title: Controlled attenuation parameter (CAP) for the diagnosis of steatosis: a prospective study of 5323 examinations.
abstract: OBJECTIVE
  Controlled attenuation parameter (CAP) evaluated with transient elastography (FibroScan®) is a recent method for non-invasive assessment of steatosis. Its usefulness in clinical practice is unknown. We prospectively investigated the determinants of CAP failure and the relationships between CAP and clinical or biological parameters in a large cohort of consecutive patients.
  
  
  METHODS
  All CAP examinations performed in adult patients with suspected chronic liver disease were included. CAP failure was defined as zero valid shot. The following factors were analyzed for their influence on CAP value and the relationships between CAP and clinico-biological parameters: age, gender, body mass index, waist circumference, hypertension, diabetes, metabolic syndrome, alcohol use, liver stiffness measurement, indication, and different biological parameters.
  
  
  RESULTS
  CAP failure occurred in 7.7% of 5323 examinations. By multivariate analysis, factors independently associated with CAP measurement failure were female gender, BMI, and metabolic syndrome. By multivariate analysis, factors significantly associated with elevated CAP were BMI [25-30]kg/m(2), BMI >30kg/m(2), metabolic syndrome, alcohol >14 drink/week and liver stiffness >6kPa. CAP increased with the number of parameters of metabolic syndrome, BMI, waist circumference, the presence of diabetes or hypertension, and the cause of the disease. In the 440 patients with liver biopsy, for the diagnosis of steatosis >10%, steatosis >33%, and steatosis >66%, AUROCs of CAP were 0.79 (95% CI 0.74-0.84, p<0.001), 0.84 (95% CI 0.80-0.88, p<0.001), 0.84 (95% CI 0.80-0.88, p<0.001), respectively.
  
  
  CONCLUSIONS
  CAP provides an immediate assessment of steatosis simultaneously with liver stiffness measurement. The strong association of CAP with the metabolic syndrome and alcohol use could be of interest for the follow-up of NAFLD or alcoholic patients.
authors.affiliation: Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France; INSERM U1053, Université Bordeaux Segalen, Bordeaux, France. Electronic address: victor.deledinghen@chu-bordeaux.fr.
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.affiliation: Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Vergniol
authors.affiliation: Service de Chirurgie Viscérale, Hôpital Saint-André, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France.
authors.forename: Maylis
authors.initials: M
authors.lastname: Capdepont
authors.affiliation: Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France.
authors.forename: Faiza
authors.initials: F
authors.lastname: Chermak
authors.affiliation: Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Hiriart
authors.affiliation: Service d'Imagerie Médicale, Hôpital Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cassinotto
authors.affiliation: Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France.
authors.forename: Wassil
authors.initials: W
authors.lastname: Merrouche
authors.affiliation: Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Foucher
authors.affiliation: Laboratoire de Pathologie, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France.
authors.forename: Le Bail
authors.initials: le B
authors.lastname: Brigitte
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D015992:Body Mass Index; D015331:Cohort Studies; D003951:Diagnostic Errors; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D005235:Fatty Liver, Alcoholic / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012307:Risk Factors
keywords: CAP; FibroScan; Liver stiffness; Metabolic syndrome; NAFLD; Obesity; Steatosis; Transient elastography