Transient elastography for noninvasive assessment of liver fibrosis  in patients with primary biliary cirrhosis

Tamara Alempijevic; Ana Copertino; Ivan Boricic; Biljana Milicic; Aleksandra Pavlovic-Markovic; Miodrag Krstic; Vera Matovic; Dusan Dj Popovic

doi:10.2298/10.2298/VSP160409337A

Tamara Alempijevic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Ana Copertino 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Ivan Boricic 1.Faculty of Medicine, University of Belgrade, Belgrade, Serbia 2.Institute for Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Biljana Milicic Institute for Medical Informatics, University of Belgrade, Faculty of Dental Medicine, Belgrade, Serbia
Aleksandra Pavlovic-Markovic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Miodrag Krstic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Vera Matovic Emergency Center, Clinical Center of Serbia, Serbia
Dusan Dj Popovic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

DOI: https://doi.org/10.2298/10.2298/VSP160409337A

Abstract

Backgrund/Aim. In recent decades noninvasive methods for the assessment and monitoring of liver fibrosis have been developed and evaluated in numerous chronic liver diseases. The aim of this study was to evaluate the diagnostic accuracy of noninvasive markers for fibrosis assessment transient elastography (TE) and biochemical markers using liver biopsy as reference in patients with primary biliary cirrhosis (PBC). Methods. One hundred and twenty-two patients underwent both liver biopsy and blood tests on the same day and TE in a month following the biopsy and the tests. Liver biopsies were reviewed by a single pathologist using the METAVIR scoring system for assessment of liver fibrosis. Aspartate aminotransferase (AST), platelet ratio index (APRI), Forns scores, AST and alanine transaminase (ALT) ratio and TE were compared with liver fibrosis stage in order to determine the best noninvasive marker of liver fibrosis. Results. There was a statistically significant difference (p < 0.05) for the APRI score, Forns index and TE according to stages of liver fibrosis. TE showed superior diagnostic performance when compared to other surrogate markers of liver fibrosis that were investigated. Optimal cut-off for TE were 4.25 and 5.9 kPa for diagnosing the presence of fibrosis and distinguishing mild/moderate and advanced stages of fibrosis respectively. The areas under the receiver operating characteristic (AUROC) of TE were 0.963 and 0.865, respectively. Conclusion. Based on our investigation the APRI score, Forns index and TE adequately predict fibrosis stage in patients with primary biliary cirrhosis, but the most sensitive and specific parameter appears to be TE. Using noninvasive markers and methods in the evaluation of patients in daily clinical practice may reduce, but not eliminate, the need for invasive diagnostic procedures.

Author Biographies

Tamara Alempijevic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Ana Copertino, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Ivan Boricic, 1.Faculty of Medicine, University of Belgrade, Belgrade, Serbia 2.Institute for Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Biljana Milicic, Institute for Medical Informatics, University of Belgrade, Faculty of Dental Medicine, Belgrade, Serbia

Aleksandra Pavlovic-Markovic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Miodrag Krstic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Vera Matovic, Emergency Center, Clinical Center of Serbia, Serbia

Dusan Dj Popovic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

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