Dataset Information

Combination of Transient Elastography and an Enhanced Liver Fibrosis Test to Assess the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B.

ABSTRACT:

Background/aims

Liver stiffness (LS) was assessed using transient elastography, and the enhanced liver fibrosis (ELF) test was performed to accurately assess fibrotic burden. We validated the LS-ELF algorithm and investigated whether the sequential LS-ELF algorithm performs better than concurrent combination of these analyses in chronic hepatitis B (CHB) patients.

Methods

Between 2009 and 2013, 222 CHB patients who underwent liver biopsy (LB), as well as LS measurement and the ELF test, were enrolled.

Results

Advanced fibrosis (?F3) and cirrhosis (F4) were identified in 141 (63.6%) and 118 (53.2%) patients, respectively. Areas under receiver operating characteristic curve for LS predictions of ?F3 (0.887 vs 0.703) and F4 (0.853 vs 0.706) were significantly higher than the ELF test (all p?0.001). Based on the LS-ELF algorithm, 60.4% to 71.6% and 55.7% to 66.3% of patients could have avoided LB to exclude ?F3 and F4, respectively, whereas 68.0% to 78.7% and 63.5% to 66.1% of patients could have avoided LB to confirm ?F3 and F4, respectively. When confirmation and exclusion strategies were applied simultaneously, 69.4% to 72.5% and 60.8% to 65.3% of patients could have avoided LB and been diagnosed as ?F3 and F4, respectively. The proportion of patients who correctly avoided LB for the prediction of ?F3 (69.4% to 72.5% vs 42.3% to 59.0%) and F4 (60.8% to 65.3% vs 23.9% to 49.5%) based on the sequential LS-ELF algorithm was significantly higher than the concurrent combination (all p?0.05).

Conclusions

The sequential LS-ELF algorithm conferred a greater probability of avoiding LB in CHB patients to diagnose advanced fibrosis and cirrhosis, and this test performed significantly better than the concurrent combination.

SUBMITTER: Heo JY

PROVIDER: S-EPMC5832344 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Publications

Combination of Transient Elastography and an Enhanced Liver Fibrosis Test to Assess the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B.

Heo Ja Yoon JY Kim Beom Kyung BK Park Jun Yong JY Kim Do Young DY Ahn Sang Hoon SH Kim Hyon-Suk HS Park Young Nyun YN Han Kwang-Hyub KH Song Kijun K Kim Seung Up SU

Gut and liver 20180301 2

<h4>Background/aims</h4>Liver stiffness (LS) was assessed using transient elastography, and the enhanced liver fibrosis (ELF) test was performed to accurately assess fibrotic burden. We validated the LS-ELF algorithm and investigated whether the sequential LS-ELF algorithm performs better than concurrent combination of these analyses in chronic hepatitis B (CHB) patients.<h4>Methods</h4>Between 2009 and 2013, 222 CHB patients who underwent liver biopsy (LB), as well as LS measurement and the ELF ...[more]

PMID: 29069887

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Project description: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.

Dataset Information

Combination of Transient Elastography and an Enhanced Liver Fibrosis Test to Assess the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B.

Background/aims

Methods

Results

Conclusions

Publications

Combination of Transient Elastography and an Enhanced Liver Fibrosis Test to Assess the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B.

Similar Datasets

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