Controlled attenuation parameter for non-invasive assessment of hepatic steatosis in Chinese patients.
OBJECTIVE
To evaluate the performance of a novel non-invasive controlled attenuation parameter (CAP) to assess liver steatosis.


METHODS
This was a multi-center prospective cohort study. Consecutive patients (aged ≥ 18 years) who had undergone percutaneous liver biopsy and CAP measurement were recruited from three Chinese liver centers. Steatosis was categorized as S0: < 5%; S1: 5%-33%; S2: 34%-66%; or S3: ≥ 67%, according to the nonalcoholic fatty liver disease (NAFLD) activity score. The FibroScan(®) 502 equipped with the M probe (Echosens, Paris, France) was used to capture both CAP and liver stiffness measurement values simultaneously. Receiver operating characteristic curves were plotted, and the areas under the curves were calculated to determine the diagnostic efficacy. The accuracy of the CAP values at the optimal thresholds was defined by maximizing the sum of sensitivity and specificity (maximum Youden index).


RESULTS
A total of 152 patients were recruited, including 52 (34.2%) patients with NAFLD and 100 (65.8%) with chronic hepatitis B (CHB) virus infection. After adjustment, the steatosis grade (OR = 37.12; 95%CI: 21.63-52.60, P < 0.001) and body mass index (BMI, OR = 6.20; 95%CI: 2.92-9.48, P < 0.001) were found independently associated with CAP by multivariate linear regression analysis. CAP was not influenced by inflammation, fibrosis or aetiology. The median CAP values and interquartile ranges among patients with S0, S1, S2 and S3 steatosis were 211 (181-240) dB/m, 270 (253-305) dB/m, 330 (302-360) dB/m, and 346 (313-363) dB/m, respectively. The cut-offs for the CAP values in all patients with steatosis ≥ 5%, ≥ 34% and ≥ 67% were 253 dB/m, 285 dB/m and 310 dB/m, respectively. The areas under the curves were 0.92, 0.92 and 0.88 for steatosis ≥ 5%, ≥ 34% and ≥ 67%, respectively. No significant differences were found in the CAP values between the NAFLD group and the CHB group in each steatosis grade.


CONCLUSIONS
CAP appears to be a promising tool for the non-invasive detection and quantification of hepatic steatosis, but is limited by BMI.
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Feng
F
Shen
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Rui-Dan
RD
Zheng
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Yu-Qiang
YQ
Mi
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Xiao-Ying
XY
Wang
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Qin
Q
Pan
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Guang-Yu
GY
Chen
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Hai-Xia
HX
Cao
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Ming-Li
ML
Chen
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Liang
L
Xu
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Jian-Neng
JN
Chen
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Yi
Y
Cao
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Rui-Nan
RN
Zhang
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Lei-Ming
LM
Xu
Feng Shen, Qin Pan, Guang-Yu Chen, Hai-Xia Cao, Yi Cao, Rui-Nan Zhang, Lei-Ming Xu, Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Jian-Gao
JG
Fan
D000328:Adult; D019540:Area Under Curve; D044466:Asian People; D001706:Biopsy; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002681:China; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D016014:Linear Models; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000208:ethnology / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index
Chronic hepatitis B; Controlled attenuation parameter; Fatty liver; Nonalcoholic; Transient elastography