Date Published: March 11, 2019
Publisher: Public Library of Science
Author(s): Dong Won Park, Yoon Jin Lee, Won Chang, Ji Hoon Park, Kyoung Ho Lee, Young Hoon Kim, Nam Kyu Kang, Jung Wha Chung, Hee Yoon Jang, Soomin Ahn, Haeryoung Kim, Sook-Hyang Jeong, Jin-Wook Kim, Eun Sun Jang, Silvia C. Sookoian.
Elastography point quantification is a convenient method for measuring liver stiffness. It can be performed simultaneously with conventional ultrasonography. This study aimed to evaluate its diagnostic performance for assessing hepatic fibrosis in patients with autoimmune liver disease (AILD), including autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC).
The diagnostic performance of elastography point quantification (ElastPQ) was evaluated and compared with that of serum fibrosis markers, including the aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4), using the receiver operating characteristics analysis with histologic evaluation as the reference standard.
In 49 AIH patients, sensitivity and specificity of ElastPQ were 93.6% and 44.4%, respectively, for significant fibrosis (≥ F2, cutoff 4.47 kPa), and 63.6% and 86.8% for cirrhosis (F4, cutoff 9.28 kPa). In 41 PBC patients, they were 81.8% and 73.3%, respectively, for significant fibrosis (≥ F2, cutoff 5.56 kPa), and 100% and 81.6%, respectively, for advanced fibrosis (≥ F3, cutoff 6.04 kPa). The areas under the receiver operating characteristic curves of ElastPQ for significant fibrosis (0.77, 95% CI 0.67–0.86) and cirrhosis (0.81, 95% CI 0.65–0.96) were higher than those of APRI and FIB-4 in AILD patients. According to the multivariable analysis, histological activity, steatosis, and body max index (BMI) were not significant factors that influenced the result of ElastPQ.
ElastPQ exhibited better diagnostic performance–without the influence of confounding factors–for assessing hepatic fibrosis in AILD patients than serum fibrosis markers.
Hepatic fibrosis staging has been used as a prognostic factor by clinicians to measure clinical outcomes and as an index to establish therapeutic plans in patients with chronic liver disease (CLD) [1, 2]. Thus far, invasive liver biopsy is considered as the “gold standard” for assessing hepatic fibrosis stages and necroinflammatory activity .
In the present study, the diagnostic performance of ElastPQ for assessing hepatic fibrosis was retrospectively analyzed in 90 patients with AILD, including 49 patients with AIH and 41 patients with PBC. The results of our study demonstrated a significant positive correlation between the median ElastPQ values and the stages of hepatic fibrosis in patients with AILD. The diagnostic performance of ElastPQ for assessing liver cirrhosis (F4) was significantly better than that of serum biochemical markers (APRI and FIB-4). After adjusting for the fibrosis grade in AILD patients, histological activity, steatosis, and BMI were not significant contributing factors for ElastPQ.