Z Gastroenterol 2017; 55(08): e57-e299
DOI: 10.1055/s-0037-1605183
Kurzvorträge
Stoffwechsel, Ernährung und gastroenterologische Endokrinologie
Stoffwechsel, Ernährung und gastroenterologische Endokrinologie: Donnerstag, 14 September 2017, 08:00 – 09:36, Rotterdam/Forschungsforum 2
Georg Thieme Verlag KG Stuttgart · New York

Controlled attenuation parameter predicts steatosis in alcoholic liver disease and correlates with poor metabolic phenotype and cardiovascular risk: A biopsy-controlled multicenter study

M Thiele
1   Dpt. of Gastroenterology and Hepatology, Odense University Hospital, Odense, Dänemark
,
V Rausch
2   Innere Medizin, Salem Krankenhaus und Center for Alcohol Research, Universität Heidelberg, Heidelberg, Deutschland
,
B Straub
3   Institut für Pathologie, Universität, Mainz, Deutschland
,
M Lupsor-Platon
4   Department of Ultrasonography, University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology „Prof. Dr. Octavian Fodor”, Cluj-Napoca, Rumänien
,
V Ledinghen
5   Centre d'investigation de la fibrose hépatique, Hopital Haut-Leveque, Pessac, Frankreich
,
HK Seitz
2   Innere Medizin, Salem Krankenhaus und Center for Alcohol Research, Universität Heidelberg, Heidelberg, Deutschland
,
S Detlefsen
1   Dpt. of Gastroenterology and Hepatology, Odense University Hospital, Odense, Dänemark
,
B Madsen
1   Dpt. of Gastroenterology and Hepatology, Odense University Hospital, Odense, Dänemark
,
A Krag
1   Dpt. of Gastroenterology and Hepatology, Odense University Hospital, Odense, Dänemark
,
S Mueller
2   Innere Medizin, Salem Krankenhaus und Center for Alcohol Research, Universität Heidelberg, Heidelberg, Deutschland
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
02. August 2017 (online)

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    Background and aims:

    Fatty liver is a risk factor for liver fibrosis and cardiovascular disease (CVD). While non-alcoholic and alcoholic fatty liver disease are mutually exclusive, the metabolic syndrome (MetS) is common in alcoholic patients, where it may aggravate steatosis and act in synergy with alcohol as a 'second hit'. We therefore aimed to determine the value of controlled attenuation parameter (CAP) for assessment of steatosis and the response of CAP to alcohol detoxification.

    Methods:

    We recruited 225 patients from four European centres with concomitant liver biopsy, metabolic profiling, liver blood tests and measurement of CAP and liver stiffness (FibroScan Echosens, France). Another 340 patients referred for detoxification had CAP measurements at baseline and after abstinence. We used the International Diabetes Federation criteria to define MetS. The Framingham risk score denoted 10-year risk of CVD. Liver histology was assessed according to Kleiner for steatosis (S0 – 3) and fibrosis (F0 – 4).

    Results:

    Eighty of the 225 patients (36%) had S2 or S3 steatosis; 90 (40%) had advanced liver fibrosis. CAP was fairly good to diagnose ≥S2 steatosis (AUC 0.78, 0.72 – 0.84), with a better performance than BLEP (AUC 0.65, AUC comparison P = 0.001). CAP below 250 dB/m2 ruled out S2 steatosis (sens 89%, NPV 88%), while CAP above 300 dB/m2 ruled in ≥S2 steatosis (spec 81%, PPV 61%). 270 dB/m2 was the best overall cut-off (sens 80%, spec 60%, NPV 85%, PPV 53%, 67% correct classifications). In multivariable regression, liver steatosis, MetS and 10-year CVD risk were strong predictors of CAP, rather than amount of alcohol intake. Irrespective of histological steatosis stage, patients with MetS on average had 40 dB/m2 higher CAP than patients without MetS. Every 5% increase in CVD risk corresponded to a 4 dB/m2 CAP increase. In 340 patients admitted to detox, CAP decreased from 291 to 258 dB/m2 during 6 ± 2 days (P < 0.001).

    Conclusion:

    Controlled attenuation parameter is an important tool for alcoholic fatty liver disease. Alcoholic patients with high CAP after short-term detoxification have a poor metabolic profile and higher risk of cardiovascular disease.


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