Alimentary Pharmacology & Therapeutics
Early View (Online Version of Record published before inclusion in an
issue)
Summary
Background Transient elastography has gained popularity to stage liver
fibrosis in chronic viral hepatitis, however, diagnostic cut-offs for
severe fibrosis in chronic hepatitis B are poorly defined.
Aim To evaluate an algorithm with two distinct cut-offs for positive and
negative prediction of significant fibrosis and cirrhosis in chronic
hepatitis B patients.
Methods Two cohorts of treatment-naïve patients with chronic hepatitis B
(125 training and 92 validations) were consecutively and concurrently
examined by percutaneous liver biopsy and transient elastography. Fibrosis
was staged by Metavir (significant fibrosis = F ≥ 2; cirrhosis = F4) in
≥2 cm long liver tissue cores.
Results A >13.1 kPa positive and a ≤9.4 kPa negative cut-off for
cirrhosis had a >90% sensitivity and specificity, with an accuracy of 94%.
The corresponding cut-offs for F ≥ 2 were >9.4 and ≤6.2 kPa, thus
classifying 56% of patients with an overall accuracy of 90%. In the
validation cohort, F4 and F ≥ 2 were predicted by the above transient
elastography cut-offs with an overall accuracy >90%. In 165 patients with
higher than upper limit of normal transaminase activity the dual cut-off
algorithm of transient elastography was as accurate as in the 52 patients
with normal alanine aminotransferase values in the prediction and exclusion
of cirrhosis, only.
Conclusions A dual cut-off algorithm allowed for correctly classifying
both significant fibrosis and cirrhosis in the majority of the patients
with chronic hepatitis B, independent of alanine aminotransferase values,
thus reducing the need for liver biopsy investigations.
Alimentary Pharmacology &Therapeutics
DOI: 10.1111/j.1365-2036.2011.04722.x
Dual cut-off transient elastography to assess liver fibrosis in chronic hepatitis B: a cohort study with internal validation