Two-dimensional shear wave elastography predicts survival in advanced chronic liver disease

Abstract

ObjectiveLiver stiffness measurement (LSM) is a tool used to screen for significant fibrosis and portal hypertension. The aim of this retrospective multicentre study was to develop an easy tool using LSM for clinical outcomes in advanced chronic liver disease (ACLD) patients.DesignThis international multicentre cohort study included a derivation ACLD patient cohort with valid two-dimensional shear wave elastography (2D-SWE) results. Clinical and laboratory parameters at baseline and during follow-up were recorded. LSM by transient elastography (TE) was also recorded if available. The primary outcome was overall mortality. The secondary outcome was the development of first/further decompensation.ResultsAfter screening 2148 patients (16 centres), 1827 patients (55 years, 62.4% men) were included in the 2D-SWE cohort, with median liver SWE (L-SWE) 11.8 kPa and a model for end stage liver disease (MELD) score of 8. Combination of MELD score and L-SWE predict independently of mortality (AUC 0.8). L-SWE cut-off at ≥20 kPa combined with MELD ≥10 could stratify the risk of mortality and first/further decompensation in ACLD patients. The 2-year mortality and decompensation rates were 36.9% and 61.8%, respectively, in the 305 (18.3%) high-risk patients (with L-SWE ≥20 kPa and MELD ≥10), while in the 944 (56.6%) low-risk patients, these were 1.1% and 3.5%, respectively. Importantly, this M10LS20 algorithm was validated by TE-based LSM and in an additional cohort of 119 patients with valid point shear SWE-LSM.ConclusionThe M10LS20 algorithm allows risk stratification of patients with ACLD. Patients with L-SWE ≥20 kPa and MELD ≥10 should be followed closely and receive intensified care, while patients with low risk may be managed at longer intervals.

Acute-on-chronic liver failure: a global disease

“…One step in this direction was the introduction of the M10LS20 algorithm, which allows bed-side stratification of patients with advanced chronic liver disease based on Model for Endstage Liver Disease (MELD) and liver shearwave elastography (L-SWE). 9 In summary, this meta-analysis, conducted by Mezzano and colleagues, is the first study to gather worldwide epidemiological data on prevalence and mortality of ACLF to systematically evaluate the global burden of disease (see figure 1). Even though the authors chose to restrict study inclusion by EASL-CLIF definition of ACLF, the significance of the general conclusions drawn from this meta-analysis remain most relevant.…”

“…One step in this direction was the introduction of the M10LS20 algorithm, which allows bed-side stratification of patients with advanced chronic liver disease based on Model for Endstage Liver Disease (MELD) and liver shear-wave elastography (L-SWE). 9 …”

Pancreatic Ductal Adenocarcinoma: Relating Biomechanics and Prognosis

“…It is not applied to endoscopic ultrasound which may limit its predictive use, but also is a less invasive procedure. SWE using FibroScan has also been shown to correlate well to liver stiffness in the diagnosis of non-alcoholic fatty liver disease (NAFLD) [ 132 , 133 ] and has recently been demonstrated to predict survival in chronic liver disease [ 134 ].…”

Longitudinal increase in albumin–bilirubin score is associated with non-malignancy-related mortality and quality of life in patients with liver cirrhosis

“…However, the “point of no return” exists, which is the progression of LC even after hepatitis has been regulated, as typified by hepatitis C [ 9 , 10 ]. Several factors related to the prognosis of LC have been reported, such as the Child–Pugh grade [ 1 ], model for end-stage liver disease (MELD) score [ 1 ], renal impairment [ 11 ], liver stiffness (ultrasound-based transient elastography or magnetic resonance elastography) [ 12 , 13 ], the combination of liver stiffness and MELD score [ 14 ], hepatic venous pressure gradient [ 15 ], sarcopenia [ 16 ], and albumin–bilirubin (ALBI) score [ 17 ]; however, these factors do not assess the course of progression.…”