Performance of liver stiffness measurements by transient elastography in chronic hepatitis

Abstract

Aim: To compare results of liver stiffness measurements by transient elastography (TE) obtained in our patients population with that used in a recently published meta-analysis.

Methods: This was a single center cross-sectional study. Consecutive patients with chronic viral hepatitis scheduled for liver biopsy at the outpatient ward of our Infectious Diseases Department were enrolled. TE was carried out by using FibroScan™ (Echosens, Paris, France). Liver biopsy was performed on the same day as TE, as day case procedure. Fibrosis was staged according to the Metavir scoring system. The diagnostic performance of TE was assessed by using receiver operating characteristic (ROC) curves and the area under the ROC curve analysis.

Results: Two hundred and fifty-two patients met the inclusion criteria. Six (2%) patients were excluded due to unreliable TE measurements. Thus, 246 (171 men and 75 women) patients were analyzed. One hundred and ninety-five (79.3%) patients had chronic hepatitis C, 41 (16.7%) had chronic hepatitis B, and 10 (4.0%) were coinfected with human immunodeficiency virus. ROC curve analysis identified optimal cut-off value of TE as high as 6.9 kPa for F ≥ 2; 7.9 kPa for F ≥ 3; 9.6 kPa for F = 4 in all patients (n = 246), and as high as 6.9 kPa for F ≥ 2; 7.3 kPa for F ≥ 3; 9.3 kPa for F = 4 in patients with hepatitis C (n = 195). Cut-off values of TE obtained by maximizing only the specificity were as high as 6.9 kPa for F ≥ 2; 9.6 kPa for F ≥ 3; 12.2 kPa for F = 4 in all patients (n = 246), and as high as 7.0 kPa for F ≥ 2; 9.3 kPa for F ≥ 3; 12.3 kPa for F = 4 in patients with hepatitis C (n = 195).

Conclusion: The cut-off values of TE obtained in this single center study are comparable to that obtained in a recently published meta-analysis that included up to 40 studies.

Keywords: Chronic viral hepatitis; Elastography; FibroScan; Hepatitis C; Liver; Liver biopsy; Liver fibrosis; Transient elastography; Ultrasound.

Figure 1

Receiver operating characteristic curve. A: F0-F1 vs F2- F4 (F > 2) in all patients (n = 246); B: F0-F2 vs F3- F4 (F > 3) in all patients (n = 246); C: F0-F3 vs F4 (F = 4) in all patients (n = 246); D: F0-F1 vs F2- F4 (F > 2) in patients with chronic hepatitis C (n = 195); E: F0-F2 vs F3- F4 (F > 3) in patients with chronic hepatitis C (n = 195); F: F0-F3 vs F4 (F = 4) in patients with chronic hepatitis C (n = 195).