December 09, 2019
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One-time liver stiffness measurement can predict decompensation in PSC

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A single liver stiffness measurement and changes in liver stiffness over time correlated with hepatic decompensation in patients with primary sclerosing cholangitis, researchers found. However, changes in liver stiffness occurred slowly in those without advanced fibrosis or decompensation.

“As previously described, [magnetic resonance elastography (MRE)] has several advantages over [transient elastography] among those with PSC,” John E. Eaton, MD, from the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “Several of these advantages include an ability to sample a larger volume of the liver and an ability to perform MRE with magnetic resonance cholangiography, which can in turn detect disease related complications and flow limiting strictures that can increase the [liver stiffness] beyond what would be expected for fibrosis alone.”

Eaton and colleagues enrolled 204 patients with PSC who underwent MRE at two time points. The median liver stiffness at the first MRE “normal” (range, 2.32-3.44 kPa) and the overall change in liver stiffness was minimal (0.05 kPa per year).

Notably, liver stiffness progression was slow among patients with lower baseline liver stiffness values and faster among those with higher baseline values.

A single liver stiffness measurement obtained at the second MRE was associated with hepatic decompensation, which occurred in 23 patients (HR = 1.8; 95% CI, 1.57-2.07).

The optimal cut-off for a single liver stiffness measurement to predict decompensation was 4.32 kPa before (HR = 60.41; 95% CI, 17.85-204.47) and after adjusting for liver stiffness change over time per year (HR = 44.17; 95% CI, 12.57-155.16).

A change in liver stiffness of more than 0.34 kPa over time was also an independent predictor of hepatic decompensation before and after adjusting for baseline liver stiffness values and other prognostic covariates including the presence of portal hypertension.

Combining both cut-offs of one-time liver stiffness measurement and change in liver stiffness improved the ability of the individual liver stiffness covariates to predict hepatic decompensation (concordance score = 0.93; 95% CI, 0.88-0.98).

Eaton and colleagues noted, however, that the short-term prognostic implications of an increase rate of liver stiffness progression were attenuated when the current value was low.

“While it is important to note that the change in this biomarker is meaningful, the change in [liver stiffness] does not supersede the prognostic relevance of a single contemporary [liver stiffness] measurement,” the researchers wrote. “These findings raise new questions and have implications for both clinical trials and patient care.” – by Talitha Bennett

Disclosures: Eaton reports that the Mayo Clinic has intellectual property rights and a financial interest related to magnetic resonance elastography. The authors report no other relevant financial disclosures.