Acute viral hepatitis increases liver stiffness values measured by transient elastography

Abstract

I read with great interest the study by Arena et al.,1 which concluded that the extent of necroinflammatory activity needs to be carefully considered in future studies aimed at further validating transient elastography, particularly in patients with absent or low-stage liver fibrosis. The study also concluded that liver stiffness measurement does not represent a reliable instrument to detect the presence of advanced fibrosis and cirrhosis in patients presenting with a clinical picture of acute hepatitis. The methods and interpretation of the results, however, raise several concerns. It is well known that transient elastography has been proposed as a rapid and noninvasive technique for the evaluation of disease progression in chronic liver diseases. That is to say, transient elastography should be performed to evaluate disease progression in chronic liver diseases by liver stiffness measurement, even if liver stiffness measurement does not represent a reliable instrument to detect the presence of advanced fibrosis and cirrhosis in patients presenting with a clinical picture of acute hepatitis. Then, it is important that transient elastography should be performed after the resolution of acute hepatitis to evaluate disease progression in chronic liver diseases. In other words, it is important that the liver stiffness values as measured by transient elastography should correspond well to the histological degree of fibrosis as confirmed by a liver biopsy after resolution of the acute liver damage. In the study by Arena et al.1, however, a liver biopsy was not taken. Therefore, the aforementioned question needs to be further addressed. The authors stated that among the 18 enrolled patients, the cause of acute viral hepatitis was hepatitis A virus in seven, hepatitis B virus in eight, and hepatitis C virus in three and that no significant difference was observed in the relationship between aminotransferase levels and liver stiffness measurement values in the different etiological groups of viral hepatitis.1 It is well known that liver stiffness values in the general population are influenced independently by gender, body mass index, and metabolic syndrome.2 In the study by Arena et al.,1 however, the difference of the aforementioned baseline parameters in the different etiological groups of viral hepatitis were not well described. Also, is there any relation between the difference of the above-mentioned baseline parameters in the different etiological groups of viral hepatitis to the relationship between aminotransferase levels and liver stiffness measurement values? In other words, were the influences of acute liver damage in liver stiffness measurement different in the different etiological groups of viral hepatitis? Ze-Zhou Song M.S.*, * Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.