title: Comparison of transient elastography, serum markers and clinical signs for the diagnosis of compensated cirrhosis.
abstract: OBJECTIVE
  Non-invasive diagnosis of compensated cirrhosis is important. We therefore compared liver stiffness by transient elastography, APRI score, AST/ALT ratio, hyaluronic acid and clinical signs to determine which modality performed best at identifying compensated cirrhosis.
  
  
  METHODS
  Patients undergoing evaluation at a single center were recruited and had clinical, serological, endoscopy, radiological imaging, liver stiffness measurement and liver biopsy. Patients were stratified into cirrhotic and non-cirrhotic.
  
  
  RESULTS
  In 404 patients (124 cirrhosis), transient elastography was diagnostically superior to the other modalities yielding an AUC 0.9 +/- 0.04 compared with hyaluronic acid (AUC 0.81 +/- 0.04: P < 0.05), clinical signs (AUC 0.74 +/- 0.04: P < 0.05), APRI score (AUC 0.71 +/- 0.03: P < 0.05) and AST/ALT ratio (AUC 0.66 +/- 0.03: P < 0.05). The optimum cut-off for transient elastography was 12 kPa giving a sensitivity of 89% and specificity of 87% for cirrhosis. In 238 hepatitis C patients (87 cirrhosis), transient elastography yielded an AUC 0.899 +/- 0.02 for cirrhosis and in 166 non-HCV patients (37 cirrhosis) the results were similar with an AUC 0.928 +/- 0.03; with transient elastography being superior to HA, APRI, AST/ALT and clinical signs for all etiologies of cirrhosis (P < 0.05 for all). Importantly, transient elastography was statistically superior at identifying cirrhosis in 38 biopsy proven Childs Pugh A cirrhotics with no clinical, biochemical or radiological features of cirrhosis or portal hypertension (AUC 0.87 +/- 0.04).
  
  
  CONCLUSIONS
  Transient elastography accurately identified compensated cirrhosis; a liver stiffness of >12 kPa represents an important clinical measurement for the diagnosis of cirrhosis.
authors.affiliation: Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Raza
authors.initials: R
authors.lastname: Malik
authors.forename: Michelle
authors.initials: M
authors.lastname: Lai
authors.forename: Amama
authors.initials: A
authors.lastname: Sadiq
authors.forename: Rory
authors.initials: R
authors.lastname: Farnan
authors.forename: Shruti
authors.initials: S
authors.lastname: Mehta
authors.forename: Imad
authors.initials: I
authors.lastname: Nasser
authors.forename: Tracy
authors.initials: T
authors.lastname: Challies
authors.forename: Detlef
authors.initials: D
authors.lastname: Schuppan
authors.forename: Nezam
authors.initials: N
authors.lastname: Afdhal
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001900:Boston; D004796:Clinical Enzyme Tests; D054459:Elasticity Imaging Techniques; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000821:virology; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D006975:Hypertension, Portal / Q000175:diagnosis / Q000821:virology; D008099:Liver / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D006820:Hyaluronic Acid; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase