Liver elastography can predict degree of advanced fibrosis for autoimmune hepatitis in biochemical remission

ABSTRACT: Abstract

Background and Aim

The aim was to analyze the concordance of liver stiffness measurement (LSM) either by transient elastography (TE) or ARFI with liver biopsy in autoimmune hepatitis (AIH) patients with biochemical remission and to identify those with histological remission. Liver biopsy is still the golden standard for AIH diagnosis. However, it is an invasive procedure and these patients, most of the time, require many biopsies, so it would be valuable to search for noninvasive method that could select all these patients and keep under observation.

Methods

Thirty‐three patients with AIH were submitted for liver biopsy to evaluate histological remission after at least 18 months of normal aminotransferases. The efficiency of LSM and fibrosis stages was tested by a receiver operating characteristic curve analysis (AUROC).

Results

One patient (3%) was F0, 6 (18.2%) were F1, 8 (24.2%) were F2, 10 (30.3%) were F3, and 8 (24.2%) were F4, according to METAVIR. Thirteen of thirty‐three (39.4%) patients did not achieve histological remission. AUROC for F4 stage was 0.83 (IC: 0.76–0.99) for TE and 0.78 (IC: 0.65–0.95) for ARFI. Optimal LSM cutoff values were 12.3 kPa (Se = 87.5%, Sp = 88%) for TE and 1.65 m/s (Se = 87.5%, Sp = 76%) for ARFI. The tests were unable to differentiate patients with histological activity from those in histological remission (P < 0.05).

Conclusion

TE and ARFI accurately identify liver fibrosis by METAVIR score in AIH patients with biochemical remission. No cutoff value was detected to indicate whether the patient achieved histological remission. We present the results of the assessment of liver fibrosis by noninvasive methods (TE/ARFI) in 33 patients with autoimmune hepatitis in biochemical remission and defined the optimal cutoff values for advanced fibrosis. For fibrosis stage F ≥ 3, optimal stiffness cutoff values were 8.7kPa (Se = 72.2%, Sp = 80%) for TE, and 1.5 m/s (Se = 66.7%, Sp = 80%) for fibrosis stage F = 4, cutoff values were 12.3 kPa (Se = 87.5%, Sp = 88%) for TE, and 1.65 m/s (Se = 87.5%, Sp = 76%) for ARFI. This is the first study to evaluate the accuracy of the method to evaluate remission only in patients already under immunosuppressive treatment with biochemical remission, with clearly defined end points of treatment, which enhances its results.

SUBMITTER: Paranagua‐Vezozzo D 

PROVIDER: S-EPMC10134765 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature