Two-dimensional shear wave elastography predicts survival in advanced chronic liver disease.

Trebicka, Jonel; Gu, Wenyi; de Ledinghen, Victor; Aubé, Christophe; Krag, Aleksander; Praktiknjo, Michael; Castera, Laurent; Dumortier, Jerome; Bauer, David Josef Maria; Friedrich-Rust, Mireen; Pol, Stanislas; Grgurevic, Ivica; Zheng, Rongqin; Francque, Sven; Gottfriedovà, Halima; Mustapic, Sanda; Sporea, Ioan; Berzigotti, Annalisa; Uschner, Frank Erhard; Simbrunner, Benedikt; ... (2021). Two-dimensional shear wave elastography predicts survival in advanced chronic liver disease. (In Press). Gut BMJ Publishing Group 10.1136/gutjnl-2020-323419

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OBJECTIVE

Liver stiffness measurement (LSM) is a tool used to screen for significant fibrosis and portal hypertension. The aim of this retrospective multicentre study was to develop an easy tool using LSM for clinical outcomes in advanced chronic liver disease (ACLD) patients.

DESIGN

This international multicentre cohort study included a derivation ACLD patient cohort with valid two-dimensional shear wave elastography (2D-SWE) results. Clinical and laboratory parameters at baseline and during follow-up were recorded. LSM by transient elastography (TE) was also recorded if available. The primary outcome was overall mortality. The secondary outcome was the development of first/further decompensation.

RESULTS

After screening 2148 patients (16 centres), 1827 patients (55 years, 62.4% men) were included in the 2D-SWE cohort, with median liver SWE (L-SWE) 11.8 kPa and a model for end stage liver disease (MELD) score of 8. Combination of MELD score and L-SWE predict independently of mortality (AUC 0.8). L-SWE cut-off at ≥20 kPa combined with MELD ≥10 could stratify the risk of mortality and first/further decompensation in ACLD patients. The 2-year mortality and decompensation rates were 36.9% and 61.8%, respectively, in the 305 (18.3%) high-risk patients (with L-SWE ≥20 kPa and MELD ≥10), while in the 944 (56.6%) low-risk patients, these were 1.1% and 3.5%, respectively. Importantly, this M10LS20 algorithm was validated by TE-based LSM and in an additional cohort of 119 patients with valid point shear SWE-LSM.

CONCLUSION

The M10LS20 algorithm allows risk stratification of patients with ACLD. Patients with L-SWE ≥20 kPa and MELD ≥10 should be followed closely and receive intensified care, while patients with low risk may be managed at longer intervals.

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

UniBE Contributor:

Berzigotti, Annalisa and Margini, Cristina

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0017-5749

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Rahel Fuhrer

Date Deposited:

12 May 2021 12:05

Last Modified:

12 May 2021 12:05

Publisher DOI:

10.1136/gutjnl-2020-323419

PubMed ID:

33479052

Uncontrolled Keywords:

chronic liver disease clinical decision making liver cirrhosis liver failure portal hypertension

BORIS DOI:

10.48350/155527

URI:

https://boris.unibe.ch/id/eprint/155527

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