Transient elastography can stratify patients with Child–Pugh A cirrhosis according to risk of early decompensation

Dillon, Audrey; Galvin, Zita; Sultan, Alyshah Abdul; Harman, D. J.; Guha, Indra Neil; Stewart, Stephen

doi:10.1097/meg.0000000000001224

Cited by 7 publications

(8 citation statements)

References 26 publications

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“…We included patients who had a previous episode of decompensation but remained fully compensated for at least 6 months prior to enrolment. Previous work has shown that previous decompensation had no difference on LSM measurement or liver related outcome at 2 years, and in this study we show similar lack of impact.…”

Section: Discussionmentioning

confidence: 99%

Liver stiffness and thrombin generation in compensated cirrhosis

Dillon

Egan

Kevane

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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Background Decompensated cirrhosis is associated with coagulation abnormalities that can increase the risk of thrombosis and bleeding. It is unclear precisely when these abnormalities arise and whether they are exacerbated as compensated cirrhosis progresses. Transient elastography using FibroScan generates liver stiffness measurements ( LSM ) that associate with portal hypertension, clinical outcomes and provides prognostic information at an earlier stage than traditional liver function scores eg, MELD score. Objective To characterize thrombin generation in patients with compensated cirrhosis and to determine whether parameters of coagulation change throughout compensated cirrhosis, staged using LSM . Patients/Methods Blood samples were collected from well‐compensated cirrhotic patients n = 61, All Child Pugh A stage) attending the Mater Misericordiae University Hospital, Ireland. Comprehensive clinical staging of liver disease, including LSM , was performed. Tissue Factor‐stimulated thrombin generation was measured by calibrated automated thrombography. Results Using LSM to stage well‐compensated cirrhotic patients, we demonstrate a significant decrease in the rate of propagation, the rate of attenuation, and total thrombin generation as LSM increase. LSM correlated with endogenous thrombin potential, peak thrombin generation, the rate of propagation, and the rate of attenuation. This association between thrombin generation and LSM was still evident in sub‐analyses excluding patients with ongoing alcohol use, active HCV infection, or a history of decompensation. In contrast, there was no significant correlation between thrombin generation, prothrombin times, Child‐Pugh scores, or MELD scores. Conclusion Liver stiffness measurements identify differences in parameters of thrombin generation within a cohort of compensated cirrhotic patients before changes in clotting times occur.

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Section: Discussionmentioning

confidence: 99%

Liver stiffness and thrombin generation in compensated cirrhosis

Dillon

Egan

Kevane

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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“…34,35 Similarly, TE showed a prognostic role in predicting the risk of HCC, decompensation and LRE development. 8,16,17,19,21,[36][37][38][39][40][41] In this multicentre, retrospective, large cohort study (n = 9300) with a long-term follow-up period (median: 60.0 months), we assessed the risk of HCC and LRE development using US and TE and investigated whether the combined use of US and TE could be beneficial for the risk assessment of HCC and LRE in patients with CHB.…”

Section: Discussionmentioning

confidence: 99%

“…Our study has several clinical implications. First, the cumulative incidence rates of HCC increased in the order of US(+)TE(+), US(−) Although previous studies have examined the correlation between fibrotic burden measured by either US or TE and the risks of HCC or LRE development, 8,16,17,19,21,[35][36][37][38][39][40][41] little is known about the prognostic value of the combined use of US and TE. Our study suggests that the combined use of these diagnostic modalities might be more helpful for providing a detailed prognostication than the use of a single modality.…”

Section: Discussionmentioning

confidence: 99%

“…8,18 In addition, TE can assess the risk of LRE, such as decompensation or liver transplantation. [19][20][21][22] Despite the usefulness of TE, the current guidelines recommend abdominal US for HCC surveillance, not TE for HCC-risk prediction. 23,24 In fact, other HCC prediction models such as the individual prediction model, Chinese University-HCC, guide with age, sex, HBV DNA, core promoter mutations and cirrhosis-HCC (GAG-HCC) used abdominal US or the patients' clinical characteristics to diagnose cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

“…[25][26][27] To date, many studies have reported the usefulness of US or TE in predicting HCC and LRE. 8,18,19,21,22,[25][26][27] However, few studies have assessed the risk of HCC and LRE development using both US and TE. Thus, this multicentre, retrospective, large cohort study aimed to assess the risk of HCC and LRE development using US and TE and to investigate whether the combined use of US and TE is beneficial for the risk assessment of HCC and LRE in patients with CHB.…”

Section: Introductionmentioning

confidence: 99%

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Risk assessment of hepatocellular carcinoma and liver‐related events using ultrasonography and transient elastography in patients with chronic hepatitis B

Yoo

Lim

Lee

et al. 2021

Journal of Viral Hepatitis

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Cirrhosis has prognostic value. We investigated whether the combined use of ultrasonography (US) and transient elastography (TE) to diagnose cirrhosis is beneficial for the risk assessment of hepatocellular carcinoma (HCC) and liver-related events in patients with chronic hepatitis B (CHB). A total of 9300 patients with CHB who underwent US and TE in two institutions between 2006 and 2018 were enrolled. TE value ≥13 kPa was set to indicate cirrhosis. Patients were divided into four groups: US(+) TE(+) (cirrhosis by US and TE), US(+)TE(−) (cirrhosis by US, but not by TE), US(−)TE(+) (cirrhosis by TE, but not by US) and US(−)TE(−) (non-cirrhosis by US and TE).The patients were predominantly male (n = 5474, 58.9%) with a mean age of 47.5 years. The proportions of patients with cirrhosis diagnosed by US and TE were 17.2% (n = 1595) and 13.2% (n = 1225), respectively. The proportion of patients with discordant results in diagnosing cirrhosis by US and TE was 18.7% (n = 1740). During follow-up (median: 60.0 months), HCC and liver-related events developed in 481 (5.2%) and 759 (8.2%) patients, respectively. The cumulative incidence rates of HCC and liverrelated events were highest in the US(+)TE(+) group, intermediate-high in the US(−) TE(+) group, intermediate-low in the US(+)TE(−) group and lowest in the US(−)TE(−) group (overall p < .001). Cirrhosis assessed using US and TE was a major predictor of HCC and liver-related event development in patients with CHB. Cirrhosis assessed using TE seemed better in predicting HCC or liver-related events than using US, when cirrhosis diagnosis was discordant by US and TE.| 1363 YOO et al.

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Liver Stiffness Changes in Patients with Established Liver Cirrhosis

Piecha

Mueller

2020

Liver Elastography

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Transient elastography can stratify patients with Child–Pugh A cirrhosis according to risk of early decompensation

Cited by 7 publications

References 26 publications

Liver stiffness and thrombin generation in compensated cirrhosis

Liver stiffness and thrombin generation in compensated cirrhosis

Risk assessment of hepatocellular carcinoma and liver‐related events using ultrasonography and transient elastography in patients with chronic hepatitis B

Liver Stiffness Changes in Patients with Established Liver Cirrhosis

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