S3265 Assessment of the Likelihood of Hepatic Decompensation and Portal Hypertension Using Noninvasive Techniques in NAFLD-Cirrhotic Patients

Abstract

INTRODUCTION: Nonalcoholic Fatty Liver Disease (NAFLD) can culminate in liver cirrhosis with the potential complication of portal hypertension. Among patients with cirrhosis, prognosis of their condition has been demonstrated through the use of the Model for End-Stage Liver Disease (MELD)-Na. Other methods of assessing a patient with cirrhosis’s prognosis is through measuring their hepatic venous pressure gradient (HVPG). The HVPG has been shown in previous studies to correlate with a patient’s MELD-Na score. The aim of this study was to determine the relationship between non-invasive measures of fibrosis with invasive HVPG measurements in a NAFLD-cirrhotic population. The MELD-Na scores were then calculated to assess their correlation with these noninvasive and invasive measures of clinical prognosis. METHODS: A retrospective study was done on a cohort of NAFLD-cirrhosis patients seen at Liver Associates of Texas in Houston, TX from 1/18 – 5/20. Patients’ portal hypertension was assessed using the HVPG calculated from transjugular pressure measurements. Fibrosis measurements were measured through liver stiffness readings through transient elastography. A multivariate linear regression was performed using fibrosis on elastography as the outcome variable to assess factors independently associated with fibrosis progression: gender, ethnicity, HPVG measurements, AST, ALT, and MELD-Na. Then a linear regression was performed between the MELD-Na and kilopascal (kPa) score to assess the correlation between these two values. RESULTS: 99 patients were included in the study, 38 had transjugular liver biopsies, and 49 had fibrosis measurements. 69% were females. 43% were Caucasian, 5% African American, 20% Hispanic, 4% Asian, and 27% were other. 29.05 (± 17.81) and 10.20 (±4.3) were the mean kPa and MELD-Na scores respectively. No significant finding was seen between HVPG and kPa measurements. Elastography and MELD-Na score were significantly correlated (P = 0.03) as well as elastography with AST (P = 0.034). CONCLUSION: This study demonstrated a significant correlation between elastography and the MELD-Na score in patients with NAFLD-cirrhosis. AST was also identified as a possible surrogate marker of fibrosis while HVPG was not. This gives more credence to the idea that NAFLD patients with cirrhosis could be better prognosticated through noninvasive studies such as the use of elastography or serum AST levels rather than more invasive methods such as HVPG measurements.Table 1.: Linear Regression on Selected Variables Compared to Fibrosis Measured on Elastography