Kim Nicole J, Vutien Philip, Borgerding Joleen A, Beste Lauren A, Li Muyi, Barnard-Giustini Abbey, Johnson Kay M, Ioannou George N
Division of Gastroenterology, University of Washington, Seattle, Washington, USA.
Health Service Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
Am J Gastroenterol. 2024 Oct 25;120(7):1529-1537. doi: 10.14309/ajg.0000000000003161.
The controlled attenuated parameter (CAP) score derived from vibration-controlled transient elastography (VCTE, i.e., FibroScan) is a well-validated marker of hepatic steatosis. It is unclear whether CAP scores are associated with risks of liver-related outcomes or all-cause mortality.
In this retrospective cohort study, we identified 7,587 United States veterans (2,689 with cured hepatitis C [hepatitis C virus], 1,523 with alcohol-associated liver disease, and 3,375 with metabolic dysfunction-associated steatotic liver disease [MASLD]) who underwent VCTE between May 2015 and December 2021. We followed patients for new hepatic decompensation, hepatocellular carcinoma, and death from the VCTE date until January 1, 2022. Multivariable Cox-proportional hazards regression was used to assess for the associations between CAP measurements and clinical outcomes, adjusting for age, sex, race/ethnicity, body mass index, Charlson Comorbidity Index, diabetes, liver disease etiology, liver stiffness measurements, and Fibrosis-4 score, and was reported separately by disease etiology and advanced fibrosis status.
Over a median follow-up time of ∼1.9 years, hepatic steatosis (grades 1-3 vs 0) was associated with a lower risk of death (adjusted hazard ratio [aHR] 0.70, 95% CI: 0.57-0.85). Among patients with MASLD, hepatic steatosis was associated with a lower risk of decompensation (aHR 0.54, 95% CI: 0.32-0.90) and death (aHR 0.52, 95% CI: 0.37-0.73). These associations persisted in subgroup analyses of patients with advanced fibrosis and without cirrhosis.
Among patients who underwent VCTE in clinical practice, the presence of substantial hepatic steatosis estimated by the CAP score was associated with lower all-cause mortality among all patients and lower risk of decompensation and death among those with MASLD.
通过振动控制瞬时弹性成像（VCTE，即FibroScan）得出的控制衰减参数（CAP）评分是一种经过充分验证的肝脂肪变性标志物。目前尚不清楚CAP评分是否与肝脏相关结局风险或全因死亡率相关。
在这项回顾性队列研究中，我们纳入了2015年5月至2021年12月期间接受VCTE检查的7587名美国退伍军人（2689名丙型肝炎治愈患者、1523名酒精性肝病患者和3375名代谢功能障碍相关脂肪性肝病[MASLD]患者）。从VCTE检查日期至2022年1月1日，我们对患者进行随访，观察新出现的肝失代偿、肝细胞癌和死亡情况。采用多变量Cox比例风险回归分析来评估CAP测量值与临床结局之间的关联，并对年龄、性别、种族/民族、体重指数、Charlson合并症指数、糖尿病、肝病病因、肝脏硬度测量值和Fibrosis-4评分进行校正，同时按疾病病因和晚期纤维化状态分别报告结果。
在中位随访时间约1.9年期间，肝脂肪变性（1-3级与0级相比）与较低的死亡风险相关（校正风险比[aHR]为0.70，95%置信区间[CI]：0.57-0.85）。在MASLD患者中，肝脂肪变性与较低的失代偿风险（aHR为0.54，95%CI：0.32-0.90）和死亡风险（aHR为0.52，95%CI：0.37-0.73）相关。这些关联在晚期纤维化患者和无肝硬化患者的亚组分析中依然存在。
在临床实践中接受VCTE检查的患者中，通过CAP评分评估的显著肝脂肪变性与所有患者较低的全因死亡率以及MASLD患者较低的失代偿和死亡风险相关。
