Background & Aims
Assessment of hepatic steatosis by transient elastography (TE)based controlled attenuation parameter (CAP) might predict hepatic decompensation. Therefore, we aimed to evaluate the prognostic value of CAP in patients with compensated advanced chronic liver disease (cACLD) and decompensated cirrhosis (DC).
A total of 430 patients who underwent TE (liver stiffness 10 kPa) and CAP measurements were included in this retrospective analysis. Half of patients (n = 189) underwent simultaneous HVPG measurement. In cACLD patients, first hepatic decompensation was defined by new onset of ascites, hepatic encephalopathy or variceal bleeding. In patients with DC, the following events were considered as further hepatic decompensation: requirement of paracentesis, admission for/development of grade 3/4 hepatic encephalopathy, variceal (re)bleeding or liverrelated death.
First hepatic decompensation occurred in 25 of 292 (9%) cACLD patients, while 46 of 138 (33%) DC patients developed further hepatic decompensation during a median followup of 22 and 12 months respectively. CAP was not predictive of first (cACLD; per 10 dB/m; hazard ratio [HR]: 0.97, 95% confidence interval [95% CI]: 0.911.03, P = 0.321) or further hepatic decompensation (DC; HR: 0.99, 95% CI: 0.941.03, P = 0.554) in adjusted analysis. Using the wellestablished CAP cutoff of 248 dB/m for hepatic steatosis, the incidence of first (cACLD; P = 0.065) and further hepatic decompensation (DC; P = 0.578) was similar in patients with hepatic steatosis or without. Serum albumin levels (per mg/dL; HR: 0.83, 95% CI: 0.770.89, P < 0.001) and MELDNa (per point; HR: 1.15, 95% CI: 1.041.28, P = 0.006) in cACLD and MELDNa (per point; HR: 1.12, 95% CI: 1.051.19, P < 0.0001) in DC patients were the only parameters independently associated with first and further hepatic decompensation, respectively.
Controlled attenuation parameter does not predict the development of first (cACLD)/further (DC) hepatic decompensation, while serum albumin levels and MELDNa are of prognostic value.