Can Transient Elastography Replace Liver Histology for Determination of Advanced Fibrosis in Alcoholic Patients

Background/Goals Consensus is lacking whether cut-off values for different fibrosis stages using transient elastography (TE, FibroScan) are universally applicable to all liver diseases. We evaluated the performance of TE in predicting severe fibrosis (≥F3) in alcoholic patients using cut-off values validated for chronic hepatitis C. Study Patients admitted for alcohol withdrawal were prospectively evaluated by TE and biochemistry for aspartate aminotransferase to platelet ratio index (APRI) and Forns score calculations. If TE revealed severe fibrosis (≥F3), hepatic venous pressure gradient measurements and transjugular liver biopsy were proposed results of which were correlated and compared with TE measurements or APRI and Forns scores. Results Among 239 patients, 72 had liver TE scores ≥F3 and 23 declined liver biopsy leaving a final study population of 49 patients. Compared with biopsy, 32 patients were correctly classified by TE, whereas 16 patients differed by 2 fibrosis stages yielding a positive predictive value of 65% for liver fibrosis ≥F3 at TE. Specificity and sensitivity of TE improved beyond 75% and 70%, respectively, with modified cut-offs of 17 (F3) and 21.1 kPa (F4). Areas under the receiver operating characteristic curves were 0.766 and 0.864 for severe fibrosis (≥F3) and cirrhosis, respectively. APRI and Forns scores performed less well than TE regarding sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic values. A significant correlation was found between hepatic venous pressure gradients and liver stiffness values at TE. Conclusions TE with modified cut-offs has the potential to predict advanced fibrosis and significant portal hypertension in alcoholic patients. APRI and Forns scores are of limited usefulness in alcoholics.