A diagnostic algorithm for assessment of liver fibrosis by liver stiffness measurement in patients with chronic hepatitis B

Abstract

Steatosis could affect liver stiffness measurement in patients with nonalcoholic fatty liver disease and chronic hepatitis C. In this study, we aimed to investigate the impact of steatosis on liver stiffness in hepatitis B virus (HBV)-infected patients and develop a diagnostic algorithm for prediction of liver fibrosis by liver stiffness based on the controlled attenuation parameter. A total of 488 HBV-infected patients who underwent clinical examination, Fibroscan and liver biopsy were prospectively enrolled. The best liver stiffness measurement (kPa) cut-offs for significant fibrosis (S≥3) and advanced fibrosis (S≥4) were 8.1 and 10.9, respectively. The best controlled attenuation parameter cut-off for severe steatosis (≥30%) was 287 dB/m. Among patients with low-grade fibrosis (S0-S2/S0-S3), mean liver stiffness values were significantly higher in subjects with severe steatosis or controlled attenuation parameter ≥287 dB/m compared with those without. Moreover, in subjects with low-grade fibrosis, a higher rate of false-positive rate was observed in patients with severe steatosis than those in patients without (F0-F2: 28.2% vs 9.7%; F0-F3: 17.0% vs 5.3%), and in patients with CAP≥287 dB/m compared with their counterpart (F0-F2: 23.7% vs 9.2%; F0-F3: 14.1% vs 4.8%). Low-grade fibrosis was accurately identified by γ-glutamyl transpeptidase-to-platelet ratio (GPR) with a cut-off value of 0.17. In patients with GPR<0.17, similar results were observed. The presence of steatosis may lead to overestimation of fibrosis assessed by liver stiffness measurement in patient with chronic hepatitis B. A diagnostic algorithm for assessing fibrosis using liver stiffness was developed by combining both controlled attenuation parameter and GPR values.

Epidemiological features of chronic hepatitis C infection caused by remunerated blood donors: A nearly 27-year period survey

“…The results were expressed in kPa, and each LSM value corresponds to the median of 10 validated measurements[ 8 ]. An examination was considered successful and reliable if the interquartile range (IQR)/median for LSM was ≤ 30% or the LSM was < 7.1 kPa when the IQR/median for LSM was > 30%[ 9 ]. For the diagnosis of liver cirrhosis, a cut-off value of 12 kPa was used.…”

<p>Association of Serum Fibroblast Growth Factor 23 Levels with the Presence and Severity of Hepatic Steatosis Is Independent of Sleep Duration in Patients with Diabetes</p>

“…Details of the measurements have been previously described. 18 Hepatic steatosis was determined as CAP≥302 dB/m. 19…”

Hepatic Arterial Blood Flow Index Is Associated with the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B Virus Infection

“…Liver fibrosis degree can significantly affect the prognosis and treatment of chronic liver diseases. Considering the prognosis of hepatic diseases and the association of treatment success with fibrosis degree, the precise evaluation of liver fibrosis degree is highly important in CHB-infected patients (5).…”

“…Liver biopsy has been used as a reference to diagnose the liver fibrosis stage. Nonetheless, this technique is invasive, expensive, and associated with complications, sampling errors, and probable risks in clinical use (3,5). Therefore, the development of non-invasive approaches to evaluate liver fibrosis is recommended for improving the treatment of CHB and for the preparation of the liver biopsy (3,6).…”