Authors
Jonel Trebicka; Wenyi Gu; Victor de Ledinghen; Christophe Aubé; Aleksander Krag; Michael Praktiknjo; Laurent Castera; Jérôme Dumortier; David Bauer; Mireen Friedrich-Rust; Stanislas Pol; Ivica Grgurević; Rongqin Zheng; Sven Francque; Halima Gottfriedová; Sanda Mustapic; Ioan Sporea; Annalisa Berzigotti; Frank Erhard Uschner; Benedikt Simbrunner; Maxime Ronot; Christophe Cassinotto; Maria Kjærgaard; Filipe Andrade; Martin Schulz; Georg Semmler; Ida Tjesic Drinkovic; Johannes Chang; Maximilian J. Brol; Pierre-Emmanuel Rautou; Thomas Vanwolleghem; Christian P. Strassburg; Jérôme Boursier; Philip G. Ferstl; Ditlev Nytoft Rasmussen; Thomas Reiberger; Valérie Vilgrain; Aymeric Guibal; Olivier Guillaud; Stefan Zeuzem; Camille Vassord; Xue Lu; Luisa Vonghia; Renata Senkerikova; Alina Popescu; Cristina Margini; Wen-Ping Wang; Maja Thiele; Chrisitan Jansen
Abstract
Objective
Liver 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.
Design
This 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.
Results
After 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.
Conclusion
The 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.