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P1027 IS THE ELF-SCORE A VALID SUBSTITUTION FOR HVPG TO DETECT CLINICALLY SIGNIFICANT PORTAL HYPERTENSION (CSPH) NON-INVASIVELY?
POSTERS P1026 A NEW ECL-BASED ASSAY TO MEASURE SERUM CYTOKERATIN-18 IN PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE E.P. Jeffries1 , J.A. Miller2 , J.A. White1 , C.K. Argo3 , S.H. Caldwell3 . 1 Wellstat Diagnostics, LLC, 2 Wellstat Biologics, LLC, Gaithersburg, MD, 3 GI/Hepatology, University of Virginia, Charlottesville, VA, United States E-mail: [email protected] Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is a spectrum of disorders characterised by hepatic steatosis, which may be benign (NAFL) or which may progress via inflammation and fibrosis to nonalcoholic steatohepatitis (NASH) and then to cirrhosis and liver failure. Liver biopsy is the standard diagnostic approach for NAFL/NASH. However it has limitations due to sampling site variability, cost and procedure-related morbidity. Appropriate NAFLD-specific circulating biomarkers may enable diagnosis, staging and monitoring of NAFL/NASH with fewer biopsies. Circulating fragments of cytokeratin-18 (K18), a marker of hepatocyte death, have been shown in several studies to indicate the transition from benign fatty liver to NASH, with a risk of fibrosis, in patients with NAFLD. Our goal was to develop a highly specific serum K-18 assay to monitor hepatic disease severity in patients with different stages of NAFLD. Methods: An assay to measure K18 fragments in serum using electrochemiluminescence (ECL) technology was developed using proprietary K18 fragment-specific antibodies: one labelled with an ECL-active ruthenium chelate reporter and a second antibody bound to paramagnetic beads. Results: Thirty known NAFL and NASH patient serums with assigned NAS scores were evaluated. K18 fragment concentrations in biopsy-proven NASH were elevated compared to NAFL (1232 U/L and 345 U/L respectively). The results also demonstrated good correlation with the M30 antibody assay. Conclusions: An ECL-based assay has been developed for the quantitation of serum K18 fragments. This new diagnostic test may enable routine monitoring in both central laboratories and physician’s offices of disease severity and progression in patients with NAFLD. P1027 IS THE ELF-SCORE A VALID SUBSTITUTION FOR HVPG TO DETECT CLINICALLY SIGNIFICANT PORTAL HYPERTENSION (CSPH) NON-INVASIVELY? S. Hametner1 , A. Ferlitsch2 , A. Etschmaier2 , M. Ferlitsch2 , R. Schofl ¨ 1, A. Ziachehabi1 , D. Trubert-Exinger3 , A. Maieron1 . 1 Gastroenterology and Hepatology, KH d. Elisabethinen Linz, Linz, 2 Medical University of Vienna Department of Gastroenterology and Hepatology, Vienna, 3 Institute of Laboratory Medicine, LKH St. P¨ olten, St. P¨ olten, Austria E-mail: [email protected] Background and Aims: CSPH defined by HVPG ≥ 10 mm/Hg causes major complications. To improve survival, early diagnosis is crucial. vWF-Ag shows significant ability to diagnose CSPH and is a predictor for mortality. ELF-Score detects liver cirrhosis in most cases. Methods: 119 cirrhotic patients underwent HVPG measurement. Patients were categorized into 3 groups of different HVPG-ranges (<10, ≥10–<20, ≥20 mmHg) and ELF-Score was analysed. Blood samples were obtained during HVPG measurement. Child Pugh Score (CPS), MELD score and D’Amico staging system were assessed. Results: 119 patients (male: 90) were included. Aetiology: ALD 38.7%, NASH 12.6%, HepC 26.1% and others 22.7%. CPS A: 63.9%, CPS B: 22.7%, CPS C: 7.6%, unknown: 5.8. According D’Amico: 54.6% were compensated. 18 (15.1%) patients showed no CSPH, 101 (84.9%) showed CSPH. ELF-Score is significantly increasing with progression of HVPG (p < 0.034). Median ELF-Score in 3 HVPG groups (<10, ≥10–<20,
≥20 mmHg) shows: 10.02 (8.61–11.09), 10.83 (9.97–11.97), 11.35 (10.04–12.24). ELF-Score shows a sensitivity of 80.2% and a specificity of 44.4% at a cut off of 9.7 for predicting CSPH. ELF-Score is significantly increasing with Child Pugh Stage (p < 0.001). Median ELF-Scores for CPS A, B and C were: 10.65 (9.25–11.55), 11.43 (10.27–12.56), 12.89 (11.73–13.86). ELF-Score significantly differs in compensated patients compared to decompensated patients (p < 0.000). In compensated patients the median ELF-Score is 10.49 (8.92–11.4) and in decompensated patients 11.47 (10.36–12.59). Conclusions: ELF-Score correlates significantly with HVPG groups, CPS and D’Amico classification and could add valuable additive information on patients at risk. P1028 NON-INVASIVE SCORE SYSTEM FOR FIBROSIS (NISF) IN CHRONIC LIVER DISEASE: A NEW MODEL COMBINING BIOCHEMICAL, ELASTOGRAPHIC AND ULTRASOUND DATA S. Gaia1 , D. Campion1 , M. Spandre1 , A. Cantamessa1 , F. Brunello1 , A. Evangelista2 , L. Cosso1 , P. Carucci1 , E. Rolle1 , G. Ciccone2 , E. Bugianesi1 , S. Carenzi1 , M. Rizzetto1 . 1 Gastro-Hepatology, 2 Epidemiology of Tumors, Citt` a della Salute e della Scienza di Torino, University of Turin, Turin, Italy E-mail: [email protected] Background and Aims: We elaborated a Non-Invasive Score system for Fibrosis (NISF) for chronic viral hepatitis (CH) and Non-Alcoholic Fatty Liver Disease (NAFLD), comparing its diagnostic performance versus Fibroscan. Methods: One hundred and forty-one patients undergoing liver biopsy were prospectively enrolled (83 CH, 58 NAFLD). Clinical, biochemical, elastographic and ultrasonographic parameters (collected by 2 blind operators), with good inter-observer agreement and correlation to histologic stage, were combined into 2 algorithms to predict fibrosis. Predicted fibrosis stages (3 for CH: F0–1, F2, F3–4 and 2 for NAFLD: F0–1, F2–3–4) were compared to Metavir/Brunt histological score. Results: The algorithms can be processed by a calculator as mathematical formulas or graphically displayed as nomograms. CH-NISF includes: bluntness of liver edges, irregularity of left lobe surface, S4 diameter, liver stiffness, platelet count, ALT values. CHNISF agrees with liver biopsy in 80%, 62.5% and 79% of F0–1, F2 and F3–4 stages, respectively. The diagnostic accuracy for discrimination of F3–4 vs F0–1, F2 vs F0–1 and F3–4 vs F2 is better for CH-NISF (AUROCs of 0.95, 0.83 and 0.92, respectively) compared to Fibroscan alone (AUROCs of 0.92, 0.57 and 0.79, respectively). NAFLD-NISF includes: liver stiffness, platelet count and AST levels. For discrimination of F0–1 versus F2–3–4 stages, NAFLD-NISF and Fibroscan show similar diagnostic accuracy (0.86 for NAFLD-NISF vs 0.81 for Fibroscan). Conclusions: CH-NISF can be proposed as an easily-available tool, superior to Fibroscan alone, to predict histologic fibrosis, especially in intermediate stages. Further evaluations are needed to improve NISF accuracy in NAFLD. P1029 LIVER STIFFNESS (LS) ASSESSED WITH ACOUSTIC RADIATION FORCE IMPULSE (ARFI) CAN BE PROGNOSTIC FOR FIRST EPISODE OF ASCITES (AD) IN PATIENTS AFFECTED BY CHRONIC LIVER DISEASE (CLD) A. De Santis, C. Bassanelli, M. Lupo, C. Iegri, C. Di Ciesco, M. Forlino, G. Gallusi, A.F. Attili. Gastroenterology Division, Department of Clinical Medicine, Policlinico Umberto I, Rome, Italy E-mail: [email protected] Background and Aims: ARFI is a noninvasive method to measure LS during the routine ultrasound examination. It has already been demonstrated that LS measured by Fibroscan can be a prognostic
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≥20 mmHg) shows: 10.02 (8.61–11.09), 10.83 (9.97–11.97), 11.35 (10.04–12.24). ELF-Score shows a sensitivity of 80.2% and a specificity of 44.4% at a cut off of 9.7 for predicting CSPH. ELF-Score is significantly increasing with Child Pugh Stage (p < 0.001). Median ELF-Scores for CPS A, B and C were: 10.65 (9.25–11.55), 11.43 (10.27–12.56), 12.89 (11.73–13.86). ELF-Score significantly differs in compensated patients compared to decompensated patients (p < 0.000). In compensated patients the median ELF-Score is 10.49 (8.92–11.4) and in decompensated patients 11.47 (10.36–12.59). Conclusions: ELF-Score correlates significantly with HVPG groups, CPS and D’Amico classification and could add valuable additive information on patients at risk. P1028 NON-INVASIVE SCORE SYSTEM FOR FIBROSIS (NISF) IN CHRONIC LIVER DISEASE: A NEW MODEL COMBINING BIOCHEMICAL, ELASTOGRAPHIC AND ULTRASOUND DATA S. Gaia1 , D. Campion1 , M. Spandre1 , A. Cantamessa1 , F. Brunello1 , A. Evangelista2 , L. Cosso1 , P. Carucci1 , E. Rolle1 , G. Ciccone2 , E. Bugianesi1 , S. Carenzi1 , M. Rizzetto1 . 1 Gastro-Hepatology, 2 Epidemiology of Tumors, Citt` a della Salute e della Scienza di Torino, University of Turin, Turin, Italy E-mail: [email protected] Background and Aims: We elaborated a Non-Invasive Score system for Fibrosis (NISF) for chronic viral hepatitis (CH) and Non-Alcoholic Fatty Liver Disease (NAFLD), comparing its diagnostic performance versus Fibroscan. Methods: One hundred and forty-one patients undergoing liver biopsy were prospectively enrolled (83 CH, 58 NAFLD). Clinical, biochemical, elastographic and ultrasonographic parameters (collected by 2 blind operators), with good inter-observer agreement and correlation to histologic stage, were combined into 2 algorithms to predict fibrosis. Predicted fibrosis stages (3 for CH: F0–1, F2, F3–4 and 2 for NAFLD: F0–1, F2–3–4) were compared to Metavir/Brunt histological score. Results: The algorithms can be processed by a calculator as mathematical formulas or graphically displayed as nomograms. CH-NISF includes: bluntness of liver edges, irregularity of left lobe surface, S4 diameter, liver stiffness, platelet count, ALT values. CHNISF agrees with liver biopsy in 80%, 62.5% and 79% of F0–1, F2 and F3–4 stages, respectively. The diagnostic accuracy for discrimination of F3–4 vs F0–1, F2 vs F0–1 and F3–4 vs F2 is better for CH-NISF (AUROCs of 0.95, 0.83 and 0.92, respectively) compared to Fibroscan alone (AUROCs of 0.92, 0.57 and 0.79, respectively). NAFLD-NISF includes: liver stiffness, platelet count and AST levels. For discrimination of F0–1 versus F2–3–4 stages, NAFLD-NISF and Fibroscan show similar diagnostic accuracy (0.86 for NAFLD-NISF vs 0.81 for Fibroscan). Conclusions: CH-NISF can be proposed as an easily-available tool, superior to Fibroscan alone, to predict histologic fibrosis, especially in intermediate stages. Further evaluations are needed to improve NISF accuracy in NAFLD. P1029 LIVER STIFFNESS (LS) ASSESSED WITH ACOUSTIC RADIATION FORCE IMPULSE (ARFI) CAN BE PROGNOSTIC FOR FIRST EPISODE OF ASCITES (AD) IN PATIENTS AFFECTED BY CHRONIC LIVER DISEASE (CLD) A. De Santis, C. Bassanelli, M. Lupo, C. Iegri, C. Di Ciesco, M. Forlino, G. Gallusi, A.F. Attili. Gastroenterology Division, Department of Clinical Medicine, Policlinico Umberto I, Rome, Italy E-mail: [email protected] Background and Aims: ARFI is a noninvasive method to measure LS during the routine ultrasound examination. It has already been demonstrated that LS measured by Fibroscan can be a prognostic
Journal of Hepatology 2014 vol. 60 | S361–S522
S417