Clinical value of FibroScan in diagnosis of moderate-to-severe liver fibrosis in patients with chronic hepatitis B

ObjectiveTo investigate the clinical value of transient elastography (FibroScan) in the diagnosis of moderate-to-severe liver fibrosis in patients with chronic hepatitis B (CHB). MethodsA total of 245 patients with pathologically confirmed CHB by liver biopsy who underwent FibroScan and serological examinations in Shanghai Public Health Clinical Center from 2012 to 2015 were enrolled and divided into mild liver fibrosis group (S1-S2, 189 patients) and moderate-to-severe liver fibrosis group (S3-S3, 56 patients). The FibroScan value, aspartate aminotransferase-to-platelet ratio index (APRI) ［(aspartate aminotransferase/upper limit of normal×100)/platelet count］, and levels of hyaluronic acid (HA), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were measured. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between groups. A logistic regression analysis was used for risk prediction. The receiver operating characteristic (ROC) curve, 95% confidence interval (95%CI), and area under the ROC curve (AUC) were used to investigate the accuracy of FibroScan in the diagnosis of moderate-to-severe liver fibrosis. The FibroScan value corresponding to the maximum of the sum of sensitivity and specificity was the optimal cut-off value for liver fibrosis. ResultsThere were significant differences in age, the levels of ALT, AST, and HA, APRI, and FibroScan value between the two groups (all P＜0.05). The univariate analysis showed that the severity of liver fibrosis was associated with the measured FibroScan value, HA level, and APRI (OR=2.56, 1.03, and 31.73, all P＜0.001), and the multivariate analysis showed that only FibroScan value was associated with moderate-to-severe liver fibrosis (OR=2.25, P＜0.001). The AUCs of FibroScan, HA, and APRI in the diagnosis of moderate-to-severe liver fibrosis were 0.985 (95%CI:0.969-1.000), 0.842 (95%CI:0.774-0.911), and 0.868 (95%CI:0.813-0.922), respectively, at cut-off values of 11.65, 104.4, and 0.69, respectively. In the diagnosis of moderate-to-severe liver fibrosis, FibroScan, HA, and APRI had sensitivities of 98.9%, 96.3%, and 96.3%, specificities of 85.7%, 55.4%, and 48.2%, positive predictive values of 95.9%, 87.9%, and 86.3%, and negative predictive values of 96.0%, 81.6%, and 79.4%. ConclusionFibroScan has a high clinical value in the diagnosis of moderate-to-severe liver fibrosis and plays an important role in early identification of liver fibrosis and accurate evaluation of fibrosis degree.