Scientific Session 09 — Gastrointestinal - Diffuse Liver DiseaseTuesday, May 2, 2017
3307. Liver Surface Nodularity Score as a Predictor of Liver and Cardiovascular Events in NAFLD
Florez E*, Vakilian M, Varney E, Lirette S, Smith A. University of Mississippi Medical Center, Jackson, MS
Address correspondence to A. Smith (email@example.com)
Objective: Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease, and higher stages of disease are associated with a higher risk of liver and cardiovascular events. Liver surface nodularity (LSN) increases with higher stages of liver fibrosis and cirrhosis, can be measured on routine CT using quantitative software, and has been used to predict liver events in patients with cirrhosis. The purpose of this study is to evaluate the LSN score as a predictor of future liver and cardiovascular events in patients with NAFLD.
Materials and Methods: For this institutional review board–approved, HIPAA-compliant retrospective study, adult patients with NAFLD and unenhanced CT obtained between January 1, 2004, and June 30, 2016, were identified from the electronic medical record (n = 596). The LSN score was measured using unenhanced CT images and quantitative software. When available, the NAFLD fibrosis index (a predictor of the stage of liver fibrosis) was calculated (n = 340). Competing risk regression was used to determine the association between LSN score and subsequent development of the first liver or cardiovascular event (cirrhosis, ascites, hepatic encephalopathy, hepatorenal syndrome, bleeding varices, stroke, myocardial infarction, cardiac catheterization, coronary artery bypass surgery, or death). The time to first liver or cardiovascular event in patients with an LSN score less than 3 and those with a score of 3 or more was compared using Kaplan-Meier plots.
Results: In patients with NAFLD, 12% (72/596) had a liver or cardiovascular event during a median follow-up of 1.1 years. LSN score was 3 or more in 27% (161/596) of patients with NAFLD, and 16% (52/334) had a NAFLD fibrosis index greater than or equal to 0.675. Patients with an LSN score of 3 or more were 93% more likely to develop a liver or cardiovascular event than patients with an LSN score less than 3 (HR [hazard ratio], 1.93; 95% CI, 0.8–4.4; p < 0.117). By comparison, no statistically significant association was seen between the NAFLD fibrosis index and development of the first liver or cardiovascular event (HR, 0.95; 95% CI, 0.2–4.5; p = 0.947). Time to the first liver or cardiovascular event for 10% of patients with an LSN score greater than or equal to 3 was 1.9 vs 6.0 years for patients with an LSN score less than 3 (p < 0.111).
Conclusion: The LSN score, as derived from routine CT images, may be predictive of future liver and cardiovascular events in patients with NAFLD and could be used as a prognostic tool to identify high risk patients and guide clinical management.