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

 Vincent Wai-Sun Wong  ;  Pietro Lampertico  ;  Victor de Lédinghen  ;  Pik Eu Chang  ;  Seung Up Kim  ;  Yongpeng Chen  ;  Henry Lik-Yuen Chan  ;  Giampaolo Mangia  ;  Juliette Foucher  ;  Wan Cheng Chow  ;  Sang Hoon Ahn  ;  Jinlin Hou 
 DIGESTIVE DISEASES AND SCIENCES, Vol.60(5) : 1448-1456, 2015 
Journal Title
Issue Date
Adult ; Alanine Transaminase/blood ; Asia ; Biomarkers/blood ; Biopsy ; Chi-Square Distribution ; Clinical Enzyme Tests ; Elasticity Imaging Techniques* ; Europe ; Female ; Hepatitis B, Chronic/blood ; Hepatitis B, Chronic/complications ; Hepatitis B, Chronic/diagnosis* ; Hepatitis B, Chronic/pathology ; Humans ; Linear Models ; Liver/pathology* ; Liver/virology ; Liver Cirrhosis/blood ; Liver Cirrhosis/diagnosis* ; Liver Cirrhosis/pathology ; Liver Cirrhosis/virology ; Liver Function Tests ; Logistic Models ; Male ; Middle Aged ; Predictive Value of Tests ; Probability ; Reproducibility of Results ; Severity of Illness Index
FibroScan ; Transient elastography ; Cirrhosis ; Liver fibrosis ; Liver biopsy
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
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