title: Prognostic value of the combined use of transient elastography and fibrotest in patients with chronic hepatitis B.
abstract: OBJECTIVE
  Liver stiffness (LS) measurement using transient elastography and the FibroTest (FT) are alternatives to liver biopsy (LB) in assessing liver fibrosis. We investigated the prognostic role of the combined use of LS and FT in predicting liver-related events (LREs) in patients with chronic hepatitis B (CHB).
  
  
  METHODS
  Consecutive patients with CHB who underwent LB, along with LS and FT on the same day were recruited. LRE was defined as hepatic decompensation, hepatocellular carcinoma (HCC) or liver-related death.
  
  
  RESULTS
  A total of 151 patients (86 male) were analyzed. During follow-up (median 59.9 months), overall 18 (11.9%) patients experienced LREs. The areas under receiver-operating characteristic curves of LS, FT, LS + FT and LS × FT in predicting LRE were 0.701, 0.668, 0.702 and 0.741 respectively. After adjusting for age and histological fibrosis staging, significant variables in univariate analysis (both P < 0.05), LS + FT and LS × FT were independent predictors of LREs with hazard ratios (HRs) of 1.080 and 1.126 (all P < 0.05) respectively. When subjects were divided into three groups according to quartile stratification (low quartile, interquartile and high quartile) using LS + FT and LS × FT, cumulative LRE development rate significantly increased with a corresponding increase in value among three groups respectively (log-rank test, all P < 0.05).
  
  
  CONCLUSIONS
  The combined use of LS and FT significantly predicted forthcoming LRE development, but with only a slight additional benefit compared to LS or FT alone.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Mi Sung
authors.initials: MS
authors.lastname: Park
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.forename: Beom Kyung
authors.initials: BK
authors.lastname: Kim
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Shin
authors.forename: Wonseok
authors.initials: W
authors.lastname: Kang
authors.forename: Chansoo
authors.initials: C
authors.lastname: Moon
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
mesh_terms: D019540:Area Under Curve; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology; D018450:Disease Progression; D054459:Elasticity Imaging Techniques; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology*; D017093:Liver Failure / Q000175:diagnosis* / Q000209:etiology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve
keywords: chronic hepatitis B; fibrotest; liver-related event; prognostic value; transient elastography