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Prognostic factors for long-term outcome in alcoholic liver disease (ALD) are not well defined. The aim of the present study was to investigate the prognostic impact of clinical, biochemical and histological parameters on liver-related long-term mortality of asymptomatic and symptomatic patients with biopsy-proven …

Prognostic factors for long-term outcome in alcoholic liver disease (ALD) are not well defined. The aim of the present study was to investigate the prognostic impact of clinical, biochemical and histological parameters on liver-related long-term mortality of asymptomatic and symptomatic patients with biopsy-proven …

S07.1 INDIVIDUAL CIRRHOSIS SCREENING VIA LIVER STIFFNESS: PRACTICAL APPROACH AND INTERPRETATION {#article-title-2} Noninvasive screening for liver cirrhosis in patients addicted to drugs or alcohol has been a continuing problem in internal and addictive medicine. This has dramatically changed with the recent introduction of transient elastography (Fibroscan) to directly measure liver stiffness (LS). This novel technique is expanding rapidly around the globe since it allows the diagnosis of liver cirrhosis in a true bed-side manner within minutes. LS is an excellent screening parameter for cirrhosis with a high negative predictive value. Thus, a normal LS < 6 kPa excludes ongoing liver disease while a LS of 8 kPa and 12.5 kPa represent generally accepted cut-off values for F3 and F4 fibrosis. Meanwhile, LS has also been successfully used to monitor treatment outcome of patients with alcoholic liver cirrhosis and as prognostic parameter for hepatic complications such as the risk of variceal bleeding or hepatocellular carcinoma. However, it is important to conceive that several other factors apart from cirrhosis stage may affect LS. Such factors include liver inflammation, liver congestion, cholestasis and rare conditions such as amyloidosis or mastocytosis. Thus, although LS is an excellent screening tool for liver disease, it should always be interpreted in the clinical context. For such a hepatological expert interpretation of LS values, a concomitant ultrasound and laboratory parameters are required which will increase the diagnostic accuracy over 99%. Novel actual algorithms will be discussed especially with regard to alcoholic liver disease, how to interpret increased LS values within the clinical setting. # S07.2 LIVER STIFFNESS AND CONTROLLED ATTENUATION PARAMETER MEASUREMENTS USING SHEAR WAVE BASED QUANTITATIVE ELASTOGRAPHY {#article-title-3} Introduced in 2003, Vibration-Controlled Transient Elastography (Fibroscan®, Echosens, France) disruptive technology is now widely used in routine clinical practice and research. Indeed, a large body of evidence demonstrated that liver stiffness measurement significantly correlates with liver fibrosis. Other factors, such as chronic inflammation, mechanic cholestasis and liver congestion have been shown to increase liver stiffness. Recently a new parameter has been introduced: Controlled Attenuation Parameter (CAP) . CAP is a measure of ultrasound attenuation developed to assess steatosis. With CAP, Fibroscan® can help assessing both liver fibrosis and steatosis. In this paper, the different quantitative shear wave based techniques will be presented. Advantages and limitations of each technique will be described in terms of technology, clinical results, examination procedure, etc. The performances of CAP will be detailed and we will present how these performances can be enhanced using a dedicated liver guidance tool. # S07.3 IS THERE A ROLE FOR HISTOLOGY IN THE PREDICTION OF LONG-TERM MORTALITY IN ALD? {#article-title-4} Patients with non-severe alcoholic liver disease (ALD) are at lower risk of short-term mortality but die at later time points. The aims of our study were to develop a non-invasive model for the prediction of long-term mortality in patients with ALD and to investigate if histological parameters of ALD can improve the diagnostic accuracy of the non-invasive model. A cohort of 189 consecutive patients with a history of significant alcohol consumption (> 40 g/d for women (n = 69); >60g/day for men (n = 120)) enrolled between 1985 and 2008 was studied. Other causes of liver disease were excluded. All patients underwent liver biopsy for staging. Cox regression models were used for uni- and multivariate analyses. Variables indepentently associated with mortality were used to build new prognostic models. The parameters included in the non-invasive c linical- b iochemical (CB) model were sex, alkaline phosphatase, bilirubin, creatinine, INR and thromobocyte count. The c linical- b iochemical- h istological (CBH) model included fibrosis stage and pericellular fibrosis in addition to parameters of the CB model. Diagnostic accuracies of the CB, CBH and Child Pugh score (CPS) were evaluated by ROC analysis for prediction of mortality at one and five years. The performance of the CBH model (AUCCBH 1a: 0.87/5a: 0.85) was superior to the CB and CPS at both time points (AUCCB 1a: 0.83/5a: 0.81 and AUCCPS1a: 0.77/5a: 0.74, respectively). Each of the prognostic models showed better performance in men as compared to women. The CBH model is a new prognostic tool for the prediction of long-term mortality particularly in men with ALD. # S07.4 WHAT SHOULD BE USED TO MEASURE LIVER STIFFNESS: TE, ARFI OR SSE? {#article-title-5} One of the most important benefits of elastographic methods (transient elastography TE, ARFI, spleens stiffness elastography SSE) is the non-invasive diagnosis of liver chirrhosis. The areas under the ROC curve for the prediction of cirrhosis by TE reach 0.90-0.99, for cutoff values between 9-26.6 kPa. In some patients, although the cirrhosis diagnosis is established on pathological and ultrasonographic criteria, with evident nodular regeneration, liver sttiffness may not reach cirrhotic values when the finer septa surrounding the nodules do not increase the overall fibrosis of the liver. Generally speaking, liver stiffness will be lower in macronodular than in micronodular cirrhosis. Liver stiffness increases as the liver disorder progresses, but the prognostic significance of liver stiffness values is still under evaluation. Liver stiffness alone is not reliable enough to be used as a screening method to detect the esophageal varices grade in liver cirrhosis patients, but using TE to measure both liver and spleen stiffness ensures a better prediction of the presence of esophageal varices. Real-time ultrasonographic elastography is another technique assessing liver stiffness through different methods: either through interpretation of a colour map, or through numerical quantification of the shear wave speed in the liver parenchyma (ARFI technique). The performance of ARFI is similar with that of TE in predicting cirrhosis but lower in early fibrosis stages. This presentation is a comparative review of the performance of TE, ARFI and SSE, alone or in combination, for the diagnosis and monitoring of liver cirrhosis. # S07.5 LIVER STIFFNESS AND SERUM MARKER: COMPETITION OR SUPPLEMENTATION? {#article-title-6} Transient Elastography (TE, Fibroscan) and serum markers (Fibrotest, Fibrometer) can be used for non-invasive diagnosis of liver fibrosis in Alcoholic Liver Disease. Specfic TE Cut offs have been described for the diagnosis of alcoholic cirrhosis. Some cautions must be known, as a significantly higher elasticity for the diagnosis of alcoholic cirrhosis compared with cut offs used in viral cirrhosis, the impact of alcohol abstinence on reducing liver stiffness, or the presence of histological evidence of alcoholic hepatitis. Some serum markers are patented. Diagnostic accuracy is high for diagnosis of cirrhosis. The combination of serum markers with elastography improves the diagnostic performance in the area of fibrosis caused by virus C, but it is not demonstrated in the field of Alcoholic Liver Disease. Furthermore, hepatic elastography as serum markers may have other uses, such as non-invasive diagnosis of portal hypertension and large esophageal varices significant. Finally, Fibrotest could estimate the presence of alcoholic hepatitis (Ashtest), and also has a prognostic value on survival at 5 and 10 years in patients with alcoholic hepatic fibrosis.

In his letter, Dr Rosalki (1996) criticizes our claim (Stauber et al, 1995) of superior sensitivity of carbohydrate-deficient transferrin (CDT) over that of gamma-glutamyltransferase (gamma-GT). It was not our intention to claim that sensitivity of CDT alone is superior to that of gamma-GT, but that sensitivity and specificity of CDT together, and thus its overall diagnostic accuracy, are superior. For comparison of CDT with gamma-GT, we analysed only data obtained from outpatients who had various kinds of chronic liver disease, but were not preselected because of an elevated gamma-GT. As can be seen in Table 2 of our article (Stauber et al., 1995), the sensitivities of CDT (85%) and gamma-GT (83%) were comparable, while the specificity of CDT (83%) was superior to that of gamma-GT (16%). These findings are consistent with a previous study by Bell et al. (1993), who reported sensitivities of 61% for CDT and 85% for gamma-GT and specificities of 92% for CDT and 18% for gamma-GT. Based on these data, it may be clearly concluded that overall diagnostic accuracy of CDT is superior to that of gamma-GT in patients with liver disease.