Impact of skin capsular distance on the performance of controlled attenuation parameter in patients with chronic liver disease

Background & AimsControlled attenuation parameter (CAP) is a non-invasive method for evaluating hepatic steatosis. However, larger skin capsular distance (SCD) can affect the accuracy. The aim of this study was to investigate the impact of SCD on the diagnostic performance of CAP and liver stiffness measurement (LSM). MethodsOf 101 patients with non-alcoholic fatty liver disease (NAFLD) and 280 patients with chronic hepatitis B (CHB) who underwent liver biopsy were prospectively recruited. CAP, LSM and SCD were performed using FibroScan with M probe. The areas under receiver operating characteristics curves (AUROCs) were calculated to determine the diagnostic efficacy. The optimal thresholds were defined by the maximum Youden index. ResultsSCD (B 30.34, P<0.001) and hepatic steatosis (B 23.04, P<0.001) were independently associated with CAP by multivariate analysis. The AUROCs were slightly higher for SCD <25mm compared to those for SCD 25mm for steatosis 5% (0.88 vs. 0.81), >33% (0.90 vs. 0.85) and >66% (0.84 vs. 0.72). For SCD <25mm, the optimal CAP cut-offs for differentiating steatosis 5%, >33% and >66% were 255.0 dB/m, 283.5 dB/m and 293.5 dB/m. However, cut-offs were elevated by approximately 60-70 dB/m for SCD 25mm. When stratified by fibrosis grade, LSM was significantly affected by SCD 25mm for advanced fibrosis (F3) in NAFLD, but not in CHB. ConclusionCAP is a promising tool for detecting and quantifying hepatic steatosis. SCD 25mm may cause overestimation of steatosis. Similarly, SCD 25mm affects the detection of advanced fibrosis by LSM in NAFLD patients.