studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 603A
(NPV 99%). To rule in cirrhosis, the optimal cut off values were
51.4 and 27.3 for TE and 2D-SWE. Above these limits, only
four patients did not have cirrhosis on biopsy (PPV 86% for TE
and 84% for 2D-SWE). Conclusion: TE and 2D-SWE can be
used as screening tools for alcoholic cirrhosis, with higher cutoff
values than for HCV cirrhosis. Elastography reliably predicts
the absence of cirrhosis. However, the risk of having cirrhosis
in case of a positive test varies substantially according to the
population’s disease prevalence. The positive predictive value
should be taken into account when interpreting liver stiffness
results.
Disclosures:
Aleksander Krag - Advisory Committees or Review Panels: Norgine; Speaking
and Teaching: Norgine
The following authors have nothing to disclose: Maja Thiele, Bjørn S. Madsen,
Janne F. Hansen, Sönke Detlefsen, Linda S. Møller, Annette D. Fialla
790
Comparison of noninvasive fibrosis scores and association
with mortality in adults with moderate to severe
hepatic steatosis and NAFLD
Benjamin D. Renelus 1 , Fengxia Yan 2 , Michael C. Flood 3 ; 1 Internal
Medicine, Morehouse School of Medicine, Atlanta, GA; 2 Clinical
Research Center, Community Health and Preventive Medicine,
Morehouse School of Medicine, Atlanta, GA; 3 Division of Gastroenterology,
Morehouse School of Medicine, Atlanta, GA
Background: Non-alcoholic fatty liver disease (NAFLD) is highly
prevalent, causing the majority of elevated serum aminotransferases.
NAFLD is a disease spectrum ranging from steatosis
to steatohepatitis. Steatohepatitis, which requires liver biopsy
for confirmation, may progress to fibrosis, cirrhosis and liver
cancer, thus contributing to overall morbidity and mortality.
Knowledge regarding non-invasive long-term prognostic factors
of NAFLD is limited. Aim: The purpose of this study is to evaluate
accuracy of non-invasive fibrosis markers and scores with
mortality among adults with moderate to severe steatosis and
NAFLD. Methods: We conducted a cross-sectional analysis of
data derived from the Third National Health National Health
and Nutrition Examination Survey 1988-1994 (NHANES III)
and ensuing follow-up mortality data through December of
2006. NAFLD was defined as ultrasonographic findings consistent
with moderate to severe hepatic steatosis in the absence
of viral hepatitis, or excessive alcohol use. Excessive alcohol
use was defined as >/=2 drinks/day in males, and >/=1
drinnk/day in females. Mortality was paired with noninvasive
markers of inflammation and fibrosis. These included NAFLD
fibrosis score (NFS), Fibrosis-4 score (FIB-4), aspartate aminotransferase
to platelet ratio index (APRI), C-reactive protein
(CRP) and serum vitamin D (VDP). Results: A total of 11,490
adults between the ages of 20-74 who underwent abdominal
ultrasound were found to have NAFLD. Of those, 2641 were
found to have moderate to severe steatosis based on ultrasonographic
findings. Among those with moderate to severe
steatosis there were 549 documented deaths. The vast majority
of secondary causes were related to cardiovascular disease
(213), followed by non-cancer liver related deaths (8) and
hepatocellular carcinoma (HCC) (4). The diagnostic threshold
for NAFLD among the inflammatory and fibrosis markers were
as follows: VDP level 3mg/L, APRI >0.98,
NFS >0.676, and FIB-4 >3.25. The area under the receiver
operating characteristic curve (ROC curve) for the noninvasive
markers with all-cause mortality were NFS 0.722, FIB-4 0.733,
CRP 0.559, APRI 0.515, VDP 0.517. P-value were significant
for all markers except for APRI and VDP. Conclusion: FIB-4 has
strongest association with mortality among adults with ultrasound
based moderate to severe NAFLD. FIB-4 may have some
prognostic role in those with advanced NAFLD however further
studies are necessary to confirm.
Disclosures:
The following authors have nothing to disclose: Benjamin D. Renelus, Fengxia
Yan, Michael C. Flood
791
Effect of inflammation on liver stiffness in active autoimmune
liver disease: A simultaneous biopsy-controlled
study using Acoustic Radiation Force Impulse (ARFI)
elastography
David I. Sherman 1 , Waleed Fateen 1 , Minal J Sangwaiya 2 , Paul
Tadrous 3 , Philip J. Shorvon 2 ; 1 Gastroenterology, Central MIddlesex
Hospital, London North West Healthcare NHS Trust, London,
United Kingdom; 2 Radiology, Central Middlesex Hospital, London
North West Healthcare NHS Trust, London, United Kingdom;
3 Cellular Pathology, Northwick Park Hospital, London North West
Healthcare NHS Trust, London, United Kingdom
Introduction ARFI elastography (virtual touch quantification,
VTq) is a well validated technique for non-invasive assessment
of liver fibrosis in viral hepatitis. The interpretation of
shear velocity readings in active autoimmune liver disease
(AILD) may be affected by a number of factors. However, few
studies have specifically examined the effect of inflammation
on liver stiffness (LS) in this group. We report the results of a
preliminary study in which LS and histology have been sampled
simultaneously from the same region of liver tissue in a large
cohort with active AILD. Patients and Methods Our local database
of 101 patients with AILD (63 autoimmune hepatitis AICH
+/- overlap, 38 cholestatic - PBC or PSC) was investigated. LS
estimation by ARFI was performed using a standard validated
protocol by a single operator. Biopsies were performed from
the same region of liver using an 18G Biopince needle,
immediately after LS measurement. Clinical, biochemical, ultrasonic
and histopathological data were collated retrospectively.
ARFI/histological variance (AHV) was defined as a difference
of more than 1 Metavir or 2 Ishak stages from that predicted
by ARFI, according to standard calibration. 1 Results Sixty one
ARFI + liver biopsies performed at the same session were identified
out of a total of 164 ARFI and 114 liver biopsies. Patients
included group 1: 34 active AICH (diagnosis / flare on therapy);
group 2: 7 AICH remission; and group 3: 17 cholestatic
liver disease. Validation confirmed satisfactory ARFI quality:
SD/mean > 0.3 in 4(6.9%), failure in 3(4.9%). Co-pathology
was seen in 8(13%), mostly NAFLD. Mean ARFI shear velocities
in groups 1, 2 and 3 were 2.41, 1.29 and 1.64 m/sec; AHV
occurred in 44.1, 28.6 and 29.4%, respectively. AHV prevalence
was 41.4% overall, with 100% in group 1 and 88%
overall reflecting overestimation of fibrosis. Across all groups,
Ishak necro-inflammatory grade was strongly correlated with
both ARFI shear velocity (r=0.58,p