Diagnostic accuracy of vibration-controlled transient elastography for staging liver fibrosis in autoimmune liver diseases: A systematic review and meta-analysis

Abstract

Background/aims: The assessment of liver fibrosis is crucial for managing autoimmune liver diseases such as primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis (PSC). However, data on the efficacy of noninvasive tests for these diseases are limited. This meta-analysis evaluated the diagnostic accuracy of vibration-controlled transient elastography (VCTE) for staging fibrosis in patients with autoimmune liver disease.

Methods: Searches were conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases to assess the diagnostic accuracy of VCTE against histology as the reference standard in adult patients with autoimmune liver disease. The summary area under the curve (sAUC) and diagnostic odds ratio were calculated for significant fibrosis (SF), advanced fibrosis (AF), and cirrhosis, according to liver biopsy.

Results: Fourteen articles were included, comprising 559 PBC patients from six studies, 388 AIH patients from five studies, and 151 PSC patients from three studies. VCTE demonstrated good performance for fibrosis staging in PBC, AIH, and PSC. In PBC, sAUCs of VCTE were 0.87, 0.89, and 0.99 for staging SF, AF, and cirrhosis, respectively. In AIH, the sAUCs were 0.88, 0.88, and 0.92, respectively, while in PSC, they were 0.88, 0.95, and 0.92, respectively. The cutoff values for AF were 7.5-17.9 kPa in PBC, 8.18-12.1 kPa in AIH, and 9.6 kPa in PSC.

Conclusion: VCTE shows high diagnostic accuracy for staging liver fibrosis in patients with autoimmune liver diseases. This non-invasive method serves as a valuable tool for the evaluation and monitoring of fibrosis in these lifelong diseases.

Keywords: Autoimmune disease; Liver fibrosis; Noninvasive test; Transient elastography.

Figure 1.

Flow diagram of study screening and selection. VCTE, vibration-controlled transient elastography.

Figure 2.

sROC curves and test performance to detect liver fibrosis in patients with primary biliary cholangitis. (A) Significant fibrosis (≥F2), (B) advanced fibrosis (≥F3), (C) cirrhosis (F4). sROC, summary receiver operating characteristic; AUC, area under the curve; DOR, diagnostic odds ratio.

Figure 3.

sROC curves and test performance to detect liver fibrosis in patients with autoimmune hepatitis. (A) Significant fibrosis (≥F2), (B) advanced fibrosis (≥F3), (C) cirrhosis (F4). sROC, summary receiver operating characteristic; AUC, area under the curve; DOR, diagnostic odds ratio.