Two-dimensional Shear Wave Elastography Is Predictive Of Progression Of Patients With Decompensated Cirrhosis Due To Hepatis B Viral Infection

Objectives:1.To investigate the feasibility of two-dimensional shear-wave elastography(2D SWE)in predicting progression of patients with decompensated cirrhosis due to hepatis B viral(HBV)infection.2.To evaluate accuracy of 2D SWE in predicting progression of patients with decompensated cirrhosis and HBV infection.3.To explore the stability of 2D SWE values in predicting progression of patients with HBV decompensated cirrhosis.Methods:1.From September 2019 to January 2021,we enrolled 138 patients(aged51.64±11.82 years,102 males,36 females)in the Department of Infectious Diseases and Department of Gastroenterology of the First Affiliated Hospital of Nanchang University.2.We collected baseline data(including clinical,HBV,laboratory data,conventional ultrasound and 2D SWE parameters),and recorded 90-day outcome through the electronic medical record system or telephone interview,and record the outcome.Those who experienced hospital readmission or was death due to decompensated cirrhosis and its complications were in the worsening group,and the rest were in the steady group.3.Univariate and multivariate Logistic regression models were performed to determine the independent factors related to outcomes,and the area under the receiver operating characteristic curve(AUC)was performed to evaluate the accuracy.4.The accommodating covariates receiver in receiver operator characteristic curve(AROC)was performed to assess the stability of 2D SWE values.Results:1.There were significant differences in 2D SWE values between the steady group and worsening group(43.80 [interquartile range(IQR)35.65-55.25] vs.29.25[IQR 17.50-41.70],p<0.001).The 2D SWE value is an independent predictive factor of progression(odds ratio [OR] 1.047,95%CI 1.020-1.076;p<0.001).2.The AUC of 2D SWE is 0.715(95% CI 0.625-0.806)is comparable with Child-Pugh,Model for End-Stage Liver Disease(MELD),Model for End-Stage Liver Disease Combined with Sodium(MELD-Sodium),and Chronic Liver Failure Consortium acute decompensation(CLIF-C AD)scores(p>0.05).3.The AUC of the multivariate model,composed of 2D SWE values,prothrombin activity(PTA),ascites and infection,is 0.825(95% CI 0.757-0.893),was larger than that of MELD-Sodium score(p=0.076),and significantly larger than Child-Pugh,MELD and CLIF-C AD scores(p<0.05).4.The AROC showed that there was no significant difference in AUC before and after adjustment by ALT,AST and standard antiviral therapy(p=0.123,0.420 and0.372,respectively).Conclusions:1.The 2D SWE is a useful tool for predicting accurately progression of patients with decompensated cirrhosis due to HBV infection,and could provide guidance for follow-up,treatment,transplantation and prognosis.2.The predictive ability of 2D SWE values and the multivariate model are comparable or even higher than that of the classical scoring model composed of laboratory data.3.The predictive performance of 2D SWE values is stable.