OBJECTIVE: Liver stiffness measurement (LSM) is a tool used to screen for significant fibrosis and portal hypertension. The aim of this retrospective multicentre study was to develop an easy tool using LSM for clinical outcomes in advanced chronic liver disease (ACLD) patients. DESIGN: This international multicentre cohort study included a derivation ACLD patient cohort with valid two-dimensional shear wave elastography (2D-SWE) results. Clinical and laboratory parameters at baseline and during follow-up were recorded. LSM by transient elastography (TE) was also recorded if available. The primary outcome was overall mortality. The secondary outcome was the development of first/further decompensation. RESULTS: After screening 2148 patients (16 centres), 1827 patients (55 years, 62.4% men) were included in the 2D-SWE cohort, with median liver SWE (L-SWE) 11.8 kPa and a model for end stage liver disease (MELD) score of 8. Combination of MELD score and L-SWE predict independently of mortality (AUC 0.8). L-SWE cut-off at ≥20 kPa combined with MELD ≥10 could stratify the risk of mortality and first/further decompensation in ACLD patients. The 2-year mortality and decompensation rates were 36.9% and 61.8%, respectively, in the 305 (18.3%) high-risk patients (with L-SWE ≥20 kPa and MELD ≥10), while in the 944 (56.6%) low-risk patients, these were 1.1% and 3.5%, respectively. Importantly, this M10LS20 algorithm was validated by TE-based LSM and in an additional cohort of 119 patients with valid point shear SWE-LSM. CONCLUSION: The M10LS20 algorithm allows risk stratification of patients with ACLD. Patients with L-SWE ≥20 kPa and MELD ≥10 should be followed closely and receive intensified care, while patients with low risk may be managed at longer intervals.

Bern University Hospital Bern Switzerland

CHU Bordeaux and INSERM U1053 Bordeaux University Bordeaux France

Department of Gastroenterology and Hepatology Odense University Hospital Odense Denmark

Department of Gastroenterology Hepatology Antwerp University Hospital Antwerp Belgium

Department of Hepato Gastroenterology Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Internal Medicine 1 Frankfurt University Hospital Frankfurt am Main Hessen Germany

Department of Radiology Beaujon University Hospital Clichy France

Department of Radiology Saint Jean Hospital Perpignan France

Department of Ultrasound Guangdong Key Laboratory of Liver Disease Research 3rd Affiliated Hospital of Sun Yat Sen University Guangzhou Guangdong China

Division of Gastroenterology and Hepatology Department of Internal Medicine 3 Medical University of Vienna Wien Austria

European Foundation for the Study of Chronic Liver Failure Barcelona Catalunya Spain

Fédération des Spécialités Digestives Hôpital Edouard Herriot Lyon France

Gastroenterology and Hepatology University of Medicine and Pharmacy Victor Babes Timisoara Timisoara Romania

InflaMed Centre of Excellence Translational Sciences in Inflammation and Immunology Laboratory of Experimental Medicine and Paediatrics Faculty of Medicine and Health Sciences University Hospital Antwerp Edegem Antwerp Belgium

Internal Medicine 1 University of Bonn Bonn Germany

Paris Cochin University Hopital Paris France

University Hospital and HIFIH Lab Angers France

University hospital Dubrava University of Zagreb School of Medicine Zagreb Zagreb Croatia

Zhongshan Hospital Fudan University Shanghai Shanghai China

AJR Am J Roentgenol. 2021 Oct;217(4):1012. doi: 10.2214/AJR.21.25821. PubMed

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