Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver diseases: a prospective study of a native Korean population

Authors

  • Young Eun Chon,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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    • Both authors contributed equally to this work as joint first authors.
  • Kyu Sik Jung,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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    • Both authors contributed equally to this work as joint first authors.
  • Seung Up Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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    • Both authors contributed equally to this work.
  • Jun Yong Park,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Young Nyun Park,

    1. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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  • Do Young Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Sang Hoon Ahn,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
    4. Brain Korea 21 Project of Medical Science, Yonsei University College of Medicine, Seoul, Korea
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  • Chae Yoon Chon,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Hye Won Lee,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Yehyun Park,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Kwang-Hyub Han

    Corresponding author
    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
    4. Brain Korea 21 Project of Medical Science, Yonsei University College of Medicine, Seoul, Korea
    • Correspondence

      Kwang-Hyub Han, MD Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun–gu, Seoul 120–752, Korea

      Tel: +82 2 2228 1949

      Fax: +82 2 393 6884

      e-mail: gihankhys@yuhs.ac

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    • Both authors contributed equally to this work.

Abstract

Background

Controlled attenuation parameter (CAP) is a non-invasive method of measuring hepatic steatosis using a process based on transient elastography. We investigated the diagnostic accuracy of CAP in detecting hepatic steatosis in patients with chronic liver disease (CLD).

Methods

A total of 135 patients with CLD who underwent liver biopsy and CAP were consecutively enrolled in this prospective study. The performance of CAP for detection of hepatic steatosis compared with liver biopsy was calculated using area under receiver operating characteristics curves (AUROC). Steatosis was categorized into S0 (<5%), S1 (5–33%), S2 (34–66%) and S3 (>66% of hepatocytes).

Results

Male gender predominated (n = 87, 64%) and the median age was 51 years. The aetiologies of CLD included non-alcoholic fatty liver disease (n = 56, 41.5%) and chronic viral hepatitis because of hepatitis B (n = 47, 34.8%) and C (n = 12, 8.9%). Steatosis repartition was: S0 31.1% (n = 42), S1 43.7% (n = 59), S2 18.5% (n = 25) and S3 6.7% (n = 9) respectively. In the multivariate analysis, steatosis grade and body mass index were independently associated with CAP (all < 0.001), whereas fibrosis stage and activity grade were not. The AUROCs of CAP were 0.885 for ≥S1 (sensitivity 73.1%, specificity 95.2%), 0.894 for ≥S2 (sensitivity 82.4%, specificity 86.1%) and 0.800 for S3 (sensitivity 77.8%, specificity 84.1%). The optimal cut-off CAP values that maximized the Youden index were 250 dB/m (≥S1), 299 dB/m (≥S2), and 327 dB/m (=S3) respectively.

Conclusions

Our data showed that CAP had high diagnostic accuracy for detecting hepatic steatosis in patients with CLD and suggested that CAP is also applicable for Asian patients.

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