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Liver Int. 2019 Mar;39(3):494-502. doi: 10.1111/liv.14001. Epub 2018 Dec 2.

Clinical outcomes and management of patients with chronic hepatitis B and liver stiffness measurement in the grey zone.

Liu K1,2, Wong VWS3,4,5, Liang LY3,4, Lui GCY3,6, Chan HLY3,4,5, Wong GLH3,4,5.

Author information

1
AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
2
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
3
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong City, Hong Kong.
4
State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong City, Hong Kong.
5
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong City, Hong Kong.
6
Division of Infection Disease, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong City, Hong Kong.

Abstract

BACKGROUND:

A significant number of patients have liver stiffness measurements in the grey zone where liver biopsy is recommended.

AIMS:

To study chronic hepatitis B patients with initial liver stiffness measurements in the grey zone with regards to rates of liver biopsy, repeat liver stiffness measurements and outcomes.

METHODS:

Consecutive chronic hepatitis B patients who underwent transient elastography from August 2006 to July 2017 were retrospectively studied. Liver-related events were defined as hepatocellular carcinoma or cirrhotic complications. Grey zone was defined as liver stiffness measurements: 6.1-9.0 kPa (normal ALT) or 7.6-12.0 kPa (ALT 1-5 × upper limit of normal) on M-probe and 6.9-10.0 kPa on XL-probe.

RESULTS:

Of the 3212 patients analysed, 837 (26%) had initial liver stiffness measurements in grey zone. Only 3.6% of grey zone patients proceeded to liver biopsy within 6 months of transient elastography, of which 33% had METAVIR F3-4 fibrosis. Repeat liver stiffness measurements was performed in 44% of grey zone patients. Liver biopsy and repeat liver stiffness measurements prompted change in management in 47% and 31% of patients respectively. Independent predictors for liver-related events in grey zone patients included increased age, low albumin and low platelet count. Liver-related events rates were increased (9%-17%) in patients with METAVIR > F2 fibrosis on biopsy or repeat liver stiffness measurements which did not improve.

CONCLUSIONS:

Chronic hepatitis B patients with initial liver stiffness measurements in the grey zone rarely proceed to a clarifying liver biopsy which would reveal advanced fibrosis or cirrhosis in one-third of patients. Both liver biopsy and repeat liver stiffness measurements in grey zone patients have clinical utility in prompting changes in management and providing prognostic information.

KEYWORDS:

chronic hepatitis B; grey zone; liver stiffness measurement; liver-related events

PMID:
30417579
DOI:
10.1111/liv.14001

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