Improving transient elastography performance for detecting hepatitis B cirrhosis

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Improving transient elastography performance for detecting hepatitis B cirrhosis

Digestive and Liver Diseases, 09/29/2011

Chen YP et al. – Amongst alanine aminotransferase(ALT)–stratified cutoffs,

bilirubin normalization and transient elastography–based algorithm, bilirubin

normalization was especially important for improving performance of transient

elastography for compensated hepatitis B cirrhosis detection.

Methods

• Total of 315 compensated patients were analysed following liver biopsies,

transient elastography, ultrasonography and blood tests.

Results

• Area under the receiver operating characteristics (ROC) curve of transient

elastography for predicting cirrhosis was 0.88 (95% confidence interval

0.84-0.92).

• Cutoffs to exclude and confirm cirrhosis were 10.4kPa and 17.3kPa in

patients with ALT <5x upper limit of normal range, 13.7kPa and 25.0kPa in ALT

≥5x upper limit of normal range, respectively.

• With ALT-stratified cutoffs, 68.6% of patients did not require liver

biopsies.

• Areas under the ROC curve in patients with normal or abnormal bilirubin was

0.90(0.85–0.95) and 0.84(0.77–0.92), respectively.

• In patients with normal bilirubin, the cutoffs for excluding and confirming

cirrhosis were 10.6kPa and 16.9kPa, respectively.

• By transient elastography screening, 78.3% of patients with normal bilirubin

would not need a liver biopsy.

• Areas under the ROC curves between transient elastography and transient

elastography-based algorithm including transient

elastography–splenomegaly–platelet index [0.90(0.86–0.94)] and ultrasonic

score-transient elastography index [0.91(0.86–0.96)] were not significantly

different.

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