Sci Rep. 2018 Mar 27;8(1):5224. doi: 10.1038/s41598-018-23646-2.
Diagnostic accuracy of liver stiffness measurement in chronic hepatitis B patients with normal or mildly elevated alanine transaminase levels.Li Q1,2, Chen L3, Zhou Y4. Author information 1Department of liver disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China.2Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai, 200040, China.3Department of liver disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China. [email protected].4Department of Infectious Disease, Ruian people's hospital, Wenzhou, Zhejiang, 325200, China. [email protected].
AbstractWe aimed to evaluate the diagnostic accuracy of liver stiffness measurement (LSM) in 188 chronic hepatitis B (CHB) patients with alanine transaminase (ALT) ≤ twice the upper limit of normal (ULN). Liver fibrosis was staged using METAVIR scoring system. Define significant fibrosis as F2-F4, severe fibrosis as F3-F4, and cirrhosis as F4. To predict F2-F4, the AUROC of LSM was higher than that of APRI (0.86 vs 0.73, p = 0.001) and FIB-4 (0.86 vs 0.61, p < 0.001). To predict F4, the AUROC of LSM was also higher than that of APRI (0.93 vs 0.77, p = 0.012) and FIB-4 (0.93 vs 0.64, p < 0.001). Patients with ALT levels 1-2 ULN had higher cut-off values than patients with normal ALT levels for the diagnosis of F2-F4 (6.5 vs 6 kPa) and F4 (10.2 vs 7.8 kPa). Using cut-off values regardless of ALT levels, the diagnostic accuracy of LSM was 81% for F2-F4, and 89% for F4. Applying ALT-stratified cut-off values, the diagnostic accuracy of LSM was 82% for F2-F4, and 86% for F4. In conclusion, LSM is a reliable noninvasive test for the diagnosis of liver fibrosis. Applying ALT-stratified cut-off values did not enhance diagnostic accuracy of LSM in CHB patients with ALT ≤ 2 ULN.