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.

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

Bugianesi E.;
2021-01-01

Abstract

Background & Aims: Patients with advanced fibrosis related to nonalcoholic fatty liver disease (NAFLD) are at risk of developing hepatic and extrahepatic complications. 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.
2021
19
4
806
815
cACLD; NASH; Prognostic Factor; Steatohepatitis; Gastrointestinal Hemorrhage; Humans; Liver; Liver Cirrhosis; Retrospective Studies; Carcinoma, Hepatocellular; Elasticity Imaging Techniques; Esophageal and Gastric Varices; Liver Neoplasms; Non-alcoholic Fatty Liver Disease
Petta S.; Sebastiani G.; Vigano M.; Ampuero J.; Wai-Sun Wong V.; Boursier J.; Berzigotti A.; Bugianesi E.; Fracanzani A.L.; Camma C.; Enea M.; Grottes...espandi
File in questo prodotto:
File Dimensione Formato  
Petta_2021.pdf

Accesso aperto

Tipo di file: POSTPRINT (VERSIONE FINALE DELL’AUTORE)
Dimensione 786.43 kB
Formato Adobe PDF
786.43 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1805566
Citazioni
  • ???jsp.display-item.citation.pmc??? 44
  • Scopus 125
  • ???jsp.display-item.citation.isi??? 117
social impact