Noninvasive markers of fibrosis and inflammation in clinical practice: prospective comparison with liver biopsy.

BACKGROUND The efficiency of transient elastography for the assessment of liver fibrosis has been evaluated mainly in patients with chronic hepatitis C and chronic hepatitis B, with few studies with nonviral chronic liver disease (CLD) such as autoimmune hepatitis, alcoholic liver disease and nonalcoholic steatohepatitis. In this study, we examined the value of transient elastography in a number of groups in comparison with the Fibrotest/Actitest (FT/AT), using the liver biopsy (LB) as the reference standard. METHODS An unselected and consecutive group of 65 patients had an LB either as part of an initial diagnosis or of a follow-up assessment, and in addition had a transient elastography measurement [Fibroscan (FS)] and serum blood tests FT/AT performed before the LB. The group consisted of patients diagnosed with a variety of CLD: chronic hepatitis C (n=27), chronic hepatitis B (n=8), alcoholic liver disease (n=14), autoimmune hepatitis (n=13) and nonalcoholic steatohepatitis (n=4). RESULTS FS optimal cutoff values were 9.70 kPa for F at least 2, 13.00 kPa for F at least 3, and 16.00 kPa for F=4. The areas under the receiver operating characteristic curve of FS and FT for F at least 2 were 0.88 versus 0.78 in the viral CLD group and 0.81 versus 0.70 in the nonviral CLD group and 0.87 versus 0.80 in all patients. The areas under the receiver operating characteristic curve for A at least 2 in all patients was 0.83. The optimal cutoff for A at least 2 was 0.50. CONCLUSION FT/AT is a reliable method for predicting significant liver fibrosis and necroinflammation in both viral and nonviral CLD patients with a value measurement comparable with that of the FS.