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Mo1942 The Feasability and Reliability of Transient Elastography by FibroScan: A Practice Audit of 3,000 Examinations
was not (HR 1.61, p 0.3). Conclusions: Low platelet count is a sensitive predictor of postTIPS mortality and is a sign of more advanced liver disease. Patients with platelet count of less than 100,000 had higher short and long term post-TIPS mortality rates than those with higher platelet counts. Larger scale studies are needed to confirm this finding. Comparison Table: patients with platelet count of less than 100,00 vs those with higher platelet count
Kaplan-Meier Survival Analysis post-Liver Transplantation based on mRECIST Response (CR/PR) or Non-response (SD/PD).
AASLD Abstracts
Mo1942 The Feasability and Reliability of Transient Elastography by FibroScan: A Practice Audit of 3,000 Examinations Christopher P. Schneider, Faruq Pradhan, Robert P. Myers, Pam Crotty, Jenna E. Tracey Background: Liver stiffness measurement (LSM) using transient elastography has emerged as an important tool in the management of patients with chronic liver disease. Our objectives were to examine the feasibility and reliability of LSM and to identify patient and operator characteristics predictive of unreliable results. Methods: We retrospectively investigated the frequency and determinants of LSM failure and unreliable results using the FibroScan (Echosens; Paris, France) over a 3-year period. All LSMs were performed by two experienced operators (>50 prior exams). LSM failure was defined as no valid measurements, and unreliable LSM had <10 valid measurements, a success rate <60%, and/or an interquartile range (IQR)/LSM (IQR/M) >30%. Potential predictors of unreliable LSM were examined in multivariate logistic regression analyses including patient age, gender, the operator, operator experience (first 499 scans, 500-999th scans, ≥1000 scans), FibroScan probe (M vs. XL), and presumed cirrhosis (LSM ≥13 kPa). In a subset of patients, medical records were reviewed to identify additional predictors including liver disease etiology (HCV, HBV, NAFLD, vs. other/unknown), obesity (body mass index [BMI] ≥30 kg/m2), and diabetes mellitus. Results: Between June 2008 and June 2011, we performed 2,966 LSMs (87% using the M probe and 13% using the XL probe) in 2,437 patients. LSM failure occurred in 4.8% (n=141) of all examinations and 4.8% (n=118) at the first examination. LSM failure did not differ between the M and XL probes (4.8% vs. 5.3%; P=0.71). Excluding patients with LSM failure, unreliable LSMs were observed in 14% (n=335) of patients at their first examination and were more common using the XL probe (22% vs. 14%; P=0.01). In the primary analysis, independent predictors of unreliable LSM included older age (odds ratio [OR] per year: 1.03; 95% confidence interval [CI] 1.02-1.04), female sex (OR 1.39; 95% CI 1.09-1.77), presumed cirrhosis (OR 1.75; 95% CI 1.43-2.32), and use of the XL probe (OR 1.98; 95% CI 1.29-3.03). Although reliability varied by operator (OR 0.50; 95% CI 0.40-0.64), operator experience did not influence the risk of unreliable LSM. In a sub-analysis including patients with complete clinical data (n=429), the only independent predictors of unreliable results were older age (OR per year, 1.03; 95% CI 1.00-1.05), the operator (OR 0.37; 95% CI 0.17-0.78), and obesity (OR 3.01; 95% CI 1.68-5.41). Gender, diabetes, the underlying liver disease, cirrhosis, operator experience, and the FibroScan probe were not significant in this analysis. Conclusions: Although FibroScan failure is uncommon (5%), unreliable results are obtained in approximately one in seven patients. The most important determinants of unreliable results are obesity and the operator, emphasizing the need for adequate operator training.
This survival curve shows the difference in survival between patients with platelet count less than 100,000 and those with higher platelet counts. Mo1944 Ultrasound Shear Wave Elastography: A Non-Invasive Tool to Predict Liver Fibrosis Vilas Patwardhan, Manish Dhyani, Kathleen E. Corey, Atul K. Bhan, Qian Li, Raymond T. Chung, Anthony Samir
Mo1943 Peripheral Blood Platelet Count Predicts Post-Tips Mortality in Patients With Cirrhosis Wissam Bleibel, Wael Saad, Daniel Sheeran, Curtis L. Anderson, Patrick G. Northup, Abdullah M. Al-Osaimi
Background: Patients with chronic liver disease and hepatic fibrosis are routinely evaluated with abdominal ultrasound. Liver biopsy, which is commonly performed under ultrasound guidance, is the current gold standard for staging liver fibrosis, but is invasive and may be associated with sampling error and inadequate tissue acquisition. Ultrasound shear wave elastography (SWE) is a new technology that may represent a non-invasive alternative to liver biopsy to measure hepatic fibrosis. Methods: From May 2010 through April 2011, patients were prospectively enrolled to undergo ultrasound-guided liver biopsy and concurrent hepatic ultrasound SWE. Liver biopsies were obtained to evaluate fibrosis stage in patients with known chronic liver disease or for evaluation of abnormal liver chemistries of unknown etiology. SWE measurements were obtained by a single technician at the left lobe, right lobe superficially, right lobe deep, and at the approximate biopsy site. SWE data was interpreted by a single radiologist who was blinded to biopsy results and was not involved with SWE image acquisition. Biopsy specimens underwent blinded pathologist review and were assigned METAVIR and Ishak fibrosis, steatosis, and inflammation scores. Receiver operator curves (ROC) of the ability of SWE to predict varying stages of liver fibrosis were then constructed. Results: Seventy-six patients underwent liver biopsy and SWE for staging of fibrosis (n=36) or evaluation of abnormal liver chemistries (n=40). Etiologies of liver disease based on biopsy pathology included hepatitis C (HCV; n=24), hepatitis B (HBV; n= 4), steatohepatitis (nonalcoholic and alcoholic; n=21), sarcoidosis (n=2), cholestatic liver disease (n=10), drugs (n=1), and autoimmune hepatitis (n=5). The cause of liver disease
Introduction: There is laboratory and autopsy data suggesting that platelet activation may be a contributing factor in the development and progression of cirrhosis and portal hypertension. In addition, there is increasing evidence that thrombocytopenia of liver disease is not only a marker of portal hypertension and hypersplenism but also an indicator of loss of hepatocellular mass and function. It was the aim of this study to determine if peripheral blood platelet count predicts mortality in cirrhosis patients after a TIPS procedure. Methods: In this retrospective study, 148 consecutive patients who underwent TIPS at a single transplant center were evaluated with laboratory tests prior to the procedure. We evaluated the hospital EMR and social security death index databases to determine patients' survival. Results: The patients were predominantly male (61.5%), suffered from alcoholic hepatitis (33.8%), had a mean age of 54.7 years (SD 11.9), a mean MELD score of 13.6 (SD 6.5), and a mean platelet count of 135,700 (SD 93,900) at the time of TIPS. The post-procedural mortality rate was 18.9, 26.4, 33.1, and 53.4 percent at 3 months, 6 months, 1 year and 2.5 years respectively. There was a direct correlation between length of survival and platelet count. In a multivariate regression model, platelet count of less than 100,000 (HR 1.58, 95% CI 1.03-2.41, p 0.036) was a strong predictor of mortality. Among MELD components creatinine (HR 1.25, p 0.015) and bilirubin (HR 1.09, p 0.006) were predictive yet INR
AASLD Abstracts
S-1006
Kaplan-Meier Survival Analysis post-Liver Transplantation based on mRECIST Response (CR/PR) or Non-response (SD/PD).
AASLD Abstracts
Mo1942 The Feasability and Reliability of Transient Elastography by FibroScan: A Practice Audit of 3,000 Examinations Christopher P. Schneider, Faruq Pradhan, Robert P. Myers, Pam Crotty, Jenna E. Tracey Background: Liver stiffness measurement (LSM) using transient elastography has emerged as an important tool in the management of patients with chronic liver disease. Our objectives were to examine the feasibility and reliability of LSM and to identify patient and operator characteristics predictive of unreliable results. Methods: We retrospectively investigated the frequency and determinants of LSM failure and unreliable results using the FibroScan (Echosens; Paris, France) over a 3-year period. All LSMs were performed by two experienced operators (>50 prior exams). LSM failure was defined as no valid measurements, and unreliable LSM had <10 valid measurements, a success rate <60%, and/or an interquartile range (IQR)/LSM (IQR/M) >30%. Potential predictors of unreliable LSM were examined in multivariate logistic regression analyses including patient age, gender, the operator, operator experience (first 499 scans, 500-999th scans, ≥1000 scans), FibroScan probe (M vs. XL), and presumed cirrhosis (LSM ≥13 kPa). In a subset of patients, medical records were reviewed to identify additional predictors including liver disease etiology (HCV, HBV, NAFLD, vs. other/unknown), obesity (body mass index [BMI] ≥30 kg/m2), and diabetes mellitus. Results: Between June 2008 and June 2011, we performed 2,966 LSMs (87% using the M probe and 13% using the XL probe) in 2,437 patients. LSM failure occurred in 4.8% (n=141) of all examinations and 4.8% (n=118) at the first examination. LSM failure did not differ between the M and XL probes (4.8% vs. 5.3%; P=0.71). Excluding patients with LSM failure, unreliable LSMs were observed in 14% (n=335) of patients at their first examination and were more common using the XL probe (22% vs. 14%; P=0.01). In the primary analysis, independent predictors of unreliable LSM included older age (odds ratio [OR] per year: 1.03; 95% confidence interval [CI] 1.02-1.04), female sex (OR 1.39; 95% CI 1.09-1.77), presumed cirrhosis (OR 1.75; 95% CI 1.43-2.32), and use of the XL probe (OR 1.98; 95% CI 1.29-3.03). Although reliability varied by operator (OR 0.50; 95% CI 0.40-0.64), operator experience did not influence the risk of unreliable LSM. In a sub-analysis including patients with complete clinical data (n=429), the only independent predictors of unreliable results were older age (OR per year, 1.03; 95% CI 1.00-1.05), the operator (OR 0.37; 95% CI 0.17-0.78), and obesity (OR 3.01; 95% CI 1.68-5.41). Gender, diabetes, the underlying liver disease, cirrhosis, operator experience, and the FibroScan probe were not significant in this analysis. Conclusions: Although FibroScan failure is uncommon (5%), unreliable results are obtained in approximately one in seven patients. The most important determinants of unreliable results are obesity and the operator, emphasizing the need for adequate operator training.
This survival curve shows the difference in survival between patients with platelet count less than 100,000 and those with higher platelet counts. Mo1944 Ultrasound Shear Wave Elastography: A Non-Invasive Tool to Predict Liver Fibrosis Vilas Patwardhan, Manish Dhyani, Kathleen E. Corey, Atul K. Bhan, Qian Li, Raymond T. Chung, Anthony Samir
Mo1943 Peripheral Blood Platelet Count Predicts Post-Tips Mortality in Patients With Cirrhosis Wissam Bleibel, Wael Saad, Daniel Sheeran, Curtis L. Anderson, Patrick G. Northup, Abdullah M. Al-Osaimi
Background: Patients with chronic liver disease and hepatic fibrosis are routinely evaluated with abdominal ultrasound. Liver biopsy, which is commonly performed under ultrasound guidance, is the current gold standard for staging liver fibrosis, but is invasive and may be associated with sampling error and inadequate tissue acquisition. Ultrasound shear wave elastography (SWE) is a new technology that may represent a non-invasive alternative to liver biopsy to measure hepatic fibrosis. Methods: From May 2010 through April 2011, patients were prospectively enrolled to undergo ultrasound-guided liver biopsy and concurrent hepatic ultrasound SWE. Liver biopsies were obtained to evaluate fibrosis stage in patients with known chronic liver disease or for evaluation of abnormal liver chemistries of unknown etiology. SWE measurements were obtained by a single technician at the left lobe, right lobe superficially, right lobe deep, and at the approximate biopsy site. SWE data was interpreted by a single radiologist who was blinded to biopsy results and was not involved with SWE image acquisition. Biopsy specimens underwent blinded pathologist review and were assigned METAVIR and Ishak fibrosis, steatosis, and inflammation scores. Receiver operator curves (ROC) of the ability of SWE to predict varying stages of liver fibrosis were then constructed. Results: Seventy-six patients underwent liver biopsy and SWE for staging of fibrosis (n=36) or evaluation of abnormal liver chemistries (n=40). Etiologies of liver disease based on biopsy pathology included hepatitis C (HCV; n=24), hepatitis B (HBV; n= 4), steatohepatitis (nonalcoholic and alcoholic; n=21), sarcoidosis (n=2), cholestatic liver disease (n=10), drugs (n=1), and autoimmune hepatitis (n=5). The cause of liver disease
Introduction: There is laboratory and autopsy data suggesting that platelet activation may be a contributing factor in the development and progression of cirrhosis and portal hypertension. In addition, there is increasing evidence that thrombocytopenia of liver disease is not only a marker of portal hypertension and hypersplenism but also an indicator of loss of hepatocellular mass and function. It was the aim of this study to determine if peripheral blood platelet count predicts mortality in cirrhosis patients after a TIPS procedure. Methods: In this retrospective study, 148 consecutive patients who underwent TIPS at a single transplant center were evaluated with laboratory tests prior to the procedure. We evaluated the hospital EMR and social security death index databases to determine patients' survival. Results: The patients were predominantly male (61.5%), suffered from alcoholic hepatitis (33.8%), had a mean age of 54.7 years (SD 11.9), a mean MELD score of 13.6 (SD 6.5), and a mean platelet count of 135,700 (SD 93,900) at the time of TIPS. The post-procedural mortality rate was 18.9, 26.4, 33.1, and 53.4 percent at 3 months, 6 months, 1 year and 2.5 years respectively. There was a direct correlation between length of survival and platelet count. In a multivariate regression model, platelet count of less than 100,000 (HR 1.58, 95% CI 1.03-2.41, p 0.036) was a strong predictor of mortality. Among MELD components creatinine (HR 1.25, p 0.015) and bilirubin (HR 1.09, p 0.006) were predictive yet INR
AASLD Abstracts
S-1006