The associations between fibrosis changes and liver-related events in patients with metabolic dysfunction-associated steatotic liver disease
Corresponding Author
Hye Won Lee
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
Correspondence
Hye Won Lee, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, Republic of Korea.
Email: [email protected]
Jonggi Choi, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected]
Search for more papers by this authorKun Hee Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorSang Hoon Ahn
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
Search for more papers by this authorHan Chu Lee
Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorCorresponding Author
Jonggi Choi
Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Correspondence
Hye Won Lee, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, Republic of Korea.
Email: [email protected]
Jonggi Choi, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Hye Won Lee
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
Correspondence
Hye Won Lee, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, Republic of Korea.
Email: [email protected]
Jonggi Choi, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected]
Search for more papers by this authorKun Hee Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorSang Hoon Ahn
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
Search for more papers by this authorHan Chu Lee
Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorCorresponding Author
Jonggi Choi
Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Correspondence
Hye Won Lee, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, Republic of Korea.
Email: [email protected]
Jonggi Choi, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected]
Search for more papers by this authorHandling Editor: Dr. Luca Valenti
Abstract
Background
The prognosis of metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with liver fibrosis. We investigated the associations between changes in liver stiffness measurement (LSM) over 3-year period and the development of cirrhosis or hepatocellular carcinoma (HCC) in patients with MASLD.
Methods
This study involved patients with MASLD who underwent transient elastography at baseline and 3 years after baseline from 2012 to 2020. Low (L), indeterminate (I) and high (H) LSM values were classified as <8 kPa, 8–12 kPa and >12 kPa respectively.
Results
Among 1738 patients, 150 (8.6%) were diagnosed with cirrhosis or HCC. The proportions of patients with L, I and H risk were 69.7%, 19.9% and 10.5% at baseline, and 78.8%, 12.8% and 8.4% at 3 years after baseline, respectively. The incidence rates of cirrhosis or HCC per 1000 person-years were 3.7 (95% confidence interval [CI], 2.4–5.5) in the L → L + I group, 23.9 (95% CI, 17.1–32.6) in the I → L + I group, 38.3 (95% CI, 22.3–61.3) in the H → L + I group, 62.5 (95% CI, 32.3–109.2) in the I → H group, 67.8 (95% CI, 18.5–173.6) in the L → H group and 93.9 (95% CI 70.1–123.1) in the H → H group. Two risk factors for the development of cirrhosis or HCC were LSM changes and low platelet counts.
Conclusion
LSM changes could predict clinical outcomes in patients with MASLD. Thus, it is important to monitor changes in the fibrotic burden by regular assessment of LSM values.
CONFLICT OF INTEREST STATEMENT
The authors do not have any disclosures to report.
Supporting Information
| Filename | Description |
|---|---|
| liv15897-sup-0001-Supinfo.docxWord 2007 document , 186.2 KB |
Data S1. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Rinella ME, Lazarus JV, Ratziu V, et al. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Ann Hepatol. 2023; 29:101133.
- 2Wong VW-S, Ekstedt M, Wong GL-H, Hagström H. Changing epidemiology, global trends and implications for outcomes of NAFLD. J Hepatol. 2023; 79: 842-852.
- 3Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023; 77: 1335.
- 4Taylor RS, Taylor RJ, Bayliss S, et al. Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis. Gastroenterology. 2020; 158: 1611-1625.e12.
- 5Dulai PS, Singh S, Patel J, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017; 65: 1557-1565.
- 6Simon TG, Roelstraete B, Khalili H, Hagström H, Ludvigsson JF. Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort. Gut. 2021; 70: 1375-1382.
- 7Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but No other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015; 149: 389-397.e10.
- 8Hagström H, Nasr P, Ekstedt M, et al. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017; 67: 1265-1273.
- 9Wong VW, Wong GL, Choi PC, et al. Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years. Gut. 2010; 59: 969-974.
- 10Kang SH, Lee HW, Yoo JJ, et al. KASL clinical practice guidelines: management of nonalcoholic fatty liver disease. Clin Mol Hepatol. 2021; 27: 363-401.
- 11Singh S, Allen AM, Wang Z, Prokop LJ, Murad MH, Loomba R. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol. 2015; 13: 643-654.e1-9; quiz e39-40, 654.e9.
- 12Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999; 116: 1413-1419.
- 13Ahmed A, Wong RJ, Harrison SA. Nonalcoholic fatty liver disease review: diagnosis, treatment, and outcomes. Clin Gastroenterol Hepatol. 2015; 13: 2062-2070.
- 14 EASL-ALEH Clinical Practice Guidelines. Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015; 63: 237-264.
- 15Cholankeril G, Kramer JR, Chu J, et al. Longitudinal changes in fibrosis markers are associated with risk of cirrhosis and hepatocellular carcinoma in non-alcoholic fatty liver disease. J Hepatol. 2023; 78: 493-500.
- 16Siddiqui MS, Yamada G, Vuppalanchi R, et al. Diagnostic accuracy of noninvasive fibrosis models to detect change in fibrosis stage. Clin Gastroenterol Hepatol. 2019; 17: 1877-1885.e5.
- 17Zhang X, Wong GL, Wong VW. Application of transient elastography in nonalcoholic fatty liver disease. Clin Mol Hepatol. 2020; 26: 128-141.
- 18Chon YE, Jung KS, Kim SU, et al. Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver diseases: a prospective study of a native Korean population. Liver Int. 2014; 34: 102-109.
- 19Sasso M, Beaugrand M, de Ledinghen V, et al. Controlled attenuation parameter (CAP): a novel VCTE™ guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010; 36: 1825-1835.
- 20Zhang S, Mak LY, Yuen MF, Seto WK. Screening strategy for non-alcoholic fatty liver disease. Clin Mol Hepatol. 2023; 29: S103-S122.
- 21Chon YE, Choi EH, Song KJ, et al. Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: a meta-analysis. PLoS ONE. 2012; 7:e44930.
- 22De A, Keisham A, Mishra S, et al. FibroScan-AST (FAST) score for nonalcoholic Steatohepatitis - validation in an Indian cohort. J Clin Exp Hepatol. 2022; 12: 440-447.
- 23Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007; 45: 846-854.
- 24John K, Franck M, Al Aoua S, et al. Non-invasive detection of fibrotic NASH in NAFLD patients with low or intermediate FIB-4. J Clin Med. 2022; 11: 4394.
- 25Lee HW, Yoo EJ, Kim BK, et al. Prediction of development of liver-related events by transient elastography in hepatitis B patients with complete virological response on antiviral therapy. Am J Gastroenterol. 2014; 109: 1241-1249.
- 26Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023; 77: 1797-1835.
- 27Mózes FE, Lee JA, Selvaraj EA, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis. Gut. 2022; 71: 1006-1019.
- 28Hsu C, Caussy C, Imajo K, et al. Magnetic resonance vs transient Elastography analysis of patients with nonalcoholic fatty liver disease: a systematic review and pooled analysis of individual participants. Clin Gastroenterol Hepatol. 2019; 17: 630-637.e8.
- 29Siddiqui MS, Vuppalanchi R, Van Natta ML, et al. Vibration-controlled transient Elastography to assess fibrosis and steatosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2019; 17: 156-163.e2.
- 30Petta S, Sebastiani G, Viganò M, et al. Monitoring occurrence of liver-related events and survival by transient Elastography in patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease. Clin Gastroenterol Hepatol. 2021; 19: 806-815.e5.
- 31Gidener T, Dierkhising RA, Mara KC, et al. Change in serial liver stiffness measurement by magnetic resonance elastography and outcomes in NAFLD. Hepatology. 2023; 77: 268-274.
- 32Lee HW, Wong GLH, Kwok R, et al. Serial transient elastography examinations to monitor patients with type 2 diabetes: a prospective cohort study. Hepatology. 2020; 72: 1230-1241.
- 33Fan JG, Kim SU, Wong VW. New trends on obesity and NAFLD in Asia. J Hepatol. 2017; 67: 862-873.
- 34Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021; 161: 1657-1669.
- 35Udompap P, Therneau TM, Canning RE, Benson JT, Allen AM. Performance of American Gastroenterological Association clinical care pathway for the risk stratification of patients with nonalcoholic fatty liver disease in the US population. Hepatology. 2023; 77: 931-941.
Citing Literature
