Significantly Increased Liver Stiffness Detected  by ElastPQ Ultrasound Shear Wave Elastography  in Patients with Chronic Liver Disease of Over 75  Years of Age: A Cross-Sectional Study

Derya Demirtaş; Hilmi Erdem Sümbül

doi:10.5152/EurJTher.2019.19033

Authors

Derya Demirtaş Department of Internal Medicine, University of Health Sciences Adana Health Practice and Research Center, Adana https://orcid.org/0000-0001-9449-8759
Hilmi Erdem Sümbül Department of Internal Medicine, University of Health Sciences Adana Health Practice and Research Center, Adana https://orcid.org/0000-0002-7192-0280

DOI:

https://doi.org/10.5152/EurJTher.2019.19033

Keywords:

Aged, chronic hepatitis B and C, non-alcoholic fatty liver disease

Abstract

Objective: Aging is associated with worsening of disease severity and poor prognosis in patients with non-alcoholic fatty liver disease (NAFLD), chronic hepatitis B/C (HBV/HCV), alcoholic liver disease, and liver transplantation. The aim of this study was to determine the frequency of liver fibrosis (LF) and its related parameters by calculating the liver stiffness (LS) value in patients having NAFLD and HBV/HCV who were over 75 years of age.
Methods: A total of 120 individuals over 75 years of age were included in our study, according to their liver disease status as having normal liver function (NLF), NAFLD, or HBV/HCV. The LS measurement was performed with the elastography point quantification (ElastPQ) technique. If a patient had an LS value of >7.0 kPa, he or she was was accepted as having LF.
Results: The LS values of patients over 75 years of age with NLF, NAFLD, and HBV/HCV were 4.75±2.34 kPa, 6.45±3.12 kPa, and 8.68±2.76 kPa, respectively. LF was found to be 25%, 40%, and 70% in the NLF, NAFLD, and HBV/HCV groups, respectively. Creatinine and AST levels were independently associated with the LS value. Creatinine, AST values, and liver size were independently determined to be associated with LF; creatinine (0.1 increase), AST (1 increase), and liver size (1 cm decrease) levels were found to increase the LF by 18.4%, 14.6%, and 42.9% respectively.
Conclusion: Patients with NAFLD and HBV/HCV who were over 75 years old had their level of LS determined by liver elastography, which was increased as compared to those with NLF. Patients older than 75 years of age with NAFLD and HBV/HCV also showed significant decrease in LF as compared to NLF patient.

Metrics

Metrics Loading ...

References

United Nations World Population Prospects: key findings & advanced tables the 2017 Revision. United Nations Publications. New York (NY), 2017.

Kim IH, Kisseleva T, Brenner DA. Aging and liver disease. Curr Opin Gastroenterol 2015; 31: 184-91.

Ferraioli G, De Silvestri A, Reiberger T, Taylor-Robinson SD, de Knegt RJ, Maiocchi L, et al. Adherence to quality criteria improves concordance between transient elastography and ElastPQ for liver stiffness assessment-A multicenter retrospective study. Dig Liver Dis 2018; 50: 1056-61.

Conti F, Serra C, Vukotic R, Felicani C, Mazzotta E, Gitto S, et al. Assessment of Liver Fibrosis with Elastography Point Quantification vs Other Non-Invasive Methods. Clin Gastroenterol Hepatol 2019; 17: 510-7.

Mare R, Sporea I, Lupuşoru R, Şirli R, Popescu A, Danila M, et al. The value of ElastPQ for the evaluation of liver stiffness in patients with B and C chronic hepatopathies. Ultrasonics 2017; 77: 144-51.

Ma JJ, Ding H, Mao F, Sun HC, Xu C, Wang WP. Assessment of liver fibrosis with elastography point quantification technique in chronic hepatitis B virus patients: a comparison with liver pathological results. J Gastroenterol Hepatol 2014; 29: 814-9.

Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology 2018; 67: 1560-99.

Poulose N, Raju R. Aging and injury: alterations in cellular energetics and organ function. Aging Dis 2014; 5: 101-8.

Poynard T, Ratziu V, Charlotte F, Goodman Z, McHutchison J, Albrecht J. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis c. J Hepatol 2001; 34: 730-9.

Ling W, Lu Q, Quan J, Ma L, Luo Y. Assessment of impact factors on shear wave based liver stiffness measurement. Eur J Radiol 2013; 82: 335-41.

Poynard T, Ratziu V, Charlotte F, Goodman Z, McHutchison J, Albrecht J, et al. Point shear wave elastography method for assessing liver stiffness. World J Gastroenterol 2014; 20: 4787-96.

Huang Z, Zheng J, Zeng J, Wang X, Wu T, Zheng R. Normal liver stiffness in healthy adults assessed by real-time shear wave elastography and factors that influence this method. Ultrasound Med Biol 2014; 40: 2549-55.

Wong GL. Non-invasive assessments for liver fibrosis: The crystal ball we long for. J Gastroenterol Hepatol 2018; 33: 1009-15.

Sirli R, Bota S, Sporea I, Jurchis A, Popescu A, Gradinaru-Tascău O, et al. Liver stiffness measurements by means of supersonic shear imaging in patients without known liver pathology. Ultrasound Med Biol 2013; 39: 1362-7.

Popescu A, Sporea I, Sirli R, Bota S, Focşa M, Dănilă M, et al. The mean values of liver stiffness assessed by Acoustic Radiation Force Impulse elastography in normal subjects. Med Ultrason 2011; 13: 33-7.

Kim SU, Choi GH, Han WK, Kim BK, Park JY, Kim DY, et al. What are ‘true normal’ liver stiffness values using FibroScan: a prospective study in healthy living liver and kidney donors in South Korea. Liver Int 2010; 30: 268-74.

Petta S, Wong VW, Cammà C, Hiriart JB, Wong GL, Vergniol J, et al. Serial combination of non-invasive tools improves the diagnostic accuracy of severe liverfibrosis in patients with NAFLD. Aliment Pharmacol Ther 2017; 46: 617-27.

Castera L. Diagnosis of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: Non-invasive tests are enough. Liver Int 2018; 38(suppl 1): 67-70.

Wong VW, Vergniol J, Wong GL, Foucher J, Chan HL, Le Bail B, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology 2010; 51: 454-62.

Koc AS, Sumbul HE. Prediabetes Is Associated With Increased Liver Stiffness Identified by Noninvasive Liver Fibrosis Assessment: ElastPQ Ultrasound Shear Wave Elastography Study. Ultrasound Q. 2019 Feb 4. doi: 10.1097/RUQ.0000000000000419.

Boursier J, Vergniol J, Guillet A, Hiriart JB, Lannes A, Le Bail B, et al. Diagnostic accuracy and prognostic significance of blood fibrosis tests and liver stiffness measurement by FibroScan in non-alcoholic fatty liver disease. J Hepatol 2016; 65: 570-8.