Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage

Sagir, Abdurrahman; Erhardt, Andreas; Schmitt, Marcus; Häussinger, Dieter

doi:10.1002/hep.22056

Cited by 451 publications

(351 citation statements)

References 18 publications

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“…The range of LS variations were significantly wider in patients with ALT flares intervened by complete biochemical remissions, as compared to patients with persistent ALT elevations between flares (FS variations ranged from 1.4 to 4.4-fold in the former and 1.2 to 1.6-fold in the latter group, P = 0.019). Altogether these findings confirm our original observation and other more recent reports on the major influence of the biochemical profile on LS in the setting of both acute and chronic liver damage [8][9][10] . Finally, we found that prolonged biochemical remissions were associated with progressive reductions of FS values.…”

Section: Discussionsupporting

confidence: 92%

“…We showed that during hepatitis exacerbations, LS increased, paralleling the kinetics of ALT, whereas FS values were lower than expected according to the histological stage in patients with long-lasting (≥ 12 mo) ALT normalization [8] . Similar LS profiles have been reported in patients with acute viral hepatitis [9,10] .…”

supporting

confidence: 85%

“…In fact, LS is a physical parameter that correlates primarily with fibrosis, but it is influenced also by other factors that modify the elasticity of the liver, such as significant variations of inflammatory infiltrate, edema and vascular congestion of the liver [8][9][10]19] . Accordingly, we showed that LS variations parallel ALT values during hepatitis exacerbations in the setting of both acute and chronic liver damage [8] .…”

Section: Discussionmentioning

confidence: 99%

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Liver stiffness in the hepatitis B virus carrier: A non-invasive marker of liver disease influenced by the pattern of transaminases

Oliveri¹,

Coco²,

Ciccorossi³

et al. 2008

WJG

117

100

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AIM:To investigate the usefulness of transient elastography by Fibroscan (FS), a rapid non-invasive technique to evaluate liver fibrosis, in the management of chronic hepatitis B virus (HBV) carriers. METHODS: In 297 consecutive HBV carriers, we studied the correlation between liver stiffness (LS), stage of liver disease and other factors potentially influencing FS measurements. In 87 chronic hepatitis B (CHB) patients, we monitored the FS variations according to the spontaneous or treatment-induced variations of biochemical activity during follow-up. RESULTS: FS values were 12.3 ± 3.3 kPa in acute hepatitis, 10.3 ± 8.8 kPa in chronic hepatitis, 4.3 ± 1.0 kPa in inactive carriers and 4.6 ± 1.2 kPa in blood donors. We identified the cut-offs of 7.5 and 11.8 kPa for the diagnosis of fibrosis ≥ S3 and cirrhosis respectively, showing 93.9% and 86.5% sensitivity, 88.5% and 96.3% specificity, 76.7% and 86.7% positive predictive value (PPV), 97.3% and 96.3% negative predictive value (NPV) and 90.1% and 94.2% diagnostic accuracy. At multivariate analysis in 171 untreated carriers, fibrosis stage (t = 13.187, P < 0.001), active vs inactive HBV infection (t = 6.437, P < 0.001), alanine aminotransferase (ALT) (t = 4.740, P < 0.001) and HBV-DNA levels (t = -2.046, P = 0.042) were independently associated with FS. Necroinflammation score (t = 2.158, > 10/18 vs ≤ 10/18, P = 0.035) and ALT levels (t = 3.566, P = 0.001) were independently associated with LS in 83 untreated patients without cirrhosis and long-term biochemical remission (t = 4.662, P < 0.001) in 80 treated patients. During FS monitoring (mean followup 19.9 ± 7.1 mo) FS values paralleled those of ALT in patients with hepatitis exacerbation (with 1.2 to 4.4-fold increases in CHB patients) and showed a progressive decrease during antiviral therapy. CONCLUSION: FS is a non-invasive tool to monitor liver disease in chronic HBV carriers, provided that the pattern of biochemical activity is taken into account. In the inactive carrier, it identifies non-HBV-related causes of liver damage and transient reactivations. In CHB patients, it may warrant a more appropriate timing of control liver biopsies.

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Section: Discussionsupporting

confidence: 92%

supporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Liver stiffness in the hepatitis B virus carrier: A non-invasive marker of liver disease influenced by the pattern of transaminases

Oliveri¹,

Coco²,

Ciccorossi³

et al. 2008

WJG

117

100

View full text Add to dashboard Cite

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“…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].…”

Section: Limitationssupporting

confidence: 70%

Non-invasive assessment of liver fibrosis in chronic hepatitis C

Castéra

2011

Hepatol Int

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“…1 Previously, increased liver stiffness (LS) has been shown to reflect liver inflammation from acute hepatitis, 2,3 congestion from increased central venous pressure, 4 and extrahepatic cholestasis. 5 While food intake has also been previously demonstrated to increase LS, 6 the most recent article by Arena et al 7 further illustrates the timeframe and pattern of this increase in LS.…”

Section: Liver Stiffness Changes During Meal Timesmentioning

confidence: 99%