Abstract
BackgroundLiver stiffness measurement (LSM) has recently become available for assessment of liver fibrosis. We aimed to develop a prediction model for liver fibrosis using clinical variables, including LSM.MethodsWe performed a prospective study to compare liver fibrosis grade with fibrosis score. LSM was measured using magnetic resonance elastography in 184 patients that underwent liver resection, and liver fibrosis grade was diagnosed histologically after surgery. Using the prediction model established in the training group, we validated the classification accuracy in the independent test group.ResultsFirst, we determined a cut-off value for stratifying fibrosis grade using LSM in 122 patients in the training group, and correctly diagnosed fibrosis grades of 62 patients in the test group with a total accuracy of 69.3%. Next, on least absolute shrinkage and selection operator analysis in the training group, LSM (r = 0.687, P < 0.001), indocyanine green clearance rate at 15 min (ICGR15) (r = 0.527, P < 0.001), platelet count (r = –0.537, P < 0.001) were selected as variables for the liver fibrosis prediction model. This prediction model applied to the test group correctly diagnosed 32 of 36 (88.8%) Grade I (F0 and F1) patients, 13 of 18 (72.2%) Grade II (F2 and F3) patients, and 7 of 8 (87.5%) Grade III (F4) patients in the test group, with a total accuracy of 83.8%.ConclusionsThe prediction model based on LSM, ICGR15, and platelet count can accurately and reproducibly predict liver fibrosis grade.
Highlights
Liver stiffness measurement (LSM) has recently become available for assessment of liver fibrosis
Patients The 122 patients enrolled in the first two thirds of the study period were selected for the training group, and the remaining 62 patients in the second one third were selected as the test group (Fig. 1)
Pathology of the liver After the operation, 44 (23.9%), 59 (32.0%), 26 (14.1%), 26 (14.1%), and 29 (15.7%) patients were pathologically diagnosed with liver fibrosis degree F0, F1, F2, F3, and F4, respectively, and 103 (55.9%), 52 (28.2%), and 29 (15.7%) patients were classified into Grade I, Grade II, and Grade III, respectively
Summary
Liver stiffness measurement (LSM) has recently become available for assessment of liver fibrosis. We aimed to develop a prediction model for liver fibrosis using clinical variables, including LSM. It is clinically important to diagnose the grade of fibrosis in patients with chronic liver disease. Accurate assessment of liver fibrosis is necessary to determine the indications for treatment of hepatitis C virus infection using direct-acting antivirals [1,2,3] or interferon therapy [4, 5]. Assessment of the extent of fibrosis provides a means to predict surgical risks in patients undergoing liver resection [7]. Percutaneous core-needle biopsy remains the gold standard and has been widely used to evaluate the cause or grade of liver fibrosis in patients with several liver diseases or abnormalities [8]. Histological diagnosis of biopsy specimens can provide direct diagnostic information, percutaneous liver biopsy is contraindicated in such patients with a tendency to easy bleeding, ascites, or difficult approach for biopsy by ultrasonography
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