Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement.
Aliment Pharmacol Ther
; 47(7): 989-1000, 2018 Apr.
Article
in En
| MEDLINE
| ID: mdl-29446106
ABSTRACT
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.
Full text:
1
Collection:
01-internacional
Health context:
8_ODS3_consumo_sustancias_psicoactivas
Database:
MEDLINE
Main subject:
Elasticity Imaging Techniques
/
Liver
/
Liver Cirrhosis
Type of study:
Diagnostic_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limits:
Adult
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Female
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Humans
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Male
/
Middle aged
Language:
En
Journal:
Aliment Pharmacol Ther
Year:
2018
Document type:
Article