Elastography for the diagnosis of severity of fibrosis in chronic liver disease: A meta-analysis of diagnostic accuracy

Tsochatzis, Emmanuel; Gurusamy, Kurinchi Selvan; Ntaoula, S.; Cholongitas, Evangelos; Davidson, Brian R; Burroughs, Andrew K.

doi:10.1016/j.jhep.2010.07.033

Cited by 634 publications

(501 citation statements)

References 56 publications

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“…[8][9][10] However, because HCC cannot be completely prevented by entecavir, regular HCC surveillance is still needed even if/when undetectable HBV DNA is achieved. 28,29 Our study has the strength of large sample size and long follow-up, which increased the statistical power and reliability of the results. Inclusion of a historical cohort as the control group rendered meaningful comparisons to establish the beneficial effects of entecavir therapy.…”

Section: Discussionmentioning

confidence: 95%

Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients With liver cirrhosis

et al. 2013

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Entecavir is a potent antiviral agent with high genetic barrier to resistance, hence it is currently recommended as first-line antiviral therapy for chronic hepatitis B (CHB). The aim of this study was to investigate the efficacy of entecavir on clinical outcomes and deaths. It was a retrospective-prospective cohort study based on two cohorts of patients. The entecavir cohort included consecutive CHB patients who had received entecavir 0.5 mg/day for at least 12 months. The historical control cohort included untreated patients recruited since 1997 who underwent routine clinical care. The primary outcome was the 5-year cumulative probability of hepatic events, defined as any cirrhotic complications, hepatocellular carcinoma (HCC), and/or liver-related mortality. A total of 1,446 entecavir-treated patients (72% men; age, 51 6 12 years; follow-up, 36 6 13 months) and 424 treatment-naïve patients (65% men; age, 41 6 13 years; follow-up, 114 6 31 months) were studied. Overall, there was no difference in hepatic events between the entecavir and control cohorts. Among patients with liver cirrhosis (482 entecavir-treated, 69 treatment-naïve), entecavir-treated patients had reduced risks of all clinical outcomes when compared with treatment-naïve patients with cirrhosis after adjusted for model for end-stage liver disease score: hepatic events (hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.34-0.78; P 5 0.002), HCC (HR, 0.55; 95% CI, 0.31-0.99; P 5 0.049), liver-related mortality (HR, 0.26; 95% CI, 0.13-0.55; P < 0.001), and all-cause mortality (HR, 0.34; 95% CI, 0.18-0.62; P < 0.001). Entecavir-treated patients with cirrhosis who failed to achieve undetectable hepatitis B virus DNA (105/482 [22%]) had comparable risk of hepatic events as the untreated patients. Conclusion: Entecavir therapy reduces the risks of hepatic events, HCC, liver-related and all-cause mortality of CHB patients with liver cirrhosis in 5 years, particularly among those who had maintained viral suppression. (HEPATOLOGY 2013;58:1537-1547 C hronic hepatitis B (CHB) is the leading cause of liver cirrhosis and hepatic events, including various cirrhotic complications and hepatocellular carcinoma (HCC) in Asia. 1 A high level of hepatitis B virus (HBV) DNA has been consistently shown to be an independent risk factor for the development of cirrhosis and HCC. 2,3 Antiviral therapy is effective in suppressing HBV DNA and reducing the risk of hepatic events and HCC. 4,5 Lamivudine, the first generation oral nucleoside analogue was shown to reduce the incidence of hepatic events in patients with advanced fibrosis or compensated cirrhosis by 50%. 6 However, the clinical benefit may be negated by lamivudine resistance and virologic relapse after cessation of treatment. 6,7 Therefore, lamivudine is no longer the firstline antiviral therapy for CHB. Instead, nucleos(t)ide analogues with high genetic barrier to resistancenamely, entecavir and tenofovir disoproxil fumarateare recommended by international guidelines. [8][9][10] Entecavir is a more potent ...

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Section: Discussionmentioning

confidence: 95%

Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients With liver cirrhosis

et al. 2013

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“…161 Comparative trials: Same or better than APRI for cirrhosis [191][192][193] Same or worse than FibroTest by stages 191,194 FibroTest and FibroScan match liver biopsy 191 Confirmed effective by four meta-analyses 179,[195][196][197] Predictive of 5-year survival in chronic HCV 162 Many non-fibrotic factors affect liver stiffness [201][202][203][204] Tested in chronic HCV 189,191,194 , HBV 198,199 Real-time elastography Measures echo displacement before and after liver compression and reconstructs strain field as reflective of tissue elasticity Spleen stiffness correlates with varices 217,218 Many non-fibrotic factors affect liver stiffness 221,225 Tested in diverse chronic liver diseases 209 APRI, aspartate aminotransferase/platelet ratio index; ARFI, acoustic radiation force impulse imaging; AST, serum aspartate aminotransferase level; HBV, hepatitis B virus; HCV, hepatitis C virus.…”

Section: Transient Elastographymentioning

confidence: 99%

Section: Transient Elastographymentioning

confidence: 99%

“…178,[194][195][196] Pooled estimates for sensitivity have been 83-87% for cirrhosis, and the specificity has been 89-95%. [194][195][196] Pooled estimates for sensitivity have been 70-79% for hepatic fibrosis stages ≥2, and the specificity has been 79-84%. [194][195][196] The heterogeneity of the pooled results in the patient groups have been ascribed to cutoff values that have not been validated or standardised in independent cohorts and that have had wide ranges or overlaps within and between stages.…”

Section: Transient Elastographymentioning

confidence: 99%

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Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

Czaja

2014

Aliment Pharmacol Ther

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SummaryBackgroundImmunosuppressive treatment of autoimmune hepatitis can prevent or reverse hepatic fibrosis, but these anti‐fibrotic effects are inconsistent secondary gains.AimTo describe the anti‐fibrotic effects of current therapies for autoimmune hepatitis, discuss the pathogenic mechanisms of hepatic fibrosis that might be targeted by anti‐fibrotic interventions, indicate the non‐invasive diagnostic tests of hepatic fibrosis that must be validated in autoimmune hepatitis and to suggest promising treatment opportunities.MethodsStudies cited in PubMed from 1972 to 2013 for autoimmune hepatitis, hepatic fibrosis, cirrhosis, anti‐fibrotic therapy and non‐invasive tests of hepatic fibrosis were selected.ResultsHepatic fibrosis improves in 53–57% of corticosteroid‐treated patients with autoimmune hepatitis; progressive fibrosis slows or is prevented in 79%; and cirrhosis may be reversed. Progressive hepatic fibrosis is associated with liver inflammation, and the inability to fully suppress inflammatory activity within 12 months is associated with progression to cirrhosis (54%) and death or need for liver transplantation (15%). Liver tissue examination remains the gold standard for assessing hepatic fibrosis, but laboratory and radiological tests may be useful non‐invasive methods to measure the fibrotic response. Severe liver inflammation can confound radiological assessments, and the preferred non‐invasive test in autoimmune hepatitis is uncertain. Individualised treatment adjustments and adjunctive anti‐fibrotic therapies are poised for study in this disease.ConclusionsThe prevention and reversal of hepatic fibrosis are achievable objectives in autoimmune hepatitis. Strategies that evaluate individualised therapies adjusted to the rapidity and completeness of the inflammatory response, and the use of adjunctive anti‐fibrotic interventions, must be evaluated.

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“…Sequential testing of serum aminotransferase concentrations and regular office visits to assess for evidence of disease progression or complications is suggested. In adults with chronic hepatitis C infection, recent advancements have enabled the validation of both circulating biomarker tests and vibration‐controlled transient elastography in determining the stage of fibrosis,3, 124, 125, 126, 127, 128 progression and regression of fibrosis,129, 130, 131 as well as their use in determining liver‐related complications and overall survival 132, 133. Validation of these technologies in children and adolescents is emerging; however, the low incidence of progressive hepatitis C infection in the pediatric population will require large cohorts with extended follow‐up to determine their efficacy.…”

Section: Managementmentioning

confidence: 99%

Hepatitis C virus infection in children and adolescents

Squires

Balistreri

2017

Hepatology Communications

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Elastography for the diagnosis of severity of fibrosis in chronic liver disease: A meta-analysis of diagnostic accuracy

Cited by 634 publications

References 56 publications

Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients With liver cirrhosis

Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients With liver cirrhosis

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

Hepatitis C virus infection in children and adolescents

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