The usefulness of liver stiffness measurement using FibroScan in chronic hepatitis C in South Korea: A multicenter, prospective study

Abstract

Aim: We investigated the accuracy of liver stiffness measurement (LSM) in chronic hepatitis C (CHC) in a multicenter, prospective study in South Korea. Methods: Between June 2005 and July 2009, 91 CHC patients without a previous history of antiviral treatment, clinical evidences of cirrhosis, coinfection with other viruses, and heavy alcohol consumption and with alanine aminotransferase (ALT) Յ 5x upper limit of normal, total bilirubin Յ 1.5 mg/dL, sufficient liver biopsy quality (Ն 15 mm and more than six portal tracts), interquartile range to median liver stiffness (LS) value ratio Յ 0.21, and more than 10 valid measurements, were recruited. The Batts and Ludwig scoring system was used for histologic assessment. Age-platelet index (API), aspartate aminotransferase (AST)-to-platelet ratio index (APRI), and age-spleen-platelet ratio index (ASPRI) were calculated. Area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of LSM and other noninvasive models. Results: The mean age was 47.9 years, and the mean LS value was 7.7 kPa (44 men and 47 women). LS value was highly correlated to the fibrosis stages (r = 0.835, P < 0.001). The AUROCs of LSM were 0.909 for Ն F2, 0.993 for Ն F3, and 0.970 for F = 4 and were superior to those of API (0.72, 0.858, and 0.948, respectively), APRI (0.780, 0.887, and 0.904, respectively), and ASPRI (0.713, 0.862, and 0.957, respectively). The optimal cutoff LS values were 6.2 kPa for Ն F2, 7.7 kPa for Ն F3, and 11.0 kPa for F = 4. Conclusions: Our data suggest that LSM can accurately assess liver fibrosis in patients with CHC and be applied in South Korea.

New noninvasive index for predicting liver fibrosis in Asian patients with chronic viral hepatitis

“…Therefore, as alternatives to liver biopsy, many noninvasive methods and scoring systems have been developed to assess the stages and dynamic changes of liver fibrosis. Currently, several advanced imaging technologies, including transient elastography, acoustic radiation force impulse elastography, and magnetic resonance imaging elastography, are utilised to measure hepatic fibrosis 9–11 . However, they are costly and not widely utilised by medical institutions.…”

Clinical applications of transient elastography

“…In South Korea, one multi-center cohort study reported the diagnostic performance of TE in populations with CHC (Table 1). 29 In this study, the optimal cutoff value for significant fibrosis was 6.2 kPa and that for cirrhosis was 11.0 kPa, which were more accurate than other non-invasive parameters such as aspartate aminotransferase (AST)-to-platelet ratio index (APRI) 29…”

“…7,8,26 29. In these studies, the AUROC of TE ranged from 0.77 to 0.90, with a cutoff value of 6.2-8.7 kPa for assessment of significant fibrosis (F≥2), and an AUROC of 0.90-0.97 and cutoff value of 9.6-14.8 kPa for assessment of cirrhosis (Table 1).…”

Development of algorithms based on serum markers and transient elastography for detecting significant fibrosis and cirrhosis in chronic hepatitis B patients: Significant reduction in liver biopsy

“…Weight, ALT level, and TB level were factors affecting the accuracy of the results . Numerous studies have described the detailed background and examination procedures of FS …”