Non‐invasive algorithm of enhanced liver fibrosis and liver stiffness measurement with transient elastography for advanced liver fibrosis in chronic hepatitis B

Alimentary Pharmacology and Therapeutics - Tập 39 Số 2 - Trang 197-208 - 2014
Grace Lai‐Hung Wong1,2, Henry Lik‐Yuen Chan1,2, Paul Cheung‐Lung Choi3, Anthony W.H. Chan3, Zhuo Yu2, Jennifer Wing-Yan Lai1, Hoi–Yun Chan1,2, Vincent Wai‐Sun Wong1,2
1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
2Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong, China
3Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong, China

Tóm tắt

SummaryBackgroundThe accuracy of Enhanced Liver Fibrosis (ELF; ADVIA Centaur, Siemens Healthcare Diagnostics, Tarrytown, NY, USA) in assessing liver fibrosis in chronic hepatitis B (CHB) is to be determined.AimTo derive and validate a combined ELF‐liver stiffness measurement (LSM) algorithm to predict advanced fibrosis in CHB patients.MethodsUsing the data of a previously reported cohort of 238 CHB patients, an ALT‐based LSM algorithm for liver fibrosis was used as a training cohort to evaluate the performance of ELF against liver histology. The best combined ELF‐LSM algorithm was then validated in new cohort of 85 CHB patients not previously reported.ResultsIn the training cohort, LSM has better performance of diagnosing advanced (≥F3) fibrosis (area under the receiver operating characteristics curve [AUROC] 0.83, 95% confidence interval [CI 0.76–0.91] than ELF (AUROC 0.69, 95% CI 0.63–0.75). The optimal cut‐off values of ELF were 8.4 to exclude advanced fibrosis, and 10.8 to confirm advanced fibrosis. In the training cohort, an ELF ≤ 8.4 had a sensitivity of 95% to exclude advanced fibrosis; an ELF > 10.8 had a specificity of 92% to confirm advanced fibrosis. In the combined algorithm, low ELF or low LSM could be used to exclude advanced fibrosis as both of them had high sensitivity (≥90%). To confirm advanced fibrosis, agreement between high ELF and high LSM could improve the negative predictive value specificity (from 65% and 74% to 80%).ConclusionsAn Enhanced Liver Fibrosis ‐ liver stiffness measurement algorithm could improve the accuracy of prediction of either ELF or LSM alone. Liver biopsy could be correctly avoided in approximately 60% of patients.

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Alimentary Pharmacology and Therapeutics

Tập 39 Số 2

197-208

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