Transient elastography (FibroScan) in critical care: Applications and limitations

Table 1 Non-invasive tests for diagnosing and staging of liver fibrosis

Categories of test	Clinical application	Clinical tests
Blood-based tests	Serum markers of fibrosis, laboratory variables	Alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, platelets, albumin
Methods assessing physical properties of the liver tissue	Liver stiffness	Transient elastography, bidimensional shear wave elastography, magnetic resonance elastography
Imaging methods	Assessing the anatomy of the liver and other abdominal organs	Ultrasound, CT scan, magnetic resonance scans

CT: Computed tomography.

Table 2 Potential clinical applications of transient elastography

	Clinical condition	Clinical applications
Patients without chronic liver disease	Acute liver dysfunction	Diagnosis. Prognostication
	Heart failure	Response to therapy. Prognostication. Prediction of complications like cardiac cirrhosis
	Left ventricular assist device placement	Prognostication. Therapeutic intervention. Prediction of complications like right ventricular failure
	General critically ill	Prognostication marker
	Pregnancy	Prediction of complications like preeclampsia
	Acute liver failure	Differentiate between acute and chronic liver dysfunction. Prognostication. Need for transplantation
Patients with underlying chronic liver disease	Chronic liver failure	Diagnosis of decompensation. Differentiation of aetiology. Severity assessment. Prediction of complications like portal hypertension, variceal bleeding, hepatocellular carcinoma. Response to treatment. Prognostication
	Post liver transplant	Prognostication. Acute transplant rejection

Table 3 Liver stiffness measurement in heart failure

	Measurement
Indications of FibroScan in HF	(1) Assessment of adequate venous decongestion prior to discharge; (2) prognosis after an acute exacerbation; and (3) risk stratification for determining right ventricular support needs before LVAD placement
The cut-off value of LS in HF	LS < 7 kPa: Normal RV filling pressure and exclusion of RV failure
	LS 7-8 kPa: Gray zone
	LS 8-12.5 kPa: Increased risk of morbidity and mortality from HF or cardiac death; increased risk of RV failure in case of LVAD implantation
	LS > 35 kPa: BiVAD needed due to RV failure

HF: Heart failure; LS: Liver stiffness; LVAD: Left ventricular assist device; BiVAD: BiVACOR biventricular assist device; RV: Right ventricular.