INTRODUCTION The Controlled Attenuated Parameter (CAP) score derived from vibration-controlled transient elastography (VCTE, i.e. Fibroscan®) is a well-validated marker of hepatic steatosis. It is unclear if CAP scores are associated with risks of liver-related outcomes or all-cause mortality. METHODS In this retrospective cohort study, we identified 7,587 U.S. Veterans (2,689 with cured hepatitis C [HCV], 1,523 with alcohol-associated liver disease [ALD], 3,375 with metabolic dysfunction-associated steatotic liver disease [MASLD]) who underwent VCTE between 5/2015-12/2021. We followed patients for new hepatic decompensation, hepatocellular carcinoma (HCC), and death from the VCTE date until 1/1/2022. Multivariable Cox-proportional hazards regression was used to assess for the associations between CAP measurements and clinical outcomes, adjusting for age, sex, race/ethnicity, body mass index, Charlson Comorbidity Index, diabetes, liver disease etiology, liver stiffness measurements, and FIB-4, and was reported separately by disease etiology and advanced fibrosis status. RESULTS Over a median follow-up time of ∼1.9 years, hepatic steatosis (grades 1-3 vs. 0) was associated with a lower risk of death (aHR 0.70, 95% CI: 0.57-0.85). Among patients with MASLD, hepatic steatosis was associated with a lower risk of decompensation (aHR 0.54, 95% CI: 0.32-0.90) and death (aHR 0.52, 95% CI: 0.37-0.73). These associations persisted in subgroup analyses of patients with advanced fibrosis and without cirrhosis. DISCUSSION Among patients who underwent VCTE in clinical practice, the presence of substantial hepatic steatosis estimated by the CAP score was associated with lower all-cause mortality among all patients and lower risk of decompensation and death among those with MASLD.

中文翻译：

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通过 VCTE 衍生的 CAP 评分估计的肝脂肪变性与慢性肝病患者肝脏相关事件风险和全因死亡率降低相关。


引言 来自振动控制瞬时弹性成像（VCTE，即 Fibroscan®）得出的受控衰减参数 （CAP） 评分是经过充分验证的肝脂肪变性标志物。目前尚不清楚 CAP 评分是否与肝脏相关结局或全因死亡率风险相关。方法 在这项回顾性队列研究中，我们确定了 7,587 名美国退伍军人 （2,689 名治愈的丙型肝炎 [HCV]，1,523 名酒精相关肝病 [ALD]，3,375 名代谢功能障碍相关脂肪性肝病 [MASLD]）在 2015 年 5 月至 2021 年 12 月期间接受了 VCTE。我们跟踪了从 VCTE 日期到 2022 年 1 月 1 日的新发肝功能失代偿、肝细胞癌 （HCC） 和死亡患者。多变量 Cox 比例风险回归用于评估 CAP 测量与临床结果之间的关联，调整年龄、性别、种族/民族、体重指数、查尔森合并症指数、糖尿病、肝病病因、肝脏硬度测量和 FIB-4，并按疾病病因和晚期纤维化状态分别报告。结果 在中位随访时间 ∼1.9 年，肝脂肪变性 （1-3 级 vs. 0） 与较低的死亡风险相关 （aHR 0.70,95% CI： 0.57-0.85）。在 MASLD 患者中，肝脂肪变性与失代偿 （aHR 0.54， 95% CI： 0.32-0.90） 和死亡 （aHR 0.52， 95% CI： 0.37-0.73） 风险较低相关。这些关联在晚期纤维化和无肝硬化患者的亚组分析中持续存在。讨论 在临床实践中接受 VCTE 的患者中，通过 CAP 评分估计的大量肝脂肪变性的存在与所有患者的全因死亡率较低以及 MASLD 患者失代偿和死亡风险较低相关。