Prognostic relevance of ARFI elastography in comparison to liver histology and the FIB-4 score

Moritz Klüppel; Werner Adler; Barbara Schellhaas; Daniel Jesper; Markus F Neurath; Lukas Pfeifer

doi:10.1055/a-2178-4808

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2024; 45(03): 316-322
DOI: 10.1055/a-2178-4808

Original Article

Prognostic relevance of ARFI elastography in comparison to liver histology and the FIB-4 score

Prognostische Bedeutung der ARFI-Elastografie im Vergleich zur Leberhistologie und dem FIB-4-Score

Moritz Klüppel

¹Department of Internal Medicine 1, Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany (Ringgold ID: RIN72175)

,

Werner Adler

²Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (Ringgold ID: RIN9171)

,

Barbara Schellhaas

¹Department of Internal Medicine 1, Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany (Ringgold ID: RIN72175)

,

Daniel Jesper

¹Department of Internal Medicine 1, Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany (Ringgold ID: RIN72175)

,

Markus F Neurath

¹Department of Internal Medicine 1, Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany (Ringgold ID: RIN72175)

³German Center Immunotherapy (DZI), Erlangen University Hospital, Erlangen, Germany (Ringgold ID: RIN27168)

,

Lukas Pfeifer

⁴Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany (Ringgold ID: RIN155897)

› Author Affiliations

Abstract

Purpose Liver histology has prognostic relevance and is used in surveillance and therapeutic strategies. This longitudinal study was designed to evaluate the prognostic relevance of ARFI elastography in comparison to liver histology and to the FIB-4 score in a 5-year observation interval.

Materials and Methods Based on the hospital database, patients with an elastography examination of the liver between 2010–2012, a liver biopsy, and a follow-up of 5 years were included in the study. The AUROCs of the events liver-related death, HCC, and liver decompensation/variceal bleeding were calculated for ARFI elastography, liver histology, and FIB-4 and compared using the DeLong test.

Results In the final analysis 113 patients were included with 30 (26.5 %) patients having high-grade fibrosis and 19 (16.8 %) having liver cirrhosis in histology. The AUROC for liver-related death in the 5-year interval (9.7 %, n=11) was 0.80 [0.68–0.92] for ARFI elastography, 0.79 [0.66–0.92] for liver histology, and 0.66 [0.53–0.79] for FIB-4 with a p-value of 0.83 comparing ARFI to histology and a p-value of 0.02 comparing ARFI to FIB-4. The AUROC for liver decompensation/variceal bleeding (13.3 %, n=15) was 0.86 [0.76–0.94] for ARFI, which is significantly higher than the AUROC of liver histology with 0.71 [0.56–0.86] (p=0.02) and FIB-4 with 0.67 [0.54–0.80] (p=0.003). There was no significant difference for the event HCC when comparing ARFI to histology (p=0.33) or FIB-4 (p=0.14).

Conclusion The prognostic value of ARFI elastography seems to not be inferior to liver histology regarding liver-related survival and might even outperform histology and the FIB-4 score for predicting some liver-related complications.

Zusammenfassung

Ziel Die Leberhistologie hat prognostische Relevanz und wird für die Überwachung von Therapiestrategien eingesetzt. In dieser Längsschnittstudie soll die prognostische Bedeutung der ARFI-Elastografie im Vergleich zur Leberhistologie und zum FIB-4-Score in einem 5-Jahres-Intervall untersucht werden.

Material und Methode Anhand der Krankenhaus-Datenbank wurden Patienten mit einer ARFI-Untersuchung der Leber zwischen 2010–2012, einer Leberbiopsie sowie einem Follow-up von 5 Jahren in die Studie aufgenommen. Die AUROCs der Ereignisse leberabhängiges Überleben, HCC und Leberdekompensation/Varizenblutung wurden für die ARFI-Elastografie, Leberhistologie und FIB-4 berechnet und verglichen.

Ergebnisse Es wurden 113 Patienten einbezogen, von denen 30 (26,5%) eine hochgradige Fibrose und 19 (16,8%) eine Leberzirrhose aufwiesen. Die AUROC für leberabhängiges Überleben (9,7%, n=11) betrug 0,80 [0,68–0,92] für ARFI, 0,79 [0,66–0,92] für die Histologie und 0,66 [0,53–0,79] für den FIB-4 Score mit einem p-Wert von 0,83 im Vergleich ARFI vs. Histologie und einem p-Wert von 0,02 im Vergleich ARFI vs. FIB-4. Die AUROC für Leberdekompensation/Varizenblutung (13,3%, n=15) war mit 0,86 [0,76–0,94] für ARFI signifikant höher als die der Histologie mit 0,71 [0,56–0,86] (p=0,02) und FIB-4 mit 0,67 [0,54–0,80] (p=0,003). Für das Ereignis HCC gab es keinen Unterschied zwischen ARFI und Histologie (p=0,33) oder FIB-4 (p=0,14).

Schlussfolgerung Der prognostische Wert der ARFI-Elastografie scheint der Leberhistologie in Bezug auf das leberabhängige Überleben nicht unterlegen zu sein und könnte die Histologie und den FIB-4-Score bei der Vorhersage einiger leberbezogener Komplikationen übertreffen.

Keywords

ARFI elastography - liver fibrosis - liver cirrhosis - FIB-4 Score - liver histology

Full Text

References

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