Transient elastography improves detection of liver cirrhosis compared to routine screening tests

Table 1 Baseline clinical and biochemical characteristics of all patients

	All	HCV	ASH/NASH	HBV	Cryptogenic	HDV	Other causes
	(n = 291)	(n = 92)	(n = 109)	(n = 35)	(n = 13)	(n = 10)	(n = 32)
Age, yr	54 ± 15	59 ± 13b	53 ± 15	51 ± 13b	59 ± 15	43 ± 9a	50 ± 17a
Gender,%
Female	39.9	41.3	36.7	28.6	38.5	30	59.4a
Male	60.1	58.7	63.3	71.4	61.5	70	40.6
Cirrhosis, %	62.5	76.1	56	68.6	100b	70	25.0d
BMI, kg/m²	25.5 ± 4.2	24.6 ± 3.9a	25.8 ± 4.8	27.2 ± 3.3	25.3 ± 3.0	23.2 ± 4.9	25.2 ± 3.6
Bilirubin, mg/dL	2.7± 4.8	1.5 ± 2.5b	4.3 ± 7.0	1.5 ± 1.5b	1.8 ± 1.3	2.0 ± 1.6	4.1 ± 5.8
Albumin, g/dL	3.6 ± 0.7	3.8 ± 0.6b	3.4 ± 0.7a	3.8 ± 0.7	3.4 ± 0.7	3.4 ± 0.6	3.7 ± 0.4
Immunoglobulins, g/dL	1.7 ± 0.7	1.8 ± 0.7	1.5 ± 0.7	1.7 ± 0.8	1.5 ± 0.4	2.6 ± 0.7b	1.7 ± 0.5
AST, U/L	116 ± 175	100 ± 54	113 ± 187	76 ± 51	70 ± 55	155 ± 94	243 ± 400
ALT, U/L	106 ± 176	102 ± 71	73 ± 100b	72 ± 52	43 ± 20	131 ± 62	300 ± 462a
AFP, μg/L¹	6.2	9.7	5.8	3.4	5.9	7.2	2.9
Platelets, a1000/μL	170 ± 83	152 ± 82	181 ± 79	165 ± 78	168 ± 77	127 ± 74	208 ± 96
Prothrombin time, %	83 ± 18	88 ± 16b	78 ± 21b	85 ± 13	81 ± 23	73 ± 14	86 ± 15

¹Median value.

^aP≤ 0.05;

^bP≤ 0.01 vs all other patients. HCV: Hepatitis C virus; HBV: Hepatitis B virus; HDV: Hepatitis D virus; ASH: Alcoholic steatohepatitis; NASH: Non-alcoholic steatohepatitis.

Table 2 Sensitivity, specificity, positive and negative predictive value of the different non-invasive examinations for detection of liver cirrhosis

	All					Viral hepatitis1
	Sensitivity	Specificity	PPV	NPV	P value3	Sensitivity	Specificity	PPV	NPV	P value3
Liver stiffness ≥ 13 kPa	90.4	51.4	75.2	76.7		91.3	44.4	82.5	64.0
Ultrasound2	80.1	82.4	88.7	70.6	0.02	96.6	61.2	81.4	90.9	0.04
Platelets < 150.000/μL	58.0	80.2	83.3	52.8	0.03	63.1	72.2	86.7	40.6	0.05
Cutaneous liver signs2	45.1	72.1	70.4	47.2	0.0001	42.7	64.7	77.4	28.6	0.01
APRI-Score ≥ 2	NA	NA	NA	NA	NA	56.1	63.3	87.7	24.1

¹n = 139; only patients with chronic hepatitis B, C and D were included;

²According to the definitions in the patients and methods section; available for 257 patients;

³For comparison of sensitivities with liver stiffness as reference. NA: Not applicable; PPV: Positive predictive value; NPV: Negative predictive value.

Table 3 Sensitivities for detection of liver cirrhosis by different combinations of non-invasive examinations

	All patients (n = 182)
	Sensitivity	Specificity	PPV	NPV	P value1
Liver stiffness ≥ 13 kPa and/or ultrasound cirrhosis	96.1%	50.5%	76.5%	88.5%
Liver stiffness ≥ 13 kPa and/or platelets < 150.000/μL	93.9%	49.1%	75.4%	82.8%	< 0.0001
Ultrasound and/or platelets < 150.000/μL	88.2%	68.0%	82.6%	76.9%	< 0.0001
Ultrasound and/or cutaneous liver signs	87.6%	62.0%	79.7%	74.7%	< 0.0001
Platelets < 150000/μL and/or cutaneous liver signs	79.4%	63.7%	78.5%	65%	< 0.004

¹Sensitivity compared to the combination of liver stiffness and/or ultrasound. NS: Not significant; PPV: Positive predictive value; NPV: Negative predictive value.

Table 4 Comparison of transient elastography with clinical and biochemical parameters

	≥ 13 kPa(n = 161)	≥ 27.5 kPa1(n = 94)	≥ 54 kPa1(n = 48)	≥ 27.5kPa vs< 27.5 kPaP value	≥ 54 kPa vs< 54 kPaP value	≥ 54 kPa vs27.5-54 kPaP value
Age, yr	60 ± 14	56 ± 13	55 ± 13	NS	NS	NS
BMI, kg/m²	26.2 ± 3.7	25.5 ± 4.0	24.8 ± 3.7	NS	0.05	NS
Bilirubin, mg/dL	1.1 ± 1.0	3.2 ± 5.6	4.4 ± 6.9	0.0001	0.007	0.04
Albumin, g/dL	3.9 ± 0.4	3.4 ± 0.7	3.2 ± 0.7	0.0001	0.0001	0.02
Immunoglobulins, g/dL	1.6 ± 0.7	2.0 ± 0.7	2.1 ± 0.8	0.02	0.007	0.03
AST, U/L	79 ± 49	102 ± 71	115 ± 83	0.02	0.015	0.07
ALT, U/L	79 ± 56	71 ± 51	69 ± 54	NS	NS	NS
AFP, μg/L2	7.6	7.7	7.8	NS	NS	NS
Platelets, 1000/μL	145 ± 68	144 ± 82	151 ± 77	NS	NS	NS
Prothrombin time, %	88 ± 13	76 ± 19	70 ± 18	0.0001	0.0001	0.02
APRI-Score3	2.4 ± 1.8	3.6 ± 3.1	4.3 ± 3.6	0.03	NS	NS
Platelets < 150.000/μL, %	59.7	60.6	56.3	NS	NS	NS
Ultrasound cirrhosis, %	73.1	88.9	93.6	0.02	0.01	NS
Splenomegaly, %	57.8	71.4	72.3	0.09	NS	NS
Ascites, %	16.4	35.5	52.1	0.01	0.0001	0.01
Cutaneous liver signs, %	43.3	55.3	63.2	NS	0.09	NS

¹Cut-off values in accordance to Foucher et al[30];

²AFP is given as median value;

³APRI-Score was only applied to patients with chronic viral hepatitis. NS: Not significant.

Table 5 Usefulness of transient elastography in cirrhotic patients with Child-Pugh A or normal platelet count

	Child-Pugh A1					Normal platelet count2
	Sensitivity	Specificity	PPV	NPV	P value3	Sensitivity	Specificity	PPV	NPV	P value3
Liver stiffness ≥ 13 kPa	91.5%	48.8%	59.5	87.5		85.3%	62.4%	66.7	82.8
Ultrasound	75.2%	75.2%	72.5	77.8	0.02	71.2%	86.4%	82.5	76.9	0.04
Platelets < 150.000/μL	55.1%	78.6%	68.6	67.3	NS	NA	NA	NA	NA
Cutaneous liver signs	42.0%	74.8%	59.2	59.7	0.01	46.2%	81.3%	66.7	65.0	0.001

¹n = 107;

²n = 161; Normal platelet count was 150.000-400.000/μL;

³Values are given for the comparison of sensitivities with transient elastography. NA: Not applicable; NS: Not significant; PPV: Positive predictive value; NPV: Negative predictive value.