2D Shear Wave Elastography Predicts Survival in Advanced Chronic Liver Disease: AIXPLORER PREDICT and VALIDATE

Background and Aims Measurement of liver stiffness (LSM) by 2-dimensional shear wave elastography (2D-SWE) is an established technique to assess significant fibrosis and clinically significant portal hypertension. The aim of this multi-center retrospective study was to assess the value of LSM by 2D-SWE (L-SWE) to predict outcome in advanced chronic liver disease (ACLD) patients.

Method This international multi-center cohort study included patients with ACLD, valid L-SWE at baseline and at least 28-day follow-up. More than 40 % of patients were also recorded of LSM by transient elastography (TE). Clinical and laboratory parameters at baseline as well as complications during follow-up were recorded. An external validation cohort was also established of patients with pSWE measurements. The primary outcome was overall mortality of the patients. The secondary outcome was worsening or development of any decompensation episode.

Results After screening 2,148 patients from 16 centers, 1,827 patients were included. The median age of the study population was 55 years, with approx. 62.4 % males. The median L–SWE was 11.8 kPa (interquartile range: 7.4–24.5). Apart from the MELD score, L-SWE is an independent risk factor of mortality with an AUC of 0.80 (95 %CI: 0.76-0.83). A cut-off of 20 kPa in L-SWE combined with a cut-off of 10 in the MELD score could stratify risk of mortality and development of decompensations. The two-year mortality and decompensations rates were 36.9 % and 61.8 %, respectively, in high-risk patients with L-SWE ≥ 20 kPa and MELD≥10, whereas mortality and decompensation rates were 1.1 % and 3.5 %, respectively, in low-risk patients with L-SWE < 20 kPa and MELD < 10 (M10S20). The M10S20 algorithm was also confirmed with the TE measurement and in external validation cohort for predicting risk of decompensations development and the risk of mortality.

Conclusion This study delivers an easy algorithm for the stratification of patients with ACLD based on L-SWE and MELD score. Patients with L-SWE≥20 kPa combined with MELD score≥10 should be followed closely and receive more intensified care, while patients with low risk can be managed at longer intervals.

Publication History

Article published online:
04 January 2021