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Liver stiffness measurement among patients with chronic hepatitis B and C: results from a 5-year prospective study.

Christiansen KM, Mössner BK, Hansen JF, Jarnbjer EF, Pedersen C, Christensen PB - PLoS ONE (2014)

Bottom Line: Overall, patients with LSM values <17 kPa were not associated with adverse outcomes.In contrast, LSM values ≥ 17 kPa were associated with significant risk of liver-related problems.The results of the current study suggest that clinical decisions should not be taken based on a single LSM measurement.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.

ABSTRACT
Liver stiffness measurement (LSM) is widely used to evaluate liver fibrosis, but longitudinal studies are rare. The current study was aimed to monitor LSM during follow-up, and to evaluate the association of LSM data with mortality and liver-related outcomes. We included all patients with chronic viral hepatitis and valid LSM using Fibroscan. Information about liver biopsy, antiviral treatment, and clinical outcome was obtained from medical records and national registers. The study included 845 patients: 597 (71%) with hepatitis C virus (HCV), 235 (28%) with hepatitis B virus (HBV) and 13 (2%) with dual infection. The initial LSM distribution (<7/7-9.9/10-16.9/≥ 17 kPa) was 58%/16%/14%/12%. Among patients with initial LSM values of 7-9.9 kPa, 60% of HCV patients and 83% of HBV patients showed LSM values of <7 kPa at the latest follow-up. Progression rates (defined as >20% and >2 kPa increase, with one measure >7 kPa) were 3.4/100 person years (PY) for HCV and 1.5/100 PY for HBV infected patients. Patients with LSM values of ≥ 17 kPa had the same liver-related complication incidence as patients with biopsy-proven cirrhosis (11.1 versus 12.1/100 PY). Thirteen liver-related deaths occurred among HCV patients (0.6/100 PY), but none among HBV patients. Among patients who died of liver-related causes, all but one had baseline LSM values of ≥ 17 kPa. Overall, patients with LSM values <17 kPa were not associated with adverse outcomes. In contrast, LSM values ≥ 17 kPa were associated with significant risk of liver-related problems. The results of the current study suggest that clinical decisions should not be taken based on a single LSM measurement.

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Flow chart of patients showing follow-up liver stiffness measurements.
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pone-0111912-g001: Flow chart of patients showing follow-up liver stiffness measurements.

Mentions: The study included a total of 845 patients with chronic viral hepatitis and a valid LSM examination. Of these patients, 71% (597) had hepatitis C, 28% (235) hepatitis B, and 2% (13) had both infections (Figure 1). Hepatitis B and C patients significantly differed in many aspects, with hepatitis C patients more commonly showing fibrosis-associated factors, such as older age, male gender, alcohol consumption, etc. Median LSM was 1.8 kPa higher in hepatitis C patients than hepatitis B patients (p<0.001; Table 1). Several liver test results were also significantly higher among hepatitis C patients (Table 2).


Liver stiffness measurement among patients with chronic hepatitis B and C: results from a 5-year prospective study.

Christiansen KM, Mössner BK, Hansen JF, Jarnbjer EF, Pedersen C, Christensen PB - PLoS ONE (2014)

Flow chart of patients showing follow-up liver stiffness measurements.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219798&req=5

pone-0111912-g001: Flow chart of patients showing follow-up liver stiffness measurements.
Mentions: The study included a total of 845 patients with chronic viral hepatitis and a valid LSM examination. Of these patients, 71% (597) had hepatitis C, 28% (235) hepatitis B, and 2% (13) had both infections (Figure 1). Hepatitis B and C patients significantly differed in many aspects, with hepatitis C patients more commonly showing fibrosis-associated factors, such as older age, male gender, alcohol consumption, etc. Median LSM was 1.8 kPa higher in hepatitis C patients than hepatitis B patients (p<0.001; Table 1). Several liver test results were also significantly higher among hepatitis C patients (Table 2).

Bottom Line: Overall, patients with LSM values <17 kPa were not associated with adverse outcomes.In contrast, LSM values ≥ 17 kPa were associated with significant risk of liver-related problems.The results of the current study suggest that clinical decisions should not be taken based on a single LSM measurement.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.

ABSTRACT
Liver stiffness measurement (LSM) is widely used to evaluate liver fibrosis, but longitudinal studies are rare. The current study was aimed to monitor LSM during follow-up, and to evaluate the association of LSM data with mortality and liver-related outcomes. We included all patients with chronic viral hepatitis and valid LSM using Fibroscan. Information about liver biopsy, antiviral treatment, and clinical outcome was obtained from medical records and national registers. The study included 845 patients: 597 (71%) with hepatitis C virus (HCV), 235 (28%) with hepatitis B virus (HBV) and 13 (2%) with dual infection. The initial LSM distribution (<7/7-9.9/10-16.9/≥ 17 kPa) was 58%/16%/14%/12%. Among patients with initial LSM values of 7-9.9 kPa, 60% of HCV patients and 83% of HBV patients showed LSM values of <7 kPa at the latest follow-up. Progression rates (defined as >20% and >2 kPa increase, with one measure >7 kPa) were 3.4/100 person years (PY) for HCV and 1.5/100 PY for HBV infected patients. Patients with LSM values of ≥ 17 kPa had the same liver-related complication incidence as patients with biopsy-proven cirrhosis (11.1 versus 12.1/100 PY). Thirteen liver-related deaths occurred among HCV patients (0.6/100 PY), but none among HBV patients. Among patients who died of liver-related causes, all but one had baseline LSM values of ≥ 17 kPa. Overall, patients with LSM values <17 kPa were not associated with adverse outcomes. In contrast, LSM values ≥ 17 kPa were associated with significant risk of liver-related problems. The results of the current study suggest that clinical decisions should not be taken based on a single LSM measurement.

Show MeSH
Related in: MedlinePlus