Document Detail


Can transient elastography replace liver histology for determination of advanced fibrosis in alcoholic patients: a real-life study.
MedLine Citation:
PMID:  20104185     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/GOALS: Consensus is lacking whether cut-off values for different fibrosis stages using transient elastography (TE, FibroScan) are universally applicable to all liver diseases. We evaluated the performance of TE in predicting severe fibrosis (> or =F3) in alcoholic patients using cut-off values validated for chronic hepatitis C.
STUDY: Patients admitted for alcohol withdrawal were prospectively evaluated by TE and biochemistry for aspartate aminotransferase to platelet ratio index (APRI) and Forns score calculations. If TE revealed severe fibrosis (> or =F3), hepatic venous pressure gradient measurements and transjugular liver biopsy were proposed results of which were correlated and compared with TE measurements or APRI and Forns scores.
RESULTS: Among 239 patients, 72 had liver TE scores > or =F3 and 23 declined liver biopsy leaving a final study population of 49 patients. Compared with biopsy, 32 patients were correctly classified by TE, whereas 16 patients differed by 2 fibrosis stages yielding a positive predictive value of 65% for liver fibrosis > or =F3 at TE. Specificity and sensitivity of TE improved beyond 75% and 70%, respectively, with modified cut-offs of 17 (F3) and 21.1 kPa (F4). Areas under the receiver operating characteristic curves were 0.766 and 0.864 for severe fibrosis (> or =F3) and cirrhosis, respectively. APRI and Forns scores performed less well than TE regarding sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic values. A significant correlation was found between hepatic venous pressure gradients and liver stiffness values at TE.
CONCLUSIONS: TE with modified cut-offs has the potential to predict advanced fibrosis and significant portal hypertension in alcoholic patients. APRI and Forns scores are of limited usefulness in alcoholics.
Authors:
Filip Janssens; Nicolas de Suray; Hubert Piessevaux; Yves Horsmans; Philippe de Timary; Peter Stärkel
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of clinical gastroenterology     Volume:  44     ISSN:  1539-2031     ISO Abbreviation:  J. Clin. Gastroenterol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-20     Completed Date:  2010-12-06     Revised Date:  2011-08-25    
Medline Journal Info:
Nlm Unique ID:  7910017     Medline TA:  J Clin Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  575-82     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology, St Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Biopsy
Elasticity Imaging Techniques / methods*
Female
Humans
Hypertension, Portal / diagnosis*,  etiology
Liver / pathology
Liver Cirrhosis, Alcoholic / diagnosis*,  pathology
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
ROC Curve
Sensitivity and Specificity
Severity of Illness Index
Venous Pressure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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