Transient elastography for predicting clinical outcomes in patients with chronic liver disease

Abstract

There is increasing interest in developing noninvasive means to evaluate liver fibrosis in patients with chronic liver disease to determine disease severity, prognosis and optimal treatment. Transient elastography (TE) has previously been demonstrated to predict the presence or absence of advanced fibrosis. The current study was conducted to determine whether TE can identify patients with chronic liver disease at risk of clinical decompensation. A total of 667 patients underwent TE and were followed for a median of 861 days and 57 patients achieved the primary outcome, a composite of clinical endpoints including death, ascites, encephalopathy, increased Child Score ≥ 2, variceal bleed, hepatocellular carcinoma or listing for transplant. Overall, TE had an area under the receiver operating characteristic curve of 0.87 for predicting clinical outcome. Using a cut-off of 10.5 kPa, TE has a sensitivity, specificity, positive predictive value and negative predictive value (NPV) of 94.7%, 63.0%, 19.3% and 99.2%, respectively. A predictive model for clinical events was developed using generalized cross-validation for clinical endpoints considering TE, liver biopsy results and multiple other predictors. Individually, TE performed better than biopsy, or any other variable, for predicting clinical outcome [Harrell's C Statistic 0.86 for TE, 0.78 for stage]. Patients with a TE score of >12.5 kPa were found to have a relative hazard for clinical event of 18.99 compared with patients with TE score <10.5. A combined variable model including TE, aspartate aminotransferase/alanine aminotransferase ratio and model for end-stage liver disease (MELD) yielded the highest predictive accuracy with Harrell's C value of 0.93. In the subset of patients with cirrhosis, TE was not found to be independently associated with clinical outcomes in univariate or multivariate analysis although it retained a high sensitivity and NPV of 97.5% and 92.3%, respectively, at a kPa cut-off of 10.5. TE can successfully identify patients with chronic liver disease who are at low risk of clinical decompensation over a time period of 2 years.

Liver Stiffness Measurement among Patients with Chronic Hepatitis B and C: Results from a 5-Year Prospective Study

“…Among these patients, cirrhosis had not been suspected or the patients had refused to undergo liver biopsy. Our present rates of complications (12.7/100 PY) and liver-related deaths (0.6/100 PY) were comparable to those previously reported in both LSM-based and biopsy-based studies, in which decompensation has been reported as 5–12/100 PY and liver-related mortality as 1/100 PY [18], [28]–[31]. We observed few liver-related complications among hepatitis B patients; however, due to the low number of events, the incidence was not statistically different from that among hepatitis C patients.…”

Noninvasive screening for liver fibrosis and portal hypertension by transient elastography—a large single center experience

“…Since repeated liver biopsy is not feasible to provide information on clinical progression of cirrhosis and is not favored by patients and HVPG measurement is not routinely performed in every center, several noninvasive methods have been developed to substitute these invasive procedures, among those several serum biomarkers [7] or measurement of LS by TE [8]. The potential of TE for assessment of the degree of liver fibrosis has been extensively studied in different forms of chronic liver disease [8][9][10][11][12], in this context TE may also provide prognostic information [13,14]. An additional application of TE for identifying patients with portal hypertension or with gastroesophageal varices has been suggested in several other studies [15][16][17][18][19].…”

Prognostic Value of Transient Elastography in Human Immunodeficiency Virus-Infected Patients With Chronic Hepatitis C

“…The prognostic capacity of TE has been evaluated in patients with chronic liver diseases of varying etiologies [9, 25–27], in compensated HCV-related liver cirrhosis with or without human immunodeficiency virus (HIV)-coinfection [28–31], and in liver transplantation [32]. All of these studies reported a good ability of TE for the identification of clinical outcomes including liver-related events (LRE) [9, 26, 27, 29–31], death [26, 30, 33], hepatocellular carcinoma [28], and composite endpoints [25]. However, no validated prediction model based on TE has been developed for LRE in patients with chronic hepatitis C with or without cirrhosis, and very little is known about TE cutoffs for stratification of the risk of LRE.…”