The usefulness of transient elastography in the assessment of patients with HBeAg‐negative chronic hepatitis B virus infection

Abstract

Histological severity is often mandatory for the management of HBeAg-negative chronic HBV patients. We evaluated the performance of transient elastography (TE) in this setting. We included 357 untreated HBeAg-negative patients with ≥ 1 reliable liver stiffness measurement (LSM-kPa) by TE: 182 inactive carriers with HBV-DNA < 2000 (n = 139) or 2000-19 999 IU/mL (n = 43) and 175 patients with chronic hepatitis B (CHB). In carriers, HBV-DNA > 2000 and/or LSM > 6.5 were considered as biopsy indications. LSMs did not differ between carriers with low and high viremia, but were lower in carriers than in patients with CHB (5.8 ± 1.7 vs 9.0 ± 5.6, P < 0.001) offering moderate differentiation between these two groups (AUROC: 0.705). LSMs did not change significantly in carriers after 16 (12-24) months. In carriers with a liver biopsy, Ishak's staging scores were similar between cased with low and high viremia but higher in cases with LSM > 6.5 than ≤ 6.5 kPa. Moderate fibrosis (stages: 2-3) was detected in 0/10 carriers with only HBV-DNA > 2000 IU/mL, 2/10 (20%) carriers with only LSM > 6.5 and 5/10 (50%) carriers with both HBV-DNA > 2000 and LSM > 6.5 (P = 0.009). In patients with CHB, LSMs correlated significantly with grading and staging scores and offered excellent accuracy for ≥ moderate, ≥ severe fibrosis or cirrhosis (AUROC ≥ 0.919-0.950). TE can be helpful for the noninvasive assessment of HBeAg-negative chronic HBV patients. In conclusion, LSMs offer excellent accuracy for fibrosis severity in HBeAg-negative patients with CHB and can identify carriers with high risk of moderate fibrosis, which may be present in up to 35% of carriers with LSM > 6.5 kPa and 50% of carriers with LSM > 6.5 kPa and HBV-DNA > 2000 IU/mL.

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

“…However, the diagnostic accuracy of this method can be influenced by the levels of serum alanine aminotransferase (ALT) and total bilirubin (TB) and the weight of the patients, as well as the skill of the operators. Moreover, the equipment has not been widely used due to its high price . Serological detection methods based on scores such as the aspartate aminotransferase (AST)‐to‐platelet ratio index (APRI) and the fibrosis index based on four factors (FIB‐4), which are calculated from results of routine laboratory tests using certain formulas, have been used to evaluate liver fibrosis.…”

“…Moreover, the equipment has not been widely used due to its high price. [18][19][20][21] Serological detection methods based on scores such as the aspartate aminotransferase (AST)-toplatelet ratio index (APRI) and the fibrosis index based on four factors (FIB-4), which are calculated from results of routine laboratory tests using certain formulas, have been used to evaluate liver fibrosis. These methods are economically inexpensive and convenient, but their diagnostic accuracy and sensitivity are not high.…”

Australian Liver Association (ALA) expert consensus recommendations for the use of transient elastography in chronic viral hepatitis

“…Individuals in this phase of disease may not require antiviral therapy. Several studies have included cohorts of patients with inactive hepatitis B . These patients appear to have a low rate of LSM progression over time and a low rate of clinically relevant outcomes.…”

“…Several studies have included cohorts of patients with inactive hepatitis B. [82][83][84][85][86] These patients appear to have a low rate of LSM progression over time and a low rate of clinically relevant outcomes. In one of these cohorts, 86 only 11 patients (5.5%) had an LSM > 7.2 kPa.…”

A combination of different diagnostic tools allows identification of inactive hepatitis B virus carriers at a single time point evaluation

“…Consequently, it would be of considerable relevance to find a diagnostic approach allowing the accurate identification of subjects with inactive HBV infection at a single time point evaluation. A number of recent studies have proposed either the quantification of serum HBsAg (qHBsAg) or the liver stiffness measurement (LSM) as potential diagnostic tools in chronic HBV infection . However, the available data concerning the utility of these tools in the recognition of ICs are not uniform, and studies integrating the information derived from the simultaneous application of distinct diagnostic approaches are very few .…”