Combination of transient elastography and an enhanced liver fibrosis test to assess the degree of liver fibrosis in patients with chronic hepatitis B

Ja Yoon Heo, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Hyon Suk Kim, Young Nyun Park, Kwang Hyub Han, Kijun Song, Seung Up Kim

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Abstract

Background/Aims: Liver stiffness (LS) was assessed using transient elastography, and the enhanced liver fibrosis (ELF) test was performed to accurately assess fibrotic burden. We validated the LS-ELF algorithm and investigated whether the sequential LS-ELF algorithm performs better than concurrent combination of these analyses in chronic hepatitis B (CHB) patients. Methods: Between 2009 and 2013, 222 CHB patients who underwent liver biopsy (LB), as well as LS measurement and the ELF test, were enrolled. Results: Advanced fibrosis (≥F3) and cirrhosis (F4) were identified in 141 (63.6%) and 118 (53.2%) patients, respectively. Areas under receiver operating characteristic curve for LS predictions of ≥F3 (0.887 vs 0.703) and F4 (0.853 vs 0.706) were significantly higher than the ELF test (all p<0.001). Based on the LS-ELF algorithm, 60.4% to 71.6% and 55.7% to 66.3% of patients could have avoided LB to exclude ≥F3 and F4, respectively, whereas 68.0% to 78.7% and 63.5% to 66.1% of patients could have avoided LB to confirm ≥F3 and F4, respectively. When confirmation and exclusion strategies were applied simultaneously, 69.4% to 72.5% and 60.8% to 65.3% of patients could have avoided LB and been diagnosed as ≥F3 and F4, respectively. The proportion of patients who correctly avoided LB for the prediction of ≥F3 (69.4% to 72.5% vs 42.3% to 59.0%) and F4 (60.8% to 65.3% vs 23.9% to 49.5%) based on the sequential LS-ELF algorithm was significantly higher than the concurrent combination (all p<0.05). Conclusions: The sequential LS-ELF algorithm conferred a greater probability of avoiding LB in CHB patients to diagnose advanced fibrosis and cirrhosis, and this test performed significantly better than the concurrent combination. (Gut Liver 2018;12:190-200).

Original languageEnglish
Pages (from-to)190-200
Number of pages11
JournalGut and liver
Volume12
Issue number2
DOIs
Publication statusPublished - 2018 Mar

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Elasticity Imaging Techniques
Chronic Hepatitis B
Liver Cirrhosis
Liver
Biopsy
Fibrosis

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

@article{faf82bc9defe4b3896d6a321172494bb,
title = "Combination of transient elastography and an enhanced liver fibrosis test to assess the degree of liver fibrosis in patients with chronic hepatitis B",
abstract = "Background/Aims: Liver stiffness (LS) was assessed using transient elastography, and the enhanced liver fibrosis (ELF) test was performed to accurately assess fibrotic burden. We validated the LS-ELF algorithm and investigated whether the sequential LS-ELF algorithm performs better than concurrent combination of these analyses in chronic hepatitis B (CHB) patients. Methods: Between 2009 and 2013, 222 CHB patients who underwent liver biopsy (LB), as well as LS measurement and the ELF test, were enrolled. Results: Advanced fibrosis (≥F3) and cirrhosis (F4) were identified in 141 (63.6{\%}) and 118 (53.2{\%}) patients, respectively. Areas under receiver operating characteristic curve for LS predictions of ≥F3 (0.887 vs 0.703) and F4 (0.853 vs 0.706) were significantly higher than the ELF test (all p<0.001). Based on the LS-ELF algorithm, 60.4{\%} to 71.6{\%} and 55.7{\%} to 66.3{\%} of patients could have avoided LB to exclude ≥F3 and F4, respectively, whereas 68.0{\%} to 78.7{\%} and 63.5{\%} to 66.1{\%} of patients could have avoided LB to confirm ≥F3 and F4, respectively. When confirmation and exclusion strategies were applied simultaneously, 69.4{\%} to 72.5{\%} and 60.8{\%} to 65.3{\%} of patients could have avoided LB and been diagnosed as ≥F3 and F4, respectively. The proportion of patients who correctly avoided LB for the prediction of ≥F3 (69.4{\%} to 72.5{\%} vs 42.3{\%} to 59.0{\%}) and F4 (60.8{\%} to 65.3{\%} vs 23.9{\%} to 49.5{\%}) based on the sequential LS-ELF algorithm was significantly higher than the concurrent combination (all p<0.05). Conclusions: The sequential LS-ELF algorithm conferred a greater probability of avoiding LB in CHB patients to diagnose advanced fibrosis and cirrhosis, and this test performed significantly better than the concurrent combination. (Gut Liver 2018;12:190-200).",
author = "Heo, {Ja Yoon} and Kim, {Beom Kyung} and Park, {Jun Yong} and Kim, {Do Young} and Ahn, {Sang Hoon} and Kim, {Hyon Suk} and Park, {Young Nyun} and Han, {Kwang Hyub} and Kijun Song and Kim, {Seung Up}",
year = "2018",
month = "3",
doi = "10.5009/gnl17092",
language = "English",
volume = "12",
pages = "190--200",
journal = "Gut and Liver",
issn = "1976-2283",
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TY - JOUR

T1 - Combination of transient elastography and an enhanced liver fibrosis test to assess the degree of liver fibrosis in patients with chronic hepatitis B

AU - Heo, Ja Yoon

AU - Kim, Beom Kyung

AU - Park, Jun Yong

AU - Kim, Do Young

AU - Ahn, Sang Hoon

AU - Kim, Hyon Suk

AU - Park, Young Nyun

AU - Han, Kwang Hyub

AU - Song, Kijun

AU - Kim, Seung Up

PY - 2018/3

Y1 - 2018/3

N2 - Background/Aims: Liver stiffness (LS) was assessed using transient elastography, and the enhanced liver fibrosis (ELF) test was performed to accurately assess fibrotic burden. We validated the LS-ELF algorithm and investigated whether the sequential LS-ELF algorithm performs better than concurrent combination of these analyses in chronic hepatitis B (CHB) patients. Methods: Between 2009 and 2013, 222 CHB patients who underwent liver biopsy (LB), as well as LS measurement and the ELF test, were enrolled. Results: Advanced fibrosis (≥F3) and cirrhosis (F4) were identified in 141 (63.6%) and 118 (53.2%) patients, respectively. Areas under receiver operating characteristic curve for LS predictions of ≥F3 (0.887 vs 0.703) and F4 (0.853 vs 0.706) were significantly higher than the ELF test (all p<0.001). Based on the LS-ELF algorithm, 60.4% to 71.6% and 55.7% to 66.3% of patients could have avoided LB to exclude ≥F3 and F4, respectively, whereas 68.0% to 78.7% and 63.5% to 66.1% of patients could have avoided LB to confirm ≥F3 and F4, respectively. When confirmation and exclusion strategies were applied simultaneously, 69.4% to 72.5% and 60.8% to 65.3% of patients could have avoided LB and been diagnosed as ≥F3 and F4, respectively. The proportion of patients who correctly avoided LB for the prediction of ≥F3 (69.4% to 72.5% vs 42.3% to 59.0%) and F4 (60.8% to 65.3% vs 23.9% to 49.5%) based on the sequential LS-ELF algorithm was significantly higher than the concurrent combination (all p<0.05). Conclusions: The sequential LS-ELF algorithm conferred a greater probability of avoiding LB in CHB patients to diagnose advanced fibrosis and cirrhosis, and this test performed significantly better than the concurrent combination. (Gut Liver 2018;12:190-200).

AB - Background/Aims: Liver stiffness (LS) was assessed using transient elastography, and the enhanced liver fibrosis (ELF) test was performed to accurately assess fibrotic burden. We validated the LS-ELF algorithm and investigated whether the sequential LS-ELF algorithm performs better than concurrent combination of these analyses in chronic hepatitis B (CHB) patients. Methods: Between 2009 and 2013, 222 CHB patients who underwent liver biopsy (LB), as well as LS measurement and the ELF test, were enrolled. Results: Advanced fibrosis (≥F3) and cirrhosis (F4) were identified in 141 (63.6%) and 118 (53.2%) patients, respectively. Areas under receiver operating characteristic curve for LS predictions of ≥F3 (0.887 vs 0.703) and F4 (0.853 vs 0.706) were significantly higher than the ELF test (all p<0.001). Based on the LS-ELF algorithm, 60.4% to 71.6% and 55.7% to 66.3% of patients could have avoided LB to exclude ≥F3 and F4, respectively, whereas 68.0% to 78.7% and 63.5% to 66.1% of patients could have avoided LB to confirm ≥F3 and F4, respectively. When confirmation and exclusion strategies were applied simultaneously, 69.4% to 72.5% and 60.8% to 65.3% of patients could have avoided LB and been diagnosed as ≥F3 and F4, respectively. The proportion of patients who correctly avoided LB for the prediction of ≥F3 (69.4% to 72.5% vs 42.3% to 59.0%) and F4 (60.8% to 65.3% vs 23.9% to 49.5%) based on the sequential LS-ELF algorithm was significantly higher than the concurrent combination (all p<0.05). Conclusions: The sequential LS-ELF algorithm conferred a greater probability of avoiding LB in CHB patients to diagnose advanced fibrosis and cirrhosis, and this test performed significantly better than the concurrent combination. (Gut Liver 2018;12:190-200).

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