Role of Magnetic Resonance Elastography in compensated and decompensated liver disease

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.
Accepted Manuscript

Abstract

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.

Methods

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).

Results

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.

Conclusion

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

Source

Vitamin D deficiency is associated with mortality in patients with advanced liver cirrhosis

Eur J Clin Invest. 2013 Nov 15. doi: 10.1111/eci.12205. [Epub ahead of print]

Stokes CS, Krawczyk M, Reichel C, Lammert F, Grünhage F.

Department of Medicine II, Saarland University Medical Center, Homburg, Germany.

Abstract

BACKGROUND: Chronic liver disease is the fifth most common cause of mortality in Europe. Recently, vitamin D deficiency has been associated with an increased risk of mortality in the general population. Since patients with advanced liver disease frequently exhibit vitamin D deficiency, we assessed for a possible association of vitamin D deficiency with survival in a cohort of patients with advanced liver disease.

METHODS:  Sixty-five patients with liver cirrhosis (median age, 58 years; range, 19-76 years; 66% male; Child-Pugh stage C, 46%) were included in our prospective single-center survival study. Serum 25-hydroxyvitamin D concentrations were measured by chemiluminescence immunoassay. The optimal cut-off was determined using area under the curve (AUC) and Kaplan-Meier analysis. Chi-square statistics and multivariate binary logistic regression analysis were also conducted.

RESULTS: Median serum vitamin D levels were 8.2 ng/ml (range < 4.0-95.8 ng/ml). Overall, 48% of patients (31/65) died during a 24-month follow-up period. AUC analysis determined a vitamin D level of 6.0 ng/ml as optimal cut-off for discriminating survivors from non-survivors. Kaplan-Meier analysis of survival confirmed low vitamin D levels as significant predictor of death (P = 0.012). Finally, multivariate analysis identified low vitamin D levels (OR = 6.3; 95% CI, 1.2-31.2; P = 0.012) and MELD scores (OR = 1.4; 95% CI, 1.2-1.7; P < 0.001) as independent predictors of survival.

CONCLUSION: Low vitamin D levels are associated with increased mortality in patients with advanced liver disease. Thus, serum levels of vitamin D might represent a critical marker of survival in advanced liver cirrhosis. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS: 25-hydroxyvitamin D, cholecalciferol, chronic liver disease, survival analysis

PMID: 24236541 [PubMed - as supplied by publisher]

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