title: Validation of Transient Elastography and Comparison with Spleen Length Measurement for Staging of Fibrosis and Clinical Prognosis in Primary Sclerosing Cholangitis.
abstract: BACKGROUND
  Patients with primary sclerosing cholangitis (PSC) develop progressive liver fibrosis and end-stage liver disease. Non-invasive and widely available parameters are urgently needed to assess disease stage and the risk of clinical progression. Transient elastography (TE) has been reported to predict fibrosis stage and disease progression. However, these results have not been confirmed in an independent cohort and comparison of TE measurement to other non-invasive means is missing.
  
  
  METHODS
  In a retrospective study we collected data from consecutive PSC patients receiving TE measurements from 2006 to 2014 (n = 139). Data from 62 patients who also underwent a liver biopsy were used to assess the performance of TE and spleen length (SL) measurement for the staging of liver fibrosis. Follow-up data from this cohort (n = 130, Hamburg) and another independent cohort (n = 80, Paris) was used to compare TE and SL as predictors of clinical outcome applying Harrel's C calculations.
  
  
  RESULTS
  TE measurement had a very good performance for the diagnosis and exclusion of higher fibrosis stages (≥F3: AUROC 0.95) and an excellent performance for the diagnosis and exclusion of cirrhosis (F4 vs. < F4: AUROC 0.98). Single-point TE measurement had very similar predictive power for patient outcome as previously published. In a combined cohort of PSC patients (n = 210), SL measurements had a similar performance as TE for the prediction of patient outcome (5 x cross-validated Harrel's C 0.76 and 0.72 for SL and TE, respectively).
  
  
  CONCLUSIONS
  Baseline TE measurement has an excellent performance to diagnose higher fibrosis stages in PSC. Baseline measurements of SL and TE have similar usefulness as predictive markers for disease progression in patients with PSC.
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.|Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Hanno
authors.initials: H
authors.lastname: Ehlken
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Raluca
authors.initials: R
authors.lastname: Wroblewski
authors.affiliation: Service d'Hépatologie, Centre de Référence des Maladies Inflammatoires des Voies Biliaires, Hôpital Saint-Antoine, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine et Université Pierre et Marie Curie, site Saint-Antoine, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Corpechot
authors.affiliation: Service de Radiologie, Hôpital Saint-Antoine, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine et Université Pierre et Marie Curie, site Saint-Antoine, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Arrivé
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Rieger
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Hartl
authors.affiliation: Department of Medical Biometry and Epidemiology, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Lezius
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hübener
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Kornelius
authors.initials: K
authors.lastname: Schulze
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Zenouzi
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Marcial
authors.initials: M
authors.lastname: Sebode
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Peiseler
authors.affiliation: Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Ulrike W
authors.initials: UW
authors.lastname: Denzer
authors.affiliation: Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Quaas
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Weiler-Normann
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
authors.affiliation: Service d'Hépatologie, Centre de Référence des Maladies Inflammatoires des Voies Biliaires, Hôpital Saint-Antoine, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine et Université Pierre et Marie Curie, site Saint-Antoine, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chazouilleres
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schramm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D049448:Cholangiopancreatography, Magnetic Resonance; D015209:Cholangitis, Sclerosing / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013154:Spleen / Q000502:physiology*; D015996:Survival Rate; D055815:Young Adult