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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
 Digestive Diseases and Sciences 
Issue Date
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. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
김승업(Kim, Seung Up)
안상훈(Ahn, Sang Hoon)
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