title: Combining transient elastography with FIB4 enhances sensitivity in detecting advanced fibrosis of the liver.
abstract: OBJECTIVE
  To evaluate the predictive value of transient elastography (TE), easy available biochemical scores and a combination of these to detect advanced liver fibrosis (i.e. fibrosis stage ≥F3) in patients with chronic liver disease of different etiologies.
  
  
  METHODS
  A valid TE was obtained in 418 patients with chronic liver disease of mixed etiologies during the period of 2007-2010. Reliable fibrosis staging and biochemical data for calculation of APRI, FIB4, and AST/ALT-ratio (AAR) were available in 187 cases of which 50 had clinical obvious cirrhosis. Logistic regression analyses were performed to investigate if biochemical scores were significant predictors of advanced fibrosis independent of TE.
  
  
  RESULTS
  In the whole group, TE correlated significantly with APRI and FIB4 but not with AAR. In patients with TE ≥7 kPa, a new formula combining TE and FIB4 improved the accuracy for detecting advanced fibrosis. Area under the receiver operating characteristic curve (AUROC) and sensitivity for the combined formula was 0.94 and 0.92, respectively, as opposed to 0.90 and 0.87 for TE alone. After exclusion of cases with clinical obvious cirrhosis, only FIB4 was a significant predictor of advanced liver fibrosis independent of TE. A combined formula gave a marginally improved AUROC in this group.
  
  
  CONCLUSIONS
  Our findings suggest that the combination of TE and FIB4 is useful in the prediction of advanced fibrosis. The effect of this combination was marginal when only asymptomatic patients were included. Larger studies are needed to see if this effect is statistically significant and to detect possible differences according to etiology.
authors.affiliation: Department of Gastroenterology, Oslo University Hospital, Oslo, Norway. Hans.Lannerstedt@getmail.no
authors.forename: Hans
authors.initials: H
authors.lastname: Lannerstedt
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Konopski
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.forename: Terese
authors.initials: T
authors.lastname: Haaland
authors.forename: Else Marit
authors.initials: EM
authors.lastname: Løberg
authors.forename: John Willy
authors.initials: JW
authors.lastname: Haukeland
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase