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A novel liver stiffness measurement-based prediction model for cirrhosis in hepatitis B patients

 Beom Kyung Kim  ;  Kwang-Hyub Han  ;  Jun Yong Park  ;  Sang Hoon Ahn  ;  Chae Yoon Chon  ;  Ja Kyung Kim  ;  Yong Han Paik  ;  Kwan Sik Lee  ;  Young Nyun Park  ;  Do Young Kim 
 LIVER INTERNATIONAL, Vol.30(7) : 1073-1081, 2010 
Journal Title
Issue Date
Adult ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Biopsy ; Chi-Square Distribution ; Clinical Enzyme Tests ; Elasticity ; Elasticity Imaging Techniques* ; Female ; Hepatitis B, Chronic/complications* ; Humans ; Liver/diagnostic imaging ; Liver/enzymology ; Liver/pathology* ; Liver Cirrhosis/diagnosis* ; Liver Cirrhosis/diagnostic imaging ; Liver Cirrhosis/etiology ; Logistic Models ; Male ; Middle Aged ; Platelet Count ; Predictive Value of Tests ; Prospective Studies ; Reproducibility of Results ; Republic of Korea ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity ; Spleen/diagnostic imaging
aminotransferase ; chronic hepatitis B ; cirrhosis ; liver biopsy ; prediction ; liver stiffness measurement
BACKGROUNDS/AIMS: While liver stiffness measurement (LSM) predicts histological cirrhosis accurately, complementary methods are needed for better performance. Furthermore, alanine aminotransferase (ALT) influences LSM, making it necessary to modify its use in patients with high ALT levels. We developed a new LSM-based prediction model for cirrhosis and estimated the thresholds for different ALT levels. METHODS: From 2008 to 2009, we prospectively enrolled 330 consecutive patients who were diagnosed with chronic hepatitis B (CHB) and underwent a liver biopsy and LSM on the same day. For detection of cirrhosis, we performed univariate and multivariate analyses, using the chi(2)-test/t-test and logistic regression respectively. Thereafter, a prediction model was derived from multivariate predictors. RESULTS: In multivariate analyses of patients with and without cirrhosis, we found significant differences in the LSM, spleen diameter and platelet count. Then, we developed an LSM-spleen diameter to platelet ratio index (LSPI): (LSM x spleen diameter/platelet count) x 100. The area under the receiver operating curve was 0.956, significantly higher than LSM alone (0.919, P=0.032). We suggested different thresholds in patients with ALT< or = upper limit of normal (ULN) (normal-ALT group, 164 patients) and ALT>ULN (high-ALT group, 166 patients). In the normal-ALT group, LSPI thresholds of 38 and 62 provided 95.7% negative predictive value (NPV) and a 95.5% PPV (positive predictive value), while in the high-ALT group, thresholds of 42 and 94 yielded 95.1% NPV and 96.4% PPV respectively. Therefore, liver biopsy could be avoided in 76.7% of the subjects. CONCLUSIONS: LSPI is a useful, non-invasive tool that can replace liver biopsy in the assessment of liver fibrosis in the majority of CHB patients
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Ja Kyung(김자경) ORCID logo https://orcid.org/0000-0001-5025-6846
Park, Young Nyun(박영년) ORCID logo https://orcid.org/0000-0003-0357-7967
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Paik, Yong Han(백용한)
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Kwan Sik(이관식) ORCID logo https://orcid.org/0000-0002-3672-1198
Chon, Chae Yoon(전재윤)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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