S2-E52.1 – MRE Predicts Long-Term Progression and Outcomes in Chronic Liver Disease Patients

Podcast about Long-Term Progression
Alina Allen and Ian Rowe join the Surfers to discuss the recent Mayo Clinic paper, "MRE for Prediction of Long-Term Progression and Outcome in Chronic Liver Disease: A Retrospective Study." In this conversation, Alina summarizes the paper, after which Stephen Harrison asks questions about availability of subgroup analysis.

“MRE for Prediction of Long-Term Progression and Outcome in Chronic Liver Disease: A Retrospective Study.” was recently published in the journal Hepatology. While previous Mayo Clinic work focused solely on NASH patients, this retrospective look focused on 1,200 patients with assorted liver diseases who underwent MRE for the first time between 2007 and 2009 and tracked patients through 2020. In this analysis, MRE had strong ability to predict future outcomes, with the strongest results predicting which patients with some level of fibrosis would progress to compensated cirrhosis. In this group, every one-level increase in LSM translate into slightly more than a two-fold increase in risk of cirrhosis. MRE also provides robust prediction of progressing from compensated cirrhosis to decompensation, with every one-level increase in LSM translating to a 22% increase in the likelihood of progressing to decompensation. Prediction is lower in predicting outcomes for decompensated patients, largely because at this point liver function assumes greater relevance than stiffness. As Alina states, “this is why we use a MELD score for transplantation priorities” and similar issues.

The other important point Alina makes (and Ian Rowe has made in past episodes) is that biomarkers provide continuous numbers to plot progression over time, as compared to fibrosis level which is ordinal with four levels, or other metrics that have a high zone, a low zone and a gray zone between them. Continuous variables are easier to track for individual patients and provide richer statistical analyses.

When Alina finishes, Stephen Harrison asks questions about population subtypes in this study. Alina points out that the northern midwest is fairly homogenous demographically and the clinical charts from which researchers derived data did not have genetic information.