Combining liver stiffness with hyaluronic acid provides superior prognostic performance in chronic hepatitis C

Janne Fuglsang Hansen*, Karen Mølgaard Christiansen, Benjamin Staugaard, Belinda Klemmensen Moessner, Søren Lillevang, Aleksander Krag, Peer Brehm Christensen

*Kontaktforfatter for dette arbejde

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Resumé

Background Non-invasive methods are the first choice for liver fibrosis evaluation in chronic liver diseases, but few studies investigate the ability of combined methods to predict outcomes. Methods 591 chronic hepatitis C patients with baseline liver stiffness (LSM) by FibroScan and hyaluronic acid measurements were identified retrospectively. The patients were grouped by baseline LSM: < 10kPa, 10-16.9kPa, and 17-75kPa. Primary outcomes were all-cause mortality and liver-related mortality, analyzed using cox regression and competing risk regression models, respectively. Results Median follow-up was 46.1 months. Prevalence of cirrhosis at baseline was 107/591 (18.1%). Median LSM was 6.8kPa (IQR 5.3-11.6) and divided into groups, 404/591 (68.4%) had a LSM < 10kPa, 100/591 (16.9%) had a LSM between 10-16.9kPa and 87/591 (14.7%) had a LSM between 17-75kPa. There were 69 deaths, 27 from liver-related disease. 26 patients developed cirrhosis and 30 developed complications of cirrhosis. The mortality rate in the 17-75kPa group was 9.7/100 person-years, compared to 2.2/100 person-years and 1.1/100 person-years in the 10-16.9kPa and <10kPa groups (p<0.005). Liver-related mortality increased 10-fold for each group (p<0.005). Cirrhotic complications occurred almost exclusively in the 17-75kPa group, with an incidence of 10.3/100 person-years, compared to 1.8/100 person-years and 0.2/100 person-years in the 10-16.9kPa and <10kPa groups (p<0.005). Median hyaluronic acid in the 17-75kPa group was approximately 200ng/mL. Patients with a LSM 17-75kPa had significantly higher risks of death, liver-related death, and complications to cirrhosis if their hyaluronic acid measurement was more than or equal to 200ng/mL at baseline, with hazard ratios of 3.25 (95% CI 1.48-7.25), 7.7 (95% CI 2.32-28), and 3.2 (95% CI 1.35-7.39), respectively. Conclusions The combination of LSM and circulating hyaluronic acid measurements significantly improved prognostic ability, relative to LSM alone. Combined static and dynamic markers of liver fibrosis could provide superior risk prediction.

OriginalsprogEngelsk
Artikelnummere0212036
TidsskriftPLOS ONE
Vol/bind14
Udgave nummer2
Antal sider17
ISSN1932-6203
DOI
StatusUdgivet - 1. feb. 2019

Fingeraftryk

chronic hepatitis C
hyaluronic acid
Chronic Hepatitis C
Hyaluronic Acid
Liver
Stiffness
liver
liver cirrhosis
death
Liver Cirrhosis
Liver Diseases
liver diseases
methodology
incidence
Hazards
prediction
Incidence

Citer dette

Hansen, Janne Fuglsang ; Christiansen, Karen Mølgaard ; Staugaard, Benjamin ; Moessner, Belinda Klemmensen ; Lillevang, Søren ; Krag, Aleksander ; Christensen, Peer Brehm. / Combining liver stiffness with hyaluronic acid provides superior prognostic performance in chronic hepatitis C. I: PLOS ONE. 2019 ; Bind 14, Nr. 2.
@article{2d0ed9a9a67e40af957f13d7ce17e8b3,
title = "Combining liver stiffness with hyaluronic acid provides superior prognostic performance in chronic hepatitis C",
abstract = "Background Non-invasive methods are the first choice for liver fibrosis evaluation in chronic liver diseases, but few studies investigate the ability of combined methods to predict outcomes. Methods 591 chronic hepatitis C patients with baseline liver stiffness (LSM) by FibroScan and hyaluronic acid measurements were identified retrospectively. The patients were grouped by baseline LSM: < 10kPa, 10-16.9kPa, and 17-75kPa. Primary outcomes were all-cause mortality and liver-related mortality, analyzed using cox regression and competing risk regression models, respectively. Results Median follow-up was 46.1 months. Prevalence of cirrhosis at baseline was 107/591 (18.1{\%}). Median LSM was 6.8kPa (IQR 5.3-11.6) and divided into groups, 404/591 (68.4{\%}) had a LSM < 10kPa, 100/591 (16.9{\%}) had a LSM between 10-16.9kPa and 87/591 (14.7{\%}) had a LSM between 17-75kPa. There were 69 deaths, 27 from liver-related disease. 26 patients developed cirrhosis and 30 developed complications of cirrhosis. The mortality rate in the 17-75kPa group was 9.7/100 person-years, compared to 2.2/100 person-years and 1.1/100 person-years in the 10-16.9kPa and <10kPa groups (p<0.005). Liver-related mortality increased 10-fold for each group (p<0.005). Cirrhotic complications occurred almost exclusively in the 17-75kPa group, with an incidence of 10.3/100 person-years, compared to 1.8/100 person-years and 0.2/100 person-years in the 10-16.9kPa and <10kPa groups (p<0.005). Median hyaluronic acid in the 17-75kPa group was approximately 200ng/mL. Patients with a LSM 17-75kPa had significantly higher risks of death, liver-related death, and complications to cirrhosis if their hyaluronic acid measurement was more than or equal to 200ng/mL at baseline, with hazard ratios of 3.25 (95{\%} CI 1.48-7.25), 7.7 (95{\%} CI 2.32-28), and 3.2 (95{\%} CI 1.35-7.39), respectively. Conclusions The combination of LSM and circulating hyaluronic acid measurements significantly improved prognostic ability, relative to LSM alone. Combined static and dynamic markers of liver fibrosis could provide superior risk prediction.",
author = "Hansen, {Janne Fuglsang} and Christiansen, {Karen M{\o}lgaard} and Benjamin Staugaard and Moessner, {Belinda Klemmensen} and S{\o}ren Lillevang and Aleksander Krag and Christensen, {Peer Brehm}",
year = "2019",
month = "2",
day = "1",
doi = "10.1371/journal.pone.0212036",
language = "English",
volume = "14",
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issn = "1932-6203",
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Combining liver stiffness with hyaluronic acid provides superior prognostic performance in chronic hepatitis C. / Hansen, Janne Fuglsang; Christiansen, Karen Mølgaard; Staugaard, Benjamin; Moessner, Belinda Klemmensen; Lillevang, Søren; Krag, Aleksander; Christensen, Peer Brehm.

I: PLOS ONE, Bind 14, Nr. 2, e0212036, 01.02.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Combining liver stiffness with hyaluronic acid provides superior prognostic performance in chronic hepatitis C

AU - Hansen, Janne Fuglsang

AU - Christiansen, Karen Mølgaard

AU - Staugaard, Benjamin

AU - Moessner, Belinda Klemmensen

AU - Lillevang, Søren

AU - Krag, Aleksander

AU - Christensen, Peer Brehm

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background Non-invasive methods are the first choice for liver fibrosis evaluation in chronic liver diseases, but few studies investigate the ability of combined methods to predict outcomes. Methods 591 chronic hepatitis C patients with baseline liver stiffness (LSM) by FibroScan and hyaluronic acid measurements were identified retrospectively. The patients were grouped by baseline LSM: < 10kPa, 10-16.9kPa, and 17-75kPa. Primary outcomes were all-cause mortality and liver-related mortality, analyzed using cox regression and competing risk regression models, respectively. Results Median follow-up was 46.1 months. Prevalence of cirrhosis at baseline was 107/591 (18.1%). Median LSM was 6.8kPa (IQR 5.3-11.6) and divided into groups, 404/591 (68.4%) had a LSM < 10kPa, 100/591 (16.9%) had a LSM between 10-16.9kPa and 87/591 (14.7%) had a LSM between 17-75kPa. There were 69 deaths, 27 from liver-related disease. 26 patients developed cirrhosis and 30 developed complications of cirrhosis. The mortality rate in the 17-75kPa group was 9.7/100 person-years, compared to 2.2/100 person-years and 1.1/100 person-years in the 10-16.9kPa and <10kPa groups (p<0.005). Liver-related mortality increased 10-fold for each group (p<0.005). Cirrhotic complications occurred almost exclusively in the 17-75kPa group, with an incidence of 10.3/100 person-years, compared to 1.8/100 person-years and 0.2/100 person-years in the 10-16.9kPa and <10kPa groups (p<0.005). Median hyaluronic acid in the 17-75kPa group was approximately 200ng/mL. Patients with a LSM 17-75kPa had significantly higher risks of death, liver-related death, and complications to cirrhosis if their hyaluronic acid measurement was more than or equal to 200ng/mL at baseline, with hazard ratios of 3.25 (95% CI 1.48-7.25), 7.7 (95% CI 2.32-28), and 3.2 (95% CI 1.35-7.39), respectively. Conclusions The combination of LSM and circulating hyaluronic acid measurements significantly improved prognostic ability, relative to LSM alone. Combined static and dynamic markers of liver fibrosis could provide superior risk prediction.

AB - Background Non-invasive methods are the first choice for liver fibrosis evaluation in chronic liver diseases, but few studies investigate the ability of combined methods to predict outcomes. Methods 591 chronic hepatitis C patients with baseline liver stiffness (LSM) by FibroScan and hyaluronic acid measurements were identified retrospectively. The patients were grouped by baseline LSM: < 10kPa, 10-16.9kPa, and 17-75kPa. Primary outcomes were all-cause mortality and liver-related mortality, analyzed using cox regression and competing risk regression models, respectively. Results Median follow-up was 46.1 months. Prevalence of cirrhosis at baseline was 107/591 (18.1%). Median LSM was 6.8kPa (IQR 5.3-11.6) and divided into groups, 404/591 (68.4%) had a LSM < 10kPa, 100/591 (16.9%) had a LSM between 10-16.9kPa and 87/591 (14.7%) had a LSM between 17-75kPa. There were 69 deaths, 27 from liver-related disease. 26 patients developed cirrhosis and 30 developed complications of cirrhosis. The mortality rate in the 17-75kPa group was 9.7/100 person-years, compared to 2.2/100 person-years and 1.1/100 person-years in the 10-16.9kPa and <10kPa groups (p<0.005). Liver-related mortality increased 10-fold for each group (p<0.005). Cirrhotic complications occurred almost exclusively in the 17-75kPa group, with an incidence of 10.3/100 person-years, compared to 1.8/100 person-years and 0.2/100 person-years in the 10-16.9kPa and <10kPa groups (p<0.005). Median hyaluronic acid in the 17-75kPa group was approximately 200ng/mL. Patients with a LSM 17-75kPa had significantly higher risks of death, liver-related death, and complications to cirrhosis if their hyaluronic acid measurement was more than or equal to 200ng/mL at baseline, with hazard ratios of 3.25 (95% CI 1.48-7.25), 7.7 (95% CI 2.32-28), and 3.2 (95% CI 1.35-7.39), respectively. Conclusions The combination of LSM and circulating hyaluronic acid measurements significantly improved prognostic ability, relative to LSM alone. Combined static and dynamic markers of liver fibrosis could provide superior risk prediction.

U2 - 10.1371/journal.pone.0212036

DO - 10.1371/journal.pone.0212036

M3 - Journal article

VL - 14

JO - P L o S One

JF - P L o S One

SN - 1932-6203

IS - 2

M1 - e0212036

ER -