Monitoring Occurrence of Liver-Related Events and Survival by Transient Elastography in Patients With Nonalcoholic Fatty Liver Disease and Compensated Advanced Chronic Liver Disease,Clinical Gastroenterology and Hepatology

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Monitoring Occurrence of Liver-Related Events and Survival by Transient Elastography in Patients With Nonalcoholic Fatty Liver Disease and Compensated Advanced Chronic Liver Disease
Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2020-07-02 , DOI: 10.1016/j.cgh.2020.06.045
Salvatore Petta ₁ , Giada Sebastiani ₂ , Mauro Viganò ₃ , Javier Ampuero ₄ , Vincent Wai-Sun Wong ₅ , Jerome Boursier ₆ , Annalisa Berzigotti ₇ , Elisabetta Bugianesi ₈ , Anna Ludovica Fracanzani ₉ , Calogero Cammà ₁ , Marco Enea ₁₀ , Marraud des Grottes ₁₁ , Vito Di Marco ₁ , Ramy Younes ₈ , Aline Keyrouz ₂ , Sergio Mazzola ₁₂ , Yuly Mendoza ₇ , Grazia Pennisi ₁ , Manuel Romero-Gomez ₄ , Antonio Craxì ₁ , Victor de Ledinghen ₁₁

Affiliation

Sezione di Gastroenterologia e Epatologia, Mother and Child Care, Internal Medicine and Medical Specialties, Università di Palermo, Palermo, Italy.
Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.
Hepatology Unit, Ospedale San Giuseppe, University of Milan, Milan, Italy.
Digestive Diseases Unit, Hospital Universitario Virgen del Rocío, Biomedical Research Networking Center in Hepatic and Digestive Diseases, Instituto de Biomedicina de Sevilla, University of Seville, Seville, Spain.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
Hepato-Gastroenterology Department, Angers University Hospital, Angers, France.
Hepatology Group, University Clinic for Visceral Surgery and Medicine, Inselspital, Department for Biomedical Research, University of Bern, Bern, Switzerland.
Division of Gastroenterology, Department of Medical Sciences, University of Torino, Turin, Italy.
Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, Milan, Italy.
Dipartimento di Scienze Economiche, Aziendali e Statistiche, University of Palermo, Palermo, Italy.
Centre d'Investigation de la Fibrose Hépatique, INSERM U1053, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France.
Clinical Epidemiology and Cancer Registry Operative Unit, University Hospital Policlinico "Paolo Giaccone," Palermo, Italy.

Background & Aims

Patients with advanced fibrosis related to nonalcoholic fatty liver disease (NAFLD) are at risk of developing hepatic and extrahepatic complications. We investigated whether, in a large cohort of patients with NAFLD and compensated advanced chronic liver disease, baseline liver stiffness measurements (LSMs) and their changes can be used to identify patients at risk for liver-related and extrahepatic events.

Methods

We performed a retrospective analysis of consecutive patients with NAFLD (n = 1039) with a histologic diagnosis of F3–F4 fibrosis and/or LSMs>10 kPa, followed for at least 6 months, from medical centers in 6 countries. LSMs were made by FibroScan using the M or XL probe and recorded at baseline and within 1 year from the last follow-up examination. Differences between follow up and baseline LSMs were categorized as: improvement (reduction of more than 20%), stable (reduction of 20% to an increase of 20%), impairment (an increase of 20% or more). We recorded hepatic events (such as liver decompensation, ascites, encephalopathy, variceal bleeding, jaundice, or hepatocellular carcinoma [HCC]) and overall and liver-related mortality during a median follow-up time of 35 months (interquartile range, 19–63 months).

Results

Based on Cox regression analysis, baseline LSM was independently associated with occurrence of hepatic decompensation (hazard ratio [HR], 1.03; 95% CI, 1.02–1.04; P < .001), HCC (HR, 1.03; 95% CI, 1.00–1.04; P = .003), and liver-related death (HR, 1.02; 95% CI, 1.02–1.03; P = .005). In 533 patients with available LSMs during the follow-up period, change in LSM was independently associated with hepatic decompensation (HR, 1.56; 95% CI, 1.05–2.51; P = .04), HCC (HR, 1.72; 95% CI, 1.01–3.02; P = .04), overall mortality (HR, 1.73; 95% CI, 1.11–2.69; P = .01), and liver-related mortality (HR, 1.96; 95% CI, 1.10–3.38; P = .02).

Conclusions

In patients with NAFLD and compensated advanced chronic liver disease, baseline LSM and change in LSM are associated with risk of liver-related events and mortality.

中文翻译：

通过瞬时弹性成像监测非酒精性脂肪性肝病和代偿性晚期慢性肝病患者肝脏相关事件的发生和存活率

背景与目标

与非酒精性脂肪性肝病 (NAFLD) 相关的晚期纤维化患者有发生肝脏和肝外并发症的风险。我们调查了在一大群 NAFLD 和代偿性晚期慢性肝病患者中，基线肝硬度测量 (LSM) 及其变化是否可用于识别有肝脏相关和肝外事件风险的患者。

方法

我们对来自 6 个国家的医疗中心的组织学诊断为 F3-F4 纤维化和/或 LSM>10 kPa 的连续 NAFLD 患者（n = 1039）进行了回顾性分析，随访至少 6 个月。LSM 由 FibroScan 使用 M 或 XL 探针制成，并在基线和最后一次随访检查后的 1 年内记录。随访和基线 LSM 之间的差异分为：改善（减少超过 20%）、稳定（减少 20% 到增加 20%）、受损（增加 20% 或更多）。我们记录了中位随访 35 个月（四分位距，19-63个月）。

结果

根据 Cox 回归分析，基线 LSM 与肝功能失代偿的发生独立相关（风险比 [HR]，1.03；95% CI，1.02–1.04；P < .001），HCC（HR，1.03；95% CI，1.00 –1.04；P = .003）和肝脏相关死亡（HR，1.02；95% CI，1.02–1.03；P = .005）。在随访期间有可用 LSM 的 533 名患者中，LSM 的变化与肝功能失代偿（HR，1.56；95% CI，1.05–2.51；P = .04）、HCC（HR，1.72；95% CI）独立相关, 1.01–3.02; P = .04)、总死亡率 (HR, 1.73; 95% CI, 1.11–2.69; P = .01) 和肝脏相关死亡率 (HR, 1.96; 95% CI, 1.10–3.38; P = .02）。