACLD according to liver stiffness measurement (LSM).Methods: This is a single-centre retrospective study including patients with cACLD defined as LSM ≥10 kPa, CAP measurement and liver biopsy (reference standard for steatosis and fibrosis) observed in 06/2015-06/2017. Steatosis was graded as S0 (<5%), S1 (5%-32%), S2 (33%-66%) and S3 (>66%). The diagnostic performance of CAP for any grade of steatosis and for high-grade steatosis (≥S2) was studied.Results: Among 461 consecutive patients, 111 with LSM-based diagnosis of cACLD were included (63% male, median age 55 years, median body mass index 28.1 Kg/m 2 , aetiology: 32% non-alcoholic fatty liver disease/non-alcoholic steatohepatitis, 32% alcohol or viral + metabolic syndrome, 15% viral, 6% autoimmune, 4% alcohol, 11% others). Median LSM and CAP were 16.1 kPa and 277 dB/m respectively. On liver biopsy, steatosis was found in 88/111 patients (79%); 44 patients (43 with metabolic syndrome) had high-grade steatosis. CAP was accurate in identifying any grade of steatosis (area under the receiving operating characteristic curves 0.847; 95% CI 0.767-0.926, P < .0001), and ≥S2 steatosis (0.860; 95% CI 0.788-0.932, P < .0001). CAP performed similarly in patients with CAP-interquartile range (IQR) ≥ or <40 dB/m. Conclusions:Steatosis is frequent in patients with cACLD and metabolic syndrome.CAP diagnostic accuracy for any steatosis and high-grade steatosis is good in this population. A CAP-IQR ≥40 dB/m does not impair CAP diagnostic accuracy in cACLD. K E Y W O R D Scirrhosis, liver biopsy, liver stiffness, NASH, steatosis

Ultrasound Elastography—Cornerstone of Non-Invasive Metabolic Dysfunction-Associated Fatty Liver Disease Assessment

“…The study showed that CAP can identify any grade of steatosis and S2–S3 steatosis with moderate accuracy, with results that did not differ from those obtained in patients with less severe chronic liver disease. The obtained data support the cut-off of 268 dB/m as accurate to rule out high-grade steatosis in cACLD patients [ 34 , 35 ]. These data could be particularly important in the light of prior publication by the same study group where they demonstrated that CAP can be used as a non-invasive predictor of prognosis in patients with cACLD and could improve the risk stratification for clinically relevant events and clinical decompensation provided by LSM.…”

“…Although little attention has been paid to this area so far, steatosis may also be more common in patients, with cACLD being observed in 77% of the patients in the reported study [ 34 ]. However, a significant liver fat content was almost exclusively observed in patients with metabolic syndrome.…”

Liver and Nonliver-Related Outcomes at 2 Years Are Not Influenced by the Results of the FIB-4 Test and Liver Elastography in a Real-Life Cohort of Patients with Type 2 Diabetes

“…Whereas, the impact of steatosis has not been proven, and fibrosis plays the prominent role on the development of liver-related complications as well as overall morbidity and mortality as already pointed out. According to recent data, steatosis might be present even in the patients with the compensated advanced chronic liver disease (cACLD), and the higher grade of steatosis might be associated with the worse prognosis in terms of decompensation and death [20][21][22]. For less advanced stages of chronic liver disease, probably the rationale for quantifying liver steatosis is to objectively follow reduction in steatosis while the patient is taking lifestyle measures to correct his/her metabolic abnormalities.…”

Liver steatosis is highly prevalent and is associated with metabolic risk factors and liver fibrosis in adult patients with type 1 Gaucher disease

“…29,30 Moreover, large prospective studies including patients with chronic liver diseases of various aetiologies consistently reported a good correlation of CAP values with the amount of steatosis assessed by liver biopsy. [31][32][33][34] Of note, since CAP is integrated in Fibroscan®, it is possible to have a one-shot reliable non-invasive assessment of both liver steatosis and fibrosis using the same equipment.…”

“…Several studies have clearly shown that CAP values are strongly associated with obesity, MetS and alcohol consumption, variables epidemiologically associated with liver steatosis 29,30 . Moreover, large prospective studies including patients with chronic liver diseases of various aetiologies consistently reported a good correlation of CAP values with the amount of steatosis assessed by liver biopsy 31‐34 . Of note, since CAP is integrated in Fibroscan®, it is possible to have a one‐shot reliable non‐invasive assessment of both liver steatosis and fibrosis using the same equipment.…”