Range of Normal Liver Stiffness and Factors Associated With Increased Stiffness Measurements in Apparently Healthy Individuals

Fateh Bazerbachi, Samir Haffar, Zhen Wang, Joaquín Cabezas, Maria Teresa Arias-Loste, Javier Crespo, Sarwa Darwish-Murad, M. Arfan Ikram, John K. Olynyk, Eng Gan, Salvatore Petta, Alessandra Berzuini, Daniele Prati, Victor de Lédinghen, Vincent W. Wong, Paolo Del Poggio, Norberto C. Chávez-Tapia, Yong Peng Chen, Pin Nan Cheng, Man Fung YuenKausik Das, Abhijit Chowdhury, Llorenç Caballeria, Núria Fabrellas, Pere Ginès, Manoj Kumar, Shiv Kumar Sarin, Fabio Conti, Pietro Andreone, Roxana Sirli, Helena Cortez-Pinto, Sofia Carvalhana, Takaaki Sugihara, Seungup Kim, Pathik Parikh, Kazuaki Chayama, Christophe Corpechot, Kang Mo Kim, George Papatheodoridis, Ayman Alsebaey, Patrick S. Kamath, M. Hassan Murad, Kymberly D. Watt

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Background & Aims: Transient elastography (TE) is a noninvasive technique used to measure liver stiffness to estimate the severity of fibrosis. The range of liver stiffness measurements (LSMs) in healthy individuals is unclear. We performed a systematic review to determine the range of LSMs, examined by TE, in healthy individuals and individuals who are susceptible to fibrosis. Methods: We collected data from 16,082 individuals, in 26 cohorts, identified from systematic searches of Embase, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies of liver stiffness measurements. Studies analyzed included apparently healthy adults (normal levels of liver enzymes, low-risk alcohol use patterns, and negative for markers of viral hepatitis). The presence of diabetes, hypertension, dyslipidemia, or steatosis, based on ultrasound examination, was known for most participants. We performed a meta-analysis of data from individual participants. The cohort was divided into 4 groups; participants with a body mass index <30 kg/m2 were examined with the medium probe and those with a body mass index ≥30 kg/m2 were examined with the extra-large probe. Linear regression models were conducted after adjusting for potential confounding factors of LSMs. We performed several sensitivity analyses. Results: We established LSM ranges for healthy individuals measured with both probes—these did not change significantly in sensitivity analyses of individuals with platelets ≥150,000/mm3 and levels of alanine aminotransferase ≤33 IU/L in men or ≤25 IU/L in women. In multivariate analysis, factors that modified LSMs with statistical significance included diabetes, dyslipidemia, waist circumference, level of aspartate aminotransferase, and systolic blood pressure at examination time. Significant increases in LSMs were associated with the metabolic syndrome in individuals examined by either probe. Diabetes in obese individuals increased the risk of LSMs in the range associated with advanced fibrosis. Conclusions: In a systematic review and meta-analysis of data from individual participants, we established a comprehensive set of LSM ranges, measured by TE in large cohorts of healthy individuals and persons susceptible to hepatic fibrosis. Regression analyses identified factors associated with increased LSMs obtained by TE with the medium and extra-large probes.

Original languageEnglish
Pages (from-to)54-64.e1
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1

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Reference Values
Liver
Elasticity Imaging Techniques
Fibrosis
Dyslipidemias
Meta-Analysis
Linear Models
Body Mass Index
Blood Pressure
Waist Circumference
Aspartate Aminotransferases
Alanine Transaminase
MEDLINE
Hepatitis
Blood Platelets
Multivariate Analysis
Biomarkers
Regression Analysis
Alcohols
Databases

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Bazerbachi, Fateh ; Haffar, Samir ; Wang, Zhen ; Cabezas, Joaquín ; Arias-Loste, Maria Teresa ; Crespo, Javier ; Darwish-Murad, Sarwa ; Ikram, M. Arfan ; Olynyk, John K. ; Gan, Eng ; Petta, Salvatore ; Berzuini, Alessandra ; Prati, Daniele ; de Lédinghen, Victor ; Wong, Vincent W. ; Del Poggio, Paolo ; Chávez-Tapia, Norberto C. ; Chen, Yong Peng ; Cheng, Pin Nan ; Yuen, Man Fung ; Das, Kausik ; Chowdhury, Abhijit ; Caballeria, Llorenç ; Fabrellas, Núria ; Ginès, Pere ; Kumar, Manoj ; Sarin, Shiv Kumar ; Conti, Fabio ; Andreone, Pietro ; Sirli, Roxana ; Cortez-Pinto, Helena ; Carvalhana, Sofia ; Sugihara, Takaaki ; Kim, Seungup ; Parikh, Pathik ; Chayama, Kazuaki ; Corpechot, Christophe ; Kim, Kang Mo ; Papatheodoridis, George ; Alsebaey, Ayman ; Kamath, Patrick S. ; Murad, M. Hassan ; Watt, Kymberly D. / Range of Normal Liver Stiffness and Factors Associated With Increased Stiffness Measurements in Apparently Healthy Individuals. In: Clinical Gastroenterology and Hepatology. 2019 ; Vol. 17, No. 1. pp. 54-64.e1.
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title = "Range of Normal Liver Stiffness and Factors Associated With Increased Stiffness Measurements in Apparently Healthy Individuals",
abstract = "Background & Aims: Transient elastography (TE) is a noninvasive technique used to measure liver stiffness to estimate the severity of fibrosis. The range of liver stiffness measurements (LSMs) in healthy individuals is unclear. We performed a systematic review to determine the range of LSMs, examined by TE, in healthy individuals and individuals who are susceptible to fibrosis. Methods: We collected data from 16,082 individuals, in 26 cohorts, identified from systematic searches of Embase, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies of liver stiffness measurements. Studies analyzed included apparently healthy adults (normal levels of liver enzymes, low-risk alcohol use patterns, and negative for markers of viral hepatitis). The presence of diabetes, hypertension, dyslipidemia, or steatosis, based on ultrasound examination, was known for most participants. We performed a meta-analysis of data from individual participants. The cohort was divided into 4 groups; participants with a body mass index <30 kg/m2 were examined with the medium probe and those with a body mass index ≥30 kg/m2 were examined with the extra-large probe. Linear regression models were conducted after adjusting for potential confounding factors of LSMs. We performed several sensitivity analyses. Results: We established LSM ranges for healthy individuals measured with both probes—these did not change significantly in sensitivity analyses of individuals with platelets ≥150,000/mm3 and levels of alanine aminotransferase ≤33 IU/L in men or ≤25 IU/L in women. In multivariate analysis, factors that modified LSMs with statistical significance included diabetes, dyslipidemia, waist circumference, level of aspartate aminotransferase, and systolic blood pressure at examination time. Significant increases in LSMs were associated with the metabolic syndrome in individuals examined by either probe. Diabetes in obese individuals increased the risk of LSMs in the range associated with advanced fibrosis. Conclusions: In a systematic review and meta-analysis of data from individual participants, we established a comprehensive set of LSM ranges, measured by TE in large cohorts of healthy individuals and persons susceptible to hepatic fibrosis. Regression analyses identified factors associated with increased LSMs obtained by TE with the medium and extra-large probes.",
author = "Fateh Bazerbachi and Samir Haffar and Zhen Wang and Joaqu{\'i}n Cabezas and Arias-Loste, {Maria Teresa} and Javier Crespo and Sarwa Darwish-Murad and Ikram, {M. Arfan} and Olynyk, {John K.} and Eng Gan and Salvatore Petta and Alessandra Berzuini and Daniele Prati and {de L{\'e}dinghen}, Victor and Wong, {Vincent W.} and {Del Poggio}, Paolo and Ch{\'a}vez-Tapia, {Norberto C.} and Chen, {Yong Peng} and Cheng, {Pin Nan} and Yuen, {Man Fung} and Kausik Das and Abhijit Chowdhury and Lloren{\cc} Caballeria and N{\'u}ria Fabrellas and Pere Gin{\`e}s and Manoj Kumar and Sarin, {Shiv Kumar} and Fabio Conti and Pietro Andreone and Roxana Sirli and Helena Cortez-Pinto and Sofia Carvalhana and Takaaki Sugihara and Seungup Kim and Pathik Parikh and Kazuaki Chayama and Christophe Corpechot and Kim, {Kang Mo} and George Papatheodoridis and Ayman Alsebaey and Kamath, {Patrick S.} and Murad, {M. Hassan} and Watt, {Kymberly D.}",
year = "2019",
month = "1",
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doi = "10.1016/j.cgh.2018.08.069",
language = "English",
volume = "17",
pages = "54--64.e1",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
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Bazerbachi, F, Haffar, S, Wang, Z, Cabezas, J, Arias-Loste, MT, Crespo, J, Darwish-Murad, S, Ikram, MA, Olynyk, JK, Gan, E, Petta, S, Berzuini, A, Prati, D, de Lédinghen, V, Wong, VW, Del Poggio, P, Chávez-Tapia, NC, Chen, YP, Cheng, PN, Yuen, MF, Das, K, Chowdhury, A, Caballeria, L, Fabrellas, N, Ginès, P, Kumar, M, Sarin, SK, Conti, F, Andreone, P, Sirli, R, Cortez-Pinto, H, Carvalhana, S, Sugihara, T, Kim, S, Parikh, P, Chayama, K, Corpechot, C, Kim, KM, Papatheodoridis, G, Alsebaey, A, Kamath, PS, Murad, MH & Watt, KD 2019, 'Range of Normal Liver Stiffness and Factors Associated With Increased Stiffness Measurements in Apparently Healthy Individuals', Clinical Gastroenterology and Hepatology, vol. 17, no. 1, pp. 54-64.e1. https://doi.org/10.1016/j.cgh.2018.08.069

Range of Normal Liver Stiffness and Factors Associated With Increased Stiffness Measurements in Apparently Healthy Individuals. / Bazerbachi, Fateh; Haffar, Samir; Wang, Zhen; Cabezas, Joaquín; Arias-Loste, Maria Teresa; Crespo, Javier; Darwish-Murad, Sarwa; Ikram, M. Arfan; Olynyk, John K.; Gan, Eng; Petta, Salvatore; Berzuini, Alessandra; Prati, Daniele; de Lédinghen, Victor; Wong, Vincent W.; Del Poggio, Paolo; Chávez-Tapia, Norberto C.; Chen, Yong Peng; Cheng, Pin Nan; Yuen, Man Fung; Das, Kausik; Chowdhury, Abhijit; Caballeria, Llorenç; Fabrellas, Núria; Ginès, Pere; Kumar, Manoj; Sarin, Shiv Kumar; Conti, Fabio; Andreone, Pietro; Sirli, Roxana; Cortez-Pinto, Helena; Carvalhana, Sofia; Sugihara, Takaaki; Kim, Seungup; Parikh, Pathik; Chayama, Kazuaki; Corpechot, Christophe; Kim, Kang Mo; Papatheodoridis, George; Alsebaey, Ayman; Kamath, Patrick S.; Murad, M. Hassan; Watt, Kymberly D.

In: Clinical Gastroenterology and Hepatology, Vol. 17, No. 1, 01.01.2019, p. 54-64.e1.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Range of Normal Liver Stiffness and Factors Associated With Increased Stiffness Measurements in Apparently Healthy Individuals

AU - Bazerbachi, Fateh

AU - Haffar, Samir

AU - Wang, Zhen

AU - Cabezas, Joaquín

AU - Arias-Loste, Maria Teresa

AU - Crespo, Javier

AU - Darwish-Murad, Sarwa

AU - Ikram, M. Arfan

AU - Olynyk, John K.

AU - Gan, Eng

AU - Petta, Salvatore

AU - Berzuini, Alessandra

AU - Prati, Daniele

AU - de Lédinghen, Victor

AU - Wong, Vincent W.

AU - Del Poggio, Paolo

AU - Chávez-Tapia, Norberto C.

AU - Chen, Yong Peng

AU - Cheng, Pin Nan

AU - Yuen, Man Fung

AU - Das, Kausik

AU - Chowdhury, Abhijit

AU - Caballeria, Llorenç

AU - Fabrellas, Núria

AU - Ginès, Pere

AU - Kumar, Manoj

AU - Sarin, Shiv Kumar

AU - Conti, Fabio

AU - Andreone, Pietro

AU - Sirli, Roxana

AU - Cortez-Pinto, Helena

AU - Carvalhana, Sofia

AU - Sugihara, Takaaki

AU - Kim, Seungup

AU - Parikh, Pathik

AU - Chayama, Kazuaki

AU - Corpechot, Christophe

AU - Kim, Kang Mo

AU - Papatheodoridis, George

AU - Alsebaey, Ayman

AU - Kamath, Patrick S.

AU - Murad, M. Hassan

AU - Watt, Kymberly D.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background & Aims: Transient elastography (TE) is a noninvasive technique used to measure liver stiffness to estimate the severity of fibrosis. The range of liver stiffness measurements (LSMs) in healthy individuals is unclear. We performed a systematic review to determine the range of LSMs, examined by TE, in healthy individuals and individuals who are susceptible to fibrosis. Methods: We collected data from 16,082 individuals, in 26 cohorts, identified from systematic searches of Embase, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies of liver stiffness measurements. Studies analyzed included apparently healthy adults (normal levels of liver enzymes, low-risk alcohol use patterns, and negative for markers of viral hepatitis). The presence of diabetes, hypertension, dyslipidemia, or steatosis, based on ultrasound examination, was known for most participants. We performed a meta-analysis of data from individual participants. The cohort was divided into 4 groups; participants with a body mass index <30 kg/m2 were examined with the medium probe and those with a body mass index ≥30 kg/m2 were examined with the extra-large probe. Linear regression models were conducted after adjusting for potential confounding factors of LSMs. We performed several sensitivity analyses. Results: We established LSM ranges for healthy individuals measured with both probes—these did not change significantly in sensitivity analyses of individuals with platelets ≥150,000/mm3 and levels of alanine aminotransferase ≤33 IU/L in men or ≤25 IU/L in women. In multivariate analysis, factors that modified LSMs with statistical significance included diabetes, dyslipidemia, waist circumference, level of aspartate aminotransferase, and systolic blood pressure at examination time. Significant increases in LSMs were associated with the metabolic syndrome in individuals examined by either probe. Diabetes in obese individuals increased the risk of LSMs in the range associated with advanced fibrosis. Conclusions: In a systematic review and meta-analysis of data from individual participants, we established a comprehensive set of LSM ranges, measured by TE in large cohorts of healthy individuals and persons susceptible to hepatic fibrosis. Regression analyses identified factors associated with increased LSMs obtained by TE with the medium and extra-large probes.

AB - Background & Aims: Transient elastography (TE) is a noninvasive technique used to measure liver stiffness to estimate the severity of fibrosis. The range of liver stiffness measurements (LSMs) in healthy individuals is unclear. We performed a systematic review to determine the range of LSMs, examined by TE, in healthy individuals and individuals who are susceptible to fibrosis. Methods: We collected data from 16,082 individuals, in 26 cohorts, identified from systematic searches of Embase, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies of liver stiffness measurements. Studies analyzed included apparently healthy adults (normal levels of liver enzymes, low-risk alcohol use patterns, and negative for markers of viral hepatitis). The presence of diabetes, hypertension, dyslipidemia, or steatosis, based on ultrasound examination, was known for most participants. We performed a meta-analysis of data from individual participants. The cohort was divided into 4 groups; participants with a body mass index <30 kg/m2 were examined with the medium probe and those with a body mass index ≥30 kg/m2 were examined with the extra-large probe. Linear regression models were conducted after adjusting for potential confounding factors of LSMs. We performed several sensitivity analyses. Results: We established LSM ranges for healthy individuals measured with both probes—these did not change significantly in sensitivity analyses of individuals with platelets ≥150,000/mm3 and levels of alanine aminotransferase ≤33 IU/L in men or ≤25 IU/L in women. In multivariate analysis, factors that modified LSMs with statistical significance included diabetes, dyslipidemia, waist circumference, level of aspartate aminotransferase, and systolic blood pressure at examination time. Significant increases in LSMs were associated with the metabolic syndrome in individuals examined by either probe. Diabetes in obese individuals increased the risk of LSMs in the range associated with advanced fibrosis. Conclusions: In a systematic review and meta-analysis of data from individual participants, we established a comprehensive set of LSM ranges, measured by TE in large cohorts of healthy individuals and persons susceptible to hepatic fibrosis. Regression analyses identified factors associated with increased LSMs obtained by TE with the medium and extra-large probes.

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UR - http://www.scopus.com/inward/citedby.url?scp=85058420488&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2018.08.069

DO - 10.1016/j.cgh.2018.08.069

M3 - Review article

C2 - 30196155

AN - SCOPUS:85058420488

VL - 17

SP - 54-64.e1

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 1

ER -