Underestimation of Liver Fibrosis Using Vibration-Controlled Transient Elastography on Cirrhosis. Are There Predictors?

Abstract

Background: Detection of liver fibrosis helps to make therapeutic decisions and with screening in patients with chronic liver diseases. Transient elastography (TE) is an accurate, noninvasive technique to assess liver fibrosis but sometimes it is underestimated. Here we aimed for associations and predictors related to the underestimation of liver fibrosis using TE.

Methods: We conducted a prospective cohort study involving adult patients with cirrhosis who underwent TE and had their clinical data analyzed. Patients were categorized into two groups based on liver stiffness measurement (LSM), either ≥10 kPa or <10 kPa, which was considered an underestimation of liver fibrosis. Multivariate analysis and logistic regression models were used to identify predictors and their associated strengths. One-way analysis of variance and multiple Tukey comparisons were used to determine the association with cirrhosis etiology.

Results: Of 248 patients included, 29.4% had underestimation of liver fibrosis, and when compared with the ≥10 kPa group, significant differences were found in cirrhosis etiology (p = 0.03) and alanine aminotransferase (ALT; p = 0.03), among others. The main cirrhosis etiologies included nonalcoholic fatty liver disease (30.65%), alcohol-related liver disease (27.02%), and hepatitis C virus (26.21%), with significant liver stiffness mean difference between them. There was a significant association between LSM <10 kPa and cirrhosis etiology (odds ratio 1.147; 95% CI 1.012-1.301) and ALT (odds ratio 1.019; 95% CI 1.005-1.033).

Conclusions: Underestimation of liver fibrosis using TE in cirrhosis likely occurs with hepatitis C virus, nonalcoholic fatty liver disease, and low ALT levels.