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Accuracy of transient elastography in assessing fibrosis at diagnosis in individuals with autoimmune liver disease

  • Author Footnotes
    # Yue Shen and Hong Chen contribute equally to this work.
    Yue Shen
    Footnotes
    # Yue Shen and Hong Chen contribute equally to this work.
    Affiliations
    Dept. of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai 200032, China

    Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai 200032, China
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  • Author Footnotes
    # Yue Shen and Hong Chen contribute equally to this work.
    Hong Chen
    Footnotes
    # Yue Shen and Hong Chen contribute equally to this work.
    Affiliations
    Dept. of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai 200032, China

    Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai 200032, China
    Search for articles by this author
  • Sheng-Di Wu
    Correspondence
    Corresponding authors. Address: Dept. of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Zhongshan Hospital (Xiamen), Fudan University, 180 Fenglin Road, Shanghai 200032, China; Tel.: +86(21)6404-1990, fax: +86(21)6404-1990.
    Affiliations
    Dept. of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai 200032, China

    Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai 200032, China
    Search for articles by this author
  • Wei Jiang
    Correspondence
    Corresponding authors. Address: Dept. of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Zhongshan Hospital (Xiamen), Fudan University, 180 Fenglin Road, Shanghai 200032, China; Tel.: +86(21)6404-1990, fax: +86(21)6404-1990.
    Affiliations
    Dept. of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai 200032, China

    Dept. of Gastroenterology & Hepatology, Zhongshan Hospital (Xiamen), Fudan University Xiamen 361015, China

    Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai 200032, China
    Search for articles by this author
  • Author Footnotes
    # Yue Shen and Hong Chen contribute equally to this work.
Published:August 18, 2022DOI:https://doi.org/10.1016/j.jhep.2022.08.013

      Linked Article

      To the Editor:
      Recently, this Journal published a large, multi-center, longitudinal cohort study by Corpechot et al., which validated the prognostic value of baseline liver stiffness (LS) by vibration-controlled transient elastography (VCTE) in individuals with primary biliary cholangitis (PBC). LS also improved the prognostic performance of established biochemical markers of treatment response.
      • Corpechot C
      • Carrat F
      • Gaouar F
      • Chau F
      • Hirschfield G
      • Gulamhusein A
      • et al.
      Liver stiffness measurement by vibration-controlled transient elastography improves outcome prediction in primary biliary cholangitis.
      The study has directly supported the inclusion of baseline LS in prognostic tools developed for PBC. Interestingly, results from our meta-analysis regarding the diagnostic performance of LS for autoimmune liver disease (AILD) also provided indirect explanation for its prognostic role, considering baseline histological fibrosis is an independent predictor of disease progression and clinical outcomes in individuals with AILD.
      • Murillo Perez CF
      • Hirschfield GM
      • Corpechot C
      • Floreani A
      • Mayo MJ
      • van der Meer A
      • et al.
      Fibrosis stage is an independent predictor of outcome in primary biliary cholangitis despite biochemical treatment response.
      ,
      • Hartl J
      • Ehlken H
      • Sebode M
      • Peiseler M
      • Krech T
      • Zenouzi R
      • et al.
      Usefulness of biochemical remission and transient elastography in monitoring disease course in autoimmune hepatitis.
      Of the 754 articles identified through the systematic search, a total of 44 studies published from 2006 to 2021 including 3,488 participants with AILD were finally enrolled. Taking liver biopsy as standard, we explored the diagnostic ability of 11 non-invasive markers of fibrosis in subgroups of individuals with autoimmune hepatitis (AIH) (n = 1,253), PBC (n = 1,734) and primary sclerosing cholangitis (PSC) (n = 501). Moreover, considering genetic and environmental factors can contribute to the development and progression of AILD, both Asian and European populations were covered in our study
      • Gulamhusein AF
      • Hirschfield GM
      Primary biliary cholangitis: pathogenesis and therapeutic opportunities.
      (Table S1). Our results indicated that LS by transient elastography had a remarkable diagnostic performance compared to other non-invasive biomarkers of liver fibrosis (Table S2). Moreover, LS performed better for the diagnosis of PBC than AIH. LS had an excellent diagnostic accuracy in detecting liver fibrosis with summary area under ROC curves (AUROCs) of 0.94, 0.92 and 0.93 for significant fibrosis (SF), advanced fibrosis (AF) and cirrhosis, respectively, in individuals with PBC. While LS had a moderate to excellent accuracy with summary AUROCs of 0.83, 0.91 and 0.90 in individuals with AIH (Fig. 1). Liver histology predicts fibrosis progression and cirrhosis development in individuals with AILD; thus, the higher consistency between LS and liver histopathology in individuals with PBC can provide further support for Corpechot et al.’s findings.
      Figure thumbnail gr1
      Fig. 1Summary ROC plot of liver stiffness by transient elastography in detecting significant fibrosis, advanced fibrosis and cirrhosis in individuals with AIH and PBC.
      The summarry sensitivity and specificity were calculated for each enrolled study and the summary ROC plot was produced in Review Manager (Revman 5.3 version).
      AF, advanced fibrosis; AIH, autoimmune hepatitis; LS, liver stiffness; PBC, primary biliary cholangitis; SF, significant fibrosis.
      In conclusion, we agree with Corpechot et al. that VCTE is a reliable predictor of clinical outcomes in individuals with PBC and that LS should be incorporated into the prognostic markers to determine the state of disease progression. Still, the differential diagnostic efficiency of LS in our study provides a hint that the prognostic value of LS in individuals with PSC, AIH or PBC-AIH overlap syndrome warrants further investigation. More importantly, studies regarding dynamic changes of LS during the follow-up of individuals with AILD are needed to further validate its prognostic impact.

      Financial support

      The authors received no financial support to produce this manuscript.

      Conflict of interest

      All authors declare that no conflict of interest is associated with participation and contribution to this work.
      Please refer to the accompanying ICMJE disclosure forms for further details.

      Authors’ contributions

      YS: data analysis and manuscript drafting. HC: data analysis and manuscript drafting. SDW: manuscript revision. WJ: study concept and manuscript revision.

      Supplementary data

      The following are the supplementary data to this article:

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        Liver stiffness measurement by vibration-controlled transient elastography improves outcome prediction in primary biliary cholangitis.
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