The Qi Xiaolong team of Lanzhou University used liver stiffness and platelet count to stratify the risk of decompensation

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iNature's latest EASL guidelines for assessing liver disease severity and prognosis propose a non-invasive tool for risk stratification of compensated chronic liver disease (CLD)
.

Patients with liver stiffness measurement (LSM) <20 kPa and platelet count (PLT)> 150 × 109/L are extremely unlikely to need treatment for varicose veins, and those who do not meet this criteria are at increased risk of clinical decompensation
.

 However, in the latest EASL and AASLD portal hypertension guidelines, it is not clear whether 20 kPa or 25 kPa is better to distinguish patients at risk of clinical decompensation
.

On October 14, 2021, the Qi Xiaolong team of Lanzhou University published an online research paper entitled "Risk stratification of decompensation using liver stiffness and platelet counts in compensated advanced chronic liver disease" in the Journal of Hepatology (IF=25.
08).
The use of LSM cut-off values ​​of 20 kPa and 25 kPa to further stratify patients at risk of clinical decompensation can be used as a supplement to the non-invasive risk stratification of cACLD patients in the latest EASL guidelines
.

In addition, on August 1, 2021, Qi Xiaolong of Lanzhou University and Zhang Wenhong of Fudan University published an online report entitled "Safety and immunogenicity of COVID-19 vaccination in patients with non-alcoholic fatty liver" in Journal of Hepatology (IF=25.
08) disease (CHESS2101): A multicenter study" research paper, this multicenter study included NAFLD patients without a history of SARS-CoV-2 infection
.

All patients received 2 doses of inactivated vaccine against SARS-CoV-2
.

The main safety result is the incidence of adverse reactions within 7 days after each injection and the overall incidence of adverse reactions within 28 days.
The main immunogenic result is the neutralizing antibody reaction at least 14 days after the entire course of vaccination
.

The study shows that the inactivated COVID-19 vaccine appears to be safe in a large number of non-alcoholic fatty liver patients and has good immunogenicity
.

The latest EASL guidelines for assessing liver disease severity and prognosis propose a non-invasive tool for risk stratification of compensated chronic liver disease (CLD)
.

Patients with liver stiffness measurement (LSM) <20 kPa and platelet count (PLT)> 150 × 109/L are extremely unlikely to need treatment for varicose veins, and those who do not meet this criteria are at increased risk of clinical decompensation
.

 LSM is the most effective non-invasive tool for CLD risk stratification.
The cut-off value> 20-25 kPa can be used to identify patients with clinically significant portal hypertension, which is closely related to the decompensation of CLD patients
.

However, in the latest EASL and AASLD portal hypertension guidelines, it is not clear whether 20 kPa or 25 kPa is better to distinguish patients at risk of clinical decompensation
.

This study aims to use the LSM cut-off values ​​of 20 kPa and 25 kPa to further stratify patients at risk of clinical decompensation
.

The study retrospectively included adults diagnosed with compensatory advanced chronic liver disease (cACLD) in a study initiated by the China Portal Hypertension Alliance (CHESS) in China, Japan, and South Korea between January 2009 and June 2018 Patient
.

Decompensation events, defined as ascites, varicose veins, bleeding or hepatic encephalopathy reviewed from follow-up data
.

As a result, 661 eligible cACLD patients (male/female, 405/256) were included, with an average age of 53 years (standard deviation, 12)
.

The median follow-up time was 41.
2 months (interquartile range, 28.
2-60.
5)
.

The overall decompensation rate was 10.
6% (70/661)
.

Based on transient elastography and PLT LSM, patients are divided into four levels, level 0 (LSM <20 kPa and PLT >150 ×109/ L) (n=223), level 1 (LSM <20 kPa and PLT <150 × 109/L) (n=238), level 2 (20 kPa ≤ LSM <25 kPa) (n=66) and level 3 (LSM ≥ 25 kPa) (n=134)
.

Ascites is still the most common decompensation event in patients at all levels
.

The cumulative incidence curve shows an increasing trend in the incidence of decompensation in patients from grade 0 to grade 3.

.

Except for the comparison between level 1 and level 2 (P adjustment = 0.
148), pairwise comparisons using the log-rank test in the four groups showed significant differences in the incidence of decompensation (all P adjustments <0.
001)
.

Summary of article results (picture from Journal of Hepatology) LSM <20 kPa and PLT> 150 × 109/L, known as Baveno VI standard, has been fully verified to identify varicose veins that are unlikely to require treatment and can be safely Avoid cACLD patients undergoing endoscopy for varicose vein screening
.

The results of the study show that patients who do not meet the Baveno VI criteria have a higher risk of liver decompensation than those who meet the criteria
.

More importantly, the results of this study show that grade 1 (LSM <20 kPa and PLT <150 ×109/L) and grade 2 (20 kPa ≤ LSM <25 kPa, regardless of PLT), these patients may be classified as Patients with moderate risk of clinical decompensation
.

In addition, patients with LSM ≥ 25 kPa have a significantly higher decompensation rate than patients with grades 0, 1, and 2; therefore, they can be classified as patients with a high risk of clinical decompensation
.

Since the etiology of cACLD should be considered when applying non-invasive tools, the main etiology and retrospective nature of the hepatitis B or C virus of this study may bring bias to the study; therefore, prospective studies with different etiological spectrums are required to verify Research results
.

All in all, this international study further stratifies patients at risk of clinical decompensation, and can be used as a supplement to the non-invasive risk stratification of cACLD patients in the latest EASL guidelines
.

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