Poster Presentations

Session Title: CIRRHOSIS AND COMPLICATIONS - b)CLINICAL ASPECTS
Presentation Date: Apr 23, 2009

PROGNOSTIC VALUE OF TRANSIENT ELASTOGRAPHY AND NON-INVASIVE MARKERS OF FIBROSIS IN PATIENTS WITH CHRONIC LIVER DISEASE. A PROSPECTIVE ANALYSIS OF 4,935 PERSON-YEARS

J. Vergniol, J. Foucher, E. Terrebonne, J. Font, W. Merrouche, P. Couzigou, V. de Ledinghen
Hopital Haut Leveque, Pessac, France

The aim of this prospective study was to compare the 5-year prognostic value of transient elastography (TE), FibroTest (FT), APRI, FIB-4, Lok, and Child-Pugh score for predicting overall and specific survival, and cirrhosis decompensation in patients with chronic liver disease.
FibroScan and biomarkers were assessed in a cohort of 1346 patients (mean age 51 years) between April 2003 and February 2005. Median follow-up was 44 months (CI 95% 40-50). Aetiologies of liver diseases were HCV infection in 956 cases, HBV in 102, HIVHCV in 63, alcohol in 149, NAFLD in 72, HBVHCV in 4.
A total of 92 patients died (61 specific deaths from liver disease). At 50 months, overall survival was 92%. Overall survival and specific survival were significantly lower in patients with TE >20 kPa, FT >0.74, APRI >2, FIB-4 >3, Lok >0.5, Child-Pugh score > 6 (p< 0.0001). Portal hypertension worsening, and hepatocellular carcinoma development were significantly more frequent in patients with TE >20 kPa, FT >0.74, APRI >2, FIB-4 >3, LOK >0.5, Child-Pugh score > 6 (p< 0.0001) (Kaplan-Meier survival).
By multivariate analysis, factors associated with overall survival were TE > 20 kPa (OR 6.9 CI95% 3.2-14.8, p< 0.0001), FT > 0.74 (2.1, 1.1-4.2, p=0.03) and FIB-4 > 3 (3.0, 1.3-7.0, p=0.01). Only TE > 20 kPa (OR 7.7, 3.0-20.1, p< 0.0001) was associated with specific survival. Factors associated with portal hypertension worsening were TE > 20 kPa (p< 0.0001), FT > 0.74 (p=0.009) and Lok>0.5 (p=0.002). No factor was associated with hepatocellular carcinoma development.
TE has a better predictor than other tests for overall survival with area under the ROC curve of 0,86 (CI95% 0.81-0.91) vs 0,83 (95%CI 0,78-0,89) for FT and FIB-4, 0.83 (0.78-0.88) for Lok, 0.76 (0.69-0.82) for APRI, and 0.64 (0.58-0.72) for Child-Pugh Score > 6.
In conclusion, all non-invasive methods have a prognostic value in patients with chronic liver disease. However, TE is the only method associated with both overall and specific survival and portal hypertension worsening, even by comparison with Child-Pugh score > 6. Therefore, TE could be very useful for the decision of TIPS insertion or liver transplantation.