Predicting clinical decompensation in patients with cirrhosis using the Hepquant‐SHUNT test

Abstract

SummaryBackgroundEarly identification of risk for decompensation in clinically stable cirrhotic patients helps specialists target early interventions and supports effective referrals from primary care providers to specialty centres.AimsTo examine whether the HepQuant‐SHUNT test (HepQuant LLC, Greenwood Village, Colorado, USA) predicts decompensation and the need for liver transplantation, hospitalisation or liver‐related death.MethodsThirty‐five compensated and 35 subjects with a previous episode of decompensation underwent the SHUNT Test and were followed for a median of 4.2 years. The disease severity index (DSI) (range 0‐50) was examined for association with decompensation in compensated patients; and liver transplantation, liver‐related death, and the number and days of liver related hospitalisations in all. DSI prediction of decompensation was also evaluated in 84 subjects with compensated cirrhosis from the Hepatitis C Antiviral Long‐Term Treatment against Cirrhosis Trial (HALT‐C) followed for a median of 5.8 years.ResultsAt baseline, subjects with prior decompensation had significantly higher DSI than compensated subjects (32.6 vs 20.9, P < 0.001). DSI ≥24 distinguished the decompensated from the compensated patients and independently predicted adverse clinical outcomes (hazard ratio: 4.92, 95% confidence interval: 1.42‐17.06). In the HALT‐C cohort, 65% with baseline DSI ≥24 vs 19% with DSI <24 experienced adverse clinical outcomes (relative risk 3.45, P < 0.0001).ConclusionsThe SHUNT test is a novel, noninvasive test that predicts risk of decompensation in previously compensated patients. DSI ≥24 is independently associated with risk for clinical decompensation, liver transplantation, death and hospitalisation.

Hepatic fibrosis 2022: Unmet needs and a blueprint for the future

“…In cirrhosis, measures such as the Model for End-Stage Liver Disease score, which clearly reflect function, robustly predict outcomes, yet it is unclear if subtle, overlooked features of hepatic function might be detectable at earlier stages-initial data using the HepQuant test hint that this may be possible. [103] Efforts to catalog the proteome and lipidome in liver disease are promising, but candidate analytes typically lack biologic plausibility (i.e., how do they contribute to liver disease, and why do they change), which undermines interest in their development. On the other hand, regression of fibrosis in patients cured of HCV or treated for HBV leads to improved liver function associated with regeneration, yet there has been almost no effort to capture regenerative signals, either by assessment of secreted molecules or by imaging.…”

Within‐individual reproducibility of a dual sample oral cholate challenge test (DuO) and simplified versions of the HepQuant SHUNT test

“…The parameters of the SHUNT test have been independently linked to the risk of future clinical outcomes, such as in patients with various etiologies of cirrhosis, 21 ongoing HCV infection, 21 and PSC 10 . Further, the SHUNT test is associated with portal pressure 22,23 and risk of toxicity and hepatic impairment in hepatocellular carcinoma treatment 24 .…”

Serum metabolomic profiling of patients with liver cirrhosis at different stages

“…Therefore, an important step in early prevention and the ability to predict the risk of decompensation. The ALBI-FIB4 Score [4], SHUNT test [5], and liver stiffness with platelet counts [6] can detect decompensation cirrhosis by quantifying liver function. However, Baveno VII workshop recommends hepatic venous pressure gradient (HVPG) measurements as a gold standard to determine the presence of CSPH in virus-related cirrhotic patients [3].…”