title: Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B.
abstract: OBJECTIVE
  Liver stiffness measurement (LSM) using transient elastography (FibroScan) is a useful tool to assess fibrosis in various chronic liver diseases. However, studies were mainly performed in Western countries and largely focused on chronic hepatitis C (CHC). We therefore carried out a multicenter study to validate the accuracy of LSM in the assessment of liver fibrosis in a large cohort of Chinese patients with chronic hepatitis B (CHB).
  
  
  METHODS
  We compared LSM results to histological staging and serum fibrosis markers (five direct markers, APRI and FIB-4) using Spearman correlation analysis and area under receiver operating characteristic (ROC) curves (AUROCs).
  
  
  RESULTS
  Four hundred sixty-nine patients were enrolled and eligible for statistical analysis. LSM in F0 to F4 was 5.5 ± 1.7, 5.8 ± 2.2, 7.6 ± 3.4, 14.5 ± 10.8, and 22.3 ± 13.6 kPa, respectively (correlation with fibrosis stage r = 0.522, P < 0.001). AUROC for LSM to correctly allocate patients to histological fibrosis stage ≥ F2, ≥ F3, and F4 was 0.82, 0.88, and 0.90, respectively. LSM outperformed serum fibrosis markers for detection of fibrosis F ≥ 2 and F4. Patients with ALT levels 1-5x and > 5x the upper limit of normal values had significantly higher stiffness values than stage-matched patients with normal alanine aminotransferase.
  
  
  CONCLUSIONS
  Transient elastography is a reliable noninvasive technique to predict significant liver fibrosis in Chinese patients with CHB, being superior to current biomarker panels. However, enhanced inflammatory activity can lead to elevated stiffness values unrelated to histological fibrosis stage.
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China.
authors.forename: Jidong
authors.initials: J
authors.lastname: Jia
authors.forename: Jinlin
authors.initials: J
authors.lastname: Hou
authors.forename: Huiguo
authors.initials: H
authors.lastname: Ding
authors.forename: Guofeng
authors.initials: G
authors.lastname: Chen
authors.forename: Qing
authors.initials: Q
authors.lastname: Xie
authors.forename: Yuming
authors.initials: Y
authors.lastname: Wang
authors.forename: Minde
authors.initials: M
authors.lastname: Zeng
authors.forename: Jingmin
authors.initials: J
authors.lastname: Zhao
authors.forename: Tailing
authors.initials: T
authors.lastname: Wang
authors.forename: Xiqi
authors.initials: X
authors.lastname: Hu
authors.forename: D
authors.initials: D
authors.lastname: Schuppan
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D007797:Laminin / Q000097:blood; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011347:Procollagen / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007797:Laminin; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D006820:Hyaluronic Acid; D000410:Alanine Transaminase
keywords: biomarker; fibrosis; inflammation; noninvasive; transient elastography