Controlled Attenuation Parameter for Assessment of Hepatic Steatosis in Indian Patients

Background/Aims The gold standard method for measurement of hepatic steatosis is liver histology. Controlled Attenuation Parameter (CAP) can measure hepatic steatosis non-invasively. We aimed to assess the accuracy of CAP for detection of hepatic steatosis. Methods A total of 462 patients (May 2012–January 2017)—89 non-alcoholic fatty liver disease, 182 chronic hepatitis B, 88 chronic hepatitis C and 103 patients with other etiologies who underwent simultaneous liver biopsy and CAP estimation using Transient Elastography (TE) were included. Steatosis was graded as S0: steatosis in 0–5% of hepatocytes, S1: 6–33%, S2: 34–66% and S3: 67–100%. Receiver Operating Characteristic (ROC) curves were plotted to evaluate the accuracy of CAP in detecting hepatic steatosis. Predictors of CAP were assessed by multivariate linear regression model. Results The mean age ± SD was 33.8 ± 11.6 years; 296 (64.1%) were males. On liver histology, steatosis grades S0, S1, S2 and S3 were seen in 331 (71.6%), 74 (16.0%), 39 (8.4%) and 18 (3.9%), respectively. The median CAP (IQR) values for S0, S1, S2, and S3 steatosis were 206 (176–252) dB/m, 295 (257–331) dB/m, 320 (296–356) dB/m, and 349 (306–363) dB/m, respectively. For estimation of ≥S1, ≥S2, and ≥S3 using CAP, AUROC were 0.879, 0.893, and 0.883, respectively. In multivariate analysis, only BMI (OR 1.18; CI, 1.11–1.26, P P  = 0.003; grade 2, OR 42.04; 95% CI, 4.97–355.31, P  = 0.001 and grade 3, OR 35.83; 95% CI 4.31–297.61, P  = 0.001) independently predicted CAP. Conclusions CAP detects hepatic steatosis with good accuracy in Indian patients with various etiologies.