Controlled attenuation parameter and alcoholic hepatic steatosis

• Verfasst von: Thiele, Maja [VerfasserIn]
• Verfasst von: Rausch, Vanessa [VerfasserIn]
• Verfasst von: Fluhr, Gabriele [VerfasserIn]
• Verfasst von: Piecha, Felix [VerfasserIn]
• Verfasst von: Müller, Johannes [VerfasserIn]
• Verfasst von: Seitz, Helmut K. [VerfasserIn]
• Verfasst von: Mueller, Sebastian [VerfasserIn]
• Titel: Controlled attenuation parameter and alcoholic hepatic steatosis
• Titelzusatz: diagnostic accuracy and role of alcohol detoxification
• Verf.angabe: Maja Thiele, Vanessa Rausch, Gabriele Fluhr, Maria Kjærgaard, Felix Piecha, Johannes Mueller, Beate Katharina Straub, Monica Lupșor-Platon, Victor De-Ledinghen, Helmut Karl Seitz, Sönke Detlefsen, Bjørn Madsen, Aleksander Krag, Sebastian Mueller
• E-Jahr: 2018
• Jahr: 16 January 2018
• Umfang: 8 S.
• Teil: volume:68
• Teil: year:2018
• Teil: number:5
• Teil: pages:1025-1032
• Teil: extent:8
• Fussnoten: Gesehen am 06.08.2019
• Titel Quelle: Enthalten in: Journal of hepatology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1985
• Jahr Quelle: 2018
• Band/Heft Quelle: 68(2018), 5, Seite 1025-1032
• ISSN Quelle: 1600-0641
• DOI: doi:10.1016/j.jhep.2017.12.029
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Alcohol detoxification
• Sach-SW: Alcoholic liver disease
• Sach-SW: Controlled attenuation parameter
• Sach-SW: Diagnostic test
• Sach-SW: Fatty liver
• Sach-SW: FibroScan
• Sach-SW: Non-invasive
• Sach-SW: Sensitivity
• Sach-SW: Specificity
• Sach-SW: Steatohepatitis
• K10plus-PPN: 1670614484

Abstract

Background & Aims - Controlled attenuation parameter (CAP) is a novel non-invasive measure of hepatic steatosis, but it has not been evaluated in alcoholic liver disease. Therefore, we aimed to validate CAP for the assessment of biopsy-verified alcoholic steatosis and to study the effect of alcohol detoxification on CAP. - Methods - This was a cross-sectional biopsy-controlled diagnostic study in four European liver centres. Consecutive alcohol-overusing patients underwent concomitant CAP, regular ultrasound, and liver biopsy. In addition, we measured CAP before and after admission for detoxification in a separate single-centre cohort. - Results - A total of 562 patients were included in the study: 269 patients in the diagnostic cohort with steatosis scores S0, S1, S2, and S3=77 (28%), 94 (35%), 64 (24%), and 34 (13%), respectively. CAP diagnosed any steatosis and moderate steatosis with fair accuracy (area under the receiver operating characteristic curve [AUC] ≥S1=0.77; 0.71-0.83 and AUC ≥S2=0.78; 0.72-0.83), and severe steatosis with good accuracy (AUC S3=0.82; 0.75-0.88). CAP was superior to bright liver echo pattern by regular ultrasound. CAP above 290dB/m ruled in any steatosis with 88% specificity and 92% positive predictive value, while CAP below 220dB/m ruled out steatosis with 90% sensitivity, but 62% negative predictive value. In the 293 patients who were admitted 6.3days (interquartile range 4-6) for detoxification, CAP decreased by 32±47dB/m (p<0.001). Body mass index predicted higher CAP in both cohorts, irrespective of drinking pattern. Obese patients with body mass index ≥30kg/m2 had a significantly higher CAP, which did not decrease significantly during detoxification. - Conclusions - CAP has a good diagnostic accuracy for diagnosing severe alcoholic liver steatosis and can be used to rule in any steatosis. In non-obese but not in obese, patients, CAP rapidly declines after alcohol withdrawal. - Lay summary - CAP is a new ultrasound-based technique for measuring fat content in the liver, but has never been tested for fatty liver caused by alcohol. Herein, we examined 562 patients in a multicentre setting. We show that CAP highly correlates with liver fat, and patients with a CAP value above 290dB/m were highly likely to have more than 5% fat in their livers, determined by liver biopsy. CAP was also better than regular ultrasound for determining the severity of alcoholic fatty-liver disease. Finally, we show that three in four (non-obese) patients rapidly decrease in CAP after short-term alcohol withdrawal. In contrast, obese alcohol-overusing patients were more likely to have higher CAP values than lean patients, irrespective of drinking.