Journal Mobile Options
Table of Contents
Vol. 85, No. 3, 2012
Issue release date: May 2012

Risk Assessment of Development of Hepatic Decompensation in Histologically Proven Hepatitis B Viral Cirrhosis Using Liver Stiffness Measurement

Kim B.K. · Park Y.N. · Kim D.Y. · Park J.Y. · Chon C.Y. · Han K.-H. · Ahn S.H.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background/Aims: There are few studies regarding the predictive value of liver stiffness measurement (LSM) for development of hepatic decompensation. We assessed the risk of hepatic decompensations in B-viral compensated cirrhosis, using an LSM and LSM-based model (LSM-spleen diameter to platelet ratio score, LSPS = LSM × spleen diameter/platelet count) in a prospective, longitudinal study. Methods: We analyzed 217 patients with histologically proven B-viral cirrhosis, well-preserved liver function, and no history of decompensation. The Kaplan-Meier and Cox regression method were used to examine the major endpoint, time to the first decompensation event, defined as development of ascites, hepatic encephalopathy, variceal hemorrhage, and deterioration of liver function to Child-Pugh class B/C. Results: During follow-up, 26 patients experienced hepatic decompensation, ascites (n = 22), hepatic encephalopathy (n = 11), variceal hemorrhage (n = 9), and deterioration of liver function (n = 20). For risk stratification, patients were grouped as LSM <13, 13–18, and ≥18 kPa, and from multivariate analysis, patients with LSM 13–18 kPa [hazard ratio (HR) 4.547/ p = 0.044] and ≥18 kPa (HR 12.446/p < 0.001) retained independently higher risks than patients with LSM <13 kPa. Similarly, when patients were grouped as LSPS <1.1, 1.1–2.5, and ≥2.5, those with LSPS 1.1–2.5 (HR 5.796/p = 0.004) and ≥2.5 (HR 13.618/p < 0.001) retained independently higher risks than those with LSPS <1.1. Conclusion: LSM and LSPS are useful in risk assessment of hepatic decompensation among complication-naive B-viral cirrhotic patients.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Han KH, Yoon KT: New diagnostic method for liver fibrosis and cirrhosis. Intervirology 2008;51(suppl 1):11–16.

    External Resources

  2. Cadranel JF, Rufat P, Degos F: Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology 2000;32:477–481.
  3. Bosch J, Berzigotti A, Garcia-Pagan JC, Abraldes JG: The management of portal hypertension: rational basis, available treatments and future options. J Hepatol 2008;48(suppl 1):S68–S92.

    External Resources

  4. Thalheimer U, Mela M, Patch D, Burroughs AK: Targeting portal pressure measurements: a critical reappraisal. Hepatology 2004;39:286–290.

    External Resources

  5. Smith JO, Sterling RK: Systematic review: non-invasive methods of fibrosis analysis in chronic hepatitis C. Aliment Pharmacol Ther 2009;30:557–576.
  6. Castera L, Forns X, Alberti A: Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol 2008;48:835–847.
  7. Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, Petrarca A, Moscarella S, Belli G, Zignego AL, Marra F, Laffi G, Pinzani M: Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology 2007;45:1290–1297.
  8. Kazemi F, Kettaneh A, N’Kontchou G, Pinto E, Ganne-Carrie N, Trinchet JC, Beaugrand M: Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. J Hepatol 2006;45:230–235.
  9. Castera L, Le Bail B, Roudot-Thoraval F, Bernard PH, Foucher J, Merrouche W, Couzigou P, de Lédinghen V: Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: Comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores. J Hepatol 2009;50:59–68.
  10. Kim BK, Han KH, Park JY, Ahn SH, Kim JK, Paik YH, Lee KS, Chon CY, Kim Do Y: A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis. Am J Gastroenterol 2010;105:1382–1390.

    External Resources

  11. Kim BK, Kim DY, Han KH, Park JY, Kim JK, Paik YH, Lee KS, Chon CY, Ahn SH: Risk assessment of esophageal variceal bleeding in B-viral liver cirrhosis by a liver stiffness measurement-based model. Am J Gastroenterol 2011;106:1654–1662.

    External Resources

  12. Bedossa P, Poynard T: An algorithm for the grading of activity in chronic hepatitis C. The Metavir Cooperative Study Group. Hepatology 1996;24:289–293.
  13. Dittrich M, Milde S, Dinkel E, Baumann W, Weitzel D: Sonographic biometry of liver and spleen size in childhood. Pediatr Radiol 1983;13:206–211.
  14. Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M: Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology 2005;41:48–54.
  15. Heagerty PJ, Lumley T, Pepe MS: Time-dependent roc curves for censored survival data and a diagnostic marker. Biometrics 2000;56:337–344.
  16. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC: A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000;31:864–871.
  17. Fluss R, Faraggi D, Reiser B: Estimation of the Youden index and its associated cutoff point. Biom J 2005;47:458–472.

    External Resources

  18. Ripoll C, Groszmann R, Garcia-Tsao G, Grace N, Burroughs A, Planas R, Escorsell A, Garcia-Pagan JC, Makuch R, Patch D, Matloff DS, Bosch J: Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology 2007;133:481–488.
  19. Robic MA, Procopet B, Metivier S, Peron JM, Selves J, Vinel JP, Bureau C: Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study. J Hepatol 2011;55:1017–1024.

    External Resources

  20. Rockey DC: Noninvasive assessment of liver fibrosis and portal hypertension with transient elastography. Gastroenterology 2008;134:8–14.

    External Resources

  21. Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, Mele MR, Testa E, Mansi C, Savarino V, Testa R: Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 2003;52:1200–1205.
  22. Giannini EG: Thrombocytopenia in chronic liver disease and pharmacologic treatment options. Aliment Pharmacol Ther 2006;23:1055–1065.
  23. Poynard T, Trabut JB, Ratziu V, Thabut D: Prediction of oesophageal varices with platelet count/spleen diameter ratio or platelets alone. Gut 2004;53:913–914.

    External Resources

  24. Kim BK, Kim SA, Park YN, Cheong JY, Kim HS, Park JY, Cho SW, Han KH, Chon CY, Moon YM, Ahn SH: Noninvasive models to predict liver cirrhosis in patients with chronic hepatitis B. Liver international 2007;27:969–976.
  25. Kim BK, Han KH, Park JY, Ahn SH, Kim JK, Paik YH, Lee KS, Chon CY, Kim do Y: Prospective validation of p2/ms noninvasive index using complete blood counts for detecting oesophageal varices in b-viral cirrhosis. Liver International 2010;30:860–866.

    External Resources

  26. Kim BK, Han KH, Park JY, Ahn SH, Chon CY, Kim JK, Paik YH, Lee KS, Park YN, Kim do Y: A novel liver stiffness measurement-based prediction model for cirrhosis in hepatitis B patients. Liver Int 2011;30:1073–1081.

    External Resources

  27. Lok AS, McMahon BJ: Chronic hepatitis B: update 2009. Hepatology 2009;50:661–662.
  28. Wiegand J, van Bommel F, Berg T: Management of chronic hepatitis B: status and challenges beyond treatment guidelines. Semin Liver Dis 2010;30:361–377.
  29. European Association for the Study of the Liver: EASL Clinical Practice Guidelines: management of chronic hepatitis B. J Hepatol 2009;50:227–242.
  30. Liaw YF, Leung N, Kao JH, Piratvisuth T, Gane E, Han KH, Guan R, Lau GK, Locarnini S: Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int 2008;2:263–283.
  31. Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, Tanwandee T, Tao QM, Shue K, Keene ON, Dixon JS, Gray DF, Sabbat J: Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004;351:1521–1531.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50