The severity of steatosis influences liver stiffness measurement in patients with nonalcoholic fatty liver disease

Abstract

In nonalcoholic fatty liver disease, the influence of severity of steatosis on liver stiffness measurement (LSM) is poorly studied and still debated. We assessed the impact of steatosis severity and its ultrasonographic (US) sign, severe bright liver echo pattern, on LSM values and on transient elastography accuracy for the diagnosis of liver fibrosis in a cohort of consecutive patients with nonalcoholic fatty liver disease. Patients (n = 253) were assessed by clinical, US, and histological (Kleiner score) features. Transient elastography was performed using the M probe. Among patients with low amounts of fibrosis (F0‐F1 and F0‐F2), median LSM values, expressed in kilopascals, were significantly higher in subjects with severe steatosis (≥66% at liver biopsy) compared to those without (F0‐F1 6.9 versus 5.8, P = 0.04; F0‐F2 7.4 versus 6.0, P = 0.001) as well as in patients with severe bright liver echo pattern on US compared to their counterparts (F0‐F1 7.3 versus 5.6, P = 0.001; F0‐F2 7.6 versus 6.0, P < 0.001). In subjects without significant fibrosis (F0‐F1) and without severe fibrosis (F0‐F2), a higher rate of false‐positive LSM results was observed in patients with steatosis ≥66% compared to those without (F0‐F1 23.6% versus 14.9%, F0‐F2 33.3% versus 13.2%) and in patients with severe bright liver echo pattern on US (F0‐F1 22.2% versus 15.4%, F0‐F2 28.8% versus 15.6%) compared to their counterparts. Conclusions: In patients with nonalcoholic fatty liver disease, the presence of severe steatosis, detected by histology or by US, should always be taken into account in order to avoid overestimations of liver fibrosis assessed by transient elastography. (Hepatology 2015;62:1101‐1110)

Pancreatic Diabetes Mellitus and Heavy Drinking are Risk Factors for the Development of Liver Fibrosis in Alcoholic Chronic Pancreatitis

“…These results may suggest that the toxic injury was more severe and prolonged and the severity of ACP was more advanced in the ACP patients with liver fibrosis group [32,33]. Moreover, DM may induce steatohepatitis, which may act synergistic ally with alcohol to result in the liver parenchyma alterations and the TE findings [34,35]. DM was more frequent in our ACP patients than in a previous study [6] and this may explain the higher rate of ALF in our study as compared to the previous results.…”

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“…Other diseases, which cause increased liver stiffness, independent of liver fibrosis include amyloidosis, lymphomas and extramedullary hemopoiesis. Presently, it is uncertain whether hepatic steatosis modulates liver stiffness [52,53] or does not [54,55].…”

Reply

“…As a consequence, we reported higher rates of false-positive LSM results for the noninvasive assessment of F2-F4 and F3-F4 fibrosis by transient elastography in patients with severe steatosis compared with their counterparts. (1) Accordingly, we suggested that in nonalcoholic fatty liver disease patients the presence of severe steatosis, per se or evaluated by ultrasound, should always be taken into account in order to avoid overestimations of liver fibrosis. (1) Notably, we reported similar results in the setting of chronic hepatitis C patients as well.…”

“…(1) Accordingly, we suggested that in nonalcoholic fatty liver disease patients the presence of severe steatosis, per se or evaluated by ultrasound, should always be taken into account in order to avoid overestimations of liver fibrosis. (1) Notably, we reported similar results in the setting of chronic hepatitis C patients as well. (2) We thank Lupsor and colleagues for their interest in our study.…”

“…(2) We thank Lupsor and colleagues for their interest in our study. (1) According to our hypothesis, (1) they tested whether steatosis noninvasively assessed by the controlled attenuated parameter (CAP), a measure recorded using a different software in the FibroScan, overestimates LSM in a small cohort of 30 patients with F2 fibrosis and with chronic liver disease due to different etiologies. Notably, other than to confirm the expected association between CAP and body mass index, they reported significantly higher LSM values in patients with CAP >280 m/second compared with their counterparts.…”