PO:34:209 | Increased liver stiffness and fibrosis in systemic sclerosis: a single-center transient elastography cohort study.

Nicola Ortalli^1|2, Simone Aldo Lari^1|2, Alessandra Vacca³, Erika Meleddu^1|2, Alberto Civolani⁴, Emanuela Vargiu⁴, Alberto Floris^1|2, Massimo Claudio Fantini⁴, Alberto Cauli^1|2. | ¹Rheumatology Unit, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy; ²Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; ³Rheumatology Unit, Presidio Ospedaliero CTO di Iglesias Iglesias Italy; ⁴Gastroenterology Unit, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy.

Abstract

Background. This study aims to evaluate and compare the liver stiffness (LS) and the prevalence of liver fibrosis in patients with systemic sclerosis (SSc) versus healthy controls (HCs). Additionally, within the SSc cohort, it sought to identify demographic, clinical, or serological factors having a potential role as predictors of increased LS and overt liver fibrosis.

Materials and Methods. Data from a monocentric cohort of 94 SSc patients, diagnosed according to the ACR/EULAR 2013 classification criteria, and 50 gender - and age - matched HCs were analyzed. All SSc patients and HCs were screened for concomitant infective, metabolic or autoimmune hepatic disorders and excluded if positive. The LS was measured in all patients and HCs by the Transient Elastography (FibroScan®) performed by a trained gastroenterology clinician. A cut-offs of > = 5.4 kPa and > = 7.5 kPa were applied to define, respectively, increased LS and overt fibrosis. Demographic, clinical, treatment and laboratory data, including autoantibodies profile, were recorded in all SSc patients and analyzed as potential predictors of LS and overt liver fibrosis in uni-and multivariate analysis.

Results. Out of the 94 SSc patients, 79 (84%) were female. The mean (SD) age at enrollment and disease duration were 58.4 (12.9) and 9.4 (7.6) years, respectively. SSc patients exhibited a significantly higher mean (SD) LS compared to HCs (5.12 ± 1.95 kPa vs 4.18 ± 0.98 kPa; p = 0.002). Similarly, SSc patients showed a significantly higher prevalence of increased LS (40.4% vs 10.0%, p < 0.001) and overt liver fibrosis (11.7% vs 0, p = 0.009). In univariate analysis anti-centromere antibody (ACA) positivity (40.9% vs 24%, p = 0.028.), and increased serum GOT levels (23.9 ± 9,4 vs 19.9 ± 5.9, p = 0.008) were significantly associated with increased LS. However, in multivariate analysis only telangiectasias (p= 0.010 ) and elevated GOT (p= 0.009) levels were confirmed to be independently associated with increased LS. No demographic, clinical or serological factors were associated with liver fibrosis.

Conclusions. In SSc patients, increased liver stiffness (ranging up to overt fibrosis) occurs significantly more frequently than in healthy individuals, likely reflecting the disease's inherent pro-fibrotic nature. Although liver biopsy remains the diagnostic gold standard, Transient Elastography offers a valuable, non-invasive method for early detection of hepatic fibrosis. Larger, prospective longitudinal studies are warranted to better characterize the extent and clinical implications of liver involvement in SSc.

Keywords

• SYSTEMIC SCLEROSIS
• HEPATIC RIGIDITY
• TRANSITORY ELASTOGRAPHY