Background&Aims: Patients with advanced fibrosis related to nonalcoholic fatty liver disease(NAFLD) are at risk of developing hepatic and extrahepatic complications. Liver stiffness measurement(LSM)by FibroScan has a good diagnostic accuracy for advanced fibrosis and can also predict the occurrence of liverrelated events in patients with chronic hepatitis C.Data about the accuracy of LSM in the prediction of events in NAFLD,especially in patients with NAFLD and F3-F4 fibrosis,are scarce. We investigated whether,in a large cohort of patients with NAFLD and compensated advanced chronic liver disease(cACLD),LSM at baseline,at followup, and its variations are accurate for the prediction of hepatic and extrahepatic events. Methods: We retrospectively evaluated consecutive individuals with NAFLD with histological diagnosis of F3-F4 fibrosis and/or LSM>10KPa,and prospectively followed-up for at least 6months.LSM wasmeasured by FibroScan usingMor XL probe,and recorded at baseline and within 1year from the last follow-up visit.Difference between follow-up and baseline LSM(delta LSM)was categorized as < -20%, -20% to + 20%, > + 20%.Hepatic(liver decompensation–ascites,encephalopathy,variceal bleeding and jaundice-and hepatocellular carcinoma(HCC))and extrahepatic( cardiovascular and extrahepatic cancers)events,as well as overall and liver-related death were recorded during follow-up. Results: 937 patients(56.5%males,mean age60.2 years,mean BMI32.5Kg/m2,61.1%with diabetes,78.6%with cirrhosis)with a median follow-up of 37.9months were enrolled.67(7.2%)hepatic decompensation,34(3.6%)HCC,33(3.5%)cardiovascular events, 25(2.7%)extrahepatic cancers,56(6%)all-cause deaths and 33(3.5%)liver-related deaths were recorded.By Cox regression analysis and after adjusting for age,gender(only for HCC),serum albumin and platelets,baseline LSM was independently associated with occurrence of hepatic decompensation(HR1.03,95%C.I. 1.02-1.04,p < 0.001),HCC(HR1.02, 95%C.I. 1.00-1.04,p = 0.01) and liver-related death(HR1.03,95%C.I. 1.02-1.04,p < 0.001).In a subgroup of 494patients with available follow-up LSM,delta LSM was independently associated with hepatic decompensation(HR1.54,95%C.I. 1.04-2.48,p = 0.04),together with baseline LSM(HR1.03,95%C.I. 1.00-1.05,p = 0.01) and with liver related death(HR1.87,95%C.I. 1.05-3.34,p = 0.03). Conclusions: In patients with NAFLD and F3-F4 fibrosis baseline LSM can predict the occurrence of hepatic decompensation,HCC and liver-related death.Moreover,changes in LSM during followup can further help to identify patients at higher risk of hepatic decompensation and liver-related death.
Liver stiffness measurement by fibroscan predicts the occurrence of liver-related events and death in patients with NAFLD-related compensated advanced chronic liver disease
Bugianesi E;Younes M;
2020-01-01
Abstract
Background&Aims: Patients with advanced fibrosis related to nonalcoholic fatty liver disease(NAFLD) are at risk of developing hepatic and extrahepatic complications. Liver stiffness measurement(LSM)by FibroScan has a good diagnostic accuracy for advanced fibrosis and can also predict the occurrence of liverrelated events in patients with chronic hepatitis C.Data about the accuracy of LSM in the prediction of events in NAFLD,especially in patients with NAFLD and F3-F4 fibrosis,are scarce. We investigated whether,in a large cohort of patients with NAFLD and compensated advanced chronic liver disease(cACLD),LSM at baseline,at followup, and its variations are accurate for the prediction of hepatic and extrahepatic events. Methods: We retrospectively evaluated consecutive individuals with NAFLD with histological diagnosis of F3-F4 fibrosis and/or LSM>10KPa,and prospectively followed-up for at least 6months.LSM wasmeasured by FibroScan usingMor XL probe,and recorded at baseline and within 1year from the last follow-up visit.Difference between follow-up and baseline LSM(delta LSM)was categorized as < -20%, -20% to + 20%, > + 20%.Hepatic(liver decompensation–ascites,encephalopathy,variceal bleeding and jaundice-and hepatocellular carcinoma(HCC))and extrahepatic( cardiovascular and extrahepatic cancers)events,as well as overall and liver-related death were recorded during follow-up. Results: 937 patients(56.5%males,mean age60.2 years,mean BMI32.5Kg/m2,61.1%with diabetes,78.6%with cirrhosis)with a median follow-up of 37.9months were enrolled.67(7.2%)hepatic decompensation,34(3.6%)HCC,33(3.5%)cardiovascular events, 25(2.7%)extrahepatic cancers,56(6%)all-cause deaths and 33(3.5%)liver-related deaths were recorded.By Cox regression analysis and after adjusting for age,gender(only for HCC),serum albumin and platelets,baseline LSM was independently associated with occurrence of hepatic decompensation(HR1.03,95%C.I. 1.02-1.04,p < 0.001),HCC(HR1.02, 95%C.I. 1.00-1.04,p = 0.01) and liver-related death(HR1.03,95%C.I. 1.02-1.04,p < 0.001).In a subgroup of 494patients with available follow-up LSM,delta LSM was independently associated with hepatic decompensation(HR1.54,95%C.I. 1.04-2.48,p = 0.04),together with baseline LSM(HR1.03,95%C.I. 1.00-1.05,p = 0.01) and with liver related death(HR1.87,95%C.I. 1.05-3.34,p = 0.03). Conclusions: In patients with NAFLD and F3-F4 fibrosis baseline LSM can predict the occurrence of hepatic decompensation,HCC and liver-related death.Moreover,changes in LSM during followup can further help to identify patients at higher risk of hepatic decompensation and liver-related death.
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