Elevated Liver Stiffness Measurement Research Articles

Evaluating the risk of hepatocellular carcinoma in patients with prominently elevated liver stiffness measurements by FibroScan: a multicentre study

Background and aimsThere are limited data on the significance of liver stiffness measurements (LSM) by transient elastography in the upper extreme end of the measurable spectrum. This multicentre retrospective observational study evaluated the risk of hepatocellular carcinoma (HCC) in patients with LSM ≥20 kPa. Methods432 cirrhosis patients with LSM ≥20 kPa between June 2007 and October 2015 were retrospectively followed-up through electronic records. ResultsA minimum 1-year follow-up was available for 278 patients (177 men; average age 57, range 18–84). LSM ranged from 20.0 to 75.0 kPa (mean 34.6 kPa). Cumulative incidences of HCC were 19 (6.8%), 30 (10.8%) and 41 (14.7%) at 1, 2 and 3 years, respectively. HCC was associated with age (p = 0.003), higher LSM (p = 0.005) and viral aetiology (p = 0.007). Patients were divided into 4 groups based on LSM at entry: 20–25 kPa (n = 74); 25–30 kPa (n = 62); 30–40 kPa (n = 75); >40 kPa (n = 67). Compared to the 20–25 kPa group, the 30–40 kPa group had a hazard ratio (HR) of 3.0 (95% CI, 1.1–8.3; p = 0.037), and the >40 kPa group had a HR of 4.8 (95% CI, 1.7–13.4; p = 0.003). ConclusionsThis study shows an association between LSM at the upper extreme and HCC risk. Physicians may find this beneficial as a non-invasive dynamic approach to assessing HCC risk in cirrhosis patients.

Su1006 Longer Duration of Transient Elastography Predicts Unreliable Measurements and Measurement Failure

Introduction: Transient elastography (TE) is a noninvasive, validated method to assess liver fibrosis by obtaining liver stiffness measurements (LSM). Measurement failure (MF) and unreliable measurement (UM) occur in up to 3% and 15% of patients, respectively. The relationship between time taken to perform TE (duration) and UM has not been studied. Aim: To determine whether the examination duration correlates with unreliable measurement and measurement failure of transient elastography. Materials and Methods: This is a prospective study of the frequency and predictors of UM based on LSM obtained by FibroscanTM from September 2008 to June 2013. UM was defined as any of the following: 30% of the median LSM. MF was defined as zero valid measurements. All operators had performed >100 prior examinations. Data collected included age, sex, BMI (kg/m2), probe used (M or XL), stiffness (LSM in kPa), duration of TE (in minutes:seconds) and aetiology of liver disease. Patients were categorised as cirrhotic according to validated disease-specific median liver stiffness cut-offs. Multivariate binary logistic regression was performed to identify factors independently associated with UM. Results: Liver stiffness measurements of 2835 patients were analysed (55% male, median age 51 years [IQR 4160]). The aetiologies of liver disease were hepatitis B (42.7%), hepatitis C (23.7%), nonalcoholic fatty liver disease (7.8%), alcohol (3.4%) and other (22.4%). MF and UM occurred in 3.1% and 19.0%, respectively. Duration, LSM and obesity were independent predictors of UM. The area under the receiver operating curve (AUROC) of duration for diagnosing UM was 0.716 (0.69-0.74) with an optimal cut-off of 3mins 47s (sensitivity 70%, specificity 65%, odds ratio (OR) 4.2[95% CI 2.7-6.6], P 30kg/m2) was an independent predictor of UM (OR 1.9[1.2-3.0], P=0.009). Patients with median LSM falling in the cirrhosis range were more likely to have UM (OR 2.3[1.4-3.9], P=0.002). The majority of these UM (72.7%) were attributed to IQR >30%, indicating higher variability at the upper ranges of LSM. Conclusions: In experienced hands, duration is a strong predictor of UM in patients undergoing TE. Examinations longer than 4 minutes are more likely to be unreliable. Examinations longer than 8 minutes are unlikely to yield a valid result and should be considered a futility endpoint. Obesity and elevated LSM in the cirrhosis range are independent, albeit weaker, predictors of UM. Table1. Duration cut-offs for UM at 90, 95 and 99% specificity

Su1007 Tenofovir or Lamivudine Use in Late Pregnancy Safely Reduces Perinatal Transmission of Hepatitis B Virus in Real-Life Practice

Introduction: Transient elastography (TE) is a noninvasive, validated method to assess liver fibrosis by obtaining liver stiffness measurements (LSM). Measurement failure (MF) and unreliable measurement (UM) occur in up to 3% and 15% of patients, respectively. The relationship between time taken to perform TE (duration) and UM has not been studied. Aim: To determine whether the examination duration correlates with unreliable measurement and measurement failure of transient elastography. Materials and Methods: This is a prospective study of the frequency and predictors of UM based on LSM obtained by FibroscanTM from September 2008 to June 2013. UM was defined as any of the following: 30% of the median LSM. MF was defined as zero valid measurements. All operators had performed >100 prior examinations. Data collected included age, sex, BMI (kg/m2), probe used (M or XL), stiffness (LSM in kPa), duration of TE (in minutes:seconds) and aetiology of liver disease. Patients were categorised as cirrhotic according to validated disease-specific median liver stiffness cut-offs. Multivariate binary logistic regression was performed to identify factors independently associated with UM. Results: Liver stiffness measurements of 2835 patients were analysed (55% male, median age 51 years [IQR 4160]). The aetiologies of liver disease were hepatitis B (42.7%), hepatitis C (23.7%), nonalcoholic fatty liver disease (7.8%), alcohol (3.4%) and other (22.4%). MF and UM occurred in 3.1% and 19.0%, respectively. Duration, LSM and obesity were independent predictors of UM. The area under the receiver operating curve (AUROC) of duration for diagnosing UM was 0.716 (0.69-0.74) with an optimal cut-off of 3mins 47s (sensitivity 70%, specificity 65%, odds ratio (OR) 4.2[95% CI 2.7-6.6], P 30kg/m2) was an independent predictor of UM (OR 1.9[1.2-3.0], P=0.009). Patients with median LSM falling in the cirrhosis range were more likely to have UM (OR 2.3[1.4-3.9], P=0.002). The majority of these UM (72.7%) were attributed to IQR >30%, indicating higher variability at the upper ranges of LSM. Conclusions: In experienced hands, duration is a strong predictor of UM in patients undergoing TE. Examinations longer than 4 minutes are more likely to be unreliable. Examinations longer than 8 minutes are unlikely to yield a valid result and should be considered a futility endpoint. Obesity and elevated LSM in the cirrhosis range are independent, albeit weaker, predictors of UM. Table1. Duration cut-offs for UM at 90, 95 and 99% specificity

P1094 FIBROSIS REGRESSION IN PERSONS TREATED FOR HBV UTILIZING TRANSIENT ELASTOGRAPHY (FIBROSCAN)

Introduction: Transient elastography (TE) is a noninvasive, validated method to assess liver fibrosis by obtaining liver stiffness measurements (LSM). Measurement failure (MF) and unreliable measurement (UM) occur in up to 3% and 15% of patients, respectively. The relationship between time taken to perform TE (duration) and UM has not been studied. Aim: To determine whether the examination duration correlates with unreliable measurement and measurement failure of transient elastography. Materials and Methods: This is a prospective study of the frequency and predictors of UM based on LSM obtained by FibroscanTM from September 2008 to June 2013. UM was defined as any of the following: 30% of the median LSM. MF was defined as zero valid measurements. All operators had performed >100 prior examinations. Data collected included age, sex, BMI (kg/m2), probe used (M or XL), stiffness (LSM in kPa), duration of TE (in minutes:seconds) and aetiology of liver disease. Patients were categorised as cirrhotic according to validated disease-specific median liver stiffness cut-offs. Multivariate binary logistic regression was performed to identify factors independently associated with UM. Results: Liver stiffness measurements of 2835 patients were analysed (55% male, median age 51 years [IQR 4160]). The aetiologies of liver disease were hepatitis B (42.7%), hepatitis C (23.7%), nonalcoholic fatty liver disease (7.8%), alcohol (3.4%) and other (22.4%). MF and UM occurred in 3.1% and 19.0%, respectively. Duration, LSM and obesity were independent predictors of UM. The area under the receiver operating curve (AUROC) of duration for diagnosing UM was 0.716 (0.69-0.74) with an optimal cut-off of 3mins 47s (sensitivity 70%, specificity 65%, odds ratio (OR) 4.2[95% CI 2.7-6.6], P 30kg/m2) was an independent predictor of UM (OR 1.9[1.2-3.0], P=0.009). Patients with median LSM falling in the cirrhosis range were more likely to have UM (OR 2.3[1.4-3.9], P=0.002). The majority of these UM (72.7%) were attributed to IQR >30%, indicating higher variability at the upper ranges of LSM. Conclusions: In experienced hands, duration is a strong predictor of UM in patients undergoing TE. Examinations longer than 4 minutes are more likely to be unreliable. Examinations longer than 8 minutes are unlikely to yield a valid result and should be considered a futility endpoint. Obesity and elevated LSM in the cirrhosis range are independent, albeit weaker, predictors of UM. Table1. Duration cut-offs for UM at 90, 95 and 99% specificity

Detection of liver injury in IBD using transient elastography

BackgroundUp to 5% of inflammatory bowel disease (IBD) patients are thought to have clinically significant liver disease due to multifactorial causes, however, this figure may be an underestimate due to reliance on abnormal liver tests (LTs) and/or liver biopsies. AimsOur aim was to evaluate the prevalence of clinically significant liver disease in IBD patients as defined by an increased liver stiffness measurement (LS) ≥8kPa using transient elastography (TE). Methods110 IBD patients, and 55 non-IBD control subjects, had their LS recorded using FibroScan® (EchoSense, Paris, France) by a single blinded operator trained in TE. Results71 Crohn's disease and 39 ulcerative colitis subjects were included. All demographic variables were similar between the IBD and control groups apart from a significantly higher proportion of IBD patients who smoked (17.3% vs 3.6%, P=0.013). Seven IBD patients (6.4%) had an LS over 8kPa and 3 had persistently elevated LS 6months later. One patient had compensated cirrhosis. No significant differences in overall LS were observed between the IBD and control groups. Increased BMI and age, however, were independently associated with a higher LS in the IBD but not in the control group (P<0.001 and 0.010 respectively). ConclusionUsing TE, the prevalence of clinically significant liver disease in IBD patients is low. The association of increased BMI and age with increased LS in IBD suggests fatty liver disease being the prevailing aetiology in these patients.

S13 * NONINVASIVE SCREENING FOR LIVER CIRRHOSIS IN ADDICTIVE PATIENTS * S13.1 * IS LIVER STIFFNESS THE NOVEL GOLD STANDARD TO ASSESS LIVER CIRRHOSIS?

S13 * NONINVASIVE SCREENING FOR LIVER CIRRHOSIS IN ADDICTIVE PATIENTS * S13.1 * IS LIVER STIFFNESS THE NOVEL GOLD STANDARD TO ASSESS LIVER CIRRHOSIS?

Outreach screening of drug users for cirrhosis with transient elastography

Transient elastography (TE) is a non-invasive sensitive tool for diagnosing cirrhosis in hospital-based cohorts. This study aimed to evaluate TE as a screening tool for cirrhosis among drug users. Cross-sectional study. All treatment centres in the county of Funen, Denmark. Drug users attending treatment centres during the presence of the study team. Liver stiffness measurements (LSM) by transient elastography using the Fibroscan device; blood tests for viral hepatitis, HIV infection and hyaluronic acid (HA) levels; and routine liver tests. Individuals with LSM ≥ 8 kPa were referred to the hospital for treatment evaluation. Individuals with LSM ≥ 12 kPa were recommended a liver biopsy. Among 175 drug users negative for hepatitis C, 13% had LSM = 8-11.9 kPa and 4% had LSM ≥ 12 kPa; elevated LSM was associated with a body mass index (BMI) > 30. Among 128 drug users with chronic hepatitis C, 19.5% had LSM = 8-11.9 kPa and 21.1% had LSM ≥ 12 kPa (P < 0.001). Repeat LSM at liver biopsy performed a median 3 months after screening showed a significant decrease (<12 kPa) among 30% (six of 20), and this was independent of alcohol consumption, BMI, age and gender. In 29 patients where liver biopsy was performed a LSM ≥ 16 kPa predicted cirrhosis with 88.9% sensitivity and 90% specificity. Transient elastography is a feasible screening tool for cirrhosis among drug users. Transient elastography identifies severe liver fibrosis in a significant proportion of drug users with hepatitis C infections but management should not be based on a single elevated liver stiffness measurement.