Combination of Transient Elastography and an Enhanced Liver Fibrosis Test to Assess the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B - PubMed (original) (raw)

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

Ja Yoon Heo et al. Gut Liver. 2018.

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.

Keywords: Enhanced liver fibrosis; Hepatitis B, chronic; Liver cirrhosis; Liver stiffness; Transient elastography.

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1

Fig. 1

Receiver operating characteristic curves of liver stiffness (LS) and enhanced liver fibrosis (ELF) values to predict fibrosis stages. LS and ELF values were similarly predictive of ≥F2 stage (A) (area under receiver operating characteristic curve [AUC], 0.857 vs 0.802; p=0.286), whereas the LS value was superior to the ELF value for predicting the ≥F3 (B) (AUC, 0.887 vs 0.703; p<0.001) and F4 stages (C) (AUC, 0.853 vs 0.706; p<0.001).

Fig. 2

Fig. 2

Prediction of ≥F3 and F4 stages using the combined LS-ELF algorithm with internal (A, B) and external cutoff values (C, D). LS, liver stiffness; ELF, enhanced liver fibrosis; CHB, chronic hepatitis B.

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