Moderate to severe hepatic steatosis leads to overestimation of liver stiffness measurement in chronic hepatitis B patients without significant fibrosis

Summary Background Liver stiffness measurement (LSM) by transient elastography is a noninvasive method for the diagnosis of hepatic fibrosis. The impact of hepatic steatosis on LSM remains to be explored. Aim To determine whether LSM is affected by hepatic steatosis in patients with chronic hepatitis B (CHB). Methods Consecutive patients with biopsy‐proven CHB were prospectively enrolled. Hepatic steatosis was classified by pathology as none (S0, <5%), mild (S1, 5%‐33%), and moderate‐severe (S2‐3, >33%), and quantitatively by controlled attenuation parameter (CAP) as CAP S0 (≤247 dB/m), CAP S1 (248‐267 dB/m) and CAP S2‐3 (≥268 dB/m). Liver fibrosis was assessed by METAVIR classification and noninvasively by LSM. Results The prevalence of non‐alcoholic fatty liver disease (n = 223) in CHB patients (n = 593) was 37.6%. Forty‐eight belonged to S2‐3 and 127 belonged to CAP S2‐3. In patients without significant fibrosis (F0‐1), the median LSM (kPa) was 7.4 in S2‐3 and 7.1 in CAP S2‐3, which was significantly higher than that in S0/S1 ( P = 0.005) and CAP S0/S1 ( P = 0.003). No significant difference was found in significant fibrosis (F2‐4). For LSM identifying significant fibrosis (F2‐4), the negative predictive value was higher in CHB patients with CAP ≥ 268 compared to those with CAP < 268 (0.81 vs 0.73); the positive predictive value was lower in CAP ≥ 268 than its counterpart (0.65 vs 0.76). Conclusions Moderate‐severe steatosis increased the LSM value in CHB patients without significant fibrosis. A CAP ≥ 268 did not affect LSM for ruling out, but it slightly affected LSM for ruling in significant fibrosis. Trial Registration: ChiCTR‐DDT‐13003983.