Liver Stiffness Score Research Articles

The Accuracy of Liver Stiffness, Spleen Diameter and Platelet Count Ratio Score (LSPS) Versus Gastroscopy to Predict the Presence of Esophageal Varices in Adult Patients With Liver Cirrhosis: A Meta-analysis

The Accuracy of Liver Stiffness, Spleen Diameter and Platelet Count Ratio Score (LSPS) Versus Gastroscopy to Predict the Presence of Esophageal Varices in Adult Patients With Liver Cirrhosis: A Meta-analysis

Liver Stiffness in Pediatric Patients with Fatty Liver Disease: Diagnostic Accuracy and Reproducibility of Shear-Wave Elastography.

Purpose To evaluate the diagnostic accuracy of shear-wave elastography (SWE) in identifying different degrees of fibrosis in a cohort of consecutive children and adolescents with nonalcoholic steatohepatitis (NASH). Materials and Methods Consecutive pediatric patients scheduled to undergo liver biopsy were studied with an ultrasonography-based SWE system. Elastography was performed in 68 of 69 patients with biopsy-proved NASH (37 boys and 31 girls; mean age, 12.6 years ± 2.48; age range, 8-17 years). The correlations among laboratory findings, liver stiffness, and fibrosis score were analyzed, and the area under the receiver operating characteristic curve (AUC) was used to assess the presence of any fibrosis (score ≥F1) or significant fibrosis (score ≥F2). Findings from histologic examination were used as the standard of reference. Results SWE showed a very high correlation with liver fibrosis (P < .001) at univariate and multivariate analyses. The AUCs for the association of any and significant fibrosis were 0.92 (95% confidence interval [CI]: 0.86, 0.98) and 0.97 (95% CI: 0.95, 0.99), respectively. The intraclass correlation coefficient for absolute agreement was 0.95 (95% CI: 0.90, 0.97). Conclusion SWE is an accurate and reproducible noninvasive technique that efficiently depicts the presence of significant liver fibrosis and, less accurately, mild liver fibrosis in pediatric patients with nonalcoholic fatty liver disease. Larger clinical prospective studies are warranted to confirm SWE accuracy and establish threshold values for fibrosis grading in comparison or in combination with other noninvasive methods. © RSNA, 2016.

Liver Stiffness Decreases Rapidly in Response to Successful Hepatitis C Treatment and Then Plateaus.

Background and AimTo investigate the impact of a sustained virological response (SVR) to hepatitis C virus (HCV) treatment on liver stiffness (LS).MethodsLS, measured by transient elastography (FibroScan), demographic and laboratory data of patients treated with interferon (IFN)-containing or IFN-free regimens who had an SVR24 (undetectable HCV viral load 24 weeks after the end of treatment) were analyzed using two-tailed paired t-tests, Mann-Whitney Wilcoxon Signed-rank tests and linear regression. Two time intervals were investigated: pre-treatment to SVR24 and SVR24 to the end of follow-up. LS scores ≥ 12.5 kPa indicated LS-defined cirrhosis. A p-value below 0.05 was considered statistically significant.ResultsThe median age of the patients (n = 100) was 60 years [IQR (interquartile range) 54–64); 72% were male; 60% were Caucasian; and 42% had cirrhosis pre-treatment according to the FibroScan measurement. The median LS score dropped from 10.40 kPa (IQR: 7.25–18.60) pre-treatment to 7.60 kPa (IQR: 5.60–12.38) at SVR24, p <0.01. Among the 42 patients with LS-defined cirrhosis pre-treatment, 25 (60%) of patients still had LS scores ≥ 12.5 kPa at SVR24, indicating the persistence of cirrhosis. The median change in LS was similar in patients receiving IFN-containing and IFN-free regimens: -1.95 kPa (IQR: -5.75 –-0.38) versus -2.40 kPa (IQR: -7.70 –-0.23), p = 0.74. Among 56 patients with a post-SVR24 LS measurement, the LS score changed by an additional -0.90 kPa (IQR: -2.98–0.5) during a median follow-up time of 1.17 (IQR: 0.88–1.63) years, which was not a statistically significant decrease (p = 0.99).ConclusionsLS decreased from pre-treatment to SVR24, but did not decrease significantly during additional follow-up. Earlier treatment may be needed to reduce the burden of liver disease.

Fontan circulation causes early, severe liver damage. Should we offer patients a tailored strategy?

BackgroundIn patients with Fontan circulation, the liver is profoundly affected by chronic venous stasis. Little is known about early hepatic changes in this population. MethodsWe performed echocardiography, abdominal ultrasound, liver elastography, cardiac catheterization, esophago-gastro-duodenoscopy and calculated MELD-XI score in 64 Fontan patients (69% minors), at an interval of 1–15years since Fontan. ResultsCardiac output remained stable in the first 5years after Fontan, then significantly decreased (r=−0.45, p(r=0)=0.003). NYHA class significantly increased after Fontan. Patients in NYHA class II/III (n=21, 14 minors) had significantly higher hepatic pressures, but normal ventricular function and pulmonary vascular resistances (PVR). Patients with pulmonary arterial pressure (PAP) ≥15mmHg (n=12, 6 minors) and those with PVR≥2WU*m2 (n=27, 25 minors), had higher hepatic pressures (p<0.0001), a higher incidence of liver collaterals and/or esophageal varices (p<0.0001) and splenomegaly (p<0.02).Liver stiffness (LS) was elevated in most patients (median, 25th–75th percentile:17.3KPa, 14.1–21.4). It rapidly increased during the first 5-years after Fontan, compared to the following 5-years (from 12.2KPa, 9.8–14.1 to 17.5KPa, 14.3–24.5, p=0.007), then remained stable (19.1KPa, 16.9–22.6, p=0.60). MELD-XI score increased linearly with the time interval since Fontan (r=0.31, p(r=0)=0.01). For patients above 12years we found a linear correlation between LS and MELD-XI score in the 6–15years period after Fontan (r=0.40. p(r=0)=0.04). The overall incidence of established liver cirrhosis was 22%. ConclusionsThis is the largest study showing that Fontan circulation prompts early, progressive and eventually irreversible liver damage. Precautions should be taken immediately after Fontan, to protect this fragile population.

Elevation of serum urokinase plasminogen activator receptor and liver stiffness in postoperative biliary atresia.

AIMTo investigate serum urokinase-type plasminogen activator receptor (uPAR) and liver stiffness in biliary atresia (BA) and examine the correlation of circulating uPAR, liver stiffness, and clinical outcomes in postoperative BA children.METHODSEighty-five postKasai BA children and 24 control subjects were registered. Circulating uPAR was measured using enzyme-linked immunosorbent essay. Liver stiffness was analyzed using transient elastography.RESULTSBA children had significantly greater circulating uPAR and liver stiffness scores than control subjects (P < 0.001). Circulating uPAR and liver stiffness were substantially higher in jaundiced BA children than non-jaundiced BA children (P < 0.001). In addition, circulating uPAR was positively associated with serum aspartate aminotransferase (r = 0.507, P < 0.001), alanine aminotransferase (r = 0.364, P < 0.001), total bilirubin (r = 0.559, P < 0.001), alkaline phosphatase (r = 0.325, P < 0.001), and liver stiffness scores (r = 0.508, P < 0.001).CONCLUSIONCirculating uPAR and liver stiffness values were greater in BA children than healthy controls. The increased circulating uPAR was associated with liver dysfunction in BA. As a consequence, serum uPAR and liver stiffness may be used as noninvasive biomarkers indicating the progression of liver fibrosis in postKasai BA.

Cyclooxygenase-2 Inhibitor Reduces Hepatic Stiffness in Pediatric Chronic Liver Disease Patients Following Kasai Portoenterostomy.

PurposeThe purpose of this study was to define the role of cyclooxygenase-2 inhibitors (COX-2i) in reducing hepatic fibrosis in pediatric patients with chronic liver disease.Materials and MethodsFrom September 2009 to September 2010, patients over 2 years old who visited our outpatient clinic for follow-up to manage their chronic liver disease after Kasai portoenterostomy for biliary atresia, were included in this study. Volunteers were assigned to the study or control groups, according to their preference. A COX-2i was given to only the study group after obtaining consent. The degree of hepatic fibrosis (liver stiffness score, LSS) was prospectively measured using FibroScan, and liver function was examined using serum analysis before and after treatment. After 1 year, changes in LSSs and liver function were compared between the two groups.ResultsTwenty-five patients (18 females and 7 males) were enrolled in the study group. The control group included 44 patients (26 females and 18 males). After 1 year, the least square mean values for the LSSs were significantly decreased by 3.91±0.98 kPa (p=0.004) only in the study group. Serum total bilirubin did not decrease significantly in either group.ConclusionCOX-2i treatment improved the LSS in patients with chronic liver disease after Kasai portoenterostomy for biliary atresia.

Noninvasive Rapid Acquisition Technique for Predicting Esophageal Varices Using Magnetic Resonance Elastography

Introduction: Current guidelines recommend serial variceal screening of cirrhotic patients with esophagogastroduodenoscopy (EGD). Evidence does not support any noninvasive method. Magnetic Resonance Elastography (MRE) and labs are noninvasive modalities used to help predict hepatic fibrosis. We evaluated these methods as potential predictors for the detection of esophageal varices (EV). Methods: Twelve patients with clinically compensated cirrhosis undergoing an EGD for variceal screening or surveillance were recruited for the study (six without EV and six with EV). Patients with a history of variceal ligation or currently on a non-selective beta blocker at the time of the EGD were excluded. MRE was then prospectively performed using a 3T MRI scanner (Tim-trio, Siemens Healthcare, Germany) using standard (MREs) and rapid (MREr) sequences. MRE wave images were processed using online reconstruction to report a mean stiffness value (kPa) for the liver as well as the spleen. Routine laboratory data was collected to calculate the model for end-stage liver disease (MELD) scores, AST to platelet ratio index (APRI) and The Lok index. Univariate logistic regression models were used to determine the odds of a patient having EV for a one unit increase in each of the variables. Results: The odds ratio (OR) for having EV for an increase of one unit in the liver stiffness score is 0.633 using MREs and 0.698 using MREr. The OR for having EV for an increase of one unit in the spleen stiffness score is 0.903 using MREs and 0.735 using MREr. Increases in liver and spleen stiffness scores for both MREs and MREr techniques were associated with lower odds of predicting EV, however, statistical significance was not achieved (p values ranged from 0.323-0.753). The OR for having EV for an increase of one unit in MELD is 1.254, APRI is 3.597, and Lok index is 1.080. Increases in all scores were associated with higher odds of predicting EV, however, statistical significance was not achieved (p values ranged from 0.227-0.922). Conclusion: Our experience thus far has shown that neither the use of MRE stiffness values nor other models predictive of hepatic fibrosis are accurate in screening for the presence of EV, but our small sample size has limited any further statistical analysis. MRE is a safe and effective method for the assessment of liver fibrosis, and further investigation for its role in conjunction with other predictive models is warranted to find a potential noninvasive screening method for EV.

Telomere Length in Peripheral Blood Leukocytes Is Associated with Severity of Biliary Atresia.

ObjectiveThe purpose of this study was to investigate the association of telomere length in peripheral blood leukocytes with the severity of biliary atresia (BA).MethodsOne hundred and fourteen BA patients and 114 age-matched healthy controls were enrolled. Relative telomere length (RTL) was assessed using a quantitative real-time polymerase chain reaction. Multivariate regression analysis was used to estimate RTL as an independent risk factor of BA. Receiver operating characteristic curve analysis was used to calculate the accuracy of biomarkers in the prediction of liver cirrhosis.ResultsBA patients had significantly shorter telomeres than healthy controls (p < 0.0001). The RTL in BA patients with jaundice was considerably lower than that of patients without jaundice (p = 0.005). Moreover, RTL was markedly shorter in patients with cirrhosis (F4), as compared to patients with mild fibrosis (F2) and non-fibrosis (F0-F1, p < 0.0001). Logistic regression analysis indicated that short RTL was associated with a higher risk of liver cirrhosis in BA. Tertile analysis showed a dose-response effect for this association (p trend < 0.0001). Additionally, RTL in BA children revealed a negative correlation with age (r = -0.50, p < 0.001). We noted an association between reduction of RTL and liver stiffness scores, adjusted for age and gender (b = -0.01, p < 0.0001). Short RTL can be employed to distinguish cirrhosis patients from non-cirrhosis patients (AUC = 0.78). Further analysis showed a linear correlation between leukocyte RTL and liver RTL in BA patients (r = 0.83, p < 0.001).ConclusionThe findings of this study provide evidence that telomere shortening is associated with an elevated risk of liver cirrhosis in BA.

PWE-121 Non-alcoholic steatohepatitis in patients with diabetes mellitus: as clinicians how good are we at identifying patients at risk?

Introduction Over the past thirty years the number of people with diabetes mellitus (DM) has more than doubled globally and the WHO predicts that DM will be the seventh leading cause of death by 2030. DM is a causative factor of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Presently raised alanine transaminase (ALT) is used as a marker for NAFLD however it is recognised that ALT is not a sensitive marker for either diagnosing or assessing the severity of NAFLD. Ultrasound is a better method of disease detection and the degree of fibrosis can be documented using elastography. Method We aimed to determine the prevalence of NAFLD and extent of liver fibrosis in an unselected population of subjects with DM attending outpatient clinics in secondary care. Secondary endpoints included determining whether there were any differences in ALT levels and liver stiffness scores between subjects with type 1(T1) and type 2(T2)DM. On five separate occasions we attended DM clinics offering fibroscans to patients (pts) waiting to be seen. We also collected data on age, sex, weight, height; liver function tests (LFTs), alcohol intake and type of diabetes. Results We performed fibroscans on 45 pts; 25 T1DM (15 females (F) age range (AR) 31–67, median age (MA) 42; 10 males (M) AR 22–84, MA 45) and 20 with T2DM (17M; AR23–72, MA54 and 3F;AR 31–58, MA44). All pts consumed less than the government recommended units of alcohol. In the T1DM cohort, median BMI: 27; range19–37, median ALT 23 iu/L; range 12–51 iu/L*,median liver stiffness: 4.8 KPa; range 2.8–11.9 KPa (F: median ALT 19 iu/L, liver stiffness 4.7 KPa; M: median ALT 30 iu/L, liver stiffness 5.2 KPa). One pt (F) had METAVIR stage 4 fibrosis on fibroscan. In the T2DM cohort, the median BMI: 31; range 27–40, median ALT 50 iu/L, range 13–119 iu/L, median liver stiffness: 8.9 KPa, range 4.1–21.3 KPa (F: median ALT 21 iu/L, liver stiffness 6.3 KPa; M: median ALT 55 iu/L, liver stiffness 9.1 KPa). Elevated ALT was documented in 13/20 (65%), median liver stiffness: 11.3 KPa (METAVIR stage 4), none of these pts were known to hepatology services. In this cohort scatterplot analysis demonstrated a positive correlation between ALT level and median liver stiffness. *Normal range of ALT: M: Conclusion In an unselected asymptomatic cohort of DM pts, 16/45 (35%) had raised ALT levels with a prevalence of 24% of advanced fibrosis in this cohort. Abnormal ALT levels and elevated liver stiffness scores were more common in T2DM pts compared to T1DM pts. This study highlights the importance of early identification of pts with risk factors for NASH, regular monitoring of LFTs, reacting to abnormalities and specialist referral for fibrosis assessment using elastography. Disclosure of interest None Declared.

A matched cross-sectional study of the association between circulating tissue factor activity, immune activation and advanced liver fibrosis in hepatitis C infection.

BackgroundTissue factor (TF) is a protein that mediates the initiation of the coagulation cascade. TF expression is increased in patients with poorly-controlled HIV, and may be associated with increased immune activation that leads to cardiovascular morbidity. The role of TF in immune activation in liver disease in hepatitis C virus (HCV)-monoinfection and HIV/HCV-coinfection has not been explored.MethodsFifty-nine patients were stratified: A) HIV-monoinfection (N = 15), B) HCV-monoinfection with chronic hepatitis C (CHC) (N = 15), C) HIV/HCV-coinfection with CHC (N = 14), and D) HIV/HCV-seropositive with cleared-HCV (N = 15). All HIV+ patients had undetectable HIV viremia. Whole blood was collected for CD4/CD8 immune activation markers by flow cytometry and plasma was assayed for microparticle TF (MPTF) activity. Subjects underwent transient elastography (TE) to stage liver fibrosis. Undetectable versus detectable MPTF was compared across strata using Fisher's Exact test.ResultsMPTF activity was more frequently detected among patients with HCV-monoinfection (40%), compared to HIV-monoinfection and HIV/HCV-seropositive with cleared HCV (7%) and HIV/HCV-coinfection with CHC (14%) (p = 0.02). Mean TE-derived liver stiffness score in kPa was higher in patients with detectable MPTF (12.4 ± 8.5) than those with undetectable MPTF (6.4 ± 3.0) (p = 0.01). Mean CD4 + HLADR+ and CD4 + CD38-HLADR+ expression were higher in those with detectable MPTF (44 ± 9.8% and 38 ± 8.7%, respectively) than those with undetectable MPTF (36 ± 11% and 31 ± 10.4% respectively) (p = 0.05 and 0.04 respectively).ConclusionsHCV-monoinfection and HIV/HCV-coinfection with CHC were associated with MPTF activity. MPTF activity is also associated with advanced liver fibrosis and with CD4 + HLADR+ immune activation.

Comparison of the Transient Elastography (Fibroscan) Results Among Diabetic and Non-Diabetic Patients with Non- Alcoholic Fatty Liver Disease

Background and Objective: Diabetes is a risk factor for developing and progressing Non- Alcoholic Fatty Liver Disease (NAFLD) and assessing hepatic fibrosis is necessary to check the prognosis in these patients. Transient Elastography (TE) as a noninvasive, easy to use and reproducible technique could be appropriate in the monitoring of fibrosis among NAFLD patients. This study designed to compare liver stiffness among diabetic and non-diabetic patients by using TE method. Materials and Methods: Overall 67 patients (age range of 20-60 years) with the evidence of fatty liver in sonography and after exclusion of other causes were divided into two groups of diabetics and non-diabetics. Then patients were assessed with TE after lab tests and their lab data and liver stiffness scores were compared between two groups. Results: Demographic characters of both groups were similar (including mean age, sex, BMI, AST, ALT, Total Cholesterol, LDL and TG) (P>0.05). Mean liver stiffness scores in the diabetic group were significantly higher than non-diabetics (P = 0.025). In diabetic patients group, only mean levels of AST and TG in F3 and F4 stiffness score were significantly higher in comparison with lower stiffness scores (P<0.05). Conclusion: Significant liver fibrosis is more frequently present in diabetic patients and TE could be appropriate as a monitoring method in diabetic patients with liver fibrosis.

PTU-091 Transient Elastography as a Predictor of Oesophageal and Gastric Varcies

IntroductionScreening for varices with two yearly gastroscopy is recommended practise for all patients with liver cirrhosis. Prevalence of oesophageal or gastric varices in patients with liver cirrhosis varies in the...

AB0784 Two no-invasive methods to evaluate liver fibrosis in systemic sclerosis patients: Transient elastography (fibroscan) and APRI score

BackgroundSystemic sclerosis (SSc) is a complex and rare autoimmune disease characterized by vascular damage as well as skin and internal organs sclerosis. The occurrence and extent of primary liver damage...

Liver fibrosis in young Egyptian beta-thalassemia major patients: relation to hepatitis C virus and compliance with chelation

Background. The main causes of liver fibrosis in transfusion-dependent thalassemia major are hepatitis C virus (HCV) infection and hepatic iron overload. The study aimed to assess liver fibrosis in Egyptian adolescents and young adult poly-transfused beta thalassemia patients infected with HCV using liver FibroScan in relation to iron overload and Liver iron concentration (LIC).Material and methods. Fifty-one regularly transfused beta thalassemia patients above 12 years old were subjected to measurement of serum alanine transaminase (ALT), serum ferritin (SF), HCV (antibody and RNA), LIC assessed by hepatic R2* and transient elastography (TE) (FibroScan). FibroTest and liver biopsy were done to 25 patients.Results. Eighty two% of studied thalassemia patients were HCV antibody positive; 21(49%) of them were viremic (HCV RNA positive); median LIC was 12 mg/gm dry weight. There were strong positive correlation between the degree of liver stiffness and Ishak fibrosis score assessed in liver biopsy specimens (P = 0.002) and between FibroScan and FibroTest results (P < 0.001). Patients with HCV viremia showed significantly higher ALT, γ-glutamyl transpeptidase (GGT), SF, LIC and increased liver stiffness compared to patients with no viremia (P = 0.0001, 0.001, 0.012, 0.006 and 0.001) respectively. Liver cirrhosis (TE values > 12.5kPa) was encountered in 23.5% and variable degrees of liver fibrosis (TE values > 6–12.5 kPa) in 35% of studied thalassemic patients.Conclusion. Young beta thalassemia patients with active hepatitis C infection may have hepatic cirrhosis or fibrosis at young age when accompanied with hepatic siderosis. Non invasive Liver FibroScan and Fibro-Test were reliable methods to assess liver fibrosis in young thalassemic-patients.

Correlation of connective tissue growth factor with liver stiffness measured by transient elastography in biliary atresia

Biliary atresia (BA) is a neonatal liver disease defined as chronic progressive fibrotic obliteration of extrahepatic bile ducts. The objective of this study was to determine the association of serum connective tissue growth factor (CTGF) with clinical outcome and liver stiffness measurement. Eighty-two BA patients post-Kasai operation and 28 healthy controls were recruited. BA patients were categorized into two groups based on their portal hypertension (PH) status. Serum CTGF levels were determined by enzyme-linked immunosorbent assay. Liver stiffness scores were measured by transient elastography. BA patients had greater CTGF levels (905.9 ± 57.7 vs 238.3 ± 23.5 pg/mL, P < 0.001) and higher liver stiffness values than controls (28.2 ± 2.6 vs 5.0 ± 0.5 kPa, P < 0.001). Serum CTGF levels were remarkably elevated in BA patients with PH compared to those without PH (1092.4 ± 73.9 vs 582.6 ± 45.7 pg/mL, P < 0.001). Furthermore, BA patients with PH had significantly higher liver stiffness values compared to those without PH (37.3 ± 3.0 vs 10.6 ± 1.1 kPa, P < 0.001). Additionally, serum CTGF was positively correlated with liver stiffness (r = 0.875, P < 0.001) and total bilirubin (r = 0.462, P < 0.001). There was an inverse correlation between serum CTGF and serum albumin (r = -0.579, P < 0.001). High serum CTGF was associated with a poor outcome in BA patients. Accordingly, serum CTGF and transient elastography may serve as non-invasive biomarkers reflecting the disease severity in postoperative BA patients.

Soluble receptor for advanced glycation end products and liver stiffness in postoperative biliary atresia

ObjectivesSoluble receptor for advanced glycation end products (sRAGE) has emerged as a possible biomarker of several disease conditions, including liver injury. This study was aimed to assess serum sRAGE and liver stiffness in biliary atresia (BA). Design and methodsForty postoperative BA patients and 20 controls were enrolled. Serum sRAGE levels were analyzed by enzyme-linked immunosorbent assay. Liver stiffness scores were measured by transient elastography. ResultsBA patients had higher serum sRAGE and liver stiffness values than controls (P<0.001). Serum sRAGE and liver stiffness values were significantly elevated in BA patients with jaundice compared to those without jaundice (P<0.001). Additionally, serum sRAGE was correlated with liver stiffness and serum total bilirubin (r=0.65, P<0.001 and r=0.71, P<0.001, respectively). ConclusionSerum sRAGE was associated with the severity of BA. Accordingly, serum sRAGE and liver stiffness may serve as indicators reflecting the severity and the development of hepatic fibrosis in postoperative BA.

PTU-024 A “real world” controlled study of liver stiffness measured by ARFI (acoustic radiation force impulse) elastography in hospitalised patients with decompensated alcoholic liver disease (ALD): a new paradigm in assessment of severity and prognosis?

IntroductionAcoustic Radiation Force Impulse (ARFI, Virtual Touch©) elastography is a novel validated technique for measuring liver stiffness (LS), with advantages over transient elastography including greater accuracy in ascites or obesity....

Tu1019 A “Real World” Controlled Study of Liver Stiffness Measured by ARFI (Acoustic Radiation Force Impulse) Elastography in Hospitalised Patients With Decompensated Alcoholic Liver Disease (ALD): A New Paradigm in Assessment of Severity and Prognosis?

Introduction Acoustic Radiation Force Impulse (ARFI, Virtual Touch © ) elastography is a novel validated technique for measuring liver stiffness (LS), with advantages over transient elastography including greater accuracy in ascites or obesity. However, elastography has not been well studied in acutely ill patients with decompensated chronic liver disease (CLD). We report our experience in a consecutive controlled cohort in a secondary care setting. Aims : (1) To establish whether LS is significantly different in patients hospitalised for decompensated CLD from outpatient controls with proven cirrhosis; (2) To investigate correlation between ARFI and severity scores such as DF, GAH, Lille, Child Pugh and MELD. Methods ARFI was performed by a single radiologist, using a standard 10 observation technique. 108 patients were studied: (1) 60 hospitalised patients (13 AAH-acute alcoholic hepatitis with Bili >80; 19 DALD-decompensated ALD; 12 DCLD-decompensated CLD; 10 ALC-alcoholics without severe liver disease; 6 acute hepatitis), representing 39% of 152 consecutive cases seen by the liver service; and (2) 48 age and sex matched CLD controls (all never hospitalised, 33 with biopsy-proven advanced fibrosis/cirrhosis; 15 with clear clinical/radiological/endoscopic evidence of advanced CLD). Results Validation: technical ARFI failure Conclusion In this “real world” study, ARFI elastography is an accurate and highly reproducible tool in assessing severity and prognosis in acutely ill patients with decompensated CLD, as shown by (a) increased LS in hospitalised ALD/CLD patients compared with cirrhotic controls, and importantly (b) further increases in LS reflect severity and adverse prognosis as shown by standard scores. As higher LS scores appear to reflect disease processes beyond fibrosis, the usefulness of this “real” measurement as an alternative to current “surrogate” prognostic markers merits further analysis in larger studies. Competing interests None declared.

Performance and utility of transient elastography and noninvasive markers of liver fibrosis in primary biliary cirrhosis

Background The performance of transient elastography in primary biliary cirrhosis has yet to be fully established. Aim To assess: (1) the performance of transient elastography in identifying significant fibrosis in primary biliary cirrhosis by comparison with surrogate markers (AST platelet ratio index (APRI), FIB-4, Fibroindex, Forns, aspartate aminotransferase/alanine aminotransferase ratio); (2) the correlation between liver stiffness and Mayo score prognostic index. Methods One hundred and twenty patients with primary biliary cirrhosis were consecutively enrolled. The performance of each marker and of liver stiffness was compared with histological staging and METAVIR at time of liver biopsy. Results The area under receiver operating characteristic (ROC) of liver stiffness were 0.87, 0.88, 0.99 for histological stage ≥II, ≥III and =IV and 0.89, 0.92, 0.99 for METAVIR ≥2, ≥3 and =4. Transient elastography alone proved better able in identifying any grade of fibrosis or cirrhosis than noninvasive markers. Combining each surrogate marker with transient elastography did not improve the area under ROC. Transient elastography correlated positively with the Mayo score ( P < 0.001). Logistic regression analysis showed that transient elastography was associated with an advanced fibrosis ( P < 0.001). Conclusions Transient elastography proved a simple, reliable and useful method for assessing liver fibrosis in primary biliary cirrhosis, whereas noninvasive surrogate markers proved unsatisfactory in predicting significant fibrosis.

Transient elastography for predicting esophageal/gastric varices in children with biliary atresia

BackgroundTransient elastography (TE) is an innovative, noninvasive technique to assess liver fibrosis by measuring liver stiffness in patients with chronic liver diseases. The purpose of this study has been to explore the accuracy of TE and clinical parameters in predicting the presence of esophageal/gastric varices in children with biliary atresia (BA) following portoenterostomy.MethodsPatients with BA status post portoenterostomy and normal children were recruited. Splenomegaly and presence of EV/GV were determined by physical examination and endoscopy, respectively. Aspartate transaminase to platelet ratio index (APRI) was used as a serum fibrosis marker. TE was performed by using FibroScan. Data was expressed as mean ± SD.ResultsSeventy-three BA patients (male:female = 32:41; age 9.11 ± 5.64 years) and 50 normal controls (male:female = 19:31; age 11.00 ± 3.31 years) were enrolled. The liver stiffness score of BA patients was significantly higher than that of normal controls (27.37 ± 22.48 and 4.69 ± 1.03 kPa; p < 0.001). Patients with EV/GV had significantly higher liver stiffness score and APRI than those without EV/GV. As for EV/GV diagnosis, the areas under the receiver operating characteristic curve were 0.89 (95% CI 0.80 to 0.98) for TE and 0.87 (95% CI 0.78 to 0.96) for APRI, respectively. The sensitivity (and specificity) of TE (using a cut-off value of 12.7 kPa) and APRI (using a cut-off value of 1.92) in predicting EV/GV were 84% (77%) and 84% (83%), respectively, whereas the sensitivity (and specificity) of splenomegaly in predicting EV/GV were 92% (85%).ConclusionsTransient elastography is a useful tool for predicting the presence of EV/GV. In addition, basic physical examination, routine biochemical and hematological tests, are still worthwhile and correlate well with the presence of EV/GV in patients with BA post portoenterostomy.