Observational Study
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World J Gastroenterol. Jun 7, 2014; 20(21): 6626-6631
Published online Jun 7, 2014. doi: 10.3748/wjg.v20.i21.6626
Controlled attenuation parameter for evaluating liver steatosis in chronic viral hepatitis
Giovanna Ferraioli, Carmine Tinelli, Raffaella Lissandrin, Mabel Zicchetti, Barbara Dal Bello, Gaetano Filice, Carlo Filice
Giovanna Ferraioli, Raffaella Lissandrin, Mabel Zicchetti, Gaetano Filice, Carlo Filice, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, 27100 Pavia, Italy
Carmine Tinelli, Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Barbara Dal Bello, Department of Pathology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Author contributions: Ferraioli G and Tinelli C contributed equally to this work; Ferraioli G, Tinelli C and Filice C designed the research; Lissandrin R, Zicchetti M and Dal Bello B performed the research; Tinelli C analyzed the data; Ferraioli G, Zicchetti M and Lissandrin R wrote the paper; Tinelli C, Dal Bello B, Filice G and Filice C reviewed the manuscript; Ferraioli G, Tinelli C, Lissandrin R, Zicchetti M, Dal Bello B, Filice G and Filice C approved the final version; all authors of the Liver Steatosis Study Group performed the research, reviewed the manuscript and approved the final version.
Supported by Fibroscan device was made available for the study by Echosens (Paris, France)
Correspondence to: Giovanna Ferraioli, MD, Researcher, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, Via Taramelli 5, 27100 Pavia, Italy. giovanna.ferraioli@unipv.it
Telephone: +39-382-502887 Fax: +39-382-501505
Received: December 12, 2013
Revised: February 9, 2014
Accepted: March 8, 2014
Published online: June 7, 2014
Abstract

AIM: To assess the performance of controlled attenuation parameter (CAP) in patients with chronic viral hepatitis.

METHODS: CAP is a new technique that measures the attenuation in the liver of an ultrasound beam, which is directly related to lipid accumulation. Consecutive patients undergoing liver biopsy for chronic viral hepatitis were studied using the M probe of FibroScan device (Echosens, Paris, France). The device estimates liver steatosis in decibel per meter (dB/m). An expert operator performed all measurements. Steatosis was graded according to Kleiner’s classification. Pearson or Spearman rank coefficient was used to test correlation between two study variables. Linear regression was used for multivariate model to assess the association between CAP and other variables. Receiver operating characteristic curve analysis was performed to calculate area under the curve (AUROC) for S0 vs S1-S3 and S0-S1 vs S2-S3.

RESULTS: 115 subjects (85 males and 30 females) were prospectively studied. The mean values of CAP were 227.1 ± 43.1 for S0; 254.6 ± 38.9 for S1; 297.8 ± 49.4 dB/m for S2-S3. In univariate analysis CAP showed a significant correlation with age, body mass index (BMI), degree of steatosis, and cholesterol. Multivariate regression analysis confirmed the correlation with the degree of steatosis [coefficient, 1.2 (0.60-1.83); P < 10-5] and BMI [coefficient, 4.1 (0.5-7.8); P = 0.03] but not with all other variables. Optimal cutoff values for S ≥ 1 and S ≥ 2 were 219 dB/m [AUROC, 0.76 (0.67-0.84); sensitivity, 91.1% (78.8-97.5); specificity, 51.6% (38.7-64.2); positive predictive value, 56.9% (44.7-68.6); negative predictive value, 89.2% (74.3-97.0); positive likelihood ratio, 1.88 (1.4-2.5); negative likelihood ratio, 0.17 (0.07-0.5)] and 296 dB/m [AUROC, 0.82 (0.74-0.89); sensitivity, 60.0% (32.3-83.7); specificity, 91.5% (83.9-96.3); positive predictive value, 52.9% (27.8-77.0); negative predictive value, 93.5% (86.3-97.6); positive likelihood ratio, 7.05 (3.2-15.4); negative likelihood ratio, 0.44 (0.2-0.8)], respectively.

CONCLUSION: Controlled attenuation parameter could be a useful tool in the clinical management of patients with chronic viral hepatitis for detecting liver steatosis.

Keywords: Liver steatosis, Noninvasive techniques, Controlled attenuation parameter, Transient elastography, Chronic liver disease

Core tip: A number of factors may affect response to treatment of patients with chronic viral hepatitis and it is well known that patients with liver steatosis are less responsive to antiviral drugs. On the other hand, early stages of liver steatosis are usually reversible with appropriate intervention. Controlled attenuation parameter (CAP) is a new method for non-invasive quantification of liver steatosis. The results of our study show that CAP is highly and significantly correlated with the extent of liver fat accumulation and it could be a useful tool in the clinical setting to diagnose the presence/absence of liver steatosis.