Prognostic value of multiparametric magnetic resonance imaging, transient elastography and blood-based fibrosis markers in patients with chronic liver disease
Prognostic value of multiparametric magnetic resonance imaging, transient elastography and blood-based fibrosis markers in patients with chronic liver disease
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DOI：
10.1111/liv.14625
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发表时间：
2020-12-01
影响因子：
6.7
通讯作者：
Pavlides, Michael
中科院分区：
文献类型：
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作者：
Jayaswal, Arjun N. A.;Levick, Christina;Pavlides, Michael
背景和目标 肝脏 cT(1)、肝脏 T-1、瞬时弹性成像 (TE) 和血液生物标志物已被独立证明可以预测临床结果，但尚未在单个患者队列中进行直接比较。我们的目的是比较这些测试在代偿性慢性肝病患者队列中的预后价值。方法对患有未选择的代偿性肝病病因的患者进行基线评估，并对临床结果的发展进行随访，对影像学结果不知情。对预先设定阈值下的非侵入性肝脏检测的预后价值进行了评估，以评估包括腹水、静脉曲张出血、肝性脑病、肝细胞癌、肝移植和死亡率在内的综合临床终点。 结果 对 197 名中位年龄为 54 岁的患者（61% 男性）进行了为期 693 患者年的随访（中位 (IQR) 43 (26-58) 个月）。主要诊断为 NAFLD（41%）、病毒性肝炎（VH，25%）和酒精相关性肝病（ArLD；14%）。随访期间发生 14 起新的临床事件，其中 11 人死亡。临床结果预测为：肝脏 cT(1) > 825ms，HR 9.9（95% CI：1.29-76.4，P = .007）；TE > 8kPa，HR 7.8（95% CI：0.97-62.3，P = .02）；FIB-4 > 1.45，HR 4.09（95% CI： 0.90-18.4，P = .05）。在考虑技术故障和不可靠性的分析中，肝脏 cT(1) > 825 ms 可以预测临床结果 (P = .03)，但 TE > 8kPa 不能 (P = .4)。结论 我们提供了进一步的证据，表明肝脏 cT(1)、TE 和基于血清的生物标志物可以预测临床结果，但当考虑到技术故障/不可靠性时，TE 截止值的表现比 cT(1) 和血液的截止值更差生物标志物。
Background & Aims Liver cT(1), liver T-1, transient elastography (TE) and blood-based biomarkers have independently been shown to predict clinical outcomes but have not been directly compared in a single cohort of patients. Our aim was to compare these tests' prognostic value in a cohort of patients with compensated chronic liver disease.Methods Patients with unselected compensated liver disease aetiologies had baseline assessments and were followed up for development of clinical outcomes, blinded to the imaging results. The prognostic value of non-invasive liver tests at prespecified thresholds was assessed for a combined clinical endpoint comprising ascites, variceal bleeding, hepatic encephalopathy, hepatocellular carcinoma, liver transplantation and mortality.Results One hundred and ninety-seven patients (61% male) with median age of 54 years were followed up for 693 patient-years (median (IQR) 43 (26-58) months). The main diagnoses were NAFLD (41%), viral hepatitis (VH, 25%) and alcohol-related liver disease (ArLD; 14%). During follow-up 14 new clinical events, and 11 deaths occurred. Clinical outcomes were predicted by liver cT(1) > 825ms with HR 9.9 (95% CI: 1.29-76.4, P = .007), TE > 8kPa with HR 7.8 (95% CI: 0.97-62.3, P = .02) and FIB-4 > 1.45 with HR 4.09 (95% CI: 0.90-18.4, P = .05). In analysis taking into account technical failure and unreliability, liver cT(1) > 825 ms could predict clinical outcomes (P = .03), but TE > 8kPa could not (P = .4).Conclusions We provide further evidence that liver cT(1), TE and serum-based biomarkers can predict clinical outcomes, but when taking into account technical failure/unreliability, TE cut-offs perform worse than those of cT(1) and blood biomarkers.