Transient Elastography for Diagnosis of Stages of Hepatic Fibrosis and Cirrhosis in People with Alcoholic Liver Disease

Abstract

The presence and progression of hepatic (liver) fibrosis into cirrhosis is a prognostic variable having impact on survival in people with alcoholic liver disease. Transient elastography (TE) is a non-invasive method for assessing and staging hepatic fibrosis. To determine the diagnostic accuracy of TE for diagnosis and staging hepatic fibrosis in people with alcoholic liver disease when compared with liver biopsy (LB). Diagnostic cohort and diagnostic case-control study designs that assessed hepatic fibrosis in participants with alcoholic liver disease with TE and LB, irrespective of language or publication status. We followed the guidelines in the draft Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Five retrospective and nine prospective cohort studies with 834 participants provided data for the review analyses. We performed an HSROC analysis and reported an SROC curve for hepatic fibrosis stage F4 (cirrhosis). The HSROC analysis suggested that when the cut-off value changes, there is a wide variation in specificity and a more limited variation in sensitivity. We performed an additional analysis with the studies with the most commonly used cut-off value of 12.5 kPa. The summary sensitivity and specificity of TE (seven studies with 330 participants) were 0.95 and 0.71 with LR+ 3.3 and LR- 0.07. TE may be used as a diagnostic method to rule out liver cirrhosis(F4) in people with alcoholic liver disease when the pre-test probability is about 51% (range 15% to 79%). TE may also help in ruling out severe fibrosis (F3 or worse). LB investigation remains an option if the certainty to rule in or rule out the stage of hepatic fibrosis or cirrhosis remains insufficient after a clinical follow-up or any other non-invasive test considered useful by the clinician.