Liver stiffness and histological features in healthy persons, and patients with occult hepatitis B, chronic active hepatitis B, and hepatitis B-related cirrhosis.

Abstract

Background: Liver stiffness measurement using transient elas-tography has become a popular tool to assess liver fibrosis.Aim: To determine liver stiffness values and histological featuresin healthy subjects and patients with chronic hepatitis B.Patients and Methods: A total of 157 persons were included(28 healthy subjects, 18 occult hepatitis B infection, 102 activechronic hepatitis B, and 9 end-stage hepatitis B cirrhosis). His-tology and liver stiffness measurements were obtained from allpatients. Results: The median liver stiffness in healthy subjects,occult hepatitis B, active hepatitis B, and end-stage cirrhosiswere 4.6, 4.2, 8.7, and 33.8 kPa respectively, with signifi-cantly higher values in the latter 2 groups compared to the for-mer 2 groups (p<0.001). In healthy subjects and patients with occult hepatitis B infection, no one had significant fibrosis onhistology and all had liver stiffness <7.2 kPa. In patients withchronic active hepatitis B, 32 (31%) had liver stiffness >11.0kPa, but only 4 (12%) had cirrhosis on histology. Using liverstiffness to predict cirrhosis in this group had a sensitivity of100%, specificity of 69%, a positive predictive value of 10%,and a negative predictive value of 100%. All 9 patients withend-stage liver cirrhosis had liver stiffness >11.0 kPa. The over-all AUROC for diagnosing cirrhosis using a cut-off of 11.3 kPawas 0.89. Conclusion: Liver stiffness measurement has an over-all good diagnostic accuracy with excellent negative predictivevalue. In chronic active hepatitis B, the diagnostic accuracymay be reduced when underlying inflammatory activity issevere.