Noninvasive tests predict liver-related events in early alcohol-related liver disease

In patients with early-stage alcohol-related liver disease, transient elastography (TE), the enhanced liver fibrosis test (ELF), and 2-dimensional shear-wave elastography (2D-SWE) can reliably predict the risk of symptomatic liver events, a recent study has found.

Researchers conducted a prospective cohort study of 462 patients (median age 57 years, 76 percent men) with early, compensated alcohol-related liver disease. Noninvasive biomarkers, including TE, 2D-SWE, ELF, FibroTest, fibrosis-4 index, and nonalcoholic fatty liver fibrosis score, were assessed at baseline, along with the collection of a needle liver biopsy sample.

Over a median follow-up of 49 months, the primary outcome of liver-related events, such as alcoholic hepatitis, ascites, and hepatocellular carcinoma, among others, occurred in 84 patients (18 percent). Ascites (n=81), covert hepatic encephalopathy (n=15), and varices needing treatment (n=15) were the most common events.

All noninvasive tests were elevated in patients who developed liver-related events, but TE had the best predictive value with a C-statistic of 0.876, followed by 2D-SWE (C-statistic, 0.868) and ELF (C-statistic, 0.859). The C-statistics for these three biomarkers were statistically comparable with each other and were significantly superior to other noninvasive tests performed.

Moreover, areas under the curve for the prediction of liver-related events were highest for TE, 2D-SWE, and ELF.

“Our study endorses the use of elastography and the ELF test as highly accurate prognostic markers in patients with early stages of alcohol-related liver fibrosis or compensated cirrhosis, with easy-to-use cut-offs to distinguish between patients at substantially different risks of liver-related events,” the researchers said.