Interobserver concordance in the assessment of liver fibrosis in HIV/HCV-coinfected patients using transient elastometry.
OBJECTIVE
Although the reproducibility of transient elastometry (TE) in hepatitis C virus (HCV)-monoinfected patients seems to be high, this may not be the case in HIV/HCV-coinfected patients because of different degrees of steatosis and/or inflammation. This study was aimed to determine the interobserver concordance of TE measurements in HIV/HCV-coinfected patients.


METHODS
A total of 188 patients were evaluated in a cross-sectional, prospective study in two hospitals. The interobserver variability of TE results and the rate of unequal classification of significant fibrosis (cutoff value = 7.2 kPa) and cirrhosis (cutoff value = 14.6 kPa) for two observers were evaluated.


RESULTS
The values of liver stiffness (LS) for two observers highly correlated [intraclass correlation index = 0.976; 95% confidence interval (CI): 0.968-0.982]. The kappa indexes for the concordance of patient classification were 0.60 for significant fibrosis and 0.89 for cirrhosis. Using two cutoff points to diagnose or rule out significant fibrosis (LS >or=9 kPa or <6 kPa) yielded a kappa index of 0.96, but 46% of patients were not classified. Covariables that influenced the interobserver agreement were a high interquartile range in the determination (adjusted odd ratio: 0.189; 95% CI: 0.087-0.411; P = 0.001) and elevated levels of triglycerides (adjusted odd ratio: 1.004; 95% CI: 1.000-1.008; P = 0.031).


CONCLUSIONS
TE measurement is an observer-independent method to evaluate LS in HIV/HCV coinfected patients. The concordance of the classification of mild-to-severe fibrosis is good and for the diagnosis of cirrhosis is excellent. Lower interquartile ranges and triglyceride levels lead to a higher interobserver agreement.
Neukam
Karin
K
Unit of Infectious Diseases, Hospital Universitario de Valme, Seville, Spain. keule165@gmail.com
Recio
Eva
E
Camacho
Angela
A
Macías
Juan
J
Rivero
Antonio
A
Mira
José A
JA
López
Cristina
C
Almeida
Carmen
C
de la Torre
Julián
J
Pineda
Juan A
JA
D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000000981:diagnostic imaging*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood
D014280:Triglycerides