Factors affecting the accuracy of Controlled Attenuation Parameter (CAP) in assessing hepatic steatosis in patients with chronic liver disease

Kyu Sik Jung, Beom Kyung Kim, Seung Up Kim, Young Eun Chon, Kyung Hyun Cheon, Sung Bae Kim, Sang Hoon Lee, Sung Soo Ahn, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Young Nyun Park, Kwang Hyub Han

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Background & Aims: Controlled attenuation parameter (CAP) can measure hepatic steatosis. However, factors affecting its accuracy have not been described yet. This study investigated predictors of discordance between liver biopsy (LB) and CAP. Methods: A total of 161 consecutive patients with chronic liver disease who underwent LB and CAP were enrolled prospectively. Histological steatosis was graded as S0 (<5%), S1 (5-33%), S2 (34-66%), and S3 (>66% of hepatocytes). Cutoff CAP values were calculated from our cohort (250, 301, and 325 dB/m for ≥S1, ≥S2, and S3). Discordance was defined as a discrepancy of at least two steatosis stages between LB and CAP. Results: The median age (102 males and 59 females) was 49 years. Repartition of histological steatosis was as follows; S0 26.1% (n = 42), S1 49.7% (n = 80), S2 20.5% (n = 33), and S3 3.7% (n = 6). In multivariate linear regression analysis, CAP value was independently associated with steatosis grade along with body mass index (BMI) and interquartile range/median of CAP value (IQR/MCAP) (all P<0.05). Discordance was identified in 13 (8.1%) patients. In multivariate analysis, histological S3 (odd ratio [OR], 9.573; 95% confidence interval [CI], 1.207-75.931; P = 0.033) and CAP value (OR, 1.020; 95% CI, 1.006-1.034; P = 0.006) were significantly associated with discordance, when adjusting for BMI, IQR/MCAP, and necroinflammation, reflected by histological activity or ALT level. Conclusions: Patients with high grade steatosis or high CAP values have a higher risk of discordance between LB and CAP. Further studies are needed to improve the accuracy of CAP interpretation, especially in patients with higher CAP values.

Original languageEnglish
Article numbere98689
JournalPloS one
Issue number6
Publication statusPublished - 2014 Jun 5

Bibliographical note

Funding Information:
This study was supported by the Liver Cirrhosis Clinical Research Center, in part by a grant from the Korea Healthcare technology R & D project, Ministry of Health and Welfare, Republic of Korea (no. A102065), and by the Yonsei Liver Blood Bank (YLBB), in part by a grant from sanofi-aventis Korea. BioPredictive kindly provided the complimentary service for calculation of FT score. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

All Science Journal Classification (ASJC) codes

  • General


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