The natural history of advanced chronic liver disease defined by transient elastography.

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dc.contributor.authorShearer, Jessica E
dc.contributor.authorJones, Rebecca
dc.contributor.authorParker, Richard
dc.contributor.authorFerguson, James
dc.contributor.authorRowe, Ian A
dc.contributor.departmentLiveren_US
dc.contributor.roleMedical and Dentalen_US
dc.contributor.trustauthorFerguson, James
dc.date.accessioned2024-01-10T16:25:38Z
dc.date.available2024-01-10T16:25:38Z
dc.date.issued2022-03-23
dc.description.abstractBackground & aims: The clinical course of cirrhosis does not follow a predictable trajectory. Transient elastography (TE) is commonly used in clinical practice to diagnose liver fibrosis and increasingly to risk stratify patients. The aim of this study was to assess the natural history of advanced chronic liver disease (ACLD) defined by TE using electronic health record (EHR) data in a multistate framework. Methods: TE data were collected between 2008 and 2019. Patients with a liver stiffness measurement (LSM) >10 kPa were included. Disease and procedure code information held in EHR was analyzed. Clinical events including decompensation, hepatocellular carcinoma (HCC), and death were identified. Outcomes were described in a multistate model using flexible parametric survival methods including LSM and the albumin bilirubin (ALBI) score. Results: Three thousand and twenty eight patients were included. Median follow up was 3.1 years. LSM and ALBI were associated with the development of varices and decompensation, and ALBI, age, sex, and viral liver disease were associated with the development of HCC from the compensated state. The cumulative incidence of HCC before decompensation was low for patients with alcohol-related liver disease (3.8%) and nonalcoholic fatty liver disease (1.3%) at 5 years after TE. Importantly, death was predicted to occur before decompensation or HCC in most cases. Conclusions: Liver stiffness, ALBI score, and disease etiology are each associated with outcomes in a large contemporary cohort with ACLD. EHR data can be used to define clinical progression in these patients, facilitating large clinical effectiveness trials and cost-effectiveness analyses.en_US
dc.identifier.citationShearer JE, Jones R, Parker R, Ferguson J, Rowe IA. The Natural History of Advanced Chronic Liver Disease Defined by Transient Elastography. Clin Gastroenterol Hepatol. 2023 Mar;21(3):694-703.e8. doi: 10.1016/j.cgh.2022.03.015. Epub 2022 Mar 23en_US
dc.identifier.doi10.1016/j.cgh.2022.03.015
dc.identifier.eissn1542-7714
dc.identifier.issn1542-3565
dc.identifier.pmid35337981
dc.identifier.urihttp://hdl.handle.net/20.500.14200/3351
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.urlhttp://www.sciencedirect.com/science/journal/15423565en_US
dc.rightsCopyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.
dc.source.beginpage694
dc.source.countryUnited States
dc.source.endpage703.e8
dc.source.issue3
dc.source.journaltitleClinical Gastroenterology and Hepatology
dc.source.volume21
dc.subjectHealth services. Managementen_US
dc.titleThe natural history of advanced chronic liver disease defined by transient elastography.en_US
dc.typeArticle
dspace.entity.typePublication
oa.grant.openaccessnaen_US
rioxxterms.versionNAen_US
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