Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases

Abstract

Liver stiffness was measured by transient elastography (FibroScan) in 228 consecutive patients with chronic viral hepatitis, with (115) or without cirrhosis (113), to study its correlations with serum transaminases [alanine aminotransferase (ALT)], fibrosis stage and surrogate noninvasive markers of fibrosis (APRI, FORNS, FibroTest and hyaluronic acid). The dynamic profiles of serum transaminases and liver stiffness were compared by multiple testing in 31 patients during a 6-month follow-up. We identified 8.3 and 14 kPa as the fibrosis >/=F2 and cirrhosis cut-offs, respectively: their sensitivities were 85.2%/78.3%; specificities 90.7%/98.2%; positive predictive values 93.9%/97.8%; negative predictive values 78.8%/81.6%; diagnostic accuracies 87.3%/88.2%. FibroScan performed better than the other surrogate markers of fibrosis (P < 0.001). Other than fibrosis, other factors independently associated with liver stiffness were ALT for all patients and chronic hepatitis patients (P < 0.001), and 12-month persistently normal ALT (biochemical remission, P < 0.001) in cirrhotics. In patients with biochemical remission either spontaneous or after antiviral therapy (48 of 228, 21%), liver stiffness was lower than in patients with identical fibrosis stage, but elevated ALT (P < 0.001). The liver stiffness dynamic profiles paralleled those of ALT, increasing 1.3- to 3-fold during ALT flares in 10 patients with hepatitis exacerbations. Liver stiffness remained unchanged in 21 with stable biochemical activity (P = 0.001). In conclusion, transient elastography is a new liver parameter that behaves as a reliable surrogate marker of fibrosis in chronic viral hepatitis patients, provided that its relationship with major changes of biochemical activity is taken into account.

Non-invasive assessment of liver fibrosis in chronic hepatitis C

“…Indeed, as previously mentioned, the extent of necro-inflammatory activity has been shown to influence TE measurements in patients with viral hepatitis with a steady increase of liver stiffness values in parallel with the degree of histological activity [66,70,100]. Consistent with these results, the risk of overestimating liver stiffness values has been reported in case of ALT flares in patients with acute viral hepatitis or chronic hepatitis B [101][102][103], as well as in cases of extrahepatic cholestasis [104] or congestive heart failure [105].…”

Shear-Wave Elastography for the Estimation of Liver Fibrosis in Chronic Liver Disease: Determining Accuracy and Ideal Site for Measurement

“…Some studies with transient elastography (19)(20)(21), SWE (21), and MR elastography (22,23) have concluded that the correlation between liver stiffness values and fibrosis stage is not affected by steatosis or necroinflammation. Other studies have suggested that inflammation, as suggested by elevated transaminase levels (24,25) or diagnosed at liver biopsy (26)(27)(28), affects transient elastography assessment of fibrosis. Similarly, steatosis has been reported to have no effect on acoustic radiation force imaging-based fibrosis assessment (29), whereas in several transient elastography studies, steatosis has been reported to have an effect on noninvasive fibrosis staging (28,30,31).…”

Targeting liver fibrosis: Strategies for development and validation of antifibrotic therapies

“…In addition, severe inflammation and mechan-ical cholestasis can significantly increase hepatic stiffness, thus confounding the fibrosis readout. [104][105][106] Nonetheless, ultrasound elastography should prove useful for stratification of patients for inclusion into treatment studies.…”