Higher Liver Stiffness Predicting Adverse Outcomes in Cirrhotic Patients with Child-Pugh Grades A and B
Lin Chunlei1, Ye Qian1, Qu Yundong1
1Department of Infectious Diseases and Hepatolgy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Insights
In patients with mild cirrhosis (Child-Pugh A and B), higher liver stiffness at baseline predicts adverse outcomes within two years. Liver stiffness also improved over 12 months in this cohort.
Area of Science:
- Hepatology
- Gastroenterology
- Medical Diagnostics
Background:
- Child-Pugh grades A and B represent patients with mild to moderate cirrhosis.
- Assessing prognosis in these patients is crucial for management.
- Liver stiffness measurement (LSM) is a non-invasive tool for liver fibrosis assessment.
Purpose of the Study:
- To characterize baseline features and two-year outcomes in patients with Child-Pugh A and B cirrhosis.
- To evaluate the predictive capability of liver stiffness for adverse outcomes (AOs) in this population.
- To explore the role of LSM in predicting liver-related death and hepatocellular carcinoma (HCC).
Main Methods:
- Prospective cohort study conducted between September 2018 and March 2021.
- 174 patients with Child-Pugh A or B cirrhosis were enrolled and followed for two years.
- Liver stiffness and controlled attenuation parameter were measured at baseline, 6, and 12 months; AOs (death, HCC) were recorded.
Main Results:
- Hepatitis B virus (HBV) was the primary cause of cirrhosis in 82.2% of patients.
- Six patients experienced AOs within two years.
- Increased baseline liver stiffness was the sole independent predictor of AOs (OR 1.071, p=0.006); LSM improved significantly at 12 months (median 10.6 vs. 13.3 kPa, p<0.001).
Conclusions:
- Patients with Child-Pugh A and B cirrhosis demonstrate acceptable short-term prognosis.
- Elevated liver stiffness is a significant predictor of two-year adverse outcomes in patients with relatively mild cirrhosis.
- Further research is needed to investigate the prognostic significance of changes in liver stiffness over time.
Objective:
To describe the baseline characteristics and two-year outcomes of patients with Child-Pugh grades A and B cirrhosis; and evaluate the predictive value of liver stiffness for the development of adverse outcomes (AOs) in this patient population.
Study Design:
A prospective cohort study.
Place And Duration Of Study:
The Second Hospital, Cheeloo College of Medicine, Shandong University, China between September 2018 and March 2021.
Methodology:
The present study consecutively included patients with Child-Pugh grades A and B cirrhosis. Patients were followed up every six months until two years. Baseline demographic characteristics and laboratory indexes were collected. Liver stiffness and controlled attenuation parameter were measured at baseline, month 6 and month 12. The observational endpoint was AOs, including liver-related patient death and hepatocellular carcinoma (HCC).
Results:
A total of 174 patients were included in the final cohort. Hepatitis B virus (HBV)-induced liver cirrhosis accounted for the vast majority of enrolled cases (82.2%). AOs were observed in six patients. Multivariate logistic regression model was performed and liver stiffness was considered as the only independent predictor for AOs (OR 1.071, p = 0.006). Liver stiffness was also significantly improved at 12 months compared with the baseline data (median 10.6 vs. 13.3 kPa, p <0.001).
Conclusion:
Patients with Child-Pugh grades A and B cirrhosis had an acceptable short-term prognosis. Greater liver stiffness predicted two-year AOs in these patients with relatively mild cirrhosis. The prognostic value of changes in liver stiffness warrants further investigation. Key Words: Liver cirrhosis, Child-Pugh score, Liver stiffness, Asian population, Outcome.
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