Liver Stiffness Is Associated With Risk of Decompensation, Liver Cancer, and Death in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis

Abstract

BACKGROUND & AIMS Liver stiffness measurement (LSM), using elastography, can independently predict outcomes of patients with chronic liver diseases (CLDs). However, there is much variation in reporting and consistency of findings. We performed a systematic review and meta-analysis to evaluate the association between LSM and outcomes of patients with CLDs. METHODS We performed a systematic review of the literature, through February 2013, for studies that followed up patients with CLDs prospectively for at least 6 months and reported the association between baseline LSM and subsequent development of decompensated cirrhosis or hepatocellular carcinoma (HCC), as well as mortality. Summary relative risk (RR) estimates per unit of LSM and 95% confidence intervals (CIs) were estimated using the random effects model. RESULTS Our final analysis included 17 studies, reporting on 7058 patients with CLDs. Baseline LSM was associated significantly with risk of hepatic decompensation (6 studies; RR, 1.07; 95% CI, 1.03–1.11), HCC (9 studies; RR, 1.11; 95% CI, 1.05–1.18), death (5 studies; RR, 1.22; 95% CI, 1.05–1.43), or a composite of these outcomes (7 studies; RR, 1.32; 95% CI, 1.16–1.51). We observed considerable heterogeneity among studies—primarily in the magnitude of effect, rather than the direction of effect. This heterogeneity could not be explained by variations in study locations, etiologies and stages of CLD, techniques to measure liver stiffness, adjustment for covariates, or method of imputing relationship in the meta-analysis. CONCLUSIONS Based on a meta-analysis of cohort studies, the degree of liver stiffness is associated with risk of decompensated cirrhosis, HCC, and death in patients with CLDs. LSM therefore might be used in risk stratification.

Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update

“…In a meta-analysis of 17 studies with 7058 patients with chronic liver disease, baseline liver stiffness was associated with the risk of hepatic decompensation [relative risk (RR) 1.07, 95 % CI 1.03-1.11], HCC development (RR 1.11, 95 % CI 1.05-1.18) and death (RR 1.22, 95 % CI 1.05-1.43) [120]. A study of patients undergoing hepatectomy for HCC [121] showed that liver stiffness[15.7 kPa was a risk factor for postoperative liver failure (sensitivity 96 % and specificity 69 %).…”

New challenges in clinical research on hepatocellular carcinoma

“…Nevertheless, many authors have recently showed that the risk of developing HCC is not homogeneous and have suggested different tools to predict it. Regarding patients with chronic HCV infection, liver elastography seems to be a useful tool in order to stratify patients at risk of developing HCC (19,20). It is worthy to highlight that in those cases of HCV-related cirrhosis, the achievement of sustained virological response does not rid the risk of developing HCC after treatment (21) and therefore these patients should remain under surveillance.…”

Hagen-Poiseuille’s law: The link between cirrhosis, liver stiffness, portal hypertension and hepatic decompensation

“…These tests may be more predictive of post resection outcomes [10] . Meta-analysis of studies of liver stiffness suggest an association with risk of decompensation, liver cancer and death in patients with chronic liver disease [26] .…”