title: A novel liver stiffness measurement-based prediction model for cirrhosis in hepatitis B patients.
abstract: OBJECTIVE
  While liver stiffness measurement (LSM) predicts histological cirrhosis accurately, complementary methods are needed for better performance. Furthermore, alanine aminotransferase (ALT) influences LSM, making it necessary to modify its use in patients with high ALT levels. We developed a new LSM-based prediction model for cirrhosis and estimated the thresholds for different ALT levels.
  
  
  METHODS
  From 2008 to 2009, we prospectively enrolled 330 consecutive patients who were diagnosed with chronic hepatitis B (CHB) and underwent a liver biopsy and LSM on the same day. For detection of cirrhosis, we performed univariate and multivariate analyses, using the chi(2)-test/t-test and logistic regression respectively. Thereafter, a prediction model was derived from multivariate predictors.
  
  
  RESULTS
  In multivariate analyses of patients with and without cirrhosis, we found significant differences in the LSM, spleen diameter and platelet count. Then, we developed an LSM-spleen diameter to platelet ratio index (LSPI): (LSM x spleen diameter/platelet count) x 100. The area under the receiver operating curve was 0.956, significantly higher than LSM alone (0.919, P=0.032). We suggested different thresholds in patients with ALT< or = upper limit of normal (ULN) (normal-ALT group, 164 patients) and ALT>ULN (high-ALT group, 166 patients). In the normal-ALT group, LSPI thresholds of 38 and 62 provided 95.7% negative predictive value (NPV) and a 95.5% PPV (positive predictive value), while in the high-ALT group, thresholds of 42 and 94 yielded 95.1% NPV and 96.4% PPV respectively. Therefore, liver biopsy could be avoided in 76.7% of the subjects.
  
  
  CONCLUSIONS
  LSPI is a useful, non-invasive tool that can replace liver biopsy in the assessment of liver fibrosis in the majority of CHB patients.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Beom Kyung
authors.initials: BK
authors.lastname: Kim
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.forename: Chae Yoon
authors.initials: CY
authors.lastname: Chon
authors.forename: Ja Kyung
authors.initials: JK
authors.lastname: Kim
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Paik
authors.forename: Kwan Sik
authors.initials: KS
authors.lastname: Lee
authors.forename: Young Nyun
authors.initials: YN
authors.lastname: Park
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D016009:Chi-Square Distribution; D004796:Clinical Enzyme Tests; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000201:enzymology / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase