Mendoza, Yuly; Cocciolillo, Sila; Murgia, Giuseppe; Chen, Tianyan; Margini, Cristina; Sebastiani, Giada; Berzigotti, Annalisa (2020). Noninvasive Markers of Portal Hypertension Detect Decompensation in Overweight or Obese Patients With Compensated Advanced Chronic Liver Disease. Clinical gastroenterology and hepatology, 18(13), 3017-3025.e6. Elsevier 10.1016/j.cgh.2020.04.018
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Noninvasive Markers of Portal Hypertension Detect Decompensation in Overweight or Obese Patients With Compensated Advanced Chronic Liver Disease yuly paulin.pdf - Accepted Version Restricted to registered users only Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (1MB) |
BACKGROUND & AIMS
Some patients with compensated advanced chronic liver disease (cACLD) require use of an extra-large probe for liver stiffness measurement (LSM), due to overweight or obesity. However, no one has fully assessed the ability of non-invasive markers of portal hypertension and the controlled attenuation parameter (CAP) to determine which of these patients are at risk for decompensation.
METHODS
We collected data from 272 patients with cACLD (LSM ≥10 kPa by XL probe; 57% with non-alcoholic steatohepatitis; mean body mass index, 33.8±6.5Kg/m2; median Child score, 5; median LSM, 16.8 kPa; mean CAP 318±66 dB/m) evaluated at 2 academic centers from 2015 through 2018. We collected clinical data on decompensation (ascites, portal hypertension bleeding, jaundice, hepatic encephalopathy) and severe bacterial infections; patients were followed for median 17 months (interquartile range, 11-24 months). We evaluated associations between these events and LSM, CAP, LSM*spleen size/platelet count (LSPS) and portal hypertension risk scores.
RESULTS
Decompensation occurred in 12 patients and severe bacterial infections developed in 5 patients. LSM, LSPS, and portal hypertension risk score identified patients with decompensation with area under the receiver operating characteristic curve values of 0.848 (95% CI, 0.720-0.976, P<.0001), 0.881 (95% CI, 0.798-0.954, P<.0001), and 0.890 (95% CI, 0.814-0.966, P<.0001) respectively. In multivariate Cox regression analysis, in patients with non-alcoholic steatohepatitis, LSM and CAP were independently associated with decompensation and severe bacterial infection; CAP≥220dB/m was associated with a reduced risk of decompensation (hazard ratio, 0.043, 95% CI, 0.004-0.476; P=.01).
CONCLUSIONS
LSM, LSPS, and portal hypertension risk score identify obese or overweight patients with cACLD who are at increased risk of decompensation and severe bacterial infection.
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