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Prospective Evaluation of FibroScan for the Diagnosis of Hepatic Fibrosis Compared with Liver Biopsy/AST Platelet Ratio Index and FIB-4 in Patients with Chronic HBV Infection

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Abstract

Background

The FibroScan (FS), the aspartate aminotransferase-to-platelet ratio index (APRI), and the FIB-4 index are simple and inexpensive methods to detect liver fibrosis.

Aims

The primary objective was to evaluate the performance of FS for the noninvasive diagnosis of hepatic fibrosis in Western Chinese patients with chronic hepatitis B virus (HBV) infection compared with APRI and FIB-4; the secondary objective was to determine liver stiffness measurement (LSM) cutoff values for the noninvasive diagnosis of significant fibrosis and liver cirrhosis.

Methods

Overall, 175 consecutive patients with chronic HBV infection, successful liver biopsy, and alanine aminotransferase levels ≤2× ULN were prospectively studied. Liver fibrosis was graded by an independent pathologist using the METAVIR (F0–F4) classification. APRI and FIB-4 were calculated from laboratory data.

Results

The area under receiver operating characteristics curves (AUROC) for LSM for significant fibrosis (METAVIR F2–3) and cirrhosis (F4) was 0.95 (95% confidence interval, 0.91–0.98) and 0.98 (0.96–0.99), respectively. For the detection of significant fibrosis and cirrhosis, the AUROC of APRI were 0.81 (0.74–0.87) and 0.83 (0.77–0.90); the AUROC of FIB-4 were 0.86 (0.80–0.91) and 0.77 (0.68–0.85). FS optimal cutoff values for the identification of significant fibrosis and cirrhosis were 7.9 and 13.8 kPa, respectively.

Conclusions

FS is a reliable predictor of significant fibrosis and cirrhosis in Western Chinese patients with chronic HBV infection, and is superior to APRI and FIB-4. FS cutoff values could be considered as clinical reference for detecting significant fibrosis and cirrhosis.

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References

  1. Poynard T, Mathurin P, Lai CL, et al. A comparison of fibrosis progression in chronic liver diseases. J Hepatol. 2003;38:257–265.

    Article  PubMed  CAS  Google Scholar 

  2. Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology. 2007;45:507–539.

    Article  PubMed  CAS  Google Scholar 

  3. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344:495–500.

    Article  PubMed  CAS  Google Scholar 

  4. Castera L, Negre I, Samii K, Buffet C. Pain experienced during percutaneous liver biopsy. Hepatology. 1999;30:1529–1530.

    Article  PubMed  CAS  Google Scholar 

  5. Rousselet MC, Michalak S, Dupre F, et al. Sources of variability in histological scoring of chronic viral hepatitis. Hepatology. 2005;41:257–264.

    Article  PubMed  Google Scholar 

  6. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–526.

    Article  PubMed  Google Scholar 

  7. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317–1325.

    Article  PubMed  CAS  Google Scholar 

  8. Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705–1713.

    Article  PubMed  Google Scholar 

  9. Ziol M, Handra-Luca A, Kettaneh A, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41:48–54.

    Article  PubMed  Google Scholar 

  10. Castera L, Vergniol J, Foucher J, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128:343–350.

    Article  PubMed  Google Scholar 

  11. Chan HL, Wong GL, Choi PC, et al. Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B. J Viral Hepat. 2009;16:36–44.

    Article  PubMed  Google Scholar 

  12. Lucidarme D, Foucher J, Le Bail B, et al. Factors of accuracy of transient elastography (fibroscan) for the diagnosis of liver fibrosis in chronic hepatitis C. Hepatology. 2009;49:1083–1089.

    Article  PubMed  Google Scholar 

  13. Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Infectious Diseases CMA. Guideline on prevention and treatment of chronic hepatitis B in China (2005). Chin Med J (Engl). 2007;120:2159–2173.

    Google Scholar 

  14. Kim SU, Kim do Y, Park JY, et al. How can we enhance the performance of liver stiffness measurement using FibroScan in diagnosing liver cirrhosis in patients with chronic hepatitis B? J Clin Gastroenterol. 2010;44:66–71.

    Article  PubMed  Google Scholar 

  15. Colletta C, Smirne C, Fabris C, et al. Value of two noninvasive methods to detect progression of fibrosis among HCV carriers with normal aminotransferases. Hepatology. 2005;42:838–845.

    Article  PubMed  Google Scholar 

  16. Marcellin P, Ziol M, Bedossa P, et al. Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B. Liver Int. 2009;29:242–247.

    Article  PubMed  Google Scholar 

  17. Sagir A, Erhardt A, Schmitt M, Haussinger D. Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage. Hepatology. 2008;47:592–595.

    Article  PubMed  CAS  Google Scholar 

  18. Arena U, Vizzutti F, Corti G, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 2008;47:380–384.

    Article  PubMed  CAS  Google Scholar 

  19. Coco B, Oliveri F, Maina AM, et al. Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Viral Hepat. 2007;14:360–369.

    Article  PubMed  CAS  Google Scholar 

  20. LC Fung J, Fong DY, Yuen JC, Wong DK, Yuen MF. Correlation of liver biochemistry with liver stiffness in chronic hepatitis B and development of a predictive model for liver fibrosis. Liver Int. 2008;28:1408–1416.

    Article  Google Scholar 

  21. Fung JLC, Cheng C, Wu CH, Wong D, Yuen MF. Mild-to-moderate elevation of alanine aminotransferase may increase liver stiffness measurement by transient elastography in patients with chronic hepatitis B. Hepatol. 2009;50:971A.

    Google Scholar 

  22. Fung JLC, But D, Hsu A, Seto WK, Cheng C, Wong DKH, Yuen MF. Reduction of liver stiffness following resolution of acute flares of chronic hepatitis B. Hepatol Int. 2010;4:716–722.

    Google Scholar 

  23. Foucher J, Castera L, Bernard PH, et al. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations. Eur J Gastroenterol Hepatol. 2006;18:411–412.

    Article  PubMed  Google Scholar 

  24. Chang PE, Lui HF, Chau YP, et al. Prospective evaluation of transient elastography for the diagnosis of hepatic fibrosis in Asians: comparison with liver biopsy and aspartate transaminase platelet ratio index. Aliment Pharmacol Ther. 2008;28:51–61.

    Article  PubMed  CAS  Google Scholar 

  25. Fraquelli M, Rigamonti C, Casazza G, et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut. 2007;56:968–973.

    Article  PubMed  Google Scholar 

  26. Forns X, Ampurdanes S, Llovet JM, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology. 2002;36:986–992.

    PubMed  Google Scholar 

  27. Imbert-Bismut F, Ratziu V, Pieroni L, Charlotte F, Benhamou Y, Poynard T. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet. 2001;357:1069–1075.

    Article  PubMed  CAS  Google Scholar 

  28. Patel K, Gordon SC, Jacobson I, et al. Evaluation of a panel of non-invasive serum markers to differentiate mild from moderate-to-advanced liver fibrosis in chronic hepatitis C patients. J Hepatol. 2004;41:935–942.

    Article  PubMed  CAS  Google Scholar 

  29. Rosenberg WM, Voelker M, Thiel R, et al. Serum markers detect the presence of liver fibrosis: a cohort study. Gastroenterology. 2004;127:1704–1713.

    Article  PubMed  Google Scholar 

  30. Wong GL, Wong VW, Choi PC, Chan AW, Chan HL. Development of a non-invasive algorithm with transient elastography (Fibroscan) and serum test formula for advanced liver fibrosis in chronic hepatitis B. Aliment Pharmacol Ther. 2010;31:1095–1103.

    Article  PubMed  Google Scholar 

  31. Sanchez-Conde M, Montes-Ramirez ML, Miralles P, et al. Comparison of transient elastography and liver biopsy for the assessment of liver fibrosis in HIV/hepatitis C virus-coinfected patients and correlation with noninvasive serum markers. J Viral Hepat. 2010;17:280–286.

    Article  PubMed  CAS  Google Scholar 

  32. Gonzalez Guilabert MI, Hinojosa Mena-Bernal C, del Pozo Gonzalez J, del Pozo Perez MA. Retrospective study of FibroScan, APRI, FIB-4 and FORNS indexes compared with liver biopsy in the evaluation of liver fibrosis in patients with chronic hepatitis C monoinfection and HIV coinfection. Gastroenterol Hepatol. 2010;33:425–432.

    Article  PubMed  Google Scholar 

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Acknowledgments

We wish to thank all patients who participated in the study. We also thank Prof. Li-Chun Wang and Bing-Jun Lei (Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China) who agreed to have their patients participate in this study. This work was financially supported by the National Key Technologies Research and Development Program of China during the 11th Five-Year Plan Period (No.2008ZX10002-006), National S&T Major Project for Infections Diseases Control (No.2009ZX10004-905), and the National Basic Research Program of China (No.2007CB512902).

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Authors and Affiliations

  1. Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, 610041, Wu Hou District, Chengdu, China

    Xia Zhu, Li-Chun Wang, En-Qiang Chen, Xue-Bing Chen, Li-Yu Chen, Li Liu, Xue-Zhong Lei, Cong Liu & Hong Tang

  2. Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, 610041, Chengdu, China

    Xia Zhu, Li-Chun Wang, En-Qiang Chen, Xue-Bing Chen, Li-Yu Chen, Li Liu, Xue-Zhong Lei, Cong Liu & Hong Tang

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  1. Xia Zhu
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Correspondence to Hong Tang.

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Zhu, X., Wang, LC., Chen, EQ. et al. Prospective Evaluation of FibroScan for the Diagnosis of Hepatic Fibrosis Compared with Liver Biopsy/AST Platelet Ratio Index and FIB-4 in Patients with Chronic HBV Infection. Dig Dis Sci 56, 2742–2749 (2011). https://doi.org/10.1007/s10620-011-1659-1

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