Accuracy of transient elastography in assessing fibrosis at diagnosis in individuals with autoimmune liver disease

Liver stiffness measurement by vibration-controlled transient elastography improves outcome prediction in primary biliary cholangitisJournal of HepatologyVol. 77Issue 6PreviewLiver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) has been shown to predict outcomes of patients with primary biliary cholangitis (PBC) in small-size studies. We aimed to validate the prognostic value of LSM in a large cohort study. Full-Text PDF Recently, this Journal published a large, multi-center, longitudinal cohort study by Corpechot et al., which validated the prognostic value of baseline liver stiffness (LS) by vibration-controlled transient elastography (VCTE) in individuals with primary biliary cholangitis (PBC). LS also improved the prognostic performance of established biochemical markers of treatment response.[1]Corpechot C Carrat F Gaouar F Chau F Hirschfield G Gulamhusein A et al.Liver stiffness measurement by vibration-controlled transient elastography improves outcome prediction in primary biliary cholangitis.J Hepatol. 2022; 77: 1545-1553https://doi.org/10.1016/j.jhep.2022.06.017Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar The study has directly supported the inclusion of baseline LS in prognostic tools developed for PBC. Interestingly, results from our meta-analysis regarding the diagnostic performance of LS for autoimmune liver disease (AILD) also provided indirect explanation for its prognostic role, considering baseline histological fibrosis is an independent predictor of disease progression and clinical outcomes in individuals with AILD.[2]Murillo Perez CF Hirschfield GM Corpechot C Floreani A Mayo MJ van der Meer A et al.Fibrosis stage is an independent predictor of outcome in primary biliary cholangitis despite biochemical treatment response.Aliment Pharmacol Ther. 2019; 50: 1127-1136Crossref PubMed Scopus (56) Google Scholar,[3]Hartl J Ehlken H Sebode M Peiseler M Krech T Zenouzi R et al.Usefulness of biochemical remission and transient elastography in monitoring disease course in autoimmune hepatitis.J Hepatol. 2018; 68: 754-763Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar Of the 754 articles identified through the systematic search, a total of 44 studies published from 2006 to 2021 including 3,488 participants with AILD were finally enrolled. Taking liver biopsy as standard, we explored the diagnostic ability of 11 non-invasive markers of fibrosis in subgroups of individuals with autoimmune hepatitis (AIH) (n = 1,253), PBC (n = 1,734) and primary sclerosing cholangitis (PSC) (n = 501). Moreover, considering genetic and environmental factors can contribute to the development and progression of AILD, both Asian and European populations were covered in our study[4]Gulamhusein AF Hirschfield GM Primary biliary cholangitis: pathogenesis and therapeutic opportunities.Nat Rev Gastroenterol Hepatol. 2020; 17: 93-110Crossref PubMed Scopus (146) Google Scholar (Table S1). Our results indicated that LS by transient elastography had a remarkable diagnostic performance compared to other non-invasive biomarkers of liver fibrosis (Table S2). Moreover, LS performed better for the diagnosis of PBC than AIH. LS had an excellent diagnostic accuracy in detecting liver fibrosis with summary area under ROC curves (AUROCs) of 0.94, 0.92 and 0.93 for significant fibrosis (SF), advanced fibrosis (AF) and cirrhosis, respectively, in individuals with PBC. While LS had a moderate to excellent accuracy with summary AUROCs of 0.83, 0.91 and 0.90 in individuals with AIH (Fig. 1). Liver histology predicts fibrosis progression and cirrhosis development in individuals with AILD; thus, the higher consistency between LS and liver histopathology in individuals with PBC can provide further support for Corpechot et al.’s findings. In conclusion, we agree with Corpechot et al. that VCTE is a reliable predictor of clinical outcomes in individuals with PBC and that LS should be incorporated into the prognostic markers to determine the state of disease progression. Still, the differential diagnostic efficiency of LS in our study provides a hint that the prognostic value of LS in individuals with PSC, AIH or PBC-AIH overlap syndrome warrants further investigation. More importantly, studies regarding dynamic changes of LS during the follow-up of individuals with AILD are needed to further validate its prognostic impact. The authors received no financial support to produce this manuscript. All authors declare that no conflict of interest is associated with participation and contribution to this work. Please refer to the accompanying ICMJE disclosure forms for further details. YS: data analysis and manuscript drafting. HC: data analysis and manuscript drafting. SDW: manuscript revision. WJ: study concept and manuscript revision. The following are the supplementary data to this article: Download .pdf (.78 MB) Help with pdf files Multimedia component 1 Download .pdf (.18 MB) Help with pdf files Multimedia component 2