Controlled attenuation parameter value-based diagnostic algorithm improves the accuracy of liver stiffness measurement in chronic hepatitis B patients

Abstract

Liver stiffness measurement (LSM) frequently overestimates the severity of liver fibrosis because of steatosis. However, the impact of the controlled attenuation parameter (CAP) on liver stiffness cutoff values remains unknown; CAP was used to quantify and diagnose the severity of hepatic steatosis. The study was conducted to determine the effect of CAP on liver stiffness cutoff values in chronic hepatitis B (CHB) patients. A retrospective cross-sectional study was performed in liver biopsy-proven CHB patients. The median LSM (kPa) in the elevated CAP group was higher than that in the normal CAP group at the same fibrosis stage. For S2-4, the area under the receiver operating characteristic (AUROC) curve of LSM was 0.78 and 0.72 in the normal and elevated CAP groups, respectively. When a cutoff value of 8.9 kPa was used, the diagnostic accuracy was 77.82% and 63.41% in the normal and elevated CAP groups, respectively. Compared with the alanine transaminase (ALT)-based LSM algorithm, the CAP-based LSM algorithm had a similar correct diagnosis rate (33.64% vs. 33.94%, respectively) but a lower misdiagnosis rate (16.97% vs. 20.30%, respectively). The new CAP-based LSM diagnostic algorithm will improve the diagnostic accuracy of liver fibrosis in CHB patients.

Persistent steatosis retards fibrosis regression during anti-HBV treatment in patients with chronic HBV infection

“…[12] However, there are concerns regarding the accuracy of CAP and LSM in evaluating steatosis and brosis in those patients. [13] Studies based on histological changes in steatosis and brosis are required to con rm the conclusion and elucidate the mechanisms drawn through noninvasive tests.…”

Persistent steatosis correlates with decreased fibrosis regression during anti‐HBV treatment in patients with chronic HBV infection

“…12 However, there are concerns regarding the accuracy of CAP and LSM in evaluating steatosis and fibrosis in those patients. 13 This study was conducted in compliance with the ethical principles of the Declaration of Helsinki and was approved by the ethics committee. Written informed consent was obtained from all patients before enrollment.…”

“…In a recent study of CHB patients who did not meet antihepatitis B Virus (HBV) indication, conducted in Hong Kong, persistent severe hepatic steatosis defined by controlled attenuation parameter (CAP) was independently associated with fibrosis progression, evaluated by liver stiffness measurement (LSM) (odds ratio [OR] = 2.379, p = 0.01) 12 . However, there are concerns regarding the accuracy of CAP and LSM in evaluating steatosis and fibrosis in those patients 13 . Studies based on histological changes in steatosis and fibrosis are required to confirm the conclusion and elucidate the mechanisms drawn through noninvasive tests.…”

Impact of hepatic steatosis on treatment response of autoimmune hepatitis: A retrospective multicentre analysis

“…A recent analysis confirmed that CAP can effectively evaluate hepatic steatosis in patients with autoimmune liver disease (AILD), regardless of the acute or chronic course ( 16 ). CAP can identify steatosis independently of intrahepatic inflammation (such as ALT elevation) ( 17 – 19 ). This paper includes multicentre research data with a relatively large sample size to analyse the impact of baseline hepatic steatosis on the biochemical response, development of liver fibrosis, and long-term clinical outcome of AIH patients by innovatively utilizing this easily accessible steatosis quantification.…”