Performance of Controlled Attenuation Parameter in Patients with Advanced Chronic Liver Disease and Portal Hypertension

Abstract

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.

Novel reliability criteria for controlled attenuation parameter assessments for non‐invasive evaluation of hepatic steatosis

“…Therefore, CAP needs to be interpreted with caution in these patients. Apart from diabetes and BMI, liver fibrosis has been suggested as a factor influencing CAP values 13 , 30 , 31 . However, reports on its impact are inconsistent, but could have attenuated the correlation of CAP and histology in our cohort.…”

“…Apart from diabetes and BMI, liver fibrosis has been suggested as a factor influencing CAP values. 13,30,31 However, reports on its impact are inconsistent, but could have attenuated the correlation of CAP and histology in our cohort. Of note, inflammation (as assessed serologically) does not significantly impact on the performance of CAP, 13 which has been confirmed by our study.…”

Influence of Genetic Variants on Disease Regression and Outcomes in HCV-Related Advanced Chronic Liver Disease after SVR

“…Interestingly, genetic variants did not influence liver disease regression in our study, although we observed a trend towards a discordancy in the evolution of CAP between carriers and non-carriers of the PNPLA3 rs738409 G -allele (i.e., decreases in non-carriers vs. increases in carriers). Nevertheless, the diagnostic ability of CAP in patients with ACLD is limited [ 51 ], and the impact of genetic variants on long-term outcomes has yet to be investigated.…”

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

“…Second, the reliability of CAP may be lower in patients with CSPH. 17 Moreover, in this cohort, no histologic confirmation of fibrosis at the time of LSM assessment was available, as such we did not have access to the gold standard to confirm the diagnosis of cACLD. According to Petta et al, 18 higher CAP values reduce LSM accuracy for fibrosis using the M probe; despite our study being performed in patients who were assessed using the XL probe, we cannot rule out that some of the patients with high CAP values classified as cACLD based on a LSM of 10 kPa or greater might have a milder stage of fibrosis in which liver-related events are not expected.…”