Transient elastography (TE) is more effective for the identification of HCV patients with severe (> F3) rather than significant (> F2) liver fibrosis

Background and aims. TE has received increasing interest for the evaluation of disease progression in CLD patients. The aim of this study was to assess the value of TE for the prediction of significant or severe fibrosis and the possible interfering role of inflammation and steatosis. Methods. Liver biopsy and TE were performed in 150 consecutive patients with chronic HCV-related hepatitis (92 men and 58 women, age 50.6±12.5) on the same day. Histopathology revealed significant and severe fibrosis in 84 (56%) and 56 (37.3%) patients respectively. Necroinflammatory activity and the degree of steatosis were also evaluated. Results. The AUROC for the prediction of significant or severe fibrosis were 0.91 and 0.98, respectively. For TE cutoff values of 7.8 kPa and 12.4 kPa, sensitivities were 85.7% and 83.3%, respectively. We then calculated multilevel LRs for different TE values for the diagnosis of significant or severe fibrosis (Table). This is a more efficient and correct approach since it treats TE measurements as a continuous variable. 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 ≥12 clearly indicated the absence or the presence of significant fibrosis, respectively. Values of TE <9 or ≥12 clearly indicated the absence or the presence of severe fibrosis, respectively. However, intermediate values could not reliably indicate the absence or presence of significant or severe fibrosis. LR for significant fibrosis (≥F2) LR for severe fibrosis (≥F3) TE (kPa) LR (90% CI) TE (kPa) LR (90% CI) <6 0.025 (0.004–0.139) <6 0 (0–0.190) ≥6 and <9 0.596 (0.379–0.931) ≥6 and <9 0.034 (0.006–0.179) ≥9 and <12 1.702 (0.712–4.159) ≥9 and <12 0.979 (0.415–2.256) ≥12 Infinity (10.369 to infinity) ≥12 Infinity (21.820–infinity) The presence of inflammation significantly affected TE measurements in non-cirrhotic patients (p < 0.0001), even after adjusting for the fibrosis stage. Liver stiffness in patients withA= 2–3was on average 2.36 units higher than in patients with A= 0–1. Importantly, TE measurements were not influenced by the degree of steatosis. Conclusions. TE is more effective for the identification of patients with severe fibrosis than those with significant fibrosis. In subjects in which LRs are not optimal to provide a reliable indication of the disease stage, liver biopsy should be considered if clinically indicated. Necro-inflammatory activity, but not steatosis, strongly and independently influences TE measurement in non-cirrhotic patients.