Basal values and changes of liver stiffness predict the risk of disease progression in compensated advanced chronic liver disease

Background and aims: Transient elastography has been proposed as a tool to predict the risk of decompensation in patients with chronic liver disease. We aimed to identify risk groups of disease progression, using a combination of baseline liver stiffness measurement (LSM) and its change over time (delta-LSM) in patients with compensated advanced chronic liver disease (cACLD). Methods: Ninety-four patients with baseline LSM >= 10 kPa, Child-Pugh score 5 and without previous decompensation were included. A second LSM was performed during follow-up and data on liver function and liver-related events were collected. The primary endpoint was a composite that included death, liver decompensation and impairment in at least 1 point in Child-Pugh score. Results: After a median follow-up of 43.6 months, 15% of patients presented the primary endpoint. Multivariate analysis identified baseline LSM (OR 1.12, P = 0.002) and delta-LSM (OR 1.02, P = 0.048) as independent predictors of the primary endpoint. A high risk group represented by patients with baseline LSM >= 21 kPa and delta-LSM >= 10% (risk of progression 47.1%, 95% CI: 23-71%) was identified, while patients with LSM < 21 kPa and delta-LSM < 10% presented zero risk of progression (P = 0.03). Conclusions: Simple classification rules using baseline LSM and delta-LSM identify cACLD patients at low or high risk of disease progression. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.