Etiology-related determinants of liver stiffness values in chronic viral hepatitis B or C

Articles in Press

Mirella Fraquelli 1, Cristina Rigamonti 2, Giovanni Casazza 3, Maria Francesca Donato 2, Guido Ronchi 2, Dario Conte 1, Mariagrazia Rumi 2, Pietro Lampertico 2, Massimo Colombo 2

Received 22 January 2010; received in revised form 23 July 2010; accepted 23 July 2010. published online 26 November 2010.
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Abstract

Background & Aims
Transient elastography (TE) has gained popularity for the non-invasive assessment of severity of chronic viral hepatitis, but a comprehensive evaluation of the factors that might account for discrepancy in diagnostic accuracy between TE and the standard of care liver biopsy (LB) is still needed.

Methods
Patients with chronic hepatitis-B (HBV, n=104) or -C (HCV, n=453) underwent percutaneous LB concomitantly with TE (FibroScan®; Echosens, Paris, France). Liver cell necroinflammatory activity (A) and fibrosis (F) were assessed by METAVIR. Perisinusoidal fibrosis was rated with a 0–3 score. Determinants of TE results were investigated by a linear regression model whereas discordance between TE and LB results was assessed by logistic regression.

Results
Fibrosis (p<0.0001) and liver cell necroinflammatory activity (p<0.0001) were independently associated with TE results in both HBV and HCV patients, whereas steatosis (p<0.0001) was independently associated with TE in HCV only. Fibrosis overestimation was predicted by severe/moderate necroinflammatory activity in HBV and by older age (41–60 or>60years vs.<40), >2 UNL AST and>2 UNL GGT, as well as severe/moderate necroinflammatory activity and severe/moderate steatosis in HCV. In the latter patients, however, moderate/severe necroinflammatory activity and steatosis were the only independent predictors of fibrosis overestimation.

Conclusions
Fibrosis and necroinflammatory activity are the main determinants of TE in chronic viral hepatitis. Since TE staging of Fibrosis is influenced by necroinflammatory activity and steatosis, a diagnostic LB is deemed necessary for a reliable intra-patient TE monitoring of the course of viral hepatitis.

Abbreviations: TE, transient elastography, LB, liver biopsy, CLD, chronic liver disease, A, necroinflammatory activity, F, fibrosis stage, BMI, body mass index, HBV, hepatitis B virus, HCV, hepatitis C virus, ALT, alanine aminotransferase, AST, aspartate aminostransferase, GGT, gamma-glutamyltranspeptidase, HBsAg, hepatitis B surface antigen, US, ultrasound, kPa, kilopascal, IQR, interquartile range, UNL, upper normal limit, OR, odds ratio, 95% CI, 95% confidence interval

Keywords: Transient elastography, Liver biopsy, Liver fibrosis, Hepatitis B, Hepatitis C

1 Second Division of Gastroenterology, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milano, Italy
2 First Division of Gastroenterology, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milano, Italy
3 Department of Statistic and Biometry, University of Milan, Milano, Italy

Corresponding author. Address: Second Division of Gastroenterology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy. Tel.: +39 02 55033445; fax: +39 02 55033644.

PII: S0168-8278(10)00805-6
doi:10.1016/j.jhep.2010.07.017
© 2010 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.

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