Novel controlled attenuation parameter for noninvasive assessment of steatosis using Fibroscan^®: validation in chronic hepatitis C

Abstract

A novel controlled attenuation parameter (CAP) has been developed for Fibroscan(®) to assess liver steatosis, simultaneously with liver stiffness measurement (LSM). We assessed CAP diagnostic accuracy in a large cohort of patients with chronic hepatitis C (CHC) virus. A total of 615 patients with CHC, who underwent both Fibroscan(®) and liver biopsy, were analysed. Fibrosis was graded using METAVIR score. Steatosis was categorized by visual assessment as S(0) : steatosis in <10% of hepatocytes, S(1) : 11-33%, S(2) : 34-66% and S(3) : 67-100%. Performances of CAP and liver stiffness were determined using receiver operating characteristic (ROC) curve analysis and cross-validated using the bootstrap method. The Obuchowski measure was used to assess overall accuracy of CAP and to differentiate between steatosis grades. In multivariate analysis, CAP was related to steatosis (P < 10(-15) ) independently of fibrosis stage (which was related to LSM). The areas under ROC curves using CAP to detect steatosis were 0.80 (95% CI, 0.75-0.84) for S ≥ S(1) , 0.86 (0.81-0.92) for S ≥ S(2) and 0.88 (0.73-1) S = S(3) . CAP exhibited a good ability to differentiate steatosis grades (Obuchowski measure = 0.92). Performance of LSM for fibrosis assessment confirmed results from previous studies. CAP is a novel tool to assess the degree of steatosis and both fibrosis and steatosis can be evaluated noninvasively during the same procedure using Fibroscan(®) , in patients with CHC.

Steatosis, Glycation and Liver Fibrosis in Patients with Diabetes

“…NAFLD are twice more of frequent among subjects with diabetes [20,21]. Studies employing non-invasive methods reported severe fibrosis in 5.6% of outpatients using fibrotest [22] and up to 15% in hospitalized patients in our previous study using LSM [11].…”

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

“…CAP efficiently detected low-grade steatosis ([10 %), with a sensitivity of 91 % and specificity of 81 % at a cutoff value of 238 dB/m in a retrospective cohort of patients of mixed etiology chronic liver diseases [9]. The accuracy of CAP was confirmed in two prospective studies of mixed etiology liver disease [10,11], and in single etiology populations, including chronic hepatitis B (CHB), chronic hepatitis C, NAFLD, and alcoholic liver disease [12]. The suggested diagnostic performance and cutoff values for different degrees of steatosis are summarized in Table 1.…”

“…Chon et al [16] report CAP data from 264 healthy subjects, either as potential liver donors or in subjects undergoing routine Table 1 Diagnostic performance and suggested cutoff values of controlled attenuation parameter for the diagnosis of hepatic steatosis Authors Sasso et al [9] de Ledinghen et al [10] Myers et al [11] Sasso et al [12] Cardoso et al…”

Interpretation of Serum Visfatin Level in Relation to Hepatic Injury is Probably Gender Dependent in Nonalcoholic Fatty Liver Disease

“…A related cross-sectional formula was used to calculate the sample size with a power of 80%. The inclusion criteria were age of 18 years old or more with a diagnosis of steatosis based on ultrasonographic findings and controlled attenuation parameter (CAP) on fibroscan (21), and a stable body weight (± 2%) and physical activity for at least 3 months before the study.…”