title: Etiology-related determinants of liver stiffness values in chronic viral hepatitis B or C.
abstract: OBJECTIVE
  Transient elastography (TE) has gained popularity for the non-invasive assessment of severity of chronic viral hepatitis, but a comprehensive evaluation of the factors that might account for discrepancy in diagnostic accuracy between TE and the standard of care liver biopsy (LB) is still needed.
  
  
  METHODS
  Patients with chronic hepatitis-B (HBV, n=104) or -C (HCV, n=453) underwent percutaneous LB concomitantly with TE (FibroScan®; Echosens, Paris, France). Liver cell necroinflammatory activity (A) and fibrosis (F) were assessed by METAVIR. Perisinusoidal fibrosis was rated with a 0-3 score. Determinants of TE results were investigated by a linear regression model whereas discordance between TE and LB results was assessed by logistic regression.
  
  
  RESULTS
  Fibrosis (p<0.0001) and liver cell necroinflammatory activity (p<0.0001) were independently associated with TE results in both HBV and HCV patients, whereas steatosis (p<0.0001) was independently associated with TE in HCV only. Fibrosis overestimation was predicted by severe/moderate necroinflammatory activity in HBV and by older age (41-60 or>60years vs.<40), >2 UNL AST and>2 UNL GGT, as well as severe/moderate necroinflammatory activity and severe/moderate steatosis in HCV. In the latter patients, however, moderate/severe necroinflammatory activity and steatosis were the only independent predictors of fibrosis overestimation.
  
  
  CONCLUSIONS
  Fibrosis and necroinflammatory activity are the main determinants of TE in chronic viral hepatitis. Since TE staging of fibrosis is influenced by necroinflammatory activity and steatosis, a diagnostic LB is deemed necessary for a reliable intra-patient TE monitoring of the course of viral hepatitis.
authors.affiliation: Second Division of Gastroenterology, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milano, Italy. mfraquelli@yahoo.it
authors.forename: Mirella
authors.initials: M
authors.lastname: Fraquelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Rigamonti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casazza
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Donato
authors.forename: Guido
authors.initials: G
authors.lastname: Ronchi
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Rumi
authors.forename: Pietro
authors.initials: P
authors.lastname: Lampertico
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000175:diagnosis; D005260:Female; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D016014:Linear Models; D008103:Liver Cirrhosis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D059039:Standard of Care; D055815:Young Adult