Effect of liver inflammation on accuracy of FibroScan device in assessing liver fibrosis stage in patients with chronic hepatitis B virus infection

Huang, Lingling; Yu, Xueping; Li, Julan; Lin, Huiming; Kang, Na-Ling; Jiang, Jiaji; Zhu, Yueyong; Liu, Yurui; Zeng, Da‐Wu

doi:10.3748/wjg.v27.i7.641

Cited by 23 publications

(13 citation statements)

References 21 publications

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“…Relevant studies had shown that LSM could diagnose different stages of liver fibrosis in patients with CHB after 78 weeks of antiviral treatment, and the decrease of LSM absolute value could reflect the remission of liver inflammation [ 33 ]. The latest study found that Liver inflammation activity over 2 (OR = 3.53) was an independent risk factor for misdiagnosis of fibrosis stage using FibroScan, patients with liver inflammation activity ≥ 2 showed higher LSM values using FibroScan and higher rates of misdiagnosis of fibrosis stage, whereas the diagnostic performance of FibroScan for different fibrosis stages was significantly lower than that in patients with inflammation activity < 2 (all P < 0.05) [ 34 ]. It is expert opinion that each patient becomes his or her own control, using the stiffness delta changes over time to evaluate the efficacy of the treatment or the progression of disease—remembering that the measurement reflects stiffness and not fibrosis [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic efficacy of FibroScan for liver inflammation in patients with chronic hepatitis B: a single-center study with 1185 liver biopsies as controls

Jiang

Zhang

et al. 2022

BMC Gastroenterol

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Background Noninvasive diagnostic technologies that can dynamically monitor changes in liver inflammation are highly important for the management of chronic hepatitis B (CHB) patients and thus warrant further exploration. This study assessed the diagnostic efficacy of FibroScan for liver inflammation in CHB patients. Methods A total of 1185 patients were selected, and ultrasound-guided liver biopsy was performed within 1 month after the FibroScan test. The liver stiffness measurement (LSM), the reliability criteria (IQR/M) of LSM, the quality of liver biopsy (complete portal area, PA), and the liver inflammation grades were the main observation items of this study. With liver biopsy as the control, the diagnostic efficacy of FibroScan for liver inflammation in CHB patients was evaluated by receiver operating characteristic (ROC) curve analysis. Results The grade of liver inflammation was positively correlated with the stage of fibrosis (rho = 0.829, P < 0.001). Different grades of inflammation will have significant rise in LSM values within the same fibrosis stage, and LSM values were positively correlated with liver inflammation grade and fibrosis stage, and the rho is 0.579 and 0.593 respectively (P < 0.001). Significant differences in the LSM of FibroScan were observed among different grades of liver inflammation (P < 0.0001). Liver biopsy (PA > 10) served as the control, and the cutoff point and the area under ROC curves (AUCs) of the LSMs for different inflammation grades were as follows: G2, 8.6 kPa, 0.775; G3 9.8 kPa, 0.818; and G4, 11.0 kPa; 0.832. With LSM cutoff values of 8.6 kPa, 9.8 kPa and 11.0 kPa, FibroScan showed certain diagnostic value for CHB patients with G2, G3 and G4 liver inflammation, especially those with G4 inflammation. Conclusions The grade of liver inflammation was positively correlated with the stage of fibrosis, different grades of inflammation will have significant rise in LSM values within the same fibrosis stage. In addition to liver fibrosis, FibroScan could evaluate liver inflammation in CHB patients in a noninvasive manner.

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Section: Discussionmentioning

confidence: 99%

Diagnostic efficacy of FibroScan for liver inflammation in patients with chronic hepatitis B: a single-center study with 1185 liver biopsies as controls

Jiang

Zhang

et al. 2022

BMC Gastroenterol

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“…The absence of diagnostic DILI biomarkers has led to that serum AST/ALT, ALP, and TBL levels still remain the pillars for DILI case detection and qualification ( Andrade and Robles-Díaz, 2020 ). FibroScan is recommended as a non-invasive tool to assess fibrosis according to the European Association for the Study of the Liver guidelines and World Health Organization guidelines ( Huang et al, 2021b ). However, the accuracy of FibroScan in chronic DILI patients has been discussed rarely.…”

Section: Discussionmentioning

confidence: 99%

“…A pilot study clearly indicates that transient elastography cannot correctly classify all patients with persistent cirrhosis following 4 years of a patient with a sustained virological response (SVR) ( D'Ambrosio et al, 2013 ). All of the presence of inflammation and obesity or ascites can compromise the diagnostic accuracy of FibroScan ( Myers et al, 2012 ; Lupsor-Platon and Badea, 2015 ; Huang et al, 2021b ). Of course, there are several limitations in our study.…”

Section: Discussionmentioning

confidence: 99%

Metabolomic Profiling for Histologically Fibrotic Stage in Chronic Drug-Induced Liver Injury

Zhou

Cheng

et al. 2022

Front. Pharmacol.

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Background and aims: Chronic drug-induced liver injury (DILI) is a rare but under-researched adverse drug reaction–related disease, which is highly likely to progress into liver fibrosis and even cirrhosis. In this study, metabolomics was used to screen out characteristic metabolites related to the histological progression of fibrosis in chronic DILI and analyze the metabolic changes during the development of fibrosis to explain the underlying mechanism.Methods: Chronic DILI patients who underwent liver biopsy were divided into different fibrosis grades. Serum was analyzed by untargeted metabolomics to find serological characteristic metabolite fingerprints. The screened fingerprints were validated by the validation group patients, and the identification ability of fingerprints was compared using FibroScan.Results: A total of 31 metabolites associated with fibrosis and 11 metabolites associated with advanced fibrosis were identified. The validation group confirmed the accuracy of the two metabolite fingerprints [area under the curve (AUC) value 0.753 and 0.944]. In addition, the fingerprints showed the ability to distinguish the grades of fibrosis by comparing using FibroScan. The metabolite fingerprint pathway showed that bile acid synthesis is disturbed while lipid metabolism is extremely active, resulting in an overload of lipid metabolites in the occurrence and development of chronic DILI–associated fibrosis.Conclusions: Our metabolomic analysis reveals the unique metabolomic fingerprints associated with chronic DILI fibrosis, which have potential clinical diagnostic and prognostic significances. The metabolomic fingerprints suggest the disturbance of the lipid metabolites as the most important factor in the development of DILI fibrosis.

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“…The distribution of the E values significantly changed from NAFL to NASH s0-1, NASH s2-3, and NASH s4 ( Figure 3-b ). These results indicated that the liver stiffness (E value) would be influenced not only by liver fibrosis but also by chronic inflammation (26) , (27) .…”

Section: Discussionmentioning

confidence: 82%

Positive Pattern Recognition System Using Alanine Aminotransferase, Type IV Collagen 7s, and E Value (Liver Stiffness) for the Diagnosis of Nonalcoholic Steatohepatitis Based on Natural History

Tsujisaki

Sasaki

Akutsu

et al. 2022

JMA J

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Introduction: The use of a simple diagnostic system for nonalcoholic fatty liver disease (NAFLD) instead of a biopsy is expected. We investigated a positive pattern recognition system for the evaluation of nonalcoholic fatty liver (NAFL) and the stages of nonalcoholic steatohepatitis (NASH). Methods: A total of 68 Japanese patients with biopsy-confirmed NAFLD were enrolled. Serological biomarkers and medical imaging markers were investigated to determine candidate markers. The markers were statistically evaluated, and the patients were distributed to pattern combinations. Results: We selected three markers based on natural history and set the critical values: alanine aminotransferase/ALT (persistent ≧ 44 IU/L) as a marker for hepatitis, type IV collagen 7S (≧5.1 ng/mL) for fibrosis, and E value (≧5.5 kPa) for stiffness. After evaluation of statistical accuracies, every patient was classified into their combination patterns. Comparing the relationships between histological classifications and positive patterns, the patients with NAFL were mainly distributed in pattern (ALT, type IV collagen, E value: −, −, −), those with NASH stage 0-1 in (+, −, +), those with NASH stage 2-3 in (+, +, +), and those with NASH stage 4 in (−, +, +). Conclusions: The positive patters changed with the NAFL and NASH conditions. Our results indicated a correlation between the positive patterns using three markers and the histological results. The positive pattern recognition system based on natural history is useful for the differential diagnosis of NAFLD and for the evaluation of the severity of fibrosis in patients with NASH.

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Effect of liver inflammation on accuracy of FibroScan device in assessing liver fibrosis stage in patients with chronic hepatitis B virus infection

Cited by 23 publications

References 21 publications

Diagnostic efficacy of FibroScan for liver inflammation in patients with chronic hepatitis B: a single-center study with 1185 liver biopsies as controls

Diagnostic efficacy of FibroScan for liver inflammation in patients with chronic hepatitis B: a single-center study with 1185 liver biopsies as controls

Metabolomic Profiling for Histologically Fibrotic Stage in Chronic Drug-Induced Liver Injury

Positive Pattern Recognition System Using Alanine Aminotransferase, Type IV Collagen 7s, and E Value (Liver Stiffness) for the Diagnosis of Nonalcoholic Steatohepatitis Based on Natural History

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