학술논문
Liver stiffness thresholds to predict disease progression and clinical outcomes in bridging fibrosis and cirrhosis
Document Type
article
Author
Loomba, Rohit; Huang, Daniel Q; Sanyal, Arun J; Anstee, Quentin Mark; Trauner, Michael; Lawitz, Eric J; Ding, Dora; Ma, Lily; Jia, Catherine; Billin, Andrew; Huss, Ryan S; Chung, Chuhan; Goodman, Zachary; Wong, Vincent Wai-Sun; Okanoue, Takeshi; Romero-Gómez, Manuel; Abdelmalek, Manal F; Muir, Andrew; Afdhal, Nezam; Bosch, Jaime; Harrison, Stephen; Younossi, Zobair M; Myers, Robert P
Source
Gut. 72(3)
Subject
Language
Abstract
ObjectiveIn retrospective studies, liver stiffness (LS) by vibration-controlled transient elastography (VCTE) is associated with the risk of liver decompensation in patients with non-alcoholic steatohepatitis (NASH), but prospective data in biopsy-confirmed cohorts with advanced fibrosis are limited. We aimed to establish thresholds for LS by VCTE that predict progression to cirrhosis among patients with bridging fibrosis and hepatic decompensation among patients with cirrhosis due to NASH.DesignWe used data from four randomised placebo-controlled trials of selonsertib and simtuzumab in participants with advanced fibrosis (F3-F4). The trials were discontinued due to lack of efficacy. Liver fibrosis was staged centrally at baseline and week 48 (selonsertib study) or week 96 (simtuzumab study). Associations between LS by VCTE with disease progression were determined using Cox proportional hazards regression analysis.ResultsProgression to cirrhosis occurred in 16% (103/664) of participants with bridging fibrosis and adjudicated liver-related events occurred in 4% (27/734) of participants with baseline cirrhosis. The optimal baseline LS thresholds were ≥16.6 kPa for predicting progression to cirrhosis, and ≥30.7 kPa for predicting liver-related events. Baseline LS ≥16.6 kPa (adjusted HR 3.99; 95% CI 2.66 to 5.98, p