Han Ma Ai Thanda, Vipani Aarshi, Noureddin Nabil, Ramirez Kim, Gornbein Jeffrey, Saouaf Rola, Baniesh Nader, Cummings-John Oladuni, Okubote Toluwalase, Setiawan Veronica Wendy, Rotman Yaron, Loomba Rohit, Alkhouri Naim, Noureddin Mazen
Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Liver Int. 2020 Sep;40(9):2242-2251. doi: 10.1111/liv.14593. Epub 2020 Jul 22.
BACKGROUND & AIMS: Liver fibrosis assessed by liver biopsy is predictive of clinical liver events in patients with nonalcoholic fatty liver disease (NAFLD). Magnetic resonance elastography (MRE) correlates with liver biopsy in assessing liver fibrosis. However, data assessing the relationship between MRE and clinical liver events are lacking. We investigated the association between MRE and clinical liver events/death and identified the cut-off to predict clinical liver events in NAFLD patients.
We conducted a multicenter retrospective study of NAFLD patients who underwent MRE between 2016 and 2019. Clinical liver events were defined as decompensation events and death. We categorized patients into noncirrhosis, compensated cirrhosis and decompensated cirrhosis. Fisher's exact test was used to test association strength. Receiver operative curve methods were used to determine the optimal cut-off of MRE liver stiffness and to maximize the accuracy for classifying noncirrhosis, compensated cirrhosis and decompensated cirrhosis. Logistic regression modelling was used to predict decompensation.
The study included 320 NAFLD patients who underwent MRE. The best threshold for distinguishing cirrhosis from noncirrhosis was 4.39 kPa (AUROC 0.92) and from decompensated cirrhosis was 6.48 kPa (AUROC 0.71). Odds of decompensation increased as liver stiffness increased (OR 3.28) (P < .001). Increased liver stiffness was associated with ascites, hepatic encephalopathy, oesophageal variceal bleeding and mortality (median 7.10, 10.15 and 10.15 kPa respectively).
In NAFLD patients, liver stiffness measured by MRE with a cut-off of ≥6.48 kPa is associated with decompensation and mortality, and specific MRE cut-offs are predictive of individual clinical liver events.
通过肝活检评估的肝纤维化可预测非酒精性脂肪性肝病（NAFLD）患者的临床肝脏事件。磁共振弹性成像（MRE）在评估肝纤维化方面与肝活检相关。然而，缺乏评估MRE与临床肝脏事件之间关系的数据。我们研究了MRE与临床肝脏事件/死亡之间的关联，并确定了预测NAFLD患者临床肝脏事件的临界值。
我们对2016年至2019年间接受MRE检查的NAFLD患者进行了一项多中心回顾性研究。临床肝脏事件定义为失代偿事件和死亡。我们将患者分为非肝硬化、代偿期肝硬化和失代偿期肝硬化。采用Fisher精确检验来检验关联强度。采用受试者操作曲线方法确定MRE肝脏硬度的最佳临界值，并最大化区分非肝硬化、代偿期肝硬化和失代偿期肝硬化的准确性。采用逻辑回归模型预测失代偿情况。
该研究纳入了320例接受MRE检查的NAFLD患者。区分肝硬化与非肝硬化的最佳阈值为4.39 kPa（曲线下面积0.92），区分失代偿期肝硬化的最佳阈值为6.48 kPa（曲线下面积0.71）。随着肝脏硬度增加，失代偿几率增加（比值比3.28）（P <.001）。肝脏硬度增加与腹水、肝性脑病、食管静脉曲张出血和死亡率相关（中位数分别为7.10、10.15和10.15 kPa）。
在NAFLD患者中，MRE测量的肝脏硬度临界值≥6.48 kPa与失代偿和死亡率相关，特定的MRE临界值可预测个体临床肝脏事件。
