Non-invasive assessment of liver fibrosis by measuring the liver stiffness and biochemical markers in chronic hepatitis B patients

Background: Transient elastography (FibroScan(R)) is a rapid and non-invasive method to measure liver stiffness and this allow the assessment of liver fibrosis. The aim of this study was to assess the diagnostic accuracy of measuring the liver stiffness in addition to measuring the other biochemical markers such as the aspartate transaminase to platelet ratio index [APRI] and the AST/ALT ratio. Methods: We enrolled 228 HBsAg positive patients whose liver stiffness was measured by FibroScan(R) between March 2005 and September 2005. Liver biopsy examinations were performed in 34 patients. The fibrosis (F) was staged on a 0-4 scale according to the Ludwig classification. Results: According to the clinical diagnosis, the median values of liver stiffness were 7.0±2.7 kPa for inactive carriers (n=29), 8.3±5.3 kPa for chronic hepatitis patients (n=106), 15.9±8.3 kPa for compensated cirrhosis patients (n=63), 31.8±20.3 kPa for decompensated cirrhosis patients (n=26), and 45.1±34.5 kPa for HCC patients (n=4). The degree of liver stiffness was significantly different between the different disease groups (p<0.001). Liver stiffness was well correlated with the fibrosis stages (r=0.726; p< 0.001). The AUROC of FibroScan(R), the APRI and the AST/ALT ratio values were of the same order; 0.72, 0.61 and 0.58, respectively, for F≥2; 0.92, 0.73, and 0.56, respectively, for F≥3; and 0.97, 0.79, and 0.55, respectively, for F=4. FibroScan(R) offered the best diagnostic performance both for significant fibrosis (F≥2) and severe fibrosis-cirrhosis (F3-F4). Conclusions: FibroScan(R) is a reliable, rapid non-invasive method to diagnose the severity of chronic liver disease and to predict fibrosis in patients with chronic hepatitis B, in addition to using the APRI and AST/ALT ratio.ope