Transient Elastography Accurately Screens for Compensated Advanced Chronic Liver Disease in Patients With Ongoing or Recent Alcohol Withdrawal.

Jean-Jacques Chavagnat, Romain Moirand, Dominique Guyader, Caroline Le Lan, Frederic Oberti, Natacha Lacave-Oberti, Gérard Le Dréau, Jacqueline Kerjean, Christine Silvain, Ludivine Legros, Nicole Bouvard, Cynthia Lemoine, Karim Aziz, Antonia Le Gruyer, Stéphanie Hamonic, Sophie Michalak, Bruno Turlin, Edouard Bardou-Jacquet

Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2022;20(7):1542-1552.e6

PMID: 33588101

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Abstract

BACKGROUND & AIMS

Liver stiffness measurement by transient elastography (TE) is a promising method for staging fibrosis in alcohol-related liver disease, but uncertainties remain regarding the influence of alcohol consumption and thus the ideal timing for TE performance. We evaluated the performance of TE compared with liver biopsy to exclude compensated advanced chronic liver disease (cACLD) in patients hospitalized for alcohol detoxification.

METHODS

Patients were recruited prospectively at 6 in-patient addiction centers in France. Eligible patients had increased aspartate aminotransferase levels, and no history or signs of overt cirrhosis. TE, histology, and biochemistry measurements were obtained within a median of 6 days after alcohol withdrawal. TE and biochemistry were repeated 1 and 2 months later.

RESULTS

The study included 259 patients for per-protocol analysis, of whom 45 (17%) had cACLD. TE identified patients with high accuracy at inclusion and at the 1- and 2-month follow-up evaluation, with area under the curve values of 0.96 (95% CIs, 0.94-0.99), 0.96 (95% CIs, 0.92-0.99), and 0.93 (95% CIs, 0.85-1.00), respectively. In 84% of patients, cACLD was ruled out when liver stiffness was less than 10 kPa (negative predictive value, 99% (95% CIs, 98%-100%)) or ruled in when greater than 25 kPa (positive predictive value, 93% (95% CI, 83%-102%)). Algorithms based on aminotransferase levels and/or bilirubin did not add to the diagnostic performance of TE in this period. Among patients with initial liver stiffness of 10 to 25 kPa, more than half of those with no cACLD showed liver stiffness of less than 10 at 1- and 2-month follow-up testing.

CONCLUSIONS

TE performed during the first 2 months after alcohol cessation is an excellent method for excluding alcohol-related cACLD.

CLINICAL TRIAL NUMBER

NCT01789008.

Address: Service des Maladies du Foie, Rennes, France.; Service des Maladies du Foie, Rennes, France; Université (Univ) Rennes, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE) INSERM, Centre Hospitalier Universitaire (CHU) Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France.; Department of Pathology, Rennes, France.; Department of Pathology, University Hospital, Angers, France.; Epidemiology and Public Health Department, Rennes University Hospital, Rennes, France.; Yves Le Foll Hospital, Saint-Brieuc, France.; Department of Addiction, Caen, France.; Pôle d'Imagerie Médicale, CHU Caen, Caen, France.; Hepatology Unit, Poitiers University Hospital, France.; Service d'Addictologie, Hôpital de Lorient, France.; Service d'Hépato-gastro-enterologie, Hopital de Lorient, France.; Addiction and Psychiatry Department, Angers, France; Hemodynamique, Interaction Fibrose et Invasivite Tumorales Hepatiques (HIFIH) Laboratory, Unité Propre à l'Enseignement Supérieur (UPRES) Equipe Associée (EA)3859, Angers, France.; Hemodynamique, Interaction Fibrose et Invasivite Tumorales Hepatiques (HIFIH) Laboratory, Unité Propre à l'Enseignement Supérieur (UPRES) Equipe Associée (EA)3859, Angers, France; Hepato-gastroenterology Department, Angers University Hospital, Angers, France.; Unité Fonctionelle (UF) Addictologie, Rennes, France.; Université (Univ) Rennes, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE) INSERM, Centre Hospitalier Universitaire (CHU) Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France; Unité Fonctionelle (UF) Addictologie, Rennes, France. Electronic address: [email protected].

DOI: 10.1016/j.cgh.2021.02.021

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MeSH Terms: Alcoholism, Elasticity Imaging Techniques, Humans, Liver, Liver Cirrhosis, Liver Diseases, Substance Withdrawal Syndrome