Liver stiffness measurement in combination with noninvasive markers for the improved diagnosis of B-viral liver cirrhosis.
OBJECTIVE
To investigate the performance of liver stiffness measurement (LSM) in combination with available noninvasive markers in hepatitis B virus-related chronic liver disease.


BACKGROUND
Few noninvasive methods are available for predicting liver cirrhosis in chronic hepatitis B (CHB).


METHODS
Between January 2006 and June 2007, we studied 130 consecutive treatment-naive CHB patients who underwent liver biopsy (LB) and LSM. The aspartate to alanine aminotransferase ratio, age-platelet index (API), aspartate aminotransferase to platelet ratio index (APRI), LSM, and their combinations were compared with liver histology.


RESULTS
The API, APRI, and LSM, but not the aspartate to alanine aminotransferase ratio, correlated significantly with liver cirrhosis (all P<0.001). The diagnostic accuracy of LSM and API exceed that of the other diagnostic methods for predicting liver cirrhosis (area under the receiver operating characteristic curve=0.840 and 0.818). When LSM was combined with API and APRI, the diagnostic accuracy was improved markedly (area under the receiver operating characteristic curve =0.871, and 0.846). When both LSM and API results were in agreement, LB confirmed them in 89.1% (41/46) of cases for liver cirrhosis. LB could have been avoided in 41 (31.5%) of the 130 patients who were examined for the potential diagnosis of liver cirrhosis.


CONCLUSIONS
The combination of LSM and API can avoid unnecessary invasive LB procedures in CHB patients.
Kim
Seung Up
SU
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Ahn
Sang Hoon
SH
Park
Jun Yong
JY
Kang
Wonseok
W
Kim
Do Young
DY
Park
Young Nyun
YN
Chon
Chae Yoon
CY
Han
Kwang Hyub
KH
D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000201:enzymology / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D008297:Male; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase