Elastography For The Diagnosis And Graduation Of Liver Disease In Patients With Long Term Parenteral Nutrition

Introduction: Liver disease is a major complication in long-term parenteral nutrition (PN) and its diagnosis usually depends on liver biopsy. Noninvasive methods such as transient elastography (TE) simplified the diagnosis and graduation of chronic liver disease; however, there are few studies assessing TE in liver dysfunction associated to long-term PN. HC-FMUSP is one of the world pioneer and reference of home PN and intestinal transplantation in Brazil (1-3). Our aim was to compare the results of TE and liver biopsy for the diagnosis and staging of liver disease due to long-term PN in a single center. Method: Patients from HC-FMUSP presenting liver dysfunction associated to long-term PN were included in this survey. Liver injury degree assessed by TE and biopsy (Brunt’s method) were classified as grade I, II, III e IV. TE and histological graduation values of liver disease for each patient were compared by Bland -Altman and Fisher’s statistical tests. Results: From the period between 2017 to 2019, twenty adults (8 female / 12 male) with long-term PN were selected for this study. Median time of patient’s PN use was 30.5 months. They all presented liver dysfunction observed by abnormal image exams and liver enzymes blood test. We observed in these patients a high agreement rate of liver injury graduation using both, TE and histology analysis by biopsy with Kappa index of 0.839 (p <0.005). Conclusion: In the current study we observed that TE is correlated with liver biopsy and histological analysis to assess liver disease associated with long-term PN.