FibroScan Most Reliable Test for Assessing Severe Fibrosis and Cirrhosis in Alcoholic Liver Disease

FibroScan Most Reliable Test for Assessing Severe Fibrosis and Cirrhosis in Alcoholic Liver Disease: Presented at AASLD

 By Cheryl Lathrop

BOSTON — November 14, 2012 — Ultrasound-based transient elastography provides a reliable noninvasive indicator of severe liver fibrosis and cirrhosis in alcoholic liver disease, and FibroScan appears to provide the best results of currently available tests, according to a study presented here at the 63rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

Michael Fernandez, Erasme Hospital, Brussels, Belgium, and colleagues presented the findings of this retrospective study on November 12. The aim of the study was to compare the liver stiffness found by ultrasound-based transient elastography and different biochemical markers with histological scores of liver fibrosis and then to establish the best liver-stiffness cutoff values for severe fibrosis (F≥3) and cirrhosis (F4).

A total of 139 consecutive patients (mean age, 54 years; 68% men) with compensated alcoholic liver disease (≥5 drinks/day in the preceding year) who underwent liver biopsy because of impaired liver function tests (54 percutaneous biopsy, 85 transjugular biopsy) were included in the study. Distribution of liver fibrosis in these patients was 17.3% F0, 6.5% F1, 23.0% F2, 12.2% F3, and 41.0% F4.

Patient fibrosis was staged using the Metavir classification system. Within 6 months of the biopsy, patients had tests and evaluations with standard liver imagery, FibroScan, FibroTest, FIB-4, aminotransferase/platelet ratio index, and Forns test. Patients were also tested for aspartate aminotransferase and alanine aminotransferase.

Area under the receiver operating characteristic curve (AUROC) determined the diagnostic accuracy of the administered tests for severe fibrosis and cirrhosis. The AUROCs for severe fibrosis were 0.89 for FibroScan (P < .0001), 0.81 for FibroTest, 0.70 for FIB-4, 0.67 for aminotransferase/platelet ratio index, and 0.65 for Forns test. The AUROCs for cirrhosis were 0.94 for FibroScan (P < .0001), 0.88 for FibroTest, 0.72 for FIB-4, 0.75 for aminotransferase/platelet ratio index, and 0.78 for Forns test.

For predicting F≥3, the best liver-stiffness cutoff value was 10.5 kPa (91% sensitivity, 67% specificity, 75% positive predictive value, and 87% negative predictive value). The best liver-stiffness cutoff value for predicting F4 was 15.7 kPa (90% sensitivity, 87% specificity, 82% positive predictive value, and 93% negative predictive value).

Diagnostic accuracy and cutoff values were not changed when the researchers removed aspartate aminotransferase levels >100 IU/L.

“FibroScan should be recommended in the initial assessment and follow-up of liver fibrosis and cirrhosis in [patients with] alcoholic liver disease,” the researchers concluded.

[Presentation title: Fibroscan (Transient Elastography) Is the Most Reliable Non-Invasive Method for the Assessment of Severe Fibrosis and Cirrhosis in Alcoholic Liver Disease. Abstract 1332]

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