Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis

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J Viral Hepat. 2008 Jul 28. [Epub ahead of print]

Alanine aminotransferase-based algorithms of liver stiffness measurement by

transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B.

Chan HL, Wong GL, Choi PC, Chan AW, Chim AM, Yiu KK, Chan FK, Sung JJ, Wong VW.

Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong,

China.

The aim of this study is to know the liver stiffness measurement (LSM) cutoffs

for different stages of liver fibrosis in chronic hepatitis B (CHB) and to

investigate the effect of alanine aminotransferase (ALT) on LSM. We

prospectively studied consecutive CHB patients undergoing liver biopsy and

transient elastography examinations. Diagnostic performance of LSM for different

degrees of liver fibrosis was evaluated. One hundred and sixty-one CHB patients

with adequate liver biopsy sample size were studied. Area under receiver

operating characteristics curves of LSM for no fibrosis (F0 vs F1-4), bridging

fibrosis (F0-2 vs F3-4) and liver cirrhosis (F0-3 vs F4) was 0.80 (95% CI:

0.68-0.92), 0.87 (95% CI: 0.82-0.93) and 0.93 (95% CI: 0.89-0.97) respectively.

For liver cirrhosis, these optimal cutoff values were 8.4 kPa (98% sensitivity),

9.0 kPa (maximum sum of sensitivity and specificity), 13.4 kPa (94% specificity)

and 13.4 kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the

same fibrosis staging but higher ALT levels tend to have higher LSM, and the

diagnostic performance for low stage fibrosis was most seriously affected when

ALT was elevated. Different LSM cutoff values and algorithms were derived for

normal and elevated ALT levels. Based on these algorithms, liver biopsy can be

avoided in 62% and 58% of patients with normal and elevated ALT respectively. In

conclusion, transient elastography is a reasonable noninvasive tool to

substitute liver biopsy among the lowest and highest risk patients for the

assessment of liver fibrosis.

PMID: 18673426 [PubMed - as supplied by publisher]

[Guest guest]

J Viral Hepat. 2008 Jul 28. [Epub ahead of print]

Alanine aminotransferase-based algorithms of liver stiffness measurement by

transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B.

Chan HL, Wong GL, Choi PC, Chan AW, Chim AM, Yiu KK, Chan FK, Sung JJ, Wong VW.

Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong,

China.

The aim of this study is to know the liver stiffness measurement (LSM) cutoffs

for different stages of liver fibrosis in chronic hepatitis B (CHB) and to

investigate the effect of alanine aminotransferase (ALT) on LSM. We

prospectively studied consecutive CHB patients undergoing liver biopsy and

transient elastography examinations. Diagnostic performance of LSM for different

degrees of liver fibrosis was evaluated. One hundred and sixty-one CHB patients

with adequate liver biopsy sample size were studied. Area under receiver

operating characteristics curves of LSM for no fibrosis (F0 vs F1-4), bridging

fibrosis (F0-2 vs F3-4) and liver cirrhosis (F0-3 vs F4) was 0.80 (95% CI:

0.68-0.92), 0.87 (95% CI: 0.82-0.93) and 0.93 (95% CI: 0.89-0.97) respectively.

For liver cirrhosis, these optimal cutoff values were 8.4 kPa (98% sensitivity),

9.0 kPa (maximum sum of sensitivity and specificity), 13.4 kPa (94% specificity)

and 13.4 kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the

same fibrosis staging but higher ALT levels tend to have higher LSM, and the

diagnostic performance for low stage fibrosis was most seriously affected when

ALT was elevated. Different LSM cutoff values and algorithms were derived for

normal and elevated ALT levels. Based on these algorithms, liver biopsy can be

avoided in 62% and 58% of patients with normal and elevated ALT respectively. In

conclusion, transient elastography is a reasonable noninvasive tool to

substitute liver biopsy among the lowest and highest risk patients for the

assessment of liver fibrosis.

PMID: 18673426 [PubMed - as supplied by publisher]