MR elastography-based liver fibrosis correlates with liver events in nonalcoholic fatty liver patients: A multicenter study.

BACKGROUND & AIMS: Liver 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. METHODS: We 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. RESULTS: The 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). CONCLUSION: In 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.

Overview of Updated Practice Guidelines for Pediatric Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is a form of chronic liver disease that is characterized by excessive fatty infiltration of the liver in the absence of significant alcohol consumption. As in the adult population, the etiology of NAFLD in children has been attributed to genetic predilection, insulin resistance, and obesity. The prevalence of NAFLD in the pediatric population has consistently increased over the past few decades, and it is currently considered the most common chronic liver disease in children. With increasing disease prevalence, NAFLD diagnosis and management have become more challenging. New guidelines for the management of pediatric NAFLD were published in 2017 by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Additionally, the American Association for the Study of Liver Diseases updated their guidelines on NAFLD and included a section dedicated to the pediatric population. This article provides an overall description of the burden and natural history of pediatric NAFLD, with a focus on diagnosis and management in light of the recently updated guidelines.