1. Two-dimensional shear wave elastography predicts survival in advanced chronic liver disease
- Author
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Maximilian J. Brol, Maxime Ronot, Ioan Sporea, Laurent Castera, David Bauer, Rongqin Zheng, Renata Senkerikova, Ida Tjesic Drinkovic, Alina Popescu, Wenyi Gu, Benedikt Simbrunner, Thomas Vanwolleghem, Ditlev Nytoft Rasmussen, Johannes Chang, Luisa Vonghia, Martin Schulz, Christian P. Strassburg, Thomas Reiberger, Stanislas Pol, Cristina Margini, Sanda Mustapic, Maja Thiele, Xue Lu, Chrisitan Jansen, Maria Kjærgaard, Ivica Grgurević, Michael Praktiknjo, Olivier Guillaud, Halima Gottfriedová, Jérôme Boursier, Sven Francque, Mireen Friedrich-Rust, Valérie Vilgrain, Jonel Trebicka, Aymeric Guibal, Philip G. Ferstl, Filipe Andrade, Victor de Ledinghen, Christophe Cassinotto, Jérôme Dumortier, Annalisa Berzigotti, Stefan Zeuzem, Frank Erhard Uschner, Wen-Ping Wang, Christophe Aubé, Camille Vassord, Pierre-Emmanuel Rautou, Georg Semmler, Aleksander Krag, Grifols Chair, Partenaires INRAE, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Department of Internal Medicine, Service d'Hépato-Gastro-Entérologie, CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), and Hospices Civils de Lyon (HCL)
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,liver cirrhosis ,[SDV]Life Sciences [q-bio] ,610 Medicine & health ,Chronic liver disease ,clinical decision making ,03 medical and health sciences ,0302 clinical medicine ,Model for End-Stage Liver Disease ,Predictive Value of Tests ,Internal medicine ,Risk of mortality ,Humans ,Medicine ,Decompensation ,Retrospective Studies ,business.industry ,Liver Diseases ,liver failure ,Gastroenterology ,chronic liver disease ,portal hypertension ,Middle Aged ,medicine.disease ,Survival Rate ,030104 developmental biology ,ROC Curve ,Chronic Disease ,Cohort ,Cardiology ,Elasticity Imaging Techniques ,Portal hypertension ,Female ,030211 gastroenterology & hepatology ,Human medicine ,business ,Transient elastography ,Algorithms ,Cohort study - Abstract
ObjectiveLiver stiffness measurement (LSM) is a tool used to screen for significant fibrosis and portal hypertension. The aim of this retrospective multicentre study was to develop an easy tool using LSM for clinical outcomes in advanced chronic liver disease (ACLD) patients.DesignThis international multicentre cohort study included a derivation ACLD patient cohort with valid two-dimensional shear wave elastography (2D-SWE) results. Clinical and laboratory parameters at baseline and during follow-up were recorded. LSM by transient elastography (TE) was also recorded if available. The primary outcome was overall mortality. The secondary outcome was the development of first/further decompensation.ResultsAfter screening 2148 patients (16 centres), 1827 patients (55 years, 62.4% men) were included in the 2D-SWE cohort, with median liver SWE (L-SWE) 11.8 kPa and a model for end stage liver disease (MELD) score of 8. Combination of MELD score and L-SWE predict independently of mortality (AUC 0.8). L-SWE cut-off at ≥20 kPa combined with MELD ≥10 could stratify the risk of mortality and first/further decompensation in ACLD patients. The 2-year mortality and decompensation rates were 36.9% and 61.8%, respectively, in the 305 (18.3%) high-risk patients (with L-SWE ≥20 kPa and MELD ≥10), while in the 944 (56.6%) low-risk patients, these were 1.1% and 3.5%, respectively. Importantly, this M10LS20 algorithm was validated by TE-based LSM and in an additional cohort of 119 patients with valid point shear SWE-LSM.ConclusionThe M10LS20 algorithm allows risk stratification of patients with ACLD. Patients with L-SWE ≥20 kPa and MELD ≥10 should be followed closely and receive intensified care, while patients with low risk may be managed at longer intervals.
- Published
- 2021
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