Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement

T. Karlas, D. Petroff, M. Sasso, J. G. Fan, Y. Q. Mi, V. de Lédinghen, M. Kumar, M. Lupsor-Platon, K. H. Han, A. C. Cardoso, G. Ferraioli, W. K. Chan, V. W.S. Wong, R. P. Myers, K. Chayama, M. Friedrich-Rust, M. Beaugrand, F. Shen, J. B. Hiriart, S. K. SarinR. Badea, H. W. Lee, P. Marcellin, C. Filice, S. Mahadeva, G. L.H. Wong, P. Crotty, K. Masaki, J. Bojunga, P. Bedossa, V. Keim, J. Wiegand

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis. Aim: To determine how to use CAP in interpreting liver stiffness measurements. Methods: This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP. Results: Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis. Conclusions: Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.

Original languageEnglish
Pages (from-to)989-1000
Number of pages12
JournalAlimentary Pharmacology and Therapeutics
Volume47
Issue number7
DOIs
Publication statusPublished - 2018 Apr

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Liver Cirrhosis
Fibrosis
Elasticity Imaging Techniques
Liver
Vibration
Research
Meta-Analysis
Logistic Models
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

Cite this

Karlas, T., Petroff, D., Sasso, M., Fan, J. G., Mi, Y. Q., de Lédinghen, V., ... Wiegand, J. (2018). Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement. Alimentary Pharmacology and Therapeutics, 47(7), 989-1000. https://doi.org/10.1111/apt.14529
Karlas, T. ; Petroff, D. ; Sasso, M. ; Fan, J. G. ; Mi, Y. Q. ; de Lédinghen, V. ; Kumar, M. ; Lupsor-Platon, M. ; Han, K. H. ; Cardoso, A. C. ; Ferraioli, G. ; Chan, W. K. ; Wong, V. W.S. ; Myers, R. P. ; Chayama, K. ; Friedrich-Rust, M. ; Beaugrand, M. ; Shen, F. ; Hiriart, J. B. ; Sarin, S. K. ; Badea, R. ; Lee, H. W. ; Marcellin, P. ; Filice, C. ; Mahadeva, S. ; Wong, G. L.H. ; Crotty, P. ; Masaki, K. ; Bojunga, J. ; Bedossa, P. ; Keim, V. ; Wiegand, J. / Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement. In: Alimentary Pharmacology and Therapeutics. 2018 ; Vol. 47, No. 7. pp. 989-1000.
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abstract = "Background: Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis. Aim: To determine how to use CAP in interpreting liver stiffness measurements. Methods: This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP. Results: Two thousand and fifty eight patients fulfilled the inclusion criteria (37{\%} women, 18{\%} NAFLD/NASH, 42{\%} HBV, 40{\%} HCV, 51{\%} significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98{\%}). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70{\%}) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68{\%} and 55{\%} respectively, despite specificity-optimised cut-offs for cirrhosis. Conclusions: Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.",
author = "T. Karlas and D. Petroff and M. Sasso and Fan, {J. G.} and Mi, {Y. Q.} and {de L{\'e}dinghen}, V. and M. Kumar and M. Lupsor-Platon and Han, {K. H.} and Cardoso, {A. C.} and G. Ferraioli and Chan, {W. K.} and Wong, {V. W.S.} and Myers, {R. P.} and K. Chayama and M. Friedrich-Rust and M. Beaugrand and F. Shen and Hiriart, {J. B.} and Sarin, {S. K.} and R. Badea and Lee, {H. W.} and P. Marcellin and C. Filice and S. Mahadeva and Wong, {G. L.H.} and P. Crotty and K. Masaki and J. Bojunga and P. Bedossa and V. Keim and J. Wiegand",
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Karlas, T, Petroff, D, Sasso, M, Fan, JG, Mi, YQ, de Lédinghen, V, Kumar, M, Lupsor-Platon, M, Han, KH, Cardoso, AC, Ferraioli, G, Chan, WK, Wong, VWS, Myers, RP, Chayama, K, Friedrich-Rust, M, Beaugrand, M, Shen, F, Hiriart, JB, Sarin, SK, Badea, R, Lee, HW, Marcellin, P, Filice, C, Mahadeva, S, Wong, GLH, Crotty, P, Masaki, K, Bojunga, J, Bedossa, P, Keim, V & Wiegand, J 2018, 'Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement', Alimentary Pharmacology and Therapeutics, vol. 47, no. 7, pp. 989-1000. https://doi.org/10.1111/apt.14529

Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement. / Karlas, T.; Petroff, D.; Sasso, M.; Fan, J. G.; Mi, Y. Q.; de Lédinghen, V.; Kumar, M.; Lupsor-Platon, M.; Han, K. H.; Cardoso, A. C.; Ferraioli, G.; Chan, W. K.; Wong, V. W.S.; Myers, R. P.; Chayama, K.; Friedrich-Rust, M.; Beaugrand, M.; Shen, F.; Hiriart, J. B.; Sarin, S. K.; Badea, R.; Lee, H. W.; Marcellin, P.; Filice, C.; Mahadeva, S.; Wong, G. L.H.; Crotty, P.; Masaki, K.; Bojunga, J.; Bedossa, P.; Keim, V.; Wiegand, J.

In: Alimentary Pharmacology and Therapeutics, Vol. 47, No. 7, 04.2018, p. 989-1000.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement

AU - Karlas, T.

AU - Petroff, D.

AU - Sasso, M.

AU - Fan, J. G.

AU - Mi, Y. Q.

AU - de Lédinghen, V.

AU - Kumar, M.

AU - Lupsor-Platon, M.

AU - Han, K. H.

AU - Cardoso, A. C.

AU - Ferraioli, G.

AU - Chan, W. K.

AU - Wong, V. W.S.

AU - Myers, R. P.

AU - Chayama, K.

AU - Friedrich-Rust, M.

AU - Beaugrand, M.

AU - Shen, F.

AU - Hiriart, J. B.

AU - Sarin, S. K.

AU - Badea, R.

AU - Lee, H. W.

AU - Marcellin, P.

AU - Filice, C.

AU - Mahadeva, S.

AU - Wong, G. L.H.

AU - Crotty, P.

AU - Masaki, K.

AU - Bojunga, J.

AU - Bedossa, P.

AU - Keim, V.

AU - Wiegand, J.

PY - 2018/4

Y1 - 2018/4

N2 - Background: Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis. Aim: To determine how to use CAP in interpreting liver stiffness measurements. Methods: This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP. Results: Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis. Conclusions: Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.

AB - Background: Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis. Aim: To determine how to use CAP in interpreting liver stiffness measurements. Methods: This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP. Results: Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis. Conclusions: Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.

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DO - 10.1111/apt.14529

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