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

Liver International - Tập 39 Số 1 - Trang 127-135 - 2019
Bernhard Scheiner1, Lisa Steininger1, Georg Semmler1, Lukas Unger2, Philipp Schwabl1, Theresa Bucsics1, Rafael Paternostro1, Arnulf Ferlitsch1, Michael Trauner1, Thomas Reiberger1, Mattias Mandorfer1
1Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
2Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria

Tóm tắt

AbstractBackground & AimsAssessment of hepatic steatosis by transient elastography (TE)‐based controlled attenuation parameter (CAP) might predict hepatic decompensation. Therefore, we aimed to evaluate the prognostic value of CAP in patients with compensated advanced chronic liver disease (cACLD) and decompensated cirrhosis (DC).MethodsA total of 430 patients who underwent TE (liver stiffness ≥10 kPa) and CAP measurements were included in this retrospective analysis. Half of patients (n = 189) underwent simultaneous HVPG measurement. In cACLD patients, first hepatic decompensation was defined by new onset of ascites, hepatic encephalopathy or variceal bleeding. In patients with DC, the following events were considered as further hepatic decompensation: requirement of paracentesis, admission for/development of grade 3/4 hepatic encephalopathy, variceal (re‐)bleeding or liver‐related death.ResultsFirst hepatic decompensation occurred in 25 of 292 (9%) cACLD patients, while 46 of 138 (33%) DC patients developed further hepatic decompensation during a median follow‐up of 22 and 12 months respectively. CAP was not predictive of first (cACLD; per 10 dB/m; hazard ratio [HR]: 0.97, 95% confidence interval [95% CI]: 0.91‐1.03, P = 0.321) or further hepatic decompensation (DC; HR: 0.99, 95% CI: 0.94‐1.03, P = 0.554) in adjusted analysis. Using the well‐established CAP cut‐off of ≥248 dB/m for hepatic steatosis, the incidence of first (cACLD; P = 0.065) and further hepatic decompensation (DC; P = 0.578) was similar in patients with hepatic steatosis or without. Serum albumin levels (per mg/dL; HR: 0.83, 95% CI: 0.77‐0.89, P < 0.001) and MELD‐Na (per point; HR: 1.15, 95% CI: 1.04‐1.28, P = 0.006) in cACLD and MELD‐Na (per point; HR: 1.12, 95% CI: 1.05‐1.19, P < 0.0001) in DC patients were the only parameters independently associated with first and further hepatic decompensation, respectively.ConclusionControlled attenuation parameter does not predict the development of first (cACLD)/further (DC) hepatic decompensation, while serum albumin levels and MELD‐Na are of prognostic value.

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Liver International

Tập 39 Số 1

127-135

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