Non-invasive assessment of liver fibrosis using two-dimensional shear wave elastography in patients with autoimmune liver diseases

Table 1 Demographic data, blood tests and histological results in patients with autoimmune liver diseases n (%)

Characteristic	n = 114
Age, yr (SD; range)	45.6 (12.5; 18-74)
Gender, male, n (%)	21 (18.4)
BMI, kg/m2 (SD; range)	21.6 (3.0; 15.4-36.4)
AST, IU/L (IQR; range)	84.0 (51.3-148.0;16.0-473.0)
ALT, IU/L (IQR; range)	78.5 (49.5-142.0; 9.0-920.0)
Alkaline phosphatase, IU/L (IQR; range)	208 (110.0-353.0; 47.0-873.0)
Gamma-glutamyl transferase, IU/L (IQR; range)	252.0 (111.0-523.8; 16.0-1535.0)
Total bilirubin, umol/L (IQR; range)	20.3 (13.6-43.6; 3.6-375.8)
Serum albumin, g/L (SD; range)	37.6 (5.0; 25.9-47.0)
Platelets count, 109/L ((SD; range)	188.2 (69.5; 28.0-414.0)
Prothrombin activity, % (SD; range)	106.6 (22.6; 50.0-158.0)
METAVIR fibrosis stage1
F0	4 (0.04)
F1	28 (24.6)
F2	35 (30.7)
F3	24 (21.1)
F4	23 (20.2)
METAVIR activity grade2
A0	2 (0.02)
A1	17 (14.9)
A2	48 (42.1)
A3	47(41.2)

¹F0, no fibrosis; F1, portal fibrosis without septa; F2, portal fibrosis and few septa; F3, numerous septa without cirrhosis; F4, cirrhosis;

²A0, none; A1, mild; A2, moderate; A3, severe. IQR: Inter quartile range; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; BMI: Body mass index.

Table 2 Number of patients with autoimmune liver diseases at different fibrosis stages

	F0-F1 (n)	F2 (n)	F3 (n)	F4 (n)
AIH	19	18	9	16
PBC	8	10	8	4
PSC	1	1	0	1
PBC-AIH	4	6	7	2
Total	32	35	24	23

AIH: Autoimmune hepatitis; PBC: Primary biliary cholangitis; PSC: Primary sclerosing cholangitis; PBC-AIH: PBC-AIH overlap syndrome.

Table 3 Median values, inter quartile range, ranges, and P values of measurements obtained for each fibrosis stage using two-dimensional shear wave elastography

METAVIR stage	F0-F1	F2	F3	F4
Median value, kPa	7.7	11.7	14.7	22.0
IQR	6.5-9.2	8.3-15.4	12.3-22.3	18.8-33.3
Range	4.9-25.8	4.6-51.7	8.7-67.2	10.1-45.3
P value1		< 0.001	0.009	0.011

¹P values refer to differences between consecutive fibrosis stages. IQR: Inter quartile range.

Table 4 Performance characteristics of two-dimensional shear wave elastography for staging liver fibrosis in patients with autoimmune liver diseases

	Cutoff, kPa	Se, % (95%CI)	Sp, % (95%CI)	PPV, % (95%CI)	NPV, % (95%CI)	LR+, ratio (95%CI)	LR-, ratio (95%CI)
≥ F2	9.71	81.7 (71.6-89.4)	81.3 (63.6-92.8)	91.8 (83.0-96.9)	63.4 (46.9-77.9)	4.4 (3.6-5.3)	0.23 (0.10-0.5)
	7.22	93.9 (86.3-98.0)	40.6 (23.7-59.4)	80.2 (70.8-87.6)	72.2 (46.5-90.3)	1.6 (1.0-2.4)	0.15 (0.06-0.4)
	7.13	93.9 (86.3-98.0)	37.5 (21.1-56.3)	79.4 (70.0-86.9)	70.6 (44.0-89.7)	1.5 (1.0-2.4)	0.16 (0.07-0.4)
≥ F3	13.21	83.0 (69.2-92.4)	74.6 (62.5-84.5)	69.6 (55.8-81.3)	86.2 (74.6-93.9)	3.3 (2.7-4.0)	0.23 (0.1-0.5)
	9.12	95.7 (85.5-9.5)	52.2 (39.7-64.6)	58.4 (46.6-69.6)	94.6 (81.5-99.4)	2.0 (1.6-2.5)	0.08 (0.02-0.3)
	8.73	97.9 (88.7-99.9)	49.3 (36.8-61.8)	57.5 (45.9-68.5)	97.1 (84.7-99.9)	1.9 (1.5-2.5)	0.04 (0.01-0.3)
F4	16.31	87.0 (66.4-97.2)	80.2 (70.6-87.8)	52.6 (35.6-69.2)	96.1 (88.9-99.2)	4.4 (3.6-5.3)	0.16 (0.05-0.5)
	11.72	95.7 (78.1-99.9)	57.1 (46.3-67.5)	36.1 (24.2-49.4)	98.1 (89.8-100.0)	2.2 (1.8-2.7)	0.08 (0.01-0.5)
	10.43	95.7 (78.1-99.9)	48.4 (37.7-59.1)	31.9 (21.2-44.2)	97.8 (88.2-99.9)	1.9 (1.5-2.3)	0.09 (0.01-0.6)

¹Cut-off values in patients with autoimmune liver diseases;

²Cut-off values in patients with chronic hepatitis B;

³Cut-off values in patients with chronic hepatitis C. Se: Sensitivity; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; LR+: Positive likelihood ratio; LR-: Negative likelihood ratio.

Table 5 Analysis of concordance of liver stiffness measurements obtained using two-dimensional shear wave elastography vs METAVIR stages

	METAVIR stage					Concordance rate
	F0-F1	F2	F3	F4	Total
F0-F1, ≤ 9.7kPa	26	13	2	0	41	63.4%
F2, > 9.7 to ≤ 13.2 kPa	3	7	4	2	16	43.8%
F3, > 13.2 to ≤ 16.3 kPa	1	9	8	1	19	42.1%
F4, > 16.3 kPa	2	6	10	20	38	52.6%
Cumulative concordance						53.5%