title: Improving transient elastography performance for detecting hepatitis B cirrhosis.
abstract: BACKGROUND
  Transient elastography is a well-established method for detecting cirrhosis.
  
  
  OBJECTIVE
  To improve the performance of transient elastography in detecting hepatitis B cirrhosis by alanine aminotransferase (ALT)-stratified cutoffs, bilirubin normalization and transient elastography-based algorithms.
  
  
  METHODS
  A total of 315 compensated patients were analysed following liver biopsies, transient elastography, ultrasonography and blood tests.
  
  
  RESULTS
  The area under the receiver operating characteristics (ROC) curve of transient elastography for predicting cirrhosis was 0.88 (95% confidence interval 0.84-0.92). The cutoffs to exclude and confirm cirrhosis were 10.4 kPa and 17.3 kPa in patients with ALT <5 × upper limit of normal range, 13.7 kPa and 25.0 kPa in ALT ≥5 × upper limit of normal range, respectively. With ALT-stratified cutoffs, 68.6% of patients did not require liver biopsies. Areas under the ROC curve in patients with normal or abnormal bilirubin was 0.90(0.85-0.95) and 0.84(0.77-0.92), respectively. In patients with normal bilirubin, the cutoffs for excluding and confirming cirrhosis were 10.6 kPa and 16.9 kPa, respectively. By transient elastography screening, 78.3% of patients with normal bilirubin would not need a liver biopsy. Areas under the ROC curves between transient elastography and transient elastography-based algorithm including transient elastography-splenomegaly-platelet index [0.90(0.86-0.94)] and ultrasonic score-transient elastography index [0.91(0.86-0.96)] were not significantly different.
  
  
  CONCLUSIONS
  Amongst ALT-stratified cutoffs, bilirubin normalization and transient elastography-based algorithm, bilirubin normalization was especially important for improving performance of transient elastography for compensated hepatitis B cirrhosis detection.
authors: Department of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors: Yong Peng
authors: YP
authors: Chen
authors: Xie Er
authors: XE
authors: Liang
authors: Lin
authors: L
authors: Dai
authors: Qi
authors: Q
authors: Zhang
authors: Jie
authors: J
authors: Peng
authors: You Fu
authors: YF
authors: Zhu
authors: Wei Qun
authors: WQ
authors: Wen
authors: Henry Lik-Yuen
authors: HL
authors: Chan
authors: Jin Lin
authors: JL
authors: Hou
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000465:Algorithms; D001663:Bilirubin / Q000097:blood*; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D000410:Alanine Transaminase; D001663:Bilirubin