Sivesh K Kamarajah1,2, Wah-Kheong Chan3, Nik Raihan Nik Mustapha4, Sanjiv Mahadeva1. 1. Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. 2. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. 3. Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. wahkheong2003@hotmail.com. 4. Department of Pathology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia.
Abstract
INTRODUCTION: The value of repeated liver stiffness measurement (LSM) in non-alcoholic fatty liver disease (NAFLD) has not been shown before. METHODS: A longitudinal study of biopsy-proven NAFLD patients was conducted at the Asian tertiary hospital from November 2012 to January 2017. Patients with paired liver biopsies and LSM were followed prospectively for liver-related and non-liver related complications, and survival. RESULTS: The data for 113 biopsy-proven NAFLD patients (mean age 51.3 ± 10.6 years, male 50%) were analyzed. At baseline, advanced fibrosis based on histology and LSM was observed in 22 and 46%, respectively. Paired liver biopsy and LSM at 1-year interval was available in 71 and 80% of patients, respectively. High-risk cases (defined as patients with advanced fibrosis at baseline who had no fibrosis improvement, and patients who developed advanced fibrosis on repeat assessment) were seen in 23 and 53% of patients, based on paired liver biopsy and LSM, respectively. Type 2 diabetes mellitus was independently associated with high-risk cases. The median follow-up was 37 months with a total follow-up of 328 person-years. High-risk cases based on paired liver biopsy had significantly higher rates of liver-related complications (p = 0.002) but no difference in other outcomes. High-risk patients based on paired LSM had a significantly higher rate of liver-related complications (p = 0.046), cardiovascular events (p = 0.025) and composite outcomes (p = 0.006). CONCLUSION: Repeat LSM can predict liver-related complications, similar to paired liver biopsy, and may be useful in identifying patients who may be at an increased risk of cardiovascular events. Further studies in a larger cohort and with a longer follow-up should be carried out to confirm these observations.
INTRODUCTION: The value of repeated liver stiffness measurement (LSM) in non-alcoholic fatty liver disease (NAFLD) has not been shown before. METHODS: A longitudinal study of biopsy-proven NAFLD patients was conducted at the Asian tertiary hospital from November 2012 to January 2017. Patients with paired liver biopsies and LSM were followed prospectively for liver-related and non-liver related complications, and survival. RESULTS: The data for 113 biopsy-proven NAFLD patients (mean age 51.3 ± 10.6 years, male 50%) were analyzed. At baseline, advanced fibrosis based on histology and LSM was observed in 22 and 46%, respectively. Paired liver biopsy and LSM at 1-year interval was available in 71 and 80% of patients, respectively. High-risk cases (defined as patients with advanced fibrosis at baseline who had no fibrosis improvement, and patients who developed advanced fibrosis on repeat assessment) were seen in 23 and 53% of patients, based on paired liver biopsy and LSM, respectively. Type 2 diabetes mellitus was independently associated with high-risk cases. The median follow-up was 37 months with a total follow-up of 328 person-years. High-risk cases based on paired liver biopsy had significantly higher rates of liver-related complications (p = 0.002) but no difference in other outcomes. High-risk patients based on paired LSM had a significantly higher rate of liver-related complications (p = 0.046), cardiovascular events (p = 0.025) and composite outcomes (p = 0.006). CONCLUSION: Repeat LSM can predict liver-related complications, similar to paired liver biopsy, and may be useful in identifying patients who may be at an increased risk of cardiovascular events. Further studies in a larger cohort and with a longer follow-up should be carried out to confirm these observations.
Authors: Raymond Kwok; Kai Chow Choi; Grace Lai-Hung Wong; Yuying Zhang; Henry Lik-Yuen Chan; Andrea On-Yan Luk; Sally She-Ting Shu; Anthony Wing-Hung Chan; Ming-Wai Yeung; Juliana Chung-Ngor Chan; Alice Pik-Shan Kong; Vincent Wai-Sun Wong Journal: Gut Date: 2015-04-14 Impact factor: 23.059
Authors: Thomas Karlas; David Petroff; Magali Sasso; Jian-Gao Fan; Yu-Qiang Mi; Victor de Lédinghen; Manoj Kumar; Monica Lupsor-Platon; Kwang-Hyub Han; Ana C Cardoso; Giovanna Ferraioli; Wah-Kheong Chan; Vincent Wai-Sun Wong; Robert P Myers; Kazuaki Chayama; Mireen Friedrich-Rust; Michel Beaugrand; Feng Shen; Jean-Baptiste Hiriart; Shiv K Sarin; Radu Badea; Kyu Sik Jung; Patrick Marcellin; Carlo Filice; Sanjiv Mahadeva; Grace Lai-Hung Wong; Pam Crotty; Keiichi Masaki; Joerg Bojunga; Pierre Bedossa; Volker Keim; Johannes Wiegand Journal: J Hepatol Date: 2016-12-28 Impact factor: 25.083
Authors: Robert J Wong; Maria Aguilar; Ramsey Cheung; Ryan B Perumpail; Stephen A Harrison; Zobair M Younossi; Aijaz Ahmed Journal: Gastroenterology Date: 2014-11-25 Impact factor: 22.682
Authors: David E Kleiner; Elizabeth M Brunt; Mark Van Natta; Cynthia Behling; Melissa J Contos; Oscar W Cummings; Linda D Ferrell; Yao-Chang Liu; Michael S Torbenson; Aynur Unalp-Arida; Matthew Yeh; Arthur J McCullough; Arun J Sanyal Journal: Hepatology Date: 2005-06 Impact factor: 17.425
Authors: Max M Puthenpura; Vishal Patel; John Fam; Leon Katz; David S Tichansky; Stephan Myers Journal: Obes Surg Date: 2020-09-26 Impact factor: 4.129
Authors: Semanti Chakraborty; Mohd Ashraf Ganie; Ibrahim Masoodi; Manisha Jana; Nandita Gupta; Nighat Yaseen Sofi Journal: Indian J Med Res Date: 2020-04 Impact factor: 2.375