Reduction of liver stiffness following resolution of acute flares of chronic hepatitis B

Abstract

BackgroundMeasuring liver stiffness is becoming more popular as a non-invasive tool for assessing liver fibrosis.AimTo assess the effect of severe hepatitis B flare on liver stiffness and determine factors that correlate with liver stiffness measurements.MethodsTwenty-nine patients with severe hepatitis B flare (ALT > 10 × upper limit of normal) were followed up for 1 year. Serial transient elastography was performed at the time of flare, 3–6, and 12 months after flare.ResultsAt the time of flare, the median liver stiffness was 16.8 kPa, with no patients having normal liver stiffness (<6 kPa). There was a significant decrease in liver stiffness from baseline to 3–6 months (16.8 vs. 7.9 kPa, respectively, P < 0.001), and a further smaller decline from 3–6 to 12 months (7.9 vs. 6.9 kPa, respectively, P = 0.039). By 12 months, 10 (34%) had normalized their liver stiffness. Baseline parameters which correlated with liver stiffness include bilirubin, ALT, albumin, prothrombin time and platelet levels (all P < 0.05).ConclusionLiver stiffness was increased in patients with severe hepatitis B flares, with return to near normal levels by 6 months. Transient elastography for proper assessment of liver fibrosis should be performed at least 6 months after flare.

Prospective Evaluation of FibroScan for the Diagnosis of Hepatic Fibrosis Compared with Liver Biopsy/AST Platelet Ratio Index and FIB-4 in Patients with Chronic HBV Infection

“…It is well known that acute liver flares can increase the LSM which returns back to near normal by 6 months, and further decreases at 12 months. Studies have shown previously that differences in ALT can be associated with different LSM [20][21][22]. In our study, we aimed at decreasing the influence of ALT levels on FS measurements by excluding patients with ALT C 2ULN, making the results much more accurate.…”

Clinical applications of transient elastography

“…Therefore, in patients with acute flare, TE examinations should be delayed until ALT levels are stabilized. Regarding this issue, several studies have tried to investigate the optimal period (3 to 6 months) to restore of reliability of TE values in patients with acute flare 16,86,87…”

Clinical Application of Liver Stiffness Measurement Using Transient Elastography: A Surgical Perspective

“…First, the extent of histological necroinflammatory activity influences TE results, resulting in an overestimation of TE values that increases in parallel with the degree of necroinflammatory score [29,41,42,68,69,70,71,72,73,74]. Since even mild to moderate ALT elevation is associated with higher LS values, and may cause discrepancies between TE results and the actual underlying fibrosis, physicians should exercise caution in interpreting TE results.…”