Increased liver stiffness in alcoholic liver disease: differentiating fibrosis from steatohepatitis.
OBJECTIVE
To test if inflammation also interferes with liver stiffness (LS) assessment in alcoholic liver disease (ALD) and to provide a clinical algorithm for reliable fibrosis assessment in ALD by FibroScan (FS).


METHODS
We first performed sequential LS analysis before and after normalization of serum transaminases in a learning cohort of 50 patients with ALD admitted for alcohol detoxification. LS decreased in almost all patients within a mean observation interval of 5.3 d. Six patients (12%) would have been misdiagnosed with F3 and F4 fibrosis but LS decreased below critical cut-off values of 8 and 12.5 kPa after normalization of transaminases.


RESULTS
Of the serum transaminases, the decrease in LS correlated best with the decrease in glutamic oxaloacetic transaminase (GOT). No significant changes in LS were observed below GOT levels of 100 U/L. After establishing the association between LS and GOT levels, we applied the rule of GOT < 100 U/L for reliable LS assessment in a second validation cohort of 101 patients with histologically confirmed ALD. By excluding those patients with GOT > 100 U/L at the time of LS assessment from this cohort, the area under the receiver operating characteristic (AUROC) for cirrhosis detection by FS improved from 0.921 to 0.945 while specificity increased from 80% to 90% at a sensitivity of 96%. A similar AUROC could be obtained for lower F3 fibrosis stage if LS measurements were restricted to patients with GOT < 50 U/L. Histological grading of inflammation did not further improve the diagnostic accuracy of LS.


CONCLUSIONS
Coexisting steatohepatitis markedly increases LS in patients with ALD independent of fibrosis stage. Postponing cirrhosis assessment by FS during alcohol withdrawal until GOT decreases to < 100 U/mL significantly improves the diagnostic accuracy.
Mueller
Sebastian
S
Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Zeppelinstrasse 11-33, 69121 Heidelberg, Germany. sebastian.mueller@urz.uni-heidelberg.de
Millonig
Gunda
G
Sarovska
Lucie
L
Friedrich
Stefanie
S
Reimann
Frank M
FM
Pritsch
Maria
M
Eisele
Silke
S
Stickel
Felix
F
Longerich
Thomas
T
Schirmacher
Peter
P
Seitz
Helmut Karl
HK
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D000465:Algorithms; D001219:Aspartate Aminotransferases / Q000097:blood; D004548:Elasticity; D005234:Fatty Liver / Q000175:diagnosis / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000473:pathology*; D008108:Liver Diseases, Alcoholic / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve
D001219:Aspartate Aminotransferases