title: Transient elastography alone and in combination with FibroTest®for the diagnosis of hepatic fibrosis in alcoholic liver disease.
abstract: The reliability of transient elastography (TE) to assess liver fibrosis is insufficiently validated in alcoholic liver disease (ALD). We aimed to validate the diagnostic utility of TE for liver fibrosis in patients with excessive alcohol consumption and evaluate whether Fibrotest®adds diagnostic value relative to or in combination with TE.
  
  
  
  We conducted a multicentre prospective study on a total of 217 heavy drinkers with high serum aminotransferase levels. Patients underwent liver biopsy, TE, Fibrotest®, PGAA, APRI, FIB-4 and FORNS. The overall diagnostic performance was evaluated by the area under the receiver operating characteristic (AUROC) curves and Obuchowski measures.
  
  
  
  TE values correlated with fibrosis stage (r=.73; P<.0001) and steatosis stage (r=.19; P<.01). Patients with alcoholic hepatitis had higher TE values than those without alcoholic hepatitis (P<.0001). In an multivariate analysis, fibrosis stage and the presence of alcoholic hepatitis were the only parameters that correlated with liver stiffness. For the diagnosis of advanced fibrosis (F≥3), the AUROC curves were 0.90, 0.85, 0.83, 0.91 and 0.90 for TE, Fibrotest®, PGAA and associations TE-Fibrotest®, TE-PGAA respectively. For the diagnosis of cirrhosis, the AUROC curves were 0.93, 0.88, 0.89, 0.94 and 0.95 respectively. The Obuchowski measures for the diagnosis of fibrosis were 0.94, 0.92, 0.91, 0.95 and 0.94 respectively. The performance of TE was not significantly different than those of Fibrotest®, PGAA and combinations TE-Fibrotest®, TE-PGAA.
  
  
  
  TE has excellent diagnostic value for liver fibrosis in alcoholic liver disease. The combined use of TE-Fibrotest®or TE-PGAA does not improve the performance of TE.
authors.affiliation: AP-HP, Service d'hépato-gastroentérologie et nutrition, Hôpital Antoine Béclère, Clamart, France.|INSERM, U996, Labex Lermit, IPSIT, Clamart, France.|Faculté de médecine Paris-Sud, Univ Paris-Sud, Univ Paris-Saclay, DHU Hepatinov, Kremlin-Bicêtre, France.
authors.forename: Cosmin Sebastian
authors.identifier: 0000-0002-7161-9631
authors.initials: CS
authors.lastname: Voican
authors.affiliation: Service des Maladies de l'Appareil Digestif, Hôpital Claude Huriez, Lille, France.|Unité INSERM U995 Lille, Lille, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Louvet
authors.affiliation: AP-HP, Groupe Hospitalier Cochin Saint-Vincent de Paul, Unité d'Hépatologie et d'Addictologie, Paris, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Trabut
authors.affiliation: AP-HP, Service d'hépato-gastroentérologie et nutrition, Hôpital Antoine Béclère, Clamart, France.
authors.forename: Micheline
authors.initials: M
authors.lastname: Njiké-Nakseu
authors.affiliation: Service des Maladies de l'Appareil Digestif, Hôpital Claude Huriez, Lille, France.|Unité INSERM U995 Lille, Lille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
authors.affiliation: APHP, Groupe Hospitalier Cochin Saint-Vincent de Paul, Service d'Anatomo-pathologie, Paris, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sanchez
authors.affiliation: AP-HP, Département d'Hépatologie, Groupe Hospitalier Cochin Saint-Vincent de Paul, Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Corouge
authors.affiliation: AP-HP, Service d'hépato-gastroentérologie et nutrition, Hôpital Antoine Béclère, Clamart, France.
authors.forename: Karima
authors.initials: K
authors.lastname: Lamouri
authors.affiliation: AP-HP, Service d'hépato-gastroentérologie et nutrition, Hôpital Antoine Béclère, Clamart, France.|Faculté de médecine Paris-Sud, Univ Paris-Sud, Univ Paris-Saclay, DHU Hepatinov, Kremlin-Bicêtre, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Lebrun
authors.affiliation: AP-HP, Service d'hépato-gastroentérologie et nutrition, Hôpital Antoine Béclère, Clamart, France.
authors.forename: Axel
authors.initials: A
authors.lastname: Balian
authors.affiliation: Faculté de médecine Paris-Sud, Univ Paris-Sud, Univ Paris-Saclay, DHU Hepatinov, Kremlin-Bicêtre, France.|AP-HP, Service d'Anatomie pathologique, Hôpital Antoine Béclère, Clamart, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Prévot
authors.affiliation: AP-HP, Service de Biochimie-Hormonologie, Hôpital Antoine Béclère, Clamart, France.
authors.forename: Mounia
authors.initials: M
authors.lastname: Lachgar
authors.affiliation: AP-HP, Service de Radiologie, Hôpital Antoine Béclère, Clamart, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Maitre
authors.affiliation: AP-HP, Unité de recherche clinique Paris-Sud, Hôpital Bicêtre, Kremlin-Bicêtre, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Agostini
authors.affiliation: Service des Maladies de l'Appareil Digestif, Hôpital Claude Huriez, Lille, France.|Unité INSERM U995 Lille, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
authors.affiliation: AP-HP, Service d'hépato-gastroentérologie et nutrition, Hôpital Antoine Béclère, Clamart, France.|INSERM, U996, Labex Lermit, IPSIT, Clamart, France.|Faculté de médecine Paris-Sud, Univ Paris-Sud, Univ Paris-Saclay, DHU Hepatinov, Kremlin-Bicêtre, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Perlemuter
authors.affiliation: AP-HP, Service d'hépato-gastroentérologie et nutrition, Hôpital Antoine Béclère, Clamart, France.|INSERM, U996, Labex Lermit, IPSIT, Clamart, France.|Faculté de médecine Paris-Sud, Univ Paris-Sud, Univ Paris-Saclay, DHU Hepatinov, Kremlin-Bicêtre, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Naveau
mesh_terms: D000328:Adult; D019540:Area Under Curve; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D016014:Linear Models; D008104:Liver Cirrhosis, Alcoholic / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D055815:Young Adult
keywords: alcoholic liver disease; hepatic fibrosis; non-invasive method; transient elastography