- Email: [email protected]
Clinical and prognostic associations of liver volume determined using computed tomography in patients with cirrhosis
POSTER PRESENTATIONS Results: 62 patients were found to have no steatosis (grade 0) while 27 were found to have steatosis (12 with grade 1, 6 with grade 2, and 9 with grade 3). LIC values ranged from 0.3 to 42.7 mg Fe/g dw for patients without steatosis and from 0.3 to 24.5 mg Fe/g dw for patients with steatosis. The mean differences (biases) between LIC measured by SDPA R2-MRI and chemical assay of biopsy were not significantly different from zero (−3 ± SE 4% for the patients without steatosis and 8 ± SE 8% for the patients with steatosis) and were not significantly different from each other ( p = 0.22). Data are shown in Figure 1. Conclusions: Unlike T2*/R2* methods, SDPA R2-MRI measurement of LIC is not confounded by the presence of liver steatosis. SDPA R2-MRI may be particularly suited to assessing transfusional iron overload in cancer survivors where liver steatosis owing to chemotherapy is commonly encountered in conjunction with liver siderosis. SAT-501 Clinical and prognostic associations of liver volume determined using computed tomography in patients with cirrhosis T.Y. Lim1, S. Brown1, S.-L. Kelly1, P. Peddu1, P. Kane1, J. Karani2, N. Heaton1, W. Bernal1. 1Institute of Liver Studies; 2Institute of Live Studies, King’s College Hospital, London, United Kingdom E-mail: [email protected] Background and Aims: Liver volume can be easily determined utilising computed tomography (CT) analysis and may parallel the degree of compromise of liver function. Its relation to the nature and severity of cirrhotic chronic liver disease (CLD) is poorly defined, as are its prognostic implications. In a cohort of patients with CLD we assessed the clinical associations and prognostic utility of liver volume determined in this way. Methods: 250 patients with CLD undergoing liver transplantation (LT) assessment over 4 year period in a single centre were studied. Liver Volume on CT was determined from 5 mm axial sections using Volume Viewer (GE Healthcare) and standard methodology. Predicted liver volume (PLV) was determined using the method of Kokudo et al. (J Hep 64(4)848–54, 2015). Association of volume and proportion of PLV with etiology and presentation, laboratory findings and non-transplanted survival was assessed. Statistical analysis utilised non-parametric testing and Kaplan-Meier (KM) and Cox regression survival analysis; data is presented as median (interquartile range) or n (%). Results: Median age was 56 years (47–62) and 72 (29%) were female. At time of CT, MELD was 13 (9–18). Etiology of cirrhosis was alcohol (ALD) in 35%, viral in 29%, immune (AI) in 13%, NASH in 10% and other causes in 13%. 71 (28%) had hepatocellular carcinoma (HCC). Median follow-up was 503 (302–678) days during which time 102 (41%) underwent LT and 45 (18%) died. Median liver volume was 1353 cm3 (1097–1767), 77% (63–10) of PLV (PLV%). Both measures did not vary signficantly by etiology. Volume was larger in patients with HCC by median 94 cm3. Liver volume correlated with albumin (r = 0.246, p < 0.001) and inversely with INR (r = −0.226, p < 0.001) and weakly with MELD (r = −0.125 p = 0.05). Liver volume of <50% PLV was associated with LT indications of synthetic failure ( p < 0.001) and Encephalopathy ( p < 0.01) and approached significance in relation to reduced non-transplanted survival (KM Log-rank p < 0.12). Conclusions: Using CT-analysis of liver volume we found the majority of patients with cirrhosis undergoing LT assessment to have decreased liver volume that was associated with encephalopathy and measures of synthetic failure. In patients assessed for and waitlisted for LT, decreased liver volume was only weakly associated with impaired non-transplanted mortality and is unlikely to serve as an additional prognostic maker.
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SAT-502 Serum Wisteria floribunda agglutinin-positive Mac-2 binding protein as a serum biomarker for disease severity in nonalcoholic fatty liver disease L.L. Lai1, W.K. Chan1, P. Sthaneshwar2, N.R.N. Mustapha3, K.L. Goh1, S. Mahadeva1. 1Department of Medicine; 2Department of Pathology, University of Malaya, Kuala Lumpur; 3Department of Pathology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia E-mail: [email protected] Background and Aims: Wisteria floribunda agglutinin-positive Mac2 binding protein (WFA+-M2BP) has been suggested to be useful for the assessment of disease severity in non-alcoholic fatty liver disease (NAFLD). We aimed to evaluate its usefulness for the diagnosis of non-alcoholic steatohepatitis (NASH) and fibrosis stage in NAFLD patients, and for follow-up of NASH patients after a period of intervention Methods: Consecutive adult NAFLD patients who had a liver biopsy were included. Serum WFA+-M2BP level was measured using a lectinantibody sandwich immunoassay using a chemiluminescence enzyme immunoassay machine (HISCL-5000, Sysmex, Kobe, Japan). The measured levels were indexed using the following equation: COI = ([WFA+-M2BP]sample – [WFA+-M2BP]NC) / ([WFA+M2BP]PC – [WFA+-M2BP]NC), where PC = positive control and NC = negative control. Histopathological examination of liver biopsy specimen was reported according to NASH Clinical Research Network Scoring System. Results: Data for 220 cases were analyzed (mean age 50.1 ± 11.5 years, 51.8% male). The study population consisted of 72.7% NASH patients. The distribution of fibrosis stages was as follows: F0, 32.3%; F1, 40.9%; F2, 7.3%; F3, 16.4%; F4, 3.2%. The COI was significantly higher in NASH patients compared with non-NASH patients (0.60 vs.0.50, p = 0.001). The AUROC of the COI for the diagnosis of NASH was 0.65. The COI was significantly different across the fibrosis stages (F0, 0.46; F1, 0.57; F2, 0.64; F3, 0.69; F4, 0.91, p = 0.000). The AUROC of the COI for F0 vs. F1F2F3F4, F0F1 vs. F2F3F4, F0F1F2 vs. F3F4 and F0F1F2F3 vs. F4 was 0.61, 0.71, 0.74 and 0.84, respectively. Out of the 220 cases, 154 cases were the same 77 NASH patients who had a repeat liver biopsy after 48 weeks of intervention. The AUROC of the change in the COI to detect improvement in steatosis, lobular inflammation, hepatocyte ballooning and fibrosis, and for histological improvement was 0.57, 0.54, 0.59, 0.52 and 0.63, respectively. The AUROC of the percentage of change in the COI to detect improvement in steatosis, lobular inflammation, hepatocyte ballooning and fibrosis, and for histological improvement was 0.55, 0.59, 0.58, 0.55 and 0.60, respectively. Conclusions: Serum WFA+-M2BP was most useful for the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis in NAFLD patients. However, it was less useful for differentiating NASH from non-NASH, and for diagnosis and follow-up of the individual histopathological components of NASH. SAT-503 Collagen formation and degradation biomarkers identify advanced fibrosis in NASH patients Y. Luo1, E.D. Charles1, R. Vincent2, R. Gagnon1, A. Oseini2, B. Banini2, F. Mirshahi2, K. Daita2, R. Christian1, A. Sanyal2. 1Bristol-Myers Squibb, Princeton, NJ; 2Virginia Commonwealth University, Richmond, VA, United States E-mail: [email protected] Background and Aims: Novel non-invasive biomarkers are needed to identify patients at high risk for non-alcoholic steatohepatitis (NASH). Liver fibrosis stage, as assessed by liver biopsy histology, correlates with liver-related clinical outcomes in NASH; however, liver biopsy is invasive and imprecise. Fibrosis reflects the accumulation of collagen, which is likely due to the net excess of formation compared to degradation. We aimed to compare a panel of collagen formation and degradation biomarkers with liver fibrosis stage and with NAFLD Activity Score (NAS) in NASH patients.
Journal of Hepatology 2017 vol. 66 | S543–S750
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SAT-502 Serum Wisteria floribunda agglutinin-positive Mac-2 binding protein as a serum biomarker for disease severity in nonalcoholic fatty liver disease L.L. Lai1, W.K. Chan1, P. Sthaneshwar2, N.R.N. Mustapha3, K.L. Goh1, S. Mahadeva1. 1Department of Medicine; 2Department of Pathology, University of Malaya, Kuala Lumpur; 3Department of Pathology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia E-mail: [email protected] Background and Aims: Wisteria floribunda agglutinin-positive Mac2 binding protein (WFA+-M2BP) has been suggested to be useful for the assessment of disease severity in non-alcoholic fatty liver disease (NAFLD). We aimed to evaluate its usefulness for the diagnosis of non-alcoholic steatohepatitis (NASH) and fibrosis stage in NAFLD patients, and for follow-up of NASH patients after a period of intervention Methods: Consecutive adult NAFLD patients who had a liver biopsy were included. Serum WFA+-M2BP level was measured using a lectinantibody sandwich immunoassay using a chemiluminescence enzyme immunoassay machine (HISCL-5000, Sysmex, Kobe, Japan). The measured levels were indexed using the following equation: COI = ([WFA+-M2BP]sample – [WFA+-M2BP]NC) / ([WFA+M2BP]PC – [WFA+-M2BP]NC), where PC = positive control and NC = negative control. Histopathological examination of liver biopsy specimen was reported according to NASH Clinical Research Network Scoring System. Results: Data for 220 cases were analyzed (mean age 50.1 ± 11.5 years, 51.8% male). The study population consisted of 72.7% NASH patients. The distribution of fibrosis stages was as follows: F0, 32.3%; F1, 40.9%; F2, 7.3%; F3, 16.4%; F4, 3.2%. The COI was significantly higher in NASH patients compared with non-NASH patients (0.60 vs.0.50, p = 0.001). The AUROC of the COI for the diagnosis of NASH was 0.65. The COI was significantly different across the fibrosis stages (F0, 0.46; F1, 0.57; F2, 0.64; F3, 0.69; F4, 0.91, p = 0.000). The AUROC of the COI for F0 vs. F1F2F3F4, F0F1 vs. F2F3F4, F0F1F2 vs. F3F4 and F0F1F2F3 vs. F4 was 0.61, 0.71, 0.74 and 0.84, respectively. Out of the 220 cases, 154 cases were the same 77 NASH patients who had a repeat liver biopsy after 48 weeks of intervention. The AUROC of the change in the COI to detect improvement in steatosis, lobular inflammation, hepatocyte ballooning and fibrosis, and for histological improvement was 0.57, 0.54, 0.59, 0.52 and 0.63, respectively. The AUROC of the percentage of change in the COI to detect improvement in steatosis, lobular inflammation, hepatocyte ballooning and fibrosis, and for histological improvement was 0.55, 0.59, 0.58, 0.55 and 0.60, respectively. Conclusions: Serum WFA+-M2BP was most useful for the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis in NAFLD patients. However, it was less useful for differentiating NASH from non-NASH, and for diagnosis and follow-up of the individual histopathological components of NASH. SAT-503 Collagen formation and degradation biomarkers identify advanced fibrosis in NASH patients Y. Luo1, E.D. Charles1, R. Vincent2, R. Gagnon1, A. Oseini2, B. Banini2, F. Mirshahi2, K. Daita2, R. Christian1, A. Sanyal2. 1Bristol-Myers Squibb, Princeton, NJ; 2Virginia Commonwealth University, Richmond, VA, United States E-mail: [email protected] Background and Aims: Novel non-invasive biomarkers are needed to identify patients at high risk for non-alcoholic steatohepatitis (NASH). Liver fibrosis stage, as assessed by liver biopsy histology, correlates with liver-related clinical outcomes in NASH; however, liver biopsy is invasive and imprecise. Fibrosis reflects the accumulation of collagen, which is likely due to the net excess of formation compared to degradation. We aimed to compare a panel of collagen formation and degradation biomarkers with liver fibrosis stage and with NAFLD Activity Score (NAS) in NASH patients.
Journal of Hepatology 2017 vol. 66 | S543–S750