Functional liver imaging score and relative enhancement index predict transplant-free survival in cirrhosis.
Low functional liver imaging score independently linked to worse transplant-free survival in cirrhosis
Functional liver imaging score and relative enhancement index predict transplant-free survival in cirrhosis.
To evaluate the prognostic performance of the Relative Enhancement Index (Relative Enhancement Index) and the Functional Liver Imaging Score (Functional Liver Imaging Score), derived from gadoxetic acid-enhanced MRI, for predicting transplant-free survival in patients with cirrhosis; to determine whether these imaging biomarkers provide prognostic information after adjustment for clinical severity markers; to assess their interobserver agreement; and, because transplantation and death are competing events, to disentangle the association of Functional Liver Imaging Score and Relative Enhancement Index with each outcome using a competing-risks framework.
The cohort was assembled using stratified convenience sampling, with 20 patients selected from each Child-Pugh class (A, B, and C), to ensure representation across the full spectrum of liver dysfunction.
low Functional Liver Imaging Score nearly triples the risk of transplant or death after adjustment
During follow-up, 20 patients underwent liver transplantation (33.3 %), 16 died (26.7 %), and 24 remained alive without transplantation (40 %).
In univariable Cox analysis, Functional Liver Imaging Score 0-3 and Relative Enhancement Index < 100 were significant predictors of adverse outcomes (death or liver transplantation), with hazard ratios of 3.767 (95 % CI: 1.872-7.579; p < 0.001) and 3.883 (95 % CI: 1.679-8.979; p = 0.002), respectively.
Functional Liver Imaging Score and Relative Enhancement Index demonstrate excellent interobserver agreement and are associated with transplant-free survival in patients with cirrhosis, with moderate discriminative performance by AUROC analysis.
Functional Liver Imaging Score remained independently associated with outcome after adjustment for age, MELD score, and Child-Pugh score, whereas Relative Enhancement Index showed an association of similar magnitude that did not reach significance after multivariable adjustment.