Abstract
Background & AimsControlled attenuation parameter (CAP) can measure hepatic steatosis. However, factors affecting its accuracy have not been described yet. This study investigated predictors of discordance between liver biopsy (LB) and CAP.MethodsA total of 161 consecutive patients with chronic liver disease who underwent LB and CAP were enrolled prospectively. Histological steatosis was graded as S0 (<5%), S1 (5–33%), S2 (34–66%), and S3 (>66% of hepatocytes). Cutoff CAP values were calculated from our cohort (250, 301, and 325 dB/m for ≥S1, ≥S2, and S3). Discordance was defined as a discrepancy of at least two steatosis stages between LB and CAP.ResultsThe median age (102 males and 59 females) was 49 years. Repartition of histological steatosis was as follows; S0 26.1% (n = 42), S1 49.7% (n = 80), S2 20.5% (n = 33), and S3 3.7% (n = 6). In multivariate linear regression analysis, CAP value was independently associated with steatosis grade along with body mass index (BMI) and interquartile range/median of CAP value (IQR/MCAP) (all P<0.05). Discordance was identified in 13 (8.1%) patients. In multivariate analysis, histological S3 (odd ratio [OR], 9.573; 95% confidence interval [CI], 1.207–75.931; P = 0.033) and CAP value (OR, 1.020; 95% CI, 1.006–1.034; P = 0.006) were significantly associated with discordance, when adjusting for BMI, IQR/MCAP, and necroinflammation, reflected by histological activity or ALT level.ConclusionsPatients with high grade steatosis or high CAP values have a higher risk of discordance between LB and CAP. Further studies are needed to improve the accuracy of CAP interpretation, especially in patients with higher CAP values.
Highlights
[4,5] fatty burden can negatively influence the prognosis of patients with chronic liver disease (CLD), as reported by recent studies revealing that coexistent steatosis in chronic hepatitis C is associated with fibrosis progression and decreased treatment response, and that steatosis may lead to a poor postoperative outcome such as a graft failure after liver transplantation or high mortality after hepatectomy. [6,7,8,9] these studies suggested that even low burden of hepatic steatosis could affect treatment outcome or prognosis
[15] Previous studies have demonstrated that controlled attenuation parameter (CAP) can be performed rapidly, and painlessly with high patient acceptance and that it can accurately grade the severity of steatosis in patients with CLDs. [15,16,17,18] in contrast to a situation that several confounding factors which determines the accuracy of liver stiffness (LS) values such as interquartile range/median value (IQR/M) or necroinflammatory activity have been identified, factors that affect the accuracy of CAP in assessing hepatic steatosis have not yet been identified. [19,20,21,22] Here, this study investigated factors which can influence the diagnostic accuracy of CAP for estimating the severity of hepatic steatosis
After excluding 9 patients based on our exclusion criteria, 161 patients were selected for statistical analysis (Fig. 1)
Summary
The clinical implications of hepatic steatosis are gaining more attention in Western countries, and in Asian countries with a westernized lifestyle such as Japan, China, and Korea. [1,2] the incidence of non-alcoholic fatty liver disease (NAFLD), the most common condition of steatosis, is increasing worldwide and it is the most common cause of abnormal liver function tests and chronic liver disease (CLD) in both developed and developing countries. [3].Severe forms of NAFLD can cause serious liver-related complications such as liver failure and hepatocellular carcinoma.[4,5] fatty burden can negatively influence the prognosis of patients with CLD, as reported by recent studies revealing that coexistent steatosis in chronic hepatitis C is associated with fibrosis progression and decreased treatment response, and that steatosis may lead to a poor postoperative outcome such as a graft failure after liver transplantation or high mortality after hepatectomy. [6,7,8,9] these studies suggested that even low burden of hepatic steatosis could affect treatment outcome or prognosis. [4,5] fatty burden can negatively influence the prognosis of patients with CLD, as reported by recent studies revealing that coexistent steatosis in chronic hepatitis C is associated with fibrosis progression and decreased treatment response, and that steatosis may lead to a poor postoperative outcome such as a graft failure after liver transplantation or high mortality after hepatectomy. [15] Previous studies have demonstrated that CAP can be performed rapidly, and painlessly with high patient acceptance and that it can accurately grade the severity of steatosis in patients with CLDs. [19,20,21,22] Here, this study investigated factors which can influence the diagnostic accuracy of CAP for estimating the severity of hepatic steatosis. This study investigated predictors of discordance between liver biopsy (LB) and CAP
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