The Application of Liver Stiffness Measurement in Residents Without Overt Liver Diseases Through a Community-Based Screening Program

Cheng, Pin Nan; Chiu, Yen Cheng; Chiu, Hung Chih; Chien, Shih Chieh

doi:10.1097/md.0000000000003193

Cited by 16 publications

(28 citation statements)

References 36 publications

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“…Consistent with previous reports, the findings of this study demonstrates that high BMI, high AST levels, low platelet counts, and low albumin levels are independent risk factors for significant liver fibrosis assessed through TE . The mechanism underlying higher LSM values in patients with higher BMI values has not been well documented.…”

Section: Discussionsupporting

confidence: 83%

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Determination of the predictive factors for significant liver fibrosis assessed through transient elastography

Kao

Fang

et al. 2019

Adv in Digestive Medicine

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Several studies have reported the accuracy of transient elastography (TE), a noninvasive, reproducible, and reliable method for predicting liver fibrosis. This study evaluated the predictive factors associated with significant liver fibrosis assessed through TE. This study enrolled 1799 consecutive patients who underwent TE at Taipei Medical University Hospital between February 2014 and June 2015, including 810 patients with normal serum alanine aminotransferase (ALT) levels (<40 U/L). We evaluated the risk factors for significant liver fibrosis (liver stiffness measurement [LSM] > 7 kPa) assessed through TE and compared the results with those of the aspartate aminotransferase (AST)/platelet ratio index (APRI), a validated serum marker of liver fibrosis, in 672 patients with detailed laboratory data. Significant liver fibrosis was defined as an APRI score of >0.7. Significant liver fibrosis was detected through TE in 103 (12.7%) of 810 patients with normal serum ALT levels and in 91 (19.4%), 17 (18.7%), and 13 (5.8%) patients with chronic hepatitis B, chronic hepatitis C, and nonalcoholic fatty liver disease, respectively. Univariate analysis of patients with detailed biochemical test data showed that compared with without significant fibrosis, patients with significant fibrosis in the LSM > 7 kPa group were older; had higher body mass index (BMI) values; had higher fasting glucose, ALT, AST, total bilirubin, gamma‐glutamyltransferase, and ferritin levels; had higher APRI and fibrosis index based on four factors scores; had lower serum albumin levels and platelet counts; and higher rates of hypertension, diabetes, hepatitis C virus (HCV) positivity, splenomegaly, and hepatocellular carcinoma than those without significant fibrosis. Multivariate analysis disclosed that high BMI (P < 0.001), high AST levels (P = 0.006), low platelet counts (P < 0.001), and low albumin levels (P = 0.008) were the independent factors associated with significant liver fibrosis. In patients with normal serum ALT levels, the factors determining significant liver fibrosis were high BMI (P < 0.001), high AST levels (P < 0.001), low platelet counts (P = 0.001), and anti‐HCV positive (P = 0.006). LSM exhibited a moderate correlation with APRI scores (R2 = 0.325, P < 0.001). Among patients with normal serum ALT levels, the percentage of significant liver fibrosis defined as LSM > 7 kPa (11.2%) was higher than that of significant liver fibrosis defined as APRI > 0.7 (2.6%) (P < 0.001). Significant liver fibrosis is not uncommon in patients with chronic hepatitis and normal serum ALT levels. TE is a reliable method for assessing the degree of liver fibrosis. High BMI values, high AST levels, low platelet counts, and low albumin levels are correlated with the diagnosis of significant liver fibrosis through TE.

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Section: Discussionsupporting

confidence: 83%

“…We assessed the risk factors to be associated with significant liver fibrosis (LSM > 7 kPa) assessed through TE and compared with the APRI, which is a validated serum marker of liver fibrosis. Significant liver fibrosis was defined as an APRI score of >0.7 .…”

Section: Methodsmentioning

confidence: 99%

Determination of the predictive factors for significant liver fibrosis assessed through transient elastography

Kao

Fang

et al. 2019

Adv in Digestive Medicine

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“…Abnormal waist circumference was linked to higher prevalence of NAFLD, in the study done by Cheng PN et al 22 Authors also found significant correlation of liver stiffness with waist circumference (p<0.01).…”

Section: Discussionmentioning

confidence: 81%

Assessment of liver involvement in type 2 diabetes mellitus using fibroscan® and correlation with risk factors

Alagesan

Kumar

2019

Int J Adv Med

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Background: Non‐alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver injury. The most important predictor of mortality in NAFLD is the extent of liver fibrosis. Advanced liver fibrosis is associated with overall and liver related mortality. The upcoming non-invasive imaging modality for the evaluation of liver fibrosis is transient elastography (TE) (Fibro scan®). The aim of this study is to assess hepatopathy among diabetics using TE and to correlate the degree of hepatopathy with the associated risk factors.Methods: Type 2 diabetes mellitus patients were assessed for liver stiffness using TE. Liver stiffness was correlated with the associated risk factors. Authors recruited 100 patients from diabetic clinic in tertiary care teaching hospital.Results: About 55% of males and 39% of females had increased liver stiffness. 14% of males and 11% of females had severe fibrosis(F3-F4). Body mass index, waist circumference, fasting blood sugar levels, and liver enzymes, had significant positive correlation with liver stiffness whereas triglyceride levels, high-density lipoprotein levels, and duration of diabetes mellitus did not correlate with liver stiffness.Conclusions: Diabetic patients have high prevalence of NAFLD and advanced fibrosis. Those with obesity and dyslipidaemia are at particularly high risk. Type 2 diabetes mellitus patients with hepatopathy can be easily identified using TE scan eliminating the need for liver biopsy. The establishment of a national program for the recognition of NAFLD is essential to reduce the risk of liver disease progression.

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“…For sensitivity analysis, we defined increased CAP as more than 248 dB/m . LSM ≥ 7 kPa was considered to indicate significant fibrosis, according to previous reports …”

Section: Methodsmentioning

confidence: 99%

“…14 LSM ≥ 7 kPa was considered to indicate significant fibrosis, according to previous reports. 12,15…”

Section: Key Pointsmentioning

confidence: 99%

Clinical implications of controlled attenuation parameter in a health check‐up cohort

Kwak

Chung

Yang

et al. 2017

Liver International

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Background & Aims Evaluation of the controlled attenuation parameter (CAP) is a promising noninvasive method for assessing hepatic steatosis. Despite the increasing reliability of the CAP for assessing steatosis in subjects with chronic liver disease, few studies have evaluated the CAP in asymptomatic subjects without overt liver disease. Therefore, we aimed to evaluate the usefulness of the CAP for a health check‐up population. Methods We enrolled subjects who underwent abdominal ultrasonography (US), FibroScan (Echosens, France) and blood sampling during medical health check‐ups. The CAP was measured using FibroScan, and increased CAP was defined as CAP ≥ 222 dB/m. Results A total of 1133 subjects were included; 589 subjects (52.0%) had fatty liver based on US, and 604 subjects (53.3%) had increased CAP. Increased CAP was significantly associated with metabolic abnormalities, including higher body mass index (BMI)[odds ratio (OR) = 1.33;95% confidence interval (CI),1.24‐1.43; P < .001], higher alanine aminotransferase (ALT) (OR = 1.02; 95% CI, 1.01‐1.04; P = .003), higher insulin (OR = 1.04; 95% CI, 1.00‐1.08; P = .037), higher triglyceride (OR = 1.00; 95% CI, 1.00‐1.01; P = 0.042) and older age (OR = 1.02; 95% CI, 1.00‐1.03; P = .05). Furthermore, a comparison of clinical parameters among three groups (normal vs no fatty liver by US but increased CAP vs fatty liver based on US) revealed that metabolic parameters, including blood pressure, BMI, waist circumference, aspartate aminotransferase (AST), ALT, triglycerides, fasting glucose, uric acid, insulin, homeostasis model assessment‐estimated insulin resistance and liver stiffness measurements, gradually increased across the three groups (all P < .001). Conclusions In conclusion, increased CAP could be an early indicator of fatty liver disease with metabolic abnormalities that manifests even before a sonographic fatty change appears.

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The Application of Liver Stiffness Measurement in Residents Without Overt Liver Diseases Through a Community-Based Screening Program

Cited by 16 publications

References 36 publications

Determination of the predictive factors for significant liver fibrosis assessed through transient elastography

Determination of the predictive factors for significant liver fibrosis assessed through transient elastography

Assessment of liver involvement in type 2 diabetes mellitus using fibroscan® and correlation with risk factors

Clinical implications of controlled attenuation parameter in a health check‐up cohort

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