- Email: [email protected]
388 SPLEEN STIFFNESS CORRELATES WITH PORTAL HYPERTENSION AND INCREASES THE ACCURACY OF DETECTION OF ESOPHAGEAL VARICES IN HCV CIRRHOSIS
POSTERS The CAP could effectively separate S0 from S1S2S3; S0S1 from S2S3; S0 from S2 and S3; S1 from S3 patients. Conclusion: The CAP can be used to quantify steatosis in ALD and NAFLD patients. Performance is particularly satisfactory for the differentiation of S0 or S1 patients versus S2 or S3. Table AUROC (95% CI)
S0 vs S1S2S3 (≥11%)
S0S1 vs S2S3 (≥33%)
S0S1S2 vs S3 (≥67%)
CAP apparent performance CAP Jack-Knife cross-validation performance
0.85 (0.77–0.93)
0.87 (0.79–0.94)
0.77 (0.60–0.93)
0.85 (0.76–0.94)
0.87 (0.79–0.94)
0.77 (0.65–0.89)
386 TRANSIENT ELASTOGRAPHY AND DEVELOPMENT OF A NON-INVASIVE MULTIPARAMETER SCORE FOR ASSESSMENT OF ALLOGRAFT FIBROSIS IN LIVER TRANSPLANT PATIENTS S. Beckebaum1,2 , S. Iacob1 , C.G. Klein1,2 , A. Dechene2 , J. Varghese1 , H.A. Baba3 , G. Sotiropoulos1 , A. Paul1 , G. Gerken2 , V.R. Cicinnati1,2 . 1 Department of General, Visceral and Transplantation Surgery, 2 Department of Gastroenterology and Hepatology, 3 Institute of Pathology and Neuropathology, University Hospital Essen, Essen, Germany E-mail: [email protected] Background: To date, there is no non-invasive score available for transplant recipients which can be used irrespective of the indication for liver transplantation (LT). There is also little information about the diagnostic accuracy of transient elastography (TE) in non-HCV LT patients. Methods and Results: In this prospective study, the optimal TE cut-off values for HCV patients and non-HCV LT patients were 4.7 and 5.0 kPa for F ≥ 1, 7.1 and 7.3 kPa for F ≥ 2, 10.9 kPa and 9.9 kPa for F ≥ 3, and 17.3 and 12.6 kPa for F = 4, respectively. The corresponding area under the receiver operating characteristic (AUROC) curves for F ≥ 1, F ≥ 2, F ≥ 3, and F = 4 were 0.95 and 0.86, 0.89 and 0.85, 0.97 and 0.88, and 0.99 and 0.97 for HCV and non-HCV patients, respectively. Based on the logistic regression equation, a predictive model (FibroTransplant score) was created that allows the calculation of a risk score for advanced fibrosis (F ≥ 3) after LT. This model comprises HCV infection as a categorical parameter, time since LT, total protein, INR, glucose, alkaline phosphatase and alpha2macroglobulin as numeric values. The optimal cut-off value for diagnosis of F ≥ 3 for the entire training group was 0.55 with a specificity, sensitivity, positive predictive value (PPV), and negative
predictive value (NPV) of 90.2%, 61.8%, 77.2% and 81.4%, respectively. The accuracy of this model was tested in a validation group (n = 74). The model provided a high AUROC curve (0.92 [CI95% 0.83–0.97]) for the whole validation group indicating a good prediction of advanced graft fibrosis. Conclusions: Our results indicate that TE and the FibroTransplant score are accurate non-invasive approaches for diagnosing advanced fibrosis in patients transplanted for HCV and non-HCVrelated liver diseases. 387 PLATELET COUNT/SPLEEN DIAMETER RATIO COMPARED TO HVPG AND TRANSIENT ELASTOGRAPHY TO PREDICT SEVERE PORTAL HYPERTENSION IN PATIENTS WITH LIVER CIRRHOSIS D. Bitetto1 , W. De Bernardi-Venon2 , C. Fabris1 , P. Toniutto1 , M. Rizzetto2 , A. Marzano2 . 1 Medical Liver Trasplant Unit, University of Udine, Udine, 2 Gastroenterology, University of Turin, Torino, Italy E-mail: [email protected] Background and Aim: Portal hypertension (PHT) is defined as a hepatic venous pressure gradient (HVPG) >5 mmHg. HVPG <10 mmHg are never associated with oesophageal varices and the risk of bleeding is inconsistent for HVPG <12 mmHg. No study has been performed with the aim to evaluate the relationship between PLT/SPL (PSD) ratio and the direct measurement of portal pressure. The present study aimed to evaluate the role of PSD ratio as a non-invasive marker of PHT. Methods: One hundred-one consecutive cirrhotics (74 males, median age 51 years) who underwent measurement of HVPG were retrospectively analyzed (training set). A prospective cohort of 40 patients was also evaluated (test set). All patients underwent clinical examination, measurement of HVPG, ultrasound measurement of spleen diameter; in the test set transient elastography (LSM) was performed. Results: In the training set 13 patients had HVPG <10 mmHg, 13 had 10 ≤HVPG <12 mmHg, 30 had 12≤HVPG < 16 mmHg, 27 had 16 ≤ HVPG < 20 mmHg, 18 had HVPG ≥ 20 mmHg. A significant linear trend for decreasing PSD ratio values in relationship to increasing HVPG levels was found (p < 0.0001). ROC curves showed the following accuracies in discriminating patients with different HVPG values: Conclusions: PSD ratio measurement may be considered a useful noninvasive tool in the assessment of the presence of PHT. It seems to be more discriminating than LSM for the presence of severe PHT, condition related to a higher risk of bleeding. 388 SPLEEN STIFFNESS CORRELATES WITH PORTAL HYPERTENSION AND INCREASES THE ACCURACY OF DETECTION OF ESOPHAGEAL VARICES IN HCV CIRRHOSIS V. Calvaruso1 , V. Di Marco1 , F. Bronte1 , G. Licata1 , F. Simone1 , G. Butera1 , G. Pecoraro1 , D. Cabibbi2 , N. Alessi1 , C. Camma` 1 , A. Craxì1 . 1 Gastroenterology and Hepatology, DIBIMIS, 2 Anatomia Patologica, University of Palermo, Palermo, Italy E-mail: [email protected] Background: Liver stiffness measurement(LSM) by transient elastography(TE) correlates well with cirrhosis but is fairly accurate to assess portal hypertension. Since in cirrhosis the spleen shows fibrotic changes secondary to congestion of its extensive vascular bed, spleen stiffness measurement(SSM) could correlate with HVPG and enhance the predictive accuracy of TE for portal hypertension. Aim: To assess the correlation between SSM and HVPG and evaluate the accuracy of TE in predicting the presence of esophageal varices(EV) by LSM and SSM. Patients and Methods: LSM and SSM were performed at the time of diagnosis in 159 consecutive patients(72% men, age:63±13) with HCV-related cirrhosis. 18 of them had also HVPG measurement. TE
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S159
POSTERS was unreliable in 15 obese patients(8.9%). 54 patients (37.5%) had an histological and 90 (62.5%) a clinical diagnosis of cirrhosis. All patients underwent endoscopy. LS and SS were measured under US control. Results: In the subgroup with haemodinamic evaluation, we found a significant correlation between HVPG value and SSM(Linear regression analysis: r = 0.671; p = 0.009). 9 of them had the highest SS value(75 kPa). Mean HVPG was significant different between patients with SSM lower or equal 75 kPa(12.5 mmHg vs 19.1 mmHg, p = 0.013) without significant differences for bilirubin, albumin or INR values(p=ns). All 9 patients with SSM = 75 kPa had large esophageal varices(6 F2, 3 F3). In the whole cohort of patients, 80 (55.6%) had EV and 28 (19.4%) had large EV(F2 or F3). The AUROCs of LS and SS were almost the same(0.76 vs 0.73) for the prediction of EV but SSM was significantly better than LSM to predict large EV(AUROCs:0.84 vs 0.72). The best cut-offs of LS and SS for the diagnosis of cirrhosis with EV were 21 kPa(Sens. 71%, Spec. 72%) and 47 kPa(Sens. 79%, Spec. 70%) respectively. Twenty-four patients with a LSM <21 kPa had EV and 6 of them had large EV. Seventeen patients with SSM <47 had varices but none of them had a diagnosis of large varices(NPV = 100%). Conclusion: The stiffness of the spleen correlates with portal hypertension. Hence the measurement of SS in patients with cirrhosis adds to the accuracy of TE as a non-invasive tool to predict the presence of esophageal varices. 389 LONG-TERM EVALUATION OF FIBROSIS BY TRANSIENT ELASTOGRAPHY IN PATIENTS CLEARING HCV ON ANTIVIRAL THERAPY V. Calvaruso1 , P.L. Almasio1 , P. Pizzillo2 , R. Di Stefano2 , V. Di Marco1 , C. Cottone1 , S. Petta1 , A. Calì1 , A. Craxì1 . 1 Gastroenterology and Hepatology, DIBIMIS, 2 Cattedra di Virologia, Dipartimento di Scienze per la Promozione della Salute ‘G. D’Alessandro’, University of Palermo, Palermo, Italy E-mail: [email protected] Background and Aim: Reversibility of advanced fibrosis after long term HCV clearance is an important goal of therapy. Measuring liver stiffness (LS) by transient elastography (TE) might be helpful in this setting. Patients and Methods: We evaluated 149(M/F = 90/59) patients with biopsy proven chronic hepatitis C (CHC) and sustained virological response (SVR) after Peg-IFN plus ribavirin since at least 18 months. HCV eradication was confirmed at last follow up visit searching for HCV RNA in serum by TMA® (sensitivity >5–10 IU/ml). Cut-off values of LS in our untreated HCV patients population (comparison cohort) were: F1: 5.5 kPa, F2: 6.5 kPa, F3: 8.0 kPa, F4: 11.5 kPa. Results: TE could not be performed due to obesity In 9 patients. Data of the remaining 140 patients were analysed. 101 subjects were infected by HCV G1 (72%), 28 by G2 (20%), 9 byG3 (7%) and 2 by G4 (1%). Metavir staging of biopsy was F1 in 40 patients, F2 in 70, F3 in 17 and F4 in 8 patients. The median interval elapsed since achieving SVR was 36 months (range 18–77). Median TE value was 4.6 kPa (range 2.1–12.4). Stratifying patients according to the baseline biopsy stage, a clearcut gradient of LS values was observed from F0–1: median 3.9 kPa (range 2.5–8–0) to F2: 4.6 kPa (2.1–12.4), F3: 5.4 kPa (2.8–9.8) and F4: 8.5 kPa (5.4–12.5); p = 0.001 by Anova. The time interval between SVR and last follow up observations was influent on LS values for each stage of fibrosis. Overall, 107 patients (76.4%) had lower values of LS than the corresponding Metavir stage class in the comparison cohort. At multivariate logistic analysis, BMI (OR:1.192, CI 95%:1.005–1.414, p = 0.044) and gGT (OR:1.054, CO 95%:1.004–1.105, p = 0.033) were independently associated with higher values of LS. S160
Conclusion: Long term responders to IFN based therapies have lower liver stiffness values than those who are untreated and viraemic. This could be related to regression of fibrosis but also to loss of necroinflammation. High BMI and elevated gGT, both markers of insulin resistance, may hamper reduction of liver stiffness after HCV clearance. 390 DIAGNOSTIC PERFORMANCE OF TRANSIENT ELASTOGRAPHY IS SIMILAR IN HEPATITIS B AND HEPATITIS C PATIENTS A.C. Cardoso1 , R.J. Carvalho-Filho1 , C. Stern1 , A. Dipumpo1 , N. Giuily1 , M.-P. Ripault1 , T. Asselah1 , C. Castelnau1 , N. Boyer1 , T. Le Picart1 , M. Martinot-Peignoux1 , P. Bedossa2 , P. Marcellin1 . 1 Service d’H´epatologie and INSERM U773 – CRB3, Hˆ opital Beaujon, University Paris 7, 2 Service d’Anatomie Pathologique Hˆ opital Beaujon, Clichy, France E-mail: [email protected] Background and Aims: Transient elastography (TE) is an effective tool for predicting fibrosis stage in chronic hepatitis C. However, the accuracy of TE in patients with chronic hepatitis B has not been well established. This study is aimed to compare diagnostic performances of TE for the assessment of liver fibrosis in HBV in comparison with HCV subjects. Methods: Naïve patients consecutively seen in a single reference center with positive serum HBsAg or detectable HCV RNA for ≥6 months were enrolled. Patients were submitted to liver biopsy (LB) and TE on the same day. TE was performed by the same operators. Only patients with LB ≥15 mm and/or at least 6 portal tracts were included. METAVIR score was used for histological analysis by a single pathologist. TE cutoffs were: 7.2 (F ≥ 2) and 8.1 (F ≥ 3) kPa for HBV (Marcellin et al, Liver International 2009); 7.1 (F ≥ 2) and 9.5 (F ≥ 3) kPa for HCV (Castera et al, Gastroenterology 2005). Results: 613 patients were included. After the exclusion of 48 cases (7.8%) with unreliable/unsuccessful TE measurements, 202 HBV and 363 HCV patients were analyzed. Liver histology showed significant fibrosis (F ≥ 2) in 42% and 54% in HBV and HCV groups, respectively, and showed advanced fibrosis (F ≥ 3) in 17% and 24% in HBV and HCV groups, respectively. The areas under the receiver operating characteristic curve (AUROCs) of TE for predicting F ≥ 2 were 0.867±0.026 and 0.868±0.019 in HBV and HCV patients, respectively (P = 0.975). For predicting F ≥ 3, AUROCs were 0.896±0.016 and 0.894±0.020 in HBV and HCV subjects, respectively (P = 0.938). TE predicted F ≥ 2 with accuracy, sensitivity, specificity, positive LR and negative LR of 82%, 74%, 88%, 6.19 and 0.29 in HBV patients, and 77%, 68%, 88%, 5.98 and 0.35 in HCV individuals. For F ≥ 3, the same parameters were 82%, 88%, 81%, 4.63 and 0.14 in HBV group, and 86%, 67%, 92%, 8.51 and 0.35 in HCV group. Conclusions: In chronic hepatitis B, TE measurement reliably predicts the absence or the presence of significant and advanced liver fibrosis and exhibits similar diagnostic performance as compared to HCV patients. Our results validate the cutoff values previously proposed for HBV and HCV patients. 391 ABSENCE OF INFLUENCE OF METABOLIC FACTORS ON DIAGNOSTIC PERFORMANCE OF LIVER STIFFNESS MEASUREMENT IN CHRONIC HEPATITIS B AND C A.C. Cardoso1 , R.J. Carvalho-Filho1 , C. Stern1 , A. Dipumpo1 , N. Giuily1 , M.-P. Ripault1 , T. Asselah1 , C. Castelnau1 , N. Boyer1 , C.G. Figueiredo-Mendes1 , C. Zurita1 , P. Bedossa2 , P. Marcellin1 . 1 Service d’H´epatologie and INSERM U773 – CRB3, Hˆ opital Beaujon, University Paris 7, 2 Service d’Anatomie Pathologique Hˆ opital Beaujon, Clichy, France E-mail: [email protected] Background: Transient elastography (TE) is effective for predicting the stage of fibrosis in HCV subjects. Progression of fibrosis is
Journal of Hepatology 2010 vol. 52 | S59–S182
S0 vs S1S2S3 (≥11%)
S0S1 vs S2S3 (≥33%)
S0S1S2 vs S3 (≥67%)
CAP apparent performance CAP Jack-Knife cross-validation performance
0.85 (0.77–0.93)
0.87 (0.79–0.94)
0.77 (0.60–0.93)
0.85 (0.76–0.94)
0.87 (0.79–0.94)
0.77 (0.65–0.89)
386 TRANSIENT ELASTOGRAPHY AND DEVELOPMENT OF A NON-INVASIVE MULTIPARAMETER SCORE FOR ASSESSMENT OF ALLOGRAFT FIBROSIS IN LIVER TRANSPLANT PATIENTS S. Beckebaum1,2 , S. Iacob1 , C.G. Klein1,2 , A. Dechene2 , J. Varghese1 , H.A. Baba3 , G. Sotiropoulos1 , A. Paul1 , G. Gerken2 , V.R. Cicinnati1,2 . 1 Department of General, Visceral and Transplantation Surgery, 2 Department of Gastroenterology and Hepatology, 3 Institute of Pathology and Neuropathology, University Hospital Essen, Essen, Germany E-mail: [email protected] Background: To date, there is no non-invasive score available for transplant recipients which can be used irrespective of the indication for liver transplantation (LT). There is also little information about the diagnostic accuracy of transient elastography (TE) in non-HCV LT patients. Methods and Results: In this prospective study, the optimal TE cut-off values for HCV patients and non-HCV LT patients were 4.7 and 5.0 kPa for F ≥ 1, 7.1 and 7.3 kPa for F ≥ 2, 10.9 kPa and 9.9 kPa for F ≥ 3, and 17.3 and 12.6 kPa for F = 4, respectively. The corresponding area under the receiver operating characteristic (AUROC) curves for F ≥ 1, F ≥ 2, F ≥ 3, and F = 4 were 0.95 and 0.86, 0.89 and 0.85, 0.97 and 0.88, and 0.99 and 0.97 for HCV and non-HCV patients, respectively. Based on the logistic regression equation, a predictive model (FibroTransplant score) was created that allows the calculation of a risk score for advanced fibrosis (F ≥ 3) after LT. This model comprises HCV infection as a categorical parameter, time since LT, total protein, INR, glucose, alkaline phosphatase and alpha2macroglobulin as numeric values. The optimal cut-off value for diagnosis of F ≥ 3 for the entire training group was 0.55 with a specificity, sensitivity, positive predictive value (PPV), and negative
predictive value (NPV) of 90.2%, 61.8%, 77.2% and 81.4%, respectively. The accuracy of this model was tested in a validation group (n = 74). The model provided a high AUROC curve (0.92 [CI95% 0.83–0.97]) for the whole validation group indicating a good prediction of advanced graft fibrosis. Conclusions: Our results indicate that TE and the FibroTransplant score are accurate non-invasive approaches for diagnosing advanced fibrosis in patients transplanted for HCV and non-HCVrelated liver diseases. 387 PLATELET COUNT/SPLEEN DIAMETER RATIO COMPARED TO HVPG AND TRANSIENT ELASTOGRAPHY TO PREDICT SEVERE PORTAL HYPERTENSION IN PATIENTS WITH LIVER CIRRHOSIS D. Bitetto1 , W. De Bernardi-Venon2 , C. Fabris1 , P. Toniutto1 , M. Rizzetto2 , A. Marzano2 . 1 Medical Liver Trasplant Unit, University of Udine, Udine, 2 Gastroenterology, University of Turin, Torino, Italy E-mail: [email protected] Background and Aim: Portal hypertension (PHT) is defined as a hepatic venous pressure gradient (HVPG) >5 mmHg. HVPG <10 mmHg are never associated with oesophageal varices and the risk of bleeding is inconsistent for HVPG <12 mmHg. No study has been performed with the aim to evaluate the relationship between PLT/SPL (PSD) ratio and the direct measurement of portal pressure. The present study aimed to evaluate the role of PSD ratio as a non-invasive marker of PHT. Methods: One hundred-one consecutive cirrhotics (74 males, median age 51 years) who underwent measurement of HVPG were retrospectively analyzed (training set). A prospective cohort of 40 patients was also evaluated (test set). All patients underwent clinical examination, measurement of HVPG, ultrasound measurement of spleen diameter; in the test set transient elastography (LSM) was performed. Results: In the training set 13 patients had HVPG <10 mmHg, 13 had 10 ≤HVPG <12 mmHg, 30 had 12≤HVPG < 16 mmHg, 27 had 16 ≤ HVPG < 20 mmHg, 18 had HVPG ≥ 20 mmHg. A significant linear trend for decreasing PSD ratio values in relationship to increasing HVPG levels was found (p < 0.0001). ROC curves showed the following accuracies in discriminating patients with different HVPG values: Conclusions: PSD ratio measurement may be considered a useful noninvasive tool in the assessment of the presence of PHT. It seems to be more discriminating than LSM for the presence of severe PHT, condition related to a higher risk of bleeding. 388 SPLEEN STIFFNESS CORRELATES WITH PORTAL HYPERTENSION AND INCREASES THE ACCURACY OF DETECTION OF ESOPHAGEAL VARICES IN HCV CIRRHOSIS V. Calvaruso1 , V. Di Marco1 , F. Bronte1 , G. Licata1 , F. Simone1 , G. Butera1 , G. Pecoraro1 , D. Cabibbi2 , N. Alessi1 , C. Camma` 1 , A. Craxì1 . 1 Gastroenterology and Hepatology, DIBIMIS, 2 Anatomia Patologica, University of Palermo, Palermo, Italy E-mail: [email protected] Background: Liver stiffness measurement(LSM) by transient elastography(TE) correlates well with cirrhosis but is fairly accurate to assess portal hypertension. Since in cirrhosis the spleen shows fibrotic changes secondary to congestion of its extensive vascular bed, spleen stiffness measurement(SSM) could correlate with HVPG and enhance the predictive accuracy of TE for portal hypertension. Aim: To assess the correlation between SSM and HVPG and evaluate the accuracy of TE in predicting the presence of esophageal varices(EV) by LSM and SSM. Patients and Methods: LSM and SSM were performed at the time of diagnosis in 159 consecutive patients(72% men, age:63±13) with HCV-related cirrhosis. 18 of them had also HVPG measurement. TE
Journal of Hepatology 2010 vol. 52 | S59–S182
S159
POSTERS was unreliable in 15 obese patients(8.9%). 54 patients (37.5%) had an histological and 90 (62.5%) a clinical diagnosis of cirrhosis. All patients underwent endoscopy. LS and SS were measured under US control. Results: In the subgroup with haemodinamic evaluation, we found a significant correlation between HVPG value and SSM(Linear regression analysis: r = 0.671; p = 0.009). 9 of them had the highest SS value(75 kPa). Mean HVPG was significant different between patients with SSM lower or equal 75 kPa(12.5 mmHg vs 19.1 mmHg, p = 0.013) without significant differences for bilirubin, albumin or INR values(p=ns). All 9 patients with SSM = 75 kPa had large esophageal varices(6 F2, 3 F3). In the whole cohort of patients, 80 (55.6%) had EV and 28 (19.4%) had large EV(F2 or F3). The AUROCs of LS and SS were almost the same(0.76 vs 0.73) for the prediction of EV but SSM was significantly better than LSM to predict large EV(AUROCs:0.84 vs 0.72). The best cut-offs of LS and SS for the diagnosis of cirrhosis with EV were 21 kPa(Sens. 71%, Spec. 72%) and 47 kPa(Sens. 79%, Spec. 70%) respectively. Twenty-four patients with a LSM <21 kPa had EV and 6 of them had large EV. Seventeen patients with SSM <47 had varices but none of them had a diagnosis of large varices(NPV = 100%). Conclusion: The stiffness of the spleen correlates with portal hypertension. Hence the measurement of SS in patients with cirrhosis adds to the accuracy of TE as a non-invasive tool to predict the presence of esophageal varices. 389 LONG-TERM EVALUATION OF FIBROSIS BY TRANSIENT ELASTOGRAPHY IN PATIENTS CLEARING HCV ON ANTIVIRAL THERAPY V. Calvaruso1 , P.L. Almasio1 , P. Pizzillo2 , R. Di Stefano2 , V. Di Marco1 , C. Cottone1 , S. Petta1 , A. Calì1 , A. Craxì1 . 1 Gastroenterology and Hepatology, DIBIMIS, 2 Cattedra di Virologia, Dipartimento di Scienze per la Promozione della Salute ‘G. D’Alessandro’, University of Palermo, Palermo, Italy E-mail: [email protected] Background and Aim: Reversibility of advanced fibrosis after long term HCV clearance is an important goal of therapy. Measuring liver stiffness (LS) by transient elastography (TE) might be helpful in this setting. Patients and Methods: We evaluated 149(M/F = 90/59) patients with biopsy proven chronic hepatitis C (CHC) and sustained virological response (SVR) after Peg-IFN plus ribavirin since at least 18 months. HCV eradication was confirmed at last follow up visit searching for HCV RNA in serum by TMA® (sensitivity >5–10 IU/ml). Cut-off values of LS in our untreated HCV patients population (comparison cohort) were: F1: 5.5 kPa, F2: 6.5 kPa, F3: 8.0 kPa, F4: 11.5 kPa. Results: TE could not be performed due to obesity In 9 patients. Data of the remaining 140 patients were analysed. 101 subjects were infected by HCV G1 (72%), 28 by G2 (20%), 9 byG3 (7%) and 2 by G4 (1%). Metavir staging of biopsy was F1 in 40 patients, F2 in 70, F3 in 17 and F4 in 8 patients. The median interval elapsed since achieving SVR was 36 months (range 18–77). Median TE value was 4.6 kPa (range 2.1–12.4). Stratifying patients according to the baseline biopsy stage, a clearcut gradient of LS values was observed from F0–1: median 3.9 kPa (range 2.5–8–0) to F2: 4.6 kPa (2.1–12.4), F3: 5.4 kPa (2.8–9.8) and F4: 8.5 kPa (5.4–12.5); p = 0.001 by Anova. The time interval between SVR and last follow up observations was influent on LS values for each stage of fibrosis. Overall, 107 patients (76.4%) had lower values of LS than the corresponding Metavir stage class in the comparison cohort. At multivariate logistic analysis, BMI (OR:1.192, CI 95%:1.005–1.414, p = 0.044) and gGT (OR:1.054, CO 95%:1.004–1.105, p = 0.033) were independently associated with higher values of LS. S160
Conclusion: Long term responders to IFN based therapies have lower liver stiffness values than those who are untreated and viraemic. This could be related to regression of fibrosis but also to loss of necroinflammation. High BMI and elevated gGT, both markers of insulin resistance, may hamper reduction of liver stiffness after HCV clearance. 390 DIAGNOSTIC PERFORMANCE OF TRANSIENT ELASTOGRAPHY IS SIMILAR IN HEPATITIS B AND HEPATITIS C PATIENTS A.C. Cardoso1 , R.J. Carvalho-Filho1 , C. Stern1 , A. Dipumpo1 , N. Giuily1 , M.-P. Ripault1 , T. Asselah1 , C. Castelnau1 , N. Boyer1 , T. Le Picart1 , M. Martinot-Peignoux1 , P. Bedossa2 , P. Marcellin1 . 1 Service d’H´epatologie and INSERM U773 – CRB3, Hˆ opital Beaujon, University Paris 7, 2 Service d’Anatomie Pathologique Hˆ opital Beaujon, Clichy, France E-mail: [email protected] Background and Aims: Transient elastography (TE) is an effective tool for predicting fibrosis stage in chronic hepatitis C. However, the accuracy of TE in patients with chronic hepatitis B has not been well established. This study is aimed to compare diagnostic performances of TE for the assessment of liver fibrosis in HBV in comparison with HCV subjects. Methods: Naïve patients consecutively seen in a single reference center with positive serum HBsAg or detectable HCV RNA for ≥6 months were enrolled. Patients were submitted to liver biopsy (LB) and TE on the same day. TE was performed by the same operators. Only patients with LB ≥15 mm and/or at least 6 portal tracts were included. METAVIR score was used for histological analysis by a single pathologist. TE cutoffs were: 7.2 (F ≥ 2) and 8.1 (F ≥ 3) kPa for HBV (Marcellin et al, Liver International 2009); 7.1 (F ≥ 2) and 9.5 (F ≥ 3) kPa for HCV (Castera et al, Gastroenterology 2005). Results: 613 patients were included. After the exclusion of 48 cases (7.8%) with unreliable/unsuccessful TE measurements, 202 HBV and 363 HCV patients were analyzed. Liver histology showed significant fibrosis (F ≥ 2) in 42% and 54% in HBV and HCV groups, respectively, and showed advanced fibrosis (F ≥ 3) in 17% and 24% in HBV and HCV groups, respectively. The areas under the receiver operating characteristic curve (AUROCs) of TE for predicting F ≥ 2 were 0.867±0.026 and 0.868±0.019 in HBV and HCV patients, respectively (P = 0.975). For predicting F ≥ 3, AUROCs were 0.896±0.016 and 0.894±0.020 in HBV and HCV subjects, respectively (P = 0.938). TE predicted F ≥ 2 with accuracy, sensitivity, specificity, positive LR and negative LR of 82%, 74%, 88%, 6.19 and 0.29 in HBV patients, and 77%, 68%, 88%, 5.98 and 0.35 in HCV individuals. For F ≥ 3, the same parameters were 82%, 88%, 81%, 4.63 and 0.14 in HBV group, and 86%, 67%, 92%, 8.51 and 0.35 in HCV group. Conclusions: In chronic hepatitis B, TE measurement reliably predicts the absence or the presence of significant and advanced liver fibrosis and exhibits similar diagnostic performance as compared to HCV patients. Our results validate the cutoff values previously proposed for HBV and HCV patients. 391 ABSENCE OF INFLUENCE OF METABOLIC FACTORS ON DIAGNOSTIC PERFORMANCE OF LIVER STIFFNESS MEASUREMENT IN CHRONIC HEPATITIS B AND C A.C. Cardoso1 , R.J. Carvalho-Filho1 , C. Stern1 , A. Dipumpo1 , N. Giuily1 , M.-P. Ripault1 , T. Asselah1 , C. Castelnau1 , N. Boyer1 , C.G. Figueiredo-Mendes1 , C. Zurita1 , P. Bedossa2 , P. Marcellin1 . 1 Service d’H´epatologie and INSERM U773 – CRB3, Hˆ opital Beaujon, University Paris 7, 2 Service d’Anatomie Pathologique Hˆ opital Beaujon, Clichy, France E-mail: [email protected] Background: Transient elastography (TE) is effective for predicting the stage of fibrosis in HCV subjects. Progression of fibrosis is
Journal of Hepatology 2010 vol. 52 | S59–S182