Transient Elastography for Detecting Significant Liver Fibrosis in Thai Patients with Chronic Hepatitis C
Tanita Suttichaimongkol MD1, Nitiwat Chansuk MD1, Churairat Kularbkaew MD2, Prakasit Sa-ngaimwibool MD2, Wattana Sukeepaisarnjaroen MD1
Affiliation : 1 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 2 Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Objective : Transient elastography [TE] has been validated as a non-invasive test to measure liver stiffness with high accuracy
to as certain the stage of liver fibrosis. However, the liver stiffness value is confounded by food intake. Previous studies have
yielded little data regarding the cutoff point for liver stiffness as measured after fasting, and there are no studies available
regarding chronic hepatitis C [HCV] in Thai patients. The present study aimed to demonstrate the cutoff liver stiffness value
to predict significant fibrosis (METAVIR stage >F2) using TE compared with that found through liver biopsy.
Materials and Methods : We prospectively enrolled 84 chronic HCV patients, who underwent liver biopsy to assess liver
fibrosis before treatment at Srinagarind hospital from March 2016 to February 2017. On the day of the liver biopsy, liver
stiffness was assessed using TE after fasting for at least three hours. Liver histology was evaluated using the METAVIR
scoring system. Optimal cutoff values for liver stiffness were chosen and the area under the receiver operating characteristic
curve [AUROC] was also calculated in order to identify the best cutoff values for detection of patients with METAVIR
fibrosis >F2.
Results : The AUROC was 0.79 for patients with significant fibrosis (>F2). There was a cutoff value of 8.1 to detect
significant fibrosis with a sensitivity, specificity, positive predictive value, and negative predictive value of 84.4%, 61.5%,
71.7%, and 77.4%, respectively. Age, sex, body mass index, history of alcohol consumption, and ALT did not significantly
affect the cutoff value.
Conclusion : A liver stiffness measurement >8.1 kPa was a predictor of the significant fibrosis (F2) in Thai chronic HCV
patients. This result may be useful in identifying patients for priority treatment.
Keywords : Chronic hepatitis C, Cutoff, Liver biopsy, Liver fibrosis, Transient elastography
