Acute viral hepatitis increases liver stiffness values measured by transient elastography

Abstract

Liver tissue alterations other than fibrosis may have an impact on liver stiffness measurement. In this study we evaluated 18 patients without a previous clinical history of liver disease, consecutively admitted for acute viral hepatitis. In each patient, aminotransferase determination and liver stiffness measurement were performed on the same study day, at 3 different points: (1) peak increase in aminotransferase; (2) aminotransferase 50% or less of the peak; (3) aminotransferase levels <2؋ the upper limit of normal. In all patients, the degree of liver stiffness at the time of the peak increase in aminotransferases exceeded the cutoff values proposed for the prediction of significant fibrosis or cirrhosis. A progressive significant reduction in liver stiffness values was observed (P < 0.0001) in the follow-up period in parallel with the reduction of aminotransferase levels (P < 0.0001). Moreover, a statistically significant, positive correlation between aminotransferases and liver stiffness measurement (LSM) at the onset of acute viral hepatitis was found (r ‫؍‬ 0.53, P ‫؍‬ 0.02 and r ‫؍‬ 0.51, P ‫؍‬ 0.03 for alanine aminotransferase and aspartate aminotransferase, respectively). In conclusion, the extent of necroinflammatory activity needs to be carefully considered in future studies aimed at further validating transient elastography, particularly in patients with absent or low-stage liver fibrosis (in other words, F0-F2 METAVIR). LSM does not represent a reliable instrument to detect the presence of advanced fibrosis and cirrhosis in patients presenting with a clinical picture of acute hepatitis. (HEPATOLOGY 2008;47:380-384.)

Liver stiffness in the hepatitis B virus carrier: A non-invasive marker of liver disease influenced by the pattern of transaminases

“…We showed that during hepatitis exacerbations, LS increased, paralleling the kinetics of ALT, whereas FS values were lower than expected according to the histological stage in patients with long-lasting (≥ 12 mo) ALT normalization [8] . Similar LS profiles have been reported in patients with acute viral hepatitis [9,10] .…”

Non-invasive assessment of liver fibrosis in chronic hepatitis C

“…Indeed, as previously mentioned, the extent of necro-inflammatory activity has been shown to influence TE measurements in patients with viral hepatitis with a steady increase of liver stiffness values in parallel with the degree of histological activity [66,70,100]. Consistent with these results, the risk of overestimating liver stiffness values has been reported in case of ALT flares in patients with acute viral hepatitis or chronic hepatitis B [101][102][103], as well as in cases of extrahepatic cholestasis [104] or congestive heart failure [105].…”

Clinical courses after administration of oral corticosteroids in patients with severely cholestatic acute hepatitis A; three cases

“…Considering that the histopathology showed at most portal or periportal fibrosis in these patients, this marked increase of liver stiffness is thought to have a relationship with the severity of intrahepatic necroinflammation or cholestasis. It was also previously reported that the increased liver stiffness found in patients with acute hepatitis would be related to the severity of the hepatocyte swelling resulted from necroinflammatory process 17. However, there is no report demonstrated the increase of liver stiffness in acute viral hepatitis patients with corresponding histopathologic findings to our knowledge.…”