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Non-invasive algorithm for advanced liver fibrosis in chronic hepatitis B

January's Alimentary Pharmacology & Therapeutics developed a non-invasive algorithm of enhanced liver fibrosis and liver stiffness measurement with transient elastography for advanced liver fibrosis in chronic hepatitis B.

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The accuracy of Enhanced Liver Fibrosis (ELF) in assessing liver fibrosis in chronic hepatitis B is to be determined.

Dr Wong and colleagues from Hong Kong derived and validated a combined ELF-liver stiffness measurement algorithm to predict advanced fibrosis in chronic hepatitis B patients.

Using the data of a previously reported cohort of 238 chronic hepatitis B patients, an ALT-based liver stiffness measurement algorithm for liver fibrosis was used as a training cohort to evaluate the performance of ELF against liver histology.

The best combined ELF-liver stiffness measurement algorithm was then validated in new cohort of 85 chronic hepatitis B patients not previously reported.

In the training cohort, liver stiffness measurement has better performance of diagnosing advanced (≥F3) fibrosis than ELF.

An ELF of 10.8 or more had a specificity of 92% to confirm advanced fibrosis
Alimentary Pharmacology & Therapeutics

The researchers found that optimal cut-off values of ELF were 8.4 to exclude advanced fibrosis, and 10.8 to confirm advanced fibrosis.

In the training cohort, an ELF of 8.4 or less had a sensitivity of 95% to exclude advanced fibrosis.

The research team found that an ELF of 10.8 or more had a specificity of 92% to confirm advanced fibrosis.

In the combined algorithm, low ELF or low liver stiffness measurement could be used to exclude advanced fibrosis as both of them had high sensitivity.

The researchers found that to confirm advanced fibrosis, agreement between high ELF and high liver stiffness measurement could improve the negative predictive value specificity.

Dr Wong's team concludes, "An Enhanced Liver Fibrosis - liver stiffness measurement algorithm could improve the accuracy of prediction of either ELF or liver stiffness measurement alone."

"Liver biopsy could be correctly avoided in approximately 60% of patients."

Aliment Pharmacol Ther 2014: 39(2): 197–208
16 January 2014

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