Optimization of hepatitis B cirrhosis detection by stepwise application of transient elastography and routine biomarkers

Abstract

By transient elastography-based stepwise combination with readily available serum markers, performance of detecting compensated CHB cirrhosis could be significantly improved in terms of diagnosis accuracy and proportion of obviating liver biopsy.

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

“…The cutoff of 9.1 kPa suggested by Liang et al 25 was derived from a study cohort that included patients with abnormal bilirubin. However, abnormal bilirubin impairs the performance for cirrhosis detection, and a previous study has recommended bilirubin normalization as being important for improving VCTE performance.…”

“…To address this issue, stepwise combinations of VCTE with other routine available markers, such as FIB-4, aspartate aminotransferase to platelet ratio index and red cell distribution width-platelet ratio, were applied to minimize the proportion of patients involved in the grey zone. 25 , 27 The stepwise combination could also minimize the proportion of patients wrongly diagnosed as cirrhotic, due to fluctuating levels of ALT or hepatitis flares, which cause misleadingly high LSM even at 3–6 months after ALT normalization in patients with severe acute exacerbation of CHB. 28 To the contrary, cirrhotic patients with mild necro-inflammation would be characterized as having lower LSM, thereby resulting in false negative diagnosis.…”

Stepwise application of fibrosis index based on four factors, red cell distribution width–platelet ratio, and aspartate aminotransferase–platelet ratio for compensated hepatitis B fibrosis detection

“…While FibroTest and VCTE may not be available in source‐limited settings, the APRI and FIB‐4 are more readily available with lower costs, not requiring particular expertise in interpretation, and can be performed in an outpatient setting . Unfortunately, the performance of FIB‐4 and APRI detecting liver fibrosis of CHB had been validated far from satisfactory with conflicting results, which may be due to the difference in the pathogenesis of liver fibrosis between CHB and chronic hepatitis C . The proportion of CHB patients classified as cirrhosis or non‐cirrhosis with enough strong evidence and obviating liver biopsies was only 41.1% by FIB‐4 and 24.2% by APRI …”

“…Non‐invasive assessment of liver fibrosis had been suggested to reduce but not substitute the need for liver biopsy . By cut‐offs with enough strong evidence, the stepwise combination of several non‐invasive methods had been proved to minimize the need of liver biopsies . Stepwise combination of VCTE, FIB‐4, and APRI for hepatitis B cirrhosis detection freed 10% more of patients from liver biopsies .…”

“…By cut‐offs with enough strong evidence, the stepwise combination of several non‐invasive methods had been proved to minimize the need of liver biopsies . Stepwise combination of VCTE, FIB‐4, and APRI for hepatitis B cirrhosis detection freed 10% more of patients from liver biopsies . The aim of this study is to further validate the clinical value of RPR in SF and cirrhosis detection and evaluate the stepwise application of FIB‐4, RPR, and APRI for source‐limited settings without VCTE.…”