title: Steatosis affects the performance of liver stiffness measurement for fibrosis assessment in patients with genotype 1 chronic hepatitis C.
abstract: OBJECTIVE
  In Chronic Hepatitis C (CHC), the influence of steatosis on liver stiffness measurement (LSM) is still debated. We assessed the impact of steatosis and its ultrasonographical sign - bright liver echo pattern (BLEP) - on LSM values and on transient elastography (TE) accuracy for the diagnosis of liver fibrosis, in a cohort of consecutive patients with Genotype 1 (G1) CHC.
  
  
  METHODS
  Patients (n=618) were assessed by clinical, ultrasonographic and histological (Scheuer score) features. TE was performed using the M probe.
  
  
  RESULTS
  Male gender (p=0.04), steatosis as continuous variable (p<0.001), severity of necroinflammation (p=0.02) and stage of fibrosis (p<0.001) were associated with LSM by multivariate linear regression analysis. Among patients within the same fibrosis stages (F0-F2 and F3-F4; F0-F3 and F4), mean LSM values, expressed in kPa, were significantly higher in subjects with moderate-severe steatosis (⩾20% at liver biopsy) compared with those without, as well as in patients with BLEP on US compared with their counterpart. In subjects without severe fibrosis (F0-F2) and without cirrhosis (F0-F3), a higher rate of false-positive LSM results was observed in patients with steatosis ⩾20% compared with those without (F0-F2: 35.3% vs. 17.9%; F0-F3: 38.9% vs. 16.6%), and in patients with BLEP on US (F0-F2: 28.0% vs. 18.3%; F0-F3: 29.7% vs. 17.8%) compared with their counterpart.
  
  
  CONCLUSIONS
  In patients with G1 CHC, the presence of moderate-severe steatosis, detected by histology or by US, should always be taken into account in order to avoid overestimations of liver fibrosis assessed by TE.
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy. Electronic address: fsmacaluso@gmail.com.
authors.forename: Fabio Salvatore
authors.initials: FS
authors.lastname: Macaluso
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Maida
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cabibbo
authors.affiliation: Cattedra di Anatomia Patologica, University of Palermo, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Cabibi
authors.affiliation: Dipartimento di Scienze Economiche, Aziendali e Statistiche (SEAS), University of Palermo, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Alduino
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Di Marco
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D015897:Comorbidity; D004548:Elasticity / Q000502:physiology*; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000235:genetics*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014463:Ultrasonography
keywords: Cirrhosis; Evaluation; Fibroscan®; Non-invasive; Ultrasound