ABSTRACT Background and Aims: TE has been proposed for the evaluation of disease progression in patients with hepatitis C. Aim of this study was to assess the accuracy of TE for prediction of significant or advanced fibrosis and the possible interfering role of inflammation and steatosis. Methods: Liver biopsy and TE were performed on the same day in 150 consecutive patients with chronic hepatitis C (92 men and 58 women, age 50.6±12.5). Histopathology showed significant or advanced fibrosis in 84 (56%) and 56 (37.3%) patients, respectively. Results: The AUROC for prediction of significant or advanced fibrosis were 0.91 and 0.98, respectively. For TE cut-off values of 7.8 kPa and 12.4 kPa, sensitivities were 85.7% and 83.3%, respectively. The Table shows multilevel LRs at different TE values for the diagnosis of significant or advanced fibrosis. Analysis of multilevel LRs is a more efficient and correct approach since it explores the whole spectrum of TE measurements. LRs above 10 and below 0.1 are considered to provide strong evidence to rule in or rule out a given diagnosis, respectively. Values of TE <6 or > or = 12 clearly indicated the absence or the presence of significant fibrosis, respectively. Values of TE <9 or > or = 12 clearly indicated the absence or the presence of advanced fibrosis. However, intermediate values could not reliably indicate the absence or presence of significant or advanced fibrosis. Inflammation significantly affected TE measurements in non-cirrhotic patients (P<0.0001), even after adjusting for fibrosis stage. Liver stiffness in patients with A= 2−3 was on average 2.36 units higher than in patients with A= 0−1. TE measurements were not influenced by the degree of steatosis. Conclusions: TE is more effective for the identification of patients with advanced fibrosis than those with significant fibrosis. In subjects in whom LRs are suboptimal to provide an indication of the disease stage, liver biopsy should be considered. Necro-inflammatory activity, but not steatosis, independently influences TE measurement in non-cirrhotic patients.
Transient elastography (TE) is more effective for the identification of HCV patients with advanced (F3-F4) rather than significant (F2-F4) liver fibrosis / U. Arena ; F. Vizzutti; JG. Abraldes; G. Corti; C. Stasi; S. Moscarella; S. Milani; E. Lorefice; A. Petrarca; G. Laffi; J. Bosch; F. Marra; M. Pinzani. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - STAMPA. - 48 (Suppl 2):(2008), pp. S284-S285.
Transient elastography (TE) is more effective for the identification of HCV patients with advanced (F3-F4) rather than significant (F2-F4) liver fibrosis
VIZZUTTI, FRANCESCO;CORTI, GIAMPAOLO;STASI, CRISTINA;MOSCARELLA, STEFANIA;MILANI, STEFANO;LOREFICE, ELISABETTA;PETRARCA, ANTONIO;LAFFI, GIACOMO;MARRA, FABIO;PINZANI, MASSIMO
2008
Abstract
ABSTRACT Background and Aims: TE has been proposed for the evaluation of disease progression in patients with hepatitis C. Aim of this study was to assess the accuracy of TE for prediction of significant or advanced fibrosis and the possible interfering role of inflammation and steatosis. Methods: Liver biopsy and TE were performed on the same day in 150 consecutive patients with chronic hepatitis C (92 men and 58 women, age 50.6±12.5). Histopathology showed significant or advanced fibrosis in 84 (56%) and 56 (37.3%) patients, respectively. Results: The AUROC for prediction of significant or advanced fibrosis were 0.91 and 0.98, respectively. For TE cut-off values of 7.8 kPa and 12.4 kPa, sensitivities were 85.7% and 83.3%, respectively. The Table shows multilevel LRs at different TE values for the diagnosis of significant or advanced fibrosis. Analysis of multilevel LRs is a more efficient and correct approach since it explores the whole spectrum of TE measurements. LRs above 10 and below 0.1 are considered to provide strong evidence to rule in or rule out a given diagnosis, respectively. Values of TE <6 or > or = 12 clearly indicated the absence or the presence of significant fibrosis, respectively. Values of TE <9 or > or = 12 clearly indicated the absence or the presence of advanced fibrosis. However, intermediate values could not reliably indicate the absence or presence of significant or advanced fibrosis. Inflammation significantly affected TE measurements in non-cirrhotic patients (P<0.0001), even after adjusting for fibrosis stage. Liver stiffness in patients with A= 2−3 was on average 2.36 units higher than in patients with A= 0−1. TE measurements were not influenced by the degree of steatosis. Conclusions: TE is more effective for the identification of patients with advanced fibrosis than those with significant fibrosis. In subjects in whom LRs are suboptimal to provide an indication of the disease stage, liver biopsy should be considered. Necro-inflammatory activity, but not steatosis, independently influences TE measurement in non-cirrhotic patients.File | Dimensione | Formato | |
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