Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases

TLDR

The study aimed to assess how liver stiffness measured by transient elastography correlates with serum transaminases, fibrosis stage, and other noninvasive fibrosis markers in 228 chronic viral hepatitis patients. Liver stiffness was quantified by FibroScan® in 228 patients, and dynamic changes were tracked over six months in 31 patients using repeated measurements. Transient elastography accurately identified fibrosis stages with cutoffs of 8.3 kPa for ≥F2 and 14 kPa for cirrhosis (sensitivity 85.2%/78.3%, specificity 90.7%/98.2%) and outperformed other surrogate markers; liver stiffness also correlated independently with ALT levels and fluctuated with biochemical activity, being lower in patients with biochemical remission. Summary.

Abstract

Summary. Liver stiffness was measured by transient elastography (FibroScan®) in 228 consecutive patients with chronic viral hepatitis, with (115) or without cirrhosis (113), to study its correlations with serum transaminases [alanine aminotransferase (ALT)], fibrosis stage and surrogate noninvasive markers of fibrosis (APRI, FORNS, FibroTest and hyaluronic acid). The dynamic profiles of serum transaminases and liver stiffness were compared by multiple testing in 31 patients during a 6‐month follow‐up. We identified 8.3 and 14 kPa as the fibrosis ≥F2 and cirrhosis cut‐offs, respectively: their sensitivities were 85.2%/78.3%; specificities 90.7%/98.2%; positive predictive values 93.9%/97.8%; negative predictive values 78.8%/81.6%; diagnostic accuracies 87.3%/88.2%. FibroScan ® performed better than the other surrogate markers of fibrosis ( P < 0.001). Other than fibrosis, other factors independently associated with liver stiffness were ALT for all patients and chronic hepatitis patients ( P < 0.001), and 12‐month persistently normal ALT (biochemical remission, P < 0.001) in cirrhotics. In patients with biochemical remission either spontaneous or after antiviral therapy (48 of 228, 21%), liver stiffness was lower than in patients with identical fibrosis stage, but elevated ALT ( P < 0.001). The liver stiffness dynamic profiles paralleled those of ALT, increasing 1.3‐ to 3‐fold during ALT flares in 10 patients with hepatitis exacerbations. Liver stiffness remained unchanged in 21 with stable biochemical activity ( P = 0.001). In conclusion, transient elastography is a new liver parameter that behaves as a reliable surrogate marker of fibrosis in chronic viral hepatitis patients, provided that its relationship with major changes of biochemical activity is taken into account.