Abstract
BackgroundIn patients with non‐alcoholic fatty liver disease (NAFLD), the impact of the severity of steatosis and inflammatory activity on the accuracy of liver stiffness measurement (LSM) by transient elastography (TE) and by two‐dimensional shear wave elastography (2D‐SWE) in staging liver fibrosis is still debated and scarce. We aimed to focus on this aspect.MethodsWe prospectively studied 104 patients requiring biopsy for the assessment of NAFLD. We used ordinary least squares regression to test for differences in the association between fibrosis and LSM by TE and 2D‐SWE when other factors (steatosis and inflammatory activity) are considered.ResultsAmong 104 patients, 102 had reliable LSM by TE, and 88 had valid LSM by 2D‐SWE. The association between fibrosis based on histology and LSM was significantly stronger when 2D‐SWE assessed LSM compared to TE (Spearman's correlation coefficient of .71; P < .001 vs .51, P < .001; Z = 2.21, P = .027). Inflammatory activity was an independent predictor of LSM by TE but not of LSM by 2D‐SWE. After controlling for fibrosis, age, sex and body mass index, the inflammatory activity and the interaction between inflammatory activity and fibrosis independently explained 11% and 13% of variance in LSM by TE respectively. Steatosis did not affect the association of fibrosis and LSM by either method.ConclusionInflammatory activity on histology significantly affects LSM by TE, but not LSM by 2D‐SWE in NAFLD. LSM by 2D‐SWE reflects liver fibrosis more accurately than LSM by TE. Furthermore, the severity of steatosis on histology did not influence the association of LSM and fibrosis by either elastography method.
Highlights
Liver fibrosis is the most important prognostic factor in patients with non-alcoholic fatty liver disease (NAFLD).[1]
transient elastography (TE) has been validated in NAFLD as a method to identify and stage fibrosis, it has been shown that steatosis and inflammatory activity might influence the accuracy of liver stiffness measurements (LSM) to predict fibrosis.[9]
In this prospective cohort study, we found that inflammatory activity assessed on histology significantly affects liver stiffness measured by TE, but not liver stiffness measured by two-dimensional shear wave elastography (2D-SWE) in patients with NAFLD
Summary
Liver fibrosis is the most important prognostic factor in patients with non-alcoholic fatty liver disease (NAFLD).[1]. TE has been validated in NAFLD as a method to identify and stage fibrosis, it has been shown that steatosis and inflammatory activity might influence the accuracy of liver stiffness measurements (LSM) to predict fibrosis.[9] the data regarding the impact of steatosis on LSM are still controversial. This study aimed to assess whether histological steatosis and inflammatory activity in NAFLD patients affects the accuracy of LSM by two different ultrasound elastography methods (TE and 2D-SWE) in predicting fibrosis. Continuous variables are described as mean ± standard deviation, categorical variables as a number of cases (percentage) These descriptive statistics are provided for the complete group (104 patients) and the subgroups with valid LSM by TE and by 2D-SWE. Bivariate associations between patient demographic characteristics, laboratory and liver histology parameter, and the two non-invasive tests, LSM by TE and LSM by 2D-SWE, were calculated using pairwise Spearman's correlations on multiply imputed data. Statistical analyses were conducted using R open-source statistical software, version 4.0.3
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