title: [Transient elastography accurately predicts the severity of disease in patients with chronic hepatitis B].
abstract: OBJECTIVE
  To evaluate the value of transient elastography (TE) for predicting severity of liver fibrosis in patients with chronic hepatitis B (CHB).
  
  
  METHODS
  A total of 969 patients with CHB was enrolled and recruited for analysis, which had been received TE scan, including 258 patients of liver biopsy, and 117 patients of gastric endoscopy.
  
  
  RESULTS
  A total of 35 patients was excluded from analysis due to TE failure or unreliable TE. Liver stiffness measurement (LSM) was independently influenced by bilirubin, AST, liver fibrosis and inflammation, ultrasonic score and albumin. TE predicted Child-Pugh C, B/C, liver fibrosis S4, ≥ S3 and ≥ S2 with respective area under receiver operating characteristics curves (AUROC) 0.907 (95%CI 0.886 - 0.928), 0.920(95%CI 0.899 - 0.940), 0.871(95%CI 0.819 - 0.923), 0.852(95%CI 0.805 - 0.899) and 0.807(95%CI 0.749 - 0.865), respectively. While LSM < 32.2 kPa excluded Child-Pugh C with 99.4% probability, LSM ≥ 35.3 kPa determined Child-Pugh B/C with positive predictive value (PPV) 0.820. For compensated CHB, cut-offs of LSM 23.3, 15.2 and 10.8 kPa diagnosed cirrhosis, liver fibrosis ≥ S3 and ≥ S2 with positive likelihood ratio nearly 10.0 and PPV 0.692, 0.882 and 0.980, respectively; and cut-offs 8.8 kPa, 6.6 kPa excluded cirrhosis, liver fibrosis ≥ S3 with negative likelihood ration nearly 0.1 and negative predictive value 0.977 and 0.903, respectively. Correlation coefficient between LSM and grades of esophageal varices was only 0.180, and AUROC for TE predicting EV was of no clinical value.
  
  
  CONCLUSIONS
  TE relatively make accurate prediction in the severity of liver fibrosis and classification of Child-Pugh. Patients with LSM ≥ 10.8 kPa should be considered for receiving antivirus treatment.
authors.affiliation: Department of Infectious Disease, Southern Medical University, Guangzhou, China. cypsmu@yahoo.com.cn
authors.forename: Yong-peng
authors.initials: YP
authors.lastname: Chen
authors.forename: Xie-er
authors.initials: XE
authors.lastname: Liang
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Lin
authors.initials: L
authors.lastname: Dai
authors.forename: Jie
authors.initials: J
authors.lastname: Peng
authors.forename: Jin-lin
authors.initials: JL
authors.lastname: Hou
mesh_terms: D000328:Adult; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019694:Hepatitis B, Chronic / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests