Diagnosis of Hepatic Fibrosis and Cirrhosis by Transient Elastography in HIV/Hepatitis C Virus-Coinfected Patients

Lédinghen, Victor de; Douvin, Catherine; Kettaneh, A.; Ziol, Marianne; Roulot, Dominique; Marcellin, Patrick; Dhumeaux, Daniel; Beaugrand, Michel

doi:10.1097/01.qai.0000194238.15831.c7

Cited by 326 publications

(279 citation statements)

References 23 publications

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“…Most include patients with HCV infection, one includes patients with chronic liver disease of any origin, one includes patients with biliary cirrhosis due to primary biliary cirrhosis or primary sclerosing cholangitis, and one includes only those patients who are coinfected with HIV and HCV. These studies show that FibroScan results are reproducible across operators and time [35]. All the studies report that FibroScan's diagnostic performance is good, indicating that it agrees perfectly with liver biopsy.…”

Section: Fibroscansupporting

confidence: 53%

Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)

et al. 2008

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Section: Fibroscansupporting

confidence: 53%

Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)

et al. 2008

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“…In clinical practice, such results could be of major relevance, mainly for excluding cirrhosis in patients with CLD. In addition to previous studies mostly performed in HCV patients, [27][28][29][30] our results suggest that cutoff values could be optimized if specifically defined for each cause, mainly chronic hepatitis versus alcoholic CLD or nonalcoholic fatty liver or steatohepatitis presumably attributable to the discrepancies in fibrosis amounts between these various conditions.…”

Section: Discussionmentioning

confidence: 95%

“…Transient elastography is a new, noninvasive, and reproducible technique that measures tissue stiffness. 26 Liver stiffness measurement (LSM) has been demonstrated to be a reliable tool for assessing hepatic fibrosis and cirrhosis mainly in patients with chronic hepatitis C. [27][28][29][30] Additional studies evaluated the accuracy of LSM for the diagnosis of liver fibrosis in patients with CLD of various causes 31 and in patients with cholestatic liver diseases. 32 The purpose of this prospective multicenter study was to assess the accuracy of LSM for the diagnosis of cirrhosis in a large cohort of patients with CLD of various causes, to determine the cutoff values of LSM for optimal diagnosis in the different subgroups, and to describe histological liver lesions found in misclassified patients.…”

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confidence: 99%

Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases

et al. 2006

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A proper diagnosis of cirrhosis is essential for the management of patients with chronic liver diseases. We assessed the accuracy of liver stiffness measurement by Fibroscan for the diagnosis of cirrhosis in 1,257 patients with chronic liver diseases of various causes enrolled in a prospective multicenter study as well as clarified causes of discrepancies between liver histology and Fibroscan. One hundred thirty-two patients had unsuitable biopsy specimens, and 118 had unreliable liver stiffness measurements. Because 232 patients overlapped with a previous study, analysis was performed in the 775 new patients then derived in the whole population (1,007; 165 cirrhosis). Diagnostic accuracy was assessed by receiver operator curve (ROC) analysis. Liver samples were re-analyzed in case of discrepancies. The area under the ROC (AUROC) was 0.95 (95% CI, 0.93-0.96) for the diagnosis of cirrhosis in either 775 or 1,007 patients. The cutoff value with optimal diagnosis accuracy was 14.6 kPa in 1,007 patients (positive and negative predictive values, 74% and 96%) with discrepancies among the etiological groups. Eighty patients were misclassified: (1) among 45 patients without cirrhosis with liver stiffness 14.6 kPa or greater, 27 (60%) had extensive fibrosis and 10 (22%) significant perisinusoidal fibrosis; and (2) among 35 patients with cirrhosis and liver stiffness less than 14.6 kPa, 10 (29%) had a macronodular pattern and 25 (71%) either none or mild activity. In conclusion, Fibroscan is a reliable method for the diagnosis of cirrhosis in patients with chronic liver diseases, better at excluding than at predicting cirrhosis using a threshold of 14.6 kPa. False-negatives are mainly attributable to inactive or macronodular cirrhosis. (HEPATOLOGY 2006;44:1511-1517

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“…Thirty-three studies examined the APRI in patients with chronic hepatitis C. Ultimately, 11 studies were excluded for duplication of data (n ϭ 1), 38 insufficient data (n ϭ 5), 11,[39][40][41][42] small sample size (n ϭ 2), 43,44 or failure to use biopsy as the reference test (n ϭ 3). [45][46][47] Thus, our final data set for the meta-analysis included 22 studies (Table 1).…”

Section: Search Resultsmentioning

confidence: 99%

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

2007

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The development of noninvasive markers of liver fibrosis is a clinical and research priority. The aspartate aminotransferase-to-platelet ratio index (APRI) is a promising tool with limited expense and widespread availability. Our objective was to systematically review the performance of the APRI in hepatitis C virus (HCV)-infected patients. Random effects meta-analyses and areas under summary receiver operating characteristic curves (AUC) were examined to characterize APRI accuracy for significant fibrosis (stages 2-4) and cirrhosis. In 22 studies (n ‫؍‬ 4,266), the summary AUCs of the APRI for significant fibrosis and cirrhosis were 0.76 [95% confidence interval (CI), 0.74-0.79] and 0.82 (95%CI, 0.79-0.86), respectively. For significant fibrosis, an APRI threshold of 0.5 was 81% sensitive and 50% specific. At a 40% prevalence of significant fibrosis, this threshold had a negative predictive value (NPV) of 80%, but could reduce the necessity of liver biopsy by only 35%. For cirrhosis, a threshold of 1.0 was 76% sensitive and 71% specific. At a 15% cirrhosis prevalence, the NPV of this threshold was 91%. Higher APRI thresholds had suboptimal positive predictive values except in settings with a high prevalence of cirrhosis. APRI accuracy was not affected by the prevalence of advanced fibrosis, or study and biopsy quality. However, the accuracy for cirrhosis was greater in studies including human immunodeficiency virus (HIV)/HCV-co-infected patients. Conclusion: The major strength of the APRI is the exclusion of significant HCV-related fibrosis. Future studies of novel markers should demonstrate improved accuracy and cost-effectiveness compared with this economical and widely available index. (HEPATOLOGY 2007;46:912-921.)

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Diagnosis of Hepatic Fibrosis and Cirrhosis by Transient Elastography in HIV/Hepatitis C Virus-Coinfected Patients

Abstract: Liver stiffness measurement is a promising noninvasive method for the assessment of fibrosis in HIV-infected patients with chronic HCV infection. Its use for the follow-up of these patients should be further evaluated.

Cited by 326 publications

References 23 publications

Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)

Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)

Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

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