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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2021; 27(1): 80-91
Published online Jan 7, 2021. doi: 10.3748/wjg.v27.i1.80
Evaluation of controlled attenuation parameter in assessing hepatic steatosis in patients with autoimmune liver diseases
Xi-Xi Ni, Min Lian, Hui-Min Wu, Xiao-Yun Li, Li Sheng, Han Bao, Qi Miao, Xiao Xiao, Can-Jie Guo, Hai Li, Xiong Ma, Jing Hua
Xi-Xi Ni, Hui-Min Wu, Xiao-Yun Li, Xiao Xiao, Jing Hua, Department of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200127, China
Min Lian, Han Bao, Can-Jie Guo, Department of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Li Sheng, Xiong Ma, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease, Shanghai 200127, China
Qi Miao, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200127, China
Hai Li, Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Xiong Ma, Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China
Author contributions: Ni XX, Lian M, Wu HM, and Li XY contributed equally to this work, and collected and analyzed the data; Sheng L coordinated the research; Bao H and Xiao X performed the transient elastography and coordinated the liver biopsy; Miao Q contributed to histological examination; Ma X, Hua J, Li H, and Guo CJ analyzed the data; Hua J designed the study; Ni XX, Lian M, and Hua J wrote the manuscript; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81470842 and No. 81770572.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Renji Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jing Hua, MD, PhD, Professor, Department of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, No. 160 Pujian Road, Shanghai 200127, China. hua_jing88@163.com
Received: September 11, 2020
Peer-review started: September 11, 2020
First decision: November 23, 2020
Revised: December 1, 2020
Accepted: December 11, 2020
Article in press: December 11, 2020
Published online: January 7, 2021
BACKGROUND
Hepatic steatosis commonly occurs in some chronic liver diseases and may affect disease progression.
AIM
To investigate the performance of controlled attenuation parameter (CAP) for the diagnosis of hepatic steatosis in patients with autoimmune liver diseases (AILDs).
METHODS
Patients who were suspected of having AILDs and underwent liver biopsy were consistently enrolled. Liver stiffness measurement (LSM) and CAP were performed by transient elastography. The area under the receiver operating characteristic (AUROC) curve was used to evaluate the performance of CAP for diagnosing hepatic steatosis compared with biopsy.
RESULTS
Among 190 patients with biopsy-proven hepatic steatosis, 69 were diagnosed with autoimmune hepatitis (AIH), 18 with primary biliary cholangitis (PBC), and 27 with AIH-PBC overlap syndrome. The AUROCs of CAP for the diagnosis of steatosis in AILDS were 0.878 (0.791-0.965) for S1, 0.764 (0.676-0.853) for S2, and 0.821 (0.716-0.926) for S3. The CAP value was significantly related to hepatic steatosis grade (P < 0.001). Among 69 patients with AIH, the median CAP score was 205.63 ± 47.36 dB/m for S0, 258.41 ± 42.83 dB/m for S1, 293.00 ± 37.18 dB/m for S2, and 313.60 ± 27.89 dB/m for S3. Compared with patients with nonalcoholic fatty liver disease (NAFLD) presenting with autoimmune markers, patients with AIH concomitant with NAFLD were much older and had higher serum IgG levels and LSM values.
CONCLUSION
CAP can be used as a noninvasive diagnostic method to evaluate hepatic steatosis in patients with AILDs. Determination of LSM combined with CAP may help to identify patients with AIH concomitant with NAFLD from those with NAFLD with autoimmune phenomena.
Core Tip: This retrospective study determined that controlled attenuation parameter (CAP) could be used as a noninvasive diagnostic tool to evaluate hepatic steatosis effectively and accurately in patients with autoimmune liver diseases. Patients with autoimmune hepatitis concomitant with nonalcoholic fatty liver disease (NAFLD) had higher IgG levels and liver stiffness measurement values, while patients with NAFLD with autoimmune phenomena had higher gamma-glutamyl transferase levels and CAP values, which benefits the identification of these two kinds of patients.
