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Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis

Authors
 Thomas Karlas  ;  David Petroff  ;  Magali Sasso  ;  Jian-Gao Fan  ;  Yu-Qiang Mi  ;  Victor de Lédinghen  ;  Manoj Kumar  ;  Monica Lupsor-Platon  ;  Kwang-Hyub Han  ;  Ana C Cardoso  ;  Giovanna Ferraioli  ;  Wah-Kheong Chan  ;  Vincent Wai-Sun Wong  ;  Robert P Myers  ;  Kazuaki Chayama  ;  Mireen Friedrich-Rust  ;  Michel Beaugrand  ;  Feng Shen  ;  Jean-Baptiste Hiriart  ;  Shiv K Sarin  ;  Radu Badea  ;  Kyu Sik Jung  ;  Patrick Marcellin  ;  Carlo Filice  ;  Sanjiv Mahadeva  ;  Grace Lai-Hung Wong  ;  Pam Crotty  ;  Keiichi Masaki  ;  Joerg Bojunga  ;  Pierre Bedossa  ;  Volker Keim  ;  Johannes Wiegand 
Citation
 JOURNAL OF HEPATOLOGY, Vol.66(5) : 1022-1030, 2017-05 
Journal Title
JOURNAL OF HEPATOLOGY
ISSN
 0168-8278 
Issue Date
2017-05
MeSH
Adult ; Body Mass Index ; Fatty Liver / diagnostic imaging* ; Fatty Liver / pathology ; Female ; Hepatocytes / pathology ; Humans ; Male ; Meta-Analysis as Topic ; Middle Aged ; ROC Curve ; Ultrasonography*
Keywords
Controlled attenuation parameter (CAP) ; Liver steatosis ; Transient elastography (TE)
Abstract
Background & aims: The prevalence of fatty liver underscores the need for non-invasive characterization of steatosis, such as the ultrasound based controlled attenuation parameter (CAP). Despite good diagnostic accuracy, clinical use of CAP is limited due to uncertainty regarding optimal cut-offs and the influence of covariates. We therefore conducted an individual patient data meta-analysis.

Methods: A review of the literature identified studies containing histology verified CAP data (M probe, vibration controlled transient elastography with FibroScan®) for grading of steatosis (S0-S3). Receiver operating characteristic analysis after correcting for center effects was used as well as mixed models to test the impact of covariates on CAP. The primary outcome was establishing CAP cut-offs for distinguishing steatosis grades.

Results: Data from 19/21 eligible papers were provided, comprising 3830/3968 (97%) of patients. Considering data overlap and exclusion criteria, 2735 patients were included in the final analysis (37% hepatitis B, 36% hepatitis C, 20% NAFLD/NASH, 7% other). Steatosis distribution was 51%/27%/16%/6% for S0/S1/S2/S3. CAP values in dB/m (95% CI) were influenced by several covariates with an estimated shift of 10 (4.5-17) for NAFLD/NASH patients, 10 (3.5-16) for diabetics and 4.4 (3.8-5.0) per BMI unit. Areas under the curves were 0.823 (0.809-0.837) and 0.865 (0.850-0.880) respectively. Optimal cut-offs were 248 (237-261) and 268 (257-284) for those above S0 and S1 respectively.

Conclusions: CAP provides a standardized non-invasive measure of hepatic steatosis. Prevalence, etiology, diabetes, and BMI deserve consideration when interpreting CAP. Longitudinal data are needed to demonstrate how CAP relates to clinical outcomes.

Lay summary: There is an increase in fatty liver for patients with chronic liver disease, linked to the epidemic of the obesity. Invasive liver biopsies are considered the best means of diagnosing fatty liver. The ultrasound based controlled attenuation parameter (CAP) can be used instead, but factors such as the underlying disease, BMI and diabetes must be taken into account. Registration: Prospero CRD42015027238.
Full Text
https://www.sciencedirect.com/science/article/pii/S0168827816307553
DOI
10.1016/j.jhep.2016.12.022
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Jung, Kyu Sik(정규식)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/195776
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