Published online Oct 21, 2023. doi: 10.3748/wjg.v29.i39.5503
Peer-review started: July 2, 2023
First decision: August 30, 2023
Revised: September 9, 2023
Accepted: October 11, 2023
Article in press: October 11, 2023
Published online: October 21, 2023
Noninvasive methods have been developed to detect fibrosis in many liver diseases due to the limits of liver biopsy. However, previous studies have focused primarily on chronic viral hepatitis and nonalcoholic fatty liver disease. The diagnostic value of transient elastography for autoimmune liver diseases (AILDs) is worth studying.
To compare the diagnostic accuracy of imaging techniques with serum biomar
The PubMed, Cochrane Library and EMBASE databases were searched. Studies evaluating the efficacy of noninvasive methods in the diagnosis of AILDs [autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC)] were included. The summary area under the receiver operating characteristic curve (AUROC), diagnostic odds ratio, sensitivity and specificity were used to assess the accuracy of these noninvasive methods for staging fibrosis.
A total of 60 articles were included in this study, and the number of patients with AIH, PBC and PSC was 1594, 3126 and 501, respectively. The summary AUROC of transient elastography in the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis in patients with AIH were 0.84, 0.88 and 0.90, respectively, while those in patients with PBC were 0.93, 0.93 and 0.91, respectively. The AUROC of cirrhosis for patients with PSC was 0.95. However, other noninvasive indices (aspartate aminotransferase to platelet ratio index, aspartate aminotransferase/alanine aminotransferase ratio, fibrosis-4 index) had corresponding AUROCs less than 0.80.
Transient elastography exerts better diagnostic accuracy in AILD patients, especially in PBC patients. The appropriate cutoff values for staging advanced fibrosis and cirrhosis ranged from 9.6 to 10.7 and 14.4 to 16.9 KPa for PBC patients.
Core Tip: Onset of autoimmune liver diseases is frequently insidious, and immune cell infiltration and continuous inflammation drive hepatic fibrosis, which gradually progresses to cirrhosis, causing poorer long-term outcomes. Liver biopsy as the reference standard is an invasive procedure. Thus, repeated biopsies are difficult to implement. Consequently, appropriate noninvasive methods are essential to dynamically monitor the degree of liver fibrosis. Our meta-analysis compared the diagnostic accuracy of imaging techniques with serum biomarkers of fibrosis in autoimmune liver diseases.