Cut-off Values Of Liver Stiffness Measurement Research Articles

Possible use of 2D shear wave liver elastography in new-onset ascites evaluation

BackgroundNo data on the use of 2D shear wave elastography exists regarding the evaluation of the new-onset ascites causality.AimsTo determine whether 2D shear wave elastography can help in the non-invasive assessment of the new-onset ascites cause. To assess the applicability of liver stiffness measured by 2D shear wave elastography using Esaote MyLab Nine apparatus in patients with ascites.MethodsIn 52 consecutive patients with new-onset ascites (January 2020 to October 2021), liver stiffness using 2D shear wave elastography was prospectively measured. The reliable measurements were used for further analysis. Relevant clinical and laboratory data was collected.ResultsThe calculated liver stiffness measurement cut-off value of 14.4 kPa held 94% accuracy, 100% sensitivity, and 83% specificity when determining ascites with serum ascites albumin gradient ≥11 g/L. Reliable 2D shear wave elastography success rate was 84%.Conclusions2D shear wave elastography may potentially be used to differentiate transudative from exudative ascites, especially in patients with portal hypertension and peritoneal carcinomatosis.

P68 Liver fibrosis is independent of methotrexate use in patients with moderate-to-severe psoriasis

Abstract Methotrexate has been implicated for liver disease in patients with psoriasis for many years. Liver fibrosis (LF) has various established risk factors, but data on the impact of methotrexate on LF in patients with psoriasis are lacking. This cross-sectional cohort study aimed to determine the prevalence of LF using noninvasive LF markers in patients with psoriasis, and to evaluate the relationship between LF and the cumulative dose of methotrexate and other liver disease risk factors. Adults with moderate-to-severe chronic plaque psoriasis diagnosed by a dermatologist, who were selected for a LF assessment, were recruited from dermatology clinics in a tertiary centre between June 2020 and March 2021. Data were recorded as part of standard clinical care and at the time of recruitment. Patients underwent transient elastography to evaluate LF. Three values for liver stiffness measurement (LSM) were used, indicating ≥ mild LF (≥ 7 kPa), ≥ moderate LF (≥ 7.9 kPa) and ≥ advanced LF (≥ 9.5 kPa). Both continuous and categorical LSM values were used for evaluation. A total of 225 patients were included [median age 48, interquartile range (IQR) 37–57, 51% female]. Fifty-six per cent had a body mass index (BMI) ≥ 30 kg m−2, and the median alcohol use disorders identification test (AUDIT) score was 4 (IQR 1–7, 23% score ≥ 8). Ninety-one per cent had received methotrexate for a median duration of 36 months (IQR 14–78). Prevalence rates of LF were 31%, 21% and 13% using LSM ≥ 7 kPa, ≥ 7.9 kPa and ≥ 9.5 kPa, respectively. There was no association between methotrexate and continuous LSM values [unadjusted coefficient 0.16, 95% confidence interval (CI) 0.49–0.82; P = 0.63] or using the categorical LSM cutoff values: 7 kPa (unadjusted coefficient 1.06, 95% CI 0.98–1.15; P = 0.19), 7.9 kPa (unadjusted coefficient 1.03, 95% CI 0.94–1.12; P = 0.58) and 9.5 kPa (unadjusted coefficient 1.01, 95% CI 0.91–1.12; P = 0.84). Similarly, no significant relationship was found when adjusting for other risk factors for LF. The following risk factors were associated with higher LSM values: BMI (P < 0.001), waist circumference (P < 0.001), metabolic syndrome (P < 0.001), AUDIT score (P = 0.020) and Fib-4 score (P = 0.03). This study confirms a high prevalence of significant LF in patients with moderate-to-severe psoriasis. More importantly, it shows that cumulative methotrexate was not associated with LF, and other risk factors including BMI, waist circumference, metabolic syndrome, alcohol intake and Fib-4 score are important predictors for LF. The findings suggest that these risk factors should be assessed in this group of patients to identify patients requiring regular liver health monitoring. Further research is needed to determine whether methotrexate contributes to the progression of LF in the context of pre-existing LF.

1303-P: Screening for Metabolic Dysfunction–Associated Fatty Liver Disease (MAFLD) in Asian-Indians with Type 2 Diabetes Using Vibration-Controlled Transient Elastography—A Cross-Sectional Observational Study

Background: Metabolic dysfunction associated fatty liver disease (MAFLD) is a common finding in people with type 2 diabetes (T2D). Aims: To evaluate the association of liver steatosis and fibrosis in Asian-Indians with T2D using Vibration-Controlled Transient Elastography (VCTE). Methods: A total of 120 patients underwent NAFLD screening from July 2022 to December 2022 after excluding alcoholics and nondiabetes patients we had 73 people with T2D, recruited from Liver Clinic of Endocrine speciality centre. VCTE (Fibroscan 430 Mini Plus, Echosens, France) was used for Liver Stiffness measurement (LSM) in KiloPascals (KPa) and Controlled Attenuation Parameter (CAP) in Decibels per meter (dB/m). CAP score cut-offs used for steatosis: Grade 0 < 237 dB/m, Grade I is 238 - 259 dB/m Grade II is 260 - 292 dB/m and Grade III > 292 dB/m. LSM cut-off values used: F0 < 7 kPa, F1 is 7 - 10 kPa, F2 is 10 - 13 kPa, F3 is 13 - 16 kPa and F4 > 16 kPa. Results: The mean age was 53.4 ± 12.5 years and 26% (n=19) were women. Overweight seen in 21.9 % (n=16) and obesity in 67.1 % (n=49). We found liver steatosis in 73.7% (n=56) having Grade I in 16.4 % (n=12), Grade II in 34.2 % (n=25) and Grade III in 26 % (n=19). Liver fibrosis was detected in 30.1 % (n=22) with Mild fibrosis (F1) in 20.5 % (n=15) and clinically significant in 9.5 % (n=7) i.e., Moderate fibrosis (F2) in 6.8 % (n=5) and Cirrhosis grade (F4) in 2.7 % (n=2). We noticed that CAP score had significant positive correlation with BMI (P=0.01) and LSM had significant positive correlation with BMI (p=0.001), SGOT (p=0.01), SGPT (p=0.015) and Platelet count (P=0.04). Conclusions: Our data demonstrated that people with T2D have a high prevalence of steatosis and fibrosis which can lead to the development and progression of complications with high morbidity and mortality rates. So, we suggest screening for MAFLD should be a universal approach in diabetes co-morbidities management. Disclosure S. Chandel: None.K. Ravi Teja: None.

1260-P: Verifying the Use of FIB4 and BARD Scores to Predict Advanced Fibrosis Using Transient Elastography in People with Type 2 Diabetes in a Tertiary Care Center in India

Background: There is a high prevalence of nonalcoholic fatty liver disease in people with type 2 diabetes. Liver biopsy is the gold standard for diagnosing advanced fibrosis but is usually not feasible in routine clinical practice. Transient elastography is accepted as a viable non-invasive alternative but is not universally available due to high cost. FIB4 and BARD scores are easy to perform in routine clinical practice and can guide for referral for transient elastography or liver biopsy. The aim of this study was to assess the utility of these simple scores (FIB4 and BARD) to exclude advanced fibrosis in people with type 2 diabetes. Material and Methods: A total of 133 consenting people were subjected to fibro scan. Serum markers (AST, ALT, Platelet count) were measured, and FIB 4 and BARD scores were calculated using standard equations. LSM (liver stiffness measurement) cut-off value of 11.4 was used to exclude advanced fibrosis. Results: Out of 133 people with diabetes in the study, 51.1% males and 48.9% were females, with a mean age of 50years, BMI 26.6, hba1c 8.7%, duration of diabetes 7.6yrs. The average LSM was 9.1, mean AST was 36 U/ml and ALT 38.5U/ml, platelet count was 208cubic mm. Mean FIB4 score was1.7 and BARD score was 3. 82.7% had a LSM value of <11.5 and 17.3% had a LSM value of>11.5%, neither BARD score nor FIB4 had significant correlation with liver stiffness measurement. Fib4 had a (Negative predictive value) NPV of 83.6% and BARD score had a NPV of 85.7% to exclude advanced fibrosis (>11.4) Conclusion: A FIB 4 score of less than 2.6 and BARD score of less than 2 have a high negative predictive value to exclude advanced fibrosis. Due to the high incidence of NAFLD in people with diabetes, these should be routinely used to exclude advanced fibrosis and the decision to referral for fibro scans and liver biopsy. Disclosure A. Tewari: None. J. Tewari: None. A. Maheshwari: None. V. Tewari: None. B. Tewari: None.

Liver elastography can predict degree of advanced fibrosis for autoimmune hepatitis in biochemical remission.

The aim was to analyze the concordance of liver stiffness measurement (LSM) either by transient elastography (TE) or ARFI with liver biopsy in autoimmune hepatitis (AIH) patients with biochemical remission and to identify those with histological remission. Liver biopsy is still the golden standard for AIH diagnosis. However, it is an invasive procedure and these patients, most of the time, require many biopsies, so it would be valuable to search for noninvasive method that could select all these patients and keep under observation. Thirty-three patients with AIH were submitted for liver biopsy to evaluate histological remission after at least 18 months of normal aminotransferases. The efficiency of LSM and fibrosis stages was tested by a receiver operating characteristic curve analysis (AUROC). One patient (3%) was F0, 6 (18.2%) were F1, 8 (24.2%) were F2, 10 (30.3%) were F3, and 8 (24.2%) were F4, according to METAVIR. Thirteen of thirty-three (39.4%) patients did not achieve histological remission. AUROC for F4 stage was 0.83 (IC: 0.76-0.99) for TE and 0.78 (IC: 0.65-0.95) for ARFI. Optimal LSM cutoff values were 12.3 kPa (Se=87.5%, Sp=88%) for TE and 1.65 m/s (Se=87.5%, Sp=76%) for ARFI. The tests were unable to differentiate patients with histological activity from those in histological remission (P< 0.05). TE and ARFI accurately identify liver fibrosis by METAVIR score in AIH patients with biochemical remission. No cutoff value was detected to indicate whether the patient achieved histological remission.

EARLY PREDICTION OF ESOPHAGEAL VARICES ON THE BASIS OF ASPARTATE AMINO-TRANSFERASE (AST) TO PLATELET RATIO INDEX (APRI) AND TRANSIENT ELASTOGRAPHY IN PATIENTS OF CIRRHOSIS OF LIVER

Objectives: To study the etiological prole in liver cirrhosis patients &amp; to predict development of esophageal varices at the earliest with the help of Aspartate Amino-Transferase (AST) to Platelet ratio index (APRI) and Transient Elastography in these patients. The study wasMethods: conducted on 100 patients with chronic liver disease from June 2019 to June 2021. Informed consent was taken from the patients and detailed history, physical examination, laboratory investigations were carried out &amp; UGI endoscopies were performed. APRI scores &amp; Transient Elastography (broscan) liver stiffness measurement (LSM) values were then correlated with 'presence or absence' of esophageal varices (EVs) and with the 'grading' of varices. Among the 100 patients with liver cirrhosis, the overall prevalence of liver cirrhosis was higher in malesResults: (67.0%) than females (33.0%). The main cause of liver cirrhosis was alcoholic liver disease (39.0%) followed by chronic hepatitis B infection (15.0%). Different APRI cut-offs of 1.9, 1.4, 0.9 were taken &amp; correlated with 'presence or absence' of EVs &amp; with the 'grading' of EVs, but none shows satisfactory negative predictive value (NPV), proving that there is no satisfactory cut-off value of APRI to be used as a predictor of esophageal varices. However, as the APRI score is increasing, the grading of varices found on UGI endoscopy is increasing (r = 0.605, p&lt;0.001). LSM cut-off values of 24KPa, 19KPa &amp; 14KPa were taken &amp; we observed NPV of 75.0% for predicting esophageal varices at LSM cutoff of 14 KPa. Also, as the LSM score is increasing, the grading of varices found on UGI endoscopy is increasing (r = 0.842, p&lt;0.001). APRIConclusion: scores correlate poorly with the 'presence or absence' of esophageal varices but it correlate signicantly with the 'grading' of varices. Transient elastogram liver stiffness values correlate signicantly with the 'presence or absence' of esophageal varices &amp; also with the 'grading' of varices. Liver stiffness value of ≥14.0 KPa can be used as a guide for early prediction of esophageal varices &amp; endoscopy should be done in these patients to prevent fatal GI bleed from esophageal varices by medical management to decrease portal pressure or by early endotherapy in the form of endoscopic variceal ligation (EVL) or sclerotherapy.

The value of liver stiffness measured by two-dimensional shear wave elastography for predicting symptomatic posthepatectomy liver failure in patients with hepatocellular carcinoma

PurposeTo assess and compare the value of liver stiffness measurement (LSM) by two-dimensional shear wave elastography (2D-SWE) with the diagnosis of clinically significant portal hypertension (CSPH) and pathological examination in predicting symptomatic posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC). MethodA total of 130 patients who underwent liver resection for HCC between August 2018 and July 2021 were enrolled. Preoperative assessments for LSM and other clinicopathological tests were performed in all patients. The performance of LSM, CSPH and fibrosis stage in predicting symptomatic PHLF was assessed and compared. Univariate and multivariate analyses were conducted on the risk factors for symptomatic PHLF. ResultsSymptomatic PHLF occurred in 40 patients (30.8%). The best LSM cutoff value for predicting symptomatic PHLF was 9.5 kPa. The areas under the receiver operating characteristic curve (AUCs) of LSM ≥ 9.5 kPa, fibrosis stage and CSPH for predicting symptomatic PHLF were 0.732 (95% CI: 0.638–0.826, p < 0.001), 0.655 (95% CI: 0.553–0.758, p = 0.005) and 0.594 (95% CI: 0.484–0.705, p = 0.086), respectively. The AUC of LSM ≥ 9.5 kPa was significantly higher than that of CSPH (p = 0.010), and was comparable to that of fibrosis stage (p = 0.073). Multivariate analysis identified LSM ≥ 9.5 kPa (p = 0.001), major hepatectomy (p = 0.007) and CSPH diagnosis (p = 0.040) as independent predictors of symptomatic PHLF. ConclusionsLSM by 2D-SWE was promising for predicting symptomatic PHLF in HCC patients. The predictive performance was higher than that of CSPH and comparable to that of pathological fibrosis stage.

The Utility and Diagnostic Accuracy of Transient Elastography in Adults with Morbid Obesity: A Prospective Study

Patients with morbid obesity are at high risk for nonalcoholic fatty liver disease (NAFLD) complicated by liver fibrosis. The clinical utility of transient elastography (TE) by Fibroscan in patients with morbid obesity (body mass index (BMI) ≥ 40 kg/m2) is not well-defined. We examined the diagnostic accuracy of Fibroscan in predicting significant liver fibrosis (fibrosis stage ≥2) in morbidly obese patients (BMI ≥ 40 kg/m2). Patients scheduled for bariatric surgery were prospectively enrolled. Intraoperative liver biopsy, liver-stiffness measurement (LSM) by Fibroscan (XL probe), and biochemical evaluation were all performed on the same day. The endpoint was significant liver fibrosis defined as fibrosis stage ≥2 based on the Nonalcoholic Steatohepatitis Clinical Research Network. The optimal LSM cutoff value for detecting significant fibrosis was determined by using the Youden Index method. Routine clinical, laboratory, and elastography data were analyzed by stepwise logistic regression analysis to identify predictors of significant liver fibrosis and build a predictive model. An optimal cutoff point of the new model’s regression formula for predicting significant fibrosis was determined by using the Youden index method. One hundred sixty-seven patients (mean age, 46.4 years) were included, of whom 83.2% were female. Histological assessment revealed the prevalence of steatohepatitis and significant fibrosis of 40.7% and 11.4%, respectively. The median LSM was found to be significantly higher in the significant fibrosis group compared to those in the no or non-significant fibrosis group (18.2 vs. 7.7 kPa, respectively; p = 0.0004). The optimal LSM cutoff for predicting significant fibrosis was 12.8 kPa, with an accuracy of 71.3%, sensitivity of 73.7%, specificity of 70.9%, positive predictive value of 24.6%, negative predictive value of 95.5%, and ROC area of 0.723 (95% CI: 0.62–0.83). Logistic regression analysis identified three independent predictors of significant fibrosis: LSM, hemoglobin A1c, and alkaline phosphatase. A risk score was developed by using these three variables. At an optimal cutoff value of the regression formula, the risk score had an accuracy of 79.6% for predicting significant fibrosis, sensitivity of 89.5%, specificity of 78.4%, positive predictive value of 34.7%, negative predictive value of 98.3%, and ROC area of 0.855 (95% CI: 0.76–0.95). Fibroscan utility in predicting significant liver fibrosis in morbidly obese subjects is limited with accuracy of 71.3%. A model incorporating hemoglobin A1c and alkaline phosphatase with LSM improves accuracy in detecting significant fibrosis in this patient population.

Diagnostic efficacy of FibroScan for liver inflammation in patients with chronic hepatitis B: a single-center study with 1185 liver biopsies as controls

BackgroundNoninvasive diagnostic technologies that can dynamically monitor changes in liver inflammation are highly important for the management of chronic hepatitis B (CHB) patients and thus warrant further exploration. This study assessed the diagnostic efficacy of FibroScan for liver inflammation in CHB patients.MethodsA total of 1185 patients were selected, and ultrasound-guided liver biopsy was performed within 1 month after the FibroScan test. The liver stiffness measurement (LSM), the reliability criteria (IQR/M) of LSM, the quality of liver biopsy (complete portal area, PA), and the liver inflammation grades were the main observation items of this study. With liver biopsy as the control, the diagnostic efficacy of FibroScan for liver inflammation in CHB patients was evaluated by receiver operating characteristic (ROC) curve analysis.ResultsThe grade of liver inflammation was positively correlated with the stage of fibrosis (rho = 0.829, P < 0.001). Different grades of inflammation will have significant rise in LSM values within the same fibrosis stage, and LSM values were positively correlated with liver inflammation grade and fibrosis stage, and the rho is 0.579 and 0.593 respectively (P < 0.001). Significant differences in the LSM of FibroScan were observed among different grades of liver inflammation (P < 0.0001). Liver biopsy (PA > 10) served as the control, and the cutoff point and the area under ROC curves (AUCs) of the LSMs for different inflammation grades were as follows: G2, 8.6 kPa, 0.775; G3 9.8 kPa, 0.818; and G4, 11.0 kPa; 0.832. With LSM cutoff values of 8.6 kPa, 9.8 kPa and 11.0 kPa, FibroScan showed certain diagnostic value for CHB patients with G2, G3 and G4 liver inflammation, especially those with G4 inflammation.ConclusionsThe grade of liver inflammation was positively correlated with the stage of fibrosis, different grades of inflammation will have significant rise in LSM values within the same fibrosis stage. In addition to liver fibrosis, FibroScan could evaluate liver inflammation in CHB patients in a noninvasive manner.

Liver stiffness measured with two-dimensional shear wave elastography comparable to histopathology falls dominantly on the severe liver fibrosis.

Two-dimensional shear-wave elastography (2D-SWE) has been used for years for liver assessment of patients with chronic hepatitis B (CHB), but its effectiveness remains unclear in different populations and using different ultrasound systems. This study investigated the effectiveness of 2D-SWE in evaluating liver fibrosis in patients with CHB. A prospective investigation was conducted after approval by the institutional ethics committee, with 116 out of 133 patients with CHB referred for liver biopsy included and 50 patients with healthy livers selected as controls. Assessment with 2D-SWE of liver stiffness measurement (LSM) was compared with histopathological results. Cutoff values for LSM were set to determine the degree of fibrosis, and area under the receiver operating characteristic (AUROC) curve, sensitivity, and specificity were calculated. The optimal LSM cutoff for differentiating healthy livers from livers with CHB and any liver fibrosis was 6.485 kPa, with an AUROC of 0.927, sensitivity of 94%, and specificity of 19.8%. The optimal LSM cutoff values for F1, F2, F3, and F4 were 6.19 kPa, 6.485 kPa, 7.46 kPa, and 9.62 kPa, respectively, with corresponding AUROCs of 0.516, 0.625, 0.779, and 0.881, respectively. Comparisons of AUROCs between F1 and F3, F1 and F4, F2 and F3, and F2 and F4 were all significantly different (P = 0.0001, P < 0.0001, P = 0.0139, and P = 0.0003, respectively); comparisons of AUROCs between F1 and F2 and between F3 and F4 were not significantly different (P = 0.1232 and P = 0.2462, respectively). Comparisons of LSMs between healthy livers and F0 and between healthy livers and a combination of F0 and F1 were significantly different (P = 0.002 and P = 0.001, respectively). Comparisons of LSMs between F1 and F2 and between F3 and F4 were not significantly different (P = 0.233 and P = 0.072, respectively). Other comparisons between fibrosis score groups were significantly different (F1 and F3, P = 0.003; F1 and F4, P = 0.007; F2 and F3, P = 0.013; F2 and F4, P = 0.015). 2D-SWE using a specific diagnostic ultrasound system is effective for the assessment of severe liver fibrosis and cirrhosis, but is limited in diagnosing mild liver fibrosis.

Different Risk Factors for Early and Late Recurrence After Curative Resection of Hepatocellular Carcinoma.

Factors of early and late recurrence after curative resection of hepatocellular carcinoma (HCC) may be different. The aim of this study was to identify clinical factors, including liver stiffness measurement (LSM), which are associated with HCC recurrence after curative resection. Patients who underwent preoperative LSM and primary curative resection for HCC between October 2015 and May 2018 were retrospectively reviewed, with 1year as the cut-off between early and late recurrence. Recurrence was observed in 42/149 (28.2%) patients over a median follow-up of 38.3months (early recurrence: 10 [6.7%] patients; late recurrence: 32 [21.5%] patients). Multivariate analysis identified LSM (P = 0.026) and tumor size (P = 0.010) as the only factors that were significantly associated with recurrence-free survival. Compared with patients without recurrence, those with early recurrence had larger tumor size (P = 0.035) and those with late recurrence had higher LSM (P = 0.024). Receiver-operating characteristic analysis indicated that the optimal LSM cut-off value for predicting HCC recurrence was 7.4kPa. Tumor size was associated with early HCC recurrence after curative resection and LSM was associated with late recurrence. LSM cut-off of 7.4kPa is recommended in predicting recurrence.

Accuracy of FibroTouch in assessing liver steatosis and fibrosis in patients with metabolic-associated fatty liver disease combined with type 2 diabetes mellitus.

Metabolic-associated fatty liver disease (MAFLD) is highly prevalent in type 2 diabetes mellitus (T2DM) patients and can rapidly progress to steatohepatitis, liver fibrosis, and hepatocellular carcinoma (HCC). Accurate evaluation and proper management of MAFLD can help prevent adverse liver outcomes. Here we evaluated the precision of the FibroTouch (FT) in the staging of liver steatosis and fibrosis in patients with MAFLD combined with T2DM using two indicators: controlled attenuation parameter (CAP) and liver stiffness measurement (LSM). Eighty-five adult MAFLD combined with T2DM patients were selected at our center from July 2016 to July 2019 and underwent liver puncture biopsy for histopathology and the FT assay simultaneously. Two blinded pathologists independently reviewed the samples. The severity of fatty liver was classified using two scoring systems: the nonalcoholic fatty liver disease activity score (NAS) and the fibrosis score. Scores were then assessed following the Pathology Working Group of the NASH Clinical Research Network of the National Institutes of Health. Similarly, the severity of nonalcoholic steatohepatitis (NASH) was classified using the European Steatosis Activity Fibrosis (SAF) system. The FT assay was applied to obtain the LSM and the CAP. FT accuracy in diagnosing steatosis and fibrosis was determined by the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUROC). Using biopsy analysis as the gold standard, the AUROCs and cutoff values of CAP in diagnosing liver steatosis were as follows: 0.84 (95% CI: 0.67-1.01) and 278 dB/m for S ≥ S1, 0.88 (95% CI: 0.81-0.95) and 305 dB/m for S ≥ S2, 0.89 (95% CI: 0.82-0.95) and 307 dB/m for S ≥ S3. The AUROCs and cutoff values of LSM in diagnosing liver fibrosis were as follows: 0.76 (95% CI: 0.66-0.86) for F ≥ F2, 0.81 (95% CI: 0.71-0.91) and 13.8 kPa for F ≥ F3, 0.92 (95% CI: 0.85-1.00) and 20.1 kPa for F ≥ F4. In patients of MAFLD with T2DM, CAP and LSM obtained by FT are highly accurate in assess liver steatosis and fibrosis, respectively, with AUROC values ranging from 0.76 to 0.92.

Unreliable Estimation of Fibrosis Regression During Treatment by Liver Stiffness Measurement in Patients With Chronic Hepatitis B.

INTRODUCTION:Little reliable evidence has been reported regarding usefulness of liver stiffness measurement (LSM) for monitoring the hepatic fibrosis changes during treatment. We aimed to assess the association between changes in LSM and histological outcomes in patients with chronic hepatitis B.METHODS:In this prospective multicenter study, 727 treatment-naive patients receiving entecavir-based therapy, who underwent paired biopsies at treatment baseline and week 72, were analyzed. Changes in LSM were defined as ≥30% decrease, minor change, and ≥30% increase. Multivariate logistic regression was used to estimate odds ratios (ORs) of changes in LSM on clinical outcomes accounting for regression to the mean. A new on-treatment LSM threshold was established by receiver operating curve.RESULTS:Overall regression of fibrosis, improvement of inflammation, significant histological response, virologic response, alanine aminotransferase normalization, and hepatitis B e antigen seroconversion were 51.2%, 74.4%, 22.0%, 86.0%, 83.5%, and 13.3%, respectively. The association between changes in LSM and improvement of inflammation was nonlinear (P = 0.012). LSM decrease ≥30% was associated with regression of fibrosis (OR 1.501, 95% confidence interval [CI] 1.073–2.099, P = 0.018), significant histological response (OR 1.726, 95% CI 1.124–2.652, P = 0.013), and alanine aminotransferase normalization (OR 2.149, 95% CI 1.229–3.757, P = 0.007). After adjusting for regression to the mean, LSM increase ≥30% became negatively associated with the above 3 outcomes. A new on-treatment LSM cutoff value of 5.4 kPa was established for indicating the significant histological response.DISCUSSION:Changes in LSM are unreliable to estimate regression of fibrosis during treatment; the established cutoff value of on-treatment LSM can optimize monitoring strategy for histological outcomes in patients with chronic hepatitis B.

Early Kidney Dysfunction in Metabolic-Associated Fatty Liver Disease: Is Transient Elastography Useful as a Screening Method?

Introduction: Increasing evidence suggests an association between metabolic-associated fatty liver disease (MAFLD) and CKD. Timely prediction of early kidney dysfunction (EKD) is thus essential in this population although a screening method is not stablished. We aimed to evaluate the role of transient elastography (TE) in predicting EKD in patients with MAFLD. Materials and Methods: A prospective cohort study that included patients with MAFLD scheduled for evaluation was performed between May 2019 and January 2020. Demographic, clinical, and laboratory data and TE parameters were prospectively obtained. EKD was defined as microalbuminuria (urinary albumin-to-Cr ratio 30–300 mg/g) and estimated glomerular filtration rate ≥60 mL/min/1.73 m². Significant liver fibrosis was defined as liver stiffness measurement (LSM) ≥8.2 kPa. Results: Of the included 45 patients with MALFD, 53.3% were of female gender with mean age of 53.5 ± 10.9 years. EKD was found in 17.8% of patients. MAFLD patients with EKD were significantly more obese (BMI ≥30) (75.0 vs. 32.4%, p = 0.045) and had significantly higher LSM (8.5 ± 4.1 vs. 5.8 ± 2.2 kPa, p = 0.01). After adjustment of potential confounders for EKD, the presence of liver fibrosis remained a significant predictor of EKD, being associated with a 14.3-fold increased risk of EKD (p = 0.04). The optimal cutoff value of LSM to predict EKD was 6.1 kPa (sensitivity: 85.7%; specificity: 67.6%). Conclusion: Significant liver fibrosis is associated with a significant increased risk of EKD in patients with MAFLD, regardless of other comorbidities. Higher levels of LSM, particularly >6.1 kPa, alert for timely identification of EKD and associated comorbidities, as well as their control, in order to prevent the development of CKD in the long term.

Diagnostic value of liver stiffness measurement for the evaluation of liver fibrosis in nonalcoholic fatty liver

Objective: To investigate the clinical and diagnostic value of liver stiffness measurement (LSM) for the evaluation and comparison of aspartate aminotransferas/platelet ratio index (APRI), fibrosis 4 indexes (FIB-4) and NAFLD fibrosis score (NFS) with liver fibrosis staging in relation to nonalcoholic fatty liver disease (NAFLD). Methods: 103 cases with NAFLD who met the inclusion criteria confirmed by liver biopsy were selected for retrospective analysis. The results of serological tests and LSM were recorded. The APRI, FIB-4 and NFS were calculated. The accuracy and applicability of four liver fibrosis models in the diagnosis of liver fibrosis in NAFLD patients were compared with the receiver operating characteristic curve (ROC), and the diagnostic cut-off value of LSM was established. Results: Varying degrees of LSM, APRI, FIB-4 and NFS had shown positive correlations with the increasing degree of liver fibrosis. Among them, LSM was positively correlated with the degree of liver fibrosis, and the correlation coefficient was r = 0.727, P < 0.0001. Consistent with this, the area under the receiver operating characteristic curve, sensitivity, and specificity of LSM diagnosis of liver fibrosis in different stages was significantly higher than APRI, FIB-4 and NFS. Area under receiver operating characteristic curve of LSM was 0.862 and 0.928 for significant liver fibrosis (f ≥ 2), and advanced liver fibrosis (f ≥ 3). Conclusion: LSM has a good diagnostic exclusion value for NAFLD-induced fibrosis, and its sensitivity and specificity are better than APRI, FIB-4 and NFS.

Combination of gamma-glutamyl transferase and liver stiffness measurement for biliary atresia screening at different ages: a retrospective analysis of 282 infants

BackgroundThis study aims to explore the diagnostic accuracy of the combination of gamma-glutamyl transferase (GGT) and liver stiffness measurement (LSM) for biliary atresia (BA) screening at different ages.MethodsOur retrospective study involved 282 infants under the age of 120 days with jaundice who were admitted into Beijing Children’s Hospital between January 2016 to December 2018. The GGT and LSM levels of infants were obtained. A parallel test was used, and ROC curve was created to obtain cutoff values of GGT and LSM for BA infants at different ages.ResultsOf the 282 infants, 135 were diagnosed with BA and 147 were non-BA infants. In all age groups (A: ≤60 days; B: 61–90 days; C: 91–120 days), the LSM and GGT levels of the BA group were significantly higher than that of the non-BA group, P < 0.05. The cutoff value of GGT and LSM to diagnosis BA was 191.2 U/L, 213.2 U/L, 281.5 U/L and 7.5 kPa, 10.0 kPa, 11.0 kPa in groups A, B and C, respectively. The parallel test was used to determine a sensitivity of 97.3, 98.1 and 100% in group A, B and C when either GGT or LSM levels were met in BA infants. The sensitivities of parallel testing for group A and B were higher than LSM or GGT used alone.ConclusionsCutoff values of GGT and LSM to screen BA increased with age. Parallel testing of GGT and LSM in infants who are younger than 90 days old can decrease the rate of BA misdiagnosis.

Assessing the risk of hepatocellular carcinoma by combining liver stiffness and the controlled attenuation parameter

Ultrasound technology can now be used for liver stiffness measurement (LSM) and for evaluating the amount of hepatic fat quantitatively known as the controlled attenuation parameter (CAP). This study aimed to determine the applicable cut-off values of LSM and the CAP for primary hepatocellular carcinoma (HCC), and to investigate their clinical usefulness for assessing HCC risk in patients with chronic liver disease. A total of 1054 patients (88 with primary HCC and 966 without HCC) whose LSM and the CAP were measured by transient elastography with clinically evident hepatitisC virus (419 patients), hepatitisB virus (377 patients), and non-alcoholic fatty liver disease (258 patients) were enrolled in this study. Subsequently, a total of 966 patients who did not have HCC initially were followed, and the usefulness of the cut-off values of LSM and CAP for HCC development were evaluated. In hepatitisC virus patients, the incidence of HCC development was significantly higher among those with a combination of LSM ≥8.0kPa and CAP ≤221dB/m than among those with other values (log-rank test 0.0239, hazard ratio 2.66, 95%CI 1.07-6.47, P= 0.0362). In non-alcoholic fatty liver disease patients, the incidence of HCC development was significantly higher among those with a combination of LSM ≥5.4kPa and CAP ≤265dB/m than among others (log-rank test 0.0040, hazard ratio 8.91, 95% CI 1.47-67.97, P= 0.0192). In the hepatitisC virus and non-alcoholic fatty liver disease groups, a combination of LSM and the CAP cut-off values would be useful for screening to identify the high-risk group for primary HCC development.

A noninvasive indicator for the diagnosis of early hepatitis B virus-related liver fibrosis.

Liver stiffness measurement (LSM) detected by FibroScan, combined with biochemical indexes, has shown potential values for assessment of liver fibrosis pathological degrees. Here we aimed to investigate a noninvasive method for hepatitis B virus-related liver fibrosis. In all, 307 patients who underwent liver biopsy and LSM measurement were included. Inflammation grades and fibrosis stages were evaluated according to METAVIR scoring system. Spearman's rank correlation analysis, logistic regression analysis, and receiver operating characteristic (ROC) curves analysis were performed to assess the factors' role in inflammation grades/fibrosis stages. Spearman's rank correlation analysis showed that LSM, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and AST-to-platelet ratio index were positively correlated with inflammation grades and histologic fibrosis stages; platelets showed negative correlation, and AST-to-ALT ratio was not related. Logistic regression analysis indicated that LSM and APRI were risk factors for inflammation grades; LSM was the independent risk factor for fibrosis stages, P<0.0001, odds ratio>1. ROC curve analysis found LSM cutoff values and areas under the curve for the diagnosis of fibrosis scores: 6.95 and 0.804, respectively, for the diagnosis of significant fibrosis (F≥F2); 10.35 and 0.856, respectively, for severe fibrosis (F≥F3); 11.35 and 0.897, respectively, for cirrhosis (F=F4). Considering ALT as a confounding factor, ROC analysis was repeated in patients with normal and elevated ALT separately; the results indicated that when ALT was up to 40 U/l, LSM cutoff value and areas under the curve for the diagnosis of significant fibrosis (F≥F2) were 6.55 and 0.748, respectively. This study provided a noninvasive treatment and prevention indicator for early hepatitis B virus-related liver fibrosis.

Value of shear wave elastography in diagnosing biliary atresia by ultrasonography

Objective To investigate the value of the shear wave elastography (SWE) in the diagnosis of biliary atresia (BA) in infants by ultrasonography. Methods SWE was used to measure the liver stiffness measurement(LSM) of 138 infants. Following surgical or pathological diagnosis, the infants were subclassified into BA and non-biliary atresia (non-BA) groups. ROC analysis was used to determine the sensitivity and specificity of LSM, the ultrasonic findings in the differential diagnosis of suspected BA, and the cut-off value to diagnose BA. Results Of the 138 infants with cholestatic hepatitis, 51 were diagnosed as BA group and 87 cases were assigned to the non-BA group. The ROC analysis showed the cut-off value of LSM for diagnosis of biliary atresia in children with jaundice was 12.35 kPa, the AUC was 0.936, and the sensitivity and specificity were 84.3% and 89.7%, respectively.In the parallel test, the triangular cord (TC) sign combined with abnormal gallbladder (AbGB) had the best diagnostic performance in all patients. However, in patients older than 30 days, the LSM combined with TC had the best AUC(0.987) and diagnostic performance(98.6%) like with TC combined with AbGB. Conclusions Both SWE and gray scale ultrasound have higher diagnostic performance for BA. LSM can be used as a valuable index for diagnosing BA by ultrasound. Key words: Ultrasonography; Shear wave elastography; Infant; Liver; Biliary atresia

Prognostic value of liver stiffness measurement for the liver-related surgical outcomes of patients under hepatic resection: A meta-analysis.

BackgroundPrevious studies have discussed the liver stiffness measurement (LSM) performance on predicting liver-related surgical outcomes for patients of hepatocellular carcinoma (HCC) under hepatic resection, yet there is much variation in reporting and consistency of findings. Therefore, we report a meta-analysis on this issue.MethodsWe comprehensively searched PubMed, Embase, and Web of science to find the eligible cohort studies. The pooled Odds Ratios (OR) and 95% confidence intervals (CIs) were calculated to evaluate effect. The weighted mean LSM value was calculated as the optimal LSM cut-off value among studies.Results12 prospective cohort studies and one retrospective cohort study, including a total of 1942 cases were identified. The pooled results showed that preoperative LSM is significantly associated with the occurrence of overall postoperative complications (OR 1.76, 95% CI 1.46–2.11). In addition, a weighted mean LSM value of 14.2 kPa and 11.3KPa were suggested as the optimal LSM cut-off value reference using transient elastoqraphy (TE) for predicting overall postoperative complications in Asia countries and European countries, respectively.ConclusionsPreoperative LSM should be taken into account cautiously in the management of patients undergoing hepatectomy of HCC. Future studies could focus on setting a prognostic model integrated with LSM in predicting post-hepatectomy outcomes.