- Email: [email protected]
Transient Elastography and Combination of Fibrotest® and Transient Elastography for Diagnosis of Advanced Fibrosis and Cirrhosis in Patients with Alcoholic Liver Disease: A Prospective Multicenter Cohort Study
POSTER PRESENTATIONS Conclusions: In the U.S. population, intermediate to high liver fibrosis probability using APRI was associated with increased mortality from liver disease, cancer, and all-causes, but was not associated with cardiovascular disease or diabetes mortality. SAT-433 TRANSIENT ELASTOGRAPHY IS SUPERIOR TO FIB-4 IN ASSESSING THE RISK OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CHRONIC HEPATITIS B B.K. Kim1, S.U. Kim1, J.Y. Park1, D.Y. Kim1, S.H. Ahn1, K. Song2, K.H. Han1. 1Internal Medicine; 2Biostatistics, Yonsei University College of Medicine, Seoul, South Korea E-mail: [email protected] Background and Aims: Liver stiffness (LS), assessed using transient elastography (TE), and FIB-4 can both estimate the risk of developing hepatocellular carcinoma (HCC). We compared prognostic performances of LS and FIB-4 to predict HCC development in patients with chronic hepatitis B (CHB). Methods: Data from 1,308 patients with CHB, who underwent TE, were retrospectively analyzed. FIB-4 was calculated for all patients. The cumulative rate of HCC development was assessed using KaplanMeier curves. The predictive performances of LS and FIB-4 were evaluated using time-dependent receiver-operating characteristic (ROC) curves. Results: The mean age (883 men) was 50 years. During follow-up (median 6.1 years), 119 patients developed HCC. The area under the ROC curves (AUROCs) predicting HCC risk at 3, 5, and 7 years were consistently greater for LS than for FIB-4 (0.791∼0.807 vs. 0.691∼0.725; all p < 0.05). Similarly, when the respective AUROCs for LS and FIB-4 at every time point during the 7-year follow-up were plotted, LS also showed consistently better performance than FIB-4 after 1 year of enrollment. The combined use of LS and FIB-4 significantly enhanced the prognostic performance compared with the use of FIB-4 alone ( p < 0.05), but the performance of the combined scores was statistically similar to that of LS alone ( p > 0.05). Conclusions: LS showed significantly better performance than FIB-4 in assessing the risk of HCC development, and the combined use of LS and FIB-4 did not provide additional benefit compared with the use of LS alone. Hence, LS assessed using TE might be helpful for optimizing HCC surveillance strategies. SAT-434 ALGORITHM TO RULE-OUT CLINICALLY SIGNIFICANT PORTAL HYPERTENSION COMBINING SHEAR-WAVE ELASTOGRAPHY OF LIVER AND SPLEEN: A PROSPECTIVE MULTI-CENTER STUDY C. Jansen1, C.K.-P. Bogs1, W. Verlinden2, M. Thiele3, P. Moeller1, J. Goertzen1, J. Lehmann1, M. Praktiknjo1, J. Chang 1, A. Krag3, C. Strassburg1, S. Franque4, J. Trebicka1,3. 1Department of Internal Medicine I, University of Bonn, Bonn, Germany; 2Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium; 3Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; 4Department of Internal Medicine I, University Hospital Antwerp, Antwerp, Belgium E-mail: [email protected] Background and Aims: Clinically significant portal hypertension (CSPH) is associated with severe complications and decompensation. Shear-wave elastography (SWE) of the liver might be a promising tool to predict CSPH. Spleen stiffness by transient elastography (TE) is another tool to detect CSPH. However, the value of spleen-SWE (SSWE) is still uncertain. Methods: 158 patients with pressure gradient measurements were included into this prospective multicenter study. Liver stiffness by SWE was obtained in 155 patients. Spleen stiffness by SWE was measured in 112 patients. Among these patients 109 received both measurements.
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Results: SWE (L-SWE) and S-SWE correlated with clinical events and decompensation (Child, MELD Score, ascites). SWE of liver and spleen revealed strong correlations with the pressure gradient with a great ability to distinguish between patients with and without CSPH (AUC = 0.861 for L-SWE and AUC = 0.837 for S-SWE), as well as for pressure gradients >5 mmHg and >12 mmHg. The best cut-off values regarding sensitivity and specificity were 24.6 kPa for L-SWE and 26.3 kPa for S-SWE. L-SWE < 16.0 kPa and S-SWE <26.6 kPa were able to rule-out CSPH. Cut-off values of L-SWE >29.5 kPa and S-SWE >35.6 kPa were able to rule-in CSPH. Furthermore, in patients with LSWE <16.0 kPa, S-SWE was useful to identify CSPH and by sequential use, sensitivity was raised up to 98.6%. Conclusions: SWE accurately identified patients with clinical decompensation of liver cirrhosis. Moreover, spleen stiffness by SWE is also useful to predict CSPH. Importantly, this study offers an easy algorithm to rule-out CSPH by using sequential L- and S-SWE. SAT-435 TRANSIENT ELASTOGRAPHY AND COMBINATION OF FIBROTEST® AND TRANSIENT ELASTOGRAPHY FOR DIAGNOSIS OF ADVANCED FIBROSIS AND CIRRHOSIS IN PATIENTS WITH ALCOHOLIC LIVER DISEASE: A PROSPECTIVE MULTICENTER COHORT STUDY C.S. Voican1, A. Louvet2, J.-B. Trabut3, M. Njiké-Nakseu1, S. Dharancy4, A. Sanchez5, M. Corouge6, K. Lamouri1, A. Lebrun1, A. Balian1, S. Prévot7, M. Lachgar8, S. Maitre9, H. Agostini10, P. Mathurin4, G. Perlemuter1, S. Naveau1. 1Service d’hépato-gastroentérologie et nutrition, Hôpital Antoine Bécler̀ e, Clamart; 2Service des Maladies de l’Appareil Digestif, Hôpital Claude Huriez, Lille; 3Unité d’Hépatologie et d’Addictologie, Groupe Hospitalier Cochin Saint-Vincent de Paul, Paris; 4 Service des Maladies de l’Appareil Digestif, Hôpital Claude Huriez, Lille; 5 Service d’Anatomo-pathologie; 6Département d’Hépatologie, Groupe Hospitalier Cochin Saint-Vincent de Paul, Paris; 7Service d’Anatomie pathologique; 8Service de Biochimie-Hormonologie; 9Service de Radiologie, Hôpital Antoine Bécler̀ e, Clamart; 10Unité de recherche clinique Paris-Sud, Hôpital Bicêtre, Kremlin-Bicêtre, France E-mail: [email protected]
Journal of Hepatology 2016 vol. 64 | S631–S832
POSTER PRESENTATIONS Background and Aims: Utility of transient elastography (TE) to assess liver fibrosis is insufficiently proved in alcoholic liver disease. Therefore, liver biopsy (LB) remains the gold standard for evaluation of hepatic fibrosis in these patients. The goal of our study is to validate the diagnostic utility of TE for advanced fibrosis and cirrhosis in patients with alcohol liver disease, and evaluate whether Fibrotest® add diagnostic value in comparison or in combination with TE. Methods: We conducted a multicentre prospective cohort study including a total of 217 patients with heavy alcohol consumption (≥80 g/day over a period ≥5 years) and indication for LB examination (high serum aminotransferase levels or suspected cirrhosis) admitted due to alcoholism and alcoholic liver disease. The exclusion criteria were: concomitant liver disease, contraindication or refusal of LB, severe associated disease and body mass index ≥30 Kg/m2. All patients underwent ultrasound-guided LB, TE and Fibrotest®. The overall diagnostic performance was evaluated by the area under the receiver operating characteristic (ROC) curves. The Obuchowski measures were also assessed taking into account the distribution of fibrosis stages in the cohort. Results: Twenty-four patients were excluded due to unsuitable LB (specimen length <10 mm and number of portal spaces <10) or unreliable TE. A total of 193 patients were considered for the analysis. Distribution of patients according to liver fibrosis stage (BruntKleiner classification) was homogenous: F0: 24%, F1: 16%, F2: 20%, F3: 25% and F4: 15%. Liver stiffness measurement was correlated to fibrosis stage (r = 0.73; p < 0.0001), presence of alcoholic hepatitis (r = 0.61; p < 0.0001) and steatosis stage (r = 0.19; p < 0.01). In multivariate analysis, fibrosis stage and presence of alcoholic hepatitis were the only parameters correlated with liver stiffness. For diagnosis of advanced fibrosis (F ≥ 3), the areas under the ROC curve were 0.90, 0.85 and 0.91 for TE, Fibrotest® and association TEFibrotest® respectively. For diagnosis of cirrhosis, the areas under the ROC curve were 0.93, 0.88 and 0.94 respectively. The Obuchowski measures for diagnosis of fibrosis were 0.94, 0.92 and 0.94 respectively. Performances of Fibrotest® and combination TEFibrotest® were not significantly different from those of TE. Conclusions: TE has an excellent diagnostic value for cirrhosis and advanced fibrosis in patients with alcoholic liver disease. The combined use of TE and Fibrotest® does not improve the performance of TE. SAT-436 LIVER STIFFNESS MEASURED BY ACOUSTIC RADIATION FORCE IMPULSE QUANTIFICATION IN PRIMARY SCLEROSING CHOLANGITIS: A COMPARISON WITH TRANSIENT ELASTOGRAPHY PERFORMED BY FIBROSCAN® AND OTHER NON-INVASIVE TESTS D. Roccarina1,2, F. Saffioti1,3, M. Rosselli1, M. Pinzani1, A. Marshall1, D. Thorburn1. 1Sheila Sherlock Liver Centre, Royal Free London, NHS Foundation Trust and UCL Institute for Liver and Digestive Health, University College London, London, United Kingdom; 2Division of Internal Medicine and Gastroenterology, Institute of Medical Pathology, Università Cattolica del Sacro Cuore, Rome; 3Department of Clinical and Experimental Medicine, Division of Clinical and Molecular Hepatology, University of Messina, Messina, Italy E-mail: [email protected] Background and Aims: Stratifiers of disease severity and prognosis in PSC are required. Recent data highlight the utility of non-invasive assessments of liver fibrosis by F-TE for staging and prognostication in PSC. Thus far there has been no direct comparison of acoustic radiation force impluse quantification (ARFI) and Fibroscan® (F-TE) in Primary sclerising cholangitis (PSC). Our aim was to evaluate ARFI performance in a cohort of UK patients affected by PSC and its correlations with F-TE and the currently available clinical scores of fibrosis. Methods: Demographics, biochemistry, clinical and ultrasonographic data, were prospectively collected in 66 PSC patients [39(59%) male, 7 (10.6%) small duct, 15(23%) autoimmune overlap, 18(27%) cirrhotic]
consecutively attending our clinic (Nov 2014–2015). F-TE (Fibroscan®, Echosens (10 valid measurements, IQR <30%, SR>60%) and ARFI (Affinity 70G Philips, median kPa of 10 measurements) were performed on the day of the visit, after 3 hrs fasting. The most commonly used clinical scores of disease/fibrosis severity were obtained on the day of assessment. Correlations of F-TE and ARFI with scores and clinical variables were investigated. Since histology was not available for the majority of patients, liver stifness (LS) measured by Fibroscan was used as a surrogate of liver fibrosis, using the cutoffs recently validated in PSC (7.4, 8.6, 9.6 and 14.4 kPa for fibrosis stages F1, F2, F3, and F4, respectively). ROC curve analysis was performed in order to define optimal cutoff values for ARFI.
Results: F-TE and ARFI values were significantly correlated ( p < 0.0001). LS obtained with both the techniques significantly correlated with portal hypertension, splenomegaly, presence of oesophageal varices, cholestasis and inflammation, Mayo risk and MELD score, APRI, FIB-4, Fibroindex, Gotebörg University Cirrhosis Index (GUCI) and King’s score ( p < 0.0001), FibroQ and Lok index ( p < 001) but not with AST/ALT ratio. Areas under curves (95%CI) for ARFI were 0.91(0.84–0.99), 0.95(0.89– 1), 0.99(0.97–1) and 0.97(0.94–1) for fibrosis stage ≥1, ≥2, ≥3 and =4, respectively. Optimal cutoff values for F ≥ 1, F ≥ 2, F ≥ 3, F = 4 were 7 (89% sens, 82% spec), 8 (96% sens, 87% spec), 10.6 (100% sens, 93% spec) and 14.5 kPa (93% sens, 94% spec), respectively. Conclusions: ARFI correlated well with Fibroscan and other noninvasive assessments of liver fibrosis/disease stage in this cohort of PSC patients. This novel preliminary data suggests a role for ARFI in staging and monitoring progression in PSC and identifies an optimal sensitivity and specifity in detecting significant fibrosis (F ≥ 3) with a cut off of 10.6 kPa. SAT-437 TRUE COLLAGEN TYPE III FORMATION (PRO-C3) IS PREDICTIVE OF OUTCOME IN HCV PATIENTS WITH ADVANCED LIVER FIBROSIS WITHIN THE TRENT STUDY D.J. Leeming1, G. Dolman2, M.J. Nielsen1, M.A. Karsdal1, K. Patel3, W. Irving2, I.N. Guha2. 1Fibrosis Biology and Biomarkers, Nordic Bioscience, Herlev, Denmark; 2Biomedical Research Unit, NIHR Nottingham Digestive Diseases, Nottingham, United Kingdom; 3 University of Toronto, Toronto, Canada E-mail: [email protected] Background and Aims: Prediction of clinical outcome is important in the management of patients with advanced liver fibrosis, yet there is limited data on performance of biomarkers in predicting clinical
Journal of Hepatology 2016 vol. 64 | S631–S832
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Results: SWE (L-SWE) and S-SWE correlated with clinical events and decompensation (Child, MELD Score, ascites). SWE of liver and spleen revealed strong correlations with the pressure gradient with a great ability to distinguish between patients with and without CSPH (AUC = 0.861 for L-SWE and AUC = 0.837 for S-SWE), as well as for pressure gradients >5 mmHg and >12 mmHg. The best cut-off values regarding sensitivity and specificity were 24.6 kPa for L-SWE and 26.3 kPa for S-SWE. L-SWE < 16.0 kPa and S-SWE <26.6 kPa were able to rule-out CSPH. Cut-off values of L-SWE >29.5 kPa and S-SWE >35.6 kPa were able to rule-in CSPH. Furthermore, in patients with LSWE <16.0 kPa, S-SWE was useful to identify CSPH and by sequential use, sensitivity was raised up to 98.6%. Conclusions: SWE accurately identified patients with clinical decompensation of liver cirrhosis. Moreover, spleen stiffness by SWE is also useful to predict CSPH. Importantly, this study offers an easy algorithm to rule-out CSPH by using sequential L- and S-SWE. SAT-435 TRANSIENT ELASTOGRAPHY AND COMBINATION OF FIBROTEST® AND TRANSIENT ELASTOGRAPHY FOR DIAGNOSIS OF ADVANCED FIBROSIS AND CIRRHOSIS IN PATIENTS WITH ALCOHOLIC LIVER DISEASE: A PROSPECTIVE MULTICENTER COHORT STUDY C.S. Voican1, A. Louvet2, J.-B. Trabut3, M. Njiké-Nakseu1, S. Dharancy4, A. Sanchez5, M. Corouge6, K. Lamouri1, A. Lebrun1, A. Balian1, S. Prévot7, M. Lachgar8, S. Maitre9, H. Agostini10, P. Mathurin4, G. Perlemuter1, S. Naveau1. 1Service d’hépato-gastroentérologie et nutrition, Hôpital Antoine Bécler̀ e, Clamart; 2Service des Maladies de l’Appareil Digestif, Hôpital Claude Huriez, Lille; 3Unité d’Hépatologie et d’Addictologie, Groupe Hospitalier Cochin Saint-Vincent de Paul, Paris; 4 Service des Maladies de l’Appareil Digestif, Hôpital Claude Huriez, Lille; 5 Service d’Anatomo-pathologie; 6Département d’Hépatologie, Groupe Hospitalier Cochin Saint-Vincent de Paul, Paris; 7Service d’Anatomie pathologique; 8Service de Biochimie-Hormonologie; 9Service de Radiologie, Hôpital Antoine Bécler̀ e, Clamart; 10Unité de recherche clinique Paris-Sud, Hôpital Bicêtre, Kremlin-Bicêtre, France E-mail: [email protected]
Journal of Hepatology 2016 vol. 64 | S631–S832
POSTER PRESENTATIONS Background and Aims: Utility of transient elastography (TE) to assess liver fibrosis is insufficiently proved in alcoholic liver disease. Therefore, liver biopsy (LB) remains the gold standard for evaluation of hepatic fibrosis in these patients. The goal of our study is to validate the diagnostic utility of TE for advanced fibrosis and cirrhosis in patients with alcohol liver disease, and evaluate whether Fibrotest® add diagnostic value in comparison or in combination with TE. Methods: We conducted a multicentre prospective cohort study including a total of 217 patients with heavy alcohol consumption (≥80 g/day over a period ≥5 years) and indication for LB examination (high serum aminotransferase levels or suspected cirrhosis) admitted due to alcoholism and alcoholic liver disease. The exclusion criteria were: concomitant liver disease, contraindication or refusal of LB, severe associated disease and body mass index ≥30 Kg/m2. All patients underwent ultrasound-guided LB, TE and Fibrotest®. The overall diagnostic performance was evaluated by the area under the receiver operating characteristic (ROC) curves. The Obuchowski measures were also assessed taking into account the distribution of fibrosis stages in the cohort. Results: Twenty-four patients were excluded due to unsuitable LB (specimen length <10 mm and number of portal spaces <10) or unreliable TE. A total of 193 patients were considered for the analysis. Distribution of patients according to liver fibrosis stage (BruntKleiner classification) was homogenous: F0: 24%, F1: 16%, F2: 20%, F3: 25% and F4: 15%. Liver stiffness measurement was correlated to fibrosis stage (r = 0.73; p < 0.0001), presence of alcoholic hepatitis (r = 0.61; p < 0.0001) and steatosis stage (r = 0.19; p < 0.01). In multivariate analysis, fibrosis stage and presence of alcoholic hepatitis were the only parameters correlated with liver stiffness. For diagnosis of advanced fibrosis (F ≥ 3), the areas under the ROC curve were 0.90, 0.85 and 0.91 for TE, Fibrotest® and association TEFibrotest® respectively. For diagnosis of cirrhosis, the areas under the ROC curve were 0.93, 0.88 and 0.94 respectively. The Obuchowski measures for diagnosis of fibrosis were 0.94, 0.92 and 0.94 respectively. Performances of Fibrotest® and combination TEFibrotest® were not significantly different from those of TE. Conclusions: TE has an excellent diagnostic value for cirrhosis and advanced fibrosis in patients with alcoholic liver disease. The combined use of TE and Fibrotest® does not improve the performance of TE. SAT-436 LIVER STIFFNESS MEASURED BY ACOUSTIC RADIATION FORCE IMPULSE QUANTIFICATION IN PRIMARY SCLEROSING CHOLANGITIS: A COMPARISON WITH TRANSIENT ELASTOGRAPHY PERFORMED BY FIBROSCAN® AND OTHER NON-INVASIVE TESTS D. Roccarina1,2, F. Saffioti1,3, M. Rosselli1, M. Pinzani1, A. Marshall1, D. Thorburn1. 1Sheila Sherlock Liver Centre, Royal Free London, NHS Foundation Trust and UCL Institute for Liver and Digestive Health, University College London, London, United Kingdom; 2Division of Internal Medicine and Gastroenterology, Institute of Medical Pathology, Università Cattolica del Sacro Cuore, Rome; 3Department of Clinical and Experimental Medicine, Division of Clinical and Molecular Hepatology, University of Messina, Messina, Italy E-mail: [email protected] Background and Aims: Stratifiers of disease severity and prognosis in PSC are required. Recent data highlight the utility of non-invasive assessments of liver fibrosis by F-TE for staging and prognostication in PSC. Thus far there has been no direct comparison of acoustic radiation force impluse quantification (ARFI) and Fibroscan® (F-TE) in Primary sclerising cholangitis (PSC). Our aim was to evaluate ARFI performance in a cohort of UK patients affected by PSC and its correlations with F-TE and the currently available clinical scores of fibrosis. Methods: Demographics, biochemistry, clinical and ultrasonographic data, were prospectively collected in 66 PSC patients [39(59%) male, 7 (10.6%) small duct, 15(23%) autoimmune overlap, 18(27%) cirrhotic]
consecutively attending our clinic (Nov 2014–2015). F-TE (Fibroscan®, Echosens (10 valid measurements, IQR <30%, SR>60%) and ARFI (Affinity 70G Philips, median kPa of 10 measurements) were performed on the day of the visit, after 3 hrs fasting. The most commonly used clinical scores of disease/fibrosis severity were obtained on the day of assessment. Correlations of F-TE and ARFI with scores and clinical variables were investigated. Since histology was not available for the majority of patients, liver stifness (LS) measured by Fibroscan was used as a surrogate of liver fibrosis, using the cutoffs recently validated in PSC (7.4, 8.6, 9.6 and 14.4 kPa for fibrosis stages F1, F2, F3, and F4, respectively). ROC curve analysis was performed in order to define optimal cutoff values for ARFI.
Results: F-TE and ARFI values were significantly correlated ( p < 0.0001). LS obtained with both the techniques significantly correlated with portal hypertension, splenomegaly, presence of oesophageal varices, cholestasis and inflammation, Mayo risk and MELD score, APRI, FIB-4, Fibroindex, Gotebörg University Cirrhosis Index (GUCI) and King’s score ( p < 0.0001), FibroQ and Lok index ( p < 001) but not with AST/ALT ratio. Areas under curves (95%CI) for ARFI were 0.91(0.84–0.99), 0.95(0.89– 1), 0.99(0.97–1) and 0.97(0.94–1) for fibrosis stage ≥1, ≥2, ≥3 and =4, respectively. Optimal cutoff values for F ≥ 1, F ≥ 2, F ≥ 3, F = 4 were 7 (89% sens, 82% spec), 8 (96% sens, 87% spec), 10.6 (100% sens, 93% spec) and 14.5 kPa (93% sens, 94% spec), respectively. Conclusions: ARFI correlated well with Fibroscan and other noninvasive assessments of liver fibrosis/disease stage in this cohort of PSC patients. This novel preliminary data suggests a role for ARFI in staging and monitoring progression in PSC and identifies an optimal sensitivity and specifity in detecting significant fibrosis (F ≥ 3) with a cut off of 10.6 kPa. SAT-437 TRUE COLLAGEN TYPE III FORMATION (PRO-C3) IS PREDICTIVE OF OUTCOME IN HCV PATIENTS WITH ADVANCED LIVER FIBROSIS WITHIN THE TRENT STUDY D.J. Leeming1, G. Dolman2, M.J. Nielsen1, M.A. Karsdal1, K. Patel3, W. Irving2, I.N. Guha2. 1Fibrosis Biology and Biomarkers, Nordic Bioscience, Herlev, Denmark; 2Biomedical Research Unit, NIHR Nottingham Digestive Diseases, Nottingham, United Kingdom; 3 University of Toronto, Toronto, Canada E-mail: [email protected] Background and Aims: Prediction of clinical outcome is important in the management of patients with advanced liver fibrosis, yet there is limited data on performance of biomarkers in predicting clinical
Journal of Hepatology 2016 vol. 64 | S631–S832
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