Assessment of Steatosis and Fibrosis in Liver Transplant Recipients Using Controlled Attenuation Parameter and Liver Stiffness Measurements

Aim. The primary objective of this study was to evaluate the prevalence of increased controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) as surrogate markers of liver steatosis and fibrosis in liver transplant recipient (LTR). Secondary objectives were to determine the predictors of increased CAP and LSM in population of LTR. Methods. In this prospective, cross-sectional study, we have evaluated 175 LTRs’ mean age as 61 (53–65) with a functioning graft for more than one year who came for regular outpatient examinations to the Department of Gastroenterology, University Hospital (UH) Merkur, Zagreb, Croatia. Results. Of 175 analyzed LTRs, 34.28% had obesity, 64.00% had hypertension, 38.28% had diabetes, and 58.85% had hyperlipidemia. The prevalence of liver steatosis was 68.57%, while the prevalence of severe liver steatosis was 46.85%. On multivariate analysis, independent factors associated with liver steatosis were male gender, total cholesterol as positive predictor, and HDL as negative predictor, and independent factors positively associated with severe liver steatosis were higher body mass index (BMI) and higher triglyceride levels. The prevalence of moderate liver fibrosis was 54.85%, while the prevalence of advanced liver fibrosis was 24%. On multivariate analysis, independent factors positively associated with moderate fibrosis were gamma-glutamyl transferase (GGT) and CAP, while the independent factor positively associated with advanced fibrosis was GGT. Conclusion. Our study showed high prevalence of increased CAP and LSM measurements as surrogate markers of liver steatosis and fibrosis. Metabolic syndrome components were highly present and were associated with CAP and LSM values as well as in the pretransplant setting. Due to high prevalence of metabolic comorbidities and nonalcoholic fatty liver disease in LTRs and the lack of the abnormal liver test in a significant number of these patients, TE with CAP may be a reasonable initial assessment for LTRs with one or more components of the metabolic syndrome.

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Noninvasive and Convenient Screening of Metabolic Syndrome Using the Controlled Attenuation Parameter Technology: An Evaluation Based on Self-Paid Health Examination Participants

Journal of Clinical Medicine ◽

10.3390/jcm8111775 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1775 ◽

Cited By ~ 4

Author(s):

Yu-Jiun Lin ◽

Chang-Hsien Lin ◽

Sen-Te Wang ◽

Shiyng-Yu Lin ◽

Shy-Shin Chang

Keyword(s):

Metabolic Syndrome ◽

Univariate Analysis ◽

Liver Steatosis ◽

Liver Stiffness ◽

Health Examination ◽

Physical Status ◽

Controlled Attenuation Parameter ◽

Final Model ◽

Attenuation Parameter ◽

Convenient Model

Background: There is a medical need for an easy, fast, and non-invasive method for metabolic syndrome (MetS) screening. This study aimed to assess the ability of FibroScan to detect MetS, in participants who underwent a self-paid health examination. Methods: A retrospective cohort study was conducted on all adults who underwent a self-paid health examination comprising of an abdominal transient elastography inspection using FibroScan 502 Touch from March 2015 to February 2019. FibroScan can assess the level of liver fibrosis by using a liver stiffness score, and the level of liver steatosis by using the controlled attenuation parameter (CAP) score. The logistic regression analysis and receiver operating characteristic curve were applied to select significant predictors and assess their predictability. A final model that included all significant predictors that are found by univariate analysis, and a convenient model that excluded all invasive parameters were created. Results: Of 1983 participants, 13.6% had a physical status that fulfilled MetS criteria. The results showed that the CAP score solely could achieve an area under the curve (AUC) of 0.79 (0.76–0.82) in predicting MetS, and the AUC can be improved to 0.88 (0.85–0.90) in the final model. An AUC of 0.85 (0.83–0.88) in predicting MetS was obtained in the convenient model, which includes only 4 parameters (CAP score, gender, age, and BMI). A panel of predictability indices (the ranges of sensitivity, specificity, positive and negative likelihood ratio: 0.78–0.89, 0.66–0.82, 2.64–4.47, and 0.17–0.26) concerning gender- and BMI-specific CAP cut-off values (range: 191.65–564.95) were presented for practical reference. Conclusions: Two prediction systems were proposed for identifying individuals with a physical status that fulfilled the MetS criteria, and a panel of predictability indices was presented for practical reference. Both systems had moderate predictive performance. The findings suggested that FibroScan evaluation is appropriate as a first-line MetS screening; however, the variation in prediction performance of such systems among groups with varying metabolic derangements warrants further studies in the future.

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The combination of liver stiffness measurement and NAFLD fibrosis score improves the noninvasive diagnostic accuracy for severe liver fibrosis in patients with nonalcoholic fatty liver disease

Liver International ◽

10.1111/liv.12584 ◽

2014 ◽

Vol 35 (5) ◽

pp. 1566-1573 ◽

Cited By ~ 70

Author(s):

Salvatore Petta ◽

Ester Vanni ◽

Elisabetta Bugianesi ◽

Vito Di Marco ◽

Calogero Cammà ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Fatty Liver Disease ◽

Liver Stiffness ◽

Fibrosis Score ◽

Severe Liver ◽

Liver Stiffness Measurement ◽

Nonalcoholic Fatty Liver ◽

Stiffness Measurement ◽

Nafld Fibrosis Score

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RELATIONSHIP BETWEEN COFFEE CONSUMPTION, SLEEP DURATION AND SMOKING STATUS WITH ELASTOGRAPHIC PARAMETERS OF LIVER STEATOSIS AND FIBROSIS; CONTROLLED ATTENUATION PARAMETER AND LIVER STIFFNESS MEASUREMENTS

10.22541/au.159542459.96867019 ◽

2020 ◽

Author(s):

Ivana Mikolasevic ◽

Viktor Domislovic ◽

Tajana Filipec Kanizaj ◽

Delfa Radic Kristo ◽

Zeljko Krznaric ◽

...

Keyword(s):

Sleep Duration ◽

Smoking Status ◽

Liver Steatosis ◽

Liver Stiffness ◽

Coffee Consumption ◽

Controlled Attenuation Parameter ◽

Attenuation Parameter

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Increased liver stiffness in patients with severe sleep apnoea and metabolic comorbidities

European Respiratory Journal ◽

10.1183/13993003.00601-2018 ◽

2018 ◽

Vol 51 (6) ◽

pp. 1800601 ◽

Cited By ~ 9

Author(s):

Wojciech Trzepizur ◽

Jérôme Boursier ◽

Marc Le Vaillant ◽

Pierre-Henri Ducluzeau ◽

Séverine Dubois ◽

...

Keyword(s):

Metabolic Syndrome ◽

Liver Disease ◽

Liver Fibrosis ◽

Liver Stiffness ◽

Sleep Apnoea ◽

Screening Tools ◽

The Metabolic Syndrome ◽

Obstructive Sleep ◽

Increased Risk ◽

Metabolic Comorbidities

The goal of this study was to assess the relationship between the severity of obstructive sleep apnoea (OSA) and liver stiffness measurement (LSM), one of the most accurate noninvasive screening tools for liver fibrosis in nonalcoholic fatty liver disease.The study included 147 patients with at least one criterion for the metabolic syndrome, assessed by polysomnography for suspected OSA. LSM was performed using transient elastography (FibroScan). Significant liver disease and advanced liver fibrosis were defined as LSM ≥7.3 and ≥9.6 kPa, respectively.23 patients were excluded because of unreliable LSM. Among 124 patients, 34 (27.4%) had mild OSA, 38 (30.6%) had moderate OSA and 52 (42.0%) had severe OSA. LSM values were 7.3– <9.6 kPa in 18 (14.5%) patients and ≥9.6 kPa in 15 (12.1%) patients. A dose–response relationship was observed between OSA severity and LSM values (p=0.004). After adjustment for age, sex, metabolic syndrome and insulin resistance, severe OSA was associated with an increased risk of LSM ≥7.3 kPa (OR 7.17, 95% CI 2.51–20.50) and LSM ≥9.6 kPa (OR 4.73, 95% CI 1.25–17.88).In patients with metabolic comorbidities, severe OSA is independently associated with increased liver stiffness, which may predispose to a higher risk of significant liver disease and poorer prognosis.

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Improved noninvasive prediction of liver fibrosis by liver stiffness measurement in patients with nonalcoholic fatty liver disease accounting for controlled attenuation parameter values

Hepatology ◽

10.1002/hep.28843 ◽

2016 ◽

Vol 65 (4) ◽

pp. 1145-1155 ◽

Cited By ~ 102

Author(s):

Salvatore Petta ◽

Vincent Wai-Sun Wong ◽

Calogero Cammà ◽

Jean-Baptiste Hiriart ◽

Grace Lai-Hung Wong ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Liver Stiffness ◽

Controlled Attenuation Parameter ◽

Liver Stiffness Measurement ◽

Nonalcoholic Fatty Liver ◽

Stiffness Measurement ◽

Parameter Values

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The Prevalence of Liver Steatosis and Fibrosis Assessed by Vibration-Controlled Transient Elastography and Controlled Attenuation Parameter in Apparently Healthy Romanian Medical Students

Diagnostics ◽

10.3390/diagnostics11122341 ◽

2021 ◽

Vol 11 (12) ◽

pp. 2341

Author(s):

Robert Nastasa ◽

Carol Stanciu ◽

Sebastian Zenovia ◽

Ana-Maria Singeap ◽

Camelia Cojocariu ◽

...

Keyword(s):

Medical Students ◽

Transient Elastography ◽

Liver Steatosis ◽

Liver Stiffness ◽

Moderate Degree ◽

Advanced Fibrosis ◽

Controlled Attenuation Parameter ◽

Significant Fibrosis ◽

Attenuation Parameter ◽

Associated Risk Factors

Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP) is used as a non-invasive method for evaluating liver steatosis and fibrosis simultaneously. In this prospective study, we aimed to assess the prevalence of liver steatosis and fibrosis, as well as the associated risk factors in Romanian medical students by VCTE and CAP score. We used a cut-off CAP score of ≥248 dB/m for the diagnosis of mild steatosis (S1), ≥268 dB/m for moderate steatosis (S2), and ≥280 dB/m to identify severe steatosis (S3). For liver fibrosis, the cut-off values were: ≤5.5 kPa, indicating no fibrosis (F0), 5.6 kPa for mild fibrosis (F1), 7.2 kPa for significant fibrosis (F2), 9.5 kPa for advanced fibrosis (F3), and 12.5 kPa for cirrhosis (F4). In total, 426 Romanian medical students (67.8% females, mean age of 22.22 ± 1.7 years) were evaluated. Among them, 352 (82.6%) had no steatosis (S0), 32 (7.5%) had mild steatosis (S1), 13 (3.1%) had a moderate degree of steatosis (S2), and 29 (6.8%) had severe steatosis (S3). Based on liver stiffness measurements (LSM), 277 (65%) medical students did not have any fibrosis (F0), 136 (31.9%) had mild fibrosis (F1), 10 (2.4%) participants were identified with significant fibrosis (F2), 3 (0.7%) with advanced fibrosis (F3), and none with cirrhosis (F4). In conclusion, the prevalence of liver steatosis and fibrosis is low among Romanian medical students.

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Liver and Nonliver-Related Outcomes at 2 Years Are Not Influenced by the Results of the FIB-4 Test and Liver Elastography in a Real-Life Cohort of Patients with Type 2 Diabetes

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/5582813 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Ivica Grgurevic ◽

Nermin Salkic ◽

Sanda Mustapic ◽

Tomislav Bokun ◽

Kristian Podrug ◽

...

Keyword(s):

Type 2 Diabetes ◽

Liver Fibrosis ◽

Fatty Liver ◽

Transient Elastography ◽

Liver Steatosis ◽

Liver Stiffness ◽

Real Life ◽

Adverse Outcomes ◽

Advanced Fibrosis

Aims. To investigate morbidity and mortality in a real-life cohort of patients with type 2 diabetes (T2D) in relation to prevalence and severity of nonalcoholic fatty liver disease (NAFLD). Methods. Patients with T2D were referred for assessment of liver fibrosis by the FIB-4 test and liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE). Liver steatosis was quantified by the controlled attenuation parameter (CAP). These patients were followed until death or censored date. Results. Among 454 patients (52% males, mean age 62.5 years, BMI 30.9 kg/m2), 82.6% was overweight, 77.8% had fatty liver, and 9.9% and 3.1% had LSM and FIB-4 values suggestive of advanced fibrosis, respectively. During the follow-up period of median 2 years, 106 (23%) patients experienced adverse event (11% cardiovascular) and 17 (3.7%) died, whereas no liver-related morbidity or mortality was observed. Independent predictors of adverse outcomes were age and higher platelet count, while FIB-4, LSM, and CAP were not. Conclusion. In a cohort of T2D patients, no liver-related morbidity or mortality occurred during 2 years. Our patients probably have low real prevalence of advanced fibrosis which is likely overestimated by LSM ≥ 9.6 kPa. Liver fibrosis may be safely reassessed in the 2 years interval in noncirrhotic patients with T2D.

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Accuracy of liver stiffness measurement and controlled attenuation parameter using FibroScan® M/XL probes to diagnose liver fibrosis and steatosis in patients with nonalcoholic fatty liver disease: a multicenter prospective study

Journal of Gastroenterology ◽

10.1007/s00535-019-01635-0 ◽

2019 ◽

Vol 55 (4) ◽

pp. 428-440 ◽

Cited By ~ 10

Author(s):

Satoshi Oeda ◽

Hirokazu Takahashi ◽

Kento Imajo ◽

Yuya Seko ◽

Yuji Ogawa ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Prospective Study ◽

Fatty Liver Disease ◽

Liver Stiffness ◽

Controlled Attenuation Parameter ◽

Liver Stiffness Measurement ◽

Nonalcoholic Fatty Liver ◽

Stiffness Measurement ◽

Multicenter Prospective Study

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Diagnostic Accuracy of FibroScan and Factors Affecting Measurements

Diagnostics ◽

10.3390/diagnostics10110940 ◽

2020 ◽

Vol 10 (11) ◽

pp. 940 ◽

Cited By ~ 1

Author(s):

Satoshi Oeda ◽

Kenichi Tanaka ◽

Ayaka Oshima ◽

Yasue Matsumoto ◽

Eisaburo Sueoka ◽

...

Keyword(s):

Liver Fibrosis ◽

Liver Steatosis ◽

Liver Stiffness ◽

The Body ◽

Liver Stiffness Measurement ◽

Alcoholic Fatty Liver ◽

Factors Affecting ◽

Non Invasive ◽

Significant Difference ◽

Alcoholic Fatty Liver Disease

Evaluating liver steatosis and fibrosis is important for patients with non-alcoholic fatty liver disease. Although liver biopsy and pathological assessment is the gold standard for these conditions, this technique has several disadvantages. The evaluation of steatosis and fibrosis using ultrasound B-mode imaging is qualitative and subjective. The liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) determined using FibroScan are the evidence-based non-invasive measures of liver fibrosis and steatosis, respectively. The LSM and CAP measurements are carried out simultaneously, and the median values of more than ten valid measurements are used to quantify liver fibrosis and steatosis. Here, we demonstrate that the reliability of the LSM depends on the interquartile range to median ratio (IQR/Med), but CAP values do not depend on IQR/Med. In addition, the LSM is affected by inflammation, congestion, and cholestasis in addition to fibrosis, while CAP values are affected by the body mass index in addition to steatosis. We also show that the M probe provides higher LSM values but lower CAP values than the XL probe in the same population. However, there was no statistically significant difference between the diagnostic accuracies of the two probes. These findings are important to understand the reliability of FibroScan measurements and the factors influencing measurement values for all patients.

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