Journal of Hepatology
Article in Press
Sumeet K. Asrani, Jayant A. Talwalkar, Patrick S. Kamath, Vijay H. Shah, Giovanna Saracino, Linda Jennings, John B. Gross, Sudhakar Venkatesh, Richard L. Ehman
Received 12 June 2013; received in revised form 27 November 2013; accepted 9 December 2013. published online 20 December 2013.
Background and Aims
Non-invasive predictors identifying subjects with compensated liver disease at highest risk for transitioning to a decompensated state are lacking. We hypothesized that liver shear stiffness as measured by magnetic resonance elastography is an important non-invasive predictor of hepatic decompensation.
Among patients with advanced fibrosis undergoing magnetic resonance elastography (2007-11), a baseline cohort and follow up cohort (compensated liver disease) were established. Cause specific cox proportional hazards analysis adjusting for competing risks was utilized to determine the association between elevated liver shear stiffness and development of decompensation (hepatic encephalopathy, ascites, variceal bleeding).
In the baseline cohort (n=430), subjects with decompensated liver disease had a significantly higher mean liver shear stiffness (6.8 kPa, IQR 4.9-8.5) as compared to subjects with compensated liver disease (5.2 kPa, IQR 4.1-6.8). After adjustment for Model for End Stage Liver Disease score, hepatitis C, age, gender, albumin, and platelet count, the mean liver shear stiffness (OR=1.13, 95%CI 1.03-1.27) was an independently associated with decompensated cirrhosis at baseline. Over a median follow up of 27 months (n=167), 7.2% of subjects with compensated disease experienced hepatic decompensation. In the follow up cohort, the hazard of hepatic decompensation was 1.42 (95% CI 1.16 -1.75) per unit increase in liver shear stiffness over time. The hazard of hepatic decompensation was 4.96 (95% CI 1.4-17.0, p=0.019) for a subject with compensated disease and meanLSS value greater then or equal to 5.8 kPa as compared to an individual with compensated disease and lower mean LSS values.
Baseline liver shear stiffness assessed by magnetic resonance elastography is independently associated with decompensated liver disease.
Abbreviations: LSS, Liver shear stiffness, MRE, magnetic resonance elastography, HCV, hepatitis C, MELD, model for end stage liver disease, CI, confidence interval, OR, Odds ratio
Keywords: Non invasive, Outcomes, Natural history, Prognosis, Cirrhosis