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Point shear wave elastography predicts fibrosis severity and steatohepatitis in alcohol-related liver disease

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Abstract

Background

Point shear wave elastography (pSWE) is a convenient noninvasive tool for assessing liver fibrosis in chronic liver disease. However, there is little information on the correlation between pSWE and the histological findings of alcohol-related liver disease (ALD). Thus, we investigated the diagnostic performance of pSWE in discriminating the fibrosis stage of patients with ALD.

Methods

A total of 251 Korean patients with ALD were prospectively enrolled. The diagnostic performance of pSWE was evaluated on the basis of histological fibrosis severity according to Kleiner/Brunt et al.’s criteria and the Laennec classification.

Results

Median liver stiffness on pSWE significantly increased as liver fibrosis stage increased (p < 0.001). Liver stiffness measurement proved to be an excellent diagnostic indicator in the evaluation of a ≥ F2 stage (area under the receiver operating characteristics curve [AUROC] 0.93; cutoff > 1.46 m/s), ≥ F3 stage (AUROC 0.90; cutoff > 1.47 m/s), and F4 stage (AUROC 0.91; cutoff > 1.66 m/s). Compared with noninvasive serum fibrosis tests, pSWE had the highest AUROC for predicting ≥ F2, ≥ F3, and = F4 stages and the highest Obuchowski index (0.931 ± 0.007; all p < 0.001). The AUROC for discriminating steatohepatitis from simple steatosis was 0.93 (> 1.49 m/s) and the AUROC for discriminating cirrhosis with steatohepatitis from cirrhosis without steatohepatitis was 0.92 (> 2.52 m/s).

Conclusion

pSWE not only gives an accurate indication of liver fibrosis stage in ALD, but also can allow patients with severe alcoholic steatohepatitis to begin corticosteroid treatment without exposing them to the risks of liver biopsy.

Clinical trial registration

Clincialtrials.gov Identifier NCT01943318.

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Abbreviations

pSWE:

Point shear wave elastography

ALD:

Alcohol-related liver disease

ASH:

Alcoholic steatohepatitis

LSM:

Liver stiffness measurement

AUDIT-K:

Korean version of the Alcohol Use Disorders Identification Test

AUROC:

Area under the receiver operating characteristic curve

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

GGT:

Gamma-glutamyl transferase

MDF:

Maddrey’s discriminant function

AAR:

Aspartate aminotransferase to alanine aminotransferase ratio

APRI:

Aspartate aminotransferase to platelet ratio index

FIB-4:

Fibrosis index based on the four factors

Sn:

Sensitivity

Sp:

Specificity

PLR:

Positive likelihood ratio

NLR:

Negative likelihood ratio

PPV:

Positive predictive value

NPV:

Negative predictive value

IQR:

Interquartile range

HVPG:

Hepatic venous pressure gradient

CI:

Confidence interval

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Funding

This work was supported by Seoul Metropolitan Government Seoul National University (SMG-SNU) Boramae Medical Center (03-2019-2).

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Author notes

  1. Yuri Cho and Youn I. Choi contributed equally and share co-first authorship.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea

    Yuri Cho

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government, Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea

    Youn I. Choi, Jimin Han, Sae Kyung Joo, Dong Hyeon Lee, Yong Jin Jung, Byeong Gwan Kim, Kook Lae Lee & Won Kim

  3. Department of Hepatology, Gachon University, Gil Medical Center, Incheon, Republic of Korea

    Youn I. Choi

  4. Department of Biostatistics, Seoul National University College of Medicine, Seoul Metropolitan Government, Boramae Medical Center, Seoul, Republic of Korea

    Sohee Oh

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  1. Yuri Cho
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Correspondence to Won Kim.

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Conflict of interest

Yuri Cho, Youn I. Choi, Sohee Oh, Jimin Han, Sae Kyung Joo, Dong Hyeon Lee, Yong Jin Jung, Byeong Gwan Kim, Kook Lae Lee and Won Kim have any relevant conflict of interest or other financial disclosures.

Ethical approval

This study was conducted in accordance with the 1975 Declaration of Helsinki as revised in 2008. The study was approved by the Research Ethics Committees of Seoul Metropolitan Government Boramae Medical Center.

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Informed consent was obtained from all patients.

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Cho, Y., Choi, Y.I., Oh, S. et al. Point shear wave elastography predicts fibrosis severity and steatohepatitis in alcohol-related liver disease. Hepatol Int 14, 270–280 (2020). https://doi.org/10.1007/s12072-019-10009-w

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