• HanMa Ai ThandaMAThttps://orcid.org/0000-0002-2740-2486Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Aarshi Vipani, Nabil Noureddin, Kim Ramirez, Jeffrey Gornbein, Rola Saouaf, Nader Baniesh, Oladuni Cummings-John, Toluwalase Okubote, Veronica Wendy Setiawan, Yaron Rotman, Rohit Loomba, Naim Alkhouri, and Mazen Noureddin.
• Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
• Liver Int. 2020 Sep 1; 40 (9): 2242-2251.

Background & AimsLiver fibrosis assessed by liver biopsy is predictive of clinical liver events in patients with nonalcoholic fatty liver disease (NAFLD). Magnetic resonance elastography (MRE) correlates with liver biopsy in assessing liver fibrosis. However, data assessing the relationship between MRE and clinical liver events are lacking. We investigated the association between MRE and clinical liver events/death and identified the cut-off to predict clinical liver events in NAFLD patients.MethodsWe conducted a multicenter retrospective study of NAFLD patients who underwent MRE between 2016 and 2019. Clinical liver events were defined as decompensation events and death. We categorized patients into noncirrhosis, compensated cirrhosis and decompensated cirrhosis. Fisher's exact test was used to test association strength. Receiver operative curve methods were used to determine the optimal cut-off of MRE liver stiffness and to maximize the accuracy for classifying noncirrhosis, compensated cirrhosis and decompensated cirrhosis. Logistic regression modelling was used to predict decompensation.ResultsThe study included 320 NAFLD patients who underwent MRE. The best threshold for distinguishing cirrhosis from noncirrhosis was 4.39 kPa (AUROC 0.92) and from decompensated cirrhosis was 6.48 kPa (AUROC 0.71). Odds of decompensation increased as liver stiffness increased (OR 3.28) (P < .001). Increased liver stiffness was associated with ascites, hepatic encephalopathy, oesophageal variceal bleeding and mortality (median 7.10, 10.15 and 10.15 kPa respectively).ConclusionIn NAFLD patients, liver stiffness measured by MRE with a cut-off of ≥6.48 kPa is associated with decompensation and mortality, and specific MRE cut-offs are predictive of individual clinical liver events.© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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