Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2021; 27(7): 641-653
Published online Feb 21, 2021. doi: 10.3748/wjg.v27.i7.641
Effect of liver inflammation on accuracy of FibroScan device in assessing liver fibrosis stage in patients with chronic hepatitis B virus infection
Ling-Ling Huang, Xue-Ping Yu, Ju-Lan Li, Hui-Ming Lin, Na-Ling Kang, Jia-Ji Jiang, Yue-Yong Zhu, Yu-Rui Liu, Da-Wu Zeng
Ling-Ling Huang, Hui-Ming Lin, Na-Ling Kang, Jia-Ji Jiang, Yue-Yong Zhu, Yu-Rui Liu, Da-Wu Zeng, Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Xue-Ping Yu, Ju-Lan Li, Department of Infectious Diseases, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
Yue-Yong Zhu, Fujian Key Laboratory of Precision Medicine for Cancer, Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Author contributions: Huang LL, Liu YR, Yu XP, Li JL contributed equally to this work; Huang LL, Zeng DW and Liu YR conceived and designed the experiments; Huang LL, Jiang JJ and Zeng DW performed the experiments; Huang LL, Yu XP, Zeng DW and Zhu YY analyzed the data; Li JL, Lin HM and Kang NL contributed the reagents/materials/analysis tools; Huang LL and Zeng DW wrote the manuscript; all authors approved the final version of the manuscript.
Supported by Science and Technology Department of Fujian Province, China, No. 2019Y0015 and No. 2019J01432; Chinese National 13th Five-Year Plan's Science and Technology Projects, No. 2017ZX10202201; Quanzhou Science and Technology Project of Fujian Province, China, No. 2018Z074.
Institutional review board statement: This study was approved by the Institutional Review Board of Fujian Medical University.
Informed consent statement: The need for informed consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Da-Wu Zeng, MD, PhD, Associate Chief Physician, Doctor, Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou 350005, Fujian Province, China. zengdw1980@fjmu.edu.cn
Received: November 26, 2020
Peer-review started: November 26, 2020
First decision: December 21, 2020
Revised: December 30, 2020
Accepted: January 13, 2021
Article in press: January 13, 2021
Published online: February 21, 2021
Processing time: 85 Days and 10 Hours
Abstract
BACKGROUND

Transient elastography (FibroScan) is a new and non-invasive test, which has been widely recommended by the guidelines of chronic hepatitis B virus (HBV) management for assessing hepatic fibrosis staging. However, some confounders may affect the diagnostic accuracy of the FibroScan device in fibrosis staging.

AIM

To evaluate the diagnostic value of the FibroScan device and the effect of hepatic inflammation on the accuracy of FibroScan in assessing the stage of liver fibrosis in patients with HBV infection.

METHODS

The data of 416 patients with chronic HBV infection who accepted FibroScan, liver biopsy, clinical, and biological examination were collected from two hospitals retrospectively. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic performance of FibroScan for assessing the stage of liver fibrosis. Any discordance in fibrosis staging by FibroScan and pathological scores was statistically analyzed. Logistic regression and ROC analyses were used to analyze the accuracy of FibroScan in assessing the stage of fibrosis in patients with different degrees of liver inflammation. A non-invasive model was constructed to predict the risk of misdiagnosis of fibrosis stage using FibroScan.

RESULTS

In the overall cohort, the optimal diagnostic values of liver stiffness measurement (LSM) using FibroScan for significant fibrosis (≥ F2), severe fibrosis (≥ F3), and cirrhosis (F4) were 7.3 kPa [area under the curve (AUC) = 0.863], 9.7 kPa (AUC = 0.911), and 11.3 kPa (AUC = 0.918), respectively. The rate of misdiagnosis of fibrosis stage using FibroScan was 34.1% (142/416 patients). The group of patients who showed discordance between fibrosis staging using FibroScan and pathological scores had significantly higher alanine aminotransferase and aspartate aminotransferase levels, and a higher proportion of moderate to severe hepatic inflammation, compared with the group of patients who showed concordance in fibrosis staging between the two methods. Liver inflammation activity over 2 (OR = 3.53) was an independent risk factor for misdiagnosis of fibrosis stage using FibroScan. Patients with liver inflammation activity ≥ 2 showed higher LSM values using FibroScan and higher rates of misdiagnosis of fibrosis stage, whereas the diagnostic performance of FibroScan for different fibrosis stages was significantly lower than that in patients with inflammation activity < 2 (all P < 0.05). A non-invasive prediction model was established to assess the risk of misdiagnosis of fibrosis stage using FibroScan, and the AUC was 0.701.

CONCLUSION

Liver inflammation was an independent risk factor affecting the diagnostic accuracy of FibroScan for fibrosis stage. A combination of other related non-invasive factors can predict the risk of misdiagnosis of fibrosis staging using FibroScan.

Keywords: Liver stiffness measurement; Fibrosis stage; Liver inflammation; Hepatitis B virus; FibroScan; Predictive model

Core Tip: Transient elastography (FibroScan) is a recommended non-invasive test for evaluation of liver fibrosis in patients with chronic hepatitis B virus (HBV) infection. In this study, we demonstrated the good performance of FibroScan in predicting liver fibrosis staging. However, we found discordance between Fibroscan fibrosis staging and pathological score. Liver inflammation was an independent risk factor affecting the accuracy of FibroScan assessing HBV-related liver fibrosis staging. The combination of other related non-invasive factors can predict the risk of FibroScan staging misdiagnosis, and may be helpful for guiding the diagnosis and therapy of chronic HBV infection.