Abstract
Background and Aims Concordance between transient elastography (TE) and ultrasonography (US) in assessing liver fibrosis in patients with chronic hepatitis B (CHB) and concurrent nonalcoholic fatty liver disease (NAFLD) has been rarely studied. This study aimed to evaluate the individual and combined performances of TE and US in assessing liver fibrosis and cirrhosis. Patients and Methods Consecutive CHB patients with NAFLD were prospectively enrolled. TE and US examinations were performed, with liver biopsy as a reference standard. Receiver operating characteristic (ROC) curves were obtained to evaluate the diagnostic performance. Differences between the areas under the ROC curves (AUCs) were compared using DeLong's test. Results TE and US scores correlated significantly with the histological fibrosis staging scores. TE was significantly superior to US in the diagnosis of significant fibrosis (AUC, 0.84 vs 0.73; P=0.02), advanced fibrosis (AUC, 0.95 vs 0.76; P<0.001), and cirrhosis (AUC, 0.96 vs 0.71; P<0.001). Combining TE with US did not increase the accuracy of detecting significant fibrosis, advanced cirrhosis, or cirrhosis (P=0.62, P=0.69, and P=0.38, respectively) compared to TE alone. However, TE combined with US significantly increased the positive predictive value for significant fibrosis when compared to TE alone. The optimal cut-off values of TE for predicting advanced fibrosis and cirrhosis were 8.7 kPa and 10.9 kPa, with negative predictive values of 92.4% and 98.7%, respectively. Conclusions TE is useful for predicting hepatic fibrosis and excluding cirrhosis in CHB patients with NAFLD. A combination of TE and US does not improve the accuracy in assessing liver fibrosis or cirrhosis.
Highlights
Chronic hepatitis B (CHB) and nonalcoholic fatty liver disease (NAFLD) are chronic liver diseases with a high incidence worldwide [1, 2]
Forty-two patients were excluded for the following reasons: 2 patients were coinfected with hepatitis C virus (HCV), 4 patients had a history of significant alcohol consumption, 1 patient had concurrent hepatocellular carcinoma (HCC), 10 patients had a body mass index (BMI) ≥30 kg/m2, and 25 patients had ALT or AST levels ≥5 times of upper limit of normal (ULN)
The comparison of areas under the ROC curves (AUCs) revealed that transient elastography (TE) was significantly superior to US in the diagnosis of advanced fibrosis (AUC, 0.95 vs 0.76, P
Summary
Chronic hepatitis B (CHB) and nonalcoholic fatty liver disease (NAFLD) are chronic liver diseases with a high incidence worldwide [1, 2]. A study found that NASH (a type of NAFLD) was independently correlated with liver fibrosis in patients with CHB [6]. Another cohort study found that concurrent fatty liver can independently increase hepatitis B virus (HBV)related HCC development 7.3-fold [7]. These reports suggest that timely and accurate diagnosis of liver fibrosis in CHB patients with NAFLD is urgent. Concordance between transient elastography (TE) and ultrasonography (US) in assessing liver fibrosis in patients with chronic hepatitis B (CHB) and concurrent nonalcoholic fatty liver disease (NAFLD) has been rarely studied. A combination of TE and US does not improve the accuracy in assessing liver fibrosis or cirrhosis
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