How can we enhance the performance of liver stiffness measurement using FibroScan in diagnosing liver cirrhosis in patients with chronic hepatitis B?
OBJECTIVE
This study aimed to enhance the diagnostic accuracy by defining different cutoff liver stiffness measurement (LSM) values according to alanine aminotransferase (ALT) level and combining LSM with noninvasive models in patients with chronic hepatitis B (CHB).


BACKGROUND
Several studies have indicated that ALT influences LSM using FibroScan.


METHODS
The study prospectively enrolled 200 patients (143 men, mean age 45.4 y) between June 2007 and November 2008 who had been diagnosed with CHB and underwent both liver biopsy and LSM on the same day.


RESULTS
The area under the receiver operating characteristic curves (AUROC) of LSM for predicting cirrhosis in patients with ALT < or = upper limit of normal (ULN) was higher than that of all patients or those with ALT >ULN and < or = 2x ULN (AUROC=0.884 vs. 0.849 and 0.867). The cutoff LSM values for > or = F2, > or = F3, and F4 were 6.0, 7.5, and 10.1 kPa, respectively, in patients with ALT < or = ULN, whereas they were 8.9, 11.0, and 15.5 kPa, respectively, in those with ALT >ULN and < or = 2x ULN. The combination of LSM and the age-spleen-platelet ratio index performed the best at predicting cirrhosis, regardless of ALT level (AUROC=0.917 in patients with ALT < or = ULN, 0.909 in those with ALT < or = 2x ULN, and 0.894 in all patients).


CONCLUSIONS
Different cutoff LSM values according to ALT level and combination with age-spleen-platelet ratio index can enhance the performance of LSM in CHB, regardless of ALT level.
Kim
Seung Up
SU
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Kim
Do Young
DY
Park
Jun Yong
JY
Lee
Jin Ha
JH
Ahn
Sang Hoon
SH
Kim
Ja Kyung
JK
Paik
Yong Han
YH
Lee
Kwan Sik
KS
Chon
Chae Yoon
CY
Choi
Eun Hee
EH
Song
Ki Jun
KJ
Park
Young Nyun
YN
Han
Kwang-Hyub
KH
D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013154:Spleen / Q000378:metabolism
D000410:Alanine Transaminase