Performance of Controlled Attenuation Parameter in Patients with Advanced Chronic Liver Disease and Portal Hypertension.
Adult
Aged
Area Under Curve
Chronic Disease
Elasticity Imaging Techniques
Fatty Liver
/ complications
Female
Hepatitis, Viral, Human
/ complications
Humans
Hypertension, Portal
/ complications
Liver
/ diagnostic imaging
Liver Diseases
/ complications
Liver Diseases, Alcoholic
/ complications
Male
Middle Aged
Non-alcoholic Fatty Liver Disease
/ complications
ROC Curve
Sensitivity and Specificity
Severity of Illness Index
CAP
CSPH
Cirrhosis
Portal hypertension
Transient elastography
VCTE
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
10
03
2019
accepted:
04
06
2019
pubmed:
19
6
2019
medline:
23
6
2020
entrez:
19
6
2019
Statut:
ppublish
Résumé
Liver stiffness (LS) measured by vibration-controlled transient elastography (VCTE) is influenced by liver fibrosis and hepatic perfusion pressure. VCTE-based controlled attenuation parameter (CAP) is a noninvasive marker for hepatic steatosis (HS). To investigate the diagnostic performance of CAP in patients with advanced chronic liver disease (ACLD)/portal hypertension (PHT: hepatic venous pressure gradient (HVPG) ≥ 6 mmHg). Eighty-eight patients with LS ≥ 10 kPa and/or HVPG ≥ 6 mmHg who underwent simultaneous liver biopsy, CAP, and HVPG measurement were included. HS was histologically graded according to the modified Brunt classification. Patient characteristics: Mean MELD:11 (standard derivation [SD] ± 4), median HVPG:16 (interquartile range [IQR]10-19) mmHg, median LS:27.4 (IQR 16.2-48.9) kPa, and mean CAP:221 (SD ± 75) dB/m. According to histology, 47 (53.4%) patients had no HS (S0), 28 (31.8%) had S1, 11 (12.5%) had S2, and 2 (2.3%) had S3. The area under the receiver operating characteristic curve (AUROC) of CAP for diagnosing any HS (S0 vs. ≥ S1) was 0.692 (95% confidence interval [95% CI] 0.582-0.802) in the overall cohort, 0.830 (95% CI 0.637-1.0) in patients with HVPG < 10 mmHg, and 0.629 (95% CI 0.497-0.761) in patients with clinically significant portal hypertension (CSPH; HVPG ≥ 10 mmHg; n = 69). Using the established cutoff for any HS (248 dB/m), the sensitivity/specificity of CAP was only 48.8%/76.6%, respectively. In contrast, the AUROC and sensitivity/specificity (cutoff 268 dB/m) for diagnosing HS ≥ S2 were 0.842 (95% CI 0.747-0.936) and 84.6%/81.3%, respectively. CAP correlated with the percentage of steatotic hepatocytes (Spearman's ρ = 0.402; p ≤ 0.001) and showed a weak correlation with liver stiffness (ρ = 0.225; p = 0.035). The diagnostic performance of CAP for any HS seems to be limited in patients with ACLD, if CSPH is present.
Sections du résumé
BACKGROUND
Liver stiffness (LS) measured by vibration-controlled transient elastography (VCTE) is influenced by liver fibrosis and hepatic perfusion pressure. VCTE-based controlled attenuation parameter (CAP) is a noninvasive marker for hepatic steatosis (HS).
AIMS
To investigate the diagnostic performance of CAP in patients with advanced chronic liver disease (ACLD)/portal hypertension (PHT: hepatic venous pressure gradient (HVPG) ≥ 6 mmHg).
METHODS
Eighty-eight patients with LS ≥ 10 kPa and/or HVPG ≥ 6 mmHg who underwent simultaneous liver biopsy, CAP, and HVPG measurement were included. HS was histologically graded according to the modified Brunt classification.
RESULTS
Patient characteristics: Mean MELD:11 (standard derivation [SD] ± 4), median HVPG:16 (interquartile range [IQR]10-19) mmHg, median LS:27.4 (IQR 16.2-48.9) kPa, and mean CAP:221 (SD ± 75) dB/m. According to histology, 47 (53.4%) patients had no HS (S0), 28 (31.8%) had S1, 11 (12.5%) had S2, and 2 (2.3%) had S3. The area under the receiver operating characteristic curve (AUROC) of CAP for diagnosing any HS (S0 vs. ≥ S1) was 0.692 (95% confidence interval [95% CI] 0.582-0.802) in the overall cohort, 0.830 (95% CI 0.637-1.0) in patients with HVPG < 10 mmHg, and 0.629 (95% CI 0.497-0.761) in patients with clinically significant portal hypertension (CSPH; HVPG ≥ 10 mmHg; n = 69). Using the established cutoff for any HS (248 dB/m), the sensitivity/specificity of CAP was only 48.8%/76.6%, respectively. In contrast, the AUROC and sensitivity/specificity (cutoff 268 dB/m) for diagnosing HS ≥ S2 were 0.842 (95% CI 0.747-0.936) and 84.6%/81.3%, respectively. CAP correlated with the percentage of steatotic hepatocytes (Spearman's ρ = 0.402; p ≤ 0.001) and showed a weak correlation with liver stiffness (ρ = 0.225; p = 0.035).
CONCLUSIONS
The diagnostic performance of CAP for any HS seems to be limited in patients with ACLD, if CSPH is present.
Identifiants
pubmed: 31209721
doi: 10.1007/s10620-019-05702-7
pii: 10.1007/s10620-019-05702-7
pmc: PMC6858384
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3642-3651Références
Clin Gastroenterol Hepatol. 2018 Apr;16(4):575-583.e2
pubmed: 28970146
Hepatology. 1996 Aug;24(2):289-93
pubmed: 8690394
Hepatology. 2018 Jul;68(1):361-371
pubmed: 29222911
Gastroenterology. 2006 May;130(6):1636-42
pubmed: 16697727
J Hepatol. 2017 May;66(5):1022-1030
pubmed: 28039099
Hepatology. 2018 Apr;67(4):1348-1359
pubmed: 29108123
Hepatology. 2016 Apr;63(4):1392-3
pubmed: 26096988
Liver Int. 2014 Jan;34(1):102-9
pubmed: 24028214
J Hepatol. 2018 May;68(5):1025-1032
pubmed: 29343427
J Viral Hepat. 2018 Jan;25(1):97-104
pubmed: 28772340
Liver Int. 2019 Jan;39(1):127-135
pubmed: 30107095
Aliment Pharmacol Ther. 2018 Aug;48(4):451-459
pubmed: 29956823
Liver Int. 2017 Oct;37(10):1544-1553
pubmed: 28544208
Hepatology. 2002 Sep;36(3):729-36
pubmed: 12198667
Wien Klin Wochenschr. 2012 Jun;124(11-12):395-402
pubmed: 22699260
Gastroenterology. 2018 Aug;155(2):307-310.e2
pubmed: 29660324
Wien Klin Wochenschr. 2017 Nov;129(Suppl 3):135-158
pubmed: 29063233
Gut. 2003 Feb;52(2):288-92
pubmed: 12524415
JGH Open. 2018 Mar 30;2(2):54-58
pubmed: 30483564
Gastroenterology. 2009 Aug;137(2):549-57
pubmed: 19445938
Liver Int. 2015 Sep;35(9):2115-20
pubmed: 25585656
Surg Endosc. 2017 Mar;31(3):1142-1147
pubmed: 27405478
Hepatology. 2016 Jul;64(1):73-84
pubmed: 26707365
Hepatology. 2005 Jun;41(6):1313-21
pubmed: 15915461
J Gastroenterol Hepatol. 2016 Apr;31(4):848-55
pubmed: 26514665
J Hepatol. 2018 Aug;69(2):406-460
pubmed: 29653741
Liver Transpl. 2001 Jul;7(7):608-14
pubmed: 11460228
GE Port J Gastroenterol. 2017 Jul;24(4):161-168
pubmed: 29255745
Hepatology. 2017 Apr;65(4):1293-1305
pubmed: 27997989
Hepatology. 2017 Apr;65(4):1145-1155
pubmed: 27639088
J Viral Hepat. 2012 Apr;19(4):244-53
pubmed: 22404722
J Hepatol. 2007 Aug;47(2):284-94
pubmed: 17561303
Am J Gastroenterol. 2017 Dec;112(12):1812-1823
pubmed: 29087391
Hepatology. 2015 Oct;62(4):1101-10
pubmed: 25991038
PLoS One. 2016 Jun 10;11(6):e0157358
pubmed: 27284700
Hepatology. 2010 Mar;51(3):828-35
pubmed: 20063276
Dig Dis Sci. 2016 Sep;61(9):2710-20
pubmed: 27262844
Hepatology. 1990 Jan;11(1):74-80
pubmed: 2295475
J Hepatol. 2009 Jan;50(1):1-3
pubmed: 19017551
Am J Surg Pathol. 1995 Dec;19(12):1409-17
pubmed: 7503362
Liver Int. 2015 Feb;35(2):381-90
pubmed: 24953516
J Gastroenterol Hepatol. 2014 Jun;29(6):1149-58
pubmed: 24476011
J Hepatol. 2014 May;60(5):1026-31
pubmed: 24378529
Gastroenterology. 2014 Jun;146(7):1680-90.e1
pubmed: 24631577
Hepatol Commun. 2018 Jul 24;2(8):929-940
pubmed: 30094404
PLoS One. 2017 Aug 15;12(8):e0182784
pubmed: 28813448
J Hepatol. 2017 Sep;67(3):577-584
pubmed: 28506907
Aliment Pharmacol Ther. 2018 Apr;47(7):989-1000
pubmed: 29446106
Dig Dis Sci. 2017 Sep;62(9):2569-2577
pubmed: 28577247
J Vis Exp. 2020 Jun 18;(160):
pubmed: 32628153
World J Gastroenterol. 2014 Jun 21;20(23):7089-103
pubmed: 24966582
J Hepatol. 2015 Sep;63(3):743-52
pubmed: 26047908
Ultrasound Med Biol. 2010 Nov;36(11):1825-35
pubmed: 20870345