The Clinical Utility of Transient Elastography (TE) in Predicting Clinical Outcomes and Decompensation in Cirrhosis

Abstract

Background: Transient Elastography (TE) is a non-invasive method providing reliable measurements help staging liver fibrosis which is crucial for both prognosis and management. In this study, we assess the utility of TE in predicting clinical outcomes. Methods: Retrospective cohort 272 patients underwent serial TE measurements in a single liver center. TE scores at baseline and longitudinal change over time were correlated with the primary outcome of clinical decompensation (ascites, encephalopathy, variceal bleed, increase in CPC > 2, HCC, liver transplant, and death). Results: 162 patients (62%) had an initial TE score of < 12.5 kPa (non-cirrhotic) and 100 patients (38%) had a TE score of >12.5 kPa consistent with cirrhosis. In the cirrhosis group, mean TE score 26.4 kPa compared to 7.0 kPa non-cirrhosis (p < 0.0001). In the cirrhotic group, 85% had esophageal varices on upper endoscopy that had baseline TE score of ≥ 21.0 kPa in compare to 13% with baseline TE scores 12.5- 20.0kPa (p < 0.05). During a median follow-up period of 4.5 years, 14% of patients achieved a primary outcome of clinical decompensation [30% cirrhosis versus 4% non-cirrhosis (p < 0.01)]. Logistic regression analysis demonstrates that TE score of ≥35 kPa was the strongest predictor for primary endpoint OR 6.5 (95% CI 8.2 – 4.8, p < 0.01). An Annual increase in TE score of ≥8 kPa to the cirrhotic range ≥12.5 kPa was associated with a significant OR 2.8 (95% CI 2.1-3.9, p < 0.01) for developing clinical decompensation. Conclusion: Baseline TE scores ≥35kPa & annual increment TE score ≥8 kPa were associated with a significant risk of clinical decomposition. Key words: Transient elastography; liver fibrosis; Fibroscan; clinical decompensation;