Computed tomography derived liver volume: a prognostic factor in decompensated alcoholic cirrhosis?

Abstract

Introduction: Decompensated alcoholic liver disease (ALD) causes high morbidity and mortality. Factors associated with a poor clinical evolution, as well as the impact of liver atrophy linked with cirrhosis are poorly determined. The goal of this study is to explore the link between the liver volumetry calculated by computed tomography (CT) and the evolution of liver insufficiency in patients admitted for decompensated ALD. Materials and methods: Non-abstinent patients with acute decompensation of ALD (increase in serum bilirubin and deterioration of liver function) from a prospective study were included. This trial did not evidence any benefice of cellular therapy during the 3 months of follow up (Spahr L et al. Autologous bone marrow stem cell transplantation versus standard of care in patients with decompensated alcoholic liver disease: interim analysis of a RCT. Hepatology 2011;54:A62). Liver volumes evaluated by CT performed rapidly after patient admission were compared to further evolution of hepatic insufficiency, irrespective of treatment allocation. We defined patients with a ≥ 3 points decrease in MELD compared to baseline value as “improvers”, and those with less than 3 points decrease in MELD as “non-improvers”. Results: Fifty-eight patients were included. At admission, mean MELD score was 20.6 points. All patients had cirrhosis. Biopsy proven alcoholic steatohepatitis was diagnosed in 81% of cases. Patients with severe steatohepatitis (Maddrey score ≥ 32) were treated by steroids (66 %). 34 patients (59%) with a good evolution at 3 months (decrease in MELD score of 3 points or more) were classified as improvers meanwhile 24 patients (41%) were classified as non-improvers. Patients’ characteristics at admission depending on the 3 month evolution are reported in this table. Parameter Improvers n=34 Non-improvers n=24 P Age (years) 54 [35-63] 55 [44-67] 0.11 Hepatovenous pressure gradient (mmHg) 19.2 ± 2.7 19.2 ± 4.1 0.25 MELD score 20.7 ± 5.9 20.6 ± 3.3 0.96 Albumin (g/l) 22.2 ± 4.4 22.4 ± 6.7 0.41 Steroid treatment (%) 67.6 62.5 0.68 Cellular therapy (%) 52.9 41.7 0.39 Liver volume (cm3) 2389 ± 998 1646 ± 489 0.0005 Ratio liver volume-body weight (%) 3.2 ± 1.5 2.2 ± 1.0 0.002 Conclusion: This study highlights the link between the severity of hepatic atrophy associated with cirrhosis and the prognosis in case of liver decompensation. Indeed, in patients with decompensated ALD, a low liver volume evaluated by CT is associated with a bad evolution of hepatic function evaluated by MELD score