Combining routine markers improves the accuracy of transient elastography for hepatitis B cirrhosis detection

Liang, Xie; Dai, Letian; Yang, Shu; Zhong, Chun; Peng, Jie; Zhu, Yafang; Chen, Yong Peng; Hou, Jin

doi:10.1016/j.dld.2016.02.002

Cited by 11 publications

(10 citation statements)

References 28 publications

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“…Liang et al[23] retrospectively evaluated patients with HBV and they demonstrated that combining routine markers ameliorates the accuracy of transient elastography for cirrhosis diagnosis in these patients.…”

Section: Emerging Non-invasive Assessment Of Extensive Fibrosis or CImentioning

confidence: 99%

Evolving strategies for liver fibrosis staging: The non-invasive assessment

Stasi

Milani

2017

WJG

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Transient elastography and the acoustic radiation force impulse techniques may play a pivotal role in the study of liver fibrosis. Some studies have shown that elastography can detect both the progression and regression of fibrosis. Similarly, research results have been analysed and direct and indirect serum markers of hepatic fibrosis have shown high diagnostic accuracy for advanced fibrosis/cirrhosis. The prognosis of different stages of cirrhosis is well established and various staging systems have been proposed, largely based on clinical data. However, it is still unknown if either non-invasive markers of liver fibrosis or elastography may contribute to a more accurate staging of liver cirrhosis, in terms of prognosis and fibrosis regression after effective therapy. In fact, not enough studies have shown both the fibrosis regression in different cirrhosis stages and the point beyond which the prognosis does not change - even in the event of fibrosis regression. Therefore, future studies are needed to validate non-invasive methods in predicting the different phases of liver cirrhosis.

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Section: Emerging Non-invasive Assessment Of Extensive Fibrosis or CImentioning

confidence: 99%

Evolving strategies for liver fibrosis staging: The non-invasive assessment

Stasi

Milani

2017

WJG

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“…This was true for the single optimal cutoff and the dual (i.e., exclusionary and confirmatory) cutoffs. Unlike their performance in HBV mono‐infected patients not on anti‐HBV therapy, the poor performance of the serum‐based models in HBV‐HIV patients receiving cART may be attributed to their reliance on serum ALT and AST levels, which were normal or near normal due to HBV viral suppression with therapy.…”

Section: Discussionmentioning

confidence: 99%

“…This was true for the single optimal cutoff and the dual (i.e., exclusionary and confirmatory) cutoffs. Unlike their performance in HBV mono-infected patients not on anti-HBV therapy, (4)(5)(6)(10)(11)(12)(13)(14) the poor performance of the serum-based models in HBV-HIV patients receiving cART may be attributed to their reliance on serum ALT and AST levels, which were normal or near normal due to HBV viral suppression with therapy. Although studies in HBV patients consistently show a significant correlation between liver stiffness and severity of liver disease, no single cutoff has had sufficient accuracy to replace the need for biopsy in HBV to determine stages of fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Although most of these tests were developed in patients with chronic hepatitis C virus (HCV), they have also been applied to those with chronic hepatitis B virus (HBV). (7)(8)(9) However, most studies involving those with HBV were performed in subjects who were not on anti-HBV therapy, (4)(5)(6)(10)(11)(12)(13)(14) making their applicability to HBV-treated patients unclear.…”

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confidence: 99%

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Evaluating Noninvasive Markers to Identify Advanced Fibrosis by Liver Biopsy in HBV/HIV Co‐infected Adults

et al. 2019

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Noninvasive biomarkers are used increasingly to assess fibrosis in patients with chronic liver disease. We determined the utility of dual cutoffs for noninvasive biomarkers to exclude and confirm advanced fibrosis in hepatitis B virus (HBV)–human immunodeficiency virus (HIV) co‐infected patients receiving combined antiretroviral therapy. Participants were anti‐HIV/hepatitis B surface antigen–positive adults from eight clinical sites in the United States and Canada of the Hepatitis B Research Network. Fibrosis was staged by a central pathology committee using the Ishak fibrosis score (F). Clinical, laboratory, and vibration‐controlled transient elastography (VCTE) data were collected at each site. Dual cutoffs for three noninvasive biomarkers (aspartate aminotransferase‐to‐platelet ratio index, Fibrosis‐4 index [FIB‐4], and liver stiffness by VCTE) with the best accuracy to exclude or confirm advanced fibrosis (F ≥ 3) were determined using established methodology. Of the 139 enrolled participants, 108 with a liver biopsy and having at least one noninvasive biomarker were included: 22% had advanced fibrosis and 54% had normal alanine aminotransferase. The median (interquartile range) of APRI (n = 106), FIB‐4 (n = 106), and VCTE (n = 63) were 0.34 (0.26‐0.56), 1.35 (0.99‐1.89), and 4.9 (3.8‐6.8) kPa, respectively. The area under the curve for advanced fibrosis was 0.69 for APRI, 0.66 for FIB‐4, and 0.87 for VCTE. VCTE cutoffs of 5.0 kPa or less (to exclude) and 8.8 kPa or greater (to confirm) advanced fibrosis had a sensitivity of 92.3% and specificity of 96.0%, respectively, and accounted for 65.1% of participants. Among the 34.9% with values between the cutoffs, 26.1% had advanced fibrosis. Considering APRI or FIB‐4 jointly with VCTE did not improve the discriminatory capacity. Conclusion: VCTE is a better biomarker of advanced fibrosis compared with APRI or FIB‐4 in HBV/HIV co‐infected adults on combined antiretroviral therapy. Using VCTE dual cutoffs, approximately two‐thirds of patients could avoid biopsy to determine advanced fibrosis.

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“…For cutoffs determining cirrhosis, the suggested LSMs ranging between 11.8 kPa and 18.5 kPa were characterized with PLR of >10.0. The LSM of 18.5 kPa with PLR of 15.2 suggested by Liang et al 23 and the LSM of 18.2 kPa with PLR of 19.0 suggested by Marcellin et al 24 implied that the rational cutoff for ruling in diagnosis should be lower than 18.2 kPa. While cutoffs of 13.4 kPa and 13.1 kPa were derived from study cohorts of nearly 100 patients, cutoffs of 16.9 kPa and 17.0 kPa were suggested by study cohorts with more than 200 patients.…”

Section: Detecting Cirrhosismentioning

confidence: 96%

Clinical Application of Vibration Controlled Transient Elastography in Patients with Chronic Hepatitis B

Liang

Chen

2017

Journal of Clinical and Translational Hepatology

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Evaluation of the extent and progression of liver fibrosis and cirrhosis is of critical importance in the management and prognosis of patients with chronic hepatitis B. Due to the limitation of liver biopsy, non-invasive methods, especially liver stiffness measurement (LSM) by vibration controlled transient elastography, have been developed and widely applied for liver fibrosis assessment. LSM aims to reduce, but not to substitute, the need for liver biopsy for fibrosis/cirrhosis diagnosis. While LSM may have potential utility in monitoring treatment response, its applications in prediction of liver complications in terms of portal hypertension and esophageal varices, as well as disease prognosis, have been gradually validated. Here, we review the latest clinical applications of LSM in patients with chronic hepatitis B.

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Combining routine markers improves the accuracy of transient elastography for hepatitis B cirrhosis detection

Cited by 11 publications

References 28 publications

Evolving strategies for liver fibrosis staging: The non-invasive assessment

Evolving strategies for liver fibrosis staging: The non-invasive assessment

Evaluating Noninvasive Markers to Identify Advanced Fibrosis by Liver Biopsy in HBV/HIV Co‐infected Adults

Clinical Application of Vibration Controlled Transient Elastography in Patients with Chronic Hepatitis B

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