Liver stiffness worsens among NAFLD patients with stage 3 fibrosis

The annual risk for cirrhosis based on liver stiffness criteria was 7% among patients with nonalcoholic fatty liver disease enriched with nonalcoholic steatohepatitis, according to research presented at The Digital International Liver Congress.

“In this study with a midterm follow-up, the liver stiffness significantly worsened only those with stage 3 fibrosis on baseline liver biopsy,” Naga P. Chalasani, MD, from Indiana University School of Medicine, gastroenterology and hepatology, said during his presentation. “These observations might be useful in clinical practice and for designing early phase clinical trials with noninvasive endpoints.”

Chalasani and colleagues performed vibration transient elastography starting in 2014 in 1,010 patients from the NASH Clinical Research Network database 2 study who had biopsy-proven NAFLD. Of these patients, 58% had definite NASH and 8% had cirrhosis on biopsy. Investigators estimated change in liver stiffness over time with random effects models, the Kaplan-Meier estimator for time to event statistics and stepwise Cox regression to assess risk factor analysis of 22 clinical, anthropometrics, histological and laboratory variables at first VCTE visit.

Results showed liver stiffness increased over time in patients with baseline stage liver fibrosis (0.57; 95% CI, 0.22-0.93 kPa/year); whereas, it did not increase in patients with other liver fibrosis stages (0.995; 95% CI, 0.992–0.998), higher portal inflammation by each point (HR = 1.5; 95% CI, 1.0–2.2), higher fibrosis by one stage (HR = 1.7; 95% CI, 1.4–2), higher international normalized ratio by 0.1 (HR = 3.3; 95% CI, 1–10.6), lobular inflammation by each point (HR = 0.8; 95% CI, 0.6–1),, and higher gamma-glutamyl transferase per U/L (HR = 1.003; 95% CI, 1–1.006) were among the risk factors associated with progression to cirrhosis.

“During follow-up in those who did not have cirrhosis at first VCTE, the annual risk was 6.8%, stiffness and the 25th percentile time to development of liver stiffness was 4.4 years,” Chalasani said. “In other words, 25% of patients in our cohort without cirrhosis at baseline VCTE developed cirrhosis by criteria in 4.4 years.”