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

Abstract

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.

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].…”

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

“…161 Comparative trials: Same or better than APRI for cirrhosis [191][192][193] Same or worse than FibroTest by stages 191,194 FibroTest and FibroScan match liver biopsy 191 Confirmed effective by four meta-analyses 179,[195][196][197] Predictive of 5-year survival in chronic HCV 162 Many non-fibrotic factors affect liver stiffness [201][202][203][204] Tested in chronic HCV 189,191,194 , HBV 198,199 Real-time elastography Measures echo displacement before and after liver compression and reconstructs strain field as reflective of tissue elasticity Spleen stiffness correlates with varices 217,218 Many non-fibrotic factors affect liver stiffness 221,225 Tested in diverse chronic liver diseases 209 APRI, aspartate aminotransferase/platelet ratio index; ARFI, acoustic radiation force impulse imaging; AST, serum aspartate aminotransferase level; HBV, hepatitis B virus; HCV, hepatitis C virus.…”

“…Increased serum ALT levels ≥2-fold the ULN range can reduce the accuracy of transient elastography for detecting cirrhosis in patients with chronic hepatitis B, 197 especially in patients with low stage fibrosis. 198 Furthermore, acute liver damage can increase liver stiffness to pathologically high levels suggestive of cirrhosis which can then improve to non-cirrhotic levels. Liver tissue examinations in these instances have been unable to confirm advanced hepatic fibrosis.…”

Fat and Fiber: How the Controlled Attenuation Parameter Complements Noninvasive Assessment of Liver Fibrosis

“…To overcome this confounder, the skin-liver capsule distance (SCD) was applied to multivariate analysis; SCD [25 mm consistently increased CAP *60 dB/m regardless of the grade of hepatic steatosis (unpublished data from the same group). Therefore, a SCDbased algorithm, similar to the ALT-based algorithm for LSM derived from CHB patients [19], may be considered for the interpretation of CAP in obese subjects.…”