Stepwise Application of Transient Elastography and Routine Biomarkers Optimizes Hepatitis B Cirrhosis Detection

2016 Journal of Gastroenterology & Hepatology In press;

AIM: Significant inflammation may overestimate liver stiffness and result in false positive diagnosis by transient elastography for CHB cirrhosis detection. This study tries to further improve the performance by stepwise combination with routine biomarkers. METHODS: A total of 236 compensated CHB patients with alanine transferase lower than 5 times upper limit of normal, liver biopsies, transient elastography and routine blood tests were included. Performance of stepwise combining transient elastography and routine biomarkers were analyzed. RESULTS: The area under ROC for detecting cirrhosis was 0.876 for transient elastography, 0.794 for FIB-4, 0.765 for API, 0.715 for APRI and 0.661 for AAR, respectively. The numbers for significant fibrosis were 0.844, 0.662, 0.580, 0.595, 0.695 and 0.510 in the same order. The proportion of patients determined as cirrhosis or non-cirrhosis was 66.5% by transient elastography, 41.1% by FIB-4, 14.4% by API and 24.2% by APRI, respectively; the numbers for significant fibrosis were 55.5% by transient elastography, 11.9% by APRI and none by the other serum markers. Stepwise combination of transient elastography and FIB-4/APRI increased positive predictive value of confirming cirrhosis diagnosis from 0.677 to 0.808 and 0.724, respectively; and the proportion of patients being determined the state of cirrhosis and obviating liver biopsy was up to 76%. CONCLUSIONS: By transient elastography based stepwise combination with readily available serum markers, performance of detecting compensated CHB cirrhosis could be significantly improved in terms of diagnosis accuracy and proportion of obviating liver biopsy.

Pubmed : 27346683