Prognostic value of liver stiffness measurement and contrast-enhanced ultrasound in chronic liver disease: a prospective cohort study.

backgroundChronic liver disease (CLD) has a heterogeneous clinical course, and noninvasive identification of patients at increased risk of liver-related adverse outcomes remains clinically important. Although liver stiffness measurement (LSM) is widely used to assess fibrosis and disease severity, the prognostic value of CEUS findings in CLD remains less well defined. This study evaluated the prognostic value of LSM and CEUS findings, individually and in combination, in patients with CLD.

methodsA prospective cohort study was conducted involving 258 CLD patients from a tertiary hospital between June 2020 and June 2022. All patients underwent conventional ultrasound, liver elastography (LE), and contrast-enhanced ultrasound (CEUS) examinations, with 3-year follow-up to observe adverse events including hepatic decompensation and hepatocellular carcinoma occurrence. Collinearity assessment and events per variable principle were applied to ensure model stability. Kaplan-Meier method was used for survival analysis, Cox regression for prognostic factor analysis, ROC curves for predictive efficacy evaluation, and subgroup analyses for consistency assessment across different clinical strata.

resultsFollow-up was completed in 235 patients (91.08%). During follow-up, 46 liver-related adverse events (19.57%) occurred, including 35 cases of hepatic decompensation, 8 cases of hepatocellular carcinoma, and 3 cases of liver-related deaths. The adverse event group had significantly higher liver stiffness measurement (LSM) values compared to the non-event group (24.68 ± 8.12 kPa vs. 17.02 ± 6.35 kPa, P < 0.001), and higher CEUS abnormality rates (67.39% vs. 28.57%, P < 0.001). Multivariate Cox regression with four variables (disease duration, Child-Pugh score, LSM value, and CEUS abnormality) showed that LSM values (HR = 1.098, 95%CI: 1.069-1.128, P < 0.001) and CEUS abnormalities (HR = 2.412, 95%CI: 1.326-4.389, P = 0.004) were independent prognostic factors. LSM values ≥ 18.72 kPa predicted adverse endpoint events with 69.57% sensitivity, 86.77% specificity, and AUC of 0.811 (95%CI: 0.734-0.887). CEUS abnormalities predicted adverse endpoint events with 67.39% sensitivity, 71.43% specificity, and AUC of 0.735 (95%CI: 0.654-0.816). Combined ultrasound parameters achieved 84.78% sensitivity, 74.60% specificity, and AUC of 0.846 (95%CI: 0.775-0.917), superior to individual indicators (P < 0.05). Risk stratification based on LSM values and CEUS classified patients into low-risk group (3-year event-free survival rate 93.89%), intermediate-risk group (78.79%), and high-risk group (36.84%), with statistically significant differences between groups (P < 0.001). Subgroup analyses confirmed consistent prognostic value across different disease etiologies and liver function strata (all P for interaction > 0.05).

conclusionHigher LSM values and CEUS abnormalities were independently associated with liver-related adverse outcomes in patients with CLD. Combining LSM and CEUS may improve prognostic stratification; however, prospective external validation is required before routine clinical implementation.