PREVALENCE AND RISK FACTORS OF SEVERE FIBROSIS IN THE ELDERLY:
TRANSIENT ELASTOGRAPHY IN A POPULATION-BASED STUDY
Edith M. Koehler1, Jeoffrey N.L. Schouten1, Bettina E. Hansen 1,2, Bruno H. Stricker3,4,5,
Laurent Castera6, Harry L.A. Janssen 1
1 Dept.
of Gastroenterology and Hepatology, Erasmus MC University Hospital, Rotterdam, The
Netherlands. 2 Dept. of Public Health, Erasmus MC University Hospital, Rotterdam, The Netherlands.
3 Dept.
of Epidemiology, Erasmus MC University Hospital, Rotterdam, The Netherlands. 4 Dept. of
Internal Medicine, Erasmus MC University Hospital, Rotterdam, The Netherlands. 5 Dept. of Medical
Informatics, Erasmus MC University Hospital, Rotterdam, The Netherlands. 6 Dept. of Hepatology,
Hôpital Beaujon, Clichy, Université Paris-7, France.
Transient elastography (TE) measures liver stiffness, which correlates well with histological
stages of liver fibrosis. By means of TE, we aimed to assess the prevalence and risk factors
of severe liver fibrosis and cirrhosis in the elderly (> 65 years). This study was based on
2317 participants of a large population-based cohort study among elderly persons. All
participants underwent an interview and clinical examination that included a blood collection,
abdominal ultrasound and TE (by a single operator). Nonalcoholic fatty liver disease
(NAFLD) was defined as fatty liver at ultrasonography, in the absence of 1) excessive alcohol
consumption (>14 drinks weekly), 2) positive HBsAg or anti-HCV, and 3) use of drugs
associated with fatty liver. TE was considered reliable if ≥ 60% success rate (≥10 valid
measurements) and IQR/median liver stiffness measurement (LSM) ≤0.3. LSM>9.5 kPa was
taken as a cut-off for presence of severe fibrosis and 13 kPa for cirrhosis. Associations
between LSM>9.5kPa or LSM as a continuous dependent variable was assessed using
logistic or linear regression analysis. Failure and unreliable LSM were observed in 282
(12.1%) and 711 (29.4%) patients, respectively. Data on LSM were analysed in 1324
participants (mean age 74.0±5.6; mean BMI 26.6±3.6). In multivariable analysis, failure and
unreliable LSM was associated with higher age, higher BMI and female gender (pvalues<.001). The prevalence of LSM >9.5kPa and >13kPa was 4.2% and 1.1%,
respectively. Higher age (OR1.12, 95%CI 1.06-1.17;p<.001), greater HOMA-IR (OR1.05,
95%CI 1.00-1.10; p=0.044), higher ALT (OR1.04, 95%CI1.02-1.06; p<.001), lower platelets
(OR0.99, 95%CI 0.99-1.00; p=.03) and greater spleen size (OR1.37; 95%CI 1.13-1.66;
p=.001) were associated with LSM >9.5kPa in logistic regression analysis. In total, 16 of 329
participants (4.9%) with NAFLD had LSM >9.5kPa; HOMA-IR was independently associated
with elevated LSM in participants with NAFLD. Conclusions: Our results suggest that
severe fibrosis and cirrhosis may be present in 4.2% and 1.1% of the elderly population,
respectively. Elevated LSM was associated with higher age, ALT, HOMA-IR, spleen size and
lower platelets. Feasibility of TE in this elderly population is however disputable with either
failure or unreliable results in more than one-third of the participants.