European Radiology

, Volume 28, Issue 10, pp 4465–4474 | Cite as

2D shear wave elastography combined with MELD improved prognostic accuracy in patients with acute-on-chronic hepatitis B liver failure

  • Jie-Yang Jin
  • Yu-Bao Zheng
  • Jian Zheng
  • Jing Liu
  • Yong-Jiang Mao
  • Shi-Gao Chen
  • Zhi-Liang GaoEmail author
  • Rong-Qin ZhengEmail author



To evaluate accuracy of two-dimensional shear wave elastography (2D SWE) and develop and validate a new prognostic score in predicting prognosis of acute-on-chronic liver failure (ACLF) patients.


From 1 October 2013 to 30 September 2015, we consecutively enrolled 290 patients, sequentially collected data (including 2D SWE, ultrasound parameters, laboratory data and prognostic scores) and recorded patients’ outcome (recovering/steady or worsening) during a 90-day follow-up period. We evaluated ability of 2D SWE to predict outcomes of acute-on-chronic hepatitis B liver failure (ACLF-HBV) patients. We developed a new score (MELD-SWE, combining MELD and SWE values) for predicting mortality risk of ACLF-HBV in 179 patients in a derivation group, and validated in 111 patients.


2D SWE values were higher in worsening patients than recovering/steady ones (p < 0.001). Accuracy of 2D SWE in predicting outcomes of ACLF-HBV was comparable to that of the MELD score (p = 0.441). MELD-SWE showed a significantly higher prognostic value than MELD in both derivation (AUROC, 0.80 vs. 0.76, p = 0.040) and validation (AUROC, 0.87 vs. 0.82, p = 0.018) group.


The MELD-SWE score, combining MELD and SWE values, was superior to MELD alone for outcoming prediction in patients with ACLF-HBV.

Key Points

2D SWE is a simple prognostic evaluation tool in patients with ACLF-HBV.

MELD-SWE was created in this study: 1.3×MELD + 0.3×2D SWE (kPa).

MELD-SWE score was superior to MELD alone for outcoming prediction in ACLF-HBV.

In this study, 46.8 was the optimal cut-off value of MELD-SWE score.


Acute-on-chronic liver failure Elastography Prognosis End-stage liver disease Ultrasonography 



Two-dimensional shear wave elastography


American Association for the Study of Liver Diseases


Acute-on-chronic hepatitis B liver failure


Acute-on-chronic liver failure




Alkaline phosphatase


Alanine aminotransferase


Asian Pacific Association for the Study of the Liver


Aspartate aminotransferase


Area under the receiver operating characteristic curve


Chronic Liver Failure Acute-on-Chronic Liver Failure in Cirrhosis


Total cholesterol


Confidence interval


Serum creatinine




Gamma-glutamyl transpeptidase


Hepatitis B e antigen


Hepatitis B surface antigen


Hepatitis B virus deoxyribonucleic acid


Hepatitis B virus




Intraclass correlation coefficient


International normalized ratio


Interquartile range


King’s College Hospital


Wei-Min Ke




Liver stiffness measurement


Liver transplantation


Model for End-stage Liver Disease


Model for End-stage Liver Disease score combined with Sodium


Serum sodium


Platelet count


Point shear wave elastography


Prothrombin time


Prothrombin activity


Region of interest


Standard deviation


Total bilirubin


Transient elastography


United Network for Organ Sharing




White blood cell


World Health Organization



This study has received funding by the Science and technology project of Guangdong Province (No. 2014A020212059), the Natural Science Fund of Guangdong province (No. 2015A030313172 and 2016A030313237), the Guangzhou city science and technology project (No. 201607010064).

Compliance with ethical standards


The scientific guarantor of this publication is Rongqin Zheng.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2018_5336_MOESM1_ESM.docx (34 kb)
ESM 1 (DOCX 33 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Jie-Yang Jin
    • 1
    • 2
  • Yu-Bao Zheng
    • 2
    • 3
  • Jian Zheng
    • 1
    • 2
  • Jing Liu
    • 2
    • 3
  • Yong-Jiang Mao
    • 1
    • 2
  • Shi-Gao Chen
    • 4
  • Zhi-Liang Gao
    • 2
    • 3
    Email author
  • Rong-Qin Zheng
    • 1
    • 2
    Email author
  1. 1.Department of Medical Ultrasonicsthe Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina
  2. 2.GuangDong Key Laboratory of Liver Disease Researchthe Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina
  3. 3.Department of Infectious Diseasesthe Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina
  4. 4.Department of Physiology and Biomedical EngineeringMayo Clinic College of MedicineRochesterUSA

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