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Probability-based interpretation of liver stiffness measurement in untreated chronic hepatitis B patients

Title
 Probability-based interpretation of liver stiffness measurement in untreated chronic hepatitis B patients
Authors
 Vincent Wai-Sun Wong; Pietro Lampertico; Jinlin Hou; Sang Hoon Ahn; Wan Cheng Chow; Juliette Foucher; Giampaolo Mangia; Henry Lik-Yuen Chan; Yongpeng Chen; Seung Up Kim; Pik Eu Chang; Victor de Lédinghen
Issue Date
2015
Journal Title
 Digestive Diseases and Sciences
ISSN
 0163-2116
Citation
 Digestive Diseases and Sciences, Vol.60(5) : 1448~1456, 2015
Abstract
BACKGROUND: Liver stiffness measurement (LSM) by transient elastography is a popular noninvasive test of fibrosis. Traditional LSM cutoffs dichotomize patients and do not clearly indicate the confidence of diagnosis. AIM: We derived and validated probability functions of fibrosis and cirrhosis based on LSM and determined the effect of alanine aminotransferase (ALT) on the scores. METHODS: Consecutive chronic hepatitis B patients who underwent liver function tests, LSM, and liver biopsies at six European and Asian centers (2/3 in the training cohort and 1/3 in the validation cohort) were recruited. Binary logistic regression was performed to predict the probabilities of different fibrosis stages based on LSM and/or ALT. RESULTS: A total of 1,051 patients were included in the final analysis (53 % with ALT ≥ 60 IU/L, 32 % F2, 20 % F3, and 24 % F4). The probability functions (LiFA-HBV score) with and without ALT adjustment closely mirrored the proportion with different fibrosis stages in both the training and validation cohorts. For a range of up to 300 IU/L, ALT maintained a weak linear relationship with LSM for each fibrosis stage (r (2) = 0.018-0.13). Based on relative integrated discrimination improvement, the addition of ALT to the LiFA-HBV score increased the correct reclassification of F3-4 and F4 by 5 and 17 %, respectively. CONCLUSIONS: ALT increases LSM in a linear fashion in chronic hepatitis B patients at any fibrosis stage. The LiFA-HBV score accurately predicts the probability of fibrosis. ALT adjustment increases the rate of reclassification modestly and is not essential.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/141528
DOI
10.1007/s10620-014-3488-5
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
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Link
 http://link.springer.com/article/10.1007%2Fs10620-014-3488-5
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