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. 2024 Apr;12(3):364-373.
doi: 10.1002/ueg2.12513. Epub 2023 Dec 23.

Predictors of controlled attenuation parameter in metabolic dysfunction

Cristiana Bianco  1 , Serena Pelusi  1 , Sara Margarita  1 , Federica Tavaglione  2   3 , Oveis Jamialahmadi  4 , Francesco Malvestiti  5 , Giulia Periti  1 , Jessica Rondena  1 , Melissa Tomasi  1 , Rossana Carpani  1 , Luisa Ronzoni  1 , Matteo Vidali  6 , Ferruccio Ceriotti  6 , Mirella Fraquelli  7 , Umberto Vespasiani-Gentilucci  2   3 , Stefano Romeo  4   8   9 , Daniele Prati  1 , Luca Valenti  1   5
Affiliations

Predictors of controlled attenuation parameter in metabolic dysfunction

Cristiana Bianco et al. United European Gastroenterol J. 2024 Apr.

Abstract

Background & aims: Hepatic fat content can be non-invasively estimated by controlled attenuation parameter (CAP) during transient elastography. The aim of this study was to examine the determinants and predictors of CAP values in individuals with metabolic dysfunction.

Methods: We enrolled 1230 consecutive apparently healthy individuals (Liver-Bible-2022 cohort) with ≥3 metabolic dysfunction features. CAP was measured by Fibroscan. CAP determinants and predictors were identified using backward stepwise analysis and introduced in generalized linear models.

Results: Participants were predominantly males (82.9%), mean age was 53.8 ± 6.4 years, 600 (48.8%) had steatosis (CAP ≥ 275 dB/m), and 27 had liver stiffness measurement (LSM) ≥ 8 kPa. CAP values correlated with LSM (p < 10-22). In multivariable analysis, fasting insulin and abdominal circumference (AC) were the main determinants of CAP (p < 10-6), together with body mass index (BMI; p < 10-4), age, diabetes, triglycerides, ferritin, and lower HDL and thyroid stimulating hormone (TSH; p < 0.05 for all). In a subset of 592 participants with thyroid hormone measurement, we found an association between higher free triiodothyronine levels, correlating with lower TSH, and CAP values, independent of TSH and of levothyroxine treatment (p = 0.0025). A clinical CAP score based on age, BMI, AC, HbA1c, ALT, and HDL predicted CAP ≥ 275 dB/m with moderate accuracy (AUROC = 0.73), which was better than that of the Fatty Liver Index and of ALT (AUROC = 0.70/0.61, respectively) and validated it in multiple cohorts.

Conclusion: Abdominal adiposity and insulin resistance severity were the main determinants of CAP in individuals with metabolic dysfunction and may improve steatotic liver disease risk stratification. CAP values were modulated by the hypophysis-thyroid axis.

Keywords: CAP; LSM; abdominal circumference; controlled attenuation parameter; fasting insulin; fibroscan; liver stiffness measurement; metabolic syndrome; steatosis; thyroid; transient elastography.

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Conflict of interest statement

The authors declare that they have no conflicts of interest relevant to the present study. LV has received speaking fees from MSD, Gilead, AlfaSigma and AbbVie, served as a consultant for Gilead, Pfizer, AstraZeneca, Novo Nordisk, Intercept, Diatech Pharmacogenetics, Ionis Pharmaceuticals, Boeringher Ingelheim, Resalis and received research grants from Gilead. DP served as a consultant for and has received speaking fees, travel grants, and research grants from Macopharma, Ortho Clinical Diagnostics, Grifols, Terumo, Immucor, Diamed, and Diatech Pharmacogenetics.

Figures

FIGURE 1
FIGURE 1
Comparison of the diagnostic accuracy of non‐invasive markers of SLD in the liver‐bible‐2022 cohort.
See this image and copyright information in PMC

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