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. 2020 Mar;40(3):581-589.
doi: 10.1111/liv.14301. Epub 2019 Dec 8.

Liver stiffness measurement predicts long-term survival and complications in non-alcoholic fatty liver disease

Sarah Shili-Masmoudi  1 , Grace Lai-Hung Wong  2   3 , Jean-Baptiste Hiriart  1 , Ken Liu  4   5 , Faiza Chermak  1 , Sally She-Ting Shu  2   3 , Juliette Foucher  1 , Yee-Kit Tse  2   3 , Pierre-Henri Bernard  1 , Terry Cheuk-Fung Yip  2   3 , Wassil Merrouche  1 , Henry Lik-Yuen Chan  2   3 , Vincent Wai-Sun Wong  2   3 , Victor de Lédinghen  1   6
Affiliations

Liver stiffness measurement predicts long-term survival and complications in non-alcoholic fatty liver disease

Sarah Shili-Masmoudi et al. Liver Int. 2020 Mar.

Abstract

Background and aims: In non-alcoholic fatty liver disease (NAFLD), fibrosis is the strongest prognostic factor and can be assessed by non-invasive methods. We evaluated the ability of liver stiffness measurement (LSM) to predict overall survival and liver, cardiovascular and oncologic complications.

Methods: We prospectively collected data on 2251 consecutive NAFLD patients (mean age 59 years, male 53%, mean body mass index 28 kg/m2 ) in two centres. At inclusion, all patients had LSM, clinical and biological evaluation. During follow-up, we recorded cardiovascular events, cancers, liver complications, liver transplantation and death. The primary endpoint was overall survival. Survival curves according to LSM were first performed using Kaplan-Meier method for the primary endpoint, and Aalen-Johansen method for secondary outcomes to take into account competitive risks. In a second step, a Cox proportional hazard model analysis was done to identify independent predictors of overall survival.

Results: Median follow-up was 27 months [IQR: 25-38]. Fifty-five patients died and three patients had liver transplantation. Overall survival significantly decreased as baseline LSM increased. Twenty-one patients (0.9%) had a liver event, 142 (6.3%) developed cancer (excluding HCC) and 151 (6.7%) had a cardiovascular event during follow-up. By multivariable analysis, independent predictors of overall survival were as follows: baseline LSM (adjusted HR (aHR) = 2.85 [1.65-4.92], P = .0002), age (aHR = 1.11 [1.08-1.13], P < .0001) and male sex (aHR = 2.05 [1.17-3.57], P = .012). Patients with elevated LSM were also more likely to develop cardiovascular, and liver events but not other cancers.

Conclusion: LSM can be used to predict survival, cardiovascular and liver complications in NAFLD patients.

Keywords: NAFLD; fibrosis; morbidity; mortality; prognosis.

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References

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