Factors associated with discordance in the assessment of fibrosis stage between transient elastography and liver biopsy in NAFLD patients

Abstract

Background and aimsFew studies focus on the concordance of fibrosis stage assessment between transient elastography (TE) and liver biopsy (LB) in non-alcoholic fatty liver disease (NAFLD). This study aimed to investigate the rate of discordance and factors associated with discordance in the fibrosis stage assessment between TE and LB. MethodsLB-proven NAFLD patients were enrolled retrospectively. Liver fibrosis was assessed via TE and LB based on Steatosis-Activity-Fibrosis (SAF) criteria. Cohen's kappa was used to estimate the discordance between the fibrosis stage assessment by TE and LB. Logistic regression was utilized to determine the factors associated with discordance. ResultsA total of 172 eligible patients were included. The concordance of fibrosis staging between TE and LB was moderate (kappa = 0.446, p < 0.001). The overall rate of discordance was 52.90% (91/172) and highest in the F2 stage (66.28%) and F3 stage (60.42%), moderate in the F1 stage (23.81%), and lowest in the F4 stage (0.00%). The rate of overestimation and underestimation was 23.66% and 38.71% in patients detected by M-probe, while the rate of overestimation and underestimation was 33.87% and 19.35% in patients detected by XL-probe, respectively. BMI [OR=1.494, p = 0.017] and type 2 diabetes mellitus (T2DM) (OR=4.678, p = 0.008) were significantly associated with the overestimation in fibrosis stage assessment when the M-probe was applied. ConclusionsThe discordance between TE and LB in fibrosis stage assessment was unexpectedly high and mainly observed in F1-F3 patients. BMI and T2DM were the factors associated with overestimation using the M-probe.