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Steatosis affects the performance of liver stiffness measurement for fibrosis assessment in patients with genotype 1 chronic hepatitis C

      Background & Aims

      In Chronic Hepatitis C (CHC), the influence of steatosis on liver stiffness measurement (LSM) is still debated. We assessed the impact of steatosis and its ultrasonographical sign – bright liver echo pattern (BLEP) – on LSM values and on transient elastography (TE) accuracy for the diagnosis of liver fibrosis, in a cohort of consecutive patients with Genotype 1 (G1) CHC.

      Methods

      Patients (n = 618) were assessed by clinical, ultrasonographic and histological (Scheuer score) features. TE was performed using the M probe.

      Results

      Male gender (p = 0.04), steatosis as continuous variable (p <0.001), severity of necroinflammation (p = 0.02) and stage of fibrosis (p <0.001) were associated with LSM by multivariate linear regression analysis. Among patients within the same fibrosis stages (F0–F2 and F3–F4; F0–F3 and F4), mean LSM values, expressed in kPa, were significantly higher in subjects with moderate-severe steatosis (⩾20% at liver biopsy) compared with those without, as well as in patients with BLEP on US compared with their counterpart. In subjects without severe fibrosis (F0–F2) and without cirrhosis (F0–F3), a higher rate of false-positive LSM results was observed in patients with steatosis ⩾20% compared with those without (F0–F2: 35.3% vs. 17.9%; F0–F3: 38.9% vs. 16.6%), and in patients with BLEP on US (F0–F2: 28.0% vs. 18.3%; F0–F3: 29.7% vs. 17.8%) compared with their counterpart.

      Conclusions

      In patients with G1 CHC, the presence of moderate-severe steatosis, detected by histology or by US, should always be taken into account in order to avoid overestimations of liver fibrosis assessed by TE.

      Abbreviations:

      AUROC (area under roc curve), BLEP (bright liver echo pattern), CHC (chronic hepatitis C), G1 (genotype 1), LR (likelihood ratio), LSM (liver stiffness measurement), TE (transient elastography), US (ultrasonography)

      Keywords

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