title: Impact of transient elastography on clinical decision-making in patients with chronic viral hepatitis.
abstract: OBJECTIVE
  Transient elastography is a noninvasive tool to quantify liver fibrosis by liver stiffness measurements (LSMs). Previous studies have extensively evaluated the accuracy of LSMs compared to liver biopsy. In this retrospective study we explore potential impact of LSMs on clinical decisions in chronic viral hepatitis.
  
  
  METHODS
  LSM-based medical advice whether to start antiviral treatment and/or surveillance for hepatocellular carcinoma (HCC) and clinical follow-up after LSMs were analyzed in 349 patients.
  
  
  RESULTS
  In 20% of 184 hepatitis B virus (HBV)-infected patients and 38% of 165 hepatitis C virus (HCV)-infected patients, significant fibrosis (≥F2) was detected. In 5% (n = 7) of the 129 untreated HBV patients and in 12% (n = 19) of the HCV-infected patients, antiviral treatment was recommended solely based on LSMs. Advice for surveillance for HCC was in 40 patients based solely on LSMs (11% of all patients). Furthermore, 95% of 19 non-viremic HCV-patients (after spontaneous clearance or sustained viral response) could be discharged due to favorable LSMs (≤F2). Medical advice was followed by the treating physician in the majority of cases. However, in only 47% of 51 HCV-infected patients with advice to start treatment, this was followed in clinical practice.
  
  
  CONCLUSIONS
  Transient elastography has a major impact on clinical practice, both as an indication to start or postpone antiviral treatment, to start surveillance for HCC, and to discharge HCV patients from follow-up after viral clearance and favorable LSMs. Medical advice to start antiviral treatment is followed in the large majority of HBV patients, but in only half of HCV patients.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Thijs
authors.initials: T
authors.lastname: Feuth
authors.forename: Joop E
authors.initials: JE
authors.lastname: Arends
authors.forename: Faydra I
authors.initials: FI
authors.lastname: Lieveld
authors.forename: Marco W
authors.initials: MW
authors.lastname: Mundt
authors.forename: Andy Im
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Karel J
authors.initials: KJ
authors.lastname: van Erpecum
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000821:virology*; D060085:Coinfection / Q000150:complications / Q000473:pathology / Q000628:therapy; D003657:Decision Making; D054459:Elasticity Imaging Techniques; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000473:pathology / Q000628:therapy*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D057832:Watchful Waiting
chemical_list: D000998:Antiviral Agents