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Gut Liver. 2018 Mar 15;12(2):190-200. doi: 10.5009/gnl17092.

Combination of Transient Elastography and an Enhanced Liver Fibrosis Test to Assess the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B.

Author information

1
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
2
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
3
Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
4
Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
5
Department of Biostatics, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Background/Aims:

Liver stiffness (LS) was assessed using transient elastography, and the enhanced liver fibrosis (ELF) test was performed to accurately assess fibrotic burden. We validated the LS-ELF algorithm and investigated whether the sequential LS-ELF algorithm performs better than concurrent combination of these analyses in chronic hepatitis B (CHB) patients.

Methods:

Between 2009 and 2013, 222 CHB patients who underwent liver biopsy (LB), as well as LS measurement and the ELF test, were enrolled.

Results:

Advanced fibrosis (≥F3) and cirrhosis (F4) were identified in 141 (63.6%) and 118 (53.2%) patients, respectively. Areas under receiver operating characteristic curve for LS predictions of ≥F3 (0.887 vs 0.703) and F4 (0.853 vs 0.706) were significantly higher than the ELF test (all p<0.001). Based on the LS-ELF algorithm, 60.4% to 71.6% and 55.7% to 66.3% of patients could have avoided LB to exclude ≥F3 and F4, respectively, whereas 68.0% to 78.7% and 63.5% to 66.1% of patients could have avoided LB to confirm ≥F3 and F4, respectively. When confirmation and exclusion strategies were applied simultaneously, 69.4% to 72.5% and 60.8% to 65.3% of patients could have avoided LB and been diagnosed as ≥F3 and F4, respectively. The proportion of patients who correctly avoided LB for the prediction of ≥F3 (69.4% to 72.5% vs 42.3% to 59.0%) and F4 (60.8% to 65.3% vs 23.9% to 49.5%) based on the sequential LS-ELF algorithm was significantly higher than the concurrent combination (all p<0.05).

Conclusions:

The sequential LS-ELF algorithm conferred a greater probability of avoiding LB in CHB patients to diagnose advanced fibrosis and cirrhosis, and this test performed significantly better than the concurrent combination.

KEYWORDS:

Enhanced liver fibrosis; Hepatitis B, chronic; Liver cirrhosis; Liver stiffness; Transient elastography

PMID:
29069887
PMCID:
PMC5832344
DOI:
10.5009/gnl17092
[Indexed for MEDLINE]
Free PMC Article

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