Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement

Autor:	V. de Ledinghen, R. Myers, Thomas Karlas, David Petroff, H. W. Lee, Keiichi Masaki, Michel Beaugrand, Jean-Baptiste Hiriart, Maneesh Kumar, P. Bedossa, Y. Q. Mi, Sanjiv Mahadeva, Giovanna Ferraioli, Jian-Gao Fan, Wah-Kheong Chan, Magali Sasso, Volker Keim, Pam Crotty, Monica Lupsor-Platon, Carlo Filice, Radu Badea, Shiv Kumar Sarin, Patrick Marcellin, Johannes Wiegand, Kazuaki Chayama, Grace Lai-Hung Wong, Feng Shen, Mireen Friedrich-Rust, A.C. Cardoso, Kwang Hyub Han, Vincent Wai-Sun Wong, Jörg Bojunga
Rok vydání:	2018
Předmět:	0301 basic medicine medicine.medical_specialty Cirrhosis Hepatology medicine.diagnostic_test business.industry Fatty liver Gastroenterology medicine.disease 03 medical and health sciences 030104 developmental biology 0302 clinical medicine Fibrosis Positive predicative value Meta-analysis Internal medicine medicine 030211 gastroenterology & hepatology Pharmacology (medical) Elastography Steatosis Transient elastography business
Zdroj:	Alimentary Pharmacology & Therapeutics. 47:989-1000
ISSN:	0269-2813
DOI:	10.1111/apt.14529
Popis:	Background Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis. Aim To determine how to use CAP in interpreting liver stiffness measurements. Methods This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP. Results Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis. Conclusions Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.
Databáze:	OpenAIRE
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