title: Are different cut-off values of liver stiffness assessed by transient elastography according to the etiology of liver cirrhosis for predicting significant esophageal varices?
abstract: OBJECTIVE
  To determine if liver stiffness (LS) measurements by means of Transient Elastography (TE) vary according to the etiology of the underlying liver cirrhosis and to find if there are different TE cut-off values able to predict the presence of significant EV in alcoholic vs. viral etiology of cirrhosis.
  
  
  METHODS
  This retrospective study included patients diagnosed with liver cirrhosis of viral or alcoholic etiology. All patients were evaluated by means of TE (FibroScan) and upper gastrointestinal endoscopy. We performed 10 LS measurements in each patient and a median value expressed in kiloPascals (kPa) was calculated. Only those with a SR >/= 60% and an IQR<30% were considered as reliable MS measurements. According to the presence of EV the patients were divided in two categories: without significant EV and patients with significant EV (at least grade 2).
  
  
  RESULTS
  The study included 697 cirrhotic patients with reliable LS measurements. The median LS values assessed by TE were significantly higher in cirrhotic patients with alcoholic etiology as compared with those with viral etiology of liver disease: 41 kPa vs. 21.1 kPa, p<0.0001. In the entire cohort of cirrhotic patients, LS assessed by means of TE for a cut-off value >29.5 kPa, had 77.5% sensitivity and 86.9% specificity for predicting the presence of significant EV (AUROC=0.871). The best LS cut-off value for predicting the presence of significant EV was higher in alcoholic cirrhosis as compared with those with viral etiology of liver cirrhosis: 32.5 kPa (AUROC=0.836) vs. 24.8 kPa (AUROC=0.867).
  
  
  CONCLUSIONS
  LS cut-off values assessed by TE for predicting significant EV are significantly higher in patients with alcoholic cirrhosis as compared with patients with liver cirrhosis of viral etiology.
authors.affiliation: Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania. isporea@umft.ro
authors.forename: Ioan
authors.initials: I
authors.lastname: Sporea
authors.forename: Iulia
authors.initials: I
authors.lastname: Raţiu
authors.forename: Simona
authors.initials: S
authors.lastname: Bota
authors.forename: Roxana
authors.initials: R
authors.lastname: Şirli
authors.forename: Ana
authors.initials: A
authors.lastname: Jurchiş
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015897:Comorbidity; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods / Q000706:statistics & numerical data*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005235:Fatty Liver, Alcoholic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006525:Hepatitis, Viral, Human / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D018570:Risk Assessment; D012383:Romania / Q000453:epidemiology; D012680:Sensitivity and Specificity; D055815:Young Adult