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Cited by 197Liver Disease Diagnosis and TreatmentLiver Disease and TransplantationLiver Diseases and Immunity

Monitoring occurrence of liver-related events and survival by transient elastography in patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease

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Petta, Salvatore, Sebastiani, Giada, Viganò, Mauro, Ampuero, Javier, Wai-Sun Wong, Vincent, Boursier, Jerome, Berzigotti, Annalisa, Bugianesi, Elisabetta +13 more·2021·Clinical Gastroenterology and Hepatology
DOI 10.1016/j.cgh.2020.06.045
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Abstract

Background & aims Patients with advanced fibrosis related to nonalcoholic fatty liver disease (NAFLD) are at risk of developing hepatic and extrahepatic complications. We investigated whether, in a large cohort of patients with NAFLD and compensated advanced chronic liver disease, baseline liver stiffness measurements (LSMs) and their changes can be used to identify patients at risk for liver-related and extrahepatic events.Methods We performed a retrospective analysis of consecutive patients with NAFLD (n = 1039) with a histologic diagnosis of F3-F4 fibrosis and/or LSMs>10 kPa, followed for at least 6 months, from medical centers in 6 countries. LSMs were made by FibroScan using the M or XL probe and recorded at baseline and within 1 year from the last follow-up examination. Differences between follow up and baseline LSMs were categorized as: improvement (reduction of more than 20%), stable (reduction of 20% to an increase of 20%), impairment (an increase of 20% or more). We recorded hepatic events (such as liver decompensation, ascites, encephalopathy, variceal bleeding, jaundice, or hepatocellular carcinoma [HCC]) and overall and liver-related mortality during a median follow-up time of 35 months (interquartile range, 19-63 months).Results Based on Cox regression analysis, baseline LSM was independently associated with occurrence of hepatic decompensation (hazard ratio [HR], 1.03; 95% CI, 1.02-1.04; P < .001), HCC (HR, 1.03; 95% CI, 1.00-1.04; P = .003), and liver-related death (HR, 1.02; 95% CI, 1.02-1.03; P = .005). In 533 patients with available LSMs during the follow-up period, change in LSM was independently associated with hepatic decompensation (HR, 1.56; 95% CI, 1.05-2.51; P = .04), HCC (HR, 1.72; 95% CI, 1.01-3.02; P = .04), overall mortality (HR, 1.73; 95% CI, 1.11-2.69; P = .01), and liver-related mortality (HR, 1.96; 95% CI, 1.10-3.38; P = .02).Conclusions In patients with NAFLD and compensated advanced chronic liver disease, baseline LSM and change in LSM are associated with risk of liver-related events and mortality.

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  • Studies in MASLD indicate an elevated HCC risk with FIB-4 > 3.25 (risk > 1%/year) or change of LSM over time in individuals with histologic diagnosis of F3-F4 fibrosis and/or baseline LSM > 10 kPa (HR 1.72) in individuals without cirrhosis.

    “Studies in MASLD indicate an elevated HCC risk with FIB-4 &gt; 3.25 (risk &gt; 1%/year) 244 or change of LSM over time in individuals with histologic diagnosis of F3-F4 fi brosis and/or baseline LSM &gt; 10 kPa (HR 1.72) 185 in individuals without cirrhosis.”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [185]

    The ‘Monitoring LSM do predict HCC occurrence’ section reports that change in LSM predicted HCC in patients with follow-up measurements (HR 1.72). However, the study population had NAFLD with compensated advanced chronic liver disease, including compensated cirrhosis; the reported HR is not specifically for individuals without cirrhosis. The available Patient Selection passage also does not establish the stated F3–F4 histology and/or baseline LSM >10 kPa criteria. The FIB-4 claim is attached to a different citation. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Change in LSM over time predicts the occurrence of HCC (HR 1.72; 95% CI 1.01-3.02) in individuals with MASLD with F3-F4 fibrosis and/or LSM > 10 kPa.

    “The analysis of 1,039 individuals with MASLD with a histologic diagnosis of F3-F4 fi brosis and/or an LSM &gt; 10 kPa showed that the change in LSM over time predicted the occurrence of HCC (HR 1.72; 95% CI 1.01-3.02). 185”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [185]

    The ‘Monitoring LSM do predict HCC occurrence’ section reports that change in LSM predicted HCC with the stated HR and confidence interval. However, ‘Clinical and Features and Liver Stiffness’ says the cohort had 1,039 patients but follow-up LSM was available for only 533; the reported change-in-LSM analysis was in that subgroup, not all 1,039. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • Baseline LSM was an independent risk factor for developing HCC, hepatic decompensation and liver-related death in individuals with advanced MASLD-related fibrosis or compensated cirrhosis.

    “baseline LSM was an independent risk factor for developing HCC, hepatic decompensation and liver-related death in individuals with advanced MASLD-related fi brosis/compensated cirrhosis. 185”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [185]

  • In longitudinal studies with serial VCTE measurements, changes in LSM (20% increase, stable, 20% decrease) correlated with the risk of liver-related events including HCC and liver-related death.

    “In longitudinal studies with serial VCTE measurements, changes in LSM (20% increase, stable, 20% decrease) correlated with the risk of liver-related events (including HCC) and liver-related death. 184,185”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [185]

  • A retrospective analysis of 533 cases with compensated advanced chronic liver disease related to MASLD demonstrated that changes in LSM independently predicted the occurrence of hepatic decompensation, HCC, overall mortality, and liver-related mortality.

    “a retrospective analysis of 533 cases with compensated advanced chronic liver disease related to MASLD demonstrated that changes in LSM independently predicted the occurrence of hepatic decompensation, HCC, overall mortality, and liver-related mortality. 185”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [185]

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Authors
Petta, S., Sebastiani, G., Viganò, M., Ampuero, J., Wai-Sun Wong, V., Boursier, J., Berzigotti, A., Bugianesi, E., Fracanzani, A. L., Cammà, C., Enea, M., Grottes, M. D., Di Marco, V., Younes, R., Keyrouz, A., Mazzola, S., Mendoza, Y., Pennisi, G., Romero-Gomez, M., Craxì, A., & de Ledinghen, V.
Affiliations
  • University of Palermo (IT)
  • McGill University Health Centre (CA)
  • University of Milan (IT)
  • Instituto de Biomedicina de Sevilla (ES)
  • University of Bern (CH)
  • University of Turin (IT)
  • Inserm (FR)
  • Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo (IT)
Corresponding author
Petta, Salvatore
ORCID
Venue
Clinical Gastroenterology and Hepatology
Publisher
Elsevier BV
Published
2021-04
Volume
19
Issue
4
Pages
806-815.e5
ISSN
1542-3565 (ISSN-L)
DOI
10.1016/j.cgh.2020.06.045
OpenAlex
W3038330698
Cited by
197
References
34
Citations by year
2026: 26 · 2025: 32 · 2024: 45 · 2023: 38 · 2022: 27 · 2021: 25 · 2020: 4
FWCI
16.84
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Gastroenterology and Hepatology (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
  • RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
  • HAL (submittedVersion)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • BORIS (University Library Bern) (submittedVersion, other-oa)
  • DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion)
  • Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
  • Open Access CRIS of the University of Bern
Funders
Fonds de Recherche du Québec - Santé (267806, 27127)
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
Keywords
non-alcoholic fatty liver disease, compensated advanced chronic liver disease, liver stiffness, transient elastography, liver fibrosis, hepatic decompensation, hepatocellular carcinoma, liver-related mortality, extrahepatic complications, liver-related events, risk stratification, variceal bleeding, ascites, encephalopathy
MeSH terms
Esophageal and Gastric Varices, Gastrointestinal Hemorrhage, Carcinoma, Hepatocellular, Humans, Liver, Liver Cirrhosis, Liver Neoplasms, Retrospective Studies, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease

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