Probability-Based Interpretation of Liver Stiffness Measurement in Untreated Chronic Hepatitis B Patients

Vincent Wai Sun Wong, Pietro Lampertico, Victor de Lédinghen, Pik Eu Chang, Seung Up Kim, Yongpeng Chen, Henry Lik Yuen Chan, Giampaolo Mangia, Juliette Foucher, Wan Cheng Chow, Sang Hoon Ahn, Jinlin Hou

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Liver stiffness measurement (LSM) by transient elastography is a popular noninvasive test of fibrosis. Traditional LSM cutoffs dichotomize patients and do not clearly indicate the confidence of diagnosis. Aim: We derived and validated probability functions of fibrosis and cirrhosis based on LSM and determined the effect of alanine aminotransferase (ALT) on the scores. Methods: Consecutive chronic hepatitis B patients who underwent liver function tests, LSM, and liver biopsies at six European and Asian centers (2/3 in the training cohort and 1/3 in the validation cohort) were recruited. Binary logistic regression was performed to predict the probabilities of different fibrosis stages based on LSM and/or ALT. Results: A total of 1,051 patients were included in the final analysis (53 % with ALT ≥ 60 IU/L, 32 % F2, 20 % F3, and 24 % F4). The probability functions (LiFA-HBV score) with and without ALT adjustment closely mirrored the proportion with different fibrosis stages in both the training and validation cohorts. For a range of up to 300 IU/L, ALT maintained a weak linear relationship with LSM for each fibrosis stage (r2 = 0.018–0.13). Based on relative integrated discrimination improvement, the addition of ALT to the LiFA-HBV score increased the correct reclassification of F3–4 and F4 by 5 and 17 %, respectively. Conclusions: ALT increases LSM in a linear fashion in chronic hepatitis B patients at any fibrosis stage. The LiFA-HBV score accurately predicts the probability of fibrosis. ALT adjustment increases the rate of reclassification modestly and is not essential.

Original languageEnglish
Pages (from-to)1448-1456
Number of pages9
JournalDigestive diseases and sciences
Volume60
Issue number5
DOIs
Publication statusPublished - 2015 May 1

Fingerprint

Chronic Hepatitis B
Alanine Transaminase
Fibrosis
Liver
Elasticity Imaging Techniques
Liver Function Tests
Alanine
Logistic Models
Biopsy

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

Cite this

Wong, Vincent Wai Sun ; Lampertico, Pietro ; de Lédinghen, Victor ; Chang, Pik Eu ; Kim, Seung Up ; Chen, Yongpeng ; Chan, Henry Lik Yuen ; Mangia, Giampaolo ; Foucher, Juliette ; Chow, Wan Cheng ; Ahn, Sang Hoon ; Hou, Jinlin. / Probability-Based Interpretation of Liver Stiffness Measurement in Untreated Chronic Hepatitis B Patients. In: Digestive diseases and sciences. 2015 ; Vol. 60, No. 5. pp. 1448-1456.
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title = "Probability-Based Interpretation of Liver Stiffness Measurement in Untreated Chronic Hepatitis B Patients",
abstract = "Background: Liver stiffness measurement (LSM) by transient elastography is a popular noninvasive test of fibrosis. Traditional LSM cutoffs dichotomize patients and do not clearly indicate the confidence of diagnosis. Aim: We derived and validated probability functions of fibrosis and cirrhosis based on LSM and determined the effect of alanine aminotransferase (ALT) on the scores. Methods: Consecutive chronic hepatitis B patients who underwent liver function tests, LSM, and liver biopsies at six European and Asian centers (2/3 in the training cohort and 1/3 in the validation cohort) were recruited. Binary logistic regression was performed to predict the probabilities of different fibrosis stages based on LSM and/or ALT. Results: A total of 1,051 patients were included in the final analysis (53 {\%} with ALT ≥ 60 IU/L, 32 {\%} F2, 20 {\%} F3, and 24 {\%} F4). The probability functions (LiFA-HBV score) with and without ALT adjustment closely mirrored the proportion with different fibrosis stages in both the training and validation cohorts. For a range of up to 300 IU/L, ALT maintained a weak linear relationship with LSM for each fibrosis stage (r2 = 0.018–0.13). Based on relative integrated discrimination improvement, the addition of ALT to the LiFA-HBV score increased the correct reclassification of F3–4 and F4 by 5 and 17 {\%}, respectively. Conclusions: ALT increases LSM in a linear fashion in chronic hepatitis B patients at any fibrosis stage. The LiFA-HBV score accurately predicts the probability of fibrosis. ALT adjustment increases the rate of reclassification modestly and is not essential.",
author = "Wong, {Vincent Wai Sun} and Pietro Lampertico and {de L{\'e}dinghen}, Victor and Chang, {Pik Eu} and Kim, {Seung Up} and Yongpeng Chen and Chan, {Henry Lik Yuen} and Giampaolo Mangia and Juliette Foucher and Chow, {Wan Cheng} and Ahn, {Sang Hoon} and Jinlin Hou",
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Wong, VWS, Lampertico, P, de Lédinghen, V, Chang, PE, Kim, SU, Chen, Y, Chan, HLY, Mangia, G, Foucher, J, Chow, WC, Ahn, SH & Hou, J 2015, 'Probability-Based Interpretation of Liver Stiffness Measurement in Untreated Chronic Hepatitis B Patients', Digestive diseases and sciences, vol. 60, no. 5, pp. 1448-1456. https://doi.org/10.1007/s10620-014-3488-5

Probability-Based Interpretation of Liver Stiffness Measurement in Untreated Chronic Hepatitis B Patients. / Wong, Vincent Wai Sun; Lampertico, Pietro; de Lédinghen, Victor; Chang, Pik Eu; Kim, Seung Up; Chen, Yongpeng; Chan, Henry Lik Yuen; Mangia, Giampaolo; Foucher, Juliette; Chow, Wan Cheng; Ahn, Sang Hoon; Hou, Jinlin.

In: Digestive diseases and sciences, Vol. 60, No. 5, 01.05.2015, p. 1448-1456.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Probability-Based Interpretation of Liver Stiffness Measurement in Untreated Chronic Hepatitis B Patients

AU - Wong, Vincent Wai Sun

AU - Lampertico, Pietro

AU - de Lédinghen, Victor

AU - Chang, Pik Eu

AU - Kim, Seung Up

AU - Chen, Yongpeng

AU - Chan, Henry Lik Yuen

AU - Mangia, Giampaolo

AU - Foucher, Juliette

AU - Chow, Wan Cheng

AU - Ahn, Sang Hoon

AU - Hou, Jinlin

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background: Liver stiffness measurement (LSM) by transient elastography is a popular noninvasive test of fibrosis. Traditional LSM cutoffs dichotomize patients and do not clearly indicate the confidence of diagnosis. Aim: We derived and validated probability functions of fibrosis and cirrhosis based on LSM and determined the effect of alanine aminotransferase (ALT) on the scores. Methods: Consecutive chronic hepatitis B patients who underwent liver function tests, LSM, and liver biopsies at six European and Asian centers (2/3 in the training cohort and 1/3 in the validation cohort) were recruited. Binary logistic regression was performed to predict the probabilities of different fibrosis stages based on LSM and/or ALT. Results: A total of 1,051 patients were included in the final analysis (53 % with ALT ≥ 60 IU/L, 32 % F2, 20 % F3, and 24 % F4). The probability functions (LiFA-HBV score) with and without ALT adjustment closely mirrored the proportion with different fibrosis stages in both the training and validation cohorts. For a range of up to 300 IU/L, ALT maintained a weak linear relationship with LSM for each fibrosis stage (r2 = 0.018–0.13). Based on relative integrated discrimination improvement, the addition of ALT to the LiFA-HBV score increased the correct reclassification of F3–4 and F4 by 5 and 17 %, respectively. Conclusions: ALT increases LSM in a linear fashion in chronic hepatitis B patients at any fibrosis stage. The LiFA-HBV score accurately predicts the probability of fibrosis. ALT adjustment increases the rate of reclassification modestly and is not essential.

AB - Background: Liver stiffness measurement (LSM) by transient elastography is a popular noninvasive test of fibrosis. Traditional LSM cutoffs dichotomize patients and do not clearly indicate the confidence of diagnosis. Aim: We derived and validated probability functions of fibrosis and cirrhosis based on LSM and determined the effect of alanine aminotransferase (ALT) on the scores. Methods: Consecutive chronic hepatitis B patients who underwent liver function tests, LSM, and liver biopsies at six European and Asian centers (2/3 in the training cohort and 1/3 in the validation cohort) were recruited. Binary logistic regression was performed to predict the probabilities of different fibrosis stages based on LSM and/or ALT. Results: A total of 1,051 patients were included in the final analysis (53 % with ALT ≥ 60 IU/L, 32 % F2, 20 % F3, and 24 % F4). The probability functions (LiFA-HBV score) with and without ALT adjustment closely mirrored the proportion with different fibrosis stages in both the training and validation cohorts. For a range of up to 300 IU/L, ALT maintained a weak linear relationship with LSM for each fibrosis stage (r2 = 0.018–0.13). Based on relative integrated discrimination improvement, the addition of ALT to the LiFA-HBV score increased the correct reclassification of F3–4 and F4 by 5 and 17 %, respectively. Conclusions: ALT increases LSM in a linear fashion in chronic hepatitis B patients at any fibrosis stage. The LiFA-HBV score accurately predicts the probability of fibrosis. ALT adjustment increases the rate of reclassification modestly and is not essential.

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