J Clin Transl Hepatol. 2019 Dec 28;7(4):313-321. doi: 10.14218/JCTH.2019.00040. Epub 2019 Dec 11.
Liver Stiffness Measurement Can Reflect the Active Liver Necroinflammation in Population with Chronic Liver Disease: A Real-world Evidence Study.
Wang L1, Zhu M2, Cao L3, Yao M4, Lu Y5, Wen X1, Zhang Y6, Ning J1, Long H7, Zhu Y8, Hu G9, Dang S10, Fu Q11, Chen L12, Zhang X2, Zhao J13, Gao Z7, Nan Y6, Lu F1,14.
Author information
1
Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
2
Department of Infectious Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
3
Liver Disease Center, Qinhuangdao Third Hospital, Qinhuangdao, Hebei, China.
4
Department of Anatomy and Embryology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
5
Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
6
Department of Traditional and Western Medical Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
7
Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
8
Liver Research Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
9
Department of Infectious Diseases, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
10
Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
11
Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, China.
12
Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
13
Department of Pathology and Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China.
14
Intervention and Cell Therapy Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
Abstract
Background and Aims: Non-invasive evaluation of liver necroinflammation in patients with chronic liver disease is an unmet need in clinical practice. The diagnostic accuracy of transient elastography-based liver stiffness measurement (LSM) for liver fibrosis could be affected by liver necroinflammation, the latter of which could intensify stiffness of the liver. Such results have prompted us to explore the diagnosis potential of LSM for liver inflammation. Methods: Three cross-sectional cohorts of liver biopsy-proven chronic liver disease patients were enrolled, including 1417 chronic hepatitis B (CHB) patients from 10 different medical centers, 106 non-alcoholic steatohepatitis patients, and 143 patients with autoimmune-related liver diseases. Another longitudinal cohort of 14 entecavir treatment patients was also included. The receiver operating characteristic (ROC) curve was employed to explore the diagnostic value of LSM. Results: In CHB patients, LSM value ascended with the increased severity of liver necroinflammation in patients with the same fibrosis stage. Such positive correlation between LSM and liver necroinflammation was also found in non-alcoholic steatohepatitis and autoimmune-related liver diseases populations. Furthermore, the ROC curve exhibited that LSM could identify moderate and severe inflammation in CHB patients (area under the ROC curve as 0.779 and 0.838) and in non-alcoholic steatohepatitis patients (area under the ROC curve as 0.826 and 0.871), respectively. Such moderate diagnostic value was also found in autoimmune-related liver diseases patients. In addition, in the longitudinal entecavir treated CHB cohort, a decline of LSM values was observed in parallel with the control of inflammatory activity in liver. Conclusions: Our study implicates a diagnostic potential of LSM to evaluate the severity of liver necroinflammation in chronic liver disease patients.