Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
Liver Int. 2019 Jan;39(1):127-135. doi: 10.1111/liv.13943. Epub 2018 Sep 22.
BACKGROUND & AIMS: Assessment 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).
A 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.
First 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.
Controlled 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.
瞬时弹性成像（TE）的受控衰减参数（CAP）评估肝脂肪变性可能预测肝失代偿。因此，我们旨在评估 CAP 在代偿性晚期慢性肝病（cACLD）和失代偿性肝硬化（DC）患者中的预后价值。
共纳入 430 名接受 TE（肝硬度≥10kPa）和 CAP 测量的患者进行回顾性分析。患者的一半（n=189）同时进行 HVPG 测量。在 cACLD 患者中，新发生腹水、肝性脑病或静脉曲张出血定义为首次肝失代偿。在 DC 患者中，以下事件被认为是进一步的肝失代偿：需要进行腹腔穿刺术、因/发展为 3/4 级肝性脑病、静脉曲张（再）出血或与肝脏相关的死亡。
292 名 cACLD 患者中有 25 名（9%）发生首次肝失代偿，而 138 名 DC 患者中有 46 名（33%）在中位随访 22 个月和 12 个月时分别发生进一步的肝失代偿。在调整分析中，CAP 不能预测首次（cACLD；每增加 10dB/m；风险比 [HR]：0.97，95%置信区间 [95%CI]：0.91-1.03，P=0.321）或进一步的肝失代偿（DC；HR：0.99，95%CI：0.94-1.03，P=0.554）。使用已建立的 CAP 截断值≥248dB/m 来评估肝脂肪变性，具有肝脂肪变性的患者与不具有肝脂肪变性的患者首次（cACLD；P=0.065）和进一步肝失代偿（DC；P=0.578）的发生率相似。血清白蛋白水平（每毫克/分升；HR：0.83，95%CI：0.77-0.89，P<0.001）和 cACLD 中的 MELD-Na（每点；HR：1.15，95%CI：1.04-1.28，P=0.006）以及 DC 中的 MELD-Na（每点；HR：1.12，95%CI：1.05-1.19，P<0.0001）是唯一与首次和进一步肝失代偿相关的参数。
CAP 不能预测首次（cACLD）/进一步（DC）肝失代偿的发生，而血清白蛋白水平和 MELD-Na 具有预后价值。
