Noninvasive Markers of Portal Hypertension Detect Decompensation in Overweight or Obese Patients With Compensated Advanced Chronic Liver Disease

Mendoza, Yuly; Cocciolillo, Sila; Murgia, Giuseppe; Chen, Tianyan; Margini, Cristina; Sebastiani, Giada; Berzigotti, Annalisa

doi:10.1016/j.cgh.2020.04.018

Cited by 22 publications

(17 citation statements)

References 22 publications

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“…296,297 Studies focusing on patients with cACLD confirmed the prognostic value of LSM by TE, which is maintained even above the threshold indicating CSPH, indicating a higher risk with higher values. 298,299 In untreated HCV-related cirrhosis, both liver and spleen stiffness predicted clinical decompensation, the latter showing a stronger predictive value (independent of MELD score; cut-off for discrimination: 54 kPa). 297 However, data regarding spleen stiffness are still insufficient to recommend its use for prognostic assessment in cACLD.…”

Section: Recommendationsmentioning

confidence: 99%

EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update

Berzigotti¹,

Tsochatzis²,

Boursier³

et al. 2021

Journal of Hepatology

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Section: Recommendationsmentioning

confidence: 99%

EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update

Berzigotti¹,

Tsochatzis²,

Boursier³

et al. 2021

Journal of Hepatology

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1,023

615

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“…A study including 272 patients with compensated advanced chronic liver disease (cACLD) found that liver stiffness and CAP (XL probe) were independently associated with the risk of decompensation and severe bacterial infection, and a CAP value higher than 220 dB/m was associated with a decreased risk of decompensation (hazard ratio: 0.043) [ 39 ]. These findings are interesting, even though it must be highlighted that this was a retrospective study and only a small number of subjects experienced clinically relevant events in the follow-up period.…”

Section: Prognostic Value Of Capmentioning

confidence: 99%

Quantitative assessment of liver steatosis using ultrasound controlled attenuation parameter (Echosens)

Ferraioli

2021

J Med Ultrasonics

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Controlled attenuation parameter (CAP) is the algorithm available on the FibroScan system (Echosens, France) for quantification of liver steatosis. It assesses the ultrasound beam attenuation, which is directly related to liver fat content. The inter-observer reproducibility of the technique is high, with a reported concordance correlation coefficient of 0.82. Specific quality criteria for CAP measurements are not clearly defined yet, and there are conflicting results in the literature. Using liver biopsy as the reference standard, several studies have assessed the CAP performance in grading liver steatosis, and have reported that values are not affected by liver fibrosis. The cutoff for detection of liver steatosis reported in the literature ranges from 222 decibels per meter (dB/m) in a cohort of patients with chronic hepatitis C to 294 dB/m in a meta-analysis of nonalcoholic fatty liver disease (NAFLD) patients. CAP has been used as a tool to noninvasively evaluate the prevalence of NAFLD in groups at risk or in the general population; however, it should be underscored that different CAP cutoffs for steatosis detection (S > 0) were used in different studies, and this limits the robustness of the findings. CAP, alone or combined with other noninvasive indices or biomarkers, has been proposed as a tool for assessing nonalcoholic steatohepatitis or as a noninvasive predictor of prognosis in patients with chronic liver disease. CAP is easy to perform and has become a point-of-care technique. However, there is a large overlap of values between consecutive grades of liver steatosis, and cutoffs are not clearly defined.

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“…6,[32][33][34] Other well-known clinical complications of cirrhosis such as hepatocellular carcinoma, malnutrition, sarcopenia and frailty have relevant negative prognostic implications in patients with cirrhosis. [35][36][37] In spite of this, these complications, with few exceptions, 37 have never been considered as markers of decompensation. In our opinion this is justified because these complications may occur at any time along the course of the liver disease without a well-known relationship with the main pathways of decompensation, AD and NAD.…”

Section: Introductionmentioning

confidence: 99%

Towards a new definition of decompensated cirrhosis

D’Amico

Bernardi

Angeli

2022

Journal of Hepatology

106

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There is a universal agreement that the occurrence of clinical complications, such as ascites, hepatic encephalopathy, gastrointestinal bleeding, and jaundice mark the transition from the compensated to the decompensated stage of cirrhosis. Decompensation is associated with a substantial worsening of patient prognosis and is therefore considered the most important stratification variable for the risk of death. However, this classification is an oversimplification, as it does not discriminate between the prognostic subgroups that characterise the course of decompensation, which depends on the type and number of decompensating events. A deeper insight into the clinical course of decompensated cirrhosis is provided by observational studies characterising acute decompensation (AD), which occurs mostly in patients who have already experienced decompensating events. Decompensation presents as AD in a portion of patients while in many others it presents as a slow development of ascites or mild grade 1 or 2 hepatic encephalopathy, or jaundice, not requiring hospitalisation. Thus, we propose that decompensation of cirrhosis occurs through 2 distinct pathways: a non-acute and an acute (which includes acute-on-chronic liver failure) pathway. Moreover, while non-acute decompensation is the most frequent pathway of the first decompensation, AD mostly represents further decompensation.

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Noninvasive Markers of Portal Hypertension Detect Decompensation in Overweight or Obese Patients With Compensated Advanced Chronic Liver Disease

Cited by 22 publications

References 22 publications

EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update

EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update

Quantitative assessment of liver steatosis using ultrasound controlled attenuation parameter (Echosens)

Towards a new definition of decompensated cirrhosis

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