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Monitoring Occurrence of Liver-Related Events and Survival by Transient Elastography in Patients With Nonalcoholic Fatty Liver Disease and Compensated Advanced Chronic Liver Disease
Open accessAbstract
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) 244 or change of LSM over time in individuals with histologic diagnosis of F3-F4 fi brosis and/or baseline LSM > 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]
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“The analysis of 1,039 individuals with MASLD with a histologic diagnosis of F3-F4 fi brosis and/or an LSM > 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]
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“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]
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“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]
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“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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Cited by
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Metadata
- 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)
- OpenAlex
- W3038330698
- Cited by
- 197
- References
- 34
- Citations by year
- 2026: 26 · 2025: 32 · 2024: 45 · 2023: 38 · 2022: 27 · 2021: 25
- FWCI
- 16.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 › Hepatology › 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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