Overestimation of liver fibrosis staging using transient elastography in patients with chronic hepatitis C and significant liver inflammation.
BACKGROUND
Transient elastography (TE) is a non-invasive method that allows liver fibrosis staging on the basis of hepatic stiffness measurements. Little is known about the influence of chronic liver inflammation on the stiffness of hepatic tissue.


METHODS
A total of 112 patients with chronic hepatitis C underwent a liver biopsy and TE.


RESULTS
Mean values of liver stiffness (in kPa) by inflammation strata were 4.8, 6.4, 9.4 and 12.6 for A0, A1, A2 and A3, respectively, in hepatitis C virus (HCV)-monoinfected individuals (P=0.018). These figures were 8.0, 10.4, 12.9 and 12.6 for A0, A1, A2 and A3, respectively, in HIV-HCV-coinfected patients (P=0.35). In HCV-monoinfected patients with fibrosis staging F3-F4, mean liver stiffness was greater if inflammation was > or =A2 versus A0-A1 (14.6 versus 6.2 kPa; P=0.04). By contrast, no differences in liver stiffness according to inflammation were seen in HCV-monoinfected patients with <F3 or in HIV-HCV-coinfected patients regardless of liver fibrosis staging. Among HCV-monoinfected patients, mean liver stiffness was greater for alanine aminotransferase >100 versus <100 IU/l (10.5 versus 8.5 kPa; P=0.04).


CONCLUSIONS
The extent of liver inflammation might affect the accuracy of TE for staging liver fibrosis, particularly in HCV-monoinfected patients with advanced fibrosis on liver biopsy and/or increased alanine aminotransferase levels.
Infectious Diseases Department, Hospital Carlos III, Madrid, Spain.
Eugenia
E
Vispo
Pablo
P
Barreiro
José
J
Del Valle
Ivana
I
Maida
Victor
V
de Ledinghen
Carmen
C
Quereda
Alberto
A
Moreno
Juan
J
Macías
Laurent
L
Castera
Juan Antonio
JA
Pineda
Vincent
V
Soriano
D000328:Adult; D000410:Alanine Transaminase / Q000032:analysis; D001706:Biopsy; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000201:enzymology / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation; D008099:Liver / Q000201:enzymology / Q000473:pathology / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000201:enzymology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
D000410:Alanine Transaminase