Liver stiffness in the hepatitis B virus carrier: a non-invasive marker of liver disease influenced by the pattern of transaminases.
OBJECTIVE
To investigate the usefulness of transient elastography by Fibroscan (FS), a rapid non-invasive technique to evaluate liver fibrosis, in the management of chronic hepatitis B virus (HBV) carriers.


METHODS
In 297 consecutive HBV carriers, we studied the correlation between liver stiffness (LS), stage of liver disease and other factors potentially influencing FS measurements. In 87 chronic hepatitis B (CHB) patients, we monitored the FS variations according to the spontaneous or treatment-induced variations of biochemical activity during follow-up.


RESULTS
FS values were 12.3 +/- 3.3 kPa in acute hepatitis, 10.3 +/- 8.8 kPa in chronic hepatitis, 4.3 +/- 1.0 kPa in inactive carriers and 4.6 +/- 1.2 kPa in blood donors. We identified the cut-offs of 7.5 and 11.8 kPa for the diagnosis of fibrosis >or= S3 and cirrhosis respectively, showing 93.9% and 86.5% sensitivity, 88.5% and 96.3% specificity, 76.7% and 86.7% positive predictive value (PPV), 97.3% and 96.3% negative predictive value (NPV) and 90.1% and 94.2% diagnostic accuracy. At multivariate analysis in 171 untreated carriers, fibrosis stage (t = 13.187, P < 0.001), active vs inactive HBV infection (t = 6.437, P < 0.001), alanine aminotransferase (ALT) (t = 4.740, P < 0.001) and HBV-DNA levels (t = or-2.046, P = 0.042) were independently associated with FS. Necroinflammation score (t = 2.158, > 10/18 vs <or= 10/18, P = 0.035) and ALT levels (t = 3.566, P = 0.001) were independently associated with LS in 83 untreated patients without cirrhosis and long-term biochemical remission (t = 4.662, P < 0.001) in 80 treated patients. During FS monitoring (mean follow-up 19.9 +/- 7.1 mo) FS values paralleled those of ALT in patients with hepatitis exacerbation (with 1.2 to 4.4-fold increases in CHB patients) and showed a progressive decrease during antiviral therapy.


CONCLUSIONS
FS is a non-invasive tool to monitor liver disease in chronic HBV carriers, provided that the pattern of biochemical activity is taken into account. In the inactive carrier, it identifies non-HBV-related causes of liver damage and transient reactivations. In CHB patients, it may warrant a more appropriate timing of control liver biopsies.
Oliveri
Filippo
F
UO Epatologia, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa n. 2-Cisanello, Pisa 56124, Italy.
Coco
Barbara
B
Ciccorossi
Pietro
P
Colombatto
Piero
P
Romagnoli
Veronica
V
Cherubini
Beatrice
B
Bonino
Ferruccio
F
Brunetto
Maurizia-Rossana
MR
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D002353:Carrier State; D004796:Clinical Enzyme Tests; D003430:Cross-Sectional Studies; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult
D000998:Antiviral Agents; D000410:Alanine Transaminase