The accuracy of noninvasive methods in predicting the development of hepatocellular carcinoma and hepatic decompensation in patients with chronic hepatitis B.
BACKGROUND
Liver stiffness measurement (LSM) using transient elastography (FibroScan) can accurately assess the degree of liver fibrosis and predict the development of hepatocellular carcinoma (HCC) and variceal bleeding in patients with chronic hepatitis B (CHB).


OBJECTIVE
We compared the accuracy of noninvasive liver fibrosis prediction methods in predicting the development of HCC or hepatic decompensation in patients with CHB.


METHODS
A total of 1126 patients with CHB who underwent LSMs and attended regular follow-ups to detect the development of HCC and hepatic decompensations (variceal bleeding, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, or hepatorenal syndrome) were enrolled. Noninvasive liver fibrosis prediction methods included, age-spleen-to-platelet ratio index, LSM, LSM-spleen diameter-to-platelet ratio index (LSPI), P2/MS, and FIB-4.


RESULTS
During follow-up (median, 30.7 mo), HCC and hepatic decompensation developed in 63 and 68 patients, respectively. The accuracy of LSM and LSPI in predicting the development of HCC or hepatic decompensation was higher than that of aspartate aminotransferase-to-platelet ratio index, age-spleen-to-platelet ratio index, P2/MS, or FIB-4 (areas under the receiver operating characteristic curve=0.789 and 0.788 vs. 0.729, 0.756, 0.696, and 0.744 for HCC development; areas under the receiver operating characteristic curve=0.820 and 0.848 vs. 0.787, 0.799, 0.812, and 0.784 for hepatic decompensation). On multivariate analyses, LSM and LSPI were identified as independent predictors of the development of HCC [hazard ratio (HR), 1.040 (LSM); HR, 1.001 (LSPI)] and hepatic decompensation [HR, 1.033 (LSM); HR, 1.002 (LSPI)].


CONCLUSIONS
Our results suggest that LSM or LSPI may be useful predictors of the development of HCC and hepatic decompensation in patients with CHB.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Young Eun
YE
Chon
Eun Suk
ES
Jung
Jun Yong
JY
Park
Do Young
DY
Kim
Sang Hoon
SH
Ahn
Kwang-Hyub
KH
Han
Chae Yoon
CY
Chon
Kyu Sik
KS
Jung
Seung Up
SU
Kim
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D054459:Elasticity Imaging Techniques; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D011446:Prospective Studies; D012306:Risk; D013154:Spleen