DUAL CUT-OFF TRANSIENT ELASTOGRAPHY TO ASSESS LIVER FIBROSIS IN CHRONIC HEPATITIS B: A COHORT STUDY WITH INTERNAL VALIDATION - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Alimentary Pharmacology and Therapeutics Année : 2011

DUAL CUT-OFF TRANSIENT ELASTOGRAPHY TO ASSESS LIVER FIBROSIS IN CHRONIC HEPATITIS B: A COHORT STUDY WITH INTERNAL VALIDATION

Résumé

Background Transient elastography (TE) has gained popularity to stage liver fibrosis in chronic viral hepatitis, however diagnostic cut-offs for severe fibrosis in chronic hepatitis B are poorly defined. Aim To evaluate an algorithm with two distinct cut-offs for positive and negative prediction of significant fibrosis and cirrhosis in chronic hepatitis B patients. Methods Two cohorts of treatment-naïve patients with chronic hepatitis B (125 training and 92 validation) were consecutively and concurrently examined by percutaneous liver biopsy (LB) and TE. Fibrosis was staged by Metavir (significant fibrosis = F ≥ 2; cirrhosis = F4) in ≥ 2 cm long liver tissue cores. Results A >13.1 kPa positive and a ≤9.4 kPa negative cut-off for cirrhosis had a >90% sensitivity and specificity, with an accuracy of 94%. The corresponding cut-offs for F ≥ 2 were >9.4 and ≤6.2 kPa, thus classifying 56% of patients with an overall accuracy of 90%. In the validation cohort, F4 and F ≥ 2 were predicted by the above TE cut-offs with an overall accuracy >90%. In 165 patients with higher than upper limit of normal transaminase activity (ALT) the dual cut-off algorithm of TE was as accurate as in the 52 patients with normal ALT values in the prediction and exclusion of cirrhosis, only. Conclusions A dual cut-off algorithm allowed for correctly classifying both significant fibrosis and cirrhosis in the majority of the patients with chronic hepatitis B, independently of ALT values, thus reducing the need of LB investigations.

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hal-00646925 , version 1 (01-12-2011)

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Mauro Viganò, Silvia Paggi, Pietro Lampertico, Mirella Fraquelli, Sara Massironi, et al.. DUAL CUT-OFF TRANSIENT ELASTOGRAPHY TO ASSESS LIVER FIBROSIS IN CHRONIC HEPATITIS B: A COHORT STUDY WITH INTERNAL VALIDATION. Alimentary Pharmacology and Therapeutics, 2011, 34 (3), pp.353. ⟨10.1111/j.1365-2036.2011.04722.x⟩. ⟨hal-00646925⟩

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