Simon C Ling, Michael R Narkewicz, John C Magee, Randolph K Otto, Nicole Green, Jennifer L Nicholas, Estella M Alonso, Alex J Towbin, Sarah Jane Schwarzenberg, Adina Alazraki, Wikrom Karnsakul, Oscar M Navarro, Marilyn J Siegel, Roger Harned, Boaz Karmazyn, Prakash Masand, Janis Stoll, Joseph J Palermo, A Jay Freeman, Shruti M Paranjape, Wen Ye, Jean P Molleston, Daniel H Leung
Journal: Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society 2023;22(4):745-755
PMID: 37032248
BACKGROUND
This study examines whether heterogeneous (HTG) pattern on liver ultrasound (US) identifies children at risk for advanced cystic fibrosis liver disease (aCFLD).
METHODS
Prospective 6-year multicenter case-controlled cohort study. Children with pancreatic insufficient cystic fibrosis (CF) aged 3-12 years without known cirrhosis underwent screening US. Participants with HTG were matched (by age, Pseudomonas infection status and center) 1:2 with participants with normal (NL) US pattern. Clinical status and laboratory data were obtained annually and US bi-annually for 6 years. Primary endpoint was development of nodular (NOD) US pattern consistent with aCFLD.
RESULTS
722 participants underwent screening US, with 65 HTG and 592 NL. Final cohort included 55 HTG and 116 NL with ≥ 1 follow-up US. ALT, AST, GGTP, FIB-4, GPR and APRI were higher, and platelets were lower in HTG compared to NL. HTG had a 9.5-fold increased incidence (95% confidence interval [CI]:3.4, 26.7, p<0.0001, 32.7% vs 3.4%) of NOD versus NL. HTG had a sensitivity of 82% and specificity of 75% for subsequent NOD. Negative predictive value of a NL US for subsequent NOD was 96%. Multivariate logistic prediction model that included baseline US, age, and log(GPR) improved the C-index to 0.90 compared to only baseline US (C-index 0.78). Based on survival analysis, 50% of HTG develop NOD after 8 years.
CONCLUSIONS
Research US finding of HTG identifies children with CF with a 30-50% risk for aCFLD. A score based on US pattern, age and GPR may refine the identification of individuals at high risk for aCFLD.
CLINICAL TRIAL REGISTRATION
Prospective Study of Ultrasound to Predict Hepatic Cirrhosis in CF: NCT 01,144,507 (observational study, no consort checklist).
Copyright © 2023 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
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