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Background & Aims Liver stiffness ( LS) value using transient elastography is a reliable, non-invasive tool for assessing liver fibrosis. LS-based prediction model, LSPS (=LS value × spleen diameter/platelet count) is well correlated with the risk of developing portal hypertension-related cirrhotic complications. Here, we assessed the prognostic performance of LSPS in predicting the development of hepatocellular carcinoma ( HCC) in patients with chronic hepatitis B ( CHB). Methods Between 2006 and 2010, we recruited 227 patients with CHB who underwent liver biopsy and LS measurement. The major end point was HCC development. Results Median age was 45 years and 156 (68.7%) patients were male. During the follow-up period (median, 61 months), HCC developed in 18 patients. Patient with HCC had a higher LS value, a longer spleen, and lower platelet counts (all P < 0.05) than those without HCC. On multivariate analysis, LSPS was identified as an independent predictor of HCC development [hazard ratio ( HR) 1.541, P < 0.001] after adjusting for age, serum albumin level and histological fibrosis stage. When patients were stratified into three groups (LSPS <1.1, 1.1-2.5 and >2.5), the 5-year cumulative risk of HCC increased significantly in association with a higher LSPS value (4.0, 13.8, 36.2%, respectively, P < 0.001). Patients with LSPS 1.1-2.5 ( HR 2.0, P = 0.032) and LSPS > 2.5 (HR 8.7, P = 0.002) had a higher risk of developing HCC than those with LSPS < 1.1. Conclusions LS value-spleen diameter to platelet ratio score is useful for assessing the risk of HCC development and careful surveillance strategies are required in an individual manner. [ABSTRACT FROM AUTHOR]

Background & Aims Liver stiffness ( LS) measurement using transient elastography and the FibroTest ( FT) are alternatives to liver biopsy ( LB) in assessing liver fibrosis. We investigated the prognostic role of the combined use of LS and FT in predicting liver-related events ( LREs) in patients with chronic hepatitis B ( CHB). Methods Consecutive patients with CHB who underwent LB, along with LS and FT on the same day were recruited. LRE was defined as hepatic decompensation, hepatocellular carcinoma ( HCC) or liver-related death. Results A total of 151 patients (86 male) were analyzed. During follow-up (median 59.9 months), overall 18 (11.9%) patients experienced LREs. The areas under receiver-operating characteristic curves of LS, FT, LS + FT and LS × FT in predicting LRE were 0.701, 0.668, 0.702 and 0.741 respectively. After adjusting for age and histological fibrosis staging, significant variables in univariate analysis (both P < 0.05), LS + FT and LS × FT were independent predictors of LREs with hazard ratios ( HRs) of 1.080 and 1.126 (all P < 0.05) respectively. When subjects were divided into three groups according to quartile stratification (low quartile, interquartile and high quartile) using LS + FT and LS × FT, cumulative LRE development rate significantly increased with a corresponding increase in value among three groups respectively (log-rank test, all P < 0.05). Conclusion The combined use of LS and FT significantly predicted forthcoming LRE development, but with only a slight additional benefit compared to LS or FT alone. [ABSTRACT FROM AUTHOR]