Controlled Attenuation Parameter for Assessment of Hepatic Steatosis in Indian Patients

Gyanranjan Rout; Saurabh Kedia; Baibaswata Nayak; Rajni Yadav; Prasenjit Das; Subrat K Acharya; Deepak Gunjan; Vishwajeet Singh; Mousumi Mahanta; Swatantra Gupta; Sandeep Aggarwal; Shalimar

doi:10.1016/j.jceh.2018.02.010

Controlled Attenuation Parameter for Assessment of Hepatic Steatosis in Indian Patients

J Clin Exp Hepatol. 2019 Jan-Feb;9(1):13-21. doi: 10.1016/j.jceh.2018.02.010. Epub 2018 Mar 14.

Affiliations

¹ Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
² Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
³ Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background/aims: The gold standard method for measurement of hepatic steatosis is liver histology. Controlled Attenuation Parameter (CAP) can measure hepatic steatosis non-invasively. We aimed to assess the accuracy of CAP for detection of hepatic steatosis.

Methods: A total of 462 patients (May 2012-January 2017)-89 non-alcoholic fatty liver disease, 182 chronic hepatitis B, 88 chronic hepatitis C and 103 patients with other etiologies who underwent simultaneous liver biopsy and CAP estimation using Transient Elastography (TE) were included. Steatosis was graded as S0: steatosis in 0-5% of hepatocytes, S1: 6-33%, S2: 34-66% and S3: 67-100%. Receiver Operating Characteristic (ROC) curves were plotted to evaluate the accuracy of CAP in detecting hepatic steatosis. Predictors of CAP were assessed by multivariate linear regression model.

Results: The mean age ± SD was 33.8 ± 11.6 years; 296 (64.1%) were males. On liver histology, steatosis grades S0, S1, S2 and S3 were seen in 331 (71.6%), 74 (16.0%), 39 (8.4%) and 18 (3.9%), respectively. The median CAP (IQR) values for S0, S1, S2, and S3 steatosis were 206 (176-252) dB/m, 295 (257-331) dB/m, 320 (296-356) dB/m, and 349 (306-363) dB/m, respectively. For estimation of ≥S1, ≥S2, and ≥S3 using CAP, AUROC were 0.879, 0.893, and 0.883, respectively. In multivariate analysis, only BMI (OR 1.18; CI, 1.11-1.26, P < 0.001) and grade of hepatic steatosis (grade 1, OR, 3.94; 95% CI, 1.58-9.84, P = 0.003; grade 2, OR 42.04; 95% CI, 4.97-355.31, P = 0.001 and grade 3, OR 35.83; 95% CI 4.31-297.61, P = 0.001) independently predicted CAP.

Conclusions: CAP detects hepatic steatosis with good accuracy in Indian patients with various etiologies.

Keywords: ALT, Alanine Aminotransferase; AST, Aspartate Aminotransferase; AUROC, Area Under Receiver Operating Characteristics Curves; BMI, Body Mass Index; CAP, Controlled Attenuation Parameter; CHB, Chronic Hepatitis B; CHC, Chronic Hepatitis C; IQR, Interquartile Range; LSM, Liver Stiffness Measurement; NAFLD; NAFLD, Non-Alcoholic Fatty Liver Disease; SD, Standard Deviation; fibrosis; hepatitis B virus; hepatitis C virus; liver biopsy.