Prognostic Value of Non-Invasive Fibrosis and Steatosis Tools, Hepatic Venous Pressure Gradient (HVPG) and Histology in Nonalcoholic Steatohepatitis

Non-invasive diagnostic methods for liver fibrosis predict clinical outcomes in viral hepatitis and nonalcoholic fatty liver disease (NAFLD). We specifically evaluated prognostic value of non-invasive fibrosis methods in nonalcoholic steatohepatitis (NASH) against hepatic venous pressure gradient (H...

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Veröffentlicht in:	PloS one Jg. 10; H. 6; S. e0128774
Hauptverfasser:	Sebastiani, Giada, Alshaalan, Rasha, Wong, Philip, Rubino, Maria, Salman, Ayat, Metrakos, Peter, Deschenes, Marc, Ghali, Peter
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Public Library of Science 17.06.2015 Public Library of Science (PLoS)
Schlagworte:	Adult Aged Area Under Curve Biopsy Cirrhosis Complications Confidence intervals Diabetes mellitus Diagnostic systems Fatty liver Female Fibrosis Follow-Up Studies Hepatitis Histocytochemistry Histology Humans Liver Liver - blood supply Liver - pathology Liver - surgery Liver cirrhosis Liver diseases Liver Transplantation Liver transplants Male Medical prognosis Middle Aged Non-alcoholic Fatty Liver Disease - diagnosis Non-alcoholic Fatty Liver Disease - mortality Non-alcoholic Fatty Liver Disease - pathology Non-alcoholic Fatty Liver Disease - surgery Patients Platelets Portal Pressure Pressure Prognosis Regression analysis Retrospective Studies Statistical analysis Steatosis Survival Analysis Transplantation Ultrasound Venous pressure Virus diseases Xenografts Xenon Xenon 133
ISSN:	1932-6203, 1932-6203
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Zusammenfassung:	Non-invasive diagnostic methods for liver fibrosis predict clinical outcomes in viral hepatitis and nonalcoholic fatty liver disease (NAFLD). We specifically evaluated prognostic value of non-invasive fibrosis methods in nonalcoholic steatohepatitis (NASH) against hepatic venous pressure gradient (HVPG) and liver histology. This was a retrospective cohort study of 148 consecutive patients who met the following criteria: transjugular liver biopsy with HVPG measurement; biopsy-proven NASH; absence of decompensation; AST-to-Platelets Ratio Index (APRI), fibrosis-4 (FIB-4), NAFLD fibrosis score, ultrasound, hepatic steatosis index and Xenon-133 scan available within 6 months from biopsy; a minimum follow-up of 1 year. Outcomes were defined by death, liver transplantation, cirrhosis complications. Kaplan-Meier and Cox regression analyses were employed to estimate incidence and predictors of outcomes, respectively. Prognostic value was expressed as area under the curve (AUC). During a median follow-up of 5 years (interquartile range 3-8), 16.2% developed outcomes, including 7.4% who died or underwent liver transplantation. After adjustment for age, sex, diabetes, the following fibrosis tools predicted outcomes: HVPG >10mmHg (HR=9.60; 95% confidence interval [CI] 3.07-30.12), histologic fibrosis F3-F4 (HR=3.14; 1.41-6.95), APRI >1.5 (HR=5.02; 1.6-15.7), FIB-4 >3.25 (HR=6.33; 1.98-20.2), NAFLD fibrosis score >0.676 (HR=11.9; 3.79-37.4). Prognostic value was as follows: histologic fibrosis stage, AUC=0.85 (95% CI 0.76-0.93); HVPG, AUC=0.81 (0.70-0.91); APRI, AUC=0.89 (0.82-0.96); FIB-4, AUC=0.89 (0.83-0.95); NAFLD fibrosis score, AUC=0.79 (0.69-0.91). Neither histologic steatosis nor non-invasive steatosis methods predicted outcomes (AUC<0.50). Non-invasive methods for liver fibrosis predict outcomes of patients with NASH. They could be used for serial monitoring, risk stratification and targeted interventions.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: GS has acted as speaker for Merck, Vertex, Gilead, Echosens, served as an advisory board member for Boheringer Ingelheim and Novartis and has received research funding from Vertex, ViiV and Merck. PG has acted as consultant for Merck, Vertex and Gilead. PW has served as consultant for Bristol Myers Squibb, Gilead, Merck, Novartis, Roche, Vertex. MD has served as an advisory board member for Roche, Merck, Janssen, Vertex, Gilead. PM, RA, AS and MR have nothing to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Conceived and designed the experiments: GS PG. Analyzed the data: GS PG. Contributed reagents/materials/analysis tools: GS RA PW MR AS PM MD PG. Wrote the paper: GS RA PG.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0128774