Diagnostic performance of transient elastography for staging of liver fibrosis of patients with drug-induced liver injury / 解放军医学杂志

ABSTRACT

Objective: To assess the diagnostic performance of transient elastography (TE) on staging of liver fibrosis of patients with biopsy-proven drug-induced liver injury (DILI). Methods: 1157 DILI patients who underwent liver biopsy in the Fifth Medical Center of Chinese PLA General Hospital from January 2012 to December 2017, were enrolled in the study, and liver stiffness measurement (LSM) by TE was performed within 3 days before liver biopsy. Clinical parameters and the pathological features were analyzed retrospectively. Non-invasive models for assessing liver fibrosis (APRI and FIB-4) were calculated based on their own formula. The correlations between these three non-invasive approaches and liver fibrosis stages by biopsy were analyzed with Spearman method, the diagnostic performances were analyzed with receiver operating characteristic (ROC). Results: Altogether, 1157 chronic biopsy-proven DILI patients were enrolled, among them, 83 cases (7.2%) had no liver fibrosis (S0), 440(38.0%) were mild fibrosis (S1), 341(29.5%) moderate fibrosis (S2), 232(20.1%) server fibrosis (S3), and 61(5.3%) cirrhosis (S4), according to pathological liver fibrosis staging. As fibrosis stage increasing, percentage of female patients, age, ALT, AST, TBIL, LSM, APRI, FIB-4, and percentage of autoimmunity increased correspondingly, nevertheless, cholinesterase and blood platelet count decreased, all the differences were statistically significant. Body mass index had no correlation with liver fibrosis stages. LSM, APRI and FIB-4 correlated with fibrosis stages positively (r=0.555, 0.400, and 0.414, P<0.001). Compared with APRI or FIB-4, the correlation of LSM with liver fibrosis was the best, and its areas under the ROC curves of S1-S4 were 0.810, 0.775, 0.798, and 0.896 with the corresponding cuf-off values of 7.2, 8.5, 12.3, and 13.7 kPa, representing the diagnostic performance of LSM was the highest. Conclusion: TE is a promising non-invasive approach for assessing liver fibrosis stage of patients with chronic DILI, which might help to establish or adjust the optimal treatment strategy, thus having a good clinical application value.