Transient elastography can stratify patients with Child Pugh A cirrhosis according to long-term risk of decompensation: a longitudinal cohort study.

There are no robust noninvasive tools to predict long-term liver-related events in well-compensated cirrhosis. We assessed the performance of noninvasive fibrosis tools in predicting decompensation, hepatocellular carcinoma (HCC), and liver-related mortality (LRM) within a mixed aetiology Child Pugh A cirrhosis cohort. Patients were followed in a single centre for 10 years. The primary outcome was decompensation (ascites, encephalopathy, or variceal bleeding). Secondary outcomes were HCC and LRM. All patients received baseline transient elastography for liver stiffness measurement (LSM) and blood tests to calculate Fibrosis-4 (FIB-4). In 114 patients, 31% decompensated during the follow-up period. 11% developed HCC. Increased LSM is associated with greater decompensation risk (P = 0.007). When controlling for FIB-4 and alcohol consumption, for each 1 kPa increase, the 10-year risk of decompensation increased by 2.2% [P = 0.009, hazard ratio: 1.022, 95% confidence interval (CI): 1.01-1.04]. Ten-year risk of decompensation was 20% for LSM < 21 kPa, 32% in the 21-35 kPa group, and 47% in the ≥35 kPa group (P = 0.019). After censoring for HCC, index LSM was associated with risk of death or liver transplant [odds ratio (OR): 1.029 (95% CI: 1-1.06) P = 0.039]. FIB-4 is associated with HCC risk (P = 0.001) with an OR: 1.16 (95% CI: 1.01-1.32). Ten-year risk of decompensation increased with increasing LSM in mixed aetiology compensated cirrhosis. LSM can be used to risk-stratify real-world patients, in order to reassure those at lowest risk and potentially focus resources on patients with higher scores and greatest decompensation risk.