Cosmin Sebastian Voican1,2,3, Alexandre Louvet4,5, Jean-Baptiste Trabut6, Micheline Njiké-Nakseu1, Sébastien Dharancy4,5, Andrea Sanchez7, Marion Corouge8, Karima Lamouri1, Amandine Lebrun1,3, Axel Balian1, Sophie Prévot3,9, Mounia Lachgar10, Sophie Maitre11, Hélène Agostini12, Philippe Mathurin4,5, Gabriel Perlemuter1,2,3, Sylvie Naveau1,2,3. 1. AP-HP, Service d'hépato-gastroentérologie et nutrition, Hôpital Antoine Béclère, Clamart, France. 2. INSERM, U996, Labex Lermit, IPSIT, Clamart, France. 3. Faculté de médecine Paris-Sud, Univ Paris-Sud, Univ Paris-Saclay, DHU Hepatinov, Kremlin-Bicêtre, France. 4. Service des Maladies de l'Appareil Digestif, Hôpital Claude Huriez, Lille, France. 5. Unité INSERM U995 Lille, Lille, France. 6. AP-HP, Groupe Hospitalier Cochin Saint-Vincent de Paul, Unité d'Hépatologie et d'Addictologie, Paris, France. 7. APHP, Groupe Hospitalier Cochin Saint-Vincent de Paul, Service d'Anatomo-pathologie, Paris, France. 8. AP-HP, Département d'Hépatologie, Groupe Hospitalier Cochin Saint-Vincent de Paul, Paris, France. 9. AP-HP, Service d'Anatomie pathologique, Hôpital Antoine Béclère, Clamart, France. 10. AP-HP, Service de Biochimie-Hormonologie, Hôpital Antoine Béclère, Clamart, France. 11. AP-HP, Service de Radiologie, Hôpital Antoine Béclère, Clamart, France. 12. AP-HP, Unité de recherche clinique Paris-Sud, Hôpital Bicêtre, Kremlin-Bicêtre, France.
Abstract
BACKGROUND & AIMS: The reliability of transient elastography (TE) to assess liver fibrosis is insufficiently validated in alcoholic liver disease (ALD). We aimed to validate the diagnostic utility of TE for liver fibrosis in patients with excessive alcohol consumption and evaluate whether Fibrotest® adds diagnostic value relative to or in combination with TE. METHODS: We conducted a multicentre prospective study on a total of 217 heavy drinkers with high serum aminotransferase levels. Patients underwent liver biopsy, TE, Fibrotest® , PGAA, APRI, FIB-4 and FORNS. The overall diagnostic performance was evaluated by the area under the receiver operating characteristic (AUROC) curves and Obuchowski measures. RESULTS: TE values correlated with fibrosis stage (r=.73; P<.0001) and steatosis stage (r=.19; P<.01). Patients with alcoholic hepatitis had higher TE values than those without alcoholic hepatitis (P<.0001). In an multivariate analysis, fibrosis stage and the presence of alcoholic hepatitis were the only parameters that correlated with liver stiffness. For the diagnosis of advanced fibrosis (F≥3), the AUROC curves were 0.90, 0.85, 0.83, 0.91 and 0.90 for TE, Fibrotest® , PGAA and associations TE-Fibrotest® , TE-PGAA respectively. For the diagnosis of cirrhosis, the AUROC curves were 0.93, 0.88, 0.89, 0.94 and 0.95 respectively. The Obuchowski measures for the diagnosis of fibrosis were 0.94, 0.92, 0.91, 0.95 and 0.94 respectively. The performance of TE was not significantly different than those of Fibrotest® , PGAA and combinations TE-Fibrotest® , TE-PGAA. CONCLUSIONS: TE has excellent diagnostic value for liver fibrosis in alcoholic liver disease. The combined use of TE-Fibrotest® or TE-PGAA does not improve the performance of TE.
BACKGROUND & AIMS: The reliability of transient elastography (TE) to assess liver fibrosis is insufficiently validated in alcoholic liver disease (ALD). We aimed to validate the diagnostic utility of TE for liver fibrosis in patients with excessive alcohol consumption and evaluate whether Fibrotest® adds diagnostic value relative to or in combination with TE. METHODS: We conducted a multicentre prospective study on a total of 217 heavy drinkers with high serum aminotransferase levels. Patients underwent liver biopsy, TE, Fibrotest® , PGAA, APRI, FIB-4 and FORNS. The overall diagnostic performance was evaluated by the area under the receiver operating characteristic (AUROC) curves and Obuchowski measures. RESULTS: TE values correlated with fibrosis stage (r=.73; P<.0001) and steatosis stage (r=.19; P<.01). Patients with alcoholic hepatitis had higher TE values than those without alcoholic hepatitis (P<.0001). In an multivariate analysis, fibrosis stage and the presence of alcoholic hepatitis were the only parameters that correlated with liver stiffness. For the diagnosis of advanced fibrosis (F≥3), the AUROC curves were 0.90, 0.85, 0.83, 0.91 and 0.90 for TE, Fibrotest® , PGAA and associations TE-Fibrotest® , TE-PGAA respectively. For the diagnosis of cirrhosis, the AUROC curves were 0.93, 0.88, 0.89, 0.94 and 0.95 respectively. The Obuchowski measures for the diagnosis of fibrosis were 0.94, 0.92, 0.91, 0.95 and 0.94 respectively. The performance of TE was not significantly different than those of Fibrotest® , PGAA and combinations TE-Fibrotest® , TE-PGAA. CONCLUSIONS: TE has excellent diagnostic value for liver fibrosis in alcoholic liver disease. The combined use of TE-Fibrotest® or TE-PGAA does not improve the performance of TE.
Authors: Matias A Avila; Jean-François Dufour; Alexander L Gerbes; Fabien Zoulim; Ramon Bataller; Patrizia Burra; Helena Cortez-Pinto; Bin Gao; Ian Gilmore; Philippe Mathurin; Christophe Moreno; Vladimir Poznyak; Bernd Schnabl; Gyongyi Szabo; Maja Thiele; Mark R Thursz Journal: Gut Date: 2019-12-26 Impact factor: 23.059