Liver stiffness predicts liver failure, cancer and mortality in cirrhotic patients

 July 10, 2012 Researchers from Spain established that liver stiffness, measured by transient elastography (TE), is an independent predictor of liver failure, hepatocellular carcinoma (HCC), and mortality in cirrhotic patients coinfected with the human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS), and hepatitis C virus (HCV). Findings available in the July issue of Hepatology, a journal published by Wiley on behalf of the American Association for the Study of Liver Diseases, also show that measurement of liver stiffness predicts potential recovery and survival in patients with cirrhosis, adding to the prognosis value provided by the Child-Turcotte-Pugh (CTP) or model for end-stage liver disease (MELD) scores. According to the World Health Organization (WHO), chronic HCV affects up to 170 million people worldwide, with more than 350,000 of those dying from HCV-related liver diseases annually. WHO also reports that in 2010 nearly 34 million individuals worldwide were living with HIV. Additionally, a 2008 report from the Centers for Disease Control and Prevention (CDC) found that mortality rates were highest among those infected with HCV at nearly five deaths per 100,000 people. In fact, since 1999 deaths from HCV have steadily increased and now exceed HIV infection mortalities. For the present study Dr. Nicolás Merchante from the Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme in Sevilla, Spain conducted a multicenter prospective study of cirrhotic patients coinfected with HIV and HCV beginning in February 2006. A total of 239 consecutive HIV/HCV patients with a new diagnosis of compensated cirrhosis participated in the study to assess the predictive value of liver stiffness as measured by TE. Participants were followed between nine and 34 months, and 13% of patients developed liver failure (decompensation). The incidence of decompensation was 6.7 cases per 100 person-years. Researchers reported 15 patient deaths with ten due to liver disease, and liver transplant was performed on one patient. In 8% of 181 patients with baseline liver stiffness less than 40 kPa developed liver failure compared with 29% of 58 patients with liver stiffness greater than 40 kPa. Medical evidence shows that end-stage liver disease from chronic HCV is a leading cause of death in HIV-infected individuals living in western countries. "For patients with end-stage liver disease, transplantation is often the only treatment option," said Dr. Merchante. "Earlier recognition of cirrhosis and optimal treatment of cirrhotic patients at the initial stages are critical. Our findings indicate that liver stiffness predicts risk of liver failure and liver-related deaths in patients with compensated cirrhosis who are coinfected with HIV and HCV, providing more advanced detection of disease severity." The authors suggest that future studies should evaluate if liver stiffness is also an independent prognostic marker in decompensated cirrhosis, which then could be used in conjunction with CTP and MELD scores in considering patients referred for liver transplantation. More information: "Liver Stiffness Predicts Clinical Outcome in Hiv/Hcv-Coinfected Patients with Compensated Liver Cirrhosis." Nicolás Merchante, Antonio Rivero-Juárez, Francisco Téllez, Dolores Merino, Maria José Ríos-Villegas, Manuel Márquez-Solero, Mohamed Omar, Juan Macías, Ángela Camacho, Montserrat Pérez-Pérez, Jesús Gómez-Mateos, Antonio Rivero, Juan Antonio Pineda on behalf of the Grupo Andaluz para el Estudio de las Hepatitis Víricas (HEPAVIR) de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI). Hepatology; (DOI: 10.1002/hep.35616); Print Issue Date: July, 2012. Journal reference: Hepatology 

肝臟纖維掃描儀對肝纖維化的非侵襲性評估

高偉育、蘇建維、侯明志（臨床醫學 2009; 64: 133-40） 肝臟纖維掃描儀（transient elastography (TE, FibroScan?）是一種非侵襲性的新方法，可藉由測量肝硬度（liver stiffness）來評估慢性肝病病患肝纖維化（liver fibrosis）的情形。肝臟纖維掃描儀是一種快速且容易操作的技術，可用於門診或在住院病人的床邊，立即得到結果並有很好的重現性（reproducibility）。約有5%的病例會測量失敗，主要是在肥胖的病人。肝臟纖維掃描儀在慢性C型肝炎患者診斷肝纖維化方面，與肝臟切片結果相較，二者有良好的相關性，合併肝臟纖維掃描儀和血清標記檢驗更可增加診斷的準確性，這樣可避免使用肝切片來對慢性C型肝炎做初期的評估。這個策略可再用於評估其他病因造成的慢性肝疾病。此外，肝臟纖維掃描儀在早期偵測肝硬化及其預後方面，似乎也是一個出色的工具。肝臟纖維掃描儀容易被病人所接受，因此可使用於監測個別病例的肝纖維化惡化和改善之情形。但在臨床上廣泛使用肝臟纖維掃描儀做為診療常規，仍尚需等待更多應用的研究數據以及指導方針來佐證。