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

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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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Mendoza, Yuly; Murgia, Giuseppe and Berzigotti, Annalisa

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1542-3565

Publisher:

Elsevier

Language:

English

Submitter:

Yuly Paulin Mendoza Jaimes

Date Deposited:

26 Aug 2020 18:53

Last Modified:

18 Nov 2020 01:32

Publisher DOI:

10.1016/j.cgh.2020.04.018

PubMed ID:

32289534

Uncontrolled Keywords:

NASH cirrhosis fibrosis ultrasound

BORIS DOI:

10.7892/boris.146145

URI:

https://boris.unibe.ch/id/eprint/146145

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