title: Performance and utility of transient elastography and noninvasive markers of liver fibrosis in primary biliary cirrhosis.
abstract: BACKGROUND
  The performance of transient elastography in primary biliary cirrhosis has yet to be fully established.
  
  
  OBJECTIVE
  To assess: (1) the performance of transient elastography in identifying significant fibrosis in primary biliary cirrhosis by comparison with surrogate markers (AST platelet ratio index (APRI), FIB-4, Fibroindex, Forns, aspartate aminotransferase/alanine aminotransferase ratio); (2) the correlation between liver stiffness and Mayo score prognostic index.
  
  
  METHODS
  One hundred and twenty patients with primary biliary cirrhosis were consecutively enrolled. The performance of each marker and of liver stiffness was compared with histological staging and METAVIR at time of liver biopsy.
  
  
  RESULTS
  The area under receiver operating characteristic (ROC) of liver stiffness were 0.87, 0.88, 0.99 for histological stage ≥II, ≥III and =IV and 0.89, 0.92, 0.99 for METAVIR ≥2, ≥3 and =4. Transient elastography alone proved better able in identifying any grade of fibrosis or cirrhosis than noninvasive markers. Combining each surrogate marker with transient elastography did not improve the area under ROC. Transient elastography correlated positively with the Mayo score (P<0.001). Logistic regression analysis showed that transient elastography was associated with an advanced fibrosis (P<0.001).
  
  
  CONCLUSIONS
  Transient elastography proved a simple, reliable and useful method for assessing liver fibrosis in primary biliary cirrhosis, whereas noninvasive surrogate markers proved unsatisfactory in predicting significant fibrosis.
authors.affiliation: Department of Surgical and Gastroenterological Sciences, University of Padova, Padua, Italy. annarosa.floreani@unipd.it
authors.forename: Annarosa
authors.initials: A
authors.lastname: Floreani
authors.forename: Nora
authors.initials: N
authors.lastname: Cazzagon
authors.forename: Diego
authors.initials: D
authors.lastname: Martines
authors.forename: Luisa
authors.initials: L
authors.lastname: Cavalletto
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Baldo
authors.forename: Liliana
authors.initials: L
authors.lastname: Chemello
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005260:Female; D005355:Fibrosis; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase